Fermina Rojo-Pérez

Factors Associated With Loneliness of Noninstitutionalized and Institutionalized Older Adults

Objectives: First, to seek if sociodemographic and health factors contribute differentially to the explanation of loneliness in institutionalized and noninstitutionalized older adults; and second, to analyze the influence of institutionalization on loneliness. Method: This work was based on two surveys of older adults aged 60 years or more in Spain. A group of 234 community-dwelling people and 234 nursing homes residents were selected (n = 468). Logistic regression models were applied using the six-item De Jong Gierveld Loneliness Scale as dependent variable. Results: Depression was associated with loneliness in both populations. Sex and marital status contributed to explain loneliness among those living at home, whereas gathering with family, friends, and neighbors showed a significant effect in the institutionalized group. Institutionalization per se showed a strong effect on loneliness. Discussion: Findings have potential implications for targeting older adults at risk for loneliness.

Prevalence of disability in a composite ≥75 year-old population in Spain: A screening survey based on the International Classification of Functioning

BackgroundThe prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.MethodsNine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100).ResultsThe age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32).ConclusionsDisability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.

Residential satisfaction, sense of belonging and loneliness among older adults living in the community and in care facilities ☆

The aim of this study was to analyze the influence of residential satisfaction and sense of belonging on loneliness in old age in two different contexts: the community and the residential care facility. We used two surveys of 1106 non-institutionalized and 234 institutionalized older adults, aged 60 years or more in Spain. Results from structural equation modeling and path analysis suggest that residential satisfaction would positively affect sense of belonging and would be negatively associated with loneliness in both residential environments, thus playing a protective role against the experience of loneliness.

Psychometric properties of the International Wellbeing Index in community-dwelling older adults

BACKGROUNDnThis is the first study to analyze the psychometric properties of the International Wellbeing Index (IWI), which comprises the Personal Wellbeing Index (PWI) and National Wellbeing Index (NWI), among community-dwelling older adults.nnnMETHODSnThe IWI was applied to 1106 community-dwelling adults aged 60 years and over. The sample was additionally assessed using scales for comorbidity, disability, mood, general orientation to life, social support, health-related quality of life, and two questions assessing satisfaction with life as a whole and with life in Spain. The PWI and NWI were separately analyzed for acceptability, internal consistency, convergent and discriminative validity, and precision. Linear regression analyses of the PWI and the NWI were also conducted.nnnRESULTSnMean scores were 71.0 ± 13.5 for the PWI and 49.5 ± 14.4 for the NWI. No floor or ceiling effects were detected. Cronbachs α was 0.88 for the PWI and 0.92 for the NWI. Factor analysis identified two factors in the IWI, and one factor in the PWI and NWI respectively. The PWI showed a correlation of 0.50 with the satisfaction with life as a whole item, and the NWI showed a correlation of 0.73 with the satisfaction with life in Spain item. There were significant differences in scores: in the PWI, according to gender, age, social support, education and depression; and in the NWI, according to education and depression. The regression model identified psychosocial, health and functional factors as determinants of the PWI (explained variance: 46.8%).nnnCONCLUSIONSnThe IWI displays good acceptability and is a consistent, valid and precise measure of global quality of life in older adults.

Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia

Objectives: Active ageing, considered from the perspective of participation in leisure activities, promotes life satisfaction and personal well-being. The aims of this work are to define and explain leisure activity profiles among institutionalized older adults, considering their sociodemographic characteristics and objective and subjective conditions in relation to their quality of life. Methods: Two samples of institutionalized people aged 60 and over were analysed together: 234 older adults without dementia and 525 with dementia. Sociodemographic, economic, family and social network, and health and functioning variables were selected. Cluster analysis was applied to obtain activity profiles according to the leisure activities, and ordinal regression models were performed to analyse factors associated to activity level. Results: The sample was clustered into three groups of people: active (27%), moderately active (35%) and inactive people (38%). In the final regression model (Nagelkerke pseudo R2 = 0.500), a higher level of activity was associated with better cognitive function (Pfeiffer scale), self-perceived health status and functional ability, as well as with a higher frequency of gathering with family and friends, and higher educational level. Conclusion: The decline in physical and mental health, the loss of functional capabilities and the weakening of family and social ties represent a significant barrier to active ageing in a context of institutionalization.

Design, measures and sample characteristics of the CadeViMa-Spain survey on quality of life in community-dwelling older adults.

BACKGROUNDnThe survey Quality of life in older adults-Spain (CadeViMa-Spain) was designed to obtain information about objective and subjective determinants of Quality of Life (QoL) in old age, from a multidimensional perspective. This paper presents the overall description, methodology, sample characteristics and reliability of the measures used.nnnMETHODSnA cross-sectional survey was carried out in a representative sample of 1106 community-dwelling adults aged 60 years and over in Spain. The sample was obtained by a geodemographically-based proportional multistage stratified sampling. A home-based questionnaire included validated scales and questions about sociodemographic characteristics, global QoL, health, family and social networks, financial means and retirement, leisure and social participation, residential environment, and satisfaction with those issues. Face-to-face semi-structured interviews were conducted. Cronbachs α coefficients were used to assess internal consistency of the scales.nnnRESULTSnThis nationally representative survey furnishes information about global QoL, health-related QoL, resources availability, living conditions, and satisfaction with the assessed aspects, including life domains most valued by this group. In general, community-dwelling older adults reported positive assessments of health, living conditions, and high levels of satisfaction with the different aspects of QoL. The reliability of the measures in this population was good.nnnCONCLUSIONSnThis survey provides comprehensive and useful information, based on the view of older people themselves, with potential to contribute to health and social policies towards promoting active aging. The database is available for in-depth comparisons.

Measurement properties of the Community Wellbeing Index in older adults

PurposeThe international wellbeing index (IWI) consists of two scales, the personal (PWI) and national (NWI) wellbeing indices. The community wellbeing index (CWI) is a new measure of the individual’s level of satisfaction with the local place of residence. The main goal of this paper is to validate the CWI in a sample of older adults.MethodsThe IWI was satisfactorily applied to survey the global quality of life of a community sample of 1,106 people aged 60xa0years and over residing in Spain. The CWI psychometric properties were studied using Rasch analysis. Classic psychometric parameters were also analyzed.ResultsTests of unidimensionality, and exploratory and confirmatory factor analyses, revealed the presence of three subscales: community services, community attachment, and physical and social environment. To achieve adequate model fit of the three subscales to the Rasch model, one item (distribution of wealth) of the initial 11 was removed and item response categories were rescored. The person separation index was 0.82–0.85, indicating a good reliability. All items were free from gender bias. The three subscales displayed satisfactory convergent validity with the PWI and NWI and were able to discriminate between groups with high and low satisfaction with local place of residence.ConclusionThe CWI, made up of three subscales, is a valid and reliable measure of subjective wellbeing related to the community as assessed by older adults. Further research with this promising measure should focus on cross-national comparisons.

Influencia de los problemas crónicos de salud en las dimensiones del cuestionario EQ-5D: estudio en personas mayores institucionalizadas y no instituzionalizadas

Background: Chronic medical conditions represent risk factors for health related quality of life (HRQOL). The aim of this study is to analyze the influence of self-reported chronic health conditions in HRQOL, measured through the EQ-5D dimensions, in non-institutionalized and institutionalized older adults. Methods: Data were obtained from two studies of quality of life in population aged 60 years or over, in Spain, with a sample of 1,106 community-dwelling adults and 234 residents of care facilities. To analyse the influence of the most prevalent chronic health conditions on HRQOL multiple logistic regression models were adjusted using as dependent variable each EQ-5D dimension, controlling for socio-demographic variables. Results: The chronic health conditions that most influenced the HRQOL of both groups were depression (OR range in the different EQ-5D dimensions: 1.97-6.48), followed by arthrosis/arthritis (OR: 2.81-6.00), sleep problems (OR: 2.81-4.61), diabetes (OR: 1.68-3.44) and hypertension (OR: 1.42-2.45). These problems affected differentially the EQ-5D dimensions and the two groups considered. Pain/discomfort and mobility were the EQ-5D dimensions where more difficulties were reported. Conclusions: The results of this work indicate that the debilitating effect of chronic health conditions on the HRQOL is different for institutionalized and non-institutionalized older adults. They also highlight the importance of promoting healthy ageing to attenuate the negative impact of chronic health conditions on HRQOL in old age.

Self-perceived health status in older adults: regional and sociodemographic inequalities in Spain

OBJECTIVEnTo assess regional and sociodemographic differences in self-perceived health status among older adults.nnnMETHODSnA face-to-face quality of life survey was conducted in a representative sample of the Spanish population comprising 1,106 non-institutionalized elderly aged 60 or more in 2008. Logistic regression models were used to explain self-perceived health status according to the EuroQol Group Visual Analogue Scale (EQ-VAS). Independent variables included sociodemographic and health characteristics as well as the nomenclature of territorial units for statistics level 1 (NUTS1: group of autonomous regions) and level 2 (NUTS 2: autonomous regions).nnnRESULTSnYounger and better off respondents were more likely to have a positive self-perceived health status. Having no chronic conditions, independence in performing daily living activities and lower level of depression were also associated with positive self-perceived health status. People living in the south of Spain showed a more negative self-perceived health status than those living in other regions.nnnCONCLUSIONnThe study results point to health inequality among Spanish older adults of lower socioeconomic condition and living in the south of Spain. The analysis by geographic units allows for international cross-regional comparisons.OBJETIVO: Analisar as diferencas regionais e sociodemograficas no estado de saude percebido por adultos mais velhos. METODOS: Realizou-se um inquerito de qualidade de vida mediante entrevista pessoal com amostra representativa da populacao espanhola de 1.106 pessoas com 60 e mais anos nao institucionalizadas, em 2008. Aplicaram-se modelos de regressao logistica para explicar a saude percebida segundo a escala visual analogica do EuroQol Group (EQ-VAS). As variaveis independentes incluiram caracteristicas sociodemograficas e de saude, assim como unidades territoriais estatisticas de nivel 1 (grupo de comunidades autonomas) e nivel 2 (comunidades autonomas). RESULTADOS: Os participantes dos grupos mais jovens e os que tinham uma melhor situacao economica mostraram maior probabilidade de ter uma percepcao positiva da sua saude. A ausencia de problemas cronicos de saude, a independencia para realizar atividades da vida diaria e menor nivel de depressao tambem se associaram positivamente a saude percebida como boa. Os idosos que viviam no sul mostraram uma percepcao mais negativa da saude do que as que vivem noutras regioes. CONCLUSOES: Os resultados indicam uma desigualdade relativa no estado de saude dos adultos mais velhos de niveis socioeconomicos inferiores e dos habitantes do sul do pais. A analise por unidades territoriais estatisticas permite estabelecer comparacoes entre regioes em nivel internacional.

Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning

OBJECTIVESnThe International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability.nnnMETHODSnNine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses.nnnRESULTSnThe sample was composed of 503 participants aged ≥ 75 years. Alzheimeŕs disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74).nnnCONCLUSIONSnDisability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression.