Aging and public health: the Brazilian Longitudinal Study of Aging (ELSI-Brazil)

Maria Fernanda Lima-Costa About the author

Brazil is experiencing one of the fastest rates of population aging worldwide11. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2015 revision. New York; 2015 [cited 2016 Dec 3]. Available from: https://www.un.org/development/desa/publications/world-population-prospects-2015-revision.htm
https://www.un.org/development/desa/publ...
. As Brazil has the fifth largest population in the world, the aging of its population has repercussions that transcend the country’s borders. This demographic shift brings both opportunities and challenges not yet fully understood. Promoting active aging22. World Health Organization. Active ageing: a policy framework. Geneva:WHO; 2002. and strengthening economic and social institutions to ensure financial security and provision of adequate health care33. Cotlear D. Population aging: is Latin America ready? Washington (DC):The World Bank; 2011. are crucial issues.

Large population-based longitudinal studies on aging have been conducted in various countries of the Americas, Europe, and Asia. These studies, known as the Health and Retirement Family of Studies44. National Institute of Aging. Why population aging matters to health: a global perspective. Washington (DC): National Institute of Health; World Health Organization; 2011 [cited 2016 Dec 3]. (NIH Publication nº 11-773). Available from: https://nihpublications.od.nih.gov/PublicationDetails.aspx?PubID=6431
https://nihpublications.od.nih.gov/Publi...
, investigate the social and biological determinants of aging and the consequences of this demographic change for the individual and for society. Although these studies are independent, to meet the demands and particularities of each country, they seek to adopt a common methodology to allow for international comparisons. The Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in a nationally representative sample of people aged 50 years and over, is part of this international network55. Lima-Costa MF, Bof de Andrade F, Souza Jr PRB, Neri AL, Duarte YAO, Castro-Costa E, et al. The Brazilian Longitudinal Study of Aging (ELSI-BRAZIL): objectives and design. Am J Epidemiol. 2018;187(7):1345-53. https://doi.org/10.1093/aje/kwx387
https://doi.org/10.1093/aje/kwx387...
. ELSI is funded by the Brazilian Ministry of Health and has the support of researchers from several Brazilian and foreign academic institutions, as well as from policymakers from the Brazilian Unified Health System (SUS) at its various levels. The manuscripts included in this supplement of the Revista de Saúde Pública are fruit of these important collaborations.

The selection of topics covered in these articles was based on the three pillars of the policy framework for active aging of the World Health Organization, i.e., participation, health, and security22. World Health Organization. Active ageing: a policy framework. Geneva:WHO; 2002.. Social security is important at all ages, but its demand is even greater later in life. In the Federal Constitution of Brazil, social security is defined as “initiatives of public authorities and society, aimed at ensuring the rights related to health, welfare, and social assistance”66. Brasil. Constituição (1988). Constituição da República Federativa do Brasil. Brasília (DF): Senado Federal; 1988. Art. 94.. Therefore, social security has been addressed in several manuscripts whilst health was analyzed in all.

High levels of social inequality are found in the majority of topics investigated, with the poorest or those with lower educational level affected most. Inequalities are observed in physical activity77. Peixoto SV, Mambrini JVM, Firmo JOA, Loyola Filho AI, Souza-Junior PRB, Bof de Andrade F, et al. Physical activity practice among older adults: results of the ELSI-Brazil Rev Saude Publica. 2018;52 Suppl 2:5s. https://doi.org/10.11606/S1518-8787.2018052000605
https://doi.org/10.11606/S1518-8787.2018...
, oral health status88. Bof de Andrade F, Antunes JLF, Souza-Junior PRB, Lima-Costa MF, Oliveira C. Lifecourse socioeconomic inequalities and oral health status in later life: ELSI-Brasil. Rev Saude Publica. 2018;52 Suppl 2:7s. https://doi.org/10.11606/S1518-8787.2018052000628
https://doi.org/10.11606/S1518-8787.2018...
, limitations to perform basic activities of daily living99. Bof de Andrade F, Duarte YAO, Souza-Junior PRB, Torres JL, Lima-Costa MF, Andrade FCD. Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015. Rev Saude Publica. 2018;52 Suppl 2:14s. https://doi.org/10.11606/S1518-8787.2018052000617
https://doi.org/10.11606/S1518-8787.2018...
, frailty1010. Andrade JM, Duarte YAO, Alves LC, Andrade FCD, Souza-Junior PRB, Lima-Costa MF, et al. Frailty profile in Brazilian older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:17s. https://doi.org/10.11606/S1518-8787.2018052000616
https://doi.org/10.11606/S1518-8787.2018...
, adequate control of hypertension1111. Firmo JOA, Mambrini JVM, Peixoto SV, Loyola Filho AI, Souza-Junior PRB, Bof de Andrade F, et al. Adequate control of hypertension among older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:13s. https://doi.org/10.11606/S1518-8787.2018052000646
https://doi.org/10.11606/S1518-8787.2018...
, underutilization of medications due to financial reasons1212. Loyola Filho AI, Firmo JOA, Mambrini JVM, Peixoto SV, Souza-Junior PRB, Bof de Andrade F, et al. Cost-related underuse of medications in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:8s. https://doi.org/10.11606/S1518-8787.2018052000622
https://doi.org/10.11606/S1518-8787.2018...
, source of health care1313. Macinko J, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brasil). Rev Saude Publica. 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
https://doi.org/10.11606/S1518-8787.2018...
, and capacity to work1414. Castro CMS, Lima-Costa MF, César CC, Neves JAB, Bof de Andrade F, Souza-Junior PRB, et al. Life course and work ability among older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:11s. https://doi.org/10.11606/S1518-8787.2018052000648
https://doi.org/10.11606/S1518-8787.2018...
. Social participation1515. Ferreira FR, César CC, Bof de Andrade F, Souza-JuniorPRB, Lima-Costa MF, Proietti FA. Aspects of social participation and neighborhood perception: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:18s. https://doi.org/10.11606/S1518-8787.2018052000647
https://doi.org/10.11606/S1518-8787.2018...
and the fear of falling1616. Pimentel WRT, Pagotto V, Stopa SR, Hoffmann MCCL, Bof de Andrade F, Souza-Junior PRB, et al. Falls among Brazilian older adults living in urban areas: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:12s. https://doi.org/10.11606/S1518-8787.2018052000635
https://doi.org/10.11606/S1518-8787.2018...
are associated with the urban environment. Perceived quality of life is associated with sociability and emotional and instrumental support1717. Neri AL, Borim FSA, Fontes AP, Rabello DF, Cachioni M, Batistoni SST, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:16s. https://doi.org/10.11606/S1518-8787.2018052000613
https://doi.org/10.11606/S1518-8787.2018...
. Performance in cognitive function tests is shown to be worse in the Northeast region1818. Castro-Costa E, Lima-Costa MF, Bof de Andrade F, Souza-Junior PRB, Ferri CP. Cognitive function among older adults: ELSI-Brazil results. Rev Saude Publica. 2018;52 Suppl 2:4s. https://doi.org/10.11606/S1518-8787.2018052000629
https://doi.org/10.11606/S1518-8787.2018...
. Back pain and hypertension play a prominent role in the configuration of multimorbidity1919. Nunes BP, Batista SRR, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF, Facchini LA. Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil). Rev Saude Publica. 2018;52 Suppl 2:10s. https://doi.org/10.11606/S1518-8787.2018052000637
https://doi.org/10.11606/S1518-8787.2018...
. Women are the main source of care for those with functional limitations and, among those who worked, a third stopped working to be caregivers2020. Giacomin KC, Duarte YAO, Camarano AA, Nunes DP, Fernandes D. Care and functional disabilities in daily activities – ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:9s. https://doi.org/10.11606/S1518-8787.2018052000650
https://doi.org/10.11606/S1518-8787.2018...
. Some indicators of utilization and quality of health services are better among those who have access to the private health system, who have better socioeconomic conditions1313. Macinko J, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brasil). Rev Saude Publica. 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
https://doi.org/10.11606/S1518-8787.2018...
. Access to primary care is high by international standards1313. Macinko J, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brasil). Rev Saude Publica. 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
https://doi.org/10.11606/S1518-8787.2018...
, but many hospitalizations could be prevented by more effective actions at this level of care2121. Melo-Silva AM, Mambrini JVM, Souza-Junior PRB, Bof de Andrade F, Lima-Costa MF. Hospitalizations among older adults: results from ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:3s. https://doi.org/10.11606/S1518-8787.2018052000639
https://doi.org/10.11606/S1518-8787.2018...
. Differences in the performance of primary care among users of the SUS are found, with a better performance of the Family Health Strategy compared to the traditional basic units1313. Macinko J, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brasil). Rev Saude Publica. 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
https://doi.org/10.11606/S1518-8787.2018...
. Incapacity to work1414. Castro CMS, Lima-Costa MF, César CC, Neves JAB, Bof de Andrade F, Souza-Junior PRB, et al. Life course and work ability among older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:11s. https://doi.org/10.11606/S1518-8787.2018052000648
https://doi.org/10.11606/S1518-8787.2018...
, as well as the receipt of pensions2222. Andrade EIG, Cherchiglia ML, Souza-Junior PRB, Bof de Andrade F, Mambrini JVM, Lima-Costa MF. Factors associated with the receipt of pensions among older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:15s. https://doi.org/10.11606/S1518-8787.2018052000665
https://doi.org/10.11606/S1518-8787.2018...
are associated with worse health conditions. However, people who receive pensions are more autonomous and have more financial security2222. Andrade EIG, Cherchiglia ML, Souza-Junior PRB, Bof de Andrade F, Mambrini JVM, Lima-Costa MF. Factors associated with the receipt of pensions among older adults: ELSI-Brazil. Rev Saude Publica. 2018;52 Suppl 2:15s. https://doi.org/10.11606/S1518-8787.2018052000665
https://doi.org/10.11606/S1518-8787.2018...
.

One of the goals of the Post-2015 Development Agenda, supported by 193 members states of the United Nations, is to ensure healthy lives and promote well-being for all at all ages2323. United Nations. United Nations Sustainable Development Summit 2015, 25-27 set 2015; New York. [cited 2018 May 5]. Available from: https://sustainabledevelopment.un.org/post2015/summit
https://sustainabledevelopment.un.org/po...
,2424. Suzman R, Beard JR, Boerma T, Chatterji S. Health in an aging world: what do we know? Lancet. 2015;385(9967):484-6. https://doi.org/10.1016/S0140-6736(14)61597-X
https://doi.org/10.1016/S0140-6736(14)61...
. Based on the main findings from ELSI, reported in this special issue, the post-2015 development goals may be jeopardized without investments in social protection/security, education, and health, as well as in overcoming the associated social inequalities. The existing Family Health Strategy program needs to be reinforced and improved to meet the needs of older adults. A social care policy at the national level for those with disability is pressing, given demographic trends pointing to a decrease in the availability of informal (non-paid) care55. Lima-Costa MF, Bof de Andrade F, Souza Jr PRB, Neri AL, Duarte YAO, Castro-Costa E, et al. The Brazilian Longitudinal Study of Aging (ELSI-BRAZIL): objectives and design. Am J Epidemiol. 2018;187(7):1345-53. https://doi.org/10.1093/aje/kwx387
https://doi.org/10.1093/aje/kwx387...
. Finally, the results also highlight the need to consider health in the current discussions around extending working lives and potential changes in the rules for pensions, since health conditions are associated with early retirement and decreased work capacity.

REFERENCES

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    » https://nihpublications.od.nih.gov/PublicationDetails.aspx?PubID=6431
  • 5
    Lima-Costa MF, Bof de Andrade F, Souza Jr PRB, Neri AL, Duarte YAO, Castro-Costa E, et al. The Brazilian Longitudinal Study of Aging (ELSI-BRAZIL): objectives and design. Am J Epidemiol 2018;187(7):1345-53. https://doi.org/10.1093/aje/kwx387
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    Peixoto SV, Mambrini JVM, Firmo JOA, Loyola Filho AI, Souza-Junior PRB, Bof de Andrade F, et al. Physical activity practice among older adults: results of the ELSI-Brazil Rev Saude Publica 2018;52 Suppl 2:5s. https://doi.org/10.11606/S1518-8787.2018052000605
    » https://doi.org/10.11606/S1518-8787.2018052000605
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    Bof de Andrade F, Antunes JLF, Souza-Junior PRB, Lima-Costa MF, Oliveira C. Lifecourse socioeconomic inequalities and oral health status in later life: ELSI-Brasil. Rev Saude Publica 2018;52 Suppl 2:7s. https://doi.org/10.11606/S1518-8787.2018052000628
    » https://doi.org/10.11606/S1518-8787.2018052000628
  • 9
    Bof de Andrade F, Duarte YAO, Souza-Junior PRB, Torres JL, Lima-Costa MF, Andrade FCD. Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015. Rev Saude Publica 2018;52 Suppl 2:14s. https://doi.org/10.11606/S1518-8787.2018052000617
    » https://doi.org/10.11606/S1518-8787.2018052000617
  • 10
    Andrade JM, Duarte YAO, Alves LC, Andrade FCD, Souza-Junior PRB, Lima-Costa MF, et al. Frailty profile in Brazilian older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:17s. https://doi.org/10.11606/S1518-8787.2018052000616
    » https://doi.org/10.11606/S1518-8787.2018052000616
  • 11
    Firmo JOA, Mambrini JVM, Peixoto SV, Loyola Filho AI, Souza-Junior PRB, Bof de Andrade F, et al. Adequate control of hypertension among older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:13s. https://doi.org/10.11606/S1518-8787.2018052000646
    » https://doi.org/10.11606/S1518-8787.2018052000646
  • 12
    Loyola Filho AI, Firmo JOA, Mambrini JVM, Peixoto SV, Souza-Junior PRB, Bof de Andrade F, et al. Cost-related underuse of medications in older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:8s. https://doi.org/10.11606/S1518-8787.2018052000622
    » https://doi.org/10.11606/S1518-8787.2018052000622
  • 13
    Macinko J, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF. Primary care and healthcare utilization among older Brazilians (ELSI-Brasil). Rev Saude Publica 2018;52 Suppl 2:6s. https://doi.org/10.11606/S1518-8787.2018052000595
    » https://doi.org/10.11606/S1518-8787.2018052000595
  • 14
    Castro CMS, Lima-Costa MF, César CC, Neves JAB, Bof de Andrade F, Souza-Junior PRB, et al. Life course and work ability among older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:11s. https://doi.org/10.11606/S1518-8787.2018052000648
    » https://doi.org/10.11606/S1518-8787.2018052000648
  • 15
    Ferreira FR, César CC, Bof de Andrade F, Souza-JuniorPRB, Lima-Costa MF, Proietti FA. Aspects of social participation and neighborhood perception: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:18s. https://doi.org/10.11606/S1518-8787.2018052000647
    » https://doi.org/10.11606/S1518-8787.2018052000647
  • 16
    Pimentel WRT, Pagotto V, Stopa SR, Hoffmann MCCL, Bof de Andrade F, Souza-Junior PRB, et al. Falls among Brazilian older adults living in urban areas: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:12s. https://doi.org/10.11606/S1518-8787.2018052000635
    » https://doi.org/10.11606/S1518-8787.2018052000635
  • 17
    Neri AL, Borim FSA, Fontes AP, Rabello DF, Cachioni M, Batistoni SST, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:16s. https://doi.org/10.11606/S1518-8787.2018052000613
    » https://doi.org/10.11606/S1518-8787.2018052000613
  • 18
    Castro-Costa E, Lima-Costa MF, Bof de Andrade F, Souza-Junior PRB, Ferri CP. Cognitive function among older adults: ELSI-Brazil results. Rev Saude Publica 2018;52 Suppl 2:4s. https://doi.org/10.11606/S1518-8787.2018052000629
    » https://doi.org/10.11606/S1518-8787.2018052000629
  • 19
    Nunes BP, Batista SRR, Bof de Andrade F, Souza-Junior PRB, Lima-Costa MF, Facchini LA. Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil). Rev Saude Publica 2018;52 Suppl 2:10s. https://doi.org/10.11606/S1518-8787.2018052000637
    » https://doi.org/10.11606/S1518-8787.2018052000637
  • 20
    Giacomin KC, Duarte YAO, Camarano AA, Nunes DP, Fernandes D. Care and functional disabilities in daily activities – ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:9s. https://doi.org/10.11606/S1518-8787.2018052000650
    » https://doi.org/10.11606/S1518-8787.2018052000650
  • 21
    Melo-Silva AM, Mambrini JVM, Souza-Junior PRB, Bof de Andrade F, Lima-Costa MF. Hospitalizations among older adults: results from ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:3s. https://doi.org/10.11606/S1518-8787.2018052000639
    » https://doi.org/10.11606/S1518-8787.2018052000639
  • 22
    Andrade EIG, Cherchiglia ML, Souza-Junior PRB, Bof de Andrade F, Mambrini JVM, Lima-Costa MF. Factors associated with the receipt of pensions among older adults: ELSI-Brazil. Rev Saude Publica 2018;52 Suppl 2:15s. https://doi.org/10.11606/S1518-8787.2018052000665
    » https://doi.org/10.11606/S1518-8787.2018052000665
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  • 24
    Suzman R, Beard JR, Boerma T, Chatterji S. Health in an aging world: what do we know? Lancet 2015;385(9967):484-6. https://doi.org/10.1016/S0140-6736(14)61597-X
    » https://doi.org/10.1016/S0140-6736(14)61597-X

  • Funding: The ELSI-Brazil baseline study was supported by the Brazilian Ministry of Health (DECIT/SCTIE – Department of Science and Technology from the Secretariat of Science, Technology and Strategic Inputs (Grant 404965/2012-1); COSAPI/DAPES/SAS – Healthcare Coordination of Older Adults, Department of Strategic and Programmatic Actions from the Secretariat of Health Care) (Grants 20836, 22566, and 23700); and the Brazilian Ministry of Science, Technology, Innovation and Communication.
Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br