The article's aim is to analyse the way in which informal care has become the object of public policy in Portugal. The law is compared with those of other European countries, and the article identifies issues around the framing of the law and where it leads to adverse consequences and social risks to family carers. Two focus groups were conducted with caregivers. A thematic content analysis allowed the identification of difficult caregiving experiences and gender inequalities throughout the cycle of family life. Selectivity criteria, based on income, limit access for thousands of carers in need, and the new care regulation has become a policy to combat poverty.
Purpose In most European countries there is a range of quality control system mechanisms, however, poor quality and institutional violence can be found in the residential sector. Taking Portugal as an example of a country that uses an inspection-only approach, this paper focuses on the monitoring system for controlling the quality of care in nursing homes. The purpose of this paper is to analyse how mistreatment of older people is identified and dealt with by the national social security services. In particular it looks at what the indicators are with which to assess poor quality care and mistreatment (how it is perceived and defined), which factors affect mistreatment of older people and intervention outputs (i.e. what are the sanctions to prevent and combat this).
Design/methodology/approach An exploratory approach was based on a mixed method, using a database of 3,685 complaints reported to the social security inspection services. To understand the context of the complaints and the assessment of institutional violence, focus groups were carried out with inspectors from the National Inspection Service.
Findings The focus groups identified severe situations of poor care, mistreatment of older people and loss of human rights and dignity. Some indicators were found in key areas of care and the factors associated with this were based on Kamavarapu's typology (2017): physical conditions of facilities; closed organisational models; difficult working conditions; and perceived concerns of residents. Monitoring and inspection systems are still based on minimum standards focusing on structural and process quality, devoting little attention to the human rights situation of older persons and clinical issues.
Research limitations/implications The number of participants in the focus groups was limited in size but the uniqueness of this exploratory method draws a dark picture of non-licensed nursing homes in Portugal.
Originality/value An exploratory analysis was useful to identify institutional violence and discuss potential implications, in terms of effectiveness of quality care control, which calls for special attention by policy makers and researchers when monitoring the human rights of older persons.
The quality of care practices is still a central issue for long-term care policy. Following seven signs used to evaluate care practices, this article presents the initial results of ongoing research carried out in three Portuguese care homes in 2017. The article uses mixed methods (24 interviews and a data survey), based on the perspectives of care workers, professional staff and managers. The findings highlight the non-recognition of care work, difficult working conditions, poor training and a limited monitoring of the care system as factors that reduce the quality of care and increase the risk of an institutionalised culture of care omission.
Purpose Reciprocal abuse inside care practices remain under-studied due to their invisibility and further research is required. The purpose of this paper is to explore different levels of conflicts inside organisations.
Design/methodology/approach The paper is based on a self-administered questionnaire filled out by care workers (n = 150), in 16 Portuguese care homes.
Findings Results indicated that, overall, 54.7% of care workers had observed abuse, in their daily practice, in the preceding 12 months: 48.7% psychological; 36.0% neglectful care practices; 14.0% physical and 3.3% financial abuse. The figures decreased significantly as regards abuse committed themselves, with 16.7% of those admitting to having committed at least one of these behaviours. The highest figures were also recorded for psychological abuse (13.3%) and neglect (6.7%). However, there is a statistically significant relationship between abuse committed by care workers and abuse committed by residents. Overall, 52.0% of care workers reported having been the target of at least one such behaviour by residents.
Research limitations/implications This paper has its limitations as the sample consisted of only 16 nursing homes (12 not-for-profit and 4 for-profit nursing homes). The fact that only 4 of the 16 LTC homes were for-profit is a potential limitation both in general and in particular because research has shown that lower quality of care and elder abuse and neglect are more common in for-profit nursing homes at least in Portugal. The results were also based on self-reported measures.
Practical implications A reactive behaviour, the risk of retaliation, after a complaint, the difficulty in dealing with dementia and the residents' aggressive behaviour, an absence of a training and support policy in an environment where difficult working conditions prevail, are factors enhancing a reciprocal process of abuse. The analysis followed by a discussion of potential implications to prevent institutional elder abuse and neglect, based on communication and social recognition, including better working conditions and training, and a cooperative work environment.
Social implications Conflict is much more than reducing an interpersonal relationship problem between residents and staff (care workers, professional staff, managers) and extending to the whole organisation. Therefore, there are still uncertainties on how organisations, staff and residents interact between themselves, and affect care practises.
Originality/value Reciprocal abuse in nursing homes is an important area of research and this paper enabled a discussion of potential implications concerning the quality of care, which required the identification of levels of conflict, in an organisational system, including interactions, the context where care is provided, difficult working conditions, lack of training and levels of support. All these factors are important when considering elder abuse and neglect and this calls for special attention by policymakers and researchers.
Purpose – The purpose of this paper is to reflect on how qualitative approaches can improve a prevalence study on older adults' violence. The paper describes how qualitative data can help frame a complex and multidimensional problem, such as older adults' violence, within the culture where it happens and therefore prevent two risks present in prevalence studies: underestimation and overestimation.
Design/methodology/approach – To adequately measure violence and violent behaviours the authors first conducted four focus groups with the target population – older adults aged 60 and over – and 13 in-depth interviews with older adult victims of violence. Through content analysis of focus groups and in-depth interviews the authors sought to understand how violence is perceived, defined and limited by the general population and by victims.
Findings – By employing qualitative methods the authors were able to operationalise violence, decide upon and select specific behaviours to measure, rephrase questions and develop strategies to approach the general population through telephone interviews.
Research limitations/implications – The qualitative approaches helped reduce participants bias in the prevalence study and therefore to minimise the risks of underestimation and overestimation.
Originality/value – The study exemplifies how assessing quantitatively to a sensitive subject requires taking into account the perspective of the target population through a qualitative approach.
Purpose Psychological elder abuse (PEA) assessment is described with different thresholds. The purpose of this paper is to examine how the prevalence of PEA and the phenomenon's characterisation varied using two different thresholds.
Design/methodology/approach Participants from the cross-sectional population-based study, Aging and Violence (n=1,123), answered three questions regarding PEA. The less strict measure considered PEA as a positive response to any of the three evaluated behaviours. The stricter measure comprised the occurrence, for more than ten times, of one or more behaviours. A multinomial regression compared cases from the two measures with non-victims.
Findings Results show different prevalence rates and identified perpetrators. The two most prevalent behaviours (ignoring/refusing to speak and verbal aggression) occurred more frequently (>10 times). Prevalence nearly tripled for "threatening" from the stricter measure (>10 times) to the less strict (one to ten times). More similarities, rather than differences, were found between cases of the two measures. The cohabiting variable differentiated the PEA cases from the two measures; victims reporting abuse >10 times were more likely to be living with a spouse or with a spouse and children.
Research limitations/implications Development of a valid and reliable measure for PEA that includes different ranges is needed.
Originality/value The study exemplifies how operational definitions can impact empirical evidence and the need for researchers to analyse the effect of the definitional criteria on their outcomes, since dichotomization between victim and non-victim affects the phenomenon characterisation.
The paper presents facts and figures about Portuguese demography and its relation to the national institutional organisation of long-term care system. Hereby, the focus lies on "Digital Competence among long-term care system" where are presented elements of the current status of the use of technology and social innovations in elderly care institutions, specific policy initiatives and some "best practices" on the use of different technologies and innovations in Portugal. Second, the following chapters provides the "Implications for elderly, staff and working places" with regard to information technologies (IT) applied in the care work, or as mentioned in this report, to "welfare technologies". There it is analysed the digital effects on organisation of work in long-term care system, the education problems and further training of care staff. The final chapters are about the challenges and risks of the use of technology in care work (covering the topics of integrity, ethical and economical challenges and risks), the societal debates, regulations and best practices, and, finally, the future perspectives and reflections. ; publishersversion ; published
Introduction: Health surveys constitute a relevant information source to access the population's health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey. ; Introdução: Os inquéritos de saúde constituem uma importante fonte de informação para conhecer o estado de saúde da população. Visto que os erros associados aos inquéritos podem afetar significativamente as estimativas, invalidando as suas conclusões, é crucial monitorizar o progresso do trabalho de campo. Este estudo teve como objetivo descrever a monitorização do trabalho de campo realizado durante o primeiro Inquérito Nacional de Saúde com Exame Físico (INSEF) referente a desvios ao protocolo e principais indicadores de desempenho (KPI). Métodos: Dados resultantes da observação dos entrevistadores e do controlo estatístico de qualidade de alguns dos KPI foram utilizados para monitorizar as quatro componentes do inquérito (recrutamento, exame físico; colheita de sangue e questionário de saúde), durante a implementação do trabalho de campo. Os KPI selecionados incluíram a taxa de resposta, distribuição do tempo médio de realização dos procedimentos, proporção do último dígito para medidas específicas, proporção de amostras de sangue hemolisadas e dos valores omissos. Resultados: A observação dos entrevistadores permitiu identificar e corrigir atempadamente desvios ao protocolo. Após a implementação de medidas corretivas, com base na monitorização dos KPI, a taxa de participação aumentou 2,5 vezes e foi observada uma redução de 4,4 vezes na não adesão aos procedimentos padronizados para a medição da pressão arterial. Após o estudo piloto, a proporção de medições com o dígito terminal de 0 ou 5 diminuiu para 19,6% e 16,5%, respectivamente. A proporção de amostras hemolisadas foi inferior a 2,5%. A proporção dos valores omissos foi minimizada comunicando-os imediatamente ao entrevistador, que poderia recontactar o participante e completar a informação. Discussão/Conclusão: Embora a maioria dos desvios ao protocolo tenha ocorrido durante as primeiras semanas do trabalho de campo, os resultados mostram a importância da sua monitorização continua nos inquéritos de saúde de forma a garantir a qualidade dos dados recolhidos. ; INSEF was developed as part of the predefined project of the Public Health Initiatives Program, "Improvement of Epidemiological Health Information to Support Public Health Decision and Management in Portugal. Towards Reduced Inequalities, Improved Health, and Bilateral Cooperation," that benefited from a EUR 1,500,000 grant from Iceland, Liechtenstein and Norway through the EEA Grants and the Portuguese government. ; info:eu-repo/semantics/publishedVersion
<b><i>Background:</i></b> The genetic inter-individual variability of drug response can lead to therapeutic failure or adverse drug reactions (ADRs). The aims of this study were to assess the pharmacogenetic profile of a South Portuguese population according to established dosing guidelines for commonly prescribed drugs and to compare it with that of previously genotyped populations. <b><i>Methods:</i></b> A cross-sectional study was developed in the context of the Portuguese Component of the European Health Examination Survey (EHES). A total of 47 pharmacogenetically relevant variants in 23 different genes were genotyped in 208 participants. Allelic and genotypic frequencies were calculated, and the pharmacogenetic profile of the participants was defined. A comparative analysis was conducted through electronic database search. Pairwise<i> Fst</i> calculations were performed to assess the genetic distance between populations. <b><i>Results:</i></b> We found a significant small differentiation between the Portuguese regional populations regarding <i>CYP2C9 </i>rs1057910<i>, CYP2D6 </i>rs3892097<i>, MTHFR </i>rs1801133 and <i>F5 </i>rs6025. When consid-ering 4 HapMap populations, <i>ADH1B</i> rs2066702,<i> ADH1B</i> rs1229984,<i> NAT2</i> rs1799931 and <i>VKORC1</i> rs9923231 displayed a significant population differentiation. We found that 18.9% of the participants are intermediate or poor metabolizers for at least 3 drugs simultaneously and that 84.6% of the participants have at least one therapeutic failure or ADR risk allele for the considered drugs. <b><i>Conclusions:</i></b> There is a high prevalence of risk alleles associated with an altered drug metabolism regarding drugs largely used by the South Portuguese population. This knowledge contributes to the prediction of their clinical efficacy and/or toxicity, optimizing therapeutic response while improving cost-effectiveness.
