Healthcare for older adults with unintentional weight loss: perceptions of Primary Care professionals in São Paulo, Brazil

Sardinha, Aline Nascimento; Almeida, Maria Helena Morgani de

doi:10.1590/interface.230478

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Articles • Interface (Botucatu) 28 • 2024 • https://doi.org/10.1590/interface.240443 linkcopy

Healthcare for older adults with unintentional weight loss: perceptions of Primary Care professionals in São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Aging involves biological changes such as unintentional weight loss. This study aimed to understand primary care professionals’ perceptions of the nutritional status of older adults who are users of Primary Care Units, emphasizing unintentional weight loss and identifying possibilities for intervention by the interprofessional team. Seventeen individual interviews and one focus group were conducted in 2019 with health professionals in São Paulo, Brazil. Data were transcribed, submitted to thematic content analysis, and discussed in triangulation. Participants demonstrated difficulty in identifying older adults with unintentional weight loss. Challenges for care included food insecurity and problems in the work process in Primary Care, while possibilities for care involved health education, interprofessionality, and intersectoral work.

Keywords
Primary Health Care; Weight loss; Comprehensive health care; Older adults’ nutritional physiological phenomena

	Interviews		Focus Group
Sex	Nº	%	Nº	%
Men	4	23.53	2	16.67
Women	13	76.47	10	83.33
Total	17	100.0	12	100.00
Academic background	Nº	%	Nº	%
Nurse	7	41.18	5	41.66
Physiotherapist	3	17.65	2	16.67
Dietitian	2	11.77	1	8.33
Speech pathologist and audiologist	1	5.88	1	8.33
Physical education professional	1	5.88	1	8.33
Psychologist	1	5.88	1	8.33
Social worker	1	5.88	1	8.33
Physician	1	5.88	0	0.00
Total	17	100.0	12	100.00
Interprofessional experience in the undergraduate course?	Nº	%	Nº	%
Yes	11	64.71	7	58.33
No	6	35.29	5	41.67
Total	17	100.0	12	100.00
Length of service in PHC	Nº	%	Nº	%
<1 year	3	17.65	3	25.00
1 to 5 years	7	41.18	5	41.67
5 to 10 years	1	5.88	0	0.00
> 10 years	6	35.29	4	33.33
Total	17	100.0	12	100.00

Themes		Categories
1	Issues related to the demographic and biopsychosocial aspects of aging	Population aging and the high number of older adults in the Central Area
		Functionality conditions resulting from aging
		Older adults’ acceptance of the frailty that may derive from aging
2	Issues associated with older adults’ social vulnerability	Situations of violence and neglect suffered by older adults
2	Issues associated with older adults’ social vulnerability	Older adults with frail bonds
3	Possibilities of care for older adults in Primary Healthcare	Team meeting or matrix support
		Home visit
		Individual and shared assistances
		Group approaches
		Older Adult Reception Room
		Comprehensive approach to older adults
		Care shared with the RASPI
4	Multidimensional Assessment of Older Adults in Primary Care (AMPI-AB)	Application of the AMPI-AB in the “Older Adult Room”
		AMPI-AB as an instrument that guides older adult care
		AMPI-AB as a political request
5	Nutritional care provided by the primary care unit to the older population	Management of Chronic Noncommunicable Diseases
		Referral to the dietitian
		Nutritional orientations
6	Unintentional weight loss in older adults: identification of the problem and possible causes	Identification of unintentional weight loss
		Causes of unintentional weight loss
		Mental health issues as the cause of unintentional weight loss
		Investigation and assessment of unintentional weight loss
7	Uniprofessional work and interprofessional teamwork in the care for older adults, including those with unintentional weight loss	Professionals’ specific action in older adult care
7		Interprofessional work and NASF team
8	Challenges in the care for older adults with unintentional weight loss	Absence or insufficiency of family support
		Older adults who live in single-person households
		Risk of food insecurity due to financial insufficiency
		Older adults’ non-adherence to care proposals
9	Work process challenges in the care for older adults, including those with unintentional weight loss	Health services professionals’ impatience towards older adults
		Limited time for assistances and fully booked schedules
		Difficulties with the physical structure in the health services
		Bureaucracy of the services that provide older adult care
		Weakening of the Healthcare Networks that provide older adult care
		Lack of specific instruments for the nutritional assessment of older adults
		Isolated action of the NASF team with older adults
10	Possibilities to address unintentional weight loss in older adults	Group approaches
		Case discussion
		Assessment, monitoring, and guidance on lifestyle
		Referral to Nutrition
		Nutritional supplementation
		Permanent Health Education
11	Importance of intersectoral work in older adult care and in addressing unintentional weight loss in this population	Home Meal Service for Older Adults (SADPI), “Meals on Wheels”
11		Intersectoral work in the care for older adults with unintentional weight loss

Themes		Categories
1	Identification of unintentional weight loss in older adults in PHC	Non-identification of unintentional weight loss
		Possibilities of identification of unintentional weight loss
		Causes of unintentional weight loss
2	Multidimensional Assessment of Older Adults in Primary Care (AMPI-AB)	Application of the AMPI-AB as a possibility of identification of unintentional weight loss
		Difficulties in the application of the AMPI-AB
		AMPI-AB as an instrument to collect data
3	Psychological suffering experienced by PHC professionals	Professionals’ perceptions of the limits and possibilities of their practice
3	Psychological suffering experienced by PHC professionals	Community Health Agents’ perceptions of mental health
4	Challenges in the care for older adults with unintentional weight loss	Problems in the work process
		Bureaucracy in the work process
		Productivity goals in PHC
		Older adults’ non-adherence to care proposals
		Social vulnerability
		Other challenges
5	Possibilities to address unintentional weight loss in older adults	Permanent Health Education
		Care provided by an interprofessional team
		Access to the services provided by the Municipal Department of Social Assistance and Development

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[1] Source: Prepared by the authors.