Um estudo dos idosos e de seus cuidadores em uma instituição de longa permanência antes e durante a pandemia: impactos da covid-19 na cognição, comportamento de agitação, funcionalidade e mortalidade

Abstract

INTRODUCTION Dementia affects approximately 50 million older people worldwide, and 60% of older people with dementia live in low- and middle-income countries. As the disease progresses, there is an increase in dependence in activities of daily living, and thus, there is a need for a caregiver. This caregiver may be a family member, an informal caregiver, or a hired professional, a formal caregiver. An alternative for elderly people with dementia and dependence are long-term care institutions, which provide the elderly person with all the necessary support, including constant care from a formal caregiver. However, this caregiver often presents physical and mental overload, in addition to occupational stress, which can result in a poor quality of life and a decline in work performance. Furthermore, due to low wages and long working hours, in several institutions to supplement their income, these caregivers can become vehicles for transmitting communicable diseases, such as Covid-19. Institutionalized elderly people are the most vulnerable and have the highest morbidity and mortality rates from Covid 19, generating a social and health system impact, as well as short and long-term consequences on the body's various systems, both in infected individuals and those uninfected, due to the effects of social isolation. GOALS Given the increase in the number of elderly people around the world, the current structure of families, the need for long-term care institutions and the Covid-19 pandemic, the objectives of this study were: to analyze the presence of pain, sleep disorders and occupational stress in caregivers of elderly people in a long-term care facility; characterize the Covid-19 outbreak that affected the long-term care institution for the elderly, and analyze whether there was a worsening of cognitive, agitation behavior, functionality and mortality in these elderly residents, with the Covid-19 outbreak in the institution. METHODS This is a cross-sectional analytical study, with a longitudinal component, carried out in a long-term care institution. The sample was made up of 17 formal caregivers and nursing technicians who work at the institution, and 50 elderly people, previously in a situation of social vulnerability (homeless people and victims of abandonment/family abuse) who live there. Issues related to pain, sleep and occupational stress in these caregivers were assessed; and evaluated issues related to cognition, functionality and degree of agitation in elderly residents, before and after the Covid-19 outbreak in the institution. RESULTS The results found demonstrated that the group of elderly residents initially presented cognitive deficit, low level of agitation behavior, high degree of dependence for activities of daily living and high mortality. Caregivers, on the other hand, had subjective pain and objective pain, mainly in the lumbar spine; presence of changes in subjective and objective sleep and absence of occupational stress. The caregivers' total sleep time objectively assessed with actigraphy was in the transition between the lower limit of normality and sleep deprivation. Furthermore, there was a correlation between changes in subjective sleep and subjective pain and objective pain in caregivers. It can be observed that the good dynamics established among elderly caregivers caused and allowed the absence of occupational stress. In relation to the Covid-19 outbreak at the Institution, 80% of the elderly were infected, regardless of the degree of cognitive impairment, agitation and functionality. There were 12 deaths. In the elderly who survived, cognitive worsening was observed in the long term in both infected and non infected elderly people, and a worsening of agitation behavior in non-infected elderly people. CONCLUSION Elderly residents already had cognitive deficits, low agitation scores, total dependence in activities of daily living and high mortality, even before the pandemic. Furthermore, caregivers presented objective pain and subjective pain, symptoms of insomnia and poor sleep quality, but without occupational stress. The absence of occupational stress is probably due to the good work dynamics proposed by them. After the pandemic, all elderly people, infected and non-infected, were cognitively affected. The non-infected people had worse agitation behavior, suggesting that the impacts of social isolation were more significant than the effect of the virus infection itself. Therefore, it is important to assess whether, in the face of a new epidemic/pandemic in the future, ILPIs should not be able to educate and provide comprehensive clothing, with much more protective and more modern equipment than those improvised in the current pandemic, all their employees and visitors. , in order to avoid such strict social isolation, which removed the last possibilities of direct human contact and skin touching possible for these elderly people without family.