Liliana Sousa

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.

HOW MULTIPROBLEM FAMILIES TRY TO FIND SUPPORT IN SOCIAL SERVICES

This article aims to contribute to a better understanding of the relationship between multiproblem families and social agencies, and in particular of how families try to find support in larger systems. Usually, multiproblem families are also multi‐assisted, since the several problems they live with attract intervention from a wide range of social protection services. This research used a qualitative approach; data were collected from 56 multiproblem households, using a semi‐structured interview. Findings suggest seven categories of families: ‘outsider’ families (who reject the existence of problems, so never try to find support); ‘resigned’ families (who give up looking for formal support after a first refusal, and continue coping on their own); ‘persistent’ families (who insist in getting support from several social agencies); ‘over‐needy’ families (any minimal difficulty justifies the search for formal support); ‘balanced’ families (who apply for formal support only when they experience difficulties in dealing with problems); ‘imprudent’ families (these ask social agencies for support only when problems reach an unsustainable level); and ‘ignored’ families (who do not try to get support, and no formal help reaches them).

INTERVENTION WITH MULTI‐PROBLEM POOR CLIENTS: TOWARDS A STRENGTHS‐FOCUSED PERSPECTIVE

Since multi‐problem poor clients are mostly recognized by their problems, intervention is developed from a problem‐centered perspective, which has shown itself to be only modestly effective. The strengths perspective, on the other hand, which assumes that every system has competences, has been shown to be more effective. Nevertheless, incorporating the strengths approach is difficult since the problem‐centered view is embedded in our social, cultural and professional context. This study aims to learn whether the strengths approach is incorporated (or not) in practice involving multi‐problem poor clients, thus allowing us to perceive what obstacles and potentialities to such an approach emerge. An interview was administered to both clients and practitioners, and the results confirm that the problem‐centered perspective is dominant and that a shift in perspectives is still in an incipient stage.

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.

BUILDING ON PERSONAL NETWORKS WHEN INTERVENING WITH MULTI‐PROBLEM POOR FAMILIES

Which strengths exist in the personal social networks of members of multi‐problem poor families? This is a crucial question at a time when a substantial amount of data demonstrates the protector effect of social ties and the harmful effect of their insufficiency in aspects such as well‐being, personal development and social adjustment. In addition, recent research has demonstrated that professionals are no longer the only providers of solutions for the problems of families and individuals in need. Therefore, personal networks must be involved so that intervention is based on the competences and strengths of the family, its members and the social networks of these elements. With the aim of analyzing the strengths which exist in the personal social networks of members of multi‐problem poor families, a sample of 100 members of these families was surveyed, using a structured interview, based on Sluzki (La red social: frontera de la practica sistemica, Gedisa, Barcelona, 1996). The main results of this exploratory study suggest that: strong family ties constitute a resource to be taken into account; friends and neighbours are a resource that needs to be activated; the members of these families need to develop more reciprocal relationships within their personal network; emotional support is an open door towards the activation of other forms of support; it is necessary to give special attention to two sub‐groups (women and the elderly).

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.

How communication of genetic information within the family is addressed in genetic counselling: a systematic review of research evidence

Supporting consultands to communicate risk information with their relatives is key to obtaining the full benefits of genetic health care. To understand how health-care professionals address this issue in clinical practice and what interventions are used specifically to assist consultands in their communication of genetic information to appropriate relatives, we conducted a systematic review. Four electronic databases and four subject-specific journals were searched for papers published, in English, between January 1997 and May 2014. Of 2926 papers identified initially, 14 papers met the inclusion criteria for the review and were heterogeneous in design, setting and methods. Thematic data analysis has shown that dissemination of information within families is actively encouraged and supported by professionals. Three overarching themes emerged: (1) direct contact from genetic services: sending letters to relatives of mutation carriers; (2) professionals’ encouragement of initially reluctant consultands to share relevant information with at-risk relatives and (3) assisting consultands in communicating genetic information to their at-risk relatives, which included as subthemes (i) psychoeducational guidance and (ii) written information aids. Findings suggest that professionals’ practice and interventions are predicated on the need to proactively encourage family communication. We discuss this in the context of what guidance of consultands by professionals might be appropriate, as best practices to facilitate family communication, and of the limits to non-directiveness in genetic counselling.

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.

When Multi-problem Poor Individuals' Myths Meet Social Services Myths

• Summary: This article addresses the myths that multi-problem poor clients and professionals hold about each other, since process variables play a decisive role in the success of the intervention. • Findings: The principal myths which have emerged from this study indicate that the effectiveness of the intervention is perceived by clients and professionals to depend on the actions of the professional; and the ineffectiveness of the intervention is perceived by clients to depend on the actions of the professional and by the professionals to depend on the capacity of the families to follow their instructions. • Applications : The emerging myths allow us to understand that the process of intervention can be affected by disculpability and adequate impotence, since each sub-system tends to blame the other when interventions run a negative course.