Socio-sanitary profile of the elderly in the family health strategy: a descriptive study

 

SUMMARY

Objective: To evaluate the living and health conditions of the elderly attended by Family Health Strategy teams of a municipality in the Amazon region. Method: a descriptive cross-sectional study conducted with 441 elderly selected by non-probabilistic sample in the city of Benevides, Brazil. The Elderly Handbook was applied to assign the profile of the elderly users. Results: predominantly young elderly (46%), with low education (86%), sedentary (84%), with chronic conditions (82%), with a normal self-reported health status (55%), who only seek health clinics to purchase medicines (58%) were found in the profile. Discussion: The data showed the need to adopt actions to promote healthy aging based on comprehensive care. Conclusion: the inference of the results obtained for the elderly population of the studied municipality promotes the realization of the reception of elderly users based on the real needs of this population, with focus on nursing in Primary Health Care in similar, needier contexts, of the Amazon region.

Keywords: Elderly population; Health conditions; Family Health Strategy; Primary care; Nursing.

 

INTRODUCTION

Studies worldwide have highlighted the phenomenon of demographic transition, which leads to a change in the age pattern of the population. The population profile of Brazil demonstrates an increase in the elderly age group (60 years and over), especially in the prolongation of life, with the population living until 80 and over (1).

In developed countries, population aging occurred gradually in the nineteenth century, while in developing countries, such as Brazil, this process was accelerated, with statistical projections forecasting that, by 2020, Brazil will occupy the sixth place in the world to have over 30 million elderly people (1). This process is accompanied by an epidemiological transition with chronic conditions, progressive fragility and dysfunctionalities, which burden public coffers with expenditure on social and health care. Maintaining autonomous and independent elderly or minimizing dependence for basic activities of daily living is challenging to the health sector and its correlates for the elderly population for active and healthy aging (2).

Given the conjuncture of the aging process of the population and the increase in people's longevity (1), it is imperative that intersectoral efforts provide basic attention that privileges the general educational character of protection of life and health in societal daily life, focused on welfare and quality of life of the elderly(3). In the Amazonian municipality in question, primary health care is provided by the Primary Health Unit and Family Health Strategy (FHS) teams, where most of the population live in poverty and marginalization. It represents one of the few resources in the health care of populations aimed at the elderly population.

In this context it is important to know the socio-sanitary health profile of the elderly users of the municipality, including those living in rural areas, considering the precariousness of health care resources and the general demands of the population, observed in local reality contexts, contributing to the implementation of public policies aimed at this specific population. Thus, the objective was to evaluate the living and health conditions of the elderly attended by the FHS teams of Benevides-PA.

 

METHOD

An Inferential descriptive cross-sectional study with elderly participant users of both sexes, registered in the 16 units (06 urban and 10 rural) of the FHS in Benevides, Pará. The sample consisted of 441 elderly, selected by non-probabilistic sample, and adopted a sampling error of 4.51%.

The sample size (n) was calculated based onimage1.pngwhere  Figura1and the sampling and N   is the total number of elderly registered and attended (4,250 elderly) (4).

Contextualization of the study site: The municipality is located 25 km from the capital city of Belém, has a geographical area of 177,769 km2 and a population of 51,663 inhabitants. The urban area has 56% of the population, and the rural area has 44%. In 2014, Primary Care had units with 16 FHS teams, with six in the rural area and ten in the urban area, representing a coverage of 82% of the total population of the municipality (5).

In order to meet the proposed objective, it was chosen to collect the data from the Ministry of Health's Elderly Booklet (6), as it is a useful clinical instrument already adopted in health units in the country. This booklet registers living and health conditions of the elderly, identifying risk factors in order to prioritize health care actions by including sociodemographic data; unhealthy habits such as smoking, alcohol use, physical inactivity; support network, identifying who would take care of the elderly when necessary and with whom they live. The item on health itself covers: self-perception of health status; health problems (complaints); use of medicines (polypharmacy); falls and hospitalizations suffered in recent years, which is a set of variables that can identify important risk indicators of diseases and frailty (6,7).

Data collection took place from January to February 2014 and met the inclusion criteria for the elderly aged 60 years or older, able to answer the research instruments, resident in the area of the family health units. Those who were not in their homes (for whatever reason) and those who did not completely answer the instruments (withdrawal of the elderly during the application of the instruments) were excluded.

The data were submitted to descriptive statistics analysis considering statistically significant values with a significance level of 5% (p ≤ 0.05).

The study was authorized by the Benevides Health Department and approved by the Ethics Committee on Research with Human Beings of the Universidade Federal do Pará and filed under no. 514,297, CAAE 22819013.2.0000.0018. All the elderly who agreed to participate in the study signed the Informed Consent Form (ICF).

 

RESULTS

The sociodemographic characterization of the sample is shown in Table 1, in which the weight of the younger 60-70 year-old age group (46%) and the majority of the female gender (52%), married/ or in civil union (61%), retired (49%) and with low education (86%) were observed. As for living situation, the majority lived with their families, and only 10.5% lived alone.

As seen in table 2, in relation to non-communicable chronic diseases, most of the elderly are affected (81%), although 54% reported having normal health and 36% reported having  good or excellent health. As for medication, it was found that most use up to two medications (58%) while 41% used three to six. However, they reported that they did not take sleeping medication (93%). They had not suffered falls in the last 12 months either (92%).

Regarding lifestyle, it was observed that only 13% of the elderly are smokers, but sedentary lifestyles (83%) with little physical activity is highlighted.

 

Table 1: Sociodemographic profile of the elderly population users of the Family Health Strategy, municipality of Benevides - PA, 2014.

Variables

          n (441)                                             %

Age group

 

 

60├ 70

203

46.0

70├ 80

138

31.2

>80

100

22.6

Sex

 

 

Male    

208

47.1

Female

233

52.8

Marital status

 

 

Married/Civil union

272

61.6

Widow

92

20.8

Single

66

14.9

Divorced/separated

11

2.4

Living situation

 

 

with partner

270

61.2

with children

103

23.3

Alone

46

10.5

with others*

22

5.0

Occupation

 

 

Retired

219

49.6

Schooling

 

 

≤4 years

382

86.6

5 - 8 years

52

12.0

≥ 9 years

7

1.5

Total

441

100.0

*Carer, siblings

 

 

Table 2: Living and health conditions of the elderly population, using the Family Health Strategy, Benevides - PA, Brazil, 2014.

Variables

n (441)

   %              

Self-reported health status

 

 

Bad

37

8.4

Normal

241

54.7

Good/great

163

36.9

Noncommunicable Chronic Disease

 

 

Yes

361

81.8

No

80

18.1

Medication use

 

 

Up to two medications

259

58.7

3 to 6 medications

182

41.3

Sleeping medication

 

 

Yes

32

7.0

No

409

93.0

Fall in the last year

 

 

Yes

34

7.8

No

407

92.2

Smoking

 

 

Actively smoking

 60

13.6

Physical exercise

 

 

Sedentary

371

83.9

Not sedentary

70

16.1

 

DISCUSSION

The data of the variables highlighted in the Elderly Booklet are easily understood by the FHS team and allows early interventions to minimize or remove risk factors for the improvement and/or worsening of chronic conditions. Therefore, this information was analyzed because they are essential for the management of comprehensive care, since fragmented care in health services is still prevalent, i.e., the elderly only attend the health unit when they are sick and/or to purchase medicines, an attitude which is still prevalent in traditional biomedical actions in the regional context under study.

The results showed a predominance of younger elderly in the sample, similar to other studies conducted in the region, such as elderly from the Marajoara archipelago (7) and elderly from Belém (8). However, this group of young elderly will need support from the social network of continuing care in the near future, as old age progresses over time, and they have low levels education, live in chronic situations, live under the same roof with scarce resources to provide for an entire family.

In addition, these same studies revealed a similar rate of around 20% of older elderly aged 80 and over. There are few studies aimed at this age group of the population, but specific demands for continued care are predictable (9,11).

The feminization of old age was also observed in 52%, corroborating well-known IBGE demographic data. Regarding marital status, most of the elderly are married or are in a civil union relationship (61%), a characteristic still observed among the elderly population in many studies in different regions of the country (7,12,13). Some authors emphasize that family life can minimize risk factors such as falls, health problems, hospitalization, due to help relationships and self-care in the home-family unit.

Regarding living situations, there was a predominance of married elderly (61%), which is consistent with national studies that show that being married is indicative of the elderly being future caregivers of each other, a worrying fact as most of the time, they cannot maintain adequate or quality care (7).

The study showed that most elderly people are affected by chronic diseases (81%), especially hypertension, diabetes mellitus and other metabolic diseases, among which obesity (7%) can be explained by sedentary lifestyle (84%) and possible unhealthy eating habits. Among the clinical characteristics, normal health (54%) predominates, as self-reported by the elderly, corroborated by national studies that show the perception of the elderly regarding the possible consequences of the deterioration of their health condition (7). Smoking does not predominate among the elderly, unlike other studies conducted especially in the South and Southeast, where older smokers, especially men, prevail. The onset of chronic disease may be a factor in the cessation of this habit, and health professionals should pay attention to action strategies that encourage the reduction or cessation of smoking among the elderly (14,15).

The elderly said they consumed one to six medications. International studies have found that the elderly population consumes an average of 3 to 5 drugs and 41% of these elderly take six or more drugs, thus characterizing polypharmacy as consuming more than five drugs per capita. Another study showed that polypharmacy can cause health risks and may influence the risk of falls. In Brazil, the free distribution by programs that are part of public health policies is a large factor that contributes to the indiscriminate use of drugs. This free offer can lead to younger people to use and abuse benzodiazepines and its chronic use contributes to dependence in older age groups (16, 17).

In this study, risk factors for health problems due to falls were minimal, perhaps due to the sample of younger elderly, or also due to the underreporting of lower consequence falls, such as those that do not result in fractures. Falling is defined as an accident that places the individual in a lower level position than their initial position. Falls have negative impacts on the quality of life of the elderly, because they have consequences for autonomy, functional capacity and independence, making the elderly dependent on care, consequently restricted to their daily activities, with the aggravation that the fear of falling generally decreases activity. (16)

Based on the results obtained, the demands presented should encourage the Family Health Strategy team professionals to develop integrated, intersectoral actions, with the perspective that, by knowing the specific living and health conditions, a community social support network can be created and made available to meet the needs of the elderly population. This is because, despite the absence of immediate physical or pathological problems, the elderly seek health facilities to meet their general needs, which can be sustained in a more holistic view of the human being and integrated into the local cultural context - the Amazon - and not solely focused on the symptom or underlying pathology. It is also worth noting that professionals, especially nurses, use resources as group activities to stimulate the empowerment of the elderly in coping with life and health issues as a way to promote the practice of active aging (17).

From this perspective, the adoption of  comprehensive care is based on the principles of the Unified Health System, becoming a challenge capable of making the access to health services effective, but which still needs to be practiced by the family health team, focusing on the context of the family nucleus and its community (17). In addition, health promotion care should be part of the work process of nurses; this may contribute to the creation of care protocols linked with health care networks for the elderly (18).

 

CONCLUSION

It was possible to evaluate the sociodemographic and sanitary profile of the elderly population, users of the FHS of an Amazonian municipality, based on the analysis of data provided by the Elderly Booklet - MS, as it identified the possible risk factors that favor health prioritizing actions in the health context. Half of the sample population represents young elderly between 60 and 70 years, however, a fifth is already octogenarian, the vast majority were affected by chronic diseases and self-reported as having normal health. Harmful health habits such as physical inactivity were also identified. Polypharmacy is present, but reports of falls are low.  Regarding social support, most are married and live with family, but those who are widowers, separated or single also live with family or friends, with only 10% living alone.

The results obtained for the elderly population of the studied city brings challenges to the care of elderly users based on the real needs of this population, with primary focus on nursing in Primary Health Care in similar, more needy, contexts of the Amazon region.

This study was limited as it was cross-sectional which did not allow the progression of living and health conditions of this population to be monitored. However, it stimulates  new research that can assist in the implementation of public policies for the elderly population.

 

REFERENCES

1. Pissinati PSC, Haddad MCFL, Silva LMM, Gvozd R, Galdino MJQ, Rossaneis MA. Envolvimento de pré-aposentados com ações favoráveis ao planejamento da aposentadoria: estudo analítico. Online Brazilian Journal of Nursing, [S.l.] [internet] 2018 Maio [cited 2019 Jun 20] 17(2). Available from: <http://www.objnursing.uff.br/index.php/nursing/article/view/5965>. 20 jun. 2019. doi: https://doi.org/10.17665/1676-4285.20185965.

 

2. Cavalcanti AD, Moreira RS, Barbosa JMV, Silva VL. Envelhecimento ativo e estilo de vida: uma revisão sistemática da literatura. Estud. interdiscipl. envelhec. [internet] 2016 Jan [cited 2019 Jun 20] 21 (1). Disponível em: https://www.seer.ufrgs.br/RevEnvelhecer/article/view/53402/40713

3. Miranda LCV, Soares SM, Silva PAB. Qualidade de vida e fatores associados em idosos de um Centro de Referência à Pessoa Idosa. Ciênc. saúde colet. [internet] 2016 Nov [cited 2019 Jun 20] 21 (11): 3533-44. Available from: https://www.scielosp.org/article/csc/2016.v21n11/3533-3544/# doi: https://doi.org/10.1590/1413-812320152111.21352015

 

4. Maleta CHM. Epidemiologia e Saúde pública. Belo Horizonte: COOPMED;2017.

 

5. Instituto Brasileiro de Geografia e Estatística. Censo 2015 [internet] [cited 2019 Jun 20]. Disponível em: https://ww2.ibge.gov.br/home/estatistica/populacao/tabuadevida/evolucao_da_mortalidade.shtm#

 

6. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde, Departamento de Ações Programáticas e Estratégicas. Caderneta de Saúde da Pessoa Idosa: manual de preenchimento. Brasília (DF): Ministério da Saúde, 2014. [cited 2016 Aug 03]. Available from: http://189.28.128.100/dab/docs/publicacoes/ geral/pnab.pdf

 

7. Goncalves LHT, Polaro SHI, Carvalho JN, Góes TM, Medeiros HP, Souza FJD. Condições de vida e saúde de idosos amazônidas: realidade de comunidades periféricas de cidades paraenses. Rev. Enferm. UFPE online. 2015. [Cited 2016 Oct 27]; 9(1): 39-46. Doi: http://dx.doi.org/JNUOL/10.5205/01012007

8. Freitas CV, Sarges ESNF, Moreira KECS, Carneiro SR. Avaliação de fragilidade, capacidade funcional e qualidade de vida dos idosos atendidos no ambulatório de geriatria em um hospital universitário. Rev Bras Geriatr Gerontol. 2016. [Cited 2016 Oct 20]19(1):119-128.Available from: http://www.redalyc.org/articulo.oaid=403844773011

 

9. Melo NCV de, Teixeira KMD, Barbosa TL, Montoya AJA, Silveira MB. Arranjo domiciliar de idosos no Brasil: a partir da Pesquisa Nacional por Amostras de Domicílios. Rev Bras Geriatr Gerontol. 2016. [Cited 2016 Oct 20] 19(1): 139-151. Available from: http://www.redalyc.org/articulo.oaid=403844773013

 

10. Sposito G, Neri AL, Yassuda MS. Atividades avançadas de vida diária (AAVDs) e o desempenho cognitivo em idosos residentes na comunidade. Rev Bras Geriatr Gerontol. 2016. [Cited 2016 Oct 20] 19(1):7-20. Available from: http://www.redalyc.org/articulo.oaid=403844773002

11. Campos ACV, Ferreira EF, Vargas AMD, Gonçalves LHT.   Healthy aging profile in octagenarians in Brazil. Rev Latino-Am. Enfermagem. 2016. [Access 2016 Oct 22]; 24: 2724. Available in: www.scielo.br/pdf/rlae/v24/0104-1169-rlae-24-02724.pdf. DOI: http://dx.doi.org/10.1590/1518-8345.0694.2724

 

12. Brito QKD, Menezes TN, Olinda RA. Incapacidade funcional e fatores socioeconômicos e demográficos associados em idosos. Rev Bras Enferm. 2015. [Access 2016 Oct 22]; 68(4):633-41. Available in: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672015000400633 DOI: http://dx.doi.org/10.1590/0034-7167.2015680409i

 

13. Rodrigues RMC, Silva CFR, Loureiro LMJ, Silva SMDT, Crespo SSS, Azeredo ZAS. The oldest old: multidimensional functional assessment. Rev Enf Ref. [internet] 2015. [Cited 2016 Sep 06]; 4(5):65-74. Available from: https://www.researchgate.net/profile/Zaida_Azeredo/publication/282447152_The_oldest_old_multidimensional_functional_assessment/links/56e4b36208ae65dd4cbe8047.pdf DOI: http://dx.doi.org/10.12707/RIV14040

 

14. Certo A, Sanhez K, Galvão AM, Fernades H. A síndrome da fragilidade nos idosos: revisão da literatura. Actas de Gerontologia [internet] 2016. [Cited 2016 Sep 06] 2(1): 1-11. Available from: http://hdl.handle.net/10198/12983

 

15. Focchesatto A, Rockett FC, Perry IDS. Fatores de risco e proteção para o desenvolvimento de doenças crônicas em população idosa rural do Rio Grande do Sul. Rev Bras Geriatr Gerontol. 2015. [Cited 2016 Sep 16]. 18(4):779-795. Available from: http://www.lume.ufrgs.br/handle/10183/18761 doi: http://hdl.doi.handle.net/10183/18761

 

16. Bezerra TA, Brito de MAA, Costa KNFC. Caracterização do uso de medicamentos entre idosos atendidos em uma unidade básica de saúde da família. Cogitare Enferm. [internet] 2016. [Access 2016 Sep 10]. 21(1): 01-11. Available from:  http://revistas.ufpr.br/cogitare/article/view/43011 DOI: http://dx.doi.org/10.5380/ce.v21i1.43011

 

17. Monterroso LEP, Joaquim N, Sá LO de. Adesão do regime terapêutico medicamentoso dos idosos integrados nas equipas domiciliárias de cuidados continuados. Rev Enf Ref. 2015. [Cited 2016 Aug 15]. 4(5):9-16 Available from: http://search.proquest.com/openview/8711d7320eecb302d737a58bc436f19c/1?pq-origsite=gscholar&cbl=2036194 doi: http://dx.doi.org/10.12707/RIV14047

 

18. Szerwieski LLD, Cortez DAG, Bennemann RM, Silva ES, Cortez LER. Capacidad cognitiva, estilo y calidad de vida de los ancianos: estudio transversal. Online Braz j nurs, [internet] 2017 Sep. [Cited 2019 Jun 15]. 16 (3): 298- 308. Available from: http://www.objnursing.uff.br/index.php/nursing/article/view/5723

Doi: https://doi.org/10.17665/1676-4285.20175723.

 





 

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