Homebound oral care for older adults: A qualitative study of professional carers' perspectives in Perth, Western Australia.

OBJECTIVE: To examine professional support workers and case managers' (professional carers) perspectives of what promoted or compromised oral health care in homebound adults aged over 65 years in Perth, Western Australia and identify professional carers' need for support in this context. BACKGROUND: Accessing dental services can be difficult to navigate and unaffordable for homebound older adults. Paid carers often play a substantial role in facilitating access to services yet there is limited qualitative evidence of the perspectives of these stakeholders. METHODS: Given limited evidence in this area, this simple qualitative study was informed by constructivist grounded theory. Participants comprised 15 professional carers of homebound older adults. Transcripts were analysed to identify participant perceptions of key barriers and enablers to providing oral health care. RESULTS: Barriers to clients accessing dental care included participants' uncertainty around navigating the dental system, low priority of oral health care, affordability and confusion around who was responsible to provide oral care. Enablers included participants supporting clients' autonomy around oral care, better integration of oral care into primary health care and education and opportunity for training for professional carers. CONCLUSION: Ensuring oral health is part of primary health plans, clarifying roles and responsibilities around delivering oral health care to homebound older adults and training carers were key findings. Inter-sectoral collaboration between the dental and aged care sectors can benefit dental practitioners and professional carers in shared learning and has likely flow-on effects for homebound older adults.

Using the Primary care Academic CollaboraTive to explore the characteristics and healthcare use of older housebound patients in England: protocol for a retrospective observational study and clinician survey (the CHiP study).

BACKGROUND: Older housebound people are an under-researched group for whom achieving good primary health care can be resource intensive. AIMS: To describe the characteristics and healthcare use of older (≥65 years) housebound people; explore clinician views on delivery of care to housebound people; and assess the feasibility of using a new network of healthcare professionals to deliver high quality research. DESIGN & SETTING: Retrospective observational study of electronic GP records and clinician survey in England. METHOD: Clinical members of a new UK research network called the Primary care Academic CollaboraTive (PACT) will collect the data. For part A, around 20 GP practices will be recruited and clinicians will identify 20 housebound and 20 non-housebound people, matched by age and gender (around 400 total in each group). Anonymised data will be collected on characteristics (age, gender, ethnicity, deprivation decile), long-term conditions, prescribed medicines, quality of healthcare (via Quality Outcomes Framework targets), and continuity of care. Reports with benchmarked practice-level data will be provided to practices to identify areas for quality improvement and to enhance engagement. For part B, 2-4 clinicians will be recruited from around 50 practices in England (around 150 clinicians) to complete a survey about delivery of healthcare for housebound people. For part C, data will be collected to assess the feasibility of using the PACT network to deliver primary care research. CONCLUSION: Older housebound people are a neglected group both in terms of research and clinical care. Understanding the characteristics and use of primary healthcare of housebound people will help identify how to improve their care.

Addressing Healthcare Utilization and Costs for Older Adults with Limited Mobility Through a Multidisciplinary Home-Based Primary Care Program.

INTRODUCTION: Home-based primary care (HBPC) has shown promise in the management of multiple chronic conditions for patients who are homebound or who have limited mobility. The objective of this study was to implement and evaluate an HBPC program that integrates the services of clinical pharmacists and community aging services providers in a community-based setting. METHODS: Mountain Area Health Education Center's (MAHEC) HBPC program brought together an interdisciplinary team including medical providers, pharmacists, and community aging services providers to conduct home visits with older adults (age 50+). A single-arm, prepost analysis was conducted to determine differences from the year before program enrollment to the year postenrollment. We examined the frequency of health care visits, high-cost health care utilization (emergency department [ED] utilization and hospitalizations), and health care costs. Descriptive statistics characterized the study population and outcomes. Fisher's Exact Tests were used to determine if there was a significant difference between years. RESULTS: There were 130 home visits with 62 patients enrolled in the program. The Medicare Annual Wellness Visit (AWV) was completed for 32 (51.6%) patients. There were 13 (21.0%) and 12 (19.4%) individuals who had at least 1 ED visit and hospitalization, respectively, pre-enrollment as compared with 8 (12.9%) and 9 (14.5%) individuals postenrollment (p-value = 0.05, p-value = 0.06). During the postenrollment year, patient enrollees had an average per-member-per-month (PMPM) cost of $1567.96 as compared with $3053.21 in the year prior. CONCLUSIONS: Pharmacist and community agency services-integrated HBPC was implemented in the community setting. There was a decrease in high-cost health care utilization and total health care expenditures for patients as compared with the previous year.

Necesidades y demandasde servicios de salud por parte del cuidador principal del paciente inmovilizado / Needs and demands for health services by the main caregiver of the immobilized patient

Objetivo: Evaluar las necesidades y las demandas de servicios desalud del cuidador principal de pacientes inmovilizados en el Centrode Salud de Caranza. Metodología: Estudio descriptivo transversalsobre los cuidadores principales de pacientes inmovilizados, mediantela identificación de inmovilizados y captación de 39 cuidadoresprincipales que voluntaria y anónimamente participaron. Inclusiónde variables de calidad (≥ 2 visitas/año), clínicas (sobrecarga, apoyo,estrés, ansiedad y depresión), sociodemográficas y de satisfaccióncon el servicio. Resultados: El indicador de calidad se superó en el89,8% de inmovilizados. Entre sobrecarga y parentesco (p = 0,040),nivel de cobertura (p = 0,012) o tiempo de respuesta (p = 0,015) seobservaron diferencias estadísticamente significativas. También hubodiferencias estadísticamente significativas entre apoyo social y nivelde cobertura (p < 0,001), tiempo de respuesta (p = 0,022), sobrecarga(p = 0,003), ansiedad (p = 0,046) o depresión (p = 0,040). Por último,se apreciaron diferencias estadísticamente significativas entre nivel deestrés y género (p = 0,035). Conclusiones: El presente trabajo muestraque las necesidades y demandas de servicios de salud se deben dirigir adisminuir el elevado nivel de sobrecarga, estrés y depresión detectado.De este modo, el estudio pone en evidencia el tipo de actuacionesmultidisciplinarias que los servicios de salud deben implementar paramejorar la calidad de vida y mitigar los problemas de salud de loscuidadores principales de pacientes inmovilizados. (AU)

Objective: Assess the needs and demands for health servicesof the main caregiver of immobilized patients at the CaranzaHealth Center. Methodology: Cross-sectional descriptive studyon the main caregivers of immobilized patients, through theidentification of immobilized patients and recruitment of 39main caregivers who voluntarily and anonymously participated.Inclusion of quality variables (≥ 2 visits/year), clinical (burden,support, stress, anxiety, and depression), sociodemographic, andsatisfaction with the service. Results: The quality indicator wasexceeded in 89.8% of fixed assets. Between burden and kinship(p = 0.040), level of coverage (p = 0.012) or response time(p = 0.015), statistical differences were observed. There were alsostatistically significant differences between social support andcoverage level (p < 0.001), response time (p = 0.022), overload(p = 0.003), anxiety (p = 0.046) or depression (p = 0.040). Finally,statistically significant differences were observed between stresslevel and gender (p = 0.035). Conclusions: The present workshows that the needs and demands of health services shouldbe aimed at reducing the high level of overload, stress anddepression detected. In this way, the study highlights the type ofmultidisciplinary actions that health services must implement toimprove the quality of life and mitigate the health problems of themain caregivers of immobilized patients. (AU)

Oral health care of homebound older adults: multidimensional theoretical model / Cuidado à saúde bucal de idosos domiciliados: modelo teórico multidimensional

OBJECTIVES: To understand the dimensions of oral health care of homebound older adults and to develop a preliminary theoretical model that explains how these dimensions are interrelated in the provision of care. METHODS: Cross-sectional, qualitative study, based on Grounded Theory. Participants were 37 intentionally selected older adults registered at a Primary Health Care center, Florianópolis (SC), Brazil. Data collection was conducted at home, following an interview script. The interviews were audio-recorded, transcribed, and analyzed by constant comparison. Formulation of the model followed the Glaserian approach. RESULTS: The theoretical model presents the dimensions of oral health care of homebound older adults - who, why, when, how, and where oral health care is provided. Frailties were identified in all dimensions of oral health care, with emphasis on those related to older adults' living, health, and oral health conditions, compromising dental care provided at home, access to dental services, and presence of the dentist. In combination, these frailties constitute a rupture in the possibilities for oral health care. CONCLUSIONS: Strategies for provision of oral health care to homebound older adults should be implemented in each of the dimensions to overcome the frailties identified and promote better oral health conditions and access to dental services. (AU)

OBJETIVOS: Compreender quais as dimensões presentes no cuidado à saúde bucal de idosos domiciliados e elaborar um modelo teórico preliminar que explique de que modo essas dimensões estão inter-relacionadas na produção do cuidado. METODOLOGIA: Estudo transversal, qualitativo, com referencial da Teoria Fundamentada nos Dados. Participaram 37 idosos, intencionalmente selecionados, cadastrados na Atenção Primária à Saúde, Florianópolis (SC). A coleta de dados foi realizada no domicílio, seguindo roteiro de entrevista. As falas foram gravadas em áudio, transcritas e analisadas por comparação constante. A elaboração do modelo seguiu a vertente glaseriana do método. RESULTADOS: Identificaram-se fragilidades no processo de cuidado em todos os elementos de caracterização (quem, porque, quando, como e onde), destacando-se as relacionadas ao próprio idoso, a sua condição de saúde bucal, ao cuidado realizado no domicílio, ao acesso aos serviços odontológicos e à participação do cirurgião-dentista. O somatório dessas fragilidades promove uma ruptura nas possibilidades de cuidado à saúde bucal nas múltiplas dimensões: individual, familiar, profissional e institucional. CONCLUSÕES: Estratégias de cuidado à saúde bucal prestado aos idosos em domicílio devem ser implementadas em cada uma das dimensões identificadas a fim de superar as fragilidades e promover melhores condições de saúde bucal e acesso aos serviços odontológicos. (AU)

Preparo dos pais para a desospitalização de crianças em uso de traqueostomia e gastrostomia / Preparación de los padres para la deshospitalización de niños en uso de traqueostomía y gastrostomía / Parents' preparation for the dehospitalization of children using tracheostomy and gastrostomy

RESUMO Objetivo: relatar a experiência de uma ação educativa para o preparo dos pais para a desospitalização de crianças em uso de traqueostomia e gastrostomia. Método: relato de experiência sobre uma ação educativa, que é parte de um Programa de Treinamento de um hospital público de alta complexidade referência em pediatria, no período de dezembro de 2017 a dezembro de 2018. Resultados: o preparo dos responsáveis para a desospitalização de crianças em uso de traqueostomia e gastrostomia foi feito a partir de 5 etapas: 1) Instruções aos pais; 2) Treinamento dos pais para manuseio do dispositivo utilizado pela criança; 3) Manipulação dos dispositivos pelos pais sob supervisão do enfermeiro; 4) Feedback oferecido pela Enfermagem; e 5) Avaliação da ação educativa. Considerações finais: Acredita-se que a educação terapêutica fornecida aos envolvidos contribuiu na qualificação do cuidado à criança em uso de traqueostomia e gastrostomia, favorecendo sua qualidade de vida e reduzindo as intercorrências domiciliares relacionadas ao manuseio inadequado dos dispositivos em questão.

resumen Objetivo: relatar la experiencia de una acción educativa para la preparación de los padres para la deshospitalización de niños en uso de traqueostomía y gastrostomía. Método: relato de experiencia sobre una acción educativa, que hace parte de un Programa de Entrenamiento de un hospital público de alta complejidad referencia en pediatría, en el período de diciembre de 2017 a diciembre de 2018. Resultados: la preparación de los responsables para la deshospitalización de niños en uso de traqueostomía y gastrostomía se hizo a partir de 5 etapas: 1) Instrucciones a los padres; 2) Entrenamiento de los padres para manejo del dispositivo utilizado por el niño; 3) Manipulación de los dispositivos por los padres bajo supervisión del enfermero; 4) Feedback ofrecido por la Enfermería; y 5) Evaluación de la acción educativa. Consideraciones finales: Se cree que la educación terapéutica proporcionada a los involucrados contribuyó en la calificación del cuidado del niño en uso de traqueostomía y gastrostomía, favoreciendo su calidad de vida y reduciendo las complicaciones domiciliarias relacionadas con el manejo inadecuado de los dispositivos en cuestión.

ABSTRACT Objective: to report the experience of an educational action for the preparation of parents for the dehospitalization of children using tracheostomy and gastrostomy. Method: experience report on an educational action, which is part of a Training Program of a public hospital of high complexity reference in pediatrics, from December 2017 to December 2018. Results: the preparation of those responsible for the dehospitalization of children using tracheostomy and gastrostomy was made from 5 stages: 1) Instructions to parents; 2) Training of parents to handle the device used by the child; 3) Manipulation of the devices by parents under the supervision of the nurse; 4) Feedback offered by Nursing; and 5) Evaluation of educational action. Final considerations: It is believed that the therapeutic education provided to those involved contributed to the qualification of care for children using tracheostomy and gastrostomy, favoring their quality of life and reducing home complications related to inadequate handling of the devices in question.

Hilly environment and frequency of going out-of-home among older adults: Examining moderating effect of driving status.

AIM: The health benefits of "going out-of-home" frequently among older adults are well known. A hilly environment would inhibit this habit. This study examined (i) longitudinal associations between a hilly environment and the frequency of going out-of-home, and (ii) the moderating effect of driving status on their association among older adults. METHODS: This study involved a longitudinal study design. Data on 856 older adults in Nada Ward, Kobe, Japan, was obtained from a three-wave questionnaire survey (Wave 1: December 2017 to January 2018; Wave 2: after 1 year; Wave 3: after 3 years). In each survey, the frequency of going out-of-home time was measured. The average land slope within 500 m network buffers of each participant's home was calculated as the index of the hilly environment. Driving status was also measured. RESULTS: The latent growth model revealed that while a higher value of average land slope was not significantly associated with changes in the frequency of going out-of-home over time, it was significantly associated with a lower frequency of going out-of-home at the initial level. The interaction term in the latent growth model showed that driving status did not moderate the associations of the average land slope with the initial level of, and changes in, the frequency of going out-of-home. CONCLUSIONS: Although it remains unclear whether a hilly environment would accelerate a decline in the frequency of going out-of-home over time, this study found that older adults living in a hilly environment were less likely to leave their homes. Geriatr Gerontol Int 2022; 22: 961-967.

Factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients.

BACKGROUND: Inappropriate management of medications is a major threat to homebound patients with chronic conditions. Despite many efforts in improving medication reconciliation in ambulatory and inpatient settings, little research has focused on home care settings. In 2016, Taiwan initiated the Integrated Home Health Care programme, which was intended to reduce potentially inappropriate medication management and risks of uncontrolled polypharmacy through the integration of different medication sources for chronic conditions among homebound patients. This study investigated factors associated with having home care physicians as an integrated source of medications for chronic conditions among homebound patients. METHOD: This retrospective cohort study enrolled 3142 community-dwelling homebound patients from Taipei City Hospital. Homebound patients' adherence to using home care physicians as an integrated source of chronic condition medications was defined as having all prescriptions for their chronic conditions prescribed by a single home care physician for at least 6 months. Both patient and home care physician characteristics were analysed. Multivariable logistic regression was applied. RESULTS: Of the 3142 patients with chronic conditions, 1002 (31.9%) had consistently obtained all medications for their chronic illnesses from their home care physicians for 6 months and 2140 (68.1%) had not. The most common chronic diseases among homebound patients were hypertension, diabetes mellitus, dementia, cerebrovascular disease and constipation. Oldest-old patients with poor functional status, fewer daily medications, no co-payment exemption and no recent inpatient experience were more likely to adhere to this medication integration system. In addition, patients whose outpatient physicians were also their home care physicians were more likely to adhere to the system. CONCLUSIONS: The finding suggests that building trust and enhancing communication among homebound patients, caregivers and home care physicians are critical. Patient and provider variations highlight the need for further improvement and policy modification for medication reconciliation and management in home care settings. The improvement in medication management and care integration in home care settings may reduce misuse and polypharmacy and improve homebound patients' safety.

[Physician's role in the medical and legal protection of elderly patients]. / "Rôle du médecin traitant dans la protection médicale et juridique des patients âgés".

"Physician's role in the medical and legal protection of elderly patients.The world and french population is currently aging and losing autonomy both medically and legally. Preventing the vulnerability and loss of autonomy of the elderly is a public health objective. These complex situations could be anticipated through an exchange of elderly patients with their general practitioner. The evolution of medical protection measures (such as advance directives and the appointment of a trustworthy person) and the evolution of legal protection measures (such as a mandate for future protection, family empowerment, placement under guardianship or curatorship, ...) make it necessary to reassess the role of the GP in the medical and legal protection of his elderly patients. This development is the result of a thesis work based on the interrogation of GPs in a thesis."

"Rôle du médecin traitant dans la protection médicale et juridique des patients âgés .La population française, et même mondiale, est actuellement vieillissante et en perte d'autonomie tant sur le plan médical que juridique. La prévention de la vulnérabilité et de la perte d'autonomie des personnes âgées est un objectif de santé publique. Ces situations complexes pourraient être anticipées grâce à un échange des patients âgés avec leur médecin généraliste. L'évolution des mesures de protection médicale (telles que les directives anticipées et la désignation d'une personne de confiance) et l'évolution des mesures de protection juridique (telles que mandat de protection future, habilitation familiale, placement sous tutelle ou curatelle…) obligent à réévaluer le rôle du médecin généraliste dans la protection médicale et juridique de ses patients âgés. Cette mise au point est l'aboutissement d'un travail de thèse fondé sur une enquête auprès de médecins généralistes."

Descripción de un servicio de visitas domiciliarias a pacientes adultos mayores confinados en sus hogares y análisis de los determinantes de su utilización / Description of a home visits service for elderly homebound patients and analysis of the determinants of its use

Introducción: Desarrollamos un servicio de visitas domiciliarias a pacientes confinados en sus hogares en un establecimiento de salud en Quito-Ecuador. Objetivos: (i) describir el proceso de atención en el servicio de visitas domiciliarias y evaluar su ajuste al modelo de atención primaria en salud, (ii) describir el flujo de procesos del servicio como una propuesta para replicar en otros ámbitos, (iii) identificar los determinantes de alta utilización del servicio; y (iv) validar un sistema de puntuación que incluya a esos determinantes como predictores de su uso. Sujetos y métodos: Estudio observacional longitudinal retrospectivo y desarrollo de un score. Se analizaron las características sociodemográficas y clínicas de los pacientes en la primera visita y contando el número de visitas domiciliarias por paciente 18 meses después. Mediante modelos de regresión binomial negativa se identificaron los determinantes de utilización de vivitas domiciliarias, cuyos ß-coeficientes ajustados y transformados en score, fueron validados internamente mediante el cálculo del área bajo la curva. Resultados: 120 pacientes recibieron 285 vistas domiciliarias después de 18 meses, 70% fueron mujeres con una media de edad de 83 años. Nueve pacientes recibieron 75 visitas domiciliarias. Edad, estado civil, multimorbilidad-polifarmacia y la realización inicial de procedimientos clínicos fueron determinantes independientes de ≥4 visitas domiciliarias por año. El área bajo la curva fue de 0.80 (IC 95%=0.78 a 0.82).Discusión y conclusión: Nuestro servicio de visitas domiciliarias a pacientes confinados se ajusta al modelo de atención primaria de salud. El flujograma podría adoptarse/adaptarse en contextos similares. Edad, estado civil, multimorbilidad-polifarmacia y requerimiento de procedimientos clínicos predijeron, de manera fiable, la utilización del servicio.

Background: We developed an innovative service of home health care visits (HV) for home-bound patients, assigned to a health care center in Quito-Ecuador.Objectives: (i) To describe the service and evaluate its adjustment to the primary care model, (ii) to describe the flow of service processes to subsequently adopt or adapt it in other healthcare facilities, (iii) to identify the determinants of HV utilization; and (iv) to internally validate the fiability of a scoring system, based on those determinants.Subjects and methods: We performed an observational longitudinal retrospective study and developing of a scoring system. We analyzed the sociodemographic and clinical charac-teristics of the patients during the first home visit and counted the number of home visits per patient 18 months later. Through negative binomial regression models, we identified the determinants of home visits utilization. The adjusted ß-coefficients were transformed into a score and validated internally by calculating the area under the curve.Results: 120 patients received 285 home visits after 18 months, 70% were women with a mean age of 83 years. Nine patients received 75 home visits. Age, marital status, multimorbi-dity-polypharmacy, and the initial performance of clinical procedures were independent deter-minants of ≥4 HV per year. The area under the curve score was 0.80 (95% CI = 0.78 to 0.82).Discussion y conclusion: Our home visit service to homebound patients resulted in an in-tervention that fit the primary care model. The flowchart allows it to be adopted or adapted in other health care facilities. Age, marital status, multimorbidity-polypharmacy and the perfor-mance of clinical procedures reliably predicted the service utilization.

Validation of nursing diagnosis for nursing consultation on home visit to adults / Validez de diagnóstico de enfermería para consulta de enfermería en la visita domiciliaria al adulto / Validação de diagnósticos de enfermagem para consulta de enfermagem na visita domiciliar ao adulto

ABSTRACT Objectives: to identify and confirm the priority nursing diagnosis of International Classification for Nursing Practice® for home nursing consultation to adults in Primary Health Care. Methods: qualitative study, of methodological and validation type. The 5-point Likert scale was used, with a minimum Content Validity Index of 80% consensus among judges., considering the answers "priority" or "very priority" for the list of nursing diagnoses presented. 23 expert judges participated in this survey. Results: a hundred and eleven nursing diagnoses of prepared statements lists have been grouped by human systems and sociodemographic characteristics. were grouped by human systems and sociodemographic characteristics. Eighty-three of them (74.77%) had a Content Validity Index equal or higher to 0.8; and 27 (32.5%) had an index of 1.0 (100%) among judges. Conclusions: nursing diagnosis validated can be used to assist clients in home nursing consultations in Primary Health Care.

RESUMEN Objetivos: identificar e validar diagnósticos de enfermería prioritarios de la Clasificación Internacional para Práctica de Enfermería® para consulta de enfermería domiciliaria del adulto en la Atención Primaria de Salud. Métodos: estudio cuantitativo, del tipo metodológico y de validez. Utilizó escala Likert de 5 puntos, con Índice de Validez de Contenido mínimo de 80% de consenso entre los jueces, considerando las respuestas "prioritario" o "muy prioritario" para la lista de diagnósticos de enfermería presentada. Participaron de la investigación 23 jueces especialistas. Resultados: los 111 diagnósticos de enfermería de la lista de enunciados elaborada, agrupados por sistemas humanos y características sociodemográficas. De estos, 83 (74,77%) obtuvieron Índice de Validez de Contenido mayor o igual a 0,8; e 27 (32,5%) obtuvieron índice 1,0 (100%) entre jueces. Conclusiones: los Diagnósticos de Enfermería validados pueden ser utilizados en la atención a los clientes en las consultas de enfermería domiciliarias en la Atención Primaria de Salud.

RESUMO Objetivos: identificar e validar os diagnósticos de enfermagem prioritários da Classificação Internacional para a Prática de Enfermagem® para a consulta de enfermagem domiciliar do adulto na Atenção Primária à Saúde. Métodos: estudo quantitativo, do tipo metodológico e de validação. Utilizou-se a escala Likert de 5 pontos, com o Índice de Validade de Conteúdo mínimo de 80% de consenso entre os juízes, considerando as respostas "prioritário" ou "muito prioritário" para a lista de diagnósticos de enfermagem apresentada. Participaram da pesquisa 23 juízes especialistas. Resultados: os 111 diagnósticos de enfermagem da lista de enunciados elaborada foram agrupados por sistemas humanos e características sociodemográficas. Destes, 83 (74,77%) obtiveram Índice de Validade de Conteúdo maior ou igual a 0,8; e 27 (32,5%) obtiveram índice 1,0 (100%) entre juízes. Conclusões: os Diagnósticos de Enfermagem validados podem ser utilizados no atendimento aos clientes nas consultas de enfermagem domiciliares na Atenção Primária à Saúde.

Translation and cross-cultural adaptation of the NutriQoL® questionnaire to the Portuguese language: Brazilian version / Tradução e adaptação do questionário NutriQoL® para a língua portuguesa: versão Brasileira

ABSTRACT Objective The objective of this study was to translate and cross-culturally adapt the NutriQoL® into Brazilian Portuguese. Methods The NutriQoL® comprises 17 questions that evaluate the quality of life of patients receiving home enteral nutrition therapy. The methodological procedures included the translation from the Spanish version into Portuguese by two translators, synthesis of the translations, back translation, evaluation by a committee of judges composed of 24 individuals in which a content validity index > 0.78 was considered acceptable, and generation of the pre-final version. A pre-test to analyze its semantic equivalence was administered to 12 patients receiving home enteral nutrition therapy. The final version of the questionnaire was then prepared. Results A summary version of the questionnaire was obtained using two versions of the translation. Both back translations were identical for 73.6% of sentences (n=25). Twenty-four volunteers were included in the committee of judges. The content validity index was 0.88±0.11, and 14.7% (n=5) of questions had a low content validity index and were thus reformulated. In the pre-test, 35.3% (n=12) of items obtained low levels of understanding and required adjustment. In the preparation of the final version, the inconsistencies of the items mentioned were corrected and/or adjusted. Conclusion After completing the methodological procedures, a Brazilian Portuguese version of the NutriQoL® questionnaire was obtained. Following the validation process, it can be used by dieticians and other health professionals to assess the quality of life of patients receiving home enteral nutrition therapy to contribute to improvements in care practices.

RESUMO Objetivo O intuito deste estudo foi realizar a tradução do NutriQoL para a língua portuguesa e a adaptação transcultural para o Brasil. Métodos O NutriQoL® é composto de 17 pares de perguntas que avaliam a qualidade de vida de pacientes em terapia nutricional enteral domiciliar. Os procedimentos metodológicos foram: tradução da versão em espanhol para a língua portuguesa por dois tradutores; síntese das traduções; retrotradução; avaliação, da versão traduzida, por um comitê de juízes composto por 24 indivíduos, na qual o índice de validade de conteúdo > 0,78 foi considerado, gerando a versão pré-final e realização de um pré-teste no qual a versão pré-final do questionário foi aplicada a 12 pacientes em uso de terapia nutricional enteral domiciliar para análise da equivalência semântica e elaboração da versão final do questionário. Resultados Observou-se que, a partir das duas versões traduzidas, foi possível obter uma versão síntese do questionário. As duas retrotraduções geradas foram idênticas em 73,6% das sentenças (n=25). O índice de validade de conteúdo foi 0,88 ± 0,11, e 14,7% (n=5) das questões tiveram baixo índice de validade de conteúdo, sendo então reformuladas. No pré-teste foi observado que 35,3% (n=12) dos itens obtiveram baixos índices de compreensão e necessitaram de ser reformulados. Na elaboração da versão final do questionário as inconsistências dos itens mencionados foram sanadas e/ou adaptadas. Conclusão Após conclusão dos procedimentos metodológicos, foi possível obter a versão brasileira do questionário NutriQoL® em língua portuguesa para que, após processo de validação, o instrumento seja utilizado pelo nutricionista ou demais profissionais de saúde para avaliação da qualidade de vida de pacientes em uso de terapia nutricional enteral domiciliar, a fim de contribuir com melhorias nas práticas assistenciais.

Saúde bucal de pessoas idosas domiciliadas acompanhadas na atenção primária: estudo transversal / Oral health of homebound older adults followed by primary care: a cross sectional study

Resumo Objetivo caracterizar a condição de vida, saúde e saúde bucal das pessoas idosas domiciliadas cadastradas na atenção primária e os cuidados realizados em domicílio. Método estudo transversal, de base domiciliar com amostra de conveniência, em Florianópolis, sul do Brasil. A coleta de dados ocorreu por meio de questionário e exame clínico, os quais incluíram variáveis sociodemográficas, condição de dentes e mucosa, higiene bucal, acesso a atendimento odontológico e visita de cirurgião-dentista no domicílio. Procedeu-se análise de frequência absoluta e relativa e análise bivariada (qui-quadrado, IC=95%). Resultados participaram 123 idosos com idade média de 81,3 anos, 62,6% eram mulheres. Possuíam cuidador 87%, 60% encontravam-se domiciliados por até 5 anos e 89,4% eram frágeis. Quanto à presença de dentes, 56,1% eram edêntulos e 40,5% possuíam de 1 a 8 dentes. Restos radiculares foram observados em 12,8%, lesão de cárie não tratada em 25,2%, biofilme visível em 69,9%, e lesões na mucosa em 8,9%. Necessitavam de auxílio para higiene bucal 45,5% e não realizavam limpeza diária 24,4%. A dificuldade de acessar atendimento odontológico por estar domiciliado foi relatada por 32,5% e visita do cirurgião-dentista ocorreu em 16,3%. Sexo feminino e menor escolaridade estiveram associados à ausência de dentes e menor força física. Conclusão a saúde bucal das pessoas idosas estudadas é precária pela presença de problemas bucais que demandam intervenção. Há dependência de terceiros para cuidados bucais, que não são garantidos de modo consistente, no domicílio. O estudo aponta necessidade de atendimento odontológico no domicílio no âmbito dos serviços públicos de saúde.

Abstract Objective to characterize the life, health, and oral health conditions of homebound older people registered in the primary care teams and oral homecare provided. Method cross-sectional, household based study with a convenience sample, in Florianópolis, southern Brazil. Data collection through a questionnaire and clinical oral examination which included sociodemographic variables, condition of teeth and mucosa, oral hygiene, access to dental care and dentist providing homecare. Absolute and relative frequency analysis and bivariate analysis (chi-square, CI=95%) were performed. Results 123 older people participated with mean age of 81.3 years, 62.6% were women. Living with a caregiver were 87%, 60% were domiciled for up to 5 years, and 89.4% were frail. Regarding the presence of teeth, 56.1% were edentulous and 40.5% had from 1 to 8 teeth. Root remains were observed in 12.8%, untreated caries lesions in 25.2%, visible biofilm in 69.9%, tooth mobility in 57.7% and mucosal lesions in 8.9% of the elders; 45.5% needed help with oral hygiene and 24.4% did not perform daily mouth cleaning. The difficulty in accessing dental care due to homeboundness was reported by 32.5% and home visits provided by the dentist occurred in only 16.3%. Conclusion the oral health of the older adults studied is poor due to the presence of oral problems that require intervention. There is dependence on third parties for oral care, which is not consistently guaranteed at home. The study points to the need for dental homecare provided by public health services.

Needs for family caregivers of Cerebrovascular Accident survivors.

OBJECTIVES: To know the needs of family caregivers of Cerebrovascular Accident survivors. METHODS: This is a qualitative, descriptive, and exploratory study. Data were collected from 37 family caregivers of Cerebrovascular Accident survivors from a city in the interior of Bahia, through an interview using a semi-structured form, between September 2017 and March 2018, and submitted to thematic content analysis. RESULTS: Three categories emerged: the early need for health education on the disease and care for family caregivers; the need to restructure care for family caregivers; 3) family caregivers need free time for social activities and (self)care. CONCLUSIONS: Caregivers have basic needs for health care and social interaction, which can enable by educational health interventions.

Organizational flow chart of home care for children with special health care needs / Organigrama de atención domiciliaria a niños con necesidades de salud especiales / Fluxograma organizativo de atenção domiciliar às crianças com necessidades especiais de saúde

ABSTRACT Objective: To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana. Method: Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart. Results: Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed. Conclusion: The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.

RESUMEN Objetivo: Desarrollar un protocolo de organigrama en los servicios de atención domiciliaria (AD) de la modalidad AD2 para niños con necesidades de salud especiales (CRIANES), en el estado de Paraná. Método: Se trata de una investigación cuantitativa, descriptiva, exploratoria, con estudio de casos múltiples. La recolección de datos se llevó a cabo con profesionales de los ocho servicios de atención domiciliaria paranaenses. Los datos se analizaron con la metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades), de la cual se elaboró el plan de acción con el método 5W2H que produjo el organigrama normativo. Resultados: Considerando las estrategias encontradas en los servicios de atención domiciliaria, como alta hospitalaria programada, preparación del cuidador, transporte sanitario organizado y proyecto terapéutico singular, se desarrolló el protocolo del organigrama para niños con necesidades de salud especiales en los servicios de atención domiciliaria. Conclusión: El protocolo desarrollado posibilita organizar el diagrama de flujo de atención a niños con necesidades especiales de saluden atención domiciliaria.

RESUMO Objetivo: Desenvolver protocolo de organização de fluxo nos serviços de atenção domiciliar (AD) para o cuidado na modalidade AD2a crianças com necessidades especiais de saúde (CRIANES), no estado do Paraná. Método: Pesquisa quantitativa, descritiva, exploratória, estudo de casos múltiplos. Coleta de dados com profissionais dos oito serviços de atenção domiciliar paranaenses. Os dados foram analisados com a metodologia Strengths, Weaknesses, Opportunities e Threats (SWOT), a partir da qual foi elaborado plano de ação pelo método 5W2H, originando fluxograma normativo. Resultados: Considerando as estratégias encontradas nos serviços de atenção domiciliar, como alta hospitalar programada, preparo do cuidador, transporte sanitário organizado e projeto terapêutico singular, foi desenvolvido protocolo de organização de fluxo para crianças com necessidades especiais de saúde nos serviços de atenção domiciliar. Conclusão: O protocolo desenvolvido possibilita organizar o fluxo de atenção às crianças com necessidades especiais de saúde na atenção domiciliar.

Organizational flow chart of home care for children with special health care needs / Organigrama de atención domiciliaria a niños con necesidades de salud especiales / Fluxograma organizativo de atenção domiciliar às crianças com necessidades especiais de saúde

ABSTRACT Objective: To develop a workflow protocol for Home Care (HC) services in the HC2 modality for children with special health care needs (CSHCN) in the state of Parana. Method: Quantitative, descriptive, exploratory, multiple case studies. Data was collected with professionals from the eight home care services in Parana. Data were analyzed using the Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology, from which a 5W2H method of action plan was developed, resulting in a flow chart. Results: Considering the strategies found in Home Care services, such as planned hospital discharge, caregiver training, organized transportation and singular therapeutic project, a flow organization protocol for children with special health care needs in Home Care services was developed. Conclusion: The protocol developed makes it possible to organize the care provided to children with special health care needs in home care.

RESUMEN Objetivo: Desarrollar un protocolo de organigrama en los servicios de atención domiciliaria (AD) de la modalidad AD2 para niños con necesidades de salud especiales (CRIANES), en el estado de Paraná. Método: Se trata de una investigación cuantitativa, descriptiva, exploratoria, con estudio de casos múltiples. La recolección de datos se llevó a cabo con profesionales de los ocho servicios de atención domiciliaria paranaenses. Los datos se analizaron con la metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades), de la cual se elaboró el plan de acción con el método 5W2H que produjo el organigrama normativo. Resultados: Considerando las estrategias encontradas en los servicios de atención domiciliaria, como alta hospitalaria programada, preparación del cuidador, transporte sanitario organizado y proyecto terapéutico singular, se desarrolló el protocolo del organigrama para niños con necesidades de salud especiales en los servicios de atención domiciliaria. Conclusión: El protocolo desarrollado posibilita organizar el diagrama de flujo de atención a niños con necesidades especiales de saluden atención domiciliaria.

RESUMO Objetivo: Desenvolver protocolo de organização de fluxo nos serviços de atenção domiciliar (AD) para o cuidado na modalidade AD2a crianças com necessidades especiais de saúde (CRIANES), no estado do Paraná. Método: Pesquisa quantitativa, descritiva, exploratória, estudo de casos múltiplos. Coleta de dados com profissionais dos oito serviços de atenção domiciliar paranaenses. Os dados foram analisados com a metodologia Strengths, Weaknesses, Opportunities e Threats (SWOT), a partir da qual foi elaborado plano de ação pelo método 5W2H, originando fluxograma normativo. Resultados: Considerando as estratégias encontradas nos serviços de atenção domiciliar, como alta hospitalar programada, preparo do cuidador, transporte sanitário organizado e projeto terapêutico singular, foi desenvolvido protocolo de organização de fluxo para crianças com necessidades especiais de saúde nos serviços de atenção domiciliar. Conclusão: O protocolo desenvolvido possibilita organizar o fluxo de atenção às crianças com necessidades especiais de saúde na atenção domiciliar.

Older adults undergoing home enteral nutrition therapy: integration of national public policy and municipal programs / Idosos em terapia nutricional enteral no domicílio: integração das políticas públicas nacionais e programas municipais

Abstract Objective: to verify if national public policies and municipal programs contain elements that contribute to ensure the Human Right to Adequate Food (HRAF) of older adults undergoing home enteral nutrition therapy (HENT) and to propose the integration of these elements. Method: a qualitative study was carried out based on the content analysis of the documents of the National Policy for Older Adults (or PNI), the National Policy for the Health of Older Adults (or PNSPI) and the National Food and Nutrition Policy (or PNAN). Analysis of the relationships (co-occurrences) in programs of the 29 cities of the 2nd regional health region of Paraná to provide care for people with special dietary needs (SDN), such as older adults undergoing HENT, was also carried out. For the analysis of the relationships, the keywords older adult and right were used. Furthermore, the integration of national public policies and municipal programs was proposed. Results: the PNI, PNSPI and PNAN contain converging principles, guidelines and actions, but they are not fully integrated into the programs. Only seven cities with programs that aimed to organize care involving SDN were identified, documented in five protocols and two decrees. A co-occurrence was verified in three of the analyzed documents, but a relationship between the keywords older adult and right was not verified in the protocols and decrees. In the integration proposal, a network was described, based around the goal of reaching the center, which represents the HRAF for older adults undergoing HENT. Conclusion: national public policies contain elements to ensure the HRAF of older adults undergoing HENT, but the municipal programs do not include all these elements. A proposal to integrate the elements was created.

Resumo Objetivo: Verificar se políticas públicas nacionais e programas municipais apresentam elementos que contribuem para a garantia do Direito Humano à Alimentação Adequada (DHAA) de idosos em Terapia Nutricional Enteral em domicílio (TNED) e propor a integração desses elementos. Método: Estudo qualitativo em que foi realizada análise de conteúdo dos documentos da Política Nacional do Idoso (PNI), da Política Nacional de Saúde da Pessoa Idosa (PNSPI) e da Política Nacional de Alimentação e Nutrição (PNAN) e análise das relações (coocorrências) de protocolos e decretos de programas de 29 municípios da 2ª regional de saúde do Paraná para atender as pessoas com necessidades especiais de alimentação (NEA), como idosos em TNED. Para análise das relações, as palavras-chave foram: idoso e direito. Ainda, foi elaborada uma proposta de integração de políticas públicas nacionais e de programas municipais. Resultados: Existem princípios, diretrizes e ações convergentes nas PNI, PNSPI e PNAN, mas, apresentaram-se pouco incluídos nos programas. Foram identificados apenas sete municípios que apresentaram programa com vistas à organização do cuidado em NEA, documentados em cinco protocolos e dois decretos. A coocorrência das palavras-chaves idoso e direito foi verificada em três dos documentos, mas a relação entre elas não foi encontrada. Na proposta de integração, há a formação de uma rede, com a intenção de alcançar o centro, o qual representa o DHAA de idosos em TNED. Conclusão: As políticas públicas nacionais apresentam elementos para a garantia do DHAA de idosos em TNED, mas os programas municipais não contemplam todos esses elementos. Uma proposta de integração desses elementos foi criada.

Recommendations in covid-19 times: a view for home care / Recomendaciones en tiempos de COVID-19: una mirada a la atención domiciliaria / Recomendações em tempos de COVID-19: um olhar para o cuidado domiciliar

ABSTRACT Objective: To suggest recommendations for the practice of Home Nursing in the context of COVID-19. Method: Reflective study, originated from readings associated with the theme, available in current guidelines from the Pan American Health Organization, World Health Organization and the Ministry of Health. Results: Recommendations were developed from current scientific evidence for prevention of infections, control of epidemics and pandemics in the Brazilian home scenario. Final considerations: the reflections achieved contribute to guiding actions for better assistance to the patient, family caregivers and the community in the perspective of safe home care with COVID-19, and it is characterized as an introductory discussion on the theme, encouraging new studies to be carried out from the unfolding of the current scenario.

RESUMEN Objetivo: Proponer recomendaciones para la práctica de enfermería domiciliaria en el contexto de la COVID-19. Método: Estudio reflexivo, producido a partir de lecturas relacionadas con el área temática, disponibles en directrices actuales de la Organización Panamericana de la Salud, Organización Mundial de la Salud y Ministerio de la Salud. Resultados: Han sido construidas recomendaciones a partir de evidencias científicas actuales para prevención de infecciones, control de epidemias y pandemias en el contexto domiciliario brasileño. Conclusiones: Las reflexiones realizadas contribuyen para orientar acciones con vistas a una mejor asistencia al paciente, familiares cuidadores y comunidad en la perspectiva de una atención domiciliaria segura en relación a la COVID-19; se caracterizan como una discusión inicial sobre el tema, estimulando que nuevos estudios sean realizados a partir de la evolución del escenario actual.

RESUMO Objetivo: Propor recomendações para a prática de enfermagem domiciliar no contexto da COVID-19. Método: Estudo reflexivo, produzido com base em leituras correlacionadas com a área temática, disponíveis em diretrizes atuais da Organização Pan-Americana da Saúde, Organização Mundial da Saúde e Ministério da Saúde. Resultados: Foram construídas recomendações segundo evidências científicas atuais para prevenção de infecções, controle de epidemias e pandemias no contexto domiciliar brasileiro. Considerações finais: As reflexões realizadas contribuem para nortear ações com vistas a uma melhor assistência ao paciente, familiares cuidadores e comunidade na perspectiva de um cuidado domiciliar seguro em relação à COVID-19; se caracterizam como uma discussão inicial sobre o tema, estimulando que novos estudos sejam realizados com base na evolução do cenário atual.

Síndrome de inmovilidad en adultos mayores del Policlínico Bernardo Posse del municipio San Miguel del Padrón / Immobilization syndrome in elderly people in "Bernardo Posse" Policlinic in San Miguel del Padron

RESUMEN Fundamento: Dentro de los grandes síndromes geriátricos, la inmovilidad es una de las más graves consecuencias de las enfermedades que puede sufrir el anciano. Objetivo: Caracterizar el comportamiento del síndrome de inmovilidad en los adultos mayores del Grupo Básico de Trabajo n.o 1 del policlínico Bernardo Posse de San Miguel del Padrón. Metodología: Se realizó un estudio descriptivo, retrospectivo, en 145 pacientes con síndrome de inmovilidad, de una población de 160 ancianos desde enero de 2015 a diciembre del 2017. Se determinó el tipo de inmovilidad, y las causas principales, así como las complicaciones. Resultados: El síndrome predominó en pacientes femeninos en edades altas de la vida. El tipo de inmovilidad más frecuente fue la larvada y las causas más frecuentes fueron las enfermedades osteomioarticulares, las infecciones, el cáncer y el síndrome del cuidador. Las complicaciones que predominaron fueron a nivel de los sistemas digestivo, respiratorio, cardiovascular y la piel. Conclusiones: El riesgo de presentar algún tipo de inmovilidad aumenta con la edad y el sexo femenino es más susceptible a este. La inmovilidad es una entidad sindromática que deteriora de manera significativa la calidad de vida de los adultos mayores ya que el anciano inmovilizado es un paciente de alto riesgo para la aparición de complicaciones.

ABSTRACT Background: Within the great geriatric syndromes, immobility is one of the most serious consequences of the diseases that the elderly can suffer. Objective: To characterize the behavior of the immobility syndrome in the elderly from the Basic Working Group No. 1 at Bernardo Posse polyclinic in San Miguel del Padrón. Methodology: A retrospective descriptive study was carried out in 145 patients with immobility syndrome, from a population of 160 elderly people, from January 2015 to December 2017. The type of immobility was determined, as well as the main causes, as well as complications. Results: The syndrome predominated in female patients at high ages of life. The most frequent type of immobility was larvae and the most frequent causes were osteomyoarticular diseases, infections, and cancer also the caregiver syndrome. The predominated complications were at the level of the digestive, respiratory, cardiovascular and skin systems. Conclusions: The risk of presenting some type of immobility increases with age, and the female sex is more susceptible to it. Immobility is a syndromic disease that significantly deteriorates the quality of life of elderly, since the immobilized elderly person is a high-risk patient for complications.

Síndrome de inmovilidad en adultos mayores del Policlínico Bernardo Posse del municipio San Miguel del Padrón / Immobilization syndrome in elderly people in "Bernardo Posse" Policlinic in San Miguel del Padron

RESUMEN Fundamento: Dentro de los grandes síndromes geriátricos, la inmovilidad es una de las más graves consecuencias de las enfermedades que puede sufrir el anciano. Objetivo: Caracterizar el comportamiento del síndrome de inmovilidad en los adultos mayores del Grupo Básico de Trabajo n.o 1 del policlínico Bernardo Posse de San Miguel del Padrón. Metodología: Se realizó un estudio descriptivo, retrospectivo, en 145 pacientes con síndrome de inmovilidad, de una población de 160 ancianos desde enero de 2015 a diciembre del 2017. Se determinó el tipo de inmovilidad, y las causas principales, así como las complicaciones. Resultados: El síndrome predominó en pacientes femeninos en edades altas de la vida. El tipo de inmovilidad más frecuente fue la larvada y las causas más frecuentes fueron las enfermedades osteomioarticulares, las infecciones, el cáncer y el síndrome del cuidador. Las complicaciones que predominaron fueron a nivel de los sistemas digestivo, respiratorio, cardiovascular y la piel. Conclusiones: El riesgo de presentar algún tipo de inmovilidad aumenta con la edad y el sexo femenino es más susceptible a este. La inmovilidad es una entidad sindromática que deteriora de manera significativa la calidad de vida de los adultos mayores ya que el anciano inmovilizado es un paciente de alto riesgo para la aparición de complicaciones.

ABSTRACT Background: Within the great geriatric syndromes, immobility is one of the most serious consequences of the diseases that the elderly can suffer. Objective: To characterize the behavior of the immobility syndrome in the elderly from the Basic Working Group No. 1 at Bernardo Posse polyclinic in San Miguel del Padrón. Methodology: A retrospective descriptive study was carried out in 145 patients with immobility syndrome, from a population of 160 elderly people, from January 2015 to December 2017. The type of immobility was determined, as well as the main causes, as well as complications. Results: The syndrome predominated in female patients at high ages of life. The most frequent type of immobility was larvae and the most frequent causes were osteomyoarticular diseases, infections, and cancer also the caregiver syndrome. The predominated complications were at the level of the digestive, respiratory, cardiovascular and skin systems. Conclusions: The risk of presenting some type of immobility increases with age, and the female sex is more susceptible to it. Immobility is a syndromic disease that significantly deteriorates the quality of life of elderly, since the immobilized elderly person is a high-risk patient for complications.