Este documento resume un estudio epidemiológico de curso de vida llamado IMIAS. El estudio examinó la discapacidad de movilidad en personas mayores de 65-74 años en 5 países. Hallazgos clave incluyen: 1) Exposiciones tempranas como la pobreza y la malnutrición se asociaron con un menor rendimiento físico en la vejez; 2) Dar a luz a una edad temprana se asoció con un menor rendimiento físico y discapacidad de movilidad; 3) Los lazos y actividades

1. INVESTIGACION EN
EPIDEMIOLOGIA DE CURSO DE
VIDA:
ESTUDIO IMIAS
JOSÉ FERNANDO GÓMEZ MONTES
P R O G R A M A D E I N V E S T I G A C IO N E S E N G E R O N T O L O G ÍA Y G E R I A T R Í A
UNIVERSIDAD DE CALDAS
MANIZALES

3. CONTENIDOS:
• Teorías de la distribución de la salud.
• Epidemiología de curso de vida.
• Estudio IMIAS: discapacidad de
movilidad.
• Hipótesis sobre la transición de la
discapacidad.
• Conclusiones

4. TEORIAS INTEGRADORAS DE LAS
CAUSAS DE ENFERMEDAD
(TEORIAS DE LA DISTRIBUCION
DE LA ENFERMEDAD)
“¿Por qué algunos individuos tienen la hipertensión?” es diferente
a “¿Por qué algunas poblaciones tienen mucha hipertensión,
mientras que en otras es rara?”
1. PRODUCCION SOCIAL DE LA ENFERMEDAD /
ECONOMIA POLITICA DE LA SALUD. Determinantes
sociales de la salud.
2. TEORIA ECOSOCIAL Y PERSPECTIVAS DINAMICAS
RELACIONADAS MULTI-NIVEL. Disparidades
(desigualdades) de la salud.
3. TEORIA PSICO-SOCIAL. Estresores múltiples. De la
“etiología específica” a la “susceptibilidad generalizada”.
Moiso A. Determinantes de salud. Fundamentos de Salud Pública

5. Early determinants of the ageing trajectory. Best Practice & Research Clinical Endocrinology & Metabolism 26 (2012) 613–626

6. EPIDEMIOLOGIA DEL CURSO
DE VIDA
ES EL ESTUDIO DE LOS EFECTOS A LARGO PLAZO EN LA
SALUD O EL RIESGO DE ENFERMEDAD POR EXPOSICIONES
FISICAS O SOCIALES DURANTE LA GESTACION, LA INFANCIA,
LA ADOLESCENCIA, LA ADULTEZ TEMPRANA Y EN LA VEJEZ.
Su objetivo es dilucidar los procesos biológicos, conductuales y
psicosociales que operan a través del curso de vida individual, o a
través de generaciones, que influencian el desarrollo del riesgo de
enfermar.
Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J. J Epidemiol Community Health 2003 57:778-783

8. MODELO SOBRE LOS EFECTOS DE LA
NUTRICIÓN EN LA SALUD DE LOS
ANCIANOS.

9. LOS MODELOS
Acumulación de riesgos (Hipótesis de la acumulación)
Cadena de riesgos
Periodos críticos (critical periods)
Movilidad social (social mobility)

10. Independiente
Acumulación de
riesgos
Acumulación con
agrupación de riesgos
Factores mediadores
Efecto aditivo
Cadenas de riesgo
Factores modificadores
Efecto disparador

11. MODELO DE PERIODOS
CRÍTICOS
Un periodo crítico en el desarrollo es una ventana de
tiempo durante la que ocurren cambios de forma rápida en
la organización de los sistemas biológicos
Durante estos periodos, la organización puede ser
modificada de forma favorable o desfavorable.
« Biological programming », « Latency model »
El modelo postula que los cambios durante los periodos
críticos pueden causar enfermedades más tarde en la vida.
Variación « critical period with later modifiers effects »=
interacciones entre los factores iniciales y posteriores = el
efecto de una exposición al inicio de la vida varía según los
niveles de exposición posteriores

12. MODELO DE PERIODOS
CRÍTICOS
Exposición
A
Factor modificador
B
Tiempo
Periodo
crítico
Inducción
Latencia
detección
Inicio de la
enfermedad
Periodo crítico= el sistema es plástico y sensible al medio ambiente
E
N
F
E
R
M
E
D
A
D

13. MODELO DE PERIODO CRITICO
(MODELO LATENTE)
EXPOSICION A
INFECCIONES
Hepatitis B
Tuberculosis
Poliomielitis
H. Pilory
Fiebre reumática
Enfermedad de Chagas
Malaria
EXPOSICIONES
MEDIOAMBIENTALES
Plomo
Deficiencia de yodo
Polución dentro de la
casa
Malnutrición proteico energética
Trauma al nacer

14. MOVILIDAD
SOCIAL
Las exposiciones en la infancia pueden
ser revertidas en la edad adulta

17. CONDICIONES TEMPRANAS EN LA INFANCIA Y SALUD
EN ANCIANOS: PAISES DE BAJO Y MEDIO INGRESO
CONCLUSIONES
• Exposiciones en útero/infancia y enfermedad cardiovascular y
DM.
• Pobre nutrición y mortalidad, dificultades de cognición y DM.
• Enfermedades específicas (Fiebre Reumática/malaria) y
enfermedad cardiovascular y mortalidad.
• Pobre salud y discapacidad/limitación funcional y
enfermedades crónicas.
• SES pobre y mortalidad, discapacidad/limitación funcional y
cognición.
• Sobrevivencia de los padres y discapacidad/limitación
funcional y cognición.
Journal of Developmental Origins of Health and Disease (2013), 4(1), 10–29.

18. DIFERENCIAS DE GENERO EN MOVILIDAD: QUÉ SE
PUEDE APRENDER PARA MEJORAR LA MOVILIDAD
AL ENVEJECER?

19. Natal, Brazil
Manizales, Colombia
Kingston, Ontario
St Hyacinthe , Quebec

21. FOLLOW-UP (AGE 65-74)
5th
year
Baseline
Mobility; life
course,
Gender,
Neighborhood and
social networks,
biological
pathways,
Chronic conditions
3rd year
Mobility;
Violence,
chronic
conditions
Mobility;
Violence,
chronic
conditions

22. PERDIDA DE MOVILIDAD
Source: IMIAS, 2012

23. PERDIDA DE MOVILIDAD: ACTIVIDADES DE
VIDA DIARIA
50
44.86
45
40
38.24
38.1
MEN
35
WOMEN
32.5
30
25
23.44
24.39
22.84
25.48
22.16
20
14.2
15
10
5
0
Natal P=0.002
(M=192/W=210)
Manizales P=0.053
(M=162/W=160)
Tirana P=0.387
(M=69 /W=122)
St Hyacinthe P=0.054
(M=162/W=194)
Kingston P=0.854
(M=82/W=157)
Vafaei A, Zunzunegui MV, Guralnik J, Curcio CL, Gomez F, Guerra R, Alvarado BE. Evaluation of the late life disability instrument
(LLDI) in low income older populations. (Manuscript in revision)

24. PERDIDA DE MOVILIDAD
(OBJETIVA)
Figure 1. Low physical performance (SPPB < 8)
30
26.17
24.29
25
MEN
WOMEN
20
15.63
15.1
15
11.76
10
8.25
7.32
7.64
6.17
4.94
5
0
Natal P=0.021
Manizales P=0.006 Tirana P=0.022
(M=192/W=210)
(M=162/W=160)
Source: IMIAS, 2012
St Hyacinthe /W=107) (M=131/W=147) P=0.928 (M=82/W=157)
(M=68 P=0.231
Kingston

25. VÍAS EXPLICATIVAS DE
LA DISCAPACIDAD DE LA
MOVILIDAD AL
ENVEJECER
1. Vías biológicas.
2. Perspectiva de curso de vida.
3. Medioambiental: perspectiva ecosocial.
4. Clínica: condiciones crónicas específicas.

26. LATINOAMERICA
DE CADA 100 ANCIANOS:
• 77 al menos 1 enfermedad
• 44 al menos 2 enfermedades
• 19 al menos 1 discapacidad
• 17 al menos 1 enfermedad y 1 discapacidad
• 12 al menos 1 discapacidad y 2 enfermedades
•
21 ni discapacidad ni enfermedad
Rose AMC. et al. Public Health 2008; 8:124

27. PREVALENCIA DE LIMITACIONES DE
MOVILIDAD, AJUSTADA POR EDAD
50
Men
45
Women
40
35
30
25
20
15
10
5
0
Buenos Aires
Bridgetown
Sao Paulo
Santiago
Lifting and carrying 10 pounds, walking several
blocks, climbing a flight of stairs, kneeling /
stooping / crouching, and getting up from a chair
Havana
Mexico
Montevideo
OR=2.34
Heterogeneity: p= 0.04

29. CONDICIONES SOCIALES Y LIMITACION
DE MOVILIDAD EN ANCIANAS EN LAC
OR
95% CI
Pobreza en la infancia
Salud pobre
1.28
1.12- 1.46
1.17
1.04- 1.31
Hambre antes 15 años
1.47
1.23 – 1.76
Falta de escolaridad
1.39
1.17- 1.64
Ingreso insuficiente
1.54
1.35- 1.74
Comorbilidad
3.16
2.80- 3.52
Deterioro cognoscitivo
3.90
2.26-6.74
Alvarado B, Guerra R, Zunzunegui MV. J of Aging and Health 2007

31. SYMPOSIUM
THE SEX GAP OF MOBILITY DISABILITY:
THE EMBODIMENT OF GENDER
CHAIR: JACK GURALNIK
CO-CHAIR: MARIA VICTORIA ZUNZUNEGUI
DISCUSSANT: K MARKIDES
THE INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS) IS A LONGITUDINAL STUDY OF AGING
CONDUCTED IN CANADA (KINGSTON, ST HYACINTHE), ALBANIA (TIRANA), BRAZIL (NATAL) AND
COLOMBIA (MANIZALES) TO EXPLAIN THE SEX GAP IN MOBILITY USING A LIFE-COURSE AND GENDER
PERSPECTIVE. IT IS FINANCED BY THE CANADIAN INSTITUTES FOR HEALTH RESEARCH.
THE HYPOTHESIS IS THAT THE GAP IN MOBILITY DISABILITY BETWEEN MEN AND WOMEN DIMINISHES
AS GENDER EQUALITY INCREASES IN THE MAINSTREAM SOCIETIES OF DIFFERENT COUNTRIES.

33. FACTORES TEMPRANOS
Pobre nutrición
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restricción espacio de vida
Depresión
Medio ambiente
Espacio de vida
FACTORES EN LA VIDA MEDIA
SES adulto
Embarazos a temprana edad
Restricción espacio de vida
Depresión
Ejercicio físico limitado
Dietas no saludables
CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metabólico
Diabetes M. Enf. cardiovascular
Limitación funcional
Discapacidad

34. CHILDHOOD SOCIAL AND ECONOMIC ADVERSITIES
AND PHYSICAL PERFORMANCE IN PEOPLE AGED 65-74
LIVING IN CANADA, BRAZIL, COLOMBIA AND ALBANIA.
Ricardo Guerra, Dimitri Taurino Guedes, Fernando Gomez, Mai Thanh Tu,
Georges Koné Karna, Alban Ylli, Jack Guralnik
In IMIAS, we examined associations of physical performance Short
Physical Performance Battery, SPPB) with social (parental death,
drug/alcohol abuse, witness violence and experience physical abuse) and
economic (low socio-economic status, hunger, parental unemployment and
father’s manual occupation) adversities during the first 15 years of life.
Cumulative index of social and economic adversity varied from 0 to 4
according to the number of reported adverse events. Poor function
(SPPB<8) was present in 7.8% of the Kingston sample (Ontario), 6.7% in
St Hyacinthe (Quebec), 20.8% in Tirana (Albania), 18.4% in Manizales
(Colombia) and 19.9% in Natal (Brazil). Logistic regression analyses
revealed poor function in old age was associated with high exposure to
childhood social adversities (OR=3.49, CI: 2.0;6.0) and high exposure to
economic adversity (OR=1.80, CI: 1.0;3.2), adjusting for research site, age
and sex.

35. FACTORES TEMPRANOS
Pobre nutrición
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restricción espacio de vida
Depresión
Medio ambiente
Espacio de vida
FACTORES EN LA VIDA MEDIA
SES adulto
Embarazos a temprana edad
Restricción espacio de vida
Depresión
Ejercicio físico limitado
Dietas no saludables
CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metabólico
Diabetes M. Enf. cardiovascular
Limitación funcional
Discapacidad

36. EARLY AGE AT FIRST BIRTH IS ASSOCIATED
WITH LOW PHYSICAL PERFORMANCE IN OLD
AGE.
Catherine Pirkle, Beatriz Alvarado, Ricardo Guerra, Carmen-Lucia Curcio,
Alban Ylli, Jack Guralnik.
Early age at first birth (EAFB) is a risk factor for obstetrical complication,
because physiological development is often incomplete, and it may have longterm implications for physical performance and mobility.
We examine the relationship between early age at first birth, defined as ≤18
years of age, poor physical performance (Short Physical Performance Battery≤8)
and self-reported mobility disability in community representative samples of
women between 65 and 74 years of age from Canada, Albania, Columbia, and
Brazil (N=919). EAFB was significantly associated with poor physical
performance and mobility disability. Adjusting for the study site, age, education
and lifetime births, women who gave birth at a young age had 1.78(95% CI 1.192.65) the odds of poor SPPB and 2.31 (95%CI 1.52-3.53) the odds of mobility
disability. These relationships were stronger in Canada and weaker in Albania,
Colombia and Brazil, which may be attributable to decreased survival in
women who would have gone on to have mobility problems had they survived.

37. FACTORES TEMPRANOS
Pobre nutrición
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restricción espacio de vida
Depresión
Medio ambiente
Espacio de vida
FACTORES EN LA VIDA MEDIA
SES adulto
Embarazos a temprana edad
Restricción espacio de vida
Depresión
Ejercicio físico limitado
Dietas no saludables
CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metabólico
Diabetes M. Enf. cardiovascular
Limitación funcional
Discapacidad

38. SOCIAL TIES, SOCIAL ACTIVITIES AND INCOME INFLUENCE LIFE
SPACE ASSESSMENTS (LSA) IN OLD AGE:
BEATRIZ ALVARADO, CARMEN-LUCIA CURCIO, RICARDO GUERRA, ALBAN YLLI, ELLEN FREEMAN, JACK
GURALNIK.
IN IMIAS, WE EXAMINED THE ASSOCIATIONS OF LSA SCORE WITH INCOME AND SOCIAL TIES AND
ACTIVITIES ACROSS RESEARCH SITES BY FITTING SEX SPECIFIC REGRESSIONS CONTROLLING FOR
AGE, SELF-RATED HEALTH, DEPRESSION SCORE AND PHYSICAL PERFORMANCE.
RESULTS: BOTH IN WOMEN AND MEN, A POSITIVE GRADIENT IN LSA ACCORDING TO INCOME WAS
OBSERVED; BEING MARRIED WAS NOT ASSOCIATED WITH LSA. AMONG WOMEN, HAVING FRIENDS
AND CHILDREN AND BEING INVOLVED IN SOCIAL ACTIVITIES WERE SIGNIFICANTLY ASSOCIATED WITH
HIGHER LSA. AMONG MEN, NO SOCIAL TIES OR ACTIVITIES WERE ASSOCIATED WITH LSA. SITE-SPECIFIC
ANALYSES SHOWED DIFFERENCES IN THE NATURE OF SOCIAL TIES RELEVANT FOR LSA: STRONGEST
ASSOCIATIONS WERE FOR FRIENDS IN TIRANA, BROTHERS AND SISTERS IN MANIZALES, SOCIAL
ACTIVITIES IN NATAL AND CHILDREN IN ST HYACINTHE. SOCIAL TIES WERE NOT ASSOCIATED WITH LSA
IN KINGSTON. WHILE POVERTY IMPACTS LIFE SPACE IN ALL SITES, SOCIAL RELATIONSHIPS MAY
INCREASE LIFE SPACE ONLY IN WOMEN AND MORE OUTSIDE CANADA THAN IN CANADA.

39. FACTORES TEMPRANOS
Pobre nutrición
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restricción espacio de vida
Depresión
Medio ambiente
Espacio de vida
FACTORES EN LA VIDA MEDIA
SES adulto
Embarazos a temprana edad
Restricción espacio de vida
Depresión
Ejercicio físico limitado
Dietas no saludables
CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metabólico
Diabetes M. Enf. cardiovascular
Limitación funcional
Discapacidad

40. SELF REPORTED MOBILITY AND DEPRESSION IN OLDER MEN
AND WOMEN OF FIVE COUNTRIES: THE IMIAS STUDY
ALBAN YLLI, NANDINI DESHPANDE, SUSAN PHILLIPS, FERNANDO GOMEZ, RICARDO GUERRA, JACK
GURALNIK.
IN IMIAS, WE EXAMINED WHETHER THE ASSOCIATION BETWEEN MOBILITY AND DEPRESSION
REMAINED BEYOND POOR PHYSICAL PERFORMANCE.
METHOD: DIFFICULTY WALKING 400 METERS OR CLIMBING STAIRS WAS USED FOR MOBILITY
DISABILITY(MD); CES-D FOR DEPRESSION, THE SHORT PHYSICAL PERFORMANCE BATTERY (SPPB) FOR
PHYSICAL PERFORMANCE.
RESULTS: TWENTY SEVEN PERCENT HAD CESD SCORES OF 16 OR OVER, RANGING FROM 39% IN
TIRANA TO 10% IN KINGSTON; 38.3% HAD MD, RANGING FROM 55.3% IN TIRANA TO 20.2% IN
KINGSTON. ADJUSTING FOR SPPB, AGE, EDUCATION, INCOME AND STUDY SITE, MD WAS HIGHER
AMONG PEOPLE WITH DEPRESSION (58.6% VS. 30.8%, P<0.001); THIS ASSOCIATION WAS STRONG (OR
2.2; 1.7;2.9) AND SIMILAR FOR MEN (OR=1.9; 1.3;2.8) AND WOMEN (OR=2.3; 1.7;3.1). SITE-SPECIFIC
MOBILITY DISABILITY OR FOR DEPRESSION WERE 3.8 (1.7;8.5) IN KINGSTON;2.8 (1.5;5.3) IN NATAL; 2.3
(1.4;3.7)IN TIRANA; 2.3(1.3;4.1) IN MANIZALES AND 1.4 (0.8;2.5) IN ST HYACINTHE.
DISCUSSION: DEPRESSED PEOPLE ARE LIKELY TO HAVE MOBILITY DISABILITY REGARDLESS OF THEIR
CONTEXT, SEX AND PHYSICAL PERFORMANCE.

41. FACTORES TEMPRANOS
Pobre nutrición
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restricción espacio de vida
Depresión
Medio ambiente
Espacio de vida
FACTORES EN LA VIDA MEDIA
SES adulto
Embarazos a temprana edad
Restricción espacio de vida
Depresión
Ejercicio físico limitado
Dietas no saludables
CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metabólico
Diabetes M. Enf. cardiovascular
Limitación funcional
Discapacidad

42. EXCESS IN PREVALENCE OF METABOLIC SYNDROME IN WOMEN
FROM MIDDLE INCOME COUNTRIES
OBJECTIVE: TO SHOW THAT THAT AN EXCESS IN PREVALENCE OF METABOLIC SYNDROME IS OBSERVED IN WOMEN
FROM ALBANIA, BRAZIL AND COLOMBIA COMPARED WITH CANADIAN WOMEN WHILE NO VARIATIONS IN THIS
PREVALENCE ARE OBSERVED IN MEN FROM THOSE COUNTRIES. WE INVESTIGATED THE PREVALENCE OF METABOLIC
SYNDROME (METS) IN DIFFERENT SOCIETIES (CANADA, BRAZIL, COLOMBIA AND ALBANIA) AND ACROSS
GENDERS, AMONG REPRESENTATIVE COMMUNITY SAMPLES OF 1728 SUBJECTS, 65 - 74 YEARS-OLD, USING DATA FROM
THE INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS).
METHODS: METS WAS DEFINED BY THE NCEP-ATPIII CRITERIA, WITH THE PRESENCE OF AT LEAST THREE OF THESE
CONDITIONS: ABDOMINAL OBESITY, HYPERTENSION, HIGH TRIGLYCERIDES, HYPERGLYCAEMIA AND HIGH LDL.
PREVALENCE OF METS IN MEN AND WOMEN AND SEX ODDS RATIO FOR METS WERE ESTIMATED AT EACH SITE.
RESULTS: METS PREVALENCE VARIED IN WOMEN ACROSS SOCIETIES BUT NOT IN MEN: FROM 23.7% IN
KINGSTON, ONTARIO, TO 63.1% IN TIRANA, ALBANIA AMONG WOMEN AND FROM 22.1% IN SAINT
HYACINTHE, QUEBEC TO 33.5% IN TIRANA AMONG MEN. TAKING KINGSTON MEN AS REFERENCE, NO SIGNIFICANT
DIFFERENCES IN THE ODDS OF METS WERE OBSERVED AMONG MEN OF DIFFERENT SITES. TAKING KINGSTON WOMEN
AS REFERENCE, THE METS ODDS RATIO FOR WOMEN AT TIRANA WAS 5.62 (95%CI 3.51; 9.01); THE CORRESPONDING
OR AT NATAL WAS 3.59 (95% CI 1.97;6.55), AT MANIZALES 1.51 (0.85;2.68) AND AT SAINT HYACINTHE 1.21 (95%CI
0.74;1.98).
IN CANADA NO GENDER DIFFERENCE IN PREVALENCE OF METS WAS OBSERVED.
DISCUSSION: THESE RESULTS PROVIDE EVIDENCE FOR WIDE VARIATIONS OF THE PREVALENCE OF
METS AMONG WOMEN ACROSS SOCIETIES WHILE VARIATIONS IN MEN ARE SMALL.

43. THE RELATIONSHIP BETWEEN VISION AND LIFE
SPACE BY SEX AND GLOBAL SITE
ELLEN E. FREEMAN, NANDINI DESHPANDE, CARMEN-LUCIA CURCIO, HANEN
HARRABI, RICARDO GUERRA, JACK GURALNIK.
PREVIOUS RESEARCH DONE IN THE UNITED STATES HAS FOUND A RELATIONSHIP
BETWEEN WORSE VISION AND MORE RESTRICTED LIFE SPACE.
WE DETERMINED WHETHER THE RELATIONSHIP BETWEEN VISION AND LIFE SPACE
VARIED BY SEX AND ACROSS FIVE DIVERSE GLOBAL SITES.
HABITUAL VISUAL ACUITY WAS MEASURED BINOCULARLY USING THE TUMBLING E
CHART AT 2 METERS. MOBILITY WAS MEASURED USING THE COMPOSITE SCORE OF
THE LIFE SPACE ASSESSMENT WHICH RANGED FROM 0-120. MULTIPLE LINEAR
REGRESSION WAS USED TO ADJUST FOR AGE, EDUCATION, GENERAL HEALTH
STATUS, NUMBER OF COMORBIDITIES, AND INCOME WHILE STRATIFYING BY SEX AND
SITE. IN POOLED ANALYSES, WORSE VISUAL ACUITY WAS ASSOCIATED WITH MORE
RESTRICTED LIFE SPACE (P<0.001). STRATIFYING BY SEX, VISION WAS ONLY
ASSOCIATED WITH LIFE SPACE IN WOMEN (P<0.001). SITE DIFFERENCES WERE FOUND.
THE LOSS OF VISION APPEARS TO BE MORE DETRIMENTAL TO MOBILITY IN WOMEN
AND IN SOME ENVIRONMENTS THAN IN OTHERS. REASONS FOR THIS SHOULD BE
FURTHER EXPLORED.

44. FACTORES TEMPRANOS
Pobre nutrición
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restricción espacio de vida
Depresión
Medio ambiente
Espacio de vida
FACTORES EN LA VIDA MEDIA
SES adulto
Embarazos a temprana edad
Restricción espacio de vida
Depresión
Ejercicio físico limitado
Dietas no saludables
CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metabólico
Diabetes M. Enf. cardiovascular
Limitación funcional
Discapacidad

45. THE MOBILITY GAP BETWEEN OLDER MEN AND WOMEN FROM
DIVERSE POPULATIONS: THE EMBODIMENT OF GENDER
MARIA-VICTORIA ZUNZUNEGUI, SUSAN PHILLIPS, GEORGES KARNA, MAI THANH TU, GENTIANA QIRJAKO, RICARDO
GUERRA, FERNANDO GOMEZ.
WE EXAMINE SEX GAPS IN MOBILITY, ACTIVITIES OF DAILY LIVING DISABILITY AND PHYSICAL PERFORMANCE (SHORT
PHYSICAL PERFORMANCE BATTERY, SPPB) ACROSS DIVERSE POPULATIONS AND FORMULATE HYPOTHESES TO EXPLAIN
DIFFERENCES BETWEEN MEN AND WOMEN RELATING TO THE EMBODIMENT OF GENDER-RELATED LIFE COURSE
CONDITIONS.
AGE-ADJUSTED PREVALENCE RATES OF LOW SPPB, SELF-REPORTED MOBILITY DISABILITY AND ADL DISABILITY AT EACH
SITE WERE SIGNIFICANTLY HIGHER IN WOMEN THAN IN MEN EXCEPT FOR KINGSTON (ONTARIO). FEW DIFFERENCES IN
PHYSICAL FUNCTION OR MOBILITY WERE OBSERVED BETWEEN MEN AT DIFFERENT RESEARCH SITES. SITE DIFFERENCES
BETWEEN MEN AND WOMEN ARE THEREFORE DRIVEN BY DIFFERENCES BETWEEN WOMEN ACROSS SITES. AMONG
WOMEN, AND TAKING KINGSTON AS THE REFERENCE SITE, AGE-ADJUSTED ODDS RATIOS FOR POOR SPPB, MOBILITY
AND ADL DISABILITY WERE HIGHER FOR ST HYACINTHE, MANIZALES, NATAL AND TIRANA.
THE MOBILITY-SEX GAP IS SMALL OR DISAPPEARS IN THE MORE EGALITARIAN SITES (ONTARIO) WHILE IT REMAINS
LARGE IN SEX-SEGREGATED SOCIETIES (BRAZIL, COLOMBIA, ALBANIA).

46. CONCLUSIONES
1.
La perspectiva de curso de vida se enfoca en comprender como
experiencias tempranas en la vida pueden formar la salud a travès de la
via entera y potencialmente a través de generaciones.
2.
Se debe dirigir la mirada hacia el papel del contexto, incluyento el
contexto social y fìsico junto con factores biològicos. Todos ellos a travès
del tiempo.
3.
La perspectiva de curso de vida permitiría entender los determinantes y
las disparidades en salud.