Elderly caregivers of the elderly: frailty, loneliness and depressive symptoms

a cross - sectional study carried out with 341 elderly caregivers enrolled in Family Health Units of a city in the countryside of São Paulo State. The interviews were domiciliary and included questionnaire for characterization of the caregiver, Fried’s frailty phenotype, family APGAR (family functionality), Geriatric Depression Scale (depressive symptoms) and item 3 of the Herth Hope Scale (loneliness). Logistic regression was used to analyze the association between depressive symptoms and solitude (independent variables), and frailty and pre-frailty (dependent variables).

Results:

there was an association between frailty, loneliness and depressive symptoms. Elderly caregivers had increased odds of 158% presenting pre-frailty, and 360% of frailty. Elderly caregivers with depressive symptoms had an increased chance of 242% of presenting fragility.

Conclusion:

elderly and lonely caregivers with depressive symptoms are more likely to be frail and pre-frail.

Descriptors:
Caregivers; Depression; Frail Elderly; Loneliness; Geriatric Nursing

Variables	Categories	%	Mean	(95% CI)
Gender	Female	76.8
	Male	23.2
Age (years)			69.61	(68.8-70.3)
	60-69 years	57.8
	70-79 years	30.8
	80 years or more	11.4
Schooling (years)			3.81	(3.4-4.1)
	9 years or more	9.7
	5-8 years	9.7
	1-4 years	62.8
	No schooling	17.8
Marital status	Married	90.3
	Not married	4.1
	Divorced	1.8
	Widowed	3.8
Family Income (reais)			2303.21	(2128.69-2477.73)
Morbidity			5.44	(5.1-5.7)
	Multimorbidity	90.3
Medications in use			3.13	(2.8-3.3)
	Polipharmacy	24.9

Variables	Categories	%	Mean	(95% CI)
APGAR family result			17.06	(16.57-17.56)
Family Functionality	Good family function	85.0
	Moderate family dysfunction	7.6
	High family dysfunction	7.4
Relationship of the elderly	Spouse	85.0
	Father/mother	7.3
	Father-in-law/mother-in-law	7.3
	Brother/sister	3.8
	Others	1.8
People in the house	Good family function		3.02	(2.88-3.16)
Number of children			4.05	(3.75-4.35)
Time of care (years)			9.96	(8.55-11.36)
	≤ 10 years	46.3
	> 10 years	50.7
	Missing	2.9
Hours of care per day			6.13	(5.61-6.65)
APGAR family result	Up to 8	74.5
	More than 8	22.9
	Missing	2.6

Variables	Categories	%
Frailty	Non-rail	22.9
	Pre-frail	56.3
	Frail	20.8
Frailty criteria	Weight loss	21.7
	Fatigue	24.3
	Weakness	34.6
	Slowness	15.2
	Physical inactivity	54.3
Loneliness feeling	Yes	23.8
	No	76.2
GDS results	No depressive symptoms	70.4
	Depressive symptoms	29.6

Variables	Pre-frailty		p value	Frailty		p value
Variables	OR	95% CI	p value	OR	95% CI	p value
Without loneliness feeling (ref)	1.0	-	-	1.0	-	-
With loneliness feeling	3.33	1.54-7.40	.003^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135).	3.43	1.40-8.40	.007^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135).
No depressive symptoms (ref)	1.0	-	-	1.0	-	-
Depressive symptoms	3.40	1.59-7.26	.002^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135).	6.65	2.88-15.37	<.001*

Variables	Pre-frailty		p value	Frailty		p value
Variables	OR	95% CI	p value	OR	95% CI	p value
Without feeling of loneliness (ref)	1.0	-	-	1.0	-	-
With feeling of loneliness	2.58	1.04-6.37	.040^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.	4.60	1.40-14.0	.012^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.
No depressive symptoms (ref)	1.0	-	-	1.0	-	-
With depressive symptoms	2.31	0.96-5.57	.061	3.42	1.19-9.79	.022^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.
Female (ref)	1.0	-	-	1.0	-	-
Male	0.73	0.36-1.48	.397	0.89	0.32-2.47	.826
Age 60-69 years (ref)	1.0	-	-	1.0	-	-
Age ≥ 70 years	2.62	1.33-5.17	.005^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.	3.89	1.50-10.13	.005^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.
Schooling > 4 years (ref)	1.0	-	-	1.0	-	-
Schooling (≤ 4 years)	0.48	0.21-1.09	.081	1.05	0.24-4.57	.938
Income (continuous)	1.00	0.98-1.0	.028^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.	1.00	0.99-1.00	1.0
Number of children (continuous)	1.02	0.90-1.17	.679	1.15	0.99-1.33	.061
APGAR without dysfunction (ref)	1.0	-	-	1.0	-	-
APGAR with family dysfunction	1.18	0.42-3.28	.741	1.78	0.47-6.70	.388
Absence of multimorbity (ref)	1.0	-	-	1.0	-	-
With multimorbity	0.89	0.34-2.34	.828	0.54	0.11-3.75	.630
Absence of polypharmacy (ref)	1.0	-	-	1.0	-	-
Polypharmacy	1.99	0.86-4.61	.106	4.69	1.67-12.95	.003^* * p≤0.05. Ref: reference variable; pre-frailty (n = 192/251); frailty (n = 71/135). "Non-frail" was the reference category.

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[1] Corresponding Author: Ariene Angelini dos Santos-Orlandi. E-mail: arieneangelini@yahoo.com.br