Needs for Care, Service Use and Quality of Life in Dementia: 12-Month Follow-Up of the Actifcare Study in Portugal.

INTRODUCTION: The intermediate stages of dementia are relatively under-researched, including in Portugal. The Actifcare (ACcess to TImely Formal Care) EU-JPND project studied people with mild-moderate dementia, namely their needs, access to and use of community services (e.g., day centers, home support). In our baseline assessment of the Portuguese Actifcare cohort, the unmet needs of some participants would call for formal support, which was not always accessible or used. We now report the main results of the 12-month follow-up, analyzing changes in needs, service (non)use, quality of life and related variables. METHODS: This was a longitudinal, observational study using a convenience sample of 54 dyads of people with dementia and their family carers. Our main outcomes were the Camberwell Assessment of Need for the Elderly (CANE) and the Resources Utilization in Dementia. Clinical-functional, quality of life, psychological distress and caregiving-related assessments were also used. RESULTS: At follow-up, the cognitive and functional status of people with dementia declined (p < 0.001), and their neuropsychiatric symptoms increased (p = 0.033). Considering CANE interviewers' ratings, the total needs of people with dementia increased at follow-up (p < 0.001) but not the unmet needs. Quality of life was overall stable. The use of formal care did not increase significantly, but informal care did in some domains. Carers' depressive symptoms increased (p = 0.030) and perseverance time decreased (p = 0.045). However, carers' psychological distress unmet needs were lower (p = 0.007), and their stress and quality of life remained stable. CONCLUSION: People with dementia displayed complex biopsychosocial unmet needs. Their cognitive-functional decline over one year was not accompanied by a corresponding increase in any pattern of unmet need, nor of service use. Reliance on informal care (namely supervision) may have contributed to this. Caregiving-related outcomes evolved according to different trends, although stability was almost the rule. Primary carers were even more present at follow-up, without an apparently heavier toll on their own needs, burden, and quality of life. Overall, this longitudinal study comprehensively assessed Portuguese community-dwelling people with dementia. Despite the lack of generalizability, participants' needs remained overall stable and partly unmet over one year. Longer follow-up periods are needed to understand such complex processes.

The relationship between health-related knowledge and attitudes and health risk behaviours among Portuguese university students.

Scientific evidence reveals a high prevalence of health risk behaviour among university students. This calls for the creation of educational programmes that promote more knowledge about health. However, knowledge alone is not enough to change behaviours; other factors should be considered, including attitudes towards health. The objective of this cross-sectional study was to analyse the relationship between knowledge, attitudes and health risk behaviours among university students. For this, a previously validated self-report questionnaire was applied to a stratified sample of 840 students, by year of study (first- and third-year students) and their scientific area. In addition to sociodemographic issues, the questionnaire contains a health-related knowledge scale, an attitudes towards health scale, and questions about health risk behaviours. Students displayed poor knowledge about health, correctly answering 17.77 (SD = 4.59) questions out of a total of 36, and moderate scores concerning attitudes towards health (M = 2.61, SD = 0.48, range: 1-5). Students reported always engaging in, on average, 3.88 (SD = 1.45) of the seven behaviours subject to the analysis. Mediation analyses indicated that knowledge about health and attitudes towards health were statistically significant predictors of risky behaviours. Furthermore, it was indicated that attitudes towards health have a mediating effect between health knowledge and health risk behaviours. Findings from this study indicate that public health and education policies should promote healthy behaviours among university students, taking into account not only the level of knowledge but essentially the development of positive attitudes when facing behaviours which put health at risk.