Study shows inequality in the health of the elderly – 04/25/2023 – Health

Elderly aged 80 or over, with higher income, report having better health than those who are poorer, ten to 15 years younger. In the first group, an average of 52% rated their health status as good or very good. In the second, between 65 and 69 years old, this rate varied between 35% and 40%.

The finding comes from a new study by Ieps (Institute of Studies for Health Policies), which analyzed the impact of population aging on the public health system and on society in general based on data from the PNAD (National Household Sample Survey). and the PNS (National Health Survey), among others.

Inequalities are also evident in access to health services. People aged 60 to 64 with higher incomes were more likely to have had a medical appointment in the last year compared to those aged 80 and over with lower incomes, according to the study.

“If the elderly person has a femur fracture, for example, the protocol is to operate and leave the hospital in three days. But in many public services, the prosthesis has not even arrived in 14 days, which increases the chances of infection and death. The same happens with cancer. We have patients who die before the diagnosis”, reports geriatrician Maísa Kairalla, professor at Unifesp (Federal University of São Paulo).

The doctor, who works both at Hospital Albert Einstein (SP) and at Unifesp’s public outpatient clinic, sees these inequalities on a daily basis. “I tell the patient [do SUS]: ‘You need to eat protein’. And he answers me: ‘I have no way’. He has no teeth, no social support from a caregiver. What are you going to eat? Noodles, because it’s easier, because you’re alone. Sometimes it’s not just the lack of money, it’s the care itself”, explains the geriatrician.

According to Matías Mrejen, a senior researcher at Ieps and one of the authors of the study, these challenges should become more pronounced in the coming years in the country. In 2031, the percentage of elderly people should exceed the rate of children, and their participation in the total population will increase at a much faster rate than that observed in other countries.

France, for example, saw its proportion of elderly people double from 10% to 20% in 140 years, the United Kingdom in 80 years, and the United States in 75 years. In Brazil, however, this should occur in just 25 years, between 2010 and 2035. This period is shorter than that of India (40) and similar to that of China (25) and Latin America as a whole (30).

Data from the IBGE (Brazilian Institute of Geography and Statistics) show that there has already been an increase in the rate of households with elderly people in the last decade, from 19.9% ​​in 1998 to 23.4% in 2019. , also increases the percentage of those who need help with day-to-day activities.

While about a quarter of seniors aged up to 69 years declare themselves having some degree of difficulty in carrying out daily activities, in the next age group (from 75 to 79 years old), the rate is 41%. Among those aged 80 and over, it jumps to 57%.

“In Brazil, aging is very uneven and will bring many challenges to the health system and families. The elderly will need help with eating, bathing and other day-to-day activities and, in most cases, this help will have to be provided by family members”, says Mrejen.

According to work, hiring caregivers is only significant among higher-income families. Only 0.4% of the poorest elderly have these professionals. Among those with higher income, these percentages vary between 27% and 69%.

“This can mainly harm women’s position in the labor market. They are more likely to carry out personal care tasks at home when there are elderly people with functional limitations”, says Letícia Nunes, assistant professor at Insper and co-author of the study.

The country is also not prepared to meet the demands of an aging population in terms of human resources. Only 0.5% of graduates in medical residency completed the geriatrics course, according to the Brazilian Medical Demography 2023.

At the same time, pediatrics was the option for 9.8% of residents, obstetrics and gynecology for 7.5%, and dermatology and plastic surgery for 2.3% and 1.6%, respectively. .

“In addition to a considerable discrepancy with our current needs, this profile of new specialists also does not seem to have changed over time”, observes Nunes, from Insper.

For physician and gerontologist Alexandre Kalache, president of the International Longevity Center, more geriatricians are needed, however, the main measure to face these challenges of population aging is “to give a gerontological bath” in the training of health professionals.

“We don’t just need more doctors. We need more nurses, physiotherapists, nutritionists, speech therapists, everyone needs to learn about aging. More and more patients will be older people and will have more risks associated with this condition.”

Another sign of the health system’s unpreparedness is the low supply of long-stay beds, which treat patients who are no longer in serious conditions, but who are highly dependent and in need of rehabilitation —in large part, they are elderly.

According to data from the CNES (National Register of Health Establishments), in the last decade there has been a drop in the supply of these beds. In 2010, there were 0.6 chronic or rehabilitation beds in Brazil for every thousand elderly people. In 2021, the ratio was 0.4 per thousand.

The lack of these beds causes chronic patients with high dependency to remain for long periods in emergency rooms, general hospitalization beds and even ICUs, when they could be in other services designed for this purpose. “This generates high hospital costs for the system and additional financing needs”, says Nunes.

These long-stay beds are found in only 36% of Brazilian municipalities, and most are concentrated in private establishments.

“The data suggest that Brazil is not prepared to face the challenges of the accelerated aging of its population and needs an intersectoral action with the policies of social assistance, social security, health and care for the elderly”, says Mrejen, from Ieps .