Avaliação das Instituições de Longa Permanência para Idosos no Brasil: um panorama das desigualdades regionais / Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Resumo O objetivo deste artigo é avaliar as Instituições de Longa Permanência para Idosos (ILPI) brasileiras, segundo o Modelo Teórico Multidimensional Integrado de Qualidade e Atendimento (MIQA), e comparar o desempenho alcançado entre as regiões do país. Estudo ecológico descritivo realizado com dados secundários públicos das ILPI participantes do Censo do Sistema Único da Assistência Social de 2018. Uma Matriz de Avaliação foi construída a partir das variáveis do Censo e do Modelo Teórico MIQA. Parâmetros de qualidade foram empregados para classificar o desempenho das instituições para cada indicador em "incipiente", "em desenvolvimento" ou "desejável. O índice de disparidade foi obtido para cada indicador. Foram analisadas 1.665 instituições. Observaram-se diferenças nos percentuais de ILPI com desempenho "desejável" entre as regiões brasileiras, e a necessidade de aprimoramento na maioria das ILPI em relação à proporção de cuidadores de pessoas idosas, a composição da equipe multiprofissional, a acessibilidade e a oferta de ações de promoção de saúde. Verificou-se a necessidade de apoio governamental para a supressão dos critérios de diferenciações excludentes e para a expansão dos serviços para superar as superlotações.

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions' performance for each indicator as "incipient", "developing" or "desirable". The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with "desirable" performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

Geografia das respostas sociais para as pessoas idosas em Portugal / Geography of social care for older people in Portugal

Resumo: Este estudo analisa a distribuição geográfica das respostas sociais dirigidas à população idosa em Portugal continental, e compara os padrões espaciais dos equipamentos dos sectores público, solidário e lucrativo. Os resultados mostram uma distribuição heterogénea e uma tendência para a concentração espacial das estruturas do sector privado em áreas mais urbanizadas. Conclui-se que a crescente liberalização do sector constitui um risco para a equidade territorial dos cuidados sociais.

Abstract: This study analyses the geographical distribution of social care for older adults in mainland Portugal, and compares the spatial patterns of public, non-profit and profit institutions. The results show a heterogeneous distribution and a tendency towards spatial concentration of private sector structures in more urbanised areas. We conclude that the increasing liberalisation of the sector constitutes a risk to the territorial equity of social care provision.

Virtual reality training can effectively improve the cognitive functioning and functional fitness of persons with subjective cognitive decline / 中华物理医学与康复杂志

Objective:To observe any effect of virtual reality (VR) training on the cognitive functioning and functional fitness of nursing home residents with subjective cognitive decline (SCD).Methods:Fifty-six of such residents were randomly divided into an observation group and a control group, each of 28. Both groups received health education and routine care, but the observation group was additionally provided with 45 minutes of VR training three times a week for 6 months. The training included Baduanjin, magic, flying bird, supermarket shopping, gravity ball and gym episodes. Both groups′ cognition was evaluated using the subjective cognitive decline questionnaire (SCD-Q), the Montreal cognitive assessment (MoCA), the Rivermead Behavioural Memory Test (second edition) (RBMT-Ⅱ), a digit symbol substitution test (DSST), an animal fluency test (AFT) and trail-making test A-B (TMT A-B). Functional fitness was quantified using the 8-foot up-and-go test (8UGT), a 30-second arm curl test (30sACT), a 30-second chair stand test (30sCST), a back scratching test (BST), the sit-and-reach test (CSRT) and a 2-minute step test (2MST) before and after the 6-month intervention.Results:After the intervention, the average SCD-Q, MoCA, RBMT-Ⅱ, DSST, TMT-A, and TMT-B scores of the observation group were significantly better than before the intervention, and significantly better than the control group′s averages. And except for the back scratching their functional results were also significantly better, on average, than those of the control group.Conclusions:VR training can effectively improve the cognition and functional fitness of nur-sing home residents with SCD. Such training is worthy of promotion and wider application in nursing homes.

The effects of combining virtual reality training with aromatherapy on Alzheimer′s disease patients in a nursing home / 中华物理医学与康复杂志

Objective:To explore any effects of combining virtual reality training with aromatherapy in caring for Alzheimer′s disease patients in a nursing home.Methods:Fifty nursing home residents with Alzheimer′s were divided at random into an observation group and a control group, each of 25. Both groups received routine rehabilitation, while the observation group was additionally given 45 minutes of virtual reality training combined with aromatherapy, 3 times a week for 6 months. Both groups′ cognition was then evaluated using the MMSE and an Alzheimer′s cognition assessment scale (ADAS-cog). Psycho-behavioral symptoms were quantified using the Alzheimer′s disease pathological behavior scale (BEHAVE-AD). Motor functioning was quantified using the timed up and go test (TUGT), the 30-second sit-to-stand test (30sCST), the 30-second arm curl test (30sACT) and the sit-and-reach test (CSRT). Ability in the activities of daily living (ADL) and life quality were quantified using the activity of daily living scale and of the quality of life scale for Alzheimer′s disease (QOL-AD) before and after the intervention.Results:After the intervention the average MMSE, ADAS-cog, BEHAVE-AD and ADL scores of both groups had improved significantly, with the average improvement in the observation group significantly greater than that in the control group. The TUGT, 30sCST, 30sACT and CSRT results of both groups were also significantly better, with those of the observation group again significantly superior, on average, to the control group′s results. The average QOL-AD score in the observation was significantly improved after the intervention, and was then significantly better than the control group′s average.Conclusions:Virtual reality training combined with aromatherapy can significantly improve the cognition, psycho-behavioral symptoms, activity in daily living, motor functioning and life quality of Alzheimer′s patients in a nursing home. It is worthy of promotion and application in nursing homes.

Cognitive impairment among older adults living in the community and in nursing home in Indonesia: a pilot study / Comprometimento cognitivo entre idosos que vivem na comunidade e em casa de repouso na indonésia: um estudo piloto

ABSTRACT The demographic phenomenon of population aging has brought some consequences, including a higher prevalence of cognitive impairment. Objective: This study aimed to assess and compare cognitive impairment and its risk factors between older persons living in the community and in nursing home in Indonesia. Methods: A cross-sectional study was employed among 99 older adults living in the community and 49 nursing home residents. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results: Older people living in the community showed a higher score on MMSE than those living in nursing home (p=0.044). Age, marital status, education level, and literacy status were significantly related to the cognitive function of older adults living in the community (p=0.003, p=0.007, p=0.005, p=0.001, respectively), while gender, education level, and literacy status were significantly related to that of nursing home residents (p=0.012, p=0.004, p=0.001, respectively). Conclusions: Older adults living in the nursing home were more likely to experience cognitive decline than their counterparts in the community. Factors associated with cognitive decline differ between community-dwelling older adults and nursing home residents.

RESUMO O fenômeno demográfico do envelhecimento da população trouxe algumas consequências, incluindo uma maior prevalência de comprometimento cognitivo. Objetivo: Este estudo teve como objetivo avaliar e comparar o comprometimento cognitivo e seus fatores de risco entre os idosos que vivem na comunidade e no lar de idosos na Indonésia. Métodos: Um estudo transversal foi empregado entre 99 idosos que vivem na comunidade e 49 residentes de casa de repouso. A função cognitiva foi avaliada usando o Mini-Mental State Examination (MMSE). Resultados: Os idosos que vivem na comunidade mostraram uma pontuação mais alta no MMSE do que aqueles que vivem em casa de repouso (p=0,044). Idade, estado civil, nível de educação e alfabetização estavam significativamente relacionados à função cognitiva de idosos que vivem na comunidade (p=0,003, p=0,007, p=0,005, p=0,001, respectivamente), enquanto gênero, nível educacional e alfabetização estavam significativamente relacionados aos idosos residentes da casa de repouso (p=0,012, p=0,004, p=0,001, respectivamente). Conclusões: Os idosos que vivem na casa de repouso tinham maior probabilidade de experimentar um declínio cognitivo do que seus colegas na comunidade. Os fatores associados ao declínio cognitivo diferem entre os idosos que habitam a comunidade e os residentes da casa de repouso.

ß-lactamasas de espectro extendido y factores de virulencia en Escherichia coli uropatógenas en asilos de ancianos en Lima, Perú / ß-lactamases and virulence factors in uropathogenic Escherichia coli in nursing homes in Lima, Peru

RESUMEN Los asilos de ancianos son instituciones con una alta prevalencia de infecciones del tracto urinario ocasionado por Escherichia coli productoras de ß-lactamasas de espectro extendido (BLEE), con diversos factores de virulencia. El objetivo del estudio fue determinar la frecuencia del gen bla CTX-M y de ocho genes de virulencia en 35 E. coli uropatógenas productoras de BLEE provenientes de seis asilos en Perú, durante el 2018. El 57,1% (20/35) de las E. coli fueron portadores del gen bla CTX-M. Además, se obtuvo una frecuencia del 46% (15/35) y 37% (13/35) de hly-alfa y cnf-1, respectivamente; elevada presencia de los genes iucC (63%, 22/35), aer (94%, 33/35) y chuA (94%, 33/34) y una frecuencia del 46% (16/35) y del 91% (32/34) de los genes pap GII y nanA, respectivamente. Existe predominancia en la distribución del gen bla CTX-M, además de una alta frecuencia de exotoxinas que le confieren una ventaja competitiva para diseminarse hacia el torrente sanguíneo.

ABSTRACT Nursing homes are institutions with high prevalence of urinary tract infections caused by ESBL-producing E. coli with several virulence factors. The aim of this study was to determine the frequency of the bla CTX-M gene and eight virulence genes in 35 ESBL-producing uropathogenic E. coli from six nursing homes in Peru during 2018. Of the E. coli samples, 57.1% (20/35) were carriers of the bla CTX-M gene. Furthermore, we obtained frequencies of 46% (15/35) and 37% (13/35) for hly-alpha and cnf-1, respectively; we also found high presence of the iucC (63%, 22/35), aer (94%, 33/35) and chuA genes (94%, 33/34) as well as a frequency of 46% (16/35) and 91% (32/34) for the pap GII and nanA genes, respectively. The bla CTX-M gene is predominant and a high frequency of exotoxins gives it a competitive advantage for spreading into the bloodstream.

Adaptación y validación chilena de la escala de adaptación de la persona mayor a su residencia / Adaptation and validation of aged adults' adaptation scale to their residence (EAPAR) in Chile

BACKGROUND: The adaptation of older people to nursing homes may be problematic. Scales to assess the degree of adaptation are required. AIM: To adapt and evaluate the psychometric characteristics of the Scale of Adaptation of the Older Adults to their Residence (EAPAR) in the Chilean population. MATERIAL AND METHODS: EAPAR and self-esteem scales were applied to 106 people aged 79 ± 7 years (57% women) living in nursing homes. Reliability was measured using Cronbach's alpha. RESULTS: The instrument was adequately understood by the Chilean participants. In the content validity, the structure of the scale appears homogeneous and with an acceptable statistical significance. CONCLUSIONS: EAPAR is a reliable and valid instrument to be used by health professionals.

Determination of prevalence, characteristics, management and related factors for pain in the older adults: pain among nursing home residents

This study aimed to determine pain assessment approaches and pain management strategies in elderly people in a nursing home.The cross-sectional-descriptive study sample consisted of 147 older adults living in a nursing home in Turkey in 2019. They all agreed to participate in the study (n = 147); however, as our research was about older adultswith pain problems, the study was completed with a total of 108 older adultsexperiencing pain problems. The participants' average age was 73.60 ± 6.97 years. Geriatric pain scale scores were higher for women aged 75 years and over, those who had a chronic disease and those who received analgesics, and there was a statistically significant difference between the mean scores (p < 0.05). Nurses must pay attention to pain assessment and management in nursing homes because of the adverse effects of pain on older adults' health status, vital functions, and well-being.

The incidence and influential factors of hyperuricemia in older adult patients living in sanatorium / 中国基层医药

Objective:To investigate the incidence and influential factors of hyperuricemia in older adult patients who live in the sanatorium and to improve the prevention and treatment of hyperuricemia people.Methods:A total of 800 older adult patients living in Wuyunshan Sanatorium between June 2017 and December 2019 were recruited for this study. The prevalence of hyperuricemia was determined as per the diagnostic criteria of hyperuricemia. These patients were divided into control and hyperuricemia groups according to whether they had hyperuricemia. General data, health status, physical examination, and laboratory indices were compared between the two groups. The influential factors of hyperuricemia were analyzed using the logistic regression analysis method.Results:The incidence of hyperuricemia in older adult patients living in the sanatorium was 18% (144/800). There was significant difference in the prevalence of hyperuricemia between male and female older adults [22.17% (104/469) vs. (12.08%) (40/331), χ2 = 13.38, P < 0.001]. The incidence of hyperuricemia was significantly higher in male older adults aged 60-90 years than in female older adults at the same age brackets [18.50% (59/319) vs. 5.48% (12/219), χ2 = 19.20, P < 0.001]. The overall prevalence of hyperuricemia and the prevalences of hyperuricemia in male and female older adults significantly increased with aging ( Z = 30.47, 11.92, 24.81, P < 0.001). There were significant differences in age, sex, alcohol consumption, urinary protein-positive, exercise, the prevalences of hypertriglyceridemia, hypercholesterolemia, and renal insufficiency between the control and hyperuricemia groups ( χ2/ t = 2.36, 19.41, 41.18, 10.11, 50.42, 8.24, 6.43, 8.59, all P < 0.05). Age, alcohol consumption, hypercholesterolemia and renal insufficiency were independent risk factors of hyperuricemia in older adults living in sanatorium ( OR = 2.07, 2.54, 2.31, 2.76, 95% CI = 1.218-3.541, 1.740-3.729, 1.538-3.468, 1.920-3.974). Exercise was a protective factor of hyperuricemia ( OR = 0.49, 95% CI = 0.356-0.694). Conclusion:Older adults living in sanatorium have a high incidence of hyperuricemia. Prevention and treatment of hyperuricemia should be strengthened in older adults who have a high risk for hyperuricemia to reduce the incidence of hyperuricemia.

Real emotional experience of subjective well-being of elderly people in nursing homes during the COVID-19 pandemic / 中国实用护理杂志

Objective:To describe the real experience of the elderly who has felt happy during the time they stayed at nursing homes, and discuss the meaning which is behind their experience during the COVID-19 pandemic, to provide scientific basis for improving their subjective well-being.Methods:Qualitative explanatory phenomenological analysis methods, and semi-structured in-depth interviews were used to interview 21 elderly people living in Guangzhou Songhe Nursing Home. Data analysis and subject extraction were carried out with reference to the Colaizzi 7-step analysis.Results:The real experience of subjective well-being of the elderly in nursing homes has six themes: be satisfied with the nursing home management service, be satisfied with harmonious interpersonal relationship, be satisfied with good health, be satisfied with family support, grateful and expectations for the social support system, be satisfied with and grateful for the epidemic prevention work during the COVID-19 epidemic.Conclusions:The elderly who live in a nursing home with perfect management and service, care for each other, are healthy, receive family and social support, are grateful, and understand family and social support will be more likely to feel happy. Improving the subjective well-being of the elderly in nursing homes requires the coordination and support of nursing homes, the elderly, families, society and other aspects.

COVID-19 containment management strategies in a nursing home

ABSTRACT Objective: To describe the first COVID-19 pandemic at Casa Ondina Lobo, a philanthropic nursing home in São Paulo city, and the containment measures against the pandemic that proved to be effective. Methods: Several preventive measures were taken before and during the pandemic, with emphasis on universal testing by reverse transcription polymerase chain reaction for COVID-19. All residents and employees were tested twice in a D9 period. Results: Among the 62 residents and 55 employees, in both testing, eight residents and nine employees tested positive for COVID-19. Of 22% of employees and 75% of residents evolved asymptomatic, emphasizing the importance of universal testing for the detection and isolation of these cases. A quarter of residents evolved without any symptoms, however, with COVID-19 signs, reinforcing the importance of monitoring vital signs. The second testing did not detect any new cases among residents, demonstrating the effectiveness of the containment measures, however, it found four new cases among employees. This emphasized their role in COVID-19 outbreaks in nursing homes. Only one patient died, a 12.5% lethality among those known to be infected and a 1.6% mortality in the total population of residents were seen. Conclusion: The adoption of appropriate containment measures enabled to contain an COVID-19 pandemic in studied nursing home. Universal reverse transcription polymerase chain reaction testing for COVID-19 has proved to be particularly important and effective.

Caracterización de la prescripción de ansiolíticos en adultos mayores institucionalizados en un hogar de ancianos / Characterization of the prescription of anxiolytics in institutionalized older adults in the nursing home

El objetivo de este estudio fue caracterizar la prescripción de los medicamentos ansiolíticos utilizados en población de adultos mayores institucionalizados en el hogar de ancianos de Pinar del Río durante el año 2017.Se realizó un estudio descriptivo transversal, con recogida de datos retrospectiva, sobre prescripción de medicamentos ansiolíticos en la población de adultos mayores institucionalizados en el hogar de ancianos, se analizó la forma de utilización de los medicamentos, su indicación y prescripción con elementos de esquema terapéutico y factores que condicionan los hábitos de prescripción. Se trabajó con el universo (U= 98) de estudio el cual estuvo conformado por el total de pacientes institucionalizados, que estaban consumiendo ansiolíticos. Se revisaron las historias clínicas individuales y se confeccionó un modelo de recolección de datos.El medicamento más consumido por los adultos mayores fue el nitrazepam (41,8 %), siendo este a su vez el más consumido por el sexo masculino, no así para el femenino que resultó ser el clorodiazepóxido (64,6 %), el grupo de edad que más predominó fue el de 60-69 años, asimismo los viudos y el nivel educacional primario, el 79,5 % de los ancianos consume otros medicamentos que poseen interacción farmacocinética. El profesional que más indicó fue el médico de familia, la prescripción e intervalos entre dosis fue adecuada, la prescripción se consideró no racional.La prescripción de ansiolíticos en la población objeto de estudio, disminuye a medida que aumenta la edad, los más consumidores son los del sexo masculino y los institucionalizados por abandono familiar, esto apunta a la necesidad de continuar trabajando desde el nivel primario de atención dado que es de donde proceden estos ancianos.

The objective of this study was to characterize the prescription of anxiolytic medications used in the institutionalized elderly population at the Pinar del Río Nursing Home during 2017.A cross-sectional descriptive study was carried out, with retrospective data collection, on the prescription of anxiolytic medications in the population of institutionalized older adults in the Nursing Home, the form of use of the medications, their indication and prescription with elements of the therapeutic scheme was analyzed and factors that condition prescription habits. We worked with the universe (U = 98) of the study, which was made up of the total number of institutionalized patients who were consuming anxiolytics. Individual medical records were reviewed and a data collection model was created.The drug most consumed by older adults was nitrazepam (41.8%), this in turn being the most consumed by males, not so for females, which turned out to be chlorodiazepoxide (64.6%), the group The most prevalent age group was 60-69 years, likewise widowers and primary educational level, 79.5% of the elderly consume other drugs that have pharmacokinetic interaction. The professional who indicated the most was the family doctor, the prescription and intervals between doses were adequate, the prescription was considered non-rational.The prescription of anxiolytics in the population under study decreases as age increases, the most consumers are those of the male sex and those institutionalized due to family abandonment, this points to the need to continue working from the primary level of care since that is where these elders come from.

Prevalence of dementia in long-term care institutions: a meta-analysis / Prevalência de demência em instituições de longa permanência: uma metanálise

ABSTRACT Objective: This study comprises a systematic review and meta-analysis that aimed to estimate the prevalence of dementia in long-term care institutions (LTCIs). Methods: We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Original transversal and longitudinal articles published until July 2020 were eligible in this review. Databases PubMed/MedLine, Web of Science, Scopus and ScienceDirect were searched. Overall prevalence and confidence intervals were estimated. Heterogeneity was calculated according to the index of heterogeneity (I2). Results: One hundred seventy-five studies were found in all databases and 19 studies were meta-analyses, resulting in an overall prevalence of 53% (CI 46-59%; p < 0.01) of demented older adults living in LTCIs. Conclusion: Prevalence of dementia is higher in older adults living in LTCIs than those living in general communities. This data shows a worrying reality that needs to be changed. There is a need for a better understanding of the elements that cause this increase in dementia in LTCFs to direct actions to improve the quality of life and health of institutionalized elderly.

RESUMO Objetivo: Esta revisão sistemática e metanálise objetiva estimar a prevalência de demência em instituições de longa permanência para idosos (ILPIs). Métodos: Utilizou-se o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Artigos originais transversais e longitudinais publicados até julho de 2020 foram elegíveis para esta revisão. As buscas foram conduzidas por meio das bases de dados do PubMed/MedLine, Web of Science, Scopus e Science Direct. A prevalência geral e o intervalo de confiança foram estimados. A heterogeneidade foi calculada de acordo com o índice de heterogeneidade (I2). Resultados: Cento e setenta e cinco estudos foram encontrados em todas as bases de dados e 19 estudos foram analisados, resultando em uma prevalência geral de idosos com demência de 53% (IC 46-59%; p < 0,01) que habitam em ILPIs. Conclusão: A prevalência de demência é maior em idosos moradores de ILPIs que em idosos da população geral. Tal dado mostra uma realidade preocupante e que precisa ser modificada. Há necessidade de melhor entendimento dos elementos que causam esse aumento de demência nas ILPIs para direcionar ações para melhorar a qualidade de vida e a saúde dos idosos institucionalizados.

COVID-19 among nursing home residents: results of an urgent pre-hospital intervention by a multidisciplinary task force

ABSTRACT The current coronavirus disease-2019 (COVID-19) pandemic caused 10,541 deaths among nursing home residents in France, by July 17th, 2020. This study reported the results of an urgent pre-hospital intervention in eight French nursing homes. A retrospective study was conducted from March 26th to May 7th, 2020, before and after the intervention of a task force which took action from April 9th to April 11th, 2020. The task force included nurses and specialists of the county general hospital. The intervention had four steps: i) daily notification of deaths; ii) audit by infectious diseases and hygiene specialists focused on nursing team reinforcing, tracking of suspected cases, patients' cohorting, review of preventive and protective measures, hydration, thromboembolism prevention; iii) intervention of an emergency team which urgently performed procedures suggested; iv) relay with a geriatric team. There were a total of 770 residents distributed in eight facilities with capacity varying from 53 to 145 residents. The number of deaths peaked at 139 in week 2 and the trough at 0 occurred in weeks 6−7. Comparison between periods (before vs after intervention) showed a significant decrease in number of new deaths (83/770; 11% vs 35/687; 5%, p = 0.0001) and new COVID-19 cases (348/770; 45% vs 123/422; 29%, p < 0.001). The urgent pre-hospital intervention by a multidisciplinary task force achieved mortality reduction during COVID-19 outbreak in nursing homes. Pre-hospital intervention is a valid alternative to hospitalization in case of hospital saturation.

El impacto de la Covid-19 en la población mayor dependiente en España con especial referencia al sector residencial / The impact of COVID-19 on the elderly dependent population in Spain with special reference to the residential care sector

Resumen Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.

Abstract The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.

Factors associated with oral health-related quality of life of institutionalized elders

Abstract This study aimed to evaluate the correlation between two Oral Health-Related Quality of Life (OHRQoL) questionnaires (the Oral Health Impact Profile (OHIP-14) and the Geriatric Oral Health Assessment Index (GOHAI)) and to investigate the factors associated with the OHRQoL of institutionalized elderly individuals. A cross-sectional multicenter study was performed with 344 institutionalized elderly individuals residing in two Brazilian cities. Six trained researchers interviewed the elderly individuals. Sociodemographic data were collected from medical records. Dental caries experience and the use of and need for dentures were recorded through oral examination performed by two trained examiners. A Likert scale (1-5 points) was used to assess general health and self-perceived oral health. The number of chewing cycles needed to chew a portion of peanuts was used to assess the swallowing threshold. The OHIP-14 and GOHAI were used to evaluate OHRQoL, and statistically significant correlations were assessed using Spearman's correlation test (p < 0.05). Poisson regression (p < 0.05) was used to investigate the association of OHRQoL with independent variables. Scores on the OHIP-14 (7.57 ± 8.63) and GOHAI (32.46 ± 3.85) were strongly and inversely correlated (r2 = -0.671, p < 0.001), although these measures were associated with different factors. A higher OHIP-14 total score (worse OHRQoL) was associated with female gender, a greater number of healthy teeth, worse self-perceived general health and oral health, and a lower swallowing threshold (p < 0.05). A higher GOHAI total score (better OHRQoL) was associated with a greater number of filled teeth, better self-perceived oral health and a greater swallowing threshold (p < 0.05). In conclusion, worse OHRQoL among institutionalized elderly individuals is associated with worse self-perceived oral health and a greater swallowing threshold.

Investigation and analysis of oral health status of the elderly in nursing homes in Taiyuan / 华西口腔医学杂志

OBJECTIVES@#This study aims to investigate awareness of oral health care and health status among elderly people in nursing homes in Taiyuan. Strategies for preventing and treating oral diseases and improving the quality of life of the elderly in nursing homes were formulated on the basis of analyzed data.@*METHODS@#A total of 359 participants from 48 nursing homes in six districts were selected randomly. Awareness, attitude, and behavior with regard to oral health care among the elderly were investigated through a survey using questionnaires and oral health examinations. Data were statistically analyzed with SPSS 20.0.@*RESULTS@#Among the elderly in the nursing homes in Taiyuan, awareness and behavior with regard to oral health care were deficient and inappropriate, and thus professional guidance was needed. In addition to method and time of brushing teeth and bad oral habits, the oral health status of the elderly was statistically affected by age and education. Compared with the data of the Fourth National Oral Epidemiological Investigation, the number of elderly people aged 55-64 or 65-74 years who brush their teeth every day and accept oral diagnosis and treatment was lower. However, the ratios of edentulous and missing teeth without treatment were higher than the national average level for the same age groups.@*CONCLUSIONS@#The awareness and attitude of the elderly in nursing homes with regard to oral health care are unsatisfactory, and their oral health status is poor. Education on oral health care, development of good oral care habits, and regular oral health examination are essential to the maintenance of oral health in elderly people.

The current status and its influencing factors of sedentary behavior of the elderly in nursing homes in Taiyuan / 中国实用护理杂志

Objective:To investigate the sedentary behavior of the elderly in Taiyuan nursing homes and analyze its influencing factors, so as to provide theoretical basis for the construction of targeted intervention programs for sedentary behavior.Methods:A total of 215 elderly people in 6 nursing homes in Taiyuan from October 2019 to January 2020 were investigated by general data questionnaire and sedentary behavior questionnaire. Descriptive analysis, single factor analysis and multiple linear stepwise regression analysis were used to explore the influencing factors of sedentary behavior.Results:The sedentary time of the elderly in Taiyuan nursing homes was (8.85±2.81) h/d, and 83% (174/209) of the elderly had a sedentary time≥6 h/d. Gender, age, type of disease, type of residence, sedentary hobby and environmental safety in homes were the important factors influencing sedentary behavior of the elderly in nursing homes( P<0.05). Conclusions:The sedentary behavior of the elderly in nursing homes is not optimistic. Targeted intervention measures should be taken to improve the sedentary behavior of the elderly and promote the healthy aging of the elderly in nursing homes.

Methodological description of the mapping of Brazilian long-term care facilities for older adults / Descrição metodológica do mapeamento das instituições de longa permanência para idosos no Brasil

OBJECTIVE: To describe the methodological approach adopted to build a database of long-term care facilities (LCTFs) in Brazil. METHODS: This exploratory research was conducted for 12 months, between August 2020 and July 2021, based on primarily publicly accessible data. First, the Unified Social Assistance System (Sistema Único de Assistência Social [SUAS]) database from 2019 was adopted as the primary source of information. In addition, public agencies and managers were consulted and invited to share their databases, while researchers and private entities collaborated by making their spreadsheets available. Data were organized in spreadsheets for each Brazilian state. LTCFs not catering to older adults (aged 60 years and over) were excluded. Duplicate data were excluded when overlaps were identified. RESULTS: This brief communication describes the methodology adopted for mapping the current status of Brazilian LTCFs. Despite its caveats, this study represents an important advance in the identification, characterization, and monitoring of these services nationwide. A total of 5769 facilities were found in the 2019 SUAS census. After excluding facilities not caring for residents aged 60 years or over, this number decreased to 2381 LTCFs. The consolidation and filtering of information from multiple data sources led to the identification of 7029 LTCFs throughout the country. CONCLUSION: Building a solid database was paramount to devising a national policy on long-term care. By including multiple sources, the scope of this survey was wider than all previous efforts and constituted an unprecedented collaborative experience in the country, including the potential to become the first national dataset for the Brazilian LTC secto

OBJETIVO: Descrever a abordagem metodológica adotada para a construção de um banco de dados brasileiro de instituições de longa permanência (ILPIs) no país. METODOLOGIA: Esta pesquisa exploratória foi realizada durante 12 meses, entre agosto de 2020 ­ 2021, com base principalmente em dados acessíveis ao público. Em primeiro lugar, o banco de dados do Sistema Único de Assistência Social para 2019 foi adotado como principal fonte de informação. Além disso, órgãos públicos e gestores foram consultados e convidados a compartilhar seus bancos de dados. Da mesma forma, pesquisadores e entidades privadas colaboraram disponibilizando suas planilhas. Os dados foram colocados em planilhas para cada estado brasileiro. Excluíram-se as ILPIs que não atendiam a idosos (60 anos ou mais). Dados duplicados foram excluídos quando as sobreposições foram identificadas. RESULTADOS: Esta comunicação breve descreve a metodologia adotada para mapear a situação atual das ILPIs brasileiras. Apesar de suas ressalvas, este estudo representa um importante avanço na identificação, caracterização e monitoramento desses serviços em âmbito nacional. Um total de 5769 instalações foram encontradas no censo do SUAS de 2019. Após a exclusão dos estabelecimentos que não atendiam residentes idosos, esse total passou para 2381. A consolidação e filtragem das informações de múltiplas fontes de dados levaram à identificação de 7029 ILPIs para o país como um todo. CONCLUSÃO: A construção de um banco de dados sólido é fundamental para a formulação de uma Política Nacional de Cuidados de Longa Duração. Por incluir fontes múltiplas, o escopo desta pesquisa é muito maior do que todos os esforços anteriores e constitui uma experiência colaborativa sem precedentes no país, incluindo o potencial de se tornar o primeiro conjunto de dados nacional para o setor.

Mecanismos de enfrentamento e qualidade de vida entre idosos com hipertensão: um estudo transversal / Estrategias de afrontamiento y calidad de vida en adultos mayores con hipertensión: un estudio transversal / Coping strategies and quality of life among older people with hypertension: a cross-sectional study

RESUMO Objetivo analisar as diferenças nos mecanismos de enfrentamento e na qualidade de vida entre idosos com hipertensão em casas de repouso da Indonésia. Método foi realizado um estudo transversal entre 71 idosos durante dezembro de 2018 em casas de repouso. Foi utilizado um questionário autoadministrado foi para identificar as características dos participantes e a qualidade de vida dos idosos, ao mesmo tempo em que o esfigmomanômetro foi usado para medir a pressão arterial. A análise de dados foi feita com teste qui-quadrado. Resultados houve diferenças significativas entre os mecanismos de enfrentamento e a qualidade de vida dos idosos com hipertensão (X2=4,15; p=0,041). Os idosos que usavam mecanismos de enfrentamento focando nos problemas eram mais propensos a ter uma qualidade de vida moderada (OR=2,86; 95% IC=1,02-7,97). Conclusão os mecanismos de enfrentamento de idosos com hipertensão devem ser aprimorados para que alcancem qualidade de vida por meio de cuidado e aconselhamento.

RESUMEN Objetivo analizar las diferencias entre estrategias de afrontamiento y calidad de vida en adultos mayores con hipertensión que viven en asilos de Indonesia. Método se llevó a cabo un estudio transversal con 71 individuos de edad avanzada que viven en asilos durante el mes de diciembre de 2018. Se utilizó un cuestionario autoadministrado para identificar características de los participantes y de la calidad de vida en adultos mayores; mientras que, para medir la presión arterial, se empleó un esfigmomanómetro. Se realizó una prueba de chi-cuadrado para analizar los datos. Resultados se registraron diferencias significativas entre las estrategias de afrontamiento y la calidad de vida de adultos mayores con hipertensión (X2=4,15; p=0,041). Los adultos mayores que emplearon estrategias de afrontamiento enfocándose en problemas fueron más propensos a tener una calidad de vida moderada (OR=2,86; IC 95%=1,02-7,97). Conclusión en consecuencia, deberían mejorarse las estrategias de afrontamiento de los adultos mayores con hipertensión para que logren una buena calidad de vida a través de atención y asesoramiento en salud.

ABSTRACT Objective to analyze the differences of coping strategies and quality of life among older people with hypertension in nursing homes of Indonesia. Method a cross-sectional study was conducted among 71 older people during December 2018 in nursing homes. A self-administered questionnaire was used to identify characteristic of participants and quality of life for older people, while Sphygmomanometer was used to measure blood pressure. A Chi-quare test was performed to analyse the data. Results there were significant differences between coping strategies and quality of life of older people with hypertension (χ2=4.15; p=0.041). Older people who used coping strategies by focusing on problems have more likely moderate quality of life (OR=2.86; 95% CI=1.02-7.97). Conclusion therefore, coping strategies of older people with hypertension should be improved to achieve their quality of life through caring and counselling.