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- Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases - CORRIGENDUMPublication . Tziraki, Chariklia; Grimes, Corrina; Ventura, Filipa; O'Caoimh, Ronan; Santana, Silvina; Zavagli, Veronica; Varani, Silvia; Tramontano, Donatella; Apóstolo, João; Geurden, Bart; Luca, Vincenzo de; Tramontano, Giovanni; Romano, Maria Rosaria; Anastasaki, Marilena; Lionis, Christos; Rodríguez-Acuña, Rafael; Capelas, Manuel Luís; Afonso, Tânia dos Santos; Molloy, D. William; Liotta, Giuseppe; Iaccarino, Guido; Triassi, Maria; Eklund, Patrik; Roller-Wirnsberger, Regina; Illario, Maddalena
- Adaptation and validation into portuguese language of the six-item cognitive impairment test (6CIT)Publication . Apóstolo, João Luís Alves; Paiva, Diana dos Santos; Silva, Rosa Carla; Santos, Eduardo José Ferreira; Schultz, Timothy JohnBackground: The six-item cognitive impairment test (6CIT) is a brief cognitive screening tool that can be administered to older people in 2–3 min.Objective: To adapt the 6CIT for the European Portuguese and determine its sychometric properties based on a sample recruited from several contexts (nursing homes; universities for older people; day centres; primary health care units).Method: The original 6CIT was translated into Portuguese and the draft Portuguese version (6CIT-P) was back-translated and piloted. The accuracy of the 6CIT-P was assessed by comparison with the Portuguese Mini-Mental State examination (MMSE). A convenience sample of 550 older people from various geographical locations in the north and centre of the country was used. Results: The test–retest reliability coefficient was high (r = 0.95). The 6CIT-P also showed good internal consistency (α = 0.88) and corrected item-total correlations ranged between 0.32 and 0.90. Total 6CIT-P and MMSE scores were strongly correlated. The proposed 6CIT-P threshold for cognitive impairment is ≥10 in the Portuguese population, which gives sensitivity of 82.78% and specificity of 84.84%. The accuracy of 6CIT-P, as measured by area under the ROC curve, was 0.91.Conclusion: The 6CIT-P has high reliability and validity and is accurate when used to screen for cognitive impairment
- Effectiveness of multisensory stimulation in managing neuropsychiatric symptoms in older adults with major neurocognitive disorder: a systematic review protocolPublication . Silva, Rosa; Cardoso, Daniela; Apóstolo, JoãoREVIEW QUESTION/OBJECTIVE: This review aims to identify and synthesize the effectiveness of multisensory stimulation in managing neuropsychiatric symptoms in older adults with major neurocognitive disorder.More specifically, this review focuses on the following questions: what are the effects of multisensory stimulation in managing neuropsychiatric symptoms such as delusion, hallucination, agitation, aggression, mood liability, anxiety, apathy, motor disturbances, night-time behavior and eating disorders in elderly patients with major neurocognitive disorder?
- Effectiveness of multisensory stimulation in managing neuropsychiatric symptoms in older adults with major neurocognitive disorder: a systematic reviewPublication . Silva, Rosa Carla; Abrunheiro, Sérgio; Cardoso, Daniela; Costa, Paulo; Couto, Filipa; Agrenha, Cátia; Apóstolo, JoãoObjective: The objective of the review was to synthesize the effectiveness of multisensory stimulation in managing neuropsychiatric symptoms (NPS) in older adults with major neurocognitive disorder (NCD). Introduction: Major neurocognitive disorder is characterized by changes in specific cognitive domains with a progressive deterioration in cognitive ability and capacity for independent living. Most older adults with this condition have one or more concomitant symptoms known as NPS. Evidence shows that nonpharmacological therapies have been effective in controlling these symptoms, with multisensory stimulation attracting further investigation. Inclusion criteria: The review considered studies on older adults aged 65 years or over with major NCD. The intervention of interest was multisensory stimulation, and the comparator was usual care (e.g. no occupational therapy, no cognitive training, and no art therapy, but with possible control of activities such as looking at photographs or doing quizzes), or another intervention (e.g. occupational therapy, cognitive training and art therapy). Primary outcomes were NPS (agitation, aggression, motor disturbances, mood liability, anxiety, apathy, night-time behaviour, eating disorders, delusion and hallucination). Secondary outcomes were quality of life, functional status in activities of daily living, cognitive status and caregiver burden. Experimental study designs were considered. Methods: A broad range of keywords and a three-step search strategy were used to identify potentially eligible published and unpublished studies from January 1990 to June 2016 in major healthcare-related online databases. Studies in English, Spanish and Portuguese were included. Two independent reviewers assessed the methodological quality of eight included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists for Randomized Controlled Trials and Quasi-Experimental Studies. Data were extracted using the standardized data extraction tool from the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) and included details about the interventions, populations, study methods and outcomes of interest. Significant differences were found between participants, interventions, outcome measures (clinical heterogeneity), and designs (methodological heterogeneity). For these reasons, a meta-analysis could not be performed. Therefore, the results have been described in a narrative format. Results: Eight studies (seven randomized controlled trials and one quasi-experimental study) were included, with a total sample of 238 participants (pre-intervention). Four studies confirmed the effectiveness of multisensory stimulation in domains such as physically nonaggressive behavior, verbally agitated behavior and agitation. However, these effects did not always persist in the long-term. Six studies showed poorly consistent results on the effects of multisensory stimulation in improving mood, with only one displaying significant effects. Similarly, despite poor results, two studies showed benefits concerning anxiety. Participants reported significantly decreased levels of anxiety over the course of the intervention, and this improvement persisted in the long-term. In regard to functional status in activities of daily living, two studies reported an improvement in the short-term. Moreover, the effectiveness in cognitive domains such as memory and attention to surroundings also showed inconsistent results across the seven studies that analyzed this outcome. Two studies reflected an improvement during the intervention, but also reported a gradual decline in the long-term. Only one study observed significantly better results during the intervention that persisted until the follow-up assessment. Apathy, night-time behavior, eating disorders, delusion and hallucination were NPS that were not explored in the studies that met the criteria to be included in this review. Conclusions: These findings suggest that multisensory stimulation could be an effective intervention for managing NPS in older adults with major NCD in a mild to severe stage, particularly for managing behavioral symptoms such as agitation. This research provides an indication of the likely effect of the multisensory stimulation on NPS such as agitation and anxiety, as well on cognitive status.
- Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseasesPublication . Tziraki, Chariklia; Grimes, Corrina; Ventura, Filipa; O'Caoimh, Rónán; Santana, Silvina; Zavagli, Veronica; Varani, Silvia; Tramontano, Donatella; Apóstolo, João; Geurden, Bart; Luca, Vincenzo de; Tramontano, Giovanni; Romano, Maria Rosaria; Anastasaki, Marilena; Lionis, Christos; Rodríguez-Acuña, Rafael; Capelas, Manuel Luís; Afonso, Tânia dos Santos; Molloy, David William; Liotta, Giuseppe; Iaccarino, Guido; Triassi, Maria; Eklund, Patrik; Roller-Wirnsberger, Regina; Illario, MaddalenaNon-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
- Effects of caregiver-provided individual cognitive interventions on cognition, social functioning and quality of life in older adults with major neurocognitive disorders: a systematic reviewPublication . Silva, Rosa; Bobrowicz-Campos, Elzbieta; Cardoso, Daniela; Costa, Paulo; Couto, Filipa; Camarneiro, Ana Paula; Abrunheiro, Sérgio; Almeida, Maria; Apóstolo, JoãoObjective: The objective of this review was to investigate the effectiveness of caregiver-provided individual cognitive interventions for improving cognition, social functioning and quality of life in older adults with major neurocognitive disorders. Introduction: A large number of people with major neurocognitive disorders live in their homes, requiring ongoing community care. Different individual cognitive intervention programs have been explored as a potential approach for implementation by caregivers on a one-to-one basis. These programs have the advantage of being implemented in a home setting and in the real-life context of the older adult, in a society that is increasingly aging and where aging in place is being fostered. Inclusion criteria: This review considered experimental studies that included older adults aged 60 years and over with major neurocognitive disorders who were receiving individual cognitive interventions (e.g. cognitive stimulation, cognitive training or cognitive rehabilitation) provided by their caregivers. The comparator was usual care, waitlist control or alternative therapeutic intervention. The primary outcomes of interest included cognition, social functioning and quality of life. Additionally, behavior, mood and activities of daily living were considered. Methods: A comprehensive search strategy was used to identify relevant published and unpublished studies from January 1995 to March 2018, written in English, Spanish and Portuguese. Studies meeting the inclusion criteria were retrieved and their methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklists for randomized controlled trials and quasi-experimental studies. Quantitative data were extracted using the standardized data extraction tool from the JBI System for the Unified Management, Assessment and Review of Information. Due to the clinical and methodological heterogeneity in the included studies, statistical pooling was not possible. Therefore, findings are presented in a narrative format. Results: Eight randomized controlled trials and two quasi-experimental studies were included, with a total sample of 844 dyads (older adults and caregivers). The number of dyads included in the studies ranged from 16 to 356. Beneficial effects of the caregiver-provided individual cognitive interventions were observed in various cognitive domains, including memory, attention, verbalfluency and problem-solving. Two studies additionally reported the positive impact of the intervention of interest on general cognitive functioning. None of the reviewed studies revealed significant changes in quality of life. Social functioning was not analyzed in any of the included studies. Beneficial effects were also reported in relation to behavior and activities of daily living, despite the low level of evidence. Conclusions: This review responds to a gap in current international literature on the synthesis of evidence on the use of caregiver-provided individual cognitive interventions. The intervention of interest is associated with improvement in cognitive performance, revealing some benefits for the stabilization of neuropsychiatric symptoms and an increase in autonomy in activities of daily living. Further research on the impact of sociodemographic and clinical factors on the intervention effects is needed, as these factors seem to interfere with successful intervention implementation. To reinforce current evidence, the methodological quality of future studies should be improved.
- Effectiveness of caregiver-provided cognitive interventions on cognition, social functioning and quality of life among older adults with major neurocognitive disorder: a systematic review protocolPublication . Silva, Rosa; Cardoso, Daniela; Abrunheiro, Sérgio; Almeida, Maria; Apóstolo, João
- Cognitive stimulation in older adults: an innovative good practice supporting successful aging and self-carePublication . Apóstolo, J.; Bobrowicz-Campos, E.; Gil, I.; Silva, R.; Costa, P.; Couto, F.; Cardoso, D.; Barata, A.; Almeida, M.The project Cognitive Stimulation in Older Adults: Intervention on Cognitive Frailty and Promotion of Self-Care (in brief the ECOG project) arises in a context of worldwide demographic aging, and is fostered by the need to provide a sustainable solution to the progressive increase in the prevalence of age-related cognitive impairment. The main goal of the ECOG project is to promote active citizenship in old age through the empowerment for autonomy and self-care. Namely, the ECOG team is working on the development of evidence-based programs and tools that promote gains in health in cognitively frail and cognitively impaired older adults from the community. It is also working on the transfer of ECOG products to the practice of health and social care, promoting active involvement of geriatric care institutions in the implementation of the ECOG programs and tools, and ensuring appropriate training of professionals. Finally, the ECOG team is deploying a digital platform to reach out to the broadest audience possible and support the remote access and scaling up of the ECOG products. The impacts expected at an individual level include improvements in cognition, functionality, and autonomy of older adults, with simultaneous reduction of depressive symptomatology, and increase in quality of life of both person cared and his/her caregiver. Regarding societal gains, we anticipate an increase in life expectancy and significant postponement of institutionalization associated with geriatric problems. We also believe that the wide implementation of the ECOG products will reduce the costs of interventions for cognitively impaired citizens, contributing to sustainability and efficiency of health systems.
- Use of innovative technologies in group-based reminiscence interventions in older adults’ with dementia: a scoping reviewPublication . Gil, Isabel; Santos-Costa, Paulo; Bobrowicz-Campos, Elzbieta; Santos, Eduardo; Silva, Rosa Carla; Sousa, Liliana B.; Almeida, Maria de Lurdes; Apóstolo, JoãoBackground: Reminiscence therapy (RT) emerges in the literature as a non-pharmacological intervention commonly implemented in groups of older adults with dementia, and which has significant positive results in outcomes such as cognition and depressive symptomatology. Simultaneously, we witness the gradual addition of innovative technologies in non-pharmacological interventions in this population segment. However, no studies have synthesized the main contributions of the use of technology in group-based RT sessions. Aim: To map the available evidence on group-based RT sessions/activities aided by technological innovations, and critically discussed the potentialities and weaknesses of its use. Methods: Scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results: Seven studies were included. Overall, the use of technological aids potentiates the interaction and communication between older adults with dementia, staff, and relatives. Nevertheless, issues related to ergonomics, connectivity, and intention of use emerge as recurrent pitfalls. Conclusion: While technological aids can foster a more personalized and dynamic group-based RT session, the development of such innovations must follow an user-centered approach that involves older adults with different stages of dementia in order to create solutions with significance and applicability to its end-users.