Is self-esteem associated with the elderly person’s quality of life?

¿La autoestima está relacionada a la calidad de vida de la persona anciana?

Edison Vitório de Souza Júnior Diego Pires Cruz Lais Reis Siqueira Randson Souza Rosa Cristiane dos Santos Silva Chrisne Santana Biondo Namie Okino Sawada About the authors

ABSTRACT

Objective:

To analyze the association between self-esteem and quality of life in the elderly.

Methods:

Cross-sectional web survey developed with 519 elderly people. Participants filled out three data collection instruments developed on the Google Forms platform and widely disseminated through all of Brazil. Fisher’s exact test, Mann-Whitney, Pearson correlation, and linear regression with 95% confidence interval were used.

Results:

Self-esteem was associated with all quality-of-life facets: sensory skills [β= 1.307; p<0.001]; autonomy [β= 2.101; p<0.001]; past, present, and future activities [β= 2.486; p<0.001]; social presence [β= 2.547; p<0.001]; death and dying [β= 2.175; p<0.001]; and intimacy [β=2.378; p<0.001].

Conclusion:

There is a positive and statistically significant association between self-esteem and quality of life in the elderly. We therefore suggest the development of local policies capable of raising this age groups’ self-esteem and reaffirming aging as a new possibility for discoveries and pleasure.

Descriptors:
Mental Health; Elderly Health; Public Health; Geriatric Nursing; Holistic Nursing

RESUMEN

Objetivo:

Analizar la relación entre autoestima y calidad de vida de ancianos.

Método:

Estudio seccional web survey desarrollado con 519 ancianos. Participantes rellenaron tres instrumentos para la recolecta de datos organizados en la plataforma Google Forms y ampliamente divulgados para todo Brasil. Utilizadas las pruebas Exacta de Fisher, Mann-Whitney, correlación de Pearson y regresión lineal con intervalo de confianza de 95%.

Resultados:

Autoestima estuvo relacionada con todas las facetas de la calidad de vida: habilidades sensoriales [β= 1,307; p<0,001]; autonomía [β= 2,101; p<0,001]; actividades pasadas, presentes y futuras [β= 2,486; p<0,001]; participación social [β= 2,547; p<0,001]; muerte y morir [β= 2,175; p<0,001]; e intimidad [β= 2,378; p<0,001].

Conclusión:

Hay relación positiva y estadísticamente significante entre autoestima y calidad de vida de ancianos. Sugerimos, así, el desarrollo de políticas locales capaces de elevar la autoestima de ese grupo etario y reafirmar el envejecimiento como una nueva posibilidad de descubiertas y placer.

Descriptores:
Salud Mental; Salud del Anciano; Salud Pública; Enfermería Geriátrica; Enfermería Holística

RESUMO

Objetivo:

Analisar a associação entre autoestima e qualidade de vida de idosos.

Métodos:

Estudo seccional web survey desenvolvido com 519 idosos. Os participantes preencheram três instrumentos para a coleta dos dados organizados na plataforma Google Forms e amplamente divulgados para todo o Brasil. Utilizaram-se os testes Exato de Fisher, Mann-Whitney, correlação de Pearson e regressão linear com intervalo de confiança de 95%.

Resultados:

Autoestima esteve associada com todas as facetas da qualidade de vida: habilidades sensoriais [β= 1,307; p<0,001]; autonomia [β= 2,101; p<0,001]; atividades passadas, presentes e futuras [β= 2,486; p<0,001]; participação social [β= 2,547; p<0,001]; morte e morrer [β= 2,175; p<0,001]; e intimidade [β= 2,378; p<0,001].

Conclusão:

Há associação positiva e estatisticamente significante entre autoestima e qualidade de vida de idosos. Sugerimos, portanto, o desenvolvimento de políticas locais capazes de elevar a autoestima desse grupo etário e reafirmar o envelhecimento como uma nova possibilidade de descobertas e prazer.

Descritores:
Saúde Mental; Saúde do Idoso; Saúde Pública; Enfermagem Geriátrica; Enfermagem Holística

INTRODUCTION

In Brazil, an “elder” is a person aged 60 years or over(11 Ribeiro VS, Rosa RS, Sanches GJC, Ribeiro ÍJS, Cassotti CA. Qualidade de vida e depressão em domicílios no contexto doméstico. Enferm Actual Costa Rica. 2017;(34). https://doi.org/10.15517/revenf.v0i34.30983
https://doi.org/10.15517/revenf.v0i34.30...
). Currently, the country has a population of more than 28 million elderly people, which represents 13% of the population, according to data from the Instituto Brasileiro de Geografia e Estatística (IBGE) [Brazilian Institute of Geography and Statistics](22 Instituto Brasileiro de Geografia e Estatística (IBGE). Idosos indicam caminhos para uma melhor idade. Rev Retratos [Internet] 2019 [cited 2021 Aug 04]. Available from: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/24036-idosos-indicam-caminhos-para-uma-melhor-idade
https://agenciadenoticias.ibge.gov.br/ag...
). In addition, Brazilian estimates point to the possibility of having twice as many people over 60 years of age in the coming decades(22 Instituto Brasileiro de Geografia e Estatística (IBGE). Idosos indicam caminhos para uma melhor idade. Rev Retratos [Internet] 2019 [cited 2021 Aug 04]. Available from: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/24036-idosos-indicam-caminhos-para-uma-melhor-idade
https://agenciadenoticias.ibge.gov.br/ag...
); and, by 2050, the World Health Organization states that, for every five people, one will be aged 60 years or over(33 Organização Mundial da Saúde (OMS). Orientações sobre a avaliação centrada na pessoa e roteiros para a atenção primária: manual [Internet] 2020 [cited 2021 Aug 04]. Available from: https://iris.paho.org/bitstream/handle/10665.2/51974/OPASFPLHL200004A_por.pdf?sequence=1&isAllowed=y
https://iris.paho.org/bitstream/handle/1...
).

The aging process is an active, progressive, and intrinsic phenomenon, being accompanied by several physical and psychophysiological changes that can result in unsatisfactory repercussions on the adaptive capacity of the elderly to the environment in which they live(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
) and, consequently, affect their self-esteem. In this sense, there are some factors intrinsic to aging that negatively influence self-esteem, such as the cessation of work(55 Spadoni-Pacheco LM, Carvalho GA. Quality of life and self-esteem in elderly patients who did or did not have cosmetic surgery. Rev Bras Cir Plást [Internet]. 2018 [cited 2021 Feb 21];33(4):528-35. Available from: http://www.rbcp.org.br/details/2218/pt-BR/qualidade-de-vida-e-autoestima-em-idosas-submetidas-e-nao-submetidas-a-cirurgia-estetica
http://www.rbcp.org.br/details/2218/pt-B...
), significant loss of social roles, physiological limitations, physical changes, and loss of loved ones(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
).

Self-esteem can be understood as a personal assessment, involving thoughts and feelings that individuals have about themselves, considering their limits and expectations(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
). It is a construct that shows how much the individuals like themselves, how they see themselves, and what they think about themselves(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
), thus becoming a sense of self-worth and self-acceptance(55 Spadoni-Pacheco LM, Carvalho GA. Quality of life and self-esteem in elderly patients who did or did not have cosmetic surgery. Rev Bras Cir Plást [Internet]. 2018 [cited 2021 Feb 21];33(4):528-35. Available from: http://www.rbcp.org.br/details/2218/pt-BR/qualidade-de-vida-e-autoestima-em-idosas-submetidas-e-nao-submetidas-a-cirurgia-estetica
http://www.rbcp.org.br/details/2218/pt-B...
). In addition, it is considered an important indicator of mental health, so there is a need for strategies that favor its increase considering the health of the elderly and the prevention of mental disorders(55 Spadoni-Pacheco LM, Carvalho GA. Quality of life and self-esteem in elderly patients who did or did not have cosmetic surgery. Rev Bras Cir Plást [Internet]. 2018 [cited 2021 Feb 21];33(4):528-35. Available from: http://www.rbcp.org.br/details/2218/pt-BR/qualidade-de-vida-e-autoestima-em-idosas-submetidas-e-nao-submetidas-a-cirurgia-estetica
http://www.rbcp.org.br/details/2218/pt-B...
). This is because the positive self-assessment reflects good mental health and provides greater security and confidence to the elderly, which, in turn, contributes to an adjusted life(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
).

Therefore, this study was motivated by the scarcity of current investigations focusing on the analysis of the relationship between self-esteem and the elderly’s quality of life (QoL) within the national and international scope(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
,77 Oliveira DV, Nascimento MA, Fernandes A, Franco MF, Nascimento Jr JRA. Self-esteem among older adults treated at basic health units and associated factors. Geriatr Gerontol Aging. 2019;13:133-40. https://doi.org/10.5327/Z2447-211520191900029
https://doi.org/10.5327/Z2447-2115201919...
). Furthermore, considering that elderly people are more vulnerable to loss of self-esteem resulting from role changes and changes in interpersonal relationships(88 Veni RK, Merlene AMA. Gender differences in self-esteem and quality of life among the elderly. IJHW [Internet] 2017 [cited 2021 Aug 04];8(8):885-7. Available from: https://www.proquest.com/docview/1961766049
https://www.proquest.com/docview/1961766...
), that psychological dimensions are predictors of a better QoL, which can maximize successful aging(99 Ingrand I, Paccalin M, Liuu E, Gil R, Ingrand P. Positive perception of aging is a key predictor of quality-of-life in aging people. PLoS ONE. 2018;13(10):e0204044. https://doi.org/10.1371/journal.pone.0204044
https://doi.org/10.1371/journal.pone.020...
), and that self-esteem is an important aspect in coping with the aging process(99 Ingrand I, Paccalin M, Liuu E, Gil R, Ingrand P. Positive perception of aging is a key predictor of quality-of-life in aging people. PLoS ONE. 2018;13(10):e0204044. https://doi.org/10.1371/journal.pone.0204044
https://doi.org/10.1371/journal.pone.020...
), some authors confirm the importance of intensifying studies on this topic due to its high impact on the health system(77 Oliveira DV, Nascimento MA, Fernandes A, Franco MF, Nascimento Jr JRA. Self-esteem among older adults treated at basic health units and associated factors. Geriatr Gerontol Aging. 2019;13:133-40. https://doi.org/10.5327/Z2447-211520191900029
https://doi.org/10.5327/Z2447-2115201919...
).

Following this perspective, we developed this study aiming to fill the existing gap regarding the quantitative limitation of research in the area, as well as to continue the line of thought of some authors(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
,77 Oliveira DV, Nascimento MA, Fernandes A, Franco MF, Nascimento Jr JRA. Self-esteem among older adults treated at basic health units and associated factors. Geriatr Gerontol Aging. 2019;13:133-40. https://doi.org/10.5327/Z2447-211520191900029
https://doi.org/10.5327/Z2447-2115201919...
) who reported such gap. Also in this sense, given the growing elderly population, we must invest in methods that go beyond the biological aspects and begin to value the subjectivities and actions that promote the health and QoL of these elderly people, as increasing the number of days in life is not enough: quality should also be added to those additional years.

Our study considered the definition of QoL proposed by the World Health Organization (WHO), which defines it as “the individual’s perception of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns”(1010 The Whoqol Group. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569-85. https://doi.org/10.1016/s0277-9536(98)00009-4
https://doi.org/10.1016/s0277-9536(98)00...
). Therefore, considering the impacts of the aging process and the need to promote quality to the years to come, the hypothesis of this study is that self-esteem is positively associated with the QoL of the elderly.

OBJECTIVE

To analyze the association between self-esteem and quality of life in the elderly.

METHODS

Ethical aspects

This study complied with all ethical and bioethical aspects regarding the development of research with human beings in accordance with Resolution No. 466/2012 of the National Health Council. The project was approved, in 2020, by the Research Ethics Committee (REC) of the Escola de Enfermagem de Ribeirão Preto - Universidade de São Paulo (EERP/USP) [Ribeirão Preto College of Nursing - University of São Paulo]. All participants read and agreed to the Free and Informed Consent Form (FICF), which was sent with a blind copy to all emails informed.

Study design, time and place

This study has a web survey type, sectional design, with a descriptive approach, built in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool. The study scenario covered the five regions of Brazil (North, Northeast, Midwest, Southeast, and South). There were no face-to-face meetings between participants and researchers. Data collection was online and took place between July and October 2020; the elderly remained in their respective homes.

Sample; inclusion and exclusion criteria

The sample was selected using the consecutive non-probabilistic technique, being determined a priori with the following parameters: α = 0.05 (5%), CI = 95% (zα/2 = 1.96), 50% conservative proportion, and adjustment for infinite population. With this, there was a need for at least 385 elderly people. However, foreseeing the possibility of losses and incompleteness of answers to the questionnaire, more than 30% (n = 134) were added to the final calculation, which resulted in 519 participants.

They met all the inclusion criteria: people residing in any region of Brazil; aged 60 years or over; with internet access and an active Facebook account. Such criteria were controlled using Facebook’s post boosting feature, through which you delimit the dissemination of the instruments only to the previously defined public.

The exclusion criteria were: elderly people residing in long-term and other similar institutions, those hospitalized during the collection period, with some degree of dependence for undertaking basic daily living activities, and those with any neurodegenerative comorbidity that compromised the understanding of the instruments. Such criteria were tracked through four dichotomous questions (yes/no) carried out in the initial stage of data collection, questioning whether they fit any aforementioned characteristic. Elderly people who answered negatively to all questions were considered eligible.

Since the collection was online and considering the skills needed to handle electronic devices such as smartphones and/or laptops, in addition to the active interaction of the elderly in a social network, the application of instruments to assess cognitive conditions was dispensed with. We also emphasize that there was no way to ensure that the participants responded to the instruments without assistance.

Study protocol

Data collection took place between July and October 2020 through a social interaction page on Facebook, created exclusively for the development of scientific research on sexuality, health, and QoL, as well as for the dissemination of information related to these themes.

The authors published an invitation to participate which contained the study title, institution and responsible researchers, inclusion criteria, contact email, and a hyperlink that directed interested parties to the survey questionnaire developed on the Google Forms platform. This questionnaire was structured in five blocks: 1) study presentation, 2) free and informed consent form (FICF), 3) bio-sociodemographic data, 4) data on self-esteem and 5) data on QoL.

The first block contained information about the presentation and justification of the study, in addition to the inclusion criteria that should be met by the participants.

In the second block, the FICF, project approval number by the REC and contact information (telephone and email) were presented. After reading the consent form, the participants declared their acceptance to participate in the study through a mandatory question. Also in this second block, participants were required to include their email for the sending of a duplicate of the consent form and for data control, allowing the researchers to track and correct a possible multiplicity of responses by the same participant and, consequently, avoid bias, which did not occur in the present study.

The third block was structured with questions elaborated by the researchers themselves and aimed to know the bio-sociodemographic profile of the participants. It contained questions related to sex, age group, marital status, sexual orientation, religious belief, Brazilian region in which they live, education, ethnicity, and whether they lived with their children.

The fourth block included the Rosenberg Self-Esteem Scale, adapted and validated for the Brazilian population. It is organized into ten items with four Likert-type answer possibilities, ranging from 1 point (totally disagree) to 4 points (totally agree)(1111 Hutz CS, Zanon C. Revisão da adaptação, validação e normatização da escala de autoestima de Rosenberg. Aval Psicol [Internet]. 2011[cited 2021 Aug 04];10(1):41-9. http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-04712011000100005&lng=pt
http://pepsic.bvsalud.org/scielo.php?scr...
). A cutoff point was adopted: < 30 (poor self-esteem) and ≥ 30 (satisfactory self-esteem)(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
). In the present study, the scale showed good reliability, as evidenced by Cronbach’s alpha of 0.854.

Finally, the fifth block was built with the World Health Organization Quality of Life - Old (WHOQOL-Old) instrument, adapted and validated for Brazilian elderly(1212 Fleck MP, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saúde Publica 2006;40(5):785-91. https://doi.org/10.1590/S0034-89102006000600007
https://doi.org/10.1590/S0034-8910200600...
). It consists of 24 questions distributed in six facets of assessment: sensory skills; autonomy; past, present, and future activities; social presence; death and dying; and intimacy. Each question has five possible answers on a Likert-type scale ranging from 1 to 5 points. There is no cutoff point for WHOQOL-Old. Its total score varies between 24 and 100 points; and, the higher the final score, the better the interviewee’s QoL(1313 Scherrer Jr G, Okuno MFP, Oliveira LM, Barbosa DA, Alonso AC, Fram DS, et al. Quality of life of institutionalized aged with and without symptoms of depression. Rev Bras Enferm. 2019;72(2):127-33. https://doi.org/10.1590/0034-7167-2018-0316
https://doi.org/10.1590/0034-7167-2018-0...
). It is noteworthy that, before the analysis, the recoding of the necessary items was performed.

In the present study, the WHOQOL-Old showed good reliability, with a Cronbach’s alpha of 0.901. In the reliability analysis, the facets had the following results: sensory skills (α = 0.795); autonomy (α = 0.701); past, present, and future activities (α = 0.761); social presence (α = 0.833); death and dying (α = 0.822); and intimacy (α = 0.888).

The authors contracted the post boosting feature on a monthly basis. This is an option offered by Facebook that allows for increased engagement in the publication, expanding the possibility of the research being liked, commented on, and shared among users, in addition to making the questionnaire available throughout the Brazilian territory. In this way, we were able to achieve the required sample.

Analysis of results and statistics

Data were transported from Microsoft Excel to the IBM SPSS® statistical software (version 25) to be stored and analyzed. We considered a 95% confidence interval (p < 0.05) for all analyses. Quantitative variables were presented as median (Md) and interquartile range (IQ). Qualitative variables were expressed through absolute and relative frequencies.

Fisher’s exact test was used to analyze the proportions of bio-sociodemographic variables and the two classifications of self-esteem (satisfactory and unsatisfactory). The Mann-Whitney U test was used to compare two independent groups with the QoL facets.

To analyze the relationship between the independent variable (self-esteem) and the dependent ones (QoL facets), the Pearson correlation (r) was used. Finally, the analyses that presented a p value < 0.2 were included in the linear regression model by the “insert” method, whose results were given through their respective β coefficients (standardized and non-standardized), standard error, 95% confidence interval (CI 95%), coefficient of determination (R2), and p-value. The model’s adequacy was attested by the Durbin-Watson test.

RESULTS

Among the 519 participants, there was a higher prevalence of elderly males (n = 354; 68.2%); aged between 60 and 64 years (n = 257; 49.5%); of the Catholic religion (n = 258; 49.7%); self-declared white (n = 340; 65.5%); with complete higher education (n = 196; 37.8%); married (n = 313; 60.3%); who live with their spouse for over 20 years (n = 293; 56.5%); heterosexuals (n = 445; 85.7%); who do not live with their children (n = 339; 65.3%); and reside in the Southeast region of the country (n = 239; 46.1%).

Also, most elderly people had satisfactory self-esteem (n = 388; 74.8%); and self-esteem was statistically associated with ethnicity (p = 0.034); education (p = 0.016); and sexual orientation (p = 0.001), according to Fisher’s exact test (Table 1).

Table 1
Comparison of the bio-sociodemographic variables with self-esteem, Ribeirão Preto, São Paulo, Brazil, 2020

The highest proportion of categories with unsatisfactory self-esteem was observed among elderly who self-declared yellow (63.6%), bisexual (70.0%), and with education up to middle school (40.0%). As for satisfactory self-esteem, the highest proportion was found among self-declared browns (80.6%), with higher education (80.1%), and heterosexuals (77.3%).

According to Table 2, it is observed that, regardless of the classification of self-esteem, the elderly showed better QoL in the Sensory Skills facet. Also, it is noted that elderly people with unsatisfactory self-esteem have the lowest QoL scores in all facets, with worse QoL when compared to elderly people with satisfactory self-esteem (p < 0.001).

Table 2
Comparison of the Quality of Life facets with self-esteem, Ribeirão Preto, São Paulo, Brazil, 2020

Table 3 demonstrates that all facets of QoL were significantly correlated with self-esteem, presenting positive correlations of different magnitudes (p < 0.001).

Table 3
Correlations between the facets of Quality of Life and self-esteem, Ribeirão Preto, São Paulo, Brazil, 2020

The final analysis of linear regression showed that the self-esteem scale remained positively associated with all facets of QoL, thus indicating that an increase in self-esteem implies an increase in the elderly’s QoL (p < 0.001), as shown in Table 4. In addition, the model was able to explain 50.8% of the relationship between self-esteem and general quality of life of the studied elderly.

Table 4
Final regression models for overall self-esteem and Quality of Life facets, Ribeirão Preto, São Paulo, Brazil, 2020

DISCUSSION

We identified that most elderly people had a satisfactory self-esteem (n = 388; 74.8%), corroborating another similar investigation(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
) and even a research developed with different cutoff points and classifications(1414 Meira SS, Vilela ABA, Casotti CA, Silva DM. Self esteem and factors associated with social conditions in the elderly. Rev Pesqui: Cuid Fundam. 2017;9(3):744. https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
https://doi.org/10.9789/2175-5361.2017.v...
). Such evidence can be explained by the fact that the participants of the study developed in Paraná(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
) who were users of the third age gym, while the participants of another study carried out in Minas Gerais(66 Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
https://doi.org/10.15309/19psd200319...
), that had a good health status, in addition to those with a higher level of education had the best self-esteem scores. Therefore, it is inferred that physical activity and the increase in social presence provided by the elderly gym, as well as education, are three factors that can positively influence the level of self-esteem of elderly people.

The fact that most of the participants in our study present satisfactory self-esteem gives health professionals a sense of accomplishment, since self-esteem is considered an essential factor in old age and corresponds to one of the personality dimensions that exerts the greatest influence on wellbeing and adapting to the world; therefore, it is a relevant aspect for success and satisfaction with life(1414 Meira SS, Vilela ABA, Casotti CA, Silva DM. Self esteem and factors associated with social conditions in the elderly. Rev Pesqui: Cuid Fundam. 2017;9(3):744. https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
https://doi.org/10.9789/2175-5361.2017.v...
). In addition, higher self-esteem scores have been associated with positive attitudes towards health, while low scores are related to risky behavior, such as suicidal behavior(1515 Silva MN, Monteiro JCS. Self-esteem assessment of young female university students according to race/skin color criteria. Rev Latino-Am Enfermagem. 2020;28:e3362. https://doi.org/10.1590/1518-8345.3866.3362
https://doi.org/10.1590/1518-8345.3866.3...
). In this sense, we bring an inference about the self-care of the elderly with their health: we noticed better self-esteem scores among females, as men only seek health services when they are already ill, which, consequently, can compromise their health, self-esteem, and QoL, considering possible causality between these variables.

From this perspective, given the negative effects of low self-esteem, we should not ignore the reality of the other 25.2% of participants who had unsatisfactory self-esteem. Although they constitute a minority in our study (n = 131), this lower proportion does not prevent them from suffering the harmful consequences nor does it reduce the right of these elderly people to access all means that preserve their physical and mental health, as recommended by the Statute of the Elderly(1616 Presidência da República (BR). Lei no 10.741, de 1o de outubro de 2003. Dispõe sobre o Estatuto do Idoso e dá outras providências[Internet]. Brasília; Oct 3, 2003[cited 2021 Aug 04]. Available from: http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm
http://www.planalto.gov.br/ccivil_03/lei...
). Some alternatives with beneficial effects on elderly’s self-esteem can be mentioned, such as living in a good family system, participating in activities and social groups(11 Ribeiro VS, Rosa RS, Sanches GJC, Ribeiro ÍJS, Cassotti CA. Qualidade de vida e depressão em domicílios no contexto doméstico. Enferm Actual Costa Rica. 2017;(34). https://doi.org/10.15517/revenf.v0i34.30983
https://doi.org/10.15517/revenf.v0i34.30...
), practicing physical activities(1717 Moral-García JE, García DO, García SL, Jiménez MA, Dios RM. Influence of physical activity on self-esteem and risk of dependence in active and sedentary elderly people. An Psicol. 2018;34(1):162-6. https://doi.org/10.6018/analesps.34.1.294541
https://doi.org/10.6018/analesps.34.1.29...
), encouraging the expression of sexuality(1818 Souza Jr EV, Silva CS, Lapa PS, Trindade LES, Silva Filho BF, Sawada NO. Influence of sexuality on the health of the elderly in process of dementia: integrative review. Aquichan. 2020;20(1):e2016. https://doi.org/10.5294/aqui.2020.20.1.6
https://doi.org/10.5294/aqui.2020.20.1.6...
), and sexual activity(1919 Erens B, Mitchell KR, Gibson L, Datta J, Lewis R, Field N, et al. Health status, sexual activity and satisfaction among older people in Britain: a mixed methods study. PLoS One. 2019;14(3):e0213835. https://doi.org/10.1371/journal.pone.0213835
https://doi.org/10.1371/journal.pone.021...
) among others — were all included as comments in the online invitation, during data collection. These beneficial effects for self-esteem, proven through studies, also collaborate with the improvement of QoL.

Another relevant finding of our study was the association found between self-esteem and ethnicity, education, and sexual orientation, similar to other studies that also found a statistically significant association of low self-esteem with non-white people(2020 Watson LB, DeBlaere C, Langrehr KJ, Zelaya DG, Flores MJ. The influence of multiple oppressions on women of color’s experiences with insidious trauma. J Couns Psychol. 2016;63(6):656-67. https://doi.org/10.1037/cou0000165
https://doi.org/10.1037/cou0000165...
), lower education level(2121 Salerno MC, Bolina AF, Dias FA, Martins NPF, Tavares DMS. Autoestima de idosos comunitários e fatores associados: estudo de base populacional. Cogitare Enferm. 2015;20(4):782. https://doi.org/10.5380/ce.v20i4.41895
https://doi.org/10.5380/ce.v20i4.41895...
), and those whose sexual orientation does not include heteronormativity(2222 Albuquerque GA, Parente JS, Belém JM, Garcia CL. Violência psicológica em lésbicas, gays, bissexuais, travestis e transexuais no interior do Ceará, Brasil. Saúde Debate. 2016;40(109):100-11. https://doi.org/10.1590/0103-1104201610908
https://doi.org/10.1590/0103-11042016109...
).

In more detail, our results showed that participants who self-declared as yellow ethnicity, with education up to middle school, and bisexuals had unsatisfactory self-esteem. As for satisfactory self-esteem, the highest statistically significant proportion was found among self-declared browns, with higher education and heterosexuals. This may be due to better income, employment, and access to health care opportunities without suffering discrimination within these services, contrary to what is observed among people belonging to minority groups from a social point of view, such as yellow people, with low education, and outside the heterosexual pattern.

In Brazil, the yellow ethnicity classification refers to people of Asian origin who reside in the Brazilian territory(2323 Instituto Brasileiro de Geografia e Estatística (IBGE). Síntese de indicadores sociais: uma análise das condições de vida da população brasileira[Internet]. 2020 [cited 2021 Aug 04]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101760.pdf
https://biblioteca.ibge.gov.br/visualiza...
). Although the yellow elderly have shown significant proportions of unsatisfactory self-esteem, there is no data in the literature on this ethnic group to encourage discussion. The few existing studies address issues of racial discrimination with a focus on the black population of different age groups, not necessarily focusing on the approach to the elderly population.

In this sense, international studies have shown an association between exposure and racial discrimination with negative impacts on the mental health of victims aged between 18 and 58 years old(2020 Watson LB, DeBlaere C, Langrehr KJ, Zelaya DG, Flores MJ. The influence of multiple oppressions on women of color’s experiences with insidious trauma. J Couns Psychol. 2016;63(6):656-67. https://doi.org/10.1037/cou0000165
https://doi.org/10.1037/cou0000165...
) and between 18 and 76 years old(2424 Moody AT, Lewis JA. Gendered racial microaggressions and traumatic stress symptoms among black women. Psychol Women Q. 2019;43(2):201-14. https://doi.org/10.1177/0361684319828288
https://doi.org/10.1177/0361684319828288...
). Otherwise, there is a Brazilian study developed with women between 18 and 24 years old that did not identify a statistically significant association between the level of self-esteem and self-reported race/color, although black participants showed the lowest mean self-esteem scores when compared to non-black participants(1515 Silva MN, Monteiro JCS. Self-esteem assessment of young female university students according to race/skin color criteria. Rev Latino-Am Enfermagem. 2020;28:e3362. https://doi.org/10.1590/1518-8345.3866.3362
https://doi.org/10.1590/1518-8345.3866.3...
).

Furthermore, the fact that the self-declared brown elders have better self-esteem in our study may be associated with issues related to the “strength of racial identity”, defined as the positive feeling of belonging and attachment to their identity(1515 Silva MN, Monteiro JCS. Self-esteem assessment of young female university students according to race/skin color criteria. Rev Latino-Am Enfermagem. 2020;28:e3362. https://doi.org/10.1590/1518-8345.3866.3362
https://doi.org/10.1590/1518-8345.3866.3...
), which increases their self-esteem and acts to protect these people from the internalization of bad feelings resulting from discrimination(2525 Urzúa A, Ferrer R, Olivares E, Rojas J, Ramírez R. El efecto de la discriminación racial y étnica sobre la autoestima individual y colectiva según el fenotipo autoreportado en migrantes colombianos en Chile. Ter Psicol. 2019;37(3):225-40. https://doi.org/10.4067/S0718-48082019000300225
https://doi.org/10.4067/S0718-4808201900...
). Therefore, self-esteem is, in most cases, a psychological strategy for protection, adaptation, and coping with stressful events(2626 Castro NB, Lopes MVO, Monteiro ARM. Low chronic self-esteem and low situational self-esteem: a literature review. Rev Bras Enferm. 2020;73(1):e20180004. https://doi.org/10.1590/0034-7167-2018-0004
https://doi.org/10.1590/0034-7167-2018-0...
).

As for the association found between self-esteem and education level, our results corroborate a study(2121 Salerno MC, Bolina AF, Dias FA, Martins NPF, Tavares DMS. Autoestima de idosos comunitários e fatores associados: estudo de base populacional. Cogitare Enferm. 2015;20(4):782. https://doi.org/10.5380/ce.v20i4.41895
https://doi.org/10.5380/ce.v20i4.41895...
) carried out with 980 elderly Brazilians, which identified lower education level as a predictor of low self-esteem. They also ratify another study(1414 Meira SS, Vilela ABA, Casotti CA, Silva DM. Self esteem and factors associated with social conditions in the elderly. Rev Pesqui: Cuid Fundam. 2017;9(3):744. https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
https://doi.org/10.9789/2175-5361.2017.v...
) carried out with 279 elderly people, in which a higher level of education was significantly associated with a higher level of self-esteem among the participants. From this perspective, it can be inferred that more educated elderly people have greater self-esteem, as they take care of their health more frequently and carefully, thus preserving their health and QoL during their aging process.

The literature points out that education plays a fundamental role with regard to the feeling of security and dignity in social relationships, leading to better self-esteem among the elderly(1414 Meira SS, Vilela ABA, Casotti CA, Silva DM. Self esteem and factors associated with social conditions in the elderly. Rev Pesqui: Cuid Fundam. 2017;9(3):744. https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
https://doi.org/10.9789/2175-5361.2017.v...
), especially among those who have never had the opportunity to study(2121 Salerno MC, Bolina AF, Dias FA, Martins NPF, Tavares DMS. Autoestima de idosos comunitários e fatores associados: estudo de base populacional. Cogitare Enferm. 2015;20(4):782. https://doi.org/10.5380/ce.v20i4.41895
https://doi.org/10.5380/ce.v20i4.41895...
). In addition, higher education is associated with better social opportunities, access to information, better living conditions(2121 Salerno MC, Bolina AF, Dias FA, Martins NPF, Tavares DMS. Autoestima de idosos comunitários e fatores associados: estudo de base populacional. Cogitare Enferm. 2015;20(4):782. https://doi.org/10.5380/ce.v20i4.41895
https://doi.org/10.5380/ce.v20i4.41895...
), use of health services, adherence to health and educational programs focused on health promotion and protection(1414 Meira SS, Vilela ABA, Casotti CA, Silva DM. Self esteem and factors associated with social conditions in the elderly. Rev Pesqui: Cuid Fundam. 2017;9(3):744. https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
https://doi.org/10.9789/2175-5361.2017.v...
) and, above all, the search for knowledge, which promotes positive impacts on self-esteem(2121 Salerno MC, Bolina AF, Dias FA, Martins NPF, Tavares DMS. Autoestima de idosos comunitários e fatores associados: estudo de base populacional. Cogitare Enferm. 2015;20(4):782. https://doi.org/10.5380/ce.v20i4.41895
https://doi.org/10.5380/ce.v20i4.41895...
) — these results are confirmed by ours, in which seniors with higher education showed satisfactory self-esteem.

Regarding sexual orientation, a study(2222 Albuquerque GA, Parente JS, Belém JM, Garcia CL. Violência psicológica em lésbicas, gays, bissexuais, travestis e transexuais no interior do Ceará, Brasil. Saúde Debate. 2016;40(109):100-11. https://doi.org/10.1590/0103-1104201610908
https://doi.org/10.1590/0103-11042016109...
) developed with 316 individuals belonging to the community of Lesbians, Gays, Bisexuals, Transvestites, Transsexuals, Queers, Intersex People, and other identities (LGBTTQI+) identified three feelings that predominated among the participants: sadness (52.2%), low self-esteem (37.7%), and anxiety (35.7%). In our study, we identified poor self-esteem among elderly bisexuals, while heterosexuals showed better self-esteem.

We emphasize that the LGBTTQI+ community faces significant conflicts when going against the heteronormative standard and its hegemony in the systems of values and behaviors, in addition to sexual and social standards. In this sense, any manifestations that are not within the heterosexual scope can be the target of physical, sexual, and/or psychological violence, which, in turn, result in negative repercussions for the mental health and QoL of this public. These negative effects include an increase of approximately six times more chances of suffering depressive states and their consequences such as fear, anxiety, social isolation, guilt, shame, hostility, use and/or abuse of psychoactive substances, confusion(2222 Albuquerque GA, Parente JS, Belém JM, Garcia CL. Violência psicológica em lésbicas, gays, bissexuais, travestis e transexuais no interior do Ceará, Brasil. Saúde Debate. 2016;40(109):100-11. https://doi.org/10.1590/0103-1104201610908
https://doi.org/10.1590/0103-11042016109...
), among others, such as reduced self-esteem.

Therefore, considering that self-esteem is an important marker of mental health, and the literature presents a significant limitation in the number of studies that investigate this topic and the QoL of the LGBTTQI+ audience, we highlight the need to develop more current investigations in order to find connections between self-esteem and several variables related to this specific group(2727 Marmara J, Hosking W, Lyons A. Body image disturbances as predictors of reduced mental health among Australian gay men: being in a relationship does not serve as a protective factor. Arch Sex Behav. 2018;47:2467-79. https://doi.org/10.1007/s10508-018-1208-5
https://doi.org/10.1007/s10508-018-1208-...
).

Our results showed that, regardless of the self-esteem classification, the elderly had better QoL in the Sensory Skills facet, confirming data from similar studies(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
,2828 Almeida BL, Souza MEBF, Rocha FC, Fernandes TF, Evangelista CB, Ribeiro KSMA. Quality of life of elderly people who practice physical activities. Rev Pesqui: Cuid Fundam. 2020;12(0):432-6. https://doi.org/10.9789/2175-5361.rpcfo.v12.845
https://doi.org/10.9789/2175-5361.rpcfo....
-2929 Manso MEG, Maresti LTP, Oliveira HSB. Analysis of quality of life and associated factors in a group of elderly persons with supplemental health plans in the city of São Paulo, Brazil. Rev Bras Geriatr Gerontol. 2019;22(4):e190013. https://doi.org/10.1590/1981-22562019022.190013
https://doi.org/10.1590/1981-22562019022...
) and diverging from another(3030 Molina NPFM, Tavares DMS, Haas VJ, Rodrigues LR. Religiousity, spirituality and quality of life of elderly according to structural equation modeling. Texto Contexto Enferm. 2020;29:e20180468. https://doi.org/10.1590/1980-265X-TCE-2018-0468
https://doi.org/10.1590/1980-265X-TCE-20...
), in which the elderly had a greater perception of QoL in the Intimacy facet. The Sensory Skills facet is responsible for evaluating the loss of senses (hearing, vision, touch, and taste) and its impacts on the QoL of the elderly(3131 Simeão SFAP, Martins GAL, Gatti MAN, Conti MHS, Vitta A, Marta SN. Comparative study of quality of life of elderly nursing home residents and those attneding a day center. Ciên Saúde Coletiva. 2018;23(11):3923-34. https://doi.org/10.1590/1413-812320182311.21742016
https://doi.org/10.1590/1413-81232018231...
). This is a fundamental facet, as any change in the sensory components of the elderly interferes in an undesirable way in their QoL, since the sensory functions are responsible for establishing relationships between the individual and the world, being able to influence their patterns and behavior(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
).

We observed that elderly people with unsatisfactory self-esteem have the lowest QoL scores in all facets, evidencing worse QoL when compared to elderly people with satisfactory self-esteem. These results corroborate a Brazilian study(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
) carried out with 1,691 elderly people, in which participants with lower self-esteem had the worst QoL scores. Furthermore, our final linear regression analysis revealed that the self-esteem scale remained positively associated with all facets of QoL, explaining 50.8% of the relationships between self-esteem and the general quality of life of the elderly who participated.

We emphasize that self-esteem is a positive factor for the QoL not only of the elderly, but also of other age groups in different clinical contexts, as observed in investigations carried out with individuals with a mean age of 45.47 years after kidney transplantation(3232 Rocha FL, Echevarría-Guanilo ME, Silva DMGV, Gonçalves N, Lopes SGR, Boell JEW, et al. Relationship between quality of life, self-esteem and depression in people after kidney transplantation. Rev Bras Enferm. 2020;73(1):e20180245. https://doi.org/10.1590/0034-7167-2018-0245
https://doi.org/10.1590/0034-7167-2018-0...
) ; women diagnosed with fibromyalgia with a mean age of 42.7 years(3333 Sechi C, Vismara L, Brennstuhl MJ, Tarquinio C, Lucarelli L. Adult attachment styles, self-esteem, and quality of life in women with fibromyalgia. Health Psychol Open. 2020. https://doi.org/10.1177/2055102920947921
https://doi.org/10.1177/2055102920947921...
); and obese adolescents with a mean age of 15.3 years(3434 Avalos MRA, Ayers SL, Patrick DL, Jager J, Castro FG, Konopken YP, et al. Familism, self-esteem, and weight-specific quality of life among latinx adolescents with obesity. J Pediatr Psychol. 2020;45(8):848-57. https://doi.org/10.1093/jpepsy/jsaa047
https://doi.org/10.1093/jpepsy/jsaa047...
).

Limitations of the study

The results presented here must be interpreted with caution, given that the non-probabilistic sampling used does not allow extrapolating the results to the elderly population in general, which ends up becoming a limitation of the study. Another limitation concerns the possible selection bias, since, as data collection took place online, elderly people living in a situation of social vulnerability were indirectly excluded from the sample, either because they do not have access to the internet, or due to the low level of education, which possibly hindered the ability to read and understand texts.

Finally, although there is a progressive increase in scientific publications in the field of human aging, there is a considerable quantitative limitation of national and international studies that analyze the mental health of the elderly(3535 Silva PAS, Rocha SV, Santos LB, Santos CA, Amorim CR, Vilela ABA. Prevalência de transtornos mentais comuns e fatores associados entre idosos de um município do Brasil. Ciên Saúde Coletiva. 2018;23(2):639-46. https://doi.org/10.1590/1413-81232018232.12852016
https://doi.org/10.1590/1413-81232018232...
), especially regarding self-esteem and its relationship with QoL(44 Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
https://doi.org/10.1590/1413-81232015211...
). In this sense, it was not possible to make further comparisons with our results. This reality reinforces the need for more investigations on self-esteem among the elderly, as our findings point to self-esteem as a non-pharmacological strategy that can help increase the quality of the additional years of life in this age group.

Contributions to the field of nursing

This study contributes by providing subsidies for the creation of strategies capable of providing old age with self-esteem and QoL. Our results have the potential to change the fragmented and medicalized care practice, especially in Primary Care, in which health care for the elderly is focused on chronic-degenerative pathologies and there is an invisibility of the elderly’s self-esteem in their biopsychospiritual state. Therefore, we emphasize the importance of health professionals, especially nurses, to expand their knowledge about comprehensive care and to be based on nursing values, especially regarding holistic care.

In this sense, we bring to nursing the need for a more attentive and less simplified look at this population. With the knowledge generated here, it is possible to assume a differentiated practice in nursing, aimed beyond the bodily and physiological needs of elderly people, which will trigger the creation of new methods for the evolution of self-esteem and, consequently, improvement in QoL. For example, the past, present, and future activities facet had the highest correlation coefficient with self-esteem. In this sense, health professionals can draw attention to this facet in order to explore the perspectives of the elderly in these three time spaces and intervene with educational approaches on the peculiarities of aging and ways to adapt and enjoy this new stage of the vital cycle.

Another point that deserves to be highlighted is that the minority groups in our study (low education, yellow, and bisexual people) need more attention from professionals, as they had worse self-esteem. These are groups that often suffer from health inequities, and therefore face obstacles to accessing services efficiently, which can bring undesirable effects to their health, self-esteem, and QoL. Here, we reinforce the commitment that must exist with users of the Unified Health System, as one of its principles is “equality of health care, without prejudice or privileges of any kind”, as provided for in current legislation(3636 Presidência da República (BR). Lei nº 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências[Internet]. Diário Oficial da União. 1990 [cited 2021 Aug 04]. Available from: http://www.planalto.gov.br/ccivil_03/leis/l8080.htm
http://www.planalto.gov.br/ccivil_03/lei...
).

Finally, it is noteworthy that we address an audience with characteristics not very much observed in the literature (elderly people with high education), which makes our study innovative in the area. Furthermore, we emphasize that high education may be a predominant feature in the future generation of elderly people, as there is an expansion of undergraduate and graduate courses in Brazil, and this may affect the profile of this public in the future. Due to this process, it is relevant to develop more studies that produce early knowledge of this group of elderly people.

CONCLUSION

We conclude that most elderly people have satisfactory self-esteem. Furthermore, self-esteem was significantly associated with ethnicity, education, and sexual orientation, with the best self-esteem being identified among brown, college-educated, and heterosexual participants. On the other hand, we identified that the worst self-esteem was among the self-declared yellow, with low education, and bisexual elderly.

We also observed that, regardless of the self-esteem classification, the elderly showed better QoL in the Sensory Abilities facet, and the highest correlation coefficient was identified in the Past, present, and future activities facet, when compared to self-esteem.

Furthermore, the elderly with unsatisfactory self-esteem showed worse QoL in all facets evaluated; and we observed that satisfactory self-esteem has a positive association with QoL, assuming, therefore, a directly proportional behavior, and the final self-esteem score explained 50.8% of the variation in the participants’ general QoL data.

We therefore suggest the development of local policies capable of raising the self-esteem of the elderly and reaffirming aging as a new possibility for discoveries and pleasure. It is difficult to say here how these local policies should be carried out, given the need to consider the reality of each individual who is inserted in a given geographic space and who shares different individual and collective characteristics - because they are different needs, the process becomes unique and dynamic. Therefore, the health professional, especially the nurse, must carry out situational diagnoses and determine priorities identified in loco so that, with this survey, there is the necessary planning and health interventions to increase the elderly person’s self-esteem.

  • FUNDING
    This work was carried out with the support of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Financing Code 001.

REFERENCES

  • 1
    Ribeiro VS, Rosa RS, Sanches GJC, Ribeiro ÍJS, Cassotti CA. Qualidade de vida e depressão em domicílios no contexto doméstico. Enferm Actual Costa Rica. 2017;(34). https://doi.org/10.15517/revenf.v0i34.30983
    » https://doi.org/10.15517/revenf.v0i34.30983
  • 2
    Instituto Brasileiro de Geografia e Estatística (IBGE). Idosos indicam caminhos para uma melhor idade. Rev Retratos [Internet] 2019 [cited 2021 Aug 04]. Available from: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/24036-idosos-indicam-caminhos-para-uma-melhor-idade
    » https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/24036-idosos-indicam-caminhos-para-uma-melhor-idade
  • 3
    Organização Mundial da Saúde (OMS). Orientações sobre a avaliação centrada na pessoa e roteiros para a atenção primária: manual [Internet] 2020 [cited 2021 Aug 04]. Available from: https://iris.paho.org/bitstream/handle/10665.2/51974/OPASFPLHL200004A_por.pdf?sequence=1&isAllowed=y
    » https://iris.paho.org/bitstream/handle/10665.2/51974/OPASFPLHL200004A_por.pdf?sequence=1&isAllowed=y
  • 4
    Tavares DMS, Matias TGC, Ferreira PCS, Pegorari MS, Nascimento JS, Paiva MM. Quality of life and self-esteem among the elderly in the community. Ciên Saúde Coletiva. 2016;21(11):3557-64. https://doi.org/10.1590/1413-812320152111.03032016
    » https://doi.org/10.1590/1413-812320152111.03032016
  • 5
    Spadoni-Pacheco LM, Carvalho GA. Quality of life and self-esteem in elderly patients who did or did not have cosmetic surgery. Rev Bras Cir Plást [Internet]. 2018 [cited 2021 Feb 21];33(4):528-35. Available from: http://www.rbcp.org.br/details/2218/pt-BR/qualidade-de-vida-e-autoestima-em-idosas-submetidas-e-nao-submetidas-a-cirurgia-estetica
    » http://www.rbcp.org.br/details/2218/pt-BR/qualidade-de-vida-e-autoestima-em-idosas-submetidas-e-nao-submetidas-a-cirurgia-estetica
  • 6
    Oliveira D, Ladeira Â, Giacomin L, Pivetta N, Antunes M, Batista R, et al. Depressão, autoestima e motivação de idosos para a prática de exercícios físicos. Psicol Saúde Doenças. 2019;20(3):803-12. https://doi.org/10.15309/19psd200319
    » https://doi.org/10.15309/19psd200319
  • 7
    Oliveira DV, Nascimento MA, Fernandes A, Franco MF, Nascimento Jr JRA. Self-esteem among older adults treated at basic health units and associated factors. Geriatr Gerontol Aging. 2019;13:133-40. https://doi.org/10.5327/Z2447-211520191900029
    » https://doi.org/10.5327/Z2447-211520191900029
  • 8
    Veni RK, Merlene AMA. Gender differences in self-esteem and quality of life among the elderly. IJHW [Internet] 2017 [cited 2021 Aug 04];8(8):885-7. Available from: https://www.proquest.com/docview/1961766049
    » https://www.proquest.com/docview/1961766049
  • 9
    Ingrand I, Paccalin M, Liuu E, Gil R, Ingrand P. Positive perception of aging is a key predictor of quality-of-life in aging people. PLoS ONE. 2018;13(10):e0204044. https://doi.org/10.1371/journal.pone.0204044
    » https://doi.org/10.1371/journal.pone.0204044
  • 10
    The Whoqol Group. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med. 1998;46(12):1569-85. https://doi.org/10.1016/s0277-9536(98)00009-4
    » https://doi.org/10.1016/s0277-9536(98)00009-4
  • 11
    Hutz CS, Zanon C. Revisão da adaptação, validação e normatização da escala de autoestima de Rosenberg. Aval Psicol [Internet]. 2011[cited 2021 Aug 04];10(1):41-9. http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-04712011000100005&lng=pt
    » http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-04712011000100005&lng=pt
  • 12
    Fleck MP, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saúde Publica 2006;40(5):785-91. https://doi.org/10.1590/S0034-89102006000600007
    » https://doi.org/10.1590/S0034-89102006000600007
  • 13
    Scherrer Jr G, Okuno MFP, Oliveira LM, Barbosa DA, Alonso AC, Fram DS, et al. Quality of life of institutionalized aged with and without symptoms of depression. Rev Bras Enferm. 2019;72(2):127-33. https://doi.org/10.1590/0034-7167-2018-0316
    » https://doi.org/10.1590/0034-7167-2018-0316
  • 14
    Meira SS, Vilela ABA, Casotti CA, Silva DM. Self esteem and factors associated with social conditions in the elderly. Rev Pesqui: Cuid Fundam. 2017;9(3):744. https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
    » https://doi.org/10.9789/2175-5361.2017.v9i3.738-744
  • 15
    Silva MN, Monteiro JCS. Self-esteem assessment of young female university students according to race/skin color criteria. Rev Latino-Am Enfermagem. 2020;28:e3362. https://doi.org/10.1590/1518-8345.3866.3362
    » https://doi.org/10.1590/1518-8345.3866.3362
  • 16
    Presidência da República (BR). Lei no 10.741, de 1o de outubro de 2003. Dispõe sobre o Estatuto do Idoso e dá outras providências[Internet]. Brasília; Oct 3, 2003[cited 2021 Aug 04]. Available from: http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm
    » http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm
  • 17
    Moral-García JE, García DO, García SL, Jiménez MA, Dios RM. Influence of physical activity on self-esteem and risk of dependence in active and sedentary elderly people. An Psicol. 2018;34(1):162-6. https://doi.org/10.6018/analesps.34.1.294541
    » https://doi.org/10.6018/analesps.34.1.294541
  • 18
    Souza Jr EV, Silva CS, Lapa PS, Trindade LES, Silva Filho BF, Sawada NO. Influence of sexuality on the health of the elderly in process of dementia: integrative review. Aquichan. 2020;20(1):e2016. https://doi.org/10.5294/aqui.2020.20.1.6
    » https://doi.org/10.5294/aqui.2020.20.1.6
  • 19
    Erens B, Mitchell KR, Gibson L, Datta J, Lewis R, Field N, et al. Health status, sexual activity and satisfaction among older people in Britain: a mixed methods study. PLoS One. 2019;14(3):e0213835. https://doi.org/10.1371/journal.pone.0213835
    » https://doi.org/10.1371/journal.pone.0213835
  • 20
    Watson LB, DeBlaere C, Langrehr KJ, Zelaya DG, Flores MJ. The influence of multiple oppressions on women of color’s experiences with insidious trauma. J Couns Psychol. 2016;63(6):656-67. https://doi.org/10.1037/cou0000165
    » https://doi.org/10.1037/cou0000165
  • 21
    Salerno MC, Bolina AF, Dias FA, Martins NPF, Tavares DMS. Autoestima de idosos comunitários e fatores associados: estudo de base populacional. Cogitare Enferm. 2015;20(4):782. https://doi.org/10.5380/ce.v20i4.41895
    » https://doi.org/10.5380/ce.v20i4.41895
  • 22
    Albuquerque GA, Parente JS, Belém JM, Garcia CL. Violência psicológica em lésbicas, gays, bissexuais, travestis e transexuais no interior do Ceará, Brasil. Saúde Debate. 2016;40(109):100-11. https://doi.org/10.1590/0103-1104201610908
    » https://doi.org/10.1590/0103-1104201610908
  • 23
    Instituto Brasileiro de Geografia e Estatística (IBGE). Síntese de indicadores sociais: uma análise das condições de vida da população brasileira[Internet]. 2020 [cited 2021 Aug 04]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101760.pdf
    » https://biblioteca.ibge.gov.br/visualizacao/livros/liv101760.pdf
  • 24
    Moody AT, Lewis JA. Gendered racial microaggressions and traumatic stress symptoms among black women. Psychol Women Q. 2019;43(2):201-14. https://doi.org/10.1177/0361684319828288
    » https://doi.org/10.1177/0361684319828288
  • 25
    Urzúa A, Ferrer R, Olivares E, Rojas J, Ramírez R. El efecto de la discriminación racial y étnica sobre la autoestima individual y colectiva según el fenotipo autoreportado en migrantes colombianos en Chile. Ter Psicol. 2019;37(3):225-40. https://doi.org/10.4067/S0718-48082019000300225
    » https://doi.org/10.4067/S0718-48082019000300225
  • 26
    Castro NB, Lopes MVO, Monteiro ARM. Low chronic self-esteem and low situational self-esteem: a literature review. Rev Bras Enferm. 2020;73(1):e20180004. https://doi.org/10.1590/0034-7167-2018-0004
    » https://doi.org/10.1590/0034-7167-2018-0004
  • 27
    Marmara J, Hosking W, Lyons A. Body image disturbances as predictors of reduced mental health among Australian gay men: being in a relationship does not serve as a protective factor. Arch Sex Behav. 2018;47:2467-79. https://doi.org/10.1007/s10508-018-1208-5
    » https://doi.org/10.1007/s10508-018-1208-5
  • 28
    Almeida BL, Souza MEBF, Rocha FC, Fernandes TF, Evangelista CB, Ribeiro KSMA. Quality of life of elderly people who practice physical activities. Rev Pesqui: Cuid Fundam. 2020;12(0):432-6. https://doi.org/10.9789/2175-5361.rpcfo.v12.845
    » https://doi.org/10.9789/2175-5361.rpcfo.v12.845
  • 29
    Manso MEG, Maresti LTP, Oliveira HSB. Analysis of quality of life and associated factors in a group of elderly persons with supplemental health plans in the city of São Paulo, Brazil. Rev Bras Geriatr Gerontol. 2019;22(4):e190013. https://doi.org/10.1590/1981-22562019022.190013
    » https://doi.org/10.1590/1981-22562019022.190013
  • 30
    Molina NPFM, Tavares DMS, Haas VJ, Rodrigues LR. Religiousity, spirituality and quality of life of elderly according to structural equation modeling. Texto Contexto Enferm. 2020;29:e20180468. https://doi.org/10.1590/1980-265X-TCE-2018-0468
    » https://doi.org/10.1590/1980-265X-TCE-2018-0468
  • 31
    Simeão SFAP, Martins GAL, Gatti MAN, Conti MHS, Vitta A, Marta SN. Comparative study of quality of life of elderly nursing home residents and those attneding a day center. Ciên Saúde Coletiva. 2018;23(11):3923-34. https://doi.org/10.1590/1413-812320182311.21742016
    » https://doi.org/10.1590/1413-812320182311.21742016
  • 32
    Rocha FL, Echevarría-Guanilo ME, Silva DMGV, Gonçalves N, Lopes SGR, Boell JEW, et al. Relationship between quality of life, self-esteem and depression in people after kidney transplantation. Rev Bras Enferm. 2020;73(1):e20180245. https://doi.org/10.1590/0034-7167-2018-0245
    » https://doi.org/10.1590/0034-7167-2018-0245
  • 33
    Sechi C, Vismara L, Brennstuhl MJ, Tarquinio C, Lucarelli L. Adult attachment styles, self-esteem, and quality of life in women with fibromyalgia. Health Psychol Open. 2020. https://doi.org/10.1177/2055102920947921
    » https://doi.org/10.1177/2055102920947921
  • 34
    Avalos MRA, Ayers SL, Patrick DL, Jager J, Castro FG, Konopken YP, et al. Familism, self-esteem, and weight-specific quality of life among latinx adolescents with obesity. J Pediatr Psychol. 2020;45(8):848-57. https://doi.org/10.1093/jpepsy/jsaa047
    » https://doi.org/10.1093/jpepsy/jsaa047
  • 35
    Silva PAS, Rocha SV, Santos LB, Santos CA, Amorim CR, Vilela ABA. Prevalência de transtornos mentais comuns e fatores associados entre idosos de um município do Brasil. Ciên Saúde Coletiva. 2018;23(2):639-46. https://doi.org/10.1590/1413-81232018232.12852016
    » https://doi.org/10.1590/1413-81232018232.12852016
  • 36
    Presidência da República (BR). Lei nº 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências[Internet]. Diário Oficial da União. 1990 [cited 2021 Aug 04]. Available from: http://www.planalto.gov.br/ccivil_03/leis/l8080.htm
    » http://www.planalto.gov.br/ccivil_03/leis/l8080.htm

Publication Dates

  • Publication in this collection
    07 Mar 2022
  • Date of issue
    2022

History

  • Received
    24 May 2021
  • Accepted
    23 Oct 2021
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