Corrective role of social representations and health practices to the national comprehensive care program for older adults

Abstract

Population aging in Cuba constitutes a demographic phenomenon that challenges the health system in its capacity for comprehensive response. The National Comprehensive Care Program for Older Adults (PAIAM) represents the main social policy instrument for this sector; however, its implementation at the community level reveals significant gaps between normative design and healthcare reality. This article aims to propose corrective actions to the PAIAM based on the diagnosis of social representations and health practices of older adults in the Flores Popular Council, Santiago de Cuba. A single case study with a mixed approach was employed, combining qualitative and quantitative techniques: participant and non-participant observation, semi-structured interviews with key informants, a questionnaire applied to 250 older adults, and document analysis. Theoretical and methodological triangulation allowed the identification of critical deficiencies in the dimensions of structure, process, and outcome of the community subprogram, evidencing that less than 60% of the evaluated indicators reach the required standard. It was identified that 78.2% of health providers have less than five years of experience in Primary Care, there is low coverage of dispensarization and periodic health examinations, and an absence of multidimensional evaluation. The article proposes a set of corrective actions articulated in three strategic axes: strengthening the institutional structure, optimizing care processes, and improving health outcomes. It is concluded that the incorporation of social representations as a permanent input for policy correction constitutes a fundamental methodological tool to adapt health interventions to the real logics of older adults, overcoming the assistance-based approach and promoting active, dignified, and healthy aging.