Envelhecimento ativo e sua relação com a independência funcional

Abstract

This study's objective was to analyze the factors determining active aging and its relationship to functional independence. It was conducted with a hundred elderly individuals cared for in a Family Health Unit in João Pessoa, PB, Brazil. The Functional Independence Measure and a socio-demographic questionnaire were used to assess the elderly participants. Data were analyzed using the SPSS. According to the results, all the participants were functionally independent for the performance of the studied activities. Data also showed that functional independence promotes greater integration of elderly individuals within the community, through strengthening social and family bonds, friendship and leisure, factors considered to be determinants of an active aging process. Descriptors: Aging actively. Independence. Functionality. INTRODUCTION Aging is a dynamic and progressive process, characterized both by morphological, functional, and biochemical alterations and also by psychological alterations. These changes determine the progressive loss of the ability to adapt to the environment, causing greater vulnerability and a greater incidence of pathological processes that can lead to death. 1 One of the consequences of aging is the gradual decrease of one's functional capacity, which is progressive and increases with age. Hence, the most important adversities facing health associated with age are functional capacity and dependence. These lead to the restriction/loss of one's abilities or difficulty/inability in the performance of functions and daily living activities. Such difficulties are caused by physical and cognitive limitations, so that the health conditions of the elderly can be determined by various specific indicators, among them the presence of physical and cognitive deficits. 2-3 Functional capacity is defined as the maintenance of one's ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), necessary and sufficient for an independent and autonomous life. Being able to perform ADLs is something necessary for an elderly individual's survival, keeping the individual active in the management of his/her own health and self-care and in the performance of household chores. 4-5 Therefore, the study of functional capacity has become a key component to evaluating the health of elderly individuals and is usually directed to the analysis of their ability to perform certain routine activities. Hence, the health of elderly individuals is closely linked to their functional independence, which is measured through functional evaluations. 2-6 Brazil has attained the highest levels of elderly population ratios in the world context. However, being able to live longer is not always synonymous with living better. Aging may be associated with suffering, increased physical dependence, functional decline, social isolation, depression and a lack of productivity, among other negative factors. It is, however, possible to live with greater a quality of life through independence and autonomy, with good physical and mental health, so that the aging process is healthy and active. 7-8 Autonomy can be defined as the freedom to act independently and make decisions concerning one's own life. It can also be seen as the ability to perform activities without the help of others, in light of the fact that motor and cognitive conditions are required to perform certain tasks. However, autonomy and independence are not inter-dependent concepts, since an individual can be autonomous but not independent, as is the case with individuals with dementia. One can also be autonomous but not independent, as in the case of individuals with severe sequelae from cerebrovascular accidents but with no cognitive changes. In such a situation, the individual is autonomous in making decisions regarding his/her own life but is physically dependent of others. 2 In the search for a better quality of life, which would be a result of aging with independence and autonomy, of a healthy and active aging process, investments have been made to develop social and health programs focused on the preservation of the independence and autonomy of elderly individuals, essential goals not only for the government but for all sectors of society. An important strategy to accomplish such a challenge is the Family Health Program, developed in Family Health Units of the Brazilian Unified Health System (SUS). This program has been efficient to achieve specific measures of health promotion and disease prevention, caring for elderly individuals living in the community. 9-10 However, health workers have found elderly individuals with chronic health problems that lead to functional dependence at the various levels of healthcare delivery. When these conditions are identified belatedly, they hinder strategies that could reverse or at least minimize them. Therefore, it is important to conduct studies that enable the identification of factors that determine a healthier aging process through the implementation of health promotion and disease prevention. 5 When viewed from this perspective, the aging process becomes very complex and a relevant concern, justifying studies addressing the relationship between functional capacity and factors determining a healthy aging process. Hence, this study aims to find answers for existing questions concerning a potential relationship between active aging and functional independence. Based on the previous discussion, this study sought to analyze factors determining healthy aging, verifying the degree of functional independence of elderly individuals enrolled in a Primary Health Care Unit. It is based on the assumption that functional independence promotes greater integration of elderly individuals into the community through possessing the autonomy to perform daily living activities and strengthening social and family bonds, friendship and leisure, factors considered to be determinants of an active aging process. METHOD This study was conducted in the Nova Conquista Family Health Unit, located in the city of João Pessoa, PB, Brazil. The sample was a convenience sample and was composed of 100 elderly individuals; their ages ranged from 60 to 93 years old (M=68; SD=7.53), of both genders and varied educational levels. Inclusion criteria were being 60 years old or older, living in the community, and being cared for by the Family Health Program. An instrument recommended by the Brazilian Ministry of Health 11 , the Functional Independence Measure (FIM), was used to evaluate the functional capacity of elderly individuals. FIM is a test that quantifies the help one needs to perform a set of 18 tasks. It has items addressing the performance of elderly individuals, taking into account six theoretical dimensions: (1) self-care (e.g. eating, personal hygiene, bathing, getting dressed); (2) sphincter control; (3) transferences (ability to transfer from bed to chair and other places); (4) mobility; (5) communication (comprehension and verbalization of ideas); and (6) social cognition (related to social interaction). The tasks evaluated during application of the FIM were classified on a scale with seven degrees of dependence in which "1" refers to total dependence, while 2,3 and 4 refer to maximum, moderate and minimum assistance, respectively. Level 5 refers to supervision, stimulus or preparation, when the presence, control, suggestion, or encouragement of another is required, but there is no physical contact or when another person is needed to prepare the objects that will be used or help to put on an orthosis or prosthesis. Level 6 refers to modified independence in which activities require technical help, adaptation, prosthesis or orthosis, and/or when these are performance of activities requires excessive time. Finally, Level 7 refers to complete independence in which tasks are performed without technical help and within a reasonable time. A socio-demographic questionnaire was applied after the FIM was administered. It addressed the individuals' gender, age, level of education, religion, origin, living conditions, whom the individual lived with, physical activities, what type of physical activity, occupation and health condition. The participation of the elderly individuals was voluntary and complied with Resolution 196/96, Ministry of Health, National Council of Health/ National Committee of Ethics Research and was approved by the Ethics Research Committee from the Health Sciences Center at the Federal University of Paraíba, Brazil (protocol No. 0188\08). The instruments were individually applied at the participants' homes. All data collected were analyzed through descriptive statistics using SPSS version 15. RESULTS AND DISCUSSION The sample's demographic profile indicated that most participants were women (73%). A prevalence of women was also observed in other studies including elderly individuals in Family Health Units, revealing that the number of female elderly individuals in Brazil has been higher than that of men for a long time. This aspect may be explained by differentiated mortality observed between genders, something very apparent in the Brazilian population. 12-13 In terms of education, 40% of the individuals were illiterate and 48% reported incomplete primary school. This information seems to be coherent with what has been observed in other studies addressing the education of the elderly population in Brazil. According to these studies, access to education was much more difficult in the past, especially for women. These observations explain the large incidence of illiteracy or low levels of education among the elderly individuals addressed in this study. 12 A total of 79% of the participants reported some pathology; hypertension was the most frequently reported. Hypertension does not impair one's functional capacity or socio-family integration when properly treated. Note that 21% of the elderly individua