Abstract
Objective
To compare the quality of life of older adult participants and non-participants of community groups in a region of the Brazilian Western Amazon.
Method
An observational, cross-sectional study was conducted. A total of 424 older adult users of the Family Health Strategy were included. Data collection was performed using a sociodemographic questionnaire and the WHOQOL-BREF and WHOQOL-OLD scales for measuring quality of life by the World Health Organization. Participants were stratified according to participation in 3 different community groups: Group 1: physical exercise group; Group 2: physical exercise and health education group; Group 3: religious activities and/or community association group; and non-participants in community groups. The chi-square and multinomial regression tests were used to compare quality of life (QoL) among the groups. A 5% level of significance was adopted.
Results
The sample had a mean age of 69.86 years, community group participation of 44.22%, and predominance of females (66.75%). There was a statistically significant difference (p<0.05) in QoL between community group participants and non-participants. Group 1: Psychological (OR=0.21); Environment (OR=0.16; OR=0.21) and Social Participation (OR= 0.35) domains. Group 2: Environment (OR=0.29; OR=0.19); Autonomy (OR=0.12; OR=0.26); Past, Present and Future Activities (OR=0.44); Social Participation (OR=0.27) and General Score (OR=0.46) domains. Group 3: Environment (OR=0.31); Autonomy (OR=0.56) and Social Participation (OR=0.10; OR=0.47) domains.
Conclusion
Participation in community groups was associated with better QoL score, confirming that social engagement confers important benefits for health and QoL and contributes to healthy aging.
Keywords
Aged; Quality of Life; Social Participation; Primary Care
Resumo
Objetivo
comparar a qualidade de vida de pessoas idosas participantes e não participantes de grupos comunitários de uma região da Amazônia Ocidental Brasileira.
Método
Estudo observacional, de corte transversal. Participaram 424 pessoas idosas cadastradas na Estratégia Saúde da Família. Para coleta dos dados, utilizou-se questionário sociodemográfico e instrumentos de avaliação da qualidade de vida da Organização Mundial da Saúde, WHOQOL-BREF e WHOQOL-OLD. Os participantes foram estratificados conforme a participação em três diferentes grupos comunitários: Grupo 1: grupo de exercício físico; Grupo 2: grupo de exercício físico e educação em saúde; Grupo 3: Grupo de atividades religiosas e/ou associação comunitária; e não participantes. Utilizou-se os testes qui-quadrado e regressão multinominal para analisar a qualidade de vida entre os grupos. Nível de significância de 5%.
Resultados
Amostra com faixa etária média de 69,86 anos; participantes de grupos comunitários (44,22%); e predominância do sexo feminino (66,75%). Observou-se diferença significativa (p<0,05) na qualidade de vida dos participantes de grupos comunitários quando comparados aos não participantes. Grupo 1: domínios Psicológico (OR=0,21); Meio Ambiente (OR=0,16; OR=0,21) e Participação Social (OR= 0,35). Grupo 2: domínios Meio Ambiente (OR=0,29; OR=0,19); Autonomia (OR=0,12; OR=0,26); Atividades Passadas, Presentes e Futuras (OR=0,44); Participação Social (OR=0,27) e Escore Geral (OR=0,46). Grupo 3: domínios Meio Ambiente (OR=0,31); Autonomia (OR=0,56) e Participação Social (OR=0,10; OR=0,47).
Conclusão
A participação em grupos comunitários foi associada a melhores escores de qualidade de vida, confirmando que o engajamento social permite ganhos importantes para a saúde e qualidade de vida, contribuindo para um envelhecimento saudável.
Palavras-Chave:
Idoso; Qualidade de Vida; Participação Social; Atenção Primária à Saúde
INTRODUCTION
Community groups for older adults promote improvements in quality of life (QoL) by offering physical and intellectual activities that can enhance physical and mental health. Social contact reduces loneliness and depression, increasing wellbeing and self-esteem. Expanding social support networks is a beneficial strategy for older individuals and for health services11 Previato GF, Nogueira IS, Luís Mincoff RC, Jaques AE, Carreira L, Baldissera VDA. Conviviality groups for elderly people in primary health care: contributions to active aging. Rev Pesqui Cuid é Fundam Online [Internet]. 2019 Jan 1;11(1):173–80. Disponível em: https://doi.org/10.9789/2175-5361.2019.v11i1.173-180
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. These groups prevent social isolation, promoting a sense of belonging and purpose in life. In addition, this social interaction facilitates access to relevant information and services. Adopting inclusive, empathic policies for the older population is fundamental to ensure healthy aging, 22 Silva Santos PR, Soares Pereira AE, Costa e Silva SP, Oliveira FMRL de. Benefícios da inserção da pessoa Idosa em Grupos de Convivência: Revisão Integrativa. ID line Rev Psicol [Internet]. 2023 fev. 28;17(65):213–24. Disponível em: https://idonline.emnuvens.com.br/id/article/view/3678. https://doi.org/10.14295/idonline.v17i65.3678.
There is growing interest in the factors associated with longevity and in the aging process, given the older population have specific health needs. Aging is accompanied by greater prevalence and severity of problems, including chronic diseases, which can negatively impact QoL and autonomy, creating the need for remodeling public health policies33 Torres KRB de O, Campos MR, Luiza VL, Caldas CP. Evolução das políticas públicas para a saúde do idoso no contexto do Sistema Único de Saúde. Physis Rev Saúde Coletiva [Internet]. 2020;30(1):1–22. Disponível em: http://dx.doi.org/ 10.1590/s0103-73312020300113
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The quality of life theme is associated with a variety of approaches and concepts. However, the most widely known concept is that defined by the WHO44 WHOQOL GROUP. The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med. 1995 Nov 1;41(10):1403–9. Disponível em: https://doi.org/10.1016/0277-9536(95)00112-K5
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as: “an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.”
The observation of Munford et al.55 Munford LA, Wilding A, Bower P, Sutton M. Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England. BMJ Open [Internet]. 2020 Feb 6;10(2):e033186. Disponível em: https://doi.org/10.1136/ bmjopen-2019-033186
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regarding participation in community groups highlights a crucial aspect for QoL. Social participation in these groups not only fosters active aging, but is also associated with improved QoL and lower costs of care. This suggests that engagement in communities can be a valuable component for promoting a healthy satisfying life, particularly for older individuals.
Group activities, such as religious groups, associations, and physical or leisure activities, contribute positively to self-rated health and confer important gains in QoL66 Oliveira BLCA de, Lima SF, Costa ASV, Silva AM da, Alves MTSS de B e A. Social participation and self-assessment of health status among older people in Brazil. Cien Saude Colet [Internet]. 2021 Feb;26(2):581–92. Disponível em: https://doi.org/10.1590/1413-81232021262.2034201929. Disponível em: https://www.who.int/docs/default-source/decade-of-healthy-ageing/final-decade-proposal/decade-proposal-final-apr2020-en.pdf
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and active aging, providing opportunities for leisure, socialization, learning and enhancing mental and physical health11 Previato GF, Nogueira IS, Luís Mincoff RC, Jaques AE, Carreira L, Baldissera VDA. Conviviality groups for elderly people in primary health care: contributions to active aging. Rev Pesqui Cuid é Fundam Online [Internet]. 2019 Jan 1;11(1):173–80. Disponível em: https://doi.org/10.9789/2175-5361.2019.v11i1.173-180
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.
Maintaining good health in late-life enables continued effective involvement in family and community life, representing a pivotal element for strengthening societies77 Organização Pan-Americana da Saúde. Década do Envelhecimento Saudável 2020-2030. Organ Pan-Americana da Saúde. 2020;1–29. Available from: https://www.who.int/docs/default-source/decadeof-healthy-ageing/final-decade-proposal/decadeproposal-final-apr2020-en.pdf
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.
Conversely, poor health, social isolation and dependence are associated with increased health system utilization and higher public spending. Thus, implementing measures which seek to replace curative models with integral care models allow older adults to successfully enjoy this phase of life.
As an example, the Ministry of Health99 Brasil. Ministério da Saúde. PORTARIA No 2.528 DE 19 DE OUTUBRO DE 2006 [Internet]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2006/prt2528_19_10_2006.html
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introduced, via ruling no. 2.528/2006, the National Health Policy for Older Adults (PNPSI) implemented by means of a network of Family Health Strategy (ESF). The primary goal of the PNPSI is to restore, maintain and promote the autonomy and independence of older individuals through collective and individual health measures, pursuant to the principles and recommendations of the Brazilian National Health System (SUS).
Public policies that stimulate and reinforce the importance of maintaining good health status are pivotal factors for promoting healthy aging, where health professionals should stay abreast of the aspects of longevity affecting the older population1010 Souza Madeira E, Ramos Machado da Silva J, Alfradique de Souza P, Cristina Macedo E, Magno Carvalho da Silva C, Yuji Koike Felix R. Quality of life in elderly attend of a social center / Qualidade de vida em idosos integrantes de um centro de convivência. Rev Pesqui Cuid é Fundam Online [Internet]. 2022 out. 4;14:1–7. Disponível em: https://doi.org/10.9789/2175-5361.rpcfo.v14.11865.
Previous studies1111 de Oliveira L da SSCB, Souza EC, Rodrigues RAS, Fett CA, Piva AB. The effects of physical activity on anxiety, depression, and quality of life in elderly people living in the community. Trends Psychiatry Psychother [Internet]. 2019 Mar;41(1):36–42. Disponível em: http://dx.doi.org/10.1590/2237-6089-2017-0129
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12 Figueira HA, Figueira OA, Figueira AA, Figueira JA, Polo-Ledesma RE, Lyra da Silva CR, et al. Impact of Physical Activity on Anxiety, Depression, Stress and Quality of Life of the Older People in Brazil. Int J Environ Res Public Health [Internet]. 2023 Jan 8;20(2):1127. Disponível em: https://doi.org/10.3390/ ijerph20021127
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-1313 Fiorilli G, Buonsenso A, Centorbi M, Calcagno G, Iuliano E, Angiolillo A, et al. Long Term Physical Activity Improves Quality of Life Perception, Healthy Nutrition, and Daily Life Management in Elderly: A Randomized Controlled Trial. Nutrients [Internet]. 2022 Jun 17;14(12):2527. Disponível em: https:// doi.org/10.3390/nu14122527
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focusing on QoL of older adults and exploring aspects related to physical exercise intervention programs have mostly been conducted in the more developed South and Southeast regions of Brazil or in developed countries that have different sociodemographic characteristics.
Investigations of participation in community groups and its impacts on QoL are essential, especially studies involving older individuals from less developed regions such as the North of Brazil. The infrastructure of Primary Care teams in these areas is often poorer and the distribution of health services uneven relative to other regions1414 Soares Filho AM, Vasconcelos CH, Dias AC, Souza ACC de, Merchan-Hamann E, Silva MRF da. Atenção Primária à Saúde no Norte e Nordeste do Brasil: mapeando disparidades na distribuição de equipes. Cien Saude Colet [Internet]. Jan 2022;27(1):377–86. Disponível em: https:// doi.org/10.1590/1413-81232022271.39342020
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.
In the Northern state of Acre, 94% of the population are users of the public health system, which is available mainly in the capital (Rio Branco) city of the state. A number of challenges are evident, including the socioeconomic and cultural diversity of cities located in remote areas, geographical barriers hampering access to health services, disparities between municipal priorities and national guidelines, and also issues pertaining to access to local health services by the riverside-dwelling population, indigenous reserves and immigrants from border areas1515 Teston LM, Mendes Á, Carnut L, Louvison MCP. Desafios políticos e operacionais na percepção de gestores sobre a regionalização em saúde no Acre. Saúde em Debate [Internet]. Abr. 2019;43(121):314–28. Disponível em: https:// doi.org/10.1590/0103-1104201912102
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. The increase in migration of patients from the interior to urban centers in search of medical care can lead to higher local demand for health services. This burden leads to the need for allocation of additional resources to recruit medical professionals, purchase equipment and expand facilities. As a result, waiting times for appointments, tests and medical treatments can be longer, causing delays and dissatisfaction among public health users from Rio Branco city.
Understanding the ways in which participation in community groups can influence QoL in this specific setting is fundamental for developing public policies and implementing effective interventions that cater for these communities. Therefore, the objective of this study was to compare the QoL of older adult participants and non-participants of community groups in a region of the Brazilian Western Amazon.
METHOD
A cross-sectional, observational study of older adult users of four basic health units (UBS) located in the 1st district of the city of Rio Branco, Acre state, was conducted according to the STROBE guidelines by the EQUATOR network. The UBS were selected by simple random draw from units that met the criteria for inclusion of catering for older adults and belonging to different regional health sectors.
Sample size was calculated using Sample Size for Proportion (Finite Population). The population was defined as the 5,809 older adult users of the UBS which catered for groups of older individuals belonging to the 1st district of the city of Rio Branco city, Acre state. The necessary sample size based on a population of 5,809 people, with a 95% confidence level and 5% margin of error, was 365 older adults. A further 15% was added to this total to account for potential losses, giving a final estimated sample size of at least 420 people.
Interviews were conducted between 01 June and 30 November 2022 by the researcher with the assistance of community health workers (CHW), based on a preexisting list of older adult users registered at each UBS.
Sample selection was by convenience and performed when patients sought treatment and during home visits made by CHWs. Individuals that agreed to take part scheduled a data and time for application of the questionnaires at their homes.
Eligibility criteria were individuals age ≥60 years registered at the selected UBS, and not diagnosed with cognitive disorders or bedridden at the time of interview. Exclusion criteria were not being found after 3 tries by interviewer or failure to complete all the forms required for the study.
Information was obtained by applying instruments collecting sociodemographic and QoL data via interviews (average duration 50 minutes) conducted individually at each respondent´s home.
Sociodemographic data were obtained using a structured questionnaire collecting information on age, sex, color, education, marital status, occupation, family income, number of diseases, use of medications, participation in community groups and self-rated health status.
Participants were stratified into groups according to their responses regarding participation or otherwise in community groups and types of activities undertaken. Thus, the sample was divided into the following categories: i) Community group involving physical exercise (Group 1); ii) Community group involving physical exercise and health education (Group 2); iii) Community group involving religious activities and/or community associations (Group 3); and iv) Comparator group containing non-participants in group activities (Group 0).
Quality of life was assessed using two instruments devised by the WHO: the short version of the World Health Organization Quality of Life Group (WHOQOL-BREF)1616 Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref.” Rev Saude Publica [Internet]. Abr. 2000 [acesso em: 7 set. 2021];34(2):178–83. Disponível em: https://doi.org/ 10.1590/S0034-89102000000200012
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and the specific version for older adults (WHOQOL-OLD)1717 Fleck MP, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica [Internet]. 2006 Oct [acesso em: 7 set. 2021];40(5):785–91. Disponível em: https://doi.org/ 10.1590/S0034-89102006000600007 Dez. 2021 10;9(3):43–52. Disponível em: https://doi.org/10.25194/rebrasf.v9i3.1480
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, with both translated into Brazilian Portuguese and validated for use in the Brazilian older population.
The WHOQOL-BREF comprises 26 items divided into 4 domains, namely: Physical health, Psychological, Social relationships and Environment. The WHOQOL-OLD is specifically for use in the older population and applied together with the WHOQOL-BREF. The WHOQOL-OLD comprises 24 items divided into 6 facets each containing 4 items: Sensory Abilities; Autonomy; Past, Present and Future Activities; Social Participation; Death and Dying; and Intimacy. Scores for these 6 facets, or the values for the 24 items of the WHOQOL-OLD module, can be combined to yield a general score.
Scores on both these scales range from 0-100, where higher score indicates better QoL. Results were expressed as means, with categorized values1818 Marian Otto Barrientos A, Alves e Silva K, Ferreira dos Santos C, Priscila Batista Farias E, Ricardo Nepomuceno Pereira S, Cipriano Santos M, et al. QUALIDADE DE VIDA UTILIZANDO WHOQOL-BREF EM DIABÉTICOS NA ATENÇÃO BÁSICA DE SAÚDE EM CACHOEIRA-BA. Rev Bras Saúde Func [Internet]. Dec 2021 10;9(3):43–52. Available from: https://doi.org/10.25194/rebrasf.v9i3.1480
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,1919 Hoffmann-Horochovski MT, Castilho-Weinert LV. O WHOQOL-Bref para avaliar qualidade de vida como instrumento de apoio à Gestão Pública. NAU Soc [Internet]. Abr. 2018; 30;9(16):59–68. Disponível em: https://doi.org/10.9771/ns.v9i16.31412
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. For the calculation, the values of each domain are summed and divided by the number of questions to give an average score of 1 to 5. These values are transformed into categorical variables: score of 1-2.9 = needs improving; 3-3.9 = Fair; and 4-5 = Good/Very Good.
The chi-square or Likelihood Ratio tests were used to analyze the associations of the domains and facets of QoL by group. Subsequently, Odds Ratios were calculated using Multinomial Regression to verify the associations of domains and facets between the types of groups. A 5% (p<0.005) level of significance was adopted.
The study was conducted according to the ethics legislation in compliance with the ethics recommendations for research involving humans pursuant to National Board of Health Resolution CNS Nº 466/2012. The project was submitted to the Research Ethics Committee of the Universidade Federal de São Paulo (UNIFESP) and approved under permit no. 5.358.027. All participants agreed to take part in the study by signing the Free and Informed Consent form.
RESULTS
At conclusion of data collection, 428 older adults were invited to take part in the study. Of this total, 3 individuals refused to participate and 1 failed to complete all the questionnaires, giving a final total of 424 subjects that met the inclusion criteria.
Sample participants had a mean age of 69.86 years and were predominantly female, brown, married, retired, had incomplete primary education, mean income of 1.63 minimum wages and no participation in community groups. Regarding health status, most participants reported as being healthy, having an average of 1.07 diseases and using a mean of 2.45 medications daily (Table 1).
Sociodemographic characteristics of older adult users (n=424) of UBS in Rio Branco city, Acre state, Brazilian Western Amazon, 2022.
Analysis of QoL using the WHOQOL-BREF revealed a statistically significant group difference (p<0,005). For the Psychological domain (p=0.0071), the percentage of Good/Very good responses was greater among participants in Groups 1 (82%), 2 (55%) and 3 (54%) than in Group 0 (47%). Similarly, for the Environment domain (p<0.001, the percentage of Good/Very good responses was greater among participants in Groups 1 (33%), 2 (33%) and 3 (18%) than in Group 0 (9%). The analysis using the WHOQOL-OLD revealed a statistically significant group difference (p<0.005) for the facet Autonomy (p<0.001), where the percentage of Good/Very good responses was greater in Groups 1 (39%), 2 (55%) and 3 (35%) than in Group 0 (22%); and for the facet Social Participation (p<0.001), where the percentage of Good/Very good responses was greater in Groups 1 (55%), 2 (61%) and 3 (48%) than in Group 0 (29%). (Table 2).
Analysis of associations of domains and facets of QoL on WHOQOL-BREF and WHOQOL-OLD with group type (n=424). Rio Branco city, Acre state, 2022.
The odds ratios for QoL on the domains of the WHOQOL-BREF and facets of the WHOQOL-OLD according to Group type are presented in Table 3.
Odds Ratio (OR) - WHOQOL-BREF and WHOQOL-OLD, according to Group type (n=424). Rio Branco city, Acre state, 2022.
On the analysis of QoL, Group 1 participants had lower odds of rating QoL as “Needs improving” or “Fair” on the Psychological domain (Fair x Good/Very good; OR=0.21) and Environment domain (Needs improving x Good/Very good; OR=0.16) and (Fair x Good/Very good; OR=0.21), and on the Social Participation facets (Fair x Good/Very good; OR=0.35) than Group 0 participants. Group 2 participants had lower odds ratio of rating QoL as “Needs improving” or “Fair” on the Environment domain (Needs improving x Good/Very good; OR=0.29) and (Fair x Good/Very good; OR=0.19) and the facets of Autonomy (Needs improving x Good/Very good; OR=0.12) and (Fair x Good/Very good; OR=0.26), Past, present and future activities (Fair x Good/Very good; OR=0.44), Social Participation (Fair x Good/Very good; OR=0.27) and General score (Fair x Good/Very good; OR=0.46) than Group 0 participants. Group 3 participants had a lower odds ratio of rating QoL as “Needs improving” or “Fair” on the Environment domain (Needs improving x Good/Very good; OR=0.31) and the facets of Autonomy (Fair x Good/Very good; OR=0.56) and Social Participation (Needs improving x Good/Very good; OR=0.10) and (Fair x Good/Very good; OR=0.47) than Group 0 participants.
DISCUSSION
In the present study, the results of the analysis of the QoL of participants in community groups (Groups 1, 2 and 3) showed a higher rate of “Good/Very good” responses compared to non-participants (Group 0) on the Psychological, Environment, Autonomy and Social Participation domains. Of the different types of activities engaged in by the groups, those of Group 2, which included the combination of physical exercise plus health education actions promoted by the UBS, showed the best results on the QoL analysis compared with the other groups.
Regarding the sociodemographic characteristics of the older adults in the study sample, most participants were female, self-declared brown, and married. This profile was similar to that seen in the studies of Bezerra2020 Bezerra PC de L, Rocha BL da, Monteiro GTR. Fatores associados à fragilidade em pessoas idosas usuárias de serviços de Atenção Primária à Saúde de uma capital da Amazônia Brasileira. Rev Bras Geriatr e Gerontol [Internet]. 2023;26. Disponível em: https://doi.org/ 10.1590/1981-22562023026.230018.pt
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,2121 Bezerra PC de L, dos Santos EMA. Perfil sociodemográfico e situação de saúde de idosos acompanhados na Atenção Primária à Saúde em uma capital da Amazônia Ocidental*. Rev Kairós-Gerontologia [Internet]. 2020;23(1):451–69. Disponível em: https://dx.doi.org/10.23925/2176-901X.2020v23i1p451-469
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, also involving older adults in the state of Acre. Another factor which might explain the higher number of women in the sample is that males tend to seek primary care services as a preventive measure less than females2222 Miranda JF, Araújo MP de, Oliveira KGZ. O homem na busca dos serviços de atenção primária em saúde na cidade de Imperatriz-MA. Res Soc Dev [Internet]. Jan. 2022; 15;11(1):e56011124946. Disponível em: https://dx.doi.org/ 10.33448/rsd-v11i1.24946
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, and the sample studied was drawn from older adults who sought health services. Moreover, the predominance of females in the older population is a phenomenon commonly observed in many other parts of the world2323 United Nations Department of Economic and Social Affairs (UNDESA). The World’s Women 2010 [Internet]. 2010 p. 153. Disponível em: https://unstats.un.org/unsd/demographic/products/worldswomen/WW_fullreport_BW.pdf
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.
Most study participants were retired and had a monthly income of <2 minimum wages. Also, the participants were mainly low-educated, with majority reporting incomplete primary level, followed by no formal schooling. These data corroborate the findings of a previous study in Brazil, which found that older individuals with more educational and financial resources had greater access to activities associated with health and well-being2424 Sousa NF da S, Lima MG, Barros MB de A. Desigualdades sociais em indicadores de envelhecimento ativo: estudo de base populacional. Cien Saude Colet [Internet]. Out. 2021;26(suppl 3):5069–80. Disponível em: https://doi.org/ 10.1590/1413-812320212611.3.24432019
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. Moreover, lower educational level can represent a barrier to attaining good health in that it can hamper the search for knowledge and information for disease prevention and promoting a healthy lifestyle2525 Ha NT, Le NH, Khanal V, Moorin R. Multimorbidity and its social determinants among older people in southern provinces, Vietnam. Int J Equity Health [Internet]. 2015 Dec 30;14(1):50. Disponível em: http://dx.doi.org/10.1186/s12939-015-0177-8
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.
High levels of income and education are known factors facilitating social participation of older adults, highlighting the importance of implementing health promotion programs, providing financial support and developing transport infrastructure2626 Jalali MT, Sarikhani Y, Askarian F, Marzaleh MA, Najibi SM, Delavari S. Factors facilitating and inhibiting the social participation of the elderly in health-oriented activities in Shiraz, Southern Iran. BMC Geriatr [Internet]. 2023 Mar 27;23(1):175. Disponível em: https://doi.org/10.1186/s12877-023-03892-4
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.
The present study results revealed that over half of the older adult users of the UBS participated in no community groups run by the UBS or available in the community. These findings mirror the results of a population-based study in Southeast Brazil, showing that the population depending on the national health service had lower rates of participation in activities that benefit health2424 Sousa NF da S, Lima MG, Barros MB de A. Desigualdades sociais em indicadores de envelhecimento ativo: estudo de base populacional. Cien Saude Colet [Internet]. Out. 2021;26(suppl 3):5069–80. Disponível em: https://doi.org/ 10.1590/1413-812320212611.3.24432019
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.
Social participation has great potential for improving the general health of older individuals and, hence, the importance of services that integrate them into their communities2727 Douglas H, Georgiou A, Westbrook J. Social participation as an indicator of successful aging: An overview of concepts and their associations with health. Aust Heal Rev. 2017;41(4):455–62. Dísponível em : http://dx.doi.org/10.1071/AH1603822
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. Strategies which increase levels of social participation during the life span, particularly in the transition to older age, confer a protective effect against the emergence of physical and mental disability and play a facilitating role in adjustment of the individual and in their adaptation to losses inherent to the aging process2828 Silva SR, Marques FDC, Lavado N, Parente LFD, Rafael ACM, Gonçalves DP, et al. Qualidade de Vida e Participação em Iniciativas de Base Comunitária: Um estudo num município da zona centro de Portugal. Rev Kairós Gerontol [Internet]. Set. 2019 30;22(3):43–66. Disponível em: http://dx.doi.org/10.23925/2176-901X.2019v22i3p43-66
https://doi.org/10.23925/2176-901X.2019v...
.
Although the majority of study participants reported having some type of disease, when probed about their health status respondents stated they felt healthy. This shows that harboring a disease and being in use of medications does not necessarily impact subjective perceived health. Recent studies2929 Ma X, Piao X, Oshio T. Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China. BMC Public Health [Internet]. 2020 Dec 15;20(1):502. Disponível em: https://doi.org/10.1186/s12889-020-08650-4
https://doi.org/10.1186/s12889-020-08650...
,3030 Palmes MS, Trajera SM, Ching GS. Relationship of Coping Strategies and Quality of Life: Parallel and Serial Mediating Role of Resilience and Social Participation among Older Adults in Western Philippines. Int J Environ Res Public Health [Internet]. 2021 Sep 23;18(19):10006. Disponível em: https:// doi.org/10.3390/ijerph181910006
https://doi.org/10.3390/ijerph181910006 ...
investigating social participation strategies of older individuals found these strategies had a significant positive impact on mental health and perceived health status of the subjects assessed, suggesting that they can be deployed as a means of promoting health.
The analysis of QoL of the groups revealed a statistically significant difference among participants in the community groups (Groups 1, 2 and 3) compared to non-participants (Group 0) on the Psychological and Environment domains, and on the Autonomy and Social Participation facets. Participation in these groups likely has a beneficial effect on the aspects of emotional wellbeing, positive feelings, and satisfaction with life and with the physical and social environment to which subjects are exposed. Expanding the availability of these activities and stimulating greater participation in social activities are ways of improving the QoL of older adults3030 Palmes MS, Trajera SM, Ching GS. Relationship of Coping Strategies and Quality of Life: Parallel and Serial Mediating Role of Resilience and Social Participation among Older Adults in Western Philippines. Int J Environ Res Public Health [Internet]. 2021 Sep 23;18(19):10006. Disponível em: https:// doi.org/10.3390/ijerph181910006
https://doi.org/10.3390/ijerph181910006 ...
.
The current findings are consistent with those of Blancafort et al.3131 Blancafort Alias S, Monteserín Nadal R, Moral I, Roqué Fígols M, Rojano i Luque X, Coll-Planas L. Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS. BMC Public Health [Internet]. 2021 Dec 7;21(1):84 Disponível em: https://doi.org/10.1186/s12889-020-10094-9
https://doi.org/10.1186/s12889-020-10094...
, affirming that group interventions with a strong social component run in the primary health setting appear to be a promising solution for improving health strategies offered to older adults.
Generally, engagement in community groups is a factor that contributes to improved QoL. Similar results were found in the study by Munford et al.3232 Munford LA, Panagioti M, Bower P, Skevington SM. Community asset participation and social medicine increases qualities of life. Soc Sci Med [Internet]. 2020 Aug;259(March):113-149. Disponível em: https://doi.org/10.1016/j.socscimed.2020.113149
https://doi.org/10.1016/j.socscimed.2020...
, confirming that community asset participation increases QoL, whereas older adults who do not participate obtain the worst scores.
The multiple regression analysis showed an association in the community group involving physical exercise plus health education activities (Group 2) with most of the domains and facets analyzed. The actions performed in this group entailed a combination of engaging in physical exercise and health education activities, such as talks, healthcare workshops, conversation circles and socialization of experiences. Community groups have great potential to offer participants the opportunity to promote health, prevent disease and provide integrated care3333 Silva DS da, Mota JL, Silva EV da, Almeida PS, Caixeta GG, Lima LF de, et al. Senescência: percepções sobre este processo e a sua singularidade na vida de idosos que participam de um grupo de convivência. Rev Eletrônica Acervo Saúde [Internet]. 28 mar. 2022;15(3):e9975. Disponível em: https://doi.org/ 10.25248/reas.e9975.2022
https://doi.org/ 10.25248/reas.e9975.202...
. Also, studies have shown a significant association between regular involvement in social activities and longer overall survival in older adults3434 Wang Z, Zheng Y, Ruan H, Li L, Duan L, He S. Association between social activity frequency and overall survival in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). J Epidemiol Community Health [Internet]. 2023 May;77(5):277–84. Disponível em: https://doi.org/ 10.1136/jech-2022-219791
https://doi.org/ 10.1136/jech-2022-21979...
. Furthermore, such groups encourage engagement in physical activities, representing a key factor in delaying the transition from robustness to frailty in this group3535 Hayashi C, Toyoda H, Ogata S, Okano T, Mashino S. Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study. Environ Health Prev Med [Internet]. 2021 Dec 20;26(1):105. Disponível em: https://doi.org/10.1186/s12199-021-01028-x
https://doi.org/10.1186/s12199-021-01028...
.
Improving the social participation of older adults is a key factor for essential aspects of aging including physical and mental health. A recent study showed a significant relationship between physical activity, anxiety, stress and QoL. The inclusion of physical activity in groups for older adults constitutes an alternative for improving other variables affecting health such as anxiety and stress.
The present results should be interpreted with caution in as far as the conclusions cannot be generalized to other contexts because the sample consisted of urban older adults only. Another aspect to take into account is that factors such as duration and frequency of participation in the groups were not investigated, aspects which may have influenced the QoL scores attained. Lastly, the QoL of the participants may have been overestimated, since subjects with more severe disabilities, such as cognitive impairment or being bedridden, were excluded from the sample.
CONCLUSION
The present study revealed that participation in community groups was associated with better QoL scores. Notably, the physical exercise plus health education group, with an emphasis on activities such as engaging in guided physical exercise and health education actions, attained better QoL scores on the domains and facets assessed.
Generally, participation in community groups is an important factor in strengthening ties, feelings of belonging and individual and collective wellbeing, promoting enhanced QoL and, consequently, healthy aging.
These findings underscore the importance of implementing public policies centered community programs for older adults, fostering participation and involvement in activities which optimize social connections, fundamental for improving and maintaining QoL, particularly in the population reliant on the public health system.
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No funding was received in relation to the presente study.
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DATA AVAILABILITY
The complete anonymized dataset underpinning the results of the present study are available on figshare from [https://doi.org/10.6084/m9.figshare.25746663].
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» https://doi.org/10.3390/ijerph181910006 -
31Blancafort Alias S, Monteserín Nadal R, Moral I, Roqué Fígols M, Rojano i Luque X, Coll-Planas L. Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS. BMC Public Health [Internet]. 2021 Dec 7;21(1):84 Disponível em: https://doi.org/10.1186/s12889-020-10094-9
» https://doi.org/10.1186/s12889-020-10094-9 -
32Munford LA, Panagioti M, Bower P, Skevington SM. Community asset participation and social medicine increases qualities of life. Soc Sci Med [Internet]. 2020 Aug;259(March):113-149. Disponível em: https://doi.org/10.1016/j.socscimed.2020.113149
» https://doi.org/10.1016/j.socscimed.2020.113149 -
33Silva DS da, Mota JL, Silva EV da, Almeida PS, Caixeta GG, Lima LF de, et al. Senescência: percepções sobre este processo e a sua singularidade na vida de idosos que participam de um grupo de convivência. Rev Eletrônica Acervo Saúde [Internet]. 28 mar. 2022;15(3):e9975. Disponível em: https://doi.org/ 10.25248/reas.e9975.2022
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34Wang Z, Zheng Y, Ruan H, Li L, Duan L, He S. Association between social activity frequency and overall survival in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). J Epidemiol Community Health [Internet]. 2023 May;77(5):277–84. Disponível em: https://doi.org/ 10.1136/jech-2022-219791
» https://doi.org/ 10.1136/jech-2022-219791 -
35Hayashi C, Toyoda H, Ogata S, Okano T, Mashino S. Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study. Environ Health Prev Med [Internet]. 2021 Dec 20;26(1):105. Disponível em: https://doi.org/10.1186/s12199-021-01028-x
» https://doi.org/10.1186/s12199-021-01028-x
Edited by
Data availability
The complete anonymized dataset underpinning the results of the present study are available on figshare from [https://doi.org/10.6084/m9.figshare.25746663].
Publication Dates
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Publication in this collection
26 Aug 2024 -
Date of issue
2024
History
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Received
04 Dec 2023 -
Accepted
04 July 2024