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"Apóstolo, João"
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Effectiveness of a Cognitive Stimulation Program in Older Adults with Mild Neurocognitive Disorder: Insights from fNIRS Analysis in a Randomized Controlled Trial
by
Nogueira, Débora
,
Justo-Henriques, Susana I.
,
Silva, Rosa C. G.
in
Alzheimer's disease
,
Cognitive ability
,
cognitive function
2025
Background/Objectives: Neurocognitive disorders (NCDs) encompass a spectrum of conditions that significantly impact cognitive domains, including attention, memory, and language. Mild NCD, increasingly prevalent with aging, represents an early stage of these disorders, characterized by cognitive deficits that do not interfere with daily functioning. Non-pharmacological therapies, especially cognitive stimulation, are widely recommended to preserve cognitive function of older adults. This study aimed to evaluate the effectiveness of a 12-week individual cognitive stimulation (iCS) program on cognitive performance, mood, and prefrontal cortex activation in older adults with mild NCD using a single-blind, randomized, parallel two-arm RCT. Methods: A sample of 36 older adults were selected from a central region of Portugal. The intervention group (n = 18) received 24 iCS sessions, twice weekly for 12 weeks. The control group (n = 18) completed their regularly scheduled activities. Outcomes included global cognitive function, executive functioning, and mood. All participants were assessed at baseline and after the intervention. Functional near infra-red spectroscopy (fNIRS) was also collected to measure prefrontal cortex activity at both time points in the intervention group. Results: The intervention group showed a significant improvement in global cognition and executive functions, and reduced depressive symptomatology compared to the control group. fNIRS data revealed enhanced activation and functional efficiency in the lateral prefrontal cortex following the iCS program. Adherence and degree of collaboration to the intervention were very high. Conclusions: These findings suggest that iCS is an effective approach to improving cognitive function and mood in mildly cognitively impaired older adults.
Journal Article
Effectiveness of a Randomized Controlled Trial of Individual Reminiscence Therapy on Cognition, Mood and Quality of Life in Azorean Older Adults with Neurocognitive Disorders
by
Justo-Henriques, Susana I.
,
Pérez-Sáez, Enrique
,
Apóstolo, João L. Alves
in
Anxiety
,
Cognition & reasoning
,
Cognitive ability
2021
Reminiscence therapy (RT) is a form of cognitive stimulation therapy that incorporates discussion of past activities, events, and experiences to stimulate individual memories; it has had some success in treating persons with neurocognitive disorders. This research aims to evaluate the ability of individual RT, using a simple reminiscence format, to improve the overall cognitive function, memory, executive functions, emotional status, and quality of life in older adults with neurocognitive disorders who received social care and support services. A multicenter randomized controlled trial was completed in the Azores archipelago (an independent region of Portugal) using repeated measures (pre-intervention, post-intervention, and follow-up). The intervention group underwent individual RT sessions, twice weekly for 13 weeks, while the control group completed regular activities administered as part of their program. Results did not reveal any significant differences between the intervention and control groups. While results did not reveal significant effects, a number of historical and contextual factors are considered as possible explanations for the lack of effects—namely, data collection occurring during the COVID-19 global pandemic, participant cohort effects, and therapist heterogeneity.
Journal Article
Design of Innovative Clothing for Pressure Injury Prevention: End-User Evaluation in a Mixed-Methods Study
by
Rêgo, Anderson da Silva
,
Sousa, Liliana B.
,
Santos-Costa, Paulo
in
Biosensors
,
Body measurements
,
Humidity
2023
The global relevance of pressure injury (PI) prevention technologies arise from their impact on the quality of life of people with limited mobility and the costs associated with treating these preventable injuries. The purpose of this mixed methods study is to evaluate the design of a prototype integrating Smart Health Textiles for PI prevention based on feedback from specialist nurses who care for individuals who are prone to or have PIs. This is a mixed methods study. A structured questionnaire was conducted as part of an evaluation of a prototype garment for the prevention of PIs. This questionnaire was applied during the evaluation of the prototype and afterwards focus group discussions were held with experts. Descriptive statistics techniques were used to analyze the data and thematic and integrated content analysis was conducted through concomitant triangulation. Nineteen nurses took part, aged 30 to 39 years (52.6%) and with 12.31 ± 8.96 years of experience. Participants showed that the prototype required more manipulation and physical effort, which interfered its usefulness, in addition to presenting difficulties with the openings and the material of the closure system, which interfered with the ease of use and learning. Overall satisfaction with the product was moderate, with some areas for improvement found, such as satisfaction, recommendations to colleagues, and pleasantness of use. It is concluded that areas for improvement have been found in all dimensions, including in the design of openings and the choice of materials. These findings supply significant insights for improving clothing to meet the needs of healthcare professionals and patients.
Journal Article
Reliability and Validity of the Geriatric Depression Scale in a Sample of Portuguese Older Adults with Mild-to-Moderate Cognitive Impairment
by
Justo-Henriques, Susana I.
,
Pérez-Sáez, Enrique
,
Apóstolo, João L. Alves
in
Aging
,
Cognitive ability
,
depression screening
2023
Although the Geriatric Depression Scale (GDS) is a well-established instrument for the assessment of depressive symptoms in older adults, this has not been validated specifically for Portuguese older adults with cognitive impairment. The objective of this study was to analyze the psychometric properties of two Portuguese versions of the GDS (GDS-27 and GDS-15) in a sample of Portuguese older adults with mild-to-moderate cognitive impairment. Clinicians assessed for major depressive disorder and cognitive functioning in 117 participants with mild-to-moderate cognitive decline (76.9% female, Mage = 83.66 years). The internal consistency of GDS-27 and GDS-15 were 0.874 and 0.812, respectively. There was a significant correlation between GDS-27 and GDS-15 with the Beck Depression Inventory-II (GDS-27: rho = 0.738, p < 0.001; GDS-15: rho = 0.760, p < 0.001), suggesting good validity. A cutoff point of 15/16 in GDS-27 and 8/9 in GDS-15 resulted in the identification of persons with depression (GDS-27: sensitivity 100%, specificity 63%; GDS-15: sensitivity 90%, specificity 62%). Overall, the GDS-27 and GDS-15 are reliable and valid instruments for the assessment of depression in Portuguese-speaking older adults with cognitive impairment.
Journal Article
The Quality of Carer–Patient Relationship Scale: Adaptation and Validation into Portuguese
2021
Background: This study aimed to translate and adapt the Quality of the Carer–Patient Relationship (QCPR) scale into Portuguese and analyse both its psychometric properties and correlation with sociodemographic and clinical variables. Methods: Phase (1) Translate and culturally adapt the scale. Phase (2) Assess the scale’s confirmatory factorial analysis, internal consistency, construct validity, and correlations. Results: The experts classified the overall quality of the translation as adequate. A total of 53 dyads (cared-for person and carer) were assessed. In both versions, measures of central tendency and symmetry were also adequate, and the two factors under investigation had appropriate reliability, although in the conflict/critical factor, this was more fragile. Cronbach’s alpha values were 0.89 for the cared-for person version and 0.91 for the carer version. Conclusions: The QCPR scale showed satisfactory to good values of reliability. The assessment is essential to guarantee structured interventions by health professionals, since the quality of the dyads’ relationship seems to influence both older adults’ quality of life and carers’ health status. This study is a significant contribution to the introduction of the QCPR scale in the Portuguese clinical and scientific culture but also an opportunity to increase its use internationally.
Journal Article
Trends in Telecare Use among Community-Dwelling Older Adults: A Scoping Review
by
Korkmaz Yaylagul, Nilufer
,
Apóstolo, João
,
Dantas, Carina
in
Aged
,
Aging in place
,
Alzheimer's disease
2022
A scoping review was conducted to map and analyze the concept of telecare services and the trends in telecare use. This scoping review was conducted according to Arksey and O’Malley’s framework. A search was conducted in CINAHL (via EBSCO), ERIC, Academic Search Ultimate, and MEDLINE/PubMed databases. This scoping review considered quantitative (e.g., analytical observational studies, including prospective and retrospective cohort studies, case-control, analytical cross-sectional, and descriptive-observational studies), qualitative (e.g., phenomenology, grounded theory, ethnography, and action research), and mixed-method primary studies. Forty research articles published from 1 January 2012, to 1 January 2022 were included in this review, these studies met the eligibility criteria as all were focused on telecare and targeting older adults over 65 living at home. The reviewers coded the data in an Excel spreadsheet, including the articles’ title, year, author, journal information and subject, research methods, sample size, location, and summary. Then, the researchers analyzed the conceptual definitions, measurement techniques, and findings in detail and the findings were grouped into categories. The trends around the concept of telecare are independent living, remote care, aging in place, and safety. Telecare research focuses mainly on service use, chronic illness, ethics, and cost-effectiveness. Technology acceptance among older individuals is a critical factor for telecare use. The results found in the literature about the cost-effectiveness of telecare are inconsistent.
Journal Article
Comfort experience in palliative care: a phenomenological study
2016
Background
Palliative care aims to provide maximum comfort to the patient. However it is unknown what factors facilitate or hinder the experience of comfort, from the perspective of inpatients of palliative care units. This lack of knowledge hinders the development of comfort interventions adjusted to these patients. The aim of this research is to describe the comfort and discomfort experienced by inpatients at palliative care units.
Methods
A phenomenological descriptive study was undertaken. Ten inpatients were recruited from a Spanish palliative care unit and seven from a Portuguese palliative care unit. Data were collected using individual interviews and analysed following the method of Giorgi.
Results
Four themes reflect the essence of the lived experience: The Palliative Care as a response to the patient’s needs with advanced disease, attempt to naturalize advanced disease, confrontation with their own vulnerability, openness to the spiritual dimension.
Conclusions
Informants revealed that they experience comfort through humanized care, differentiated environment, symptomatic control, hope and relationships. The discomfort emerges from the losses and powerlessness against their situation. Even if such findings may seem intuitive, documenting them is essential because it invites us to reflect on our convictions about what it means to be comfortable for these patients, and allows incorporating this information in the design of focused interventions to maximize the comfort experience.
Journal Article
End-User Assessment of an Innovative Clothing-Based Sensor Developed for Pressure Injury Prevention: A Mixed-Method Study
by
Ainla, Alar
,
Fangueiro, Raul
,
Arruda, Luísa M.
in
Analysis
,
Clothing and dress
,
Equipment Design
2023
This study aimed to evaluate a clothing prototype that incorporates sensors for the evaluation of pressure, temperature, and humidity for the prevention of pressure injuries, namely regarding physical and comfort requirements. A mixed-method approach was used with concurrent quantitative and qualitative data triangulation. A structured questionnaire was applied before a focus group of experts to evaluate the sensor prototypes. Data were analyzed using descriptive and inferential statistics and the discourse of the collective subject, followed by method integration and meta-inferences. Nine nurses, experts in this topic, aged 32.66 ± 6.28 years and with a time of profession of 10.88 ± 6.19 years, participated in the study. Prototype A presented low evaluation in stiffness (1.56 ± 1.01) and roughness (2.11 ± 1.17). Prototype B showed smaller values in dimension (2.77 ± 0.83) and stiffness (3.00 ± 1.22). Embroidery was assessed as inadequate in terms of stiffness (1.88 ± 1.05) and roughness (2.44 ± 1.01). The results from the questionnaires and focus groups’ show low adequacy as to stiffness, roughness, and comfort. The participants highlighted the need for improvements regarding stiffness and comfort, suggesting new proposals for the development of sensors for clothing. The main conclusions are that Prototype A presented the lowest average scores relative to rigidity (1.56 ± 1.01), considered inadequate. This dimension of Prototype B was evaluated as slightly adequate (2.77 ± 0.83). The rigidity (1.88 ± 1.05) of Prototype A + B + embroidery was evaluated as inadequate. The prototype revealed clothing sensors with low adequacy regarding the physical requirements, such as stiffness or roughness. Improvements are needed regarding the stiffness and roughness for the safety and comfort characteristics of the device evaluated.
Journal Article
Validation and Screening Capacity of the European Portuguese Version of the SUNFRAIL Tool for Community-Dwelling Older Adults
by
Cardoso, Daniela
,
Cardoso, Ana Filipa
,
Apóstolo, João
in
Aged
,
Body mass index
,
Coronaviruses
2021
Early detection of frailty may prevent or delay adverse health outcomes in community-dwelling older adults. In Portugal, there are currently no valid multidimensional frailty screening tools. SUNFRAIL is a user-friendly multidimensional tool for frailty screening that can be used in primary care. Aims: (i) to determine the validity and reliability of the European Portuguese version of the SUNFRAIL tool for use in community-dwelling older adults; (ii) to assess the screening capacity of this version of SUNFRAIL using Fried’s phenotypic model criteria for frailty as a reference test. Methods: Cross-sectional pilot study in a convenience sample of 128 community-dwelling older adults. Objective and subjective data were collected. Internal consistency, concurrent validity, sensitivity, and specificity (ROC curve analysis) were examined. Results: Internal consistency was low. Significant moderate to strong correlations were found between different domains and the total score. The differences between robust, pre-frail, and frail older adults were significant. SUNFRAIL was also correlated with multimorbidity. Sensitivity and specificity were satisfactory. Conclusions: The European Portuguese version of the SUNFRAIL tool is a promising frailty screening tool for community-dwelling older adults to be routinely used in clinical practice. However, more consistent results on its validity and reliability are needed to be used nationwide.
Journal Article
Effectiveness of Reminiscence Therapy versus Cognitive Stimulation Therapy in Older Adults with Cognitive Decline: A Quasi-Experimental Pilot Study
by
Apóstolo, João
,
Gil, Isabel
,
Silva, Rosa
in
Activities of daily living
,
Cognition & reasoning
,
cognitive decline
2022
Cognitive impairment can represent a predecessor to neuro-degenerative processes; however, evidence suggests that non-pharmacologic interventions such as reminiscence therapy (RT) and cognitive stimulation therapy (CST) can potentially stabilize or reverse this trend. Community-based settings are widely regarded as the key area of intervention by healthcare professionals in this field. Thus, this study aimed to assess the effects of an RT and a CST program in the cognition, depressive symptomatology, and quality of life (QoL) of older adults with cognitive decline who attend community support structures (CSS) in central Portugal. A quasi-experimental study with two arms (RT and CST program) was conducted for seven weeks. Participants were allocated to each arm based on the CSS they attended. Of the 109 older adults initially screened, 76 completed the intervention (50 in the RT program and 26 in the CST program). A pre- and post-intervention analysis showed statistically significant differences in older adults’ cognition, especially in their delayed recall ability, in both groups. Older adults in the RT program evidence improved QoL scores post-intervention. Both the RT and CST programs implemented throughout the study are beneficial to older adults’ cognitive performance, although results are more pronounced in the earlier stages of cognitive decline. Participation in the RT program was associated with improvements in older adults’ QoL scores.
Journal Article