[Embracement with risk classification in the emergency department from the perspective of older adults]. / Acolhimento com classificação de risco em service de emergência na perspectiva do idoso.

OBJECTIVE: To assess practices of embracement at the patient intake area of the emergency department of Porto Alegre Clinicas Hospital from the perspective of the older adults. METHODS: Qualitative investigation using the case study approach with 30 older adults trough semi-structured interview between July by November 2010. Data were assessed by thematic analysis with the Nvivo software suite. RESULTS: Responses focused on wait times and on the role of nurses in patient classification. User embracement practices enhanced the work process and highlighted the direct contact between nurses and users. CONCLUSIONS: The care needs of the older adults, the respect for the assessment protocol intervals and work on internal and external network can be improved in order to qualify attention to these patients.

[Association between the functional capacity of dependent elderly people and the burden of family caregivers]. / Associação entre a capacidade functional de idosos dependents e a sobrecarga do cuidador familiar.

The aim of this study was to characterize dependent elderly people and their main family caregivers and the association between functional capacity of the elderly and the burden of caregivers. This cross-sectional study was conducted with 112 elderly people and caregivers connected to a primary care service in Porto Alegre, Brazil. The applied instruments related to care and socioeconomic variables were Physical and Instrumental Activities of Daily Living (PADL and IADL) and the Burden Interview. The Spearman correlation coefficient was also used. Average age of the elderly individuals in this study was 81.41 years, while the average score for PADL was 10.36 and 6.25 for IADL. Of the 112 elderly individuals, 71.4% had severe dependence. Among caregivers, 75% were women, 61.6% were the sons or daughters with an average age of 57.98 and an average burden of 29.53, which is equivalent to moderate burden. Results revealed a significant correlation between functional capacity of the elderly and caregiver burden. It was verified that the higher the dependence of elderly people, the greater the burden of caregivers.

Effect of Unna's boot on venous ulcer healing: a systematic review and meta-analysis.

OBJECTIVE: To analyze the effect of Unna's Boot on the healing of venous ulcers compared to other therapies. METHODS: Systematic Review carried out in the databases Scopus, Embase, Cochrane Library, Web of Science, PubMed, Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, and grey literature. Population - adult patients with venous ulcers; Intervention- Unna's Boot (UB); Control - other compression therapies (CT); Outcome- healing; Designs- randomized clinical trial, cohort study, and case control, published from 2001 to 2024. The effect of the intervention, risk of bias, and quality of evidence were evaluated. Registered with PROSPERO (CRD42021290077). RESULTS: A total of 39 studies were included, with 5.151 patients. The majority (71.8%) were randomized controlled trials (RCT). UB was used as intervention/control in eight studies. When comparing CTs, only 1 study with UB showed a superior effect (p < .001) in healing, compared with high compression elastic bandage. In the quality of evidence analysis, 27 studies were assessed as having a high risk of bias. CONCLUSION: No superiority of UB was found in the healing of venous ulcers when compared to other CTs.

[Sociodemographics, health, and social support to senior users of emergency services]. / Caracterização sociodemográfica, de saúde e apoio social de idosos usuários de um serviço de emergência.

The aim of this study was to characterize the sociodemographic aspects, health issues and social support offered to the senior users of the Emergency Department of the Hospital de Clinicas in Porto Alegre. A cross-sectional survey was conducted with a random sample of 220 seniors. A structured data form was used to collect data related to the sociodemographic and health characteristics and social support. The majority of subjects were women, married retired,from Porto Alegre, and aged from 60 to 69 years. Almost half reported having poor or very poor health and the prevalent self-reported morbidities were cardiovascular diseases. Differently from other studies with seniors from the community, the majority reported receiving support from family and few provided support. Social support from the formal network was small. Health care must occur in a comprehensive network to provide support to the seniors and their families and to prevent the frequent use of emergency services and to qualify assistance.

Development of an online course for caregivers of older stroke patients.

OBJECTIVE: To describe the development process of a massive, open, and online course for family caregivers of older people who had a medically diagnosed stroke. METHOD: Experience report on the development of a massive, open, and online course. The preparation of the course took place from July 2021 to October 2022 and consisted of the stages:definition and analysis of the contents of the course; construction and approval of the storyboard; digital construction and approval of the early version; making the project available on a digital platform; preliminary evaluation and approval of the final version. RESULTS: The course aims to provide tools for the family care of older people who have suffered a stroke, improving their ability to provide care. It was built in twelve modules, using demonstrative videos, hypertext, pictures, and narrations. CONCLUSION: The course development process required a team with expertise in different areas and had a positive preliminary assessment.

A longitudinal study of burden among spouse and non-spouse caregivers of older adults with stroke-induced-dependency.

OBJECTIVE: to assess the burden of spouse and non-spouse caregivers of older adults with stroke-induced-dependency after discharge from a university hospital's Specialized Care Stroke Unit in southern Brazil. METHODS: a longitudinal survey. The sample consisted of 48 consenting caregivers, among which 20 were spouse caregivers. Data were collected between May 2016 and July 2018. One week after discharge, caregivers completed a sociodemographic profile, the Functional Independence Measure, and the Caregiver Burden Scale. Burden was also measured two months after discharge. Data were analyzed using Multivariate Analyses of Variance. RESULTS: regarding time 1, non-spouse caregivers experienced greater burden with respect to social isolation (p = .01). Along with a persistently greater sense of isolation (p=.04), non-spouse caregivers felt far greater general strain (p =.01). CONCLUSION: statistically significant differences in burden over time highlight the importance of assessing caregiver burden after discharge and the need for a formal support program.

Quality of life in caregivers of aged stroke survivors in southern Brazil: Arandomized clinical trial.

OBJECTIVE: to evaluate the effect of nursing home care interventions on the quality of life in family caregivers of aged stroke survivors. METHOD: a Randomized Clinical Trial, blinded for outcome evaluation. Forty-eighty family caregivers of aged stroke survivors participated in the study. The Intervention Group received three home visits by nurses one month after hospital discharge to provide stroke-related education (i.e., how to access health services and perform care activities) and emotional support. The Control Group received the usual guidance from the health services. Quality of life was assessed using the World Health Organization Quality of Life Assessment (WHOQOL-BREF) instrument and the Old Module(WHOQOL-OLD) 1 week, 2 months, and 1 year after discharge. RESULTS: the caregivers were mainly women, children, or spouses. The caregivers in the Intervention Group and Control Group did not significantly differ in terms of their Overall Quality of Life at baseline. There was no interaction effect between group allocation and Overall Quality of Life(p=0.625) over time. However, there was an interaction effect for Social Relations(p=0.019) and Autonomy (p=0.004). CONCLUSION: the intervention exerted a statistically significant effect on the quality of life of family caregivers with respect to social relationships and autonomy. TRIAL REGISTRATION: NCT02807012.

Effects of the Alpha-Health intervention on elderly's health literacy in primary health care.

OBJECTIVE: to assess the effects of the Alpha-Health intervention on health literacy and health habits of elderly people linked to primary care, when compared to usual health care. METHODS: a quasi-experimental investigation, with mixed methods, with 21 elderly individuals in each group. Alpha-Health was performed by a nurse for five months. The Short Assessment of Health Literacy for Portuguese Speaking Adults, Health Literacy and questions about health habits were used. In the quantitative analysis, the GEE Model was used, and in the qualitative, thematic analysis. RESULTS: there was an interaction effect on health literacy scores. Health habits such as vaccination, three meals a day and meat consumption had a statistically significant interaction effect. In the qualitative stage, development in skills of accessing, communicating and assessing information was observed as well as stability in the ability to understand. CONCLUSIONS: Alpha-Health is an important device for developing elderly's health literacy.

A qualitative study to explore health literacy skills in older people from a disadvantaged community in Brazil.

We aim to describe older peoples' experiences of accessing, understanding, communicating and appraising health information in the context of primary care in a disadvantaged community in North-East Brazil. A qualitative interview study was conducted with 42 older people at two primary healthcare units in the city of Arapiraca, Brazil. Semi-structured interviews were guided by a qualitative health literacy instrument, translated and adapted for use in Brazil. Of the 42 participants, 30 were women and the majority (n = 32) were 60-69 years of age. Qualitative analysis identified that participants had difficulties accessing, understanding and communicating health information, often in the context of chronic disease. Few participants demonstrated an understanding about their specific health concerns, and most had difficulty explaining and interpreting health conditions more generally. Most participants indicated that they did not actively seek health information and this was compounded by physicians who were reported to provide limited information about diagnosis and treatment of health conditions. More than half of the participants reported that they did not understand medical terms included in health information, but most reported that they took no action to clarify understanding. In conclusion, we observed that conventional health literacy skills are very poor in this population of older Brazilians living in a disadvantaged community, with many resigned to not receiving health information or relying on sources other than health professionals. The findings from this study speak to the need for health literacy interventions targeting older adults in Brazil. A two-tiered approach which seeks to reduce the demands and complexities placed upon patients within the healthcare system but also targets interventions toward building the skills and capacities of individuals is likely to be most effective.

Global functionality and associated factors in the older adults followed by Home Care in Primary Health Care.

OBJECTIVE: to analyze the association of global functionality with the main functional systems and the sociodemographic variables of older adults followed by Home Care in Primary Health Care. METHOD: a cross-sectional study with 124 older people developed through home interviews. Functionality was assessed by Basic Activities of Daily Living (Barthel) and Instrumental Activities of Daily Living (Lawton and Brody); the main functional systems were assessed using the Mini-Mental State Exam, by the Timed Up and Go test, by the Geriatric Depression Scale (15 items), and questionnaire with sociodemographic variables. Bivariate and multivariate analyses were applied (Poisson Regression). RESULTS: 46% of the older adults showed moderate/severe/total dependence for basic activities and instrumental activities had a median of 12. In the multivariate analysis, there was an association between moderate/severe/total dependence on basic activities with cognitive decline (p=0.021) and bedridden/wheelchair users (p=0.014). Regarding the dependence on instrumental activities, there was an association with age ≥80 years (p=0.006), single/divorced marital status (p=0.013), cognitive decline (p=0.001), bedridden/wheelchair (p=0.020), and Timed Up and Go ≥20 seconds (p=0.048). CONCLUSION: the decline in cognitive and mobility was associated with poor functionality in basic and instrumental activities. The findings highlight the need to monitor Home Care for these individuals and serve as guidelines for health actions.

Life satisfaction and health self-assessment of older adults assisted through home care.

OBJECTIVE: to identify sociodemographic and health characteristics according to age groups and to analyze the association between self-assessed health status and satisfaction with regular/bad life with sociodemographic characteristics, global functioning and falls of older adults linked to home care within the primary health care network. METHOD: cross-sectional study with 124 older adults, conducted using home interviews. A sociodemographic data and health status questionnaire was used, together with Barthel Index, Lawton Instrumental Activities of Daily Living Scale (IADL), the Mini-Mental State Examination, the Geriatric Depression Scale and the Timed Up and Go Test. Bivariate and multivariate analyses (Poisson regression) were applied. RESULTS: there was a predominance of female octogenarians. Self-assessment of regular/bad health was associated with mild (p=0.002) and severe (p<0.001) depressive symptoms. Satisfaction with regular/bad life was associated with fear of falling (p=0.019) and with mild (p<0.001) and severe (p<0.001) depressive symptoms. CONCLUSION: depressive symptoms were associated with a worse life satisfaction and health self-assessment.

The capacity of informal caregivers in the rehabilitation of older people after a stroke.

OBJECTIVES: To characterize informal caregivers of dependent older people after a stroke related to aspects of care, and to describe the activities performed and the difficulties faced by these caregivers. METHODS: Cross-sectional, descriptive study, held in southern Brazil with 190 informal caregivers of older adults after stroke. The sociodemographic data instrument and the Capacity Scale for Informal Caregivers of Elderly Stroke Patients (ECCIID-AVC), adapted and validated for use in Brazil by Dal Pizzol et al., were used. RESULTS: Most caregivers were women (82.6%) or children (56.3%), had average schooling of 9.6 years, and the majority (68.3%) provided care for people with moderate to severe disability. The main activities carried out included: providing materials and/or support for eating (99%), dressing (98.4%), and administering medications (96.2%). Caregivers had the most difficulty with transferring and positioning activities. CONCLUSIONS: Most caregivers have adequate capacity to provide essential care to the dependent older adult after a stroke. However, a significant portion had difficulty in the activities of transferring and positioning the older person due to the lack of guidance regarding the posture to carry out these activities. The assessment of nurses regarding the activities performed and the difficulties faced by caregivers is an important strategy to identify problems and effectively attend to the needs of these individuals at all levels of health care.

Functional capacity of elder elderly: comparative study in three regions of Rio Grande do Sul.

Study conducted with secondary data from cross-sectional population-based studies developed in three regions of the state of Rio Grande do Sul (RS), which aimed to compare the level of dependency for activities of daily living (ADL) of 155 older persons aged 80 years and over. Demographic data and the ADL scale from the 3 studies were used and a multinomial multivariate logistic regression analysis was carried out. The older persons from the urban region of Porto Alegre/RS and from the Northern region of this state presented significantly higher severe dependency than people from the countryside. The results illustrate the heterogeneity of the aging process. Health policies and actions should be planned for the elder elderly in this state.

[Functional capacity of elder people from a rural community of Rio Grande do Sul]. / Capacidade funcional de idosos de uma comunidade rural do Rio Grande do Sul.

Cross-sectional study, conducted with 34 elder people from a rural community of Rio Grande do Sul, Brazil, in 2008. The objective is to evaluate their functional capacity and to compare interest variables between sexes. The household survey addressed social, economic and demographic variables, aspects related to health/disease, the Mini-Mental State Examination (MMSE) and the Scale of Activities of Daily Living (ADL) of the Older American Resources and Services (OARS). Descriptive statistics were used for data analysis. Compared to men, women were more likely to be more educated, have less community activities, have similar MEEM scores, worst health perception and were more dependent to perform ADL. The peculiarities of rural elder persons are highlighted, as well the need to tailor actions to promote their adaptability in this context and allow the minimization of disabilities.

Adaptation and Validation of the Capacity Scale for Informal Caregivers of Elderly Stroke Patients to be Used in Brazil.

BACKGROUND AND PURPOSE: The Portuguese instrument for informal caregivers' skills providing care of aged people after a stroke (ECPICID-AVC) evaluates the capacities that informal caregivers must have for supporting aged stroke survivors. The purpose was to adapt and validate the ECPICID-AVC to be used in Brazil. METHODS: A methodological study was conducted. RESULTS: The terms with the lowest degree of comprehension were adapted. The factor analysis suggested the exclusion of three items and that the remaining be grouped into six domains. The factor loadings varied from 0.525 to 0.924. The internal intra-assessor consistency was satisfactory (ICC = 0.94, CI 95%). Total reliability was considered excellent (Cronbach's alpha = 0.914). CONCLUSIONS: The ECPICID-AVC is considered appropriate for using in Brazil.

Development and validation a nursing care protocol with educational interventions for family caregivers of elderly people after stroke.

OBJECTIVE: development and validation the content of a nursing care protocol with educational interventions for family caregivers of elderly people after stroke. METHODS: a methodological study conducted in three stages: (1) protocol development through literature review; (2) pretest with multidisciplinary team, analyzed with literature articulation; (3) protocol validation by the Delphi Technique. RESULTS: the protocol was structured in the following areas: Disease Guidelines; Emotional Support; Using the Health Care Network; Diet; Airways; Medications; Hygiene; Skin Care; Disposal; Dressing/Undressing; Positioning and Transfer; Fall Prevention. In the pretest, eight experts assessed protocol clarity and content. In validation, there were two rounds by the Delphi Technique. The validated protocol consisted of 12 domains, containing 42 items and 240 care guidelines. CONCLUSION: the protocol qualifies the transition of care after hospital discharge assisting nurses in home care practice.

Use of health services by elderly people post-stroke: a randomized controlled trial.

AIM: To verify the relation of a nursing home care educational intervention in the use of health services by elderly people post-stroke. METHODS: A randomized controlled trial conducted with 44 family caregivers of elderly people post-stroke. Data was collected between May/2016 and July/2018 in a hospital in the South of Brazil and at the participants' homes. The intervention group (IG=21) received home visits by nurses after hospital discharge. The control group (CG=23) had a conventional follow-up in a conventional health services. The Pearson's Chi-Square Test or the Fisher's Exact Test was performed for assessment of the outcome at 60 days and 1 year after discharge. Clinical Trial registration NCT02807012. RESULTS: There was a significant difference regarding the use of hospital outpatient service (IG=100%, CG=78.3%, p<0.050) 60 days after discharge. CONCLUSION: The great use of outpatient service by the IG demonstrates the effectiveness of nursing educational intervention focused on health care network after discharge.

Burden of informal caregivers of dependent elderlies in the community in small cities.

AIM: To analyze sociodemographic factors and aspects of care related to the burden of informal caregivers of dependent elderlies in the community. METHODS: A cross-sectional study with 125 caregivers. Data collection was carried out in municipalities of the Northwest of Rio Grande do Sul through a structured interview in 2017 and 2018. The Caregiver Burden Inventory was used. The Pearson or Spearman correlation coefficients and t-student test or Analysis of Variance (ANOVA) were done. For the multivariate analysis, Linear Regression was used. RESULTS: Most caregivers were female (73.6%), married (55.2%) and daughters (68.0%). The variables that showed a statistically significant relationship with burden were: caregiver age (p = 0.039), education (p = 0.001), time devoted to care (p = <0.001), kinship degree (p = 0.001), living with the elder (p <0.001), using their income (p = 0.001) and female gender (p = 0.017). CONCLUSION: Women caregivers, with less education, who spend more time in weekly care and lived with the elder presented higher burden.

Filial responsibility: what are the attitudes of adult child caregivers on the institutionalization of aged parents? / Responsabilidade filial: quais as atitudes dos filhos sobre a institucionalização dos pais idosos?

OBJECTIVE: To analyze attitudes of filial responsibility about the institutionalization of aged parents. METHODS: A qualitative descriptive study with intentional sample of 100 caregivers of aged people from two Primary Health Care Units of Porto Alegre/Brazil. The information was collected in 2014, through a semi-structured interview. Thematic analysis was carried out. The NVIVO® software version 10 was used. RESULTS: Two categories were elaborated according to the protocol questions: the possibility of institutionalization of the aged parents and expectation of care. FINAL CONSIDERATIONS: Most adult child caregivers did not consider the institutionalization of aged parents in the reason of a duty they felt to take care of their parents, and the institutionalization was considered as abandonment. Most of the adult child caregivers had an expectation to be cared by their children and perceived the institutionalization as an alternative of receiving this care. The results of the study contribute to the strengthening of the formal and informal network for the aged and their adult child caregiver.

Falls of elderly people living in rural areas: prevalence and associated factors.

OBJECTIVE: to identify the prevalence and factors associated with falls in the elderly population living in rural areas. METHOD: this is a cross-sectional study, carried out in 2014, with 820 older adults recorded in the Family Health Strategy (Estratégia Saúde da Família). The association between the reporting of falls in 12 months and their associated factors was verified by the Chi-square and Fischer's exact tests and by multivariate logistic regression analysis. RESULTS: the majority of the sample was female (56.1%), white (90.2%) and aged 60-69 years (54.9%). The prevalence of falls was 27.9%, and being female, hypertensive and diabetic was associated to falls. CONCLUSION: it is the responsibility of health professionals to have a closer look at the elderly who have these chronic diseases, especially within the scope of the Family Health Strategy, which works longitudinally with these patients, in addition to improving nursing care aimed at this population.