Impact of multidimensional interventions on quality of life and depression among older adults in a primary care setting in Brazil: a quasi-experimental study

Miranda, Jéssica Maria Arouca de; Cavalcante, Anna Carolyna Vieira; Toscano, Gislani Acásia da Silva; Torres, Larissa Silva Sadovski; Rossignolo, Simone Camargo de Oliveira; Nobre, Thaíza Teixeira Xavier; Maia, Eulália M C; Miranda, Francisco Arnoldo Nunes de; Torres, Gilson de Vasconcelos

doi:10.1590/1516-4446-2019-0577

Cited by 16 publications

(20 citation statements)

References 32 publications

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“…The promising results reported by this study in mental health are supported by previous reseach which showed that the participation in a community-based intervention reduced depressive symptoms in older adults with comorbidity [38,39]. Similarly, multi-domain interventions among community-living older persons and in primary care settings also reduced depressive symptomatology and demonstrated a significant improvement in mental health [40,41]. The lack of results in self-management and social capital differ from previous studies [42] which shown that strengthening social support in group-based interventions might improve self-management behaviours among socioeconomically deprived patients.…”

Section: Discussionsupporting

confidence: 79%

Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS

et al. 2021

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Background Evidence is scarce on how to promote health and decrease cumulative inequalities for disadvantaged older people. Downstream complex interventions focusing on intermediate factors (self-management, health literacy and social capital) may have the potential to mitigate the inequitable impacts of social determinants in health. The aim of the AEQUALIS study was to assess the effectiveness of a group-based intervention to improve self-perceived health as indicator of health inequality. Methods Pragmatic randomised clinical trial addressed to older adults (≥ 60 years) living in urban disadvantaged areas with low self-perceived health. The intervention was delivered in primary care settings and community assets between 2015 and 2017 and consisted in 12 weekly sessions. The primary outcome was self-perceived health assessed in two ways: with the first item of the SF-12 questionnaire, and with the EQ-5D visual analog scale. Secondary outcomes were health-related quality of life, social capital, self-management, mental health and use of health services. Outcomes were assessed at baseline, post intervention and follow-up at 9 months after the end of the intervention. Results 390 people were allocated to the intervention group (IG) or the control group (CG) and 194 participants and 164 were included in the data analysis, respectively. Self perceived health as primary outcome assessed with SF-12-1 was not specifically affected by the intervention, but with the EQ-5D visual analog scale showed a significant increase at one-year follow-up only in the IG (MD=4.80, 95%CI [1.09, 8.52]). IG group improved health literacy in terms of a better understanding of medical information (− 0.62 [− 1.10, − 0.13]). The mental component of SF-12 improved (3.77 [1.82, 5.73]), and depressive symptoms decreased at post-intervention (− 1.26 [− 1.90, − 0.63]), and at follow-up (− 0.95 [− 1.62, − 0.27]). The use of antidepressants increased in CG at the follow-up (1.59 [0.33, 2.86]), while it remained stable in the IG. Conclusions This study indicates that a group intervention with a strong social component, conducted in primary health care and community assets, shows promising effects on mental health and can be used as a strategy for health promotion among older adults in urban disadvantaged areas. Trial registration ClinicalTrials.gov, NCT02733523. Registered 11 April 2016 - Retrospectively registered

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Section: Discussionsupporting

confidence: 79%

Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The promising results reported by this study in mental health are supported by previous reseach which showed that the participation in a community-based intervention reduced depressive symptoms in older adults with comorbidity [37,38]. Similarly, multi-domain interventions among community-living older persons and in primary care settings also reduced depressive symptomatology and demonstrated a signi cant improvement in mental health [39,40]. The lack of results in self-management and social capital differ from previous studies [41] which shown that strengthening social support in group-based interventions might improve self-management behaviours among socioeconomically deprived patients.…”

Section: Discussionsupporting

confidence: 78%

Promoting Social Capital, Self-management and Health Literacy in Older Adults Through a Group-based Intervention Delivered in Low-income Urban Areas: Results of the Randomized Trial AEQUALIS

Alias

Nadal²,

Moral³

et al. 2020

Preprint

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BackgroundEvidence is scarce on how to promote health and decrease cumulative inequalities for disadvantaged older people. Downstream complex interventions focusing on intermediate factors (self-management, health literacy and social capital) may have the potential to mitigate the inequitable impacts of social determinants in health. The aim of the AEQUALIS study was to assess the effectiveness of a group-based intervention to improve self-perceived health as indicator of health inequality. MethodsPragmatic randomised clinical trial addressed to older adults (≥ 60 years) living in urban disadvantaged areas with low self-perceived health. The intervention was delivered in primary care settings and community assets between 2015-2017 and consisted in 12 weekly sessions. The primary outcome was self-perceived health assessed in two ways: with the first item of the SF-12 questionnaire, and with the EQ-5D visual analog scale. Secondary outcomes were health-related quality of life, social capital, self-management, mental health and use of health services. Outcomes were assessed at baseline, post intervention and follow-up at 9 months after the end of the intervention. Results390 people were allocated to the intervention group (IG) or the control group (CG) and 194 participants and 164 were included in the data analysis, respectively. Self perceived health as primary outcome assessed with SF-12-1 was not specifically affected by the intervention, but with the EQ-5D visual analog scale showed a significant increase at one-year follow-up only in the IG (MD=4.80, 95%CI [1.09, 8.52]). IG group improved health literacy in terms of a better understanding of medical information (-0.62 [-1.10, -0.13]). The mental component of SF-12 improved (3.77 [1.82, 5.73]), and depressive symptoms decreased at post-intervention (-1.26 [-1.90, -0.63]), and at follow-up (-0.95 [-1.62, -0.27]). The use of antidepressants increased in CG at the follow-up (1.59 [0.33, 2.86]), while it remained stable in the IG. ConclusionsThis study indicates that a group intervention with a strong social component, conducted in primary health care and community assets, shows promising effects on mental health and can be used as a strategy for health promotion among older adults in urban disadvantaged areas.Trial registration: ClinicalTrials.gov, NCT02733523. Registered 11 April 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02733523

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“…This reality was indicated in the two countries we studied, but more clearly among Brazilians. Regarding this scenario, the importance of multidimensional interventions is increased to improve and/or minimize the nutritional de cits and depressive symptoms of the participants, as illustrated by successful past experiences in the Brazilian PHC scenario itself (9) . However, the coronavirus pandemic, which began in 2019, is also projected to have effects on the general population, which includes elderly people, involving greater di culty in circumventing the problem of depression in view of its substantial impact on mental health, which is generated by economic losses, deaths of family members, and other aspects affected in terms of behaviour, lifestyle and, consequently, nutritional status (4,5) .…”

Section: Discussionmentioning

confidence: 99%

“…In Brazil, an emerging country in South America, malnutrition is strongly associated with socioeconomic factors, such as low family income, female gender and low level of education (8) ; these data are also similar when analysing depression in the same country (9) . Portugal, the country with the fourth highest number of elderly people in the European Union, presents scarce literature on nutritional assessments, especially for its geriatric population (10) ; however, mental disorders are already a real concern in relation to the entire Portuguese population (11) .…”

Section: Introductionmentioning

confidence: 94%

Correlation Between Nutritional Deficit and the Presence of Depressive Symptoms: Comparative Study Between Elderly Brazilians and Portuguese in Primary Health Care

Toscano¹,

Cavalcante²,

Torres³

et al. 2020

Preprint

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Background: Among the countless diseases that affect the world population, malnutrition has stood out in several social and demographic contexts; among them, there has been an exponential progression in elderly people, a population group that presents a strong tendency to develop depression and malnutrition. Data from the World Health Organization show that the worldwide prevalence of depressive disorders among elderly people is in the range of 10 to 20%. Similarly, the prevalence of depression, in turn, combined with chronic diseases, accounts for 50% of premature mortality.Objective: To compare the nutritional status and the level of depressive symptoms and to evaluate the correlation between both aspects in Brazilian and Portuguese elderly people assisted in Primary Health Care (PHC).Methods: A cross-sectional, comparative study with a quantitative approach conducted among PHC elderly people in Brazil and Portugal. The sociodemographic and health questionnaire, Mini-Mental State Examination (MMSE), Geriatric Depression scale (GDS-15) and Mini-Nutritional Assessment (MNA) were used.Results: We included 160 participants (110 Brazilians and 50 Portuguese) in the study. In this sample, 81.9% of participants had a risk of malnutrition or malnutrition and 45.0% of participants had mild depressive symptoms. There was a significant association and correlation in Brazil with the presence of a risk of malnutrition and mild symptoms of depression. Portugal also demonstrated a significant association, however, for the chance of not presenting alterations.Conclusion: Our research showed that the risk of malnutrition or the presence of malnutrition was associated with the presence of depressive symptoms in the studied sample. In the intergroup comparison, among Brazilians, those at risk of malnutrition were more likely to have changes associated with depression, while for participants in Portugal, the odds ratio tended to show no changes, as the majority were individuals without nutritional or depressive demands. Screening and prevention measures should be emphasized in PHC to avoid the progression of symptoms in order to refer patients with medium and high complexity since this segment of the public is susceptible to malnutrition and depression.

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Impact of multidimensional interventions on quality of life and depression among older adults in a primary care setting in Brazil: a quasi-experimental study

Cited by 16 publications

References 32 publications

Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS

Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS

Promoting Social Capital, Self-management and Health Literacy in Older Adults Through a Group-based Intervention Delivered in Low-income Urban Areas: Results of the Randomized Trial AEQUALIS

Correlation Between Nutritional Deficit and the Presence of Depressive Symptoms: Comparative Study Between Elderly Brazilians and Portuguese in Primary Health Care

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