DEPRESSION, ANXIETY AND QUALITY OF LIFE OF THE ELDERLY AT A THIRD AGE OPEN UNIVERSITY DEPRESSÃO, ANSIEDADE E QUALIDADE DE VIDA EM IDOSOS DE UMA UNIVERSIDADE ABERTA À TERCEIRA IDADE

Objective: The aim of this study was to test the association between anxiety, depression and the quality of life of elderly participants at a Third Age Open University (UATI, acronym in Portuguese). Methods: This is a descriptive, cross-sectional study with a quantitative approach, carried out with elderly people (≥ 60 years) without cognitive decline, UATI participants in Senhor do Bonfim, BA. The elderly were evaluated using three questionnaires: Geriatric Depression Scale, Geriatric Anxiety Inventory and World Health Organization quality of life assessment instrument (WHOQOL-Old). Data were subjected to descriptive analysis and Spearman's correlation analysis was used to verify the association between the variables. Results: Among the 28 elderly participants, there was a prevalence of 14.3% of depression and 17.9% of anxiety. Regarding the quality of life domains, Social Participation (77.9 ± 11.3) and Sensory Functioning (76.3 ± 17.1) had the highest means. Quality of life was negatively and moderately correlated with depression (-0.439) and anxiety (-0.436), while both disorders showed a positive and moderate correlation (0.671) with each other. Conclusions: The elderly who had a higher degree of anxiety and depression had a worse quality of life, demonstrating the existence of a significant association between these variables. These findings direct the need for studies that investigate the emergence of anxiety and depression in the elderly, dissociating these diseases from natural aging processes.


INTRODUCTION
Aging is a dynamic, progressive and irreversible biological process whose changes are characterized by structural and functional changes in the human body (1) . The population aging process is expressed in the increase in life expectancy, which is due to technological advances in health, changes in family structure, work patterns and migrations, as well as in the perceptions of subjects about biological, cultural, psychological and social aspects (2) .

According to World Health
Organization (WHO), the number of people aged 60 and over will have increased by approximately 70% by 2025, especially in developing countries (3) . In Brazil, there are an estimated 32.9 million people aged 65 or over, with a growth curve projected to 58.2 million by 2060, equivalent to 25.5% of the population (2) .
Currently, there is an increase in the incidence of psychological disorders in the elderly. WHO estimates that approximately one in 10 elderly people may suffer from depression (4) .
In elderly, depression is the most frequent psychiatric disorder, being associated with a higher risk of morbidity, mortality and lack of control over one's emotional state (5) .
Still, it is a disease that is often underdiagnosed and undertreated for having similarities with physical and mental complications, considered natural to aging (6) .
Anxiety is associated with limitations present in old age, causing negative perceptions of reality and questions about their own intellectual abilities. High levels of anxiety in the elderly lead to experiences that interfere with selective attention and the encoding of information in memory, thus blocking understanding and reasoning (7) .
Quality of life is a multidimensional and multifactorial set of subjective satisfactions that subjects obtain in their daily lives, which consider physical, psychological and social aspects of life, being useful to determine the global impact of diseases and medical treatments from the perspective of the subject (8) . Therefore, considering that anxiety and depression disorders tend to reduce quality of life, understanding the relationship between these conditions is especially important in elderly, as these disorders can affect the interpersonal relationships, the physical and social support and the performance cognitive, which negatively impacts the quality of life (9) . However, there are few studies regarding the relationship between these psychiatric disorders and the quality of life in the elderly population (10) .
The aim of this study was to test the association between anxiety, depression and the quality of life of the elderly.  (11) .

Participants Assessment Instruments
An identification form was applied to collect sociodemographic data: gender, age, marital status, education, living arrangement and income.

Geriatric Depression Scale
Depression was assessed using the

Geriatric Anxiety Inventory
The Geriatric Anxiety Inventory (GAI) is an instrument for assessing anxiety in the elderly in community and geriatric contexts, proposed by the study. (14) . This questionnaire consists of 20 questions, in which the respondent declares that he agrees or disagrees with the statements presented.
The sum of the answers being >10 characterizes the individual with symptoms of anxiety. It can be self-applied or applied by an interviewer.

WHOQOL-Old
To assess the quality of life of the elderly, it was used the World Health Organisation Quality of Life (WHOQOL-Old) Assessment Instrument (15) . This    From the cutoff points suggested by the authors (13) for depression and by the authors (14) for anxiety, there was a prevalence of 14.3% of elderly people with depression and 17.9% with anxiety, as shown in figure 1. Fonte: Autores (13,14) The association between anxiety,

DISCUSSION
The participation of the elderly in interventional health education and self-care programs has a positive impact on promoting mental health and healthy lifestyles, as well as preventing physical and cognitive declines (16) . An example of such a program is the performance. In a study by (20)  The prevalence of psychiatric illnesses investigated in this study is lower than those observed (23,(24) , in Brazilian subjects from the community, with similar sociodemographic  (25)(26)(27) . A study (28)  Subjects with high levels of anxiety had worse quality of life scores in fields such as vitality, social aspects and social withdrawal (30) .
It was possible to verify the negative, moderate and statistically significant association between quality of life and depression in line with the results of a Brazilian study carried out by the authors (31) , which it was observed worsening in quality of life in domains such as autonomy, activities, privacy, and social participation in depressed older adults compared to older adults without symptoms of depression. The authors (30) , found that subjects in a depressive state have little social interaction and use health services more.
There was a positive, moderate and statistically significant correlation between anxiety and depression. The authors (32) highlight that subjects affected in the same period by anxiety and depression suffered an increase in the occurrence of physical disorders, including vision problems, persistent cough, hypertension and gastrointestinal problems, as well as heart disease and asthma, compared to those who suffered only from anxiety and only with depression. According to the authors (7) , subjects with depressive symptoms rate their health as poor and are less satisfied with their health status than people without depression.
In addition, the authors report that it is common for people with anxiety to also present depression in some intensity.

ORIGINAL ARTICLE
There are many studies that indicate the lack of investigation of these psychiatric diseases by health professionals in the clinical context, although they are common as clinical complaints presented by patients (7) . The clinical and laboratory evaluation of anxiety and depression is important, as it is necessary to investigate diseases that may be associated with these disorders, so that, if not properly understood and treated, they can cause negative repercussions on health and quality of life of elderly people, which can lead to an increase in morbidity and mortality, as well as increased costs for the health system (33) .
Although small, the sample is