Homes In Portugal Research Articles

Portuguese Older Persons' Views about Living in a Nursing Home: Challenges to the Rehabilitation of the Image of LTC in Post-Pandemic Times.

This paper addresses the broad topic of what older people think about nursing homes in Portugal. In the aftermath of the COVID-19 pandemic and considering the tragic events taking place in nursing homes, the challenge of reimagining the sector involves not only improving procedures and models of care, making sure they meet what citizens consider adequate, but also rehabilitating the image people have about nursing homes and rebuilding trust. Current and future decisions about how one meets LTC needs is influenced by the extent to which individuals see the alternatives as adequate. The paper presents evidence collected from a qualitative study run just before the COVID-19 pandemic began, with a sample of 45 community-dwelling individuals aged 60 plus, in Portugal. Opinions and views about nursing homes were collected and the results point to enduring negative aspects that are considered at odds with what constitutes adequate care. The paper discusses in length what those aspects are and concludes that future reforms of the nursing homes sector in Portugal need to consider what current and future users think and feel about that specific type of service. Debates in Portugal tend to be more focused on discussions about expanding the sector and less on aspects of quality of care. Views and opinions of interviewed participants, however, suggest that people may be more worried about quality of care.

Spatial and Temporal Analysis of COVID-19 in the Elderly Living in Residential Care Homes in Portugal.

Background: The goal of this study is to identify geographic areas for priority actions in order to control COVID-19 among the elderly living in Residential Care Homes (RCH). We also describe the evolution of COVID-19 in RHC throughout the 278 municipalities of continental Portugal between March and December 2020. Methods: A spatial population analysis of positive COVID-19 cases reported by the Portuguese National Health Service (NHS) among the elderly living in RCH. The data are for COVID-19 testing, symptomatic status, comorbidities, and income level by municipalities. COVID-19 measures at the municipality level are the proportion of positive cases of elderly living in RCH, positive cases per elderly living in RCH, symptomatic to asymptomatic ratio, and the share of comorbidities cases. Spatial analysis used the Kernel density estimation (KDE), space-time statistic Scan, and geographic weighted regression (GWR) to detect and analyze clusters of infected elderly. Results: Between 3 March and 31 December 2020, the high-risk primary cluster was located in the regions of Braganca, Guarda, Vila Real, and Viseu, in the Northwest of Portugal (relative risk = 3.67), between 30 September and 13 December 2020. The priority geographic areas for attention and intervention for elderly living in care homes are the regions in the Northeast of Portugal, and around the large cities, Lisbon and Porto, which had high risk clusters. The relative risk of infection was spatially not stationary and generally positively affected by both comorbidities and low-income. Conclusion: The regions with a population with high comorbidities and low income are a priority for action in order to control COVID-19 in the elderly living in RCH. The results suggest improving both income and health levels in the southwest of Portugal, in the environs of large cities, such as Lisbon and Porto, and in the northwest of Portugal to mitigate the spread of COVID-19.

Nursing homes in Portugal during the COVID-19 outbreak: Challenges for the future

ObjetivoEste estudio pretende explorar la percepción de los especialistas sobre el desempeño de las residencias de ancianos durante la COVID-19.MétodoEste es un estudio desarrollado en 2 fases: 1) un grupo focal, con el que se trabajó en mayo 2020, con 5 especialistas y 2) un Delphi modificado, implementado en septiembre 2020 con 22 especialistas, ambos en el área de asistencia en residencias de ancianos del norte y centro de Portugal.ResultadosLos resultados permitieron identificar 3 áreas principales que influenciaron el desempeño de las residencias de ancianos desde el inicio del brote de la COVID-19: modelos de organización y recursos; salud física y mental de los residentes y; la familia como apoyo.ConclusionesLas personas mayores que residen en residencias para ancianos quedan particularmente vulnerables a la COVID-19, pues esta enfermedad puede tener para ellos consecuencias muy graves o incluso conducirle a la muerte. Es importante que las residencias prevengan la fragilidad física y mental de los ancianos, así como la soledad que muy probablemente les asola debido a las circunstancias pandémicas. Los responsables por las residencias de ancianos deben percibir que las personas mayores que viven en ellas tienen. por lo general. problemas de salud, lo que debería determinar la implementación de nuevas estrategias, entre ellas el aumento del número de profesionales debidamente capacitados.

Management of clinical relevant drug-drug interactions with antipsychotics in nursing homes

Introduction Antipsychotics (APs) have been linked to several clinically relevant drug-drug interactions (leading, e.g. to QT-prolongation, torsades de pointes) but little is known about their management in nursing homes residents. Our aim was to characterise clinically relevant drug-drug interactions involving APs and to assess their prevalence in nursing homes residents. Materials and methods We conducted a cross-sectional study in two nursing homes in Portugal. Patients were included if they were older ≥65 and prescribed at least one AP (registered in medical charts). Interactions were identified using Drug Interaction Chequer (Medscape [1]) and supplemented with the summary of product characteristics (SmPC) when deemed necessary. Clinical relevant interactions were defined as serious or contraindicated interactions according to Medscape tool. Data were analysed using univariate statistics (Microsoft Excel 2016). Results A total of 59 patients (83.7 ± 7.1 years) were analysed, 79.7% (n = 47) females. A mean of 1.6 ± 0.7 antipsychotics were prescribed/patient, mostly on a regular basis (61.0%; n = 36). The majority were exclusively prescribed atypical APs (59.3%; n = 35), 28.8% (n = 17) simultaneously atypical and typical APs and 11.9% (n = 7) prescribed only typical APs. Nearly 90% (n = 52; 88.1%) of patients reported interactions with APs, (mean = 2.9 ± 2.3/patient). A total of 169 interactions with APs were found, mainly with antidepressants (27.2%; n = 46), benzodiazepines (22.4%; n = 38), and other antipsychotics (10.6%; n = 18). The majority of AP-drug interactions (83.4%; n = 141) were classified as “to be closely monitored”, mostly due to the sedation effect (56.7%; n = 80). Quetiapine was the AP most often involved in interactions (45.6%; n = 77), where 9.1% (n = 7) were considered “serious”. Haloperidol also registered 37 interactions (21.9%), four of which resulted in increased QTc interval (10.8%). Discussion and conclusions Data showed that one third of patients had clinically relevant AP-drug interactions. Future work will include the development of a user-friendly booklet on clinical relevant drug-drug interactions in elderly patients using APs, expected to contribute to enhanced patient safety and a more rational use of medicines.

A cross-sectional study on nurses' attitudes towards physical restraints use in nursing homes in Portugal.

AimTo explore nurses' opinions regarding restraint measures and attitudes towards physical restraints use in nursing homes.DesignCross‐sectional study.MethodsNursing staff of 33 Portuguese nursing homes was asked to complete the Portuguese version of the Maastricht Attitude Questionnaire (MAQ), an instrument on attitudes regarding physical restraints (reasons, consequences and appropriateness of restraint use) and opinions about restraint measures (restrictiveness and discomfort). Descriptive statistics and bivariate analysis were performed.ResultsData from 186 nurses were included in the analysis. Overall, nurses expressed neutral to moderately positive attitudes towards physical restraints usage. Nurses with longer professional experience reported a more positive attitude regarding the appropriateness of restraint use in their clinical practice. Wrist and ankle restraints were the measures that nurses reported feeling most uncomfortable using, and the most restrictive. Bilateral bedrails were globally assessed as a slightly restrictive measure and nurses reported not feeling uncomfortable using them.

Patients' clinical information requirements to apply the STOPP/START criteria.

Background The STOPP/START criteria are an explicit tool to detect potentially inappropriate medications (PIMs). Patient clinical information may not be available in all settings. Objective To identify patient clinical information needed to apply the STOPP/START criteria. Setting: Fournursing homes in Portugal. Methods First, a theoretical analysis was performedto identify the patient information required to apply the STOPP/START criteria (v2), according to the following categories: patients' current medication, medication history (previous medication and duration), medical records (current and past medical conditions), and laboratory test results. A verification of the information requirements was conducted through a cross-sectional study on a nursing home population with patients over 65years old. Patients' medical records were appraised to extract only demographic data and current medication profiles. Main outcome measure Information requirements of STOPP/START. Results For only 29 of the 81 STOPP criteria and 1 of the 34 START criteria, a judgement could be made with only the information in the patient's medication profile. 52 STOPP and 33 START criteria require additional information, (i.e. duration of therapy, previous medication, current and past medical conditions, and laboratory data). The 208 evaluatedpersons (87years; 68.75% female) used 1770 medications, with 989 (55.9%) potentially involved in 1629 STOPP criteria. Sufficient information to judge STOPP criteria was available for only 529 (32.5%) potential STOPP criteria situations, with a positive identification of a STOPP PIM in 397 instances (75.0%). Conclusions Although STOPP/START criteria can be considered a high-level tool to identify PIMs, their use may be compromised in scenarios where access to patients' clinical information is limited.

Quality procedures and complaints: nursing homes in Portugal

Purpose In most European countries there is a range of quality control system mechanisms, however, poor quality and institutional violence can be found in the residential sector. Taking Portugal as an example of a country that uses an inspection-only approach, this paper focuses on the monitoring system for controlling the quality of care in nursing homes. The purpose of this paper is to analyse how mistreatment of older people is identified and dealt with by the national social security services. In particular it looks at what the indicators are with which to assess poor quality care and mistreatment (how it is perceived and defined), which factors affect mistreatment of older people and intervention outputs (i.e. what are the sanctions to prevent and combat this). Design/methodology/approach An exploratory approach was based on a mixed method, using a database of 3,685 complaints reported to the social security inspection services. To understand the context of the complaints and the assessment of institutional violence, focus groups were carried out with inspectors from the National Inspection Service. Findings The focus groups identified severe situations of poor care, mistreatment of older people and loss of human rights and dignity. Some indicators were found in key areas of care and the factors associated with this were based on Kamavarapu’s typology (2017): physical conditions of facilities; closed organisational models; difficult working conditions; and perceived concerns of residents. Monitoring and inspection systems are still based on minimum standards focusing on structural and process quality, devoting little attention to the human rights situation of older persons and clinical issues. Research limitations/implications The number of participants in the focus groups was limited in size but the uniqueness of this exploratory method draws a dark picture of non-licensed nursing homes in Portugal. Originality/value An exploratory analysis was useful to identify institutional violence and discuss potential implications, in terms of effectiveness of quality care control, which calls for special attention by policy makers and researchers when monitoring the human rights of older persons.

Low serum levels of vitamin B12 in older adults with normal nutritional status by mini nutritional assessment.

Undernutrition as well as low levels of vitamin B12 and folic acid are common problems among older adults. However, recommended routine nutritional status assessment tools may result in inadequate vitamin serum levels to go unnoticed. Therefore, the aim of this study is to evaluate the inadequacy of serum levels of vitamin B12 and folic acid within Mini Nutritional Assessment (MNA) classification categories among older adults. A cross-sectional study was conducted with 97 older adults residing in care homes in Portugal. Undernutrition was identified through the MNA, and serum levels of vitamin B12 and folic acid were measured using chemiluminescence. Cognitive function, depressive symptoms and functional characteristics were also assessed using the Abbreviated Mental Test Score, the Epidemiologic Studies Depression Scale and the Barthel Index, respectively. The mean age of older adults was 82.2 (6.3) years; 3.1% were undernourished and 26.8% were at undernutrition risk. In the MNA normal nutritional status group, 11.8% presented vitamin B12 deficiency (<200 pg/ml), 32.4% had low serum levels (200-400 pg/ml) and 4.4% had folic acid deficiency (<3 ng/ml). A high proportion of older adults with low serum levels of vitamin B12 presenting normal nutritional status by MNA was identified. This finding emphasizes the need to evaluate serum vitamin B12 levels, independently of the MNA results.

Validity and reliability of the European portuguese version of neuropsychiatric inventory in an institutionalized sample.

BackgroundNeuropsychiatric symptoms are very common in dementia and have been associated with patient and caregiver distress, increased risk of institutionalization and higher costs of care. In this context, the neuropsychiatric inventory (NPI) is the most widely used comprehensive tool designed to measure neuropsychiatric Symptoms in geriatric patients with dementia. The aim of this study was to present the validity and reliability of the European Portuguese version of NPI.MethodsA cross-sectional study was carried out with a convenience sample of institutionalized patients (≥ 50 years old) in three nursing homes in Portugal. All patients were also assessed with mini-mental state examination (MMSE) (cognition), geriatric depression scale (GDS) (depression) and adults and older adults functional assessment inventory (IAFAI) (functionality). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected subjects.ResultsThe sample included 166 elderly, with a mean age of 80.9 (standard deviation: 10.2) years. Three out of the NPI behavioral items had negative correlations with MMSE: delusions (rs = -0.177, P = 0.024), disinhibition (rs = -0.174, P = 0.026) and aberrant motor activity (rs = -0.182, P = 0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (rs = 0.166, P = 0.038). NPI showed good internal consistency (overall α = 0.766; frequency α = 0.737; severity α = 0.734). The inter-rater reliability was excellent (intraclass correlation coefficient (ICC): 1.00, 95% confidence interval (CI) 1.00 - 1.00), as well as test-retest reliability (ICC: 0.91, 95% CI 0.80 - 0.96).ConclusionThe results found for convergent validity, inter-rater and test-retest reliability, showed that this version appears to be a valid and reliable instrument for evaluation of neuropsychiatric symptoms in institutionalized elderly.

EPA-0742 – The neuropsychiatric inventory (npi): validation of the portuguese version

Introduction Assessment of neuropsychiatric symptoms is crucial to the management of dementia. In this context, the Neuropsychiatric Inventory (NPI) is the most widely used comprehensive tool, assessing twelve domains (delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, aberrant motor activity, night-time behaviour and appetite/eating abnormalities). NPI records severity, frequency and caregiver distress. It has been translated and validated into a number of languages and shown to be reliable in cross-cultural studies. Aim To present preliminary results of the NPI Portuguese validation study. Methods A cross-sectional study was conducted with a convenience sample of institutionalized elderly (≥ 60 years old) in three Nursing Homes in Portugal. All patients were also assessed with MMSE (cognition) and GDS (depression). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected elderly. Results The sample included 166 elderly, with a mean age of 80.9 (10.2sd). Three out of the NPI behavioural items had significant negative correlations with MMSE: delusions (r=−0.177, p=0.024), disinhibition (r=−0.174, p=0.026) and aberrant motor activity (r=−0.182, p=0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (r=0.166, p= 0.038). NPI showed good internal consistency (overall α=0.766; frequency α=0.737; severity α=0.734). The inter-rater reliability was excellent (ICC=1.00, CI95% 1.00–1.00), as well as test-retest reliability (ICC=0.91, CI95%0.80–0.96). Conclusion These results suggested that the Portuguese version is a valid and reliable instrument for the evaluation of neuropsychiatric symptoms in elderly people.

Swallowing disorders in nursing home residents: how can the problem be explained?

BackgroundThe swallowing mechanism changes significantly as people age, even in the absence of chronic diseases. Presbyphagia, a term that refers to aging-related changes in the swallowing mechanism, may be linked to many health conditions and presents itself in distinct ways. Swallowing disorders are also identified as a major problem amongst the elderly population living in nursing homes.MethodsThe study sought to determine the prevalence of swallowing disorders in nursing home residents, to identify the relationship between self-perceived swallowing disorders, cognitive functions, autonomy, and depression, and also to analyze which variables explain the score of the Dysphagia Self-Test (DST). For this purpose, the researchers chose to apply a survey conveying questions on demographic aspects, general health, eating and feeding, as well as instruments to assess functional performance and the 3 ounce Water Swallow Test.ResultsThe sample consisted of 272 elderly people living in eight nursing homes in Portugal. Six did not sign the informed consent form. Of the total, 29% were totally dependent, 33% were depressed, 45% had cognitive impairment, and 38% needed help with feeding. About 43% of the individuals reported having problems related to eating. Regarding the DST, 40% showed signs of dysphagia. With respect to the 3 ounce Water Swallow Test, 38% revealed at least one of the symptoms, wet voice being the most prevalent. Correlation measures showed that age had no linear association with the DST score although correlation with the Barthel Index and Mini Mental State Examination was found to be significant. A linear regression model was estimated with the DST score as the dependent variable and the MMSE and BI scores, gender, age, education, the Geriatric Depression Scale score, 3 ounce Water Swallow Test, and diagnosed conditions (such as neurological disorder, dementia, and cardiorespiratory problems) as explaining variables.ConclusionResults showed a high prevalence of dysphagia signs amongst a nursing home population. For the purpose of the present study, both a subjective and an objective assessment were applied. Results pointed to a significant statistical relation between objective and subjective measures, thus indicating that a self-perception test should be included in the assessment of swallowing disorders in a nursing home population. Notwithstanding, it should not be used as a single or principal measure as it is influenced by the individuals’ cognitive condition.

Food handlers’ knowledge on food hygiene: The case of a catering company in Portugal

The aim of this study was to assess the food hygiene knowledge of professional food handlers from an institutional catering company which manufactures and distributes meals to the canteens of schools, kindergartens and nursing homes in Portugal. A total of 101 food handlers from 18 geographically distributed business units were assessed. Data collection employed a previously used, multiple-choice questionnaire, aimed at exploring the food safety knowledge and practices of individual respondents. The average score of questions answered correctly was 13 out of 23 (56.5%) with a standard deviation (SD) of 3.22. However, the percentage of correct answers varies with the issues questioned, being significantly lower on issues such as temperature control (p < 0.001) and sources of contamination/high-risk foods (p < 0.001). The level of knowledge was influenced by the level of formal education (p = 0.025) of respondents. The results reinforce the importance of conducting a preliminary assessment of training needs and evaluating the effectiveness of training.

The marriage of female foundlings in nineteenth-century Italy

The large-scale abandonment of infants in the European past has attracted a great deal of scholarly attention in recent years. Its staggering dimensions in many countries of Europe, as recently as the nineteenth century, have prompted some uncomfortable rethinking about family life and parent–child (and especially mother–child) relations in the past. Studies of abandonment have contributed to our understanding not only of gender ideology and gender relations, but also of the roles played by state and Church in regulating sexuality and family life.Yet research on abandoned children to date has had a limited focus. The great bulk of the literature looks at the process of abandonment itself, the terrifyingly high mortality of the foundlings in infancy, and the process by which foundling homes placed their wards in rural foster homes. Perhaps because of the notoriously high mortality of the abandoned babies – though also no doubt due to the greater difficulty of generating suitable data from the archives – little attention has been paid to those foundlings who survived childhood. Typical is the admission found in the major study of foundling homes in Portugal: ‘The fate of the few foundlings who reached adulthood is unknown.’Yet through the nineteenth century – which provides our focus here – large numbers of foundlings did reach adulthood, and a variety of public authorities were very much concerned about just what kinds of adults they became. Even in determining the placement of infants with wetnurses, foundling home authorities considered the long-term implications for their future as adults. The widespread aversion to placing abandoned infants with wetnurses in the cities was linked to both a belief that the city was corrupt and was likely to produce less wholesome adults than a rural upbringing and to a concern that concentrating a large number of propertyless, family-less foundlings in the city might well create an adult population that would pose a threat to public order.