Are there still sex differences in the functioning of the elderly?

Introduction : Sex is one of the demographic characteristics that better differentiates the independence of the elderly, despite this distinction not being consensual. Objective: To know the differences in functioning associated with sex in elderly people aged ≥ 65 years according to the International Classification of Functioning, Disability, and Health (ICF) . Methods: This was an analytical and cross-sectional observational study with a sample of 451 subjects. The instruments were a sociodemographic questionnaire identical to a ICF checklist and the Biopsychosocial Assessment Method. The student t, Mann-Whitney, chi-square, and Spearman correlation tests were used considering p < 0.05. Results: The average age was between 79.5 ± 7.5 years with a female prevalence (62.1%). Of the 43 variables studied, sex differences were found in 17 (39.5%). In the personal factors, women showed greater vulnerability in conjugality (p ≤ 0.001), cohabitation (p = 0.037), and economic income (p = 0.002). Nonetheless, they showed healthier behaviors in all health-related habits. As for environmental factors and body functions, greater fragility was once again observed in women: the need for assistive devices (p ≤ 0.001) and urinary incontinence (p = 0.021). In activities/participation, differences were found in mobility, where women experienced more restrictions, whereas men were more dependent on washing/drying clothes in domestic life (p = 0.022). Conclusion: Women are more unprotected in social and economic areas, while men showed more vulnerability in habits related to health. These differences are linked to demographic issues related to longevity, cultural differences


Introduction
Along with age, sex is one of the demographic characteristics with the greatest weight in differentiating the functioning of the elderly, albeit this is not unanimous in the literature. Despite most studies indicating an advantage for men, [1][2][3][4] the differences tend to fade at older ages. 5,6 According to the World Health Organization Research on the differences between men and women has gone beyond epidemiological knowledge.
Its importance and conclusions should focus predominantly on the possibility of reducing social and cultural differences, namely at the level of social institutions, identity, and power relations, the results of which will be projected onto health and functioning. 8,9 Dessa forma, apesar de o sexo ser um fator pessoal não modificável, a determinação da sua influência na funcionalidade/incapacidade na população idosa deve continuar a ser investigada, pois poderá ser um contributo para intervenções mais sistematizadas ao nível dos serviços, sistemas e políticas.
Thus, although sex is a non-modifiable personal factor, determining its influence on functioning/ disability in the elderly population must continue to be investigated, as it may contribute to more systematized interventions at the service, system, and policy levels.
Given this scenario, this study sought to determine the differences in functioning associated with sex according to the ICF in elderly people aged ≥65 years.

Methods
This is an observational, analytical, cross-sectional study whose sample includes elderly people aged

Results
The sample consisted of 451 individuals, with a mean age of 79.48 ± 7.46 years and a female prevalence (62.1%). The mean age of women was relatively higher than the men (p = 0.037; 80.5 ± 7.38 to 78.5 ± 7.52 years).
Of the 43 variables studied, sex differences were In the environmental factors, women showed more need for assistive devices (p ≤ 0.001), and the distribution of "who helps with activities" also revealed differences (p ≤ 0.001): women mainly receive help from their children, while men receive it from their spouses.  Table 3.
The differences found in body functions occurred in urinary incontinence (p = 0.021), where women showed a higher frequency in this dysfunction; nonetheless, sex was not associated with the presence of this condition.
The results concerning this component are listed in Table 4.     Of the 20 variables of activities/participation,  Table 5.

Discussion
The most significant differences between men and women occurred in the personal factors component. This result corroborates the literature, which emphasizes the importance of studying social, economic, and cultural asymmetries as determinants of health status and functioning in populations because, when modifiable, they can exert an equal or greater power than those related to biological and physiological differences. 8 The "widowed/single/separated" conjugality was higher among women due to their greater longevity, a situation that tends to progress with advancing age mainly because of widowhood.
No differences were found in schooling, with a meager rate in the total sample (over 90% of the individuals had no schooling or schooling of 4 years or less), although the 2011 Census reported that the illiteracy rate for women is roughly twice that of men (6.8 against 3.5%).
Although The percentage of elderly living alone at home was higher among women, which must be related to the greater longevity of women, which, precipitating their widowhood, makes them also live more isolated.
Nevertheless, the percentage of individuals spending over 8 h alone was higher than individuals living alone In the same way that overall low schooling was observed, a poor professional differentiation was also found (77.4% of individuals with unskilled occupations).
Education is undoubtedly inseparable from qualification and professional differentiation, the manifestation of which is observed in the older generations and, above Fisioter Mov. 2022;35:e35103 10 than tobacco consumption (28.8% vs. 15.5%), which is not unrelated to the fact that Portugal has important wine production as it is rooted in its consumption in the main meals.
Over half of the individuals reported requiring help in performing daily activities, especially more complex ones, although with no differences in sex. As we will see later in the analysis of the different activities, the differences in functioning between sexes were basically related to mobility/locomotion. This may be why no sex differences were found in the need and type of help to carry out activities.
Although the number of falls was not significantly different between men and women, the sequelae observed were higher in women. The literature usually refers that women fall more often, 18 although this differentiation tends to disappear at more advanced ages, 6 as previously reported herein. The justification for the higher number of sequelae in women may be their greater frailty and prevalence of sarcopenia and osteoporosis, 18,19 but also, as observed in our study, it may be linked to difficulties in mobility and marital status. Indeed, impairment in gait dynamics (e.g., changes in direction and speed) leads to more severe sequelae after falls. 5 Nonetheless, some studies suggest that the presence of a partner or cohabitation may be a protective factor for this risk 5,19 based on the support and supervision they can provide.
About two-thirds of the individuals (65.6%) reported needing an assistive device, and this use was higher among women. In the remaining activities/participation analyzed, differences were only found in the activity "washing/ drying clothes," whose results were more unfavorable for men. Usually, men have greater difficulties in domestic life activities, which is more due to cultural and educational reasons than neuromotor disabilities. The "washing/drying clothes" task may be an example of this difference, since it remains socially associated with women, even in younger generations. cohabitation is also a decisive factor for the caregiver's option, 21,22 presupposing a common experience whose physical and affective proximity is established in the care and that for widowers is reflected in the children, while for married people, in the spouses. In recent years, the maintenance of informal support has raised several questions and debates that are based, among others, on its sustainability. The changes in recent years in the demographic, social, family, and economic spheres show increasing unavailability for the so-called "family care potential," which compromises the much desired "aging at home." 24 However, the sustainability of institutional resources backed by the welfare state has progressively and increasingly shown its inability to provide support.
Finding the balance between institutional and informal support is a major challenge of the coming years of social policies on aging.
The frequency of urinary incontinence proved to be different between men and women, although this was regardless of the sex.

Conclusion
Women are more unprotected in the social and economic dimensions, while men manifest more vulnerable health habits. These differences are linked to demographic issues of longevity and cultural and socialization differences. Differences in activities/ participation tend to be blurred between the sexes.