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 / Qualidade de vida de cuidadores de idosos sobreviventes de AVC no sul do Brasil: Ensaio clínico randomizado / Calidad de vida en cuidadores de adultos mayores sobrevivientes de accidentes cerebrovasculares en el sur de Brasil: Ensayo clínico aleatorizado

Abstract 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.

Resumo Objetivo: avaliar o efeito de intervenção educativa domiciliar de enfermagem na qualidade de vida de cuidadores familiares de idosos sobreviventes de acidente vascular cerebral (AVC). Método: Ensaio Clínico Randomizado, cego para avaliação de resultados. Quarenta e oito cuidadores familiares de idosos sobreviventes de AVC participaram do estudo. O Grupo de Intervenção recebeu três visitas domiciliares de enfermeiros, um mês após a alta hospitalar, para fornecer educação relacionada ao AVC (como acessar os serviços de saúde e realizar atividades de cuidado) e apoio emocional. O Grupo Controle recebeu as orientações habituais dos serviços de saúde. A qualidade de vida foi avaliada usando o instrumento Avaliação da Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-BREF) e o Módulo Old (WHOQOL-OLD) em 1 semana, 2 meses e 1 ano após a alta. Resultados: os cuidadores eram principalmente mulheres, filhos ou cônjuges. Os cuidadores do Grupo Intervenção e do Grupo Controle não diferiram significativamente em termos de Qualidade de Vida Geral no início do estudo. Não houve efeito de interação entre a alocação do grupo e a Qualidade de Vida Geral (p=0,625) ao longo do tempo. No entanto, houve efeito de interação para Relações Sociais (p=0,019) e Autonomia (p=0,004). Conclusão: a intervenção apresentou efeito estatisticamente significativo na qualidade de vida dos cuidadores familiares no que diz respeito às relações sociais e autonomia. Registro do ensaio clínico: NCT02807012.

Resumen Objetivo: evaluar el efecto de intervenciones de atención domiciliaria de enfermería sobre la calidad de vida en cuidadores familiares de adultos mayores sobrevivientes de accidentes cerebrovasculares. Método: Ensayo Clínico Aleatorizado, cegado para la evaluación de los desenlaces. Los participantes del estudio fueron 48cuidadores familiares de adultos mayores sobrevivientes de accidentes cerebrovasculares (ACV). El Grupo Intervención recibió tres visitas domiciliarias a cargo de enfermeros un mes después del alta hospitalaria, en las que se les ofreció instrucción relacionada con ACV (es decir, cómo acceder a los servicios de salud y realizar las actividades inherentes a los cuidados) y apoyo emocional. Al Grupo Control se le brindó la orientación habitual de los servicios de salud. La calidad de vida se evaluó mediante el instrumento World Health Organization Quality of Life Assessment (WHOQOL-BREF) y el módulo Old(WHOQOL-OLD) 1semana, 2meses y 1año después del alta. Resultados: en su mayoría, los cuidadores fueron mujeres, hijos o cónyuges. Los cuidadores de los grupos Intervención y Control no presentaron diferencias significativas en términos de su Calidad de Vida general de base. La intervención no ejerció ningún efecto entre la asignación a los grupos y la Calidad de Vida general(p=0,625) con el transcurso del tiempo. Sin embargo, la intervención sí tuvo efecto sobre las Relaciones Sociales (p=0,019) y la Autonomía(p=0,004). Conclusión: la intervención ejerció un efecto estadísticamente significativo sobre la calidad de vida de los cuidadores familiares con respecto a las relaciones sociales y a la autonomía. Registro del ensayo: NCT02807012.

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.

A longitudinal study of burden among spouse and non-spouse caregivers of older adults with stroke-induced-dependency / Sobrecarga entre cuidadores cônjuges e não cônjuges de idosos dependentes por AVC: estudo longitudinal / La carga entre cuidadores conyugales y no conyugales de ancianos con dependencia inducida por ictus: estudio longitudinal

ABSTRACT 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.

RESUMO Objetivo: avaliar sobrecarga de cuidadores cônjuges e não cônjuges de idosos dependentes por AVC pós-alta da Unidade de Atendimento Especializado em AVC de um hospital do sul do Brasil. Método: pesquisa longitudinal. Amostra foi composta por 48 cuidadores, sendo 20 cuidadores cônjuges. Dados foram coletados entre maio/2016 e julho/2018. Uma semana pós-alta, verificou-se a capacidade funcional dos idosos pela Medida de Independência Funcional, o perfil sociodemográfico dos cuidadores e a sobrecarga com a Caregiver Burden Scale. A sobrecarga também foi medida dois meses pós-alta. Dados foram analisados por meio de Análise Multivariada de Variância. Resultados: no tempo 1, não cônjuges apresentaram maior sobrecarga em relação ao isolamento social (p=0,01). Juntamente com isolamento (p=0,04), não cônjuges sentiram tensão geral muito maior (p=0,01). Conclusão: diferenças estatisticamente significativas na sobrecarga ao longo do tempo destacam a importância de avaliar a sobrecarga do cuidador pós-alta e a necessidade de um programa formal de apoio.

RESUMEN Objetivo: evaluar la carga de los cuidadores conyugales y no conyugales de ancianos con dependencia inducida por ictus después del alta de la Unidad de Atención Especializada en Ictus de un hospital del sur de Brasil. Métodos: una encuesta longitudinal, con 48 cuidadores (20 cónyuges). Datos fueron recolectados entre mayo/2016 y julio/2018. Una semana después del alta, se aplicó la Medida de Independencia Funcional a los ancianos y la Caregiver Burden Scale a los cuidadores. Los datos se analizaron mediante análisis multivariado de varianza. Resultados: en tiempo 1, los cónyuges experimentaron mayor carga en relación al aislamiento social (p=0,01). Los cónyuges sintieron una tensión general y sensación de aislamiento mucho mayor (p=0,01; p=0,04). Conclusión: las diferencias estadísticamente significativas en la carga a lo largo del tiempo resaltan la importancia de evaluar la carga del cuidador después del alta y la necesidad de un programa de apoyo formal.

Development of an online course for caregivers of older stroke patients / Desarrollo de un curso online para cuidadores familiares de personas mayores tras un acv / Elaboração de um curso online para cuidadores familiares de pessoas idosas após acidente vascular cerebral

ABSTRACT 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.

RESUMEN Objetivo: Describir el proceso de desarrollo de un curso masivo, abierto y en línea para cuidadores familiares de personas mayores con diagnóstico de accidente cerebrovascular. Método: Relato de experiencia de un curso masivo, abierto y en línea. Se preparó al curso de julio de 2021 a octubre de 2022. Sus etapas fueran: definición y análisis del contenido; construcción y aprobación del storyboard; construcción digital y aprobación de la versión parcial; disponibilidad en plataforma digital; evaluación preliminar y aprobación de la versión final. Resultados: El curso tiene como objetivo dar herramientas para cuidadores familiares de personas mayores que han sufrido accidentes cerebrovasculares. Fue construido en doce módulos, con el uso de videos demostrativos, hipertexto, fotografías y narraciones. Conclusión: El proceso de desarrollo del curso requería un equipo con experiencia em diferentes áreas y la evaluación preliminar fue positiva.

RESUMO Objetivo: Descrever o processo de desenvolvimento de um curso massivo, aberto e online para cuidadores familiares de pessoas idosas com diagnóstico médico de AVC. Método: Relato de experiência do desenvolvimento de um curso massivo, aberto e online. A elaboração do curso ocorreu de julho de 2021 a outubro de 2022 e foi composta das etapas das de definição e análise do conteúdo do curso; construção e aprovação do storyboard; construção digital e aprovação da versão parcial; disponibilização em plataforma digital; avaliação preliminar e aprovação da versão final. Resultados: O curso visa instrumentalizar os cuidados familiares de pessoas idosas que sofreram acidente vascular cerebral, melhorando a sua capacidade de cuidar. Foi construído em doze módulos, com a utilização de vídeos demonstrativos, hipertexto, figuras e narrações. Conclusão: O processo de desenvolvimento do curso requereu uma equipe com expertise em diferentes áreas e apresentou uma avaliação preliminar positiva.

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.

Fragilidade e funcionalidade familiar de idosos da Atenção Domiciliar: estudo transversal analítico / Fragilidad y funcionalidad familiar de adultos mayores en la Atención Domiciliaria: estudio transversal analítico / Frailty and family functionality of older people in Home Care: an analytical cross-sectional study

Resumo Objetivo Identificar a prevalência da fragilidade em idosos e o nível de funcionalidade familiar e analisar a associação dessas variáveis com características sociodemográficas e com o acesso aos serviços de saúde de idosos vinculados à Atenção Domiciliar tipo 1 da Atenção Primária à Saúde. Métodos Estudo transversal analítico, realizado por meio de visitas domiciliares, de outubro de 2018 a abril de 2019, com 124 idosos de 60 anos ou mais, vinculados à Atenção Domiciliar tipo 1 de um distrito sanitário de Porto Alegre. Utilizaram-se a Escala de Fragilidade de Edmonton, o APGAR da família e o questionário de dados sociodemográficos e de acesso ao serviço de saúde. Aplicaram-se o teste t de Student, o teste de Mann-Whitney, o teste do qui-quadrado, o teste exato de Fisher e o modelo de regressão de Poisson na análise estatística. Foi considerado como valor significativo p<0,05. Resultados A prevalência de fragilidade foi de 75%, e 84,7% dos idosos apresentaram bom nível de funcionalidade familiar. A fragilidade apresentou associação estatisticamente significativa, com maior faixa etária (p=0,009), elevado número médio de morbidades (p=0,027), presença de cuidador (p<0,001), não morar sozinho (p<0,001), défice cognitivo (p<0,001) e com forma de atendimento exclusivamente domiciliar (p<0,001). A funcionalidade familiar não apresentou associação estatisticamente significativa com as variáveis em estudo. Conclusão Houve alta prevalência de fragilidade e de boa funcionalidade familiar. Apenas a fragilidade esteve associada significativamente com algumas das variáveis em estudo. Conhecer essa população específica é imprescindível para que intervenções possam ser desenvolvidas, garantindo acesso aos serviços de saúde.

Resumen Objetivo Identificar la prevalencia de la fragilidad en adultos mayores y el nivel de funcionalidad familiar y analizar la asociación de esas variables con características sociodemográficas y con el acceso a los servicios de salud de adultos mayores vinculados a la Atención Domiciliaria tipo 1 de la Atención Primaria a la Salud. Métodos Estudio transversal analítico, realizado por medio de visitas domiciliarias, de octubre de 2018 a abril de 2019, con 124 adultos mayores de 60 años o más, vinculados a la Atención Domiciliaria tipo 1 de un distrito sanitario de Porto Alegre. Se utilizó la Escala de Fragilidad de Edmonton, el APGAR de la familia y el cuestionario de datos sociodemográficos y de acceso al servicio de salud. Se aplicaron la prueba t de Student, la prueba de Mann-Whitney, la prueba chi cuadrado, y la prueba exacta de Fisher y el modelo de regresión de Poisson en el análisis estadístico. Se consideró valor significante p<0,05. Resultados La prevalencia de fragilidad fue de 75 % y el 84,7 % de los adultos mayores presentaron un buen nivel de funcionalidad familiar. La fragilidad presentó una asociación estadísticamente significante, con mayor grupo de edad (p=0,009), elevado número promedio de morbilidades (p=0,027), presencia de cuidador (p<0,001), no vivir solo (p<0,001), déficit cognitivo (p<0,001) y con forma de atención exclusivamente domiciliaria (p<0,001). La funcionalidad familiar no presentó asociación estadísticamente significante con las variables en estudio. Conclusión Hubo una alta prevalencia de fragilidad y de buena funcionalidad familiar. Apenas la fragilidad estuvo asociada significantemente con algunas de las variables en estudio. Conocer a esa población específica es imprescindible para que se puedan desarrollar intervenciones, garantizando el acceso a los servicios de salud.

Abstract Objective To identify frailty prevalence and family functionality level in older people and analyze the association of these variables with sociodemographic characteristics and with access to health care services for older people linked to Home Care type 1 in Primary Health Care. Methods This is an analytical cross-sectional study, carried out through home care visits, from October 2018 to April 2019, with 124 older people aged 60 years or older, linked to Home Care type 1 in a health district in Porto Alegre. The Edmonton Frail Scale, the family APGAR and the sociodemographic data and access to health care service questionnaire were used. Student's t test, Mann-Whitney test, chi-square test, Fisher's exact test and Poisson regression model were applied in the statistical analysis. A significant value p<0.05 was considered. Results Frailty prevalence was 75%, and 84.7% of the older adults had a good family functionality level. Frailty had a statistically significant association, with a higher age group (p=0.009), a high average number of morbidities (p=0.027), presence of a caregiver (p<0.001), not living alone (p<0.001), cognitive decline (p<0.001) and exclusively home care (p<0.001). Family functionality did not show a statistically significant association with the variables under study. Conclusion There was a high frailty prevalence and good family functionality. Only frailty was significantly associated with some of the variables under study. Knowing this specific population is essential so that interventions can be developed, ensuring access to health care services.

Effects of the Alpha-Health intervention on elderly's health literacy in primary health care / Efectos de la intervención Alfa-Salud en la alfabetización sanitaria de los ancianos en la atención primaria de salud / Efeitos da intervenção Alfa-Saúde na alfabetização em saúde do idoso na atenção primária à saúde

ABSTRACT 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.

RESUMEN Objetivo: evaluar los efectos de la intervención Alfa-Salud sobre la alfabetización sanitaria y los hábitos de salud de los ancianos vinculados a la atención primaria, en comparación con la atención sanitaria habitual. Métodos: investigación cuasiexperimental, con métodos mixtos, con 21 ancianos en cada grupo. El Alfa-Salud fue realizado por una enfermera durante cinco meses. Los instrumentos utilizados fueron la Short Assessment of Health Literacy for Portuguese Speaking Adults, Health Literacy y preguntas sobre hábitos de salud. En el análisis cuantitativo se utilizó el Modelo GEE y en el análisis cualitativo temático. Resultados: hubo un efecto de interacción en los puntajes de alfabetización en salud. Los hábitos de salud como la vacunación, las tres comidas al día y el consumo de carne mostraron un efecto de interacción estadísticamente significativo. En la etapa cualitativa, hubo un desarrollo en las habilidades para acceder, comunicar y evaluar la información, y estabilidad en la capacidad de comprensión. Conclusiones: el Alfa-Salud es un dispositivo importante para el desarrollo de la alfabetización en salud para las personas mayores.

RESUMO Objetivo: avaliar os efeitos da intervenção Alfa-Saúde na alfabetização em saúde e hábitos de saúde de idosos vinculados à atenção primária, quando comparada ao atendimento de saúde usual. Métodos: investigação quase-experimental, com métodos mistos, com 21 idosos em cada grupo. O Alfa-Saúde foi realizado por enfermeira durante cinco meses. Instrumentos utilizados foram o Short Assessment of Health Literacy for Portuguese Speaking Adults, Health Literacy e perguntas sobre hábitos de saúde. Na análise quantitativa, foi utilizado o GEE Model, e na qualitativa, análise temática. Resultados: houve efeito de interação nos escores da alfabetização em saúde. Hábitos de saúde, como vacinação, três refeições diárias e consumo de carne, apresentaram efeito de interação com significância estatística. Na etapa qualitativa, observou-se o desenvolvimento nas habilidades de acessar, comunicar e avaliar a informação, e estabilidade na habilidade de compreensão. Conclusões: o Alfa-Saúde é um dispositivo importante para o desenvolvimento da alfabetização em saúde de idosos.

Utilização dos serviços públicos de saúde especializados por pessoas idosas no sul do Brasil / Use of specialized public health services by older people in southern Brazil

Resumo Objetivo Analisar a utilização dos serviços públicos de saúde especializados por idosos de acordo com o sexo e grupo etário no município de Porto Alegre. Métodos Estudo transversal com dados secundários dos sistemas de consulta ambulatorial e de internação do município. Utilizaram-se todos os registros de 2019, sendo aplicado o teste qui-quadrado de Pearson. Resultados No total, 64.888 idosos buscaram serviços especializados, gerando 113.694 atendimentos (82,8% atendimentos ambulatoriais e 17,2% internações). Verificou-se que 74,7% dos idosos foram referenciados pela atenção primária para atendimento especializado, com maiores percentuais de idosos jovens e mulheres (p<0,001). Já homens e idosos com 80 anos ou mais foram encaminhados com maior frequência para atendimento a partir de hospitais e pronto atendimentos (p<0,001). Mulheres e idosos entre 60 e 79 anos utilizaram em maior proporção os centros ambulatoriais, fisioterapia, centros de reabilitação, odontologia e saúde mental (p<0,001). Os principais motivos de utilização dos serviços especializados foram doenças do aparelho circulatório, sendo mais expressivo entre idosos com 80 anos ou mais e homens (p<0,001). As doenças osteomusculares (22,5%) foram os principais motivos de consultas ambulatoriais e, nas internações de urgência, as doenças do aparelho circulatório (37,9%). Idosos com histórico de consultas ambulatoriais tiveram menos internações hospitalares (p<0,001). Conclusão Destaca-se a necessidade de ações articuladas dos serviços de saúde priorizando a população masculina e longeva, enfocando a prevenção/controle de doenças crônicas não transmissíveis e as vulnerabilidades dessa etapa de vida.

Abstract Objective To analyze the use of specialized public health services by older adults, by sex and age group, in the city of Porto Alegre. Methods A cross-sectional study with secondary data from the city's outpatient and inpatient consultation systems. All records from 2019 were used, and Pearson's chi-square test was applied. Results In total, 64,888 older people sought specialized services, generating 113.694 visits (82,8% outpatient visits and 17.2% hospitalizations). It was found that 74.7% of the older adults were referred by primary care for specialized care, with higher percentages of young older people and women (p<0.001). On the other hand, men and older adults aged 80 years or older were referred more frequently for care from hospitals and emergency rooms (p<0.001). Women and older adults between 60 and 79 years old used outpatient centers, physical therapy, rehabilitation centers, dentistry and mental health in greater proportion (p<0.001). The main reasons for using specialized services were diseases of the circulatory system, being more expressive among older adults aged 80 years or older and men (p<0.001). Musculoskeletal diseases (22.5%) were the main reasons for outpatient consultations and, in emergency hospitalizations, diseases of the circulatory system (37.9%). Older adults with a history of outpatient consultations had fewer hospital admissions (p<0.001). Conclusion The need for articulated actions by health services is highlighted, prioritizing the male and long-lived population, focusing on the prevention/control of non-communicable chronic diseases and the vulnerabilities of this stage of life.

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.

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.

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.

Global functionality and associated factors in the older adults followed by Home Care in Primary Health Care / Funcionalidad global y factores asociados en los adultos mayores acompañados por la Atención Domiciliar de la Atención Básica / Funcionalidade global e fatores associados em idosos acompanhados pela Atenção Domiciliar da Atenção Básica

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.

Objetivo: analizar la asociación de la funcionalidad global con los principales sistemas funcionales y con variables sociodemográficas de los adultos mayores vinculados a la Atención Domiciliar de la Atención Básica. Método: estudio transversal con 124 adultos mayores realizado por medio de entrevistas domiciliares. La funcionalidad fue evaluada por las Actividades Básicas de Vida Diaria (Barthel) y por las Actividades Instrumentales de Vida Diaria (Lawton y Brody); los principales sistemas funcionales fueron evaluados con el Mini Examen del Estado Mental, el test Timed Up and Go y la Escala de Depresión Geriátrica (15 ítems); además, se utilizó el cuestionario con variables sociodemográficas. Se aplicaron análisis bivariados y multivariados (Regresión de Poisson). Resultados: 46% de los adultos mayores poseían dependencia moderada/grave/total para las actividades básicas y presentaron mediana de 12 en las actividades instrumentales. En los análisis multivariados, hubo asociación entre dependencia moderada/grave/total en las actividades básicas con disminución cognitiva (p=0,021) y en postrado en cama o en silla de ruedas (p=0,014). En la dependencia de las actividades instrumentales hubo asociación con edad ≥80 años (p=0,006), estado conyugal soltero/divorciado (p=0,013) con disminución cognitiva (p=0,001), postrado en cama o en silla de ruedas (p=0,020) y Timed Up and Go ≥20 segundos (p=0,048). Conclusión: la disminución del estado cognitivo y de la movilidad estuvo asociada con peor funcionalidad en las actividades básicas e instrumentales. Los hallazgos destacan la necesidad del acompañamiento de la Atención Domiciliar para esos individuos y sirven como orientadores de acciones de salud.

Objetivo: analisar a associação da funcionalidade global aos principais sistemas funcionais e às variáveis sociodemográficas de idosos vinculados à Atenção Domiciliar da Atenção Básica. Método: estudo transversal com 124 idosos realizado por meio de entrevistas domiciliares. A funcionalidade foi avaliada pelas Atividades Básicas de Vida Diária (Barthel) e pelas Atividades Instrumentais de Vida Diária (Lawton e Brody); os principais sistemas funcionais foram avaliados pelo Mini Exame do Estado Mental, pelo teste Timed Up and Go, pela Escala de Depressão Geriátrica (15 itens), além de questionário com variáveis sociodemográficas. Aplicaram-se análises bivariada e multivariada (Regressão de Poisson). Resultados: 46% dos idosos possuíam dependência moderada/elevada/total para as atividades básicas e apresentaram mediana de 12 nas atividades instrumentais. Na análise multivariada, houve associação entre dependência moderada/elevada/total nas atividades básicas com declínio cognitivo (p=0,021) e em acamado/cadeirante (p=0,014). Na dependência das atividades instrumentais houve associação com idade ≥80 anos (p=0,006), estado conjugal solteiro/divorciado (p=0,013), declínio cognitivo (p=0,001), acamado/cadeirante (p=0,020) e Timed Up and Go ≥20 segundos (p=0,048). Conclusão: o declínio da cognição e da mobilidade esteve associado à pior funcionalidade nas atividades básicas e instrumentais. Os achados ressaltam a necessidade do acompanhamento da Atenção Domiciliar para esses indivíduos e servem como norteadores de ações de saúde.

Idosos vinculados à atenção domiciliar da atenção primária à saúde: caracterização, morbidades e acesso aos serviços / Personas de edad avanzada vinculadas a la atención domiciliaria provista por la atención primaria de la salud: caracterización, morbilidades y acceso a los servicios de salud / Older adults linked to home care provided by primary health care: characterization, morbidities, and access to the services

RESUMO Objetivo: analisar idosos que recebem Atenção Domiciliar da Atenção Primária quanto às variáveis sociodemográficas, morbidades e acesso aos serviços de saúde por sexo e faixa etária. Método: estudo transversal analítico com 124 idosos da Atenção Domiciliar Tipo 1, realizado entre 2018 e 2019 através de visita domiciliar. Foi aplicado questionário sobre dados socioeconômicos, morbidades e acesso aos serviços. Utilizou-se os testes t-Student, Mann-Whitney, qui-quadrado e exato de Fisher. Resultados: a média de idade foi de 82,8 anos e predominou o sexo feminino. A maioria dos idosos mais velhos estudou de zero a quatro anos e era viúva. Dentre as morbidades, a hipertensão prevaleceu e a artrose apresentou associação significativa com o sexo feminino (p=0,004). Em relação ao acesso, as mulheres recebiam visita domiciliar com menor frequência (p=0,033). Conclusão: esses dados poderão subsidiar a implementação de intervenções, além de identificar possíveis melhorias nessa modalidade de atendimento.

RESUMEN Objetivo: analizar a las personas de edad avanzada que reciben Atención Domiciliaria provista por la Atención Primaria en relación con las variables sociodemográficas, las morbilidades y el acceso a los servicios de salud, por sexo y grupo etario. Método: estudio transversal y analítico con 124 personas de edad avanzada atendidos por la Atención Domiciliaria Tipo 1, realizado entre 2018 y 2019 a través de visitas domiciliarias. Se aplicó un cuestionario sobre datos socioeconómicos, morbilidades y acceso a los servicios de salud. Se utilizaron las pruebas t-Student, Mann-Whitney, chi-cuadrado y exacta de Fisher. Resultados: la media de edad fue de 82,8 años y hubo predominio del sexo femenino. La mayoría de las personas de edad más avanzada estudió entre cero y cuatro años y eran viudos/viudos. Entre las morbilidades, prevaleció la hipertensión y la artrosis presentó una asociación significativa con el sexo femenino (p=0,004). En relación con el acceso a los servicios de salud, las mujeres recibieron visitas domiciliarias con menor frecuencia (p=0,033). Conclusión: estos datos podrán sustentar la implementación de intervenciones, además de identificar posibles mejoras en esta modalidad de atención.

ABSTRACT Objective: to analyze the readiness assurance step of the Team-Based Learning through the performance of Nursing students in the Individual Readiness Assurance Test - iRAT and Team Readiness Assurance Test - tRAT. Method: descriptive study of quantitative nature. Twenty-six fifth semester students of a university of northern Brazil participated. Data collection took place in October and November 2018 with questionnaires applied in five units. The analysis was descriptive, by questionnaire, question, team and student. Results: the team performance was superior, but not in all units. There are issues where students individually and in teams presented difficulties, suggesting intervening variables of pedagogical origin. Conclusion: the analysis by performance of students suggests failures in the readiness assurance. The study contributes by indicating possible pedagogical variables that can influence the success of this step of the Team-Based Learning.

Construction and validation of an educational manual for family caregivers of older adults after a stroke / Construcción y validación de manual educativo para familiares cuidadosos de personas mayores tras accidente cerebro vascular / Construção e validação de manual educativo para cuidadores familiares de idosos após acidente vascular cerebral

ABSTRACT Objective to construct and validate an educational manual for family caregivers of older adult dependent on care after a stroke. Method a methodological study with four stages: focus group with five family caregivers, to identify doubts and difficulties regarding home care for older adults with stroke; preparation of the manual by six researchers; content validation by 18 specialist nurses, and face validation by 12 family caregivers. For data analysis, thematic analysis was performed, the Content Validity Index (CVI) was calculated, and the consensus of the target population was verified. Results from the focus group, the experiences and challenges faced by the caregivers in caring for aged family members with a stroke were identified, which supported the elaboration of an educative manual, in the second stage. In the expert consensus, a global CVI of 0.97 was obtained and, in face validation, a consensus of 95.51% by the target population. Conclusion an educational manual for family caregivers of older adults after a stroke was built, which was validated in terms of content and appearance. In view of this, it can be used as complementary material to the guidelines of the professionals, enabling improvement of the care provided by family members to the older adult dependent on care after a stroke.

RESUMEN Objetivo construir y validar un manual educativo para familiares cuidadores de personas mayores dependientes de cuidados con posterioridad al Accidente Cerebro Vascular (ACV). Método estudio metodológico de cuatro etapas: grupo focal con cinco familiares cuidadores, para identificación de dudas y dificultades con la atención domiciliaria de personas mayores con ACV; elaboración del manual por seis investigadores; validación de contenido por 18 enfermeras especializadas y validación de apariencia por 12 familiares cuidadores. Para el análisis de datos se llevó a cabo un análisis temático, se calculó el Índice de Validez de Contenido (IVC) y se verificó el consenso de la población objetivo. Resultados a partir del grupo focal se identificaron las experiencias y desafíos que enfrentan los familiares cuidadores en el cuidado de la persona mayor con ACV, lo que fomentó la elaboración de un manual educativo en la segunda etapa. En el consenso de expertos, se obtuvo un IVC global de 0,97 y, en la validación de apariencia, un consenso del 95,51% por parte de la población objetivo. Conclusión se elaboró un manual educativo para familiares cuidadores de personas mayores tras un ACV, el cual fue validado en cuanto a contenido y apariencia. Por ello, se puede utilizar como material complementario en la orientación de profesionales, lo que permite la mejora de la atención que brindan los familiares a las personas mayores dependientes de cuidados tras un ACV.

RESUMO Objetivo construir e validar um manual educativo para cuidadores familiares de pessoas idosas dependentes de cuidados após Acidente Vascular Cerebral (AVC). Método estudo metodológico com quatro etapas: grupo focal com cinco cuidadores familiares, para identificação de dúvidas e de dificuldades quanto ao cuidado no domicílio ao idoso com AVC; elaboração do manual por seis pesquisadoras; validação de conteúdo por 18 enfermeiros especialistas e validação de aparência por 12 cuidadores familiares. Para análise dos dados, realizou-se análise temática, cálculo do Índice de Validade de Conteúdo (IVC) e se verificou o consenso da população-alvo. Resultados a partir do grupo focal, foram identificadas as vivências e os desafios enfrentados pelos cuidadores ao cuidar do familiar idoso com AVC, o que embasou a elaboração de um manual educativo, na segunda etapa. No consenso de especialistas, obteve-se IVC global de 0,97 e, na validação de aparência, consenso de 95,51% pela população-alvo. Conclusão foi construído um manual educativo para cuidadores familiares de idosos após AVC, o qual foi validado quanto ao conteúdo e à aparência. Em vista disso, poderá ser utilizado como material complementar às orientações dos profissionais, possibilitando melhoria do cuidado prestado por familiares ao idoso dependente de cuidados após AVC.

Life satisfaction and health self-assessment of older adults assisted through home care / Autoevaluación de salud y satisfacción con la vida de ancianos seguidos por atención domiciliaria / Autoavaliação de saúde e satisfação com a vida de idosos acompanhados pela atenção domiciliar

ABSTRACT 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.

RESUMEN Objetivos: Identificar características sociodemográficas y de salud según fajas etarias y analizar asociación de autoevaluación del estado de salud y de satisfacción con la vida regular/mala con características sociodemográficas, funcionalidad global y caídas de ancianos en seguimiento por Atención Domiciliaria de la Atención Básica. Métodos: Estudio transversal con 124 ancianos, realizado mediante entrevistas domiciliarias. Se utilizó cuestionario de datos sociodemográficos y condiciones de salud, Índice de Barthel, Escala de Lawton, Mini Examen del Estado Mental, Escala de Depresión Geriátrica y Test Timed Up and Go. Se aplicó análisis bivariado y multivariado (Regresión de Poisson). Resultados: Predominaron octogenarias de sexo femenino. Autoevaluación de salud regular/mala presentó asociación con síntomas depresivos leves (p=0,002) y severos (p<0,001). Satisfacción con la vida regular/mala estuvo asociada con miedo a caer (p=0,019) y con síntomas depresivos leves (p<0,001) y severos (p<0,001). Conclusión: Los síntomas depresivos estuvieron asociados con peor autoevaluación de salud y satisfacción con la vida.

RESUMO Objetivos: identificar características sociodemográficas e de saúde de acordo com faixas etárias e analisar associação da autoavaliação do estado de saúde e da satisfação com a vida regular/ruim com características sociodemográficas, funcionalidade global e quedas de idosos vinculados à Atenção Domiciliar da Atenção Básica. Método: estudo transversal com 124 idosos, realizado através de entrevistas domiciliares. Utilizou-se questionário de dados sociodemográficos e condições de saúde, Índice de Barthel, Escala de Lawton, Mini Exame do Estado Mental, Escala Depressão Geriátrica e Teste Timed Up and Go. Aplicaram-se análises bivariada e multivariada (Regressão de Poisson). Resultados: houve predomínio de octogenários do sexo feminino. Autoavaliação de saúde regular/ruim apresentou associação com sintomas depressivos leves (p=0,002) e severos (p<0,001). Satisfação com a vida regular/ruim teve associação com medo de cair (p=0,019) e com sintomas depressivos leves (p<0,001) e severos (p<0,001). Conclusão: sintomas depressivos estiveram associados com pior autoavaliação de saúde e satisfação com a vida.

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.