Maria-Eugenia Prieto-Flores

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.

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.

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.

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.

Identifying Connections Between the Subjective Experience of Health and Quality of Life in Old Age

The importance of qualitative methods in quality of life (QoL) studies is being increasingly recognized. Whereas attention has mainly focused on the exploration of relevant domains, subjective well-being, and representations of health in aging, less consideration has been given to relations among different QoL domains. We aimed in this research to identify connections between subjective health and other relevant domains from the perspective of older adults. We identified four central categories: adaptation to the limits of health in aging; seeking a balance in subjective health and QoL in aging; sense of place in centers for older people; and health and family interrelated dimensions of QoL in old age. According to the participants, the family domain positively impacts health as a consequence of contacts, support, and accomplishments. It might also have a negative impact as a result of a relatives’ death or severe disease. The qualitative QoL perspective contributes to capturing the multidimensionality of health, aging, and place.

Individual's perspective of local community environment and health indicators in older adults

Aim:  This study evaluated the relationship between individuals perspective of local community environment and health in older people.

Rasch analysis of the International Wellbeing Index in older adults

BACKGROUND The International Wellbeing Index is a measure of general quality of life formed by two scales: the Personal Wellbeing Index (PWI) and the National Wellbeing Index (NWI). This paper studies the psychometric properties of the PWI and NWI, using Rasch analysis and classic psychometric methods. METHODS The PWI and NWI were applied to a representative sample of 1106 community-dwelling adults, aged 60 years and over, residing in Spain. Mean ± standard deviation age was 72.07 ± 7.83 years and 56.3% were women. RESULTS Five PWI items (achieving in life, relationships, safety, community connectedness, and future security), and five NWI items (economic situation, state of environment, social conditions, business, and national security of the country) fitted the Rasch model. After adjusting the response scale format, satisfactory fit was obtained, with good reliability (person separation index of 0.91 for both the PSI and NWI), local independency of items, and strict unidimensionality. The measures showed adequate external construct validity with related measures. CONCLUSIONS The PWI and the NWI, with fewer items and simpler response scale formats, provided valid and reliable linear measures in older adults, according to Rasch and classic psychometric analyses.

¿Cómo interpretan el envejecimiento activo las personas mayores en España? Evidencias desde una perspectiva no profesional / How do elderly people in Spain assess active aging? Evidence from a lay-perspective

espanolLa poblacion espanola esta envejeciendo lo que, unido a una mejora de condiciones de vida, hace aumentar las posibilidades de desarrollar un envejecimiento activo. Investigadores y agentes sociales han intentado medirlo, a pesar de su dificultad. Este trabajo pretende analizar como las personas mayores en Espana construyen su envejecimiento activo, evaluando sus dimensiones, factores y efectos en su estilo de vida. Los datos cuantitativos proceden de la Encuesta Piloto del Estudio Longitudinal Envejecer en Espana (ELES-EP). Se complementan con 7 grupos focales a 50 personas de 50 y mas anos, participantes en ELES-EP, y 10 entrevistas en profundidad con responsables de organizaciones de la sociedad civil de personas mayores. Analizados con ATLAS.ti, aportan una vision no profesional sobre el envejecimiento activo. Los resultados muestran que estas personas en Espana no definen claramente el envejecimiento activo, pero identifican factores condicionantes relacionados con el pilar “participacion”, las actividades principales (personales, culturales y sociales, de disfrute de tiempo libre, de participacion en iniciativas sociales) y los beneficios que consiguen. Esta vision no profesional puede ser asi comparada con la identificada en la literatura cientifica. Estudios futuros deberian encaminarse a obtener las claves para la conceptualizacion del envejecimiento activo por los propios protagonistas. EnglishThe Spanish population is becoming older and alternatives for the development of an active living in different social contexts arise. Efforts to make active ageing an operative concept under professional and non-professional views (research, social agents, individuals) have been made. The paper aims at analysing how older adults in Spain build their active ageing, by studying the dimensions, factors and consequences that derive from their way of living. Quantitative data come from the Longitudinal Aging Study in Spain, Pilot Survey, ELES-PS, completed those from seven focus groups, composed by 50 individuals older than 50, participants in ELES-PS, and 9 indepth interviews with senior social organizations officers. Qualitative data have been analysed with ATLAS.ti. Results show that older people in Spain do not clearly define what active ageing is for them, but their discourses allows identifying some conditioning factors of their active behaviour, their main declared activities (personal, cultural, social activities, leisure time in general, involvement in some social participation interests) and the benefits they get. Literature on active ageing will allow comparison with active ageing’s lay vision. Future research should aim to obtain the keys for the conceptualization of active aging by the older people themselves.

Análisis espacial de la mortalidad por enfermedades cardiovasculares en la ciudad de Madrid, España

BACKGROUND Cardiovascular disease is the leading cause of death worldwide, but its spatial distribution is not homogeneous. The objective of this study is to analyze the spatial pattern of mortality from these diseases for men and women, in the populated urban area (AUP) of the municipality of Madrid, and to identify spatial aggregations. METHODS An ecological study was carried out by census tract, for men and women in 2010. Standardized Mortality Ratio (SMR), Relative Risk Smoothing (RRS) and Posterior Probability (PP) were calculated to consider the spatial pattern of the disease. To identify spatial clusters the Moran index (Moran I) and the Local Index of Spatial Autocorrelation (LISA) were used. The results were mapped. RESULTS SMR higher than 1.1 was observed mainly in central areas among men and in peripheral areas among women. The PP that RRS was higher than 1 surpassed 0.8 in the center and in the periphery, in both men and women. Morans I was 0.04 for men and 0.03 for women (p <0.05 in both cases). CONCLUSIONS Sex differences were observed in the spatial distribution of mortality cases. RME RRS and PP maps showed a heterogeneous pattern in men, whereas in women a clearer pattern was detected, with a relatively higher risk in peripheral areas of the AUP. The LISA method showed similar patterns to those previously observed.Background: Cardiovascular disease is the leading cause of death worldwide, but its spatial distribution is not homogeneous. The objective of this study is to analyze the spatial pattern of mortality from these diseases for men and women, in the populated urban area (AUP) of the municipality of Madrid, and to identify spatial aggregations. Methods: An ecological study was carried out by census tract, for men and women in 2010. Standardized Mortality Ratio (SMR), Relative Risk Smoothing (RRS) and Posterior Probability (PP) were calculated to consider the spatial pattern of the disease. To identify spatial clusters the Moran index (Moran I) and the Local Index of Spatial Autocorrelation (LISA) were used. The results were mapped. Results: SMR higher than 1.1 was observed mainly in central areas among men and in peripheral areas among women. The PP that RRS was higher than 1 surpassed 0.8 in the center and in the periphery, in both men and women. Morans I was 0.04 for men and 0.03 for women (p <0.05 in both cases). Conclusions: Sex differences were observed in the spatial distribution of mortality cases. RME RRS and PP maps showed a heterogeneous pattern in men, whereas in women a clearer pattern was detected, with a relatively higher risk in peripheral areas of the AUP. The LISA method showed similar patterns to those previously observed.