Orientador: Marilisa Berti de Azevedo Barros / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T22:21:36Z (GMT). No. of bitstreams: 1 Rodrigues_IaraGuimaraes_D.pdf: 6310603 bytes, checksum: d1eea070e0d48052f60f6e77c1870433 (MD5) Previous issue date: 2014 / Resumo: Objetivo: Analisar a prevalência e os fatores associados à osteoporose autorreferida, à ocorrência de quedas, bem como a associação das quedas com a QVRS através do SF-36 em idosos residentes em Campinas/SP. Método: Trata-se de um estudo de corte transversal de base populacional, que utilizou informações provenientes do Inquérito de Saúde do município de Campinas/SP (IsaCAmp 2008), realizado entre Fevereiro/2008 a Abril/2009, com amostra representativa da população de idosos (60 anos e mais) de Campinas/SP. Foram estimadas as prevalências de osteoporose autorreferida e ocorrência de quedas nos últimos 12 meses segundo variáveis sociodemográficas, morbidades, condições e problemas de saúde e a associação entre ocorrência de queda e os domínios do SF-36 segundo sexo, faixa etária e escolaridade. Utilizou-se das razões de prevalência brutas e ajustadas por sexo e/ou idade e/ou comorbidades por meio de regressão múltipla de Poisson e modelo de regressão linear simples e múltipla para cada dominio do SF-36. Aplicou-se o comando svy a fim de incorporar as ponderações decorrentes do processo amostral. Todas as análises foram realizadas utilizando o software Stata 11.0 (StataCorp, Colégio Station, Estados Unidos). Resultados: A população total estudada foi de 1520 idosos, com média de idade de 69,5 anos, 57,2% do sexo feminino e 55,9% com 60 a 69 anos. A prevalência encontrada de osteoporose autorreferida e de ocorrência de quedas foram de 14,8% e 6,5%. Dentre os fatores associados à osteoporose destacaram-se o reumatismo/artrite/artrose, asma/bronquite/enfisema, distúrbios do sono e sobrepeso. Em relação a ocorrência de quedas, a tontura, insônia, asma/bronquite/enfisema foram os que se ressaltaram. A associação entre as quedas e QVRS, foi existente em praticamente todos os domínios do SF-36, com destaque para o maior impacto das quedas na QVRS dos idosos do sexo masculino. Conclusão: Por meio da identificação da prevalência e dos fatores associados à osteoporose, ocorrência de quedas e da associação das quedas na QVRS nos idosos, o presente estudo, sinaliza os segmentos de idosos mais susceptíveis a estes eventos. Considera-se que os resultados apresentados possam contribuir para o planejamento de melhores políticas públicas, programas voltados ao controle da osteoporose e da ocorrência de quedas, bem como a promoção do envelhecimento saudável e com qualidade de vida / Abstract: Objective: Analyze the prevalence and factors associated with self-referred osteoporosis, the occurrence of falls, as well as the association of falls with HRQoL through the SF-36 in elderly people living in Campinas/SP. Method: This is a cross-sectional population-based study, which used information from the Health Survey in the municipality of Campinas/SP (IsaCamp 2008), carried out between February/2008 and April 2009, with representative sample of the elderly population (60 years old and over) of Campinas/SP. The prevalence of self-referred osteoporosis and the occurrence of falls in the last 12 months were estimated according to sociodemographic variables, morbidities, health conditions and problems and the association between the occurrence of falls and the SF-36 domains, according to sex, age, and educational level. It was used crude and adjusted prevalence ratios, by sex and/or age and/or comorbidities, using Poisson multiple regression and simple and multiple linear regression model for each SF-36 scale. Svy command was applied to incorporate the weightings resulting from the sampling process. All analyzes were performed using Stata 11.0 software (Stata Corp Station College, USA). Results: The total studied population was of 1520 elderly people, with a mean age of 69.5 years, 57.2% female and 55.9% were 60 to 69 years old. The prevalence found of self-referred osteoporosis and occurrence of falls were of 14.8% and 6.5%. Among the factors associated with osteoporosis the most important were rheumatism/arthritis/osteoarthritis, asthma/bronchitis/emphysema, sleep disorders and overweight. Regarding the occurrence of falls, those underscored were dizziness, insomnia, asthma/bronchitis/emphysema. The association between falls and HRQoL was found in virtually all SF-36 domains, highlighting the greatest impact of falls on HRQoL of elderly men. Conclusion: Through the identification of the prevalence and factors associated with osteoporosis, the occurrence of falls and the association of falls on HRQoL of elderly people this study indicates the segments of elderly people more susceptible to these events. We believe that the results presented can contribute to the planning of improved public policies, programs aimed at the control of osteoporosis and the occurrence of falls, as well as promoting healthy aging and quality of life / Doutorado / Epidemiologia / Doutora em Saúde Coletiva

Face à une population vieillissante et à la prévalence du risque de dénutrition, cette thèse s’est intéressée à comprendre comment développer des produits nutritionnellement et sensoriellement adaptés à l’alimentation des personnes âgées en s’appuyant sur les outils sensoriels.Grâce à une enquête comparative multidisciplinaire réalisée dans 5 pays européens, nous avons mis en évidence trois grands profils d’habitudes et de préférences alimentaires chez des personnes âgées dépendantes pour leur alimentation (n=405). Malgré ces différences, nous fournissons une liste de fruits et légumes consensuels dans les pays étudiés.Chez 130 personnes âgées de plus de 65 ans, nous confirmons la variabilité des performances sensorielles.Nous apportons des résultats originaux quant à la discrimination gustative encore très peu étudiée. Elle resterait stable avant 80 ans mais semblerait diminuer ensuite. Enfin, aucun lien n’a été trouvé entre perceptions sensorielles et appréciation de différentes purées de pommes. Dans un contexte d’innovation, nos résultats précisent un cahier des charges en recommandant des plages de variations possibles pour les concentrations de sucre et d’acide utilisées en purées de pommes.Enfin, avec un panel expert et 344 personnes âgées,nous montrons qu’un enrichissement vitaminique ne modifie pas la perception de smoothies ; alors qu’une supplémentation en protéines (pois et blé) dégrade des purées de carottes sur le plan sensoriel et hédonique.Nos résultats illustrent l’importance des outils sensoriels dans un processus de développement produit ainsi que leur intégration dans une démarche d’innovation / In a context of aging population and rising prevalence of malnutrition, the aim of this PhD thesis was to understand how to develop innovative food products that are nutritionally and sensorially adapted to elderly people’s diet using sensory tools. A comparative multidisciplinary survey was performed in 5 European countries. We highlighted three main patterns of food habits and preferences in elderly people with culinary dependency (n=405). Despite those differences, we deliver a list of consensual fruit and vegetables (in the studied countries). With 130 elderly people aged over 65 years old, we confirm the variability of sensory performances. We report original findings about gustatory discrimination abilities in which very few is known. Gustatory discrimination ability seems to remain stable before 80 years old but may decrease after. No link was found between sensory perceptions and appreciation for different apple purees. In a context of innovation, our results precise specifications by providing recommendations about possible ranges for sugar and acid concentrations to be used in apple purées. Finally, using a sensory expert panel and 344 elderly people, we show that smoothies were not affected by the addition of vitamins. However, a protein supplementation (pea and wheat) significantly decreases sensory characteristics and hedonic evaluation of carrot purées. Our results highlight the importance of sensory tools in a product development approach. It is important to include them all along the process of innovation.

Este trabalho versa sobre a hipótese de reparação civil por abandono afetivo que decorre da infração ao dever de cuidado do idoso. Analisa-se a tutela dos direitos dos idosos no ordenamento jurídico brasileiro através de um retrospecto legal com sutil referência ao contexto histórico mundial e ao Direito Comparado. Contextualiza-se a interpretação dos direitos dos idosos em face do fundamento do Direito pátrio na dignidade da pessoa humana a partir da Constituição Federal de 1988 e a transposição desta no Direito Civil e no Direito de Família. Adiante é apreciado o abandono afetivo, seu conceito e expansão pela a adoção do modelo atual eudemonista da família que importou na inclusão do dever de cuidado como elemento do afeto. A seguir o cuidado é abordado enquanto infração ao dever que dele decorre para identificação da conduta omissiva. Por fim, é explorado o instituto da responsabilidade civil, através do estudo de cada um dos seus requisitos, para conclusão quanto ao cabimento do dever de reparação pela constatação da ocorrência do ato ilícito de infração ao dever de cuidado que implica abandono afetivo em razão do dano que dele resulta e da extensão deste, isto valorado no caso concreto. / This paper deals with the hypothesis of civil reparation for affective abandonment of the elderly that results from the violation of the duty of care of the elderly. It analyzes the protection of the rights of the elderly in the Brazilian legal system through a legal retrospect with subtle reference to the world historical context and Comparative Law. The interpretation of the rights of the elderly in the face of the foundation of the patrimony right in the dignity of the human being is contextualized from the Federal Constitution of 1988 and the transposition of this one in the Civil Law and in the Right of Family. Above, affection abandonment, its concept and its expansion are appreciated by the adoption of the current eudemonist model of the family that has imported the inclusion of the duty of care as an element of affection. Care is then approached as an infraction of the duty derived from it to identify the omissive conduct. Finally, the institute of civil responsibility is explored, through the study of each one of its requirements, to conclude on the compliance of the duty to make reparation for the finding of the occurrence of the illicit act of infraction to the duty of care that implies affective abandonment due to the damage that results from it and the extent of it, that is valued in the concrete case.

The work deals with a design of an electric mobility scooter for seniors or people with limited mobility with regard to technical, ergonomic and aesthetic requirements. The final design is based on the results of design and technical analysis. Emphasis is placed on the needs of the target user, for whom the scooter means freedom of movement. The design solves insufficient storage space even for larger luggage, thanks to the different arrangement of internal components. We managed to create a product with a more psychologically friendly expression, with optimal ergonomics, acceptable to the wider environment

Peu de données ont été publiées sur le statut nutritionnel des personnes âgées vivant àdomicile. Le premier objectif de cette thèse était d’évaluer le statut nutritionnel de personnesâgées de 65 ans et plus vivant à domicile et les facteurs associés à cet état. Le second objectifde la thèse était d’étudier la survenue de plusieurs événements de santé en fonction du statutnutritionnel. Les données de deux cohortes prospectives incluant des personnes âgées de 65ans et plus (AMI, n=1002 et E3C, n=9294) ont été exploitées. Les résultats de cette thèsemontrent qu’une proportion non négligeable de personnes âgées vivant à domicile présente unstatut nutritionnel altéré. Les individus les plus concernés étaient les plus âgés, de genreféminin, veufs, de niveaux de revenus et scolaire faibles, déments, présentant unesymptomatologie dépressive et des incapacités aux activités de la vie quotidienne. Cesindividus avaient de moins bonnes habitudes alimentaires caractérisées par desconsommations faibles de poisson, légumes, fruits, et élevées de biscuits et viennoiseries. Unstatut nutritionnel altéré à l’inclusion était significativement associé à la survenue de diversévénements au cours des 12 ans de suivi: démence, chute, fracture, incapacités, incontinence,institutionnalisation et décès. L’ensemble de ces travaux montre qu’un état nutritionnel altéré,avant que la dénutrition ne soit installée, n’est pas rare chez les sujets âgés vivant à domicileet que cet état est associé à la survenue plus fréquente d’événements de santé graves. Cesrésultats plaident pour une détection plus active qu’actuellement de ces sujets à risque et pourune prise en charge adaptée. / Few data about the nutritional status of elderly people living at home are available. The firstaim of this work was to evaluate the nutritional status of community-dwellers aged 65 andover and the factors associated with this state. The second aim of the thesis was to study theoccurrence of several health events according to the nutritional status. The data of twoprospective cohorts including people aged 65 and over (AMI, n=1,002 and 3C, n=9294) wereanalyzed. The results of this work show that a relatively high proportion of older people livingat home have a poor nutritional status. Individuals most affected were older, of female gender,widowed, with low levels of income and education, presenting a dementia, a depressivesymptomatology and disability in activities of daily living. These individuals had poorereating habits characterized by low consumption of fish, vegetables, fruits, and highconsumption of biscuits and pastries. A poor nutritional status at baseline were significantlyassociated with the occurrence of several events during the 12 years of follow-up: dementia,falls, fractures, disability, incontinence, institutionalization and death. These results show thatpoor nutritional status is frequent in elderly living at home, before malnutrition is established,and that this state is associated with the occurrence of serious health events. These results alsoadvocate for a more active detection of these subjects and a more appropriate healthmanagement.

Bakgrund: Risk för undernäring och lång nattfasta för äldre personer som bor på särskilt boende är något som uppmärksammats enligt aktuell forskning. Anledningen till att ämnet känns viktigt att studera vidare är att en nattfasta över 11 timmar kan vara första steget till undernäring. Undernäring i sin tur kan orsaka fysiskt lidande och ger en ökad risk för fallskador, infektioner och svårläkta sår. Syfte: Studiens syfte var att belysa distriktssköterskors erfarenheter av nutritionsvård på särskilt boende för äldre personer. Metod: Studien genomfördes enligt en kvalitativ induktiv ansats med hjälp av semistrukturerade intervjuer. Åtta distriktssköterskor intervjuades. Datainsamlingen analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analys av resultatet genererade tre huvudkategorier och sju underkategorier. Teamsamverkan spelar en viktig roll i omvårdnadsarbetet, både med hänseende till kommunikation och distriktssköterskans roll. Ledningens stöd eller ibland brist på stöd samt organisatoriska frågor har betydelse för hur arbetet med nutrition prioriteras i de olika vårdprofessionerna. Delaktighet inkluderar både den äldre personen och omvårdnadspersonalen. Den personcentrerade vården avspeglas i hur delaktigheten utnyttjas och används i positivt syfte. Slutsats: Det krävs ett välfungerande samarbete och en bra kommunikation mellan alla inblandade vårdprofessioner för att skapa en god vård för den äldre personen och för att undvika lidande i form av undernäring och för lång nattfasta. / Background: Risk of malnutrition and long night fasting for elderly people living in special housing is something that has been noted according to current research. The reason why the subject feels important to study further is that a night fast over 11 hours can be the first step to malnutrition. Malnutrition, in turn, can cause physical suffering and increases the risk of fall injuries, infections and severe wounds. Aim: The purpose of the study was to elucidate district nurses´ experiences of nutrition care in special housing for the elderly. Method: The study was conducted according to a qualitative inductive approach using semistructured interviews. Eight district nurses were interviewed. The data collection was analyzed based on a qualitative content analysis. Results: Analysis of the result generated three main categories and seven subcategories. Team collaboration plays an important role in the nursing work, both with regard to communication and the role of the district nurse. Management´s support or sometimes lack of support and organizational issues have an impact on how nutrition work is prioritized in the various health care professions. Participation includes both the elderly peolpe and the nursing staff. The person-centered care is reflected in how participation is utilized and used for a positive purpose. Conclusion: A well-functioning collaboration and good communication between all health care professionals involved is required to create good care for the elderly people and to avoid suffering in the form av malnutrition and long night fasting.

Psykisk ohälsa är ett växande samhällsproblem, både globalt och i Sverige och risken att drabbas ökar med stigande ålder. Depression hos en äldre person kan vara svårt att uppmärksamma. Äldre som utsätts för en ökad psykisk belastning, som till exempel i samband med sjukdom, förluster av närstående och ensamhetskänslor, riskerar att utveckla depressiva symtom. Dessa symtom utsätter den äldre för ett stort lidande, ökar risken att dö i förtid samt utgör en stor samhällskostnad. Syftet var att studera distriktssköterskans erfarenheter när det gäller att uppmärksamma och förbättra depressiva symtom hos äldre inom kommunal hemsjukvård. Metoden var kvalitativ och hade en induktiv ansats. Åtta distriktssköterskor i fem olika kommuner i södra Sverige intervjuades i 30-60 minuter. Med hjälp av en intervjuguide delgav distriktssköterskorna fritt sina erfarenheter. Innehållsanalysen var kvalitativ och innebar att meningsbärande enheter identifierades och processades till underkategorier samt abstraherades till kategorier. I resultatet framkom att distriktssköterskan använde sin intuitiva förmåga samt förlitade sig på sin erfarenhet, då han/hon i mötet och samtalet med den äldre uppmärksammat depressiva symtom. Mötet och samtalet med den äldre visade sig även vara viktiga redskap för att förbättra dessa symtom. Skattningsinstrument nyttjades inte i någon av kommunerna. Distriktssköterskan i hemsjukvården har en unik möjlighet att på ett tidigt stadium uppmärksamma depressiva symtom samt genom olika omvårdnadshandlingar förbättra dessa symtom. Genom att stå upp för den äldres rättighet till den vård och behandling han/hon är i behov av, får distriktssköterskan en nyckelfunktion i rollen som den äldres företrädare. / Mental illness is a growing problem in society, both global and in Sweden and the risk of suffering from depressive symptoms (DS) increases with ageing. It can be difficult to identify DS in an older person. Elderly people are sometimes at a higher risk of mental pressure, when at the same time dealing with sickness, loss of close relationships and loneliness, which often lead to DS. These symptoms cause the elderly person a great suffering, increases the risk of dying prematurely and is a big cost for the society. The aim was to study district nurses experiences when it comes to identify and improve DS by elderly people in municipal home nursing. The method was qualitative and had an inductive approach. Eight district nurses from five different municipalities in southern Sweden were interviewed for 30-60 minutes. The analysis was qualitative which means that parts with meaning contents were identified and processed into categories and subcategories. The result showed that district nurses used their intuitive ability and leaned on their experience, when in an encounter and in a conversation with an elderly person identified DS. The encounter and the conversation with an elderly person turned out to be an important instrument even when it came to improve these symptoms. A valuation scale was not used in any of the municipalities. The district nurse in home nursing has and unique possibility to, in an early stage, identify DS and by different caring actions improve these symptoms. By standing up for the elderly person's right to get the care and treatment he/she is in need of, the district nurse has a key function in the role as the elderly person’s representative.

Allergien sind häufige Erkrankungen in vielen industrialisierten Ländern. Ihre Entstehung beruht auf einem komplexen Zusammenspiel von genetischen und umweltassoziierten Einflüssen. Eine Vielzahl möglicher Faktoren ist beschrieben, die das Auftreten von AllerT gien beeinflussen können, etwa das Alter oder das Geschlecht. Es gibt allerdings nur sehr wenige Daten zur Verbreitung allergischer Erkrankungen in der älteren Bevölkerung. Das Ziel der vorliegenden Arbeit ist es, eine Übersicht zur Prävalenz allergischer ErkranT kungen und Sensibilisierungen in einer Stichprobe der 40T79Tjährigen Bevölkerung Leipzigs zu geben. Hierzu wurden insgesamt 4088 Probanden der zweiten ZwischenausT wertung (1. November 2011 bis 12. Juni 2013) der LIFETStudie untersucht. LIFE (Leipziger Forschungskomplex für Zivilisationserkrankungen) ist eine Kohortenstudie zur Erfassung von lebensstilT und umweltassoziierten Erkrankungen, beispielsweise Allergien, und mögT lichen Einflussfaktoren. In der vorliegenden Arbeit werden allergische Erkrankungen (alT lergische Rhinitis, Asthma bronchiale, atopisches Ekzem, Urtikaria, Anaphylaxie, NahT rungsmittelT und Insektengiftallergien) anhand eines AllergieTInterviews erfragt; SensibiliT sierungen werden mittels IgETDiagnostik für InhalationsT (SX1T) und NahrungsmittelallerT gene (FX5TScreeningtest) bzw. mittels Hautpricktest (Birke, Wiesenlieschgras, Beifuß, Dermatophagoides pteronyssinus, Alternaria alternata und Ambrosia) erfasst, weiterhin wird das GesamtTIgE bestimmt. Als mögliche Einflussfaktoren werden das Geschlecht, das Alter, der sozioökonomische Status und die allergologische Familienanamnese unterT sucht, hierzu werden neben den Prävalenzen auch OddsTRatios berechnet. Allergien sind häufige Erkrankungen in vielen industrialisierten Ländern. Ihre Entstehung beruht auf einem komplexen Zusammenspiel von genetischen und umweltassoziierten Einflüssen. Eine Vielzahl möglicher Faktoren ist beschrieben, die das Auftreten von Allergien beeinflussen können, etwa das Alter oder das Geschlecht. Es gibt allerdings nur sehr wenige Daten zur Verbreitung allergischer Erkrankungen in der älteren Bevölkerung. Das Ziel der vorliegenden Arbeit ist es, eine Übersicht zur Prävalenz allergischer Erkrankungen und Sensibilisierungen in einer Stichprobe der 40-79-jährigen Bevölkerung Leipzigs zu geben. Hierzu wurden insgesamt 4088 Probanden der zweiten Zwischenauswertung (1. November 2011 bis 12. Juni 2013) der LIFE-Studie untersucht. LIFE (Leipziger Forschungskomplex für Zivilisationserkrankungen) ist eine Kohortenstudie zur Erfassung von lebensstil- und umweltassoziierten Erkrankungen, beispielsweise Allergien, und möglichen Einflussfaktoren. In der vorliegenden Arbeit werden allergische Erkrankungen (allergische Rhinitis, Asthma bronchiale, atopisches Ekzem, Urtikaria, Anaphylaxie, Nahrungsmittel- und Insektengiftallergien) anhand eines Allergie-Interviews erfragt; Sensibilisierungen werden mittels IgE-Diagnostik für Inhalations- (SX1-) und Nahrungsmittelallergene (FX5-Screeningtest) bzw. mittels Hautpricktest (Birke, Wiesenlieschgras, Beifuß, Dermatophagoides pteronyssinus, Alternaria alternata und Ambrosia) erfasst, weiterhin wird das Gesamt-IgE bestimmt. Als mögliche Einflussfaktoren werden das Geschlecht, das Alter, der sozioökonomische Status und die allergologische Familienanamnese untersucht, hierzu werden neben den Prävalenzen auch Odds-Ratios berechnet. Insgesamt zeigt sich, dass allergische Erkrankungen und Sensibilisierungen in der untersuchten Stichprobe häufig sind. Die Einflussfaktoren zeigen unterschiedliche Effekte für das Risiko einer Allergie. Beispielsweise geht eine positive allergologische Familienanamnese mit einem erhöhten Risiko einher. Die möglichen Ursachen für Prävalenzunterschiede bei den allergischen Erkrankungen im Vergleich mit der Literatur und das Verhalten der Einflussfaktoren werden, ebenso wie die bestehenden Limitationen von LIFE, kritisch diskutiert. In der vorliegenden Arbeit wird erstmalig der Status quo von allergischen Erkrankungen in einer Probandengruppe der älteren Leipziger Bevölkerung gezeigt. Allergien sind bei den älteren Teilnehmern weniger häufig als bei den jüngeren, aber immer noch weit verbreitet. Weitere Untersuchungen sind notwendig, um mögliche Prävalenzänderungen zu dokumentieren und weitere Einflussfaktoren zu untersuchen. LIFE und seine geplanten Nachuntersuchungen bieten hierfür passende Möglichkeiten.

The submitted dissertation of the PhD study programme Longevity Studies was prepared and financially supported by the project GAUK - Grant Agency of Charles University No. 760219 entitled "Met and Unmet Needs Of Particularly Vulnerable Older Patients in Home and Inpatient Care", of which I am a co-investigator. The mentioned research project is also in the intentions of the strategic plan and long-term activities of the research team CELLO (Center for the Study of Longevity and Long-Term Care), which is the scientific basis of the PhD study programme Longevity Studies. The main goal of the GAUK project is to provide a comprehensive overview of the needs of vulnerable older patients who are provided health care. The project is focused on three areas, which are: the needs of patients with dementia, the needs of geriatric patients at home and the needs of geriatric patients in hospital care. Partial goals are the exploration of current knowledge of the issue based on a review of Czech and foreign literature. The aim of the survey is to find out attitudes and opinions on satisfying needs from the perspective of patients and healthcare professionals. The practical goal is to create recommendations for good practice for the health care of these patients. The dissertation consists of a total of seven...

Bakgrund Andelen äldre personer ökar i Sverige och den grupp bland äldre som ökar mest är över 90 år. Antalet äldre som är i behov av vård- och omsorgsinsatser från både socialtjänsten och hälso- och sjukvård förväntas därmed också öka. Ökad efterfrågan på kommunal hjälp i hemmet ställer höga krav på god samverkan och kommunikation mellan de olika instanserna för att minska risken för brister och vårdskador hos den äldre personen med komplexa vårdbehov. Komplexa vårdbehov innebär samtidig närvaro av förändringar som kommer av åldrandet, multisjuklighet, polyfarmaci och skörhet. Syfte Syftet med studien var att undersöka sjuksköterskors erfarenhet av kommunikation kring den äldre patienten med komplexa vårdbehov inom den kommunala hälso- och sjukvården. Metod Studien var en kvalitativ intervjustudie med induktiv ansats. Deltagarna i studien arbetade inom kommunal hälso- och sjukvård i två sydsvenska kommuner. Sex av deltagarna var grundutbildade sjuksköterskor, tre av deltagarna var distriktssjuksköterskor och en var specialistsjuksköterska inom vård av äldre. Datan som samlats in analyserades med hjälp av kvalitativ innehållsanalys. Resultat Resultatet ledde fram till tre huvudkategorier och sju underkategorier. Huvudkategorierna var Samverkan och dialog, Organisatoriska förutsättningar samt Utbildning, Språk och Kompetens. En nära relationen till omvårdnadspersonalen, rätt kompetens och erfarenhet hos omvårdnadspersonalen samt regelbundna möten och träffar var faktorers som ansågs underlätta kommunikationen. Slutsats  Sjuksköterskorna beskrev att teamsamverkan med planerade teamträffar och fysiska möten med personalen var viktigt för fungerande kommunikation. Att minska distansen mellan personalen och ha fungerande rutiner kring kommunikationen var andra värdefulla aspekter som framkom. Det som ansågs försvåra kommunikationen var stress och tidsbrist samt brister i språket hos omvårdnadspersonalen men även organisatoriska hinder så som dålig täckning på mobiltelefoner, laghinder och bristande kontinuitet hos omvårdnadspersonalen. / Background  The proportion of elderly people is increasing in Sweden, and the group among the elderly that is increasing the most is over 90 years of age. The number of elderly people who need care and care interventions from both social services and health care is therefore also expected to increase. Increased demand for municipal help in the home places high demands on good cooperation and communication between the various agencies to reduce the risk of deficiencies and care injuries in the elderly person with complex care needs. Complex care needs mean the simultaneous presence of changes that come from aging, multimorbidity, polypharmacy and frailty. Purpose The purpose of the study was to investigate nurses' experience of communication regarding the elderly patient with complex care needs within the municipal health care system.  Method The study was a qualitative interview study with an inductive approach. The participants in the study worked in municipal health care in two municipalities in southeast of Sweden. Six of the participants were basic nurses, three of the participants were district nurses and one was a specialist nurse in the care of the elderly. The data collected was analyzed using qualitative content analysis. Results The result led to three main categories and seven subcategories. The main categories were Collaboration and dialogue, Organizational conditions and Education, Language and Competence. A close relationship with the nursing staff, the right skills and experience of the nursing staff and regular meetings were considered to facilitate communication. Conclusion  The nurses described that team cooperation with planned team meetings and physical meetings with the staff was important for effective communication. Reducing the distance between staff and having working routines around communication were other valuable aspects that emerged. What was considered to make communication difficult was stress and lack of time as well as deficiencies in the language of the nursing staff, but also organizational obstacles such as poor mobile phone coverage, legal obstacles and a lack of continuity among the nursing staff.