Avaliação Cognitiva de Idosos Em Uma Instituição de Longa Permanência de Botucatu: Estudo Transversal
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Data
2019-08-01
Autores
Bremenkamp, Mariana Gegenheimer
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Há poucos estudos com qualidade metodológica que avaliam o perfil dos idosos institucionalizados, porém, estes observam alta prevalência de déficit cognitivo. Conhecer a prevalência de déficit cognitivo desta população poderá ampliar as discussões acerca da necessidade de estruturação da rede de cuidados. Objetivo: Avaliar a prevalência de déficit cognitivo em idosos residentes em Instituição de Longa Permanência. Métodos: Estudo transversal realizado entre maio de 2018 e janeiro de 2019, no Lar Padre Euclides, em Botucatu. Foi realizada avaliação quanto a capacidade funcional (escalas de Katz, Lawton e Pfeffer), cognição (Mini Exame do Estado Mental - MEEM) e sintomas depressivos (Escala de Depressão Geriátrica - GDS). Portadores de demência foram classificados quanto a gravidade pelo Clinical Dementia Rating (CDR). Foram realizadas análises descritivas, testes de associação (teste Exato de Fisher e t-Student) e de correlação (teste de Pearson), sendo estatisticamente significativo quando p-valor < 0,05. Resultados: A amostra avaliada foi de 52 idosos, com média de idade de 77,90 (± 8,82) anos, 55,8% do sexo feminino. 96,2% (n=50) apresentavam déficit cognitivo pelo MEEM, sendo que apenas 30% (n=15) possuíam o diagnóstico prévio de demência. Dos 35 portadores de déficit cognitivo sem diagnóstico prévio, 77,1% apresentavam algum grau de dependência funcional. Dentre os portadores de demência (n=15), 60% estavam em estágios moderados ou graves, segundo o CDR. 41 idosos com déficit cognitivo foram avaliados com GDS, e, destes, 36,5% apresentavam sintomas depressivos. Discussão: Os achados discrepantes entre a prevalência de demência relatada em prontuário e de déficit cognitivo com comprometimento funcional sugerem subdiagnóstico de demência, e a alta prevalência de portadores de demência em estágios mais avançados reforça a necessidade de capacitação da equipe para o cuidado. Embora a presença de sintomas depressivos possa interefir na avaliação cognitiva, não foi possível estabelecer relação causal entre as variáveis (cognição e sintomas depressivos), sendo necessário mais estudos. Conclusão: Os achados reforçam a necessidade de desenvolvimento de protocolos para diagnóstico precoce de déficit cognitivo pela equipe de assistência e para a estruturação da rede de cuidados, visando melhoria da assistência à saúde.
Introduction: There are few studies with methodological quality that assess the institutionalized elderly profile, but they observe a high prevalence of cognitive impairment. Knowing the prevalence of cognitive impairment in this population may increase the discussions about the need to structure the care network. Objective: To explore the prevalence of cognitive impairment in residents at home for the aged. Methods: Cross-sectional study conducted between May 2018 and January 2019 at Padre Euclides Home in Botucatu. Functional capacity (Katz, Lawton and Pfeffer scales), cognition (Mental State Mini Examination - MMSE) and depressive symptoms (Geriatric Depression Scale - GDS) were evaluated. Dementia carriers were classified as severity by the Clinical Dementia Rating (CDR). Descriptive analyzes, association (Fisher's exact test and t-Student) and correlation tests (Pearson test) were performed, being statistically significant when p-value < 0,05. Results: Fifty-two elderly individuals were evaluated, with an average age of 77,90 (± 8,82) years, 55,8% female. 96,2% (n = 50) presented cognitive impairment by MMSE, and only 30% (n = 15) had previous diagnosis of dementia. About 35 patients with cognitive impairment without previous diagnosis, 77,1% had some degree of functional dependence. Among those with dementia (n = 15), 60% were in moderate or severe stages, according to CDR. 41 elderly people with cognitive impairment were evaluated with GDS, and of these, 36,5% presented depressive symptoms. Discussion: Differing findings between the prevalence of dementia with medical records and cognitive impairment with functional impairment suggest an underdiagnosis of dementia, and the high prevalence of dementia in more advanced stages reinforces the need for staff training for care. Although the presence of depressive symptoms may interfere in the cognitive evaluation, it was not possible to establish a causal relationship between the variables (cognition and depressive symptoms) and further studies are necessary. Conclusion: The findings reinforce the need for the development of protocols for the early diagnosis of cognitive impairment by the care team and for the structuring of the care network, looking for improve health care.
Introduction: There are few studies with methodological quality that assess the institutionalized elderly profile, but they observe a high prevalence of cognitive impairment. Knowing the prevalence of cognitive impairment in this population may increase the discussions about the need to structure the care network. Objective: To explore the prevalence of cognitive impairment in residents at home for the aged. Methods: Cross-sectional study conducted between May 2018 and January 2019 at Padre Euclides Home in Botucatu. Functional capacity (Katz, Lawton and Pfeffer scales), cognition (Mental State Mini Examination - MMSE) and depressive symptoms (Geriatric Depression Scale - GDS) were evaluated. Dementia carriers were classified as severity by the Clinical Dementia Rating (CDR). Descriptive analyzes, association (Fisher's exact test and t-Student) and correlation tests (Pearson test) were performed, being statistically significant when p-value < 0,05. Results: Fifty-two elderly individuals were evaluated, with an average age of 77,90 (± 8,82) years, 55,8% female. 96,2% (n = 50) presented cognitive impairment by MMSE, and only 30% (n = 15) had previous diagnosis of dementia. About 35 patients with cognitive impairment without previous diagnosis, 77,1% had some degree of functional dependence. Among those with dementia (n = 15), 60% were in moderate or severe stages, according to CDR. 41 elderly people with cognitive impairment were evaluated with GDS, and of these, 36,5% presented depressive symptoms. Discussion: Differing findings between the prevalence of dementia with medical records and cognitive impairment with functional impairment suggest an underdiagnosis of dementia, and the high prevalence of dementia in more advanced stages reinforces the need for staff training for care. Although the presence of depressive symptoms may interfere in the cognitive evaluation, it was not possible to establish a causal relationship between the variables (cognition and depressive symptoms) and further studies are necessary. Conclusion: The findings reinforce the need for the development of protocols for the early diagnosis of cognitive impairment by the care team and for the structuring of the care network, looking for improve health care.
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Palavras-chave
Distúrbios da cognição em idosos, Instituição de longa permanência para idosos, Idoso, Cognitive impairment, aged, homes for the aged, health of institucionalized elderly