Gema Pérez-Rojo

Modification of dysfunctional thoughts about caregiving in dementia family caregivers: Description and outcomes of an intervention programme

Among the diverse group of interventions developed to help dementia family caregivers cognitive-behavioural approaches show especially promising results. Objectives: This study describes a cognitive-behavioural group intervention aimed principally at the modification of dysfunctional thoughts associated with caregiving (MDTC). The efficacy of the MDTC intervention in reducing caregivers’ depressive symptomatology, together with the frequency and appraisal of problem behaviours, is compared to that of a waiting-list control group (WL). Furthermore, the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers’ depressive symptomatology is analyzed. Of the 74 dementia caregivers who were randomized to one of two conditions (MDTC and WL), 39 completed the post-intervention assessment. Statistical analyses were performed on an intention-to-treat basis, using last observation carried forward. The results reveal that the MDTC intervention is successful in reducing caregivers’ level of depressive symptomatology and dysfunctional thoughts about caregiving, as well as in modifying their appraisal of their relatives problem behaviours. Furthermore, a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology. The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted.

Risk factors of elder abuse in a community dwelling Spanish sample

We analyzed the discriminative capacity of several risk factors for elder abuse and neglect, in order to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect. Forty-five caregivers of relatives with dementia participated. The combination of caregiving impact, frequency of aggressive behaviors by care-recipients, stress related to provocative and aggressive behaviors, the frequency of provocative behaviors, interpersonal burden, autoefficiency expectations, quantity of help received and depression classify correctly as risk factors in 90.9% of the cases. This study permits us to identify what characteristics distinguish between caregivers with a high or low risk of abuse and neglect and caregivers.

Optimising the diagnostic performance of the Geriatric Depression Scale

The aim of this work is to empirically generate a shortened version of the Geriatric Depression Scale (GDS), with the intention of maximising the diagnostic performance in the detection of depression compared with previously GDS validated versions, while optimizing the size of the instrument. A total of 233 individuals (128 from a Day Hospital, 105 randomly selected from the community) aged 60 or over completed the GDS and other measures. The 30 GDS items were entered in the Day Hospital sample as independent variables in a stepwise logistic regression analysis predicting diagnosis of Major Depression. A final solution of 10 items was retained, which correctly classified 97.4% of cases. The diagnostic performance of these 10 GDS items was analysed in the random sample with a receiver operating characteristic (ROC) curve. Sensitivity (100%), specificity (97.2%), positive (81.8%) and negative (100%) predictive power, and the area under the curve (0.994) were comparable with values for GDS-30 and higher compared with GDS-15, GDS-10 and GDS-5. In addition, the new scale proposed had excellent fit when testing its unidimensionality with CFA for categorical outcomes (e.g., CFI=0.99). The 10-item version of the GDS proposed here, the GDS-R, seems to retain the diagnostic performance for detecting depression in older adults of the GDS-30 items, while increasing the sensitivity and predictive values relative to other shortened versions.

Prevalencia de malos tratos hacia personas mayores que viven en la comunidad en España

BACKGROUND AND OBJECTIVE Although elder abuse is not a new phenomenon, it remains hidden. There have been carried out various preliminary studies about the prevalence of elder abuse in different countries. The aim of this study is to estimate the prevalence of suspicion of elder abuse in old persons without cognitive impairment, dwelling in community, who were attended in Primary Health Care or Social Services Centres. PATIENTS AND METHOD We carried out a transverse study in which 340 elders participated. RESULTS We found a 12.1% prevalence of suspicion of elder abuse. Psychological abuse suspicion was the most frequent type and it was very common the simultaneous presence of different types of abuse (psychological and physical and sexual). The suspicion of elder abuse was more frequent in women and spouses were responsible in a high great frequency. CONCLUSIONS The information obtained allows advancing in the knowledge of elder abuse in Spain, where the research about this issue is poor. However, the prevalence found neither has to be considered as a social alarm nor as a social slackness.

OriginalPrevalencia de malos tratos hacia personas mayores que viven en la comunidad en EspañaPrevalence of elder abuse in Spanish dwelling in community

BACKGROUND AND OBJECTIVE Although elder abuse is not a new phenomenon, it remains hidden. There have been carried out various preliminary studies about the prevalence of elder abuse in different countries. The aim of this study is to estimate the prevalence of suspicion of elder abuse in old persons without cognitive impairment, dwelling in community, who were attended in Primary Health Care or Social Services Centres. PATIENTS AND METHOD We carried out a transverse study in which 340 elders participated. RESULTS We found a 12.1% prevalence of suspicion of elder abuse. Psychological abuse suspicion was the most frequent type and it was very common the simultaneous presence of different types of abuse (psychological and physical and sexual). The suspicion of elder abuse was more frequent in women and spouses were responsible in a high great frequency. CONCLUSIONS The information obtained allows advancing in the knowledge of elder abuse in Spain, where the research about this issue is poor. However, the prevalence found neither has to be considered as a social alarm nor as a social slackness.

Tratamiento psicológico del miedo a las caídas: un estudio de caso

Resumen Objetivo el miedo a las caidas es la complicacion mas comun entre las personas mayores que han presentado una caida de la que no se ha derivado lesion fisica importante. Material y metodo se presentan los resultados de una intervencion conductual llevada a cabo con una mujer de 69 anos que, durante un periodo de 1 ano, habia presentado diversas caidas sin causa fisica que, segun informe medico, las justificara. Esta persona habia reducido drasticamente su actividad, y se desplazaba tan solo apoyada en muebles o en otra persona. La intervencion consistio en una fase educativa acerca del problema y la explicacion de este en terminos conductuales; el aprendizaje de estrategias para minimizar la ansiedad ante la realizacion de actividades y reanudar de forma gradual las actividades temidas (exposicion en vivo, respiracion profunda, autoinstrucciones, parada de pensamiento y asercion encubierta), asi como correciones ambientales y eliminacion de factores de riesgo. Resultados y discusion los resultados del programa, tras 8 sesiones de intervencion, evaluados con distintas tecnicas de autoinforme y tests situacionales, indican que se ha reducido de una forma notable la ansiedad global para andar y mantenerse de pie, asi como que ha aumentado significativamente el numero de conductas de movilidad en solitario —especialmente, en el ambito del hogar— y de actividades de la vida diaria realizadas de forma independiente, cuya realizacion se habia suprimido desde la primera caida.

Factores de riesgo de maltrato y/o negligencia hacia las personas mayores dependientes en el ámbito familiar. Estudio exploratorio

Resumen Introduccion el objetivo de este estudio es analizar el fenomeno del maltrato y el descuido de las personas mayores con demencia por parte de cuidadores informales en relacion con las caracteristicas del cuidador (p. ej., ira u hostilidad), de la persona cuidada (p. ej., presencia de comportamientos problematicos) o de la situacion propia de cuidado (p. ej., ayuda recibida). Material y metodo 45 cuidadores de familiares con demencia (34 mujeres y 11 varones) reclutados desde diferentes centros de servicios sociales. Se evaluo el riesgo de maltrato (CASE), la depresion (CES-D), la frecuencia de conductas agresivas y provocadoras y el estres asociado a dichas conductas y por la dependencia de la persona mayor, la carga de cuidado (ZBI), la ira y la hostilidad (STAXI-2), el estado funcional, la cantidad de ayuda recibida y la calidad de la relacion. Resultados un 60% de la muestra presenta elevado riesgo de maltrato. Estos cuidadores presentan mas sintomas de depresion, mas estres asociado a las conductas agresivas y provocadoras y por la dependencia de la persona cuidada, mas frecuencia de conductas agresivas y provocadoras, mas carga percibida y mas expresion interna de la ira y reciben menos ayuda formal e informal que los cuidadores con bajo riesgo de maltrato. Conclusion en resumen, existe un perfil diferenciado entre situaciones de bajo y alto riesgo de maltrato en funcion de las caracteristicas del cuidador, de la persona cuidada y del contexto de la situacion.

Maltrato de las personas mayores: situación actual en el Reino Unido

Resumen A pesar de que el maltrato y la negligencia hacia las personas mayors no es un fenomeno nuevo, en la actualidad continua siendo poco reconocido o informado a pesar de las graves consecuencias a las que conduce. Por tanto, el objetivo de este trabajo es conocer la situacion actual del maltrato de las personas mayores en el Reino Unido. Con este fin, la contribucion de este trabajo es doble. En primer lugar, se escriben aspectos generales sobre el maltrato hacia las personas mayores en el Reino Unido, como aspectos relacionados con la definicion del termino, la tasa de prevalencia, los diferentes tipos de maltrato existentes, los factores de riesgo que pueden estar presentes. En segundo lugar, tambien se incluye informacion sobre aspectos mas concretos relacionados con estrategias de prevencion e intervencion en el maltrato de personas mayors que se estan llevando a cabo en el Reino Unido.

Aportación española a los avances internacionales en la adaptación lingüística y cultural de un instrumento de detección de sospecha de maltrato hacia personas mayores

En este trabajo se describen los resultados de la aplicacion en Espana del proyecto «Respuesta global al maltrato hacia las personas mayores, incluyendo la negligencia: capacitacion de los servicios de atencion primaria para el abordaje de un problema mundial», proyecto en el que la Sociedad Espanola de Geriatria y Gerontologia (SEGG) y el Instituto de Mayores y Servicios Sociales (IMSERSO) han colaborado con la Organizacion Mundial de la Salud (OMS) y la Universidad de Ginebra.