Mental health effects secondary to the COVID-19 pandemic were till recently considered less important or were neglected. Portugal and Brazil are facing the pandemic in quite different ways. This study aimed to describe the mental health status of the general adult population in Portugal and Brazil during the COVID-19 pandemic and analyze the differences between the two countries. A cross-sectional quantitative study was based on an online questionnaire. Socio-demographic data were collected in addition to four validated scales: CAGE (acronym cut-annoyed-guilty-eye) Questionnaire, Satisfaction with Life Scale, Generalized Anxiety Disorder-7 and Patient Health Questionnaire-2. For each outcome, a multiple linear regression was performed. Five hundred and fifty people answered the questionnaire (435 women). The median age was 38 (Q1, Q3: 30, 47) years, 52.5% resided in Brazil and 47.5% in Portugal. The prevalence of anxiety was 71.3% (mild anxiety was present in 43.1%), the prevalence of depression was 24.7% and 23.8% of the sample had both depression and anxiety. Isolation was a significant factor for depression but not for anxiety. Well-being was below average. Mental illness was considerably higher than pre-COVID-19 levels. Portugal and Brazil will have to be prepared for future consequences of poor mental health and contribute immediate psychological support to their adult populations.

The COVID-19 pandemic has negatively affected the mental health of the general population, and for healthcare workers (HCWs) it has been no different. Religiosity and spirituality are known coping strategies for mental illnesses, especially in stressful times. This study aimed to describe the role of spiritual-religious coping regarding fear and anxiety in relation to COVID-19 in HCWs in Portugal. A cross-sectional quantitative online survey was performed. Socio-demographic and health data were collected as well as the Duke University Religion Index, Spirituality Scale, Fear of COVID-19 Scale, and Coronavirus Anxiety Scale. Two hundred and twenty-two HCWs participated in the study, 74.3% were female and 81.1% were physicians. The median age was 37 years (Q1, Q3: 31, 51.3). Religiosity was neither a significant factor for coronavirus-related anxiety nor it was for fear of COVID-19. Participants with higher levels in the hope/optimism dimension of the Spirituality Scale showed less coronavirus-related anxiety. Female HCWs, non-physicians, and the ones with a previous history of anxiety presented higher levels of fear and/or anxiety related to COVID-19. HCWs’ levels of distress should be identified and reduced, so their work is not impaired.

The decrease in cognitive and physical ability among people with dementia can significantly affect eating performance, resulting in mealtime support needs that could lead to inadequate oral intake, weight loss, malnutrition, and reduced functionality in activities of daily living. This scoping review aimed to identify and summarize available research literature on mealtime interventions for people with dementia, and their impact on older people with dementia living in a residential care setting, care staff, and care context/environment. A scoping review of available research published in English, French, Portuguese, or Spanish, was conducted according to the methodology established by The Joanna Briggs Institute. The search was conducted between November 2022 and February 2023 in the following databases: MEDLINE, Web of Science, Scopus, CINAHL Complete, and SciELO. A total of 275 articles were retrieved, of which 33 studies were selected according to inclusion criteria. The interventions were classified into four general categories: environmental, mealtime assistance, staff training, and multicomponent. Most studies demonstrated effectiveness in increasing oral intake and improving behaviors such as agitation and aggression in people with dementia. The impact of interventions on care staff was linked to greater knowledge and attitudes towards mealtime support needs. There is a lack of reporting on the impact of interventions on the care context/environment. Most interventions examined the effects exclusively on residents, focusing on their oral intake and behavioral patterns, particularly agitation among individuals with dementia. However, it is crucial to conduct studies that evaluate the impact on administrators, to comprehend the viewpoints of various hierarchical levels within an organization regarding challenges associated with mealtime. The findings of this scoping review can support the development of new supportive programs, or strategies to improve mealtime experience with positive impact according to the reality and needs of each person or institution.

In advanced dementia, individuals usually develop feeding difficulties. The Feeding Skills Checklist (FSC) is an instrument to assess caregivers’ skills when assisting people with dementia (PwD) at mealtimes. This study aimed to adapt and culturally validate a European Portuguese version of the FSC (FSC-PT) and test its reliability. Initially, translation and cultural validation of the FSC, with estimation of the content validity index (CVI), was conducted. Then, the FSC was applied to 23 female nursing assistants (mean age 44.73 ± 10.42 years) while offering lunch (n = 41 meals) to institutionalized PwD. Inter-rater reliability was determining using Cohen’s Kappa. FSC-PT showed excellent content validity, with item-content validity index ranging from 0.85 to 1, scale level average CVI = 0.94 and universal agreement CVI = 0.54. It also showed very satisfactory inter-observer reliability, with Cohen’s Kappa = 0.844. Of the 41 meals analyzed, only 37.7% of the actions/good practices in feeding PwD were observed. A positive and moderate correlation was found between the length of time working as nursing assistance and the FSC environment dimension (r_s = 0.435; p = 0.038). The results supported the content validity of the FSC-PT, which shows considerable potential to be an instrument for verifying caregivers’ skills when helping PWD to eat and should be increasingly studied.

Introduction: In advanced stages, people with dementia (PwD) may develop feeding difficulties. The assessment of these difficulties is the first step towards an adequate intervention. The Edinburgh Feeding Evaluation in Dementia Scale (EdFED) is an instrument for assessing the feeding difficulties of older PwD. Objective: The objective of this observational, cross-sectional, exploratory-descriptive study was to contribute to the adaptation of the EdFED to the Portuguese population and to analyze some of its psychometric properties, namely internal consistency and interobserver reliability. Methods: First, translation, cultural and linguistic adaptation, as well as validation were performed using an expert panel and calculation of the content validity index (CVI). Then the instrument was applied in 51 institutionalized older PwD (mean age 86.06 ± 6.77 years, 86.2% women). Results: The results showed excellent content validity, with a CVI of 0.950. The Portuguese version of the EdFED showed reasonable internal consistency (Cronbach’s α = 0.705) and very satisfactory interobserver reliability (Cohen’s κ = 0.882). Conclusion: The main results suggest that the Portuguese version of the EdFED is a reliable instrument that allows the assessment of eating/feeding difficulties among institutionalized older PwD.

This study examined how nursing home staff adapt to challenging mealtime behaviors in residents with dementia, such as turning away or refusing food. Ten focus groups were conducted with 52 clinical and administrative staff from three southeastern U.S. nursing homes. Transcripts were analyzed using four key codes: feeding behaviors, interventions, training, and communication. Staff described a range of mealtime challenges, including cognitive and functional decline, dysphagia, and elopement. Feeding-related behaviors like refusing to eat reflect the complexity of care required. Staff reported adapting interventions based on residents’ abilities, their own interactions, or environmental factors. Most strategies aligned with evidence-based practices, though one novel tactic involved “sprinkling sugar” to stimulate appetite. Findings suggest that reframing feeding behaviors as communication may improve care and reinforces the need for tailored interventions. Differences in staff perspectives emphasize the value of cross-role collaboration in managing mealtime challenges and improving outcomes for residents with dementia.