THE TEACHING ABOUT THE CARE OF THE ELDERLY IN NURSING TRAINING: THE SITUATION IN PORTUGAL

This paper aims to look at the teaching situation of the nursing undergraduate degree’s courses about eldercare in Portugal. A documentary research on the teaching programs in 39 nursing schools, 26 schools presented syllabus units related to the topic ‘eldercare’ and in eight of these schools the contents of the units were identified. Using textual analysis and from the categories we concluded that the teaching regarding eldercare for the nurse training in Portugal is focused on hospital care; it is directed to the adult/elderly/family; it explores the definitions related to the aging process; it explores community issues, legislation and research. People responsible for the design/monitoring of teaching programs should include teaching regarding eldercare in the nurse training, considering that the elder population is increasing in Portugal.

Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Prevention of falls in the elderly in the home: promoting active ageing

Objective: To determine the frequency of falls and identify risk factors in the homes of the elderly under the Home Care Service of a village in Alentejo (Portugal). Method: Exploratory, descriptive study. The target group were elderly persons under the Home Care Service (23). The questionnaire consists of open and closed questions, and was based on the Jefferson Area Board for Aging Safety in the Home Assessment; Instrument to Assess the Risk of Falls and Adaptations to Prevent Falls at Home. Results: Of the 23 seniors, 13 were men; the mean age was 85; 10 widowers; 11 live alone; 12 cannot read or write; 17 have experienced falls, loss of balance being the main cause. They report changes in vision (21), hearing (14) and rheumatic diseases (14); hypertension (19); they use 4 or more drugs on a daily basis (16). Conclusion: The physiological changes associated with ageing may increase the risk of falls. Due to the consequences, it is a priority field in community intervention.

Increased physical activity and fitness above the 50th percentile prevents the institutionalization of elderly people: a cross-sectional pilot study.

Introduction Institutionalization in a nursing home restricts autonomy, most notably free will, free choice, and free action. Decreased physical activity and fitness are predictive of disability and dependence (Rikli & Jones, 2013; Tak, Kuiper, Chorus, & Hopman-Rock, 2014); however little is known about the impact of these factors on institutionalization. Thus, this study aimed to analyze the impact of physical activity and fitness and on the risk of elderly people without cognitive impairment become institutionalized. Methods This cross-sectional study involved 195 non-institutionalized (80.14.4yrs) and 186 institutionalized (83.85.2yrs) participants. Cognitive impairment was assessed using Mini-Mental State Examination, physical activity was assessed using the International Physical Activity Questionnaire, and measures of physical fitness were determined by the Senior Fitness Test. Results: Multivariate binary logistic analysis selected 4 main predictors of institutionalization in both genders. The likelihood of becoming institutionalized increased by +18.6% for each additional year of age, while it decreased by -24.8% by each fewer kg/m2 in BMI, by -0.9% for each additional meter performed in the aerobic endurance test and by -2.0% for each additional 100MET-min/wk of physical activity expenditure (p<0.05). Values ≤50th percentile (age ≥81yrs, BMI≥26.7kg/m2, aerobic endurance ≤367.6m, and physical activity ≤693MET-min/wk) were computed using Receiver Operating Characteristics analysis as cut-offs discriminating institutionalized from non-institutionalized elderly people. Conclusion The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance) may prevent the institutionalization of elderly people without cognitive impairment only if they are above the 50th percentile; the following is highly recommend: expending ≥693MET-min/wk on physical activity, being ≤26.7kg/m2 on BMI, and being able to walk ≥367.6m in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cut-offs in old, and very old people. References Rikli, R., & Jones, C. (2013). Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 53, 255-267. Tak, E., Kuiper, R., Chorus, A., & Hopman-Rock, M. (2014). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev, 12, 329-338.

Prevention of falls in the elderly in the home: promoting active ageing

To determine the frequency of falls and identify risk factors in the homes of the elderly under the Home Care Service of a village in Alentejo (Portugal). Method: Exploratory, descriptive study. The target group were elderly persons under the Home Care Service (23). The questionnaire consists of open and closed questions, and was based on the Jefferson Area Board for Aging Safety in the Home Assessment; Instrument to Assess the Risk of Falls and Adaptations to Prevent Falls at Home. Results: Of the 23 seniors, 13 were men; the mean age was 85; 10 widowers; 11 live alone; 12 cannot read or write; 17 have experienced falls, loss of balance being the main cause. They report changes in vision (21), hearing (14) and rheumatic diseases (14); hypertension (19); they use 4 or more drugs on a daily basis (16). Conclusion: The physiological changes associated with ageing may increase the risk of falls. Due to the consequences, it is a priority field in community intervention.

The daily life of informal caregivers of elderly

Objectives: To identify the reasons why the informal caregivers to take care of the elderly; to identify enjoyed support and the problems/needs senses. Methods: A descriptive, exploratory and cross study. The sample was 366 informal caregivers of the elderly residents in the District of Évora (Alentejo). Applied a questionnaire, which identified the reasons that led to cohabitation, the difficulties experienced by caregivers, experienced changes in their health and support they receive. Results: Most caregivers are women, with a mean age of 54 years. The main reason of care was elderly disease. These caregivers have changed in relaxation and leisure activities, on the organization of day-to-day and on economic aspects. They receive support from health institutions, social security and firemen’s. Conclusions: Family is the support in the disease, despite the difficulties, particularly in relaxation and leisure activities, organization of day-to-day and economic matters. They requested support in healthcare, transportation and economic aid.

Socio-demographic and Health Aspects Associated with the Quality of Life in the Elderly of the Family Health Strategy. An Analytical Study

to analyze the association between the socio-demographic and health aspects to the quality of life (QOL) of elderly peoplelinked to the ESF.

Social Representations of Violence against the Elderly

The repercussions of violence on the mental, social, and physical well-being of the elderly are some of the most challenging problems in public health today. Using a qualitative design, we conducted a study in Portugal and the United States that applied both descriptive and comparative methods in order to understand the social representations of violence against the elderly. Utilizing the Theory of Social Representations, we explored the perspectives of the elderly, their families, and healthcare professionals on the subject of violence against the elderly. The data on which the findings were based were obtained in two very different cultural contexts, yet the representations of violence against the elderly revealed no significant cross-cultural differences. However, conceptualizations regarding expectations of care and protection for the elderly proved to be distinct. We discussed concerns about the general attitudes of tolerance toward violence, including those of the elderly who self-identified as eventual victims. Violence against the elderly was portrayed as a part of old age and also somehow was justified by it. The results also indicated the need to better prepare healthcare professionals and society in general to deal with the consequences of the problem and not, as we would like to report, to prevent it from happening.

Symposium: Violence in Adults and the elderly: to investigate and intervene

This symposium aims to address some studies on violence in adults, as well as address the job done in an intervention network in domestic violence and a project on the study of violence in the elderly, in Alentejo. Communications: - PREVALÊNCE OF VIOLENCE IN ADULTS- Zangão, Maria Otília; Serra, Isaura; Gemito, Maria Laurência; Pinheiro, Felícia Tavares; Magalhães, Dulce; Marques, Maria de Fátima - SOCIAL REPRESENTATION OF DOMESTIC VIOLENCE - Gemito, Maria Laurência; Pinheiro, Felícia Tavares; Zangão, Maria Otília; Serra, Isaura; Magalhães, Dulce; Marques, Maria de Fátima - DOMESTIV VIOLENCE IN THE PERSPECTIVE OF WOMEN WHO LIVE IT - Magalhães, Dulce; Marques, Maria de Fátima; Zangão, Maria Otília; Serra, Isaura; Gemito, Maria Laurência; Pinheiro, Felícia Tavares - INTEGRATED INTERVENTION NETWORK OF DISTRICT OF ÉVORA (RIIDE): A multidisciplinary response to violence - Gemito, Maria Laurência; Pinheiro, Felícia Tavares; Lopes, Manuel - ESACA - Ageing Safely in Alentejo – Understanding for Action - Mendes, Felismina; Gemito, Maria Laurência; Zangão, Maria Otilia; Chora, Maria Antónia; Pereira, Catarina Symposium goal(s): - To present studies on violence in Alentejo. - To discuss the importance of networks in the problem of violence. - To present Project underway on how to age with security in Alentejo. Symposium moderator(s): Maria Otília Brites Zangão Project affiliation:All three studies have resulted in an intervention project against domestic violence "Love me, love me not- Why does the violence exist and why does it not choose ages?" funded by POPH. ESACA Project - Aging Safely in Alentejo - Understanding to act, co-funded by: Alentejo 2020 Portugal 2020 and the European Union.

Health Problems of Institutionalized Elderly

Introduction: human aging is marked by a decrease in the performance of some daily tasks, some even considered banal and imperceptibly when this limitation is followed by chronic diseases, the elderly becomes a source of concern for the family. Objective: identifying the health problems of the elderly living in long-stay institutions from self-reported diseases. This is a descriptive and quantitative study, conducted in northeastern Brazil capital, involving 138 elderly. For data collection we used a questionnaire containing demographic variables, institutional and related to self-reported health problems. Data were evaluated using bivariate analysis and association chi-square. Results: predominance of women was found (61.6%), aged 60-69 years old (39.1%), coming from the state capital (51.4%), and institutional permanence time between 1-5 years (77.5%). The most frequent diseases were related to the cardiovascular system (15.9%) and endocrine, nutritional and metabolic diseases (9.4%). It showed a significant association between self-reported diseases and the age of the elderly (p=0.047). Conclusion: it is expected to raise awareness among health professionals to provide a better assistance to the institutionalized elderly focusing on the real needs of these persons.

Functional defict and sensitive outcomes to nursing care for elderly: Systematic literature review.

ABSTRACT Objective of this study was to determine sensitive outcomes to nursing care in relation to the functional deficit of people aged 65 and older. It is a Systematic Literature Review with qualitative synthesis and meta-analysis. From the qualitative synthesis, it was found that sensitive outcomes to nursing care, observed from structured intervention, were described as improvement of: functional status, self-care, symptom control, safety/adverse events, customer satisfaction, psychological support, decreased healthcare costs, therapeutic system management and quality of life. In meta-analysis we found that there is an improvement of effect on the level of sensitive outcomes to the nursing care between the experimental and control groups. It is noticed that it is necessary to rouse more guided study in clinical practice, to understand the importance of interventions sensitive to nursing care and health outcomes.