In clustered survival data, unobservable cluster effects may exert powerful influences on the outcomes and thus induce correlation among subjects within the same cluster. The ordinary partial likelihood approach does not account for this dependence. Frailty models, as an extension to Cox regression, incorporate multiplicative random effects, called frailties, into the hazard model and have become a very popular way to account for the dependence within clusters. We particularly study the two-level nested lognormal frailty model and propose an estimation approach based on the complete data likelihood with frailty terms integrated out. We adopt B-splines to model the baseline hazards and adaptive Gauss-Hermite quadrature to approximate the integrals efficiently. Furthermore, in finding the maximum likelihood estimators, instead of the Newton-Raphson iterative algorithm, Gauss-Seidel and BFGS methods are used to improve the stability and efficiency of the estimation procedure. We also study competing risks models with missing cause of failure in the context of Cox proportional hazards models. For competing risks data, there exists more than one cause of failure and each observed failure is exclusively linked to one cause. Conceptually, the causes are interpreted as competing risks before the failure is observed. Competing risks models are constructed based on the proportional hazards model specified for each cause of failure respectively, which can be estimated using partial likelihood approach. However, the ordinary partial likelihood is not applicable when the cause of failure could be missing for some reason. We propose a weighted partial likelihood approach based on complete-case data, where weights are computed as the inverse of selection probability and the selection probability is estimated by a logistic regression model. The asymptotic properties of the regression coefficient estimators are investigated by applying counting process and martingale theory. We further develop a double robust approach based on the full data to improve the efficiency as well as the robustness.

L’objectif de la thèse était d’effectuer la validation psychométrique de la grille de fragilité SEGA modifiée (Short Emergency Geriatric Assessment) chez des sujets âgés vivant à domicile. Nous avons mené une étude longitudinale prospective dans deux régions françaises, incluant des sujets de 65 ans ou plus, vivant à domicile. Nous avons étudié l’acceptabilité et la faisabilité de l’instrument, sa validité de structure, sa fiabilité, sa validité discriminante, ainsi que sa capacité prédictive. Au total, 167 patients ont été inclus. Ils étaient âgés de 77 ± 7 ans, avec une majorité de femmes (70,7%). La faisabilité et acceptabilité du volet A de la grille SEGAm étaient excellentes : il n’y avait aucun refus de participation ni arrêt de passation, aucune donnée manquante ni aucun effet plancher ou plafond. Le temps moyen de passation était de 5,0 ± 3,5 min. Il s’agissait d’un outil unidimensionnel présentant une bonne cohérence interne (coefficient alpha de Cronbach à 0,68) et une bonne reproductibilité (coefficient de corrélation intraclasse à 0,88 pour le test-retest entre J0 et J7). La grille SEGAm avait également une très bonne capacité discriminante concernant l’état thymique, nutritionnel, l’équilibre, le niveau d’indépendance, et les comorbidités. La grille SEGAm avait une bonne capacité prédictive vis-à-vis de la perte d’indépendance ; le niveau de fragilité à l’inclusion était significativement associé à la perte d’indépendance à 12 mois (OR = 4,52 ; IC 95 % [1,40-14,68] ; p=0,01). La grille SEGAm nous apparaît comme un outil de choix dans la stratégie de dépistage de la fragilité en communauté, pour permettre la mise en place précoce d’interventions ciblées. / We aimed to validate the modified version of the Short Emergency Geriatric Assessment (SEGAm) frailty instrument among elderly community-dwelling subjects. A longitudinal, prospective study was conducted in two French regions and subjects aged 65 years or more and living at home were included. For psychometric validation, feasibility, acceptability, internal structure validity, reliability, discriminant validity and predictive validity of the SEGAm instrument were studied. Overall, 167 patients were included. Average age was 77±7 years, the majority were women (70.7%). Feasibility and acceptability of the sheet A of the SEGAm instrument were excellent: no refusal to participate, no drop-out during administration, no missing items, no ceiling or floor effects were noted. Administration time was short (5.0±3.5 min). By factor analysis, the instrument proved to be unidimensional. It showed good internal consistency (Cronbach’s alpha coefficient: 0.68) and good test-retest (intra-class correlation: 0.88). Discriminant validity showed a significant difference for mood and depression risk, nutritional status, fall risk, dependency, and comorbidities. Frailty status at baseline was significantly associated with loss of autonomy at 12 months of follow-up (OR=4.52, 95% CI=1.40-14.68; p=0.01). The SEGAm appears to be an easy-to-use instrument that is particularly suitable for use in the community to identify frail elderly people who could benefit from early targeted interventions.

The osteological paradox addresses how well interpretations of past population health generated from human skeletal remains reflect the health of the living population from which they were drawn. Selective mortality and hidden heterogeneity in frailty are particularly relevant when assessing childhood health in the past, as subadults are the most vulnerable group in a population and are therefore less likely to fully represent the health of those who survived. The ability of subadults to represent the health of those who survived is tested here by directly comparing interpretations of childhood stress based on non-survivors (subadults aged 6-20,14 females and 9 males) to those based on retrospective analyses of survivors (adults aged 21-46, 26 females and 27 males). Non-survivors and survivors were directly matched by birth year, using the Coimbra Identified Skeletal Collection; therefore interpretations of childhood stress reflect a shared childhood. Long bone and vertebral canal growth, linear enamel hypoplasia, cribra orbitalia, porotic hyperostosis, scurvy indicators and periosteal bone reactions were assessed for both groups. Overall, long bone growth generates the same interpretation of health for both non-survivors and survivors, and both groups exhibit the same range of stress (mild to severe), but the pattern of stress experienced in childhood differs between the two groups. Female survivors reveal different timing of stress episodes and a higher degree of stress than female non-survivors. Male survivors exhibit less stress than male non-survivors. These different patterns suggest that interpretations based solely on non-survivors would under-represent the stress experienced by female survivors and over-represent the stress experienced by male survivors, further demonstrating the importance of addressing issues of selective mortality. In addition, these different patterns suggest that hidden heterogeneity of frailty may be sex specific where males are more vulnerable to stress and females more able to develop resistance to stress and survive.

The osteological paradox addresses how well interpretations of past population health generated from human skeletal remains reflect the health of the living population from which they were drawn. Selective mortality and hidden heterogeneity in frailty are particularly relevant when assessing childhood health in the past, as subadults are the most vulnerable group in a population and are therefore less likely to fully represent the health of those who survived. The ability of subadults to represent the health of those who survived is tested here by directly comparing interpretations of childhood stress based on non-survivors (subadults aged 6-20,14 females and 9 males) to those based on retrospective analyses of survivors (adults aged 21-46, 26 females and 27 males). Non-survivors and survivors were directly matched by birth year, using the Coimbra Identified Skeletal Collection; therefore interpretations of childhood stress reflect a shared childhood. Long bone and vertebral canal growth, linear enamel hypoplasia, cribra orbitalia, porotic hyperostosis, scurvy indicators and periosteal bone reactions were assessed for both groups. Overall, long bone growth generates the same interpretation of health for both non-survivors and survivors, and both groups exhibit the same range of stress (mild to severe), but the pattern of stress experienced in childhood differs between the two groups. Female survivors reveal different timing of stress episodes and a higher degree of stress than female non-survivors. Male survivors exhibit less stress than male non-survivors. These different patterns suggest that interpretations based solely on non-survivors would under-represent the stress experienced by female survivors and over-represent the stress experienced by male survivors, further demonstrating the importance of addressing issues of selective mortality. In addition, these different patterns suggest that hidden heterogeneity of frailty may be sex specific where males are more vulnerable to stress and females more able to develop resistance to stress and survive.

Recurrent data are widely encountered in many applications. This thesis work focuses on how the recurrent hospital admissions relate to the air pollutants. In particular, we consider the data for two major cities in Saskatchewan. The study period ranges from January 1, 2005 to December 30, 2011 and involves 20,284 patients aged 40 years and older. The hospital admission data is from the Canadian Institute for Health Information (CIHI). The air pollutants data is from the National Air Pollution Surveillance Program (NAPS) from Environment Canada. The data set has been approved by the Biomedical Research Ethics Board, University of Saskatchewan. The gaseous pollutants included in this study are carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), as well as particulate matter PM2:5 (tiny particles in the air that are 2:5 microns in width). In the data analysis, we applied three different existing models to all respiratory diseases and asthma, respectively. The three models are the Poisson process model (also called Andersen-Gill model), the Poisson process model with the number of previous events as a covariate and the Poisson process model with shared gamma distributed frailties (random effects). For all respiratory diseases, the Poisson process model with random effects provides the best t in comparison to the other two models. The model output suggests that the increased risk of hospital readmission is significantly associated with increased CO and O3. For asthma, the Poisson process model provides the best t in comparison to the other two models. We found that only CO and O3 have significant effects on recurrent hospital admissions due to asthma. We concluded this thesis with the discussion on the current and potential future work.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Ilha Grande situa-se na chamada Costa Verde do Estado do Rio de Janeiro, tem a totalidade de seu território protegido legalmente e vem sendo alvo de especuladores e investidores cujos interesses são, principalmente, explorar o potencial natural do bioma de Mata Atlântica. Observa-se um processo de transformação local em diversos aspectos que englobam o meio ambiente e a sociedade, como a degradação ambiental e o deslocamento da comunidade tradicional. O Poder Público manteve-se distante ou mesmo ausente por décadas, o que possibilitou a instalação de problemas ambientais e a configuração de conflitos na esfera do planejamento e gestão. Considerando-se a relevância socioambiental deste território insular e, em especial, com a implantação do Centro de Estudos Ambientais e Desenvolvimento Sustentável (CEADS) da Universidade do Estado do Rio de Janeiro (UERJ) na Enseada de Dois Rios, o presente estudo tem como objetivo identificar a dinâmica ambiental estabelecida na ilha. Os aspectos relacionados ao uso e ocupação do solo e à fragilidade ambiental são fundamentais para a análise integrada, para a compreensão da configuração atual do território e para a formulação de diretrizes de desenvolvimento adequadas à complexa realidade da Ilha Grande, cuja atividade econômica está pautada no turismo. Identificou-se como as principais causas dos problemas ambientais e dos conflitos de gestão: o caótico ordenamento do território, a falta de infraestrutura de serviços, a dificuldade de mobilização social, a falta de integração entre as políticas públicas e competências administrativas, a precariedade da fiscalização, a impunidade aos que não cumpriram a normatização em vigor e, a não observância da fragilidade ambiental do geossistema Ilha Grande. / The Ilha Grande is situated on the so called Costa Verde of Rio de Janeiro State. The totality of its territory is legally protected, and it has recently become the target of speculators and investors whose interests are mainly the exploration of the rainforests biome natural potential. There is a process of local transformation in many aspects relating to the environment and the society, for instance, the environmental degradation and the displacement of traditional communities. The State has kept its distance, being absent for decades, a fact that has contributed to the advent of environmental problems and of conflicts on the planning and management spheres. Considering the socioenvironmental relevance of this island territory and specially considering the installation of the Center for Environmental Studies and Sustainable Development (CEADS) of Rio De Janeiro State University (UERJ) in the Dois Rios cove, this study has the goal of identifying the environmental dynamics of the Ilha Grande. The aspects relating to the use and occupation of the soil and to the environmental frailty are crucial for developing an integrated analysis, comprehending the current configuration of the territory and formulating development guidelines which are adequate to the complex reality of the Ilha Grande, whose economic activity is based on tourism. The study has identified the main causes behind the environmental problems and the management conflicts: the chaotic planning of the territory, the lack of a services infrastructure, the difficulty in social mobilizations, the lack of integration between public policies and administrative jurisdictions, the precarious supervision, the impunity to those who fail to comply with current laws and the disregard for the environmental frailty of the Ilha Grande geosystem.

La précarité est associée à une morbi-mortalité accrue. Ce phénomène est moins étudié auprès des sujets âgés qu’il ne l’est auprès des adultes jeunes. Pourtant, le vieillissement démographique et la précarisation de la population font que la France connait chaque jour davantage de personnes présentant cette double caractéristique d’être âgées et précaires. L’objectif de cette thèse est de mieux caractériser les liens existant entre la précarité – définie en son sens initial psycho-socio-économique – et deux problématiques du vieillissement que sont la cognition et la fragilité. Nous avons tout d’abord étudié le vieillissement cognitif au cours de 25 années de suivi de la cohorte Paquid. Cette étude a rapporté un déclin cognitif et un risque de démence majorés pour les personnes âgées précaires. Par la suite, nous avons complété cette première étude en y intégrant une mesure de précarité géographique et en appliquant une méthodologie statistique prenant en compte le risque compétitif de décès. Les résultats ont confirmé l’association entre la précarité psycho-socio-économique et le risque de démence, mais n’ont montré aucun effet de la précarité géographique. Mis en perspective avec les différents travaux scientifiques, ces études ont servi de base à une revue de la littérature sur l’impact de la précarité sur le vieillissement cognitif soumise pour publication. Enfin, un dernier travail a examiné les relations entre la précarité psycho-socio-économique, la fragilité et le décès. Sur la base de 14 années de suivi de la cohorte des 3 Cités, les résultats ont montré qu’aussi bien la précarité que la fragilité augmentent le risque de mortalité mais de manière indépendante. Ces travaux permettent de mieux comprendre ce qu’implique vieillir en situation de précarité et soulignent en particulier l’influence des déterminants psycho-sociaux de la précarité sur la santé, aussi bien en termes de survie que de santé cognitive. / Precariousness is associated with higher morbi-mortality. This phenomenon is less studied among the elderly than it is among adults. Yet, the aging of the population, as well as the increasing precariousness of the population, implies that a growing number of people in France are experiencing both conditions of aging and precariousness. The objective of this thesis is to better characterize the links between precariousness - defined with a psychosocioeconomic approach - and two issues related to aging: cognition and frailty. We first studied cognitive aging over 25 years within the Paquid cohort study. This study reported an accelerated cognitive decline and an increased risk of dementia for the precarious elderly. Then, this study was completed by including a measure of geographical deprivation and by applying a statistical methodology taking into account the competing risk of death. The results confirmed the association between psychosocioeconomic precariousness and the risk of dementia, but did not show any effects of geographical deprivation. In link with previous scientific literature, these two works have been the basis of a literature review on the impact of precariousness on cognitive aging submitted for publication. A final study examined the relationship between psychosocioeconomic precariousness, frailty and death. Based on the 14 years of follow-up of the 3 Cities cohort study, the results showed that both precariousness and frailty increased the risk of death but independently. This thesis contributes to a better understanding of the impact of precariousness on aging and in particular, it emphasizes the influence of the psychosocial determinants of precariousness on health in terms of survival and better cognition.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A Ilha Grande situa-se na chamada Costa Verde do Estado do Rio de Janeiro, tem a totalidade de seu território protegido legalmente e vem sendo alvo de especuladores e investidores cujos interesses são, principalmente, explorar o potencial natural do bioma de Mata Atlântica. Observa-se um processo de transformação local em diversos aspectos que englobam o meio ambiente e a sociedade, como a degradação ambiental e o deslocamento da comunidade tradicional. O Poder Público manteve-se distante ou mesmo ausente por décadas, o que possibilitou a instalação de problemas ambientais e a configuração de conflitos na esfera do planejamento e gestão. Considerando-se a relevância socioambiental deste território insular e, em especial, com a implantação do Centro de Estudos Ambientais e Desenvolvimento Sustentável (CEADS) da Universidade do Estado do Rio de Janeiro (UERJ) na Enseada de Dois Rios, o presente estudo tem como objetivo identificar a dinâmica ambiental estabelecida na ilha. Os aspectos relacionados ao uso e ocupação do solo e à fragilidade ambiental são fundamentais para a análise integrada, para a compreensão da configuração atual do território e para a formulação de diretrizes de desenvolvimento adequadas à complexa realidade da Ilha Grande, cuja atividade econômica está pautada no turismo. Identificou-se como as principais causas dos problemas ambientais e dos conflitos de gestão: o caótico ordenamento do território, a falta de infraestrutura de serviços, a dificuldade de mobilização social, a falta de integração entre as políticas públicas e competências administrativas, a precariedade da fiscalização, a impunidade aos que não cumpriram a normatização em vigor e, a não observância da fragilidade ambiental do geossistema Ilha Grande. / The Ilha Grande is situated on the so called Costa Verde of Rio de Janeiro State. The totality of its territory is legally protected, and it has recently become the target of speculators and investors whose interests are mainly the exploration of the rainforests biome natural potential. There is a process of local transformation in many aspects relating to the environment and the society, for instance, the environmental degradation and the displacement of traditional communities. The State has kept its distance, being absent for decades, a fact that has contributed to the advent of environmental problems and of conflicts on the planning and management spheres. Considering the socioenvironmental relevance of this island territory and specially considering the installation of the Center for Environmental Studies and Sustainable Development (CEADS) of Rio De Janeiro State University (UERJ) in the Dois Rios cove, this study has the goal of identifying the environmental dynamics of the Ilha Grande. The aspects relating to the use and occupation of the soil and to the environmental frailty are crucial for developing an integrated analysis, comprehending the current configuration of the territory and formulating development guidelines which are adequate to the complex reality of the Ilha Grande, whose economic activity is based on tourism. The study has identified the main causes behind the environmental problems and the management conflicts: the chaotic planning of the territory, the lack of a services infrastructure, the difficulty in social mobilizations, the lack of integration between public policies and administrative jurisdictions, the precarious supervision, the impunity to those who fail to comply with current laws and the disregard for the environmental frailty of the Ilha Grande geosystem.

Este trabalho é resultado de pesquisa exegética e bibliográfica, feita na área bíblica, que investiga o termo pa,roikoj como metáfora sobre a provisoriedade da vida. Pa,roikoj (paroikos) é uma palavra grega que corresponde ao termo rG (gēr) hebraico. O termo tem espectro amplo e variável, podendo receber traduções diversas. A mais importante, porém, e que, está presente na maioria dos conceitos, é a de peregrino, migrante e estrangeiro. Na primeira parte, a partir da análise dos textos gregos e hebraicos, é feito um levantamento sobre os sujeitos a quem o termo é relacionado, sua condição de vida e status social. Verificou-se que as ondas migratórias são fenômenos importantes na história de Israel e na vida dos povos bíblicos que lutaram por espaço e pela terra, e que a condição de estrangeiro residente limitava os direitos do indivíduo, colocando-o em situação de inferioridade. Na sociologia do cristianismo primitivo, a provisoriedade das realidades cotidianas e a exclusão social, vivida pelos cristãos, deu-lhes o título de paroikoi. A autoconsciência dos cristãos de serem cidadãos do céu deu origem à expectativa escatológica de uma cidade celeste e reforçou a identidade de paroikos. São destacadas as variantes e a evolução do termo no Antigo Testamento, no Novo Testamento e na literatura extrabíblica. O conceito de pa,roikoj é analisado em sua atribuição simbólica e, são pesquisadas as ocorrências em que recebe ele conotação escatológica de provisoriedade da vida e expectativa de imortalidade. Na segunda parte, é analisada a noção de provisoriedade da vida presente nas fases do desenvolvimento humano, do nascimento à morte, passando pelas perdas e mudanças ocorridas ao longo da vida. O ser humano vive em estado provisório e migra de uma condição a outra, por meio de um êxodo contínuo, cada nova fase significando a morte da precedente. Com este postulado, apresentamos as várias mortes simbólicas que acontecem na vida da mesma pessoa e os pontos de contato com o conceito de paroikos, como aquele que está em trânsito. Para finalizar, são apresentados os ritos de passagem como mecanismos importantes para elaboração dos lutos simbólicos oriundos da condição de itinerância que marca a vida humana. / This work is a result of an exegetical and bibliographical research, made in the biblical area, which investigates the term paroikoj as a metaphor about the temporality of life. Paroikoj (paroikos) is a Greek word that corresponds to the term rG (gēr), in Hebrew. The application of the term has a broad and variable spectrum, but the most important, and that is present in most of the concepts, is the one which refers to pilgrim, migrant and foreigner. In the first part, from the analysis of Greek and Hebrew texts, It is made a survey on the subject to whom the term is assigned to, their living conditions and social status. It was found that the migratory waves are an important phenomena in the history of Israel, and in the lives of biblical peoples who fought for space and land, and that being a resident foreigner used to limit the rights of individuals, placing them at an inferiority condition. In the Sociology of early Christianity, the frailty of the everyday realities and social exclusion, experienced by the Christians, gave them the title of paroikos. The self-consciousness of the Christians to be citizens of heaven led to the eschatological expectation of a heavenly city and strengthened the identity of paroikos. The variants and the evolution of the term in the Old Testament, in the New Testament and in the extra-biblical literature are highlighted. The concept of paroikoj is analyzed in its symbolic allocation and it is researched the occurrences of where it receives the eschatological connotation of temporality of life and expectation of immortality. The second part analyzes the notion of temporality of life in the stages of human development, from birth to death, through the losses and changes throughout life. The human being lives in a frailty state, and migrates from one condition to another, by a continuous exodus, each new phase meaning the death of the old one. With this postulate we present the several symbolic deaths that happen in the life of the same person and the points of contact with the concept of paroikos, meaning the one who is in transit. To conclude we present the rites of passage as important mechanisms for the elaboration of the symbolic mourning from the roaming conditions that mark human life.

A qualidade de vida em idosos é um conceito subjetivo, amplo e multifatorial, que resulta da interação entre pessoas em mudanças que vivem em sociedade e de suas relações intra, extraindividuais e comunitárias. Trata-se de um estudo transversal, teve por objetivo avaliar a qualidade de vida de idosos vulneráveis a fragilidade e os frágeis que vivem em comunidade. A amostra probabilística resultou na participação de 131 idosos residentes em 20 setores censitários do município de João Pessoa - PB. Os dados foram coletados mediante entrevistas domiciliares, realizadas no período de abril a junho de 2011, utilizando instrumento contendo questões sociodemográficas para a caracterização do idoso e para identificar problemas de saúde autorreferidos; Escala de Fragilidade de Edmonton (EFS); Escala de Depressão Geriátrica (EDG); WHOQOL-BREF e WHOQOL-OLD. Os dados foram analisados pela estatística descritiva, com testes para comparação de médias entre dois grupos (t-student); três ou mais grupos (análise de variância- Anova) e a correlação entres as variáveis (teste de Pearson). A média de idade foi de 75,4 (DP = 7,7) anos. Houve predominância do sexo feminino (74,0%), cor parda (45,0%), casados (45,0%), analfabetos (29,8%), renda familiar de 1 a 2 salários mínimos (31,3%); predominância do estado aparentemente vulnerável à fragilidade entre os idosos (45,8%). Ao relacionar os escores de fragilidade com variáveis sociodemográficas, observou-se que a cor da pele (p = 0,036) e a ocorrência de comorbidades (p = 0,002) apresentaram-se estatisticamente significantes. O problema de saúde autorreferido mais frequente entre os idosos foi a hipertensão arterial (69,5%), e o sexo feminino apresentou maior frequência em todos os problemas de saúde, com significância estatística para a hipertensão arterial e a audição prejudicada. Verificou-se dependência estatística entre as morbidades: DPOC/ Enfizema - doença bronco-pulmonar (p = 0,012), derrame (p < 0,001), doença cardíaca (p<0,001), doença neurológica - Parkinson/Esclerose (p = 0,022), hipertensão arterial (p = 0,031), incontinência urinária ou fecal (p = 0,001) e a síndrome de fragilidade. Os maiores escores médios da qualidade de vida foi para o domínio relações sociais (68,06) e a faceta intimidade (63,93). Houve diferença estatisticamente significativa (p = 0,029) na comparação das médias de homens e mulheres na faceta passado-presente - futuro. E entre as médias das facetas habilidades sensoriais e autonomia (p = 0,043 e p = 0,013) segundo a variável faixa etária. O único domínio da qualidade de vida a apresentar diferença estatisticamente significativa (p = 0,001) com os escores de fragilidade foi o físico. Todos os domínios do WHOQOL-BREF e as facetas autonomia (p = 0,039), atividades passado- presente-futuro (p<0,001), participação social (p<0,001) e intimidade (p<0,001) mostraram diferença estatisticamente significativa quando relacionado aos sintomas de depressão. O conhecimento dos níveis de fragilidade favorece a identificação de grupos de riscos, auxiliando na formulação de plano de cuidado para os idosos frágeis, com vistas à promoção da saúde e sua qualidade de vida / Quality of life of elderly people is a subjective, broad and multifactorial concept resulting from the interaction of people who live in society undergoing changes, and from their community, intra- and extraindividual relationships. The aim of this cross- sectional study was to assess the quality of life of elderly individuals vulnerable to frailty and that of frail elderly individuals who live in community. The probabilistic sample resulted in the participation of 131 elderly individuals living in 20 census sectors in the municipality of João Pessoa, state of Paraíba. Data were collected by means of home interviews, in the period between April and June of 2011, using an instrument containing sociodemographic questions so as to characterize the elderly and to identify self-reported health care problems, namely: Edmonton Frail Scale (EFS); Geriatric Depression Scale (GDS); WHOQOL-BREF and WHOQOL-OLD. Data were analyzed using descriptive statistics and tests to compare the means between the two groups (student\'s t test); three or more groups (analysis of variance -Anova) and the correlation between the variables (Pearson\'s test). The mean age was 75.4 (SD = 7.7) years. There was predominance of female (74.0%), mixed race (45.0%), married (45.0%), and illiterate (29.8%) individuals, with a family income of 1 to 2 minimum wages (31.3%); and predominance of the apparently vulnerable state to frailty among the elderly (45.8%). Relating the frailty scores with the sociodemographic variables allowed to observe that the skin color (p = 0.036) and the occurrence of comorbidities (p = 0.002) were statistically significant. The most frequent self-reported health problem among the elderly was arterial hypertension (69.5%), and women presented a higher frequency in all of the health problems, with statistical significance for arterial hypertension and impaired hearing. Statistical dependence was also observed between the comorbidities: bronchopulmonary disease - chronic obstructive pulmonary disease/emphysema (p = 0.012), stroke (p < 0.001), cardiac disease (p<0.001), neurologic disease - Parkinson/sclerosis (p = 0.022), arterial hypertension (p = 0.031), urinary or fecal incontinence (p = 0.001) and the frailty syndrome. The highest mean scores of quality of life were found in the domain of social relationships (68.06) and in the dimension of intimacy (63.93). There was a statistically significant difference (p = 0.029) in the comparison of the means of men and women in the dimension past-present-future, and between the means of the dimensions of sensory skills and autonomy (p = 0.043 and p = 0.013) according to the age range variable. The physical domain was the only domain in quality of life to present a statistically significant difference (p = 0.001) with the scores of frailty. All of the domains in the WHOQOL-bref and the dimensions of autonomy (p = 0.039), past- present-future activities (p<0.001), social participation (p<0.001) and intimacy (p<0.001) showed a statistically significant difference when related to the symptoms of depression. The knowledge of frailty levels favors the identification of risk groups, assisting to elaborate a care plan towards frail elderly individuals, aimed to promote their health and quality of life