Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures.

Using individual-level administrative data, we investigate the spatial patterns of unexplained shares of health care expenditures (HCE) at the municipality level. The focus is on the elderly population in the Italian Region Friuli-Venezia Giulia observed over the period 2017-2019. The empirical analysis comprises two steps. First, random-effects two-part models are estimated to analyze the effect of age, morbidity, and death on the probability and amount of positive individual total HCE and its components. Second, the unexplained shares of HCE at the municipality level are examined to identify areas with under- or over-spending and substitution among services. Results confirm the existing findings on the determinants of HCE and reveal geographic patterns in the unexplained shares of expenditures. We identify clusters of municipalities with observed HCE higher than predicted for each type of service and clusters with substitution between home care and all other services. These findings are associated with the degree of urbanization of these areas and, consequently, with the ease of access to health care. This is crucial from a policy perspective, as it indicates specific policy targets for public health intervention.

Energy-Aware IoT-Based Method for a Hybrid On-Wrist Fall Detection System Using a Supervised Dictionary Learning Technique.

In recent decades, falls have posed multiple critical health issues, especially for the older population, with their emerging growth. Recent research has shown that a wrist-based fall detection system offers an accessory-like comfortable solution for Internet of Things (IoT)-based monitoring. Nevertheless, an autonomous device for anywhere-anytime may present an energy consumption concern. Hence, this paper proposes a novel energy-aware IoT-based architecture for Message Queuing Telemetry Transport (MQTT)-based gateway-less monitoring for wearable fall detection. Accordingly, a hybrid double prediction technique based on Supervised Dictionary Learning was implemented to reinforce the detection efficiency of our previous works. A controlled dataset was collected for training (offline), while a real set of measurements of the proposed system was used for validation (online). It achieved a noteworthy offline and online detection performance of 99.8% and 91%, respectively, overpassing most of the related works using only an accelerometer. In the worst case, the system showed a battery consumption optimization by a minimum of 27.32 working hours, significantly higher than other research prototypes. The approach presented here proves to be promising for real applications, which require a reliable and long-term anywhere-anytime solution.

Vulnerabilidade clínico funcional de idosos usuários da atenção primária à saúde: estudo transversal / Clinical-Functional Vulnerability of Elderly Users of Primary Healthcare: Cross-sectional Study

Identificar condições de saúde e de vida relacionadas com a perda de funcionalidade da pessoa idosa contribui na construção de políticas públicas e intervenções que as auxilie a viverem com mais autonomia e independência. Na realidade da Atenção Primária à Saúde (APS), a identificação de idosos frágeis ou em risco de fragilização necessita ser simples e rápida. O propósito deste estudo foi identificar a vulnerabilidade clínico-funcional de idosos usuários da APS. Tratou-se de um estudo quantitativo e transversal, realizado por meio da aplicação do questionário Índice de Vulnerabilidade Clínico Funcional - 20 (IVCF-20), que avalia oito domínios preditoras de declínio funcional e óbito em idosos: idade, autopercepção da saúde, atividade de vida diária (AVD), cognição, humor/comportamento, mobilidade, comunicação e presença de comorbidades múltiplas. Participaram 67 idosos com idade média de 69,1 (± 6,9) anos. Desses, 47 (70,0%) eram do sexo feminino, 43 (64,1%) eram aposentados, 41 (61,1%) apresentavam ensino fundamental incompleto, 42 (62,6%) manifestaram alguma limitação física e 42 (62,6%) eram sedentários. Todos mostraram ter alteração em pelo menos um dos oito domínios avaliados pelo IVCF-20, especialmente mobilidade (n=67; 100%), cognição (n=54; 80,5%) e humor (n=40; 59,7%). Finalmente, 23 idosos (34,3%) foram classificados como robustos, 30 (44,7%) como em risco de fragilização e 14 (20,8%) como frágeis. A maioria dos idosos avaliados estava em risco de fragilização ou era frágil. O IVCF-20 demonstrou ser um instrumento de simples e rápida aplicação na APS para contribuir com a identificação, acompanhamento e manejo de idosos em risco de vulnerabilidade clínico-funcional.

Identifying health and life conditions related to the loss of functionality of the elderly contributes to the construction of public policies and interventions that help them live with more autonomy and independence. In the reality of Primary Health Care (PHC), the identification of fragile elderly or those at risk of fragility needs to be simple and fast. The purpose of this study was to identify the clinical-functional vulnerability of elderly PHC users. This was a quantitative and transverse study, carried out through the application of the clinical-functional vulnerability index-20 (CFVI-20), which evaluates eight predicting domains of functional decline and death in the elderly: age, self-perception of health, activities of daily life (ADL), cognition, mood/behavior, mobility, communication, and presence of multiple comorbidities. 67 elderly people with an average age of 69.1 (± 6.9) years old were included. Of these, 47 (70.0%) were female, 43 (64.1%) were retired, 41 (61.1%) had an incomplete elementary education, 42 (62.6%) expressed some physical limitation, and 42 (62.6%) were sedentary. Everyone showed a change in at least one of the eight domains evaluated by CFVI-20, especially mobility (n = 67; 100%), cognition (n = 54; 80.5%), and mood (n = 40; 59.7%). Finally, 23 elderly (34.3%) were classified as robust, 30 (44.7%) as being at risk of fragility, and 14 (20.8%) as fragile. Most elderly evaluated were at risk of fragility or fragile. The CFVI-20 has proved to be an instrument of simple and rapid application in PHC to contribute to the identification, monitoring and management of elderly at risk of clinical-functional vulnerability.

Preferences of Older Adult Veterans With Heart Failure for Engaging With Mobile Health Technology to Support Self-care: Qualitative Interview Study Among Patients With Heart Failure and Content Analysis.

BACKGROUND: Heart failure (HF) affects approximately 6.5 million adults in the United States, disproportionately afflicting older adults. Mobile health (mHealth) has emerged as a promising tool to empower older adults in HF self-care. However, little is known about the use of this approach among older adult veterans. OBJECTIVE: The goal of this study was to explore which features of an app were prioritized for older adult veterans with HF. METHODS: Between January and July 2021, we conducted semistructured interviews with patients with heart failure aged 65 years and older at a single facility in an integrated health care system (the Veterans Health Administration). We performed content analysis and derived themes based on the middle-range theory of chronic illness, generating findings both deductively and inductively. The qualitative questions captured data on the 3 key themes of the theory: self-care maintenance, self-care monitoring, and self-care management. Qualitative responses were analyzed using a qualitative data management platform, and descriptive statistics were used to analyze demographic data. RESULTS: Among patients interviewed (n=9), most agreed that a smartphone app for supporting HF self-care was desirable. In addition to 3 a priori themes, we identified 7 subthemes: education on daily HF care, how often to get education on HF, support of medication adherence, dietary restriction support, goal setting for exercises, stress reduction strategies, and prompts of when to call a provider. In addition, we identified 3 inductive themes related to veteran preferences for app components: simplicity, ability to share data with caregivers, and positive framing of HF language. CONCLUSIONS: We identified educational and tracking app features that can guide the development of HF self-care for an older adult veteran population. Future research needs to be done to extend these findings and assess the feasibility of and test an app with these features.

Economic Implications of Health Care Burden for Elderly Population.

The implications of population aging for economic growth is not only the shrinking working-age population, but also the increasing health care burden of the elderly population. It is difficult to explain clearly the relationship between a country's aging population and its economy without considering health effects. Based on the Solow economic growth model, the aims of this study are to estimate the economic effects of the health care burden for elderly population, and to access whether reducing effective labor input for economic production. The analysis employs a set of econometric approaches including fixed effects, generalized method of moments, instrumental variable, and mediation regression analyses using a multinational multi-database covering the years 2000-2019. The empirical evidence indicates that the health care burden was negatively correlated with economic growth during the study period, with every 1% increase in the health care burden leading to a 0.083% decrease in the GDP growth rate. The results of heterogeneity analysis and mediating analysis further confirmed that worsening health in the elderly population could be associated with the deceleration in economic development through the indirect pathway that lowering the employment rate of working-age population. This study provides new empirical evidence on the economic impact of population aging that the poor health of elderly population can be one critical factor of limiting economic growth, for the reason the labor inputs in household production are likely crowded out by family caregiving.

"We are never taught anything about the elderly." Establishing the gap in elderly health care competencies in nursing education in Uganda.

BACKGROUND: Nurses contribute the largest portion of Uganda's health workforce providing care to individuals of all ages and communities. However, despite the growing number of the elderly population in Uganda with improved life expectancy, there is hardly any study that has looked at the elderly health care competencies in the nursing training programs at various levels. This paper provides an overview of the gaps in elderly health care competencies in nursing education in Uganda. METHODS: We conducted a descriptive qualitative cross-sectional study that involved document review, Key Informant Interviews (KIIs) with nursing leaders, and Focus Group Discussions ( FGDs) with faculty at all levels of nursing training and nurses in practice. Data was analyzed using latent and manifest content analysis with Open Code software 4.03. Common categories were identified and incorporated into a matrix to create themes. RESULTS: Almost all the curricula and minimum standards for training nurses at certificate, diploma, and degree levels lack a module and nursing competencies on elderly nursing care. This is aggravated by a lack of faculty trained in elderly health care skills, and a lack of specialized wards for nursing elderly care clinical training among others. CONCLUSIONS: There is hardly any elderly health care training module and elderly nursing competencies at all levels of nursing training in Uganda.

Adding health to years: A review of the National Programme for Health Care of the Elderly (NPHCE) in India.

The global share of elderly persons (60 years and above) is expected to rise from 13.4% in 2020 to 21.3% by 2050. In India, the elderly population accounts for 8.6% of the total population. A large share of responsibility on ensuring the health and well-being befalls on the government. Driven by the vision of healthy ageing, the National Programme for the Health Care of Elderly (NPHCE) was launched in 2011 by the Ministry of Health and Family Welfare. Yet, its effective implementation is challenged by the changing landscapes and epidemiological transitions. This review article explores the progress of elderly care with NPHCE, with a special focus on its implementation status, service delivery, and human resources to provide future directions for the program. It primarily uses the Common Review Mission Reports (2007-2019), archival sources from government websites, and relevant literature from PubMed, MEDLINE, and Google Scholar to provide an informed perspective of elderly care in India. We conclude that NPHCE requires strengthening through collaborative action between the relevant stakeholders. Strong implementation of appropriate policies and programs to address health care challenges of the ageing population is of crucial importance for India to achieve the health care needs of its elderly. As the elderly population is set to grow dramatically in the next few decades, this review article reveals areas needing urgent attention to strengthen elderly care through NPHCE in India.

Breaking Up and a New Beginning When One's Partner Goes into a Nursing Home: An Interview Study.

In aging societies worldwide, spouses take on great responsibility for care when their partner continues to live at home. Nursing home placement occurs when the partner becomes too frail due to multimorbidity, and this will cause a change in the spouse's life. This study aimed to explore the spouse's experience of their partner's move to a nursing home. Two interviews were conducted at 9-month intervals within the project entitled "Implementation of Knowledge-Based Palliative Care in Nursing Homes". Thirteen spouses from both urban and rural areas were included, with an age-range of 60-86 years (median 72). Qualitative content analysis was performed. The main findings were captured in two themes: Breaking up of close coexistence and Towards a new form of daily life. The first encompassed processing loneliness, separation and grief, exhaustion, increased burden, and a sense of guilt. The second encompassed a sense of freedom, relief, acceptance, support and comfort. Professionals in both home care and nursing home care need to develop and provide a support programme conveying knowledge of the transition process to prevent poor quality of life and depression among the spouses. Such a programme should be adaptable to individual needs and should ideally be drawn up in consultation with both partners.

Study of the current status and strategic policy for elderly health care by TCM / 国际中医中药杂志

China has entered an aging society.The situation of elderly-care has become immensely serious.The task of providing health care for the elderly demands immediate and urgent attention,in which traditional Chinese medicine plays unique advantages.Currently,with government support,elderly health care provided by TCM has achieved good results,and reached an unprecedented rapid rising stage of opportunities.However,there is still quite a gap between the elderly health care services provided by traditional Chinese medicine and the increasing demand.By examining the current situation of elderly health care provided by TCM,this paper reveals the difficulties and challenges faced by elderly health care provided by TCM,such as lack of TCM geriatric professionals,disconnection with the Internet,impairment of necessary facilities.By studying the current status,this paper proposes strategies to promote elderly health care provided by TCM as an active response to the call of the aging population.

Autoestima de idosos comunitários e fatores associados: estudo de base populacional / Self-esteem of community-based elderly and associated factors: a population-based study / Autoestima de ancianos comunitarios y factores asociados: estudio de base populacional

Objetivou-se avaliar autoestima de idosos comunitários e verificar sua associação com variáveis sociodemográficas e de saúde. O inquérito epidemiológico ocorreu na zona urbana de Uberaba, estado de Minas Gerais, no qual participaram 980 idosos. Utilizaram-se Escalas de Autoestima de Rosenberg, Katz, Lawton e Depressão Geriátrica Abreviada e análise descritiva com testes de Mann Whitney, Kruskal Wallis, correlação de Spearman e regressão linear múltipla (p<0,05). A coleta de dados ocorreu entre agosto de 2012 e março de 2013. Predominou o sexo feminino, 70-80 anos, casados, renda de um salário mínimo, quatro a sete anos de estudo, que moravam com filhos. A mediana foi de cinco doenças. Os escores de autoestima apresentaram mediana de 10. Os preditores dos piores níveis de autoestima foram maior idade (p<0,01), menor escolaridade (p=0,021) e indicativo de depressão (p<0,001). Os idosos comunitários apresentaram elevada autoestima e o indicativo de depressão foi o preditor principal da baixa autoestima (AU).

The aim was to assess the self-esteem of community-based elderly and verify its association with socio-demographic and health variables. The epidemiological survey was held in the urban region of Uberaba, a city in the state of Minas Gerais, with 980 elderly people. The Rosenberg Self-Esteem, Katz, Lawton and Short Geriatric Depression Scales were used and, for descriptive analysis, the Mann-Whitney and Kruskal-Wallis tests, Spearman's correlation and multiple linear regression were used (p<0.05). The data were collected between August 2012 and March 2013. The female gender was predominant, 70-80 years, married, income one minimum wage, between four and seven years of education, who lived with their children. The median number of illnesses was five. The median self-esteem score was ten. The predictors of worse levels of self-esteem were higher age (p<0.01), lower education (р=0.021) and signs of depression (р<0.001). The community-based elderly presented high self-esteem and signs of depression were the main predictor of low self-esteem (AU).

Estudio cuyo objetivo fue evaluar la autoestima de ancianos comunitarios y verificar su asociación con variables sociodemográficas y de salud. La investigación epidemiológica ocurrió en la zona urbana de Uberaba, estado de Minas Gerais. Participaron 980 ancianos. Fueron utilizadas Escalas de Autoestima de Rosenberg, Katz, Lawtone Depresión Geriátrica Abreviada y análisis descriptivo con testes de Mann Whitney, Kruskal Wallis, correlación de Spearman y regresión linear múltipla (p<0,05). Los datos fueron obtenidos entre agosto de 2012 y marzo de 2013. Fueron predominantes el sexo femenino, 70-80 años, casados, renta de un salario mínimo, cuatro a siete años de estudio, que vivían con hijos. La mediana fue de cinco enfermedades. Los scores de autoestima presentaron mediana de 10. Los predictores de los peores niveles de autoestima fueron mayor edad (p<0,01), menor escolaridad (р=0,021) e indicativo de depresión (р<0,001). Los ancianos comunitarios presentaron elevada autoestima y el indicativo de depresión fue el predictor principal de la baja autoestima (AU).

Prescrição inadequada de medicamentos a idosos portadores de doenças crônicas em um plano de saúde no município de São Paulo, Brasil / Inappropriate medication use in older adults with chronic diseases in a health plan in São Paulo, Brazil

INTRODUÇÃO: A polifarmácia e a prescrição de medicamentos inapropriados para idosos podem causar uma série de efeitos indesejados, comprometendo sua capacidade funcional. OBJETIVO: Verificação da presença de prescrição de medicamentos inapropriados em um grupo de idosos vinculados a um plano de saúde privado com cobertura na cidade de São Paulo-SP. METODOLOGIA: Estudo realizado mediante a análise de prescrições feitas a um grupo de idosos vinculados a um plano de saúde privado, todos portadores de doenças crônico-degenerativas e acompanhados por médicos de especialidades diversas, na capital do estado de São Paulo, durante os anos de 2012 e 2013. Os medicamentos foram examinados segundo os Critérios de Beers revisados pela American Geriatrics Society em 2012. RESULTADOS: Foram observadas prescrições feitas a 2.500 idosos com um total de 8.760 medicamentos. Destes, 2.926 33,4% foram considerados inapropriados para uso em idosos. Os fármacos mais prescritos foram os anti-inflamatórios não esteroides, seguidos por medicamentos cardiovasculares e de ação central. A maioria desses idosos não possui médico de referência, sendo acompanhados, em média, por quatro médicos de especialidades diferentes. CONCLUSÃO: O grupo pesquisado apresenta um número elevado de prescrições de medicamentos inapropriados para uso em idosos, os quais, somados às características próprias, fazem com que esse grupo se torne de alto risco para o aparecimento de iatrogenias. Utilizar critérios de fácil memorização para identificação desses medicamentos e, principalmente, rever a forma como o setor de saúde suplementar brasileiro atende a este segmento etário é de suma importância, a fim de preservar a qualidade de vida desses idosos.

INTRODUCTION: Polypharmacy and prescribing inappropriate medication to the elderly can cause a lot of unwanted effects, compromising their functional capacity. OBJECTIVE: Checking for the presence of inappropriate medication prescription in a group of elderly linked to a private health plan with coverage in the city of São Paulo-SP, Brazil. METHODOLOGY: Study based on the analysis of prescriptions made to a group of elderly linked to a private health plan, all bearers of chronic degenerative diseases and accompanied by doctors of various specialities, in the capital of the state of São Paulo, Brazil, during years 2012 and 2013. The medications were examined according to the criteria of Beers reviewed by the American Geriatrics Society in 2012. RESULTS: Were observed prescriptions made to 2,500 elderlies with a total of 8,760 medicines. Of those, 2,926 33.4% were considered inappropriate for use in older adults. The most prescribed were anti-inflammatory drugs, followed by cardiovascular and centrally acting medications. Most of these aged people have no personal doctor, being accompanied, on average, by 4 doctors of different specialties. CONCLUSION: The researched group features a high number of prescriptions of inappropriate medications for use in the elderly, which, added to their own characteristics, causes this group to have an increased risk for the appearance of iatrogenics. The use of criteria of easier memorization to identify these drugs and, mainly, to review how the supplementary health sector in Brazil serves this age segment is of paramount importance in order to preserve the quality of life of elderly.

Aging in rural America.

For older Americans, accessing high-quality care can be a challenge. For those in rural communities, it's even harder.

As características do cuidar em gerontologia na ótica da equipe multiprofissional do Centro de Referência à Assistência Social do Idoso (CRASI) do município de Montes Claros (MG), Brasil / The characteristics of care in gerontology form the viewpoint of the multidisciplinar team of the Centro de Referência à Assistência Social do Idoso (CRASI) the city of Montes Claros (Minas Gerais ­ Brazil)

Este estudo teve como objetivo conhecer a visão de uma equipe de saúde sobre o cuidado ao idoso. Trata-se de um estudo descritivo com abordagem qualitativa conduzido com profissionais de saúde de um centro de referência em atenção ao idoso no município de Montes Claros, Minas Gerais, Brasil. Os dados foram coletados por meio de entrevistas semi-estruturadas, sendo as falas analisadas por meio da análise de conteúdo do tipo temática. Os resultados revelaram que os profissionais atribuem grande importância ao cuidado multiprofissional ao idoso, além de reconhecerem a necessidade do apoio familiar para a melhoria das condições de saúde dos idosos. Concluiu-se que o processo de envelhecimento é encarado como um processo natural e que a participação da família é de importância fundamental para a qualidade do cuidado.

The aim of this study was to become familiar with the vision of the healthcare team about the care of the elderly. It is a descriptive study with a qualitative approach conducted with healthcare professionals from a referral Center for care of the elderly in the city of Montes Claros, Minas Gerais, Brazil. The data was collected by structured interviews, with the content discussed during the interview being subsequently analyzed using thematic analysis. The results revealed that the professionals attribute great importance to multidisciplinary elderly care, beyond recognizing the need for family support to improve the health of the elderly. The final conclusion was that the aging process is viewed as a natural process and that participation of the family is fundamental for the quality of care.

Obstáculos al acceso a la salud del anciano: la visión de los profesionales de salud / Access challenges in elderly health care: the views of healthcare professional / Obstáculos ao acesso à saúde do idoso: o olhar dos profissionais de saúde

Objetivo: identificar los obstáculos de acceso a la salud del anciano por medio de evaluación y percepción de profesionales de la salud, en el atendimiento al anciano, en la Unidad de Salud del distrito Este de una ciudad del interior paulista, Brasil. Material y métodos: se trata de una investigación de campo, de abordaje cuantitativo que utilizó un cuestionario conteniendo datos de identificación, además de la evaluación de situaciones que pueden constituirse como barreras de acceso al anciano en el servicio de salud que frecuenta, sobre su proceso salud-enfermedad y sus propiaslimitaciones, según 60 profesionales de la atención básica, que atienden al anciano en la unidad de estudio. Resultados: la población se constituye de 58,3% de auxiliares de enfermería, 30% de agentes comunitarios de salud, 8,4% de enfermeros y 3,3% de técnicos de enfermería, siendo 96,7% de sexo femenino. Cerca de 60 % de los entrevistados son bachilleres y 36,7% actúan en pronto socorro. El agente comunitario de salud fue mencionado como principal facilitador de acceso a la salud del anciano. Los sujetos de la investigación señalaron la ausencia de un cuidador como el gran obstáculo en relación al propio anciano, sin embargo también se observo influencia en la salud del anciano, de aspectos como edad, renta y sexo. En cuanto a los profesionales y a las unidades de salud, señalaron la influencia de elementos que causan estrés en la vida cotidiana de los profesionales y el flujo de atención de la unidad como factores que determinan los principales obstáculos de acceso a la salud del anciano. Conclusiones: el estudio demostró exigen cia de acceso real a los ancianos y los resultados pueden servir como indicadores en la atención de la salud del anciano,ponderando la mejor adecuación del ambiente y existencia de profesionales entrenados y capacitados para atender alanciano.

Objetive: This study aimed at identifying the challenges concerning access to service from the point of view ofprofessionals who work with the elderly in a Healthcare Unit in the eastern district of a city in inner São Paulo state,Brazil. Materials and methods: This is a quantitative field study that made use of a questionnaire including identificationdata and the assessment of situations that might represent difficulty to health care access at the site where the elderlyseek assistance, concerning their health-illness process and their own limitations, as perceived by 60 basic health care professionals that care for these users at the unit under investigation. Results: The population in this study wascomprised as follows: 58.3% nursing assistants, 30% healthcare community agents, 8.4% nurses and 3.3% nursing technicians, among which 96.7% were female. Approximately 60% of the respondents have completed secondary education, and 36.7% work in immediate care. The health care community agent was reported to be the main facilitatorto elderly health care access. Research subjects viewed the absence of carers as the main obstacle regarding the elderly themselves; however, factors were noted to affect the health of the elderly, such as age, income and gender. As concerns the professionals and the healthcare unit, stressful elements were regarded to play a role in the everyday lives of professionals and the work flow in the unit, thus representing the main obstacles to elderly health care access. Conclusions: The study revealed there is demand for actual access by the elderly, and such findings may work asindicators in elderly health care that take into account the need to make environments more suitable and the need for professionals who are more qualified and trained to care for the elderly.

Objetivo: este trabalho teve o objetivo de identificar os obstáculos de acesso à saúde do idoso por meio da avaliaçãoe percepção de profissionais da saúde, no atendimento ao idoso, em Unidade de Saúde do distrito leste de uma cidadedo interior paulista, Brasil. Materiais y métodos:trata-se de uma pesquisa de campo, de abordagem quantitativa queutilizou um questionário contendo dados de identificação, além da avaliação de situações que podem se constituir comobarreiras de acesso ao idoso no serviço de saúde que frequenta, sobre o seu processo saúde-doença e suas próprias limitações, segundo 60 profissionais da atenção básica, que atendem o idoso na unidade do estudo. Resultados: apopulação constituiu-se de 58,3% auxiliares de enfermagem, 30% agentes comunitárias de saúde, 8,4% enfermeiros e 3,3% técnicos de enfermagem, sendo 96,7% do sexo feminino. Cerca de 60% dos entrevistados possuem ensino médiocompleto e 36,7% atuam em pronto atendimento. O agente comunitário de saúde foi referido como principal facilitador de acesso à saúde do idoso. Os sujeitos da pesquisa apontaram a ausência de um cuidador como o maior obstáculo em relação ao próprio idoso, porém foi observada influência na saúde do idoso relacionada aos aspectos como idade, renda e sexo. Quanto aos profissionais e à unidade de saúde, apontaram os reflexos de elementos estressores na vida cotidiana do profissional e o fluxo de atendimento da unidade como fatores que determinam os principais obstáculos de acesso à saúde do idoso. Conclusões: o estudo demonstrou exigência de acesso real aos idosos e os resultados podem servir como indicativos na atenção à saúde do idoso, ponderando a melhor adequação do ambiente e existência de profissionais treinados e capacitados para atender o idoso.

Perspectivas da participação do fisioterapeuta no Programa Saúde da Família na atenção à saúde do idoso / Perspectives of physical therapy participation in the Family Health Program for elderly care

Mobilizados pela problemática em torno das mudanças sociodemográficas, particularmente com o aumento da população de idosos, pela consolidação de uma política nacional de saúde calcada na noção de direitos de cidadania e a partir das reflexões suscitadas pela experiência de São Carlos (SP), na qual há a inserção do fisioterapeuta no PSF sob a forma de apoio matricial, os autores propõem, neste artigo, uma configuração do campo e núcleo das práticas de fisioterapia, na atenção à saúde do idoso, sob a perspectiva de sua inserção qualificada no Programa de Saúde da Família.

The premise of this paper was to introduce the concept of elderly physical therapy care in the Family Health Program. Inspired by the impact attributable to the socio-demographic changes, the increase of an elderly population and for the consolidation of a national health policy inspired by civil rights principles, the authors present an initiative for physical therapy practice aimed at the elderly. The successful integration of physical therapy in the Family Health Program conducted in the city of São Carlos, São Paulo State, has shown that the idea is likely to achieve great results and qualified participation.

Job Performance Frequency and the Training Needs of Dieticians in Elderly Healthcare Facilities

The purpose of this study was to identify job frequency and the training needs of dieticians in elderly health care facilities. This study consisted of dieticians working in elderly health care facilities with a capacity of over 50 elderly. Survey questionnaires were distributed to 190 dieticians through the mail and 106 dieticians (55.8%) participated in this study. The results of the survey showed that dieticians in elderly health care facilities frequently performed the following job: work management, safety and sanitation management, purchase management, human resource management, finance management, nutrition management, and marketing management. The job frequency in safety and sanitation management (p<0.05) and nutrition management (p<0.01) areas were significantly different by the number of dieticians. Safety and sanitation management and menu management were considered job areas that needed further training and education. Dieticians in elderly health care facilities responded that the following jobs should require not only training but are also frequently performed: safety and sanitation management, menu management, work management, and human resource management. Thus, based on the results of this study, continuous training programs in these fields should be offered to satisfy the needs of dieticians.