The Elderly Nursing Core Set and the cognition of Portuguese older adults: a cross-sectional study

A rapid literature review on the health-related outcomes of long-term person-centered care models in adults with chronic illness

Introduction

The strong association between age and the increasing prevalence of chronic diseases, makes it imperative to promote self-care throughout life. Systematic knowledge on the health findings of person-centered care models may contribute to designing effective healthcare strategies to promote empowerment for self-care in long-term care.

Objective

To assess the association between the implementation of person-centered care models that promote self-care training in long-term care and health-related outcomes, among adults with chronic illness.

Methods

A rapid review of the literature was performed following the Cochrane rapid review methodology. The electronic databases CINAHL, MedicLatina, MEDLINE, and Psychology and Behavioral Sciences Collection were searched for randomized experimental studies, published between 2017 and 2022, that implemented interventions based on person-centered models to promote self-care in adults aged ≥18 years with chronic diseases and needing long-term health care. Verification of the eligibility of the articles and the extraction of data were performed by two independent investigators. Quantitative data on the health-related variables assessed were collected and, through narrative synthesis, health outcomes were grouped into individual, institutional and societal levels.

Results

Eight studies, mostly conducted in European countries, were included. All satisfied more than 60% of the methodological quality score. A large variability among studies was found regarding the number of participants, the data collection period and duration of the intervention, the samples selected and the care model implemented. A high number of health-related outcomes (n = 17) were analyzed in the studies, using 52 different instruments. The main health-related outcomes were multidimensional, with implications at the individual, institutional and societal levels. The promotion of overall health and wellbeing (n = 4), the implementation of patient-centered care models (n = 1), the positive and more frequent interactions with health professionals (2), the decrease on staff psychosocial distress (n = 1), and the absence of added costs (n = 1), while improving family caregivers' skills (n = 1) were the main health-related outcomes described.

Conclusion

There is a need to develop robust experimental studies focused on the views and experiences of all stakeholders and conducted in different countries and cultures. Short-, medium- and long-term health outcomes should be measured using internationally accepted and validated scales for chronic patients.

Long-term care units: a Portuguese study about the functional profile

Aim: In this study, we analyze the relationship between the functional profile of older people admitted to long-term care units in Portugal and some demographic variables such as education level, sex, and age as well as the emotional state of mind. Methods: A sample of 59,516 older people from the National Network of Integrated Continuous Care of Portugal were analyzed in this longitudinal study. All the retrospective data of the older people were collected during the period of hospitalization at the long-term care units. The database records of these units were analyzed, and a functional profile spanning the period of hospitalization was calculated. Results: Activities of daily living and cognitive states improved, in the first 90 days of hospitalization, while mobility and instrumental activities of daily living worsened for the same period of 90 days. Generally, there was a decline in all domains after 450 days of hospitalization. The older women that did not attend school, those over 85 years old, and those who suffered from anxiety were pre-dominantly placed in the group of those with greater dependence (severe/complete dependence). Conclusion: The participants hospitalized between 90 and 360 days presented the best results in the long-term care units of the National Network of Integrated Continuous Care of Portugal. With this study, we highlight the importance of evaluating the functional status of persons in long-term hospitalizations and the influence exerted by the level of education on the recovery and rehabilitation of dependence.

"Geriatric Proximity" Intervention in COVID-19 Context: Contribution to Reducing Loneliness and Improving Affectivity

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a "Geriatric Proximity" intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the "Geriatric Proximity" intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention "Geriatric Proximity" showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

Functional Profile of Older Adults Hospitalized in Rehabilitation Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study

BACKGROUND

The success of healthy aging depends on the ability of countries to study and act on frailty in the elderly, control chronic diseases, improve functional capacity and prevent cognitive decline and social interaction.

AIM

(1) to evaluate the functional profile of older adults hospitalized in a Unit of the National Network of Integrated Continuous Care of Portugal; and (2) to assess the relationship between functional profile and age, gender, level of education and emotional state.

METHODS

Longitudinal study with a population of 59,013 older adults (65 years or older) hospitalized in Medium-Term Care and Rehabilitation Units in Portugal.

RESULTS

Older age (≥85 years), no school attendance, low body mass index and presence of sad or depressed mood were predictive factors for a deficit in functional capacity. We identified significant improvements in rehabilitation, but after 210 days of hospitalization, older people incurred a loss of functionality. Total compensation needs were typified by severe deficits in self-care and functional capacity: 47.1%. A moderate deficit was present in 43.1%, and a slight self-care and functional deficit occurred in 9.8% of the individuals.

CONCLUSIONS

Knowing the determinants of functional capacity and self-care needs will make it possible to define priority intervention groups and implement quality and financing models based on gains in functionality.

Multidimensional Frailty and Lifestyles of Community-Dwelling Older Portuguese Adults

(1) Background: Lifestyles are referred to as conditioning factors for the frailty of older adults. However, there are few studies that explore its association. The objective of the present study is to analyze the association between sociodemographic, clinical, and lifestyle factors of older adults people with multidimensional frailty. (2) Methods: Descriptive and correlational study carried out with older adults people registered in a Health Unit in Portugal. Data were collected through a sociodemographic and clinical questionnaire and application of the Individual Lifestyle Profile and Tilburg Frailty Index to assess the lifestyles and multidimensional frailty of older adults, respectively. This last instrument, being of a multidimensional nature, assesses not only physical, but also psychological and social frailty, with a cut-off point of 6. (3) Results: Of the 300 older adults who participated, most were female (60.3%) and had a mean age of 81.34 ± 6.75 years. Moreover, 60.3% of the sample were frail older adults. Gender, marital status, number of household members, number of chronic diseases, number of daily medications, self-perception of health status and lifestyle and use of a walking device were associated with multidimensional frailty (p ≤ 0.001). Healthy eating habits, physical activity, relational behaviour, preventive behaviour, and stress management were significantly associated with lower physical, psychological, and social frailty (p ≤ 0.001). (4) Conclusions: When community health workers are aware of multidimensional frailty predictors and their components, they can intervene early and, consequently, delay the onset and progression of frailty in older adults.

Assessment of Functioning in Older Adults Hospitalized in Long-Term Care in Portugal: Analysis of a Big Data

Background

Functioning assessment is a key tool for health professionals to characterize the person's degree of dependence and plan care.

Objectives

The objectives were: (1) know the functioning components of older adults hospitalized in the National Network of Continuous Integrated Health Care (NNCIHC) in Portugal; and (2) compare the conceptual frameworks used in this network with the International Classification of Functioning, Disability and Health (ICF).

Methods

A longitudinal retrospective study is made with 171,414 individuals aged 65 years and over. The Principal Components Analysis (PCA) was realized to reduce the number of variables, previously suggested by a scoping review, about the concepts that characterize the functionality. Then, a consensus meeting was held, where the items were matched with the ICF.

Results

The average age of the sample is 80.17 years old (SD = 7.383), predominantly female (59%), without a spouse (54%), and with <6 years of education (56.4%). Four concepts were grouped: mobility, life daily activities, instrumental activities, and cognitive status that demonstrated good internal consistency. Most items correspond to ICF, except for the item "taking medication."

Conclusion

Theoretical and conceptual similarities support the use of instruments based on the ICF in Portugal's healthcare network. We suggest that ICF also encompasses a specific dimension related to medication management, given its importance for people's health.

Health Promotion and Disease Prevention in the Elderly: The Perspective of Nursing Students

Health promotion and disease prevention are closely linked to health literacy. Therefore, intervention to increase individuals’ knowledge is essential if action is to be taken to promote a healthy lifestyle with support from health professionals for decision making on choices leading to behavioral change. Taking into account the growing aging population, nurses and nursing students have to develop interventions to promote health and prevent disease in these people, in order to keep them healthy and with quality of life. This study aims to understand how nursing students’ experiences in a clinical teaching context contributed to the development of their competencies in the promotion of health and prevention of disease in the elderly. Method: Qualitative, exploratory, and descriptive study carried out with ten students about to finish a graduate nursing course in a higher education institution in the South of Portugal. This study was carried out through narratives, one of the most common data collection procedures in social and health investigations. The content analysis technique, more specifically the thematic categorical analysis, was used for data analysis. The study received authorization from the Ethics Committee of the institution where it took place. Results: Three categories were found: “Strategies to promote health and prevent disease in the elderly”, “Health improvements from the implementation of the strategies to promote health and prevent disease in the elderly”, and “The impact your participation in these strategies to promote health and prevent disease in the elderly had on your formative process”. Conclusion: The students developed competencies during their clinical teaching experiences through the implementation of strategies of health promotion and disease prevention adapted to/focused on the needs of the elderly.

Functional Profile of Older Adults Hospitalized in Convalescence Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study

Aim: To evaluate the evolution of the functional profile of older adults admitted to a health unit in Portugal; to relate the functional profile of these individuals with age, sex, education level and emotional state; and to evaluate the probability of the degree of dependence as a function of age and sex. Methods: longitudinal, retrospective study with a sample of 59,013 older adults admitted to convalescence units of the National Network of Integrated Continuous Care of Portugal. Results: In the first 75 days of hospitalization, activities of daily living, mobility and cognitive state improved, but there was a decline after 75 days of hospitalization. The ability to perform instrumental activities of daily living improved in the first 15 days of hospitalization, stabilized until 45 days and then began to worsen. Women had a higher probability of having a severe/complete dependence three years earlier than men (88 years to 91 years). A higher education level and stable emotional state were protective factors against functional decline. Conclusions: The functional profile of older adults improved during the length of stay recommended for hospitalization in convalescence units (30 days). It is critical for health systems to adopt strategies to prevent declines in the emotional state of frail individuals.

Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study

The functioning and cognition of older adults can be influenced by different care contexts. We aimed to compare the functioning profiles and cognition of institutionalized and noninstitutionalized older adults and to evaluate the effect of sociodemographic factors on the functioning and cognition. This is a cross-sectional study that included 593 older adults. The data were collected using the Elderly Nursing Core Set and Mini Mental State Examination. Women, older adults who did not attend school and those live in Residential Homes are more likely to have a higher degree of cognitive impairment than men, those who attended school and those frequent Day Centre. The chances of an older adult with moderate or severe cognitive impairment increases with age. Older women, older adults who did not attend school, and older adults who live in Residential Homes had a higher degree of functional problem than men, those who attended school and those who frequent a Day Centre, independently to age. It is necessary to promote the health literacy of older adults throughout life. The implementation of social and health responses should allow older adults to remain in their homes, given the influence of functioning and cognition on self-care and quality of life.