Social support networks and health conditions of elderly female family members of military police officers in the state of Rio de Janeiro, BrazilAbstract
This article investigates the health conditions and social support networks of elderly female family members of Military Police Officers in the State of Rio de Janeiro. This is a qualitative, exploratory study that involved nine semi-structured interviews with elderly women aged 60 or older, family members (four mothers), and dependents (three widows and two wives) of active-duty, veteran, or deceased military police officers-seven enlisted men and four officers. The data were subjected to thematic content analysis. They suffer impacts on their physical and mental health: due to premature loss resulting from homicide (two), other causes (two) of police officer deaths, and changes (two) in their place of residence due to violence (threats and risk to life). Support from informal networks, especially family, was found to predominate. Improvements in the corporation’s health services and in the working conditions of military police officers were suggested. It is concluded that access to a formal support network combined with an informal support network can reduce harm to physical and mental health and improve the living conditions of older women.
Key words:
Support Networks; Elderly Women’s Health; Military Police
Resumo
Este artigo investiga as condições de saúde e as redes de apoio social das familiares idosas de Policiais Militares do Estado do Rio de Janeiro. É uma pesquisa qualitativa, do tipo exploratório, em que foram realizadas nove entrevistas semiestruturadas, com mulheres idosas de 60 anos ou mais, familiares (quatro mães) e dependentes (três viúvas e duas esposas) de policiais militares da ativa, veteranos ou falecidos, sendo sete praças e quatro oficiais. Os dados foram submetidos à análise de conteúdo, modalidade temática. Os resultados mostram que as idosas pertencem ao estrato socioeconômico médio baixo. Sofrem impactos na saúde física e mental: pela perda precoce decorrente de homicídio (duas), outras causas (duas) do policial e por mudanças (duas) do local de moradia devido à violência (ameaças e risco de vida). Verificou-se que prepondera o apoio da rede informal, sobretudo da família. Sugeriram melhorias nos serviços de saúde da corporação e nas condições de trabalho do policial militar. Conclui-se que o acesso a uma rede de apoio formal conjugada com uma rede de apoio informal pode reduzir danos à saúde física e mental, e melhorar as condições de vida de mulheres idosas.
Palavras-chave:
Redes de Apoio; Saúde de mulheres Idosas; Polícia Militar
Resumen
Este artículo investiga las condiciones de salud y las redes de apoyo social de mujeres mayores de 60 años, familiares de oficiales de la Policía Militar en el estado de Río de Janeiro. Se trata de un estudio exploratorio cualitativo que incluyó nueve entrevistas semiestructuradas con mujeres mayores de 60 años, familiares (cuatro madres) y dependientes (tres viudas y dos esposas) de oficiales de la policía militar en servicio activo, veteranos o fallecidos: siete soldados y cuatro oficiales. Los datos se sometieron a un análisis de contenido temático. Los resultados muestran que estas mujeres mayores pertenecen al estrato socioeconómico medio-bajo. Sufren impactos en su salud física y mental: por pérdidas prematuras por homicidio (dos), otras causas (dos) de muerte de policías y cambios (dos) de lugar de residencia por violencia (amenazas y riesgo a la vida). Se encontró que el apoyo de las redes informales, especialmente la familia, predomina. Se sugirieron mejoras en los servicios de salud de la corporación y en las condiciones laborales de los oficiales de la policía militar. Se concluye que el acceso a una red de apoyo formal, combinado con una red de apoyo informal, puede reducir el daño a la salud física y mental y mejorar las condiciones de vida de las mujeres mayores.
Palabras clave:
Redes de apoyo; Salud de la mujer adulta mayor; Policía militar
Introduction
Population aging is a rapidly growing process in Brazil and worldwide, with projections indicating that it will reach 1.2 billion people aged 60 years or older by 2025, according to the Pan American Health Organization (PAHO)1. In this context, the feminization of the older population stands out as a complex and multifaceted event that exceeds statistical data2, since the health, work, and citizenship conditions of older women result from experiences accumulated throughout life3. Although the female population lives, on average, at least eight years longer than the male population, this greater longevity does not necessarily correspond to a better quality of life4. Gender relations and other forms of discrimination, such as social class and skin color, may greatly influence women’s health conditions and quality of life throughout life and in old age3,4. All these conditions affect the demands placed on public policies and social protection services5.
The older women who are family members of officers of the Military Police of the State of Rio de Janeiro (PMERJ), the focus of this study, are included in this context of vulnerabilities. Military police officers and their families experience peculiar living conditions because, due to the nature of their professional activity, they are exposed to everyday risks. This risk is evidenced by the higher mortality and morbidity rates resulting from abuse suffered both on and off duty by these professionals, compared with the general population, which imposes an overload of care on this family group due to socioeconomic vulnerability and exposure to violence6. A relevant indicator of this structure is the Rioprevidência data (2020), which indicates that military pensioners represent 21% of the total number of pensioners in the state, including descendants and direct ascendants, spouses, and other dependents7, reinforcing the magnitude of this female contingent dependent on the military protection system.
Notably, women’s low social and economic status, combined with gender issues and greater longevity, are risk factors for violence, especially domestic violence8. Aging brings to the fore discussions about the rights of older adults, and women’s low social and economic status may be both a cause and a consequence of the violence they experience9.
To address these challenges, strengthening the social support network constitutes a fundamental political strategy. The social support network is understood here as an open and multicentered system that, through dynamic exchanges among family, neighborhood, and institutions, enhances resources to solve problems or meet needs10. This support may be classified into material, instrumental, informational, and affective dimensions11. In this context, the social support network acts as a kind of web of exchange relationships, marked by reciprocal obligations and bonds of mutual dependence8.
Lack of access to a minimal support network-or what Guedes et al. 10 call an inadequate support network for older people-may result in several harms to health, such as exposure to situations of risk and vulnerability, a greater likelihood of suffering some type of violence, or committing suicide, and consequently an increase in mortality from external causes (accidents and violence).
Given the lack of visibility of this specific group in knowledge production within the Collective Health, the present study seeks to investigate support networks and self-reported health conditions among older women who are family members of PMERJ officers. It starts from the assumption that access to these networks is a determinant of comprehensive care and the strengthening of social protection at the interface between gerontology and public security.
Material and method
This qualitative, exploratory study aimed to identify and analyze the perceptions, opinions, and beliefs of older women with family ties to military police officers regarding their health and their formal and informal support networks. According to Minayo12, the qualitative method is appropriate for the study of history, relationships, representations, beliefs, perceptions, and opinions, which are products of the interpretations human beings make regarding how they live, build their artifacts and themselves, feel, and think.
The participant group consisted of a convenience sample of older women who were family members of military police officers, aged 60 years or older, in accordance with Article 1 of the Statute of the Older Person13. Mothers, wives, partners, and widows recognized by the Military Police as dependents or pensioners in accordance with the Military Police Statute7 were characterized as family members. All hierarchical levels were considered, from soldier to colonel, whether active, retired, or deceased.
The inclusion criteria provided for the participation of lucid women aged 60 years or older who were users of the Military Police Social Assistance system. Women with family/institutional ties younger than 60 years and those with health problems that prevented them from participating in the interview, such as mental health problems or neurocognitive disorders, were excluded.
A total of 94 (ninety-four) families fitting the selected profile were identified from the files of military police officers and their family members assisted by the General Directorate of Social Assistance (DGAS/SEPM) through its respective services, programs, and record-keeping instruments14. Invitations were made by telephone contact and in person at DGAS, where the purpose of this research and the voluntary nature of participation were explained.
Semistructured interviews were conducted using a roadmap containing three blocks of questions, covering the socioeconomic profile of the respondents; the participants’ living and health conditions; and the formal and informal support networks of the interviewed participants. All interviews were conducted in person in the following locations: five interviews were conducted in the DGAS auditorium, two at the respondent’s home, one at the respondent’s workplace, and one in a rented room in downtown Rio de Janeiro.
The interviews were administered, transcribed verbatim, and checked by the researcher. After this stage, the entire set of materials was organized according to the respondent’s family and/or institutional tie and the current status of the reference military police officer (Active, Retired, or Deceased). A fictitious name was assigned to each participant in order to preserve their anonymity.
The body of information was analyzed using the Content Analysis technique, thematic modality, as recommended by Minayo12, who describes it as a set of communication analysis techniques that, through systematic and objective procedures for describing content, make it possible to extract indicators-quantitative or otherwise-capable of supporting inferences about the conditions of production and reception of these messages.
The Thematic Analysis modality consists of identifying the meaning cores that make up a communication, whose presence or frequency signifies something for the intended analytical object11. Bardin15 affirms that thematic analysis is cross-cutting across all the interviews through categories already made explicit in the contents, with greater emphasis placed on the frequency of the themes obtained in the set of interviews, classified as segmentable and comparable information.
The data analysis presents the socioeconomic profile of the participants in Chart 1 and, based on their reports, seeks to identify their perceptions of the formal and informal support networks available to them, how they perceive their living and health conditions, and what suggestions they offer for improving the corporation’s services.
All ethical procedures for human research were followed in accordance with National Health Council Resolution No. 510/201616 and SEPM Resolution No. 278 of January 30, 202017.
To conduct this research, authorization was requested from two committees responsible for evaluating ethical issues in human research: the Research and Development Office (EPD)/Strategic Affairs Coordination (CAES) of PMERJ, approved on December 23, 2021, under No. 25845094; and the Human Research Ethics Committee of the Fernandes Figueira National Institute of Women’s, Children’s, and Adolescents’ Health (IFF/FIOCRUZ), approved under substantiated Opinion No. 5.351.991 on April 14, 2022.
All participants signed the Informed Consent Record. In order to minimize discomfort due to the topic and the memories triggered, psychological support, social care, and other services made available by the corporation and by the external network were also offered.
It is important to consider that the stages of this research took place during the COVID-19 pandemic, which began in 2020. For this reason, it is important to highlight what Kalache et al. 18 state about the pandemic context and some aggravating factors for the Brazilian older population, a moment that required intergenerational and interdisciplinary solidarity from society.
Results
The results are organized into four parts: characterization of the socioeconomic profile of the participating older women; knowledge of living and health conditions (physical and mental); identification of formal and informal support networks; and suggestions for improvements in the corporation’s services.
Characterization of the socioeconomic profile of older women who are family members of PMERJ officers
The socioeconomic profile of the study participants is described in Chart 1. Ages ranged from 62 to 88 years. The mean age was 79 years among those linked to retired officers, and the mean age was 69.5 years among those linked to deceased officers. The youngest women were observed in the group linked to active-duty officers, with a mean age of 68 years. Regarding skin color, four identified as Brown, three as White, and two as Black.
A large proportion of the respondents had low educational attainment, ranging from illiteracy to complete higher education. Notably, due to low formal schooling and limited professional training over the life course, most had the survivor’s pension left by the police officer as their main source of income, and the family income of older women related to active-duty and retired officers was also composed mainly of the military’s earnings. Among the nine older women, only three reported having their own income, derived from wages and retirement benefits.
The family and/or institutional ties of the older women regarding the reference military police officer were represented as follows: four mothers and two wives formed the group of dependents; three were widows and pensioners. In the group of older women whose military family members were deceased, three were wives, and one was a mother; three of these deaths were homicides, and one was from natural causes.
The respondents’ places of residence were diverse and distributed across the state of Rio de Janeiro, both in Rio de Janeiro and in other municipalities (Central Zone - 1, North Zone - 2, West Zone - 2, Baixada Fluminense - 2, and Eastern Fluminense region - 2).
Living and health conditions of older women who are family members of PMERJ officers
Most respondents assessed their own physical health as unsatisfactory because of their health problems. On the other hand, some participants praised their good mental health because they were lucid and considered this to be a positive and important factor in their lives.
In their reports, they stated that they had chronic diseases, mental and/or cognitive disorders, physical disability, or reduced mobility. Among these conditions, they mentioned chronic kidney disease, diabetes, hypertension, heart disease, stroke, orthopedic and gastrointestinal problems, thyroid disorders, osteoporosis, obesity, depression, panic syndrome, and memory loss. The following excerpts portray some of these reports:
Physically, fair-for my age-, I walk well; mentally, I receive psychiatric follow-up. Before he passed away in 2019, I had already been in treatment for a year, because I developed panic syndrome [...] I take medication for panic syndrome, and I take medication to sleep (Heloisa).
My physical condition is very poor; my mental health is a 10, my mind is very lucid (Marcela).
The older women reported using PMERJ’s health service network, the private network through private health insurance, and the public health service network of the Unified Health System (SUS).
Regarding experiences and exposure to violence, they highlighted urban violence in the region where they lived and lethal violence affecting a family member. Regarding urban violence, two older women had to leave their homes in a hurry because of threats or risk to the lives of their military police family members. The following excerpts are from two older women, a mother and a wife of retired officers, who had to change residence due to violence:
I feel safer: if I go back there now, he can’t go to my house anymore (Dandara).
Where I have my own house, we don’t have much support; from 2005 onward, it turned into a drug trafficking area [...]. So, it became hard to live there. And that was the main reason I left my own home a year ago to live in a rented place. I left my house precisely because of this problem (Lorena).
Among the nine family members, five reported the loss of family members due to violent causes. Even those selected because of their ties to active-duty or retired officers indicated the loss of some family member due to violence, whether the victim was a military officer or not. The following excerpts portray these experiences:
It’s a scar, a wound that never closes. When you lose a father, lose a mother, you feel it - but when you lose a child... (Teresa).
The greatest violence in the world was losing my son (Heloisa).
I lost my husband, murdered in our store by a robber. Before the murder, I had no problems with my mind, but with what happened, everything got worse... (Celina).
I became a widow at 28. My daughters were little (Luana).
In addition to lethal violence, one of the older women subtly referred to psychological violence and abuse, as shown in an excerpt from her testimony:
It was a Military Police officer giving a lecture at the school where I studied, saying that you have rights and don’t know it. She talked about verbal violence, if you are assaulted (Edith).
Formal and informal support networks of older women who are family members of PMERJ officers
In the interviews, the older women identified the supports that, in their perception, make up the formal and informal support network available to them. Figure 1 shows the supports they mentioned, listed in descending order of frequency in the interviews.
Some reports suggest that, within the formal support network, these older women find instrumental and material support, but also affective-emotional support:
One thing I attend and really like is the Police project [West Zone]. It’s an exercise project. It’s really good. I have fun there. It’s a group where people are of various ages, not just older people. Everyone mixed together. It’s a project for the population, even for those who have no ties to the Military Police. There they have exercise, water aerobics. Police officers with disabilities also participate there (Teresa).
The support I have, which is spiritual, comes from the Church and from people. We don’t leave each other alone. It’s spiritual, really through prayers (Celina).
Among informal supports, the group emphasized the family as the main support at this stage of life. They also mentioned neighbors, friends from religious institutions, military police friends, and coworkers. Some older women stated that they were self-sufficient with regard to instrumental support, because they had autonomy to carry out household and daily activities.
Suggestions for improving the Corporation’s services
When asked about what they needed and what they suggested to improve the corporation’s services, five older women reported the need for improvements in the support provided by the corporation, such as home care, private health insurance, among others; four of them mentioned the poor working conditions of military police officers (high risk of death, unsatisfactory salary, devaluation of police work, insecurity, few rights and benefits). They considered the corporation’s health care network insufficient and pointed to the need for improvements in military police working conditions. Finally, one of them reinforced the need for better dissemination of the “Gymnastics for All” project (CEFD/PMERJ), which she valued as highly beneficial.
Discussion
This article sought to explore the perceptions of older women who are family members and dependents of military police officers in Rio de Janeiro regarding their health conditions and the support networks available to them. The results demonstrate the complex intersection among gender, social class, skin color, and aging in the context of violence experienced by older women who are family members of public security professionals. In this specific group of older women had conditions that place them in a situation of greater socioeconomic vulnerability, such as health problems, low educational attainment, low income, and economic dependence. Together with the accumulated distress resulting from losses due to violent events, these act as factors that challenge the idea that greater female longevity is accompanied by a better quality of life.
Most older women in the study reported having incomplete elementary education, and only one had incomplete higher education, which is consistent with what Fonte19 describes about income and education indicators being low among the older population, mostly composed of women. According to 2022 Census data, illiteracy among the older population has declined proportionally over the last three demographic censuses. However, in the group aged 65 years or older, the illiteracy rate was 20.3% in 202220.
Such socioeconomic conditions limit these women’s opportunities for social advancement and accumulate and consolidate vulnerabilities and exclusion. The low educational attainment of the older women and their financial dependence on a pension or the military relative’s income reaffirm historical gender inequalities in access to formal education and women’s participation in the labor market. Furthermore, the lower income reported by the widows of lower-ranking officers reveals that inequities and economic vulnerability in old age may become even more evident with the death of the provider, often due to violent causes.
The meanings assigned to women’s roles and aging in contemporary society remain connected to the culture forged in capitalist sociability, marked by antagonistic relations among social classes. Understanding the history of human societies, therefore, requires studying the condition of class exploitation and gender oppression. To this end, we infer the need to reflect on the fact that gender and generational relations determine the meanings attributed to women’s roles and aging and cannot be dissociated from the dynamics of social classes within capitalism, since these processes determine the meanings of female aging21.
The reported dissatisfaction with physical health due to self-reported chronic diseases (hypertension and diabetes) and mental disorders (depression and panic syndrome) may reflect accumulated experiences and the limited resources available to treat them. Special attention should be given to the reports of the oldest participants, linked as wives/dependents of retired military officers, who referred to more compromised health, likely because they were full-time caregivers and had less time for self-care. This gendered role is often expected of and assumed by women. It overburdens them at all stages of life and may act as a social determinant of health, compromising older women’s quality of life. This perspective is discussed by Rocha et al. 22, who argue that the changes occurring in aging have a unique meaning influenced by social construction and discriminatory and exclusionary factors related to gender, ethnicity, social and economic conditions, geographic origin, and place of residence, among others.
In this context, it is essential to understand the structural inequalities, discrimination, and prejudice that women face at different stages of their lives. The consequences of this oppression becoming even more serious in old age, when they are faced with unsatisfactory living and health conditions incompatible with their important and vital role in developing society19. It becomes relevant to give visibility to the social role of older women, since, historically, women have been targets of economic, social, and political inequalities21.
Therefore, within social violence, noteworthy is that gender violence is insidiously reproduced in society, affecting women of different age groups and potentially further deteriorating the health conditions of these older women. Minayo23 emphasizes that violence is found in social relations and structurally constitutes everyday life. Understanding this event requires an integrated approach that considers gender inequalities, the violence intrinsic to these inequalities, and the long-term impacts on victims and their families23.
Also, another factor that strongly emerged in expectations or preexisting experiences was the risk that the police officer to whom they were related and/or dependent might die and/or suffer injuries in the exercise of the profession. Both police officers and their families experience what Giddens24 called “high consequence risk,” or what Souza and Minayo25 termed “risk as a profession,” since they perform work of elevated risk that materializes in the frequent injuries and deaths resulting from abuse, both inside and outside the institution. Nor is their fear unfounded: in Brazil, military police officers on duty died at twice the rate of civil police officers and police officers in the United States25. This victimization is even greater when they are off duty.
This situation may increase violence, affecting not only the individuals directly involved, but also their families, who sometimes lack access to care and support resources26 and become physically and emotionally ill after the loss of a loved one due to violent death27, which corroborates the results of this study.
The results of this study show that the formal or informal support networks available to older women who are family members of military police officers were limited to fundamental health needs and emotional support. Along with this, their reports of fear due to the risk inherent in the relative’s profession and personal experiences with traumatic events, such as the loss of children and partners due to violence, may be factors that further restrict the already limited support networks of these older women.
Support networks for victims of violence should be in place, especially for grieving families, as emphasized by the Portuguese Victim Support Association28, which defends the need to provide social, emotional, legal, and psychological support to these people. This institution also highlights the possibility of pathological grief developing among family members of homicide victims, even long after the loss28. Other authors26,27,29 discuss the great difficulty of families of people who die due to violence (including police officers) in having their grief recognized and legitimized by society, as well as the abandonment they feel in these situations. These authors also stress the need to coordinate support, rights, and protection networks for what they call “indirect victims.” They further highlight the importance of training professionals who work in these services to address the grief these people experience.
The older women who were family members of military police officers underscored the importance of PMERJ’s health and social assistance services, as well as the private network, with few references to the SUS health network, which tends to be common in groups with specific institutional ties, such as military police families, reflecting the institution-based dependence on the corporation. Notably, exclusive use of SUS services is a reality30 for 70% of the Brazilian population, which was not observed among the older women participating in this study, who, despite having lower socioeconomic status, still had access to the corporation’s services.
Although they were the most cited, the corporation’s health services received critical evaluations from the older women, who considered them limited. Among the reports, there was an idealization of private health insurance paid for by the corporation. This perception is consistent with Camarano’s31 argument that, although the legal frameworks in favor of older people represent significant advances, social inclusion policies have not been prioritized in their implementation and financing. The author believes that, as a consequence, the costs of several proposed measures end up being shared with society, which may threaten intergenerational solidarity.
On the other hand, the Gymnastics Project was highly valued among the older women as an example of affective and instrumental support. Their reported satisfaction with the support received in these initiatives leave no doubt as to the role played by this action in health promotion and socialization, both of which are so important at this stage of life.
The data presented indicate the need to value social support networks for older people in order to promote their health and prevent situations of violence. Also, such networks may be important sources of support in coping with challenging situations such as traumatic events and risks experienced by this group of family members of public security agents. The importance of expanding formal and informal support networks is highlighted, since they complement each other in the social reality of these older women, from a perspective of social protection, respect, dignity, and quality of life.
To this end, the study by Souza et al. 8 signals the importance of fostering the strengthening of formal and informal support and protection networks in order to restore feelings of shared identity, belonging to the community, and collectivity. In other words, it calls for the formation of solidarity networks as a pathway toward restoring citizenship and confronting violence8 and abandonment in old age.
The concept of formal and informal support networks and their use as a work strategy for the performance of different professionals in the fields of Health, Public Security, Social Assistance, Education, among others, is essential and should be more frequently used in studies focusing on the theme in different institutions and public policies, with frontline professionals and with groups or people in situations of vulnerability and risk26.
The present research had some limitations that may be improved in future studies. For example, issues related to social security benefits and/or accident insurance provided, and rights and institutional benefits available to the families of deceased police officers, were not addressed. Furthermore, the convenience sample and the small number of respondents may have limited the potential to identify the diverse existing situations. Nevertheless, the study fulfills the role of giving visibility to the perceptions of this group of older women, who are scarcely represented in the national scientific literature.
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The data sources adopted in the research are indicated in the article’s body.
Source: Authors.