Fatores associados a violência contra pessoas idosas no Brasil: análise pela Pesquisa Nacional de Saúde 2019

Abstract

Objective: To analyze the prevalence and factors associated with self-reported of elder abuse (EA) in Brazil. Methods: This thesis was structured in two articles that present cross-sectional, population-based epidemiological studies, with an analytical approach, with people ≥60 years of age, interviewed in the National Health Survey 2019. Article 1 - Prevalence rates and 95% confidence intervals (95%CI) were calculated for total violence and its subtypes, according to sociodemographic and health variables, stratified by sex. Associations between total violence and the explanatory variables were investigated using the Poisson regression model with robust variance, and crude and adjusted prevalence ratios were estimated. In the final model, variables with a p-value ≤0.05 remained associated with total violence. Article 2 - The Ecological Model was used to choose the variables. The prevalence and 95%CI of total violence and the explanatory variables were calculated. Bivariate analyses were carried out using the Multilevel Logistic Regression model between total violence and the variables at each level of the Ecological Model, and crude odds ratios were estimated. In the multivariate analysis, the null model was calculated, with the individual as level 1 and the federated units as level 2, in order to verify whether there is variability in the occurrence of violence between the federated units. Five models were adjusted, using the structure of the Ecological Model to enter the variables. Before adjusting the model with the social level variables, Pearson's Correlation was assessed between the percentage of poverty and average per capita income, indicators that had categories with a p-value ≤0.20 in the bivariate analysis. The analysis was carried out in Stata®, version 14.1, with the “survey” command which takes into account the post-stratification weights of the sample. Results: Article 1 - One tenth of elderly Brazilians reported some kind of violence in the last year prior to the survey, 11.09% women and 8.69% men. Women aged 60 to 69 and 70 to 79 had a 2.18 and 91% higher prevalence of violence than women aged ≥80. Divorced/separated women had a 74% higher prevalence of EA, while those living in urban areas had a 49% higher prevalence. Regular and poor/very poor self-rated health increased the prevalence of EA by 34% and 2.04, respectively. The presence of depressive symptoms increased the prevalence of violence by 2.13 and multimorbidity by 21%. Among men, those aged between 60 and 69 had a 79% lower prevalence of violence, while those of non-white race/skin color had a 44% higher prevalence. Living in an urban area increased prevalence by 28%, regular self-rated health increased prevalence by 36% and those with depressive symptoms had a 2.57 times higher prevalence of violence. Those with 1 to 4 years of schooling had a 44% lower prevalence of EA than those with higher education. Article 2 - At the individual level, women were 14% more likely than men to experience EA. The 60-69 age group was 98% more likely, while the 70-79 age group was 53% more likely. Alcohol abuse was associated with 58% greater odds and negative self-rated health with 26% greater odds. The chance of EA was 2.52 times higher in those with depressive symptoms and 46% in those with multimorbidity. Individuals with difficulties in instrumental activities of daily living were 55% less likely to have a EA. At the relational level, living in a household with more than two people was associated with 86% lower odds of EA. Having a family member and a friend to rely on reduced the likelihood of EA by 53% and 87%, respectively. At the community level, living in an urban area increased the chance of violence by 19%. Participating in voluntary activities and practicing religious activities increased the odds by 53% and 15%, respectively. At the social level, federated units with an average per capita income of between R$854.00 and R$998.00 (quartile 2) were 20% more likely to experience EA. Conclusions: One in ten elderly Brazilians reported some kind of violence in the last year before being discharged from hospital. There were differences in the factors associated with EA, suggesting variations related to gender. The sociodemographic and health factors associated with violence for elderly women were divorced/separated marital status and multimorbidity, while for elderly men, having between 5 and 9 years of schooling was associated with a lower prevalence of EA and nonwhite race/skin color with a higher prevalence of violence. When considering the structure of the ecological model, it was possible to observe an association between multiple factors at different levels of violence. At the individual level, female gender, age range 60-79, alcohol abuse, negative self-rated health, depressive symptoms and multimorbidity were associated with a higher chance of violence. At the relational level, living with more than two people and having support from family and friends were associated with a lower chance of violence. At the community level, living in an urban area increased the chance of EA, as did taking part in voluntary work and religious activities. Finally, there was little variability in the occurrence of EA among the federated units, however, average per capita income was associated with a higher chance of EA. These findings reinforce the need for an articulated approach between the individual, relational, community and social levels of the Ecological Model for the prevention, identification and coping with EA.