Fatores associados à doença renal crônica em idosos cuidadores de idosos / Factores asociados con la enfermedad renal crónica en ancianos cuidadores de ancianos / Factors associated with chronic kidney disease in older adult caregivers of elderly people

RESUMO Objetivo: identificar os fatores associados ao desenvolvimento de doença renal crônica em idosos cuidadores de idosos. Método: estudo transversal, realizado no período de janeiro a setembro de 2019 com 111 idosos cuidadores familiares de idosos da atenção primária à saúde. Para a coleta de dados, foram utilizados o Questionário de Caracterização Sociodemográfica, de Saúde e do Contexto do Cuidado, a Triagem para Doença Renal Oculta, o Exame Cognitivo de Addenbrooke - Versão Revisada, a Escala de Depressão Geriátrica, o Inventário de Sobrecarga de Zarit e a Escala de Estresse Percebido. Foi realizada estatística descritiva e análise múltipla de regressão logística pelo método stepwise forward (p<0,05). Todos os preceitos éticos foram observados. Resultados: a amostra apresentou predomínio de mulheres, casadas, que ofertavam o cuidado ao cônjuge. Através da triagem para doença renal crônica, constatou-se que 99,1% dos participantes apresentaram alta predisposição para o desenvolvimento da doença renal crônica. Cada acréscimo no número de medicamentos aumenta 1,257 vezes a chance de os idosos cuidadores desenvolverem doença renal crônica. Conclusão: houve predominância de alta predisposição para doença renal crônica na amostra de idosos cuidadores, e o número de medicamentos em uso foi o fator associado a esta predisposição.

RESUMEN Objetivo: identificar los factores asociados al desarrollo de enfermedad renal crónica en ancianos cuidadores de ancianos. Método: estudio transversal, realizado en el período de enero a septiembre de 2019 con 111 ancianos cuidadores familiares de ancianos de la atención primaria de salud. Para la recolección de datos, fueron utilizados el Cuestionario de Caracterización Sociodemográfica, de Salud y del Contexto del Cuidado; la Detección de Enfermedad Renal Crónica Oculta; el Test Cognitivo de Addenbrooke - Versión Revisada; la Escala de Depresión Geriátrica; la Escala de Sobrecarga del Cuidador de Zarit y la Escala de Estrés Percibido. Se realizaron estadística descriptiva y análisis múltiple de regresión logística por el método stepwise forward (p<0,05). Todos los preceptos éticos fueron observados. Resultados: la muestra presentó predominio de mujeres, casadas, que ofrecían el cuidado al cónyuge. A través de la clasificación de enfermedad renal crónica, se constató que el 99,1% de los participantes presentó alta predisposición para el desarrollo de la enfermedad renal crónica. Cada aumento en el número de medicamentos aumenta 1,257 veces la probabilidad de que los cuidadores mayores desarrollen enfermedad renal crónica. Conclusión: hubo predominancia de alta predisposición para enfermedad renal crónica en la muestra de ancianos cuidadores, y el número de medicamentos en uso fue el factor asociado a esta predisposición.

ABSTRACT Objective: to identify factors associated with the development of chronic kidney disease in older adult caregivers of elderly people. Method: cross-sectional study, carried out from January to September 2019 with 111 older adult family caregivers of elderly people in primary health care. For data collection, the Sociodemographic, Health and Care Context Characterization Questionnaire, the Screening for Occult Kidney Disease, the Addenbrooke Cognitive Examination - Revised Version, the Geriatric Depression Scale, the Zarit Burden Inventory and the Perceived Stress Scalewere used. Descriptive statistics and multiple logistic regression analysis were performed using the stepwise forward method (p<0.05). All ethical precepts were observed. Results: the sample showed a predominance of women, married, who offered care to their spouse. Through screening for chronic kidney disease, it was found that 99.1% of the participants had a high predisposition to the development of chronic kidney disease. Each unit of increase in the number of drugs increased the chance of older adult caregivers developing chronic kidney disease by 1,257 times. Conclusion: there was a predominance of high predisposition to chronic kidney disease in the sample of older adult caregivers and the number of drugs in use was the factor associated with this predisposition.

El cuidado del adulto mayor en la atención primaria en salud en tiempos de COVID-19 / Elderly care in primary health care in times of COVID-19

Por ende, la comunidad de enfermeras que conforma la Red de Salud del Adulto Mayor (REDESAM ­ Brasil), en alianza con las 12 Redes de América Latina, propusieron la elaboración de este E-book, titulado "El Cuidado del Adulto Mayor en la Atención Primaria en Salud en Tiempos de COVID-19". Teniendo como objetivo contemplar a las enfermeras de América Latina y Portugal junto a sus propuestas de intervención en enfermería para la Atención Primaria en salud del adulto mayor durante el período pandémico y post-pandémico de COVID-19; Es evidente que el futuro de la Enfermería Gerontológica ha llegado, incluso de cara a la adversidad de la sociedad. En el actual contexto, sociodemográfico, pandémico y de evolución tecnológica, se ha destacado a un grupo de población con mayor riesgo de vulnerabilidad (física, social y emocional) en las diversas dimensiones humanas: "El Adulto Mayor". La esperanza de vida y el número de personas adulto mayor ha aumentado exponencialmente a un ritmo que exige y urge un movimiento de la sociedad en busca de estrategias que conduzcan a nuevas y mejores formas de vida. Ante esta perspectiva, la Red de Salud del Adulto Mayor (REDESAM ­ Brasil), en conjunto con algunos profesionales de esta en América Latina se han comprometido a incrementar y avanzar en el desarrollo de la investigación y la difusión de nuevas estrategias asistenciales para el control de la pandemia COVID-19. Recientemente, la pandemia de COVID-19 impuso una carga de trabajo adicional a los profesionales de la salud, especialmente a los enfermeros. Cada día, han demostrado su fuerza de trabajo en la asistencia y en el descubrimiento de nuevas formas de enseñar e investigar temas sobre el Adulto Mayor, dándole una gran visibilidad social a dicha profesión.

Staffing policy in aged care must look beyond the numbers.

The COVID-19 pandemic has highlighted an aged care system struggling to meet the needs of vulnerable Australians. Staffing levels and skill mix in aged care have declined, whereas the health and social needs of an older and more clinically complex population have risen. Increasing staff and improving personal care workers' skills and education are essential steps to quality aged care in Australia, but it will not be possible without funding models that foster secure employment, development opportunities and long-term career pathways.

Percepção da equipe multiprofissional sobre a contenção mecânica de idosos: paradoxos do cuidado / Perception of a multidisciplinary team on physical restraint use on older adults: care paradoxes

OBJETIVO: Descrever a percepção da equipe multiprofissional sobre o uso da contenção mecânica em idosos. METODOLOGIA: Pesquisa qualitativa realizada com 58 profissionais da área da saúde em duas Instituições de Longa Permanência para Idosos localizadas no estado do Rio de Janeiro, Brasil. Utilizou-se entrevista semiestruturada, com análise temática do conteúdo. O período de coleta de dados foi de novembro de 2017 a junho de 2018. RESULTADOS: Foram identificadas 21 unidades de registro, organizadas em três categorias: percepção da equipe sobre as consequências e riscos do uso da contenção mecânica: o paradoxo da segurança do paciente; implicações na decisão da contenção mecânica de idosos; e estratégias para conter e não conter. CONCLUSÕES: Os achados refletem a necessidade de capacitação dos profissionais no que tange às estratégias de cuidado alternativas, livres de contenção, como parte da promoção de uma cultura de cuidado que respeite o direito à liberdade e a dignidade das pessoas, especialmente as mais vulneráveis.

OBJECTIVE: To describe the perception of a multidisciplinary team on the use of physical restraint in older adults. METHODS: Qualitative research conducted with 58 health professionals in two long term care facilities for older adults located in the state of Rio de Janeiro, Brazil. Semi-structured interviews were further analyzed using thematic content analysis. The data was collected from November 2017 to June 2018. RESULTS: Twenty-one initial codes were identified and organized in three categories: team perception of the consequences and risks of a physical restraint (the patient's safety paradox); implications of the decision of physical restraint of the older adults; and strategies to restrain and not restrain. CONCLUSIONS: The results reinforce the need for training of professionals on restraint-free alternatives of care, as part promoting a culture of care that respects the right to freedom and the dignity of people ­ especially the most vulnerable ones.

Structure evaluation of the implementation of geriatric models in primary care: a multiple-case study of models involving advanced geriatric nurses in five municipalities in Norway.

BACKGROUND: The Advanced Geriatric Nurse role recently has been introduced into Norway's primary healthcare system, and our study's purpose was to examine the implementation of models of care developed for Advanced Geriatric Nurse in primary care. With a structure evaluation, we tried to identify conditions that affect the implementation of different models of care and understand how these conditions affected the realisation of each model's intentions and goals. METHODS: An embedded multiple-case study was used that included five Norwegian municipalities and seven AGNs. The study included data from August 2014 through September 2018. We used data from 25 semi-structured face-to-face interviews with AGNs and stakeholders, documents and statistical information. We used a cross-case procedure with an emphasis on case findings for the analysis of the multiple case study. RESULTS: We analysed the structure-related conditions on two levels: the meso-level and the micro-level. On the meso-level, we found that the conditions that affected the implementation of the different models of care were related to each municipality's structure characteristics, stakeholders' involvement in the design of the models of care, the clarity of the models and their goals, the evaluation of the models and their adaptation. At the micro-level, we found that the conditions that affected the models' implementation were related to the collaboration within the implemented models of care, the role clarity of Advanced Geriatric Nurses themselves and adjustments within the models. CONCLUSIONS: The implementation of the AGN role in Norway seems to have been implemented in ways that can impact patients and municipalities positively. Potential improvements include extensive stakeholder involvement, improved roles, goal clarity and better documentation of structures and outcomes. The models' dynamic nature seemed to be a beneficial characteristic, but adaptation should be systematic and a necessary time should be considered for a new model of care to be integrated and produce results.

Family- and Person-Centered Interdisciplinary Telehealth: Policy and Practice Implications Following Onset of the COVID-19 Pandemic.

With the onset of the COVID-19 pandemic, telehealth was thrust to the forefront, becoming one of the most predominant forms of care almost overnight. Despite years of research, practice, and policymaking, tenets for providing telehealth in an interdisciplinary, family- and person-centered fashion, and across a wide breadth of settings remain underdeveloped. In addition, although telehealth has the potential to increase equity in care, it can also further exacerbate disparities. The current article discusses the opening created by the pandemic and provides recommendations for how to make permanent changes in telehealth policy and practice to allow for interdisciplinary, person- and family-centered care while also taking care to address issues of equity and ethics and privacy issues related to telehealth and remote monitoring. [Journal of Gerontological Nursing, 46(9), 9-13.].

Visionaries in geriatric nursing: A legacy for the future.

There are many nurses who had a significant impact on the development and growth of gerontological nursing. There are those that provided the foundation and were the building blocks of gerontological nursing. Those following served as the cornerstones to fortify the foundation of gerontological nursing. Today there are rising scholars serving as the stepping-stones for the future of gerontological nursing. This article highlights the exemplary gerontological nurses that contributed and are contributing to the research, practice, and education of the mature specialization of gerontological nursing.

Gerontological nursing: Growth, adaptation and change after John A. Hartford Foundation investments.

This article chronicles the John A. Hartford Foundation (JAHF) funded gerontological nursing initiatives 1996-present. These initiatives, in particular BAGNC, were designed to impact the health of older adults through building gerontological nursing capacity by preparing new and retooling current faculty with expert gerontological nursing competencies, preparing new researchers, developing a knowledgeable nurse workforce with competency in gerontological nursing and prepare leaders in academics and health care systems. A description of major programs funded by the Foundation is presented and the impact, adaptation, and change in gerontological nursing resulting from over $86 million in funding awarded to these efforts is examined and intended to inform our way forward. NHCGNE, Legacy Affiliates and partners named in this article continue to innovate and transform healthcare systems as a way forward.

Care providers' troubled conscience related to an implementation of a time management system in residential care for older people-a participatory action research study.

BACKGROUND: Care providers in residential care for older people often refer to time shortage, a problem that may generate troubled conscience. AIM: The aim of the study was to describe a PAR process to assist care providers in municipal residential care for older people to constructively deal with their troubled conscience related to an implemented time management system. METHOD: This intervention study was carried out with 14 care providers and their manager in residential care for older people with the support of participatory action research (PAR). The recorded PAR sessions were transcribed and compiled with inspiration from content analysis. ETHICAL CONSIDERATIONS: The participants were given oral and written information and gave their written informed consent. FINDINGS: The PAR process was found to empower the participants to form their own structure of the practical professional planning, adapted to the residents needs and to their daily work. In this process, participants used their troubled conscience as a driving force and as an asset. CONCLUSION: Instead of launching change without any deeper information, it is important to carefully prepare, involve and inform those who are going to execute the change. Meeting places should be arranged wherein care providers have the opportunity to share and reflect on challenging situations that can generate troubled conscience, especially when comprehensive changes in their work are going to be implemented.

[The organization of medical nurse support of patients of elderly age in geriatric practice].

In recent years, the concept of nursing process has been actively introduced. It is especially important in geriatric practice, where the issues of nursing support prevail over those in the young and middle age. There are forms of organization of care, where it is the average medical staff is leading in the provision of medical care (hospices, nursing care hospitals, homes for the elderly, etc.). In these conditions, the responsibility of nurses in making and implementing medical decisions in the event of emergency conditions increases.

Partnership integration for rural health resource access.

Increasing numbers of older adults are residing in rural areas of the USA. Many of these individuals experience greater rates of chronic diseases and lower income levels compared to their urban-residing counterparts. Aging in rural environments creates greater challenges in the provision of funding, staff and resources to meet the needs of these older adults, and contributes to immense health disparities and health inequities. Urban and rural older adult residents alike need healthcare, gerontological and public health resources to promote successful aging in place. Due to the nature of rural environments, many of these resources often exist great distances from these residents, which creates access challenges. There are also limitations in locally available facilities and trained practitioners, resulting in resource shortages for addressing chronic health conditions. The creation and use of interdisciplinary partnerships provides this much-needed support while addressing ever-increasing funding and staffing limitations. This article provides an innovative conceptual interdisciplinary partnership model that combines nursing, public health and gerontology to address the health and social challenges that rural-residing older adults face. Although well-trained practitioners who work within their discipline are an important contributor to assist with the needs of rural-residing older adults, this silo approach is expensive, inefficient, and clearly cannot support all of the needs for older adults in this type of environment. There is a need to blend the complementary skills provided by each of the presented disciplines so that the focus of the interdisciplinary partnership is on person-centered care addressing the health disparities and health inequities experienced by these older adults. To illustrate the integration of nursing, public health and gerontology disciplines, these disciplines are initially combined and presented as dyads, and are then incorporated into the full conceptual model. The dyads are public health and gerontology, public health and nursing, and gerontology and nursing. Steps are provided for the development of this (or any) interdisciplinary partnership. An example of the model's use through clinical and non-clinical disciplines and a community engagement framework is also described. Interdisciplinary approaches focused on person-centered care provide more well-rounded health and social support for rural older adults than any one discipline in isolation. Allocation of shared resources, roles, responsibilities and expenses allows practitioners engaged in interdisciplinary teams to provide superior economic and capacity efficiency. This efficiency is crucial at a time when many entities experience limitations in sustainable resources. Thus, practitioners and community agencies collaborating through interdisciplinary partnerships are better able to address the complex issues experienced by rural-residing community members.

Student Nurses' Perceptions About Older People.

Educating nursing students about the ageing population is situated within negative societal, heath care and nursing perceptions. A cross-sectional design using Burbank's perceptions towards older people scale was used to survey students in a pre-licensure nursing program in western Canada. Findings revealed that students' perceptions about older people were lower in the third year of the nursing program and after four clinical experiences. We suggest that students' first experiences in long-term care settings, in which they learn to provide basic care to older people, be balanced with experiences of older people in a variety of settings. Such experiences would allow students to develop the knowledge and skill needed to work with an ageing population with complex healthcare needs. More research is needed to better understand students' experiences and perceptions about where in the program more learning strategies about how to best work with older people would be helpful.

Intentional Rounding With Certified Nursing Assistants in Long-Term Care: A Pilot Project.

Intentional rounding (IR) is a strategy used by predominately acute care nursing staff to proactively address patients' needs at regular and consistent intervals. The current project piloted the use of IR with certified nursing assistants (CNAs) on a 60-bed unit of a 120-bed skilled nursing facility (SNF). Using a pre/post intervention design and the Plan-Do-Study-Act (PDSA) framework, the authors measured knowledge of IR's "4Ps" (potty, position, possessions, and pain) and the incidence of falls and lost possessions. Uptake of IR over 10 weeks of implementation and CNAs' perceptions of intervention were also assessed. The pilot showed positive outcomes for each of the five aims. Data suggest that IR was well received by CNAs and changed practice patterns regarding quality, safety, and satisfaction. Based on these findings, replication of this project in other SNFs is recommended, given the current small and underpowered study. [Journal of Gerontological Nursing, 45(6), 15-21.].

The Family in Europe: Structure, Intergenerational Solidarity, and New Challenges to Family Health.

Understanding the family experience of health and illness within the family's social and cultural context helps health professionals understand a family's stories. The purpose of this article is to present salient characteristics of the Western European family to extend understanding about family structure and values in relation to caring and intergenerational solidarity. The goal is to provide nurses and other health professionals with culturally competent knowledge that can inform practice with families. Evidence suggests that a family model, characterized by strong-family type societies consisting of coresidence, solidarity, and intergenerational relationships, stalwartly continues in Mediterranean countries. However, due to the recent economic crisis in Spain and other European countries, there is a trend toward the withdrawal of state responsibility toward the family, and an increasing weight on families' responsibility, particularly for women, toward the care of their old and chronically ill relative. Therefore, there is a need to make health and social systems more effective, sustainable, and focused on family care.