Health risk behaviors in elderly Brazilian widowers. / Comportamientos de riesgo para la salud en hombres mayores brasileños viudos.

The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

Se buscó comparar la prevalencia de comportamientos de riesgo para la salud en hombres mayores viudos con las de hombres mayores con pareja, solteros y divorciados/separados, así como la prevalencia de comportamientos de riesgo en hombres mayores viudos según rango de edad, escolaridad y raza/color. Se realizó un estudio transversal con hombres mayores (≥ 60 años) entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2016 (n=5.384) y 2017 (n=5.801) que incluye muestras representativas de adultos de las capitales de los estados brasileños y del Distrito Federal. De ellos, 886 eran viudos. Los comportamientos de riesgo fueron: inactividad física en el tiempo libre, consumo irregular de frutas, verduras y legumbres, tabaquismo y consumo abusivo de alcohol. La prevalencia de tabaquismo fue menor entre los hombres mayores con pareja [RP = 0,68; IC95% (0,52-0,90)] que entre los viudos. En los demás comportamientos de riesgo no se observaron diferencias en la prevalencia de los viudos en relación a los demás grupos. Cuando se analizaron solamente los viudos, se observaron importantes asociaciones de los comportamientos de riesgo con las variables grupo de edad y escolaridad, pero no con raza/color.

Comportamientos de riesgo para la salud en hombres mayores brasileños viudos / Health risk behaviors in elderly Brazilian widowers

RESUMEN Se buscó comparar la prevalencia de comportamientos de riesgo para la salud en hombres mayores viudos con las de hombres mayores con pareja, solteros y divorciados/separados, así como la prevalencia de comportamientos de riesgo en hombres mayores viudos según rango de edad, escolaridad y raza/color. Se realizó un estudio transversal con hombres mayores (≥ 60 años) entrevistados por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2016 (n=5.384) y 2017 (n=5.801) que incluye muestras representativas de adultos de las capitales de los estados brasileños y del Distrito Federal. De ellos, 886 eran viudos. Los comportamientos de riesgo fueron: inactividad física en el tiempo libre, consumo irregular de frutas, verduras y legumbres, tabaquismo y consumo abusivo de alcohol. La prevalencia de tabaquismo fue menor entre los hombres mayores con pareja [RP = 0,68; IC95% (0,52-0,90)] que entre los viudos. En los demás comportamientos de riesgo no se observaron diferencias en la prevalencia de los viudos en relación a los demás grupos. Cuando se analizaron solamente los viudos, se observaron importantes asociaciones de los comportamientos de riesgo con las variables grupo de edad y escolaridad, pero no con raza/color.

ABSTRACT The objective of this study was to compare the prevalence of health risk behaviors among elderly widowers with that of elderly partnered males, as well as single or divorced/separated men. Additionally, we set out to examine the prevalence of risk behaviors in elderly widowered men according to age, education level, and race/skin color. A cross-sectional study was conducted with elderly men (≥ 60 years) who were interviewed through the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) in 2016 (n=5,384) and 2017 (n=5,801). The Vigitel survey includes representative samples of adults residing in the capitals of Brazilian states and the Federal District, and of those surveyed, 886 were widowers. Identified risk behaviors included physical inactivity during leisure time, irregular consumption of fruits, vegetables and legumes, smoking and alcohol abuse. The prevalence of smoking was lower among partnered elderly men [PR=0.68, CI95% (0.52-0.90)] than among widowers. There were no differences in the prevalence of other risk behaviors between widowers and other groups. When only widowers were taken into account, there was significant association of risk behaviors with age and educational level, but not with race/skin color.

Health situation in the perception of elderly widows assisted by primary health care.

OBJECTIVE: Analyze the perception of elderly widow women about their health situation. METHOD: Descriptive and exploratory research, based on qualitative approach performed with 34 widowed women aged 60 years and over, enrolled in primary health care. It was used content analysis in its thematic analysis modality. RESULTS: Three thematic nuclei were obtained: "positive self-perception of health in old age", "negative understanding of health related to the diseases" and "negative repercussions of the absence of the husband in the health situation of the widows". Presence of the family, chronic diseases under control, physical limitations and absence of the partner directly influenced the responses of the elderly widows. FINAL CONSIDERATIONS: The elderly widows perceive their health situation as relatively good and some factors are challenges to a better health situation. For the participants, widowhood means more than just the physical loss of the husband, interfering negatively in the perception of their health situation.

Health situation in the perception of elderly widows assisted by primary health care / Situación de salud en la percepción de viudas ancianas asistidas por la atención primaria de salud / Situação de saúde na percepção de idosas viúvas assistidas pela atenção primária à saúde

ABSTRACT Objective: Analyze the perception of elderly widow women about their health situation. Method: Descriptive and exploratory research, based on qualitative approach performed with 34 widowed women aged 60 years and over, enrolled in primary health care. It was used content analysis in its thematic analysis modality. Results: Three thematic nuclei were obtained: "positive self-perception of health in old age", "negative understanding of health related to the diseases" and "negative repercussions of the absence of the husband in the health situation of the widows". Presence of the family, chronic diseases under control, physical limitations and absence of the partner directly influenced the responses of the elderly widows. Final considerations: The elderly widows perceive their health situation as relatively good and some factors are challenges to a better health situation. For the participants, widowhood means more than just the physical loss of the husband, interfering negatively in the perception of their health situation.

RESUMEN Objetivo: Analizar la percepción de la mujer viuda anciana acerca de su propia situación de salud. Método: Investigación descriptiva y exploratoria, basada en el enfoque cualitativo realizado con 34 mujeres viudas de al menos 60 años, inscritas en la atención primaria de salud. Se utilizó análisis de contenido en su modalidad de análisis temático. Resultados: Se obtuvieron tres núcleos temáticos: "autopercepción positiva de la salud en la vejez", "comprensión negativa de la salud relacionada con las enfermedades" y "repercusiones negativas de la ausencia de la pareja en la situación de salud de las viudas". La presencia de la familia, las enfermedades crónicas bajo control, las limitaciones físicas y la ausencia de la pareja influyeron directamente en las respuestas de las viudas ancianas. Consideraciones finales: Las viudas ancianas perciben que su situación de salud es relativamente buena y algunos factores son desafíos para mejorar la situación de la salud. Para las participantes, la viudez significa más que solo la pérdida física del esposo, lo que interfiere negativamente en la percepción de su situación de salud.

RESUMO Objetivo: Analisar a percepção de mulheres idosas viúvas sobre sua situação de saúde. Método: Pesquisa descritiva e exploratória, baseada na abordagem qualitativa realizada com 34 mulheres viúvas com idade igual ou superior a 60 anos, cadastradas na atenção primária à saúde. Utilizou-se da análise de conteúdo em sua modalidade análise temática. Resultados: Foram obtidos três núcleos temáticos: "a autopercepção positiva da saúde na velhice", "compreensão negativa da saúde relacionada aos agravos" e "repercussões negativas da ausência do companheiro na situação de saúde das viúvas". Presença da família, doenças crônicas sob controle, limitações físicas e ausência do companheiro influenciaram diretamente as respostas das idosas viúvas. Considerações finais: As idosas viúvas percebem sua situação de saúde como relativamente boa e alguns fatores são desafios a uma melhor situação de saúde. Para as participantes, a viuvez significa mais que apenas a perda física do cônjuge, interferindo negativamente na percepção de sua situação de saúde.

Changes in depressive symptoms during widowhood among older Mexican Americans: the role of financial strain, social support, and church attendance.

OBJECTIVES: This study examines how depressive symptoms change during the widowhood process among older adults of Mexican descent. This research also investigates whether financial strain, social support, and church attendance moderate changes in depressive symptoms in the context of widowhood. METHOD: This study uses seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly collected at approximately two-year intervals. This research applies multiphase growth models to examine changes in depressive symptomatology before, during, and after the transition to widowhood (the measurement wave at which spousal bereavement was first reported) among 385 older adults of Mexican descent who experienced the death of a spouse during the survey. RESULTS: This study demonstrates that older adults of Mexican descent experienced a significant increase in depressive symptoms pre-widowhood and in particular, during the transition to widowhood. The levels and rates of changes in depressive symptoms post-widowhood did not differ from the pre-widowhood ones. Greater social support was related to more depressive symptoms during the transition to widowhood. More frequent church attendance was a protective factor against increases in depressive symptoms pre-widowhood. CONCLUSION: This study highlights the multiphase pattern in the effects of the widowhood process on depressive symptomatology among older adults of Mexican descent. The findings also suggest that social support and church attendance can have implications for the interplay between widowhood and depressive symptoms.

Personal and social determinants of health services utilization by Mexican older people.

BACKGROUND: Increased healthcare needs among older individuals around the world demands a better understanding of factors influencing healthcare service utilization patterns. OBJECTIVE: To examine personal and social correlates to health services utilization among Mexican older persons. DESIGN AND METHODS: This was a cross-sectional study conducted between 2004 and 2006 with 2030 Mexican adults 60 years and older and based on a health services utilization framework. A two-stage cluster sampling with probability proportionate to size was used. Participants were randomly selected and recruited in four metropolitan areas in Northeastern Mexico. Chi-square and Pearson's chi-squared tests and logistic regression were used for data analyses. RESULTS: Significantly more women than men had lost a spouse and were illiterate. Also, females reported significantly poorer health, higher nutritional risk and lower ability to perform activities of daily and instrumental living than males. Predictors of healthcare utilization were: Having a caregiver during an illness; perceiving to have a health problem; being able to afford food, and having children. CONCLUSIONS: Predisposing, enabling and need factors are strong predictors of health services utilization among Mexican older persons. In addition, gender differences exist among this population in relation to health status, but not to health services demands.

Social network types and functional dependency in older adults in Mexico.

BACKGROUND: Social networks play a key role in caring for older adults. A better understanding of the characteristics of different social networks types (TSNs) in a given community provides useful information for designing policies to care for this age group. Therefore this study has three objectives: 1) To derive the TSNs among older adults affiliated with the Mexican Institute of Social Security; 2) To describe the main characteristics of the older adults in each TSN, including the instrumental and economic support they receive and their satisfaction with the network; 3) To determine the association between functional dependency and the type of social network. METHODS: Secondary data analysis of the 2006 Survey of Autonomy and Dependency (N = 3,348). The TSNs were identified using the structural approach and cluster analysis. The association between functional dependency and the TSNs was evaluated with Poisson regression with robust variance analysis in which socio-demographic characteristics, lifestyle and medical history covariates were included. RESULTS: We identified five TSNs: diverse with community participation (12.1%), diverse without community participation (44.3%); widowed (32.0%); nonfriends-restricted (7.6%); nonfamily-restricted (4.0%). Older adults belonging to widowed and restricted networks showed a higher proportion of dependency, negative self-rated health and depression. Older adults with functional dependency more likely belonged to a widowed network (adjusted prevalence ratio 1.5; 95%CI: 1.1-2.1). CONCLUSION: The derived TSNs were similar to those described in developed countries. However, we identified the existence of a diverse network without community participation and a widowed network that have not been previously described. These TSNs and restricted networks represent a potential unmet need of social security affiliates.

Chronic pain and gender in Salvador population, Brazil.

Chronic pain is a public health problem with high impact on various population segments. There are few population studies with the aim of delineating the profile of the chronic pain patient, and generating data for actions to prevent, control and minimize the problem. The aim of this study was to estimate the prevalence of chronic pain in the population of Salvador, Bahia, Brazil and identify independent predictors associated with this morbidity. A cross-sectional study was conducted in a sample population of 2297 individuals of >20 years of age, in Salvador, Brazil. A standardized questionnaire was applied at home to collect data about socio-demographic characteristics, lifestyle, chronic pain and abdominal circumference measurement. The chronic pain was defined as pain with a duration of longer than 6 months. Prevalence of pain and the OR (univariate analysis) were estimated and adjusted (logistic regression), and their ICs at 95% and p<0.05 in the two analyses. The presence of chronic pain was found in 41.4% of the total study population, women being more affected (48.4% against 32.8% in men), with OR of 1.92 IC 95% 1.6-2,28 p<0.001. Among the studied factors, in the gross analysis, the following were shown to be associated with chronic pain: conjugal situation, smoking, excessive alcohol consumption, presence of central obesity and age, all with p<0.05. In the multivariate analysis, female sex, smoking, excessive alcohol consumption, and age were sustained as independent predictors. The presence of chronic pain was predominant in women, the elderly, smokers or ex-smokers and excessive alcohol consumers.

Impairment of sexual activity in middle-aged women in Chile.

OBJECTIVE: It has been suggested that approximately 40% of women between 40 and 64 years of age cease their sexual activity. Our objective was to examine the reasons that sexual activity has stopped and to determine the effect that this behavior has on the marital stability of those middle-aged women. DESIGN: A total of 534 healthy women between 40 and 64 years of age who were attending the Southern Metropolitan Health Service in Santiago, Chile, were asked to take part in the study. RESULTS: The main reasons for sexual inactivity in middle-aged women were sexual dysfunction (49.2%), unpleasant personal relationship with a partner (17.9%), and lack of a partner (17.7%). These reasons vary with aging; in women younger than 45 years, the most frequent reason was erectile dysfunction (40.7%); in those between 45 and 59, low sexual desire (40.5%); and, in women older than 60 years, the lack of a partner (32.4%). Sexual inactivity did not affect marital stability because women without sexual relationships (68.2% of the entire sample) were married. Among the divorced women, female sexual dysfunction was responsible for only 11.7% of the separations. CONCLUSION: Low sexual desire is the main reason for ceasing sexual activity. Nevertheless, stopping sexual relationships does not seem to be important in marital stability.

Gender, widowhood, and long-term care in the older Mexican American population.

The objective of this study is to examine the influences of gender on long-term care service use among older Mexican American widows and widowers. Our analysis is based on a sample of 773 widows and 183 widowers from the Longitudinal Study of Elderly Mexican American Health (H-EPESE). In this sample widows resemble widowers in terms of demographic and health characteristics. However, widows report more financial strain than widowers and a greater welfare dependency (SSI) and Medicaid use. Among those who suffered diminished health, widows were more likely than widowers to use community-based long-term care services whereas widowers were more likely to enter a nursing home. Widows also had more instrumental and socioemotional support than widowers. Serious cognitive and functional impairment, though, places widows and widowers at the same risk of institutionalization. We end with a discussion of the policy implications of these findings.