Health record as an instrument for multidimensional assessment of institutionalized older adults

Gregório Cavalcante Silveira¹, Aimêe Leitão Cruz², Luiza Gomes Ferreira³, Rafaela Beatriz Nóbrega Mota Eulálio⁴, Nayara Kalila dos Santos Bezerra⁵, Paulo Sérgio da Silva⁶, Raquel Voges Caldart⁷, Fátima Helena do Espírito Santo⁷

^1,2,3,4,5,7Federal University of Roraima. Boa Vista (RR), Brazil.

⁶Federal University of Lavras. Lavras (MG), Brazil.

⁶Fluminense Federal University. Niterói (RJ), Brazil.

Introduction

Healthcare for older adults primarily aims to preserve a good state of health, enabling individuals to achieve their full potential for active life, supported by a family and social network. To this end, health services must adequately address their needs, not only in terms of disease prevention and control but also in promoting active and healthy aging, with the goal of greater autonomy and well-being.^1-2

Despite being a natural process, aging impacts health conditions, rendering older adults susceptible to frailty. This age group presents specific needs arising from the aging process, whether natural or pathological, which can interfere with functionality and increase the demand for social and health care.^1,3-4

This becomes increasingly evident as the national demographic scenario is characterized by a growing aging population. In 2022, the older adult population aged 60 years or older reached 15.8% of the total population, representing a 56.0% increase compared to 2010, when it was 10.8%.⁵

In this context, public policies have been implemented over the last decades with the objective of ensuring comprehensive care for these individuals and promoting active and healthy aging.⁶ It is also noteworthy that population aging has become a central theme in discussions about the Sustainable Development Goals (SDGs), especially concerning SDG-3, which aims to ensure healthy lives and promote well-being for all at all ages.⁷

Therefore, strategies focused on preserving the functional capacity of older adults are necessary, given that physical, cognitive, and social limitations are avoidable throughout the aging process, in addition to the need to implement actions to reduce hospitalizations and increase older adults' self-care skills.⁸

Within this set of strategies is the Older Adult Health Record (OAHC), an instrument that assists in identifying the particularities, vulnerabilities, and fragilities inherent to the aging process. The OAHC also aids in promoting specific actions to provide older adults with comprehensive care, contributing to the improvement of their quality of life.^9-10

The use of the OAHC is an important instrument that allows for a broad assessment of the individual, improving care and bringing benefits to health promotion. Furthermore, when used as recommended by the Ministry of Health, it promotes improvements in health services for older adults.^9-10 The OAHC is a tool that supports multidimensional assessment in the comprehensive care of older adults, as it integrates important information on mobility, cognition, emotional state, support network, socioeconomic conditions, and functionality, guiding more precise and personalized interventions, favoring autonomy, preventing disabilities, and promoting quality of life. Thus, its application is recommended at different levels of healthcare and services that serve older adults, including Long-Term Care Facilities for Older Adults (LTCFs).

In this regard, it is important to note that LTCFs are residential spaces intended for the collective housing of individuals aged 60 years or older, with or without family support, in conditions of freedom, dignity, and citizenship. They should also constitute a place that promotes comprehensive health care, ensuring measures aimed at the promotion, prevention, and protection of older adults. To this end, these institutions must have health professionals linked to their work team.¹¹

Considering the presence of nurses in LTCFs and the specificities of institutionalized older adults, the importance of a systematic and continuous assessment of the older adult is emphasized to guide actions for preventing harm, promoting health, and controlling potential complications.⁴ Thus, the use of the OAHC is an important instrument that can contribute to such an assessment in these settings.

It is also important to highlight that the northern region of Brazil has the lowest percentage of older adults (15.8%) compared to the South and Southeast regions, which each have 17.8%. Roraima is the youngest state in the country, with 7.9% of older adults.⁵Consequently, the number of studies addressing this theme, in general, is concentrated in large metropolitan regions. This results in a scarcity of research on the use of the OAHC, especially when it comes to institutionalized older adults, which limits the understanding of its application in the care and health management of these individuals.

Therefore, carrying out actions that seek to identify the characteristics of institutionalized older adults at the local level is fundamental to guide the care offered to this population. In this context, the use of the OAHC, a nationally consolidated document, was the tool chosen to analyze the health conditions of older adults residing in an LTCF located in northern Brazil.

Considering the benefits that the health record can provide for the long-term monitoring of older adults' health, it was proposed, through a research project articulated with an extension project of a Nursing undergraduate course, to implement its use in an LTCF.

In this way, we seek to give visibility to this tool and contribute to the training of future professionals skilled in its use, since the health record considers not only biomedical aspects but also physical, psychological, social, and functional factors, allowing for the early identification of fragilities and the guidance of individualized interventions, promoting autonomy, preventing disabilities, and fostering healthy aging.^1,10 Furthermore, the use of the OAHC assists nurses in clinical reasoning and in the development of care plans centered on the older adult, contributing to the improvement of functionality, independence, and quality of life.

The study objective is to describe the sociodemographic characteristics, clinical conditions, and functional status of older adults following the implementation of the older adult health record in a long-term care facility.

Method

This quantitative, observational, and descriptive study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and conducted in a Long-Term Care Facility for Older Adults located in the city of Boa Vista, Roraima. The institution has the capacity to accommodate approximately 40 older adults in situations of social vulnerability and has a multidisciplinary health team comprising nurses, nursing technicians and assistants, among other professionals.

The study population consisted of older adults residing in the institution during the research period, from August 2022 to March 2024. Inclusion criteria were individuals aged 60 years or older, of both sexes. Exclusion criteria included those who, for any reason, were unable to participate in the study, such as cases of hospital admission, isolation, or other situations that compromised their participation.

Data collection was performed by sixth and seventh-semester undergraduate nursing students from a public university in the state of Roraima, who were qualified and instructed by the supervising professor. Data were collected through the completion of the OAHC, the application of the Katz Index, and the Mini-Mental State Examination (MMSE), as described below.

The OAHC contains information on personal data, older adult assessment, medications and polypharmacy, previous diagnoses and hospitalizations, surgeries performed, adverse drug reactions or allergies, anthropometric data, the Vulnerable Elders Survey-13 (VES-13) protocol, cognition and mood, environmental assessment, falls, identification of chronic pain, lifestyle habits, blood pressure and glucose control, vaccination schedule, oral health, scheduling of appointments and examinations, among others.¹⁰

It is important to note that the VES-13 is an instrument capable of identifying vulnerable older adults based on age, self-perception of health, presence of physical limitations, and disabilities. Easily applicable, it can be answered by health professionals themselves, the older adult, or family members/caregivers, without requiring direct observation of the user. It is based on the record of abilities necessary for performing daily tasks and is used for screening and assessing older adults, allowing for the identification of those at higher risk of functional decline.¹⁰

The Katz Index was used to determine the dependence of older adults in performing basic activities of daily living (ADLs). Based on this index, older adults were classified as independent (independence in all six evaluated items) and dependent (dependence in at least one of the six evaluated items) in six activities: bathing, dressing, toileting, continence, transferring, and feeding.¹

The cognitive status of older adults was assessed through the application of the MMSE. The test has a total score of 30 points, and for the establishment of the result, the older adult's education level should be considered according to the suggested cutoff scores (illiterate: 19 points; 1 to 3 years of education: 23 points; 4 to 7 years of education: 24 points; more than 7 years of education: 28 points).¹

The Katz Index and the MMSE were included in the study because these instruments were deemed appropriate for the specificities of the institutionalized older adult population, which generally presents more fragile health conditions compared to older adults living in the community.

The completion of the health record and the application of the Katz Index and the MMSE were carried out during nursing consultations by the students under the supervision of a service nurse and the supervising professor. Consultations were conducted individually with the older adults participating in the study, in a location that provided privacy and comfort. To complement the data, the medical records and prescriptions of the older adults residing in the LTCF were also consulted.

The collected data were coded and tabulated in Microsoft Excel® spreadsheets and analyzed using descriptive statistics. Measures of central tendency and dispersion (mean and standard deviation) and absolute (n) and relative (%) frequencies were used.

For the determination of the degree of dependence, the results obtained from the application of the Katz Index and the MMSE were used, proceeding as follows: degree I: independent older adults, even if they require the use of self-help equipment; degree II: older adults with dependence in up to three self-care activities of daily living (feeding, mobility, hygiene); without cognitive impairment or with controlled cognitive impairment; and degree III: older adults with dependence requiring assistance in all self-care activities of daily living and/or with cognitive impairment.¹¹

It is important to note that not all data present in the OAHC were collected and evaluated in this study. The decision not to include some items was mainly due to the difficulty in obtaining complete and updated records of this information at the institution, in addition to the limitation of time and resources available for the detailed collection of all fields of the health record. Therefore, the analysis focused on sociodemographic data, clinical conditions, level of vulnerability, and degree of functional dependence, as these are fundamental aspects for understanding the profile of institutionalized older adults and directly related to the planning of individualized care and the promotion of comprehensive health care for this population. This delimitation allowed for a more in-depth approach aligned with the study objectives.

This research is part of a larger project, which was submitted to and approved by the Research Ethics Committee on Human Beings of the Federal University of Roraima, under opinion number 5.541.017. To comply with ethical aspects, the project was previously presented to the institution where it would be carried out, and its consent was obtained. For older adults with cognitive conditions to consent to their participation, the Informed Consent Form (ICF) was presented. In the case of older adults with cognitive impairment that prevented them from consenting, the ICF was presented to the legal guardian of the older adult in the institution. The costs of this research were financed by the authors themselves.

Results

Data from the health records of 52 older adults residing in the LTCF during the study period were analyzed. Notably, 92.3% (n=48) were male. The mean age was 75.9 (±9.2) years, ranging from 60 to 95 years. The mean time of institutionalization was 3.1 (±3.9) years, ranging from 9 days to 18 years. The majority of the older adults were Brazilian (92.3%; n=48) and single (76.9%; n=40), with low educational attainment, as 19.2% (n=10) were illiterate and 71.2% (n=37) had ≤ 4 years of schooling. Regarding income, only 30.8% (n=16) received the Continuous Cash Benefit (BPC), and 9.6% (n=5) were retired. Furthermore, 67.3% (n=35) did not receive visits or engage in external activities, and 34.6% (n=18) had no children (Table 1).

Table 1 - Distribution of older adults residing in a long-term care facility, according to sociodemographic characteristics. Boa Vista (RR), Brazil, 2024.

Variables		n (=52)	%
	Sex
	Male	48	92.3
	Female	4	7.7
	Age group (years)
	60-69	12	23.1
	70-79	23	44.2
	80-89	12	23.1
	90 or more	5	9.6
	Time of institutionalization
	< 1 year	10	19.2
	1 to 5 years	34	65.4
	6 to 9 years	4	7.7
	≥ 10 years	4	7.7
	Nacionality
	Brazilian	48	92.3
	Other nationalities	4	7.7
	Marital status
	Single	40	76.9
	Separated/Divorced	5	9.6
	Married	2	3.8
	Did not know/No information	5	9.6
	Education level (years)
	None	10	19.2
	1 to 4 years	37	71.2
	4 to 7 years	0	0.0
	8 or more	0	0.0
	Did not know/No information	5	9.6
	Income
	No income	31	59.6
	Continuous Cash Benefit (BPC)	16	30.8
	Retirement	5	9.6
	Receives visits or engages in activities
	No	35	67.3
	Yes	7	13.5
	Did not know/No information	10	19.2
	Has children
	No	18	34.6
	Yes	11	21.2
	Did not know/No information	23	44.2
	Mean age in years (±SD)	75.9 (±9.2)
	Mean time of institutionalization (±SD)	3.1 (±3.9)

All older adults (100.0%; n=52) had a medical diagnosis of at least one chronic disease, with an average of 2.3 (±1.5) diseases per older adult. Among the most prevalent were diseases of the cardiovascular system, with hypertension being the most frequent (76.9%; n=40), followed by diseases of the nervous system, especially sequelae of stroke (36.6%; n=18), and nutritional, endocrine, and metabolic diseases, with type II diabetes mellitus highlighted at 21.2% (n=11). Mental and behavioral disorders were identified in 17.9% (n=9) of the older adults.

The mean number of medications used per older adult was 9.1 (±4.6), and it was observed that 78.8% (n=41) of these older adults used polypharmacy (Table 2). Among the study participants, 80.8% (n=42) had some type of disability (Table 2), with cognitive/intellectual disability being the most prevalent. Other analyzed variables were the report of chronic pain and a history of falls, observed in 26.9% (n=14) and 15.4% (n=8) of the older adults, respectively.

Regarding the Vulnerable Elders Survey-13 (VES-13) present in the OAHC, it was identified that 94.2% (n=49) of the older adults met the criterion for attention/action by presenting a score ≥ 3 points. The mean score of the older adults on the VES-13 was 7.2 (±2.1) points (Table 2).

Table 2 - Distribution of older adults residing in a long-term care facility, according to clinical characteristics. Boa Vista (RR), Brazil, 2024.

Variables	n (=52)	%
Presence of chronic diseases
Yes	52	100.0
No	0	0.0
Medication use
Yes	52	100.0
No	0	0.0
Polypharmacy
Yes	41	78.8
No	11	21.2
Disability
Yes	42	80.8
No	10	19.2
Report of chronic pain
Yes	14	26.9
No	38	73.1
Falls in the last 6 months
Yes	8	15.4
No	44	84.6
VES-13 score
0-2 points	3	5.8
≥ 3 points	49	94.2
Mean number of chronic diseases (±SD)	2.3 (±1.5)
Mean number of medications (±SD)	9.1 (±4.6)
Mean VES-13 score (±SD)	7.2 (±2.1)

The cognitive status of the older adults was assessed, and regarding this aspect, a high percentage of older adults were unable to perform the cognitive assessment test due to cognitive impairment (38.5%; n=20). Among those who were able to respond to the assessment test (MMSE), 48.1% (n=25) had a result suggestive of cognitive deficit (Table 3).

The mobility of the older adults was also observed, identifying that 34.6% (n=18) ambulated without assistance and 9.6% (n=5) ambulated with the aid of a cane and/or walker, 28.8% (n=15) were bedridden, and 26.9% (n=14) were wheelchair users.

For the purpose of determining the degree of dependence, the Katz Index was applied. Based on this assessment, a high degree of dependence was observed among the older adults, of whom 57.7% (n=30) presented total or partial dependence for four or more ADLs (Katz E, F, and G). The activities "bathing" and "dressing" had the highest percentage of dependence, with 71.2% (n=37) each, followed by "continence" with 57.7% (n=30), and "toileting" and "transferring," each representing 51.9% (n=27). The activity "feeding" was the only one with a higher percentage of independence (75.0%; n=39).

The determination of the degree of dependence, which considers the dependence of older adults for self-care activities and cognitive impairment,<sup>11</sup> demonstrated a high percentage (73.1%; n=38) of older adults with a degree of dependence III, which corresponds to older adults who require assistance for four or more activities of daily living and/or have cognitive impairment (Table 3).

Finally, the results regarding the vulnerability assessment score (VES-13) were calculated. In this aspect, 94.2% (n=49) of the older adults obtained a score ≥ 3 points, characterizing a result that requires attention/action. This result indicates a high percentage of older adults with a gerontogeriatric diagnosis compatible with frailty or in the process of frailty.

Table 3 - Distribution of older adults residing in a long-term care facility, according to cognitive conditions (MMSE), vulnerability (VES-13), mobility, and degree of dependence. Boa Vista (RR), Brazil, 2024.

Variable	N	%	Mean (±SD)	Median	Minimum-Maximum
MMSE
Suggestive of cognitive impairment	25	48.0	9.64 (±5.25)	8	2-18
Not suggestive of cognitive impairment	7	13.5	21.14 (±2.03)	20	20-25
Not applicable*	20	38.5	*	*	*
Mobility
Ambulates with/without assistance	23	44.2	-	-	-
Bedridden/confined to bed/chair	15	28.8	-	-	-
Wheelchair user	14	26.9	-	-	-
Degree of dependence
Degree I	4	7.7	-	-	-
Degree II	10	19.3	-	-	-
Degree III	38	73.1	-	-	-
VES-13
Attention/action	49	94.2	7.6 (±1.5)	7	4-11
Routine monitoring	3	5.8	1.5 (±1.1)	2	0-2

*Older adults with cognitive impairment and unable to respond to the MMSE.

Discussion

Over the past decades, an increase in the institutionalization of older adults has been observed. This phenomenon is attributed to population aging and the social and health profiles of these individuals, coupled with changes in family structure and dynamics, socioeconomic status, and the family's inability to provide care for older adults, especially those who are older and frail.¹²

Thus, LTCFs become an alternative when older adults require care, addressing the lack of family, social, and health support. These facilities rely on the work of health and social care professionals who meet the demands arising from these individuals. To this end, recognizing institutionalized older adults as part of a vulnerable and specific group, it is fundamental to identify their care needs.⁴

From this perspective, the OAHC becomes a useful tool that contributes to the determination of the gerontogeriatric diagnosis, assists in decision-making, and can guide the care process, in addition to collaborating in the determination of the health profile and allowing communication between the different levels of care and services used by the older adult.⁹

This is due to the longer life expectancy of women and the greater likelihood of a woman residing in an LTCF because, being older, they are frailer, in addition to a disadvantaged position in family arrangements, considering that men have a greater chance of being cared for by their spouses and remaining at home with their families for a longer time.^3,13 However, the predominance of the male sex observed here may be explained by the migratory wave of men who came to Roraima to work in mining during the period between the 1970s and 1990s. These men, for the most part, came in search of better living conditions and were generally unaccompanied, without family members.¹⁴

Regarding socioeconomic variables, a high percentage of older adults with low education and low income was observed. In Brazil, older adults with low income have the lowest educational attainment and represent the largest proportion of illiterates in the country. Estimates indicate that 18% of people aged 60 years or older are illiterate, and that a large part of public policies is aimed at the literacy of young people and adults. It is also noteworthy that individuals with a higher level of education generally have greater health literacy when compared to individuals with fewer years of schooling.¹⁵

In this aspect, health literacy, defined as the degree to which individuals have the capacity to find, understand, and use information and services to make decisions and take actions related to their own health and for others, is one of the most important social determinants of health. Factors related to health literacy are multidimensional, as they involve the individual and their reading and writing skills, as well as health-related organizations, since the latter are responsible for disseminating understandable information and eliminating health inequities.¹⁶

Low health literacy can result in various problems, such as poorer self-perception of health, greater use of health services, inadequate management of chronic diseases, lower engagement in preventive actions, self-care deficits, and increased morbidity and mortality. This is especially concerning among older adults, whose functional, socioeconomic, and health difficulties make care more complex. Therefore, it is crucial to recognize this issue beyond educational attainment so that care is effective and generates better outcomes.¹⁷

Still within the personal information present in the OAHC are those related to the socio-family situation. Considering this aspect, this study revealed a high percentage of single older adults (76.9%) and older adults who do not receive visits and/or do not leave the institution to visit relatives or friends or engage in any leisure activity outside the LTCF (67.3%). This reveals social isolation, since the main bond of these older adults is generally with the professionals who work at the institution, and they only participate in activities developed within the scope of the LTCF.

LTCFs constitute residences that meet the needs of their residents, allowing for a life with citizenship and dignity. However, in general, the institutionalization of older adults presents as a risk factor for the breakdown of affective and social bonds. This can provoke feelings of fear, tension, sadness, anguish, and insecurity. In light of this, the maintenance of affective and social bonds becomes fundamental for the emotional balance of older adults.¹⁸

In the absence of family ties, the nursing team is responsible for providing most of the direct care to older adults in LTCFs.¹⁹ Placing this in a context where most of these older adults do not have family and social ties and have low education to deal with health issues, the health record emerges as an ally for these older adults and professionals, in the dissemination and sharing of detailed and updated information about their current health condition.

Regarding health-disease conditions, in the "older adult assessment" item present in the OAHC, it was observed that 100% of the older adults had at least one chronic disease, with emphasis on arterial hypertension, diabetes mellitus, and sequelae of stroke. Chronic diseases are characterized as a set of health deviations with multiple causes and risk factors, long latency periods and prolonged course, and can result in functional disabilities. In dependent older adults, they are associated with loss of functionality and are the main cause of dysfunctionality in most South American countries, including Brazil. Dysfunctionality refers to impairments, activity limitations, or restrictions in community and social participation.²⁰

Multimorbidity, frequently observed in the older adult population, is related to drug therapy. In this aspect, it was observed that all older adults in this study used some medication, and 78.8% met the criteria for polypharmacy, defined as the routine use of five or more medications. A previous study conducted at the same institution showed that 72.0% of older adults had more than 10 different medications prescribed, 24.0% between 5 and 10, and only 4.0% of older adults had fewer than 5 different medications prescribed during the evaluated period, with an average of 14.0 ± 5.8 medications per older adult.²¹

The use of many drugs simultaneously, without effective and permanent control, constitutes a risk factor in terms of promoting adverse effects or drug interactions. Polypharmacy in older adults may also be related to worse physical and mental health outcomes, increased hospitalization, and mortality. It is also worth noting that polypharmacy (≥5 medications) increases the risk of death by 1.28 times, and hyperpolypharmacy (≥10 medications) increases the risk of death by 1.44 times, in addition to simulating geriatric syndromes, as it increases the risk of urinary incontinence, falls, dementia, and diabetes in the older adult population.²⁰ Therefore, the detailed evaluation and monitoring of the pharmacological therapy of older adults is fundamental when aiming to provide quality of life to this population, and the OAHC becomes a tool that contributes to this monitoring.

The health record also has an instrument (VES-13) that identifies the health vulnerability of older adults based on age, self-perception of health, physical limitations, and disabilities. This instrument assists in the detection of older adults who present an excessive risk of functional decline and mortality over a period of 2 years, in addition to detecting low quality of life among older adults in the context of Primary Health Care and estimating the risk of long-term mortality.^10,22

It is highlighted that the VES-13 is routinely used in the scope of primary health care; in this context, this protocol is capable of screening older adults with limited life expectancy, defined as a mortality risk ≥50% in 10 years.²³ For older adults with VES-13 scores ≥ 2, multidimensional assessment is recommended to investigate the causes and intervene, acting in the prevention and/or reversal of functional decline.²⁴

The application of the VES-13 in institutionalized older adults revealed that 94.2% of them presented health vulnerability (VES-13 ≥3). Considering that the profile of these older adults is generally characterized by frailty when compared with older adults living in the community, the application of the VES-13 in the context of institutionalization provides a better classification of the susceptibility of these older adults to various health-related risks and problems, facilitating the development of a care plan from their admission to the institution. However, it is essential to carry out additional assessments and referrals for gerontogeriatric evaluation and, thus, support the planning of care and services aimed at the older adult population.²³

For the purpose of determining the degree of dependence, as recommended by the Ministry of Health¹¹, the cognitive condition (MMSE) and dependence for performing ADLs (Katz Index) were evaluated. In these aspects, the results indicated a high percentage of older adults with cognitive impairment (86.5%).

A high prevalence of cognitive impairment based on the MMSE, corresponding to 69.0%²⁵ and 79,1%²⁶, has also been observed in other studies conducted with institutionalized older adults. These findings may reflect the lack of spatial and temporal orientation and physical and recreational activities that provide cognitive stimulation for older adults residing in LTCFs. Furthermore, older adults with possible cognitive impairment may present a high degree of associated total dependence, increasing the demand on the professional team.^25,26

The application of the Katz Index revealed a high percentage of total or partial dependence in four or more ADLs, with emphasis on the activities of "bathing" and "dressing", both at 71.2%. This dependence among institutionalized older adults was also observed in a study on nursing diagnoses, which highlighted self-care deficit for bathing (75.8%) and self-care deficit for dressing (68.1%) as the most frequent diagnoses.⁴

The high prevalence of dependence is frequently observed in older adults residing in LTCFs. These institutions are considered limiting factors for independence, and in this environment, it is important to encourage older adults, stimulating self-care and the maintenance and/or rehabilitation of functional capacity, independence, and autonomy for the longest possible period through physical and cognitive activities.²⁶

The assessment of the degree of dependence showed that 73.1% presented degree III and 19.3% degree II. The high dependence for self-care activities was also observed in other studies with institutionalized older adults, which obtained percentages ranging from 65.8% to 71.7%.^3,27

The assessment of the degree of dependence in institutionalized older adults is crucial to guide the planning and implementation of appropriate actions. In addition to dependence, it is fundamental to evaluate activities of daily living, as they reflect social participation and quality of life in aging. Changes in these activities are often not perceived without a specific functional assessment, highlighting the importance of early identification of changes in performance. Thus, the multidisciplinary team should carefully observe the limitations of older adults and plan specific care that promotes rehabilitation, aiming to enable them to perform their daily activities with maximum autonomy and independence, facilitating adaptation to the LTCF environment.³

Concern about institutionalization and the social and health conditions of older adults arises in a context that demands adequate care and protection parameters. Nationally, there is growing concern about how older adults are treated in these environments, including difficulties in accessing health, precarious hygiene conditions, inadequate environments, and mistreatment.²⁸

The process of institutionalizing an older adult is difficult and delicate, especially for older adults who present social vulnerability and loss of their support network. When residing in an LTCF, it is necessary to follow institutional norms, care routines, and daily activities, and often to lose the social interaction and relationships that existed before institutionalization.²⁹

In this context, the health record stands out as an important tool for the clinical and functional assessment of older adults, including those who are institutionalized, serving as a basis for decision-making, planning, and execution of specialized and continuous care in LTCFs. The application of the health record allows older adults to receive humanized care, guided by a gerontogeriatric diagnosis obtained from a complete and detailed assessment, oriented by the OAHC. For this, it is essential that institutions have access to the services of a qualified multidisciplinary team to efficiently use the available materia.³⁰

Regarding the present study, it is important to mention its limitations, among which the fact that the data are not generalizable stands out, since the sample was not selected to represent the older adult population as a whole. Thus, the results may not reflect the characteristics of other older adult populations, which limits the possibility of extrapolation to different contexts. Another limitation refers to the academic nature of the study, considering that the implementation of the OAHC occurred within the scope of an extension project, requiring the awareness of the institution's multidisciplinary team for its continuity. Furthermore, the limitation in collecting all the items present in the OAHC allowed only a snapshot of the social and health conditions of the participating older adults. However, the application of the OAHC in this context made it possible to reflect on the need for possible adaptations of the instrument to the reality of long-term care facilities.

It is known that the application of the health record in the scope of LTCFs is essential to ensure comprehensive and continuous care, allowing for the systematic registration and monitoring of the health conditions of resident older adults. However, its effectiveness depends directly on the awareness and engagement of health professionals. When well understood and used by the multidisciplinary team, the health record becomes an important tool to guide clinical decisions, plan individualized interventions, and promote the quality of life of institutionalized older adults.

Conclusion

A predominance of males, a mean age of 75.9 years, low educational attainment, single marital status, and a mean institutionalization time of 3.1 years were observed. The majority of residents had low income, did not receive visits, presented with multimorbidities, used polypharmacy, exhibited high scores on the VES-13, and demonstrated cognitive deficit, dependence for basic activities of daily living, and a degree of dependence III, characterizing a profile of frailty.

The multidimensional assessment of institutionalized older adults is fundamental from the moment of their admission to the institution, and the health record can guide this assessment, allowing for comparisons of results and promoting the rehabilitation and recovery of the older adult's health. However, due to the characteristics of these older adults, the complementation of OAHC data through the use of other assessment instruments may be necessary in the context of LTCFs.

Despite the limitations of the study, of an academic nature and restricted to the survey of some items of the health record, the analyzed data are fundamental for person-centered care planning, based on the knowledge of the profile of these institutionalized older adults, and thus, ensuring dignified aging with quality of life.

Further studies in this area are necessary, especially in contexts where population aging is not yet so expressive, allowing for the proposition of monitoring strategies that consider the characteristics and clinical and social conditions of older adults, as well as research that verifies the knowledge of LTCF health professionals regarding the importance of using the older adult health record in these settings.

This study contributes to the application of the health record in the context of an LTCF, addressing aspects related to its feasibility, utility, and limitations in this specific environment. By identifying which fields of the health record are most applicable and which require adaptations to the institutional reality, the research proposes important reflections for the adequacy of assessment instruments to the needs of more vulnerable populations with a higher degree of dependence. Furthermore, by highlighting the sociodemographic, clinical, and functional data collected through the health record, the study reinforces its potential as a tool to support multidimensional assessment, the construction of individualized care plans, and the qualification of health care for institutionalized older adults, directly contributing to the strengthening of gerontogeriatric nursing.

Authors Contributions

Concepção do estudo: Gregório Cavalcante Silveira, Aimêe Leitão Cruz, Luiza Gomes Ferreira, Rafaela Beatriz Nóbrega Mota Eulálio, Nayara Kalila dos Santos Bezerra, Paulo Sérgio da Silva, Raquel Voges Caldart, Fátima Helena do Espírito Santo. Coleta de dados: Gregório Cavalcante Silveira, Aimêe Leitão Cruz, Luiza Gomes Ferreira, Rafaela Beatriz Nóbrega Mota Eulálio. Análise e interpretação dos dados: Gregório Cavalcante Silveira, Aimêe Leitão Cruz, Luiza Gomes Ferreira, Rafaela Beatriz Nóbrega Mota Eulálio. Redação do manuscrito: Gregório Cavalcante Silveira, Aimêe Leitão Cruz, Luiza Gomes Ferreira, Rafaela Beatriz Nóbrega Mota Eulálio, Raquel Voges Caldart. Revisão crítica do manuscrito: Nayara Kalila dos Santos Bezerra, Paulo Sérgio da Silva, Raquel Voges Caldart, Fátima Helena do Espírito Santo. Aprovação da versão final do texto: Nayara Kalila dos Santos Bezerra, Paulo Sérgio da Silva, Raquel Voges Caldart, Fátima Helena do Espírito Santo.

Conflict of interest

The authors declare that there is no conflict of interest.

Funding

The study was funded by the Institutional Program of Scientific Initiation Scholarships of the National Council for Scientific and Technological Development (PIBIC/CNPq) and by the Federal University of Roraima (PIBIC/UFRR).

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Corresponding Author

Nayara Kalila dos Santos Bezerra

E-mail: nayara.kalila@gmail.com