Objectives
Research about decision-making capacity has been growing in the last decades. That relates to more concerns regarding patients’ autonomy, and an increase in diseases that can negatively ...impact capacity. This research aims to: explore perceptions, legal aspects, and assessment procedures related to healthcare decision-making capacity in older adults with cognitive impairment; and study the first version of a new assessment instrument of this capacity.
Method
Nine focus groups were conducted, including healthcare, law and justice, nursing home professionals, institutionalized older adults, and dwelling older adults. Focus group discussions followed semi-structured interview scripts, specifically developed for each group. After group discussions, the assessment instrument was presented, and participants were asked to evaluate each item relevance and comprehensibility. Qualitative coding of the transcriptions was performed with resource to MAXQDA, using direct content analysis.
Results
Six primary themes emerged from the qualitative analysis: Decision-making capacity features; Abilities implied in decision-making; Factors influencing decision-making; Obstacles to decision-making; Legal aspects; and Assessment procedures.
Discussion
Results corroborate previous theoretical formulations of capacity. Generally, research results have implications for clinical and assessment practices, as well as preventive strategies that can improve older adult’s decision-making capacity. Assessment procedures of capacity should include a thorough protocol for the assessment of cognition, functionality, depressive symptoms, and decision-making abilities. In this respect, the need for an assessment tool that can provide valid information during evaluation processes is highlighted. Concerning the strategies to promote decision-making capacity, these rely on improving older adult’s health literacy and healthcare providers communication skills, as well as conduct actions to reduce stigma toward people with dementia.
The relationship between bacterial diversity and the bioavailability of nutrients, toxic metals and the herbicide oxyfluorfen in a tropical vegetable growing area was evaluated. The study was ...conducted in a vegetable growing area located in the mountainous region of Rio de Janeiro (Brazil), and samples were collected in areas of vegetable cultivation and areas of environmental reserve. Fertility analyses and determination of the pseudototal levels of toxic metals in the soil samples were performed. The profile of the soil bacterial community was determined by amplification of the 16S rRNA gene and separation by DGGE. The results showed that the levels of toxic metals and elements associated with soil fertility were higher in vegetable production areas. These differences in the physical and chemical characteristics of the soil favored the presence of a greater number of OTUs in the cultivation areas (17.3-27 OTUs) than in the areas of environmental reserve (13-22 OTUs). Therefore, this study demonstrates that the presence of toxic metals and the herbicide oxyfluorfen and the increase in fertility in soils in areas with intensive vegetable cultivation resulting from the intensive management adopted in these areas promotes a differentiation of the bacterial profiles in soils in tropical vegetable growing areas.
Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, ...which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments. To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals. The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.
This study intends to assess the relationship between resilience in extremely long-lived individuals and sociodemographic, cognitive and health status variables, and significant life events. A ...selected sample of 48 centenarians (mean age = 100.8 years, SD = 1.2; 83.3% female) from two centenarian studies was considered. A resilience score covering five items (aging and usefulness, hopefulness, worryness, loneliness, and control) was considered. Multivariable linear regression analyses were conducted in order to identify predictors of resilience. No significant differences in the resilience score regarding sociodemographic variables or typology of significant life events were found. Our findings underscore that health perception (better) and pain (less frequent) were associated with higher levels of resilience. In being present in extremely long-lived individuals, resilience should be object of interest in further research.
Cognitive impairment can constrict healthcare decision-making capacity, as it affects the ability to understand, appreciate, and reason with information, as well as communication abilities. ...Therefore, decision-making capacity of elders with mild cognitive impairment or Alzheimer's disease should be carefully assessed when patients are asked to make decisions regarding their health. Vignettes are particularly relevant to assess healthcare decision capacity, since they can come close to real life situations and improve statistical reliability of capacity assessment instruments.
This paper describes the construction and development process of three hypothetical vignettes, to be included in a new Portuguese assessment tool of healthcare decision-making capacity (CAI-Health).
For vignettes’ development, examples from other assessment tools were first reviewed to summarize their text length, language complexity and health information contained. Most prevalent causes of mortality and morbidity in Portuguese elders were then identified, in order to select the health issues to include in CAI-Health’ vignettes. Seven vignettes were developed, and three were selected to be included in CAI-Health. After vignette's selection, these were reviewed by three experienced medical experts, during a focus group.
Vignettes final version include cases of increased complexity, presenting situations of mild cognitive impairment, lung tumor and knee arthrosis.
Le déficit cognitif peut limiter la capacité de prise de décisions concernant les soins de santé, étant donné qu’il affecte la capacité de compréhension, d’évaluation, de raisonnement et la capacité de communication. Par conséquent, la capacité de prendre des décisions des personnes âgées atteintes de déficit cognitif léger ou de maladie d’Alzheimer doit être soigneusement évaluée quand il s’avère nécessaire qu’elles prennent des décisions en rapport avec leur santé. Les vignettes sont particulièrement appropriées pour évaluer la capacité de décision concernant les soins de santé, puisqu’elles peuvent se rapprocher de situations de la vie réelle et augmenter la fiabilité statistique d’outils d’évaluation de la capacité.
Ce document décrit le processus de construction et de développement de trois vignettes hypothétiques, à inclure dans un nouvel outil portugais d’évaluation de la capacité de prise de décision concernant les soins de santé (CAI-Health).
Pour développer ces vignettes, des exemples d’autres outils d’évaluation ont d’abord été revus, puis analysés quant à leur extension textuelle, leur complexité linguistique et l’information de santé contenue. Ultérieurement, les principales causes de mortalité et de morbidité des personnes âgées portugaises ont été identifiées, de façon à sélectionner les problèmes de santé à faire figurer dans les vignettes de l’CAI-Health. Sept vignettes ont été développées, dont trois sélectionnées afin d’intégrer l’CAI-Health. Après cette sélection des vignettes, celles-ci ont été revues par trois experts médicaux qualifiés, en groupe de discussion.
La version finale des vignettes intègre des cas de complexité croissante, en présentant des situations de déficit cognitif léger, de tumeur au poumon et d’arthrose du genou.
The prevalence of neurodegenerative diseases has been significantly increasing in the last decades, and it is expected to continue to grow. These health disorders can impair patients’ decision-making ...capacity in healthcare. The capacity to make healthcare decisions is a fundamental pillar of informed consent, therefore, it should be carefully assessed. Clinicians’ assessment, when not supported by a standardized tool, has revealed to be unreliable, so the recourse to an instrument of capacity assessment is crucial. The present paper aims to identify and summarize published instruments of healthcare decision-making capacity. To do so, a search of peer-reviewed articles in English, Portuguese and Spanish was conducted. A total of eighteen articles, detailing seventeen assessment instruments were selected. Instruments differ on format, structure, assessed abilities and psychometric properties. Likewise, instruments’ targeted population also varies, with a few being specifically developed for patients with dementia. Although a high number of instruments were found, there is still no gold standard for healthcare decision-making capacity assessment. The lack of a gold standard highlights the need for more research in this field, as well as an effort to develop guidelines and normative data, in order to improve clinical practices.
Pelo fio da narrativa do conflito entre Paulo Freire e feministas estadunidenses sobre a linguagem utilizada pelo primeiro, este trabalho busca acrescer um olhar sobre o caminho escolhido por uma ...delas, bell hooks, em sua crítica. Sendo leal a sua tese, analisando e admitindo o equívoco de reduzir o impacto da linguagem em sua Pedagogia da esperança após as críticas feministas, Freire passa a usar a linguagem inclusiva. A interlocução preciosa de bell hooks, entretanto, vai além de crítica e conserto. Em sua análise da situação, ela expõe em seu Ensinando a transgredir, com delicadeza, os frutos nascidos pós-crítica. É nosso objetivo observar essa ponte criada em educação para direitos humanos, que considera lutas sociais, gênero, classe, raça e sexualidade na perspectiva interseccional, entre um mestre e uma mestra educando-se mutuamente.
Following narratives on the conflict between Paulo Freire and U.S. feminists about the language Freire used, this article seeks to bring an additional view on the path chosen by one of them, bell hooks, in her criticism. Loyal to his thesis, analysing and admitting to the mistake of minimizing the impact of language in his Pedagogy of hope after feminist criticism, Freire begins to use inclusive language. Bell hooks’s precious dialogue, however, goes beyond criticism and fixing. In her analysis of the situation, she explains in her Teaching to transgress, in a delicate manner, the fruits yielded post-criticism. It is our aim to observe that bridge built in education for human rights, which considers social, gender, class, race and sexuality struggles from an intersectional perspective, between a male and a female masters educating themselves mutually.
MHC class I molecules regulate brain development and plasticity in mice and HLA class I molecules are associated with brain disorders in humans. We investigated the relationship between ...plasma‐derived soluble human HLA class I molecules (sHLA class I), HLA class I serotypes and dementia. A cohort of HLA class I serotyped elderly subjects with no dementia/pre‐dementia (NpD, n = 28), or with dementia (D, n = 28) was studied. Multivariate analysis was used to examine the influence of dementia and HLA class I serotype on sHLA class I levels, and to compare sHLA class I within four groups according to the presence or absence of HLA‐A23/A24 and dementia. HLA‐A23/A24 and dementia, but not age, significantly influenced the level of sHLA class I. Importantly, the concurrent presence of HLA‐A23/A24 and dementia was associated with higher levels of sHLA class I (p < 0.001). This study has shown that the simultaneous presence of HLA‐A23/HLA‐A24 and dementia is associated with high levels of serum sHLA class I molecules. Thus, sHLA class I could be considered a biomarker of neurodegeneration in certain HLA class I carriers.
E-Commerce is reaching a new stage of conspicuous and widely disseminated development also due to the recent challenges of COVID 19. Thus, the process of shopping includes a first decision problem ...quite critical to the success of any business: which site of e-commerce should be selected by the consumer? This means that the selection of such site should be studied in terms of the satisfaction of the consumer when using it for shopping compared with other competitive sites rather on its descriptive features. The list of studies comparing and evaluating the E-Commerce sites is quite long but almost no attempts have been made to model the satisfaction function of the consumer and so they are not particularly relevant to study the competitive choice of sites by the consumer. In this paper a new model of consumer satisfaction is proposed using an approach-TRIDENT-based on the Multi Attribute Utility Theory (MAUT) and the critical stage of estimating the weights of multiple criteria is solved using an original method OptionCards which avoids the shortcomings of more traditional surveys. The utility function describing the satisfaction function concerning websites of E-Commerce is estimated using the OptionCards method for a group of young professionals and university students confirming a similar importance assigned to the three major criteria. Such utility function was used to estimate the rating of the 14 major Portuguese websites of E-Commerce using the answers of a group of young professionals using E-Commerce and the overall score confirms their relative level of popularity.
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