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Introdução: A complexidade e variabilidade que qualificam o envelhecimento acentuam as diferenças individuais dificultando a ação profissional. No Porto, esta realidade adquire especial relevo pelo efeito em espiral de fatores demográficos, socioeconómicos e familiares que contribuíram para que as atividades de assistência às pessoas idosas vulneráveis passassem a ser confiadas a respostas sociais, como o serviço de apoio domiciliário. O quadro conceptual ancorado na mais recente literatura científica indica-nos que, nestes casos, a vulnerabilidade, como estado, resulta do somatório de determinantes comunitários com determinantes individuais. Objetivo: Caracterizar a vulnerabilidade das pessoas idosas inscritas em serviços de apoio domiciliário da cidade do Porto, esperando colocar a descoberto a prevalência dos fenómenos, potencialmente sensíveis aos cuidados de enfermagem, promotores dessa vulnerabilidade, bem como, as relações que entre eles se estabelecem. Espera-se que este conhecimento disciplinar contribua para decidir acerca da adequação deste serviço, definir terapêuticas de enfermagem e políticas públicas percursoras do desenvolvimento de modelos mais integrados e sustentáveis. Material e Métodos: Estudo observacional, analítico e transversal que decorreu entre maio de 2018 e setembro de 2019. Optou-se pela amostragem por conglomerados de uma única etapa. A participação foi, sempre, voluntária e os participantes e/ou representante legal e/ou cuidador informal foram informados e esclarecidos. Os dados foram recolhidos por formulário junto de 320 pessoas idosas inscritas em serviços de apoio domiciliário integrados em instituições particulares de solidariedade social da cidade do Porto. A recolha de dados sobre as políticas de saúde e sociais, realizou-se pela consulta de documentos de referência. A sintaxe da vulnerabilidade contou com as variáveis que compõem os domínios dos determinantes comunitários e as dimensões dos determinantes individuais. A Comissão de Ética da Universidade Católica Portuguesa - Centro Regional do Porto aprovou o estudo. Resultados: Na cidade do Porto, 17,1% da população idosa que recebe serviços de apoio social no domicílio, através de instituições particulares sem fins lucrativos, é muito vulnerável. Neste nicho, assinalam-se nos determinantes comunitários, a elevada percentagem de mulheres com 83 ou mais anos, reduzida escolaridade, que não gerem a pensão de reforma, que consideram o rendimento mensal insuficiente para responder às necessidades quotidianas, que não usufruem de cuidados informais e que contratualizam três ou mais serviços ao apoio social no domicílio. Nos determinantes individuais atesta-se a elevada prevalência de fenómenos, sensíveis aos cuidados de enfermagem, que se encontram afetados, como: declínio cognitivo, compromisso do estado de consciência, do sono e da mobilidade, polimedicação, queda acidental, dor, dependência nas atividades básicas e instrumentais de vida diária, perda de massa magra, alto risco de desenvolver úlceras de pressão, presença de úlceras de pressão e autoperceção de saúde negativa, bem como, a existência de relações estatisticamente significativas entre esses mesmos fenómenos, ampliando a vulnerabilidade. No entanto, à medida que aumenta a vulnerabilidade aumenta a utilização do serviço de urgência e o número de internamentos o que aliado à ausência de relação estatística com o número de vezes que é utilizada a unidade de saúde familiar sugere que para as pessoas idosas e suas famílias os cuidados sociais e de saúde diferenciados são as respostas adotadas. Face a esta realidade, o apoio social no domicílio responde com cuidados que complementam ou substituem o próprio e, se existir, o cuidador informal/família revelando que não estão preparados para o desafio de promover um envelhecimento saudável, mas sim para perpetuar o ageing in place, atrasando a institucionalização. Conclusão: Identificaram-se áreas sensíveis aos cuidados de enfermagem aparentemente a descoberto. Destaca-se a necessidade de um diálogo permanente entre qualidade de vida, ageing in place e cuidados domiciliários que atenda à importância do processo multidisciplinar de diagnóstico interdisciplinar com vista ao desenvolvimento de ações integradas, contínuas e coordenadas potenciadoras do envelhecimento saudável.
Introduction: The complexity and variability that qualify aging accentuate individual differences, making professional action difficult. In Porto, this reality acquires a special relevance due to the spiral effect of demographic, socioeconomic and family factors that contributed to the activities of assistance to vulnerable elderly people to be entrusted to social responses such as the home social support services. The conceptual framework anchored in the most recent scientific literature indicates that, in these cases, vulnerability as a state results from the sum of community determinants with individual determinants. Objective: Characterize the vulnerability of the elderly people enrolled in home social support services in the city of Porto, hoping to uncover the prevalence of phenomena, potentially sensitive to nursing care, that promote this vulnerability, as well as the relation between them. It is hoped that the construction of this disciplinary knowledge will contribute to decide on the adequacy of this service, as well as to define nursing therapies and public policies that are precursors for the development of more integrated and sustainable models. Material and Methods: An observational, analytical and cross-sectional study that took place between May 2018 and September 2019. We opted for single-stage cluster sampling. Participation was always voluntary and the participants and/or their legal representative and/or their informal caregiver were informed and clarified. Data were collected through a form from 320 elderly people enrolled in home social support services integrated in private social solidarity institutions in the city of Porto. The collection of data on health and social policies was carried by consulting of documents of reference. The vulnerability syntax included the variables that make the domains of the community determinants and the dimension of the individual determinants. The Ethics Committee of Universidade Católica Portuguesa - Centro Regional do Porto approved the study. Results: In the city of Porto 17,1% of the elderly population who receive home social support services, through private non-profit institutions, is very vulnerable. In this niche, it is noted, in the community determinants, the high percentage of women aged 83 or more, low education, who do not manage the retirement pension, who consider the monthly income insufficient to meet daily needs, who do not enjoy informal care and who contract three or more services for social support at home. In the individual determinants, it is evident the high prevalence of phenomena, sensitive to nursing care, which are affected, such as: cognitive decline, compromised state of consciousness, sleep and mobility, polymedication, accidental fall, pain, dependence on activities basic and instrumental of daily life, loss of lean mass, high risk of developing pressure ulcers, presence of pressure ulcers and negative self-perception of health, as well as the existence of statistically significant relationships between these same phenomena, which increasing vulnerability. However, as vulnerability increases, the use of the emergency service and the number of hospitalizations increases, what associated with the absence of statistical relationship with the number of times that family health unit is used, suggests that for the elderly and their families differentiated health care and social are the responses adopted. In view of this reality, the home social support services responds with care that complements or replaces the elderly person’s own care and also, if there is any, the informal caregiver/family, revealing that they are not prepared for the challenge of promoting a healthy aging, but rather to perpetuate the aging in place, delaying the institutionalization. Conclusion: Areas sensitive to nursing care were identified, apparently uncovered. The results highlight the need for a permanent dialogue between the quality of life, aging in place and home care services that meets the importance of the multidisciplinary process of interdisciplinary diagnosis in order to develop integrated, continuous and coordinated actions that enhance healthy aging.
Introduction: The complexity and variability that qualify aging accentuate individual differences, making professional action difficult. In Porto, this reality acquires a special relevance due to the spiral effect of demographic, socioeconomic and family factors that contributed to the activities of assistance to vulnerable elderly people to be entrusted to social responses such as the home social support services. The conceptual framework anchored in the most recent scientific literature indicates that, in these cases, vulnerability as a state results from the sum of community determinants with individual determinants. Objective: Characterize the vulnerability of the elderly people enrolled in home social support services in the city of Porto, hoping to uncover the prevalence of phenomena, potentially sensitive to nursing care, that promote this vulnerability, as well as the relation between them. It is hoped that the construction of this disciplinary knowledge will contribute to decide on the adequacy of this service, as well as to define nursing therapies and public policies that are precursors for the development of more integrated and sustainable models. Material and Methods: An observational, analytical and cross-sectional study that took place between May 2018 and September 2019. We opted for single-stage cluster sampling. Participation was always voluntary and the participants and/or their legal representative and/or their informal caregiver were informed and clarified. Data were collected through a form from 320 elderly people enrolled in home social support services integrated in private social solidarity institutions in the city of Porto. The collection of data on health and social policies was carried by consulting of documents of reference. The vulnerability syntax included the variables that make the domains of the community determinants and the dimension of the individual determinants. The Ethics Committee of Universidade Católica Portuguesa - Centro Regional do Porto approved the study. Results: In the city of Porto 17,1% of the elderly population who receive home social support services, through private non-profit institutions, is very vulnerable. In this niche, it is noted, in the community determinants, the high percentage of women aged 83 or more, low education, who do not manage the retirement pension, who consider the monthly income insufficient to meet daily needs, who do not enjoy informal care and who contract three or more services for social support at home. In the individual determinants, it is evident the high prevalence of phenomena, sensitive to nursing care, which are affected, such as: cognitive decline, compromised state of consciousness, sleep and mobility, polymedication, accidental fall, pain, dependence on activities basic and instrumental of daily life, loss of lean mass, high risk of developing pressure ulcers, presence of pressure ulcers and negative self-perception of health, as well as the existence of statistically significant relationships between these same phenomena, which increasing vulnerability. However, as vulnerability increases, the use of the emergency service and the number of hospitalizations increases, what associated with the absence of statistical relationship with the number of times that family health unit is used, suggests that for the elderly and their families differentiated health care and social are the responses adopted. In view of this reality, the home social support services responds with care that complements or replaces the elderly person’s own care and also, if there is any, the informal caregiver/family, revealing that they are not prepared for the challenge of promoting a healthy aging, but rather to perpetuate the aging in place, delaying the institutionalization. Conclusion: Areas sensitive to nursing care were identified, apparently uncovered. The results highlight the need for a permanent dialogue between the quality of life, aging in place and home care services that meets the importance of the multidisciplinary process of interdisciplinary diagnosis in order to develop integrated, continuous and coordinated actions that enhance healthy aging.
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Keywords
Vulnerabilidade Enfermagem Idosos Serviço de apoio domiciliário Vulnerability Nursing Elderly Home support service