Abstract

This work aimed to identify the prevalence of positive self-perceived health among non-long-lived and long-lived older adults and associated factors. This is a study with older adults in the Family Health Strategy of Montes Claros. The Brazilian Older Americans Resources and Services Multidimensional Function Assessment Questionnaire was used. Bivariate and multiple analyses were performed using Poisson Regression. A total of 1,750 older adults participated in the study, of which 1,420 were non-long-lived older adults, and 330 were long-lived older adults. Positive self-perception was reported among 71.9% of the non-long-lived older adults and 67.8% of the long-lived older adults. Among the non-long-lived, positive self-perceived health was associated with five years of schooling (PR=1.12); household income from two to less than three minimum wages (PR=1.13) and ≥three minimum wages (PR=1.12); preserved vision (PR=1.13); proper chewing (PR=1.16); preserved sleep (PR=1.23); absence of polypathologies (PR=1.29); absence of diabetes (PR=1.15); falls in the last year (PR=1.13); and physical activity (PR=1.11). Among the long-lived older adults, it was associated with the use of prosthesis, sleeping disorders, and polypathologies and physical activities. Positive self-perception of health is associated with social and health determinants.

Key words:
Self-perception; Aging; Elderly health; Health conditions

Introduction

Population aging is a global event resulting from the demographic transition associated with increased longevity, which contributes to changes in epidemiological, economic, and social characteristics¹1 Organização Mundial de Saúde (OMS). Relatório Mundial de Envelhecimento e Saúde. Genebra: OMS; 2015.. It is associated with the declining general mortality levels, lower infant mortality rates, and increased life expectancy at birth²2 Vasconcelos AMN, Gomes MMF. Transição demográfica: a experiência brasileira. Epidemiol Serv Saude 2012; 21(4):539-548.^,33 Simões CCS. Relações entre as alterações históricas na dinâmica demográfica brasileira e os impactos decorrentes do processo de envelhecimento da população. Rio de Janeiro: IBGE; 2016..

The age range in older adults’ composition distinguishes between the strata of non-long-lived (between 60 and 79 years old) and long-lived (of 80 years old or more) older adults’ strata that must be considered due to specific clinical characteristics. As long-lived older adults assume a more significant proportion in the population, the frequency of “hidden conditions” or not classified as fatal diseases increases and adversely affects social and family ties, functional capacity, and well-being⁴4 Hazra NC, Gulliford M. Evolution of the "fourth stage" of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records. Populat Health Metrics 2017; 15(1):18.. Moreover, multiple morbidities, disabilities, or dependencies establish a worse quality of life⁵5 Porciúncula RCR, Carvalho EF, Barreto KML, Leite VMM. Perfil socioepidemiológico e autonomia de longevos em Recife-PE, Nordeste do Brasil. Rev Bras Geriatr Gerontol 2014; 17(2):315-325. t^,66 Franzon K, Byberg L, Sjogren P, Zethelius B, Cederholm T, Kilander L. Predictors of independent aging and survival: a 16-year follow-up report in octogenarian men. J Am Geriatr Soc 2017; 65(9):1953-1960.. For older adults in general, the cost of maintaining physical and mental capacities and structuring protection mechanisms against problems related to chronic conditions put pressure on the socioeconomic and health sectors⁷7 Krug RR, Schneider IJC, Giehl MWC, Antes DL, Confortin SC, Mazo GZ, Xavier AJ, d'Orsi E. Fatores sociodemográficos, comportamentais e de saúde associados à autopercepção de saúde positiva de idosos longevos residentes em Florianópolis, Santa Catarina. Rev Bras Epidemiol 2018; 21:e180004..

Qualified assistance for elderly health care has been the subject of different public policies in Brazil⁸8 Brasil. Ministério da Saúde (MS). Departamento de Atenção Básica. Envelhecimento e Saúde da Pessoa Idosa. Brasília: MS; 2006.

9 Brasil. Ministério da Saúde (MS). Portaria nº 2.528, de 19 de outubro de 2006. Aprova a Política Nacional de Saúde da Pessoa Idosa. Diário Oficial da União; 2006.

10 Brasil. Lei nº 13.466, de 12 de julho de 2017. Altera os arts. 3º, 15 e 71 da Lei nº 10.741, de 1º de outubro de 2003, que dispõe sobre o Estatuto do Idoso e dá outras providências. Diário Oficial da União 2017; 13 jul.

11 Camacho ACLF, Coelho MJ. Políticas públicas para a saúde do idoso: revisão sistemática. Rev Bras Enferm 2010; 63(2):279-284.^-1212 Fernandes MTO, Soares SM. O desenvolvimento de políticas públicas de atenção ao idoso no Brasil. Rev Esc Enferm USP 2012; 46(6):1494-1502.. In Primary Health Care (PHC), represented by the Family Health Strategy (ESF), attributions were defined for planning, programming, and carrying out actions that involve elderly health care in their area of coverage. A multidisciplinary team’s performance to survey and monitor older adults in situations of frailty or functional risk is also provided for, besides promoting specific educational actions⁸8 Brasil. Ministério da Saúde (MS). Departamento de Atenção Básica. Envelhecimento e Saúde da Pessoa Idosa. Brasília: MS; 2006.^,1313 Castro APR, Vidal ECF, Saraiva ARB, Arnaldo SM, Borges AMM, Almeida MI. Promoting health among the elderly: actions in primary health care. Rev Bras Geriatr Gerontol 2018; 21(2):155-163..

Based on a performance closer to the subject and adequate use of family health tools, ESF teams can provide individualized care, identifying the association between psychological well-being and physical health timely. In this sense, the concept of self-perceived health allows understanding older adults’ perspective about their health and how it relates to the health service.

Because it is linked to socioeconomic, environmental, biological, emotional, cultural, and care factors, it is essential to understand which aspects influence self-perceived health and how. These results would allow providing qualified care focused on real needs and modifying the factors responsible for older adults’ illness and vulnerability. Self-perceived health has been recommended to assess people’s health conditions due to the coincidence between perceived and actual health status, besides its widespread and rapid application¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.. Older adults’ self-perception refers to the correlation between health condition and functionality, and is a good indicator of the quality of life, morbidity, functional decline, and a predictor of mortality¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.

15 Cardoso JDC, Azevedo RCS, Reiners AAO, Louzada CV, Espinosa MM. Autoavaliação de saúde ruim e fatores associados em idosos residentes em zona urbana. Rev Gaucha Enferm 2014; 35(4):35-41.

16 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.^-1717 Buccella S, Brandi R. Evaluación geriátrica integral: propuesta de un modelo de autonotificación del estado de salud. Salus 2016; 20(3):22-28..

The assessment of positive self-perception of health allows the understanding of factors related to the quality of life and health conditions. Thus, the collection of these data can assist in providing health care to older adults and the organization of the work process in line with their peculiarities⁸8 Brasil. Ministério da Saúde (MS). Departamento de Atenção Básica. Envelhecimento e Saúde da Pessoa Idosa. Brasília: MS; 2006.^,99 Brasil. Ministério da Saúde (MS). Portaria nº 2.528, de 19 de outubro de 2006. Aprova a Política Nacional de Saúde da Pessoa Idosa. Diário Oficial da União; 2006.^,1111 Camacho ACLF, Coelho MJ. Políticas públicas para a saúde do idoso: revisão sistemática. Rev Bras Enferm 2010; 63(2):279-284.^,1212 Fernandes MTO, Soares SM. O desenvolvimento de políticas públicas de atenção ao idoso no Brasil. Rev Esc Enferm USP 2012; 46(6):1494-1502.^,1616 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060., and can also contribute to directing intersectoral actions that can positively and longitudinally affect the well-being of this population¹¹11 Camacho ACLF, Coelho MJ. Políticas públicas para a saúde do idoso: revisão sistemática. Rev Bras Enferm 2010; 63(2):279-284.^,1212 Fernandes MTO, Soares SM. O desenvolvimento de políticas públicas de atenção ao idoso no Brasil. Rev Esc Enferm USP 2012; 46(6):1494-1502.^,1616 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.. This study aims to identify the factors associated with positive self-perceived health and its prevalence in non-long-lived and long-lived older adults assisted by the ESF teams in Montes Claros-MG, Brazil.

Method

This study derives from the intervention project entitled Elderly Health Multidisciplinary Support in Primary Health Care in Montes Claros, Minas Gerais, Brazil. This is a cross-sectional and analytical research conducted with older adults registered in ESF teams who work as centers of the Family and Community Medicine Residency (RMFC). The Strengthening the Reporting of Observational Studies in Epidemiology (Strobe) checklist for observational studies was employed to assist the research and reporting the results obtained¹⁸18 Malta M, Cardoso LO, Bastos FI, Magnanini MMF, Silva CMFP. Iniciativa STROBE: subsídios para a comunicação de estudos observacionais. Rev Saude Publica 2010; 44(3):559-565..

The municipality is located in the north of Minas Gerais, ranked as the sixth-largest population and the largest in this region of the state¹⁹19 Prefeitura Municipal de Montes Claros. Montes Claros. Aspectos Gerais [Internet]. [acessado 2018 nov 18]. Disponível em: http://www.montesclaros.mg.gov.br/cidade/aspectos_gerais.htm.
http://www.montesclaros.mg.gov.br/cidade... . IBGE estimates a population of 409,341 inhabitants²⁰20 Instituto Brasileiro de Geografia e Estatística (IBGE). Rio de Janeiro. População [Internet]. [acessado 2018 jul 1]. Disponível em: https://cidades.ibge.gov.br/brasil/mg/montes-claros/panorama.
https://cidades.ibge.gov.br/brasil/mg/mo... . Of the 131 ESF teams in the municipality (97.75% coverage), 38 teams were linked to the RMFC of the Clemente de Faria University Hospital/Unimontes, grouped into 13 educational centers (28.35% coverage).

The sample was calculated for an infinite population and considered the estimated population for the municipality at the time, and 8.17% were older adults. For this elderly population, the frequency of the studied event was considered at 50%, with a 95% confidence interval, an error margin of 3%, and adjustment by the effect of design (deff=1.5). The calculated sample was 1,708 individuals. The sample was selected by two-stage cluster probabilistic sampling, with a draw of the RMFC centers in the municipality’s urban area, followed by a draw of teams and micro areas from each center.

All older adults of the selected teams with conditions to answer the questionnaires and a caregiver available during the collection visits were included. Those who were absent from home after three interview attempts, even after previous scheduling on different days and times, were excluded from the study. While the instrument used for data collection allows the caregiver to provide much information, for self-perceived health assessment, older adults who were unfit for such judgment according to the family’s assessment were also excluded.

Data collection employed the Brazilian Older Americans Resources and Services Multidimensional Function Assessment Questionnaire (Bomfaq)²¹21 Blay SL, Ramos LR, de Mari JJ. Validity of a brazilian version of the older americans resources and services (OARS) Mental Health Screening Questionnaire. J Am Geriatr Soc 1988; 36(8):687-692.. The investigated variables were grouped into blocks: socioeconomic and physical and mental health²¹21 Blay SL, Ramos LR, de Mari JJ. Validity of a brazilian version of the older americans resources and services (OARS) Mental Health Screening Questionnaire. J Am Geriatr Soc 1988; 36(8):687-692.. For analysis purposes, the variables were categorized as described in Charts 1 and 2.

The data were collected by health professionals and previously trained students at the older adults’ homes at agreed times, from September 2016 to May 2017. For data analysis, older adults were stratified into two groups: non-elderly long-lived (aged 60 to 79) and long-lived (aged 80 or more) older adults. Descriptive analysis was performed by simple and relative frequency. Self-perceived health was used as a dependent variable, categorized as positive (excellent/good) or negative (poor/very bad) self-perception. Sociodemographic characteristics (gender, skin color, schooling, marital status, remunerated work, income, and people living in the household), physical and mental health (visual impairment, hearing impairment, dental prosthesis, difficulty chewing, difficulty swallowing, sleep disorders, insomnia, polypharmacy, cognitive impairment, polypathology, hypertension, diabetes, obesity, depression, falling, and physical activity).

Initially, a bivariate analysis was performed for each group, and the variables with a p-value up to 0.20 were selected for the multiple analysis. The magnitude of the association between the independent variable and the independent variables was measured by the crude and adjusted prevalence ratios (PR), which were estimated by the Poisson regression model with robust variance. The significance level was set at 0.05. The deviance test was used to assess the quality of the models. All statistical analyses were performed using the statistical software IBM SPSS® (Statistical Package for the Social Science), version 20.0 for Windows.

The study was conducted under Resolution N° 466, of December 12, 2012, of the National Health Council, Ministry of Health²²22 Brasil. Ministério da Saúde (MS). Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. Diário Oficial da União 2013; 13 dez.. The Research Ethics Committee of the State University of Montes Claros (CEP/Unimontes). Participants were informed about the purposes, methods and procedures, benefits, risks, discomforts, and precautions of the study, and agreed by signing an Informed Consent Form.

Results

A total of 1,750 older adults participated in this study, 1,420 (81.1%) were non-long-lived older adults and 330 (18.9%) long-lived older adults. Females were predominant in both non-long-lived and long-lived older adults’ strata, 63.7% and 62.4%, respectively. Self-declared non-whites predominate in both strata (65.5% and 55.7%). Low education and illiteracy reached 67.8% of the older adults in the sample, with 64.6% of the non-long-lived elderly and 82.5% of the long-lived. Ninety percent of the individuals live with someone, and 41.8% of the non-long-lived and 63.5% of the long-lived older adults have no partner. Income distribution follows the same pattern in both strata: 20% with a subsidy below one minimum wage, and about 57% receiving between one and less than three minimum wages. Positive self-perception was reported in 71.2% of the older adults, with 71.9% among non-long-lived and 67.8% among long-lived.

Table 1 shows the bivariate analysis visualized and variables associated with positive perception in non-long-lived older adults. The variables selected for multiple analysis were gender (p=0.001); up to 4 years schooling (p=0.072) and 5 years or more (p<0.001); income of 2 to less than 3 minimum wages (p=0.013) and greater than 3 minimum wages (p<0.001); visual difficulty (p<0.001); hearing difficulty (p=0.008); dental prosthesis (p=0.146); difficulty chewing (p<0.001); difficulty swallowing (p=0.012); sleep disorders (p<0.001); insomnia (p<0.001); polypharmacy (p<0.001); polypathology (p<0.001); arterial hypertension (p<0.001); diabetes mellitus (p<0.001); obesity (p=0.008), falls (p<0.001); and physical activities (p<0.001).

The bivariate analysis for positive self-perception in long-lived older adults is shown in Table 2. The variables selected for multiple analysis were 5 years or more schooling (p=0.040); income of 2 to less than 3 minimum wages (p=0.158); hearing difficulty (p=0.165); dental prosthesis (p=0.019); difficulty chewing (p=0.005); sleep disorders (p<0.001); insomnia (p <0.001); polypharmacy (p=0.059); cognitive impairment (p=0.045); polypathologies (p<0.001); diabetes (p=0.180); depression (p=0.143); falls in the last year (p=0.040); and physical activities (p=0.011).

Table 3 shows the adjusted analysis results for positive self-perceived health in older adults regarding the selected independent variables. Regarding non-long-lived older adults, an association was found with 5 years or more schooling (PR=1.26); household income of 2 to less than 3 minimum wages (PR=1.13) and greater than or equal to 3 minimum wages (PR=1.12); preserved vision (PR=1.13); proper chewing (PR=1.16); preserved sleep (PR=1.23); absence of polypathologies (PR=1.29); not having diabetes (PR=1.15); no falls in the last year (PR=1.13); and physical activities (PR=1.11). Concerning long-lived older adults, the results of the adjusted analysis showed an association of positive self-perceived health with the variables use of prosthesis (PR=1); lack of sleep disorders (PR=1.37); not having polypathologies (PR=1.22), and physical activities (PR=1.24).

Discussion

This study identified positive self-perceived health in more than two-thirds of the non-long-lived and long-lived older adults assessed. The prevalence values for this outcome vary in the literature. A study based on the 2013 National Health Survey (PNS) with 23,815 older adults showed a 44% prevalence of positive self-perception²³23 Zanesco C, Bordin D, Santos CB, Müller EV, Fadel CB. Fatores que determinam a percepção negativa da saúde de idosos brasileiros. Rev Bras Geriatr Gerontol 2018; 21(3):283-292.. Another study conducted in Florianópolis-SC in 2018 with a sample of 239 long-lived older adults observed a 41.8% prevalence of positive self-perception among older adults⁷7 Krug RR, Schneider IJC, Giehl MWC, Antes DL, Confortin SC, Mazo GZ, Xavier AJ, d'Orsi E. Fatores sociodemográficos, comportamentais e de saúde associados à autopercepção de saúde positiva de idosos longevos residentes em Florianópolis, Santa Catarina. Rev Bras Epidemiol 2018; 21:e180004.. In an investigation also conducted in the municipality of Montes Claros, among community older adults evidenced a 42.4% prevalence of positive self-perception of health²⁴24 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386.. Such differences can be attributed to the social, economic, cultural, demographic, and health factors of each region and also to different criteria for measuring self-perceived health.

Knowledge about the real needs of older adults is essential for planning actions appropriate to their situation, but strategies are still lacking²⁵25 Silva SPZ, Marin MJS, Rodrigues MR. Condições de vida e de saúde de idosos acima de 80 anos. Rev Gaucha Enferm 2015; 36(3):42-48.. The perception of health is a good indicator of the population’s health status. This study can show the profile of the non-long-lived, and long-lived older adults with a positive perception of health, essential for the surveillance of their general health¹⁶16 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.. The investigation of health perception also represents a determinant of the use of services. Therefore, this measure evaluated by health professionals and managers can potentially provide an alert to improve health care for the older adults assisted in PHC and promote the quality of life and increase longevity²⁴24 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386..

Primary care is the preferred area for a subject-centered approach and provides the appropriate use of family health tools to promote individualized care. It represents the possibility for health professionals to act using epidemiological, political, and social characteristics to diagnose local health problems and act on the social determinants of the illness process²⁶26 Savassi LCM. A satisfação do usuário e a autopercepção da saúde em atenção primária. Rev Bras Med Fam Comunidade 2010; 5(17):3-5.. Self-perceived health can influence the demand for health care and, in some situations, adherence to health treatment, especially in chronic patients, who should change their lifestyle. Thus, determining how this population self-perceives its health situation can also be useful for health planning and contributes to the success of interventions by health professionals within PHC, considering its reality²⁷27 Lindemann IL, Reis NR, Mintem GC, Mendoza-Sassi RA. Autopercepção da saúde entre adultos e idosos usuários da Atenção Básica de Saúde. Cien Saude Colet 2019; 24(1):45-52..

Changes in short-term health conditions can generate changes in functional capacity and affect older adults’ autonomy and independence and, therefore, reflect on their perception of well-being¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.^,1616 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.. The assessment of the perceived health status can be a good predictor of quality of life, functional capacity, morbidity, and mortality among older adults²³23 Zanesco C, Bordin D, Santos CB, Müller EV, Fadel CB. Fatores que determinam a percepção negativa da saúde de idosos brasileiros. Rev Bras Geriatr Gerontol 2018; 21(3):283-292.^,2828 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734.. The prevalence of positive self-perceived health declines with aging, due to the increased number and severity of pathologies⁷7 Krug RR, Schneider IJC, Giehl MWC, Antes DL, Confortin SC, Mazo GZ, Xavier AJ, d'Orsi E. Fatores sociodemográficos, comportamentais e de saúde associados à autopercepção de saúde positiva de idosos longevos residentes em Florianópolis, Santa Catarina. Rev Bras Epidemiol 2018; 21:e180004.^,1414 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.^,1616 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.^,2424 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386.^,2828 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734..

In this study, perception varied among older adults, with a lower frequency of positive evaluation among long-lived older adults. A national household survey in the five Brazilian geographic regions with 12,324 individuals evidenced a negative perception of health associated with increased age, with 62% of negative evaluations among older adults linked to a worse health status²⁸28 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734.. These differences show that the elderly PHC users underlie a group with specific characteristics requiring individualized care in this regard.

The analysis of factors associated with positive self-perceived health in older adults revealed that the absence of polypathologies and physical activity was statistically significant. Both non-long-lived and long-lived older adults who do not have polypathologies had a higher positive perception of health. Healthy individuals or those with fewer chronic conditions have a better self-assessment of their health status²⁸28 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734.. A lower number of pathologies are possibly linked to lower restriction of activities of daily living, preserved functionality, and better perception of health¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.^,1616 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.^,2323 Zanesco C, Bordin D, Santos CB, Müller EV, Fadel CB. Fatores que determinam a percepção negativa da saúde de idosos brasileiros. Rev Bras Geriatr Gerontol 2018; 21(3):283-292.^,2929 Campos ACV, Ferreira EF, Vargas AMD, Albala C. Aging, gender and quality of life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults. Health Qual Life Outcomes 2014; 12(1):166..

Regularly physically active, non-long-lived, and long-lived older adults had a higher prevalence of positive self-perceived health than older adults in the same stratum who were not. Positive self-perception is higher in regularly physically-active individuals linked to maintaining and improving functionality, decreasing morbidities, and improving social activities, and the consequent improved general well-being¹⁶16 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.^,2424 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386.^,2929 Campos ACV, Ferreira EF, Vargas AMD, Albala C. Aging, gender and quality of life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults. Health Qual Life Outcomes 2014; 12(1):166.. A national epidemiological survey showed that physical activity doubled the likelihood of positive self-assessment²⁸28 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734..

Non-long-lived older adults also showed an association between positive self-perceived health and 5 years or more schooling, household income of 2 or more minimum wages, preserved vision, preserved chewing, absence of insomnia, not being diabetic, and not having falls in the last year. The highest educational level is related to better access to information, and the adoption of better lifestyle habits: physical activity, balanced diet, adequate weight, moderate consumption of alcohol and non-smoking¹⁶16 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.^,2424 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386.^,2929 Campos ACV, Ferreira EF, Vargas AMD, Albala C. Aging, gender and quality of life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults. Health Qual Life Outcomes 2014; 12(1):166.^,3030 Antunes JLF, Chiavegatto Filho ADP, Duarte YAO, Lebrão ML. Desigualdades sociais na autoavaliação de saúde dos idosos da cidade de São Paulo. Rev Bras Epidemiol 2019; 21(2):e180010..

A national household survey study associated worse perception of health with the presence of lower income and chronic disease²³23 Zanesco C, Bordin D, Santos CB, Müller EV, Fadel CB. Fatores que determinam a percepção negativa da saúde de idosos brasileiros. Rev Bras Geriatr Gerontol 2018; 21(3):283-292.. Higher household income may be related to better access to health services, treatments, more effective drugs, and better adherence¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.. Visual difficulty and other sensory changes limit the performance of activities, changing functionality, and deteriorating the quality of life³¹31 Loyola Filho AI, Firmo JOA, Uchôa E, Lima-Costa MF. Fatores associados à autoavaliação negativa da saúde entre idosos hipertensos e/ou diabéticos: resultados do projeto Bambuí. Rev Bras Epidemiol 2013; 16(3):559-571.

32 Lima MG, Barros MBA, Alves MCGP. Sleep duration and health status self-assessment (SF-36) in the elderly: a population-based study (ISA-Camp 2008). Cad Saude Publica 2012; 28(9):1674-1684.^-3333 Oliveira BHD, Yassuda MS, Cupertino APFB, Neri AL. Relações entre padrão do sono, saúde percebida e variáveis socioeconômicas em uma amostra de idosos residentes na comunidade: Estudo PENSA. Cien Saude Colet 2010; 15(3):851-860.. In the municipality of Sete Lagoas (MG), in the evaluation of 2,052 older adults showed impaired quality of life in individuals who reported functional limitations²⁹29 Campos ACV, Ferreira EF, Vargas AMD, Albala C. Aging, gender and quality of life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults. Health Qual Life Outcomes 2014; 12(1):166..

Non-long-lived older adults who never had difficulty chewing have a higher prevalence of positive self-perceived health. Oral problems and edentulism are common in this population and can promote masticatory difficulty, change food choice and compromise nutrition, socialization, maintenance of functionality, and quality of life, worsening with age³⁴34 Milagres CS, Tôrres LHN, Neri AL, Sousa MLR. Condição de saúde bucal autopercebida, capacidade mastigatória e longevidade em idosos. Cien Saude Colet 2018; 23(5):1495-1506.. A multicenter study with a sample of 3,478 older adults showed a higher prevalence of absence of natural teeth and difficulty or pain in chewing hard food in long-lived older adults compared to non-long-lived older adults²⁴24 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386.. A study with 326 older adults carried out in the urban area of Passo Fundo-RS revealed that the lack of dental problems was associated with better satisfaction with life³⁵35 Rigo L, Basso K, Pauli J, Cericato GO, Paranhos LR, Garbin RR. Satisfação com a vida, experiência odontológica e autopercepção da saúde bucal entre idosos. Cien Saude Colet 2015; 20(12):3681-3688. and, consequently, better self-perceived health.

The absence of insomnia is associated with fewer mood changes³¹31 Loyola Filho AI, Firmo JOA, Uchôa E, Lima-Costa MF. Fatores associados à autoavaliação negativa da saúde entre idosos hipertensos e/ou diabéticos: resultados do projeto Bambuí. Rev Bras Epidemiol 2013; 16(3):559-571.

32 Lima MG, Barros MBA, Alves MCGP. Sleep duration and health status self-assessment (SF-36) in the elderly: a population-based study (ISA-Camp 2008). Cad Saude Publica 2012; 28(9):1674-1684.^-3333 Oliveira BHD, Yassuda MS, Cupertino APFB, Neri AL. Relações entre padrão do sono, saúde percebida e variáveis socioeconômicas em uma amostra de idosos residentes na comunidade: Estudo PENSA. Cien Saude Colet 2010; 15(3):851-860., culminating in a better quality of life. A study with 1,418 older adults using a self-administered questionnaire correlated low sleep duration with poor health status³³33 Oliveira BHD, Yassuda MS, Cupertino APFB, Neri AL. Relações entre padrão do sono, saúde percebida e variáveis socioeconômicas em uma amostra de idosos residentes na comunidade: Estudo PENSA. Cien Saude Colet 2010; 15(3):851-860..

The absence of diabetes, associated with a higher positive perception in this study, may result from the negative view that falls on chronic diseases, especially their irreversibility, and the difficulty in adhering to the lifestyle changes required, continuous use of medications, and fear of chronic complications²⁸28 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734.. The health framework, such as the absence of disease, can also be an influencing factor¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.. The association between positive self-perception and the non-occurrence of falls in the last year can be explained by the risk of falls promoting fractures, restricted mobility, gait instability, psychological trauma, social limitation, and impaired autonomy and independence, which adversely affects the quality of life and reduces the positive perception¹⁶16 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060.^,2424 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386..

An association with the use of dental prosthesis and sleep disorders was observed in the long-lived older adults. Tooth loss is related to discomfort and reduced masticatory efficiency, leading to less consistent and carbohydrate-rich foods, with possible adverse repercussions on general health³⁴34 Milagres CS, Tôrres LHN, Neri AL, Sousa MLR. Condição de saúde bucal autopercebida, capacidade mastigatória e longevidade em idosos. Cien Saude Colet 2018; 23(5):1495-1506.^,3535 Rigo L, Basso K, Pauli J, Cericato GO, Paranhos LR, Garbin RR. Satisfação com a vida, experiência odontológica e autopercepção da saúde bucal entre idosos. Cien Saude Colet 2015; 20(12):3681-3688.. The use of dental prostheses favors the expansion of the food spectrum and provides better nutrition and functional preservation³⁴34 Milagres CS, Tôrres LHN, Neri AL, Sousa MLR. Condição de saúde bucal autopercebida, capacidade mastigatória e longevidade em idosos. Cien Saude Colet 2018; 23(5):1495-1506..

In older adults evaluated by the Study of Healthy Aging Processes (PENSA) Project, the positive perception in 62% of the sample showed a statistical association with good sleep quality³3 Simões CCS. Relações entre as alterações históricas na dinâmica demográfica brasileira e os impactos decorrentes do processo de envelhecimento da população. Rio de Janeiro: IBGE; 2016.. The volume of pathologies and the number of medications influence the worst quality of sleep. Aging determines changes in the duration of sleep stages, with shortening of deep sleep and increased superficial stages, which can lead to more nighttime awakenings, early awakening, and less effective sleep³³33 Oliveira BHD, Yassuda MS, Cupertino APFB, Neri AL. Relações entre padrão do sono, saúde percebida e variáveis socioeconômicas em uma amostra de idosos residentes na comunidade: Estudo PENSA. Cien Saude Colet 2010; 15(3):851-860..

Adaptations to the aging process, with the recognition of diseases and limitations due to the normal development of this process, possibly do not harm health assessment²⁸28 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734.. Therefore, ESF’s actions must be directed towards the maintenance and recovery of functionality and prevention of processes that may culminate in disability and dependence¹³13 Castro APR, Vidal ECF, Saraiva ARB, Arnaldo SM, Borges AMM, Almeida MI. Promoting health among the elderly: actions in primary health care. Rev Bras Geriatr Gerontol 2018; 21(2):155-163.. The PHC professional should consider self-perceived health in the care of older adults as part of the assessment, signaling possible organic and contextual changes to equate the care provided³⁶36 Veras RP, Caldas CP, Motta LB, Lima KC, Siqueira RC, Rodrigues RTSV, et al. Integração e continuidade do cuidado em modelos de rede de atenção à saúde para idosos frágeis. Rev Saude Publica 2014; 48(2):357-365..

Self-perceived health is a good indicator that reflects morbimortality in older adults¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.^,2323 Zanesco C, Bordin D, Santos CB, Müller EV, Fadel CB. Fatores que determinam a percepção negativa da saúde de idosos brasileiros. Rev Bras Geriatr Gerontol 2018; 21(3):283-292.^,2828 Pavão ALB, Werneck GL, Campos MR. Autoavaliação do estado de saúde e a associação com fatores sociodemográficos, hábitos de vida e morbidade na população: um inquérito nacional. Cad Saude Publica 2013; 29(4):723-734.. Understanding which variables can interfere in the positive self-perception of the health of non-long-lived and long-lived older adults can allow building the interventions aimed at quality of life, in contrast to health problems’ remedies⁷7 Krug RR, Schneider IJC, Giehl MWC, Antes DL, Confortin SC, Mazo GZ, Xavier AJ, d'Orsi E. Fatores sociodemográficos, comportamentais e de saúde associados à autopercepção de saúde positiva de idosos longevos residentes em Florianópolis, Santa Catarina. Rev Bras Epidemiol 2018; 21:e180004.^,1616 Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saude Publica 2015; 31(5):1049-1060..

In this study, the robust sample and the use of a validated collection instrument increased the reliability of information and analysis. Nevertheless, the possible interference from the survival factor of individuals with better health conditions should be recognized, which may overestimate the prevalence of positive self-perceived health. One limitation is the use of self-reported information and the lack of uniformity in the responses of studies in the literature, which hinders the comparison of the results¹⁴14 Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Public 2013; 33(4):302-310.^,2424 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Cien Saude Colet 2016; 21(11):3377-3386..

Final considerations

This study showed a high prevalence of positive self-perceived health among older adults, which can be explained by differences related to social determinants and health behaviors, with specificities between the strata of non-long-lived and long-lived older adults.

The guidelines contained in the National Elderly Health Policy orient the relevance of programmed disease prevention and health promotion actions. Considered a good indicator of the health and well-being of this population, the analysis of self-perceived health and its associated factors can assist in more effective interventions in maintaining and preserving their quality of life.

Given healthy aging, this study can help pool the knowledge of organic and non-organic factors with the most significant impact on its functionality. Positive self-perception of health can lead to points of broad and integrated multidisciplinary intervention focused on the quality of life added to the years lived. Further longitudinal studies with this population and that consider the heterogeneous age groups and cultural, social, and economic scenarios are suggested.

Acknowledgments

We are grateful to the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig), and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), for their financial support.

References

Publication Dates

History