Transição do cuidado de idosos com demência do contexto hospitalar para domiciliar : revisão integrativa

Abstract

Transitions of care are actions aim at coordination and good communication between people from different backgrounds, experiences, and skills so that the continuity of care occurs in the transfer of patients between different health services or even transfer to their own home. This process includes patients, families, and caregivers. It is essential to prevent recurrent hospitalizations of older adults with dementia and require families to prepare for care management. Thus, this integrative review aimed to analyze the scientific evidence on the transitional care of older adults with dementia from hospital to home. The research question was: "What is the scientific evidence available on the transitions of care of older adults with dementia from hospital to home?" The search for primary studies was in November 2020, and the databases used were LILACS; MEDLINE; CINAHL; EMBASE; WEB OF SCIENCE. The sample consisted of five primary studies published in Australia, the United States and Canada. All primary studies obtained a VI level of evidence classification. It was observed in the studies that there is a similarity between the transitional care interventions in the countries. The research evidence mainly the use of technology as an excellent tool in health services; use of electronic medical records; individualized care plan with an association of daily hospital care instruments; health educations strategies; improving communication between the Healthcare team, family caregivers; monitoring after hospital discharge and the central insertion of the patient and the family caregivers in the discharge planning. In summary, the main implications for improving transitional care for older adults with dementia described in the reviewed studies that point to ways to promote safe transitional care are continuous and effective communication between family, health professionals and community health services. Most of the time, it proved to be the main responsible for the planning and execution of the care transition, since it is the professional who is directly linked to the care of these patients, from their admission to hospital discharge, but this process involves several actors. Communication between different levels of health is an excellent strategy for the transition of care. Since the health system is composed of different levels of health, each country inevitably guarantees access to health services in a certain way but understand the patient's health-disease process and are highly relevant to the effectiveness of transitional care and empowerment the patient, caregiver and family in this process