Apoio social e limitação funcional entre os idosos

Abstract

Social support is a complex and multidimensional concept, measured under the following aspects: i) structural, which evaluates the network of relationships, and ii) functional, which analyzes the quality and effectiveness of interpersonal resources. Functional limitation in activities of daily living (ADLs) refers to the difficulty or inability to perform tasks essential for independence, being classified as basic (ABVDs), related to self-care, and instrumental (IADLs), which involve autonomy in more complex tasks. Some authors mention an association between social support and functional limitation among the elderly; however, there is no systematic review of the literature that points out the direction and magnitude of the association, as well as the challenges and gaps in research. It is known that elderly individuals with functional limitations in performing ADLs may require support of different types and levels. Despite the need, support may not be provided or effective, which may have negative consequences on the individual's quality of life and aging. Therefore, this thesis aimed to estimate the frequency of social support and explore its association with functional limitation in carrying out activities of daily living, using data from the Brazilian Longitudinal Study of the Health of Older Adults (ELSI-Brazil) and the National Health Survey (PNS) of 2019. To this end, three articles make up this thesis. The first article aimed to summarize and evaluate the association between functional social support and functional limitation in performing ADLs among non-institutionalized elderly people. It was observed that social support, particularly emotional and instrumental support, is frequently associated with functional limitation, especially in the context of ADLs. However, the level of certainty of the evidence is low, which implies the need for more longitudinal studies with greater methodological quality. The second article, conducted using data from ELSI-Brazil, identified that almost 14% in 2015 and 11% in 2019 of the elderly reported receiving financial support. Elderly people with functional limitations presented higher frequencies of receiving financial support compared to elderly people who did not receive support. In addition, it was observed that women, individuals without a spouse, and those who had functional limitations for basic and instrumental activities were more likely to receive financial support. Finally, the third article made relevant contributions by exploring the lack of social support and its association with social limitation among elderly individuals living in urban and rural areas, indicating that approximately 5% of the elderly individuals reported a lack of family support, while approximately 22% reported a lack of support from friends, and 2% did not have either type of support. Furthermore, the study showed that the lack of social support from family and/or friends was positively associated with demographic and socioeconomic factors, such as advanced age, low education level, lower income, not having a spouse, and living in urban areas. In addition, elderly individuals with functional limitations for BADL and IADL presented a higher frequency of lack of support from friends but not from family members. The findings point to the existence of an association between social support and functional limitation, highlighting the importance of policies and interventions that 10 strengthen support networks for elderly individuals in vulnerable situations, in addition to the need for further research.