Is the Physical Environment Associated with Spiritual and Religious Coping in Older Age? Evidence from Brazil.

In this cross-sectional Brazilian survey, we examined associations between aspects of physical environment (PE) and spiritual/religious coping (SRC) behaviors. Our studied sample was 77 nursing homes (NH) and 326 community-dwelling residents (CDRs). Aspects of the PE were measured using the environmental domain of the WHOQOL-BREF. SRC was assessed using the BRIEF SRC scale. The PE was significantly associated with positive SRC alone and differed between the two studied samples. "Feeling safe in daily life" and "having access to health services" were positively associated with positive SRC behaviors in NH residents. "Having access to information" and "adequate transport" were significant among CDRs. Positive SRC behaviors are influenced by PE and should be considered in geriatric and gerontology care.

[Long-term informal care in Spain: challenges, views and solutions]. / Cuidados informales de larga duración en España: retos, miradas y soluciones.

Caring for chronic illnesses at all ages represents a growing social and public health problem. Due to insufficient public coverage in Spain, around 80% of long-term care is provided by the sick person's social network. Based in ethnographic research on chronicity carried out between 2009 and 2013 in Spain, this article analyzes the problem of long-term informal care for middle-aged adults with chronic diseases. The results highlight the factors that condition, enhance or limit informal care: the personal, domestic and family situation of the sick person; the cyclical course of chronic diseases; and the social response to illness. The limitations of the informal care model suggest the need to listen to the voices of those affected in order to understand their real needs and adapt official programs oriented towards chronicity accordingly.

Cuidados informales de larga duración en España: retos, miradas y soluciones / Long-term informal care in Spain: challenges, views and solutions

RESUMEN El cuidado de la enfermedad crónica a todas las edades representa un problema social y de salud pública en aumento. En España, debido a la insuficiente cobertura estatal, cerca del 80% de los cuidados de larga duración los realiza la red social del enfermo. A partir de una investigación etnográfica sobre cronicidad, desarrollada entre 2009 y 2013 en el estado español, este artículo analiza la problemática de los cuidados informales de larga duración sobre la base de las narrativas de adultos de mediana edad con enfermedades crónicas. Los resultados señalan los factores que condicionan, favorecen o limitan el cuidado informal: la situación personal, doméstica y familiar del enfermo; el curso cíclico de la enfermedad crónica; y la respuesta social a la enfermedad. Las limitaciones del modelo de cuidado informal emplazan a escuchar las voces de los afectados para conocer sus necesidades reales y adecuar los planes y programas de atención a la cronicidad.

ABSTRACT Caring for chronic illnesses at all ages represents a growing social and public health problem. Due to insufficient public coverage in Spain, around 80% of long-term care is provided by the sick person's social network. Based in ethnographic research on chronicity carried out between 2009 and 2013 in Spain, this article analyzes the problem of long-term informal care for middle-aged adults with chronic diseases. The results highlight the factors that condition, enhance or limit informal care: the personal, domestic and family situation of the sick person; the cyclical course of chronic diseases; and the social response to illness. The limitations of the informal care model suggest the need to listen to the voices of those affected in order to understand their real needs and adapt official programs oriented towards chronicity accordingly.

Spiritual Religious Coping is Associated with Quality of Life in Institutionalized Older Adults.

The purpose of this study was to investigate the relationship between spiritual/religious coping (SRCOPE) strategies and quality of life (QoL) in institutionalized older adults. This is a cross-sectional, correlational study, with a sample of 77 older adults in Brazil. The present study found long-term care patients use religious and spiritual coping strategies to deal with their chronic health conditions. Positive SRCOPE and Total SRCOPE have positive correlations with most QoL domains from the WHOQOL-OLD and WHOQOL-BREF. On the other hand, Negative SRCOPE strategies correlated negatively with the facets of "death and dying" from the WHOQOL-OLD. These results suggest the need for an integrative approach for long-term care patients, considering the positive and negative aspects of coping.

Factors associated with functional incapacity in elders living in long stay institutions in Brazil: a cross-sectional study.

BACKGROUND: The increase of the elderly population and the high prevalence of chronic diseases have contributed to the increasing importance of functional ability as a global public health problem. This study aimed to assess functional capacity in institutionalized elders, as well as undertake an exploratory analysis of its associated factors. METHODS: This is a cross-sectional study with institutionalized Brazilian elders. Functional capacity was assessed using the Katz Index for Activities of Daily Living (ADL) and the Lawton Scale for Instrumental Activities of Daily Living (IADL). The characteristics of dependent individuals were described and logistic regression models were developed for both scales. Multiple models that included all selected variables were developed using a hierarchical approach. We considered the results from the Wald test (p <0.05) as a rule for progressing to the next level. RESULTS: A population of 760 elders was considered. The prevalence of dependence was 50.3% for ADL and 81.2% for IADL. We observed associations between ADL dependence and the following factors: self-report of stroke, difficulty of walking 400 meters, lower total scores in questions related to the temporal orientation section of the cognition test, and self-reports of frequently feeling upset. IADL dependence was associated with educational level, self-report of cancer, difficulty of walking 400 meters, use of glasses, and self-reported memory problems. CONCLUSIONS: Sociodemographic and health conditions were associated with functional incapacity in institutionalized elders. Based on these findings, we emphasize the importance of both prevention and treatment of chronic conditions as well as social support in the maintenance of individuals' autonomy.

Cognitive assessment in elderly residents of long-stay institutions.

OBJECTIVE: To evaluate the cognitive performance of institutionalized elderly in the city of Natal, state of Rio Grande do Norte, Brazil. METHODS: A descriptive, longitudinal study of 85 aged individuals via an interview conducted following the application of a classification form and the Mini-Mental State Examination (MMSE), with different cutoff points according to the level of education. The study was approved by the Research Ethics Committee of the Universidad Federal do Rio Grande do Norte (164/2011). RESULTS: The mean age of the elderly studied was 76.8 years, 48.3% were single and 62.0% women, with an average of 3.27 children and 3 years of schooling; cognitive losses were recorded over a 6-month period following the 1st assessment, declining from 18.8 to 16.9% at the 2nd assessment for the following items: orientation to space (p = 0.02), language (p = 0.02) and repetition (p = 0.01). CONCLUSION: The results show significant cognitive changes among elderly subjects, with 64.6% exhibiting cognitive impairment. The findings suggest systematic evaluations in elders as a mean to establish prevention measures for health losses, taking into account that the referred deficits are capable of causing damage in the everyday life of these elderly residents of institutions.

Quality of life determinants in patients of a Psychosocial Care Center for alcohol and other drug users.

Quality of life assessments in patients receiving treatment for substance dependence can serve as one predictor of response to treatment. This study aimed to identify determinants of quality of life in patients of a Psychosocial Care Center for alcohol and other drug users (CAPSad). The sample consisted of 77 patients with a diagnosis of substance dependence being treated at CAPSad for more than six months. Severity of substance dependence was assessed using the Addiction Severity Index (ASI-6), quality of life was assessed using the World Health Organization Quality of Life assessment instrument-short version (WHOQOL-BREF), and depressive symptoms were assessed by the Beck Depression Inventory (BDI). Data on CAPSad activities, psychiatric diagnoses, and medications used were collected from the medical records. Quality of life was significantly impaired in more severe cases of substance dependence and in those with more severe depressive symptoms. As for other variables, poorer quality of life was significantly associated with a greater number of years of education, unemployment, use of medications, and greater use of individual sessions with the reference professional. Linear regression analysis revealed depressive symptom severity to be an independent determinant of quality of life impairment, accounting for over 50% of the variation in physical and psychological domains. These results demonstrate the need to consider other factors, such as depressive symptoms and quality of life, in the treatment of substance dependence.

Puerto Rican elders' knowledge and use of community-based long-term care services.

We conducted 3 focus groups with 28 Spanish-speaking Puerto Rican elders to explore their knowledge and use of community-based long-term care services, including an exploration of whether their residential setting influences access to services. Analysis revealed themes relating to participants' difficulties and frustrations with formal services. A major theme was a reliance on formal services, given a lack of reliable familial help. Elders living in Latino senior housing reported the greatest access to services, with availability of Spanish-speaking housing staff and informal support from neighbors serving as critical components of their social networks. Practice and policy recommendations are provided.

Care of older people in migration contexts: local and transnational arrangements between Peru and Spain.

Care arrangements for the elderly are becoming a main social process in contemporary societies due to socio-political and lifestyle changes over the last few decades. The family and the State play a basic role in the construction of care systems and in the establishment of strategies to access care resources. In the present context of migration, these resources interact at a transnational level, challenging family and State migratory regimes. These new realities need the recognition of basic international social rights, as the experiences of Peruvians living in a migration context in Spain show.

The lived experience of long-term psychiatric hospitalization of four women in Brazil.

PROBLEM: What is the experience from long-term psychiatric hospitalization? How can psychiatric nursing contribute to reduce the emotional suffering and the feeling of social exclusion related to this process? METHODS: This study was conducted on four women committed to long periods of psychiatric hospitalization in Brazil. Data were collected through open interviews and drawings made by the patients, and interpreted according to the theory of social representations. FINDINGS: Reports on the patients refer to a process of social exclusion, emotional suffering, and inadequate treatment in the hospital, leading to no other option but recurrent hospitalization. CONCLUSION: Negative experiences related to long-term hospitalization could possibly be minimized through adequate assistance provided by psychiatric nursing in open services, as proposed in the recent Brazilian psychiatric reform.

Nativity, declining health, and preferences in living arrangements among elderly Mexican Americans: implications for long-term care.

This study employs data from the 1993-94 Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE) to assess the impact of nativity on preferences in living arrangements for a sample of 3,046 Mexican American individuals over the age of 65. Our results reveal great differences between the native and foreign-born in their desire to live with their children. A larger fraction of the foreign-born than native-born currently live with their children and state that they would care to continue living with their children in the event that they could no longer care for themselves. The data also reveal that the foreign-born face more serious economic constraints than the native-born and suggest that living with children may be motivated in part by economic need. We end by speculating on the implications of these findings for community-based care for elderly Mexican Americans.