REVISIONES

 

Health needs of the elderly woman in the context of primary health care: integrative review

Necessidades de saúde da mulher idosa no contexto da atenção básica: revisão integrativa

Necesidades de salud de la mujer de edad avanzada en el contexto de la atención primaria de salud: revisión integral

 

 

Silva, Luana Christina Souza da*; Cunha, Lidiane Passos**; Carvalho, Simone Mendes***; Tocantins, Florence Romijn****

*Specialist in Women, Children and Adolescents Health Care, Master's Student of the Postgraduate Program in Nursing at UNIRIO, Scholarship Holder CAPES-DS. E-mail: luanachristinaenf@gmail.com
**Specialist in Nephrology, Master's Student of the Postgraduate Program in Nursing at UNIRIO, Scholarship Holder CAPES-DS.
***Doctorate in Public Health, Associate Professor at the Federal University of the State of Rio de Janeiro (UNIRIO).
****Doctorate in Nursing, Professor at the Federal University of the State of Rio de Janeiro - UNIRIO. Brazil.

 

 

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ABSTRACT

Objectives: To identify scientific production on health needs of the elderly woman in the context of primary care and analyze what aspects are addressed as the health needs of the elderly woman in the context of primary care.
Method: Integrative review search question: What are the concepts addressed in the literature on the theme health needs of the elderly woman in the context of primary care? The search occurred in LILACS and MEDLINE databases, in March 2014. Inclusion criteria: article in its entirety; Portuguese, English or Spanish and Brazilian reality.
Results: The sample of five articles points care needs of women in the reproductive cycle supported in PNAISM perspective. It is noteworthy that the health-disease process is a socially conditioned phenomenon and not just biological.
Conclusions: On the importance of moving towards new health care approaches, giving reasons for professional practice focused on comprehensive care to women.

Key words: Women's Health; Primary Health Care; Health Services Needs and Demands.

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RESUMO

Objetivos: Identificar produções científicas sobre necessidades de saúde da mulher idosa no contexto da atenção básica e analisar que aspectos são abordados quanto as necessidades de saúde da mulher idosa no contexto da atenção básica.
Método: Revisão integrativa com questão de busca teve-se: Quais são as concepções abordadas na literatura quanto à temática necessidade de saúde da mulher idosa no contexto da atenção básica? A busca ocorreu nas bases LILACS e MEDline, em março de 2014. Como critérios de inclusão: artigo na íntegra; idiomas Português, Inglês ou Espanhol e realidade brasileira.
Resultados: A amostra de cinco artigos aponta necessidades assistenciais da mulher no ciclo reprodutivo apoiado na perspectiva PNAISM. Destaca-se que o processo saúde doença é um fenômeno socialmente condicionado e não apenas biológico.
Conclusões: À relevância de avançar para novas abordagens de cuidado em saúde, fundamentando a atuação profissional voltada para a integralidade da atenção à mulher

Palavras chave: Saúde da Mulher; Atenção Primária à Saúde; Necessidades e Demandas de Serviços de Saúde.

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RESUMEN

Objetivos: Identificar producciones científicas sobre necesidades de salud de la mujer mayor en el contexto de la atención primaria y analizar qué aspectos se tratan en cuanto a las necesidades de salud de la mujer de edad avanzada en el contexto de la atención primaria.
Método: Revisión integral con la cuestión de la búsqueda: ¿Cuáles son los conceptos tratados en la literatura sobre el tema de las necesidades de salud de la mujer mayor en el contexto de la atención primaria? La búsqueda se produjo en bases de datos LILACS y MEDline, en marzo de 2015. Criterios de inclusión: artículo en su totalidad; portugués, inglés o español y realidad brasileña.
Resultados: La muestra de cinco artículos apunta necesidades asistenciales de la mujer en el ciclo reproductivo apoyado en perspectiva PNAISM. Es de destacar que el proceso salud-enfermedad es un fenómeno socialmente condicionado y no sólo biológico.
Conclusiones: La importancia de avanzar hacia nuevos enfoques para el cuidado de la salud, explicando los motivos de la práctica profesional centrada en la atención integral a la mujer.

Palabras clave: Salud de la mujer; Primeros Auxilios; Necesidades y Demanda de Servicios de Salud.

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Introduction

The basic health care has been considered one of the pillars of the organization of any health system, configured as the user's first contact with the health system. Thus, the basic level of health care has great potential to solve significant number of complaints/demands presented⁽¹⁾.

The National Policy of Primary Health Care - PNAB presents in one of its foundations the making of completeness in its various aspects, seeking interdisciplinary and team action. In this sense, it emphasizes the comprehensiveness as the comprehensive care of health promotion to healing and rehabilitation, allowing the user of the Unified Health System - SUS getting beyond the focus on disease, a decent and a comprehensive care, walking this way toward to health promotion⁽²⁾.

Historically, in 1984 there was created the Program of Integral Attention to Women's Health (PAISM). This program has come up with proposals and approaches aimed at women's health, aimed at comprehensive care, not just reproductive health. It was from the PAISM that there was a new focus on public policies for women's health at all stages of their life cycle. The PAISM advocated actions involving prenatal, birth and postpartum, gynecological cancer, sexually transmitted diseases and family planning with a focus on conception and contraception⁽³⁾.

In 2004, the Ministry of Health created the document of the National Comprehensive Policy to Women's Health Care (PNAISM), which reiterates the proposals of PAISM⁽⁴⁾, according to the National Policy for Integral Attention to Women's Health⁽⁴⁾.

"humanization and quality of care are essential conditions for health actions to reflect on the resolution of the problems identified in the satisfaction of users, in strengthening the capacity of women facing the identification of their demands, recognizing and claiming their rights and self-care promotion"⁽⁴⁾.

Note that the PNAISM also has the purpose to emphasizing the importance of empowerment of SUS users and their participation in instances of social control.

The health-disease process is a complex phenomenon, socially determined, modulated by biological, psychological, cultural, economic and political conditioning.

The nurse participates as a team member, the actions aimed at meeting the health needs of the population and the defense of the principles of public policy, ensuring universal access to health services and comprehensive care⁽⁶⁾.

Given the importance and the increase in this group of elderly woman population it becomes relevant this theme for the performance of nursing because its concept in the reflections on the work process in health nursing facing the health needs of the elderly woman in the context of primary care, it presents operating, innovative and current. Thus, this research will enable the exchange of experience to be coupled with other studies carried out with the theme for strengthening the process of reflection/discussion and the production of knowledge from the reality. Therefore, the present study has the following objectives: identifying scientific productions about health needs of the elderly woman in the context of primary health care and analyze what aspects are addressed as the health needs of the elderly woman in the context of primary care.

 

Material and method

This is a qualitative approach study performed from an integrative literature review⁽⁷⁾, contributing to the process of systematization and analysis of results, aiming at the understanding of a particular subject, from other independent studies.

This integrative review was developed from the respective stages: search question of identification; select descriptors; selection of databases; application of inclusion and exclusion criteria; identification of selected studies; categorization of the selected studies; and analysis and interpretation of results⁽⁷⁾.

In this way, it had as literature for question: What are the concepts addressed in the literature about the theme of health needs of the elderly woman in the context of primary care?

The descriptors set for use after consulting the "Descriptors in Health Sciences" -(MeSH) were: "Needs and Health Service Demands"; "Women"; "Women's Health"; "Health Services"; "Primary Health Care" and "Health of the Elderly".

The survey of scientific production was conducted in the Virtual Health Library (VHL), specifically in electronic databases: Medical Literature Analysis and Retrieval System Online (MEDline) and Latin American and Caribbean Health Sciences (LILACS), from March 2014. Concerning the temporality, this was not delimitation object in this study.

It was established as inclusion criteria: text with content in full and available with free online access, scientific papers, and scientific articles in Portuguese (Brazil), English or Spanish, and scientific articles that portray the Brazilian reality, the time frame of the publications were not used.

To checking the amount of indexed scientific publications in online databases MEDline and LILACS, the descriptors were first inserted individually, by subject descriptor. Then, in order to identify the scientific production with the intention of composing the study, the descriptors were inserted in an articulated manner.

From publications found there was created, with the purpose of organization, an analysis matrix with the following aspects: title of the paper, professional category of authors, journal name, year of publication and country of publication.

The content of the articles was analyzed by content analysis⁽⁸⁾, with reference to the concept of necessity presented.

 

Results

The identification of the quantity of productions available in full emerged through individualized search in electronic databases LILACS, MEDline.

Most publications are found in the Medline database. However, there are also publications in LILACS database. This allows the importance of confirming the search on both bases. Among the descriptors used, which presented a greater quantity of scientific productions in the search made by the Medline database was the descriptor Primary Health Care with 15.367 scientific publications, already in LILACS database which presented a greater quantity was the descriptor "Health Service", with 5.265 scientific productions found. With the "Women's Health" descriptors and "Women" quantitative remained more expressive in the database MEDline, with 6.168 and 1.723 scientific productions, respectively. It is worth noting that even the amount of scientific productions being more expressive in the Medline database, with the descriptor "Health of the Elderly" there were no scientific publications on this basis.

Then, a search articulating different descriptors was taken. Only by linking the two triads with the descriptors "Needs and Health Service Demands", "Women" and "Primary Health Care" and the descriptors "Needs and Health Service Demands", "Women's Health", "Warning primary Health Care "that scientific productions were identified in the LILACS and MEDline.

With the prospect of limiting the studies to be analyzed, the process of search and quantity found is depicted in Figures 1 and 2, where the inclusion criteria were applied.

 

 

 

When articulating the following descriptors "Needs and Health Service Demands" and "Women" and "Primary Health Care" there were found 13 publications (Figure 1).

From these 13 publications two were found in LILACS and 10 in MEDIine, and one publication found in the PAHO database, this publication was not included because the database has not been determined for the study.

Continuing to apply the inclusion criteria text content in full and available with free online access, the two publications in the LILACS database were not found any publication that meets this criterion; MEDline of 10 publications, two are full text and available with free online access. When applying the criteria for inclusion scientific paper, the two publications found met this criterion. The choice of language, were found two articles in English and none in Spanish and Portuguese. But none of them relate to the Brazilian reality. The time frame of the publications was not used as an inclusion criterion.

By articulating the descriptors "Needs and Health Service Demands" "Women's Health" and "Primary Health Care", it was also found 13 publications (Figure 2).

When applying the criteria for inclusion through the process mentioned above, three scientific articles were identified, none of which refers to the Brazilian reality.

The articles not contemplating the Brazilian reality, but the studies found out the health needs of women. It is worth noting that the importance of researching such a theme, since studies in the area could help to support the professional practice with a view to meet the health needs of the elderly woman, besides contributing to the strengthening of the process of reflection and discussion and the production of knowledge in the health of the elderly woman in the context of primary care.

Considering this previously executed strategy, it was first held up the organization of data about these publications that can be seen in Table 1.

 

 

As is visualized in Table 1, the professional category was identified by the authors as medical and statistical. They were published in English in Scientific American, English and Canadian journals, in the 1999-2013 periods.

Articles had their abstracts analyzed in order to identify the articles that way address the health needs of the elderly woman in the context of primary care.

In respect of the content of the articles, the article entitled Trends in US women's use of sexual and reproductive health care services, 1995-2002⁽⁹⁾ addresses the use of sexual and reproductive health services of American women by type of provider for women in age group 15-44 years old, in the 1995-2002 periods.

The article entitled "Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic"⁽¹⁰⁾ focuses the access to mental health services among women aged between 20 and 49 years old.

The article entitled Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland⁽¹¹⁾ refers to sex workers, listing the potential vulnerability factors in this population and examining the use of health care and needs. The article entitled The supply of physicians and care for breast cancer in Ontario and California, 1998 to 2006⁽¹²⁾, deals with the provision of medical services in the treatment of breast cancer.

The article titled Dental Care Access and Use Among HIV-Infected Women⁽¹³⁾ refers to women infected with HIV.

It can be identified in this first approach that the theme health needs of the elderly woman in the context of primary health care is not a focus of scientific production identified.

However, for clarity it opted for more detail to analyzing the content of the articles as is shown in Table 2.

 

 

Note: The aim for the content, the scenario and the focus of the articles was translated from English into Portuguese by the authors.

As it is displayed in Table 2, in relation to the objectives identified that the subject matter is related to the health service which includes the group of women; another aspect considered is the setting for obtaining the data, essentially standing out database, workplace or residence of women, and a primary health care clinic.

No articles focused on older women have been identified: the focus is on women aged 20-49 years old.

In this sense, it can be said that the theme of health needs of the elderly woman in the context of primary health care is not a focus of the articles.

 

Discussion

Despite being not identified scientific articles that focus on the theme "Health needs of the elderly woman in the context of primary health care", with reference to health needs of conceptions^(14-15), it was considered to be relevant to analyze the way of content contextualized.

In the selected scientific articles there were identified some points raised as the theme health care needs in the health professional perspective or service⁽¹⁶⁾.

Articles bring a focused approach to: the reproductive cycle of women ⁽⁹⁾, need for mental health care in the woman Clinic⁽¹⁰⁾, the use of health care and presented care needs⁽¹¹⁾, supply of professionals in specialized treatment⁽¹²⁾, and access to services (dental) available⁽¹³⁾, as can be seen in the excerpts below:

The provision of contraceptive services among American women increased significantly between 1995 and 2002⁽⁹⁾.

American women have less access to mental health services⁽¹⁰⁾.

Sex workers are unaware of the health services, resulting in inappropriate use of services⁽¹¹⁾.

The offer of medical professionals was not associated with the need to care for breast cancer⁽¹²⁾.

HIV-infected women had never been served by a dentist⁽¹³⁾.

It identifies so the technological organization, from professionals, actions and health services by introducing assistance needs without necessarily match the health needs conditioned by the social context of users of services⁽¹⁷⁾.

It notes also that the setting of primary health care is not the central focus of publications.

It is noteworthy that Brazilian policy toward the attention to women's health⁽⁴⁾ essentially covers the age group 10-49 years old and that policies turned to the elderly⁽¹⁸⁾ do not focus on the profile of women's study theme.

 

Conclusions

This study allows us to identify the scientific production about the subject incipient health needs focusing on the elderly woman in primary care, which points to the importance of conducting and publishing studies that address the issue.

The scientific production about health needs of the elderly woman, in the context of primary care, focus primarily on the reproductive cycle related to various difficulties experienced from the daily lives of women especially at the level of secondary care.

Therefore, it becomes necessary achievement and socialization studies in order to promote the strengthening of the process of reflection and discussion and the production of knowledge from the concrete reality of a population group.

From this perspective, we must break the silence that still rules, when what is at issue are the health needs of the elderly woman in the context of primary care.

It also emphasizes the importance of awakening new management approaches of nursing care that are associated with the idea of moving towards new fields of professional activities, adopting new approaches to attention and focused intervention for concrete reality and health of elderly woman.

 

 

Received: August 4, 2015
Accepted: September 10, 2015

 

 

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