Mortalidade de residentes em ILPI de Belo Horizonte, 2016: a terminalidade da vida e o cuidado necessário

Abstract

The quality of life implies a process of death also appropriate, in the light of the concept of Good Death - occurring in the right time, with dignity and relief of suffering in its physical, psychic, social and spiritual aspects. This observational study focuses on the way 104 of 116 elderly people institutionalized died in Belo Horizonte, Minas Gerais, Brazil, in the year 2016. The death certificates and the institutional records of these elderly people were used to study the variables associated with the deceased and their family and social environment and identify factors associated with care in the final phase of life. The main social determinant of institutionalization was family insufficiency (notably the absence of a partner), with a history of mistreatment in 23% of the cases. The frequency of cognitive impairment was high at the time of admission to ILPI, as well as advanced age and loss of autonomy for the Basic Activities of Daily Living. The majority of deaths occurred in the aged ones with a profile that coincided with the one that determined the institutionalization: female, white, low schooling and absence of family support (notably a partner), as well as cognitive alterations. The proportional mortality was higher in patients over 80 years. Record deficiencies were observed, including those respecting existing pathologies and presence of geriatric syndromes. The data found indicate probable situations of suffering and qualitative and quantitative inadequacy of the care provided in the quarter preceding the death, with inadequately addressed physical suffering: persistent dyspnea and pain occurred in more than half of the elderly; fatigue and other symptoms had low frequency, probably due to under registration. Family, social and spiritual support was insufficient. Adequate quality of death was only reported in 24% of the participants. These findings confirm the literature data regarding inadequate support provided to people during the dying process. The results point to the need for additional studies, since knowing the main causes of morbidity and mortality in institutionalized elderly will contribute to a better planning of health actions, taking into account their specific needs. It concludes by the importance of discussing the terminality and empowering those responsible for supporting and comforting those who are dying.