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.

Factors associated with attitudes toward the elderly in a sample of elderly caregivers.

BACKGROUND: The number of elderly caregivers is increasing in the world. It is important to know the attitudes toward the elderly, because they can influence a range of behaviors. Our aim was to determine factors associated with attitudes toward the elderly in a sample of older carers. METHODS: Three hundred and thirteen elderly caregivers (75.4% women, mean age 69.7 ± 7.1) who cared for a dependent older person at home completed a cross-sectional household interview. In addition to the four domains of the Neri Scale to Assess Attitudes Toward the Elderly, participants were evaluated regarding the demographics, care recipient (CR) characteristics, functional and cognitive status, general health, life satisfaction, perceived stress, and depressive symptoms. RESULTS: Overall, attitudes toward the elderly were neutral in this sample. More negative attitudes in some Neri Scale domains were associated with being older, living in an urban setting, taking more medications per day, caring for an elderly dependent in basic Activities of Daily Living (ADLs), being "more or less" satisfied with life, and having higher levels of perceived stress. There was a negative association between positive attitudes and educational level. CONCLUSIONS: The results highlight the need for public policies to promote more positive attitudes toward aging and change negative stereotypes usually used to designate older people. These public policies can try to modify some predictors of negative attitudes, such as perceived stress, which was associated with all four domains of Neri Scale.

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.

Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults.

OBJECTIVE: Evaluate the cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization in older adults over a four-year period. METHOD: Four hundred five older adults (60-95 years; mean age: 70.62 ±â€¯7.12 years), 57 % female. The frailty evaluation was performed using the clinical criteria of the Cardiovascular Health Study (CHS): weight loss, fatigue, weakness, slowness and low physical activity. Cognitive impairment was defined by cutoff scores of the Mini Mental State Examination (MMSE) based on schooling. Follow-up - functional decline was assessed using the Lawton&Brody scale of instrumental activities of daily living (IADL). An investigation was also performed of the occurrence of falls and admissions to the hospital in the previous twelve months. RESULTS: Cognitive impairment was associated with admissions to the hospital and declines in the IADL category of using a telephone. Frailty was associated with admissions to hospital. Cumulative effects were observed for hospitalization and the decline in using the telephone and shopping. Frailty and cognitive impairment increased the risk of being admitted to hospital by 557 % and increased the risk of a decline in using the phone by 262% and shopping by 208%. No conditions were associated with the risk of falls. CONCLUSION: The combination of the MMSE and the CHS criteria was adequate for measuring the cumulative effects of cognitive impairment and frailty. Shared physiological mechanisms may explain the relation between cognitive impairment and frailty, but further investigations are needed in Brazil and other low/middle-income countries.

Pre-frailty, frailty and associated factors in older caregivers of older adults.

INTRODUCTION: Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES: To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS: A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS: The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION: Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.

Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults.

Limited formal education is still common in ageing populations. Although limited formal education seems to be independently and negatively associated with cognition, functional abilities and frailty in ageing, no studies have examined whether the gradient of limited formal education has an impact on health in later life. OBJECTIVE: to examine the relationship of limited formal education with cognitive status, functional abilities, and frailty status. METHODS: a cross-sectional study was conducted involving 540 older adults stratified into groups: no formal education, 12-24 months of education, and 25-48 months of education. Cognitive screening (MMSE), functional abilities (Lawton Index), and frailty (CHS criteria) were measured. Regression analyses were performed. RESULTS: 27% had no formal education, 21% had 12-24 months of formal education, and 55% had 25-48 months of formal education. Limited formal education has a clear gradient of negative impact: No formal education was associated with scoring below MMSE cut-off scores (OR = 7.9), being totally/partially dependent for IADLs (OR = 2.5) and frail (OR = 2.0). Having 12-24 months of education was associated with scoring below MMSE cut-off scores (OR = 5.2) and with being frail (OR = 2.0). The No formal education group was 10.1 times more likely to have worse cognitive scores, worse functional abilities and frailty/pre-frailty status concomitantly (CCoFF), while older adults who had 12-24 months of education had a 4.6 times greater chance of having CCoFF. CONCLUSION: limited education had a gradient association with cognitive performance, functional disability and frailty. These findings clearly emphasize the importance of prevention through education from childhood to older age.

A baixa escolaridade ainda é comum na população idosa. Embora a limitação na educação formal pareça estar independentemente e negativamente associada à cognição, habilidades funcionais e fragilidade no envelhecimento, nenhum estudo examinou a associação entre baixa escolaridade e um impacto futuro na saúde. OBJETIVO: esse estudo examinou a relação entre baixa escolaridade e o status cognitivo, habilidades funcionais e fragilidade. MÉTODOS: estudo transversal com 540 idosos divididos em grupos: sem educação formal, 12-24 meses de escolaridade e 25-48 meses de escolaridade. Informações da triagem cognitiva (MEEM), habilidades funcionais (Índice de Lawton); a fragilidade (critérios do CHS) foram coletadas. Análises de regressão foram realizadas. RESULTADOS: 27% não tinham educação formal, 21% tinham entre 12-24 meses de educação formal e 55% tinham entre 25-48 meses de educação formal. Baixa escolaridade apresentou um impacto negativo e gradiente: nenhuma educação formal foi associada à pontuação abaixo do escore do MEEM (OR = 7,9), à dependência total/parcialmente em AIVD (OR = 2,5) e fragilidade (OR = 2,0). Ter 12-24 meses de escolaridade foi associado à pontuação abaixo do escore do MEEM (OR = 5,2) e a ser frágil (OR = 2,0). O grupo sem educação formal foi 10,1 vezes mais provável de apresentar piores escores cognitivos, pior capacidade funcional e fragilidade/pré-fragilidade concomitante (CCoFF), enquanto adultos idosos que tinham entre 12-24 meses de escolaridade tiveram 4,6 vezes maior chance de apresentar CCoFF. CONCLUSÃO: a baixa escolaridade apresentou associação com desempenho cognitivo, limitações funcionais e fragilidade. Os achados enfatizam claramente a importância da prevenção através da educação desde a infância à velhice.

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.

Relationship between cognitive processing, language and verbal fluency among elderly individuals.

Some cognitive dimensions, such as attention, memory and executive functions, may decline with age, while other functions remain intact or even improve due to greater life experience. OBJECTIVE: to analyze the relationship between cognitive processing, language and verbal fluency among elderly individuals seen by primary healthcare services located in a city in the interior of São Paulo, Brazil. METHODS: a cross-sectional study with a quantitative method was conducted. A total of 149 elderly individuals were assessed through previously scheduled interviews. Data collection included a questionnaire on sociodemographic data and the Addenbrooke's Cognitive Examination - Revised (ACE-R). Cognitive processing (P300) was assessed using a device that captures potentials elicited in auditory tasks. Descriptive analysis and Spearman's correlation were performed with the level of significance established at 5%. RESULTS: a negative correlation was found between language and P300 latency, while a positive correlation was found between verbal fluency and P300 amplitude. Comprehension and naming tasks showed a negative correlation with latency. The repetition task revealed a positive correlation with P300 amplitude. CONCLUSION: although more extensive testing is needed, these findings suggest that language correlates with P300 latency, whereas verbal fluency correlates with P300 amplitude.

As dimensões cognitivas, como atenção, memória e funções executivas, podem diminuir com a idade, enquanto outras funções permanecem ou até melhoram devido a uma maior experiência de vida. OBJETIVO: analisar a relação entre processamento cognitivo, linguagem e fluência verbal em idosos atendidos em serviços de atenção básica localizados em um município do interior de São Paulo, Brasil. MÉTODOS: estudo transversal, método quantitativo. Um total de 149 idosos foram avaliados por meio de entrevistas previamente agendadas. A coleta de dados incluiu um questionário abordando dados sociodemográficos e o Exame Cognitivo de Addenbrooke - Revisado (ACE-R). O processamento cognitivo (P300) foi avaliado por meio de um dispositivo que capta potenciais elicitados em tarefas auditivas. A análise descritiva e a correlação de Spearman foram realizadas com o nível de significância estabelecido em 5%.\. RESULTADOS: foi encontrada correlação negativa entre a linguagem e a latência do P300 e uma correlação positiva entre a fluência verbal e a amplitude do P300. Tarefas de compreensão e nomeação apresentaram uma correlação negativa com a latência. A tarefa de repetição revelou correlação positiva com a amplitude do P300. CONCLUSÃO: embora testes mais extensos sejam necessários, esses achados sugerem que a correlação de linguagem com a latência e fluência do P300 está correlacionada com a amplitude do P300.

Prevalence of Physical Inactivity and Associated Factors Among Older Caregivers of Older Adults.

OBJECTIVE: The aim of this study is to analyze the prevalence of physical inactivity (PI) and associated factors in older caregivers of older adults. METHOD: A cross-sectional study was conducted including 312 older caregivers. Sociodemographic, clinical, and care-related characteristics were considered the independent variables for the determination of associated factors with PI in the logistic regression model. RESULTS: The prevalence of PI was 75.3% (95% confidence interval [CI] = [70.1%, 80.0%]). The following factors were associated with PI: being female (odds ratio [OR] = 2.8, 95% CI = [1.3, 5.9]), being older than 75 years of age (OR = 7.1, 95% CI = [2.2, 22.9]), not having a marital life (OR = 4.2, 95% CI = [1.1, 15.8]), being prefrail (OR = 6.2, 95% CI = [1.7, 21.9]), and being frail (OR = 14.8, 95% CI = [3.8, 57.7]). DISCUSSION: The prevalence of PI was high and associated with the female sex, an advanced age, and not being married. Specific public policies considering these results should be created for older caregivers.

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.

High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas.

INTRODUCTION: Older caregivers living in rural areas may be exposed to three vulnerable conditions, i.e., those related to care, their own aging, and their residence context. OBJECTIVE: To analyze the association of burden and frailty with cognition performance in older caregivers in rural communities. METHOD: In this cross-sectional survey, 85 older caregivers who cared for dependent elders were included in this study. Global cognition (Addenbrooke's Cognitive Examination - Revised; Mini Mental State Examination), burden (Zarit Burden Interview) and frailty (Fried's frailty phenotype) were assessed. All ethical principles were observed. RESULTS: Older caregivers were mostly women (76.7%); mean age was 69 years. Cognitive impairment was present in 15.3%, severe burden in 8.2%, frailty in 9.4%, and pre-frailty in 52.9% of the older caregivers. More severely burdened or frail caregivers had worse cognitive performance than those who were not, respectively (ANOVA test). Caregivers presenting a high burden level and some frailty degree (pre-frail or frail) simultaneously were more likely to have a reduced global cognition performance. CONCLUSION: A significant number of older caregivers had low cognitive performance. Actions and resources to decrease burden and physical frailty may provide better cognition and well-being, leading to an improved quality of life and quality of the care provided by the caregivers.

Subjective memory complaints associated with depression and cognitive impairment in the elderly: A systematic review.

The aging process can be accompanied by a slight decline in cognitive functioning, and subjective memory complaints (SMC) appear to be common in the elderly population. OBJECTIVE: To determine whether SMC is associated with cognitive loss or depression and can predict dementia. METHODS: A systematic review of the literature was conducted. Articles were selected on the following databases, LILACS, SCOPUS, SCiELO, PubMed and Web of Science from August to October 2013. Article selection was based on inclusion and exclusion criteria. Studies published between 2010 and 2013, written in English, Spanish or Portuguese, involving populations 65 years or older, were included. Reviews were excluded. RESULTS: After the selection, a summary of the 20 articles retrieved was carried out. Of the total articles retrieved, fifteen were cross-sectional studies and five were longitudinal studies. Most of the cross-sectional studies associated SMC with depression, objective cognitive impairment and anxiety. The emergence of dementia in people with SMC was evidenced in longitudinal studies. Albeit less frequently, SMC were also associated with reduced quality of life, impairment in Activities of Daily Living (ADL), emergence of neuropsychiatric symptoms, lower hippocampal volume, amygdala volume reduction, increased activation of the left temporal, bilateral thalamus, caudate and posterior cingulate, and with the occurrence of ApoE ε4. CONCLUSION: SMC may be associated with changes in mood and/or cognition, and its occurrence appears to increase the likelihood of dementia. In order to further our understanding of the topic, future studies should consider the recruitment of representative samples with control groups and longitudinal designs.

O processo de envelhecimento pode vir acompanhado de um declínio leve no funcionamento cognitivo e a queixa subjetiva de memória (QSM) parece ser frequente na população idosa. OBJETIVO: Verificar se a QSM está associada à perda cognitiva ou depressão e se pode predizer demência. MÉTODOS: Uma revisão sistemática da literatura foi realizada. Artigos foram selecionados nas seguintes bases de dados LILACS, SCOPUS, SciELO, PubMed e Web of Science entre agosto e outubro de 2013. Para seleção dos artigos foram usados critérios de inclusão e exclusão. Foram incluídos estudos publicados entre 2010 e 2013, escritos em inglês, espanhol ou português, com amostras de pessoas com 65 anos ou mais. Revisões foram excluídas. RESULTADOS: Após a seleção, uma síntese foi feita de 20 artigos. Quinze eram estudos transversais e cinco estudos longitudinais. A maioria dos estudos transversais associaram QSM com depressão, comprometimento cognitivo objetivo e ansiedade. A ocorrência de demência em pessoas com QSM foi evidenciado nos estudos longitudinais. Com menor frequência, QSM estava associada a redução da qualidade de vida, prejuízo nas Atividades da Vida Diária (AVD), surgimento de sintomas neuropsiquiátricos, menor volume hipocampal, redução do volume da amígdala, maior ativação do lobo temporal esquerdo, tálamo bilateral, cingulado posterior e caudado, e ocorrência de ApoE ε4. CONCLUSÃO: QSM pode estar associada a mudanças no humor e/ou cognitivas, e sua ocorrência parece aumentar a chance para demência. Para contribuir com o entendimento do assunto, futuras investigações podem considerar o recrutamento de amostras representativas, com grupos controles em desenhos longitudinais.

Relationship between cognition and frailty in elderly: A systematic review.

OBJECTIVE: The aim of this study was to analyze the relationship between cognition and frailty in the elderly. METHODS: A systematic review on the currently existing literature concerning the subject was carried out. The search strategy included LILACS, SCOPUS, SciELO, PsycINFO, PubMed and Web of Science databases. RESULTS: A total of 19 studies were selected for review, from which 10 (52.6%) were cross-sectional and 9 (47.4%) longitudinal, and the majority Brazilian. All of the studies established a link between cognition and frailty. There was a relationship between components of frailty and the cognitive domains. Risk of Mild Cognitive Impairment (MCI), dementia and mortality were all evidenced in the relationship between frailty and cognitive impairment. CONCLUSION: The theory remains limited, but results show the variables that appear to be linked to cognition and frailty in elderly. This data can help in implementing actions to improve the quality of life among elderly.

OBJETIVO: Este estudo objetivou analisar a relação entre cognição e fragilidade em pessoas idosas. MÉTODOS: Realizou-se uma revisão sistemática da literatura sobre o assunto. A estratégia de busca incluiu as bases LILACS, SCOPUS, SciELO, PsycINFO, PubMed e Web of Science. RESULTADOS: Foram selecionados 19 estudos para revisão. Dos estudos, 10 (52,6%) eram transversais e 9 (47,4%) longitudinais, sendo a maioria brasileiros. Todos os estudos estabeleceram relação entre cognição e fragilidade. Componentes da fragilidade e os domínios cognitivos apresentaram-se relacionados. Risco de Comprometimento Cognitivo Leve (CCL), demência e mortalidade foi evidenciado a partir da relação entre fragilidade e alterações cognitivas. CONCLUSÃO: A literatura continua limitada, mas os resultados mostram as variáveis que parecem estar relacionadas à cognição e fragilidade em pessoas idosas. Esses dados poderão auxiliar na implantação de ações para melhorar a qualidade de vida desses idosos.

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.

Pre-frailty, frailty and associated factors in older caregivers of older adults

ABSTRACT INTRODUCTION Providing care to an older adult is an activity that requires considerable physical effort and can cause stress and psychological strain, which accentuate factors that trigger the cycle of frailty, especially when the caregiver is also an older adult. However, few studies have analyzed the frailty process in older caregivers. OBJECTIVES To investigate the prevalence of pre-frailty, frailty and associated factors in older caregivers of older adults. METHODS A cross-sectional study was conducted including 328 community-dwelling older caregivers. Frailty was identified using frailty phenotype. Socio-demographic, behavioral and clinical aspects, characteristics related to care and functioning were covariables in the multinomial logistic regression. RESULTS The prevalence of pre-frailty and frailty were 58.8% and 21.1%, respectively. An increased age, female sex, not having a conjugal life, depressive symptoms and pain were commonly associated with pre-frailty and frailty. Sedentary lifestyle was exclusively associated with pre-frailty, whereas living in an urban area, low income and the cognitive decline were associated with frailty. A better performance on instrumental activities of daily living reduced the chance of frailty. CONCLUSION Many factors associated with the frailty syndrome may be related to the act of providing care, which emphasizes the importance of the development of coping strategies for this population.