Characterization of older adults from a family doctor's office in Palma Soriano

INTRODUCTION

Aging, understood as an intrinsic biological phenomenon, is a natural process characterized by the progressive accumulation of molecular and cellular alterations over time. These underlying changes trigger a series of morphological and physiological transformations that gradually compromise the body's ability to adapt and respond effectively to harmful agents. This loss of functional resilience results in a gradual deterioration of physical and cognitive abilities, a substantial increase in susceptibility to disease, and, ultimately, the end of the life cycle.

At the same time, a demographic phenomenon with far-reaching implications is being observed on a global scale: population aging. This manifests itself as a structural reconfiguration of age pyramids, with the segments corresponding to older and long-lived adults experiencing sustained growth, while younger age groups tend to stabilize or decline. The data speaks for itself: while in the mid-20th century only 5,4 % of humanity was over 60 years old, by 2002 this proportion had risen to 8 %. Projections indicate a continued rise, with estimates reaching 12,8 % by 2025 and exceeding 20 % by 2050.(2)

Various prospective analyses agree that there will be a significant increase in the geriatric population in the coming decades, which will inevitably lead to higher morbidity rates and a growing demand for health services.(2)

In the regional context, Mexico, with a population of over 126 million, recorded 12,3 % of its citizens (15,4 million) aged 60 or over, according to the Demographic Dynamics Survey. Cuba, for its part, stands out as one of the most aged nations in the Americas. By 2022, provinces such as Villa Clara (22,8 %), Havana (20,8 %), and Sancti Spíritus (20,6 %) had the highest longevity rates.

By the end of 2023, 20,8 % of Cubans belonged to this age group, and this figure is projected to rise to 30 % by 2030. With a life expectancy of around 78,5 years, most older Cuban adults remain independent in their basic activities.

This accelerated aging in Cuba, a phenomenon with profound implications for the present and future, is mainly due to increased life expectancy, reduced mortality, a persistent decline in fertility, and negative net migration.(3)

This accelerated demographic aging represents one of the greatest challenges of the 21st century, inseparable from the increase in the burden of age-related disease. In this scenario, the concept of "healthy aging" takes on fundamental relevance. Defined by the World Health Organization (WHO) as "the process of promoting and maintaining functional capacity that enables well-being in old age," it emphasizes the importance of preserving the physical and mental attributes that allow people to continue doing what they value.(4)

The increasing longevity observed in recent decades, both in developed and developing nations, has profound implications for the socioeconomic planning of all countries, including Cuba. The high morbidity characteristic of this population segment generates significant demand for care, with an increase in mortality attributable to chronic noncommunicable diseases (CNCDs) directly related to increased life expectancy.(5)

Therefore, the objective of this study is to characterize the elderly population belonging to Family Medical Clinic No. 1 of the Carlos Montalván South Polyclinic in Palma Soriano during the period from March to June 2025.

METHOD

RESULTS

Males predominated (51,52 %), with the highest concentration in the 70-75 age group (21,21 %) and the 75-80 age group (21,55 %). The highest masculinity indices were recorded in adults aged 65-69 (189,47) and ≥85 (194,44) (table 1).

58,92 % of older adults were classified as ill (Group III), followed by 22,90 % at risk (Group II). Only 5,39 % were identified as apparently healthy (Group I) (table 2).

In the patient group, the most common conditions were high blood pressure (86,20 %), diabetes mellitus (67,68 %), and smoking (79,46 %). Heart disease (32,66 %) and psychiatric disorders (21,55 %) were the most relevant comorbidities after metabolic conditions (table 3).

A high prevalence of multimorbidity was observed, with most older adults presenting two or more simultaneous chronic diseases (figure 1).

Extended families (35,29 %) and enlarged families (33,82 %) predominated, with the majority being functional (72,06 %). Sixty-point-two-nine percent were in the "contraction" stage of the life cycle, and 20,59 % were overcrowded (table 4).

44,78 % were of normal weight, but obesity was observed in 13,13 % of men (vs. 5,72 % in women) and underweight in 9,76 % of women (vs. 4,71 % in men) (table 5).

93,27 % received full family support. The risk of domestic accidents (81,14 %) was the most common geriatric syndrome, and 92,93 % maintained full functional capacity. Urinary incontinence (22,56 %) was the main clinical complication reported (table 6).

DISCUSSION

Population aging in Cuba, particularly in semi-urban contexts such as Palma Soriano, represents a multifactorial challenge for the health system. The comprehensive characterization of older adults receiving primary care reveals epidemiological, social, and functional dynamics that transcend demographic indicators, shaping a health profile with implications for geriatric policies.

The predominance of males in the total sample contrasts with studies such as those by Angulo et al.(6) in rural Cuban contexts, where a higher representation of females is reported. This discrepancy could be attributed to migratory or sociodemographic particularities of the locality studied, where there may be less labor mobility among older men compared to other regions. However, the higher masculinity in the 65-69 and 85+ age groups coincides with the findings of Diaz et al.(7) in Santiago de Cuba, suggesting regional patterns of male longevity potentially linked to lifestyles, genetic factors, or a lower prevalence of risk behaviors in these specific cohorts. The most numerous age group differs from the research by Espinosa et al.(8) in urban areas, which identified a higher concentration in the >80 age group, which could be explained by a younger demographic structure in the semi-urban area or by differential migratory flows of very old adults to urban centers.

With regard to morbidity, the high percentage of older adults in group III exceeds the 45 % reported by Bustamante et al.(9) This higher burden of chronic disease in our population could be a consequence of the accumulation of risk factors throughout life, combined with better access to diagnosis in primary care. However, it is consistent with the burden of morbidity described by PAHO in aging rural populations. The low proportion of "apparently healthy" individuals is consistent with studies such as that by Arévalo-Avecillas et al.(10), which report less than 7 % in this group, reflecting the high level of chronicity that characterizes aging populations.

Hypertension and diabetes exceed global prevalences but replicate trends in the Caribbean islands, as shown in the research by Félix López et al.(11), suggesting the influence of regional dietary factors and similar epidemiological transitions. Smoking doubles the Cuban national average, possibly reflecting historical cohorts as shown by Acosta Martínez et al.(12), indicating the persistence of habits acquired in past decades. The frequency of heart disease is in line with Briceño et al.(13), while renal failure is lower than reports from Mexico according to the study by Guerra et al.(14), a difference that could be due to variations in diagnostic criteria, access to nephrology services, or the prevalence of its main causal factors.

In the psychosocial sphere, the predominance of extended and enlarged families coincides with the support network model described by Cardozo et al.(15) in Cuban older adults, suggesting the persistence of supportive family structures as a coping strategy in the face of economic constraints. Family dysfunction is lower than in Brazilian studies such as that by Ferrony et al.(16), possibly due to cultural differences in the perception of family functionality, but overcrowding exceeds the 15 % observed in Havana by Gómez et al.(17), reflecting housing limitations typical of semi-urban areas. The "contraction" stage of the life cycle reflects the findings of Campos-Tapia et al.(18) on reduced family units in rural areas, a phenomenon associated with the emancipation of children and the aging of couples.

In terms of nutritional status, normal weight is lower than the 52 % recorded by Rodríguez et al.(19) in Camagüey, which could be related to differences in regional dietary patterns or access to varied foods. While male obesity is twice that of females, a pattern also documented by Corrales et al.(20), this could be explained by gender roles that keep men away from domestic food management. Underweight rates are higher among women than men, coinciding with Ekmeiro et al.(21) on nutritional risks in older women, perhaps associated with greater socioeconomic vulnerability or greater longevity with debilitating chronic diseases.

Total family support exceeds 85 % in Colombian studies such as that by Toneto et al.(22), supporting the Cuban model of multigenerational care and strong family ties as buffers against material deprivation. The high functional capacity contrasts with the 78 % in Spanish older adults reported by Chavarro-Carvajal et al.(23), which could be due to a selection effect or a more active aging pattern in this context, although the risk of domestic accidents is in line with WHO warnings about non-adapted environments, pointing to the need to implement home adaptation programs.

CONCLUSIONS

There is evidence of a geriatric population with a high burden of chronicity, where the extended/enlarged family structure acts as the predominant support despite moderate dysfunctions. The combination of nutritional risks, together with functional capacities preserved in most cases, coexists with environmental threats such as domestic accidents.

References

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