SOCIODEMOGRAPHIC AND HEALTH PROFILE OF INSTITUTIONALIZED ELDERLY PEOPLE

Objective: to describe the sociodemographic and health profile of institutionalized elderly people. Method: This is a quantitative, descriptive, cross-sectional study based on the evaluation of 219 medical records of the elderly, using a semi-structured instrument. Data were analyzed with the help of the SPSS, version 20.0, and presented in tables. Results: there was a predominance of elderly women, mean age of 77 years, schooling from 4 to 15 years, single marital status, Catholics, coming from their own domicile, with institutionalization time of less than 5 years, retired, and elderly people who received visits. Regarding clinical characteristics, 44.7% had 3 to 4 comorbidities and 49.3% used 0 to 4 medicines. As for the degree of dependence, it was observed that 35.6% of the elderly presented grade III. Conclusion: it is noteworthy that the data described stimulate a reflection on issues that directly influence the process of adaptation of the elderly to institutionalization, as well as the need for the multiprofessional team to provide individualized care based on knowledge of the profile of the institutionalized elderly.

English/Portuguese J Nurs UFPE online., Recife, 13(3):674-9, Mar., 2019  675 It is known that in Brazil the number of elderly people is increasing, especially due to the introduction of new technologies, the decrease of fecundity, and of mortality, and the increase of life expectancy.It should be noted that, according to the Economic Commission for Latin American and the Caribbean countries, 12% of the Brazilian population is composed of elderly people. 1 It is understood that, although aging is a natural process, it has repercussions on health conditions, making the elderly persons more prone to frailty to the point of impairing their quality of life.It is perceived that population aging causes relevant socioeconomic changes such as increased demand and restructuring of health services and professionals able to assist this population. 1It should be emphasized that attention should be intensified because these changes cause greater demand in health, social security and social services.There is a need for professional follow-up, and also referrals to Long Stay Institutions for the Elderly (LSIE).
It is noteworthy that LSIE are collective residences that serve elderly people who resort to them, either due to family and/or income needs, or due to need for long-term care. 2 It is noted that these characteristics present changes, since elderly people also seek to maintain their independence and manage their daily lives. 3It is assumed that LSIE residents are people who have never had or lost close family members, who experience family conflicts, and/or who are not physically or mentally qualified to manage their daily life, nor to guarantee their livelihood. 3 is considered that the services provided by LSIE need to be responsive to the needs of the elderly in order to reduce the risks related to institutionalization. 4 It should be noted that many of the existing Brazilian institutions have poor infrastructure conditions and face many financial difficulties.It is reported that this problem implies inability to provide better assistance.It is evidenced that LSIE should be a place of protection, care and comprehensive attention, especially for elderly people in the condition of social vulnerability.
• To describe the sociodemographic and health profile of institutionalized elderly.This is a quantitative, descriptive, crosssectional study carried out in a philanthropic LSIE in the Northeast of Brazil, in which 219 elderly people of both sexes lived.The elderly were from different social classes, and were mainly people who had been abandoned, victims of violence, or had been in some other situations of social vulnerability.
Data were collected during the period from November to December 2015.Data were obtained from the analysis of the 219 medical records of the elderly through the application of a semi-structured form approaching information about sex, age, schooling, marital status, occupation, time, reason for institutionalization, and reception of visits.In the clinic of the sample, variables on chronic diseases, use of medicines, and degree of dependence were collected.It is reported that with respect to issues of institutionalization, the data collected were the time the elderly person had lived in the institution, whether or not they were visited, and with whom they resided before entering the institution.
Elderly people were classified as grade I (independent), grade II (difficulty in up to three activities of daily living) and grade III (difficulty in more than three activities of daily living and severe cognitive impairment) , according to the Resolution of the Collegiate Board 266/2005, of the National Sanitary Surveillance Agency, which regulates the operation of LSIE. 5 The Microsoft Excel 2010 and the SPSS, version 20.0, were used for the analyses.Tables were drawn with relative and absolute frequencies and measures of central tendency as means and standard deviations.] It is reported that the greater probability of women to live in long stay institutions may be due to the fact that they are older, have poorer health and functional capacity, and have a disadvantaged position in family arrangements.The literature has pointed out that men have a greater chance than women

DISCUSSION
English/Portuguese J Nurs UFPE online., Recife, 13(3):674-9, Mar., 2019 677 to be cared for by their respective spouses and, consequently, to stay longer with the family. 3e study shows that most of the elderly were single (51.6%) and had zero to three years of schooling (48%).It should be noted that the data is in line with another study that found a higher prevalence of unmarried elderly people (46.3%), illiterate (46.3%) or low schooling (22.2%). 6Low schooling is a very frequent finding when philanthropic institutions are evaluated. 8This is a result of the previous reality of discrimination of educational opportunities for these elderly people.
The association between socioeconomic conditions, completion of primary and secondary education, and access to higher education is reflected in Brazil. 9 terms of institutionalization variables, the information about receiving visits is worrying, since 40.6% of the elderly did not receive visits from family or friends.In another study carried out in Natal, 100% of the elderly in a for-profit institution received visits, while 14.7% at the non-profit institution did not receive them. 9 It is noted that the absolute frequency of elderly people who received visits is much higher when compared to the present study.
It is noteworthy that in the process of institutionalization, the support network is essential, as it helps the elderly to adapt to this situation, improving their well-being and quality of life.It is perceived that the great challenge is to help the institutionalized elderly to establish social relations, mainly with the other residents of the institution.It is evidenced that studies indicate that institutionalized elderly people have low motivation to develop friendships with other peers, besides presenting prejudiced and despising attitudes toward them. 10terpersonal communication is often hampered in the LSIE environment, and social and affective life is limited.In institutional life, it is necessary for the elderly people to establish new relationships and demarcate their space, having their old lifestyle as reference. 11 is inferred that, before this situation, the multiprofessional team inserted in this scenario has the responsibility to support these elderly in their process of institutionalization and have to provide social, emotional, physical and mental support.It is recommended that the links and reintegration in the family context be stimulated and strenghened, giving to the family the responsability to care the elderly.

It
was verified, on the clinical characteristics, that 44.7% of the elderly had at least three or four comorbidities.These findings are similar to those of other studies carried out with elderly people living in LSIE. 12t is indicated that the presence of comorbidities is a risk factor for disability, which in turn is the result of the fraility syndrome.It is evident that when all these factors overlap, they lead to impairment of quality of life and functional status, resulting in incapacity, hospitalization, institutionalization and death. 13Moreover, it is known that the prevalence of chronic diseases is doubled in female elderly, 14 and also that fragile individuals with more than one comorbidity are at higher risk of mortality. 15us, the daily activities of institutionalized elderly people are hampered by comorbidities.They require more careful care from the multiprofessional team.It should be stressed that the promotion and maintenance of health should always be considered as priorities in the planning of health care in LSIE.
It was also observed the consumption of a high number of medicines by the elderly.The practice of polypharmacy is associated with an increased risk and severity of adverse reactions, drug interactions, cumulative toxicity, medication errors, reduction of adherence to treatment, and elevation of morbidity and mortality. 16hus, the prescription of multiple medications to the elderly should be considered, as well as the observation of the occurrence of adverse events. 17us, the importance of detecting health needs/problems that indicate the real need for medication is evident.Being attentive to feeding schedules and interactions with medications for chronic use is also important, as well as the inclusion of medications, such as antibiotics and anti-inflammatories, and possible interactions. 6 the evaluation of the degree of dependence, 65.8% of the elderly had grade II or grade III.Another study carried out in Montes Claros-MG showed that almost 60% of the institutionalized elderly had some degree of dependence. 18The importance of the evaluation of the degree of dependence of institutionalized elderly as a means of subsidizing planning and execution of actions within the institutional framework is highlighted. 18 is also considered the evaluation of activities of daily living and the knowledge of the main characteristics of this group of activities, because they reflect levels of social English/Portuguese J Nurs UFPE online., Recife, 13(3):674-9, Mar., 2019 678 participation and quality of life in aging. 19It should be noted that the modifications in these activities are often not perceived without the application of a specific functional evaluation, which reiterates the relevance of this theme for the early identification of small changes in performance. 19 is pointed out that, in view of these situations, the multiprofessional team should devote careful attention to the limitations and should plan, along with the specialized team, specific and effective care and rehabilitation so that the elderly can carry out, with the maximum autonomy and independence, their activities of daily life by encouraging they to overcome certain obstacles to their better adaptation to the new living environment in LSIE.
It is believed that one of the major challenges in the care to the elderly is the perception of the multiprofessional team regarding all the factors that influence their lives.It is understood that care must happen in a holistic and comprehensive way based on all the possibilities that may affect, in a negative way, their quality of life.
It should be noted that socioeconomic aspects are also related to the health situation and the morbidity and mortality pattern of the population.They should be considered in the health monitoring and care planning by health professionals, subsidizing health actions directed to the needs of institutionalized elderly. 6 was observed a predominance of female adults, mean age of 77 years, literate people, single, Catholic, coming from their own home, with institutionalization time of less than five years, retirees, who received visits, had three to four comorbidities, used zero to four medicines, and presented grade III of dependence.
It is believed that, despite the limitations of this study, which has an academic nature and was restricted to the survey of some variables of the profile of institutionalized elderly living in one long stay institution, the results obtained stimulate reflection on issues that directly influence the process of adaptation of the elderly to this new situation.
Another concern is related to the multiprofessional team.Care should be provided to maintain the LSIE prepared to receive this population well and in a dignified manner.The focus should be to maintain a pleasant environment for the promotion, rehabilitation and recovery of the general health of the elderly.Emphasis is given to individualized and humanized care, based on the knowledge of the profile of the institutionalized elderly, promoting a dignified aging.
It is suggested that future studies allow the continuity of research on the characteristics that influence the longevity and quality of life of institutionalized elderly.Themes related to institutionalization, Gerontology and Nursing/Health must be studied and improved so as to plan actions for a more effective care that encompasses the real needs of these elderly people, thus improving their biopsychosocial well-being.