Journal special edition on older people and COVID-19 in Brazil
Summary and translation: Thais De Carvalho Rodrigues Lopes
Cadernos de Saúde Púlica (in English, Reports in Public Health) is a monthly journal from the Sergio Arouca National School of Public Health (ENSP) and Oswaldo Cruz Foundation (FIOCRUZ), both based in Brazil. In a recent issue, the journal published a series of articles about aging in Brazil amid COVID-19. In particular, the issue presents the national Longitudinal Study of Aging (ELSI-Brasil), an initiative based on remote interviews with a representative sample of the Brazilian population aged 50 or older.
Brazil gained prominence in the pandemic, occupying 2nd place in the global ranking of infections and deaths. Considering the risk factors among older people, the ELSI-COVID-19 initiative arose as a strategy to understand the effects of the pandemic in the lives of older adults. The methodology of the study had to consider the restrictions imposed by the pandemic on social interaction. Thus, the research took place via phone between late May and early June 2020 with 6,149 people. Its results show regional discrepancies in people’s experiences of COVID-19. For instance, while only 10.4% of all interviewees reported any COVID-19 related symptoms up to 30 days prior to the interview, this percentage soared to 50% in the Northern region. In addition, the number of those people reporting symptoms that had sought care, was also concerning: only 33.6% of respondents, and this percentage was even lower in the Southern region. The research also identified delays and cancellations of health procedures: of each 6 people interviewed, 1 had to reschedule surgery or medical care. This number was also higher for women and for people with higher levels of education, along with patients with chronic illnesses.
The study also investigated compliance with COVID-19 prevention protocols among older people showing less adherence to social distancing or use of facemasks and hand washing habits. Considering ‘social distancing’ as a restriction to the home environment in the past 7 days, the research found only 32.8% of participants had stayed at home at all times and 15.7% left the house every day. The reasons to go out were to ‘buy food and medicine (74.2%), to work (25.1%), to pay bills (24.5%), for health care (10.5%). 8.8% also broke protocol to see family and 6.2% to exercise. Of those respondents leaving the house, 97.3% wore face masks and washed their hands regularly. Men were more likely to go out, and for different reasons than women. Male respondents tended to leave home for work and exercise, whereas women went out for health reasons. There was a higher tendency to leave the home among highly educated men in urban centres.
Research also investigated whether people with healthier habits were more likely to adopt the COVID-19 prevention protocol. For this purpose, unhealthy behaviours were defined as smoking, consuming alcohol, not eating fruits/vegetables and lack of regular exercise. The study found people with a regular habit of exercising were less likely to stay at home. Former smokers did comply with the necessity of wearing a facemask, whereas people who exercised regularly were less likely to do so. Respondents with a low-risk level of alcohol consumption sanitised their hands more often. The study indicated that certain health behaviours could be considered as another factor of risk among the vulnerable population.
Another paper discussed the protective behaviours of people with comorbidities. It showed married women aged 50-59 years in urban areas as the ones most likely to present multi-morbidity. Those were among the respondents who left the house less often – only 10.3% went out every day. For respondents with multi-morbidities who left home more often, preventive measures were common habits: there was nearly universal adoption of hand washing (>98%) and face masks (>96%) among all respondents. Women with multimorbidities were more likely to stay at home, and the tendency towards social distancing was higher for older people, and lower for people who are more educated. In sum, the study showed that respondents with comorbidity were more cautious, but stressed the consequences of isolation on these people’s access to health care.
The ELSI-COVID-19 survey was able to examine characteristics of older people with a positive diagnosis. Only a small group (2.4%) of respondents had received a positive diagnosis at the time of inquiry, and only a half of this 2.4% had been confirmed as COVID-19 positive by a RT-PCR test. The study found and a higher likelihood of contagion among specific groups of older Brazilians, based on the prevalence of a positive diagnosis. The highest risk was for people aged 50-60 years, with lower household income, comorbidities and residing in the Northern region of Brazil, where COVID-19 was more prevalent. These findings can potentially help shape targeted campaigns and health care for a population with a higher risk of infection. Finally, ELSI-COVID-19 data were compared to information previously obtained in face-to-face interviews for the earlier ELSI-Brazil survey which had run between August 2019 and March 2020. This comparison shower growing rates of unemployment and of people needing to leave the house for work during the pandemic. Results show that men aged 50 to 59 were those older adults most likely to go out for work reasons. Self-employed women and women working in the informal labour market were less likely to exit the house during the pandemic. However, this is probably not an indication of higher compliance with infection control protocols. Instead, the study suggests instead that these women in the informal labour were more vulnerable to redundancies, whereas those who were self-employed chose to stop working during the COVID-19 crisis.
Details of the articles can be found in this link on the journal’s website.
Reference to the journal issue:
Cadernos de Saúde Pública
36 nº.Suplemento 3
Rio de Janeiro, 2020