Health care network model for older adults: a co-creation and participatory action research approach / Modelo assistencial à saúde do idoso em rede: uma abordagem de cocriação e pesquisa-ação participativa

OBJECTIVE: To develop a collaborative, multidisciplinary care model for older adults that improves interdisciplinary teamwork and increases access to specialized services for frail patients, helping solve management problems in the Brazilian Unified Health System. In the state of Bahia, the health care network for older adults requires better interaction and integration with the Unified Health System and the Unified System of Social Assistance to improve patient flow in the network. METHODS: We used a co-creation and participatory action research approach based on reflection, data collection, interaction, and feedback with participants and stakeholders. Data was collected from health professionals, representatives of health agencies, and older adults through collective and individual interviews, reflective diaries, and direct communication. RESULTS: An action plan involving members of the older adult care network was developed to put the new model into practice. A pilot study with a multidisciplinary team allowed adjustments and implementation of the model at our institution. CONCLUSIONS: The new model improved both the internal management of the State Reference Center for Older Adult Health Care (Centro de Referência Estadual de Atenção à Saúde do Idoso - CREASI) and its interaction with primary care, optimizing patient flow and establishing rules for shared management between CREASI and primary care institutions. In view of this, restructuring the care model reorganized relations between the agencies, expanding CREASI's role in the management and systematization of older adult health.

OBJETIVO: Desenvolver um modelo assistencial colaborativo, multiprofissional e centrado na pessoa idosa para melhorar o trabalho em equipe interdisciplinar e o acesso de idosos frágeis ao serviço especializado, ajudando na resolução de problemas com o gerenciamento do idoso no Sistema Único de Saúde (SUS). A rede de assistência à saúde do idoso na Bahia requer avanços na interação e na integração entre os órgãos do SUS e do Sistema Único de Assistência Social para melhorar o fluxo dos pacientes na rede. METODOLOGIA: Foi realizada uma pesquisa-ação participativa e cocriação baseadas na reflexão, coleta de dados, interação e feedback com participantes e partes interessadas. A coleta dos dados foi realizada com os profissionais de saúde, representantes dos órgãos de saúde e idosos por meio entrevistas coletivas e individuais, diários reflexivos e registros de comunicação direta. RESULTADOS: Foi elaborado um plano de ação com participação dos membros da rede de assistência ao idoso para colocar em prática o novo modelo. Realizou-se um piloto com uma equipe multidisciplinar que possibilitou ajustes e a implementação do modelo na instituição. CONCLUSÕES: O novo modelo favoreceu tanto o gerenciamento interno do Centro de Referência Estadual de Atenção à Saúde do Idoso (CREASI) como a interação com a atenção básica, otimizando o fluxo de pacientes e estabelecendo regras de gerenciamento compartilhado entre CREASI e atenção básica. Diante disso, a reestruturação do modelo assistencial representou uma reorganização das relações entre os órgãos, ampliando o papel do CREASI no gerenciamento e na sistematização da saúde do idoso.

Prevalence of falls in frail elderly users of ambulatory assistive devices: a comparative study.

Aim: The aim of this study was to verify the prevalence of falls in frail users of ambulatory assistive devices (AAD) and compare with controls.Materials and methods: Nineteen frail elderly users of AAD (G1) and 31 non-users (G2) participated in the study. The occurrence of falls, at the last 6 months, was collected by an interview with the patient and the caregiver. Cognitive status was assessed by the Mini Mental State Examination, functional capacity by the Pfeffer's Questionnaire and Modified Barthel's Index, the frail level by a functional stratification and the risk of falls by the Timed Up and Go (TUG) test. T-Student test was used to compare independent variables. The significance level was set at 5%.Results: Both groups G1 and G2 were homogeneous in relation to the functional and sociodemographic variables. G1 reported more falls in the last 6 months, but most of the participants did not use AAD at the time of the fall. Transferences were the main reason for falls in G1 and stumble in the street in G2.Conclusion: Elderly users of AAD fall out when they are not using the walk device.IMPLICATIONS FOR REHABILITATIONFalling is the second leading cause of death from unintentional injuries in the world. Fall prevention programmes prescribe ambulatory assistive devices, such as walking sticks, crutches and walkers device and walking training with a physiotherapist to provide independence, safety, satisfaction, adherence and psychosocial benefits. However, studies have showed a higher prevalence of falls in frail elderly users of ambulatory-assistive devices.In our study, we verified if users of the ambulatory-assistive devices were using it at the moment of the fall. We found that frail elderly fall down when they are not using the walk device during their activities of day living. Thus, education strategies should be developed to encourage the use of ambulatory-assistive devices by the frail elderly previously evaluated by physiotherapists. Prevalence of falls in this population could reduce if frail elderly users of ambulatory assistive devices really use it during the activities of daily living.