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.

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.

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 ± 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.

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.

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.

Senior caregivers in different housing arrangements: comparison of health and care profiles

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.

Factors associated with cognitive performance in elderly caregivers

OBJECTIVE

To explore the socioeconomic, demographic and psychosocial factors associated with cognitive performance in elderly caregivers from Brazil.

METHODS

We evaluated 351 Brazilian elderly caregivers attending primary healthcare services regarding sociodemographic and care variables. Addenbrooke's Cognitive Examination-Revised (ACE-R) domains of orientation/attention, memory, verbal fluency, language and visuospatial were used as dependent variables in the Tobit model.

RESULTS

Literacy and family income were positively associated with all ACE-R domains. Age, gender, time of care (days/week) were negatively associated with some cognitive domains. Moreover, receiving emotional help and the level of hope were positively associated with specific domains.

DISCUSSION

The results may be useful for planning interventions aimed at elderly caregivers in order to prevent deficits in the different cognitive domains.

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.

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.

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

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.

Association between depressive syndrome and visual complaints among elderly caregivers

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.

Social support and cognitive processing among elderly caregivers and non-caregivers of other elderly persons

Abstract 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.

Use of digital game therapy among elderly persons undergoing dialytic treatment: cognitive aspects and depressive symptoms

Abstract Objective :to evaluate the presence of depressive symptoms and cognitive disorders before and after an intervention program with a digital therapeutic game among elderly persons undergoing hemodialysis. Method: a quasi-experimental study was carried out with 26 elderly patients on hemodialysis. For the data collection, a questionnaire relating to sociodemographic and health conditions, the Geriatric Depression Scale - 15 items and Addenbrooke’s Cognitive Examination Revised were used. The intervention with the digital therapeutic game was performed over 5 sessions. Results: of the participants, 80.8% were male, with a mean age of 66.7 (± 5.8) years. The mean pre-intervention depressive symptom score was 3.9 (± 3.0) while post-intervention it was 2.8 (± 2.9), representing a statistically significant difference (p = 0.005). Regarding cognitive function, there was no statistically significant difference before and after the intervention. There was a statistically significant difference in the mean of the depressive symptom scores, which were lower after the intervention. In addition, there was no statistically significant difference in the mean of the cognitive assessments. Conclusion: intervention studies with patients undergoing hemodialysis treatment are still scarce and this study describes the positive results of an intervention with a digital therapeutic game, demonstrating improvement in the depressive symptoms of the participants.

Descriptive data in different paper-based cognitive assessments in elderly from the community Stratification by age and education

Cognitive aging is dynamic and heterogeneous in elderly, thus adequate tools such as paper-based tests are relevant to describe the cognitive profile of this population.

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.

On the use of the P300 as a tool for cognitive processing assessment in healthy aging: A review

Changes in patterns of performance for the cognitive functions of memory, processing speed, and focused attention are expected in old age.

High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas

Abstract Introduction: Older caregivers living in rural areas may be exposed to three vulnerable conditions, i.e., those related to care, their own aging, and their residence context. Objective: To analyze the association of burden and frailty with cognition performance in older caregivers in rural communities. Method: In this cross-sectional survey, 85 older caregivers who cared for dependent elders were included in this study. Global cognition (Addenbrooke's Cognitive Examination – Revised; Mini Mental State Examination), burden (Zarit Burden Interview) and frailty (Fried's frailty phenotype) were assessed. All ethical principles were observed. Results: Older caregivers were mostly women (76.7%); mean age was 69 years. Cognitive impairment was present in 15.3%, severe burden in 8.2%, frailty in 9.4%, and pre-frailty in 52.9% of the older caregivers. More severely burdened or frail caregivers had worse cognitive performance than those who were not, respectively (ANOVA test). Caregivers presenting a high burden level and some frailty degree (pre-frail or frail) simultaneously were more likely to have a reduced global cognition performance. Conclusion: A significant number of older caregivers had low cognitive performance. Actions and resources to decrease burden and physical frailty may provide better cognition and well-being, leading to an improved quality of life and quality of the care provided by the caregivers.

Health profile of family caregivers of the elderly and its association with variables of care: a rural study

Abstract Objective: to analyze the profile of a population of caregivers from a city in a rural area of the state of São Paulo, Brazil, and identify their health complaints and the characteristics of care provided. Method: a prospective cross-sectional study was performed based on a domicile survey of 99 caregivers and their elderly care recipients. Information about the profile, context of care and health complaints of the caregivers was collected. The caregivers responded to the Zarit Burden Inventory and the Geriatric Depression Scale-15 and the elderly underwent a cognition and functionality assessment. The chi-squared test with odds ratio (OR) was performed to test associations. Result: the majority of the caregivers were women (n=76), elderly (n=83), with a median age 65.8 (±10.4) years and 4.9 (±4.2) years of formal schooling. The most frequent health complaints were pain, systemic hypertension, insomnia, back problems and vision problems. The elderly care recipients were men (n=75), with an average age of 72.0 (±8.2) years. Analysis of associations revealed that caregivers who received emotional support had a lower chance of being highly overburdened (OR=0.37; CI95% 0.15-0.90). Caring for over five years was associated with arthritis (OR=2.50; CI95% 1.0-6.56). Caring of an elderly person with cognitive impairment was strongly associated with peripheral vascular diseases (OR=2.70; CI95% 1.11-6.85) and other diseases (OR=6.94; CI95% 1.43-33.63). Conclusion: A better understanding of the reality of care in rural and remote areas and the identification of factors related to the health care of caregivers provides better care management for the elderly and caregivers, who themselves are aging.

Factors associated with the resilience of family caregivers of persons with dementia: a systematic review

Abstract Background: Resilience is the ability of individuals or groups to overcome adversity without displaying physical or mental disorders, or even learning to deal with unfavorable conditions more efficiently. There have been many studies on resilience, which try to identify the conditions under which people in situations of deprivation or adversity overcome such challenges. Objective: The present article aimed to identify factors associated the with development of resilience in family caregivers of people with dementia and the possible outcomes of resilience for the caregiver and receiver of care. Method: The study consisted of a systematic literature review carried out in accordance with the PRISMA methodology with searches in the Lilacs, PsycInfo, PubMed, SciELO, SCOPUS and Web of Science databases, using pre-established descriptors. Results: After synthesis of the extracted data and the considerations of this review, it was possible to identify possible factors associated with the development of resilience in family caregivers of persons with dementia: depression, anxiety, burden, drug use, the relationship with the person receiving care and health conditions are associated with the resilience of family caregivers. Conclusion: We found in literature that the development of resilience by family caregivers of people with Alzheimer's is influenced by factors related to the patient and the caregiver himself or herself.

Relationship between cognition and frailty in elderly: A systematic review

Objective

The aim of this study was to analyze the relationship between cognition and frailty in the elderly.

Methods

A systematic review on the currently existing literature concerning the subject was carried out. The search strategy included LILACS, SCOPUS, SciELO, PsycINFO, PubMed and Web of Science databases.

Results

A total of 19 studies were selected for review, from which 10 (52.6%) were cross-sectional and 9 (47.4%) longitudinal, and the majority Brazilian. All of the studies established a link between cognition and frailty. There was a relationship between components of frailty and the cognitive domains. Risk of Mild Cognitive Impairment (MCI), dementia and mortality were all evidenced in the relationship between frailty and cognitive impairment.

Conclusion

The theory remains limited, but results show the variables that appear to be linked to cognition and frailty in elderly. This data can help in implementing actions to improve the quality of life among elderly.

Subjective memory complaints associated with depression and cognitive impairment in the elderly: A systematic review

The aging process can be accompanied by a slight decline in cognitive functioning, and subjective memory complaints (SMC) appear to be common in the elderly population.

Factors associated with quality of life in elderly undertaking literacy programs

Increased life expectancy has led to a significant number of elderly enrolling on Youth and Adult Education programs (YAE). These individuals leave inactivity and negative aspects of aging in search of opportunities for social inclusion.