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1.
J Korean Med Sci ; 35(42): e383, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33140593

RESUMO

Multiple neurological complications have been associated with the coronavirus disease-19 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. This is a narrative review to gather information on all aspects of COVID-19 in elderly patients with cognitive impairment. First, the following three mechanisms have been proposed to underlie the neurological complications associated with COVID-19: 1) direct invasion, 2) immune and inflammatory reaction, and 3) hypoxic brain damage by COVID-19. Next, because the elderly dementia patient population is particularly vulnerable to COVID-19, we discussed risk factors and difficulties associated with cognitive disorders in this vulnerable population. We also reviewed the effects of the patient living environment in COVID-19 cases that required intensive care unit (ICU) care. Furthermore, we analyzed the impact of stringent social restrictions and COVID-19 pandemic-mediated policies on dementia patients and care providers. Finally, we provided the following strategies for working with elderly dementia patients: general preventive methods; dementia care at home and nursing facilities according to the activities of daily living and dementia characteristics; ICU care after COVID-19 infection; and public health care system and government response. We propose that longitudinal follow-up studies are needed to fully examine COVID-19 associated neurological complications, such as dementia, and the efficacy of telemedicine/telehealth care programs.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Demência/epidemiologia , Serviços de Saúde para Idosos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Atividades Cotidianas , Idoso , Betacoronavirus , Encéfalo/fisiopatologia , Cuidadores , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Infecções por Coronavirus/complicações , Cuidados Críticos , Demência/complicações , Humanos , Hipóxia , Sistema Imunitário , Inflamação , Casas de Saúde , Pneumonia Viral/complicações , Medicina Preventiva , Saúde Pública , Fatores de Risco , Isolamento Social , Telemedicina
2.
Clin Nutr ESPEN ; 40: 110-114, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183522

RESUMO

BACKGROUND & AIM: Verify the prevalence of hypovitaminosis D and obesity in elderly patients infected by new coronavirus. The patients developed severe symptoms and were admitted in intensive care unit (ICU) to receive invasive ventilation due to diagnosis of acute respiratory distress syndrome (ARDS). METHODS: A cross-sectional descriptive study composed of elderly (age ≥ 60 years) admitted to the ICU. Were collected demographic (sex, age), anthropometric data, presence of comorbidities (hypertension, diabetes, heart disease, lung, neurological and oncological diseases), severity score in ICU (SAPS III), PaO2/FiO2 ratio, analysis of C-reactive protein (CRP) and serum dosage of 25-hydroxy vitamin D (25 OHD) in the first day of hospitalization to identify elderly with hypovitaminosis D (low values < 30 ng/mL). The diagnosis of obesity in elderly was determined by calculating the body mass index (BMI) ≥ 30 kg/m2. RESULTS: A total of 176 elderly met the inclusion criteria. 54% were elderly men and mean age of 72.9 ± 9.1 years. The median BMI was 30.5 (28.1-33) kg/m2 with 68.7% having a nutritional diagnosis of obesity and 15.3% had BMI ≥ 35 kg/m2. The most prevalent comorbidities were hypertension (72.2%) and diabetes (40.9%). Prevalence of hypovitaminosis D with values of 25 OHD <30 ng/mL, < 20 ng/mL and <10 ng/mL was 93.8%, 65.9% and 21% respectively. The prevalence of hypovitaminosis D (<30 ng/mL) in obese elderly was 94.2%. There was a negative and significant bivariate correlation between BMI and levels of 25 OHD (r = - 0.15; p = 0.04). CONCLUSION: Hypovitaminosis D and obesity in elderly have a high prevalence in critically ill patients in ICU infected by the new coronavirus. Laboratory investigation of vitamin D becomes important, especially in obese elderly patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Obesidade Mórbida/epidemiologia , Pneumonia Viral/complicações , Deficiência de Vitamina D/complicações , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Pandemias , Prevalência , Índice de Gravidade de Doença , Deficiência de Vitamina D/sangue
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47909

RESUMO

No Dia Internacional e Nacional do Idoso (1º de outubro), o Ministério da Saúde visa sensibilizar a sociedade para as questões do envelhecimento e sobre a necessidade de proteção a saúde das pessoas idosas. Durante a pandemia da Covid-19, esses cuidados estão sendo redobrados, já que pessoas com 60 anos ou mais apresentam maior risco de complicações e letalidade pelo coronavírus.


Assuntos
Serviços de Saúde para Idosos , Infecções por Coronavirus
4.
Med Clin North Am ; 104(6): 989-1006, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33099456

RESUMO

Cancer screening decisions in older adults can be complex due to the unclear cancer-specific mortality benefits of screening and several known harms including false positives, overdiagnosis, and procedural complications from downstream diagnostic interventions. In this review, we provide a framework for individualized cancer screening decisions among older adults, involving accounting for overall health and life expectancy, individual values, and the risks and benefits of specific cancer screening tests. We then discuss strategies for effective communication of recommendations during clinical visits that are considered more effective, easy to understand, and acceptable by older adults and clinicians.


Assuntos
Detecção Precoce de Câncer , Serviços de Saúde para Idosos , Idoso , Idoso de 80 Anos ou mais , Comunicação , Tomada de Decisões , Humanos , Estados Unidos
5.
J Cross Cult Gerontol ; 35(4): 493-500, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33015728
6.
Emerg Med J ; 37(11): 714-716, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32972913

RESUMO

We describe the expansion and adaptation of a frailty response team to assess older people in their usual place of residence. The team had commenced a weekend service to a limited area in February 2020. As a consequence of demand related to the COVID-19 pandemic, we expanded it and adapted the model of care to provide a 7-day service to our entire catchment area. Five hundred and ninety two patient reviews have been completed in the first 105 days of operation with 43 patients transferred to hospital for further investigation or management following assessment.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviços Médicos de Emergência/organização & administração , Idoso Fragilizado , Avaliação Geriátrica , Serviços de Saúde para Idosos/organização & administração , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pandemias
7.
Artigo em Inglês | MEDLINE | ID: mdl-32867252

RESUMO

In the Netherlands, there is an increasing need for collective forms of housing for older people. Such housing bridges the gap between the extremes of living in an institutionalised setting and remaining in their own house. The demand is related to the closure of many residential care homes and the need for social engagement with other residents. This study focuses on housing initiatives that offer innovative and alternative forms of independent living, which deviate from mainstream housing arrangements. It draws on recent literature on healthcare 'rebels' and further develops the concept of 'rebellion' in the context of housing. The main research question is how founders dealt with challenges of establishing and governing 'rebellious' innovative living arrangements for older people in the highly regulated context of housing and care in the Netherlands. Qualitative in-depth interviews with 17 founders (social entrepreneurs, directors and supervisory board members) were conducted. Founders encountered various obstacles that are often related to governmental and sectoral rules and regulations. Their stories demonstrate the opportunities and constraints of innovative entrepreneurship at the intersection of housing and care. The study concludes with the notion of 'responsible rebellion' and practical lessons about dealing with rules and regulations and creating supportive contexts.


Assuntos
Assistência à Saúde/organização & administração , Instituição de Longa Permanência para Idosos , Habitação para Idosos , Habitação , Vida Independente , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Saúde para Idosos/organização & administração , Humanos , Masculino , Países Baixos , Casas de Saúde , Características de Residência
10.
Eur J Public Health ; 30(Supplement_4): iv22-iv27, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894300

RESUMO

The present study explores the situation of migrant carers in long-term care (LTC) in European Union Member States and the disruptions caused by the COVID-19 pandemic from a public health perspective. The aim is to bring LTC migrant carers into health workforce research and highlight a need for trans-sectoral and European heath workforce governance. We apply an exploratory approach based on secondary sources, document analysis and expert information. A framework comprising four major dimensions was developed for data collection and analysis: LTC system, LTC health labour market, LTC labour migration policies and specific LTC migrant carer policies during the COVID-19 crisis March to May 2020. Material from Austria, Italy, Germany, Poland and Romania was included in the study. Results suggest that undersupply of carers coupled with cash benefits and a culture of family responsibility may result in high inflows of migrant carers, who are channelled in low-level positions or the informal care sector. COVID-19 made the fragile labour market arrangements of migrant carers visible, which may create new health risks for both the individual carer and the population. Two important policy recommendations are emerging: to include LTC migrant carers more systematically in public health and health workforce research and to develop European health workforce governance which connects health system needs, health labour markets and the individual migrant carers.


Assuntos
Cuidadores/psicologia , Emigração e Imigração , Pessoal Profissional Estrangeiro , Mão de Obra em Saúde , Assistência de Longa Duração , Política Pública , Betacoronavirus , Infecções por Coronavirus , Europa (Continente) , União Europeia , Governo , Serviços de Saúde para Idosos/organização & administração , Humanos , Assistência de Longa Duração/organização & administração , Pandemias , Pneumonia Viral , Saúde Pública
12.
Ann Emerg Med ; 76(3): 280-290, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828327

RESUMO

STUDY OBJECTIVE: Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse. METHODS: We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool. RESULTS: Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%). CONCLUSION: This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.


Assuntos
Maus-Tratos ao Idoso/diagnóstico , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Sensibilidade e Especificidade , Estados Unidos
13.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32787399

RESUMO

The older persons in our society are a special group of people in need of additional measures of care and protection. They have medical, financial, emotional and social needs. The novel Coronavirus disease 2019 (COVID-19) only exacerbates those needs. COVID-19 is a new disease, and there is limited information regarding the disease. Based on currently available information, older persons and people of any age who have serious underlying medical conditions may be at higher risk of severe illness from COVID-19. Family physicians provide care for individuals across their lifespan. Because geriatricians are internists or family physicians with post-residency training in geriatric medicine, they are major stakeholders in geriatric care. The authors are concerned about the absence of a COVID-19 response guideline/special advisory targeting the vulnerable population of older adults. The management and response to COVID-19 will be implemented in part based on the local context of available resources. Nigeria has been described as a resource-constrained nation. Infection prevention in older persons in Nigeria will far outweigh the possibilities of treatment given limited resources. The aim was to recommend actionable strategies to prevent COVID-19-related morbidity or mortality among older persons in Nigeria and to promote their overall well-being during and after the pandemic. These recommendations cut across the geriatric medicine domains of physical health, mental health, functioning ability and socio-environmental situation.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Política de Saúde , Serviços de Saúde para Idosos , Pandemias/prevenção & controle , Médicos de Família/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Idoso , Humanos , Nigéria/epidemiologia
14.
Med J Aust ; 213(7): 321-326, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32776351

RESUMO

OBJECTIVES: To develop and validate a frailty index, derived from aged care eligibility assessment data. DESIGN: Retrospective cohort study; analysis of the historical national cohort of the Registry of Senior Australians (ROSA). PARTICIPANTS: 903 996 non-Indigenous Australians aged 65 years or more, living in the community and assessed for subsidised aged care eligibility during 2003-2013. MAIN OUTCOME MEASURES: 44-item frailty index; summary statistics for frailty index score distribution; predictive validity with respect to mortality and entry into permanent residential aged care during the five years after assessment. RESULTS: The mean frailty index score during 2003-2013 was 0.20 (SD, 0.07; range, 0-0.41); the proportion of assessed older people with scores exceeding 0.20 increased from 32.1% in 2003-2005 to 75.0% in 2012-2013. The risks of death and entry into permanent residential aged care at one, three and five years increased with frailty index score level (at one year, high [over 0.35] v low scores [under 0.05]: hazard ratio for death, 5.99; 95% CI, 5.69-6.31; for entry into permanent residential aged care, 8.70; 95% CI, 8.32-9.11). The predictive validity (area under the receiver operating characteristic curve) of Cox proportional hazard models including age, sex, and frailty index score was 0.64 (95% CI, 0.63-0.64) for death and 0.63 (95% CI, 0.62-0.63) for entry into permanent residential aged care within one year of assessment. CONCLUSIONS: We used Australian aged care eligibility assessment program data to construct and validate a frailty index. It can be employed in aged care research in Australia, but its application to aged care planning requires further investigation.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Indicadores Básicos de Saúde , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Modelos de Riscos Proporcionais , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco
16.
Aging (Albany NY) ; 12(15): 15186-15195, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32788424

RESUMO

Italy was the first European nation to be affected by COVID-19. The biggest cluster of cases occurred in Lombardy, the most populous Italian region, and elderly men were the population hit in the hardest way. Besides its high infectivity, COVID-19 causes a severe cytokine storm and old people, especially those with comorbidities, appear to be the most vulnerable, presumably in connection to inflammaging. In centenarians inflammaging is much lower than predicted by their chronological age and females, presenting survival advantage in almost all centenarian populations, outnumber males, a phenomenon particularly evident in Northern Italy. Within this scenario, we wondered if: a) the COVID-19 mortality in centenarians was lower than that in people aged between 50 and 80 and b) the mortality from COVID-19 in nonagenarians and centenarians highlighted gender differences.We checked COVID-19-related vulnerability/mortality at the peak of infection (March 2020), using data on total deaths (i.e. not only confirmed COVID-19 cases). Our conclusion is that excess mortality increases steadily up to very old ages and at the same time men older than 90 years become relatively more resilient than age-matched females.


Assuntos
Envelhecimento , Betacoronavirus/fisiologia , Infecções por Coronavirus , Serviços de Saúde para Idosos/estatística & dados numéricos , Inflamação , Mortalidade , Pandemias , Pneumonia Viral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Inflamação/epidemiologia , Inflamação/virologia , Itália/epidemiologia , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Saúde Pública/métodos , Fatores Sexuais , Populações Vulneráveis
17.
Medicine (Baltimore) ; 99(31): e21419, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756143

RESUMO

Both total-body iron stores and inflammation influence the concentration of ferritin in the blood. Ferritin as an inflammatory marker might serve as a prognostic marker in the elderly. Therefore, we characterized the clinical circumstances and long-term outcomes of hyperferritinemia (> 1000 µg/L) in hospitalized elderly patients.A retrospective analysis of elderly (> 70 years) inpatients with ferritin levels of > 1000 µg/L in a tertiary medical center during a 3-year period. We obtained both laboratory and clinical data, assessing the potential association of high ferritin levels with long-term mortality.Overall, 242 patients (median age 79 years; median ferritin level 1436 µg/L) met the inclusion criteria and were followed for a median time of 18.6 months. Clinical outcomes were dismal for the whole cohort: the diagnosis of solid malignancy occurred in 23.5% of cases while 31% had a severe infection (ranging from sepsis to septic shock). The median survival time of the whole cohort was 4.7 months only. Within the cohort, risk stratification was feasible: higher ferritin levels differentiate between groups of patients who had a poor prognosis (with either septic shock or solid malignancy) and those who had a relatively favorable prognosis (patients diagnosed as suffering from sepsis without shock and patients with iatrogenic causes for hyperferritinemia).Hyperferritinemia in elderly inpatients is associated with high rates of mortality. Within this group of patients, differential ferritin levels enable further risk stratification. High ferritin levels in the elderly can differentiate the bad from the worst.


Assuntos
Ferritinas/sangue , Idoso Fragilizado , Hospitalização , Sobrecarga de Ferro/mortalidade , Idoso , Biomarcadores/sangue , Estudos de Coortes , Serviços de Saúde para Idosos , Humanos , Sobrecarga de Ferro/sangue , Israel , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
PLoS One ; 15(7): e0236830, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735592

RESUMO

BACKGROUND: Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS: In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS: The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.


Assuntos
Demência/complicações , Prescrições de Medicamentos , Serviços de Saúde para Idosos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Interações Medicamentosas , Feminino , Humanos , Estudos Longitudinais , Masculino , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Estudos Retrospectivos , Fatores de Risco
20.
J Ment Health Policy Econ ; 23(3): 101-109, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32853159

RESUMO

BACKGROUND: Since June 2017, the Primary Health Care Integrated Geriatric Services Initiative (PHC IGSI) has been implemented in Alberta, Canada to, among other aims, reduce costs of unplanned health service utilization while maximizing the utilization of available community resources to support people living with dementia living in communities. AIM OF THE STUDY: We performed an economic evaluation of this initiative to inform policy regarding sustainability, scale up and spread. METHODS: We used a cohort design together with a difference-in-difference approach and a propensity score matching technique to calculate impacts of the intervention on patient's health service utilization, including inpatient, outpatient and physician services, as well as prescription drugs. We then used a decision tree to compare between benefits and costs of the intervention and reported net benefits (NB) and return on investment ratios (ROI). We used a health system perspective and a time horizon of 1 year. Both deterministic and probabilistic sensitivity analyses were performed for the uncertainty of parameters. We analyzed real-world data extracted from the Alberta Health Administrative Databases. All costs/savings were inflated to 2019 CAD (CAD 1 \sim = USD 0.75) using the Canadian Consumer Price Index. RESULTS: The intervention reduced the use of hospital (inpatient, emergency, and outpatient) services by increasing the use of community services (physician and prescription drug). As hospital services are expensive, the PHC IGSI community intervention resulted in a NB from CAD 554 to 4,046 per patient-year for the health system, and a ROI from 1.3 to 3.1 meaning that every CAD invested in PHC IGSI would bring CAD 1.3 to 3.1 in return. The probability of PHC IGSI to be cost-saving was 56.4% to 69.3%. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The PHC IGSI is cost-effective in Alberta. IMPLICATIONS FOR HEALTH POLICY: The savings would be larger if the initiative is sustained, scaled up and spread because of not only a reduced cost of intervention in the sustainability phase, but also because of the increased number of patients that would be impacted. IMPLICATIONS FOR FURTHER RESEARCH: Future studies taking a societal perspective to also include costs for families and health and social sectors at the community level, would be desirable. Additionally, future works to determine how wellbeing is impacted by the PHC IGSI as vertical and horizontal integration interventions are implemented at the community level, are essential to undertake. Finally, in addition to people living with dementia, the PHC IGSI also supports people living in the community with frailty and other geriatric syndromes, therefore, the cost-savings estimated in this study are likely underestimated.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Serviços de Saúde para Idosos/economia , Atenção Primária à Saúde/economia , Idoso , Alberta , Redução de Custos , Análise Custo-Benefício , Serviços de Saúde , Humanos
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