Idoso e fragilidade na unidade de saúde da família: tomada de decisão, evidências e contribuições para a linha de cuidado

Abstract

Objective: To analyze the decision-making process of health team members regarding the therapeutic plan for frail older people, registered at Family Health Units (FHU) in the region served by the Family Health Support Center (NASF) in a municipality from the interior of São Paulo. Method: This is a cross-sectional study, with a qualitative approach, supported by the concepts of Bardin, through focus groups with Health Agents and analysis of medical records. Data were collected in the municipality of São Carlos, in a region that presents greater social vulnerability, identified in the Cidade Aracy region, in three Family Health Units, in the period from 2016 - 2018 and the participation of 8 members of health teams. Data were collected from focus group meetings and analysis of medical records of frail older people, evaluated in a larger study to which the present study was linked and registered in the USF’s. The study was approved by the Research Ethics Committee. Results: The teams' perception of the older person's health was verified, identifying financial conditions and social support; the therapeutic plan through team meetings; conduct of care for the elderly, through interaction with the community, guidance, family support, assessments as factors of alert, home visit, identification and specific behaviors of the frailty and use of the Health Handbook for the Older People and also within the care contacts the people y also checked decision making; finally, the potential and limitations observed throughout the research were identified potentialities and limitations. Conclusion: the health teams that participated in the present study identify the need for a therapeutic plan, however, they do not have a specific decision-making and therapeutic plan for the frail persons within the Family Health Unit.