Aging and public health: the Brazilian Longitudinal Study of Aging (ELSI-Brazil)Brazil is experiencing one of the fastest rates of population aging worldwide1. As Brazil has the fifth largest population in the world, the aging of its population has repercussions that transcend the country’s borders. This demographic shift brings both opportunities and challenges not yet fully understood. Promoting active aging2 and strengthening economic and social institutions to ensure financial security and provision of adequate health care3 are crucial issues.
Large population-based longitudinal studies on aging have been conducted in various countries of the Americas, Europe, and Asia. These studies, known as the Health and Retirement Family of Studies4, investigate the social and biological determinants of aging and the consequences of this demographic change for the individual and for society. Although these studies are independent, to meet the demands and particularities of each country, they seek to adopt a common methodology to allow for international comparisons. The Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in a nationally representative sample of people aged 50 years and over, is part of this international network5. ELSI is funded by the Brazilian Ministry of Health and has the support of researchers from several Brazilian and foreign academic institutions, as well as from policymakers from the Brazilian Unified Health System (SUS) at its various levels. The manuscripts included in this supplement of the Revista de Saúde Pública are fruit of these important collaborations.
The selection of topics covered in these articles was based on the three pillars of the policy framework for active aging of the World Health Organization, i.e., participation, health, and security2. Social security is important at all ages, but its demand is even greater later in life. In the Federal Constitution of Brazil, social security is defined as “initiatives of public authorities and society, aimed at ensuring the rights related to health, welfare, and social assistance”6. Therefore, social security has been addressed in several manuscripts whilst health was analyzed in all.
High levels of social inequality are found in the majority of topics investigated, with the poorest or those with lower educational level affected most. Inequalities are observed in physical activity7, oral health status8, limitations to perform basic activities of daily living9, frailty10, adequate control of hypertension11, underutilization of medications due to financial reasons12, source of health care13, and capacity to work14. Social participation15 and the fear of falling16 are associated with the urban environment. Perceived quality of life is associated with sociability and emotional and instrumental support17. Performance in cognitive function tests is shown to be worse in the Northeast region18. Back pain and hypertension play a prominent role in the configuration of multimorbidity19. Women are the main source of care for those with functional limitations and, among those who worked, a third stopped working to be caregivers20. Some indicators of utilization and quality of health services are better among those who have access to the private health system, who have better socioeconomic conditions13. Access to primary care is high by international standards13, but many hospitalizations could be prevented by more effective actions at this level of care21. Differences in the performance of primary care among users of the SUS are found, with a better performance of the Family Health Strategy compared to the traditional basic units13. Incapacity to work14, as well as the receipt of pensions22 are associated with worse health conditions. However, people who receive pensions are more autonomous and have more financial security22.
One of the goals of the Post-2015 Development Agenda, supported by 193 members states of the United Nations, is to ensure healthy lives and promote well-being for all at all ages23,24. Based on the main findings from ELSI, reported in this special issue, the post-2015 development goals may be jeopardized without investments in social protection/security, education, and health, as well as in overcoming the associated social inequalities. The existing Family Health Strategy program needs to be reinforced and improved to meet the needs of older adults. A social care policy at the national level for those with disability is pressing, given demographic trends pointing to a decrease in the availability of informal (non-paid) care5. Finally, the results also highlight the need to consider health in the current discussions around extending working lives and potential changes in the rules for pensions, since health conditions are associated with early retirement and decreased work capacity.
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5 Lima-Costa MF, Bof de Andrade F, Souza Jr PRB, Neri AL, Duarte YAO, Castro-Costa E, et al. The Brazilian Longitudinal Study of Aging (ELSI-BRAZIL): objectives and design. Am J Epidemiol 2018;187(7):1345-53. https://doi.org/10.1093/aje/kwx387
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7 Peixoto SV, Mambrini JVM, Firmo JOA, Loyola Filho AI, Souza-Junior PRB, Bof de Andrade F, et al. Physical activity practice among older adults: results of the ELSI-Brazil Rev Saude Publica 2018;52 Suppl 2:5s. https://doi.org/10.11606/S1518-8787.2018052000605
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8 Bof de Andrade F, Antunes JLF, Souza-Junior PRB, Lima-Costa MF, Oliveira C. Lifecourse socioeconomic inequalities and oral health status in later life: ELSI-Brasil. Rev Saude Publica 2018;52 Suppl 2:7s. https://doi.org/10.11606/S1518-8787.2018052000628
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9 Bof de Andrade F, Duarte YAO, Souza-Junior PRB, Torres JL, Lima-Costa MF, Andrade FCD. Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015. Rev Saude Publica 2018;52 Suppl 2:14s. https://doi.org/10.11606/S1518-8787.2018052000617
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10 Andrade JM, Duarte YAO, Alves LC, Andrade FCD, Souza-Junior PRB, Lima-Costa MF, et al. Frailty profile in Brazilian older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:17s. https://doi.org/10.11606/S1518-8787.2018052000616
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11 Firmo JOA, Mambrini JVM, Peixoto SV, Loyola Filho AI, Souza-Junior PRB, Bof de Andrade F, et al. Adequate control of hypertension among older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:13s. https://doi.org/10.11606/S1518-8787.2018052000646
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12 Loyola Filho AI, Firmo JOA, Mambrini JVM, Peixoto SV, Souza-Junior PRB, Bof de Andrade F, et al. Cost-related underuse of medications in older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:8s. https://doi.org/10.11606/S1518-8787.2018052000622
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13 Macinko J, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brasil). Rev Saude Publica 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
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14 Castro CMS, Lima-Costa MF, César CC, Neves JAB, Bof de Andrade F, Souza-Junior PRB, et al. Life course and work ability among older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:11s. https://doi.org/10.11606/S1518-8787.2018052000648
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15 Ferreira FR, César CC, Bof de Andrade F, Souza-JuniorPRB, Lima-Costa MF, Proietti FA. Aspects of social participation and neighborhood perception: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:18s. https://doi.org/10.11606/S1518-8787.2018052000647
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16 Pimentel WRT, Pagotto V, Stopa SR, Hoffmann MCCL, Bof de Andrade F, Souza-Junior PRB, et al. Falls among Brazilian older adults living in urban areas: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:12s. https://doi.org/10.11606/S1518-8787.2018052000635
» https://doi.org/10.11606/S1518-8787.2018052000635 -
17 Neri AL, Borim FSA, Fontes AP, Rabello DF, Cachioni M, Batistoni SST, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:16s. https://doi.org/10.11606/S1518-8787.2018052000613
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18 Castro-Costa E, Lima-Costa MF, Bof de Andrade F, Souza-Junior PRB, Ferri CP. Cognitive function among older adults: ELSI-Brazil results. Rev Saude Publica 2018;52 Suppl 2:4s. https://doi.org/10.11606/S1518-8787.2018052000629
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19 Nunes BP, Batista SRR, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF, Facchini LA. Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil). Rev Saude Publica 2018;52 Suppl 2:10s. https://doi.org/10.11606/S1518-8787.2018052000637
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Funding: The ELSI-Brazil baseline study was supported by the Brazilian Ministry of Health (DECIT/SCTIE – Department of Science and Technology from the Secretariat of Science, Technology and Strategic Inputs (Grant 404965/2012-1); COSAPI/DAPES/SAS – Healthcare Coordination of Older Adults, Department of Strategic and Programmatic Actions from the Secretariat of Health Care) (Grants 20836, 22566, and 23700); and the Brazilian Ministry of Science, Technology, Innovation and Communication.
