Inglês (pdf)
Artigo em XML
Referências do artigo
Tradução automática
Permalink
INTRODUCTION
It is estimated that the world’s elderly population by 2050 will consist of 2 billion individuals, which represents 22% of the population aged 60 years or older1. In Brazil, according to the 2019 Population Census, the elderly represent 13.5% of the population, and projections indicate that this amount will jump to 24.5% in two and a half decades2. Thus, in a general overview, the Brazilian population in the year 2060 will reach more than 58 million people, where 32 million of these individuals will be elderly3.
In the state of Amazonas, the number of elderly people increased between 2005 and 2015, from 9.8% to 14.3%4. In Coari, a city located 363km from the capital of Manaus, the elderly represent 5.3% of the total population5; such a scenario makes us pay attention to care focused and conducted to this public in order to promote aging with quality of life and longevity6.
When it comes to longevity, it is important to understand the dynamic and progressive physiological and functional changes that are common to the elderly7.
The main habit adopted as a way to promote health and prevent diseases is the practice of physical activity. This is capable of providing much more than fitness and physical conditioning, but also the rescue of autonomy, mental and functional health, and, consequently, a greater sense of purpose in life8. The purpose of life is called the ability to perceive the direction of one’s own life. For9, the elderly who have a purpose in life are able to set goals for themselves, feel more motivated to live, and are usually active in the implementation of plans they set for themselves.
Facing the pandemic scenario caused by the coronavirus in 2020, which Cesar et al., (2021)10 determines 2020 as the first wave of COVID-19 with rates incidence of 2.23% and the second wave in March 2021 with higher peaks in mortality, lethality and incidence of the virus, many were the negative impacts caused to the elderly population mainly because they are part of the group with a high risk of infection and worsening disease symptoms; they had to stay away from social life to avoid the spread and infection of the disease, because of this they isolated themselves inside their homes often changing their own perception of health10 it is believed that these factors may also have impacted the purpose of life of this group.
In this study, we describe the presence of purpose in life in a group of elderly practitioners of physical activity before and during the COVID-19 pandemic in the city of Coari, inland Amazonas, Brazil.
METHODS
Study Location and Period
Is moment 1(M1) performed in the second semester of 2019 and moment 2 (M2) second semester of 2021, when covid 19 vaccination had already advanced in the city of Coari.
Study Population and Eligibility Criteria
The study population consisted of elderly people who live in the city of Coari in the interior of the state of Amazonas, aged 60 years or older, of both genders, and who practice group physical activity at least three times a week. Initially, the sample was composed of 66 elderly people, 3 of whom died during the pandemic, leaving only 63 elderly people. The inclusion and permanence criterion for the study required the practice of physical activity three times a week and frequency in the group measured by the physical educator.
The recruitment occurred in some specific locations in the city of Coari, such as sports squares, the elderly center, the airport road, and other places where the elderly performed the practice of guided physical exercise. To participate in the study, the elderly should have 1 hour and a half available for the application of the study protocol.
Data Collection
Sociodemographic characteristics were assessed, and questions were asked about the use of medications and self-perception of vision and hearing.
To assess well-being and life direction, we applied the life purpose questionnaire adapted for the Brazilian version of the Life Purpose Scale (LP) and used with the elderly in Brazil11. The scale has 10 items that contain 6 single-choice alternatives: totally agree (5); agree (4); partially agree (3); partially disagree (2); disagree (1); totally disagree (0). Each alternative is rated by the evaluation according to the degree of agreement with each statement. And to perform the final calculation, it is necessary to reverse the score negatively for questions (2, 3, 5, 6, and 10), and obtaining the final score is the result of the average of 10 questions (sum/10) that can vary from 1 to 5, with high scores representing higher levels of life purpose11.
Data Analysis
The collected data were tabulated in a spreadsheet in Excel 2020 software for further analysis, and each elderly received an identification code to ensure the confidentiality of the information. For sociodemographic characterization and information on medications, vision, and hearing, a descriptive analysis was performed using absolute and relative frequency. Then, data normality was tested using the Shapiro-Wilk test. For the comparative analysis of life purpose in M1 and M2, the Student’s t-test for paired samples and parametric data was used. The analyses were performed in the statistical software IBM/Stata MP version 14.0.
Ethical and Legal Aspects of the Research
The study was approved by the Research Ethics Committee of the Federal University of Amazonas - UFAM under the registration number CAEE: CAEE 08021419.2.0000.5020. All participants received information about the evaluation process of the study and consequently signed the Informed Consent Form (ICF) that guaranteed the confidentiality of the information collected.
RESULTS
The population studied consisted of 63 elderly people. Of these, there was a predominance of females born in the interior of Amazonas, retired, and living with a monthly income of up to one minimum wage, who are illiterate, born in the interior of Amazonas, and use two to four medications, the most used being antihypertensives. The other data are described in Table 1 below.
Table 1 Sociodemographic characteristics of elderly participants in the study, Coari/AM (n=63).
| Variables (n=63) | % | n |
|---|---|---|
| Age | ||
| 60 a 69 | 45,5 | 30 |
| 70 a 79 | 34,8 | 23 |
| 80 an 89 | 10,6 | 7 |
| Above 90 | 4,5 | 3 |
| Sex | ||
| Female | 71,2 | 47 |
| Male | 24,2 | 16 |
| Education | ||
| Illiterate | 31,8 | 21 |
| Primary School complete | 19,7 | 13 |
| Primary incomplete | 12,1 | 8 |
| High School Complete | 9,1 | 6 |
| High School Complete | 7,6 | 5 |
| High School incomplete | 6,1 | 4 |
| High School incomplete | 4,5 | 3 |
| Gymnasium Complete | 4,5 | 3 |
| Naturality | ||
| Amazonas interior | 92,4 | 61 |
| Amazonas capital | 1,5 | 1 |
| Outside Amazonas | 1,5 | 1 |
| Current Occupation | ||
| Retired | 74,2 | 49 |
| Self-employed | 10,6 | 7 |
| Housewife | 6,1 | 4 |
| Volunteer | 1,5 | 1 |
| Employee | 1,5 | 1 |
| Unemployed | 1,5 | 1 |
| Monthly rent | ||
| Less than a salary | 75,8 | 50 |
| One wage | 15,2 | 10 |
| Three minimum wages | 3,0 | 2 |
| Two minimum wages | 1,5 | 1 |
| Housing | ||
| Living with someone | 86,4 | 57 |
| Living alone | 7,6 | 5 |
| Did not answer | 1,5 | 1 |
| Lives with | ||
| Spouse | 37,9 | 25 |
| Son | 30,3 | 20 |
| Grandchild | 18,2 | 12 |
| Nobody | 12,1 | 8 |
| Nephew | 1,5 | 1 |
| Medication | ||
| Two to four medications | 51,5 | 34 |
| One medication | 21,2 | 14 |
| No medication | 18,2 | 12 |
| More than four medications | 4,5 | 3 |
| Uses tea | - | - |
| Medication class | ||
| Antihypertensive | ||
| Yes | 72,7 | 48 |
| No | 22,7 | 15 |
| Vitamin | ||
| No | 60,6 | 40 |
| Yes | 34,8 | 23 |
| For pain | ||
| No | 81,8 | 54 |
| Yes | 13,6 | 9 |
| View | ||
| Terrible | 36,4 | 24 |
| Regular | 34,8 | 23 |
| Good | 22,7 | 15 |
| Excellent | 1,5 | 1 |
| Hearing | ||
| Good | 47,0 | 31 |
| Regular | 28,8 | 19 |
| Excellent | 10,6 | 7 |
| Terrible | 9,0 | 6 |
Source: Dantas, 2023.
When analyzing the purpose of life of the elderly before the Covid-19 pandemic, 50.0% reported feeling good when thinking about the past and future and 30.3% completely disagreed that their daily life activities are banal and unimportant. And when evaluating the purpose of life of this population during the pandemic, 1.5% agreed that they feel good when they think about the past and future and 42.4% disagree that their daily life activities are banal and unimportant .The main findings about life purpose are described in table 2. During the Covid-19 pandemic, the elderly decreased their perception of life purpose, as described in table 3.
Table 2 : Life purpose characterization in elderly people practicing physical activity in the countryside of Amazonas in the city of Coari before and during the pandemic by Covid-19 (n=63).
| Variables | Before the pandemic | After the pandemic | ||||
|---|---|---|---|---|---|---|
| Life purpose | Response | % | n | Response | % | n |
| I feel good when I think about the past and the future | I agree | 50,0 | 33 | I agree | 1,5 | 1 |
| I live one day at a time | Disagree | 42,4 | 28 | Disagree | 0 | 0 |
| Focus on the Present | Disagree | 47,0 | 31 | Disagree | 9,1 | 6 |
| I have a sense of direction and purpose in life | Totally agree | 50,0 | 33 | Totally agree | 0 | 0 |
| Trivial and unimportant activities of daily living | Totally Disagree | 30,3 | 20 | Totally Disagree | 42,4 | 28 |
| No goals, waste of time | Totally Disagree | 33,3 | 22 | Totally Disagree | 36,4 | 24 |
| I make plans for the future | Totally agree | 56,1 | 37 | Totally agree | 0 | 0 |
| I am an active person | Totally agree | 51,5 | 34 | Totally agree | 0 | 0 |
| I have objectives | Totally agree | 43,9 | 29 | Totally agree | 0 | 0 |
| I feel like I’ve done everything in life | Totally Disagree | 39,4 | 26 | Totally Disagree | 16,7 | 11 |
Source: Dantas, 2023.
Table 3 : Comparative analysis of the life purpose of the elderly participants in the study before and during the pandemic.
| Variables | AP | IC95% | DP | IC | Value p |
|---|---|---|---|---|---|
| Life purpose (points - average) | 3,9 | 3,8 – 4,0 | 3,0 | 2,8 – 3,1 | <0.001 |
*AP: Before the pandemic; *IC: Confidence Interval; *DP: During the pandemic. Source: Dantas, 2023.
DISCUSSION
Most of the active elderly in this study are female, which corroborates the cross-sectional study12 conducted with 36 elderly women who practiced physical activity in the municipality of Coari, which was also composed of elderly women, illiterate and retired. The assiduous presence of elderly women in these studies occurs because women take more care of themselves and seek care for their health even with work overload13.
The elderly in this study are mostly retired, as seen in another study14, with a majority of elderly and retired women. For15, the elderly population is getting longer due to healthy living habits and staying active. These facts provide a considerable drop in the mortality rate, generating a potential challenge for the financial sustainability of society’s protection systems, which is retirement.
It is known that seniors who have a good socioeconomic status have a better life purpose and that it is closely linked to schooling and psychological well-being that helps to develop functional abilities to achieve personal goals and objectives, as well as autonomy and financial independence16was also observed in this group. Still in the study by Sanglard et al., (2023)17, it argues that a person can be considered healthy, even if they have a chronic illness, and that if they have good functional capacity and a good socioeconomic level they can carry out their activities independently and autonomously, always maintaining purposes.
As for the low schooling or illiteracy presented by most of the elderly in this study6. This data is due to the fact that education is not considered a priority for most of the elderly in the Amazon interior region who highlight work as a priority and indispensable for family income collection6.
Another important factor linked to education is the practice of physical activity mainly by literate women or those with some level of education, which makes them assiduous and regular in exercises, which differs from the findings of this study, considering that even the elderly with low education, this was not an obstacle to the realization of regular physical activity18.
The elderly in this study do not live alone, and this data is similar to the longitudinal study conducted in Brazil by19, where most of the retired elderly live with a family member. For19, the elderly who live with family members usually present disabilities resulting from difficulties in performing basic activities of daily living, making them dependent on the support and assistance of another person20.
Most of the elderly in this study mentioned using at least one medication, especially antihypertensive medications, as in another study20. Elderly, during the COVID-19 pandemic, redoubled their use of antihypertensive medications, this being the most common and high-risk comorbidity for the virus, thus developing a severe clinical picture of COVID-19 in the elderly with uncontrolled blood pressure22. Thus, the study by Sanglard et al., (2023)17 states that keeping the elderly active, socialized, inserted in the community and family are simple practices, but with great results in reducing vulnerability, consequently reducing functional decline, isolation, sedentary lifestyle and polypharmacy.
As for the regular to poor visual perception24, in his study with elderly individuals in Brazil observed that this is a common complaint. One of the most common difficulties presented by the elderly is seeing objects near or far away, or even the difficulty in reading25, which is due to the significant ocular alteration resulting from the aging process, thus favoring macular degeneration, leading to impairments in the quality of life of the elderly person26.
As for the hearing aspect, the elderly in this study pointed out to have good hearing. These data differ from those of24, where the hearing loss in the elderly is predominant, especially in those who live alone. However26 emphasizes that hearing is one of the changes that occur physiologically with age and that it reduces the social contact of the elderly, affecting self-esteem and causing social isolation.
The pandemic seems to have influenced how the elderly in this study evaluate the trajectory of their life purpose before and during the course of the disease; the isolation during the high contagion may have influenced this view. Life purpose functions as a psychological resource to cushion loneliness for the elderly, proving to be a strong ally during the COVID-19 pandemic and a major factor impacted by social isolation27.
The life purpose of the elderly was impacted by the pandemic by Covid-19 due to psychological disorders arising from changes in social and functional habits, thus causing loss of family income, social and health inequality, and especially the progression of psychosocial disorders common and pre-existing elderly, such as the feeling of loneliness and depression, sadness and social withdrawal from friends and family, thus generating demotivation, hopelessness, and low life expectancy and future days28. Sanglard (2023)17 understands that the quality of life of the elderly as well as the degree of clinical and functional vulnerability during the COVID-19 pandemic can be affected by the number of existing chronic diseases, as well as different contexts associated with social isolation.
Access to information regarding cases of death caused by the COVID-19 virus was also a factor that collaborated negatively in the way the elderly began to see the world because the fear of being infected by the virus brought with it various feelings of hopelessness, fear, sadness, and depression, impacting on their life projects28.
CONCLUSION
With this, it is evident that elderly people who practice physical activity who live in the interior of the state of Amazonas, are able to maintain the presence of purpose in life during the Covid-19 pandemic when they were subjected to reevaluation for the second time, and demonstrated that despite the weaknesses that were experienced during this period, the ability to establish future projects, achievable goals, life direction, self-esteem and motivation to live were not affected.
