A morte e o morrer nas instituições de longa permanência para idosos sob a percepção dos terapeutas ocupacionais: um estudo qualitativo

Abstract

There has been an increase in aging populations in Brazil and in the world in recent decades. The increase in longevity reflects cultural changes and advances in healthcare. There may be difficulties in this scenario in maintaining adequate care for older adults at home. Thus, Long-Term Care Facilities (LTCFs) for older adults present themselves as a possibility to provide care. LTCFs will be a new home for many older adults, and the place where they will spend their last days. Thus, occupational therapists need to provide them with dignified care at the time of death. In this context, this thesis sought to investigate the perceptions of occupational therapists who work in LTCFs about death and dying. Two studies were carried out using a qualitative methodology. The first aimed to understand the perceptions of occupational therapists about death and dying in LTCFs. Data from this study were collected through focus groups and analyzed using Thematic Analysis. A total of 12 occupational therapists participated in the study and two themes were generated: “The experience of death and dying” and “The approach of occupational therapists in facing death and dying”. The results showed that death and dying permeate the daily lives of occupational therapists in a complex and conflicting way. Death presents itself as a phenomenon full of values and meanings and at times as taboo and synonymous with failure. The approach to death and dying requires occupational therapists to implement action strategies which attend to the real needs of older adults in LTCFs. Thus, the results of this study can contribute to better care for institutionalized older adults in the process of death and dying. The second study aimed to discuss the perceptions of occupational therapists about death and other losses in the COVID-19 pandemic in LTCFs. In-depth interviews were conducted with eight occupational therapists, and two themes were generated after carrying out the Thematic Analysis. In the first, “Tangible loss: the proximity of death”, the interviewees addressed the feeling of imminent death and feelings related to their own death, that of their family members and the older adults. For the second theme, “Symbolic losses in life”, occupational therapists emphasized three groups of losses: social, functional and psychological/cognitive. The results of this study showed that the Pandemic directly affected older adults and occupational therapists in LTCFs, imposing a need to reflect on human finitude and frailty. These professionals face a challenging moment and it is hoped that this study can contribute to improve the care for institutionalized older adults during the COVID-19 Pandemic. Finally, this thesis showed that the experience of death and dying is challenging and requires innovative action strategies by occupational therapists, especially at this time during the COVID-19 pandemic.