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About this book

This book constitutes the thoroughly refereed post-conference proceedings of the Second International Workshop on Gerotechnology, IWoG 2019, held in Cáceres, Spain, in September 2019.
The 24 revised full papers along with 11 short papers presented were carefully reviewed and selected from 77 submissions. The papers are organized in topical sections on smart technologies and algorithms for health; technologies to increase the quality of life of the elderly population;Internet of Things (IoT); solutions for active aging, social integration and self-care; monitoring and management of chronic and non-chronic diseases; health interventions to support caregivers of elderly people; public and other health initiatives.

Table of Contents


Smart Technologies and Algorithms for Health


YourPantry: Food Monitoring Through Pantry Analysis Using the Smartphone and Making Use Machine Learning and Deep Learning Techniques

Food is one of the fundamental pillars of our lives, and that of the elderly as well. In many cases, elderly people do not follow a balanced diet according to their vital needs. Nowadays, there are technological solutions that help in the daily activities of the elderly and indicate which foods they should eat. But all of these solutions require attention and manual registration. Therefore, we propose an application for smartphones that assists in feeding the elderly through the realization of a photograph of their pantry. This application uses Artificial Intelligence techniques such as Machine Learning and Deep Learning.

Enrique Moguel, José García-Alonso, Sergio Laso

Use of Innovative Technologies in Group-Based Reminiscence Interventions in Older Adults’ with Dementia: A Scoping Review

Background: 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.

Isabel Gil, Paulo Santos-Costa, Elzbieta Bobrowicz-Campos, Eduardo Santos, Rosa Carla Silva, Liliana B. Sousa, Maria de Lurdes Almeida, João Apóstolo

Innovative Devices for Bedridden Older Adults Upper and Lower Limb Rehabilitation: Key Characteristics and Features

Older adults are often bedridden as a consequence of acute disease that leads to hospitalization. Immobilization in a bed for a long period can affect negatively the function of many body systems, especially when talking about skeletal muscle. Lower limbs are strongly affected which will difficult the achievement of independence and will slow down the discharge moment. This study aims to identify the current patents of medical devices that allow for physical rehabilitation of bedridden patients, particularly of upper and lower limbs. Also, the scope of this patent review is to describe the key characteristics and features of the identified devices. A patent review was conducted between May 2019 and July 2019, identifying 39 devices for physical rehabilitation of bedridden patients. The majority of the devices are designed for lower or lower/upper limbs rehabilitation, which allows for early prevention or even reversion of main immobilization complications like physical disability. Modularity, flexibility, and automation are important features of the developed mechatronic solutions and seem to be able to enrich and promote a more efficient rehabilitation program in hospitals and nursing homes.

Rafael A. Bernardes, Paulo Santos-Costa, Liliana B. Sousa, João Graveto, Anabela Salgueiro-Oliveira, Beatriz Serambeque, Inês Marques, Arménio Cruz, Pedro Parreira

FoodScan: Food Monitoring Through Purchase Tickets Analysis Using the Smartphone

Using applications in Smartphones and other smart devices that improve or help people’s lives and nutrition is getting more and more common. And this also happens in the elderly. There are several applications in the market related to the control of people nutrition in order to lose weight, follow a certain diet, etc. However, these applications may be very tedious as users have to introduce by hand all the aliments they have consumed along the day. This paper proposes an mobile App oriented to elderly in order to control their nutrition, scanning the items that exist on the purchase ticket, making use their smartphone. This solution can make recommendations in what users should eat based on a recommended diet.

Enrique Moguel, José García-Alonso

Internet Use Among Informal Caregivers of People with Dementia: Results of an Online Survey

Informal caregivers (IC) of people with dementia (PWD) possess a greater risk of developing physical and psychological health problems. The internet was considered a promising modality to provide resources aimed at minimizing negative outcomes from caregiving. This descriptive study aims to determine the prevalence of internet use for health and caregiving-related purposes by former and current IC of PWD; and to explore caregiver and care receiver-related factors that might facilitate such use. Cross-sectional primary data was collected through a web-based survey (N = 97). The frequency of internet use for health and caregiving-related purposes varied greatly across specific purposes. Internet was more frequently used to gather information on the disorders and care provision strategies; while it was used less often to get emotional support and learn how to manage negative effects of caregiving. Regardless of the specific purpose, a frequent internet use was never observed in more than 50% of the sample. A more frequent use of internet for health and caregiving-related purposes was reported by IC classifying the care receivers’ degree of dependence as ‘total’ or ‘severe’; or assessing their own physical health as ‘much worse’ or ‘worse’ when compared to their counterparts. IC evaluating their own psychological health as ‘worse’ or ‘much worse’ when compared to their counterparts reported a more frequent use of internet resources to learn about the disease or to provide good care, but a less frequent use to get emotional support. These findings can be used to make decisions on resource distribution to IC of PWD.

Soraia Teles, Constança Paúl, Ana Margarida Ferreira

Technologies to Increase the Quality of Life of the Elderly Population


Digital Avatars for Older People’s Care

The continuous increase in life expectancy poses a challenge for health systems in modern societies, especially with respect to older people living in rural low-populated areas, both in terms of isolation and difficulty to access and communicate with health services. In this paper, we address these issues by applying the Digital Avatars framework to Gerontechnology. Building on our previous work on mobile and social computing, in particular the People as a Service model, Digital Avatars make intensive use of the capabilities of current smartphones to collect information about their owners, and applies techniques of Complex Event Processing extended with uncertainty for inferring the habits and preferences of the user of the phone and building with them a virtual profile. These virtual profiles allow to monitor the well-being and quality of life of older adults, reminding pharmacological treatments and home health testings, and raising alerts when an anomalous situation is detected.

Manuel F. Bertoa, Nathalie Moreno, Alejandro Perez-Vereda, David Bandera, José M. Álvarez-Palomo, Carlos Canal

Socially Assistive Robots in the Aging Population: End Users’ Involvement on Their Development Process

There is an urgent need for efficient solutions that can promote healthy aging, with quality of life and well-being. Technological solutions might be strong allies in the promotion of active aging, to allow for the older adult to adapt and fulfill daily living activities at home. When applying technology to healthcare, particularly in the older population, socially assistive robots are found to be an important emerging research topic, being promising in preventing diseases related to aging and frailty, contributing to healthy aging. Human-centered design appears as a methodology to involve the user in the development process. Unfortunately, in the revision we made, only in few robots’ development, the authors reported the involvement of end users in the process.

Liliana B. Sousa, Paulo Santos Costa, Rafael A. Bernardes, Inês Marques, Beatriz Serambeque, João Apóstolo, Pedro Parreira

Sensors as a Technological Solution for a Successful Ageing

There is a growing need to implement and evaluate technological solutions that allow early detection of age-related adverse outcomes, like frailty, and enable assessment of lifestyle habits that can be maintained or improved to prevent such adverse outcomes. In this study, the sample is composed by older adults aged 65–80 years, recruited from the community, and who agreed to use an electronic device ACM Kronowise® 2.0. This electronic device allows a proactive and continuous monitoring of circadian health, physical activity, and sleep and eating habits. The participants used the ACM Kronowise® 2.0 during a period from seven to ten days. In the end, the participants were invited to share their experience and satisfaction with the device’s use and functionality and to express their awareness of healthy habits and usefulness of technologies in health. Data obtained can be used as a set of guidelines in the selection of suitable technological equipment for older adults. Understanding seniors’ perceptions about the use of technology are crucial to optimize design and application and improve educational strategies that may reduce caregiver burden. In our view, the implications of this study’ findings for clinical practice include the possibility to develop and validate tools to improve older’ people lifestyle and timely prevention of frailty progress.

Luísa Teixeira-Santos, Elzbieta Bobrowicz-Campos, Vitor Parola, Adriana Coelho, Isabel Gil, Maria de Lurdes Almeida, Teresa Moreno-Casbas, João Apóstolo

Person in Need of Airway Cleaning and Use of Mechanical Insufflator-Exsufflator Device

Gains from Rehabilitation Nursing Intervention for People in Intensive Care

Airway clearance in patients under Invasive Mechanical Ventilation (IMV) or noninvasive mechanical ventilation (NIMV) is a key intervention that should be performed regularly, not only to prevent secretion accumulation, but also to prevent adverse effects that may result from this accumulation of secretions. One of the most relevant interventions in this type of patient is the use of the Mechanical Insufflator-Exsufflator device (MI-E), commonly known as Cough Assist®. On the other hand, Respiratory Functional Rehabilitation (RFR) involves a set of non-invasive procedures that ensure the release of secretions, namely the fluidization of secretions and the use of techniques that allow their mobilization, properly combined with directed and assisted cough teachings. The effectiveness of RFR associated with the use of MI-E yields gains from this conjugation, especially when the person does not collaborate, has decreased muscle strength, or cannot effectively cough. The study conducted in an Intensive Care Unit (ICU) in Portugal shows significant gains in the association of an RFR program with MI-E, with evident improvements in the level of dyspnea, which can be quantified with the implementation of the Modified Borg. At the beginning of the implementation of the RFR program the patients had mild to moderate level of dyspnea and at the end the patients did not have dyspnea. This study made clear the gains that exist for the ICU or NIMV intensive care admission person using MI-E in combination with airway cleaning techniques, in terms of ventilatory performance, airway permeability and decreased complications.

Ana Daniela Costa, Rogério Ferreira, Raquel Amorim, João Vitor Vieira, César Fonseca

Peripheral Venipuncture in Elderly Patients: Is Near-Infrared Light Technology an Option to Avoid Vein Depletion?

Background: Peripheral venipuncture is the minimal invasive procedure most commonly performed in acute settings. However, several publications report that health professionals perform multiple puncture attempts until a successful catheterization or blood draw is achieved. Among the patients most affected by this reality are the elderly patients, who often display a number of factors that increase difficulty. In recent years, several recent technological aids, such as the Near-Infrared Light, have emerged in the medical devices market as potential facilitators of vein selection and puncture. However, while Near-Infrared Light devices are widely studied in pediatric settings, there are no known reviews of its use and applicability with elderly patients. Methods: A scoping review of the literature was conducted following the Joanna Briggs Institute method. Study relevance, data extraction, and synthesis were performed by two independent reviewers. Results: Three studies were included in this review. The use of NIR technology may improve the number of peripheral veins located in elderly patients, as well as reduce hematoma development and patient anxiety before, during and after the procedure. Moreover, one study briefly explored health professionals’ usability and technology acceptance related outcomes. Conclusions: While peripheral venipuncture of elderly patients assisted by NIR devices is still an understudied area, the studies found indicated results favorable to its clinical application. However, such results should be carefully analyzed, since potential bias and lack of larger study samples may prevent the generalization of the results.

Paulo Santos-Costa, Liliana B. Sousa, Beatriz Serambeque, Rafael Bernardes, Pedro Parreira, Anabela Salgueiro-Oliveira, Margarida Vieira, João Graveto

Internet of Things (IoT)


Allowing IoT Devices Collaboration to Help Elderly in Their Daily Lives

Elderly people have the stereotype of being bad to technology, but they are one of the groups that can benefit the most from recent technological advances. The Internet of Things (IoT) is one of the new technologies that aims to facilitate people’s lives, automating tasks or allowing them to be carried out more easily. IoT smart devices provide an increasing number of ways for elderly people to stay active, independent and secure. In addition, the collaboration among smart devices increases the possibilities that the IoT offers, achieving that it can be more exploited. Unfortunately, this collaboration is not easy considering the different types of devices that exist in the market and the absence of communication standards. To mitigate this problem, solutions based on semantic web have shown promise, facilitating interoperability among different devices through the representation and the relationship of their information. In this paper, we propose a system that improves the interoperability among smart devices in the application domains of healthcare and smarthome by using semantic web and ontologies. This solution allows a proactive collaboration among smart devices that elderly people have around them regardless of the technology used, in order to increase their quality of life through more effective and efficient monitoring, and promoting actions associated with their needs.

Daniel Flores-Martin, Sergio Laso, Javier Berrocal, Carlos Canal, Juan M. Murillo

Technology for Anthropological Research. Feedelio: An Application for Food and Nutrition Studies

Food has a social and cultural sense that surpasses dietary rationality and visions focused exclusively on caloric values. Anthropology has developed an entire field of study focused on analyzing all that underlies the forms of eating and food in different cultures and societies. This space has not escaped, in recent years, the use of technology to facilitate the work of anthropological fieldwork. The aim of this text is to set the context and lines of development in which we have designed an application in order to provide fundamental support when making ethnographies of food. It is an application for smartphone developed on the Android platform and optimized to work in versions equal or superior to API 22, with a compatibility with 80.2% of Android devices. It compiles different tools, such as the recording of interviews or the collection of surveys 24 h Menu Recall, which try to facilitate the collection and organization of materials in the field. The application can be adapted to different scenarios and research contexts.

Borja Rivero Jiménez, Manuel Jesús-Azabal, David Conde Caballero, Muñoz González Beatriz, Lorenzo Mariano Juárez

Providing Support to IoT Devices Deployed in Disconnected Rural Environment

The increase in the end and near-to-the-end devices capabilities has led to the development of paradigms such as the Internet of Things, Fog Computing and Edge Computing. These devices require an internet connection for sending the sensed or processed data, and for getting specific requests. Many of these devices are intended to make people’s live easier and they can also be used to better monitor people’s health. One of the problems of these devices is that they require internet connection and in most rural areas there is a poor internet infrastructure, making their use almost unfeasible. This paper presents a tool for generating applications with a mobile-centric architectural style that takes advantage of the capabilities of the end devices for processing and storing the sensed data. This style allows devices to process the information requests asynchronously, reducing the Internet requirements and allowing the use of these technologies in areas where the Internet connection is poor and intermittent.

Sergio Laso, Daniel Flores-Martín, Juan Luis Herrera, Carlos Canal, Juan Manuel Murillo, Javier Berrocal

Remembranza Pills: Using Alexa to Remind the Daily Medicine Doses to Elderly

European countries are facing a population widespread ageing. The percentage of third age inhabitants is becoming higher, specially in rural areas, where older adults demand special services in order to improve their life, notably when they live alone. This way, some tasks like medicine management can be a very hard day-to-day challenge. In this paper, Remembranza Pills is introduced. This is a platform that supports elderly at daily medicine takes using Alexa. The system reminds users the medicines and pills that have to be taken in each moment of the day using a web platform to manage the prescriptions. In this manner, medical staff and relatives can keep control over consumed doses.

Manuel Jesús-Azabal, José Agustín Medina-Rodríguez, Javier Durán-García, Daniel García-Pérez

Solutions for Active Aging, Social Integration and Self-care


Theoretical Contributions from Orem to Self-care in Rehabilitation Nursing

Self-care allows one to maintain the health and well-being of the person and may be compromised. Approaches to Orem’s theory and rehabilitation specialist nurse competencies allow the development of intervention plans to minimize the person’s dependence on self-care. Objective: To identify Orem’s theoretical contributions to self-care and their relevance to Rehabilitation Nurse practice. Methods: Integrative literature review through search engines (EBSCO, RCAAP and Google Scholar), using the descriptors self-care, nursing, and Orem, assisting us from the Boolean operator “AND”. Results: Nine articles were selected, the results of which we grouped into two studies of a theoretical nature and three groups according to Orem’s theory (fully compensatory systems, partially compensatory systems and educational support systems). Conclusions: Praying to privilege your approach to self-care, can differentiate their performance, with visible gains in the health of the person.

Susana Fernandes, Anabela Silva, Liliana Barbas, Rogério Ferreira, César Fonseca, Manuel Agostinho Fernandes

Physical Activity for Elderly People After an Acute Myocardial Infarction

Acute Myocardial Infarction (AMI) emerges, within cardiovascular diseases, as the leading cause of death and disability in Portugal and in the world with higher prevalence in the elderly population, thus emerging as a central axis in intervention strategies of health professionals. Population aging is accompanied by progressive changes that, in addition to increasing susceptibility to the development of cardiovascular diseases (CVDs), also have an impact on functional capacity, autonomy and independence versus dependence. It is essential that interventions with significant gains in nursing are developed that actively seek to intervene with an elderly individual after an AMI. The aim of this study was to identify health gains resulting from the intervention of nursing care in the practice of physical activity in the elderly person after an AMI. To this end, a systematic literature review was carried out using articles on the subject under analysis, published retrospectively until 2014. The results show gains from the practice of physical activity that are framed with the descriptive statements of the regulation of nursing care quality standards. Thus, physical exercise emerges as a form of treatment that should be implemented with multiple benefits in terms of decreasing morbidity and mortality rates, controlling cardiovascular risk factors, promoting healthy lifestyles, increasing functional capacity, improved prognosis and decreased limitations.

Adriana Catarina Lopes, Rogério Ferreira, João Vítor Vieira, Maria Margarida Goes

Flourishing and Satisfaction with Life in Older People Practicing Yoga

We live in a time when the increase in life expectancy is reality. In many cases, life expectancy can exceed 100 years. Therefore, there is a real concern that the elderly have the right to enjoy well-being and quality of life. The present study is part of the field of psychogerontology and positive psychology, whose main objective is to understand well-being (happiness) and increase the amount of human flourishing (positive emotions, engagement, positive relationships, meaning and achievement, as determinants for achieving happiness). It would be ideal if the elderly could find happiness and full bloom in their lives. This is an exploratory, cross-sectional study of quantitative and qualitative methodology, focused on four dimensions: flourishing, satisfaction with life, perception of flourishing and implications of the practice of yoga for the welfare of the elderly. We count on the participation of twelve elderly, regular yoga practitioners, divided into two groups, from Spain and Portugal.Evidence has shown that yoga practitioners are people who are characterized by a high level of flourishing and satisfaction with life, however, exhibit some fragility in optimistic disposition. Based on the results obtained, an intervention project “Senior Flourishing & Yoga” was designed, whose main objective is to improve the well-being, the successful ageing and the health skills of the elderly population through yoga.

Sandra Lozano, Maria Cristina Faria

An Opportunistic Routing Solution to Monitor Isolated Elderly People in Rural Areas

Countries are experiencing a global population ageing. It is estimated that the percentage of third age people will notably increase in next decades, implying a difficult challenge to society. Rural areas are the most affected locations by these conditions. Currently, small villages are facing an increasing ageing of population where almost 40% of inhabitants are over 65. Medical needs are one of the most relevant aspects in this context. This factor, in conjunction with other reasons such as loneliness, motivates technological solutions. Despite this, Internet is not accessible from rural and low income areas, due to the lack of interest from the operator side to invest in these locations. In this paper, an opportunistic routing solution based on BLE is proposed, with the aim of monitoring loneliness population in order to detect potential emergencies.

Manuel Jesús-Azabal, Javier Berrocal, José García-Alonso, Vasco N. G. J. Soares, Jaime Galán-Jiménez

Earnings from Rehabilitation Nursing Care in People in Intensive Care with Respiratory Disorders Based on a Self-care Model

Background: The increase in the average life expectancy has increased the need for intensive care. In these units people remain under ventilatory support, remaining in bed for long periods. It is up to the rehabilitation nurse to intervene, reducing dependency and promoting self-care, conditioning a better quality of life. Objective: To identify the gains obtained through the intervention of the rehabilitation nurse. Methodology: Exploratory descriptive study following the methodology of Robert Yin’s case study and Manuel Lopes’s theory of medium range, using the ENCS scale and the Barthel Index as data collection instruments. Results/Discussion: It can be seen from the data analysis that the interventions of the rehabilitation nurse contributed to a functional improvement of the person, reducing dependence on self-care. Conclusion: All persons included in the professional intervention strategy improved functionally.

Marco Jacinto, César Fonseca, Manuel Lopes, José Garcia-Alonso, Felismina Mendes, Juan M. Murillo

Monitoring and Management of Chronic and Non-chronic Diseases


A Script for Nursing Intervention on Elderly People with Chronic Pain by Telephone Consultation

Chronic pain is a true problem for, at least, 50% of the elderly people. However, chronic pain in the elderly people is an undertreated and medically devalued situation, since only 20% of those persons take analgesic therapy. Guidelines for nursing intervention on elderly people with chronic pain in medical consultation made by phone have been also omitted from the literature, namely, guidelines supported on a partnership model with the elderly people and family where the Foucault’s concept of Care of the Self is considered. A script for a systematic nursing intervention based on a partnership model that emphasizes the Care of the Self and help the elderly people continuing its project of live was developed and used in the Multidisciplinary Pain Center of a Portuguese’s Hospital. The information collected contributed to a better understanding of the difficulties that the elderly people have to manage therapeutic plans, namely the complex ones, and improved the adherence to analgesic therapy, minimizing the chronic pain and the functionality of elderly people.

Idalina Gomes, Madalena Mela, Dulce Guerreiro, Maria P. Lopes, Beatriz Gomes

A Microservice Architecture for Access Control Based on Long-Distance Facial Recognition

With each new year, the world’s population is more aged and the birth rate decreases. That is why, in a not distant future, we will encounter the challenge that there will be many elderly people in our population and few young people to care for them. To help facilitate this task, the use of new technologies is increasing. Therefore, this paper proposes the use of a not intrusive system that, using a microservice architecture and long-distance, non-intrusive facial recognition, allows to control elderly assistance to their daily tasks in residences, facilitating the work of nurses. For example, to check that all the elderly regularly go to the dining room at meal times or to the gym if they should do some type of rehabilitation exercises. For this, the system uses security cameras that are installed in the access of the different zones to be controlled.

Javier Rojo, Juan Luis Herrera, Enrique Moguel, Juan Hernández

Psychomotricity in Elderly People with Hearing Impairment

During life, there are several stages where one of the endings is aging. This aging causes several changes in the motor, physical and cognitive levels. There are several types of aging, such as primary, secondary and tertiary.During adulthood, there is a gradual hearing loss that intensifies around the age of 50 (presbycusis). These hearing impairments increase with age and can affect 31.6% of elderly people between 65 and 74 years and 62.1% with 85 years or more (data taken from the American population).Objective: Identify the consequences that these hearing impairments have on the lives of elderly people and the role of psychomotricity and how it can minimize the impact of these impairments on their daily lives.Methods: A systematic review of the literature was carried out through the EBSCO host (MEDLINE with Full Text and MedicLatina).Results: Several consequences were found, with emphasis on: “Effects of hearing aids on cognitive functions and depressive signs in elderly people”, “Falls in older people: epidemiology, risk, factors and strategies for prevention” and “Application of a computer-based neurocognitive assessment battery in the elderly with and without hearing loss”.Conclusion: Psychomotricity, can then, intervene with these people on an emotional level and even on the level of gait and balance. Therefore, it is an added value for these elderly people to benefit from a psychomotor intervention.

Ana Caldeira, Carolina Barroso, Joana Carapinha, Laura Nogueira, Mariana Gameiro, Soraia Matias, César João Vicente da Fonseca

Early Weaning of People Undergoing Invasive Mechanical Ventilation: The Impact of Rehabilitation Nursing Interventions

Objective: to identify the impact of rehabilitation nursing interventions on early weaning of people undergoing invasive mechanical ventilation. Method: a descriptive and cross-sectional pilot study applied to persons undergoing invasive mechanical ventilation in an accidental sample of five people. Modified Borg Scale, Glasgow Coma Scale and Pain Scale were used. Results: through the interventions included in the early rehabilitation program, there was an improvement in the dyspnea index, with a direct relation to the success rate in weaning the person undergoing invasive mechanical ventilation. Conclusion: the patients included in this study underwent an effective ventilatory weaning process and the extubation procedure was successfully performed, being transferred from the Intensive Care Unit to their destination inpatient services, no need for mechanical ventilatory support. The most significant gains in respiratory function were the gains in symptomatic pain control and level of consciousness.

Raquel Amorim, Rogério Ferreira, Ana Daniela Costa, João Vitor Vieira, César Fonseca

Health Interventions to Support Caregivers of Elderly People


Towards an Automated Management of Well-Being Goals in Nursing Homes

Nursing home culture change movement advocates for care that is less hospital-like, and more patient-centered. Despite being a step towards the good direction in providing a proper service for elderly people, considering their well-being is not easy due to a number of factors as: specific treatments with a high price; the number of involved stakeholders (e.g. patient, doctors, relatives, nursing home clerks, funding organisations, etc); or the difficulties to gather an accurate measure for the patients well-being. In current position paper we devise some potential challenges that arise in this context and we provide our insights on potential techniques to solve them by means of a framework to automate the management of well-being goals in nursing homes.

Carlos Müller, Pablo Fernández, Antonio Ruiz-Cortés, Fabio Casati

Study of Accessibility to the Home of Dependent Elderly People in Rural Areas

Increasing numbers of dependent people are estimated in rural areas due to increased life expectancy. Most of the population residing in rural areas is elderly, which is why many of them are in a situation of dependency. The objective of this study was to analyse accessibility and barriers present in the home and environment of 30 users of the dependency system living in rural areas of an area with high geographic dispersion. For the study, home visits were conducted, and the data were obtained through interviews and observations. Information was gathered regarding the sociodemographic and clinical variables of the users, as well as the present barriers and the use of support products, assistive technologies and sensors, either in the home environment and/or in monitoring systems of body movements. The average age (standard deviation) of the sample was 85 years (±6.7). The majority of users (n = 17, 56.7%) had degree II or III dependency. A total of 56.7% of the users used call-for-help telecare devices without knowledge of other types of systems. All users presented comorbidity. The use of support products and the presence of barriers were frequent.

Virginia Iglesias Moreno, Pablo Sánchez-García, Cristina Franco-Antonio, Esperanza Santano-Mogena, Yolanda Castaño-Blanco, Sergio Cordovilla-Guardia

Structured Proposal for Rehabilitation Nursing (RN) Care Intervention: Sensitive Gains to RN Care for the Person with Self-care Deficit and in the Surgical Process

Surgical needs have been growing in Portugal due to the aging population, the increasing number of people with acute and chronic disease with consequent acquisition of deficiencies and restrictions, being verified dependence on self-care of the people in surgical process. The purpose of rehabilitation nursing intervention is to enable the person to perform his/her self-care and demonstrate the sensitive results to rehabilitation nursing care, allowing the quality of care provided to be proven. Objective. To evaluate the functionality of the person in the surgical process and the gains gained in the rehabilitation nursing care verified after the implementation of a structured proposal of intervention of nursing care of Rehabilitation. Methodology. The study is descriptive and exploratory, using the qualitative methodology of Robert Yin (multiple case studies), Lopes’ medium-range theory and the self-care model of Fonseca and Lopes, based on the nursing theory of the self-care of Orem. Results. There was a significant increase in the functionality of the person and the sensitive results to rehabilitation nursing care. Conclusion. The intervention of Rehabilitation Nursing through the application of a structured intervention plan, with the objective of enabling the person and caregiver to achieve maximum functionality and independence, translate into positive sensitive results to nursing care.

Vânia Nascimento, César Fonseca, Rogério Ferreira, Manuel Lopes, Enrique Moguel

Benefits of Nursing Interventions in Preventing Complications in the Elderly with Alterations in Swallowing After Stroke

Introduction: Stroke, the most common cerebrovascular disease in the elderly population, is the leading cause of death in Portugal. Changes in swallowing, one of the most common sequelae of this neurological event, have a negative impact on the person’s prognosis, contributing to high morbidity and mortality rates, due to the risk of dehydration, malnutrition and aspiration pneumonia. Nurses, the health professionals who participate more actively in feeding and patient supervision, may play a key role in the early detection of swallowing changes in this population. Objective: To identify the benefits of nursing interventions in the prevention of complications in the elderly with changes in swallowing after stroke. Method: Systematic review that led to the search in the EBSCOHost search engine, in the databases CINAHL Complete and MEDLINE Complete, to identify studies published between 2015 and 2019, using the descriptors “stroke”, “intervention”, “nurse” “ and “deglutition disorders “. After implementing the inclusion and exclusion criteria and evaluating the methodological quality of the results obtained, three studies were selected. The levels of evidence were assured by the levels of evidence proposed by Melnyk and Fineout-Overholt. Results: Nursing interventions for the elderly with changes in swallowing after stroke can contribute to improvements in the prevention of complications, well-being and self-care, health promotion and continuity of care. Conclusion: The benefits of nursing interventions to the elderly with changes in swallowing after stroke are evident. However, in view of the scarcity of studies on the subject, it is suggested that more quantitative studies be carried out, with more representative samples.

Gertrudes Espada, Rogério Ferreira, João Vítor Vieira, Maria Margarida Goes

Rehabilitation Nursing in the Elderly with Mobility Deficit Due to Fracture of the Femur

The Portuguese population is becoming increasingly aged, so all the changes concerning this process led to an increase of the risk of falling. The reduced mobility after undergoing a surgical process led to the development and implementation of a rehabilitation nursing programme especially directed to the elderly suffering from femur fracture. The specialist nurse’s skills were developed through the implementation and evaluation of a plan of intervention using evaluation instruments depending on the identified focus and diagnosis. The intervention programme had as a result a functional improvement of the elderly people lives concerning mobility, balance, muscular strength and range of movement, allowing them to become more independent on their daily life activities as well. Through a specialized intervention, the rehabilitation nurse helps elderly patients to achieve health gains after having suffered from reduced mobility due to a femur fracture.

Maria João Soares, Rogério Ferreira, Alexandra Alcobia, João Vitor Vieira, César Fonseca

Public and Other Health Initiatives


Technology and Rural Elderly Loneliness. Thinking About Analog Solutions for the Community

Loneliness has been raised in recent years as one of the main problems affecting older people. A 2017 study by the Madrid City Council shows that 6.8% of surveyed population had feelings of loneliness, rising to 14.2% in over 65 population. Most of the approaches that deal with the problem of loneliness do so from biomedical positions. Social sciences can offer approaches towards community oriented solutions. Most approaches do not delve into the structural causes and factors that appear in modern loneliness. In this text we try to point out some ideas of the relationship between loneliness and technology and how in recent years technological solutions appear to alleviate loneliness in elderly people. In rural contexts such as the one in which we are developing the 4IE project (the regions of Extremadura, in Spain, and Alentejo, in Portugal) older people still use analogue technologies, like television. We try to point out the importance and centrality of these technologies in the contexts and how relevant are when developing technological solutions for elderly people loneliness.

Borja Rivero Jiménez, David Conde Caballero, Beatriz Muñoz González, Lorenzo Mariano Juárez

Psychometric Qualities of a Core Set to Ascertain the Functional Profile of Portuguese Elderly Citizens

Objectives: This paper describes the psychometric qualities of a core set composed initially of 31 codes and extracted from International Classification of Functioning, Disability and Health, to ascertain the Functional Profile of Portuguese Elderly Citizens, residing in their own home or at a family or friends’ home. Methods: Cross-sectional, descriptive study, with a final sample totaled 351 elderlies. Data collected by health professionals in the participants’ houses, using the Elderly Nursing Core Set questionnaire. Results: The recommendation of the construct to the EFA was “excellent”. Regarding reliability, the construct revealed factorial reliability. In terms of validity, the construct presented factorial validity and convergent validity, although failing regarding discriminant validity. Discussion: Comparing psychometric qualities between the original Elderly Nursing Core Set previously applied to institutionalized citizens in relation to the one presented in this paper (citizens residing in their own home or at a family or friends’ home), lead to five latent factors and differences between functional profiles. More than half of the citizens are married and almost half of the sample never went to school, thus revealing an important aspect characterizing a lower literacy level of the citizens involved in this research.Conclusions: The work based on Core Sets extracted from the International Classification of Functioning, Disability and Health, delineated to assess the nursing care needs and/or the outcomes of nursing interventions of citizens aged 65 years old or older, will be an ongoing process that will lead to the promotion of an Healthy Ageing and functional ability, as stated by World Health Organization.

Maria Goes, Manuel Lopes, Henrique Oliveira, João Marôco, César Fonseca, Margarida Santos, José Caeiro

Aging and Health Literacy: Site of Proximity to the Community

The Observatory of the Dynamics of Aging in Alentejo of the Polytechnic Institute of Beja, created in 2013, is part of IPBeja’s functioning as an “Open, Solidarity, Participatory and Coherent Community” and an understanding of the relevance of its Social Dimension. In 2019, the “ODEA-IPBeja Website of Proximity to the Community” was created, which is an instrument that has a number of perspectives: (1) A platform that gathers information, studies and research in the area of Aging at a local and global level; (2) Dissemination and sharing of initiatives, activities and projects on aging at local, regional, national and international levels; (3) Mobilization and articulation of the local and regional actors involved in this theme, through the sharing of information and knowledge; (4) A tool that provides the scientific production of IPBeja teachers, dissertations and master’s projects of IPBeja, in particular the Master’s degree in Social and Community Gerontology and Community Development and Entrepreneurship, and the activities and dynamics of Psychogerontology Short Cycle; and (5) Link to the ODEA-IPBeja Website. Close to the Community can be found on the IPBeja page or at . This paper aims to show the functioning and value of the “ODEA-IPBeja Website Project” for the aging literacy, empower older persons and construction of health and well-being in the aging community.

Maria Cristina Faria, Maria Inês Faria, Sandra Lozano

How to Delineate the General Profiles of Functionality of Citizen’s Aged 65 Years and Old as a Function of Its Age

Objectives: A core set of International Classification of Functioning, Disability and Health codes was used, to ascertain the general profile of functionality as a function of biological and sociodemographic characteristics, notably the age of the citizens.Methods: Data were collected by health professionals in the participants’ houses. The factorial validity of the construct was assessed by a confirmatory factor analysis. An ordinal regression model was built to identify the general profile of functionality as a function of age.Results: It is expected that people under the age of 74 years will present no functional problems and that, after age 74, the most likely functionality problem will be a “MILD problem”.Discussion: The functional profile of each elderly is interrelated with his or her sociodemographic context as well as with the overarching biological, cultural, and environmental characteristics of society. A progressive decrease in GPF occurs with age.Conclusions: The evaluation of each person (even those with no perceived or incipient levels of functional impairment who are at risk of progressing to a more severe disability) about what are the factors that are related with this functional decline as people get older, allows identify the respective nursing interventions to be developed.

Maria Goes, Manuel Lopes, Henrique Oliveira, João Marôco, César Fonseca, Margarida Santos, José Caeiro

Representations of Aging in Nursing and Social Work Students

The professionals involved in supporting the aging process of older people play a decisive role in the psychological, social and health support of this age group. It is intended that these actors understand the aging process and know how to act with competence, enabling an adequate response to the needs of older adults. Therefore, it is important to invest in personal training and gerontology early on. This study had as main objective to know the visions of future professionals of social service and nursing on older people in order to identify their representations and perceptions about old age. The study participants were thirteen students (Women = 7; Males = 6), from the 1st to the 4th year, single, aged between 18 and 34 years. Participants have contact with older people aged 80 to 105 years. The sampling was non-probabilistic of the snowball type. The Focus Group technique was used for data collection. A script was created in seven strands: Positive and negative images of older people; Contact/conviviality with older people; Elderly Aging gains and losses; Work of the professional with the Elders of society; and Training needs on gerontology. The analysis of the results evidenced that future professionals reveal a differentiated understanding about the well and unsuccessful aging. They suggested formative orientations along with the respective courses that allow future professionals a more qualified practice to promote the quality of life of the elderly.

Maria Cristina Faria, Ana Isabel Fernandes

A Nursing Care Intervention Model for Elderly People Adopting Self-care as a Central Concept

Objectives: A core set of International Classification of Functioning, Disability and Health codes was used, to ascertain the general profile of functionality as a function of biological and sociodemographic characteristics and to determine systematized nursing interventions in accordance with self-care needs identified with the study of self-care behavior, in elderly living in extensive and sparsely populated rural areas. Methods: Data were collected by health professionals in the participants’ houses. An exploratory factor analysis allowed reducing data dimensions. A bar graph was set as a measurement tool of nursing care needs as a function of self-care behavior and the functional profile level. Results: Regarding the nursing care needs, the produced model allowed inferring that “Support and Relationships” is the functional concept that presents higher levels of functional problems and, consequently, more need for self-care interventions, as well as people with age 85 and more always present therapeutic self-care deficits. Conclusions: The developed nursing care model might contribute to the development of health programs and a multidisciplinary/home support network that is more specific and effective at promoting functionality, preventing and compensating for disabilities, and enabling people to remain in their homes, with the quality of life that they deserve. This is a model a model of nursing care centered on the person and their caregiver, based on self-care.

Maria Goes, Manuel Lopes, Henrique Oliveira, João Marôco, César Fonseca, Margarida Santos, José Caeiro


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