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1
Acta Paul Enferm. 2024; 37:eAPE003094.
Chronic pain in elderly caregivers and inuence
on stress and depressive symptoms
Dor crônica em idosos cuidadores e inuência no estresse e sintomas depressivos
Dolor crónico en personas mayores y su inuencia en el estrés y en síntomas depresivos
Marielli Terassi1 https://orcid.org/0000-0002-8933-3519
Estefani Seram Rossetti1 https://orcid.org/0000-0002-5209-5035
Sirlei Ricarte Bento1 https://orcid.org/0000-0002-4662-632X
Soa Cristina Iost Pavarini1 https://orcid.org/0000-0001-9359-8600
Priscilla Hortense1 https://orcid.org/0000-0003-0554-451X
1Universidade Federal de São Carlos, São Carlos, SP, Brazil.
Conicts of interest: nothing to declare.
Abstract
Objective: To verify the effect of chronic pain on stress and depressive symptoms in elderly caregivers over
four years.
Method: This is a longitudinal study, with data collection in 2014 and 2018, with 104 individuals aged 60
years and older who provided care to another older adult living in the same household and residing in the
urban areas of the city of São Carlos-SP, registered in Family Health Units (FHU). For statistical analyses, the
linear regression model with mixed effects (random and xed effects) and analysis of covariance (ANCOVA)
were used. All models were adjusted for sex, age, education, number of medications and number of diseases.
Results: Participants with chronic pain had an average of 5.21 points higher in the stress score (p=0.019; CI:
-9.823 – -0.604) in the second assessment (2018) and an increase of 1.3 in the depressive symptoms score
in the rst assessment (2014), in addition to 1.8 in the second assessment (2018) (=0.020; CI: -2.530 - -
0.225 and p=0.003; CI: -3.016 - -0.640, respectively). Pain intensity was associated with stress (p=0.019;
CI= 0.179- 1.958) and depressive symptoms in the rst and second assessments (p=0.001; CI: 0.218-
0.772; p=0.013; CI: 0.066- 0.538). Through ANCOVA analysis, it was found that the greater the difference in
pain intensity, the greater the difference in depressive symptoms over time.
Conclusion: It is necessary to take effective action to manage chronic pain in elderly caregivers to minimize
problems related to stress and depressive symptoms.
Resumo
Objetivo: Vericar o efeito da dor crônica no estresse e nos sintomas depressivos de idosos cuidadores de
idosos no decorrer de quatro anos.
Método: Estudo longitudinal, com coleta de dados em 2014 e 2018, com 104 indivíduos com idade igual ou
superior a 60 anos, que realizavam cuidado a outro idoso que morava no mesmo domicílio e residentes nas
áreas urbanas do município de São Carlos-SP, cadastrados nas Unidades de Saúde da Família (USF). Para as
análises estatísticas, foram utilizados o modelo de regressão linear com efeitos mistos (efeitos aleatórios e
xos) e a análise de covariância (ANCOVA). Todos os modelos foram ajustados por sexo idade, escolaridade,
número de medicamento e número de doenças.
Resultados: Participantes com dor crônica apresentaram média de 5,21 pontos maior no escore de estresse
(p=0,019; IC: -9,823 – -0,604) na segunda avaliação (2018) e um aumento de 1,3 no escore dos sintomas
depressivos na primeira avaliação (2014), e 1,8 na segunda avaliação (2018) (=0,020; IC:-2,530 - - 0,225
e p=0,003; IC: -3,016 - -0,640, respectivamente). A intensidade da dor esteve associada ao estresse
(p=0,019; IC= 0,179- 1,958) e sintomas depressivos na primeira e segunda avaliação (p=0,001; IC: 0,218-
Keywords
Stress, physiological; Depression; Chronic pain; Caregivers;
Aged
Descritores
Estresse siológico; Depressão; Dor crônica, Cuidadores;
Idoso
Descriptores
Estrés siológico; Depresión; Dolor crónico; Cuidadores;
Anciano
Submitted
October 17, 2021
Accepted
March 19, 2024
Corresponding author
Estefani Seram Rossetti
E-mail: tetirossetti@hotmail.com
Associate Editor
Thiago da Silva Domingos
(https://orcid.org/0000-0002-1421-7468)
Escola Paulista de Enfermagem, Universidade Federal de
São Paulo, São Paulo, SP, Brasil
How to cite:
Terassi M, Rossetti ES, Bento SR, Pavarini SC,
Hortense P. Chronic pain in elderly caregivers and
inuence on stress and depressive symptoms. Acta
Paul Enferm. 2024;37:eAPE003094.
DOI
http://dx.doi.org/10.37689/acta-ape/2024AO0030944
Original Article
2Acta Paul Enferm. 2024; 37:eAPE003094.
Chronic pain in elderly caregivers and inuence on stress and depressive symptoms
Introduction
With the aging of the population, the increasing in-
cidence of chronic non-communicable and degen-
erative diseases in older adults is notable, often pro-
gressing to disabilities and dependence,(1) impacting
functional and cognitive capacity. Older adults of-
ten need the assistance of a caregiver to carry out
their daily activities.(1,2)
A caregiver is responsible for the act of caring,
which includes assistance with basic and instrumental
activities of daily living. A caregiver can be informal,
not having an employment relationship and providing
care to a family member, or formal, having the same
duties, but with remuneration for providing care. A
caregiver can be primary, who has full responsibility
for care, or secondary, who carries out complementary
activities. e vast majority of caregivers do not have
any qualications or preparation for this.(2)
Most of the time, these caregivers are also older
adults and have health conditions that are aggravated
by care burden.(3) e burden on caregivers, in turn, can
increase the likelihood of this older adult experiencing
depressive symptoms, stress and chronic pain.(4,5)
According to the literature, chronic pain in old-
er adults is a clinical condition present in the aging
process, but it is underestimated and undertreated,
favoring a decrease in quality of life and causing
negative impacts on physical and mental health.(6-8)
Among the impacts caused on the health of
people with chronic pain, anxiety and depression
stand out.(6,9,10) Research carried out in Finland with
older adults over 75 years old and divided into two
groups, 175 participants with chronic pain and 220
with no pain found that the group with pain rated
their health and physical mobility worse, in addi-
tion to feeling sadder, isolated and tired when com-
pared to the group with no pain.(11)
Studies that investigate the psychological and
physical health of older adults who care for other
older adults indicate that stress levels can have a
negative eect on their health and quality of care.
(11,12) erefore, it is necessary to study the existence
of these variables even before the chronic pain pro-
cess begins, analyzing how these variables behave.
A study carried out with 46 elderly caregivers
with low back pain showed, through correlational
analyses, a signicant and directly proportional re-
lationship between the intensity of low back pain
and depressive symptoms, although of a weak mag-
nitude (rho=0.302, p=0.041).(13)
Investigations into the relationship between these
variables in older adults who care for other older
adults are necessary, as they are scarce in the litera-
ture, and it is necessary to establish a relationship be-
tween chronic pain, stress and depressive symptoms.
e eect of chronic pain on stress and depressive
symptoms in elderly caregivers occurs over four years.
0,772; p=0,013; IC: 0,066- 0,538). Por meio da análise da ANCOVA, vericou-se que, quanto maior a diferença na intensidade da dor, maior a diferença
nos sintomas depressivos ao longo do tempo.
Conclusão: É necessário realizar uma ação efetiva para o manejo da dor crônica em cuidadores idosos para minimizar os agravos relacionados ao estresse
e sintomas depressivos.
Resumen
Objetivo: Vericar los efectos del dolor crónico sobre el estrés y los síntomas depresivos en personas mayores cuidadoras de personas mayores en el
transcurso de cuatro años.
Método: Estudio longitudinal, cuya recopilación de datos se realizó en 2014 y 2018, llevado a cabo con 104 individuos de 60 años o más, que cuidaban a
otras personas mayores que vivían en el mismo domicilio y eran residentes de áreas urbanas del municipio de São Carlos, estado de São Paulo, registrados
en las Unidades de Salud de la Familia (USF). Para los análisis estadísticos, se utilizó el modelo de regresión lineal de efectos mixtos (efectos aleatorios y jos)
y el análisis de covarianza (ANCOVA). Todos los modelos se ajustaron según sexo, edad, escolaridad, número de medicamentos y número de enfermedades.
Resultados: Participantes con dolor crónico presentaron un promedio de 5,21 puntos más en el puntaje de estrés (p=0,019; IC: -9,823 – -0,604) en la
segunda evaluación (2018) y un aumento de 1,3 en el puntaje de los síntomas depresivos en la primera evaluación (2014), y 1,8 en la segunda evaluación
(2018) (=0,020; IC:-2,530 - - 0,225 y p=0,003; IC: -3,016 - -0,640, respectivamente). La intensidad del dolor se relacionó con el estrés (p=0,019; IC=
0,179- 1,958) y con síntomas depresivos en la primera y segunda evaluación (p=0,001; IC: 0,218- 0,772; p=0,013; IC: 0,066- 0,538). Mediante el análisis
ANCOVA, se vericó que, cuanto mayor es la diferencia en la intensidad del dolor, mayor es la diferencia en los síntomas depresivos a lo largo del tiempo.
Conclusión: Es necesario realizar una acción efectiva para el manejo del dolor crónico de cuidadores que son personas mayores para minimizar los agravios
relacionados con el estrés y los síntomas depresivos.
3
Acta Paul Enferm. 2024; 37:eAPE003094.
Terassi M, Rossetti ES, Bento SR, Pavarini SC, Hortense P
erefore, the present study aims to verify the eect
of chronic pain on stress and depressive symptoms in
elderly caregivers over four years.
Methods
is is a quantitative, observational and longitudinal
study guided by the STrengthening the Reporting of
OBservational studies in Epidemiology (STROBE)
checklist, with data collection carried out in 2014
and 2018.
Data collection was carried out in the city of
São Carlos-SP. People aged 60 or older who provid-
ed informal care to another older adult in the same
household, residing in urban areas of the city of São
Carlos-SP and registered in Family Health Units
(FHU), were included. Older adults who were not
at home within three attempts were excluded due
to death, change of address, refusal and situation in
which the two older adults were equally indepen-
dent in activities of daily living.
Data collection occurred through two assess-
ments, carried out in 2014 and 2018, after prior
scheduling, at older adults’ own homes, by a pair of
previously trained interviewers. e rst assessment
was carried out between April and November 2014,
and participants were identied through lists made
available by FHU, which included the names and
addresses of all older adults who lived with at least
one other older adult in the same household. To
identify elderly caregivers, questionnaires assessing
performance in basic activities of daily living(14,15)
and instrumental activities of daily living were used.
(16) e older adult with the best performance, in
the sum of the scores from the two instruments,
was considered the caregiver, and the older adult
with the lowest score was considered the one who
received the care. All homes that appeared on the
lists made available by FHU were visited by the re-
searchers, and after applying the aforementioned
inclusion and exclusion criteria, 266 elderly care-
givers took part in the rst stage.
e second assessment took place between April
and September 2018, and all 266 homes were visited
again by researchers, as described in a previous study.(17)
A total of 32 participants were excluded due to
death; 16 participants, after three unsuccessful con-
tact attempts on dierent days and times; 36, due
to a change of address in which the interviewer was
unable to obtain information about the new resi-
dence; and 46, due to refusals. Given the objective
of this study, we decided to exclude participants
who showed a change in the presence of pain over
the four years, i.e., the participant who reported
pain in 2014 and did not report it in 2018 (n=9)
as well as what did not report in 2014 and report-
ed in 2018 (n=14). Furthermore, elderly caregivers
who presented speech impairment or very signi-
cant cognitive decline were excluded, in which the
interviewer was unable to carry out the assessment
(n=9). us, the nal sample consisted of 104 el-
derly caregivers.
During interviews with participants, informa-
tion was collected on sociodemographic charac-
teristics (sex, age, education), self-reported health
information (number of illnesses and number of
medications) and data related to care (hours of daily
care and relationship with recipient of care).
To assess chronic pain, the Visual Numerical
Scale (VNS) was used, which ranges from zero to
10, so that pain intensity is represented with nu-
merical increase (from one to three: mild pain; four
to six: pain moderate pain; and seven to 10: severe
pain). Pain lasting six months or more, continuous
or recurrent, was considered chronic. VNS is a re-
liable and valid measure for assessing pain intensi-
ty in elderly patients, with moderate to substantial
temporal stability.(18)
Regarding the functionality of older adults, two
instruments were used: Basic Activities of Daily
Living (ADL) and Instrumental Activities of Daily
Living Scale (IADL). ese assessment instru-
ments were created with a focus on assessing older
adults’ ability to perform tasks.(15,16) ey are reliable
tools(19,20) for assessing self-care tasks and assessment
of older adults’ performance of more complex tasks,
respectively.
Since, ADL measures activities related to the
ability to feed, bathe, dress, groom, mobilize and
maintain control over elimination. It consists of
six questions that present three alternatives in each
4Acta Paul Enferm. 2024; 37:eAPE003094.
Chronic pain in elderly caregivers and inuence on stress and depressive symptoms
question, and the one that most represents the con-
dition of the older adult is highlighted. At the end
of the exam, it is possible to calculate the resulting
score, which can vary from zero to six. erefore,
zero indicates total independence and six total or
partial dependence in carrying out all activities. e
intermediate score warns of total or partial depen-
dence on any of the activities.(14,15)
Meanwhile, IADL is used to assess older adults’
performance of more complex tasks, such as using
the telephone, shopping, preparing meals, house-
work, using transport, taking medication and han-
dling money. Each assessment question has three
answer options. Number three represents that the in-
terviewee demonstrates a condition of independence;
number two indicates a state of semi-dependence
(needs partial help to carry out the task); and num-
ber one signals the existence of total dependence. e
full scale score can range from seven to 21, with seven
meaning total dependence, eight to 20 points partial
dependence and 21 meaning independence.(16)
Burden was assessed using the Zarit Overload
Scale, with 22 questions with Likert-type answers.
e sum of the questions can vary from 0 to 88
points, which presents good internal consistency
indexes.(21-22)
Depressive symptoms were measured by the
Geriatric Depression Scale (GDS-15), which aims
to screen depressive symptoms in older adults. It
consists of 15 questions, with dichotomous alter-
natives, “yes” or “no”, and the score can vary from
0 to 15 points. Scores greater than six indicate the
presence of depressive symptoms.(23)
Perceived stress was assessed using the Perceived
Stress Scale (PSS), composed of 14 questions in
which each item has response options ranging from
0 to 4 (0 = never, 1 = almost never, 2 = sometimes,
3 = almost always, 4 = always). e total scale can
range from 0 to 56.(24) e scale does not present
a cut-o score, and the higher the score on the in-
strument, the higher the level of stress. It is a scale
with psychometric qualities suitable for assessing
Brazilian older adults.(24)
Participants who presented changes in any of
the scales were notied by the research participants
as well as by the FHU covered by that participant.
For data analysis, a database was created and
double-entered in Excel® 2010. After double entry
validation, the data was exported to SAS system for
Windows® (9.2). In the independent sample com-
parison tests (comparison of sociodemographic and
health characteristics), at baseline, Student’s t test
and chi-square test were chosen. For the analyzes in-
volving the relationship between stress and depres-
sive symptoms with the presence and chronic pain
intensity, the linear regression model with mixed
eects (random and xed eects) was proposed. For
the relationships between time deltas (before-after)
between depressive symptoms and stress with pain
intensity, analysis of covariance (ANCOVA) was
proposed. All models were adjusted for sex, age,
education, number of medications and number of
diseases. For all statistical tests, a signicance level
of 5% was adopted.
e present study was authorized by the
Municipal Health Department, and was approved
by a Research Ethics Committee (CAAE (Certicado
de Apresentação para Apreciação Ética - Certicate
of Presentation for Ethical Consideration)
34577920.4.0000.5504) (Opinion: 4.292.235).
All older adults who agreed to participate in the
study signed the Informed Consent Form.
Results
A total of 104 elderly caregivers participated in the
study, divided into the chronic pain (n=73) and
no pain (n=31) groups. Regarding the sociodemo-
graphic and health characteristics of participants
at baseline (2014), it was observed that number of
medications, number of comorbidities, stress and
depressive symptoms present higher rates in par-
ticipants with chronic pain, with signicant statis-
tical dierences. e majority of participants were
female (83.6%), with an average age of 67.7 years
(Table 1).
As for care characteristics, in both groups, the
prevalence of spouse in providing care was observed,
represented by 63% in the chronic pain group and
96.7% in the without pain group. ere were no
statistical dierences between groups in relation to
5
Acta Paul Enferm. 2024; 37:eAPE003094.
Terassi M, Rossetti ES, Bento SR, Pavarini SC, Hortense P
daily time spent on care, with both groups averag-
ing approximately 5.7 hours per day. Table 2 pres-
ents the results of the relationship between stress
and depressive symptoms with the presence of pain,
during 2014 and 2018, through linear regression
analysis with mixed eects. ere was no eect on
the interaction of duration on the presence of pain
and stress (p=0.331); however, in the second assess-
ment (2018), a dierence was observed between the
presence or absence of pain, in which participants
with chronic pain presented average of 5.21 points,
higher in the stress score (p=0.019; CI: -9.823 –
-0.604). Concerning depressive symptoms, it was
observed that there was also no interaction with du-
ration (p=0.458); however, it was observed that the
presence of chronic pain in the rst and second as-
sessment increases by 1.3 and 1.8, respectively, the
average points in depressive symptoms (p=0.020;
CI: -2.530 - -0.225 and p=0.003; CI: -3.016 -
-0.640). Table 2 presents detailed data.
Pain intensity was associated with stress
(p=0.006, CI=-0.319 – 1784), but without the ef-
fect of duration. In 2018, it was observed that an
increase of one point in pain intensity increases
the stress score by one point (p=0.019; CI= 0.179-
1.958). In relation to depressive symptoms and
pain intensity, despite not having shown an eect
of duration, an association was detected, with one
unit in pain intensity favoring an increase in the
depressive symptoms scale by 0.398 points (p=<
0.001, CI= 0.203 – 0.593). Similar results were evi-
denced in 2014 and 2018, observing that the eect
on depressive symptoms was 0.4 points (p=0.001;
CI: 0.218- 0.772) for the rst assessment and 0.3
(p=0.013; CI: 0.066- 0.538) for the second assess-
ment for each unit of increase in pain intensity.
Table 3 shows detailed data is presented.
Table 1. Comparison of sociodemographic variables and health
characteristics between groups of caregivers with chronic pain
and those without pain at baseline
Variables
With chronic
pain
(n=73)
Without pain
(n=31) p-value
Sex
Female 83.6% 61.3% 0.014
Male 16.4% 38.7%
Age (mean, standard deviation) 67.7 (±5.55) 69.7 (±6.06) 0.995
Education 3.0 3.1 0.798
Number of medications 3.6 1.7 <0.001
Number of comorbidities 6.0 2.7 <0.001
Care burden (continuous) 20.9 15.5 0.096
Perceived stress 21.8 12.9 <0.001
Depressive symptoms
Presence 37% 3.3% <0.000
Absence 63% 96.7%
Table 2. Relationship of stress and depressive symptoms with
duration and presence of chronic pain
Variables Estimate p-value IC 95%
Stress
Difference between duration (2014 versus
2018)*
-0.897 0.484 -3.433
1.639
Presence of pain associated with duration
(2014-2018)
0.331
Presence of pain (no/yes) (2014) -2.764 0.217 -7.182
1.654
Presence of pain (no/yes) (2018) -5.213 0.027 -9.823
-0.604
Depressive symptoms
Difference between duration (2014 versus
2018)**
0.863 0.006 0.252
1.473
Presence of pain associated with duration
(2014-2018)
0.458
Presence of pain (no/yes) (2014) -1.377 0.020 -2.530
-0.225
Presence of pain (no/yes) (2018) -1.828 0.003 -3.016
-0.640
Model adjusted for sex, age, education, number of medications and number of diseases; *Result of the
difference between duration (2014 versus 2018) in stress; **Result of the difference between duration
(2014 versus 2018) in depressive symptoms.
Table 3. Relationship of stress and depressive symptoms with
chronic pain intensity
Variables Estimate p-value 95% CI
Stress
Difference between duration (2014 versus 2018) -2915 0.487 -11.258
5.428
Pain intensity 1.052 0.006 0.319
1.784
Intensity associated with duration (2014 -2018) 0.957
Pain intensity (2014) 1.035 0.051 -0.006
2.076
Pain intensity (2018) 1.069 0.019 0.179
1.958
Depressive symptoms
Difference between duration (2014 versus 2018) -0.816 0.463 -3030
1.398
Pain intensity 0.398 <0.001 0.203
0.593
Intensity associated with duration (2014 - 2018) 0.254
Pain intensity (2014) 0.495 0.001 0.218
0.772
Pain intensity (2018) 0.302 0.013 0.066
0.538
Model adjusted for sex, age, education, number of medications and number of diseases.
Table 4 presents the results of ANCOVA analy-
sis, which veried the relationship between change
6Acta Paul Enferm. 2024; 37:eAPE003094.
Chronic pain in elderly caregivers and inuence on stress and depressive symptoms
in pain intensity (rst and second assessment) and
inuence on stress and depressive symptoms. e
present study showed that the greater the dier-
ence in pain intensity, the greater the dierence in
depressive symptoms, i.e., with an increase in pain
intensity, there is an increase in the presence of de-
pressive symptoms over duration.
reinforcing that the older adult who cares for an-
other older adult suers greater health problems.(26)
e prole of elderly caregivers can lead to fra-
gility in their health. Data presented by a study with
elderly caregivers of older adults showed, with statis-
tically signicant results, that increased burden leads
to an increase in the number of chronic diseases, con-
sequently increasing the risk of chronic pain in elder-
ly caregivers of older adults.(27) Continuity in health
problems can be seen based on the data veried in
this present work, demonstrating the inuence of
chronic pain on elderly caregivers’ mental health.
Considering a study carried out over a period of
eight years between 2006 and 2014, which involved
the participation of 963 American couples, it was
found that pain intensity was signicantly associ-
ated with depressive symptoms in older adults in
all waves of the study. According to the couples’ re-
ports, pain intensity was related to change in depres-
sive symptoms.(28) ese results are similar to our
ndings. Although the study did not characterize
caregivers, the authors state that greater pain inten-
sity has the potential to put older adults and their
partners at risk for elevated depressive symptoms.
Other studies carried out with older adults show
similar results, observing the inuence of chronic
pain on depressive symptoms.(29,30) Research carried
out with 419 older adults aged 70 years or older
analyzed the relationship between chronic pain
and sociodemographic variables and health condi-
tions, verifying a direct and bidirectional associa-
tion between depressive symptoms and the pres-
ence of chronic pain.(29) Furthermore, similar data
were identied in a study with 1,788 Chinese older
adults, with an association between the presence of
chronic pain and depressive symptoms through lo-
gistic regression results. is study found an addi-
tive interaction eect between the presence of pain
and depressive symptoms with increased physical
frailty in older adults.(30) In parallel, in the present
study, in addition to the impact of the association of
pain and depressive symptoms, older adults called
caregivers of other older adults oer care by giving
up their own physical and psychological care, caus-
ing greater implications for their health and the care
oered.(28,31)
Table 4. Relationship of change in pain intensity (2014-2018)
with depressive symptoms and stress
Variables Estimate p-value 95% CI
Stress
Pain intensity 0.934 0.058 -0.031
1.898
Depressive symptoms
Pain intensity 0.287 0.027 0.033
0.541
Model adjusted for sex, age, education
Discussion
e results of this study made it possible to identify
a trend in the eect of presence of chronic pain and
pain intensity on stress and depressive symptoms
in elderly caregivers, but without the interaction of
duration. e presence of chronic pain was associ-
ated with an increase in stress scale scores in the sec-
ond assessment (2018) and in depressive symptoms
in both assessments (2014 and 2018). Regarding
pain intensity, similar results were observed.
It is noteworthy that the results obtained
through ANCOVA analysis demonstrate that the
greater the increase in pain intensity, the higher the
score of depressive symptoms over time, and these
data were not evidenced in stress.
Longitudinal studies investigating depressive
symptoms in elderly caregivers with chronic pain
are still scarce in the literature. However, in Brazil,
a cross-sectional study with 186 elderly caregivers
found that 24.2% of the sample had mild depres-
sive symptoms and 5.4% had severe symptoms.
Among the results of this study, the authors con-
rmed the association between pain intensity and
stress through univariate regression analysis, and
the association with stress was conrmed through
multivariate regression.(25) From these results, it is
possible to verify similarity with the present study,
7
Acta Paul Enferm. 2024; 37:eAPE003094.
Terassi M, Rossetti ES, Bento SR, Pavarini SC, Hortense P
e literature presents hypotheses about the
various inuences and associations of the presence
of depressive symptoms in patients with chronic
pain related to anatomical and physiological is-
sues and the negative feelings that are triggered.
According to studies, similar biochemical mecha-
nisms may be involved in the process of depression
and pain, resulting in reduced availability of some
neurotransmitters. Another important factor to be
mentioned is related to negative feelings (anger,
fear, anxiety) that can be experienced by individu-
als who report pain as well as by individuals with
depressive symptoms.(32-36)
Regarding stress, the present study identied an
association between the presence and intensity of
chronic pain and increase in stress scale scores, re-
gardless of duration. However, studies that assess
stress longitudinally in older adults who care for oth-
er older adults are still incipient. However, support-
ing the ndings of this study, cross-sectional research
was developed with 341 elderly caregivers, with high-
er levels of stress being associated with pain intensity,
and this relationship may be a consequence of the
care provided by these older adults.(12) e role of
caregiver can be received as a privilege of caring for a
loved one, however burden can lead to deterioration
of physical and psychological health.(27)
Providing care maintains an intrinsic relation-
ship with stress, according to a study carried out
with 43 caregivers of older adults, as it involves
acceptance of the roles of provider and recipient
of care, with implications for family balance and
quality of life for those who care. e authors of
this study point out that caregivers for older adults
experience stress that is related to physical aspects,
such as pain.(33) Furthermore, a study carried out
with 94 elderly caregivers proves, through a regres-
sion analysis, that caregivers with stress have an av-
erage of 56.61% more burden than caregivers with-
out stress, i.e., burden is a factor of risk for stress.(34)
Caregivers are more vulnerable to health problems
when compared to non-caregivers.(35) e act of car-
ing includes carrying out arduous tasks which, of-
ten, due to a lack of training for this activity, make
them more costly to their health and can result in
conditions such as pain and stress.
e present study assessed older adults in the
community who provided care to other older adults
in the same household, a population that is grow-
ing in our country due to increased life expectancy
and advances in medicine. However, health actions
aimed specically at caregivers of older adults who
are also elderly are still scarce, as is the inuence of
the act of caring on elderly caregivers’ physical and
psychological health. erefore, it is necessary to
implement health service actions and interventions
with a focus on the demands of older adults who
play the role of caring for others, with a focus on
improving physical and psychological well-being,
with the aim of contributing to the quality of life of
this population and reduce care burden, especially
in individuals who report chronic pain.
e presence of chronic pain in older adults,
in itself, contributes to the worsening of health
conditions and worsening of psychosocial condi-
tion.(28) However, when added to care demand and
burden, these problems can be intensied, demon-
strating the importance of assessments and con-
tinuous monitoring so that future interventions
can be carried out in health services.(33) us, the
present study makes contributions with the aim of
highlighting the association between the presence
and pain intensity and stress and depressive symp-
toms over the course of 4 years.
Among the limitations of this study, we can
highlight the lack of more specic data related to
chronic pain duration (in years) and the consider-
ation of only self-reports on the number of medica-
tions in use and the presence of diseases.
Conclusion
e present study identied the eect of chronic
pain on stress and depressive symptoms, regardless
of duration, in elderly caregivers living in the com-
munity. e presence of chronic pain was associated
with an increase in stress scale scores and depressive
symptoms, and an increase in pain intensity is also
associated with an increase in the scores of these
variables. Furthermore, the greater the increase in
pain intensity, the higher the depressive symptom
8Acta Paul Enferm. 2024; 37:eAPE003094.
Chronic pain in elderly caregivers and inuence on stress and depressive symptoms
score, data that demonstrate the need for eective
action to manage chronic pain in this population.
Discussing the eect of chronic pain on psycholog-
ical variables is necessary to enable reection on the
need for assessment and management of chronic
pain in elderly caregivers, with the aim of develop-
ing strategies within the health system, in the short
and long term, to promote caregivers’ physical and
mental health.
Acknowledgements
is work was developed with the support of the
São Paulo Research Support Foundation (Fundação
de Amparo à Pesquisa do Estado de São Paulo - Process
2018/23756-7).
Collaborations
Terassi M, Rossetti ES, Bento SR, Pavarini SCI and
Hortense P declare that they contributed to study
design, data analysis and interpretation, article writ-
ing, critical review of relevant intellectual content
and approval of the nal version to be published.
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