Associação dos parâmetros clínicos de sarcopenia e comprometimento cognitivo em pessoas idosas: estudo transversal / Association of clinical parameters of sarcopenia and cognitive impairment in older people: cross-sectional study

Resumo Objetivo Associar os parâmetros clínicos de sarcopenia com o comprometimento cognitivo em pessoas idosas. Método Estudo transversal, com 263 idosos (≥60 anos) usuários de um serviço público de atenção especializada. Variáveis sociodemográficas e clínicas caracterizaram a amostra e os parâmetros clínicos de sarcopenia (força, massa muscular e desempenho físico) foram avaliados, respectivamente, por meio da Força de Preensão Palmar (FPP), circunferência da panturrilha (CP) e o Teste Timed Up and Go (TUG). Utilizou-se o Miniexame do Estado Mental (MEEM) para avaliar o estado cognitivo. As associações foram investigadas por regressões lineares e logísticas simples e múltiplas considerando os parâmetros clínicos de sarcopenia (variáveis independentes) e o estado cognitivo (variável dependente), ajustadas para idade, sexo, anos de estudo, número de medicação, estado nutricional e capacidade funcional. Resultados Dos participantes com comprometimento cognitivo, 59,6% apresentaram baixa força muscular. O Conclusão A baixa força muscular foi o parâmetro de sarcopenia independentemente associado ao comprometimento cognitivo. Essa informação é útil para atentar-se para a probabilidade de comprometimento cognitivo quando identificada baixa força muscular em pessoas idosas.

Abstract Objective To associate clinical parameters of sarcopenia with cognitive impairment in older people. Method Cross-sectional study with 263 older adults (≥60 years) treated at a specialized public health facility. Sociodemographic and clinical variables were used to characterize the sample and the clinical parameters of sarcopenia (muscle strength, muscle mass and physical performance) were assessed based on handgrip strength (HGS), calf circumference (CC) and the Timed Up and Go (TUG) test. The Mini-Mental State Examination (MMSE) was used to evaluate cognitive status. Associations were analyzed by simple and multiple linear and logistic regression considering the clinical parameters of sarcopenia (independent variables) and cognitive status (dependent variable), adjusted for age, sex, years of schooling, number of medications, nutritional status and functional capacity. Results Of participants with cognitive impairment, 59.6% exhibited low muscle strength. Conclusion Low muscle strength was the sarcopenia parameter independently associated with cognitive impairment. This information is useful in highlighting the likelihood of cognitive impairment when poor muscle strength is identified in older people.

Nivel de dependencia funcional de los adultos mayores de la comunidad de Tula de Allende / Level of functional dependence of older adults in the community of Tula de Allende

Introducción: El estado funcional se mide mediante la autonomía que tienen las personas para desarrollar las actividades de la vida diaria, cuando no se pueden realizar de manera autónoma es necesario un cuidador. Esta medida se sustenta en el modelo de adaptación de Sor Callista Roy, ya que se identifica el proceso de envejecimiento como el estímulo focal que produce una respuesta inmediata en el adulto mayor de acuerdo con el modo de interdependencia. Objetivo: Conocer el nivel de dependencia funcional de los adultos mayores de la comunidad de Tula de Allende, Hidalgo. Material y métodos: Estudio de aplicabilidad básica, cuantitativo, descriptivo y trasversal. Participaron 366 adultos mayores de Tula de Allende, y se les dio a conocer los términos de confidencialidad conforme a lo establecido en la Ley General de Salud y Declaración de Helsinki mediante el consentimiento informado. Se aplicó el cuestionario de Índice de Barthel (IB), para medir la dependencia funcional en las actividades instrumentales de la vida diaria. Resultados: Predomina el género femenino con el 52.7% representado por 193 participantes, la mayoría son casadas y amas de casa. De acuerdo con el IB la mayoría de los participantes tiene una dependencia leve, con una frecuencia de 206 y un porcentaje de 56.3%, y el cruce de variables arroja como resultado una relación significativa. Conclusión: Los adultos mayores de la comunidad de Tula de Allende presentan un nivel de dependencia funcional leve.

Introduction: Functional status assesses people's ability to carry out daily activities; when these cannot be performed autonomously, a caregiver is necessary. This measure is based on the Roy Adaptation Model, which identifies the aging process as the focal stimulus that generates an effect according to the interdependence mode. Objective: To evaluate the level of functional dependence of the elderly in the community of Tula de Allende, Hidalgo. Material and methods: Quantitative, descriptive, and cross-sectional study of basic applicability. 366 older adults from Tula de Allende participated and were informed about confidentiality terms in accordance with the General Health Law and the Declaration of Helsinki through informed consent. The Barthel Index (BI) questionnaire was applied to measure functional dependence on daily instrumental activities. Results: The female gender predominates with 52.7% represented by 193 participants, the majority are married housewives. According to the BI, most of the participants have a slight dependency, with a frequency of 206 and a percentage of 56.3%; the correlation of variables showed statistical significance. Conclusion: Older adults in the community of Tula de Allende present a mild functional dependence level.

Grado de satisfacción e impacto social y medioambiental en pacientes incluidos en un programa de seguimiento remoto de marcapasos / Degree of satisfaction and social and environmental impact in patients included in a remote pacemaker monitoring program

Resumen Objetivo: Describir el grado de satisfacción y el impacto sociolaboral y medioambiental de los pacientes de un programa de seguimiento remoto de marcapasos. Método: Estudio observacional prospectivo que incluyó 160 pacientes del programa de seguimiento remoto entre 2016 y 2017. Se pasó una encuesta de satisfacción a dichos pacientes y se cuantificó la disminución del CO2 emitido al reducir el número de visitas. Resultados: Los pacientes acudían acompañados (86%) y en coche (66%) la mayoría de las veces, y mostraron un grado de satisfacción «bueno o excelente¼ en un 96%. Se estima un ahorro de emisión de CO2 de casi un 10% por ciclo de seguimiento. Conclusiones: El seguimiento remoto de marcapasos implantado en nuestra unidad de arritmias reduce el impacto sociolaboral, económico y medioambiental.

Abstract Objective: To describe the degree of satisfaction and social, occupational and environmental impact of patients on our remote pacemaker monitoring programme run. Method: Prospective observational study including 160 patients on the remote pacemaker monitoring programme between 2016 and 2017. We handed out a satisfaction survey and quantified the decrease in CO2 emitted by reducing the number of visits. Results: The patients attended visits accompanied (86%) and by car (66%) most of the time. 96% of respondents said their degree of satisfaction was "good or excellent". We estimated a saving in CO2 emissions of almost 10% for each remote monitoring cycle. Conclusions: The remote monitoring of pacemakers implemented by our arrhythmia unit reduces the social, occupational, financial and environmental impact.

Care to the dependent older person: motivations of caregivers in Brazil and Portugal / O cuidado ao idoso dependente: motivações de cuidadores do Brasil e Portugal / Cuidando a los dependientes mayores: motivaciones de cuidadores en Brasil y Portugal

In an attempt to fulfill care needs to the elderly, the family usually assumes this function. In order to understand the social representations of informal caregivers of Brazilian and Portuguese elderly people about the motivations for care, a qualitative, exploratory-descriptive research was carried out, based on the Social Representations Theory, in which 21 informal Brazilian caregivers and 11 informal Portuguese caregivers of elderly dependents were interviewed. Thematic Content Analysis and QSR NVivo® software were used in the treatment of the data, and the results showed care as the main motivation: family relationships, in which marriage, parenting, and the affections resulting from these relationships led to the function; the negative representation of Portuguese caregivers on the home, as a place of abandonment and action contrary to the cultural norm; and the representation of the elderly as frail and dependent, who, like children, constantly need care and attention.

Na tentativa de suprir as necessidades de cuidado destinado ao idoso, a família comumente é a instituição que assume tal função. Com o objetivo de compreender as representações sociais dos cuidadores informais de idosos brasileiros e portugueses acerca das motivações para o cuidado, realizou-se uma pesquisa qualitativa, exploratória e descritiva, fundamentada na Teoria das Representações Sociais, em que foram entrevistados 21 cuidadores informais brasileiros e 11 cuidadores informais portugueses de idosos dependentes. Utilizaram-se a análise de conteúdo temática e o software QSR NVivo® no tratamento dos dados, e os resultados evidenciaram como principais motivações o cuidado: as relações familiares, em que o matrimônio, a parentalidade e os afetos decorrentes dessas relações conduziram a função; a representação negativa dos cuidadores portugueses sobre o lar como local de abandono e ação contrária à norma cultural; e a representação da pessoa idosa como frágil e dependente, que, assim como as crianças, precisa constantemente de cuidados e atenção.

En un intento por atender las necesidades de cuidado de las personas mayores, la familia suele ser la institución que asume esta función. Para comprender las representaciones sociales de los cuidadores informales de ancianos brasileños y portugueses sobre las motivaciones del cuidado, se realizó una investigación cualitativa, exploratoria-descriptiva, basada en la Teoría de las Representaciones Sociales, en la que 21 cuidadores informales brasileños y 11 informales portugueses Se entrevistó a los cuidadores de ancianos dependientes. En el tratamiento de los datos se utilizó el software de Análisis de Contenido Temático y QSR NVivo® y los resultados se mostraron como las principales motivaciones: las relaciones familiares, en las que el matrimonio, la paternidad y los afectos resultantes de estas relaciones condujeron a la función; la representación negativa de los cuidadores portugueses en el hogar, como lugar de abandono y acción contraria a la norma cultural; y la representación de los ancianos como frágiles y dependientes, quienes, como los niños, necesitan cuidados y atenciones constantes.

Relação entre dependência para realização de atividades básicas de vida diária e risco de sarcopenia em idosos internados / Relationship between dependence to carry out basic activities of daily living and risk of sarcopenia in elderly hospitals

O processo de envelhecimento pode ser influenciado pelo estilo de vida adotado pelo indivíduo e os determinantes sociais de saúde, acarretando em limitações oriundas de alterações morfológicas, funcionais, biológicas e psicológicas, que podem ser intensificadas durante um processo de internamento hospitalar. Objetivo: Analisar a prevalência e a relação entre dependência para realização de atividades básicas de vida diária e risco de sarcopenia em idosos internados. Método: Estudo transversal, de caráter quantitativo, realizado junto a idosos internados nos setores de clínica médica e cirúrgica, no período de março de 2021 a junho de 2021, em um hospital universitário do Paraná. Aplicou-se o instrumento sociodemográfico, Escala Índice de Katz para avaliar a capacidade funcional do idoso em relação às atividades básicas de vida diária (ABVD), Questionário SARC-F para selecionar risco de sarcopenia, avaliação da força muscular com o dinamômetro e mensuração da circunferência da panturrilha como preditor da quantidade e função muscular. Realizou-se análise teste qui-quadrado e regressão logística. Resultados: A amostra final compreendeu 162 idosos, com predomínio do sexo masculino (55,6%) e com idade entre 60 e 69 anos (59,9%). A prevalência de dependentes para realização de ABVD foi de 66,7% e para risco de sarcopenia 61,7%. Verificou-se que idosos com risco de sarcopenia dispunham de 3,8 mais chances de ser dependentes para realização de ABVD (p<0,001). Conclusão: Identificou-se alta prevalência para dependência na realização de ABVD e risco de sarcopenia, sendo essas condições associadas. Idosos com dependência para realização de ABVD apresentaram maior risco de sarcopenia.

The aging process can be influenced by the lifestyle adopted by the individual and the social determinants of health, resulting in limitations arising from morphological, functional, biological and psychological changes, which can be intensified during a hospitalization process. Objective: To analyze the prevalence and relationship between dependence to perform basic activities of daily living and risk of sarcopenia in hospitalized elderly. Method: Cross-sectional, quantitative study, carried out with elderly hospitalized in the medical and surgical sectors, from March 2021 to June 2021, in a university hospital in Paraná. We applied the sociodemographic instrument, Katz Index Scale to assess the functional capacity of the elderly in relation to basic activities of daily living (BADL), SARC-F Questionnaire to select the risk of sarcopenia, assessment of muscle strength with a dynamometer and measurement of Calf circumference as a predictor of muscle quantity and function. Chi-square test and logistic regression analysis were performed. Results: The final sample comprised 162 elderly, predominantly male (55.6%) and aged between 60 and 69 years (59.9%). The prevalence of dependents for performing BADL was 66.7% and for sarcopenia risk 61.7%. It was found that elderly people at risk of sarcopenia had 3.8 more chances of being dependent to perform BADL (p<0.001). Conclusion: We identified a high prevalence of dependence in performing BADL and risk of sarcopenia, these conditions being associated. Elderly people with dependence to perform ABVD had a higher risk of sarcopenia.

Representações sociais de cuidadores de idosos brasileiros e portugueses sobre o cuidar / Social representations of brazilian and portuguese elderly caregivers about caring

A demanda pelos cuidados se estabelece e, com isso, a instituição familiar é requisitada a prestar assistência ao seu familiar. O objetivo foi analisar as Representações Sociais de cuidadores de idosos com dependência funcional do Brasil e de Portugal sobre o ato de cuidar. Trata-se de um estudo exploratório-descritivo com abordagem qualitativa fundamentada na Teoria das Representações Sociais. Os participantes foram 21 cuidadores familiares brasileiros e 11 cuidadores informais portugueses de idosos dependentes. A coleta foi realizada por meio da entrevista e utilizou-se a Análise de Conteúdo proposta por Bardin (2011), com auxílio do software QSR NVivo® versão 11 A partir da análise, emergiram duas categorias: "Suprir necessidade e ser vigilante" e "Dedicação e amor". Percebeu-se como a influência histórico-cultural e até mesmo moral-religiosa das construções sociais incidem sobre a família e os seus posicionamentos.(AU)

The demand for care is established and, as a result, the family institution is required to provide assistance to its family member. The objective was to analyze the Social Representations of caregivers of elderly people with functional dependence in Brazil and Portugal on the act of caring. This is an exploratory-descriptive study with a qualitative approach based on the Theory of Social Representations. Participants were 21 Brazilian family caregivers and 11 informal Portuguese caregivers of dependent elderly people. The collection was carried out through the interview and the Content Analysis proposed by Bardin was used with the aid of the QSR NVivo® software version 11. From the analysis, two categories emerged: "Supply needs and vigilancy" and "Dedication and love". It was perceived how the influence of historical-cultural and even moral-religious in the social constructions affects the family and its positions.(AU)

Buenas prácticas en la visita domiciliaria integral en atención primaria chilena / Good practices in the integral home care visits in Chilean primary care

La atención del paciente en el domicilio, constituye una excelente alternativa de salud, con múltiples beneficios demostrados, en especial para un grupo de pacientes con dificultades de acceso. El objetivo principal de una visita domiciliaria integral (VDI) es favorecer el autocuidado en salud, ofreciendo una atención de salud centrada en la persona y su familia, considerando las variables biopsicosociales, facilitando el acceso a la atención y redes de apoyo, mejorando así su calidad de vida y potenciando su recuperación y rehabilitación. Una VDI, consta de tres etapas: planificación previa de la visita en base a los motivos de consulta principales; la ejecución de la visita en sí, en la cual se busca generar el vínculo, observar el ambiente familiar y priorizar los problemas biopsicosociales para lograr cambios e intentar mejorar la situación; y por último, realizar un monitoreo y evaluación del caso. El objetivo de este artículo es brindar una breve sistematización al equipo de salud de atención primaria de salud, para que puedan comprender la relevancia y el proceso del desarrollo de una VDI, sumado a síntesis de buenas prácticas para el trabajo eficiente en equipo

Home care visits are an excellent chance of health attention, with multiple proven benefits, specially, for a group of patients with access difficulties. The main objective of an integral home care visit is to promote self-care in health, offering a person and family centered care, taking in consideration biopsychosocial variables, facilitating the access to healthcare systems and support networks, improving their quality of life and enhancing their recovery and rehabilitation. An integral home care visit, has mainly three stages: planification of the visit with anticipation according to the main complaints; the execution of the visit itself, which seeks to create an initial bond, observe the family and domestic environment, prioritize biopsychosocial problems to achieve changes and try to improve the situation; and at last, to monitor and evaluate the case. The objective of this article is to provide a brief systematization to the primary health care team, so that they can understand the relevance and the process of developing an integral home care visit, added to a synthesis of good practices to achieve an efficient interdisciplinary team work.

Comportamiento de la dependencia en el adulto mayor del Hogar de ancianos "Lidia Doce" / Behavior of the dependence in elderly at home day care "Lidia Doce" / Comportamento de dependência em idosos do asilo "Lidia Doce"

RESUMEN En últimas décadas se ha observado un aumento sostenido de la población de adultos mayores. Los cambios resultantes del envejecimiento dan una nueva visión sobre el cuidado de estos adultos, lo que requiere priorizar la independencia funcional y de autonomía. Con el propósito de determinar el comportamiento de la dependencia del adulto mayor se realizó un estudio descriptivo transversal, en adultos mayores pertenecientes al Hogar de ancianos "Lidia Doce Sánchez", durante los meses de mayo - julio de 2020. Las variables en estudio: edad, sexo, antecedentes personales y grado de dependencia. Se utilizó: el porcentaje, la media y la desviación estándar. Prevaleció el sexo masculino (72,7 %) y una edad promedio de 76,5 ± 9,9 años. El principal antecedente personal fue la Hipertensión arterial (65,9 %). El 68,2 % fueron dependientes para realizar las actividades de la vida diaria; 28,8 % problemas ligeros y 23,5 % problemas moderados. Los adultos institucionalizados en el Hogar de Ancianos "Lidia Doce" de Bayamo, del sexo masculino y edades comprendidas entre 70 y 89 años, son dependientes para realizar actividades básicas de la vida diaria. El grado de dependencia aumenta con la edad.

ABSTRACT Within the last decades, there has been a constant increase of the elderly. The changing results of aging give us a different approach about these adults care, which require the priority of the autonomy and functional independence, to determine the behavior of dependence in elderly. A descriptive and transversal design study was performed at "Lidia Doce Sánchez" home daycare, Granma province, from May - July 2020. The variables measured were: age, sex, past medical history and dependence degree. It was used from the statistic: percentage, mean and Gamma Coefficient. The male sex prevail (72. 7 %) and the average age 76. 5 ± 9, 9 years. The main personal history was Hypertension (65. 9 %). 68. 2 % showed dependence to the daily life activities; 28.8 % light problems and 23.5 % moderate problems. The institutionalize elderly at "Lidia Doce" home daycare, belong to male sex, between 70-89 years be unable to daily life activities. The dependence degree has increased with the ages.

RESUMO Nas últimas décadas, observa-se um aumento sustentado da população idosa. As mudanças decorrentes do envelhecimento proporcionam uma nova visão do cuidado a esses adultos, o que requer priorização da independência e autonomia funcional. A fim de determinar o comportamento de dependência dos idosos, foi realizado um estudo descritivo transversal em idosos pertencentes à Casa de Saúde "Lidia Doce Sánchez", durante os meses de maio a julho de 2020. Variáveis ​​em estudo: idade, sexo, história pessoal e grau de dependência. Foram utilizados: a porcentagem, a média e o desvio padrão. Prevaleceu o sexo masculino (72,7%) e média de idade de 76,5 ± 9,9 anos. A principal história pessoal foi hipertensão arterial (65,9%). 68,2% eram dependentes para realizar atividades de vida diária; 28,8% problemas leves e 23,5% problemas moderados. Os adultos internados na Casa de Saúde "Lidia Doce" em Bayamo, do sexo masculino e com idade entre 70 e 89 anos, são dependentes para a realização de atividades básicas da vida diária. O grau de dependência aumenta com a idade.

Dependencia funcional y diabetes mellitus tipo 2 en adultos mayores afiliados al Seguro Social de Salud del Perú: análisis de la ENSSA-2015 / Functional dependence and type 2 diabetes mellitus in elderly subjects covered by Peruvian Social Security: analysis of ENSSA-2015

RESUMEN Objetivo: estimar la prevalencia de dependencia funcional y evaluar su asociación con la diabetes mellitus tipo 2 (DM) en adultos mayores afiliados al Seguro Social de Salud (EsSalud) del Perú en 2015. Materiales y métodos: análisis secundario de los datos de la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud 2015 (ENSSA-2015), una encuesta de hogares con muestreo probabilístico bietápico, representativa a nivel nacional de la población de afiliados a EsSalud. Se incluyeron adultos mayores (60 años a más) afiliados EsSalud. La dependencia funcional fue evaluada mediante el índice de Katz (≥ 1 punto). La DM fue evaluada mediante autorreporte del participante. Se estimaron razones de prevalencia ajustadas (RPa) por potenciales factores de confusión mediante regresión log-Poisson múltiple junto con sus intervalos de confianza al 95% (IC 95%) y valores p. Todos los análisis tuvieron en cuenta el muestreo complejo de la ENSSA-2015. Resultados: se incluyeron 10 985 participantes de 12 805 elegibles en el análisis. Las prevalencias de dependencia funcional parcial y severa fueron de 12,9% (IC 95%: 11,9-13,8) y 6,0% (IC 95%: 5,3-6,7), respectivamente. La prevalencia de dependencia funcional (parcial o severa) en diabéticos fue 23% mayor que la de no diabéticos, luego de controlar por potenciales factores de confusión (RPa-1,23; IC 95%: 1,04-1,44; p=0,013). Conclusiones: cerca de uno de cada cinco adultos mayores afiliados a EsSalud tuvieron algún grado de dependencia funcional (parcial o severa). Asimismo, la DM estuvo asociada con una mayor probabilidad de tener dependencia funcional en esta población.

ABSTRACT Objective: to estimate the prevalence of functional dependence and to assess its association with type 2 diabetes mellitus (DM) in elderly subjects registered in Peruvian Social Security (EsSalud) in 2015. Materials and methods: this is a secondary analysis of the National Socioeconomic Healthcare Access Survey performed in EsSalud members in 2915 (ENSSA-2015), a survey performed in households using two-stage probabilistic sampling that was representative at a national level of population registered in EsSalud. Functional dependence was assessed using the Katz index (≥ 1 point). DM was determined by participants' self- report. Adjusted prevalence rates (aPR) were estimated according to potential confounding factors using multiple log-Poisson regression alongside their 95% confidence intervals (CI) and p-values. All analyses took into account the complex sampling used in ENSSA-2015. Results: nearly eleven thousand participants (10,985) out of 12,805 eligible subjects were included in the analysis. Prevalence values for partial and severe functional dependence were 12.9% (95% CI: 11.9-13.8) and 6.0% (95% CI: 5.3-6.7), respectively. The prevalence of functional dependence (partial or severe) in diabetic subjects was 23% higher than that of non-diabetics, after controlling for potential confounding factors (aPR 1.23; 95% CI: 1.04-1.44; p= 0.013). Conclusions: nearly one of five elderly subjects registered in EsSalud had some degree of functional dependence (partial or severe). Also, DM was associated with a greater likelihood for having functional dependence in this population.

Independência funcional entre comportamentos de falante e ouvinte relativos a paisagens desconhecidas / Functional independence between speaker-listener behaviors related to unknown landscapes / Independencia funcional entre comportamientos de hablante y oyente relacionados a paisajes desconocidos

Este estudo investigou o efeito de treinos sucessivos na emissão não treinada de comportamentos de ouvinte e falante após o treino do outro operante. Doze adultos universitários típicos foram divididos em dois grupos com base na ordem de exposição aos treinos e testes em três fases experimentais. Os participantes do Grupo Ouvinte-Falante passaram por treinos de ouvinte e testes de falante, e os demais foram submetidos a treinos e testes na ordem inversa. Os cinco estímulos utilizados por fase foram palavras inventadas e paisagens desconhecidas por eles. Os participantes do Grupo Falante-Ouvinte atingiram o critério de dependência funcional nas três fases experimentais. No outro grupo, apenas um integrante apresentou dependência funcional na primeira fase experimental, sendo observada melhora gradual no desempenho nos testes ao longo do experimento para os demais. Discutiu-se a eficácia dos treinos sucessivos na ocorrência de dependência funcional condicionalmente a aspectos do procedimento...(AU)

This study investigated the effect of successive training on the untrained emission of listener and speaker behaviors after the training of the other operant. Twelve typical undergraduates were divided into two groups based on order of training and testing in three experimental phases. The participants of the Listening-Speaker Group underwent listener training and speaker test; and the other participants were subjected to training and tests in the reverse order. The five stimuli used per phase were invented words and unknown landscapes. The participants of the Speaker-Listener Group reached the criterion of functional dependence in the three experimental phases. In the other group, only one participant presented functional dependence in the first experimental phase, with a gradual improvement in performance in the tests throughout the experiment for the remaining subjects. The efficacy of successive training in the occurrence of functional dependence associated to aspects of the procedure was discussed...(AU)

El presente estudio investigó el efecto de los entrenamientos sucesivos en la emisión no entrenada de las conductas del oyente y el hablante después del entrenamiento del otro operante. Se dividieron doce universitarios adultos típicos en dos grupos según el orden de entrenamiento y los test en tres fases experimentales. Los participantes del Grupo Oyente-Hablante pasaron por entrenamientos de oyentes y test de los hablantes; y los otros participantes se sometieron a entrenamientos y test en el orden inverso. Los cinco estímulos utilizados por fase fueron palabras inventadas y paisajes desconocidos por ellos. Los participantes del Grupo Hablante-Oyente alcanzaron el criterio de dependencia funcional en las tres fases. En el otro grupo, solo un participante presentó dependencia funcional en la primera fase, con una mejora gradual en el rendimiento en los test a lo largo del experimento para los demás. Se discutió la eficacia de los entrenamientos sucesivos en la aparición de dependencia funcional condicionalmente a aspectos del procedimiento...(AU)

Dependencia funcional y su relación con la mortalidad general en adultos mayores. México: 2001-2015 / Functional dependence and its relationship to general mortality in older adults. Mexico: 2001-2015

Resumen Objetivo: El objetivo de este artículo es estimar las probabilidades de transición entre los diversos grados de dependencia funcional, así como la capacidad predictiva de dicha dependencia para la mortalidad general de hombres y mujeres de 65 años y más residentes en México. Métodos: Mediante probabilidades se calculan transiciones entre diversos grados de dependencia funcional y, con modelos de riesgos proporcionales de Cox, se estiman los riesgos relativos de mortalidad. Resultados: Los resultados indican que las mujeres tienen mayores probabilidades de transitar de dependencia funcional ligera a moderada o severa que los hombres. Así mismo, las mujeres y los hombres con dependencia funcional severa, evaluada en la línea basal, tienen mayores riesgos relativos de mortalidad que los riesgos de mortalidad de los individuos sin dependencia funcional. Conclusión: Existen diferencias en las probabilidades de transición a la dependencia funcional, destacando que las mujeres muestran mayores probabilidades de transitar a mayores grados de restricciones físicas que los hombres. En este sentido, tener limitaciones físicas en el desarrollo de actividades básicas de la vida diaria incrementa los riesgos de mortalidad entre personas adultas mayores mexicanas.

Abstract Objective: The objective of this article is to estimate the probabilities of transition between different degrees of functional dependence, as well as the predictive capacity of this dependence for general mortality of women and men living in Mexico aged 65 and over. Methods: By means of probabilities, transitions between different degrees of functional dependence are calculated and, with proportional Cox risks models, the relative risks of mortality are estimated. Results: The results indicate that women are more likely to move from mild functional dependence to moderate or severe functional dependence than men. Likewise, women and men with severe functional dependence, assessed at the baseline, have higher relative risks of mortality than the mortality risks of individuals without functional dependence. Conclusion: There are differences in the probabilities of transition to functional dependence, noting that women are more likely to move to higher degrees of physical restraint than men. In this sense, having physical limitations in the development of basic activities of daily living increases mortality risks among Mexican elderly.

Apoyo social percibido y dependencia funcional en el adulto mayor con dolor / Perceived social support in the elderly with pain

Resumen En la actualidad la prevalencia de dolor en el adulto mayor constituye un problema de salud pública. Esta condición del doliente, en ocasiones tiende agravarse con el tiempo, limitan las actividades diarias del individuo y generan un impacto psicológico, social, familiar y laboral. El objetivo de este artículo es describir el nivel dependencia funcional y apoyo social percibido en el adulto mayor con dolor. Metodológicamente se concibe como una investigación transversal descriptiva con muestreo no probabilístico por conveniencia con una muestra de 200 adultos mayores de Bucaramanga. Se aplicó el instrumento de apoyo social percibido, la prueba Barthel y el cuestionario Mcguill. Como resultado se obtuvo que hay una mayor prevalencia de mujeres, casadas, en edades entre los 65 y 75 años, pertenecientes a estratos 3, con nivel de escolaridad sin finalización de básica primaria. Los participantes describen su dolor en mayor medida como brusco 58,5 %, cruel 71,5 % y molesto 61,0 %. La mayoría tiene altos niveles de apoyo social y el 86,5 % son totalmente independientes.

Abstract Currently, the prevalence of pain in the elderly constitutes a public health problem, since these disorders tend to worse over time, limiting the daily activities of the individual and generating a psychological, social, family and work impact. Objective: Describing the functional dependence level and the perceived social support in the elderly with pain. Methodology: transversal descriptive research with non-probability convenience sampling, with a sample of 200 older adults from bucaramanga. the instrument of perceived social support, the Barthel test and the McGill questionnaire were applied. The results indicate higher prevalence of 69% women, married, with ages between 65 and 75 years, belonging to social strata 3, with a level of education without the elementary school complete. that participants describe their pain as abrupt 58.5%, 71.5% cruelly, 61.0% Most have high levels of social and 86.5% is totally independent.

Dependencia funcional y dolor crónico asociados a la calidad de vida del adulto mayor / Functional dependence and chronic pain associated with the quality of life among the elderly

Resumen Objetivo: En la medida que la población va envejeciendo, la presencia de enfermedades crónicas, dolores y discapacidades va aumentando; estas afecciones cuentan con un bajo pronóstico de cura, lo cual lleva a complicaciones en el desempeño de las actividades de la vida diaria, dificul tando la independencia y la autonomía de quien las padece. Actualmente más de 868 millones de personas superan los 60 años. Se habla de casi un 12 % del total de la población mundial, y para el año 2050, se estima que haya un incremento del 21 %, equiparando el porcentaje de los menores de 15 años. Esta proyección supone nuevos retos sociales y una respuesta del sistema de salud, que permita favorecer entre los envejecidos, procesos de adaptabilidad y crecimiento psi cosocial. Objetivo: Identificar la asociación existente entre la dependencia funcional entendida como aquella condición de imposibilidad por deterioro físico y cognitivo, que tiene el sujeto para valerse por sus propios medios y el dolor al cual hace referencia, aquella experiencia senso rial y emocional desagradable causada por injuria real o potencial a un tejido. Método: Para el presente artículo se efectuó una búsqueda bibliográfica en bases de datos como Redalyc, Google académico, Ebsco, Medline, entre otras, donde fueron seleccionados 60 artículos que estuviesen incluidos en revistas indexadas. Resultados: Se encuentra una gran prevalencia de estudios que reportan que el envejecimiento asociado al dolor evidencia mayor nivel de dependencia funcional en el adulto mayor.

Abstract Objective: The presence of chronic diseases and increased pain and disability suggest a poor prog nosis for rehabilitation. This prognosis tends to generate complications in performing routine activities; and restraint in individual independence and autonomy is evident in most of the cases as the population ages. Currently more than 868 million people are over 60 years and they make up almost 12 % of the total world population. By 2050, it is estimated that there will be a 21 % increase in relation to the percentage of children under 15. This data implies that new social chal lenges and health care system response subserve elderly processes of adaptability and psychosocial growth in order to generate a range of resources for the elderly to cope health problems which affect their quality of life. To identify the association between functional dependence understood as the condition of physical impossibility and cognitive impairment elderly people have in carry ing out everyday tasks and pain related to "sensory experience and unpleasant emotional injury caused by real or potential tissue. Methodology: The literature review submitted in this paper was retrieved from databases such as Redalyc, Google Scholar, Ebsco, Medline Databases, etc., and 60 items included in indexed journals were selected. Results: As a result, a high prevalence of studies reporting that aging was associated with a higher level of functional dependency in the elderly.

Prevalência e fatores associados à dependência funcional em idosos restritos ao lar / Prevalence and factors associated with functional dependency in homebound elderly people in Brazil

INTRODUCTION: Population ageing is a worldwide reality that requires attention, and a concern for healthy and functional ageing is increasingly the focus of government policies and programmes. OBJECTIVE: To identify the prevalence of homebound elderly people, and the influence of sociodemographic and economic characteristics on their functional dependency. METHODS: Cross-sectional study with 178 homebound elderly people assisted by a family healthcare unit in Vitória, ES, Brazil. Functional independence was measured by the Functional Independence Measure (FIM) and the sociodemographic and economic variables were collected by a questionnaire developed by the authors. Binary logistic regression was used to determine the influence of the sociodemographic and economic characteristics on the risk of being functionally dependent. RESULTS: Forty-eight percent of the participants were functional dependents, 80% were female, 72% belonged to the fourth age, 74% were white, 63% were widowed, 78% had retired, 90% had children, 83% had a caregiver, 52% had low education and 40% had low income. Logistic regression indicated that having a caregiver increased by 40 times the chance of being functionally dependent (OR = 40.2; 95%CI 4.8-355.4) and having between one to eight years of education decreased the chance of functional dependency (OR = 0.2; 95%CI 0.04-0.9). CONCLUSIONS: The prevalence of functional dependency was very high in this sample, and since the presence of a caregiver was the strongest and significant predictor of functional dependency, we suggest that guidance and support should be offered to caregivers, followed by a family healthcare strategy, to make consistent efforts with the objective of improving functional recovery and independence of homebound elderly.

INTRODUÇÃO: O envelhecimento populacional é uma realidade de proporções mundiais que requer atenção, e a preocupação com o envelhecimento saudável e funcional é cada vez mais o foco de políticas e programas do governo. OBJETIVO: Verificar a prevalência e influência dos fatores sócio demográficos e econômicos na dependência funcional em idosos restritos ao lar. MÉTODO: Estudo transversal com 178 idosos restritos ao lar assistidos por uma Unidade de Saúde da Família de Vitória-ES. Aferiu-se a dependência funcional através da Medida de Independência Funcional e coletou-se variáveis para caracterização o perfil dos idosos. Utilizou-se a Regressão Logística Binária para determinar o nível de predição da dependência funcional. RESULTADOS: Quarenta e oito por cento dos idosos apresentavam dependência funcional, 80% eram do sexo feminino, 72% na 4º idade, 74% brancos, 63% viúvos, 78% aposentados, 90% com filhos, 83% com cuidador, 52% com baixa escolaridade e 40% com baixa renda. A presença de cuidador se comportou como preditor da dependência funcional (OR=40.2; IC95% 4,8-355,4) e a escolaridade entre 1 e 8 anos se mostrou como fator de proteção (OR=0,2; IC95% 0,04-0,9). CONCLUSÃO: A prevalência dependência funcional mostrou-se elevada, e a presença de cuidador figurou como um forte e significante preditor, propõe-se o estabelecimento de 'suporte' para o cuidador mediado pelas equipes da Estratégia Saúde da Família para manutenção/recuperação da funcionalidade dos longevos.

Sobrecarga en cuidadores principales de adultos mayores / Overload in primary caregivers of older adults

Introducción: En Paraguay, la población de 65años y más, constituye el 7,4% de la población total.El cuidador primario es aquella persona que deforma cotidiana se hace cargo de las necesidadesbásicas y psicosociales del adulto mayor; y la sobrecargadel cuidador, es un estado psicológico queresulta de la combinación de trabajo físico, presiónemocional, y restricciones sociales. Objetivos:Determinar el grado de sobrecarga que padece elcuidador primario del adulto mayor. Metodología:Estudio observacional, descriptivo de cortetransverso con componente analítico, realizados encuidadores principales de adultos mayores, en losbarrios que forman parte del territorio de la USFClínicas 1 y 2, Asunción, de julio a setiembre del2015. Se utilizó la escala de Zarit, la escala de depresiónde Goldberg y expedientes clínicos. Resultados:Grado de sobrecarga se observó que el33,3% no lo presentó, mientras que el 50% sí; el68% fueron mujeres y el 65 % mayor de 40 años.Presentaron depresión 67%. Se encontró asociaciónentre sobrecarga del cuidador primario y vínculofamiliar, X2≥ 23,12 (p<0,05), y entre sobrecargadel cuidador y depresión en el mismo, X2≥17,18(p<0,05). Conclusión: El grado de sobrecargadel cuidador principal en esta serie fue predominante,presentando síntomas depresivos. El perfilsocio-demográfico corresponde a mujeres, más de40 años, casada, con escolaridad secundaria y nexofamiliar. Se encontró asociación con significaciónestadística entre grado de sobrecarga del cuidadorprimario y vínculo familiar, como también entregrado de sobrecarga del cuidador y depresión enel mismo.

In Paraguay, population 56 years old and oldercomprises 7.4% of the total population. The primarycaregiver is that person who takes care ofthe basic and psychosocial needs of the older adulton a daily basis, and the caregiver overload is apsychological state resulting from the combinationof physical work, emotional pressure, and socialrestrictions. Objective: To determine the degreeof overload the primary caregiver of older peoplesuffer. Methodology: Observational, descriptivestudy with a transversal analytic component, carriedout in primary caregivers of older adults, inneighborhoods that are part of the USF territory ofClinicas 1 and 2, Asunción, from July to September2015. The scales used were Zarit, the depressionscale of Goldberg, and medical records.Results: itwas observed that 33.3% of the population studieddid not show a degree of overload, while 50%did; 68% were women and 65% over 40 years old.67% showed depression. An association was foundbetween the overload of the primary caregiverand the family links with the patient, X2≥ 23,12(p<0,05), and between the overload of the primarycaregiver and depression, X2≥17,18 (p<0,05).Conclusion: The degree of overload in the primarycaregiver in this series was predominant, andincluded symptoms of depression. The social-demographicprofile is: women, over 40 years old,married, with secondary school studies, and family links. Association was found with statistical significancebetween the degree of overload in the primarycaregiver and their family links, as well asbetween their degree of overload and depression.

Perfil clínico, epidemiológico y valoración geriátrica funcional en el barrio San Miguel de Asunción, Paraguay

Introducción: el envejecimiento poblacional caracteriza a las últimas décadas. En Paraguay la población mayor de 60 años constituye el 10%, con edad promedio de 70 años. La funcionalidad geriátrica es la capacidad para realizar independientemente actividades básicas de la vida. Objetivos: determinar perfil clínico epidemiológico y prevalencia de dependencia funcional en adultos mayores del Barrio San Miguel de Asunción, Paraguay. Metodología: estudio observacional,de corte transverso, descriptivo con componente analítico, realizado en adultos mayores de 65 años del Barrio San Miguel, de abril a julio del año 2014. Variables estudiadas: edad, sexo, enfermedades crónicas, síndromes geriátricos y capacidad funcional. Se utilizó el índice de Katz, la escala geriátrica de depresión de Yesavage y expedientes clínicos. Resultados: se encontró 3% de prevalencia de adultos mayores de 65 años. El perfil sociodemográfico correspondió a un adulto mayor con predominio del sexo femenino, edad media de 71,8 años, casado, con escolaridad primaria. La enfermedad crónica con mayor frecuencia fue la HTA. El 79% de los adultos mayores presentan algún síndrome geriátrico, predominando la depresión (43%). El 41% de la población estudiada presenta dependencia funcional en las actividades básicas de la vida diaria. Se encontró asociación significativa entre depresión y funcionalidad básica Conclusión: la enfermedad crónica más prevalente es la hipertensión arterial. La prevalencia de dependencia funcional y de depresión es alta en los adultos mayores.

Introduction: The last decades are characterized by population aging. In Paraguay, the population older than 60 years old represents 10% with an average mean of 70 years. The geriatric functionality is the capacity to perform basic activities of life independently. Objectives: To determine the epidemiological-clinical profile and prevalence of functional dependence in the older adults from San Miguel neighborhood in Asunción, Paraguay. Methodology: This was a descriptive cross-sectional observational study with analytical component carried out in adults older than 65 years in San Miguel neighborhood from April to July, 2014. The studied variables were: age, sex, chronic diseases, geriatric syndromes and functional capacity. The Katz index, geriatric depression scale of Yesavage and clinical records were used. Results: There was 3% of prevalence of adults older than 65 years. The socio-demographic profile corresponded to an older adult with predominance of women, mean age of 71.8 years, married and with primary education. The most frequent chronic disease was AHT while 79% of the elderly presented a geriatric syndrome prevailing depression (43%). Forty one percent of the studied population presented functional dependence in the basic activities of daily living. A significant association was found between depression and basic functionality. Conclusion: The most frequent chronic disease was arterial hypertension. The prevalence of functional dependence and depression is high in older adults.

Sobrecarga del agente de cuidado dependiente y su relación con la dependencia funcional del adulto mayor / Overload in the dependent care agent and its relation to the elder adult functional dependency

Métodos: Estudio descriptivo, correlacional, transversal, muestreo por conveniencia, incluyó a 90 adultos mayores y 90 agentes de cuidado dependiente. Se describió el perfil socio demográfico, se aplicó el índice de Barthel para evaluar el nivel de dependencia del adulto mayor y la entrevista de Zarit para evaluar la sobrecarga subjetiva del agente de cuidado dependiente. Objetivo: Identificar la relación entre el nivel de sobrecarga subjetiva del agente de cuidado dependiente y el nivel de dependencia funcional del adulto mayor con enfermedad crónico degenerativa en el Hospital General de Silao, Guanajuato en México. Resultados: La edad promedio de los adultos mayores fue de 70.9 ±10, en el índice de Barthel presentaron dependencia leve (41.1%) en las actividades de la vida diaria. El perfil del agente de cuidado dependiente correspondió a una mujer de edad media (53.8 ±5.2), casada (88.9%), ama de casa (73.3%), hija de quien cuida (48.9%). En la entrevista de Zarit se encontró a agentes de cuidado dependiente sin sobrecarga (85.6%). Para verificar si existía correlación entre las variables sobrecarga subjetiva y dependencia funcional, se obtuvo el coeficiente de correlación rho de Spearman (-0.46), p<0.05. Discusión: Orem infirió que en situaciones donde se requiera de cuidado, la sobrecarga del agente de cuidado dependiente se relaciona con la dependencia funcional del adulto mayor. Conclusión: A menor grado de dependencia del adulto mayor, menor es el nivel de sobrecarga subjetiva del agente de cuidado dependiente.

Objective: To identify the relationship between the subjective overload level of the dependent care agent and the functional dependency level of the elder adult suffering from chronic degenerative illnesses at the Silao General Hospital in Guanajuato, Mexico. Methods: A descriptive, correlational, transversal and basic study design was used. Sampling was by convenience, and included 90 elder adults and 90 dependent care agents. The social and demographic profile was described. The Barthel index was used to assess the level of dependence of the elder adult, while the Zarit interview was used to assess the subjective overload of the dependent care agent. Results: The elder adult average age was 70.9 ±10; and after using the Barthel index, 41.1% showed dependency in their daily life. The profile of the dependent care agent corresponded to that of a middle aged woman (53.8 ±5.2), married (88.9%), housewife (73.3%), and daughter of the elder (48.9%). From the Zarit interview, it was found that 85.6% were dependent care agents without overload. In order to verify if a correlation existed between the variables subjective overload and functional dependency, the Spearman correlation rho was calculated, and turned out to be -0.46, p<.05. Discussion: Orem inferred that in situations where healthcare is required, the dependent care agent overload is related to the functional dependency of the elder adult. Conclusions: The lower the grade of dependence of the elder adult, the lower the subjective overload of the dependent care agent.

Evaluación de los estados funcional y afectivo en la población geriátrica del área de salud "28 de Septiembre" / Evaluation of the functional and affective states in the geriatric population of "28 de septiembre" health area

Se realizó un estudio descriptivo y transversal de 108 ancianos con 60 años y más, pertenecientes al Policlínico Universitario "28 de Septiembre" de Santiago de Cuba, desde abril hasta octubre del 2011, a fin de evaluar los estados funcional y afectivo en esta población geriátrica. En la casuística prevalecieron las edades de 70-79 años (35,2 %), el sexo femenino (60,2 %) y las que tenían dependencia funcional en la realización de 1 o 2 tareas básicas de la vida diaria, así como en 3 o 4 actividades instrumentadas. También primaron los trastornos afectivos con predominio de la depresión y la ansiedad.

A descriptive and cross-sectional study of 108 aged patients with 60 years and over, belonging to "28 de Septiember" University Polyclinic in Santiago de Cuba , was carried out from April to October, 2011, in order to evaluate the functional and affective states in this geriatric population. Ages from 70-79 years (35.2 %), the female sex (60.2 %) and those who had functional dependence in carrying out 1 or 2 basic tasks of the daily life activity, as well as in 3 or 4 instrumental activities, prevailed in the case material. The affective disorders also prevailed with a prevalence of depression and anxiety.

Dependencia funcional y enfermedades crónicas en ancianos mexicanos / Functional dependence and chronic disease in older Mexicans

OBJETIVO: Determinar la prevalencia de dependencia funcional y las enfermedades crónicas que se le asocian. MATERIAL Y MÉTODOS: El estudio se realizó de junio a diciembre de 2004 en el Departamento de Geriatría del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, en México, DF. Los datos de las variables se obtuvieron de la información de la encuesta para el Estudio Nacional sobre Salud y Envejecimiento en México (ENASEM), realizada con base en la Ley de Información Estadística y Geográfica,Capítulo V,Artículo 38.Se incluyó un total de 4 872 personas mayores de 65 años, a quienes se les interrogó sobre ayuda para las actividades básicas de la vida diaria (AVD) y actividades instrumentales (AIVD) de la vida diaria; así como sobre la presencia de enfermedad crónica. RESULTADOS: De los mayores de 65 años, 24 por ciento resultó dependiente en AVD y 23 por ciento en AIVD. Las enfermedades crónicas relacionadas con dependencia funcional en actividades básicas e instrumentadas fueron las enfermedades articular y cerebrovascular, el deterioro cognitivo y la depresión. CONCLUSION: La prevalencia de dependencia funcional es alta enlos mayores de 65 años.Este estudio demuestra cuáles enfermedades crónicas están asociadas con la dependencia. Es necesario desarrollar medidas orientadas al tratamiento y prevención de estas entidades crónicas que se asociaron con dependencia funcional.

OBJECTIVE: The aim of this study is to determine the prevalence of functional dependence in older Mexicans and associated chronic conditions. MATERIAL AND METHODS: The study was conducted between June and December 2004 in the Geriatric Department of the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City. The data for the variables were obtained from the information in the National Study of Health and Aging in Mexico survey (ENASEM).The survey was based on the law for statistical and geographic information,Chapter V,Article 38.A total of 4 872 subjects from the national survey of aging and health in Mexico were asked about their need for help in basic activities of daily living (BADL) and instrumental activities of daily living (IADL). Presence of disease was obtained through selfreporting. RESULTS: Prevalence of functional dependence was 24 and 23 percent for BADL and IADL, respectively. Joint disease, cerebrovascular disease, cognitive impairment and depression were associated with dependency in BADL and IADL. CONCLUSION: The prevalence of functional dependence is high among Mexicans over 65 years old. This study shows the chronic conditions that are closely associated with functional dependence and provides a perspective in order to develop preventative measures.

Calidad de vida de los cuidadores familiares: Life Quality among Family Carers

El objetivo de esta investigación es describir, desde la perspectiva etnográfica, cómo podría estar afectada la calidad de vida de los cuidadores familiares de adultos mayores con dependencia funcional, como consecuencia del desempeño del rol de cuidador, y según su percepción. Se trata de un estudio cualitativo etnográfico, con apoyo en la etnografía enfocada, en 14 cuidadoras familiares de adultos mayores de 65 años, con más de seis meses a su cuidado, en el municipio de Envigado, Colombia, en 2002, y una muestra de quince entrevistas en profundidad. El análisis de las entrevistas identificó siete grandes temas o categorías con las percepciones de las cuidadoras sobre su rol y los efectos de éste en su calidad de vida: significado de calidad de vida, percepción de la cuidadora sobre el rol de cuidadora, consecuencias del rol sobre su salud física y mental, relaciones cuidadora y persona cuidada, conocimientos y aprendizajes sobre el cuidado de las personas, apoyos que recibe la cuidadora para el cuidado, y la invisibilidad del trabajo de las cuidadoras. Las categorías que emergieron coinciden con las de otros estudios; se hace énfasis en la categoría "la invisibilidad del trabajo de la cuidadora familiar", en tanto es la menos documentada en la literatura, y en la importancia del acercamiento a los valores y las tradiciones de grupos para la interpretación de las respuestas de su vida social.

The aim of this research is to describe, from an ethnographical view, the way life quality of family carers of elderly population functionally dependent could be affected, as consequence of performing as such, as well as their own point of view. This is an ethnographical study, supported by focused ethnography, among 14 family carers of 65 years people, who had been caring for more than six months. It was done in the municipality of Envigado (Colombia), in the year 2002. The sampling was made of fifteen in depth interviews. The interview analysis evidenced seven major topics or categories about carers own perception on their role as such and its effects on their life quality: meaning of life quality; carers perception about their own role; physical and mental health consequences of the role; carer-caree relations; knowledge and learning about care people; carers support for developing as such; and invisibility of carers' job. The resulting categories coincide with the ones of some other studies. The category "invisibility of family carers' job" is noticeable but it is the least documented in literature and in the importance on value and group traditions approach for analyzing their responses to social life.