Implementation of the Humanitude Care Methodology: contribution to the quality of health care / Implementação da Metodologia de Cuidado Humanitude: contribuição para a qualidade da assistência à saúde / Implementación de la Metodología de Cuidado Humanitud: contribución a la calidad de la asistencia a la salud

ABSTRACT Objective: to evaluate the contribution of the implementation of the Humanitude Care Methodology to the quality of health care in a Continuing Care Unit. Method: an action-research study with a non-probability convenience sampling, involving 34 health professionals from one unit in Portugal. Data was collected through a questionnaire and an observation worksheet for the Structured Sequence of Humanitude Care Procedures. We used data content analysis with the Statistical Package for Social Science, version 17.0. Results: health professionals demonstrated difficulties to provide care for people who are agitated, confused, disoriented, aggressive and who refuse care, and to communicate with patients who do not communicate verbally. The professionals valued the accomplishment of the stages of the observation worksheet. There were discrepancies between the perception of accomplishment and the actual practice. Throughout the implementation of the methodology, there was an increase in the practical application of the procedures, with positive repercussion for the patients and for the professionals. Conclusion: the results allowed to perceive the contribution of the process of implementation of the methodology, through the positive transformations in health care delivery.

RESUMO Objetivo: avaliar a contribuição da implementação da Metodologia de Cuidado Humanitude para a qualidade da assistência à saúde em uma Unidade de Cuidados Continuados. Método: estudo de investigação-ação, que utilizou processo de amostragem não probabilística por conveniência, envolvendo 34 profissionais de saúde de uma unidade, em Portugal. A coleta de dados foi realizada por meio de questionário e planilha de observação de Sequência Estruturada de Procedimentos Cuidativos Humanitude. Utilizou-se análise de conteúdo dos dados e tratamento com Statistical Package for Social Science, versão 17.0. Resultados: os profissionais de saúde manifestaram dificuldades na prestação de cuidados de pessoas agitadas, confusas, desorientadas, agressivas e que recusavam os cuidados e, ainda, na comunicação com pacientes que não se expressavam verbalmente. Os profissionais valorizaram a realização das etapas da planilha de observação e verificaram discrepâncias entre a percepção de realização e a prática realmente efetivada. Ao longo da implementação da metodologia, observou-se aumento da aplicação prática dos procedimentos, repercutindo em ganhos para as pessoas cuidadas e para os profissionais. Conclusões: os resultados permitiram perceber a contribuição do processo de implementação da metodologia na transformação positiva da prestação de cuidados de saúde.

RESUMEN Objetivo: evaluar la contribución de la implementación de la Metodología de Cuidado Humanitud para la calidad de la asistencia a la salud en una Unidad de Cuidados Continuos. Método: estudio de investigación y acción, mediante un proceso de muestreo no probabilístico por conveniencia, con la participación de 34 profesionales de la salud, desde una unidad, en Portugal. Recolección de datos realizada por medio de un cuestionario y una ficha de observación de Secuencia Estructurada de Procedimientos Cuidadativos Humanitud. Utilizado análisis de contenido de los datos y tratamiento con Statistical Package for Social Science, versión 17.0. Resultados: los profesionales de la salud manifestaron dificultades en la prestación de cuidados de personas agitadas, confusas, desorientadas, agresivas y que rechazan los cuidados y aún, de comunicarse con pacientes que no se comunican verbalmente. Los profesionales valoraron la realización de las etapas de la ficha de observación y verificaron discrepancias entre la percepción de realización y la práctica, realmente, efectiva. A lo largo de la implementación de la metodología, se observó un aumento de la aplicación práctica de los procedimientos, repercutiendo en beneficios para las personas cuidadas y para los profesionales. Conclusiones: los resultados permitieron percibir la contribución del proceso de implementación de la metodología, en la transformación positiva de la prestación de atención de salud.

Origins and consequences of technology acquirement by independent-living seniors: towards an integrative model.

BACKGROUND: Living independently can be challenging for seniors. Technologies are expected to help older adults age in place, yet little empirical research is available on how seniors develop a need for technologies, how they acquire these technologies, and how these subsequently affect their lives. Aging is complex, dynamic and personal. But how does this translate to seniors' adoption and acceptance of technology? To better understand origins and consequences of technology acquirement by independent-living seniors, an explorative longitudinal qualitative field study was set up. METHODS: Home visits were made to 33 community-dwelling seniors living in the Netherlands, on three occasions (2012-2014). Semi-structured interviews were conducted on the timeline of acquirements, and people and factors involved in acquirements. Additionally, participants were interviewed on experiences in using technologies since acquirement. Thematic analysis was employed to analyze interview transcripts, using a realist approach to better understand the contexts, mechanisms and outcomes of technology acquirements. RESULTS: Findings were accumulated in a new conceptual model: The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS), which provides an integrative perspective on why and how technologies are acquired, and why these may or may not prove to be appropriate and effective, considering an independent-living senior's needs and circumstances at a given point in time. We found that externally driven and purely desire-driven acquirements led to a higher risk of suboptimal use and low levels of need satisfaction. CONCLUSIONS: Technology acquirement by independent-living seniors may be best characterized as a heterogeneous process with many different origins, pathways and consequences. Furthermore, technologies that are acquired in ways that are not congruent with seniors' personal needs and circumstances run a higher risk of proving to be ineffective or inappropriate. Yet, these needs and circumstances are subject to change, and the C-TAILS model can be employed to better understand contexts and mechanisms that come into play.

Cohort Differences in Received Social Support in Later Life: The Role of Network Type.

OBJECTIVES: The objective is to assess cohort differences in received emotional and instrumental support in relation to network types. The main guiding hypothesis is that due to increased salience of non-kin with recent social change, those in friend-focused and diverse network types receive more support in later birth cohorts than earlier birth cohorts. METHOD: Data from the Longitudinal Aging Study Amsterdam are employed. We investigate cohort differences in total received emotional and instrumental support in a series of linear regression models comparing birth cohorts aged 55-64, 65-74, 75-84, and 85-94 across three time periods (1992, 2002, and 2012). RESULTS: Four network types (friend, family, restricted, and diverse) are identified. Friend-focused networks are more common in later birth cohorts, restrictive networks less common. Those in friend-focused networks in later cohorts report receiving more emotional and instrumental support. No differences in received support are evident upon diverse networks. DISCUSSION: The increased salience of non-kin is reflected in an increase in received emotional and instrumental support in friend-focused networks in later birth cohorts. The preponderance of non-kin in networks should not be perceived as a deficit model for social relationships as restrictive networks are declining across birth cohorts.

Fragmentation in social security old-age benefit provision in China.

Currently, in many countries most workers are covered by a national social security benefits program that applies equally in all parts of the country. In China, however, social security old-age benefits are provided in a highly fragmented manner. This article documents the high degree of fragmentation. It discusses both why that has occurred and the effects of the fragmentation on participants. It examines effects of the fragmentation on benefit levels, focusing on variations in the generosity of benefit formulas but also considering other measures of benefit adequacy. Fragmentation is seen to cause differences in benefit levels even within a single city. While the new National Rural Pension Scheme is a major improvement in the provision of retirement security for rural workers, important differences still exist in the social security programs for urban and rural workers.

Challenges in organizing care networks for the elderly in two regions of Brazil

The global trend of ageing populations is present in Brazil. Brazilian society is going through an intensive process of transformation, where young adults are increasingly fewer, thus raising the question of who will take care of the elderly in the 21st Century? There is an urgent need to establish care networks for the elderly, covering primarycare, including care with housing (Healthy Housing), as well as to ensure access to secondary and tertiary levels of care, providing early diagnoses and rapid access to treatment. This article reports two Brazilian experiences: the restructuring of a shelter for elderly indigents, with 500 elderly residents in Rio de Janeiro, which involved a broad process of humanization, with strong physical restructuring of the buildingsthat dated from 1930; and the process of organizing the care referral line for the elderly within the Conceição Hospital Group, in Rio Grande do SulState, which included a health care complex with diverse health units, encompassing all stages of care: from primary care to the most complex hospital treatment. (AU)

The benefit system and older people.

This article, brought to you in association with Help the Aged, looks at the maze of benefits available to the older person. There are significant benefits going unclaimed annually. The article provides up-to-date information and useful addresses for making claims and getting professional benefit advice.

A critical review of Singapore's policies aimed at supporting families caring for older members.

This article critically examines the family-oriented social policies of the Singapore government aimed at supporting families caring for older members. The sectors focused on are financial security, health, and housing. Singaporeans have been reminded that the family should be the first line of defense for aging families, followed by the community - the state would step in as the last resort. Drawing from recent research and examination of the state policies, the author argues that more should be done to help family caregivers looking after elder relatives. Recommendations for innovative ways to recognize and reward family carers conclude the paper.

Supporting older people: care needs and care fees.

In this article, brought to you in association with Help the Aged, Phillip Spiers discusses the different options for older people who are not coping at home, and directs carers to sources of financial support with care.

Programa de assistência à saúde do idoso em Manaus em nível ambulatorial: uma análise crítica / Program of attendance to the senior's health in Manaus in level ambulatorial: a critical analysis

Este estudo tem como propósito analisar o Programa de Atenção à Saúde do Idoso - PASI, em nível ambulatorial, no município de Manaus, com base nas políticas públicas de saúde de atenção ao idoso do Ministério da Saúde do Brasil, por intermédio da visão dos gestores e dos usuários do PASI da Secretaria Municipal de Saúde. A amostra é composta pelos 54 usuários enquadrados nos critérios de inclusão e pelos 8 gestores. Foram utilizadas as entrevistas individuais semi-estruturadas e a pesquisa documental. Os dados foram transcritos na íntegra para um editor de texto recebendo exame minucioso através da técnica análise de conteúdo. Os resultados foram extraídos das entrevistas, perfazendo um conjunto de nove grandes temáticas, sendo cinco dos usuários: conhecimento do PASI, oferta organizada, acessibilidade profissional, autopercepção da assistência e melhoria da assistência e quatro dos gestores: política municipal, funcionamento do PASI, assistência integral e análise dos serviços. O conhecimento do PASI evidenciou programas assistenciais (consultas médicas, enfermagem e serviço social; complemento alimentar e medicamentos), atendimento prioritário, atividades extramuros e desconhecimento do próprio PASI. A oferta organizada destacou-se assistência médica, medicamentos, atividades extramuros e desconhecimento de ofertas. A acessibilidade profissional a equipe compreendeu médicos, enfermeiros, assistentes sociais, laboratoristas, agentes comunitários e dentistas. A autopercepção da assistência prestada destacou-se ôbem atendidoö. Para melhoria da assistência os idosos anseiam por mais médicos, remédios e complemento alimentar. Na ótica dos gestores, a política municipal referiu-se aos planos de saúde de 1999-2001 e 2002-2003. O funcionamento do PASI foi feito descritivamente. A assistência integral ao idoso é efetuada por programas e estabelecimento de parcerias. A análise dos serviços enfatizou-se programas oferecidos, necessidade de capacitação e falta de infra-estrutura. Os resultados obtidos evidenciaram a importância de preparar-se qualitativa e quantitativamente para os vindouros perfis demográfico e epidemiológico da população, assim como rever ações e serviços atualmente ofertados aos idosos.

Fonoaudiologia em geriatria: identificando o universo do idoso. Mapa Mínimo de Relações: adaptações de um instrumento gráfico para identificar a rede de suporte social do idoso / Speech pathology in geriatrics: identifying the social universe of the elderly person. Minimum Chart of Relationships: adaptation of a graphic instrument to identify the net of social support of the elderly person

Aborda-se, nesta oportunidade, a importância em se conhecer a rede de suporte social do indivíduo idoso, por representar a base de assistência informal a ele prestada. Utilizando-se do Mapa Mínimo de Relações, propõem-se modificações adquando-o a prestar-se como instrumento gráfico para orientação multiprofissional e multidisciplinar no cuidado e tratamento destes indivíduos. Utilizou-se, para tanto, uma amostragem de 30 idosos divididos em dois grupos etários com idades variando de 60 a 75 anos e de 75 anos ou mais. Este estudo permitiu concluir que o instrumento utilizado mostrou-se útil na identificação do universo de relacionamentos interpessoais na chamada terceira idade, conhecendo-se a composição e funções de cada um dos envolvidos, facilitando a comunicação e o exercício profissional no cuidado com a saúde do idoso.

Una aproximación a la situación de los adultos/as mayores y de las Asociaciones, Clubes y Grupos Parroquiales que los nuclea

Estudio exploratorio de la situación de los adultos/as mayores para analizar sus organizaciones, normasy procedimientos. Describe la creencias, prejuicios y estereotipos de la población urbana paraguaya hacia los adultos mayores, resaltando a aquellos que mantienen nuestra cultura y determinan su estilo de vida. Presenta el análisis del anteproyecto de Ley que estaba en estudio en la Cámara de Senadores

Medición del riesgo funcional en adultos mayores pobres, con un instrumento validado en Canadá / Functional risk assessment of poor Chilean elders using an instrument validated in Canada

Background: Information about medical and social situation of elders is limited in Chile. Aim: To assess the functional risk of Chilean elders using an instrument validated in Canada. Subjects and methods: As part of a project aimed to help poor elders, 2,116 subjects living in Santiago, aged 65 to 99 years old (1,334 female, and 625 older than 75 years old), were interviewed. Results: Thirty percent of these elders were using more than three medications and 13 percent lived alone. Visual problems were detected in 75 percent, memory problems were found in 62 percent, 63 percent felt depressed, 46 percent had hearing problems, 42 percent suffered a fall during the last year, 35 percent had a health problem that forced them to stay at home, 32 percent did not count with help in a case of need, 33 percent referred some type of nutritional problem, 26 percent needed help for daily living activities and 25 percent considered to have a worst health than counterparts of the same age. Among subjects older than 75 years old, the frequency of memory problems, auditory impairment, number of falls, health problems that precluded leaving the house, limitation for daily activities and the use of walking aids, was significantly higher. Although men and women had similar ages, men were in worst functional conditions, and had required more admissions to hospitals. There was a higher proportion of women living alone. Females also had a higher frequency of depression, memory disturbances, falls and use of more than three medications. Conclusions: Women elders tend to be in better functional conditions than men and people older than 75 years old have a higher functional risk. The applied instrument allowed a better focalization of our geriatric program

Creencias, prejuicios y estereotipos de la población urbana paraguaya hacia los adultos mayores

Revisa los mitos, prejuicios y las falsas ideas existentes sobre las personas mayores, como parte de los condicionamientos sociales y confronta conceptos, realidades y capacidades de los adultos mayores dentro de su situación socioeconómico cultural. Expone la trayectoria histórica de los mitos y estereotipos sobre los adultos mayores, resaltando que ellos mantienen nuestra cultura y determinan su estilo de vida