O envelhecimento na perspectiva do cuidador de idosos

Este estudo relata a percepção de cuidadores de idosos que atuam em três instituições de amparo ao idoso na cidade de Araçatuba, São Paulo. Foram abordadas questões em relação ao envelhecimento, motivações pessoais dos cuidadores em buscar trabalho com essa parcela da população, relacionamento com o idoso, dificuldades durante o trabalho e a satisfação encontrada junto ao idoso. Realizou-se entrevista com os cuidadores, e o material verbal coletado foi analisado utilizando a técnica do Discurso do Sujeito Coletivo. Pôde-se perceber, através dos relatos, o envolvimento emocional do cuidador com seu trabalho, a sobrecarga física e emocional à qual está exposto. Relatos a respeito do envelhecimento também puderam ser coletados, além de questões de ordem social, que motivaram o cuidador a buscar esse tipo de trabalho. Os diversos olhares do cuidador nos impulsionam na busca de estratégias de capacitação teórica e suporte psicológico a esse grupo, pensando no seu bem-estar e no bem-estar do idoso.

Locomoção, distúrbios neuropsiquiátricos e alterações do sono de pacientes com demência e seus cuidadores

INTRODUÇÃO: Os distúrbios neurodegenerativos representam condições clínicas graves, por provocar declínio neuropsíquico. OBJETIVO: Analisar a prevalência dos distúrbios neuropsiquiátricos em pacientes com demência, em relação à sua locomoção (independentes vs. dependentes), e no que se refere ao desgaste emocional e à qualidade do sono dos cuidadores. MATERIAIS E MÉTODOS: Participaram do estudo 34 sujeitos, assim divididos: dez pacientes independentes para locomoção e sete dependentes (cadeirantes); dez cuidadores dos pacientes independentes e sete cuidadores de pacientes dependentes. Os sujeitos foram avaliados no Ambulatório de Neuropsiquiatria da Universidade Estadual de Campinas. Para avaliar as funções cognitivas, utilizou-se o CAMCOOG; para quantificar frequência, intensidade e desgaste do cuidador, aplicou-se o Inventário Neuropsiquiátrico; e para mensurar as alterações do sono dos cuidadores, foi utilizado o Miniquestionário do Sono. A análise estatística foi realizada por meio dos testes U - Mann Whitney e índice de correlação de Spearman, ambos com 5% de significância. RESULTADOS: Com relação à prevalência dos distúrbios neuropsiquiátricos entre os pacientes, observou-se diferença estatisticamente significativa entre os grupos, especificamente no que se refere à irritabilidade (p < 0,05) e ao escore total dos distúrbios neuropsiquiátricos (p < 0,01). Também foram encontradas diferenças entre os grupos de cuidadores, com relação às alterações do sono (p < 0,05). CONCLUSÃO: Idosos independentes para locomoção apresentam menor prevalência dos distúrbios neuropsiquiátricos, quando comparados a idosos dependentes de cadeira de rodas. A locomoção parece não influenciar no desgaste físico e emocional do cuidador, mas constitui uma variável relevante na qualidade do sono dos cuidadores de idosos com diagnóstico de demência vascular e mista.

Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial

OBJECTIVE: To analyze the effects of motor intervention on the neuropsychiatric symptoms of Alzheimer's disease and on the caregivers' burden. DESIGN: This is a controlled trial evaluating the effects of a motor intervention program on the neuropsychiatric symptoms. SETTING: The intervention was performed on community patients from two university centers specializing in physical exercise for the elderly. SUBJECTS: Patients with Alzheimer's disease were divided into two groups: sixteen received the motor intervention and sixteen controls (five controls were excluded because of clinical intercurrences). INTERVENTIONS: Aerobic exercises (flexibility, strength, and agility) and functional balance exercises were conducted over six months for 60 minutes three times per week. MAIN MEASURES: Psychopathological features of patients were evaluated with the Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Caregivers were evaluated using the Neuropsychiatric Inventory-Distress and Burden Interview. A two-way analysis of variance (ANOVA) was applied to observe interactions (pre- vs. post-intervention; participants vs. controls). RESULTS: Patients from the intervention presented a significant reduction in neuropsychiatric conditions when compared to controls (Neuropsychiatric Inventory: F: 11.12; p = 0.01; Cornell Depression scale: F: 11.97; p = 0.01). The burden and stress of caregivers responsible for patients who participated in the intervention significantly decreased when compared to caregivers responsible for controls (Neuropsychiatric Inventory-Distress: F: 9.37; p = 0.01; Burden Interview: F: 11.28; p = 0.01). CONCLUSIONS: Aerobic exercise was associated with a reduction in the neuropsychiatric symptoms and contributed to attenuate the caregivers' burden. However, the researchers were not blinded to the patient's intervention status, which constitutes an important limitation of this study.

Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia

INTRODUCTION: A significant benefit from physical activity has recently been described in some patients who suffer from neurodegenerative diseases. OBJECTIVE: To assess the effects of physical activity on neuropsychiatric disturbances in demented patients and on the mental burden of their caregivers. METHODS: Assisted by a public geriatric psychiatry clinical unit, we studied 59 patients with dementia. Patients were divided into three groups according to their diagnosis and level of physical activity. Data were assessed through a semi-structured interview. Patients were evaluated with the Neuropsychiatric Inventory, the Mini-Sleep Questionnaire and the Baecke Questionnaire. The data were statistically analyzed using the Mann-Whitney U test and linear regression, with the level of significance set at 5%. RESULTS: Patients with Alzheimer's or vascular dementia who engaged in physical activity had fewer neuropsychiatric symptoms than those who did not. When compared to the control group, the caregivers of patients with vascular dementia who engaged in physical activity had a reduced burden. CONCLUSION: The regular practice of physical activity seems to contribute to a reduction in neuropsychiatric symptoms in dementia patients and to attenuate the burden of the caregivers of those patients.

Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention

Background: Cognitive decline has a negative impact on functional activities in Alzheimer's disease. Investigating the effects of motor intervention with the intent to reduce the decline in functionality is an expected target for patients and caregivers. The aim of this study was to verify if a 6-month motor intervention programme promoted functionality in Alzheimer's patients and attenuated caregivers' burden. Methods: The sample comprised 32 community patients with Alzheimer's disease and their 32 respective caregivers. Patients were divided into two groups: 16 participated in the motor intervention programme and 16 controls. Subjects performed 60 minutes of exercises, three times per week during the 6-month period, to improve flexibility, strength, agility and balance. Caregivers followed the procedures with their patients during this period. Functionality was evaluated by the Berg Functional Balance Scale and the Functional Independence Measure. Caregivers completed the Neuropsychiatric Inventory Caregiver Distress Scale and the Zarit Carer Burden Scale. Two-way ANOVA was used to verify the interaction between time (pre- and post-intervention) and the motor intervention program. Results: While patients in the motor programme preserved their functionality, as assessed by the Functional Independence Measure, the controls suffered a relative decline (motor intervention group: from 109.6 to 108.4 vs controls: from 99.5 to 71.6; P= 0.01). Patients from motor intervention also had better scores than the controls on functional balance assessed by Berg scale (F: 22.2; P= 0.001). As assessed by the Neuropsychiatric Inventory and Zarit scale, burden was reduced among caregivers whose patients participated in the motor intervention programme compared with caregivers whose patients did not participate in this programme (Neuropsychiatric Inventory, caregiver's part: F: 9.37; P= 0.01; Zarit: F: 11.28; P= 0.01). Conclusion: Patients from the motor intervention group showed reduced functional decline compared to the controls, and there was an associated decrease in caregivers' burden.

Programa de apoio a cuidadores: uma ação terapêutica e preventiva na atenção à saúde dos idosos

Dans le cadre du service de gériatrie du Centre de Santé-école de la faculté de médecine de Botucatu (Université de São Paulo), a été établi un programme d'appui à ces soignants avec les objectifs suivants: préserver leur qualité de vie et favoriser de meilleures conditions familiales aux patients. Le programme comprend de 10 à 12 réunions par semaine, de deux heures de durée, coordonnées par deux psychologues. on utilise des techniques de psychodrame centrées sur le rôle du soignant et leurs conséquences sociales et émotionnelles. Les informations théoriques sont transmises au moyen de discussions de groupe et de moyens audiovisuels. Les thèmes suivants sont abordés : signification et motivation du soin donné, signaux d'alertes de fatigue physique et mentale du soignant, les possibilités de se traiter et de demander de l'aide, une méthode d'amélioration de la communication face à une déficience visuelle, auditive et cognitive, une méthode pour favoriser l'indépendance et l'autonomie et surmonter les problèmes relatifs à l'hygiène, la mobilité, l'agression, l'irritation, les hallucinations et les idées délirantes de la personne âgée. Au cours de la première réunion de chaque groupe (qui comprend de 10 à 20 participants) on applique une échelle d'évaluation de l'impact émotionnel sur les soignants (Zarit et al., 1980) et le SRQ (Self Report Questionnaire - Mari and Williams, 1986) qui identifient des désordres psychiatriques. Ces échelles sont reproduites à la fin du programme, pour observer d'éventuelles modifications. Les données obtenues indiquent des changements favorables dans l'expression d'émotions, l'établissement de limites et de retour à des activités de loisirs.

Experiences of family members regarding the oral health care of children

Este estudo objetivou verificar a compreensão das experiências dos familiares em relação ao cuidado com a saúde bucal das crianças. É estudo qualitativo, realizado em 2007, em distrito de saúde do município de Ribeirão Preto, SP, com 12 cuidadores. Utilizou-se referencial teórico da vulnerabilidade e a perspectiva hermenêutica. Três categorias empíricas foram elaboradas: os significados do cuidado com a saúde bucal, em busca das causas e da prevenção de agravos bucais e a realidade dos serviços de saúde bucal. Entre outros elementos potencializadores da vulnerabilidade infantil aos agravos bucais, emergiu a supervalorização da causalidade biológica, do atendimento de alta complexidade e da odontologia estética e, entre os protetores, a valorização do saber popular e a integração de ações e conhecimentos profissionais. Aponta-se para a revisão das estratégias de prevenção e promoção de saúde bucal, fornecendo elementos para auxiliar os serviços de saúde a reorganizarem o cuidado com a saúde bucal de crianças.

Efeito da capacitação dos cuidadores informais sobre a qualidade de vida de idosos com déficit de autocuidado

A proporção de idosos no Brasil vem crescendo consideravelmente e essa transição demográfica traz um quadro em que cada vez mais a sobrevivência deles fica dependente de seus familiares. Para aprimorar a qualidade de vida desse grupo há a proposta da elaboração de um programa de capacitação que contribua para melhorar os serviços prestados a estes indivíduos. O objetivo do presente estudo é avaliar um Programa de Capacitação para Cuidadores Informais na qualidade de vida de idosos. Foram realizadas visitas às residências de 15 idosos com déficit de autocuidado, onde foi aplicado o questionário SF-36. em seguida realizou-se um programa multiprofissional de capacitação para seus cuidadores. Após 2 meses aplicou-se novamente o questionário para verificar a eficácia do programa de capacitação na qualidade de vida dos idosos. Houve um aumento significativo dos escores relacionados ao domínio saúde mental e uma diminuição significativa dos relacionados às limitações por aspectos físicos. A partir dos dados obtidos concluiu-se que deve ser incentivada a formação de grupos de cuidadores informais, conduzidos por profissionais da área de saúde, para fomentar o conhecimento, a troca de experiências e a discussão sobre estratégias para melhorar o ato de cuidar.

Perfil de cuidadores de idosos e percepção sobre saúde bucal

O objetivo deste estudo foi avaliar o perfil e conhecimento sobre saúde bucal de profissionais cuidadores de idosos, que atuam em três asilos da cidade de Araçatuba. Foram entrevistados 18 cuidadores de três instituições, com o auxílio de um formulário, visando avaliar o grau de conhecimento destes quanto aos aspectos de saúde bucal. em relação à formação escolar, 83,3% desses profissionais possuem curso técnico de auxiliar de enfermagem e 16,7% não apresentam qualquer tipo de formação técnica. Mais da metade dos entrevistados (61,11%) relatou ter iniciado o trabalho por necessidade, não por afinidade. Quanto ao conhecimento em saúde bucal, detectou-se carência de informações, sendo que a maior parte necessita de esclarecimento quanto aos problemas mais prevalentes que ocorrem na boca e muitos deles (55,56%) acreditam que a perda dos dentes faz parte do envelhecimento. Constatou-se que os cuidadores precisam ser informados sobre aspectos de saúde bucal voltados para idosos.

Oral health of Alzheimer's patients in Sao Jose dos Campos, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Care arrangements for people with dementia in developing countries

Background: Rapid demographic ageing will soon lead to large increases in the numbers of persons with dementia in developing countries. This study is the first comprehensive assessment of care arrangements for people with dementia in those regions. Methods: A descriptive and comparative study of dementia care; caregiver characteristics, the nature of care provided, and the practical, psychological (Zarit Burden Interview, General Health Questionnaire) and economic impact upon the caregiver in 24 centres in India, China and South East Asia, Latin America and the Caribbean and Africa. Results: We interviewed 706 persons with dementia, and their caregivers. Most caregivers were women, living with the person with dementia in extended family households. One-quarter to one-half of households included a child. Larger households were associated with lower caregiver strain, where the caregiver was co-resident. However, despite the traditional apparatus of family care, levels of caregiver strain were at least as high as in the developed world. Many had cutback on work to care and faced the additional expense of paid carers and health services. Families from the poorest countries were particularly likely to have used expensive private medical services, and to be spending more than 10% of the per capita GNP on health care. Conclusions: Older people in developing countries are indivisible from their younger family members. The high levels of family strain identified in this study feed into the cycle of disadvantage and should thus be a concern for policymakers in the developing world. Copyright © 2004 John Wiley & Sons, Ltd.

O papel do enfermeiro como educador junto a cuidadores familiares de pessoas com AVC.

This article was written based on bibliographical research aiming at making a thematic analysis of the production of knowledge in newspapers and magazines about the nurse's role as an educator toward people who care for BVA (brain vascular accident) patients. The analysis gathered articles published in the 80's and 90's, from the Medline, Lilacs and Cinahl databases. Content analysis was the methodological background that allowed the organization of knowledge in two categories: educational intervention in the acute stage and the post-discharge support.

Construction and validation of the brazilian questionário de respostas socialmente habilidosas segundo relato de professores (QRSH-PR)

Behavioral problems in preschool children are one of the most frequent motives for seeking psychological care by parents and caregivers. Instruments are considered necessary, created from a Social Skills Training theoretical-practical perspective, which may systematically assist the identification of social skills and behavioral deficits, helping professionals in the prevention and/or reduction of behavioral problems. The purpose of this study was to test the psychometric validity and reliability of an instrument for evaluation of Socially Skilled Responses, from a teacher's perspective (QRSH-PR For this purpose, 260 preschool children were evaluated, differentiated in subgroups without and without behavioral difficulties, based on the Child Behavior Scale (Escala de Comportamento Infantil/ECI-Professor Studies were conducted for construct, discrimination, concurrent and predictive validity. The Cronbach Alpha was calculated to evaluate internal consistency. The obtained results pointed to positive indicators in reference to construct, discrimination, and predictive validity, and even for good internal consistency, indicating that the items consistently measure the construct of social skills, and differentiated children with and without behavioral problems. The questionnaire is considered to be gauged for evaluation of socially skilled responses from preschool children, and applicable in educational and clinical environments. Copyright 2009 by The Spanish Journal of Psychology.

Clinical and microbiological evaluation of the use of toothpaste containing 1% chlorhexidine and the influence of motivation on oral hygiene in patients with motor deficiency

Patients with motor deficiency have variable difficulties with mechanical plaque control, and as a consequence, the incidence of dental caries and periodontal disease can be higher in these patients. The objective of this study was to evaluate the clinical and microbiological efficacy of a toothpaste containing 1% chlorhexidine, which was used by patients with motor deficiency for 14 days. The reduction in plaque and gingival index and the impact on salivary microorganisms was evaluated. We conclude that the motivation of caregivers to carry out oral hygiene for patients with mental and motor deficiency is of great importance and is effective in reducing the formation of plaque as long as it is continuously reinforced. The use of chlorhexidine- containing toothpaste significantly reduced the plaque index and microorganism count between days 0 and 14. A reduction was also observed in the group that used a dentifrice without the chlorhexidine, but this difference was not significant. © 2010 Special Care Dentistry Association and Wiley Periodicals, Inc.

Dornase alfa improves the health-related quality of life among Brazilian patients with cystic fibrosis - A one-year prospective study

Background: Health-related quality of life (HRQOL) measurements provide valuable information about the psychological and social impact of treatment on patients with cystic fibrosis (CF). This study evaluated the HRQOL of Brazilian patients with CF and assessed the changes in HRQOL domains over 1 year after dornase alfa (Pulmozyme) introduction. Patients and Methods: One hundred fifty-six stable patients with CF and 89 caregivers answered the Portuguese-validated version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (T 0), and at 3 (T 1), 6 (T 2), 9 (T 3), and 12 (T 4) months of follow-up. Eighteen patientswere excluded because they did not fulfill the inclusion criteria. The patients were analyzed in two groups: those aged 6-11 years and those aged 14 years and older. ANOVA for observed repeated results and the last observation carried forward (LOCF) method for missing data were used for the statistical analysis. Results: After 1 year of follow-up, there was significant improvement in respiratory symptoms (T 4-T 0=8.1; 95% confidence interval (95% CI)=[2.1;14.0]; effect size (ES)=0.35; P<0.001), Emotional Functioning (T 4-T 0=5.6; 95% CI=[1.1;10.1]; ES=0.31; P<0.05), Social Functioning (T 4-T 0=6.0; 95% CI=[1.3;11.7]; ES=0.31; P<0.05), Body Image (T 4-T 0=11.9; 95% CI=[4.1;19.7]; ES=0.42; P<0.05), and Treatment Burden (T 4-T 0=5.3; 95% CI=[0.3;10.3]; ES=0.24; P<0.05) domains in the younger group. A significant improvement in Role Functioning (T 4-T 0=6.1; 95% CI=[1.1;11.1]; ES=0.40; P<0.05), Body Image (T 4-T 0=12.6; 95% CI=[3.5;21.7]; ES=0.46; P<0.05), and Weight (T 4-T 0=11.7; 95% CI=[1.8;21.6]; ES=0.40; P<0.05) was obtained in the older group. The caregivers' CFQ-R showed improvements in the Digestive Symptoms (T 4-T 0=5.5; 95% CI=[1.5;9.4]; ES=0.30; P<0.05), Respiratory Symptoms (T 4-T 0=7.6; 95% CI=[3.9;11.4]; ES=0.48; P<0.05), and Weight (T 4-T 0=10.1; 95% CI=[1.6;18.6]; ES=0.26; P<0.05) domains. Conclusion: The introduction of dornase alfa improved the HRQL of the patients with CF during the first year of treatment. © 2010 Wiley-Liss, Inc.