Resumo: Sentir-se saudável ou doente é uma condição subjetiva. Mensurar o grau ou o significado de uma enfermidade para um determinado indivíduo é, portanto, uma atividade complexa. A subjetividade inerente ao processo saúde-doença resulta em grande variação na identificação de diagnósticos clínicos e, nesse sentido, a utilização de instrumentos padronizados aumenta a concordância entre os profissionais de saúde. Aferir e validar a coerência e consistência de instrumentos utilizados para a avaliação clínica de idosos. Estudo epidemiológico do tipo transversal. A base de dados provém de uma pesquisa de 2002. Foram entrevistados em domicílio 353 idosos com os questionários: Atividades Básicas da Vida Diária (AVD), Atividades Instrumentais de Vida Diária (AIVD), Escala de Depressão Geriátrica (EDG), Mini Exame do Estado Mental (MEEM), Avaliação de Suporte Social do Medical Outcomes Study, Avaliação de Adesão Medicamentosa, Escala de Dependência de Nicotina, Escala de Avaliação de Problemas com Álcool (questionário CAGE) e uma Avaliação Sócio-econômica. Foram realizados cálculos da consistência interna das variáveis através do Coeficiente α de Cronbach e a técnica Split-Half nos instrumentos completos para avaliar reprodutibilidade. As escalas que podem ser utilizadas sem modificações ou ressalvas são: a AIVDs; o MEEM; o questionário CAGE e a Avaliação do Suporte Social do Medical Outcomes Study. A Escala de Atividades Básicas da Vida Diária (AVD) apresenta uma questão incoerente com o constructo. Quando esta é excluída das análises, ocorre melhora da coerência da escala. / Abstract: Feeling healthy or ill is a subjective condition. To measure the level or meaning of a disease is, therefore, a complex activity. The subjectivity inherent to the health-disease process results in a large variation in the identification of clinical diagnoses and, in this sense, the use of standardized instruments increases agreement among healthcare professionals. To analyze and validate the coherence and consistency of instruments used for clinical evaluation of elderly. This is a transversal-type epidemiological study. The database was obtained from a study conducted in 2002. Three hundred and fifty-three elderly individuals were inquired at home by trained interviewers using the following questionnaires: Daily-Life Basic Activities Scale (ADL), Daily-life Instrumental Activities (IADL), Geriatric Depression Scale, Mini Mental State Examination (MMSE), Social Support Survey from the Medical Outcomes Study (MOS), Medication adherence Evaluation, Nicotine Dependence Scale, Scale for Alcohol-Related Problems (the CAGE questionnaire) and a Socio-economic Evaluation. Calculations of the internal consistency of variables were performed by using the Cronbach's α Coefficient and the Split-Half technique for the complete instruments in order to evaluate reproducibility. The scales that can be used without modifications or restrictions are: the IADL; the MEEM; the Social Support Survey from the MOS; the CAGE questionnaire. The ADL has a question which was incoherent with the scale was observed. / Orientador: José Eduardo Corrente / Coorientador: Tania Ruiz / Banca: João de Castilho Cação / Banca: Beatriz Funayama Alvarenga Freire / Banca: Silvia Cristina Mangini Bocchi / Mestre

Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-22Bitstream added on 2014-06-13T18:59:10Z : No. of bitstreams: 1 colombininetto_m_me_botfm.pdf: 1740709 bytes, checksum: 6b4c4f018ca67eb9460bf6299709d4a3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Sentir-se saudável ou doente é uma condição subjetiva. Mensurar o grau ou o significado de uma enfermidade para um determinado indivíduo é, portanto, uma atividade complexa. A subjetividade inerente ao processo saúde-doença resulta em grande variação na identificação de diagnósticos clínicos e, nesse sentido, a utilização de instrumentos padronizados aumenta a concordância entre os profissionais de saúde. Aferir e validar a coerência e consistência de instrumentos utilizados para a avaliação clínica de idosos. Estudo epidemiológico do tipo transversal. A base de dados provém de uma pesquisa de 2002. Foram entrevistados em domicílio 353 idosos com os questionários: Atividades Básicas da Vida Diária (AVD), Atividades Instrumentais de Vida Diária (AIVD), Escala de Depressão Geriátrica (EDG), Mini Exame do Estado Mental (MEEM), Avaliação de Suporte Social do Medical Outcomes Study, Avaliação de Adesão Medicamentosa, Escala de Dependência de Nicotina, Escala de Avaliação de Problemas com Álcool (questionário CAGE) e uma Avaliação Sócio-econômica. Foram realizados cálculos da consistência interna das variáveis através do Coeficiente α de Cronbach e a técnica Split-Half nos instrumentos completos para avaliar reprodutibilidade. As escalas que podem ser utilizadas sem modificações ou ressalvas são: a AIVDs; o MEEM; o questionário CAGE e a Avaliação do Suporte Social do Medical Outcomes Study. A Escala de Atividades Básicas da Vida Diária (AVD) apresenta uma questão incoerente com o constructo. Quando esta é excluída das análises, ocorre melhora da coerência da escala. / Feeling healthy or ill is a subjective condition. To measure the level or meaning of a disease is, therefore, a complex activity. The subjectivity inherent to the health-disease process results in a large variation in the identification of clinical diagnoses and, in this sense, the use of standardized instruments increases agreement among healthcare professionals. To analyze and validate the coherence and consistency of instruments used for clinical evaluation of elderly. This is a transversal-type epidemiological study. The database was obtained from a study conducted in 2002. Three hundred and fifty-three elderly individuals were inquired at home by trained interviewers using the following questionnaires: Daily-Life Basic Activities Scale (ADL), Daily-life Instrumental Activities (IADL), Geriatric Depression Scale, Mini Mental State Examination (MMSE), Social Support Survey from the Medical Outcomes Study (MOS), Medication adherence Evaluation, Nicotine Dependence Scale, Scale for Alcohol-Related Problems (the CAGE questionnaire) and a Socio-economic Evaluation. Calculations of the internal consistency of variables were performed by using the Cronbach’s α Coefficient and the Split-Half technique for the complete instruments in order to evaluate reproducibility. The scales that can be used without modifications or restrictions are: the IADL; the MEEM; the Social Support Survey from the MOS; the CAGE questionnaire. The ADL has a question which was incoherent with the scale was observed.

Made available in DSpace on 2016-04-27T18:47:07Z (GMT). No. of bitstreams: 1 Monica Priscila Ribeiro.pdf: 349438 bytes, checksum: a17979035d105c63cfa49a32e4e7252c (MD5) Previous issue date: 2011-06-16 / In this work, the focus of the inquiry is come back toward (1) the configuration of Ample Geriatric Evaluation and the effect of its use in the scope of the Alive Program more good best age (a set of activities proposals for an operator of plans of health in the São Paulo city) e, also, for (2) the quarrel of the contribution of the nursing in the promotion of health of the aged one. The use of the Ample Geriatric Evalution , disgnostic instrument considered by Warren (1930), has been tied with the adoption of new a paradigm in the attention to the health of the aged one, in function of the instauration of a differentiated look - more full and humanized - to approach the health condition and to guide therapeutical come back toward the improvement of the quality of life of this age segment. A qualitative boarding of the data - gotten through the accomplishment of interviews half-structuralized with participant citizens of the related Program associates to the notations, made for me (observing participant) of the accompaniment of the same ones -, was taken as one of the ways (beyond the quarrel properly theoretician) to make possible the commitment of inquiry with the object of this study. One notices that I gave priority when saying of the aged ones. I clarify, still, that the directed reflection took as reference theoretician-methodological the works of Canguilhem (1966), Beauvoir (1970), Geertz (1989) e Bogdan (1994). In the first chapter, I explore the concepts of health and illness and the way as such reflection (directed in the Medicine) has produced effect in the field of the Gerontology. I looked for to make to be valid the beddings of this field (that if distance of an exclusively biological vision of the aging and the oldness) to problematize the subjective-social condition of the aged ones submitted to the Ample Geriatric Evaluation. In as the chapter, what it is in cause is the joint of the team to multidiscipline required for the accomplishment of ample the geriatric evaluation - with prominence for the contribution of the nursing. What it was intended was, from a critical reading of representative authors of this field, to designate its necessary opening to the beddings that underpin the reflection directed in the gerontological studies. Finally, in the third chapter, I offer an interpretation of the data collected in the field research. The results of this enterprise had indicated that she is necessary to place in relief, in the specific formation required the nurse, a resizing of the health notion that includes the opening of listening for the complex demands restored in the practical one of care with the aged one. This creates the requirement of installation of the paradigm to interdisciplinary in the area of the health, what it implies, of my point of view, to take the aged one as protagonist of changes so that to live the oldness well it is possibility each time next to the reality (in such a way of the social point of view, as subjective). I wait that the debate carried through here contributes the reflection and awareness of the multiprofessional team of health on ample the geriatric evaluation and its function of disgnostic complementation, with emphasis in the education in health / Neste trabalho, o foco da investigação está voltado para (1) a configuração da Avaliação Geriátrica Ampla (AGA) e os efeitos da sua utilização no âmbito do Programa Viva melhor a melhor idade (um conjunto de atividades propostas por uma operadora de planos de saúde na cidade São Paulo) e, também, para (2) a discussão da contribuição da enfermagem na promoção de saúde do idoso. A utilização da AGA, instrumento diagnóstico proposto por Warren (1930), tem sido vinculada à adoção de um novo paradigma na atenção à saúde do idoso, em função da instauração de um olhar diferenciado - mais integral e humanizado para abordar a condição de saúde e orientar terapêuticas voltadas para a melhoria da qualidade de vida desse segmento etário. Uma abordagem qualitativa dos dados - obtidos através da realização de entrevistas semi-estruturadas com sujeitos participantes do referido Programa associadas às anotações, feitas por mim (observadora participante) do acompanhamento dos mesmos -, foi tomada como um dos meios (além da discussão propriamente teórica) para viabilizar o compromisso de investigação com o objeto deste estudo. Note-se que dei prioridade ao dizer dos idosos. Esclareço, ainda, que a reflexão encaminhada tomou como referencial teórico-metodológico os trabalhos de Canguilhem (1966), Beauvoir (1970), Geertz (1989) e Bogdan (1994). No primeiro capítulo, exploro os conceitos de saúde e doença e o modo como tal reflexão (encaminhada na Medicina) tem produzido efeitos no campo da Gerontologia. Procurei fazer valer os fundamentos deste campo (que se distancia de uma visão exclusivamente biológica do envelhecimento e da velhice) para problematizar a condição subjetivo-social dos idosos submetidos à AGA. No segundo capítulo, o que está em causa é a articulação da equipe multidisciplinar requerida para a realização da avaliação geriátrica ampla - com destaque para a contribuição da enfermagem. O que se pretendeu foi, a partir de uma leitura crítica de autores representativos desse campo, assinalar sua necessária abertura aos fundamentos que alicerçam a reflexão encaminhada nos estudos gerontológicos. Finalmente, no terceiro capítulo, ofereço uma interpretação dos dados coletados na pesquisa de campo. Os resultados desse empreendimento indicaram que é preciso colocar em relevo, na formação específica requerida ao enfermeiro, um redimensionamento da noção de saúde que inclua a abertura da escuta para as complexas demandas instauradas na prática de cuidado com o idoso. Isso cria a exigência de assunção do paradigma interdisciplinar na área da saúde, o que implica, do meu ponto de vista, tomar o idoso como protagonista de mudanças para que viver bem a velhice seja possibilidade cada vez mais próxima da realidade (tanto do ponto de vista social, como subjetivo). Espero que o debate aqui realizado contribua a reflexão e conscientização da equipe multiprofissional de saúde sobre a avaliação geriátrica ampla e a sua função de complementação diagnóstica, com ênfase na educação em saúde

Le vieillissement observé dans la population est souvent responsable de déficits amenant une perte d’autonomie, et une situation de handicap plus ou moins importante. Ces difficultés n’ont pas toujours de possibilités thérapeutiques (i.e. médicamenteuses ou chirurgicales). En revanche, il faut pouvoir soigner, diminuer ou neutraliser ces symptômes. Les technologies numériques semblent pouvoir jouer un rôle sur certaines manifestations du vieillissement en aidant, en assistant, en stimulant, en rééduquant, et, in fine, fournir davantage de qualité de vie et d’autonomie.Cependant, cette nouvelle opportunité a du mal à trouver sa place auprès des seniors, pour des raisons aussi diverses que complexes. En effet, la mise en place, l’organisation, l’évaluation, l’acceptation, le diagnostic, etc. sont autant d’obstacles à l’intégration des technologies. Toutefois, on remarque que le frein le plus important semble être la conception de ces technologies elles-mêmes. Effectivement, pour concevoir, les professionnels doivent avoir de multiples compétences et savoir analyser les besoins, poser des diagnostics compliqués avec des tableaux cliniques et environnementaux multiples (i.e. polypathologie, polyhandicap, évaluation de l’environnement, etc.), pour fournir l’ensemble des solutions ergonomiques, techniques et technologiques possibles. Pour autant, les profils orientés conception (i.e. informaticiens, ingénieurs, architectes, etc.) auxquels appartiennent, au final, la conception et la fabrication des technologies, ont peu de compétences d’évaluation globale et multidimensionnelle d’un sujet en perte d’autonomie et de son environnement.Cette thèse a pour objectif d’apporter un outil informatique capable d’être une aide concrète pour les professionnels de la santé, de la réinsertion et de la conception, en leur proposant une méthodologie d’analyse des déficits sous forme d’un profil précis des potentiels, des freins, et de l’environnement. Pour cela, notre travail tient compte de la pluridisciplinarité des professionnels, et de la complexité de l’évaluation gériatrique.Notre démarche est basée sur un outil informatique ayant plusieurs avantages : d’une part, donner une check-list afin d’être au maximum exhaustif dans l’évaluation des déficits liés à l’âge et ainsi éviter les erreurs ou les oublis lors de l’évaluation. D’autre part, permettre une standardisation par l’administration de tests précis, et ainsi donner un profil à la fois quantitatif et qualitatif de la personne et de son environnement. Enfin, notre méthodologie fournit également une évaluation des systèmes technologiques destinés aux seniors. Notre système, baptisé DAD « Design for Adapted Device » est conçu selon un modèle de conception centré utilisateurs. Nous avons consulté en préconception nos utilisateurs primaires (i.e. sujets âgés), et nous avons relevé dans notre état de l’art les tests d’évaluation de références. Ensuite, nous avons mis au point plusieurs prototypes que nous avons testés auprès de nos utilisateurs secondaires (i.e. professionnels du diagnostic). Enfin, nous avons conçu notre logiciel dans sa version finale, et nous avons soumis des professionnels de la gérontologie (i.e. des professionnels médico-sociaux et des profils orienté conception) à des tests face à des patients. Les résultats issus de nos tests sont très encourageants et suggèrent que notre outil est fidèle et valide.L’outil devrait sensibiliser, inciter et guider les différents producteurs de technologies (i.e. industriel, designer, informaticien ingénieur, etc.), ainsi que les acteurs de santé (i.e. médecin, infirmier, kinésithérapeute, ergothérapeute, psychologue, etc.) à intégrer les personnes âgées dans leur prise en charge, dans leurs décisions, ou dans les différents projets qu’ils envisagent de mettre en place (e.g. conception, prescription, suivi, etc.). / The observed aging of the population is often responsible of deficits causing a loss of autonomy & handicap situation which turns to be more and more important. The encountered difficulties do not always have therapeutic alternatives (i.e. neither through drugs nor surgery). However, having the symptoms treated, reduced or neutralized is a must. The digital technologies seem capable to play a role on aging consequences, on quality of life & autonomy helping, assisting, stimulating, reeducating elderly population.Nevertheless, the digital opportunity does not seem to have success among elderly people for many different & complex reasons. Fair to underline that challenges are faced while trying to integrate these technologies : set up, organization, assessment, acceptance, diagnosis etc. The biggest challenge though remains the design of the technology itself. In fact, professionals need to have multiple competences and know how to analyze requirements, diagnose through multiple clinical & environment situations (multiple pathologies, multiple disabilities, environment assessment, etc.) in order to propose exhaustive ergonomic, technical & technological solutions. Having this said, the profiles who are design oriented (e.g. IT, engineers, architects, etc.) and who own the design & build of the technologies have limited capacities in global, multidimensional assessment on autonomy loss & its environment.Our thesis aims at proposing a digital device able to help concretely professionals specialized in healthcare, reintegration, and design while providing a methodology to analyze deficits through precise profiling of environment, potentials and constraints. That is the reason why, our work considers professionals’ multidisciplinary, geriatrics complex assessment.Our approach consists on an IT device with has multiple advantages: a check list in order to evaluate deficiencies linked to aging and prevent mistakes or omissions during the assessment ;a standardization through precise testing ;a definition of a qualitative & quantitative profile of the person and the environment ;a strong assessment of the digital technologies focusing on elderly population.Our tool, named DAD « Design for Adapted Device » was designed according to a model focusing on users. At the very first step of the design, primary users (i.e. elderly patients) were consulted and in the conceptual framework, we picked the gold standards. Then, we launched several prototypes which were subjects to testing by our secondary users (i.e. diagnosis professionals). Last but not least, we designed the final version of our tool and we had gerontology professionals (medico-social professionals & design oriented profiles) going through tests in front of patients. Our testing results looked encouraging and suggest that our tool is reliable and valid.The tool should sensitive, encourage and guide the digital actors (such as industrials, designers, IT engineers, etc.) as well as health professionals (such as doctors, nurses, physiotherapists, ergotherapists, psychologists, etc.) to strongly consider elderly patients in their therapeutic approaches, in their decision making or in their different to-be projects (e.g. design, prescription and follow up, etc.).