Socioeconomic Vulnerabilities and Population Aging in Brazil: a Longitudinal Study

Silva C.B., Maciel L.C., Pereira B.C., Pessanha J.M., Reis T.B.

A falta de conhecimento financeiro aliada ao baixo nível de escolaridade pode comprometer a compreensão dos aspectos relacionados à gestão financeira e aos riscos envolvidos nas transações econômicas. Muitos idosos encontram-se em situações de vulnerabilidade financeira, com dificuldades em equilibrar suas despesas e receitas, o que os leva a recorrer a empréstimos como forma de suprir suas necessidades básicas ou lidar com imprevistos. O objetivo geral deste trabalho é analisar a relação entre a falta de conhecimento financeiro e o endividamento na terceira idade. Para o alcance deste objetivo foram coletados dados e informações, através de um formulário aplicado aos aposentados do INSS de São João da Barra - RJ, a fim de analisar e compreender os principais motivos do endividamento na terceira idade e o processo decisório dos idosos enquanto consumidores. Os resultados revelaram a existência de uma correlação entre a falta de conhecimento financeiro, a baixa escolaridade e o endividamento desmedido na terceira idade, com possíveis impactos na segurança e saúde destes indivíduos.

Silva B.D., Silveira L.D., Saliba N.A., Moimaz S.A., Saliba T.A.

Ao longo das décadas, as taxas de natalidade e mortalidade diminuíram, alterando a estrutura etária. O estudo objetiva avaliar as implicações sociais e de saúde desse fenômeno, utilizando dados demográficos do IBGE. Entre 1980 e 2022, a proporção de idosos aumentou significativamente, enquanto a de crianças diminuiu. O envelhecimento, associado a avanços médicos, impacta a dinâmica populacional, demandando estruturas sociais sólidas para atender às demandas dessa nova realidade. Ressalta-se a importância de considerar a heterogeneidade da população idosa e destaca-se o papel do governo na garantia de uma assistência integral a essa crescente parcela da sociedade. A análise abordou disparidades regionais, indicando a necessidade de políticas específicas. Apesar dos avanços, persistem lacunas na compreensão da diversidade da população idosa e na eficácia das estratégias governamentais.

Dias M.D., Sampaio S.M., Noriller R.M., Correa A.D., Silva J.P.

A distribuição desigual de renda é característica da desigualdade econômica, que sofre influências de fatores históricos, sociais e também pela falta de investimentos em políticas públicas. O presente trabalho teve como objetivo identificar se as desigualdades de renda entre os grupos formados por gênero, raça e idade foram acentuadas, no período compreendido entre 2012 e 2022. Foi realizada uma pesquisa bibliográfica sobre desigualdade de renda no Brasil, e um levantamento de dados no Instituto Brasileiro de Geografia e Estatística, tomando por base dados da Pesquisa Nacional por Amostra de Domicílios (PNAD) e PNAD Contínua. Por meio de uma análise estatística descritiva, os resultados indicaram uma relação positiva e significativa a 1,0% entre a variável dependente, Índice de Gini, e as variáveis idade, gênero e raça, em que o maior rendimento foi verificado no gênero masculino, de raça branca e de maior idade.

Vieira K.M., Matheis T.K., Rosenblum T.O.

ABSTRACT This article aims to assess the perception of financial preparation for retirement in the non-retired Brazilian population. Also, it seeks to identify how socioeconomic, demographic, and behavioral variables influence financial preparation for retirement. This study advances by using a multidimensional measure of financial preparation for retirement in a comprehensive sample of Brazilians, bringing significant contributions to the implementation of new public policies for the most vulnerable groups. Identifying the level of financial preparation for retirement and the most vulnerable groups is key for a better understanding of the impact of social security and retirement on the lives of Brazilian citizens. In the Brazilian context, the Financial Preparation for Retirement Scale (FPRS) makes it possible to assess the public policies designed and it serves as a parameter for them to be reformulated, with a view to improving financial preparation for retirement in the most vulnerable groups. This is a survey, with 2,920 respondents from all Brazilian regions. The analysis techniques consisted in descriptive statistics, association test, and multiple regression analysis. Most Brazilians show low or very low financial preparation for retirement. It has been identified that 3 out of 4 Brazilians stop to think about how much they would need to save for their retirement. Despite being able to carry out some financial planning for retirement, most Brazilians cannot have good future expectations and savings behavior. Women, young people, divorced/separated persons, black persons, individuals with up to complete elementary education, borrowed housing, unemployed, with a gross monthly family income of up to R$ 1,100.00 and having 4 or more dependent persons constitute the profile of citizens less capable of dealing with financial preparation for retirement.

Palmeira N.C., Moro J.P., Getulino F.D., Vieira Y.P., Soares Junior A.D., Saes M.D.

RESUMO Objetivo: descrever o acesso e a utilização de serviços de saúde na população brasileira segundo características sociodemográficas, de acordo com a Pesquisa Nacional de Saúde (PNS) 2019. Métodos: estudo descritivo transversal, a partir de amostra da PNS; foram calculadas as prevalências e respectivos intervalos de confiança dos dados, estratificados por sexo, escolaridade, idade e macrorregião nacional de residência; os dados foram analisados utilizando-se o software Stata versão 16.1. Resultados: foram entrevistados 293.725 indivíduos; os do sexo masculino apresentaram menores proporções de consulta médica (66,6%) e de procura por atendimentos de saúde (17,6%); entre aqueles residentes na região Norte, 69,1% realizaram consulta médica; 16,5% dos indivíduos menos escolarizados obtiveram medicamentos pelo Programa Farmácia Popular. Conclusão: os resultados reforçam as iniquidades no acesso e na utilização dos serviços de saúde, além da necessidade de monitoração dos indicadores, para orientar políticas de saúde no Brasil.

Lima-Costa M.F., de Melo Mambrini J.V., Bof de Andrade F., de Souza P.R., de Vasconcellos M.T., Neri A.L., Castro-Costa E., Macinko J., de Oliveira C.

LaFave S.E., Suen J.J., Seau Q., Bergman A., Fisher M.C., Thorpe R.J., Szanton S.L.

We reviewed research that examines racism as an independent variable and one or more health outcomes as dependent variables in Black American adults aged 50 years and older in the USA. Of the 43 studies we reviewed, most measured perceived interpersonal racism, perceived institutional racism, or residential segregation. The only two measures of structural racism were birth and residence in a “Jim Crow state.” Fourteen studies found associations between racism and mental health outcomes, five with cardiovascular outcomes, seven with cognition, two with physical function, two with telomere length, and five with general health/other health outcomes. Ten studies found no significant associations in older Black adults. All but six of the studies were cross-sectional. Research to understand the extent of structural and multilevel racism as a social determinant of health and the impact on older adults specifically is needed. Improved measurement tools could help address this gap in science.

Souza K.O., Fracolli L.A., Ribeiro C.J., Menezes A.F., Silva G.M., Santos A.D.

ABSTRACT Objective: To analyze the association between quality of basic health care and social vulnerability in municipalities of the Brazilian northeast. Method: Ecological study with spatial analysis using univariate global and local Moran’s indexes. Bivariate analyses were employed to examine the relationship between the quality of basic health care and the Social Vulnerability Index in the Northeast. The dependent variable corresponded to the final scores of certifications of teams of basic health care in the Northeast that had participated in the third cycle of the Brazilian Program for the Improvement of Access and Quality of Basic Health Care. The independent variable was the Social Vulnerability Index of the municipality. Results: The bivariate analysis has pointed out the presence of areas of low vulnerability with high quality basic health care in the municipalities in the states of Piauí, Ceará, Rio Grande do Norte, Pernambuco, and Bahia. The state of Maranhão is emphasized for its low performance in basic health care in a large number of municipalities with high vulnerability. Conclusion: The study has revealed a spatial relation between the indicators of social vulnerability and quality of basic health care in the Northeast, suggesting that limitations in access to health resources and services may be related to social and health determinants.

Bellio E., Buccoliero L.

PurposeDelivering patient-centered healthcare is now seen as one of the basic requirements of good quality care. In this research, the impact of the perceived quality of three experiential dimensions (Physical Environment, Empowerment and Dignity and Patient–Doctor Relationship) on patient's Experiential Satisfaction is assessed.Design/methodology/approach259 structured interviews were performed with patients in private and public hospitals across Italy. The research methodology is based in testing mediation and moderation effects of the selected variables.FindingsThe study shows that: perceived quality of Physical Environment has a positive impact on patient's Experiential Satisfaction; perceived quality of Empowerment and Dignity and perceived quality of Patient–Doctor Relationship mediate this relationship reinforcing the role of Physical Environment on Experiential Satisfaction; educational level is a moderator in the relationship between perceived quality of Patient–Doctor Relationship and overall Satisfaction: more educated patients pay more attention to relational items. Subjective Health Frailty is a moderator in all the tested relationships with Experiential Satisfaction: patients who perceive their health as frail are more reactive to the quality of the above-mentioned variables.Originality/valuePhysical Environment items are enablers of both Empowerment and Dignity and Patient–Doctor Relationship and these variables must be addressed all together in order to improve the value proposition provided to patients. Designing a hospital, beyond technical requirements that modern medicine demands and functional relationships between different medical departments, means dealing with issues like the anxiety of the patient, the stressful working environment for the hospital staff and the need to build a sustainable and healing building.

Rothermund K., Klusmann V., Zacher H.

Abstract Age discrimination can undermine older people’s motivation to stay engaged with their lives and poses a major challenge to healthy aging. In this article, we review research on age discrimination in different life domains, including health and work. Motivation and health constitute potential antecedents as well as outcomes of age discrimination, with reduced motivation and impaired health increasing the likelihood of becoming a victim of age discrimination, but also resulting from age discrimination. Furthermore, high levels of motivation and health can also serve as buffers against the negative effects of age discrimination. Based on our literature review, we discuss possible strategies aimed at reducing age discrimination. Understanding and combating age discrimination can foster older people’s motivation to participate in meaningful activities and promote healthy aging.

Schenkman S., Bousquat A.

Health equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems. Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks. Both methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV. The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.

De Araújo P.O., Guimarães Silva Freitas M.Y., Carvalho E.S., Peixoto T.M., Silva Servo M.L., Santana L.D., Dos Santos Silva J.M., Vieira Moura J.C.

This article presents a systematized reflection and discussion around two guiding axes: the first discusses aging and vulnerabilities to biological, physical, cognitive, social and affective losses that require specific attention, as well as vulnerabilities to COVID-19 to which institutionalized elderly people are exposed; the second, we reflect on the adoption of restrictive and protective measures to prevent the spread of the virus, aiming to keep the elder health and mitigate the effects of the pandemic. The conclusion is that the pandemic has increased the many vulnerabilities to which institutionalized older people were already exposed, adding vulnerability to a new disease, such as COVID-19, due to its high lethality and comorbidity, aggravated by precariousness of long-term Brazilian institutions due to the negligence of public authorities, civil society, the management of the institution and the families of the patients. The post-pandemic scenario will require collective efforts to protect and ensure the survival of the elderly living in those residences.

Figueira O., Figueira H., Soleiman Franco R., Marcellini P.S., Sganzerla A., Corradi Perini C.

Quality of Life (QOL) is essential for healthy aging and through the WHOQOL-Old, it is possible to analyze factors that increase vulnerability and reduce QOL. Aligned with healthy aging is Potter's global bioethics proposing expanded ethics and social justice.To analyze the QOL of Brazilian elderly from the perspective of Potteŕs global bioethics.Analytical observational research with a quantitative approach composed of 280 Brazilian, aged 60 or over, of both gender, volunteers, who answered the WHOQOL-Old online.Global score of 77.9%, with the mean ± standard deviation: Functioning of the senses 86% (17.22 ± 2.80); Autonomy 78.5% (15.7 ± 2.60); Past, present, and future activities 77.3% (15.46 ± 2.34); Social participation 74.9% (14.99 ± 2.62); Death and dying 71.6% (14.33 ± 3.88) and Intimacy 79.1% (15.82 ± 2.82).Elderly perceived their QOL positively. In the quest to promote healthy aging, it is necessary to broaden the vision for social justice proposed by Potteŕs global bioethics.

Bezerra É.C., Santos P.S., Lisbinski F.C., Dias L.C.

Resumo Uma das preocupações ligadas à pandemia da COVID-19 se refere à capacidade da estrutura do sistema de saúde suportar a demanda por atendimento e tratamento de pessoas acometidas por esta doença. Diante disso, o objetivo deste estudo consiste em criar e mapear o Índice de Infraestrutura de Saúde (IIS) das Unidades da Federação (UFs) brasileiras, bem como verificar a sua distribuição espacial. Para isso, foi aplicada a metodologia de Análise Fatorial por Componentes Principais. Aplicou-se os testes de Bartlett e Kaiser-Meyer-Olkin para verificação da sua adequabilidade. Em seguida procedeu-se a Análise Exploratória de Dados Espaciais. Os dados foram coletados no DATASUS, COFEN, Ministério da Saúde, Portal de Compras do Governo e Portal da Transparência. Quanto aos resultados, o índice revelou que nove estados do Norte e Nordeste registraram os menores índices e cinco estados do Sudeste e Sul apresentaram os maiores índices. Foi registrado um cluster baixo-baixo nos estados do Amazonas e Pará e um Cluster alto-alto em Minas Gerais, Rio de Janeiro, São Paulo e Paraná.