Effects of Anxiety, Stress and Perceived Social Support on Depression and Loneliness Among Older People During the COVID-19 Pandemic: A Cross-Sectional Path Analysis.

During the COVID-19 pandemic, older people were exposed to high levels of anxiety and stress leading to loneliness and depressive disorders. The purpose of the present study was to investigate the effects of anxiety, positive coping, perceived social support, and perceived stress on depression and loneliness among older people during the COVID-19 pandemic. This was a cross-sectional online/telephone survey. A non-probability convenience sampling method was used. Participants were 112 people aged 60 years and above, without cognitive impairment, who experienced confinement (from March 2020 onward) and had access to the internet or telephone. A path analysis model showed a direct significant effect of anxiety on both, depression (ß = .68, P < .001) and perceived stress (ß = .65, P < .001), as well as an indirect effect of anxiety on loneliness via perceived stress (ß = .65) * (ß = .40); and social support (ß = -.21) * (ß = -.20). The model showed adequate fit χ2(df = 4) =5.972, P = .201; RMSEA = 0.066 (0.000, 0.169), CFI = 0.992; TLI = 0.970. Anxiety had a significant effect on depressive symptoms as well as on loneliness via perceived social support and perceived stress. According to our findings, in order to reduce depressive symptoms and perceived loneliness, it is essential to develop timely interventions that decrease levels of anxiety and stress and increase levels of perceived social support in older people, particularly when there are any restrictions, physical or contextual, that prevent face-to-face contact. This can be achieved by implementing preventive community-based programs, enhancing accessibility to mental health services, and collaborating with local support groups, among others.

[Early integration of palliative care; implications for people with chronic diseases]. / Integración temprana de cuidados paliativos; implicancias para personas con enfermedades crónicas.

INTRODUCTION: Globally, there is a growing number of population with noncommunicable and aging diseases that are eligible for palliative care. OBJECTIVE: To analyze when palliative care should be integrated in people with non-oncological chronic diseases and the implications of its implementation. METHODOLOGY: Review of scientific literature in the Web of Science, PubMed and CINAHL databases, using the descriptors palliative care, chronic diseases, and benefits. RESULTS: 28 scientific articles were selected, identifying four categories: palliative care for all; early integration of palliative care; strategies for implementation; benefits of palliative care integration. CONCLUSIONS: Palliative care is a strategy of care for all people with complex chronic pathologies, which should be integrated early, in an active, multidimensional and safe way, under the wing of a trained and coordinated health team at different levels of care.

[Key considerations in the process of assent in children and adolescents: an integrative review]. / Consideraciones claves en el proceso de asentimiento en niños, niñas y adolescentes: revisión integrativa.

The participation of children and adolescents in research requires bioethical measures to safeguard their autonomy and well-being through the application of the informed consent process. OBJECTIVE: To critically analyze the factors involved in the process of assent/consent in children and adolescents in research. METHODOLOGY: Integrative review of scientific evidence carried out between April and June 2023, from manuscripts published between 2014 and 2023 in Web of Science, PubMed, CUIDEN, and CINAHL databases, using the descriptors Process Assessment OR Assent AND Informed Consent AND Bioethics AND Minors OR Child OR Children AND adolescent OR teenage AND Pediatrics AND Research. Twenty primary articles were found, and the results were subjected to content analysis. RESULT: Three categories were identified: shared consent/assent; child-specific factors for giving assent (age of the child to give assent and autonomy of the child to give assent), and key aspects of the assent process (assent form format; assent form content, and context for applying the assent process). CONCLUSIONS: The assent process is a key tool for legal and ethical compliance with the rights of children and adolescents in clinical trial participation. In addition to favoring participation in informed decision-making together with the parents, it is also an instance where the participant's competencies, capacity for understanding, and autonomy are valued.

Internet use by informal caregivers in Chile: An analysis including age and gender perspectives.

OBJECTIVES: This study explored the relationship between Internet use and informal caregivers' characteristics. METHODS: We used the Chilean Sociodemographic Characterization Survey. A total of 86,172 informal caregivers were identified. We conducted a weighted χ2 to test differences in 10 types of Internet use and weighted logistic regressions with caregivers' characteristics as predictors of Internet use. RESULTS: Younger caregivers engaged in more types of use than the older ones. Education level was positively associated with all types of use, such as searching for information (OR = 3.52, CI 95% [2.34, 5.29]). Age was negatively related to Internet use. Women used the Internet more to communicate via social networks. Being single reduced the likelihood of performing certain types of use, such as information seeking. The number of people living in households has increased entertainment. CONCLUSIONS: Older caregivers with lower education levels are at greater risk of digital exclusion. The same occurred in some types of use with single caregivers, where fewer people lived in the household. CLINICAL IMPLICATIONS: The Internet can be a tool for coping with caregiving tasks and their negative consequences. Interventions should consider these characteristics when promoting online tools and performing online interventions to reach the broadest possible audience.

Soledad en cuidadores informales de personas con demencia durante la pandemia de COVID-19 / Loneliness in informal caregivers of people with dementia during the COVID-19 pandemic

ANTECEDENTES Y OBJETIVO: La soledad es un factor de riesgo para el desarrollo de enfermedades físicas y mentales, causando disminución en la calidad de vida y un aumento de la mortalidad. El objetivo de este artículo fue determinar los factores predictores de soledad en personas cuidadoras informales de personas con demencia dentro de un contexto de crisis como fue la pandemia por COVID-19 con el fin de identificar e intervenir en dichos factores desde la atención primaria de salud. DISEÑO Y METODOLOGÍA: Este es un estudio cuantitativo de carácter transversal para el cual se realizó un muestreo de conveniencia no probabilístico. Ciento noventa y cinco personas cuidadores informales, por medio de una encuesta en línea, respondieron preguntas sociodemográficas y clínicas sobre ellos mismos (soledad, síntomas ansiosos y depresivos, actividades físicas y mentales, sobrecarga y apoyo psicosocial) y sobre la persona con demencia (cambios en la memoria y en los síntomas conductuales y psicológicos). Los datos fueron recolectados durante 6 meses y se hicieron análisis descriptivos, de correlación y de regresión. RESULTADOS: La baja escolaridad, disminución del ingreso económico, no mantener durante la pandemia las actividades físicas y mentales y la sobrecarga en el cuidador se relacionaron significativamente con mayor soledad, mientras que los factores predictores de la misma fueron la presencia de sintomatología ansiosa depresiva, la baja percepción de apoyo psicosocial y la convivencia de la persona cuidadora con la persona con demencia. CONCLUSIÓN: El riesgo de desarrollar soledad en los cuidadores informales de personas con demencia es alto. Los profesionales de enfermería, particularmente en atención primaria, deben estar alertas a identificar a aquellos cuidadores que conviven con la persona con demencia, que presentan síntomas ansiosos y depresivos y que reportan una baja percepción de apoyo psicosocial dado que son más vulnerables de experimentar soledad percibida.

BACKGROUND AND OBJECTIVE: Loneliness is a risk factor for the development of physical and mental illness, causing decreased quality of life and increased mortality. The aim of this article was to recognise predictors of loneliness in informal caregivers of people with dementia in the context of a crisis such as the COVID-19 pandemic. DESIGN AND METHODOLOGY: 195 informal caregivers, through an online survey, answered sociodemographic and clinical questions about themselves (loneliness, anxious and depressive symptoms, physical and mental activities, overload and psychosocial support) and about the person with dementia (changes in memory and behavioural and psychological symptoms). RESULTS: Low schooling, decreased income, failure to maintain physical and mental activities during the pandemic and caregiver overload were significantly related to increased loneliness, while predictors of loneliness were the presence of depressive anxiety symptoms, low perception of psychosocial support and the caregiver living with the person with dementia. CONCLUSION: The risk of developing loneliness in caregivers of people with dementia is high. Nursing professionals, particularly in primary care, should be on the alert for those caregivers within this group who live with the person with dementia, who present anxious and depressive symptoms and who report a low perception of psychosocial support, as they are more vulnerable to experiencing perceived loneliness.

Autoeficacia de cuidadores informales de personas en cuidado paliativo domiciliario: Revisión narrativa / Self-efficacy of informal caregivers of people in palliative home care: A narrative review

Los cuidadores informales presentan altos niveles de estrés y sobrecarga frente al cuidado de personas a fin de vida. Sin embargo, algunos han logrado afrontar esta situación a través de su autoeficacia. OBJETIVO: El objetivo de esta revisión fue identificar los factores que influyen en el desarrollo de la autoeficacia en cuidadores informales de personas en cuidados paliativos e identificar los efectos de la autoeficacia en dichos cuidadores. MÉTODO: Se condujo una revisión narrativa de literatura científica realizada en las bases de datos Web of Science, PubMed, CUIDEN y CINAHL en base al flujograma de PRISMA, entre septiembre y octubre del 2022, por medio de los descriptores autoeficacia, cuidadores y cuidados paliativos. Los hallazgos de los artículos encontrados fueron sometidos un análisis temático por ambas autoras. RESULTADOS: Se seleccionaron 15 artículos científicos, identificando tres categorías: Factores que disminuyen el desarrollo de autoeficacia de los cuidadores informales (sentimientos de estrés, angustia y ansiedad, y sobrecarga del cuidador); Factores que favorecen el desarrollo de la autoeficacia de los cuidadores informales (esperanza, apoyo social y capacitación de los cuidadores); y los Efectos de la autoeficacia en los cuidadores informales (confianza en el cuidado otorgado, calidad de vida del receptor del cuidado, disminución del estrés y disminución de la sobrecarga del cuidador). CONCLUSIONES: A partir de los hallazgos, se concluye que el cuidador informal debe afrontar importantes retos con prontitud y de manera adecuada al brindar cuidados. Por lo que, la autoeficacia desarrollada a partir de la esperanza, el apoyo social y la capacitación, le permite mejorar la calidad de vida y bienestar tanto de sí mismo como de la persona bajo su cuidado.

Informal caregivers present high levels of stress and overload in the face of end-of-life care. However, some have managed to cope with this situation through their self-efficacy. OBJECTIVE: This study had the objective of identifying the factors that influence the development of self-efficacy in informal caregivers of people in palliative care and identify the effects of self-efficacy on these caregivers. METHOD: A narrative review of scientific literature was carried out in the databases Web of Science, PubMed, CUIDEN, and CINAHL based on the PRISMA flowchart, between September and October 2022, using the descriptors self-efficacy, caregivers, and palliative care. The findings of the articles were subjected to a thematic analysis by both authors. RESULTS: 15 scientific articles were selected, identifying three categories: Factors that decrease the development of informal caregivers' self-efficacy (feelings of stress, distress and anxiety, and caregiver overload); Factors that favour the development of informal caregivers' self-efficacy (hope, social support, and caregiver empowerment); and the Effects of self-efficacy on informal caregivers (confidence in the care given, quality of life of the care recipient, decreased stress and decreased caregiver overload). CONCLUSIONS: It was concluded that the informal caregiver must meet important challenges promptly and appropriately when providing care. Therefore, the self-efficacy developed from hope, social support, and training enables them to improve the quality of life and well-being of both them and the cared-for person.

Predictors of Unmet Needs in Chilean Older People with Dependency: A Cross-Sectional Study.

Approximately one in five Chilean older adults has some degree of dependency. Limited evidence is available on self-perceived needs in Latin-American older people. The main aim of this study was to identify predictors of unmet needs of dependent older persons without cognitive impairment, considering personal and primary informal caregivers' factors. This cross-sectional study was conducted with a sample of 77 dyads of older people with dependency and their caregivers. A survey was administered, evaluating sociodemographic characteristics, anxious and depressive symptomatology, health-related quality of life, and social support. Older people's self-reported met and unmet needs and caregivers' burden and self-efficacy were also assessed. To determine predictors of unmet needs, a multiple regression analysis was carried out. Most participants had mild to moderate levels of dependency. The most frequent unmet needs were "daytime activities" (33.8%), "company" (23.4%), "benefits" (23.4%), and "psychological distress" (24.7%). Older people's higher level of dependency and anxious symptomatology were predictors of a higher number of unmet needs, with a model whose predictive value was 31%. The high prevalence of anxious symptomatology and its relationship with the presence of unmet needs highlight the importance of making older people's psychological and social needs visible and addressing them promptly.

The Impact of a Yoga-Based Mindfulness Intervention versus Psycho-Educational Session for Older Adults with Mild Cognitive Impairment: The Protocol of a Randomized Controlled Trial.

BACKGROUND: There is a global agreement in the medical community that a significant proportion of dementia cases could be prevented or postponed. One of the factors behind this agreement comes from scientific evidence showing that mind-body interventions such as mindfulness and yoga for the elderly have been related to a range of positive outcomes, including improved cognition performance in seniors with mild cognitive impairment (MCI). OBJECTIVE: This study aims to evaluate the effectiveness of a yoga-based mindfulness intervention (YBM) versus psychoeducational sessions for older adults with MCI attending Hospital Clinic Universidad de Chile in Santiago. METHOD: Two-arm, individually randomized controlled trial (RCT) will be carried out at Clinical Hospital Universidad de Chile in Santiago. Older people over 60 years with any type of MCI using a score < 21 in the Montreal Cognitive Assessment (MoCA) test and a score of 0.05 in the Clinical Dementia Rating (CDR) Scale; and with preserved activities of daily living will be randomly assigned with an allocation ratio of 1:1 in either the yoga-based mindfulness intervention or the active control group based on the psycho-educational program. People who have performed yoga and/or mindfulness in the last 6 months or/and people with a psychiatric clinical diagnosis will be excluded from the study. Montreal Cognitive Assessment, the Lawton Instrumental Activities of Daily Living Scale (IADL), the Barthel Index (BI), the Pemberton happiness index, the Geriatric Anxiety Inventory (GAI) as well as the Geriatric Depression Scale (GDS-5) will be administered by blinded outcomes assessors before random assignment (Pre-test), the week following the last session of the intervention (post-test), and then after 3- and 6-months follow-up. RESULTS: The YBM intervention protocol based on a video recording has been adapted and designed. This is the first RCT to examine the effects of a yoga-based mindfulness intervention in improving cognitive and physical functions and mental health outcomes for Chilean elderly diagnosed with MCI. It is expected to be implemented as an acceptable and effective non-pharmacological option for older people with MCI. CONCLUSION: Providing evidence-based programs such as preventive therapy for Alzheimer's disease has relevant implications for public mental health services in Chile.

Predictors, Types of Internet Use, and the Psychological Well-Being of Older Adults: A Comprehensive Model.

OBJECTIVES: This study aims to evaluate a comprehensive model that includes predictors of use, types of Internet use, and psychological well-being outcomes in the older population. METHODS: The total sample comprised 650 older Internet users. Structural equation modeling was used to estimate the effect of predictors (i.e., effort expectancy, performance expectancy, social influence, and ageism) on types of Internet use (i.e., information seeking, communication, instrumental use, and leisure) and the impact of the type of use on the psychological well-being of older adults (i.e., depressive and anxious symptomatology). In addition, the indirect effect of different types of Internet use was evaluated, that is, they were considered as mediator variables. RESULTS: Effort expectancy, social influence, and ageism predicted different types of Internet use. The relationship between effort expectancy and anxious symptomatology had an indirect effect via information seeking, whereas the relationship between ageism and anxious symptomatology showed an indirect effect via leisure. DISCUSSION: The findings support the importance of differentiating the types of Internet use to understand its impact on psychological well-being. Information seeking is associated with anxious symptomatology and is predicted by effort expectancy. On the contrary, leisure is crucial because of its relationship with anxious symptomatology, and less ageism can promote it. This information is useful for developing effective interventions that promote the well-being of older adults through the Internet, including strategies to cope with some online challenges that could lead to negative consequences, such as information overload.

Impact of social isolation and coping strategies in older adults with mild cognitive impairment during the covid-19 pandemic: A qualitative study.

OBJECTIVES: The objective of this study was to explore the experiences and feelings of older adults with MCI during the COVID-19 outbreak in Chile and to know what strategies they used to overcome social isolation. METHOD: A qualitative design was used. Ten participants with a diagnosis of MCI took part in this study. All interviews were recorded and coded using thematic analysis. RESULTS: The thematic analysis identified three themes related to the quarantine experience of older adults with MCI diagnosis: (1) Effects of social isolation during the COVID-19 pandemic (2) Believes, feelings and behaviors about the SARS-CoV-2 virus (3) Coping with social isolation/response to difficulties during the pandemic. It was found that older adults with MCI have been mainly psychologically and socially affected by social distancing and isolation, particularly individuals who were alone during COVID-19 outbreak. The only physical dimension negatively affected was the level of activity. Social isolation led to a significant number of negative emotions such as anger, fear of contracting the virus or possibility of contagion for their families, worries and sadness as well as emotional loneliness. It is noteworthy that the majority of participants have used several coping strategies during this challenging time. CONCLUSION: Since social isolation and a sedentary life have been associated with poorer cognition and functionality in people with MCI, a rational plan to both prevent the progression of cognitive decline and to increase social contact, is essential. Special attention must be drawn to maintaining people physically active at home and keeping their daily routine (within the possibilities) and also to ensure social connectedness through technology. Implementation of these measures could potentially reduce negative emotions during the pandemic.

[Effects of the COVID-19 confinement on mental health among higher education students in Chile]. / Efectos del confinamiento por COVID-19 en la salud mental de estudiantes de educación superior en Chile.

BACKGROUND: Chilean higher education students have faced highly stressful events in 2020, including confinement and remote education. This population is particularly susceptible to mental health problems, such as high levels of stress, anxiety, and depression. AIM: To evaluate possible negative impacts of confinement by COVID-19 on Chilean higher education students' mental health. MATERIAL AND METHODS: The Center for Epidemiologic Studies Depression Scale (CES-D) Scale and the Profile of Mood States (POMS) were applied to 315 students during 2016 and to 301 students during 2020. RESULTS: In 2020, depression mean scores for men (24.1) and women (29.7) exceeded the cutoff point, therefore suggesting the presence of depressive disorder. Women had higher depressive and anxious symptoms in both years, however, in 2020 a significant increase was observed for depression, indicating interaction between the year of assessment andgender (0 = 6.74; p <.001). In both samples, first-year students hadsignificantly higherdepressionscores (fl = -1,909;p = 0.05). CONCLUSIONS: An increase in depression was observed in 2020. Confinement by COVID-19 had a high impact on mental health in female students. Women and first-year students appear to be high risk groups for developing depressive symptoms.

Met and unmet needs of dependent older people according to the Camberwell Assessment of Need for the Elderly (CANE): A scoping review.

In order to address the complexity of needs of dependent older people, multidimensional and person-centered needs assessment is required. The objective of this review is to describe met and unmet needs of dependent older people, living in the community or in institutions, and the factors associated with those needs. Selection criteria included papers about need asessment which employed the Camberwell Assesment of Need for the Elderly (CANE). A search through MEDLINE, SCOPUS, WOS and CINHAL databases was carried out. Twenty-one articles were finally included. Unmet needs were found more frequently in psychosocial areas (mainly in "company", "daytime activities" and "psychological distress") and in institutionalized population. In addition, unmet needs were often associated with depressive symptoms, dependency, and caregiver burden. Discrepancies between self-reported needs and needs perceived by formal and informal caregivers were identified. It is important that professionals and caregivers try to make visible the perspective of older people and their psychological and social needs, particularly when the person is dependent, depressed or cognitively impaired.

Impact of Social Isolation on People with Dementia and Their Family Caregivers.

BACKGROUND: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. OBJECTIVE: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. METHODS: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. RESULTS: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. CONCLUSION: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.

Efectos del confinamiento por COVID-19 en la salud mental de estudiantes de educación superior en Chile / Effects of the COVID-19 confinement on mental health among higher education students in Chile

Background: Chilean higher education students have faced highly stressful events in 2020, including confinement and remote education. This population is particularly susceptible to mental health problems, such as high levels of stress, anxiety, and depression. Aim: To evaluate possible negative impacts of confinement by COVID-19 on Chilean higher education students' mental health. Material and Methods: The Center for Epidemiologic Studies Depression Scale (CES-D) Scale and the Profile of Mood States (POMS) were applied to 315 students during 2016 and to 301 students during 2020. Results: In 2020, depression mean scores for men (24.1) and women (29.7) exceeded the cutoff point, therefore suggesting the presence of depressive disorder. Women had higher depressive and anxious symptoms in both years, however, in 2020 a significant increase was observed for depression, indicating interaction between the year of assessment andgender (0 = 6.74; p <.001). In both samples, first-year students hadsignificantly higherdepressionscores (fl = −1,909;p = 0.05). Conclusions: An increase in depression was observed in 2020. Confinement by COVID-19 had a high impact on mental health in female students. Women and first-year students appear to be high risk groups for developing depressive symptoms.

Predictors of unmet needs in Chilean older people with dementia: a cross-sectional study.

BACKGROUND: The needs of people with dementia (PWD) have not been assessed in any Latin American country. Several European countries have already related unmet needs with quality of life, caregiver's age, burden, stress, anxiety and depression. The aim of this study was to identify met and unmet needs in Chilean older adults with dementia and to determine if those needs were associated with PWD's, their informal caregivers' and social factors. METHOD: This was a cross-sectional study. One-hundred and sixty-six informal caregivers and their care recipients were interviewed. PWD was assessed about cognitive function and their caregivers answered instruments about PWD's needs, functional status and behavioral and psychological symptoms. Caregiver's burden, depression, anxiety and social support were also evaluated. A stepwise multiple linear regression analysis was performed to determine predictors of unmet needs in Chilean PWD. RESULTS: The most frequent met needs were "Looking after home" (81.3%%), "Food" (78.9%) and "Selfcare" (75.3%). Most common unmet needs were "Daily living activities" (39.2%), "Company" (36.1%), and "Memory" (34.9%). Caregivers' lower age was correlated to a higher number of PWD's unmet needs (rs = -.216; p < 0.005). Higher PWD's dependence was associated with higher number of unmet needs (rs = .177; p < 0.05). The best predictors of unmet needs were caregivers' low level of social support, high burden, young age and high level of anxiety. CONCLUSION: It is necessary to address psychological and social needs of PWD. The fact that PWD's unmet needs were associated mostly with caregivers' factors, highlights the importance of considering both, the PWD and their informal caregivers as targets of institutional support. It is expected that recently launched national public policies decrease PWD's unmet needs by the provision of new services for them and their informal caregivers.

Validation of the Geriatric Anxiety Inventory in Chilean older people.

OBJECTIVE: Currently in Chile there is a lack of validated tools for measuring anxiety in the elderly population. Considering this, the purpose of this study was to validate the Geriatric Anxiety Inventory (GAI) in the country. METHOD: An analysis of the psychometric properties of the GAI was carried out, using a non-clinical sample of 301 older adults in the Metropolitan and Valparaíso regions of Chile. Older people were asked about anxiety, rumination, depression, well-being and sociodemographic data. RESULTS: An excellent internal reliability was obtained with a Cronbach score of 0.931. An adequate convergent validity was observed with the Depression scales (CES-D) (Rho = 0.549, p < .01), Rumination (RSS) (Rho = 0.618; p < 0.01) and Experiential avoiding (Rho = 0.485; p < 0.01). On the other hand, the discriminant validity of the psychological well-being scale presented a negative correlation of Rho = -0.699 (p < 0.01). Finally, and Exploratory Factor Analysis was made, revealing a one-dimensional model of the instrument. CONCLUSION: The Geriatric Anxiety Inventory has very good psychometric properties measuring anxiety in elderly people, being an adequate instrument for the screening of anxiety on this population.

Impact of mind-body interventions in older adults with mild cognitive impairment: a systematic review.

ABSTRACTBackground:Mind-body interventions have been associated with a range of positive outcomes in older adults with mild cognitive impairment (MCI). The aim of the present study was to review the impact of different non-pharmacological programs based on mind-body intervention for older adults with MCI. METHODS: A comprehensive search method as required by the Cochrane Collaboration has been performed through the following databases: Google Scholar, Science Direct, PubMed, PsycINFO, MEDLINE, EMBASE, CINHAL, Cochrane, Ebsco. We included the studies that evaluated the impact of mind-body interventions such as mindfulness or meditation, yoga, Tai Chi and Qigong on cognitive function and everyday functionality of non-hospitalized adults aged 55 years or over with MCI. RESULTS: Nine studies met the inclusion criteria. Results indicated that mind-body interventions improved cognitive function, everyday activities functioning, and mindfulness, as well as resulting in a moderate reduction in fall risk, depression and stress and lower risk of dementia at one year. CONCLUSION: Several mind-body interventions focused broadly on mindfulness, yoga and Tai Chi training have been studied. This review shows that mind-body interventions improved cognitive function and everyday activities functioning, memory, resilience and mindfulness in older adults with MCI. However, the conclusions faced limitations, such as small sample size, heterogeneity of outcome measures, lack of an active control group and absence of long-term follow up. Further high-quality evidence is needed in order to determine whether mind-body interventions are cost-effective for improving cognitive decline in older adults with MCI and for delaying the rapid progression from MCI to Alzheimer or other types of dementia.

Adherencia a la medicación antipsicótica en pacientes indígenas con esquizofrenia / Adherence to antipsychotic medication in indigenous patients with schizophrenia

Resumen: Introducción: La falta de adherencia a la medicación antipsicótica sigue siendo un problema en el tratamiento de pacientes con esquizofrenia, más aún en población indígena. Objetivo: Evaluar las diferencias en la adherencia farmacológica, medida a través de la actitud hacia los antipsicóticos, entre pacientes aymara y no-aymara con esquizofrenia. Método: La muestra estuvo compuesta por pacientes que recibían tratamiento en los Servicios Públicos de Salud Mental de Bolivia (32.8%), Perú (33.6%) y Chile (33.6%). Se utilizó el Inventario de Actitud hacia la Medicación (DAI-10); la Escala Barnes de Acatisia (EBA) como medida de efectos secundarios y la Escala para el Síndrome Positivo y Negativo de la Esquizofrenia (PANSS) para evaluar la severidad del trastorno. Resultados: Los pacientes aymara presentan una menor adherencia que los pacientes no-aymara, sin embargo, estas diferencias no fueron significativas (t = 1.29; p = 0.19). La severidad del trastorno y la edad mostraron una asociación significativa con la adherencia, observándose que pacientes más jóvenes y con mayor sintomatología presentan una actitud más negativa hacia los fármacos. Discusión y conclusión: Se discute cómo las dinámicas migratorias han promovido la pérdida de tradiciones y costumbres propias de la etnia promoviendo la adopción de estilos de vida nuevos y cada vez más interculturales, e incluso cambiando su concepción de la enfermedad mental. Los profesionales tratantes deben estar conscientes de no aplicar estereotipos en cuanto a la relación etnia-antipsicóticos.

Abstract: Introduction: Non-adherence to antipsychotic medication remains a complex problem in the treatment of schizophrenia patients, especially in indigenous population. Objective: The aim of the study was to assess the differences in drug adherence, measured by the attitude towards the antipsychotics among Aymara and Non-Aymara patients with schizophrenia. Method: The sample consisted of patients receiving treatment in the Mental Health Public Services in Bolivia (32.8%), Peru (33.6%) and Chile (33.6%). We used the Drug Attitude Inventory (DAI-10); the Barnes Akathisia Scale (BAS), as a measure of side effects, and the Positive and Negative Syndrome Scale (PANSS) to assess the severity of the disorder. Results: The findings showed that Aymara patients present less adherence than Non-Aymara people; however, these differences were not significant (t = 1.29; p = 0.19). The severity of the disorder, as well as the age, showed a significant association with adherence, revealing that younger patients and with greater symptoms presented a more negative attitude toward the drugs. Discussion and conclusion: The lack of significant differences between the groups responds to three possible reasons: 1. This sample of indigenous patients is integrated on Mental Health Services that offer a clear biomedical approach where drug therapy is the primary treatment. 2. It is possible that these indigenous patients are changing their conception of mental disorder, and 3. A significant number of families have migrated to urban areas. These migratory dynamics have promoted the loss of traditions and customs of the ethnic group, which gradually adopts new and intercultural lifestyles. Professionals should be warned about applying stereotypes regarding the relationship between ethnicity and antipsychotics.

Implementación de un programa de estimulación cognitiva en personas con demencia tipo Alzheimer: un estudio piloto en chilenos de la tercera edad / Implementation of a Cognitive Stimulation Program for People with Alzheimer Disease: A Pilot Study in a Chilean Elderly Sample

La Terapia de Estimulación Cognitiva (TEC) es una intervención psicosocial para personas con demencia que ha obtenido buenos resultados en población anglosajona. El objetivo de este estudio fue evaluar la eficacia de la TEC en una muestra de personas chilenas. Participaron 22 pacientes con diagnóstico de Enfermedad de Alzheimer (EA) en fase leve a moderada, pertenecientes a un centro asistencial de la ciudad de Quillota, Chile. Para determinar la eficacia del programa, se definió un diseño experimental mixto 2x2 de medidas repetidas, asignándose aleatoriamente la muestra a dos grupos: intervención (GI) y control (GC). Se establecieron tres dimensiones para evaluar: cognición, calidad de vida y capacidad funcional de la persona con demencia. Posterior a la intervención, el GI presentó una mejoría significativa en sus indicadores de deterioro cognitivo y calidad de vida; por el contrario, el GC no evidenció cambios positivos en ninguna dimensión, empeorando el declive cognitivo. Ninguno de los grupos experimentó cambios significativos en la capacidad funcional. Si bien en la comparación intergrupo no existieron diferencias significativas en ninguna variable, el GI presentó una mejoría sustancial de la función cognitiva, en comparación con el aumento en la progresión del deterioro cognitivo en el GC. Se recomienda que futuras investigaciones contrasten dichos resultados utilizando una muestra más grande de personas con EA.

Cognitive Stimulation Therapy (CST) is a psychosocial intervention for people with dementia that has been successful in Anglo-Saxon population. The aim of this study was to assess the effectiveness of CST in a sample of Chilean elders. The participants were 22 patients diagnosed with Alzheimer's disease (AD) in mild to moderate stage, who were living in a residential care home in the town of Quillota, Chile. In order to determine the effectiveness of the program, an experimental mixed design 2x2 (repeated measures) was employed. The sample was randomly assigned into two groups: intervention group (IG) and control group (CG). Three dimensions were assessed: cognition, quality of life and functional ability. After the intervention, the IG presented a significant improvement in their cognitive function and quality life. In contrast, the CG did not show positive changes in any dimension. In fact, CG showed a worsening in its cognitive deterioration. Both groups did not showed significant changes in functional ability. Even though intergroup comparisons did not yield significant differences, the IG showed an important improvement in cognitive function, compared with an increase in the progression of cognitive impairment in the CG. It is recommended that future research will contrast these results using a larger sample of people with AD.