Berta Ausín

Prevalence of mental disorders in elderly people: the European MentDis_ICF65+ study.

BACKGROUND Except for dementia and depression, little is known about common mental disorders in elderly people. AIMS To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people. METHOD The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65-84 years) living in selected catchment community areas of participating countries. RESULTS One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders. CONCLUSIONS Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.

Measuring symptoms and diagnosing mental disorders in the elderly community: the test–retest reliability of the CIDI65+

Prevalence findings for the elderly are artificially low, most likely due to insufficient consideration of age‐related cognitive abilities in diagnostic interviews.

Anxiety Disorders in Old Age: Psychiatric Comorbidities, Quality of Life, and Prevalence According to Age, Gender, and Country

OBJECTIVES Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life. DESIGN The study used a cross-sectional multicenter survey. PARTICIPANTS The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel. MEASUREMENTS Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+). RESULTS The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75-84 years compared with those aged 65-74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder. CONCLUSIONS The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.

Personas mayores en aislamiento social en la ciudad de Madrid: experiencia de una intervención a través de la estrategia psicológica de búsqueda activa

El objetivo del Servicio de Apoyo Psicologico a Ancianos Fragiles con Aislamiento Social en Madrid es lograr un acercamiento a las personas mayores con claro riesgo de aislamiento social, que permita conducir esas situaciones a la normalizacion, asignando los recursos sociales oportunos en cada caso e incluso facilitando el internamiento involuntario y considerando la incapacitacion legal en ultimo extremo. Se describe en el articulo el Servicio, la metodologia que emplea y los resultados obtenidos en los primeros 19 meses de existencia del mismo, en cuanto a personas atendidas. Por ultimo, se describe la poblacion en cuanto a salud y funcionamiento psicosocial, necesidades socio-sanitarias, funcionamiento global y discapacidad. La presente investigacion aplicada ha puesto de manifiesto la necesidad de contar con profesionales formados en estrategias psicologicas de busqueda activa, enganche y tratamiento que permita abordar con ciertas garantias los problemas de este grupo de poblacion. Los datos indican que las intervenciones con este tipo de poblacion necesitan de una duracion prolongada, con intervenciones a medio y largo plazo (entre 3 y 15 meses). Conviene diferenciar entre tres grupos de intervencion (Normalizacion, Contencion y Custodia) en los que los tiempos de intervencion son diferentes.

Prevalence of Mental Disorders in the Elderly in the Community of Madrid: Results of the Mentdis_ICF65+ Study

The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcohol-related disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/women 0.42; CI 0.25-0.68) with a significance level of p < .001, while elderly men were more affected by any substance-related disorder (OR men/women 3.96; CI 1.62-11.07) with a significance level of p < .001. Each disorders prevalence decreased with age (OR 65-74/75-85, 1.85; CI 1.25-2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted.

Loneliness, Sociodemographic and Mental Health Variables in Spanish Adults over 65 Years Old

Loneliness is a risk factor for morbidity as well as mortality. Older people are more vulnerable to feeling alone due to age-associated changes and losses they might experience. This study aimed to analyze sociodemographic, psychosocial, and mental health variables related to loneliness in the elderly. A random sample of 419 people over 65 years old from the Community of Madrid was used. The UCLA Loneliness Scale, the CIDI65+ Diagnostic Interview, and the WHOQOL-BREF Quality of Life Measure were administered. A regression p model was estimated to identify the variables that best predict loneliness associated with old age. Loneliness-associated variables included living alone t(161.41) = 2.07; p < .040, marital status F(5, 404) = 4.52; p < .001, frequency of economic problems F(1, 408 ) = 4.86; p < .028, quality of life F(4, 405) = 7.36; p < .001, satisfaction with life F(4, 405) = 3.80; p < .005, satisfaction with social relationships F(4, 405) = 19.50; p < .001, presence of a mental disorder (t(98.70) = 2.92; p < .004), and having an anxiety disorder (t(51.11) = 2.19; p < .033). The results presented in this paper highlight some predictors of loneliness in older people that could be useful in intervention, to minimize harmful conditions that can lead to loneliness in people over 65.

Prevalence and correlates of somatoform disorders in the elderly: Results of a European study

Somatoform disorders have rarely been addressed in epidemiological and health care services studies of the elderly. The few existing studies vary considerably in their methodologies limiting comparability of findings. Data come from the MentDis_ICF65+ study, in which a total of 3142 community‐dwelling respondents aged 65–84 years from six different countries were assessed by the Composite International Diagnostic Interview adapted to the needs of the elderly (CIDI65+). The 12‐month prevalence rate for any somatoform disorders was found to be 3.8, whereby the prevalence for somatization disorder according to DSM‐IV was 0%, the prevalence for abridged somatization was 1.7% and the rate for 12‐months somatoform pain disorder was 2.6%. We found a significant variation by study centre (p < 0.005). There was a significant gender difference for pain disorder, but not for abridged somatization. Significant age‐related effects revealed for both disorder groups. Somatoform disorders were found to be associated with other mental disorders [odds ratio (OR) anxiety =4.8, OR affective disorders 3.6], as well as with several impairments and disabilities. Somatoform disorders are prevalent, highly impairing conditions in older adults, which are often associated with other mental disorders and should receive more research and clinical attention.

Development of the self-administered Spanish version of the Health of the Nation Outcome Scales for Older Adults: HoNOS65+A

OBJECTIVES The purpose of this study is to develop a self-administered version of the Health of the Nation Outcome Scales for Older Adults (HoNOS65+) in Spanish - the HoNOS65+A - and to study its reliability and validity. METHODS There are two phases in the study: construction of the HoNOS65+A and the study of its psychometric properties. In the second phase, 179 users of 10 services for older people of Madrid were interviewed. They completed the HoNOS65+A, the Spanish version of the HoNOS65+, and other instruments that evaluate similar constructs. Reliability (internal consistency with the other-administered HoNOS65+, intraclass) and validity (concurrent, discriminant, and criterion validity) were analyzed. RESULTS High reliability indexes (intraclass correlation coefficients) were found for all the scales (HoNOS65+ and HoNOS65+A), except for items 4 and 6. Moreover, the HoNOS65+A has satisfactory concurrent (except 4, 6, and 9) and discriminant validity (except for items 4 and 10). Considering all these data and some theoretical points the items 4 and 6 have eliminated from the scale. Upon eliminating items 4 and 6, the analysis of the reliability (Cronbachs Alpha) and criterion validity (discriminant function among autonomous and assisted people) presents positive values. CONCLUSION The results indicate that the HoNOS65+A is a useful measure that does not assess a homogeneous area but instead different aspects of health and psychosocial functioning.

Prevalencia de los trastornos de ansiedad en las personas mayores de 65 años: una revisión sistemática

Anxiety is an emotional problem that causes discomfort and suffering to those that suffer from it. Anxiety disorders can affect the functioning in different facets of a persons life. Studies on the prevalence of anxiety disorders in people over 65 years show variable results, ranging between 0.1% and 17.2%. Most of these studies include samples of the general population, in which the population of people over 65 years is under-represented. These studies evaluate older people with the same diagnostic tools used to assess anxiety disorders in people under 65 years, and collect data from people between 65 and 75 years old, leaving out people aged 75 and over. A systematic review of the prevalence studies of anxiety disorders in elderly people is presented. It is concluded that when representative samples of people over 65 years are used and evaluated with suitable tools, the prevalence rate of these disorders in the elderly is much higher than previously thought, reaching an annual prevalence rate of 20.8%.

Alcohol use, abuse and dependence in an older European population: Results from the MentDis_ICF65+ study

Background Alcohol use disorders (AUD) in older people have been the subject of increasing interest in Europe and worldwide. However, thus far, no reliable data exist regarding the prevalence of AUD in people over the age of 65 years in Europe. Objective To assess the current (past month), 12-month and lifetime prevalence of alcohol use, abuse and dependence in people aged 65–84 years. Study design The MentDis_ICF65+ study was a representative stepwise cross-sectional survey that was conducted in six European and associated cities (Hamburg, Germany; Ferrara, Italy; London/Canterbury, England; Madrid, Spain; Geneva, Switzerland and Jerusalem, Israel). Method In total, 3,142 community-dwelling people aged between 65 and 84 years who lived in participating cities were assessed with an age-sensitive diagnostic interview (CIDI65+). Results The prevalence of lifetime alcohol use was 81% for the overall sample. The observed AUD (DSM-IV-TR) prevalence was as follows: current, 1.1%; 12-month, 5.3% and lifetime, 8.8%. Alcohol consumption and AUD were more prevalent in males, and a significant interaction between gender and city was observed; greater gender differences in the prevalence of these disorders were observed in Hamburg, London/Canterbury and Geneva in comparison to the other cities. The prevalence of lifetime alcohol consumption and 12-month AUD tended to be lower in older persons. Conclusion The results highlight the appropriateness of using age-adjusted diagnostic tools (CIDI65+) to identify alcohol use and AUD in older people. Different alcohol use patterns were observed in males and females. The results seem to indicate the presence of different alcohol use patterns between northern and southern European countries. Specialized services are proposed, including brief and/or more intensive interventions framed intensive and more simple interventions framed in stepped care strategies, to improve the social and health resources available for older people across Europe.