RESUMO
BACKGROUND: non-pharmacological interventions to prevent delirium are useful in hospitalised older adults. However, they are poorly implemented in clinical practice. We aimed to develop a software for bedside use by hospitalised older adults and to improve their access to these interventions. METHODS: a transdisciplinary team composed of healthcare professionals, designers, engineers and older adults participated in the development of the software. Scrum methodology was used to coordinate the work of the team, and the software was evaluated in a feasibility study. RESULTS: a software for touchscreen mobile devices that supports Android 5.0 or later was produced, including modules for time-spatial re-orientation, cognitive stimulation, early mobilisation, sensorial support use promotion, sleep hygiene and pain management optimisation. Horizontal disposition, use of colour contrast and large interaction areas were used to improve accessibility. The software's usability and accessibility were evaluated in 34 older adults (average age 73.2 ± 9.1 years) showing that 91.1% of them got access to all the software functions without previous instructions. The clinical feasibility assessment showed that 83.3% of the 30 enrolled hospitalised patients (76 ± 8 years) completed the 5-day protocol of software usage during hospitalisation. Software use was associated with a decreased trend in delirium incidence of 5 of 32 (15.6%) at baseline to 2 of 30 (6.6%) after its implementation. CONCLUSION: a highly accessible and implementable software, designed to improve access to non-pharmacological interventions to prevent delirium in hospitalised older adults, was developed. The effectiveness of the software will be evaluated in a randomised clinical trial.
Assuntos
Sistemas de Apoio a Decisões Clínicas , Delírio/prevenção & controle , Aplicativos Móveis , Idoso , Computadores de Mão , Delírio/etiologia , Estudos de Viabilidade , Feminino , Hospitalização , Humanos , Masculino , Equipe de Assistência ao Paciente , Fatores de Risco , Design de Software , Interface Usuário-ComputadorRESUMO
A promoção de condições para a vida independente é, possivelmente, um dos maiores desafios decorrentes do fenômeno mundial de envelhecimento populacional. Para as áreas de projeto e desenvolvimento de produtos, este contexto implica em pensar novos produtos que atendam às características, necessidades e preferências desta população. Na prática, o desafio é desenvolver produtos cujas demandas para o uso sejam diminuídas, o que resulta na facilitação do uso para uma maior diversidade de usuários. Estas demandas compreendem as habilidades físicas, sensoriais e cognitivas que o uso de um determinado produto exige do usuário para um desempenho satisfatório. Considerando o declínio funcional natural que decorre do processo de envelhecimento com alterações como diminuição da força muscular, flexibilidade e controle postural, assim como diminuição da acuidade visual, a pessoa idosa pode vir a ter dificuldades no uso de produtos cujas demandas sejam elevadas. Conhecer de que forma as alterações fisiológicas do processo de envelhecimento influenciam as habilidades físicas, cognitivas e sensoriais do idoso é, portanto, fundamental para o sucesso no processo de design para produtos pensados para o público idoso. Especificamente, no caso de produtos de Tecnologia Assistiva, os aspectos simbólicos são importantes, pois remetem ao significado do produto para o usuário e podem influenciar a aceitação e engajamento ao uso destes dispositivos. É, portanto, necessário que o design de produtos assistivos para o público idoso busque não somente atender as questões funcionais, mas também conceber produtos atrativos e desejáveis.(AU)
The promotion of conditions for independent living is possibly one of the biggest challenges arising from the worldwide phenomenon of population aging. In the context of product design and development, this implies thinking about new products that meet the characteristics, needs and preferences of this population. In practice, the challenge is to develop products whose usage demands are reduced, which results in facilitating use for a greater diversity of users. These demands include the skills - physical, sensory and cogni- tive - that the use of a particular product requires from the user for satisfactory performance. Considering the natural functional decline that results from the aging process with changes such as decreased muscle strength, flexibility and body balance, as well as decreased visual acuity, the elderly may have difficulties in using products whose demands for use are high. Knowing how the physiological changes of the aging process influence the physical, cognitive and sensory skills of the elderly is, therefore, fundamental to the success in the design process for products designed for the elderly. Specifically, in the case of Assistive Technology products, the symbolic aspects are important as they refer to the meaning of the product to the user and may influence the acceptance and engagement to the use of these devices. It is, therefore, necessary that the design of assistive products for the elderly seeks not only to address functional issues, but also to design attractive and desirable products.(AU)
Assuntos
Tecnologia Assistiva , IdosoRESUMO
Este artigo analisa os conceitos de "complexo econômico-industrial da saúde" (Gadelha, 2006) e de "Economia da Longevidade" (Felix, 2007), com a intenção de estabelecer seus pontos de intersecção no que diz respeito a uma política industrial, focada nos setores de saúde e cuidados de longa duração para idosos. Defende-se que, diante do envelhecimento populacional, esses setores são estratégicos na concorrência global e na inserção internacional do Brasil. Dentro de uma perspectiva marxiano-schumpteriano-cepalina, apresenta-se a proposta de construção de um complexo econômico-industrial da saúde e do cuidado. À luz da Teoria Novo-desenvolvimentista, analisam-se as limitações e possibilidades macroeconômicas de implementação dessas estratégias industriais no Brasil.
This article analyzes the concepts of "Health Economic-Industrial Complex" (Gadelha, 2006) and "Silver Economy" or "Longevity Economy" (Felix, 2007), with the intention of set up its points of intersection which regard to an industrial policy, focused on health and long-term care for the elderly people. It is argued that, faced with population aging, these sectors are strategic in global competition and in the Brazilian foreign trade insertion. From a Marxian-Schumpterian-ECLAC perspective, the proposal for the construction of an economic-industrial complex of health and care is presented. Therefore, it is necessary to investigate the macroeconomic limitations and possibilities of the two concepts to be promising in Brazil, which is done in the light of the New-Developmentalism theory (Bresser-Pereira, 2015).
Este artículo analiza los conceptos de "Complejo Económico-Industrial de la Salud" (Gadelha, 2006) y de "Economía de la Longevidad" (Felix, 2007), con la intención de establecer sus puntos de intersección en lo que se refiere a una política industrial, enfocada en los sectores de salud y cuidados de larga duración para ancianos. Se defiende que, ante el envejecimiento poblacional, esos sectores son estratégicos en la competencia global y en la inserción internacional de Brasil. Dentro de una perspectiva marxiana-schumpteriana-cepalina, se presenta la propuesta de construcción de un complejo económico-industrial de la salud y del cuidado. A la luz de la Teoría Novo-desarrollista, se analizan las limitaciones y posibilidades macroeconómicas de implementación de esas estrategias industriales en Brasil.
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tecnologia Biomédica , Projetos Industriais , Geriatria , LongevidadeRESUMO
La actual transición demográfica y epidemiológica por la que atraviesan varias regiones en el mundo, incluyendo México, están desafiando la sustentabilidad de los sistemas de salud, conduciendo al desarrollo de nuevos enfoques de atención para la población de adultos mayores (AM). La estrategia central está enfocada en un envejecimiento saludable donde el aumento de la esperanza de vida sea libre de discapacidad. La gerontecnología pretende contribuir a la disminución de los problemas de los AM que conllevan las transiciones del envejecimiento apoyando el cumplimiento de la estrategia central. La realización de rapid review en gerontecnología demuestra que Holanda y E.U.A. encabezan la lista de países promotores de investigaciones y desarrollos gerontecnológicos a nivel mundial, con 14 y 10 publicaciones respectivamente. México aporta a la generación de conocimientos en el campo con una publicación. A nivel mundial la tendencia es la generación de grupos multidisciplinarios con profesionales de las ciencias de Sociología, Demografía (Gerontología) en conjunto con profesionales de las áreas de Comunicación e Informática (Tecnología); teniendo como principal objetivo el Apoyo y Organización en los cuidados de los adultos mayores en los dominios de Vivienda y Actividades de la Vida Diaria.
Current demographic and epidemiological transitions being experienced by several regions in the world, including Mexico, are challenging the sustainability of health systems, leading to the development of new approaches to care for the elderly population. The core strategy is focused on healthy aging where increased life expectancy is free of disability. Gerontechnology intended to help reduce the problems of seniors that involve transitions of aging by supporting the implementation of the core strategy. Conducting rapid review in gerontechnology shows that the Netherlands and United States top the list of countries promoting research and gerontechnologic developments worldwide, with 14 and 10 publications respectively. Mexico contributes to the generation of knowledge in the field with one publication. Worldwide the trend is the generation of multidisciplinary groups with science professionals on Sociology, Demography (Gerontology) in conjunction with professionals in the areas of Communication and Information Technology (Technology); having as main objective the support and organization in care of the elderly in the domains of Housing and Activities of Daily Living.
RESUMO
OBJECTIVE: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults. DESIGN: Unblinded, randomized, controlled trial. SETTING: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico. PARTICIPANTS: Patients were aged over 60 years with a frailty index score higher than 0.14. INTERVENTION: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups. MEASUREMENTS: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered. RESULTS: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group. CONCLUSION: An intervention based on NV+AB seems to have a positive effect on frailty scores.