Challenges and possibilities of health professionals in the care of dependent older adults
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DOI: 10.1590/1413-81232020261.31972020 89
Challenges and possibilities of health professionals
article
in the care of dependent older adults
Raimunda Magalhães da Silva (https://orcid.org/0000-0001-5353-7520) 1
Christina César Praça Brasil (https://orcid.org/0000-0002-7741-5349) 1
Indara Cavalcante Bezerra (https://orcid.org/0000-0003-0647-2490) 2
Maria do Livramento Fortes Figueiredo (https://orcid.org/0000-0003-4938-2807) 3
Míria Conceição Lavinas Santos (https://orcid.org/0000-0001-5896-3895) 1
Jonas Loiola Gonçalves (https://orcid.org/0000-0003-1015-9173) 1
Maria Helena de Agrela Gonçalves Jardim (https://orcid.org/0000-0001-7622-1449) 4
Abstract This study investigates the challenges
and possibilities of health professionals in man-
aging care for dependent older adults in PHC.
We employed a qualitative approach based on
dialectical hermeneutic fusion. Interviews were
carried out with 38 health professionals, from
June to December 2019, in eight cities in the five
Brazilian regions, which resulted in themes about
the challenges of professionals in the manage-
ment of care for older adults, the strategies used,
and their suggestions for improving the quality
of care for dependent older adults. Management
failures, structural factors, access barriers, scarce
supplies, disrupted network, and lack of security,
were pointed out as hardships in directing health
protection, prevention, and promotion actions.
The applied strategies are diverse and conflicting
1
Programa de Pós- and aim to articulate the multiprofessional teams,
Graduação em Saúde
Coletiva. Universidade de which involve the Family Health Strategy and
Fortaleza. Av. Washington specialists to implement care. Strengthening recep-
Soares 1321, Edson Queiroz. tion, encouraging home consultation, mobilizing
60811-905 Fortaleza CE
Brasil. rmsilva@unifor.br. support groups, and carrying out health education
2
Mestrado Profissional were among the participants’ integrative practices.
em Gestão em Saúde, Due to the complex study object, it was evidenced
Universidade Estadual do
Ceará. Fortaleza CE Brasil. that professionals recognize the shortcomings in
3
Programa de Pós- the health services and face undesirable situations
Graduação em Enfermagem, due to the lack of qualified personnel in the teams
Centro de Ciências da
Saúde, Universidade Federal and the defective materials and transportation.
do Piauí. Teresina PI Brasil. Key words Health care, Health personnel, De-
4
Curso de Enfermagem, pendent older adults, Primary Health Care, Qual-
Universidade da Madeira.
Ilha da Madeira Portugal. itative research90
Silva RM et al.
Introduction care, focusing on prevention and health promo-
tion actions14. In the reorientation of the PHC
Population aging is part of the demographic re- health care model, Family Health Strategy (ESF)
ality in Brazil and worldwide. The World Health leads the care to the family and the community14.
Organization (WHO) warns that two billion old- From the perspective of Oliveira et al.15, the
er adults are expected in 2050, and, in the Ameri- way of caring for older adults in Brazil, particu-
cas, people over 60 will increase more than three- larly dependent older adults, must be reworked
fold in the next 30 years, up from eight to thirty to achieve a logical and coherent care path in the
million1,2. Brazil will be the sixth highest ranked face of an articulated network of services and
country in older adults by 2025, reaching 22.71% people. These transformations must be imple-
of the total population in 2050. mented in services, training of health profession-
Chronic health problems arise with age. They als, support to the organization, and manage-
often lead older adults to become dependent on ment of resources and financing.
care and challenges from health systems that de- However, it is necessary to clarify the strate-
mand more resolute lines of care and care net- gies used to prevent risks and manage this pop-
works3. The World Health Organization (WHO) ulation’s health conditions. Understanding the
spearheads the Decade of Healthy Aging 2020- challenges of professionals who address the care
2030 to promote longevity and healthy lives, in of these dependent older adults within PHC dai-
line with the Sustainable Development Goals4. In ly and investigating their care strategies and the
parallel with aging is an urgent need to care for suggestions for improvements to support coping
this population to prevent dementia and physical with health problems of this frail population can
and mental disabilities5. open new avenues and strengthen comprehen-
The Ministry of Health developed from 1994 sive care in the SUS. This study aimed to inves-
to the present the National Policy for Older tigate the challenges and possibilities of health
Adults6. As of 2000, Policies have intensified – professionals for the management of care for
Statute for Older Adults7; National Health Policy dependent older adults in Primary Health Care.
for Older Adults8; Primary Care Policy9; Strategic
Action Plan for Coping with Chronic Non-Com-
municable Diseases in the 2011-202210 period; Methods
National Active Aging11 Policy; Guidelines for the
Care of Older Adults in the Unified Health Sys- This paper is nested in a multicenter study called
tem (SUS); and Technical Guidelines for the Im- Situational study of dependent older adults living
plementation of the Care Line for Comprehen- with their families to subsidize care and support
sive Health Care for Older Adults in the SUS12. policy for caregivers, linked to the Jorge Careli
The increased life expectancy and the frag- Department of Violence and Health Studies, the
mented care in the care networks for older adults Oswaldo Cruz Foundation.
are a reality that influences the system’s resolu- A qualitative study was conducted from a her-
tion and leaves dependent older adults receiving meneutic-dialectic perspective, which anchors the
care at home unassisted. Depending on this fact, comprehensive and critical processes of a social
PAHO/WHO2 expresses that disability-associ- event16,17. Hermeneutics seeks to near the mean-
ated aging has increased by 12.6% since 2009. ing established by professionals when they live the
PAHO’s Plan of Action on the Health of Older experience of caring for dependent older adults,
Persons, including Active and Healthy Aging for emphasizing beliefs, values, objective actions, and
the period 2009-2018 report, showed that health subjective meanings. Dialectics allows confront-
workers are not prepared to meet the needs of ing social components under critical lenses.
older adults4. The study reported here was developed in
Health care management must involve mul- eight municipalities in the five Brazilian regions,
tiple dimensions, adjusting to each stage of life, including Brasília, Teresina, Fortaleza, Manaus,
searching for well-being, security, and autonomy, Rio de Janeiro, and Belo Horizonte Porto Alegre,
and can benefit from access to health resources and Araranguá. These municipalities were cho-
available in the social environment13. In the SUS sen to understand the national realities due to the
organizational scope, PHC is the main gateway to diverse and intricate aspects of social, cultural,
the system, as it is where users’ first contact with and health conditions18.
health services and professionals should take Thirty-eight PHC professionals who pro-
place longitudinally, aiming at comprehensive vided some care to dependent older adults were91
Ciência & Saúde Coletiva, 26(1):89-98, 2021
interviewed for this section of the study. Among Results
the professional categories interviewed were
doctors (8), nurses (18), psychologists (1), phys- The results are presented in two themes that
iotherapists (1), social workers (3), dentists (2), emerged from the collected empirical material. It
biologists (1), physical educators (1), nursing is worth mentioning that the reference to “old-
technicians (1), pedagogues (1) and community er adult” is extended to “dependent older adult”
health workers (1). Participants with at least one- (DOA), since the research analysts of this study
year experience in PHC services were included considered the principle of inseparability, since
to ensure the experience of caring for dependent they belong to the same population group, only
older adults. Those who were on vacation or were differing concerning the level or intensity of care
removed for any reason from work activities were demanded.
excluded.
Key informants from the municipal health Challenges for professionals in the
departments indicated the participants, based management of care for dependent
on previous knowledge about the registration of older adults
households and UBS that attended older adults
dependent on any type of physical, mental, or so- The participants’ main challenges are related
cial care. The inclusion criteria considered health to inefficient PHC management, structural diffi-
professionals who had worked, for at least a year, culties, territorial and access barriers, scarce sup-
in PHC services and municipal programs that plies, counter-referral system bureaucracy, long
provided support to older adults and their fam- waiting lines, and lack of public security. The
ilies. The invited professionals were contacted in inefficient management of PHC is evidenced by
person, by phone, or social media. They received care lag and lack of priority resources and man-
information about the study upon accepting the agement.
invitation. There’s no such thing as primary care! All ends
Data were collected through semi-struc- up staying much more at doctor’s offices, losing the
tured interviews to capture identification data, vital ability to identify inside people’s homes. (Enf.,
sociodemographic characteristics, facilities, and Porto Alegre).
difficulties in receiving and monitoring the care When talking about primary care, we think
of the dependent older adults and the support about prevention and health education. Today, we
strategies used. Interviews were held from June are doing 1% of education and health. The rest is
to December 2019 after participants signed the just walk-in demand. So [the actions carried out]
Informed Consent Form (ICF), at reserved plac- lost a little the meaning of primary care. (Med.,
es in the respondent’s work environments, with a Fortaleza).
mean duration of 20 minutes. PHC structural difficulties are challenging
The data were sorted, classified, and analyzed and worthy of attention by responsible bodies.
following the steps of transcribing the interviews, Professionals aim for spaces to conduct collective
reading, rereading the material, and separating activities and establish a shared care network.
the sets of signs that emerged from the text (sort- In the health unit, we have NASF’s room that
ing); grouping the sets of signs and their analyt- does not even accommodate NASF professionals.
ical classification (classification), and interpreta- Five professionals in there pack the place. So, we
tion of the data, bringing to the fore the comple- can’t develop groups. (PSIC., Fortaleza).
mentarities, convergences, divergences, and the How can I implement something different
unusual, from the empirical universe17. without having space for it? Without having a pro-
The research follows the dictates of Resolu- fessional with me? Nothing is easy for primary care.
tion 466/201219, having been approved by the Nothing is easy! It is difficult to establish a network!
Research Ethics Committee of Oswaldo Cruz (Enf., Rio de Janeiro).
Foundation. The abbreviations of the profes- The difficulties in assisting DOAs also exist
sions, followed by the name of the city where the in the health unit, due to territorial and access
collection was carried out, were used to protect barriers:
the identities of the participants. Not all units have good access or a lift, for ex-
ample. You see a ladder here. We tried to put the
doctors down there, tests, nursing. However, a fe-
male older adult has to climb stairs if she needs to
go to the gynecologist. (As., Belo Horizonte).92
Silva RM et al.
The post was built in an area where the most home visits alone for the sake of safety in the area.
significant demand comes from across the avenue. (Enf., Porto Alegre).
This is a hurdle for older adults because there are Sometimes, in the territory, no one could vis-
no buses, and they cannot cross. (Enf., Fortaleza). it because there was a shooting or something that
Mobility is a barrier. Older adults have to come prevented or hindered this visit. This has happened
and get the medicine here. The frailest older adult several times. (Enf., Fortaleza).
cannot come here, you know? (Med., Belo Hori-
zonte). Strategies and suggestions of professionals
Besides structural problems and DOA’s ac- for the care of dependent older adults
cess to services, professionals recognize the com-
plaints of relatives: Interprofessional communication, hiring pro-
He has great difficulty taking the older adult fessionals and specialists, reception, therapeutic
to do any type of exam, except for home collection, and community groups, training and continuing
which we also perform, but, generally, they are un- education actions with caregivers and relatives,
able to take the user to any hospital to do simple and home visits, were necessary strategies for
radiography. (Enf., Rio de Janeiro). DOA care. The professionals stated that elderly
The houses are not always close to the post. healthcare requires interdisciplinary and multi-
When they are, we accompany the older adult. professional articulations to form a more efficient
(Enf., Porto Alegre). care network.
The particularities of some cities reveal the It is necessary to reinforce the multiprofessional
shortage of supplies for simple and biosafety network to improve the quality of care for these older
procedures: adults. (Med., Fortaleza).
We have difficulty in having material to treat NASF has several rehabilitation professionals,
an injury. Sometimes it takes a month or more for such as a social worker, psychologist, physiothera-
the order to arrive. The primary material is miss- pist, nutritionist, pharmacist, occupational thera-
pist, and we use this network to talk to them about
ing: gloves, serum, and dressing material. (Enf.,
the older adults’ needs. (As, Belo Horizonte).
Teresina).
We have a supporter who is from the municipal
Imaging and other tests that do not happen
health department. She reviews the entire structure
within the PHC unit and that the older adult has
of the ESF and seeks to remedy the problems regard-
to do still take longer. Tests that require referrals to
ing care to these families. (Enf., Teresina).
specialists are even more challenging. (Enf., For-
The participants realized the lack of human
taleza).
resources in several areas, highlighting the need to
Other difficulties are the long waiting lines
hire specialists to strengthen ESF care.
and bureaucracy in the counter-referral system
It is necessary to have more geriatricians in the
for the monitoring or referral of DOAs, which
team for better care to older adults because one can-
hampers resolute care: not do much. (Med., Brasília).
The patient is registered, and there’s a waiting The social worker would come to clarify what
list. Some people wait for several months, unable to the role of the caregiver is, how far he can go when
perform tests or the appointment with the special- he can help [...], but we don’t have a social worker,
ist. When he is more fragile and requires secondary and we need it. (Enf., Rio de Janeiro).
care, we refer this patient and see several hurdles. It would be great if this team had more profes-
(Med., Fortaleza). sionals, such as a psychologist, to provide better sup-
There is a specialty that we can follow more port for these older adults. (ACS, Manaus).
quickly, like geriatrics. An Alzheimer’s patient can The intention to receive DOAs in the health
be referred to a geriatrician, as neurology takes service was evident in the search for a resolutive
time. The referral remains here for a long time. strategy for everyday problems.
(Enf., Teresina). Receiving is the easiest part. Receiving, listening.
SUS bureaucracy is enormous, and regulation We have a group and. We receive walk-in demand
takes time. The number of older adults is enor- every day. You sit, listen, and see what you can do.
mous, and there’s a long delay in meeting all needs. (Enf., Fortaleza).
(Enf., Fortaleza). The initiatives employed must always be thought
The lack of public safety in several territories from the perspective of the patient’s well-being. User
expressed the reality of Brazilian cities. reception plays a fundamental role in this process, as
The health worker always accompanies the it is the moment to create bonds with the family and
nurse, so as she doesn’t go alone, we try not to make the patient. (Fisio., Manaus).93
Ciência & Saúde Coletiva, 26(1):89-98, 2021
The professionals recognized community Discussion
groups as initiatives favorable to care to promote
the health of DOAs. In some health services, com- As for the professional’s challenges regarding
plementary, integrative practices are valuable to the care of DOAs in PHC, the professionals’ per-
this audience. ception showed that the management of health
A work coordinated by the social service once a services directed to this population is inefficient.
week is focused on caregivers. Especially family care- Ravioli et al.20 analyzed the management of ser-
givers for dependent older adults receive guidance vices in the SUS, from 2005 to 2016, and detected
and instructions. The most interesting thing is the administrative difficulties for managers, such as
conversation between them, one helping the other. “[...] low operational capacity, lack of budgetary,
It is the moment to vent. It is therapeutic. (PSIC., financial, and administrative autonomy, poor
Brasília). quality controls, external political influence, ex-
We have a group called “The Empowered” who cessive bureaucracy to hire staff, making adjust-
are ladies making handicrafts. They are widows. ments to the structure and to buy supplies, med-
Their children already left the house. It is compelling icines, and equipment”.
because you take away idleness, depression, and give In general, inefficient management actions
this woman the means to earn money. She makes challenge PHC’s underpinning processes, from
handicrafts and sells, socializes, makes friends. It’s a recruiting human resources to organizing ser-
great network! (Enf., Rio de Janeiro). vices and purchasing supplies. Public managers
We already have community support in this need to know their problems, study health in-
support unit. This is expanded, and it is valuable for dicators so that they know how to plan, struc-
older adults! Here at the clinic, we also have com- ture, organize and evaluate technical-scientific
munity therapy for caregivers, who is sometimes and political-institutional actions, and establish
more debilitated than the older adult. He is crying, projects that can intervene on the health status
more anxious, and tired from taking care of him day of the population21. Managers and professionals
and night. (Enf., Fortaleza). providing health care must rethink their work22
Actions based on interdisciplinary practices based on users’ needs23.
stem from professionals to assist DOA’s caregivers Analyzing the elderly healthcare model, Veras
and relatives. and Oliveira24 point out that, in current health
One of the most significant initiatives is a course systems, fragmented care and poor coordination
for caregivers, who are often other older adults. Some issues can be solved from integrated care models.
necessary information, mainly about hygiene, food To this end, the authors suggest redesigning the
handling, things that can prevent them from having care levels, which ensures a coherent flow of ed-
any complications and bedsores. (Enf., Teresina). ucation, health promotion, and problem preven-
Training of caregivers, mostly relatives, with tion actions, creating a care line favoring older
mobility techniques in bed and transfers, which they adults’ reception and the monitoring of palliative
can use daily. (To, Fortaleza). care.
We do so much education at school to talk about The lack of space to develop work with DOAs
child care, talking to pregnant women, and a prena- was also identified in the research on the Bra-
tal group. We should also have it for older adults, so zilian Primary Health Care Structure Census25,
the family knows that needs are different, and some- which may be related to the use of houses adapt-
times they have to receive some special care. (Med., ed for health units’ functioning, often without
Belo Horizonte). specific planning or project.
Professionals stressed home visits mediated by The territorial barriers and the lack of accessi-
health education actions as a crucial care resource, bility to health services identified in this study are
especially for DOAs who do not attend the health reflected in care coverage, as they fragment the
center or live alone. care cycle, break users’ attendance, and weaken
When we go on a visit, we try to guide the ques- bonds with professionals26. In the Census carried
tions about food, hydration, skincare, the issue of out by Poças et al.25, the situations found are sim-
carpets (to avoid falls), the older adults’ difficulty. ilar to the inadequate structure of physical envi-
(Enf., Porto Alegre). ronments and difficult transportation and access,
We provide individual guidance here. When we especially for older adults and the disabled.
go home, we give guidance to the family about spe- The scarce supplies for necessary procedures
cific care for older adults. (Enf., Teresina). were among the difficulties associated with the94
Silva RM et al.
production of care in the ESF in different Bra- Concerning the strategies and suggestions of
zilian regions. The lack of required materials professionals for the DOA care in PHC, improv-
for dressings in DOAs and bedridden patients ing the articulation with the interdisciplinary and
becomes an unworkable task. Other studies25,27 multiprofessional team stands out through an ap-
showed a macro problem of poor resource man- proach centered on comprehensive and contin-
agement in the country. uous care. The repercussions transpose the bio-
The multiple DOA’s demands require inter- medical model and configure the very users’ in-
sectoral health care actions. However, challenges volvement with their support network, bringing
in the consolidation of comprehensive care for shared responsibility to the therapeutic care set31.
this public are pointed out, such as the difficul- In China, researchers show that interdisciplin-
ty of articulating with the care network and bu- ary care is beneficial to improve the performance
reaucratization so that DOAs are accepted in all of chronic DOA’s conditions, exemplifying that
their complexity14. This articulation favors care patients with Alzheimer’s disease have significant
comprehensiveness and must consider all the ter- functional gains with this approach32.
ritory’s resources, from health services, squares, The multidisciplinary team’s valorization in
churches, clubs, to professional centers and asso- the scope of DOA care management has been a
ciations, in order to meet affective, health, social, significant challenge for public health policies,
economic, cultural, religious, educational, and with an urgent need for expanded care that con-
leisure’s demands for older adults28. siders strategies for structuring and reorganizing
The bureaucracy of the referral and count- services and changes in the work process33. In this
er-referral system and the long and lengthy wait- sense, the clinical knowledge and technologies
ing lists for attending DOAs in medical specialties are still preferred and can be added to the com-
interrupts the continuity of care in the therapeu- mitment and bond, performing more integrated
tic itinerary. Schenker and Costa14 characterize intersectoriality and interdisciplinarity practices
the referral to specialized care as fragmented and to expand and strengthen the daily lives of ESF
out of context, weakening the DOAs’ care. teams34.
Kantorski et al.28 show that the referral and In the search for this type of care, the reports
the counter-referral system must be considered issue suggestions to put the professionals in the
an essential resource in the line of care, since, if service and hire specialists to work with DOAs.
well structured, it promotes the efficient flow of The incorporation of professionals in the health
referrals of users to the different levels of care care network is highlighted as the desire of the
and recommends the integration of services in a participants of this research, since its fixation
committed and effective manner. consolidates the therapeutic bonds with the reg-
Another factor is the lack of public security istered population, increasing territorial recog-
to carry out activities, especially home visits to nition and strengthening health practice, which
older adults. Sturbelle et al.29 emphasize that vi- enhances DOAs’ resolutive health care35,36.
olence in health services increases by the day. In It is noteworthy that it is necessary to observe
PHC, services are developed in the community, factors such as the health unit’s location, work-
whether in health units, in other spaces, and their er’s age, function, level of expertise, pressure, and
own homes. This brings professionals closer to satisfaction in the work activity to hire a profes-
the territory and can expose them to violence, sional. Failure to observe these factors can lead to
especially in drug trafficking areas. This situation turnover, as highlighted by 42.3% of PHC doc-
becomes more severe in the capitals due to ur- tors in a study developed in Chongqing, China37,
banization, associated with crime escalation. whose researchers found the need to reformulate
Brazilian police struggle with containing vio- the incentives and work proposals for fixing and
lence as they face the growing factions (organized the continuity of professional care in PHC37.
and well-equipped criminal groups) and their in- From this perspective, the recruitment of spe-
secure working conditions. Souza and Minayo30 cialists in Geriatrics and Gerontology can provide
point out that the solution would not be just to or consolidate more resolutive care to DOAs, fa-
provide the police with more armaments, but ex- cilitating work in healthcare networks38,39.
cellent training, daily support in conflicted areas, User reception was highlighted as a diver-
adequate rest, and emotional protection – not sified resource with multiple interfaces in the
forgetting the need for investments in infrastruc- health of DOAs, which can interfere during the
ture in the police and health services for the safe- implementation of care, and is a challenge for
ty of health workers29. health teams40. Regarding ‘reception’, profession-95
Ciência & Saúde Coletiva, 26(1):89-98, 2021
als’ statements are in line with the National Hu- potential in the home context, highlighting the
manization Policy, as reception favors a space for improved experiences for patients and caregiv-
listening and receiving DOAs and other users41. ers, which leads to lower healthcare costs, mainly
In this study, the realization of communi- when care is provided by expanded interprofes-
ty groups was highlighted as a reality in health sional teams46.
services from several professionals’ initiative. In
contrast, the absence of groups focused exclu-
sively on DOAs was also observed. The literature Final considerations
highlights support groups as methods to expand
care for DOAs, emphasizing prevention and health Elderly care associated with social, physical, or
promotion, even though older adults’ participa- emotional types of dependence resulting from
tion in these groups occurs as adherence to treat- older adults’ longevity requires institutions and
ment, when there is already a health problem14. professionals to adopt attitudes that determine
Elderly health requires a network-type care effective care standards and promote a practice
logic, comprehensive care, and macro or micro- that can improve the quality of health and life
management aspects. For the implementation of for older adults and their relatives. This practice
this care, management must make the necessary must be anchored in dialogue, interrelation of
articulations for the network’s composition and those involved, and in the incorporation of in-
the priority care plan42. novative actions that enable favorable conditions
Regarding family caregivers, the lack of sup- for the engagement of caregivers.
port and guidance is sensitive. The professionals The management of DOA care is a unique,
revealed the objective of intensifying the per- broad, and complex circumstance, where the
spective for older adults’ families, as they are the health operator assumes challenging dimensions
primary care providers. Araújo et al.43 postulate to make decisions involving protection, preven-
the concept that actions for the family’s empow- tion, and health promotion, prioritizing resourc-
erment are not sufficient and the family context es and service management. The structural and
must be understood to assist in relationships and administrative conditions of PHC services in the
care with DOAs. Public policies must promote cities studied showed weaknesses in DOA care at
care and feasibility so that families can provide home and the health unit, underscoring the in-
care, observing how older adults see themselves in efficient management, hardships in the physical,
the family context, which interferes with the exe- territorial, and access areas, lack of care material,
cution of practices that facilitate daily activities. administrative bureaucracy in the counter-refer-
In care management, the family must be ral system, long waiting lists, and lack of public
viewed in a multidimensional context, valuing security.
the uniqueness of family interpersonal relation- The professionals revealed that the difficulties
ships, giving meaning to living, experience, reli- in health services are related to several factors,
gion, and culture33. but they struggle to supply them, undertaking
The idea that strengthening PHC is a global actions emphasizing greater integration of the
strategy is highlighted. In Thailand, training pro- multidisciplinary team, adaptations to improve
grams developed over a decade indicated that, the work environment, and the involvement of
once the multiple competencies of PHC mem- community resources. They stressed that com-
bers were established, the resolution of complex munity groups, complementary integrative prac-
problems in different local contexts was expand- tices, and health education are fundamental for
ed, enhancing the care outcomes of teams from the development of protective actions for DOAs
low- and middle-income countries44. and their relatives.
Home visit is an excellent care strategy for In the universe of elderly care in PHC, espe-
DOAs in the professionals’ perception. The cially for care-dependent older adults, the chal-
consolidation of this strategy is highlighted as lenges faced by professionals are diverse and com-
supporting a study conducted in rural Japanese plex, requiring an effective inter-professional and
communities, in which nursing students dissemi- intersectoral articulation to expand resolutive care.
nate preventive actions, encompassing individual Thus, there is a need for reworking health prac-
and environmental perspectives of well-being in tices geared to older adults, considering structural,
community life45. administrative, social and political aspects, which
In effect, these findings corroborate the ‘por- promote changes in essential conditions to manage
trait’ of Canadian PHC, highlighting the care daily demand, in the health units and the homes.96
Silva RM et al.
Collaborations
Our contribution was to design and plan the re-
search project (RM Silva, CCP Brasil and MHAG
Jardim); data collection, analysis and interpre-
tation of results (IC Bezerra, JL Gonçalves, and
MLF Figueiredo); writing of the manuscript (IC
Bezerra, CCP Brasil, MCL Santos and RM Silva)
and critical review of the manuscript (RM Silva,
CCP Brasil, JL Gonçalves and MLF Figueiredo).97
Ciência & Saúde Coletiva, 26(1):89-98, 2021
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