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The Association between Depression-related Disorders, Chronic Physical Conditions and Leisure-time Physical Activity among Canadians in Late Life: Results from the Canadian Community Health Survey (Cycle 2.1)Song, Geum Ju 21 January 2009 (has links)
Introduction: The benefits of leisure-time physical activity on mental and physical health among older adults are well documented, but few studies have explored the association between depression and leisure-time physical activity within a theoretical framework.
Objective: The purpose of the present study was to identify the association between depression and leisure-time physical activity among community-dwelling, Canadian adults aged 65 and older, using a modified version of the International Classification of Functioning, Disability and Health (ICF) framework.
Method: The present study included a weighted sample of 3,785,145 community- dwelling, seniors aged 65 years or older who participated in the Canadian Community Health Survey (Cycle 2.1). Univariate and multiple logistic regressions were used to examine the cross-sectional association between depression-related disorders and leisure-time physical activity in the context of chronic physical conditions and psychosocial factors.
Results: Older adults reporting depression-related disorders were less likely to participate in leisure-time physical activity after adjusting for relevant psychosocial factors (odds ratios (ORs) ranged from 0.76 to 0.79, p < 0.001). This association was partially mediated by activity limitations associated with depression-related disorders. Similar results were observed between chronic physical conditions and participation in leisure-time physical activity.
Conclusion: Although the present study was unable to identify the temporal relationships among study variables, the results provide clinicians who care for older adults with depression and/or chronic physical diseases with potentially useful information on the benefits of physical activity. They also provide evidence in support of community-based exercise or leisure-time physical activity program for seniors who are physically inactive to prevent chronic mental or physical illnesses and reduced quality of life
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O perfil do envelhecimento populacional em São Carlos - SP: 1980-2005: questões sócio-espaciais e qualidade de vidaOliveira, Ricardo Antunes Dantas de [UNESP] 29 November 2006 (has links) (PDF)
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oliveira_rad_me_rcla.pdf: 2391346 bytes, checksum: 870e5d2549d7d217fbf6f5bfce948e94 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O presente estudo teve como objetivo, a análise do processo de envelhecimento da população urbana de São Carlos SP nos últimos 25 anos. Para isto, foram desenvolvidas três etapas de análise: revisão bibliográfica; avaliação do processo histórico de desenvolvimento social, econômico e territorial em suas relações com a evolução da dinâmica demográfica local; e, estudo detalhado do processo de envelhecimento da população local. O desenvolvimento da pesquisa foi baseado na revisão de bibliografia sobre diversos aspectos relevantes; no trabalho com dados secundários diversos; na aplicação de questionários; e, nas entrevistas com profissionais que trabalham com questões relativas aos idosos da cidade. A heterogeneidade de situações caracteriza a qualidade de vida da população idosa local. Este fato representa grande desafio, em virtude daquilo que se apresenta na atualidade, mas especialmente, para o futuro. As questões levantadas tornam necessária a atuação urgente e eficaz da administração e da sociedade local, com o intuito de minimizar ou solucionar as diversas demandas deste grupo populacional. / This study had the objective of analyze the aging process of São Carlos's population, in the last 25 years. To reach this objective, three stages were considered: bibliographical revision; evaluation of the historical process of social, economic and territorial development, in its relations with the local demographic dynamic evolution; and; detailed study of the aging process of local population. The development of the research was based on: the bibliographical revision of various relevant aspects; the work with diverse secondary data; the application of questionnaires; and, interviews with people who works with questions related to the São Carlos's elderly population. The heterogeneity of situations characterizes the quality of life of local elderly population. This fact represents a great challenge, because of its present but, specially, to the future. The questions evaluated showed the need of urgent and efficient intervention of local's administration and society, with the objective of minimize or solve the diverse kind of demands from this population group.
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Idosos assistidos no serviço de atenção domiciliar: Integralidade das ações em saúdeNASCIMENTO, Michelli Barbosa Do 04 July 2016 (has links)
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Previous issue date: 2016-07-04 / Objetivo: Avaliar a garantia da integralidade das ações no serviço de saúde à pessoa idosa
pela atenção domiciliar do Sistema Único de Saúde. Método: Foi utilizado o método de
Análise do Discurso contido nos documentos governamentais sobre a atenção domiciliar em
saúde principalmente os relativos ao Programa Melhor em Casa do Governo Federal. Ao
mesmo tempo foi realizado um levantamento bibliográfico em torno da literatura
especializada sobre a temática. Foram realizadas entrevistas em profundidade junto a pessoas
idosas com idade maior ou igual a 60 anos, de ambos os sexos, inclusos no serviço de atenção
domiciliar em uma unidade hospitalar na cidade do Recife; com profissionais de saúde do
serviço; assim como cuidadores participantes do Serviço de Atenção Domiciliar. Foi
elaborado um roteiro de entrevista a ser submetido ao Comitê de Ética, mediante assinatura do
Termo de Consentimento Livre e Esclarecido, concordando em participar do estudo
previamente aprovado pelo Comitê de Ética da instituição de ensino. Resultados: Todos os
idosos relatam satisfação com o serviço, entendem as orientações dos profissionais e possuem
boa relação com eles. Dois idosos referem terem sido pouco esclarecidos a respeito do mesmo
antes de serem cadastrados, mas todos relatam algum avanço em sua saúde/vida após a
inclusão no serviço. Ainda dois idosos afirmam que o serviço precisa de algumas melhorias,
como por exemplo: a entrega de fraldas e medicamentos. No que se refere às cuidadoras e seu
olhar sobre o serviço, todas as entrevistadas afirmam não ter conhecimento sobre o serviço,
antes da sua inclusão. Todas Afirmam que o serviço atende as necessidades do idoso, estando,
assim, satisfeitos com o serviço. Todas as entrevistadas afirmam ter boa relação com os
profissionais e estes são claros no que diz respeito às orientações prestadas em casa. Duas
cuidadoras afirmaram que o SAD não oferece tudo o que foi prometido para o cuidado,
relatando a falta de visita médica e a falta de fraldas. Os profissionais do serviço explanaram
sobre o conceito de integralidade da atenção à saúde dos idosos, onde três afirmam que o
serviço exerce essa integralidade junto aos assistidos. Conclusão: o Programa Melhor em
Casa, materializado pelo Serviço de Atenção Domiciliar, surge como uma resposta, uma
estratégia de contenção de demanda, fundamental para reduzir o pleito por serviços
hospitalares e de fomento à constituição de parcerias entre o sistema de saúde, famílias e
comunidades, minimizando a responsabilidade do Estado no que diz respeito a provisão de
cuidados em saúde. Um Programa Federal característico de uma contrarreforma do Estado,
que expressa novas determinações e demandas ao conjunto dos profissionais da saúde. Tornase
um espaço não de afirmação dos direitos dos idosos à saúde integral e humanizada, mas de
resposta à necessidade do Estado. / Objective: To evaluate the guarantee of integrated care in the health service for the elderly for
home care of the Unified Health System. Method: We used the discourse analysis method
contained in government documents on the home health care especially for the program best
Home Federal Government. At the same time it carried out a literature around the literature on
the subject. depth interviews were conducted with older people with older or equal to 60
years, of both sexes included in the home care service in a hospital in the city of Recife; with
health service professionals; as well as participating caregivers, Home Care Service. It was
developed an interview script to be submitted to the Ethics Committee by signing the Consent
and Informed by agreeing to participate in the study previously approved by the Ethics
Committee of the educational institution. Results: All older people report satisfaction with the
service, they understand the guidance of the professionals and have good relationship with
them. Two seniors reported having been poorly informed about the same before being
registered, but all reported some improvement in their health / life after inclusion in the
service. Still two elderly say the service needs some improvements, such as: delivery of
diapers and medicines. With regard to the caregivers and your eye on the service, all
interviewed say they have no knowledge about the service prior to its inclusion. All claim that
the service meets the needs of the elderly and is thus satisfied with the service. All
respondents claim to have good relationship with professionals and these are clear with regard
to the guidance given at home. Two caregivers said that SAD does not offer all that was
promised to care, reporting the lack of medical visit and the lack of diapers. Professional
service explanaram on the concept of integral health care of the elderly, where three claim that
the service carries this wholeness with the beneficiaries. Conclusion: Program Best in House,
materialized by the Home Care Service, is a response, a demand for containment strategy, key
to reducing the vote for hospital services and fostering partnerships between the health
system, families and communities, minimizing the state's responsibility regarding the
provision of health care. A Federal program characteristic of a contrarreforma the state,
expressing new determinations and demands to all health professionals. It is not a space of
affirmation of the rights of the elderly to full and humanized health, but response to the state's
needs.
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Déterminants psychologiques de l'acceptation et du refus de participer à un essai clinique destiné à prévenir la maladie d'Alzheimer en population âgée fragilisée / Psychological determinants of acceptance and refusal to take part in an Alzheimer disease preventive study in frail elderly populationConiasse-Brioude, Delphine 27 September 2011 (has links)
Notre recherche porte sur la participation d’individus âgés fragilisés à un essai clinique destiné à prévenir les syndromes démentiels dégénératifs. 812 personnes âgées, dont 527 ayant accepté de participer à une étude destinée à prévenir la maladie d’Alzheimer et 285 ayant refusé de participer à ce même essai ont rempli un questionnaire comprenant des renseignements sociodémographiques et des échelles évaluant les variables psychologiques suivantes : le soutien social perçu, le lieu de contrôle de la santé, la facette anxiété du Névrosisme, la menace perçue de la maladie d’Alzheimer, les motifs d’acceptation et de refus de participer un une étude destinée à prévenir la maladie d’Alzheimer. Les résultats mettent en évidence que le niveau d’étude, l’âge, la menace perçue de la maladie d’Alzheimer, le contrôle interne et le contrôle externe «personnages puissants» participent à distinguer les « acceptants » et les « refusants ». Les «acceptants» ont un niveau d’étude plus élevé et sont plus jeunes que les «refusants». Les « acceptants » se sentent davantage menacés par la maladie d’Alzheimer et ont plus tendance à présenter un contrôle de la santé de type interne ou externe «personnages puissants» que les «refusants». Trois facteurs motivationnels d’acceptation de participer ont été mis en évidence : le facteur I «Bénéfices perçus», le facteur II «Influence sociale» et le facteur III «Orientation sur soi». Trois facteurs motivationnels de refus de participer ont émergé : le facteur I «Manque d’intérêt», le facteur II «Raisons médicales» et le facteur III «Contraintes perçues». La présente étude contribue à une meilleure compréhension des caractéristiques psychologiques des individus âgés acceptant ou refusant de participer à une étude préventive conduite dans le domaine de la maladie d’Alzheimer, ce qui pourrait notamment aider à la mise en place d’actions améliorant la participation des personnes âgées. / Our research deals with frail elderly persons participation in a dementia preventive study. 812 elderly persons: 527 which accepted and 285 which refused participation in an Alzheimer disease preventive program, completed a questionnaire which evaluated sociodemographic variables and psychological variables: social support, health locus of control, anxiety facet of Neuroticism, perceived threat about Alzheimer disease, motives to accept or to refuse to take part in an Alzheimer disease preventive study. Results show that level of education, age, threat about Alzheimer disease, internal control and external «powerful others» control, contribute to discriminate «acceptors» and «refusers». Persons who accepted participation have a higher level of education and are younger than people in the refusing-to-participate group. Persons who accepted to take part in the study showed an internal control, a «powerful others» control, and felt more threatened by Alzheimer disease than people in the refusing-to-participate group. Motivational factors to accept to take part in a dementia preventive study are: factor I «Perceived benefits», factor II «Social influence», factor III «Focus on self». Motivational factors to refuse to take part are: factor I «Lack of interest, factor II «Medical reasons», factor III «Perceived constraints». This study contributes to a better understanding of psychological characteristics of elderly people which accept or refuse to take part in an Alzheimer disease preventive study. This knowledge could help to develop actions improving elderly’s participation.
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O perfil do envelhecimento populacional em São Carlos - SP : 1980-2005: questões sócio-espaciais e qualidade de vida /Oliveira, Ricardo Antunes Dantas de. January 2006 (has links)
Orientador: Odeibler Santo Guidugli / Banca: Rosana Aparecida Baeninger / Banca: Lucia Mayumi Yazaki / Resumo: O presente estudo teve como objetivo, a análise do processo de envelhecimento da população urbana de São Carlos SP nos últimos 25 anos. Para isto, foram desenvolvidas três etapas de análise: revisão bibliográfica; avaliação do processo histórico de desenvolvimento social, econômico e territorial em suas relações com a evolução da dinâmica demográfica local; e, estudo detalhado do processo de envelhecimento da população local. O desenvolvimento da pesquisa foi baseado na revisão de bibliografia sobre diversos aspectos relevantes; no trabalho com dados secundários diversos; na aplicação de questionários; e, nas entrevistas com profissionais que trabalham com questões relativas aos idosos da cidade. A heterogeneidade de situações caracteriza a qualidade de vida da população idosa local. Este fato representa grande desafio, em virtude daquilo que se apresenta na atualidade, mas especialmente, para o futuro. As questões levantadas tornam necessária a atuação urgente e eficaz da administração e da sociedade local, com o intuito de minimizar ou solucionar as diversas demandas deste grupo populacional. / Abstract: This study had the objective of analyze the aging process of São Carlos's population, in the last 25 years. To reach this objective, three stages were considered: bibliographical revision; evaluation of the historical process of social, economic and territorial development, in its relations with the local demographic dynamic evolution; and; detailed study of the aging process of local population. The development of the research was based on: the bibliographical revision of various relevant aspects; the work with diverse secondary data; the application of questionnaires; and, interviews with people who works with questions related to the São Carlos's elderly population. The heterogeneity of situations characterizes the quality of life of local elderly population. This fact represents a great challenge, because of its present but, specially, to the future. The questions evaluated showed the need of urgent and efficient intervention of local's administration and society, with the objective of minimize or solve the diverse kind of demands from this population group. / Mestre
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Kvalitativní studie užívání alkoholu u seniorů na venkově / Qualitative study of alcohol among the elderly population in the rural areaMachová, Jana January 2020 (has links)
Background: The global trend of population ageing causes in new challenges, one of them is a wider dedication to the mental health of the elderly. In line with the mental health of the elderly the alcohol consumption issues among this group are still in place and those are one of the crucial factors that might causes negative impact on the health of the elderly. There is a large group of seniors in the Czech population living in the cities however numerous groups of the seniors still live also in the countryside where the living is very different to the one in the cities and there are also many specifics in alcohol consumption among those living in the countryside. Aims: The qualitative study aims to learn about the subjective evaluation of the alcohol consumption among the elderly in a small village community through the deep interviews and thus enriches the contemporary knowledge of the alcohol consumption level among the elderly. Methods: Semi-structured interviews complemented by the AUDIT screening questionnaire were executed within the 14 elderly in a small village during July - August 2019. The research group consisted of 5 men and 9 women aged 65 and over was selected using a simple purposeful selection method. The data were processed by thematic analysis. Results: The results of the study...
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Understanding Spiritual Life and Healthy Eating Behaviors Among Older African AmericansWheeler, Meeshay, PhD, Lee, Sung-Jin, PhD, Giddings, Valerie L., PhD 04 April 2020 (has links)
As the face of aging in our society changes, there is an increasing need for healthy interventions for the elderly. Spirituality and religion are powerful cultural influences for many African Americans and are used as resources to overcome personal, physical and health crises. Churches and other faith-based organizations have become increasingly popular settings to conduct health promotion and research studies, particularly in the African American community. The proposed study is to contextualize the spiritual life and eating behaviors of older adults (63 years and older) using the H.E.A.L. Congregation study. This survey was developed by the research team and utilized a mixed methods approach to assess the role of the church on their health and well-being and administered via Qualtrics to over 300 African Americans across the US. Preliminary analyses identified nearly 75% of participants recognized the church having a role in their spiritual and physical growth.
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The role of psychological distance in knowledge acquisition and absorptive capacity : A quantitative study investigating Nordic firms targeting the elderly populationLjungberg, Patrik, Paakkunainen, Tomi January 2016 (has links)
An aging population is becoming an increasingly growing global phenomenon, and 2050 is said to be a historical breaking point where 65+ will outnumber those between 0-5 years old. However, previous research has failed to provide sufficient explanations for consumer behavior for this particular segment, and a large incidence have been found to share the belief that technology fails to be adapted to meet their needs properly. An overlooked aspect of knowledge management was found and a research gap was thus identified addressing the role of cognition when assessing and interpreting customer needs. The purpose has been to develop a deeper understanding of certain aspects of how companies within this industry acquire and assimilate knowledge, and how product developers perceive the role of cognition in these processes. In order to shed light on these dimensions of knowledge management, a research question has been formulated as follows: "How does psychological distance affect knowledge acquisition, absorptive capacity and relationship quality?" A quantitative study was carried out involving 45 companies operating in a variety of industries ranging from robotics, hygiene and special nutrition, to eldercare and mobility products. Altogether, 51 responses were collected and analyzed using simple- and multiple regression, and were subsequently discussed based on a developed theoretical framework. The results found in this study have been used to identify combinations of cognitive dimensions and relationship quality for the purpose of developing a better understanding of its respective impact on knowledge acquisition and absorptive capacity. The findings culminated in a model through which to explain for these combinations of psychological distance, level of construal and relationship quality and their effect on the ability to acquire and disseminate new knowledge from elderly.High-level information was found easier to acquire among the respondent companies, and low-level contrarily easier to absorb. Greater psychological distance in combination with low relationship quality had a positive impact of high-level construal individuals to acquire knowledge from external sources. In contrast to these findings, perceived proximity in the psychological distances and high relationship quality were jointly found to assist in knowledge dissemination processes for low-level construal individuals.
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[en] CONTRIBUTION TO THE INTEGRATION THE MODERN LIFE OF THE ELDERLY POPULATION THROUGH THE USE OF THE AUTOMATIC TELLER MACHINE / [pt] CONTRIBUIÇÃO À INTEGRAÇÃO A VIDA MODERNA DA POPULAÇÃO ENVELHECIDA POR MEIO DA UTILIZAÇÃO DOS TERMINAIS DE AUTO-ATENDIMENTO BANCÁRIOSRENATO LUIZ ZINEZZI CASSEB 13 August 2007 (has links)
[pt] Apesar do constante avanço do envelhecimento populacional
brasileiro, a
sociedade tende a desestimular a participação da população
envelhecida nos
processos sócio-econômicos e culturais de produção e nos
processos de decisão e
integração da sociedade. Esta pesquisa pretende contribuir
a integração da
população envelhecida sugerindo recomendações que adaptem
os terminais de
auto-atendimento bancários às suas características
físicas, cognitivas e culturais. A
pesquisa foi realizada com pessoas idosas com o objetivo
de avaliar e
compreender a maneira como elas interagem com os
terminais. Os métodos
utilizados foram: dois questionários, uma análise de
similares, análise de leitura
das opções no menu do sistema dos terminais de auto-
atendimento bancários e
uma análise de hierarquização de etapas do sistema. A
partir dos resultados, foi
possível propor recomendações que podem adequar algumas
das funcionalidades
dos terminais de auto-atendimento bancários às capacidades
e habilidades de
interação da população envelhecida. / [en] Despite of the constant advances of the Brazilian
population aging, the
society tends to discourage the participation of the
elderly population in the
socioeconomic and cultural processes of production and in
the processes of
decision and integration of the society. This research
intends to contribute with
the integration of the elderly population suggesting
recommendations that adapt
the automated teller machine (ATM) to their Physical ,
cognitive and cultural
characteristics . The research was accomplished with aged
people with the
objective to evaluate and understand the way they interact
with the terminals
(ATM). The used methods were: two questionnaires, an
analysis of similarities,
an reading analysis of options in the menu of the
automated teller machine
systems and an analysis of hierarchization of stages of
the system. Starting from
the results, it was possible to propose recommendations
that can adapt some of the
functionalities of the automated teller machine to the
capacities and abilities of
interaction of the elderly population.
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Planos de saúde e envelhecimento populacional: um modelo viável? / Healthcare insurance and population aging: a viable model?Trettel, Daniela Batalha 06 March 2015 (has links)
O presente trabalho versa sobre a relação presente e futura dos planos de saúde com os idosos. Tem como pressupostos iniciais a existência de uma janela demográfica de oportunidades que será encerrada, conforme estimativa do IBGE, em 2020 e o fato de o modelo de atenção à saúde por planos de saúde se encontrar em expansão. Diante da realidade de envelhecimento populacional, pergunta-se: Os planos de saúde são um modelo viável para a garantia da atenção à saúde dos idosos? As respostas a essa questão foram construídas adotando-se como método de trabalho a análise de doutrina, jurisprudência, legislação e, quando necessário, fontes não tradicionais do Direito como os dados de órgãos de pesquisa demográficos e econômicos, a imprensa e as associações setoriais. Inicialmente tratou-se do funcionamento do setor de planos de saúde, desde a sua origem, indicando-se que historicamente sempre manteve uma relação simbiótica com o Estado, em especial com os recursos públicos. Para tanto, foram explorados temas como o ressarcimento ao SUS, o uso da estrutura dos hospitais públicos pelos planos de saúde e a existência de subsídios, abatimentos e outras formas de financiamento público das atividades deste setor. No capítulo seguinte se detalhou a questão do envelhecimento populacional, apresentando-se a legislação pertinente, os dados que revelam a composição presente e estimada da população brasileira, os principais problemas de saúde que afetam os idosos e os impactos da mudança de perfil demográfico para a política de saúde. No capítulo 3 evidenciou-se a já problemática relação dos planos de saúde com os idosos, permeada por discriminações na contratação, cobrança de mensalidades proibitivas e reajustes expulsivos, presença de cláusulas abusivas em contratos antigos, judicialização dos reajustes por mudança de faixa etária e conflitos decorrentes da prevalência da contratação na forma coletiva. Por fim, no derradeiro capítulo concluiu-se que o modelo de planos de saúde não é viável para a garantia da atenção à saúde do idoso, sendo urgente que haja uma discussão sobre qual modelo de saúde o país deseja sob pena de que as conquistas decorrentes da afirmação da saúde como direito fundamental se percam. Há características inerentes ao setor que o aparta dos idosos e, portanto, da nova realidade demográfica do país, como a prática da seleção de risco, a cobrança de mensalidades com preços insustentáveis para os idosos, o foco no modelo curativo de atenção à saúde e o afastamento da prevenção. Por outro lado, o cenário se agrava por conta das recorrentes falhas na regulação e na regulamentação, e pelo tratamento cindido, na prática, da política de saúde como se não fosse una e não devesse funcionar em harmonia, independentemente da fonte de financiamento. Há, portanto, um alto risco de que a situação dos idosos nos planos de saúde se torne insustentável, dando margem a medidas imediatistas ampliadoras dos subsídios públicos aos planos de saúde. A contrarreforma sanitária, entendida como o retrocesso das ações e dos serviços de saúde ao modelo anterior à Constituição Federal, é um perigo a ser considerado e combatido. / This paper discusses the present and future relationship between healthcare insurances companies and the elderly population. Initially, it is considered that a demographic window of opportunity exists - which will be closed, as estimated by IBGE in 2020 - and that the healthcare insurance model is expanding. Faced with the reality of an aging population, one asks: Healthcare insurances are a viable model for ensuring health care for the elderly? The methodology adopted for the construction of answers to this question are analysis of doctrine, jurisprudence, legislation and, where appropriate, non-traditional sources such as data on demographic and economic research institutions, the press, and sectorial associations. At first, the functioning of the health insurance sector was studied, from its origins which historically maintained a symbiotic relationship with the State, particularly with public resources. For this, themes were explored such as the reimbursement to SUS, the use of the structure of public hospitals by health insurance, and the existence of subsidies, rebates and other forms of public funding of the activities of this sector. The next chapter detailed the issue of population aging, presenting the relevant legislation, the present and projected data about the composition of the population, the main health problems that affect the elderly, and the impacts of demographic change for health public policy. Chapter 3 showed the already problematic relationship between healthcare insurance companies and the elderly population which involves discrimination when hiring, prohibitive fees and expulsive adjustments, unfair terms in old contracts, judicial discuss of adjustments for age and conflicts arising from the prevalence of collective contracts. Finally, the last chapter concludes that the health insurance model is not viable for the guarantee of health care for the elderly. There is an urgent need for a public discussion about which health model Brazil wants to otherwise, the achievements of the proclamation of health as a fundamental right are in dangerous. There are inherent characteristics of the health insurance sector that not considerers the elderly needs, as the practice of risk selection, the charging of unsustainable prices for the elderly, the focusing on the curative model of health care and the removal of prevention. On the other hand, the scenario worsens because of recurrent failures in regulation, and the split treatment of the health public policy as if it was not only one and should not work in harmony, regardless of funding source. There is therefore a high risk that the situation of older people in health insurance becomes unsustainable, giving rise to the investment of more public money in the sector. The retreat to the previous model of health attention, adopted before the promulgations of the Federal Constitution of 1988, is a danger to be considered and dealt with.
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