Association between cognitive impairment and criteria for frailty syndrome among older adults.

OBJECTIVE: The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. To analyze the association between cognitive impairment and the criteria for frailty. METHODS: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. RESULTS: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. CONCLUSION: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

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

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

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

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

Association between cognitive impairment and criteria for frailty syndrome among older adults / Associação entre o comprometimento cognitivo e os critérios para a síndrome de fragilidade em idosos

Abstract The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. Objective: To analyze the association between cognitive impairment and the criteria for frailty. Methods: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. Results: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. Conclusion: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

Resumo A associação entre comprometimento cognitivo e fragilidade tem sida estudada em idosos e os critérios de fragilidade e níveis de fragilidade podem também apresentar influência na função cognitiva. Objetivo: Analisar a associação entre comprometimento cognitivo e os critérios de fragilidade em idosos. Métodos: O estudo analisou transversalmente dados de 667 idosos (≥60 anos) do estudo 'Variables associated to cognition in elderly caregivers' conduzido com usuários da atenção primária a saúde de áreas urbanas e rurais. Comprometimento cognitivo foi definido em função dos escores no Miniexame do Estado Mental baseado na escolaridade e a fragilidade e pré-fragilidade foi operacionalizada segundo os critérios do Cardiovascular Health Study. Foram realizados modelos de regressão multinominal para analisar a associação entre níveis de fragilidade e comprometimento cognitivo. Resultados: Proporções semelhantes de mulheres (54,8%) e homens (45,2%) participaram do estudo (média de idade: 71 anos). Comprometimento cognitivo, pré-fragilidade e fragilidade foram encontrados em 34, 54 e 24% dos participantes, respectivamente. Concomitante comprometimento cognitivo e fragilidade foi evidenciado em 13%. As chances de apresentar comprometimento cognitivo aumentaram em 330% (Odds Ratio [OR]: 4.3; intervalo de confiança de 95% [IC95%] 2.4‒7.7; p<0.001) entre indivíduos frágeis e 70% (OR: 1.7; IC95% 1.0‒2.8; p=0.033) entre indivíduos pré-frágeis em comparação com indivíduos robustos/não-frágeis. Após controle da idade, escolaridade, local de residência e dependência funcional, os critérios de lentidão e fadiga foram significativamente associados ao comprometimento cognitivo. Conclusão: Os idosos mais frágeis têm maior probabilidade de apresentar comprometimento cognitivo comparados a adultos idosos pré-frágeis ou robustos. A prevalência de comprometimento cognitivo e fragilidade é consistente com os dados relatados na literatura e fornece suporte para futuras investigações sobre a fragilidade cognitiva.

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

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

Factors associated with the development of diabetes mellitus in older caregivers.

OBJECTIVE: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. METHOD: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. RESULTS: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). CONCLUSION: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.

Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms.

OBJECTIVE: to investigate the association between frailty, loneliness and depressive symptoms of elderly caregivers. METHOD: a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried's frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables). RESULTS: there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility. CONCLUSION: elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.

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

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

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

Relationship between cognitive processing, language and verbal fluency among elderly individuals / Relação entre processo cognitivo, linguagem e fluência verbal entre idosos individuais

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

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

Senior caregivers in different housing arrangements: comparison of health and care profiles. / Idosos cuidadores em diferentes arranjos de moradia: comparação do perfil de saúde e de cuidado.

OBJECTIVE: To compare the physical, cognitive and psychological health profile and care context of elder caregivers of the elderly in different home arrangements. METHOD: Quantitative and transversal study with elderly caregivers. The sample consisted of 349 caregivers divided into mono-gerational, bi-gerational and multi-generational housing arrangements. Sociodemographic and care questionnaires and physical, cognitive and psychological health assessment instruments were used for evaluation. The Chi-square distribution and Mann Whitney's U were used for data analysis. RESULTS: Elderly caregivers in mono-generational homes were significantly older and independent for instrumental activities of daily living. In multigenerational households there was a significantly greater proportion of caregivers who considered family income insufficient, received emotional help, and felt overwhelmed and stressed. CONCLUSION: The differences identified between the groups can contribute to the elaboration of care policies and for the health promotion of elderly caregivers.

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

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

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

Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in older adults / Associação entre baixa escolaridade, desempenho cognitivo reduzido, incapacidade funcional e fragilidade em idosos

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

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

Brief version of Zarit Burden Interview (ZBI) for burden assessment in older caregivers.

The degree of burden related to the demands of daily care provided to a dependent older adult is important to evaluate due to the negative influence exerted on caregivers' physical and psychological health. OBJECTIVE: To analyze the validity of the 12-item version of the Zarit Burden Interview administered to older caregivers of community-dwelling older dependent individuals and suggest a cut-off score based on quartiles. METHODS: Three hundred and forty-one older caregivers (mean age: 69.6±7.1 years; 76.8% women) registered with primary healthcare centers were evaluated using the ZBI-12. Additional evaluations addressed stress (Perceived Stress Scale [PSS]), depressive symptoms (Geriatric Depression Scale [GDS]) in the older caregivers and the degree of dependence of the older care recipients (Lawton and Brody [L&B]). RESULTS: Cronbach's alpha demonstrated very good internal consistency (α=0.81). Correlations were found between all ZBI-12 items and overall score on the PSS (r=0.53; p<0.01). GDS (r=0.43; p<0.01) and L&B (r= -0.23; p<0.01) scale scores. The PSS demonstrated the strongest correlation with ZBI-12 score and proved to be the standard reference. Based on caregivers with a higher degree of stress considering the PSS score quartiles, a cut-off score of 13 points on the ZBI-12 is suggested for screening burden in community-dwelling older caregivers, but should not be assumed as normative data. CONCLUSION: The ZBI-12 can be considered valid for evaluation of burden in clinical practice and research as a fast, efficient option for screening burden among older caregivers of community-dwelling older adults.

O grau de sobrecarga relacionado às demandas do cuidado diário ao idoso dependente é uma importante medida a ser avaliada por influenciar de modo negativo na saúde física e psicológica do cuidador. OBJETIVO: Analisar a validade da Zarit Burden Interview versão 12 itens (ZBI-12) em idosos cuidadores de idosos da comunidade e sugerir nota de corte de acordo com quartis. MÉTODOS: Foram avaliados 341 idosos cuidadores (M=69,6±7,1 anos; 76,8% feminino) cadastrados na Estratégia Saúde da Família utilizando a ZBI-12. Adicionalmente, foram realizadas avaliações de estresse (Escala de Estresse Percebido [PSS]) e de sintomas depressivos (Escala de Depressão Geriátrica [GDS]) no idoso cuidador, e avaliada a dependência dos idosos receptores de cuidado (Escala de Atividades da Vida Diária de Lawton e Brody [L&B]). RESULTADOS: As análises por alfa de Cronbach mostraram consistência interna de α=0.81. Foi encontrada correlação entre todos os itens da ZBI-12 e do escore geral com os escores de PSS (r=0,53; p<0,01), GDS (r=0,43; p<0,01) e L&B (r= -0,23; p<0,01). Especificamente, a PSS obteve associação mais estreita com o escore da ZBI-12, se mostrando o padrão-referência. Considerando a divisão por quartil da PSS, para os cuidadores mais estressados, sugere-se nota de corte de 13 pontos na ZBI-12 para rastreio da sobrecarga em idosos cuidadores da comunidade em geral. CONCLUSÃO: A ZBI-12 apresentou boa consistência interna e pode ser considerada válida nessa população. Espera-se que o instrumento auxilie na avaliação da sobrecarga na prática clínica e na pesquisa e se torne uma alternativa de aplicação rápida e eficiente no rastreio de sobrecarga entre cuidadores mais velhos na comunidade.

Brief version of Zarit Burden Interview (ZBI) for burden assessment in older caregivers / Versão abreviada da Zarit Burden Interview para avaliação de sobrecarga em idosos cuidadores

ABSTRACT: The degree of burden related to the demands of daily care provided to a dependent older adult is important to evaluate due to the negative influence exerted on caregivers' physical and psychological health. Objective: To analyze the validity of the 12-item version of the Zarit Burden Interview administered to older caregivers of community-dwelling older dependent individuals and suggest a cut-off score based on quartiles. Methods: Three hundred and forty-one older caregivers (mean age: 69.6±7.1 years; 76.8% women) registered with primary healthcare centers were evaluated using the ZBI-12. Additional evaluations addressed stress (Perceived Stress Scale [PSS]), depressive symptoms (Geriatric Depression Scale [GDS]) in the older caregivers and the degree of dependence of the older care recipients (Lawton and Brody [L&B]). Results: Cronbach's alpha demonstrated very good internal consistency (α=0.81). Correlations were found between all ZBI-12 items and overall score on the PSS (r=0.53; p<0.01). GDS (r=0.43; p<0.01) and L&B (r= -0.23; p<0.01) scale scores. The PSS demonstrated the strongest correlation with ZBI-12 score and proved to be the standard reference. Based on caregivers with a higher degree of stress considering the PSS score quartiles, a cut-off score of 13 points on the ZBI-12 is suggested for screening burden in community-dwelling older caregivers, but should not be assumed as normative data. Conclusion: The ZBI-12 can be considered valid for evaluation of burden in clinical practice and research as a fast, efficient option for screening burden among older caregivers of community-dwelling older adults.

RESUMO: O grau de sobrecarga relacionado às demandas do cuidado diário ao idoso dependente é uma importante medida a ser avaliada por influenciar de modo negativo na saúde física e psicológica do cuidador. Objetivo: Analisar a validade da Zarit Burden Interview versão 12 itens (ZBI-12) em idosos cuidadores de idosos da comunidade e sugerir nota de corte de acordo com quartis. Métodos: Foram avaliados 341 idosos cuidadores (M=69,6±7,1 anos; 76,8% feminino) cadastrados na Estratégia Saúde da Família utilizando a ZBI-12. Adicionalmente, foram realizadas avaliações de estresse (Escala de Estresse Percebido [PSS]) e de sintomas depressivos (Escala de Depressão Geriátrica [GDS]) no idoso cuidador, e avaliada a dependência dos idosos receptores de cuidado (Escala de Atividades da Vida Diária de Lawton e Brody [L&B]). Resultados: As análises por alfa de Cronbach mostraram consistência interna de α=0.81. Foi encontrada correlação entre todos os itens da ZBI-12 e do escore geral com os escores de PSS (r=0,53; p<0,01), GDS (r=0,43; p<0,01) e L&B (r= -0,23; p<0,01). Especificamente, a PSS obteve associação mais estreita com o escore da ZBI-12, se mostrando o padrão-referência. Considerando a divisão por quartil da PSS, para os cuidadores mais estressados, sugere-se nota de corte de 13 pontos na ZBI-12 para rastreio da sobrecarga em idosos cuidadores da comunidade em geral. Conclusão: A ZBI-12 apresentou boa consistência interna e pode ser considerada válida nessa população. Espera-se que o instrumento auxilie na avaliação da sobrecarga na prática clínica e na pesquisa e se torne uma alternativa de aplicação rápida e eficiente no rastreio de sobrecarga entre cuidadores mais velhos na comunidade.

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

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

Factors associated with the development of diabetes mellitus in older caregivers / Factores asociados al desarrollo de diabetes mellitus en ancianos cuidadores / Fatores associados ao desenvolvimento de diabetes mellitus em idosos cuidadores

ABSTRACT Objective: evaluate the factors associated with the risk of diabetes mellitus in older caregivers. Method: this is a cross-sectional study conducted with 326 older caregivers enrolled in Family Health Units. Data were collected using a sociodemographic characterization questionnaire, clinical and care information, and the Finnish Diabetes Risk Score to assess the risk of developing diabetes. Results: 35.5% of the caregivers presented a high risk of developing diabetes. The factors associated with the risk of developing diabetes were: use of medication (OR = 3.88), satisfactory or poor health assessment (OR = 1.72), and the fact of being female (OR = 0.48). Conclusion: more than one third of older caregivers present high risk of developing diabetes. Therefore, being female, living with other people, using medication, and having a poor health assessment are factors associated with increased risk of developing diabetes.

RESUMEN Objetivo: evaluar los factores asociados al riesgo de diabetes mellitus en ancianos cuidadores. Método: se trata de un estudio transversal, en el cual participaron 326 ancianos cuidadores registrados en Unidades de Salud de la Familia. Se utilizó en la recolección de datos un cuestionario de caracterización sociodemográfica, de informaciones clínicas y del cuidado, y en la evaluación del riesgo de desarrollo de la diabetes el Finnish Diabetes Risk Score. Resultados: el 35,5% de los cuidadores presentaron un alto riesgo de desarrollo de diabetes. Los factores asociados al riesgo de desarrollo fueron: el uso de medicamentos (OR = 3,88), la evaluación de la salud como regular o negativa (OR = 1,72) y ser del sexo femenino (OR = 0,48). Conclusión: más de un tercio de los los ancianos cuidadores presentaron un alto riesgo de desarrollo de diabetes. Por lo tanto, el hecho de ser del sexo femenino, residir con más personas, hacer uso de medicamentos y tener una evaluación negativa de la salud son los factores asociados al aumento de ese riesgo.

RESUMO Objetivo: avaliar os fatores associados ao risco de diabetes mellitus em idosos cuidadores. Método: trata-se de um estudo transversal, realizado com 326 idosos cuidadores cadastrados em Unidades de Saúde da Família. Para a coleta de dados utilizou-se um questionário de caracterização sociodemográfica, informações clínicas e do cuidado, e o Finnish Diabetes Risk Score para a avaliação do risco de desenvolvimento de diabetes. Resultados: dos cuidadores, 35,5% apresentaram alto risco de desenvolvimento de diabetes. Os fatores associados ao risco de desenvolvimento foram o uso de medicamentos (OR = 3,88), a avaliação da saúde regular ou negativa (OR = 1,72) e ser do sexo feminino (OR = 0,48). Conclusão: mais de um terço dos idosos cuidadores apresentam alto risco de desenvolvimento de diabetes. Portanto, ser do sexo feminino, residir com mais pessoas, fazer uso de medicamentos e ter uma avaliação negativa da saúde são fatores associados ao aumento desse risco.

Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms / Ancianos cuidadores de ancianos: fragilidad, solidon y sintomas depresivos / Idosos cuidadores de idosos: fragilidade, solidão e sintomas depressivos

ABSTRACT Objective: to investigate the association between frailty, loneliness and depressive symptoms of elderly caregivers. Method: a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried's frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables). Results: there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility. Conclusion: elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.

RESUMEN Objetivo: investigar la asociación entre fragilidad, soledad y síntomas depresivos de ancianos que cuidan de ancianos. Método: estudio transversal, realizado con 341 ancianos cuidadores catastrados en Unidades de Salud de la Familia de un municipio del interior paulista. Las entrevistas fueron domiciliarias e incluyeron cuestionario para caracterización del cuidador, fenotipo de fragilidad de Fried, APGAR de familia (funcionalidad familiar), Escala de Depresión Geriátrica (síntomas depresivos) y ítem 3 de la Escala de Esperanza de Herth (soledad). La regresión logística fue utilizada para analizar la asociación entre síntomas depresivos y soledad (variables independientes), y fragilidad y pre-fragilidad (variables dependientes). Resultados: hubo asociación entre fragilidad, soledad y síntomas depresivos. Los ancianos cuidadores solitarios tuvieron posibilidades aumentadas en el 158% de tener pre-fragilidad, y el 360% de fragilidad. Los ancianos cuidadores con síntomas depresivos tuvieron posibilidades aumentadas en un 242% de tener fragilidad. Conclusión: los ancianos cuidadores solitarios y que presentan síntomas depresivos tienen más probabilidades de ser frágiles y pre-frágiles.

RESUMO Objetivo: investigar a associação entre fragilidade, solidão e sintomas depressivos de idosos que cuidam de idosos. Método: estudo transversal, realizado com 341 idosos cuidadores cadastrados em Unidades de Saúde da Família de um município do interior paulista. As entrevistas foram domiciliares e incluíram questionário para caracterização do cuidador, fenótipo de fragilidade de Fried, APGAR de família (funcionalidade familiar), Escala de Depressão Geriátrica (sintomas depressivos) e item 3 da Escala de Esperança de Herth (solidão). A regressão logística foi utilizada para analisar a associação entre sintomas depressivos e solidão (variáveis independentes), e fragilidade e pré-fragilidade (variáveis dependentes). Resultados: houve associação entre fragilidade, solidão e sintomas depressivos. Idosos cuidadores solitários tiveram chances aumentadas em 158% de apresentar pré-fragilidade, e 360% de fragilidade. Idosos cuidadores com sintomas depressivos tiveram chances aumentadas em 242% de apresentar fragilidade. Conclusão: idosos cuidadores solitários e que apresentam sintomas depressivos têm mais chances de serem frágeis e pré-frágeis.

Idosos cuidadores em diferentes arranjos de moradia: comparação do perfil de saúde e de cuidado / Ancianos cuidadores en diferentes arreglos de vivienda: comparación del perfil de salud y de cuidado / Senior caregivers in different housing arrangements: comparison of health and care profiles

Resumo OBJETIVO Comparar o perfil de saúde física, cognitiva e psicológica e o contexto de cuidado de idosos cuidadores de idosos em diferentes arranjos de moradia. MÉTODO Estudo quantitativo e transversal realizado com 349 cuidadores divididos em arranjos de moradia unigeracional, bigeracional e multigeracional. Para avaliação foram utilizados questionários sociodemográfico e de cuidado, e instrumentos de avaliações da saúde física, cognitiva e psicológica. Para análises dos dados foram utilizados os testes Qui-quadrado e U Mann Whitney. RESULTADOS Os idosos cuidadores de lares unigeracionais eram mais velhos e independentes para as atividades instrumentais de vida diária. Nos arranjos de moradia multigeracionais houve proporção significativamente maior de cuidadores que consideravam a renda familiar insuficiente, recebiam ajuda emocional e sentiam-se mais sobrecarregados e estressados. CONCLUSÃO As diferenças identificadas entre os grupos podem contribuir para elaboração de políticas de cuidado e promoção da saúde de idosos cuidadores.

Resumen OBJETIVO Comparar el perfil de salud física, cognitiva y psicológica y el contexto de cuidado de cuidadores ancianos en diferentes arreglos habitacionales. MÉTODO Estudio cuantitativo y transversal con cuidadores de ancianos. La muestra fue formada por 349 cuidadores divididos en arreglos de vivienda unigeracionales, bigeracionales y multigeracionales. Para la evaluación, se utilizaron cuestionarios sociodemográficos, asistenciales y de estudio de salud física, cognitiva y psicológica. Las pruebas de Chi cuadrado y U Mann Whitney se utilizaron para el análisis de datos. RESULTADOS Los cuidadores unigeracionales ancianos fueron significativamente más viejos e independientes para las actividades instrumentales de la vida diaria. En los arreglos de alojamiento multigeracional, una proporción significativamente mayor de cuidadores que consideraban la renta familiar insuficiente recibía ayuda emocional y se sentía más sobrecargada y estresada. CONCLUSIÓN Las diferencias identificadas entre los grupos pueden contribuir al desarrollo de políticas de cuidado y promoción de la salud del anciano cuidador.

Abstract OBJECTIVE To compare the physical, cognitive and psychological health profile and care context of elder caregivers of the elderly in different home arrangements. METHOD Quantitative and transversal study with elderly caregivers. The sample consisted of 349 caregivers divided into mono-gerational, bi-gerational and multi-generational housing arrangements. Sociodemographic and care questionnaires and physical, cognitive and psychological health assessment instruments were used for evaluation. The Chi-square distribution and Mann Whitney's U were used for data analysis. RESULTS Elderly caregivers in mono-generational homes were significantly older and independent for instrumental activities of daily living. In multigenerational households there was a significantly greater proportion of caregivers who considered family income insufficient, received emotional help, and felt overwhelmed and stressed. CONCLUSION The differences identified between the groups can contribute to the elaboration of care policies and for the health promotion of elderly caregivers.

Association between depressive syndrome and visual complaints among elderly caregivers / Associação entre síndrome depressiva e queixas visuais em idosos cuidadores

ABSTRACT Objectives To determine depressive syndrome in community-dwelling elderly caregivers; and to test the association between such syndrome and both visual complaints (VC) and aspects of care. Methods This is a cross-sectional study conducted with 332 elderly caregivers. Geriatric Depression Scale (GDS-15) was used to screen for depressive symptoms (cutoff > 5 points). Logistic regression was performed to identify associations between depression and both VC and aspects related to care. Results Median age of the caregivers was 68 years. The majority was female (75.9%) and took care of a spouse (84.3%). The prevalence of depressive syndrome was 22.6%. The syndrome was associated with VC when it affected activities of daily living (OR = 2.4; 95% CI: 1.37-4.27) and caring for an individual with cognitive impairment (OR = 1.85; 95% CI: 1.05-3.26). Conclusions While measured aspects of care did not exert an influence on the incidence of depressive symptoms, VC associated to functional limitation and caring for elderly individuals with cognitive impairment was associated with such symptoms in the elderly caregivers.

RESUMO Objetivos Determinar a síndrome depressiva em idosos cuidadores da comunidade e testar a associação entre tal síndrome, queixas visuais e aspectos dos cuidados. Métodos Este é um estudo transversal realizado com 332 idosos cuidadores. A Escala de Depressão Geriátrica (GDS-15) foi utilizada para triagem da síndrome depressiva (corte > 5 pontos). Regressão logística foi realizada para identificar associações entre depressão, queixas visuais e aspectos relacionados ao cuidado. Resultados A mediana de idade dos cuidadores foi de 68 anos. A maioria era do sexo feminino (75,9%) e estava cuidando do seu cônjuge (84,3%). A prevalência da síndrome depressiva foi de 22,6%. A síndrome foi associada com queixas visuais quando estas prejudicavam o desempenho nas atividades da vida diária do cuidador (OR = 2,4; IC 95%: 1,37-4,27). Além disso, cuidar de um indivíduo com comprometimento cognitivo também esteve associado à depressão nos cuidadores (OR = 1,85; IC 95%: 1,05-3,26). Conclusões Os aspectos do cuidado não exerceram influência sobre a incidência de síndrome depressiva, no entanto a queixa visual associada à limitação funcional e o ato de cuidar de idosos com comprometimento cognitivo estiveram associados ao humor deprimido em idosos cuidadores da comunidade.

Social support and cognitive processing among elderly caregivers and non-caregivers of other elderly persons / Apoio social e processamento cognitivo entre idosos cuidadores e não cuidadores de outros idosos

Objective : to analyze measures of social support and cognitive processing among elderly caregivers and non-caregivers. Method : a comparative, cross-sectional and quantitative study was performed. Participants were divided into two groups: 41 elderly caregivers of other elderly persons (G1) and 41 elderly non-caregivers (G2). Sociodemographic, health and care variables, social support, cognition and cognitive processing (verified by long-latency auditory evoked potential acquisition with the Neuron-Spectrun-4 / EPM device) were assessed. Results : in G1, the majority were female (n=33, 80.5%), married (n=34, 82.9%), with a mean age of 68.5 (± 5.8) years, a mean 4.5 (± 3.7) years of schooling and had provided care on average for 18.0 (± 18.4) years for 6.5 (± 5.1) hours per day. In G2, the majority were female (n=31, 75.6%), widowed (n=23, 56.1%), had a mean age of 69.8 (± 7.2) years and a mean 3.7 (± 2) years of schooling. There were no statistically significant differences between the groups in social support, cognition and cognitive processing. Conclusion : the task of caring did not have a negative influence on social support and cognitive processing. This research may contribute to the planning of actions among primary health care providers and to future research investigating other factors that permeate this relationship.

Objetivo : analisar as medidas de apoio social e de processamento cognitivo de idosos cuidadores e não cuidadores. Método : trata-se de um estudo comparativo, transversal e quantitativo. Os participantes foram divididos em dois grupos: 41 idosos cuidadores de outros idosos (G1) e 41 idosos não cuidadores (G2). Foram identificadas variáveis sociodemográficas, de cuidado e de saúde, apoio social, cognição e processamento cognitivo (obtido por meio da capitação do potencial evocado auditivo de longa latência, com o aparelho Neuron-Spectrun-4/EPM). Resultados : no G1, a maioria era do sexo feminino (n=33; 80,5%), com vida conjugal (n=34; 82,9%), média de idade de 68,5 (±5,8) anos, média de 4,5 (±3,7) anos de escolaridade e prestava o cuidado em média por 18,0 (±18,4) anos por 6,5 (±5,1) horas de cuidado diárias. No G2, a maioria era do sexo feminino (n=31; 75,6%), viúvas (n=23; 56,1%), com média de idade de 69,8 (± 7,2) anos e média de 3,7 (±2) anos de escolaridade. Quanto ao apoio social, cognição e processamento cognitivo não houve diferenças estatisticamente significantes entre os grupos. Conclusão : não houve influência negativa da tarefa de cuidar no apoio social e processamento cognitivo. Esta pesquisa poderá trazer contribuições para o planejamento de ações junto aos cuidadores da atenção primária à saúde e pesquisas futuras para investigar outros fatores que permeiam essa relação.