Diante da necessidade de mudança do paradigma do sistema de saúde e uma maior coerência entre o serviço ofertado e as condições de saúde da população, vários países tem buscado a reconfiguração de seus sistemas e/ou novos modelos de organização da gestão. No Brasil, vem sendo instituídas as Redes de Atenção à Saúde (RAS) e como referencial teórico operacional de gestão nesta nova organização se destacam a Gestão da Clínica e a Clínica Ampliada. A Continuidade do Cuidado é um dos elementos principais desse novo paradigma, assim, novos modelos assistenciais surgem em resposta. Os Cuidados Continuados Integrados (CCI) é uma experiência internacional exitosa, de um novo modelo assistencial que se situa nos desenhos de atenção entre o hospital geral e a atenção primária. Está sendo implantado no Brasil, aonde assume a denominação de Cuidados Prolongados e se insere na Rede de Atenção às Urgências e Emergências. OBJETIVO: O presente trabalho tem por objetivo estudar a Unidade de Cuidados Prolongados (UCP), como uma estratégia de atenção no Sistema Único de Saúde (SUS), identificando o processo de trabalho de unidades de um projeto piloto, sob as referências da Gestão da Clínica e da Clínica Ampliada. MÉTODOS: Trata-se de estudo transversal, qualitativo quanto a abordagem, descritivo e exploratório quanto aos objetivos. O trabalho foi elaborado em três etapas complementares, sendo observação (etapa 1), análise de documentos (etapa 2) e aplicação de questionário estruturado composto de 82 assertivas, dividido em 6 blocos temáticos (trabalho em equipe, fluxo do usuário, prática clínica, estrutura / ambiente / materiais, gestão da qualidade e satisfação profissional). O instrumento foi aplicado aos trabalhadores da UCP de dois municípios do Estado de São Paulo (passo 3), que concordaram em participar da pesquisa (N de 26 participantes, 13 de cada unidade em estudo). A análise de dados foi realizada para compreender a organização do fluxo de trabalho e a percepção de trabalhadores e funcionários sobre a instituição, o processo e sua satisfação. A análise das respostas foi realizada calculando a escala média (RM) para a escala de Likert, medindo o grau de concordância dos participantes, em relação ao assertivo. Atribuiuse um valor de 1 (total discordância) a 5 (total concordância) correlacionando as variáveis estudadas intra e interunidades, buscando significação nas variações. RESULTADOS E DISCUSSÃO: foram identificados o desenho assistencial desenvolvido por ambas unidades, desde o referenciamento do usuário de acordo com o modelo de atenção estudado, até seu contra-referenciamento para a atenção básica, além do processo de trabalho e organização da equipe. Através da aplicação do questionário, identificou-se que os profissionais têm a tendencia à satisfação em ii relação aos 6 blocos temáticos (3,1 a 4,3), entretanto com variações significativas em assertivas individuais, em todos os blocos. CONCLUSÃO: O modelo de atenção estudado apresenta evidências de resultados positivos que estão em alinhamento com a literatura estudada, apresentando um design funcional dentro dos princípios do SUS. A articulação deste modelo na RAS ainda é um ponto a ser melhorado. De acordo com as percepções dos profissionais que compõem o trabalho em equipe, devem ser alcançadas melhorias em todos os tópicos estudados, a fim de preencher toda a operação com as propostas de gestão clínica e a clínica ampliada. / Several countries have sought the reconfiguration of their systems and/or new management organization models when faced with the need to change the paradigm of the health system and greater coherence between the delivered services and the health conditions of the population. In Brazil, the establishing of Health Care Networks (RAS) are in course. Clinical Management and the Extended Clinic are the highlights of the theoretical concepts for the operational management of this new arrangement. Continuity of Care is one of the main elements of this new paradigm, so innovative care models emerge in response. Integrated Continuing Care (CCI) is a successful international experience of a novel care model located in the design of care between the general hospital and primary care. It has been implemented in Brazil, denominated by the name of Extended Care and it is part of the Care Network for Urgencies and Emergencies. OBJECTIVE: The aim of this work is to study the Extended Care Unit (UCP), as a care strategy in the Unified Healthcare System (SUS), identifying the workflow of pilot UCP healthcare units, under the references of Clinical Management and Extended Clinic. METHODS: This is a cross-sectional study, with qualitative approach, descriptive and exploratory regarding the objectives. The work was elaborated in three complementary stages, being observation (step 1), analysis of documents (step 2) and application of structured questionnaire composed of 82 assertions, divided into 6 thematic blocks (teamwork, users\' flow, clinical practice, structure / environment / materials, quality management and professional satisfaction). The instrument was applied to UCP workers of two municipalities of the State of São Paulo (step 3), which have agreed to participate of the research (N of 26 participants, 13 of each unit under study). The data analysis was performed in order to understand the organization of the workflow and the perception of workers and staff about the institution, the process, and their satisfaction. Analysis of the responses was performed by calculating the Mean Ranking (RM) for Likert scale, measuring the degree of agreement of the participants, in relation to the assertive. It was assigned values of 1 (total disagreement) to 5 (total concordance) correlating the intra and inter-unit variables studied, seeking significance in the variations. RESULTS AND DISCUSSION: The design of patient assistance carried out by both units were identified, from user referral according to the model of care studied, until their counter-referral for primary care, as well as the workflow process and the team organization. Based on the application of the questionnaire, it was identified that professionals have the tendency to satisfaction in relation to the 6 thematic blocks (3,1 to 4,3), however with significant variations in individual assertives, in each block. iv CONCLUSION: The care model studied presents evidence of positive outcomes that are in alignement with the literature studied, presenting a functional design inside the SUS principles. The articulation of this model in RAS is still a point to be improved. According to the perceptions of the professionals that compose the teamwork, improvements must be achieved in every topic studied, in order to fill the whole operation with the proposals of the clinical management and the extended clinic.

International retirement migration (IRM) and its related fields of expatriate residency (expats), residential tourism, long-term tourism and international second homes are rapidly growing and changing. From its early modern beginnings when Northern Europeans moved to Spanish beaches in the 1950’s, geographic distribution has now expanded to include Mexico and the emerging IRM markets of Central and South America as well as Southeast Asia. A combination of many factors will contribute to the growth of IRM in the future with retiring baby boomers being the primary reason. Though the vast majority are of persons older, IRM is a misnomer for this topic as non-retired younger generations are also moving to these destinations, as they are increasingly able to work from virtually anywhere, due to the Internet economy and other trends associated with ever-increasing globalization. IRM in Udon Thani, Thailand consists almost exclusively of retired Western men marrying local women who are almost always much younger. Almost all the men first spend time in the sex tourism haven of Pattaya, Thailand before moving to the interior Northeastern city of Udon Thani at or near where their wives are from. Thus, there are many linkages and commonalities between the expatriate residents in Pattaya and Udon Thani. Without proper planning, Udon Thani will continue to adopt many of the undesirable attributes of Pattaya such as beer bars and sex tourism which are already present and growing rapidly. This practicum focuses on IRM and expats in the city of Udon Thani, Thailand and examines impacts on the host community. The practicum also tries to develop general models of IRM in different communities in developing nations and recommend planning guidelines to help deal with this phenomenon. The research methods employed included: a review of the literature, key informant interviews, informal exploratory interviews with locals and the IRM population as well as observations. Outside of planning research conducted in Spain, no IRM or expatriate research has examined planning issues in detail. This practicum attempts to establish or contribute to a body of work to aide in future work on this topic. The primary planning issues in Udon Thani were found to be: sprawling residential growth, economic development, gender issues and integration of IRM and expat populations into the local communities. IRM shares many commonalities in all its global locations. However, planning for IRM in Udon Thani and possibly other Southeast Asian communities is unique due to the homogenous makeup of male retirees who bring with them a host of Western cultural values and problems related to bars and sex tourism. It has been found that planning for IRM shares commonalities with planning for amenity migration in North American mountain communities. There are many types of IRM communities. For example, beach communities may have a population that is more seasonal and has less attachment to host communities, while interior cities such as San Miguel and Lake Chapala, Mexico as well as Udon Thani may have more permanent year-round populations. Planning issues surrounding care-giving and marriage are also examined as medical care will be a future catalyst for many of these communities. / May 2008

International retirement migration (IRM) and its related fields of expatriate residency (expats), residential tourism, long-term tourism and international second homes are rapidly growing and changing. From its early modern beginnings when Northern Europeans moved to Spanish beaches in the 1950’s, geographic distribution has now expanded to include Mexico and the emerging IRM markets of Central and South America as well as Southeast Asia. A combination of many factors will contribute to the growth of IRM in the future with retiring baby boomers being the primary reason. Though the vast majority are of persons older, IRM is a misnomer for this topic as non-retired younger generations are also moving to these destinations, as they are increasingly able to work from virtually anywhere, due to the Internet economy and other trends associated with ever-increasing globalization. IRM in Udon Thani, Thailand consists almost exclusively of retired Western men marrying local women who are almost always much younger. Almost all the men first spend time in the sex tourism haven of Pattaya, Thailand before moving to the interior Northeastern city of Udon Thani at or near where their wives are from. Thus, there are many linkages and commonalities between the expatriate residents in Pattaya and Udon Thani. Without proper planning, Udon Thani will continue to adopt many of the undesirable attributes of Pattaya such as beer bars and sex tourism which are already present and growing rapidly. This practicum focuses on IRM and expats in the city of Udon Thani, Thailand and examines impacts on the host community. The practicum also tries to develop general models of IRM in different communities in developing nations and recommend planning guidelines to help deal with this phenomenon. The research methods employed included: a review of the literature, key informant interviews, informal exploratory interviews with locals and the IRM population as well as observations. Outside of planning research conducted in Spain, no IRM or expatriate research has examined planning issues in detail. This practicum attempts to establish or contribute to a body of work to aide in future work on this topic. The primary planning issues in Udon Thani were found to be: sprawling residential growth, economic development, gender issues and integration of IRM and expat populations into the local communities. IRM shares many commonalities in all its global locations. However, planning for IRM in Udon Thani and possibly other Southeast Asian communities is unique due to the homogenous makeup of male retirees who bring with them a host of Western cultural values and problems related to bars and sex tourism. It has been found that planning for IRM shares commonalities with planning for amenity migration in North American mountain communities. There are many types of IRM communities. For example, beach communities may have a population that is more seasonal and has less attachment to host communities, while interior cities such as San Miguel and Lake Chapala, Mexico as well as Udon Thani may have more permanent year-round populations. Planning issues surrounding care-giving and marriage are also examined as medical care will be a future catalyst for many of these communities.

International retirement migration (IRM) and its related fields of expatriate residency (expats), residential tourism, long-term tourism and international second homes are rapidly growing and changing. From its early modern beginnings when Northern Europeans moved to Spanish beaches in the 1950’s, geographic distribution has now expanded to include Mexico and the emerging IRM markets of Central and South America as well as Southeast Asia. A combination of many factors will contribute to the growth of IRM in the future with retiring baby boomers being the primary reason. Though the vast majority are of persons older, IRM is a misnomer for this topic as non-retired younger generations are also moving to these destinations, as they are increasingly able to work from virtually anywhere, due to the Internet economy and other trends associated with ever-increasing globalization. IRM in Udon Thani, Thailand consists almost exclusively of retired Western men marrying local women who are almost always much younger. Almost all the men first spend time in the sex tourism haven of Pattaya, Thailand before moving to the interior Northeastern city of Udon Thani at or near where their wives are from. Thus, there are many linkages and commonalities between the expatriate residents in Pattaya and Udon Thani. Without proper planning, Udon Thani will continue to adopt many of the undesirable attributes of Pattaya such as beer bars and sex tourism which are already present and growing rapidly. This practicum focuses on IRM and expats in the city of Udon Thani, Thailand and examines impacts on the host community. The practicum also tries to develop general models of IRM in different communities in developing nations and recommend planning guidelines to help deal with this phenomenon. The research methods employed included: a review of the literature, key informant interviews, informal exploratory interviews with locals and the IRM population as well as observations. Outside of planning research conducted in Spain, no IRM or expatriate research has examined planning issues in detail. This practicum attempts to establish or contribute to a body of work to aide in future work on this topic. The primary planning issues in Udon Thani were found to be: sprawling residential growth, economic development, gender issues and integration of IRM and expat populations into the local communities. IRM shares many commonalities in all its global locations. However, planning for IRM in Udon Thani and possibly other Southeast Asian communities is unique due to the homogenous makeup of male retirees who bring with them a host of Western cultural values and problems related to bars and sex tourism. It has been found that planning for IRM shares commonalities with planning for amenity migration in North American mountain communities. There are many types of IRM communities. For example, beach communities may have a population that is more seasonal and has less attachment to host communities, while interior cities such as San Miguel and Lake Chapala, Mexico as well as Udon Thani may have more permanent year-round populations. Planning issues surrounding care-giving and marriage are also examined as medical care will be a future catalyst for many of these communities.

Com a atual transição demográfica refletida no envelhecimento populacional, as doenças crônicas transmissíveis foram substituídas pelas doenças crônicas não transmissíveis (DCNT), que ocasionam implicações no processo do envelhecimento saudável, para o idoso e para as famílias, havendo a necessidade da procura por Instituições de Longa Permanência para Idosos (ILPI). Nesse contexto, o objetivo desse trabalho foi descrever o perfil de saúde de idosos residentes em instituições de longa permanência públicas do município de Bauru/SP, possibilitando o tratamento e monitoramento para melhor qualidade de vida dessa população. Trata-se de um estudo transversal descritivo analítico, realizado entre os anos 2015 e 2017, com amostra constituída por 146 idosos residentes das duas únicas ILPI públicas do município de Bauru/Sp. Foram realizados exames de hemograma, glicemia de jejum, e perfil lipídico para avaliar respectivamente anemia, diabetes e dislipidemia nessa população. Foram utilizados dados sóciodemográficos dos prontuários médicos dos residentes e utilizado o IMC dos idosos para avaliação nutricional. Os resultados obtidos destacam que 72 (49%) idosos eram do sexo masculino e 74 (51%) do sexo feminino, com prevalência de indivíduos com idade entre 60 e 69 anos (40%) com pele branca (68,5%). Quanto ao hemograma, 33 (22,6%) idosos estavam com valores indicativos de anemia, 54 (37%) resultados abaixo do aceitável de HDL-colesterol, 44 (30,1%) idosos com resultados elevados de LDL-colesterol, característicos de dislipidemias. 77% dos idosos apresentaram peso normal, indicando boa condição nutricional. As mulheres foram as mais acometidas (17,6%) pelo baixo peso na faixa etária entre 60 e 69 anos em associação com os casos de anemia. Concluímos que as condições de saúde da maioria dos idosos residentes em ILPI públicas no município de Bauru foram consideradas de boa qualidade frente aos desafios diários, fragilidades individuais e a complexidade de fatores envolvidos nesta avaliação. A prática de exercícios físicos para o controle das dislipidemias é de extrema importância durante o envelhecimento, porém nas instituições os exercícios são realizados com moderação respeitando as individualidades. Ressalta-se a importância dos cuidados multiprofissionais adequados e aos exames de sangue periódicos para que haja integração do conhecimento sobre o perfil de saúde e monitoramento das doenças crônicas, promovendo a melhor qualidade de vida dos idosos, especialmente os institucionalizados. / With the current demographic transition reflected in population aging, chronic communicable diseases have been replaced by chronic noncommunicable diseases (NCDs), which have implications for the aging process for the elderly and for families. Long Stay for the Elderly people (ILPI). In this context, the objective of this study was to describe the health profile of elderly people living in long-term public institutions in the city of Bauru/SP, allowing treatment and monitoring to improve the quality of life of this population. This is a descriptive cross-sectional analytical study, carried out between 2015 and 2017, with a sample of 146 elderly residents of the only two public ILPI in the city of Bauru/SP. Hemogram, fasting glycemia, and lipid profile tests were performed to assess anemia, diabetes and dyslipidemia in this population, respectively. Data from medical records and BMI of the elderly were used for nutritional evaluation. The results showed that 72 (49%) of the elderly were male and 74 (51%) were female, with a prevalence of individuals aged between 60 and 69 years (40%) and white skin (68.5%). Regarding the CBC, 33 (22.6%) elderly patients had values indicative of anemia, 54 (37%) below-acceptable HDL-cholesterol, 44 (30.1%) elderly patients with high LDL-cholesterol Of dyslipidemias. 77% of the elderly presented normal weight, indicating an excellent nutritional condition. The women were the most affected (17.6%) due to the low weight in the age group between 60 and 69 years, all of them being associated with anemia. We conclude that the health conditions of the majority of the elderly people living in public ILPI in the city of Bauru were considered of good quality in face of daily challenges, individual fragilities and the complexity of factors involved in this evaluation. The practice of physical exercises for the control of dyslipidemias is extremely important during aging, but in institutions the exercises are performed with moderation respecting the individualities. The importance of appropriate multiprofessional care and periodic blood exams is important in order to integrate knowledge about the health profile and monitoring of chronic diseases, promoting the better quality of life of the elderly, especially the institutionalized ones.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2018-09-25T13:58:39Z No. of bitstreams: 1 jamilivargascontemontenario.pdf: 3694016 bytes, checksum: c2ab9df9a09c4165163ab293c2d693c7 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-10-16T12:12:35Z (GMT) No. of bitstreams: 1 jamilivargascontemontenario.pdf: 3694016 bytes, checksum: c2ab9df9a09c4165163ab293c2d693c7 (MD5) / Made available in DSpace on 2018-10-16T12:12:36Z (GMT). No. of bitstreams: 1 jamilivargascontemontenario.pdf: 3694016 bytes, checksum: c2ab9df9a09c4165163ab293c2d693c7 (MD5) Previous issue date: 2018-08-13 / Trata-se de um estudo descritivo de abordagem quantitativa realizado em uma Instituição de Longa Permanência para Idosos do município de Juiz de Fora, Minas Gerais. Apresenta como objetivos: analisar a prevalência de quedas; descrever o perfil sócio demográfico dos idosos e analisar as associações entre as variáveis independentes relacionadas às quedas. A coleta dos dados aconteceu no período de 28 de dezembro de 2017 a 15 de fevereiro de 2018. Utilizado questionário elaborado a partir das variáveis apontadas como risco para queda conforme o Protocolo de Quedas do Ministério da Saúde e aplicação da escala de quedas, validada no país, Morse Fall Scale –MRS. Participaram da pesquisa 48 idosos, 43,8% do sexo feminino e 56,2% do sexo masculino, com média de idade de 76,2 anos (DP=7,2). Foi elaborado um banco de dados por meio do Software Statistic Package Social Survey (SPSS), versão 15.0. Realizou-se análise descritiva em que foram observadas as frequências absolutas e relativas das variáveis, bem como a média e o desvio padrão. Para a análise bivariada realizou-se o cálculo da razão de prevalência (RP) com a utilização do teste qui-quadrado (intervalo de confiança de 95%). Efetuada análise múltipla pela Regressão de Poisson, sendo incluídas todas as variáveis que apresentaram associações com p-valor < 0,20. Os resultados evidenciaram que a prevalência geral de quedas foi de 39,6%; 54,2% apresentaram risco de moderado a alto risco para quedas. Estiveram associadas à ocorrência das quedas no último ano as variáveis: tontura (RP=8,306; p=0,002), síncope (RP=6,231; p=0,045), dor intensa (RP= 4,320; p=0,025), incontinência ou urgência miccional (RP= 4,815; p=0,018), osteoporose (RP= 5,769; p=0,033), classificação da visão (RP=4,582; p=0,015), depressão (RP=5,271; p=0,013) e a ansiedade (RP=5,333 p=0,013). Na análise multivariada a depressão (RP = 14,755, IC95% 2,543-85,621; p=0,003) e a síncope (RP = 8,055; IC95% = 1,011-64,144; p=0,049) mantiveram-se associadas independente do sexo e da idade. Concluiu-se que os resultados alcançados neste estudo se aproximam ao que é descrito na literatura e reforçam a necessidade de um gerenciamento contínuo do cuidado geriátrico e gerontológico no que tange a avaliação do risco e a prevenção das quedas entre os idosos institucionalizados. / This is a descriptive study of a quantitative approach carried out in a Long Stay Institution for the Elderly in the city of Juiz de Fora, Minas Gerais. It presents as objectives: to analyze the prevalence of falls; to describe the socio-demographic profile of the elderly and to analyze the associations between the independent variables related to falls. The data collection was carried out from December 28, 2017 to February 15, 2018. A questionnaire elaborated using the variables considered as risk for falls according to the Protocol of Falls of the Ministry of Health and application of the scale of falls, validated in the country, Morse Fall Scale -MRS. Thirty-eight elderly, 43.8% female and 56.2% male, with a mean age of 76.2 years (SD = 7.2) participated in the study. A database was elaborated through Software Statistic Package Social Survey (SPSS), version 15.0. A descriptive analysis was performed in which the absolute and relative frequencies of the variables were observed, as well as the mean and the standard deviation. For the bivariate analysis, the prevalence ratio (PR) was calculated using the chi-square test (95% confidence interval). Multiple analysis was performed by Poisson regression, and all variables that presented associations with p-value <0.20 were included. The results showed that the general prevalence of falls was 39.6%; 54.2% presented moderate to high risk for falls. The following variables were associated with the occurrence of falls in the last year: dizziness (PR = 8.306, p = 0.002), syncope (PR = 6.231, p = 0.045), intense pain (PR = 4,320, p = 0,025), urinary incontinence or urgency (RP = 4.855, p = 0.018), osteoporosis (RP = 5.769, p = 0.033), vision rating (RP = 4.582, p = 0.015), depression 5,333 p = 0.013). In the multivariate analysis, depression (RP = 14,755, 95% CI 2.543-85.621, p = 0.003) and syncope (RP = 8,558, 95% CI = 1,011-64,144, p = 0.049) remained independent of gender and age. It was concluded that the results achieved in this study are close to what is described in the literature and reinforce the need for a continuous management of geriatric and gerontological care in relation to risk assessment and prevention of falls among institutionalized elderly.

Made available in DSpace on 2014-12-17T14:23:31Z (GMT). No. of bitstreams: 1 CristianeADA_DISSERT.pdf: 5621618 bytes, checksum: feb61d4327573fb26291a997347a2647 (MD5) Previous issue date: 2013-02-22 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The aging population and individual have been the subject of a multitude of studies nowadays. This is probably due to the impact of this phenomenon in various sectors of society, like social security, social assistance and public health. The process of aging of the individual imply the demand for specific services, considering the limitations and vulnerabilities of the individual at that stage of life cycle. The growth of the elderly contingent in the last decades raises challenges for policymakers, the family and also for the society at large. In this scenario, long-stay institutions for the elderly (LSIEs) appear as an option to aid and support the elderly and their family, assisting in all or part in the activities of daily living and self-care. Inside these LSIEs we find the professional responsible for the direct care of the elderly, the formal caregiver. In this context, this dissertation presents two main objectives: an analysis of the phenomenon of population aging in a given brazilian municipality Natal / RN, based on the Demographic Censuses of 2000 e 2010; and a social, demographic and economic characterization of the Formal caregiver for the institutionalized elderly in the municipality, evaluating aspects of his quality of life and also analyzing the institutions where they are inserted. Furthermore, we intend to identify demographic, socioeconomic and quality of life factors that are correlated with caregivers quitting the job. The data used in the second part of this work comes from the research project named Long-Stay Institutions for Elderly: abandonment or a family need? . This survey interviewed 92 caregivers in eleven LSIEs in Natal/RN. In the data treatment logistic regressions, cluster analysis and statistical tests were used. The survey revealed that aging in Natal is more pronounced in the older, more traditional districts: Petr?polis, Lagoa Seca and Tirol. It also allowed a broad characterization of the formal caregivers in LSIEs. Most of these professionals are female. The educational level is predominantly complete high school and more. Most caregivers reported being married or in union, or have ever been in a union. Family monthly income is under three times the minimum wage. The mean age is of 37.4 years. The mean time of work as a caregiver was 5.93 years. The associations showed that being woman, not being single, having caregiving training and physical limitations (regarding quality of life) are related to wanting to quit the caregiving job. As for the characterization of the LSIEs, it was found that the philanthropic ones are older and have most (62.5%) of the institutionalized elderly. The institutions managers gave social interaction and affinity with the elderly as the main criteria with which to evaluate and hire caregivers. It is intended with this study to contribute to improving the quality of life of the elderly and their caregiver, providing information on aspects of institutionalization of elderly both in the philanthropic and particular institutions, in Natal/RN; this dissertation may also be used as a starting point for later works / O envelhecimento populacional e individual tem sido objeto de diversos estudos na atualidade. Isso se deve, provavelmente, ao impacto desse fen?meno em diversos setores da sociedade, principalmente nos de previd?ncia social, assist?ncia social e sa?de p?blica. O envelhecimento do indiv?duo, na figura do idoso, demanda servi?os espec?ficos, tendo em vista as limita??es e vulnerabilidades do indiv?duo nessa fase da vida humana. O crescimento desse contingente nas ?ltimas d?cadas traz desafios para os gestores, para a fam?lia e para a sociedade. Nesse cen?rio, as institui??es de longa perman?ncia para idosos (ILPI) surgem como uma op??o de aux?lio e amparo ao idoso e a sua fam?lia, com a presta??o de assist?ncia integral ou parcial nas atividades de vida di?ria e no autocuidado. No ambiente dessas ILPIs se encontra o profissional respons?vel pelo cuidado direto ao idoso, o cuidador formal de idosos. Diante de tal contexto, a disserta??o apresenta dois grandes enfoques: uma an?lise do fen?meno do envelhecimento populacional num determinado munic?pio brasileiro &#8210; Natal/RN, &#8210; com base nos Censos Demogr?ficos de 2000 e 2010, e uma caracteriza??o social, demogr?fica e econ?mica do cuidador formal de idosos institucionalizado do munic?pio, avaliando os aspectos de sua qualidade de vida, e tamb?m, analisando as institui??es onde est?o inseridos. Ademais, pretende-se identificar os fatores socioecon?micos e demogr?ficos, e os ligados ? qualidade de vida que levam os cuidadores a deixar essa ocupa??o. Os dados utilizados na segunda parte deste trabalho prov?m do projeto de pesquisa intitulado Institui??es de longa perman?ncia para idosos: abandono ou. uma necessidade familiar? . A pesquisa envolveu 92 cuidadores formais, distribu?dos em onze ILPIs localizadas em Natal/RN. No tratamento dos dados, foram utilizadas Regress?es Log?sticas, An?lise de Agrupamento e Testes Estat?sticos. A pesquisa permitiu constatar que o envelhecimento no munic?pio de Natal ? maior nos bairros mais antigos e tradicionais: Petr?polis, Lagoa Seca e Tirol. Permitiu tamb?m uma ampla caracteriza??o dos cuidadores formais lotados nas ILPIs. A maioria ? do sexo feminino. A escolaridade predominante ? ensino m?dio completo e mais. A maior parte dos cuidadores declararam estar casados/unidos ou alguma vez unidos. A renda familiar mensal ? inferior a tr?s sal?rios. Quanto ? idade, em m?dia, ? de 37,4 anos. O tempo m?dio de exerc?cio da fun??o de cuidador ? de 5,93 anos. As associa??es mostraram que ser mulher, n?o ser solteiro, fazer o curso de cuidador e a limita??o por aspectos f?sicos (dom?nio da qualidade de vida) se relacionam a pretens?o de deixar de ser cuidador de idosos (atividade). Quanto ? caracteriza??o das ILPIs, verificou-se que as de natureza filantr?pica s?o mais antigas e concentram o maior n?mero de idosos institucionalizados (62,5%). Para contratar os cuidadores, os dirigentes das ILPIs citaram como principal qualidade/capacidade a intera??o social e a afinidade com o idoso. Pretende-se, com este estudo, contribuir para a melhoria da qualidade de vida do idoso e de seu cuidador formal, fornecendo informa??es sobre aspectos da institucionaliza??o do idoso, tanto em estabelecimentos filantr?picos quanto em estabelecimentos privados, no munic?pio de Natal/RN, que poder?o servir de par?metro para estudos posteriores mais aprofundados

No description available.

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2012. / Submitted by eloisa silva (eloisa1_silva@yahoo.com.br) on 2013-04-11T17:34:43Z No. of bitstreams: 1 janainaavila.pdf: 2636680 bytes, checksum: a3a2a4bbc2df00321dfcffda0c7ef76e (MD5) / Approved for entry into archive by Bruna Vieira(bruninha_vieira@ibest.com.br) on 2013-06-12T19:17:02Z (GMT) No. of bitstreams: 1 janainaavila.pdf: 2636680 bytes, checksum: a3a2a4bbc2df00321dfcffda0c7ef76e (MD5) / Made available in DSpace on 2013-06-12T19:17:02Z (GMT). No. of bitstreams: 1 janainaavila.pdf: 2636680 bytes, checksum: a3a2a4bbc2df00321dfcffda0c7ef76e (MD5) Previous issue date: 2012 / O estudo teve como objetivo geral: propor cuidados de enfermagem para prevenção das quedas junto aos idosos institucionalizados, por meio do processo de enfermagem, embasados em elementos da Classificação Internacional da Funcionalidade,Incapacidade e Saúde (CIF). Os objetivos específicos foram: elaborar instrumento que guiasse o processo de enfermagem, visando à prevenção de quedas nos idosos institucionalizados, embasado em elementos da Classificação Internacional da Funcionalidade,Incapacidade e Saúde; desenvolver processo de enfermagem direcionado à prevenção de quedas do idoso institucionalizado, utilizando North American Nursing Diagnosis Association e Classificação das Intervenções de Enfermagem, avaliando funcionalidade, incapacidade e saúde. Pesquisa qualitativa, do tipo estudo de caso. Os participantes foram nove pessoas idosas residentes em uma instituição de longa permanência, no Rio Grande, Rio Grande do Sul, Brasil. Na coleta dos dados foram utilizados: Miniexame do Estado Mental, Escala de Risco para Quedas e Histórico de enfermagem, aplicados por meio da entrevista semiestruturada, observação e exame físico. Os dados foram coletados em maio de 2012. Na análise de dados, os casos foram apresentados, tendo como produto final o processo de enfermagem dire cionado ao idoso institucionalizado, embasado em elementos da Classificação Internacional de Funcionalidade, Incapacidade e Saúde e voltado à prevenção das quedas. Houve aprovação do comitê de ética e pesquisa, parecer número 003/2012. Verificou-se que o maior número de residentes com risco de quedas eram mulheres, viúvas, entre 80 a 90 anos; sabiam ler e escrever; hipertensas; faziam uso de polifarmácia; moradia com barreiras arquitetônicas. Foram identificados doze diagnósticos de enfermagem. Para cada diagnóstico de enfermagem, seguindo a Taxonomia da North American Nursing Diagnosis Association, foram verificados em média de três a quatro domínios alterados da Classificação Internacional da Funcionalidade, Incapacidade e Saúde e propostas intervenções de enfermagem por meio da Nursing Interventions Classification. Foram os principais diagnósticos de enfermagem: Risco de quedas, Risco para perfusão tissular cardíaca diminuída, Proteção ineficaz, Risco de glicemia instável, Nutrição desequilibrada: mais do que as necessidades corporais, Percepção sensorial visual perturbada, Incontinência urinária de urgência, Percepção sensorial auditiva perturbada, Dor aguda, Estilo de vida sedentário, Dor crônica, Mobilidade física prejudicada. Espera-se com esta pesquisa contribuir para um cuidado de enfermagem adequado, específico, a fim de que a pessoa idosa institucionalizada seja considerada em seus aspectos multidimensionais, conforme preconiza a classificação internacional de funcionalidade, incapacidade e saúde. E, através dessa perspectiva, promover avanços para que estratégias sejam criadas para a manutenção da autonomia, funcionalidade e prevenção de quedas à pessoa idosa institucionalizada. / The study aimed to: propose nursing care for the prevention of falls among institutionalized elderly, through the nursing process, based on elements of the International Classification of Functioning, Disability and Health. The specific objectives were: elaborate instrument that guided the nursing process, aimed at preventing drops in elderly institutionalized, based on the International Classification of Functioning Disability and Health; develop nursing processaiming at preventing drops among the institutionalized elderly, using North American Nursing Diagnosis Association and Nursing Interventions Classification, assessing functioning, disability and health. Qualitative research, the case study. Participants were nine elderly residents in a long-stay institution in Rio Grande, Rio Grande do Sul, Brazil. In collection data were used: records of enderly, Mini Mental State Examination, Questionnairefor Risk about Drops, Historic of nursing, applied through semi-structured interviews, observation and examination. Data were collected in May 2012.In data analysis, cases were presented, with the final product a proposed nursing care directed to the institutionalized elderly, focused on the nursing process, based on the International Classification of Functioning, Disability and Health and turned the prevention of drops. There was approval of the ethics committee and research, opinion number 003/2012. It was found that the largest number of residents at risk of falling were women, widows, between 80 to 90 years, could read and write; hypertensive; made use of polypharmacy, housing with architectural barriers.We identified twelve nursing diagnoses. For each nursing diagnosis, following the taxonomy of the North American Nursing Diagnosis Association, were found on average three to four domains altered the International Classification of Functioning, Disability and Health nursing interventions and proposals through the Nursing Interventions Classification. Were the main nursing diagnoses:Risk of drops, risk for decreased cardiac tissue perfusion, ineffective Protection, Risk glucose unstable, imbalanced Nutrition: more than body requirements, visual sensory perception disturbed, Urge Urinary Incontinence, auditorysensory perception disturbed, Acute Pain, Lifestyle sedentary, chronic pain, impaired physical mobility. It is hoped that this research contribute to adequate nursing care, specific, so that the institutionalized elderly have a multidimensional nursing care, as recommended by the international classification of functioning, disability and health. And from this perspective, to promote advances strategies are established to maintain autonomy, functionality and drops prevention for the elderly institutionalized. / El estudio tuvo como objetivo: proponer los cuidados de enfermería para la prevención de caídas entre los ancianos, a través del proceso de enfermería, con base en los elementos de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF). Los objetivos específicos fueron: elaborar un instrumento que guíe el proceso de enfermería, orientada a la prevención de caídas en ancianos institucionalizados, basado en la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud; desarrollar el proceso de enfermería dirigida a la prevención de las caídas en los ancianos institucionalizados, utilizando Asociación Norte Americana de Enfermería Diagnóstico y Clasificación de Intervenciones de Enfermería que evalúe el funcionamiento, la discapacidad y la salud. La investigación cualitativa, el estudio de caso. Participaron nueve residentes personas anciano en una institución de larga estancia en Rio Grande, Rio Grande do Sul, Brasil. En la recolección de datos se utilizaron: registros de los ancianos, Mini Examen del Estado Mental, Cuestionario de Riesgo, de la Histórico de la enfermería, aplicado a través de entrevistas semi-estructuradas, observación y examen. Los datos fueron recogidos en mayo de 2012. En el análisis de datos, los casos se presentaron con el producto final a los cuidados de enfermería propuesta dirigida a las personas ancianos institucionalizados, se centró en el proceso de enfermería, basado en la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud y de cara a la prevención de caídas. Hubo aprobación del comité de ética e investigación, opinión número 003/2012. Se encontró que el mayor número de residentes en riesgo de caer eran mujeres, viudas, año entre 80 y 90, sabían leer y escribir, hipertensos, el uso hecho de la polifarmacia, vivienda con barreras arquitectónicas. Se identificaron doce diagnósticos de enfermería. Para cada diagnóstico de enfermería, siguiendo la taxonomía de la Asociación North American Nursing Diagnosis, se encontraron en promedio de tres a cuatro dominios alterado la Clasificación Internacional de las intervenciones de enfermería Funcionamiento, de la Discapacidad y de la Salud y las propuestas a través de la Clasificación de Intervenciones de Enfermería. Fueron los principales diagnósticos de enfermería: Riesgo de caídas, el riesgo de disminución de la perfusión del tejido cardiaco, la protección efectiva, la glucosa Riesgo inestable, nutrición desequilibrada: superior a los requerimientos, la percepción sensorial visual alterada,incontinencia urinaria de urgencia, la percepción sensorial auditiva alterada, dolor agudo, estilo de vida sedentario, dolor crónico, deterioro de la movilidad física. Se espera que esta investigación contribuya a una asistencia adecuada, específica, de modo que los ancianos institucionalizados tienen un cuidado de enfermería multidimensional, según lo recomendado por la clasificación internacional del funcionamiento, la discapacidad y la salud. Y desde este punto de vista, para promover los avances que se han establecido estrategias para mantener la autonomía, la funcionalidad y la prevención de caídas en los ancianos institucionalizados.