Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up.

OBJECTIVES: To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people. METHODS: A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups. RESULTS: Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention. CONCLUSIONS: Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care.

Factors associated with happiness among community-dwelling older adults: a systematic review.

OBJECTIVES: To identify factors associated with self-reported happiness among community-dwelling older adults. METHODS: A systematic review of the literature was conducted. Searches were conducted in the PsycInfo, Web of Science, Scopus and Pubmed databases for relevant articles published in English, Spanish or Portuguese using the following search strategy and Boolean operators: (happiness*) AND (elder* OR (old adult*)). No restriction was imposed with regards to year of publication. This review was registered in PROSPERO (CRD42018107302). RESULTS: Forty-six articles met the eligibility criteria and were included in the review. Economic, social and health-related factors were associated with happiness among community-dwelling older adults. The sociodemographic characteristics of older adults, such as the female sex, being married, an older age, a higher level of schooling and having a religion, were also associated with happiness. CONCLUSIONS: The articles included in the present systematic review demonstrate that social, economic and health-related aspects have an association with happiness in community-dwelling older adults.

Development and validation of a brief digital cognitive test based on the paradigm of stimulus equivalence in a sample of older adults.

With the technological advancement and democratization of electronic devices, computerized cognitive tests have been increasingly used in the clinical context to evaluate cognitive performance in individuals. Objective: This study aimed to propose a brief digital cognitive test based on the paradigm of stimulus equivalence and assess its convergent validity by comparing it with traditionally applied tests. Methods: The study was carried out with a non-probabilistic sample of 50 older adults selected from a public call through the communication media, health units, and day centers of a city in the countryside of São Paulo. Participants were assessed by the brief digital cognitive test, Mini-Mental State Examination, Brief Cognitive Screening Battery, and the Five Digit Test. Results: Participants had a mean age of 71.23 years (standard deviation [SD]: ±9.36) and a mean of 7.15 years of schooling (SD: ±5.34). The mean time to answer the test was 5.33 minutes (SD: ±1.92). There were statistically significant correlations between traditional and digital tests in most domains evaluated. In addition, considering the total score of the digital test, the test could discriminate participants with and without cognitive impairment: area under the ROC curve=0.765; 95%CI 0.630-0.901. Conclusion: The brief digital cognitive test, using the stimulus equivalence paradigm, is an easy-to-apply and valid instrument for the investigation of cognitive impairment in older adults.

Com o avanço tecnológico e a democratização de dispositivos eletrônicos, os testes cognitivos computadorizados vêm sendo cada vez mais utilizados no contexto clínico para avaliar o desempenho cognitivo de indivíduos. Objetivo: Este estudo teve como objetivo propor um Teste Cognitivo Digital Breve baseado no paradigma de equivalência de estímulos e avaliar sua validade convergente comparando-o com testes aplicados tradicionalmente. Métodos: O estudo foi realizado com uma amostra não probabilística de 50 idosos selecionados por chamada pública pelos meios de comunicação, unidades de saúde e centros dia de uma cidade do interior de São Paulo. Os participantes foram avaliados pelo Teste Cognitivo Digital Breve, Miniexame do Estado Mental, Bateria Breve de Rastreio Cognitivo e Teste dos Cinco Dígitos. Resultados: Os participantes tinham média de idade de 71,23 anos (desvio padrão ­ DP: ±9,36) e média de anos de estudo de 7,15 anos (DP: ±5,34). O tempo médio para a realização do teste foi de 5,33 minutos (DP: ±1,92). Houve correlações estatisticamente significativas entre os testes tradicionais e o Teste Digital na maioria dos domínios avaliados. Além disso, considerando o escore total do teste digital, o teste foi capaz de discriminar participantes com e sem comprometimento: área sob a curva ROC=0,765; IC95% 0,630­0,901. Conclusão: O teste digital cognitivo breve com o uso do paradigma de equivalência de estímulos é um instrumento de fácil aplicação e válido para a investigação de comprometimento cognitivo em idosos.

The frequency of psychotic symptoms in types of dementia: a systematic review.

The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives: This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods: A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results: A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions: We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.

A frequência de sintomas psicóticos em idosos é alta, principalmente em cognições neurocognitivas das mais variadas etiologias. Objetivos: Revisar os estudos que analisam a frequência dos tipos de delírios, alucinações e erros de identificação em quadros demenciais de diferentes etiologias. Métodos: Foi realizada uma revisão sistemática em 9 de agosto de 2021, nas bases de dados PubMed, PsycInfo, Embase, Web of Science e Scopus, com os seguintes descritores: (demência OR doença de alzheimer OR demência com corpos de Lewy OR demência frontotemporal OR demência mista OR vascular demência OU transtorno neurocognitivo maior OU demência da doença de Parkinson) E (sintomas psicóticos OU psicose OU alucinações OU delírios OU psicopatologia OU identificação errônea) E (prevalência OU epidemiologia). Resultados: Foram encontrados 5.077 artigos, com inclusão final de 35. A frequência geral de sintomas psicóticos foi de 34 a 63% em quadros demenciais das mais variadas etiologias. A doença de Alzheimer (DA) apresenta mais delírios, alucinações e maior frequência quanto à presença de erros de identificação. Por outro lado, a demência com corpos de Lewy (DCL) parece apresentar mais alucinações, inclusive auditivas, quando comparada às demais demências, concomitantemente aos delírios. As demências vascular e frontotemporal apresentam menos sintomas psicóticos do que a DCL e a DA. Conclusões: Identificamos lacuna na literatura quanto à descrição dos sintomas psicóticos das demências, principalmente naquelas de etiologia não DA. Estudos que aprofundem os sintomas neuropsiquiátricos das demências podem contribuir de forma mais definitiva para o diagnóstico causal da demência.

The frequency of psychotic symptoms in types of dementia: a systematic review / A frequência de sintomas psicóticos em tipos de demência: uma revisão sistemática

ABSTRACT The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives: This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods: A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results: A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions: We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.

RESUMO A frequência de sintomas psicóticos em idosos é alta, principalmente em cognições neurocognitivas das mais variadas etiologias. Objetivos: Revisar os estudos que analisam a frequência dos tipos de delírios, alucinações e erros de identificação em quadros demenciais de diferentes etiologias. Métodos: Foi realizada uma revisão sistemática em 9 de agosto de 2021, nas bases de dados PubMed, PsycInfo, Embase, Web of Science e Scopus, com os seguintes descritores: (demência OR doença de alzheimer OR demência com corpos de Lewy OR demência frontotemporal OR demência mista OR vascular demência OU transtorno neurocognitivo maior OU demência da doença de Parkinson) E (sintomas psicóticos OU psicose OU alucinações OU delírios OU psicopatologia OU identificação errônea) E (prevalência OU epidemiologia). Resultados: Foram encontrados 5.077 artigos, com inclusão final de 35. A frequência geral de sintomas psicóticos foi de 34 a 63% em quadros demenciais das mais variadas etiologias. A doença de Alzheimer (DA) apresenta mais delírios, alucinações e maior frequência quanto à presença de erros de identificação. Por outro lado, a demência com corpos de Lewy (DCL) parece apresentar mais alucinações, inclusive auditivas, quando comparada às demais demências, concomitantemente aos delírios. As demências vascular e frontotemporal apresentam menos sintomas psicóticos do que a DCL e a DA. Conclusões: Identificamos lacuna na literatura quanto à descrição dos sintomas psicóticos das demências, principalmente naquelas de etiologia não DA. Estudos que aprofundem os sintomas neuropsiquiátricos das demências podem contribuir de forma mais definitiva para o diagnóstico causal da demência.

Development and validation of a brief digital cognitive test based on the paradigm of stimulus equivalence in a sample of older adults / Desenvolvimento e validação de um teste cognitivo digital breve baseado no paradigma de equivalência de estímulos em uma amostra de idosos

ABSTRACT With the technological advancement and democratization of electronic devices, computerized cognitive tests have been increasingly used in the clinical context to evaluate cognitive performance in individuals. Objective: This study aimed to propose a brief digital cognitive test based on the paradigm of stimulus equivalence and assess its convergent validity by comparing it with traditionally applied tests. Methods: The study was carried out with a non-probabilistic sample of 50 older adults selected from a public call through the communication media, health units, and day centers of a city in the countryside of São Paulo. Participants were assessed by the brief digital cognitive test, Mini-Mental State Examination, Brief Cognitive Screening Battery, and the Five Digit Test. Results: Participants had a mean age of 71.23 years (standard deviation [SD]: ±9.36) and a mean of 7.15 years of schooling (SD: ±5.34). The mean time to answer the test was 5.33 minutes (SD: ±1.92). There were statistically significant correlations between traditional and digital tests in most domains evaluated. In addition, considering the total score of the digital test, the test could discriminate participants with and without cognitive impairment: area under the ROC curve=0.765; 95%CI 0.630-0.901. Conclusion: The brief digital cognitive test, using the stimulus equivalence paradigm, is an easy-to-apply and valid instrument for the investigation of cognitive impairment in older adults.

RESUMO Com o avanço tecnológico e a democratização de dispositivos eletrônicos, os testes cognitivos computadorizados vêm sendo cada vez mais utilizados no contexto clínico para avaliar o desempenho cognitivo de indivíduos. Objetivo: Este estudo teve como objetivo propor um Teste Cognitivo Digital Breve baseado no paradigma de equivalência de estímulos e avaliar sua validade convergente comparando-o com testes aplicados tradicionalmente. Métodos: O estudo foi realizado com uma amostra não probabilística de 50 idosos selecionados por chamada pública pelos meios de comunicação, unidades de saúde e centros dia de uma cidade do interior de São Paulo. Os participantes foram avaliados pelo Teste Cognitivo Digital Breve, Miniexame do Estado Mental, Bateria Breve de Rastreio Cognitivo e Teste dos Cinco Dígitos. Resultados: Os participantes tinham média de idade de 71,23 anos (desvio padrão — DP: ±9,36) e média de anos de estudo de 7,15 anos (DP: ±5,34). O tempo médio para a realização do teste foi de 5,33 minutos (DP: ±1,92). Houve correlações estatisticamente significativas entre os testes tradicionais e o Teste Digital na maioria dos domínios avaliados. Além disso, considerando o escore total do teste digital, o teste foi capaz de discriminar participantes com e sem comprometimento: área sob a curva ROC=0,765; IC95% 0,630-0,901. Conclusão: O teste digital cognitivo breve com o uso do paradigma de equivalência de estímulos é um instrumento de fácil aplicação e válido para a investigação de comprometimento cognitivo em idosos.

Construction of face databases for tasks to recognize facial expressions of basic emotions: a systematic review.

Recognizing the other's emotions is an important skill for the social context that can be modulated by variables such as gender, age, and race. A number of studies seek to elaborate specific face databases to assess the recognition of basic emotions in different contexts. Objectives: This systematic review sought to gather these studies, describing and comparing the methodologies used in their elaboration. Methods: The databases used to select the articles were the following: PubMed, Web of Science, PsycInfo, and Scopus. The following word crossing was used: "Facial expression database OR Stimulus set AND development OR Validation." Results: A total of 36 articles showed that most of the studies used actors to express the emotions that were elicited from specific situations to generate the most spontaneous emotion possible. The databases were mainly composed of colorful and static stimuli. In addition, most of the studies sought to establish and describe patterns to record the stimuli, such as color of the garments used and background. The psychometric properties of the databases are also described. Conclusions: The data presented in this review point to the methodological heterogeneity among the studies. Nevertheless, we describe their patterns, contributing to the planning of new research studies that seek to create databases for new contexts.

Reconhecer as emoções do outro é uma habilidade importante para o contexto social, que pode ser modulada por variáveis como sexo, idade e raça. Vários estudos buscam elaborar bancos de faces específicos para avaliar o reconhecimento de emoções básicas em diferentes contextos. Objetivos: Esta revisão sistemática buscou reunir esses estudos, descrevendo e comparando as metodologias utilizadas em sua elaboração. Métodos: As bases de dados utilizadas para a seleção dos artigos foram: PubMed, Web of Science, PsycInfo e Scopus. Foi utilizado o seguinte cruzamento de palavras: "facial expression database OR stimulus set AND development OR validation". Resultados: O total de 36 artigos mostrou que a maioria dos estudos utilizou atores para expressar as emoções, que foram suscitadas de situações específicas para serem o mais espontâneas possível. Os bancos de faces foram compostos principalmente de estímulos coloridos e estáticos. Além disso, a maioria dos estudos buscou estabelecer e descrever padrões para registrar os estímulos, como a cor das roupas utilizadas e o fundo. As propriedades psicométricas dos bancos de faces também são descritas. Conclusões: Os dados apresentados nesta revisão apontam para a heterogeneidade metodológica entre os estudos. Apesar disso, descrevemos seus padrões, contribuindo para o planejamento de novas pesquisas que buscam criar bancos de faces específicos para novos contextos.

Prevalence of frailty syndrome in Brazil: a systematic review / Prevalência da síndrome da fragilidade no Brasil: uma revisão sistemática

Abstract Background The population is aging rapidly, which leads to an increased prevalence of frailty syndrome. A large number of investigations on the subject have been conducted in Brazil, but no systematic review of prevalence studies involving the Brazilian population has been carried out considering the characteristics of the sample and the evaluation methods used. Objective To develop a systematic review of studies that assess the prevalence of frailty syndrome in Brazil, analyzing the clinical and demographic characteristics of the samples and the methods used for the diagnosis of the syndrome. Method The searches were carried out in the PubMed, SciELO and Web of Science databases using the following keywords: (prevalence or epidemiology) and frailty and Brazil. Results Forty-seven articles met the eligibility criteria and were included in the review. The prevalence of frailty ranged from 3.85% to 74.1%, depending on the assessment instrument used, context, region and population studied. Conclusion The prevalence data are discrepant, and the standardization of screening methods for the frailty syndrome could facilitate the comparison between studies, in order to maximize and create intervention strategies, especially in a country with cultural diversity and regional disparities, such as Brazil

Resumo Introdução A população está envelhecendo rapidamente, o que leva a um aumento da prevalência da síndrome da fragilidade. Um grande número de investigações sobre o tema tem sido conduzido no Brasil, mas nenhuma revisão sistemática de estudos de prevalência envolvendo a população brasileira foi realizada, considerando as características da amostra e os métodos de avaliação utilizados. Objetivo Desenvolver uma revisão sistemática de estudos que avaliam a prevalência da síndrome da fragilidade no Brasil, analisando as características clínicas e demográficas das amostras e os métodos utilizados para o diagnóstico da síndrome. Método As pesquisas foram realizadas nas bases de dados do PubMed, SciELO e Web of Science usando as seguintes palavras-chave: (prevalence or epidemiology) and frailty and Brazil. Resultados Quarenta e sete artigos preencheram os critérios de elegibilidade e foram incluídos na revisão. A prevalência de fragilidade variou de 3,85% a 74,1%, dependendo do instrumento de avaliação utilizado, contexto, região e população estudada. Conclusão Os dados de prevalência são discrepantes, sendo que a padronização dos métodos de triagem para a síndrome da fragilidade poderia facilitar a comparação entre os estudos, a fim de maximizar e criar estratégias de intervenção, especialmente em um país com diversidade cultural e disparidades regionais, como o Brasil.

Construction of face databases for tasks to recognize facial expressions of basic emotions: a systematic review / Construção de bancos de faces para tarefas de reconhecimento de expressões faciais de emoções básicas: uma revisão sistemática

ABSTRACT. Recognizing the other's emotions is an important skill for the social context that can be modulated by variables such as gender, age, and race. A number of studies seek to elaborate specific face databases to assess the recognition of basic emotions in different contexts. Objectives: This systematic review sought to gather these studies, describing and comparing the methodologies used in their elaboration. Methods: The databases used to select the articles were the following: PubMed, Web of Science, PsycInfo, and Scopus. The following word crossing was used: "Facial expression database OR Stimulus set AND development OR Validation." Results: A total of 36 articles showed that most of the studies used actors to express the emotions that were elicited from specific situations to generate the most spontaneous emotion possible. The databases were mainly composed of colorful and static stimuli. In addition, most of the studies sought to establish and describe patterns to record the stimuli, such as color of the garments used and background. The psychometric properties of the databases are also described. Conclusions: The data presented in this review point to the methodological heterogeneity among the studies. Nevertheless, we describe their patterns, contributing to the planning of new research studies that seek to create databases for new contexts.

RESUMO. Reconhecer as emoções do outro é uma habilidade importante para o contexto social, que pode ser modulada por variáveis como sexo, idade e raça. Vários estudos buscam elaborar bancos de faces específicos para avaliar o reconhecimento de emoções básicas em diferentes contextos. Objetivos: Esta revisão sistemática buscou reunir esses estudos, descrevendo e comparando as metodologias utilizadas em sua elaboração. Métodos: As bases de dados utilizadas para a seleção dos artigos foram: PubMed, Web of Science, PsycInfo e Scopus. Foi utilizado o seguinte cruzamento de palavras: "facial expression database OR stimulus set AND development OR validation". Resultados: O total de 36 artigos mostrou que a maioria dos estudos utilizou atores para expressar as emoções, que foram suscitadas de situações específicas para serem o mais espontâneas possível. Os bancos de faces foram compostos principalmente de estímulos coloridos e estáticos. Além disso, a maioria dos estudos buscou estabelecer e descrever padrões para registrar os estímulos, como a cor das roupas utilizadas e o fundo. As propriedades psicométricas dos bancos de faces também são descritas. Conclusões: Os dados apresentados nesta revisão apontam para a heterogeneidade metodológica entre os estudos. Apesar disso, descrevemos seus padrões, contribuindo para o planejamento de novas pesquisas que buscam criar bancos de faces específicos para novos contextos.

Cultural factors associated with burden in unpaid caregivers of older adults: A systematic review.

The aim of the present systematic review was to investigate cultural factors associated with burden in unpaid caregivers of older adults. Searches were conducted in the Pubmed, Web of Science, PsycInfo, Scopus, Embase, LILACs and SciELO databases for relevant articles published in English, Portuguese and Spanish using the search terms 'Caregiver AND Culture AND (Burnout OR Caregiver Burden) AND Aged'. No restriction was imposed regarding year of publication. A total of 1234 articles were identified, 34 of which were selected for the present review. The following sociodemographic characteristics were associated with burden: being female, married, White caregivers, young and the spouse of the care recipient; having no siblings; having low schooling and low economic status. Cultural factors associated with burden were living with the care recipient, not professing a religion or having little spirituality, familism (i.e. less reciprocity) and an absence of social support. The present findings underscore the importance of developing intervention strategies that consider cultural factors to minimise the negative impacts of care on unpaid caregivers of older adults.

Empathy Training for Caregivers of Older People: A Systematic Review.

OBJECTIVES: To identify empathy training models and the effects on psychological concerns in paid and unpaid caregivers of older people. METHODS: A systematic review was conducted. Searches for relevant articles were performed in the Embase, LILACS, PsycInfo, Pubmed, Scopus and Web of Science databases using the following search strategy: "Empathy AND (Education OR Training OR Intervention) AND Caregiver." No restrictions were imposed regarding language or year of publication. RESULTS: Empathy training for caregivers of older people were performed in six studies, three of which identified a significant increase in empathy levels and consequent reduction in psychological concerns. Empathy training focused on aspects of empathy and/or the caregiver had significant effects on the outcome variables. Moreover, training conducted online, by telephone and/or in person can generate satisfactory results. The other three studies that conducted training with a focus on aspects of dementia and/or old age did not present any effect on the outcome variables. CONCLUSIONS: Empathy training for caregivers of older people can increase levels of this ability, especially in the cognitive domain, as well as diminish psychological concerns caused by the negative impact of providing care. CLINICAL IMPLICATIONS: Empathy training directed at empathic abilities and/or aspects of providing care can be effective at increasing levels of this ability. Moreover, training in different care contexts can minimize the negative impacts of providing care.

Psychological Concerns Associated with Empathy in Paid and Unpaid Caregivers of Older People: A Systematic Review.

OBJECTIVES: Identify associations between psychological concerns and empathy (affective and cognitive domains) in paid and unpaid caregivers of older people. METHODS: A systematic review of the literature was conducted. Searches were performed in the Pubmed, Web of Science, PsycINFO, Scopus and Embase databases using the search terms "Empathy," "Caregiver," "Depression," "Burnout," Anxiety", Caregiver Burden" and "Psychological Stresses" and the Boolean operators "AND" and "OR." No restrictions were imposed regarding language or year of publication. This review was registered in PROSPERO (CRD42021267276). RESULTS: Twelve articles met the inclusion criteria and were included in the present review. Most studies involved the participation of unpaid caregivers. Higher levels of empathy were associated with greater psychological concerns. Regarding affective empathy, direct associations were found with depressive symptoms, anxiety and stress. In contrast, high levels of cognitive empathy were associated with fewer depressive symptoms as well as less stress and burnout syndrome. CONCLUSIONS: An association was found between greater affective empathy and psychological impairment in caregivers of older people. Higher levels of cognitive empathy can help minimize psychological concerns. CLINICAL IMPLICATIONS: Working on empathic ability among caregivers of older people in different environments can contribute positively to the emotional impact of caregiving. Moreover, empathetic cognitive training among caregivers can serve as a strategy to minimize the negative consequences of the impact of caregiving.

Association between falls and cognitive performance among community-dwelling older people: a cross-sectional study

ABSTRACT BACKGROUND: Falls among older people have a negative impact on health and therefore constitute a public health problem. Cognitive decline can also accompany the aging process, and both conditions lead to significant increases in morbidity and mortality in this population. Objective: To analyze the cognitive performance of older people, classified as non-fallers, sporadic fallers and recurrent fallers, and investigate the relationship between falls and cognition. DESIGN AND SETTING: Cross-sectional study conducted in the interior of the state of São Paulo, Brazil. METHODS: Evaluations on 230 older people were conducted. They were divided into three groups: non-fallers, sporadic fallers (one fall) and recurrent fallers (two or more falls). The Mini-Mental State Examination, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Brief Cognitive Screening Battery (BCSB), Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) similarities subtest and digit span test were applied. RESULTS: In multinomial logistic regression, being a recurrent faller was significantly associated with lower scores in the CERAD word list (odds ratio, OR = 0.92; 95% confidence interval, CI, 0.86-0.98; P = 0.01), in CERAD constructive praxis (OR = 0.88; 95% CI, 0.79-0.98; P = 0.02), in BCSB figure list memory (OR = 0.94; 95% CI, 0.89-0.99; P = 0.02) and in verbal fluency (OR = 0.89; 95% CI, 0.81-0.97; P = 0.01). Recurrent fallers also had lower scores in these same tests, compared with sporadic fallers. CONCLUSION: Cognitive impairment, especially in the domains of memory and executive functioning, can influence occurrences of recurrent falls.

Association between falls and cognitive performance among community-dwelling older people: a cross-sectional study.

BACKGROUND: Falls among older people have a negative impact on health and therefore constitute a public health problem. Cognitive decline can also accompany the aging process, and both conditions lead to significant increases in morbidity and mortality in this population. OBJECTIVE: To analyze the cognitive performance of older people, classified as non-fallers, sporadic fallers and recurrent fallers, and investigate the relationship between falls and cognition. DESIGN AND SETTING: Cross-sectional study conducted in the interior of the state of São Paulo, Brazil. METHODS: Evaluations on 230 older people were conducted. They were divided into three groups: non-fallers, sporadic fallers (one fall) and recurrent fallers (two or more falls). The Mini-Mental State Examination, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Brief Cognitive Screening Battery (BCSB), Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) similarities subtest and digit span test were applied. RESULTS: In multinomial logistic regression, being a recurrent faller was significantly associated with lower scores in the CERAD word list (odds ratio, OR = 0.92; 95% confidence interval, CI, 0.86-0.98; P = 0.01), in CERAD constructive praxis (OR = 0.88; 95% CI, 0.79-0.98; P = 0.02), in BCSB figure list memory (OR = 0.94; 95% CI, 0.89-0.99; P = 0.02) and in verbal fluency (OR = 0.89; 95% CI, 0.81-0.97; P = 0.01). Recurrent fallers also had lower scores in these same tests, compared with sporadic fallers. CONCLUSION: Cognitive impairment, especially in the domains of memory and executive functioning, can influence occurrences of recurrent falls.

Recognition of Facial Expressions of Emotion and Depressive Symptoms among Caregivers with Different Levels of Empathy.

OBJECTIVES: To assess differences in the recognition of facial expressions of emotion among caregivers of older people with different levels of empathy. METHODS: A cross-sectional study was conducted with 158 caregivers of older adults who provided care in family residences or nursing homes. The caregivers were divided into three groups based on the score of the multidimensional Interpersonal Reactivity Index: "lower empathy", "intermediate empathy", and "higher empathy". Data collection involved the administration of a sociodemographic questionnaire, the Emotion Recognition Test, and the Patient Health Questionnaire. RESULTS: No significant differences were found among the groups in terms of sociodemographic variables. Regarding clinical characteristics, the "higher empathy" group had more depressive symptoms than the other groups (p = .001). Moreover, the "higher empathy" group exhibited greater accuracy at recognizing the expression of sadness than the "lower empathy" group (p = .033). The recognition of sadness remained significant in the analysis of variance adjusted for depressive symptoms (p < .05). CONCLUSIONS: Caregivers with higher levels of empathy showed greater accuracy at recognizing sadness emotion compared to caregivers with lower levels of empathy. Additionally, caregivers with greater empathy have more depressive symptoms. CLINICAL IMPLICATIONS: The recognition of facial expressions of sadness may give caregivers a skill to infer possible needs in older care recipients. However, a higher level of empathy may exert a negative psychological impact on caregivers of older people, which could have repercussions regarding the quality of care provided.

What factors are associated with affective and cognitive empathy in informal and formal caregivers of older people?

OBJECTIVE: To analyse factors associated with affective and cognitive empathy in informal and formal caregivers of older people. METHODS: A cross-sectional study was conducted with 111 formal and informal caregivers divided into three groups (lower, intermediate and higher empathy) based on the Multidimensional Interpersonal Reactivity Index score (total, affective and cognitive empathy). A sociodemographic questionnaire, the Zarit Burden Inventory, Patient Health Questionnaire-9 and Functional Assessment Questionnaire were applied. RESULTS: The participants were predominantly women (91%), and median [IQR] age was 46 [33-57] years. In the multinomial regression analysis being an informal caregiver, being older and having depressive symptoms were associated with higher levels of empathy (total score and the affective domain). No associations were found for the cognitive domain. CONCLUSIONS: A high level of empathy, especially affective empathy, was associated with depressive symptoms, older age and being an informal caregiver. Family relationships and the lack of training among informal caregivers should be explored.

Relationship of burden with depressive symptoms, mental disorders and older adults' functional dependence: A study with paid and unpaid caregivers in Brazil.

The objective of this study was to identify the relationship of burden with depressive symptoms, mental disorders and older adults' functional dependence in paid and unpaid caregivers. This is a quantitative and cross-sectional study, carried out in the inland of the state of São Paulo with 111 caregivers, 60 of whom were unpaid and 51 were paid. The caregivers answered a questionnaire for the assessment of sociodemographic and care characteristics, the Zarit Burden Inventory (ZBI), the Patient Health Questionnaire (PHQ-9), the Self-Report Questionnaire (SRQ-20), and the Functional Assessment Questionnaire (FAQ). Unpaid caregivers were older, married, have been providing care for a longer period of time, and devoted more days and hours per week to care when compared to paid caregivers. Depressive symptoms and mental disorders (non-psychotic) are related to the levels of burden in both paid and unpaid caregivers (p < 0.001). The care process causes harm such as burden, depressive symptoms, and mental disorders in paid and unpaid caregivers. Thus, it is important to think about coping strategies to minimize the psychological consequences of the care process.

Depression and empathy in health professionals who work in the long-term care institutions for older adults.

Empathy is an important factor to guarantee the quality of care provided in the long-term care institutions (LTCIs) for older adults, and depression is a factor that affects the health of the professional and, consequently, the care. Thus, it is important that studies are conducted on the relationship of these variables in this context. OBJECTIVE: The aim of this study is to verify the relationship between empathy and depressive symptoms among health professionals working in the LTCIs. METHODS: A cross-sectional study was carried out at LTCIs in the state of São Paulo, Brazil. The final sample was constituted by 101 health professionals (i.e., caregivers and nursing technicians) with direct participation in the care of institutionalized older adults. The instruments were used as follows: the Interpersonal Reactivity Index (IRI) to assess empathy and the Patient Health Questionnaire-9 (PHQ-9) for the diagnosis of depression. For the analyses, the patients were divided into groups with and without depression, according to the score of the PHQ-9. RESULTS: The prevalence of depression among health professionals was 19.8%. Significant statistical differences were found between the groups for the total score of the IRI (p=0.029), for the emotional domain (p=0.023), and for the personal distress (p=0.009). CONCLUSIONS: The findings indicate that the presence of depression among health professionals at LTCIs is related to the higher levels of empathy, especially in the emotional domain. Thus, future studies that contribute to understanding how care must be provided with empathy, but without harming the health of the professional, should be carried out.

A empatia é um importante fator na garantia da qualidade do cuidado prestado em Instituições de Longa Permanência para Idosos (ILPIs), e a depressão é um fator que prejudica a saúde do profissional e, consequentemente, esse cuidado. Dessa forma, é importante que se realizem estudos sobre a relação dessas variáveis nesse contexto. OBJETIVO: Verificar a relação entre empatia e sintomas depressivos em profissionais de saúde de ILPIs. MÉTODOS: Estudo transversal, realizado em ILPIs no estado de São Paulo. A amostra final foi composta por 101 profissionais da saúde (cuidadores e técnicos de enfermagem), que participavam diretamente do cuidado de idosos institucionalizados. Os instrumentos utilizados foram: a Escala Multidimensional de Reatividade Interpessoal (EMRI) para avaliar empatia e o Patient Health Questionnaire-9 (PHQ-9) para o diagnóstico de depressão. Para as análises, os participantes foram divididos em grupos com e sem depressão, de acordo com a pontuação do PHQ-9. RESULTADOS: A prevalência de depressão entre os profissionais de saúde foi de 19,8%. Foram encontradas diferenças estatísticas significativas entre os grupos para a pontuação total do EMRI (p=0,029), para o domínio emocional (p=0,023) e angústia pessoal (p=0,009). CONCLUSÕES: Nossos achados apontam que a presença de depressão entre os profissionais de saúde de ILPIs está relacionada a maiores os níveis de empatia, principalmente no domínio emocional. Assim, pesquisas futuras que contribuam para entender como deve se dar o cuidado prestado com empatia, porém sem prejudicar a saúde do profissional, devem ser realizadas.

Is slowness a better discriminator of disability than frailty in older adults?

BACKGROUND: The trajectory of incident disability that occurs simultaneously with changes in frailty status, as well as how much each frailty component contributes to this process in the different sexes, are unknown. The objective of this study is to analyse the trajectory of the incidence of disability on basic and instrumental activities of daily living (BADL and IADL) as a function of the frailty changes and their components by sex over time. METHODS: Longitudinal analyses of 1522 and 1548 of the English Longitudinal Study of Ageing study participants without BADL and IADL disability, respectively, and without frailty at baseline. BADL and IADL were assessed using the Katz and Lawton Scales and frailty by phenotype at 4, 8, and 12 years of follow-up. Generalized mixed linear models were calculated for the incidence of BADL and IADL disability, as an outcome, using changes in the state of frailty and its components, as the exposure, by sex in models fully adjusted for sociodemographic, behavioural, biochemical, and clinical characteristics. RESULTS: The mean age, at baseline, of the 1522 eligible individuals free of BADL and free of frailty was 68.1 ± 6.2 years (52.1% women) and of the 1548 individuals free IADL and free frailty was 68.1 ± 6.1 years (50.6% women). Women who became pre-frail had a higher risk of incidence of disability for BADL and IADL when compared with those who remained non-frail (P < 0.05). Men and women who became frail had a higher risk of incidence of disability regarding BADL and IADL when compared with those who remained non-frail (P < 0.05). Slowness was the only component capable of discriminating the incidence of disability regarding BADL and IADL when compared with those who remained without slowness (P < 0.05). Weakness and low physical activity level in men and exhaustion in women also discriminated the incidence of disability (P < 0.05). CONCLUSIONS: Slowness is the main warning sign of functional decline in older adults. As its evaluation is easy, fast, and accessible, screening for this frailty component should be prioritized in different clinical contexts so that rehabilitation strategies can be developed to avoid the onset of disability.

Depression and empathy in health professionals who work in the long-term care institutions for older adults / Depressão e empatia em profissionais de saúde de Instituições de Longa Permanência para Idosos

ABSTRACT Empathy is an important factor to guarantee the quality of care provided in the long-term care institutions (LTCIs) for older adults, and depression is a factor that affects the health of the professional and, consequently, the care. Thus, it is important that studies are conducted on the relationship of these variables in this context. Objective: The aim of this study is to verify the relationship between empathy and depressive symptoms among health professionals working in the LTCIs. Methods: A cross-sectional study was carried out at LTCIs in the state of São Paulo, Brazil. The final sample was constituted by 101 health professionals (i.e., caregivers and nursing technicians) with direct participation in the care of institutionalized older adults. The instruments were used as follows: the Interpersonal Reactivity Index (IRI) to assess empathy and the Patient Health Questionnaire-9 (PHQ-9) for the diagnosis of depression. For the analyses, the patients were divided into groups with and without depression, according to the score of the PHQ-9. Results: The prevalence of depression among health professionals was 19.8%. Significant statistical differences were found between the groups for the total score of the IRI (p=0.029), for the emotional domain (p=0.023), and for the personal distress (p=0.009). Conclusions: The findings indicate that the presence of depression among health professionals at LTCIs is related to the higher levels of empathy, especially in the emotional domain. Thus, future studies that contribute to understanding how care must be provided with empathy, but without harming the health of the professional, should be carried out.

RESUMO A empatia é um importante fator na garantia da qualidade do cuidado prestado em Instituições de Longa Permanência para Idosos (ILPIs), e a depressão é um fator que prejudica a saúde do profissional e, consequentemente, esse cuidado. Dessa forma, é importante que se realizem estudos sobre a relação dessas variáveis nesse contexto. Objetivo: Verificar a relação entre empatia e sintomas depressivos em profissionais de saúde de ILPIs. Métodos: Estudo transversal, realizado em ILPIs no estado de São Paulo. A amostra final foi composta por 101 profissionais da saúde (cuidadores e técnicos de enfermagem), que participavam diretamente do cuidado de idosos institucionalizados. Os instrumentos utilizados foram: a Escala Multidimensional de Reatividade Interpessoal (EMRI) para avaliar empatia e o Patient Health Questionnaire-9 (PHQ-9) para o diagnóstico de depressão. Para as análises, os participantes foram divididos em grupos com e sem depressão, de acordo com a pontuação do PHQ-9. Resultados: A prevalência de depressão entre os profissionais de saúde foi de 19,8%. Foram encontradas diferenças estatísticas significativas entre os grupos para a pontuação total do EMRI (p=0,029), para o domínio emocional (p=0,023) e angústia pessoal (p=0,009). Conclusões: Nossos achados apontam que a presença de depressão entre os profissionais de saúde de ILPIs está relacionada a maiores os níveis de empatia, principalmente no domínio emocional. Assim, pesquisas futuras que contribuam para entender como deve se dar o cuidado prestado com empatia, porém sem prejudicar a saúde do profissional, devem ser realizadas.