Reducción de la sobrecarga del cuidador tras entrenamiento supervisado en ancianos pluripatológicos y paliativos

Abstract

Objetivo. Conocer la relación entre el nivel de independencia de un grupo de ancianos crónicos-pluripatológicos y paliativos (ACP-P) y la sobrecarga de sus cuidadores, tras un programa de entrenamiento multicomponente adaptado al ámbito domiciliario. Diseño mixto, cuantitativo y cuasiexperimental, con medidas repetidas en el factor Entrenamiento, y dos factores de agrupación: edad (70-79 y ≥80 años) y nivel de deambulación del ACP-P (anda/no anda). Emplazamiento. Intervención realizada en la Unidad de Hospitalización a Domicilio (UHD) del Hospital General de Alicante, durante 2014-2016. Participantes. 17 pacientes ACP-P, edad media 81,6 años (DE 5,6). Intervención. 3 sesiones semanales durante 26 semanas del programa de entrenamiento funcional-cognitivo EFAM-UVH©; 3 fases, reduciendo progresivamente la presencia del entrenador para fomentar la autonomía (28 sesiones supervisadas y 20 autónomas en total). Mediciones principales. Evaluación de Sobrecarga del cuidador (Zarit) y Nivel de independencia (Índice de Barthel “IB”), apoyados por indicadores fisiológicos y funcionales. Resultados. IB mejoró con el entrenamiento supervisado (p<0,05), y se mantuvo o descendió leve, aunque no significativamente, al aumentar la autonomía. Estas mejoras se acompañaron de una reducción en la sobrecarga del cuidador, con una dinámica similar, fundamentalmente en cuidadores del grupo <79 años y de los que no andan. No se encontró relación entre IB y Zarit, pero los deltas de ambas variables se asociaron en las fases supervisadas (r=-0,596, p= 0,015), reflejando el impacto del ejercicio. Conclusiones. El entrenamiento multicomponente ayuda a contener la sobrecarga del cuidador, reducida de forma concomitante al aumento de independencia del ACP-P entrenado. Este beneficio indirecto potencia la necesidad de equipos multidisciplinares y programas de ejercicio temprano y supervisado. Objective. To know the relationship between the level of independence of a group of chronic-pluripatological and palliative elders (ACP-P) and the overload of their caregivers, after a multicomponent training program adapted to the home environment.
 Design. Mixed, quantitative and quasi-experimental design, with repeated measures in the training factor, and two grouping factors: age (70-79 and ≥80 years) and the ambulation level of the ACP-P (walk / don't walk).
 Location. Intervention carried out in the Home Hospitalization Unit (HHU) of the General Hospital of Alicante, during 2014-2016.
 Participants. 17 ACP-P patients [81.6 years (SD5.6)].
 Intervention. 3 weekly sessions for 26 weeks of the EFAM-UVH© multicomponent training program (functional + cognitive); 3 phases, progressively reducing the presence of the coach to promote autonomy (28 supervised and 20 autonomous sessions in total).
 Main measurements. Evaluation of caregiver overload (Zarit) and level of independence (Barthel Index “BI”) of the ACP-P, supported by physiological and functional indicators.
 Results. BI improved with supervised training (p <0.05), and remained or fell slightly, although not significantly, when increasing the autonomy. These improvements were accompanied by a reduction in the overload of the caregiver, with a similar dynamic, mainly in the caregivers of the group <79 years and those who do not walk. No relationship was found between IB and Zarit, but the deltas of both variables were associated in the supervised phases (r = -0.596, p = 0.015), reflecting the impact of physical exercise.
 Conclusions. Multicomponent exercise training at the HHU helps to contain the caregiver's overload, reduced concomitantly to the increased of independence of the trained ACP-P. This indirect benefit maximizes the need of multidisciplinary teams, and early and supervised physical exercise training programs. Objetivo. Conhecer a relação entre o nível de independência de um grupo de idosos pluripatológicos e paliativos crônicos (ACP-P) e a sobrecarga de seus cuidadores, após um programa de treinamento multicomponente adaptado ao ambiente doméstico.
 Desenho misto, quantitativo e quase experimental, com medidas repetidas no fator Treinamento e dois fatores de agrupamento: idade (70-79 e ≥80 anos) e nível de deambulação do ACP-P (caminhada / partida).
 Localização. Intervenção realizada na Unidade de Hospitalização Doméstica (UHD) do Hospital Geral de Alicante, durante o período 2014-2016.
 Participantes. 17 pacientes com ACP-P, com idade média de 81,6 anos (DP 5,6).
 Intervenção. 3 sessões semanais por 26 semanas do programa de treinamento cognitivo-funcional EFAM-UVH ©; 3 fases, reduzindo progressivamente a presença do treinador para promover a autonomia (28 sessões supervisionadas e 20 autônomas no total).
 Principais medidas. Avaliação da sobrecarga do cuidador (Zarit) e nível de independência (Índice de Barthel "IB"), apoiados por indicadores fisiológicos e funcionais.
 Resultados. O IB melhorou com o treinamento supervisionado (p <0,05) e permaneceu ou caiu ligeiramente, embora não significativamente, aumentando a autonomia. Essas melhorias foram acompanhadas por uma redução na sobrecarga do cuidador, com dinâmica semelhante, principalmente nos cuidadores do grupo <79 anos e naqueles que não andam. Não foi encontrada relação entre IB e Zarit, mas os deltas de ambas as variáveis ​​foram associados nas fases supervisionadas (r = -0,596, p = 0,015), refletindo o impacto do exercício.
 Conclusões. O treinamento multicomponente ajuda a conter a sobrecarga do cuidador, reduzida concomitantemente à crescente independência do ACP-P treinado. Esse benefício indireto aumenta a necessidade de equipes multidisciplinares e programas de exercícios precoces e supervisionados.

Multicomponent Physical Exercise Training in Multimorbid and Palliative Oldest Adults

“…Whatever the level, postural control and gait are the main objectives. On the other hand, the exercise intervention, followed the multicomponent and dual-task approach, setting individual progression by means of physical conditioning maps based the participants capabilities, as usually in EFAM-UV© [31][32][33]38,39].…”

“…Exercises, volume, and intensity were conditioned to the patients' capacities, classified into high, medium, or low level, according to their dependence status, health, technical capacities, and movement velocity. According to the EFAM-UV© basis [32,33,37], there were one to three different exercises for the same motor target, so the progression in volume and intensity was guided by changes in the difficulty and complexity of the task. For instance, changes in the balance demands (sitting to sitting-tandem; sitting to standing; standing to tandem position, etc.…”

“…), the level of coordination and cognitive demands, or changes in the range of movement and/or the movement velocity (slow and then quicker; short-isometric and then large and dynamic muscular contractions), among other constraints, were used to ensure variability in practice. In fact, EFAM-UV© avoided the exercise repetitions to increase the amount and type of stimuli in one session [32,33].…”

“…Notwithstanding, current exercise recommendations [24,29,30] present some complexity in training programs addressed to very unfit ill seniors [12,23,25,31]. They require adjusting exercise to their individual characteristics and environment [11,12,25,31,32], their own or any of their siblings' houses, long or short-term hospital units, or even the nursing homes. They may also need a different assessment approach, attending to those qualitative or small changes which are difficult to quantify or analyze with current tests and quantitative normal references.…”

Physical Activity and the Improvement of Autonomy, Functional Ability, Subjective Health, and Social Relationships in Women over the Age of 60

“…From this interaction between physical activity and the improvement in social relationships, psychological and functional status and independence, an improvement in subjective perception of health is also obtained [ 5 ], which entails a decrease in the degree of dependence [ 19 ], as well as a perception of greater body control and self-esteem [ 20 ]. In this regard, it should be noted that, as with other variables, there could be a relationship concerning the intensity of physical activity practiced and the subjective perception of health; the higher the intensity, the better the subjective perception of wellbeing is, and vice versa [ 21 ].…”