Characteristics of disorders among older adults and the care provided by a mobile pre-hospital service. Researcher of the nursing and health care to the adult and elderly group. Email: marciabath gmail. II Nurse.

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Characteristics of disorders among older adults and the care provided by a mobile pre-hospital service. Researcher of the nursing and health care to the adult and elderly group. Email: marciabath gmail. II Nurse.

Email: daniellesamara hotmail. IV Nurse. Doctorate in Sociology. Email: graacafernandes hotmail. V Nurse. Email: katianeyla yahoo. Email: kamylaoliveira hotmail. In that light, this retrospective, quantitative, documentary study aimed to characterize the main disorders among older adults in a mobile pre-hospital service in the city of Joao Pessoa, Paraiba, Brazil, and to examine the corresponding care provided by health professionals.

The study found that mobile pre-hospital care provided to elderly patients must be approached on clear criteria. The findings revealed a lack of specific planning for this public and an absence of specific care procedures given the increasing need for preventive approaches to elderly casualties.

Keywords: Elderly people; emergency; morbidity; external causes. The growth of the elderly population is a worldwide phenomenon and, in Brazil, modifications occur radically and quite fast. The speed of the process of demographic and epidemiological transition experienced by the country in the last decades brings a series of crucial issues for managers and researchers of health systems, with repercussions for society as a whole1.

Despite the increase in the survival of the population be a world conquest, this phenomenon has been accompanied of the prevalence of chronic and multiple diseases, leading to increased demand for urgent and emergency care in this population, especially in cases of intensification of these problems2. The greater vulnerability of the elderly and the occurrence of grievance by external causes, such as violence, falls and car accidents, typical of urban development in the country, also increase their health care needs.

The APH is defined as the assistance provided in a first level of care to patients with acute cases, clinical in nature, traumatic or psychiatric that occurs outside the hospital environment, which can lead to sequels or even death4. Among the measures to be imposed to cope with this new health care scenario the organization of networks of integral care to the urgency room has been determined, while maintenance chain to life, with the components: hospital, post-hospital, fixed pre-hospital and mobile pre-hospital, being the last one represented by the Mobile Urgency Attendance Service SAMU 3.

Similarly, the increase in the number of elderly who are victims of injuries from external causes serviced by SAMU is also object of concern of health professionals, by favoring the higher incidence of mortality from these individuals, compared to the general population6. In Brazil, the structuring of this type of service was driven from the decade of , with the reorganization of health services. The SBV is the preservation of life, without invasive maneuvers, with which professionals work under medical supervision.

The SAV has features like invasive maneuvers of greater complexity, and, for this reason, this service is carried out exclusively by doctors and nurses4. The service request is performed by the population through connection to the free system, on the phone, , willing throughout the national territory. These professionals should have a selective profile, with different skills than those of the attendance of traumatic and psychiatric clinical aggravations that affect different age groups in urgent and emergency situations.

Among the important skills for practical exercise in pre-hospital attendance are the ability to perform the procedures, quickly clinical reasoning and psychological preparation8. Anyway, it should be noted that, in recent years, managers of public health policy of the states are broadening the pre-hospital mobile attendance, by virtue of the growing need to reduce mortality, as well as the sequels produced by acute events in the pre-hospital setting, safeguarding the fundamental principles of fast, accurate and efficient attendance service.

Thus, it should be noted that the pre-hospital care should be distinguished when it comes to elderly person, because sudden manifestations of diseases and traumas are more frequent in this population compared to younger individuals; in addition to suffer influence of type of lesion, the elderly have specific features, such as: decreased physiological reserves, associated chronic diseases and medicines of continuous use9, The determination of the sample was of probabilistic type, simple casual or random.

To this end, the following procedures were adopted: initially it was identified the number of calls performed by the SAMU between the months of January to July , obtaining the total of 15, attendances. Next, between them it was identified the amount of elderly people 60 years or more assisted in the same period, which corresponded to 3, For the data analysis procedure it was used the titles of EpiInfo program and for the generation of results using the statistical program SPSS version The data were arranged in tables and discussed in the relevant literature.

This survey obeyed to the rules and guidelines contained in Resolution No. There were female predominance both in attendance to clinical grievance - That ratio is reversed in attendance to hospital transfers - 24 With regard to the clinical evaluation of elderly, arterial hypertension was reported in It was found that An enhanced support was held in 85 Most of these attendances, Then, the main clinical and traumatic causes were evaluated that led to put in action the SAMU, relating them to the team that provided the first accounts.

The basic support team met more occurrences by lowering the level of consciousness, totaling 60 In the attendance to elderly affected by external causes, the fall of their own height was present in 94 There are 11 7. Of the attendances related to the external causes, the USBs were put into action in and the USAs in only eight. Hemodynamic assessment occurred in The main procedures performed by the teams of SAMU in serving the elderly affected by clinical grievance by external causes, for transfers and for psychiatric disorders are described in Table 2.

It is highlighted that the pulse oximetry - Of the total number of attendances, Public state hospitals received most of these elderly Only 32 6. The analysis of urgent and emergency attendance of grievances to people with more than 60 years allows following the behavior of chronic non-communicable diseases DCNTs , the impact of population growth and violence in this age group and the preparation of professionals working in pre-hospital care. Accordingly, studies about these conditions that affect the elderly are of fundamental importance for the planning of public health policies that may attend this growing portion of the Brazilian population.

The main diseases associated with the elderly population are the neurological, coronary and those linked to traumas However, is important to point out that The elderly trauma victims are, generally, independent people who can initiate a deterioration of their mental and physical health after accidents6. The accidents and violence represent an important impact on functional capacity of the Brazilians elderly. The admissions for aggression represent 1. It is important to point out that many violent events do not require hospitalization and, therefore, are considered less serious, but they involve physical aggression, psychological and negligence to which the elderly are exposed in the family context, in the community and in institutions, and they are not notified.

For this reason, we do not have the exact notion of violence experiences of Brazilians elderly Elderly attendance who is a victim of events by external causes accidents and violence must be the subject of concern of professionals working in pre-hospital attendance, because the elderly are more physiological susceptibility in traumatic events, by arising comorbidity from chronic-degenerative diseases, contributing to the morbidity and mortality, along with the decline of the musculoskeletal and sensory system The elderly population is the most exposed to death and to all kinds of external causes, except homicide and drowning, and falls are the events that most contribute to the production of fatal injuries in this population Confirming data from the literature, one of the attendances made in traumatic events, the fall had the largest number of occurrences, with The fall in the elderly nearly always comes with organism clinical changes or resulting from the natural process of human aging, however, like the other variants of the so-called external causes, it is preventable, through the reorientation of confluent public policies to elderly person15,20, Among clinical occurrences, the neurological change was the main cause of putting into action the SAMU in relation to elderly, being assigned to the demotion of the level of awareness in 82 In a study conducted in Porto Alegre-RS, it was identified that However, due to the greater portion of these attendances have been made by team consisting of nursing technician and paramedic driver, the association of neurological cause lifting or diagnostic elucidation was not performed.

In this context, there is a need for the presence of the nurse in all modalities of attendance so that they can be established all the steps of the nursing process.

It was found that basic support teams and advanced support used parameters of the Revised Trauma Score RTS for clinical evaluation of elderly. This tool is used for quick assessment of trauma victims, in which they are used the Glasgow Coma Scale, the respiratory rate and systolic blood pressure, noting that the greater the change in these parameters, the lower the probability of survival of patients However, such behaviors have resulted in greater exposure to risk conditions, which is determined by the alarming growth of the elderly population victim of accidents and traumas.

Based on this research, it was found that the elderly population is representing an important focus of attention, especially for health services, in the face of significant population growth in this age group. Thus, it is beneficial that the various social sectors to develop and move forward in order to suit the contemporary reality.

The study identified that pre-hospital mobile assistance offered to elderly patients demands selective approaches.

From the findings, the lack of specific planning for the public concerned and the absence of specific streams of attendance on the growing need for preventive approaches for elderly victimized was verified, being met as any other person of minor age. The attendance aimed at traumatized elderly or victim of acute emergency state is based on the same criteria applied to the adult and however, they should respect the specificities related to the contributing factors and constraints of this population.

Veras R. Rev Bras Ter Intensiva. Rev Bras Enferm. Rev enferm UERJ. Gentil R. C, Ramos L. Rev Latino-am Enfermagem. National Association of Emergency Medical Technicians. Rio de Janeiro: Elsevier; Aprova as diretrizes e normas regulamentadoras de pesquisa envolvendo seres humanos. Acta Paul Enferm.

Rev Bras Epidemiol. Rev esc enferm USP. Epidemiologia do trauma. In: Freire E. Mortalidade por causas externas em idosos em Minas Gerais, Brasil. Esc Anna Nery. Melo EG, Azevedo E. Quedas no idoso. Conselho Federal de Enfermagem.


Despacho n.ยบ 10319/2014

A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Trauma was predominant among women Among the mechanisms, falls Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.


PHTLS: Atendimento Pr -Hospitalar Traumatizado, Oitava EDI O by NAEMT (Paperback, 2016)


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