Discrimination perceived by elderly adults in the use of health services: an integrative review Luciana de Souza Braga, Camila Teixeira Vaz, Danielle Nunes Moura Silva, Elaine Leandro Machado, Amélia Augusta de Lima Friche Ciencia E Saude Coletiva, 2023 Resumo Este trabalho analisa as evidências atuais sobre a discriminação percebida por adultos mais velhos (> 50 anos) no uso de serviços de saúde e identifica os fatores associados a essa experiência. Trata-se de uma revisão integrativa da literatura, realizada a partir de pesquisa nos sítios eletrônicos Biblioteca Virtual de Saúde, CINAHL, Medline, Scopus e Web of Science, em junho de 2021. Foram utilizados os descritores: discriminação social ou ageismo; pessoa de meia-idade ou idoso de 80 anos ou mais ou idoso; e serviço de saúde ou serviço de saúde para idosos, incluindo sinônimos, nos idiomas português, inglês e espanhol. A estratégia de busca identificou 1.165 artigos; 19 cumpriram os critérios de elegibilidade e inclusão. O acervo inclui estudos quantitativos e qualitativos publicados entre 2002 e 2021; cerca de 60% realizados nos Estados Unidos e Austrália. A prevalência de discriminação no uso de serviços de saúde variou de 2% a 42%. O relato de práticas discriminatórias se mostrou associado a características étnico-raciais, sexo, idade, orientação sexual, aparência física e classe social. Ao dar visibilidade ao tema, este trabalho visa estimular a definição de formas concretas de enfrentamento à discriminação e interromper a perpetração de iniquidades no âmbito da atenção à saúde.
A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil Luciana de Souza Braga, Bruno de Souza Moreira, Juliana Lustosa Torres, Amanda Cristina de Souza Andrade, Anna Carolina Lustosa Lima, et al. Cadernos De Saude Publica, 2023 This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.
Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities Marianela Castillo-Riquelme, Goro Yamada, Ana V. Diez Roux, Tania Alfaro, Sandra Flores-Alvarado, et al. BMC Public Health, 2022 Background Understanding how urban environments influence people’s health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations. Objectives To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association. Methods Cross-sectional analyses of 71,541 adults aged 25–97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators. Results Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73–0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25–65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25–65) and SRH in men and women, with SEI the interaction was less clear. Conclusions Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging.
Prevalence of urinary incontinence, impact on quality of life and associated factors in users of Primary Health Care Units Camila Amâncio Alves, Denise Cristina Cardoso Ferreira, Marina Ferreira de Lima, Karoline Amaral Coimbra, Camila Teixeira Vaz Fisioterapia Em Movimento, 2022 Resumo Introdução: A incontinência urinária (IU) causa considerável impacto negativo na qualidade de vida, ocasionando prejuízo psicossocial, emocional e higiênico, além de alto custo para o sistema de saúde e limitações nas atividades de vida diária. Objetivo: Descrever a proporção de mulheres com IU e o seu impacto na qualidade de vida, bem como investigar os fatores associados a essa condição de saúde entre usuárias de Unidades de Atenção Primária à Saúde (UAPS) do município de Governador Valadares, MG. Métodos: Estudo transversal realizado entre mulheres usuárias de UAPS do município. Um questionário elaborado pelas pesquisadoras foi utilizado para coleta de dados. As participantes que relataram queixa de perda urinária em qualquer situação responderam ao International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Resultados: Participaram do estudo 201 mulheres. A proporção de mulheres com incontinência urinária foi de 36,32% e entre essas o escore do ICIQ-SF teve mediana igual a 7 pontos, indicando impacto moderado na qualidade de vida. A incontinência urinária associou-se à idade, renda, índice de massa corporal e paridade. Conclusão: A proporção de mulheres com IU está de acordo com a prevalência descrita pela International Continence Society (ICS), impactando moderadamente na qualidade de vida, o que indica uma normalização do problema. Ademais, a IU esteve associada à idade, renda, IMC e número de gestações. Assim, estratégias de educação em saúde para esse grupo são necessárias, a fim de prevenir e tratar a IU nas UAPS, bem como ações intersetoriais para melhorar a renda da população, no sentido de controlar os fatores de risco que são modificáveis.
Loneliness and social disconnectedness in the time of pandemic period among Brazilians: evidence from the ELSI COVID-19 initiative Juliana Lustosa Torres, Luciana de Souza Braga, Bruno de Souza Moreira, Camila Menezes Sabino Castro, Camila Teixeira Vaz, et al. Aging and Mental Health, 2022 Objectives: This study aimed at estimating the pre-pandemic and pandemic prevalence of loneliness and investigating the association of loneliness with social disconnectedness during social distancing strategies in the time of the COVID-19 pandemic period. Methods: We used data from the ELSI COVID-19 initiative with participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which comprised 4,431 participants aged 50 years and over. Loneliness (hardly ever/some of the time/often) was assessed by the question “In the past 30 days, how often did you feel alone/lonely?”. Social disconnectedness included information on social contacts through virtual talking (i.e. telephone, Skype, WhatsApp, or social media) and outside-home meetings with people living in another household. Covariates included sociodemographic and health related characteristics. Multinomial logistic regression models were used to estimate odds ratios (OR) with their 95% confidence interval (CI). Results: The overall prevalence of loneliness during the pandemic was 23.9% (95% CI 20.7-27.5); lower than in the pre-pandemic period (32.8%; 95% CI 28.6-37.4). In the pandemic period, 20.1% (95% CI 16.9-23.6) reported some of the time feeling lonely and 3.9% (95% CI 3.1-4.8) reported often feeling lonely. In the fully adjusted model, virtual talking disconnectedness (OR=1.67; 95% CI 1.09-2.56) was positively associated with some of the time feeling lonely and outside-home disconnectedness (OR=0.33; 95% CI 0.18-0.60) was negatively associated with often feeling lonely. Conclusion: Individuals with virtual talking disconnectedness and without outside-home disconnectedness are at higher risk of loneliness during the time of COVID-19 pandemic. Stimulating virtual talking connectedness might have the potential to diminish loneliness despite steep outside-home disconnectedness.
A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil Luciana de Souza Braga, Bruno de Souza Moreira, Juliana Lustosa Torres, Amanda Cristina de Souza Andrade, Anna Carolina Lustosa Lima, et al. Cadernos De Saude Publica, 2022 This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.
Life expectancy and mortality in 363 cities of Latin America Usama Bilal, Philipp Hessel, Carolina Perez-Ferrer, Yvonne L. Michael, Tania Alfaro, et al. Nature Medicine, 2021 The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.
The results of a 24-h pad test in Brazilian women Elyonara Mello Figueiredo, Raquel Gontijo, Camila Teixeira Vaz, Elza Baracho, Andrea Moura Rodrigues Maciel da Fonseca, et al. International Urogynecology Journal, 2012
