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4.
Cien Saude Colet ; 25(9): 3437-3444, 2020 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32876245

RESUMO

The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.


Assuntos
Infecções por Coronavirus/mortalidade , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Assistência de Longa Duração , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Humanos , Institucionalização/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia
5.
Clin Interv Aging ; 15: 915-926, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606633

RESUMO

Purpose: Population ageing is challenging healthcare systems with limited resources, necessitating the development of new care models to address the needs of older, frail community-dwellers. Community Virtual Wards (CVW) reduce adverse events in these patients. We examined the effect of an established CVW on pre-defined health trajectories (between "stable", "deteriorating", and "unstable" states) and characteristics that increased the likelihood of adverse healthcare outcomes (hospitalization, institutionalization and death). Patients and Methods: We collected prospective data on frail patients admitted to a CVW in a single centre in Ireland. Relationships between risk scores, health states and adverse outcomes at 30, 60 and 90 days after admission were examined using multinomial regression analysis. Results: In total, 88 community-dwellers, mean (±SD) age of 82.8 ±6.4 years, were included. Most were severely frail on the Rockwood Clinical Frailty Scale (mean 6.8/9 ±1.33). Reaching stability ("stable" state) within 30 days was a predictor for stability at 60 and 90 days and remaining at home. Stability was also associated with fewer care episodes (<2) (p=<0.001), a requirement for fewer healthcare professionals (HCP) (<7) (p<0.001) and lower risk of delirium (p<0.001). By contrast, being "unstable" at 60 days increased the numbers of HCP referrals (>7) and was predictive of more acute episodes (>2) and institutionalization or death (p<0.001). Predictors of adverse outcomes of either institutionalization or death included frailty status, function, mobility, nutrition, pressure ulcer risk and cognition. Conclusion: A CVW model can provide a framework for monitoring and case management to support older people to remain at home or identify those at risk of institutional care. The use of defined health states helped to stratify those at lower or higher risk in an already high-risk frail population. Level of frailty, function, mobility, nutrition, pressure ulcer risks and cognition were predictive of remaining at home and reaching a level of stability or instability/deterioration and institutional care.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Vida Independente/estatística & dados numéricos , Institucionalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Administração de Caso , Feminino , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Irlanda , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Apoio Social
6.
Am J Occup Ther ; 74(4): 7404205030p1-7404205030p11, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32602442

RESUMO

IMPORTANCE: A key objective of the Americans With Disabilities Act of 1990 (ADA) is community integration; yet, nearly 30 yr later, little is known about the participation of people with disabilities who transition from institutions to the community. OBJECTIVE: To understand how people with disabilities describe full participation after transitioning from an institution to the community and to identify environmental barriers and facilitators to participation during and after this transition. DESIGN: The ADA-Participatory Action Research Consortium (ADA-PARC), a collaboration among researchers, people with disabilities, and community organizations, is implementing a multimethod, participatory action research study of participation among people with disabilities posttransition. This article presents qualitative findings from semistructured interviews collected as part of the larger ADA-PARC project. SETTING: ADA-PARC community partners across the United States. PARTICIPANTS: One hundred fifty-three adults with disabilities. OUTCOMES AND MEASURES: We used a semistructured interview guide to ask participants about their experiences during and after transition to the community. RESULTS: We identified four themes: (1) the process of transition as ongoing rather than a single event, (2) access to everyday occupations as full participation and what fully represents "living a life," (3) environmental barriers to participation, and (4) social identity as participation as the transformative process of moving from the disempowering isolation of the institution to being integrated into the community. CONCLUSIONS AND RELEVANCE: As people with disabilities transition into community settings, they require ongoing supports to facilitate their full, long-term participation. WHAT THIS ARTICLE ADDS: People with disabilities reported that transitioning from institutions to the community was itself not enough to support their full community participation; rather, they viewed transition as an ongoing process, and they needed services and supports to fully participate. Occupational therapy practitioners working in institutional and community settings can partner with local disability advocacy communities to support their clients' sense of identity and self-confidence during and after transition to the community.


Assuntos
Pessoas com Deficiência , Terapia Ocupacional , Adulto , Participação da Comunidade , Humanos , Institucionalização , Organizações , Estados Unidos
8.
Rev. SPAGESP ; 21(1): 66-76, jan.-jun. 2020. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1092173

RESUMO

O objetivo do presente artigo é analisar a incidência de casos de reinstitucionalização de crianças e adolescentes e discutir como a política de atendimento a essa população está organizada para fortalecer a função protetiva da família. Para tanto, foi realizada pesquisa documental em bancos de dados oficiais. Estes dados foram posteriormente categorizados e analisados à luz dos princípios da Doutrina da Proteção Integral. Nas análises documentais foram encontradas 81 Guias de Acolhimento que apontavam a reinstitucionalização. Destas, 34,6% referiam-se a acolhidos cujas famílias eram oriundas da Região Administrativa Oeste. Os dados apontam que a reinstitucionalização das crianças e adolescentes pode possuir forte relação com a situação de pobreza e ausência do Estado na proposição de políticas públicas efetivas.


The purpose of this article is to analyze the incidence of cases of new institutionalization of children and adolescents and to discuss how the policy of attending to this population is organized to strengthen the family's protective function. For this, a documentary research was carried out in official databases. These data were later categorized and analyzed. In the documentary analyzes were found 81 Guidance Reception that pointed to the new institutionalization. Of these, 34.6% referred to foster families whose families came from the Western Administrative Region. The data indicate that the new institutionalization of children and adolescents may have a strong relationship with the situation of poverty and absence of the State in proposing effective public policies.


El objetivo del artículo es analizar la incidencia de casos de reinstitucionalización de niños y adolescentes y discutir cómo la política de atención a esa población está organizada para fortalecer la función protectora de la familia. Para eso, se realizó una investigación documental en bases de datos oficiales. En los análisis documentales se encontraron 81 Guías de Acogimiento que apuntaban a la reinstitucionalización. De estas, el 34,6% se refería a acogidos cuyas familias provenían de la Región Administrativa Oeste. Los datos apuntan que la reinstitucionalización de los niños y adolescentes puede tener una fuerte relación con la situación de pobreza y ausencia del Estado en la propuesta de políticas públicas efectivas.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Assunção de Riscos , Defesa da Criança e do Adolescente , Criança Institucionalizada , Adolescente Institucionalizado , Acolhimento , Reincidência , Institucionalização , Criança Acolhida
10.
Rev Lat Am Enfermagem ; 28: e3268, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32491125

RESUMO

OBJECTIVE: determine the psychometric properties of the safety practices and behaviors dimension of the Scale of Practices and Behaviors of Institutionalized Elderly People to Prevent Falls in a sample of elderly people with cognitive decline. METHOD: methodological study, with a quantitative approach, to assess the psychometric properties of the mentioned scale in a sample with 102 elderly people with cognitive decline who lived in two long-term care institutions for the public in this age group. Internal consistency evaluation was carried out by calculating the Cronbach's alpha coefficient; interobserver reliability was expressed by Cohen's kappa coefficient; and temporal stability, by obtaining Spearman correlation. Compliance with all ethical procedures was observed. RESULTS: the dimension of safety practices and behaviors showed α = 0.895 for its 11 items. Seven out of the 11 items reached good to excellent agreement among the experts for interobserver reliability. Kappa index values indicated that the instrument is valid and reliable. Safety practices and behaviors were influenced by institutionalization time, being at least 85 years old, and gait skills. CONCLUSION: the results pointed out that the instrument has good reproducibility and is valid and reliable, which allows its use in clinical practice in elderly people with cognitive decline as well as in research.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica , Escalas de Graduação Psiquiátrica/normas , Idoso , Idoso de 80 Anos ou mais , Comportamento , Feminino , Psiquiatria Geriátrica , Humanos , Institucionalização , Masculino , Variações Dependentes do Observador , Psicometria/métodos , Reprodutibilidade dos Testes
15.
PLoS One ; 15(5): e0232834, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413064

RESUMO

BACKGROUND: Sleep problems have become the most common complaints among the elderly. There are a few studies that explored the prevalence of poor sleep quality and its associated factors among the elderly in nursing homes. Therefore, this study aimed to examine the prevalence of poor sleep quality and its associated factors among the Chinese elderly in nursing homes. METHODS: A total of 817 elderly residents, from 24 nursing homes, were included in this cross-sectional study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and poor sleep quality was defined as PSQI >5. Multiple binary logistic regression was used to estimate the strength of the association between risk factors and poor sleep quality in terms of adjusted odds ratios (AORs) and their 95% confidence intervals (CIs), and interactions of risk factors for poor sleep quality were also examined. RESULTS: The prevalence of poor sleep quality was 67.3% (95% CI: 64.0, 70.5%) among the Chinese elderly in nursing homes. Multiple binary logistic regression results showed that participants with the following characteristics had an increased risk of poor sleep quality after adjustments for other confounders: being 70-79 years old (AOR: 1.78, 95% CI: 1.08, 2.92) or 80 years old and above (AOR: 2.67, 95% CI: 1.68, 4.24); having one to two kinds of chronic diseases (AOR: 2.05, 95% CI: 1.39, 3.01) or three or more kinds of chronic diseases (AOR: 2.35, 95% CI: 1.39, 4.00); depression symptoms (AOR: 1.08, 95% CI: 1.04, 1.11), anxiety symptoms (AOR: 1.11, 95% CI: 1.05, 1.18), and social support(AOR: 0.97, 95% CI: 0.95, 0.99). Additive interactions were detected between age and anxiety symptoms (AOR: 8.34, 95% CI: 4.43, 15.69); between chronic disease and anxiety symptoms (AOR: 8.61, 95% CI; 4.28, 17.31); and between social support and anxiety symptoms (AOR: 6.43, 95% CI: 3.22, 12.86). CONCLUSIONS: The prevalence of poor sleep quality among the elderly in nursing homes is relatively high. Besides, anxiety symptoms has additive interactions with age, chronic disease and social support for poor sleep quality. These findings have significant implications for interventions that aim to improve sleep quality among elderly residents in nursing homes.


Assuntos
Envelhecimento/fisiologia , Dissonias/epidemiologia , Institucionalização , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , China/epidemiologia , Doença Crônica/epidemiologia , Comorbidade , Intervalos de Confiança , Estudos Transversais , Depressão/epidemiologia , Dissonias/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Apoio Social , Fatores Socioeconômicos
16.
Lancet Child Adolesc Health ; 4(5): 370-377, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32151317

RESUMO

BACKGROUND: Children living in institutionalised settings are at risk of negative health and developmental outcomes, as well as physical and emotional abuse, yet information on their numbers is scarce. Therefore, the aim of our study was to estimate global-level, regional-level, and country-level numbers and percentages of children living in institutional care. METHODS: In this estimation study, we did a systematic review of peer-reviewed publications and a comprehensive review of surveys and unpublished literature to construct a dataset on children living in institutional care from 136 countries between 2001 and 2018. We applied a wide range of methods to estimate the number and percentages of children living in institutional care in 191 countries in 2015, the year the Sustainable Development Goals were adopted. We generated 98 sets of estimates for each dataset, with possible combinations of imputation methods for countries with different available data points. Of these 98 sets, we report here five types of global-level estimates: estimates with the highest values, those with the lowest values, those with median values, those with uncertainty levels, and those derived from methods with the smallest root-mean-square errors (RMSE). FINDINGS: Global estimates of children living in institutions in 2015 was highly sensitive to the methods and data used, ranging from 3·18 million to 9·42 million children, with a median estimate of 5·37 million. When selecting the method with the lowest RMSE, the global estimate was 4·21 million, whereas with negative binomial regression with bootstrapping, the global estimate was 7·52 (95% CI 7·48-7·56) million. We also observed large variations in country-level estimates. Compared with other regions, estimates in south Asia, sub-Saharan Africa, and Latin America had larger variations in values when switching between estimation methods. High-income countries had the highest average prevalence of institutionalisation, whereas low-income countries had the lowest average prevalence. Estimates from the full data with the smallest RMSE method showed that south Asia had the largest estimated number of children living in institutions (1·13 million), followed by Europe and central Asia (1·01 million), east Asia and Pacific (0·78 million), sub-Saharan Africa (0·65 million), Middle East and North Africa (0·30 million), Latin America and the Caribbean (0·23 million), and North America (0·09 million). North America consistently had the lowest estimates among all regions. INTERPRETATION: Worldwide, institutional care places millions of children at elevated risk of negative health and developmental outcomes, highlighting the need for deinstitutionalisation. However, there is considerable uncertainty regarding the number of children living in institutions. To improve estimates of the size of this population, we need to standardise the definition of institutional care and improve data collection, particularly in countries with large child populations. FUNDING: Lumos Foundation.


Assuntos
Adolescente Institucionalizado/estatística & dados numéricos , Criança Institucionalizada/estatística & dados numéricos , Institucionalização/estatística & dados numéricos , Adolescente , África ao Sul do Saara , África do Norte , Ásia , Ásia Central , Criança , Pré-Escolar , Europa (Continente) , Extremo Oriente , Humanos , Lactente , Recém-Nascido , América Latina , Oriente Médio , América do Norte , Orfanatos , Prevalência , Instituições Residenciais
18.
Medicina (Kaunas) ; 56(2)2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32033126

RESUMO

Background and objectives: Following the accumulation of a sufficient amount of scientific evidence, it is now possible to appeal for changes in the organization of nursing services. Our aims are to assess the health status of patients discharged from nursing hospitals and to identify their home care needs by applying the international InterRAI Home Care (HC) assessment form. Material and methods: 152 geriatric patients (older than 65 years of age) discharged after a 90-120-day stay at a nursing hospital were examined using face-to-face interviews. The data from the medical records were also assessed. The capacities of patients were discussed with the patients themselves, nursing personnel, and relatives of the patients. Results: The analysis revealed that 45.4% of the respondents had severely impaired cognitive skills, while 27.6% had moderately impaired cognitive skills for decision making in daily living. People with greater cognitive difficulties were more dependent during daily instrumental activities and ordinary daily activities. The strongest relationship was established among the cognitive skills and management of medications, management of finances, and ordinary housework. For the greater part of respondents, a special need for permanent nursing (57.9%) or assistance (25.7%) was determined, i.e., official, state-funded nursing at home was appointed. The remaining respondents (16.4%) were not appointed further state-funded nursing or assistance at home, but an assessment of the independence of these patients based on the InterRai Activities of Daily Living Hierarchy Scale indicated that these skills varied from moderate independence (decision making was difficult only in new situations) to severely impaired skills (made no independent decisions or they were scarce). Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing. Conclusions: The low independence observed in all participants, as well as their limited capacities, prove the need for nursing services at home and the necessity of their continuity. Despite the low independence of respondents, the majority of them would prefer nursing services at home to institutional nursing.


Assuntos
Avaliação Geriátrica/métodos , Assistência Domiciliar/organização & administração , Determinação de Necessidades de Cuidados de Saúde , Alta do Paciente , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Estudos Transversais , Tomada de Decisões , Feminino , Nível de Saúde , Humanos , Institucionalização , Lituânia , Masculino , Casas de Saúde , Preferência do Paciente
19.
CMAJ ; 192(8): E173-E181, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32051130

RESUMO

BACKGROUND: Medical assistance in dying (MAiD) was legalized across Canada in June 2016. Some have expressed concern that patient requests for MAiD might be driven by poor access to palliative care and that social and economic vulnerability of patients may influence access to or receipt of MAiD. To examine these concerns, we describe Ontario's early experience with MAiD and compare MAiD decedents with the general population of decedents in Ontario. METHODS: We conducted a retrospective cohort study comparing all MAiD-related deaths with all deaths in Ontario, Canada, between June 7, 2016, and Oct. 31, 2018. Clinical and demographic characteristics were collected for all MAiD decedents and compared with those of all Ontario decedents when possible. We used logistic regression analyses to describe the association of demographic and clinical factors with receipt of MAiD. RESULTS: A total of 2241 patients (50.2% women) were included in the MAiD cohort, and 186 814 in the general Ontario decedent cohort. Recipients of MAiD reported both physical (99.5%) and psychologic suffering (96.4%) before the procedure. In 74.4% of cases, palliative care providers were involved in the patient's care at the time of the MAiD request. The statutory 10-day reflection period was shortened for 26.6% of people. Compared with all Ontario decedents, MAiD recipients were younger (mean 74.4 v. 77.0 yr, standardized difference 0.18);, more likely to be from a higher income quintile (24.9% v. 15.6%, standardized difference across quintiles 0.31); less likely to reside in an institution (6.3% v. 28.0%, standardized difference 0.6); more likely to be married (48.5% v. 40.6%) and less likely to be widowed (25.7% v. 35.8%, standardized difference 0.34); and more likely to have a cancer diagnosis (64.4% v. 27.6%, standardized difference 0.88 for diagnoses comparisons). INTERPRETATION: Recipients of MAiD were younger, had higher income, were substantially less likely to reside in an institution and were more likely to be married than decedents from the general population, suggesting that MAiD is unlikely to be driven by social or economic vulnerability. Given the high prevalence of physical and psychologic suffering, despite involvement of palliative care providers in caring for patients who request MAiD, future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to a MAiD request.


Assuntos
Renda/estatística & dados numéricos , Estado Civil/estatística & dados numéricos , Neoplasias/epidemiologia , Cuidados Paliativos/estatística & dados numéricos , Suicídio Assistido/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Feminino , Acesso aos Serviços de Saúde , Humanos , Institucionalização/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/epidemiologia , Ontário/epidemiologia , Características de Residência , Doenças Respiratórias/epidemiologia , Estudos Retrospectivos , Viuvez/estatística & dados numéricos
20.
Geriatr Gerontol Int ; 20(3): 195-200, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31923924

RESUMO

Exergames have already been used as therapeutic tools to enhance both physical and cognitive functions in older adults. AIM: To evaluate the effects of a Kinect-based physical activity program on the quality of life, depression, functional fitness and body composition in institutionalized older adults. METHODS: A total of 50 older adults aged >60 years were selected and randomized to a control and video game group. Body composition was determined by means of anthropometric measurements. Quality of life was assessed using the WHOQOL-BREF questionnaire, and depression was classified using the Beck Depression inventory. Functional fitness was assessed using the Arm Curl, Chair Stand, 8-foot up-and-go, sit and reach, and the aerobic endurance test. RESULTS: After 12 weeks of protocol, we observed a significant improvement in all functional fitness parameters. CONCLUSIONS: Our findings suggest that a Kinect-based physical activity program seems to positively impact the three domains related to quality of life and directly associated with age (physical, social and psychological domains), and to promote a more active lifestyle in institutions housing older individuals. Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Depressão/terapia , Terapia por Exercício/métodos , Desempenho Físico Funcional , Jogos de Vídeo , Idoso , Composição Corporal , Índice de Massa Corporal , Feminino , Humanos , Institucionalização , Estilo de Vida , Aptidão Física , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Distribuição Aleatória , Inquéritos e Questionários
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