Knowledge produced on the health of low-income older women: an integrative review

Tavares, Renata Evangelista; Jesus, Maria Cristina Pinto de; Cordeiro, Samara Macedo; Machado, Daniel Rodrigues; Braga, Vanessa Augusta; Merighi, Miriam Aparecida Barbosa

doi:10.1590/0034-7167-2017-0024

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 70 (4) • Jul-Aug 2017 • https://doi.org/10.1590/0034-7167-2017-0024 copy

Knowledge produced on the health of low-income older women: an integrative review

Conocimiento producido sobre la salud de las ancianas de bajos ingresos: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify the knowledge produced on the health of low-income older women.

Method:

an integrative review was conducted in February 2016 on the SCOPUS, CINAHL, MEDLINE, LILACS, EMBASE, WEB OF SCIENCE databases, and in the SciELO journals directory. After the application of inclusion and exclusion criteria, 24 articles were selected.

Results:

the knowledge produced comprises two main themes: "health in face of economic adversities" and "reciprocity in social support between low-income older women and their social network".

Final considerations:

health professionals, especially nurses, should be attentive to aspects related to social determinants and the health of low-income older women, highlighting the fact that they are not always the recipients of care.

Descriptors:
Poverty; Elderly; Social Support; Women's Health; Public Health Nursing

Databases	Search strategy	Articles found
SCOPUS	Keywords - "elderly woman" AND "low income"	89
CINAHL	CINAHL terms - "elderly woman" AND "low income"	29
MEDLINE	Descriptors (MeSH) - "aged" OR "elderly" OR "senior" OR "older people" AND "women" AND "poverty" NOT "men"	2,488
LILACS	Descriptors (DeCS) - "Saúde da mulher" AND "Idoso" AND "Pobreza"	9
EMBASE	Emtree terms: "female" AND "aged" AND "poverty"	6,308
WEB OF SCIENCE	Keywords - "female" OR "women" AND "aged" OR "elderly" OR "senior" OR "older people" AND "poverty" OR "low income" NOT "male" OR "men"	1,319
SciELO	Keywords - "elderly women" AND "poverty" OR "low income" NOT "male"	435

Title	Year/Country	Design/Number of participants	Intervention	Outcome
Correlates of self-care behaviors among low-income elderly women with hypertension in South Korea⁽¹⁰10 Yang SO, Jeong GH, Kim SJ, Lee SH. Correlates of self-care behaviors among low-income elderly women with hypertension in South Korea. J Obstet Gynecol Neonatal Nurs [Internet]. 2014 [cited 2017 Jan 08];43(1):97-106. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24354464 https://www.ncbi.nlm.nih.gov/pubmed/2435... ⁾	2014 South Korea	Quantitative, descriptive correlationaln= 234	Secondary data analysis of a community-based intervention study for hypertension control	The youngest elderly women had better control of hypertension, were self-effective and more prone to report better behaviors of self-care.
"My legs affect me a lot… I can no longer walk to the forest to fetch firewood": challenges related to health and the performance of daily tasks for older women in a high HIV context⁽¹¹11 Schatz E, Gilbert L. My legs affect me a lot. ...I can no longer walk to the forest to fetch firewood": challenges related to health and the performance of daily tasks for older women in a high HIV context. Health Care Women Int [Internet]. 2014 [cited 2017 Jan 08];35(9):771-88. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24628607 https://www.ncbi.nlm.nih.gov/pubmed/2462... ⁾	2014 South Africa	Qualitative, narrative analysis n=30	Open interviews about daily activities	The elderly women took care of their homes and families, made grass carpets or sold traditional beer, [...] took care of ill people. They were responsible for many of their grandchildren.
Future talk in later life⁽¹²12 Paoletti I, Gomes S. Future talk in later life. J Aging Stud [Internet]. 2014[cited 2017 Jan 08];29:131-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24655681 https://www.ncbi.nlm.nih.gov/pubmed/2465... ⁾	2014 Portugal	Qualitative, ethnomethodologicaln=7	Workshop named "Self-awareness about the future" performed in three sessions	The older women expressed negative perceptions of their future and negative connotations on aging.
Aspects of quality of life associated with self-rated health: a study of elderly women from a physical activity program in low-income neighborhoods in Curitiba in the state of Paraná, Brazil⁽¹³13 Vagetti GC, Moreira NB, Barbosa Filho VC, Oliveira V, Cancian CF, Mazzardo O, et al. Domínios da qualidade de vida associados à percepção de saúde: um estudo com idosas de um programa de atividade física em bairros de baixa renda de Curitiba, Paraná, Brasil. Ciênc Saúde Colet [Internet]. 2013 [cited 2017 Jan 09];18(12):3483-93. Available from: http://www.scielo.br/pdf/csc/v18n12/a05v18n12.pdf http://www.scielo.br/pdf/csc/v18n12/a05v... ⁾	2013 Brazil	Quantitative, cross-sectionaln=450		The Physical and Environmental domains had the greatest associations with negative health perception. Eight in each ten older women had a negative health perception.
Older women associating obesity with a negative perception of their health: a study in low-income neighborhoods in Curitiba, southern Brazil⁽¹⁴14 Vagetti GC, Barbosa-Filho VC, Moreira NB, Oliveira V, Schiavini L, Mazzardo O, et al. Associação da obesidade com a percepção de saúde negativa em idosas: um estudo em bairros de baixa renda de Curitiba, Sul do Brasil. Rev Salud Pública [Internet]. 2012 [cited 2017 Jan 09];14(6):923-36. Available from: http://www.scielosp.org/pdf/rsap/v14n6/v14n6a03.pdf http://www.scielosp.org/pdf/rsap/v14n6/v... ⁾	2012 Brazil	Quantitative, correlational, cross-sectional n=449	Questionnaire application, measurement of body weight (kg) and height (m)	Obese older women had 2.09 more chance of having a negative health perception.
Factors associated to risk of malnutrition amongst elderly women in low-income communities⁽¹⁵15 Virtuoso-Júnior JS, Tribess S, Perez VR, Guerra RO. Factors associated to risk of amongst elderly women in low-income communities. Colomb Med [Internet]. 2012 [cited 2017 Jan 09];43(1):54-62. Available from: http://colombiamedica.univalle.edu.co/index.php/comedica/article/view/1059/1681 http://colombiamedica.univalle.edu.co/in... ⁾	2012 Brazil	Quantitative, cross-sectionaln=222	Questionnaire application, measurement of body weight (kg) and height (m), arm and calf circumference (cm)	The older women had a prevalence of 33.8% with risk of malnutrition, or were undernourished, and 64% were classified as overweight or obese.
Functional incapacity among low-income older women⁽¹⁶16 Virtuoso Júnior JS, Guerra RO. Incapacidade funcional em mulheres idosas de baixa renda. Ciênc Saúde Colet [Internet]. 2011 [cited 2017 Jan 09];16(5):2541-8. Available from: http://www.scielo.br/pdf/csc/v16n5/a24v16n5.pdf http://www.scielo.br/pdf/csc/v16n5/a24v1... ⁾	2011 Brazil	Quantitative, cross-sectionaln=222	Questionnaire application, measurement of body weight (kg) and height (m), arm and calf circumference (cm)
Informal support networks of low-income senior women living alone: evidence from Fort St. John, BC⁽¹⁷17 Ryser L, Halseth G. Informal support networks of low-income senior women living alone: Evidence from Fort St. John, BC. J Women Aging [Internet]. 2011 [cited 2017 Jan 09];23(3):185-202. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21767084 https://www.ncbi.nlm.nih.gov/pubmed/2176... ⁾	2011 Canada	Qualitativen=62	Questionnaire, via mail, to identify the support networks	Older women who lived alone depended more on their families and friends (informal support).
Factors associated with depressive symptoms in low-income, older Korean women with hypertension⁽¹⁸18 Sung K. Factors associated with depressive symptoms in low-income, older korean women with hypertension. Nurs Health Sci [Internet]. 2011 [cited 2017 Jan 09];13(3):309-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21733052 https://www.ncbi.nlm.nih.gov/pubmed/2173... ⁾	2011 South Korea	Quantitative, cross-sectionaln=107	Geriatric Depression Scale, Katz Index of Independence in Activities of Daily Living, and The Lubben Social Network Scale	64.5% of the older women showed social isolation or were in high risk of isolation.
Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility⁽¹⁹19 Szanton SL, Wenzel J, Connolly AB, Piferi RL. Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility. BMC Complement Altern Med [Internet]. 2011 [cited 2017 Jan 09];11(44):1-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21627807 https://www.ncbi.nlm.nih.gov/pubmed/2162... ⁾	2011 USA	Qualitativen=13	Focus groups in the Eldershine Program	Benefits such as stress management and possibility of social support were found.
Social support among elderly women in a low income area in the municipality of Rio de Janeiro⁽²⁰20 Sousa AI, Silver LD, Griep RH. Social support among elderly women in a low income area in the municipality of Rio de Janeiro. Acta Paul Enferm [Internet]. 2010 [cited 2017 Jan 09];23(5):625-31. Available from: http://www.scielo.br/pdf/ape/v23n5/en_07.pdf http://www.scielo.br/pdf/ape/v23n5/en_07... ⁾	2010 Brazil	Quantitative, cross-sectionaln=442	Application of questionnaire to measure social support	The flow of exchange relations was greater from the older women to their families than the opposite.
Concurrent validity of self-reported weight and height for diagnosingelderly women's nutritional status⁽²¹21 Virtuoso-Júnior JS, Guerra RO. Validade concorrente do peso e estatura auto-referidos no diagnóstico do estado nutricional em mulheres idosas. Rev Salud Pública [Internet]. 2010 [cited 2017 Jan 09];12(1):71-81. Available from: http://www.scielo.org.co/pdf/rsap/v12n1/v12n1a07.pdf http://www.scielo.org.co/pdf/rsap/v12n1/... ⁾	2010 Brazil	Quantitative, cross-sectionaln=181	Questionnaire application, measurement of body weight (kg) and height (m)	62% of older women were classified as overweight or obese.
Effects of exercise program on physical fitness, depression, and self-efficacy of low-income elderly women in South Korea⁽²²22 Shin KR, Park HJ, Heitkemper M. Effects of exercise program on physical fitness, depression, and self-efficacy of low-income elderly women in South Korea. Public Health Nurs [Internet]. 2009 [cited 2017 Jan 09];26(6):523-31. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19903272 https://www.ncbi.nlm.nih.gov/pubmed/1990... ⁾	2009 South Korea	Quantitative, experimentaln=48	Exercise program consisting of four weeks of education and eight weeks of physical exercise.	Significant improvements were noted in relation to depression, self-efficacy and all measures of physical fitness, except for heart rate and flexibility (experimental group).
Factors associated with physical inactivity amongst elderly women in low-income communities⁽²³23 Tribess S, Virtuoso-Júnior JS, Petroski EL. Fatores Associados à Inatividade Física em Mulheres Idosas em Comunidades de Baixa Renda. Rev Salud Pública [Internet]. 2009 [cited 2017 Jan 09];11(1):39-49. Available from: http://www.scielosp.org/pdf/rsap/v11n1/v11n1a05.pdf http://www.scielosp.org/pdf/rsap/v11n1/v... ⁾	2009 Brazil	Quantitative, cross-sectionaln=265	Questionnaire application, Geriatric Depression Scale, Body Perception Questionnaire and International Physical Activity Questionnaire	35.5% of the women were classified as insufficiently active. There was a significant association with the age group of 80 years and over, moderate to severe type of dependence on instrumental activities of daily living, and dissatisfaction with excess body weight.
Factors associated to functional limitations in elderly of low income⁽²⁴24 Virtuoso Júnior JS, Guerra RO. Fatores associados às limitações funcionais em idosas de baixa renda. Rev Assoc Med Bras [Internet]. 2008 [cited 2017 Jan 09];54(5):430-5. Available from: http://www.scielo.br/pdf/ramb/v54n5/a17v54n5.pdf http://www.scielo.br/pdf/ramb/v54n5/a17v... ⁾	2008 Brazil	Quantitative, cross-sectionaln=208	Questionnaire application and Fulleton Physical tests	56% of the older women had moderate or severe functional limitations. There was a significant association with the age group over 80 years, widowhood conditions, presence of arterial hypertension and physical inactivity in leisure time.
Testing and developing the health promotion model in low-income, Korean elderly women⁽²⁵25 Shin KR, Kang Y, Park HJ, Cho MO, Heitkemper M. Testing and developing the health promotion model in low-income, Korean elderly women. Nurs Sci Q [Internet]. 2008 [cited 2017 Jan 09];21(2):173-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18263763 https://www.ncbi.nlm.nih.gov/pubmed/1826... ⁾	2008 South Korea	Quantitative, Structural Equations Modeling (SEM)n=389	Likert Scale to evaluate health behavior, Rosenberg's self-esteem scale.	Psychological factors were perceived as the most important component of health promoting behaviors.
Socio-demographic profile and self-reported health status ofelderly women in a low-income community⁽²⁶26 Sousa AI, Silver LD. Perfil sociodemográfico e estado de saúde auto-referido entre idosas de uma localidade de baixa renda. Esc Anna Nery Rev Enferm [Internet]. 2008 [cited 2017 Jan 09];12(4):706-16. Available from: http://www.scielo.br/pdf/ean/v12n4/v12n4a15.pdf http://www.scielo.br/pdf/ean/v12n4/v12n4... ⁾	2008 Brazil	Quantitative, cross-sectionaln=369	Questionnaire application based on Brazil Old Age Schedule	62.3% of the older women had a monthly income of up to one minimum wage, and 22% reported having no income. The higher the income, the better the perception of the elderly regarding their current state of health.
Living vigilant lives with chronic illness: stories from older low-income minority women⁽²⁷27 Shawler C, Logsdon D. Living vigilant lives with chronic illness: stories from older low-income minority women. Health Care Women Int [Internet]. 2008 Jan [cited 2017 Jan 09];29(1):76-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18176881 https://www.ncbi.nlm.nih.gov/pubmed/1817... ⁾	2008 USA	Qualitative, descriptiven=13	Focus groups on experiences on dealing with chronic diseases.	Speaking for themselves something positive, having strong spiritual faith and not letting themselves lose the meaning of life were strategies used by the older women.
Medicalization of elderly females and interaction with consumption of tranquilizers⁽²⁸28 Mendonça RT, Carvalho ACD, Vieira EM, Adorno RCF. Medicalização de mulheres idosas e interação com consumo de calmantes. Saúde Soc [Internet]. 2008 [cited 2017 Jan 09];17(2):95-106. Available from: http://www.scielo.br/pdf/sausoc/v17n2/10.pdf http://www.scielo.br/pdf/sausoc/v17n2/10... ⁾	2008 Brazil	Qualitative, descriptiven=18	Questionnaire application on use of tranquilizing drugs	Older women with experience in attending health services, including psychiatric ones, were able to incorporate knowledge and experiences on the use of tranquilizers, promoting their diffusion in the social environment.
Nursing Diagnoses of Pauper Elderly Women of aFamily Health Program (FHP)⁽²⁹29 Marin MJS, Cecílio LCO, Rodrigues LCR, Ricci FA, Druzian S. Diagnósticos de enfermagem de idosas carentes de um programa de saúde da família (PSF). Esc Anna Nery Rev Enferm [Internet]. 2008 [cited 2017 Jan 09];12(2):278-84. Available from: http://www.scielo.br/pdf/ean/v12n2/v12n2a12 http://www.scielo.br/pdf/ean/v12n2/v12n2... ⁾	2008 Brazil	Qualitativen=69	Questionnaire application, Geriatric Depression Scale and Behavior Scale	Among the most frequent diagnoses, the following stood out: "Impaired physical mobility", "Chronic pain" and "Impaired home maintenance".
Nutrient intakes and serum lipid profiles are improved in elderly Korean women with home food delivery⁽³⁰30 Park JK, Son SM. Nutrient intakes and serum lipid profiles are improved in elderly Korean women with home food delivery. Nutr Res [Internet]. 2007 [cited 2017 Jan 09];27(2)78-85. Available from: http://www.nrjournal.com/article/S0271-5317(06)00294-6/abstract http://www.nrjournal.com/article/S0271-5... ⁾	2007 South Korea	Quantitative, experimentaln=27	Delivery of food at home to be consumed for one week	Significantly improved intakes of vegetables, protein, fat, iron and vitamin A, and reduced depression significantly in the group receiving food at home.
Elderly women show neither a shortage of strategies nor an overreliance on drugs in handling aging and in dealing with minor health problems⁽³¹31 Voyer P, Laberge S, Rail G. Elderly women show neither a shortage of strategies nor an overreliance on drugs in handling aging and in dealing with minor health problem. J Women Aging [Internet]. 2005 [cited 2017 Jan 09];17(2):83-98. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15914421 https://www.ncbi.nlm.nih.gov/pubmed/1591... ⁾	2005 Canada	Qualitativen=49		Medication was not seen as panacea nor as source of youth by the older women.
Breast cancer knowledge, beliefs, and Screening behaviors among low-income, Elderly black women⁽³²32 Jones AR, Thompson CJ, Oster RA, Smadi A, Davis MK, Mayberry RM, Caplan LS. Breast cancer knowledge, beliefs, and screening behaviors among low-income, elderly black women. J Nati Med Assoc [Internet]. 2003 [cited 2017 Jan 09];95(9):791-805. Available from: https://www.ncbi.nlm.nih.gov/pubmed/14527046 https://www.ncbi.nlm.nih.gov/pubmed/1452... ⁾	2003 USA	Quantitative, cross-sectionaln=214	Focus groups on Breast Cancer Knowledge, Beliefs and Screening	The younger group (65-74) was twice as likely to recognize risk factors for breast cancer compared to the older (≥85 years).
Elderly Mexican women's perceptions of exercise and conflicting role responsibilities⁽³³33 Gonzalez BC, Jirovec MM. Elderly Mexican women's perceptions of exercise and conflicting role responsibilities. Int J Nurs Stud [Internet]. 2001[cited 2017 Jan 09];38(1):45-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11137722 https://www.ncbi.nlm.nih.gov/pubmed/1113... ⁾	2001 Mexico	Quantitative, cross-sectionaln=50	Questionnaire application and instrument Stages of Change-Exercise	Obstacles for participation in physical activities: caring for the husband and grandchildren, housework, church appointments and childcare at home.

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[1] CORRESPONDING AUTHOR: Renata Evangelista Tavares. Email: renata_tavares@usp.br