FAMI LY AND SOCI AL VULNERABI LI TY: A STUDY W I TH OCTOGENARI ANS
Sofia Cr ist ina I ost Pav ar ini1 Elizabet h Joan Bar ha2 Mar isa Silv ana Zazzet t a de Mendiondo3 Car m en Lucia Alv es Filizola4
José Fer nando Pet r illi Filho5 †
Ar iene Angelini dos Sant os6
Pavarini SCI , Barha EJ, Mendiondo MSZ, Filizola CLA, Pet rilli JF Filho, Sant os AA. Fam ily and social vulnerabilit y : a st udy w it h oct ogenar ians. Rev Lat ino- am Enfer m agem 2009 m aio- j unho; 17( 3) : 374- 9.
I n or der t o guide t he developm ent of dem ent ia- r elat ed public policies for t he elder ly, it is im por t ant t o ident ify f act or s t h at v ar y t oget h er w it h t h e social v u ln er ab ilit y of t h is popu lat ion . Th is st u dy aim ed t o iden t if y t h e r elat ionship bet w een t he São Paulo Social Vulner abilit y I ndex ( I PVS) and v ar ious indicat or s of fam ily suppor t for elder ly people over 80 year s of age, w ho pr esent ed cognit ive alt er at ions ( N= 49) . All et hical guidelines w er e follow ed. Dat a w er e collect ed at t he hom es of t he elder ly people. A lar ge m aj or it y of t he r espondent s lived w it h fam ily m em ber s ( 88% ) . I n half of t he cases, t he r espondent s lived w it h one ( 41% ) or t w o ( 9% ) ot her elder ly per sons. On aver age, t her e w as one m or e non- elder ly per son living in t he high vulner abilit y fam ily cont ex t ( M = 3.6, sd = 1.70) t han in cont ext s of ver y low vulner abilit y ( M = 2.4, sd = 1.07) , F( 2.43) = 3.364, p < 0.05. How ev er , t he funct ionalit y of t he suppor t pr ov ided by t hese fam ily m em ber s needs t o be v er ified, in each of t h ese con t ex t s.
DESCRI PTORS: aged, 80 and ov er ; dem ent ia; fam ily healt h; social suppor t ; social v ulner abilit y
LA FAMI LI A Y LA VULNERABI LI DAD SOCI AL: UN ESTUDI O CON OCTOGENARI OS
Par a elabor ar polít icas públicas par a el cuidado de anciano con dem encia, es im por t ant e v er ificar fact or es que var ían con la vulner abilidad social de esa población. El obj et ivo de est e est udio fue ident ificar la r elación ent r e una m edida de vulner abilidad social ( I PVS) y algunos indicador es de apoyo fam iliar par a ancianos, con m ás de 80 años, con alt er aciones cognit iv as ( N= 49) . Todas las r ecom endaciones ét icas fuer on obser v adas. Los dat os fuer on r ecolect ados en los dom icilios de los ancianos. La gr an m ayor ía de los ent r evist ados vivía con la fam ilia ( 88% ) . En la m it ad de las fam ilias los ancianos vivían con uno ( 41% ) o dos ancianos ( 9% ) . En pr om edio había una per sona m ás, que no er a anciana, viviendo en el cont ext o fam iliar de alt a vulner abilidad ( M= 3,6, DE= 1,70) que en el cont ex t o de m uy baj a v ulner abilidad ( M= 2,4, DE= 1,07) , F ( 2, 43) = 3,364, p< 0,05. Sin em bar go, es necesar io v er ificar la funcionalidad del apoy o fam iliar en esos cont ex t os.
DESCRI PTORES: anciano de 80 o m ás años; dem encia; salud de la fam ilia; apoy o social; v ulner abilidad social
FAMÍ LI A E VULNERABI LI DADE SOCI AL: UM ESTUDO COM OCTOGENÁRI OS
Par a d ir ecion ar p olít icas p ú b licas p ar a cu id ad o ao id oso com d em ên cia, é im p or t an t e v er if icar f at or es q u e var iam com a vulner abilidade social dessa população. O obj et ivo foi ident ificar a r elação ent r e um a m edida de vulner abilidade social ( I PVS) e alguns indicador es de apoio fam iliar par a idosos acim a de 80 anos, com alt er ações cognit iv as ( N= 49) . Todos os cuidados ét icos for am obser v ados. Os dados for am colet ados nos dom icílios dos idosos. A gr ande m aior ia dos ent r ev ist ados m or av a com a fam ília ( 8 8 % ) . Em m et ade das fam ílias os idosos m or avam com m ais um ( 41% ) ou dois idosos ( 9% ) . Em m édia havia um a pessoa a m ais, não idosa, m or ando no cont ext o fam iliar de alt a vulner abilidade ( M= 3,6, dp= 1,70) do que no cont ext o de m uit o baixa vulner abilidade ( M= 2 , 4 , dp= 1 , 0 7 ) , F ( 2 , 4 3 ) = 3 , 3 6 4 , p< 0 , 0 5 . Por ém , h á n ecessidade de v er if icar a f u n cion alidade do apoio f am iliar n esses con t ex t os.
DESCRI TORES: idoso de 80 anos ou m ais; dem ência; saúde da fam ília; apoio social; v ulner abilidade social
Univer sidade Federal de São Car los, Brazil: 1RN, Ph.D. in Educat ion, Associat e Pr ofessor, e- m ail: sofia@ufscar.br ; 2Psychologist , Ph.D. in Social Psychology and Applied, Associat e Pr ofessor, e- m ail: lisa@ufscar.br ; 3Social Wor ker, Ph.D. in Social Wor k, Adj unct Pr ofessor, e- m ail: m ar isam @ufscar.br ; 4RN, Ph.D. in Nur sing, Adj unct Pr ofessor, e- m ail: filizola@ufscar.br ; 5RN, Assist ant Pr ofessor ; 6RN, Mast er ’s st udent in Nur sing, e- m ail: ar ieneangelini@yahoo.com .br.
I NTRODUCTI ON
R
esearch on care delivered t o t he oldest old ( elder ly people over 80) is a new focus of at t ent ion inp o p u l a t i o n a g i n g r e se a r ch . D e m o g r a p h i c st u d i e s
docu m en t r apid in cr eases in t h e size of t h e elder ly
populat ion. I t is est im at ed t hat , in 2050, t her e w ill be
t w o billion elderly people in t he w orld and, in t he sam e
y ear, proj ect ions indicat e t her e w ill be m or e t han five
m illion eld er ly m en an d alm ost n in e m illion eld er ly
w om en in Br azil, aged 80 y ear s or older( 1).
Reduct ions in m or t alit y am ong t he oldest old
h av e r esu lt ed in in cr eases in t h e n u m b er of m or e
fr agile elder ly people( 2). The Nat ional Elder ly Healt
h-Ca r e Po l i cy, b a sed o n a m o r e g e n e r i c co n ce p t o f
fr agilit y, consider s fr ail elder ly people as: t hose w ho
a r e b e d r i d d e n , t h o s e w h o h a v e b e e n r e c e n t l y
h o s p i t a l i z e d f o r a n y r e a s o n , t h o s e w i t h h e a l t h
pr oblem s k n ow n t o cau se f u n ct ion al in capacit y, an d
t hose w ho liv e in sit uat ions of dom est ic v iolence and
ar e ov er 75 y ear s of age( 3). Fr agilit y is consider ed t o
be a syndr om e. Alt hough t her e is not yet a consensual
d ef i n i t i o n o f f r a g i l i t y, st u d i es i n d i ca t e t h a t i t ca n
int erfere in t he funct ionalit y of t he aged, causing higher
depen den ce. Fr agilit y is m or e pr ev alen t am on g t h e
older old( 4). I t is est im at ed t hat bet w een 10 t o 25% of
non- inst it ut ionalized elder ly people ( ov er 65 y ear s of
ag e) , ar e con sid er ed f r ail. Th is p er cen t ag e r ises t o
46% am ong t hose ov er 85 y ear s of age( 5).
The oldest old w ho have cognit ive alt er at ions
( dem en t ia) can be con sider ed a h igh - r isk gr ou p f or
f r a g i l i t y i n o l d a g e , w i t h a h i g h e r p r o b a b i l i t y o f
r educt ions in t heir funct ional capacit y. Dem ent ia can
be cau sed by m an y pat h ologies t h at alt er cogn it iv e
fu n ct ion s su ch as m em or y, lan gu age/ pr ax ia, gn osia,
ab st r act i o n , o r g an i zat i o n , p l an n i n g an d seq u en t i al
ca p a ci t i e s. St u d i e s sh o w t h a t t h e p r e v a l e n ce o f
dem ent ia is m uch higher in higher age gr oups, am ong
t hose w it h low er educat ional lev els, and t ends t o be
m o r e f r e q u e n t a m o n g w o m e n( 6 ). D e m e n t i a i s
ch ar act er ized by cogn it iv e im pair m en t s t h at lead t o
t he loss of funct ional capacit y, increasing t he dem and
for car e( 7). I n Br azil, t he car e of elder ly people w it h
cog n i t i v e i m p ai r m en t s i s m ost l y p r ov i d ed b y t h ei r
fam ily m em ber s( 8 - 9 ).
Changes in fam ily st r uct ures, associat ed w it h
an incr ease in t he size and dependency lev els of t he
eld er ly p op u lat ion , h av e st r on g ly af f ect ed Br azilian
f am ily lif e, in bot h em ot ion al an d f in an cial aspect s.
Changes in m or t alit y and fecundit y pat t er ns have led
t o i m p o r t a n t m o d i f i ca t i o n s i n f a m i l y a r ch i t ect u r e,
w hich can influence t he w ay fam ilies look aft er t heir
e l d e r l y m e m b e r s . On t h e o n e h a n d , d e c r e a s i n g
fecundit y has r educed t he size of fam ilies, nar r ow ing
oppor t u n it ies f or in t er gen er at ion al r elat ion s. On t h e
ot h er h an d, lon gev it y h as in cr eased t h e n u m ber of
m u lt igen er at ion al fam ilies( 2 ).
Fam ily st r u ct u r es am on g t h e elder ly u su ally
fall int o one of four differ ent cat egor ies: 1- t hose w ho
live alone, 2- t hose w ho live w it h t heir part ner, children
or ot her r elat iv es, 3- t hose w ho liv e w it h childr en or
ot her r elat ives, but w it hout t heir par t ner, and 4- t hose
w h o l i v e o n l y w i t h t h e i r p a r t n e r( 1 ). A l t h o u g h
m u lt ig en er at ion al f am ilies ar e n ow in t h e m aj or it y,
t her e is no guar ant ee t hat t hese fam ilies ar e pr epar ed
t o assu m e t h e r ole of eld er ly car eg iv er. Th e m ain
r eason s t h at l ead f am i l i es t o of f er car e t o el d er l y
r e l a t i v e s i n c l u d e f i n a n c i a l , p e r s o n a l a n d s o c i a l
fact ors( 10).Sit uat ions of fragilit y and dependence creat e
t he need t o adapt and r eor ganize fam ilies, leading t o
ch an g es i n f am i l y r ol es, w h i ch ar e r ed ef i n ed ov er
t im e, based on t he w ay each m em ber int er act s w it h
t h e ot h er s. At t h e sam e t im e, r eadj u st m en t s in t h e
fam ily st r uct ur e depend on t he w ay in w hich changes
i n t h e e l d e r l y r e l a t i v e ’ s n e e d s o ccu r a n d o n t h e
r esour ces av ailable t o deal w it h t hese changes( 11).
Fam ily su p p or t , t h er ef or e, var ies accor d in g
t o t he cont ex t of higher or low er social v ulner abilit y.
Vu l n er a b i l i t y i s a m u l t i d i m en si o n a l co n st r u ct t h a t
r efer s t o a dy nam ic cont ex t in w hich som eone is at
r isk for t he dev elopm ent of healt h pr oblem s, r esult ing
f r o m i n a d e q u a t e e co n o m i c, so ci a l , p sy ch o l o g i ca l ,
f a m i l y, co g n i t i v e o r p h y si ca l r eso u r ces( 1 2 ). I n t h i s
s t u d y, t h e S ã o Pa u l o S o c i a l Vu l n e r a b i l i t y I n d e x
( I PVS) w as u sed t o est ab lish t h e d eg r ee of social
v u ln er ab ilit y in w h ich oct og en ar ian s w it h cog n it iv e
a l t e r a t i o n s w e r e l i v i n g . T h e I PV S w a s c r e a t e d
con sid er in g t h e m u lt id et er m in ist ic n at u r e of social
v ulner abilit y, and t o support t he definit ion of priorit ies
and choice of st r at egies for public act ion, in or der t o
r educe pov er t y. This index has been used t o classify
t he social vulnerabilit y level of people in each census
t ract of t he st at e of São Paulo. The classificat ion levels
a r e d e f i n e d b a s e d o n t h e s o c i o e c o n o m i c a n d
dem ogr aphic char act er ist ics of t he inhabit ant s of t he
st at e( 13). Six classificat ion lev els w er e est ablished.
“ Gr ou p 1 – n o v u ln er ab ilit y : com p r ises t h e cen su s
t r a c t s i n w h i c h t h e r e s i d e n t s h a v e t h e h i g h e s t
socioeconom ic condit ions ( v er y high SES) , giv en t hat
and educat ional lev els. Alt hough t he st age of life of
t he m em bers of t hese fam ilies is not used t o classify
t hese gr oups, heads of t he household t end t o be older,
a n d t h e r e a r e f e w e r y o u n g c h i l d r e n a n d f e w e r
in h abit an t s in t h e h ou se, in com par ison w it h n or m s
for t he ent ir e st at e of São Paulo.
Gr oup 2 – ver y low vulner abilit y: com pr ises t he census
t r act s classif ied as secon d h ig h est in t h e st at e, in
t er m s of socioeconom ic w ellbeing ( av er age or high) .
Th ese a r ea s h a v e a h i g h er co n cen t r a t i o n , o n t h e
av er age, of older fam ilies.
Gr ou p 3 – low v u ln er ab ilit y : f or m ed b y t h e cen su s
t r a c t s c l a s s i f i e d a s h i g h o r a v e r a g e l e v e l s o f
socioeconom ic w ellbeing. The dem ogr aphic pr ofile of
t h i s g r o u p i s ch ar act er i zed b y a p r ed o m i n an ce o f
fam ilies com pr ised of y out hs and adult s.
Gr oup 4 – aver age vulner abilit y: consist s of t he t r act s
t hat present average levels in t erm s of socioeconom ic
w ellb ein g . I t r an k s f ou r t h in t h e scale in t er m s of
i n co m e a n d e d u ca t i o n l e v e l s o f t h e h e a d o f t h e
h o u se h o l d . I n t h e se se ct o r s, y o u n g f a m i l i e s a r e
present , t hat is, fam ilies w it h young heads ( less t han
30 y ear s old) and sm all childr en.
Gr ou p 5 – h ig h v u ln er ab ilit y : com p r ises t h e cen su s
t r act s w i t h t h e w o r st co n d i t i o n s i n t er m s o f t h ei r
socioecon om ic w ellb ein g ( low ) . I t is on e of t h e t w o
g r ou p s in w h ich t h e h ead s of t h e f am ilies h av e, on
t h e a v e r a g e , t h e l o w e st i n co m e a n d e d u ca t i o n a l
l e v e l s . T h e r e i s a h i g h p e r c e n t a g e o f o l d e r
f a m i l i e s, w i t h a l o w p e r ce n t a g e o f f a m i l i e s w i t h
s m a l l c h i l d r e n .
Gr oup 6 – v er y high v ulner abilit y : t he second of t he
t w o p o o r e s t g r o u p s i n t e r m s o f s o c i o e c o n o m i c
w ellbein g ( low ) , w it h a h igh con cen t r at ion of y ou n g
fam ilies. “ The com binat ion of young household heads
w i t h l o w i n co m e a n d e d u ca t i o n a l l e v e l s, a n d t h e
sig n if ican t p r esen ce of sm all ch ild r en lead s t o t h e
dedu ct ion t h at t h is is t h e gr ou p m ost v u ln er able t o
pov er t y ”( 1 3 ).
Thus, t he pur pose of t his st udy w as t o ident ify
t h e r e l a t i o n s h i p b e t w e e n a m e a s u r e o f s o c i a l
v u ln er abilit y ( I PVS) an d v ar iou s in dicat or s of fam ily
suppor t for elder ly people over 80 year s of age, w ho
pr esen t ed cogn it iv e alt er at ion s.
METHOD
Th is st u d y p r esen t s d escr ip t iv e d at a, u sin g
qu an t it at iv e r esear ch m et h ods. All et h ical pr in ciples
for r esear ch w it h hum an beings w er e obser v ed. The
pr oj ect had t he pr ior appr oval of t he Resear ch Et hics
Com m it t ee ( Ev aluat ion No. 0 5 5 / 2 0 0 6 ) .
Su b j ect s
Th e p ar t i ci p an t s of t h i s st u d y i n cl u d ed 4 9
people ov er 8 0 y ear s of age ( M = 1 1 and F = 3 8 ) ,
living in a cit y in t he int erior of t he st at e of São Paulo,
and w ho m et t he follow ing eligibilit y crit eria: regist ered
in a public, fam ily - healt h unit , ov er 80 y ear s of age,
an d w h o ob t ain ed a Min i- Men t al St at e Ex am in at ion
( MMSE) r esu lt below t h e cu t - of f poin t , accor din g t o
t h e r espon den t ’s edu cat ion al lev el.
Pr o ced u r es
Pr e v i o u sl y sch e d u l e d i n - h o m e v i si t s w e r e
c o n d u c t e d i n t h e r e s i d e n c e o f e a c h o f t h e 4 9
o c t o g e n a r i a n s . D a t a c o l l e c t i o n c o n s i s t e d o f a
st r u ct u r ed in t er v iew w it h t h e r espon den t s an d t h eir
f am ily m em ber s, u sin g a Gen ogr am t o r egist er t h e
f am ily st r u ct u r e.
I n o r d e r t o c r e a t e t h e r e s p o n d e n t ’ s
Ge n o g r a m , t h e e l d e r l y p e r s o n a n d o t h e r f a m i l y
m e m b e r s w h o w e r e p r e s e n t a t t h e t i m e o f t h e
i n t e r v i e w w e r e i n v i t e d t o d e s c r i b e t h e f a m i l y ’ s
st r u ct u r e a n d h i st o r y. Th e i n f o r m a t i o n co l l e ct e d
i n cl u d e d : n a m e a n d a g e o f t h e f a m i l y m e m b e r s,
m ar i t al st at u s, p at h o l o g i es w h i ch f am i l y m em b er s
h a d i n t h e p a st o r a t t h e t i m e o f t h e i n t e r v i e w ,
a m o n g o t h e r s. I n f o r m a t i o n a b o u t a t l e a st t h r e e
g e n e r a t i o n s w a s i n c l u d e d , m a k i n g n o t a t i o n s i n
ch r on olog ical or d er, t h at is, f r om t h e old est t o t h e
y o u n g est f am i l y m em b er, r eg i st er ed f r o m t h e l ef t
t o t h e r i g h t o n t h e d i a g r a m f o r ea ch g en er a t i o n .
S t a n d a r d i z e d s y m b o l s w e r e u s e d f o r i m p o r t a n t
ev en t s su ch a s d a t es o f b i r t h , d ea t h s, m a r r i a g es
a n d d i v o r ce s. Fa m i l y m e m b e r s w h o l i v e d i n t h e
sam e r esid en ce w er e en cir cled , on t h e d iag r am( 1 4 ).
Th e d at a f r om t h e Gen og r am s f or each f am ily, w er e
t h en sy st em at i zed an d st at i st i cal l y an al y zed .
Th e Sã o Pa u l o So ci a l Vu l n e r a b i l i t y I n d e x
( I PVS) w as u sed t o an aly ze t h e r esp on d en t s’ d eg r ee
o f v u l n er ab i l i t y( 1 3 ). I n t h i s st u d y, t h e I PVS v al u es
w er e o b t a i n ed f o r t h e cen su s t r a ct o f t h e Fa m i l y
He a l t h Un i t ( FHU) w h e r e t h e e l d e r l y p e r so n w a s
r eg ist er ed . Fir st , t h e cen su s t r act f or each FHU w as
d e t e r m i n e d u si n g t h e i r st r e e t a d d r e sse s. At t h i s
Geog r ap h y an d St at ist ics) u n it assist ed in p r ov id in g
t h e cen su s t r act cod es f or each ad d r ess. Nex t , t h e
I PVS m ap w as con su lt ed t o ob t ain t h e I PVS v alu e
f o r each t r act . FHU’ s f o r w h i ch I PVS v al u es w er e
n o t a v a i l a b l e w er e ex cl u d ed .
RESULTS
A lar ge m aj or it y of t he r espondent s lived w it h
fam ily m em ber s, but w er e w it hout t heir spouse ( 71% ) ;
1 2 % l i v e d w i t h t h e i r s p o u s e a n d o t h e r f a m i l y
y t i l i b a r e n l u v l a i c o
S Numberofelderlypeople
t x e t n o c l a i c o s h c a e n i d e t a u l a v e f o s r a e y 0 8 r e v o e l p o e p y l r e d l e f o r e b m u N t n i o p f f o -t u c e h t w o l e b E S M M h t i w , e g
a Percentage (%)
w o l y r e
V 145 19 13,1
e g a r e v
A 278 13 4,7
h g i
H 243 14 5,8
h g i h y r e
V 103 3 2,9
m em ber s; 12% lived alone and ot her s ( 5% ) lived only
w it h t heir spouse. How ever, in m ost cases, t he fam ilies
w er e not ver y lar ge. On aver age, t he par t icipant s lived
w it h 1.9 ot her people ( sd = 1.34) . I n half of t he cases,
subj ect s lived w it h eit her one ( 41% ) or t w o ( 9% ) ot her
eld er ly p er son s.
Con t ex t of social v u ln er abilit y
Th e co m p o si t i o n o f t h i s sa m p l e ( Ta b l e 1 )
included elder ly people liv ing in differ ent cont ex t s of
social v u ln er abilit y.
Table 1 – Com posit ion of t he sam ple, by level of social v ulnerabilit y. São Car los, SP, 2008
Lif e ex p ect an cy is r elat ed t o socioecon om ic
l e v e l s , b e c a u s e s o c i o e c o n o m i c w e l l b e i n g i s
r ef l ect ed i n l i f e co n d i t i o n s t h a t a f f ect i n d i v i d u a l s’
h ealt h an d t h eir access t o h ealt h ser v ices( 1 5 ). Th u s,
a s e x p e c t e d , a v e r y s m a l l p e r c e n t a g e o f t h e
oct og en ar ian s liv ed in con t ex t s of v er y h ig h social
v u ln er ab ilit y, χ2 ( 3 ) = 1 1 . 0 , p < 0 . 0 5 .
Co n t e x t s o f s o c i a l v u l n e r a b i l i t y a n d t h e s o c i a l
su p p o r t n e t w o r k
Th e p r esen ce of a f am ily su p p or t n et w or k
( e . g . . w h e n t h e e l d e r l y p e r so n l i v e s w i t h f a m i l y
m em b er s f r o m y o u n g er g en er a t i o n s) ca n b e v er y
im p or t an t t o assu r e t h e w ell b ein g of oct og en ar ian s.
Nev er t h eless, t h e p r esen ce of t h is k in d of su p p or t
can b e i n f l u en ced b y t h e el d er l y p er so n ’s co n t ex t
o f so ci a l v u l n e r a b i l i t y. Th e d a t a sh o w e d t h a t t h e
p e r c e n t a g e o f e l d e r l y p e o p l e l i v i n g i n a
m u l t i g e n e r a t i o n a l v e r s u s u n i g e n e r a t i o n a l f a m i l y
co n t ex t w a s si g n i f i ca n t l y r el a t ed t o t h ei r l ev el o f
social v u ln er ab ilit y, χ2 ( 3 ) = 1 0 . 1 8 , p < 0 . 0 5 ( Tab le
2 ) . I n t h e con t ex t of h ig h social v u ln er ab ilit y, t h er e
w as a h ig h er p er cen t ag e of eld er ly p eop le liv in g in
u n i g e n e r a t i o n a l t h a n i n m u l t i g e n e r a t i o n a l
r esid en ces, w h ile m u lt ig en er at ion al f am ily set t in g s
p r ev ai l ed i n o t h er co n t ex t s o f soci al v u l n er ab i l i t y .
A t f i r s t , t h i s r e s u l t d o e s n o t s e e m t o
co r r o b o r a t e st a t i st i cs sh o w i n g t h a t , a m o n g l o w
-i n c o m e p e o p l e , t h e n u m b e r o f p e o p l e l -i v -i n g
t o g e t h e r i s h i g h e r. H o w e v e r, t h e g r o u p o f
o c t o g e n a r i a n s l i v i n g i n a c o n t e x t o f v e r y h i g h
v u ln er ab ilit y w as ex t r em ely sm all ( n = 3 ) , d ist or t in g
an aly ses t h at in clu d e t h is con t ex t . Wh en t h ose liv in g
in con t ex t s of v er y h ig h v u ln er ab ilit y w er e ex clu d ed
f r o m t h e a n a l y si s, t h e n u m b e r o f p e o p l e i n t h e
e l d e r l y p e r s o n ’ s r e s i d e n c e w a s s i g n i f i c a n t l y
d i f f e r e n t , i n d i f f e r e n t c o n t e x t s o f v u l n e r a b i l i t y
F( 2 . 4 3 ) = 3 . 3 6 4 , p < 0 . 0 5 . Eld er ly p eop le w h o liv ed
i n c o n t e x t s o f h i g h v u l n e r a b i l i t y r e s i d e d w i t h a
sig n if ican t ly h ig h er n u m b er of p eop le ( M = 3 . 6 , sd
= 1 . 7 0 ) t h an t h ose w h o l i v ed i n co n t ex t s of v er y
low v u ln er ab ilit y ( M = 2 . 4 , sd = 1 . 0 7 ) . On av er ag e,
oct og en ar ian s in con t ex t s of h ig h v u ln er ab ilit y liv ed
w i t h o n e m o r e p e r s o n t h a n t h o s e w h o l i v e d i n
con t ex t s of v er y low v u ln er ab ilit y. I t can b e af f ir m ed
t h a t t h i s a d d i t i o n a l p e r s o n , i n m o s t c a s e s , w a s
so m eo n e w i t h t h e p o t en t i al t o p r o v i d e su p p o r t t o
t h e o ct o g e n a r i a n , a s t h e t o t a l n u m b e r o f p e o p l e
l i v i n g i n t h e r e s i d e n c e v a r i e d a c c o r d i n g t o t h e
co n t e x t o f v u l n e r a b i l i t y, b u t n o t a s a f u n ct i o n o f
t h e n u m b er of p eop le ov er 6 0 y ear s old ( p > 0 . 0 5 ) .
H o w e v e r, l i v i n g i n t h e s a m e p l a c e d o e s n o t
Table 2 – Fam ily com posit ion of t he household, by cont ex t of social v ulnerabilit y. São Car los, SP, 2008
* t he elder ly per son lived eit her alone or w it h t heir spouse.
* * t he elder ly per son lived w it h ot her fam ily m em ber s ( w it h or w it hout t heir spouse) .
Age and social v ulner abilit y
The age of t he par t icipant s ( all over 80 year s
of age) w as not significant ly differ ent in t he v ar ious
co n t e x t s o f so ci a l v u l n e r a b i l i t y. On ce a g a i n , i t i s
obser ved t hat t he gr oup of elder ly people in t he cont ext
of v er y high v ulner abilit y does not pr ov ide a r eliable
m easu r e of t h e ch ar act er ist ics of t h is g r ou p , as it
includes only t hr ee people.
DI SCUSSI ON
An u n d er st an d in g of t h e f am ily con t ex t of
eld er ly p eop le liv in g in d if f er en t con t ex t s of social
v ulner abilit y can cont r ibut e t o t he dev elopm ent of a
p r o g r a m o f ca r e se r v i ce s f o r e l d e r l y p e o p l e w i t h
d e m e n t i a , w i t h i n t h e p u b l i c h e a l t h c a r e s y s t e m ,
esp ecially w it h r esp ect t o car e ser v ices f or eld er ly
p eop le of f er ed b y t h e Fam ily Healt h Pr og r am . Th e
Nat ional Healt h Car e Policy for t he Elder ly, issued in
2006, det er m ines t hat access t o healt h car e for elder ly
people st ar t s w it h t he Basic Healt h Car e and Fam ily
Healt h Car e pr ogr am s( 3 , 1 6 ).
Recen t st u d ies sh ow t h at r esear ch er s h av e
not achieved a consensus w it h r espect t o t he concept
of social suppor t . I t is a com plex t er m t hat should be
j u d iciou sly u sed( 1 7 - 1 8 ). Th is st u d y in v est ig at ed on ly
som e of t h e in dicat or s of f am ily su ppor t f or elder ly
people ov er 80 y ear s of age, w ho also had cognit iv e
alt erat ions, and w ho lived in different cont ext s of social
v u ln er ab ilit y.
Car e t o t he aged in t he fam ily cont ext involves
a co m p l e x r e a l i t y, m a r k e d b y so ci o d e m o g r a p h i c,
cult ural and psychological variables, by t he hist ory of
t he fam ily r elat ionships, by t he nat ur e of t he elder ly
per son’s needs and t he car e r equir ed, t o m eet t hese
n eeds, by t h e r esou r ces an d su ppor t s bein g offer ed
by for m al or infor m al net w or ks, and by t he car egiver ’s
and ot her fam ily m em ber s’ subj ect iv e ev aluat ions of
car e and of t he life st ages( 19- 20).
Dat a r ev ealed t h at t h er e w er e sig n if ican t ly
few er oct ogenar ians living in t he cont ext of ver y high
so ci a l v u l n e r a b i l i t y ( n = 3 ) t h a n i n o t h e r so ci a l
v ulner abilit y cont ex t s. Apar t fr om t hese t hr ee cases,
t h e aged in t h e con t ex t of h igh v u ln er abilit y h ad a
h ig h er p ot en t ial t o r eceiv e f am ily su p p or t t h an t h e
elderly people living in t he cont ext of low vulnerabilit y,
as t hey had one addit ional per son, under 60 year s of
age, liv ing in t heir r esidence.
Lon g ev it y, f r ag ilit y an d m u lt ig en er at ion alit y
a r e k ey i ssu es i n u n d er st a n d i n g t h e d y n a m i cs o f
Brazilian fam ilies t hat live in different cont ext s of social
vulnerabilit y, especially in cont ext s of great er povert y.
Un f or t u n at ely, in Br azil, t h e in cr ease of t h e eld er ly
p op u lat ion occu r s in an en v ir on m en t ch ar act er ized
by pov er t y and gr eat social inequalit ies( 21).
CONCLUSI ON
The longev it y of t he Br azilian populat ion has
incr eased t he m ult igener at ionalit y of fam ily life. The
oldest old const it ut e a r isk gr oup for fr agilit y in old
age. I n t his st udy, m ost of t he elder ly lived w it h fam ily
m em b er s ( 8 8 % ) , b u t w it h ou t t h eir sp ou se ( 7 1 % ) .
Fa m i l i es w er e sm a l l a n d , o n av e r a g e, t h e el d er l y
p eop le liv ed w it h 1 . 9 ot h er p eop le ( sd = 1 . 3 4 ) . I n
near ly half t he cases, t he r espondent s lived w it h one
ot her per son ov er 60 y ear s of age ( 41% ) .
Th e r e w e r e f e w e r o ct o g e n a r i a n s l i v i n g i n
co n t ex t s o f h i g h v u l n er a b i l i t y t h a n i n co n t ex t s o f
av er ag e an d v er y low v u ln er ab ilit y. Th er e w as on e
a d d i t i o n a l n o n - e l d e r l y p e r s o n l i v i n g w i t h t h e
r espondent s w ho lived in cont ext s of high vulnerabilit y.
Th is addit ion al su ppor t can be ex t r em ely im por t an t
for t he longev it y of t he elder ly per son, as fam ilies in
con t ex t s of h igh v u ln er abilit y do n ot h av e f in an cial
r esour ces t o pay for t hir d- par t y ser v ices.
y t i l i b a r e n l u v l a i c o
S Unigenerational*(%) Multigerational**(%) Numberofpeopleinthehouse Numberofelderlypeopleinthehouse
M dp M dp
w o l y r e
V 21,1 78,9 2,4 1,07 1,8 0,63
m u i d e
M 0 100 3,2 1,07 1,3 0,63
h g i
H 7,1 92,9 3,6 1,70 1,6 0,65
h g i h y r e
V 66,6 33,3 2,3 1,53 1,7 0,58
l a t o
Hav ing one ex t r a per son, how ever, does not
n e ce ssa r i l y m e a n g e t t i n g m o r e a p p r o p r i a t e ca r e .
Thus, in or der t o guide public policy developm ent w it h
r esp ect t o eld er ly p eop le w h o h av e d em en t ia, t h e
funct ionalit y of t he fam ily support net w ork st ill needs
t o b e in v est ig at ed , esp ecially f or lon g - liv ed eld er ly
people w ho have cognit ive alt erat ions and w ho live in
cont ex t s of high social v ulner abilit y.
ACKNOW LEDGMENTS
We ack now ledge t he financial suppor t of t he
Resear ch an d Pr oj ect s Fin an cin g Agen cy - FI NEP, of
t h e Min ist r y of Scien ce an d Tech n olog y an d of t h e
Na t i o n a l Co u n ci l f o r Sci e n t i f i c a n d Te ch n o l o g i ca l
Dev elopm en t – CNPq.
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