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COGNITION AND MOOD/BEHAVIOR IN HOME CARE ELDERLY

ABSTRACT

Objectives:

to identify the sociodemographic characteristics; and to analyze the association of sociodemographic variables with functional systems related to cognition and mood/behavior of elderly people linked to Home Care.

Method:

cross-sectional, descriptive research, carried out with the participation of 108 elderly people linked to Home Care in the city of Santa Maria - RS - Brazil. We used a questionnaire of sociodemographic data and the Clinical and Functional Vulnerability Index IVCF-20. The association of the variables was analyzed using the chi-square test and independent samples test.

Results:

predominance of elderly females; mean age 78.7 ± 9.3 years; and low education and family income between 1 and 2 minimum wages. The most frequent morbidity was systemic arterial hypertension. No associations were found between the sociodemographic variables and the functional systems regarding cognition and mood/behavior.

Conclusion:

the importance of planning and interventions in the home environment is highlighted.

DESCRIPTORS:
Geriatric Nursing; Aged/Elderly; Cognition; Behavior; Home Care Services

RESUMO

Objetivos:

identificar as características sociodemográficas; e analisar a associação das variáveis sociodemográficas aos sistemas funcionais referentes à cognição e humor/comportamento de idosos vinculados à Atenção Domiciliar.

Método:

pesquisa transversal, descritiva, realizada com a participação de 108 idosos vinculados à Atenção Domiciliar do município de Santa Maria- RS - Brasil. Utilizaram-se o questionário de dados sociodemográficos e o Índice de Vulnerabilidade Clínico Funcional IVCF-20. Analisou-se a associação das variáveis por meio do teste do qui-quadrado e teste de amostras independentes.

Resultados:

predomínio de idosos do sexo feminino; idade média de 78,7 ± 9,3 anos; e escolaridade baixa e renda familiar entre 1 e 2 salários-mínimos. A morbidade mais frequente foi a hipertensão arterial sistêmica. Não foram encontradas associações entre as variáveis sociodemográficas e os sistemas funcionais referentes à cognição e humor/comportamento.

Conclusão:

salienta-se a importância do planejamento e de intervenções no ambiente domiciliar.

DESCRITORES:
Enfermagem geriátrica; Idoso; Cognição; Comportamento; Serviço de Assistência Domiciliar

RESUMEN

Objetivos:

identificar las características sociodemográficas; y analizar la asociación de las variables sociodemográficas a los sistemas funcionales relacionados con la cognición y el estado de ánimo/comportamiento de las personas mayores vinculadas a la Atención Domiciliaria.

Método:

investigación transversal, descriptiva, realizada con la participación de 108 ancianos vinculados a la Asistencia Domiciliaria en el municipio de Santa Maria- RS - Brasil. Se utilizó el cuestionario de datos sociodemográficos y el Índice de Vulnerabilidad Clínico Funcional IVCF-20. La asociación de variables se analizó mediante la prueba chicuadrado y la prueba de muestras independientes.

Resultados:

predominio de mujeres de edad avanzada; edad media 78,7 ± 9,3 años; y bajo nivel educativo e ingresos familiares entre 1 y 2 salarios mínimos. La morbilidad más frecuente fue la hipertensión arterial sistémica. No se encontraron asociaciones entre las variables sociodemográficas y los sistemas funcionales relacionados con la cognición y el estado de ánimo/comportamiento.

Conclusión:

se destaca la importancia de la planificación y las intervenciones en el entorno domiciliario.

DESCRIPTORES:
Enfermería geriátrica; Anciano; Cognición; Conducta; Servicios de Atención de Salud a Domicilio

HIGHLIGHTS

  1. Sociodemographic characterization of the elderly in Home Care.

  2. Most frequent comorbidities in the elderly in Home Care.

  3. Clinical-functional indicators related to cognition and mood/behavior.

HIGHLIGHTS

  1. Sociodemographic characterization of the elderly in Home Care.

  2. Most frequent comorbidities in the elderly in Home Care.

  3. Clinical-functional indicators related to cognition and mood/behavior.

INTRODUCTION

Population aging is occurring worldwide in a significant and accelerated way. It is estimated that in the year 2050, the world population over 60 years old will reach the mark of 2 billion people1. In Brazil, it is expected that in that year the elderly aged 65 years or older will represent 21.87% of the population22. Instituto Brasileiro de Geografia e Estatística. (IBGE). Projeções e estimativas da população do Brasil e das Unidades da Federação [Internet]. 2021 [cited 2021 Mar. 21]. Available from: https://www.ibge.gov.br/apps/populacao/projecao/index.html.
https://www.ibge.gov.br/apps/populacao/p...
.

This demographic transition of the population, characterized by aging and explained by the drop in birth rates and mortality, is accompanied by the epidemiological transition33. Oliveira, AS. Transição demográfica, transição epidemiológica e envelhecimento populacional no Brasil. Revista Brasileira de Geografia Médica e da Saúde. Hygeia [Internet]. 2019 [cited 2021 Mar. 21];15(31): 69-79. Available from: http://www.seer.ufu.br/index.php/hygeia/article/view/48614/27320.
http://www.seer.ufu.br/index.php/hygeia/...
. The aging process results in changes in the characteristics of the population getting sick, showing the predominance of non-transmissible chronic diseases44. Silveira, EA; Vieira, LL; Souza, JD. Elevada prevalência de obesidade abdominal em idosos e associação com diabetes, hipertensão e doenças respiratórias. Ciênc. saúde coletiva [Internet]. 2018 [cited 2021 Mar. 23]; 23(3): 903-912. Available from: https://doi.org/10.1590/1413-81232018233.01612016.
https://doi.org/10.1590/1413-81232018233...
. With the increase in chronic diseases, functional disabilities are added to the elderly individuals55. Moraes, EN; Azevedo, RS; Moraes, FL; Pereira, AMVB. Secretaria de Estado da Saúde do Paraná. Superintendência de Atenção à Saúde. Avaliação multidimensional do idoso. SAS [Internet]. 2018 [cited 2021 Mar. 21]:0-113. Available from: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/avaliacaomultiddoidoso_2018_atualiz.pdf.
https://www.saude.pr.gov.br/sites/defaul...
.

However, in the health care process for the elderly, aging should not be seen as a certainty of disability and dependence, but as a greater risk for vulnerability. Even with some health problems, the elderly are often able to play their role in society. However, this finding does not make it possible to think of strategies to transform care models, and it is significant to use functional capacity as a health indicator55. Moraes, EN; Azevedo, RS; Moraes, FL; Pereira, AMVB. Secretaria de Estado da Saúde do Paraná. Superintendência de Atenção à Saúde. Avaliação multidimensional do idoso. SAS [Internet]. 2018 [cited 2021 Mar. 21]:0-113. Available from: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/avaliacaomultiddoidoso_2018_atualiz.pdf.
https://www.saude.pr.gov.br/sites/defaul...
. Global functionality can be understood as the individual’s ability to adapt to the difficulties encountered in their daily lives, realizing their insertion in society, even in the face of social, physical and mental limitations66. Ballesteros, SM, Montoya, MJ. Individual- and state-level factors associated with functional limitation prevalence among Colombian elderly: a multilevel analysis. Cad Saúde Pública [Internet]. 2018 [cited 2021 Apr. 22]; 34(8). Available from: https://doi.org/10.1590/0102-311X00163717.
https://doi.org/10.1590/0102-311X0016371...
.

Well-being is related to functionality and is reflected in autonomy (capacity of decision) and independence (capacity of execution), enabling the individual to take care of his/her life, and both capacities are strictly intrinsic to the integrated functioning of the functional domains: cognition; mood/behavior; mobility; and communication. The basis for the functionality assessment will be based on these domains and evaluated based on the basic daily life activities, related to self-care, such as the ability of the elderly to take a bath, and instrumental, in other words, activities with greater complexity, associated with the ability to perform daily life tasks such as the ability to clean the house55. Moraes, EN; Azevedo, RS; Moraes, FL; Pereira, AMVB. Secretaria de Estado da Saúde do Paraná. Superintendência de Atenção à Saúde. Avaliação multidimensional do idoso. SAS [Internet]. 2018 [cited 2021 Mar. 21]:0-113. Available from: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/avaliacaomultiddoidoso_2018_atualiz.pdf.
https://www.saude.pr.gov.br/sites/defaul...
.

In this context, one notices the importance of tracking and identifying characteristics that identify frailty as to functionality in the elderly, since many health professionals in the country tend to consider the elderly fragile, based on their general appearance, diseases and comorbidities77. Moraes EM, Carmo JÁ, Moraes FL, Azevedo RS, Machado CJ, Montilla DER. Índice de Vulnerabilidade Clínico Funcional-20 (IVCF-20): reconhecimento rápido do idoso frágil. Rev. Saúde Pública [Internet] 2016 [cited 2021 Apr. 22]; 50. Available from: https://doi.org/10.1590/s1518-8787.2016050006963.
https://doi.org/10.1590/s1518-8787.20160...
. Therefore, the assessment of global functionality and the main functional systems, especially cognition and mood/behavior are essential to preserve and stimulate the autonomy of the elderly.

Thus, it is essential to use rapid screening instruments that can be performed by any healthcare professional and that are able to identify the elderly at risk of functional frailty, such as the Clinical and Functional Vulnerability Index-20 (IVCF-20)88. Moraes EN, Carmo JA, Machado CJ, Moraes FL. Índice de Vulnerabilidade Clínico-Funcional-20: proposta de classificação e hierarquização entre os idosos identificados como frágeis. Rev. Fac. Ciênc. Méd. Sorocaba [Internet]. 2021 [cited 2021 Apr. 21]; 22(1):31-5. Available from: https://revistas.pucsp.br/index.php/RFCMS/article/view/43424.
https://revistas.pucsp.br/index.php/RFCM...
. The IVCF-20 is an important tool to quickly and simply recognize the frail elderly in Home Care (HC).

The HC stands out as a strategy to provide a singular and comprehensive health care, performed at the user’s home, promoting the individual’s autonomy, family participation and the expanded view of the health team in the care process99. Ministério da Saúde (BR). Caderno de Atenção Domiciliar Melhor em Casa [Internet]. Brasília (DF): Ministério da Saúde; 2013 [cited 2021 Mar. 20]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/caderno_atencao_domiciliar_melhor_casa.pd.
http://bvsms.saude.gov.br/bvs/publicacoe...
. Therefore, to evaluate the global functionality of elderly people in AD by means of the IVCF-20, with emphasis on cognition and mood/behavior, is fundamental to recognize the health needs of this population in relation to autonomy, supporting the planning of health actions. It is also important that nurses are familiar with global functionality assessment tools, knowing how to apply them, facilitating the screening of frail elderly and allowing advances in the health of the elderly.

In view of the above, the present study had as a research question: How are the functional systems related to cognition and mood/behavior of older adults followed by the HC of Primary Health Care (PHC)? The objective was to identify the sociodemographic characteristics and analyze the association of sociodemographic variables with the functional systems related to cognition and mood/behavior of the elderly linked to the HC.

METHOD

Cross-sectional, descriptive research, of quantitative approach and carried out via telephone contact. The research participants were 108 elderly people aged 60 years or older linked to HC1 of the PHC in the city of Santa Maria, region located in the state of Rio Grande do Sul - Brazil.

The study field was composed of four Family Health Strategies (FHS). The selection of the four FHSs was due to the fact that they represent 28.5% of the units with the highest number of elderly individuals registered in the HC. The choice of the FHSs was made through a survey with the person responsible for the Health Policy for the Elderly of the Municipal Health Secretariat, totaling 247 elderly people enrolled in the HC in these four FHSs of the city. Data collection occurred from July to August 2021.

To identify the sample size calculation, we obtained a population of 247 elderly individuals linked to the four FHS participating in the study. A reliability level of 95%, a margin of error of 5%, and an expected proportion of 10%10 were considered, resulting in the need for a sample of 108 elderly people.

The inclusion criteria for the study participants were: elderly aged 60 years or older, of both genders, and the elderly registered in the HC1 of the aforementioned family health strategies. Among the exclusion criteria were: elderly people with whom it was not possible to make telephone contact after three attempts in different periods and times; institutionalized or hospitalized elderly people at the time of data collection; and elderly people with cognitive impairment or disability and diagnosed with advanced dementia.

After previous training on the phone call, application of the questionnaire, instrument, and ethical aspects in order to avoid biases in the application of the instruments, the researchers, nursing students, started data collection by phone from July to August 2021. The sociodemographic data questionnaire and the clinical-functional vulnerability index (IVCF-20)88. Moraes EN, Carmo JA, Machado CJ, Moraes FL. Índice de Vulnerabilidade Clínico-Funcional-20: proposta de classificação e hierarquização entre os idosos identificados como frágeis. Rev. Fac. Ciênc. Méd. Sorocaba [Internet]. 2021 [cited 2021 Apr. 21]; 22(1):31-5. Available from: https://revistas.pucsp.br/index.php/RFCMS/article/view/43424.
https://revistas.pucsp.br/index.php/RFCM...
were used. In the interviews, the researcher was present, who made the telephone contact, and the elderly with their caregiver or family member who helped with the answers to the questionnaire and the instrument to be applied.

First, the elderly linked to the HC1 of the FHSs were identified through lists provided by the health teams participating in the study. With the users who met the inclusion criteria, a telephone contact was made, scheduling an available time for the dialogue with the elderly according to their preference and by video calls or only voice calls.

Three attempts at telephone contact were made both for the initial scheduling call and for the interview, on different days and shifts, excluding from the 247 users in HC1: 67 users because contact was not obtained; two users who were institutionalized or hospitalized at the time of data collection; 22 elderly who had a disability or cognitive impairment and with a diagnosis of advanced dementia identified in the users’ medical records; 10 elderly who died; five elderly who did not agree to participate in the research and 33 users whose telephone contact was listed as non-existent or outdated, totaling for the final sample 108 elderly.

The calls were recorded using an online messaging service that can be used by different devices at the same time. With the application it was possible to organize groups where members could share files simultaneously, save and consult them in a safe way.

In the interview stage, the Informed Consent Form was explained and, after consent, the following instruments were applied: the questionnaire of sociodemographic data and the CFVI-20. The interviews lasted an average of 30 minutes. During data collection, the caregivers helped the researchers in the questioning directed to the elderly.

The sociodemographic data questionnaire was developed by the researchers of this study, containing the following questions: date of birth, age, gender, marital status, level of education, religion, family income, number of individuals living in the same household, type of caregiver the user has, and health problems (comorbidities).

The IVCF-20 is a multidimensional and interdisciplinary instrument, which was developed by a group of researchers in Brazil, with the aim of being a screening methodology of easy application in PHC and assesses the main determinants of health in the elderly.55. Moraes, EN; Azevedo, RS; Moraes, FL; Pereira, AMVB. Secretaria de Estado da Saúde do Paraná. Superintendência de Atenção à Saúde. Avaliação multidimensional do idoso. SAS [Internet]. 2018 [cited 2021 Mar. 21]:0-113. Available from: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/avaliacaomultiddoidoso_2018_atualiz.pdf.
https://www.saude.pr.gov.br/sites/defaul...
It is a simple instrument, with an average application time of five to 10 minutes and consists of 20 questions that assess eight dimensions that predict functional decline in the elderly: age; self-perception of health; activities of daily living; cognition; mood; mobility; communication; and the presence of multiple comorbidities. In the present study, the dimensions related to cognition (three questions) and to mood/behavior (two questions)55. Moraes, EN; Azevedo, RS; Moraes, FL; Pereira, AMVB. Secretaria de Estado da Saúde do Paraná. Superintendência de Atenção à Saúde. Avaliação multidimensional do idoso. SAS [Internet]. 2018 [cited 2021 Mar. 21]:0-113. Available from: https://www.saude.pr.gov.br/sites/default/arquivos_restritos/files/documento/2020-04/avaliacaomultiddoidoso_2018_atualiz.pdf.
https://www.saude.pr.gov.br/sites/defaul...
were used.

Due to the context of the pandemic by COVID-19, during the period of data collection, the author of the IVCF-20 instrument was asked about the possibility of applying it by telephone contact. The author stated that the collection could be conducted in this way.

Data were entered into an Excel® spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 25. A descriptive analysis was made of the sociodemographic and health variables of the elderly, and of the clinical and functional vulnerability indicators of the functional systems cognition and mood/behavior, with the quantitative variables represented as mean and standard deviation and the qualitative variables as absolute and relative frequency. For the association of socio-demographic variables with the functional systems referring to cognition and mood/behavior, the chi-square test and Student’s T test for independent samples were used for the mood/behavior functional system. The associations were considered significant when the results presented a p-value < 0.05.

The ethical aspects were met in accordance with the opinion of the Research Ethics Committee, under number 4,733,308.

RESULTS

The research users were mostly women, 77 (71.3%), with a mean age of 78.7 ± 9.3 years, 48 (44.4%) were married/stable union and 47 (43.5%) were widows, and 71 (65.7%) had only incomplete elementary school education. As for the total household income, 56 (54.3%) earned between 1 and 2 minimum wages. In relation to comorbidity, the most frequent one was systemic arterial hypertension (SAH) 69 (63.9%), followed by diabetes mellitus (DM) 41(38%) and arthritis/arthritis 35(32.4%). Table 1 presents the sociodemographic characteristics and the most frequent comorbidities in the elderly participants of the research.

Table 1
Characterization regarding sociodemographic data and comorbidities of the elderly in HC. Santa Maria, RS, Brazil, 2021

The data of the functional systems related to the indicators of clinical and functional vulnerability related to cognition showed that 67 (62%) of the elderly reported that some family member or friend said that the elderly person was getting forgetful. On the other hand, 34 (31.5%) of the users perceived that forgetfulness was worsening in recent months, and only 16 (14.8%) reported that forgetfulness was preventing them from performing some activity of daily living.

In the questions related to mood/behavior, it was evidenced that 63 (58.3%) of the elderly felt discouraged, sad or hopeless in the last month and 39 (36.1%) lost interest or pleasure in performing activities previously considered pleasurable in the same period. Table 2 presents the functional systems cognition and mood/behavior and the questions related to the indicators of clinical and functional vulnerability of these systems.

Table 2
Functional systems - cognition and mood/behavior and indicators of clinical-functional vulnerability. Santa Maria, RS, Brazil, 2021

Table 3 exposes that no indicator of clinical and functional vulnerability concerning the cognition functional system had a significant association when associated with gender, age, education, and data on the regular use of one or more medications every day, collected by the IVCF-20 instrument.

Table 3
Associations of sociodemographic variables and clinical-functional-cognition vulnerability indicators. Santa Maria, RS, Brazil, 2021

Table 4 demonstrates the associations made with the variables presented and the indicators of clinical and functional vulnerability and mood/behavior. It can be observed that the variable “number of comorbidities in total” had no relation with the indicators of clinical and functional vulnerability.

Table 4
Associations of sociodemographic variables and indicators of clinical and functional vulnerability - Mood/behavior. Santa Maria, RS, Brazil, 2021

DISCUSSION

Most of the research participants were women with a mean age of 78 years, corroborating studies carried out with elderly in HC in Rio de Janeiro and São Paulo 11, 12. The feminization of aging can be explained by the fact that women have a longer life expectancy, are less exposed to work risks, use less tobacco and alcohol, and have a different attitude towards diseases and disabilities when compared to men1313. Jesus ITM, Orlandi AAS, Grazziano ES, Zazzetta MS. Fragilidade de idosos em vulnerabilidade social. Acta Paul Enferm [Internet] 2017 [cited 2021 May 03]; 30(6):614-620. Available from: https://doi.org/10.1590/1982-0194201700088.
https://doi.org/10.1590/1982-01942017000...
.

The low education level of the users with incomplete elementary school education corroborates a study carried out in the city of Campinas, São Paulo, with 986 elderly individuals, showing low education levels and pointing out that most of the elderly had only zero to four years of education2222. Arreguy-Sena C, Marangon A, Gomes AT, de Melo L, Martins R, Fontes F. Representações Sociais sobre Esquecimento e Depressão por Pessoas Idosas: Abordagem Processual. Enfermagem em Foco [Internet]. 2020 [cited 2021 Dec. 23]; 11(1). Available from: https://doi.org/10.21675/2357-707X.2020.v11.n1.2480.
https://doi.org/10.21675/2357-707X.2020....
. Other studies with similar themes ratify this data1515. Ceccon RF, Vieira LJES, Brasil CCP, Soares KG, Portes VM et al. Envelhecimento e dependência no Brasil: características sociodemográficas e assistenciais de idosos e cuidadores. Cienc. saude colet [Internet] 2021 [cited 2021 May 03]; 26 (01): 17-26. Available from: https://doi.org/10.1590/1413-81232020261.30352020.
https://doi.org/10.1590/1413-81232020261...
,1616. Júnior, FBA, Machado, ITJ, Santos-Orlandi, AA, Pergola-Marconato, AM, Pavarini, S.C.I., Zazzetta, MZ. Fragilidade, perfil e cognição de idosos residentes em área de alta vulnerabilidade social. Cien. Saúde Coletiva [Internet]. 2017 [cited 2021 Oct. 01]; 24(8): 3047-3056. Available from: http://www.cienciaesaudecoletiva.com.br/artigos/fragilidade-perfil-e-cognicao-de-idosos-residentes-em-area-de-alta-vulnerabilidade-social/16530?id=16530.
http://www.cienciaesaudecoletiva.com.br/...
. Therefore, in home care, the health professional must, through a comprehensive view and educational actions, guide the elderly so that they are informed about the care related to their health1717. Ramos G, Predebon ML, Dal Pizzol FLF, Soares JV, Paskulin LMG, Rosset I. Idosos vinculados à atenção domiciliar da atenção primária à saúde: caracterização, morbidades e acesso aos serviços. Cogitare enferm.[Internet]. 2021 [cited 2021 Oct. 01]; 26. Available from: https://doi.org/10.5380/ce.v26i0.73818.
https://doi.org/10.5380/ce.v26i0.73818...
.

Studies found in the Brazilian literature1111. Neves ANOJ, Seixas CT, Andrade AM, Castro EAB. Atenção domiciliar: perfil assistencial de serviço vinculado a um hospital de ensino. Physis: Revista de Saúde Coletiva [Internet]. 2019 [cited 2021 May 01]; 29 (02). Available from: https://doi.org/10.1590/S0103-73312019290214.
https://doi.org/10.1590/S0103-7331201929...
,1818. Maia LC, Colares TFB, Moraes EN, Costa SM, Caldeira AP. Impacto do apoio matricial a idosos na atenção primária: ensaio comunitário randomizado. Rev Saúde Pública [Internet]. 2021; [cited 2021 Oct. 03]; 55(10). Available from: https://doi.org/10.11606/s1518-8787.2021055002685.
https://doi.org/10.11606/s1518-8787.2021...
reiterate the finding of low family income observed in this research. Low education and reduced financial conditions expose the elderly to greater social vulnerability and negative consequences to their health, such as greater risk of frailty and cognitive deficit1616. Júnior, FBA, Machado, ITJ, Santos-Orlandi, AA, Pergola-Marconato, AM, Pavarini, S.C.I., Zazzetta, MZ. Fragilidade, perfil e cognição de idosos residentes em área de alta vulnerabilidade social. Cien. Saúde Coletiva [Internet]. 2017 [cited 2021 Oct. 01]; 24(8): 3047-3056. Available from: http://www.cienciaesaudecoletiva.com.br/artigos/fragilidade-perfil-e-cognicao-de-idosos-residentes-em-area-de-alta-vulnerabilidade-social/16530?id=16530.
http://www.cienciaesaudecoletiva.com.br/...
. Recognizing that the elderly represent one of the most vulnerable portions of the population, it is expected that PHC services can organize and provide health services for the elderly, taking into account the particularities of this population, in order to reduce health inequities1919. Schenker MC, Costa DH. Avanços e desafios da atenção à saúde da população idosa com doenças crônicas na Atenção Primária à Saúde. Ciência & Saúde Coletiva [Internet]. 2019 [cited 2021 Oct. 03]; 24(4): 1369-1380. Available from: https://doi.org/10.1590/1413-81232018244.01222019.
https://doi.org/10.1590/1413-81232018244...
.

Among the most frequent comorbidities presented by the research, SAH and DM stand out, followed by arthritis/arthritis. In a research1717. Ramos G, Predebon ML, Dal Pizzol FLF, Soares JV, Paskulin LMG, Rosset I. Idosos vinculados à atenção domiciliar da atenção primária à saúde: caracterização, morbidades e acesso aos serviços. Cogitare enferm.[Internet]. 2021 [cited 2021 Oct. 01]; 26. Available from: https://doi.org/10.5380/ce.v26i0.73818.
https://doi.org/10.5380/ce.v26i0.73818...
on the elderly linked to home care in primary health care, SAH showed the highest prevalence among comorbidities, followed by arthritis and depression. Demonstrating the importance of health promotion strategies, disease prevention and treatment in the PHC setting, aiming at the healthy aging of the assisted population2020. Kessler M., Thumé E, Duro SMS, Tomasi E, Siqueira FCV, Silveira DS et al. Ações educativas e de promoção da saúde em equipes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, Rio Grande do Sul, Brasil. Epidemiol. Serv. Saúde [Internet]. 2018 [cited 2020 Dec. 21]; 27(2): e2017389. Available from: http://dx.doi.org/10.5123/s1679-49742018000200019.
http://dx.doi.org/10.5123/s1679-49742018...
.

Regarding the questions related to the clinical-functional vulnerability indicators related to cognition, most of the elderly reported that some friend or relative said that the elderly were getting forgetful; in this aspect, a study about the predictor dimensions of clinical-functional conditions and cognition in the elderly brings divergent results, however important, when using the indicators related to cognition of the IVCF-20. On the contrary, only 40.3% of the elderly reported that some family member or friend told them that the elderly were getting forgetful; 18.4% of the elderly noticed that forgetfulness was worsening in the last months, and 5.9% reported that forgetfulness was preventing them from performing some activity of daily living2121. Silva JNMA, Leite MT, Gaviraghi LC, Kirsten VR, Kinalski SS,Hildebrandt LM, et al. Predicting dimensions of clinicalfunctionalconditions and cognition in the elderly.Rev Bras Enferm. [Internet].2020[cited 20221 Dec. 21];73(Suppl 3): e20190162. Available from: http://dx.doi.org/10.1590/0034-7167-2019-0162.
http://dx.doi.org/10.1590/0034-7167-2019...
.

Forgetfulness is sometimes associated with cognitive loss and is often perceived as something inherent to aging and associated with the presence of depression, as the elderly can become socially isolated due to the fact that the perception of memory loss is seen as something negative by society2222. Arreguy-Sena C, Marangon A, Gomes AT, de Melo L, Martins R, Fontes F. Representações Sociais sobre Esquecimento e Depressão por Pessoas Idosas: Abordagem Processual. Enfermagem em Foco [Internet]. 2020 [cited 2021 Dec. 23]; 11(1). Available from: https://doi.org/10.21675/2357-707X.2020.v11.n1.2480.
https://doi.org/10.21675/2357-707X.2020....
. Cognitive loss is considered a condition that exposes the elderly to vulnerability, requiring health professionals to develop strategies to preserve cognitive status, reduce depressive symptoms, and promote quality of life2323. Gil I, Costa P, Parola V, Cardoso D, Almeida M, Apóstolo J. Efficacy of reminiscence in cognition, depressive symptoms and quality of life in institutionalized elderly: a systematic review. Revista da Escola de Enfermagem da USP[Internet]. 2019 [cited 2021 Dec. 20]; v.53(e03458). Available from: https://doi.org/10.1590/S1980-220X2018007403458.
https://doi.org/10.1590/S1980-220X201800...
, such as encouraging the social interaction of the elderly through group activities in the FHSs.

Regarding mood/behavioral issues, they showed that more than half of the elderly users felt discouraged, sad, or hopeless in the last month. A randomized community trial developed in northern Minas Gerais, where the IVCF-20 was used for the stratification of clinical and functional vulnerability of the elderly followed by FHS teams found that at the end of the study there were higher percentages for “no manifestation of sadness, discouragement or hopelessness” from 62, 1% to 67%, and that “no loss of interest or pleasure” from 80.2% to 87.3% after matriciamento actions with educational activities for health teams1818. Maia LC, Colares TFB, Moraes EN, Costa SM, Caldeira AP. Impacto do apoio matricial a idosos na atenção primária: ensaio comunitário randomizado. Rev Saúde Pública [Internet]. 2021; [cited 2021 Oct. 03]; 55(10). Available from: https://doi.org/10.11606/s1518-8787.2021055002685.
https://doi.org/10.11606/s1518-8787.2021...
, demonstrating that the assistance to health professionals qualifies the care scenarios, reflecting in beneficial results to the health of the elderly.

Furthermore, health professionals should be aware of the need for psychosocial interventions for the elderly in HC. These interventions should be executed by planning a singularized care, feasible to be done in the home environment and seeking early observation of depressive symptoms and their consequences2424. Predebon MP, Ramos G, Dal Pizzol FLF, Soares JV, Paskulin LMG, Rosset I. Life satisfaction and health selfassessmentof older adults assisted through home care. Rev Bras Enferm. [Internet] 2021[cited 2021 Dec. 19];74(Suppl 2):e20200357. Available from: http://dx.doi.org/10.1590/0034-7167-2020-0357.
http://dx.doi.org/10.1590/0034-7167-2020...
.

Regarding the factors associated with sociodemographic variables and clinical-functional vulnerability indicators - cognition, these did not show a statistically significant association in the analysis. However, it is relevant to point out that increasing age, low education2121. Silva JNMA, Leite MT, Gaviraghi LC, Kirsten VR, Kinalski SS,Hildebrandt LM, et al. Predicting dimensions of clinicalfunctionalconditions and cognition in the elderly.Rev Bras Enferm. [Internet].2020[cited 20221 Dec. 21];73(Suppl 3): e20190162. Available from: http://dx.doi.org/10.1590/0034-7167-2019-0162.
http://dx.doi.org/10.1590/0034-7167-2019...
and polypharmacy2626. Nazar F, Gomes FRH, Oliveira V, Vagetti GC. Qualidade de vida, atividade física e cognição na população idosa: uma revisão sistemática. Rev. UNINGÁ Review [Internet]. 2020 [cited 2021 Nov. 03]; 35 (eRUR2789). Available from: https://doi.org/10.46311/2178-2571.35.eRUR2789.
https://doi.org/10.46311/2178-2571.35.eR...
can negatively impact the cognitive and functional aspects and lead to a reduction in functional capacity and, consequently, a decline in autonomy and independence of the elderly2121. Silva JNMA, Leite MT, Gaviraghi LC, Kirsten VR, Kinalski SS,Hildebrandt LM, et al. Predicting dimensions of clinicalfunctionalconditions and cognition in the elderly.Rev Bras Enferm. [Internet].2020[cited 20221 Dec. 21];73(Suppl 3): e20190162. Available from: http://dx.doi.org/10.1590/0034-7167-2019-0162.
http://dx.doi.org/10.1590/0034-7167-2019...
.

Thus, it is essential to promote educational aspects related to the health of the elderly in order to improve and preserve cognitive functions2626. Nazar F, Gomes FRH, Oliveira V, Vagetti GC. Qualidade de vida, atividade física e cognição na população idosa: uma revisão sistemática. Rev. UNINGÁ Review [Internet]. 2020 [cited 2021 Nov. 03]; 35 (eRUR2789). Available from: https://doi.org/10.46311/2178-2571.35.eRUR2789.
https://doi.org/10.46311/2178-2571.35.eR...
, ensure appropriate pharmacotherapy for the individual, especially in the PHC setting2727. Oliveira PC, Silveira MR, Cecatto MGB, Reis AMM, Pinto IVL, Reis EA. Prevalência e Fatores Associados à Polifarmácia em Idosos Atendidos na Atenção Primária à Saúde em Belo Horizonte-MG, Brasil. Ciência & Saúde Coletiva [Internet]. 2021[cited 2021 Nov. 05]; (26) 4: 1553-1564. Available from: https://doi.org/10.1590/1413-81232021264.08472019.
https://doi.org/10.1590/1413-81232021264...
, and reflect on other forms of therapy for elderly users, besides drug therapy, aiming to provide preventive and complementary forms, such as healthy eating and physical activity2525. Maragno LB, Matta AL, Nascimento DSF, Xavier AJ. Polifarmácia e cognição em pacientes com idade avançada. Revista da Sociedade Brasileira de Clínica Médica [Internet]. 2019 [cited 2021 Nov. 03]; 17(4): 180-182. Available from: https://www.sbcm.org.br/ojs3/index.php/rsbcm/article/view/714.
https://www.sbcm.org.br/ojs3/index.php/r...
.

In the analysis of the variable “how many morbidities” and the answer “yes” to the question referring to the mood/behavior indicator as to whether the elderly person had felt discouraged, sad, or hopeless in the last month, there was no statistically significant association.

However, in clinical practice, it is observed that a broad geriatric evaluation with adequate anamnesis and approach to the mood/behavioral functional system, assessed in this study, enable the strengthening of elderly care, thus expanding the access to health care. A study carried out with elderly individuals in an FHS allowed us to notice that the multimorbidity in the elderly population is closely associated with depression symptoms and lower perception regarding quality of life2828. Amaral TLM, Amaral CA, Lima NS, Herculano PV, Prado PR, Monteiro GTR. Multimorbidade, depressão e qualidade de vida em idosos atendidos pela Estratégia de Saúde da Família em Senador Guiomard, Acre, Brasil. Cienc. saude colet [Internet]. 2018 [cited 20212 Nov. 05]; 23(9): 3077-3084. Available from: https://doi.org/10.1590/1413-81232018239.22532016.
https://doi.org/10.1590/1413-81232018239...
.

Gender, age and marital status had no significant association with the indicators of the functional mood system. Opposing this result, a research indicates that the female gender, widowed and divorced elderly have greater symptoms of depression2929. Sousa KA, Freitas FFQ, Castro AP, Oliveira CDB, Almeida AAB, Sousa KA. Prevalência de sintomas de depressão em idosos assistidos pela Estratégia de Saúde da Família. REME Rev Min Enferm. [Internet]. 2017 [cited 2021 Oct. 10]; 21:e-1018. Available from: http://dx.doi.org/10.5935/1415-2762.20170028.
http://dx.doi.org/10.5935/1415-2762.2017...
. As well as the increase in age, which tends to make people more vulnerable to health problems, disabilities, and chronic diseases, leading to a negative self-perception of health and mood3030. Ribeiro P, Banhato E, Guedes D. Perfil clínico e uso de serviços de saúde em idosos. Revista Hospital Universitário Pedro Ernesto [Internet]. 2019 [cited 2021 Oct. 11]; 17: 25-34. Available from: https://doi.org/10.12957/rhupe.2018.40808.
https://doi.org/10.12957/rhupe.2018.4080...
.

Regarding the limitations of this study, it is observed that the data presented show the characterization of a specific sample of elderly users in home care, and cannot represent a more comprehensive portion of this age group in HC. However, it is expected that the data resulting from the research may contribute to the realization of new studies and serve to qualify the care of the elderly in HC through the results obtained, bringing improvements to this model of health care and, consequently, to the health of the elderly population, maintaining functionality, promoting autonomy and independence of the elderly in HC.

CONCLUSION

It highlights the importance of directing the planning and interventions within the home environment to health care that is feasible and directed to the needs of the aging process and the functionality of the elderly individual, encompassing cognition and mood/behavior when developing care. In this sense, the research brings contributions to the gerontological area, as it can help in the planning of actions of home care services, as well as serve as a subsidy for the development of new studies related to the theme.

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  • 30
    Ribeiro P, Banhato E, Guedes D. Perfil clínico e uso de serviços de saúde em idosos. Revista Hospital Universitário Pedro Ernesto [Internet]. 2019 [cited 2021 Oct. 11]; 17: 25-34. Available from: https://doi.org/10.12957/rhupe.2018.40808
    » https://doi.org/10.12957/rhupe.2018.40808
  • *
    Article extracted from the master’s/PhD thesis “CARGA DE TRABALHO DA EQUIPE DE ENFERMAGEM E RASTREADORES DE EVENTOS ADVERSOS NA ENFERMAGEM PEDIATRICA”, HOSPITAL UNIVERSITARIO JULIO MULLER, UNIVERSIDADE FEDERAL DE MATO GROSSO, CUIABA, MT, BRASIL, 2021.

Edited by

Associate editor:

Dra. Juliana Balbinot Reis Girondi

Publication Dates

  • Publication in this collection
    24 Mar 2023
  • Date of issue
    2023

History

  • Received
    04 Jan 2022
  • Accepted
    07 Aug 2022
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