Ana Paula Gil

Elder Abuse in Portugal: Findings From the First National Prevalence Study

In this study, we present findings of the Portuguese national prevalence study, “Aging and Violence,” the purpose of which was to estimate the prevalence of abuse and neglect of older people in family settings over a 12-month period and examine the relationship between abuse and sociodemographic and health characteristics. Through a telephone survey of a representative probability sample (N = 1,123), we evaluated 12 abusive behaviors and demographic data. Overall, 12.3% of older adults experienced elder abuse in family settings. The prevalence rates of specific types were as follows: psychological, 6.3%; financial, 6.3%; physical, 2.3%; neglect, 0.4%; and sexual, 0.2%. Logistic regression was employed to determine the relationship between abuse and covariates. The study suggests that education level, age, and functional status are significantly associated with abuse. Accurate estimates of the prevalence of elder abuse and understanding of victim and perpetrator characteristics are fundamental to designing effective strategies for prevention and intervention.

Prevalência da violência contra as pessoas idosas: uma revisão crítica da literatura

Os estudos de prevalencia sobre a violencia contra as pessoas idosas, em contexto familiar, desenvolvidos nas tres ultimas decadas, especialmente na Europa e paises anglo-saxonicos, nao sao suficientemente esclarecedores, por insuficiencias na definicao dos modelos teoricos e nos conceitos operatorios. Neste artigo de revisao sistematica da literatura identifica-se a diversidade de definicoes e desenhos de investigacao, com impacto inevitavel nas variacoes das estimativas. Tambem a percecao da opiniao publica europeia sobre o problema colide com os baixos valores estimados. Procurar-se-a refletir sobre as razoes subjacentes a essas representacoes e refletir criticamente sobre as estimativas dos estudos de prevalencia de base populacional.Os estudos de prevalencia sobre a violencia contra as pessoas idosas, em contexto familiar, desenvolvidos nas tres ultimas decadas, especialmente na Europa e paises anglo-saxonicos, nao sao suficientemente esclarecedores, por insuficiencias na definicao dos modelos teoricos e nos conceitos operatorios. Neste artigo de revisao sistematica da literatura identifica-se a diversidade de definicoes e desenhos de investigacao, com impacto inevitavel nas variacoes das estimativas. Tambem a percecao da opiniao publica europeia sobre o problema colide com os baixos valores estimados. Procurar-se-a refletir sobre as razoes subjacentes a essas representacoes e refletir criticamente sobre as estimativas dos estudos de prevalencia de base populacional.

Development of a culture sensitive prevalence study on older adults violence: qualitative methods contribution

Purpose – The purpose of this paper is to reflect on how qualitative approaches can improve a prevalence study on older adults’ violence. The paper describes how qualitative data can help frame a complex and multidimensional problem, such as older adults’ violence, within the culture where it happens and therefore prevent two risks present in prevalence studies: underestimation and overestimation. Design/methodology/approach – To adequately measure violence and violent behaviours the authors first conducted four focus groups with the target population – older adults aged 60 and over – and 13 in-depth interviews with older adult victims of violence. Through content analysis of focus groups and in-depth interviews the authors sought to understand how violence is perceived, defined and limited by the general population and by victims. Findings – By employing qualitative methods the authors were able to operationalise violence, decide upon and select specific behaviours to measure, rephrase questions and deve...

Estudo sobre pessoas idosas vítimas de violência em Portugal: sociografia da ocorrência

O presente artigo apresenta dados sobre violencia contra pessoas com 60 e mais anos residentes em Portugal ha mais de 12 meses. O estudo transversal e descritivo recolheu dados por meio de um questionario aplicado presencialmente a vitimas que recorreram a tres entidades governamentais e a uma instituicao nao-governamental de apoio a vitimas. A amostra nao probabilistica foi constituida por 510 vitimas de violencia em contexto familiar. A violencia fisica e a psicologica foram os tipos mais reportados, afetando 87,8% e 69,6% das pessoas estudadas, seguindo-se a violencia financeira (47,5%), sexual (7,5%) e a negligencia (6,5%). A maioria (74,1%) dos respondentes indicou mais de um tipo de violencia. As vitimas, na maioria mulheres, tinham uma media de idade de 70,7 anos. A maioria dos agressores pertencia a familia nuclear, nomeadamente, conjuges ou companheiros, filhos/enteados e filhas/enteadas. Contudo, observaram-se diferencas no agressor consoante o genero da vitima. Os resultados indicam que a violencia nao e um fenomeno uniforme, apresentando-se sob diferentes configuracoes.This article presents data on violence against persons aged 60 years or older and living in Portugal for at least 12 months. The cross-sectional descriptive study collected data with a face-to-face questionnaire applied to victims that had sought assistance at three government institutions and one non-governmental support service for victims. The non-probabilistic sample included 510 victims of violence in family settings. Physical and psychological violence were the most common (87.8% and 69.6%, respectively). Financial violence was reported by 47.5% of the victims, followed by sexual assault (7.5%) and neglect (6.5%). The majority of victims (74.1%) reported more than one type of violence. Victims were mostly women, and mean age was 70.7 years. Most of the perpetrators belonged to the nuclear family, namely spouses or partners, sons/sons-in-law, and daughters/daughters-in-law. However, differences were observed according to victims gender. The results indicate that violence is not a uniform phenomenon, presenting different configurations.

Genetic variation at the CYP2C19 gene associated with metabolic syndrome susceptibility in a South Portuguese population: results from the pilot study of the European Health Examination Survey in Portugal

BackgroundMetabolic syndrome (MetS) is a cluster of conditions that occur together, increasing the risk of heart disease, stroke and diabetes. Since pathways implicated in different diseases reveal surprising insights into shared genetic bases underlying apparently unrelated traits, we hypothesize that there are common genetic components involved in the clustering of MetS traits. With the aim of identifying these common genetic components, we have performed a genetic association study by integrating MetS traits in a continuous MetS score.MethodsA cross-sectional study developed in the context of the Portuguese Component of the European Health Examination Survey (EHES) was used. Data was collected through a detailed questionnaire and physical examination. Blood samples were collected and biochemical analyses were performed. Waist circumference, blood pressure, glucose, triglycerides and high density lipoprotein cholesterol (HDL) levels were used to compute a continuous MetS score, obtained by Principal Component Analysis. A total of 37 single nucleotide polymorphisms (SNPs) were genotyped and individually tested for association with the score, adjusting for confounding variables.ResultsA total of 206 individuals were studied. Calculated MetS score increased progressively with increasing number of risk factors (P < 0.001). We found a significant association between CYP2C19 rs4244285 and the MetS score not detected using the MetS dichotomic approach. Individuals with the A allelic variant seem to be protected against MetS, displaying a lower MetS score (Mean difference: 0.847; 95%CI: 0.163-1.531; P = 0.015), after adjustment for age, gender, smoking status, excessive alcohol consumption and physical inactivity. An additive genetic effect of GABRA2 rs279871, NPY rs16147 and TPMT rs1142345 in the MetS score variation was also found.ConclusionsThis is the first report of a genetic association study using a continuous MetS score. The significant association found between the CYP2C19 polymorphism and the MetS score but not with the individual associated traits, emphasizes the importance of lipid metabolism in a MetS common etiological pathway and consequently on the clustering of different cardiovascular risk factors. Despite the sample size limitation of our study, this strategy can be useful to find genetic factors involved in the etiology of other disorders that are defined in a dichotomized way.

Prevalence of overweight and obesity in Portugal: Results from the First Portuguese Health Examination Survey (INSEF 2015)

Obesity is recognised as a serious public health issue, due to its associated morbidity and mortality. This study aimed at estimating the prevalence of overweight and obesity in the Portuguese population through direct measurements obtained by the 1st National Health Examination Survey (INSEF 2015) and to identify its associated sociodemographic factors. INSEF was a nationally representative cross-sectional prevalence study conducted on 4911 Portuguese adults aged 25-74 years, in 2015. Height and weight were measured according to the European Health Examination Survey procedures. Poisson regression was used to estimate the adjusted prevalence ratios of overweight and obesity according to age, marital status, occupational activity, education, urbanization of living area and smoking status. Overall prevalences of overweight and obesity were 39.1% and 28.6%, respectively. The prevalence of overweight was higher among men (45.5% vs 33.2%) while the prevalence of obesity was higher among women (32% vs 25%). The sociodemographic factors associated with overweight and obesity were age, marital status and education. Smoking status was associated with overweight and obesity but only in women. INSEF suggests that a high prevalences of overweight and obesity are found in older individuals, married, with lower education levels and non-smoking women. Public health interventions are urgently required for obesity prevention, namely throughout health literacy strategies.

Psychological elder abuse: measuring severity levels or potential family conflicts?

Purpose Psychological elder abuse (PEA) assessment is described with different thresholds. The purpose of this paper is to examine how the prevalence of PEA and the phenomenon’s characterisation varied using two different thresholds. Design/methodology/approach Participants from the cross-sectional population-based study, Aging and Violence (n=1,123), answered three questions regarding PEA. The less strict measure considered PEA as a positive response to any of the three evaluated behaviours. The stricter measure comprised the occurrence, for more than ten times, of one or more behaviours. A multinomial regression compared cases from the two measures with non-victims. Findings Results show different prevalence rates and identified perpetrators. The two most prevalent behaviours (ignoring/refusing to speak and verbal aggression) occurred more frequently (>10 times). Prevalence nearly tripled for “threatening” from the stricter measure (>10 times) to the less strict (one to ten times). More similarities, rather than differences, were found between cases of the two measures. The cohabiting variable differentiated the PEA cases from the two measures; victims reporting abuse >10 times were more likely to be living with a spouse or with a spouse and children. Research limitations/implications Development of a valid and reliable measure for PEA that includes different ranges is needed. Originality/value The study exemplifies how operational definitions can impact empirical evidence and the need for researchers to analyse the effect of the definitional criteria on their outcomes, since dichotomization between victim and non-victim affects the phenomenon characterisation.

Exploring the Correlates to Depression in Elder Abuse Victims: Abusive Experience or Individual Characteristics?

Depression and depressive symptoms have been studied both as risk factors and consequences of elder abuse, even though the most common cross-sectional design of the studies does not allow inferring cause or consequence relationships. This study estimates the proportion of older adults who screened positive for depressive symptoms among those self-reporting elder abuse and examines whether individual characteristics and/or abusive experience aspects are associated with self-reported depressive symptoms. Participants were 510 older adults self-reporting experiences of abuse in family setting enrolled in the cross-sectional victims’ survey of the Aging and Violence Study. Depressive symptoms were assessed through the abbreviated version of the Geriatric Depression Scale (GDS-5). Poisson regression was used to determine the prevalence ratio (PR) of screening depressive symptoms according to individual and abusive experience covariates: sex, age group, cohabitation, perceived social support, chronic diseases, functional status, violence type, perpetrator, and number of conducts. Women (PR = 1.18, 95% confidence interval [CI] = [1.04, 1.35]) individuals perceiving low social support level (PR = 1.36, 95% CI = [1.16, 1.60]) and with long-term illness (PR = 1.17, 95% CI = [1.02, 1.33]) were found to be associated with increased risk for screening depressive symptoms. In regard to abusive experience, only the number of abusive conducts increased the PR (PR = 1.07, 95% CI = [1.05, 1.09]). Routine screening for elder abuse should include psychological well-being assessment. Interventions toward risk alleviation for both mental health problems and elder abuse should target women perceiving low social support level and with long-term illness.

Pharmacogenetic profile of a South Portuguese population: results from the pilot study of the European Health Examination Survey in Portugal.

Background: The genetic inter-individual variability of drug response can lead to therapeutic failure or adverse drug reactions (ADRs). The aims of this study were to assess the pharmacogenetic profile of a South Portuguese population according to established dosing guidelines for commonly prescribed drugs and to compare it with that of previously genotyped populations. Methods: A cross-sectional study was developed in the context of the Portuguese Component of the European Health Examination Survey (EHES). A total of 47 pharmacogenetically relevant variants in 23 different genes were genotyped in 208 participants. Allelic and genotypic frequencies were calculated, and the pharmacogenetic profile of the participants was defined. A comparative analysis was conducted through electronic database search. Pairwise Fst calculations were performed to assess the genetic distance between populations. Results: We found a significant small differentiation between the Portuguese regional populations regarding CYP2C9 rs1057910, CYP2D6 rs3892097, MTHFR rs1801133 and F5 rs6025. When consid-ering 4 HapMap populations, ADH1B rs2066702, ADH1B rs1229984, NAT2 rs1799931 and VKORC1 rs9923231 displayed a significant population differentiation. We found that 18.9% of the participants are intermediate or poor metabolizers for at least 3 drugs simultaneously and that 84.6% of the participants have at least one therapeutic failure or ADR risk allele for the considered drugs. Conclusions: There is a high prevalence of risk alleles associated with an altered drug metabolism regarding drugs largely used by the South Portuguese population. This knowledge contributes to the prediction of their clinical efficacy and/or toxicity, optimizing therapeutic response while improving cost-effectiveness.

A sociography of elderly victims of family violence in Portugal

O presente artigo apresenta dados sobre violencia contra pessoas com 60 e mais anos residentes em Portugal ha mais de 12 meses. O estudo transversal e descritivo recolheu dados por meio de um questionario aplicado presencialmente a vitimas que recorreram a tres entidades governamentais e a uma instituicao nao-governamental de apoio a vitimas. A amostra nao probabilistica foi constituida por 510 vitimas de violencia em contexto familiar. A violencia fisica e a psicologica foram os tipos mais reportados, afetando 87,8% e 69,6% das pessoas estudadas, seguindo-se a violencia financeira (47,5%), sexual (7,5%) e a negligencia (6,5%). A maioria (74,1%) dos respondentes indicou mais de um tipo de violencia. As vitimas, na maioria mulheres, tinham uma media de idade de 70,7 anos. A maioria dos agressores pertencia a familia nuclear, nomeadamente, conjuges ou companheiros, filhos/enteados e filhas/enteadas. Contudo, observaram-se diferencas no agressor consoante o genero da vitima. Os resultados indicam que a violencia nao e um fenomeno uniforme, apresentando-se sob diferentes configuracoes.This article presents data on violence against persons aged 60 years or older and living in Portugal for at least 12 months. The cross-sectional descriptive study collected data with a face-to-face questionnaire applied to victims that had sought assistance at three government institutions and one non-governmental support service for victims. The non-probabilistic sample included 510 victims of violence in family settings. Physical and psychological violence were the most common (87.8% and 69.6%, respectively). Financial violence was reported by 47.5% of the victims, followed by sexual assault (7.5%) and neglect (6.5%). The majority of victims (74.1%) reported more than one type of violence. Victims were mostly women, and mean age was 70.7 years. Most of the perpetrators belonged to the nuclear family, namely spouses or partners, sons/sons-in-law, and daughters/daughters-in-law. However, differences were observed according to victims gender. The results indicate that violence is not a uniform phenomenon, presenting different configurations.