Abstract

This study sought to investigate the association between the scores for quality of life (QoL) and self-esteem among the elderly in an urban community. A cross-sectional, quantitative and analytical household survey was conducted with 1,691 elderly persons resident in an urban area in a county in Minas Gerais state. The World Health Organization Quality of Life BREF (WHOQOL-BREF), the World Health Organization Quality of Life OLD (WHOQOL-OLD) questionnaires and the Rosenberg Self-Esteem Scale were used in this study. A descriptive statistical analysis and a linear regression model (p < 0.05) were conducted. The results revealed that the social relationships domain (71.19) and the topic of death and dying (74.30) had the highest mean scores among the elderly; while the lowest mean scores were the environment domain (60.39) and the topic of social participation (63.06). The self-esteem scores showed an average of 9.36 ± 4.09. Associations were evident for the lower scores of quality of life in all the WHOQOL-BREF domains and WHOQOL-OLD aspects (except death and dying) with lower levels of self-esteem (p <0.001). The results provide data that contribute to a better understanding of the aspects that influence the QoL of the elderly due to reduced self-esteem, thus providing information for the development of health strategies.

Elderly; Quality of Life; Self-image

Introduction

Aging is an intrinsic, active and progressive process, accompanied by physical, physiological and psychological changes, which can cause difficulty for elderly persons to cope with their daily routine¹1. Mourão CA, Silva NM. Influência de um programa de atividades físicas recreativas na autoestima de idosos institucionalizados. RBCEH [Internet] 2010 [acessado 2015 jan 16];7(3):324-334. Disponível em: http://www.upf.br/seer/index.php/rbceh/article/view/494/pdf
http://www.upf.br/seer/index.php/rbceh/a... . In this scenario, the increase in life expectancy becomes a phenomenon of interest given its impact on quality of life (QoL) at this stage of life²2. Park SH, Han KS, Kang CB. Effects of exercise programs on depressive symptoms, quality of life and self-esteem in older people: A systematic review of randomized controlled trials. Applied Nursing Research 2014; 26(4):219-226..

Consequently, it is important that health professionals should implement strategies to encourage the elderly to live well³3. Silva LWS, Santos RG, Squarcini CFR, Souza AL, Azevedo MP, Barbosa FNM. Perfil do estilo de vida e autoestima da pessoa idosa. Perspectivas de um programa de treinamento físico. Revista Temática Kairós Gerontologia [Internet] 2011 [acessado 2014 dez 20]; 14(3):145-166. Disponível em: http://revistas.pucsp.br/index.php/kairos/article/view/6497
http://revistas.pucsp.br/index.php/kairo... , in order to attain the best QoL. The feeling of happiness and joy, the feeling of being at peace with life and oneself is healthy especially when one is aging³3. Silva LWS, Santos RG, Squarcini CFR, Souza AL, Azevedo MP, Barbosa FNM. Perfil do estilo de vida e autoestima da pessoa idosa. Perspectivas de um programa de treinamento físico. Revista Temática Kairós Gerontologia [Internet] 2011 [acessado 2014 dez 20]; 14(3):145-166. Disponível em: http://revistas.pucsp.br/index.php/kairos/article/view/6497
http://revistas.pucsp.br/index.php/kairo... . To reach this stage of life with optimism, self-control and high self-esteem can bring increased sense of security in living the last stage of the life cycle and impacts positively on QoL³3. Silva LWS, Santos RG, Squarcini CFR, Souza AL, Azevedo MP, Barbosa FNM. Perfil do estilo de vida e autoestima da pessoa idosa. Perspectivas de um programa de treinamento físico. Revista Temática Kairós Gerontologia [Internet] 2011 [acessado 2014 dez 20]; 14(3):145-166. Disponível em: http://revistas.pucsp.br/index.php/kairos/article/view/6497
http://revistas.pucsp.br/index.php/kairo... .

Research conducted with elderly members of a community in Montreal, Canada, found that the decline in self-esteem may contribute to deregulate the hypothalamic-pituitary-adrenal axis functions which can cause adverse outcomes to the health of the elderly, such as social isolation and a negative score in QoL⁴4. Liu SY, Wrosch C, Miller GE, Pruessner JC. Self-esteem change and diurnal cortisol secretion in older adulthood. Psychoneuroendocrinology 2014; 41:111-120.. Thus, knowledge on this topic can help to systematize care for the elderly with low self-esteem.

Self-esteem can be characterized as the feeling, appreciation and consideration that people have for themselves, namely how much they like themselves, how the see and what they think about themselves⁵5. Dini GM, Quaresma MR, Ferreira LM. Adaptação cultural e validação da versão brasileira da escala de Auto Estima de Rosenberg. Rev. Soc. Bras. Cir. Plást [Internet] 2004 [acessado 2015 maio 15]; 19(1):41-52. Disponível em: http://www.rbcp.org.br/imagebank/pdf/19-01-04pt.pdf
http://www.rbcp.org.br/imagebank/pdf/19-... . Therefore, research into QoL and self-esteem is of great importance.

As with the concept of self-esteem, QoL is considered to be subjective and multidimensional, comprising positive and negative aspects of life⁶6. The Whoqol Group. The world health organization quality of life assessment: position paper from the world health organization. Soc Sci Med 1995; 41(10):1403-1409.. It is defined as the “individual’s perception of his/her position in life in terms of culture and value systems in which he/she lives and in relation to his/her goals, expectations, standards and concerns”⁶6. The Whoqol Group. The world health organization quality of life assessment: position paper from the world health organization. Soc Sci Med 1995; 41(10):1403-1409..

National surveys conducted with the elderly with self-esteem as the goal of the study did not evaluate the QoL¹1. Mourão CA, Silva NM. Influência de um programa de atividades físicas recreativas na autoestima de idosos institucionalizados. RBCEH [Internet] 2010 [acessado 2015 jan 16];7(3):324-334. Disponível em: http://www.upf.br/seer/index.php/rbceh/article/view/494/pdf
http://www.upf.br/seer/index.php/rbceh/a... ^,77. Maia MFM, Ruas ARM, Rocha FP, Oliveira NFR, Souza JS. A autoestima em uma amostra de idosos com prática de caminhada orientada. Motricidade [Internet] 2012 [acessado 2014 dez 14]; 8(S2):1085-1088. Disponível em: http://www.redalyc.org/articulo.oa?id=273023568138
http://www.redalyc.org/articulo.oa?id=27... and involved people who practiced some form of physical activity¹1. Mourão CA, Silva NM. Influência de um programa de atividades físicas recreativas na autoestima de idosos institucionalizados. RBCEH [Internet] 2010 [acessado 2015 jan 16];7(3):324-334. Disponível em: http://www.upf.br/seer/index.php/rbceh/article/view/494/pdf
http://www.upf.br/seer/index.php/rbceh/a... ^,77. Maia MFM, Ruas ARM, Rocha FP, Oliveira NFR, Souza JS. A autoestima em uma amostra de idosos com prática de caminhada orientada. Motricidade [Internet] 2012 [acessado 2014 dez 14]; 8(S2):1085-1088. Disponível em: http://www.redalyc.org/articulo.oa?id=273023568138
http://www.redalyc.org/articulo.oa?id=27... . Thus, considering the lack of national studies, as well as the possible cultural differences and specificities of the elderly, the association between QoL and self-esteem among the elderly in a community, measured by means of specific tools for this age group is yet to be answered.

This research aims to contribute to further knowledge in this field, in order to support strategies that can influence the domains and issues of QoL, based on maintaining the self-esteem of the elderly. Thus, the objective of this study was to investigate the association between the QoL and self-esteem of the elderly in a community.

Methodology

A household survey with a cross-sectional, quantitative and analytical approach was carried out with elderly persons residing in an urban area of Uberaba county, Minas Gerais, Brazil.

This study arises from research initiated in 2005⁸8. Tavares DMS, Pereira GA, Iwamoto HH, Miranzzi SSC, Rodrigues LR, Machado ARM. Incapacidade funcional entre idosos residentes em um município do interior de Minas Gerais. Texto Contexto Enferm 2007; 16(1):32-39. that calculated the sample based on a population of 24,714 elderly persons, with a 95% confidence interval, test power of 80% and a 4% margin of error for interval estimates, and with an estimated proportion p = 0.5 for ratios of interest. Thus, the sample size was estimated to be 2116 elderly persons. In 2012, interviewers visited the homes of 2,116 elderly people, of which 1,691 were interviewed after taking into account the inclusion criteria, namely being 60 years old or older, living in an urban area of the county and not having any cognitive impairment. Exclusions and/or losses were related to deaths (265) and cognitive impairment (160).

The survey questionnaires were applied in private at the homes of the elderly by ten (10) selected interviewers who had been previously trained by the lead researcher on how to approach the elderly, apply the questionnaires as well as the ethical aspects of the research. Field supervisors reviewed the interviews to check for any incomplete answers or inconsistency in the responses. If such situations occurred, the interviewer returned to the interviewee to correct and/or complete the data on the form.

Initially, the cognitive status of the sample was assessed using the Mini Mental State Examination (MMSE), translated and validated for Brazil⁹9. Bertolucci PHF, Brucki SMD, Campacci SR, Juliano YO. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994; 52(1):1-7., with scores that range from 0 to 30 points. The MMSE questions are grouped into seven categories: orientation to time and place; mention of three words; attention and calculation; recall of the three words; language and constructive visual capacity. In MMSE, the cutoff point for cognitive decline considers the respondent’s educational level, corresponding to 13 points for illiterates, 18 points or less for those with 1 to 11 years of schooling and 26 points for those with over 11 years of education⁸8. Tavares DMS, Pereira GA, Iwamoto HH, Miranzzi SSC, Rodrigues LR, Machado ARM. Incapacidade funcional entre idosos residentes em um município do interior de Minas Gerais. Texto Contexto Enferm 2007; 16(1):32-39..

The QoL assessment used the World Health Organization Quality of Life BREF (WHOQOL-BREF) questionnaire that has 26 questions; two general, related to global QoL and overall health, and 24 that make up the four domains: physical, psychological, social relations and environmental¹⁰10. Fleck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref”. Rev Saude Publica 2000; 34(2):178-183.. Also, the World Health Organization Quality module of Life Old (WHOQOL-OLD) questionnaire, validated for the elderly Brazilian population that consists of 24 items divided into six topics: sensory abilities, autonomy, past, present and future activities, death and dying, and intimacy¹¹11. Fleck MPA, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica 2006; 40(5):785-791. was applied. The WHOQOL-OLD¹¹11. Fleck MPA, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica 2006; 40(5):785-791. is a specially designed instrument to assess QoL in the elderly and should be applied jointly with the WHOQOL-BREF. The scores are calculated by specific criteria and range from 0 to 100, where higher numbers represent better QoL.

The Rosenberg Self-Esteem Scale, which contains 10 randomly distributed items, evaluated the self-esteem of the sample. Each item is assigned a value, from 0 to 3, and the sum of all the questions varies from 0 to 30 points⁵5. Dini GM, Quaresma MR, Ferreira LM. Adaptação cultural e validação da versão brasileira da escala de Auto Estima de Rosenberg. Rev. Soc. Bras. Cir. Plást [Internet] 2004 [acessado 2015 maio 15]; 19(1):41-52. Disponível em: http://www.rbcp.org.br/imagebank/pdf/19-01-04pt.pdf
http://www.rbcp.org.br/imagebank/pdf/19-... . Low scores are associated with high self-esteem.

Some variables (age, sex, schooling, income, number of illnesses, functional incapacity for Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) and signs of depression were considered as potentially confounding factors for the analysis of association. Therefore, adjustments were made for these variables.

To characterize the sample studied and for the adjustment variables the instrument built by the Research Group on Health for socioeconomic and demographic data and self-reported morbidities, the Scale of Independence for BADL¹²12. Lino VTS, Pereira SEM, Camacho LAB, Ribeiro Filho ST, Buksman. Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Kats). Cad Saude Publica 2008; 24(1):103-112. (Katz Scale) and the Lawton and Brody (1969) Scale¹³13. Lopes SR, Virtuoso JS Júnior. Confiabilidade da versão brasileira da escala de atividades instrumentais da vida diária. Rev Bras Promoção Saúde 2008; 21(4):290-296. that assesses the IADL were used.

Elderly persons who showed no difficulty in any of the BADL and IADL tasks were considered independent and those with difficulty tackling one or more of the tasks were considered dependent. Besides these, the Geriatric Depression Scale (GDS-15) adapted for Brazil was applied and a score over 5 was considered to be a sign of depression¹⁴14. Almeida OP, Almeida AS. Confiabilidade da versão brasileira da Escala de Depressão Geriátrica (GDS) versão reduzida. Arq Neuropsiquiat 1999; 57(2B):421-426..

The following variables were selected for the study: gender (male/female); age bracket in years (60├70, 70├80 and 80 or over); marital status (never married or lived with a partner, lives with spouse or partner, a widow(er); separated, legally separated or divorced, unspecified); education in years of schooling (no schooling, 1├4, 4├8, 9├11, ≥ 11); individual monthly income in minimum wages (no income, <1, 1, 1┤3, 3┤5, > 5); number of self-reported morbidities; disability for BADL (dependent/independent) and IADL (dependent/independent); signs of depression (yes/no); self-esteem; QOL: domains (physical, psychological, social relationships and environment) and aspects (sensory abilities, autonomy, past, present and future activities, social participation, death and dying, and intimacy).

An Excel^® spreadsheet was created to perform the analysis. The data collected were processed in two databases to check consistency. In the case of any inconsistent data the original interview was verified for accuracy. Later, the data were imported into version 17.0 of the software Statistical Package for Social Sciences (SPSS).

Descriptive statistical analysis was conducted by means of the distribution of absolute frequencies and percentages for the categorical variables and averages and standard deviations for the numerical variables. Each WHOQOL-BREF domain and WHOQOL-OLD topic were considered in isolation, with their respective criteria.

A linear regression model (enter method) was used to confirm the association between the WHOQOL-BREF domains and the WHOQOL-OLD topics with the self-esteem scores, through the analysis adjusted for the variables: age, gender, education, income, number of self-reported diseases, lack of ability for the BADL and IADL tasks and signs of depression (p <0.05). The age, education, number of self-reported diseases, lack of ability variables for the BADL and IADL tasks and signs of depression were considered quantitative. Minimum prerequisites were considered including the residue analyses (normality, linearity and homoscedasticity) and multicollinearity.

The Ethics Committee on Human Research of the Universidade Federal do Triângulo Mineiro (CEP/UFTM) approved this study. The elderly were asked to sign the Free and Informed Consent form before the interview was conducted.

Results

Among the 1.691 respondents, there was a predominance of females, aged between 70 and 79 years old, married, 1 to 4 years of schooling and an individual monthly income of one minimum wage, Table 1.

There was a high percentage of elderly people with five and more morbidities, independent in terms of the BADL and IADL tasks, and with no signs of depression, Table 2.

The social relationships domain (71.19) and the death and dying topic (74.30) had the highest mean scores of QOL among the elderly; while the lowest were observed in the environment domain (60.39) and social participation topic (63.06) Table 3. The self-esteem scores had a mean of 9.36 ± 4.09.

In order to analyze the association between QoL and self-esteem, adjustments were made for the variables: age, gender, education, income, number of diseases, lack of ability for BADL and IADL tasks and signs of depression, thus avoiding any potentially confounding factors. The minimum prerequisites considered were met and the determining coefficients in the adjusted analysis ranged from 0.160 to 0.534.

The lowest scores of all the QoL domains and topics (except for the death and dying topic) were associated with the worst levels of self-esteem (p < 0.001), with emphasis on the psychological domain and the topic of intimacy, Table 4.

Discussion

The demographic and economic data collected in this work tally with a Brazilian study of the elderly in a community where there was a predominance of women, with low educational and income levels, average age of 72 years old and married¹⁵15. Chaves ECL, Paulino CF, Souza VHS, Mesquita AC, Carvalho FS, Nogueira DA. Qualidade de vida, sintomas depressivos e religiosidade em idosos: um estudo transversal.Texto Contexto Enferm 2014, 23(3):648-655..

However, divergent results concerning clinical conditions were found in a study conducted with the elderly in a community in São Paulo, where the highest percentage had only one morbidity (65.1%)¹⁶16. Campolina AG, Dini PS, Ciconelli RM. Impacto da doença crônica na qualidade de vida de idosos da comunidade em São Paulo (SP, Brasil). Cien Saude Colet 2011; 16(6):2919-2925..

In terms of overall health, the prevalence of independence related to the BADL and IADL tasks is consistent with the results found in a survey of elderly persons in Montes Claros, State of Minas Gerais¹⁷17. Barbosa BR, Almeida JM, Barbosa MR, Rossi-Barbosa LAR. Avaliação da capacidade funcional dos idosos e fatores associados à incapacidade. Cien Saude Colet 2014; 19(8):3317-3325.. Divergent data was found in relation to signs of depression in research among the elderly in Alfenas, State of Minas Gerais¹⁵15. Chaves ECL, Paulino CF, Souza VHS, Mesquita AC, Carvalho FS, Nogueira DA. Qualidade de vida, sintomas depressivos e religiosidade em idosos: um estudo transversal.Texto Contexto Enferm 2014, 23(3):648-655..

The QoL measured by the WHOQOL-BREF indicated that the higher scores in the social relations domain are probably related to greater opportunities for the elderly in this study to experience and participate in daily activities, especially in the community, as shown by the items evaluated in this domain¹⁰10. Fleck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref”. Rev Saude Publica 2000; 34(2):178-183..

With respect to the higher scores for the death and dying topic, it should be remembered that the end of life process, although little discussed in society, is part of human existence, ending the life cycle, from birth, through growth to development¹⁸18. Gutierrez BAO, Auricchio AM, Medina NVJ. Mensuração da qualidade de vida de idosos em centros de convivência. J Health Sci Inst [Internet] 2011 [acessado 2015 maio 05]; 29(3):186-190. Disponível em: http://189.2.156.229/comunicacao/publicacoes/ics/edicoes/2011/03_jul-set/V29_n3_2011_p186-190.pdf
http://189.2.156.229/comunicacao/publica... . However, in this research, the perception of death did not have a negative influence on the QoL of the elderly.

A survey with the elderly in the city of São Paulo had low QoL scores in the environment domain, as was the case in this investigation¹⁸18. Gutierrez BAO, Auricchio AM, Medina NVJ. Mensuração da qualidade de vida de idosos em centros de convivência. J Health Sci Inst [Internet] 2011 [acessado 2015 maio 05]; 29(3):186-190. Disponível em: http://189.2.156.229/comunicacao/publicacoes/ics/edicoes/2011/03_jul-set/V29_n3_2011_p186-190.pdf
http://189.2.156.229/comunicacao/publica... . It is assumed that this result may be related to the low financial resources of the elderly, which additionally can contribute to reduced access to health services, a lesser sense of safety, poor housing and few opportunities for recreation and leisure; items that were evaluated in this topic¹⁰10. Fleck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref”. Rev Saude Publica 2000; 34(2):178-183..

In the study in Curitiba, State of Paraná, which tallied with the findings of this research, the lowest QoL scores were in the social participation topic¹⁹19. Vagetti GC, Oliveira V, Barbosa Filho VC, Moreira NB, Campos W. Predição da qualidade de vida global em idosas ativas por meio dos domínios do Whoqol-Bref e do Whoqol-Old. Motricidade [Internet] 2012 [acessado 2014 nov 07]; 12(S2):709-718. Disponível em: http://www.redalyc.org/articulo.oa?id=273023568084
http://www.redalyc.org/articulo.oa?id=27... , which assesses the satisfaction of the elderly in participating in daily activities, especially in the community¹⁰10. Fleck MPA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref”. Rev Saude Publica 2000; 34(2):178-183.. From this standpoint, it is important that the health team, with the support of family members, encourage the elderly to participate in activities provided by the community, favoring the (re)integration or expansion of participation in the social environment.

The results showed high levels of self-esteem among the elderly, which is consistent with other studies conducted in Brazil, for this age bracket²⁰20. Antunes G, Mazo GZ, Balbé GP. Relação da autoestima entre a percepção de saúde e aspectos sociodemográficos de idosos praticantes de exercício físico. Rev. educ. fis. UEM 2011; 22(4).^,2121. Meurer ST, Benedetti TRB, Mazo GZ. Teoria da autodeterminação: compreensão dos fatores motivacionais e autoestima de idosos praticantes de exercícios físicos. Revista Brasileira de Atividade Física & Saúde[Internet] 2011[acessado 2014 dez 14]; 16(1):18-24. Disponível em: http://periodicos.ufpel.edu.br/ojs2/index.php/RBAFS/article/viewFile/551/549
http://periodicos.ufpel.edu.br/ojs2/inde... .

On the other hand, elderly persons with low self-esteem were shown to have low QoL scores. The concepts of self-esteem⁵5. Dini GM, Quaresma MR, Ferreira LM. Adaptação cultural e validação da versão brasileira da escala de Auto Estima de Rosenberg. Rev. Soc. Bras. Cir. Plást [Internet] 2004 [acessado 2015 maio 15]; 19(1):41-52. Disponível em: http://www.rbcp.org.br/imagebank/pdf/19-01-04pt.pdf
http://www.rbcp.org.br/imagebank/pdf/19-... and QoL⁶6. The Whoqol Group. The world health organization quality of life assessment: position paper from the world health organization. Soc Sci Med 1995; 41(10):1403-1409. prove to be interrelated as they deal with an individual’s subjective perceptions of him/herself⁵5. Dini GM, Quaresma MR, Ferreira LM. Adaptação cultural e validação da versão brasileira da escala de Auto Estima de Rosenberg. Rev. Soc. Bras. Cir. Plást [Internet] 2004 [acessado 2015 maio 15]; 19(1):41-52. Disponível em: http://www.rbcp.org.br/imagebank/pdf/19-01-04pt.pdf
http://www.rbcp.org.br/imagebank/pdf/19-... ^,66. The Whoqol Group. The world health organization quality of life assessment: position paper from the world health organization. Soc Sci Med 1995; 41(10):1403-1409. and life⁶6. The Whoqol Group. The world health organization quality of life assessment: position paper from the world health organization. Soc Sci Med 1995; 41(10):1403-1409.. Thus, low self-esteem scores are expected to produce low QoL scores.

Moreover, the scientific literature states that self-esteem is correlated with aspects of living such as: human relations, work, health and consequently with healthy aging²²22. Han K, Lee Y, Gu J, Oh H, Han J, Kim K. Psychosocial factors for influencing healthy aging in adults in Korea. Health and Quality of Life Outcomes [Internet] 2015 [acessado 2015 jan 03];13:31. Disponível em: http://hqlo.biomedcentral.com/articles/10.1186/s12955-015-0225-5
http://hqlo.biomedcentral.com/articles/1... ^,2323. Kim HK. Factors affecting Successful Aging among Male Elders in Korea. Journal of Convergence Information Technology 2013; 8(14):341-350.. In this context, it is important that the health team identify the factors that may be affecting the self-esteem of the elderly, in order to intervene and promote improvements in QoL.

Concerning the relationship between low levels of self-esteem and the scores in the physical domain, it is possible, although this has not been investigated, that this is due to the termination of professional activities and the advent of retirement. Leaving the job market for the elderly can result in dissatisfaction, less social participation and more concerns about income. Therefore, in this stage of life, qualified listening and reintegration of the elderly into society, not only through work activities, but also in areas that provide personal satisfaction and the development of new projects, must be recognized as an important strategy which will benefit the QoL²⁴24. Lopes APN, Burgardt VM. Idoso: um perfil de alunos na EJA e no mercado de trabalho.Estud. interdiscipl. Envelhec[Internet] 2013 [acessado 2015 jan 27]; 18(2):311-330. Disponível em: http://seer.ufrgs.br/index.php/RevEnvelhecer/article/view/21474
http://seer.ufrgs.br/index.php/RevEnvelh... .

Research conducted with the elderly has shown a relationship between self-esteem and self-image²⁵25. Fonseca CC, Chaves ECL, Pereira SS, Barp M, Moreira AM, Nogueira DA. Autoestima e satisfação corporal em idosas praticantes e não praticantes de atividades corporais. Rev. Educ. Fís/UEM, 2014 [acessado 2015 maio 17]; 25(3):429-439. Disponível em: http://www.scielo.br/pdf/refuem/v25n3/1983-3083-refuem-25-03-00429.pdf
http://www.scielo.br/pdf/refuem/v25n3/19... and complaints about loss of memory²⁶26. Santos AT, Leyendecker DD, Costa ALS, Souza-Talarico JN. Queixa subjetiva de comprometimento da memória em idosos saudáveis: influência de sintomas depressivos, percepção de estresse e autoestima. Rev. esc. enferm. USP [Internet] 2012 Out [acessado 2015 maio 17]; 46(spe):24-29. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342012000700004&lng=en. http://dx.doi.org/10.1590/S0080-62342012000700004
http://www.scielo.br/scielo.php?script=s... , which are topics in the psychological domain. Satisfaction with self-image can interfere, directly or indirectly, in maintaining a healthy and active lifestyle, which impacts health care²⁷27. Bevilacque LA, Daronco LSE, Balsan LNG. Fatores associados à insatisfação com a imagem corporal e autoestima em mulheres ativas. Salusvita 2012; 31(1):55-69. and can improve QoL. Complaints related to memory, which are frequent among the elderly, should be investigated, in order to identify related factors, since this alone represents dissatisfaction with their abilities and can negatively influence their well-being and QoL²⁶26. Santos AT, Leyendecker DD, Costa ALS, Souza-Talarico JN. Queixa subjetiva de comprometimento da memória em idosos saudáveis: influência de sintomas depressivos, percepção de estresse e autoestima. Rev. esc. enferm. USP [Internet] 2012 Out [acessado 2015 maio 17]; 46(spe):24-29. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0080-62342012000700004&lng=en. http://dx.doi.org/10.1590/S0080-62342012000700004
http://www.scielo.br/scielo.php?script=s... .

The social relationships domain evaluates, among other factors, satisfaction with sexual activity⁹9. Bertolucci PHF, Brucki SMD, Campacci SR, Juliano YO. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994; 52(1):1-7.. A study of literature reviews highlights that sexual satisfaction combined with self-esteem, improves sexual, mental and physical health. Having a positive sexuality, refers to the recognition and valorization of past sexual experiences²⁸28. Anderson RM. Positive sexuality and its impacto on overall well-being. Bundesgesundheitsbl [Internet] 2013 [acessado 2015 maio 15]; 56(2):208-214. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23361205
http://www.ncbi.nlm.nih.gov/pubmed/23361... . However, it is known that with aging, physiological changes in the body, besides prejudice, stereotypes and culture of asexuality in old age can inhibit the desires and the sexual act²⁹29. Alencar DL, Marques APO, Leal MCC, Vieira JCM. Fatores que interferem na sexualidade de idosos: uma revisão integrativa. Cien Saude Colet 2014; 19(8):3533-3542.. Health education activities may be relevant strategies to assist in the improvement of social relations, by including information and instructions on obtaining a positive sex life, including sexual communication, the understanding of the physiological factors and self-confidence²⁸28. Anderson RM. Positive sexuality and its impacto on overall well-being. Bundesgesundheitsbl [Internet] 2013 [acessado 2015 maio 15]; 56(2):208-214. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/23361205
http://www.ncbi.nlm.nih.gov/pubmed/23361... .

The environment domain shows that when the elderly have the opportunity to walk on the sidewalks, in the parks, or even use a form of transport safely, they have a greater chance of being more physically and socially active³⁰30. Dias DSG, Carvalho CS, Araújo CV. Comparação da percepção subjetiva de qualidade de vida e bem-estar de idosos que vivem sozinhos, com a família e institucionalizados. Rev. Bras. Geriatr. Gerontol [Internet] 2013 [acessado 2015 maio 15]; 16(1):127-138. Disponível em: http://www.scielo.br/pdf/tce/v23n3/pt_0104-0707-tce-23-03-00648.pdf
http://www.scielo.br/pdf/tce/v23n3/pt_01... . Therefore, actions that provide greater security at home and in the external environment should be developed. Such measures would allow the health professionals to stimulate the elderly in activities at home, as well as broaden their social life, and thus improve their levels of self-esteem and QoL for this domain.

Sensory changes that occur with aging can have a negative effect on the elderly’s QoL, as the sensory functions establish an individual’s connection with his/her world and can influence his/her behavior³¹31. Lamas MC, Paúl CO. O envelhecimento do sistema sensorial: implicações na funcionalidade e qualidade de vida. Actas de Gerontologia [Internet] 2013 [acessado 2015 maio 05]; 11(1):2-11. Disponível em: http://actasdegerontologia.pt/index.php/Gerontologia/article/view/34/39
http://actasdegerontologia.pt/index.php/... . This fact may explain the association between the ‘functioning of the senses’ topic and low levels of self-esteem.

The lower QoL scores in the autonomy topic among those with low levels of self-esteem may be related to inhibiting their decision-making capacity among the elderly as they get older; this result tallies with a study of elderly persons in the state of Paraíba³²32. Melo RLP, Eulálio MC, Gouveia VV, Silva HDM. O efeito do estresse na qualidade de vida de idosos: o papel moderador do sentido de vida. Psicologia: Reflexão e Crítica[Internet] 2013[acessado 2014 out 24]; 26(2):222-230. Disponível em: http://www.scielo.br/scielo.php?pid=S0102-79722013000200002&script=sci_arttext
http://www.scielo.br/scielo.php?pid=S010... . This fact may impact the self-esteem of the elderly, and one way to minimize this process is to ensure the maintenance of autonomy and independence³³33. Farias RG, Santos SMA. Influência dos determinantes do envelhecimento ativo entre idosos mais idosos. Texto Contexto Enferm 2012; 21(1):167-176..

Past, present and future activities portray satisfaction with the achievements made and future hopes¹¹11. Fleck MPA, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica 2006; 40(5):785-791.. The results indicate that the elderly with low scores in the past, present and future activity topics may not be satisfied with their achievements or hold few prospects for the future, negatively influencing their self-esteem. Groups for the elderly can enhance the skills of individuals and help them carry out their projects³⁴34. Serbim AK, Figueiredo AEPL. Qualidade de vida de idosos em um grupo de convivência. Scientia Medica[Internet] 2011[acessado 2015 jan 16]; 21(4):166-172. Disponível em: http://revistaseletronicas.pucrs.br/ojs/index.php/scientiamedica/article/viewFile/9405/726
http://revistaseletronicas.pucrs.br/ojs/... , and thus indirectly increase their self-esteem.

The topic of social participation measures the satisfaction with participation in routine activities, especially within the community¹¹11. Fleck MPA, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica 2006; 40(5):785-791.. In this study, the elderly that had low QoL scores also had low self-esteem, a fact that should be further investigated by the health team. However, involvement in social activities can provide benefits that relate to physical, cognitive, functional issues and longevity. Moreover, such social activities contribute to further exchange of experiences and the sense of feeling useful and belonging to society³⁵35. Neri AL, Vieira LAM. Envolvimento social e suporte social percebido na velhice. Rev. Bras. Geriatr. Gerontol [Internet] 2013 [acessado 2015 jan 16]; 16(3):419-432. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232013000300002
http://www.scielo.br/scielo.php?script=s... . Thus, the inclusion of the elderly in community activities should be encouraged by family members, health professionals and those they live with.

The intimacy topic assesses the capacity for personal and intimate relations¹¹11. Fleck MPA, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publica 2006; 40(5):785-791.. The findings of the research may be explained by the dissatisfaction in the elderly of living with their partners and with those around them. In this sense, intimate relationships should be considered by the health professionals during the evaluation and monitoring of the elderly that have demonstrated impaired self-esteem. Therefore, it is important to train health professionals to work on the issue of intimate relationships with the elderly and their families, even if these are delicate issues to address.

It should be stressed that the lack of research on the relationship between QoL and self-esteem in the elderly hampers a comparative discussion of these results with other studies. Moreover, this study had some limitations such as the cross-sectional design, which does not allow for the establishment of causal relationships; and the use of a questionnaire, which may underestimate or overestimate some of the information found.

In conclusion, the data analyzed shows that the low QoL scores in all domains and topics are associated with low levels of self-esteem, except for the death and dying issue. The psychological domain and the social participation topic were the most affected by a low level of self-esteem.

The results of this study could help to develop health actions, considering the specificities of the aging process, based on a better understanding of the aspects that influence the QoL of elderly due to reduced self-esteem.

References

Publication Dates

History