Perfil das instituições de longa permanência para idosos em uma cidade no estado de São Paulo

Abstract

CONTEXT AND OBJECTIVE: The prevalence of pressure ulcers varies according to geographic region and population group, such as the institutionalized elderly. The aim of this study was to identify the prevalence of pressure ulcers among elderly people living in long-stay institutions. DESIGN AND SETTING: Cross-sectional study in six long-stay institutions for the elderly in São Paulo, Brazil. METHODS: Demographic and clinical data were collected in six long-stay institutions on two visits to each institution between May and August 2007, during which all elderly patients with pressure ulcers were evaluated. The Braden scale was used to identify the risk of developing pressure ulcers and the National Pressure Ulcer Advisory Panel (NPUAP) stages for classifying the pressure ulcers. Statistical analysis was performed using the chi-square test, Student's t-test and Fisher's exact test. RESULTS: There was no significant difference in the results between visits. The population was 181 elderly people in May and 184 in August: 23 had pressure ulcers in May (prevalence of 12.7%) and 17 in August (prevalence of 9.2%). The mean age at the two times was 84 years, and the average length of stay was 32 months. Pressure ulcers were found mainly in the sacral region (mean, 71.5%), and most commonly in stage II (mean, 41%). CONCLUSION: The prevalence of pressure ulcers was 10.95%. These data provide background information that may aid in developing protocols for applying best practices for prevention and treatment of pressure ulcers, consequently reducing the prevalence. RESUMO CONTEXTO E OBJETIVO: A prevalência de úlcera por pressão (UP) varia de acordo com a região geográfica e grupo populacional, como idosos institucionalizados. O objetivo foi identificar a prevalência de UP em instituições de longa permanência para idosos (ILPI). TIPO DE ESTUDO E LOCAL: Estudo transversal em seis ILPI em São Paulo. MÉTODOS: A coleta de dados demográficos e clínicos foi realizada em seis ILPI durante duas visitas a cada instituição no período de maio a agosto de 2007, sendo avaliados todos os idosos com UP. Foi utilizada a Escala de Braden para identificar o risco de desenvolver UP e o National Pressure Ulcer Advisory Panel (NPUAP) para a classificação das UP. Foram realizados os testes: Exato de Fisher, Q-Quadrado e t-Student para análise estatística. RESULTADOS: Não houve significância estatística nos resultados encontrados. A população era de 181 idosos em maio e 184 em agosto, sendo 23 idosos com UP (prevalência de 12,7%) e 17 idosos com UP (prevalência de 9,2%) respectivamente. A média de idade nos dois períodos foi de 84 anos, e 32 meses de permanência nas Instituições. A região sacral foi a mais frequente com média de 71,5% e as úlceras no estágio II com média de 41%. CONCLUSÃO: A prevalência de UP foi de 10,95%. Estes dados fornecem informações de base que podem auxiliar no desenvolvimento de protocolos para a aplicação de melhores práticas na prevenção e tratamento de úlceras de pressão, consequentemente reduzindo a prevalência.

Homes for the Aged: a study of a Health Region in Rio Grande do Sul, Brazil

“…The reports of some professionals demonstrated the negative influence of the non-division of tasks on the quality of care, highlighting the lack of time for good care. These results are also consistent with a survey that outlined the profile of nine HFAs in the municipality of Botucatu, São Paulo, Brazil in which four of them did not have employees exclusively responsible for laundry, food and cleaning19 .…”

“…This study revealed this proportion in only two HFAs in the form of an institutional contract, and in six, leisure and culture activities took place without hiring a professional, being in charge of volunteers and assigned. Although the importance of leisure for the elderly and of requests for exercise is well known, a Brazilian survey found that less than 40% of these institutions offered such activities19 .Philanthropic HFAs are known to have difficulties with regard to human and material resources. Depending on the management, leisure opportunities may come from partnerships or may not exist, which facilitates the isolation of the elderly.…”

Long-stay institutions for the elderly: physical-structural and organizational aspects

“…By founding LSIEs, the legislation allows the private sector to provide care to the elderly however these institutions must ensure the civil rights, and the dignity of their residents, and provide quality services. 1 A study carried out in the state of São Paulo found a predominance of private institutions, 17 and another study carried out in all LSIEs in Maceió, state of Alagoas found that most were religious charitable institutions (88%), with the remaining being private nursing homes (12%). 5 Predominantly in Brazil, LSIEs are financed by the elderly themselves using their pensions.…”

“…19 The lack of leisure activities for the elderly was also reported in a study carried out in São Paulo, where 62.5% of the institutions investigated did not provide this service. 17 Consequently, there may be little interaction among residents, excessive idle time, or only their involvement in passive activities. 7 A study on the sensory and cognitive decline of 4156 elderly people living in nursing homes in eight European countries reported that factors such as hearing and visual impairment are directly associated with functional decline.…”

“…18,22 In many institutions, there is also a diversion of the functions of caregivers who begin to perform tasks such as food preparation and cleaning. 17 Another reality is the lack of clarity in the differentiation between the responsibilities of the caregiver and the nursing technician or assistant. 22 Because of this the elderly are exposed to the risk of receiving unqualified care with the potential of incurring injuries.…”