Home health care for the elderly: associated factors and characteristics of access and health care.

OBJECTIVE To assess factors associated with home health care for the elderly and its characteristics based on different care models, the Family Health Strategy and traditional primary care. METHODS A population-based cross-sectional study was conducted in a representative sample of 1,593 individuals aged >60 years living in the urban area of the city of Bagé, Southern Brazil, in 2008. A multistage sampling was carried out. Data was collected during individual interviews about access to services, providers' involvement, users' satisfaction and health status after care. Poisson regression model was used for estimating crude and adjusted prevalence ratios, their related 95% confidence intervals and p-values (Wald test). RESULTS Home health care was statistically associated with prior history of stroke, signs of dementia and disability in activities of daily living. The family was requested 75% of home care visits. Medical doctors provided most of the care in traditional primary care settings while nursing staff provided most care within the Family Health Strategy. Approximately 78% of the elderly received care within 24 hours after the request and 95% of them positively evaluated the care received. Two thirds of the elderly reported improved health status. CONCLUSIONS The variables associated with home health care were consistent with fragility indicators included in the Brazilian National Health Policy for the Elderly, reinforcing the role of this strategy for promoting equitable health care to elderly population. Users' satisfaction and the positive impact on their health status confirm home as a setting for providing care.

[1]  Alison Moore,et al.  No place like home. , 2008, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[2]  L. Feuerwerker,et al.  [Home care's contribution to alternative health care networks: deinstitutionalization and transformation of practices]. , 2008, Revista panamericana de salud publica = Pan American journal of public health.

[3]  M. Lawton,et al.  Assessment of older people: self-maintaining and instrumental activities of daily living. , 1969, The Gerontologist.

[4]  Roberta Pereira NiquiniI,et al.  Rev Saúde Pública , 2010 .

[5]  R. Veras.  Envelhecimento populacional contemporâneo: demandas, desafi os e inovações Population aging today: demands, challenges and innovations , 2009 .

[6]  Kênia Lara Silva,et al.  Internação domiciliar no Sistema Único de Saúde , 2005 .

[7]  Y. Duarte,et al.  Atendimento domiciliar: um enfoque gerontológico , 2000 .

[8]  I. Kickbusch,et al.  A global strategy for healthy ageing. , 1997 .

[9]  Márcia Cristina Bauer Cunha,et al.  Assistência Domiciliar à Saúde (Home Health Care): sua História e sua Relevância para o Sistema de Saúde Atual ^ , 2001 .

[10]  René Verreault,et al.  More Than the Epidemiology of Alzheimer's Disease: Contributions of the Canadian Study of Health and Aging , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[11]  P. Hallal,et al.  Prevalência de quedas em idosos e fatores associados , 2007 .

[12]  J. Yesavage,et al.  Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. , 1986 .

[13]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[14]  Ricardo Alexandrino Garcia,et al.  O envelhecimento da população brasileira: um enfoque demográfico , 2003 .

[15]  Ana Luiza d'Ávila Viana,et al.  A reforma do sistema de saúde no Brasil e o Programa de Saúde da Família , 1998 .

[16]  M. Cezar-Vaz,et al.  Considerações sobre a atenção domiciliária e suas aproximações com o mundo do trabalho na saúde , 2008 .

[17]  T. Rehem,et al.  Assistência domiciliar em saúde: subsídios para um projeto de atenção básica brasileira , 2005 .

[18]  A. Barros,et al.  Bmc Medical Research Methodology Open Access Alternatives for Logistic Regression in Cross-sectional Studies: an Empirical Comparison of Models That Directly Estimate the Prevalence Ratio Cox Regressioncross-sectional Studieslogistic Regressionodds Ratiopoisson Regressionprevalence Ratiorobust Varia , 2003 .

[19]  Renato Peixoto Veras.  Envejecimiento poblacional contemporáneo: demandas, desafíos e innovaciones , 2009 .

[20]  E. Crimmins,et al.  Trends in the health of the elderly. , 2004, Annual review of public health.

[21]  S. Katz,et al.  STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. , 1963, JAMA.

[22]  M. Izquierdo,et al.  Análisis de la demanda de actuación de un equipo de soporte de atención domiciliaria (ESAD) , 2001 .

[23]  P. Kemper.  The use of formal and informal home care by the disabled elderly. , 1992, Health services research.