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Family support has been identified as an important factor for the psychological adjustment of patients with chronic physical conditions. This study aimed to systematically review and conduct a meta-analysis of studies comparing the effectiveness of family-based versus patient-oriented interventions for chronic physical conditions. The search was performed between April 12 and April 29, 2021, on Web of Science (all databases included), Scopus, PsycINFO, and CENTRAL. Thirteen RCTs were included. The results favored family-based interventions for various patient outcomes related to pain, distress, self-efficacy, social and emotional function, coping, the welfare of the domestic environment, capacity to mobilize social support, and sexual relationships with medium to large effect sizes (Cohen's d range: 0.45-0.90). This type of intervention also decreased family members' anxiety, depression, sleep problems, and distress, improving search and presence of meaning in life, social support, the support provided to the patient, and sexual relationships with medium to very large effect sizes (Cohen's d range: 0.58-2.76). The meta-analytical findings suggested that the patients' (k = 12, d = 0.34; 95% CI = 0.13-0.55, IEl apoyo familiar se ha reconocido como un factor importante para la adaptación psicológica de los pacientes con enfermedades físicas crónicas. El presente estudio tuvo como finalidad analizar sistemáticamente y realizar un metaanálisis de estudios que comparan la eficacia de las intervenciones familiares y de las orientadas al paciente en las enfermedades físicas crónicas. La búsqueda se realizó entre el 12 de abril y el 29 de abril de 2021 en Web of Science (se incluyeron todas las bases de datos), Scopus, PsycInfo, y CENTRAL. Se incorporaron trece ensayos clínicos aleatorizados y controlados. Los resultados favorecieron las intervenciones familiares en los casos de diferentes desenlaces de los pacientes relacionados con el dolor, el distrés, la autoeficacia, la función social y emocional, el afrontamiento, el bienestar del entorno doméstico, la capacidad de movilizar el apoyo social, y las relaciones sexuales con tamaños del efecto entre medianos y grandes (rango de la d de Cohen: entre 0.45 y 0.90). Este tipo de intervención también disminuyó la ansiedad, la depresión, los problemas de sueño y el distrés de los miembros de la familia, mejoró la búsqueda y la presencia del significado en la vida, el apoyo social, el apoyo brindado al paciente y las relaciones sexuales con tamaños del efecto entre medianos y muy grandes (rango de la d de Cohen: entre 0.58 y 2.76). Los resultados metaanalíticos sugirieron que los resultados psicosociales de los pacientes (k = 12, d = 0.34; 95 % CI = 0.13―0.55, I2 = 74 %, p.01) y de los familiares (k = 4, d = 0.68; 95 % CI = 0.08―1.27, I2=88 %, p.01) mejoraron considerablemente con las intervenciones familiares en comparación con las intervenciones orientadas a los pacientes. El metaanálisis de la autoeficacia de los pacientes demostró un efecto de tamaño mediano (d = 0.64; k = 3; I2 = 19 %). Los resultados sugieren una tendencia hacia los efectos beneficiosos de las intervenciones familiares, pero se necesitan más investigaciones con ensayos controlados aleatorizados de mayor calidad para confirmar esta hipótesis.家庭支持被认为是慢性身体疾病患者心理调整的一个重要因素。本研究旨在系统地回顾并进行meta分析，比较以家庭为基础和以患者为导向的干预对慢性身体疾病的有效性。该研究于2021年4月12日至4月29日期间针对Web of Science(包括所有数据库)、Scopus、PsycInfo和CENTRAL上的研究进行荟萃分析，包括了13项随机对照试验。研究结果支持以家庭为基础的干预措施，对患者的各种结果进行干预，这些结果涉及疼痛、痛苦、自我效能感、社会和情绪功能、应对、家庭环境的福利、动员社会支持的能力以及中到大的效应量(Cohen’s d范围: 0.45 - 0.90)。这种类型的干预也减少了家庭成员的焦虑、抑郁、睡眠问题和痛苦，改善了对生活意义的寻找和存在、社会支持、提供给患者的支持以及中等到非常大的效应量的性关系(Cohen’s d范围:0.58到2.76)。荟萃分析结果显示，基于家庭的干预明显改善了患者（k = 12，d = 0.34；95% CI = 0.13-0.55，I2 = 74%，p.01）和家庭成员（k = 4，d = 0.68；95% CI = 0.08-1.27，I2 = 88%，p.01）的社会心理结果。对患者自我效能的荟萃分析显示出中等规模的影响（d=0.64；k=3；I2=19%）。结果表明，基于家庭的干预趋向于有益的效果，但需要更多的研究和更高质量的RCT来证实这一假设。.

Introduction Caring for a patient with end‐stage renal disease undergoing in‐centre haemodialysis can be a stressful experience, likely to involve significant burden. Within the context of the new coronavirus pandemic, these patients are highly vulnerable to infection by COVID‐19, which might increase the care demands and burden of family caregivers. Aim This study aimed to explore the subjective experiences of family caregivers of non‐COVID‐19 patients with end‐stage renal disease undergoing in‐centre haemodialysis during the COVID‐19 lockdown. Study design A qualitative study was performed with a purposive sample. Methods Semi‐structured telephone interviews were conducted with 19 family caregivers (50.7 ± 14 years old) of patients undergoing in‐centre haemodialysis in April 2020. Findings Four major themes were identified: (1) emotional distress; (2) changes in caregiving responsibilities; (3) educational and supportive needs; and (4) coping strategies to deal with the outbreak and with the lockdown. Discussion The findings suggest that family caregivers of patients undergoing in‐centre haemodialysis have to manage several additional care responsibilities due to COVID‐19 lockdown. The dialysis team should consider the development of educational and supportive interventions to meet family caregivers’ needs, mitigate emotional distress, fears and concerns, and prevent caregiver burden during the COVID‐19 pandemic.

Aim To explore how informal caregivers of persons with dementia perceive training needs and preferences in the context of online training and support interventions. Background Informal dementia caregivers commonly present high needs across several domains. Paradoxically, they are more likely to have unmet needs and lower levels of service usage when compared to other caregivers. Most studies on unmet needs of dementia caregivers have been quantitative and resorted to assessment checklists, with a minority focusing on subjective needs. Design Mixed-methods. Methods Eighty-eight Portuguese digitally literate caregivers filled a web-based questionnaire collecting written statements on training needs and importance ratings on design preferences. Content analysis of text data was carried out by two independent researchers to check the reliability of the analytic process. Descriptive statistics were produced for ratings on design preferences, and associations with caregivers' sociodemographic and care-related variables were inspected. Reporting followed the criteria for reporting qualitative research checklist. Results Five main categories of training needs have emerged: knowledge of dementia; care interactions; caregiver self-care; community resources; and laws or regulations affecting the caregiver and the care recipient. The most reported need was on care interactions, on the subcategory of providing good quality care. Thematic prominence was analysed according to the caregiver, caregiving and health perception characteristics, with trends found on formal education, relationship with the care recipient, number of hours caring per week, perceived level of dependence of the care recipient and perceived physical and psychological health status of the caregiver. Most valued design features included the use of plain language, easy to interact interface and communication with a professional. Conclusions Findings from this study further support the delivery of comprehensive interventions addressing the multiple needs of caregivers. Relevance to clinical practice Clues are provided for the delivery of online interventions, and conclusions are useful to health professionals working with dementia caregivers.

Aim In the present study, we aimed to update the data of frailty status in the European community-dwelling population of older adults, based on the latest data released (wave 6) of the Survey of Health, Aging and Retirement in Europe database, and to study the impact of each criterion on frailty assessment. Methods Frailty status was assessed applying a version of the Fried phenotype operationalized for the Survey of Health, Aging and Retirement in Europe. We included all participants who answered all the questions used in a frailty assessment and who disclosed their sex and, furthermore, who were aged ≥50 years. Our final sample was 60 816 individuals. Of these, the mean age was 67.45 ± 9.71 years; 38 497 (56.4%) were women. Results The overall prevalence of pre-frailty was 42.9% (ranging from 34.0% in Austria to 52.8% in Estonia), and frailty was 7.7% (ranging from 3.0% in Switzerland to 15.6% in Portugal). Pre-frailty and frailty prevalence increased along with age, and were more frequent among women. Regarding the five criteria considered on frailty assessment, exhaustion seems to be the criterion that contributes most to frailty status, followed by low activity, weakness, loss of appetite and slowness. Conclusions With this work, we showed that >50% of the European population aged >50 years are pre-frail/frail, which must be considered when designing interventions to reduce/postpone/mitigate the progression of this condition, thus reducing the burden associated with it. Geriatr Gerontol Int 2019; 19: 723-729.

Objectives This study examined the main sources of strain and the presence of psychological distress in a sample of centenarians’ children who assumed the role of primary caregivers. Method A sample of 43 children (M age = 67.10 ± 6.67 years; 90.7% female) caring for a centenarian parent was interviewed and asked about their overall caregiving experience. Information on caregiving burden (Zarit Burden Interview) and psychological distress (Hospital Anxiety and Depression Scale) was also obtained. Several characteristics of the caregiving dyads (e.g. age, co-residence) were tested to compare caregivers with and without anxiety and depressive symptoms. Qualitative data from the interviews were analysed for recurrent themes using thematic analysis. Results Main caregiving impacts concern social and leisure dimensions (role captivity), with important personal mid-life and late-life plans needing to be changed or postponed. Centenarians’ children present higher levels of anxiety (M = 6.95 ± 4.7) than depression (M = 6.0 ± 4.1), and psychological distress was found to be significantly associated with high subjective burden, low life satisfaction, poorer perceived health, and perceived income inadequacy. Conclusion The significant levels of psychological distress, along with the loss of autonomy and incapacity to prosecute plans for retirement, reinforce the psychological demands of late-life caregiving. Paying attention to these relationships is imperative to promote adequate responses for these caregivers.

AIM: To examine discharges of octogenarians, nonagenarians and centenarians from Portuguese public hospitals, namely admission type, principal diagnoses, comorbidities and length of stay. METHODS: The present study used administrative data from public acute care hospitals in the Portuguese National Health Service. All discharges of persons aged ≥80 years between 2000 and 2014 were analyzed. HCUP Clinical Classifications Software was considered to aggregate principal diagnosis, and comorbidities were assessed using the Charlson Comorbidity Index computed using International Classification of Diseases 9th Revision Clinical Modification codes. RESULTS: A total of 2 494 924 discharges of persons aged 80 years or older were registered. Most (73.7%) referred to inpatient episodes, of which 73% were unplanned and medical (non-surgical). Pneumonia (12.2%), acute cerebrovascular disease (7.1%) and non-hypertensive cardiac heart failure (5.3%) were the most common principal diagnoses among inpatient episodes. Congestive heart failure and diabetes without chronic complications were the two most frequent comorbidities (16.6%), and discharge diagnoses with higher median length of stay were tuberculosis, burns, and infective arthritis and osteomyelitis. CONCLUSIONS: The number of hospitalizations of the oldest old has suffered a significant increase in the past few years, reinforcing the need for healthcare services being prepared to the specificities of the oldest old population. Geriatr Gerontol Int 2017; ••: ••-••.© 2017 Japan Geriatrics Society. Language: en

SUMMARY Introduction Non-adherence to therapeutic regimens is a recognised problem in the dialysis population that compromises the opportunity to achieve maximum treatment effect and, therefore, might lead to increased morbidity and mortality. In this study, we aimed to evaluate the prevalence of self-reported medication non-adherence in patients with end-stage kidney disease (ESKD) undergoing online-haemodiafiltration (OL-HDF), as well as to evaluate the factors that could affect medication adherence. Patients and methods We evaluated 122 patients with ESKD undergoing OL-HDF. Patients' reported medication adherence was measured by the Measure Treatment Adherence (MTS) scale. Social support was evaluated by the abbreviated Lubben Social Network Scale (LSNS); depression status by the Geriatric Depression Scale (GDS). Socio-demographic, co-morbidity and clinical data were also evaluated. Results Our results showed that 10.7% of patients with ESKD perceived themselves as non-adherent to medication. When two groups of patients (adherent and non-adherents) were compared, significantly higher levels of triglycerides, and higher diastolic and systolic blood pressure were found in the non-adherent group. Significant correlations were found between the MTS score, and diastolic blood pressure, age and GDS score. Multiple regression analysis identified age and the GDS score as independent variables significantly associated with the MTS score. Conclusions Non-adherence to therapeutic regimens in patients with ESKD is associated with higher levels of triglycerides and higher blood pressure and are, therefore, at a higher cardiovascular risk. Moreover, we found that age and depression status are important variables in non-adherence to therapeutic regimens.

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Purpose This paper describes the effectiveness of cognitive stimulation therapy (CST) on cognition and depressive symptoms in older adults in nursing homes (NHs). Design A randomized controlled trial, carried out from 2012 to 2013, included 56 residents from four NHs, 36 women and 20 men (randomized into experimental and control groups). Eight participants dropped out. Methods Participants of the experimental group underwent 14 CST sessions (7 weeks) in groups of six to eight older adults, and participants of the control group received usual care. The Montreal Cognitive Assessment, the Geriatric Depression Scale-15, and the Barthel Index of activities of daily living (ADLs) were administered at baseline and postintervention. Findings Repeated measures revealed that CST increased cognition (F = 8.581; p = .005; partial η squared = 0.157; power = 0.82). There were no statistically significant differences in depressive symptoms (F = 1.090; p = .302). Baseline level of ADLs did not affect the outcomes. Conclusions CST had significantly improved cognition, explaining the 15.7% variability, but there was no statistical evidence of its effectiveness on depressive symptoms. This improvement was not affected by the baseline level of dependence-independence in ADLs. Clinical Relevance CST offers a range of activities, providing general stimulation for thinking, concentration, and memory, usually in a social setting. These results will support implementation of CST in NHs. In addition to the impact on elderly independence and autonomy, CST may also have an economic impact by reducing the direct costs of the impact of elders’ cognitive frailty.