Abstract

Introduction

Population aging is one of the most significant phenomena of the 21st century ¹1. United Nations Population Fund; HelpAge International. Ageing in the twenty-first century: a celebration and a challenge. New York: United Nations Population Fund/London: HelpAge International; 2012.. The annual growth rate of the global elderly population is approximately 3%, and it is estimated that this population will reach 2.1 billion by 2050. There are currently 962 million individuals sixty years or older in the world, representing 13% of the total population. By 2050, all regions of the world except Africa will have at least one-fourth of their populations in this age bracket ²2. United Nations. World population prospects: key findings and advance tables. The 2017 revision. New York: United Nations; 2017.. In Brazil, 13% of the population is over sixty years of age ²2. United Nations. World population prospects: key findings and advance tables. The 2017 revision. New York: United Nations; 2017., with the proportion expected to reach 29.3% by 2050 ³3. United Nations. World population prospects: key findings and advance tables. The 2015 revision. New York: United Nations; 2015..

A phenomenon that accompanies population aging is the feminization of old age, i.e., a higher proportion of women than men in the elderly population, especially in the more advanced ages. In 2012, for every one hundred women sixty years or older in the world, there were only 84 men, and for every one hundred women eighty years or older there were only 61 men ¹1. United Nations Population Fund; HelpAge International. Ageing in the twenty-first century: a celebration and a challenge. New York: United Nations Population Fund/London: HelpAge International; 2012.. Despite variations between regions of the world, women comprise more than half of the elderly population in all of them ⁴4. United Nations. The World's women 2010. Trends and statistics. New York: United Nations; 2010.. However, although women tend to live longer, they experience worse quality of life than men, especially due to gender relations that structure the entire life cycle and influence access to resources and opportunities, generating continuous and cumulative impacts on social and economic life ¹1. United Nations Population Fund; HelpAge International. Ageing in the twenty-first century: a celebration and a challenge. New York: United Nations Population Fund/London: HelpAge International; 2012.^,55. Calasanti T. Feminist gerontology and old men. J Gerontol B Psychol Sci Soc Sci 2004; 59:S305-14..

Women experience less protection, security, and wellbeing in old age due to various factors, featuring the higher likelihood of working in the informal sector, lower income and schooling, and more chronic and disabling diseases ¹1. United Nations Population Fund; HelpAge International. Ageing in the twenty-first century: a celebration and a challenge. New York: United Nations Population Fund/London: HelpAge International; 2012.^,44. United Nations. The World's women 2010. Trends and statistics. New York: United Nations; 2010.^,66. Cobos FM, Almendro JME. Envejecimiento activo y desigualdades de género. Aten Prim 2008; 40:305-9.. A major concern for men is the need to promote a culture of self-care. In addition, when elderly men retire and stop working their social support network shrinks, making them more socially vulnerable ¹1. United Nations Population Fund; HelpAge International. Ageing in the twenty-first century: a celebration and a challenge. New York: United Nations Population Fund/London: HelpAge International; 2012.^,77. World Health Organization. Men ageing and health. Geneva: World Health Organization; 2001..

Given the gender differences in life-course social roles, experiences, and opportunities, a gender approach is essential for implementing active aging policies, currently acknowledged as a key strategy for responding to the revolution in population aging ⁸8. World Health Organization. Active ageing: a policy framework. Geneva: World Health Organization; 2002.^,99. Centro Internacional de Longevidade Brasil. Envelhecimento ativo: um marco político em resposta à revolução da longevidade. Rio de Janeiro: Centro Internacional de Longevidade Brasil; 2015.. The concept of active aging adopted by the World Health Organization (WHO) applies to both societies and individuals. In societies, life-course health opportunities, participation, security, and learning should be optimized through proactive policies, which are necessary for maintaining active living. At the individual level, elderly people should be able to enjoy the opportunities provided according to their needs, capacities, and preferences. In the WHO approach, active aging is a multidimensional concept, including not only economic participation by the elderly, but also unpaid forms of participation such as formal and informal social, cultural, and leisure-time activities or those requiring physical or mental effort ⁸8. World Health Organization. Active ageing: a policy framework. Geneva: World Health Organization; 2002.^,99. Centro Internacional de Longevidade Brasil. Envelhecimento ativo: um marco político em resposta à revolução da longevidade. Rio de Janeiro: Centro Internacional de Longevidade Brasil; 2015.. The WHO thus implicitly acknowledges the different contributions that various groups of elderly can make to society ¹⁰10. Ilinca S, Rodrigues R, Schmidt A, Zolyomi E. Gender and social class inequalities in active ageing: policy meets theory. Vienna: European Centre for Social Welfare Policy and Research; 2016.. Nevertheless, little attention has been given to gender implications and other demographic and socioeconomic aspects in studies on active aging, either in the global scenario ¹⁰10. Ilinca S, Rodrigues R, Schmidt A, Zolyomi E. Gender and social class inequalities in active ageing: policy meets theory. Vienna: European Centre for Social Welfare Policy and Research; 2016.^,1111. Timonen V. Beyond successful and active ageing: a theory of model ageing. Bristol: Bristol University Press; 2016. or in the Brazilian context ¹²12. Ribeiro PCC, Neri AL, Cupertino APFB, Yassuda MS. Variabilidade no envelhecimento ativo segundo gênero, idade e saúde. Psicol Estud 2009; 14:501-9., thus leaving an entire agenda open for current research ¹³13. Paz A, Doron I, Tur-Sinai A. Gender, aging, and the economics of "active aging": setting a new research agenda. J Women Aging 2017; 3:1-20.. The current study thus aimed to analyze the prevalence of indicators of active aging in the elderly population in a city in Southeast Brazil, as well as gender and age differences in these indicators.

Method

This was a cross-sectional population-based study using data from the Campinas Municipal Health Survey (ISA-CAMP) in Campinas, São Paulo State, Brazil, for 2014-2015. The survey aimed to analyze social patterns, trends, and disparities in multiple health dimensions using home interviews. ISA-CAMP collected data from three subpopulations - adolescents, adults, and elderly - corresponding to the age groups 10-19 years, 20-59 years, and 60 years and older, residing in permanent private households in the urban area of Campinas. The current study only analyzed individuals sixty years or older.

A sample of the population was selected using a complex sampling design, starting by dividing the population in five strata corresponding to the five health districts in Campinas: east, northwest, north, southeast, and south. A two-stage cluster selection was then performed with the census tracts and households. Fourteen census tracts were selected in each stratum, totaling 70 units. To obtain the sample, estimated at one thousand elderly individuals, and considering a 20% non-response rate, 3,157 households were sampled. This number of interviews was planned to guarantee estimates of 0.50 with an error of up to five percentage points, 95% confidence interval (95%CI), and a design effect of 2. All the elderly present in each selected household were interviewed. We opted not to randomly select individuals in each sampled household because the accuracy is similar when interviewing all the elders in the household and is less costly than the design in which only one person is picked per household ¹⁴14. Alves MCGP, Escuder MML, Claro RM, Silva NN. Sorteio intradomiciliar em inquéritos de saúde. Rev Saúde Pública 2014; 48:86-93..

Data in ISA-CAMP 2014-2015 were collected with a pre-coded questionnaire containing mostly closed questions and organized in 13 thematic blocks. Data were collected by trained interviewers using a direct interview with the individual, optimized with the use of a tablet. Interviewers had received prior training to discuss the expected approach during the interviews and the details for each question in the study instrument, as well as to allow proper handling of the tablet and a full grasp of the content. All the instructions were provided in a manual.

As for the study variables, active aging was approached according to the definition established by the WHO ⁸8. World Health Organization. Active ageing: a policy framework. Geneva: World Health Organization; 2002. for the term “active”, which relates to participation in activities with multiple dimensions (social, physical, cultural, intellectual, economic, civic, and political). Thus, among the questions available in the questionnaire, we selected those belonging to four of these dimensions ⁸8. World Health Organization. Active ageing: a policy framework. Geneva: World Health Organization; 2002.^,99. Centro Internacional de Longevidade Brasil. Envelhecimento ativo: um marco político em resposta à revolução da longevidade. Rio de Janeiro: Centro Internacional de Longevidade Brasil; 2015., as described below:

(1) Social dimension: the elderly were asked about their participation in four domains: (a) family circle - whether they routinely received or made visits to friends and family; (b) sociocultural activities - whether they participated in activities like movies, theater, community centers, bingos, dances, and others; (c) groups or associations - volunteer work or participation in some association or sporting, cultural, charitable, political, or religious group; (d) religious practice - attendance at a place of worship once a week or more.

(2) Dimension of physical activity: estimated from questions from the International Physical Activity Questionnaire (IPAQ) - long version ¹⁵15. Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fís Saúde 2001; 6:5-18., which estimates the time spent per week in moderate and/or vigorous physical activities in the domains of work, commuting, household activities, and leisure. To classify the level of physical activity in each of these domains, a physical activity score was constructed in minutes per week. The score was the sum of the minutes spent in moderate activities plus the minutes spent in vigorous activities (with the latter multiplied by two). This strategy aimed to represent the different intensities of each activity, as recommended by the WHO ¹⁶16. World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.. A score greater than 150 minutes per week was defined as the cutoff to classify individuals as active in each domain.

(3) Intellectual dimension: estimated on the basis of two variables: (a) Internet use and (b) regular attendance at courses in literacy training, basic education, or higher education or courses in computers, languages, dance, and arts.

(4) Work dimension: based on participation in the following domains: (a) paid work (estimated with the question: “Do you currently do any paid work or help anyone in your family with their work?”); (b) retirees that work (elderly that are already retired but still do some form of work).

The study population was characterized by the following demographic and socioeconomic variables: sex (female or male); age bracket (60-69, 70-79, 80 and older); race/color (white, black/brown, other); conjugal status (married/in stable union, separated/divorced, widow/widower, single); religion (none, Protestant, Catholic, other); and schooling in years (0-4, 5-10, 11 or more).

For gender, the prevalence rates were analyzed for each domain of active aging, and the prevalence rates for active aging were stratified by age brackets. The proportions were compared with the Pearson chi-square test, setting statistical significance at p < 0.05, and using adjusted prevalence ratios and the respective 95%CI, calculated with Poisson regression.

The final weight for each individual in the sample was calculated by multiplying the design weight by the non-response weight and by the post-stratification adjustment weight. The gender and age distributions were also considered, based on the population projection by the São Paulo Data Analysis System (SEADE). The effect of the complex sampling design was considered in all the analyses, using the survey module from Stata 14.0 (https://www.stata.com).

The ISA-CAMP study was approved by the Institutional Review Board of the School of Medicine, State University of Campinas, case review n. 409.714, September 30, 2013.

Results

Of the 1,168 elderly individuals located in the households, there was a 14% refusal rate and 1.5% losses for other reasons. The study population thus consisted of 986 elderly, predominantly women (57.6%). As shown in Table 1, in both sexes, the majority of the elderly were between 60 and 69 years of age, white, and had zero to four years of schooling. As for conjugal status and religion, there were statistically significant differences between the sexes in the distribution of the respective categories. For conjugal status, 76.1% of the men were married or in stable unions, as compared to only 40.7% of the women. Meanwhile, there were relatively more widows (41.1% of the women) than there were widowers (12.7% of the men). As for religion, Catholicism predominated in both sexes, but men were more likely than women to not practice any religion (10% and 2.8%, respectively).

Table 2 shows the prevalence rates for participation in activities in the four dimensions. All activities in the social dimension showed extensive participation by the elderly, varying from 23.3% (belonging to groups or associations) to 89% (visits to family). As for the dimension of physical activity, except for the leisure-time domain, with a prevalence of 25.3%, the other domains showed prevalence rates around 10%. In relation to the intellectual dimension, Internet use was reported by approximately one-fifth of the study population, while taking courses was the least frequent activity (2.6%). Prevalence of participation in paid work was 22.1% in the overall sample, but there was a low proportion of retired elderly that were still working (5.2%).

Table 2 also shows in the social dimension that only the prevalence of religious practice showed a statistical difference between the sexes, where it was lower in men (PR = 0.67). As for the physical dimension, men were more active in the work domain (PR = 2.10), commuting (PR = 1.61), and leisure time (PR = 1.44). In the work dimension, the prevalence rates of men that did some form of paid work and that were working even after retiring were higher than in women (PR = 1.78 and 2.79, respectively). No statistically significant differences were seen between men and women in the intellectual dimension.

There were distinct gender patterns in the analysis of active aging when stratified by age brackets and adjusted for conjugal status and years of schooling. For men, only two of the twelve activities analyzed (physical activity at work and paid work) were statistically less prevalent in elderly males eighty years or older when compared to those 60 to 69 years of age; meanwhile, no differences were observed between these age brackets in any of the activities in the social and intellectual dimensions. In addition, when the 70 to 79 year and eighty and older brackets were compared, the prevalence rates were similar for participation in all the target activities (Table 3). Meanwhile, women showed lower participation in six activities in the age bracket eighty years and older when compared to 60 to 69 years, especially in the dimension of physical activity, where all the domains showed lower prevalence rates among the oldest elderly women. When the age brackets 70 to 79 years and eighty years and older were compared, there were differences in the social dimension (sociocultural activities and volunteering/belonging to groups or associations) and in the physical dimension (in the domain of commuting), as shown in Table 4. Without adjusting for years of schooling, Internet use (in both sexes) and participation in volunteering/associations (for women) also showed significant differences between the age brackets and were less prevalent in eighty and older bracket compared to 60 to 69 years (data not shown).

Discussion

The results showed considerable participation by the elderly in social activities and leisure-time physical activity, while also revealing less participation in intellectual activities, physical activities other than in leisure time, and in paid work. The study also identified differences between men and women in participation in activities in three dimensions of active aging. Men were more active in the work market and in the dimension of physical activity, except for household activities. Women were more active in the social dimension, especially in weekly attendance at religious services. The study’s results also showed that participation in activities were more limited in women than in men in more advanced ages. This demarcation of activities based on demographic characteristics reveals the study’s potential for identifying access to assets, services, resources, and rights, besides signaling hierarchical power relations, in which one group’s privilege is related (intentionally or unintentionally) to another’s oppression and disadvantage. In this sense, participation in various activities during any phase of life, and especially in old age, is not random, but historically and culturally constructed ⁵5. Calasanti T. Feminist gerontology and old men. J Gerontol B Psychol Sci Soc Sci 2004; 59:S305-14.^,66. Cobos FM, Almendro JME. Envejecimiento activo y desigualdades de género. Aten Prim 2008; 40:305-9..

As for the social dimension, the study found a high prevalence of participation in all the activities, with no gender differences except for attendance at worship services. Although the results for social participation are hardly comparable between studies (since there is no consensus on terminology, study protocols, and groups of activities involved ¹⁷17. Dias EG, Duarte YAO, Lebrão ML. Efeitos longitudinais das atividades avançadas de vida diária em idosos: implicações para a reabilitação gerontológica. Mundo Saúde 2010; 34:258-67.), according to data from a Brazilian study ¹⁸18. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios contínua 2016: outras formas de trabalho. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2017., only 4.6% of Brazilians fifty years and older perform volunteer work. In the current study, volunteering and/or belonging to groups or associations was estimated at 23.3%, showing that opportunities for social participation have been ensured for an important share of these elders.

The study further found that religious practice is important for the Brazilian elderly, and women’s greater attendance at worship services is consistent with other studies ¹⁹19. Moreira-Almeida A, Pinsky I, Zaleski M, Laranjeira R. Envolvimento religioso e fatores sociodemográficos: resultados de um levantamento nacional no Brasil. Rev Psiquiatr Clín (São Paulo) 2010; 37:12-5.^,2020. Pew Research Center. America's changing religious landscape. Washington DC: Pew Research Center; 2015.^,2121. Pew Research Center. The gender gap in religion around the World. Washington DC: Pew Research Center; 2016.. Some interpretative theories have attempted to explain the gender differences in religious practice based on physical, physiological, or social factors. In the latter case, for example, authors have suggested that the greater the female participation in activities outside the home, especially in the work market, the more women resemble men in terms of religiosity, even after adjusting for other factors that are also associated with religious practice, such as schooling, age, and conjugal status. One hypothesis is that working outside the home provides social and psychological benefits that are similar to those that can be obtained from religion, making the latter less relevant for some people in these circumstances ²¹21. Pew Research Center. The gender gap in religion around the World. Washington DC: Pew Research Center; 2016.. In our study, even after adjusting for age, schooling, and conjugal status, women remained more active in attendance at religious services, strengthening the consensus that gender difference in religion probably stems from a complex combination of multiple factors, in which culture, religious tradition, and workforce participation play a modulating role ²¹21. Pew Research Center. The gender gap in religion around the World. Washington DC: Pew Research Center; 2016..

The current study analyzed physical activity in four domains: leisure, work, household, and commuting. The analysis of physical activity according to these domains is relevant: although the benefits of regular weeklong physical activity are well-known, particularly in the context of leisure time, there is growing recognition of the need to encourage integrating physical activity into daily lifestyle in order for individuals to achieve the recommended levels ¹⁶16. World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.. However, the effects of each domain of physical activity on health may differ (it is more common to observe the pronounced beneficial effects of leisure-time physical activity on health when compared to physical activity in other domains ²²22. Abu-Omar K, Rütten A. Relation of leisure time, occupational, domestic, and commuting physical activity to health indicators in Europe. Prev Med 2008; 47:319-23.). The current study showed low prevalence of physical activity at work, at home, and during commuting when compared to the leisure-time domain. For physical activity in leisure time, the observed prevalence was similar to that in Brazil’s state capitals (22.3%) ²³23. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2016. Brasília: Ministério da Saúde; 2017., but more than double the rate in 2008 in a study in the same population ²⁴24. Francisco PMSB, Segri NJ, Barros MBA, Malta DC. Desigualdades sociodemográficas nos fatores de risco e proteção para doenças crônicas não transmissíveis: inquérito telefônico em Campinas, São Paulo. Epidemiol Serv Saúde 2015; 24:7-18. and also considerably higher than the national estimate of the elderly that are physically active in leisure time, namely 13.6% ²⁵25. Malta DC, Andrade SSCA, Stopa SR, Pereira CA, Szwarcwald CL, Silva Júnior JB, et al. Estilos de vida da população brasileira: resultados da Pesquisa Nacional de Saúde, 2013. Epidemiol Serv Saúde 2015; 24:217-26..

The literature has consistently reported higher rates of leisure-time physical activity in men ²⁴24. Francisco PMSB, Segri NJ, Barros MBA, Malta DC. Desigualdades sociodemográficas nos fatores de risco e proteção para doenças crônicas não transmissíveis: inquérito telefônico em Campinas, São Paulo. Epidemiol Serv Saúde 2015; 24:7-18.^,2626. Notthoff N, Reisch P, Gerstorf D. Individual characteristics and physical activity in older adults: a systematic review. Gerontology 2017; 63:443-59., corroborating the current study’s findings. The prevalence rates in the current study, both for men and women, are also similar to those seen in Brazil’s state capitals (29.4% and 18%, respectively) ²³23. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde, Secretaria de Vigilância em Saúde, Ministério da Saúde. Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2016. Brasília: Ministério da Saúde; 2017.. Some authors have suggested that this difference may be due to a genetic predisposition to be more or less physically active ²⁷27. Moore-Harrison T, Lightfoot JT. Driven to be inactive? The genetics of physical activity. Prog Mol Biol Transl Sci 2010; 94:271-90., but any such predisposition is purportedly mediated by a series of biological, psychological, social, and environmental factors that accumulate over time and affect the later stages of life ²⁸28. Bailey R, Wellard I, Dismore H. Girls' participation in physical activities and sports: benefits, patterns, influences and ways forward. Geneva: World Health Organization; 2004. (Technical Report).. Consistent with this perspective, evidence indicates that leisure-time physical activity in childhood and youth, plus life-course gender expectations, are the most important determinants of leisure-time physical activity in old age ²⁹29. Schutzer KA, Graves BS. Barriers and motivations to exercise in older adults. Prev Med 2004; 39:1056-61.^,3030. Allender S, Cowburn G, Foster C. Understanding participation in sport and physical activity among children and adults: a review of qualitative studies. Health Educ Res 2006; 21:826-35.^,3131. Hirvensalo M, Lintunen T. Life-course perspective for physical activity and sports participation. Eur Rev Aging Phys Act 2011; 8:13-22.^,3232. Salles-Costa R, Heilborn ML, Werneck GL, Faerstein E, Lopes CS. Gênero e prática de atividade física de lazer. Cad Saúde Pública 2003; 19 Suppl 2:S325-33..

In the other domains of physical activity, we observed gender differences in physical activity at work and during commuting, both of which were more prevalent in men. As for physical activity at work, a systematic review showed that men, ethnic minorities, lower-income individuals, and blue-collar workers have higher levels of physical activity at work ³³33. Smith L, McCourt O, Sawyer A, Ucci M, Marmot A, Wardle J, et al. A review of occupational physical activity and sedentary behaviour correlates. Occup Med (Lond) 2016; 66:185-92.. According to the review, this kind of physical activity can be a marker of both gender and social inequalities, and it should thus be analyzed with caution. Both the physical work activities performed by different categories of workers (executives, blue-collar workers, farm workers, and large landholding farmers, among others) and the motivations and objectives of the work activities themselves are unequal and sometimes involuntary ³⁴34. Waissmann W. Desigualdade social e atividade física. In: Bagrichevsky M, Palma A, Estevão A, organizadores. A saúde em debate na educação física. Blumenau: Edibes; 2003. p. 53-78.. Another systematic review ²⁶26. Notthoff N, Reisch P, Gerstorf D. Individual characteristics and physical activity in older adults: a systematic review. Gerontology 2017; 63:443-59. also found that men are more active in commuting than women. Note however that active commuting can involve unfavorable conditions such as exposure to air pollution and hazardous streets and sidewalks, a point that requires greater attention from studies on the specific effects of each domain of physical activity on health ²²22. Abu-Omar K, Rütten A. Relation of leisure time, occupational, domestic, and commuting physical activity to health indicators in Europe. Prev Med 2008; 47:319-23..

In the intellectual dimension, the results highlighted the low prevalence of Internet use in both men and women, corroborating findings from other Brazilian studies ³⁵35. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios: síntese de indicadores 2013. 2ª Ed. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015.^,3636. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional por amostra de domicílios: acesso à internet e à televisão e posse de telefone móvel celular para uso pessoal 2015. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2016.. Although Internet use by elderly Brazilians has increased (from 12.6% in 2013 to 17.4% in 2015), sixty and older is still the age bracket with the least Internet access in the country ³⁵35. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios: síntese de indicadores 2013. 2ª Ed. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2015.^,3636. Instituto Brasileiro de Geografia e Estatística. Pesquisa nacional por amostra de domicílios: acesso à internet e à televisão e posse de telefone móvel celular para uso pessoal 2015. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2016.. The Brazilian reality differs from that of the United States, for example, where 67% of elderly report being connected to the Internet, ranging from 82% for elderly Americans 65 to 69 years of age to 44% for those eighty years or older ³⁷37. Pew Research Center. Tech adoption climbs among older adults. Washington DC: Pew Research Center; 2017.. Notably, Internet use by the oldest Americans (octogenarians and older) is already higher than in the youngest Brazilian elders in the current study, which underscores the challenge of digital inclusion in Brazil. Since Internet use can provide key benefits for the elderly such as access to health information, cognitive stimulus, and social interaction (especially with younger users), digital inclusion policies are recommended with the elderly as priority targets ³⁸38. Miranda LM, Farias SF. As contribuições da internet para o idoso: uma revisão de literatura. Interface Comun Saúde Educ 2009; 13:383-94.. Further in relation to the intellectual dimension, the study found negligible participation by the elderly in courses, corroborating a study in Juiz de Fora, Minas Gerais State, Brazil, in which this type of activity was the least frequently reported by the elderly (7.1%) ¹²12. Ribeiro PCC, Neri AL, Cupertino APFB, Yassuda MS. Variabilidade no envelhecimento ativo segundo gênero, idade e saúde. Psicol Estud 2009; 14:501-9.. This reality runs contrary to the expectations of active aging policy, in which a priority is to optimize learning opportunities, considering any form of formal or informal learning as vital for social and technological inclusion, personal and professional growth ⁹9. Centro Internacional de Longevidade Brasil. Envelhecimento ativo: um marco político em resposta à revolução da longevidade. Rio de Janeiro: Centro Internacional de Longevidade Brasil; 2015., and preservation of cognitive functioning.

In the work dimension, the proportion of elderly that performed paid work (22.1%) corresponds to the employment level in the elderly Brazilian population as a whole, which has shown a downward trend in recent years, from 30.2% in 2005 to 26.3% in 2015 ³⁹39. Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira 2016. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2016.. This finding indicates that despite the growing attention in political discourses to the need to prolong individuals’ working life, the opportunities for access to work by elders appear not to keep pace. It is thus necessary to expand and guarantee access to employment for older workers, with job opportunities under equal conditions with other age brackets, thus avoiding discrimination on grounds of age. It is also necessary to promote opportunities for professional development as a way of preserving the jobs of people already participating in the work market ⁴⁰40. Ghosheh N. Age discrimination and older workers: theory and legislation in comparative context. Geneva: International Labour Office; 2008..

Male hegemony in the labor market, identified in this study and in other Brazilian and international research ¹⁰10. Ilinca S, Rodrigues R, Schmidt A, Zolyomi E. Gender and social class inequalities in active ageing: policy meets theory. Vienna: European Centre for Social Welfare Policy and Research; 2016.^,4141. Soares C, Saboia AL. Tempo, trabalho e afazeres domésticos: um estudo com base nos dados da Pesquisa Nacional por Amostra de Domicílios de 2001 a 2005. Rio de Janeiro: Coordenação de População e Indicadores Sociais, Instituto Brasileiro de Geografia e Estatística; 2007. (Texto para Discussão. Diretoria de Pesquisas, 21).^,4242. Alves JED, Corrêa S. Igualdade e desigualdade de gênero no Brasil: um panorama preliminar, 15 anos depois de Cairo. In: Brasil, 15 anos após a Conferência de Cairo. Campinas: Associação Brasileira de Estudos Populacionais/Fundo de População das Nações Unidas; 2009.^,4343. Camarano AA. O idoso brasileiro no mercado de trabalho. Rio de Janeiro: Instituto de Pesquisa Econômica Aplicada; 2001. (Texto para Discussão, 830).^,4444. He W, Goodkind D, Kowal P. An aging world: 2015. U.S. Census Bureau. International Population Reports P95/16-1. Washington DC: U.S. Government Publishing Office; 2016., both in pensioners and non-pensioners, is closely related to the traditional family support model, in which men are the primary breadwinners, while women are left in charge of unpaid family care, resulting in their own economic dependence on men ⁴⁵45. Giullari S, Lewis J. The adult worker model family, gender equality and care: the search for new policy principles and the possibilities and problems of a capabilities approach. Geneva: United Nations Research Institute for Social Development; 2005. (Paper, 19).. Gender disparity in the prevalence of paid work can also be explained by the countries’ levels of economic and educational development ⁴⁴44. He W, Goodkind D, Kowal P. An aging world: 2015. U.S. Census Bureau. International Population Reports P95/16-1. Washington DC: U.S. Government Publishing Office; 2016. and by more intrinsic gender factors such as women’s career interruptions to dedicate their time and work to motherhood or care for dependent relatives (which can hinder women’s reinsertion in the work market), besides the difference in legal retirement age between men and women ¹⁰10. Ilinca S, Rodrigues R, Schmidt A, Zolyomi E. Gender and social class inequalities in active ageing: policy meets theory. Vienna: European Centre for Social Welfare Policy and Research; 2016.^,4646. Camarano AA, Pasinato MT. Envelhecimento e pobreza e proteção social na América Latina. Rio de Janeiro: Instituto de Pesquisa Econômica Aplicada; 2007. (Texto para Discussão, 1292).. Although women retire earlier than men, retirement for women apparently translates in practice as definitive exclusion from the work market ⁴⁷47. Camarano AA, Kanso S, Fernandes D. Saída do mercado de trabalho: qual é a idade? In: Boletim Mercado de Trabalho: conjuntura e análise nº 51. Brasília: Instituto de Pesquisa Econômica Aplicada/Ministério do Trabalho e Emprego; 2012. p. 19-28.. Thus, studies have shown that more retired men return to the labor market when compared to retired women ⁴³43. Camarano AA. O idoso brasileiro no mercado de trabalho. Rio de Janeiro: Instituto de Pesquisa Econômica Aplicada; 2001. (Texto para Discussão, 830).^,4848. Wajnman S, Oliveira AM, Oliveira EL. Os idosos no mercado de trabalho: tendências e consequências. In: Camarano AA, organizadora. Os novos idosos brasileiros: muito além dos 60? Rio de Janeiro: Instituto de Pesquisa Econômica Aplicada; 2004. p. 453-79..

As for observed gender differences in indicators of active aging according to age brackets, at more advanced ages, women participated less in activities than men. Among the oldest elderly men, participation was only lower in two activities. Meanwhile, the oldest women showed lower participation in six activities. For certain activities such as work, the proportion can be expected to decrease with advancing age in both men and women ⁴⁴44. He W, Goodkind D, Kowal P. An aging world: 2015. U.S. Census Bureau. International Population Reports P95/16-1. Washington DC: U.S. Government Publishing Office; 2016.. For other activities however, especially those that promote social interaction and preservation of physical and cognitive functions, this reduction is not desirable ¹⁷17. Dias EG, Duarte YAO, Lebrão ML. Efeitos longitudinais das atividades avançadas de vida diária em idosos: implicações para a reabilitação gerontológica. Mundo Saúde 2010; 34:258-67.. What is actually expected is an adaptation to such activities in order to respect individual needs, capacities, and preferences, which can change in each phase of old age ⁹9. Centro Internacional de Longevidade Brasil. Envelhecimento ativo: um marco político em resposta à revolução da longevidade. Rio de Janeiro: Centro Internacional de Longevidade Brasil; 2015.. The observed differences between men and women in active aging according to age thus merit closer attention. Since this was a cross-sectional study, it is not possible to speak of “decline” or “reduction” in activities with advancing age. The reference is actually to individuals from different birth cohorts, i.e., it is possible that the oldest elderly did not “stop doing” certain activities, but rather had never taken them up in the first place. Profound social transformations that began in the early 20th century, such as women’s continuous emancipation and changes in family composition ⁴²42. Alves JED, Corrêa S. Igualdade e desigualdade de gênero no Brasil: um panorama preliminar, 15 anos depois de Cairo. In: Brasil, 15 anos após a Conferência de Cairo. Campinas: Associação Brasileira de Estudos Populacionais/Fundo de População das Nações Unidas; 2009. have led to increasingly lower impact from traditional gender conventions with each passing generation, contributing to a gradual increase in women’s participation in society throughout the life cycle and in a wide range of domains. Such transformations may be the source of the sharp differences in women when comparing those sixty versus eighty years of age, as seen in this study. Therefore, one can expect that with each new generation there will be smaller differences in the way people age, especially for women.

The study used indicators that provide an overview of the current experience with active aging, thereby helping expand knowledge on this issue. However, some limitations were identified, such as the lack of information on the actual frequency of sociocultural activities and participation in groups or associations, the reasons for (and frequency) of Internet use, and satisfaction from work. Such details are useful for understanding active aging, since activities can have different effects on health and well-being, depending on the context. Survival bias was considered as another study limitation, based on the logical error of studying elderly that survived early mortality, the latter being more common in persons with greater life-course risk exposure. Such a bias would thus tend to reduce the size of associations between study variables ⁴⁹49. Lima-Costa MF, Barreto SM. Tipos de estudos epidemiológicos: conceitos básicos e aplicações na área do envelhecimento. Epidemiol Serv Saúde 2003; 12:189-201.. Meanwhile, the study strengths were the sample size (which allowed estimating most of the indicators of active aging with good precision in the target strata), high data quality, and the use of indicators that have received less attention in the elderly population, based on a multidimensional approach to active aging.

Final remarks

The study’s results reveal positive aspects of active aging among the elderly in the sample, such as important participation in the social dimension and in leisure-time physical activity, with prevalence rates exceeding the national estimates for Brazil. The study further contributed to identifying activities with less participation by elderly Brazilians, such as taking courses, Internet use, and paid work, which are still challenges for active aging. The study also showed that participation in various activities in old age is intrinsically related to traditional gender roles that may be consolidated throughout the life course and are taken for granted by the time one reaches old age. In turn, this condition at least partly shapes differential access by men and women to resources, goods, and services that optimize participation in certain life domains. Finally, the study found that differences in active aging between men and women increase when ones analyzes the indicators according to age brackets. Men eighty years and older, when compared to those 60 to 69 years of age, only decreased their participation in physical activity at work and in paid work. Meanwhile, women eighty years and older showed lower participation in sociocultural activities, in all domains of physical activity, and in work market participation when compared to younger elderly women. These findings highlight the need for strategies to promote active aging that are adapted and appropriate for men and women in different age groups in order avoid the persistence and aggravation of gender inequalities.

Acknowledgments

The authors wish to thank the São Paulo State Research Foundation (FAPESP) for funding the ISA-CAMP survey (n. 2012/23324-3), the Brazilian Ministry of Health (Health Surveillance Department) and the Campinas Municipal Health Department for additional funding of ISA-CAMP (n. 02-P-28749/2013), the Brazilian Graduate Studies Coordinating Board (Capes) for the PhD scholarship for N. F. S. Sousa, and the Brazilian National Research Council (CNPq) for the research scholarship for M. B. A. Barros.

References

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