Novas competências profissionais em saúde e o envelhecimento populacional brasileiro: integralidade, interdisciplinaridade e intersetorialidadeNew professional competences in the field of health and the aging Brazilian population: integrality, interdisciplinarity, intersectoriality
A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.
INTRODUÇÃO: Estima-se que 50% das quedas em idosos resultem em algum tipo de lesão. O objetivo deste estudo é estimar a prevalência e identificar fatores associados a quedas em idosos em um município no Rio de Janeiro. METODOLOGIA: Um inquérito foi conduzido em residentes com mais de 60 anos capazes de prestar informações por si, através de um questionário de avaliação multidimensional, aplicado por agentes comunitários treinados. As análises incluíram cálculos de proporções e respectivos intervalos de confiança de 95%. RESULTADOS: Foram entrevistados 1.064 idosos, em sua maioria mulheres (57%), com idade média de 71,4 anos. No ano anterior à entrevista, 322 participantes (30,3% - IC95% 27,6-33,2) caíram, dos quais 148 (13,9% - IC95% 11,9-16,2) o fizeram pelo menos duas vezes. Algumas associações se evidenciaram: sexo feminino, idade avançada, ser divorciado, morar só, assim como as variáveis indicadoras de más condições de saúde, capacidade funcional e satisfação com a vida. CONCLUSÃO: Este estudo ratifica fatores associados a quedas em idosos já conhecidos. O grande desafio deste conhecimento é a proposição de intervenções nos fatores modificáveis e a identificação ativa dos idosos sob risco, objetivando a reabilitação preventiva.
ResumoO propósito deste artigo de atualização é contribuir para a estruturação de uma linha completa de cuidados para os idosos. Trata-se de um modelo baseado na identificação precoce dos riscos de fragilização dos usuários. Uma vez identificado o risco, a prioridade é a reabilitação precoce, a fim de reduzir o impacto das condições crônicas na funcionalidade. Partindo do pressuposto de que é adequado hierarquizar o processo de cuidado segundo as perdas funcionais que ocorrem com o passar dos anos, são estabelecidos sete pontos de atenção. O modelo é hierarquizado pela capacidade funcional, mas poliárquico na prática, pois a partir dos três primeiros níveis é possível seguir para qualquer outro ponto de atenção. Este modelo é vantajoso para o idoso, que amplia sua vida com qualidade; para a família, que terá seu familiar ativo e participativo; e para as operadoras de saúde, que evitarão internações repetidas e de alto custo. AbstractThis paper aims to update knowledge about the structure of a complete line of care for the elderly. It is a model based on early identification of risks for frailty of users. Once identified the risk, priority is early rehabilitation in order to reduce the impact of chronic conditions on functionality. Assuming it is appropriate to prioritize the process of care, according to the functional losses that occur over the years, seven points of attention are established. The model is hierarchical by functional capacity, but polyarchical in practice, since from the first three levels it is possible to follow any other point of attention. This model is advantageous for the elderly, which improves the quality of life; for the family, whixh will have their relative activated and participatory, and for health operators, which will avoid repeated and costly hospitalizations. Palavras-chave: Idoso. Prevenção de Doenças. Cuidado Periódico. Qualidade de Vida. Linha de Cuidados. Capacidade Funcional.
Resumo Este artigo tem por objetivos identificar e discutir os fatores que favorecem e os que dificultam a implementação de uma Rede de Atenção ao Idoso em um município com 100% de cobertura pela Estratégia Saúde da Família. Foi utilizada a metodologia qualitativa, com a realização de dez grupos focais e entrevista semiestruturada com o gestor de saúde do município. Os resultados foram contrastados com dados da estrutura do sistema de saúde local. O estudo revela que lógica atual do processo de trabalho da ESF não diferencia a assistência ao idoso à do adulto. Apesar da consolidação da atenção primária como porta de entrada e da forte atuação dos agentes comunitários de saúde no município estudado, a fragmentação do sistema de saúde e a ausência de um modelo de atenção à saúde da pessoa idosa ainda são grandes limitadores da assistência a essa população. Esse contexto é agravado pela deficiência dos recursos humanos e pelo cenário de desvalorização social da velhice. Espera-se que os conhecimentos gerados possam se transformar em subsídios para a implementação de um modelo de atenção à saúde do idoso adequado à realidade local.
Background The challenges faced by caregivers of the elderly with chronic diseases are always complex. In this context, mobile technologies have been used with promising results, but often have restricted functionality, or are either difficult to use or do not provide the necessary support to the caregiver - which leads to declining usage over time. Therefore, we developed the Mobile System for Elderly Monitoring, SMAI. The purpose of SMAI is to monitor patients with functional loss and to improve the support to caregivers’ communication with the health team professionals, informing them the data related to the patients’ daily lives, while providing the health team better tools. Method SMAI is composed of mobile applications developed for the caregivers and health team, and a web portal that supports management activities. Caregivers use an Android application to send information and receive care advice and feedback from the health team. The system was constructed using a refinement stage approach. Each stage involved caregivers and the health team in prototype release-test-assessment-refinement cycles. SMAI was evaluated during 18 months. We studied which features were being used the most, and their use pattern throughout the week. We also studied the users’ qualitative perceptions. Finally, the caregiver application was also evaluated for usability. Results SMAI functionalities showed to be very useful or useful to caregivers and health professionals. The Focus Group interviews reveled that among caregivers the use of the application gave them the sensation of being connected to the health team. The usability evaluation identified that the interface design and associated tasks were easy to use and the System Usability Scale, SUS, presented very good results. Conclusions In general, the use of SMAI represented a positive change for the family caregivers and for the NAI health team. The overall qualitative results indicate that the approach used to construct the system was appropriate to achieve the objectives.
Alzheimer's (AD) and Parkinson's diseases (PD) share clinical and pathological features, suggesting that they could have common pathogenic mechanisms, as well as overlapping genetic modifiers. Here, we performed a case-control study in a Brazilian population to clarify whether the risk of AD and PD might be influenced by shared polymorphisms at PICALM (rs3851179), CR1 (rs6656401) and CLU (rs11136000) genes, which were previously identified as AD risk factors by genome-wide association studies. For this purpose, 174 late-onset AD patients, 166 PD patients and 176 matched controls were genotyped using TaqMan assays. The results revealed that there were significant differences in genotype and allele frequencies for the SNP PICALM rs3851179 between AD/PD cases and controls, but none for CR1 rs6656401 and CLU rs11136000 intronic polymorphisms. After stratification by APOE ε4 status, the protective effect of the PICALM rs3851179 A allele in AD cases remains evident only in APOE ε4 (-) carriers, suggesting that the APOE ε4 risky allele weakens its protective effect in the APOE ε4 (+) subgroup. More genetic studies using large-sized and well-defined matched samples of AD and PD patients from mixed populations as well as functional correlation analysis are urgently needed to clarify the role of rs3851179 in the AD/PD risk. An understanding of the contribution of rs3851179 to the development of AD and PD could provide new targets for the development of novel therapies.
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