RESEARCH ARTICLES

Interdisciplinary practices in promoting the health of older adults

Milena Silva Costa^I; Eliane de Sousa Leite^II; Jamili Anbar Torquato^III; Iluska Pinto Costa^IV; Ana Margareth Marques Fonseca Sarmento^V; Maria Adelaide Silva Paredes Moreira^VI

^I Nurse. Ph.D. student of the Graduate Program in Nursing of the Federal University of Paraíba. Professor of the Nursing Course of the Federal University of Campina Grande. Cajazeiras, Paraíba, Brazil. E-mail: milenascosta2011@hotmail.com
^II Nurse. Ph.D. student of the Graduate Program in Nursing of the Federal University of Paraíba. Brazil. E-mail: elianeleitesousa@yahoo.com.br
^III Physiotherapist. Professor of the Physiotherapy Course and Coordinator of the Postgraduate course in Cardiorespiratory Physiotherapy and Hospital of the University of Cruzeiro do Sul. Doctorate in Sciences, Medicine School of São Paulo. Brazil. E-mail: jamilianbar@yahoo.com
^IV Nurse. Master student of the Graduate Program in Nursing at the Federal University of Paraíba. Professor of the Health Technical School at the Federal University of Campina Grande. Cajazeiras, Paraíba, Brazil. E-mail: lucosta.ufcg@gmail.com
^V Physiotherapist. Master student of the Graduate Program in Nursing at the Federal University of Paraíba. Professor of the Technology School of Paraíba. João Pessoa, Paraíba, Brazil. E-mail: ana-margareth@hotmail.com
^VI Physiotherapist. Ph.D. in Health Science. Professor of the Graduate Program in Nursing at the Federal University of Paraíba, João Pessoa, Paraíba, Brazil. E-mail: jpadelaide@hotmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2015.21628

ABSTRACT

This quanti-qualitative, descriptive study aimed to ascertain the health promotion practices applied to a group of older adults by an interdisciplinary care team. Twelve 12 health professionals of the senior care group, Amigos de Irmã Fernanda, in Cajazeiras, Paraíba State, answered a questionnaire in 2013. Content analysis of their responses highlighted: the participants' understanding of health promotion for the elderly; the structure of the work; the activities relating to health education and interdisciplinarity; the efficacy of the practices that resulted in improved quality of life for the older adults; and the challenges involved in promoting the activities were chronic diseases, and a lack of human and material resources. It is considered that to promote health requires knowledge, teamwork and proactivity in order for the results to emerge in the older adults' quality of life.

Keywords: Older adults; health promotion; interdisciplinarity; health care.

INTRODUCTION

The growing number of elderly people in the world and Brazil urges the society to think how to offer appropriate care and attention to this age group of the population, given that the aging is a stage of the life cycle of losses and gains, and it is inserted in a historical, socio-cultural, economic and political moment¹.

In the past, health care of the elderly was restricted to cure the disease, with essentially therapeutic purpose, to which the behavior adopted was decided only by the doctor. Nowadays, because of the multiple facets of the aging process, its frequency and its repercussions on health, the curative care no longer meets the health needs of the elderly².

In recent decades, health promotion has been understood as a promising strategy to address the multiple health problems affecting human populations and its environment, particularly the elderly popupalation³. It presents as health education interface, aiming at improving self-esteem, reducing alienation and increasing the knowledge, expanding the individual choices of possibilities, leaving him free to choose on his behavior⁴.

Under an expanded approach, health promotion is understood as a proposal for a permanent education of the community to improve the living and health conditions. The promotion actions result from a combination of state actions in their public health policies; cross-sectoral interventions, community activities and the individuals to develop their skills⁵.

The educational activity is the method considered more promising to carry out health promotion, which consists of activities directed to transforming behaviors of individuals, focusing on their lifestyles. These activities must be conducted in groups, where the practices lead to reflection on aging in its multiple determinations and stimulate desiring and participatory investment in life^3,4.

The themes addressed in the health care of the elderly should have effective dialogue and overcome the issues of disease and risk factors. They are themes such as aging, sexuality, leisure, family relationships, social rights, as well as countless other topics expressing needs and interests of the elderly.

In this perspective, practices of health promotion developed by interdisciplinary teams began to present an elderly people care model aimed for completeness. Its primary objective is maintaining a good health that through various professional optics, use health education, aimed at a maximum range of active life, allowing autonomy, physical, psychological and social independence, the environment in which is inserted with their family^5,6.

It can be seen from the above that, to offer comprehensive care to the elderly, the acting ceases to be exercised by one or few professionals and is now run by a team, whose members will be responsible for various areas of geriatric knowledge obviously worked from the perspective of interdisciplinarity.

By considering these aspects, this study aimed to assess the health promotion practices developed by the interdisciplinary team with a group of elderly.

LITERATURE REVIEW

The study of human aging has become the subject relevant to today's society, given the rise in life expectancy and tendency to increase in the elderly population. However, this issue is related to the need for formulation, expansion and delivery of public policies to support the elderly, because they demand special care¹.

In this context, public policies were created to contemplate the health of the elderly, such as the Pact for the Defense of Life, the National Health Policy for the Elderly and the Elderly Statute. In all of them, the promotion of health lies as one of the main approaches⁴.

The National Policy for Health Promotion provides that for the individual to have quality of life, including the elderly, it is necessary that this person has a healthy diet, body practice/physical activities, prevention, and control of smoking, reducing morbidity and mortality due to the abuse of alcohol and other drugs, traffic accidents, violence prevention and encouraging the culture of peace, promotion of sustainable development³.

METHODOLOGY

It is a quantitative, qualitative and descriptive study because the scientific research of quantitative nature are characterized by the use of statistics translating into numbers the opinions and information, and the qualitative nature of studies seeking to understand and explain the dynamics of social relationships that are generated from the actions, beliefs, values, attitudes and human habits⁷.

It is characterized as a field research developed in the elderly group Amigos de irmã Fernanda located in Cajazeiras - PB. There were, 12 health care workers being two nurses, three physical educators, two physical therapists, two dietitians, a psychologist, a dentist, and a doctor participating in the study. These health professionals are voluntary members of the interdisciplinary team of the group and come from higher education institutions such as the Federal University of Campina Grande (UFCG) and the School Santa Maria (FSM), and also the Secretary of the Municipality of Cajazeiras PB-Education (SEMC). Thus, it was not necessary to adopt statistical procedures to select the study subjects.

Information was obtained through a self-applied questionnaire in January 2013 after the activities developed in 2012. The instrument was built from the proposed objective in this investigation and included questions about the socio-demographic and professional profile of the participants, understanding, developed activities, the effectiveness of practices and challenges to implementing actions to promote the health of the elderly. Each participant had a period of 15 days for returning the completed questionnaire.

Quantitative data were analyzed according to simple descriptive statistics in absolute numbers and percentage, organized and presented in a table.

As for qualitative data, the thematic technique was used form of content analysis, following the steps of pre-analysis, which consisted in selecting the documents to be considered as the initial objective of the research, that is, at this stage a thorough reading of the responses to the questionnaire of the study subjects was performed seeking to respond to the initial proposal. Then, material exploration, which enabled the classification of data to achieve the core of understanding the text. The third stage comprised the treatment of the results, which was based on the analysis of clusters of data contained in the questionnaires, establishing relationships between the results and the literature. Finally, the interpretation addressing the actual examination of the study⁸. After compiling the data, the results were analyzed from the literature.

The content analysis of the subjects emerges from the elaboration of four thematic categories entitled: Understanding health promotion, Health promotion activities, Effectiveness of interdisciplinary practices, Difficulties for health actions.

The participation of the subjects begins by signing the Informed Consent Form (TCLE), with the assent Number 0289.0.133.000-11 by the Ethics Committee in Research of the State University of Paraíba/UEPB as now advocates the Resolution 466/12 of the National Health Council/National Research Ethics System (CNS/SISNEP) that regulates research with human beings in Brazil⁹.

The anonymity of the health professionals who participated in the study was ensured. The clippings of their responses were identified by the letter S from a subject followed by the number of the questionnaire return sequence.

RESULTS AND DISCUSSION

Characterization of professional study participants

As regards the age of the participants, health professional predominated - young adults, from 25 to 35 years old, according to the data of Table 1.

TABLE 1: Socio-demographic and professional profile of the participants who were part of the interdisciplinary team. Cajazeiras - PB 2012 (N=12)

In the academic training of previous decades, there was no incentive for health promotion activities, differentiating the proposed new curriculum guidelines of healthcare courses¹⁰. It adds that the new health professionals are also being prepared to adopt postures that offer empowerment to older people in promoting their health⁵. In this context, it was expected the prevalence of the age group declared by such participants.

As for gender, 10 (83.3%) of the participants were women, according to Table 1. This result is expected when it comes to health professionals because although men have increased for such profession, there is still female predominance in healthcare¹¹.

On the title of these professionals, 8 (66.7%) were experts in their fields and 4 (33.3%) were masters in various areas. These data show that these professionals sought to qualify for the assistance to the population and, in particular, the promotion of health of the elderly.

The training of professionals in gerontology should be a priority for the evolution of Brazilian public health policies of the elederly¹².

The thinking and practicing of health require a new logic and organization of work, the development of an educational process that allows health professionals be learning from other knowledge, skills and ways of working¹¹.

As for the acting time in the elderly group, 6 (50%) of the professionals performed health promotion activities between one and two years. This data is important because it expresses its relevance to the practice of care for the elderly since the work experiences enable the professional to acquire knowledge and skills to develop their functions, and strengthen the bond with this population by establishing a trust relationship, acquired and improved over time.

The four emerging themes of the study were analyzed and discussed.

Understanding of health promotion

Understanding the research participants about health promotion shows the many facets that address this issue since they inferred the new work philosophy, as a working organization prerequisite and as community participation.

It is known that people nowadays need to take care of themselves to have an old age with fewer problems; that is without chronic diseases. Thus, health promotion is a way of working with people, teaching them to take care. (S1)

Health promotion is health actions systematized and passed by a population health professional, to prevent disease and prolong the lives of people. (S4)

It is a very effective work methodology to teach and educate the elderly on prevention of chronic degenerative diseases and should be applied in primary health care by qualified professionals. (S7)

Health promotion is held with the help of the community. [...] To work health promotion, it is necessary that all who work in a health team join the community [...]. (S8)

Health promotion expression began to be published by Henry Sigerist from the 1940s. However, it was highlighted by national and international conferences in subsequent decades and came to be inserted into the work of professionals after the encouragement and understanding of its importance for the health of the population¹³. Despite the emergence period for some of the participants of this research, this issue was again on the stage of their occupational activities.

A study reinforces the concept of these professionals to say that the design of the promotion of current health is linked to a combination of strategies involving state actions, individual, community, health system, and inter-institutional partnerships, with the goal of creating actions that enable health and, consequently, better quality of life¹⁴. However, community participation is essential in this process, so that people will have the autonomy to propose and decide health practices that benefit the most.

Promoting the health aims to provide the formation of a healthy society, where all citizens have equal access to resources that constitute the quality of life such as education, housing and adequate environment, employment and income, information, leisure, culture, sanitation, food, safety, social participation and health services. Thus, involving integrated and cross-sectoral public policies that operate in the social determinants of health, with community participation^15,16.

Health promotion can also be seen as another axis; that is appearing as an activity directed at changing the behavior of individuals, emphasizing their lifestyles as received education and culture¹⁷.

Health promotion activities

The actions implemented in health care for the elderly by the professionals involved focused on health education as an activity in common for all professionals, because they are co-responsible in elderly care; and specific actions of the professionals, such as physical activity developed by physical educators, prevention of falls by physiotherapists, nutritionists and dietary guidelines for consultations by nurses.

We perform various physical activities, like a simple walk with obstacles, stretching, weightlifting [...] dance is always working in the group [...] through physical therapy work to prevent falls in the elderly. (S9)

The main activities that I do with them are on the prevention of falls, postures. They are developed in the group and oriented them to perform at home for better performance [...]. (S5)

Work with him showing the benefit of having a healthy diet, and then I speak of the value of food, as they should be eaten, [...]. (S8)

We held the gerontological nursing consultation, where we assess the elderly. [..]. The elderly are also informed on how to take their medications, advised to take care of feeding and body in general [...]. (S11)

These actions taken together enable the involvement of older people in health promotion process and the permanence in actions that promote benefits and quality of life, therefore, important in the aging process.

Some factors help both insertion and the adherence of the elderly in action programs aimed at promoting health, such as education, family, social, health, economy aspects. In this perspective, education for health is not only informing or transmitting knowledge but preparing the individual for self-care ¹⁸.

A similar study conducted in Campinas - SP showed that health professionals working in primary care for the elderly were performing scheduled appointments and possible hosting, procedures in general, educational groups, home care, vaccination, assessment of oral and gynecological cancer, discuss the therapeutic projects, planning and care management for the elderly¹⁹.

A research conducted in Portugal revealed that the use of health care for the elderly depends on the combination of several related factors, such as their health status and availability of supply of health care²⁰.

Effectiveness of interdisciplinary practices

Health promotion practices carried out with the elderly by the interdisciplinary team improved the performance of various aspects such as functionality, autonomy, independence, well-being and psychosocial quality of life of older people since they began to adopt healthy habits and changed their lifestyles.

[...] Through these health practices, the elderly is likely to have various benefits on their health such as the improvement in locomotion, better performance of basic and instrumental activities of daily living. (S7)

Healthcare practices have a better development of autonomy and independence. (S5)

By analyzing these statements, it is clear that the achievement of health practices contributed to the promotion of health, which is one of the main aspects of a healthy aging and quality of life of the elderly.

According to the National Policy for the Elderly, successful aging can be characterized by the presence of good physical and cognitive functioning, low probability of onset of disease and disability associated with them, autonomy and independence²¹.

Therefore, for the elderly to remain active and with a good capacity for development of basic and instrumental activities of daily living, it is necessary that they are involved in programs that address interdisciplinary.

Aging with quality of life is an essential aspiration that enhances the living and depends in large part on social conditions and public policies that guarantee basic rights of citizenship and enable tends healthy practices such as balanced nutrition, physical activity, pleasurable use of the body, social and occupational integration provided with care and preventive services^{13, 22}.

Health promotion is essential to prevent and control the health problems common in this stage of life. In this sense, promote healthy aging is a complex task that includes the achievement of a good quality of life and broad access to services that promote coping with aging issues in the best way possible ³. These considerations have the challenge to experience aging, the importance of health promotion, to maintain the health of the elderly.

Difficulties for health actions

The difficulties faced in carrying out health actions by the participants were related to health problems experienced by the elderly, shortage of material and physical resources.

One of the obstacles we face in the group is the small physical space for the development of health actions by professionals. (S3)

The person in old age has many chronic diseases that hinder the physical activities that are performed in the group [...]. (S4)

The biggest difficulty I see is the limitations of the elderly, such as low vision, hearing, mobility. All these things interfere with the activities of the group. (S11)

We have faced some difficulties concerning the lack of some equipment required to perform certain activities as both physical therapy [...]. (S12)

Chronic diseases in the elderly are presented as a serious health problem that needs to be diagnosed, measured, evaluated and treated by professionals, preferably by an interdisciplinary team since these are the agents capable of minimizing morbidity and improving the quality of life for these patients through interventions.

An epidemiological study revealed that the diseases that most affect the elderly are associated with chronic disorders, particularly musculoskeletal disorders such as arthritis, osteoarthritis, osteoporosis, diabetes and high blood pressure²³.

When chronic diseases are in their daily routines, they instigate, destroy, weaken, undermine and threaten their safety, autonomy and independence, preventing them often to perform instrumental and activities of daily living, as well as limiting the ability of interaction and social entertainment, significantly decreasing their quality of life²⁴.

However, the age cannot be seen as a disease but as a stage of life with its characteristics and values, in which changes occur in the organic and emotional conditions of the individual²⁵.

Participants also cited as a difficulty the deficit of working conditions, which can prevent satisfactory performance in health care provided by some of them. In a study developed in Campinas - SP, about the activities of family health teams with the elderly, the limited number of human resources and secondly, the infrastructure and equipment was found to be the main difficulty for implementation of health promotion, resembling the present study ¹⁹.

In Colombia, the reality does not differ to a large extent of Brazil, because, despite the recognition and success in various areas of primary health care programs, the difficulties are evident and similar to Brazil²⁶.

The problems cited by participants and other authors may be related to the economic crisis in the countries they live and have an impact on people´s health. The reduction in services effects on the ability of individual and collective actors respond to difficulties, which include, in a particular expression, the access to health services²⁷.

CONCLUSION

The participants' understanding of health promotion focused on the elderly working structure; the activities related to health education and interdisciplinary actions; the effectiveness of practices for improving the quality of life of older people and the challenges for health promotion, considering the specifics of chronic diseases; and the lack of material and human resources.

The limitations of the study showed gaps in the proposals of public health policies for the elderly, who may have been due to the lack of investment managers and/or performance deficit with that people.

In promoting health, there is still much to be done, since its multifaceted feature triggers barriers, which permeate the social, cultural and economic aspects. On the other hand, the practice of health promotion in the multidisciplinary approach adds new possibilities to the extent that health education and specific interventional practices of each profession can improve the functionality, autonomy and independence of the elderly, contributing to their psychosocial well-being.

Promoting health requires knowledge, commitment, and proactive capability and when performed by an interdisciplinary team, it is necessary that their promoters concentrate their efforts to completeness and improving the elderly´s quality of life.

REFERENCES

1.World Health Organization. Organização Pan-Americana da Saúde. Envelhecimento ativo: uma política de saúde. Brasília (DF): WHO; 2005.

2.Papaléo Netto M, Yuaso DR. Interdisciplinaridade em gerontologia: aspectos conceituais e objetivos. In: Papaléo Netto M. Tratado de gerontologia. São Paulo: Editora Atheneu; 2007. p. 149-62.

3.Gutierrez PR, Oberdiek HI. Concepções sobre a saúde e a doença. In: Andrade SM, Soares DA, Cordoni Júnior L. Bases da Saúde Coletiva. Londrina (PR): Ed. UEL; 2001. p.1-25.

4.Teixeira MB. Empoderamento de idosos em grupos de promoção da saúde [dissertação de mestrado]. Rio de Janeiro: Escola Nacional de Saúde Pública; 2002.

5.Santos SSC, Barlem ELD, Silva BT, Cestari ME, Lunardi VL. Promoção da saúde da pessoa idosa: compromisso da enfermagem gerontogeriátrica. Acta Paul Enferm. [Scielo-Scientific Electronic Library online] 2008 [citado em 18 jan 2015]. 21: 649-53. Disponível em: http://www.scielo.br/scielo.php?pid=S0103-21002008000400018&script=sci_arttext .

6.Assis M. Envelhecimento ativo e promoção da Saúde: reflexões para ações educativas com idosos. Rev APS. 2005; 8: 15-24.

7.Costa SFG, Silva MIT, Oliveira EF, Lima CB. Metodologia da pesquisa: coletânea de termos. João Pessoa (PB): Ideia; 2000.

8.Minayo MCS, Deslandes SF, Gomes R. Pesquisa social: teoria, método e criatividade. Petrópolis (RJ): Vozes; 2007.

9.Ministério da Saúde (Br). Conselho Nacional de Saúde. Comissão Nacional de Ética em Pesquisa. Normas para pesquisa envolvendo seres humanos: Resolução nº 466/12 do Conselho Nacional de Saúde. Brasília (DF): Ministério da Saúde; 2012.

10.Mattos D, Aguiar AC. As novas diretrizes curriculares e a integralidade em saúde: uma análise das possíveis contribuições da odontologia para o trabalho em equipe [dissertação de mestrado]. Rio de Janeiro: Universidade do Rio de Janeiro; 2006.

11.Cotta RMM, Schott M, Azeredo CM, Franceschini SCC, Priore SE, Dias G. Organização do trabalho e perfil dos profissionais do Programa Saúde da Família: um desafio na reestruturação da atenção básica em saúde. Epidemiol Serv Saúde. 2006; 15: 7-18.

12.Cassab AK. The accelerated aging of the population in Brazil. Soins Gerontol. 2013; 100: 32-5.

13.Texeira CF, Solla JP. Modelo de atenção à saúde: promoção, vigilância e saúde da família. Salvador (BA): EDUFBA; 2006.

14.Buss PM. Uma introdução ao conceito de promoção da saúde. In: Czeresnia D, Freitas CM; organizadores. Promoção da saúde: conceitos, reflexões, tendências. Rio de Janeiro: Editora Fiocruz; 2003.p.117-39.

15.Ministério da Saúde (Br). Secretaria de Vigilância em Saúde. Política Nacional de Promoção a Saúde. Brasília (DF): Secretaria de Atenção à Saúde; 2006.

16.Cruz ALB, Martins KL. Percepção da promoção da saúde do idoso: olhar de agentes comunitários de saúde. Rev enferm UFPE. 2010; 4: 1484-91.

17.Lemos LA, Fiuza MLT, Pinto ACS, Galvão MTG. Grupo de promoção da saúde para portadores do vírus da imunodeficiência humana. Rev enferm UERJ. 2013; 21: 521-26.

18.Michel RS. Portal Fórum [site de Internet]. O desafio das barreiras. [citado em 10 mai 2015]. Disponível em: http://www.portaldoenvelhecimento.net/pforum/afv2.htm.

19.Garcia MAM, Miyamoto DA, Frigério RM, Merlin SS. A atuação das equipes de saúde da família juntos aos idosos. Revista APS. 2006; 9: 4-14.

20.Quintal C, Lourenço O, Ferreira P. Utilização de cuidados de saúde pela população idosa portuguesa: uma análise por género e classes latentes. Rev port Saude Publica. 2012; 1: 35-46.

21.Ministério da Saúde (Br). Portaria de nº 2.528 de 19 de outubro de 2006. Aprova a Política Nacional de Saúde da Pessoa Idosa e dá outras providências. Brasília (DF): Gabinete Ministerial; 2006.

22.Moliterno ACM, Faller JW, Borghi AC, Marcon SS, Carreira L. Viver em família e qualidade de vida de idosos da Universidade Aberta da Terceira Idade. Rev enferm UERJ. 2012; 20: 179-84.

23.Gold DT, Roberto K A. Correlates and consequences of chronic pain in older adults. Geriatr Nurs. 2005; 21: 270-3.

24.Celich KLS, Galon C. Dor crônica em idosos e sua influência nas atividades da vida diária e convivência social. Rev Bras Geriatr Gerontol. 2009; 12: 345-60.

25.Oliveira ALB, Dourado MB, Menezes TMO. A percepção dos graduandos de enfermagem sobre envelhecimento. Rev enferm UERJ. 2014; 22: 680-5.

26.Campos AC, Soler JMA, Moreno YAC. A look at primary health care and reflections on its development in Colombia. Revista de Actualizaciones en Enfermería. 2013; 16: 50-6.

27.Loureiro I, Miranda N, Miguel JMP. Promoção da saúde e desenvolvimento local em Portugal: refletir para agir. Rev port Saude Publica. 2013; 31: 23-31.