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INTRODUCTION: The COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. METHODS: Prospective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents' clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. RESULTS: There have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents' coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. CONCLUSION: The correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions.
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COVID-19 , Hospitalización , Cuidados a Largo Plazo , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , Brasil/epidemiología , Anciano , Estudios Prospectivos , Masculino , Femenino , Hospitalización/estadística & datos numéricos , Anciano de 80 o más Años , Pandemias/prevención & control , SARS-CoV-2 , Casas de Salud/estadística & datos numéricos , Incidencia , Hogares para Ancianos/estadística & datos numéricosRESUMEN
Abstract Introduction The COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. Methods Prospective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents' clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. Results There have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents' coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. Conclusion The correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions.
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Resumo Objetivo Analisar a qualidade de vida do cuidador familiar do paciente em hemodiálise e a existência de associação com suas características clínicas e sociodemográficas. Métodos Estudo transversal, realizado com 75 cuidadores familiares em dois centros de diálise. A qualidade de vida do cuidador foi medida por meio do instrumento World Health Organization Quality of Life - BREF, e sua associação com as características sociodemográficas foi avaliada pelo teste de Kruskal-Wallis (nível de significância igual a 5%). Resultados A maioria dos cuidadores familiares era mulher (84%), cônjuge (41,3%), filho (38,7%), do lar (38,7%) e possuía renda familiar de um a três salários mínimos (85,4%). A variável trabalhar fora de casa teve influência positiva na qualidade de vida geral (p=0,014), nos domínios psicológicos (p=0,009) e nas relações sociais (p≤0,001). Ser do sexo masculino (p=0,016), não ter doenças (p=0,002) e não usar medicamentos (p=0,007) interferiram positivamente no domínio físico. A ausência de ajuda financeira de outras pessoas e/ou familiares influenciou de forma negativa nos domínios das relações sociais (p=0,050) e meio ambiente (p=0,001). Conclusão O cuidador familiar do sexo masculino, ou que trabalha fora de casa ou recebe ajuda financeira de outras pessoas e/ou familiares apresentaram melhores níveis de qualidade de vida. Em contrapartida, as condições clínicas tais como fazer uso de algum medicamento ou ter doenças influenciaram de forma negativa nos níveis de qualidade de vida.
Resumen Objetivo Analizar la calidad de vida de los cuidadores familiares de pacientes en hemodiálisis y la existencia de asociación con las características demográficas y clínicas. Métodos Estudio transversal, realizado con 75 cuidadores familiares en dos centros de diálisis. La calidad de vida de los cuidadores fue medida a través del instrumento World Health Organization Quality of Life - BREF, y su relación con las características sociodemográficas fue evaluada mediante la prueba de Kruskal-Wallis (nivel de significación igual a 5 %). Resultados La mayoría de los cuidadores familiares era mujer (84 %), cónyuge (41,3 %), hijo (38,7 %), del hogar (38,7 %) y poseía ingresos familiares de uno a tres salarios mínimos (85,4 %). La variable trabajar fuera de casa tuvo influencia positiva en la calidad de vida general (p=0,014), en los dominios psicológicos (p=0,009) y en las relaciones sociales (p≤0,001). Ser de sexo masculino (p=0,016), no tener enfermedades (p=0,002) y no usar medicamentos (p=0,007) interfirieron positivamente en el dominio físico. La ausencia de ayuda financiera de otras personas o familiares influyó de manera negativa en los dominios de las relaciones sociales (p=0,050) y del medio ambiente (p=0,001). Conclusión Los cuidadores familiares de sexo masculino, o que trabajan fuera de casa o reciben ayuda financiera de otras personas o familiares presentaron mejores niveles de calidad de vida. En contraste, las condiciones clínicas, tales como hacer uso de algún medicamento o padecer enfermedades, influyeron de forma negativa en los niveles de calidad de vida.
Abstract Objective To analyze the quality of life of family caregivers of patients under hemodialysis and the existence of an association with their sociodemographic and clinics characteristics. Methods This is a cross-sectional study conducted with 75 family caregivers in two hemodialysis centers. Caregivers' quality of life was measured using the World Health Organization Quality of Life - BREF instrument, and its association with sociodemographic characteristics was assessed using the Kruskal-Wallis test (significance level equal to 5%). Results Most family caregivers were women (84%), spouses (41.3%), children (38.7%), housewives (38.7%) and had a family income of one to three minimum wages (85.4 %). The variable working outside the home had a positive influence on overall quality of life (p=0.014), psychological domains (p=0.009) and social relationships (p≤0.001). Being male (p=0.016), not having diseases (p=0.002) and not using medications (p=0.007) positively interfered with the physical domain. The absence of financial help from other people and/or family members had a negative influence on the social relationships (p=0.050) and environment (p=0.001) domains. Conclusion Male family caregivers, or those who work outside the home or receive financial help from other people and/or family members had better quality of life levels. On the other hand, clinical conditions such as using a drug or having diseases have negatively influenced quality of life levels.
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BACKGROUND: The family caregivers of patients on hemodialysis (HD) and peritoneal dialysis (PD) typically experience higher burden than the general population because of the nature of tasks these caregivers need to carry out as a part of homecare. This fact influences both the caregivers' quality of life and the quality of their care toward the patient. Thus, this study aimed to review the effectiveness and limitations of interventions in improving the well-being of family caregivers of patients on HD and PD. METHODOLOGY: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE, VHL Regional Portal, Scopus, and Web of Science databases were searched queried for randomized controlled trials that developed interventions aimed at improving the well-being of family caregivers of patients undergoing HD and/or PD from 2009 to 2020. The study protocol was registered at the International Prospective Register of Systematic Reviews (registration no. CRD42020151161). RESULTS: Six studies met the inclusion criteria, all of which addressed caregivers of patients undergoing HD. All interventions reported in the included studies were carried out in group sessions, which addressed topics such as patient assistance and care, treatment complications, coping strategies, caregiver self-care practices, problem solving, and self-efficacy. The studies found significant improvement in the caregiver's well-being. CONCLUSIONS: Group session interventions are effective in improving the well-being of family caregivers of patients undergoing HD. In regard to PD, there is insufficient evidence to make recommendations for caregivers of patients with this treatment.
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RESUMO Introdução: O Cuidador familiar do paciente em hemodiálise é demandado de cuidados complexos com alto grau de responsabilidades, que poderão levar a um adoecimento mental e físico e podem repercutir na sua qualidade de vida. Objetivo: Analisar a qualidade de vida e a existência de associação com as características sociodemográficas do cuidador familiar de paciente em hemodiálise. Método: Estudo quantitativo, transversal, realizado com 75 cuidadores familiares de pacientes em hemodiálise em dois centros de diálise no município de Belo Horizonte/Minas Gerais, ano de 2020. As variáveis independentes representadas pelos dados sociodemográficos e os dados comportamentais do cuidador frente ao cuidado prestado foram avaliados por questionário específico e a variável dependente qualidade de vida do cuidador familiar foi medida por meio do instrumento WHOQOL- bref. O teste de Kruskal-Wallis foi utilizado na avaliação da associação entre a qualidade de vida e as características sociodemográficas (nível de significância igual a 5%). Resultados: Os achados mostraram que a maioria (84%) dos cuidadores familiares eram mulheres, média de idade 50,0 ± 13,7 anos, 41,3% cônjuges e 38,7% filhos(as), 56% casados, 38,7% do lar, 49,4% tinham estudado até o 8º ano fundamental e 85,4% com renda familiar de 1 a 3 salários-mínimos. Dos entrevistados, 54,7% cuidavam dos seus familiares há mais de 5 anos, 66,7% dedicavam mais de 8h ao cuidar, 84% não recebiam ajuda financeira de outra pessoa ou familiar, 65,3% apresentavam alguma doença crônica, 61,3% estavam em uso de algum medicamento e 76% já tinham procurado o médico pelo menos uma vez em doze meses. O nível de qualidade de vida foi regular e entre os domínios do WHOQOL-bref os domínios relações sociais e meio ambiente foram os que apresentaram valores menores. Na avaliação da associação das variáveis independentes com a qualidade de vida e os domínios do WHOQOL-bref, a variável trabalhar fora de casa teve influência positiva com significância estatística sobre a qualidade de vida geral (p=0,014), assim como nos domínios psicológicos (p=0,009) e relações sociais (p=<0,001). Por outro lado, as variáveis sexo masculino, ausência de doenças e não uso de medicamentos interferiram positivamente no domínio físico. A ajuda financeira de outras pessoas e/ou familiares também influenciou positivamente com significância estatística nos domínios das relações sociais(p=0,050) e meio ambiente (p=0,001). Tanto a saúde física quanto as condições de trabalho e financeira dos cuidadores familiares foram pontos relevantes desse estudo e merecem ser mais explorados nas pesquisas para contribuir na melhor conceituação da qualidade de vida desses sujeitos e oferecer melhores medidas de enfrentamento. Conclusão: As características sociodemográficas podem influenciar na percepção da qualidade de vida dos cuidadores familiares, sendo que os fatores comportamentais do cuidador frente ao cuidado prestado tiveram uma maior influência tanto na qualidade de vida geral quanto nos domínios do WHOQOL-bref.
Introduction: The patient's family caregiver on hemodialysis is demanded of complex care with a high degree of responsibilities, which may lead to mental and physical illness and may have repercussions on his/her quality of life. Objective: To analyze the quality of life and the existence of association with the sociodemographic characteristics of the family caregiver of hemodialysis patients. Method: Quantitative, cross-sectional study, carried out with 75 family caregivers of patients on hemodialysis in two dialysis centers in the city of Belo Horizonte/Minas Gerais, the year 2020. The independent variables represented by the sociodemographic data and the caregiver's behavioral data regarding the care provided were assessed by a specific questionnaire, and the dependent variable quality of life of the family caregiver was measured employing the WHOQOL- brief instrument. The Kruskal-Wallis test was used to evaluate the association between quality of life and the sociodemographic characteristics (significance level equal to 5%). Results: The findings showed that the majority (84%) of family caregivers were women, mean age 50.0 ± 13.7 years, 41.3% spouses and 38.7% children, 56% married, 38.7% homemakers, 49.4% had studied up to 8th-grade elementary school, and 85.4% with a family income of 1 to 3 minimum wages. Of the interviewees, 54.7% had been caring for their relatives for more than five years, 66.7% dedicated more than 8 hours to the care, 84% did not receive financial help from another person or relative, 65.3% had some chronic disease, 61.3% were taking some medication, and 76% had already seen a doctor at least once in 12 months. The level of quality of life was regular, and among the domains of the WHOQOL-brief, social relations and environment were the ones that presented the lowest values. In assessing the association of independent variables with quality of life and the domains of the WHOQOL-brief, the variable working outside the home had a positive influence with statistical significance on the overall quality of life (p=0.014), as well as in the psychological (p=0.009) and social relations (p=<0.001) domains. On the other hand, the variables male gender, absence of diseases, and no use of medication interfered positively in the physical domain. Financial help from other people and/or family members also influenced positively with statistical significance in the domains of social relations(p=0.050) and environment (p=0.001). Both the physical health and the working and financial conditions of family caregivers were relevant points of this study and deserve to be further explored in research to contribute to a better conceptualization of the quality of life of these subjects and to offer bettercoping measures. Conclusion: The sociodemographic characteristics can influence the perception of the quality of life of family caregivers. The caregiver's behavioral factors facing the care provided had a more significant influence on the overall quality of life and the domains of the WHOQOL-brief.