Prevalência e fatores associados à dependência funcional em idosos restritos ao lar / Prevalence and factors associated with functional dependency in homebound elderly people in Brazil

INTRODUCTION: Population ageing is a worldwide reality that requires attention, and a concern for healthy and functional ageing is increasingly the focus of government policies and programmes. OBJECTIVE: To identify the prevalence of homebound elderly people, and the influence of sociodemographic and economic characteristics on their functional dependency. METHODS: Cross-sectional study with 178 homebound elderly people assisted by a family healthcare unit in Vitória, ES, Brazil. Functional independence was measured by the Functional Independence Measure (FIM) and the sociodemographic and economic variables were collected by a questionnaire developed by the authors. Binary logistic regression was used to determine the influence of the sociodemographic and economic characteristics on the risk of being functionally dependent. RESULTS: Forty-eight percent of the participants were functional dependents, 80% were female, 72% belonged to the fourth age, 74% were white, 63% were widowed, 78% had retired, 90% had children, 83% had a caregiver, 52% had low education and 40% had low income. Logistic regression indicated that having a caregiver increased by 40 times the chance of being functionally dependent (OR = 40.2; 95%CI 4.8-355.4) and having between one to eight years of education decreased the chance of functional dependency (OR = 0.2; 95%CI 0.04-0.9). CONCLUSIONS: The prevalence of functional dependency was very high in this sample, and since the presence of a caregiver was the strongest and significant predictor of functional dependency, we suggest that guidance and support should be offered to caregivers, followed by a family healthcare strategy, to make consistent efforts with the objective of improving functional recovery and independence of homebound elderly.

INTRODUÇÃO: O envelhecimento populacional é uma realidade de proporções mundiais que requer atenção, e a preocupação com o envelhecimento saudável e funcional é cada vez mais o foco de políticas e programas do governo. OBJETIVO: Verificar a prevalência e influência dos fatores sócio demográficos e econômicos na dependência funcional em idosos restritos ao lar. MÉTODO: Estudo transversal com 178 idosos restritos ao lar assistidos por uma Unidade de Saúde da Família de Vitória-ES. Aferiu-se a dependência funcional através da Medida de Independência Funcional e coletou-se variáveis para caracterização o perfil dos idosos. Utilizou-se a Regressão Logística Binária para determinar o nível de predição da dependência funcional. RESULTADOS: Quarenta e oito por cento dos idosos apresentavam dependência funcional, 80% eram do sexo feminino, 72% na 4º idade, 74% brancos, 63% viúvos, 78% aposentados, 90% com filhos, 83% com cuidador, 52% com baixa escolaridade e 40% com baixa renda. A presença de cuidador se comportou como preditor da dependência funcional (OR=40.2; IC95% 4,8-355,4) e a escolaridade entre 1 e 8 anos se mostrou como fator de proteção (OR=0,2; IC95% 0,04-0,9). CONCLUSÃO: A prevalência dependência funcional mostrou-se elevada, e a presença de cuidador figurou como um forte e significante preditor, propõe-se o estabelecimento de 'suporte' para o cuidador mediado pelas equipes da Estratégia Saúde da Família para manutenção/recuperação da funcionalidade dos longevos.

Salud Oral en Adultos Mayores Postrados / Oral Health in Homebound Elderly Adults

La población de adultos mayores ha aumentado en los últimos años y se hace imprescindible determinar su estado de salud oral con el objetivo de orientar la atención de salud con base científica epidemiológica para brindarles una mejor calidad de vida. El objetivo de este trabajo fue evaluar el estado de la salud oral de los pacientes adultos mayores postrados. Se realizó un estudio descriptivo de corte transversal no probabilístico. Los datos fueron obtenidos del universo de pacientes inscritos en el programa de Atención Domiciliaria del Paciente Postrado de un centro de atención primaria. La tasa de respuesta obtenida fue 90%. El sexo predominante fue femenino; la media de edad fue 80 años; 60,9% sólo tuvo acceso a la educación primaria. La prevalencia de caries fue 100% y COPD de 25,6. El 40,6% se encontraba completamente edentulo y el 54,7% era portador de prótesis dental. El 32,8% presentaba restos radiculares. El 64,7% era capaz de cepillar sus dientes por sí mismo. El 79,4% consideraba tener una pobre salud oral. El cuidador resultó ser la hija, de aproximadamente 53 años, con nivel educacional bajo. Los adultos mayores son un grupo con gran daño odontológico, con escasos dientes remanentes y deficientes prácticas de higiene oral. Son cuidados por familiares con bajo nivel educacional.

The elderly population is on an increase and it is important for us to know the status of their oral health in order to direct our attention to epidemiological aspects on a scientific basis to provide a better quality of life. The purpose of this study was to evaluate the status of oral health of the homebound elderly. A Cross sectional study was conducted using a non-probability sampling method. The data was collected from bedridden patients enrolled in a Patient Home Care in a Primary Care Center. The response rate obtained was 90%. The majority of patients were female; their average age was 80. Only 60.9% of those surveyed had access to primary education. The prevalence of caries was 100% and the DMFT index was 25.6; 40.6% were edentulous and 54.7% had dentures. The 32.8% had root fragments; 82.8% were able to brush their teeth by themselves. 79.4% were observed to have poor oral health. In almost all cases, the caretaker was a daughter around 53 years of age, with low education level. The group surveyed had significant dental damage, had only a few remaining teeth and observed poor oral hygiene practices. Their care was also almost exclusively in the hands of family members who had a low education level.

Comparison of Nutrient Intake and Meal Service Satisfaction of Elderly at the Local Community Centers:Free and Reduced Meal Service Charge / 대한지역사회영양학회지

The purpose of this study was to compare the nutrient intake and foodservice satisfaction of homebound elderly had lunch at the local community centers by the difference of meal service charge. Two local community center with congregate meal service program located in Daegu and Gyongsan were selected; one with free of meal service charge (F), and the other with 500-1,000 won for meal service charge (K). According to the dietary assessment, energy and nutrient intakes of the 156 elderly subjects were as a whole under the Korean Recommended Dietary Allowance (RDA). Elderly of F service center showed higher % RDA for the selected nutrients and MAR (mean adequacy ratio) than those of K service center (p<0.001). Participants were satisfied with most of the congregation meal service from community center with different reasons such as 'tasty (K service center)' and 'free of charge (F service center)'. In conclusion, elderly had the lunch at the community center with free of meal service charge was poor nutrition status and lower socioeconomic level than the other type of community center in this area. Therefore, healthy menu for elderly should be developed and managed by professional dietitian, as well as its impact on health status of this group, and congregate meal service system might be extended to the homebound elderly of whole community with free of charge.

Comparison of Nutrient Intake and Meal Service Satisfaction of Elderly at the Local Community Centers:Free and Reduced Meal Service Charge / 대한지역사회영양학회지

The purpose of this study was to compare the nutrient intake and foodservice satisfaction of homebound elderly had lunch at the local community centers by the difference of meal service charge. Two local community center with congregate meal service program located in Daegu and Gyongsan were selected; one with free of meal service charge (F), and the other with 500-1,000 won for meal service charge (K). According to the dietary assessment, energy and nutrient intakes of the 156 elderly subjects were as a whole under the Korean Recommended Dietary Allowance (RDA). Elderly of F service center showed higher % RDA for the selected nutrients and MAR (mean adequacy ratio) than those of K service center (p<0.001). Participants were satisfied with most of the congregation meal service from community center with different reasons such as 'tasty (K service center)' and 'free of charge (F service center)'. In conclusion, elderly had the lunch at the community center with free of meal service charge was poor nutrition status and lower socioeconomic level than the other type of community center in this area. Therefore, healthy menu for elderly should be developed and managed by professional dietitian, as well as its impact on health status of this group, and congregate meal service system might be extended to the homebound elderly of whole community with free of charge.

Analyzing the Operational Differences of Foodservice Center for Homebound elderly by the Presence of the Dietitian

The purposes of this study was to analyze the operational difference of foodservice center for homebound elderly by the presence of the dietitian. The questionnaire was developed to measure all variables for menu management and distributed to 103 meal service centers in charge of congregate meal service program and 57 centers for home-delivered meal service program. The data of 160 centers in charge of congregate meal service and home-delivered service centers were usable for analysis. Statistical data analysis was completed using the SAS 8.1 package program for descriptive analysis and chi-square test. Only 21.9% meal service centers had dietitians, what is more, they were not professionals who did menu management but foodservice managers, volunteers, cook or social workers. The current foodservice programs for the homebound elderly were operated without professional. In the part of menu managemet, dietitians were more actively involved in menu planning in the elderly foodservice center in the presence of the dietitians. The performance level of healthcare service was not significantly different, but the nutrition education in the elderly foodservice center with the dietitians was more frequently performed than that without the dietitians(p<0.05). In the food purchasing and food production management, the significant differences were shown that in the elderly foodservice centers in the presence of the dietitians, the proportion of the contract purchasing was significantly higher than that of direct purchasing(p<0.01). In food sanitary management, the significant differences were not shown in the part of management of keeping meal for identifying the cause of food-borne illness and left-over, but the sanitation education for the foodservice employees was performed more frequently by the presence of the dietitians(p<0.01). In conclusion, the foodservice management was more systematically conducted in the elderly foodservice centers in the presence of the dietitians than that without dietitians. The elderly foodservice program has offered the health-related support for homebound elderly. Although there were several problems in elderly foodservice management, the program delivered well-targeted, effective, and efficient nutrition services and wide range of supportive service to the at-risk older population. It needs to be managed by professional for the improvement in the elderly foodservice.

Analyzing the Operational Differences of Foodservice Center for Homebound elderly by the Presence of the Dietitian

The purposes of this study was to analyze the operational difference of foodservice center for homebound elderly by the presence of the dietitian. The questionnaire was developed to measure all variables for menu management and distributed to 103 meal service centers in charge of congregate meal service program and 57 centers for home-delivered meal service program. The data of 160 centers in charge of congregate meal service and home-delivered service centers were usable for analysis. Statistical data analysis was completed using the SAS 8.1 package program for descriptive analysis and chi-square test. Only 21.9% meal service centers had dietitians, what is more, they were not professionals who did menu management but foodservice managers, volunteers, cook or social workers. The current foodservice programs for the homebound elderly were operated without professional. In the part of menu managemet, dietitians were more actively involved in menu planning in the elderly foodservice center in the presence of the dietitians. The performance level of healthcare service was not significantly different, but the nutrition education in the elderly foodservice center with the dietitians was more frequently performed than that without the dietitians(p<0.05). In the food purchasing and food production management, the significant differences were shown that in the elderly foodservice centers in the presence of the dietitians, the proportion of the contract purchasing was significantly higher than that of direct purchasing(p<0.01). In food sanitary management, the significant differences were not shown in the part of management of keeping meal for identifying the cause of food-borne illness and left-over, but the sanitation education for the foodservice employees was performed more frequently by the presence of the dietitians(p<0.01). In conclusion, the foodservice management was more systematically conducted in the elderly foodservice centers in the presence of the dietitians than that without dietitians. The elderly foodservice program has offered the health-related support for homebound elderly. Although there were several problems in elderly foodservice management, the program delivered well-targeted, effective, and efficient nutrition services and wide range of supportive service to the at-risk older population. It needs to be managed by professional for the improvement in the elderly foodservice.

Analyzing the Current Congregate Meal Service Program for Homebound Elderly / 대한지역사회영양학회지

The purpose of this study is to examine the current congregate meal service program for homebound elderly. One hundred three meal service centers in charge of the congregate meal service programs as part of the elderly foodservice program were surveyed for administrative structure, menu management, food purchasing and production management, hygiene, equipment, and facilities. Statistical data analyses were completed using the SAS 8.1 program for descriptive analysis and ANOVA. The meal cost of 54.4% of the congregate meal service centers ranged from won1,500 to won1,999 per meal. According to the menu analysis, all nutrients except calcium and Vitamin B2 were at levels of more than 33% of the Recommended Dietary Allowances for Koreans. A total of 81.5% of the centers were operated without the services of a dietitian, and food purchasing, menu planning and other food-service management processes were handled by non-professionals, such as volunteers, cooks or social workers. Although 88.3% of the centers required a therapeutic diet menu for the health of the elderly, most directors (77.6%) replied that in their current status they could not afford to serve therapeutic diets. These results suggest that financial and systematic supports by government is very necessary. Fifty-five percent of the centers never used standard recipes. For determining portion sizes, 93.2% of the congregate meal service centers depended on the personal experience of the personnel. Finally, the current congregate meal services for the homebound elderly were not operated systematically. To improve the elderly food service program, it is strongly recommended that it be managed by professionals.

Analyzing the Current Practice of the Home-Delivered Meal(HDM) Service Program for Homebound Elderly / 대한지역사회영양학회지

The purpose of this study was to research the current home delivered meal (HDM) service programs for seniors living in the community. Fifty seven centers which operated a HDM service program were surveyed with respect to their administrative structure, menu management, food purchasing and production management, hygiene and equipment and facility. -Statistical data analyses were completed using the SAS 8.1 program for descriptive analysis and t-test. The results showed that 55 percent of the study group were from 70 to 79 years old. All of the participants received free HDM. As a result of the meal cost analysis, the meal cost at 56.1% of the HDM service centers was from won2,000 to won2,499 per meal. A total of 68.4% of the HDM service centers were operated without the services of a dietitian. According to the menu analysis, all nutrients except Vitamin B2 were at levels of more than 33% of the Recommended Dietary Allowances for Koreans. Although 96.6% of the HDM service centers required a therapeutic diet menu for the health of the elderly recipients, 68% of the directors responded that they could not afford to serve therapeutic meal. Food purchasing, menu planning and other foodservice management processes were handled by non-professionals, such as volunteers, cooks or social workers. Forty two percent of the HDM service centers never used standard recipes. For determining portion sizes, 75.4% of the HDM service centers depended on personal experience. Finally, the current HDM service programs for the homebound elderly were not operated systematically. It is suggested that professionally trained personnel should be included among the staff members to provide a more effective HDM service. The HDM service programs should be supported financially and systematically by the government.