老年护理中的科学思考：其路径的可能性

Reflections on science in gerontological nursing: possibilities for its path

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Scientific knowledge in Brazilian gerontological nursing has its beginnings more than 50 years ago, specifically in the mid-1970s, in line with the worldwide movement to recognize the complexity of population aging and its challenges in the social, cultural, political and public health spheres. Since then, scientific production in this field has been related to the expansion of Stricto Sensu Graduate Programs, national legislation and international guidelines, denoting its growth and scientific maturity.

Following this trend, important scientific communication vehicles have published the knowledge produced about gerontological nursing in the country. Among them, a bibliometric study on scientific production about older adults in the Revista Brasileira de Enfermagem (REBEn - Brazilian Journal of Nursing) identified, between 2000 and 2006, the predominance of qualitative investigations, conducted in the hospital setting, highlighting the participation of Stricto Sensu Graduate Programs. It was also observed, in this time frame, the need to invest in research related to the nursing care process, from the perspective of health promotion and improvement of older adults’ quality of life(1).

Worldwide, another bibliometric study, carried out from 1900 to 2020, in the Web of Science database, identified 4,923 articles on the subject of gerontological nursing. The United States was the country with the highest scientific production (37.8%), followed by Canada (6.2%) and Australia (5.9%). In this ranking, Brazil occupied the tenth position (3.2%), being the first in Latin America. The most frequent themes were depression, malnutrition, education, Alzheimer’s disease and other dementias. Trends in more current research topics were also observed, such as COVID-19, locomotor syndrome, interprofessional practice, emergency nursing and public health(2). Still, in relation to this worldwide survey, an exponential growth in the number of publications was identified from 1990, with a maximum peak in 2018. The researchers compared the citation indicators of these articles with other bibliometric studies and found that scientific production in the area has been considered of interest to readers, however the citation rate has decreased in the last ten years(2).

Thus, when we observe the bibliometric indicators, the current production evidences the advance of scientific knowledge in gerontological nursing in recent decades. However, it is worth reflecting on the quality of the methodological approaches of the research produced in this field and, in the same way, if the themes are aligned with older adults’ health needs, nursing practices and professional training. Based on these reflections, we highlight two international documents that contribute to this discussion.

The Pan American Health Organization conducted a study to define nursing research priorities for the Regions of the Americas, guided by the concepts of universal access to health and universal health coverage. As a result of this work, six categories were listed, namely: 1) policies and education of human resources in nursing; 2) structure, organization and dynamics of health systems and services; 3) science, technology, innovation and public health information systems; 4) financing of health systems and services; 5) health policies, governance and social control; and 6) social studies in health(3).

In December 2020, the United Nations General Assembly established the global plan for the Decade of Healthy Aging (2021-2030). This initiative was based on previous guidelines, such as the goals of the Agenda for Sustainable Development in 2030, whose main objective is to achieve and support actions to build a society for all ages. To this end, four areas of action were defined: 1) change the way we think, feel and act in relation to age and aging; 2) ensuring that communities promote the capabilities of older people; 3) deliver person-centered and appropriate integrated care and Primary Health Care services for older adults; 4) provide access to long-term care for older adults who need it(4).

Considering the international documents, the specificities in elder health and the potential of the science of gerontological nursing in direct care, management, teaching and scientific production, we highlighted some reflections. Are researches based on gerontological nursing care addressing the different dimensions of the process of senescence and senility? Do studies have the potential to answer gaps that support the profession in empowering older adults and nursing professionals? Are innovative methods for gerontological care researched? Are information technology resources being used for gerontological nursing care? How are nursing professionals being prepared to care for this population? These questions and others, which can be aggregated, help us to collectively discuss the paths we should follow for safe and qualified nursing care for older adults.

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巴西老年护理方面的科学知识始于50多年前，特别是20世纪70年代中期，这与世界范围内认识到人口老龄化的复杂性及其在社会、文化、政治和公共卫生领域的挑战的运动相一致。从那时起，这一领域的科学成果与巴西老年护理领域的发展有关。Stricto Sensu 研究生课程、国家立法和国际准则，表明其成长和科学成熟。

随着这一趋势，一些重要的科学传播工具发表了国内老年护理方面的知识成果，其中，一项关于国内老年人科学成果的文献计量学研究Revista Brasileira de Enfermagem （REBEn -巴西护理杂志）确定，在2000年至2006年期间，在医院环境中进行的定性调查占主导地位，突出了以下方面的参与Stricto Sensu 研究生课程。在这段时间内，还观察到有必要从促进健康和改善老年人生活质量的角度投资于与护理过程相关的研究（1）.

在世界范围内，另一项从1900年到2020年在Web of Science数据库中进行的文献计量研究发现了4,923篇关于老年护理主题的文章。美国是科学产出最高的国家（37.8%），其次是加拿大（6.2%）和澳大利亚（5.9%）。在这一排名中，巴西位居第十（3.2%），在拉丁美洲排名第一。最常见的主题是抑郁症、营养不良、教育、阿尔茨海默氏病和其他痴呆症。还观察到更现代的研究主题的趋势，如COVID-19、运动综合征、跨专业实践、急救护理和公共卫生（2）。然而，在这项全球调查中，发现出版物数量从1990年开始呈指数增长，2018年达到最高峰。研究人员将这些文章的引用指标与其他文献计量学研究进行了比较，发现该领域的科学成果一直被认为是读者感兴趣的，但引用率在过去十年中有所下降（2）.

因此，当我们观察文献计量学指标时，当前的成果证明了近几十年来老年护理科学知识的进步。然而，值得反思的是该领域研究方法论的质量，以及以同样的方式，主题是否与老年人的健康需求、护理实践和专业培训相一致。基于这些反思，我们强调有助于这一讨论的两份国际文件。

泛美卫生组织进行了一项研究，以确定美洲区域护理研究的优先事项，这项工作以普及保健和全民医保概念为指导，结果列出了六个类别，即：1）护理人力资源政策及教育; 2）卫生系统和服务的结构、组织和动态; 3）科学、技术、创新和公共卫生信息系统; 4）保健系统和服务的资金筹措; 5）卫生政策、治理和社会控制;及6）健康方面的社会研究（3）.

2020年12月，联合国大会确立了"健康老龄化十年（2021 - 2030年）"全球计划，这一倡议基于此前的指导方针，如2030年可持续发展议程的目标，其主要目标是实现和支持建设不分年龄人人共享的社会的行动，为此明确了四个行动领域：1）改变我们与年龄和衰老有关的思考、感受和行为方式; 2）确保社区促进老年人的能力; 3）为老年人提供以人为本的适当综合护理和初级保健服务; 4）为有需要的长者提供长期护理服务（4）.

考虑到国际文献、老年人健康的特殊性以及老年护理科学在直接护理、管理、教学和科学成果方面的潜力，我们强调了一些思考。2基于老年护理学的研究是否针对衰老和衰老过程的不同维度？研究是否有潜力解决支持老年人和护理专业人员的专业差距？是否研究了老年护理的创新方法？信息技术资源是否用于老年护理？护理专业人员如何准备护理这一人群？这些问题和其他问题，可以汇总，帮助我们共同讨论为老年人提供安全和合格的护理应遵循的路径。

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