04.06.2023 Aging

In search of longevity

Study compared populations from different Brazilian cities to understand how psychosocial aspects impact the quality of life of elderly individuals

Aspectos psicossociais como depressão, solidão e isolamento têm efeito crucial sobre a capacidade funcional entre os mais idoso | Crédito: Acervo Einstein

Population aging is a global phenomenon and, in Brazil, the number of people over the age of 60 already represents nearly 15.5% of the population. It is estimated that, in the year 2050, 38 million Brazilians, or 18% of Brazil’s population, will be over the age of 65. Among the elderly, the longevous group—those aged 80 and over—is growing rapidly, which implies a marked change in the demographic pattern and the profile of prevalent diseases (with a proportional increase in hypertension, diabetes, and vision and hearing impairments, among others). Since 2015, a research group at the State University of Paraíba (UEPB), in partnership with the University of São Paulo (USP), has sought to understand which factors contribute to people aging in a healthier way.

The researchers have analyzed regional differences in aging, comparing longevous populations from the cities of São Paulo and Brejo dos Santos, a municipality located in northwestern Paraíba (on the border with Rio Grande do Norte), 448 km from the capital, João Pessoa.

The objective of the study, whose findings were described in an article published in BMC Geriatrics, was to understand how characteristics related to psychosocial aspects, household composition, sociodemographic conditions, and social support may influence the functional ability of elderly individuals 80 and over. Functional ability is understood as how capable the elderly person is of performing basic or more complex daily activities autonomously.

In the study, these abilities were assessed by reporting the need for assistance in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The ADLs are linked to the individual’s self-care—the longevous group was asked whether they can perform tasks such as walking, dressing, bathing, personal hygiene, brushing their hair, eating independently, getting into and out of bed and chairs, and going to the bathroom. The IADLs encompass tasks more related to the subject’s social participation, such as preparing hot meals, handling their own money, using transportation, shopping, using the telephone, performing light household chores, and taking medication.

The results of the study showed important regional differences related to aging in Brazil. For example, in São Paulo, nearly 70% of the elderly are women, most of whom live alone. Whereas in Brejo dos Santos, there is basically one elderly man for every woman (54% women) and most of them are married. Additionally, the populations that reside in the northeastern sertão (badlands) maintain the tradition of consanguineous marriages. On average, 20% of marriages in the sertão are among related individuals, while in the rest of Brazil this rate is 2%.

“The differences related to the proportion of females and males have repercussions in terms of the population’s health conditions. Among the longevous population, not having a partner may have a greater impact on functional ability,” says biologist Silvana Santos, a researcher at UEPB’s Center for Studies in Genetics and Education (NEGE). “The two longevous populations featured disparate sociocultural characteristics and these factors appeared to influence the psychological and family patterns established in two diverse cultures,” claims Júlia Cristina Leite Nóbrega, a physical therapist with a master’s in public health from UEPB, who also coauthored the article.

In the 1990s, the Pan American Health Organization (PAHO) developed a project in seven urban centers of Latin America to investigate the elderly population’s living and health conditions. This project was known as “Health, Well-Being, and Aging” (SABE). In Brazil, the SABE study has been further developed by researchers from USP’s School of Public Health and, a few years ago, it incorporated genetics research conducted by USP’s Human Genome Research Center and comparative studies of populations from different regions.

Brazil is a continental country with regional asymmetries and inequalities, as well as sociocultural and psychosocial differences that can influence functional ability. Scientific literature has shown that psychosocial aspects, including depression, self-rated health, subjective well-being, life satisfaction, loneliness, and isolation seem to have a critical effect on functional ability, particularly among the oldest population.

Other aspects that influence aging are human relationships and living arrangements. “We do not yet have data to understand these impacts in greater depth, but the fact that we have a broad picture of the health conditions and factors associated with the São Paulo and Brejo dos Santos populations will certainly help us understand this situation,” says Santos. “Therefore, cohort studies, those in which a given population is followed for a long period of time, are essential to understanding the population’s aging process,” she considers.

Public health network

Also, according to researchers, although the Brazilian Unified Health System (SUS) offers universal healthcare, there are still many challenges, such as limited resources and the concentration of specialized services in large urban centers. “The elderly residents of Brejo dos Santos, for example, must get blood tests in the neighboring town. If they require specialized medical care, or hospitalization, they must go to Catolé do Rocha or Cajazeiras,” explains Santos. “Sometimes, cancer treatments have to take place in Campina Grande or João Pessoa, 300 to 450 kilometers away and more than five hours of travel.”

According to the researcher, the study’s findings can help develop care programs and services in the field of gerontology, a science that studies aging, not only from a physiological perspective, but also considering biopsychosocial aspects.


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