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Quality of life in older adults according to race/color: a cross-sectional study

ABSTRACT

BACKGROUND:

Increased longevity is accompanied by new social and health demands, such as the race/color social construct, indicating the need to identify the specific needs of older adults to maintain and improve their quality of life.

OBJECTIVE:

We aimed to verify the direct and indirect associations of demographic, economic, and biopsychosocial characteristics with self-assessed quality of life in older adults according to race/color.

DESIGN AND SETTING:

This cross-sectional study included 941 older adults living in the urban area of a health microregion in Minas Gerais, Brazil.

METHODS:

Older adults were divided into three groups: white (n = 585), brown (n = 238), and black (n = 102) race/color. Descriptive and trajectory analyses were performed (P < 0.05).

RESULTS:

Among the three groups, worse self-assessed quality of life was directly associated with lower social support scores and greater numbers of depressive symptoms. Worse self-assessed quality of life was also directly associated with a higher number of functional disabilities in basic activities of daily living and the absence of a partner among older adults of brown and black race/color. Lower monthly income and higher numbers of morbidities and compromised components of the frailty phenotype were observed among participants of white race/color, as well as lower levels of education in the brown race/color group.

CONCLUSION:

Factors associated with poorer self-assessed quality of life among older adults in the study community differed according to race/color.

KEY WORDS (MeSH terms):
Aged; Quality of life; Models statistical

AUTHORS’ KEY WORDS:
Race or ethnic group distribution; Older adults; Quality of life among community-dwelling older people

INTRODUCTION

Increased longevity is accompanied by new social and health demands, indicating a requirement to meet the specific needs of older populations in order to maintain and improve their quality of life (QoL).11. Rodrigues LR, Tavares DS, Dias FA, et al. Quality of life of elderly people of the community and associated factors. J Nurs UFPE on line. 2017;11(Suppl 3):1430-8. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/13985. Accessed in 2022 (May 3).
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44. Ghosh D, Dinda S. Determinants of the quality of life among elderly: comparison between China and India. Int J Commun Social Develop. 2020;2(1):71-98. https://doi.org/10.1177/2516602620911835.
https://doi.org/https://doi.org/10.1177/...

QoL is defined as “the individual’s perception of their position in life in relation to the context and value systems in which they are inserted, as well as their goals, expectations, standards, and concerns.”55. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403-9. PMID: 8560308; https://doi.org/10.1016/0277-9536(95)00112-k.
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This definition highlights the complexity of the relationships among components, such as physical and psychological health, level of functional independence, social support, and interaction with the environment.66. Fleck MP, Louzada S, Xavier M, et al. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref” [Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref]. Rev Saude Publica. 2000;34(2):178-83. PMID: 10881154; https://doi.org/10.1590/S0034-89102000000200012.
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Several factors can negatively influence the QoL of older adults, including the presence of comorbidities and depressive symptoms,11. Rodrigues LR, Tavares DS, Dias FA, et al. Quality of life of elderly people of the community and associated factors. J Nurs UFPE on line. 2017;11(Suppl 3):1430-8. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/13985. Accessed in 2022 (May 3).
https://periodicos.ufpe.br/revistas/revi...
decreased social support,22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
https://doi.org/https://doi.org/10.11606...
,33. Şahin DS, Özer Ö, Yanardağ MZ. Perceived social support, quality of life and satisfaction with life in elderly people. Educational Gerontolology. 2019;45(1):69-77. https://doi.org/10.1080/03601277.2019.1585065.
https://doi.org/https://doi.org/10.1080/...
poor physical performance,22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
https://doi.org/https://doi.org/10.11606...
and frailty,77. Esteve-Clavero A, Ayora-Folch A, Maciá-Soler L, Molés-Julio MP. Fatores associados à qualidade de vida dos idosos. Acta Paul Enferm. 2018;31(5):542-9. https://doi.org/10.1590/1982-0194201800075.
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denoting the need to maintain health in these biopsychosocial aspects.11. Rodrigues LR, Tavares DS, Dias FA, et al. Quality of life of elderly people of the community and associated factors. J Nurs UFPE on line. 2017;11(Suppl 3):1430-8. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/13985. Accessed in 2022 (May 3).
https://periodicos.ufpe.br/revistas/revi...
,22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
https://doi.org/https://doi.org/10.11606...
In an international survey of older adults, sociodemographic characteristics (female sex and low levels of education) were the main factors associated with worse QoL.44. Ghosh D, Dinda S. Determinants of the quality of life among elderly: comparison between China and India. Int J Commun Social Develop. 2020;2(1):71-98. https://doi.org/10.1177/2516602620911835.
https://doi.org/https://doi.org/10.1177/...
In addition, a national investigation showed better QoL in white older adults compared to brown and black older adults regarding sociodemographic indicators and health conditions.88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
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Race/color is a social construct,99. Romero DE, Maia L, Muzy J. Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015 [Trend and inequality in the completeness of information on race/color in deaths of elderly in the Mortality Information System in Brazil, 2000 to 2015]. Cad Saude Publica 2019;35(12):e00223218. PMID: 31800792; https://doi.org/10.1590/0102-311X00223218.
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expressed by self-reported skin color; this concept was adopted by the Brazilian Institute of Geography and Statistics when conducting the main demographic censuses.1010. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira: 2016/IBGE, Coordenação de População e Indicadores Sociais. Rio de Janeiro: IBGE; 2016. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv98965.pdf. Accessed in 2022 (May 3).
https://biblioteca.ibge.gov.br/visualiza...
The presence of racial inequalities among older adults suggests that race/color is a marker of social position,99. Romero DE, Maia L, Muzy J. Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015 [Trend and inequality in the completeness of information on race/color in deaths of elderly in the Mortality Information System in Brazil, 2000 to 2015]. Cad Saude Publica 2019;35(12):e00223218. PMID: 31800792; https://doi.org/10.1590/0102-311X00223218.
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which also reflects the distinct distribution of risk, protection, and health hazards that accumulate throughout life.88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
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The use of racial lines in epidemiological studies contributes to the analysis of the social implications of race/color on the health of different population groups.88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
https://doi.org/https://doi.org/10.1590/...
,99. Romero DE, Maia L, Muzy J. Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015 [Trend and inequality in the completeness of information on race/color in deaths of elderly in the Mortality Information System in Brazil, 2000 to 2015]. Cad Saude Publica 2019;35(12):e00223218. PMID: 31800792; https://doi.org/10.1590/0102-311X00223218.
https://doi.org/https://doi.org/10.1590/...
,1111. Oliveira BLCA, Silva AM, Rodrigues LS, Rêgo AS. O uso da modelagem com equações estruturais na análise da influência da cor/raça e status socioeconômico na saúde de idosos brasileiros [The Use of Strucutural Equations Modeling in the Analysis of the Influence of SkinColor/Race and Socioeconomic Status on the Health of Brazilian Elderlies]. Rev Bras Cienc Saude. 2016;20(2):149-56. https://doi.org/10.4034/RBCS.2016.20.02.09.
https://doi.org/https://doi.org/10.4034/...
However, despite investigations identifying the differences in health and social conditions among older adults according to race/color,44. Ghosh D, Dinda S. Determinants of the quality of life among elderly: comparison between China and India. Int J Commun Social Develop. 2020;2(1):71-98. https://doi.org/10.1177/2516602620911835.
https://doi.org/https://doi.org/10.1177/...
,88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
https://doi.org/https://doi.org/10.1590/...
,99. Romero DE, Maia L, Muzy J. Tendência e desigualdade na completude da informação sobre raça/cor dos óbitos de idosos no Sistema de Informações sobre Mortalidade no Brasil, entre 2000 e 2015 [Trend and inequality in the completeness of information on race/color in deaths of elderly in the Mortality Information System in Brazil, 2000 to 2015]. Cad Saude Publica 2019;35(12):e00223218. PMID: 31800792; https://doi.org/10.1590/0102-311X00223218.
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it is questionable whether worse self-assessed QoL can be directly attributed to racial issues and demographic, economic, and biopsychosocial factors.

Furthermore, no previous studies have assessed the relationships among these variables in older adults considering race/color and have only used models previously tested in mediation analysis. Given the complexity of these relationships, analyses that consider direct and indirect effects, such as structural equation modeling, are required for simultaneous analysis of the dependence relationship and interrelation of multiple variables, as well as estimated the direct effects mediated by other factors integrated in the causal network of the outcomes of interest.1111. Oliveira BLCA, Silva AM, Rodrigues LS, Rêgo AS. O uso da modelagem com equações estruturais na análise da influência da cor/raça e status socioeconômico na saúde de idosos brasileiros [The Use of Strucutural Equations Modeling in the Analysis of the Influence of SkinColor/Race and Socioeconomic Status on the Health of Brazilian Elderlies]. Rev Bras Cienc Saude. 2016;20(2):149-56. https://doi.org/10.4034/RBCS.2016.20.02.09.
https://doi.org/https://doi.org/10.4034/...
,1212. Marôco J. Análise de equações estruturais: Fundamentos teóricos, software & aplicações. Lisboa: ReportNumber; 2010.

OBJECTIVE

The objective of this study was to verify the direct and indirect associations of the demographic, economic, and biopsychosocial characteristics with self-assessed QoL in older adults according to race/color.

METHODS

Design

This cross-sectional and analytical study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology1313. STROBE Statement. Switzerland: STROBE checklists; 2016. Statement and conducted in a developed urban area of a health microregion in Minas Gerais (MG), Brazil.

Sample

A multiple-stage cluster sampling technique was used for population selection. The sample size calculation considered the coefficient of determination as R2 = 0.02 in a multiple linear regression model with 12 predictors, a significance level or type I error of α = 0.05, and a type II error of beta (β) of 0.2, resulting in a priori statistical power of 80%. Using the Power Analysis and Sample Size application (version 13; NCSS, LLC, Kaysville, Utah, United States) introducing the values described above, a sample size of at least 798 older adults was obtained. Considering a sample loss of 20%, the final number of interview attempts was 958.

Older adults aged 60 years or older living in the urban area of a health microregion in Minas Gerais, Brazil were included in the study. We excluded institutionalized older adults and older adults with communication problems such as those associated with deafness not corrected by devices, severe speech disorders, and cognitive decline, as assessed by the Mini Mental State Exam.1414. Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr. 1994;52(1):1-7. https://doi.org/10.1590/S0004-282X1994000100001.
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Nine hundred and fifty-six older adults were interviewed; 31 were excluded because they presented with cognitive decline. Thus, 925 older adults were ultimately included in this study.

Data collection

The interviews took place in the participants’ homes from March 2017 to June 2018.

Explanatory and adjustment variables

Self-assessed QoL was measured using the question, “How would you rate your quality of life?” in accordance with the World Health Organization Quality of Life, Short Form (WHOQOL-BREF) questionnaire.66. Fleck MP, Louzada S, Xavier M, et al. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida “WHOQOL-bref” [Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref]. Rev Saude Publica. 2000;34(2):178-83. PMID: 10881154; https://doi.org/10.1590/S0034-89102000000200012.
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Demographic data and morbidities were obtained using a structured questionnaire developed by the researchers of this study based on the literature.

Regarding functional capacity, the activities of daily living (ADL) were evaluated as follows: basic (basic ADL),1515. Lino VT, Pereira SR, Camacho LA, Ribeiro Filho ST, Buksman S. Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz) [Cross-cultural adaptation of the Independence in Activities of Daily Living Index (Katz Index)]. Cad Saude Publica. 2008;24(1):103-12. PMID: 18209838; https://doi.org/10.1590/S0102-311X2008000100010.
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instrumental (IADL),1616. Lawton MP, Brody EM. Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. The Gerontologist. 1969;9(3 Part 1):179-86. https://doi.org/10.1093/geront/9.3_Part_1.179.
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and advanced (AADL).1717. Dias EN, Silva JV, Pais-Ribeiro JL, Martins T. Validation of the advanced activities of daily living scale. Geriatr Nurs. 2019;40(1):7-12. PMID: 29909023; https://doi.org/10.1016/j.gerinurse.2018.05.008.
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Basic ADL were measured using the Katz Index of Independence in Activities of Daily Living,1515. Lino VT, Pereira SR, Camacho LA, Ribeiro Filho ST, Buksman S. Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz) [Cross-cultural adaptation of the Independence in Activities of Daily Living Index (Katz Index)]. Cad Saude Publica. 2008;24(1):103-12. PMID: 18209838; https://doi.org/10.1590/S0102-311X2008000100010.
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and the Lawton and Brody Instrumental Activities of Daily Living Scale1616. Lawton MP, Brody EM. Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living. The Gerontologist. 1969;9(3 Part 1):179-86. https://doi.org/10.1093/geront/9.3_Part_1.179.
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for IADL. AADL were verified using the Scale of Advanced Activities of Daily Living, which includes 13 questions of a social nature.1717. Dias EN, Silva JV, Pais-Ribeiro JL, Martins T. Validation of the advanced activities of daily living scale. Geriatr Nurs. 2019;40(1):7-12. PMID: 29909023; https://doi.org/10.1016/j.gerinurse.2018.05.008.
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The activity performance in each of these scales was considered, with higher scores for basic ADL and lower scores for IADL and AADL indicating greater functional disability.

To verify depressive symptoms, we used the abbreviated Geriatric Depression Scale, which is comprised of 15 questions, with a total score ranging from 0–15 points.1818. Almeida OP, Almeida SA. Confiabilidade da versão brasileira da Escala de Depressão em Geriatria (GDS) versão reduzida. Arq Neuropsiquiatr. 1999;57(2-B):421-6. https://doi.org/10.1590/S0004-282X1999000300013.
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Frailty syndrome was identified through the five components of the frailty phenotype: 1) unintentional weight loss, 2) self-reported exhaustion or fatigue, 3) decreased muscle strength, 4) slow walking speed, and 5) low level of physical activity,1919. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. PMID: 11253156; https://doi.org/10.1093/gerona/56.3.m146.
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as described in a previous study.2020. Alves MKL, Oliveira NGN, Pegorari MS, et al. Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study. Sao Paulo Med J. 2020;138(6):465-74. PMID: 33053050; https://doi.org/10.1590/1516-3180.2020.0205.R1.06082020.
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The Brazilian version of the Short Physical Performance Battery was used to measure physical performance,2121. Nakano MM. Versão brasileira da Short Physical Performance Battery SPPB : adaptação cultural e estudo da confiabilidade[thesis] Campinas: Faculdade de Educação da Universidade Estadual de Campinas; 2007. Available from: https://1library.org/document/yn44580z-versao-brasileira-physical-performance-battery-adaptacao-cultural-confiabilidade.html. Accessed in 2022 (May 3).
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with a higher score indicating better physical performance.

Social support was measured using the Social Support Scale, with the final score ranging from 20–100 points; the higher the score, the better the level of social support.2222. Griep RH, Chor D, Faerstein E, Werneck GL, Lopes CS. Validade de constructo de escala de apoio social do Medical Outcomes Study adaptada para o português no Estudo Pró-Saúde [Construct validity of the Medical Outcomes Study’s social support scale adapted to Portuguese in the Pró-Saúde Study]. Cad Saude Publica. 2005;21(3):703-14. PMID: 15868028; https://doi.org/10.1590/S0102-311X2005000300004.
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Data analysis

We built an electronic database with double entries using Excel (Microsoft Corp., Redmond, Washington, United States). The analysis was performed using Statistical Package for Social Sciences (version 24; IBM Corp., Armonk, New York, United States), and Analysis of Moment Structures software (version 24; IBM Corp.).

The data were subjected to descriptive analysis. We considered that demographic, economic, and biopsychosocial characteristics were associated with self-assessed QoL through direct and indirect trajectories and developed a hypothetical model (Figure 1), which was tested through trajectory analysis1212. Marôco J. Análise de equações estruturais: Fundamentos teóricos, software & aplicações. Lisboa: ReportNumber; 2010. and composed of observed variables, represented by rectangles and classified as endogenous and exogenous. Endogenous variables are indicated by directional arrows and measurement errors are specified by “e” in the models.1212. Marôco J. Análise de equações estruturais: Fundamentos teóricos, software & aplicações. Lisboa: ReportNumber; 2010.

Figure 1.
Hypothetical model.

The parameters were estimated using the asymptotic distribution-free method, and the adjustment qualities of the models were assessed according to the chi-square test (χ²) with P > 0.05; goodness of fit index ≥ 0.95; comparative fit index ≥ 0.95; Tucker-Lewis index ≥ 0.90; and root mean error of approximation ≤ 0.05.1212. Marôco J. Análise de equações estruturais: Fundamentos teóricos, software & aplicações. Lisboa: ReportNumber; 2010. First, we tested the hypothetical model, and then re-specifications were conducted. For this purpose, non-significant pathways (P ≥ 0.05) were eliminated and modification indices (≥ 11) were calculated.1212. Marôco J. Análise de equações estruturais: Fundamentos teóricos, software & aplicações. Lisboa: ReportNumber; 2010.

In the trajectory analyses, age, education level, morbidities, functional capacity, depressive symptoms, frailty, physical performance, and social support were used in quantitative forms, including complete years of life, years of completed studies, number of morbidities, basic ADL/IADL/AADL scores, number of depressive symptoms, number of compromised components of the frailty phenotype, and physical performance and total social support scores.

In the analyzed model, the direct effects were presented through estimates of the standardized coefficients of the trajectories among the demographic, economic, and biopsychosocial variables and the self-assessed QoL. Furthermore, indirect effects were determined from intermediate trajectories among the aforementioned variables. For all tests, the type I error was set at 5% (P value < 0.05).

Ethical considerations

This study was approved on May 9, 2017 by the Research Ethics Committee of Universidade Federal do Triângulo Mineiro (protocol number 2, 053, 520).

RESULTS

The majority of participants were self-declared white (63.2%, n = 585), followed by brown (25.7%, n = 238), and black (11.1%, n = 102) race/color. Among the three groups, the highest percentages were observed in older adult women, aged 70–80 years, with an individual monthly income of 1 minimum wage, unmarried, and a self-rated QoL of good (Table 1).

Table 1.
Distribution of demographic and economic characteristics and self-assessed quality of life according to race/color of older people in a health microregion of Minas Gerais, Brazil in 2018

The means and standard deviations of the sociodemographic and biopsychosocial variables included in the model according to race/color in older adults in a health microregion of Brazil are shown in Table 2.

Table 2.
Distribution of means and standard deviations of the demographic and biopsychosocial variables included in the model according to race/color of older people in a health microregion of Minas Gerais, Brazil in 2018

Figure 2 shows the associations of demographic, economic, and biopsychosocial variables with the self-assessed QoL according to race/color in older adults in a health microregion of Brazil: white, brown, and black race/color.

Figure 2.
Models for analyzing the associations between demographic, economic, and biopsychosocial variables with self-assessed quality of life according to race/color of older people in a health microregion of Minas Gerais, Brazil.

In the three race/color groups (white, brown, and black), we found that a lower level of social support and presence of depressive symptoms were directly associated with worse self-assessed QoL (Table 3).

Table 3.
Direct standardized coefficients for the variables associated with self-assessed quality of life according to race/color of older people in a health microregion of Minas Gerais, Brazil in 2018

Among older adults of brown and black race/color, a higher number of functional disabilities in basic ADL and absence of a partner were directly associated with worse self-assessed QoL (Table 3).

In older adults of white race/color, lower individual monthly income, higher number of morbidities, and higher number of compromised components of the frailty phenotype were directly associated with worse self-assessed QoL (Table 3). Female sex, mediated by lower individual monthly income, lower social support score, and higher number of morbidities, presented an indirect association with worse self-assessed QoL among older adults of white race/color. In this group we also found that lower education level and older age, mediated by lower monthly individual income and frailty, was indirectly associated with worse self-assessed QoL.

The absence of a partner, mediated by a lower score for social support and a higher number of depressive symptoms (β = 0.02 and β = 0.04, respectively), was indirectly associated with worse self-assessed QoL.

In the group of older adults of brown race/color, a lower education level was directly associated with worse self-assessed QoL (Table 3). Lower physical performance (β = 0.03) and higher number of morbidities (β = -0.02), mediated by functional disability in basic ADL, were indirectly associated with worse self-assessed QoL. Older age mediated by education level (β = -0.04), as well as younger age mediated by the absence of a partner (β = 0.05), was associated with worse self-assessed QoL. A higher number of depressive symptoms and lower social support score mediated the association between a higher number of compromised components of the frailty phenotype and worse self-assessed QoL (β = -0.12 and β = -0.06, respectively). Female sex, mediated by a higher number of depressive symptoms (β = 0.04), was indirectly associated with worse self-assessed QoL.

Among older adults of black race/color, a greater number of compromised components of the frailty phenotype, mediated by a greater number of depressive symptoms, functional incapacity in basic ADL, and lower social support scores (β = -0.08; β = -0.12; and β = -0.04, respectively), were indirectly associated with worse self-assessed QoL. Female sex, mediated by the absence of a partner (β = 0.07), was indirectly associated with worse self-assessed of QoL.

DISCUSSION

In this study, regardless of race/color, decreased social support was directly associated with worse self-assessed QoL and mediated by most indirect associations. In line with these results, a survey of Brazilian older adults revealed that the best self-assessed QoL was observed among older adults who met friends frequently and received social, material and emotional support from spouses, other relatives, and first-generation descendants.22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
https://doi.org/https://doi.org/10.11606...
An investigation of older adults in Turkey found that the greater the social support, the better the self-assessed QoL.33. Şahin DS, Özer Ö, Yanardağ MZ. Perceived social support, quality of life and satisfaction with life in elderly people. Educational Gerontolology. 2019;45(1):69-77. https://doi.org/10.1080/03601277.2019.1585065.
https://doi.org/https://doi.org/10.1080/...
However, these surveys did not consider the effect of race/color on QoL. Older adults with less social support are more vulnerable to depressive symptoms, negative affect, and feelings of loneliness,22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
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,33. Şahin DS, Özer Ö, Yanardağ MZ. Perceived social support, quality of life and satisfaction with life in elderly people. Educational Gerontolology. 2019;45(1):69-77. https://doi.org/10.1080/03601277.2019.1585065.
https://doi.org/https://doi.org/10.1080/...
,2323. Hamren K, Chungkham HS, Hyde M. Religion, spirituality, social support, and quality of life: measurement and predictors CASP-12(v2) amongst older Ethiopians living in Addis Ababa. Aging Ment Health. 2015;19(7):610-21. PMID: 25175073; https://doi.org/10.1080/13607863.2014.952709.
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,2424. Shankar A, Rafnsson SB, Steptoe A. Longitudinal associations between social connections and subjective wellbeing in the English Longitudinal Study of Ageing. Psychol Health. 2015;30(6):686-98. PMID: 25350585; https://doi.org/10.1080/08870446.2014.979823.
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which are associated with increased morbidity and mortality and worsening of self-assessed QoL.2323. Hamren K, Chungkham HS, Hyde M. Religion, spirituality, social support, and quality of life: measurement and predictors CASP-12(v2) amongst older Ethiopians living in Addis Ababa. Aging Ment Health. 2015;19(7):610-21. PMID: 25175073; https://doi.org/10.1080/13607863.2014.952709.
https://doi.org/https://doi.org/10.1080/...
,2424. Shankar A, Rafnsson SB, Steptoe A. Longitudinal associations between social connections and subjective wellbeing in the English Longitudinal Study of Ageing. Psychol Health. 2015;30(6):686-98. PMID: 25350585; https://doi.org/10.1080/08870446.2014.979823.
https://doi.org/https://doi.org/10.1080/...

In the current study, we found that less social support and a higher number of depressive symptoms were also associated with worse self-assessed QoL among the three groups, similar to previous studies11. Rodrigues LR, Tavares DS, Dias FA, et al. Quality of life of elderly people of the community and associated factors. J Nurs UFPE on line. 2017;11(Suppl 3):1430-8. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/13985. Accessed in 2022 (May 3).
https://periodicos.ufpe.br/revistas/revi...
,2525. Silveira MM, Portuguez MW. Analysis of life quality and prevalence of cognitive impairment, anxiety, and depressive symptoms in older adults. Estud Psicol (Campinas). 2017;34(2):261-8. https://doi.org/10.1590/1982-02752017000200007.
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,2626. Amaral TLM, Amaral CA, Lima NS, et al. Multimorbidity, depression and quality of life among elderly people assisted in the Family Health Strategy in Senador Guiomard, Acre, Brazil. Cien Saude Colet. 2018;23(9):3077-84. PMID: 30281744; https://doi.org/10.1590/1413-81232018239.22532016.
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,2727. Chang YC, Ouyang WC, Lu MC, Wang JD, Hu SC. Levels of depressive symptoms may modify the relationship between the WHOQOL-BREF and its determining factors in community-dwelling older adults. Int Psychogeriatr. 2016;28(4):591-601. PMID: 26674362; https://doi.org/10.1017/S1041610215002276.
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,2828. Sivertsen H, Bjørkløf GH, Engedal K, Selbæk G, Helvik AS. Depression and Quality of Life in Older Persons: A Review. Dement Geriatr Cogn Disord. 2015;40(5-6):311-39. PMID: 26360014; https://doi.org/10.1159/000437299.
https://doi.org/https://doi.org/10.1159/...
conducted in the same community; however, these studies did not consider race/color. These results emphasize the importance of monitoring older adults through screenings for depressive symptoms to prevent the development of the disease and adverse QoL outcomes. These findings also highlight the relevance of actions aimed at the mental health of this population, with the objective of preventing and minimizing depressive symptoms through therapeutic groups, psychological monitoring, and encouragement to practice physical exercise and participate in social activities.2929. Alvarenga MM, Flores AS. Depression and cognitive deficit evaluation in elderly assisted by the family health strategy. J Nurs UFPE on line. 2016;10(8):2915-22. Available from: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/11360/13088. Accessed in 2022 (May 3).
https://periodicos.ufpe.br/revistas/revi...

The association between the greater number of functional incapacities for basic ADL and worse self-assessed QoL among brown and black older adults observed in this study is partially consistent with that observed in a study conducted in the Northeast with a predominance of people of brown and black race/color.3030. Brasil. Ministério da Saúde. Secretaria de Gestão Estratégica e Participativa. Departamento de Articulação Interfederativa. Temático Saúde da População Negra Negra/Ministério da Saúde, Secretaria de Gestão Estratégica e Participativa, Departamento de Articulação Interfederativa. Brasília: Ministério da Saúde; 2016. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/tematico_saude_populacao_negra_v._7.pdf. Accessed in 2022 (May 3).
https://bvsms.saude.gov.br/bvs/publicaco...
The authors assessed QoL in older adults and found that older adults of black race/color had worse QoL values compared with whites and mixed race when assessing the physical domain of QoL.3131. Silva IMC, Andrade KL. Avaliação da qualidade de vida de idosos atendidos em um ambulatório de Geriatria da região nordeste do Brasil. Rev Bras Clín Méd. 2013;11(2):129-34. Available from: http://files.bvs.br/upload/S/1679-1010/2013/v11n2/a3561.pdf. Accessed in 2022 (May 3).
http://files.bvs.br/upload/S/1679-1010/2...

The absence of a partner was another factor that negatively affected the QoL of older adults of brown and black race/color in the current study, similar to the results of another survey.88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
https://doi.org/https://doi.org/10.1590/...
The authors justified that single older people of black race/color had worse levels of social support in terms of frequency and diversity of contacts and daily instrumental support, as they essentially live alone and avoid inviting people to their homes or going out to public places88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
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, which favors a worse QoL.

Other surveys conducted of older adults, most of whom were white, found an association between comorbidity,3232. Pergolotti M, Deal AM, Williams GR, et al. Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriatr Oncol. 2017;8(4):249-54. PMID: 28285980; https://doi.org/10.1016/j.jgo.2017.02.009.
https://doi.org/https://doi.org/10.1016/...
frailty,3333. Kojima G, Iliffe S, Morris RW, et al. Frailty predicts trajectories of quality of life over time among British community-dwelling older people. Qual Life Res. 2016;25(7):1743-50. PMID: 26747318; https://doi.org/10.1007/s11136-015-1213-2.
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and lower income and worse QoL,3434. Paiva MH, Pegorari MS, Nascimento JS, Santos ÁD. Factors associated with quality of life among the elderly in the community of the southern triangle macro-region, Minas Gerais, Brazil. Cien Saude Colet. 2016;21(11):3347-56. PMID: 27828568; https://doi.org/10.1590/1413-812320152111.14822015.
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which in part support the findings of the current study. Moreover, female sex was negatively related to self-assessed QoL, as also evidenced in research conducted in Uberaba (MG), with a sample of mostly white older adults.3434. Paiva MH, Pegorari MS, Nascimento JS, Santos ÁD. Factors associated with quality of life among the elderly in the community of the southern triangle macro-region, Minas Gerais, Brazil. Cien Saude Colet. 2016;21(11):3347-56. PMID: 27828568; https://doi.org/10.1590/1413-812320152111.14822015.
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This association was notably mediated by lower monthly individual income, lower social support score, and higher number of morbidities in the current investigation. A previous study conducted on more than 90% non-Hispanic white3535. Naughton MJ, Brunner RL, Hogan PE, et al. Global Quality of Life Among WHI Women Aged 80 Years and Older. J Gerontol A Biol Sci Med Sci. 2016;71(1):S72-8. PMID: 26858327; https://doi.org/10.1093/gerona/glv056.
https://doi.org/https://doi.org/10.1093/...
and Japanese older adult women3636. Kwon M, Kim SA, So WY. Factors Influencing the Quality of Life of Korean Elderly Women by Economic Status. Int J Environ Res Public Health. 2020;17(3):888. PMID: 32023893; https://doi.org/10.3390/ijerph17030888.
https://doi.org/https://doi.org/10.3390/...
verified a relationship between morbidity, social support, and monthly individual income with QoL. Considering that older adult women perceive old age more negatively than men,77. Esteve-Clavero A, Ayora-Folch A, Maciá-Soler L, Molés-Julio MP. Fatores associados à qualidade de vida dos idosos. Acta Paul Enferm. 2018;31(5):542-9. https://doi.org/10.1590/1982-0194201800075.
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it is possible that older adult women with morbidities, impaired social support, and socioeconomic disadvantages have greater difficulty accepting the changes that occur with the human aging process, thereby negatively impacting QoL.

Lower education level and older age, mediated by lower monthly individual income and frailty, were indirectly associated with worse self-assessed QoL among older white adults. In one study, age and education, mediated by health conditions and functional incapacity, were found to be related to QoL in older adults.3737. Tobiasz-Adamczyk B, Galas A, Zawisza K, et al. Gender-related differences in the multi-pathway effect of social determinants on quality of life in older age-the COURAGE in Europe project. Qual Life Res. 2017;26(7):1865-78. PMID: 28258420; https://doi.org/10.1007/s11136-017-1530-8.
https://doi.org/https://doi.org/10.1007/...
Another national survey found that age equal to or greater than 80 years and education level of 4–7 and 8 or more years were negatively associated with QoL.22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
https://doi.org/https://doi.org/10.11606...
However, these surveys were conducted in the general older population and did not assess the effect of race/color on QoL.

The absence of a partner was associated with lower QoL among older Chinese3838. Zhou Z, Zhou Z, Gao J, Lai S, Chen G. Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province. PloS One. 2018;13(9):e0204118. PMID: 30235258; https://doi.org/10.1371/journal.pone.0204118.
https://doi.org/https://doi.org/10.1371/...
and Korean adults;3939. Kwak Y, Chung H, Kim Y. Differences in Health-related Quality of Life and Mental Health by Living Arrangement among Korean Elderly in the KNHANES 2010-2012. Iran J Public Health. 2017;46(11):1512-20. PMID: 29167769. which partially corroborates the findings of the present study that identified this association among people of white race/color. Older people who live without a partner are at greater risk for depression and less social support4040. Clay OJ, Perkins M, Wallace G, et al. Associations of Multimorbid Medical Conditions and Health-Related Quality of Life Among Older African American Men. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):258-66. PMID: 28658936; https://doi.org/10.1093/geronb/gbx090.
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which is reflected in the self-assessed QoL, as observed in this study.

Among brown older adults, lower education levels were associated with worse self-assessed QoL, which is partially corroborated by international studies.4040. Clay OJ, Perkins M, Wallace G, et al. Associations of Multimorbid Medical Conditions and Health-Related Quality of Life Among Older African American Men. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):258-66. PMID: 28658936; https://doi.org/10.1093/geronb/gbx090.
https://doi.org/https://doi.org/10.1093/...
,4141. Coley SL, Mendes de Leon CF, Ward EC, et al. Perceived discrimination and health-related quality-of-life: gender differences among older African Americans. Qual Life Res. 2017;26(12):3449-58. PMID: 28744665; https://doi.org/10.1007/s11136-017-1663-9.
https://doi.org/https://doi.org/10.1007/...
In a nationwide survey, sociodemographic variables, including low education level, better determined the health status of older adults than race/color.1111. Oliveira BLCA, Silva AM, Rodrigues LS, Rêgo AS. O uso da modelagem com equações estruturais na análise da influência da cor/raça e status socioeconômico na saúde de idosos brasileiros [The Use of Strucutural Equations Modeling in the Analysis of the Influence of SkinColor/Race and Socioeconomic Status on the Health of Brazilian Elderlies]. Rev Bras Cienc Saude. 2016;20(2):149-56. https://doi.org/10.4034/RBCS.2016.20.02.09.
https://doi.org/https://doi.org/10.4034/...
Education level is considered a determinant factor in reducing racial differences in proactive health behaviors,4242. Eneanya ND, Winter M, Cabral H, et al. Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort. J Health Care Poor Underserved. 2016;27(3):1427-40. PMID: 27524777; https://doi.org/10.1353/hpu.2016.0133.
https://doi.org/https://doi.org/10.1353/...
which is reflected positively in the QoL of this group.

In line with the results of this study, some researchers showed that black race/color (brown and black) is associated with higher risks for comorbidities and physical decline, which are related to lower QoL.4343. Thorpe RJ Jr, Duru OK, Hill CV. Advancing Racial/Ethnic Minority Men’s Health Using a Life Course Approach. Ethn Dis. 2015;25(3):241-4. PMID: 26674116; https://doi.org/10.18865/ed.25.3.241.
https://doi.org/https://doi.org/10.18865...
Notably, this association was mediated by functional incapacity in basic ADL, and reinforces the assumption that autonomy and independence during the human aging process are determining factors for physical, emotional, and mental health,4040. Clay OJ, Perkins M, Wallace G, et al. Associations of Multimorbid Medical Conditions and Health-Related Quality of Life Among Older African American Men. J Gerontol B Psychol Sci Soc Sci. 2018;73(2):258-66. PMID: 28658936; https://doi.org/10.1093/geronb/gbx090.
https://doi.org/https://doi.org/10.1093/...
particularly among older women of brown race/color.

Several studies have also verified advanced age as a predictor of worse QoL in the physical and mental domains of older adult African Americans with breast cancer,4444. Mogal HD, Howard-McNatt M, Dodson R, Fino NF, Clark CJ. Quality of life of older African American breast cancer survivors: a population-based study. Support Care Cancer. 2017;25(5):1431-8. PMID: 27987093; https://doi.org/10.1007/s00520-016-3539-x.
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which may be related to higher levels of perceived discrimination throughout life.4141. Coley SL, Mendes de Leon CF, Ward EC, et al. Perceived discrimination and health-related quality-of-life: gender differences among older African Americans. Qual Life Res. 2017;26(12):3449-58. PMID: 28744665; https://doi.org/10.1007/s11136-017-1663-9.
https://doi.org/https://doi.org/10.1007/...
Furthermore, brown older adults generally have lower levels of education than white older adults, which is considered a main aspect of health inequity in Brazil.88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
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Therefore, the structural social inequalities present in Brazil, including disparities in access to education, can have a negative effect on the QoL of older adults, especially affecting adults with older age.

In contrast, younger older people assumably have a worse QoL due to a lack of coping skills or expectations that are typically acquired with old age.4545. Assari S, Smith J, Bazargan M. Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences. Int J Environ Res Public Health. 2019;16(9):1522. PMID: 31036795; https://doi.org/10.3390/ijerph16091522.
https://doi.org/https://doi.org/10.3390/...
In the current study, younger age mediated by the absence of a partner was associated with worse self-assessed QoL in brown older adults. During the human aging process, the instrumental support of a partner is considered a predictor of better QoL,22. Neri AL, Borim FSA, Fontes AP, et al. Factors associated with perceived quality of life in older adults: ELSI-Brazil. Rev Saude Publica. 2018;52Suppl 2(Suppl 2):16s. PMID: 30379281; https://doi.org/10.11606/S1518-8787.2018052000613.
https://doi.org/https://doi.org/10.11606...
since living with a partner contributes to feelings of belonging and security, thereby reducing feelings of loneliness in older adults.4646. Fredriksen-Goldsen KI. The Future of LGBT+ Aging: A Blueprint for Action in Services, Policies, and Research. Generations. 2016;40(2):6-15. PMID: 28366980. Thus, the absence of a partner possibly in brown older people can negatively affect QoL, especially among younger older people.

In Brazil, non-white older people were four times more likely to develop this frailty syndrome,4747. Araújo Júnior FB, Machado ITJ, Santos-Orlandi AA, et al. Frailty, profile and cognition of elderly residents in a highly socially vulnerability area. Cien Saude Colet. 2019;24(8):3047-56. PMID: 31389551; https://doi.org/10.1590/1413-81232018248.26412017.
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which supports the findings of the current study. These researchers highlighted that frailty is a topic of global public interest due to its impact on QoL in older adults, families, caregivers, and health and social assistance systems.4747. Araújo Júnior FB, Machado ITJ, Santos-Orlandi AA, et al. Frailty, profile and cognition of elderly residents in a highly socially vulnerability area. Cien Saude Colet. 2019;24(8):3047-56. PMID: 31389551; https://doi.org/10.1590/1413-81232018248.26412017.
https://doi.org/https://doi.org/10.1590/...
However, this association was mediated by a greater number of depressive symptoms and lower social support scores, which indicates the importance of evaluating other risk factors that mediate the relationships with QoL in brown older adults, contributing to the inequities among races in healthcare.

Some researchers have observed that the intersection between sex and race/color influences the QoL of older adults.4141. Coley SL, Mendes de Leon CF, Ward EC, et al. Perceived discrimination and health-related quality-of-life: gender differences among older African Americans. Qual Life Res. 2017;26(12):3449-58. PMID: 28744665; https://doi.org/10.1007/s11136-017-1663-9.
https://doi.org/https://doi.org/10.1007/...
,4545. Assari S, Smith J, Bazargan M. Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences. Int J Environ Res Public Health. 2019;16(9):1522. PMID: 31036795; https://doi.org/10.3390/ijerph16091522.
https://doi.org/https://doi.org/10.3390/...
In line with the evidenced findings, a study with economically disadvantaged African Americans found that older adult women reported worse QoL in the physical component compared with men.4545. Assari S, Smith J, Bazargan M. Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences. Int J Environ Res Public Health. 2019;16(9):1522. PMID: 31036795; https://doi.org/10.3390/ijerph16091522.
https://doi.org/https://doi.org/10.3390/...
Notably, in the current study, the association of women with worse self-assessed QoL in brown older people was mediated by the greater number of depressive symptoms, which supports the hypothesis that the intersectionality of sex and race/color reflects the double marginalization of health problems in older adults, including depression.4545. Assari S, Smith J, Bazargan M. Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences. Int J Environ Res Public Health. 2019;16(9):1522. PMID: 31036795; https://doi.org/10.3390/ijerph16091522.
https://doi.org/https://doi.org/10.3390/...

Frailty, mediated by a greater number of depressive symptoms, functional incapacity in basic ADL, and less social support was indirectly associated with worse self-assessed QoL in older adults of black race/color. One possibility that justifies these findings is that older adults of black race/color are typically single, live alone, and are more vulnerable in relation to social support, especially at older ages.88. Silva AD, Rosa TEDC, Batista LE, et al. Racial inequities and aging: analysis of the 2010 cohort of the Health, Welfare and Aging Study (SABE). Rev Bras Epidemiol. 2019;21Suppl 02 (Suppl 02):e180004. PMID: 30726349; https://doi.org/10.1590/1980-549720180004.supl.2.
https://doi.org/https://doi.org/10.1590/...
In another study, the authors found that older adults who live alone also tend to develop depression and lack social support.4141. Coley SL, Mendes de Leon CF, Ward EC, et al. Perceived discrimination and health-related quality-of-life: gender differences among older African Americans. Qual Life Res. 2017;26(12):3449-58. PMID: 28744665; https://doi.org/10.1007/s11136-017-1663-9.
https://doi.org/https://doi.org/10.1007/...
In addition, functional incapacity can lead to dependence in performing ADL, resulting in frailty and consequent worsening of QoL.4848. Fhon JRS, Rodrigues RAP, Santos JLF, et al. Factors associated with frailty in older adults: a longitudinal study. Rev Saude Publica. 2018;52:74. PMID: 30066813; https://doi.org/10.11606/S1518-8787.2018052000497.
https://doi.org/https://doi.org/10.11606...
,4949. Souza DS, Berlese DB, Cunha GL, Cabral SM, Santos GA. Análise da relação do suporte social e da síndrome de fragilidade em idosos. Psicologia, Saúde e Doenças. 2017;18(2):420-33. Available from: https://www.redalyc.org/articulo.oa?id=36252193011. Accessed in 2022 (May 3).
https://www.redalyc.org/articulo.oa?id=3...
,5050. Zúñiga MP, García R, Araya AX. Fragilidad y su correlación con calidad de vida y utilización de los servicios de salud en personas mayores que viven en la comunidad [Quality of life among frail older people]. Rev Med Chil. 2019;147(7):870-76. PMID: 31859985; http://dx.doi.org/10.4067/S0034-98872019000700870.
https://doi.org/http://dx.doi.org/10.406...
Depressive symptoms may originate from different factors such as low income, living alone,5151. Lima GS, Souza IMO, Storti LB, et al. Resilience, quality of life and symptoms of depression among elderlies receiving outpatient care. Rev Lat Am Enfermagem. 2019;27:e3212. PMID: 31664416; https://doi.org/10.1590/1518-8345.3133.3212.
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and functional dependence.5252. Aguiar BM, Silva PO, Vieira MA, Costa FM, Carneiro JA. Evaluation of functional disability and associated factors in the elderly. Rev Bras Geriatr Gerontol. 2019;22(2):e180163. https://doi.org/10.1590/1981-22562019022.180163.
https://doi.org/https://doi.org/10.1590/...
Thus, the presence of depressive symptoms, incapacity to perform one or more basic ADL, and decreased social support may negatively affect the frailty of older adults, thereby worsening their QoL.5050. Zúñiga MP, García R, Araya AX. Fragilidad y su correlación con calidad de vida y utilización de los servicios de salud en personas mayores que viven en la comunidad [Quality of life among frail older people]. Rev Med Chil. 2019;147(7):870-76. PMID: 31859985; http://dx.doi.org/10.4067/S0034-98872019000700870.
https://doi.org/http://dx.doi.org/10.406...

Female sex, mediated by the absence of a partner, was indirectly associated with worse self-assessed QoL in older adult women of black race/color. Low income and the absence of a partner may be related to the restriction of social protection and housing in these women,5353. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira. Rio de Janeiro: IBGE; 2018. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101629.pdf. Accessed in 2022 (May 3).
https://biblioteca.ibge.gov.br/visualiza...
regardless of age. However, the loss of a partner has a negative impact on the lives of older adult women, which may be associated with low income and worse QoL self-assessment.3939. Kwak Y, Chung H, Kim Y. Differences in Health-related Quality of Life and Mental Health by Living Arrangement among Korean Elderly in the KNHANES 2010-2012. Iran J Public Health. 2017;46(11):1512-20. PMID: 29167769.

This study had some limitations, such as the exclusion of older adults with cognitive decline, which may have favored a healthier sample; however, the possibility of selection bias was minimized since all eligible older adults were interviewed. In addition, for the purposes of analysis, a question regarding self-assessed QoL was used; however, a broader measure including the domains/facets of QoL associated with self-reported race/color may be useful for a more in-depth analysis of the data.

CONCLUSION

Regardless of the race/color of older adults, a lower social support score and a higher number of depressive symptoms were directly associated with worse self-assessed QoL, as well as a higher number of functional disabilities in basic ADL and the absence of a partner, among older adults of brown/black race/color. The other direct associations differed among groups; in older adults of white race/color, a lower individual income and higher number of morbidities and impaired components of the frailty phenotype were directly associated with worse self-assessed QoL, whereas in older adults of brown race/color, this association was observed with lower levels of education.

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  • Uberaba Health Microregion, Minas Gerais (MG), Brazil
  • Sources of funding: This study was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil (grant number 301704/2012-0) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil (procedural number 00866-12)

Publication Dates

  • Publication in this collection
    12 Aug 2022
  • Date of issue
    Jan-Feb 2023

History

  • Received
    13 Sept 2021
  • Reviewed
    14 Jan 2022
  • Accepted
    19 Apr 2022
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