Maria Helena Morgani de Almeida

Dificuldades para atividades básicas e instrumentais de vida diária, referidas por usuários de um centro de saúde escola do município de São Paulo

Elderly who match certain demographic, social and economic criteria are especially vulnerable to illness, disability and death. The study was developed in order to both identify vulnerable elderly according to specific criteria and compare vulnerable and non-vulnerable elderly with their need for assistance with activities. This cross-sectional study had its data collected in the household of 190 elderly users of a School Health Center. It took place between 2006 and 2008, through the application of the CICAc Instrument: classification of the aged concerning self-care ability. One hundred and forty-five elderly (80%) were under at least one risk criterion; 99 (52.1%) reported one difficulty or more in basic activities, and 29 (29.3%) of them require assistance; 92 (48.4%) elderly mention difficulties in instrumental activities and 67 (72.8%) require assistance. Only 16 (8.4%) adopt self-care practices to minimize their difficulties and 38 (20%) adopt them to compensate just part of their difficulties. The elderly group that is under at least one risk criterion has a higher proportion of individuals who require assistance with basic and instrumental activities of daily living. Further analysis may verify the influence of each criterion on the functionality. Carrying out research on self-care practices with a larger number of individuals will allow a comparison between groups that make or do not make use of these practices and match risk criteria. Despite the limitations of the study, it gives rise to the planning of interventions for the elderly that have difficulties and need assistance with their activities.

Massage and Storytelling Reduce Aggression and Improve Academic Performance in Children Attending Elementary School

Background Aggressive behaviors must be addressed in elementary schools. Massage and storytelling can be strategies to deal with aggression because both involve experience exchange and social interaction. Both can decrease stress and anxiety and increase self-esteem. Objective To evaluate the effect of two interventions (massage and storytelling) on aggressive behaviors and academic performance of elementary school children. Method Three groups (n = 35 children in each group) of the second grade participated (aged 6.5–8.1 years). One group received ten extra classes of massage (MG), another group received extra classes of storytelling (SG), and the control group received extra classes of random subjects (CG). Extra classes lasted for 50 minutes, once a week. Aggressive behaviors were recorded on diaries, by the teachers and the coordinator. The frequency of aggressive behaviors and the academic performance of MG, SG, and CG were observed for six months and the groups were compared. Findings ANOVAs evidenced that MG and SG, but not CG, showed a reduction in aggressive behaviors registered by the teachers and coordinator, after the intervention. Academic performance of MG and SC improved after the intervention (p < 0.05).

Programa de orientação com ênfase em práticas de autocuidado para motoristas idosos

Objective: To present the results of an orientation program for elderly drivers which emphasized practices of self-care. The secondary objective was to describe the personal difficulties and environmental challenges identified by participants when driving a vehicle. Method: An intervention study of elderly drivers was performed. It included individual interviews, an orientation program and a focus group session. Results: A total of 13 elderly persons, aged between 62 and 82, participated in the study. Seven (54%) reported difficulties in driving, of whom five (71.4%) mentioned difficulties in interacting with the environment; three (42.9%) described emotional difficulties and three (42.9%) cited physical, sensory and/or cognitive difficulties. In the focus group session, the elderly persons reflected on factors addressed during the program that interfered with the act of driving, reporting that they had increased their self-care practices to cope with these. A majority of the participants identified the influence of attention deficits and the adverse effect of emotional issues when driving a vehicle. In terms of conditions relating to the social and physical environment, the elderly persons criticized the uncontrolled growth of traffic, mentioned their concerns about other drivers and pointed out deficiencies in the mechanisms of education, traffic control and punishment of traffic violations. They also discussed potential changes to encourage the mobility of pedestrians, a condition also experienced by the drivers. Conclusion: The elderly persons elucidated the importance of orientation in self-care practices, highlighting the importance of a dialogue between professionals and the elderly to discuss a wide range of practices related to factors that affect vehicle driving in order to maintain safety when driving for as long as possible.

Prevalence of functional incapacity by gender in elderly people in Brazil: a systematic review with meta-analysis

1 Universidade Federal do Sul e Sudeste do Pará, Instituto de Estudos em Saúde e Biológicas. Marabá, Pará, Brasil. 2 Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional. São Paulo, São Paulo, Brasil. 3 Associação de Pais e Amigos dos Excepcionais, Setor de Terapia Ocupacional. Lavras, Minas Gerais, Brasil. 4 Pontifícia Universidade Católica de Minas Gerais, Instituto de Ciências Exatas e Informática, Departamento de Matemática. Belo Horizonte, Minas Gerais, Brasil.Considering that functional capacity is an important indicator of health in aging, the present study aimed to describe the prevalence of disability by gender among elderly people in Brazil through a systematic review and meta-analysis of articles about this subject. Articles published up to June 2013 were included, and a search was performed of the MEDLINE, SciELO, LILACS, Scopus, Web of Science and Science Direct electronic databases. The inclusion of articles in the systematic review was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A descriptive analysis of the selected articles was performed and expressed in a forest-plot type graph. Of 3,656 articles initially identified in all the databases, 2,585 duplicates were excluded and 23 articles were deemed eligible for review. Prevalence rates ranged from 12.3% to 94.1% for men and from 14.9% to 84.6% for women. The methods used to assess functional capacity in elderly people in Brazil also differed between the articles. This variation complicates the comparison of results between the articles, demonstrating the need for standardized methods of measuring functional capacity.

Formal caregivers of older adults: reflection about their practice

OBJECTIVE To understand the job function of caregivers of older adults and contribute to the debate on the consolidation of this professional practice. METHODOLOGICAL PROCEDURES This is a descriptive, qualitative, and exploratory study. Four focal group sessions were performed in 2011 with 11 elderly companions, formal caregivers of older adults in the Programa Acompanhante de Idosos (Program for Caregivers of Older Adults), Sao Paulo, SP, Southeastern Brazil. These sessions, guided by a semi-structured script, were audio-recorded and fully transcribed. Data were analyzed using the Content Analysis technique, Thematic Modality. RESULTS In view of considering the caregivers of older adults as a new category of workers, it was difficult to define their duties. The elderly companions themselves as well as the care receivers, their families, and the professionals that comprised the team were unclear about their duties. The professional practice of these formal caregivers has been built on the basis of constant discussions and negotiations among them and other team members in Programa Acompanhante de Idosos during daily work. This was achieved via a recognition process of their job functions and by setting apart other workers’ exclusive responsibilities. CONCLUSIONS The delimitation of specific job functions for elderly companions is currently one of the greatest challenges faced by these workers to develop and consolidate their professional role as well as improve Programa Acompanhante de Idosos.

Cuidadores formais de idosos: contextualização histórica no cenário brasileiro

This paper aims to relate the historical of formal elderly caregivers in the Brazilian context, highlighting the main regulatory frameworks and national discussion forums related to this theme. The study acknowledged the complexity that involves the activities developed by these workers and the importance of the training programs to support them in providing assistance. The historical background showed both some controversies in legislation and different views of the participants at the discussion forums. It evinces the need of a careful and an in-depth reflection that may contribute to the appropriate regulation of the elderly caregiver profession. In this context, studies that address this theme are relevant to guide the implementation of public policies for the elderly needfulness.

Avaliação da atenção primária em saúde por usuários com e sem deficiência

PURPOSE To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities. METHODS Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated. RESULTS Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided. CONCLUSION Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.PURPOSE To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities. METHODS Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated. RESULTS Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided. CONCLUSION Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.

Reliability and Validity of the Brazilian Version of the Late-Life Function and Disability Instrument

OBJECTIVE We evaluated the test-retest reliability, internal consistency, and construct validity of the Brazilian version of the Late-Life Function and Disability Instrument. METHOD A sample of 118 older adults provided data for testing construct validity and internal consistency, and 14 provided data for testing test-retest reliability. Factor analysis with varimax rotation was used to assess construct validity. RESULTS The Function component had excellent test-retest and total internal consistency reliability. Factor analysis revealed that the Upper Extremity Function and Advanced Lower Extremity Function domains were similar to the original analysis. The Disability component showed adequate to excellent test-retest reliability, except in the Management role; total internal consistency was excellent. Factor analysis revealed that its domains were similar to the original analysis, except for some items. CONCLUSION The Late-Life Function and Disability Instrument is recommended for assessment of Brazilian community-dwelling older adults who are functionally independent and who do not require mobility assistance.