SOCI OECONOMI C AND DEMOGRAPHI C CHARACTERI STI CS AND HEALTH CONDI TI ON OF
ELDERLY PEOPLE FROM A FAMI LY HEALTH PROGRAM I N PORTO ALEGRE, BRAZI L
Luccas Melo de Souza1 Eliane Pinheir o de Mor ais2 Quenia Cam ille Mar t ins Bar t h3
Sou za LM, Mor ais EP, Bar t h QCM. Socioecon om ic an d d em og rap h ic ch ar act er ist ics an d h ealt h con d it ion of elderly people from a fam ily healt h program in Port o Alegre, Brazil. Rev Lat ino- am Enferm agem 2006 novem bro-dezem br o; 1 4 ( 6 ) : 9 0 1 - 6 .
Th i s ep i d em i o l o g i cal an d ex p l o r at o r y - d escr i p t i v e st u d y ai m ed t o i d en t i f y t h e so ci o eco n o m i c an d dem ogr aph ic f eat u r es, as w ell as t h e h ealt h an d disease con dit ion of elder ly people f r om a Fam ily Healt h Pr ogr am in Por t o Alegr e, Br azil, w it h t h e pu r pose of con t r ibu t in g t o t h e plan n in g of h ealt h act ion s f or t h is populat ion. Dat a fr om 98 elder ly people w er e collect ed t hr ough a hom e sur v ey by m eans of a sem ist r uct ur ed inst rum ent . The m ean age of t he int erview ed subj ect s w as 69.5. Sixt y- one part icipant s ( 62.2% ) w ere w om en; 40 ( 40.8% ) were m arried and 77 ( 78.6% ) did not have rem unerat ed work. Most m en ( 64.9% ) had a com panion, against 26.2% of wom en wit h a part ner. As t o healt h, 80.6% report ed suffering from som e pat hology, especially diseases of t he cir culat or y sy st em , r epor t ed by 55.1% of t he int er v iew ees. Alt hough t he collect ed dat a ar e in line wit h ot her st udies, knowledge about t hem is im port ant t o adapt healt h act ions by t he Fam ily Healt h Program t eam under st udy, in or der t o offer bet t er car e t o t hese elder ly people.
DESCRI PTORS: nursing; aged; fam ily health program ; aging; aging health; com m unity health nursing; fam ily health
CARACTERÍ STI CAS DEMOGRÁFI CAS, SOCI OECONÓMI CAS Y SI TUACI ÓN DE SALUD DE
ANCI ANOS DE UN PROGRAMA DE SALUD DE LA FAMI LI A DE PORTO ALEGRE, BRASI L
Se t r at a de un est udio epidem iológico, ex plor at or io- descr ipt iv o, que t uv o com o obj et iv o ident ificar las caract eríst icas dem ográficas, socioeconóm icas y la sit uación de salud y enferm edad de ancianos de un Program a de Salud de la Fam ilia en Por t o Alegr e, Br asil, con la finalidad de cont r ibuir par a el planeam ient o de acciones de salud a est a población. Se colect ar on dat os de 98 ancianos a t r av és de encuest a dom iciliar ia, ut ilizándose un inst rum ent o sem i- est ruct urado. Se observó que la edad prom edia de los suj et os era de 69,5 años. Del t ot al de ancianos, 61 ( 62,2% ) eran m uj eres; 40 ( 40,8% ) casados( as) y 77 ( 78,6% ) no poseían t rabaj o rem unerado. La m ayoría de los hom bres ( 64,9% ) t enía com pañera, cont rast ando con el 26,2% de m uj eres con com pañero. En cuant o a la salud, 80,6% r epor t ó alguna pat ología, dest acándose enfer m edades del apar at o cir culat or io en el 55,1% de los encuest ados. Se concluye que, aunque los dados aquí cit ados sean sem ej ant es a ot ros est udios, conocerlos es de real im port ancia para adecuar las acciones de salud del equipo del PSF est udiado, con obj et o de ofr ecer así una m ej or at ención a esos ancianos.
DESCRI PTORES: en f er m er ía; an cian o; p r og r am a salu d d e la f am ilia; en v ej ecim ien t o; salu d d el an cian o; enfer m er ía en salud com unit ar ia; salud de la fam ilia
CARACTERÍ STI CAS DEMOGRÁFI CAS, SOCI OECONÔMI CAS E SI TUAÇÃO DE SAÚDE DE
I DOSOS DE UM PROGRAMA DE SAÚDE DA FAMÍ LI A DE PORTO ALEGRE, BRASI L
Est udo epidem iológico, explor at ór io- descr it ivo que obj et ivou ident ificar as car act er íst icas dem ogr áficas, socioecon ôm icas e a sit u ação d e saú d e/ d oen ça d e id osos d e u m Pr og r am a d e Saú d e d a Fam ília d e Por t o Alegr e, Br asil, a fim de cont r ibuir par a o planej am ent o das ações de saúde a esses. Colet ou- se dados de 98 id osos at r av és d e in q u ér it o d om iciliar , u t ilizan d o- se d e in st r u m en t o sem i- est r u t u r ad o e m u lt id im en sion al. Verificou- se que a m édia de idade dos ent revist ados era de 69,5 anos. Do t ot al dos idosos: 61 eram m ulheres; 40 casados( as) e 77 não possuíam t r abalho r em uner ado. A m aior ia dos hom ens ( 64,9% ) t inha com panheir a, cont r ast ando com 26,2% de m ulher es com com panheir o. Quant o à saúde, 80,6% r elat ar am algum a pat ologia, dest acando- se as doenças do apar elho cir culat ór io em 5 5 , 1 % dos ent r ev ist ados. Conclui- se que, em bor a os dados encont r ados assem elhem - se a out r os est udos, o conhecim ent o desses é fundam ent al par a a adequação das ações de saúde da equipe do PSF est udado, com vist as à m elhor at enção a esses idosos.
DESCRI TORES: enferm agem ; idoso; program a saúde da fam ília; envelhecim ent o; saúde do idoso; enferm agem em saúde com unit ár ia; saúde da fam ília
1
RN, Master’s student, Rio Grande do Sul Federal University College of Nursing, CAPES grant holder, e- m ail: luccasm @ibestvip.com .br; 2 M.Sc. in Nursing, Doct oral St udent , Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent , Facult y, e- m ail: epm or ais@hot m ail.com ; 3 RN, Por t o Alegr e Hospit al de Clínicas, Mast er ’s st udent , Rio Gr ande do Sul Feder al Univ er sit y College of Nur sing, e- m ail: queniacam [email protected] .br. Mem ber of the Study Group on Education and Health in Fam ily and Com m unity, Rio Grande do Sul Federal University College of Nursing
I NTRODUCTI ON
I
t is know n t hat Brazil has been suffering a change in t he dem ogr aphic pr ofile of it s populat ion.This phenom enon - also called dem ographic t ransit ion
- r e f l e ct s so m e f a ct o r s, su ch a s t h e d e cr e a se i n
m at er nal fecundit y and infant m or t alit y, t he r educed
n u m b er of d eat h s cau sed b y in f ect iou s- con t ag iou s
diseases, in cr eased lif e ex pect an cy an d pr ogr essiv e
populat ion aging.
Thus, Br azil has been losing it s pr ofile as ‘a
count ry of young people’ - t he num ber of elderly has
con sider ably in cr eased at an in cr easin g pace - an d
conquer ing t he charact er ist ic of an aged count r y. I n
1991, t he elderly corresponded t o 7.3% ( 10.7 m illion)
of t h e Br azilian p op u lat ion ; accor d in g t o t h e 2 0 0 0
c e n s u s , t h i s r a t i o r o s e t o 8 . 6 % ( 1 4 . 5 m i l l i o n ) .
Pr o j e ct i o n s i n d i ca t e t h a t , i n 2 0 2 0 , 1 2 . 6 % o f t h e
Br azilian populat ion w ill consist of aged per sons and
t hat , in 2050, t his rat e will reach 16%( 1). I n it s policies, Brazil adopt s t he Wor ld Healt h Or ganizat ion’s ( WHO)
r ecom m en dat ion t o u se t h e age of 6 0 as a cu t - of f
point t o define old age in dev eloping count r ies.
Concerned about t his growing increase in t he
g l o b al el d er l y p o p u l at i o n , si n ce i t s 2 7 t h Di r ect i n g
Council, t he Pan Am erican Healt h Organizat ion ( PAHO)
h as st i m u l at ed i t s m em b er co u n t r i es t o est ab l i sh
nat ional pr ogram s and ser v ices for t he elder ly. Since
1996, t he ‘aging and healt h’ t hem e has been part of
t he Healt h Prom ot ion and Prot ect ion Division’s Fam ily
and Populat ion Healt h Pr ogr am , aim ed at elabor at ing
plans and int egrat ed act ions on ‘aging and healt h’ for
t he Am er icas( 2 ).
I n Br azil, t he cr eat ion of t he Nat ional Policy
for t he Elderly, in 1994, was a landm ark. More recent ly,
in Oct ob er 2 0 0 3 , t h e Fed er al Sen at e ap p r ov ed t h e
St at ut e of t he Elderly, wit h a view t o guarant eeing senior
cit izens’ social right s. The docum ent guarant ees t heir
access t o h ealt h an d social car e ser v ices; in t eg r al
healt h care t hrough t he Single Healt h Syst em ( SUS) ;
h o m e car e an d / o r h o sp i t al i zat i o n f o r el d er l y w i t h
locom ot ion disabilit ies and free m edicat ion, as well as
ot her t r eat m ent - r elat ed r esour ces. Anot her im por t ant
point is t he St at e’s obligat ion t o guarant ee prot ect ion
of life and healt h t o t he elderly, t hrough public policies
t h at allow f or h ealt h y an d d ig n if ied ag in g , w it h a
com for t able and adequat e life( 3). This r equir es healt h act ions for t he elderly t o aim for, am ong ot her fact ors,
m aint aining t hem in t he com m unity, wit h fam ily support ,
based on t he hom e care m odel.
I n t his sense, t he creat ion of t he Fam ily Healt h
Pr o g r a m ( FH P) s t r a t e g y i n 1 9 9 4 w a s e s s e n t i a l ,
deliv er ing car e at Fam ily Healt h Unit s ( FHU) and at
h o m e, t h r o u g h p r ev en t i o n , h ea l t h p r o m o t i o n a n d
r ecov er y act ion s.
I n t h i s s t r a t e g y, t h e w o r k o f h e a l t h
professionals, orient ed t owards int egral and perm anent
care for fam ilies linked wit h t he FHU, appears in each
phase of t heir life cy cle, in v iew of t heir fam ily and
so ci al co n t ex t . Th i s i n n o v at i v e h eal t h car e m o d el
dem ands a close relat ion bet ween healt h professionals
and t he populat ion t hey ar e r esponsible for, t hr ough
bonding and j oint r esponsibilit ies t hat enable healt h
act ions t o change t he realit y and healt h condit ions of
t h e in d iv id u als t h ey d eliv er car e t o. Th is m ak es it
f u n d am en t al t o ad ap t p r of ession als’ act ion s t o t h e
epidem iological pr ofile of t he populat ion t hey at t end,
wit h special at t ent ion t o t he elderly, due t o t heir needs
and progressive increase in num erical t erm s( 4- 5). Con sid er in g t h e ab ov e, r esear ch ab ou t t h e
ch ar act er ist ics of ag ed p eop le, t h eir ag in g p r ocess
an d t h e social con t ex t t h ey liv e in is essen t ial t o
suppor t healt h pr ofessionals’ act ions in FHU.
Hence, t he aim of t his st udy was: t o ident ify
t he dem ographic and socioeconom ic charact erist ics and
healt h sit uat ion of elderly people in an FHP area locat ed
in Port o Alegre ( Brazil) , t hus cont ribut ing t o t he planning
of healt h prom ot ion act ions for t hese client s.
MATERI AL AND METHODS
We car r i ed o u t an ep i d em i o l o g i cal , cr o
ss-sect ion al, ex p lor at or y an d d escr ip t iv e st u d y w it h a
quant it at ive approach. The research derived from t he
partnership between the Study Group on Education and
Healt h in Fam ily and Com m unit y ( NEESFAC) and t he
Port o Alegre Municipal Governm ent and was developed
in t he FHP of a poor com m unit y in t he sam e city. This
FHP pr ovides a pr act icum ar ea for st udent s fr om t he
Rio Grande do Sul Federal University School of Nursing
( EE/ UFRGS) . The study was j ointly constructed by health
se r v i ce p r o f e ssi o n a l s a n d f a cu l t y, m a st e r s a n d
undergraduat e st udent s from EE/ UFRGS.
Th e st u d y p o p u l a t i o n / sa m p l e i n cl u d e d a l l
elder ly per sons r egist er ed at t he place of st udy. The
follow in g in clu sion cr it er ia w er e u sed: age of 6 0 or
o l d e r a n d a cce p t i n g t o p a r t i ci p a t e i n t h e st u d y.
Exclusion crit eria were: having m oved out side t he FHP
visit at t em pt s by t he researchers. For t he sake of t his
st u dy, people aged 6 0 or m or e w er e con sider ed as
elder ly, in accor dance w it h t he age cr it er ion adopt ed
by t he St at ut e for t he Elderly( 3).
I n it ially, 1 3 7 sen ior s w er e select ed , 9 8 of
w h o m p a r t i ci p a t e d ( l o sse s o r r e f u sa l s: 2 8 . 4 % ) .
Reasons for loss were: not being found at hom e aft er
t hr ee v isit at t em pt s in 22 cases ( 16.1% ) ; change of
address in 8 ( 5.8% ) and deat h in 8 cases. One person
( 0. 7% ) r efused t o par t icipat e.
For dat a collect ion, we used a sem ist ruct ured
inst r um ent adapt ed fr om anot her st udy( 6), consist ing of 50 quest ions. These w er e gr ouped per dim ension
an d cov er ed t h e f ollow in g v ar iables: socioecon om ic
d at a; h ou sin g con d it ion s; leisu r e act iv it ies; u se of
healt h ser v ices and healt h/ disease sit uat ion.
A f t e r a p p r o v a l b y t h e U FRGS Et h i c s
Co m m i t t e e , d a t a c o l l e c t i o n o c c u r r e d b e t w e e n
Sep t em b er 2 0 0 3 a n d Ma r ch 2 0 0 4 , t h r o u g h h o m e
su r v ey s w it h t h e h elp of Com m u n it y Healt h Agen t s
from t he sam e FHP. Et hical principles w ere respect ed
accor ding t o t he Nat ional Healt h Council’s guidelines
est ablished in Resolut ion 196/ 96( 7). Dat a w er e t y ped an d ex p l o r ed t h r o u g h SPSS 1 3 . 0 so f t w ar e, w h i ch
m akes it possible t o insert , organize and analyze dat a
st at ist ically and provides result s as t ables and graphs.
Dat a analysis was guided by descript ive epidem iology.
Fi n d i n g s w er e p r esen t ed t h r o u g h f r eq u en ci es an d
cent r al t endency and disper sion m easur es.
RESULTS
Th e st u d y p o p u l a t i o n w a s p r e d o m i n a n t l y
f e m a l e , c o r r e s p o n d i n g t o 6 2 . 2 % ( 6 1 ) o f t h e
int erviewees. The wom en’s m ean age was 69.9 years
( ± 6.8) , against 68.8 years ( ± 4.8) for m en.
As t o t he par t icipant s’ social char act er ist ics,
w e f ou n d t h at 4 0 ( 4 0 . 8 % ) elder ly w er e m ar r ied or
l i v ed w i t h a p ar t n er. Th e r em ai n d er w as w i d ow ed
( 30. 6% ) and single, separ at ed or div or ced ( 28. 6% ) .
When relat ing gender and m arit al st at us, 64.9% ( 24)
of m en had a part ner, against only 26.2% for wom en.
Wit h respect t o educat ion, we found im port ant
differences am ong t he 98 elderly. A m aj orit y ( 40.8% )
possessed bet ween 01 and 04 years of educat ion, and
29.6% bet ween 05 and 09 years. Twent y- five ( 25.6% )
part icipant s were illit erat e, 17 of whom were wom en.
W h a t t h e i r i n c o m e w a s c o n c e r n e d , 7 4
( 7 5 . 5 % ) e l d e r l y r e ce i v e d r e t i r e m e n t o r p e n si o n
benefit s, while 14 ( 14.3% ) did not . Twent y- one persons
( 2 1 . 4 % ) w er e a ct i v e i n so m e k i n d o f p a i d w o r k ,
al t h o u g h so m e o f t h em h ad al r ead y r et i r ed . I t i s
rem arkable t hat , in 31 residencies ( 31.6% ) where t he
elderly lived wit h ( an) ot her persons( s) , ( s) he was t he
fam ily ’s only sour ce of incom e.
We found an average of 3.1 ( ± 1.8) individuals
per h om e, in clu din g t h e elder ly. Tw elv e ( 1 2 . 2 % ) of
t he 98 part icipant s lived alone; 40 ( 40.8% ) wit h one
ot her per son; 16 ( 16.3% ) w it h t w o and 30 ( 30.6% )
w it h t hr ee or m or e per sons.
As t o t heir par t icipat ion in r ecr eat ion and/ or
leisur e act iv it ies, w e found t hat 64 senior s ( 65. 3% )
regularly at t ended religious services: 45 ( 45.9% ) were
cat holic; 15 ( 15.3% ) evangelical; 04 ( 4.2% ) spirit ist ;
0 4 ( 4 . 2 % ) ot h er r eligion s an d 0 4 ( 4 . 2 % ) in dicat ed
m ore t han one religion. Ot her leisure act ivit ies included
balls ( 6.1% ) and spor t s ( 11.2% ) .
Table 1 - Dist r ibut ion of elder ly in t he FHP accor ding
t o healt h ser v ice v isit . Por t o Alegr e, 2004
Acco r d i n g t o Ta b l e 1 , 4 6 ( 4 6 . 9 % ) el d er l y
rout inely at t ended som e kind of healt h service, w hile
48 par t icipant s ( 49% ) only t ur ned t o healt h ser v ices
w h en n ecessa r y. We a l so f o u n d t h a t 3 3 ( 3 3 . 7 % )
seniors part icipat ed in t he group for hypert ensive and
diabet es pat ient s ( HI PERDI A) pr om ot ed in t he sam e
FHP.
An analysis of part icipant s’ self- report ed healt h
sit uat ion revealed t he result s shown in Table 2.
Table 2 - Dist r ibut ion of elder ly in t he FHP accor ding
t o self- r epor t ed healt h sit uat ion. Por t o Alegr e, 2004
s e l b a i r a
V n %
e c i v r e s h t l a e h e h t o t t i s i V e n it u o
R 46 46.9
y r a s s e c e n n e h
W 48 49.0
t i s i v o
N 04 4.1
p u o r g A I D R E P I H e h t n i n o i t a p i c i t r a P s e
Y 33 33.7
o
N 65 66.3
s e l b a i r a
V n %
) s ( m e l b o r p h t l a e H s e
Y 79 80,6
o
N 19 19,4
* s m e l b o r p h t l a e h n i a M m e t s y s y r o t a l u c r i
C 54 55,1
e v it c e n n o c d n a m e t s y s l a t e l e k s o l u c s u M e u s s
it 22 22,4
c il o b a t e m d n a l a n o it i r t u n , e n i r c o d n
E 20 20,4
m e t s y s y r o t a r i p s e
R 12 12,2
m e t s y s e v it s e g i
D 10 10,2
m e t s y s s u o v r e
N 09 9,1
s e x e n n a d n a e y
E 08 8,2
We also f ou n d 4 9 ( 5 0 % ) hy p er t en siv e an d
16 ( 16. 3% ) diabet ic elder ly, t en of w hom pr esent ed
b ot h d iseases at t h e sam e t im e. Wh en associat in g
t hese t wo diseases wit h part icipat ion in t he HI PERDI A
group, 26 ( 47.3% ) of t he 55 hypert ensive or diabet ic
pat ient s did not at t end t his group.
Wit h r espect t o m edicat ion use, 71.4% ( 70)
of t he FHP seniors t ook som e kind of m edicat ion, 97.1%
( 6 8 ) o n a d o c t o r ’ s p r e s c r i p t i o n . A s t o r e g u l a r
m edicat ion use, 22. 9% ( 16) of t hese 70 senior s did
not t ake it according t o t he prescript ion, wit h absence
of sy m pt om s, for get t ing, adv er se effect s and lack of
financial r esour ces as t he m ain causes.
The m ost consum ed m edicat ion t y pes w er e:
a n t i h y p e r t e n si v e s ( 4 1 . 8 % ) , f o l l o w e d b y d i u r e t i cs
( 3 2 . 6 % ) , a n a l g e s i c s / a n t i p y r e t i c ( 2 2 . 4 % ) , a n t i
-i n f l am m at o r y ( 1 7 . 3 % ) an d h y p o g l y cem -i c ( 1 1 . 2 % )
m ed icat ion .
DI SCUSSI ON
Th e s e s t u d y r e s u l t s a r e i m p o r t a n t f o r
analyzing and underst anding t he aging process of t he
populat ion regist ered in t he st udied FHU, as it is known
t h at t h er e d oes n ot ex i st on e si n g l e ol d ag e, b u t
m u lt ip le an d d iv er se f or m s of liv in g t h is p h ase in
h u m an dev elopm en t , w h ich is per son al, u n iqu e an d
h et er og en eou s.
However, som e generalizat ions can be m ade,
t o t he ext ent t hat t hese r esear ch findings r eflect t he
Br azilian r ealit y found in sim ilar st udies( 8- 9).
Mor e t han half ( 6 2 . 2 % ) of t he int er v iew ees
w er e w om en , w it h an av er ag e ag e of 6 9 . 9 y ear s,
char act er izing w hat lit er at ur e calls t he ‘w om anizat ion
of old ag e’( 8 ), esp ecially b ased on h ig h er m or t alit y r at es in t h e m ale popu lat ion . Th ese h igh er su r v iv al
rat es am ong wom en can be underst ood by t heir m ore
lim it ed exposure t o occupat ional risks, lower m ort alit y
r at es due t o ex t er nal causes and differ ent at t it udes
relat ed t o diseases, as t hey use healt h services m ore
frequent ly( 10). Only 26.2% of wom en in t his st udy had a p a r t n e r, r e f e r r i n g t o t h e so - ca l l e d ‘ p y r a m i d o f
solit ude’ as, t he older t hey becom e, t he m or e alone
t hey will be( 11). We also found m ore illit erat e wom en( 17), ev idencing t he social discr im inat ion pr act iced in t he
last cent ur y, as t hey w er e r esponsible for housew or k
a n d w er e co n seq u en t l y ex cl u d ed f r o m t h e sch o o l
en v ir on m en t .
Figures change am ong m en, as 64.9% had a
part ner, which can be explained on t he basis of social
and cult ural issues in our societ y, in which m en should
n ot be alon e an d m ar r iage w it h y ou n ger w om en is
con sider ed posit iv ely.
Alt hough a large m aj orit y of t he elderly m ainly
d ep en d s on r et ir em en t an d p en sion b en ef it s, it is
k n ow n t h at t h ese r ev en u es ar e oft en in su fficien t t o
at t end t o t heir needs st andar d. This is ev idenced in
21.4% of t he st udy populat ion’s report s, who report ed
t h e y p e r f o r m e d s o m e k i n d o f p a i d w o r k t o
com plem ent t heir m ont hly incom e. Mor eover, as age
in cr eases an d diseases appear, t h is gr ou p n eeds t o
sp e n d a l a r g e p a r t o f i t s f i n a n ci a l r e so u r ce s o n
p u r c h a s i n g m e d i c a t i o n a n d e s s e n t i a l h e a l t h
m ain t en an ce dev ices. I n t h is sen se, w e f ou n d t h at
m o st i n t er v i ew ed sen i o r s ( 8 0 . 6 % ) r ep o r t ed so m e
h ealt h pr oblem .
What m edicat ion is concerned, 71.4% of t he
elder ly n eeded som e k in d of m edicat ion , especially
an t ih y per t en siv es, diu r et ics, an algesics/ an t ipy r et ics,
an t i- in f lam m at or y an d h y p og ly cem ic ag en t s, w h ich
reflect ed t he st udy populat ion’s healt h sit uat ion, w it h
a si g n i f i can t am o u n t o f n o n - t r an sm i ssi b l e ch r o n i c
co n d i t i o n s, i n cl u d i n g h y p e r t e n si o n , d i a b e t e s a n d
m u s c u l o s k e l e t a l d i s e a s e s , s o m e o f w h i c h
concom it ant ly. Accor ding t o t he Brazilian I nst it ut e of
Geogr aph y an d St at ist ics( 1 2 ), ab ou t 5 0 % of sen ior s gain a personal incom e of one m inim um wage or less.
This inform at ion is a source of concern t o t he ext ent
t h a t h a l f o f t h e Br a zi l i a n p o p u l a t i o n sp e n d s t h e
eq u iv alen t of 2 5 % of it s r ev en u es on m ed icat ion .
Moreover, due t o high unem ploym ent rat es in younger
so ci a l g r o u p s, m a n y e l d e r l y h a v e t o sh a r e t h e i r
incom e wit h ot her fam ily m em bers, oft en t urning t hem
i n t o t h e o n l y o r m a i n r e s p o n s i b l e f o r f a m i l y
m aint enance. We found t hat t he elderly were t he only
sour ce of incom e in 31 households w her e t hey liv ed
w it h ot her per sons.
Anot her w or r y ing r esult in t his st udy is t he
senior s’ fam ily com posit ion: 12 liv ed alone, 40 w it h
one ot her per son and 30 w it h t w o. I n Br azil, due t o
t he lack of form al support , a significant part of socially
and financially less fav or ed aged per sons par t ially or
ex clu siv ely d ep en d on in f or m al su p p or t , esp ecially
by fam ily m em ber s( 13). On t he w hole, ex ist ing fam ily ar r angem ent s ( m any fam ily unit s w it h few per sons)
ar e i n cap ab l e o f at t en d i n g t o t h e sen i o r s’ n eed s,
ch ildr en , is ex t r em ely im por t an t t o at t en d t o t h ese
per sons’ needs, t o t he ex t ent t hat t his subst ant ially
in cr eases t h eir pr obabilit y of r eceiv in g h elp/ car e in
t heir act iv it ies/ diseases( 13).
Recr eat ion an d leisu r e act iv it ies ( b alls an d
sp or t s) st an d ou t as f u n d am en t al elem en t s in t h e
seniors’ lives as - when t hey no longer need t o work
- som e of t hese elderly becom e concerned about how
t o spend t heir free t im e( 15). I n t his respect , we highlight t h e im p or t an ce of en cou r ag in g an d of f er in g t h ese
act ivit ies t o t his public, as t hey are an effect ive st rat egy
t o decrease isolat ion, insert t hese persons in t he social
environm ent and develop new skills, which can direct ly
r ef lect in im p r ov ed self - est eem , q u alit y of lif e an d
healt h condit ions( 10) .
Mor eov er, d at a in t h is st u d y r ev ealed t h at
sen ior s f in d it r elev an t t o at t en d g r ou p act iv it ies,
h igh ligh t in g t h eir par t icipat ion in r eligiou s ser v ices.
This choice is oft en relat ed t o individuals’ need t o be
w elcom ed by social gr oups. This is in line w it h ot her
a u t h o r s( 1 6 ) w h o e m p h a s i z e t h a t a g e d p e r s o n s ’ par t icipat ion in r eligion s fav or s t h eir w ell- bein g an d
q u alit y of lif e an d d ecr eases, am on g ot h er t h in g s,
st ress and depression. I t also serves as social support
an d a w ay of in t er per son al in v olv em en t , f illin g t h e
v o i d p r o d u c e d b y r e t i r e m e n t , s o l i t u d e a n d / o r
w id ow h ood .
The discussion about t he elderly populat ion’s
access t o t he healt h syst em is also ext rem ely relevant
as, accor d in g t o ou r d at a, m or e t h an 9 0 % of t h e
in t er v iew ees u sed t h e h ealt h ser v ices on a r egu lar
b a s i s . H o w e v e r, t h e r e w e r e d i f f e r e n c e s i n t h e
fr equency of ser v ice use, as 46. 9% r out inely v isit ed
t he healt h service, while t he rem ained only used it in
case of n eed or h ealt h p r ob lem s. Th is r ev eals t h e
direct relat ion bet ween aging and great er use of healt h
r esou r ces, as t h e g r ow in g ag ed p op u lat ion d ir ect ly
af f ect s h ealt h sy st em u se, d u e t o t h e in cr ease in
com plex and/ or long- t erm problem s, w hose adequat e
ca r e r e q u i r e s t h e u se o f e x p e n si v e t e ch n o l o g i ca l
dev ices( 1 7 ).
I n t his r espect , it should be highlight ed t hat
t h e d em og r ap h ic t r an sit ion p r ocess b r ou g h t ab ou t
f u n d a m e n t a l c h a n g e s i n t h e e p i d e m i o l o g i c a l
panor am a of t he Br azilian populat ion’s m or bidit y and
m or t alit y. Alt hough not y et t ot ally solv ed, incidence
lev els of in f ect iou s- con t agiou s diseases ( I CD) h av e
d ecr eased , as o p p o sed t o t h e p r ev al en ce o f n o n
-t ransm issible chronic diseases ( NTCD) , -t ha-t is, a larger
part of seniors suffer from diseases like hypert ension,
diabet es, ar t hr osis and ot her s - char act er ist ics found
am ong t he st udy par t icipant s( 9 ). This fact gener at es w h at is called a ‘d ou b le d isease b u r d en ’, r ev ealin g
t h e n eed t o or gan ize a dou ble h ealt h car e agen da,
r et h in k in g cu r r en t policies an d in clu din g in n ov at iv e
care form s, such as geront ological( 18) and hom e care. From a pract ical view point , t oday, cont rolling
NTCD h as becom e a f ar m or e com plicat ed pr oblem
t han t reat ing I CD, considering t hat t here are no highly
effect iv e pr ev ent iv e m easur es ( such as v accines) for
t h e f or m er, as t h e ex ist in g alt er n at iv es t en d t o b e
ed u cat ion al( 9 ). I n t h is sen se, ach iev in g g ood NTCD t r eat m en t adh er en ce lev els in popu lat ion s w it h t h e
charact erist ics of t he elderly in t his st udy ( low incom e
and educat ion level) is a hard t ask, t o t he ext ent t hat
it m ain ly in v olv es r eed u cat ion of liv in g h ab it s an d
m edicat ion u se. Th is f act is sh ow n in t h e r esear ch
findings, where 22.9% of t he int erviewees did not use
m edicat ion accor ding t o t he doct or ’s pr escr ipt ion.
An o t h e r r e l e v a n t t r e a t m e n t f a ct i s t h e se
se n i o r s’ r e l a t i v e p a r t i ci p a t i o n i n t h e m a i n h e a l t h
educat ion act ivit y offer ed by t he FHP: HI PERDI A. We
found t hat about 1/ 3 of t he st udy populat ion at t ended
t his group, observing t hat a considerable part ( 47.3% )
o f d i a b et es a n d / o r h y p er t en si o n p a t i en t s d i d n o t
part icipat e. This indicat es t hat , for m any elderly, in a
way, HI PERDI A is not accessible, whet her due t o lack
o f k n o w l e d g e , l a ck o f i n t e r e st o r e v e n p e r so n a l
d i f f i cu l t i es t o m eet w i t h t h e g r o u p . Nev er t h el ess,
part icipat ing in educat ional act ivit ies can develop skills
an d k n ow led g e t h at collab or at e in t h e in d iv id u al’s
aut onom y as w ell as in cr it ical r eflect ions about his/
her choices. I n t his per spect iv e, it is fundam ent al t o
d i s c u s s t h e i m p o r t a n c e o f f o r m a l a n d i n f o r m a l
educat ion pr act ices, as gr oups ar e collect iv e spaces
w her e t he elder ly hav e t he oppor t unit y t o elabor at e
quest ions or iginat ed in t he conflict of ‘being elder ly ’.
This is also an opport unit y t o experience ot her ideas,
v alu es an d r ealit ies t h at w ill play a decisiv e r ole in
t h e in cor p or at ion of n ew at t it u d es in t o t h eir d aily
r ealit y( 15).
FI NAL CONSI DERATI ONS
I nit ially, an im por t ant conclusion of t his st udy
is t h at t h e pr oposed obj ect iv es w er e ach iev ed. Th e
r esult s w e found dem onst r at e t hat t he elder ly in t he
FHP u n d er st u d y p r esen t sim ilar ch ar act er ist ics in
w om en , low ed u cat ion lev el, low in com e, p r esen ce
of n on - t r an sm issible ch r on ic diseases, f r agile social
s u p p o r t n e t w o r k a n d l o w t r e a t m e n t a d h e r e n c e ,
am on g ot h er s.
We b e l i e v e t h e m a i n d i f f e r e n c e i n t h e
c o l l e c t e d a n d a n a l y z e d d a t a a p p e a r s w h e n w e
associat e t hem wit h t he cont ext t hese elderly are living
in, under st anding t his elem ent as cult ur e, life st y le,
beliefs and values. This is t he only way for figures t o
dem on st r at e t h e div er sit y fou n d in societ y in t er m s
of t he aging process. This associat ion is possible when
an FHU is select ed as a st udy / w or k ar ea, t hat is: t o
put faces on t he dat a, so as t o bet t er underst and t he
r ealit y healt h pr ofessionals ar e inser t ed in.
Wh en t h ey ar e con f r on t ed w it h d at a ab ou t
t he FHU populat ion, t hese pr ofessionals v isualize t he
l a c k o f p r e p a r a t i o n t o a t t e n d t o t h e s e n i o r s ’
pecu liar it ies an d com plex it ies, oft en r esu m in g t h em
t o t he ex pr ession ‘pat ient s w it h m ult iple com plaint s’.
This reveals t he urgent need for professional t raining
in t he basic healt h net work, as well as for t he creat ion
of ger iat r ics and ger ont ology r efer r al cent er s, w it h a
view t o providing qualit y care t o t he aged populat ion.
How ev er, t his r equir es budget r esour ces dest ined at
public policies t o t ak e int o account t he aging t hem e,
wit hout abandoning effort s in t he field of child healt h
an d edu cat ion act ion s. Th is w ill con st r u ct a societ y
pr epar ed for qualit y aging.
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