Sociodemographic, behavioral, and health factors associated with positive self-perceived health of long-lived elderly residents in Florianópolis, Santa Catarina, Brazil

Rodrigo de Rosso Krug Ione Jayce Ceola Schneider Maruí Weber Corseuil Giehl Danielle Ledur Antes Susana Cararo Confortin Giovana Zarpellon Mazo André Junqueira Xavier Eleonora d’Orsi About the authors

ABSTRACT:

The objective of this study was to identify the factors associated with positive self-perceived health of long-lived elderly (80+) individuals. This cross-sectional study was conducted in the city of Florianópolis, Santa Catarina, Brazil, and included 239 elderly participants from the EpiFloripa Ageing Project. We used collection instruments to verify sociodemographic and economic data, self-reported health status, falls, and lifestyle. Then, we identified factors associated with positive self-perceived health using a Poisson regression adjusted for sex. We found that a positive self-reported health status was more prevalent among the long-lived elderly who were not depressed (PR = 0.49), and among those who consumed alcohol (PR = 1.99). Understanding which variables may interfere in the self-perceived health of the long-lived elderly can result in better health options for this population, mainly, new methods to prevent depression. Additionally, this information can help reduce costs associated with hospitalizations, medications and health treatments, all of which are very common among the long-lived elderly.

Keywords:
Elderly people aged 80 and older; Self-assessment; Health; Comorbidity; Life style; Treatment

INTRODUCTION

The age group of people 80 years old or older (long-lived elderly people) is increasing the most in the world. Projections from the World Health Organization11. Organização Mundial de Saúde. Envelhecimento ativo: uma política de saúde. Brasília: Organização Pan-Americana da Saúde; 2005. show that this population will surpass 379 million in 2050. In Brazil, this group is also growing. In 2010, there were around 3 million (1.1% of the total Brazilian population), with projections reaching 14 million in 2040, corresponding to an increase of 466.6%. It is estimated that approximately 2.6% of these elderly Brazilians live in Santa Catarina and about 0.3% of them live in the capital city of Florianópolis22. Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais - Uma análise das condições de vida da população brasileira [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010. Disponível em: https://ww2.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2015/default_sintese.shtm (Acessado em 26 de junho de 2011).
https://ww2.ibge.gov.br/home/estatistica...
.

Long-lived elderly people have distinct characteristics, such as a higher prevalence of disabilities and diseases, mainly cardiovascular diseases, stroke, arthritis, dementia and depression22. Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais - Uma análise das condições de vida da população brasileira [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010. Disponível em: https://ww2.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2015/default_sintese.shtm (Acessado em 26 de junho de 2011).
https://ww2.ibge.gov.br/home/estatistica...
. These characteristics give rise to concerns for the economy, health and social welfare of society, due to the high cost of treating and preventing the diseases common to this age group. Challenges arise with regard to the implementation of public policies and improvements in health promotion. Furthermore, there is a need for greater opportunities for these people, so that they can maximize their participation within society11. Organização Mundial de Saúde. Envelhecimento ativo: uma política de saúde. Brasília: Organização Pan-Americana da Saúde; 2005.,22. Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais - Uma análise das condições de vida da população brasileira [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010. Disponível em: https://ww2.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2015/default_sintese.shtm (Acessado em 26 de junho de 2011).
https://ww2.ibge.gov.br/home/estatistica...
.

In addition, advancing age may worsen self-perceived health11. Organização Mundial de Saúde. Envelhecimento ativo: uma política de saúde. Brasília: Organização Pan-Americana da Saúde; 2005.. Pinquart33. Pinquart M. Correlates of subjective health in older adults: a meta-analysis. Psychol Aging. 2001; 16: 414-26. explains that this perception of poorer health among the long-lived elderly, compared to younger people, is due to the increase in the number and severity of health problems among the elderly. Moschny et al.44. Moschny A, Platen P, Klaassen-Mielke R, Trampich U, Hinrichs T. Barriers to physical activity in older adults in Germany: a cross-sectional study. Int J Behav Nutr Phys Activity. 2011; 8: 121. https://doi.org/10.1186/1479-5868-8-121
https://doi.org/10.1186/1479-5868-8-121...
, when accompanying 1,937 elderly Germans (aged between 72 and 93 years old) for 7 years, showed that people aged 80 years old and over perceived their health as worse in comparison to younger people.

Positive self-perceived health is a good indicator of one’s own health, as it predicts one’s survival55. Borim FS, Barros MBA, Neri AL. Autoavaliação da saúde em idosos: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saúde Pública. 2012; 28(4): 769-80. http://dx.doi.org/10.1590/S0102-311X2012000400016
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. It is related to good physical, cognitive and emotional health, as well as to a sense of well-being and satisfaction with life66. Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Publica. 2013; 33(4): 302-10.,77. 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 Saúde Pública. 2013; 29(4): 723-34. http://dx.doi.org/10.1590/S0102-311X2013000400010
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.

Self-perceived health is related to some important components of elderly health, such as socioeconomic aspects88. Loyola Filho AI, Firmo JOA, Uchôa E, Lima-Costa MF. Fatores associados a autoavaliação negativa da saúde entre idosos hipertensos e/ou diabéticos: resultados do projeto Bambuí. Rev Bras Epidemiol. 2013; 16(3): 559-71., physical activity9, physical capacity55. Borim FS, Barros MBA, Neri AL. Autoavaliação da saúde em idosos: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saúde Pública. 2012; 28(4): 769-80. http://dx.doi.org/10.1590/S0102-311X2012000400016
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,66. Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Publica. 2013; 33(4): 302-10.,77. 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 Saúde Pública. 2013; 29(4): 723-34. http://dx.doi.org/10.1590/S0102-311X2013000400010
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,88. Loyola Filho AI, Firmo JOA, Uchôa E, Lima-Costa MF. Fatores associados a autoavaliação negativa da saúde entre idosos hipertensos e/ou diabéticos: resultados do projeto Bambuí. Rev Bras Epidemiol. 2013; 16(3): 559-71.,99. Arnadottir SA, Gunnarsdottir ED, Stenlund H, Lundin-Olsson L. Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning. BMC Public Health. 2011; 11: 670. https://doi.org/10.1186/1471-2458-11-670
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, morbidities55. Borim FS, Barros MBA, Neri AL. Autoavaliação da saúde em idosos: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil. Cad Saúde Pública. 2012; 28(4): 769-80. http://dx.doi.org/10.1590/S0102-311X2012000400016
http://dx.doi.org/10.1590/S0102-311X2012...
,66. Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Publica. 2013; 33(4): 302-10.,77. 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 Saúde Pública. 2013; 29(4): 723-34. http://dx.doi.org/10.1590/S0102-311X2013000400010
http://dx.doi.org/10.1590/S0102-311X2013...
,88. Loyola Filho AI, Firmo JOA, Uchôa E, Lima-Costa MF. Fatores associados a autoavaliação negativa da saúde entre idosos hipertensos e/ou diabéticos: resultados do projeto Bambuí. Rev Bras Epidemiol. 2013; 16(3): 559-71.,99. Arnadottir SA, Gunnarsdottir ED, Stenlund H, Lundin-Olsson L. Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning. BMC Public Health. 2011; 11: 670. https://doi.org/10.1186/1471-2458-11-670
https://doi.org/10.1186/1471-2458-11-670...
,1010. Lorenzo T, Millán-Calenti JC, Lorenzo-López L, Sánchez A, Maseda A. Predictores de mala salud autopercibida en una población de personas mayores. Rev Esp Geriatr Gerontol. 2013; 48(6): 272-5. DOI: 10.1016/j.regg.2013.04.002
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and mortality99. Arnadottir SA, Gunnarsdottir ED, Stenlund H, Lundin-Olsson L. Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning. BMC Public Health. 2011; 11: 670. https://doi.org/10.1186/1471-2458-11-670
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,1111. Sargent-Cox KA, Anstey KJ, Luszcz MA. The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing. BMC Geriatr. 2010; 10: 18. https://dx.doi.org/10.1186%2F1471-2318-10-18
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,1212. Lacruz ME, Emeny RT, Baumert J, Ladwig KH. Prospective association between self-reported life satisfaction and mortality: Results from the MONICA/KORA Augsburg S3 survey cohort study. BMC Public Health. 2011; 11: 579. https://doi.org/10.1186/1471-2458-11-579
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. However, none of these aspects are derived from studies with long-lived elderly people, thus highlighting the need for this age group to be investigated33. Pinquart M. Correlates of subjective health in older adults: a meta-analysis. Psychol Aging. 2001; 16: 414-26.. Furthermore, most studies on this subject address negative self-perception of health66. Pagotto V, Bachion MM, Silveira EA. Autoavaliação da saúde por idosos brasileiros: revisão sistemática da literatura. Rev Panam Salud Publica. 2013; 33(4): 302-10..

This research is justified by the differentiated population being investigated (long-lived elderly), because they perceived their health to be worse than other age groups, and also because understanding the issues involved in the positive self-perceived health of the elderly can assist in the implementation of better health policies and measures for this population. as well as be an important indicator for the general health surveillance of the elderly1313. Confortin SC, Giehl MWC, Antes DL, Schneider IJC, d'Orsi E. Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil. Cad Saúde Pública. 2015; 31(5): 1049-60. http://dx.doi.org/10.1590/0102-311X00132014
http://dx.doi.org/10.1590/0102-311X00132...
. The objective of this study was to verify the factors associated with the positive self-perceived health of long-lived elderly in Florianópolis, Santa Catarina.

METHODS

TYPE OF STUDY

A cross-sectional, population-based household survey conducted in the city of Florianópolis, Santa Catarina, Brazil, with a population of elderly people of both sexes, aged 80 years old and over.

POPULATION AND SAMPLE

The EpiFloripa Idoso1414. d'Orsi E, Ed. Condições de saúde da população idosa do município de Florianópolis-SC: estudo de base populacional. 2008. Pesquisa financiada pelo Conselho Nacional de Desenvolvimento Científico e Tecnológico (Processo nº 569834/2008-2). study occurred in 2009 and 2010, in Florianópolis, and aimed to study the health conditions of the elderly population (60 years and older) of both sexes, living in the urban area of the municipality.

In order to calculate the sample size, the following criteria were considered: the expected prevalence (50%), an error of 4 percentage points, a 95% confidence interval (95%CI), a design for samples by clusters (= 2), an additional 20% to account for predicted losses, and 15% for associated studies. Furthermore, the size of the elderly population of 60 years or older was considered. Finally, a minimum value of 1,599 interviews was reached. Due to the availability of funding, the sample was expanded to include 1,911 elderly people.

The sample selection process was carried out using two-stage clusters, with the first stage including 420 census tracts (census units of the Brazilian Institute of Geography and Statistics - Instituto Brasileiro de Geografia e Estatística - IBGE) in Florianópolis. These sectors consist of 300 to 350 households each, and the households were the units of the second stage. It was estimated that 20 interviews were carried out per census tract and, due to the availability of financial resources, the number of elderly people interviewed per sector increased to 23, in order to increase the variability of the sample. The census tracts were stratified in ascending order according to the average monthly income of the head of the family (R $ 314.76 to R $ 5,057.77) and were later randomly selected, along with the households. Thus, 1,911 eligible elderly people were found. The study’s response rate was 89.1%, with a final sample of 1,702 elderly people interviewed. Interviews were considered to be incomplete after four attempts of contacting the interviewee or after the interviewee chose not to respond to the questionnaire.

The study sample was representative of the population aged 60 years old or over residing in Florianópolis. The age group of 80 years old or over in the study (239/1,705 elderly people or 14% of the sample) corresponded to the same percentage of elderly individuals that were 80 years old or over in the target population identified by the 2010 IBGE Census (6.784/48.423 or 14% of the target population).

INSTRUMENTS AND DATA COLLECTION

Data collection was performed using a standardized and pre-tested instrument applied in the form of face-to-face interviews using a Personal Digital Assistant (PDA), which is a small sized computer with a large computational capacity. It served as an agenda and as an elementary office computer system, and it was able to connect to a personal computer and a wireless computer network for internet access.

Female interviewers who had a high school diploma and who were properly trained carried out the interviews. The decision to have only female interviewers was made during the methodological planning of the study. It was considered that women tend to be better received by the interviewees. Furthermore, few questions used in the study could have suffered information bias because the interviewers were women.

Every week, data consistency and quality control was verified by applying a reduced form of the questionnaire over the phone in approximately 10% of the randomly selected interviewees.

The self-perceived health variable was verified by means of the question “In general, would you say that your health is: very good, good, fair, bad or very bad?1515. Ware JE Jr., Kosinski M, Keller SD. A 12-item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; 34: 220-33.. These responses were categorized as positive (“very good” and “good”) and negative (“fair”, “bad” and “very bad”).

The covariates studied were:

  1. sociodemographic variables: age (in years); sex (male, female); marital status (single, married/together, separated/divorced, widower); housing (alone, accompanied); caregiver (no, yes); schooling (no formal education, incomplete elementary education, elementary education, high school education, higher education); skin color (white, black/black with light skin/yellow); currently works (no, yes), which was verified by the question “Do you currently have any paid work?”; and income in minimum wages (less than 1, 1 to 3, 4 to 6, > 6, with the minimum wage in 2009 being R$ 465.00, and in 2010, R$ 510.00);

  2. health variables: cognitive decline as evaluated by the Mini Mental State Examination (MMSE) validated in Brazil by Bertolucci et al.1616. Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Bras Neuropsiquiatr. 1994; 52(1): 1-7. http://dx.doi.org/10.1590/S0004-282X1994000100001
    http://dx.doi.org/10.1590/S0004-282X1994...
    - MMSE is the most often used cognitive screening scale in the world, and it ranges from 0 to 30 points; the elderly individual’s classification was given based on their level of schooling, where elderly people that probably did not have a cognitive deficit received values greater or equal to 19/20 points (elderly individuals with no formal schooling) and greater or equal to 23/24 points (elderly individuals with a formal education); and elderly people with a probable cognitive deficit had lower values ​​than those mentioned1717. Almeida OP. Mini mental state examination and the diagnosis of dementia in Brazil. Arq Bras Neuropsiquiatr. 1998; 56(3B): 605-12. http://dx.doi.org/10.1590/S0004-282X1998000400014
    http://dx.doi.org/10.1590/S0004-282X1998...
    ; spinal disease (no, yes); arthritis and/or rheumatism (no, yes); cancer (no, yes); diabetes (no, yes); bronchitis and/or asthma (no, yes); systemic arterial hypertension (no, yes); cardiovascular diseases (no, yes); depression (no, yes); stroke (no, yes); stomach ulcer (no, yes); urinary incontinence (no, yes); and use of medications (no, yes);

  3. behavioral variables: tobacco use (no, smoked and stopped, currently smokes); and alcohol use (no, moderate/high), which was evaluated by the Alcohol Use Disorders Identification Test (AUDIT)1818. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. Audit: The Alcohol Use Disorders Identification Test. 2ª ed. Word Health Organization: Genebra; 1993., through the first three questions of the instrument that refer to the quantity and frequency of regular or occasional alcohol use1919. Magallón TJC, Robazzi MLC. Consumo de Alcohol em Trabajadores de uma Industria em Monterrey, México. Rev Latino-am Enferm. 2005; 13(número especial): 819-26. http://dx.doi.org/10.1590/S0104-11692005000700009
    http://dx.doi.org/10.1590/S0104-11692005...
    . This instrument is currently one of the most widely used measures in the world to identify groups at risk, and to track the misuse of alcohol in clinical samples and in the general population2020. Meneses-Gaya C, Zuardi AW, Loureiro SR, Crippa JAS. Alcohol Use Disorders Identification Teste (AUDIT): na updated systematic review of psychometric properties. Psychol Neurosci. 2009; 2(1): 83-97. http://dx.doi.org/10.3922/j.psns.2009.1.12
    http://dx.doi.org/10.3922/j.psns.2009.1....
    . Elderly people who did not consume alcohol were considered to not be drinking alcohol; moderate use was considered to be the consumption of one dose or less at any frequency; and high alcohol consumption was considered to be an intake of five doses or more, or two or more doses taken normally when drinking. Due to the small size of the sample, the categories were grouped into alcohol consumption (no, yes). Thus, the interpretation does not refer to the identification of risk group, but to alcohol consumption. Physical activity level was also evaluated by the International Physical Activity Questionnaire (IPAQ) with regard to leisure, in the long form and in a normal week2121. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8): 1381-95. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
    https://doi.org/10.1249/01.MSS.000007892...
    (physically inactive = performed less than 150 minutes per week of physical activity, and physically active = performed at least 150 minutes of weekly physical activity); and the participation in social groups (no, yes);

  4. falls in the last year (no, yes).

DATA ANALYSIS

Descriptive statistics were used to analyze the characteristics of the population. Categorical data were described by relative frequency and their respective 95%CI. The normality of the continuous data (age) was tested.

The prevalence of positive self-perception of health and its respective 95%CI were calculated. For the identification of factors associated with positive self-perceived health, a brute analysis was used and adjusted using a Poisson regression. In the adjusted analysis, the variables that showed an association with the outcome (p ≤ 0.05) were inserted into the model. The final model was adjusted by sex. For all of the analyzes, the statistical program STATA SE 11.0 was used (StataCorp, 2009. Stata Statistical Software: Release 11. College Station, TX, StataCorp LP.).

ETHICAL CONSIDERATIONS

The study was approved by the Ethics Committee on Human Research of the Universidade Federal de Santa Catarina, case number 352/2008. All participants signed an informed consent form. The authors declare no conflicts of interest.

RESULTS

The sample of this study totaled 239 long-lived elderly individuals with a mean age of 85.06 ± 4.68 years old. The prevalence of positive self-perceived health was 41.4% (95%CI 34.6-48.5) (Table 1).

Table 1:
Association between sociodemographic characteristics, health conditions, level of physical activity during leisure times, and the falls of long-lived elderly people from the EpiFloripa Idoso Project, Florianópolis, Santa Catarina, 2014.

The majority of the long-lived elderly individuals were female, widowed, lived with someone else, had a low educational level (were illiterate or had not completed an elementary education), were white, had no paid and/or voluntary work, and received less than three monthly minimum wages. As for health conditions, most of the individuals had no disease other than systemic arterial hypertension and took at least one medication per day. Regarding lifestyle habits, most of them never smoked and did not drink alcohol; they participated in social groups for elderly people, and were physically inactive during leisure times. Regarding falls, the majority did not have falls during the previous year (Table 1).

In Table 2, it was verified in the brute analysis that positive self-perceived health was associated with depression, medication use, no alcohol use, and being physically active during leisure times. However, after the adjusted analysis it was confirmed that positive self-perception of health remained associated with depression, with a 51% lower prevalence in those with a diagnosis of the disease (PR = 0.49, 95%CI 0.28-0.85), and with alcohol consumption, where the prevalence of positive self-perceived health was practically double that of those who did not consume alcohol (PR = 1.99, 95%CI 1.54-2.56).

Table 2:
Adjusted analyzes of the factors associated with positive self-perceived health of long-lived elderly people from the EpiFloripa Idoso Project. Florianópolis, Santa Catarina, Brazil, 2014.

DISCUSSION

In the present study, the prevalence of positive self-perceived health was 41.8%. In addition, it was found that positive self-perceived health was less prevalent in elderly people with no depressive symptoms, and was more prevalent in those who consumed alcohol.

It was observed that depression was inversely associated with positive self-perceived health, corroborating the findings of Arnadottir et al.99. Arnadottir SA, Gunnarsdottir ED, Stenlund H, Lundin-Olsson L. Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning. BMC Public Health. 2011; 11: 670. https://doi.org/10.1186/1471-2458-11-670
https://doi.org/10.1186/1471-2458-11-670...
, confirming the relationship between worse health perception and depressive symptoms, which has been well described in previous studies2222. Millán-Calenti JC, Sánchez A, Lorenzo T, Maseda A. Depressive symptoms and other factors associated with poor self-rated health in the elderly: gender differences. Geriatr Gerontol Int. 2012; 12(2): 198-206. https://doi.org/10.1111/j.1447-0594.2011.00745.x
https://doi.org/10.1111/j.1447-0594.2011...
,2323. Ocampo-Chaparro JM, Zapata-Ossa HJ, Cubides-Munévar AM, Curcio CL, Villegas JD, Reyes-Ortiz CA. Prevalence of poor self-rated health and associated risk factors among older adults in Cali, Colombia. Colomb Med. 2013; 44(4): 224-31.,2424. Blake H, Mo P, Malik S, Thomas S. How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clin Rehabil. 2009; 23: 873-87. https://doi.org/10.1177/0269215509337449
https://doi.org/10.1177/0269215509337449...
. Among the elderly, depression is a very common mental health problem2222. Millán-Calenti JC, Sánchez A, Lorenzo T, Maseda A. Depressive symptoms and other factors associated with poor self-rated health in the elderly: gender differences. Geriatr Gerontol Int. 2012; 12(2): 198-206. https://doi.org/10.1111/j.1447-0594.2011.00745.x
https://doi.org/10.1111/j.1447-0594.2011...
, which, if left untreated, increases the risk of morbidity and mortality, not to mention is associated with a social and economic burden2323. Ocampo-Chaparro JM, Zapata-Ossa HJ, Cubides-Munévar AM, Curcio CL, Villegas JD, Reyes-Ortiz CA. Prevalence of poor self-rated health and associated risk factors among older adults in Cali, Colombia. Colomb Med. 2013; 44(4): 224-31..

Positive self-perceived health was also associated with alcohol consumption among the long-lived elderly. Studies2525. Poikotainen K, Vartiainen E, Korhonen HJ. Alcohol intake and subjective health. Am J Epidemiol. 1996; 144: 346-50. https://doi.org/10.1093/oxfordjournals.aje.a008935
https://doi.org/10.1093/oxfordjournals.a...
,2626. Frisher M, Mendonça M, Shelton N, Pikhart H, Oliveira C, Holdsworth C. Is alcohol consumption in older adults associated with porr self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health. 2015; 15: 703-9. https://doi.org/10.1186/s12889-015-1993-x
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,2727. Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist. 2008; 48(5): 622-36.,2828. Linda Ng Fat. Are we overestimating the beneficial effects of alcohol in later life? The case of young non-drinkers. J Epidemiol Community Health 2012; 66: A17.,2929. Lang I, Wallace RB, Huppert FA, Melzer D. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing. 2007; 36: 256-61. https://doi.org/10.1093/ageing/afm001
https://doi.org/10.1093/ageing/afm001...
have also observed an association between higher alcohol consumption and positive health perception, after adjustment for sociodemographic and lifestyle variables, corroborating the findings of this investigation. Other research showed that the prevalence of negative self-perceived health was higher among those who had stopped drinking, followed by individuals who did not drink2727. Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist. 2008; 48(5): 622-36..

The increase in age is an important determinant of the amount of alcohol being consumed. Older people consume less alcohol when compared to younger people, but they consume it more frequently2929. Lang I, Wallace RB, Huppert FA, Melzer D. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing. 2007; 36: 256-61. https://doi.org/10.1093/ageing/afm001
https://doi.org/10.1093/ageing/afm001...
. Moderate drinking is associated with some good health conditions,2727. Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist. 2008; 48(5): 622-36.,2828. Linda Ng Fat. Are we overestimating the beneficial effects of alcohol in later life? The case of young non-drinkers. J Epidemiol Community Health 2012; 66: A17.,2929. Lang I, Wallace RB, Huppert FA, Melzer D. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing. 2007; 36: 256-61. https://doi.org/10.1093/ageing/afm001
https://doi.org/10.1093/ageing/afm001...
such as better cognition and lower risk of dementia3030. Lee SJ, Sudore RL, Williams BA, Lindquist A, Chen HL, Covinsky KE. Functional Limitations, Socioeconomic Status, and All-Cause Mortality in Moderate Alcohol Drinkers. J Am Geriatr Soc. 2009; 57(6): 955-62. https://doi.org/10.1111/j.1532-5415.2009.02184.x
https://doi.org/10.1111/j.1532-5415.2009...
, better functional performance3030. Lee SJ, Sudore RL, Williams BA, Lindquist A, Chen HL, Covinsky KE. Functional Limitations, Socioeconomic Status, and All-Cause Mortality in Moderate Alcohol Drinkers. J Am Geriatr Soc. 2009; 57(6): 955-62. https://doi.org/10.1111/j.1532-5415.2009.02184.x
https://doi.org/10.1111/j.1532-5415.2009...
, less depressive symptoms2727. Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist. 2008; 48(5): 622-36., some protection against cardiovascular diseases3131. Marmot M, Shipley M, Rose G, Thomas B. Alcohol and Mortality: a U-Shaped Curve. Lancet. 2003; 317(8220): 580-3. and asthma3232. Lieberoth S. Moderate alcohol consumption protective against asthma. Amsterdã: European Respiratory Society (ERS); 2011. Annual Congress: Abstract 319. Presented September 25, 2011., lower mortality2929. Lang I, Wallace RB, Huppert FA, Melzer D. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing. 2007; 36: 256-61. https://doi.org/10.1093/ageing/afm001
https://doi.org/10.1093/ageing/afm001...
,3131. Marmot M, Shipley M, Rose G, Thomas B. Alcohol and Mortality: a U-Shaped Curve. Lancet. 2003; 317(8220): 580-3. and better quality of life2828. Linda Ng Fat. Are we overestimating the beneficial effects of alcohol in later life? The case of young non-drinkers. J Epidemiol Community Health 2012; 66: A17.,3333. Chan AM, Mühlen DV, Kritz-Silverstein D, Barrett-Connor E. Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: The Rancho Bernardo Study. Maturitas. 2009; 62(3): 294-300. https://doi.org/10.1016/j.maturitas.2009.01.005
https://doi.org/10.1016/j.maturitas.2009...
, which can explain the positive self-perceived health of these elderly people. This association can also be explained by the higher probability of a social bond among alcohol-consuming elderly individuals2828. Linda Ng Fat. Are we overestimating the beneficial effects of alcohol in later life? The case of young non-drinkers. J Epidemiol Community Health 2012; 66: A17..

However, these results may be questioned by some biases. One bias may be economic condition, in which people with a higher income consume more alcohol and can access health services more frequently, thereby reducing the impact of alcohol on their health3434. Brasil. Ministério da Saúde. A vigilância, o controle e a prevenção das doenças crônicas não transmissíveis - DCNT - no contexto do Sistema Único de Saúde brasileiro [Internet]. Brasília: Organização Pan-Americana da Saúde; 2005. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/DCNT.pdf (Acessado em 29 de agosto de 2016).
http://bvsms.saude.gov.br/bvs/publicacoe...
. Another point of discussion is that older people who consume alcohol do so because they are healthier, and this is the most likely explanation for the association found between alcohol and positive self-perceived health, in addition to social ties. It is also important to mention that there is a difference in the evaluation of alcohol consumption among the studies, since some studies evaluate low, moderate and high consumption2626. Frisher M, Mendonça M, Shelton N, Pikhart H, Oliveira C, Holdsworth C. Is alcohol consumption in older adults associated with porr self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health. 2015; 15: 703-9. https://doi.org/10.1186/s12889-015-1993-x
https://doi.org/10.1186/s12889-015-1993-...
, some evaluate only moderate use2929. Lang I, Wallace RB, Huppert FA, Melzer D. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing. 2007; 36: 256-61. https://doi.org/10.1093/ageing/afm001
https://doi.org/10.1093/ageing/afm001...
,3030. Lee SJ, Sudore RL, Williams BA, Lindquist A, Chen HL, Covinsky KE. Functional Limitations, Socioeconomic Status, and All-Cause Mortality in Moderate Alcohol Drinkers. J Am Geriatr Soc. 2009; 57(6): 955-62. https://doi.org/10.1111/j.1532-5415.2009.02184.x
https://doi.org/10.1111/j.1532-5415.2009...
, some evaluate consumption doses2626. Frisher M, Mendonça M, Shelton N, Pikhart H, Oliveira C, Holdsworth C. Is alcohol consumption in older adults associated with porr self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health. 2015; 15: 703-9. https://doi.org/10.1186/s12889-015-1993-x
https://doi.org/10.1186/s12889-015-1993-...
,3333. Chan AM, Mühlen DV, Kritz-Silverstein D, Barrett-Connor E. Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: The Rancho Bernardo Study. Maturitas. 2009; 62(3): 294-300. https://doi.org/10.1016/j.maturitas.2009.01.005
https://doi.org/10.1016/j.maturitas.2009...
, and lastly, some evaluate frequency of consumption in days2626. Frisher M, Mendonça M, Shelton N, Pikhart H, Oliveira C, Holdsworth C. Is alcohol consumption in older adults associated with porr self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health. 2015; 15: 703-9. https://doi.org/10.1186/s12889-015-1993-x
https://doi.org/10.1186/s12889-015-1993-...
,3333. Chan AM, Mühlen DV, Kritz-Silverstein D, Barrett-Connor E. Regular alcohol consumption is associated with increasing quality of life and mood in older men and women: The Rancho Bernardo Study. Maturitas. 2009; 62(3): 294-300. https://doi.org/10.1016/j.maturitas.2009.01.005
https://doi.org/10.1016/j.maturitas.2009...
, months2626. Frisher M, Mendonça M, Shelton N, Pikhart H, Oliveira C, Holdsworth C. Is alcohol consumption in older adults associated with porr self-rated health? Cross-sectional and longitudinal analyses from the English Longitudinal Study of Ageing. BMC Public Health. 2015; 15: 703-9. https://doi.org/10.1186/s12889-015-1993-x
https://doi.org/10.1186/s12889-015-1993-...
or years2727. Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. Gerontologist. 2008; 48(5): 622-36., compared to individuals who have never consumed and/or individuals who stopped consuming alcohol.

Nevertheless, further investigations are necessary regarding the relationship between health perception and alcohol consumption in the long-lived elderly. The authors of this study do not recommend that elderly people consume alcohol in order to have a positive self-perception of their health, considering that the public health approach in the UK promotes responsible drinking, which seeks to balance the potential benefits of drinking with possible harms3434. Brasil. Ministério da Saúde. A vigilância, o controle e a prevenção das doenças crônicas não transmissíveis - DCNT - no contexto do Sistema Único de Saúde brasileiro [Internet]. Brasília: Organização Pan-Americana da Saúde; 2005. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/DCNT.pdf (Acessado em 29 de agosto de 2016).
http://bvsms.saude.gov.br/bvs/publicacoe...
. Furthermore, the Ministry of Health’s recommends no alcohol consumption for improved health and the prevention of chronic diseases3434. Brasil. Ministério da Saúde. A vigilância, o controle e a prevenção das doenças crônicas não transmissíveis - DCNT - no contexto do Sistema Único de Saúde brasileiro [Internet]. Brasília: Organização Pan-Americana da Saúde; 2005. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/DCNT.pdf (Acessado em 29 de agosto de 2016).
http://bvsms.saude.gov.br/bvs/publicacoe...
.

It is important to highlight that the present study presents some limitations, among them, the study’s cross-sectional design, which does not permit the inference of cause and effect relationships between the independent variables and the outcome. Additionally, there was a survival bias, since only elderly people that are alive can be interviewed, something which is inherent to any cross-sectional study. The most serious, the most compromised, and the sickest patients died or were admitted to long-term care facilities for the elderly, and therefore were not interviewed.

A positive aspect of this study was the fact that research with long-lived elderly people is still rarely studied in Brazil, due to the difficulty of contacting this group, which further illustrates the importance of researching this specific population. Also, the fact that the research’s outcome is that of positive self-perceived health as opposed to negative self-perceived health differs from most studies.

Longitudinal investigations may contribute to a better understanding of the associations found. In this regard, the EpiFloripa Idoso project continued the study and carried out a new wave of collections in the years 2013 and 2014.

CONCLUSION

It was concluded that the factors associated with positive self-perceived health of long-lived elderly in Florianópolis, Santa Catarina, were depression and alcohol consumption. Thus, the results show that understanding the variables that interfere with the positive self-perceived health of long-lived elderly can help to improve health measures, especially ones that help to avoid depression in this population. This knowledge, if properly applied, can help reduce costs associated with hospitalizations, medications and health treatments, which are very common in this older population. Furthermore, it serves as an important indicator for the general health surveillance of the elderly who live in this municipality.

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  • Financial support: This paper is originally from the EpiFloripa Project 2009/2010, an epidemiological study of health conditions of elderly people in Florianópolis, Santa Catarina, and was funded by the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq), case number 569834/2008-2. It was developed within the Postgraduate Program in Collective Health at the Universidade Federal de Santa Catarina.

History

  • Received
    21 Mar 2016
  • Accepted
    05 Dec 2016
  • Online publication
    02 Aug 2018
Associação Brasileira de Pós -Graduação em Saúde Coletiva São Paulo - SP - Brazil
E-mail: revbrepi@usp.br