Gerontological training: the challenge of integrating different professional categories / Formação gerontológica: o desafio da integração das diversas categorias profissionais

Gerontological training must be present on the discussion agenda of several training and professional qualification entities. Despite the expressive increase in life expectancy in Brazil, the number of qualified professionals to adequately meet the demands of the aging population is below what is necessary in the country. While many countries are already organizing themselves to elaborate standards and guidelines for gerontological education, Brazil still moves slowly in the definition of professional competencies at different levels of education, hiding the visibility of the identity of professionals working in gerontology. This article aims to shed light on the topic of gerontological training based on joint efforts of scientific societies, professional councils, professional associations, and educational institutions.

A formação gerontológica deve fazer-se presente na pauta das discussões das diversas entidades de capacitação e habilitação profissional. Apesar do aumento expressivo da expectativa de vida, o número de profissionais qualificados para atender adequadamente às demandas da população que envelhece se encontra aquém do necessário. Enquanto vários países já se organizam para elaborar normas e diretrizes para a educação gerontológica, o Brasil ainda caminha lentamente na definição das competências profissionais nos diversos níveis de formação, encobrindo a visibilidade da identidade dos profissionais que atuam na gerontologia. O presente artigo tem como objetivo dar luz ao tema da formação gerontológica mediante a união de esforços das sociedades científicas, conselhos profissionais, associações de classe e instituições de ensino.

Re-assessing the dimensional structure of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): empirical evidence for a shortened Brazilian version.

BACKGROUND: The dimensional structure, effective number of item responses and item redundancies are controversial features of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) requiring more light. The aims of the present study are to revisit the dimensional structure and propose a shorter version of the instrument. METHODS: The sample comprised 652 elderly and their informants, either attending a geriatric service of a public university clinic or enrolled in a health care provider database in Rio de Janeiro, Brazil. A Confirmatory Factor Analysis (CFA) first tested the originally proposed one-dimensional structure comprised of 26 items. This was followed by sequential Exploratory Structural Equation Model (ESEM) to evaluate alternative models, in particular a bi-dimensional solution. The identification of residual correlations (RC) lead to a shortened 20-item model, which was tested further via CFA. RESULTS: The original model fitted poorly (RMSEA = 0.073; 90% CI: 0.069-0.077). Regarding the two-dimensional model, the exploratory procedure (ESEM) indicated several RCs and a lack of factor-based discriminant validity. The ensuing CFA on the one-dimensional model with freely estimated RCs showed an adequate fit (RMSEA = 0.051; 90% CI: 0.047-0.055). Addressing the identified RCs, the CFA on the abridged 20-item version also showed an adequate fit (RMSEA = 0.058; 90% CI: 0.053-0.064) and no further RCs. CONCLUSION: A one-factor dimensional structure and a reduced version with 20 locally independent items were the most tenable solution. However, although promising, this simpler structure requires further examination before it may be fully supported and recommended.

Accuracy of the Brazilian version of the informant questionnaire on cognitive decline in the elderly at screening for dementia in community-dwelling elderly participants: findings from FIBRA-RJ study.

OBJECTIVES: To determine the accuracy of the Brazilian version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) for screening for dementia and to analyze the association of sociodemographic variables of the elderly participants and informant, as well as the mental health of the informant, in the scores of the questionnaire. METHODS: A cross-sectional study was carried out with 417 elderly participants and their informants from the sample of the Frailty in the Brazilian Elderly Study, Rio de Janeiro, Brazil. The older individuals were assessed by clinical, functional, and neurocognitive evaluation, and the diagnosis of dementia was established according to Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria. The informants were evaluated by Mini-Mental State Examination (MMSE), Center of Epidemiologic Studies--Depression Scale, and Burden Interview Scale. The Cambridge Cognitive Examination Test--Revised (CAMCOG-R) was used for convergent validity analysis. The association between IQCODE-BR and the study variables was determined by multivariate logistic regression analysis. RESULTS: The best cutoff point was 3.26; the sensitivity, specificity, and area under the receiver-operating characteristic curve were 89%, 72%, and 0.88 (95% confidence interval: 0.837-0.917), respectively. The CAMCOG-R and the MMSE showed a moderate and negative association with IQCODE-BR. CONCLUSION: The IQCODE-BR is an instrument with good accuracy for the detection of dementia syndrome in Brazilian older person.

Screening for dementia: Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly and its psychometric properties.

AIM: To assess the criterion validity of the Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly (IQCODE-BR), and analyze the influence of educational level and age of both the elderly and the informants on the questionnaire scores. METHOD: The study design was a cross-sectional study with a convenience sample. Convergent validity was assessed using the Mini-Mental State Examination, and the accuracy of the IQCODE-BR was evaluated by receiver operating characteristic curve analysis. Multivariate logistic regression analysis was carried out to determine the influence of sociodemographic characteristics on IQCODE-BR scores. RESULTS: A total of 169 elderly individuals participated in the study, of which 35.5% were diagnosed with dementia. There was no statistically significant association between the IQCODE-BR scores, and the age and educational level of both the elderly and the informants. The cut-off point for greater accuracy was 3.52, with sensitivity of 83.3% and specificity of 80.7%. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.766-0.893). There was a negative and moderate correlation between IQCODE-BR and the Mini-Mental State Examination scores (P<0.01). CONCLUSION: This study suggests that the IQCODE-BR is a valid tool for screening of dementia and that IQCODE-BR scores do not seem to be influenced by age, educational level and other factors associated with the informants. However, further studies are required to evaluate informant characteristics, such as anxiety states, depression and burden level.

Cross-cultural adaptation of the Functional Activities Questionnaire - FAQ for use in Brazil / Adaptação transcultural do Functional Activities Questionnaire - FAQ para uso no Brasil

Objective: The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). Methods: The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. Results: Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. Conclusion: Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.

Objetivo: Este trabalho tem como objetivo apresentar os resultados da primeira fase da adaptação transcultural do Questionário de Atividades Funcionais (FAQ). Métodos: O instrumento foi submetido à tradução e retro tradução, e a confiabilidade teste-reteste de uma versão de proposta para uso no Brasil foi analisada. Resultados: Dos 548 que responderam ao questionário, uma amostra de conveniência de 68 informantes foi selecionada para o reteste. A consistência interna e confiabilidade teste-reteste foram medidas pelo alfa de Cronbach (0,95), a correlação intra-classe (0,97). Os achados mostram que o FAQ é breve - uma média de sete minutos, de fácil compreensão e teve boa confiabilidade intra-observador no teste-reteste. Conclusão: Nossos resultados sugerem que esta versão adaptada do FAQ é um instrumento confiável e estável, e pode ser útil na avaliação de funcionalidade de idosos brasileiros; não obstante, ele deve ser submetido a uma análise mais aprofundada com o objectivo de alcançar a equivalência funcional.

Cross-cultural Adaptation of the "Functional Activities Questionnaire - FAQ" for use in Brazil.

OBJECTIVE: The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). METHODS: The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. RESULTS: Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. CONCLUSION: Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.

OBJETIVO: Este trabalho tem como objetivo apresentar os resultados da primeira fase da adaptação transcultural do Questionário de Atividades Funcionais (FAQ). MÉTODOS: O instrumento foi submetido à tradução e retro tradução, e a confiabilidade teste-reteste de uma versão de proposta para uso no Brasil foi analisada. RESULTADOS: Dos 548 que responderam ao questionário, uma amostra de conveniência de 68 informantes foi selecionada para o reteste. A consistência interna e confiabilidade teste-reteste foram medidas pelo alfa de Cronbach (0,95), a correlação intra-classe (0,97). Os achados mostram que o FAQ é breve - uma média de sete minutos, de fácil compreensão e teve boa confiabilidade intra-observador no teste-reteste. CONCLUSÃO: Nossos resultados sugerem que esta versão adaptada do FAQ é um instrumento confiável e estável, e pode ser útil na avaliação de funcionalidade de idosos brasileiros; não obstante, ele deve ser submetido a uma análise mais aprofundada com o objectivo de alcançar a equivalência funcional.

[Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): cross-cultural adaptation for use in Brazil]. / Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): adaptação transcultural para uso no Brasil.

This article presents the results of the translation and cross-cultural adaptation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the test-retest reliability of a version to be used in Brazil. An instrument review committee analyzed the conceptual and item equivalence. In order to analyze semantic equivalences, three translations and three back-translations were performed; a summary version was devised and pre-tested, and a test version elaborated. The Cronbach's +/- coefficient and intraclass correlation coefficient (ICC) were used to measure the internal consistency and test-retest reliability, respectively. Of the 169 informants assessed, 97 were retested. A Cronbach's +/- of 0.94 and an ICC of 0.92 were found. The reliability levels lead to the conclusion that the IQCODE-BR version is easy to comprehend. Satisfactory equivalence to the original version was observed.

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): adaptação transcultural para uso no Brasil / Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): cross-cultural adaptation for use in Brazil

O presente trabalho tem como objetivo apresentar os resultados do processo de tradução e adaptação transcultural do Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) e da confiabilidade teste-reteste de uma versão para uso no Brasil. Um comitê para revisão do instrumento analisou a equivalência conceitual e de itens. Para análise de equivalência semântica, foram realizadas três traduções e três retrotraduções; elaboração de uma versão síntese; pré-teste e elaboração de uma versão teste. A consistência interna e a confiabilidade teste-reteste foram mensuradas pelo coeficiente ± de Cronbach e o coeficiente de correlação intraclasse (CCI), respectivamente. Dos 169 informantes avaliados, 97 foram retestados. O ± de Cronbach foi 0,94 e o CCI foi de 0,92. Os níveis de confiabilidade obtidos permitem concluir que a versão do IQCODE-BR se mostrou de fácil compreensão, sendo observada uma boa equivalência com a versão original.

This article presents the results of the translation and cross-cultural adaptation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the test-retest reliability of a version to be used in Brazil. An instrument review committee analyzed the conceptual and item equivalence. In order to analyze semantic equivalences, three translations and three back-translations were performed; a summary version was devised and pre-tested, and a test version elaborated. The Cronbach's ± coefficient and intraclass correlation coefficient (ICC) were used to measure the internal consistency and test-retest reliability, respectively. Of the 169 informants assessed, 97 were retested. A Cronbach's ± of 0.94 and an ICC of 0.92 were found. The reliability levels lead to the conclusion that the IQCODE-BR version is easy to comprehend. Satisfactory equivalence to the original version was observed.

A entrevista social no processo de avaliação geriátrica ampla / The social interview in the comprehensive geriatric assessment process

As novas diretrizes do pacto de gestão fortalecem as ações de atenção à saúde do idoso a partir do momento em que se torna uma das prioridades do Ministério da Saúde. Além disso, a Política Nacional de Saúde da Pessoa Idosa preconiza uma atenção integral e integrada com ênfase em abordagens multidimensionais que buscam resgatar ou preservar a autonomia e independência do sujeito que envelhece. Um novo paradigma na atenção emerge trazendo a avaliação geriátrica ampla, realizada por uma equipe multidisciplinar, como uma prática essencial no rastreamento e identificação dos variados problemas que acometem o indivíduo idoso. Nesta modalidade de avaliação é fundamental um olhar direcionado aos problemas sociais que podem influenciar no restabelecimento da saúde ou no aparecimento de novas doenças. A entrevista social é um instrumento técnico que fornecerá ao profissional subsídios para realizar uma avaliação que possa gerar uma intervenção adequada a partir do conhecimento das possibilidades e limitações dos usuários que buscam atenção em unidades geriátricas. O objetivo deste trabalho é tecer algumas considerações acerca da avaliação social no processo de avaliação geriátrica ampla. É também um esforço preliminar de contribuir com o fazer profissional do assistente social, visto que as produções teóricas neste campo são escassas e as questões sociais se constituem em elementos essenciais para o estabelecimento de condutas terapêuticas eficazes.

The new guidelines of the pledge management strengthen actions towards the elderly care now that it has become one of the Health Ministery's priorities. Furthermore, the National Policy of Elderly prescribes a thorough and integrated care with emphasis on the multidimensional approaches that aim at rescuing or preserving both the autonomy and independence of the aging subject. A new paragon in the care appears bringing the comprehensive geriatric assessment, which is accomplished by a multidisciplinary team, as an essential praxis of both tracking and identifying the numerous illnesses to which the elderly is susceptible to. In this kind of assessment, it is fundamental to look into the social issues that might either retard the elderly's recuperation or bring about new maladies. The social interview is a technical instrument that will provide the professional with resources for an assessment that will entail an adequate intervention from the knowledge of the possibilities and limitations of the patients coming to geriatric facilities. This work aims at taking under consideration the social assessment withing the range of the comprehensive geriatric assessment. It is also an effort to contribute to the praxis of the social worker, given that theory in this is rare and social issues are central to the establishment of efficient therapeutic procedures.

A dependência e suas implicações para a perda de autonomia: estudo das representações para idosos de uma unidade ambulatorial geriátrica / The dependence and their engaged for the lost of autonomy: an study of the representations for old of a geriatric ambulatorial unit

Objetiva investigar representações de idosos sobre usas relações familiares. Pesquisa realizada com onze idosos, na faixa de 65 a 82 anos, que apresentavam incapacidade funcional, causadora de dependência para a realização das atividades básicas e instrumentais de vida diária e recebiam atendimento em unidade ambulatorial da UnATI/UERJ (Universidade Aberta da Terceira Idade da Universidade do Estado do Rio de Janeiro)