Karla Cristina Giacomin

Estudo de base populacional dos fatores associados à incapacidade funcional entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

This study assessed factors associated with functional disability in old age in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The theoretical model was based on predisposing (socio-demographic), extra-individual (social support, use of health services), and intra-individual factors (health conditions). The study was conducted in a probabilistic sample of 1,786 subjects aged > 60 years. The dependent variable was disability defined as mild (some difficulty) or severe (total dependence) in performing at least one basic activity of daily living. Prevalence of disability was 16% (8% mild; 8% severe). Age and worse self-rated health were independently and positively associated with mild and severe disability. Self-reported hypertension and arthritis were associated with mild disability, while diabetes and stroke were associated with severe disability. Severe disability was independently and negatively associated with number of visits by friends in the previous 30 days. According to the results, chronic conditions associated with disability in the study population are preventable, and severely disabled elderly had less extra-family social support.

Projeto Bambuí: um estudo de base populacional da prevalência e dos fatores associados à necessidade de cuidador entre idosos

Este estudo tem por objetivo determinar a prevalencia e os fatores associados com a necessidade de cuidador entre idosos residentes na comunidade. Foram selecionados todos os residentes na cidade de Bambui, Minas Gerais, Brasil, com > 60 anos de idade (n = 1.742). Destes, 92% foram entrevistados e 86% examinados. A variavel dependente - necessidade de cuidador - foi definida como: (1) relato de incapacidade para realizar pelo menos uma das atividades da vida diaria e/ou (2) escore inferior a 13 no Mini Mental State Examen. A prevalencia da necessidade de cuidador foi de 23%. Apresentaram associacoes positivas e independentes com a necessidade de cuidador: idade, ser solteiro, historia de alcoolismo previo, hipertensao arterial, obesidade e uso de medicamentos prescritos. Observaram-se associacoes negativas e independentes para: escolaridade, renda familiar, viver so, colesterol total > 240mmHg e ter plano privado de saude. Assim, a necessidade de cuidador em Bambui estava associada a piores condicoes socio-economicas e de saude. O cuidado dos idosos dependentes e um problema de saude publica.

Fatores que predispõem ao declínio funcional em idosos hospitalizados

INTRODUCAO: O aumento da expectativa de vida e uma realidade mundial e determina maior prevalencia de doencas cronicas e maior demanda pelos servicos de saude, incluindo os hospitalares. Atualmente, estudos tem focalizado o declinio funcional e suas consequencias - demanda por recursos materiais e humanos, institucionalizacao e hospitalizacao. O objetivo foi a revisao critica da literatura disponivel sobre os fatores de risco associados ao declinio funcional em idosos hospitalizados. METODOLOGIA: Pesquisa nas bases de dados MEDLINE, LILACS e SCIELO, nos idiomas ingles e portugues, entre 2000 e 2007, utilizando as palavras-chave hospital, elderly, functional status, aged e functional decline e referencias bibliograficas dos artigos selecionados. RESULTADOS: Satisfizeram os criterios de inclusao 31 publicacoes. Apos leitura critica do ABSTRACT, os 15 artigos mais relevantes foram selecionados. CONCLUSAO: O declinio funcional pode ocorrer antes, durante e/ou apos a hospitalizacao. Idade avancada, comprometimento funcional previo, deficit cognitivo, iatrogenias, gravidade da condicao clinica e historico de quedas foram os fatores de risco mais citados. A capacidade funcional, como marcador de saude desse grupo, merece maior investigacao.

Capacidade funcional e uso de serviços de saúde por idosos da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil: um estudo de base populacional

This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.

Enfrentamento da incapacidade funcional por idosos por meio de crenças religiosas

The way people deal with the stress of life is known as the process of coping or confrontation. We speak of religious coping when a person uses religious belief and behavior to facilitate problem solving, to prevent or alleviate stressful negative emotional consequences, notable among which is functional disability. The objective of this study was to investigate the role of religion as a strategy for coping with disability among the elderly. A qualitative approach, consisting of an observational ethnographic study was employed, the sample for which included 57 elderly individuals from Bambui, Minas Gerais. The model of signs, significances and actions was used in collecting and analyzing data. The religiosity of the elderly respondents suggested that their religious beliefs and traditions help explain and address the suffering experienced by them in the presence or imminence of functional disability. Religious coping reinforces the fatalism existing in the religious belief that mirrors the inevitability of old age with disability as an accepted and natural social code, but also helps to minimize the social responsibility for the care of the elderly and reveals the disbelief in existing public health services.

Disability and use of health services by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based study

This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.

A funcionalidade e incapacidade na velhice: ficar ou não ficar quieto

The goals of this study were to identify how community-dwelling elderly deal with the prospect of disability/functionality and to understand how the sociocultural context modulates this process. The study adopted a qualitative approach in which the signs, meanings, and actions model was used in the data collection and analysis. The study interviewed 57 elders ranging from 61 to 96 years of age and enrolled in the six primary health units in Bambui, Minas Gerais State, Brazil. “To stay still or not to stay still” is the underlying question in functioning and disability in old age. However, staying still is not a matter of individual choice, because the answer depends on the elder’s financial, intellectual, and subjective resources and available social support. Staying still also implies a concept of old age inexorably associated with disability, leaving the elderly resigned to their condition; when difficulties increase, their only choice is to “wait for death”. Health teams need to interfere in this concept, providing care to older people during their recovery and until the end of life.

O cuidado em saúde na velhice: a visão do homem

Culture determines representations of old age and gender that influence the perceptions of health, illness and care. The interface between these phenomena is the object of this study, based on the perspective of medical anthropology, which aims to investigate how older men from community express and perceive the relationship between health, disease, aging and masculinity, and how these social constructs relate to subsystems informal and professional care. We interviewed 27 men aged 60 or older, living in Bambui (MG) and assisted by the Family Health Strategy, about their daily activities, their health and their forms of healthcare. The model of signs, meanings and actions, used in the collection and analysis of data, allowed recognizing the typical ways of thinking and acting of older men in relation to the health-illness-care process, as well as their interactions and contradictions regarding to the professional and informal sectors of healthcare system. The material and symbolic production of the respondents shows that in general the male identity is linked to the concept of health, which is tied to the social relations that underlie the informal healthcare. Opposed to this perception is the aging view inexorably related to sickness, in which the professional care system is anchored. Thus, older men restrict their demand for healthcare in part because their own socio-cultural construction of masculinity denies the frailty, but also this is due to the health actions and health professionals that ignore the specificities of gender and the value of the functional independence to older men.

Cuidado e limitações funcionais em atividades cotidianas – ELSI-Brasil

I Secretaria Municipal de Saúde. Diretoria de Assistência. Belo Horizonte, MG, Brasil II Fundação Oswaldo Cruz. Instituto René Rachou. Núcleo de Estudos em Saúde Pública e Envelhecimento. Belo Horizonte, MG, Brasil III Universidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil IV Universidade de São Paulo. Escola de Enfermagem. São Paulo, SP, Brasil V Instituto de Pesquisa Econômica Aplicada. Diretoria de Estudos e Políticas Sociais. Rio de Janeiro, RJ, Brasil VI Fundação Getúlio Vargas. Escola Brasileira de Administração Pública e de Empresas. Rio de Janeiro, RJ, Brasil VII Universidade Federal do Tocantins. Curso de Enfermagem. Palmas, TO, BrasilABSTRACT OBJECTIVE To investigate the prevalence of demand and provision of care for the Brazilian population with functional disabilities in activities of daily living. METHODS This is a quantitative and descriptive study using baseline data from ELSI-Brazil (Brazilian Longitudinal Study of Aging), a cohort study with a representative sample of the Brazilian population aged 50 years or older (n = 9,412). We considered the demand for care from the self-report of having some difficulty to perform at least one activity of daily life (eating, bathing, going to the toilet, dressing, moving in a room [ambulation], and transferring from chair [transfer]). Care supply was measured by having some help to perform the activity of daily living. RESULTS Approximately a quarter of the individuals evaluated (23.2%) reported difficulty in at least one activity of daily living, especially regarding transfer and dressing. Age, schooling, and number of chronic diseases were significantly associated with the difficulty in activities of daily living. Among those who reported difficulty, 35.1% received help of others and 11.8% did not receive (lack of care). The activities with greater lack of care were bathing (13.3%) and transfer (11.7%), which reveals an undignified survival condition. Care remains a family (94.1%) and female (72.1%) issue; despite the important changes that have taken place in society, there is still a lack of care policies. Of the total caregivers, 25.8% reported stopping working or studying to perform this role and only 9.2% were paid (hired ones or family members). CONCLUSIONS The ELSI-Brazil results reveal the expressive care demand of the Brazilian population aged 50 years or older with functional disabilities on activities of daily living and the lack of care policies aimed at this public.

O médico diante da morte no pronto socorro

ABSTRACT OBJECTIVE: To analyze how physicians, as part of a sociocultural group, handle the different types of death, in a metropolitan emergency service. METHODS: This is an ethnography carried out in one of the largest emergency services in Latin America. We have collected the data for nine months with participant observation and interviews with 43 physicians of different specialties – 25 men and 18 women, aged between 28 and 69 years. RESULTS: The analysis, guided by the model of Signs, Meanings, and Actions, shows a vast mosaic of situations and issues that permeate the medical care in an emergency unit. The results indicate that physicians may consider one death more difficult than another, depending on the criteria: age, identification or not with the patient, circumstances of the death, and medical questioning as to their responsibility in the death process. CONCLUSIONS: For physicians, no death is easy. Each death can be more or less difficult, depending on different criteria that permeate the medical care in an emergency unit, and it reveals different social, ethical, and moral issues.OBJETIVO: Analisar a forma como medicos, enquanto parte de um grupo sociocultural, lidam com diferentes tipos de morte, em um servico de pronto socorro metropolitano. METODOS: Trata-se de uma etnografia realizada em um dos maiores servicos de pronto socorro da America Latina. A coleta dos dados deu-se ao longo de nove meses de observacao participante […]