Summary
This program is aimed at people aged 50 or over, carried out in the metropolitan region of Belém do Pará, Amazon, Brazil, with the objective of providing comprehensive health care, contributing to the maximization of the functional ability of the participants. AHAP continuously serves around 4,000 people in 3 cities and 12 different points. More than 95% are people aged 60 and over. Upon admission, all undergo comprehensive assessment and clinical-functional stratification, with in-depth multidimensional assessment for participants with declines in intrinsic capacity or with present warning signs. Each participant is assisted by activities according to their needs, at different levels of care, essentially primary and secondary. Assessments rely on validated instruments and therapeutic support. The activities provided to the participants cover different profiles, such as: geriatric follow-up, multicomponent physical exercise, cognitive training, nutritional follow-up, speech therapy, group and individualized psychotherapy, arts and health activities such as theater and choir, in addition to social and cultural activities such as artistic presentations and sports games. The program also has specific clinical protocols that address some geriatric syndromes such as sarcopenia, frailty and cognitive impairment. For people living with Parkinson's Disease and dementia, there are specific comprehensive care programs and care plan with established management. The evaluations are periodic with attention in a longitudinal way.
Planning and Implementation
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What was the challenge you were trying to address?
Two are highly relevant: the qualification of the workforce, which in general is not qualified for comprehensive and interdisciplinary care, which creates the need for structured educational strategies, impacting the quality of care; another relevant challenge is the remuneration model, in which a large part of our participants are assisted via partnership with public management, generating some challenges in terms of the health paradigm, where there is a need to focus on functionality and not on the disease, as has been the funding model historically. Finally, the integration of the support network for older people is challenging, as it demands responses and public-private partnerships and organized civil society, various social actors with different interests, which need to be aligned with the interests of older people.
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Who were you trying to impact?
Older people in general, Older people with chronic health conditions or disability, Older people with vulnerabilities, Both older and younger people
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What sectors were you targeting?
Health, Information and Communication
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Who else was involved?
Government
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How did older people participate?
Older people were consulted during the planning process
Lessons learned
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Please describe how collaboration worked in your initiative.
Collaboration takes place through a service partnership for users of public and private systems. Older people were involved through annual meetings and thematic meetings, being heard in their considerations and being informed about what AHAP was providing, in terms of benefits for them.
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What was the impact of your initiative on older people, their families, and/or their communities?
The impacts are diverse, but with greater relevance for the change in the health paradigm, placing the capacity of older people as a guide, this makes the actions allow the participation of the diverse clinical and functional profiles, raising self-esteem and enabling the participation in meaningful activities. This improvement in quality of life is also reflected in their general health and in the burden of care that the family presents, a double impact of the improvement in the functionality of older people. Participants perceive and propose new experiences, giving new meaning to life.
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What issues did you face, and how did you address them?
Undoubtedly, the biggest challenge is the qualification of the workforce to understand the heterogeneity that characterizes the aging process. This demands efforts, because without the technical qualification of professionals, strategies are affected, as well as care quality is compromised. At this point, some initiatives were established: partnerships for graduate courses in gerontology; training for older people's health interventions; creation of the corporate university with specific courses on human aging; and the creation of the Cynthia Charone College, with an undergraduate course in health management and a postgraduate course in gerontology.
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What lessons did you learn from implementing this initiative?
1) Older people have potential and need to be stimulated; 2) Health is an approach that goes beyond the scope of an isolated action; 3) Need for change in educational paradigms, which need to consider healthy aging as an educational policy.
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Do you have any other reflections you would like to share?
The UN Decade of Healthy Aging contributes substantially to the understanding of the policy aimed at the implementation of healthy aging strategies, systematically guiding the elaboration of the health care scope (assessment, stratification, assistance and follow-up). Guidance for the 4 areas of action contributes to the formulation of AHAP strategies, through the focus on which to act. Comprehensive care is for the AHAP the most covered, but it helps and is helped by the other areas in the design of the strategy. In addition, understanding whether the AHAP meets the guidelines proposed by the Decade, allows you to see how much we are aligned with the policies and healthy aging that have been developed globally.