Abordagem do Delirium na Comunidade

INTRODUÇÃO: O delirium é uma das complicações neuropsiquiátricas mais frequentes em Cuidados Paliativos. Constitui uma disfunção neurológica grave, não existindo diretrizes bem estabelecidas para a sua gestão na comunidade. O objetivo deste trabalho consiste na revisão da evidência existente sobre a abordagem do delirium na comunidade, em particular em Portugal.MÉTODOS: Revisão da literatura utilizando os termos MeSH delirium, palliative care, domiciliary care, general practitioners, general physicians, primary care, Portugal e end of life.RESULTADOS E CONCLUSÃO: O delirium é, habitualmente, multifatorial, tendo um impacto importante nos serviços de saúde, profissionais, cuidadores e, sobretudo, nos doentes. A evidência científica para o seu tratamento é escassa e aplica-se, sobretudo, aos cuidados hospitalares. A estruturação de cuidados de qualidade no âmbito da prevenção, identificação atempada e gestão precoce do delirium, no contexto dos Cuidados Paliativos na comunidade, deve incluir o doente, a sua família e o ambiente onde se insere.

When relationships get in the way: The emergence and persistence of care routines

Past research has shown that routines can be a vehicle for both stability and change in organizations. It is unclear however how this relationship alters and solidifies over time. In this paper, the changing behaviours of three newly-formed teams within a domiciliary care organization are tracked over a period of two years. It was seen that self-reinforcing processes shaped the emergence and persistence of action patterns within these groups. The first process achieved coordination benefits which drove the emergence of routines, as ‘action patterns’ were first negotiated and then assigned to members of the care team. The second self-reinforcing process involved sets of expectations which deepened interpersonal relationships between the care worker and client. The impact of both these processes, altered the ostensive-performative duality, as routines emerged and persisted over time. This study therefore highlights the changing dynamics of stability and change within routines, and the key role played by social relations in this process.

Initiation of domiciliary care and nursing home admission following first hospitalization for heart failure, stroke, chronic obstructive pulmonary disease or cancer

Background Patients with chronic diseases are at higher risk of requiring domiciliary and nursing home care, but how different chronic diseases compare in terms of risk is not known. We examined initiation of domiciliary care and nursing home admission among patients with heart failure (HF), stroke, COPD and cancer. Methods Patients with a first-time hospitalization for HF, stroke, COPD or cancer from 2008–2016 were identified. Patients were matched on age and sex and followed for five years. Results 111,144 patients, 27,786 with each disease, were identified. The median age was 69 years and two thirds of the patients were men. The 5-year risk of receiving domiciliary care was; HF 20.9%, stroke 25.2%, COPD 24.6% and cancer 19.3%. The corresponding adjusted hazard ratios (HRs), with HF patients used as reference, were: stroke 1.35[1.30–1.40]; COPD 1.29[1.25–1.34]; and cancer 1.19[1.14–1.23]. The five-year incidence of nursing home admission was 6.6% for stroke, and substantially lower in patients with HF(2.6%), COPD(2.6%) and cancer (1.5%). The adjusted HRs were (HF reference): stroke, 2.44 [2.23–2.68]; COPD 1.01 [0.91–1.13] and cancer 0.76 [0.67–0.86]. Living alone, older age, diabetes, chronic kidney disease, depression and dementia predicted a higher likelihood of both types of care. Conclusions In patients with HF, stroke, COPD or cancer 5-year risk of domiciliary care and nursing home admission, ranged from 19–25% and 1–7%, respectively. Patients with stroke had the highest rate of domiciliary care and were more than twice as likely to be admitted to a nursing home, compared to patients with the other conditions.

Raising the bar? The impact of the UNISON ethical care campaign in UK domiciliary care

This article critically analyses a major trade union initiative in the United Kingdom to raise standards in public contracts for domiciliary care, and in turn to improve wages and working conditions for outsourced care workers. The campaign successfully built alliances with national employer representatives, and around 25 per cent of commissioning bodies in England, Scotland and Wales have signed a voluntary charter that guarantees workers an hourly living wage, payment for travel time and regular working hours. The campaign overall, however, has had only limited effects on standards across the sector, in which low wages, zero-hours contracts and weak career paths predominate. Furthermore, the campaign has not yet yielded significant gains in terms of union recruitment, although there are signs of sporadic mobilisations of care workers in response to localised disputes.

The professionalisation of domiciliary care workers in England following COVID-19

The growing pressure of an ageing population has resulted in an increased focus and interest in home or domiciliary care. This, plus changing lifestyle trends and the COVID-19 pandemic, necessitates a review of care in the UK. The number of domiciliary carers has increased; of the 1.62 million social workers active in 2018, 685 000 were categorised as domiciliary carers. However, this group of carers are not recognised as healthcare professionals. Indeed, there is no formal recognition or definition of the role of the carer in the UK, and there seems to be an overlap between support workers and carers, without adequate explanation of what either of these roles mean in practice. This article highlights the need to pay particular attention to this care sector, particularly in light of both the COVID-19 pandemic and Brexit.

Sleeping soundly? The implications of the Mencap ruling

Many care home and domiciliary care business owners will have welcomed the Mencap ruling, from a purely financial perspective. However, what effect will it have on recruitment and retention? Lucy Gordon explains