Aline Cristina Martins Gratão

Functional independence level and cognitive deficit in elderly individuals with Alzheimer's disease

Este estudo investigou a influencia do nivel de independencia funcional dos idosos com doenca de Alzheimer segundo escores da avaliacao cognitiva. A populacao foi composta por 67 idosos atendidos no Ambulatorio de Neurologia Comportamental do Hospital das Clinicas/Ribeirao Preto, avaliados em 2008, por meio de um questionario para dados sociodemograficos, Medida de Independencia Funcional (MIF) e Mini-Exame do Estado Mental (MEEM). Observou-se que o deficit cognitivo influenciou o desempenho na realizacao das AVDs. A media da MIF para idosos sem deficit cognitivo foi 107,7 e para os com deficit, 63,2 (p<0,001). Na MIF motora, as medias foram 81,7 e 49,4 (p<0,001), e na MIF cognitiva 25,7 e 13,8 (p<0,001), respectivamente. Conhecer a reducao da independencia e da capacidade cognitiva e indispensavel para manter o provimento das necessidades basicas da vida diaria. O estudo pode subsidiar a pratica do enfermeiro, melhorando a condicao de vida do idoso e de sua familia.

Alzheimer's disease: functional decline and stage of dementia

OBJECTIVE: To determine how Alzheimers disease stage is correlated with the functional ability of elderly people, according to the Functional Independence Measure. METHODS: This observational and cross-sectional study involved elderly people diagnosed with Alzheimers disease and their caregivers. For data collection, the Functional Independence Measure and the Clinical Dementia Rating scale were used. RESULTS: The sample consisted of 67 elderly people (mean age, 79 years). Severe dementia was found in 46.3%, moderate dementia in 22.4%, and mild dementia in 31.3%. The mean scores on the Functional Independence Measure were 107.9, 84.5, and 39.7 for participants with mild, moderate, and severe dementia, respectively. A correlation was found between the Functional Independence Measure and dementia stage (p<0.001). CONCLUSION: The stage of dementia is an important predictive factor for functional performance problems in elderly people with Alzheimers disease.

Impact of cognitive stimulation on depression, anxiety, cognition and functional capacity among adults and elderly participants of an open university for senior citizens

Objective: this study evaluated the effectiveness of a Gerontological Cognitive Stimulation workshop, aimed at improving the cognitive and functional performance and mood symptoms of senescent participants in an Open University for Senior Citizens. Method: An open controlled clinical trial with a wait list was performed, with 15 people participating in the intervention group and 16 people in the control group. At the beginning and end of the study (six months later) the Digit span, ACE-R, Anxiety Inventory and Beck Depression, and Functional Independence Measure (FIM) tests were applied. Results: In the intervention group, there was improvement in the variables evaluated, with significant differences in the visuospatial domain (p=0.022), symptoms of depression (p=0.048) and anxiety (p=0.002). In the control group the symptoms of depression and anxiety deteriorated. Conclusion: The results suggest that the cognitive stimulation program has a beneficial effect on the mood symptoms of adults and elderly members of an Open University Program for Senior Citizens.

Código de ética para fisioterapeutas e terapeutas ocupacionais revela conteúdos relacionados à autonomia do profissional

Apesar de ja existir codigo mais recente, estudo que revele os conteudos do antigo pode contribuir para melhor compreensao do papel social do fisioterapeuta. Assim, este estudo procurou verificar as proporcoes de enfoques deontologicos e bioeticos presentes no codigo, identificando predominios de conteudos para subsidiar interpretacoes deste documento. Utilizou-se analise textual e interpretativa do codigo comparando-o com dois conjuntos de textos. O primeiro apresentava referencial teorico deontologico e o segundo referencial bioetico. Para o codigo de etica e para cada conjunto de textos foram identificadas unidades textuais em categorias de enfoques bioetico (principialismo) e/ou deontologico (tecnica e virtude). Para conteudos textuais do codigo de etica e para os dois respectivos conjuntos de textos identificou-se 54,4, 55,7 e 57,7% de unidades com enfoque deontologico nos seus conteudos. No codigo de etica, para as unidades de enfoque bioetico, considerando unidades de autonomia separadas entre profissional e cliente, observou-se razao de 2,15:1 (profissional:cliente). Esta razao foi menor que a observada nos textos de referencial deontologico (5,07:1 - profissional:cliente) e inversa a razao de 1,32:1 (cliente:profissional) dos textos de referencial bioetico. Conclui-se que o predominio de conteudos, tanto no codigo de etica quanto nos textos deontologicos, mostraram concepcoes corporativistas e legalistas, prevalecendo uma visao de autonomia profissional. Esta caracteristica divergiu dos textos com referencial teorico bioeticos em que se constatou predominância de valor para autonomia focada no cliente.

Mobile Digital Storytelling in a Brazilian Care Home.

Digital stories are short personal films made up of a series of still images with voiceover, music and text. The technical barriers to creating such stories are falling with the use of mobile apps which make it easy to assemble story elements as audiophoto narratives on a smartphone or tablet. In this case study, we explored the potential of mobile digital storytelling in a care home context. It was used for four weeks as form of multimedia communication between formal and informal carers inside and outside the home, and a care home resident suffering from dementia. The home was located in Sao Carlos, Brazil as part of a larger international project called Time Matters (UK and Brazil), in which Time stands for ‘This is me’. Fifteen digital stories were made by participants in the trial, which is about one for every visit of the researchers to the care home. Stories focused mainly on the resident; capturing aspects of everyday life discussed in Visit conversations (4), documenting Social events (3) inside or outside the home, recording Therapy sessions (3) with the resident or Health reports (3) by professional carers, and forming Media albums (2) of the residents’ art or life. In general, the technology was most useful for facilitating richer conversations with the resident and other participants, and stimulating greater expressivity and creativity in the resident herself. The desire to document the resident’s current life and interests in the home for later reminiscence by their family, stands in contrast to conventional reminiscence therapy and related digital systems. These use media artefacts to stimulate reminiscence of residents’ past life outside the home.

Effects of health education in the elderly with mild cognitive impairment

OBJECTIVE to analyze the effects of health education on both cognition and depressive/anxiety symptoms in the elderly with Mild Cognitive Impairment (MCI). METHOD this is a randomized and controlled clinical trial. Participants (n=22) were recruited from a specialized outpatient clinic, and assigned into two groups: a Health Education Group (HEG) (n=10) and a Control Group (CG) (n=12). The participants were evaluated before and after the intervention, which was composed of classes and dynamics. The intervention consisted of 20 meetings, over a period of five months. The assessment was performed by means of the Addenbrookes Cognitive Examination - Revised (ACER), the Mini-Mental State Examination to access participants cognitive state, and the Becks Scale to access depressive/anxiety symptoms. A Memory Complaints Scale (EQM) was also used. The analysis was carried out using the Students t test for paired samples. RESULTS the HEG group demonstrated an improvement in attention/orientation (p= 0,026), memory (p=0.001), language (p= 0.033), and ACE-R (p= 0.003). On the other hand, the CG did not present improvement. CONCLUSION the results highlight the importance of non-pharmacological interventions in older adults with MCI to reduce cognitive deficits.

Prevalence of Physical Inactivity and Associated Factors Among Older Caregivers of Older Adults

Objective: The aim of this study is to analyze the prevalence of physical inactivity (PI) and associated factors in older caregivers of older adults. Method: A cross-sectional study was conducted including 312 older caregivers. Sociodemographic, clinical, and care-related characteristics were considered the independent variables for the determination of associated factors with PI in the logistic regression model. Results: The prevalence of PI was 75.3% (95% confidence interval [CI] = [70.1%, 80.0%]). The following factors were associated with PI: being female (odds ratio [OR] = 2.8, 95% CI = [1.3, 5.9]), being older than 75 years of age (OR = 7.1, 95% CI = [2.2, 22.9]), not having a marital life (OR = 4.2, 95% CI = [1.1, 15.8]), being prefrail (OR = 6.2, 95% CI = [1.7, 21.9]), and being frail (OR = 14.8, 95% CI = [3.8, 57.7]). Discussion: The prevalence of PI was high and associated with the female sex, an advanced age, and not being married. Specific public policies considering these results should be created for older caregivers.

Effects of a Health Education program on cognition, mood and functional capacity

Objective: Assess the effect of a Health Education (HE) program on cognition, mood and functional capacity of participants in a University of The Third Age (U3A). Method: Controlled clinical trial. The HE Program consisted of 10 sessions with group dynamics, including orientations on disease prevention and cognitive stimulation exercises, lasting four months. Intervention Group (IG) n=13; and Control Group (CG) n=15. All were assessed at the start and end of the study, using Addenbrook´s Cognitive Examination-Revised (ACE-R), Beck Depression and Anxiety Inventory (BDI/BAI) and Functional Independence Measure (FIM). Results: Significant improvements were observed for the IG when comparing the total ACE-R score (p=0.001) and memory domain (p=0.011) before and after the intervention. For the CG, improvement was found in the memory domain only (p=0.027). Conclusion: a HE intervention program benefits the improvement in cognitive performance, particularly the memory of adults and active elderly who participated in a U3A.Objetivo: Avaliar o efeito de um programa de Educacao em Saude (ES) na cognicao, humor e capacidade funcional de participantes de uma Universidade Aberta da Terceira Idade (UATI). Metodo: Ensaio clinico controlado. O programa de ES consistiu de 10 sessoes com dinâmicas de grupo, incluindo orientacoes sobre prevencao de doencas e exercicios de estimulacao cognitiva, durante quatro meses. Grupo Intervencao (IG) n=13; e Grupo Controle (CG) n=15. Todos foram avaliados no inicio e no final do estudo, utilizando-se o Addenbrook´s Cognitive Examination-Revised (ACE-R), o Inventario de Depressao e Ansiedade Beck (BDI/BAI) e a Medida de Independencia Funcional (FIM). Resultados: observou-se melhora significativa no IG ao comparar o escore do ACE-R (p=0,001) e do dominio memoria (p=0,011) antes e apos a intervencao. No CG, houve melhora apenas no dominio memoria (p=0,027). Conclusao: um programa de ES beneficia a melhoria do desempenho cognitivo, particularmente a memoria de participantes ativos de uma UATI.

Cognitive and functional assessment about elderly people users of health public service

Objective: To evaluate the functional capacity, cognition and mood in three different care models for older adults. Method: A cross-sectional study conducted in 2014 with 140 older adults (37 institutionalized, 53 hospitalized and 50 outpatients). The MMSE, Clock Drawing Test (CDT), Activities of Daily Living Scale ADLs (Katz, Lawton) and the Geriatric Depression Scale (GDS) were applied. Results: Of those institutionalized, the majority were totally dependent for ADLs and 100% presented cognitive decline. Of those hospitalized and the outpatients, the majority were independent for ADLs, with 62.3% and 48.0% presenting cognitive decline, respectively. The minority presented depressive symptoms. The results indicated that age was a predictor of cognitive decline and the likelihood of prevalence in hospitalized and outpatient older adults increased by 8.7% for each year of life. Conclusion: It is important to pay attention to the cognitive and functional performance of older adults with the aim of preventing their decline, which is so frequent in the public health services in Brazil.

Has the new code of ethics for physiotherapists incorporated bioethical trends

Advances in health technology incorporate bioethical discussions in texts that address professional care. Would the new code of ethics for physiotherapists have incorporated such discussions? Given the issue, we aimed to verify the ratio of deontological and bioethical approaches in the new code of ethics when compared to the old one, investigating relationships between professional and client autonomies in healthcare. Content analysis methods were applied to written documents in order to verify in what proportion deontological and bioethical approaches are present in the new code. The bioethical approaches compose the large part of the content in this new code (53%) specially related to the justice category which represents 21,9% of the total textual units found. Changes in the new document reveal bioethical influences in the conception of the new code, which still did not modify the relationship between professional and client autonomies, revealing the need for further discussions.Advances in health technology incorporate bioethical discussions in texts that address professional care. Would the new code of ethics for physiotherapists have incorporated such discussions? Given the issue, we aimed to verify the ratio of deontological and bioethical approaches in the new code of ethics when compared to the old one, investigating relationships between professional and client autonomies in healthcare. Content analysis methods were applied to written documents in order to verify in what proportion deontological and bioethical approaches are present in the new code. The bioethical approaches compose the large part of the content in this new code (53%) specially related to the justice category which represents 21,9% of the total textual units found. Changes in the new document reveal bioethical influences in the conception of the new code, which still did not modify the relationship between professional and client autonomies, revealing the need for further discussions.