Luciana Branco da Motta

Novas competências profissionais em saúde e o envelhecimento populacional brasileiro: integralidade, interdisciplinaridade e intersetorialidade

Este trabalho discute as caracteristicas da formacao medica frente ao processo de envelhecimento e as especificidades da atencao a saude do idoso, de forma a sistematizar as competencias necessarias para profissionais de saude. A premissa e que existe uma distância marcante entre, por um lado, conteudos necessarios a boa pratica geriatrica e diretrizes das politicas de saude e educacao e, por outro lado, o curriculo atual da graduacao e da pos-graduacao. A transicao epidemiologica e demografica coloca a Geriatria e Gerontologia como uma especialidade com mercado em expansao, tanto no setor publico como privado, implicando a discussao da normatizacao da formacao e distribuicao de RH na saude. Porem, a pouca valorizacao da presenca de seus conteudos nos curriculos nao reflete apenas uma questao pedagogica. Ao que tudo indica, apesar da legislacao existente, ainda nao esta clara a importância destes conteudos para a sociedade. A inclusao do processo de envelhecimento como curso de vida e em todos os seus aspectos nos curriculos de graduacao e uma prioridade. E tambem necessario ampliar a discussao sobre o papel da pos-graduacao, da educacao permanente e da educacao continuada a fim de fazer frente ao desafio de envelhecer com qualidade.This paper discusses the challenges faced by medical education with regard to the aging Brazilian population as well as the specificities of senior health care services, aiming at systematizing the contents and practices needed to prepare health professionals. The assumption is based on a clear gap between appropriate contents for quality geriatric practices and health policy guidelines on the one hand, and current undergraduate and graduate level medical programs on the other. This epidemiological and demographic transition positions Geriatrics and Gerontology as fields of expertise in an expanding market, both in the public and private sectors, which raises the discussion on medical training standardization and health HR distribution. However, the little emphasis given to these fields in current curricula does not only reflect a mere pedagogical issue. In spite of the existing legislation, everything points to the fact that the importance of these contents to society is not yet clear. Including the aging process in undergraduate programs as part of the life course and in all of its aspects is a priority for the Brazilian population. A broad discussion on the role played by graduate, permanent, and continuing education is needed in order to face the challenge of quality aging.

Integração e continuidade do cuidado em modelos de rede de atenção à saúde para idosos frágeis

Foi realizada revisao critica da literatura sobre modelos que tenham avaliado a efetividade de redes assistenciais integradas e coordenadas para a populacao idosa. Foram pesquisadas as seguintes bases bibliograficas: Pubmed, The Cochrane Library, Lilacs, Web of Science, Scopus e SciELO. Doze artigos sobre cinco modelos diferentes foram incluidos para a discussao. A analise da literatura mostrou que a prestacao de servicos pautava-se na atencao basica incluindo servicos domiciliares. Os usuarios contavam com a integracao de atencao primaria, hospitalar, centros dia, servicos domiciliares e servicos sociais. O plano de cuidados e a gestao de caso foram elementos chaves para a continuidade de cuidado. Essa abordagem mostrou-se efetiva nos estudos, reduzindo o uso da atencao hospitalar, o que resultou em economia para o sistema financiador. Houve reducao da prevalencia de perda funcional, melhora na satisfacao e na qualidade de vida dos usuarios e de seus familiares. A analise da literatura reforca a necessidade de se modificar a abordagem de assistencia a saude dos idosos, e a integracao e coordenacao dos servicos sao formas eficientes para iniciar essa mudanca.A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

Avaliação dos gastos com o cuidado do idoso com demência

CONTEXTO: Trata-se de um estudo sobre os gastos da familia com o idoso com sindrome demencial. Considerando o impacto financeiro que essa condicao de saude gera, foram analisados os gastos de 41 familias. OBJETIVO: Identificar a estrutura de gasto e receita das familias responsaveis pelo cuidado de pacientes portadores desta condicao. METODOS: Trata-se de um estudo de avaliacao de gastos e se caracteriza por ser exploratorio, descritivo e transversal. Seu objeto envolve a unidade familiar na qual o doente se insere e os gastos relacionados ao cuidado com o idoso que tem sindrome demencial. O questionario foi aplicado a um grupo de 41 pacientes e suas familias acompanhados no ambulatorio de neurogeriatria da Universidade Aberta da Terceira Idade/Universidade do Estado do Rio de Janeiro (UnATI/UERJ). Portanto, trata-se de um estudo de caso. RESULTADOS: Os achados sugerem que a repercussao e realmente grande e chega a comprometer, em media, 66% da renda familiar com gastos que podem chegar a 75% no caso de pacientes em estagio inicial, a 62% no estagio avancado e a cerca de 80% da renda familiar, quando associada a outra doenca cronica. CONCLUSOES: Da perspectiva da saude publica, esses achados reiteram as conclusoes das pesquisas previas que apontam ser o aumento dos gastos com o cuidado uma das dimensoes que contribuem para as alteracoes na saude fisica e mental dos cuidadores. Ou seja, o impacto dos gastos pode ser considerado um indicador do grau de estresse e sobrecarga, principalmente emocional, que tao frequentemente acompanha as responsabilidades dos cuidadores.

Prevalência e fatores associados a quedas em idosos em um município do Rio de Janeiro

INTRODUCTION: Fifty percent of falls in elderly result in some kind of injury. This study aims to assess the prevalence and identify factors associated with falls in aged people in a county of the state of Rio de Janeiro, Brazil. METHODS: A survey was conducted with people 60 years-old or more who were able to respond by themselves to a multidimensional assessment questionnaire applied by trained community health agents. We calculated proportions and 95% confidence intervals. RESULTS: 1,064 individuals were included. They were mostly women (57%), with mean age of 71,4 years. 322 participants (30,3% - 95%CI 27,6-33,2) fell during the previous year, and 148 (13,9% - 95%CI 11,9 -16,2) fell at least twice. Some associations became evident: female sex, advanced age, being divorced, living alone, as well as indicators of bad health condition, functional capacity and satisfaction with life. CONCLUSION: This study highlights already known factors associated to falls in the elderly. The major challenge is the proposition of interventions towards modifiable factors and active identification of persons under risk of falling aiming at preventive rehabilitation.

A formação de profissionais para a atenção integral à saúde do idoso: a experiência interdisciplinar do NAI - UNATI/UERJ

The training of professionals in the field of healthcare for the aged is one of the priorities of the national policy for the aged in Brazil due to the accelerated aging of the population. The Nucleo de Atencao ao Idoso (NAI), a unit of the Open University of the Third Age/UERJ (UNATI/UERJ) develops an educational program in this field, based on practical care delivery with emphasis to inter-disciplinarity and teamwork. The program includes different training levels and modalities: Residency, Specialization, Professional Practice and Graduation. The program includes an introductory course in gerontology and geriatrics common to all areas, and specific theoretical-practical qualification coordinated by the professional staff from the respective areas. The practical activities occur in different sceneries: long term care institutions, health promotion educational settings, outpatient facilities and the university hospital. Interdisciplinary thinking and acting is a continuous exercise, and the team should be open to innovative strategies. The experience is a contribution to the increasing social demand for qualified professionals committed with the principles of the Unified Health System and integrated health care.

Integration and continuity of Care in health care network models for frail older adults.

Foi realizada revisao critica da literatura sobre modelos que tenham avaliado a efetividade de redes assistenciais integradas e coordenadas para a populacao idosa. Foram pesquisadas as seguintes bases bibliograficas: Pubmed, The Cochrane Library, Lilacs, Web of Science, Scopus e SciELO. Doze artigos sobre cinco modelos diferentes foram incluidos para a discussao. A analise da literatura mostrou que a prestacao de servicos pautava-se na atencao basica incluindo servicos domiciliares. Os usuarios contavam com a integracao de atencao primaria, hospitalar, centros dia, servicos domiciliares e servicos sociais. O plano de cuidados e a gestao de caso foram elementos chaves para a continuidade de cuidado. Essa abordagem mostrou-se efetiva nos estudos, reduzindo o uso da atencao hospitalar, o que resultou em economia para o sistema financiador. Houve reducao da prevalencia de perda funcional, melhora na satisfacao e na qualidade de vida dos usuarios e de seus familiares. A analise da literatura reforca a necessidade de se modificar a abordagem de assistencia a saude dos idosos, e a integracao e coordenacao dos servicos sao formas eficientes para iniciar essa mudanca.A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

Rastreamento do risco de perda funcional: uma estratégia fundamental para a organização da Rede de Atenção ao Idoso

From a critical analysis of experiments in the use of screening tools for functional loss in the elderly, it was observed that the main motivation to develop and implement a screening instrument is to improve health care for the frail elderly or those at risk of functional loss and repeated hospital admissions. The instruments are preferably short questionnaires with no more than 16 self-reported questions. The main intervention performed after screening was monitoring the elderly by a specialized nursing service that, when necessary, referring them to the medical service. The results of this approach included the reduction of functional loss, hospital admissions, deaths, lower health expenses and greater consumer satisfaction.From a critical analysis of experiments in the use of screening tools for functional loss in the elderly, it was observed that the main motivation to develop and implement a screening instrument is to improve health care for the frail elderly or those at risk of functional loss and repeated hospital admissions. The instruments are preferably short questionnaires with no more than 16 self-reported questions. The main intervention performed after screening was monitoring the elderly by a specialized nursing service that, when necessary, referring them to the medical service. The results of this approach included the reduction of functional loss, hospital admissions, deaths, lower health expenses and greater consumer satisfaction.

Desenvolvimento de uma linha de cuidados para o idoso: hierarquização da atenção baseada na capacidade funcional

O proposito deste artigo de atualizacao e contribuir para a estruturacao de uma linha completa de cuidados para os idosos. Trata-se de um modelo baseado na identificacao precoce dos riscos de fragilizacao dos usuarios. Uma vez identificado o risco, a prioridade e a reabilitacao precoce, a fim de reduzir o impacto das condicoes cronicas na funcionalidade. Partindo do pressuposto de que e adequado hierarquizar o processo de cuidado segundo as perdas funcionais que ocorrem com o passar dos anos, sao estabelecidos sete pontos de atencao. O modelo e hierarquizado pela capacidade funcional, mas poliarquico na pratica, pois a partir dos tres primeiros niveis e possivel seguir para qualquer outro ponto de atencao. Este modelo e vantajoso para o idoso, que amplia sua vida com qualidade; para a familia, que tera seu familiar ativo e participativo; e para as operadoras de saude, que evitarao internacoes repetidas e de alto custo.

Demented elderly people living at home in Rio de Janeiro, Brazil: Evaluation of expenditure on care

Background:  The present study investigates family expenditure relating to caring for elderly people with dementia. The study was exploratory, descriptive, and cross‐sectional.

LRRK2 p.G2019S Mutation Is Not Common among Alzheimer’s Disease Patients in Brazil

Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene have emerged as a potential common cause for both sporadic and familial Parkinson’s Disease (PD) in different populations. The pleomorphic features exhibited by LRRK2 mutation carriers and the central role of Lrrk2 protein in the proper functioning of central nervous system suggest that mutations in this protein might be involved in multiple cellular processes leading to other neurodegenerative disorders than PD. The location of LRRK2 gene on chromosome 12, close to a linkage peak for familial late-onset Alzheimer’s Disease (AD), highlights that LRRK2 mutations might be involved in AD pathogenesis. We screened the most common LRRK2 mutation (p.G2019S) in a series of 180 consecutive patients clinically diagnosed with Alzheimer Disease (AD). We identified the p.G2019S in one AD patient with no PD signs, indicating that this mutation is not a common etiological factor for AD in our population (0.5%), corroborating recent data found in Norwegian, North American, Chinese and Italian populations. Nevertheless, these observations together with new information about the Lrrk2 critical multifunctionality do not rule out the possible influence of other variants within LRRK2 in AD, so that other screenings focusing in the whole extension of the LRRK2 using larger sized confirmed AD sample are urgently needed.