Beatriz Olaya

Impact of Multimorbidity on Disability and Quality of Life in the Spanish Older Population

Background Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. Methods Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. Results All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. Conclusions Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Anxiety disorders in adolescents and psychosocial outcomes at age 30.

BACKGROUND Anxiety disorders are associated with adverse psychosocial functioning, and are predictive of a wide range of psychiatric disorders in adulthood. OBJECTIVE The present study examined the associations between anxiety disorders during childhood and adolescence and psychosocial outcomes at age 30, and sought to address the extent to which psychopathology after age 19 mediated these relations. METHOD Eight hundred and sixteen participants from a large community sample were interviewed twice during adolescence, at age 24, and at age 30. They completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and young adulthood. RESULTS Adolescent anxiety predicted poor total adjustment, poor adjustment at work, poor family relationships, problems with the family unit, less life satisfaction, poor coping skills, and more chronic stress. Adolescent anxiety predicted, substance (SUD), alcohol abuse/dependence (AUD), and anxiety in adulthood. No adult psychopathology mediated the relationship between childhood anxiety disorders and psychosocial outcomes at age 30. Adult, SUD, AUD and anxiety mediated the association between adolescent anxiety and most domains of psychosocial functioning at age 30. LIMITATIONS The participants are ethically and geographically homogenous, and changes in the diagnostic criteria and the interview schedules across the assessment periods. CONCLUSION Adolescent anxiety, compared to childhood anxiety, is associated with more adverse psychosocial outcomes at age 30. Adolescent anxiety affects negative outcomes at age 30 directly and through adult anxiety, SUD and AUD.

Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study

The aim of this study was to evaluate the factors associated with low skeletal muscle mass (SMM), sarcopenia, and sarcopenic obesity using nationally representative samples of people aged ≥65 years from diverse geographical regions of the world.

Multimorbidity Patterns in a National Representative Sample of the Spanish Adult Population

Background In the context of population aging, multimorbidity has emerged as a growing concern in public health. However, little is known about multimorbidity patterns and other issues surrounding chronic diseases. The aim of our study was to examine multimorbidity patterns, the relationship between physical and mental conditions and the distribution of multimorbidity in the Spanish adult population. Methods Data from this cross-sectional study was collected from the COURAGE study. A total of 4,583 participants from Spain were included, 3,625 aged over 50. An exploratory factor analysis was conducted to detect multimorbidity patterns in the population over 50 years of age. Crude and adjusted binary logistic regressions were performed to identify individual associations between physical and mental conditions. Results Three multimorbidity patterns rose: ‘cardio-respiratory’ (angina, asthma, chronic lung disease), ‘mental-arthritis’ (arthritis, depression, anxiety) and the ‘aggregated pattern’ (angina, hypertension, stroke, diabetes, cataracts, edentulism, arthritis). After adjusting for covariates, asthma, chronic lung disease, arthritis and the number of physical conditions were associated with depression. Angina and the number of physical conditions were associated with a higher risk of anxiety. With regard to multimorbidity distribution, women over 65 years suffered from the highest rate of multimorbidity (67.3%). Conclusion Multimorbidity prevalence occurs in a high percentage of the Spanish population, especially in the elderly. There are specific multimorbidity patterns and individual associations between physical and mental conditions, which bring new insights into the complexity of chronic patients. There is need to implement patient-centered care which involves these interactions rather than merely paying attention to individual diseases.

Chronic Conditions and Sleep Problems among Adults Aged 50 years or over in Nine Countries: A Multi-Country Study

Background Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted. Methods Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organizations Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011–2012 and 2007–2010 respectively were analyzed. Results The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75–2.78), arthritis (OR 1.39–2.46), and depression (OR 1.75–5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and≥4 chronic conditions was 1.41 (1.09–1.82), 2.55 (1.99–3.27), 3.22 (2.52–4.11), and 7.62 (5.88–9.87) respectively in the overall sample. Conclusions Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.

Country-level and individual correlates of overweight and obesity among primary school children: a cross-sectional study in seven European countries

BackgroundThe present study aims to estimate childhood overweight and obesity prevalence and their association with individual and population-level correlates in Eastern and Western European countries.MethodsData were obtained from the School Children Mental Health in Europe, a cross-sectional survey conducted in 2010 in Italy, Germany, the Netherlands, Romania, Bulgaria, Lithuania and Turkey. The sample consists of 5,206 school children aged 6 to 11 years old. Information on socio-demographics, children’s height and weight, life-style and parental attitude were reported by the mothers. Country-level indicators were obtained through several data banks. Overweight and obesity in children were calculated according to the international age and gender-specific child Body Mass Index cut-off points. Multivariable logistic regression models included socio-demographic, lifestyle, mothers’ attitude, and country-level indicators to examine the correlates of overweight.ResultsOverall prevalence was 15.6% (95% CI = 19.3-21.7%) for overweight and 4.9% (95% CI = 4.3-5.6%) for obesity. In overweight (including obesity), Romanian children had the highest prevalence (31.4%, 95% CI = 28.1-34.6%) and Italian the lowest (10.4%, 95% CI = 8.1-12.6%). Models in the pooled sample showed that being younger (aOR = 0.93, 95% = CI 0.87-0.97), male (aOR = 1.24, 95% CI = 1.07-1.43), an only child (aOR = 1.40, 95% CI = 1.07-1.84), spending more hours per week watching TV (aOR = 1.01, 95% CI =1.002-1.03), and living in an Eastern Country were associated with greater risk of childhood overweight (including obesity). The same predictors were significantly associated with childhood overweight in the model conducted in the Eastern region, but not in the West. Higher Gross Domestic Product and Real Domestic Product, greater number of motor and passenger vehicles, higher percentage of energy available from fat, and more public sector expenditure on health were also associated with lower risk for childhood overweight after adjusting for covariables in the pooled sample and in the east of Europe, but not in the West.ConclusionsPrevalence rates of overweight and obesity in school children is still high, especially in Eastern regions, with some socio-demographic factors and life-styles associated with being overweight. It is also in the Eastern region itself where better macro-economic indicators are related with lower rates of childhood overweight. This represents a public health concern that deserves special attention in those countries undertaking economic and political transitions.

Validation of an instrument to evaluate quality of life in the aging population: WHOQOL-AGE

BackgroundThere is a need for short, specific instruments that assess quality of life (QOL) adequately in the older adult population. The aims of the present study were to obtain evidence on the validity of the inferences that could be drawn from an instrument to measure QOL in the aging population (people 50+ years old), and to test its psychometric properties.MethodsThe instrument, WHOQOL-AGE, comprised 13 positive items, assessed on a five-point rating scale, and was administered to nationally representative samples (n = 9987) from Finland, Poland, and Spain. Cronbach’s alpha was employed to assess internal consistency reliability, whereas the validity of the questionnaire was assessed by means of factor analysis, graded response model, Pearson’s correlation coefficient and unpaired t-test. Normative values were calculated across countries and for different age groups.ResultsThe satisfactory goodness-of-fit indices confirmed that the factorial structure of WHOQOL-AGE comprises two first-order factors. Cronbach’s alpha was 0.88 for factor 1, and 0.84 for factor 2. Evidence supporting a global score was found with a second-order factor model, according to the goodness-of-fit indices: CFI = 0.93, TLI = 0.91, RMSEA = 0.073. Convergent validity was estimated at r = 0.75 and adequate discriminant validity was also found. Significant differences were found between healthy individuals (74.19 ± 13.21) and individuals with at least one chronic condition (64.29 ± 16.29), supporting adequate known-groups validity.ConclusionsWHOQOL-AGE has shown good psychometric properties in Finland, Poland, and Spain. Therefore, considerable support is provided to using the WHOQOL-AGE to measure QOL in older adults in these countries, and to compare the QOL of older and younger adults.

The role of muscle mass and body fat on disability among older adults: A cross-national analysis

BACKGROUND The aim of this study was to evaluate the association of sarcopenia and sarcopenic obesity with disability among older adults (≥65years old) in nine high-, middle- and low-income countries from Asia, Africa, Europe, and Latin America. METHODS Data were available for 53,289 people aged ≥18years who participated in the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland, and Spain, and the WHO Study on global AGEing and adult health (SAGE) survey conducted in China, Ghana, India, Mexico, Russia, and South Africa, between 2007 and 2012. Skeletal muscle mass, skeletal muscle mass index, and percent body fat were calculated with specific population formulas. Sarcopenia and sarcopenic obesity were defined by specific cut-offs used in previous studies. Disability was assessed with the WHODAS 2.0 score (range 0-100) with higher scores corresponding to higher levels of disability. Multivariable linear regression analysis was conducted with disability as the outcome. RESULTS The analytical sample consisted of 18,363 people (males; n=8116, females; n=10247) aged ≥65years with mean (SD) age 72.9 (11.1) years. In the fully-adjusted overall analysis, sarcopenic obesity was associated with greater levels of disability [b-coefficient 3.01 (95% CI 1.14-4.88)]. In terms of country-wise analyses, sarcopenia was associated with higher WHODAS 2.0 scores in China [b-coefficient 4.56 (95% CI: 3.25-5.87)], Poland [b-coefficient 6.66 (95% CI: 2.17-11.14)], Russia [b-coefficient 5.60 (95% CI: 2.03-9.16)], and South Africa [b-coefficient 7.75 (95% CI: 1.56-13.94)]. CONCLUSIONS Prevention of muscle mass decline may contribute to reducing the global burden of disability.

Factors associated with suicidal ideation and attempts in Spain for different age groups. Prevalence before and after the onset of the economic crisis

BACKGROUND Little is known about whether the prevalence of suicidal ideation and attempts has changed in the wake of the economic crisis. The aim of this study was to estimate current prevalence of suicidal ideation and attempts in the general population in Spain, to compare it with the prevalence found before the economic crisis, and to analyse the factors associated with suicidality in different age groups. METHODS A total of 4583 non-institutionalised adults were interviewed in a cross-sectional household survey of a nationally representative sample in Spain. Several modules of an adapted version of the Composite International Diagnostic Interview were administered to the participants, and logistic regression models were employed in each age group. RESULTS Lifetime prevalence of suicidal ideation and attempts in Spain were respectively, 3.67% and 1.46%. Mental disorders presented the highest significant effects on lifetime suicidal ideation. Marital status, heavy alcohol consumption, and occupational status were associated with lifetime suicidal ideation in people aged 18-49, whereas loneliness was associated with the 50-64 group, and financial problems with the 65+ group. A younger age, poor health status and the presence of depression were all associated with lifetime suicide attempts. LIMITATIONS The cross-sectional design of the study represents a methodological limitation. CONCLUSIONS The current prevalence of suicidal ideation and attempts in Spain is similar to the one found ten years ago, before the recent economic crisis. The factors associated with suicidality vary among age groups. Suicide prevention programmes should focus on early detection and prevention for depression and anxiety disorders.

Diabetes mellitus and its association with central obesity and disability among older adults: A global perspective

The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of >0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability.