Artigos

Conteúdo (article):

INTRODUCTION
Demographic and epidemiological transitions are global events characterized by
declining fertility rates, increased life expectancy, and changes in family structure and
morbidity, disability, and death patterns. 1-4 Population aging brings physical, economic,
social, and psychological consequences, including new challenges and demands, such as
the need for financial support and care. 1,4 This situation must be addressed by society
and policymakers to formulate public policies that promote and ensure a better quality
of life and health status of older adults 1,4 .
Social and economic factors stand out among the social determinants of health 4-8 .
On the other hand, the health situation of older adults 9 , such as the inability to perform
activities, can also determine the receipt of social support 10 . Social support refers to the
functionality and quality of individuals’ social networks when they need assistance in
different areas and aspects throughout the life course. 12 National and international
literature emphasize that receiving financial and care support is positively related to
demographic, socioeconomic, and health characteristics. 4-12
In Brazil, reducing inequalities by 2030 constitutes the Sustainable Development
Goals, which aim to promote social, economic, and political inclusion for all, the
implementation of adequate social protection measures and systems, and universal
coverage of health services, including financial protection and access to essential
services 13 . The likelihood of receiving financial support among older adults is higher
among individuals living without a partner, with low income, and with poor self-rated
health. However, receiving care is higher among women, those with high income,
chronic illness, poor self-rated health, and inability to perform activities of daily
living. 4,7,9-11,14
Despite the growing recognition of the importance of financial and care support,
the scientific literature has addressed chiefly social support as an explanatory variable,
with less attention paid to its receipt as an outcome. 15-16 Studies analyzing support as a
dependent variable are still scarce, limiting understanding of the factors that influence
its distribution among population groups. Furthermore, there is a predominance of
cross-sectional studies, limiting the identification of causal relationships and trajectories
over time. The lack of longitudinal studies is a gap highlighted in the literature. 17
Although cross-sectional, this study contributes by exploring the perception of support
received and analyzing the factors associated with receiving financial and care support,
broadening the understanding of inequalities in this area. Another limitation in the
literature concerns the heterogeneous measurement and definition of social support
types, hindering comparisons between studies and the consolidation of evidence. 17
Thus, investigating the receipt of financial and care support among older adults
contributes to the formulation of public policies and the organization and planning of
services, since it allows for a description based on the characteristics of the population,
thus identifying social and health inequities, facilitating the confrontation of
inequalities. 4-17 This study aimed to examine the receipt of financial and care social
support by sociodemographic characteristics, health status, and primary health care
(PHC) model in the cohort of older adults from Bagé, Rio Grande do Sul, from 2008 to
2016.
METHODS
Study design

Cohort study with older adults (60 years or older) living in the urban area of
Bagé, Rio Grande do Sul, Brazil, in 2008 and 2016/2017.
Data collection
Before beginning fieldwork, a pilot study was conducted with female older
adults living in a long-term care facility in the municipality to evaluate the
questionnaire’s application. The first data were collected in 2008, when 1,593 elderly
individuals were interviewed. 18 In both 2008 and 2016, respondents completed a
structured questionnaire with pre-coded questions, which previously trained
interviewers coordinated by field supervisors administered at the older adults’ homes.
Study location
The municipality of Bagé is located in the Brazilian South and has
approximately 15% of residents aged 60 or over. It covers a little over 4,000 km 2 , has a
population density of 28.52 inhabitants per km 2 , and a Municipal Human Development
Index (MHDI) of 0.740 19 . In 2008, the municipality had 15 Brazilian Family Health
Strategy (BFHS) teams, covering 51% of the population and five PHC units with a
traditional care model, responsible for serving the remaining inhabitants 18,20 .
Sample selection and eligibility criteria
The SIGa-Bagé cohort sample included urban residents, proportionally
distributed by the territory health service (Traditional or BFHS). Starting points were
randomly selected to ensure equiprobability, skipping six households, where the
households on the left were considered eligible. All residents aged 60 or older were
considered eligible and invited to participate in the study. Institutionalized older adults
(hospitals, long-term care facilities, and those deprived of liberty), with mental
disabilities, and without a partner or guardian, were ineligible for the study. During the
2016 follow-up, all addresses were revisited, and an attempt was made to locate the new
address in cases of change of place of residence. Interviewers made at least three
attempts to interview or schedule an appointment with family members. For older adults
with communication difficulties, a companion was requested to assist with data
collection. 18 Further details on sample size calculation and the sampling process can be
found in the methodological article 18 .
Losses and refusals
Elderly individuals living in long-term care facilities, those deprived of liberty,
those who moved from urban to rural areas or another municipality, and those who were
not found at home after three attempts were considered losses. Individuals who verbally
stated they no longer wished to participate in the study were considered refusals.
Dependent variables
Receiving financial support or care from family or others was the dependent
variable in this study and was identified when older adults answered “yes” to each of
the following questions: “Do you receive financial support from family or others?” and
“Do you receive care from family or others?” Interviewers instructed older adults to
consider family members who did or did not live in the same household. If older adults
asked who “others” were, interviewers would describe them as neighbors, friends,
caregivers, community workers, or other professionals.
Independent variables and instruments

The independent variables corresponding to the sociodemographic
characteristics were age group (up to 74 years; 75 years or more), gender (male;
female), marital status (with partner; without partner), living alone (no; yes), schooling
years (illiterate; 1-7 years; 8 years or more), work in the last month (no; yes) and
retirement pension (no; yes). To assess the health situation, the variables adopted were
self-rated health (good/excellent; very poor/poor/fair), inability to perform basic
activities of daily living (BADL) (independent; dependent); inability to perform
instrumental activities of daily living (IADL) (independent; dependent) and leaving
home in the last month (went out every day; went out once a week; went out between 2
and 4 times a week and did not go out on any day).
The inability to perform BADLs was assessed using the Katz Scale 21 , and older
adults with least one negative response to questions about the ability to independently
perform self-care tasks such as bathing, dressing, going to the bathroom, feeding
themselves, and being continent were defined as dependent. IADLs were assessed using
the Lawton and Brody Scale, 22, and dependent individuals were characterized by a
negative response to at least one of the questions about tasks that enable community
life, such as cleaning the house, handling small objects, shopping, preparing food, using
the telephone, and managing finances. Regarding health services, the PHC model
(traditional and BFHS) in the area where the elderly individual resided in 2008 was
considered.
Data analysis
We performed descriptive analysis with absolute and relative frequencies. The
chi-square test for heterogeneity and Fisher’s exact test were adopted in the bivariate
analysis as per the assumptions. Poisson regression with robust variance adjustment was
used to calculate crude and adjusted prevalence ratios (PR) and their respective 95%
confidence intervals (95% CI). Hierarchical modeling was performed in the multivariate
analysis.
Initially, variables associated with the outcomes under study (p<0.20) were
included in the model to consider potential confounding factors. In the modeling stage,
independent variables were included from the distal (first) to the proximal (third) levels,
in the following order: sociodemographic factors; health status; and care model
(variable included only in the outcome analyses, care receipt). A significance level of
5% (p<0.05) was adopted. Analyses were performed using the Stata ® statistical
program, version 15.1.
Ethical aspects
The Research Ethics Committee of the Faculty of Medicine of the Federal
University of Pelotas approved the study (File N° 15/08/2008, Opinion
N°678.664/2014). Ethical principles were ensured through the Informed Consent Form,
guaranteeing the right to not participate in the research and anonymity in the
dissemination of results.
RESULTS
In 2008, almost all the older adults (1,592 of 1,593 respondents) answered
questions regarding receipt of financial or care support. In 2016/2017, 638 deaths
(40.1%) were identified via information systems or family reports, leaving 955 older
adults alive (59.9%). Seven hundred thirty-five of these (77.0%) were effectively

interviewed, with losses and refusals totaling 220 18 . However, 711 responded to the
outcomes studied in the 2016 follow-up.
Regarding the characterization of the sample included in this study in the 2008
follow-up (n=1,593), we found that most older adults were in the age group of up to 74
years (68.8%); 62.8% were female; 51.3% lived with a partner, and 54.5% had one to
seven schooling years. Approximately 82.0% of the total did not live alone; about
72.0% were retired, and approximately 87.0% did not work; 53.5% were covered by the
BFHS; 41.2% self-rated their health situation as very poor/poor/fair; 10.6% were
incapable of performing BADLs; 34.2% were incapable of performing IADLs and
14.9% did not leave home any day in the last month (data not shown in the tables).
Regarding the characterization of the 2016/17 follow-up sample (n=735), we
found that most older adults were 75 or older (57.8%); 65.3% were women; and
approximately 58.0% lived without a partner (single, widowed, and separated); around
56.0% had 1-7 schooling years; almost 76.0% did not live alone; 79.7% were retired;
approximately 94.0% did not work; 54.4% were covered by the BFHS; 46.3% self-rated
their health situation as very poor/poor/fair; 13.5% were unable to perform BADLs;
39.6% were unable to perform IADLs, and 19.0% did not leave home any day in the last
month (data not shown in the tables).
The frequency of receiving financial support and care in 2008 was 20.2%
(95%CI 18.3-22.3) and 54.9% (95% CI 51.4-56.3), respectively, while in 2016 it was
16.9% (95% CI 14.3-19.9) and 37.0% (95% CI 33.5-40.6) (Table 1). There was a
decrease in the receipt of care of approximately 18.0 percentage points in the eight years
(from 2008 to 2016/17), and this difference was statistically significant (Table 1).
TABELA 1
Table 2 presents the crude and adjusted analysis of receipt of financial support
by sociodemographic characteristics. In the 2008 follow-up, after adjusted analysis, it
was observed that the frequency of receiving financial support was 28.0% higher among
older adults who lived without a partner (PR=1.28 95% CI 1.05-1.56), 62.0% higher
among non-retired individuals (PR=1.62 95% CI 1.32-1.94), and 50.0% higher among
those who did not work (PR=1.50 95% CI 1.03-2.17) (p<0.05). Also, after adjusting for
confounding factors, in the 2016 follow-up, women were 83.0% more likely to receive
financial support than men (PR=1.83, 95% CI 1.23-2.73) (p<0.05).
TABELA 2
In 2008, older adults with an inability to perform BADLs were 99.0% (PR=1.99,
95% CI 1.59-2.49) more likely to receive financial assistance than those without an
incapacity. Those who did not leave home any day in the last month were 48.0% more
likely to receive financial assistance than those who went out daily (PR=1.48, 95%CI
1.11-1.96) (p<0.05). In 2016, older adults with an inability to perform BADLs were
67.0% more likely to receive financial assistance than those without an incapacity
(PR=1.67, 95% CI 1.13-2.49) (p<0.05) (Table 3).
TABELA 3
In 2008, after adjustments, the prevalence of receiving care was 13.0% higher
among older adults aged 75 years or older (PR=1.13 95% CI 1.02-1.24), 18.0% higher
for females (PR=1.18 95% CI 1.05-1.31) and 19.0% higher for older adults who lived
without a partner (PR=1.19 95% CI 1.07-1.32) (p<0.05). Older adults who lived alone
were 34.0% less likely to receive care than those who did not live alone (PR=0.66, 95%

CI 0.56-0.77) (p<0.001). In 2016, older adults who did not work received
approximately 35.0% less care than those who worked (PR=0.65, 95% CI 0.46-0.92)
(Table 4).
TABELA 4
In 2008, those with an inability to perform IADLs were 53.0% more likely to
receive care than those without an inability, after adjustments (PR=1.53, 95% CI 1.39-
1.69) (p<0.001). The probability of receiving care was 20.0% lower among those who
did not leave home any day in the last month than those who went out every day
(PR=0.80, 95% CI 0.70-0.92) (p<0.001).
The adjusted analysis for potential confounding factors in 2016 showed that
older adults living in an area covered by the BFHS were 84.0% more likely to receive
care than those living in traditional areas (PR=1.84, 95% CI 1.47-2.29) (p<0.001). Older
adults with instrumental disabilities of daily living received 56.0% more care than those
without disabilities (PR=1.56, 95% CI 1.28-1.89) (p<0.001). Older adults who did not
leave home any day in the last month were approximately 40.0% less likely to receive
care than those who left home daily (PR=0.61, 95% CI 0.46-0.80) (p<0.05) (Table 5).
TABELA 5
DISCUSSION
This study’s findings showed an association between receiving financial support
and care by sociodemographic and health characteristics of older adults at two points in
time. In 2008, receiving financial support was associated with marital status, retirement,
and employment, controlling for potential confounders. Functional disabilities were
observed as a common characteristic associated with greater receipt of financial and
care support in 2008 and 2016. Older individuals with IADL disabilities and who had
not left home any day in the last month stood out as common characteristics associated
with receiving care in both follow-ups. In 2016, the relevance of the BFHS healthcare
model in receiving care support was confirmed.
The frequency of receiving financial support was 20.2% in 2008 and 16.9% in
2016. These results are similar to recent findings published in international and national
studies. An international study found a ten percentage point reduction (from 20.0% to
10.0%) in the receipt of financial assistance among Mexican older adults over a
decade. 23 A study of older adults living in rural areas found a variation in the frequency
of receiving financial assistance from 10.8% to 20.8%. 24
Regarding the frequency of receiving care, it was 54.9% in 2008 and 37.0% in
2016. Corroborating the finding of the last follow-up, a national study in Rio de Janeiro
with 369 older women found a prevalence of 31.5%. 25 We should emphasize that the
literature contains a wide variation in the operational definition and measurement of the
receipt of social support, hindering the comparison of results and may explain the
discrepancy between the results of this study and other findings in the literature.
One of the hypotheses for the decrease in care receipt, in the case of a cohort
study, can be attributed to the non-independence of the sample. Older adults may end up
living alone, losing their partners or family members, thus reducing their social support
network and having a decreased perception of receiving care, in addition to the
possibility of survivorship bias.
In demographic terms, the probability of receiving care support was higher
among very old seniors (75 years or older) and women, confirming previous findings in

the literature 14,26 . The demand for care due to the older adult’s health situation increases
with age. However, there is a declining perception of support, mainly due to the reduced
social network, not only because of the deaths of family members and friends but also
the increased physical disabilities that hinder older adults’ movement and search for
help 14 .
Regarding gender, studies confirm that women receive financial support and
care more frequently. 4,14,25 Sousa et al. found a statistically significant association
between greater receipt of social support among older women, those who lived without
a partner, and those who did not work. 25 Researchers state that men are more restrictive
in their social relationships, focusing on their partner and closest relatives 4 . In contrast,
women generally have larger social networks and offer more social support than men. 4
The difference between social and gender roles may be directly related to the findings:
women are culturally assigned the role of caring for the home, family, or children, while
men are assigned the role of providing, despite current changes in women’s roles in
society and within the home. 4
Regarding sociodemographic characteristics, current scientific knowledge shows
that the values of benefits such as retirement are insufficient and do not meet the needs
of older adults, leaving many to become financially dependent, especially on their
children. 4,9,17 According to international studies, the participation of older adults in work
is a consequence of financial deprivation and lack of support. 27 In general, older adults
spend on healthcare, mainly medication 9 .
Research reveals that older adults are partially or totally financially dependent
on another person. The authors stated that financial risk and lack of social support can
cause older adults to abandon treatment for some illness or condition due to the need to
pay for healthcare. 9,17 Authors suggest that retirement can have a protective effect against
lack of access to healthcare, increasing access to healthcare, and reducing catastrophic
expenditures. Notably, social security encompasses health, pensions, and social
assistance. The independence of older adults is directly related to socioeconomic and
health issues, such as work and functional capacity. 28-33
The 2008 adjusted analysis showed that older adults who lived alone were 32%
less likely to receive care from family or others than those who did not live alone.
Aligned with these findings, authors point out that older adults who live alone are three
times more likely to experience a lack of perceived care than those who do not live
alone. 25
According to national literature, in general, older adults who live with family
members assume the role of providing financial support and are the family heads. 29,33 A
study using data from the National Household Sample Survey indicated that living with
other people is an indication of poverty and an attempt to combat it by increasing
household income. It also showed that receiving a minimum wage through government
policies such as the continuous benefit, retirement, or pension is important in
determining the older adult’s family arrangement. 30
Authors portray income as a two-way street in determining the family
configuration of the household, since on the one hand, receiving an income can provide
older adults with the autonomy and independence of living alone and, on the other hand,
families in vulnerable situations come together in the same residence to share the
benefit, often being the main income 30 .

This study’s findings corroborate national and international literature regarding
the relationship between older adults’ functional disability and receiving financial
support or care. 11,14,33-34 A Chinese study showed in the multivariate analysis, after
adjusting for demographic and socioeconomic characteristics, that older adults with
disabilities were 135% more likely to receive financial support than those without
disabilities. 33
Another study showed that the greater the level of dependence of older adults
with age, the greater their expenditure on medications or health interventions, thus
requiring financial support. 32 Therefore, some socioeconomic, demographic, and public
policy determinants are of paramount importance in achieving equity in health financing
for older adults. 8 Researchers point out that lower income and insufficient service
provision, especially in healthcare, limit independence, fail to meet health needs, and
deteriorate living conditions 25 .
International research showed, after controlling for demographic,
socioeconomic, and health factors, that older adults with an inability to perform
activities were 4.2 times more likely to receive nursing care than those without
dependency. 14 The same authors showed that receiving nursing care is more frequent
among women, older seniors, those living without a partner, those with dependency to
perform basic activities of daily living, and those with a negative self-rated health. 14
Aging is accompanied by changes in health status, such as the development of
functional and psychosocial disabilities that increase the demand for support from
family, friends, and society. 14 A national study conducted in PHC identified that
individuals with a physical illness, especially a more severe one, tend to expand their
social support network. 33 Authors show that dependent older adults receive more
support, not only in material terms but also in terms of care 11 . These findings
corroborating those of Nunes et al. (2017), who state in the analysis adjusted for
sociodemographic, behavioral and health condition factors that the probability of
receiving home care in the last three months among older adults was 150.0% and 61.0%
higher among those with incapacity for IADL and BADL, respectively, when compared
to those without disabilities 34 .
Despite the scarcity of quantitative studies that address the importance of the
healthcare model provided to older adults and their perception of care, some researchers
highlight the relevance of access to healthcare services in contributing to a high
perception of social support 14,25 . Individuals living in areas covered by the BFHS are
encouraged to operate a family and community support network through coordinating
actions that advocate comprehensive and continuous care for individuals according to
older adults’ health needs, bringing professionals closer to users, thus increasing the
social support network 14,25 . Associating the care model with the receipt of care showed
relevance as individuals age in the present study. Notably, there is a need for public
policymakers to organize and establish programs that favor social support for older
adults in the community and, especially, in their homes 14 .
The political and economic crisis, with austerity measures following Dilma
Rousseff’s impeachment, initiated under the Temer administration and maintained by
Bolsonaro, prioritized anti-democratic, authoritarian, and regressive agendas, with cuts
to social policies and the removal of labor and social security rights. 35-36 There has been
a growing commodification and loss of social rights 35 , although the Unified Health
System (SUS) and its programs have contributed to addressing health inequalities.

Constitutional Amendment N° 95 froze primary spending for 20 years, affecting
SUS funding and the population’s health, in a backdrop of population growth, aging,
and increased demand for care. The new National Primary Care Policy is part of this
agenda of setbacks, proposing changes in the work of community health workers and
fragmented care. We also observe a declining number of pharmacies and municipalities
in the Farmácia Popular Program, the elimination of multidisciplinary teams, changes
in financing with Previne Brasil, and the discontinued the Mais Médicos Program. 38-39
The BFHS covers more than 130 million people in Brazil, focusing on at-risk
groups, ensuring an equitable public health system despite the challenges. 40 The BFHS
plays a relevant role in recognizing social, economic, and health vulnerabilities. In
various care aspects, it can track and identify the need for financial support and care for
individuals, families, and communities. We should emphasize that efforts among
managers must be made to formulate and implement a National Care Policy, requiring
not only the family to assume the role of care, but also the State, which is increasingly
less active, to take responsibility for tackling social, economic, and health inequalities.
Decision-making and some strategies, such as increasing BFHS coverage,
preserving the work process of community workers, providing multidisciplinary teams
linked to family health teams, advancing the implementation of telemedicine, increasing
spaces for social interaction, such as social centers for older adults, and guaranteeing the
Farmácia Popular Program, are potential solutions to the challenges 41 . Furthermore, it
is essential to review current social security and labor reforms and reflect that health
systems are forms of social protection and rights guaranteed by the Federal
Constitution 42 .
On a positive note, the analysis of receipt of financial support and care as a
dependent variable stands out, exploring its variation per sociodemographic and health
characteristics. This approach is innovative, given the national knowledge production
on social support over the last five years. Another point is the description of the
direction and magnitude of receipt of financial support and care using Poisson
regression with robust variance.
The results stand out for their relevance, especially for vulnerable older adults,
given the consequences of the COVID-19 pandemic. The cross-sectional analysis of the
cohort of older adults across two periods helps highlight aspects relevant to the
formulation and guidance of public policies, such as universal retirement, social
benefits, and the BFHS care model.
Potential limitations should be considered. Bidirectionality and reverse causality
may occur in some associations between outcomes and socioeconomic and health
characteristics, because, although this is a cohort study, the analyses were cross-
sectional at each follow-up. Another limitation concerns the lack of independence of the
study samples (cohort). Losses due to death, refusal, and inability to locate were
observed in the 2016 follow-up, which may have generated survival bias.
There may also have been a loss of statistical power to examine the associations.
Some associations may not have been evidenced. Regarding the operationalization of
the dependent variables, the subjectivity of the term “others” in the measurement
question may have hampered the estimates and the characterization of the support
received, as participants may not consider the role of the State in receiving financial
support or care, even if they consider the role of community health workers. In some
cases, the report may be more about the individual’s belonging to the community than
an important component in the implementation of care by managers and government

officials. Finally, the lack of characterization of who received older adults’ support
limited the knowledge of who benefited.
The Brazilian population’s aging encompasses important social and public
health issues, in addition to the demographic and epidemiological transition, marked by
the greater number of women in the labor market, the decreased availability of care for
older adults due to smaller family sizes, and growing marital separations and chronic
degenerative diseases 8 . There is a need to implement care policies for the elderly
population, expand BFHS coverage, and recommend that managers establish and
guarantee social security policies to reduce social and health inequalities.
CONCLUSION
We conclude that receiving financial support and care varied by
sociodemographic characteristics, health status, and the primary care model. We
underscore the importance of reflecting on the social role of older adults in the family,
reinforcing the need to strengthen interactions and social support throughout life. Given
the economic difficulties and deficient income distribution and social security process,
the State must expand and update social protection policies, including strengthening
family support to ensure an improved quality of life and health of older adults.
Regarding the practice of healthcare professionals, collecting this information
(receipt of financial support and care) is essential when providing care to older adults.
The results presented are expected to contribute to broadening the discussion and
formulating social security and public health strategies, besides promoting, preventing,
and monitoring the health status of older adults.
Collaborators
Conception and design or data analysis and interpretation: Venturin B, Thumé E,
Saes MO, Soares MU, Machado KP, Facchini LA. Writing the article or critically
reviewing the relevant intellectual content: Venturin B, Thumé E, Saes MO, Soares
MU, Machado KP, Facchini LA. Final approval of the version to be published: Venturin
B, Thumé E, Saes MO, Soares MU, Machado KP, Facchini LA.
Acknowledgments
This work was conducted with the support of the Coordination for the Improvement of
Higher Education Personnel – Brazil (CAPES) – Financing code 001.

REFERENCES
1. Vollset SE, Goren E, Yuan CW, Cao J, Smith AE, Hsiao T, et al. Fertility, mortality,
migration, and population scenarios for 195 countries and territories from 2017 to 2100:
a forecasting analysis for the Global Burden of Disease Study. Lancet 2020;396:1285-
1306.
2. Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah
F, et al. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE),
and population estimates in 204 countries and territories, 1950-2019: a comprehensive
demographic analysis for the Global Burden of Disease Study 2019. Lancet
2020;396:1160-1203.
3. Lopes JM. Transição demográfica e epidemiológica. In: Lopes JM, Guedes MBOG.
Fisioterapia na atenção primária: manual de prática profissional baseado em evidência.
São Paulo: Atheneu; 2019.
4. Sant’Ana LAJ, D’Elboux MJ. Social support and expectation of elderly care:
association with sociodemographic variables, health, and functionality. Saúde debate
2019;43(121):503-519.
5. Organização Pan-Americana de Saúde & Organização Mundial da Saúde. Plano
Estratégico da Organização Pan-Americana da Saúde: equidade, o coração da saúde,
2020-2025. Washington, DC; 2020.
6. Mello FCC, Costa RFR, Corso JM. Modelo conceitual aplicável a estudos sobre
determinantes sociais da saúde em municípios brasileiros. Saúde soc 2020;29(2):1-14.
7. Tavares DMS, Oliveira NGN, Ferreira PCS. Apoio social e condições de saúde de
idosos brasileiros da comunidade. Cienc Enferm 2020;26.
8. Yamashita CH. O impacto do cuidado em famílias de pacientes com incapacidade e
dependência em diferentes contextos de vulnerabilidade [Tese]. São Paulo:
Universidade de São Paulo, Escola de Enfermagem; 2019.
9.Rabelo DF, Silva J. Vulnerabilidades em idosos: saúde, suporte social, chefia e
sustento familiar. Saúde e Pesquisa 2021;14(Supl. 1):1-14.
10. Nevot-Caldentey L, Socías CO, Brage LB. Cluster analysis in the definition of
profiles of elderly people with dependency in Palma de Mallorca: relationship between
health, social support, and dependency. Rev Esp Salud Publica 2020;2(94).

11. Brito TRP, Nunes DP, Duarte YAO, Lebrão ML. Redes sociais e funcionalidade em
pessoas idosas: evidências do estudo Saúde, Bem-Estar e Envelhecimento (SABE).
Revista bras epidemiol 2019;21(suppl.02):1-15.
12. Okumura A, Espinoza MC, Boudesseul J, Heimark K. Venezuelan Forced
Migration to Peru During Sociopolitical Crisis: an Analysis of Perceived Social Support
and Emotion Regulation Strategies. Journal of International Migration and Integration
2021;1-34.
13. Organização das Nações Unidas Brasil. Os Objetivos de Desenvolvimento
Sustentável no Brasil. Brasília, DF, Brasil: Nações Unidas. 2022.
14. Burzynska M, Bryla M, Bryla P, Maniecka-Bryla I. Factors determining the use of
social support services among elderly people living in a city environment in Poland.
Health Soc Care Community 2016;24(6):758-768.
15. Ximenes VM, Nepomuceno BB, Moura Jr. JF, Abreu MKA, Ribeiro GO.
Propriedades Psicométricas da Versão Reduzida da Escala de Percepção de Suporte
Social. Psico-USF 2020;25(2):371-384.
16. Oliveira SG, Mello FE de, Dias LV, Cordeiro FR, Porto AR, Hartmann M.
Instrumentos para avaliar a sobrecarga e a qualidade de vida de cuidadores. Av Enferm
2021;39(1):93-111.
17. Muhammad T, Srivastava S, Sekher TV. Association of self-perceived income
sufficiency with cognitive impairment among older adults: a population-based study in
India. BMC Psychiatry 2021;256:1-14.
18. Thumé E, Kessler M, Machado KP, Nunes BP, Volz PM, Wachs LS, Soares MU,
Saes MO, Duro SM, Dilélio AS, Facchini LA. Cohort study of ageing from Bagé
(SIGa-Bagé), Brazil: profile and methodology. BMC Public Health 2021;21(1):1-9.
19. Instituto Brasileiro de Geografia e Estatística (IBGE). Cidades e Estados. Rio de
Janeiro: IBGE, 2022.
20. Soares MU, Nunes BP, Wachs LS, Kessler M, Dilélio AS, Soares DC, Facchini LA,
Thumé E. Relações sociais informais em idoso com Hipertensão e/ou Diabetes. Revista
de Enfermagem da UFSM 2018;8(4):780-793.
21. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the
aged: The Index of ADL: a standardized measure of biological and psychosocial
function. JAMA 1963;185(12):914-919.
22. Lawton MP, Brody EM. Assessment of older people: Self-maintaining and
instrumental activities of daily living. Gerontologist 1969;9(3):179-86.
23. Orozco-Rocha K, Gonzalez-Gonzalez C, Wong R. Family ​​ received by Mexican
older adults across socioeconomic strata: changes over a critical decade. Rev Panam
Salud Publica 2021;1(45):1-9.
24. Oliveira NA, Souza EN, Brigola AG, Rossetti ES, Terassi M, Luchesi BM, et al.
Idosos cuidadores em diferentes arranjos de moradia: comparação do perfil de saúde e
de cuidado. Rev Gaúcha de Enferm 2019; 40:1-8.
25. Sousa AI, Silver LD, Griep RH. Apoio social entre idosas de uma localidade de
baixa renda no município do Rio de Janeiro. Acta paul enferm 2010;23(5):625-631.
26. Garbaccio JL, Tonaco LAB, Estêvão WG, Barcelos BJ. Aging and quality of life of
elderly people in rural areas. Rev Bras Enferm 2018;71(suppl 2):724-732.

27. Sitoresmi SRG, Istiqomah I, Sukiman S. Why do the elderly keep working?
Trikonomika 2020;19(2):96-102.
28. Noronha K, Andrade LMB, Camargos MCS, Machado CJ. Limitação funcional e
cuidado dos idosos não institucionalizados no Brasil, 2013. Cad saúde colet
2021;29(esp.):59-72.
29. Rabelo DF, Neri AL. Tipos de configuração familiar e condições de saúde física e
psicológica em idosos. Cad Saúde Pública 2015;31(4):874-884.
30. Paulo MA, Wajnman S, de Oliveira AMCH. A relação entre renda e composição
domiciliar dos idosos no Brasil: um estudo sobre o impacto do recebimento do
Benefício de Prestação Continuada. Rev bras estud popul 2013;30(sup.):S25-S43.
31. Aragão EIS, Campos MR, Portugal FB, Gonçalves DA, Mari JJ, Fortes SLCL.
Padrões de Apoio Social na Atenção Primária à Saúde: diferenças entre ter doenças
físicas ou transtornos mentais. Ciênc saúde colet 2018;23(7):2339-2350.
32. Nunes JD, Saes MO, Nunes BP, Siqueira FCV, Soares DC, Fassa MEG, Thumé E,
Facchini LA. Indicadores de incapacidade funcional e fatores associados em idosos:
estudo de base populacional em Bagé, Rio Grande do Sul. Epidemiol Serv Saúde
2017;26(2):295-304.
33. Hao X, Gu J, Ying X, Bo T. Social support and care needs of the disabled elderly
population: An empirical study based on survey data from Beijing, China. Bioscience
trends 2017;11(5):507-515.
34. Dondo M, Monsalvo M, Garibaldi LA. Determinantes de la equidad en el
financiamiento de los medicamentos en Argentina: un estudio empírico. Cad Saúde
Pública 2016;32(1):1-14.
35. Rossi TRA, Sobrinho JEL, Chaves SCL, Martelli PJL. Crise econômica, austeridade
e seus efeitos sobre o financiamento e acesso a serviços públicos e privados de saúde
bucal. Ciênc saúde coletiva 2019;24(12):4427-4436.
36. Morais HMM, Oliveira RS, Vieira-da-Silva LM. A coalização dos empresários da
saúde e suas propostas para a reforma do sistema de saúde brasileiro: retrocessos
políticos e programáticos (2014-2018). Ciênc saúde coletiva 2019;24(12):4479-4488.
37. Nogueira KWAS, Sobrinho SJ. A nova Política de Atenção Básica à Saúde:
impactos perceptíveis em uma equipe de saúde da família no município de Alagoa
Nova-PB. Cadernos de Ciências Sociais Aplicadas 2019; 16(28):25-40.
38. Almeida ATC, Sá EB, Vieira FS, Benevides RPS. Impacto do Programa Farmácia
Popular do Brasil sobre a saúde de pacientes crônicos. Rev Saude Publica 2019;53:1-11.
39. Massuda A. Mudanças no financiamento da Atenção Primária à Saúde no Sistema
de Saúde Brasileiro: avanço ou retrocesso? Ciênc saúde coletiva 2020;25(4):1181-1188.
40. Giovanella L, Bousquat A, Schenkman S, Almeida PF, Sardinha LMV, Vieira
MLFP. Cobertura da Estratégia Saúde da Família no Brasil: o que nos mostram as
Pesquisas Nacionais de Saúde 2013 e 2019. Ciênc Saúde Colet
2021;26(Suppl.1):25432556.
41. Glidden RF, Borges CD, Pianezer AA, Martins J. A participação de idosos em
grupos de terceira idade e sua relação com satisfação com suporte social e otimismo.
Boletim – Academia Paulista de Psicologia 2019; 39(97):261-275.

42. Lobato LVC, Costa AM, Rizzotto MLF. Reforma da previdência: o golpe fatal na
seguridade social brasileira. Saúde debate 2019;43(120):5-9.