Estado de saúde percebido em idosos: desigualdades regionais e sociodemográficas na Espanha

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 diferenças regionais e sociodemográficas no estado de saúde percebido por adultos mais velhos. MÉTODOS: Realizou-se um inquérito de qualidade de vida mediante entrevista pessoal com amostra representativa da população espanhola de 1.106 pessoas com 60 e mais anos não institucionalizadas, em 2008. Aplicaram-se modelos de regressão logística para explicar a saúde percebida segundo a escala visual analógica do EuroQol Group (EQ-VAS). As variáveis independentes incluíram características sociodemográficas e de saúde, assim como unidades territoriais estatísticas de nível 1 (grupo de comunidades autônomas) e nível 2 (comunidades autônomas). RESULTADOS: Os participantes dos grupos mais jovens e os que tinham uma melhor situação econômica mostraram maior probabilidade de ter uma percepção positiva da sua saúde. A ausência de problemas crônicos de saúde, a independência para realizar atividades da vida diária e menor nível de depressão também se associaram positivamente à saúde percebida como boa. Os idosos que viviam no sul mostraram uma percepção mais negativa da saúde do que as que vivem noutras regiões. CONCLUSÕES: Os resultados indicam uma desigualdade relativa no estado de saúde dos adultos mais velhos de níveis socioeconômicos inferiores e dos habitantes do sul do país. A análise por unidades territoriais estatísticas permite estabelecer comparações entre regiões em nível internacional.OBJETIVO: Analizar las diferencias regionales y sociodemográficas en el estado de salud percibido por ancianos. MÉTODOS: Se realizó una encuesta de calidad de vida mediante entrevista personal en una muestra representativa de la población española de 1.106 personas con 60 y más años no institucionalizadas en 2008. Se aplicaron modelos de regresión logística para explicar la salud percibida de acuerdo con la escala visual analógica del EuroQol Group (EQ-VAS). Las variables independientes incluyeron características sociodemográficas y de salud, así como unidades territoriales estadísticas de nivel 1 (NUTS1: grupos de comunidades autónomas), y nivel 2 (NUTS2: comunidades autónomas). RESULTADOS: Los participantes de ambos grupos, el de los más jóvenes y los que tenían una mejor situación económica, mostraron mayor probabilidad de tener una percepción positiva de la salud. La ausencia de problemas crónicos de salud, la independencia para desarrollar actividades de la vida diaria y un menor nivel de depresión también se asociaron positivamente a la salud percibida como buena. Los ancianos que vivían en el sur mostraron una percepción más negativa de su salud que aquellos que vivían en otras regiones. CONCLUSIONES: Los resultados muestran desigualdad relativa en el estado de salud de los ancianos de niveles socioeconómicos inferiores y en los habitantes del sur del país. El análisis estadístico por unidades territoriales permite establecer comparaciones entre regiones en nivel internacional

Change and predictors of quality of life in institutionalized older adults with dementia

PURPOSE: This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period. METHODS: Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer's disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline. RESULTS: The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures. CONCLUSIONS: A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults' QoL.This study was funded by the CIEN Foundation, Carlos III Institute of Health (Ref. PI 017/09). We would like to thank the help provided by V Blaya-Novakova in language editing. The Spanish Research Group on Quality of Life and Aging is formed by: M. J. Forjaz, ENS-ISCIII; P. Martinez-Martin, CNE-ISCIII; F. Rojo-Perez, CCHS-CSIC; G. Fernandez-Mayoralas, CCHS-CSIC; B. Frades, Fundación CIEN-ISCIII; B. Leon-Salas, Fundación CIEN-ISCIII; Marina Avila, Fundación CIEN-ISCIII; M. E. Prieto-Flores, UNED; S. Martin, EULEN; I. Martinez, EULEN; C. Rodriguez-Blazquez, CNE-ISCIII; A. Ayala, ENS-ISCIII

Measurement properties of the Community Wellbeing Index in older adults

PURPOSE: The 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. METHODS: The IWI was satisfactorily applied to survey the global quality of life of a community sample of 1,106 people aged 60 years and over residing in Spain. The CWI psychometric properties were studied using Rasch analysis. Classic psychometric parameters were also analyzed. RESULTS: Tests 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. CONCLUSION: The 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.This research was supported by the Spanish Ministry of Science and Innovation (National R&D&I Plan: ref. SEJ2006-15122-C02-00). Prieto-Flores’ position is supported by the Juan de la Cierva program for postdoctoral research, of the Spanish Ministry of Science and Innovation. The Carlos III Institute of Health team is a member of the Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas—CIBERNED). The Spanish Research Group on Quality of Life and Aging is made up as follows: (1) at the Carlos III Institute of Health by M. Joao Forjaz, Pablo Martinez-Martin, Maria-Eugenia Prieto-Flores, Belen Frades-Payo, Carmen Rodriguez-Blazquez and Concepcion Delgado-Sanz; and, (2) at the Spanish National Research Council by Gloria Fernandez-Mayoralas, Fermina Rojo-Perez, Karim Ahmed-Mohamed and Raul Lardies-Bosque

Población mayor, Calidad de Vida y redes de apoyo: demanda y prestación de cuidados en el seno familiar

Esta investigación ha recibido el 2º Premio Caja Madrid de Investigación Social - Edición 2008El trabajo se enfoca desde la doble complementariedad de metodologías cuantitativa y cualitativa, al usar, respectivamente, datos de la encuesta sobre Calidad de Vida de los mayores no institucionalizados en la Comunidad de Madrid –CadeViMa- (diseñada y elaborada por el equipo de investigación en el año 2005), así como Entrevistas en Profundidad a mayores dependientes y Grupos de Discusión a familiares cuidadores (realizados en abril-mayo de 2007)

ドイツ企業買収法をめぐる最近の動向と実務からの提案 (ドイツM&A弁護士との対話3)

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, Pfeiffer's 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; Cronbach's 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 scale's 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.Estudio financiado por la Dirección General de Universidades e Investigación de la Comunidad de Madrid (PlanRegionalI+D+I. Ref.06/HSE/0417/2004) y por el Plan Nacional I+D+I del Ministerio de CienciayTecnología (Ref.BSO2003-00401).S

Care and Active Ageing

Demographic ageing is one of the key social and political challenges of recent decades.There are a number of approaches to ageing, depending on whether the emphasisis placed on biomedical, social or political aspects. From a social perspective, the analysis of ageing requires us to ask how we age and how we can achievethis with quality of life. In an unequal society, ageing varies according to social class, gender, functionality, geographical region, health and social care, among other social dimensions. In the context of care and in accordance with the principles of active ageing, this chapter aims to analyse the perceptions, experiences and values of older people with regard to different forms of ageing and the ways of organising responsibility for the care. It also includes the views of institutional managers and members of civil society organisations. The paradigm of care applied in this study, that reflects on the daily maintenance of the world, of our bodies, of our environment and of our lives, contributes to the concept of active ageing. In addition, the notion of vulnerability allows to acknowledge interdependencies and diverse functionality. The relationships identified in this work between care and active ageing help to deepen the significance of the pillars of health, participation, safety and lifelong learning, which is drawn from the interviews conducted for this study. Self-care and self-determination were identified as central in the process of advancing towards an expanded definition of activeageing with regard to care.Fil: Martín Palomo, María Teresa. Universidad de Almería.; EspañaFil: Venturiello, María Pía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; ArgentinaFil: Fernandez Mayoralas, Gloria. Consejo Superior de Investigaciones Científicas; EspañaFil: Prieto Flores, María Eugenia. Universidad Nacional de la Pampa. Facultad de Ciencias Humanas. Instituto de Geografía.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentin

La accesibilidad de la poblacion anciana a los servicios sanitarios en un area de salud rural

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai

Estado de saúde percebido em idosos: desigualdades regionais e sociodemográfi cas na Espanha

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.Study funded by the Spanish Ministry of Science and Innovation (SEJ2006-15122-C02-01 and SEJ2006-15122-C02-02). The authors declare no confl icts of interest.S

The role of gender in ageing well. A systematic review from a scientific approach

Introducción: La investigación científica ha ido incorporando paulatinamente los factores que influyen en el proceso de envejecimiento. Entre estos, el género es considerado un determinante transversal que afecta a los demás factores del Envejecimiento Activo (World Health Organization, 2002). El objetivo de esta propuesta es examinar el papel del género en la investigación sobre el buen envejecer.Metodología: Se analizaron referencias procedentes de una base bibliográfica con 2143 entradas, obtenidas mediante búsqueda sistemáticaen bases referenciadas entre los años 1997 y 2015, en los campos de título, resumen y palabras clave, de términos en inglés y español asociadosal buen envejecer. La búsqueda fue realizada en plataformas nacionales e internacionales. Posteriormente, fue complementada con unaestrategia de bola de nieve.Resultados: A partir de la base matriz fueron retenidas 214 referencias en las que género o sexo tenían un lugar destacado. Para los propósitos de esta aportación fueron retenidos 33 documentos que utilizaron una perspectiva de género, principalmente en aquellas publicaciones del ámbito de las Ciencias Sociales que desarrollaron los conceptos de envejecimiento activo oenvejecimiento con éxito. Como resultados más relevantes se destacan: i) las diferencias entre hombres y mujeres que causa el desempeño de actividades distintas (trabajo remunerado o empleo, y trabajo no remunerado, doméstico, incluyendo actividades de cuidado); ii) las consecuencias que tienen los roles de género en la participación de las personas mayores; y iii) el estado de saludpsicosocial en la vejez.Conclusiones: Aunque el marco de acción para el Envejecimiento Activo destacó el género como determinante transversal, la investigación en envejecimiento desde una aproximación de género es aún escasa. Líneas futuras habrán de considerar estos resultados para dinamizar y generar conocimiento sobre el papel del género en la vejezIntroduction: Scientific research has slowly been incorporating the factors that influence the process of ageing. Among them, gender has been considered a cross determinant which affects all other factors of Active Ageing (World Health Organization, 2002). This paper provides a review of the role of gender on ageing well. Methods: A bibliographical database with 2143 references, selected from several national and international referenced databases, was used. These references were obtained by a systematic search of terms related to ageing well (active, healthy, successful, productive) in Spanish and English, carried out through title, keywords, and abstract. Eligible studies were published between 1997 and 2015. This systematic review was complemented with a snowball strategy. Results: From the general database, 214 references were initially selected, in which sex or gender had some sort of importance. But only 33 studies that provide a gender perspective were retained from reviewing the abstract and/or the complete document, especially on those related to Social Sciences, which developed the concepts of Active Ageing or Successful Ageing. The most relevant treated areas were focused on: i) differences between men and women caused by different labour force roles (paid work and domestic work, including care activities); ii) consequences of gender roles on participation; iii) psychosocial health status on older people. Conclusions: Although the policy framework for Active Ageing gives importance to gender as a cross determinant, research carried out from a gender perspective is yet limited. Future research may consider these results to revitalize and create knowledge about gender influence on ageing well.Este artículo forma parte de los resultados de investigación del Programa de actividades de I+D ENCAGE-CM (Comunidad de Madrid-FEDER , ref.S2015/HU M-3367; Coord.: G. Fernández-Mayoralas); del proyecto I+D+i ENVACES (MINECO -FEDER , ref. CSO 2015-64115-R; IP . F. Rojo-Pérez); y de la red de excelencia ENACTIBE (MINECO -FEDER , ref. CSO 2015-71193-REDT ; IP . V. Rodríguez