Função executiva é a habilidade necessária para planejar, iniciar, realizar e monitorar comportamentos intencionais, relacionados a um objetivo ou a demandas ambientais, com base na experiência prévia. Tanto indivíduos idosos, quanto indivíduos com escolaridade baixa apresentam dificuldade em tarefas que requerem função executiva, como o Trail Making Test (TMT), que consiste em traçar retas em uma folha de papel, conectando uma seqüência de números (parte A, TMTA) e de números e letras, alternados (parte B, TMTB), o mais rápido possível. O presente estudo teve como objetivo geral desenvolver uma nova versão do TMT, o Teste de Deambulação Funcional (TDF), que poderia ser mais familiar a indivíduos com escolaridade baixa e favorecer sua compreensão e execução. Os objetivos específicos foram: testar se haveria diferenças de idade e/ou escolaridade (1) na execução das partes A e B do TDF (TDFA e TDFB) e das partes A e B do TMT (TMTA e TMTB); (2) nos deltas cognitivos do TMT (dcTMT=TMTBTMTA) e do TDF (dcTDF=TDFBTDFA); (3) nos deltas motores da parte A (dmA=TDFATMTA) e da parte B (dmB=TDFBTMTB) e (4) no aprendizado do TDF. Participaram 70 voluntários, (24 jovens, 26 adultos maduros, e 20 idosos). Na primeira sessão os voluntários realizaram (I) o TDF, (II) o TMT, (III) sete repetições do TDFA, (IV) sete repetições do TDFB. Metade dos voluntários de cada faixa etária realizou a ordem (I) e (II) e metade, (II) e (I). Depois de uma semana, realizaram (V) quatro repetições do TDFA e (VI) quatro do TDFB. Foi adotado nível de significância de p=0,05. ANOVAs mostraram que (1) os idosos, principalmente aqueles com escolaridade baixa, foram mais lentos que os adultos jovens e maduros no TMT e no TDF, sobretudo na parte B e os idosos com escolaridade alta foram mais lentos no TDFB do que no TMTB; (2) os deltas cognitivos do TMT e do TDF foram mais altos para indivíduos com maior idade e menor escolaridade e o dcTMT foi maior que o dcTDF para idosos com escolaridade baixa; (3) o dmB de idosos com escolaridade baixa foi menor que o de idosos com escolaridade alta; (4) os idosos com escolaridade baixa foram mais lentos que aqueles com escolaridade alta na avaliação 1 da TDFA e em todas as avaliações da TDFB, mas não foram observadas diferenças de escolaridade no desempenho de adultos jovens e maduros. O TDF mostrou-se uma ferramenta complementar eficaz para avaliar indivíduos com diferentes idades e escolaridades. Indivíduos mais idosos e com escolaridade mais baixa apresentaram tempos mais altos, tanto no TMT, quanto no TDF. O dcTDF não parece ter sido equivalente ao dcTMT em indivíduos com escolaridade baixa, já que eles apresentaram menor dificuldade em resolver cognitivamente o TDF. Idosos com alta e baixa escolaridade apresentaram resultados antagônicos no dmB: idosos com escolaridade baixa apresentaram menor dificuldade no TDFB, com relação ao TMTB e o contrário ocorreu para idosos com escolaridade alta. A escolaridade baixa prejudicou o aprendizado da tarefa, principalmente em idosos. Idosos apresentaram estabilização mais lenta no desempenho do que adultos maduros, que por sua vez apresentaram estabilização mais lenta que jovens. / Executive function is the ability of planning, initiating, performing and monitoring intentional behaviors, related to an objective or environmental demands, based on previous experience. Older adults and individuals with a low educational status have difficulty in performing executive function tasks, such as the Trail Making Test (TMT), which consists on linking a sequence of numbers on a sheet of paper (part A, TMTA) and alternated numbers and letters (part B, TMTB) as fast as possible. The present study had as a general aim to develop a new version of the TMT, the Functional Gait Test (FGT), which could be more familiar to individuals with a low educational status and favor their comprehension and performance. The specific aims were: to investigate possible differences due to age and/or educational status (1) in the performance of parts A and B of FGT (FGTA e FGTB) and of parts A and B of TMT (TMTA and TMTB); (2) in the cognitive deltas of TMT (cdTMT=TMTBTMTA) and of FGT (cdFGT=FGTBFGTA); (3) in the motor deltas of part A (mdA=FGTATMTA) and part B (mdB=FGTBTMTB) and (4) in the learning process of FGT. Seventy volunteers participated (24 young adults, 26 mature adults and 20 older adults). At the first session, volunteers performed (I) the FGT, (II) the TMT, (III) seven repetitions of the FGTA, (IV) seven repetitions of the FGTB. Half of the sample of each age group performed the order (I) and (II) and the other half, (II) and (I). After one week, they performed (V) four repetitions of the FGTA and (VI) four of the FGTB. Significance level was p=0,05. ANOVAs showed that (1) older adults, mainly the ones with a low educational status, were slower than young and mature adults on the TMT and on the FGT, principally on part B and older adults with a high educational status were slower on the FGTB than on the TMTB; (2) the cognitive deltas of TMT and FGT were higher for individuals with higher age and lower level of education and the cdTMT was higher than cdFGT for older adults with a low educational status; (3) the mdB of older adults with a low educational level was lower that the mdB of older adults with more years of formal education; (4) older adults with a low educational status were slower than the ones with a high level of education on assessment 1 of the FGTA and in all assessments of the FGTB, but no educational status differences were observed in the performance of young and mature adults. The FGT is an useful complementary tool to evaluate individuals with different ages and educational levels. Older adults and individuals with a lower educational level showed higher times, both in the TMT and in the FGT. The cdFGT did not seem equivalent to the cdTMT in individuals with a low educational status, since they had less difficulty in solving the cognitive part of the FGT. Older adults with a high and a low educational level had antagonistic results on mdB: older adults with a low educational status had less difficulty on the FGTB, compared to the TMTB and the opposite occurred for the ones with a high educational status. The low educational level impaired the learning process, mainly for older adults. Older adults showed slower stabilization on performance than mature adults and mature adults showed slower stabilization than young adults.

As demências Frontotemporais (DFT) compreendem 2 fenótipos clínicos: distúrbios comportamentais ou de linguagem. Coletivamente, as DFT podem ser causadas por um grupo diversas de doenças neurodegenerativas chamadas degeneração lobar frontotemporal (DLFT). Novas entidades têm sido descritas neste grupo e o conceito está em constante evolução. Parte dos mecanismos envolvidos na morte celular nas DLFTs também são observados n envelhecimento normal. Determinar as entidades e freqüência das DLFTs em uma série com utilização de imunoistoquímica. Uma série prospectiva de 833 casos avaliados prospectivamente no Centro de Pesquisas de Doença de Alzheimer da Washington University - EUA. Os casos de DFT foram selecionados por critérios clínicos e a classificação neuropatológica foi baseada em protocolos universalmente aceitos para DLFT. Dos casos de demência, 53(6,3%) atenderam aos critérios clínicos e neuropatológicos para DLFT. Outros 8 casos atenderam apenas aos critérios clínicos de DFT. As tauopatias representaram 40% dos casos. Entretanto, a maioria dos casos apresentava inclusões ubiquitina-positivas e tau-negativas. Esclerose hipocampal e alterações do tipo Doença de Alzheimer foram encontradas em 12 e 10 casos, respectivamente. Apesar da DLFT-U ter sido a entidade mais freqüente nesta série, entidades e menos comuns não incluídas nas recomendações de McKhann também podem apresentar fenótipo clínico de DFT. A inclusão destas novas entidades é mais uma evidência de que os sintomas clínicos são mais dependentes das áreas acometidas do que da entidade em si. A melhor compreensão desses mecanismos tem um grande potencial em auxiliar no desenvolvimento de medidas que possam modular ou retardar os efeitos do envelhecimento no cérebro, além é claro de trazer possibilidade de tratamento, hoje inexistente, para os pacientes acometidos. / Frontotemporal dementia (FTD) encompasses two clinical phenotypes: progressive behavioral change and language disorder. Collectively, FTD may be caused by a diverse group of neurodegenerative diseases called frontotemporal lobar degenerations (FTLDs). New entities have been described and the nosology of FTLDs continues to evolve. To determine the type and frequency of FTLDs in a series using contemporary immunohistochemical methods. Eight hundred and thirtythree dementia cases were prospectively assessed at Washington University Alzheimer Disease Research Center (WUADRC) and cases with clinical FTD were identified using existing diagnostic criteria and neuropathologic entities were ascertained using immunohistochemistry and contemporary diagnostic criteria. Of the dementia cases, 53(6.3%) met clinical criteria for FTD; 45(5.1%) fulfilled both clinical and neuropathological criteria for FTLD, and another 8 fulfilled only the clinical criteria. Forty percent of the cases were tauopathies. However, most FTLD cases were characterized by ubiquitin-positive, tau-negative inclusions. Co-existing hippocampal sclerosis and AD-type changes were observed in 12 and 10 cases, respectively. Although FTLD-MND-type is the most frequent FTLD in this prospectively assessed series, less common entities not included in the McKhann criteria, may also present clinically as FTD and should be considered as part of the neuropathologic spectrum of FTLDs that may be encountered in the dementia clinic. The better understanding of the cell death mechanisms related to those entities is likely to contribute for the development of a treatment for FTLD as well for a way of modulate brain aging.

O Plano de Atenção Gerontológica (PAGe), instrumento desenvolvido no Bacharelado em Gerontologia da Universidade de São Paulo, possui uma escala de avaliação multidimensional de idosos (AMI) que ainda não foi submetida ao processo de validação. Objetivo geral: realizar a validação de conteúdo da AMI do PAGe. Métodos: A validade de conteúdo foi realizada nas seguintes etapas: 1) revisão sistemática de instrumentos de avaliação multidimensional de idosos validados na língua inglesa: os descritores \"geriatric assessment\", \"validity\", \"reliability\" e \"elderly\" foram associados e pesquisados em quatro bases de dados. Os artigos foram selecionados por dois avaliadores após aplicação dos critérios de inclusão. Pesquisas adicionais foram feitas na tentativa de encontrar adaptações/validações para a população brasileira; 2) definição das bases conceituais: estudo aprofundado sobre como domínios/itens foram medidos por outros pesquisadores; 3) análise do desenvolvimento da escala: itens avaliados e modificados considerando: ambiguidade, comprimento, dificuldade de leitura, múltiplas negativas e duplo-caminho; e 4) avaliação do comitê de especialistas: profissionais experts em avaliação multidimensional do idoso analisaram o conteúdo do instrumento. Foram seguidos métodos sistemáticos para coleta de dados: carta convite, termo de consentimento livre e esclarecido, formulário de caracterização dos participantes, carta explicativa e questionário de avaliação dos itens/domínios. A concordância entre os especialistas foi analisada considerando os valores críticos da Content Validity Ratio (CVR) (nível de significância de p<0,02). Resultados: Foram encontradas 14 escalas validadas, na maioria voltadas para identificação de fragilidade e demandas/risco de saúde. Os domínios mais frequentes foram suporte social (100%) e capacidade funcional (92,8%), enquanto o menos presente foi sobre violência (7,1%). Todas as escalas apresentaram índices de confiabilidade, seguidos por validade de critério concorrente e conteúdo (78,5%, ambas). Validades de face (21,4%) e construto (21,4%) foram menos prevalentes. Na validação do conteúdo da AMI do PAGe seu construto foi definido, suas bases conceituais foram devidamente descritas e seus itens modificados para melhor qualidade psicométrica. O comitê foi constituído por dez especialistas. A partir do cálculo das CVRs, 42,7% dos 103 itens foram validados, 50,4% modificados, 5,8% excluídos e 0,9% mantidos sem modificações. As médias das CVRs da escala inteira nos quesitos clareza e pertinência são 0,78 e 0,95, respectivamente. Foram feitas alterações no layout e nas instruções do instrumento, excluídas as propostas de escores e incluídos sete itens. Conclusão: As escalas encontradas na revisão são mais voltadas para a área da saúde e apresentam limitações em suas validações. Há escassez de instrumentos originados no Brasil e validados para idosos brasileiros. Esta pesquisa proporcionou a identificação do construto latente da AMI pertencente ao PAGe, a qual passou a ser denominada escala de Vulnerabilidade Biopsicossocial do Idoso (VBI). O conteúdo dessa escala não foi totalmente validado, contudo os itens mantidos na mesma foram todos considerados pertinentes. Neste panorama, espera-se que a escala VBI do PAGe venha contribuir para o campo de instrumentos avaliativos da população idosa brasileira e que este trabalho contribua para maior interesse em estudos de avaliação psicométrica e uso crítico de instrumentos / The Gerontological Care Plan (originally called Plano de Atenção Gerontológica -PAGe), developed in the Bachelor of Gerontology of the University of São Paulo, has a scale of multidimensional assessment of the elderly (MAE) that has not been yet submitted to a validation process. General objective: to determine the content validation of the MAE of the PAGe. Methods: Content validity was performed in the following stages: 1) systematic review of multidimensional assessment tools for elderly validated in the English language: the descriptors \"geriatric assessment\", \"validity\", \"reliability\" and \"elderly\" were associated and searched in four databases. The articles were selected by two researchers after applying the inclusion criteria in the abstracts/titles and full articles. Additional research was done in an attempt to find adaptations/validations for the Brazilian population; 2) definition of the conceptual bases: an in-depth study on how domains/items were measured by other researchers; 3) analysis of the development of the instrument: the items were evaluated and modified considering: ambiguity, length, reading difficulty, multiple negatives and double barreled; and 4) evaluation of the specialists committee: experts in multidimensional assessment analyzed the content of the instrument. Systematic methods for data collection were followed: invitation letter, informed consent form, participant characterization form, explanatory letter and questionnaire to evaluate the items/domains. The agreement among the experts was analyzed considering the critical values of the content validity ratio (CVR) (significance level of p <0.02). Results: A total of 14 validated scales were found, mostly focused on the identification of frailty and demands / health risk. The most frequent domains were social support (100%) and functional capacity (92.8%), while the least present was violence (7.1%). All scales presented reliability indices, followed by validity of concurrent criterion and content (78.5%, both). Validities of face (21.4%) and construct (21.4%) were less prevalent. In the content validation of the MAE of the PAGe its construct was defined, its conceptual bases were properly described and its items modified for better psychometric quality. The committee consisted of ten specialists. From the CVR calculation, 42.7% of the 103 items were validated, 50.4% modified, 5.8% excluded and 0.9% maintained unchanged. The CVR averages of the entire instrument in the clarity and relevance questions are 0.78 and 0.95, respectively. Changes were made to the layout and instructions of the instrument, proposed scores were excluded and seven items were included. Conclusion: The scales retrieved in the systematic review are more focused on the healthcare field and have limitations in their validations. No instrument was originally developed in Brazil and fewer were validated for Brazilian elderly. This research provided the identification of the latent AMI construct belonging to the PAGe, which was renamed scale of Biopsychosocial Vulnerability of the Elderly (BVE). The content of this scale was not fully validaded, however the items kept in it were all considered pertinent. Finally, it is expected that BVE would contribute to the field of evaluation instruments for Brazilian elderly population and that the present study contributes to an increase interest in psychometric evaluation and critical use of instruments

Este estudo objetivou avaliar a condição clínica pré-operatória dos cães idosos submetidos à anestesia inalatória e relacionar as alterações encontradas na avaliação pré-operatória com a ocorrência de complicações e óbito perioperatório. O estudo foi prospectivo, observacional e realizado no período de abril de 2007 a abril de 2008. Os cães idosos foram avaliados por meio de anamnese, exame físico, mensuração da pressão arterial sistólica (Doppler), eletrocardiograma (ECG) e análises laboratoriais previamente ao procedimento cirúrgico. O procedimento anestésico, cirúrgico e a ocorrência de complicações transoperatórias foram analisados pelo registro nas fichas de anestesia. Incluíram-se no estudo os animais submetidos à anestesia inalatória por no mínimo 30 minutos. As complicações pós-operatórias foram avaliadas por meio da consulta pós-operatória, do registro nos prontuários e relato dos proprietários. Os grupos foram comparados por meio do teste de Mann-Whitney. Nas variáveis categóricas foi empregado o teste do qui-quadrado ou o teste exato de Fisher. O grau de significância foi de 5%. Foram incluídos no estudo 169 cães, 97 machos e 72 fêmeas, com idade média de 10,4&plusmn;2,2 anos (125,0&plusmn;26,6 meses) e com peso médio de 19,8&plusmn;12,3 kg. A idade e peso não apresentaram diferença entre os sexos (p&gt;0,05). O hematócrito abaixo dos valores normais ocorreu em 16,0% (27/169) dos animais e houve associação com a ocorrência de complicações (21/169=12,43%) e óbito (4/169=2,37%) perioperatório (p&lt;0,01). A concentração de hemoglobina abaixo dos valores normais (4/169=2,37%) e a necessidade de transfusão de hemocomponentes foram associadas com o desfecho de óbito no pós-operatório (p&lt;0,01). Os animais classificados com categoria de risco anestésico (ASA) III (34/169=20,12%) e IV (2/169=1,18%) apresentaram maior ocorrência de complicações (p&lt;0,05) e óbito (p&lt;0,01) perioperatório quando comparado a ASA II (133/169=78,70%). Nos cães categorizados com risco cirúrgico médio (96/169=56,80%) e alto (9/169=5,33%) ocorreu maior morbidade e mortalidade perioperatório quando comparado ao baixo (64/169=37,87%) (p&lt;0,01). Houve menor mortalidade com o emprego da acepromazina (89/169=52,66%) na medicação pré-anestésica (p&lt;0,05). A hipotensão arterial foi a complicação mais frequente (78/169=46,15%) no transoperatório, mas não foi associada ao uso de acepromazina e desfecho de óbito (p&gt;0,05). A administração de fentanil em bolus (54/169=31,95%) foi associada com a hipotensão arterial transoperatória (p&lt;0,05). A duração do procedimento anestésico acima de 75 minutos apresentou maior ocorrência de complicações perioperatórias (p&lt;0,01). A morbidade e mortalidade perioperatória observada nos cães idosos foi de 56,21% (IC95%: 48,38-63,82%) e 2,96% (IC95%: 0,97-6,77%), respectivamente. A partir dos resultados pode-se concluir que: o hematócrito abaixo do valor de referência indica maior ocorrência de complicações e óbito perioperatório; a concentração de hemoglobina abaixo do valor de referência e a necessidade de transfusão de hemocomponentes determinam maior mortalidade perioperatória; a classificação de risco anestésico e cirúrgico são métodos válidos na determinação dos pacientes mais propensos a ocorrência de complicações e o desfecho de óbito; a administração de acepromazina reduz a mortalidade; o procedimento anestésico superior a 75 minutos aumenta a ocorrência de complicações; e a morbidade e mortalidade perioperatória são elevadas nos cães idosos. / This study aimed to evaluate the preoperative clinical condition in elderly dogs undergoing inhalation anesthesia and relate the changes found in the preoperative evaluation with the occurrence of perioperative complications and death. This study was prospective, observational and accomplished from April 2007 to April 2008. The elderly dogs were evaluated by clinical history, physical examination, measurement of systolic blood pressure (Doppler), electrocardiogram (ECG) and laboratory tests before surgery. The anesthetic and surgical procedure and the occurrence of intraoperative complications were analyzed according to the anesthesia records. This study included the animals submitted to inhalation anesthesia for at least 30 minutes. The postoperative complications were evaluated by postoperative visit, enrollment in medical records and owners&#39; reporting. The groups were compared using the Mann-Whitney test. For the categorical variables it was used the chi-square or Fisher&#39;s exact test. The level of significance was 5%. The study included 169 dogs, 97 males and 72 females, mean age 10.4&plusmn;2.2 years old (125.0&plusmn;26.6 months old) and mean weight was 19.8&plusmn;12.3 kg. The age and weight did not differ between the genders (p&gt;0.05). The hematocrit below normal values occurred in 16.0% (27/169) of the animals and was associated with the occurrence of perioperative (p&lt;0.01) complications (21/169=12.43%) and death (4/169=2.37%). The hemoglobin concentration below normal values (4/169=2.37%) and the need for blood components transfusion were associated with the outcome of postoperative death (p&lt;0.01). The animals classified as anesthetic risk category (ASA) III (34/169=20.12%) and IV (2/169=1.18%) had a higher perioperative complication (p&lt;0.05) and death (p&lt;0.01) compared to ASA II (133/169=78.70%). The dogs categorized as moderate (96/169=56.80%) and high (9/169=5.33%) surgical risk had higher perioperative morbidity and mortality when compared to low (64/169=37.87%) (p&lt;0.01). There was a lower mortality with the use of acepromazine (89/169=52.66%) in premedication (p&lt;0.05). Hypotension was the most frequent complication (78/169=46.15%) during surgery, but was not associated with the use of acepromazine and outcome of death (p&gt;0.05). The administration of fentanyl (54/169=31.95%) was associated with intraoperative hypotension (p&lt;0.05). The duration of anesthesia for over 75 minutes had a higher incidence of perioperative complications (P&lt;0.01). The perioperative morbidity and mortality observed in older dogs was 56.21% (95% CI: 48.38-63.82%) and 2.96% (95% CI: 0.97-6.77%), respectively. According to the results it can be concluded that: the hematocrit below the reference value indicates a higher incidence of perioperative complications and death; the hemoglobin concentration below the reference value and the need for blood components transfusion determine higher perioperative mortality; the classification of anesthetic and surgical risk are valid methods in determining the most likely patients to complications and outcome of death; acepromazine administration reduces mortality; anesthesia for over 75 minutes increases the complications; and perioperative morbidity and mortality are high in elderly dogs.

Orientador: Mônica Sanches Yassuda / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T00:34:44Z (GMT). No. of bitstreams: 1 Arroyo_NataliaCosta_M.pdf: 1902872 bytes, checksum: 5408a7c634beba4926a09b390cc2314a (MD5) Previous issue date: 2013 / Resumo: A funcionalidade é um novo paradigma de saúde entre os idosos. As atividades instrumentais de vida diária (AIVD) representam um importante indicador de saúde, visto que são as primeiras atividades a serem comprometidas na presença de comprometimento cognitivo e são essenciais para a manutenção do idoso no seu contexto social. Assim, este trabalho tem por objetivo identificar dentre as variáveis sociodemográficas, de saúde autorrelatadas e indicadores de fragilidade, quais fatores são independente e conjuntamente associados às dificuldades observadas na realização das AIVD. Trata-se de um estudo de caráter transversal, conduzido com 2282 idosos que participaram da pesquisa "Estudo da fragilidade em idosos brasileiros", desenvolvida pela Rede FIBRA - Fragilidade em idosos brasileiros, pólo UNICAMP. As AIVDs foram avaliadas pela Escala de Lawton e a síndrome da fragilidade foi identificada pelos critérios propostos por Fried et al. (2001). Verificou-se que cerca de 38% da amostra apresentou dependência para pelo menos uma AIVD. Análises de regressão multivariada indicaram que os fatores mais fortemente associados à dificuldade nestas atividades foram ser frágil ou pré frágil, ter 80 anos ou mais, ter renda familiar de 0 a 3 salários mínimos e apresentar sintomas depressivos. Conclui-se que a melhora das condições de saúde dos idosos brasileiros está intimamente relacionada à melhora das condições socioeconômicas, à diminuição das condições associadas à fragilidade e à melhora em saúde mental. O desenvolvimento de medidas preventivas à síndrome da fragilidade e de programas terapêuticos para a prevenção de sintomatologia depressiva faz parte da atenção integral à pessoa idosa / Abstract: Functionality is a new health paradigm among the elderly. Instrumental activities of daily living (IADL) are an important indicator of health, as they are the first activities to be impaired in the presence of cognitive impairment and they are essential for the maintenance of the elderly in their social context. Thus, this study aimed to identify among sociodemographic variables, self-reported health indicators and markers of frailty, which factors are independently and jointly associated with perceived difficulties in performing IADL. This was a cross sectional study, conducted with 2282 seniors who participated in the study "Study of frailty among elderly Brazilians," developed by the FIBRA network, at UNICAMP. IADLs were assessed by the Lawton scale and the frailty syndrome was identified by the criteria proposed by Fried et al. (2001). Multivariate regression analyzes indicated that about 38% of participants showed limitations in at least one IADL. The factors most strongly associated with difficulty in these activities were being frail or pre frail, being 80 years or older, having a family income of 0 to 3 minimum wages and depressive symptoms. We concluded that the improvement of the health conditions of older Brazilians is closely related to the improvement of socioeconomic conditions, the reduction of conditions associated with frailty and improvement in the mental health of seniors. The development of preventive measures for the frailty syndrome and therapeutic programs for the prevention of depressive symptoms should be part of the comprehensive care of the elderly / Mestrado / Gerontologia / Mestra em Gerontologia

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-10-18T17:46:51Z No. of bitstreams: 1 Fayanne Schaustz Bom.pdf: 2448055 bytes, checksum: 87a80a4989d39bf35f62e85df9a24017 (MD5) / Made available in DSpace on 2016-10-18T17:46:52Z (GMT). No. of bitstreams: 1 Fayanne Schaustz Bom.pdf: 2448055 bytes, checksum: 87a80a4989d39bf35f62e85df9a24017 (MD5) Previous issue date: 2016 / Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro / Mestrado Profissional em Enfermagem Assistencial / Esse estudo tem como objetivo implementar uma Tecnologia Educacional em forma de Oficina para Cuidadores Familiares de Idosos como estratégia, visando promover a saúde física e mental do cuidador e melhora do cuidado prestado ao idoso. O cuidado, em nível domiciliar é exercido quase que exclusivamente pelo membro familiar, o qual geralmente não recebeu orientação para que possa atender e suprir adequadamente as demandas de cuidado do idoso, o que pode levar a sobrecarga de trabalho e ao comprometimento da sua Qualidade de Vida. As práticas educativas em saúde são pilares para a promoção da saúde e, no contexto atual das condições dos cuidadores familiares de idosos, tornam-se uma ferramenta importante para a construção da consciência crítica necessária a autonomia dos cuidadores na prática de cuidar, respeitando-se seus conceitos e valores. Nesse estudo foi utilizado a Tecnologia Educacional em saúde em forma de Oficina para orientação aos cuidadores baseado nas necessidades que os mesmos apresentam ao lidar com seu idoso. A modalidade da pesquisa neste trabalho foi a metodológica, para contemplar a abordagem foram aplicadas a escala de Zarit que avalia sobrecarga e a escala SF36 que verifica a qualidade de vida dos participantes antes e após a implementação da Tecnologia Educacional em forma de Oficina, também foi utilizado questionário sócio demográfico para conhecer o perfil dos cuidadores familiares. A partir dos dados coletados foi construído um banco de dados que foi analisado pelo programa Statistical Packagefor the Social Science (SPSS) , versão 22.0 e pelo aplicativo Microsoft Excel 2007. Esse estudo verificou que a dificuldade do cuidar não está somente na realização das tarefas em si, mas também na dedicação necessária para satisfazer as necessidades do outro, em detrimento das suas próprias necessidades. A sobrecarga moderada e a diminuição da Qualidade de vida está presente nos cuidadores familiares, porém, após a participação nas oficinas, produto desta dissertação, foi concluído que a intervenção realizada para cuidadores familiares de idosos promove melhoria significativa nos itens de qualidade de vida pontuados na escala SF-36 e sobrecarga identificada com a escala de Zarit. / This study aims to implement an educational technology in the form of Workshop for Caregivers of Elderly Family as a strategy to promote physical and mental health of the caregiver and improvement of care for the elderly. The care at the household level is exercised almost exclusively by the family member, who generally did not receive guidance so you can appropriately respond to and meet the elderly care demands, which can lead to overload of work and commitment of its Quality Life. Educational practices in health are the pillars for the promotion of health and in the current context of the conditions of family members of elderly caregivers, become an important tool for the construction of the critical consciousness necessary autonomy of caregivers in care practice, respecting, its concepts and values. In this study it was used to Educational Technology in Health in the form of workshop for guidance to caregivers based on the needs that they have to deal with their elderly. The mode of research in this work was the methodology, to contemplate the approach were applied to Zarit scale that evaluates overload and SF36 scale checks the quality of life of the participants before and after the implementation of educational technology in the form of workshop was also used demographic questionnaire to know the profile of family caregivers. From the collected data it has built a database that was analyzed by the Statistical Packagefor the Social Science (SPSS) version 22.0 and Microsoft Excel application 2007. This study found that the difficulty of care is not only in the tasks in itself, but also the dedication required to meet the needs of the other, to the detriment of their own needs. Moderate overload and decreased quality of life is present in the family caregivers, however, after participating in the workshops, product of this work, it was concluded that the intervention carried out to family caregivers of elderly promotes significant improvement in quality items punctuated life in SF-36 scale and overhead identified with the Zarit scale.

No description available.

D.Cur. / Limited funds for the delivering of health and social services necessitate the cost-effective utilization of all categories of nursing personnel in old age homes. Professional nurses are being retrenched and supervision over weekends and after hours is being scaled down due to a lack of guidelines for the cost-effective utilization of nursing personnel in old age homes. A combined quantitative-qualitative approach had been applied in this empirical study to explore and describe the utilization of nursing personnel in old age homes. The goal of the study was to compile guidelines for the cost-effective utilization of nursing personnel in old age homes. Data collection and data analysis were conducted during three phases. A survey of the population of old age homes in South Africa was first conducted to determine the composition of the residents and nursing personnel in these old age homes and to explore the cost implications of the personnel composition. The contents of job descriptions of professional nurses working in old age homes were analysed on a computer by the researcher using NUDtIST software during the second phase of the study. The third phase consisted of conducting and analysing focus groups with professional nurses regarding. their expectations of their own duties, tasks and responsibilities and those of nursing auxiliaries and lay caregivers in old age homes. The three phases were conducted simultaneously and the results of the three phases were triangulated and subjected to a limited literature control. The results were verified during visits to nursing homes in the USA, Canada and the UK. A conceptual framework and guidelines for the cost-effective utilization of nursing personnel in old age homes were developed from the findings of this study. Respondents from the first phase of the study and experts verified the guidelines for being applicable, important, clear and accessible. The findings indicated that most of the residents of the old age homes are very old and are in need of 24 hours nursing/care due to their level of frailty. The nursing personnel budget forms a significant portion of the operating budget of the old age homes and managers are of the opinion that professional nurses are expensive but an essential component of the nursing personnel. The duties, tasks and responsibilities of professional nurses were identified as well as those which are shared with nursing auxiliaries and lay caregivers in old age homes. The conceptual framework which was established from the results of the study indicates that the goal, costeffective utilization of nursing personnel, is reached when quality care has been delivered within the constraints of the budget limitations. The process has been described as the compiling of guidelines for all categories of nursing personnel regarding clinical nursing, nursing management and nursing education as well as the handling of non nursing tasks while considering the personnel standards and job descriptions. The role players are the manager, all categories of nursing personnel, lay caregivers, family and volunteers which perform within the restrictions of the personnel composition and the appropriate code of conduct regulations. The context for the utilization of nursing personnel is the old age home where nursing/care giving is delivered on a continuum and the dynamics which influence the cost-effective utilization of nursing personnel include applicable legislation and policies of government departments and non government organizations.

This study aimed to investigate the inter-relationships between self-stigma, loneliness, and culture among older adults with mental illness residing in nursing homes. This study also explored how this population experiences self-stigma and loneliness within the context of their cultural backgrounds. A mixed-methods approach was utilised. The first phase involved a quantitative face-to-face questionnaire survey (n=16). More than half of the study participants reported low levels of self-stigma (56.3%), yet a substantial number of them scored high on the self-stigma scale (43.8%). The analysis identified a statistical relationship between stereotype endorsement and marital status (sig. =.010). No relationship was identified between Internalised Stigma of Mental illness constructs (ISMI) and age, gender, religiousness, and educational level. Loneliness was identified to be prevalent among more than half of the sample (68.8%). There was also a positive correlation between loneliness, age (sig.=.062) and religiosity (sig.=.044). The second phase involved a qualitative hermeneutic phenomenological approach involving one-to-one semi-structured interviews (n=10). Seven themes emerged: ‘social loneliness’, ‘emotional loneliness’, ‘emotional reactions’, ‘coping mechanisms’, ‘insight into illness’, ‘understanding and view towards mental illness’, and ‘behavioural reactions’. Overall, the qualitative findings supported the quantitative results but also revealed additional theoretical and conceptual insight. Most participants were collectivistic-oriented, and most experienced both social and emotional loneliness. The degree of insight into mental illness played a key role in how self-stigma was experienced, while gender and culture were found to influence how loneliness was experienced. Based on the results of both phases, a new theoretical framework is posited that explains the relationships between the concepts of loneliness and self-stigma among this population. The study also evidences and discusses a wide range of methodological issues associated with the successful recruitment of nursing homes in older adult research.

Performance on the Spatial Span subtest of the Wechsler Memory Scale has been viewed as an indicator of working memory and visuospatial processing. A number of factors including age and gender have been posited to effect performance on Spatial Span by older adults. The current study examined the impact of various forms of cognitive impairment and severity of impairment on Spatial Span performance. Five hundred thirty-eight individuals between the ages of 65 and 89 were evaluated in a university memory disorders clinic using a battery of neuropsychological tests that included Spatial Span. Participants were grouped by consensus diagnosis into type of cognitive impairment (Alzheimer's disease, vascular disease, amnestic mild cognitive impairment or non-amnestic mild cognitive impairment) or cognitively normal. As expected, an increase in severity of impairment results in a decrease in Spatial Span Total Score. Other findings included a weak relationship between age and Spatial Span Total Score. Gender, as well as age, did not fully account for the decline in Spatial Span Total Score. Spatial Span Forward score was not as good a predictor of severity in that reduction in score for Spatial Span Forward remains relatively stable regardless of level of impairment. Spatial Span Backward performance was found to be more sensitive to severity. No significant differences were found between performance of Alzheimer's disease and vascular disease suggesting they share similar deficit patterns with regard to the cognitive abilities measured by the Spatial Span subtest. A comparison between those diagnosed with mild cognitive impairment and individuals without such a diagnosis showed no significant difference suggesting that visuospatial processes are not affected early in the dementing process.