Competências do enfermeiro para promoção da saúde de idosos no domicílio

revisão sistemática realizada nas bases de dados LILACS, Scopus, CINAHL, no portal PubMed e na biblioteca Cochrane, em novembro de 2017. Os artigos selecionados foram analisados de acordo com os nove domínios de competências: permitir a mudança; advogado para a saúde; mediar através de parceria; comunicação; liderança; avaliação; planejamento; implementação; e avaliação e pesquisa.

Resultados:

foram incluídos nove ensaios clínicos. Todos os domínios de competências de promoção da saúde foram identificados nas intervenções realizadas nas pesquisas nos idosos residentes no domicílio.

Conclusão:

os estudos mostraram que os tratamentos utilizados foram benéficos para a população de idosos no domicílio e as intervenções baseadas em competências para a promoção da saúde podem ser identificadas e produzem uma prática assistencial eficaz e de qualidade.

Descritores:
Idoso; Pacientes Domiciliares; Competência Profissional; Enfermagem; Promoção da Saúde

Referência e local do estudo	Delineamento/número de participantes	Intervenções	Desfechos
Tuntland et al.⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ⁾, 2015 Noruega	- 61 idosos com declínio da capacidade funcional. GC: 30 (49,2 %) GI: 31 (50,8 %)	GC: Atendimento convencional (ajuda, alarme de segurança, refeições, tecnologia assistiva e reabilitação com terapeutas). GI: Reabilitação multicomponente (identificar limitações de atividades importantes, supervisão dos cuidadores, treinamento das atividades diárias, adaptações para o meio ambiente e programas de exercícios).	Melhorias significativas nos escores médios, favorecendo a reabilitação no desempenho ocupacional no GI. Não houve diferenças significativas entre os grupos em nenhum dos desfechos secundários após 3 ou 9 meses, no entanto, os dois grupos melhoraram em sua mobilidade/equilíbrio e na maioria dos domínios de qualidade de vida relacionados à saúde. Esses efeitos foram mantidos no seguimento de 9 meses.
Gellis, Kenaley, Have⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ⁾, 2014 Estados Unidos	- 94 idosos clinicamente frágeis de idade ≥ 65 anos com histórico de hospitalização nos últimos 6 meses ou necessidade de atendimento domiciliar ≥ 3 vezes por semana que obtiveram triagem positiva para depressão. GC: 46 (48,9 %) GI: 48 (51,1 %)	GC: Cuidados habituais fornecidos por enfermeiros no domicílio por meio de visita domiciliar e psicoterapia. GI: Intervenção telessaúde integrada que consistiu em telemonitoramento, manejo da doença crônica, cuidado e tratamento da depressão.	Os grupos apresentaram sintomas elevados de depressão. Aos 3 meses, o grupo telessaúde integrada expôs menos depressão do que o GC e a tendência continuou aos 6 meses. Aos 3 e 6 meses, não foram encontradas diferenças significativas entre os grupos no estado de saúde física dos participantes. Nas habilidades para resolução de problemas, os escores aos 3 meses refletiram maiores habilidades no GI.
Kono et al.⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ⁾, 2013 Japão	- 307 participantes com idade ≥ 65 anos, domiciliados com seguro saúde.GC: 153 (49,8 %)GI: 154 (50,2 %)	GC: Idosos frágeis acompanhados em ambulatórios. GI: Idosos frágeis acompanhados em ambulatórios que receberam visitas domiciliares de enfermeiros.	Os custos médios de cuidados de saúde durante o período de 2 anos diminuíram ligeiramente no grupo que recebeu visita domiciliar comparando com o GC, mas a diferença não foi significativa. Na maioria dos meses, os custos financeiros no GI foram inferiores aos do GC e os custos médios de cuidados hospitalares durante o período de 2 anos em ambos os grupos foram semelhantes. As hospitalizações tiveram menos probabilidade de ocorrer no GI.
Gellis et al.⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾, 2012 Estados Unidos	- 102 idosos de idade ≥ 65 anos com ICC ou DPOC, hospitalizados duas vezes nos últimos 6 meses ou atendidos pelo menos duas vezes na emergência nos últimos 2 meses. GC: 51 (50 %) GI: 51 (50 %)	GC: Atendimento domiciliar padrão e educação em saúde. GI: Intervenção de telessaúde, sistema de monitoramento, no qual os pacientes foram informados dos parâmetros clínicos normais e instruídos sobre quando deviam entrar em contato com o enfermeiro de saúde. O enfermeiro estava à disposição do paciente diariamente, por telefone e para visitas domiciliares urgentes, conforme necessário.	Aos 3 meses, os pacientes do GI melhoraram significativamente nos escores dos sintomas de depressão quando comparados com o GC. O grupo telessaúde experimentou aumentos significativamente maiores em duas das três escalas do SF-36 (saúde geral e funcionamento social). No inquérito satisfação com cuidados, ambos os grupos ficaram satisfeitos com seus cuidados sem diferenças significativas. O GC teve significativamente mais visitas ao departamento de emergência do que o GI.
Shearer, Fleury, Belyea⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ⁾, 2010 Estados Unidos	42 indivíduos com idade ≥ 60 anos, falavam e entendiam inglês, conseguiam ouvir e possuíam cognição preservada. GC: 22 (52,4 %) GI: 20 (47,6 %)	GC: Neste grupo, foram enviados boletins semanais fornecendo informações sobre segurança doméstica, segurança de medicação, envelhecimento e cuidados com a pele, envelhecimento e visão, atendimento odontológico e saúde óssea. GI: Intervenção de empoderamento em saúde baseada em seis componentes integrados (recursos pessoais, construir autocapacidade, reconhecer e construir redes sociais, identificar e construir a utilização de serviços sociais, comunicarse para construir redes sociais e acessar provedores de serviços sociais e revisar o progresso). Implementada nas visitas domiciliares por enfermeiro treinado.	O GI apresentou pontuação significativamente maior nas 6ª e 12ª semanas na escala de obtenção de metas. Não houve um efeito principal significativo para o empoderamento em saúde baseado no referencial teórico. No entanto, o crescimento pessoal da subescala mostrou diferença significativa entre a comparação e intervenção no início do estudo e no tempo de 12 semanas. Ao final, o GI aumentou com relação ao crescimento pessoal. Não houve efeitos principais significativos entre os grupos para a escala que avaliou bem-estar. Entretanto, houve diferenças significativas entre aqueles que eram mais velhos; o GI aumentou o bem-estar entre 6 e 12 semanas. Não houve efeito principal significativo para a pontuação total da escala que avalia sentimentos sobre consciência, escolhas, liberdade de agir e envolvimento na criação de mudanças. No entanto, houve diferenças significativas para os homens no GI.
20. Boyd et al.⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾, 2008 Estados Unidos	- 150 idosos com doenças crônicas de alto risco. São considerados de alto risco aqueles com maior probabilidade de necessitar dos serviços de saúde. GC: 63 (76 %) GI: 31 (41 %)	GC: Receberam cuidados habituais de saúde. GI: Receberam cuidados orientados de saúde.	O GI apresentou tendência para melhoria na qualidade da comunicação entre paciente e profissional e conhecimento mais abrangente em comparação com o GC. Não houve diferenças para a integração de cuidado, tratamento interpessoal e confiança no profissional de saúde.
Vass et al.⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾, 2009 Dinamarca	- 4034 idosos domiciliados com 75 e 80 anos de idade. GC: 1942 (48,1 %) GI: 2092 (51,9 %)	GC: A população pertencente aos municípios de controle recebeu cuidados habituais e os profissionais desses municípios não participaram de nenhuma formação. GI: A população pertencente aos municípios de intervenção recebeu assistência de profissionais que receberam formação/treinamento educacional.	A intervenção não foi associada à mortalidade nos dois grupos. Durante 4 anos e meio de acompanhamento, 63 idosos de 75 anos dos municípios de intervenção se mudaram para lares de idosos em comparação com 62 idosos dos municípios de controle. Entre idosos de 80 anos, 38 versus 48 pessoas mudaram-se para lares de idosos. As taxas de internação foram menores nos participantes de 80 anos dos municípios de intervenção. A intervenção foi associada com efeitos benéficos sobre a capacidade funcional após três anos de intervenção entre os idosos de 80 anos em municípios onde foi realizada.
Engberg et al.⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾, 2002 Estados Unidos	16 indivíduos com idade ≥ 60 anos domiciliados, com relato de pelo menos dois episódios de IU por semana, que persistiu durante pelo menos 3 meses, com deficiência cognitiva e acompanhados por cuidadores. GC: 10 (62,5 %) GI: 6 (37,5 %)	GC: Receberam visitas de enfermeiros para controle de micção. Os sujeitos e seus cuidadores estavam cientes de que estavam em um estudo que examinava a eficácia de um programa de micção para IU, mas não houve discussão sobre a incontinência ou seu tratamento com o cuidador ou sujeito durante as visitas do enfermeiro. GI: O tratamento consistiu em terapia comportamental orientada por enfermeiros e a micção programada realizada com ajuda dos cuidadores por 8 semanas. Não foi fornecida intervenção durante a noite.	Redução média de 50% nos episódios diurnos de incontinência em comparação com diminuição média de 37% para sujeitos do controle. A percentagem média diária de roupa íntima molhada/fralda dimunuiu 43%, enquanto caiu 35% entre os sujeitos do GC. Os casos de tratamento tiveram uma diminuição de 55% em todos os episódios de incontinência (diurno e noturno) em comparação com uma redução de 27%.
McDowell et al.⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾, 1999 Estados Unidos	- 105 indivíduos cognitivamente intactos com idade ≥ 60 anos, residentes no domicílio, com relato de pelo menos duas perdas urinárias por semana e persistente por pelo menos 3 meses. GC: 52 (49, 5%) GI: 53 (50, 5%)	GC: Visitas de enfermeiro para fornencer interação social sem especificações para tratamento da IU, com objetivo de avaliar o efeito da socialização sobre o resultado. Não foi preenchido diário vesical durante o controle. Visita de 35 minutos durante 8 semanas. GI: Exercícios musculares do assoalho pélvico assistidos por biofeedback, estratégias de urgência e esforço e treino vesical. O diário vesical era avaliado semanalmente e o tratamento ajustado baseado na evolução. Visita de 40 a 60 minutos durante 8 semanas.	O número médio de episódios de incontinência por dia diminuiu de 4,1 para 3,5 no GC. Já no GI houve redução de 4,0 para 1,8. Com isso, os indivíduos tratados apresentaram redução significativa de perdas urinárias por dia (P ≤ 1).

Domínios CompHP	Intervenções de Enfermagem
Permitir a mudança	Promover o empoderamento⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^-¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Promover educação em saúde⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Facilitar o desenvolvimento de habilidades⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Formação profissional⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Advogado para a saúde	Possibilitar a melhoria da saúde⁽²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Possibilitar a adesão terapêutica⁽²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Facilitar o acesso a recursos comunitários⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Possibilitar redução de custos⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ⁾ Influenciar as partes interessadas para mudança⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Conscientizar para as questões de saúde⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ⁾ Estímulo para utilização dos recursos sociais⁽¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ⁾
Mediar através de parceria	Parceria com os idosos e cuidadores⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Trabalho colaborativo em equipe⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Parceria com a comunidade⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Parceria com outros profissionais⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾ Parceria com municípios e gestores⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Comunicação	Visitas domiciliares⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... 17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... 18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^-¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... 22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Recomendações escritas e material ilustrado⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Uso da tecnologia da informação⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Meios de comunicação (telefone, gravador)⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^-²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Entrevista motivacional⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Uso de tecnologia telessaúde⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Reuniões⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Liderança	Incorporar conhecimento novo⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... 22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Supervisão e treinamento⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Estimular os participantes a realizar mudanças⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ⁾ Facilitar o empoderamento e a participação⁽²¹21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... ⁾
Avaliação	Identificar as limitações existentes⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Identificar as necessidades de saúde dos pacientes⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Identificar as prioridades de ação⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Avaliação multidimensional e individualizada⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^-¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ⁾ Avaliação diária dos dados do paciente⁽¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾
Planejamento	Desenvolver um plano de ação viável⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^-¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Programar as ações⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾
Implementação	Desenvolver ações de empoderamento⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... ^,²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Implementar intervenção comportamental⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Promover estratégias de acesso aos serviços comunitários⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Utilizar recursos (escalas, instrumentos)⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... 16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^-¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^-²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ^,²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾ Desenvolvimento de recurso personalizado⁽²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Reinstrução das atividades para manutenção da terapia⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾ Acompanhamento por um período de tempo⁽¹⁷17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... ^,¹⁹19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... ^-²⁰20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... ⁾ Uso de telessaúde⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ^,¹⁸18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... ⁾ Manejo e tratamento da depressão⁽¹⁶16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... ⁾
Avaliação e Pesquisa	Avaliar os resultados das intervenções⁽¹⁵15 Tuntland H, Aaslund MK, Espehaug B, Forland O, Kjeken I. Reablement in community-dwelling older adults: a randomised controlled trial. BMC Geriatr. 2015 [cited 2017 Nov 8];15:145. Available from: https://doi.org/10.1186/s12877-015-0142-9 https://doi.org/10.1186/s12877-015-0142-... 16 Gellis ZD, Kenaley BL, Have TT. Integrated telehealth care for chronic illness and depression in geriatric home care patients: the Integrated Telehealth Education and Activation of Mood (I-TEAM) study. J Am Geriatr Soc. [Internet]. 2014 [cited 2017 Nov 8];62(5):889-95. Available from: https://doi.org/10.1111/jgs.12776 https://doi.org/10.1111/jgs.12776... 17 Kono A, Kanaya Y, Tsumura C, Rubenstein LZ. Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial. Aging Clin Exp Res [Internet]. 2013 [cited 2017 Nov 8];25(5):575-81. Available from: https://doi.org/10.1007/s40520-013-0128-4 https://doi.org/10.1007/s40520-013-0128-... 18 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Have TT. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012 [cited 2017 Nov 8];52(4):541-52. Available from: https://doi.org/10.1093/geront/gnr134 https://doi.org/10.1093/geront/gnr134... 19 Shearer NBC, Fleury JD, Belyea M. Randomized control trial of the Health Empowerment Intervention: feasibility and impact. Nurs Res [Internet]. 2010 [cited 2017 Nov 8];59(3):203-11. Available from: https://doi.org/10.1097/NNR.0b013e3181dbbd4a https://doi.org/10.1097/NNR.0b013e3181db... 20 Boyd CM, Shadmi E, Conwell LJ, Griswold M, Leff B, Brager R, et al. A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults. J Gen Intern Med [Internet]. 2008 [cited 2017 Nov 8];23(5):536-42. Available from: https://doi.org/10.1007/s11606-008-0529-9 https://doi.org/10.1007/s11606-008-0529-... 21 Vass M, Avlund K, Siersma V, Hendriksen C. A feasible model for prevention of functional decline in older home - dwelling people - the GP role. A municipality-randomized intervention trial. Fam Pract [Internet]. 2009 [cited 2017 Nov 8];26(1):56-64. Available from: https://doi.org/10.1093/fampra/cmn094 https://doi.org/10.1093/fampra/cmn094... 22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ^-²³23 McDowell BJ, Engberg S, Sereika S, Donovan N, Jubeck ME, Weber E, et al. Effectiveness of behavioral therapy to treat incontinence in homebound older adults. J Am Geriatr Soc [Internet]. 1999 [cited 2017 Nov 8];47(3):309-18. Available from: https://doi.org/10.1111/j.1532-5415.1999.tb02994.x https://doi.org/10.1111/j.1532-5415.1999... ⁾ Reavaliação dos sujeitos ao final do tratamento⁽²²22 Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. J Wound Ostomy Continence Nurs [Internet]. 2002 [cited 2017 Nov 8];29(5):252-65. Available from: https://doi.org/10.1067/mjw.2002.127207 https://doi.org/10.1067/mjw.2002.127207... ⁾

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[1] Autor Correspondente: Telma Alteniza Leandro E-mail: telmaleandro21@yahoo.com.br