Caregivers of older adults in palliative care: level of burden and depressive symptoms

Introduction: The burden perceived by informal caregivers of older adult cancer patients in palliative care is an incessant daily repetitiveness, and can negatively affect their physical and mental health, as well as their social and family life. Objective: To assess the level of burden and the intensity of depressive symptoms in caregivers, and the dependence of the older adults for basic and instrumental activities of daily living. Methods: This was a cross-sectional and descriptive study, composed of 20 caregivers and 20 older adults with cancer in palliative care. Caregivers and older adults were administered the socio-economic and demographic profile assessment. For the caregivers, the International Physical Activity Questionnaire - IPAQ, the Zarit Burden Interview (ZBI), and the Beck Depression Inventory (BDI) were used. For the older adults, the Katz Index of Independence in Activities of Daily Living (Katz Index ADL) and the Lawton and Brody Instrumental Activities of Daily Living scales (Lawton and Brody IADL scales) were used. Data were represented in absolute and percentage values. Results: Caregivers were predominantly female, mostly daughters of the older adults, married or with a partner, with elementary school education, income of 1 to 3 times the minimum wage, and had a sedentary lifestyle. A moderate level of burden was verified in 75% of the caregivers, and mild to moderate depressive symptoms in 45%. The assessment of ADL in older adults found that 55% were independent in all six functions, with greater dependence (75%) in ADL for housekeeping such as laundry (85%) and driving vehicles (90%). Conclusion: Caregivers of older adults cancer patients in palliative care show moderate level of burden, and mild to moderate depressive symptoms.


Introduction
Caregivers of older adults are people who assume the responsibility of caring, offering support and relief.
The "informal caregiver" is someone who provides unpaid assistance for activities undertaken, usually a family member; the "formal caregiver" is one who has professional preparation and training, and has assured remuneration. 1 Changes in the population demographic profile have increased chronic and/or degenerative illnesses, along with a decline in organic functions. According to the Brazilian Institute of Geography and Statistics (IBGE), the number of people aged 65 and over is expected to almost triple, reaching 58.2 million by 2060, equivalent to 25.5% of the population. 2 Some older adults may be affected by pathological conditions, such as cancer, which is considered a global public health problem, and an estimated 27  The data were processed and analyzed in SPSS software, version 11.5 for Windows. All variables were analyzed descriptively and the data obtained were presented in tables with absolute values and percentages.
Spearman's correlation test was performed, but no associations were found between the variables studied.

Results
Twenty caregivers and 20 older adults in palliative care participated in this study. The caregivers group was formed by 11 women (55%), with a mean age of 55.36 years (40-69) and nine men (45%), with a mean age of 49.18 years (28-72) ( Table 1).
Results from the Zarit Burden Interview data showed 15 (75%) of the 20 caregivers with moderate burden, and three (15%) with moderate to severe burden, as shown in Table 2. According to the Beck Depression Inventory, seven (35%) caregivers presented mild depressive symptoms and two (10%) moderate depression, therefore 45% of the caregivers presented mental disorders ( Table 2).
Regarding the assessment of functional independence (IADL), 11 (55%) were independent in the six functions (bathing, dressing, eating, toileting, transferring the patient from one place to another, and continence) and only one (5%) was dependent for all functions (Table 3).     (Table 4).
No associations were found between burden and depressive symptoms with the assessment of functional independence (ADL and IADL).

Discussion
The support for chronic patients has prioritized the  In the present study, all caregivers were informal and provided assistance to the older adults in palliative care.
When the caregiver is a family member, the care task can be perceived as more exhausting due to the greater time spent, the readjustment of daily occupations, besides the pain of witnessing the suffering of the loved one. 14 The predominance of female caregivers was verified in this study. Araújo et al. 15 state that these data reflect the condition associated with gender and historical construction, representing a reality in the care process, as caring involves tasks considered feminine, which were learned by women throughout life.
A study carried out in the United Kingdom found that in the group under 75 years of age, between 55% and 62% of the caregivers were women. However, with  The present study found that most caregivers were family members and presented a level of burden and depressive symptoms, which highlights the relevance of care for the caregiver as well. Although associations between burden and depressive symptoms (ADL and IADL) were not observed, the authors intend to continue this study by means of an exclusive outpatient clinic with multiprofessional care, offering care to informal caregivers of the older adults in palliative care.
The reduced flow in the outpatient clinic prevented an assessment involving a larger number of patients and their caregivers and can be considered a limitation of the study. Also, the prevalence of informal caregivers made a comparative analysis with formal caregivers of older adults in palliative care infeasible.

Conclusion
The data found allowed for the identification of