Margareth Guimarães Lima

Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study

OBJECTIVES To assess the impact of chronic disease and the number of diseases on the various aspects of health-related quality of life (HRQOL) among the elderly in São Paulo, Brazil. METHODS The SF-36 Health Survey was used to assess the impact of the most prevalent chronic diseases on HRQOL. A cross-sectional and population-based study was carried out with two-stage stratified cluster sampling. Data were obtained from a multicenter health survey administered through household interviews in several municipalities in the state of São Paulo. The study evaluated seven diseases--arthritis, back-pain, depression/anxiety, diabetes, hypertension, osteoporosis, and stroke--and their effects on quality of life. RESULTS Among the 1 958 elderly individuals (60 years of age or older), 13.6% reported not having any of the illnesses, whereas 45.7% presented three or more chronic conditions. The presence of any of the seven chronic illnesses studied had a significant effect on the scores of nearly all the SF-36 scales. HRQOL achieved lower scores when related to depression/anxiety, osteoporosis, and stroke. The higher the number of diseases, the greater the negative effect on the SF-36 dimensions. The presence of three or more diseases significantly affected HRQOL in all areas. The bodily pain, general health, and vitality scales were the most affected by diseases. CONCLUSIONS The study detected a high prevalence of chronic diseases among the elderly population and found that the degree of impact on HRQOL depends on the type of disease. The results highlight the importance of preventing and controlling chronic diseases in order to reduce the number of comorbidities and lessen their impact on HRQOL among the elderly.

Health related quality of life among the elderly: a population-based study using SF-36 survey

As life expectancy continues to rise, one of the greatest challenges of public health is to improve the quality of later years of life. The aim of this present study was to analyze the quality of life profile of the elderly across different demographic and socioeconomic factors. A cross-sectional study was carried out in two stages, involving 1,958 individuals aged 60 years or more. Health related quality of life (HRQOL) was assessed using the SF-36 questionnaire. The lowest scores were found among measures for vitality, mental health and general health and the highest among factors including social functioning and role limitations due to emotional and physical factors. HRQOL was found to be worse among women, in individuals at advanced ages, those who practiced evangelical religions and those with lower levels of income and schooling. The greatest differences in SF-36 scores between the categories were observed in functional capacity and physical factors. The results suggest that healthcare programs for the elderly should take into account the multi-dimensionality of health and social inequalities so that interventions can target the most affected elements of HRQOL as well as the most vulnerable subgroups of the population.

Health-related behavior and quality of life among the elderly: a population-based study

OBJECTIVE To assess the association between health-related behaviors and quality of life among the elderly. METHODS A population-based cross-sectional study was carried out including 1,958 elderly living in four areas in the state of São Paulo, southeastern Brazil, 2001/2002. Quality of life was assessed using the Medical Outcomes Study SF-36-Item Short Form Health Survey instrument. This instruments eight subscales and two components were the dependent variables. Independent variables were physical activity, weekly frequency of alcohol consumption and smoking. Multiple linear regression models were used to control for the effect of gender, age, schooling, work, area of residence and number of chronic conditions. RESULTS Physical activity was positively associated with the eight SF-36 subscales. The stronger associations were found for role-physical (β=11.9), physical functioning (β=11.3) and physical component. Elderly individuals who consumed alcohol at least once a week showed a better quality of life than those did not consume alcohol. Compared to non-smokers, smokers had a poorer quality of life for the mental component (β=-2.4). CONCLUSIONS The study results showed that physical activity, moderate alcohol consumption and no smoking are positively associated with a better quality of life in the elderly.

Fatores associados ao tabagismo em idosos: Inquérito de Saúde no Estado de São Paulo (ISA-SP)

This article reports on smoking prevalence and associated factors in the elderly, based on a population-based cross-sectional study with multi-stage sampling including 1,954 individuals 60 years or older living in four areas of Sao Paulo State, Brazil. Overall smoking prevalence was 12.2%, and higher rates were associated with male gender, age 60-69 years, not belonging to an Evangelical church, lower income, low body weight, lack of leisure-time physical activity, depression/anxiety, and hypertension. There was a high prevalence of smokers among individuals with a history of stroke, cancer, and chronic obstructive pulmonary disease. The results point to the need for effective interventions in healthcare services to promote smoking cessation among the elderly, since many are unable to stop on their own, even when they have tobacco-related illnesses. Special attention should be paid to individuals that depend on the National Health System, since smoking prevalence is higher in underprivileged socioeconomic groups.This article reports on smoking prevalence and associated factors in the elderly, based on a population-based cross-sectional study with multi-stage sampling including 1,954 individuals 60 years or older living in four areas of São Paulo State, Brazil. Overall smoking prevalence was 12.2%, and higher rates were associated with male gender, age 60-69 years, not belonging to an Evangelical church, lower income, low body weight, lack of leisure-time physical activity, depression/anxiety, and hypertension. There was a high prevalence of smokers among individuals with a history of stroke, cancer, and chronic obstructive pulmonary disease. The results point to the need for effective interventions in healthcare services to promote smoking cessation among the elderly, since many are unable to stop on their own, even when they have tobacco-related illnesses. Special attention should be paid to individuals that depend on the National Health System, since smoking prevalence is higher in underprivileged socioeconomic groups.

Sleep duration pattern and chronic diseases in Brazilian adults (ISACAMP, 2008/09)

OBJECTIVE The aim of the present study was to assess sleep patterns in the adult population of the city of Campinas (Brazil) according to socioeconomic/demographic variables, chronic diseases, and symptoms. METHODS A population-based cross-sectional study was conducted using data from the Campinas Health Survey (ISACAMP) carried out in 2008 and 2009. A total of 2637 individuals aged 18 years or older (obtained from a probabilistic sample) were analyzed. Associations between sleep pattern and the independent variables were determined using the chi-square test. Multinomial logistic regression models were used to adjust for confounders. RESULTS The prevalence of six or fewer hours of sleep was greater among individuals aged 40 years or older and among divorced or single individuals. The sleep pattern of nine or more hours was more prevalent among those with less than 40 years of age, among those who were divorced, or single, among those with a lower level of schooling, those who did not work and housewives. Both short and long sleep patterns were more prevalent among individuals with heart disease, vascular problems, rheumatism/arthritis/arthrosis, osteoporosis, or emotional problems. The prevalence of the short sleep duration was greater among individuals with back problems and those with three or more health conditions. A strong association was found between sleep duration and sleep quality. CONCLUSIONS Socio-demographic factors and health diseases were associated to sleep duration. This issue should be considered in health promotion strategies.

Social inequalities in health among the elderly

The aim of the present study was to assess social inequalities in health status, health behavior and the use of health services based on education level. A population-based cross-sectional study was carried out involving 1,518 elderly residents of Campinas, São Paulo State, Brazil. Significant demographic and social differences were found between schooling strata. Elderly individuals with a higher degree of schooling are in greater proportion alcohol drinkers, physically active, have healthier diets and a lower prevalence of hypertension, diabetes, dizziness, headaches, back pain, visual impairment and denture use, and better self-rated health. But, there were no differences in the use of health services in the previous two weeks, in hospitalizations or surgeries in the previous year, nor in medicine intake over the previous three days. Among elderly people with hypertension and diabetes, there were no differences in the regular use of health services and medication. The results demonstrate social inequalities in different health indicators, along with equity in access to some health service components.

Sentimento de felicidade em idosos: uma abordagem epidemiológica, ISA-Camp 2008

O objetivo foi detectar fatores associados a felicidade na populacao idosa. O estudo e do tipo transversal, de base populacional, com dados de 1.431 idosos do ISA-Camp 2008. A amostragem foi probabilistica, por conglomerado e em dois estagios. Foram estimadas as prevalencias do sentimento de felicidade por todo o tempo, segundo variaveis sociais, demograficas, de comportamentos e condicoes de saude. Os idosos que se sentem felizes por maior tempo sao os casados, os que trabalham, sao ativos ou insuficientemente ativos no lazer, ingerem bebida alcoolica ocasionalmente, consomem frutas, legumes e verduras todos os dias, nao sao obesos, apresentam um tempo de sono < 10 horas e dormem bem. As maiores prevalencias do maior tempo de felicidade estao nos idosos que nao apresentam doencas, que avaliam melhor a propria saude e apresentam menos incapacidades. O sentimento de felicidade relaciona-se fortemente com varios indicadores de saude, sugerindo a adequacao do uso complementar do indicador para a avaliacao de programas de promocao da saude de idosos.The objective was to identify factors associated with happiness in the elderly. A cross-sectional, population-based study was conducted in 1,431 elderly under the ISA-Camp 2008 project. The survey used a two-stage probabilistic cluster sample. Prevalence of happiness was measured over time according to socio-demographics variables, health behaviors, and health conditions. High prevalence of happiness was associated with: marital status (married), active working, activity and insufficient leisure-time activity, occasional consumption of alcoholic beverages, daily consumption of fruit, vegetables, and leafy vegetables, normal body mass index, and sleeping less than 10 hours/night and sleeping well. The highest prevalence of long-term happiness was observed among elderly with no reported illness, with better self-rated health, and with less disability. Happiness was strongly related to health indicators, suggesting the adequacy of complementary use of this indicator for evaluating health promotion programs in the elderly.

Social inequalities in health behaviors among Brazilian adults: National Health Survey, 2013

BackgroundConsidering the high socioeconomic inequalities prevailing in Brazil and lifestyle as a strong determinant of morbidity and premature mortality, our purpose was to evaluate the degree of socioeconomic disparities in the prevalence of health behaviors among Brazilian adult population using data from the 2013 Brazilian National Health Survey.MethodBased on a sample of 49,025 individuals aged 20 to 59 years, we estimated the prevalence of several health behaviors and a score of unhealthy behaviors according to gender, education, race/color and possession of private health insurance. The prevalence ratios adjusted by age and gender were estimated by means of multiple Poisson regression and the analyses took into account the sampling design.ResultsSignificant social inequalities were identified in the Brazilian adults. Higher prevalence of current smoking, leisure-time physical inactivity, sedentary lifestyle, whole milk consumption and low ingestion of greens, vegetables, and fruits were observed among the less educated, in the non-white population, and among those without private health insurance. Higher prevalence of heavy episodic drinking was found in the non-white population, but no difference in the consumption of fatty meat was found according to skin color. Score of unhealthy behavior higher than 6 was more frequent in lower educational strata (PR = 3.74) in the non-white population (PR = 1.39) and among those without private health insurance (PR = 1.78). Compared to women, men had higher prevalence rates of smoking, hazardous alcohol consumption, and fatty meat consumption and lower consumption of greens, vegetables and fruits.ConclusionThe results of the study emphasize the importance of monitoring social inequalities in health as part of national health policies and the urgent need to prioritize actions to promote healthy behaviors, especially among the most socially vulnerable segments of society.

Sleep duration and health status self-assessment (SF-36) in the elderly: a population-based study (ISA-Camp 2008)

The aim of this study was to determine the association between sleep duration and health status among the elderly. A population-based study was carried out with 1,418 elderly individuals using data from the health survey of Campinas, São Paulo State, Brazil (ISA-Camp 2008). Linear regression models were used to determine associations between the physical and mental components and subscales of the SF-36 and sleep duration. Elderly male individuals who slept ≤ 6 hours obtained lower mean SF-36 scores for the vitality and mental health scales and the mental component summary than those who slept for seven to eight hours. All scales were negatively associated with sleep duration ≥ 10 hours, except bodily pain. Scores for the mental health, vitality and role-emotional subscales were lower among women who slept for less than five hours. Mental health was negatively associated with ≥ 10 hours of sleep. Sleep deprivation and excessive sleep were associated with poorer health status, with differences between genders, principally in the long duration sleep categories.

Comportamentos relacionados a saúde e qualidade de vida em idosos: um estudo de base populacional

OBJECTIVE To assess the association between health-related behaviors and quality of life among the elderly. METHODS A population-based cross-sectional study was carried out including 1,958 elderly living in four areas in the state of São Paulo, southeastern Brazil, 2001/2002. Quality of life was assessed using the Medical Outcomes Study SF-36-Item Short Form Health Survey instrument. This instruments eight subscales and two components were the dependent variables. Independent variables were physical activity, weekly frequency of alcohol consumption and smoking. Multiple linear regression models were used to control for the effect of gender, age, schooling, work, area of residence and number of chronic conditions. RESULTS Physical activity was positively associated with the eight SF-36 subscales. The stronger associations were found for role-physical (β=11.9), physical functioning (β=11.3) and physical component. Elderly individuals who consumed alcohol at least once a week showed a better quality of life than those did not consume alcohol. Compared to non-smokers, smokers had a poorer quality of life for the mental component (β=-2.4). CONCLUSIONS The study results showed that physical activity, moderate alcohol consumption and no smoking are positively associated with a better quality of life in the elderly.