Clarissa Marceli Trentini

Projeto WHOQOL-OLD: método e resultados de grupos focais no Brasil

OBJETIVO: A investigacao sobre as condicoes que permitem uma boa qualidade de vida na velhice e de interesse cientifico e social. Assim, o estudo objetivou apresentar a metodologia utilizada e os resultados dos grupos focais para avaliacao da qualidade de vida do idoso. METODOS: A metodologia do projeto WHOQOL-OLD e a mesma utilizada no desenvolvimento de outros modulos do WHOQOL. Foram realizados cinco grupos focais no Brasil. O metodo amostral foi o de conveniencia. Dezoito idosos e cinco cuidadores participaram dos grupos focais. Todos os grupos obedeceram a uma metodologia pre-estabelecida. RESULTADOS: Observou-se uma tendencia de associacao entre qualidade de vida e bem-estar ou sentir-se bem. Espontaneamente, as respostas incluiram os seis dominios propostos no WHOQOL-100, reforcando a multidimensionalidade do construto. Das 24 facetas originais, 19 foram citadas como relevantes, sendo que as cinco facetas nao espontaneamente lembradas nao se centraram em um unico dominio. Quando perguntados sobre a importância de cada uma das 24 facetas do WHOQOL-100, os grupos consideraram-nas todas relevantes. Foram sugeridas modificacoes para serem aplicadas a idosos para cinco facetas. Itens adicionais tambem foram examinados e considerados relevantes para a avaliacao de qualidade de vida em idosos, tanto pelos idosos entrevistados como pelos cuidadores. CONCLUSOES: Os resultados corroboram com a hipotese de que os idosos constituem um grupo particular e, como tal, apresentam especificidades de importante relevância para a qualidade de vida. Assim, um instrumento adequado para a avaliacao da qualidade de vida de idosos tem que necessariamente contemplar esses aspectos.

Development and validation of the Portuguese version of the WHOQOL-OLD module.

OBJECTIVE The increasing proportion of older adults in the general population and the specific characteristics of this age group show the need for the development of specific instruments to measure quality of life in older adults. The study aimed at describing the development and validation of the Portuguese version of the World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) module. METHODS The WHOQOL-OLD instrument was administered in a sample of 424 older adults in the city of Porto Alegre, Southern Brazil, in 2005. The questionnaire comprises 24 items divided into six facets: sensory abilities; autonomy; past, present and future activities; social participation; death and dying; and intimacy. Besides the WHOQOL-OLD module, the WHOQOL-BREF, BDI and BHS instruments were also applied. The instruments internal consistency was assessed using Cronbachs alpha coefficient. RESULTS The instrument showed adequate internal consistency (Cronbachs coefficients ranging from 0.71 to 0.88), discriminant validity (p<0.01), concurrent validity (correlation coefficients ranging from -0.61 to -0.50) and test-retest reliability (correlation coefficients ranging from 0.58 to 0.82). Findings concerning criterion validity need further studies. CONCLUSIONS The WHOQOL-OLD module is a useful alternative with good psychometric performance in the investigation of quality of life in older adults.

Assessment of the psychometric performance of the WHOQOL-BREF instrument in a sample of Brazilian older adults.

BACKGROUND There has been increasing interest in the measurement of quality of life in cross-sectional investigations and in the assessment of intervention outcomes in elderly adults. Several instruments used in this measurement have not yet been adequately tested. OBJECTIVE To describe the psychometric properties of the World Health Organizations Quality of Life Instrument-Short Version (WHOQOL-BREF) in a sample of Brazilian elderly. METHOD A total of 424 elderly adults selected through convenience sampling completed the instruments WHOQOL-BREF, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS) and a sociodemographic data form. Discriminant validity, concurrent validity, criterion validity and internal consistency were analyzed. RESULTS The sample comprised predominantly women (64.2%), community-dwelling subjects (84.4%) and subjects who consider themselves healthy (67.5%). All domains in the instrument showed the ability to discriminate levels of depressive symptoms and hopelessness, as well as different perceptions of health status. The correlation coefficients among the domains and the BDI and BHS scores were statistically significant. The reliability coefficients present scores ranging from 0.614 to 0.925. CONCLUSION The WHOQOL-BREF instrument shows suitable psychometric performance in a sample of Brazilian older adults, becoming a useful alternative in the measurement of quality of life in this population.

Bereavement-related cognitive impairment in an oldest-old community-dwelling Brazilian sample.

As it is already known that depression can cause a demonstrable impact on cognition in elderly subjects, the objective of this study was to determine whether also the mourning process is associated with any cognitive impairment in this age range. A random and representative sample (a sample with 77 subjects/total county population of oldest-old with 219 subjects = 35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, the cognitive function of subjects without grief and of subjects with the presence of grief were compared. Five neuropsychological tests (the Buschke–Fuld Selective Reminding Test, the word-list from the CERAD battery, the Verbal Fluency Test, and two subtests of the Wechsler memory scale), the Mini-Mental State Examination (MMSE) and two self-perceived memory impairment questionnaires were used. Presence of depressive symptomatology was identified by the Yesavage Geriatric Depression Scale (GDS). The prevalence rates of some psychiatric diagnoses (syndromic general anxiety disorder, major and minor depression) were compared between the bereaved group and the control group. There was not a statistically significant difference between the scores of controls and subjects with grief in the GDS. The frequency of affective disorders in both groups did not differ. However, the recently bereaved elderly subjects presented a mild cognitive impairment when evaluated with the MMSE, with the digit span test and with Word-list neuropsychological memory test. Likewise these bereaved octogenarian subjects presented more frequently a diagnosis of ‘aging-associated cognitive decline’ when compared with non-bereaved oldest-old. These results suggest that the normal sadness and/or the chronic stress of the grieving process, even without the presence of an identifiable syndromal-level depression, are associated with memory and cognitive differences among the bereaved oldest-old. Cause–effect relationships, however, cannot be established from this cross-sectional correlational study: Grief may influence cognitive functioning in the elderly, but mildly cognitively compromised elderly persons may be more likely to experience strong grief reactions after loss.

The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI)

BACKGROUND The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> or = 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.

Development and validation of the Brazilian version of the Attitudes to Aging Questionnaire (AAQ): An example of merging classical psychometric theory and the Rasch measurement model

BackgroundAging has determined a demographic shift in the world, which is considered a major societal achievement, and a challenge. Aging is primarily a subjective experience, shaped by factors such as gender and culture. There is a lack of instruments to assess attitudes to aging adequately. In addition, there is no instrument developed or validated in developing region contexts, so that the particularities of ageing in these areas are not included in the measures available. This paper aims to develop and validate a reliable attitude to aging instrument by combining classical psychometric approach and Rasch analysis.MethodsPilot study and field trial are described in details. Statistical analysis included classic psychometric theory (EFA and CFA) and Rasch measurement model. The latter was applied to examine unidimensionality, response scale and item fit.ResultsSample was composed of 424 Brazilian old adults, which was compared to an international sample (n = 5238). The final instrument shows excellent psychometric performance (discriminant validity, confirmatory factor analysis and Rasch fit statistics). Rasch analysis indicated that modifications in the response scale and item deletions improved the initial solution derived from the classic approach.ConclusionThe combination of classic and modern psychometric theories in a complementary way is fruitful for development and validation of instruments. The construction of a reliable Brazilian Attitudes to Aging Questionnaire is important for assessing cultural specificities of aging in a transcultural perspective and can be applied in international cross-cultural investigations running less risk of cultural bias.

Teoria da resposta ao item aplicada ao Inventário de Depressão Beck

The Beck Depression Inventory (BDI), a scale that measures the latent trait intensity of depression symptoms, can be assessed by the Item Response Theory (IRT). This study used the Graded-Response model (GRM) to assess the intensity of depressive symptoms in 4,025 individuals who responded to the BDI, in order to efficiently use the information available on different aspects enabled by the use of this methodology. The fit of this model was done in PARSCALE software. We identified 13 items of the BDI in which at least one response category was not more likely than others to be chosen, so that these items had to be categorized again. The items with greater power of discrimination were sadness, pessimism, feeling of failure, dissatisfaction, self-hatred, indecision, and difficulty of work. The most serious items were weight loss, suicidal ideas, and social withdrawal. The group of 202 individuals with the highest levels of depressive symptoms was comprised by 74% of women and almost 84% had a diagnosis of a psychiatric disorder. The results show gains resulting from use of IRT in the analysis of latent traits.

Neurocognitive changes in depressed patients in psychodynamic psychotherapy, therapy with fluoxetine and combination therapy

BACKGROUND Randomized controlled trials (RCTs) examining the efficacy of different forms of therapy for depression are relatively common. However, there are not many RCTs comparing neurocognitive effects of these treatments. Neurocognitive changes across three types of treatment for depression were compared. Long-term psychodynamic psychotherapy (LTPP) was compared with fluoxetine treatment, and their combination, in the treatment of moderate depression. METHODS A 272 adult patients with beck depression inventory (BDI) scores 20-35 were randomized to receive LTPP, fluoxetine monotherapy or their combination for a 24 months period. The Wechsler adult intelligence scale version III (WAIS-III) was the primary neuropsychological measure. RESULT Multilevel mixed model analyses indicated that there were neurocognitive changes within and between treatments, with statistically significant differences over time (p>.01). LTPP and combined treatment seemed to be more efficacious in modifying specific areas of cognition than fluoxetine alone. LIMITATIONS Sample very homogenous, threatening external validity. CONCLUSIONS LTPP and its combination with fluoxetine demonstrated to be effective for specific neurocognitive increasing in patients with moderate depression. This study suggests marked differences over time in the neurocognitive effects between the three treatment forms compared. Results found here may be of clinical relevance for building bridges between pharmacotherapy and psychodynamic psychotherapy.

A percepção de qualidade de vida do idoso avaliada por si próprio e pelo cuidador

The perception of older adults’ quality of life assessed by themselves and their caregiver. The objective of this study was to look into the relationship between the older adult’s quality of life (QoL) perception and the perception of the same QoL in the caregiver’s opinion. Therefore, 27 pairs of old adults-caregivers were assessed. Elders were asked to answer questions on socio-demographic conditions, QoL (WHOQOL-100), and depressive symptomatology (BDI). Caregivers were asked to answer the same items concerning themselves as well as the adapted WHOQOL-100. Data show a tendency for the caregiver to answer with worse elder’s QoL estimation as compared to the caree’s. Despite this, accordance between the results of QoL perceived by the elder and the caregiver’s opinion in the physical, level of independence, environment and spirituality/ religion domains were observed. The intensity of depression in the elder plays strong influence on their own quality of life perception as well as on the perception of the caregivers about the elders.

Relationship between Inflammation and Oxidative Stress and Cognitive Decline in the Institutionalized Elderly

Objective. Cognitive impairment reduces quality of life and is related to vascular and neurodegenerative disorders. However, there is also a close relationship between these diseases and oxidative stress. Thus, the purpose of this study was to assess whether inflammation and oxidative damage are associated with low cognitive performance in the elderly with different housing conditions. Methods. The study groups consisted of 32 institutionalized and 25 noninstitutionalized Brazilian elderly subjects. Oxidative damage, inflammation markers, and cognitive function were evaluated. Results. The results demonstrated pronounced oxidative stress in the institutionalized elderly group, which also had a lower antioxidant status compared to noninstitutionalized subjects. High levels of proinflammatory cytokines were also observed in the institutionalized elderly. Furthermore, the raised levels of inflammatory markers were correlated with increased oxidative stress, and both were associated with low cognitive performance. However, based on multiple linear regression analysis, oxidative stress appears to be the main factor responsible for the cognitive decline. Conclusions. The findings suggest that individuals with lower antioxidant status are more vulnerable to oxidative stress, which is associated with cognitive function, leading to reduced life quality and expectancy.