Instituições de longa permanência para idosos durante a pandemia de COVID-19, as estratégias para manutenção da funcionalidade e a atuação do fisioterapeuta

Abstract

The older people residing in long-term care facilities (LTCF), due to the higher prevalence of pre-existing comorbidities and the characteristics of their housing, demanded a careful look at the COVID-19 pandemic. Much has been discussed about the importance of early detection of COVID-19 cases, as well as isolation, adequate clinical management and source control. Several measures have been suggested to restrict the contagion and spread of the virus, and thus reduce hospitalizations and deaths. Prohibiting visits, suspending health services considered non-essential, interrupting collective activities, maintaining adequate distance during meals are some measures proposed to preserve the elderly. While vaccination progressed, these precautions were also supplemented by universal measures such as adequate guidance for employees and residents to avoid touching, using masks when possible, frequent hand hygiene, regularly disinfecting spaces and carrying out respiratory etiquette. However, considering the particularities of the elderly residing in an ILPI, which make them more vulnerable and fragile, their functionality cannot be left out. The high prevalence of inability to perform basic and instrumental activities of daily living among institutionalized elderly people leads to constant concern with functional decline. The general objective of this thesis was to identify how the LTCF has been dealing with the COVID-19 pandemic, highlighting the role of managers and physiotherapists in the face of the functionality of the older people. In the first study, the objective was to describe the rates of infection, hospitalization and deaths due to COVID-19 among residents and employees of LTCF in the state of Minas Gerais and to identify the strategies used to prevent and control this disease. A cross-sectional study was carried out with 164 LTCF. Among the LTCF studied, 48.7% confirmed the COVID-19 infection in the older people, resulting in 39.6% hospitalization and 32.3% death among those infected. In addition, 68.9% of the LTCF confirmed COVID-19 infection in the team, with 7.3% hospitalization and 1.2% death. Preventive measures were identified and classified as organizational, infrastructure, hygiene items and personal protective equipment and personnel training against COVID-19. These measures showed strategies and barriers experienced in the daily life of LTCF during the pandemic. Considering that the loss of functionality can be as worrying as mortality itself, the objective of the second study was to evaluate the strategies employed by LTCF, in the Brazilian context, to preserve the functionality of the older people. This was a cross-sectional observational study involving an online questionnaire applied to Brazilian LTCF managers. A total of 276 LTCF, from the 5 regions of the country, participated in the study. The loss of cognitive and physical function was perceived by 60.2% and 48.2%, respectively, of the managers and the increase in depressive symptoms by 77.9%. Activities that contribute to maintaining the functionality of the older people were reduced and remote activities to maintain functionality were not carried out in most of them, the main barriers being pointed out in the study results. This study warns about how the functionality of the older people has been neglected by managers of Brazilian LTCF during the pandemic. Finally, the third study aimed to identify the profile of the physiotherapist who works in an LTCF in Brazil, to evaluate the offer of remote assistance and the perception of these professionals on the functionality of institutionalized older people and on the participation of the older people in remote assistance during the COVID-19 pandemic. For this, a cross-sectional observational study was conducted using an online questionnaire. The questionnaire was answered by 132 physiotherapists from the 5 regions of the country. The study revealed that most of them (64.3%) have a formal job, work in only one LTCF (79.5%), for more than 10 hours a week (61.4%), have other sources of income besides from work at the LTCF (75%) and maintained their face-to-face assistance during the pandemic (58.3%). Only 15.9% carried out remote assistance during the pandemic. There was a perception of loss of global functionality of the older people by 71.2% of the physiotherapists. In addition, the presence of depressive symptoms, loss of cognitive and physical function and an increase in the number of falls were reported by 92.8%, 92.5%, 78.7% and 31.7% of the physiotherapists, respectively. Regarding the adherence of the older people to remote activities, 48.5% of the physiotherapists reported that most of the older people adhered to the activities. This study made it possible to clarify that, although there is evidence of benefits of remote physiotherapy care for institutionalized older people, there are still barriers that need to be overcome, including with regard to technical skills, familiarity and beliefs of professionals.