A saúde dos idosos brasileiros às vésperas do século XXI: problemas, projeções e alternativas

Abstract

Current characteristics and perspectives of Brazilian demographic and epidemiological transition processes are analyzed. Results from the 1991, 1993, 1995 and 1996 censuses, new population projections and recent studies on socioeconomic and health profiles of elderly people of S. Paulo, Rio de Janeiro and Belo Horizonte are discussed. In 1995, estimated life expectancy at birth in Brazil was already over 67 years. The number of individuals aged 60 years and older--in 1995, 8.3%, of the total population--is expected to duplicate and probably stabilize by the year 2050. Yet lacking coverage and quality, health services are already burdened with degenerative diseases and mental disorders, frequent outpatient appointments, high hospital bed occupation and high costs. Functional impairment and self-reported diseases are related to poverty among the elderly. for whom social and health support are not properly provided. Support from informal caregivers becomes more difficult due to impoverishment, family size reduction and youth migration. Institutionalization remains a poor approach as scarcity of beds and inadequacy of staff preclude its utilization. To minimize the impact of population aging on health services, it is proposed that effective programs covering the control of degenerative diseases and the prevention of their complications should be implemented--for the elderly population too. The importance of physical exercise, screening for neoplastic diseases, immunization, prevention of fractures caused by falls and early diagnosis of depression and dementia is emphasized. Actions must be coordinated by primary health care units, oriented towards local needs. It is essential to maintain the elderly in adequate, productive activities, invest in young people's education and health and in social and medical support programs for the caregivers.

Use of psychoactive drugs and related falls among older people living in a community in Brazil

“…4 The rising prevalence of chronic diseases and physical disability observed in those countries has also been verified in studies performed in large Brazilian cities. 6,12,15 In this age group, neurodegenerative diseases (e.g.…”

“…6,9,12,15 Signs and symptoms of these conditions in older people are often misinterpreted, sometimes leading to incorrect therapeutic approaches and the related adverse effects. 4,5,11 The purpose of this retrospective study is to ascertain whether there is an association between falls and psychoactive medication use in older residents living in a community in Brazil. By including the entire population of one neighbourhood of a small municipality (population of 48,000), it is possible to assume that the conclusions drawn here may be valid for similar municipalities.…”

Dinâmica da institucionalização de idosos em Belo Horizonte, Brasil

“…Tal tendência se explica, em parte, pelo fato de as mulheres viverem mais que os homens (em 1995, para cada 100 mulheres com 70-+ anos em Belo Horizonte, existiam apenas 50 homens da mesma faixa etá-ria) 4 , tornarem-se viúvas mais cedo, apresentarem maior dificuldade para casar ou para o recasamento após separação ou viuvez, e menores níveis de instrução, taxa de ocupação e renda 1,2,7 . A proporção de idosas morando sós -e com renda ainda menor -tem aumentado no Brasil 1 .…”

“…Controladas tais variáveis, a idade torna-se um fator de risco menor 14 . Idosos residentes na comunidade nas principais capitais brasileiras apresentam alta prevalência de fatores de risco para institucionalização 4,10 : doenças crônico-degenerativas e suas seqüelas, hospitalização recente e dependência para realizar atividades da vida diária * .…”

“…Novos arranjos familiares -mulheres sós, mães solteiras, casais sem filhos, filhos que emigraram -reduzem a perspectiva de envelhecimento em um ambiente familiar seguro 1 . Fatores de risco para a institucionalização 14 como morar só, suporte social precário e baixa renda (associada à viuvez, aposentadoria, menor oportunidade de empregos formais e estáveis e aumento dos gastos com a própria saúde) são cada vez mais freqüentes no Brasil 1,4 .…”