A.R. Ferreira

Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms

Unmet needs are becoming acknowledged as better predictors of the worst prognostic outcomes than common measures of functional or cognitive decline. Their accurate assessment is a pivotal component of effective care delivery, particularly in institutionalized care where little is known about the needs of its residents, many of whom suffer from dementia and show complex needs. The aims of this study were to describe the needs of an institutionalized sample and to analyze its relationship with demographic and clinical characteristics. A cross-sectional study was conducted with a sample from three nursing homes. All residents were assessed with a comprehensive protocol that included Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Neuropsychiatric Inventory (NPI) and Adults and Older Adults Functional Inventory (IAFAI). To identify needs, the Camberwell Assessment of Need for the Elderly (CANE) was used. The final sample included 175 residents with a mean age of 81 standard deviation (SD = 10) years. From these, 58.7% presented cognitive deficit (MMSE) and 45.2% depressive symptoms (GDS). Statistically significant negative correlations were found between MMSE score and met (rs = −0.425), unmet (rs = −0.369) and global needs (rs = −0.565). Data also showed significant correlations between depressive symptoms and unmet (rs = 0.683) and global needs (rs = 0.407), and between behavioral and psychological symptoms (BPSD) and unmet (rs = 0.181) and global needs (rs = 0.254). Finally, significant correlations between functional impairment and met (rs = 0.642), unmet (rs = 0.505) and global needs (rs = 0.796) were also found. These results suggest that in this sample, more unmet needs are associated with the worst outcomes measured. This is consistent with previous findings and seems to demonstrate that the needs of those institutionalized elderly remain under-diagnosed and untreated.

Validity and Reliability of the European Portuguese Version of Neuropsychiatric Inventory in an Institutionalized Sample

Background Neuropsychiatric symptoms are very common in dementia and have been associated with patient and caregiver distress, increased risk of institutionalization and higher costs of care. In this context, the neuropsychiatric inventory (NPI) is the most widely used comprehensive tool designed to measure neuropsychiatric Symptoms in geriatric patients with dementia. The aim of this study was to present the validity and reliability of the European Portuguese version of NPI. Methods A cross-sectional study was carried out with a convenience sample of institutionalized patients (≥ 50 years old) in three nursing homes in Portugal. All patients were also assessed with mini-mental state examination (MMSE) (cognition), geriatric depression scale (GDS) (depression) and adults and older adults functional assessment inventory (IAFAI) (functionality). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected subjects. Results The sample included 166 elderly, with a mean age of 80.9 (standard deviation: 10.2) years. Three out of the NPI behavioral items had negative correlations with MMSE: delusions (rs = -0.177, P = 0.024), disinhibition (rs = -0.174, P = 0.026) and aberrant motor activity (rs = -0.182, P = 0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (rs = 0.166, P = 0.038). NPI showed good internal consistency (overall α = 0.766; frequency α = 0.737; severity α = 0.734). The inter-rater reliability was excellent (intraclass correlation coefficient (ICC): 1.00, 95% confidence interval (CI) 1.00 - 1.00), as well as test-retest reliability (ICC: 0.91, 95% CI 0.80 - 0.96). Conclusion The results found for convergent validity, inter-rater and test-retest reliability, showed that this version appears to be a valid and reliable instrument for evaluation of neuropsychiatric symptoms in institutionalized elderly.

Biosourced Binder for Wood Particleboards Based on Spent Sulfite Liquor and Wheat Flour

Currently, the majority of binders used in wood particleboard (PB) manufacturing are formaldehyde-based synthetic resins. Because of the toxicity of formaldehyde, there is a strong demand for eco-friendly alternatives with similar performances and economic viability. In this work, thick spent sulfite liquor (TSSL), an industrial byproduct from sulfite pulp mills, is proposed as a binder for fully bio-based PBs. The results showed that PBs bound with TSSL present appropriate mechanical performance, which was further improved when TSSL was combined with wheat flour at an 84:16 dry weight ratio and preheated to 94 °C prior to application. For 13.2% binder content per dry wood weight, the PB internal bond strength was 0.46 N mm−2, which is above the standard requirements for PB type P2 (0.35 N mm−2). Optical microscopy showed that TSSL hinders the gelatinization of starch granules during preheating, allowing the binder mixture to maintain a low viscosity suitable for combination with wood particles and PB production.

Hydrogel-Assisted Antisense LNA Gapmer Delivery for In Situ Gene Silencing in Spinal Cord Injury

After spinal cord injury (SCI), nerve regeneration is severely hampered due to the establishment of a highly inhibitory microenvironment at the injury site, through the contribution of multiple factors. The potential of antisense oligonucleotides (AONs) to modify gene expression at different levels, allowing the regulation of cell survival and cell function, together with the availability of chemically modified nucleic acids with favorable biopharmaceutical properties, make AONs an attractive tool for novel SCI therapy developments. In this work, we explored the potential of locked nucleic acid (LNA)-modified AON gapmers in combination with a fibrin hydrogel bridging material to induce gene silencing in situ at a SCI lesion site. LNA gapmers were effectively developed against two promising gene targets aiming at enhancing axonal regeneration—RhoA and GSK3β. The fibrin-matrix-assisted AON delivery system mediated potent RNA knockdown in vitro in a dorsal root ganglion explant culture system and in vivo at a SCI lesion site, achieving around 75% downregulation 5 days after hydrogel injection. Our results show that local implantation of a AON-gapmer-loaded hydrogel matrix mediated efficient gene silencing in the lesioned spinal cord and is an innovative platform that can potentially combine gene regulation with regenerative permissive substrates aiming at SCI therapeutics and nerve regeneration.

Needs in Elderly in Residential Care and Their Relationship to Dependency

Introduction The worlds population is aging rapidly. Along with age, other challenges, like increased levels of dependency and new, complex and often expensive needs of an aged population are rising. Since unmet needs are associated with key prognostic outcomes such as excess disability or premature institutionalization, they are major health concerns. Objectives To study the relationship between levels of dependency and needs presented by an elderly sample. Methods A cross-sectional study with an institutionalized sample (≥50years) from three Portuguese residential homes was carried out. All permanent residents were eligible. However, those with delirium, who were terminally ill, unable to communicate or who refused to participate were not included. Participants were assessed with the Adults and Older Adults Functional Assessment Inventory/IAFAI and the Camberwell Assessment of Need for the Elderly/CANE. Each resident and a respective staff carer were interviewed for residents’ current needs. Results The sample included 175 elderly, with a mean age of 81 (sd=10). The majority were female (90%) and widowed (50%) with low educational level (86%, 0-4 years). The mean functional impairment (IAFAI score) was 43.45% (sd=23.52) and the number of global needs was 12 (sd=4). A significant correlation between the IAFAI score and the total of met (r s =0.642, p s =0.505, p s =0.796, p Conclusions In this sample higher levels of dependency were related with more met/unmet needs. Despite the cross-sectional nature of the study, the findings convey an important message regarding the influence of functional disability on unmet needs.

Needs and Depressive Symptoms in Elderly Living in Residential Care: is There a Relationship?

Introduction An ageing population requires new and different approaches to care. In institutionalized settings it is well known that depression, among other psychiatric symptoms, is presented by a high proportion of residents, associated with an increase in needs, which are nevertheless often underestimated. Objectives To analyze the relation between met/unmet needs and depression in an elderly institutionalized sample. Methods This cross-sectional study included an elderly sample (≥50years) recruited from three Portuguese residential homes. All permanent residents were eligible, but residents with delirium or who were unresponsive or unwilling to complete the assessment were not included. Participants were assessed with Geriatric Depression Scale/GDS and Camberwell Assessment of Needs for the Elderly/CANE. Results The sample (n=175) had a mean age of 81(sd=10), the majority were female (90%), widowed (51%), had a low educational level (86.1%, 0-4 years) and had been institutionalized for 7(sd=11) years on average. According to GDSscore, 45.2% presented depression. Daytime activities (73.1%), Eyesight/Hearing (67.4%), Psychological distress (52.0%), Company (40.6%) and Memory (37.1%) were the most frequent unmet needs. A significant correlation between the GDSscore and the total of unmet (r s =0.683,p s =0.407,p Conclusions In this residential sample the presence of depressive symptoms was correlated with the number of needs. This association is coherent with previous findings and highlights the importance of an early assessment of these symptoms, in order to cover the unmet needs that were mostly psychological and amenable to interventions with improvement in wellbeing.