RESUMO

Due to the progressive need for care, older adults with dementia are at risk of becoming institutionalized. Caregivers of these patients are tasked with the challenge of controlling behavioral and psychological symptoms without sufficient knowledge and are therefore at greater risk of developing physical and mental health problems. In this context, psychoeducational interventions can help greatly toward improving caregiver well-being. Objective: to investigate the prevalence of behavioral and psychological symptoms of dementia (BPSD) in aged residents of long-term care facilities (LTCFs), to determine the prevalence of burden and common mental disorders in caregivers, and to assess the effects of a psychoeducational intervention. Methods: an intervention study was performed at LTCFs for aged people. The following instruments were used: Self-Reporting Questionnaire and Zarit Burden Interview for caregivers; and the MMSE, Katz Index, Clinical Dementia Rating scale and Neuropsychiatry Inventory-Questionnaire for older adults. Results: Of the 72 aged residents assessed, 52 (72.2%) were female and mean age was 82.3 (±8.14) years. The most prevalent neuropsychiatric symptoms were euphoria and elation (74%), followed by agitation and aggression (74%). Of the 54 caregivers, 49 (90.7%) were women and mean age was 33.9 (±10.8) years. Overall, 33.3% screened positive for common mental disorder and 36.1% for burden/overload. A statistically significant association was found between burden and working in philanthropic institutions (p=0.003) and also between burden and presence of common mental disorder or otherwise (p=0.001). After the psychoeducational intervention, 42.8% reported reduced burden. Conclusion: The residents presented neuropsychiatric symptoms. Caregivers showed burden and common mental disorders, especially in philanthropic institutions. It was observed a reduction in burden of caregivers with psychoeducational intervention, showing the importance of this strategy.

Em razão do aumento progressivo da necessidade de cuidados, idosos com demência apresentam risco de institucionalização. Os cuidadores desses pacientes são desafiados a controlar os sintomas comportamentais e psicológicos da demência sem o conhecimento adequado e, como resultado, estão em maior risco de adoecimento físico e emocional. Nesse contexto, a intervenção psicoeducacional contribui significativamente para a melhoria do bem-estar do cuidador. Objetivo: Investigar a prevalência de sintomas comportamentais e psicológicos na demência em idosos de instituições de longa permanência, verificar a prevalência de sobrecarga e transtorno mental comum nos cuidadores e avaliar os efeitos de uma intervenção psicoeducacional. Métodos: Estudo de intervenção realizado em instituições de longa permanência para idosos. Os instrumentos utilizados foram: Self-Reporting Questionnaire e Zarit Burden Interview para os cuidadores e o Miniexame do Estado Mental, Katz Index, Clinical Dementia Rating e Neuropsychiatry Inventory-Questionnaire para os idosos. Resultados: Dos 72 idosos, 52 (72,2%) eram mulheres, com média de idade de 82,3 (±8,14) anos. Os sintomas neuropsiquiátricos mais prevalentes foram: euforia e elação (74%) e agitação e agressividade (74%). Dos 54 cuidadores, 49 (90,7%) eram mulheres, com média de idade de 33,9 (±10,8) anos. Apresentaram rastreio positivo para transtorno mental comum 33,3% e para sobrecarga 36,1%. Foi encontrada associação estatisticamente significativa entre sobrecarga e trabalhar em instituições filantrópicas (p=0,003), assim como entre a sobrecarga e ter ou não transtorno mental comum (p=0,001). Após a intervenção psicoeducacional, 42,8% apresentaram redução da sobrecarga. Conclusão: Os residentes apresentaram sintomas neuropsiquiátricos. Os resultados dos cuidadores indicaram a presença de sobrecarga e outras manifestações em saúde mental, principalmente em instituições filantrópicas, além de demonstrar a importância de intervenções psicoeducativas voltadas aos cuidadores, considerando que foram observados efeitos na redução da sobrecarga para o grupo intervenção.

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Background: Inflammaging is a phenomenon that has been associated with the development and progression of sarcopenia and frailty syndrome. According to the literature, on the one side, the increase in body fat is associated with a systemic pro-inflammatory status, which consequently favors inflammaging, and on the other side, the regular practice of physical exercise can mitigate the development of this scenario. Therefore, here, we aimed to evaluate the association between inflammaging and physical factors, both body and functional, in a group of physically active older women. Methods: Seventy older women (mean age 72.66 ± 6.17 years) participated in this observational cross-sectional and were separated into the eutrophic, overweight, and obese groups. It was assessed: by bioimpedance-body fat percentage (Fat%) and total (Fat kg), skeletal muscle mass (muscle), and free fat mass both in percentage (FFM%) and total (FFMkg); by the International Physical Activity Questionnaire (IPAQ)-the time of moderate-intensity physical activity per week; by physical tests-handgrip (HG), sit-up-stand-on-the-chair in 5 repetitions (Sit-up) and vertical squat jump test (SJ); in addition to the determination of serum cytokine concentration (IL-6, TNF-α, IL-10, and IL-8), and also body mass index (BMI) and calf circumference (Calf). Results: Higher FFM% and lower body fat (both kg and %) were found in the eutrophic group than in the other groups. The eutrophic group also performed more weekly physical activity, jumped higher, and presented not only higher serum IL-6 concentration but also an increased ratio of IL-10/IL-6, IL-10/TNF-α, IL-10/IL-8 as compared to the values found in the overweight group. The obese group presented higher body fat (kg and %) and lower FFM% than the other groups and also higher serum IL-6 concentration than the overweight group. Interestingly, several significant negative and positive correlations between body composition, physical tests, and serum cytokine concentrations were found in the eutrophic and obese groups. Conclusion: While the eutrophic older women group showed a remarkable regulation of the systemic inflammatory status with positive associations in the physical parameters assessed, the overweight and obese groups presented impairment regulations of the inflammaging, which could be related to less weekly physical activity and higher body fat.

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ABSTRACT Due to the progressive need for care, older adults with dementia are at risk of becoming institutionalized. Caregivers of these patients are tasked with the challenge of controlling behavioral and psychological symptoms without sufficient knowledge and are therefore at greater risk of developing physical and mental health problems. In this context, psychoeducational interventions can help greatly toward improving caregiver well-being. Objective: to investigate the prevalence of behavioral and psychological symptoms of dementia (BPSD) in aged residents of long-term care facilities (LTCFs), to determine the prevalence of burden and common mental disorders in caregivers, and to assess the effects of a psychoeducational intervention. Methods: an intervention study was performed at LTCFs for aged people. The following instruments were used: Self-Reporting Questionnaire and Zarit Burden Interview for caregivers; and the MMSE, Katz Index, Clinical Dementia Rating scale and Neuropsychiatry Inventory-Questionnaire for older adults. Results: Of the 72 aged residents assessed, 52 (72.2%) were female and mean age was 82.3 (±8.14) years. The most prevalent neuropsychiatric symptoms were euphoria and elation (74%), followed by agitation and aggression (74%). Of the 54 caregivers, 49 (90.7%) were women and mean age was 33.9 (±10.8) years. Overall, 33.3% screened positive for common mental disorder and 36.1% for burden/overload. A statistically significant association was found between burden and working in philanthropic institutions (p=0.003) and also between burden and presence of common mental disorder or otherwise (p=0.001). After the psychoeducational intervention, 42.8% reported reduced burden. Conclusion: The residents presented neuropsychiatric symptoms. Caregivers showed burden and common mental disorders, especially in philanthropic institutions. It was observed a reduction in burden of caregivers with psychoeducational intervention, showing the importance of this strategy.

RESUMO Em razão do aumento progressivo da necessidade de cuidados, idosos com demência apresentam risco de institucionalização. Os cuidadores desses pacientes são desafiados a controlar os sintomas comportamentais e psicológicos da demência sem o conhecimento adequado e, como resultado, estão em maior risco de adoecimento físico e emocional. Nesse contexto, a intervenção psicoeducacional contribui significativamente para a melhoria do bem-estar do cuidador. Objetivo: Investigar a prevalência de sintomas comportamentais e psicológicos na demência em idosos de instituições de longa permanência, verificar a prevalência de sobrecarga e transtorno mental comum nos cuidadores e avaliar os efeitos de uma intervenção psicoeducacional. Métodos: Estudo de intervenção realizado em instituições de longa permanência para idosos. Os instrumentos utilizados foram: Self-Reporting Questionnaire e Zarit Burden Interview para os cuidadores e o Miniexame do Estado Mental, Katz Index, Clinical Dementia Rating e Neuropsychiatry Inventory-Questionnaire para os idosos. Resultados: Dos 72 idosos, 52 (72,2%) eram mulheres, com média de idade de 82,3 (±8,14) anos. Os sintomas neuropsiquiátricos mais prevalentes foram: euforia e elação (74%) e agitação e agressividade (74%). Dos 54 cuidadores, 49 (90,7%) eram mulheres, com média de idade de 33,9 (±10,8) anos. Apresentaram rastreio positivo para transtorno mental comum 33,3% e para sobrecarga 36,1%. Foi encontrada associação estatisticamente significativa entre sobrecarga e trabalhar em instituições filantrópicas (p=0,003), assim como entre a sobrecarga e ter ou não transtorno mental comum (p=0,001). Após a intervenção psicoeducacional, 42,8% apresentaram redução da sobrecarga. Conclusão: Os residentes apresentaram sintomas neuropsiquiátricos. Os resultados dos cuidadores indicaram a presença de sobrecarga e outras manifestações em saúde mental, principalmente em instituições filantrópicas, além de demonstrar a importância de intervenções psicoeducativas voltadas aos cuidadores, considerando que foram observados efeitos na redução da sobrecarga para o grupo intervenção.

RESUMO

OBJECTIVE: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. METHOD: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. RESULTS: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. CONCLUSION: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.

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Objectives: Internet-based interventions can help carers of people living with dementia to cope with care-related challenges and can help improve their wellbeing. This systematic review aimed at investigating the criteria of usability and acceptability of self-guided internet-based interventions for family carers of people living with dementia. Method: Searches were conducted on PubMed, Virtual Health Library Regional Portal (Americas), MEDLINE, PsycINFO, Scopus, and Cochrane. Studies published up to December 2019, in English, Portuguese, or Spanish, were eligible. We followed the definition/criteria from ISO ISO-9241-11 for usability (efficiency, effectiveness, and satisfaction) and acceptability (barriers for using and utility). Methodological quality was evaluated using specific tools according to each study design. Results: Ten studies were included, all of which had high methodological quality. Carers of people living with dementia indicated that internet-based interventions were mostly effective, efficient, and satisfactory. They considered these to be informative, relevant, and functional, highlighting the utility and intention of using the resource in the future. The high heterogeneity in the terms and methods used to evaluate usability and acceptability hindered cross-study comparisons, however internet-based interventions were considered useful and acceptable by most carers. Conclusion: Future research should consider expanding the criteria of usability and acceptability to better reflect the needs of this population.

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Resumo Objetivo: avaliar a adesão das instituições de longa permanência brasileiras às orientações de Prevenção e Controle de Infecções da Organização Mundial da Saúde, observando a associação entre seu porte e a adesão a essas recomendações. Método: estudo transversal realizado com gestores de estabelecimentos. Os autores desenvolveram um questionário de 20 itens, com base nessas orientações, e um escore global de adesão, com base na adesão a essas recomendações. A adesão foi classificada como (1) excelente para aquelas que atenderam ≥14 de 20 recomendações, (2) bom para 10 a 13 itens e (3) baixo para aquelas com menos de dez itens. O tamanho das instalações foi classificado como pequeno, médio e grande, de acordo com uma análise de cluster em duas etapas. Estatística descritiva e teste de qui-quadrado foram utilizados com nível de significância de 5%. Resultados: das 362 instituições incluídas, 308 (85,1%) aderiram a 14 ou mais recomendações. Em relação ao seu tamanho, a adesão à triagem de sintomas de COVID-19 dos visitantes (p=0,037) e ao isolamento de pacientes até que tenham dois exames laboratoriais negativos (p=0,032) foi menor em estabelecimentos maiores, em comparação com estabelecimentos de médio e pequeno porte. Conclusão: a adesão às medidas de mitigação da COVID-19 nas unidades brasileiras foi considerada excelente para a maioria das recomendações, independentemente do porte das unidades.

Abstract Objective: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. Method: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. Results: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. Conclusion: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.

Resumen Objetivo: evaluar la adhesión de instituciones brasileñas de larga estancia a las orientaciones de Prevención y Control de Infecciones de la Organización Mundial de la Salud y evaluar la asociación entre su tamaño y la adhesión a esas recomendaciones. Método: estudio transversal realizado con gerentes de establecimientos. Los autores desarrollaron un cuestionario de 20 ítems basado en estas directrices y un puntaje general de cumplimiento acorde a la observancia de estas recomendaciones. La adhesión se calificó (1) excelente para aquellas que cumplieron con ≥14 de 20 recomendaciones; (2) buena para 10 a 13 artículos; y (3) baja para aquellas con menos de diez elementos. El tamaño de las instalaciones se clasificó como pequeños, medianos y grandes de acuerdo con un análisis de clúster de dos pasos. Se utilizó estadística descriptiva y la prueba de chi-cuadrado con un nivel de significancia del 5%. Resultados: de las 362 instituciones incluidas, 308 (85,1%) se adhirieron a 14 o más recomendaciones. En cuanto a su tamaño, la adhesión al cribado de síntomas de COVID-19 de los visitantes (p=0,037) y al aislamiento de los pacientes hasta que tengan dos pruebas de laboratorio negativas (p=0,032) fue menor en los establecimientos más grandes en comparación con los establecimientos medianos y pequeños. Conclusión: la adhesión a las medidas de mitigación de la COVID-19 en las unidades brasileñas fue considerada excelente para la mayoría de las recomendaciones, independientemente del tamaño de las unidades.

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BACKGROUND: The Brazilian population has aged rapidly. The oldest old, defined as persons aged 80 years or older, is the fastest growing segment of the Brazilian population. Several instruments have been used to assess the cognitive performance of the older people and predict dementia. One of the most commonly used is the Mini-Mental State Examination (MMSE). OBJECTIVE: The aim of this study was to investigate the relationship between baseline MMSE score and the incidence of dementia in a Brazilian cohort of independent oldest old. METHODS: Sociodemographic data and serial cognitive assessment of 248 older adults were analyzed. RESULTS: Mean follow-up time of subjects was 4.0(±1.9) years, 71.4% were women, and mean MMSE score at entry was 25(±3.5). Mean MMSE scores at baseline were significantly higher (p=0.001) in the cognitively intact group than in those who developed dementia. The logistic regression showed that for a one point increase in MMSE score at baseline there was a 10% reduction in the probability of dementia. CONCLUSIONS: In the Brazilian scenario of a rapidly growing population of oldest old, the extensive use of the MMSE gives rise to the need not only to determine its effectiveness for screening dementia, but also to interpret its score in terms of future conversion to dementia.

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ABSTRACT Background: The Brazilian population has aged rapidly. The oldest old, defined as persons aged 80 years or older, is the fastest growing segment of the Brazilian population. Several instruments have been used to assess the cognitive performance of the older people and predict dementia. One of the most commonly used is the Mini-Mental State Examination (MMSE). Objective: The aim of this study was to investigate the relationship between baseline MMSE score and the incidence of dementia in a Brazilian cohort of independent oldest old. Methods: Sociodemographic data and serial cognitive assessment of 248 older adults were analyzed. Results: Mean follow-up time of subjects was 4.0(±1.9) years, 71.4% were women, and mean MMSE score at entry was 25(±3.5). Mean MMSE scores at baseline were significantly higher (p=0.001) in the cognitively intact group than in those who developed dementia. The logistic regression showed that for a one point increase in MMSE score at baseline there was a 10% reduction in the probability of dementia. Conclusions: In the Brazilian scenario of a rapidly growing population of oldest old, the extensive use of the MMSE gives rise to the need not only to determine its effectiveness for screening dementia, but also to interpret its score in terms of future conversion to dementia.

RESUMO Antecedentes: A população brasileira envelheceu rapidamente. Os longevos, definidos como pessoas com 80 anos ou mais, são o segmento da população brasileira que mais cresce. Diversos instrumentos têm sido usados para avaliar o desempenho cognitivo de idosos e para predizer demência. Um dos instrumentos mais utilizados é o Miniexame do Estado Mental (MEEM). Objetivo: Nosso objetivo foi investigar a relação entre a pontuação inicial do MEEM e a incidência de demência em uma coorte brasileira de idosos longevos independentes. Métodos: Foram avaliados dados de 248 idosos por meio de um questionário sociodemográfico e de avaliações cognitivas seriadas. Resultados: O tempo médio de acompanhamento dos participantes foi de 4,0 (±1,9) anos. Eram mulheres 71,4% deles e a pontuação média do MEEM na entrada foi de 25 (±3,5) pontos. As pontuações médias do MEEM no início do estudo foram significativamente maiores (p=0,001) no grupo cognitivamente intacto do que naqueles que desenvolveram demência. A regressão logística mostrou que, para cada ponto a mais na pontuação do MEEM no início do estudo, houve redução de 10% na probabilidade de desenvolver demência. Conclusões: No cenário brasileiro de rápido crescimento da população de idosos longevos, o uso da ferramenta cognitiva mais amplamente utilizada cria a necessidade de determinar não apenas sua eficácia no rastreamento da demência, mas também de interpretar seu escore considerando-se a futura conversão para demência.

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