Positive self-rated health in the elderly: a population-based study in the South of Brazil Autopercepção positiva de saúde em idosos: estudo populacional no Sul do Brasil Autopercepción positiva de salud en ancianos: estudio poblacional en el Sur de Brasil

The objective was to identify factors associated with positive self-rated health in the elderly in Florianópolis, Santa Catarina State, in the South of Brazil. This population-based cross-sectional study evaluated 1,705 elderly. Self-rated health was classified as positive (very good or good) or negative (fair, poor, and very poor). Crude and adjusted Poisson regression was used to identify associated factors. Prevalence of positive selfrated health was 51.2%, associated with male gender (PR = 1.13), more than 5 years of schooling, moderate (PR = 1.33) or high alcohol intake (PR = 1.37), leisure-time activity (PR = 1.20), Internet use (PR = 1.21), fewer diseases, mild/moderate dependence (PR = 2.20) or no dependence (PR = 2.67), no falls (PR = 1.19), and non-use of polypharmacy (PR = 1.27). Several modifiable factors were identified that can affect positive self-rated health in the elderly and contribute to the development of strategies to improve their quality of life. Health of the Elderly; Self-Assessment; Cross-Sectional Studies Resumo O objetivo foi identificar fatores associados à autopercepção positiva de saúde em idosos de Florianópolis, Santa Catarina, Sul do Brasil. Tratase de estudo transversal, de base populacional, com 1.705 idosos. A autopercepção de saúde foi classificada como positiva (muito boa e boa) e negativa (regular, ruim e muito ruim). A regressão bruta e ajustada de Poisson foi utilizada para identificar os fatores associados. A prevalência do desfecho foi de 51,2%, associada positivamente ao sexo masculino (RP = 1,13), ter mais de 5 anos de estudo, consumo moderado (RP = 1,33) ou alto de álcool (RP = 1,37), ser ativo no lazer (RP = 1,20), utilizar Internet (RP = 1,21), menor número de morbidades, dependência leve/moderada (RP = 2,20) ou nenhuma (RP = 2,67), não sofrer quedas (RP = 1,19) e não fazer uso de polifarmácia (RP = 1,27). Foram identificados diversos fatores modificáveis que podem interferir na autopercepção de saúde positiva de idosos e contribuir para o desenvolvimento de estratégias para melhorar a qualidade de vida desses. Saúde do Idoso; Autoavaliação; Estudos Transversais 1 ARTIGO ARTICLE http://dx.doi.org/10.1590/0102-311X00132014 Confortin SC et al. 2 Cad. Saúde Pública, Rio de Janeiro, 31(5):1-11, mai, 2015 Introduction Self-rated health is considered good indicator of health status in the elderly, since it incorporates physical, cognitive, and emotional components as well as aspects related to well-being and satisfaction with one’s own life 1,2,3. This measure has been widely used in population-based studies of the elderly, since it is consistently associated with mortality and functional decline in this age group 4,5,6, besides serving as a tool for developing health policies aimed at improving the elderly population’s health status 4. Prevalence of positive self-rated health differs considerably between studies. Although the question on self-rated health and the options for answers are similar between studies, the findings are not unanimous. This discrepancy in prevalence rates may be due to short-term fluctuations in health or disease caused by cyclical variations related to well-being. Some Brazilian studies 1,2,3,4 have analyzed self-rated health in the elderly, mainly approaching the variable as negative self-rated health. However, self-rated health in its positive form facilitates understanding the factors that be modified in the search for positive determinants of health. Prevalence rates for positive self-rated health among Brazilian population-based studies varied from 24.7 to 89.1% 1,4,7, while in international studies they varied from 35.7% to 63% 8,9,10. Since self-rated health bears a relationship to fundamental health issues in the elderly, such as gender 11, age 11, marital status 11, schooling 3,8,11,12, monthly household income 1, physical activity 1,3,7,13, and alcohol consumption 14, it is easy to understand the discrepancies in prevalence rates between studies. In addition, health conditions also bear a relationship to self-rated health, for example falls 15, physical capacity 4,7,16, depressive symptoms 1,16, and diseases 3,4,17,18, in addition to having an impact on mortality 4,6,19. The use of medicines 1,11 and healthcare services are also associated, especially the number of medical consultations 1, number of hospitalizations, and type of health insurance 11. Understanding the aspects involved in selfrated health can reveal the profile of elderly that refer to it positively, which has still received little attention in Brazilian research, as shown in a literature review on the theme, in which all the studies that were examined approached the variable in its negative form 2. By considering the theme’s relevance as an important indicator for overall health surveillance in the elderly, the current study aims to identify the prevalence of positive self-rated health and its association with demographic, socioeconomic, and lifestyle factors and health conditions in the elderly in Florianópolis, the capital of Santa Catarina State, Brazil.