Atendimento de emergência e suas interfaces: o cuidado de curta duração a idosos / Emergency care and its interfaces: the short-term care for the elderly

Introdução: O departamento de emergência é o serviço de assistência à saúde mais utilizado pelos idosos em caso de adoecimento agudo desafiando a gestão desse recurso diante do aumento da expectativade vida. Objetivo: Identificar "onde" e "como" ocorre o atendimento de emergência ao idoso. Métodos: Revisão da literatura sobre modelos de serviços de saúde de curta duração destinados aos idosos que requisitaram atendimento de emergência decorrente de trauma, infecção, infarto, exacerbação de doença respiratória crônica, cuidado paliativo. As principais medidas de desfecho utilizadas foram: (a) redução do tempo de internação; (b) redução de hospitalização; (c) redução de custos. Foram examinadas as seguintes bases bibliográficas: PubMed, Scopus, Web of Science e Science Direct, abrangendo o período de Janeiro de 2000 a Março de 2014. Resultados: Foi delineado um panorama mundial sobre os serviços que contemplam o domicílio do indivíduo e os hospitais como provável local de intervenção, conduzida por profissionais habilitados em garantir cuidado continuado. Inicia-se uma nova oportunidade de aprimorar os serviços existentes com o Geriatric Emergency Department Guideline. Conclusão: Os serviços da atenção primária são primordiais para prevenir as admissões hospitalares e acompanhar os idosos após a internação, prevenindo assim as readmissões

Introduction: The emergency department is the health care service most used by the elderly in case of acute illness challenging the management of this resource before the increase in life expectancy. Objective: To identify "where" and "how" emergency care to the elderly occurs. Methods: literaturereview of models of health services of short- term for the elderly who requested emergency care due to trauma, infection, infarction, exacerbation of chronic respiratory disease, palliative care. The main outcome measures were reductions in: (a) length of stay; (b) hospitalization; (c) costs. Thefollowing databases were searched: PubMed, Scopus, Web of Science and Science Direct, covering the period from January 2000 to March 2014. Results: was outlined an overview of services that address the domicile of the individual and hospitals as probable sites of intervention, conducted byqualified professionals to ensure continuity of care. There is a new opportunity to enhance existing services with the Geriatric Emergency Department Guideline. Conclusion: Primary care services are paramount to prevent hospital admissions and follow the elderly after hospitalization, thereby preventing re-admissions

Integration and continuity of Care in health care network models for frail older adults.

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

Integração e continuidade do cuidado em modelos de rede de atenção à saúde para idosos frágeis / Integración y continuidad del cuidado en modelos de red de atención a la salud para ancianos frágiles / Integration and continuity of Care in health care network models for frail older adults

Foi realizada revisão crítica da literatura sobre modelos que tenham avaliado a efetividade de redes assistenciais integradas e coordenadas para a população idosa. Foram pesquisadas as seguintes bases bibliográficas: Pubmed, The Cochrane Library, Lilacs, Web of Science, Scopus e SciELO. Doze artigos sobre cinco modelos diferentes foram incluídos para a discussão. A análise da literatura mostrou que a prestação de serviços pautava-se na atenção básica incluindo serviços domiciliares. Os usuários contavam com a integração de atenção primária, hospitalar, centros dia, serviços domiciliares e serviços sociais. O plano de cuidados e a gestão de caso foram elementos chaves para a continuidade de cuidado. Essa abordagem mostrou-se efetiva nos estudos, reduzindo o uso da atenção hospitalar, o que resultou em economia para o sistema financiador. Houve redução da prevalência de perda funcional, melhora na satisfação e na qualidade de vida dos usuários e de seus familiares. A análise da literatura reforça a necessidade de se modificar a abordagem de assistência à saúde dos idosos, e a integração e coordenação dos serviços são formas eficientes para iniciar essa mudança.

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change.

Rastreamento do risco de perda funcional: uma estratégia fundamental para a organização da Rede de Atenção ao Idoso / Screening the risk for functional loss: a basic strategy for organizing the elderly health care network

A partir de uma análise crítica sobre experiências com a utilização de instrumentos de rastreio de perda funcional em idosos, observou-se que a principal motivação para desenvolver e aplicar esta técnica é aperfeiçoar a assistência à saúde para os frágeis ou com risco de perda funcional e internações repetidas. Os instrumentos são preferencialmente questionários com até 16 perguntas autoadministráveis. A principal intervenção executada após o rastreio foi o acompanhamento do idoso por um serviço de enfermagem especializado que, quando necessário, referenciou-o ao serviço médico. Esta abordagem resultou na redução da perda funcional, do número de admissões hospitalares, do número de óbitos, redução de gastos com saúde e ainda uma maior satisfação do usuário.

From a critical analysis of experiments in the use of screening tools for functional loss in the elderly, it was observed that the main motivation to develop and implement a screening instrument is to improve health care for the frail elderly or those at risk of functional loss and repeated hospital admissions. The instruments are preferably short questionnaires with no more than 16 self-reported questions. The main intervention performed after screening was monitoring the elderly by a specialized nursing service that, when necessary, referring them to the medical service. The results of this approach included the reduction of functional loss, hospital admissions, deaths, lower health expenses and greater consumer satisfaction.

[Screening the risk for functional loss: a basic strategy for organizing the elderly health care network]. / Rastreamento do risco de perda funcional: uma estratégia fundamental para a organização da Rede de Atenção ao Idoso.

From a critical analysis of experiments in the use of screening tools for functional loss in the elderly, it was observed that the main motivation to develop and implement a screening instrument is to improve health care for the frail elderly or those at risk of functional loss and repeated hospital admissions. The instruments are preferably short questionnaires with no more than 16 self-reported questions. The main intervention performed after screening was monitoring the elderly by a specialized nursing service that, when necessary, referring them to the medical service. The results of this approach included the reduction of functional loss, hospital admissions, deaths, lower health expenses and greater consumer satisfaction.

[Difficulties and rewards on aging: the elderly's self perception]. / Dificuldades e recompensas no processo de envelhecimento: a percepção do sujeito idoso.

The purpose of this study was to identify in the scientific literature, the self-image and representations that elders have about themselves in different contexts. Frequently, the society considers aging as a "problem", creating stereotypes that could result in the exclusion of the aged. Through the analysis of researches that investigated the opinion of the elders about their difficulties and rewards in old age, it was evidenced how important are the choices people make through the life. The inner possibilities and the social participation were identified as important elements for the elderly self perception.

Dificuldades e recompensas no processo de envelhecimento: a percepção do sujeito idoso / Difficulties and rewards on aging: the elderly's self perception

Este estudo procurou levantar na literatura as imagens e representações que os idosos relatam de si próprios em diferentes contextos. A sociedade muitas vezes observa o envelhecimento como um "problema", criando estereótipos que podem levar à exclusão dos idosos em suas comunidades. Através da análise de trabalhos que investigam a opinião dos idosos quanto a suas dificuldades e recompensas na velhice, foi constatada a importância das escolhas ao longo da vida, das possibilidades internas e ainda a influência do engajamento social na autopercepção do envelhecimento.

The purpose of this study was to identify in the scientific literature, the self-image and representations that elders have about themselves in different contexts. Frequently, the society considers aging as a "problem", creating stereotypes that could result in the exclusion of the aged. Through the analysis of researches that investigated the opinion of the elders about their difficulties and rewards in old age, it was evidenced how important are the choices people make through the life. The inner possibilities and the social participation were identified as important elements for the elderly self perception.