Of the more than 1.8 million elderly people in the city of São Paulo, 290,771 (16%) live alone, with 22,680 of them aged 90 and over. The number of completely lonely elderly people in the capital is also a reason for analysis: more than 8 thousand, for various reasons, have no one to ask for help if they need it. They do not have an active and efficient social support network.
The data on the vulnerability of the elderly in the city of São Paulo, gathered especially for the Fapesp Agency, are part of the Study Health, Well-Being and Aging (SABE), supported by the São Paulo Research Foundation (Fapesp) . The survey on the living and health conditions of the elderly living in the city of São Paulo accompanies 1,236 participants, which forms a representative sample of all this population in the city and allows to arrive at the results presented.
“It is necessary to draw attention to this reality, especially in this pandemic moment. We are concerned about the elderly who live in institutions [os antigos asilos, hoje denominados Instituições de Longa Permanência para Idosos – ILPIs] due to its high vulnerability and the great risk of mass contagion. However, in general, the situation is also not very good, especially if we take into account the number of elderly people who are alone at home in the middle of the epidemic and with no one to help them. We all need to look at this reality and plan actions for this period ”, says to Agência Fapesp Yeda Duarte, professor at the Faculty of Public Health at the University of São Paulo (USP) and coordinator of the study in partnership with Jair Licio Ferreira Santos.
The health condition of the elderly is also a matter of concern, especially due to the fact that they have diseases considered to be at risk for COVID-19 (disease caused by the new coronavirus), adds the researcher. Among those who live alone, 63.1% (183,477) have two or more simultaneous chronic diseases. Among the most common diseases, 67.9% (197,434 elderly) are hypertensive, 25.4% (73,856) have diabetes, 22.9% (66,587) have some heart disease and 9.3% (27,042) have chronic lung disease.
In addition to the high rate of chronic diseases, there are other factors that concern specialists: 12.9% (37,510) of the elderly are fragile and 52.2% (151,782) are pre-fragile – have little resistance or energy, lose weight involuntarily and declare feeling weakness, among other risk factors.
According to SABE data, the majority (75.1%) of these elderly people who live alone in the capital of São Paulo are in a process of fragility, which makes them even more vulnerable at this time. Yeda Duarte emphasizes that elderly people with frailty syndrome should be prioritized by primary care, as they are more susceptible to falls, hospitalizations, disabilities and early death.
For the researcher, the severity of the new coronavirus epidemic highlights the reality of the lack of assistance to the elderly and the need for public policies to support this population. “The epidemic is very serious, but perhaps it can bring about a necessary transformation for society, giving visibility to those people who never received the necessary attention. It is necessary to show that these elderly people exist. These people are still alone at home and need even more attention now, both from society and the government, ”he says.
Yeda Duarte emphasizes the need for support measures, since, although they should not leave home due to the epidemic, many of them do not have a cell phone or do not know how to use it to provide, for example, food and essential items.
“In the elderly population that lives alone, more than 80 thousand (28.1%) do not have a cell phone or the ability to handle the device, for example. This forces them to go out into the street and break the quarantine, not out of stubbornness, but out of necessity. These elderly people have always existed, but public policies have failed to look at them. At this moment, the pandemic itself puts them in evidence ”, he says.
Thus, it is important that neighbors, for example, are willing to help. “These solidarity movements that grew in the city because of COVID-19 need to increase even more. When you know that there are elderly people living alone in the building or in the immediate neighborhood, it would be important to make yourself available to help them or to be in contact with the outside world ”, he says.
Among the 1.8 million elderly people in the city of São Paulo, in addition to the 16% who live alone, there are still 48% living in houses in the company of other elderly people – spouses or other relatives. “This group also deserves attention. In recent decades, the image that society has of the elderly has changed a lot. They are often seen as healthy people who enjoy life. Although some are in this condition, they are not all, nor the majority. It is necessary for society to look at everyone ”, he evaluates.
A positive data pointed out by the study is the fact that 84% of the elderly have been vaccinated against influenza in the capital of São Paulo. However, only 39% were immunized against pneumonia. “This shows that the guideline should be to vaccinate all elderly people against pneumonia and not just those considered vulnerable, as it has been happening until now”, he adds.
Another important point raised by the researcher is the need for greater planning to assist the most vulnerable elderly population during the pandemic. “There is no such planning. Generally, the vulnerable elderly person turns around, doing whatever it takes. However, in the current situation, there is no way to do this in practice. This fact can convey the mistaken idea that the elderly are now a problem and they are not ”, he points out.
According to data from the SABE Study, most elderly people live with their children. Among those who do not live alone, only 9.6% do not live with children. Of the total elderly, 12% live with children under 11 years old and 10.3% live with adolescents (12 to 18 years old).
“The data show that it is also necessary to think about social isolation measures taking into account the reality of this group at risk for the disease. There is no point in releasing the young person to work and the child to school without considering that they can, when infected by the coronavirus and often do not show symptoms of COVID-19, infect other people, including the elderly at home ”, he stresses.
Also according to data from the SABE Study, about a quarter of the elderly in São Paulo have difficulties to perform basic activities of daily living, such as, for example, bathing, dressing, eating alone and, therefore, they need a personal caregiver. “This leads us to think about a need for more planning before tougher measures, such as the lockdown, for example, ”he says.
The multicentric survey began in 2000, when, at the initiative of the Pan American Health Organization (PAHO), people aged 60 or over from seven urban centers in Latin America and the Caribbean, including São Paulo, were surveyed. With support from Fapesp, the study was reedited in São Paulo in 2006 and 2010 and in 2015 it had its fourth edition.
According to Yeda Duarte, a new edition is scheduled to happen in 2020. However, due to the epidemic of the new coronavirus, however, the researchers will start, at this moment, a telephone monitoring to identify how the elderly are facing the quarantine and its main causes. need and vulnerabilities.
Participants who eventually contract COVID-19 will also be monitored by members of the Research Center on Human Genome and Stem Cells (CEGH-CEL) at the University of São Paulo (USP) – a Research, Innovation and Dissemination Center (CEPID ) supported by Fapesp and coordinated by the professor of the Biosciences Institute at USP Mayana Zatz.
“We will see what the outcome will be if someone is infected with the new coronavirus. The elderly who can cope well with the disease certainly have protective genes in their genomes and that is what we intend to investigate, ”says Mayana Zatz to Agência Fapesp.
The CEPID team completed the genome sequencing of participants in the SABE Study a few years ago. The work was carried out under Project 80+, which studies the DNA of healthy elderly people over 80 years of age to identify genetic and environmental characteristics that make them live longer and better.