ABSTRACT

This study aims to evaluate the association between perceived and received support and the expectation of care with the sociodemographic variables, health conditions and functionality of the elderly in the community of the municipality of Várzea Grande, Mato Grosso state. It is a cross-sectional study carried out with 348 elderly people. The data collection was carried out by interviews, using an instrument with sociodemographic questions; health condition; functionality; and perceived and received support network. Analyzes were performed using Chi-square or Fisher’s Exact tests. Social support was evaluated positively among the elderly, recognizing the family as the main provider, especially women. The expectation of care was associated to the spouse, by gender, age, marital status and family arrangement, especially to daughters or daughters-in-law, while siblings and paid professional were little mentioned. In old age, there is a greater reliance on support, due to health and disability, however, there is a tendency to reduce the support network in old age. It is important to develop care strategies for the elderly and family caregivers. It is hoped that this study will subsidize the implementation of elder care actions.

KEYWORDS
Health of the elderly; Social support; Primary Health Care

Introduction

Aging occurs in a sociocultural context and requires attention and organizational care. For the individual, living old age satisfactorily depends not only on his/her competence against external and environmental demands, but also on his/her collective insertion, whose relation takes effect in the construction and maintenance of his/her well-being¹1 Santos J, Gico VV, Reis LA, et al. Construção social da velhice. In: Campos ACV, Berlezi EM, Correa AHM, organizadores. Direitos do idoso: os novos desafios das políticas públicas. Ijuí: Unijuí; 2014. p. 61-76.. In the family environment and in the relationship between friends and neighbors, ties of coping with daily difficulties and activities are established²2 Leite MT, Battisti IDE, Berlezi EM, et al. Idosos residentes no meio urbano e sua rede de suporte familiar e social. Texto & Contexto Enferm. [internet]. 2008 [acesso 2018 jun 10]; 17(2):250-257. Disponível em: http://www.redalyc.org/articulo.oa?id=71417205.
http://www.redalyc.org/articulo.oa?id=71... . Individuals in the family and community environment are substantial people, therefore, providers of social support, and form an informal support network, aimed at the daily help, that generates the well-being of those involved²2 Leite MT, Battisti IDE, Berlezi EM, et al. Idosos residentes no meio urbano e sua rede de suporte familiar e social. Texto & Contexto Enferm. [internet]. 2008 [acesso 2018 jun 10]; 17(2):250-257. Disponível em: http://www.redalyc.org/articulo.oa?id=71417205.
http://www.redalyc.org/articulo.oa?id=71...

3 Oliveira DC, D'Elboux MJ. Estudos nacionais sobre cuidadores familiares de idosos: revisão integrativa. Rev. Bras. Enferm. [internet]. 2012 [acesso 2018 jun 10]; 65(5):829-823. Disponível em: http://www.redalyc.org/articulo.oa?id=267025266017.
http://www.redalyc.org/articulo.oa?id=26...

4 Witter C, Camilo ABR. Família e envelhecimento. In: Witter C, Buriti MA, organizadores. Envelhecimento e contingências de vida. Campinas: Alínea; 2011. p. 83-102.

5 Guedes MBOG, Lima KC, Caldas CP, et al. Apoio social e o cuidado integral à saúde do idoso. Physis [internet]. 2017 [acesso 2018 jun 29]; 27(4):1185-204. Disponível em: https://www.scielosp.org/article/physis/2017.v27n4/1185-1204/pt.
https://www.scielosp.org/article/physis/...

6 Guadalupe S, Cardoso J. As redes de suporte social informal como fontes de provisão social em Portugal: o caso da população idosa. Soc. Estado [internet]. 2018 [acesso 2018 jun 29]; 33(1):213-48. Disponível em: https://dx.doi.org/10.1590/s0102-699220183301009.
https://dx.doi.org/10.1590/s0102-6992201... ^-77 Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 29]; 16(3):419-32. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002&lng=en.
http://www.scielo.br/scielo.php?script=s... .

The informal support network is embodied in social relationships, interaction and material, instrumental and affective support, providing social inclusion, health promotion and quality of life for the elderly⁵5 Guedes MBOG, Lima KC, Caldas CP, et al. Apoio social e o cuidado integral à saúde do idoso. Physis [internet]. 2017 [acesso 2018 jun 29]; 27(4):1185-204. Disponível em: https://www.scielosp.org/article/physis/2017.v27n4/1185-1204/pt.
https://www.scielosp.org/article/physis/...

6 Guadalupe S, Cardoso J. As redes de suporte social informal como fontes de provisão social em Portugal: o caso da população idosa. Soc. Estado [internet]. 2018 [acesso 2018 jun 29]; 33(1):213-48. Disponível em: https://dx.doi.org/10.1590/s0102-699220183301009.
https://dx.doi.org/10.1590/s0102-6992201...

7 Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 29]; 16(3):419-32. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002&lng=en.
http://www.scielo.br/scielo.php?script=s... ^-88 Souza DS, Berlese DB, Cunha GL, et al. Análise da relação do suporte social e da síndrome da fragilidade em idosos. Psicol. Saúde Doenças [internet]. 2017 [acesso 2018 jun 10]; 8(2):420-33. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164500862017000200011&lng=pt.
http://www.scielo.mec.pt/scielo.php?scri... . Among those with less financial resources, this type of help is even more necessary, since, under conditions of health problems and difficulties in accessing a formal health network, such as medication and treatments, they may become more dependent on an informal support network, usually located in geographically closer spaces, which makes it easier to request aid⁴4 Witter C, Camilo ABR. Família e envelhecimento. In: Witter C, Buriti MA, organizadores. Envelhecimento e contingências de vida. Campinas: Alínea; 2011. p. 83-102.^,77 Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 29]; 16(3):419-32. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002&lng=en.
http://www.scielo.br/scielo.php?script=s...

8 Souza DS, Berlese DB, Cunha GL, et al. Análise da relação do suporte social e da síndrome da fragilidade em idosos. Psicol. Saúde Doenças [internet]. 2017 [acesso 2018 jun 10]; 8(2):420-33. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164500862017000200011&lng=pt.
http://www.scielo.mec.pt/scielo.php?scri...

9 Faquinello P, Marcon SS. Amigos e vizinhos: uma rede social ativa para adultos e idosos hipertensos. Rev. Esc. Enferm. USP [internet]. 2011 [acesso 2015 jul 25]; 45(6):1345-1352. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342011000600010&lng=en.
http://www.scielo.br/scielo.php?script=s...

10 Anjos KF, Boery RNSO, Pereira R, et al. Associação entre apoio social e qualidade de vida de cuidadores familiares de idosos dependentes. Ciênc. Saúde Colet. [internet]. 2015 [acesso 2018 jun 10]; 20(5):1321-1330. Disponível em: https://www.scielosp.org/article/ssm/content/raw/?resource_ssm_path=/media/assets/csc/v20n5/pt_1413-8123-csc-20-05-01321.pdf.
https://www.scielosp.org/article/ssm/con...

11 Santos AS, Silveira RE, Farinelli MR. A dinâmica sociofamiliar do idoso. In: Campos ACV, Berlezi EM, Correa AHM, organizadores. Direitos do idoso: os novos desafios das políticas públicas. Ijuí: Unijuí; 2014. p. 123-45.

12 Wichmann FMA, Couto AN, Areosa SV, et al. Grupos de convivência como suporte ao idoso na melhoria da saúde. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 18]; 16(4):821-832. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-8232013000400821&lng=en.
http://www.scielo.br/scielo.php?script=s...

13 Lee HS, Kim C. Structural equation modeling to assess discrimination, stress, social support, and depression among the elderly in South Korea. Asian. Nurs. Res. [internet]. 2016 [acesso 2016 ago 2]; 10(3):182-188. Disponível em: https://www.asian-nursingresearch.com/article/S1976-1317(16)30039-1/pdf.
https://www.asian-nursingresearch.com/ar...

14 Li H, Ji Y, Chen T. The roles of different sources of social support on emotional well-being among Chinese elderly. PloSOne [internet]. 2014 [acesso 2016 ago 2]; 9(3):1-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24594546.
https://www.ncbi.nlm.nih.gov/pubmed/2459...

15 Alvarenga MR, Oliveira MA, Domingues MA, et al. Rede de suporte social do idoso atendido por equipes de Saúde da Família. Ciênc. Saúde Colet. [internet]. 2011 [acesso 2016 ago 5]; 16(5): 2603-2611. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-1232011000500030&lng=en.
http://www.scielo.br/scielo.php?script=s... ^-1616 Melchiorre MG, Chiatti C, Lamura GT, et al. Social support, socio-economic status, health and abuse among older people in seven European countries. PLoSOne [internet]. 2013. [acesso 2019 jun 10]; 8(1):1-10. Disponível em: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054856.
http://journals.plos.org/plosone/article... .

Population aging is a worldwide reality that points to the need for studies that subsidize care and support actions for families and caregivers of the elderly. It is relevant to know the network of support and social support to the elderly in the community of the municipality of Várzea Grande, in the state of Mato Grosso. In this context, the present study aims to evaluate the association between perceived and received support and the expectation of care with the sociodemographic variables, health conditions and functionality of the elderly in this community.

Material and methods

A cross-sectional study was carried out with elderly people from the community, attended at two Basic Health Units (BHU) in the municipality of Várzea Grande (MT). The Municipal Health Department mentioned the BHU that included elderly residents of urban, rural and riverside areas, considering the intention to reach them for the study. At the time of data collection, there were no systematized records in the BHU, and the number of elderly people was informed from the records of the Community Health Workers (CHW). The Souza Lima BHU had 362 elderly people and Água Vermelha, had 450.

Considering that there was no adherence of all CHW in the visitation for collection, there was an option for the convenience sample, that is, 191 elderly (52%) from Souza Lima and 164 (36.4%) from Água Vermelha, totaling 355 interviews. Eight CHW participated in the process of visitation and data collection, of which five collaborated in the visits and in the interviews, and only three in the visits, both at the Souza Lima BHU and at Água Vermelha BHU. Besides these, three other volunteer researchers participated in the data collection. All collaborators previously participated in a training on the research protocol, its objectives and procedures.

As inclusion criteria, were considered: people aged 60 years or over; attended at the health facilities at the study location; with communication conditions (speech, hearing and comprehension); who had agreed to participate voluntarily in the interview and signed the Informed Consent Form (ICF). Institutionalized elderly people were excluded. After applying the eligibility criteria, 7 subjects were, yet, excluded, with 348 remaining elderly.

The data collection was carried out through interviews that took place, mostly, in the households, with follow-up of the CHW, and in the health units, after group meetings or consultations. The instrument used was developed from a research protocol (questionnaire), validated in the studies ‘Fragility in Brazilian Elderly (Fibra)’, of the Graduate Program in Gerontology of the Faculty of Medical Sciences of the State University of Campinas (FCM/Unicamp), and ‘Health, Welfare and Aging (Sabe)’, in Brazil, conducted by the Faculty of Public Health of the University of São Paulo (USP), under the coordination of the Pan American Health Organization/World Health Organization (PAHO/WHO). The questions were selected and adapted according to the purpose of the study¹⁷17 Neri AL, Guariento ME, organizadoras. Fragilidade, saúde e bem-estar em idosos: dados do estudo FIBRA. Campinas: Alínea; 2011.^,1818 Lebrão ML, Laurenti R. Saúde, bem-estar e envelhecimento: o estudo SABE no Município de São Paulo. Rev. Bras. Epidemiol. [internet]. 2005 [acesso 2016 ago 5]; 8(2):127-141. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2005000200005&lng=pt&nrm=iso.
http://www.scielo.br/scielo.php?script=s... . The questionnaire was structured into six blocks: 1) identification of the participant; 2) sociodemographic variables (age, sex, marital status, race/color, occupation, schooling, housing arrangement and income); 3) health condition; 4) functionality; 5) expectation of care and perceived social support; and 6) family and social support network.

In this study, the support network and social support perceived and received, in addition to the expectation of care of people who live or not with the elderly, were associated to the sociodemographic variables and health and functional conditions categorized below:

The data were entered into the Excel spreadsheet, checked by filter and review of all questionnaires, one by one. Statistical analyzes were carried out using Software R, version 3.5.0. R Core Team (2018). Descriptive analyzes were carried out with absolute (n) and relative (%) frequency values. For the analysis of the association between the perceived and received support and the expectation of care with the sociodemographic variables, health conditions and functionality of the elderly, Chi-square or Fisher’s Exact tests were used at the 5% level of significance (p value <0.05).

The research was approved by the Ethics Committee, with the opinion nº 1.995.932, of April 3, 2017, and met the requirements for research with human beings, according to Resolution nº 466/2012 of the National Health Council. The collection took place after the reading and signing of the Informed Consent Form (ICF) by the study participants.

Results

Of the 348 elderly people interviewed: the majority were women (62.07%); cohabited with someone (85.34%); married or with companions, followed by the widows/widowers; had low schooling and income. The age group ranged from 60 to 91 years old, with a mean of 70.1 (sd=7) and the highest age group with age less than 75 years old (73.56%).

The care received or not from people living with the elderly did not show any association with the sociodemographic variables, however, more than 92% of the elderly answered that they received help from people with whom they lived together, mainly women (95.03%), young people ( 95.41%), widows/widowers and married or with partners (96.83% and 95.31%, respectively), as seen in table 1.

Still in table 1, it is observed that the help received or not from people who did not live with the elderly showed association between children and gender (p=0.0090); marital status was associated with siblings (p=0.0070); number of diseases was related to the help of other relatives and friends (p=0.0388). Regarding the help received from children, the highest proportion was among women (81.31%); the help received from siblings and paid professionals was little mentioned among the elderly; and the request for help to other relatives and friends was greater among those who had three or more diseases.

It can be noted that the elderly who expected to be cared for by their spouses had a statistically significant association (p<0.001) with all sociodemographic variables analyzed, that is, gender, age, marital status and family arrangement. Likewise, among those who expected to be cared for by their daughters or daughters-in-law, there was also a significant association (p<0.001), except for the variable age. The expectation of care was centered within the family. Daughters or daughters-in-law were identified as the primary caretakers, except for the divorced, separated or judicially separated. Regarding gender, women had the expectation of, firstly, the care of daughters or daughters-in-law (81.78%), but they did not wait for the care of their husbands. Men also expected the care from wives and daughters or daughters-in-law (71.76%); sons or sons-in-law appeared in third place as expectation of care for men and women (62.88% and 66.05%, respectively), as can be seen in table 2.

The expectation of care regarding the health and functional conditions variables showed an association between the paid professional and the IADL (p=0.0270). Although there was no statistical significance, the daughter or daughter-in-law appears, with high frequency, as the first mention in the expectation of care among the elderly, as shown in table 3.

The analysis shows that the perceived support was positively evaluated by the interviewees, since most of the elderly answered ‘always’ to all questions, but there was only association between the ‘have many people to talk to’ response to the marital status (p=0.0260). The highest proportions were among widows/widowers (62.5%) and married or with partners (60.5%), as seen in table 4.

In the association of perceived support and health and functional conditions there was a significant association between the answer ‘it is easy to find people who can help you in your tasks if you become ill’ with health self-assessment (p=0.0418) and number of diseases (p=0.0207); ‘have someone to turn to when you need a suggestion on how deal with some problem’ had an association with health self-assessment (p=0.0342). Although there was no significance among the variables, ‘have at least one person in whose opinion you absolutely trust’ showed the highest proportions among the elderly aged 75 years or older (76.09%) and who had three or more diseases (76,14 %), as shown in table 5.

Discussion

In this study, the prevalence of elderly women was observed. Most of them live with their spouse and have low schooling. When it comes to support, the help received from family members, whether they cohabit or not, prevails. The family is the main provider of care, especially, by women, whether daughters, daughters-in-law or wives. The study, therefore, corroborates other researches regarding the characteristics of the elderly, in which the majority is composed of women²⁰20 Liberalesso TEM, Dallazen F, Bandeira VAC, et al. Prevalência de fragilidade em uma população de longevos na região Sul do Brasil. Saúde debate [internet]. 2017 [acesso 2018 out 27]; 41(113):553-62. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-1042017000200553&lng=en.
http://www.scielo.br/scielo.php?script=s... ; married individuals or living with companions, followed by elderly widows/widowers⁸8 Souza DS, Berlese DB, Cunha GL, et al. Análise da relação do suporte social e da síndrome da fragilidade em idosos. Psicol. Saúde Doenças [internet]. 2017 [acesso 2018 jun 10]; 8(2):420-33. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164500862017000200011&lng=pt.
http://www.scielo.mec.pt/scielo.php?scri... ^,2121 Domingues MA, Ordonez TN, Silva TBL, et al. Redes de relações sociais dos idosos residentes em Ermelino Matarazzo, São Paulo: um estudo epidemiológico. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 17]; 16(1):49-59. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-8232013000100006&lng=pt.
http://www.scielo.br/scielo.php?script=s...

22 Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 20]; 16(3):419-32. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002&lng=pt.
http://www.scielo.br/scielo.php?script=s...

23 Iglesias HRF, Antonucci T. Convoys of social support in Mexico: examining socio-demographic variation. Int. J. Behav. Dev. [internet]. 2010 [acesso 2018 jun 18]; 40(4):324-333. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913785.
https://www.ncbi.nlm.nih.gov/pmc/article... ^-2424 Sudré MRS, Reiners AAO, Azevedo RCS, et al. Características socioeconômicas e de saúde de idosos assistidos pelas equipes de saúde da família. Ciênc. Cuid. Saúde [internet]. 2014 [acesso 2018 jul 18]; 14(1):933-40. Disponível em: http://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/19794.
http://periodicos.uem.br/ojs/index.php/C... ; with education of up to four years of study²⁰20 Liberalesso TEM, Dallazen F, Bandeira VAC, et al. Prevalência de fragilidade em uma população de longevos na região Sul do Brasil. Saúde debate [internet]. 2017 [acesso 2018 out 27]; 41(113):553-62. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-1042017000200553&lng=en.
http://www.scielo.br/scielo.php?script=s... ; and low income (up to two minimum wages)⁸8 Souza DS, Berlese DB, Cunha GL, et al. Análise da relação do suporte social e da síndrome da fragilidade em idosos. Psicol. Saúde Doenças [internet]. 2017 [acesso 2018 jun 10]; 8(2):420-33. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164500862017000200011&lng=pt.
http://www.scielo.mec.pt/scielo.php?scri... ^,2121 Domingues MA, Ordonez TN, Silva TBL, et al. Redes de relações sociais dos idosos residentes em Ermelino Matarazzo, São Paulo: um estudo epidemiológico. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 17]; 16(1):49-59. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-8232013000100006&lng=pt.
http://www.scielo.br/scielo.php?script=s... ^,2222 Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 20]; 16(3):419-32. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002&lng=pt.
http://www.scielo.br/scielo.php?script=s... ^,2424 Sudré MRS, Reiners AAO, Azevedo RCS, et al. Características socioeconômicas e de saúde de idosos assistidos pelas equipes de saúde da família. Ciênc. Cuid. Saúde [internet]. 2014 [acesso 2018 jul 18]; 14(1):933-40. Disponível em: http://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/19794.
http://periodicos.uem.br/ojs/index.php/C... .

Both inside and outside home, the results show that family members are the main providers of help for the elderly, especially children. It is important to highlight that, among the respondents, more than 60% are dependent on IADL. Elderly people who receive help from the people they live with are mostly women, elderly people aged 60 to 74, widows/widowers and married or with partners. Data from Sabe study shows that the chances of low aid frequency are higher among men and women who live alone when associated with the family arrangement; single men and widowers, if associated with marital status; and, for both genders, these chances are greater for the unmarried²⁵25 Rosa TEC, Benício MHDA, Alves MCGP, et al. Aspectos estruturais e funcionais do apoio social de idosos do Município de São Paulo, Brasil. Cad. Saúde Pública [internet]. 2007 [acesso 2018 out 27]; 23(12):2982-92. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007001200019&lng=en.
http://www.scielo.br/scielo.php?script=s... .

It is observed that, with respect to expectation of care, comparing the family members, the daughters or daughters-in-law are mentioned first, followed by children or sons-in-law⁸8 Souza DS, Berlese DB, Cunha GL, et al. Análise da relação do suporte social e da síndrome da fragilidade em idosos. Psicol. Saúde Doenças [internet]. 2017 [acesso 2018 jun 10]; 8(2):420-33. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164500862017000200011&lng=pt.
http://www.scielo.mec.pt/scielo.php?scri... . Among men, the expectation of being cared for by their wives predominates; and, among women, by daughters and daughters-in-law²⁶26 Fontes AP, Burgos ACGF, Mello DM, et al. Arranjos domiciliares, expectativa de cuidado, suporte social percebido e satisfação com as redes sociais. In: Neri AL, Guariento ME, organizadoras. Fragilidade, saúde e bem-estar em idosos: dados do estudo FIBRA. Campinas: Alínea; 2011. p. 55-73.^,2727 Gutierrez LLP, Fernandes NRM, Mascarenhas M. Caracterização de cuidadores de idosos da região metropolitana de Porto Alegre (RS): perfil do cuidado. Saúde debate [internet]. 2017 [acesso 2018 out 27]; 41(114):885-98. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042017000300885&lng=en.
http://www.scielo.br/scielo.php?script=s... . Married and younger men are the ones who most expect to be looked after by their wives. Women, older elderly and widowers expect more care from daughters or daughters-in-law. Regarding age, gender and care by the spouse, especially among men, other studies show that, compared to women, they tend to receive less social support and are more at risk of not getting this support adequately in the informal network¹⁶16 Melchiorre MG, Chiatti C, Lamura GT, et al. Social support, socio-economic status, health and abuse among older people in seven European countries. PLoSOne [internet]. 2013. [acesso 2019 jun 10]; 8(1):1-10. Disponível em: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054856.
http://journals.plos.org/plosone/article... .

Family caregivers are predominantly female²⁸28 Liu J. Ageing, migration and familial support in rural China. Geoforum [internet]. 2014 [acesso 2018 jun 10]; 51:305-312. Disponível em: https://www.sciencedirect.com/science/article/pii/S0016718513000857.
https://www.sciencedirect.com/science/ar...

29 Polaro SHI, Gonçalves LHT, Nassar SM, et al. Dinâmica da família no contexto dos cuidados a adultos na quarta idade. Rev. Bras. Enferm. [internet]. 2013 [acesso 2018 jun 29]; 66(2):228-33. Disponível em: http://www.scielo.br/pdf/reben/v66n2/12.pdf.
http://www.scielo.br/pdf/reben/v66n2/12....

30 Rocha BMP, Pacheco JEP. Elderly persons in a situation of dependence: informal carregiver stress and coping. Acta Paul. Enferm. [internet]. 2013 [acesso 2018 jun 29]; 26(1):50-56. Disponível em: http://www.redalyc.org/articulo.oa?id=307026771010.
http://www.redalyc.org/articulo.oa?id=30... ^-3131 Muniz EA, Freitas CASL, Oliveira EN, et al. Grau de sobrecarga dos cuidadores de idosos atendidos em domicílio pela Estratégia Saúde da Família. Saúde debate [internet]. 2016 [acesso 2018 out 27]; 40(110):172-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042016000300172&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... and live in the homes of the elderly²⁹29 Polaro SHI, Gonçalves LHT, Nassar SM, et al. Dinâmica da família no contexto dos cuidados a adultos na quarta idade. Rev. Bras. Enferm. [internet]. 2013 [acesso 2018 jun 29]; 66(2):228-33. Disponível em: http://www.scielo.br/pdf/reben/v66n2/12.pdf.
http://www.scielo.br/pdf/reben/v66n2/12.... ^,3131 Muniz EA, Freitas CASL, Oliveira EN, et al. Grau de sobrecarga dos cuidadores de idosos atendidos em domicílio pela Estratégia Saúde da Família. Saúde debate [internet]. 2016 [acesso 2018 out 27]; 40(110):172-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042016000300172&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... . According to Liu²⁸28 Liu J. Ageing, migration and familial support in rural China. Geoforum [internet]. 2014 [acesso 2018 jun 10]; 51:305-312. Disponível em: https://www.sciencedirect.com/science/article/pii/S0016718513000857.
https://www.sciencedirect.com/science/ar... , the provision of care, support and relatedness is centered on women, who are held accountable for the interdependence and facilitation of intergenerational ties in family contexts. A study carried out in rural areas of China shows that daughters, in the absence of brothers, are providing emotional and instrumental support for parents of old age, noting that this type of work is not valued and compensated²⁸28 Liu J. Ageing, migration and familial support in rural China. Geoforum [internet]. 2014 [acesso 2018 jun 10]; 51:305-312. Disponível em: https://www.sciencedirect.com/science/article/pii/S0016718513000857.
https://www.sciencedirect.com/science/ar... . A similar result occurs in the study carried out in Pantanal of Mato Grosso³²32 Pignatti MG, Barsaglini RA, Senna GD. Envelhecimento e rede de apoio social em território rural do Pantanal mato-grossense. Physis [internet]. 2011 [acesso 2018 jun 29]; 21(4):1469-1491. Disponível em: https://dx.doi.org/10.1590/S0103-73312011000400016.
https://dx.doi.org/10.1590/S0103-7331201... . The probability of providing care is greater for daughters than for their sons, evidencing the presence of women in the care function, and, many times, this centrality leads to the overburden of one person⁸8 Souza DS, Berlese DB, Cunha GL, et al. Análise da relação do suporte social e da síndrome da fragilidade em idosos. Psicol. Saúde Doenças [internet]. 2017 [acesso 2018 jun 10]; 8(2):420-33. Disponível em: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S164500862017000200011&lng=pt.
http://www.scielo.mec.pt/scielo.php?scri... ^,2121 Domingues MA, Ordonez TN, Silva TBL, et al. Redes de relações sociais dos idosos residentes em Ermelino Matarazzo, São Paulo: um estudo epidemiológico. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 17]; 16(1):49-59. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-8232013000100006&lng=pt.
http://www.scielo.br/scielo.php?script=s... ^,2626 Fontes AP, Burgos ACGF, Mello DM, et al. Arranjos domiciliares, expectativa de cuidado, suporte social percebido e satisfação com as redes sociais. In: Neri AL, Guariento ME, organizadoras. Fragilidade, saúde e bem-estar em idosos: dados do estudo FIBRA. Campinas: Alínea; 2011. p. 55-73.^,2828 Liu J. Ageing, migration and familial support in rural China. Geoforum [internet]. 2014 [acesso 2018 jun 10]; 51:305-312. Disponível em: https://www.sciencedirect.com/science/article/pii/S0016718513000857.
https://www.sciencedirect.com/science/ar... ^,3030 Rocha BMP, Pacheco JEP. Elderly persons in a situation of dependence: informal carregiver stress and coping. Acta Paul. Enferm. [internet]. 2013 [acesso 2018 jun 29]; 26(1):50-56. Disponível em: http://www.redalyc.org/articulo.oa?id=307026771010.
http://www.redalyc.org/articulo.oa?id=30... ^,3333 Jesus MCP, Merighi MAB, Caldeira S, et al. Cuidar da mãe idosa no contexto domiciliar: perspectiva de filhas. Texto & Contexto Enferm. [internet]. 2013 [acesso 2018 jun 29]; 22(4):1081-1088. Disponível em: http://www.redalyc.org/articulo.oa?id=71429843026.
http://www.redalyc.org/articulo.oa?id=71...

34 Pillemer K, Suitor JJ. Who provides care? A prospective study of caregiving among adult siblings. Gerontol. [internet]. 2013 [acesso 2018 jun 29]; 54(4):589-598. Disponível em: https://academic.oup.com/gerontologist/article/54/4/589/649545.
https://academic.oup.com/gerontologist/a... ^-3535 Lins AES, Rosas C, Neri AL. Satisfação com as relações e apoios familiares segundo idosos cuidadores de idosos. Rev. Bras. Geriatr. Gerontol. [internet]. 2018 [acesso 2018 set 30]; 21(3):341-52. Disponível em: http://www.rbgg.com.br/arquivos/proximas-publicacoes/2017-0177.pdf.
http://www.rbgg.com.br/arquivos/proximas... .

It is known that the residences are composed of new family arrangements, and that it can provide the division of the task of caring for the elderly. This helps to reduce hospitalizations and isolation of the elderly at home, as well as in long-stay institutions²⁷27 Gutierrez LLP, Fernandes NRM, Mascarenhas M. Caracterização de cuidadores de idosos da região metropolitana de Porto Alegre (RS): perfil do cuidado. Saúde debate [internet]. 2017 [acesso 2018 out 27]; 41(114):885-98. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042017000300885&lng=en.
http://www.scielo.br/scielo.php?script=s... ^,3131 Muniz EA, Freitas CASL, Oliveira EN, et al. Grau de sobrecarga dos cuidadores de idosos atendidos em domicílio pela Estratégia Saúde da Família. Saúde debate [internet]. 2016 [acesso 2018 out 27]; 40(110):172-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042016000300172&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... . However, it is known that such a task can be exhausting and solitary, since, often, as has already been said, it is performed by a single person, without any preparation or guidance. Even, the caregiver of the elderly may turn out to be another elderly person, and all of these factors may increase the likelihood of risks during the journey²⁷27 Gutierrez LLP, Fernandes NRM, Mascarenhas M. Caracterização de cuidadores de idosos da região metropolitana de Porto Alegre (RS): perfil do cuidado. Saúde debate [internet]. 2017 [acesso 2018 out 27]; 41(114):885-98. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042017000300885&lng=en.
http://www.scielo.br/scielo.php?script=s... ^,3131 Muniz EA, Freitas CASL, Oliveira EN, et al. Grau de sobrecarga dos cuidadores de idosos atendidos em domicílio pela Estratégia Saúde da Família. Saúde debate [internet]. 2016 [acesso 2018 out 27]; 40(110):172-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042016000300172&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... .

The paid professional is little mentioned, considering the socioeconomic characteristics of the participants. It is notorious that elderly people with fewer resources and health problems are conditioned to dependence on smaller and closer networks²³23 Iglesias HRF, Antonucci T. Convoys of social support in Mexico: examining socio-demographic variation. Int. J. Behav. Dev. [internet]. 2010 [acesso 2018 jun 18]; 40(4):324-333. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913785.
https://www.ncbi.nlm.nih.gov/pmc/article... ^,3636 Iglesias HRF, Webster NJ, Antonucci TC. The complex nature of family support across the lifespan: implications for psychological wellbeing. Dev. Psychol. [internet]. 2015 [acesso 2018 jun 20]; 51(3):277-88. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25602936.
https://www.ncbi.nlm.nih.gov/pubmed/2560... . Elderly people in a disadvantaged socioeconomic situation reported a poorer social network¹⁶ and a greater probability of receiving informal care³⁷37 Tomini F, Groot W, Tomini SM. Informal care and gifts to and from older people in Europe: The interlinks between giving and receiving. BMC Health Serv. Res. [internet]. 2016 [acesso 2018 jun 18]; 16(1):1-15. Disponível em: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1830-7.
https://bmchealthservres.biomedcentral.c... , that is, mainly provided by the relatives with whom they coexist. Children are the greatest providers of help when compared to friends, neighbors and colleagues¹⁴14 Li H, Ji Y, Chen T. The roles of different sources of social support on emotional well-being among Chinese elderly. PloSOne [internet]. 2014 [acesso 2016 ago 2]; 9(3):1-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/24594546.
https://www.ncbi.nlm.nih.gov/pubmed/2459... ^,3131 Muniz EA, Freitas CASL, Oliveira EN, et al. Grau de sobrecarga dos cuidadores de idosos atendidos em domicílio pela Estratégia Saúde da Família. Saúde debate [internet]. 2016 [acesso 2018 out 27]; 40(110):172-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042016000300172&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... , which corroborates the data of this research.

In general, the data show that the elderly people have positive views about their social support network. The questions regarding this support have more emphasis on social and emotional aspects, and most of the elderly responded ‘always’ to all questions, considering that they have someone to rely on, from whom to receive emotional or affective, instrumental and informative support⁷7 Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 29]; 16(3):419-32. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002&lng=en.
http://www.scielo.br/scielo.php?script=s... . Some authors point out that support for care is present in the majority of the elderly and is offered, in most cases, by family members, in this hierarchical order: spouse, children and friends¹¹11 Santos AS, Silveira RE, Farinelli MR. A dinâmica sociofamiliar do idoso. In: Campos ACV, Berlezi EM, Correa AHM, organizadores. Direitos do idoso: os novos desafios das políticas públicas. Ijuí: Unijuí; 2014. p. 123-45.^,2121 Domingues MA, Ordonez TN, Silva TBL, et al. Redes de relações sociais dos idosos residentes em Ermelino Matarazzo, São Paulo: um estudo epidemiológico. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 17]; 16(1):49-59. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-8232013000100006&lng=pt.
http://www.scielo.br/scielo.php?script=s... , which help in domestic activities, personal care, financial support, company and visits²¹21 Domingues MA, Ordonez TN, Silva TBL, et al. Redes de relações sociais dos idosos residentes em Ermelino Matarazzo, São Paulo: um estudo epidemiológico. Rev. Bras. Geriatr. Gerontol. [internet]. 2013 [acesso 2018 jun 17]; 16(1):49-59. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-8232013000100006&lng=pt.
http://www.scielo.br/scielo.php?script=s... ^,3232 Pignatti MG, Barsaglini RA, Senna GD. Envelhecimento e rede de apoio social em território rural do Pantanal mato-grossense. Physis [internet]. 2011 [acesso 2018 jun 29]; 21(4):1469-1491. Disponível em: https://dx.doi.org/10.1590/S0103-73312011000400016.
https://dx.doi.org/10.1590/S0103-7331201... .

This study shows that social support perceived positively is among women; young adults; those who live with someone; who are married or have a partner; who are independent for IADL and BADL; and those who have three or more diseases. Women establish more social relationships, have a more socially oriented life, which provides many sources of support and help, while men tend to trust their wives more¹⁶16 Melchiorre MG, Chiatti C, Lamura GT, et al. Social support, socio-economic status, health and abuse among older people in seven European countries. PLoSOne [internet]. 2013. [acesso 2019 jun 10]; 8(1):1-10. Disponível em: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054856.
http://journals.plos.org/plosone/article... . The Sabe study shows that, in relation to the diversity and frequency of contacts, single men and women are more likely to have less constancy in these contacts, and that the long-living women (75 years or more) are less likely to present great variety of contacts²⁵25 Rosa TEC, Benício MHDA, Alves MCGP, et al. Aspectos estruturais e funcionais do apoio social de idosos do Município de São Paulo, Brasil. Cad. Saúde Pública [internet]. 2007 [acesso 2018 out 27]; 23(12):2982-92. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007001200019&lng=en.
http://www.scielo.br/scielo.php?script=s... .

The act of fully trusting someone is positively emphasized, especially among those considered to be the most vulnerable, that is, with old age, lower schooling and income, with bad/very bad health ratings and who have three or more diseases. Other authors point out that, in the more advanced ages, the social network becomes narrower, focused on the family, and has a greater geographical proximity²³23 Iglesias HRF, Antonucci T. Convoys of social support in Mexico: examining socio-demographic variation. Int. J. Behav. Dev. [internet]. 2010 [acesso 2018 jun 18]; 40(4):324-333. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913785.
https://www.ncbi.nlm.nih.gov/pmc/article... . These elderly people tend to be more selective about time and emotional investments, resulting in a lower frequency of contacts, which are more restricted to relatives²³23 Iglesias HRF, Antonucci T. Convoys of social support in Mexico: examining socio-demographic variation. Int. J. Behav. Dev. [internet]. 2010 [acesso 2018 jun 18]; 40(4):324-333. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913785.
https://www.ncbi.nlm.nih.gov/pmc/article... ^,3535 Lins AES, Rosas C, Neri AL. Satisfação com as relações e apoios familiares segundo idosos cuidadores de idosos. Rev. Bras. Geriatr. Gerontol. [internet]. 2018 [acesso 2018 set 30]; 21(3):341-52. Disponível em: http://www.rbgg.com.br/arquivos/proximas-publicacoes/2017-0177.pdf.
http://www.rbgg.com.br/arquivos/proximas... . Long-lived individuals tend to be more isolated and less socially supported, as individuals under the age of 70 - mainly between 60 and 64 - require more support, and those aged 80 and over are prone to the reduction of social relations, as a consequence of health problems, functional limitations and retirements¹⁶16 Melchiorre MG, Chiatti C, Lamura GT, et al. Social support, socio-economic status, health and abuse among older people in seven European countries. PLoSOne [internet]. 2013. [acesso 2019 jun 10]; 8(1):1-10. Disponível em: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054856.
http://journals.plos.org/plosone/article... .

The filial responsibility is defined as social or cultural norms regarding the care for parents in the old age, and can be considered as individual attitude or belief, that is, there is the obligatoriness of the caring behavior²⁷27 Gutierrez LLP, Fernandes NRM, Mascarenhas M. Caracterização de cuidadores de idosos da região metropolitana de Porto Alegre (RS): perfil do cuidado. Saúde debate [internet]. 2017 [acesso 2018 out 27]; 41(114):885-98. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042017000300885&lng=en.
http://www.scielo.br/scielo.php?script=s... ^,3232 Pignatti MG, Barsaglini RA, Senna GD. Envelhecimento e rede de apoio social em território rural do Pantanal mato-grossense. Physis [internet]. 2011 [acesso 2018 jun 29]; 21(4):1469-1491. Disponível em: https://dx.doi.org/10.1590/S0103-73312011000400016.
https://dx.doi.org/10.1590/S0103-7331201... ^,3838 Aires M, Mocellin D, Fengler FL, et al. Associação entre responsabilidade filial no cuidado aos pais e sobrecarga dos cuidadores. Rev. Bras. Enferm. [internet]. 2017 [acesso 2018 jul 10]; 70(4):800-807. Disponível em: http://www.scielo.br/pdf/reben/v70n4/pt_0034-7167-reben-70-04-0767.pdf.
http://www.scielo.br/pdf/reben/v70n4/pt_... . Many dependent elders, due to some disease, do not have a formal care network and, under such conditions, the family is the main source of support and assistance⁴4 Witter C, Camilo ABR. Família e envelhecimento. In: Witter C, Buriti MA, organizadores. Envelhecimento e contingências de vida. Campinas: Alínea; 2011. p. 83-102.^,66 Guadalupe S, Cardoso J. As redes de suporte social informal como fontes de provisão social em Portugal: o caso da população idosa. Soc. Estado [internet]. 2018 [acesso 2018 jun 29]; 33(1):213-48. Disponível em: https://dx.doi.org/10.1590/s0102-699220183301009.
https://dx.doi.org/10.1590/s0102-6992201... ^,1111 Santos AS, Silveira RE, Farinelli MR. A dinâmica sociofamiliar do idoso. In: Campos ACV, Berlezi EM, Correa AHM, organizadores. Direitos do idoso: os novos desafios das políticas públicas. Ijuí: Unijuí; 2014. p. 123-45.^,2626 Fontes AP, Burgos ACGF, Mello DM, et al. Arranjos domiciliares, expectativa de cuidado, suporte social percebido e satisfação com as redes sociais. In: Neri AL, Guariento ME, organizadoras. Fragilidade, saúde e bem-estar em idosos: dados do estudo FIBRA. Campinas: Alínea; 2011. p. 55-73.^,3232 Pignatti MG, Barsaglini RA, Senna GD. Envelhecimento e rede de apoio social em território rural do Pantanal mato-grossense. Physis [internet]. 2011 [acesso 2018 jun 29]; 21(4):1469-1491. Disponível em: https://dx.doi.org/10.1590/S0103-73312011000400016.
https://dx.doi.org/10.1590/S0103-7331201... ^,3939 Rabelo DF, Neri Al. Arranjos domiciliares, condições de saúde física e psicológica dos idosos e sua satisfação com as relações familiares. Rev. Bras. Geriatr. Gerontol. [internet]. 2015 [acesso 2018 jun 29]; 18(3):507-519. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232015000300507&lng=en.
http://www.scielo.br/scielo.php?script=s... .

Social support is multivariate, and should be considered in health care as a whole, and not exclusively in relation to the disease, since even when very restricted in the life of the elderly, it has multiplier potential, favors integration and well-being⁵5 Guedes MBOG, Lima KC, Caldas CP, et al. Apoio social e o cuidado integral à saúde do idoso. Physis [internet]. 2017 [acesso 2018 jun 29]; 27(4):1185-204. Disponível em: https://www.scielosp.org/article/physis/2017.v27n4/1185-1204/pt.
https://www.scielosp.org/article/physis/... . In this sense, it is necessary for health professionals to recognize the family caregiver as the main provider of care and to involve them in their home care plans³¹31 Muniz EA, Freitas CASL, Oliveira EN, et al. Grau de sobrecarga dos cuidadores de idosos atendidos em domicílio pela Estratégia Saúde da Família. Saúde debate [internet]. 2016 [acesso 2018 out 27]; 40(110):172-82. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-11042016000300172&lng=pt&tlng=pt
http://www.scielo.br/scielo.php?script=s... .

The limitation of this study can be considered in the profile of the elderly, who, although they come from different regions, they present similar characteristics, which precludes greater statistical significance about perceived and received social support. In general terms, it can be said that the family has manifested itself as the main provider of care and social support. Socioeconomic vulnerability, old age, illnesses and disabilities, together or by themselves, can lead to a restriction of the support network of the elderly.

In old age, although there is a greater dependency on a network of backing and support, it tends to narrow down, limiting itself to the family nucleus. Consequently, it is important that there is support for family caregivers as well, and as a care strategy, it is suggested that caregiver groups be set up in the BHU, seeking to instrumentalize these individuals for the care of the elderly and for self-care. This is to prioritize and be attentive to the sickest, functionally compromised elderly, who live alone or live together with other elderly people, as well as older caregivers, with health problems already in place.

Conclusions

The study shows that the elderly people always expect to find, in their families, backing and support, when necessary, especially in their children, inside or outside home, having daughters or daughters-in-law as their primary caregivers, and wives are seen as potential caregivers. The most vulnerable elderly people show a positive evaluation of their social support networks.

There is a centrality in the family, which, often, does not provide sufficient or adequate care for the sick and disabled elderly, and it is suggested, thus, the need for guidance and support from the formal support network. There is no significance in the study for the backing and support of friends and neighbors in expectation of the care and support received, but it is known that the existence of a consistent network, composed of such persons, is important in the life of humans, instrumentally or materially, and, on many occasions, as emotional support in times of anguish and loneliness.

The continuation of research regarding support and social support in old age is suggested, and it is hoped that this study will, somehow, encourage the search for strategies and the implementation of programs of care and support for the elderly and their caregivers. The absence or precariousness of care for the elderly is strongly based on discussions of social rights and legal actions. In this sense, it is fundamental that there is a shared responsibility between the organs of the public power and the civil society, in order to move the effectiveness of the policies of care to the elderly, in a more comprehensive way and with more quality.

References

Publication Dates

History