Keywords

1 Introduction

With the increase in life expectancy, interventions focusing on the quality of life of the elderly are necessary. Such interventions should be focused on the autonomy and independence of the elderly [1]. Moreover, with aging there can be a gradual decrease in functional capacity, leading to functional impairment and dependence [2].

From this perspective, in certain situations, some families decide to send their elderly to long-stay institutions due to the increase in the demand for elderly care, which implies in the context of nursing work [3]. Therefore, these institutions (LSIEs) can be public or private, and with or without financial help from the government [4]. Therefore, there is the need for care to be differentiated and provided by qualified professionals.

The institutionalized elderly, in general, present functional deficits, which are mainly evident in the dimensions of self-care, learning and mental functions, including cognitive impairments [5]. However, the challenges of multidisciplinary care to the elderly are to attend to their particularities, seeking to look at the elderly, i.e., in a multidimensional way [6].

According to the National Policy on the Health of the Elderly, to have an effective care practice for the elderly, it is necessary to have a multidimensional and interdisciplinary approach that considers the physical, psychological, and social factors that influence the health of the elderly, as well as the environment in which they live [7].

It is important to mention that health professionals working in homes for the aged need to understand how the aging process occurs to then define actions aimed at contemplating the institutionalized elderly in a comprehensive way, as well as assisting them with a focus on their autonomy [8]. In this sense, it is aimed to present, through scientific evidence, how the care for the elderly has been performed by the multi-professional team in long-stay institutions for the elderly.

2 Method

This is an integrative review, which presents a method that summarizes the scientific literature on a given topic to provide a greater understanding of the guiding question [9]. The development of this research followed the steps: formulation of the guiding question, sampling, extraction of data from primary studies, critical appraisal, analysis and synthesis of the review results, presentation of the integrative review [10]. We chose to adopt the referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

The guiding question was formulated using the Population/Patient/Problem - Interest - Context, Time (PICoT) strategy: What is the available scientific evidence on the care provided by the multi-professional team to elderly people residing in LSIEs in the last five years?

It is worth noting that the acronym “P” (target population) multi-professional team of caregivers of older people in LSIE, “I” (interest) care of people in LSIE, “Co” (context) LSIE, “T” last five years. To survey the articles in the literature, we chose to search the electronic databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed; Web of Science; Latin American and Caribbean Literature on Health Sciences (LILACS) and the Nursing Database (BDENF) via the Virtual Health Library (VHL). No studies were found in SciVerse Scopus and Scientifc Eletronic Library Online (Scielo). These databases were chosen because they cover national and international databases. This search, selection, and extraction of primary studies occurred in October 2021 by four independent reviewers.

The capture of the studies was made through the use of search descriptors from the Descriptors in Health Sciences (DECS) and the Mesch Terms combined in sequence with Boolean logic basis: AND or OR and by the following search strategy in all consulted databases: Elderly OR elderly person OR geriatrics OR, Long Stay Institution for the Elderly AND Patient Care Team OR Nursing Team OR nursing OR nursing care OR interdisciplinary communication OR patient care team AND patient comfort OR nursing care OR Comprehensive Health Care.

In this search step by using the descriptors, 43,776 articles were identified. Then, articles were selected according to the inclusion and exclusion criteria. Regarding the inclusion criteria, we considered original articles on the theme of care for the elderly in homes for the aged in Portuguese, English or Spanish, with a time frame of the last five years, available in full for free. Theses, dissertations and monographs, editorials, reflections, literature reviews (narrative, integrative, systematic, scoping, meta-analysis), experience reports as well as those that did not correspond to the theme of the study were excluded. From this perspective, duplicate studies were counted only once.

After applying these criteria, 43,005 articles were excluded due to not being written in Portuguese, English or Spanish, not having been published in the last five years, not being original research, not contemplating the care of elderly people in ILPI. Six duplicate articles were found. In this step, 771 articles were selected for title and abstract reading according to the guiding question, being inserted in the Endnote [11] reference manager.

Subsequently, the 771 identified articles were carefully read from the titles, abstracts, and keywords of the studies using the Rayyan tool without the researchers having access to the decisions of others to ensure the selection of publications related to the research question independently. In this step, the researchers were allowed access to the studies for the final consensus of the 101 titles and abstracts that presented divergences. After the researchers met, 42 articles were selected to be read in their entirety. Of these, 15 studies were selected and made up the corpus of the analysis.

The interpretation of the studies and the presentation of the synthesis of the knowledge of the studies eligible for the corpus of this review will be by means of the synoptic flowchart in the PRISMA model as shown in Fig. 1:

Fig. 1.
figure 1

Source: elaborated by the authors, 2021

Flowchart of article selection on the care provided by the multiprofessional team for residents of long-term care homes, Uruguaiana, Rio Grande do Sul, Brazil, 2021.

Full size image

For the extraction of the primary studies, a word table was used to construct the table containing article number, title, type of care, main results, and level of evidence. The critical evaluation of the primary studies was verified by the level of evidence, which establishes six categories: Level I - Evidence derived from systematic reviews or meta-analyses of relevant clinical trials; Level II - Evidence derived from at least one well-designed randomized controlled trial, moderate evidence; Level III - Well-designed clinical trials without randomization; Level IV - Well-designed cohort and case-control studies; Level V - Systematic review of descriptive and qualitative studies, weak evidence; Level VI - Evidence derived from a single descriptive or qualitative study; Level VII - Authority opinion or expert committee report (Fineout et al., 2011). The fifteen articles included in the corpus of the analysis were synthesized in a synoptic chart containing the title, study objective, care provided, and level of evidence (Table 1).

Table 1. Summary of primary studies on education and care technologies used by the multiprofessional team for residents of ILPIs, Uruguaiana, Rio Grande do Sul, Brazil, 2021
Full size table

3 Results and Discussion

The care identified in the corpus was performed by caregivers and nursing staff members to the institutionalized elderly, potentially triggering a small risk of bias in the included studies. The following were identified as care performed by the multidisciplinary team to the elderly person residing in a long-stay institution: advance directives [14, 21, 26], advance care planning [14]; supportive care for physical comfort of end-of-life patients such as pain monitoring, basic care, and promotion of rest [18]; advanced care planning, symptom management, psychosocial support, spiritual care, focus on rehabilitative care, and continuity of comfort care [13]; educational intervention to improve palliative care [15]; care planning and changes in care delivery and facilitated communication [16], person-centered care model [17]; educational program, Intensive medical care; Basic medical care; Comfort care [20]; Care planning meeting and care plan recorded in the patient’s electronic medical record [22]; Person-centered care, non-pharmacological measures, person-centered care, bonding, communication for the care of the institutionalized elderly with dementia [24]. Nursing diagnoses for institutionalized elderly [12]. The Steps to Successful Caregiving Program and Advance Care Planning [26].

Advance Directives are a set of wishes, previously and expressly expressed by the patient, about care and treatment they wish to receive, when they are unable to express, freely and autonomously, their will [27]. From this perspective, advance care planning is associated with the fulfillment of advance directives of will. From this perspective, knowing the wills and recording the advance directives of the elderly helps in the planning of care for the elderly resident in LSIEs, since nursing homes are among the most common places of death in many countries [23].

A study of three hundred and twenty-two nursing homes in Belgium, Finland, Italy, the Netherlands, Poland, and England concluded that the quality of dying and quality of end-of-life care in nursing homes in the countries studied are not optimal [23]. End-of-life care can be planned with comfort measures. From this perspective, advance care planning and advance directives are presented as resources to optimize humanized patient-centered care [28] and safeguard the autonomy and dignity of the elderly.

Both the construction of advance directives and advanced care planning necessitate talking about end-of-life care with professionals and family members. To this end, a study developed in long-stay institutions with 238 elderly residents in Hong Kong and 87 in Taiwan found that 34 elderlies in Hong Kong and 16 in a study developed in long-stay institutions with 238 elderly residents in Hong Kong and 87 in Taiwan had participated in discussions about end of life. When drafting advance directives only seven in Hong Kong and eleven in a study developed [26].

In Boston, advanced care planning, construction, and compliance with Advance Directives requires knowing the wishes of seniors with dementia residing in long-stay institutions. Under this analysis, understanding the differences in intensive medical care, basic medical care, and comfort care for compliance and respect of wishes is necessary to talk about in addition to making it understandable to care seekers both formal and informal, and counseling of proxies that includes an explanation of this general poor prognosis, may shift the direction of care toward comfort [21].

Supportive care for the physical comfort of end-of-life patients such as pain monitoring, basic care, and promotion of rest are important care, but there is insufficient focus on the spiritual and psychosocial comfort of end-of-life patients [18]. It is worth noting that stubborn attempts to cure tend to lead to artificial prolongation of life, loss of personal autonomy and human dignity, triggering discussions about supposed rights of the patient to manifest their will in situations of incapacity [29].

New technological resources allow the adoption of disproportionate measures that can prolong the suffering of the patient with a disease considered terminal, without bringing him benefits, and these measures may have been rejected in advance by him [29]. In summary, the advance directives of the elderly in this study contained refusal to care that bar therapeutic obstinacy and the educational video content favored the acceptance of comfort care in the elderly who watched the video and increased the agreement between the wishes and the documentation of advance directives [14].

It is further complemented that comparing end-of-life care in long-term care facility residents with advanced dementia before and after an educational intervention aimed at improving palliative care concluded that effective in initiating a change in practices relevant to the quality of palliative care among patients with advanced dementia in Italy [15]. There is a gap in the care of the elderly person with dementia who resides in a long-stay institution [3]. Advance care planning has resolutive potential in older adults with advanced dementia. In this context, video had no effect on preferences, non-hospitalization, or costly treatments among residents with advanced dementia, but increased guidelines for withholding tube feeding [21]. There is a need for more studies on the needs and conditions of care in institutionalized elderly to allow, with greater precision, the development of models of care for the elderly [30].

The relevance of educational actions to modify care practices for the elderly in long-stay institutions is perceived. Under this approach, an educational program, in Belgium, with six stages: advance care, planning with residents and families; assessment, care; planning, and review of resident needs and problems; coordination of care via monthly multidisciplinary palliative care review meetings; high-quality palliative care with a focus on pain and depression; care in the last days of life and care after death [19].

4 Conclusion

The studies found focused on the care of the elderly person with a life-threatening illness. In view of the terminality of life, further studies are still needed on the wishes of the elderly who live in long-stay institutions about the process of death and dying well. To this end the advance care plan as well as advance directives must be recorded and applied in the multiple contexts that the elderly person goes through. The multidisciplinary team must be trained about palliative care, life threatening diseases, comfort care to avoid therapeutic obstinacy.

It is perceived that educational actions on action planning, management of complex cases, communication, bonding, person-centered model, use of the systematization of nursing care should be further encouraged since the teaching of health graduations. One should consider continuing education for formal and informal caregivers of the elderly in long-stay institutions.

Care focused on rehabilitation should be inserted to assist in active aging and comfort measures. In the context of the long-stay institution, no studies on active aging and care to maintain quality of life were found.

The results of this study should guide subsidies to deepen the construction of knowledge about human aging in the context of long-stay institutions in the world, considering cultural, social, physiological, psychological aspects in the construction of public health and social policies. All these considerations should have the potential to provide opportunities, in the future, opportunities for teaching, research and extension actions to qualify the care in the process of life, death and dying of the institutionalized elderly.

Therefore, this study is limited by the time frame of the last five years and the analysis and comparison of different cultures should be taken into consideration, since it was not possible to identify studies from all continents.