Resumen de Deterioro cognitivo y factores asociados en adultos mayores rurales

Yenny Vicky Paredes Arturo, Eunice Yarce Pinzón, Daniel Camilo Aguirre Acevedo

• español

  El deterioro cognitivo es una condición clínica entre el envejecimiento normal y un probable proceso demencial, manifestado por pérdida de memoria mayor a la esperada para la edad, sin cumplir con criterios diagnósticos establecidos para la enfermedad de Alzheimer. Esta condición se presenta en personas con edad avanzada y con características demográficas, médicas y funcionales generalmente precarias, sobre todo en contextos rurales. El objetivo del presente estudio fue identificar los factores asociados con el deterioro cognitivo en un grupo de adultos mayores de contexto rural; a través de un estudio cuantitativo, transversal analítico, con fuente de información primaria, en 266 adultos mayores residentes en la zona rural del municipio de La Unión, Nariño, Colombia, empleando muestreo por conveniencia. Los factores sociodemográficos y el estado de salud se determinaron a través de una encuesta, la condición cognitiva se evaluó con el Minimental, el nivel emocional se valoró con la escala Yesavage y para la medición funcional se aplicó el cuestionario VIDA. Los resultados mostraron que el 51 % de los adultos mayores evaluados presentaron deterioro cognitivo. Respecto a las características sociodemográficas, el realizar oficios varios evidenció casi tres veces más riesgo (OR; 3.6; IC95 % 1.36 - 10.33) de tener implicación cognitiva. Asimismo, a nivel funcional se observó relación en actividades como preparación y toma de medicamentos con respecto a la incidencia de esta implicación mental. En conclusión, para el análisis del rendimiento cognitivo global en adultos mayores son relevantes los factores sociodemográficos y el estado funcional, más aún cuando se abordan en contexto rural.

• English

  Cognitive Impairment is a clinical condition between normal aging and a probable dementia process, generally manifested by memory loss greater than expected for the age, without meeting the established diagnostic criteria for Alzheimer's disease. This disease usually occurs in elderly people whose demographic, medical and functional characteristics are generally poor, the foregoing attributed mostly in rural contexts. The objective of the present study was to identify the factors associated with cognitive impairment in a group of senior citizens from a rural context through a quantitative, cross-sectional and descriptive methodological design, with a primary source of information, in 266 older adults living in the rural area of the municipality of La Unión, Nariño, using convenience sampling. For the inclusion criteria, the following aspects were taken into account: being an adult aged 60 years or more, belonging to the Elderly Program of this municipality, which is a social assistant program for elderly people created by the Colombian Government, and also voluntarily accepting participation in the study and signing the informed consent. The exclusion criteria were the presence of some medical, cognitive and functional implication that prevented the application of the protocol.

  In this way, variables such as sociodemographic factors, medical history specifically related to perception of health, present illness and current medications treatment were considered. Each component was addressed and evaluated through an interdisciplinary team. For the cognitive evaluation, the Mini-Mental State Examination (MMSE) was applied, in this case the cut-off point used was ≥24. Similarly, depressive symptoms were established with the Yesavage geriatric depression scale, taking into account three categories according to the total score obtained from the sum of the 15 items: from 0 to 5 normal, 6 to 10 moderate depression and from 11 to 15 severe depression. For the functional measurement, the VIDA (Daily Life of the Elderly) questionnaire was applied, the score is from 10 to 38 points, assesses the independent performance of 10 activities, rated by Likert scale with 3 to 4 responses.

  The results showed from a total sample made up of 266 participants, of which 51.5 % had cognitive impairment. The findings do not show a direct relationship with the demographic characteristics, however, the subjects evaluated 81 years or older, have twice the risk of cognitive impairment compared to those aged 60 to 65 years, likewise older adults in living in civil partnership, compared to singles ones. No dose response effect was seen in relation to schooling. The presence of a caregiver and that he is younger, in particular a grandson or nephew, could be related to having cognitive impairment. Older adults who perform various trades compared to farmers, had almost three times the risk (OR; 3.6; 95 % CI 1.36 - 10.33) of having cognitive impairment. There was no evidence of a relationship between the general health perception variables and cognitive impairment. Finally, the allusive results with the Life questionnaire. Only in questions 1 (Preparation and taking of medicines) and 2 (Use of the telephone) in the category of greater independence (value of 4) compared to those with more dependence (Value of 1 on the scale) did they indicate a relationship with the condition of cognitive involvement. A dose response effect is apparently seen with the preparation and taking of medications, use of the telephone, performance of household chores and maintenance.

  These findings could guide the design of strategies, intervention programs and the structuring of public policies. The main limitation of the research was its cross-sectional nature, which did not allow answering questions of a causal nature. In conclusion, for the analysis of global cognitive performance in the elderly, sociodemographic factors and functional status are relevant even more when they are approached in a rural context.