Self-esteem among older adults treated at basic health units and associated factors

R E S U M O OBJETIVO: O objetivo do presente estudo foi investigar o nível de autoestima entre idosos assistidos em unidades básicas de saúde (UBS) e seus fatores associados. MÉTODOS: Trata-se de um estudo transversal no qual foram avaliados 654 idosos assistidos em UBS na cidade de Maringá, no estado do Paraná, Brasil. O questionário internacional de atividade física (IPAQ) e a escala de autoestima de Rosenberg (EAR) foram utilizados como instrumentos. A análise de dados foi feita através do teste de Kolmogorov-Smirnov, da correlação de postos de Spearman, do teste qui-quadrado e da regressão logística binária. RESULTADOS: Os resultados mostraram uma associação significativa entre a autoestima (p < 0,005) e a autopercepção de saúde, a qual é relacionada ao uso de UBS, histórico de quedas ou quase quedas e nível de atividade física. A regressão logística mostrou que os idosos sem histórico de quase quedas têm maiores chances de desenvolver uma boa autoestima, assim como os idosos muito ativos. A presença de autoestima elevada se correlacionou significativamente com as variáveis referentes à prática de atividades físicas de moderada e baixa intensidade. CONCLUSÃO: Concluiu-se que condições de saúde, especialmente histórico de quase quedas e nível de atividade física, são fatores associados à autoestima mais elevada. Além disso, a realização de atividades físicas de moderada e baixa intensidade está associada à boa autoestima. PALAVRAS-CHAVE: serviços públicos de saúde; idoso; acidentes por quedas; exercício. Self-esteem in older adults Geriatr Gerontol Aging. 2019;13(3):133-40 134 INTRODUCTION Aging is a dynamic and progressive process characterized by physiological, physical and psychological changes, which modify the organism and can cause damages related to the adaptive capacity of older adults, making them more susceptible to the negative adversities of life.1,2 On the other hand, research emphasizes that reaching this stage of life with high self-esteem, optimism, and self-control may have a positive effect on longevity.1,3-5 Self-esteem is described as an individual’s self-perception to judge his or her abilities in the face of life’s adversities,6 and it is related to factors such as confidence, competence and decision-making.3 It can therefore be characterized as the feeling, appreciation and consideration that a person feels for her/himself.1 Similarly to quality of life, self-esteem embraces subjective self-perceptions.7 According to the scientific literature, older people with low self-esteem have lower scores on quality of life.8 A study with Canadian older adults found that low levels of self-esteem can predict adverse health outcomes for these population.9 Therefore, knowledge on this subject can subsidize the systematization for taking care of aging adults with low self-esteem.1 In this context, it is important that the health team identifies the factors that may be interfering with the self-esteem of these patients in order to intervene on such aspects and improve their quality of life. Some authors point to the existence of a negative relationship between self-esteem and advanced age, however it seems to be the behavior of older adults that more strongly defines this relationship.1,10 Studies have shown that going to basic health units (BHUs) and engaging in regular physical activity are some of the favorable attitudes to increase the self-esteem of this population.10-12 On the other hand, it is also necessary to investigate the various factors related to the low self-esteem of these individuals. The possibility of falls, for example, directly and negatively interferes with the daily life of this population, with loss of autonomy and independence, even if it occurs for a limited time.2 Falls are increasingly causing injuries in geriatric patients, which means high treatment costs,13 and are defined as unintentional events that result in the person coming to rest on the ground or another lower level.2 After its occurrence, older people become more susceptible to low self-esteem in the performance of their daily activities, either due to fear of new episodes of falls or to other physical, psychological or social factors.5 There may also be a progressive impairment of the functional capacity, which can make these patients more vulnerable and concerned with the risk of institutionalization and even death.2,5,12 Among the Brazilian national health policies for the population aged 60 and over, three priorities stand out: health of older adults, health promotion, and strengthening of Basic Care.14 However, there is still little research on the self-esteem of geriatric patients who regularly attend BHUs, which intensifies the need to study this event, given its high impact on the health system. Therefore, this study aimed at contributing to the expansion of knowledge in this field in order to subsidize strategies of action that take into account the factors that may interfere with the quality of life, based on the maintenance of self-esteem in older adults. From this perspective, the present study aimed at investigating the factors associated with the self-esteem of older people assisted at the BHU in the city of Maringá, Paraná.