Abstract
Objective:
to identify the perspective of elderly persons on healthy aging as described by scientific literature.
Method:
a descriptive integrative review type study was performed, guided by the question: what knowledge has been produced about healthy aging from the perspective of the elderly? It was carried out using the Scopus Info Site (SCOPUS), Cumulative Index to Nursing & Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Literature of Latin America and the Caribbean (LILACS), EMBASE and WEB OF SCIENCE databases and in the directory of the Scientific Electronic Library Online Journals (SciELO), for literature published in the period between 2005 and 2016.
Result:
Eleven papers were regarded as eligible for this review. These studies revealed that healthy aging is related to different health dimensions: biological (adoption of healthy habits and behaviors with self-responsibility), psychological (feelings of optimism and happiness), spiritual (faith and religiosity) and social (reciprocity in social support factors and the capacity to live autonomously and independently).
Conclusion:
the synthesis of knowledge on healthy aging from the perspective of the elderly can support the actions of professionals who work with this population group to encourage and value the social determinants involved, so overcoming the exclusive focusing on the adoption of habits and behaviors inherent to lifestyle to achieve aging in a healthy way.
Keywords:
Aging; Health of the Elderly; Review
Resumo
Objetivo:
identificar a perspectiva de idosos sobre o envelhecimento saudável em produções científicas.
Método:
estudo descritivo, do tipo revisão integrativa, norteado pela questão: qual o conhecimento produzido acerca da perspectiva de idosos sobre o envelhecimento saudável? Realizado nas bases de dados Scopus Info Site (SCOPUS), Cumulative Index to Nursing & Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), EMBASE, WEB OF SCIENCE e no diretório de revistas Scientific Eletronic Library Online (SciELO), publicadas no período entre 2005 e 2016.
Resultado:
onze artigos foram considerados elegíveis para esta revisão. Estes permitiram identificar que o envelhecimento saudável está relacionado a diferentes dimensões de saúde: biológica (adoção de hábitos e comportamentos saudáveis como autorresponsabilidade), psicológica (sentimentos de otimismo e felicidade), espiritual (fé e religiosidade) e social (reciprocidade no apoio social e capacidade de viver com autonomia e independência).
Conclusão:
a síntese do conhecimento acerca do envelhecimento saudável sob a perspectiva do idoso poderá subsidiar ações de profissionais que atuam junto a esse público de modo a estimular e valorizar os determinantes sociais envolvidos, transpondo orientações voltadas exclusivamente para adoção de hábitos e comportamentos inerentes ao estilo de vida para envelhecer de modo saudável.
Palavras-chave:
Envelhecimento; Saúde do Idoso; Revisão
INTRODUCTION
The elderly represent 12% of the world's population, and this figure is expected to double by 205011 Suzman R, Beard JR, Boerma T, Chatterji S. Health in an ageing world: what do we know? Lancet [Internet]. 2015 [acesso em 15 jun. 2017];9967(385):484-6. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25468156
https://www.ncbi.nlm.nih.gov/pubmed/2546...
and triple by 210022 United Nations. Departament of Economic and Social Affairs. World population prospects the 2015 revision: key findings and advanced tables [Internet]. New York: United Nations; 2015 [acesso em 15 jun. 2017]. Disponível em: http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf
http://esa.un.org/unpd/wpp/publications/...
. Greater longevity can be considered a success story for mankind33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
, and these extra years of life allow people to plan their future in a different manner to previous generations, depending on one central element: health44 Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet [Internet]. 2016 [acesso em 15 jun. 2017];387(10033):2145-54. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848186/pdf/nihms-737759.pdf
https://www.ncbi.nlm.nih.gov/pmc/article...
.
With this understanding, public policies have emphasized the positive meaning of aging and the contribution the elderly can make to society with their wealth of knowledge, skills and experiences in everyday life and work33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
,55 Cannon ML. What is aging? Dis Mon [Internet]. 2015 [acesso em 15 jun. 2017];61(11):454-9. Disponível em: http://www.diseaseamonth.com/article/S0011-5029(15)00143-1/abstract
http://www.diseaseamonth.com/article/S00...
. For this positive sense of aging, different terms are used: successful aging, active aging and, more recently, the resumption of the term healthy aging, proposed by the World Health Organization (WHO)33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
The WHO defines healthy aging as the "process of development and maintenance of functional capacity that allows well-being at an advanced age"33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
,44 Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet [Internet]. 2016 [acesso em 15 jun. 2017];387(10033):2145-54. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848186/pdf/nihms-737759.pdf
https://www.ncbi.nlm.nih.gov/pmc/article...
. Functional capacity, in turn, can be understood as the combination of the intrinsic capacity of the individual, the relevant environmental characteristics and the interactions between the individual and these characteristics33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
. Intrinsic capacity is the articulation of physical and mental abilities (including psychosocial)33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
. Environmental characteristics are the context of life, including social relations. Well-being is unique and permeated with subjective aspirations, including feelings of fulfillment, satisfaction and happiness33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
Thus, the understanding of healthy aging, as defined by the WHO, is comprehensive and relevant for all elderly people, even for those living with chronic diseases. It is also not centered on the absence of aggravations, nor is it restricted to the functionality of the elderly. Instead, it is based on a process that will allow the construction of skills that will enable elderly individuals to experience aging in the best possible way44 Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet [Internet]. 2016 [acesso em 15 jun. 2017];387(10033):2145-54. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848186/pdf/nihms-737759.pdf
https://www.ncbi.nlm.nih.gov/pmc/article...
.
In addition to the comprehensive WHO understanding of healthy aging, it is also worth exploring the collected scientific evidence on the perspective of the elderly on this issue, as they are the main actors in this context. This knowledge may provide additional information to support interventions and care for this group, and contribute to one of the guidelines of the Global Strategy and Plan of Action for Aging and Health 2016-2020, which encourages the construction and synthesis of evidence on healthy aging66 World Health Organization. Global strategy and action plan on ageing and health (2016-2020) [Internet]. Geneva: WHO; 2016 [acesso em 15 jun. 2017]. Disponível em: http://who.int/ageing/GSAP-Summary-EN.pdf
http://who.int/ageing/GSAP-Summary-EN.pd...
. In this context, the present study aimed to identify the perspective of the elderly on healthy aging as described in scientific productions.
METHOD
An integrative literature review was performed, allowing the identification of themes or problems relevant to the field of health and public policy, through the gathering, critical appreciation and synthesis of knowledge about the subject under investigation77 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs [Internet]. 2005 [acesso em 15 jun. 2017];52(5):546-53. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/16268861
https://www.ncbi.nlm.nih.gov/pubmed/1626...
. Such a method contributes to Evidence-Based Practice, following a standard of excellence regarding methodological rigor88 Soares CB, Hoga LAK, Peduzzi M, Sangaleti C, Yonekura T, Silva DRAD. Integrative review: concepts and methods used in nursing. Rev Esc Enferm USP [Internet]. 2014 [acesso em 15 jun. 2017];48(2):329-39. Disponível em: http://www.scielo.br/pdf/reeusp/v48n2/0080-6234-reeusp-48-02-335.pdf
http://www.scielo.br/pdf/reeusp/v48n2/00...
.
This integrative review was performed in five stages77 Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs [Internet]. 2005 [acesso em 15 jun. 2017];52(5):546-53. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/16268861
https://www.ncbi.nlm.nih.gov/pubmed/1626...
: in the first stage, the research question was formulated: what knowledge has been produced about healthy aging from the perspective of the elderly? The second stage involved the literature search through a survey of the scientific productions carried out in February 2017 in the main databases of the area of health: Scopus Info Site (SCOPUS), Cumulative Index to Nursing & Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Literature of Latin America and the Caribbean (LILACS), EMBASE, WEB OF SCIENCE and in the journal directory of the Scientific Electronic Library Online (SciELO). The period from 2005 to 2016 was used as a temporal cut-off point, with the start date based on the publication of the document Active aging: a WHO health policy99 World Health Organization. Envelhecimento ativo: uma política de saúde [Internet]. Brasília, DF: OPAS; 2005 [acesso em 15 jun. 2017]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/envelhecimento_ativo.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
.
The search was carried out based on the key-word “Healthy aging” and the descriptor “Aged”, obtained from the Health Sciences Descriptors (DECS) and the synonyms “elderly”, “senior” and “older people”. It was decided to use terms in English and the Bolean operators AND and OR, as shown in Chart 1.
Search strategy and articles found in databases and in the search directory. São Paulo, 2017.
To compose the sample, the following inclusion criteria were used: original articles published in the period from 2005 to 2016, electronically available in full in the English language, which addressed the perspective of the elderly on healthy aging. Literature reviews, annals of scientific events, experiment reports, dissertations and theses were excluded.
The inclusion and exclusion criteria were applied and allowed the selection of 11 articles to make up the study sample, as shown in Figure 1.
Diagram of the result of applying the inclusion and exclusion criteria of the study. São Paulo, 2017.
In the third stage a critical evaluation of the scientific productions that met the established criteria was carried out. The identified articles were evaluated for rigor, credibility, and relevance through the Critical Appraisal Skills Programme checklist (CASP). This instrument classifies the studies into two categories: A and B. Those classified as Category A present a small risk of bias, as they meet at least nine of the ten topics: 1) clear and justified objective; 2) methodological design appropriate for the objectives; 3) methodological procedures presented and discussed; 4) intentional sample selection; 5) data collection, instruments and saturation process described; 6) relationship between researcher and researched; 7) ethical aspects; 8) dense and substantiated analysis; 9) results presented and discussed, pointing out the credibility and use of triangulation; 10) description of the contributions, implications of the knowledge generated and its limitations1010 Critical Appraisal Skills Programme CASP: Qualitative Research Checklist [Internet]. [Sem Local]: [Sem Publicador]; 2017. Disponível em: http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf
http://docs.wixstatic.com/ugd/dded87_256...
. Category B included those with a moderate risk of bias, that is, those that meet at least five of the ten topics1010 Critical Appraisal Skills Programme CASP: Qualitative Research Checklist [Internet]. [Sem Local]: [Sem Publicador]; 2017. Disponível em: http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf
http://docs.wixstatic.com/ugd/dded87_256...
.
The CASP checklist was applied independently by three of the authors in order to guarantee the reliability of the present study. After CASP classification, a database was elaborated that made it possible to organize and compile the following information from the selected studies: article title, profession of the first author, year of publication, country, journal title, method and results (perspectives of the elderly about healthy aging).
In the fourth stage, the perspectives of the elderly on healthy aging were grouped by similarity of content (Table 2). The results were interpreted based on the literature related to the study theme. Finally, the fifth stage included the presentation of the synthesis of knowledge, contained in the discussion and final considerations section.
RESULTS
The highest proportion of articles (27.3%) was published in 2014. The countries that published the most articles were Brazil (36.3%), Canada (18.1%) and Thailand (18.1%). The professional area which published the most studies were psychologists (54.5%), followed by nurses (27.2%). Most of the journals (63.6%) were not specific to geriatrics or gerontology.
All the sampled articles were classified as Category A according to the CASP checklist1010 Critical Appraisal Skills Programme CASP: Qualitative Research Checklist [Internet]. [Sem Local]: [Sem Publicador]; 2017. Disponível em: http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf
http://docs.wixstatic.com/ugd/dded87_256...
. In terms of content, the selected studies found that the perspective of the elderly on healthy aging covered the biological, psychological, spiritual and social dimensions.
Chart 2 represents the synopsis of the sampled articles of the integrative review.
DISCUSSION
The sample of articles analyzed was diverse, with studies from each continent: America (Canada, USA, Brazil), Oceania (New Zealand), Europe (Germany, Hungary, Latvia, Sweden, United Kingdom), Africa (Ethiopia) and Asia (Thailand). It has been found that, as addressed in the scientific literature, healthy aging is a global concern33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
In terms of the participants, individuals under 60 years of age were considered in two studies. An Ethiopian article included Ethiopians over 50 years of age due to the expectation of life in this country being 541515 Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
https://link.springer.com/article/10.100...
. And in New Zealand, New Zealanders aged 55 and over were considered elderly11.
The knowledge produced about the perception of elderly people about healthy aging was discussed through the biological, psychological, spiritual and social dimensions.
Biological dimension
The elderly perceive healthy aging as the adoption of habits and behaviors inherent to lifestyle, with emphasis on healthy eating1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
,1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
,1414 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,1919 Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
http://seer.ufrgs.br/RevEnvelhecer/artic...
20 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
-2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
, physical activities1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
14 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
-1515 Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
https://link.springer.com/article/10.100...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,2020 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
-2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
, and not smoking or drinking alcohol1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
,1414 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,2020 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
,2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
. These habits and behaviors are protective factors and help control chronic noncommunicable diseases (CNCDs)2222 Ministério da Saúde. Estratégias para o cuidado da pessoa com doença crônica [Internet]. Brasília, DF: MS; 2014 [acesso em 15 jun. 2017]. (Cadernos de Atenção Básica, n. 35). Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_doenca_cronica_cab35.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
, which represent the major causes of mortality in the elderly population through outcomes such as ischemic heart disease, strokes and chronic obstructive pulmonary disease44 Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet [Internet]. 2016 [acesso em 15 jun. 2017];387(10033):2145-54. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848186/pdf/nihms-737759.pdf
https://www.ncbi.nlm.nih.gov/pmc/article...
,2222 Ministério da Saúde. Estratégias para o cuidado da pessoa com doença crônica [Internet]. Brasília, DF: MS; 2014 [acesso em 15 jun. 2017]. (Cadernos de Atenção Básica, n. 35). Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_doenca_cronica_cab35.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
.
The set of habits and behaviors described by the elderly is a priority theme in the National Health Promotion Policy (NHPP) in Brazil2323 Ministério da Saúde. Política Nacional de Promoção da Saúde: revisão da Portaria MS/GM nº 687, de 30 de março de 2006 [Internet]. Brasília, DF: MS; 2014. [acesso em 15 jun. 2017] Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude_pnaps.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
, and is expected to form part of Primary Health Care (PHC) through advice provided in educational groups on health, medical and nursing consultations and home visits, among other opportunities2222 Ministério da Saúde. Estratégias para o cuidado da pessoa com doença crônica [Internet]. Brasília, DF: MS; 2014 [acesso em 15 jun. 2017]. (Cadernos de Atenção Básica, n. 35). Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_doenca_cronica_cab35.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...
.
Thus, the efforts of professionals to prevent or control CNCDs focus heavily on the lifestyle of the individual. Such action contributes to the elderly assuming, in an isolated manner, the self-responsibility of acquiring a healthy lifestyle. From this perspective, scientific literature encompasses two distinct approaches, which involve either stimulating this posture or encouraging it with caution.
An American study2424 Potempa KM, Butterworth SW, Flaherty-Robb MK, Gaynor WL. The Healthy Ageing Model: health behaviour change for older adults. Collegian [Internet]. 2010 [acesso em 15 jun. 2017];17(2):51-5. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20738056
https://www.ncbi.nlm.nih.gov/pubmed/2073...
which stimulated self-responsibility in acquiring a healthy lifestyle considered a model described as a possible basis for enhancing PHC actions among the elderly with chronic conditions. This model consists of four pillars: "centered on the perspective of the elderly" - the elderly population considered as a heterogeneous group that requires individualized attention; "goal-oriented approach" - setting individualized, specific and achievable goals to be shared with the elderly; “individualized 'training' strategy for behavior change in health“ - focused on the elderly and based on instrumentalization with knowledge that allows the awareness that triggers behavioral change to be achieved; and the "context in which healthy behavior occurs" - a network of meaningful relationships for the elderly that contribute to achieving their goals.
In contrast, another American study advocated cautiously encouraging actions aimed at self-responsibility in the adoption of a healthy lifestyle. It presented in a broad manner the discussion about the poor efficacy of actions directed at an individual lifestyle, emphasizing the need to tackle the deeper causes of CNCDs. It recognizes that the economic and social environment is capable of restricting or increasing opportunities as it interferes in the behavior of the population2525 Mariner WK. Beyond lifestyle: governing the social determinants of health. Am J Law Med [Internet]. 2016 [acesso em 15 jun. 2017];42(2-3):284-309. Disponível em: http://journals.sagepub.com/doi/abs/10.1177/0098858816658268
http://journals.sagepub.com/doi/abs/10.1...
. As a result, not everyone is able to eat healthily, exercise properly, lose weight and avoid using tobacco, alcohol and other drugs2525 Mariner WK. Beyond lifestyle: governing the social determinants of health. Am J Law Med [Internet]. 2016 [acesso em 15 jun. 2017];42(2-3):284-309. Disponível em: http://journals.sagepub.com/doi/abs/10.1177/0098858816658268
http://journals.sagepub.com/doi/abs/10.1...
.
In addition to understanding healthy aging as the adoption of habits and behaviors inherent to lifestyle, the elderly emphasized the importance of taking care of one’s health. This involves performing routine medical check-ups, examinations, vaccinations1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
and managing diseases efficiently1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
. However, they did not associate healthy aging with disease1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
12 Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
https://www.ncbi.nlm.nih.gov/pubmed/2467...
13 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
14 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
15 Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
https://link.springer.com/article/10.100...
16 Bacsu J, Jeffery B, Abonyi S, Johnson S, Novik N, Martz D, et al. Healthy aging in place: perceptions of rural older adults. Educ Gerontol [Internet]. 2014 [acesso em 15 jun. 2017];40(5):327-37. Disponível em: http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191
http://www.tandfonline.com/doi/abs/10.10...
-1717 Boratti KLP, Soriano FS. A percepção de idosas acerca das crenças de autoeficácia e envelhecimento saudável. Aletheia [Internet]. 2013 [acesso em 15 jun. 2017];42:51-61. Disponível em: http://pepsic.bvsalud.org/pdf/aletheia/n42/n42a05.pdf
http://pepsic.bvsalud.org/pdf/aletheia/n...
,1919 Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
http://seer.ufrgs.br/RevEnvelhecer/artic...
20 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
-2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
.
Psychological Dimension
In the psychological dimension, the perspectives of the elderly on healthy aging were aggregated, with optimism appearing most frequently1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
,1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
,1616 Bacsu J, Jeffery B, Abonyi S, Johnson S, Novik N, Martz D, et al. Healthy aging in place: perceptions of rural older adults. Educ Gerontol [Internet]. 2014 [acesso em 15 jun. 2017];40(5):327-37. Disponível em: http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191
http://www.tandfonline.com/doi/abs/10.10...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,1919 Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
http://seer.ufrgs.br/RevEnvelhecer/artic...
. The older persons revealed that being positive and optimistic is an essential part of healthy aging, with optimism understood as the expectation that something positive will happen2626 Vilhena E, Pais-Ribeiro J, Silva I, Pedro L, Meneses RF, Cardoso H, et al. Optimism on quality of life in portuguese chronic patients: moderator/mediator? Rev Assoc Med Bras [Internet]. 2014 [acesso em 15 jun. 2017];60(4):373-80. Disponível em: http://www.scielo.br/pdf/ramb/v60n4/0104-4230-ramb-60-04-0373.pdf
http://www.scielo.br/pdf/ramb/v60n4/0104...
.
Optimism in aging may result from the presence of a social support network, quality of life and individual and social activities within the daily lives of the elderly2727 Silva PA. Individual and social determinants of self-rated health and well-being in the elderly population of Portugal. Cad Saúde Pública [Internet]. 2014 [acesso em 15 jun. 2017];30(11):2387-400. Disponível em: http://www.scielo.br/pdf/csp/v30n11/0102-311X-csp-30-11-2387.pdf
http://www.scielo.br/pdf/csp/v30n11/0102...
. Based on this understanding, a Brazilian study brought together scientific productions about optimism and health, and found a significant number of international studies with this theme, considering people with CNCDs. According to these individuals, optimism is considered a factor of protection and coping with the consequences of these injuries2828 Santos MC, Wechsler SM. Análise das publicações científicas sobre otimismo em saúde no último triênio. Psicol Argum [Internet]. 2015 [acesso em 15 jun. 2017];33(83):470-82. Disponível em: http://www2.pucpr.br/reol/pb/index.php/pa?dd1=16210&dd99=view&dd98=pb
http://www2.pucpr.br/reol/pb/index.php/p...
.
There is no well-defined concept for happiness as it varies according to the cultural and social context of each country2929 Jeon SW, Han C, Lee J, Lim JH, Jeong H, Park MH, et al. Perspectives on the happiness of community-dwelling elderly in Korea. Psychiatry Investig [Internet]. 2016 [acesso em 15 jun. 2017];13(1):50-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701685/
https://www.ncbi.nlm.nih.gov/pmc/article...
. In South Korea, a study of the elderly revealed an association between family and the perception of happiness. These individuals often described the importance of being together with family and living in peace with relatives2929 Jeon SW, Han C, Lee J, Lim JH, Jeong H, Park MH, et al. Perspectives on the happiness of community-dwelling elderly in Korea. Psychiatry Investig [Internet]. 2016 [acesso em 15 jun. 2017];13(1):50-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701685/
https://www.ncbi.nlm.nih.gov/pmc/article...
. It therefore appears that elderly persons with significant contact with family members and people close to them enjoy a broader sense of well-being than those without such contacts3030 Mantovani EP, Lucca SR, Neri AL. Associations between meanings of old age and subjective well-being indicated by satisfaction among the elderly. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 15 jun. 2017];19(2):203-22. Disponível em: http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00203.pdf
http://www.scielo.br/pdf/rbgg/v19n2/en_1...
.
The welfare of the elderly is a vital component to be considered in public policies. In 2002, in Madrid, the Second World Assembly on Aging established the International Plan of Action on Aging, listing priorities for action which included "well-being in old age"3131 Fernandes MTO, Soares SM. The development of public policies for elderly care in Brazil. Rev Esc Enferm USP [Internet]. 2012 [acesso em 15 jun. 2017];46(6):1494-502. Disponível em: http://www.scielo.br/pdf/reeusp/v46n6/en_29.pdf
http://www.scielo.br/pdf/reeusp/v46n6/en...
. In 2015, the WHO report on aging and health encompassed well-being in the concept of healthy aging, emphasizing the importance of "promoting health and well-being throughout life”33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
Accordingly, in this report, the WHO recommends that to achieve healthy aging, public policies, health services and professionals should work from an intersectoral perspective, connecting the elderly, family and society, and develop actions that promote the development and maintenance of functional capacity as a strategy that allows the well-being of the elderly population33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
Spiritual dimension
This dimension brings together the perspectives of the elderly on healthy aging in relation to faith and spirituality. According to the studies that composed the analyzed sample, faith and spirituality provide support for dealing with the challenges of living with multiple sclerosis1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
and facing daily difficulties1919 Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
http://seer.ufrgs.br/RevEnvelhecer/artic...
. Most of these studies, however, while recognizing the importance of this theme for healthy aging, did not explore it further1212 Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
https://www.ncbi.nlm.nih.gov/pubmed/2467...
,1515 Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
https://link.springer.com/article/10.100...
,1717 Boratti KLP, Soriano FS. A percepção de idosas acerca das crenças de autoeficácia e envelhecimento saudável. Aletheia [Internet]. 2013 [acesso em 15 jun. 2017];42:51-61. Disponível em: http://pepsic.bvsalud.org/pdf/aletheia/n42/n42a05.pdf
http://pepsic.bvsalud.org/pdf/aletheia/n...
,2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
, with the exception of the articles on elderly Thai people1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,2020 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
.
For these individuals, food and care of the body are related to spirituality, as well as the practice of healing and worshipping of ancestors. The practice of healing involves taking care of oneself before consulting a doctor (such as body massages with a piece of wood to relieve muscle pain) and worshiping one’s ancestors to preserve health, as failing to do so may result in one falling ill1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,2020 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
.
There is evidence that older people tend to be more religious than younger people3232 Zimmer Z, Jagger C, Chiu C, Ofstedal MB, Rojo F, Saito Y. Spirituality, religiosity, aging and health in global perspective: a review. SSM Popul Health [Internet]. 2016 [acesso em 15 jun. 2017];2:373-81. Disponível em: http://www.sciencedirect.com/science/article/pii/S2352827316300179
http://www.sciencedirect.com/science/art...
. Still, the elderly who live with chronic diseases often have a need to feel close to a higher power which gives them the strength to face difficulties3333 Palencia IPG, Banquett DC, Quintana MC, Villamizar AL, Mendoza YV. Spirituality and religiosity in elderly adults with chronic disease. Invest Educ Enferm [Internet]. 2016 [acesso em 15 jun. 2017];34(2):235-42 Disponível em: http://www.scielo.org.co/pdf/iee/v34n2/v34n2a02.pdf
http://www.scielo.org.co/pdf/iee/v34n2/v...
.
Religiousness and spirituality can contribute to healthier lifestyles by assigning negative points of view to the consumption of drugs and alcoholic beverages, tobacco use and nonmarital sex, among others3232 Zimmer Z, Jagger C, Chiu C, Ofstedal MB, Rojo F, Saito Y. Spirituality, religiosity, aging and health in global perspective: a review. SSM Popul Health [Internet]. 2016 [acesso em 15 jun. 2017];2:373-81. Disponível em: http://www.sciencedirect.com/science/article/pii/S2352827316300179
http://www.sciencedirect.com/science/art...
. In addition, they can make it possible to deal with stressful life events3030 Mantovani EP, Lucca SR, Neri AL. Associations between meanings of old age and subjective well-being indicated by satisfaction among the elderly. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 15 jun. 2017];19(2):203-22. Disponível em: http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00203.pdf
http://www.scielo.br/pdf/rbgg/v19n2/en_1...
, contribute to overcoming adversities, such as the loss of loved ones, the loss of physical abilities, and promote meaning in life. Faith can promote virtues such as humility, altruism, compassion, wisdom and gratitude3232 Zimmer Z, Jagger C, Chiu C, Ofstedal MB, Rojo F, Saito Y. Spirituality, religiosity, aging and health in global perspective: a review. SSM Popul Health [Internet]. 2016 [acesso em 15 jun. 2017];2:373-81. Disponível em: http://www.sciencedirect.com/science/article/pii/S2352827316300179
http://www.sciencedirect.com/science/art...
.
Social dimension
The perspective of the elderly on healthy aging is closely related to social relationships. For these individuals, relating socially1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
,1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
,1616 Bacsu J, Jeffery B, Abonyi S, Johnson S, Novik N, Martz D, et al. Healthy aging in place: perceptions of rural older adults. Educ Gerontol [Internet]. 2014 [acesso em 15 jun. 2017];40(5):327-37. Disponível em: http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191
http://www.tandfonline.com/doi/abs/10.10...
,2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
, with the family1212 Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
https://www.ncbi.nlm.nih.gov/pubmed/2467...
,1515 Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
https://link.springer.com/article/10.100...
,1919 Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
http://seer.ufrgs.br/RevEnvelhecer/artic...
20 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
-2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
, friends1212 Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
https://www.ncbi.nlm.nih.gov/pubmed/2467...
,1414 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
,1919 Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
http://seer.ufrgs.br/RevEnvelhecer/artic...
, or with a partner1212 Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
https://www.ncbi.nlm.nih.gov/pubmed/2467...
or engaging in collective leisure activities1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
are ingredients for healthy aging.
It was also emphasized that social relations with family members, children and partners or informal relationships with friends, neighbors and colleagues, as well as formal relationships with health and community services, are fundamental to the well-being of the elderly3030 Mantovani EP, Lucca SR, Neri AL. Associations between meanings of old age and subjective well-being indicated by satisfaction among the elderly. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 15 jun. 2017];19(2):203-22. Disponível em: http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00203.pdf
http://www.scielo.br/pdf/rbgg/v19n2/en_1...
and to healthy aging33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
. Yet strong social relationships can increase quality of life, and longevity and promote resilience33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
There is ambivalence3 involved with social relations as both actors involved in the relationship are influenced in a reciprocal and singular way. At the same time, one person may influence or contribute to a greater extent than the other. In this case, when the elderly participant in the social relationship receives support through such an interaction, it can be said that social support is provided3434 Kool MB, Van Middendorp H, Lumley MA, Bijlsma JW, Geenen R. Social support and invalidation by others contribute uniquely to the understanding of physical and mental health of patients with rheumatic diseases. J Health Psychol [Internet]. 2013 [acesso em 15 jun. 2017];18(1):86-95. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/22363049
https://www.ncbi.nlm.nih.gov/pubmed/2236...
. This can alleviate everyday problems and promote physical and mental health3535 Wang X. Subjective well-being associated with size of social network and social support of elderly. J Health Psychol [Internet]. 2014 [acesso em 15 jun. 2017];21(6):1037-42. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25104778
https://www.ncbi.nlm.nih.gov/pubmed/2510...
. As a support for health actions, social support can also contribute to increasing the sense of joy, self-esteem and self-confidence of an individual3434 Kool MB, Van Middendorp H, Lumley MA, Bijlsma JW, Geenen R. Social support and invalidation by others contribute uniquely to the understanding of physical and mental health of patients with rheumatic diseases. J Health Psychol [Internet]. 2013 [acesso em 15 jun. 2017];18(1):86-95. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/22363049
https://www.ncbi.nlm.nih.gov/pubmed/2236...
,3535 Wang X. Subjective well-being associated with size of social network and social support of elderly. J Health Psychol [Internet]. 2014 [acesso em 15 jun. 2017];21(6):1037-42. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25104778
https://www.ncbi.nlm.nih.gov/pubmed/2510...
.
In addition to being supported, the elderly can also provide support. For many, supporting others is more important than receiving support, contributing to a strengthening of their self-esteem and social involvement3030 Mantovani EP, Lucca SR, Neri AL. Associations between meanings of old age and subjective well-being indicated by satisfaction among the elderly. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 15 jun. 2017];19(2):203-22. Disponível em: http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00203.pdf
http://www.scielo.br/pdf/rbgg/v19n2/en_1...
. This can be seen by their social contributions1717 Boratti KLP, Soriano FS. A percepção de idosas acerca das crenças de autoeficácia e envelhecimento saudável. Aletheia [Internet]. 2013 [acesso em 15 jun. 2017];42:51-61. Disponível em: http://pepsic.bvsalud.org/pdf/aletheia/n42/n42a05.pdf
http://pepsic.bvsalud.org/pdf/aletheia/n...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
and desire to do good2121 Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
http://www.scielo.br/pdf/prc/v20n1/a11v2...
through voluntary work1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
,1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
.
According to the WHO, voluntary work can positively influence the health of the elderly, favoring self-perception of health, reducing systemic arterial hypertension, increasing physical strength and gait speed and reducing depressive symptoms33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
, especially as it is socially valued and publicly recognized. It is worth mentioning that voluntary work should respect the autonomy of the elderly, or it may influence their mental health in a harmful way instead of bringing benefits3636 Tomioka K, Kurumatani N, Hosoi H. Positive and negative influences of social participation on physical and mental health among community-dwelling elderly aged 65-70 years: a cross-sectional study in Japan. BMC Geriatr [Internet]. 2017 [acesso em 15 jun. 2017];17(1):1-13. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437627/pdf/12877_2017_Article_502.pdf
https://www.ncbi.nlm.nih.gov/pmc/article...
.
Autonomy and independence were also perceived by the elderly as components for healthy aging. Autonomy is the ability to act and take decisions1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
while independence is the ability to perform activities without the help of other people. In this sense, the studies reviewed related autonomy to financial security1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
,1212 Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
https://www.ncbi.nlm.nih.gov/pubmed/2467...
,1414 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
, which has also been found to be a component of healthy aging33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
. In Brazil, the National Policy for the Health of the Elderly states that income contributes to the health of the elderly, demonstrating that being healthy should include financial independence, physical health, mental health, functional capacity and social support3737 Ministério da Saúde. Política Nacional de Saúde da Pessoa Idosa. Portaria nº 2.528 de 19 de outubro de 2006 [Internet]. Brasília, DF: MS; 2006 [acesso em 15 jun. 2017]. Disponível em: http://www.saudeidoso.icict.fiocruz.br/pdf/PoliticaNacionaldeSaudedaPessoaIdosa.pdf
http://www.saudeidoso.icict.fiocruz.br/p...
. This policy also stresses that care for the elderly, at all levels, must preserve their autonomy and independence3737 Ministério da Saúde. Política Nacional de Saúde da Pessoa Idosa. Portaria nº 2.528 de 19 de outubro de 2006 [Internet]. Brasília, DF: MS; 2006 [acesso em 15 jun. 2017]. Disponível em: http://www.saudeidoso.icict.fiocruz.br/pdf/PoliticaNacionaldeSaudedaPessoaIdosa.pdf
http://www.saudeidoso.icict.fiocruz.br/p...
.
Independence for the elderly involves caring for oneself1515 Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
https://link.springer.com/article/10.100...
,1616 Bacsu J, Jeffery B, Abonyi S, Johnson S, Novik N, Martz D, et al. Healthy aging in place: perceptions of rural older adults. Educ Gerontol [Internet]. 2014 [acesso em 15 jun. 2017];40(5):327-37. Disponível em: http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191
http://www.tandfonline.com/doi/abs/10.10...
and for others1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
, enjoying activities1313 Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
http://www.scielo.br/pdf/rbgg/v18n4/1809...
,1616 Bacsu J, Jeffery B, Abonyi S, Johnson S, Novik N, Martz D, et al. Healthy aging in place: perceptions of rural older adults. Educ Gerontol [Internet]. 2014 [acesso em 15 jun. 2017];40(5):327-37. Disponível em: http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191
http://www.tandfonline.com/doi/abs/10.10...
and home management1414 Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
https://www.ncbi.nlm.nih.gov/pubmed/2452...
. Elderly persons with multiple sclerosis connected the environment with independence when they noted the need to adapt the environment in which they lived to be able to live independently1111 Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
https://www.hindawi.com/journals/msi/201...
. It is because of this insight that the WHO highlights the importance of considering the environment in the promotion of healthy aging, noting that it can be a resource or a barrier33 World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
http://apps.who.int/iris/bitstream/10665...
.
Unlike Western cultures, studies that focused on Thai seniors discussed interdependence, rather than autonomy and independence. In the Thai culture the elderly are a central part of rituals, their children and grandchildren demonstrate love and respect towards them, they receive support from their families in many ways (respect, love, care, financial, clothing, among others) and they are honored in village festivals1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,2020 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
. This interdependence favors self-esteem, involves companionship, contact, concern and reciprocity in care1818 Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
https://www.ncbi.nlm.nih.gov/pubmed/2318...
,2020 Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
https://www.ncbi.nlm.nih.gov/pubmed/1985...
.
One of the limitations of this study was that it featured a small sample of articles, although the survey reflected the perception of the elderly in diversified countries in relation to cultural, political and social aspects, which influence the population's perception of healthy aging directly and indirectly.
The synthesis of knowledge about healthy aging from the perspective of the elderly can support the actions of professionals who work with this population in order to stimulate and value the social determinants involved, leading to guidance directed exclusively towards the adoption of habits and behaviors inherent to lifestyle in order to age in a healthy manner.
CONCLUSION
The study revealed that the perception of healthy aging brings together biological, psychological, spiritual and social dimensions. In the biological dimension, the need to adopt habits and behaviors inherent to lifestyle to age in a healthy way was clear. Such a position encompasses two distinct discussions: stimulating this behavior or encouraging it with caution, recognizing that the economic and social environment can restrict or expand opportunities, and as a consequence interfere in the behavior of the population.
In the psychological dimension, the elderly described optimism and happiness as important for healthy aging. In the spiritual dimension, most of the elderly recognized faith and spirituality as elements for healthy aging, yet the authors of the studies did not explore this dimension further, except for studies involving Thai seniors.
In the social dimension, social relationships with family, friends and partners were highlighted. There is some ambivalence in this dimension, which is evidenced by the need to receive support and simultaneously support and contribute, mainly through voluntary work.
In this context, further studies are recommended to broaden knowledge of the perspective of the elderly on healthy aging in order to contribute to one of the guidelines of the Global Strategy and Plan of Action for Aging and Health 2016-2020, and to strengthen the relationship between social determinants and healthy aging.
REFERENCES
-
1Suzman R, Beard JR, Boerma T, Chatterji S. Health in an ageing world: what do we know? Lancet [Internet]. 2015 [acesso em 15 jun. 2017];9967(385):484-6. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25468156
» https://www.ncbi.nlm.nih.gov/pubmed/25468156 -
2United Nations. Departament of Economic and Social Affairs. World population prospects the 2015 revision: key findings and advanced tables [Internet]. New York: United Nations; 2015 [acesso em 15 jun. 2017]. Disponível em: http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf
» http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf -
3World Health Organization. World report on ageing and health [Internet]. Geneva: WHO; 2015 [acesso em 15 jun. 2017]. Disponível em: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1
» http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?ua=1 -
4Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet [Internet]. 2016 [acesso em 15 jun. 2017];387(10033):2145-54. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848186/pdf/nihms-737759.pdf
» https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848186/pdf/nihms-737759.pdf -
5Cannon ML. What is aging? Dis Mon [Internet]. 2015 [acesso em 15 jun. 2017];61(11):454-9. Disponível em: http://www.diseaseamonth.com/article/S0011-5029(15)00143-1/abstract
» http://www.diseaseamonth.com/article/S0011-5029(15)00143-1/abstract -
6World Health Organization. Global strategy and action plan on ageing and health (2016-2020) [Internet]. Geneva: WHO; 2016 [acesso em 15 jun. 2017]. Disponível em: http://who.int/ageing/GSAP-Summary-EN.pdf
» http://who.int/ageing/GSAP-Summary-EN.pdf -
7Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs [Internet]. 2005 [acesso em 15 jun. 2017];52(5):546-53. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/16268861
» https://www.ncbi.nlm.nih.gov/pubmed/16268861 -
8Soares CB, Hoga LAK, Peduzzi M, Sangaleti C, Yonekura T, Silva DRAD. Integrative review: concepts and methods used in nursing. Rev Esc Enferm USP [Internet]. 2014 [acesso em 15 jun. 2017];48(2):329-39. Disponível em: http://www.scielo.br/pdf/reeusp/v48n2/0080-6234-reeusp-48-02-335.pdf
» http://www.scielo.br/pdf/reeusp/v48n2/0080-6234-reeusp-48-02-335.pdf -
9World Health Organization. Envelhecimento ativo: uma política de saúde [Internet]. Brasília, DF: OPAS; 2005 [acesso em 15 jun. 2017]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/envelhecimento_ativo.pdf
» http://bvsms.saude.gov.br/bvs/publicacoes/envelhecimento_ativo.pdf -
10Critical Appraisal Skills Programme CASP: Qualitative Research Checklist [Internet]. [Sem Local]: [Sem Publicador]; 2017. Disponível em: http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf
» http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf -
11Wallack EM, Wiseman HD, Ploughman M. Healthy aging from the perspectives of 683 older people with multiple sclerosis. Mult Scler Int [Internet]. 2016 [acesso em 15 jun. 2017];1-10. Disponível em: https://www.hindawi.com/journals/msi/2016/1845720/
» https://www.hindawi.com/journals/msi/2016/1845720 -
12Stephens C, Breheny M, Mansvelt J. Healthy ageing from the perspective of older people: a capability approach to resilience. Psychol Health [Internet]. 2015 [acesso em 15 jun. 2017];30(6):715-31. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24678916
» https://www.ncbi.nlm.nih.gov/pubmed/24678916 -
13Valer DB, Bierhals CCBK, Aires M, Paskulin LMG. The significance of healthy aging for older persons who participated in health education groups. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 15 jun. 2017];18(4):809-19. Disponível em: http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf
» http://www.scielo.br/pdf/rbgg/v18n4/1809-9823-rbgg-18-04-00809.pdf -
14Sixsmith J, Sixsmith A, Fänge AM, Naumann D, Kucsera C, Tomsone S, et al. Healthy ageing and home: the perspectives of very old people in five European countries. Soc Sci Med [Internet]. 2014 [acesso em 15 jun. 2017];106:1-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24524960
» https://www.ncbi.nlm.nih.gov/pubmed/24524960 -
15Waites CE, Onolemhemhen DN. Perceptions of Healthy Aging among African-American and Ethiopian Elders. Ageing Int [Internet]. 2014 [acesso em 15 jun. 2017];39(4):369-84. Disponível em: https://link.springer.com/article/10.1007/s12126-014-9203-1
» https://link.springer.com/article/10.1007/s12126-014-9203-1 -
16Bacsu J, Jeffery B, Abonyi S, Johnson S, Novik N, Martz D, et al. Healthy aging in place: perceptions of rural older adults. Educ Gerontol [Internet]. 2014 [acesso em 15 jun. 2017];40(5):327-37. Disponível em: http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191
» http://www.tandfonline.com/doi/abs/10.1080/03601277.2013.802191 -
17Boratti KLP, Soriano FS. A percepção de idosas acerca das crenças de autoeficácia e envelhecimento saudável. Aletheia [Internet]. 2013 [acesso em 15 jun. 2017];42:51-61. Disponível em: http://pepsic.bvsalud.org/pdf/aletheia/n42/n42a05.pdf
» http://pepsic.bvsalud.org/pdf/aletheia/n42/n42a05.pdf -
18Thanakwang K, Soonthorndhada K, Mongkolprasoet J. Perspectives on healthy aging among thai elderly: a qualitative study. Nurs Health Sci [Internet]. 2012 [acesso em 15 jun. 2017];14(4):472-9 Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/23186522
» https://www.ncbi.nlm.nih.gov/pubmed/23186522 -
19Deponti RN, Acosta MAF. Compreensão dos idosos sobre os fatores que influenciam no envelhecimento saudável. Estud Interdiscipl Envelhec [Internet]. 2010 [acesso em 15 jun. 2017];15(1):33-52. Disponível em: http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908
» http://seer.ufrgs.br/RevEnvelhecer/article/view/9520/10908 -
20Danyuthasilpe C, Amnatsatsue K, Tanasugarn C, Kerdmongkol P, Steckler AB. Ways of healthy aging: a case study of elderly people in a Northern Thai village. Health Promot Int [Internet]. 2009 [acesso em 15 jun. 2017];24(4):394-403. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19850569
» https://www.ncbi.nlm.nih.gov/pubmed/19850569 -
21Cupertino APFB, Rosa FHM, Ribeiro PCC. Definição de envelhecimento saudável na perspectiva de indivíduos idosos. Psicol Reflex Crit [Internet]. 2007 [acesso em 15 jun. 2017];20(1):81-6. Disponível em: http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf
» http://www.scielo.br/pdf/prc/v20n1/a11v20n1.pdf -
22Ministério da Saúde. Estratégias para o cuidado da pessoa com doença crônica [Internet]. Brasília, DF: MS; 2014 [acesso em 15 jun. 2017]. (Cadernos de Atenção Básica, n. 35). Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_doenca_cronica_cab35.pdf
» http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_pessoa_doenca_cronica_cab35.pdf -
23Ministério da Saúde. Política Nacional de Promoção da Saúde: revisão da Portaria MS/GM nº 687, de 30 de março de 2006 [Internet]. Brasília, DF: MS; 2014. [acesso em 15 jun. 2017] Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude_pnaps.pdf
» http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_promocao_saude_pnaps.pdf -
24Potempa KM, Butterworth SW, Flaherty-Robb MK, Gaynor WL. The Healthy Ageing Model: health behaviour change for older adults. Collegian [Internet]. 2010 [acesso em 15 jun. 2017];17(2):51-5. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20738056
» https://www.ncbi.nlm.nih.gov/pubmed/20738056 -
25Mariner WK. Beyond lifestyle: governing the social determinants of health. Am J Law Med [Internet]. 2016 [acesso em 15 jun. 2017];42(2-3):284-309. Disponível em: http://journals.sagepub.com/doi/abs/10.1177/0098858816658268
» http://journals.sagepub.com/doi/abs/10.1177/0098858816658268 -
26Vilhena E, Pais-Ribeiro J, Silva I, Pedro L, Meneses RF, Cardoso H, et al. Optimism on quality of life in portuguese chronic patients: moderator/mediator? Rev Assoc Med Bras [Internet]. 2014 [acesso em 15 jun. 2017];60(4):373-80. Disponível em: http://www.scielo.br/pdf/ramb/v60n4/0104-4230-ramb-60-04-0373.pdf
» http://www.scielo.br/pdf/ramb/v60n4/0104-4230-ramb-60-04-0373.pdf -
27Silva PA. Individual and social determinants of self-rated health and well-being in the elderly population of Portugal. Cad Saúde Pública [Internet]. 2014 [acesso em 15 jun. 2017];30(11):2387-400. Disponível em: http://www.scielo.br/pdf/csp/v30n11/0102-311X-csp-30-11-2387.pdf
» http://www.scielo.br/pdf/csp/v30n11/0102-311X-csp-30-11-2387.pdf -
28Santos MC, Wechsler SM. Análise das publicações científicas sobre otimismo em saúde no último triênio. Psicol Argum [Internet]. 2015 [acesso em 15 jun. 2017];33(83):470-82. Disponível em: http://www2.pucpr.br/reol/pb/index.php/pa?dd1=16210&dd99=view&dd98=pb
» http://www2.pucpr.br/reol/pb/index.php/pa?dd1=16210&dd99=view&dd98=pb -
29Jeon SW, Han C, Lee J, Lim JH, Jeong H, Park MH, et al. Perspectives on the happiness of community-dwelling elderly in Korea. Psychiatry Investig [Internet]. 2016 [acesso em 15 jun. 2017];13(1):50-7. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701685/
» https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701685/ -
30Mantovani EP, Lucca SR, Neri AL. Associations between meanings of old age and subjective well-being indicated by satisfaction among the elderly. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 15 jun. 2017];19(2):203-22. Disponível em: http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00203.pdf
» http://www.scielo.br/pdf/rbgg/v19n2/en_1809-9823-rbgg-19-02-00203.pdf -
31Fernandes MTO, Soares SM. The development of public policies for elderly care in Brazil. Rev Esc Enferm USP [Internet]. 2012 [acesso em 15 jun. 2017];46(6):1494-502. Disponível em: http://www.scielo.br/pdf/reeusp/v46n6/en_29.pdf
» http://www.scielo.br/pdf/reeusp/v46n6/en_29.pdf -
32Zimmer Z, Jagger C, Chiu C, Ofstedal MB, Rojo F, Saito Y. Spirituality, religiosity, aging and health in global perspective: a review. SSM Popul Health [Internet]. 2016 [acesso em 15 jun. 2017];2:373-81. Disponível em: http://www.sciencedirect.com/science/article/pii/S2352827316300179
» http://www.sciencedirect.com/science/article/pii/S2352827316300179 -
33Palencia IPG, Banquett DC, Quintana MC, Villamizar AL, Mendoza YV. Spirituality and religiosity in elderly adults with chronic disease. Invest Educ Enferm [Internet]. 2016 [acesso em 15 jun. 2017];34(2):235-42 Disponível em: http://www.scielo.org.co/pdf/iee/v34n2/v34n2a02.pdf
» http://www.scielo.org.co/pdf/iee/v34n2/v34n2a02.pdf -
34Kool MB, Van Middendorp H, Lumley MA, Bijlsma JW, Geenen R. Social support and invalidation by others contribute uniquely to the understanding of physical and mental health of patients with rheumatic diseases. J Health Psychol [Internet]. 2013 [acesso em 15 jun. 2017];18(1):86-95. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/22363049
» https://www.ncbi.nlm.nih.gov/pubmed/22363049 -
35Wang X. Subjective well-being associated with size of social network and social support of elderly. J Health Psychol [Internet]. 2014 [acesso em 15 jun. 2017];21(6):1037-42. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25104778
» https://www.ncbi.nlm.nih.gov/pubmed/25104778 -
36Tomioka K, Kurumatani N, Hosoi H. Positive and negative influences of social participation on physical and mental health among community-dwelling elderly aged 65-70 years: a cross-sectional study in Japan. BMC Geriatr [Internet]. 2017 [acesso em 15 jun. 2017];17(1):1-13. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437627/pdf/12877_2017_Article_502.pdf
» https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437627/pdf/12877_2017_Article_502.pdf -
37Ministério da Saúde. Política Nacional de Saúde da Pessoa Idosa. Portaria nº 2.528 de 19 de outubro de 2006 [Internet]. Brasília, DF: MS; 2006 [acesso em 15 jun. 2017]. Disponível em: http://www.saudeidoso.icict.fiocruz.br/pdf/PoliticaNacionaldeSaudedaPessoaIdosa.pdf
» http://www.saudeidoso.icict.fiocruz.br/pdf/PoliticaNacionaldeSaudedaPessoaIdosa.pdf
Publication Dates
-
Publication in this collection
Nov-Dec 2017
History
-
Received
27 June 2017 -
Reviewed
09 Sept 2017 -
Accepted
05 Nov 2017