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Previous issue date: 2004 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Objetivos: Identificar entre pacientes e cuidadores familiares, fatores de risco para institucionalizacao do portador de demencia. Verificar o impacto das intervencoes de enfermagem no comportamento e estresse dos cuidadores. Metodos: Estudo longitudinal que acompanhou por cerca de um ano e meio, 362 sujeitos, pacientes e cuidadores familiares em tres diferentes campos: ambulatorio, domicilio, e instituicao de longa permanencia (ILP). Os familiares cuidadores do ambulatorio foram avaliados quanto a intencao e risco para institucionalizacao, e os familiares dos pacientes institucionalizados para verificacao das causas. Foram utilizados, no ambulatorio e domicilio, sete instrumentos validados para avaliacoes cognitiva, funcional, comportamental e ambiental. Um protocolo de enfermagem e dois questionarios para avaliacao do perfil da familia e presenca de conflitos em sua estrutura. Para os pacientes da instituicao, foram utilizados cinco instrumentos de avaliacao cognitiva, funcional e comportamental. Exceto o Mini Exame do Estado Mental (MEEM), todos os instrumentos foram aplicados ao familiar cuidador. Resultados: Na primeira avaliacao, o risco para institucionalizacao estava associado ao declinio cognitivo (p< 0,001), e estresse do cuidador (p< 0,001). Na segunda avaliacao, o risco se manteve presente no declinio cognitivo e no estresse do cuidador.0 impacto das intervencoes de enfermagem no acompanhamento dos pacientes do ambulatorio e domicilio, na segunda avaliacao, resultou em melhora no estresse do cuidador, no Inventario Neuropsiquiatrico (INP) do paciente e em seu estado geral (p<0,001). Esta melhora, pos-intervencao de enfermagem, foi notada tambem na instituicao, pelos resultados do INP e do estresse do familiar (p< 0,001). Os resultados pos-intervencao, nos pacientes visitados em domicilio apresentaram significancia estatistica no estresse do cuidador (p= 0,030), no INP geral (p= 0,002) e em alguns subitens da escala INP, como agressividade (p=< 0,001), ansiedade (p= 0,023), apetite (p= 0,050) e disforia (p= 0,02fi). Houve melhora significante tambem nas atividades diaria (AVD) (p= 0,014). Conclusao: Os fatores de risco para institucionalizacao, identificados neste estudo, foram o declinio cognitivo e o stress dos familiares cuidadores. Houve impacto positivo das intervencoes de enfermagem na reducao do estresse, no comportamento e na funcao / Objectives: Identify among demented patients and their family caregivers, risk factors for the patient’s institutionalization. Verify the impact of the nursing intervention on the caregiver’s behavior and burden. Method: A longitudinal study was conducted and followed, for a period of one year and a half, 362 subjects (patients and their caregivers) in three different settings: ambulatory, home and long – term institutions. The family caregivers from the ambulatory were assessed aiming to determine the risk factors for institutionalization and whether they had the intention to institutionalize their patient. The caregivers who had their relative in institution were assessed in order to determine the causes who lead them to do so. For both ambulatory and home assessment, seven different instruments have been used in covering the cognitive, functional, behavioral e environmental aspects. A Nursing Protocol and two other scales, has also been used to gather informations concerning the family profile and the presence of conflicts on its structure. For the institutionalized patients, five instruments have been used to collect data related to cognition, functional and behavior status. All the instruments have been applied on the caregiver, nothing but the Mini Mental State Examination (MMES) – applied on the patient. Results: The first assessment pointed that the risk for institutionalization was related to the cognitive decline (p<0,001) and to the caregiver’s burden (p<0,001). The cognitive and caregiver’s burden factors were still present on the second assessment. The nursing intervention showed a positive impact on the ambulatory patients follow-up and on the home patients as well. These interventions resulted in improvement on the caregiver’s burden, on the patient’s behavior – assessed by the Neuropsychiatric Inventory (NPI) – and on the patient’s general heath status (p<0,001). This improvement, after the nursing intervention, was also observed among the institutionalized patients, as shown on the NPI and on the caregiver’s burden results (p<0,001). The results obtained after the nursing intervention among the patients who remained at home presented to be statistically significant concerning the caregiver’s burden (p=0,003), the general NPI (p=0,002) and also its sub-items: aggressivity (p=0,001), anxiety (p=0,023), appetite (p=0,005) and disforia (p=0,026). The activities of daily living was also improved (p=0,014). Conclusion: The risk factors for institutionalization identified on this study was the cognitive decline and the family caregiver’s burden. There has been a positive impact of the Nursing Interventions on the stress reduction and on the behavioral and functional status. / CNPq: 140580/00-0 / BV UNIFESP: Teses e dissertações
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unifesp.br:11600/18739 |
| Date | January 2004 |
| Creators | Ferretti, Ceres Eloah de Lucena [UNIFESP] |
| Contributors | Universidade Federal de São Paulo (UNIFESP), Bertolucci, Paulo Henrique Ferreira [UNIFESP] |
| Publisher | Universidade Federal de São Paulo (UNIFESP) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | 95 p. |
| Source | reponame:Repositório Institucional da UNIFESP, instname:Universidade Federal de São Paulo, instacron:UNIFESP |
| Rights | info:eu-repo/semantics/openAccess |
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