Javier Damián

Determinants of self assessed health among Spanish older people living at home.

STUDY OBJECTIVE: To identify the main determinants of self assessed health among community dwelling elderly. PARTICIPANTS AND SETTING: A representative sample of 677 people aged 65 and over of the city of Madrid, Spain. DESIGN: Cross sectional study. Information was collected through personal interviews at the homes of the selected subjects. The five category dependent variable was grouped into two categories: good and poor self assessed health. Age, sex, social class, use of physician services, number of chronic conditions, and functional capacity, were included as main explanatory factors. Adjusted odds ratios were estimated through multiple logistic regression models. MAIN RESULTS: A total of 49.5% of subjects rated their health as good or very good. Those aged 85 and over rated their health higher than those aged 65-74 (adjusted odds ratio (OR): 0.37; 95% confidence intervals (CI): 0.18, 0.77). The adjusted OR for an increase of three chronic conditions was 3.48 (95% CI: 2.49, 4.85). Functional capacity also showed a strong independent effect (OR: 3.64; 95% CI: 1.89, 7.02). Social class was one of the main determinants for the youngest group, with those in the upper class reporting a better health perception (OR: 3.28 95% CI: 1.70, 6.35), but showed no effect in the oldest old (OR: 1.05; 95% CI: 0.57, 1.96). CONCLUSIONS: Age, chronic conditions, and functional status were the main determinants of perceived health among Spanish elderly. The effect of social class on perceived health markedly decreases with age. This study may contribute to a better utilisation and interpretation of self ratings in research and in general practice.

Arsenic in public water supplies and cardiovascular mortality in Spain

BACKGROUND High-chronic arsenic exposure in drinking water is associated with increased cardiovascular disease risk. At low-chronic levels, as those present in Spain, evidence is scarce. In this ecological study, we evaluated the association of municipal drinking water arsenic concentrations during the period 1998-2002 with cardiovascular mortality in the population of Spain. METHODS Arsenic concentrations in drinking water were available for 1721 municipalities, covering 24.8 million people. Standardized mortality ratios (SMRs) for cardiovascular (361,750 deaths), coronary (113,000 deaths), and cerebrovascular (103,590 deaths) disease were analyzed for the period 1999-2003. Two-level hierarchical Poisson models were used to evaluate the association of municipal drinking water arsenic concentrations with mortality adjusting for social determinants, cardiovascular risk factors, diet, and water characteristics at municipal or provincial level in 651 municipalities (200,376 cardiovascular deaths) with complete covariate information. RESULTS Mean municipal drinking water arsenic concentrations ranged from <1 to 118 microg/L. Compared to the overall Spanish population, sex- and age-adjusted mortality rates for cardiovascular (SMR 1.10), coronary (SMR 1.18), and cerebrovascular (SMR 1.04) disease were increased in municipalities with arsenic concentrations in drinking water > 10 microg/L. Compared to municipalities with arsenic concentrations < 1 microg/L, fully adjusted cardiovascular mortality rates were increased by 2.2% (-0.9% to 5.5%) and 2.6% (-2.0% to 7.5%) in municipalities with arsenic concentrations between 1-10 and >10 microg/L, respectively (P-value for trend 0.032). The corresponding figures were 5.2% (0.8% to 9.8%) and 1.5% (-4.5% to 7.9%) for coronary heart disease mortality, and 0.3% (-4.1% to 4.9%) and 1.7% (-4.9% to 8.8%) for cerebrovascular disease mortality. CONCLUSIONS In this ecological study, elevated low-to-moderate arsenic concentrations in drinking water were associated with increased cardiovascular mortality at the municipal level. Prospective cohort studies with individual measures of arsenic exposure, standardized cardiovascular outcomes, and adequate adjustment for confounders are needed to confirm these ecological findings. Our study, however, reinforces the need to implement arsenic remediation treatments in water supply systems above the World Health Organization safety standard of 10 microg/L.

Riesgo coronario atribuible a los factores de riesgo cardiovascular en población española

Introduccion y objetivos La carga de enfermedad coronaria atribuible a los factores de riesgo cardiovascular en Espana ha sido extrapolada tradicionalmente de otras poblaciones. Este estudio pretende estimar el riesgo coronario atribuible al tabaquismo, la hipercolesterolemia, la hipertension, la diabetes y el sobrepeso, utilizando datos procedentes de poblaciones Espanolas. Metodos Las prevalencias de los factores de riesgo en la poblacion general se obtuvieron de un metaanalisis de 48 estudios transversales realizados en Espana, y las prevalencias en enfermos coronarios se tomaron de los registros hospitalarios multicentricos PRIAMHO II y PREVESE II. Los riesgos relativos brutos y ajustados de enfermedad coronaria se obtuvieron del seguimiento durante 5 anos de una cohorte de atencion primaria de 6.124 personas adultas libres de enfermedad cardiovascular. Las fracciones atribuibles brutas y ajustadas se calcularon para ambos sexos y para varones y mujeres por separado. Resultados En los varones, el 42,5% (intervalo de confianza [IC] del 95%, 6,8%-59,6%) de la incidencia ajustada de enfermedad coronaria se atribuyo al sobrepeso; el 33,9% (IC del 95%, 22,6%-41%), al tabaquismo, el 19,4% (IC del 95%, 8,2%-26,5%), a la hipercolesterolemia, y el 15,5% (IC del 95%, 1,6%-24,6%), a la hipertension. En las mujeres, el 36,5% (IC del 95%, –8%-56,3%) de los casos de cardiopatia isquemica se atribuyeron al sobrepeso, el 24,8% (IC del 95%, 12%-31,9%), a la diabetes y el 20,1% (IC del 95%, 6,1%-28,6%), a la hipercolesterolemia. Conclusiones El sobrepeso y el tabaquismo en varones son los factores de riesgo cardiovascular a los que cabe atribuir un mayor impacto poblacional en la enfermedad coronaria.

Prevalence of Urinary Incontinence among Spanish Older People Living at Home

Objective: To estimate the prevalence and characteristics of urinary incontinence (UI) in the noninstitutionalized elderly population of Madrid, Spain. Methods: We carried out a cross-sectional study in a representative sample of all community-dwelling people aged 65 or over. Subjects were interviewed in their homes. The question: Do you currently experience any difficulty in controlling your urine? ... In other words, does your urine escape involuntarily? was used to identify UI. Type of UI, use of absorbents and specific drugs were also assessed, as well as consultation behavior. Results: 589 persons were interviewed (response rate: 71.2%). The prevalence of UI was 15.5%. No significant difference was observed between men and women. Urge UI was the main type for men and mixed UI for women. Use of pads was referred by 20.2%. A total of 34.3% of subjects never went to the doctor for their problem (25.2% of men and 39.4% of women). Conclusion: Compared to other populations the overall prevalence of UI in Spanish elders living at home is relatively high. A very small difference by gender was found, although a lower response rate in women could in part explain this unexpected finding.

Factors associated with falls among older adults living in institutions

AbstractBackgroundFalls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions.MethodsData were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy.ResultsThe final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]); antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]); arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with ≤ 1 condition) was 84% (95% CI, 45-95%).ConclusionsNumber of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337

Factors associated with self-rated health in older people living in institutions

BackgroundAlthough self-rated health has been extensively studied in community older people, its determinants have seldom been investigated in institutional settings. We carried out a cross-sectional study to describe the physical, mental, and social factors associated with self-rated health in nursing homes and other geriatric facilities.MethodsA representative sample of 800 subjects 65 years of age and older living in 19 public and 30 private institutions of Madrid was randomly selected through stratified cluster sampling. Residents, caregivers, physicians, and nurses were interviewed by trained geriatricians using standardized instruments to assess self-rated health, chronic illnesses, functional capacity, cognitive status, depressive symptoms, vision and hearing problems, and social support.ResultsOf the 669 interviewed residents (response rate 84%), 55% rated their health as good or very good. There was no association with sex or age. Residents in private facilities and those who completed primary education had significantly better health perception. The adjusted odds ratio (95% confidence interval) for worse health perception was 1.18 (1.07–1.28) for each additional chronic condition, 2.37 (1.38–4.06) when comparing residents with moderate dependency to those functionally independent, and 10.45 (5.84–18.68) when comparing residents with moderate/severe depressive symptoms to those without symptoms. Visual problems were also associated with worse health perception. Similar results were obtained in subgroup analyses, except for inconsistencies in cognitively impaired individuals.ConclusionChronic conditions, functional status, depressive symptoms and socioeconomic factors were the main determinants of perceived health among Spanish institutionalized elderly persons. Doubts remain about the proper assessment of subjective health in residents with altered cognition.

Parkinson disease: Depression and anxiety in Parkinson disease

Evidence suggests that both anxiety and depression might have pathophysiological links with Parkinson disease (PD), as these mood disorders are more prevalent in individuals with PD than in patients with other chronic conditions. A new study reports that depression and anxiety are associated with different patterns of PD-related factors, suggesting divergence between the underlying mechanisms.

Descriptive epidemiology of undetected depression in institutionalized older people.

OBJECTIVE To measure the prevalence and associated factors of undetected depression in institutionalized older people. DESIGN AND SETTING Epidemiologic cross-sectional study in nursing homes and residential facilities. PARTICIPANTS A stratified cluster sample of residents 65 years of age and older living in institutions of Madrid (Spain). MEASUREMENTS Residents were considered to be depressed if they met at least 1 of the following 3 criteria: 10-item Geriatric Depression Scale score of 4 or higher, physicians diagnosis, or antidepressant use. Prevalence of undetected depression was defined as the proportion of depressed residents without documented diagnosis or treatment. RESULTS A total of 255 of 579 residents had depression (weighted prevalence 46.1%, 95% confidence interval [CI] 41.0%-51.3%) and 108 depressed residents were undetected (undetection prevalence 41.5%, 95% CI 33.2%-50.2%). Undetection was lower in younger residents, private versus public facilities (sex-, age-, and size-adjusted prevalence ratio [PR] 0.59, 95% CI 0.37-0.94), and larger facilities (sex-, age-, and ownership-adjusted PR 0.94 per 50-bed increase, 95% CI 0.88-1.00). Undetected depression was higher in residents with poor self-rated health (sex- and age-adjusted PR 1.83, 95% CI 1.24-2.73), whereas the opposite came about for physician-rated health (PR 0.65, 95% CI 0.44-0.95). Undetection decreased 11% (95% CI 4%-17%) per 1-medication increase, and it was lower in patients with Alzheimer disease, anxiety, and arrhythmia. CONCLUSIONS Number of medications and self-rated health were the main determinants of undetected depression. Physician-rated health, facility characteristics (size and ownership), and some diseases could also be considered.

Estado de salud y capacidad funcional de la población que vive en residencias de mayores en Madrid

Objetivos: Los estudios epidemiologicos sobre muestras probabilisticas de poblacion institucionalizada en Espana son muy escasos. El objetivo de este trabajo es describir el estado de salud y la capacidad funcional de una poblacion de personas mayores que viven en residencias. Sujetos y metodo: Se realizo un estudio epidemiologico transversal. Mediante un muestreo estratificado por conglomerados, se selecciono a 800 residentes de 19 residencias publicas y 26 privadas de Madrid. Se entrevisto a los residentes, a los cuidadores principales, a los medicos y a las enfermeras. Se valoraron el estado cognitivo, la salud percibida, la depresion, el dolor, la capacidad funcional, las enfermedades cronicas, las ulceras por presion, la incontinencia urinaria y fecal, el consumo de farmacos y los ingresos hospitalarios. Resultados: El 75% eran mujeres. La edad media ± desviacion tipica fue de 83,4 ± 7,3 anos. El 44% presento algun grado de deterioro cognitivo. El 46% presento independencia total o dependencia leve en las actividades basicas de la vida diaria. El 55% declaro una salud percibida muy buena o buena. El 30% presento sintomas depresivos. El 31% refirio dolor diario en los ultimos 7 dias. El 3% tenia ulceras por presion. Las enfermedades mas prevalentes fueron hipertension, artrosis, demencias y trastorno de ansiedad (45, 34, 33 y 27%, respectivamente). La prevalencia de demencia de Alzheimer fue del 14%. El 53% tenia incontinencia urinaria y el 26% fecal. El 26% fue trasladado a urgencias en el ano anterior. Conclusiones: Las estimaciones en las principales variables, como estado cognitivo y capacidad funcional, son en general mas favorables que en otras poblaciones de residentes en Europa y Norteamerica. Esto se explica en parte por la mayor proporcion de personas con baja necesidad de cuidados en las residencias de Madrid.

Analysis of disability using WHODAS 2.0 among the middle-aged and elderly in Cinco Villas, Spain

BACKGROUND The prevalence of disability, as defined by the International Classification of Functioning, Disability and Health (ICF), among the middle-aged and elderly population is poorly known. OBJECTIVE To determine disability prevalence in a resident population sample aged ≥50 years, in the Cinco Villas district, Spain, from June 2008 through June 2009. METHODS We used the WHODAS 2.0 36-item questionnaire to quantify the prevalence of disability, globally and by domain, together with a 13-item combined measure of three domains, Getting around, Self-care and Life activities, claimed to reflect the need of integrated services. In addition, we performed exploratory analyses of the relationship between disability and different variables using ordinal logistic regression. RESULTS Disability was detected by global WHODAS score in 604 of a total of 1214 persons, i.e., a prevalence of 49.8% 95% CI (46.9-52.5), with the corresponding figures for mild, moderate, severe, and extreme disability being 26.8%, 16.0%, 7.6% and 0.1%, respectively. Disability increased with age, was higher among women, and for specific domains. Prevalence of severe/extreme disability among women vs. men was as follows: Getting around, 26.8% vs. 12.1%; Life activities, 25.2% vs. 6.8%; and Self-care, 9.5% vs. 6.0%. Disability was more frequent among subjects diagnosed with dementia, chronic liver disease, severe mental disease, and stroke. The abovementioned 13-item measure yielded prevalence figures for disability levels quite similar to those obtained using 36-item scores. CONCLUSIONS For the first time, this study furnishes detailed disability prevalence figures and data on associated variables in a middle-aged and elderly Western population.