Oscar Ribeiro

Active Ageing: An Empirical Approach to the WHO Model

Background. In the beginning of the 21st century, the world summit on population taking place in Madrid approved active ageing, WHO (2002) as the main objective of health and social policies for old people. Few studies have been done on the scientific validity of the construct. This study aims to validate the construct of active ageing and test empirically the WHO (2002) model of Active Ageing in a sample of community-dwelling seniors. Methods. 1322 old people living in the community were interviewed using an extensive assessment protocol to measure WHOs determinants of active ageing and performed an exploratory factor analysis followed by a confirmatory factor analyses. Results. We did not confirm the active ageing model, as most of the groups of determinants are either not independent or not significant. We got to a six-factor model (health, psychological component, cognitive performance, social relationships, biobehavioural component, and personality) explaining 54.6% of total variance. Conclusion. The present paper shows that there are objective as well as subjective variables contributing to active ageing and that psychological variables seem to give a very important contribute to the construct. The profile of active ageing is expected to vary between contexts and cultures and can be used to guide specific community and individually based interventions.

Older male carers and the positive aspects of care

ABSTRACT Older men are becoming more visible in care-giving research but there are still few studies that focus expressly on the extent to which care-giving has made positive contributions to their life and has been rewarding. Drawing on data from in-depth personal interviews, this Portuguese study analyses the positive statements in the personal descriptions of the care-giving experience of 53 elderly men who were caring for chronically-ill wives. It also explores the differences between the positive references made by the men who were caring for a wife who had dementia and those made by men whose wives had physical impairments. Using open coding and content analysis, positive aspects were identified in 32 of the 53 care-giving situations. The most prevalent themes were ‘satisfaction’ and ‘perceived social honour’. The findings show that positive returns from the caring experience and role were strongly associated with previous good marital relationships and the husbands good self-rated health, and manifested in both specific coping strategies and global and situational meaning-making processes. The study demonstrates that much more can be learnt about the positive dimensions of care in older mens lives, and that such understanding can inform and strengthen formal and therapeutic support.

Portuguese version of the Geriatric Anxiety Inventory: Transcultural adaptation and psychometric validation

Objectives: The Geriatric Anxiety Inventory (GAI) is a recently developed anxiety instrument designed to assess the severity of anxiety symptoms across a range of presentations in older adults. In this study, the authors examined the validity of the Portuguese version of the GAI and assessed its psychometric properties. Method: A cross-sectional study was designed using a sample of 152 community-dwelling older adults, and a geriatric psychiatric sample of outpatients with clinical diagnoses of depression (n = 32), anxiety disorders (n = 23), and early Alzheimers disease (n = 10). Results: The Portuguese version of the GAI required linguistic and transcultural adaptations, particularly on the somatic expressions of anxiety. It exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberg State-Trait Anxiety Inventory, the Geriatric Depression Scale (GDS-30), and the General Health Questionnaire (GHQ-12). The optimal cut-off point to detect severe anxiety symptoms was 8/9, but no optimal cut-off point for Generalized Anxiety Disorder could be estimated. Conclusion: These findings provide initial evidence that the Portuguese version of the GAI is a valid and reliable measure for assessing late-life anxiety and highlights the need for possible modifications of the instrument before being used in other languages and cultural groups.

Predicting loneliness in old people living in the community

Loneliness and social isolation are two core concepts regarding social relationships in human life that are particularly relevant in old age. This article focuses on the prevalence of loneliness in a community sample of 1266 autonomous people aged 50 or more and on the structural circumstances (demographic social network and general health condition) that could better contribute to its experience. The prevalence of loneliness was 16.3% ( n = 206) and a small number of people presented low social network (7%). Predictors of loneliness (explaining 29% of variance) were being widowed, perceiving own health as poor or very poor, and having psychological distress and cognitive impairment. The authors emphasize the importance of psychological distress as a predictor of loneliness and the need for social and psychological interventions to prevent its consequences in morbidity and mortality.

Cognitive impairment in old people living in the community

Cognitive impairment has a high prevalence in the elderly, especially in the oldest old, and it is a major concern for autonomous old people living in the community and their families. Any possible intervention will benefit from early detection of cognitive decline related signs. The Portuguese version of the mini-mental state examination (MMSE) was used to assess cognitive impairment in a sample of 1266 old community-dwellers in Portugal, mean age 70.3+/-8.7 years. A standard questionnaire was also used including measures on social network, psychological distress, functionality, perceived health status, and socio-demographic variables. We recorded education levels and illiteracy by using different cut points to select people with and without cognitive impairment and results showed a 9.6% prevalence of positive cases. In general, cognitive impairment is higher in women, older people, widows(ers), and people with negative self-perception of health and with difficulties in basic and in instrumental activities of daily living (ADL and IADL). Cognitive impairment was found to be predicted by gender, age and psychological distress, explaining 18% of variance. Findings are discussed considering available literature and possible interventions for community residents.

Satisfaction in dementia and stroke caregivers: a comparative study

A prestacao informal de cuidados a pessoas idosas e vinculada a presenca de dificuldades e de satisfacao. Enquanto a literatura gerontologica enfoca os aspectos da dificuldade tambem tem negligenciado a analise da experiencia de satisfacao. O proposito deste estudo transversal foi comparar a experiencia de satisfacao e de sintomatologia depressiva de cuidadores de idosos demenciados (n=70) e de cuidadores de idosos com antecedentes de pelo menos um AVC (=44), atraves do Indice de Avaliacao da Satisfacao do Cuidador (CASI). Os resultados indicam a presenca de sintomatologia depressiva para ambos os grupos, satisfacao intrapessoal (centrada no idoso) e interpessoal (centrada no cuidador) para os cuidadores de demenciados e satisfacao intrapessoal (centrada no cuidador) para os cuidadores de pessoas com antecedentes de AVC. Destaca-se a necessidade de compreender melhor as experiencias de satisfacao em cuidadores de idosos com demencia e AVC.Informal caregiving to the elderly is associated with the presence of both difficulties and positive rewards, but the latter have been considered less systematically in gerontological literature. In this cross-sectional study, we compared satisfaction of caregivers of demented (n=70) and stroke patients (n=44) by means of the Carers Assessment of Satisfaction Index (CASI) and also compared their depression levels. Findings revealed the presence of satisfaction deriving from intrapersonal dynamics (elderly as main beneficiary) and from interpersonal dynamics (caregiver as main beneficiary) in dementia situations, and the presence of satisfaction deriving from intrapersonal dynamics (caregiver as main beneficiary) in stroke situations. Both subgroups of caregivers revealed similar yet significant levels of depression. The need for a better understanding of satisfaction experiences in dementia and stroke caregivers is highlighted.Informal caregiving to the elderly is associated with the presence of both difficulties and positive rewards, but the latter have been considered less systematically in gerontological literature. In this cross-sectional study, we compared satisfaction of caregivers of demented (n=70) and stroke patients (n=44) by means of the Carer’s Assessment of Satisfaction Index (CASI) and also compared their depression levels. Findings revealed the presence of satisfaction deriving from intrapersonal dynamics (elderly as main beneficiary) and from interpersonal dynamics (caregiver as main beneficiary) in dementia situations, and the presence of satisfaction deriving from intrapersonal dynamics (caregiver as main beneficiary) in stroke situations. Both subgroups of caregivers revealed similar yet significant levels of depression. The need for a better understanding of satisfaction experiences in dementia and stroke caregivers is highlighted.

Personalised participation: an approach to involve people with dementia and their families in a participatory design project

Abstract This paper presents a personalised approach to participatory design, where several aspects of the project, such as brief, process and artefacts, are left open to be redefined by the participants, in accordance with their individual needs, preferences and availabilities. Drawing upon person-centred dementia care values, personalisation is seen as an invitation for people with dementia and their families to participate. It is also a way of dealing with the uniqueness of participants, and providing opportunities for meaningful communication, so that social relationships are maintained. This approach emerged from the specificity of involving people with dementia and their families in a participatory design project, in an effort to best include them in a respectful and convivial manner. Relations between use, design and participation, which are in constant negotiation with participants, are analysed and the qualities of this personalised participation, relating to ethics, empathy and conviviality, are outlined.

Successful aging at 100 years: the relevance of subjectivity and psychological resources.

BACKGROUND Very old individuals seem to present an admirable capacity to overcome adversities and adapt to the challenges of advanced age. However, studies focusing successful pattern of centenarians found that they may easily fail to be categorized as successful agers when objective criteria are applied. The present study examines if centenarians can be considered successful agers. Following Rowe and Kahns successful aging model, the primary goal was to clarify whether centenarians are able to be successful agers according to objective and subjective criteria of no major disease and disability, high cognitive and physical functioning and engagement with life. The second goal was to investigate whether socio-demographic factors, psychological, social, and economic resources are related to objective and subjective successful aging profiles. METHODS We examined different profiles of successful aging in a high selected sample of individuals aged 100 and more years old from the population-based Oporto Centenarian Study. RESULTS Main findings reveal that centenarians do not represent the prototype of successful aging, but self-ratings demonstrate that many of them feel successful, despite not being objectively considered as so. Those who were considered successful agers presented higher values of self-efficacy, hope, and purpose in life, as well as few difficulties in covering financial expenses. CONCLUSIONS As a basis for strengthening the existing model, the value of subjectivity should be explored and psychological resources promoted in interventions to foster positive adaptation in very old age.

Estudo comparativo: percepção da satisfação de cuidadores de pessoas com demência e cuidadores de pessoas com AVC

A prestacao informal de cuidados a pessoas idosas e vinculada a presenca de dificuldades e de satisfacao. Enquanto a literatura gerontologica enfoca os aspectos da dificuldade tambem tem negligenciado a analise da experiencia de satisfacao. O proposito deste estudo transversal foi comparar a experiencia de satisfacao e de sintomatologia depressiva de cuidadores de idosos demenciados (n=70) e de cuidadores de idosos com antecedentes de pelo menos um AVC (=44), atraves do Indice de Avaliacao da Satisfacao do Cuidador (CASI). Os resultados indicam a presenca de sintomatologia depressiva para ambos os grupos, satisfacao intrapessoal (centrada no idoso) e interpessoal (centrada no cuidador) para os cuidadores de demenciados e satisfacao intrapessoal (centrada no cuidador) para os cuidadores de pessoas com antecedentes de AVC. Destaca-se a necessidade de compreender melhor as experiencias de satisfacao em cuidadores de idosos com demencia e AVC.Informal caregiving to the elderly is associated with the presence of both difficulties and positive rewards, but the latter have been considered less systematically in gerontological literature. In this cross-sectional study, we compared satisfaction of caregivers of demented (n=70) and stroke patients (n=44) by means of the Carers Assessment of Satisfaction Index (CASI) and also compared their depression levels. Findings revealed the presence of satisfaction deriving from intrapersonal dynamics (elderly as main beneficiary) and from interpersonal dynamics (caregiver as main beneficiary) in dementia situations, and the presence of satisfaction deriving from intrapersonal dynamics (caregiver as main beneficiary) in stroke situations. Both subgroups of caregivers revealed similar yet significant levels of depression. The need for a better understanding of satisfaction experiences in dementia and stroke caregivers is highlighted.Informal caregiving to the elderly is associated with the presence of both difficulties and positive rewards, but the latter have been considered less systematically in gerontological literature. In this cross-sectional study, we compared satisfaction of caregivers of demented (n=70) and stroke patients (n=44) by means of the Carer’s Assessment of Satisfaction Index (CASI) and also compared their depression levels. Findings revealed the presence of satisfaction deriving from intrapersonal dynamics (elderly as main beneficiary) and from interpersonal dynamics (caregiver as main beneficiary) in dementia situations, and the presence of satisfaction deriving from intrapersonal dynamics (caregiver as main beneficiary) in stroke situations. Both subgroups of caregivers revealed similar yet significant levels of depression. The need for a better understanding of satisfaction experiences in dementia and stroke caregivers is highlighted.

Predicting Successful Aging at One Hundred Years of Age

Objective: The present study is based upon a multidimensional model of successful aging. It aims to identify subgroups of centenarians sharing communalities in successful aging profiles, and determine the role of sociodemographic factors and psychological, social, and economic resources on successful aging. Methods: A total of 80 centenarians were face-to-face interviewed. A cluster analysis was performed to identify distinct groups of successful aging, and logistic regression models were performed considering the cluster membership as dependent covariate. Results: Two distinct clusters were grouped, with 40 centenarians in each, one of them presenting better results in all domains. Male sex and better income adequacy were the best predictors of successful aging. Conclusion: Results help to identity different patterns of successful aging and provide greater clarity regarding its correlates, increasing current understanding of its modifiable aspects.