Quality of life in people aged 65+ in Europe: associated factors and models of social welfare analysis of data from the SHARE project (Wave 5)

Purpose To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+, and to examine the relationship with models of social welfare in Europe. Methods Cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Instruments: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis: bivariate and multilevel. Results In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared with Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4). Conclusions Perceived quality of life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live

Factor structure of depressive symptoms using the EURO-D scale in the over-50s in Europe. Findings from the SHARE project

Objectives: The aims of this study are: to analyze the factor structure of the EURO-D depression scale; to explore the variables associated with depressive symptoms in the total sample and in the EURO-D factors; and to compare the presence of depressive symptoms and the factor distribution in 15 European countries. Method: 62,182 participants in Wave 5 (2013) of the Survey of Health, Aging and Retirement in Europe (SHARE) were included. Instruments: The SHARE study and the EURO-D scale. Factor, bivariate and multilevel analyses were performed. Results: Higher levels of depressive symptoms were associated with a poorer self-perception of physical health (η2 = 0.22) and economic difficulties (η2 = 0.07). Factor analysis of the EURO-D identified two factors: Suffering and Motivation. Higher levels of depressive symptoms were associated with female gender and younger age (≤ 60) in the Suffering factor, and with less activity and exercise, older age (≥ 71), widowhood and lower educational level in the Motivation factor. Poorer self-perception of physical health and economic difficulties were associated with higher depressive symptomatology in both factors. Conclusions: Poorer self-perception of physical health, female gender, economic difficulties, widowhood, lower levels of activity and exercise and lower educational level were associated with higher depressive symptomatology. In the countries of southern Europe, the Motivation factor predominated

Course of depressive symptoms and associated factors in people aged65+ in Europe: A two-year follow-up

Background: The epidemiology of depressive disorders presents notable differences among European countries. The objectives of the study are to determine the prevalence, incidence, persistence and remission rates of depressive symptoms and to identify risk factors and differences between four European regions. Method: Prospective cohort design using data from waves 5 and 6 (2013-15) of the Survey of Health, Ageing and Retirement in Europe. Sample size included 31,491 non-institutionalized adults aged 65+. Depressive symptoms were assessed using the EURO-D. Results: The prevalence of depressive symptoms (EURO-D ≥4) was 29.8% and 31.5%in waves 5 and 6, respectively. The risk factors associated depressive symptoms were poorer self-rated health, loneliness, impairment in ADL, female gender and financial difficulties. Incidence was 6.62 (99.9% CI: 6.61-6.63)/100 person-years and the persistence and remission rates were 9.22 and 5.78, respectively. Regarding the differences between European regions, the incidence (4.93 to 7.43) and persistence (5.14 to 11.86) rates followed the same ascending order: Northern, Eastern, Continental and Southern. The remission presented higher rates in the Eastern and Southern (6.60-6.61) countries than in the Northern and Continental (4.45-5.31) ones. Limitations: The EURO-D scale is unable to distinguish between clinically relevant depressive symptoms and major depression. Conclusion: The risk factors related to the incidence of depressive symptoms differed across European regions. In countries of eastern and southern Europe the most important predictors were female gender and impairment in ADL. Poorer self-rated health and older age were more relevant in the Northern countries, and chronic diseases were a key factor in the Continental region

Depresión y variables asociadas en personas mayores de 50 años en España

Introducción: La depresión es un trastorno psiquiátrico incapacitante y frecuente en la edad adulta asociado a mayor mortalidad y discapacidad funcional. Objetivos: Determinar la asociación de las variables clínicas y sociodemográficas con la depresión, en una muestra de personas mayores de 50 años residentes en España, y comparar la prevalencia de depresión con los demás países del estudio SHARE (Survey of Health, Ageing and Retirement in Europe) Material y métodos: Muestra de 5.830 participantes de la muestra española de la 'Wave 5', de 2013, del estudio SHARE. Instrumentos: EURO-D (Depresión) y CASP-12 (Calidad de vida). Análisis estadístico: Bivariante y Regresión Logística binaria. Resultados: En la regresión logística binaria, las variables asociadas a la depresión (Euro-D ≥4) fueron, principalmente, la mala percepción de salud física (OR = 13,34 IC 95% 9,74-18,27), la presencia de >2 dificultades en las Actividades de la Vida Diaria (AVD) (OR = 4,46 IC 95% 3,13-6,34) y el género femenino (OR = 2,16; CI95% 1,83-2,56). La depresión fue más frecuente en los participantes que padecían Alzheimer (76,4%), trastornos emocionales (73,9%), Parkinson (57,4%), fractura de cadera (55,4%) y reumatismos (50,9%). En la comparación con países europeos, España tenía un porcentaje de personas con depresión (29,3%) superior a la media europea (27,9%). Conclusiones: Las variables más relevantes asociadas a la depresión fueron la mala percepción de salud física, la presencia de dificultades en las AVD y el género femenino

Three-year Trajectories of Caregiver Burden in Alzheimer's Disease.

Although numerous studies have examined caregiver burden in the context of Alzheimer's disease, discrepancies remain regarding the influence of certain factors. This study aimed to identify trajectories of caregiver burden in the context of Alzheimer's disease, as well as the factors associated with them. A cohort of patients and caregivers (n = 330) was followed up over three years. Growth mixture models were fitted to identify trajectories of caregiver burden according to scores on the Zarit Burden Interview (ZBI). A multilevel multinomial regression analysis was then conducted with the resulting groups and the patient and caregiver factors. In the sample as a whole, burden increased during follow-up (F = 4.4, p = 0.004). Three groups were identified: G1 (initially high but decreasing burden), G2 (moderate but increasing burden), and G3 (low burden that increased slightly). Patients in G1 and G2 presented more neuropsychiatric symptoms and poorer functional status than did those in G3. Caregivers in G1 and G2 had poorer mental health. Spouses and, especially, adult children who lived with their parent (the patient) were more likely to belong to G2 (odds ratio [OR] 6.24; 95% CI 2.89-13.47), as were sole caregivers (OR 3.51; 95% CI 1.98-6.21). The patient factors associated with increased burden are neuropsychiatric symptoms and functional status, while among caregivers, being the sole carer, poor mental health, and living with the patient are of relevance

Symptoms of depression and associated factors in persons aged 50 and over in Europe and Israel: Analysis of data from the SHARE project

It is estimated that by 2020 depression will be the second most common health problem affecting older people. Depressive disorders among the elderly are often under-diagnosed and under-treated despite being one of the main causes of disability, resulting in an increased use of health services, poorer physical health and greater medical costs. The mean prevalence of depressive syndromes among elderly people has been reported to be 13.5% (Beekman et al., 1999). The objective of this study was to identify the variables associated with the presence of depressive symptoms in non-institutionalized individuals aged 50 and over

Depression and variables associated with quality of life in people over 65 in Spain and Europe. Data from SHARE 2013

Background and objectives: The perception of quality of life (QoL) in people over 65 years of age can be affected by individual clinical and sociodemographic characteristics, and also by the nature of the welfare models in place in particular countries. The objective of this study was to compare the association between clinical/sociodemographic variables and QoL in people ≥65 in samples from Spain and from Central-Northern European countries, using data from the SHARE (Survey of Health, Ageing and Retirement in Europe) study. Methods: Data from 22,189 participants in Wave 5 (2013) of the SHARE study were obtained. Instruments: CASP-12 (quality of life) and EURO-D (depression). Statistical analysis: Bivariate and multiple linear regression and correlations. Results: In the regression analysis, the variables most closely associated with a lower QoL (CASP-12) in both groups (Spain, r2 = 0.586 and Central-Northern Europe, (r2 = 0.453) were high depression (β = 0.444 vs. 0.361), poor physical health, economic difficulties, and deficits in activities of daily living (ADL); low level of education was relevant only in the Spanish sample. The mean QoL score in Spain was lower than in the other countries (34.8 ± 6.8 vs. 38.5 ± 5.8, p < 0.001; d = 0.58) and depression was more frequent (34.9% vs 27.4%, p < 0.001; V = 0.06). Conclusions: In all countries, low QoL was associated with high rates of depression and poor physical health. The Spanish sample had lower QoL than their Central-Northern European counterparts. A high rate of depression was the most relevant differential variabl

Causes, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015

Objective: To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. Materials and Methods: It is a prospective population-based cohort study of adults living in the community, 2013-15 (N = 48,691, age ≥50; deceased = 1,944). Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE): Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living (ADL), Frailty and Mobility. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios with confidence intervals (99% CI). Results: The crude mortality rate was 18.39 (1000 person-years at risk), (99% CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). Conclusions: The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed

Course and determinants of anosognosia in Alzheimer's disease: a 12-month follow-up

Anosognosia in Alzheimer's disease (AD) has been associated with greater cognitive impairment and more behavioural and psychological symptoms of dementia (BPSD). This study examines the incidence, persistence, and remission rates of anosognosia over a 12-month period, as well as the related risk factors. This was an observational 12-month prospective study. The longitudinal sample comprised 177 patients with mild or moderate AD, and their respective caregivers. Anosognosia was assessed using the Anosognosia Questionnaire in Dementia, and we also evaluated cognitive status (Mini-Mental State Examination), functional disability (Disability Assessment in Dementia), and the presence of BPSD (Neuropsychiatric Inventory). Multinomial logistic regression was used to determine the variables associated with the incidence, persistence and remission of anosognosia. The prevalence of anosognosia was 39.5% (95% CI = 32.1-47.1) at baseline. At 12 months, incidence was 38.3% (95% CI = 28.6-48.0), persistence was 80.0% (95% CI = 69.9-90.1) and remission was 20.0% (95% CI = 9.9-30.1). The regression model identified lower age, more education, and the presence of delusions as variables associated with incidence, and more education, lower instrumental DAD score, and disinhibition as variables associated with persistence. No variables were associated with remission (n = 14). The presence of anosognosia in AD patients is high. Education and certain neuropsychiatric symptoms may explain a greater and earlier incidence of anosognosia. However, anosognosia also increases with greater cognitive impairment and disease severit

A path analysis of patient dependence and caregiver burden in Alzheimer's Disease

Background: The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants. Methods: Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence. Results: The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioural disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress. Conclusions: Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severit