INTRODUCTION: This paper is part of a special series designed to help health professionals to develop a research project. It reviews the importance, methodology, and applicability of qualitative research.
OBJECTIVE: To discuss the methodology of qualitative research presenting validity criteria and emphasizing the scientific rigor, with focus in healthcare area, especially in geriatrics/gerontology.
METHODS: The authors performed a non-systematic literature review (PubMed.gov - U.S. National Library of Medicine/National Institute of Health) and included articles that clarified the main themes.
RESULTS: Qualitative research has grown considerably in the area of healthcare due to its ability to broaden the knowledge and interpretation of phenomena, experiences, behaviors, and their meaning in the lives of the people studied - elements not explored in quantitative methods.
CONCLUSION: Qualitative approach has scientific rigor similar to quantitative research and manages to broaden understanding of participant behavior in a more holistic approach - which is extremely relevant in the area of geriatrics/gerontology.
Keywords: quantitative research; methods; geriatrics.
BACKGROUND: Place of death (POD) distribution is influenced by sociocultural aspects, economic conditions and public policies. It is a central concern in end-of-life support and for healthcare system management, but there is limited information about POD in middle-income countries such as Brazil.
METHODS: Population data collected from the Brazilian Information about Mortality System were used to identify national and regional mortality rates, from 2002 to 2013. POD distribution was compared between age groups (<60 or ≥60 years old), and for gender and marital status in elderly population. Differences across national regions were analyzed.
RESULTS: In Brazil, POD is mostly allocated in hospitals with mean of 66.7%, followed by 21.4% at home. Other health care facilities account for less than 3% of all deaths. The number of deaths in older ages has increased. There were differences in POD distribution among regions. The North and the Northeast, for example, reported higher rates of home deaths compared with other regions. For the elderly population, there was a little difference between gender in POD distribution, and being married increased the odds of dying in hospital settings.
CONCLUSION: Deaths in Brazil is limited to hospital and at home occurrences. In-hospital rates are increasing over the last years, while deaths at home have decreased despite the increase in number of deaths in older ages and due non-communicable diseases. POD distribution may be influenced by social and demographic factors, but specific health policies to support end-of-life care is limited in Brazil.
Keywords: aged; vital statistics; developing countries; palliative care; health policy.
INTRODUCTION: Undernourishment is a common health problem among elderly individuals, and its prevalence grows among frail patients, which makes nutritional support a priority, especially in acute diseases. However, providing nutritional support to undernourished patients or to those under acute caloric deprivation may lead to electrolyte disturbances associated with neurological, respiratory, and cardiac symptoms, including cardiac arrest. These disturbances occur a few days after receiving nutritional support, and characterize the refeeding syndrome.
METHODOLOGY: Five elderly patients hospitalized for clinical reasons and who developed refeeding syndrome during the duration of the stay, were retrospectively evaluated.
RESULTS: All patients analyzed were malnourished and frail, of whom four were women. The age group ranged between 82 and 85 years, and food deprivation time ranged between 7 to 15 days. Three patients had severe dementia and were admitted with hypoactive delirium. Hypophosphatemia occurred in 100% of the sample, followed by hypokalemia (60%) and hypomagnesemia (40%). Four patients developed peripheral edema, two developed metabolic ileus and three elderly persons (who had lower phosphorus values) died during the hospital stay.
CONCLUSION: All refeeding syndrome patients developed hypophosphatemia, with fatal outcome among those whose phosphorus values were lower. The development of peripheral edema and metabolic ileus was frequent. Owing to the lack of data in literature, new researches on refeeding syndrome are extremely important. Electrolyte evaluation before and after nutritional support in patients at risk, is indispensable to facilitate recognition and treatment of this severe condition.
Keywords: malnutrition; refeeding syndrome; nutrition therapy.
OBJECTIVES: To identify the prevalence of accidental falls among elderly persons in their homes, and to evaluate determining factors to that, including intrinsic and extrinsic risk factors, as well as the awareness about falls, assessed by the Falls Risk Awareness Questionnaire (FRAQ-Brazil).
METHOD: It consisted of a quantitative, transversal, and descriptive study, performed with 472 elderly persons through interview. Data were analyzed by the chi-squared test with a confidence interval of 95%.
RESULTS: The average age of the sample was 70.6 years and most of them were female. Among the sample, 55.2% referred previous episodes of fall. The majority of them self-reported having diseases associated with gait disturbance and used medicines that could cause falls. It was observed less falls among elderly with higher level of awareness about risk factors.
CONCLUSION: A high prevalence of accidental falls and exposure of the elderly persons to several independent and concomitant risk factors were observed. Greater awareness level about falls seems to be a preventive factor, presenting a higher association with falls than level of education and income.
Keywords: aged; accidental falls; risk factors; syndrome; health literacy.
INTRODUCTION: Sleep disturbances are frequently observed in the elderly population. The objective of this study was to evaluate, by means of qualitative and parametric analyses, the sleep pattern of elderly people undergoing dialysis.
METHODS: This crosssectional study was performed at three hemodialysis centers, with a convenience sample composed of 28 patients who fulfilled the inclusion criteria. Their sleep quality was analyzed by means of the Pittsburgh index and actimetric measurements for seven days with the following variables: total nocturnal sleep time (TNST), time awake after the onset of sleep (TAOS), number of nocturnal awakenings (awakenings), total daytime sleep time (TDST), number of naps, and percentage of nocturnal sleep (% sleep).
RESULTS: Seventeen patients (58.6%) presented PSQI > 5, characterizing poor quality sleep in the last 30 days. The actimetric analyses demonstrated poor parameters on average: TNST of 341. 2 ± 90.8 minutes per night; TAOS of 91.1 ± 46.44 minutes per night, % sleep of 79.6 ± 9.8 per night; 28.5 ± 11.4 times woken up per night; 48.5 ± 14.6 naps per day, and TDST of 222.4 ± 73.9 minutes per day.
CONCLUSION: This study observed, by means of a subjective qualitative analysis (PSQI) and actimetric parameters (actimetry), that elderly people undergoing hemodialysis demonstrate having poor sleep quality.
Keywords: sleep; elderly; chronic renal insufficiency; actigraphy; renal dialysis.
INTRODUCTION: Flexibility reduces with age due to insufficient activity of the neuromuscular system, disuse of the skeletal muscles, and a lack of physical conditioning, therefore resulting in decreased autonomy and inability to perform daily activities.
OBJECTIVE: To evaluate the effects of Isostretching in aquatic environment on muscle flexibility of elderly people.
METHODS: A longitudinal, nearly experimental, uncontrolled study conducted with 26 individuals of both sexes, average age 67.5 ± 7 years, evaluated in terms of lower limb flexibility through the "sit and reach" test before and after a 12-week session of Isostretching in aquatic environment. The sample was tested for normality using the Shapiro-Wilk test, and the pre and post practice results were compared using the Wilcoxon test, considering p < 0.05.
RESULTS: When comparing pre and post results of Isostretching in aquatic environment, a significant improvement (p < 0.05) was observed in the posterior chain flexibility (12.5 cm) of lower limbs in the studied group.
CONCLUSION: Isostretching performed in aquatic environment improved the posterior chain flexibility of lower limbs in a group of elderly people.
Keywords: elderly; hydrotherapy; muscle stretching exercises.
INTRODUCTION: The population around the world is aging. With this, there will be an increased incidence of fractures due to osteoporosis of the hip and this will be a serious global health problem. A World Health Organization (WHO) estimate suggests that the incidence of hip osteoporotic fractures worldwide will triple by 2050.
OBJECTIVE: To present, through a literature review, the main results of the femoral reinforcement, a technique described by scientific articles, with the potential to increase the proximal femoral load for the occurrence of fractures, whether using polymethylmethacrylate (PMMA), phosphate cement calcium (CPC), (j elastomers and metal implants.
METHODS: Through electronic search in databases PubMed, Latin American and Caribbean Center of Health Information Information (Bireme), Coordination for the Improvement of Higher Education Personnel (Capes), Scientific Electronic Library Online (SciELO), Google Scholar And Cochrane, using the terms cementoplasty and femororplasty, the studies were selected according to a specific inclusion criterion, describing the main findings of the biomechanical results, type of study and material used to perform the femoral reinforcement.
RESULTS: Of the 15 articles analyzed, 14 were experimental analyzes and one was a clinical trial, seven studies used PMMA, two used CPC, four elastomers and two metal implants, 13 of them showed favorable Newton load (N) results for the fracture hip.
CONCLUSION: Most of the studies on femoral reinforcement is experimental, and mostly used the PMMA, presenting an increase in the load in N for fracture occurrence.
Keywords: polymethyl methacrylate; hip fractures; osteoporosis; hip.