COVID-19 e instituciones de cuidados a largo plazo en México: una deuda impostergable / COVID-19 and long-term care facilities in Mexico: a debt that cannot be postponed

Resumen Ante la pandemia de COVID-19, el grupo más afectado ha sido el de las personas mayores que viven en instituciones de cuidados a largo plazo (ICLP), el cual ha acumulado entre 30 y 60 % de los fallecimientos en el mundo. En México se han reportado brotes en residencias de por lo menos ocho entidades federativas. Diversos factores hacen susceptibles a este grupo y a las ICLP: la convivencia en lugares comunes, dormitorios compartidos y el contacto físico con el personal que ahí labora, aunados a la falta de protocolos y estándares de cuidados de observancia obligatoria, así como a la escasa capacitación del personal. Se evidencia la necesidad de desarrollar un Sistema Nacional de Cuidados que brinde apoyo a las personas con dependencia de cuidados y sus familias y que incluya a las ICLP. Derivado de los retos por la carencia de información y competencias en prevención y control de infecciones en las ICLP, un conjunto de expertos, en colaboración con instituciones públicas, integramos un grupo con el objetivo de actualizar las guías que permitan a las ICLP hacer frente a la pandemia y que contribuyan a la generación de ese Sistema Nacional de Cuidados.

Abstract Since the emergence of the COVID-19 pandemic, the most affected population group has been that of older people living in long-term care facilities (LTCFs), which has accumulated between 30 and 60 % of total number of deaths in the world. In Mexico, outbreaks have been reported in LTCFs of at least eight states. Various factors make this population group and LTCFs susceptible to COVID-1 outbreaks, mainly due to coexistence in common spaces, shared bedrooms and permanent physical contact with the personnel who work there, coupled with a lack of protocols and standards of care of mandatory observance, as well as personnel training limitations. There is evidence of the need to formally develop a National Care System that provides support to those in need of care and their families, and that includes LTCFs. In view of the challenges due to the lack of information and competencies in infection prevention and control at LTCFs, a group of experts, in collaboration with different public institutions, joined efforts with the purpose to update the guidelines in order to allow LTCFs face the pandemic and to contribute to the generation of said National Care System.

Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis / Fragilidade e mortalidade em instituições de longa permanência para idosos no Brasil: estudo de sobrevivência

OBJECTIVES: To investigate the effect of frailty on 1-year mortality in long term-care facility (LTCF) residents. METHODS: This was a prospective cohort study with survival analysis of 209 participants living in 15 Brazilian LTCFs. Data on chronic diseases, age, sex, medication use, dependence in activities of daily living (ADLs; Katz index), and frailty (FRAIL scale) were collected at baseline, and death after 1 year was the outcome measure. Kaplan-Meier estimate and log-rank test were used to analyze the survival of residents. RESULTS: In the initial assessment, 65.07 of the residents were women, and the median age was 82 (interquartile range, 71­88) years, with 55% being over 80 years old. Overall, 88% had 2 or more diseases, 59.81% were using 5 or more medications, 42.11% were considered frail, 34.92% pre-frail, and 22.97% robust, and 69.94% were dependent in 3 or more ADLs. During the 12-month follow-up, 19.61% of the residents (n=41) died. In the survival analysis for death, there was a statistically significant association with frailty (p=0.03) and dependence in ADLs (p=0.04). CONCLUSIONS: In this population of LTCF residents, frailty and functional dependence were associated with death.

OBJETIVOS: Investigar o efeito da fragilidade na mortalidade em 1 ano em residentes de instituições de longa permanência para idosos (ILPIs). METODOLOGIA: Estudo de coorte prospectivo com análise de sobrevivência de 209 participantes residentes em 15 ILPIs brasileiras. Dados sobre doenças crônicas, idade, sexo, uso de medicamentos, dependência nas atividades da vida diária (AVDs; índice de Katz) e fragilidade (escala FRAIL) foram coletados no início do estudo, e morte após 1 ano foi a medida de desfecho. A estimativa de Kaplan-Meier e o teste de log-rank foram usados para analisar a sobrevida dos residentes.. RESULTADOS: Na avaliação inicial, 65,07% dos residentes eram mulheres e a mediana da idade era de 82 (intervalo interquartil, 71­88) anos, 55% com mais de 80 anos. Em geral, 88% tinham 2 ou mais doenças, 59,81% usavam 5 ou mais medicamentos, 42,11% foram considerados frágeis, 34,92% pré-frágeis e 22,97% robustos e 69,91% eram dependentes em 3 ou mais AVDs. No decorrer do seguimento de 12 meses, 19,61% dos residentes (n =41) evoluíram para óbito. Na análise de sobrevivência para evento morte, houve associação estatisticamente significativa com fragilidade (p=0,03) e dependência para AVDs (p=0,04). CONCLUSÕES: Nesta população de residentes de ILPIs, fragilidade e dependência funcional estiveram associadas ao óbito.

Efficacy of COVID-19 outbreak management in a skilled nursing facility based on serial testing for early detection and control

ABSTRACT SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions. Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription-polymerase chain reaction (RT-PCR) and immunochromatographic assays. Active surveillance and early isolation of infected patients were implemented. Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78%) and 12 (46%) tested positive for SARS-CoV-2, respectively. High proportion (38%) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms. Five (21.74%) residents were hospitalized with COVID-19, and 2 (9%) died; only 1 (4%) HCW needed to be hospitalized and no staff members died. Active surveillance helped COVID-19 control and management in a SNF. Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission. In high-risk elderly, only symptoms screening may not be enough for outbreak control.

COVID-19 nas instituições de longa permanência para idosos: estratégias de rastreamento laboratorial e prevenção da propagação da doença / COVID-19 in long-term care facilities for the elderly: laboratory screening and disease dissemination prevention strategies

Resumo A pandemia da "novel coronavirus disease" 2019 (COVID-19), infecção causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), tem descortinado uma realidade até então oculta: a vulnerabilidade da população residente em instituições de longa permanência para idosos (ILPI). Diversas publicações científicas têm revelado a concentração de até 60% dos óbitos atribuídos à COVID-19 em tais instituições. A maioria dos residentes em ILPI reúnem os principais fatores de risco para morbimortalidade pela COVID-19, o que torna imprescindível a definição de ações voltadas à prevenção da transmissibilidade do SARS-CoV-2 neste ambiente, além das medidas usuais de distanciamento social e isolamento dos portadores da doença. Propõem-se, no presente artigo, estratégias de rastreamento da infecção em residentes e trabalhadores de ILPI por meio de testes laboratoriais disponíveis no Brasil. A identificação precoce de indivíduos portadores do SARS-CoV-2 com possibilidades de transmissão ativa e continuada do vírus permite a adoção de medidas que interrompam o ciclo de transmissão local da infecção.

Abstract An infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the 2019 Novel Coronavirus Disease (COVID-19) pandemic has unveiled a hitherto hidden reality: the vulnerability of the population living in long-term care facilities for the elderly (LTCF). To date, several scientific publications have revealed a concentration of up to 60% of deaths attributed to COVID-19 in such institutions. Most LTFC residents share the primary risk factors currently associated with increased morbimortality due to the COVID-19 infection. It is crucial to define actions to prevent SARS-CoV-2 spread in this environment, besides the usual measures of social distancing and isolation of the carriers of this disease. This paper proposes strategies for the investigation of this infection in LTCF residents and workers using laboratory tests available in Brazil. The early identification of individuals with SARS-CoV-2, who may actively and continuously spread the virus, allows adopting measures aimed at interrupting the local transmission cycle of this infection.

Association between depression and quality of life among Brazilian older adults in long-term care facilities / Asociación entre depresión y calidad de vida entre adultos mayores brasileños en centros de atención a largo plazo / Associação entre depressão e qualidade de vida entre idosos brasileiros em instituições de longa permanência

This study aims to test the association between geriatric depression and the quality of life of older adults in long-term care facilities in Brazil. Results showed that there was a significant correlation among four of the six domains that were measured in the WHOQOL-OLD questionnaire of those demonstrating symptoms and those without. In conclusion, higher depression scores were reported by participants who had lower quality of life scores. Mental health care should be carefully addressed among institutionalized older adults in long-term facilities.

Lo objectivo es probar la asociación entre la depresión geriátrica y la calidad de vida de los adultos mayores en centros de cuidados a largo plazo en Brasil. Los resultados mostraron que hubo una correlación significativa entre cuatro de los seis domínios que se midieron em el cuestionario WHOQOL-OLD de aquellos que muestram sintomas y los que no. En conclusión, los participantes que tenían puntuaciones de calidad de vida más bajas informaron puntuaciones de depresión más altas. La atención de la salud mental debe abordarse cuidadosamente entre los adultos mayores institucionalizados en instalaciones a largo plazo.

Este estudo tem como objetivo testar a associação entre depressão geriátrica e qualidade de vida de idosos em instituições de longa permanência no Brasil. Os resultados mostraram que houve uma correlação significativa entre quatro dos seis domínios que foram medidos no questionário WHOQOL-OLD daqueles que demonstraram sintomas e aqueles sem. Em conclusão, escores mais altos de depressão foram relatados pelos participantes que apresentaram escores mais baixos de qualidade de vida. Os cuidados de saúde mental devem ser cuidadosamente tratados entre idosos institucionalizados em instalações de longo prazo.

Prevalence of chronic pain and analysis of handgrip strength in institutionalized elderly / Prevalência de dor crônica e análise da força de preensão manual em idosos institucionalizados

ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal disorders are accentuated with aging. Among these, chronic pain can influence several functional aspects such as handgrip strength, especially in institutionalized elderly. The objective of this study was to check the prevalence of chronic pain and to analyze the handgrip strength in institutionalized elderly. METHODS: A cross-sectional, population-based study was carried out at long-term care facilities in Passo Fundo/RS (2016-2018). The population was composed of 281 residents, evaluated for sociodemographic variables (medical records), handgrip strength (manual dynamometry), and chronic pain (self-report). The statistical analysis used the descriptive statistics and the Student t-test of independent samples (p≤0.05). RESULTS: The sample consisted of 173 elderly individuals (80.95±8.94 years). The majority lived in private institutions, were women, widows, with 1 to 8 years of education. The prevalence of chronic pain was 39.3%, and the mean handgrip strength was 7.0±6.42kg (right hand) and 6.24±5.96kg (left hand). The handgrip strength was higher in the groups of elderly men (right and left hands: p=0.000) and non-long-living seniors (right hand: p=0.017; left hand: p=0.002). There was no difference in handgrip strength values between the groups with and without chronic pain (p>0.05). CONCLUSION: Institutionalized elderly present an expressive prevalence of chronic pain and handgrip strength values much lower than expected, being influenced by gender and age.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os distúrbios musculoesqueléticos se acentuam com o avanço da idade. Dentre eles, a dor crônica pode influenciar em diversos aspectos funcionais, como a força de preensão manual, especialmente em idosos institucionalizados. O objetivo deste estudo foi verificar a prevalência de dor crônica e analisar a força de preensão manual em idosos institucionalizados. MÉTODOS: Estudo transversal de base populacional, realizado em instituições de longa permanência de Passo Fundo/RS (2016-2018). A população foi composta por 281 residentes, avaliados quanto às variáveis sociodemográficas (registros médicos), a força de preensão manual (dinamometria manual) e a dor crônica (autorrelato). A análise estatística utilizou a estatística descritiva e o teste t Student de amostras independentes (p≤0,05). RESULTADOS: A amostra foi composta por 173 idosos (80,95±8,94 anos). A maioria residia em instituições privadas, eram mulheres, viúvas e com escolaridade de 1 a 8 anos. A prevalência de dor crônica foi de 39,3% e a força de preensão manual média foi de 7,0±6,42kg (mão direita) e 6,24±5,96kg (mão esquerda). A força de preensão manual foi maior nos grupos dos idosos do sexo masculino (mãos direita e esquerda: p=0,000) e dos idosos não longevos (mão direita p=0,017; mão esquerda p=0,002). Não houve diferença nos valores de força de preensão manual entre os grupos com e sem dor crônica (p>0,05). CONCLUSÃO: Idosos institucionalizados apresentam uma expressiva prevalência de dor crônica e valores de força de preensão manual muito abaixo do esperado, sendo influenciada pelo sexo e pela idade.

Determinant Factors in Cost to Feed for Long-Term Care Facilities Residents / 보건행정학회지

BACKGROUND: The food and food service influence the quality of life and the general health condition of older persons living in long-term care (LTC) facilities. Purchasing good food materials is a ground of good food service. In Korea, the residents in LTC facilities should pay for the cost of food materials and ingredients out of their pocket because it is not covered by LTC insurance. This study explored what factors affect the cost of food materials paid by LTC facility residents and which factor affects most. METHODS: We used data from the study on out-of-pocket payment on national LTC insurance, which surveyed 1,552 family caregivers of older residents in LTC facilities. We applied conditional multi-level model, of which the first level represents the characteristics of care receivers and caregivers and its second level reflects those of LTC facilities. RESULTS: We found that the facility residents with college-graduated family caregivers paid 11,545 Korean won more than those with less than elementary-graduated ones. However, the income level of family caregivers did not significantly affect the amount of the food material cost of the residents. The residents in privately owned, large, metropolitan-located facilities were likely to pay more than those in other types of facilities. The amount of the food material cost of the residents was mainly decided by the facility level factors rather than the characteristics of care recipients and their family caregivers (intra-class correlation=82%). CONCLUSION: These findings suggest that it might be effective to design a policy targeting facilities rather than residents in order to manage the cost of food materials of residents in LTC facilities. Setting a standard price for food materials in LTC facilities, like Japan, could be suggested as a feasible policy option. It needs to inform the choice of LTC users by providing comparable food material cost information. The staffing requirement of nutritionist also needs to be reviewed.

Fórum das instituições filantrópicas de longa permanência para idosos: parceria em rede de apoio no cuidado institucional ao idoso / Forum of nonprofit long-term care facilities for older adults: partnership with support networks for the institutional care of older adults

Resumo O artigo descreve o histórico, a metodologia e a evolução do Fórum das Instituições Filantrópicas de Longa Permanência para Idosos (ILPI) da Região Metropolitana de São Paulo, e contextualiza sua trajetória diante dos avanços normativos que regulamentam essas instituições atualmente. Foi realizado um estudo retrospectivo, descritivo, de abordagem qualitativa, por meio da leitura e análise das atas das reuniões no período entre 1999 e 2015. Observou-se que a articulação em rede, proporcionada pelas reuniões ao longo dos 16 anos de atividade, pode auxiliar a organização, o planejamento e a manutenção das ILPI, contribuindo para melhorar a qualidade da prestação dos serviços conforme a legislação vigente, promovendo aproximação e engajamento de parceiros na busca pela profissionalização dos cuidados institucionais de longa duração e pela excelência na assistência ao idoso, e no aprimoramento e capacitação dos profissionais, processos e protocolos institucionais.

Abstract This study describes the history, methodology and evolution of the Forum of NonProfit Long-Term Care Facilities for Older Adults (LTCF - Fórum das Instituições Filantrópicas de Longa Permanência para Idosos) of the São Paulo Metropolitan Region, Brazil, and contextualizes its path towards the normative advances that regulate these institutions nowadays. By reading and analyzing the reports of the meetings that occurred between the years 1999 and 2015 a descriptive, qualitative and retrospective study was performed. We observed that the network articulation provided by the meetings during the 16 years of activity can help with the organization, planning and maintenance of LTCFs, improving the quality of the services in accordance to the current legislation, promoting the approximation and engagement of partners in the search for professionalism of long-term institutional care and excellence in care for older adults, and on the improvement and qualification of professionals, processes and institutional protocols.

Desigualdade no perfil dos idosos institucionalizados na cidade de Natal, Brasil / Inequality in the characteristics of the institutionalized elderly in the city of Natal, Brazil

Resumo Objetivou-se verificar as desigualdades no perfil dos idosos residentes em Instituições de Longa Permanência para Idosos (ILPIs) com e sem fins lucrativos. Foram visitadas 12 ILPIs na cidade do Natal-RN, sendo 6 sem fins lucrativos com 260 idosos avaliados e 6 com fins lucrativos e 127 idosos. A caracterização das desigualdades no perfil dos idosos se deu a partir de dados socioeconômicos e motivo da institucionalização. Os dados foram submetidos aos testes Qui-quadrado ou t de Student com nível de significância de 5%. Como resultado, aqueles idosos analfabetos, solteiros, negros e pardos, não aposentados, sem plano de saúde, sem filhos, que não recebem visitas e que compram algo fora da instituição com o próprio dinheiro, estavam associados às ILPIs sem fins lucrativos. Ao analisar os motivos que levaram o idoso a ser institucionalizado, os conflitos familiares, o abandono e o fato de não possuir lugar para morar estiveram associados às ILPIs sem fins lucrativos. Apenas a condição “estar doente” prevaleceu como motivo principal de institucionalização em ILPIs com fins lucrativos. As condições mais desfavoráveis foram dos idosos residentes em ILPIs sem fins lucrativos, o que demonstram o reflexo da desigualdade social durante a vida desses idosos.

Abstract The aim of this study was to describe the differences in the profile of elderly residents in non-profit and for-profit Long-Term Residential Institutions for the Elderly (ILPI). We visited 12 ILPIs in the city of Natal, Rio Grande do Norte. Six of them were non-profits housing 260 elderly, and six were for-profit institutions, housing 127 elderly. The unequal characteristics of the elderly in these facilities are based on socioeconomic data and the reason for institutionalization. The data was submitted to Chi-squared or Student’s t, with a significance level of 5%. Illiterate, single, black or brown, individuals with no retirement/pension or healthcare plan, no children and no visitors who purchase something outside the institution with their own money are associated with non-profit ILPIs. When analyzing the reasons for institutionalization, family conflict, abandonment and being homeless were associated with the elderly institutionalized in non-profit ILPIs. The main reason for the elderly institutionalized in for-profit ILPIs was “being ill”. The conditions of the elderly in non-profit ILPIs were poorer, reflecting the social inequality these subjects experienced throughout their lifetime.

Uso de medicamentos e suas potenciais interações com alimentos em idosos institucionalizados / Use of medicines and their potential interactions with foods in institutionalized elderly individuals

OBJETIVOS: Verificar o uso de medicamentos e identificar potenciais interações entre fármacos e alimentos/nutrientes em idosos institucionalizados. MÉTODOS: Foi realizado um estudo transversal de abordagem quali-quantitativa. A coleta de dados ocorreu por meio da análise dos prontuários e prescrições médicas dos idosos residentes em uma instituição de longa permanência para idosos do Município de Ijuí-RS. A amostra, de conveniência, incluiu todos os idosos internados na instituição no período da coleta de dados: mês de setembro de 2015. RESULTADOS: Dos 30 idosos residentes na instituição, 29 utilizavam medicamentos de uso contínuo, com média de 8,72±2,56 medicamentos por idoso, totalizando 91 medicamentos distintos. Vinte e oito (93,3%) idosos usavam cinco ou mais medicamentos, o que indica a existência de polifarmácia na grande maioria dos residentes na instituição. Os medicamentos mais utilizados atuam no sistema nervoso (35,07%), seguidos dos que atuam no aparelho gastrointestinal ou no metabolismo (31,52%) e no sistema cardiovascular (20,1%). Constatou-se que 41 (45,05%) medicamentos apresentavam potencial para interagir com alimentos, totalizando 142 interações. Potenciais interações foram identificadas em todos os idosos que faziam uso de medicamentos, variando de duas a oito, com média de 4,89±2,00 interações por idoso. A cafeína foi o nutriente que esteve envolvido em mais interações, com potencial de interagir com nove (21,95%) medicamentos distintos, sendo que destes, cinco (12,19%) atuam no sistema nervoso. CONCLUSÕES: Identificou-se alta frequência de polifarmácia pelos idosos institucionalizados, sendo os medicamentos de ação sobre o sistema nervoso os mais utilizados. Foram identificadas várias potenciais interações entre os fármacos e alguns tipos de alimentos/nutrientes presentes na alimentação.

AIMS: To verify the use of medicines identifying their potential interactions with food/nutrients in institutionalized elderly individuals. METHODS: A qualitative and quantitative cross-sectional study was conducted. The data were collected through the analysis of medical charts and prescriptions of elderly individuals from a long-stay institution in Ijuí, Rio Grande do Sul State, Brazil. The convenience sample included all the elderly individuals institutionalized during the data collection period (September 2015). RESULTS: Of the 30 institutionalized elderly individuals, 29 were using continuous medication with a mean of 8.72±2.56 medicines per individual, totaling 91 different drugs. Twenty-eight (93.3%) individuals used five or more medicines, which indicates polypharmacy among most of the elderly residents. The most commonly used medicines were for the nervous system (35.07%), digestive system and metabolism (31.52%), and cardiovascular system (20.1%). Forty-one (45.05%) drugs could potentially interact with foods, totaling 142 interactions. Potential interactions were verified in all elderly individuals, ranging from two to eight, averaging 4.89±2.00 interactions per elderly. Caffeine was involved in most interactions, potentially interacting with nine (21.95%) different medications, five (12.19%) of which acted on the nervous system. CONCLUSIONS: There was a high frequency of polypharmacy among the institutionalized elderly and medicines to treat nervous system conditions were the most common ones. Several potential interactions between drugs and some types of foods/nutrients were verified.

Equivalência semântica, conceitual e de itens do Observable Indicators of Nursing Home Care Quality Instrument / Semantic and conceptual equivalence of the observable indicatorsof Nursing Home Care Quality Instrument

Resumo As Instituições de Longa Permanência para Idosos (ILPI) são uma importante alternativa de cuidado no mundo, porém o Brasil ainda não dispõe de instrumento válido para monitorar a qualidade dessas instituições. Portanto, o objetivo do presente artigo é descrever as etapas iniciais da adaptação transcultural do Observable Indicators of Nursing Home Care Quality Instrument (IOQ) usado para avaliar a qualidade do cuidado nas ILPI. Realizou-se a equivalência conceitual e de itens para avaliar a pertinência e a viabilidade do IOQ à realidade nacional através do Índice de Validade do Conteúdo (IVC). Em seguida, cumpriu-se a equivalência operacional, a idiomática e a semântica. Esta última tem 5 fases: (1) duas traduções e (2) duas respectivas retraduções; (3) apreciação formal; (4) revisão; e (5) aplicação do pré-teste em três ILPI. Modificações importantes foram realizadas para garantir a validade do IOQ. O IVC do instrumento referentes ao contexto brasileiro foi de 94,3% (viabilidade) e 95,3% (relevância). O IOQ mostrou-se compreensível e de fácil aplicação no pré-teste. A adaptação transcultural do IOQ contribui para avaliação e melhoria da qualidade nas ILPI brasileiras, mas os resultados devem ser complementados mediante avaliação psicométrica.

Abstract Long-term care facilities (LTCFs) for the elderly are an important health care alternative in the world, though Brazil does not yet have a valid instrument to monitor the quality of these institutions. This study sought to describe the initial stages of the cross-cultural adaptation of the Observable Indicators of Nursing Home Care Quality (OIQ) instrument used to assess the quality of care in LTCFs. Conceptual equivalence was conducted to assess the relevance and feasibility of the OIQ within the Brazilian context, using the Content Validity Index (CVI). The operational, idiomatic and semantic equivalence was then performed. This item consisted of 5 phases: (1) two translations; (2) the respective back translations; (3) formal appraisal; (4) review; and (5) application of the pre-test in three LTCFs. Significant changes were made to ensure the validity of the OIQ. The CVI instrument for the Brazilian contextwas 94.3% (viability) and 95.3% (relevance). The OIQ proved to be easy to understand and apply in the pre-test. Cross-cultural adaptation of the OIQ contributes to assessing and improving quality in Brazilian LTCFs, though the findings should be complemented by a psychometric evaluation of the instrument.

Prevalência de incontinência urinária e fecal em idosos: estudo em instituições de longa permanência para idosos / Prevalence of urinary and fecal incontinence in the elderly: a study in long-term senior care facilities

Objetivou-se investigar a prevalência de incontinência urinária (IU) e incontinência fecal (IF) entre idosos residentes nas instituições de longa permanência para idosos de João Pessoa, Paraíba. Foi um estudo de caráter transversal, populacional e descritivo, com abor¬dagem quantitativa realizada com toda a população residente nas seis instituições de longa permanência para idosos (ILPI) cadastradas no Conselho Nacional de Serviço Social e no Conselho Municipal de Idosos do município de João Pessoa, que contabilizou 322 idosos. Os dados foram coletados em instrumento composto por questionário que aborda o perfil dos participantes da pesquisa, através das variáveis sociodemográficas e condições clínicas, e foram duplamente digitados e validados em uma planilha do programa Microsoft Excel, sendo os cálculos estatísticos realizados no software SPSS (Statistical Package for the Social Sciences), versão 20.0. Foi empregada a estatística descritiva. A idade média dos participantes foi de 81,13 ± 9,39 anos, 172 (53,42%) eram brancos, 168 (53,67%) eram solteiros, 35 (59,32%), frequentaram a escola entre quatro a dez anos, 222 (84,09%), recebiam de um a três salários mínimos, 159 (49,69%) estavam na instituição há menos de três anos, 33 (10,25%) eram portadores de IU, 01 (0,31%) apresentavam IF, e 120 (37,27%) apresentavam os dois tipos de incontinência (IU e IF). Observou-se que houve um potencial significativo para que esses idosos desen-volvam incontinências, sendo, portanto essencial o planejamento e a adoção de medidas que envolvam o conhecimento desta realidade, buscando encontrar caminhos que conduzam a minimizar os efeitos físicos e emocionais deste problema.

We aim to investigate the occurrence of urinary incontinence and fecal incontinence among elderly people who live in Long-Term Care Facilities in João Pessoa, Paraíba, Brazil. This is a study cross¬-sectional, populational and descriptive study with a quantitative approach conducted with the entire living population in six Long-Term Care Facilities the Aged registered at the National Council of Social Service and at the Municipal Council of the Elderly of the municipality of João Pessoa, which accounted for 324 elderly people. Data were collected with an instrument composed of a questionnaire which approaches the profile of the research participants, through the sociodemographic variables and clinical conditions. They were double entered and validated in a Microsoft Excel spreadsheet, being the statistical calculations conducted in SPSS (Statistical Package for Social Sciences) software, version 20.0. A descriptive statistic was employed. The average age of participants was 81.13 ± 9.39 years, 172 (53.42%) were white, 168 (53.67%) were single, 35 (59.32%) attended school from four to ten years, 222 (84.09%) received one to three minimum wages, 159 (49.69%) were in the facilities for less than three years, 33 (10,25%) were suffering from UI, 01 (0,31%) presented FI, and 120 (37,27%) presented both types of incontinence (UI and FI). It was possible to observe there is a significant potential for these elderly people to develop incontinences. Therefore, the planning and adoption of measures that involve the understanding of this reality is essential, searching for paths that lead scientific research to minimize physical and emotional effects of this problem.

Quality Evaluation and Improvement for End-of-life Care toward Residents in Long Term Care Facilities in Japan: A Literature Review

Long-term care facilities have important roles providing end-of-life-care in Japan. The purpose of this literature review was to examine the current research trend regarding quality evaluation and improvement for end-of-life-care in Japanese long-term care facilities. From a search of key medical databases, potential articles regarding end of life at long-term care facilities were retrieved. We classified retrieved 23 literatures into four research types; four intervention studies, three surveys for development educational / quality improvement tool, thirteen cross-sectional surveys, three qualitative studies. Despite the current increment of the literatures, intervention studies were a few. Related factors of the death in the facilities included administrators’ policy regarding end of life care, and collaboration with the medical institutions, and clear family decision making regarding end of life care. Some research indicated that staffs in long-term care facilities felt difficulty in collaborating with medical institutions, conducting interdisciplinary work, and confirming residents’ intention regarding end-of-life. The results indicate that conducting quality intervention study, supporting administrators of long-term care facilities, promoting residents and family decision making and education for the staffs in long-term care facilities might be effective to improve quality of end-of-life care in long-term care facilities.

Capacidade funcional de idosos acolhidos em instituições de longa permanência da rede pública em uma capital da região norte / Functional capacity of elderly people in long-stay institutions of the public health network in a capital city of the northern region

As Instituições de Longa Permanência para Idosos (ILPI) são alternativas emergentes de cuidados não familiares. Este estudo analisou o perfil sociodemográfico e de saúde e a capacidade funcional de idosos em situação de acolhimento institucional em Belém, Pará. Trata-se de um estudo descritivo, transversal e quantitativo. Participaram 73 idosos de duas instituições públicas avaliados pelos Mini Exame do Estado Mental (MEEM), Índice de Katz e de Lawton e, nos casos de presença de declínio cognitivo, foi utilizada a escala de Avaliação da Incapacidade Funcional para Demência (DAD). Observou-se o predomínio do sexo feminino (53%) e de idosos solteiros com idade de 60 a 99 anos. A hipertensão arterial sistêmica (HAS) foi a doença mais prevalente (45,3%). No grupo sem declínio cognitivo, em relação à capacidade funcional, constatou-se o predomínio de idosos independentes para as Atividades Básicas de Vida Diária (ABVD) e dependentes moderados para as Atividades Instrumentais de Vida Diária (AIVD) e, no grupo com comprometimento cognitivo, constatou-se menor predomínio de independentes para ABVD e alta prevalência de dependência severa para as AIVD. O estudo permitiu traçar um perfil recente dos idosos residentes em ILPI públicas em Belém. Os dados indicam semelhanças com o restante do país em relação ao maior número de mulheres e à maior prevalência de doenças crônico-degenerativas que cooperam para a incapacidade funcional. Salienta-se a necessidade de implementação de medidas preventivas e de reabilitação para a manutenção ou melhora da capacidade funcional por meio da operacionalização de políticas públicas e da atuação multiprofissional.

The increase of elderly in need of institutional care has been a consequence of aging process and sociodemographic changes. Thus, the aim of this study was to analyze the demographic profile and functional capacity of elderly in residential care situation in Belém, Pará, Brazil. It consists of a descriptive, cross-sectional and quantitative study. Seventy-three institutionalized elderly individuals of two public institutional care residences were evaluated through Mini Mental State Examination (MMSE), Katz Index and Lawton and in the presence of cognitive decline, the scale of the Disability Assessment for Dementia (DAD) was used. The results show the predominance of elderly women (53 %) and single, aged between 60 and 99 years. The most prevalent disease was arterial hypertension (45.3%). Through the cognition and functional capacity assessments, in the group without cognitive impairment, the results have observed the prevalence of independence for the execution of Basic Activities of Daily Living (BADL) and moderate dependent for the execution of Instrumental Activities Daily Living (IADL). In the group with, cognitive decline, a low prevalence of independence for BADL and a high prevalence of severe dependence for IADL were observed. The study allowed us to outline the profile about elderly living in public ILPI in Belém. Data indicate similarity to the other regions in Brazil, as the greater number of women and higher prevalence of chronic diseases that cooperate to functional disability. The results show the need of implementations of preventive care or rehabilitation in order to improve or maintain the elderly functional capacity in the institutional context, through the operation of public policies and multidisciplinary approach.

A survey of end of life care at long-term care facilities in urban areas in Japan

The aim of this study was to investigate the end of life care provided by long-term care facilities and nursing homes. A cross-sectional survey of all long-term care facilities and nursing homes in Kobe was performed in July 2013. Questionnaires were sent to 350 facilities with an 89.7％ response rate. In total, 121（39％）of respondents stated that end of life care was available, and 151（48％）responded that facilities were willing to provide end of life care for terminally ill residents. One hundred fifty-two（48％）and 183（58％）of respondents answered that facilities were available for managing residents with percutaneous endoscopic gastrostomy, and transfusion, respectively. Seventy-two（23％）of respondents reported that facilities for managing the use of narcotics were available. In conclusion, a minority of long-term care facilities and nursing homes ware available for providing end of life care for residents, though approximately 50％ were willing to do so.

Grau de dependência de idosos residentes em instituições de longa permanência / Grado de dependencia de los ancianos residentes en Instituciones de Larga Permanencia en Montes Claros, MG / Degree of dependence of elderly residents in geriatric long-term care facilities in Montes Claros, MG

Este estudo objetivou identificar o grau de dependência dos idosos institucionalizados no município de Montes Claros, Minas Gerais, Brasil. Trata-se de um estudo transversal descritivo, realizado nas três Instituições de Longa Permanência para Idosos, de caráter filantrópico, no município de Montes Claros, Minas Gerais. Participaram todo o universo de idosos residentes nos locais do estudo, totalizando 125 sujeitos, cujos dados foram coletados por meio do Índice de Katz. Os dados foram apresentados por análise descritiva e bivariada. A independência foi observada em 41,6% (n=52), a dependência parcial em 15,2% (n=19) e a dependência total em 43,2% (n=54), sendo que os idosos apresentam melhor capacidade de execução das atividades de alimentação (86,4%; n=108) e transferência (67,2%; n=84). Assim, o presente estudo sugere a necessidade de acompanhamento contínuo na prevenção da incapacidade funcional desse grupo populacional.

Esta investigación tuvo como objetivo identificar el grado de dependencia de los ancianos institucionalizados en el municipio de Montes Claros, Minas Gerais, Brasil. Se trata de un estudio transversal y descriptivo, realizado en tres Instituciones de Larga Permanencia para Ancianos de dicho municipio. Participaron de este estudio 125 ancianos, cuyos datos fueron recolectados por medio del Índice de Katz. Los datos fueron presentados por el análisis descriptivo y bivariado. La independencia fue observada en el 41,6% (n=52), la dependencia parcial en el 15,2% (n=19) y la dependencia total en el 43,2% (n=54). Los ancianos tienen más capacidad para realizar las actividades de la alimentación (86,4%, n=108) y transferencia (67,2%, n=84). Por lo tanto, este estudio sugiere la necesidad de un acompañamiento continuo en la prevención de la incapacidad funcional de ese grupo poblacional.

This study aimed to identify the degree of dependence of institutionalized older adults in Montes Claros, Minas Gerais, Brazil. It consists of a cross-sectional descriptive study, developed in three non-profit geriatric long-term care facilities in this municipality. The sample was comprised of 125 older adults and data were collected with the use of the Katz Index. Data were presented by descriptive and bivariate analysis. Independence was observed in 41.6% (n=52), partial dependence in 15.2% (n=19) and total dependence in 43.2% (n=54). The elderly have better ability to perform feeding (86.4%, n=108) and transferring (67.2%, n=84) activities. Thus, this study suggests the need for continuous monitoring to prevent functional disability in this population group.

Survey of directors of long-term care facilities on opinions about end-of-life care and director education / 医学教育

AIM: gradual shift, from hospitals to long-term care facilities, in where elderly people spend their last years is expected in Japan.Therefore, we performed a questionnaire survey to assess the opinions of directors of long-term care facilities about end-of-life care and director education.<BR>METHODS: In December 2006, data were collected through mailed, anonymous, and self-administered questionnaires. The subjects of this study were managing directors of 214 long-term care facilities in Nagoya City. Our questionnaire survey focused on the directors' attitudes about the following end-of-life issues: 1) requirements for implementing progressive policies for end-of-life care, and 2) educational training for end-of-life care. For data analysis, we divided the facilities into three groups: geriatric hospitals, geriatric health services facilities, and nursing homes.<BR>RESULTS: Directors of 82 facilities returned completed questionnaires (response rate, 38.3%). They regarded staff education concerning end-of-life care, outside medical support, private rooms for end-of-life care, and 24-hour availability of physicians or nurse as requirements for quality end-of-life care at long-term care facilities. Nursing-home directors felt more strongly about the need for 24-hour medical services for end-of-life care than did directors of other types of facilities.Also, most directors wanted to receive additional training about clients' decision-making processes, communi-cation skills, and legal issues related to end-of-life care.<BR>CONCLUSIONS: Our results suggest that staff education concerning end-of-life care and 24-hour medical services are required for quality end-of-life care at long-term care facilities for the elderly.

A Study on the Levels of Dementia-related Knowledge, Attitude, and Practice among Nursing assistants Caring for Institutionalized elders with dementia / 성인간호학회지

This study has been conducted for the purpose of identifying the levels of knowledge and attitude about dementia, and exploring the degrees of practice and the relationship among these variables in nursing assistants caring institutionalized demented elders. The subjects were 87 formal caregivers from 3 dementia-specialized nursing facilities, 2 dementia-specialized hospitals, 1 general psychiatric hospitals, and 3 general nursing homes. The data were gathered from July 10th to August 5th, 1998 through interviews by questionnaires. The measuring instruments of this study were developed by the researcher and proven for their reliability and validity. The collected data were analyzed using SAS program. 1) The lowest score among 6 sub-areas about practice showed on this subarea of maintenance of remained ADL function, offering stimuli and activities to demented elders was the second. 2) The third hypothesis of "the higher the attitude score they have, the higher the practice score they do" was supported (r=.370, p=.025). 3) The influencing factors significantly on knowledge were educational status, learning experience about taking care of patients, learning experience about dementia during last a year. 4) A factor of the period of taking care demented elders have significantly influenced on the attitude about dementia. 5) The influencing factors significantly on practice were age, marital status, learning experience about taking care of patients, learning experience about dementia during the last a year. 6) The most difficult situation the subjects perceived in taking care of demented elders was managing the aggressive and resistive behaviors of demented elders.