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      A saúde dos idosos brasileiros às vésperas do século XXI: problemas, projeções e alternativas Translated title: Health of the Brazilian elderly population on the eve of the 21st century: current problems, forecasts and alternatives

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          Abstract

          São analizadas as características atuais e as perspectivas dos processos de transição demográfica e epidemiológica no Brasil. Foram utilizados os resultados do censo demográfico de 1991 e 1996 e Pesquisa Nacional por Amostra de Domicílios (PNAD) de 1993 e 1995, de novas projeções populacionais, e de recentes estudos sobre o perfil socioeconômico e de saúde de idosos de três grandes capitais brasileiras. Embora se estime que a proporção de idosos deverá duplicar até 2050, alcançando 15% do total da população, doenças crônico-degenerativas e distúrbios mentais já têm determinado, atualmente, maciça utilização dos serviços de saúde. O desenvolvimento de doenças, incapacidades e dependência têm sido mais freqüentes dentre aqueles de baixa renda que, no entanto, não têm conseguido garantir a assistência social e de saúde que demandam. Ações preventivas devem ser coordenadas por unidades básicas de saúde, priorizando necessidades locais. É imprescindível o investimento imediato na saúde, educação e formação técnica dos jovens, nos programas de apoio aos familiares e na manutenção de idosos em atividades produtivas adequadas.

          Translated abstract

          Current characteristics and perspectives of Brazilian demographic and epidemiological transition processes are analyzed. Results from the 1991, 1993, 1995 and 1996 censuses, new population projections and recent studies on socioeconomic and health profiles of elderly people of S. Paulo, Rio de Janeiro and Belo Horizonte are discussed. In 1995, estimated life expectancy at birth in Brazil was already over 67 years. The number of individuals aged 60 years and older - in 1995, 8.3%, of the total population - is expected to duplicate and probably stabilize by the year 2050. Yet lacking coverage and quality, health services are already burdened with degenerative diseases and mental disorders, frequent out-patient appointments, high hospital bed occupation and high costs. Functional impairment and self-reported diseases are related to poverty among the elderly, for whom social and health support are not properly provided. Support from informal caregivers becomes more difficult due to impoverishment, family size reduction and youth migration. Institutionalization remains a poor approach as scarcity of beds and inadequacy of staff preclude its utilization. To minimize the impact of population aging on health services, it is proposed that effective programs covering the control of degenerative diseases and the prevention of their complications should be implemente - for the elderly population too. The importance of physical exercise, screening for neoplastic diseases, immunization, prevention of fractures caused by falls and early diagnosis of depression and dementia is emphasized. Actions must be coordinated by primary health care units, oriented towards local needs. It is essential to maintain the elderly in adequate, productive activities, invest in young people's education and health and in social and medical support programs for the caregivers.

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          Most cited references173

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          Aging, natural death, and the compression of morbidity.

          J Fries (1980)
          The average length of life has risen from 47 to 73 years in this century, but the maximum life span has not increased. Therefore, survival curves have assumed an ever more rectangular form. Eighty per cent of the years of life lost to nontraumatic, premature death have been eliminated, and most premature deaths are now due to the chronic diseases of the later years. Present data allow calculation of the ideal average life span, approximately 85 years. Chronic illness may presumably be postponed by changes in life style, and it has been shown that the physiologic and psychologic markers of aging may be modified. Thus, the average age at first infirmity can be raised, thereby making the morbidity curve more rectangular. Extension of adult vigor far into a fixed life span compresses the period of senescence near the end of life. Health-research strategies to improve the quality of life require careful study of the variability of the phenomena of aging and how they may be modified.
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            Preventing frail health.

            Frailty is a state of reduced physiologic reserve associated with increased susceptibility to disability. Reduced physiologic capacity in neurologic control, mechanical performance, and energy metabolism are the major components of frailty. Although disease is an important cause of frailty, there is sufficient epidemiologic and experimental evidence to conclude that frailty is also due to the additive effects of low-grade physiologic loss resulting from a sedentary lifestyle and more rapid loss due to acute insults (illness, injuries, major life events) that result in periods of limited activity and bedrest. The pathogenesis of frailty involves a complicated interaction of factors that block recovery from rapid physiologic loss. To some extent, frailty is preventable. Approaches to prevention include (1) the periodic monitoring of key physiologic indicators of frailty, (2) the prevention of physiologic loss and acute and subacute episodes of physiologic loss, (3) the prediction of episodes of physiologic loss and the reduction of frailty prior to the loss, and (4) the removal of obstacles to recovery once physiologic loss has occurred.
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              Perfil do idoso em área metropolitana na região sudeste do Brasil: resultados de inquérito domiciliar

              Trata-se de estudo multicêntrico visando levantar as necessidades de saúde da população de idosos residentes em zona urbana, conduzido em 6 países na América Latina e coordenado pela Organização Panamericana da Saúde. No Brasil, 1.602 idosos (60 anos e +) residentes no Distrito de São Paulo, participaram de inquérito domiciliar com questionário de avaliação funcional multidimensional - amostra populacional aleatória, em múltiplos estágios, estratificada por nível socioeconômico. Os resultados mostraram uma população bastante carente (70% tinha uma renda per capita de menos de 100 dólares por mês), vivendo predominantemente em domicílios multigeracionais (59% viviam com os filhos e/ou com netos), com alta prevalência de doenças crônicas (somente 14% referiu não ter nenhuma doença) e distúrbios psiquiátricos (27% foram considerados casos psiquiátricos), e com uma elevada proporção de pessoas com perda de autonomia (47% precisavam de ajuda para realizar pelo menos uma das atividades da vida diária). Os resultados são analisados tendo em vista as demandas futuras por serviços de saúde especializados e suporte social por parte da crescente população de idosos no Brasil.
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                Author and article information

                Journal
                rsp
                Revista de Saúde Pública
                Rev. Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo (São Paulo, SP, Brazil )
                0034-8910
                1518-8787
                April 1997
                : 31
                : 2
                : 184-200
                Affiliations
                [01] orgnameUniversidade Federal de Minas Gerais orgdiv1 Departamento de Clínica Médica da Faculdade de Medicina
                Article
                S0034-89101997000200014 S0034-8910(97)03100214
                10.1590/S0034-89101997000200014
                9497568
                1f316705-e52a-4a55-a184-ec08fc75def3

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 24 November 1995
                : 13 June 1996
                : 10 August 1996
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 75, Pages: 17
                Product

                SciELO Brazil

                Self URI: Texto completo somente em PDF (PT)
                Categories
                Atualização

                Saúde do idoso,Transição demográfica,Necessidades e demanda de serviços de saúde,Indicadores de morbi-mortalidade,Demographic transition,Aging health,Health services needs and demand,Indicators of morbidity and mortality

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