Daniela Figueiredo

Qualidade de vida e bem-estar dos idosos: um estudo exploratório na população portuguesa

OBJECTIVES To characterize elderly peoples perception of quality of life and well-being. METHODS A sample of 1,665 elderly aged 75 years or more living in 13 districts in Portugal were studied. Of them, 311 subjects were excluded because they were not able to convey their opinions. The EASYcare (Elderly Assessment System) was used to collect data from 1,354 (81.3%) of 1,665 subjects. Statistical analysis was based on principal components analysis and cluster analysis. RESULTS EASYcares showed to have good psychometric proprieties (Cronbach a =0.92). The principal component analysis identified 4 factors: mobility, communication competencies, well-being and daily living activities. Cluster analysis showed 4 groups of elderly people: autonomous (62.8%), almost autonomous (8.5%), almost dependent (4.3%) and dependent (3.2%). CONCLUSIONS Quality of life for most of the elderly is quite positive, and only a small group presents problems related to severe cognitive impairment or some degree of dependence.

Day-to-day living with severe chronic obstructive pulmonary disease: Towards a family-based approach to the illness impacts

Objective: This study explores the perspectives of both patients and family members regarding the impact of chronic obstructive pulmonary disease (COPD) in their family life. Design: An exploratory qualitative study was conducted with patients and their family members in the chronic phase of COPD. Individual interviews were performed to explore participants’ perspectives and submitted to thematic analysis. Results: Six major themes emerged from patients’ perspective: (1) impact of COPD symptoms on personal and family daily life; (2) (over)protective family support; (3) difficulties in couple communication; (4) sense of identity loss; (5) fear of COPD progression; and (6) coping resources. Five main themes emerged from the family members’ perspective: (1) restrictions in family’s social life; (2) emotional distress related to COPD exacerbations; (3) tension in couple relationship; (4) financial strain of COPD; and (5) coping resources. Conclusions: The overall findings illustrate the complex interaction between the experience of living with COPD and communication patterns, emotional states, social support and social roles within the family. The results highlight the need to develop family-based interventions to facilitate a functional adjustment to COPD. However, these interventions in COPD remain undeveloped and empirical evidence is needed.

Coping with the caregiving role: Differences between primary and secondary caregivers of dependent elderly people

Objectives: The topic of how primary informal caregivers cope with their caregiving demands has generated significant research. However, little is known about secondary informal caregivers, who often share caregiving responsibilities. This cross-sectional study aims to analyse and compare the use and effectiveness of coping strategies of primary and secondary informal caregivers of dependent elderly people, living at home. Method: A sample of 180 informal caregivers of dependent elderly people – 90 primary and 90 secondary caregivers – was obtained. The study was conducted in the district of Aveiro (Portugal). The Portuguese version of Caregivers’ Assessment Management Index – CAMI (Nolan, Keady, & Grant, 1995) was administrated to both sub-samples. Results: Findings suggest that emotion-cognitive strategies are less efficient for secondary caregivers (e.g. drawing on personal or religious beliefs). Common problem-solving strategies adopted by both types of caregivers involve relying on own their experience and expertise and addressing and finding a solution to the problem. Neither group were highly efficient at managing care-related stress, but both identified benefits from taking time off or maintaining interests outside of caregiving. Conclusion: These findings can guide professionals in targeting and monitoring interventions aiming to develop caregivers’ effective coping strategies. Besides, engaging secondary caregivers in current available interventions and services, usually targeted to the primary caregiver, is of paramount need, as they can reduce the burden of primary caregivers and delay institutionalisation.

Effects of Person-Centered Care Approaches to Dementia Care on Staff A Systematic Review

Person-centered care (PCC) has been the subject of several intervention studies reporting positive effects on people with dementia. However, its impact on staff remains unclear. The purpose of this systematic review was to assess the impact of PCC approaches on stress, burnout, and job satisfaction of staff caring for people with dementia in residential aged care facilities. Research articles published up to 2013 were searched on PubMed, Web of Knowledge, Scopus, and EBSCO and reference lists from relevant publications. The review was limited to experimental and quasi-experimental studies, published in English and involving direct care workers (DCWs). In all, 7 studies were included, addressing different PCC approaches: dementia care mapping (n = 1), stimulation-oriented approaches (n = 2), emotion-oriented approaches (n = 2), and behavioral-oriented approaches (n = 2). Methodological weaknesses and heterogeneity among studies make it difficult to draw firm conclusions. However, 5 studies reported benefits on DCWs, suggesting a tendency toward the effectiveness of PCC on staff.

Caring for relatives with chronic obstructive pulmonary disease: how does the disease severity impact on family carers?

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for families. However, information on the impacts of caring for relatives with COPD on carers’ psychological health is limited. This study aimed to analyse the subjective burden of family carers of people with early and advanced COPD and its predictor variables. Methods: A cross-sectional study was conducted. A structured questionnaire was used to collect socio-demographics and care-giving characteristics. Self-rated physical and mental health were measured by two items from the International Classification of Functioning, Disability and Health checklist. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Subjective burden was assessed with the Carers’ Assessment of Difficulties Index (CADI). Descriptive and inferential analyses were performed. Results: A total of 167 family carers participated: 113 were caring for people with early and 54 with advanced COPD. Both groups presented anxiety/depression symptoms. Those caring for people with advanced COPD reported higher subjective burden, more depression symptoms and poorer self-rated mental health than those caring for early COPD. Advanced COPD (coefficient 6.7), depression (coefficient 6.3), anxiety (coefficient 5.6), care-giving hours per week (coefficient 3.2) and self-rated mental health (coefficient 2.8) were significant predictors of carers’ subjective burden. Conclusion: The findings suggest that the gradual course of COPD imposes an increasing physical and emotional burden on carers, with negative impacts on their psychological health. The study highlights the relevance of early interventions in the context of COPD to prevent carers’ burden.

Effects of a Motor and Multisensory-Based Approach on Residents with Moderate-to-Severe Dementia

Involving institutionalized people with dementia in their routines may be challenging, particularly in advanced stages of the disease. Motor and multisensory stimulation may help to maintain or improve residents’ remaining abilities such as communication and self-care. This study examines the effects of a motor and multisensory-based approach on the behavior of 6 residents with moderate-to-severe dementia. A single-group, pre- and post test design was conducted. Motor and multisensory stimulation strategies were implemented in residents’ morning care routines by staff, after the provision of training and assistance. Twelve video recordings of morning care (6 pre- and 6 post interventions) were coded for the type of residents’ behavior. Results showed a tendency toward improvements in residents’ levels of caregiver-direct gaze, laughing and engagement, and a reduction of closed eyes, during morning care. The introduction of a motor and multisensory-based approach in care routines may improve residents’ engagement and attention to the environment.

Making sense(s) in dementia: a multisensory and motor-based group activity program.

Lack of engagement in meaningful activities is associated with poor quality of life in dementia; thus, the development of these activities has been recommended. This pilot study aimed to develop a multisensory and motor-based group activity program for residents with dementia and assess its impact on residents’ behavior. The program was designed using a multisensory and motor-based approach in sixteen 45-minute weekly sessions tailored to residents’ characteristics. Four residents with advanced dementia participated in the program. The frequency and duration of the residents’ behavior were assessed using video recordings. All residents participated in the proposed activities, although they were more participative and communicative in some sessions than in others. Group activity programs based on multisensory and motor stimulation can be a promising approach for people with advanced dementia; however, further research is needed. This study may serve as reference to the implementation of future programs aiming to increase person-centeredness of the care provided.

People with dementia in long-term care facilities: an exploratory study of their activities and participation

Abstract Purpose: To describe the activities and participation of people with dementia living in long-term care facilities. Methods: An exploratory descriptive study with 329 people medically diagnosed with dementia was conducted in the central region of Portugal. Socio-demographics were collected with a questionnaire based on the International Classification of Functioning, Disability and Health-Checklist. Cognitive impairment was measured with the Mini-Mental State Examination (MMSE) and the activities and participation were described with the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Results: Participants mean age was 83.6 ± 7.1 years old. Most were female (79.6%), widows (60.8%), had 1–4 years of education (51.1%) and were living in a long-term care facility from 2 to 4 years (36.2%). Alzheimer’s disease (41.9%) was the most prevalent type of dementia. According to the MMSE, the cognitive status was low (8.7 ± 7.9) and 61.7% had severe cognitive impairment. The MMSE scores were negatively correlated with the WHODAS 2.0 scores. Mobility was the most affected domain of WHODAS 2.0. The total score showed that 77.8% of the sample was severely limited in activities and restricted in participation. Conclusions: This study shows that people with dementia living in long-term care facilities have severe activities limitation and participation restriction. However, most residents understand what people say, eat by themselves and get along with people who are close to them. This information on disability is crucial to plan health resources and inform rehabilitation programmes tailored to individuals’ functionality. Implications for Rehabilitation People with dementia living in long-term care facilities have severe activities limitation and participation restriction. Rehabilitation through engagement in activities and enhancement of participation seems to be crucial for this population. A multidimensional characterisation of activities and participation is recommended to inform the design and implementation of rehabilitation. Mobility was the most affected domain, highlighting the need for specific rehabilitation, as mobility restrictions are associated with residents’ dependency and caregivers’ burden.

Motor and multisensory care-based approach in dementia: long-term effects of a pilot study.

This study examined the short-, mid-, and long-term effects of a motor and multisensory care-based approach on (i) the behavior of institutionalized residents with dementia and (ii) care practices according to staff perspective. In all, 6 residents with moderate to severe dementia (mean age 80.83 ± 10.87 years) and 6 staff members (40 ± 10.87 years old) were recruited. Motor and multisensory stimulation strategies were implemented in residents’ morning care. Data were collected with video recordings and focus-group interviews before, immediately after, at 3 months and 6 months after the intervention. The frequency and duration of each resident’s behavior were analyzed. Content analysis was also performed. Results showed short-term improvements in residents’ communication and engagement, followed by a sustained decline over time. Staff reported to change their practices; however, difficulties related to the institution organization were identified. There is a need to implement long-term strategies and involve institutions at different organizational levels to sustain the results.

Effects of a pulmonary rehabilitation program with balance training on patients with COPD.

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) have balance impairments. However, pulmonary rehabilitation (PR) is associated with only minor improvements in functional balance. Therefore, there is a need to explore the role of balance training within PR. This study aimed at assessing the effects of a PR program, with a specific component of balance training, on functional balance of patients with COPD. METHODS: Outpatients with COPD (N = 22, age = 68.0 ± 11.8 years; forced expiratory volume in 1 second = 72.2 ± 22.3% predicted) participated in a 12-week PR program including exercise training and psychosocial support and education. Exercise training sessions comprised endurance, strength, and a specific component of balance training. The Timed Up and Go (TUG) test was used to assess functional balance before and after the PR. Health-related quality of life (St Georges Respiratory Questionnaire), quadriceps muscle strength (10 repetition maximum), and exercise tolerance (6-minute walk test) were also assessed. RESULTS: Patients demonstrated significant improvements in TUG scores after PR (mean change −1.7 ± 1.4 seconds; P = .001; effect size = 1.249). Before PR, 9 (41%) participants and after PR only 1 (4.5%) participant had a TUG performance worse than the average performance of age-matched healthy peers (P = .008). The St Georges Respiratory Questionnaire symptoms score (P = .012), quadriceps muscle strength (P = .001), and exercise tolerance (P = .001) were also improved. CONCLUSIONS: Pulmonary rehabilitation with a specific component of balance training had a large effect on functional balance in patients with COPD. Findings highlight the value of including balance training in PR programs. Further research is needed to determine the optimal intervention to improve balance and its specific components among patients with COPD.