Sintomas comportamentais e psicológicos na demência no contexto da longa permanência: avaliação de idosos e intervenção para cuidadores
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2022-08-17
Autores
Duarte, Evelise Saia Rodolpho
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Universidade Estadual Paulista (Unesp)
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Introdução: O envelhecimento populacional está associado ao aumento da incidência de doenças crônico-degenerativas, como as demências. Devido ao aumento progressivo da necessidade de cuidados, idosos com demência apresentam maior risco de institucionalização. Os cuidadores de pacientes com demência são desafiados a controlarem os sintomas da doença sem o conhecimento adequado, deparando-se com tarefas múltiplas e desafiadoras e, como resultado, estão em maior risco de acometimento do bem-estar físico e mental. Controlar os sintomas comportamentais é relatado como sendo mais desgastante do que gerenciar o declínio cognitivo. Por este motivo, a avaliação dos sintomas comportamentais e psicológicos na demência faz-se importante. Neste contexto, a intervenção psicoeducacional contribui significativamente para a melhoria do bem-estar do cuidador. Objetivos: Investigar a prevalência de sintomas comportamentais e psicológicos na demência em idosos residentes em instituições de longa permanência; verificar a prevalência de sobrecarga, sintomas psiquiátricos, transtorno mental comum e avaliar a qualidade de vida dos cuidadores e os efeitos de uma intervenção psicoeducacional na saúde mental destes indivíduos. Método: Trata-se de um estudo realizado em instituições de longa permanência para idosos de Botucatu, São Paulo, com dois desenhos: 1) Observacional, analítico e transversal e 2) Experimental com grupo controle. Os participantes foram aleatorizados para receberem a intervenção psicoeducacional (grupo intervenção) ou receberem um folder informativo sobre demência (grupo controle). Os instrumentos utiliza-os foram: “Self Reporting Questionnaire” (SRQ-20), “Patient Health Questionnaire” (PHQ-2), “Zarit Burden Interview”, “Short-Form Health Survey” (SF-36) e “Dementia Knowledge Assessment Tool Version 2” (DKAT-2) para os cuidadores e o miniexame do estado mental, índice de Katz, “Clinical Dementia Rating” (CDR) e “Neuropsychiatry Inventory-Questionnaire” (NPI-Q) para os idosos. Resultados: 54 cuidadores e 72 residentes foram avaliados. Dos 72 idosos institucionalizados, 52 (72,2%) eram mulheres, com média de idade de 82,3 (±8,14) anos. A doença de Alzheimer foi o tipo de demência mais frequente, tanto nas instituições privadas (71,0%) quanto nas filantrópicas (48,15%). A maioria dos idosos (mais de 90,0%) apresentou alteração no miniexame do estado mental e 50,0% da amostra demência grave de acordo com o CDR. No NPI-Q, os sintomas comportamentais e psicológicos mais prevalentes foram: euforia e elação (74%) e agitação e agressividade (74%). Na amostra de cuidadores, 49 (90,7%) eram mulheres, com média de idade de 33,9 (±10,8) anos, 40,7% solteiros, 55,6% de instituições privadas e 75,9% com carga de trabalho igual ou superior a 40 horas semanais. 33,3% dos cuidadores apresentaram rastreio positivo para transtorno mental comum, 16,7% para depressão e 36,1% para sobrecarga. Foi encontrada associação estatisticamente significativa entre sobrecarga em cuidadores nas ILPI filantrópicas (p=0,003), assim como uma associação estatisticamente significativa entre a sobrecarga em cuidadores e ter ou não transtorno mental comum (p=0,001). Após a intervenção psicoeducacional, 6 (42,8%) cuidadores do grupo intervenção apresentaram redução da sobrecarga. Conclusão: Identificou-se a presença de sintomas comportamentais e psicológicos em idosos com demência institucionalizados, bem como a presença de sobrecarga em seus cuidadores, em especial das instituições filantrópicas. A intervenção psicoeducacional produziu efeitos positivos na sobrecarga dos indivíduos do grupo intervenção.
Introduction: Population aging is associated with an increase of chronicdegenerative diseases, such as dementia. Due to the progressive increase in the need for care, older people with dementia are at higher risk of institutionalization. Caregivers of patients with dementia are challenged to control the symptoms of the disease without adequate knowledge, faced with multiple and challenging tasks and, as a result, are at greater risk of impairing their physical and mental well-being. Controlling behavioral symptoms is reported to be more stressful than managing cognitive decline. For this reason, the assessment of behavioral and psychological symptoms in dementia is important. In this context, the psychoeducational intervention contributes significantly to the improvement the caregiver's wellbeing. Aims: To investigate the prevalence of behavioral and psychological symptoms in dementia in elderly people residing in care homes; to verify the prevalence of burden, psychiatric symptoms, common mental disorder and quality of life in caregivers and to evaluate the effects of a psychoeducational intervention in mental health in caregivers. Method: This is a study carried out in care homes for the older people in Botucatu, São Paulo, with two designs: 1) Observational, analytical and cross-sectional and 2) Experimental with control group. Participants were randomized to receive the psychoeducational intervention (intervention group) or to receive an information folder about dementia (control group). The instruments used were: “Self Reporting Questionnaire” (SRQ-20), “Patient Health Questionnaire” (PHQ-2), “Zarit Burden Interview”, “Short-Form Health Survey” (SF-36) and “Dementia Knowledge Assessment Tool Version 2” (DKAT-2) for caregivers and the mini mental state examination, Katz index, “Clinical Dementia Rating” (CDR) and “Neuropsychiatry InventoryQuestionnaire” (NPI-Q) for the patients. Results: 54 caregivers and 72 residents were evaluated. Of the 72 institutionalized older people, 52 (72,2%) were female, with a mean age of 82,3 (±8,14) years. Alzheimer's disease was the most frequent type of dementia, both in private (71,0%) and philanthropic (48,15%) institutions. Most patients (over 90,0%) presented alteration according to the mini mental state examination and 50,0% of the sample had severe dementia according to the CDR. Considering the NPI-Q, the most prevalent behavioral and psychological symptoms were: euphoria and elation (74%) and agitation and aggression (74%). In the sample of caregivers, 49 (90,7%) were female, with a mean age of 33,9 (± 10,8) years, 40,7% single, 55,6% were from private institutions and 75,9% with a workload of or greater than 40 hours per week. 33,3% had positive screening for common mental disorder, 16,7% for depression and 36,1% for burden. A statistically significant association was found between burden in caregivers in philanthropic care homes (p=0,003), as well as a statistically significant association between burden in caregivers and having or not common mental disorder (p=0,001). After the psychoeducational intervention, 6 (42,8%) caregivers in the intervention group showed a reduction of burden. Conclusion: The presence of behavioral and psychological symptoms in patients was identified, as well as the presence of burden in their caregivers, especially in philanthropic institutions. The psychoeducational intervention produced positive effects on the burden of individuals in the intervention group.
Introduction: Population aging is associated with an increase of chronicdegenerative diseases, such as dementia. Due to the progressive increase in the need for care, older people with dementia are at higher risk of institutionalization. Caregivers of patients with dementia are challenged to control the symptoms of the disease without adequate knowledge, faced with multiple and challenging tasks and, as a result, are at greater risk of impairing their physical and mental well-being. Controlling behavioral symptoms is reported to be more stressful than managing cognitive decline. For this reason, the assessment of behavioral and psychological symptoms in dementia is important. In this context, the psychoeducational intervention contributes significantly to the improvement the caregiver's wellbeing. Aims: To investigate the prevalence of behavioral and psychological symptoms in dementia in elderly people residing in care homes; to verify the prevalence of burden, psychiatric symptoms, common mental disorder and quality of life in caregivers and to evaluate the effects of a psychoeducational intervention in mental health in caregivers. Method: This is a study carried out in care homes for the older people in Botucatu, São Paulo, with two designs: 1) Observational, analytical and cross-sectional and 2) Experimental with control group. Participants were randomized to receive the psychoeducational intervention (intervention group) or to receive an information folder about dementia (control group). The instruments used were: “Self Reporting Questionnaire” (SRQ-20), “Patient Health Questionnaire” (PHQ-2), “Zarit Burden Interview”, “Short-Form Health Survey” (SF-36) and “Dementia Knowledge Assessment Tool Version 2” (DKAT-2) for caregivers and the mini mental state examination, Katz index, “Clinical Dementia Rating” (CDR) and “Neuropsychiatry InventoryQuestionnaire” (NPI-Q) for the patients. Results: 54 caregivers and 72 residents were evaluated. Of the 72 institutionalized older people, 52 (72,2%) were female, with a mean age of 82,3 (±8,14) years. Alzheimer's disease was the most frequent type of dementia, both in private (71,0%) and philanthropic (48,15%) institutions. Most patients (over 90,0%) presented alteration according to the mini mental state examination and 50,0% of the sample had severe dementia according to the CDR. Considering the NPI-Q, the most prevalent behavioral and psychological symptoms were: euphoria and elation (74%) and agitation and aggression (74%). In the sample of caregivers, 49 (90,7%) were female, with a mean age of 33,9 (± 10,8) years, 40,7% single, 55,6% were from private institutions and 75,9% with a workload of or greater than 40 hours per week. 33,3% had positive screening for common mental disorder, 16,7% for depression and 36,1% for burden. A statistically significant association was found between burden in caregivers in philanthropic care homes (p=0,003), as well as a statistically significant association between burden in caregivers and having or not common mental disorder (p=0,001). After the psychoeducational intervention, 6 (42,8%) caregivers in the intervention group showed a reduction of burden. Conclusion: The presence of behavioral and psychological symptoms in patients was identified, as well as the presence of burden in their caregivers, especially in philanthropic institutions. The psychoeducational intervention produced positive effects on the burden of individuals in the intervention group.
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Palavras-chave
Demência, Cuidadores, Idosos, Instituição de longa permanência para idosos, Dementia, Caregivers, Older people, Long term care