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Doctoral Thesis
DOI
Document
Author
Full name
Emanuella Barros dos Santos
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2016
Supervisor
Committee
Rodrigues, Rosalina Aparecida Partezani (President)
Haas, Vanderlei José
Kusumota, Luciana
Pontes Neto, Octávio Marques
Robazzi, Maria Lucia do Carmo Cruz
Title in Portuguese
Trajetória e preditores do estresse psicológico dos idosos sobreviventes do AVC seis meses após a alta
Keywords in Portuguese
Acidente vascular cerebral
Enfermagem gerontológica
Estresse psicológico
Idoso
Abstract in Portuguese
O Acidente Vascular Cerebral (AVC) é uma doença com início súbito que pode afetar o funcionamento físico, cognitivo e comportamental de uma pessoa. Diante das inúmeras transformações que pode causar, há grande chance de os sobreviventes vivenciarem a ocorrência do AVC como uma experiência estressante. O presente estudo teve como objetivo analisar a trajetória e identificar os preditores do estresse psicológico dos idosos sobreviventes do AVC. Tratou-se de um estudo longitudinal e prospectivo, realizado no Distrito Federal. A amostra foi constituída por 50 idosos sobreviventes do AVC recrutados do setor de Emergência do Hospital de Base do Distrito Federal. A coleta de dados foi realizada em três momentos, a saber: duas semanas (T1), três meses (T2) e seis meses (T3) após a alta hospitalar. O instrumento para coleta de dados foi composto por questões sociodemográficas, clínicas, Mini-Exame do Estado Mental (MEEM), Escala de Estresse Percebido - 10 itens (EEP-10), Escala do AVC do National Institute of Health (NIHSS), Medida da Independência Funcional (MIF), Escala de Depressão Geriátrica - 15 itens (EGD15).A média de idade dos sobreviventes do AVC foi de 70,3 (7,6) anos. Houve predomínio de idosos mais jovens (60 a 79 anos) e sem companheiro (54%). A amostra foi composta por número igualitário de participantes do sexo masculino e feminino. Os sobreviventes estudaram, em média, 4,2 anos, e a maioria recebia de um a dois salários mínimos (70%). O AVC isquêmico foi o tipo do AVC mais prevalente (96%). A média do número de comorbidades foi de 2,36 (DP=0,8), sendo que 78% dos idosos possuíam de duas a três comorbidades. A média da EEP-10 apresentou declínio no decorrer dos seis meses (p<0,001). Houve diferença estatisticamente significativa entre as médias da EEP-10 nos momentos T1 e T2, T1 e T3, sendo mais acentuada entre os momentos T1 e T3 (p<0,001). Entre T1 e T3, a média da EEP-10 dos idosos sobreviventes do AVC apresentou queda de quase seis pontos (p<0,001). Não houve associação entre o estresse psicológico e as variáveis sociodemográficas (sexo, renda, idade, estado civil) no T1, T2, T3. Os idosos com cuidador apresentaram maior média na EEP-10 quando comparados aos idosos sem cuidador no T1 (p=0,003), T2 (p<0,001) e T3 (p=0,02). Os idosos com depressão apresentaram maior média na EEP-10 quando comparados aos idosos sem depressão no T1 (p<0,001), T2 (p<0,001) e T3 (p<0,001). Os sobreviventes com AVC moderado apresentaram maior média na EEP-10 quando comparados aos idosos com AVC leve no T1 ((p=0,001), T2 (p=0,006) e T3 (p<0,001). A redução da média da EEP-10 apresentou relação com o aumento da média da MIF (p=0,04) e a redução da média de EGD-15 (p<0,001). A média da MIF (?=-0,61; p=0,015) e da EGD-15 (?=0,30; p=0,01) no T1 foram preditores da média da EEP-10 no T3. Conclui-se que o estresse psicológico dos idosos sobreviventes do AVC diminui no decorrer dos seis meses após a alta hospitalar para casa. Além disso, menor funcionalidade e maior número de sintomas depressivos duas semanas após a alta prevêem maior nível de estresse psicológico seis meses após a alta
Title in English
Trajectory and predictors of the psychological stress among elderly stroke survivors six months after discharge
Keywords in English
Aged
Geriatric nursing
Psychological stress
Stroke
Abstract in English
Stroke is a disease with a sudden onset that can affect the physical, cognitive and behavioral functioning of a person. In the face of the many transformations it may cause, there is a great chance that survivors will experience the occurrence of stroke as a stressful experience. This study aimed to analyze the trajectory and to identify the predictors of the psychological stress of the elderly stroke survivors. It was a longitudinal and prospective study, which took place in the Federal District. The sample consisted of 50 elderly stroke survivors, recruited from the Emergency Department of the Base Hospital of the Federal District. Data collection was performed in three moments, namely: two weeks (T1), three months (T2) and six months (T3) after hospital discharge. The instrument for data collection consisted of sociodemographic and clinical questions, Mini Mental State Examination (MMSE), Perceived Stress Scale - 10 items (PSS-10), National Institute of Health Stroke Scale (NIHSS), Measure Independence Functional (MIF), Geriatric Depression Scale - 15 items (GDS-15). The average age of stroke survivors was 70.3 (7.6) years. There was a predominance of younger elderly (60 to 79 years) and those without a companion (54%). The sample consisted of an equal number of male and female participants. The survivors studied, on average, 4.2 years, and the majority received from one to two minimum wages (70%). Ischemic stroke was the most prevalent stroke type (96%). The mean number of comorbidities was 2.36 (SD = 0.8), and 78% of the elderly had from two to three comorbidities. The mean PSS-10 showed a decline over the six months (p<0.001). There was a statistically significant difference between the means of the PSS-10 at moments T1 and T2, T1 and T3, being more pronounced between T1 and T3 moments (p<0.001). Between T1 and T3, mean PSS-10 of stroke survivors presented a drop of almost six points (p<0.001). There was no association between psychological stress and sociodemographic variables (sex, income, age, marital status) in T1, T2 and T3. Elderly with caregivers presented a higher average in the PSS-10 when compared to the untreated elderly in T1 (p=0.003), T2 (p<0.001) and T3 (p=0.02). The elderly with depression presented a higher mean in the PSS-10 when compared to the elderly without depression in T1 (p<0.001), T2 (p<0.001) and T3 (p<0.001). Survivors with moderate stroke presented a higher mean in the PSS-10 when compared to the elderly with mild stroke in T1 (p=0.001), T2 (p=0.006) and T3 (p<0.001). The reduction of the mean PSS-10 was related to the increase in the mean FIM (p = 0.04) and the reduction in the mean GDS-15 (p<0.001). The mean FIM (?=-0.61, p=0.015) and the GDS-15 (?=0.30, p=0.01) in T1 were predictors of mean PSS-10 in T3. It has been concluded that the psychological stress of the elderly stroke survivors decreases during the six months after hospital discharge. In addition, lower functionality and greater number of depressive symptoms, two weeks post-discharge, predict higher level of psychological stress six months after it
 
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Publishing Date
2019-10-07
 
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