Fragilidade e condições de saúde de idosos ribeirinhos da Amazônia: indicadores epidemiológicos e aspectos subjetivos

Abstract

The purpose of this thesis was to understand the interactions between indicators of biological fragility and health conditions of the elderly in the Amazonian riverside context. To this end, we carried out an explanatory-correlational study with 108 elderly people in the region of the islands of the city of Cametá, Pará. Structurally, the thesis is organized in four empirical studies. The first study allowed understanding the particularities of the routines and the way of life of these elderly people, as well as the housing conditions of the riverside context. Despite the housing and sanitation conditions, most of the homes used private power generators, mixed water supplies and were not connected to the sewage system. In addition, they had a variety of consumer goods. Regarding the degree of satisfaction with in relation to the home environment, they denoted positive perceptions for all domains investigated. Added to these data, it was noticed that most of the elderly emphatically expressed attachment to the amazonian riverside context, pointing out the desire to stay in these places. In the second study, referring to the demographic and socioeconomic characteristics, the majority of the elderly were male, aged between 60 and 69 years, with brown skin color, married, with five or more children and with predominant coexistence in their households with spouses and descendants. The majority werw of individuals literate, with incomplete elementary education, with personal income up to a minimum wage and family between one to two minimum wages, retired and without formal work, owners of their own homes and exercising leadership in the family. There was still a predominance among those who did not receive assistance from government programs and elderly people with catholic religious practice. The third study presents and discusses the multidimensional aspects of health. In general, the data pointed to the predominance of elderly people who evaluated how their own health was regulated and in the lateral social comparison the predominance of those who considered their health was better. The majority reported an excellent level of social support, did not present polypathy, polypharmacy, or recent hospitalization. The main comorbidities reported were rheumatic diseases and ophthalmological problems, and most used few drugs. Regarding access to health services, most reported that if they needed to, they would be able to access. There was a predominance of elderly individuals with a previous history of smoking, without the alcoholic habit and with a positive perception about the food practice. They were mostly eutrophic, but presented a cardiovascular risk factor, were not indicative of sarcopenia and were mostly normotensive. In addition, they did not present cognitive impairment, indicative of depressive symptoms nor a recent history of falls. Regarding functional capacity, there was a predominance of those with excellent performance for IADL and BADL. In the fourth and last study, the biological fragility, operationalized by the phenotype proposed by Fried et al. (2001) and their associations with multidimensional indicators is discussed. The results indicate a low prevalence of this syndrome (9.3%), with the majority of the sample classified as non-fragile elderly (51.9%), in contrast to other studies with urban elders. The domain of the phenotype that most contributed to the determination of fragility was "exhaustion" (30.6%) and the main associated factors were: higher age range, family management, work, cardiovascular risk, cognitive decline, depressive symptoms, multiple comorbidities. Given the novelty of this thesis, the results show that the joint action between the biological, psychological, social, historical, ecological and cultural factors interact and influence each other, conferring a development and a low biological fragility condition among the surveyed elderly people. Finally, it is hoped that this evidence will motivate further research on development/aging in these contexts.