Gloria Fernández-Mayoralas

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.

Health services accessibility among Spanish elderly.

The paper aims to identify the variables that best explain the use of health services by people aged 65 and over in Spain. The data comes from the 1993 Spanish National Health Survey (ENSE 93). The conceptual framework is the model proposed by Andersen, who suggests that utilisation is a function of predisposition to use the services, the ability to use them and of need. A bivariate and multivariate analysis (SPSS-X Discriminant Procedure) is conducted to define the predictors that best discriminate users and non-users. The use of each health service is explained by a different set of variables. The need variables play a more important role in predicting the use of non-discretionary services that are more closely related to healing processes (medical consultations, emergencies and hospitalisation). The predisposing and enabling variables are more relevant in explaining the use of dental services, indicating a certain degree of inequity of these discretionary services.

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.

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.

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

OBJECTIVE To assess regional and sociodemographic differences in self-perceived health status among older adults. METHODS A 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). RESULTS Younger 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. CONCLUSION The 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

OBJECTIVES The 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. METHODS Nine 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. RESULTS The 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). CONCLUSIONS Disability 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.

Validation of the Functional Independence Scale

OBJECTIVE To assess the psychometric quality of an instrument designed to measure functional independence (Functional Independence Scale [FIS]) in several activities of daily living domains and to be applied by trained non-health-related interviewers. The study was carried out in the autonomous region of Madrid in community-dwelling elders. METHODS We performed a cross-sectional validation study. In addition to the FIS, Pfeiffers questionnaire, the Depression Subscale of the Hospital Anxiety and Depression Scale, the Comorbidity Index, the Barthel Index, and EQ-5D were used. These measures were cross-sectionally applied to community-dwelling elders (n=500) and outpatients in a general hospital (n=100) aged 65 years. The following FIS psychometric attributes were analyzed: acceptability, scaling assumptions, internal consistency, construct validity, and precision. RESULTS A fully computable FIS total score was obtained in 94.3% of the subjects. A ceiling effect (60.65%), but no floor effect (0.22%) was evident in the community-dwelling elders. No floor or ceiling effects were detected in the hospital sample. Scaling assumptions and internal consistency were satisfactory (item-total correlations: 0.57-0.91; Cronbachs alpha: 0.94). Factor analysis identified three factors that explained 74.3% of the variance. Indexes of convergent, internal, and known-groups validity were satisfactory. The scales precision, determined by the standard error of measurement (2.49; 95%CI=4.88), was also satisfactory. CONCLUSION The FIS is an easy-to-use instrument with appropriate metric attributes. This scale can be usefully applied in broad samples of non-institutionalized elders by non-health related personnel.

Health status and well‐being of older adults living in the community and in residential care settings: Are differences influenced by age?

The objective is to identify the differences and the main factors influencing health status and well‐being variables between institutionalized and non‐institutionalized older adults, as well as the interaction effect of institutionalization and age. Data on a total of 468 older adults from a national survey on non‐institutionalized and from a study on institutionalized older people were analyzed. Socio‐demographic variables and measures on well‐being (Personal Well‐being Index, PWI), health status (EQ‐5D), functional ability (Barthel Index), depression (Hospital Anxiety and Depression Scale‐Depression subscale), loneliness and comorbidity were used. Analysis of variance and Kruskal–Wallis tests to examine differences between groups and multiple regression analyses to identify factors associated to health and well-being were performed. Significant differences in health status variables, but not in well‐being were detected between groups. Controlling for age, differences in health status (EQ‐VAS) were found to be not significant in both groups. In the non‐institutionalized group, people aged 78 years or more reported a significantly lower well‐being (PWI) than younger counterparts. Step‐wise multiple regression analysis showed that depression, functional dependence, loneliness and sex were associated with health status; while depression, health status, loneliness and the interaction of age‐institutionalization were related to well‐being. The results suggest that age influences community‐dwelling older adults’ well‐being to a greater extent than it does to institutionalized older people. This finding has implications for resource allocation and interventions addressed to improve health and well‐being in older adults.