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Preventing cognitive decline in older portuguese citizens

FOCUS Project

At the beginning of December, FOCUS News interviewed Professor João Apóstolo and Dr Elzbieta Bobrowicz-Campos, professionals who led the implementation of the ECoRem-FOCUS Study in Portugal. 


FOCUS News: You are implementing the Portuguese branch of the FOCUS pilot in Coimbra. Could you please explain to our readers what is so new and innovative in the intervention you have designed?

Elzbieta Bobrowicz-Campos: We decided to focus on cognitive dimension of frailty. According to evidence, the changes in cognition in frail adults may involve several cognitive domains, including memory, executive function, attention, processing speed, etc. These changes are potentially reversible and may not be detectable in cognitive testing due to the compensatory efforts of an older person. However, in case of lack of timely and appropriate response, cognitive deterioration may reach significant extent and affect functional ability of the person. Some researchers believe that cognitive frailty is a precursor of neurodegenerative processes. 

João Apóstolo: During our study, we implemented two interventions. One of these interventions was a cognitive stimulation that provides several engaging activities involving complex mental process. The team of the Nursing School of Coimbra has a vast experience on the implementation of this intervention. So far, we have worked with 2000 older adults and our efforts to prevent cognitive decline in elderly have been acknowledged nationally and internationally! We also implemented a reminiscence-based program. This intervention is based on the report of personal experiences, with emphasis on significant life-events and past unresolved conflicts. The researchers from the Nursing School of Coimbra are responsible for the adaptation and validation of the reminiscence-based program for Portugal.

FOCUS News: What are the advantages of the participation in these interventions?

João Apóstolo: Besides an improvement in cognitive functioning or, at least, the maintenance of cognitive performance, the benefits of cognitive stimulation include the reduction of depressive symptoms and enhancement of quality of life. In case of elderly with mild cognitive impairment or dementia, the positive effects of cognitive stimulation are also related to the improvement of autonomy on the activities of daily living. Importantly, these effects are long lasting and may be observable even up to three months after the intervention. The positive impact on cognition and quality of life was also observed in relation to the reminiscence based program.

Elzbieta Bobrowicz-Campos: It is also important to say that both interventions were provided in groups and that the activities developed were not only didactic, but also ludic. These activities include exercises emphasizing interest and interpersonal communication, and encouraging the use of artistic expression. We consider this framework highly important as the FOCUS guidelines to inform implementation of best practices to prevent progression of frailty highlight the importance of social and psychological factors, wellbeing and fun. In addition, in line with the FOCUS guidelines, we have created the conditions for participants’ involvement in choosing the elements that identify a group (group name and song) and topics to be integrated in activities. 

FOCUS News: Who is participating in the intervention?

João Apóstolo: The participants of the study were older adults who frequent day centers in the central region of Portugal. We included in the intervention program all the persons who were interested in collaborating with us, were clinically stable and were able to remain in group for 45-60 minutes. Older adults with severe hearing and/or vision problems or currently taking cholinesterase inhibitors and/or antipsychotic medication were excluded. We also excluded from the intervention program the persons with severe cognitive decline. The reason for this decision is related to the need to enhance the effectiveness of the interventions. It is not advisable to join persons with different levels of cognitive (in)capacity into the same group of cognitive stimulation or reminiscence. The levels of exercises complexity and difficulty need to be adapted to the level of incapacity. Otherwise, they do not work. However, the elderly who were not integrated in the intervention groups were invited to participate in thematic meetings focused on traditions and historical and current events.   

FOCUS News: How did the older adults participating in the study evaluate the interventions? 

Elzbieta Bobrowicz-Campos: The participants’ feedback was very positive. They were mainly satisfied with the program contents and way of application. They also considered the program to be useful. When we asked directly about the experiences and feelings related to the interventions implementation, the participants’ responses were very enthusiastic: “I did not meet any difficulty”. “I enjoyed participating in the program. It was very important for me”. “If I could, I would again participate in such program”. They enjoyed sharing their experiences with others. The relevance of the attention given to them was also repeatedly emphasized in the informal conversations. 

João Apóstolo: The professionals who implemented the interventions also recognized that the program contents were appropriate to the participants and that the participants engaged with ease in the activities proposed. However, they emphasized that the success of such interventions is highly dependent on the institutions’ active involvement in design and planning of the interventional sessions. Our experience in this field shows the same: without the institutional support, the implementation of the interventions meets a lot of obstacles that significantly interfere with an adherence of older adults to the intervention programs and with their compliance. I would like to thank our partners for their fruitful collaboration.

FOCUS News brought to you a couple of snapshots of some of the sessions.


Pilot 4


Pilot 1


Pilot 3


Pilot 2