Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-10-13T20:44:17Z No. of bitstreams: 1 Thiara Joanna Peçanha da Cruz.pdf: 3229970 bytes, checksum: 9d166af1ff8da085af25a4b1132a18b3 (MD5) / Made available in DSpace on 2015-10-13T20:44:17Z (GMT). No. of bitstreams: 1 Thiara Joanna Peçanha da Cruz.pdf: 3229970 bytes, checksum: 9d166af1ff8da085af25a4b1132a18b3 (MD5) Previous issue date: 2011 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O objeto deste estudo é a estimulação cognitiva realizada pelo cuidador do idoso com doença de Alzheimer, levando à seguinte questão de pesquisa: “quais as influências da estimulação cognitiva no idoso com doença de Alzheimer (DA) realizada pelo cuidador em domicílio?" O estudo parte do pressuposto de que “existe uma diferença no resultado dos testes de cognição quando os idosos são estimulados esporadicamente e quando eles são estimulados continuamente no domicílio pelo cuidador”. Dessa forma têm-se como objetivos: Analisar a influência da estimulação cognitiva no domicílio realizado, diariamente pelo cuidador de idosos com DA; Implementar um programa de estimulação cognitiva, voltado para o desenvolvimento de atividades de vida diária do idoso com DA, realizado pelo cuidador em domicílio; Conhecer a influência da intervenção cognitiva voltada para o desenvolvimento de atividades de vida diária do idoso no domicílio pelo cuidador. Para a aplicação da estratégia foi utilizado o método de estudo de caso. Os sujeitos foram cinco idosos com DA e seus cuidadores participantes das oficinas terapêuticas realizadas no Programa “Enfermagem na Atenção a Saúde do Idoso e seus Cuidadores” da Universidade Federal Fluminense, no centro de Niterói - RJ. As etapas de desenvolvimento da pesquisa foram: palestra de orientação com os cuidadores, seleção dos idosos e cuidadores; abordagem dos sujeitos em domicílio, encontro em domicílio do profissional com o idoso e cuidador e reaplicação dos testes de mês em mês para acompanhamento da função cognitiva do idoso. E os resultados desse estudo, principalmente no que se refere ao teste do MEEM no domínio de orientação temporal e espacial, contrapõem os dados propostos em literatura. Foi possível identificar, após a introdução das atividades de estimulação cognitiva em domicílio, um aumento no escore do MEEM, muito significativo para o idoso com DA evidenciando a importância de motivar a prática da estimulação de forma contínua, neste caso estendida em domicílio com a participação do cuidador. Identificou que os cuidadores sendo a maioria, mulheres e ao mesmo tempo responsáveis por organizar todo o lar, apresentaram dificuldades em incluir mais uma tarefa, neste caso, a estimulação cognitiva, em suas atividades diárias. Foi possível notar que o próprio cuidador percebeu que tal estratégia foi benéfica para o idoso. Também foi possível notar que a atenção do cuidador redobrou para a detecção precoce de dependências no idoso. E ao final pode-se perceber um compromisso com tal estratégia aplicada por parte do cuidador. Os referenciais teóricos de Merhy, junto ao de Paterson e Zderad foram úteis tanto para introduzir a prática de estimulação cognitiva em domicílio pelos cuidadores, quanto na construção do conhecimento referente ao tema deste estudo. Os idosos através dos cuidadores que participaram desta pesquisa puderam ser beneficiados com a implantação desta estratégia, pois este trabalho contribuiu para melhorar a compreensão dos cuidadores em relação à importância em dar continuidade à atividade iniciada nas oficinas terapêuticas e, assim realizar um plano de cuidados de estimulação cognitiva em domicílio. Conclui-se que está estratégia pode ser considerada como uma tecnologia leve do cuidado de enfermagem para idosos com demência e que necessita de maiores aprofundamentos e implementação contínua para os idosos com tal patologia / The object of this study is the “cognitive stimulation realized by the elderly´s caregiver with Alzheimer´s disease”, leading to the following research question:“ which are the influences of the cognitive stimulation in the elderly with Alzheimer´s disease (DA) realized by the caregiver at home? The study makes the assumption that “there is a difference in the result of the cognition tests when the elderly are stimulated sporadically and when they are stimulated continuously at home by the caregiver”. Thus it has as objectives: To analyze the influence of the cognitive stimulation at home realized, everyday by the elderly ´s caregiver with DA; To implement a program of cognitive stimulation, addressed to the development of daily activities of the elderly with DA, realized by the caregiver at home; To know the influence of the cognitive intervention addressed to the development of elderly´ s daily activities at home by the caregiver. To the implementation of the strategy the case study method was used. The subjects were five elderly with DA and theirs caregivers participant of the therapeutic workshops realized in the Program “Nursing in the Attention to Elderly´ s Health and theirs Caregivers” of the Federal Fluminense University, in the center of Niterói-R.J. The stages of the research development were: lecture for orientation with the caregivers, elderly and caregivers´ selection; subjects´ approach at home, meeting at home of the professional with the elderly and caregiver and reimplementation of the tests each month for monitoring of the elderly´ s cognitive function. And the results of this study, mainly in that regarding the MEEM test in the field of time and spatial orientation, oppose the data proposed in literature. It was possible to identify, after the introduction of the cognitive stimulation activities at home, an increase in the MEEM score, very significant for the elderly with DA evidencing the importance of motivating the stimulation practice in a continuous form, in this case extended at home with the caregivers participation. It was identified that the caregivers being the majority, women and at the same time responsible for organizing all the home, presented difficulties in including more one task, in this case, the cognitive stimulation, in their daily activities. It was possible to notice that the own caregiver perceived that such strategy was beneficial for the elderly. It was also notice that the attention to the caregiver doubled for the precocious detection of dependences in the elderly. And at last it could perceive a commitment with such strategy applied by the caregiver. The Merhy and Paterson and Zderad´ s theoretical references were useful both to introduce the cognitive stimulation practice at home, and in the construction of the knowledge referent to the theme in this study. The elderly through the caregivers who participated of this research could be beneficed with the implantation of this strategy, once this work contributed to improve the caregivers´ s understanding regarding the importance in continuing the activity initiated in the therapeutic workshops and, thus realize a care plan of cognitive stimulation at home. It concluded that this strategy can be considered a soft technology of the nursing care for elderly with dementia and that needs of more continuous deepening and implementation for the elderly with such pathology

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-08T14:35:24Z No. of bitstreams: 1 Priscilla Alfradique de Souza.pdf: 3733823 bytes, checksum: 6981e7055261f56d36e73241cf842595 (MD5) / Made available in DSpace on 2015-12-08T14:35:24Z (GMT). No. of bitstreams: 1 Priscilla Alfradique de Souza.pdf: 3733823 bytes, checksum: 6981e7055261f56d36e73241cf842595 (MD5) Previous issue date: 2010 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução - As dificuldades em estabelecer critérios clínicos para identificação do diagnóstico de enfermagem (DE) memória prejudicada (MP) e para confusão crônica (CC), devido as semelhanças entre algumas características definidoras (CD) e fatores relacionados (FR) levaram à formulação dos objetivos: validar os DE propostos pela NANDA-I, MP e CC, por meio da análise diferencial; analisar os diagnósticos MP e CC a partir da revisão integrativa da literatura; analisar as CD, os FR, bem como a pertinência dos títulos, conceitos e a disposição proposta dos DEMP e CC pela NANDA-I, mediante análise por especialistas. Método - estudo quantitativo, com utilização das propostas metodológicas de Hoskins e Fehring desenvolvidas em três etapas. Na primeira, realizou-se a análise conceitual por meio de uma revisão integrativa. Adotou-se como descritores: diagnósticos de enfermagem, memória prejudicada, confusão crônica, nursing diagnosis, impaired memory e chronic confusion. Na segunda etapa, validação de conteúdo por especialistas, o estudo obteve participação de 31 enfermeiros respondentes do formulário de análise dos critérios diferenciais do DEMP e CC, encaminhado a 249 peritos de diversos estados do Brasil, com pontuação igual ou superior a 6. A análise de dados procedeu de forma estatística, descritiva e inferencial. Na terceira etapa do estudo realizou-se a validação diferencial, mediante pareamento das respostas de média geral com auxílio do teste de Wilcoxon. O estudo obteve aprovação do Comitê de Ética em Pesquisa e a concordância dos peritos mediante assinatura do termo de consentimento livre e esclarecido. Resultados - Dos 30 artigos analisados, 15 (50%) caracterizaram-se como estudos não experimentais. Quanto à distribuição entre os dois DE, 5 (16,7%) artigos estavam direcionados à MP, 4 (13,3%) a CC, e 21 (70,0%) tratavam de ambos, dando indícios da similaridade existente. Para o DEMP foram identificadas duas CD como principais: “incapacidade de determinar se uma ação foi executada” escore de 0,86 e “incapacidade de reter novas habilidades”, 0,89. Entre os FR, três foram considerados secundários: “distúrbios neurológicos” 0,78, “hipóxia” 0,70, e “débito cardíaco diminuído” 0,66 e nenhum primário. No DECC não houve CD principal, a maioria (8) permaneceu com pontuações entre 0,79 e 0,63, e duas abaixo: “evidência clínica de prejuízo orgânico” com escore de 0,57 e 0,46 para “nenhuma mudança no nível de consciência”. Entre os FR, dos cinco, três obtiveram escores principais: “acidente vascular cerebral” 0,83, “demência por multiinfarto” 0,81 e “doença de Alzheimer” 0,81. Conclusão - Os resultados apontaram pouca especificidade para esses diagnósticos, fortalecendo a hipótese nula inicial, em que se afirmou a inexistência de diferenças significativas entre as CD e os FR dos DEMP e CC. As semelhanças identificadas pelos enfermeiros ratificaram os resultados da revisão integrativa, corroborando os dados obtidos na validação diferencial dos diagnósticos. Conclui-se que a disposição dentro da NANDA-I está adequada, pois tais diagnósticos estão relacionados com a pertinência ao padrão funcional em que estão inseridos. Ainda assim, pode ocorrer necessidade de mudança dos títulos e dos conceitos, sendo necessários estudos para esta nova formulação diagnóstica. / Introduction - The difficulty to establishing clinical criteria for identification of the Nursing Diagnosis (ND) Impaired Memory (IM) and the Chronic Confusion (CC), due to the similarities between some Defining Characteristics (DC) and Related Factors (RF) led to the formulation of objectives: to validate the diagnostics proposed at NANDA-I, IM and CC, by validation of the differential diagnostic; to analyze the diagnoses IM and DC by way of the integrative review of literature; to analyze the DC, RF, as well as the relevance of titles, concepts and the order proposed for NDIM and CC by NANDA-I, through the analyzes by experts. Method - quantitative study, with the use of the Hosking and Fehring's methodological proposals developed in three stages. At first, the conceptual analysis was developed by means of an integrative review. The descriptors that were used: nursing diagnoses, impaired memory, chronic confusion, nursing diagnosis and the same words in Portuguese. In the second stage, validation of diagnostic content, the study had 31 nurses that answered the questionnaire for analysis of the differential criteria NDIM and CC, routed to 249 experts in several Brazilian states, with a score equal or higher than 6. The data analysis was proceeded by statistical, descriptive and inferential mode. In the third stage, the validation of differential diagnostic was developed by matching the replies of overall average, with the Wilcoxon test. The study was approved by the Ethics in Research and the willingness of the experts upon signature of the term of free and informed consent. Results - 30 articles were analyzed, 15 (50%) of them were characterized as observational study. About the distribution between the two ND, 5 (16.7%) of articles were directed toward IM, 4 (13.3%) to the CC, and 21 (70.0%) treated to both diagnosis, giving an evidence of similarity. For the NDIM were identified two DC as main: “inability to determine if an action was performed”, with score of 0,86 and “inability to learn new skills” (0,89). Between the RF, three were considered secondaries: “neurological disturbances”, “hypoxia” and “decreased cardiac output”, 0,78, 0,70 and 0,66 and none primary RF. In NDCC there was none principal DC, the majority (8) remained with scores between 0,79 and 0,63, and 2 with values lower than these: “clinical evidence of organic impairment”, with score of 0,57 and 0,46 for “no change in level of consciousness”. Between the RF, in a total of five, three RF obtained main scores: “cerebral vascular attack”, 0,83, “multi-infarct dementia” 0,81, and the last one, “Alzheimer's disease” 0,81. Conclusion - the results showed little specificity for these diagnoses, what strengthening the null initial hypothesis, with the absence of significant differences between the DC and the RF of NDIM and CC. The similarities identified by nurses confirmed the results of the integrative review and also reenforcing the obtained data in validation of differential diagnostic. It concludes that the provision within the NANDA-I is adequate, because such diagnostics are related to the relevance to the standard function, where they are inserted. Even so, some changes on titles and concepts may be necessary, as well as, new studies will be indispensable for this new diagnostic wording.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-07T18:48:48Z No. of bitstreams: 1 George Luiz Alves Santos.pdf: 1872027 bytes, checksum: bdfb513690f509fc90967b7a77d1a157 (MD5) / Made available in DSpace on 2016-10-07T18:48:48Z (GMT). No. of bitstreams: 1 George Luiz Alves Santos.pdf: 1872027 bytes, checksum: bdfb513690f509fc90967b7a77d1a157 (MD5) Previous issue date: 2015 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução: Para executar as Atividades Instrumentais de Vida Diária, os idosos interagem e estabelecem relações interpessoais. A comunicação é o que permite expressarem suas necessidades e desejos, contudo, no contexto da atualidade, o processo de comunicação se opera de forma rápida, informatizada, tecnológica, podendo suscitar processos comunicativos fragilizados, e resultando em ruídos na comunicação, ou mesmo em dificuldades na execução das Atividades de Vida Diária. Para tanto, formularam-se, como objetivos: discutir as implicações do processo de comunicação de idosos nas Atividades Instrumentais de Vida Diária para o cuidado de Enfermagem Gerontológica; descrever o processo de comunicação de idosos ao executar as Atividades Instrumentais de Vida Diária; e analisar os elementos constituintes, estratégias, ruídos e barreiras do processo de comunicação de idosos ao executar as Atividades Instrumentais de Vida Diária. O referencial teórico adotado neste estudo foi o Processo de Comunicação e a Teoria da Diversidade e Universalidade do Cuidado Cultural. Método: Estudo de abordagem qualitativa, do tipo etnoenfermagem. Para coleta dos dados, utilizaram-se a observação participante e a entrevista semiestruturada. Como cenário do estudo, teve-se um projeto de extensão universitária para idosos, localizado na cidade de Niterói (RJ). Participaram 35 idosos, tendo-se como critérios de inclusão frequentar há pelo menos 1 ano e de forma regular as atividades do projeto. Foram excluídos aqueles que faltaram a dois encontros agendados. Participaram do estudo sete profissionais, incluindo-se os que possuíam graduação completa e atuavam em atividades do projeto de extensão. As técnicas de coleta de dados foram a observação etnográfica (Modelo OPR); o Diário de Campo; e a entrevista de reconhecimento e aprofundamento. O período de coleta de dados foi de novembro de 2013 a agosto de 2014. Para análise dos dados, seguiram-se as quatro etapas proposta pela etnoenfermagem. O estudo teve aprovação do Comitê de Ética em Pesquisa local. Resultados: As categorias do estudo foram: comunicação nos grupos de convivência como promotora da cultura do envelhecimento ativo e saudável; Capacidade para execução das Atividades Instrumentais de Vida Diária: um conceito de saúde para os idosos; A utilização de tecnologias na execução das Atividades Instrumentais de Vida Diária: usos e possibilidades; Cenários de execução das Atividades Instrumentais de Vida Diária: fatores culturais e sociais; A comunicação no contexto de execução das Atividades Instrumentais de Vida Diária: ruídos e estratégias. Discussão: Os grupos foram espaços possíveis de problematizar a demandas dos idosos em relação à execução das Atividades de Vida Diária. As oficinas, se contextualizadas às necessidades dos idosos e fomentando a participação ativa deles nas atividades, permitem trabalhar conceitos importantes, como autonomia e independência. Diariamente, idosos executam suas atividades diárias, e a comunicação é o elo que permite a interdependência com quem eles interagem, contudo, essa necessidade está contextualizada. Assim, podem surgir ruídos na comunicação, caso o idoso não esteja adaptado; portanto, adquirir habilidades comunicadoras, como, por exemplo, o domínio da informática ou, ainda, o uso da própria linguagem de forma adequada, pode contribuir para uma comunicação efetiva. Conclusões: O treinamento das habilidades comunicadoras dos idosos nos grupos pode diminuir ruídos na comunicação quando estes executam as Atividades Instrumentais de Vida Diária, ou seja, promover a independência e a autonomia. No cuidado de enfermagem gerontológica, ao associar a promoção do envelhecimento ativo aos princípios da enfermagem transcultural, potencializa-se o cuidado congruente. / Introduction: In order to perform Instrumental Activities of Daily Living, the aged individuals interact and establish interpersonal relationships. Communication allows them to express their needs and wishes; however, nowadays, the communication process works very quick, computerized and using technology, which may cause fragile communicative processes, resulting in communication noise or even in difficulties to run the Instrumental Activities of Daily Living. Hence, the formulated objectives were: approaching the implications of the communication process of aged individuals in Instrumental Activities of Daily Living to Gerontological Nursing care; describing the communication process of aged individuals to perform Instrumental Activities of Daily Living; and analyzing the constituting elements, strategies, noises, and barriers of aged individuals’ communication process when performing Instrumental Activities of Daily Living. The theoretical referential adopted in this study was the Communication Process and the Theory of Diversity and Universality of Cultural Care. Method: This was an ethnonursing study of qualitative approach. Participant’s observation and semistructured interview were used for data collection. The study scenario was a university extension project for aged individuals, located in the city of Niterói (RJ). Thirty-five aged individuals participated, and inclusion criteria included going to the project activities at least for 1 year and in a regular basis. Participants who did not go to two scheduled meetings were excluded. Seven professionals took part in the study, including those with complete school education and those who worked in activities of the extension project. Data collection techniques included ethnographical observation (OPR Model); Field Diary; and recognition and deepening interview. Data collection period was from November 2013 to August 2014. For data analysis, the four stages proposed in ethnonursing were followed. The local Committee of Ethics Research approved the study. Results: The study categories comprised the following: Communication in groups of familiarity as a promotor of active and healthy aging culture; Capacity to perform Instrumental Activities of Daily Living: a health idea for aged individuals; The use of technologies to perform Instrumental Activities for Daily Living: uses and possibilities; Performance scenarios of Instrumental Activities for Daily Living: cultural and social factors; Communication in the performance notion of Instrumental Activities of Daily Living: noises and strategies. Discussion: Groups form spaces where it is possible to problematize the demands of aged individuals regarding the performance of Instrumental Activities of Daily Living. If the needs of aged individuals are put into context and their active participation in activities is encouraged, the workshops allow working important concepts like autonomy and independence. Every day, aged individuals run their daily activities, and communication is the link that allows interdependence with whom they interact. However, this need is contextualized. Thus, communication noises may arise if the senior is not adjusted; therefore, acquiring communicative skills, such as computing mastery or even the use of their own language appropriately, may contribute for an efficient communication. Conclusions: Practice of the communicative skills of aged individuals in groups can decrease noises in communication, when these subjects perform their Instrumental Activities of Daily Living, i.e. to promote independence and autonomy. In Gerontological Nursing care, the association of active aging promotion with transcultural nursing principles empowers the congruent care.

Made available in DSpace on 2014-08-20T14:30:07Z (GMT). No. of bitstreams: 1 Dissertacao_mauro_mesko.pdf: 1218358 bytes, checksum: 91782e3d1bf5a72f4bbadf7935232dc0 (MD5) Previous issue date: 2012-06-02 / Longevity increase is not directly related to quality of life. In Dentistry, it became in evidence by the fact that almost twenty-five percent of the population between 65 and 74 year-old presents a completely edentulous arch. As the elderly have a higher probability of being affected by chronic oral problems they tend to demand complex treatments. The aim of this survey was to: (i) evaluate the relationship between the Oral Health Impact Profile (OHIP-EDENT) and Geriatric Oral Health Assessment Index (GOHAI) questionnaires to assess the oral health quality of life in denture wearers, (ii) evaluate the associated factors to impairment in the oral health quality of life in elderly wearing removable dentures using the OHIP- EDENT and GOHAI. Evaluation of the oral health quality of life in complete denture and removable partial denture wearers was performed according to the World Health Organization criteria. The survey consisted of applying GOHAI and OHIP-EDENT questionnaires and a clinical examination. Questions about socioeconomic conditions were applied aiming to determine which factors have an influence in oral health related quality of life. The hypotheses tested were (1) different questionnaires would provide similar results when assessing oral health quality of life in totally or partially edentulous patients wearing prosthesis; (2) age, socioeconomic profile, type and location of the prosthesis and their stability and retention would not be associated to the oral health quality of life. The results showed that the questionnaires are different tools when both the total and adjusted values were compared. The exception was for Kennedy Class I and II removable partial dentures wearers. Mandibular complete dentures caused a higher impact in individuals quality of life, except for the removable partial denture wearers. For the patients aged 60 years old or more the questionnaires showed themselves quite different. Among the subscales, the only statistically difference was found in functional limitation and the domains food catching was the one that showed difference in the removable partial denture wearers group. Using the same questionnaires the variables age, familiar income, type of prosthesis, stability and retention of the prosthesis were evaluated. Factors associated to the 14 impact in OHRQoL were familiar income, stability and retention of the prostheses. Therefore, OHIP-EDENT and GOHAI are different tools, especially when used with individuals older than 60 years old, poor denture quality was associated to the impact in quality of life while income had influence on the results / O aumento da longevidade nem sempre está associado diretamente a uma melhora na qualidade de vida. Na Odontologia isso é evidente uma vez que quase um quarto da população entre 65 e 74 anos tem um de seus maxilares totalmente desdentados, conforme o levantamento de Saúde Bucal de 2010. Os pacientes idosos têm uma maior probabilidade de apresentarem problemas bucais crônicos e potencial demanda de tratamentos complexos. Os objetivos deste estudo foram (i) avaliar se existe correlação entre os questionários Oral Health Impact Profile for Edentulous (OHIP-EDENT) e Geriatric Oral Health Assessment Index (GOHAI) para medir qualidade de vida relacionada à saúde bucal em uma população de usuários de próteses removíveis; (ii) avaliar os fatores associados a incapacidades na qualidade de vida relacionada a saúde bucal em uma população de usuários de próteses removíveis utilizando o OHIP-EDENT e o GOHAI. Pacientes usuários de próteses removíveis atendidos nas Clínicas da Faculdade de Odontologia da UFPel foram avaliados seguindo os critérios da Organização Mundial de Saúde onde foi realizado exame intrabucal. Foram aplicados os questionários GOHAI e OHIP-EDENT, além de questões sobre condições demográficas e socioeconômicas, visando determinar se algum fator influenciaria na qualidade de vida destes indivíduos. As hipóteses testadas foram as de que: (1) os questionários apontariam resultados semelhantes na mensuração da qualidade de vida relacionada à saúde bucal em pacientes usuários de próteses removíveis; (2) os fatores idade, condição socioeconômica, tipo de prótese e localização da prótese, bem como sua retenção e estabilidade não estariam associados a incapacidades na qualidade de vida relacionada à saúde bucal. Os resultados mostraram que o OHIP-EDENT e o GOHAI são ferramentas diferentes tanto quando se comparam os resultados brutos quanto os ajustados, exceto para as próteses parciais removíveis Classes I e II de Kennedy. As próteses totais mandibulares se mostraram causadoras de maior impacto sobre a qualidade de vida dos indivíduos, porém isto não ocorreu com as 12 parciais removíveis. Para o grupo de pacientes acima dos 60 anos o OHIP-EDENT e o GOHAI mostraram resultados bastante diferentes, parecendo ser o OHIP-EDENT mais sensível. Dentre as subescalas dos dois questionários, a única que mostrou diferença estatística foi a limitação funcional, sendo o domínio que mostrou diferença a retenção alimentar nos grupos de próteses parciais removíveis. Utilizando os mesmos questionários, quando se avaliaram as variáveis idade, renda familiar, tipo de prótese e retenção e estabilidade das próteses, os fatores associados ao impacto na qualidade de vida foram: renda familiar, estabilidade e retenção. Conclui-se que o OHIP-EDENT e o GOHAI são ferramentas diferentes, principalmente para uso em pacientes acima dos 60 anos e que a qualidade da prótese está associada ao impacto na qualidade de vida, além do fator renda ter influência sobre os resultados

Introduction Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in this population. Methods Data from the National Social Life, Health, and Aging Project (NSHAP) wave 2 was utilized to examine the prevalence and characteristics of OTC medication use in a nationally representative sample (N=2,637) of community-dwelling US older adults (65 years and older). OTC medication use was characterized based on sociodemographic, intrapersonal, interpersonal, organizational, and community-level factors. Further, a mixed-methods study was conducted in two senior-living communities in Richmond, VA. The qualitative phase of this mixed-methods study used focus group methodology to explore the knowledge, attitude, beliefs, and experiences about OTC medications, and the OTC medication decision-making process in a sample (N=80) of older adults using the criterion sampling strategy of purposeful sampling. Results from the qualitative phase informed the development of a semi-structured questionnaire, which was used to collect data in the quantitative phase of the mixed-methods study. The quantitative phase used in-person interviews to quantify attitudes, beliefs, preferences, and practices associated with the OTC medication use and decision-making process in a different convenient sample (N=88) of older adults within the same settings. Results NSHAP Study: The majority of participants were women (54%), whites (82%), and with an education greater than high school (57%). Study findings indicate a high weighted prevalence (76%) of OTC medication use in a nationally representative sample of older adults. Among older adult men, education (p value=0.0038), race (p value=0.0003) and comorbidity (p value =<0.0001) significantly and independently predicted the OTC medication use. Older adult men who were whites had greater odds of using OTC medication than other races. Older adult men with higher than high school education were 1.54 times more likely (95% CI: 1.15-2.06) to use OTC medications than their counterparts. It was observed that with every unit increase in the number of co-morbid conditions, OTC medication use decreases by 26% (OR: 0.74, 95% CI: 0.65-0.84) among older adult men. Among older adult women, education (p value=0.0244), race (p value=0.0048), smoking (p value=0.0494), and social participation (p value=0.0341) showed a significant and independent association with OTC medication use. Older adult women who were whites and non-smokers had greater odds of using OTC medication than their counterparts. Older adult women with higher than high school education were 1.36 times more likely (95% CI: 1.04-1.79) to use OTC medications than their counterparts. It was observed that with every unit increase in the social participation, OTC medication use increases by 15% (OR: 1.15, 95% CI: 1.01-1.31) among older adult women. Qualitative Study: The majority of the sample were women (63%), whites (54%), and with an education greater than high school (60%). The study indicated that the OTC medications are generally considered very safe and effective for treating minor/routine symptoms by older adults. Brand version OTC medications were generally favored over generics by this sample of US older adults. There were found two types of decision-making scenarios following after the older adults make sense of their symptoms: 1) treatment decision-making and 2) purchase decision-making. The treatment decision-making comes with two approaches: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow physician’s recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person’s financial and healthcare resources, severity of the symptoms, experiences with the medication (past or current), and relationship with the physician. While purchasing OTC medication from the store, the majority of consumers first explore information on the drug-label, ask a pharmacist, compare various options (generic or brand), compare prices/deals, and make a final purchase decision favoring the maximum and fast relief, followed by the lower cost, and easy to swallow dosage forms. Quantitative study: The majority of the sample was women (55%), blacks (61%), and with an education less than or equal to high school (55%). Analgesics were the most (76%) prevalent OTC therapeutic category, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of the participants reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician-recommended use. A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most participants considered OTC medications very safe or safe (80%) and very effective or effective (80%) to use. The majority (79%) of participants felt very satisfied, and 16% felt satisfied with their OTC medication use. Brand name OTC medications were considered more safe and effective compared to generic versions. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source about OTC medications. Conclusions Older adults feel positive and satisfied with their OTC medication use, in general. Considering the self-reported high use, inappropriate use, and experiences of facing side effects, education focused toward older adults should be encouraged to aid in safe and responsible OTC decision-making.

INTRODUCTION: The percentage of seniors in the population is increasing worldwide and Europe is not an exception in this case. Geriatric patients create a very specific group of patients in which the risk of drug-related problems is increased due to many reasons. Explicit criteria of potentially inappropriate medications/drug procedures (PIMs) in the aged belong to instruments helping with the evaluation of the quality of drug prescribing to older patients and have been developed in the past decades with the aim to increase the quality of geriatric pharmacotherapy and to minimize the quantity and severity of adverse drug reactions. The aim of this thesis is to evaluate the registration rates and OTC availability of pharmaceuticals from the PIMs list created for the purposes of EU COST Action IS1402 initiative (2015-2018) in 5 countries - Czech Republic, Estonia, Croatia, Poland and Slovakia. METHODOLOGY: Based on the thesis by S. Grešáková, MS, a list of 487 potentially inappropriate medicines/drug procedures in the aged has been created and subsequently also the record table stating the individual PIMs and other requested characteristics that was later filled by research teams of participating countries in the period from December 2016 to April 2017. In each country the following attributes were monitored:...

Quality of life in long term care (LTC) is a concern for many stakeholders. The elders who are living in LTC facilities, their families, the staff, and government and policy makers are all interested in providing quality care and quality of life to those persons living within the facility. Culture change is one way for LTC facilities to begin to give decision making to the residents, and to increase quality of life of these elders. There are different culture change models that embrace the concept of person-centered care. No matter which model is chosen, the essence of the change is moving from a medical care model to a person-centered care model. vi The purpose of this project was to evaluate the effectiveness of a culture change intervention, teaching person-centered care to certified nursing assistants (CNA), on the quality of life (QOL) of alert and oriented residents living in a LTC facility. The elders, identified as alert and oriented by a score of 25 or greater on the Mini Mental State Exam (MMSE), participated in a QOL questionnaire. Two one hour in-services on person centered care were presented to the CNAs. The QOL questionnaire was re-administered to the elder participants after three months. The results illustrated that teaching person-centered care to CNAs showed significant improvement in the areas of dignity and security, and marginal significance in the area of individuality. This suggests the elder's increased feeling of respect from the staff, as well as an increased sense of belonging and confidence in the availability and assistance of the staff members. It also suggests the elders felt that they were known as individual persons and that their preferences were honored.

INTRODUCTION: The issue of care for older patients has recently been discussed more and more frequently. The proportion of older adults in the population has been raising exponentially, especially in the last few decades, so the expectations concerning the extent and quality of geriatric care increases as well. In order to improve the quality of pharmacotherapy in the old age, many tools have been published in the last 25 years aimed at support of physicians in better care for older adults, enabling selection of safer pharmacotherapeutic startegies that respect specific pharmacological, physiological and homeostatic changes in the old age. Consequently, multiple explicit criteria of potentially inappropriate drugs and drug procedures (PIMs) have been published to help clinicians to distinguish pharmacotherapeutic strategies of choice for geriatric patients and oppositely to identify drugs, indications and dosing schedules potentially inappropriate in seniors. The aim of this diploma thesis was to evaluate in the pilot round the registration rates and other issues related to availability of all known PIMs in countries participating in the EU COST Action IS1402 study. METHODOLOGY: Based on diploma thesis of S. Grešáková, MS ("Application of explicite criteria of medications potentially inappropriate...

Introduction: Proportion of the population over the age of 65 is continuously increasing in the European Union, and therefore, the number of polymorbid patients with polypharmacy, limited functional capacities and syndrome of geriatric frailty is rising every year as well. In order to support the quality of geriatric prescribing and to lower possible adverse drug events, explicit criteria for potentially inappropriate drugs and drug procedures for elderly have been created. The aim of the diploma thesis was to evaluate how many potentially inappropriate medications (PIMs) for elderly out of 22 explicit criteria were registered in 6 countries (Czech Republic, Hungary, Portugal, Serbia, Spain and Turkey) participating at the 1st phase of the EU COST Action IS1402 initiative and which criterion or what group of regional criteria (European, American, Asian) would be the most specific and most suitable in individual countries for prospective international study following the quality of PIM prescribing. Methods: Of 22 explicit criteria of drugs/drug procedures potentially inappropriate in the old age, validated and published in peer-review journals and journals with the impact factor by 2015 year, a list of all until now known 345 PIMs was created (disregarding the dosage scheme, interval of use or...

The elderly population in Sweden is growing and as a result of that, society is facing different types of challenges. Oral hygiene is important for preventing oral disease but also for the general health (GH). A goal for the Swedish dental society is that every inhabitant should have an equal right to dental-care and oral health (OH) under the same conditions. This is not only a challenge for dental staff but also for medical and healthcare personnel. Our hypothesis is that nursing staff do not possess the education needed regarding oral hygiene, especially not in relation to GH. The opinions regarding support for nursing staff differ between nursing staff and managers. This study was conducted through questionnaire interviews with managers and nursing staff at geriatric homes in three municipalities in the county of Västerbotten. Questions were asked about education and routines, performance of oral care, and OH linked to GH. Response frequencies were compared between municipalities, professions, and response options. A significant lower part (p &lt;0.001) of nursing staff found that non-existing oral care could cause suffering in the form of general disease than in the form of oral disease. The opinion differs between managers and staff in questions about established routines (p &lt;0.05). This study indicates that knowledge about relationships between oral and general health might be inadequate and that education is both wanted and needed among nursing staff. More extensive studies, and studies about how dental professions could support nursing staff in a better way is desirable.