Higher purpose in life and education were associated with better cognition among older adults

BACKGROUND

 With aging, some cognitive abilities change because of neurobiological processes. Cognition may also be influenced by psychosocial aspects.

OBJECTIVE

 To describe the relationship between a measure of neuroticism, depression symptoms, purpose in life, and cognitive performance in community-dwelling older adults.

METHODS

 This was a cross-sectional analysis based on the data from the second wave of the Frailty in Brazilian Older Adults (FIBRA) study, carried out between 2016 and 2017. The sample consisted of 419 older people (≥ 72 years old) cognitively unimpaired and mostly with low education. The variables of interest were sociodemographic, Neuroticism domain from the NEO-PI-R, Geriatric Depression Scale (GDS), Purpose in Life (PiL) scale, and a cognitive composite score which included the Mini-Mental State Examination (MMSE), and the scores for the sub-items of the Mini-Addenbrooke's Cognitive Examination (M-ACE), namely, Verbal Fluency (VF) - Animal, Clock Drawing Test (CDT), Episodic Memory (name and address).

RESULTS

 There was a greater number of women (70%), with older age (median = 80 years, IQR = 77-82), and low education (median = 4 years, IQR = 2-5). In the bivariate correlations, years of education (ρ = 0.415; p < 0.001) and PiL (ρ = 0.220; p < 0.001) were positively associated with cognition. Neuroticism (ρ = -0.175; p < 0.001) and depression symptoms (ρ = -0.185; p < 0.001) were negatively associated with cognition. In the logistic regression, after including confounding variables, the associations between cognition and PiL (OR = 2.04; p = 0.007) and education (OR = 1.32; p < 0.001) remained significant.

CONCLUSION

 Low PiL and low education levels were associated with worse cognition among older adults. Such results may be of relevance in programs that aim to improve cognition among older adults.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty

BACKGROUND

Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly.

OBJECTIVE

To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults.

METHODS

Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05.

RESULTS

Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities.

CONCLUSION

The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Cognitive Impairment Predicts Sarcopenia 9 Years Later Among Older Adults

OBJECTIVE

To assess the longitudinal association between cognitive impairment and sarcopenia in a sample of Brazilian community-dwelling older adults.

DESIGN

Nine-year observational prospective study.

SETTING AND PARTICIPANTS

A total of 521 community-dwelling older adults from 2 Brazilian sites of the Frailty in Brazilian Older Adults (FIBRA in Portuguese) study.

METHODS

Sarcopenia was defined as low hand-grip strength and low muscle mass. Cognitive impairment was determined at baseline using the Mini-Mental State Examination, with education-adjusted cutoff scores. The logistic regression model was used to assess the association between cognitive impairment and incident sarcopenia after adjusting for gender, age, education, morbidities, physical activity, and body mass index. Inverse probability weighting was applied to correct for sample loss at follow-up.

RESULTS

The mean age of the study population was 72.7 (±5.6) years, and 365 were women (70.1%). Being 80 years and older (odds ratio [OR], 4.62; 95% CI, 1.38-15.48; P = .013), being under- and overweight (OR, 0.29; 95% CI, 0.11-0.76; P = .012, and OR, 5.12; 95% CI, 2.18-12.01; P < .001, respectively) and having cognitive impairment (OR, 2.44; 95% CI, 1.18-5.04; P = .016) at baseline predicted sarcopenia after 9 years.

CONCLUSION AND IMPLICATIONS

Cognitive impairment may predict sarcopenia in Brazilian older adults. More studies are necessary to identify the main mechanisms shared by sarcopenia and cognitive decline, which could support the development of prevention interventions.

Fatores de Risco para Quedas em Idosos e suas Associações com Adesão a um Programa de Prevenção

O estudo testou um modelo de associações entre fatores de risco objetivos para quedas, senso de eficácia em relação às quedas e indicadores de adesão de idosos a um programa de prevenção. A partir de dados de 206 idosos (86,9% feminino), os testes estatísticos via Path Analysis identificaram associações negativas entre idade, alterações em indicadores físicos e funcionais e quedas no último ano com o senso de eficácia. Apenas a ocorrência de quedas no último ano se associou negativamente à adesão ao programa.

Estabilidade e mudança em medidas prospectivas de satisfação com a vida em idosos: Estudo Fibra

Resumo Objetivo Investigar a incidência e variáveis associadas à estabilidade e à mudança da satisfação com a vida (SV) em medidas de linha de base (LB) e seguimento (SG) realizadas a um intervalo de nove anos, em idosos recrutados na comunidade. Método Estudo longitudinal prospectivo com dados da LB (2008-2009) e do SG (2016-2017) do Estudo Fragilidade em Idosos Brasileiros, envolvendo 360 idosos com 71,7±5,0 anos na LB (68,9% mulheres). Foram calculadas associações entre variáveis sociodemográficas, indicadores objetivos e subjetivos de saúde e variáveis psicossociais em LB e a incidência de estabilidade e mudança em SV no SG. Resultados Nove anos depois da LB, foram observadas: maior incidência de estabilidade (61,1%) do que de piora (26,4%) ou melhora (12,5%) da SV; menor incidência de piora no grupo de 80 anos e mais do que no de 70 a 79; maior incidência de mudança do que estabilidade da SV entre os idosos com multimorbidades e com pontuação > 6 em sintomas depressivos; maior incidência de piora da SV entre os idosos com baixos níveis de autoavaliação de saúde (risco relativo; RR=2,26) e de satisfação com a memória (RR=2,33). Conclusões A incidência de estabilidade em SV em idosos foi mais frequente do que a de piora ou melhora. Indicadores subjetivos de saúde física e satisfação com a memória podem ser sinalizadores de deterioração em bem-estar no tempo e sintomas depressivos de instabilidade nas avaliações, possivelmente acompanhando a redução ou o aumento da SV. Foi observada considerável heterogeneidade nas manifestações de SV entre idosos.

Burden, family functioning, and psychological health of older caregivers of older adults: a path analysis

Objectives: To evaluate an explanatory model of direct and indirect associations regarding the psychological health of older caregivers of functionally dependent older adults. Methods: This is a cross-sectional study performed with older caregivers recruited in contexts of outpatient and home care. We collected information on sociodemographic characteristics, duration of caregiving, physical and cognitive function indicators of the older care recipients, perceived burden, family functioning, and psychological health measures (psychological need satisfaction and depressive symptoms). Results: We evaluated 133 caregivers (76% female, 69.5 ± 6.98 years). Variables that were significantly correlated with psychological health were selected to form an association model to be tested by structural equation modeling via path analysis. Depressive symptom variability was best explained by this model. Caregiver burden remained in the model as a mediator of indirect associations between physical function for instrumental activities of daily living and indicators of family functioning and psychological health. Three associative paths between caregiver burden and depressive symptoms were found — one of them was direct and the other two were mediated whether by family functioning or by the level of psychological need satisfaction. Conclusion: Depressive symptoms were the psychological health indicator best explained by the model involving instrumental functional demands that generate burden. Clinical consequences suggested by the model indicate interventions aimed at family functioning and opportunities of psychological need satisfaction as strategies for promoting caregivers’ psychological health.

Incontinência urinária, senso de controle e autonomia, e participação social em idosos residentes na comunidade

Resumo Objetivo Identificar a presença de sintomas de incontinência urinária (IU) e testar um modelo de associações diretas e indiretas com as variáveis psicossociais senso de controle/autonomia e participação social em idosos residentes na comunidade. Método Estudo transversal, realizado com 419 idosos de 72 anos ou mais (70,2% feminino) participantes das medidas de seguimento do Estudo Fibra-Polo Unicamp. Idade, sexo e escolaridade foram as variáveis sociodemográficas selecionadas como antecedentes das relações entre IU e participação social. Senso pessoal de controle e autonomia foi testado como mediador dessas relações em análise de caminhos via método de equações estruturais (Path Analysis). Resultados A IU foi relatada por 38% da amostra, com diferenças significativas entre os sexos (41% feminino versus 31,3% masculino). Foram propostos três níveis de participação social a partir do grau de envolvimento dos indivíduos com a sociedade. O modelo de associações explicou 15% da variância em participação social. Efeitos diretos foram encontrados entre controle e autonomia e participação social. Efeitos indiretos entre escolaridade e participação foram mediados pela presença de IU. Conclusão IU contribuiu para a restrição em participação social em todos os níveis. Controle e autonomia não se mostrou um mediador psicológico para as relações entre IU e participação, embora associada a ambas variáveis. A presença de IU potencializou as relações desvantajosas entre escolaridade e participação social. Enquanto fatores de natureza modificável, iniciativas clínicas e psicossociais sobre IU podem resultar em diminuição de efeitos psicológicos negativos e redução de desigualdades educacionais em participação social.

Stability and change in prospective measures of life satisfaction in older adults: Fibra Study

Abstract Objective The purpose of this study was to identify the incidence and variables associated with stability and change in life satisfaction (LS) between baseline and 9-year follow-up, in community-dwelling-older adults. Method A prospective longitudinal study of baseline (BL; 2008-2009) and follow-up (FW; 2016-2017) data from the Frailty in Elderly Brazilians Study involving 360 individuals aged 71.7±5.0 years at BL, 68.9% women, was conducted. Associations of sociodemographic and psychosocial variables, and objective and subjective health indicators measured at BL with the incidence of stability and change in LS between BL and FW were investigated. Results Nine years after the BL collection, the following results were observed: higher incidence of stability (61.1%) than of worsening (26.4%) or improvement (12.5%) in LS; lower incidence of worsening of LS in the ≥80 age group than in the 70-79 years group; higher incidence of change than stability of LS among the participants with multimorbidities and scores > 6 for depressive symptoms; higher incidence of LS worsening among participants with low self-rated health (relative risk; RR=2.26) and low satisfaction with memory (RR=2.33). Conclusions The incidence of stability in LS was more frequent than that of worsening or improvement. Subjective indicators of physical health and satisfaction with memory may serve as indicators of deterioration in wellbeing over time and the presence of depressive symptoms may suggest instability in self-assessments, possibly accompanying a reduction or increase in LS over time. There was considerable heterogeneity in the manifestations of LS among the older adults assessed.

Frailty, depression and mortality in a cohort of community-dwelling older adults

Abstract Objective To estimate the risk represented by the combined conditions of frailty and depression in relation to mortality in a cohort of older adults in a prospective measure. Method Prospective cohort study derived from baseline (2008/2009) and follow-up (2016/2017) measurements of the FIBRA Study - Polo Unicamp. Data from 739 older adults (67,2% female; 73,1+5.87 years) living in two urban centers in the state of São Paulo (Brazil) were analyzed to examine survival curves and to estimate mortality risk. The analyzes included four conditions resulting from the combination of depression (presence x absence of symptoms) and frailty (frail x robust) and the covariates sex, age, education, cognitive performance and comorbidities. Results The percentage of deaths was 25.7%. There were significant differences between the survival curves regarding the combinations between frailty and depression. Male sex, age over 75 years, low education, low cognitive performance and the combinations “depression-robust”, “depression-frail” and “no depression-frail” presented independent risks for mortality. In the multivariate model, the highest risks were given, respectively, by older ages, the combinations “depression-robust”, “depression-frail”, “no depression-frail”, male sex and lower cognitive performance. Conclusion Combinations between frailty and depression can result in differences in survival and mortality among older adults. In the nine-year period, depression proved to be the ordering variable of the groups in relation to risk estimates, even in the presence of important covariates. Investments in the prevention of both syndromes and their associations may result in a decrease in mortality in older people from general causes.

Fragilidade, depressão e mortalidade em uma coorte de pessoas idosas residentes na comunidade

Resumo Objetivo Estimar o risco representado por condições combinadas de fragilidade e depressão em relação à mortalidade de uma coorte de idosos em medida prospectiva. Método Estudo de coorte prospectivo derivado das medidas de linha de base (2008/2009) e seguimento (2016/2017) do Estudo Fibra - Polo Unicamp. Foram analisados dados de 739 idosos (67,2% feminino; 73,1+5,87 anos) residentes em dois centros urbanos do estado de São Paulo (Brasil) para o exame de curvas de sobrevida e para estimar risco de mortalidade. As análises incluíram quatro condições resultantes da combinação entre depressão (presença x ausência de sintomas) e de fragilidade (frágil x robusto) e as covariáveis sexo, idade, escolaridade, desempenho cognitivo e comorbidades. Resultados A porcentagem de óbitos foi de 25,7%. Houve diferenças significativas entre as curvas de sobrevida referentes às combinações entre fragilidade e depressão. Sexo masculino, idade acima de 75 anos, baixa escolaridade, baixo desempenho cognitivo e as combinações “depressão-robusto”, “depressão-frágil” e “sem depressão-frágil” apresentaram riscos independentes para mortalidade. No modelo multivariado, os maiores riscos foram dados, respectivamente, por idades mais avançadas, as combinações “depressão-robusto”, “depressão-frágil”, “sem depressão-frágil”, sexo masculino e menor desempenho cognitivo. Conclusão Combinações entre fragilidade e depressão podem resultar em diferenças em sobrevida e mortalidade entre idosos. No período de nove anos, depressão revelou ser a variável de ordenação dos grupos em relação às estimativas de risco, mesmo na presença de covariáveis importantes. Investimentos na prevenção de ambas as síndromes e de suas associações podem resultar diminuição na mortalidade de idosos por causas gerais.

Urinary incontinence, sense of control/autonomy and social participation in community-dwelling older adults

Abstract Objective Identify the presence of urinary incontinence (UI) symptoms and test a model of direct and indirect associations with the psychosocial variables sense of control/autonomy and social participation in community-dwelling older adults. Method Cross-sectional study conducted with 419 adults aged 72 years or over (70.2% female) participating in the follow-up survey of the FIBRA Study - Polo Unicamp. Age, sex and educational level were the sociodemographic variables selected as antecedents of the relationship between UI and social participation. A sense of control/autonomy was tested as a mediator of these relationships in a path analysis through structural equation modelling. Results UI was reported by 38% of the sample, with significant differences according to sex (41% female versus 31.3% male). Three levels of social participation were proposed, based on the degree of interaction between the individual and society. The model of relationships explained 15% of the variance in social participation. Direct effects were observed between control/autonomy and social participation; indirect effects between education and participation, mediated by the presence of UI. Conclusion UI contributed to restrictions in social participation at all levels. Control/autonomy, although related, did not prove to be a psychological mediator for the relationship between UI and participation. The presence of UI potentialized the disadvantageous relationships between education and social participation. As modifiable factors, the treatment and management of UI through clinical and psychosocial initiatives can act to reduce negative psychological effects and reduce socioeconomic inequalities in social participation.

Impact of functional capacity on change in self-rated health among older adults in a nine-year longitudinal study

The aims of the present study were to estimate the frequency of change in self-rated health (SRH) among community-dwelling older adults, between two measures taken at a 9-year interval; and determine factors associated with a decline and an improvement in SRH, in relation to aspects of physical/emotional health and subjective wellbeing. Data were derived from a community-based study on frailty among Brazilian elderly. Associations were investigated using Pearson’s chi-square test and relative risk ratios were estimated using multinomial logistic regression analysis. 39.3% of participants did not change their SRH at both assessment times, 21.7% rated it as worse and 39.0% rated it as better. The relative risk ratio of an improvement in SRH for individuals with disability in basic activities of daily living (ADLs) was lower than for individuals with independence in basic ADLs (IRR=0.22; IC95%: 0.08-0.63). Understanding the complex interactions between self-rated health and the dimensions that influence the improvement of health perception may shed light on key determinants of the wellbeing among older adults.

Probable sarcopenia is associated with cognitive impairment among community-dwelling older adults: results from the FIBRA study

BACKGROUND

The link between sarcopenia and cognitive impairment has not yet been thoroughly evaluated, especially among older adults.

OBJECTIVE

To evaluate the relationship between probable sarcopenia and cognitive impairment among community-dwelling older adults in two Brazilian cities.

METHODS

Probable sarcopenia was assessed using the EWGSOP2 (2018) criteria. Thus, participants were classified as probably having sarcopenia if they had SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs and Falls) ≥4 points and low grip strength. Cognitive function was evaluated through the Mini-Mental State Examination (MMSE), verbal fluency (VF) and clock drawing test (CDT).

RESULTS

In a sample of 529 older adults (mean age 80.8±4.9 years; mean education 4.2±3.67 years; 70.1% women), 27.3% of the participants had SARC-F≥4, 38.3% had low grip strength and 13.6% were classified as probable sarcopenia cases. After adjusting for possible confounders (age, sex, education, depression, diabetes, hypertension, leisure-time physical activity and obesity), probable sarcopenia was found to be associated with impairment in the MMSE (OR 2.52; 95%CI 1.42‒4.47; p=0.002) and in VF (OR 2.17; 95%CI 1.17‒4.01; p=0.014). Low grip strength was found to be associated with impairment in the MMSE (OR 1.83; 95%CI 1.18‒2.82; p=0.006) and in the CDT (OR 1.79; 95%CI 1.18‒2.73; p=0.006). SARC-F scores were found to be associated with impairment in the MMSE (OR 1.90; 95%CI 1.18‒3.06; p=0.008).

CONCLUSION

The results suggested that probable sarcopenia and its components present a significant association with cognitive deficits among community-dwelling older adults. Future longitudinal studies will further explore the causal relationship.

Psychometric study of the Awareness of Age-Related Change (AARC) Short Scale translated to Portuguese, applied to Brazilian older adults

The concept Awareness of Age-Related Change (AARC) is defined as a person’s awareness that their behavior, level of physical, cognitive and social performance, and ways of experiencing life have changed as a consequence of having grown older, and not because of disease.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Predictors of Wellbeing Among Older Adults Participants of a U3A

Abstract This study aimed to identify predictive factors for subjective and psychological well-being in a sample of 265 older adults enrolled in the University of the Third Age (U3A). The scales used were: General Satisfaction with Life Scale and referenced to the domains, Positive and Negative Affect Scale and Personal Development Scale. Multivariate logistic analysis indicated that being 70 or older and male was associated with the subjective well-being and having higher education level was associated with psychological well-being. It was concluded that sociodemographic characteristics of the interviewed elders enrolled in U3A can be important attributes that influence well-being.

Factors associated with the quality of life of elderly caregivers of other elderly persons

Abstract Objective : To evaluate the association between the double vulnerability of being elderly and a caregiver and quality of life assessed by Control, Autonomy, Self-realization and Pleasure factors (CASP-19). Method : 148 elderly caregivers participated in the present study. They were selected for convenience from Brazilian public and private health services - a sample from the study “The Psychological Well-Being of Elderly Persons Caring for Other Elderly Persons in a Family Context”. The variables: caregiver’s state of health, care demands, perception of burden, self-rated health, and quality of life were selected. Descriptive analyses, chi-squared tests, Fisher’s exact test, the Kruskal-Wallis test and analysis of multivariate hierarchical logistics were carried out, with theStepwisecriteria applied for selection of variables. Results : The hierarchical multivariate analyses found that number of symptoms and total burden were significantly associated with a poorer quality of life. Elderly persons with three or more symptoms and those with a high burden level were at a higher risk of poor quality of life. The variables number of diseases, burden, and self-rated health compared with the past, were significantly associated with a poorer quality of life. Conclusion : It can be concluded that for the elderly caregiver, physical aspects (signs and symptoms, chronic diseases and a perception of health deterioration) combined with burden are the aspects that most influence quality of life.

Factors associated with perceived quality of life in older adults: ELSI-Brazil

OBJECTIVE

To identify factors associated with perceived quality of life in a representative national sample of the population aged 50 or over.

METHODS

Data from 7,651 participants of the baseline ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between 2015 and 2016, were used. The perceived quality of life was measured by the CASP-19 scale - (CASP - control, autonomy, self-fulfillment and pleasure), considering the highest tertile as good quality of life. The independent variables included socio-demographic characteristics, mobility, loneliness, and indicators of sociability (social network, social support and social participation). The associations were tested using multivariate Poisson regression.

RESULTS

The best perceived quality of life showed a positive and independent association with the frequency of contacts with friends (PR = 1.25 for at least once every 2-3 months and PR = 1.36 for at least once a week), instrumental support from spouse or partner in the household (PR = 1.69), and emotional support from other relatives (PR = 1.45), children or children in law (PR = 1.41) and spouse or partner (PR = 1.33). Negative associations were observed for participants aged 80 and over (RP = 0.77), with 4 to 7 or 8 or more years of schooling (PR = 0.78 and 0.75, respectively) and with difficulty in mobility (PR = 0.83).

CONCLUSIONS

In addition to age and schooling, mobility, sociability and instrumental and emotional support are associated with perceived quality of life among older Brazilian adults. These characteristics must be considered when actions are taken, aiming to promote quality of life in this population.

[New semantic-cultural validation and psychometric study of the CASP-19 scale in adult and elderly Brazilians]

The study aimed to investigate psychometric indicators of validity in the new version of CASP-19 for Brazilians 55 years and older and to study relations between scores on the scale and sex, age, schooling, and conjugal status. A total of 368 participants enrolled in educational programs for the elderly answered the CASP-19 scale (control, autonomy, self-realization, and pleasure), translated from English by five specialists and tested in 19 women (α = 0.730). The data were submitted to exploratory factors analyses (EFA) and confirmatory factor analyses (CFA) using the structural equations method for latent variables and for internal consistency and correlation with scales of similar content. The scores were compared according to sex, age, schooling, and conjugal status. CFA produced a model with 19 items and 2 factors (self-realization/pleasure and control/autonomy), with good fit indices (GFI = 0.8; AGFI = 0.7606; CFI = 0.7241; NNFI = 0.6876; SRMR = 0.0902; RMSEA = 0.0928; 90%CI: 0.0827-0.1031). Cronbach's α was 0.837 for factor 1 and 0.670 for factor 2, and 0.874 on the total scale for individuals with 9 or more years of schooling, 0.834 for 5 to 8 years, and 0.772 for 1 to 4 years. High and significant correlations were observed with the scores in scales on satisfaction and subjective happiness. Men scored higher than women on self-realization/pleasure; older individuals and those with the most schooling scored lower on control/autonomy; individuals with a spouse or partner scored higher on control/autonomy. The new version of CASP-19 was effective in assessing self-rated quality of life in individuals 55 years or older in residents of the Southeast, South, and Northeast of Brazil.

The double vulnerability of elderly caregivers: multimorbidity and perceived burden and their associations with frailty

Abstract Objective: To identify if multimorbidity and burden are associated with a greater likelihood of frailty in elderly caregivers of other elderly persons within the family context. Method: 148 elderly caregivers caring for other elderly persons [M=69.7 (±7.0) years old] were recruited using a criterion of convenience in public and private health services in the city of Campinas and surrounding areas. Information was gathered about socio-demographic context, context of care, physical health, care burden using the Zarit Burden Scale, and frailty, measured by subjective evaluation. Four groups of vulnerability were created based on the presence or absence of multimorbidities and high or low burden, in order to verify which group was most strongly associated with frailty. Data were analyzed using descriptive analysis, measurements of association and multivariate hierarchical logistic regression. Results: The prevalence of multimorbidity was 55.4%. The Zarit Burden Scale presented a median of 23 out of a total of 88 points. Of the sample, 35.1% were frail, 46.0% intermediate, and 18.9% robust. Elderly caregivers with multimorbidity and high burden had a greater probability of frailty (OR=3.6; CI 1.55-8.36), followed by those with multimorbidity and low burden (OR=2.8; CI 1.13-6.79). Conclusion: The sensation of burden among caregivers was reduced; those with double vulnerability were most prevalent among the four groups and had the greatest association with the occurrence of frailty; multimorbidity was associated with frailty. If combined with perceived burden, however, the odds ratios of the elderly caregivers being frail increased.

Verbal fluency in elderly with and without hypertension and diabetes from the FIBRA study in Ermelino Matarazzo

BACKGROUND

There are few studies on the qualitative variables derived from the animal category verbal fluency test (VF), especially with data originating from low-income samples of community-based studies.

OBJECTIVE

To compare elderly with and without hypertension (HTN) and diabetes mellitus (DM) regarding the total number of animals spoken, number of categories, groups and category switches on the VF test.

METHODS

We used the database of the FIBRA (Frailty in Brazilian Elderly) community-based study. The variables number of Categories, Groups and Category Switches were created for each participant. The total sample (n = 384) was divided into groups of elderly who reported having HTN, DM, both HTN and DM, or neither of these conditions.

RESULTS

There were no significant differences between the groups with and without these chronic diseases for VF total score or for the qualitative variables.

CONCLUSION

Among independent community-dwelling elderly, the qualitative variables derived from the VF animal category may not add information regarding the cognitive profile of elderly with chronic diseases. Total VF score and the qualitative variables Category, Group and Switching did not differentiate elderly with and without HTN and DM.

CRENÇAS SOBRE O BOM CUIDADOR PROFISSIONAL DE IDOSOS DEPENDENTES NO CONTEXTO DOMICILIAR

Este estudo teve por objetivo investigar as crenças sobre o que é ser um bom cuidador profissional de idosos dependentes no contexto domiciliar. Trata-se de um estudo exploratório, descritivo e transversal. A amostra foi composta por 59 cuidadores profissionais de idosos, recrutados por conveniência. Os dados foram coletados por meio de entrevistas utilizando um questionário elaborado a partir da revisão bibliográfica. Para análise dos dados, utilizou-se a análise de conteúdo proposta por Bardin (1977/2000). As categorias foram classificadas a partir de três elementos da competência profissional, a saber: conhecimento, habilidades e atitudes. O maior número de variáveis que caracteriza o que é ser um bom cuidador profissional de idosos no contexto domiciliar está na categoria atitudes. A subcategoria mais relatada foi a demonstração de afetos com 55 unidades de análise (39%). A categoria conhecimento gerou três subcategorias, sendo a mais destacada, os “procedimentos técnicos” com 33 (50,8%) unidades de análise. Na categoria relacionada às atitudes, a subcategoria destacada foi a realização profissional. Os resultados obtidos sugerem a necessidade de aprimorar o processo de capacitação dos cuidadores formais de idosos, refletindo-se sobre a heterogeneidade e as múltiplas dimensões da velhice, visando promover a melhoria da capacidade funcional dos idosos dependentes. Também, é crucial favorecer reflexões acerca dos estigmas, estereótipos e preconceitos relacionados à velhice; superar as deficiências técnicas e fortalecer a identidade do profissional cuidador.

Variables associated with the life satisfaction of elderly caregivers of chronically ill and dependent elderly relatives

Abstract Objective: to compare the life satisfaction of family caregivers, taking into account their gender, age, time since starting care, health, religion, perceived burden and quality of life, and the level of physical and cognitive dependence of the elderly person receiving care, and to investigate the associations between these variables and low life satisfaction. Methods: a total of 148 caregivers in Indaiatuba and Campinas, in the state of São Paulo, Brazil, selected using the convenience method, were interviewed at home, in private medical clinics and outpatient units, using questionnaires about the sociodemographic characteristics, health conditions, time since starting care, scales of life satisfaction, religiosity, perceived burden and quality of life of the caregiver, and the physical and mental health of the elderly person receiving care. Descriptive, Multivariate and Univariate Logistic Regression analysis were used. Results: caregivers who exhibited low life satisfaction included more frail individuals, with three or more chronic diseases and depression, greater perceived burden and lower self-fulfillment and pleasure, and control and autonomy, scores, which are factors of the Perceived Quality of Life Scale. Elderly caregivers who scored low in self-fulfillment factor and pleasure (OR=101.29; CI=28.68 - 357.73) and who scored high in perceived burden (OR=5.89, CI=2.13 to 16.24) had a greater chance of having low life satisfaction scores. Conclusions: The assessment of caregivers of their satisfaction with life is more influenced by subjective than objective variables, and low satisfaction seems to be strongly associated with poor quality of life, high burden, and caregiver frailty.

Subjective and psychological well-being among elderly participants of a University of the Third Age

Abstract Objective: The present study aimed to analyze the distribution of measures of subjective and psychological well-being according to demographic criteria and length of participation in the program. Method: A cross sectional study using the following instruments was carried out: a sociodemographic questionnaire (age, gender, education, length of participation in University of the Third Age (U3A) and similar programs located in the city of São Paulo, Brazil; an Overall Life Satisfaction Scale; a Life Satisfaction Scale that contemplated four domains: health, physical capacity, mental capacity and social involvement; a Positive/Negative Affect Scale; and a Personal Development Scale. The data were analyzed by the chi-squared test (for comparison of categorical variables), the Mann-Whitney and the Kruskal-Wallis U tests (for comparison of continuous variables). Results: Age and gender were the main factors that were significantly associated with overall life satisfaction, life satisfaction in specific domains, and morale. Higher education was associated with psychological adjustment. Conclusion: Participating in a U3A contributes to high levels of subjective and psychological well-being. Elderly individuals of more advanced ages and men had higher rates of satisfaction with life and positive feelings. The elderly can assess their development trajectory, their commitment to society and consider their efforts in pursuing an ideal of personal excellence.

Normative data for the Brief Cognitive Screening Battery stratified by age and education

Introduction

Diagnosing neurocognitive disorders is challenging in low-educated individuals.

Objective

To report normative data for the Brief Cognitive Screening Battery (BCSB) and to assess the association of age and education with performance on the BCSB in 240 community-dwelling elderly from Ermelino Matarazzo, São Paulo city.

Methods

The inclusion criteria were scoring above the education-adjusted cut-off points on the Mini-Mental State Examination (MMSE) and below six points on the Geriatric Depression Scale (GDS).

Results

Age was associated with performance on the Naming, Incidental Memory, Verbal Fluency, Clock Drawing Test, Delayed Recall and Recognition subtests. Education was associated with performance on Naming, Recognition, Verbal Fluency and the Clock Drawing Test.

Conclusion

The normative values reported are relevant for diagnosing neurocognitive disorders in low-educated elderly.

Gerontologia Ambiental: panorama de suas contribuições para a atuação do gerontólogo

O artigo traz algumas considerações a respeito do campo teórico da Gerontologia Ambiental, ao traçar um breve panorama dos temas clássicos de estudo e aplicação dos novos campos abertos pelas demandas do envelhecimento populacional e políticas públicas decorrentes. O texto busca também salientar o aumento na produção acadêmica internacional no campo, porém não acompanhado na produção nacional. Destaca-se a importância da perspectiva ambiental para as ações práticas do profissional gerontólogo em suas tarefas de gestão de cuidados, serviços e políticas no campo da velhice e dos processos de envelhecimento.

Frailty criteria and cognitive performance are related: data from the FIBRA study in Ermelino Matarazzo, São Paulo, Brazil

OBJECTIVES

To assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance.

DESIGN

Cross sectional and population-based.

SETTING

Ermelino Matarazzo, a poor sub district of the city of São Paulo, Brazil.

PARTICIPANTS

384 community dwelling older adults, 65 and older.

MEASUREMENTS

Assessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE).

RESULTS

Frail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance.

CONCLUSION

Being frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.

[Depressive symptoms in older adults studying at a third age open university]

INTRODUCTION

Although depressive disorders prevalence among older adults usually is less than in the younger population, the presence of significant symptoms of depression is common in elderly people. Studies show that taking part in social, educational and pleasure activities is associated with a reduction in depressive symptoms in this population. The purpose of this study was to examine the prevalence of depressive symptoms above the elderly participants of a Third Age Open University, taking the time taking part as a reference.

MATERIAL AND METHODS

A cross-sectional design was implemented, with a participation of 95.2% (n=140) of the total enrolled in the first trimester of 2009 in the activities of the Third Age Open University of the Schools of Arts, Sciences and Humanities of the University of São Paulo. They all answered a socio-demographic questionnaire and the Geriatric Depression Scale (GDS-15).

RESULTS

The prevalence of depressive symptoms found was 3.57%. The statistical analysis showed a relationship between participation formore than one semester in the Third Age Open University and a lower index of depressive symptoms (p<.05).

CONCLUSIONS

Participating for longer than one academic semester is associated with less depressive symptoms, possibly being a protector factor against depression.

Depressive symptoms in elderly participants of an open university for elderly

Although the prevalence of depressive disorders among the elderly is lower than among the younger population, the presence of significant symptoms of depression is common in this group. Studies report that participation in social, educational and leisure activities is related to fewer depressive symptoms in this population.

Medidas prospectivas de sintomas depressivos entre idosos residentes na comunidade

OBJETIVO: Identificar fatores sociodemográficos associados a padrões de incidência, remissão e estabilidade de sintomas depressivos entre idosos residentes na comunidade. MÉTODOS: Estudo prospectivo em que foram entrevistados 310 idosos residentes na comunidade, em Juiz de Fora, MG, entre 2002 e 2004. O seguimento (T2) foi realizado 15,7 meses após a primeira entrevista (T1). Os sintomas de depressão foram avaliados pela escala do Center for Epidemiological Studies - Depression. Os idosos foram classificados segundo a evolução dos sintomas de depressão e comparados quanto às variáveis sociodemográficas com o teste de qui-quadrado e Exato de Fisher. RESULTADOS: Não houve diferenças na prevalência de sintomas depressivos entre T1 e T2 (33,8%). Foram identificados quatro grupos segundo a evolução dos sintomas da primeira para a segunda medida: livres de depressão (50,9%); recorrência (19,7%); incidência (15,2%); remissão (14,2%). Ter pontuado para depressão em T1, ser do sexo feminino e possuir baixa escolaridade representaram riscos para a manifestação de sintomas depressivos em T2. CONCLUSÕES: Piores trajetórias de evolução em sintomatologia depressiva (incidência e recorrência) associaram-se ao gênero feminino.

Validade e confiabilidade da versão Brasileira da Center for Epidemiological Scale - Depression (CES-D) em idosos Brasileiros

Foram identificados indicadores de validade de construto e de confiabilidade interna para a Center for Epidemiological Scale-Depression (CES-D) aplicada a idosos recrutados na comunidade, em um estudo que envolveu duas medidas sucessivas. A amostra foi composta de 347 idosos (73% mulheres) com idade média de 71,96 anos (DP=8,45), os quais foram submetidos à versão brasileira da CES-D em duas ocasiões, com um tempo médio de 15,7 meses (DP=4,57) entre as medidas. Os dados da segunda medida da CES-D foram submetidos à análise fatorial confirmatória, que revelou adequação do ajuste do modelo anterior com três fatores ("afetos negativos", "dificuldades de iniciar comportamentos", "afetos positivos"). O índice de consistência interna foi 0,82 para a escala, 0,77 para o fator 1, 0,59 para o fator 2 e 0,47 para o fator 3. A prevalência de depressão foi a mesma nas duas medidas (34%).