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About this book

This book constitutes the thoroughly refereed post-conference proceedings of the First International Workshop on Gerotechnology, IWoG 2018, held in Cáceres, Spain on December 14, 2018, and in Évora, Portugal, on December 17, 2018. The 24 revised full papers along with 8 short papers presented were carefully reviewed and selected from 71 submissions.The papers are organized in topical sections on knowledge management for health: context, cognition, behavior and user modeling; technologies to increase the quality of life of the elderly population; Internet of Things (IoT); smarts technologies and algorithms for health; monitoring and management of chronic and non-chronic diseases;solutions for active aging, social integration and self-care; health interventions to support caregivers of elderly people; public health initiatives.

Table of Contents


Knowledge Management for Health: Context, Cognition, Behavior and User Modeling


Complex Event Processing for Health Monitoring

The increase of the life expectancy has become a challenge in regions with a low population density. This fact is caused by the existence of small towns all far from one another and with the peculiarity of many elders with special health care living there. This situation increases in a high percentage the health costs of the region having to attend daily all these elders who need a close monitoring. We live in a IoT era with a huge quantity of new connected devices with lots of sensors. Taking advantage of this, it is possible to monitor these elders from the distance without having to cover the complete area of the region every day. This way, our approach is using a mobile centric architecture that permits the elders having a device which infers a health virtual profile of them with data from its sensors and from other smart devices like bands with pulsometers. At this point we propose using Complex Event Processing techniques to combine the data coming from all sources and analyze it to extract meaningful information for the doctors and caregivers and even detect important events like falls in real time.

Alejandro Pérez-Vereda, Daniel Flores-Martín, Carlos Canal, Juan M. Murillo

Facial Recognition of Emotions with Smartphones to Improve the Elder Quality of Life

The increase in the elderly population today is a fact. This group of people needs day-to-day care due to their age and, in addition, they often have health problems. Technology can be used to mitigate these problem. However, it must be beared in mind that most of this population is currently unable to get the most out of electronic devices. To help elders benefit from these devices systems adapted to their needs and preferences are needed. In particular, systems that use the elders contextual information to integrate several aspects of eldercare and adapt them to each elder would provide significant benefits. In this paper, we propose to use smartphones as the device who centralizes contextual information of the elders, focusing on emotion recognition. These emotions will be used to recognize to what extent an elderly person needs care at certain times of the day and to adapt surrounding IoT systems to their needs and moods.

Sheila Bonilla, Enrique Moguel, Jose Garcia-Alonso

Toward Privacy-Aware Healthcare Data Fusion Systems

Mobile wearable and sensor-enabled devices offer an opportunity for deluging unprecedented amount of health-related data that is beneficial in health and caregiving research. Fusing data ingested throughout various heterogeneous channels is essential for better provisioning novel healthcare solutions. However, this is typically challenged by privacy-awareness. For example, the European Commission throughout its call-for-proposals always stresses a requirement that provisioned solutions should consider privacy and should boost security- and privacy-awareness in cloud computing environments. Current solutions either do not consider privacy requirements or provide solutions that are mostly ad hoc and patch efforts. In this position paper, we motivate the adoption of Blockchain technologies for providing privacy-awareness to novel healthcare data fusion solutions. Our envisioned solution is proposed on top of current state-of-the-art blockchain and big data representatives, specifically Hyperledger Fabric and Apache Spark.

Isam Mashhour Al Jawarneh, Paolo Bellavista, Luca Foschini, Rebecca Montanari, Javier Berrocal, Juan M. Murillo

Technologies to Increase the Quality of Life of the Elderly Population


Food and Health: Relationships Between Technology and Social Sciences

Population aging constitutes one of the central issues on the political agenda of the $$21^\mathrm{st}$$ century. The social implications of these population dynamics are subject to discussion due to their evident impact on aspects such as labour relations, health and care systems, pension policy but also on family models or the social construction of feelings. In this context, the understanding of food ideologies and practices in rural populations is a crucial issue in health policies and interventions. With the traditional tools and assumptions of ethnographic fieldwork, our research is aimed at a series of objectives in order to complete the limited knowledge on these issues: (1) to know the nutritional situation of the elderly population in rural areas; (2) to describe cultural food practices and their association with ideologies, representations, supply and availability systems; and (3) to relate technological innovation with our empirical research findings. We can describe two categories of analysis on which we are working. First, the problems of access to food. The circulation of food -“the field of the eatable”- is conditioned from a structural framework. Then, is also crucial in the diagnostic phase. We work too on the mapping of study areas with a variable representation of distances and difficulties depending on factors such as functionality, but also social position or gender. The intersections between socio-cultural approaches and technology occur in the field of interventions. Technological proposals can prove successful and attractive in labs, but they need to “work” in real life.

David Conde Caballero, Borja Rivero Jiménez, Beatriz Muñoz González, Carlos Alberto Castillo Sarmiento, Carmen Cipriano Crespo, Lorenzo Mariano Juárez

Perceptions and Needs with Regard to Technologies for Professional Practice

A Prospective Qualitative Study Among Caregivers in Spain

The purpose of the paper is to gain an understanding of the perceptions and needs of caregivers looking after the elderly or those with multiple disabilities with regard to the use of technology in the course of their work, in order to design the associated training. A qualitative study using semi-structured interviews of 10 caregivers from different disciplines caring for the elderly or those with multiple disabilities in Spain.Results: There is a generalized personalized use of ICT that cannot easily be transferred to caregiving duties. The difference between formal and informal care does not seem to be as important as the type of work performed: nevertheless, formal caregivers display a standardized pattern in their responses, perceiving a potential benefit and an ease in incorporating technology, but this is not accompanied by any social influence or conditions to facilitate this. With regard to the pattern of informal caregivers’ responses, although the same tendency can be noted, some uncertainty can be appreciated, particularly with regard to performance expectancy.As a conclusion, although the benefits that technology could bring to caregivers’ tasks are perceived, no organizational or family-based context to promote or facilitate it can be appreciated, and it is this that might be the primary target of the first stage of training. In a second phase, training for caregivers would be focused on the effective use of technology.

Eulàlia Hernández-Encuentra, Alícia Aguilar-Martínez, Daniel López Gómez, Beni Gómez-Zúñiga, Modesta Pousada, Israel Conejero-Arto, Francesc Saigí-Rubió

What Technologies Can the Nurse Use to Increase the Quality of Life of the Elderly Population with Leg Ulcers? – Systematic Literature Review

The purpose of this study was to identify the new technologies that nurses could use to increase the quality of life on an elderly person with leg ulcer. Methods: it was made a systematic revision of literature with qualitative synthesis and meta-analysis. Results: Elderly persons with chronic leg ulcers frequently experience multiple disabling symptoms and these symptoms are highly related with impairment of quality of life. Nowadays, the technology is prepared to improve diagnosis and treatment of illness. For the leg ulcer, one of the newest technologies is electrical stimulation on skin with two types: electrical stimulation therapy and electroceutical treatment. These therapies consist on the application of microcurrents of electric energy to replace the current of injury which has become disrupted in chronic wounds. The therapy reduces the wound size, pain and exudate levels. Conclusion: With this recent investigation and with the enforcement of new technologies in association with the usual therapies it is possible to improve the quality of life of the patient, however, it is extremely important to continue the investigation on this area.

Ana Ripado, Ruben Pires, Rita Morais, Pedro Parreira, César Fonseca, Manuel Lopes, Céu Marques

Loneliness and Aging. Do Public Policies Dream of Technological Solutions?

The aging of population entails a series of phenomena, among which is the reality of loneliness experienced by many elderly people. Different publications point out the relationship between loneliness and health problems, something that is translating into a lower quality of life for these people during their last years. With this paper we intend to point out some important ideas about the problem of loneliness in elderly people in rural areas. For this objective, we believe it is essential that more works be developed that investigates the subjectivity of the emotional world of those who live in loneliness and that public policies develop effective actions based on this works, including technological solutions that help to alleviate this problem.

Borja Rivero Jiménez, David Conde Caballero, Beatriz Muñoz González, Nuria García Perales, Julián F. Calderón García, Lorenzo Mariano Juárez

Internet of Things (IoT)


Interconnecting IoT Devices to Improve the QoL of Elderly People

The number of internet-connected devices (Internet of Things, IoT) is growing at an unstoppable rate. Many manufacturers have developed specific protocols that are usually closed and do not follow any standard, hindering the interconnection and coordination of devices from different manufactures. This entails a greater effort from users to coordinate some devices and the loss of the benefits provided by this paradigm. Some works are proposing different techniques to reduce this barrier and avoid the vendor lock-in issue. Nevertheless, this interconnection should also depends on the context. IoT devices must adapt their behavior according to the people’s preferences around them. In this paper, we propose a system that allows to identify a dynamic interconnection of IoT devices arising from changing situations to help elderly people with their daily tasks and improve their quality of life. Our work allows us to make this interconnection context dependent, creating a collaborative environment between people and devices. Further, in a world with an accelerated population aging, there is an increasing interest on developing solutions for the elderly living assistance through IoT systems.

Daniel Flores-Martin, Alejandro Pérez-Vereda, Javier Berrocal, Carlos Canal, Juan M. Murillo

A New WSN Mesh Protocol for More Transparent IoT Devices

We are experimenting great advances in the last years towards Weiser’s Ubiquitous Computing vision. To complete his transparent computing vision, we must unnoticed the presence of computing hardware around us. Currently, we are deploying smart devices in our houses to detect e.g., smoke in the kitchen, the state of a window (open or close) and so on. However, these devices require at least an initial configuration to be able to e.g., connect to the Internet through the router and sometimes also to set up some basic parameters. This paper focuses on the way IoT devices are interconnected to be able to interact with other connected devices as well as with people (e.g. to configure them), proposing a solution closer to the Weiser’s vision that is specially necessary for people not able to configure these devices for several reasons, such as elderly people that e.g., do not have the smartphone or PC to do it or are not able to do it due to functional diversity (e.g., problems with their hands for fine-grain control). More specifically, our specific target is people living in rural areas where the technical assistance is also not available and where houses tend to be big with wide stone walls that obstruct radio signals. Trying to solve this situation we propose a new IoT protocol to deal with this situation where people can throw IoT devices to a place with typically several of them already deployed and the nodes will autoconfigure themselves.

Marino Linaje, Enrique Carlos Mesías

Health Gains of Telephone Follow-up Nursing Intervention to Patient with Heart Disease

Aim: To identify the health gains related to nursing interventions in the telephone follow-up of adult patients with heart disease.Methodology: Systematic literature review by research in EBSCO, (CINAHL and MEDLINE) in the publication time interval between January 2012 and October 2017, using the PICO method. Elected 8 articles for analysis.Results: By the using of a telephone nursing intervention with heart disease patient’s health gains were identified related to: symptomatic control, management of the therapeutic regimen, use of health services, safety/adverse events and quality of life.Conclusions: The telephone nursing intervention contributes to optimize the follow-up to the patient, translating into health gains sensitive to nursing care.Implication to professional practice: In the contexts of nursing practice for adult patients with heart disease, telephone follow-up proves to be an intervention to be considered, translating into gains in health, promoting patient follow-up and improving training in disease management.

Sara Correia, Ana Correia, Isabel Videira, Paula Abrunhosa, Célia Cuco, Raquel Bolas, Dilar Costa, César Fonseca

Supporting Active Ageing Interventions with Web and Mobile/Wearable Technologies and Using Microservice Oriented Architectures

New solutions in the e-Health domain are been applied to address problems such as monitoring, user adaptation and context influence, particularly if the patients are older people. The social and economic burdens associated with age decline can be decreased by providing more holistic technological solutions. Our aim is to contribute to the integration of different aspects in the active ageing process (cognitive, physical and social) to achieve more complete evaluations and by performing more effective interventions in the elderly. To this end, in this research work we propose a technological solution based on microservices architectures, which has been validated in two different projects: cognitive training and frailty prevention. The solution involves a system of systems engineering, thus improving reusability, extensibility, and performance in the e-Health domain.

Francisco Carranza-García, Francisco M. García-Moreno, Carlos Rodriguez-Dominguez, José Luis Garrido, María Bermúdez Edo, María José Rodriguez-Fortiz, José Manuel Pérez-Mármol

Smarts Technologies and Algorithms for Health


Automatic Learning for Improvement in Joint Mobility in the Elderly

In Europe, the elderly are the majority group, an issue that implies specific attention. On many occasions, they need to be taken care of by other people. It is essential to talk about the gait, this plays an important role and it is necessary to maintain a joint width of movement adequate in the hip, knee and ankle so that the standing and walking are functional. Among the physical factors that limit mobility in the elderly are the articular and capsular, which can produce an immobility of the person and the appearance of pain, causing a significant deterioration in the quality of life of the elderly, a question that will give rise in most cases to the appearance of depressive symptoms. It is an obvious fact that public coverage must offer health activities to promote the health of this group. The purpose of this work is to document in a bibliographic and visual way a table of physical exercises and psychological techniques for its future implantation within the Primary Health Care (PHC) and the Machine Learning tools to develop a virtual gerontology nurse to assist in deploying the exercises at home. After an adequate automatic learning and health education, with greater implication of the nursing specialist in geriatrics and gerontology (GS) and once exercised, allow the elderly to develop with a maximum of autonomy and independence at home, as well as reduce the doses of drugs, an issue that will benefit health expenditure. We are proposing a Virtual Agent based in Computer Vision, Artificial Intelligence and Natural Interfaces that can perform unattended sessions for joint mobility improvement.

Sara Romero Valencia, Sagrario Gomez Cantarino, Margarida Sim-Sim, Blanca Espina, David Mendes

Psychometric Properties of the Elderly Nursing Core Set

Aim: To assess the psychometric properties of the Elderly Nursing Core Set.Methods: Cross-sectional descriptive study; convenience sample composed of 427 individuals aged 65 years old or older.Results: Factor analysis of principal components allowed extracting 4 concepts, i.e., Self-Care, Learning and Mental Functions, Communication, and Relationship with Friends and Caregivers, which explained 82.25% of the total variance. Varimax rotation indicated a very good measure of sampling adequacy (KMO = 0.947), with Bartlett’s test of sphericity (X2(300) = 11131.28, p < 0.001) and an excellent Cronbach’s alpha value of 0.963.Conclusion: The Elderly Nursing Core Set exhibits excellent psychometric properties, i.e., consistency, reliability, and internal validity, for which reason it is recommended as a means of determining the nursing care needs of individuals aged 65 years old or older and assessing the outcomes of nursing interventions targeting that population.

César Fonseca, Manuel Lopes, David Mendes, Pedro Parreira, Lisete Mónico, Céu Marques

Monitoring and Management of Chronic and Non-chronic Diseases


The Communication with the Elderly Person Suffering from Auditive Deficiency: Psychomotricity and Supportive Technologies

Growing old is a stage in Human development in which gains and losses can be accounted for but where, more often than not, the losses overcome the gains. Auditive deficiency can be one of those losses. Auditive deficiency is characterized by the reduction or total loss of the hearing capacity, where the communication is made in either a verbal or non verbal way. The communication is of extreme importance in any exchange between the elderly and the health care professional, since it is the vehicle through which cognitive stimulation can be made, it being an essential factor in the acceptance of the individual and his/her capacities. For this reason, the health care professionals, willing to provide a superlative service, should be aware of a few strategies that facilitate the communication with this particular population.It is important to optimize communication since difficulties in communicating have socio-emotional implications, including the speeding up of the ageing process. For this motive, some up-to-date technologies that facilitate the communication processes will be presented.Last, but not least, one appeals to the investigation on how best to communicate when dealing with auditive impairments, in order to allow Psychomotor therapy to become more efficient when dealing with this population.

Adriana Feijão, Maria Queiroga, Rafaela Moreira, Raquel Jordão, César Fonseca

Mobility Deficit – Rehabilitate, An Opportunity for Functionality

There are many pathological conditions that cause mobility deficits and that ultimately influence someone’s autonomy. To overcome these difficulties implies the patient’s involvement and professional action, namely from a rehabilitation nurse, whose target is to capacitate the patient. The person can be capacitated and reach quality of life through organized and systematic rehabilitation programs, which can result in health gains. Aims: to evaluate patients with mobility deficits functional status; to implement a Rehabilitation Nursing intervention plan; to monitor health gains through mobility deficits rehabilitation; Method: Cross-sectional study, action research approximation. Non-probability sampling, 9 patients admitted at an Intensive Care Unit and at a Stroke Unit who fulfilled the inclusion criteria. The intervention plan included two moments of formal evaluation: the initial (T1) and the final (T2) that relied on specific instruments. Results: improvement and solving of rehabilitation nursing diagnoses, increased balance and better transferring ability. Data suggest that the implementation of an intervention plan decreased the level of dependence. Conclusion: Early intervention and the implementation of a nursing rehabilitation intervention plan results in health gains (direct or indirect), decreases the risk of developing Pressure Ulcers (PU) and the risk of developing a situation of immobility that affects patients’ autonomy and quality of life.

Gorete Reis, Patrícia Páscoa Pereira, Lena Sabino, Maria José Bule

“Making the Invisible Visible”: Intelligent Recovery Monitoring of Aortic Arch Repair Surgery Proposal

Thoracic pain is a very frequent reason for consultation in the primary care nursing consultation. However, when the healthcare professional is facing a patient with intense and tearing pain in the chest that induces him to think that he is facing a possible aortic dissection, then it is in an emergency where the patient requires immediate attention and a referral without loss of time to a cardiac surgery unit. This study aims to publicize the misfortunes that may occur in the patient during the recovery of aortic arch repair surgery. The results were obtained through the analysis of the clinical history of patients with aortic pathology, all of them operated in the cardiac surgery unit of the Virgen de la Salud Hospital of Toledo (CHT) Spain. We are proposing a continuous monitoring solution that can ascertain the life quality of patients that went arch repair surgery. Life quality is difficult to measure quantitatively. We suggest threshold levels for a complex dataset that, when considered simultaneously through data fusion techniques applied with reinforcement learning algorithms can have a numeric output for quality of life as a whole. In this groundbreaking paper, the fundaments of the ontological structure for data acquisition, model definition, data acquisition and reasoning based in deep learning techniques are introduced.

Mercedes de Dios, David Mendes, Sagrario G. Cantarino, Margarida Sim Sim

Study of the Innovative Characteristics of a New Technology for Bladder and Intestinal Elimination: An Empirical Study for the Evaluation of Ease of Use and Perceived Utility

Background: Bedpans are medical devices usually used in the healthcare delivery to bedridden patients which health condition implies that bladder and/or intestinal elimination is done in bed. Physical and psychological discomfort experienced by patients in these situations it’s a challenge to professionals to look for innovative proposals, looking for the reduction of negative impacts in many levels.Objective: To evaluate the acceptance, by general population of (i) classical bedpans currently in the market and (ii) an inflatable proposal based on the Technology Acceptance Model. Method: The sample included 108 participants, aged between 19 and 81 years, caretakers/users of bedpans. The Technology Acceptance Model was used to evaluate the perception of utility and ease of use. All participants completed an online self-response questionnaire, later submitted to Exploratory Factor Analysis and Confirmatory and reliability study. Results: The results allow indicating a high degree of acceptance for the value proposition of the innovative bedpan, compared to the classic model. Conclusion: This study constitutes an important contribution to the human sciences, since it allows evaluating the ease of use and utility by users of bedpans, evidencing the importance of the innovative characteristics proposed to the new inflated bedpan.

Joana Parreira, Daniela Fernandes, Lisete Mónico, Anabela Salgueiro-Oliveira, Liliana Sousa, Paulo Santos Costa, Inês Marques, Daniel Ventura, Mónica Silva, Arménio Cruz, César Fonseca, Rafael Bernardes, Carla Carvalho, Luciene Braga, Pedro Parreira

Emotional Intelligence and Life Satisfaction in Adulthood

The aim of this study was to analyze the relationship between Emotional Intelligence (EI) and Life Satisfaction (LS) (18 to 60 years) as a repertoire of acquired psychological competences and intelligent adaptive behavior through the promotion of personal success, happiness and general well-being and explore their contributions to LS. Three research hypotheses were formulated for young adulthood (18–39 years) and advanced adulthood (40–60 years), aiming at comparing the magnitude of these two life phases: (H1) EI and LS are positively related; (H2) EI and self-esteem are positively related; and, (H3) EI is a predictor of LS. The sample study is composed of 200 participants aged 18–60 years. The results did not indicate differences between EI in young and elderly adults, although the latter were significantly less satisfied with their life and reported going through a less favorable life period. The three hypotheses found statistical support, with greater magnitude in advanced adulthood. For young adults, EI accounted for 15% of their overall well-being and for older adults this proportion increased to 43%.

Lisete dos Santos Mendes Mónico, Patrícia Isabel Valente dos Santos, Carla Maria Santos de Carvalho, Joana Íris Lopes Parreira, Paulo Jorge dos Santos Costa, Pedro Miguel Dinis Parreira

Psychomotor Intervention Using Biofeedback Technology for the Elderly with Chronic Obstructive Pulmonary Disease

When we talk about aging we must take into account not only chronological age, but also a complex and dynamic process of biological, psychological and social changes. Chronic Obstructive Pulmonary Disease (COPD) is highlighted in this study, as it is one of the most common and one of the leading causes of worldwide mortality in the elderly. Thus, the importance of psychomotricity in this case, since it acts on the awareness and regulation of the physiological and psychological systems, facilitating the learning process (according to the principles of learning theory and cognitive behavioral). In addition, it is also proposed the use of support technology based on the therapeutic strategies of the biofeedback system. Therefore, through the application of the goals proposed by the psychomotricity and use of the technology associated with biofeedback, the individual with COPD becomes capable of controlling the symptoms associated with the disease, and consequently acquiring more autonomy in the daily life (essential to promote their quality of life).

Maria Santos, Rafaela Moreira, Ricardo Saldanha, Salomé Palmeiro, César Fonseca

Solutions for Active Aging, Social Integration and Self-care


Self-care Needs for Symptom Management and Medication in Elderly Person and Skills of Informal Caregiver to Care Him

Inadequate evaluation and support for dependent elderly people and their caregivers and health service practices often not adequate to the needs of elderly dependents and their caregivers justify a greater investment in this dyad.This study aims to evaluate the clinical and self-care needs in the management of symptoms and medication of the elderly dependent people; relate their needs to self-care in medication and symptom management with sex and age; to assess the socio-demographic characteristics family and capacities to care for their relatives in the self-management of symptoms and medication management and to value the information received on how to manage the symptoms and medication and the professional who transmitted them. A correlational study of 135 dependent elderly and their informal caregivers through a face-to-face interview consisting of characterization variables and cause of dependence, self-care needs assessment in symptom management and medication.Most of dependent elderly were women, mean age 83.4 ± 6.7 years and the main cause of dependence were respiratory diseases. Informal caregivers were mostly female, daughters, mean age of 59.1 ± 15.5 years. It was found that on average women were less dependent than men on self-care. Most informal caregivers considered that they were given the necessary information regarding symptom and medication management. Nurses were the professionals who provided them more information.We concluded that this study brought relevant information regarding the dependent elderly and their caregivers in the identification of their difficulties and adequate information about the best way to manage these difficulties.

Maria dos Anjos Dixe, Ana Maria Vaz, Eugénia Nunes Grilo

Virtual Assistant to Improve Self-care of Older People with Type 2 Diabetes: First Prototype

Diabetes has significant clinical, economic and humanistic implications, both at a national and global level. Type 2 diabetes (T2D) is highly prevalent in older people. This paper describes a first prototype of an application intended to facilitate self-care of older people with T2D, supplementing appointments with healthcare professionals. The application is based on a virtual assistant with an anthropomorphic representation. The virtual assistant is capable of speaking and expressing emotions through facial and body animations; it has been designed to act as a relational agent, developing long-term relationships with users. It targets adherence to medication, physical activity and diet, tailoring the intervention to users’ needs and characteristics. The Behavior Change Wheel was chosen as the theoretical approach to behaviour change and supports dialogue content. Built for Android devices, the architecture of the application first prototype includes a core component, a dialogue creator, a speech generator and a database. The first tests on the application contents and usability were conducted in a sample of ten academic nurses with expertise in primary care. Overall, these tests yielded a positive opinion, as well as suggestions for improvement. On-going work includes testing the first prototype with older people with T2D plus health professionals in primary care units of the Portuguese National Health Service, and incorporating a rule-based context-sensitive dialogue manager, which is expected to convey a more flexible dialogue flow.

Susana Buinhas, Ana Paula Cláudio, Maria Beatriz Carmo, João Balsa, Afonso Cavaco, Anabela Mendes, Isa Félix, Nuno Pimenta, Mara Pereira Guerreiro

Nursing Students Digital Competencies for the Self-management of Patients: Development of the DigiNurse Model’s Interface

Background: While the need for self-management support is increasing in the current aging European society, digital skills and competences in supporting self-management is not commonly a part of the nursing curriculum. In order to respond to this societal challenge, the Digital Nursing Model (DigiNurse) will be developed by an international consortium, offering a structured concept to be incorporated in the nursing curriculum. This project was financially supported through the Erasmus+ program, through the Key-Action “Cooperation for Innovation and the Exchange of Good Practices”. The final goal is to develop a digital interface to be used by nursing students in the follow-up of patients with chronic diseases, guided by the key-principles of the DigiNurse Model. Objective: To reflect on the different theoretical contributions that supports the creation of digital interfaces to develop digital skills/competences in nursing students and professionals. Conclusion: The development of digital skills in nursing students is important for the follow-up of patients with chronic diseases. So, the analysis of different models will support the development of DigiNurse Model, whose implementation in educational and pedagogical models in nursing curricula can contribute to significant improvements in health care of patients with chronic illness.

Pedro Parreira, Paulo Santos Costa, Anabela Salgueiro-Oliveira, Paulo Alexandre Ferreira, Liliana B. Sousa, Inês A. Marques, Rafael Bernardes, Raija Kokko, João Graveto

Models and Politics of Cares of the Elderly in the Home

Aging has been assumed as a challenge in the different areas of professional and political action. The aim of this study was to identify models and policies for elderly care at home. To that end, a integrative review of articles on the topic was published, retrospectively published until 2013. The results show three main axes that shape the models and policies of care for the elderly in a home context: (a) Despite government participation in the with regard to health and social support for elderly people in situations of dependency in the home, there is a need to expand such support, in particular to informal caregivers; (b) The need for greater coordination and integration of care, not only at the level of the health system, but between sectors, particularly at the level of social intervention; and (c) The tendency and convergence in most developed countries to broaden responses (home care) with the consequent permanence of the elderly in their places of residence for the maximum possible time, with recognized positive effects in terms of financial sustainability.

Rogério Ferrinho Ferreira, Ana Clara Nunes, Ana Maria Canhestro

Effectiveness of an Educational Program to Enhance Self-care Skills After Acute Coronary Syndrome: A Quasi-Experimental Study

Background: The aim of this study is to determine the effectiveness of an educational program to enhance self-care skills in patients after an acute coronary syndromeMethods: A quasi-experimental pretest-posttest design was used in the study. A rehabilitation nurse provided an educational program (PEpSCA-CARE) to the intervention group (n = 32), and the control group (n = 35) received the conventional nursing pre-discharge care. The data was collected using the Therapeutic Self-Care Scale (TSCS) in four dimensions: medications, symptoms, activities of daily living and health status management, applied before hospital discharge and one month after hospital discharge to both groups. Patients were recruited from an intensive cardiovascular care unit during 2016.Results: The results showed statistically significant differences between both groups (p < 0.001). The intervention group tended to improve their self-care skills while the control group had opposite trends, self-care skills decreased.Conclusions: According to the findings of the study, a systematized and structured educational program, is effective in developing self-care skills in patients after an acute coronary syndrome.

Lisa Gomes, Gorete Reis

Health Interventions to Support Caregivers of Elderly People


Sensitive Indicators to Rehabilitation Nursing Care in a Rehabilitation Program for People in the Surgical Process, Based on the Health Quality Model

Continued improvement in care is one of the primary objectives of Rehabilitation Nursing. With the current medical-surgical evolution, the Rehabilitation Nurse faces new challenges related to the recovery, enhancement and maintenance of the functionality and capacity of the person in the surgical process. The identification of the indicators that are sensitive to the care of Rehabilitation Nursing, presents in the intervention plans carried out, allow us to measure the quality of the care provided and guarantee the excellence of the care performed. Objective: To identify sensible indicators for Rehabilitation Nursing care, presents in the Rehabilitation programs executed to the person in the surgical process, based on the health quality model. Methods: A systematic review of the literature was carried out through the EBSCO host (MEDLINE with Full Text, CINAHL Plus with Full Text and MedicLatina), using the PI [C] O method. Results: 49 indicators were identified, with emphasis on: “Percentage of clients to whom rehabilitation plan and/or rehabilitation program has been implemented to maximize functional capabilities”; “Percentage of clients with potential to improve the walking ability” and “Percentage of clients with risk of muscle stiffness who were monitored for the range of joint motion through the goniometer”. Conclusion: The surgical patient, in the various areas of intervention (vascular, neurosurgical, orthopedic), presents health gains with the implementation of Rehabilitation programs, with 49 indicators that are sensitive to Rehabilitation Nursing care in the programs executed.

Vânia Nascimento, César Fonseca, Maria Céu Marques, Abílio Costa

Violence Against the Elderly: Social Representations of Portuguese and Brazilian Caregivers

The increase in life expectancy and elderly people in society, coupled with changes in family structure, have highlighted the importance of formal and informal caregivers of elderly people. Objective: To analyse the social representations of violence against the elderly, of two groups of formal and informal caregivers. Methods: Exploratory, quantitative and qualitative research, supported by the theoretical-methodological reference of the Social Representations Theory and in the context of this, the Central Core Theory. The sample was participated in by 81 formal caregivers from the project “Aging in Safety in the Alentejo - Understanding to Act, of the University of Évora” and 20 informal caregivers from the project “Qualification of caregivers and aspects related to the quality of life of the elderly people dependent on primary and tertiary care: Implementation and protocol evaluation, of the State University of Southwest of Bahia”. We used the Free Word Association Technique. The data was analysed by prototypical analysis based on two matrices by the software IRAMUTEQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) 0.7 alpha 2. Results: In Portugal, the elements “bad, mistreatment, I will be, sad, anger, patience, physical, injustice, irritation and meanness” stood out in the central core. In Brazil the mention of “hitting” was emphasized. Conclusions: In both Portugal and Brazil, physical violence takes on particular significance in the social representations of caregivers, rather than verbal and psychological violence, which is not present in the central core of social representations of violence against the elderly in either of the countries.

Felismina Mendes, Tatiana Mestre, Elaine Santana, Luciana Reis, Manuel Lopes

From No Man’s Land to Places. The Lived Territory in Nursing Homes

In an ideal situation, the elderly live in their natural environment, such as their own home or that of their relatives and is free to decide on the various aspects of their daily life in a safe environment. The decline or loss of the independence level, autonomy, social support, adverse economic conditions, loss of the dominant role within the family and loneliness are some of the causal factors that may modify this ideal situation. If action on these causal factors is insufficient or not possible, admission to a nursing home may occur as a temporary or permanent solution. After the establishment of the exchange situation, the elderly start a path of acceptance of the circumstances of living as a user of a nursing home, which becomes their home. This article intends to present some of the results obtained during a Grounded Theory research on the Promotion and Preservation of Dignity in the context of care in nursing homes, carried out in the context of the PhD in Nursing of the University of Lisbon.From the initial analysis of the data, it was noticed that residentes will try to maintain a daily life close to the one before admission, molding it to existing rules and standards, establishing a relation of use with time and space, in which relationship emerge the appropriation of social experiences and build daily life. Territoriality will allow the elderly to reinvent themselves and preserve themselves simultaneously.

Ângela Simões, Paula Sapeta

Biological and Socio-Demographic Predictors of Elderly Quality of Life Living in the Community in Baixo-Alentejo, Portugal

Objectives: To identify the biological and socio-demographic factors considered as predictors of the Quality of Life of elderly people residing in an aged and predominantly rural community in Portugal, namely the Baixo-Alentejo.Methods: Cross-sectional and descriptive study, with a random sample of 351 elderly residing in the community, stratified by gender and age group, with data collection performed by health professionals in people’s homes, using the WHOQOL-BREF instrument. In addition to a brief description of the general characteristics of the sample, a linear regression model by blocks was performed, in order to investigate about the biological and sociodemographic factors considered as predictors of Quality of life.Results: Highest percentage of women in the sample. Decreased Quality of Life in all domains as well as in the General Health Facet as age progresses. Higher average Quality of Life score obtained for the Social Relationships domain and smaller to the Physical Health one. Higher Quality of Life scores obtained for males compared to females. Education considered as one of the most significant predictors of Quality of Life, whose score increases with higher education levels.Discussion: Regarding the biological factors, age appears to be a significant predictor in the Physical Health and Environment domains, while the gender seems to be a significant predictor in the Physical Health and Psychological ones. In respect to the sociodemographic factors, the marital status appeared to be a significant predictor in Psychological and Social Relationships domains, but education was the only factor identified as a statistically significant predictor in all domains of Quality of Life.

Margarida Goes, Manuel José Lopes, Henrique Oliveira, César Fonseca, David Mendes

The Relationship Between Burnout and the Risk of Violence Against Institutionalised Elderly People: The Case of Formal Care

The work overload of the formal caregiver of the elderly is frequent and can cause health problems, both psychological and physical. One is Burnout, a phenomenon which is already considered a public health problem, which mainly affects caregivers (both formal and informal) [1]. This study aimed to analyse how the Burnout of caregivers of the elderly may be related to the risk of violence against institutionalised elderly people. 82 formal caregivers participated, from institutions that receive elderly people, temporarily or permanently, and that collaborated with the project Aging in Safety in the Alentejo - Understanding to Act, of the University of Évora. The Copenhagen Burnout Inventory (CBI) and the Caregiver Abuse Screen (CASE) were applied, and a quantitative approach was applied using IBM-SPSS software (version 24). The results indicate that caregivers have low levels of Burnout and that there is a low risk of violence against the elderly. However, significant correlations were found between these two dimensions. There is a need for intervention in this professional group, focusing on the promotion of workers’ health in the prevention of, and combat against, Burnout Syndrome, with the adoption of coping strategies. This could reduce the effects of prolonged stress levels experienced by formal caregivers of the elderly, in order to then reduce the possibility of acts of violence against the elderly.

Felismina Mendes, Joana Alegria Pereira

Intervention Proposal of the Rehabilitation Nursing Care to the People in the ICU: Systematic Review of the Literature

The increase of the average life expectancy led to an increase in acute diseases requiring hospitalization in the ICU.Goal: Identify the cares in rehabilitation nursing in the ICU to people under IMV and/or in prolonged rest in bed. Methodology: Articles were selected between January 2010 and September 2018, and the research was carried out in the databases present at EBSCO. Six articles were selected that met the inclusion criteria, and the inclusion grid of JBI, FAME was also applied. Two further studies were included that did not fit the temporal limit, but which were included by their pertinence, obtaining a total of eight articles.Interventions: The interventions that the rehabilitation nurse plans and executes can be divided into two categories that complement each other, the interventions of the physical domain and the cognitive domain.Results/Discussion: Early rehabilitation in the ICU is a fundamental tool in maintaining autonomy, as many people acquire complications during hospitalization. To reverse these complications requires the intervention of a multidisciplinary team, where the Rehabilitation Nurse develops a prominent role in the articulation of the team and in the realization of a structured plan involving the person, their relatives and the rest of the care team.Conclusion: The studies presented in this review are unanimous about the achievement of early rehabilitation for people hospitalized in the ICU, and these programs have the potential to bring significant gains to people, both physically and cognitively.

Marco Jacinto, Tânia Leite, César Fonseca

Public Health Initiatives


An Approach to Help Identifying Optimized Service Areas of Integrated Continuous Care Teams (ECCI): A Case Study in Alentejo - Portugal

Objectives: To find how many elderly persons with 65 years and older are within a service area of each Integrated Continuous Care Team (Equipa de Cuidados Continuados Integrados - ECCI), with each area computed around the geographic location of each ECCI headquarters and encompassing all accessible streets that can be reached within a certain travel time spent on driving a vehicle.Methods: A Geographic Information Systems (GIS) was developed, based on the geographical location of the elderly persons residing in the Alentejo region of Portugal (the study area), whose data was derived from the last National population census. Then, a network dataset model was also added to the GIS system, corresponding to a model of the real street network of the study area. After that, the GIS Service Area Solver was applied to determine all the ECCI service areas (one service area per each ECCI). Finally, the aim was to identify the several residing areas that overlap each ECCI service are, in order to compute the total number of elderlies residing within each ECCI service area.Results: The number of elderly residents covered by ECCI teams for two ARS sub-regions increased, notably from 36725 to 40841 in relation to the ARS Alentejo Central, as well as from 19264 to 31429 in relation to the ARS Baixo Alentejo, when considering the ECCI service areas instead of the geographic division based on the Municipalities.Discussion: The increase in elderly resident population that can be covered by ECCI teams in ARS Alentejo, based on the calculation of GIS services areas, was set in 14.6%.

Henrique Oliveira, Manuel José Lopes, César Fonseca, Margarida Goes, David Mendes, José Caeiro

The Effect of Religious Identity on Optimism Across the Lifespan

Background: It is acknowledged that religious traditions prescribe not only a framework of values but also a set of guidelines for personal life. Furthermore, people often report that their system of values endorses or are influenced by their religious trends. Objective: Given the changes in religious identity resulting from secularization and the growth of religious minorities in Portugal, this paper investigates the effect of Portuguese religious identity (minority versus majority) in the relationship between religiosity and optimism across the lifespan, given the mediation by individual’s life satisfaction.Method: We conducted an empirical study, based on a self-report questionnaire to 329 members of religious minorities in Portugal and 408 Portuguese Catholics (major religion in Portugal).Results: We found a positive correlation between religiousness and optimism in both majority and minority religious groups. However, the mediation effect of life satisfaction was only significant among Portuguese religious majority; in Portuguese religious minorities religiosity had a direct effect on optimism. A correspondence factor analysis showed mainly that participants with high levels of religiosity and optimism have a minority religious identity and high life satisfaction.Conclusions: The establishment of a self-regulating system is discussed as are beliefs and religious practices as perpetuators. Confrontation with personal frailty, powerlessness and fear were discussed as predetermining factors to disembedding, as described by Giddens (1991, 1997), and factors that facilitates the engagement in a religious system, while reembedding occurs with the individual regaining self-control, as a outcome of divine factors prone to optimism.

Lisete dos Santos Mendes Mónico, Valentim António Rodrigues Alferes


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