Telessaúde no contexto da pandemia COVID-19 e seus efeitos na capacidade funcional e preocupação de cair em pessoas idosas com demência: um ensaio clínico, randomizado e controlado

Abstract

This doctoral thesis comprised three studies addressing the theme of telehealth and older adults with dementia and their caregivers during the SARS-CoV-2 (COVID-19) pandemic. Study I involved presenting a telehealth protocol featuring physical exercises and a multidisciplinary approach for older adults with dementia and their caregivers in a situation of social distancing due to COVID-19. The reviewed studies indicated that a multicomponent exercise program has beneficial effects on cognitive function, functional capacity, and quality of life in older adults with dementia when compared to physical exercise programs performed in isolation. It was also observed that physical exercise applied to older adults with dementia can help reduce stress and caregiver burden. Study II involved the adaptation and analysis of intra- and inter-rater reliability for functional mobility and muscle strength tests conducted remotely in the home environment with older adults with dementia. The performance on these remotely executed physical tests was correlated with the Timed Up and Go (TUG) test. The study included 43 older adults with a medical diagnosis of dementia. The tests — Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), Dual-Task Timed Up and Go (TUG-DT), and the 30-Second Chair Stand Test (TSL30s) — were conducted via video calls using Google Meet. Participants’ performance during the tests was recorded for later assessment of inter- and intra-rater reliability. Intra-rater reliability ranged from good to excellent for all tests performed. Inter-rater reliability values were fair for gait speed, moderate for some SPPB items, good for the SPPB two-feet balance test and total SPPB score, and excellent for the remaining tests. All tests showed significant correlation with the TUG, suggesting an association between the performance on the applied tests. Study III aimed to analyze the effects of the telehealth program — which included physical exercises and a multidisciplinary approach — on functional capacity, activities of daily living, and fear of falling in older adults with dementia during the COVID-19 pandemic. Eighty individuals with mild to moderate dementia were randomized into two groups: intervention group (IG) (n=41) and control group (CG) (n=39). Participants were assessed pre-intervention, post-intervention (12 weeks), and at follow-up (12 weeks after the intervention ended). Assessments included the Activities of Daily Living Questionnaire (ADLQ), the World Health Organization Disability Assessment Schedule 2.0, the SPPB, the TSL30s, and the Iconographical Falls Scale. The IG did not show improvements in functional capacity, daily living activities, or fear of falling in older adults with dementia compared to the CG. However, this study provides valuable insights for future telehealth-based research. Telehealth presents itself as an adaptable approach for the assessment and follow-up of older adults with dementia, particularly through the use of functional mobility and muscle strength tests, and as a feasible means of delivering physical exercise in the home setting.