End of life and death of residents: Experiences and practices of care facility directors in Portuguese residential care facilities.

Residential care facilities (RCFs) are places where older people live and usually die. This exploratory qualitative study aims to describe the experiences and practices of the directors of Portuguese RCFs regarding residents' end of life and death. Data were obtained from 17 care facility directors (CFDs) who participated in three focus groups. Thematic data analysis was performed. The CFDs described their practices and experiences framed within three moments in the life journey of the residents in RCFs: admission and living in RCF; end of life and death; postmortem and new admission - continuing and occupying the vacancy. The results suggest that end of life and death are only addressed in the last days/hours of life of the resident. However, the CFDs' approach throughout the stay of the residents in the RCF could allow for the expression of their wishes and wills, which could facilitate a good and dignified death.

Capacity Assessment Instrument - Health: Pilot Study of a New Tool for Adults with Dementia.

OBJECTIVES: This research comprises a pilot study of the CAI-Health, a new tool for the evaluation of decision-making capacity in healthcare. It aims to analyze the instrument's indicators of reliability and internal validity to conclude its final version. METHODS: A total of 89 participants were included, of which 22 had Alzheimer's Disease; 32 had mild cognitive impairment, and 35 were controls. Cronbach's alpha and the intercorrelation matrix were used as indicators of reliability and internal validity as well as to identify items for elimination. Repeated-measures ANOVA allowed for the analysis of differences between the vignettes that comprise CAI-Health. RESULTS: The internal consistency results were acceptable, and no items were proposed for elimination. A repeated-measures ANOVA revealed that the vignettes were unexpectedly equivalent. Despite the procedures used to develop clinical vignettes with increased levels of complexity in assessing decision-making capacity, this study showed no differences in the vignettes' level of demand. CONCLUSIONS: The extensive application of CAI-Health compromises its clinical usefulness and viability. To reduce its length while maintaining a thorough assessment of each ability, it was decided to eliminate two vignettes and retain all interview items. The final version of the CAI-Health comprises a clinical vignette and a capacity interview. CLINICAL IMPLICATIONS: CAI-Health was designed for the assessment of medical decision-making capacity in older adults.

Cognitive decline complaints scale (CDCS): validation and normative studies for the adults and older adults Portuguese population.

OBJECTIVES: Subjective Cognitive Complaints, which result from the self-perception of Subjective Cognitive Decline, are frequently reported by older adults. The Cognitive Decline Complaints Scale (CDCS) assesses subjective complaints of cognitive decline in several cognitive domains through three levels of severity. This study aims to psychometrically validate this instrument considering the Classical Test Theory, and to establish preliminary normative data of the CDCS for adults and older adults of the Portuguese population. METHODS: The community-based sample consisted of 199 cognitively healthy Portuguese participants, aged 50 years or older, stratified according to several sociodemographic variables. In addition to the CDCS, all participants responded to an extensive neuropsychological assessment protocol. RESULTS: The psychometric characteristics of the CDCS were generally adequate for this community sample (e.g. Cronbach's alpha = .936). As for the sociodemographic variables analyzed, only the geographic region showed differences in the CDCS scores, which were more significant in the Azores. There were no significant correlations or differences between the CDCS scores and age and educational level and, therefore, normative data were explored considering the total sample. CONCLUSION: As a scale, the CDCS allows for the detailed assessment of subjective cognitive complaints and the determination of whether or not such complaints are considered normative, which will facilitate an empirically based understanding of this dimension of psychological functioning and also provide indications as to the need for a more extensive neuropsychological assessment.

Practitioners' knowledge, acceptability and use of external memory aids with individuals with cognitive deficits: An exploratory study.

External memory aids (EMA) are within the most effective cognitive rehabilitation techniques, having demonstrated a positive impact in terms of memory functioning in individuals with multiple cognitive deficits. Despite its proven efficacy, there is yet poor dissemination of these techniques in clinical settings. The current study aims to evaluate the level of knowledge, degree of use, and usage expectations of EMAs by health practitioners, responsible to implement these techniques. A quantitative, descriptive, and cross-sectional study was developed, and 120 practitioners working with cognitively impaired patients participated in the study. One questionnaire was developed to assess participants' knowledge and use of EMAs. Results indicate that the level of global knowledge regarding EMAs is poor, despite superior to its actual use. The degree of perceived acceptance of these prosthetics by their users is positive and stronger than the likelihood of practitioners to use these tools with their patients. This study suggests that the actual implementation of EMAs as rehabilitation tools is still poor, despite the growing evidence-based research highlighting its effectiveness to compensate for cognitive deficits. Future studies should target the current factors that are influencing the underutilization of EMAs, to improve and optimize its dissemination and to benefit cognitively impaired patients.

Transcultural Pilot Study of the Efficacy of Reminiscence Therapy for Mexican and Spanish Older Adults with Different Levels of Cognitive Decline.

The main objective for this study is to analyze the impact of a positive reminiscence therapy program (REMPOS) in cognitive functioning and depressive symptomatology for older adults in different vital situations (healthy aging, mild cognitive impairment, and Alzheimer's disease).This is a transcultural comparative study (older people from Spain and Mexico). A randomized design with pre-posttest measurement and twelve groups was formulated, during a period of six months of intervention (3 in Mexico and 3 in Spain). The design had: 6 experimental groups with REMPOS intervention (3 in Mexico and 3 in Spain) during a period of six months and 6 control groups that received cognitive stimulation.While a key aspect of this study is the cross-cultural differences, an important part is to determine whether each experimental group had similar results in terms of the change in magnitude between the pre and post analysis. In general, intervention significantly improved cognitive function and decreased depressive symptoms.These findings provide further evidence about the efficacy of the REMPOS therapy between different types of aging and both geographical and cultural contexts (Spain and Mexico).

The fear of the COVID-19 Scale: validation in the Portuguese general population.

The coronavirus disease (COVID-19) pandemic is having a profound effect on mental health and it is therefore fundamental to evaluate individual psychological responses to COVID-19. The 7-item Fear of COVID-19 Scale (FCV-19S) assesses different aspects of the fear of coronavirus and has been applied worldwide. This study aimed to translate and validate the FCV-19S in the Portuguese population. The scale was administered to a convenience sample of 1203 Portuguese adults. Exploratory factor analysis was carried out on the initial model proposed by the authors of the FCV-19S. Further analysis revealed that the Portuguese version has good psychometric properties.

Decision-Making Capacity in Healthcare: Instruments Review and Reflections About its Assessment in the Elderly with Cognitive Impairment and Dementia.

The prevalence of neurodegenerative diseases has been significantly increasing in the last decades, and it is expected to continue to grow. These health disorders can impair patients' decision-making capacity in healthcare. The capacity to make healthcare decisions is a fundamental pillar of informed consent, therefore, it should be carefully assessed. Clinicians' assessment, when not supported by a standardized tool, has revealed to be unreliable, so the recourse to an instrument of capacity assessment is crucial. The present paper aims to identify and summarize published instruments of healthcare decision-making capacity. To do so, a search of peer-reviewed articles in English, Portuguese and Spanish was conducted. A total of eighteen articles, detailing seventeen assessment instruments were selected. Instruments differ on format, structure, assessed abilities and psychometric properties. Likewise, instruments' targeted population also varies, with a few being specifically developed for patients with dementia. Although a high number of instruments were found, there is still no gold standard for healthcare decision-making capacity assessment. The lack of a gold standard highlights the need for more research in this field, as well as an effort to develop guidelines and normative data, in order to improve clinical practices.

Face-To-Face with the Pandemic: Experiences of Staff in Portuguese Residential Care Facilities.

The COVID-19 pandemic has placed care facilities for older adults under high pressure. This study aimed to identify the perception of staff in Portuguese Residential Care Facilities for Older Adults about their experience during and right after the first lockdown (March/April 2020) due to the COVID-19 pandemic. It comprises 198 respondents who answered an open question about their experiences during the pandemic on an online questionnaire. The main findings suggested three themes: 1) a cascade of new needs on top of old problems; 2) working on the razor's edge: a difficult balance between protecting against the virus and maintaining one's well-being; and 3) a need for support and appreciation. The pandemic has exposed and accentuated the fragilities of Residential Care Facilities in Portugal, which operate with low budgets, and minimum staff. The measures to protect against infection have to be balanced by actions to maintain psychosocial and rehabilitation activities with the residents, to promote their well-being and functional capacity.

From the drama of unoccupied time and isolation due to Covid-19's pandemic to the need for person-centered care at residential care facilities in Portugal.

During the pandemic, restrictive measures were implemented at Portuguese residential care facilities (PRCF), such as isolating residents and ceasing collective activities. It is important to understand how PRCF are implementing activities that allow residents to occupy their time and fight isolation. As such, we aim to analyze whether: 1. new activities were implemented for residents (identifying which were carried out); 2. occupation activities were provided to isolated residents in their rooms (identifying which were carried out); 3. the implementation of activities is associated with variables like the amount of staff. This is an exploratory, quantitative, and cross-sectional study. An online questionnaire was sent by email to 2325 PRCF and entities were asked to share it with their workers. The study was also divulged on social networks. Data collection occurred between July 8th and October 18th, 2020. The study had 784 staff members participating and 90.8% reported that new activities were implemented at their facilities, predominantly videocalls. Concerning isolated residents most respondents (64.4%) stated that providing activities was impossible. Results showed that those PRCF that expanded teams had a higher percentage of new activities and activities with residents isolated in bedrooms. These results are alarming because while residents should have had more resources to cope with the pandemic, higher risks of unoccupied time and isolation existed, a dramatic situation for its potentially harmful consequences. Focusing on sanitary issues (and less on older adults) may reinforce traditional care models that had shown negative impacts before the pandemic. This highlights the need to evolve the care paradigm during and beyond the pandemic at PRCF: with Person-Centered Care as an option.

Resilience in Very Advanced Ages: A Study With Centenarians.

This study intends to assess the relationship between resilience in extremely long-lived individuals and sociodemographic, cognitive and health status variables, and significant life events. A selected sample of 48 centenarians (mean age = 100.8 years, SD = 1.2; 83.3% female) from two centenarian studies was considered. A resilience score covering five items (aging and usefulness, hopefulness, worryness, loneliness, and control) was considered. Multivariable linear regression analyses were conducted in order to identify predictors of resilience. No significant differences in the resilience score regarding sociodemographic variables or typology of significant life events were found. Our findings underscore that health perception (better) and pain (less frequent) were associated with higher levels of resilience. In being present in extremely long-lived individuals, resilience should be object of interest in further research.

Depression and Quality of Life in Older Gay and Bisexual Men in Spain and Portugal.

The purpose of this study was to assess levels of depressive symptoms and quality of life in older gay and bisexual older Spanish and Portuguese men and explore associations between these two samples and these variables. Using online surveys, 191 older gay and bisexual men from Spain and Portugal (mean age = 70 years) completed the Spanish and Portuguese versions of the Center for Epidemiologic Studies-Depression Scale and World Health Organization Instrument to Assess Quality of Life. Overall, moderate levels of depression and quality of life were found. Gay men and Spanish men report higher levels of depressive symptoms than bisexual and Portuguese men. Gay men score higher on physical health dimensions; bisexual men score higher on the social relationships dimension. Lower levels of physical health, psychological symptoms, and social relationships were significant predictors of depressive symptoms. These exploratory findings offer both similarities and differences between the samples from the two countries-and with U.S. data-and further evidence of the pervasive experience of depression in the lives of sexual minority older men with a renewed awareness of myriad contexts within which individuals age.

Affirmative Competence and Practices of Mental Health Professionals with LGB clients: An Ibero-American Study.

There are not many studies about affirmative competence and practices among mental health professionals working with Lesbian, Gay, and/or Bisexual (LGB) clients. Thus, the objectives of this research are to assess the levels of affirmative competence and practices of professionals in Ibero-American countries. The sample consists of 630 mental health professionals from various countries whose ages range from 22 to 75 years old, with a mean age of 41.46 years. The study utilizes the following measures: a socio-demographic questionnaire, the Sexual Orientation Counselor Competency Scale, and the Affirmative Practice Questionnaire. Results show that mental health professionals who present higher levels of Affirmative Competence are those who have higher levels of education and training on LGBT topics, show left-wing political affiliations, self-identify as LGB, and have no religious affiliations. Regarding Affirmative Practices, it was found that single participants show lower practices, and more studies are needed to better understand this result. Regression models demonstrate that Affirmative Practices and Competences are predicted by the hypothesized variables, namely, religious and political beliefs, and training/education. Hence, this study indicates that mental health professionals could undergo some type of academic or professional training and/or possess experience in regard to working with LGB clients, in order to enhance their approach when working with this population.

Growing Older Out of the Closet: A Descriptive Study of Older LGB Persons Living in Lisbon, Portugal.

There is a paucity of information regarding the needs of older Lesbian, Gay, and Bisexual (LGB) adults in Portugal; to help address this imbalance, this article describes a sample of Portuguese LGB older adults living in the large, urban center of Lisbon. Specifically, the article describes (a) the broad sociodemographic characteristics of LGB 60 years of age or older; (b) the type and level of social support and the nature of interpersonal relationships of these older LGB persons; (c) their physical and sexual health; and (d) the experiences and concerns when accessing social and health-care services, including disclosing their identity to social and health professionals. Across these areas, we further seek to evaluate any differences attributable to gender and compare our results to those in the literature, largely derived from North American studies.

Aging Perceptions in Older Gay and Bisexual Men in Portugal: A Qualitative Study.

Aims and Objectives The purpose of this study was to explore the perceptions toward aging among Portuguese gay and bisexual men over 60 years old. Background Despite the growth of the older population, and the increased visibility and acceptance of lesbian, gay, and bisexual people in Western countries, the experience of aging in older gay and bisexual men is only beginning to be understood. Design We used a qualitative research methodology, based on critical gerontology, for establishing research questions and to identify the perspectives on the aging process in older gay and bisexual individuals. Methods We used a structured electronic inquiry with 25 gay and bisexual men over 60 years of age from Portugal. Data were analyzed using thematic analysis to help identify repeated patterns of meaning in the data set. Results The recurrent themes in the narratives of the aging experiences of the participants in the study were as follows: positive perceptions of aging, negative perceptions of aging, coping with being a gay/bisexual man and family ties, professional care, homophobia/discrimination, relationships and social support, intergenerational differences, mediating role of sexual orientation, sociopolitical changes, and personal characteristics. Conclusion Analysis of perceptions about the aging process in older gay and bisexual men emphasized the desire for normalization in the social awareness of sexual orientation. It is important to continue doing research on this topic and disseminate this information among professionals who work with older lesbian, gay, and bisexual people so that they may better understand how they can meet the specific needs of this population.

Predictors of anxiety in centenarians: health, economic factors, and loneliness.

BACKGROUND: Centenarians' psychological well-being is presently of great interest in psychogeriatric research but little is known about factors that specifically account for the presence of clinically relevant anxiety symptoms in this age group. This study examined the presence of anxiety and its predictors in a sample of centenarians and aims to contribute to a better understanding of anxiety determinants in extreme old age. METHODS: We examined how socio-demographic, health, functional, and social factors contribute to the presence of clinically significant anxiety symptoms in centenarians recruited from two Portuguese centenarian studies. The Geriatric Anxiety Inventory - Short Form (GAI-SF) was used to assess anxiety symptoms. RESULTS: A total of 97 centenarians (mean age 101.1 years; SD = 1.5 years; range = 100-108) with no/minor cognitive impairment were included. Clinically significant anxiety symptoms (GAI-SF ≥3) were present in 45.4% (n = 44) of the sample. Main predictive factors included worse health perception, higher number of medical conditions, financial concerns related to medical expenses (income inadequacy) and loneliness. CONCLUSIONS: Results suggest that along with health status (subjective and objective), income inadequacy related to medical expenses and feeling lonely may predispose centenarians to clinically significant anxiety and be important to their overall well-being. Further research is needed on the repercussions of clinical anxiety in centenarians' quality of life and on co-morbid conditions (e.g. depression) at such advanced ages.

Montreal Cognitive Assessment (MoCA): An update normative study for the Portuguese population.

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument that is known for its good psychometric properties and sensitivity to detect mild cognitive impairment (MCI). After ten years, it became relevant to update the previous Portuguese normative study due to changes in the population and some limitations present in the study itself. The study sample was composed of 860 cognitively healthy adults, stratified according to verified distribution of the Portuguese population across several sociodemographic variables. All participants completed a neuropsychological assessment battery, in which the MoCA was included. The analysis of the relationships between the sociodemographic variables and the MoCA show that age and educational level had a significant effect on MoCA scores, with educational level being the better predictor. These results foster the consideration of age and educational level in the development of normative data. The present study contributes to a reliable update of the normative data of MoCA. The new age groups and more stratified norms comply with the natural changes on the Portuguese population, providing an increase of power and clinical accuracy. The presented norms consider the cognitive domains subscores, consequently improving the comprehension and utility of the results obtained from the MoCA test.

Adaptation and validation of the Person-centered Care Assessment Tool (P-CAT) to the Portuguese population.

BACKGROUND: The relevance of person-centred care as an optimising approach to the quality of care provided to older adults has sparked the development of important instruments that measure this approach at residential care facilities and requires validation for the Portuguese population. OBJECTIVES: This study aims to adapt and validate the Person-centered Care Assessment Tool (P-CAT) to the Portuguese population. METHODS: The P-CAT assesses the level of person-centred care provided by residential care facilities, according to staff. The process of adapting the P-CAT to the Portuguese population includes its translation, backtranslation and a pilot study. To recruit participants for the validation study, we contacted the Portuguese residential care facilities with emails provided in the official registries, and the study was also divulged on social media. RESULTS: The study had the participation of 573 staff members. The mean score of P-CAT was 50.76 (SD = 7.65). The exploratory factor analysis showed three dimensions: the extent of care personalisation, the amount of organisational support and the degree of environmental accessibility. The results show good internal consistency for the total scale (α = 0.809) and good temporal stability in the test-retest assessed by intraclass correlation coefficient (0.893). CONCLUSIONS: This version of the P-CAT for the Portuguese population has shown adequate psychometric properties and contributes to the study of care provided at residential care facilities in Portugal through self-reporting from staff. IMPLICATIONS FOR PRACTICE: The availability of this instrument is useful for professional practice and research purposes and supports technical and scientific advancements that are necessary for the evolution of care frameworks.

Cross-cultural effects of reminiscence therapy on life satisfaction and autobiographical memory of older adults: a pilot study across Mexico and Spain.

BACKGROUND: There are increasing reports on the cognitive and emotional benefits of positive reminiscence therapy in older people. The objective of this study is to assess the differential improvement of the quality of life for older people in different vital situations (three different types of aging) and from different countries by implementing a positive reminiscence therapy program (REMPOS). METHODS: The participants were 144 older adults above the age of 65, 77 participants from Spain (45 experimental groups, 32 control groups) and 67 from Mexico (34 experimental groups, 33 control groups). The participants were recruited from nursing and retirement homes. A factorial randomized design with pre-post measurement with three independent variables: country (Mexico, Spain), condition (experimental, control), and types of aging (healthy aging, HA., mild cognitive impairment, MCI., Alzheimer's disease, AD). The experimental groups received REMPOS therapy and control groups received standard cognitive stimulation program. The quality of life was measured with the Life Satisfaction Inventory for adults (LSI-A) and autobiographical memory test (AMT) before and after REMPOS therapy. RESULTS: The REMPOS intervention showed significantly higher positive effects than the control condition on the recall of specific positive memories across countries and types of aging, except for the Spanish MCI group. Life satisfaction in the Alzheimer's and MCI group only improved with REMPOS in the Mexican sample. CONCLUSIONS: The REMPOS effects showed generalizable effects across countries, but the cross-cultural differences shown highlight the necessity of running studies to test those differential effects.

Caring and Working during the COVID-19 Pandemic: Perspective of Portuguese Residential Care Facility Workers.

Residential care facilities (RCF) for older people are facing high demands due to the COVID-19 pandemic. The aim of this study was to explore the workers' perspectives on the changes in work and care dynamics amidst the first wave of the pandemic at Portuguese RCF. This is a descriptive, quantitative, and cross-sectional study. An online questionnaire about pandemic-induced changes in work and care dynamics was sent to 2325 RCF. These entities were then asked to share it with their workers. The participants (n = 784) were mostly women (92.7%) and mostly composed of technical directors (41.6%) and direct-care workers (17.1%). The respondents reported that during the first wave of the pandemic, when compared to the pre-pandemic period, there were greater difficulties in providing care related to the basic necessities of older people (52.7%); direct-care workers were required to work more consecutive hours in each shift (69.95%); direct-care workers had to live at RCF (14.8%), and there were changes concerning the possibility of promoting person-centered care (PCC) practices. It also revealed that focusing on disease prevention and sanitary measures alone facilitates practices that reinforce the traditional model of procedure-centered care and have negative consequences on the rights and well-being of those living and working at RCF, exposing and accentuating preexisting vulnerabilities. This study considers the pandemic's serious implications and alarming questions about basic care, dignity, living, and working conditions at Portuguese RCF. These notions reinforce the need for change through redefining care policies and practices in Portuguese RCF beyond the pandemic. The current situation provides an opportunity to adopt a formal PCC model.

Healthcare decision-making capacity in old age: A qualitative study.

Objectives: Research about decision-making capacity has been growing in the last decades. That relates to more concerns regarding patients' autonomy, and an increase in diseases that can negatively impact capacity. This research aims to: explore perceptions, legal aspects, and assessment procedures related to healthcare decision-making capacity in older adults with cognitive impairment; and study the first version of a new assessment instrument of this capacity. Method: Nine focus groups were conducted, including healthcare, law and justice, nursing home professionals, institutionalized older adults, and dwelling older adults. Focus group discussions followed semi-structured interview scripts, specifically developed for each group. After group discussions, the assessment instrument was presented, and participants were asked to evaluate each item relevance and comprehensibility. Qualitative coding of the transcriptions was performed with resource to MAXQDA, using direct content analysis. Results: Six primary themes emerged from the qualitative analysis: Decision-making capacity features; Abilities implied in decision-making; Factors influencing decision-making; Obstacles to decision-making; Legal aspects; and Assessment procedures. Discussion: Results corroborate previous theoretical formulations of capacity. Generally, research results have implications for clinical and assessment practices, as well as preventive strategies that can improve older adult's decision-making capacity. Assessment procedures of capacity should include a thorough protocol for the assessment of cognition, functionality, depressive symptoms, and decision-making abilities. In this respect, the need for an assessment tool that can provide valid information during evaluation processes is highlighted. Concerning the strategies to promote decision-making capacity, these rely on improving older adult's health literacy and healthcare providers communication skills, as well as conduct actions to reduce stigma toward people with dementia.