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Advisor(s)
Abstract(s)
O enquadramento bioético dos cuidados de saúde a idosos em contexto rural e a temática do
envelhecimento, em particular, constituem tema pertinente e atual, devido a toda a conjuntura
relacionada com as políticas de saúde e a desertificação das regiões rurais. As alterações
demográficas ocorridas no último século traduziram-se na modificação das pirâmides etárias,
revelando uma população cada vez mais envelhecida e só. Considerando estas premissas, surgiu a
formulação da questão central deste estudo, orientada para um conhecimento mais aprofundado do
enquadramento bioético dos cuidados de saúde a idosos em contexto rural e que tem como
objetivos: (i) apresentar o retrato sociodemográfico da população idosa; (ii) caracterizar os recursos
de saúde e sociais; (iii) caracterizar o processo de envelhecimento nas suas diferentes dimensões
(saúde, psicológica, económica e social), no sentido da formulação de políticas ajustadas aos
desafios, exigências e necessidades da população idosa; (iv) caracterizar a perceção sobre o estado
de saúde; (v) avaliar a perceção da qualidade de vida e nos seus domínios; (vi) analisar a relação
entre a perceção da qualidade de vida e variáveis sociodemográficas, custos em cuidados de saúde
e vivência de sentimentos de solidão.
Optámos por um estudo descritivo e correlacional com variáveis de natureza quantitativa,
utilizando a escala de perceção da qualidade de vida (WHOQOL-Bref) e Survey of Health, Ageing
and Retirement in Europe (SHARE).
Não se pretendendo efetuar generalizações, pelas particularidades da realização do estudo, mas
enquadrar a perspetiva bioética nos cuidados de saúde a idosos em contexto rural, salientam-se os
principais resultados: uma amostra maioritariamente feminina de idosos entre os 65 e 70 anos;
casados (55,5%), sendo que 41,3% vivia só; com um baixo grau de instrução (60,2%); auferindo
um rendimento mensal inferior a 500 euros (90,9%). Dos idosos inquiridos, predominam as
doenças relacionadas com problemas osteoarticulares, 87,3% toma medicação, dos quais 92,4% do
grupo farmacológico dos cardiovasculares e 91,8% dos analgésicos.
Embora os encargos com as consultas médicas sejam reduzidos, atendendo ao recurso aos cuidados
de saúde do serviço nacional de saúde e à isenção decorrente de baixo rendimento, os custos com a
medicação situam-se em 389 euros por ano.
Verificámos uma relação estatisticamente positiva em todos os domínios da qualidade de vida com
o sexo, o estado civil, a idade, a instrução e o rendimento. O sexo feminino evidencia mais sentimento de solidão e pior perceção de qualidade de vida; observámos que esta diminui com a
idade e aumenta com o nível de instrução e com o rendimento; por outro lado, apurámos que
sempre que aumentam os custos com a medicação, diminui a perceção da qualidade de vida.
À bioética interessa o homem e a sua qualidade de vida, à luz dos princípios como os de
Beauchamp e Childress, a autonomia, a beneficência, a justiça, a não maleficência, mas outros
também como a solidariedade, a equidade, acompanhando o homem no seu contexto e no seu
tempo. É neste enquadramento que os cuidados de saúde e o direito à proteção da saúde dos mais
idosos devem ser intersetoriais e intercooperantes, assentes no pressuposto de que uma visão
holística da saúde é sempre conjugada com a dignidade da pessoa e com uma atitude mobilizadora
da sociedade para a construção de uma cidadania social e política.
Torna-se imperativo redimensionar a práxis dos profissionais de saúde na implementação de
programas e ações concretas que contemplem a especificidade de ser idoso em contexto rural, não
descurando que cabe ao estado a responsabilidade de definir os grandes objetivos de uma política
de proteção da saúde no respeito por uma sociedade plural e democrática que revitalize a
solidariedade e a cidadania ativa, permanentemente articulada entre a situação operativa e a
reflexão bioética
The bioethical framework of health care for the elderly in rural settings and the subject of aging, in particular, are a pertinent and current topic, due to the circumstances related to health policies and to the desertification of rural areas. The demographic changes from the last century have been reflected in the modification of the age pyramids, revealing an increasingly aging and lonely population. Based on these premises, the formulation of the central question of this study emerged, oriented to a deeper understanding of the bioethical framework of the health care for the elderly in rural settings and that aims at: (i) present the social and demographic portrait of the elderly population; (ii) characterise the health and social resources; (iii) characterise the aging process in its different dimensions (health, psychological, economical and social), towards the formulation of policies adjusted to the challenges, demands and needs of the elderly population; (iv) characterise the perception of the health condition; (v) assess the perception of quality of life and its domains; (vi) analyse the relation between the perception of the quality of life and socio demographic variables, health care expenses and the experience of feelings of loneliness. A descriptive and correlational study with quantitative variables was chosen, using a scale of the perception of the quality of life (WHOQOL-Bref) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Not intending to generalise, due to the specificities of the study, but to contextualise the bioethical perspective of the health care for the elderly in rural settings, the following main results are highlighted: a sample of predominantly elderly women between 65 and 70 years old; married (55.5%), 41.3% living alone; with a low level of education (60.2%); earning a monthly income of less than 500 euros (90.9%). From the respondent elderly, the diseases related to osteoarticular problems are predominant, 87.3% takes medication, from which 92.4% are from the cardiovascular pharmacology group and 91.8% from analgesics. Even though the expenses with medical consultations are reduced, because of the consultations of the health care national service and the exemption due to low income, the expenses with medication are about 389 euros per year. A statistically positive relation was found between all the domains of the quality of life and the gender, marital status, age, education and income. The females show more feelings of loneliness and worst perception of the quality of life; which decreases with the age and increases with the level of education and with the income; on the other hand, it was found that whenever the expenses with medication increase, the perception of the quality of life decreases. To bioethics, it is important the human being and his/her quality of life, in the light of Beauchamp‘s and Childress‘s principles, autonomy, beneficence, justice, non-maleficence, but also others like solidarity, equity, accompanying the human being in his/her context and time. It is in this context that the health care and the right to health of the elderly must be intersectoral and intercooperative, based on the presupposition that a holistic vision of health is always dependent on the dignity of the person and on a mobilising attitude of the society towards the construction of a social and political citizenship. It becomes imperative to reorganise the practice of the health care professionals in the implementation of concrete programmes and actions that consider the specificity of being elderly in a rural setting, not forgetting the state‘s responsibility of defining the major objectives of a health care policy in respect for a plural and democratic society which revitalises solidarity and an active citizenship, constantly coordinated between the operative situation and the bioethical reflection.
The bioethical framework of health care for the elderly in rural settings and the subject of aging, in particular, are a pertinent and current topic, due to the circumstances related to health policies and to the desertification of rural areas. The demographic changes from the last century have been reflected in the modification of the age pyramids, revealing an increasingly aging and lonely population. Based on these premises, the formulation of the central question of this study emerged, oriented to a deeper understanding of the bioethical framework of the health care for the elderly in rural settings and that aims at: (i) present the social and demographic portrait of the elderly population; (ii) characterise the health and social resources; (iii) characterise the aging process in its different dimensions (health, psychological, economical and social), towards the formulation of policies adjusted to the challenges, demands and needs of the elderly population; (iv) characterise the perception of the health condition; (v) assess the perception of quality of life and its domains; (vi) analyse the relation between the perception of the quality of life and socio demographic variables, health care expenses and the experience of feelings of loneliness. A descriptive and correlational study with quantitative variables was chosen, using a scale of the perception of the quality of life (WHOQOL-Bref) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Not intending to generalise, due to the specificities of the study, but to contextualise the bioethical perspective of the health care for the elderly in rural settings, the following main results are highlighted: a sample of predominantly elderly women between 65 and 70 years old; married (55.5%), 41.3% living alone; with a low level of education (60.2%); earning a monthly income of less than 500 euros (90.9%). From the respondent elderly, the diseases related to osteoarticular problems are predominant, 87.3% takes medication, from which 92.4% are from the cardiovascular pharmacology group and 91.8% from analgesics. Even though the expenses with medical consultations are reduced, because of the consultations of the health care national service and the exemption due to low income, the expenses with medication are about 389 euros per year. A statistically positive relation was found between all the domains of the quality of life and the gender, marital status, age, education and income. The females show more feelings of loneliness and worst perception of the quality of life; which decreases with the age and increases with the level of education and with the income; on the other hand, it was found that whenever the expenses with medication increase, the perception of the quality of life decreases. To bioethics, it is important the human being and his/her quality of life, in the light of Beauchamp‘s and Childress‘s principles, autonomy, beneficence, justice, non-maleficence, but also others like solidarity, equity, accompanying the human being in his/her context and time. It is in this context that the health care and the right to health of the elderly must be intersectoral and intercooperative, based on the presupposition that a holistic vision of health is always dependent on the dignity of the person and on a mobilising attitude of the society towards the construction of a social and political citizenship. It becomes imperative to reorganise the practice of the health care professionals in the implementation of concrete programmes and actions that consider the specificity of being elderly in a rural setting, not forgetting the state‘s responsibility of defining the major objectives of a health care policy in respect for a plural and democratic society which revitalises solidarity and an active citizenship, constantly coordinated between the operative situation and the bioethical reflection.
Description
Keywords
Ruralidade Idosos Bioética Qualidade de vida Rurality Elderly Bioethics Quality of life