Idoso cuidador de idoso: significados atribuídos ao cuidar de um familiar
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2023-02-02
Autores
Garcia, Deomara Cristina Damasceno
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Universidade Estadual Paulista (Unesp)
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Introdução: Com o avanço da ciência e dos recursos aprimorados, aumentou a longevidade bem como o número de idosos. Muitos deles apresentam prejuízo funcional e demandam de cuidados de longa duração. A condição de saúde do idoso doente faz surgir a necessidade de um cuidador, cujo papel é exercido, frequentemente, por um familiar e também idoso. As mudanças decorrentes do cuidar de um doente crônico desorganizam a estrutura familiar, o convívio social e profissional, os estados emocional e psíquico do cuidador e, tudo isso afeta aquele que é cuidado e a relação como um todo. Portanto, devido à escassez de pesquisas voltadas ao estudo da qualidade de vida de idosos familiares cuidadores de pessoas idosas doentes ou dependentes na família, essa pesquisa é de fundamental importância. Objetivo: avaliar, junto ao idoso familiar cuidador, os fatores associados à qualidade de vida (QV) (atrelados às características sociodemográficas, capacidade funcional, sobrecarga, ansiedade e depressão) e os significados atribuídos ao cuidar de uma pessoa idosa familiar. Objetivos específicos: Revisão Sistemática: analisar a produção científica que aborda a qualidade de vida (QV) do cuidador familiar idoso que cuida de outro idoso em ambiente familiar a partir de artigos primários. Pesquisa Quantitativa: avaliar o nível de capacidade funcional, de sobrecarga, de ansiedade, de depressão e da qualidade de vida dos idosos familiares cuidadores. Pesquisa Qualitativa: compreender os significados atribuídos ao cuidar de uma pessoa idosa da família. Intervenção psicológica: analisar os resultados do acompanhamento psicológico individual. Método: Foram utilizados os métodos mistos quantitativo e qualitativo: Revisão Sistemática – os artigos foram identificados por meio de 6 bases de dados eletrônicas: PubMed, Embase, WOS, Scopus, Cinhal e Lilacs, no período de 1988-2021, de acordo com as instruções do PRISMA. Pesquisa Quantitativa - instrumentos de pesquisa: da capacidade funcional (Lawton), da sobrecarga (Zarit abreviada), de ansiedade (GAI), de depressão geriátrica (GDS), de qualidade de vida (WHOQOL-OLD e WHOQOL-BREF). Pesquisa Qualitativa – entrevista semiestruturada. Intervenção psicológica - individual e de orientação psicanalítica. Os dados quantitativos foram tratados pela análise estatística descritiva; os qualitativos, pelas análises de conteúdo e fatorial e a interpretação dos atendimentos psicológicos, pela teoria psicanalítica. Resultados: Na revisão sistemática, foi verificada a carência de pesquisas relacionadas ao tema: qualidade de vida de idosos que cuidam dos familiares também idosos e dependentes. Dos 1.143 artigos identificados, apenas 10 foram incluídos. Desses 10 artigos, a grande maioria das pesquisas destacou: um olhar na dupla idoso cuidado e cuidador e mais voltado ao idoso cuidado; as escalas utilizadas apresentaram limitações para alcançar a subjetividade das experiências de cuidados vividas pelos indivíduos envelhecidos e destacaram que possíveis intervenções realizadas junto aos cuidadores podem ser meios potenciais para melhorar a QV deles. Pesquisa Quantitativa: foram entrevistados 51 idosos familiares cuidadores, que apresentaram boa capacidade funcional; sobrecarga subjetiva moderada; escore médio para sintomas ansiosos e normal para sintomas depressivos; boa percepção da qualidade de vida, com pontuações superiores 60%, exceto para os domínios relacionados ao social. Pesquisa Qualitativa: 23 entrevistas, em que a Análise de Conteúdo Temática Categorial elencou duas categorias: “Aspectos ligados à Qualidade de Vida do Cuidador” e “Aspectos ligados aos Cuidados”. As interpretações da Análise Fatorial corroboraram as da Análise de Conteúdo Temática Categorial, tendo como Fator 1 – referência aos “Aspectos ligados aos Cuidados” e o Fator 2 – referência aos “Aspectos da Qualidade de Vida do Cuidador”. Intervenção Psicológica: de forma individual com 5 idosas familiares cuidadoras, possibilitou a abertura de novas estratégias de enfrentamento diante das necessidades dos cuidadores e de seus familiares. Foi percebido um mecanismo inconsciente, que denominamos “avantajamento”, desvendado ao longo desta intervenção de cunho psicanalítico. Conclusão: Este estudo abre aos profissionais da saúde novas possibilidades de atuação ao ampliar a compreensão dos sentidos dados pelo idoso ao cuidar de um outro idoso familiar doente. Poderá auxiliar no incentivo de ações que possibilitem a abertura de grupos de apoio e a promoção de atendimento psicológico individual aos idosos familiares cuidadores, no sentido de amenizar suas dores, sofrimentos e os problemas advindos também de um não olhar.
Introduction: With the advancement of science and improved resources, longevity has increased as well as the number of older people. Many of them have a functional impairment and require long-term care. The health condition of the sick older person raises the need for a caregiver, whose role is often exercised by a family member who is himself an older person. The changes resulting from caring for a chronically ill person disorganize the family structure, his social and professional life, and the emotional and psychic states of the caregiver, and all of this affects the person who is cared for and the relationship as a whole. Therefore, this research is of fundamental importance due to the scarcity of research aimed at studying the quality of life of older family members who care for sick or dependent older people in the family. Objective: To assess, together with the older adult family caregiver, the factors associated with quality of life (QoL) (linked to sociodemographic characteristics, functional capacity, burden, anxiety, and depression) and the meanings attributed to caring for an older family member. Specific objectives: Systematic Review: to analyze the scientific production that addresses the quality of life (QoL) of older family caregivers who take care of another older person in a family environment, based on primary articles. Quantitative Research: to assess the level of functional capacity, burden, anxiety, depression, and quality of life of older adult family Caregivers. Qualitative Research: to understand the meanings attributed to caring for an older adult in the Family. Psychological Intervention: to analyze the results of individual psychological therapy. Method: Mixed quantitative and qualitative methods were used: Systematic Review - articles identified through 6 electronic databases: PubMed, Embase, WOS, Scopus, Cinhal, and Lilacs, in the period 1988-2021, according to the PRISMA instructions. Quantitative Research - research instruments: functional capacity (Lawton), burden (abbreviated Zarit), anxiety (GAI), geriatric depression (GDS), quality of life (WHOQOL-OLD and WHOQOL-BREF). Qualitative Research - semi-structured interviews. Psychological Intervention - individual and psychoanalytically oriented. Quantitative datas were treated by descriptive statistical analysis, and qualitative by content and factor analysis, and the interpretation of psychological care by psychoanalytic theory. Results: In the Systematic Review, there was a lack of research related to the topic: quality of life of older people who take care of older dependent family members. Of the 1,143 articles identified, only 10 were included. Of the 10 articles, the vast majority of studies highlighted: a look at the pair of older caregiver and older cared, with a more focused look at the older cared; the scales used showed limitations to reach the subjectivity of the care experiences experienced by aged individuals and highlighted that possible interventions carried out with caregivers can be potential means to improve their QoL. Quantitative Research: 51 families older caregivers were interviewed. They showed good functional capacity; moderate subjective burden; average scores for anxiety symptoms, and normal for depressive symptoms; good perception of QoL - scores above 60%, except for social domains. Qualitative Research: 23 interviews listed two categories, in the Categorical Thematic Content Analysis: “Aspects linked to the Caregiver's Quality of Life” and “Aspects linked to Care”. The interpretations of the Factor Analysis corroborated those of the Categorical Thematic Content Analysis, with Factor 1 – a reference to “Aspects linked to Care” and Factor 2 – a reference to “Aspects linked to the Caregiver's Quality of Life”. Psychological Intervention: an individual with 5 older family caregivers. The intervention opened new coping strategies for the needs of caregivers and their families. An unconscious mechanism was perceived, which we called “advantage”, unveiled throughout this psychoanalytic intervention. Conclusion: This study opens new possibilities for health professionals to act by expanding the understanding of the meanings of an older person caring for another sick older family member. It may help to encourage actions that enable the opening of support groups and the promotion of individual psychological care for older family caregivers, to ease their pain, suffering, and the problems that also arise from not looking.
Introduction: With the advancement of science and improved resources, longevity has increased as well as the number of older people. Many of them have a functional impairment and require long-term care. The health condition of the sick older person raises the need for a caregiver, whose role is often exercised by a family member who is himself an older person. The changes resulting from caring for a chronically ill person disorganize the family structure, his social and professional life, and the emotional and psychic states of the caregiver, and all of this affects the person who is cared for and the relationship as a whole. Therefore, this research is of fundamental importance due to the scarcity of research aimed at studying the quality of life of older family members who care for sick or dependent older people in the family. Objective: To assess, together with the older adult family caregiver, the factors associated with quality of life (QoL) (linked to sociodemographic characteristics, functional capacity, burden, anxiety, and depression) and the meanings attributed to caring for an older family member. Specific objectives: Systematic Review: to analyze the scientific production that addresses the quality of life (QoL) of older family caregivers who take care of another older person in a family environment, based on primary articles. Quantitative Research: to assess the level of functional capacity, burden, anxiety, depression, and quality of life of older adult family Caregivers. Qualitative Research: to understand the meanings attributed to caring for an older adult in the Family. Psychological Intervention: to analyze the results of individual psychological therapy. Method: Mixed quantitative and qualitative methods were used: Systematic Review - articles identified through 6 electronic databases: PubMed, Embase, WOS, Scopus, Cinhal, and Lilacs, in the period 1988-2021, according to the PRISMA instructions. Quantitative Research - research instruments: functional capacity (Lawton), burden (abbreviated Zarit), anxiety (GAI), geriatric depression (GDS), quality of life (WHOQOL-OLD and WHOQOL-BREF). Qualitative Research - semi-structured interviews. Psychological Intervention - individual and psychoanalytically oriented. Quantitative datas were treated by descriptive statistical analysis, and qualitative by content and factor analysis, and the interpretation of psychological care by psychoanalytic theory. Results: In the Systematic Review, there was a lack of research related to the topic: quality of life of older people who take care of older dependent family members. Of the 1,143 articles identified, only 10 were included. Of the 10 articles, the vast majority of studies highlighted: a look at the pair of older caregiver and older cared, with a more focused look at the older cared; the scales used showed limitations to reach the subjectivity of the care experiences experienced by aged individuals and highlighted that possible interventions carried out with caregivers can be potential means to improve their QoL. Quantitative Research: 51 families older caregivers were interviewed. They showed good functional capacity; moderate subjective burden; average scores for anxiety symptoms, and normal for depressive symptoms; good perception of QoL - scores above 60%, except for social domains. Qualitative Research: 23 interviews listed two categories, in the Categorical Thematic Content Analysis: “Aspects linked to the Caregiver's Quality of Life” and “Aspects linked to Care”. The interpretations of the Factor Analysis corroborated those of the Categorical Thematic Content Analysis, with Factor 1 – a reference to “Aspects linked to Care” and Factor 2 – a reference to “Aspects linked to the Caregiver's Quality of Life”. Psychological Intervention: an individual with 5 older family caregivers. The intervention opened new coping strategies for the needs of caregivers and their families. An unconscious mechanism was perceived, which we called “advantage”, unveiled throughout this psychoanalytic intervention. Conclusion: This study opens new possibilities for health professionals to act by expanding the understanding of the meanings of an older person caring for another sick older family member. It may help to encourage actions that enable the opening of support groups and the promotion of individual psychological care for older family caregivers, to ease their pain, suffering, and the problems that also arise from not looking.
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Palavras-chave
Cuidadores, Família, Idosos, Intervenção Psicossocial, Qualidade de Vida, Caregiver, Family, Older Adult, Psychosocial Intervention, Quality of Life