Health self-care practices among community older adults with morbidity

Prácticas de autocuidado en salud entre ancianos con morbilidad comunitaria

ABSTRACT

Objectives:

to describe sociodemographic and health characteristics of older adults with morbidity, identify self-care practices and verify the association of sociodemographic variables with those related to health and self-care practices.

Methods:

a quantitative, analytical and cross-sectional household survey, developed in the urban area in the countryside of Minas Gerais, from 2017 to 2018. A total of 796 older adults were assessed using validated instruments, such as Geriatric Depression Scale: short form, Brazilian Questionnaire for Functional and Multidimensional Assessment, International Physical Activity Questionnaire, Instrument for Assessing Attitude Towards Taking Medications. Multiple logistic regression (p<0.05) was used.

Results:

negative self-perceived health was associated with low income and education. As for self-care in health, being physically active associated with the age group 60 |-| 79 years and higher education.

Conclusions:

sociodemographic variables such as sex, age group, income, education, marital status, housing arrangement were related to health status and self-care practice.

Descriptors:
Aged; Self Care; Geriatric Nursing; Nursing Theory; Health Promotion

RESUMEN

Objetivos:

describir las características sociodemográficas y de salud de los ancianos con morbilidad, identificar las prácticas de autocuidado y verificar la asociación de las variables sociodemográficas con las relacionadas con la salud y las prácticas de autocuidado.

Métodos:

encuesta domiciliaria cuantitativa, analítica y transversal, desarrollada en el área urbana del interior de Minas Gerais, de 2017 a 2018.Un total de 796 ancianos fueron evaluados utilizando instrumentos validados, como la Escala de Depresión Geriátrica abreviada, el Cuestionario Brasileño de Evaluación Funcional y Multidimensional, el Cuestionario Internacional de Actividad Física, el Instrumento de Evaluación de la Actitud hacia la Toma de Medicamentos. Se utilizó regresión logística múltiple (p<0,05).

Resultados:

la autopercepción negativa de la salud se asoció con baja renta y escolaridad. En cuanto al autocuidado en salud, la actividad física se asoció con el grupo de edad 60 |-| 79 años y estudios superiores.

Conclusiones:

las variables sociodemográficas, como sexo, grupo etario, renta, escolaridad, estado civil, arreglo de vivienda, se relacionaron con el estado de salud y la práctica de autocuidado.

Descriptores:
Anciano; Autocuidado; Enfermería Geriátrica; Teoría de Enfermería; Promoción de la Salud

RESUMO

Objetivos:

descrever as características sociodemográficas e de saúde dos idosos com morbidade, identificar as práticas de autocuidado e verificar a associação das variáveis sociodemográficas com as relacionadas à saúde e às práticas de autocuidado.

Métodos:

inquérito domiciliar quantitativo, analítico e transversal, desenvolvido na zona urbana no interior de Minas Gerais, de 2017 a 2018. Avaliados 796 idosos por instrumentos validados, como Escala de Depressão Geriátrica abreviada, Questionário Brasileiro de Avaliação Funcional e Multidimensional, Questionário Internacional de Atividade Física, Instrumento de Avaliação da Atitude Frente à Tomada de Remédios. Utilizou-se regressão logística múltipla (p<0,05).

Resultados:

a autopercepção de saúde negativa associou-se às baixas renda e escolaridade. Quanto ao autocuidado em saúde, ser ativo fisicamente associou-se à faixa etária 60 |-| 79 anos e à maior escolaridade.

Conclusões:

as variáveis sociodemográficas, como sexo, faixa etária, renda, escolaridade, estado conjugal, arranjo de moradia, relacionaram-se à condição de saúde e à prática de autocuidado.

Descritores:
Idoso; Autocuidado; Enfermagem Geriátrica; Teorias de Enfermagem; Promoção da Saúde

INTRODUCTION

The process of aging and, consequently, old age have been notoriety since the beginning of civilization. The Brazilian demographic transition has been occurring rapidly with regard to developed countries. This phenomenon challenges established powers, demanding new knowledge, reorienting the economy and pointing to the reorganization of meanings and directions of ethical, scientific, political and social planning and decisions(¹-²).

In the context of health, chronic diseases and their complications in older adults have worried professionals. Thus, it is considered that one of the tools for coping is self-care, because it is an action that promoters health, well-being and healthy aging(³). Self-care is defined as “the practice of activities initiated and performed by individuals for their own benefit, for the maintenance of life, health and well-being”(⁴). It is noteworthy that, when effectively executed, it contributes to the human structure integrity and to a person’s functioning and development(⁴).

In the present research, we used Orem’s self-care theory framework(⁴), considering the guiding question: what are the characteristics of older adults that are related to self-care practice in health? This theory can be expanded to several individuals and groups, favoring a nursing practice pertinent to self-care needs. Moreover, it is the central concept for developing health promoting actions and prevention and/or complications of diseases(⁵).

The theory includes three categories of self-care requirements or requirements, such as universal, developmental, and health deviation. Self-care requirements are actions focused on its provision(⁴). The focus of this investigation was on the health deviation requirement, due to the interest in understanding possible gaps in the self-care of older adults with some morbidity, related to health and sociodemographic variables. The requirements for health deviation occur when individuals in pathological state need to adapt to this situation. Such a measure is required in conditions of illness, injury or disease, or may be a consequence of medical measures necessary to diagnose and conform to condition(⁴).

In the national and international scientific literature, there is little research that associates self-care with varied health practices in community older adults. The studies found related the theme to some chronic noncommunicable disease (NCD)(⁶) as diabetes mellitus(⁷,⁸,⁹) and hypertension(¹⁰). It is also noteworthy the knowledge gap in research that focuses on self-care in health based on nursing theories. Thus, this study studied the self-care practiced by community older adults, in a multifactorial way, subsidized by Orem’s self-care theory.

The results may support the proposition of actions by both the multidisciplinary team and those specific to nursing, for assessing and approaching older adults in primary care. Moreover, it can contribute with responses to social demands and health intervention in the training of health professionals, in addition to expanding discussions on the subject. It is also considered that knowledge of data about a particular region enables the debate of issues related to public policies, citizenship and social rights.

OBJECTIVES

To describe sociodemographic and health characteristics of older adults with morbidity, identify self-care practices and verify the association of sociodemographic variables with those related to health and self-care practices.

METHODS

Ethical aspects

The project was approved by the Research Ethics Committee with Human Beings of the Universidade Federal do Triângulo Mineiro (UFTM), in 2017, in accordance with Ordinance 466/12 of the Brazilian National Health Council. Only after the consent from the older adults and signature of the said form, the interview(¹¹) was conducted.

Study design, place and period

This is a quantitative, household survey, analytical and crosssectional study, developed in the urban area of Uberaba, countryside of Minas Gerais, from May 2017 to June 2018, guided by the EQUATOR network Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Population and sample; inclusion and exclusion criteria

The study population consisted of older adults from a city in the countryside of Minas Gerais. To calculate the sample size, physical activity level was used as an outcome, assessed through the International Physical Activity Questionnaire (IPAQ)(¹²). The calculation was performed using PASS (Power Analysis and Sample Size), version 13, and considered the 48.3% prevalence of older adults classified as active(¹³), 3.5% accuracy and 95% confidence interval for a finite population of 36,703 older adults, reaching a minimum sample of 767 subjects. Considering a 20% sampling loss, the maximum number of interview attempts was 959.

Older adults 60 years of age or older, having at least one chronic disease and living in the urban area were included. Institutionalized older adults, with communication problems such as deafness, not corrected by devices and severe speech disorders, with cognitive decline without an informant to answer Functional Activities Questionnaire (PFEFFER) and those with a final score ≥ six points, were excluded(¹⁴). Thus, the sample consisted of 796 older adults.

Study protocol

To identify the older adults to be interviewed, multistage cluster sampling was used. In the first stage, the arbitrary selection of 50.0% of the census sectors in the city was considered through systematic sampling. In the second stage, the number of older adults to be interviewed according to the sample calculation was divided by the number of census tracts selected (202 sectors) so that a similar amount was obtained within each census sector (4 older adults per sector).

For the beginning of collection, the streets of each census tract were numbered and typed in Statistical Package for the Social Sciences (SPSS®), version 17.0. Then, within each census sector, the first household was randomly selected and the others, from household to household, in a standardized way, until the sample of that sector was saturating.

Before starting the interview, a cognitive assessment was performed with older adults through the Mini Mental State Examination (MMSE), translated and validated for Brazil(¹⁵). The MMSE score ranges from 0 to 30 points, considering the cut-off points: ≤ 13 for illiterates; ≤ 18 for median education (ages one to eight); and ≤ 26 for high education (over eight years)(¹⁵).

When older adults showed cognitive decline in the MMSE assessment, the companion/informant who knew how to provide information about older adults was asked to participate, to which PFEFFER(¹⁴) was applied. It is a scale of 11 questions applied to the companion or caregiver of older adults discussing their ability to perform certain functions. The answers follow a pattern: able (0); never did, but could do now (0); with some difficulty, but does (1); never did and would have difficulty now (1); needs help (2); not able (3). The maximum score is equal to 33 points. The application of PFEFFER indicates the most severe presence of cognitive decline when the score is equal to or higher than six points and, in this case, the interview with the companion/informant(¹⁴) is closed. The interview was closed for older adults who presented cognitive decline in the MMSE and had no companion/informant.

Sociodemographic and economic variables were: sex (female, male); age group (60 |-| 69 years, 70 |-| 79 years, 80 years or more); individual monthly income, in minimum wage (≤ 1, > 1); education, in years of study (0 |-| 4, 5 or more); marital status (without a partner, with a partner); housing arrangement (live alone or with a partner). They were assessed by instrument elaborated and widely used by UFTM’s Collective Health Research Group.

The Geriatric Depression Scale: short form (GDS-15), validated for Brazil, was used to measure health-related variables(¹⁶). The scale can range from zero (absence of depressive symptoms) to fifteen points (maximum score of depressive symptoms), being the cut-off point ≥ 5 to determine the presence of depressive symptoms in older adults(¹⁶). Number of self-reported morbidities (1 |-| 4, 5 or more), personal history (yes, no) and self-perceived health (negative, positive) were obtained through the items contemplated in the Brazilian Functional and Multidimensional Assessment Questionnaire (BOMFAQ – Questionário Brasileiro de Avaliação Funcional e Multidimensional)(¹⁷) that assesses activities of daily living (ADL) and instrumental activities of daily living (IADL). This questionnaire has the ability to assess the participant when performing their daily tasks, such as lying down and getting out of bed, eating, combing their hair, dressing, going up and down stairs, among others, the greater the number of difficulties, the greater the individuals’ commitment(¹⁷).

Self-care in health variables were assessed by the IPAQ adapted to older adults(¹²). It integrates questions related to physical activities performed in a usual week, with vigorous, moderate and light intensity, with a minimum duration of 10 continuous minutes, distributed in five domains: work; transport; domestic activity; leisure/recreation activity; and sitting time. It considered active those who fired 150 minutes or more of weekly physical activity, and inactive, from zero to 149 minutes(¹⁸). Consultations, routine and preventive tests were obtained through questions developed by the research group: have you had a routine consultation in the last year? If so, with which professional (s)? Have you had a preventive test in the last year? If so, which one (s)? And specific ones for older adults, such as Pap smear and mammography, as well as for older adults, with a prostate examination. Medication compliance was verified by the Instrument for Assessing Attitude Towards Taking Medications (IAAFTR - Instrumento de Avaliação da Atitude Frente à Tomada de Remédios)(¹⁹). It consists of ten structured questions and their score ranging from 0 to 10. Scores less than or equal to seven refer to negative attitude, and higher, to positive attitude(¹⁹).

Ten interviewers with previous experience in data collection were selected, who were trained on how to fill in and apply the instruments and how to approach older adults. The interviewers noted the complications in the field worksheet. Systematic meetings were held between researchers and interviewers for training, follow-up and guidance. The interviews carried out were handed over to the supervisors, who carried out the reviews. When necessary, they were returned to the interviewer to supplement the information. After this step, data were double entered, in the electronic database, in Excel®. Consistency was verified between the two databases, and corrections were made with the original interview, if necessary. For analysis, the data were imported into SPSS®, version 17.0.

The variables referring to self-care practices in health were: physical activity level (active, inactive); routine consultation (yes, no); preventive tests (yes, no); for women, cytopathological examination (yes, no) and mammography (yes, no); for men, prostate exam (yes, no); routine tests such as blood count and urine (yes, no); attitude towards taking medication (positive, negative).

Analysis of results, and statistics

Data were subjected to descriptive analysis through distribution of absolute frequencies and percentages for categorical variables, and mean and standard deviation for numerical variables, according to data normality, performed using the Kolmogorov-Smirnov test.

To verify the association between sociodemographic and economic variables with those related to health and self-care practices, a preliminary bivariate analysis was performed, using the chi-square test. Those that met the established criterion (p≤0.10) were introduced into the multiple logistic regression model, with variables related to health and self-care practices as the main outcome (p≤0.05).

RESULTS

A total of 796 older adults were investigated, most of whom were female (67.1%), aged between 70 |-| 79 years (42.3%), with individual monthly income (56.4%) ≤ 1 minimum wage, with 0 |-| 4 years of study (67.2%), marital status, no partner (58.2%) and living with someone (82.7%).

Regarding the health-related variables, older adults predominated without indicative of the presence of depressive symptoms (80.9%), with five or more morbidities (68.5%), of which the most prevalent were vision problems (70%), hypertension (68.5%), back problems (52.1%) and poor circulation (47.6%). It was found that 84.3% reported morbidities in family history and 54.6% self-perceived negative health (Table 1).

Table 1
Frequency distribution of variables related to older adults’ health, Uberaba, Minas Gerais, Brazil, 2018

Variables	n	%
Indication of presence of depressive symptoms
Yes	152	19.1
No	644	80.9
Number of self-reported morbidities
1 |-| 4	251	31.5
5 and more	545	68.5
Morbidities in family history
Yes	671	84.3
No	107	13.4
Ignored	18	2.3
Self-perceived health
Negative	435	54.6
Positive	361	45.4

Regarding the variables of self-care in health, the highest percentage of older adults were classified as physically active (66.1%), had routine consultations (88.8%) and preventive tests (64.8%), with the highest percentage for old women (67.6%), in addition to having a positive attitude towards taking medication (76.8%). Among the older adults, most did not undergo cytopathological examination (59.3%), but underwent mammography (51.6%) and routine tests (93.4%). Among older adults, prostate (65.9%) and routine (98.2%) (Table 2) tests prevailed.

Table 2
Frequency distribution of variables related to self-care in health, Uberaba, Minas Gerais, Brazil, 2018

Variables	n	%
Physical activity level
Active	526	66.1
Inactive	270	33.9
Routine consultation
Yes	707	88.8
No	89	11.2
Preventive tests (general)
Yes	516	64.8
No	280	35.2
Attitude towards taking medications
Negative	170	23.2
Positive	563	76.8
Preventive tests (sex)
Female	349	67.6
Male	167	32.4
Female
Cytopathological examination
Yes	142	40.7
No	207	59.3
Mammography examination
Yes	180	51.6
No	169	48.4
Routine tests (e.g., blood count, urine)
Yes	326	93.4
No	23	6.6
Male
Prostate examination
Yes	110	65.9
No	57	34.1
Routine tests (e.g., blood count, urine)
Yes	164	98.2
No	3	1.8

It is noteworthy that most older adults used medications (92.8%) and had positive attitudes, such as taking the medications with them when traveling (96.9%) and providing a new medication box before ending (95.4%). As for the negative attitude, it prevailed to stop taking any medication in recent days (19.9%).

In the bivariate analysis, those related to health that met the established criterion (p<0.10) and were submitted to the multiple logistic regression model were for the absence of indicative of the presence of depressive symptoms: sex (p=0.001), education (p=0.008) and marital status (p<0.001); self-perceived health: sex (p=0.021), income (p<0.001), education (p<0.001), and marital status (p=0.021); number of self-reported morbidities: sex (p<0.001), age group (p=0.081), income (p=0.037), education (p=0.017), and marital status (p=0.064); presence of morbidities in personal history: sex (p=0.006), age group (p=0.006), and education (p=0.014).

The variables related to self-care practices in older adults’ health, who met the established criteria (p<0.10) and were submitted to the multiple logistic regression model were the level of physical activity: age group (p<0.001), education (p=0.001); performance of preventive tests: age group (p=0.029), income (p=0.071), education (p=0.002) and marital status (p=0.015); and attitude towards taking medication: education (p=0.068).

It was found that, for health-related variables, the absence of indicative of the presence of depressive symptoms was associated with male sex (p=0.026), education of 5 years and over (p=0.034) and marital status with a partner (p=0.002). Negative self-perceived health was associated with ≤ 1 minimum wage income (p=0.008) and education of 0 |-| 4 years (p=0.010). The highest number of self-reported morbidities was associated with females (p<0.001), age group 60 |-| 79 years and education of 0 |-| 4 years old. The presence of morbidities in personal history was associated with females (p=0.003), age group 60 |-|79 years (p=0.016) and education 0 |-| 4 years (p=0.013) (Table 3).

Table 3
Multiple logistic regression of sociodemographic variables related to health and self-care practices in health, Uberaba, Minas Gerais, Brazil, 2018

Variables	RCP*	(CI)**	p***
Health-related
Indication of presence of depressive symptoms
Sex	1.57	(1.05-2.33)	0.026
Education	1.50	(1.03-2.19)	0.034
Marital status	1.81	(1.25-2.62)	0.002
Self-perceived health
Sex	1.16	(0.84-1.60)	0.368
Income	1.50	(1.11-2.03)	0.008
Education	1.50	(1.10-2.05)	0.010
Marital status	1.30	(0.96-1.76)	0.092
Number of self-reported morbidities
Sex	3.75	(2.65-5.31)	<0.001
Age group	1.46	(1.00-2.15)	0.051
Income	1.05	(0.75-1.47)	0.766
Education	1.45	(1.03-2.04)	0.035
Marital status	1.10	(0.78-1.56)	0.585
Presence of morbidities in personal history
Sex	1.88	(1.23-2.86)	0.003
Age group	1.83	(1.12-2.99)	0.016
Education	1.78	(1.13-2.80)	0.013
Self-care practices in health
Physical activity level
Age group	2.54	(1.79-3.60)	<0.001
Education	1.64	(1.17-2.29)	0.004
Preventive tests
Age group	1.33	(0.93-1.91)	0.114
Income	1.24	(0.91-1.69)	0.170
Education	1.49	(1.06-2.08)	0.020
Marital status	1.33	(0.98-1.81)	0.071
Attitude towards taking medications
Education	1.43	(0.97-2.09)	0.069

• *RCP - Odds Ratio; **CI - confidence interval; p<0.05.

In the variables related to self-care in health, it was found that being physically active was associated with the 60-|-| 79 years (p<0.001) and education 5 or more (0.004). Preventive tests were associated with education of 5 years or more (p=0.020) (Table 3).

DISCUSSION

National studies developed in the community also obtained a higher percentage of older adults, age 70 |-| 79 years old, low education and ≤ 1 minimum wage(²⁰,²¹,²²). Demographic projection for Brazil points to feminization of older adults highlighting differential mortality by sex, which early affects the male population(²²).

Regarding marital status, the data differed from a national survey in which the majority has a partner(²²). The loss of conviviality experienced by older adults can lead to loneliness and isolation and, causing emotional and psychological problems, especially depression(²³).

Research among older adults, primary care users in Belo Horizonte, found that females presented a higher proportion of indicative presence of depressive symptoms (p=0.001)(²⁴), converging with the findings of this research in which there was an association of absence of depressive symptoms associated with males. It is noteworthy that women achieve greater longevity; however, it has been followed by a higher incidence of chronic diseases, among them, depression(²⁴,²⁵,²⁶). In general, they are more attentive to physical symptoms and seek health services more than men, and may favor the diagnosis of chronic diseases(²⁴,²⁵,²⁶).

The absence of indicative depressive symptoms was associated with higher education. Low education can negatively influence the way in which older adults understand and perform actions that encompass health care practices(²⁷). Higher education, among older adults, has favored access to health services, resulting in better medical treatments that, in turn, decrease the prevalence of depressive symptoms(²⁷-²⁸). Through nursing consultations, nurses can identify the presence of depressive symptoms, encourage older adults to insert themselves into self-care activities in health, seeking individualized care and respecting their peculiarities.

National(²⁹) and international research(³⁰) found that older adults who lived alone, were single and widowed had higher rates of depressive symptoms, similar to the findings in which there was an association between the absence of depressive symptoms with those who had a partner. Living with a spouse or having a partner can be considered a psychosocial protection factor, because it contributes to assistance in adverse situations and mutual support(³¹).

Negative self-perceived health associated with low income is consistent with research conducted among older community adults in the city of Diamantina (MG) (p=0.001)(³²). The perceived health condition is considered a predictor of functional disability in older adults, besides assisting in the development of health prevention strategies aimed at comprehensive care and favoring equity in public policies(³³).

It was found that there is influence on older adults’ negative self-perceived health through low income and education (p=<0.001). In a study conducted in the city of Fortaleza, state of Ceará, that aimed to raise the perceived and self-reported health condition of older adults, it showed that there was significance in negative health conditions of older adults through the low level of income and education(³³), both data corroborate the present study.

Females associated with a higher proportion of 5 or more diseases in older adults corroborate findings from national(³⁴) (p<0.001) and international(³⁵) (p<0.001) studies. When considering the increase in the number of older adults in the Brazilian population and the impact of NCD, knowledge about the factors associated with a greater number of self-reported morbidities becomes essential. The longevity and feminization of old age lead to greater vulnerability to gender, as greater susceptibility to chronic diseases(³⁶).

A national study found that advanced age was associated with multimorbidity(³⁷), diverging from the findings of this investigation in which the highest number of morbidities was associated with the age group 60 to 79 years. These data reinforce the need to implement health actions in this locality, in order to prevent the early presence of diseases among younger older adults, enabling old age to be lived with more quality.

Research found that the highest number of chronic diseases had significant associations with low education(³⁸) as well as in this investigation. Education can be a protective factor in relation to health, since older adults may have greater access to health services and treatments, reducing complications(²⁷) and functional disabilities. During care in health services, nurses should verify the understanding of older adults and develop strategies to improve their understanding, using accessible language, valuing visual communication to effectively reach the target audience(³⁹).

The presence of morbidities in personal history is considered a non-modifiable risk factor for the development of such diseases in future generations(⁴⁰). From this perspective, the association of morbidities in personal history with age 60 |-| 79 years and low education, verified in the present research, denotes the relevance of considering family history as an early indicator of chronic diseases(⁴⁰), especially in situations of social vulnerability. Primary care nurses can invest in carrying out educational actions in order to exchange knowledge with older adults and favor their involvement in self-care in health.

A study conducted with older adults in Viçosa, MG, also found that increased age was associated with physical inactivity (p=0.001), observing decline in the mean time spent on physical activity as age advances(⁴¹). Regular physical exercises are one of the essential aspects for maintaining older adults’ health, as it can minimize physiological changes associated with the aging process. In this context, it is recommended that older adults perform regular physical exercises to reduce, prevent, and treat functional declines(⁴¹).

As in the present investigation, a survey conducted with older adults in the countryside of Minas Gerais, obtained an association between being physically inactive and low education (p=0.000)(⁴²). A study conducted with older adults in Montes Claros, MG, also found an association between greater complying with health programs, seeking health services and frequency of preventive tests with higher education(²⁸). It is noteworthy that the results of this study show the central role of education in self-care in health, since research has verified that regular physical activity influences positive self-perceived health and the lower rates of depression(⁴³), in addition to the active seek more health services(²⁸) and favor early diagnosis.

Study limitations

Morbidities were self-reported by older adults and may be undersized.

Contributions to nursing, health, and public policies

The present study analyzed self-care practices in health among older adults with morbidity based on Orem’s self-care theory. The results add knowledge to the theme, provide subsidies for planning and nursing care, for professional training and help in carrying out future research that will be able to analyze the direct and indirect relationships that involve self-care practice among older adults. Thus, it contributes to nursing care improvement, having as strategy the systematization of nursing care in an individualized way, the active search for older adults, identifying gaps and finding solutions, health education with the team and community, reinforcing knowledge about senescence and senility and encouraging the ability to rescue the autonomy and individuality of these older adults.

CONCLUSIONS

Older adults, aged between 70 |-| 79 years old, low income and education and with no partner, prevailed. As for the health-related variables, the absence of an indication of the presence of depressive symptoms was associated with being male, having a higher education and having a partner. Negative self-perceived health was associated with low income and education. As for self-care in health, being physically active associated with the age group 60 |-| 79 years and higher education. Preventive tests were also associated with higher education.

Sociodemographic variables such as sex, age group, income, education, marital status, housing arrangement, were related to health status and self-care practice among older adults, highlighting those that are subject to modification and that can be worked on through public policies with the aim of improving older adults’ life and health.

• FUNDING
  Coordination for the Improvement of Higher Education Personnel (CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).

REFERENCES

• ¹
  Miranda GMD, Mendes ACG, Silva ALA. O envelhecimento populacional brasileiro: desafios e consequências sociais atuais e futuras. Rev Bras Geriatr Gerontol. 2016;19(3):507-19. https://doi.org/10.1590/1809-98232016019.150140
  » https://doi.org/10.1590/1809-98232016019.150140
• ²
  Almeida APSC, Nunes B P, Duro SMS, Lima RCD, Facchini LA. Falta de acesso e trajetória de utilização de serviços de saúde por idosos brasileiros. Ciênc Saúde Colet. 2020;25(6):2213-26. https://doi.org/10.1590/1413-81232020256.27792018
  » https://doi.org/10.1590/1413-81232020256.27792018
• ³
  Almeida L, Bastos PRHO. Elderly Self Care: a systematic review of the literature. Rev Espacios [Internet]. 2017 [cited 2021Jul 19];38(28):1-10. Available from: http://www.revistaespacios.com/a17v38n28/a17v38n28p03.pdf
  » http://www.revistaespacios.com/a17v38n28/a17v38n28p03.pdf
• ⁴
  Orem D. Nursing concepts of practice. 3 ed. New York: Mc Graw Hill Book; 1985, p. 35-106.
• ⁵
  Bezerra ML, Faria RP, Costa Jesus C, Reis PE, Pinho DL, Kamada I. Applicability of the deficit theory of Orem's self-care in Brazil: an integrative review. JMPHC. 2018; 9:e16. https://doi.org/10.14295/jmphc.v9i0.538
  » https://doi.org/10.14295/jmphc.v9i0.538
• ⁶
  Reis DA, Silva MA. Perfil sociodemográfico, situação de saúde e práticas de autocuidado dos idosos com Doença Crônica Não Transmissível em um município Amazônico. REAS. 2019;11(17):e1500. https://doi.org/10.25248/reas.e1500.2019
  » https://doi.org/10.25248/reas.e1500.2019
• ⁷
  Borba AKOT, Arruda IKG, Marques APO, Leal MCC, Diniz AS. Conhecimento sobre o diabetes e atitude para o autocuidado de idosos na atenção primária à saúde. Ciênc Saúde Colet. 2019;24(1):125-36. https://doi.org/10.1590/1413-81232018241.35052016
  » https://doi.org/10.1590/1413-81232018241.35052016
• ⁸
  Marques MB, Coutinho JFV, Martins MC, Lopes MVO, Maia JC, Silva MJ. Intervenção educativa para a promoção do autocuidado de idosos com diabetes mellitus. Rev Esc Enferm USP. 2019;53. https://doi.org/10.1590/S1980-220X2018026703517
  » https://doi.org/10.1590/S1980-220X2018026703517
• ⁹
  Vicente MC, Silva CRR, Pimenta CJL, Bezerra TA, Lucena HKV, Valdevino SC, et al. Functional Capacity and Self-care in Older Adults with Diabetes Mellitus. Aquichan. 2020;20(3):e2032. https://doi.org/10.5294/aqui.2020.20.3.2
  » https://doi.org/10.5294/aqui.2020.20.3.2
• ¹⁰
  Sousa R, Lucena A, Nascimento W, Ferreira T, Lima C, Ferreira J, et al. Particularidades de idosos hipertensos à adesão ao tratamento medicamentoso. Rev Enferm UFPE. 2018;12(1):216-23. https://doi.org/10.5205/1981-8963-v12i1a23296p216-223-2018
  » https://doi.org/10.5205/1981-8963-v12i1a23296p216-223-2018
• ¹¹
  Ministério da Saúde (BR). Conselho Nacional da Saúde. Resolução 466 de 12 de dezembro de 2012 [Internet]. Brasília, DF: Diário Oficial da União. 2012 [cited 2021 Jul 18]. Available from: https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf
  » https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf
• ¹²
  Benedetti TRB, Mazo GZ, Barros MVG. Aplicação do questionário internacional de atividades físicas (IPAQ) para avaliação do nível de atividades físicas de mulheres idosas: validade concorrente e reprodutibilidade teste-reteste. RBCM. 2004, 12(1);25-33. http://dx.doi.org/10.18511/rbcm.v12i1.538
  » http://dx.doi.org/10.18511/rbcm.v12i1.538
• ¹³
  Ribeiro CG, Ferretti F, Sa CA. Quality of life based on level of physical activity among elderly residents of urban and rural áreas. Rev Bras Geriatr Gerontol. 2017;20(3):330-9. https://doi.org/10.1590/1981-22562017020.160110
  » https://doi.org/10.1590/1981-22562017020.160110
• ¹⁴
  Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Envelhecimento e saúde da pessoa idosa [Internet]. Brasília, DF: Ministério da Saúde; 2006 [cited 2021 Jul 18]. 192 p. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/evelhecimento_saude_pessoa_idosa.pdf
  » http://bvsms.saude.gov.br/bvs/publicacoes/evelhecimento_saude_pessoa_idosa.pdf
• ¹⁵
  Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O mini exame do estado mental em uma população geral: impacto da escolaridade. Arqu Neuro-psiquiatria. 1994;52(1):1-7. https://doi.org/10.1590/S0004-282X1994000100001
  » https://doi.org/10.1590/S0004-282X1994000100001
• ¹⁶
  Almeida O P, Almeida SA. Confiabilidade da versão brasileira da Escala de Depressão em Geriatria (GDS) versão reduzida. Arqui Neuropsiquiatria. 1999;57(2-B):421-6. https://doi.org/10.1590/S0004-282X1999000300013
  » https://doi.org/10.1590/S0004-282X1999000300013
• ¹⁷
  Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross-Cult Gerontol. 1998;8(4):3313-23. https://doi.org/10.1007/BF00972560
  » https://doi.org/10.1007/BF00972560
• ¹⁸
  Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273(5):402-7. https://doi.org/10.1001/jama.1995.03520290054029
  » https://doi.org/10.1001/jama.1995.03520290054029
• ¹⁹
  Strelec MAAM, Pierin AMG, Mion Júnior DA. Influência do conhecimento sobre a doença e atitude frente à tomada de remédios no controle da hipertensão arterial. Arq Bras Cardiol. 2003;8(4):343-8. https://doi.org/10.1590/S0066-782X2003001200002
  » https://doi.org/10.1590/S0066-782X2003001200002
• ²⁰
  Berlezi EM, Gross CB, Pimentel JJ, Pagno AR, Fortes CK, Pillatt AP. Estudo do fenótipo de fragilidade em idosos residentes na comunidade. Ciênc Saúde Colet. 2019;24(11):4201-10. https://doi.org/10.1590/1413-812320182411.31072017
  » https://doi.org/10.1590/1413-812320182411.31072017
• ²¹
  Sant’ Ana LAJ, D’Elboux MJ. Suporte social e expectativa de cuidado de idosos: associação com variáveis socioeconômicas, saúde e funcionalidade. Saúde Debate. 2019;43(121):503-19. https://doi.org/10.1590/0103-1104201912117
  » https://doi.org/10.1590/0103-1104201912117
• ²²
  Ceccon RF, Vieira LJES, Brasil CCP, Soares KG, Portes VM, Garcia Júnior CAS, et al. Envelhecimento e dependência no Brasil: características sociodemográficas e assistenciais de idosos e cuidadores. Ciênc Saúde Colet. 2021;26(1):17-26. https://doi.org/10.1590/1413-81232020261.30352020
  » https://doi.org/10.1590/1413-81232020261.30352020
• ²³
  Santini ZI, Jose PE, Cornwell EY, Koyanagi A, Nielsen L, Hinrichsen C, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):e62-e70. https://doi.org/10.1016/S2468-2667(19)30230-0
  » https://doi.org/10.1016/S2468-2667(19)30230-0
• ²⁴
  Soares SM, Silva PAB, Santos JFG, Silva LB. Association between depression and quality of life in older adults: primary health care. Rev Enferm UERJ. 2017;25:e19987. https://doi.org/10.12957/reuerj.2017.19987
  » https://doi.org/10.12957/reuerj.2017.19987
• ²⁵
  El-Gilany A, Elkhawaga GO, Sarraf BB. Depression and its associated factors among elderly: A community-based study in Egypt. Arch Gerontol Geriatrics. 2018;77(1):103–7. https://doi.org/10.1016/j.archger.2018.04.011
  » https://doi.org/10.1016/j.archger.2018.04.011
• ²⁶
  Kaup AR, Byers AL, Falvey C, Simonsick EM, Satterfield S, Ayonayon HN, et al. Trajectories of depressive symptoms in older adults and risk of dementia. JAMA Psychiatry. 2016;73(5):525-531. https://doi.org/10.1001/jamapsychiatry.2016.0004
  » https://doi.org/10.1001/jamapsychiatry.2016.0004
• ²⁷
  Chaves JRF. Educação ao longo da vida: perspectivas para uma sociedade que envelhece. In: Brasil 2050: desafios de uma nação que envelhece. Estud Estratégicos. 2017.
• ²⁸
  Hajjar R, Nardelli GN, Gaudenci EM, Santos AS. Sintomas depressivos e fatores associados em idosos na Atenção Primária à Saúde. Rev Rene. 2017;18(6):727-33. https://doi.org/10.15253/2175-6783.2017000600004
  » https://doi.org/10.15253/2175-6783.2017000600004
• ²⁹
  Lampert CDT, Ferreira VRT. Fatores associados à sintomatologia depressiva em idosos. Aval Psicol. 2018;17(2):205-12. https://doi.org/10.15689/ap.2018.1702.14022.06
  » https://doi.org/10.15689/ap.2018.1702.14022.06
• ³⁰
  Tiraphat S, Peltzer K, Thamma-Aphiphol K, Suthisukon K.The Role of Age-Friendly Environments on Quality of Life among Thai Older Adults. Int. J. Environ. Res. Public Health. 2017;14(282): 01-13. https://doi.org/10.3390/ijerph14030282
  » https://doi.org/10.3390/ijerph14030282
• ³¹
  Nascimento IMT, Mello PF, Couto AM, Guimarães GL, Mendonza IYQ. Associação entre características sociodemográficas e sintomas depressivos em idosos hospitalizados. Rev Rene [Internet]. 2017 [cited 2020 Mar 1];18(6):749-55. Available from: http://periodicos.ufc.br/rene/article/view/31082/71673
  » http://periodicos.ufc.br/rene/article/view/31082/71673
• ³²
  Santos EC, Couto BM, Bastone AC. Fatores associados à autoavaliação negativa da saúde em idosos cadastrados nas Unidades Básicas de Saúde. ABCS Health Sci. 2018;43(1):47-54. https://doi.org/10.7322/abcshs.v43i1.999
  » https://doi.org/10.7322/abcshs.v43i1.999
• ³³
  Oliveira JS, Freitas SKS, Vilar NBS, Saintrain SV, Bizerril DO, Saintrain MVL. Influência da renda e do nível educacional sobre a condição de saúde percebida e autorreferida de pessoas idosas. J Health Biol Sci. 2019;7(4):395-8. https://doi.org/10.12662/2317-3076jhbs.v7i4.2343.p395-398.2019
  » https://doi.org/10.12662/2317-3076jhbs.v7i4.2343.p395-398.2019
• ³⁴
  Tavares DMS, Pelizaro PB, Pegorari MS, Paiva MM, Marchiori GF. Prevalência de morbidades autorreferidas e fatores associados entre idosos comunitários de Uberaba, Minas Gerais, Brasil. Cien Saude Colet. 2019;24(9)3305-13. https://doi.org/10.1590/1413-81232018249.31912017
  » https://doi.org/10.1590/1413-81232018249.31912017
• ³⁵
  Mini GK, Thankappan KR. Pattern, correlates and implications of noncommunicable disease multimorbidity among older adults in selected Indian states: a crosssectional study. BMJ Open. 2017;7(013529):01-06. https://doi.org/10.1136/bmjopen-2016-013529
  » https://doi.org/10.1136/bmjopen-2016-013529
• ³⁶
  Pereira AA, Borim FSA, Neri AL. Absence of association between frailty index and survival in elderly Brazilians: the FIBRA Study. Cad Saúde Pública. 2017;33(5):e00194115. https://doi.org/10.1590/0102-311X00194115
  » https://doi.org/10.1590/0102-311X00194115
• ³⁷
  Moreno CRC, Santos JLF, Lebrão ML, Ulhôa MA, Duarte YAO. Problemas de sono em idosos estão associados a sexo feminino, dor e incontinência urinária. Rev Bras Epidemiol. 2018;21(2):1-8. https://doi.org/10.1590/1980-549720180018.supl.2
  » https://doi.org/10.1590/1980-549720180018.supl.2
• ³⁸
  Silva MF, Assumpção D, Francisco PMSB, Neri AL, Yassuda MS, Borim FSA. Morbidades e associações com autoavaliação de saúde e capacidade funcional em idosos. Rev Bras Geriatr e Gerontol. 2020;23(5). https://doi.org/10.1590/1981-22562020023.200311
  » https://doi.org/10.1590/1981-22562020023.200311
• ³⁹
  Andrade AFSM, Fonseca RG, Teles WS, Silva MC, Barros AMMS, Torres RC, et al. Atuação do enfermeiro no cuidado humanizado ao idoso na Atenção Primária. Res, Soc Develop. 2021;10(12). https://doi.org/10.33448/rsd-v10i12.20283
  » https://doi.org/10.33448/rsd-v10i12.20283
• ⁴⁰
  Chibante CL, Santos TD, Espírito Santo FH. The challenges of getting old with health: profile of patients institutionalized with chronic diseases. Rev Enferm UFPE. 2014;8(9):3149-52. https://doi.org/10.5205/1981-8963-v8i9a10037p3149-3156-2014
  » https://doi.org/10.5205/1981-8963-v8i9a10037p3149-3156-2014
• ⁴¹
  Queiroz BM, Coqueiro RS, Leal Neto JS, Borgatto AF, Barbosa AR, Fernandes MH. Inatividade física em idosos não institucionalizados: estudo de base populacional. Cien Saude Colet. 2014;19(8):3489-96. https://doi.org/10.1590/1413-81232014198.19882013
  » https://doi.org/10.1590/1413-81232014198.19882013
• ⁴²
  Ribeiro AQ, Salgado SML, Gomes IS, Fogal AS, Martinho KO, Almeida LFF, et al. Prevalência e fatores associados à inatividade física em idosos: um estudo de base populacional. Rev Bras Geriatr Gerontol. 2016;19(3):483-93. https://doi.org/10.1590/1809-98232016019.150047
  » https://doi.org/10.1590/1809-98232016019.150047
• ⁴³
  Bortoluzzi EC, Pancotte J, Doring M, Graeff DB, Alves ALS, Portella MR, et al. Autopercepção de saúde de idosas praticantes de atividades físicas e fatores associados. Estud Interdiscipl Envelhec. 2018;23(2):119-31. https://doi.org/10.22456/2316-2171.64619
  » https://doi.org/10.22456/2316-2171.64619

Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho

ASSOCIATE EDITOR: Alexandre Balsanelli

Publication Dates

• Publication in this collection
  06 July 2022
• Date of issue
  2022

History

• Received
  31 Aug 2021
• Accepted
  11 Mar 2022