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Avaliação funcional da pessoa com demência através do inventário de avaliação funcional do adulto e do idoso (IAFAI) : comparação entre o relato do cuidador e a observação direta
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Introdução: a avaliação funcional é particularmente relevante no contexto das demências, sendo um dos critérios a considerar no diagnóstico clínico e intervenção terapêutica. Apesar de os clínicos dependerem significativamente do cuidador informal sobre o estado da pessoa com demência, tem-se confirmado a existência de vieses no relato do cuidador. A natureza e direção da disparidade entre o desempenho da pessoa com demência e o relato do cuidador não estão ainda bem definidas, carecendo de mais investigação. Metodologia: através de um estudo quantitativo do tipo observacional comparativo e correlacional, avaliou-se a capacidade funcional de 32 pessoas com demência (fase moderada/avançada), através de dois métodos de aplicação do IAFAI: (1) relato dos respetivos 32 cuidadores; (2) observação direta (realizada por uma terapeuta ocupacional). Os resultados do relato do cuidador foram comparados com os resultados da observação direta, investigando-se a existência de uma possível discrepância entre ambos. Através de regressões lineares múltiplas investigou-se se características do cuidador e/ou da pessoa com demência estariam associadas à (possível) discrepância entre resultados. Resultados e Conclusões: os resultados revelaram que os cuidadores tendem a atribuir níveis superiores de incapacidade funcional comparativamente com os resultados da observação direta do técnico. Características do cuidador (sintomatologia depressiva, habilitações literárias e qualidade de vida ao nível do ambiente) surgiram associadas a esta discrepância. O sexo e a deterioração cognitiva da pessoa com demência não revelaram tal associação. Alerta-se assim para a necessidade de o clínico ponderar a existência de fatores que podem influenciar negativamente a perceção do cuidador em relação à capacidade funcional do familiar com demência (fase moderada/avançada), arriscando compromisso da avaliação funcional.
Introduction: the functional assessment is particularly relevant in the context of dementia. It is one of the criteria used for the diagnosis and therapeutic intervention. Although there is a significant dependence of the clinicians on the informal caregivers’ report to access the status of the person with dementia, it has been confirmed the existence of biases. The nature and direction of the disparity between the person’s performance and the caregivers’ report are not yet well defined and suggest further research. Methods: this is a quantitative observational, comparative and correlational study. It is based on the evaluation of the functional capacity of 32 subjects with dementia (moderate/severe), through two IAFAI application methods: (1) report from the 32 caregivers; (2) direct observation of the functional performance (conducted by an occupational therapist). The results of the caregivers’ report were compared with the results from the direct observation, to examine a possible discrepancy between them. Multiple regressions were conducted to determine the extend to which caregivers’ characteristics and patients’ characteristics were associated with the discrepancy in the results with IAFAI. Results and Conclusions: the results indicate that caregivers tend to attribute higher levels of functional incapacity in comparison with the observed performance in daily activities. Caregivers’ characteristics (depressive symptoms, educational level and the environment’s quality of life) were associated with this discrepancy. Patient’s characteristics (gender and cognitive deterioration) did not associate with the discrepancy. It should be noticed that the clinician must consider the existence of factors that can influence negatively caregivers’ perception of the functional capacity, which can compromise the functional assessment of the person with dementia (moderate/severe).
Introduction: the functional assessment is particularly relevant in the context of dementia. It is one of the criteria used for the diagnosis and therapeutic intervention. Although there is a significant dependence of the clinicians on the informal caregivers’ report to access the status of the person with dementia, it has been confirmed the existence of biases. The nature and direction of the disparity between the person’s performance and the caregivers’ report are not yet well defined and suggest further research. Methods: this is a quantitative observational, comparative and correlational study. It is based on the evaluation of the functional capacity of 32 subjects with dementia (moderate/severe), through two IAFAI application methods: (1) report from the 32 caregivers; (2) direct observation of the functional performance (conducted by an occupational therapist). The results of the caregivers’ report were compared with the results from the direct observation, to examine a possible discrepancy between them. Multiple regressions were conducted to determine the extend to which caregivers’ characteristics and patients’ characteristics were associated with the discrepancy in the results with IAFAI. Results and Conclusions: the results indicate that caregivers tend to attribute higher levels of functional incapacity in comparison with the observed performance in daily activities. Caregivers’ characteristics (depressive symptoms, educational level and the environment’s quality of life) were associated with this discrepancy. Patient’s characteristics (gender and cognitive deterioration) did not associate with the discrepancy. It should be noticed that the clinician must consider the existence of factors that can influence negatively caregivers’ perception of the functional capacity, which can compromise the functional assessment of the person with dementia (moderate/severe).
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Demência Avaliação funcional Cuidador informal Observação direta do desempenho funcional Dementia Functional assessment Informal caregiver Direct observation of functional performance