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- Improving Quality of Health Care for Older Adults | RAND
The 61 statements considered non-constant underwent the process of analysis for similarities and differences. However, with the review carried out concerning the semantics of the statements created, and the need to include some less comprehensive diagnostics in the most comprehensive ones, 14 statements were eliminated from a total of 72 statements of nursing diagnoses and results valid for nursing practice with the institutionalized elderly.
Forty-six 46 were categorized as psycho-biological needs and 26 as psychosocial needs, as described in Table Picture 01 - Utterances in terms of nursing diagnoses and results constructed and validated according to the Basic Human Needs. When analyzing the results, we noticed that the characterization profile of the elderly people of this research are in line with other studies 11,12 that have been developed in other LTCFs. It appears that the institutionalized elderly are characterized as long-lived and, in addition, the feminization phenomenon of aging is noticeable.
Regarding marital status, it is observed that most individuals are single, a fact that is possibly due to family fragility, marked by the nuclear family. As for education, the low level of education found may compromise the self-care conditions of the elderly, making them more dependent. The nursing practice focuses presented the psychobiological needs with emphasis on the need for physical safety and environment with greater expressiveness. This finding is supported by the considerations proposed by Maslow's pyramid, which regards physiological and safety needs as the most vital to humans, and required the remedying of other details under hierarchically superior satisfaction levels 3.
Other studies also showed similar results in the affected needs. Psychobiological needs referred to by the indicators are body care, mobility, elimination, nutrition, circulation, neurological regulation, safety and physical integrity. Psychosocial needs are also relevant and have the following indicators: communication, cognition, love, acceptance, self-fulfillment, emotional security and gregariousness 11, These specifics are challenges for the professional nurse who should be able to interpret the singularities of the health conditions of the elderly and the care needs grounded in gerontological and geriatric knowledge through a global assessment and clinical reasoning, for a possible standardized nursing language in the care of the institutionalized elderly As a result of this study, it is observed that the needs for elimination, physical activity and physical integrity showed the largest number of nursing diagnoses and outcomes created, which may possibly allow the appearance of other problems and the presentation of new diagnoses when identified.
Moreover, the elderly are concentrated in the psychobiological needs, expressing themselves in care needs that are possibly linked to problems arising from anatomical and physiological manifestations of the aging process, but also of senility processes that favor comorbidities. Therefore, it is necessary to regulate the practice of physical exercises for strengthening the muscles so they may experience an active aging process On the need for physical integrity, a study shows that, among the nursing diagnoses observed in the elderly in other studies, disorders in terms of skin integrity are among the most prevalent problems.
This is due to common issues of the physical structure of the skin of the aging person, such as: decreased elasticity, turgor and the skin's ability to act as a barrier predisposing it to the appearance of lesions, as well as other physical characteristics of the individual: low weight, bony prominences, obesity, vascular and angiographic morbidities, among others Therefore, it is observed that studies such as this show the benefits, in terms of the practice of construction of nursing diagnoses, for specialized areas of care. As a result of research that deals with the topic currently under study, it is noticeable from the results that nurses acquired scientific and documental support for nursing actions and greater visibility of nursing ahead other professions.
In relation to being assisted, one can see comprehensive and quality care. Therefore, research that develops such practices accumulates results that enable their integration, supporting the decisions of nurses in terms of clinical focuses in distinct and specific areas 18, The survey suffered limitations regarding access to the personal and health information of some seniors, since on the occasions that it was not possible to identify the information by investigating it with the elderly directly, the information was sought in medical records and many of these records were incomplete, so it was necessary to refer to members of the local nursing and social assistance staff.
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There were also problems in the collection of data in terms of the process used. This fact possibly restricted the identification of some nursing practice focuses. The practice of systematizing nursing care actions for the institutionalized elderly is possible in LTCF environments, and in this research focuses were identified. Still, it was possible to create statements of specific nursing diagnoses for the institutionalized elderly, including 72 validated statements. This data may eventually contribute to the expansion and strengthening of terminology, to a practice with a comprehensive and individualized care and to the scientific basis of nursing actions, autonomy and professional recognition.
Therefore, there needs to be greater awareness by the nursing staff in order to direct actions more carefully regarding care in the prevention of adverse events in the health promotion and rehabilitation of the relevant needs in the pursuit of a healthier and more active aging process. We also believe that the process of caring for the institutionalized elderly must be focused on systematic actions based on gerontological knowledge, even if the practice is permeated by obstacles and challenges. We perceive the need for assistance built on pillars of theoretical and philosophical knowledge of nursing, involving technological resources and theories for a quality individualized care that brings autonomy and scientism.
Foundation for Quality Care, Inc.
Processo de enfermagem. Rio de Janeiro: Guanabara Koogan; In , Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. AARP is the nation's leading organization for people age 50 and older. It serves their needs and interests through information and education, advocacy, and community services provided by a network of local chapters and experienced volunteers throughout the country.
The organization also offers members a wide range of special benefits and services, including Modern Maturity Magazine and the monthly Bulletin. Written by a group of medical professionals, AboutAssistedLiving. The American Health Care Association AHCA is a federation of 50 state health organizations, together representing nearly 12, non-profit and for-profit assisted living, nursing facility, and subacute care providers that care for more than one million elderly and disabled individuals nationally.
AHCA was founded in to promote standards for professionals in long-term health care delivery and quality care for residents. It is recognized as the pioneer and the leading organization in the field of Hispanic Aging. It has become one of the broadest based Hispanic organizations in the nation. It is a private, non-profit c 3 corporation with both public and private funding. It has earned a national reputation for its work with the elderly and for its increasingly significant role in the larger Hispanic community.
The Association has an extended network of over public and private community service organizations throughout the nation. Senior care experts help families and caregivers decide if assisted living is a good option for their loved one, and if so, to select the best facility possible. Justice in Aging is a non-profit organization whose principal mission is to protect the rights of low-income older adults.
Through advocacy, litigation, and the education and counseling of local advocates, they seek to ensure the health and economic security of those with limited income and resources, and access to the courts for all. Since , Justice in Aging has worked to promote the independence and well-being of low-income elderly and persons with disabilities, especially women, people of color, and other disadvantaged minorities. They work to preserve and strengthen Medicaid, Medicare, Social Security and SSI, benefits programs that allow low-income older adults to live with dignity and independence. In addition, they work for greater access to the federal courts for all.
Members include adult day center providers, state associations of providers, corporations, educators, students, retired workers and others interested in working to build better lives for adults in adult day programs every day. The National Association of Area Agencies on Aging N4A is a private, nonprofit organization that represents the interests of approximately Area Agencies on Aging and more than 18, title VI native American aging programs across the nation in dealing with the Congress, the Administration, and other national organizations.
It provides leadership to the member Area Agencies by providing technical assistance, materials, information, and training. It encourages cooperation between the public and private sectors in serving the elderly.
Developing Quality of Care Indicators for the Vulnerable Elderly
It serves as a clearinghouse for the exchange of information on programs, legislation, and resources in the private sector. The National Association of Social Workers NASW was founded in as a professional organization for social workers from a merger of seven predecessor organizations. It promotes the professional growth and development of its members, establishes and maintains professional standards of practice, and advances sound social policies and legislation.
Comprehensive assessments and care plans harmonize clinical management across different care providers and unite providers around a common goal. Systematic reviews have reported that case management improves intrinsic capacity, various aspects of medication management and the use of community services. Structured self-management programmes have been shown to improve a wide range of outcomes in older adults. Improvements have been observed in physical activity, 27 — 29 self-care, 27 chronic pain 30 and self-efficacy. Home visits by health professionals in the context of community-based programmes have been shown to have positive effects.
A review of 64 randomized trials found that home visits were effective when they included multidimensional assessments and were carried out five or more times: the greatest overall effects were reductions in emergency department visits, hospital admissions, the length of hospital stay and the number of falls, and better physical functioning.
Numerous frameworks for organizing care for older people have been developed and are used in different parts of the world. Some small differences between models exist, which probably resulted from the different contexts in which they were developed or from variations in their intended applications. Documented examples of integrated care for older people are scarce, particularly from low- and middle-income countries.
Moreover, it is difficult to assess or compare different programmes because little direct evidence is available on the way integrated health care was provided for older people or on its extent.
Often terminology varies between programmes, as does the range of factors that should be included in, or excluded from, analyses. One key issue is the distinction between integrated care which can be considered as including social care and integrated health care.
The information currently available is derived mainly from case studies, which exhibit large variations in the way integrated care was implemented in practice and in how programmes were evaluated.
For example, the European Commission published a guide to innovative healthy ageing programmes being implemented in more than 30 regions, cities and communities in Europe — many featured the reform of some aspect of integrated care but descriptions of the programmes varied widely. Exemplar national programmes do exist but they tend to have been implemented at a subnational, governmental level or in a small geographical area. However, programmes in most countries are characterized by a more ad hoc approach: integrated care may be delivered in a municipality or a subnational region but not yet have taken hold across the country.
Improving Quality of Health Care for Older Adults | RAND
The types ranged from fully-integrated health and social care to approaches that built alliances to coordinate care — these alliances were often based on contractual relationships between otherwise separate partners. Several factors appear to be limiting the widespread adoption of integrated care for older people, including a lack of political commitment, gaps in general knowledge about integrated care, problems with implementation and inadequate sharing of experiences with integrated care internationally.
The inherent complexity of organizing and delivering coordinated care for a large older population can be discouraging and can undermine efforts to introduce and scale up programmes.