1
JEPonline
Analysisof the Efficiency of the Elderly Movement Program in the City of Curitiba through the Vision of Managers, Elderly Users, and Elderly Non-Users of the System
TGFL Pastre1, A. Cantelle2, MDF Gonçalves2,CF Bernardes2,FR Cavichiolli1
1Universidade Federal do Paraná, Curitiba-PR, Brasil, 2Pontifícia Universidade Católica do Paraná, Curitiba-PR, Brasil
ABSTRACT
Pastre TGFL, Cantelle A, Gonçalves MDF, Bernardes CF, Cavichiolli FR.Analyze of the Efficiency of the Elderly Movement Program in the City of Curitiba through the Vision of Managers, Elderly Users, and Elderly Non-Users of the System.JEPonline2018;21(1):172-187. The aim of this study was to evaluate the descriptive cross-sectional data from 115 users and non-users and 7 program managers via a questionnairethat was composed of personal, demographic, socio-economic considerations, level of physical activity, and program issues. The program positively influenced the subjects’ practice of physical activity and improved their health after adherence. Also, and the expansion of activities to other places was accepted by the population that did not participate in the program (allowing the increase of vacancies). However, some factors interfered with a better targeting and performance of activities. The findings indicate that it is possible to observe and direct which paths should be analyzed to solve the problems reported.
Key Words:Elderly, Health, Physical Activity, Third Age
INTRODUCTION
Old age is part of life. It is a continuation of adolescence andadulthoodthat is usually experienced in numerous ways (3).Aging, in particular, is a natural process of human existence. However, living longer is more often than not linked to diminished qualify of life and loss of independence. People living longer suffer from the consequences of chronic diseases and diminished quality of life (4).
The WHO classifies the elderly as 60 yrs old. Between 1970 and 2025, an increase of 223% or ~694 million elderly in the world is expected. By 2025 Brazil will be the sixth most populous country in terms of the number of elderly people (11).While the advancement of age guides science and health care with greater attention and responsibility for preventing chronic diseases in the elderly, the goal of medicine and health-related issues is not just to cure diseases and prevent death (18).
There are many physical changes that occur with aging, among them include bone atrophy, degenerative cartilage, loss of muscle mass, fat gain, changes in the osteoarticular system, and a decrease in control of balancethat increases the chances of falling and injury leadingto hospitalization, prolonged rehabilitation, dependence, and death(2).Thus, unfortunately, the healthcare data for individuals in the age range of their late 50s and early 60s do not indicate a positive future.
Although people are living longer today than in previous decades, the lack of regular exercise is a leading cause of death by heart diseases, hypertension, stroke, diabetes, cancer, lower respiratory disease, andAlzheimer’s illness (11).The diminished quality of life and loss of independence is a burden that is reduced when the elderly are engaged in aerobic activities, muscle strengthening, flexibility, and balance exercisesthat promote and maintain health and quality of life(17).
Fortunately, today,there is plenty of information to support physical activity as a decisive factor in helping the elderly perform and engage in essential activities of life. Regular exercise, an active social life, balanced eating, avoiding smoking, and consuming too much alcoholic can help prevent illness that leads to an improvement in life expectancy. Also, it is important to point out that medical costs are significantly lower for the active elderly versus the inactive elderly(11).In the Ottawa letter, one of the five basic aspects developed for the promotion of health was the construction of Public Health Policies of which the main objective was to indicate to the leaders and politicians that healthy choices are the easiest to carry out (19).
Although several programs were developed in Brazilto promote physical activity and health care of the elderly, little is known about the effectiveness or efficiency of these programs(13).Efficiency is interpreted as the best way things should be done or executed (i.e., methods) in order for the appropriate resources to be applied in the most rational way possible (6). To educate the public to the importance of regular exercise and better health, the government developed several campaigns and instigated through public policies the reasonswhy regular exercise is an ally in the fight and improvement of statistics associated with chronic diseases.
In the capital of Paraná, the Curitiba City Hall developed the Elderly in Movement Program through the Sports and Leisure Secretariat, where it seeks to promote and encourage the practice of physical activity and healthy habits with the objective of reducing medical care related to chronic diseases and improve the quality of life of the elderly population. Thepurpose of the program is to serve the largest number of needy elderly residents in the city, where they perform physical exercises such as gymnastics, walking, water aerobics, and walks in the nuclei of the neighborhoods of the city of Curitiba.
However, it is not enough to develop health promotion programs and physical activities. It is also necessary that the programs produce positive results, thus proving to be efficient and especially attend to increasingly more individuals of this population. The aim of the present study was to analyze the efficiency of the Elderly in Movement Program of the City Hall of Curitiba through the vision of managers, elderly users, and elderly non-users of the system.
METHODS
This study was submitted to the Human Research Ethics Committee of the Pontifical Catholic University of Paraná under Protocol No. 1,767,947. The present study represents a cross-sectional assessment of the data collected and analyzed. The Elderly in Movement Program is a public health promotion program linked to the Municipal Department of Leisure and Youth Sports of Curitiba. The activities take place during the week (Monday through Friday) in 2 shifts within the sports courts or rooms of the Streets of the Citizenship of the city of Curitiba.
At the time of data collection between October and November 2016, there were 14 nuclei distributed in the districts of Curitiba. For thisstudy, we chose to use 6 nuclei due to the proximity of the location and costs of the data collection. The nuclei selected for the study were: Bairro Novo, Boa Vista, Boqueirão, Cajuru, Matriz, and Portão.
Subjects
The study population consisted of 115 elderly individuals over 60 yrs of age divided into elderly users and non-users of the program and 7 managers of the Elderly in Movement Program for a total of 122 subjects.The population of “elderly users” of the program (Case) consisted of 60 subjects of the 122. They were divided accordingly: (a) Bairro Novo: 10 subjects;(b) Boa Vista: 10; (c) Boqueirão: 10; (d) Cajuru: 10; (e) Matriz: 10; and (f) Portão: 10. The inclusion criteria for participation in the present study were: (a) over 60 yrs of age; (b) enrolled in the Elderly in Movement Program; (c) participation in the program for at least 1 yr; a participation frequency of 100% during the last 3 months; and (d) signed the informed consent form.
The population of “non-users” of the program (Control) consisted of 55 subjects divided into: (a) Bairro Novo: 10 non-participants;(b) Boa Vista: 10; (c) Boqueirão: 10; (d) Cajuru: 6;(e) Matriz: 9; and (e) Portão: 10. The inclusion criteria for participation in the present study were: (a) over 60 yrs of age; (b) living near the nuclei that developed the program; (b) residing for at least 1 yr in the neighborhood; (c) not participating in the Elderly in Movement Program; and (d) signed the informed consent form.
The exclusion criteria for the elderly participants and the non-participants of the study were: (a) not knowing how to read and write; (b) not having cognitive ability to answer the questionnaire; and (c) not answering all questions in the questionnaire.
The program's management population was composed of 7 participants divided into: (a) Bairro Novo: 1 teacher and coordinator;(b) Boa Vista: 1 teacher and coordinator;(c) Boqueirão: 1 teacher and coordinator;(d) Cajuru: 1 teacher;(e) Matriz: 1 teacher and 1 coordinator; and (f) Portão: 1 teacher and coordinator. The inclusion criteria for participation in the study were: (a) >18 yrs of age; (b) involved in the program or the position for a minimum of 1 yr; (c) remain in the position during the data collection period; (d) answer all the questions in the questionnaire; and (e) sign the informed consent form.
Procedures
Data collection took place during October and November of 2016. The planning of the interviews was organized so that each nucleus was visited once a week, always on Thursdays in the morning and afternoon according to the class schedule.The application of the questionnaires always started with the managers. The interviews were conducted individually in the respective nucleus, 30 min before or 30 min after class time, with an average duration of 20 min. After interviewing the managers, the evaluators moved to the room or gym where the classes took place to interview the elderly users. At the beginning of the class, the evaluators invited the elderly to participate in the interview. The interviews with the users were performed individually in the respective nucleus and had an average duration of 15 min for each user. After the data collection of the elderly participants, the collection with the non-participating elderly was started. The evaluators went to the residences near the Street of Citizenship, visiting each house, looking for the elderly residents that met the inclusion criteria. In case the resident approached did not meet the inclusion criteria, they followed the neighbor until an elderly person was found who did meet the criteria. Interviews with non-users had an average duration of 15 min with each user.
The information was collected through two questionnaires, one for the elderly users and non users of the program and another for the managers. The elderly questionnaire contained information on: (a) personal and demographic data; (b) socioeconomic level; (c) clinical conditions; (d) social interaction and level of physical activity; (e) knowledge and permanence in the Elderly in Movement Program; (f) degree of satisfaction with the program; (g) perception of safety with the program; (h) barriers to participation in the program; (i) perception of access to the program; (j) evaluation of proposed activities; (k) perceived improvements in health through the program; (l) evaluation of motivation and demotivation for participation in the program; (m) evaluation of spaces and schedules offered; and (n) evaluation of new schedules and new spaces offered.The managers' questionnaire contained information on: (a) personal data;(b) professional data; (c) level of knowledge of the program; (d) level of satisfaction with the program; (e) suggestion for program improvements; and (f) motivation to join the program.
Statistical Analyses
The descriptive analysis of the data was obtained through mean, standard deviation, frequency, normality, and variance between the groups. Statistical significance was set an alpha level of P<0.05, and all analyses were performed with EpiData Entry 3.1 program.
RESULTSAND DISCUSSION
In this study, 115 elderly individuals between 60 and 87 yrs of age were evaluated. Sixty were program participants and 55 were part of the control group. Characteristics of age and division by neighborhoods with their respective mean ages are present in Table 1. The sample was intentional, evaluating only the participants and residents of the selected neighborhoods. The age variable did not present a significant difference in the findings of this study. Despite the approximate value of women and men in the control group, the majority of subjects in the program were female. However, findings from the total population of this study show that 87.3% of the women practiced physical activity in contrast to 55.6% of the men evaluated. Such a finding is in agreement with recent studies in which women are more active than men because of daily domestic tasks performed by the female population, but also being more in quantity than in men(1). This difference is due to the greater male resistance to health care and physical activity (10).
Table 1. Profile of Participants.
Elderly Users / Elderly Non-UsersTotal / Men / Women / Mean Age / Total / Men / Women / Mean Age
Bairro Novo / 10 / 03 / 07 / 73.5 / 10 / 06 / 04 / 68.3
Boa Vista / 10 / 00 / 10 / 73.2 / 10 / 08 / 02 / 64.8
Boqueirão / 10 / 01 / 09 / 67.3 / 10 / 04 / 06 / 64.3
Cajuru / 10 / 00 / 10 / 68.2 / 06 / 03 / 03 / 71.66
Matriz / 10 / 01 / 09 / 72.3 / 09 / 03 / 06 / 65.22
Portão / 10 / 00 / 10 / 67.9 / 10 / 06 / 04 / 72
TOTAL / 60 / 05 / 55 / - / 55 / 30 / 25 / -
The socioeconomic data of the subjects are presented in Table 2. None of the data presented significant differences. Most of the subjects, as was the case with the control group, were married, retired, and have their own property.
Table 2. Socioeconomic Data.
Dados / Participants / Non-ParticipantsMarital Status / 5% Single / 9.1% Single
45% Married / 65.5% Married
16.7% Divorced / 20% Divorced
33.3% Widow (er) / 5.5% Widow (er)
Retired / 81.7% Yes / 18.3% No / 65.5% Yes / 34.5% No
Educational Level / 26.7% Elementary School / 38.2% Elementary School
21.7% Incomplete Elementary School / 21.8% Incomplete Elementary School
23.3% High School / 20.0% High School
13.3% Incomplete High School / 9.1% Incomplete High School
13.3% Higher Education / 10.9% Higher Education
1.7% Incomplete Higher Education / 0% Incomplete Higher Education
Own Property / 91.7% Yes / 8.3% No / 80% Yes / 20% No
Car / 46.7% Yes / 53.3% No / 43.6% Yes / 56.4% No
In neighborhood-related issues, most subjects rated "poor” safety (60%), "great” lighting (65%), and "poor” paving (43.3%). Of the subjects in the non-participating group, 47.3% rated "poor" safety, 52.7% "optimal" lighting, and 45.5% "poor" paving in their neighborhoods. Thus, both groups report the lack of structure in their neighborhoods, which can be taken into account in the creation, adhesion, and adherence to community programs.
For the classification of chronic diseases (Figure 1), none of the data presented significant differences. Of the group of participants, the majority (65%) presented hypertension as a diagnosed chronic disease in contrast to the non-participants (43.6%). This finding is consistent with the current Brazilian scenario (5).
Figure 1.Percentage of Chronic Diseases among Participants and Non-Participants.
The injury and/or falls index (Figure 2) shows that 70% of the participants and ~62% of the non-participant group (61.8%) had not suffered an injury or fall. There was no significant difference between the two groups. However, it is important to point out that falls and injuries in the elderly are frequent. When they occur, they can aggravate existing diseases as well as diminish the quality of life of this population (9).
Figure 2.Index of Injury or Falls.
Regarding pain, both groups reported experiencing pain at some point throughout the day (51.7% for participants and 56.4% for control). Routine visits to the physician were also found to be 88.3% for the participants and 76.4% for the control. For the results of tobacco use, 96.7% for the participants and 81.8% for the control used tobacco, and 91.7% of the participants and 83.6% of the control consumed alcohol.
Regarding the subjects’ stress levels, on a scale of 0 to 10, where 0 is "no stress" and 10 is "too much stress", both the control subjects and the participants reported mostly high levels of stress (20% and 26.7%, respectively). This finding is in agreement with the studies with special populations (14)pointing out that elderly individuals tend to present a higher stress index, especially when they lack associated physical activity(16).
Figure 3 addresses the leisure activities of the groups. Although there were no significant differences between the results, only the group of participants performed activities for the elderly. However, the two groups considered good or good social life (36.7% good, 36.7% good for participants and 30.9% good and 40% good for the control group). This confirms the findings of the most recent studies, which show that the population in question has access to physical activities in large part when offered by institutions or groups (12). Some neighborhoods present more physical activity practitioners, even without participating in the program, this can be due to the educational level, influence of the doctor, friends, church, among others, where there is more information, there is a greater demand for self-care.
Figure 3.Leisure Activities.
Both groups have independence in daily activities such as domestic chores and movements. Although the majority of those who practice regular physical activity are those who participate in the offered program, these results did not present significant differences. Thus, in contrast to the benefits of regular practice of periodic activities, senile autonomy is present among the population studied (15).
Table 3. Domestic Activities - Autonomy.
Conditions / Participants / Non-ParticipantsHousework / 98.3% Without help / 98.2% Without help
1.7% With help / 1.8% With help
Movement / 98.3% Unaccompanied / 94.5% Unaccompanied
1.7% Accompanied / 5.5% Accompanied
The totality of participants in the program performed physical activities frequently, in contrast to just over half of the control group (52.7%). Of the participants, there was an average of 2.74 d·wk-1 of physical activity. The Elderly in Movement Program positively influenced the practice of physical activity. If there were no program activities, the sedentary index would probably be higher. Some elderly people only practiced twice a week, which shows that they only perform physical activity in the place offered for practice.
Despite the 47.3% of the control group, who did not perform any physical activity regularly, only 29.1% of the total group remained in the long term, as well as only 26.7% of the participants. Regarding sleep quality, the majority of participants credit as "good", the sleep quality index (40% and 41.8%, practitioners and non-practitioners, respectively) with more than 8 hrs of sleep per day (58.3% participants and 52.7% control). These results are consistent with the comparative studies between physical activity practice and sleep quality, despite the lack of relationship between sleep quality and sedentary lifestyle in the elderly (7).