Accumulated cognitive impairment, frailty, burden, and perceived stress and the risk of hospitalization and mortality in older caregivers

Bregola, Allan Gustavo; Ottaviani, Ana Carolina; Luchesi, Bruna Moretti; Pavarini, Sofia Cristina Iost

doi:10.1590/1980-5764-DN-2020-0091

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 16 (1) • Mar 2022 • https://doi.org/10.1590/1980-5764-DN-2020-0091 copy

Accumulated cognitive impairment, frailty, burden, and perceived stress and the risk of hospitalization and mortality in older caregivers

COMBINAÇÃO DE COMPROMETIMENTO COGNITIVO, FRAGILIDADE, SOBRECARGA, ESTRESSE PERCEBIDO E O RISCO DE HOSPITALIZAÇÃO E MORTALIDADE EM IDOSOS CUIDADORES

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Combination of cognitive impairment, frailty, perceived stress, and excessive burden poses a risk to the health of caregivers.

Objectives:

This study aimed to investigate the influence of the combination of these conditions on the occurrence of hospitalizations and deaths among older caregivers in a 4-year follow-up period.

Methods:

This is a longitudinal study in the communities with 351 older caregivers who underwent gerontological and geriatric evaluations in 2014 and completed cognitive (Mini-Mental State Examination), physical frailty (Cardiovascular Health Study criteria), perceived stress (Perceived Stress Scale), and care burden (Zarit Burden Interview) assessments. In 2018, data on hospitalization and mortality were collected.

Results:

As a result, 32 (12.6%) caregivers had deceased. Among the 228 survived caregivers who were reevaluated, 24% reported using hospital services in the previous year. Mean length of hospital stay was 3 days (range: 1–22 days). Hospitalization was associated with cognitive impairment co-occurring with frailty (p=0.05), stress (p=0.03), burden (p=0.01), and frailty co-occurring with stress (p=0.04). Considering singular effects, the mortality rate (33.3%) was higher among frail caregivers, followed by those with cognitive impairment (23.1%) and a high level of perceived stress (20.4%). Considering accumulative conditions, mortality rate (43.8%) was higher among frail older caregivers with cognitive impairment, followed by those with a high level of perceived stress and cognitive impairment (32.4%).

Conclusions:

The investigation of accumulated effects is important to the identification of potentially vulnerable older caregivers as well as the management and monitoring of the care, health, and independence of those who provide care for other older adults.

Keywords:
Survival; Caregivers; Longitudinal Studies; Risk Factors

		Survivors not hospitalized between 2017 and 2018 (n=171)	Survivors hospitalized between 2017 and 2018 (n=54)	Deceased between 2014 and 2018 (n=33)	All caregivers (n=258)
Sex	Male	18.1	24.1	42.4	22.5
	Female	81.9	75.9	57.6	77.5
Age (years)		68.9±6.3	69.9±6.7	73.9±9.0	69.7±6.9
	60–69	59.6	50	39.4	55.0
	70–79	32.2	38.9	36.4	34.1
	≥80	8.2	11.1	24.2	10.9
Schooling (years)		3.5±3.0	3.4±3.5	4.2±4.4	3.61±3.33
	+9	8.2	9.3	9.1	8.5
	5–8	12.3	7.4	9.1	10.9
	1–4	60.8	57.4	60.6	60.1
	Illiterate	18.7	25.9	21.2	20.5
Monthly family income (R$)		2178±1349	2266±1655	1943.48±936	2167±1376
Retired	Yes	64.9	68.5	78.8	67.4
	No	35.1	31.5	21.2	32.6
Relationship to care recipient	Spouse	84.6	90.7	78.8	85.3
	Others	15.4	9.3	21.2	14.7
Duration of care (years)		10.8±14.0	8.0±10.6	7.4±10.3	9.8±12.9
	<6	48.5	51.9	48.5	49.2
	≥6	48.5	46.3	45.5	47.7
	Missing	2.9	1.9	6.1	3.1
Hours dedicated to care per week		38.2±31.4	50.3±41.3	38.8±25.9	40.9±33.4
	<40	68.4	55.6	54.5	64.0
	>40	29.2	44.4	39.5	33.7
	Missing	2.3	–	6.1	2.3
Financial support	Yes	13.5	7.4	15.2	12.4
	No	86.0	92.6	84.8	87.2
	Missing	0.6	–	–	0.4
Affective support	Yes	46.2	44.4	45.5	45.7
	No	53.2	55.6	54.5	53.9

	Hospitalization			Death
	OR	95%CI	p-value	HR	95%CI	p-value
Cognitive impairment, unadjusted	1.77	0.91–3.44	0.088	0.80	0.33–1.93	0.624
Adjusted by sex	1.82	0.93–3.55	0.076	0.85	0.37–2.03	0.679
Adjusted by age (median 69 years)	1.82	0.94–3.56	0.075	0.49	0.71–1.43	0.196
Adjusted by sex and age (median 69 years)	1.86	0.95–3.63	0.069	0.51	0.17–1.49	0.218
Frailty, unadjusted	2.08	0.86–5.03	0.101	1.03	0.24–4.47	0.960
Adjusted by sex	1.98	0.81–4.84	0.132	0.54	0.09–3.27	0.503
Adjusted by age (median 69 years)	2.50	0.98–6.35	0.054	1.03	0.24–4.47	0.960
Adjusted by sex and age (median 69 years)	2.46	0.94–6.39	0.064	0.54	0.08–3.27	0.503
Stress, unadjusted	1.31	0.70–2.43	0.395	0.81	0.34–1.93	0.639
Adjusted by sex	1.31	0.70–2.44	0.392	0.81	0.34–1.93	0.637
Adjusted by age (median 69 years)	1.41	0.74–2.68	0.287	0.79	0.33–1.90	0.607
Adjusted by sex and age (median 69 years)	1.40	0.73–2.65	0.303	0.79	0.33–1.92	0.617
Care burden, unadjusted	1.63	0.81–3.26	0.163	7.06	1.18–42.28	0.032
Adjusted by sex	1.63	0.81–3.26	0.163	6.97	1.16–41.78	0.033
Adjusted by age (median 69 years)	1.59	0.79–3.19	0.190	6.47	1.06–39.42	0.043
Adjusted by sex and age (median 69 years)	1.60	0.79–3.21	0.186	6.30	1.03–38.46	0.046
Cumulative effects of cognitive impairment with:
Frailty, unadjusted	2.89	0.87–9.54	0.082	1.21	0.62–5.66	0.801
Adjusted by sex	3.83	1.04–14.07	0.043	1.33	0.22–8.18	0.756
Adjusted by age (median 69 years)	3.08	0.88–10.80	0.078	0.81	0.17–3.81	0.801
Adjusted by sex and age (median 69 years)	3.86	1.00–14.87	0.050	1.33	0.21–8.18	0.756
Stress, unadjusted	2.22	0.90–5.45	0.080	0.72	0.24–2.11	0.551
Adjusted by sex	2.73	1.06–7.07	0.038	0.74	0.24–2.23	0.597
Adjusted by age (median 69 years)	2.24	0.91–5.50	0.078	0.52	0.15–1.84	0.317
Adjusted by sex and age (median 69 years)	2.72	1.05–7.04	0.039	0.56	0.15–2.02	0.379
Care burden, unadjusted	3.85	1.32–11.20	0.013	14.00	0.87–223	0.062
Adjusted by sex	3.92	1.34–11.46	0.012	13.02	0.78–217	0.074
Adjusted by age (median 69 years)	3.78	1.28–11.10	0.015	9.68	0.59–157	0.111
Adjusted by sex and age (median 69 years)	3.83	1.30–11.30	0.015	8.55	0.50–144	0.137
Cumulative effects of frailty with:
Stress, unadjusted	2.14	0.80–5.75	0.129	§	§	§
Adjusted by sex	3.42	1.08–10.84	0.036	§	§	§
Adjusted by age (median 69 years)	2.02	0.74–5.48	0.167	§	§	§
Adjusted by sex and age (median 69 years)	3.27	1.01–10.58	0.048	§	§	§
Care burden, unadjusted	2.48	0.75–8.22	0.135	§	§	§
Adjusted by sex	2.79	0.80–9.66	0.104	§	§	§
Adjusted by age (median 69 years)	1.72	0.47–6.46	0.400	§	§	§
Adjusted by sex and age (median 69 years)	1.93	0.50–7.41	0.336	§	§	§

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[1] Correspondence: Allan Gustavo Bregola; Email: allanbrig@gmail.com.