Population Aging as a Challenge for Comprehensiveness in the Brazilian Unified Health System (SUS)

Population aging in Brazil has accelerated significantly in recent decades, with the elderly population increasing from 7.4% in 2010 to 10.9% in 2022, according to official data. This demographic shift demands structural adaptations within the Brazilian Unified Health System (SUS), but more critically, a transformation in the approach to elderly care. The constitutional principle of comprehensiveness requires coordinated and continuous health actions across all levels of care, considering the specificities of the elderly's life cycle. However, challenges related to funding, managerial capacity, and regulatory coherence often hinder the effective implementation of comprehensive care. The National Policy for the Health of the Elderly (PNSPI), established in 2006, introduced guidelines such as active aging, integrated care, intersectorality, professional training, and social participation. While these norms offer a robust framework for elderly care, their implementation is uneven across municipalities and depends heavily on local governance and technical support from the State. Additional policies, such as the Health Pact (2006), the Program for Improving Access and Quality in Primary Care (PMAQ-AB, 2011), and Previne Brasil (2019), further emphasize the centrality of primary care. However, their effectiveness is limited by the lack of specific indicators focused on elderly needs and the fragmentation of funding and management systems. Home care, specialized networks, and digital health technologies like telehealth and electronic medical records are promising tools to enhance care coordination. Nonetheless, these require robust infrastructure and trained personnel to be effective. The lack of geriatric training in health professionals and the dependency on municipal actions for continuing education further constrain progress. Despite legal frameworks such as the Elderly Statute (2003), which guarantees priority in care, the real implementation of these rights depends on service organization and social control mechanisms. Many municipalities still lack integrated policies connecting health with social assistance, housing, and transportation, revealing gaps in intersectoral coordination. Geographic indicators such as GeoSES reveal high inequalities in primary care coverage, emphasizing the need to align financing mechanisms with the specific demands of elderly populations. To effectively deliver comprehensive care to the elderly, SUS must unify its regulatory and operational frameworks, define specific indicators, and invest in intersectoral strategies. Without political commitment and coherent policy integration, comprehensiveness remains an elusive goal in elderly healthcare.