Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated. The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation. For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-03-28T17:09:53Z No. of bitstreams: 1 Valquiria Carvalho Silva.pdf: 2683284 bytes, checksum: 233161e1b67516605f7cbfa420767f11 (MD5) / Made available in DSpace on 2017-03-28T17:09:53Z (GMT). No. of bitstreams: 1 Valquiria Carvalho Silva.pdf: 2683284 bytes, checksum: 233161e1b67516605f7cbfa420767f11 (MD5) Previous issue date: 2016 / Mestrado Profissional em Enfermagem Assistencial / Introdução: O número elevado de admissões hospitalares de idosos representa um indicador significativo para avaliação das condições de saúde dessa clientela. A admissão hospitalar pode ser um indicativo de fragilidade relacionada à perda de capacidade funcional, interferindo na qualidade de vida e aumentando os custos com tratamento. Durante a hospitalização cabe a Enfermagem avaliar continuamente esse idoso, identificando elementos que possam subsidiar o planejamento e implementação dos cuidados de enfermagem visando proporcionar uma assistência integral e segura, considerando as alterações inerentes ao processo de envelhecimento articuladas às decorrentes do adoecimento que repercutem diretamente na autonomia, independência e capacidade funcional dessa clientela. Objeto de estudo: Capacidade Funcional do idoso durante o processo de hospitalização. Hipótese investigativa: A capacidade funcional do idoso tende a sofrer declínio durante o processo de hospitalização. Objetivo geral: Elaborar um Protocolo de Enfermagem com foco na Capacidade Funcional do Idoso Hospitalizado; Objetivos específicos: Caracterizar o perfil socioeconômico e de saúde de idosos hospitalizados; Avaliar de modo sequencial a capacidade funcional do idoso, durante a hospitalização. Método: Estudo longitudinal, com abordagem quantitativa, envolvendo acompanhamento da capacidade funcional do idoso hospitalizado. Participaram 37 idosos, de ambos os sexos, internados nas enfermarias de clínica médica masculina e feminina de um Hospital Geral no município de Campos dos Goytacazes- RJ e de um Hospital Universitário no município de Niterói-RJ. A produção de dados ocorreu de maio à setembro de 2016, mediante análise documental inicial dos prontuários dos idosos hospitalizados, para caracterização do perfil socioeconômico e de saúde; aplicação das escalas de avaliação funcional: Escala de Katz, Escala de Lawton & Brody e Mini-Cog, para acompanhar a capacidade funcional dos idosos durante a hospitalização, semanalmente; elaboração de um protocolo de enfermagem com foco na capacidade funcional do idoso hospitalizado. Os dados foram submetidos à análise estatística descritiva e inferencial; a análise do tempo de sobrevivência até o declínio funcional foi feita pela metodologia de Kaplan-Meier; a associação entre as variáveis e o risco de declínio da capacidade funcional no tempo de internação foi investigada por Modelos de Riscos Proporcionais de Cox. Resultados: Houve maior proporção do sexo masculino, baixa escolaridade e baixa renda; A faixa etária predominante foi de 65 à 67,5 anos com período de internação de 10 à 15 dias. O principal diagnóstico medico foi doença cardiovascular e a comorbidade mais frequente hipertensão arterial sistêmica. Constatou-se maior incidência de declínio no rastreio cognitivo, seguido das Atividades Instrumentais de Vida Diária e, por último, das Atividades Básicas de Vida Diária. A incidência de quedas foi diretamente proporcional à de declínio funcional. O tempo até a ocorrência do declínio das pontuações nas escalas foi de 14 dias ou mais para homens e 21 dias ou mais para mulheres. Foram considerados alguns fatores de risco aumentado para declínio nas pontuações das escalas, dentre eles a hipertensão arterial sistêmica, acidente vascular cerebral e número de internações. O protocolo elaborado espera fornecer subsídios para sistematizar a avaliação funcional do idoso durante a hospitalização e direcionar planejamento dos cuidados de enfermagem. Conclusão: A capacidade funcional do idoso tende a sofrer declínio durante o processo de hospitalização.Cabe ao enfermeiro avaliar a capacidade funcional dessa clientela modo a implementar cuidados adequados às demandas desse grupo, evitando comprometimento funcional e dependência. Identificou-se a necessidade de um espaço destinado à assistência da população idosa. O planejamento de alta e o monitoramento dos idosos após a alta hospitalar foi sugerido. Espera-se contribuir para reduzir possíveis riscos da hospitalização de idosos, com foco na capacidade funcional, e para melhorar a qualidade da assistência de enfermagem, centrada nas especificidades do idoso. A utilização do protocolo elaborado pode implicar na redução do tempo de permanência hospitalar dos idosos, redução dos custos gerados por este evento e no aumento da qualidade dos serviços prestados pela instituição à clientela idosa / Introduction: The high number of hospital admissions for the elderly represents a significant indicator for the evaluation of the health conditions of this clientele. Hospital admission may be indicative of fragility related to loss of functional capacity, interfering with quality of life and increasing treatment costs. During hospitalization it is up to Nursing to continuously evaluate this elderly person, identifying elements that can subsidize the planning and implementation of nursing care, aiming to provide integral and safe care, considering the inherent alterations to the aging process articulated to those resulting from illness that directly affect autonomy, Independence and functional capacity of this clientele. Study object: Functional capacity of the elderly during the hospitalization process. Investigative hypothesis: The functional capacity of the elderly tends to decline during the hospitalization process. General objective: To elaborate a Nursing Protocol focusing on the Functional Capacity of Hospitalized Elderly; Specific objectives: To characterize the socioeconomic and health profile of hospitalized elderly; To evaluate sequentially the functional capacity of the elderly during hospitalization. Method: Longitudinal study, with quantitative approach, involving the monitoring of the functional capacity of the hospitalized elderly. Participants were 37 elderly men and women hospitalized in the male and female medical clinics of a General Hospital in the city of Campos dos Goytacazes, RJ, and a University Hospital in the city of Niterói, RJ. The production of data occurred from May to September 2016, through an initial documentary analysis of the medical records of the hospitalized elderly, to characterize the socioeconomic and health profile; Application of the functional assessment scales: Katz Scale, Lawton & Brody Scale and Mini-Cog, to monitor the functional capacity of the elderly during hospitalization, weekly; Elaboration of a nursing protocol focusing on the functional capacity of hospitalized elderly. Data were submitted to descriptive and inferential statistical analysis; The analysis of survival time to functional decline was done by the Kaplan-Meier methodology; The association between the variables and the risk of functional capacity decline during hospitalization time was investigated by Cox Proportional Risk Models. Results: There was a higher proportion of males, low schooling and low income; The predominant age group was from 65 to 67.5 years with hospitalization period of 10 to 15 days. The main medical diagnosis was cardiovascular disease and the most common comorbid systemic arterial hypertension. There was a higher incidence of decline in cognitive screening, followed by the Instrumental Activities of Daily Living and, finally, the Basic Activities of Daily Living. The incidence of falls was directly proportional to that of functional decline. The time until the occurrence of the decline in the scales was 14 days or more for men and 21 days or more for women. We considered some increased risk factors for a decline in scales scores, including systemic arterial hypertension, stroke and number of hospitalizations. The elaborated protocol hopes to provide subsidies to systematize the functional evaluation of the elderly during the hospitalization and to direct nursing care planning. Conclusion: The functional capacity of the elderly tends to decline during the hospitalization process. It is up to the nurse to evaluate the functional capacity of this clientele so as to implement care appropriate to the demands of this group, avoiding functional compromise and dependence. It was identified the need of a space destined to the assistance of the elderly population. Planning for discharge and monitoring of the elderly after hospital discharge was suggested. It is hoped to contribute to reduce possible risks of hospitalization of the elderly, focusing on functional capacity, and to improve the quality of nursing care, focusing on the specifics of the elderly. The use of the protocol can lead to a reduction in the length of hospital stay of the elderly, a reduction of the costs generated by this event, and an increase in the quality of services provided by the institution to elderly clients

This thesis discusses current insights into the applications of deep transcranial magnetic stimulation (dTMS) in older adults with treatment-resistant depression (TRD). / Objectives: To examine current evidence of clinical efficacy and applications of deep transcranial magnetic stimulation (dTMS) among older adults with treatment-resistant depression (TRD). Methods: In Study 1, we conducted a systematic review of existing literature on the clinical efficacy of dTMS across psychiatric and cognitive disorders. Studies eligible for inclusion were clinical trials which were required to have a sham/control condition to mitigate confounding variables and to strengthen our assessment of efficacy. This dissertation specifically aimed to discuss these findings in the context of older adults with depression, as a means to investigate whether available evidence supporting the clinical efficacy of dTMS for depression is generalizable to older populations. In Study 2, we analyzed recruitment data from a pilot study investigating the effects of dTMS in older adults with TRD. Specifically, we aimed to evaluate the effectiveness of various recruitment strategies by using an enrollment-cost analysis, as well as comparing enrollment rates (i.e., enrolled participants/referrals received) for each recruitment method. Moreover, we identified potential facilitators and barriers to recruitment following a verbal thematic analysis of qualitative interview data. Results: In Study 1, most substantial evidence (n = 6 studies) within the literature supports the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes in patients with bipolar disorder (BD) or major depressive disorder (MDD). Only one randomized controlled trial was conducted in older adults with TRD. This trial reported higher remission rates in the active dTMS arm compared to the sham dTMS arm following treatment with the H1-coil. In study 2, we found (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook, to be the most effective recruitment strategies. Lastly, social support from research staff (n = 15; 88.24%) and the time-intensiveness aspect of dTMS treatments (n = 6; 35.29%) were the most frequently identified facilitators and barriers to recruitment, respectively. Conclusions: While there is notable evidence supporting the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes, the majority of such evidence is based on findings from younger-to-middle aged groups. Thus, the generalizability of dTMS treatment efficacy to older adults remains less understood. Further sham-controlled studies are needed to determine the clinical efficacy of dTMS in older adults and to improve evidence-based care in the field of geriatric psychiatry. Importantly, we aimed to address this underrepresentation of older adults in clinical research by analyzing recruitment strategies and examining facilitators and barriers to recruitment. Future research is warranted to examine facilitators and barriers to recruitment in older adults with depression, particularly the importance of social support, which may offer valuable insights on how to overcome the issue of underrepresentation. / Thesis / Master of Science (MSc) / Brain stimulation therapies, such as deep transcranial magnetic stimulation (dTMS), show promising results for treatment-resistant depression (TRD). However, the applications of dTMS remain overlooked in geriatric populations with TRD, limiting the generalizability of such treatments to older adults. This dissertation aimed to examine current evidence supporting the use of dTMS in older adults with depression. In Study 1, we conducted a systematic review of available evidence on the clinical efficacy of dTMS across psychiatric and cognitive disorders. We found most evidence supporting the clinical efficacy of dTMS for the treatment of depressive episodes. However, the underrepresentation of older adults in such research was highly prevalent, with only one study being focused on older adults. In Study 2, we explored the effectiveness of diverse recruitment methods used in an ongoing dTMS trial for older adults with depression. Additionally, we identified potential facilitators and barriers to recruitment. Overall, the most effective recruitment strategies were (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook advertising. Furthermore, social support from research staff and high time commitment of dTMS treatments were identified as facilitators and barriers to recruitment, respectively. These findings highlight the importance of conducting dTMS research in older adults to address the issue of underrepresentation and to improve evidence-based care in this special population.

Bakgrund: Urinvägsinfektion (UVI) är en av de vanligaste infektionerna hos äldre kvinnor. Escherichia coli (E-coli) är den vanligaste bakterien vid UVI. Äldre kvinnor lider när de är drabbade av UVI och det är sjuksköterskans uppgift att bland annat förebygga sjukdom och lindra lidande. Syfte: Att beskriva riskfaktorer och förebyggande omvårdnadsåtgärder mot UVI hos äldre kvinnor. Metod: Litteraturstudie, med databassökning genom databaser speciellt inriktade på vård och omvårdnad, CINAHL, PubMed, WEB OF SCIENCE och Medline. 15 artiklar har använts till resultatet. Resultat: Recidiverande UVI, diabetes, urininkontinens, smittspridning och förstoppning är riskfaktorer att drabbas av UVI. God hygien och regelbunden tillförsel av vätska ses som god evidensbaserad omvårdnadsåtgärd mot UVI. Ökad tillförsel av vätska förkastas, Tranbärstillägg behöver ytterligare forskning. Slutsats. Hög hygieniskstandard genom de basala hygienrutinerna är en viktig förebyggande åtgärd mot UVI. / Background: Urinary tract infection (UTI) is one of the most common infections for elderly women. Escherichia coli (E-coli) is the most commonly found bacteria when screening for UTI. Older women suffer when they have UTI and it’s up to the nurse to prevent sickness and to ease the pain. Aim: To describe risk factors and nursing care prevention against UTI for elderly women. Method: Based on science articles received from databases specified on care and nurse caring. CINAHL, PubMed, WEB OF SCIENCE and Medline. 15 articles is used for the results. Results: A prior history of UTI, diabetic, urinary incontinence, and constipation is risk factors to developed UTI. High hygienic standard is a good prevention against UTI. Regular infusion of liquid is good prevention to not develop UTI. Cranberry for prevention against UTI needs further research. Conclusion High hygienic standard through basic hygiene is an important prevention against UTI.

SAMMANFATTNING   Bakgrund: Trycksår är en lokal skada i huden och i underliggande vävnad som kan uppkomma i samband med sjukdom, vård och behandling. Trycksår betraktas idag som en vårdskada och ska anmälas som en avvikelse. För individen innebär det stort lidande och ger höga kostnader för samhället, större omvårdnadsbehov och förlängda vårdtider. Studier visar att kunskap om trycksårsprevention hos sjuksköterskor och undersköterskor i Sverige inte är tillräckligt hög. Ett trycksensorsystem (MAP-system) finns nu tillgängligt som ger omedelbar feedback av patientens tryckpunkter som ett hjälpmedel vid trycksårsprevention. Syfte: Att utvärdera effekten av MAP- systemet avseende förekomst av trycksår hos äldre patienter under vårdtiden på en geriatrisk avdelning på sjukhus. Metod: En randomiserad, kontrollerad studiedesign valdes. En geriatrisk vårdavdelning valdes ut med en MAP-grupp (n=91) och en kontrollgrupp (n=99). Ett studieprotokoll användes med uppgifter om: demografisk data, hudinspektion (trycksårsklassificering kategori 1-4), Modifierad Nortonbedömning, komfort, maxtryck samt preventiva åtgärder. Insamlad data behandlades i SPSS och signifikansberäkning, standardavvikelse och medeltal räknades ut. Resultat: Användande av MAP-systemet gav ingen signifikant skillnad i andelen patienter med trycksår mellan MAP- och kontrollgruppen. Andel patienter med trycksår i MAP-gruppen dag ett var 24,2 % och dag 14, 28,2 %. I kontrollgruppen var andelen dag ett 18,2 % och dag 14, 23,8 %. Vanligaste lokalisationen av trycksår var hälar därefter sakrum och glutealt. Patienter med trycksår fick signifikant fler trycksårsförebyggande åtgärder. Slutsats: Studien visar ingen signifikant skillnad mellan andelen patienter med trycksår i MAP- och kontrollgruppen. Preventiva åtgärder prioriterades främst till patienter med trycksår. Genomförandet av studien antas ha medfört ökat fokus på trycksårsprevention samt påverkat prevalensen av trycksår positivt på den aktuella avdelningen. / ABSTRACT   Background: Pressure ulcers consist of local damage to the skin and underlying tissue and can occur in relation to illness, care and treatment. Pressure ulcers are today considered as an adverse event and are to be reported as a deviation from care routines. For the individual it can be the source of great suffering. It also generates large costs for the community, increased needs of nursing as well as prolonged periods of hospitalization. Studies show that the level of knowledge among registered nurses and assistant nurses in Sweden is insufficient. A pressure mapping system (MAP system) is now available, and can provide immediate feedback about the patient´s pressure points as a tool for pressure ulcer prevention. Aim: To study the effect of the MAP system regarding the presence of pressure ulcers in elderly hospitalized patients on a geriatric ward. Method: A randomized, controlled study design was chosen. A geriatric ward was selected with a MAP group (n=91) and a control group (n=99). A study protocol containing demographic data, systematic skin inspection (with classification of pressure ulcers category 1-4), Modified Norton scale, comfort, maximum pressure and preventive measures was used. Data was processed in SPSS; generating mean, standard deviation and level of significance. Results: No significant difference in the prevalence of pressure ulcers was shown between the MAP- group and the control group. The prevalence of pressure ulcers in the MAP-group was 24,2 % on day one and 28,2 % on day 14. In the control group the corresponding numbers were 18,2 % and 23,8 %. The most common localization of pressure ulcers were heels, followed by the sacral and gluteal regions. Patients with pressure ulcers received significantly more preventive measure compared to patients without pressure ulcers. Conclusion: The study shows no significant differences between the groups regarding the prevalence of patients with pressure ulcers. Preventive measures were prioritized mostly for patients with existing pressure ulcers. The study is assumed to have increased the focus on pressure ulcer prevention thus affecting the prevalence of pressure ulcers in a positive way on the present ward.

Bakgrund: Senior alert är ett nationellt kvalitetsregister som avser att förebygga trycksår, fall, undernäring, ohälsa i munnen och blåsdysfunktion hos patienter över 65 år. För att identifiera dessa riskområden används olika bedömningsinstrument och sjuksköterskor ansvarar för att registreringarna genomförs och att förebyggande åtgärder sätts in. Syfte: Studiens syfte var att studera sjuksköterskors upplevelse av att arbeta med kvalitetsregistret Senior alert samt hur sjuksköterskorna upplever att arbetet med kvalitetsregistret påverkar vården hos de äldre. Metod: Sex sjuksköterskor verksamma inom Uppsala kommun med erfarenhet av att arbeta med Senior alert intervjuades och en kvalitativ innehållsanalys användes för att bearbeta den insamlade datan.   Resultat: Utifrån den insamlade datan utformades fyra kategorier, Upplevelser av Senior alert som redskap, Senior alert kan förbättras, Tillämpandet av senior alert i praktiken och Arbetet med Senior alert bidrar till ökad vårdprevention och sju underkategorier. Slutsats: Senior alert upplevs som ett bra redskap för att arbeta förebyggande och främja teamarbete, men uppfattas som tidskrävande. Sjuksköterskorna i den här studien anser att vården av de äldre förbättras då identifiering av riskområden sker tidigt och åtgärder sätts in. För att kunna göra resultatet överförbart och veta på vilket sätt vården förbättras behövs ett större urval och frågor som är utformade för att kunna besvara syftet. / Background: Senior Alert is a quality registry which aims to prevent pressure ulcers, falling, malnutrition, bad oral health and urinary incontinence among patients over 65 years. To identify these areas different evaluation tools are used and nurses are responsible for the registrations and making sure preventive actions are made. Aim: The aim of this study was to describe how nurses experience working with the quality registry Senior Alert and how it affects the care of the elderly. Methods: Six nurses working in Uppsala county with experience of working with Senior Alert was interviewed. The interviews were analyzed using a qualitative content analysis. Results: Four categories, Senior Alert as a tool, Senior Alert needs improvement, Working with Senior Alert and Senior Alert contributes to a better health care and seven subcategories were identified. Conclusions: The respondents found Senior Alert to be a helpful tool for preventive work and that it promotes teamwork, but is perceived as time consuming. The nurses in this study think that the care of the elderly improves by early identification and preventive actions, but to do this, study-result transferability and knowing in what way the care will improve it will need a larger target group and more questions to answer the aim of the study.

Bakgrund: Svensk statistik tyder på att antalet multisjuka äldre kommer att öka. Hälso- och sjukvårdslagen stadgar att vården skall vara av god kvalitet och tillgodose patienternas behov av trygghet. I dagens samhälle föreligger en risk att äldre människor utsätts för ålderism, vilken kan påverka vårdens kvalitet och orsaka ett lidande för de äldre patienterna. Syfte: Att beskriva äldre patienters upplevelser av vården på en geriatrisk vårdavdelning i Mellansverige. Metod: Latent kvalitativ innehållsanalys av tolv semistrukturerade intervjuer. Resultat: Resultatet utgörs av två teman och sju subteman. Temat Upplevelser av att få en god vård beskriver att de äldre patienterna upplevde sig få en vårdande miljö samt att vårdpersonalen fungerade som en hälsoresurs vilket kunde gynna patienternas välbefinnande. Temat belyser att ett gott bemötande och att få bli sedd som en person resulterade i positiva känslor samt att delaktighet och självbestämmande var viktiga faktorer. Temat Upplevelser av att få en bristande vård beskriver att upplevelser av en otrygg omgivning och avsaknad av sjukdomshänsyntagande, bristande bemötande och kunskap samt att inte få en personcentrerad vård resulterade i negativa känslor. Slutsatser: Resultatet visar att det förekommer både positiva och negativa upplevelser av vården på avdelningen. Att de äldre patienterna upplever brister i vården uppmärksammar att det finns en risk för att ålderism existerar och påverkar vårdens kvalitet. Examensarbetet kan tillföra kunskap om och förståelse för hur äldre patienter upplever vården, vilket kan bidra till bättre förutsättningar för en god vårdupplevelse. / Background:  Swedish statistics indicate that there will be an increase in the number of elderly with multiple illnesses. The Health Care Act stipulates that the care provided must be of good quality and meet the patients’ needs for security. In today's society there is a risk that older people are subjected to ageism, which can affect the quality of healthcare and expose the older patients to conditions of suffering. Aim: To describe older patients’ experiences of healthcare at a geriatric ward in central Sweden. Methods: A latent qualitative content analysis of twelve semi-structured interviews. Results: The results consist of two themes and seven subthemes. The theme Experiences of getting good health care describes that when older patients experienced a nurturing environment and the caregivers worked as a health resource, it could benefit the patients’ wellbeing. The theme emphasizes that encountering a good reception and being aknowledged as a person resulted in positive emotions, and that participation in the care process and self-determination were key factors. The theme Experiences of receiving a lack of care describes that the experience of an unsafe environment, actual diseases not being taken into account, lack of treatment and knowledge, as well as being denied person-centered care, resulted in negative emotions. Conclusions: The results indicate that both positive and negative resposnses concerning the care at the ward are experienced. The older patients who experience deficiencies in healthcare, recognize that there is a risk that ageism exists, which may affect the quality of care. The thesis provides knowledge and understanding of how older patients experience healthcare which can contribute to better conditions for the patients, in order for them to experience good healthcare.

Introdução: a vulnerabilidade é um conceito que visa ampliar a compreensão da condição de saúde do ser humano. Posto isto, o objetivo geral deste estudo foi analisar a vulnerabilidade individual, social e programática entre idosos que vivem no domicílio e sua associação com os desfechos adversos relacionados aos indicadores da condição de saúde, e mapeá-los espacialmente. Método: trata-se de um estudo epidemiológico de base populacional, do tipo inquérito domiciliar, transversal e observacional, desenvolvido no município de Uberaba (MG). Constituíram a amostra final 701 idosos selecionados por meio da amostragem por conglomerado em múltiplo estágio. Para avaliação do componente individual recorreu-se ao fenótipo de fragilidade; o programático por meio de um indicador de acesso e utilização do serviço de saúde; o social mediante a distribuição espacial dos setores censitários do município deste estudo. Procedeu-se análise descritiva, análise de componentes principais, teste qui-quadrado e modelos de regressão logística, logística multinomial e linear (p<0,05). A análise espacial foi realizada por meio de mapas temáticos. Resultados: constatou-se que 32,0 % dos idosos apresentava as três condições de vulnerabilidade (individual, social e programática) concomitantemente. Evidenciaram-se como fatores associados à condição de fragilidade física: sexo feminino (p=0,015) e faixas etárias de 70 a 79 anos (p=0,013) e 80 anos ou mais (p<0,001). Para condição de elevada/muito elevada vulnerabilidade social predominaram: faixas etárias de 60+ 70 anos (p=0,009) e 70+ 80 anos (p=0,039); ausência de escolaridade (p<0,001) (p<0,001) e 1+4 anos de estudo (p=0,001); e renda mensal < 1 salário mínimo (p=0,007), 1 salário (p=0,013) e 1+3 salários (p=0,027). Já os fatores associados à moderada vulnerabilidade programática foram: faixa etária 70+ 80 anos (p=0,039); não possuir escolaridade (p=0,017), 1+4 anos de estudo (p=0,003) e 4+9 anos de estudo (p=0,029). Na análise de associação entre os componentes da vulnerabilidade, constatou-se menor proporção de idosos frágeis com elevada vulnerabilidade programática quando comparados aos pré-frágeis e não frágeis (p=0,011). Na distribuição espacial dos desfechos adversos de saúde segundo a vulnerabilidade social, houve maior ocorrência de quedas, dependência para AIVD e péssima/má autopercepção de saúde entre idosos residentes em áreas de elevada/muito elevada vulnerabilidade social comparados aos demais. Em relação à associação entre os componentes de vulnerabilidade e os desfechos de saúde, observou-se associação da fragilidade física com todos os desfechos analisados (quedas, hospitalização, dependência para ABVD e AIVD, autopercepção de saúde e número de morbidade). O componente social associou-se à dependência para ABVD e AIVD e à autopercepção de saúde. Já o componente programático permaneceu associado apenas ao maior número de morbidade. Conclusão: os resultados evidenciaram que os idosos estão sujeitos às condições de vulnerabilidade sob as perspectivas biológica, social e no acesso e utilização de serviços de saúde. Infere-se que os componentes individual, social e programático de vulnerabilidade podem influenciar nas condições de saúde de idosos, sendo que a fragilidade física se relacionou a todos os desfechos analisados / Vulnerability is a concept intended to broaden understanding regarding the health condition of people. This study\'s general objective was to analyze the individual, social and programmatic vulnerability of elderly individuals living in the community and its association with adverse outcomes related to health status indicators, in addition to mapping them spatially. Method: This population-based, cross-sectional and observational epidemiological study included a survey conducted in the individuals\' homes in the city of Uberaba, MG, Brazil. The final sample included 701 elderly individuals selected through multistage cluster sampling. The fragility phenotype was used to assess the individual component; the programmatic component was verified through an indicator for access and attendance to health services; and the social component was verified through the spatial distribution of the census sector of the city under study. Descriptive analysis, principal components analysis, and the Chi-square test, in addition to logistic regression models and multinomial logistic regression (p<0.05) were performed. Spatial analysis was conducted using thematic maps. Results: 32.0% of the elderly individuals concomitantly presented three vulnerability conditions (individual, social and programmatic). The factors that appeared associated with a physically frail condition were: being a woman (p=0.015), aged from 70 to 79 years old (p=0.013) or 80 years old or older (p<0.001). The following predominated for conditions of high social vulnerability: aged from 60+ 70 years old (p=0.009) and 70+ 80 years old (p=0.039); no formal education (p<0.001) (p<0.001) and 1+4 years of schooling (p=0.001); and monthly income < 1 times the minimum wage (p=0.007), 1 times the minimum wage (p=0.013) and 1+3 times the minimum wage (p=0.027). The factors associated with moderate programmatic vulnerability were: ages between 70+ 80 (p=0.039); no formal education (p=0.017), 1+4 years of schooling (p=0,003) and 4+9 years of schooling (p=0,029). Analysis of association among vulnerability components revealed a lower proportion of frail elderly individuals with high programmatic vulnerability when compared to their pre-frail and non-frail counterparts (p=0.011). The spatial distribution of adverse health outcomes according to social vulnerability revealed a greater occurrence of falls, dependency for IADLs, and poor/very poor self-perception of health status among those living in areas of high/very high social vulnerability compared to their counterparts. In regard to association among vulnerability components and health outcomes, physical frailty was associated with all outcomes (falls, hospitalization, dependency for ADLs and IADLs, self-perception of health and number of morbidities). The social component was associated with ADL and IADL dependency and self-perception of health. The programmatic component remained associated only with a greater number of morbidities. Conclusion: The results evidenced that elderly individuals are subject to vulnerable conditions from a biological and social perspective also considering access and use of health services. The results suggest that individual, social and programmatic components of vulnerability influence the health conditions of elderly individuals, while physical frailty was related to all the outcomes under study

O aumento da população mundial de idosos aponta para a necessidade de adaptações, entre elas a formação de profissionais que estejam preparados para atuarem nesse novo contexto. Este estudo de cunho qualitativo, realizado junto a alunos de graduação em enfermagem, teve como objetivo identificar as crenças gerais, pessoais e normativas dos entrevistados quanto ao cuidar do idoso e a influência do currículo na construção das crenças, utilizando como referencial teórico a Teoria da Ação Racional (Theory of Reasoned Action - TRA). A pesquisa foi realizada na Universidade Cidade de São Paulo com dezoito alunos que já haviam iniciado uma abordagem sobre o envelhecimento e o cuidar do idoso. A coleta de dados se deu através de entrevistas semi-estruturadas e para análise dos dados foi utilizada a técnica de análise de conteúdo, que possibilitou evidenciar crenças positivas e negativas que foram agrupadas em três Unidades Temáticas Centrais estabelecidas a priori, dentro dos pressupostos da TRA: Crenças de Atitude, Crenças Normativas e Crenças Gerais. Nas crenças de Atitude destacaram-se as Categorias Temáticas Centrais: Crenças Afetivas, Vantagens, Desvantagens e Influência do conhecimento adquirido. Nas crenças Normativas foram evidenciados Referentes sociais e Fatores que estimulam ou desestimulam o cuidar do idoso. Dentre as crenças gerais destacamos: Crenças sobre os requisitos para cuidar do idoso, Crenças sobre habilidades e competências para cuidar do idoso, Preparo durante a faculdade e Percepção sobre cuidar do idoso. Estes resultados deixam perceber que a forma pela qual levamos o conhecimento e proporcionamos experiências aos alunos pode ter uma relação direta na consolidação, ampliação ou substituição de suas crenças, com influência marcante na sua assistência atual e principalmente futura, quando já será um profissional. Assim, este estudo nos permite a reflexão sobre a forma de ensinar e a influência que as crenças formadas poderão ter na ação do futuro profissional, sendo que para tanto necessitamos voltar o nosso olhar para a prática docente, e para qual enfermagem queremos ensinar. / The increase of the elderly population in the world points to a need of adaptations, among them the professionals\' background to be prepared to act in this new context. This qualitative study, made with nursing undergraduate students, aimed to identify the respondents\' general, personal and normative beliefs regarding to the elderly care and the influence of the curriculum to build their beliefs, using the Theory of Reasoned Action (TRA) as the theoretical referential. The research was made at the University of Sao Paulo City with eighteen students who had already started an approach to aging and the elderly care. Data collection was made through semi-structured interviews and for data analysis it was used the content analysis technique, which made it possible to evidence negative and positive beliefs that were grouped in three Central Theme Units previously established, according to the TRA premises: Behavioral Beliefs, Normative Beliefs and General Beliefs. In Behavioral Beliefs we can emphasize the Central Theme Categories: Affective Beliefs, Advantages, Disadvantages and Influence of the knowledge acquired. In Normative Beliefs it was evidenced Social References and Factors that stimulate or discourage the elderly care. Among General Beliefs we stand out: Beliefs on the requirements for caring the elderly, Beliefs on the skills and competences for caring the elderly, preparation in college and perception on caring the elderly. These results reveal that the way in which we bring knowledge and provide experiences for the students can have a straight connection to the consolidation, enlargement or substitution of their beliefs, with a strong influence in their present and mainly future care, when they will be professionals. Thus, this study allows us to reflect on the way of teaching and the influence of formed beliefs may have on the future professional\'s acting, that is to say that we need to look at the teaching staff practice and for what kind of nursing we want to teach.