Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences for students by partnering with the College of Pharmacy, the College of Clinical and Rehabilitative Health Sciences, and the local public housing authority. Select faculty from each college met and developed a plan to form student teams from all three colleges to conduct in-home comprehensive medical and nutrition assessments and medication chart reviews of high-risk older adults. Following the in-home visit, students and faculty discuss the assessment findings at planned interprofessional meetings. Students present their findings from each discipline's perspective and collaboratively set health priorities and develop intervention strategies and an inclusive follow-up plan. Excerpts from students' reflective narratives discussing the impact of the interprofessional service-learning experiences are shared.

Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences for students by partnering with the College of Pharmacy, the College of Clinical and Rehabilitative Health Sciences, and the local public housing authority. Select faculty from each college met and developed a plan to form student teams from all three colleges to conduct in-home comprehensive medical and nutrition assessments and medication chart reviews of high-risk older adults. Following the in-home visit, students and faculty discuss the assessment findings at planned interprofessional meetings. Students present their findings from each discipline's perspective and collaboratively set health priorities and develop intervention strategies and an inclusive follow-up plan. Excerpts from students' reflective narratives discussing the impact of the interprofessional service-learning experiences are shared.

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Throughout the last decades, evolving treatment-opportunities provide a better chance of cure and thereby a higher percentage of patients is being treated for chronic disease (Robert Koch Institut, 2016). As treatment-toxicity, side effects and disease-derived symptoms remain high, it has become crucial to assesses parameters reflecting patients’ perspective, instead of solely focusing on illness-centered outcomes such as survival or treatment response. During the last decades, Patient-reported outcomes (PROs) are on the rise throughout research and cancer care as a key component to capture a patient’s perspective. This work illustrates the broad framework that PROs can be conducted in. We gathered experience and pioneered a systematic PRO-assessment in routine outpatient care, which continues to be updated. We identified a suitable PRO-based geriatric screening tool to avoid a time and resource consuming comprehensive geriatric assessment. Furthermore, we explored the beneficial effects of a PRO-based tailored intervention on HRQoL and provided effect-size estimations. Assessing PROs yields many benefits throughout the care pathway (Andreassen et al., 2006; Basch et al., 2016; Kofoed et al., 2012; Velikova et al., 2004; Yang et al., 2018) and was shown to be feasible in different entities and treatment setting (Bennett et al., 2016; M. K. Schuler et al., 2016; Strasser et al., 2016; Warrington et al., 2019). As a strikingly large discordance between patients’ and clinicians’ perception of symptoms exists (Atkinson et al., 2016), PROs can increase the accuracy of detection of adverse events and even predict survival (Efficace et al., 2021). Based on these advantages, the EMA and the FDA advocate the use of PROs as endpoints in cancer research (European Medicines Agency, 2016; U.S. Department of Health and Human Services FDA Center for Drug Evaluation and Research et al., 2006). Throughout previous years, methodological progress has been made resulting in elaborated measurement technics such as computerized adaptive testing being applied to PRO-instruments (Petersen et al., 2018, 2020). Clinical usability was increased with development of summary scores, cut-off values and emerging normative data (Giesinger et al., 2016, 2020). Interventions based on PROs are promising (Ishaque et al., 2019; Kotronoulas et al., 2014). Despite this ever increasing body of literature on PRO, a significant number of questions remain unanswered. Firstly, there was scarce knowledge about the benefits of a PRO-based intervention in sarcoma patients as there was limited PRO-data available in this entity. Sarcomas are rare diseases, still accounting for slightly less than 1% of all malignant neoplasia worldwide. The age adjusted incidence ranged from 7.4 per 100.000 men and 6.6 per women in Germany (Ressing et al., 2018). As sarcoma-treatment is improving, side-effects and toxicity remain to occur frequently (Gough et al., 2011; McDonough et al., 2019; Reichardt et al., 2012; Storey et al., 2019; Winnette et al., 2017). Until recently, there was quite limited knowledge about the patient-reported burden in terms of HRQoL, symptoms and psychological distress in patients with STS (Tang et al., 2012). PRO-based interventions yield beneficial effects in different cancer entities. Nevertheless, the effects of a PRO-based intervention in STS-patients was scarcely explored. The YonLife-Study (Publication B, Hentschel et al., 2020) contributes new evidence that a PRO-based intervention yields beneficial effects on HRQoL and suggests a positive, yet non-significant effect on survival. Concerning symptoms, the results of the YonLife-intervention remain far from being encouraging. As effects sizes are available now, RCTs which are powered to a confirmatory purpose could be performed in this population. Secondly, the importance of PROs are emphasized by authorities such as EMA or FDA that emphasize the need to incorporate PRO in scientific studies. Yet during the early 2010s, the actual incorporation of PROs in clinical routine was limited in Germany. We therefore designed and established a routine assessment of PROs (Publication C, (Trautmann, Hentschel et al., 2016) incorporating the automatized calculation, comparison with normative or threshold data and implemented it to our hospital information system. As until recently, feasibility data such for such an intervention is scarce, we collect measures of adherence, required time and barriers reported by staff. For the clinical benefit, the established PRO-assessment is being developed further and expanded to other departments and clinics of our institution. Thirdly, as numbers of geriatric cancer patients rise (Le Saux et al., 2019), older patients continue to be underrepresented in clinical trials (Singh et al., 2017), therefore an immense lack of knowledge on treatment-toxicities and side effects in this population exists. Treatment needs to be adapted to older patients frailty-level, which can be conducted applying a time- and resource consuming Comprehensive Geriatric Assessment (Le Saux et al., 2019). Still, there is no consensus on which domains to include and how to measure them (Hamaker, Jonker, et al., 2012). A geriatric screening can alleviate burden of conducting a whole CGA. Several screening instruments exists, yet there is inconsistent data (Kotzerke et al., 2019; Mohile et al., 2018; Soubeyran et al., 2014) which tool yields the best predictive performance. Our project aimed to compare three of the available screening tools (VES-13, G8, POT/CARG). Being far from having a perfect predictive performance, the POT/CARG occurs to be the screening instrument with a high sensitivity and sufficient negative predictive value. Furthermore, our research supports the increasing evidence that ultra-short-screeners such as ECOG state or age bear only insufficient predictive performance.:1. Introduction 1.1 What are Patient-reported outcomes (PROs)? 1.2 Assessment of PROs 1.2.1 Feasible in clinical routine, improving relevant outcomes 1.2.2 Improving diagnostic accuracy 1.2.3 Supporting drug development 1.2.4 Evolving measurement techniques and standardization 1.3 PRO-based feedback interventions 1.4 PRO-based geriatric screening 1.5 Research needs 1.5.1 Identifying a suitable geriatric screener 1.5.2 Limited PRO-data on Soft-Tissue Sarcoma (STS) patients 1.5.3 Feasibility-research in routine care 1.6 study aims 2. Methods 2.1 Design and Sample of Publication A 2.2 Design and Sample of Publication B 2.3 Design and Sample of Publication C 2.4 Instruments 2.5 Non-PRO-Outcomes 2.5.1 Predictive performance 2.5.2 Survival analysis 2.5.3 Feasibility analysis 2.6 Statistical Analysis 2.6.1 Sample Size Estimation 2.6.2 Non-participation and drop-out analysis 2.6.3 Regression Analyses 2.6.4 Statistical software 2.6.5 Statistical analysis plans 3. Outline of Publications Publication A Publication B Publication C 4. Discussion 4.1 Main findings, integration in existing research and research implications 4.1.1 Geriatric screening tools 4.1.2 PROs in soft tissue sarcoma (STS) 4.1.3 Implementation of PROs into routine care 4.2 Strengths and Limitations 4.2.1 Strengths 4.2.2 Limitations 5. Conclusions 6. Summary 7. References 8. Appendix 8.1 Darstellung des eigenen Beitrags 8.1.1 Darstellung des eigenen Beitrags zur Publikation A 8.1.2 Darstellung des eigenen Beitrags zur Publikation B 8.1.3 Darstellung des eigenen Beitrags zur Publikation C 8.2 Erklärung über die eigenständige Abfassung der Arbeit 8.3 Curriculum Vitae 8.4 Publikationsverzeichnis 8.5 Danksagung

INTRODUÇÃO A mobilidade é um componente importante da funcionalidade, necessária para realização das atividades de vida diária. O questionário The University of Alabama at Birminghan Study of Aging Life-Space Assessment (LSA) avalia a mobilidade através dos espaços que o idoso ocupa, a frequência e independência com que se desloca. O LSA é um dos poucos instrumentos que avalia a mobilidade sob o aspecto da participação e é composto por cinco questões simples e de fácil aplicação. Além disso, a avaliação pode ser realizada presencialmente ou à distância, como por exemplo, através de contato telefônico. Já existem versões do LSA validadas para utilização em outros países e, na ausência de uma versão validada em português brasileiro do LSA, faz-se necessária a adaptação transcultural e análise das propriedades de medida desta versão, para incrementar as opções de avaliação da mobilidade de idosos. O objetivo deste trabalho foi adaptar transculturalmente para o português brasileiro o instrumento LSA e testar as propriedades de medida desta versão. MÉTODOS Este estudo de adaptação transcultural e clinimetria foi realizado em duas fases. Fase I - adaptação transcultural e validade de conteúdo: foi realizada a adaptação transcultural do questionário e suas instruções de aplicação. O pré-teste das instruções e do questionário foi realizado com 10 profissionais, e o pré-teste do questionário foi realizado com 30 idosos da comunidade. Fase II - análise das propriedades de medida (reprodutibilidade, validade de construto e interpretabilidade): foram incluídos 80 idosos da comunidade. Inicialmente foi aplicado o LSA em português brasileiro e foi colocado um acelerômetro na cintura do participante. Após sete dias, o acelerômetro foi retirado e o questionário foi reaplicado. A reprodutibilidade foi analisada através do teste alpha de Cronbach (consistência interna), Coeficientes de Correlação Intraclasse (CCI) e intervalo de confiança de 95% (IC95%) (confiabilidade), e erro padrão da medida (erro de medida). A validade de construto foi analisada através da correlação de Pearson entre os escores do LSA e acelerometria (tempo em atividades sedentárias e tempo em atividades moderadas e vigorosas). A interpretabilidade foi analisada através de histograma, cálculo da diferença mínima detectável (DMD) e determinação de efeitos piso e teto. RESULTADOS Foi obtida a versão em português brasileiro do questionário LSA e suas instruções de aplicação. Essa versão atendeu aos critérios adotados neste trabalho para validade de conteúdo. A consistência interna apresentou alpha de Cronbach de 0,92 e confiabilidade com CCI de 0,97 (IC95% 0,95 a 0,98). O erro padrão da medida foi calculado em 4,12 pontos (3%). O escore do LSA apresentou correlação negativa com o tempo em atividades sedentárias (R = -0,63; p < 0,001) e correlação positiva com o tempo em atividades moderadas e vigorosas (R = 0,49; p < 0,001), a DMD foi de 0,36 pontos, e não houve efeitos piso e teto. CONCLUSÃO A versão em português brasileiro do LSA reproduz a versão original com reprodutibilidade, validade e interpretabilidade adequadas. Recomendamos, portanto, a utilização desta versão para avaliação da mobilidade dos espaços de vida dos idosos brasileiros / BACKGROUND Mobility is an important component of functionality, necessary for performance of activities of daily living. The questionnaire The University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA) evaluates mobility from the spaces that older adults go, the frequency and independence that the person moves through these spaces. The LSA is one among only few instruments that evaluate mobility in the context of participation, and it consists of five simple and quick questions. In addition, the questionnaire may be applied in person or by telephone. There are already validated versions of the LSA for use in other countries and, in the absence of a validated version of the LSA in Brazilian Portuguese, it is necessary to adapt cross-culturally and to analyze the measurement properties of the adapted version, in order to increase the options for mobility evaluation of older adults. The purpose of this study was to adapt cross-culturally the LSA into Brazilian Portuguese, and to analyze its measurement properties. METHODS This cross-cultural adaptation and clinimetric study was conducted in two phases. Phase I - cross-cultural adaptation and analysis of content validity: we performed a cross-cultural adaption of the questionnaire and its instructions for application. The adapted version was pretested with 10 professionals and 30 community-dwelling older adults. Phase II - analysis of measurement properties (reliability, construct validity and interpretability): we included 80 community-dwelling older adults. Initially, the adapted LSA was applied; and we put an accelerometer on the participant\'s waist. After seven days, the accelerometer was removed and the questionnaire was reapplied. Reliability was analyzed by the Cronbach\'s alpha (internal consistency), intraclass correlation coefficients (ICC) and 95% confidence interval (95%CI) (reproducibility), and standard error of measurement (measurement error). The construct validity was analyzed by Pearson\'s correlation between the scores of LSA and accelerometry data (time in sedentary activities and time in moderate and vigorous activities). Interpretability was analyzed by histograms, minimal detectable change (MDC), and determination of floor and ceiling effects. RESULTS We obtained a Brazilian Portuguese version of the LSA and its instructions for application. This version met the criteria for content validity adopted in this study. Internal consistency (Cronbach\'s alpha) was 0.92 and reproducibility (ICC) was 0.97 (95%CI 0.95 to 0.98). The standard error of measurement was calculated in 4.12 points (3%). The LSA score showed negative correlation with sedentary activities (R = -0.63; p < 0.001), and positive correlation with moderate to vigorous activities (R = 0.49; p < 0.001), the MDC was 0.36 points, and we observed no floor or ceiling effects. CONCLUSION The Brazilian Portuguese version of the LSA reproduces the original version with adequate reliability, validity and interpretability. We therefore recommend the use of this version to evaluate life-space mobility of Brazilian older adults

Função executiva é a habilidade necessária para planejar, iniciar, realizar e monitorar comportamentos intencionais, relacionados a um objetivo ou a demandas ambientais, com base na experiência prévia. Tanto indivíduos idosos, quanto indivíduos com escolaridade baixa apresentam dificuldade em tarefas que requerem função executiva, como o Trail Making Test (TMT), que consiste em traçar retas em uma folha de papel, conectando uma seqüência de números (parte A, TMTA) e de números e letras, alternados (parte B, TMTB), o mais rápido possível. O presente estudo teve como objetivo geral desenvolver uma nova versão do TMT, o Teste de Deambulação Funcional (TDF), que poderia ser mais familiar a indivíduos com escolaridade baixa e favorecer sua compreensão e execução. Os objetivos específicos foram: testar se haveria diferenças de idade e/ou escolaridade (1) na execução das partes A e B do TDF (TDFA e TDFB) e das partes A e B do TMT (TMTA e TMTB); (2) nos deltas cognitivos do TMT (dcTMT=TMTBTMTA) e do TDF (dcTDF=TDFBTDFA); (3) nos deltas motores da parte A (dmA=TDFATMTA) e da parte B (dmB=TDFBTMTB) e (4) no aprendizado do TDF. Participaram 70 voluntários, (24 jovens, 26 adultos maduros, e 20 idosos). Na primeira sessão os voluntários realizaram (I) o TDF, (II) o TMT, (III) sete repetições do TDFA, (IV) sete repetições do TDFB. Metade dos voluntários de cada faixa etária realizou a ordem (I) e (II) e metade, (II) e (I). Depois de uma semana, realizaram (V) quatro repetições do TDFA e (VI) quatro do TDFB. Foi adotado nível de significância de p=0,05. ANOVAs mostraram que (1) os idosos, principalmente aqueles com escolaridade baixa, foram mais lentos que os adultos jovens e maduros no TMT e no TDF, sobretudo na parte B e os idosos com escolaridade alta foram mais lentos no TDFB do que no TMTB; (2) os deltas cognitivos do TMT e do TDF foram mais altos para indivíduos com maior idade e menor escolaridade e o dcTMT foi maior que o dcTDF para idosos com escolaridade baixa; (3) o dmB de idosos com escolaridade baixa foi menor que o de idosos com escolaridade alta; (4) os idosos com escolaridade baixa foram mais lentos que aqueles com escolaridade alta na avaliação 1 da TDFA e em todas as avaliações da TDFB, mas não foram observadas diferenças de escolaridade no desempenho de adultos jovens e maduros. O TDF mostrou-se uma ferramenta complementar eficaz para avaliar indivíduos com diferentes idades e escolaridades. Indivíduos mais idosos e com escolaridade mais baixa apresentaram tempos mais altos, tanto no TMT, quanto no TDF. O dcTDF não parece ter sido equivalente ao dcTMT em indivíduos com escolaridade baixa, já que eles apresentaram menor dificuldade em resolver cognitivamente o TDF. Idosos com alta e baixa escolaridade apresentaram resultados antagônicos no dmB: idosos com escolaridade baixa apresentaram menor dificuldade no TDFB, com relação ao TMTB e o contrário ocorreu para idosos com escolaridade alta. A escolaridade baixa prejudicou o aprendizado da tarefa, principalmente em idosos. Idosos apresentaram estabilização mais lenta no desempenho do que adultos maduros, que por sua vez apresentaram estabilização mais lenta que jovens. / Executive function is the ability of planning, initiating, performing and monitoring intentional behaviors, related to an objective or environmental demands, based on previous experience. Older adults and individuals with a low educational status have difficulty in performing executive function tasks, such as the Trail Making Test (TMT), which consists on linking a sequence of numbers on a sheet of paper (part A, TMTA) and alternated numbers and letters (part B, TMTB) as fast as possible. The present study had as a general aim to develop a new version of the TMT, the Functional Gait Test (FGT), which could be more familiar to individuals with a low educational status and favor their comprehension and performance. The specific aims were: to investigate possible differences due to age and/or educational status (1) in the performance of parts A and B of FGT (FGTA e FGTB) and of parts A and B of TMT (TMTA and TMTB); (2) in the cognitive deltas of TMT (cdTMT=TMTBTMTA) and of FGT (cdFGT=FGTBFGTA); (3) in the motor deltas of part A (mdA=FGTATMTA) and part B (mdB=FGTBTMTB) and (4) in the learning process of FGT. Seventy volunteers participated (24 young adults, 26 mature adults and 20 older adults). At the first session, volunteers performed (I) the FGT, (II) the TMT, (III) seven repetitions of the FGTA, (IV) seven repetitions of the FGTB. Half of the sample of each age group performed the order (I) and (II) and the other half, (II) and (I). After one week, they performed (V) four repetitions of the FGTA and (VI) four of the FGTB. Significance level was p=0,05. ANOVAs showed that (1) older adults, mainly the ones with a low educational status, were slower than young and mature adults on the TMT and on the FGT, principally on part B and older adults with a high educational status were slower on the FGTB than on the TMTB; (2) the cognitive deltas of TMT and FGT were higher for individuals with higher age and lower level of education and the cdTMT was higher than cdFGT for older adults with a low educational status; (3) the mdB of older adults with a low educational level was lower that the mdB of older adults with more years of formal education; (4) older adults with a low educational status were slower than the ones with a high level of education on assessment 1 of the FGTA and in all assessments of the FGTB, but no educational status differences were observed in the performance of young and mature adults. The FGT is an useful complementary tool to evaluate individuals with different ages and educational levels. Older adults and individuals with a lower educational level showed higher times, both in the TMT and in the FGT. The cdFGT did not seem equivalent to the cdTMT in individuals with a low educational status, since they had less difficulty in solving the cognitive part of the FGT. Older adults with a high and a low educational level had antagonistic results on mdB: older adults with a low educational status had less difficulty on the FGTB, compared to the TMTB and the opposite occurred for the ones with a high educational status. The low educational level impaired the learning process, mainly for older adults. Older adults showed slower stabilization on performance than mature adults and mature adults showed slower stabilization than young adults.

Introdução: O Câncer e o envelhecimento estão integralmente relacionados e evidenciam um inexorável aumento nos países desenvolvidos e em desenvolvimento. No Brasil o câncer de mama é o mais frequente nas mulheres com aumento de sua incidência e mortalidade na população idosa. A avaliação Geriátrica Ampla (AGA) é instrumento seguro e utilizado por geriatras, para estratificar os idosos entre diferentes níveis de fragilidades e tem por objetivo determinar as deficiências e incapacidades para um planejamento individual do cuidado. Objetivos : Avaliar a utilidade da AGA e sua aplicabilidade como instrumento de monitoramento longitudinal em mulheres idosas portadoras de câncer de mama no Brasil. Material e métodos: Estudo coorte, prospectivo, quasi experimental em mulheres idosas, com >= 60 anos, provindas do sistema público de saúde, recém diagnosticadas do câncer de mama e que iriam iniciar tratamento oncológico. As pacientes foram seguidas por dois anos e avaliadas pelos parâmetros da AGA: Escala de Comorbidades de Charlson; Atividades básica de vida diária (ABVD); Atividades Instrumentais de Vida Diária (AIVD); Mini Exame do Estado Mental (MEEM) ; Escala de Depressão Geriátrica (GDS-15); Mini Avaliação Nutricional (MAN) e pela Escala de Sintomas de Edmonton ao diagnóstico e a cada 4 meses no primeiro ano e após 2 anos do diagnóstico. Resultados: 20 idosas de idade média 70,2 (+ - 7.03 ), receberam um total de 97 AGAs no decorrer de 2 anos. A AGA identificou novas fragilidades em 90% das avaliações, com ampliação da conduta clinica, e 45% das pacientes tiveram o tratamento oncológico modificado após a avaliação. Como instrumento de monitoramento, houve uma tendência de diminuição do numero de novos diagnósticos após cada AGA realizada ao longo de 2 anos. Conclusão: O presente estudo valida a importância do uso da AGA na população idosa com câncer de mama no Brasil ao identificar fragilidades e sugerir mudanças no plano do tratamento oncológico. Novos estudos, em diversos tipos de câncer, com maior tempo de seguimento, são necessários para avaliar o impacto da AGA na população idosa em tratamento oncológico / Introduction: The Cancer and aging are integrally related and show an inexorable rise in developed and developing countries . In Brazil, breast cancer is the most common in women with increased incidence and mortality in the elderly population . The Comprehensive Geriatric Assessment (CGA) is an instrument used with insurance by geriatricians to stratify elderly between different levels of weaknesses and aims to determine the disabilities for an individual plan of care. Objectives : To evaluate the usefulness of CGA and its applicability as longitudinal monitoring instrument in older women with breast cancer in Brazil. Methods: Cohort study , prospective, quasi experimental in elderly women with >= 60 years , originated from the public health system , newly diagnosed breast cancer and they would start cancer treatment . The patients were followed for two years and evaluated by the parameters of CGA : Charlson Comorbidity Index (CCI); Activities of Daily Living (ADL); Instrumental Activities of Daily (IADL); Mini Mental State Evaluation (MMSE); Geriatric Depression Scale (GDS); Mini Nutritional Assessment (MAN) and Edmonton Symptom Assessment Scale. The CGA occurred every four months in the first year and after 2 years of diagnosis . Results: 20 elderly women with average age of 70.2 ( + - 7.03 ) , received a total of 97 GA in the course of two years . CGA identified new weaknesses in 90 % of cases , with expansion of the clinical conduct, and 45% of patients had cancer treatment modified after the evaluation. As monitoring instrument , there was a downward trend in the number of new diagnoses after each AGA conducted over two years. Conclusion: This study validates the importance of using the AGA in the elderly population with breast cancer in Brazil to identify weaknesses and suggest changes in cancer treatment plan. New studies in various cancers and longer follow-up are needed to assess the impact of AGA in the elderly undergoing cancer treatment

Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-15T17:01:05Z No. of bitstreams: 1 Viviane Schreiber de Souza.pdf: 582806 bytes, checksum: 002ea2ec3066a664cb5c38beb41c4702 (MD5) / Made available in DSpace on 2015-07-15T17:01:05Z (GMT). No. of bitstreams: 1 Viviane Schreiber de Souza.pdf: 582806 bytes, checksum: 002ea2ec3066a664cb5c38beb41c4702 (MD5) Previous issue date: 2014-01-31 / Nenhuma / Os idosos compõem um segmento da população mundial em crescimento constante. A mudança demográfica da população brasileira nos leva a pensar sobre os serviços existentes que não são suficientes para dar suporte para esta nova demanda. O ramo de hotelaria voltado ao cuidado de idosos, denominado de residenciais geriátricos, vem se mostrando promissor e crescente. Entre os fatores elenca-se: o número crescente de idosos, a redução do tamanho das famílias e a alteração no modo de vida do brasileiro. Essa constatação nos remete a pensar no aumento significativo da demanda por esse perfil de serviços nos próximos anos. Dessa maneira, este estudo visa a implantar a gestão administrativa e de enfermagem em um residencial geriátrico da grande Porto Alegre através de um estudo de intervenção. As atividades de intervenção realizadas resultaram na construção e na definição da missão e da visão do negócio e na identificação do perfil do cliente a ser atendido pelo residencial. O diagnóstico situacional baseado no modelo IDEALS de Facione possibilitou o mapeamento de todos os recursos físicos e humanos do residencial; este estudo possibilitou a construção do instrumento de avaliação geriátrica, buscando as melhores práticas de avaliação clínica. A elaboração dos Procedimentos Operacionais Padrão administrativos e de enfermagem conforme Colenghi foram criados de acordo com as necessidades mapeadas inicialmente no residencial geriátrico. A realização do mapeamento de todos os recursos físicos e humanos, através do diagnóstico situacional, possibilitou o conhecimento da realidade institucional e foi de extrema importância para a implantação de estratégias e programas capazes de auxiliar na organização e elaboração de propostas de melhorias nas condições de trabalho e na construção e consolidação de um instrumento de gestão. Com o intuito de propor soluções e melhorias para os problemas elencados, o presente trabalho possibilitou um direcionamento gerencial não apenas administrativo, mas de enfermagem para o residencial geriátrico, tornando-o diferenciado e competitivo enquanto empresa prestadora de serviços. / The elderly make up a segment of the world's growing population. The demographic shift of the population leads us to think about the existing services are not sufficient to provide support for this new demand. The hotel industry returned to the care of the elderly, called residential geriatric, has proved promising and growing. The associated factors: the growing number of elderly, reducing the size of families and the change in the lifestyle of the Brazilian. This observation leads us to think of the significant increase in demand for this listing services in the coming years. Thus, this study aims to deploy the administrative and nursing management in a geriatric residential Greater Porto Alegre through an intervention study. Intervention activities conducted resulted in the construction and definition of the mission and vision of the business and the identification of the client profile to be serviced by residential. The situation analysis based on the IDEALS of Facione model enabled the mapping of all physical and human resources of residential, this study allowed for the construction of the instrument of geriatric assessment seeking best practices for clinical assessment. The development of standard operating procedures and administrative nursing as Colenghi were created as needed initially mapped in geriatric residential. The completion of the mapping of all physical and human resources through situation analysis, made possible knowledge of the institutional and it was extremely important for the implementation of strategies and programs that assist in the organization and preparation of proposals for improvements in working conditions and the construction and consolidation of a management tool. In order to propose solutions and improvements for the problems listed, the present study allowed a managerial direction not only administrative, but for geriatric nursing home making it as competitive and differentiated services company.

O Plano de Atenção Gerontológica (PAGe), instrumento desenvolvido no Bacharelado em Gerontologia da Universidade de São Paulo, possui uma escala de avaliação multidimensional de idosos (AMI) que ainda não foi submetida ao processo de validação. Objetivo geral: realizar a validação de conteúdo da AMI do PAGe. Métodos: A validade de conteúdo foi realizada nas seguintes etapas: 1) revisão sistemática de instrumentos de avaliação multidimensional de idosos validados na língua inglesa: os descritores \"geriatric assessment\", \"validity\", \"reliability\" e \"elderly\" foram associados e pesquisados em quatro bases de dados. Os artigos foram selecionados por dois avaliadores após aplicação dos critérios de inclusão. Pesquisas adicionais foram feitas na tentativa de encontrar adaptações/validações para a população brasileira; 2) definição das bases conceituais: estudo aprofundado sobre como domínios/itens foram medidos por outros pesquisadores; 3) análise do desenvolvimento da escala: itens avaliados e modificados considerando: ambiguidade, comprimento, dificuldade de leitura, múltiplas negativas e duplo-caminho; e 4) avaliação do comitê de especialistas: profissionais experts em avaliação multidimensional do idoso analisaram o conteúdo do instrumento. Foram seguidos métodos sistemáticos para coleta de dados: carta convite, termo de consentimento livre e esclarecido, formulário de caracterização dos participantes, carta explicativa e questionário de avaliação dos itens/domínios. A concordância entre os especialistas foi analisada considerando os valores críticos da Content Validity Ratio (CVR) (nível de significância de p<0,02). Resultados: Foram encontradas 14 escalas validadas, na maioria voltadas para identificação de fragilidade e demandas/risco de saúde. Os domínios mais frequentes foram suporte social (100%) e capacidade funcional (92,8%), enquanto o menos presente foi sobre violência (7,1%). Todas as escalas apresentaram índices de confiabilidade, seguidos por validade de critério concorrente e conteúdo (78,5%, ambas). Validades de face (21,4%) e construto (21,4%) foram menos prevalentes. Na validação do conteúdo da AMI do PAGe seu construto foi definido, suas bases conceituais foram devidamente descritas e seus itens modificados para melhor qualidade psicométrica. O comitê foi constituído por dez especialistas. A partir do cálculo das CVRs, 42,7% dos 103 itens foram validados, 50,4% modificados, 5,8% excluídos e 0,9% mantidos sem modificações. As médias das CVRs da escala inteira nos quesitos clareza e pertinência são 0,78 e 0,95, respectivamente. Foram feitas alterações no layout e nas instruções do instrumento, excluídas as propostas de escores e incluídos sete itens. Conclusão: As escalas encontradas na revisão são mais voltadas para a área da saúde e apresentam limitações em suas validações. Há escassez de instrumentos originados no Brasil e validados para idosos brasileiros. Esta pesquisa proporcionou a identificação do construto latente da AMI pertencente ao PAGe, a qual passou a ser denominada escala de Vulnerabilidade Biopsicossocial do Idoso (VBI). O conteúdo dessa escala não foi totalmente validado, contudo os itens mantidos na mesma foram todos considerados pertinentes. Neste panorama, espera-se que a escala VBI do PAGe venha contribuir para o campo de instrumentos avaliativos da população idosa brasileira e que este trabalho contribua para maior interesse em estudos de avaliação psicométrica e uso crítico de instrumentos / The Gerontological Care Plan (originally called Plano de Atenção Gerontológica -PAGe), developed in the Bachelor of Gerontology of the University of São Paulo, has a scale of multidimensional assessment of the elderly (MAE) that has not been yet submitted to a validation process. General objective: to determine the content validation of the MAE of the PAGe. Methods: Content validity was performed in the following stages: 1) systematic review of multidimensional assessment tools for elderly validated in the English language: the descriptors \"geriatric assessment\", \"validity\", \"reliability\" and \"elderly\" were associated and searched in four databases. The articles were selected by two researchers after applying the inclusion criteria in the abstracts/titles and full articles. Additional research was done in an attempt to find adaptations/validations for the Brazilian population; 2) definition of the conceptual bases: an in-depth study on how domains/items were measured by other researchers; 3) analysis of the development of the instrument: the items were evaluated and modified considering: ambiguity, length, reading difficulty, multiple negatives and double barreled; and 4) evaluation of the specialists committee: experts in multidimensional assessment analyzed the content of the instrument. Systematic methods for data collection were followed: invitation letter, informed consent form, participant characterization form, explanatory letter and questionnaire to evaluate the items/domains. The agreement among the experts was analyzed considering the critical values of the content validity ratio (CVR) (significance level of p <0.02). Results: A total of 14 validated scales were found, mostly focused on the identification of frailty and demands / health risk. The most frequent domains were social support (100%) and functional capacity (92.8%), while the least present was violence (7.1%). All scales presented reliability indices, followed by validity of concurrent criterion and content (78.5%, both). Validities of face (21.4%) and construct (21.4%) were less prevalent. In the content validation of the MAE of the PAGe its construct was defined, its conceptual bases were properly described and its items modified for better psychometric quality. The committee consisted of ten specialists. From the CVR calculation, 42.7% of the 103 items were validated, 50.4% modified, 5.8% excluded and 0.9% maintained unchanged. The CVR averages of the entire instrument in the clarity and relevance questions are 0.78 and 0.95, respectively. Changes were made to the layout and instructions of the instrument, proposed scores were excluded and seven items were included. Conclusion: The scales retrieved in the systematic review are more focused on the healthcare field and have limitations in their validations. No instrument was originally developed in Brazil and fewer were validated for Brazilian elderly. This research provided the identification of the latent AMI construct belonging to the PAGe, which was renamed scale of Biopsychosocial Vulnerability of the Elderly (BVE). The content of this scale was not fully validaded, however the items kept in it were all considered pertinent. Finally, it is expected that BVE would contribute to the field of evaluation instruments for Brazilian elderly population and that the present study contributes to an increase interest in psychometric evaluation and critical use of instruments

Mit der vorliegenden Arbeit sollte untersucht werden, ob die Selbstausfüller-Version des STEP (Standardised assessment of elderly people in primary care in Europe) praktikabel und verständlich ist, ob sie von Patienten und Ärzten akzeptiert wird und ob sie nützlich ist, bisher unbekannte gesundheitliche Probleme der Patienten zu entdecken. 1007 von 1540 Patienten über 65 Jahren, die in 28 sächsische Hausarzt-praxen kamen, beantworteten die Selbstausfüller-Version des STEP. Ermittelt wurde, dass 95,8% der teilnehmenden Patienten den Fragebogen ohne Hilfe ausfüllen konnten. Die durchschnittliche Zeit zum Beantworten des Fragebogens nahm, abhängig vom Alter der Patienten, von 17 bis 25 Minuten zu. Vierzehn der 75 Fragen der Selbstausfüller-Version wurden von mehr als 9% der Patienten nicht beantwortet. Die Patienten gaben bei acht der 14 häufig nicht beantworteten Fragen Verständnisprobleme an. Bei einer Stichprobe von 257 zufällig ausgewählten Patienten wurden 281 gesundheitliche Probleme (1,1 pro Patient) entdeckt, die den Hausärzten noch nicht bekannt gewesen waren. Die Hausärzte gaben an, dass 16,4% dieser neuen Probleme eine Konsequenz hatten, vordergründig die physischen Probleme. Bemerkenswert war, dass die neu entdeckten psycho-sozialen Probleme keinerlei Konsequenzen hatten. Die Selbstausfüller-Version war praktikabel, nützlich und wurde von den meisten Patienten gut akzeptiert. Einige Fragen sollten hinsichtlich der Verständlichkeit überprüft werden. Weitere Studien müssen zeigen, warum einige neu entdeckte Probleme keine Konsequenzen hatten, ob diese Probleme gebessert werden können und ob es nötig ist, diese Probleme zu ermitteln. / The study was designed to evaluate the acceptance of the self-rated version of the Standardized Assessment of Elderly People in primary care in Europe (STEP) by patients and general practitioners, as well as the feasibility, comprehensibility, and usefulness in gaining new information. In all, 1007 of 1540 patients aged 65 and above, from 28 different Saxon general practices took part. We recognized that 96% of the patients were able to fill in the questionnaire by themselves. It took them an average of approximately 20 minutes to do so. Further analysis of 257 randomly selected patients identified 281 previously unknown problems (1.1 per patient). In the practitioners’ opinion, 16% of these problems, particularly physiological and mental ones, could lead to immediate consequences. Remarkably, newly identified psychosocial problems were not followed by any consequences. Fourteen of the 75 questionnaire items were not answered by more than 9% of the participants. Eight of the 14 frequently unanswered items were marked as difficult to understand by the patients. Altogether the self-rating version of the STEP was found to be feasible and useful. It was well accepted among patients; however, some questions need further review to improve their comprehensibility. Furthermore, it should be investigated why some identified problems do not have consequences and whether there is a need to record these issues at all.