Geriatric Assessment of the Portuguese Population Aged 65 and Over Living in the Community: The PEN-3S Study.

INTRODUCTION: As populations live longer, they also aim to live better. A crucial step for this is to improve the understanding about older adults' physical and psychological health. Therefore, the aim of the present study was to characterise the Portuguese population over-65 regarding nutritional status, cognitive function, functional status, symptoms of depression, and loneliness, by sex and age groups. MATERIAL AND METHODS: Cross-sectional study including a nationally representative sample of community-dwelling adults aged 65 and over. Trained interviewers collected data face-to-face on demographic and socioeconomic characteristics, health status, nutritional status, cognitive function, functional status for activities of daily living, symptoms of depression, and loneliness feelings. Complex sample procedures were used in the statistical analysis. RESULTS: Overall, 1120 community-dwellers (49.0% women, 21.3% aged ≥ 85) participated in the study. The estimated prevalence of risk of malnutrition was 16.4% (95% confidence interval: 13.3 - 19.9), while 17.7% (95% confidence interval: 12.8 - 23.9) were cognitively impaired, and 28.5% (95% confidence interval: 23.7 - 33.8) presented limitations to perform daily living activities. Moreover, 23.5% (95% confidence interval: 19.7 - 27.7) presented symptoms of depression and 13.6% (95% confidence interval: 10.6 - 17.1) reported loneliness feelings. These conditions were more prevalent among women, and generally more frequent in the oldest individuals (≥ 85). DISCUSSION: Risk of malnutrition, cognitive impairment, functional limitations, depression and loneliness were moderately frequent, which may justify screening and preventive actions at a community level. CONCLUSION: This study contributed to a national characterisation of the health of older adults, that may inform policies and interventions targeted at the needs of the Portuguese aging population.

Introdução: Com o aumento de longevidade importa também viver melhor. Um passo crucial neste sentido é aumentar o conhecimento sobre a saúde física e psicológica da população mais velha. O objetivo deste estudo foi caraterizar o estado nutricional, função cognitiva, estado funcional, sintomas de depressão, e solidão dos Portugueses com 65 ou mais anos, por sexo e grupo etário. Material e Métodos: Estudo transversal incluindo uma amostra representativa nacional de indivíduos ≥ 65 anos a residir na comunidade. Entrevistadores treinados recolheram dados face-a-face sobre caraterísticas demográficas e socioeconómicas, estado de saúde, estado nutricional, função cognitiva, estado funcional (atividades instrumentais da vida diária), sintomas de depressão, e sentimentos de solidão. Procedimentos adequados a amostras complexas foram utilizados na análise estatística. Resultados: No total participaram 1120 indivíduos (49,0% mulheres; 21,3% ≥ 85 anos). A prevalência estimada de risco de malnutrição foi 16,4% (intervalo de confiança: 95%: 13,3 ­ 19,9), enquanto que 17,7% (intervalo de confiança: 95%: 12,8 ­ 23,9) apresentavam função cognitiva comprometida, e 28,5% (intervalo de confiança: 95%: 23,7 ­ 33,8) tinham limitações para realizar atividades da vida diária. Adicionalmente, 23,5% (intervalo de confiança: 95%: 19,7 ­ 27,7) apresentavam sintomas de depressão e 13,6% (intervalo de confiança: 95%: 10,6 ­ 17,1) relatavam sentimentos de solidão. Estas condições eram mais prevalentes nas mulheres, e geralmente mais frequentes nos mais velhos (≥ 85 anos). Discussão: Risco de malnutrição, comprometimento cognitivo, limitações funcionais, depressão e solidão são moderadamente frequentes, justificando rastreios e ações preventivas de base comunitária. Conclusão: Este estudo contribuiu para a caraterização da saúde dos Portugueses com mais de 65 anos, o que pode suportar políticas e intervenções dirigidas às necessidades da população mais velha.

Excess Mortality Estimation During the COVID-19 Pandemic: Preliminary Data from Portugal.

INTRODUCTION: Portugal is experiencing the effects of the COVID-19 pandemic since March 2020. All-causes mortality in Portugal increased during March and April 2020 compared to previous years, but this increase is not explained by COVID-19 reported deaths. The aim of this study was to analyze and consider other criteria for estimating excessive all-cause mortality during the early COVID-19 pandemic period. MATERIAL AND METHODS: Public data was used to estimate excess mortality by age and region between March 1 and April 22, proposing baselines adjusted for the lockdown period. RESULTS: An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65) [corrected]. DISCUSSION: The data suggests a ternary explanation for early excess mortality: COVID-19, non-identified COVID-19 and decrease in access to healthcare. The estimates have implications in terms of communication of non-pharmaceutical actions, for research, and to healthcare professionals. CONCLUSION: Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths [corrected].

Introdução: Desde março 2020, Portugal tem sofrido os efeitos da pandemia COVID-19. A mortalidade por todas as causas aumentou em março e abril de 2020 comparativamente a anos anteriores, mas este aumento não é explicado pelas mortes reportadas de COVID-19. O objetivo deste estudo foi analisar e considerar outros critérios para estimar o excesso de mortalidade durante a pandemia COVID-19. Material e Métodos: Utilizaram-se bases de dados públicas para estimar o excesso de mortalidade por idade e região entre 1 de março e 22 de abril, propondo níveis basais ajustados ao período de estado de emergência em vigor. Resultados: Apesar da incerteza inerente, é seguro assumir um excesso de mortalidade observada de 2400 a 4000 mortes. O excesso de mortalidade encontra-se associado aos grupos etários mais idosos (idade superior a 65 anos). Discussão: Os dados sugerem uma explicação tripartida para o excesso de mortalidade: COVID-19, COVID-19 não identificado e diminuição do acesso a cuidados de saúde. As estimativas efetuadas possuem implicações ao nível da comunicação de acções não farmacológicas, da investigação científica e dos profissionais de saúde. Conclusão: Da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril foi 3 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.

Association between living setting and malnutrition among older adults: The PEN-3S study.

OBJECTIVES: Malnutrition is frequent among older adults, especially those living in nursing homes, but the association between residential setting and nutritional status is controversial. The aim of this study was to examine the association between living setting (nursing home versus community) and malnutrition while adjusting for demographic, socioeconomic, health-related, and psychosocial factors. METHODS: This cross-sectional study included a randomly selected representative sample of Portuguese adults ≥65 y of age. Interviewers collected data regarding demographic and socioeconomic characteristics, nutritional status, physical activity, energy intake, cognitive function, self-reported general health, functional status, symptoms of depression, and loneliness. Logistic regression models were used to estimate the association between residential setting and malnutrition. RESULTS: Participants were 1186 nursing home residents (72.8% women, 49.2% ≥85 y of age) and 1120 community dwellers (49% women, 21.3% ≥85 y of age). Following Mini Nutritional Assessment (MNA®) criteria, 29.6% of nursing home residents and 14.1% of community dwellers were at risk of malnutrition, whereas 2.3% and 0.3%, respectively, were malnourished. The living setting was not significantly associated with malnutrition after adjusting for functional status, symptoms of depression, and feelings of loneliness (odds ratio, 1.03; 95% confidence interval, 0.67-1.58). CONCLUSIONS: Risk of malnutrition and malnutrition are more prevalent among nursing home residents than community dwellers. Physical (functional status) and mental health (symptoms of depression and loneliness) seems more relevant to nutritional status than residential setting by itself. These findings should be taken into account when designing public health policies to tackle malnutrition among older adults.

Malnutrition among older adults living in Portuguese nursing homes: the PEN-3S study.

OBJECTIVE: To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes. DESIGN: Cross-sectional study. Data on demographic and socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, loneliness feelings and functional status were collected by trained nutritionists through a computer-assisted face-to-face structured interview followed by standardised anthropometric measurements. Logistic regression was used to identify factors associated with being at risk of malnutrition/malnourished. SETTING: Portuguese nursing homes. SUBJECTS: Nationally representative sample of the Portuguese population aged 65 years or over living in nursing homes. RESULTS: A total of 1186 individuals (mean age 83·4 years; 72·8 % women) accepted to participate. According to the Mini Nutritional Assessment, 4·8 (95 % CI 3·2, 7·3) % were identified as malnourished and 38·7 (95 % CI 33·5, 44·2) % were at risk of malnutrition. These percentages increased with age and were significantly higher for women. Logistic regression showed (OR; 95 % CI) that older adults reporting no or little appetite (6·5; 2·7, 15·3), those revealing symptoms of depression (2·6; 1·6, 4·2) and those who were more dependent in their daily living activities (4·7; 2·0, 11·1) were also at higher odds of being malnourished or at risk of malnutrition. CONCLUSIONS: Malnutrition and risk of malnutrition are prevalent among nursing home residents in Portugal. It is crucial to routinely screen for nutritional disorders, as well as risk factors such as symptoms of depression and lower functional status, to prevent and treat malnutrition.

Non-adherence to antibiotic therapy in patients visiting community pharmacies.

BACKGROUND: Patient non-adherence to antibiotic therapy may lead to therapeutic failure, re-infection, and bacterial resistance. Assessing the factors associated with this problem is important for promoting rational use of antibiotics. OBJECTIVE: This study aimed to measure prevalence and reasons for non-adherence to antibiotic treatment and to identify associated factors. METHOD: Patients were recruited for the study in community pharmacies in Lisbon, Portugal, from February to April, 2009. Data from prescriptions for oral antibiotics were collected for adult subjects. Adherence to treatment was assessed with a modified Portuguese version of the Morisky scale. Factors associated with non-adherence were identified through bivariate analysis and logistic regression models. RESULTS: A total of 243 patients were included in the study. They had a mean age 46.5 ± 16.6 years and 74.5 % of the sample was female. The prevalence of non-adherence was 57.7 % and was related to delays and failures in taking the prescribed medicine. Increasing age (OR 0.97), difficulty in buying the antibiotic (OR 2.34), duration of treatment (OR 1.28), difficulty with ingestion (OR 3.08), and satisfaction with the information given by physician (OR 0.33) were identified as independent factors associated with non-adherence. CONCLUSION: Non-adherence to antibiotics is common in the community setting. Factors related to the antibiotic, the patient, and the patient-physician relationship should be addressed to promote adherence. Pharmacists should provide information to patients about correct use of antibiotics and address barriers to adherence.