Elaboração e validação do questionário de rastreamento de disfagia aplicado aos cuidadores de idosos com demência (RaDID-QC)

Abstract

Rapid population aging and increased life expectancy are associated with the increase in the elderly population worldwide, which significantly contributes to the higher prevalence of dementia syndromes. Dementia is a clinical syndrome characterized by the progressive deterioration of multiple domains of cognition, impairment of functionality and behavioral changes. The caregiver has fundamental relevance in the care of the elderly with dementia. Regarding food, elderly people with dementia have less interest in food, greater difficulty in coordinating the food bolus and reduced food intake, determining changes in the swallowing process. It is extremely important for the caregiver to identify the signs and symptoms of swallowing disorders, as dysphagia is a risk factor for mortality. The present study aims to develop and validate the questionnaire Dysphagia Screening in older adults with Dementia - Questionnaire for caregivers (RaDID-QC), applied to caregivers of older adults with dementia due to Alzheimer's disease and/or mild vascular dementia, moderate or advanced. We built a dysphagia screening questionnaire. A cross-sectional observational validation study was carried out with the aim of identifying dysphagia in the elderly partially or totally dependent on third-party care. For evidence of content-based validity, a bibliographic survey was carried out, the first version of the questionnaire was created, and the questions were analyzed by a committee of 23 experts in dysphagia with experience in caring for the elderly. The agreement between the experts' analyzes was checked using the Content Validity Index per item (IVC-I) and the Intraclass Correlation Coefficient (ICC). For evidence of validity based on the response processes, a speechlanguage applied the instrument, through interviews, to 30 caregivers of older adults with dementia (caregiver-elderly binomial with dementia) from the Jenny Andrade Faria Institute of health care for the elderly in the Clinical Hospital of the Federal University of Minas Gerais. Then, the caregivers judged the questions regarding clarity and ease of understanding. After a new adjustment in the questionnaire, we proceeded to obtain evidence of validity based on the internal structure. In this step, 170 caregivers of elderly people with dementia answered the instrument. Data from this phase were analyzed using Cronbach's alpha coefficient, item-total correlations and exploratory factor analysis. The first version of the RaDID-QC consisted of 29 questions. After two rounds of expert evaluations, the last version remained with 24 questions. The intraclass correlation coefficient was 0.85. In the evidence of validity based on response processes, there was semantic adequacy of only one question. In the validity based on the internal structure, after the exploratory factor analysis, the questionnaire remained with 14 questions, five factors were able to explain 61.7% of the total variance, the item-total correlation coefficient presented values equal to or above 0.50 for the factors and standardized Cronbach's alpha obtained an index of 0.688. The dysphagia screening questionnaire applied to caregivers of elderly people with dementia - RaDID-QC presented evidence of validity based on content analysis, response processes and internal structure that was satisfactory, valid and reliable.