Needs of older adults with limited life conditions due to illness institutionalized in care homes in the Greater Metropolitan Area of Costa Rica

Abstract

Objective: to determine the needs of older adults (OA) institutionalized in care homes in the Greater Metropolitan Area (GAM) of Costa Rica and to propose the necessary changes and care processes for the integration of palliative care programs. Methodology: a mixed exploratory study was conducted by telephone survey of 33 of the 63 GAM's OA care homes, as well as semi-structured interviews with thirteen health professionals and eight institutionalized OA. A convenience selection sample of OA was interviewed based on the average of residents with diseases in limited life conditions or in palliative condition of the total number of residents, who had adequate cognitive capacity oriented in time, space and person. The needs of these people were determined according to the model of Maslow and Virginia Henderson. The needs of health professionals working in nursing homes were also explored. Results: in the 33 residences of the GAM, 1650 resident OA were registered, 233 of them were with disease in limited life condition or palliative condition (14.1%), on average 7.1 people per residence (mode:2).  Of the 8 OA interviewed, 50% determined to have some type of physical pain, it was possible to detect that all of them satisfied their social needs, generating links with the officials of the residences and the other residents, however, there was a limited relationship with their family group. They prioritized self-actualization needs focused on autonomy and physical independence to perform activities of daily living. They had the need to understand from the spiritual dimension that death is a natural process and is part of life. They did not manifest unsolved need for love and belonging. The health professionals of the residences interviewed indicate the need for training and changes in the infrastructure of the residences. Conclusions: the OA with diseases in limited living conditions of the GAM residences report feeling safe; however, there was evidence of a lack of sufficient human resources for care and the need to make a series of changes in their infrastructure.  As well as the implementation of continuing education programs in Palliative Care for professionals.