Factores relacionados con deterioro cognitivo y pérdida de autonomía en una población mayor de 64 años

Abstract

JUSTIFICATION It is a proven fact that as a consequence of the increase in life expectancy in recent decades, we can observe a dramatic change in the population pyramid. The average age In Spain in 1900 stood at 34.2 years, currently it stands at 82.8 years. It is estimated that by 2050, people over 50 will be fivefold. The progressive aging of the population leads to increased risk of disease, causing major disruptions to functional level and loss of skills. In the process of aging, life expectancy plays a very important role, causing an exponential increase in disease risk, all that, as a result of a longer exposure of the body to the effects of time, during which, there is a bigger risk of decreased reserves of the physiological systems, causing major disruptions at functional level and loss of skills. Among the disorders and diseases in the elderly, it should be noted those cognitive disorders known, according to DSM-5 (Manual of Diagnostic and Statistical Mental Disorders), as major neurocognitive disorder when it causes dementia or minor neurocognitive disorder when it brings a mild impairment. Major Neurocognitive disorder causes functional limitation, and reduces ability to perform daily activities, while minor neurocognitive disorder does not alter the functional ability to perform such activities. In both cases, there is a cognitive disorder (CD), defined as the set of reductions of different intellectual abilities that can be associated with several sensory, motor and personality disorders, due to a series o pathogenic causes, which include apart from those of organic nature, others of social and behavioral type. The consequences of aging related to cognitive impairment, produce a significant reduction or even a total loss of some capabilities, which leads to dependence. Disability in the elderly means a reduction in their autonomy and causes a change in habits and lifestyles joined to the inability to carry out the activities of daily living. For this reason, CI supposes an important health problem because of its magnitude and severity, and also due to the consequences in the quality of life in those people affected by this disease, their families and caregivers. The condition of dependence, in many cases, can be caused mainly by DC. Although the age is the most important factor in the development of cognitive disorders, there are other aspects of sociodemographic, clinical and behavioral nature which can accelerate the mentioned disorder. Numerous studies show that old age itself is not a risk factor for mental illness; however, age is positioned as the most decisive factor in the onset of cognitive decline. But there are other factors of sociodemographic, clinical and behavioral type that can be associated with cognitive decline and be responsible for the increased risk of developing CD in the population and therefore cause limitations in the functional capacity of the elderly. Many researchers from various fields, alerted by the devastating numbers of cognitively affected, direct their studies to those characteristics that can be associated to DC, so that we can intervene in them in order to alleviate the negative effects caused by this CD. OBJECTIVE Identify the factors related to the CI and dependence for basic activities of daily life, in people over 64 years. DESIGN Cross study in order to describe and observe the association of aspects related with CI and dependence, in 200 people over 64 years, of which 100 institutionalized and 100 noninstitutionalized. RESULTS The average age in the institutionalized group was higher than those living in their homes, predominating in both cases females. 93% of institutionalized people lived alone with no spouse. The predominant civil status in both groups was the widowhood. The prevalence of CI in the institutionalized group was 47%, higher than the prevalence of non-institutionalized group that was 8% (p <0.001). Among institutionalized people with CI, 70.3% had functional dependence in basic activities of daily living, higher than non-institutionalized group, in which of those with CI only 14.6% had both conditions. The institutionalized group had a higher incidence of anxiety and depression, being significant associated with CI. The dependence and educational activities were the only variables in both groups which were associated with the CI. Institutionalization (OR= 5.368), age (OR= 1.066) and dependence (OR= 5.036) were associated negatively with the CI. Learning activities (OR= 0.227) were positively associated. CONCLUSIONS Institutionalized population has a higher prevalence of CI with respect to the general population. A significant number of institutionalized people suffering CI also present functional dependence. There are clinical aspects related to the CI, as well as behavioral ones, that can predict the CI. Comparison of results with another studies in residential institutions, requires caution, given the heterogeneity between centers, in questions such as the admission criteria and levels of care. 5 Conducting educational activities can promote cognitive status in older people through training. It is important to include cognitive stimulation programs aimed at the older population, especially in residential institutions.