Bakgrund: Antalet äldre ökar vilket utgör en stor utmaning för samhället. Nationella satsningar pågår för att åstadkomma en sammanhållen vård och omsorg för de multisjuka äldre. Syfte: Att beskriva primärvårdsläkares och kommunala sjuksköterskors erfarenheter av samverkan för multisjuka äldre i ordinärt boende samt vilka faktorer de anser viktiga för att förebygga inläggning i slutenvården. Metod: Kvalitativ metod med fokusgruppsintervjuer där sammanlagt 15 sjuksköterskor och läkare deltog. Materialet analyserades med systematisk textkondensering. Resultat: Informanterna anser att flera faktorer påverkar om de multisjuka äldre kan vårdas kvar hemma, samverkan mellan primärvårdsläkare och kommunala sjuksköterskor utgör en viktig del men ansvaret för en allt högre medicinsk nivå i ordinärt boende kräver också andra resurser. En medicinsk vårdplanering underlättar men eftersom de mest sjuka äldres tillstånd snabbt kan förändras behöver de regelbundna hembesök. Detta är en förutsättning för att den medicinska säkerheten ska tryggas, särskilt efter utskrivning från slutenvården.  En utebliven planering och bristande information till patient och närstående ökar risken för sjukhusinläggningar som hade kunnat undvikas. Med ytterligare ersättning för att prioritera multisjuka äldre kan fler hembesök göras. De multisjuka äldres speciella behov ställer ökade krav på personalens kompetens.  Slutsats: Det finns ett engagemang för de multisjuka äldre och förslag på lösningar för att undvika slutenvård och återinläggningar både inom den egna organisation och i samverkan med vårdgrannar. De satsningar som görs nationellt och lokalt behöver utformas tillsammans med de läkare och sjuksköterskor som är närmast patienten för att tillvarata deras kompetens och erfarenhet. Först då kan rätt satsningar komma de multisjuka äldre till del. / Background: The ageing population has increased, which is a major challenge. National efforts are underway to develop coherent care for frail old people. Objective: To describe primary care physicians and community nurses' experiences of interaction for frail old people in home care, and the factors they consider important in preventing readmission. Methods: Qualitative methodology with focus groups involving 15 nurses and doctors. The material was analysed with systematic text condensation. Results: The informants consider that many factors determine whether the frail old people can stay in home care, collaboration between physicians and nurses is important but the responsibility for an increasing medical level in home care also require other resources. A medical healthcare planning facilitates but the frail old patient’s medical condition may change rapidly, regular home visits are needed. This is a prerequisite to ensure medical safety, particularly after discharge from inpatient care. Lack of planning and information to patients and their relatives increases the risk of readmission that could have been avoided. With additional compensation to prioritize the frail elderly, more home visits can be made. The frail old people’s special needs places increased demands on the staff skills. Conclusion: There is a commitment to the frail old people and suggestions for ways to avoid hospitalization and readmissions both within their own organization and in collaboration with healthcare neighbours. The efforts that are being made nationally and locally need to be in collaboration with the doctors and nurses who are closest to the patient to benefit from their skills and experiences. Only then, the right ventures can be made to benefit the frail old people.

Thesis (D. Min.)--Westminster Theological Seminary, Philadelphia, 2002. / Includes abstract. Includes vita. Includes bibliographical references (leaves 155-160).

This work is a study of the day to day experiences of older people in receipt of in-home care, the experiences of their family carers, and of their careworkers, resulting in a hypothesis about the structure of the lifecycle towards the end of life, and a consideration of both structured transition and individual transitions to and within this life stage. It has taken off from Laslett�s (1989,1996) seminal work on age divisions, into Third and Fourth Ages. Through an initial examination of secondary sources, I have hypothesized that the older people in this care bracket are in fact in a new life stage, between that of the independent Third Age and the dependent Fourth Age. I call this life stage the stage of 'Supported Independence'. Further references to the secondary sources, and references to the data, have supported this hypothesis, and have shown that there is a structured transition from the stage of independence to that of supported independence. The value of building such a life stage lies in the ability we then have to emphasize the situation of in-home care, bringing to prominence the experiences of the three stakeholders in this care environment. I have used the rites of passage concept to make known the issues involving the move from independence to dependence and those issues predominant in receiving in-home care, in being the carer at such a time, and in being the careworker within the invisibility of home. This has shown a formalized separation from the independent identity, and a prolonged stage of liminality because of an often uncertain form of service delivery. In this liminal stage also are revealed the emotions of living at home with a disability and with care, the improvisatory practices, the passivity and the assertiveness of this time of ageing. By applying this concept also to the family carers, I show the movement of families into and through the caring role, the joy of caring and the difficulties of taking responsibility without authority. I have shown carers� own improvisatory practices, and their determination to maintain the care recipient at home as long as possible. For the careworker, the rites of passage concept shows how she (and the careworker participants in this study are all women), can act to either maintain the liminal position of the recipients or assist in their reconnection to greater autonomy. Exploring the careworkers� own positions by means of the rites of passage concept highlights their inter-structural position between the public and private sectors, and highlights too, the care industry�s position, between that of a time managed industry and a recipient-directed industry. Whether this can be regarded as liminal depends on the philosophies of care adopted by the industry. In summary, the study examines the significance of the place of care, challenging the dominant ideology that home is best, and putting forward for consideration principles of care for other models of service delivery.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

Thesis (D. Min.)--Westminster Theological Seminary, Philadelphia, 2002. / Includes abstract. Includes vita. Includes bibliographical references (leaves 155-160).

Thesis (D. Min.)--Westminster Theological Seminary, Philadelphia, 2002. / Includes abstract. Includes vita. Includes bibliographical references (leaves 155-160).

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 48-50).

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Conselho Nacional de Desenvolvimento Científico e Tecnológico / A síndrome de fragilidade pode ser definida como um estado de vulnerabilidade a agentes estressores, um resultado de declínios orgânicos observados em múltiplos sistemas, comprometendo a habilidade do indivíduo em manter a homeostase. O objetivo deste estudo transversal foi avaliar a prevalência desta condição através da Escala de Fragilidade proposta pelo Cardiovascular Health Study em uma população de idosos, clientes de uma operadora de saúde, que vivem na zona norte da cidade do Rio de Janeiro, além de observar o comportamento deste instrumento em uma amostra brasileira. 754 indivíduos foram avaliados quanto aos cinco critérios da escala além de variáveis sociodemográficas, capacidade funcional, quedas, perfil cognitivo e comorbidades relatadas. Foram considerados Frágeis aqueles que apresentaram três ou mais dos seguintes critérios: a) lentificação da velocidade da marcha; b) reduzida força de preensão palmar; c) sensação de exaustão; d) baixa atividade física; e) perda de peso. Os resultados apontam que, dentre os avaliados, 9,2% eram Frágeis. Estes eram mais idosos, com pior status socioeconômico, com pior desempenho cognitivo e maior comprometimento funcional (p< 0,05). Entre os 9,2% de Frágeis, 87% apresentaram alteração da velocidade da marcha, 79,7% da força de preensão palmar, 66,8% baixa atividade física, 52,2% relato de sensação de exaustão e 36,2% relato de perda de peso. A distribuição de suas frequências quando comparado ao estudo original foi bastante semelhante. Vários estudos partem do postulado que a fragilidade pode ser identificada através de medidas clínicas. Através de sua identificação precoce, é possível reconhecer uma entidade potencialmente reversível, reduzindo morbidade e mortalidade na população idosa, no entanto é fundamental um estudo acurado sobre como esta entidade será mensurada e quais serão os critérios adotados para defini-la. Maiores estudos são necessários para realizar, no Brasil, uma análise mais aprofundada desta pertinente questão. / The Frailty Syndrome can be defined as a state of vulnerability to stress agents, an organic result of declines observed in multiple systems, compromising the ability of individuals to maintain homeostasis. The aim of this survey was to assess the prevalence of this condition through the range proposed by the Cardiovascular Health Study in an elderly population, clients of a private health care, living in the northern city of Rio de Janeiro, in addition to observing the behavior of this instrument in a Brazilian sample. 754 individuals were evaluated for five criteria of the instrument beyond socio-demographic variables, functional capacity, falls, cognitive profile and comorbidities reported. Those who reported three or more of the following criteria, slowing the speed of gait, reduced grip strength, feelings of exhaustion, low physical activity and weight loss were considered frail. The results indicate that among the subjects, 9.2% were frail. These were older, with poorer socio-economic status, with poorer cognitive performance and greater functional impairment (p <0.05). Fragile showed 87% of the change in gait velocity, 79.7% of grip strength, low physical activity 66.8, 52.2% reported feeling of exhaustion and 36.2% reported weight loss. New cutoff points were established for walking speed, energy expenditure and grip strength. The distribution of their frequencies when compared to the original study was quite similar. It is postulated that the weakness can be identified by clinical measures. Through early identification, it is possible to recognize an entity potentially reversible, reducing morbidity and mortality in the elderly population, however it is essential to accurate study on this entity will be measured and what are the criteria used to define it. Further studies are required to perform in Brazil, a deeper analysis of the proposed instrument.

Made available in DSpace on 2014-12-17T14:46:39Z (GMT). No. of bitstreams: 1 LucianePBO_DISEERT.pdf: 934190 bytes, checksum: d09b87bc0f0318ce964ae3550b82db29 (MD5) Previous issue date: 2008-12-22 / This study aims to analyze social representations of elders to their fragile situation at home, with the presence of one or more characteristics, as defined by the Brazilian Ministry of Health. It is a descriptive and qualitative study, based on methodological -principles of the Theory of Social Representations. Setting was the homes of elderly residents in the area ascribed to a Family Health Unit (FHU) in the city of Natal. A total of 10 elderly subjects, whose choice was intentional and according to the need for USF home visit in a period of time, considering the saturation process of the information. As collection procedures were used the semi-structured interview and participant observation in accordance with the ethical rules of Resolution No. 196/96, with the assent of the Ethics and Research UFRN. To analyze the results, it was used the thematic content analysis in the aspect of preparation of representations, focusing on the totality of the discourse of the subjects. The results indicate that most study participants felt difficult to give meaning to the terms weakness and to be weak, although many present one or more aspects of the syndrome of frailty. From the content analysis of participants speeches in this study, we achieved the following categories: fragility as illness and disease as aging, aging and frailty as causes of changes and difficulties in daily life, the presence of family life in the fragile elderly, fragility as weakness and the risk for falls, the perception of being weak like a different person in addition to the absence of fragility in elderly life. Thus, through the processes of anchoring and objectification, the "fragile being" became familiar and concrete, showing that the meaning of weakness, besides the scientific definition found in the reified universes, can be reinterpreted and built within the consensus universes. About the care received by the staff of Family Health, from the viewpoint of older people there seems to be an understanding about the role of professional nurses; on the other hand, older people often mention the role of the Community Health Agent / Este estudo teve como objetivo analisar representa??es sociais para idosos de sua situa??o de fragilidade em domic?lio, com a presen?a de uma ou mais caracter?sticas, conforme defini??o estabelecida pelo Minist?rio da Sa?de. ? um estudo do tipo descritivo e de natureza qualitativa, fundamentado em princ?pios te?rico-metodol?gicos da Teoria das Representa??es Sociais. Teve como cen?rio o domic?lio de idosos residentes em ?rea adscrita da Unidade de Sa?de da Fam?lia (USF), da zona administrativa leste do Munic?pio de Natal/RN. Participaram 10 idosos (as), oriundos de zona rural (com exce??o de um). Sete eram mulheres, sete sem c?njuge, apenas um sem filho, todos eles com aposentadoria ou pens?o, a maioria sendo chefes de fam?lia e morando com filhos e outros parentes. A sua escolha foi intencional e de acordo com a necessidade de visita domicili?ria da USF num per?odo de tempo estabelecido, considerando o processo de satura??o das informa??es. Como procedimentos de coleta, foram utilizadas a entrevista semiestruturada acompanhada de formul?rio e a observa??o participante, e conforme os preceitos ?ticos da Resolu??o n?. 196/96, com parecer favor?vel do Comit? de ?tica e Pesquisa da UFRN. Para a an?lise dos resultados, utilizou-se a an?lise de conte?do tem?tica na vertente de elabora??o das representa??es, centrada na totalidade do discurso dos sujeitos, os chamados sujeitos gen?ricos contextualizados e capazes de representar o grupo no indiv?duo. Os resultados obtidos indicam que a maioria dos (as) participantes deste estudo se expressava com dificuldades, para falar ou dar significado aos termos fragilidade e ser fr?gil, mesmo considerando que a sua maioria (oito) apresentava um ou mais dos aspectos da s?ndrome de fragilidade. A partir da an?lise de conte?do das falas das pessoas idosas participantes deste estudo, foram alcan?adas as seguintes categorias: Fragilidade como doen?a e Doen?a como envelhecimento; O envelhecimento e a fragilidade como causadores de mudan?as e dificuldades na vida di?ria; A presen?a de familiares na vida da pessoa idosa fr?gil; Fragilidade como algo que representa fraqueza e sua rela??o com o risco de sofrer quedas; A percep??o de que ser fr?gil torna o idoso uma pessoa diferente; e A fragilidade n?o faz parte da vida do idoso. Contudo, a partir do referencial da Teoria das Representa??es Sociais, inferiu-se que a fragilidade est? ancorada no contexto domiciliar, nas atividades da vida di?ria, na condi??o de sa?de, nas altera??es fisiol?gicas percebidas e nas dificuldades de vida enfrentadas. Portanto, atrav?s desses processos, o ser fr?gil transformou-se em algo familiar e concreto, mostrando que o significado da fragilidade, al?m da defini??o cient?fica encontrada nos universos reificados, pode ser ressignificado e constru?do dentro de universos consensuais. Sobre a aten??o recebida pela equipe de Sa?de da Fam?lia e pelo (a) enfermeiro (a), na vis?o dos idosos, ainda n?o aparecem como profissionais presentes e atuantes, embora eles fa?am men??o ? atua??o do Agente Comunit?rio de Sa?de (ACS)

Submitted by Timbo Noeme (noeme.timbo@metodista.br) on 2016-08-05T19:51:52Z No. of bitstreams: 1 Olinda Tereza Rugene.pdf: 1014782 bytes, checksum: 70ba3db4a6cd6ddfad0a84895c6c0091 (MD5) / Made available in DSpace on 2016-08-05T19:51:52Z (GMT). No. of bitstreams: 1 Olinda Tereza Rugene.pdf: 1014782 bytes, checksum: 70ba3db4a6cd6ddfad0a84895c6c0091 (MD5) Previous issue date: 2016-03-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This study aimed to: - describe the difficulties in relations between the daughters, caregivers and their dependent elderly nursing mothers, from reports of daughters; - investigate, from the accounts of family history of these daughters, the existence of previous conflicts the need to care, related to the construction of the bonds; identify the main challenges associated assistance to family caregivers of elders with respect to conflict resolution with the dependent elderly. Method - treated is a qualitative study that were presented three cases of caregivers who had been referred for psychological care by the professional staff of the Institute of Geriatrics and Gerontology, secondary care unit of the State Secretariat SP Health Results They indicated relational difficulties between the two: caretakers daughters and elderly mother. Caregivers revealed physical and emotional burden and great suffering. However, the existence of these conflicts dating back to previous relations to the current situation of dependence; getting enough evidenced both by the life stories of caregivers, as the content brought during the therapeutic process, the repetition of the first relationships established between mother and daughter. The psychotherapeutic process could allow these caregivers to understand the need to have their environmental failures met, to the extent that propiciávamos an enabling environment for human relationship. Thus, to observe that throughout the process the patients had significant changes, we believe that psychotherapy may be included as a preventive means and preservation of mental balance / Este estudo teve por objetivos: - descrever as dificuldades nas relações entre as filhas-cuidadoras e suas mães idosas dependentes de cuidados, a partir de relatos das filhas; - investigar, a partir dos relatos da história familiar dessas filhas, a existência de conflitos prévios a necessidade de cuidar, relacionados à construção dos vínculos; identificar os principais desafios associados assistência ao cuidador familiar de idosos no que tange a resolução de conflitos com o idoso dependente. Método – tratou-se de um estudo qualitativo em que foram apresentados três casos clínicos de cuidadoras que haviam sido encaminhados para atendimento psicológico pela equipe multiprofissional de um Instituto de Geriatria e Gerontologia, unidade de atenção secundária da Secretaria de Estado da Saúde de S.P. Os resultados indicaram dificuldades relacionais entre ambas: cuidadoras filhas e mães idosas. As cuidadoras revelaram sobrecarga física e emocional e grande sofrimento. Todavia, a existência desses conflitos remontava às relações anteriores à atual situação de dependência; ficando bastante evidenciado, tanto pelas histórias de vida das cuidadoras, quanto pelo conteúdo trazido durante o processo terapêutico, a repetição das relações primeiras estabelecidas entre mãe-filha. O processo psicoterapêutico pôde permitir a essas cuidadoras a compreensão da necessidade em ter suas falhas ambientais supridas, na medida em que foi propiciado um ambiente favorável ao relacionamento humano. Assim, ao observarmos que ao longo do processo as pacientes apresentavam mudanças significativas, entendemos que a psicoterapia pode figurar como meio preventivo e preservação de equilíbrio psíquico.