Developing a management plan for healthcare for the elderly combined with psychoeducational action: A case study

Abstract

This study aimed to perform a case report in order to develop a management plan of care to be shared with the elderly and health staff of a School Health Center. The aim is also conducting a psychoeducational action in relation to chronic diseases presented by the elderly. This case report is the result of intervention in Primary Care, held in an academic health center managed by the Hospital Santa Casa de Misericordia of São Paulo. We used the Geriatric Depression Scale (15-item version), we used a protocol developed by the group of teachers from the Bachelor of Gerontology EACH-USP, called Gerontological Care Plan and a complementary tool for assessing network of social and family support, the Minimum Map of Social Relations of Older Persons. After completion of four home visits, we detected the need to reactivate the relationship with the institution in relation to their routine needed to reduce your downtime, as the Basic Activities of Daily Living, we found that needed to restore some degree of autonomy, the user showed to have good social support network. The patient agreed to resume treatment at the institution, through the mediation of the trainees; psychoeducative actions were performed on diseases, medications, and use public services, the ignorance of these issues were factors that contributed to nonadherence to treatment. We prepared an itinerary of activities that the user could accomplish. The patient is awaiting contact from the team and began to perform cognitive activities.