Elderly caregivers living in urban, rural and high social vulnerability contexts.

OBJECTIVE Comparing the differences in the sociodemographic, care and health profiles of elderly caregivers of the elderly living in urban, rural, and high social vulnerability contexts. METHOD A cross-sectional study developed with elderly caregivers enrolled in the Family Health Units of a municipality in the interior of São Paulo. Household interviews and evaluations were conducted on: Activities of Daily Living (ADL), self-reported pain, frailty, cognition, life satisfaction, family functionality, burden, stress and hope. RESULTS A total of 343 elderly caregivers of elderly individuals participated in the study, of which 55.1% lived in an urban context, 23.6% in rural areas, and 21.3% in a context of high social vulnerability. The majority of elderly caregivers were women across the three contexts, with a median age of 67 years and caring for their spouse. Caregivers from regions of high social vulnerability had lower education level, received less emotional and material help to care, were less satisfied with life, more fragile, in more cognitive decline, had worse family functionality and a lower level of hope when compared to caregivers of urban and rural contexts (p≤0.05). However, caregivers from areas of high vulnerability were more independent for ADL. CONCLUSION Professionals working in Primary Care should consider these differences when planning interventions aimed at the specific group of caregivers.

Cognition and chronic pain: an analysis on community-dwelling elderly caregivers and non-caregivers.

BACKGROUND: In recent years there has been an increasing number of elderly people who care for another elderly person in the same household. These elderly people are more susceptible to overload and the presence of chronic pain, while pain can negatively influence cognitive variables. OBJECTIVE: To compare the performance and cognitive processing of elderly caregivers and non-caregivers with and without chronic pain. METHODS: This was a cross-sectional study carried out among 149 elderly people divided into four groups that were matched according to sex, age and schooling. The tests used were a numerical pain assessment scale, the Brief Cognitive Screening Battery (BCSB), Addenbrooke's Cognitive Examination (ACER-R) and cognitive processing through event-related potentials (P300). RESULTS: Statistically significant differences between participants with and without chronic pain were found with regard to attention/orientation (p=0.045) and visual-spatial skills (p=0.017), and in the total score (p=0.033). In the pain-free group, the caregivers showed better results than the non-caregivers. There were no effects between subjects or interactions (caregiving and pain factors) either on P300 amplitude or on P300 latency. CONCLUSION: In general, it was observed that pain-free individuals presented better performance. No relationship was observed between the factors care and pain regarding cognitive performance.

Association between cognitive impairment and criteria for frailty syndrome among older adults.

OBJECTIVE: The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. To analyze the association between cognitive impairment and the criteria for frailty. METHODS: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. RESULTS: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. CONCLUSION: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

Elderly caregivers of other elderly living with and without children: burden, optimism and coping strategies.

This article aims to compare level of burden, optimism and coping strategies among elderly caregivers of other elderly individuals who reside with and without children. A cross-sectional study was with a sample of 301 elderly caregivers of elderly Brazilians seen in primary health care. Among the 301 caregivers interviewed, 44 resided with children and 257 did not. Evaluations involved the administration of the Zarit Burden Inventory, Spirituality Scale (optimism) and Coping Strategies Inventory. Either the Student's t-test or the Mann-Whitney U-test was used for the comparisons between the two groups. Burden level was significantly higher among elderly caregivers who resided with children (p = 0.01). No significant differences were found with regard to optimism. Elderly caregivers who did not reside with children reported significantly greater use of coping strategies focused on the expression of negative emotions (p < 0.01), religiosity (p < 0.01) and the inhibition of negative emotions (p = 0.01). The elderly caregivers of other elderly individuals who resided with children had a higher level of burden and used coping strategies less than those who did not reside with children.

Comparison of cognitive performance and aspects of the care context in elderly caregivers in Brazil: A follow-up study.

Cognitive health is important for the quality of life and well-being of elderly caregivers. Cognitive impairments can negatively affect the ability to care for oneself and others. OBJECTIVE: To compare cognitive performance and aspects of the care context in elderly caregivers of older adults in a three-year follow-up investigation. METHODS: A longitudinal study was conducted of 61 elderly caregivers treated in primary care in a city in the interior of the state of São Paulo with data collected in 2014 and 2017. Sociodemographic characteristics, the care context, cognition, performance for activities of daily living, burden and depressive symptoms were collected in individual interviews. Data analysis was performed to compare categorical and continuous variables. RESULTS: Significant increases were found between baseline and follow-up for the language domain score of the cognitive evaluation (p=0.024), receipt of material support (p=0.020), time providing care (p=0.045) and dependence of elderly care recipient for basic activities of daily living (p=0.042). CONCLUSION: Elderly caregivers performed better on the domain of language, received more material/financial support, spent more time on care and reported greater dependence of the elderly care recipient.

A saúde cognitiva é importante para a qualidade de vida e bem-estar dos cuidadores idosos. O comprometimento cognitivo pode afetar negativamente a capacidade de cuidar de si e dos outros. OBJETIVO: Comparar o desempenho cognitivo e os aspectos do contexto do cuidado em idosos cuidadores de idosos em uma de acompanhamento de três anos. MÉTODOS: Trata-se de um estudo longitudinal com medidas em 2014 e 2017, realizado com 61 cuidadores idosos cadastrados na atenção primária de um município do interior do Estado de São Paulo. Características sociodemográficas, contexto do cuidado, cognição, desempenho nas atividades da vida diária, sobrecarga e sintomas depressivos foram coletados em entrevistas individuais. A análise dos dados foi realizada para comparar variáveis categóricas e contínuas. RESULTADOS: Foram encontrados aumentos significativos entre a linha de base e o acompanhamento do escore no domínio da linguagem da avaliação cognitiva (p=0,024), receber ajuda material (p=0,020), tempo de cuidado (p=0,045) e dependência do idoso em relação às atividades básicas da vida diária (p=0,042). CONCLUSÃO: Os cuidadores de idosos tiveram melhor desempenho no campo da linguagem, passaram a receber mais apoio material / financeiro, experimentaram aumentos no tempo gasto no cuidado e na dependência do idoso.

Factors associated with the development of diabetes mellitus in older caregivers.

OBJECTIVE: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. METHOD: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. RESULTS: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). CONCLUSION: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.

Senior caregivers in different housing arrangements: comparison of health and care profiles. / Idosos cuidadores em diferentes arranjos de moradia: comparação do perfil de saúde e de cuidado.

OBJECTIVE: To compare the physical, cognitive and psychological health profile and care context of elder caregivers of the elderly in different home arrangements. METHOD: Quantitative and transversal study with elderly caregivers. The sample consisted of 349 caregivers divided into mono-gerational, bi-gerational and multi-generational housing arrangements. Sociodemographic and care questionnaires and physical, cognitive and psychological health assessment instruments were used for evaluation. The Chi-square distribution and Mann Whitney's U were used for data analysis. RESULTS: Elderly caregivers in mono-generational homes were significantly older and independent for instrumental activities of daily living. In multigenerational households there was a significantly greater proportion of caregivers who considered family income insufficient, received emotional help, and felt overwhelmed and stressed. CONCLUSION: The differences identified between the groups can contribute to the elaboration of care policies and for the health promotion of elderly caregivers.

Brief version of Zarit Burden Interview (ZBI) for burden assessment in older caregivers.

The degree of burden related to the demands of daily care provided to a dependent older adult is important to evaluate due to the negative influence exerted on caregivers' physical and psychological health. OBJECTIVE: To analyze the validity of the 12-item version of the Zarit Burden Interview administered to older caregivers of community-dwelling older dependent individuals and suggest a cut-off score based on quartiles. METHODS: Three hundred and forty-one older caregivers (mean age: 69.6±7.1 years; 76.8% women) registered with primary healthcare centers were evaluated using the ZBI-12. Additional evaluations addressed stress (Perceived Stress Scale [PSS]), depressive symptoms (Geriatric Depression Scale [GDS]) in the older caregivers and the degree of dependence of the older care recipients (Lawton and Brody [L&B]). RESULTS: Cronbach's alpha demonstrated very good internal consistency (α=0.81). Correlations were found between all ZBI-12 items and overall score on the PSS (r=0.53; p<0.01). GDS (r=0.43; p<0.01) and L&B (r= -0.23; p<0.01) scale scores. The PSS demonstrated the strongest correlation with ZBI-12 score and proved to be the standard reference. Based on caregivers with a higher degree of stress considering the PSS score quartiles, a cut-off score of 13 points on the ZBI-12 is suggested for screening burden in community-dwelling older caregivers, but should not be assumed as normative data. CONCLUSION: The ZBI-12 can be considered valid for evaluation of burden in clinical practice and research as a fast, efficient option for screening burden among older caregivers of community-dwelling older adults.

O grau de sobrecarga relacionado às demandas do cuidado diário ao idoso dependente é uma importante medida a ser avaliada por influenciar de modo negativo na saúde física e psicológica do cuidador. OBJETIVO: Analisar a validade da Zarit Burden Interview versão 12 itens (ZBI-12) em idosos cuidadores de idosos da comunidade e sugerir nota de corte de acordo com quartis. MÉTODOS: Foram avaliados 341 idosos cuidadores (M=69,6±7,1 anos; 76,8% feminino) cadastrados na Estratégia Saúde da Família utilizando a ZBI-12. Adicionalmente, foram realizadas avaliações de estresse (Escala de Estresse Percebido [PSS]) e de sintomas depressivos (Escala de Depressão Geriátrica [GDS]) no idoso cuidador, e avaliada a dependência dos idosos receptores de cuidado (Escala de Atividades da Vida Diária de Lawton e Brody [L&B]). RESULTADOS: As análises por alfa de Cronbach mostraram consistência interna de α=0.81. Foi encontrada correlação entre todos os itens da ZBI-12 e do escore geral com os escores de PSS (r=0,53; p<0,01), GDS (r=0,43; p<0,01) e L&B (r= -0,23; p<0,01). Especificamente, a PSS obteve associação mais estreita com o escore da ZBI-12, se mostrando o padrão-referência. Considerando a divisão por quartil da PSS, para os cuidadores mais estressados, sugere-se nota de corte de 13 pontos na ZBI-12 para rastreio da sobrecarga em idosos cuidadores da comunidade em geral. CONCLUSÃO: A ZBI-12 apresentou boa consistência interna e pode ser considerada válida nessa população. Espera-se que o instrumento auxilie na avaliação da sobrecarga na prática clínica e na pesquisa e se torne uma alternativa de aplicação rápida e eficiente no rastreio de sobrecarga entre cuidadores mais velhos na comunidade.

Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms.

OBJECTIVE: to investigate the association between frailty, loneliness and depressive symptoms of elderly caregivers. METHOD: a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried's frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables). RESULTS: there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility. CONCLUSION: elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.

Educação em neurociência da dor e Pilates para idosos com dor lombar crônica: ensaio clínico controlado randomizado / Educación en neurociencia del dolor y pilates para personas mayores con dolor lumbar crónico: ensayo clínico controlado aleatorizado / Pain neuroscience education and pilates for elderly with chronic low back pain: randomized controlled clinical trial

Resumo Objetivo Avaliar o efeito da Educação em Neurociência da Dor aliada ao Pilates na catastrofização da dor em idosos com lombalgia crônica inespecífica. Métodos Ensaio clínico controlado randomizado com 80 participantes divididos em dois grupos: Grupo Pilates combinado com Educação em Neurociência da Dor - GPE, e Grupo Pilates- GP. As medidas foram feitas no início, pós-intervenção e após seis meses (seguimento). O protocolo incluiu três sessões individuais de Educação em Neurociência da Dor (END) de 30 min (somente para o GPE) e, posteriormente, oito semanas de Pilates (duas vezes por semana, 50 min/sessão, para ambos os grupos). Resultados Comparações das diferenças pré-pós e de seguimento em catastrofização, cinesiofobia, incapacidade e intensidade da dor não mostraram evidências de que a END teve efeitos adicionais em comparação com os exercícios isoladamente. Uma vantagem provável do presente protocolo de END foi que as taxas de abandono para o GPE foram menores do que para o GP, mostrando que a END aumentou a adesão ao exercício. Conclusão A relevância clínica do estudo é que o Pilates é uma intervenção segura para idosos com dor lombar crônica inespecífica e a END pode aumentar a adesão ao exercício nessa população.

Resumen Objetivo Evaluar el efecto de la educación en neurociencia del dolor como aliada a la práctica de pilates en la catastrofización del dolor en personas mayores con lumbalgia crónica inespecífica. Métodos Ensayo clínico controlado aleatorizado con 80 participantes divididos en dos grupos: Grupo pilates combinado con educación en neurociencia del dolor (GPE) y Grupo pilates (GP). Las medidas se realizaron antes y después de la intervención y después de seis meses (seguimiento). El protocolo incluía tres sesiones individuales de educación en neurociencia del dolor (END) de 30 minutos (solo para el GPE) y, posteriormente, ocho semanas de pilates (dos veces por semana, 50 min/sesión, para ambos grupos). Resultados La comparación de las diferencias antes-después y de seguimiento en catastrofización, kinesiofobia, incapacidad e intensidad del dolor no mostró evidencias de que la END tenga efectos adicionales en comparación con los ejercicios de forma aislada. Una ventaja probable del presente protocolo de END fue que los índices de abandono del GPE fueron menores que en el GP, lo que demuestra que la END aumentó la adherencia al ejercicio. Conclusión La relevancia clínica del estudio es que pilates es una intervención segura para personas mayores con dolor lumbar crónico inespecífico y la END puede aumentar la adherencia al ejercicio en esta población. Registro Brasileiro de Ensaios Clínicos: U1111-1190-673

Abstract Objective Verify the effect of Pain Neuroscience Education combined with Pilates on catastrophizing in older people with chronic non-specific low back pain. Methods A randomized controlled clinical trial with 80 participants divided into two groups: Pilates combined with Pain Neuroscience Education Group - PEG, and Pilates Group - PG. The measurements were taken at baseline, post-intervention, and after 6 months (follow-up). The protocol included three individual 30-min PNE sessions (only for PEG) and, after that, 8 weeks of Pilates (twice a week, 50 min/session, for both groups). Results Comparisons of pre-post and follow-up differences in catastrophizing, kinesiophobia, disability, and pain intensity showed no evidence that PNE had any additional effects when compared with exercises alone. One likely advantage of the present PNE protocol was that the dropout rates for the PEG group were lower than for the PG group, showing that PNE has increased exercise adherence. Conclusion The clinical relevance of the study is that Pilates is a safe intervention for older people with non-specific chronic low back pain, and that PNE can increase adherence to exercise for this population. Brazilian Clinical Trials Registry: U1111-1190-673

Descriptive data in different paper-based cognitive assessments in elderly from the community Stratification by age and education.

Cognitive aging is dynamic and heterogeneous in elderly, thus adequate tools such as paper-based tests are relevant to describe the cognitive profile of this population. OBJECTIVE: To describe different paper-based cognitive assessments tests in elderly people stratified by age and education. METHODS: A cross-sectional study of 667 elderly (≥60 years) living in the community was conducted. Sociodemographic information was collected. Global cognition was assessed by the Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini Addenbrooke's Cognitive Examination (M-ACE) and Mini-Mental State Examination (MMSE). The data were analyzed using descriptive statistics, the t-test and Pearson's Correlation Coefficient. RESULTS: The findings showed a predominance of women (53.8%), mean age of 71.3 (±7.7) years and 3.6 (±3.5) years of education. The best global cognitive performance and cognitive domain assessment scores were found in the group with higher formal educational level. Each year of education was associated with an increase of up to 10% in scores on the M-ACE and MMSE and up to 11% in ACE-R scores. The mean values of the scores varied according to age, where the 60-69 years group had better scores than other age groups. The correlation matrix between the cognitive tests showed that near perfect correlations (r=1) were frequent in the subgroup with higher education. CONCLUSION: Younger elderly and those with higher educational level had greater global and domain scores. This study describes the scores of elderly for different strata of education and age. In practice, it is important to choose the most suitable screening instrument, considering the characteristics of the elderly.

O envelhecimento cognitivo é dinâmico e heterogêneo, ressaltando a importância de ferramentas adequadas para avaliação da função cognitiva na população idosa brasileira. OBJETIVO: Descrever os dados estratificados em idade e escolaridade do desempenho de idosos em diferentes testes cognitivos baseados em papel. MÉTODOS: Estudo transversal com 667 idosos da comunidade. Informações demográficas foram coletadas. A cognição global foi mensurada pelo Exame Cognitivo de Addenbrooke - Revisado (ACE-R), Mini Exame Cognitivo de Addenbrooke (M-ACE) e pelo Mini Exame do Estado Mental (MEEM). Os dados foram analisados por meio da estatística descritiva, teste T e pelo Coeficiente de Correlação de Person. RESULTADOS: A maioria dos idosos era mulher (53,8%), as médias foram 71,3 (±7,7) anos para idade e 3,6 (±3,5) anos para escolaridade. O melhor desempenho cognitivo global e nos domínios foram nos idosos com maior nível educacional. Cada ano de escolaridade esteve associado com o melhor desempenho em até 10% nos escores de M-ACE e MEEM e até 11% nos escores de ACE-R. Os valores das médias dos escores variaram entre faixas etárias, sendo que o grupo 60-69 anos apresentou melhor desempenho. A matriz de correlação entre os testes cognitivos mostrou que as correlações próximas à perfeição (r=1) aconteceram frequentemente no subgrupo mais escolarizado. CONCLUSÃO: Idosos mais jovens e com maior escolaridade apresentaram melhores escores cognitivos. Esse estudo oferece uma descrição dos dados dos testes cognitivos considerando faixa etária e escolaridade. Na prática, é consistente que a escolha dos testes para o rastreio cognitivo considere as características da população idosa.

Factors associated with cognitive performance in elderly caregivers.

OBJECTIVE: To explore the socioeconomic, demographic and psychosocial factors associated with cognitive performance in elderly caregivers from Brazil. METHODS: We evaluated 351 Brazilian elderly caregivers attending primary healthcare services regarding sociodemographic and care variables. Addenbrooke's Cognitive Examination-Revised (ACE-R) domains of orientation/attention, memory, verbal fluency, language and visuospatial were used as dependent variables in the Tobit model. RESULTS: Literacy and family income were positively associated with all ACE-R domains. Age, gender, time of care (days/week) were negatively associated with some cognitive domains. Moreover, receiving emotional help and the level of hope were positively associated with specific domains. DISCUSSION: The results may be useful for planning interventions aimed at elderly caregivers in order to prevent deficits in the different cognitive domains.

On the use of the P300 as a tool for cognitive processing assessment in healthy aging: A review.

Changes in patterns of performance for the cognitive functions of memory, processing speed, and focused attention are expected in old age. OBJECTIVE: The main goal of this systematic review was to analyze the use of ERP in healthy elderly in studies evaluating the P300 components. METHODS: A systematic review was carried out based on recommendations for nursing research on the databases LILACS, PsycINFO, PubMed, SCOPUS and Web of Science. RESULTS: 26 studies involving 940 healthy elderly were identified, most of which sought to identify and determine the influence of age on the P300. CONCLUSION: Although there is consensus in the literature that P300 latency is significantly longer in elderly with psychiatric disorders compared to healthy elderly, it was not possible to conclude P300 associations with gender, education and other cognitive tests.

São esperadas mudanças nos padrões de desempenho nas funções cognitivas de memória, velocidade de processamento e atenção concentrada durante o processo de envelhecimento. OBJETIVO: O objetivo principal desta revisão sistemática é analisar o uso de ERP em idosos saudáveis nos estudos que avaliaram os componentes do P300. MÉTODOS: Realizou-se uma revisão sistemática com recomendações de estudo para enfermagem nos bancos de dados LILACS, PsycINFO, PubMed, SCOPUS and Web of Science. RESULTADOS: Foram identificados 26 estudos com 940 idosos saudáveis, a maioria procurava identificar e encontrar a influência da idade no P300. CONCLUSÃO: Embora haja consenso na literatura de que em idosos com transtornos psiquiátricos a latência P300 é significativamente maior, em relação aos idosos saudáveis não foi possível concluir as associações P300 com gênero, escolaridade e outros testes cognitivos.

Stress and optimism of elderlies who are caregivers for elderlies and live with children.

Objective: to evaluate the relation between stress and optimism of elderlies who are informal caregivers for elderlies and live with children. Method: cross-sectional study on 50 elderlies who provide care to elderlies, live with children, and are registered in the primary health care. The interviews occurred in the participant's residence and we evaluated characteristics of the care-dependent elderly and of the children, sociodemographic characteristics, stress through the Perceived Stress Scale and optimism through the Pinto and Pais-Ribeiro Spirituality Scale, in the elderly caregiver. For statistical analysis we used the Spearman correlation test. Results: the mean level of stress was 23.9 points and of optimism was 3.3 points. Correlation analysis showed that the higher the level of optimism the significantly lower the level of perceived stress of elderlies who provided care to elderlies and lived with children. Conclusion: inversely proportional correlation was identified between stress and optimism.

Objetivo: avaliar a relação entre estresse e otimismo de idosos cuidadores informais de idosos e que residem com crianças. Método: estudo transversal com 50 idosos cuidadores de idosos que residem com crianças e são cadastrados na atenção básica. As entrevistas ocorreram no domicílio do participante e foram avaliadas características do idoso dependente de cuidados e das crianças, características sociodemográficas, estresse por meio da Escala de Estresse Percebido e o otimismo por meio da Escala de Espiritualidade de Pinto e Pais-Ribeiro, no idoso cuidador. Para análise estatística foi utilizado o teste correlação de Spearman. Resultados: o nível médio de estresse foi de 23,9 pontos e de otimismo foi de 3,3 pontos. A análise de correlação mostrou que quanto maior o nível de otimismo significativamente menor foi o nível de estresse percebido dos idosos cuidadores de idosos que residiam com crianças. Conclusão: foi identificada correlação inversamente proporcional entre estresse e otimismo.

The evaluation of perceived stress and associated factors in elderly caregivers.

OBJECTIVE: Factors associated with perceived stress in older people have been studied previously, but this investigation in elderly caregivers is still scarce in the literature. Our aim was to assess factors that are associated with perceived stress in a sample of elderly caregivers. METHODS: This cross-sectional investigation assessed 341 elderly caregivers who cared for a dependent older person at home. They answered questionnaires including the Perceived Stress Scale (PSS-14), a sociodemographic and care characterization, health and cognitive status, and burden related to care. RESULTS: The mean score in PSS-14 was 18.5±9.9. Self-reported pain, difficult to sleep, "very poor/poor" self-rated health, impaired cognitive status, more people living in the house and higher levels of burden related to care were associated with higher levels of perceived stress. DISCUSSION: The results highlight the importance of the development of stress-reduced interventions directed to elderly caregivers focusing on the associated variables in this study. Attention should be given to cognitive decline prevention and strategies to avoid or reduce burden in the elderly caregivers.

Cognition and chronic pain: an analysis on community-dwelling elderly caregivers and non-caregivers / Cognição e dor crônica: uma análise em idosos cuidadores e não cuidadores residentes na comunidade

ABSTRACT Background: In recent years there has been an increasing number of elderly people who care for another elderly person in the same household. These elderly people are more susceptible to overload and the presence of chronic pain, while pain can negatively influence cognitive variables. Objective: To compare the performance and cognitive processing of elderly caregivers and non-caregivers with and without chronic pain. Methods: This was a cross-sectional study carried out among 149 elderly people divided into four groups that were matched according to sex, age and schooling. The tests used were a numerical pain assessment scale, the Brief Cognitive Screening Battery (BCSB), Addenbrooke's Cognitive Examination (ACER-R) and cognitive processing through event-related potentials (P300). Results: Statistically significant differences between participants with and without chronic pain were found with regard to attention/orientation (p=0.045) and visual-spatial skills (p=0.017), and in the total score (p=0.033). In the pain-free group, the caregivers showed better results than the non-caregivers. There were no effects between subjects or interactions (caregiving and pain factors) either on P300 amplitude or on P300 latency. Conclusion: In general, it was observed that pain-free individuals presented better performance. No relationship was observed between the factors care and pain regarding cognitive performance.

RESUMO Introdução: Nos últimos anos, observou-se crescente número de idosos que realizam o cuidado a outro idoso no mesmo domicílio. Esses idosos estão mais susceptíveis à sobrecarga e à presença de dor crônica, sendo que a dor pode influenciar negativamente as variáveis cognitivas. Objetivo: Comparar o desempenho e o processamento cognitivo de cuidadores idosos e não cuidadores com e sem dor crônica. Métodos: Estudo transversal realizado com 149 idosos, divididos em 4 grupos, pareados por sexo, idade e escolaridade. Os testes utilizados foram: escala numérica de avaliação da dor, Bateria Breve de Rastreio Cognitivo (BBRC), Addenbrooke's Cognitive Examination (ACER-R) e processamento cognitivo por meio de Potenciais Relacionados a Eventos (P300). Resultados: Foram encontradas diferenças estatisticamente significantes entre os participantes com e sem dor crônica nos domínios cognitivos atenção/orientação (p=0,045) e habilidades visual-espacial (p=0,017), bem como no escore total do instrumento ACE-R (p=0,033). No grupo sem dor foram encontradas diferenças estatísticas entre cuidadores e não cuidadores, com melhores resultados no grupo cuidador. Não houve efeitos entre os sujeitos ou interações (fatores de Cuidado e Dor) na amplitude do P300 ou na latência do P300. Conclusão: De maneira geral, observou-se que indivíduos sem dor apresentaram melhor desempenho. Não foi observada relação entre os fatores cuidado e dor no desempenho cognitivo.

Comparison of cognitive performance and aspects of the care context in elderly caregivers in Brazil: a follow-up study / Comparação do desempenho cognitivo e aspectos do contexto do cuidado em idosos cuidadores idosos no Brasil: um estudo de acompanhamento

ABSTRACT. Cognitive health is important for the quality of life and well-being of elderly caregivers. Cognitive impairments can negatively affect the ability to care for oneself and others. Objective: To compare cognitive performance and aspects of the care context in elderly caregivers of older adults in a three-year follow-up investigation Methods: A longitudinal study was conducted of 61 elderly caregivers treated in primary care in a city in the interior of the state of São Paulo with data collected in 2014 and 2017. Sociodemographic characteristics, the care context, cognition, performance for activities of daily living, burden and depressive symptoms were collected in individual interviews. Data analysis was performed to compare categorical and continuous variables. Results: Significant increases were found between baseline and follow-up for the language domain score of the cognitive evaluation (p=0.024), receipt of material support (p=0.020), time providing care (p=0.045) and dependence of elderly care recipient for basic activities of daily living (p=0.042). Conclusion: Elderly caregivers performed better on the domain of language, received more material/financial support, spent more time on care and reported greater dependence of the elderly care recipient.

RESUMO. A saúde cognitiva é importante para a qualidade de vida e bem-estar dos cuidadores idosos. O comprometimento cognitivo pode afetar negativamente a capacidade de cuidar de si e dos outros. Objetivo: Comparar o desempenho cognitivo e os aspectos do contexto do cuidado em idosos cuidadores de idosos em uma de acompanhamento de três anos. Métodos: Trata-se de um estudo longitudinal com medidas em 2014 e 2017, realizado com 61 cuidadores idosos cadastrados na atenção primária de um município do interior do Estado de São Paulo. Características sociodemográficas, contexto do cuidado, cognição, desempenho nas atividades da vida diária, sobrecarga e sintomas depressivos foram coletados em entrevistas individuais. A análise dos dados foi realizada para comparar variáveis categóricas e contínuas. Resultados: Foram encontrados aumentos significativos entre a linha de base e o acompanhamento do escore no domínio da linguagem da avaliação cognitiva (p=0,024), receber ajuda material (p=0,020), tempo de cuidado (p=0,045) e dependência do idoso em relação às atividades básicas da vida diária (p=0,042). Conclusão: Os cuidadores de idosos tiveram melhor desempenho no campo da linguagem, passaram a receber mais apoio material / financeiro, experimentaram aumentos no tempo gasto no cuidado e na dependência do idoso.

Elderly caregivers of other elderly living with and without children: burden, optimism and coping strategies / Idosos cuidadores de outros idosos que residem com e sem crianças: sobrecarga, otimismo e estratégias de enfrentamento

Abstract This article aims to compare level of burden, optimism and coping strategies among elderly caregivers of other elderly individuals who reside with and without children. A cross-sectional study was with a sample of 301 elderly caregivers of elderly Brazilians seen in primary health care. Among the 301 caregivers interviewed, 44 resided with children and 257 did not. Evaluations involved the administration of the Zarit Burden Inventory, Spirituality Scale (optimism) and Coping Strategies Inventory. Either the Student's t-test or the Mann-Whitney U-test was used for the comparisons between the two groups. Burden level was significantly higher among elderly caregivers who resided with children (p = 0.01). No significant differences were found with regard to optimism. Elderly caregivers who did not reside with children reported significantly greater use of coping strategies focused on the expression of negative emotions (p < 0.01), religiosity (p < 0.01) and the inhibition of negative emotions (p = 0.01). The elderly caregivers of other elderly individuals who resided with children had a higher level of burden and used coping strategies less than those who did not reside with children.

Resumo O objetivo deste artigo é comparar o nível de sobrecarga, otimismo e as estratégias de enfrentamento de idosos cuidadores de idosos que residem com e sem crianças. Estudo transversal realizado com amostra de 301 idosos cuidadores cadastrados nas Unidades de Saúde da Família. Foram entrevistados 301 idosos cuidadores, sendo que 257 não residiam com crianças e 44 residiam. Os instrumentos utilizados foram Escala de Sobrecarga de Zarit, Escala de Espiritualidade de Pinto e Pais Ribeiro e Inventário para Avaliação das Estratégias de Enfrentamento. Foram usados o teste T de Student e teste U Mann-Whitney para a comparação entre os dois grupos. O nível de sobrecarga foi significativamente maior nos idosos cuidadores que residiam com crianças (p = 0,01) e não houve diferença significativa para o otimismo. Os idosos cuidadores que não residiam com crianças reportaram o uso significativamente superior de estratégias de enfrentamento focadas em emoções negativas (p < 0,01), religiosidade (p < 0,01) e inibição de emoções negativas (p = 0,01). O nível de sobrecarga foi maior entre os idosos cuidadores que residiam com crianças. Os idosos cuidadores que não tinham crianças no domicílio reportaram maior uso de estratégias focadas na emoção e na religião para enfrentar as demandas do cuidado ao idoso.

Association between cognitive impairment and criteria for frailty syndrome among older adults / Associação entre o comprometimento cognitivo e os critérios para a síndrome de fragilidade em idosos

Abstract The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. Objective: To analyze the association between cognitive impairment and the criteria for frailty. Methods: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. Results: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. Conclusion: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

Resumo A associação entre comprometimento cognitivo e fragilidade tem sida estudada em idosos e os critérios de fragilidade e níveis de fragilidade podem também apresentar influência na função cognitiva. Objetivo: Analisar a associação entre comprometimento cognitivo e os critérios de fragilidade em idosos. Métodos: O estudo analisou transversalmente dados de 667 idosos (≥60 anos) do estudo 'Variables associated to cognition in elderly caregivers' conduzido com usuários da atenção primária a saúde de áreas urbanas e rurais. Comprometimento cognitivo foi definido em função dos escores no Miniexame do Estado Mental baseado na escolaridade e a fragilidade e pré-fragilidade foi operacionalizada segundo os critérios do Cardiovascular Health Study. Foram realizados modelos de regressão multinominal para analisar a associação entre níveis de fragilidade e comprometimento cognitivo. Resultados: Proporções semelhantes de mulheres (54,8%) e homens (45,2%) participaram do estudo (média de idade: 71 anos). Comprometimento cognitivo, pré-fragilidade e fragilidade foram encontrados em 34, 54 e 24% dos participantes, respectivamente. Concomitante comprometimento cognitivo e fragilidade foi evidenciado em 13%. As chances de apresentar comprometimento cognitivo aumentaram em 330% (Odds Ratio [OR]: 4.3; intervalo de confiança de 95% [IC95%] 2.4‒7.7; p<0.001) entre indivíduos frágeis e 70% (OR: 1.7; IC95% 1.0‒2.8; p=0.033) entre indivíduos pré-frágeis em comparação com indivíduos robustos/não-frágeis. Após controle da idade, escolaridade, local de residência e dependência funcional, os critérios de lentidão e fadiga foram significativamente associados ao comprometimento cognitivo. Conclusão: Os idosos mais frágeis têm maior probabilidade de apresentar comprometimento cognitivo comparados a adultos idosos pré-frágeis ou robustos. A prevalência de comprometimento cognitivo e fragilidade é consistente com os dados relatados na literatura e fornece suporte para futuras investigações sobre a fragilidade cognitiva.

Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study.

OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis. METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS). RESULTS: the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p<0.001) and "hope/optimism" (r=0.376; p<0.001). CONCLUSION: Since a relationship between the sense of hope and spirituality of patients with chronic kidney disease was found, these constructs should be taken into account at the time health professionals deliver care to help patients coping with the disease and treatment.