Factors associated with low life life satisfaction in community-dwelling elderly: FIBRA Study Fatores associados à baixa satisfação com a vida em idosos residentes na comunidade: Estudo FIBRA

The objectives were to identify factors associated with decreased life satisfaction in communitydwelling elderly and describe such factors according to gender and age bracket. The study interviewed 2,472 elderly individuals 65 years or older without cognitive deficits suggestive of dementia, in probabilistic samples from seven Brazilian cities. All measures were self-reported except for functional performance, indicated by handgrip and gait speed. Women had more chronic diseases, worse functional performance, and greater social involvement when compared to men. The oldest participants showed worse functional performance and less social involvement when compared to the youngest. Low satisfaction was associated with three or more diseases, memory problems, low social involvement, low handgrip strength, and urinary incontinence. The authors conclude that health, functional performance, and social involvement interact with well-being, so interventions targeting these areas can favor quality of life for the elderly. Helth of the Elederly; Aging; Muscle Strength; Quality of Life Resumo Os objetivos foram identificar fatores associados à baixa satisfação com a vida em idosos da comunidade e descrevê-los segundo sexo e faixa etária. Foram entrevistados 2.472 idosos com 65 anos ou mais, sem déficit cognitivo sugestivo de demência, de amostras probabilísticas de sete localidades brasileiras. As medidas foram autorrelatadas, exceto o desempenho funcional, indicado por testes de força de preensão palmar e velocidade de marcha. As mulheres apresentaram mais doenças, pior desempenho funcional e maior envolvimento social quando comparadas aos homens. Os mais velhos tiveram pior desempenho funcional e menor envolvimento social em comparação com os mais jovens. Associaram-se à baixa satisfação ter três ou mais doenças, problemas de memória, baixo envolvimento social, baixa força de preensão e incontinência urinária. Concluímos que saúde, desempenho funcional e envolvimento social interagem com o bem-estar, por isso a intervenção nesses aspectos favorece a qualidade de vida dos idosos. Saúde do Idoso; Envelhecimento; Força Muscular; Qualidade de Vida 2447 ARTIGO ARTICLE http://dx.doi.org/10.1590/0102-311X00173212 Pinto JM, Neri AL 2448 Cad. Saúde Pública, Rio de Janeiro, 29(12):2447-2458, dez, 2013 Introduction Life satisfaction results from the individuals’ overall cognitive assessment of their living conditions and achievements, comparing them to their needs and expectations and in light of their personal and sociocultural values 1. Levels of satisfaction suffer the influence of adverse events that impact affective states, but these tend to return to baseline after the effects of the negative experiences have ceased. Old age is accompanied by increased likelihood of adverse events that affect well-being 2. There are no homogeneous data on the relations between gender and life satisfaction in old age, but the most common finding suggests that elderly women have lower levels of satisfaction than elderly men 2,3. Various explanations have been proposed, including the influence of the lifetime accumulation of educational, economic, and health disadvantages, whose effects are aggravated by physiological decline and other losses in old age. Being a man or woman itself has no impact on life satisfaction. What influences satisfaction are gender-related physical and social conditions. For elderly women, chronic illnesses, memory, self-rated health, social support, and social relations are the most relevant domains of life satisfaction. For elderly men, income and family relations are the domains with the greatest impact on levels of satisfaction 3,4. Age itself cannot be interpreted as a direct cause of decreased or increased life satisfaction. The relations between age and satisfaction are more consistently explained by the physical and social conditions in which the individual lives than by the time since birth. For young adults, satisfaction with work and income have a large influence on overall life satisfaction, while health is the domain that most contributes to levels of satisfaction in old age 5. Levels of life satisfaction tend to decline with advancing age, when unfavorable living conditions emerge or are aggravated, such as chronic diseases, functional incapacity, restrictions to social contacts, reduce income, decreasing levels of activity and social involvement, and negative self-rated health 1,5. The dynamic and complex interaction between good health conditions and functioning, adequacy of environmental conditions, and presence of personal resources results in greater social involvement, a favorable outcome associated with active or healthy aging 6. High levels of social involvement result from good health conditions, preserved physical and cognitive capacities, motivation, adaptation to the environment, and opportunities 7. Involvement in social activities is associated with psychological and physical benefits such as increased satisfaction, lower risk of depression, lower motor function decline, and lower risk of death 7. Relations with friends and family members contributes to the development of a feeling of belonging, allow contact with sources of satisfaction, and help the maintenance social support networks and functioning. The advanced activities of daily living (AADL) are important indicators of social involvement in the elderly. They have greater physical and cognitive requirements than the instrumental (IADL) or the basic activities of daily living (BADL). While AADL allow the elderly to have direct contact while performing roles in the broader social environment and to be seen by others as active, productive, and involved participants 8, IADL place them in contact with activities of practical life performed in more restricted settings, including their own homes. Meanwhile, BADL are related to self-care and survival and become more automatic, routine, and circumscribed than other activities 7,8. The reduction in the ability to perform activities of daily living occurs by stages. Limitations begin with advanced or complex activities, and only affect the performance of IADL or BADL at a second or third stage 8. When loss of muscle strength compromises mobility, it can lead to a decrease in involvement by the elderly in complex social, productive, and leisure-time activities 9. Consequences may include the appearance or worsening of depressive symptoms, loneliness, dissatisfaction with life and inactivity, forming a vicious circle of adverse advents, with a negative impact on health, functioning, and well-being. The Brazilian literature lacks studies on factors associated with low levels of satisfaction in the country’s elderly people. Population-based studies on satisfaction in the elderly are important, but they have contemplated specific domains such as satisfaction with health services, transportation, and social relations 10,11. Other studies on life satisfaction used small samples of elderly treated at outpatient services 12,13. Knowledge on the relations between sociodemographic and health variables, functional performance, social involvement, and life satisfaction in Brazilian community-dwelling elderly contributes to the literature on the theme and helps to identify elements that are amenable to intervention in geriatric and gerontological care, especially in primary health care for the elderly. The aim of this study was to identify factors associated with low life satisfaction in Brazilian community-dwelling elderly, including gender, age, chronic diseases, memory problems, urinary incontinence, falls, measures of functional performance (hand grip strength and walking FACTORS ASSOCIATED WITH LOW LIFE SATISFACTION IN COMMUNITY-DWELLING ELDERLY 2449 Cad. Saúde Pública, Rio de Janeiro, 29(12):2447-2458, dez, 2013 speed), and social involvement, indicated by performance in AADL.