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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.

Background Informal caregivers of people with dementia often struggle with several stressors, and their mental and physical health can be negatively affected by providing care. iSupport is an online self-help programme designed by the World Health Organization to provide education, skills training, and support to those caregivers. Purpose This paper describes the development of an adapted version of iSupport to the Portuguese culture. We present the adaptation process, methods used and results for the country-specific version. Methods The adaptation of iSupport was operationalised in five steps: needs assessment; content translation by an authorised translator and technical accuracy check by health professionals; cultural adaptation; independent appraisal of contents by an expert panel; and fidelity check by programme authors. Results Findings indicated the adjustments needed in the original iSupport contents. Overall, 323 text excerpts were proposed to adaptation, comprising semantic and conceptual equivalence of expressions, and adjustments to cultural habits, customs, traditions, local resources, and practices. The expert panel identified the need to reformulate definitions, designations, recommendations, and case studies to fine-tune the original contents to local knowledge and practices. Most adaptations were considered to be in line with the core concepts of the original programme. Conclusions iSupport is an innovative tool capturing the attention of several organisations around the world interested in translating, adapting, and using the programme. This paper is the first describing the methodological approach for culturally adapting iSupport, constituting an essential resource for those aiming to replicate the process or culturally adapting evidence-based interventions. Tailoring iSupport to the Portuguese context was critical to accommodate the cultural experiences of the target group as well as the knowledge, theoretical approaches, and practices of local professionals. The European-Portuguese version of iSupport introduces the adjustments needed to implement a useful new intervention programme aimed at minimising the psychological distress of Portuguese 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.

European population ageing is associated with frailty, a complex geriatric syndrome, and polypharmacy, both resulting in adverse health outcomes. In this study we aimed to evaluate the impact of frailty and polypharmacy, on mortality rates, within 30 months, using a cohort of SHARE participants aged 65 years old or more. Frailty was assessed using a version of Fried’s phenotype criteria operationalized to SHARE while polypharmacy was defined as taking five or more drugs per day. We found a prevalence of 40.4% non-frail, 47.3% pre-frail and 12.3% frail participants. Moreover, a prevalence of polypharmacy of 31.3% was observed, being 3 three times more prevalent in frail individuals and two times in pre-frail individuals, when compared with non-frail. Individuals with both conditions had shown higher mortality rates. Comparing with non-polymedicated non-frail individuals all the other conditions are more prone to die within 30 months. Polymedicated older and male participants exhibited also higher mortality rates. This work shows polypharmacy and frailty to be associated with a higher risk of all-cause of mortality and highlights the need to decrease ‘unnecessary’ polypharmacy to reduce drug-related issues and also the need to assess frailty early to prevent avoidable adverse outcomes.

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors.Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables.Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28).Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08–1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31–3.47) and with scores 24–29 (OR 1.92; 95% CI 1.07–3.43) or 11–23 (OR 2.09; 95% CI 1.15–3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24–9 (OR 2.38; 95% CI 1.31–4.33) or low 11–23 (OR 5.31; 95% CI 2.69–10.45) scores in neuroticism were more likely to evaluate their health as very good/good.Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

The Modified Caregiver Strain Index is a widely used tool to screen for caregiver strain in family caregivers. This study presents the Portuguese version of the Modified Caregiver Strain Index and explores its psychometric properties in a sample of 347 informal caregivers of older dependent individuals. Factor analysis revealed a two-factor structure and indicated satisfactory internal consistency. Criterion-related validity was supported by positive significant correlations with the emotional health of the caregiver (psychological distress). The findings show evidence of reliability and validity of the Portuguese version of the Modified Caregiver Strain Index encouraging its use in clinical and research fields. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was partially supported by a research funding from the Calouste Gulbenkian Foundation—Portugal (Project Cuidar de Quem Cuida; Ref. M54M/2008) and by the Portuguese High Commissioner for Health (Project Cuidar em Casa; Ref. O09-80).

This study aimed to analyze caregivers and care recipients’ health characteristics and caregiving context changes during a one-year follow-up. A total of 204 informal caregivers and oldest-old care recipients ( ≥ 80 years) were assessed on two occasions, 12 months apart. Information was retrieved on the dyad’s sociodemographic profile, caregiver’s health/caregiving outcomes, care recipients’ dependency level, and caregiving context. Descriptive analysis was performed for all variables and comparisons between the two moments using paired t tests or McNemar tests. Caregiving hours, caregiver burden, and negative aspects of caregiving got significantly worse over one year. The number of unmet needs, in-home services utilization, and self-perception of mental health improved. Care recipients declined in their functional and health status and on their cognitive performance. This study provides information about caregiving trajectory changes over one year and stresses a probable caregiver adaptation even when facing increasing caregiving demands.

Participant attitudes are an explanatory factor for attrition in online health-related interventions. However, its assessment prior to interventions start is uncommon, partly because proper measures are missing. This study presents the psychometric properties of a new scale measuring attitudes towards online psychoeducational interventions (OPIs). Structural validity, reliability and screening performance of the Online Psychoeducational Intervention - Brief Attitudes Scale (OPI-BAS) were studied in a sample of 157 dementia caregivers. Scale cut-off scores were derived to categorise the participants into 'OPIs sympathisers' or 'non-sympathisers'. Groups were compared across sociodemographic and internet use variables. A parsimonious five-item version of OPI-BAS demonstrated good structural validity, with one factor explaining 63.3% of variance. Internal consistency of the scale was high (α = 0.85). OPI-BAS showed good screening performance in identifying individuals with either a preference to use conventional face-to-face or online psychoeducational interventions (area under the curve = 0.84). An optimal cut-off score of 20 was suggested by the receiver operating characteristic graph, providing good sensitivity (74%) and specificity (84%). No significant differences were found between groups on sociodemographic and internet use variables. Attitudes towards OPIs were overall positive, but face-to-face interventions were preferred. This study offers preliminary support to the psychometric quality of OPI-BAS. This short scale has practical applications for research and intervention.

Objectives: Brief screening instruments are useful in busy clinical practice to identify those requiring further assessment. This study aims to translate and validate a Portuguese version of the fo...

This pilot study used a small randomized trial to examine the feasibility and the impact of an 8-week multicomponent program among Portuguese older adults with osteoarthritis. Participants were identified from the electronic registers from three primary healthcare centers. Thirty-one older adults (50+ years) with osteoarthritis were randomly assigned to experimental (n= 23) and control conditions (n= 8). Acceptance, attendance and retention rates were measured. The effect of the program on physical performance, osteoarthritis symptomatology (pain and stiffness), functionality, physical activity, depression, anxiety and fear of movement were assessed at baseline, posttest, and 4-months. The acceptance rate was 34%, and 90.4% attended all sessions of the program. The posttest retention rate in experimental group was 69.6% and 100% in control group. Findings demonstrated benefits of the Program on physical performance, function, anxiety, and fear of movement among participants. In the future, it will be important to improve the acceptance rate, however, the high attendance rate and observed effects indicate that the program is an attractive and effective intervention for Portuguese older adults with osteoarthritis.

Nutritional status is important to elders to live without disabilities. Food Insecurity (FI) is a risk factor associated with poorer nutritional status among elderly as well as a social determinant. This research aimed to identify FI prevalence and to explore the relation between FI, weight status and socio-demographic factors. Methods This cross-sectional study was conducted from September 2015 to February 2016 in Lisbon. Malnutrition was determined using Mini Nutritional Assessment (MNA). FI was assessed using FIES (Food Insecurity Experience Scale) and social risk using Gijon’s social-familiar evaluation scale. Data were collected through face-to-face interviews and anthropometric indices were measured according to Isak procedures. Results A sample of 337 subjects, with an average age of 78.4 years old (range 66–99), mostly women (n = 210; 62.3%) were enrolled. 70.0% were FI, whereas 40.7% was at risk of malnutrition, 4.7% were malnourished and 34.7% of participants presented high social risk. Being a woman, FI, reported Depression, Loneliness, Acute Myocardial Infarction, Cerebrovascular Accident, Diabetes, being aged 74–85 years old, Health status and attending SC for less than 5 years were contributors to risk of malnutrition/malnutrition. Lack of money, socialization as a reason for attending SC, Social Risk and Diabetes were related to FI. There was no correlation between FI and obesity, but a positive correlation between FI and weight was found. Conclusion Nutritional status and food insecurity on the studied sample were associated with their health status and also with their social circumstances, such as diabetes, loneliness and lack of economic resources.

Objective To examine the unmet needs of older clients with perceived mental health problems who attend primary healthcare services. Design Unmet needs were derived from (i) the health concerns and caregiver network availability provided by a General Practitioner (GPs) and from (ii) a qualitative analysis of an open question about needs completed by informal caregivers (ICs) of those clients. Participants The sample comprised 436 clients with mean age of 75.2 years and 110 ICs with mean age of 56.7 years. Setting Primary healthcare centers in the North of Portugal. Main outcome measure The Community Assessment of Risk Instrument-CARI (Clarnette RM, Ryan JP, O'Herlihy E, et al. The community assessment of risk instrument: investigation of inter-rater reliability of an instrument measuring risk of adverse outcomes. J Frailty Aging 2015;4: 80-9; O'Caoimh R, Healy E, Connell EO, et al. The Community Assessment of Risk Tool (CART): investigation of inter-rater reliability for a new instrument measuring risk of adverse outcomes in community dwelling older adults. Irish J Med Sci 2012.) and qualitative data about needs. Results Several needs were observed in relation to (1) mental state (e.g. cognition, anxiety/depression); (2) functionality (e.g. IADLS, bathing, mobility); (3) medical state (e.g. chronic diseases, vision deficits) and (4) IC ability to meet clients' needs. From the categorical analysis of the ICs' answers, an amount of unmet needs not only health related but also related with referrals and legal issues were found. Conclusions This study shows a large number of unmet needs of older people. The evaluation of the clients combined with the evaluation of the testimonials of ICs enables the understanding of difficulties of both clients and caregivers, and which needs should be prioritized.

Fit & Strong! is a physical activity/behavior change evidence-based intervention for persons with osteoarthritis (OA) that was developed and tested in USA. This article describes the development of a new culturally adapted Portuguese version of Fit & Strong!, reviews the methods used, and describes the new features of the Portuguese program. Six steps were implemented for the cultural adaptation: training the Portuguese research team, materials translation, needs assessment which includes literature review, focus group with older adults with lower extremity joint pain, interviews with experts about Fit & Strong! format and content, program instructor training, and pilot study and program implementation. At the conclusion of the pilot, debriefing interviews were held with participants and instructors to obtain their opinions about the program. Thematic content analysis and SWOT analysis were used to analyze the qualitative data. Findings indicated needed changes to the original Fit & Strong! program protocol. In the Manuals, language was simplified and more pictures added to be suitable for people with lower level of literacy. Also, practical examples described in Manuals were adjusted or substituted to better fit the Portuguese culture. As a description of Portuguese organizations in the field, Thermal Spa and Mediterranean diet were added to the Manual. We recommend using two instructors to address individual challenges during the sessions. The Portuguese version of Fit & Strong! introduces all the necessary changes to become a relevant new intervention program to raise quality of life of patients with OA in Portugal.

This article reflects on how a lack of systematic design in planning an intergenerational program (IP) could compromise the use of an appropriate methodological framework, participant selection cri...

Background The family caregivers of patients on hemodialysis (HD) and peritoneal dialysis (PD) typically experience higher burden than the general population because of the nature of tasks these caregivers need to carry out as a part of homecare. This fact influences both the caregivers’ quality of life and the quality of their care toward the patient. Thus, this study aimed to review the effectiveness and limitations of interventions in improving the well-being of family caregivers of patients on HD and PD. Methodology A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE, VHL Regional Portal, Scopus, and Web of Science databases were searched queried for randomized controlled trials that developed interventions aimed at improving the well-being of family caregivers of patients undergoing HD and/or PD from 2009 to 2020. The study protocol was registered at the International Prospective Register of Systematic Reviews (registration no. CRD42020151161). Results Six studies met the inclusion criteria, all of which addressed caregivers of patients undergoing HD. All interventions reported in the included studies were carried out in group sessions, which addressed topics such as patient assistance and care, treatment complications, coping strategies, caregiver self-care practices, problem solving, and self-efficacy. The studies found significant improvement in the caregiver’s well-being. Conclusions Group session interventions are effective in improving the well-being of family caregivers of patients undergoing HD. In regard to PD, there is insufficient evidence to make recommendations for caregivers of patients with this treatment.

Background:Mental health problems have been reported as one of the principal causes of incapacity and morbidity. According to the World Health Organization approximately 15% of adults aged 60+ and over suffer from a mental disorder. In the oldest old population, a higher deterioration in the mental state is expected, which is ought to increase the risk of incidence of mental problems and use of healthcare services. The aim of this study is to examine inpatient episodes with a mental disorder coded as primary discharge diagnosis between 2000 and 2014 by patients aged 80+ in Portugal mainland.Method:Exploratory descriptive analyses of data regarding the number of episodes and coded diagnosis on admission were performed.Results:From a total of 1,837,613 inpatient episodes, 16,430 (0.9%) correspond to episodes having a psychiatric disorder as a primary discharge diagnosis. Delirium, dementia and amnestic and other cognitive disorders (60.1%), alcohol-related disorders (17.7%) and mood disorders (8.6%) were the most common diagnosis. An analysis by age group revealed that among octogenarians and nonagenarians delirium, dementia, and amnestic and other cognitive disorders were the most common diagnosis; in the centenarian group; however, these were outweighed by alcohol-related disorders.Conclusions:Findings from this study document the importance of neurocognitive disorders as a primary reason for hospitalization in the oldest old, but also highlights the need of paying attention to other mental disorders among this age group. Further studies should examine the prevalence of medical comorbidities in patients with mental disorders.

Purpose In Portugal, the three main kinds of care services available for older people are nursing homes, day centers and home care services. The use of these care services is mostly based on complex socioeconomic and functional criteria; however it is not clear if this placement corresponds to a higher/lower risk of adverse outcomes. The purposes of this paper are: to characterize clients of each type of service; to estimate the proportion of individuals at perceived risk of each adverse outcome according to type of service; to assess the ability of the Risk Instrument for Screening in the Community (RISC) to identify the risk profiles according to type of service. Design/methodology/approach The sample comprised individuals aged 65+ (n=224), receiving care at home, in day centers or in nursing homes. The identification of individuals at risk for three adverse outcomes (institutionalization, hospitalization and death) was performed using a short pre-screen instrument (RISC). Findings The RISC identified mental state issues as the unique factor that differentiated clients according the type of care services (χ2 (6, N=224)=20.96, p=0.002), with day center presenting the lowest percentage of mental health concerns and nursing home presenting the highest percentage (44.44 and 71.91 percent, respectively). Additionally, a gradient was found between perceived risk of adverse outcomes (institutionalization and hospitalization) and care of levels required. Originality/value The RISC can be used to discriminate people in different settings of care and can be helpful in the selection of groups at risk that will benefit more from available services.

Introduction Exceptional long-lived individuals, i.e., centenarians, are thought to have survived or escaped diseases that are common causes of death at younger ages. A better understanding of their health profile and health trajectories provides important information for geriatric care provision. This study aims to examine morbidity profiles of a sample of Portuguese centenarians with a particular focus on the characteristics of those who have evaded a list of age-related illnesses. Materials and methods Two hundred and forty-one centenarians (M age = 101.16 years; 88% female) from two centenarian studies were considered. They and/or their proxies were asked on their health history and then labeled as “escapers”, “survivors” or “delayers” following Evert et al.’s morbidity typology (2003). Sociodemographic characteristics, physical and mental health status of each group were analyzed. Results Sensorial impairments and incontinence were the most frequent conditions reported. Considering the three most lethal diseases of the elderly population (heart disease, non-skin cancer and stroke), we verified that 70.6% of centenarians escaped these diseases, and 18.2% experienced a delayed onset of such diseases until the age of 80. Conclusions Findings reinforce the great variability of age-related pathologies and overall health status in centenarians, but that a great majority had the ability to evade the most lethal conditions. Management of patients with multimorbidity in very advanced ages has become a major healthcare challenge and our findings provide further evidence for policies and targeted interventions for this population.

The ageing of populations is evident in most developed countries, and the oldest old group is one of the segments with the fastest growing. The aim of this paper is to examine sociodemographic and health related characteristics of the portuguese oldest old, using a census-based approach.A descriptive study considering all residents aged 80 years and older at the time of the 2011 Census (n = 532 219) was conducted. Information on sociodemographic characteristics, sensory functions (seeing, hearing), functional status (walking/climbing stairs, bathing/dressing alone), cognition (memory/concentration), and communication (understanding others/being understood) as assessed by the Portuguese census official questionnaires were analyzed.Findings revealed that most of the oldest old are women (64.5%), widowed (53.9%), illiterate (46.1%) and live in private households (88.8%). Walking/climbing stairs (57.1%), vision (39.1%) and hearing (35.1%) were the dimensions where the oldest old presented major constrains. In parallel, understanding others/being understood (25.9%) and memory/concentration (34.4%) were the dimensions with lower percentages of difficulties. Significant differences were found between octogenarians/nonagenarians and centenarians for vision, walk/climb stairs, and bathing/dressing alone, with centenarians presenting a higher percentage of difficulties.Portuguese oldest old showed significant difficulties in activities of daily living, nevertheless cognitive and communication capacities seem to be commonly maintained. Taken together, these findings suggest the need for functional assistance, which can be ultimately managed by the older person him/herself.Based on the observed differences between centenarians and younger oldest old, specific interventions should be equated to better respond to their potentially distinctive needs.Introdução: O envelhecimento da população é evidente na maioria dos países desenvolvidos, e o grupo dos muito idosos é um dos segmentos da população com mais rápido crescimento. O objetivo deste estudo é analisar as características sociodemográficas e de saúde dos muito idosos portugueses, usando uma abordagem baseada nos dados dos censos populacionais. Material e Métodos: Foi conduzido um estudo descritivo considerando todos os residentes com 80 ou mais anos à data dos Censos 2011 (n = 532 219). Os dados dos questionários dos Censos acerca das características sociodemográficas, funções sensoriais (visão, audição), estado funcional (andar/subir degraus, tomar banho/vestir-se sozinho), cognição (memória/concentração) e comunicação (compreender os outros/fazer-se entender) foram analisados. Resultados: Os resultados revelaram que a maioria dos muito idosos são mulheres (64,5%), viúvos (53,9%), analfabetos (46,1%) e vivem em contexto domiciliar (88,8%). Andar/subir degraus (57,1%), visão (39,1%) e audição (35,1%) foram as dimensões onde os muito idosos apresentavam maiores constrangimentos. Em paralelo, compreender os outros/fazer-se entender (25,9%) e memória/ concentração (34,4%) foram as dimensões com percentagens mais baixas de dificuldade. Foram encontradas diferenças significativas entre a população octogenária/nonagenária e a população centenária para a visão, andar/subir escadas, e tomar banho/vestir-se sozinho, com os centenários a apresentarem uma maior percentagem de dificuldade. Discussão: Os muito idosos portugueses apresentam dificuldades significativas nas atividades de vida diária, contudo, as capacidades cognitivas e de comunicação parecem ser comummente mantidas. Em conjunto, estes resultados sugerem a necessidade de assistência funcional, mas que pode ser, em última instância, gerida pelo próprio idoso. Conclusão: Considerando as diferenças observadas entre os centenários e os idosos mais jovens, devem ser equacionadas intervenções capazes de responder às necessidades potencialmente específicas de cada grupo.

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

Introduction Frailty has been studied among the old population due to its association with negative outcomes. Presently there is no gold standard for measuring frailty, but several studies have used the frailty phenotype of Fried consisting of five components (weakness, slowness, unintentional weight loss, exhaustion, and low physical activity) that classify individuals as robust, pre-frail, or frail, depending on the number of components affected, respectively, zero, one or two, and three or more. This study aims to explore the specific contribution of each of these components to the frailty phenotype in a sample of oldest old community-dwelling individuals. Materials and methods Individuals aged 80+ years old living in the community (N = 142) participated in this study. Sociodemographic data (age, sex, educational level, and marital status) and Fried's frailty phenotype were collected. Descriptive analysis summarized sociodemographic information and the frailty components. Multiple correspondence analysis (MCA) was performed to detect and explore relationships between frailty's five components. Results Participants had a mean age of 88.07 years (SD = 5.30 years) and were mainly women (73.9%). The majority of the sample were considered frail (71.8%) and pre-frail (24.7%), and the most recurrent component for both groups was slowness. From the MCA analysis, a two-dimension solution was considered the most adequate, with 53.47% of variance explained. Dimension 1 (32.21% of variance explained) showed weakness as the most discriminant component; dimension 2 (21.26% of variance explained) showed unintentional weight loss as the most discriminant component. Discussion Results revealed a high number of pre-frail and frail participants. MCA proved to add an important understanding in examining the frailty phenotype; it revealed weakness as the most discriminant component for dimension 1, suggesting a high association with the frailty phenotype. MCA also identified two main features of frailty: one related with physical features (motor behavioral and grip strength) including weakness, low physical activity, and slowness; and the second related with intrinsic conditions (unintentional weight loss and exhaustion). Conclusion This study corroborates the need of a differentiated approach to the frailty phenotype among very old individuals, bringing for consideration the specific influence of its components.

Major Neurocognitive Disorders describe the symptoms of a large group of diseases causing a progressive decline in individual’s functioning. It is an umbrella term describing a decline in memory, intellectual ability, reasoning, and social skills, as well as changes in normal emotional reactions. The general practitioner is instrumental in the early diagnosis of Major Neurocognitive Disorder. Individual risk factors act as contributing variables affecting the probability of someone developing a Major Neurocognitive Disorder and may be considered predictive factors. This study aimed (i) to show the utility of using the Global Deterioration Scale in primary health care settings as a measure to assess the stage of cognitive function for individuals identified with Major Neurocognitive Disorders and (ii) to identify predictors of severe Major Neurocognitive Disorders. Potential predictors of Major Neurocognitive Disorders considered in this study were: sex, age, years of education, social isolation, hearing impairment, cardiovascular disease, hypertension, diabetes, smoking habits, alcohol consumption, physical activity, hand strength, and nutritional status. The sample comprised 250 adults, 30.4% were classified as having probable Major Neurocognitive Disorder. The variables significantly associated with probable Major Neurocognitive Disorder were age, years of education, hearing impairment, cardiovascular disease, hand strength, nutritional status, and physical activity. In the multivariable model, only age, education, physical activity and hand strength remained significant predictors of probable Major Neurocognitive Disorder. The Global Deterioration Scale seems to be a usefull instrument in primary healthcare settings, as it guides the general practitioner in observing the patients’ cognitive functioning. Advanced age, lower education, lower hand strength and absence of physical activities should be taken into account as they increase the chance of severe Major Neurocognitive Disorders. Primary health care providers, including general practitioners are very important in the diagnosis and follow up of Major Neurocognitive Disorder. The general practitioner is in most cases the patients’ first and for many patients the only contact, thus having a critical role in evaluating with caution what is part of normal or pathological aging, and the individual factors that can increase the likelihood of developing Major Neurocognitive Disorder to further support patients in the course of the disease.

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BackgroundInformal caregivers (IC) of people with dementia (PwD) are at greater risk of developing physical and mental health problems when compared to the general population and to IC of people with other chronic diseases. Internet-based interventions have been explored for their potential to minimize the negative effects of caring, accounting for their ubiquitous nature, convenient delivery, potential scalability and presumed (cost) effectiveness. iSupport is a self-help online program developed by the World Health Organization (WHO) to provide education, skills training and support to IC of PwD. This paper describes the design of an intervention study aimed at determining the effectiveness of a Portuguese culturally adapted version of iSupport on mental health and other well-being outcomes.MethodsThe study follows an experimental parallel between-group design with two arms: access to the five modules and twenty-three lessons of “iSupport” for three months (intervention group); or access to an education-only e-book (comparison group). One hundred and eighty four participants will be recruited by referral from national associations. Inclusion criteria are: being 18 years or older and provide e-consent; being a self-reported non-paid caregiver for at least six months; of a person with a formal diagnosis of dementia; being skilled to use internet; and experience a clinically relevant level of burden (≥ 21 on Zarit Burden Interview) or depression or anxiety symptoms (≥ 8 on Hospital Anxiety and Depression Scale). Data is collected online, resorting to self-administered instruments, at baseline, 3 and 6 months after baseline. The primary outcome is caregiver burden, measured by the Zarit Burden Interview. Symptoms of depression and anxiety, quality of life, positive aspects of caregiving and general self-efficacy are secondary study outcomes. The data analysis will follow an Intention-to-treat (ITT) protocol.DiscussionThis protocol is an important resource for the many organizations in several countries aiming to replicate iSupport. Findings from this intervention study will offer evidence to bolster an informed decision making on scaling up iSupport as a new intervention program with minimal costs aimed at minimizing the psychological distress of IC of PwD in Portugal and elsewhere.Trial registrationClinicalTrials.gov,NCT04104568. Registered 26 September 2019.

Oldest-old individuals are a growing segment of the population that faces several challenges in terms of care demands. Informal caregivers experience more or less challenges, namely depending on the support they can access. The present study explores the unmet needs of a sample of informal caregivers of community-dwelling older adults aged 80+ and analyses the association of such needs with sociodemographic information, care-giving context (e.g., length of care),and health characteristics of the caregivers and care receivers (e.g., cognitive status and functionality). We recruited 175 care-giving dyads from the North of Portugal. Descriptive statistics summarised the sample's characteristics. Informal caregivers were mainly women with a mean age of 60.6 years (SD = 9.8). Care receivers' mean age was 88.7 years (SD = 5.6) and were functionally dependent (9.3 points [SD = 7.0] and 27.0 points [SD = 3.5] for Basic and Instrumental Activities of Daily Living, respectively). A thematic analysis of an open-ended question on unmet needs was performed, revealing the presence of unmet needs. The most relevant ones (financial support, caregiver support, primary care/medical specialities, and labour regulation) were further analysed, concerning the care-giving dyad's using Independent Student's t test or Mann-Whitney U Tests, and Chi-squared test or Fisher's Exact test depending on the variable. The most frequent unmet needs were associated with the caregiver's age, care receivers' kinship, number of care-giving hours, the caregiver's gender, professional status, the caregiver strain and medicines intake. Findings suggest the need for establishing policies that ensure adequate sustainability of the provision of informal care that takes into account the needs of care-giving dyads in the planning process.

WHAT IS KNOWN ON THE SUBJECT?: Positive aspects of care are considered an essential part of caregiving research. They have been related to a wide range of dimensions of the caregiving circumstances, but there are few valid, reliable and brief measures to assess them. One of the most frequently used internationally is the Positive Aspects of Caregiving (PAC) scale, whose psychometric properties have received little attention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The present study analyses the psychometric properties of the Portuguese version of the PAC scale in a sample of informal caregivers of someone with dementia and further explores the association of different factors (e.g. caregiver health, sociodemographic variables) with the PAC. The Portuguese version of PAC scale presented good psychometric characteristics, and the factor analysis revealed the presence of two factors: affirming self and enriching life. Our study also verified that higher levels of PAC are more likely to be associated with better caregiver health perception, lower levels of psychological distress and burden, the care recipient's older age, providing care to more than one care recipient, not receiving social support services and not considering institutionalizing the care recipient. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings from this study can assist professionals, including mental health nurses, to develop and implement effective interventions that help dementia caregivers to maintain their emotional health by identifying and focusing specific positive aspects of care. The study stresses the Portuguese version of the PAC scale as a reliable and valid measure for practice. ABSTRACT: Introduction Positive aspects of care refer to the psychosocial benefits of caregiving. The Positive Aspects of Caregiving (PAC) scale is one of the instruments most frequently used internationally, but its psychometric properties and correlates within the caregiving experience have received limited attention. Aim To examine the factorial structure of the Portuguese version of PAC scale and to analyse background and contextual factors that are more likely to be associated with higher levels of PAC. Method The PAC scale, a sociodemographic questionnaire and measures assessing burden and physical and mental health were administered to 204 informal caregivers of dementia patients. Results Exploratory factor analysis revealed a two-factor structure; internal consistency was adequate. Higher scores were negatively correlated with caregiver burden and distress. Better health perception, care recipient's older age, providing care to more than one care recipient and overall self-reliance were correlated with higher levels of PAC. Discussion The PAC scale was found to be a reliable and valid measure. Dementia caregiving circumstances and caregivers' and care receivers' characteristics play an important role for the presence of PAC, but relate distinctively with its dimensions. Implications for Practice Findings can help mental health nurses to recognize distinctive relations between PAC and caregiving variables.

Fit & Strong! is an evidence-based program that combines exercise with health education for older adults with lower extremity osteoarthritis. This paper explores the factors of acceptance to a randomised controlled trial that tested the Portuguese (Europe) version of Fit & Strong! and analysed the sociodemographic, lifestyle and health characteristics of people who agreed versus people who declined to participate. Patients were identified by General Practitioners at three healthcare centres during 4 months (May 2017 to July 2017). Patients who accepted the invitation and met the inclusion criteria are designated participants, and people who met the inclusion criteria, declined the opportunity to participate but agreed to answer a brief questionnaire are designated as non-participants. Data included sociodemographic, lifestyle behaviours, health, pain and ADLs from the Western Ontario and McMaster Universities Osteoarthritis. Data were analysed using descriptive analysis and the Wilcoxon-Mann-Whitney, Chi-Squared tests or Fisher's tests. The results showed that three out of 12 (25%) primary healthcare centres contacted about the new program accepted the invitation to participate in recruitment. Eighty-two patients were contacted, of whom 14 (17.2%) did not meet inclusion criteria and 32 (38.3%) met the inclusion criteria but declined to participate. The acceptance rate was 22%. Non-participants were older (U = 41.0; W = 212.0; p = .044) and experienced earlier osteoarthritis onset than participants (U = 26.0; W = 146.0; p = .031). In conclusion, younger age and a diagnosis of osteoarthritis more recent appear to predispose older adults with osteoarthritis to be more accepting of participation in a non-pharmacologic intervention designed to increase physical activity.

Successful dialysis in end-stage renal disease (ESRD) largely depends on the patients' ability to adhere to several clinical requirements and life-style changes. Social support has been consistently linked to better health outcomes in a number of chronic diseases. The current study presents a systematic review of the literature on the relationship between social support and treatment adherence in ESRD. The search was performed on Web of Science, PsycInfo, ScienceDirect, and Scopus from January 19 to May 15, 2019. Two hundred and twenty-four records were identified. After quality assessment, 17 studies were included for qualitative synthesis. This review comprised a total of 2362 patients. Most patients were on hemodialysis (97.5%) for an average of 58.2 months. Results suggested an overall pattern of mixed findings regarding the association between social support and treatment adherence. Adherence to fluid restrictions was the type of adherence with more significant associations with social support (63%). Mixed results were found for adherence to dialysis sessions (50%) and to medication (50%). Associations between adherence to diet restrictions and social support were found in 44% of the included studies. No significant associations were found between social support and adherence to follow-up consults. All of the included studies combining several types of adherence into an overall score found significant associations with social support. Findings suggested that it might be particularly beneficial to focus future research and clinical efforts toward social support from family, significant others, and health professionals, to improve patient's with ESRD treatment adherence.

Objective: To evaluate dairy intake patterns in older adults across Europe. Methods: We conducted cross-sectional analysis using data from the fourth wave (2011/2012) of the Survey of Health, Aging and Retirement in Europe (SHARE) database. Prevalence rates regarding the number of weekly servings of dairy in individuals ≥50 years old were calculated for 16 European countries. Results: The overall prevalence rate of daily dairy product intake in Europe was 66.95% (CI95%: 66.28-67.63%). Global prevalence in men was 63.35% (CI95%:62.37-64.35%) and in women 69.80% (CI95%:68.86-70.71%). Among men, this type of intake was highest in Denmark (84.89% [CI95%: 79.11-90.66%]) and lowest in Poland (26.15% [CI95%: 22.71-29.58%]). Among women, the highest prevalence was found in Spain (89.51% [CI95%: 85.16-93.86%]) and the lowest in Poland (31.33% [CI95%: 27.05-35.61%]). The overall prevalence rate of dairy product intake less than once a week was 3.99% (CI95%: 3.83-4.16%). In terms of gender, men in Hungary (11.02% [CI95%: 9.16-12.89%]) and women in Slovenia (8.76% [CI95%: 7.26-10.25%]) had the lowest such intake. Conclusions: Dairy intake is very heterogeneous across Europe, with overall intake levels lower than recommended. Differences were also observed between genders, with a lower intake in men, and with age, with the intake lower in older individuals.

Underutilization of community care services has been described for informal dementia caregivers. Most research has however examined caregivers' access to home or respite care rather than to services for themselves. The aims of this study are: to describe access and retention of informal dementia caregivers in psychosocial interventions; examine the perceived effects of interventions among users and motives for non-use among non-users; and compare caregivers with and without lifetime access and retention in psychosocial interventions across predisposing, enabling and need variables. A cross-sectional study was conducted with 179 Portuguese caregivers, who replied to a web-based survey. Participants were fairly distributed among those who have never (49.7%) and those who have ever accessed (50.3%) psychosocial interventions. Individual psychological support was the most used intervention (32.2%). Caregivers' age, time elapsed since diagnosis and the relationship with the care receiver were associated with lifetime access to various intervention types. Dropout was above 50% for most intervention types, except for psychoeducation (31.8%). Associations were found between a history of dropout/retention and caregivers' education, perceived mental health, and the number of hours spent caring. Most users of psychoeducational interventions (>80%) appraised it as beneficial to learn about the disease, provide quality care and cope with caregiving. Informational barriers were the most reported by non-users of psychoeducational interventions (45.1%). The findings show that dementia caregivers continue facing barriers to use and keep using community services for themselves. The influence of particular predisposing and need variables on access to psychosocial interventions can vary according to intervention types.

AIM: To examine the relationship between age and quality of standing balance in single and dual task conditions. METHODS: A cross-sectional study was conducted using a sample of 243 community-dwellers aged ≥65 years. Quality of standing balance was assessed by measuring the center of pressure (COP) sway with a pressure platform. Measurements were performed under single task (orthostatic position) and dual task (orthostatic position while performing a verbal fluency task) conditions. RESULTS: The mean age of the participants was 79.1(±7.3)years and 76.1% were women. Older age was associated with an increased COP sway, mainly in the medial/lateral (ML) direction. Most COP sway parameters were higher under dual task conditions than under single task. After controlling for the effect of the number of words enunciated in dual task conditions, only the differences in COP sway parameters in the ML direction remained significant. There was no significant interaction between age group (65-79; ≥80 years) and condition, which indicates that differences in COP sway caused by performing a secondary task were similar for younger and for older participants. CONCLUSION: Age did not seem to influence significantly the decline in the quality of standing balance triggered by performing a concurrent cognitive task. However, older age was consistently associated with poorer standing balance, both in single and in dual task conditions. Therefore, performing a secondary task may lead older individuals to reach their postural stability limits and, consequently, to fall.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. Language: en

Non-adherence to medical plans is recognized as an important problem in dialysis patients, since it has been associated with increased morbidity and mortality, resulting in disproportionately high costs of care. The success of renal replacement therapy depends on the adherence of patients to the different aspects of the therapeutic strategy, which includes a complex drug regimen involving a wide variety of drugs and doses, several prescribed dialysis sessions with different durations, dietetic recommendations and restriction of fluid intake. In this work, we aimed to translate and validate a previously described self-reported end-stage renal disease questionnaire (ESRD-AQ) to the Portuguese language (PESRD-AQ). After ESRD-AQ translation, a validation was performed by experts and by using a cohort of 185 Portuguese dialysis patients. PESRD-AQ reliability analysis showed strong test-retest stability across all items, with an intra-class correlation of 0.931. The average of the item-level content validity index by experts for the 46 items was 0.98, ranging from 0.94 to 1. Moreover, we found that PESRD-AQ scores indicative of non-adherence were associated with alterations in some biological and biochemical markers of non-adherence, including interdialytic weight gain. In conclusion, our results showed that PESRD-AQ, which presented an acceptable reliability and validity, is a valid tool to be used for adherence evaluation by Portuguese-speaking dialysis patients.

Background Regular physical activity is one of the key components of a healthy lifestyle. It is associated with better physical and cognitive functioning in later life and with increased life expectancy. The purpose of this study was to evaluate the prevalence of, and factors related to, physical inactivity among older adults across Europe. Methods In this cross-sectional analysis, we used data from participants aged 55 or older in Wave 4 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) database, a multidisciplinary and cross-national panel database covering health, socioeconomic status, and social and family networks. Individuals included in this study were classified as physically active or physically inactive. Clinical, psychosocial and sociodemographic variables were evaluated for their association with physical inactivity. Results From the total of 58,489 individuals in SHARE, we selected 19,298 people age 55 or older (mean age 67.8 ± 8.9 years; 11,430 (59.2%) female). The overall prevalence of inactivity among individuals age 55 or older in the 16 included countries was 12.5%. The prevalence of physical inactivity varied between countries, ranging from 4.9% (Sweden) to 29% (Portugal). Increasing age, depression, physical limitations, poor sense of meaning in life, social support and memory loss were significant variables associated with physical inactivity. Conclusions Physical inactivity can be explained by physical, cognitive and psychological conditions. Interventions aimed at promoting physical activity among older people are needed to address this diversity of factors.

Resumen Objetivo Demostrar que la implementacion del programa de estimulacion cognitiva (EC) «Making a Difference» (MD) mejora la cognicion y la sintomatologia depresiva en personas mayores y jubiladas que residen en el ambito comunitario. Metodo Estudio multicentrico y cuasiexperimental efectuado sobre 45 personas mayores (38 mujeres y 7 hombres) residentes en el ambito comunitario, con una edad media de 75,29 anos, seleccionados en 3 centros de dia localizados en contextos rural, semirrural y urbano, en la region central de Portugal. Los participantes asistieron a 14 sesiones bisemanales a lo largo de 7 semanas. La escala de Valoracion cognitiva de Montreal (Montreal Cognitive Assessment [MoCA]) y la escala de depresion geriatrica de 15 items (15-item Geriatric Depression Scale [GDS-15]) se aplicaron en 3 momentos de la evolucion: al inicio del estudio, al final del estudio y en el seguimiento. Resultados Entre el inicio del estudio y el final del estudio hubo una diferencia estadisticamente significativa en la sintomatologia depresiva (F = 7,494; p = 0,010) explicando el 21% de la varianza (valor eta cuadrado parcial [ηp2] = 0,21), potencia = 0,75; sin embargo, no hubo una diferencia estadisticamente significativa respecto a la cognicion. Entre el final del estudio y el seguimiento no hubo diferencias en los resultados correspondientes a la cognicion ni a la depresion. Conclusiones Nuestros resultados demuestran una mejoria de la sintomatologia depresiva de las personas mayores tras un programa de intervencion de 7 semanas de duracion, pero sin persistencia del efecto terapeutico a los 3 meses de seguimiento. No se ha demostrado el efecto beneficioso del programa de intervencion respecto a la mejora de la cognicion. La EC puede tener utilidad para prevenir la sintomatologia depresiva de las personas mayores cuando se incluye en el plan de cuidados para la promocion de la salud.

Background: Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown. Objective: To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one (“can manage”) to five (“absent/liability”). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death. Design: Observational cohort study. Setting and Participants: Community-dwelling adults, aged >65,attending health centres in Ireland,(n=779). Procedure and Measurements: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). Results: The majority of patients had a primary caregiver (582/779;75%), most often their child (200/582;34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%,p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. Conclusion: This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.

Background/objectives Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. Design Cross-sectional study. Setting Micro-data from the European Health Interview Survey (2006–2009) was used. Participants The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. Measurements The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. Results The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). Conclusion Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.

Objectives: This study aims to analyze the accuracy and predictive ability of the Risk Instrument for Screening in the Community (RISC) scored by general practitioners (GPs) in a sample of primary care patients aged 80+ with perceived mental health concerns. Method: GPs ranked the perceived risk of the three adverse outcomes (hospitalization, institutionalization and death) at 1 year in a five Likert scale (RISC score), where 1 is the lowest risk and 5 is the highest. Follow up contacts were conducted after 1 year of assessment in order to collect data on the three outcomes. Results: The 1-year proportion of institutionalization, hospitalization and death were 12.1 %, 25.2 % and 19.0 % respectively. Based upon the sensitivity and specificity from the Receiver Operating Characteristic (ROC) curves, we found an optimal cut-off point of ≥4 for the RISC. The RISC had fair accuracy for 1-year risk of institutionalization (Area Under the ROC curve (AUC) = 0.75, 95% CI 0.43-0.68) and hospitalization (AUC = 0.65, 95% CI 0.52-0.78), but not for death (AUC = 0.55, 95% CI 0.43-0.68). Conclusions: The RISC as a short global subjective assessment is to be considered a reliable tool for use by GPs. Our results showed that RISC seems to be a good instrument to triage very old people at risk for institutionalization but with poor accuracy at predicting hospitalization and limited predictive ability for death, suggesting further research and caution on this instrument’s use. This work was conducted within the PhD project of the first author that is supported by FCT (Portuguese Foundation for Science and Technology) under a PhD Grant (SFRH/BD/101595/2014). The Necessidades de Cuidados a Pessoas com Demências project was supported by National Funds through the General Health Directorate of the Portuguese Ministry of Health, and the FCT in the frameworks of the Pest-OE/SAU/UI0688/2014. This project is coordinated by the last author.

Background The worldwide increase of human life expectancy and the rapid aging of the population will contribute to an increasing prevalence of chronic illness. Even so, individuals who reach very advanced ages often postpone or escape age-related diseases that are common causes of death. Objective This article aims to examine health-related characteristics of two distinct samples of Portuguese centenarians (one predominantly rural – PR vs. one predominantly urban - PU), and explore potential dissimilarities in their morbidity profiles and use of health care services. Methods A total of 241 centenarians were considered. Sociodemographic characteristics, health status, and use of health care services were assessed by semi-structured interviews with the centenarians and their proxies (family or formal caregiver). Results A higher average of 4.80 self-reported illnesses (sd = 2.01) were found in the PU sample (vs. 2.96; sd = 1.77 in the PR sample); in overall the PR sample presented a better health condition with lower levels of physical and mental impairments, and a greater number of centenarians who did not succumb to the three most common lethal diseases (heart disease, non-skin cancer and stroke) in the elderly population (85.4% vs. 60% in the PU sample). Conclusions Portuguese centenarians experienced a substantial number of illnesses, but an overall better health status was found in centenarians from the PR area. By providing distinctive health-related profiles, our findings suggest the importance of contextual factors in shaping how very advanced ages may be achieved.

Background: Living beyond 100 years of age is associated with several functional and health constraints but their impact depends on one’s perception of the situation. Associations between self-rated health (SRH) with sociodemographic and psychosocial variables have been explored in several studies, revealing that one’s health appraisal depends of factors beyond the objective health condition. There is a large body of literature concerning SRH in later life but lack of evidence about centenarians’ perception of health and its associated factors, which could increase the available knowledge on the strengths and resources individuals in very advanced ages have for facing daily life limitations. Objective and Methods: This study aims to analyse the relationship between subjective and objective health status in a sample of centenarians (n = 127). Subjective health was assessed by a single-item health measure, and objective health by considering the number of reported diseases and a functional capacity scale (BADL and IADL). Main health characteristics are described as well as examined the association between objective and subjective health. Results: 46.5% of the sample has a good, very good, or excellent appraisal of their own health. SRH was associated (p < 0.05) with BADL and IADL scores and with the total number of diagnosis; when analyzing SRH according to the level of functional capacity, results revealed that most individuals with severe and moderate dependence have a reasonable to excellent SRH (p > 0.05). Conclusion: Having diseases and functional dependence at 100 years old may not mean to have a bad SRH. The high variability in SRH and the discordance between objective and subjective measures are a proof of centenarian’s capacity of adaptation and the existence of individual resources, which may be decisive for one’ perception and handling of health situation at such an advanced age. info:eu-repo/semantics/publishedVersion

For the last 10 years, ageing well in the community has become a key concern of the European Union and its member states. Action plans as well as distinct programs such as the Ambient Assisted Living (AAL) Joint Programme are evidence of this engagement. Since then, many AAL products and services have been developed and implemented in the European market. Up to now, however, access to, and the availability of these solutions is difficult, and the information on their use is scarce. ActiveAdvice, an AAL EU-funded project aims to develop an online platform which offers both information on AAL solutions as well as advice to end users. This paper discusses the application of a multi-stakeholder perspective approach. It discusses the user-centered development and reflects on the establishment of AAL ecosystems and the functional requirements of the ActiveAdvice platform. It includes an extended methodological framework, which explains conclusively the ActiveAdvice stakeholders’ identification process and the user-centered requirements analysis, built on 38 semi-structured interviews with three stakeholder groups – consumers, businesses and governments. The integration of different stakeholders in the development and implementation of AAL solutions is a necessity as well as a challenge. This holds also true for the development of the ActiveAdvice platform.

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.

Objective: This study aimed to identify independent associations of sociodemographic, functionality, physical activity, physical and mental health and osteoarthritis, among older adults. Methods: A sample of 1645 older adults (50+ years) observed by rheumatologists, from EpiReumaPt, a population based study was analyzed. A structured interview included sociodemographic data, chronic non-communicable disease and physical activity. Functional ability was assessed by the Health Assessment Questionnaire Disability Index; depression and anxiety were assessed by Hospital Anxiety and Depression Scale. Osteoarthritis (knee OA and/or hip OA and/or hand OA) was defined after medical evaluation by rheumatologists according to expert opinion combined with the fulfillment of the American College of Rheumatology classification criteria. Results: 1059 participants (64.9%) met the osteoarthritis classification criteria. Statistically significant differences were found between persons with and without OA in all sociodemographic variables, non-communicable diseases, functional status, physical activity, depression and anxiety. In the unadjusted logistic regression models all variables were associated with osteoarthritis. The final adjusted model explained 32% of the variance. Those that are Higher age Oldest people, female with higher age, have gender, more than 5 comorbidities, and lower levels of function and and lower levels of physical activity, were more likely to meet the criteria for a diagnosis of osteoarthritis. Discussion: We have analyzed data from a population-based study and found that a diagnosis of osteoarthritis was independently associated with age, female gender, higher number of comorbidities, physical disability and low levels of physical activity. These results reinforce the usefulness of the development of a multidimensional assessment to design and test effective interventions for this population.

The objectives of this article are as follows: (1) to describe the assessment protocol used to outline people with probable dementia in Primary Health Care; (2) to show the methodological design and procedure to obtain a representative sample of patients with probable dementia; and (3) to report the main characteristics of the sample collected in the context of the study “Characteristics and needs of people with probable dementia.” The study protocol was based on the “Community Assessment of Risk and Treatment Strategies (CARTS) Program” and is composed by a set of instruments that allow the assessment of older adults with probable dementia in several areas (health, psychological, functionality, and other). Descriptive analysis was used to characterize the final sample (n = 436). The study protocol as well as the methodological procedure to obtain the referral of research participants and data collection on the condition of people with probable dementia in Primary Health Care proved to be a valuable tool to obtain a sample of patients distributed by the full range of probable dementia in a large geographical area. Results may allocate the design of care pathways for old people with cognitive disorders to prevent, delay impairment, and/or optimize quality of life of patients.

Background: Active ageing encompasses a socially and individually designed mix of different domains that range from personal and familial, to social and professional. In being a key policy concept often focused on the young-old individuals, efforts in studying its dimensions in advanced ages have seldom been made. Nevertheless, there is a recognized need to promote adequate responses to the growing number of individuals reaching advanced ages, and to recognize their specific dependability on health-related aspects, services attendance, social interactions, or on psychological characteristics for what it means to “age actively”. Objective and Methods: This study provides a secondary analysis of data and follows the preceding work on the operationalization of the World Health Organization’s (WHO) Active Ageing model by means of an assessment protocol to measure which variables, within the model’s determinants, contribute the most for an active ageing process (Paul, Ribeiro & Teixeira, 2012). Authors used the achieved model (composed by six factors: health, psychological component, cognitive performance, social relationships, biological component, and personality) and performed multi-group analysis of structural invariance to examine hypothetical differences between age groups (

Background: Physical frailty and depression are common comorbid conditions that have important impact on older adults. Few studies however have examined their cooccurrence in centenarians. This paper explores the relationship between the two conditions and the most characteristic depressive symptoms associated with the frailty syndrome. Methods: Data come from two Portuguese Centenarian Studies. Frailty was measured using Fried’s phenotype, which includes at least three clinical signs: exhaustion, weight loss, weakness, slowness, and low physical activity level; the Geriatric Depression Scale was used to assess depression. Descriptive comparison and binary logistic regression models were used for data analysis. Results: The final sample comprised 91 centenarians (mean age=101.0, SD=1.3; 85.7% female). From these, 5.5% were classified as robust, 42.9% as pre-frail, and 51.6% as frail. The prevalence of depression in the whole sample was 35.2% (51.1% in frail centenarians; 21.1% in pre-frail centenarians; 0% in robust centenarians). Frail centenarians presented higher risk of depression (OR=3.92; 95% CI 1.48–10.4) when compared to pre-frail centenarians. Findings from the multivariable model (gender, living arrangements, education, cognition, subjective health, current illness, and functionality) revealed that only subjective health remained significant. Conclusion: It seems that depression is a comorbid clinical independent condition that is frequent in frail and pre-frail centenarians. This work was supported by the Portuguese Foundation for Science and Technology (FCT) [Grant PEst – C/SAU/UI0688/2011]. Authors would like to thank Dr. Rosa Marina Afonso and the PT100 Beira Interior team from University of Beira Interior (Covilhã, Portugal) for their contribution with data from the Beira Interior Centenarian Study.

Background: In the current context, associated with the increase in longevity, there is a greater need for institutionalization of old people in search of formal support. The direct care workers of institutionalized older people, who work at day care centers and residential homes, are at risk of being victims of occupational psychosocial risks. There are several psychological complaints of these workers, highlighting the need to develop a mental health promotion program aiming at job satisfaction of direct care workers, improving their provision of care at work and quality of life. Aim: The StressadaMente program is a mental health promotion program for direct care workers of institutionalized older people in day care centers and residential homes. This article aims to describe the StressadaMente program and to evaluate the level of satisfaction of the direct care workers with the program. Methods: The program was implemented in two day centers/residential homes, enrolling 25 participants, and comprised one session per week, with 90 min per session, during 7 weeks. Sociodemographic information of direct care workers was collected. The assessment protocol comprised a satisfaction questionnaire of the program. Results: In general, the program was evaluated as “very good” and “excellent” by 9.5% and 90.5% of the participants, respectively. These results may indicate that mental health promotion intervention seems to encourage new skills and changes to a better practice, prevent adverse effects of caregiving by improving the mental health of professionals.

This entry presents the first population-based study conducted in Portugal, the Oporto Cente- narian Study (PT100). It starts by providing an overview of the centenarian population in Portu- gal and then describes PT100’s methodological approach (sampling, procedures, and measures) and synthesizes its main findings on three core dimensions considered to be determinants of qual- ity of life in extreme old age (Serra et al. 2011): cognitive and physical functioning, social resources (social relationships and social activi- ties), and personal attitude toward life (valuation of life). An outlook of current satellite projects of the PT100 is presented at the end.