[Health of Brazilian elderly just before of the 21st century: current problems, forecasts and alternatives]

Current characteristics and perspectives of Brazilian demographic and epidemiological transition processes are analyzed. Results from the 1991, 1993, 1995 and 1996 censuses, new population projections and recent studies on socioeconomic and health profiles of elderly people of S. Paulo, Rio de Janeiro and Belo Horizonte are discussed. In 1995, estimated life expectancy at birth in Brazil was already over 67 years. The number of individuals aged 60 years and older--in 1995, 8.3%, of the total population--is expected to duplicate and probably stabilize by the year 2050. Yet lacking coverage and quality, health services are already burdened with degenerative diseases and mental disorders, frequent outpatient appointments, high hospital bed occupation and high costs. Functional impairment and self-reported diseases are related to poverty among the elderly. for whom social and health support are not properly provided. Support from informal caregivers becomes more difficult due to impoverishment, family size reduction and youth migration. Institutionalization remains a poor approach as scarcity of beds and inadequacy of staff preclude its utilization. To minimize the impact of population aging on health services, it is proposed that effective programs covering the control of degenerative diseases and the prevention of their complications should be implemented--for the elderly population too. The importance of physical exercise, screening for neoplastic diseases, immunization, prevention of fractures caused by falls and early diagnosis of depression and dementia is emphasized. Actions must be coordinated by primary health care units, oriented towards local needs. It is essential to maintain the elderly in adequate, productive activities, invest in young people's education and health and in social and medical support programs for the caregivers.