Carga de trabalho de enfermagem e requisição das atividades no cuidado de pessoas idosas em terapia intensiva / Nursing Workload and care required by older adults in intensive care

Resumo Objetivo Analisar a carga de trabalho e requisição de cuidados de enfermagem de pessoas idosas admitidas na unidade de terapia intensiva (UTI) em comparação com adultos. Método estudo transversal realizado em duas UTI de dois hospitais (público e privado) na região metropolitana de São Paulo. Foram extraídas do prontuário eletrônico de pacientes admitidos nas unidades no ano de 2019 as seguintes variáveis: idade, sexo, tempo de internação em UTI, escore Simplified Acute Physiology Score (SAPS 3) e do Nursing Activities Score (NAS). Os dados foram analisados por meio de estatística descritiva. A comparação de médias foi feita pelo teste T de Student e a associação entre as frequências das intervenções requeridas pelos participantes através do teste exato de Fischer. Resultados Foram incluídos no estudo 495 pacientes, dos quais 56,6% eram pessoas idosas com idade média de 74,9± 9,5 anos. O tempo de permanência das pessoas idosas na UTI foi de 6,0±7,7 dias. Verificou-se que a pontuação média do SAPS3 admissional foi de 48,3±13,7 pontos e a pontuação do NAS, também admissional, foi de 71,0±10,4 pontos, sendo maior entre pessoas idosas do que entre os adultos, tanto para a gravidade (p<0,001) quanto para a carga de trabalho (p=0,007). Conclusão a idade avançada está associada com uma maior carga de trabalho da enfermagem em unidade de cuidados intensivos e maior chance de ocorrência de intervenções, associada à maior gravidade na admissão e maior tempo de internação na UTI por essa população em comparação aos adultos.

Abstract Objective To analyze the workload and nursing care requirements of elderly people admitted to the intensive care unit (ICU) compared to adults. Method Cross-sectional study carried out in two ICUs of two hospitals (public and private) in the metropolitan region of São Paulo. The following variables were extracted from the electronic medical records of patients admitted to the units in 2019: age, gender, length of ICU stay, Simplified Acute Physiology Score (SAPS 3) and Nursing Activities Score (NAS). The data was analyzed using descriptive statistics. Means were compared using Student's t-test and the association between the frequencies of interventions required by the participants using Fischer's exact test. Results The study included 495 patients, 56.6% of whom were elderly with a mean age of 74.9± 9.5 years. The length of stay of the elderly in the ICU was 6.0±7.7 days. It was found that the average SAPS3 score on admission was 48.3±13.7 points and the NAS score, also on admission, was 71.0±10.4 points, being higher among older people than adults, both for severity (p<0.001) and workload (p=0.007). Conclusion Older age is associated with a greater workload for intensive care unit nurses and a greater chance of interventions, associated with greater severity on admission and longer ICU stays for this population compared to adults.

Influencing factors and intervention of activity limitation and disability in hospitalized older adults / 中华老年医学杂志

Hospitalization is associated with disability.The physical activity of the elderly during hospitalization is significantly lower than that during non-hospitalization.Low-level physical activity not only affects the rehabilitation of the disease during hospitalization, forming hospital-related disability, but also increases the readmission rate and long-term care needs, seriously affecting older adults' quality of life.This article reviews the influencing factors and intervention measures of physical activity in hospitalized elderly patients, aiming to provide a reference for clinical practice.

Concordância entre instrumentos de triagem nutricional em idosos hospitalizados / Agreement between nutritional screening instruments in hospitalized older patients

ABSTRACT Background The prevalence of hospitalized elderly patients has grown substantially and has impacted the hospital health services. Thus, it is believed that an investigation of the nutritional status associated with different clinical situations in elderly patients could contribute to multidisciplinary hospital intervention and nutritional care actions suitable for this population. Objective To investigate the relationship between two nutritional screening instruments in hospitalized older patients and to compare clinical variables between these two instruments. Methods Retrospective study with hospitalized older patients (n=277), investigating the agreement between two nutritional screening instruments. The data were analyzed using the McNemar, chi-square, Fisher, Mann-Whitney tests and the kappa coefficient for the agreement assessment. Results There was a significant difference (P=0.0002) between the nutritional risk classifications of the two nutritional screening instruments and moderate agreement (k=0.5430) between them. The association between nutritional risk screening and age (P=0.0255), length of hospital stay (P<0.0001), gender (P=0.0365) and illness (P=0.0001) were assessed. There was an association between Mini Nutritional Assessment and length of stay (P<0.0001), illness (P=0.0001) and body weight evolution (P=0.0479). Conclusion The nutritional risk screening and Mini Nutritional Assessment showed moderate agreement in the assessment of elderly patients.

RESUMO Contexto A prevalência de pacientes idosos hospitalizados tem crescido substancialmente e impactado os serviços de saúde hospitalar. Desta forma, acredita-se que uma investigação do estado nutricional, associado a situações clínicas variadas em pacientes idosos, poderia contribuir para ações de intervenção hospitalar multidisciplinares e de cuidado nutricional adequadas para esta população. Objetivo Investigar a relação entre dois instrumentos de triagem nutricional em pacientes idosos hospitalizados e comparar variáveis clínicas entre estes dois instrumentos. Métodos Estudo retrospectivo com pacientes idosos hospitalizados (n=277), sendo investigado a concordância entre dois instrumentos de triagem nutricional. Os dados foram analisados pelos testes McNemar, qui-quadrado, Fisher, Mann-Whitney e o coeficiente kappa para a avaliação de concordância. Resultados Houve diferença significativa (P=0,0002) entre as classificações de risco nutricional pelos dois instrumentos de triagem nutricional e concordância moderada (k=0,5430) entre eles. Verificou-se associação entre triagem de risco nutricional e idade (P=0,0255), tempo de internação (P<,0001), sexo (P=0,0365) e doenças (P=0,0001). Houve associação entre a Mini Avaliação Nutricional e tempo de internação (P<0,0001), doenças (P=0,0001) e evolução do peso corporal (P=0,0479). Conclusão Triagem de risco nutricional e a Mini Avaliação Nutricional apresentam concordância moderada para a avaliação de pacientes idosos.

Polimedicación, prescripción inapropiada y eventos adversos a fármacos en ancianos hospitalizados: un problema de seguridad del paciente / Polymedication, inappropriate prescription and adverse events to drugs in hospitalized elderly: a patient safety problem / Polimedicação, prescrição inadequada e eventos adversos a medicamentos em idosos hospitalizados: um problema para a segurança do paciente

RESUMEN Introducción: La esperanza de vida ha ido en aumento y la posibilidad de padecer una o más patologías crónicas, por ejemplo, diabetes mellitus, hipertensión arterial, etc. es alta. La respuesta a los medicamentos en los adultos mayores es marcadamente diferente que en los adultos no ancianos pues se trata de un organismo donde las consecuencias directas del envejecimiento son de relevancia (reducción de la capacidad metabólica del hígado, reducción de la capacidad de filtrado del riñón, hipoclorhidria, entre otros). Objetivo: Analizar la polifarmacia, la prescripción inapropiada y los eventos adversos en adultos mayores hospitalizados. Materiales y métodos: Estudio descriptivo de corte transversal. Resultados: Se estudiaron 318 pacientes. La frecuencia de pacientes polimedicados fue 89 % (283). La prescripción inapropiada, 18,9 %. Los fármacos mayormente presentes en los esquemas de pacientes polimedicados fueron benzodiacepinas, AINEs, anticoagulantes y antihipertensivos. Los pacientes con eventos adversos han sido 179 (56,3 %), de ese porcentaje un 30,2 % (54) ha recibido tratamiento con otro medicamento para resolver el evento producido por un medicamento, eso es la llamada cascada de prescripción o de medicamentos. Conclusiones: La polimedicación es alta y causa eventos adversos, es necesario insistir en el trabajo integral para reducir este problema sanitario.

SUMMARY Introduction: Life expectancy has been increasing and the possibility of suffering from one or more chronic pathologies, for example, diabetes mellitus, arterial hypertension, etc. is high. The response to medications in older adults is markedly different than in non-elderly adults since it is an organism where the direct consequences of aging are relevant (reduction of the metabolic capacity of the liver, reduction of the filtering capacity of the kidney, hypochlorhydria, among others). Objective: To analyze polypharmacy, inappropriate prescription, and adverse events in hospitalized older adults. Materials and methods: Descriptive cross-sectional study. Results: 318 patients were studied. The frequency of polymedicated patients was 89 % (283). Inappropriate prescription, 18.9 %. The drugs most present in the regimens of polymedicated patients were benzodiazepines, NSAIDs, anticoagulants and antihypertensives. Patients with adverse events have been 179 (56.3 %), of that percentage 30.2 % (54) have received treatment with another drug to resolve the event produced by a drug, which is the so-called prescription or prescription cascade. Conclusions: Polypharmacy is high and causes adverse events, it is necessary to insist on comprehensive work to reduce this health problem.

RESUMO Introdução: A expectativa de vida vem aumentando e a possibilidade de sofrer de uma ou mais patologias crónicas, como por exemplo, diabetes mellitus, hipertensão arterial etc. é alta. A resposta aos medicamentos em idosos é marcadamente diferente da de adultos não idosos, pois é um organismo onde as consequências diretas do envelhecimento são relevantes (redução da capacidade metabólica do fígado, redução da capacidade de filtragem do rim, hipocloridria, entre outros). Objetivo: Analisar polifarmácia, prescrição inadequada e eventos adversos em idosos hospitalizados. Materiais e métodos: Estudo transversal descritivo. Resultados: 318 pacientes foram estudados. A frequência de pacientes polimedicados foi de 89% (283). Prescrição inadequada, 18,9%. Os medicamentos mais presentes nos esquemas dos pacientes polimedicados foram benzodiazepínicos, AINEs, anticoagulantes e anti--hipertensivos. Os pacientes com eventos adversos foram 179 (56,3%), desse percentual 30,2% (54) receberam tratamento com outro medicamento para resolução do evento produzido por um medicamento, que é a chamada prescrição ou receita em cascata. Conclusões: A polifarmácia é elevada e causa eventos adversos, é necessário insistir em um trabalho abrangente para reduzir esse problema de saúde.

Fatores Precipitantes de Delirium em Pacientes Idosos Hospitalizados / Precipitating Factors of Delirium in Elderly Hospitalized / Patients Factores precipitantes del delirio en pacientes ancianos hospitalizados

Objetivo: Caracterizar os fatores precipitantes e modificáveis de delirium em idosos internados acompanhados pela equipe móvel de Geriatria e Gerontologia. Método: estudo transversal, descritivo, exploratório e prospectivo realizado em um hospital de alta complexidade de São Paulo, com idosos hospitalizados. Os dados foram analisados por estatística descritiva. Resultados: foram avaliados 12 idosos, sendo 91,7% do sexo feminino, internados predominantemente em enfermarias cirúrgicas 83,3%. Os fatores precipitantes observados foram os ambientais presentes em 100% dos sujeitos do estudo, sendo possível realizar alguma intervenção em 83,3% dos casos, seguida pela categoria das doenças intercorrentes onde 45,4% dos casos foram passíveis de intervenção. Conclusão: no presente estudo, ao caracterizar os fatores precipitantes e modificáveis de delirium em idosos hospitalizados, espera-se evidenciar a possibilidade da implementação de prevenção e tratamento do quadro apontado, visando despertar os profissionais que atuam na prestação dos cuidados para a relevância do problema

ObjectiveTo characterize the precipitating and modifiable factors of delirium in hospitalized elderly accompanied by the mobile team of Geriatrics and Gerontology. Method: crosssectional, descriptive, exploratory and prospective study conducted in a highly complex hospital in São Paulo, with hospitalized elderly. The data were analyzed using descriptive statistics. Results: 12 elderly people were assessed, 91.7% of whom were female, predominantly hospitalized in surgical wards 83.3%. The precipitating factors observed were the environmental factors present in 100% of the study subjects, and it is possible to perform some intervention in 83.3% of the cases, followed by the category of intercurrent diseases where 45.4% of the cases were subject to intervention. Conclusion: in the present study, by characterizing the precipitating and modifiable factors of delirium in hospitalized elderly people, it is expected to highlight the possibility of implementing prevention and treatment of the mentioned condition, aiming to awaken the professionals who work in the provision of care for the relevance of the problem

Objetivo: Caracterizar los factores desencadenantes y modificables del delirio en ancianos hospitalizados acompañados del equipo móvil de Geriatría y Gerontología. Método: estudio transversal, descriptivo, exploratorio y prospectivo realizado en un hospital de alta complejidad en São Paulo, con ancianos hospitalizados. Los datos se analizaron mediante estadística descriptiva. Resultados: se evaluaron 12 ancianos, 91,7% de sexo femenino, predominantemente hospitalizados en quirófano 83,3%. Los factores precipitantes observados fueron los factores ambientales presentes en el 100% de los sujetos de estudio, siendo posible realizar alguna intervención en el 83,3% de los casos, seguido de la categoría de enfermedades intercurrentes donde el 45,4% de los casos fueron sometidos a intervención. Conclusión: en el presente estudio, al caracterizar los factores precipitantes y modificables del delirio en ancianos hospitalizados, se espera resaltar la posibilidad de implementar la prevención y el tratamiento de la condición mencionada, con el objetivo de despertar a los profesionales que laboran en la prestación de cuidados para la relevancia del problema.

Intervenções de enfermagem prescritas para idosos hospitalizados segundo grau de dependência para as Atividades Básicas de Vida Diária / Nursing Interventions prescribed for hospitalized elderlies according to the level of dependence in activities of daily living

Objetivando identificar as intervenções de enfermagem mais prescritas para idosos hospitalizados, de acordo com seu nível de dependência para as Atividades Básicas de Vida Diária (ABVDs), foram analisados 51 idosos admitidos em uma enfermaria geriátrica de um hospital de grande porte da cidade de São Paulo, após consentimento informado. Observou-se que 51% dos indivíduos apresentava dependência grave, e as intervenções significativamente mais prescritas estavam relacionadas com a mobilidade, banho e segurança do paciente.

In order to identify the nursing interventions most prescribed for hospitalized elderly, according to their level of dependence for Activity of Daily Living (ADL), we analyzed 51 elderlies admitted to a geriatric ward belonging to a large hospital in São Paulo, after informed consent. It was observed that 51% of subjects had severe dependence and the most significantly prescribed interventions were related to mobility, bathing and safety of the patient.

The Importance-Satisfaction Study of Hospital Foodservice Encounters at the Elderly Health-Care Facilities

Institutional care is often necessary for the health and well-being of the elderly. Good quality foodservice provided at long-term care facilities not only includes patients satisfaction but also cares for good health, contributing to the stability of foodservice management. The purpose of this study was to assess the importance and satisfaction attributes of foodservice management by hospitalized elderly patients. The data were collected via questionnaire by a one-to-one interview with 194 hospitalized elderly patients in six different hospitals. According to the results of dependent t-tests, overall mean scores for the importance attributes (3.96) and satisfactory attributes (3.83) were significantly different (p<0.001). As indicated by the patients, the recognized importance attributes were the kindness of foodservice personnel (4.19), kind smiles by foodservice personnel (4.16), and kind speaking by foodservice personnel (4.12). The most recognized satisfaction attributes were kindness of foodservice personnel (4.36), bedside meal service by foodservice personnel (4.25), kind speaking by foodservice personnel (4.24), kind smiles by foodservice personnel (4.24), and sanitary uniforms worn by foodservice personnel (4.21). These results suggest that the above encounter attributes (importance-satisfaction) would be useful tools for hospital foodservices to adopt, in order to control foodservice quality and satisfy the nutritional needs of elderly patients.

O significado do cuidar/cuidado paliativo de idosos hospitalizados: história oral de enfermeiras / The meaning of palliative care on hospitalized elderly: nurses oral history

Este estudo tem como objetivo compreender o significado atribuído pelas enfermeiras ao cuidar/cuidado paliativo de idosos hospitalizados, tendo como eixo referencial a antropologia cultural e a história oral temática. Trata-se de uma pesquisa de natureza exploratóriodescritiva com abordagem qualitativa na análise de seus dados, tendo como campo de investigação um Centro Geriátrico de referência do Ministério de Saúde para o atendimento de idosos de uma Instituição Hospitalar filantrópica da Cidade do Salvador - Bahia. Os depoimentos dos sujeitos, dez enfermeiras, foram obtidos através de entrevistas semiestruturadas, gravadas. Dos depoimentos das colaboradoras emergiram cinco temas: O primeiro, significado do cuidado paliativo para as enfermeiras, foi interpretado como cuidado de conforto, cuidado para boa morte, trazendo uma abordagem psicobiológica da assistência, envolvendo uma equipe multidisciplinar. O segundo, participação da família dos idosos nos cuidados paliativos, revelou que a maioria dos sujeitos envolvem os familiares na assistência e os preparam progressivamente para lidar com a morte do familiar idoso. Quanto aos próprios idosos, a maioria das entrevistadas crê que estes não precisam ser informados da sua condição de paciente terminal. As entrevistadas revelaram também que os familiares não devem participar de todos os cuidados, avaliam que determinados procedimentos realizados pelos familiares podem levar a complicação do quadro clínico. Sobre esse tema, os idosos nem foram contemplados nos seus discursos. No terceiro tema, os sujeitos deixaram evidente que o domicílio é o melhor local para os idosos em condições terminais passarem o final de suas vidas, entretanto, diante da realidade do abandono dos pacientes pelos familiares, o hospital foi considerado o local mais adequado. A quarta categoria, sentimentos que emergem durante o cuidado, evidenciou que os sentimentos de angústia, negação, frustração, aprendizado e conforto surgem durante a prestação dos cuidados paliativos dos pacientes idosos, sendo a morte encarada de acordo com os aspectos da religiosidade e cultura. O quinto e último tema, dilemas éticos e bioéticos dos cuidados paliativos, aborda e discute situações de prolongamento artificial da vida, alimentação do idoso sem possibilidade de cura, negligência de informações e o princípio do duplo efeito na prática das entrevistadas. Os resultados desta pesquisa demonstram que, apesar dos avanços tecnológicos e científicos, os profissionais ainda estão em busca do conhecimento e aperfeiçoamento necessário para cuidar de idosos em condições terminais, sendo necessário a prática da abordagem holística na assistência do indivíduo, contemplando a família nesse contexto, no intuito de proporcionar aos idosos um cuidado com dignidade enquanto existir vida e no processo de morte.(AU)

Risk factors of pressure uIcers in hospitalized elderly.

This study is a hospital based concurrent cohort study with the objectives of investigating the risk factors and the predictive level of the risk factors of pressure ulcers in hospitalized elderly The study was conducted between January 9th and March 12th 2002, in the medical, surgical, and orthopedic wards of Pranangklao Hospital, a 430-bed tertiary hospitsl under the Ministry of Public Health in Nonthaburi Province. The participants in this study were 117 hospitalized elderly patients who were 60 years or older, did not have pressure ulcers on admission, and were hospitalized for at least four days. Data were collected by the researcher and the research assistant who achieved an inter-rater reliability for pressure ulcer risk assessment and skin assessment on the research instrument of 0.905 and 0.954 resprctively. Pressure ulcer risk assessment and skin assessment were conducted daily by utilizing the Braden pressure ulcer risk assessment scale and the Bergstrom’s skin assessment scale throughout the study period. Logistic regres- sion analysis was employrd to analyze the data. The results of the study revealed the greatest frequency of pressure ulcers was found in those aged 70 to 79 years old (41%) and had neurological or spinal problems (30.8%). The assessment of elderly patients’ risk of pressure ulcers on admission correctly predicted 71.8% of pressure ulces. Of the elderly patients who were predicted to have pressure ulcers, 28.2% developed this complication during the hospitalization period. Most pressure ulcers occurred on the second day after admission. Of the elderly who were predicted not to develop this complication, 93.6% were free from pressure ulcers. An increase in friction and shearing (OR=4.592, 95% CI=1.531-13.770) was the risk factor that had the most influence among the participants, where the second most important risk factor was an increase in core temperature (OR=2.760, 95%CI=1.105-6.891). This study indicates the need for pressure ulcer risk assessment at the time of admission and a need for a pressure ulcer education program for the elderly or their caregivers and for all health care providers. In addition, this study also reveals the need for proper management of these elderly patients who are prone to develop pressure ulcers at the time of admission, especially among those who have increases in friction and shear-ing forces and an increase in core temperature.

Elderly Sleep Pattern and Disturbing Factors Before and After Hospitalization / 간호학회지

Sleep is a necessity for survival, Disruption of sleep leads to numerous adverse physiological and psychological consequences. These could be particularly undesirable for older patients, who are subject to many additional factors. But there is limited research related to hospitalized elderly in Korea. The purpose of the study is to explore sleep patterns and disturbing factors of before and after hospitalization, in order to present basic information regarding elderly sleep to develop nursing intervention. The sample consisted of 32 elderly men and women between the ages of 60 and 87 years. Data collection was done from September to November 1997. Measures of sleep patterns and related factors were obtained from self-reported sleep questionnaires. Analysis of data was done by use of t-test, paired t-test, ANOVA, and Pearson Correlation Coefficient. The results of this study were summarized as follows : 1. In comparison between before and after admission of their sleep pattern, "sleep onset" tends to be delayed and nocturnal sleep time was significantly reduced. So, hospitalized elderly reported less total sleep time than before admission. 2. Regarding the sleep disturbing factors, medication(hypnotics : 37.5%), physiological factor(snoring : 59.4%) environmental factor(pillow : 78.1%), emotional factor(anxiety related to disease : 37.5%), and illness factor(fatigue : 34.7%) were reported. 3. Significant differences in gender were found. Men had more disturbances in sleep than women owing to difficulty in falling a sleep and lack of nocturnal sleep. Women consumed more sleep inducing drugs. Significant increase was reported in napping during the day with increasing age. 4. Significant differences between good sleepers and poor sleepers were found for the following variables : nocturnal sleep time, total sleep time, bed time, sleep onset latency time, sleep latency time after nocturnal awakening, time spent in bed upon arousal, environmental factors, and emotional factors. In conclusion, it was found that the quantity and quality of sleep were significantly altered in hospitalized elderly, but adequate strategies for better sleep were not practiced. Further research is needed to develop intervention strategies to promote sleep and to prevent sleep problems.

Elderly Sleep Pattern and Disturbing Factors Before and After Hospitalization / 간호학회지

Sleep is a necessity for survival, Disruption of sleep leads to numerous adverse physiological and psychological consequences. These could be particularly undesirable for older patients, who are subject to many additional factors. But there is limited research related to hospitalized elderly in Korea. The purpose of the study is to explore sleep patterns and disturbing factors of before and after hospitalization, in order to present basic information regarding elderly sleep to develop nursing intervention. The sample consisted of 32 elderly men and women between the ages of 60 and 87 years. Data collection was done from September to November 1997. Measures of sleep patterns and related factors were obtained from self-reported sleep questionnaires. Analysis of data was done by use of t-test, paired t-test, ANOVA, and Pearson Correlation Coefficient. The results of this study were summarized as follows : 1. In comparison between before and after admission of their sleep pattern, "sleep onset" tends to be delayed and nocturnal sleep time was significantly reduced. So, hospitalized elderly reported less total sleep time than before admission. 2. Regarding the sleep disturbing factors, medication(hypnotics : 37.5%), physiological factor(snoring : 59.4%) environmental factor(pillow : 78.1%), emotional factor(anxiety related to disease : 37.5%), and illness factor(fatigue : 34.7%) were reported. 3. Significant differences in gender were found. Men had more disturbances in sleep than women owing to difficulty in falling a sleep and lack of nocturnal sleep. Women consumed more sleep inducing drugs. Significant increase was reported in napping during the day with increasing age. 4. Significant differences between good sleepers and poor sleepers were found for the following variables : nocturnal sleep time, total sleep time, bed time, sleep onset latency time, sleep latency time after nocturnal awakening, time spent in bed upon arousal, environmental factors, and emotional factors. In conclusion, it was found that the quantity and quality of sleep were significantly altered in hospitalized elderly, but adequate strategies for better sleep were not practiced. Further research is needed to develop intervention strategies to promote sleep and to prevent sleep problems.