{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T05:58:47Z","timestamp":1793426327693,"version":"4.5.0"},"reference-count":47,"publisher":"FapUNIFESP (SciELO)","issue":"2","license":[{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T00:00:00Z","timestamp":1559347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dement. neuropsychol."],"abstract":"<jats:p>ABSTRACT. Limited formal education is still common in ageing populations. Although limited formal education seems to be independently and negatively associated with cognition, functional abilities and frailty in ageing, no studies have examined whether the gradient of limited formal education has an impact on health in later life.  Objective: to examine the relationship of limited formal education with cognitive status, functional abilities, and frailty status.  Methods: a cross-sectional study was conducted involving 540 older adults stratified into groups: no formal education, 12-24 months of education, and 25-48 months of education. Cognitive screening (MMSE), functional abilities (Lawton Index), and frailty (CHS criteria) were measured. Regression analyses were performed.  Results: 27% had no formal education, 21% had 12-24 months of formal education, and 55% had 25-48 months of formal education. Limited formal education has a clear gradient of negative impact: No formal education was associated with scoring below MMSE cut-off scores (OR = 7.9), being totally\/partially dependent for IADLs (OR = 2.5) and frail (OR = 2.0). Having 12-24 months of education was associated with scoring below MMSE cut-off scores (OR = 5.2) and with being frail (OR = 2.0). The No formal education group was 10.1 times more likely to have worse cognitive scores, worse functional abilities and frailty\/pre-frailty status concomitantly (CCoFF), while older adults who had 12-24 months of education had a 4.6 times greater chance of having CCoFF.  Conclusion: limited education had a gradient association with cognitive performance, functional disability and frailty. These findings clearly emphasize the importance of prevention through education from childhood to older age.<\/jats:p>","DOI":"10.1590\/1980-57642018dn13-020011","type":"journal-article","created":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T19:28:27Z","timestamp":1561577307000},"page":"216-224","source":"Crossref","is-referenced-by-count":102,"title":["Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults"],"prefix":"10.1590","volume":"13","author":[{"given":"Allan Gustavo","family":"Brigola","sequence":"first","affiliation":[{"name":"Federal University of S\u00e3o Carlos,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago da Silva","family":"Alexandre","sequence":"additional","affiliation":[{"name":"Federal University of S\u00e3o Carlos,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keika","family":"Inouye","sequence":"additional","affiliation":[{"name":"Federal University of S\u00e3o Carlos,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica Sanches","family":"Yassuda","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia Cristina Iost","family":"Pavarini","sequence":"additional","affiliation":[{"name":"Federal University of S\u00e3o Carlos,  Brazil; Federal University of S\u00e3o Carlos,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eneida","family":"Mioshi","sequence":"additional","affiliation":[{"name":"University of East Anglia,  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2019,6]]},"reference":[{"issue":"5","key":"ref1","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1590\/S0104-11692011000500022","article-title":"Socio-demographic and health characteristics of elderly individuals: Support for health services","volume":"19","author":"Pilger C","year":"2011","journal-title":"Rev Lat Am Enfermagem [Internet]"},{"issue":"3","key":"ref2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/17538963.2015.1102473","article-title":"Living arrangements of the elderly in China: evidence from the CHARLS national baseline","volume":"8","author":"Lei X","year":"2011","journal-title":"China Econ J"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"406","DOI":"10.4103\/0253-7176.108238","article-title":"Illiteracy and Cognition in Older Adults","volume":"34","author":"Tripathi R","year":"2012","journal-title":"Indian J Psychol Med"},{"key":"ref4","first-page":"1","article-title":"Education indicator in focus","year":"2013","journal-title":"OECD Indicator"},{"issue":"6","key":"ref5","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s00038-010-0169-9","article-title":"Socioeconomic status, social support and self-rated health among lone mothers in South Korea","volume":"55","author":"Kim D-S","year":"2010","journal-title":"Int J Public Health"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"341","DOI":"10.4306\/pi.2015.12.3.341","article-title":"Literacy Independent Cognitive Assessment: Assessing Mild Cognitive Impairment in Older Adults with Low Literacy Skills","volume":"12","author":"Shim Y","year":"2015","journal-title":"Psychiatry Investig"},{"issue":"1","key":"ref7","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1186\/1471-2458-14-643","article-title":"Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis","volume":"14","author":"Beydoun M","year":"2014","journal-title":"BMC Public Health [Internet]"},{"issue":"9836","key":"ref8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/S0140-6736(12)60399-7","article-title":"Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10\/66 Dementia Research Group population-based cohort study","volume":"380","author":"Prince M","year":"2012","journal-title":"Lancet"},{"issue":"2","key":"ref9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001179","article-title":"Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study","volume":"9","author":"Ferri CP","year":"2012","journal-title":"PLoS Med"},{"issue":"5","key":"ref10","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1590\/0102-311X00102013","article-title":"Functional performance and social relations among the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based epidemiological study","volume":"30","author":"Torres JL","year":"2014","journal-title":"Cad Saude Publica [Internet]"},{"issue":"8","key":"ref11","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1093\/gerona\/60.8.1022","article-title":"Is there a biomedical explanation for socioeconomic differences in incident mobility limitation?","volume":"60","author":"Koster A","year":"2005","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"3","key":"ref12","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.dhjo.2016.01.011","article-title":"Trajectories of limitations in activities of daily living among older adults in Mexico, 2001-2012","volume":"9","author":"D\u00edaz-Venegas C","year":"2016","journal-title":"Disabil Health J"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1590\/1809-9823.2016.15044","article-title":"Advanced Activities of Daily Living (AADLs) and cognitive performance in community-dwelling elderly persons: Data from the FIBRA Study - UNICAMP [Internet]","volume":"19","author":"Sposito G","year":"2016","journal-title":"Rev Bras Geriatr Gerontol"},{"issue":"2","key":"ref14","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1590\/1980-57642015DN92000005","article-title":"Relationship between cognition and frailty in elderly A systematic review","volume":"9","author":"Brigola AG","year":"2015","journal-title":"Dement Neuropsychol"},{"issue":"4","key":"ref15","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1590\/2237-6089-2016-0085","article-title":"High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas","volume":"39","author":"Brigola AG","year":"2017","journal-title":"Trends Psychiatry Psychother"},{"issue":"6","key":"ref16","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jamda.2013.03.022","article-title":"Frailty consensus: a call to action","volume":"14","author":"Morley JE","year":"2013","journal-title":"J Am Med Dir Assoc"},{"issue":"2","key":"ref17","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1590\/1980-57642018dn12-020010","article-title":"Frailty and cognitive performance of elderly in the context of social vulnerability","volume":"12","author":"Jesus ITM","year":"2018","journal-title":"Dement Neuropsychol [Internet]"},{"issue":"7","key":"ref18","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.annepidem.2014.05.002","article-title":"Explaining the association between educational level and frailty in older adults: results from a 13-year longitudinal study in the Netherlands","volume":"24","author":"Hoogendijk EO","year":"2014","journal-title":"Ann Epidemiol"},{"key":"ref19","series-title":"PLoS One [Internet]","volume-title":"Socioeconomic inequalities in frailty and frailty components among community-dwelling older citizens","volume":"12","author":"Franse CB","year":"2017"},{"key":"ref20","series-title":"What makes urban schools different?","first-page":"1","volume":"05","year":"2013"},{"key":"ref21","series-title":"Diretoria de Pesquisas, Coordena\u00e7\u00e3o de Trabalho e Rendimento, Pesquisa Nacional por Amostra de Domic\u00edlios","year":"2013"},{"issue":"12","key":"ref22","doi-asserted-by":"crossref","first-page":"2079","DOI":"10.1017\/S1041610216001538","article-title":"Factors associated with attitudes toward the elderly in a sample of elderly caregivers","volume":"28","author":"Luchesi BM","year":"2016","journal-title":"Int Psychogeriatr"},{"key":"ref23","article-title":"Elderly caregivers living in urban, rural and high social vulnerability contexts","volume":"51","author":"Pavarini SCI","year":"2017","journal-title":"Rev Esc Enferm USP"},{"issue":"3B","key":"ref24","first-page":"777","article-title":"Suggestions for utilization of the mini-mental state examination in Brazil","volume":"61","author":"Brucki SMD","year":"2003","journal-title":"Arq Neuropsiquiatr"},{"issue":"3","key":"ref25","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of older people: self-maintaining and instrumental activities of daily living","volume":"9","author":"Lawton MP","year":"1969","journal-title":"Gerontologist"},{"issue":"3","key":"ref26","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: evidence for a phenotype","volume":"56","author":"Fried LP","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"3","key":"ref27","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES-D Scale: a self report depression scale for research in the general population","volume":"1","author":"Radloff LS","year":"1977","journal-title":"Appl Psychol Meas"},{"issue":"4","key":"ref28","first-page":"598","article-title":"[Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly]","volume":"41","author":"Batistoni SST","year":"2007","journal-title":"Rev Saude Publica"},{"issue":"3","key":"ref29","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1590\/S0066-782X2011000300013","article-title":"\u00cdndice de massa corporal no adulto e no idoso","volume":"96","author":"Zortea K","year":"2011","journal-title":"Arq Bras Cardiol"},{"issue":"2","key":"ref30","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/WNN.0b013e318259594b","article-title":"Normative Data for Healthy Middle-Aged and Elderly Performance on the Addenbrooke Cognitive Examination-Revised","volume":"25","author":"Amaral-Carvalho V","year":"2012","journal-title":"Cogn Behav Neurol"},{"issue":"2","key":"ref31","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4103\/0028-3886.32779","article-title":"Mini mental state examination and the Addenbrooke's cognitive examination: effect of education and norms for a multicultural population","volume":"55","author":"Mathuranath PS","year":"2007","journal-title":"Neurol India"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"689456","DOI":"10.1155\/2014\/689456","article-title":"The Influence of Education on Chinese Version of Montreal Cognitive Assessment in Detecting Amnesic Mild Cognitive Impairment among Older People in a Beijing Rural Community","volume":"2014","author":"Zhou S","year":"2014","journal-title":"Sci World J"},{"issue":"1","key":"ref33","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1590\/S0103-21002011000100004","article-title":"Caracter\u00edsticas sociodemogr\u00e1ficas, capacidade funcional e morbidades entre idosos com e sem decl\u00ednio cognitivo","volume":"24","author":"Ferreira PC dos S","year":"2011","journal-title":"ACTA Paul Enferm"},{"issue":"3","key":"ref34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/002214650704800302","article-title":"Socioeconomic position and health: the differential effects of education versus income on the onset versus progression of health problems","volume":"48","author":"Herd P","year":"2007","journal-title":"J Health Soc Behav"},{"issue":"6","key":"ref35","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1017\/S1041610208007631","article-title":"Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment","volume":"20","author":"Pereira FS","year":"2008","journal-title":"Int psychogeriatrics"},{"issue":"1","key":"ref36","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/ggi.12441","article-title":"Engagement in paid work as a protective predictor of basic activities of daily living disability in Japanese urban and rural community-dwelling elderly residents: An 8-year prospective study","volume":"16","author":"Fujiwara Y","year":"2016","journal-title":"Geriatr Gerontol Int"},{"issue":"2","key":"ref37","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1080\/21551197.2014.908596","article-title":"Assessment of nutritional risk in community-dwelling older adults (65 to 75 years) in Kolkata, India","volume":"33","author":"Majumder M","year":"2014","journal-title":"J Nutr Gerontol Geriatr"},{"issue":"6","key":"ref38","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1007\/s00198-015-3054-9","article-title":"Education, marital status, and risk of hip fractures in older men and women: the CHANCES project","volume":"26","author":"Benetou V","year":"2015","journal-title":"Osteoporos Int"},{"issue":"9","key":"ref39","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1161\/STROKEAHA.114.005252","article-title":"Combined effects of socioeconomic position, smoking, and hypertension on risk of ischemic and hemorrhagic stroke","volume":"45","author":"Nordahl H","year":"2014","journal-title":"Stroke"},{"issue":"5","key":"ref40","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/ggi.12793","article-title":"Association between comprehensive health literacy and frailty level in community-dwelling older adults: A cross-sectional study in Japan","volume":"17","author":"Shirooka H","year":"2017","journal-title":"Geriatr Gerontol Int"},{"issue":"12","key":"ref41","doi-asserted-by":"crossref","first-page":"6630","DOI":"10.3390\/ijerph10126630","article-title":"Indicators for Healthy Ageing - A Debate","volume":"10","author":"Fuchs J","year":"2013","journal-title":"Int J Environ Res Public Health [Internet]"},{"issue":"17","key":"ref42","doi-asserted-by":"crossref","first-page":"E889","DOI":"10.1503\/cmaj.109-4289","article-title":"Rural life hardly healthier","volume":"184","author":"Monette M","year":"2012","journal-title":"CMAJ"},{"issue":"3","key":"ref43","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.cger.2017.03.001","article-title":"Cognitive Frailty: Mechanisms, Tools to Measure, Prevention and Controversy","volume":"33","author":"Fougere B","year":"2017","journal-title":"Clin Geriatr Med"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.arr.2014.12.004","article-title":"Cognitive frailty, a novel target for the prevention of elderly dependency","volume":"20","author":"Ruan Q","year":"2015","journal-title":"Ageing Res Rev"},{"issue":"2","key":"ref45","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1590\/S1980-57642014DN82000013","article-title":"Factors associated with quality of life in elderly undertaking literacy programs","volume":"8","author":"Santos BR","year":"2014","journal-title":"Dement Neuropsychol"},{"issue":"6","key":"ref46","doi-asserted-by":"crossref","first-page":"S327","DOI":"10.1093\/geronb\/58.6.S327","article-title":"Cumulative Advantage\/Disadvantage and the Life Course: Cross-Fertilizing Age and Social Science Theory","volume":"58","author":"Dannefer D","year":"2003","journal-title":"Journals Gerontol Ser B [Internet]"},{"issue":"3","key":"ref47","doi-asserted-by":"crossref","first-page":"265","DOI":"10.21149\/spm.v57i3.7566","article-title":"Effectiveness of intervention programs in primary care for the robust elderly","volume":"57","author":"Costa-de Lima K","year":"2015","journal-title":"Salud Publica Mex"}],"container-title":["Dementia &amp; Neuropsychologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/dn\/v13n2\/1980-5764-dn-13-02-0216.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T19:41:58Z","timestamp":1581104518000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1980-57642019000200216&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["S1980-57642019000200216"],"URL":"https:\/\/doi.org\/10.1590\/1980-57642018dn13-020011","relation":{},"ISSN":["1980-5764","1980-5764"],"issn-type":[{"value":"1980-5764","type":"electronic"},{"value":"1980-5764","type":"print"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}