Proximity to Facilities and Its Association with the Health-Related Habits of Functionally Independent Older Adults

The aim was to examine how proximity to facilities, as a component of community determinants, is associated with the health-related habits of functionally independent community-dwelling older adults. This was a cross-sectional study. Data were collected by face-to-face interviews. Participants were >65 years old, living in 15 municipalities of Gipuzkoa (Basque Country, Spain). Proximity to park-green spaces, cultural-sport centers, market-food stores, retirement associations, religious centers, primary care centers and hospitals was explored. Sociodemographic variables and health-related habits (diet, physical activity and self-perceived social life) were collected. Logistic regression models were performed. The sample comprised of 634 individuals (55% women; mean age: 74.8, SD 6.7 years). Older age (odds ratio-OR: 0.94, 95% CI: 0.91–0.97) was associated with lower physical activity, while being male (OR: 1.71, 95% CI: 1.08–2.68) and proximity to park-green spaces (OR: 1.64, 95% CI: 1.03–2.61) were related to more physical activity. Individuals with good self-perceived health (OR: 3.50, 95% CI: 1.82–6.74) and religious centers within walking distance (OR: 2.66, 95% CI: 1.40–5.04) had higher odds of a satisfactory social life. Encouraging the creation of park-green spaces and leisure centers near residential areas can assist in promoting physical activity and improving the social life of older adults

Variables associated with COVID-19 severity: an observational study of non-paediatric confirmed cases from the general population of the Basque Country, Spain

Objectives To investigate which were the most relevant sociodemographic and clinical variables associated with COVID-19 severity, and uncover how their inter-relations may have affected such severity.Design A retrospective observational study based on electronic health record data.Participants Individuals ≥14 years old with a positive PCR or serology test, between 28 February and 31 May 2020, belonging to the Basque Country (Spain) public health system. Institutionalised and individuals admitted to a hospital at home unit were excluded from the study.Main outcome measure Three severity categories were established: primary care, hospital/intensive care unit admission and death.Results A total of n=14 197 cases fulfilled the inclusion criteria. Most variables presented statistically significant associations with the outcome (p<0.0001). The Classification and Regression Trees recursive partitioning methodology (based on n=13 792) suggested that among all associations, those with, age, sex, stratification of patient healthcare complexity, chronic consumption of blood and blood-forming organ, and nervous system drugs, as well as the total number of chronic Anatomical Therapeutic Chemical types were the most relevant. Psychosis also emerged as a potential factor.Conclusions Older cases are more likely to experience more severe outcomes. However, the sex, underlying health status and chronic drug consumption may interfere and alter the ageing effect. Understanding the factors related to the outcome severity is of key importance when designing and promoting public health intervention plans for the COVID-19 pandemic

Inequalities in health-related quality of life according to age, gender, educational level, social class, body mass index and chronic diseases using the Spanish value set for Euroquol 5D-5L questionnaire

Abstract Background Reducing health inequalities on the basis of social factors has been a key driver in the development of Public Health policies. Health-related quality of life is a global indicator useful to assess health inequalities within a society. The objective of this study was to identify inequalities on health by analysing the interactive effects of gender, age, educational level, social class, body mass index and chronic diseases on health-related quality of life in a Spanish population sample. Methods We used data from the Spanish National Health Survey 2011–2012. Health-related quality of life was measured by the EQ-5D-5L instrument applying the Spanish value set. Probability of being in perfect health was ascertained by logistic regression models including gender, age, educational level, body mass index and social class and the corresponding terms of interaction. A two-part model combining logistic regression analysis and generalized linear models was applied to calculate the adjusted utility loss associated with chronic conditions (disutility values). Results The sample used for analysis contained 18,450 individuals. The mean age was 50 years, 51.3% were women, 55% were overweight or obese and 46.7% had low social status. The mean utility was 0.94 in men and 0.89 in women. Elderly women, obese people, those of low social class and those with chronic conditions had significant lower utility values. Within the regression analysis, interaction assessment revealed that the detrimental effect of obesity disappeared in higher social classes. Utility values for all chronic conditions considered were lower in women than in men and were on a gradient within social class, the lowest for individuals declaring stroke. The greatest decrease on health-related quality of life was determined by declaration of stroke (17.6%) or mental diseases (18.6%). Conclusions The interactive effects of gender, age, educational level, social class, body mass index and chronic diseases on health-related quality of life in the Spanish population revealed important inequalities in health. Social class acted as a modulator of the stigma associated with obesity. Chronic conditions producing loss of autonomy had the greatest impact on reduction of health-related quality of life. This is the first study using the Spanish EQ-5D-5L value set to estimate utilities

Dietary Patterns and Their Relationship with Frailty in Functionally Independent Older Adults

The impact of dietary patterns rather than single foods or nutrients on health outcomes is increasingly recognized. This cross-sectional study examines the dietary patterns of 527 non-institutionalized functionally independent older people aged ≥70 years from Gipuzkoa (Spain). Sociodemographic characteristics, health status, anthropometric measures and dietary data are collected. Multiple correspondence analysis (MCA) and cluster analysis are performed to identify dietary patterns and groups of individuals. Frequency of selected food items and compliance with food recommendations are included in the MCA. A high proportion of the sample population are overweight or obese, whereas only 3.3% are at risk of malnutrition (determined with the Mini Nutritional Assessment). Frail individuals (n = 130), measured with the Timed-Up and Go test are older, have a lower educational level, are more obese, present a poorer health status (more depressive symptoms, polypharmacy and falls, among others) and worse compliance with food recommendations than robust individuals (n = 392). Three groups of individuals are identified: cluster one (n = 285), cluster two (n = 194) and cluster three (n = 48). A gradient of increasing frailty and poorer health status is observed from cluster one to cluster three. The latter also shows the poorest dietary pattern, regarding dietary recommendations. The use of an easy-to-use tool to assess diet allows detection of differences among the three clusters. There is a need to increase awareness on the implementation of nutritional screening and a subsequent dietary assessment in primary care settings to provide nutritional care to elder, and moreover, frail individuals

Desigualdades sociales en salud en población mayor: revisión de los indicadores empleados en España

Objective: To identify the indicators of social position used to evaluate inequalities in health among the population aged 65 and over in Spain. Method: A systematic search of the literature published in English and Spanish since 2000 in health and social databases was carried out. Primary and secondary studies analyzing these inequalities in Spain were included. The indicators used were identified, as well as the advantages and limitations pointed out by the authors. The main findings were synthesized in a review of the literature. Results: We included 87 studies, described in 89 articles. The socioeconomic indicators employed were both individual and ecological. Among the former, educational level was the most analyzed socioeconomic variable (n = 73). Other individual variables used were occupation (n = 17), objective economic level (n = 16), subjective economic level (n = 4), housing and household material wealth (n = 6), relationship with work activity (n = 5), and mixed measures (n = 5). Among the ecological indicators, simple (n = 3) and complex indices (n = 7) were identified. The latter had been constructed based on several indicators, such as educational level and unemployment. Inequalities in multiple health indicators were analyzed, self-perceived health being the only indicator assessed according to all the socioeconomic indicators described. Conclusions: A wide variety of indicators is identified for the evaluation of social inequalities in health among the elderly population. There have not been sufficiently assessed from a gender perspective; this is a line of interest for future research.Este artículo ha sido realizado en el marco del Grupo de Trabajo de Determinantes Sociales de la Salud de la Sociedad Española de Epidemiología, que ha financiado los costes de publicación

Desigualdades socioeconómicas en la salud de la población mayor en España.

OBJECTIVE: To examine socioeconomic inequalities in health in the older population in Spain. METHOD: A systematic search and review of the literature published between 2000 and 2017 in English and Spanish was conducted in Social Science Citation Index, Sociology Database, Scopus, PubMed and Embase. Primary and secondary studies analysing these inequalities in Spain were included. Two researchers were responsible for the selection of the studies and the extraction of the information (first author, year of publication, region, design, population/sample, socioeconomic and health indicators used, and main results). RESULTS: A total of 89 articles were included, corresponding to 87 studies. Of the studies, 81.6% were cross-sectional, 88.5% included only non-institutionalised population and 35.6% were carried out at a national level. The studies analysed social inequalities in the following health indicators: functional status (n=29), morbidity (n=19), self-perceived health (n=18), mental and emotional health (n=10), cognitive status (n=7), quality of life (n=9), mortality (n=15) and life expectancy (n=2). Socioeconomic inequalities were detected in all of them, although the magnitude varied depending on the socioeconomic and health indicator used. The educational level and the ecological indexes were the indicators that detected more inequalities in health. The impact of inequalities by sex was different in functional status, morbidity, self-perceived health, mental and emotional health and mortality. CONCLUSION: There are socioeconomic inequalities in health among the elderly population and their magnitude varies by sex in some of the health indicators. The increase in educational level and the maintenance of sufficient pensions can be key policies that contribute to the reduction of inequalities in this population group

Desigualdades de género en los impactos del cuidado informal de mayores dependientes en Gipuzkoa: Estudio CUIDAR-SE

Background: The provision of informal care determines the existence of health inequalities, as well as gender inequalities, because of women being the most frequent caregivers. The objectives of this study were to characterize the informal caregivers of elderly dependents in Gipuzkoa, to know the impact of caring on health and health related quality of life (HRQoL), and to explain the relationship between sex and consequences attributable to care. Methods: Cross-sectional study analyzing health (self-perceived health and GHQ-12) and HRQoL (EQ-5D-5L) data of 123 women and 103 men who took care of a dependent elderly and participated in the first wave of the CUIDAR-SE study in Gipuzkoa. A descriptive study was performed, and a logistic regression analysis was carried out to examine the association between sex and the consequences attributable to care. Results: Women and men were over 60 years old, married, with primary education or less, and took care of their parents mainly. Women presented worse perceived health (46.3% vs 32.0%) and mental health (23.3% vs 13.9%), and more problems in the dimensions of anxiety/depression (35.0% vs 21.4%) and pain/discomfort (52.8% vs 31.1%) of EQ-5D-5L.The regression model showed greater risk of fatigue (OR = 2.83; 95% CI:1.53-5.24) and burden (OR = 1.87; 95% CI: 1.06-3.29) among women than among men. Conclusions: There are gender inequalities in the provision of informal care to dependent elderly people in Gipuzkoa, with women having a greater impact on their health and HRQoL than men. Considering the organization of care in this province, it will be necessary to design improvement actions more suited to the needs of caregivers.Fundamentos: La prestación de cuidados informales determina la existencia de desigualdades en salud, a las cuales se suman las desigualdades de género por el papel mayoritario de las mujeres en dicha prestación. Los objetivos de este estudio fueron caracterizar a la población cuidadora informal de mayores dependientes en Gipuzkoa, conocer los impactos de cuidar sobre la salud y la calidad de vida relacionada con la salud (CVRS), y explicar la relación entre el sexo y las consecuencias atribuibles al cuidado. Métodos: Estudio transversal en el que se analizaron datos de salud (salud percibida y GHQ-12) y CVRS (EQ-5D-5L) de 123 mujeres y 103 hombres cuidadores de mayores dependientes que participaron en la primera oleada del estudio CUIDAR-SE en Gipuzkoa. Se realizó un estudio descriptivo, y un análisis de regresión logística para examinar la asociación entre el sexo y las consecuencias del cuidado. Resultados: Mujeres y hombres tenían más de 60 años, estaban casadas/os, tenían educación primaria o inferior, y cuidaban a sus progenitores fundamentalmente. Las mujeres presentaban peor salud percibida (46,3% vs 32,0%) y mental (23,3% vs 13,9%), y más problemas en las dimensiones de ansiedad/depresión (35,0% vs 21,4%) y dolor/malestar (52,8% vs 31,1%) de laEQ-5D-5L. El modelo de regresión mostró mayor riesgo de cansancio (OR=2,83; IC95%:1,53-5,24) y sobrecarga (OR=1,87; IC95%:1,06-3,29) en mujeres que en hombres. Conclusiones: Existen desigualdades de género en la provisión de cuidados informales a mayores dependientes en Gipuzkoa, mostrando las mujeres un mayor impacto en su salud y CVRS que los hombres. Considerando la organización del cuidado en esta provincia, será necesario el diseño de acciones de mejora más adecuadas a las necesidades de las personas cuidadoras

Supervivencia del cáncer en el País Vasco entre 1995 y 2004

Fundamentos: las diferencias geográficas descritas en el pronóstico de los pacientes de cáncer en el País Vasco han sido atribuidas a la diferente incidencia en tumores de diferente letalidad. Por ello, se incluye la supervivencia relativa del cáncer ajustada por la casuística para estimar la supervivencia del conjunto de los tumores malignos por provincias y comarcas sanitarias, utilizando los datos de 1995 a 2004. El objetivo del trabajo es estimar la supervivencia de los tumores malignos en el País Vasco por provincias y comarcas sanitarias durante el período 1995-2004. Métodos: se incluyeron 93.585 tumores malignos del registro poblacional de cáncer. Se calculó la supervivencia relativa (SR) a 5 años con el método de Ederer. Se estimó el exceso de riesgo relativo (ERR) de muerte a los 5 años con el modelo lineal generalizado, estandarizando por edad y ajustando por sexo, período de diagnostico y casuística. Resultados: la SR a los 5 años aumentó en el período 2000-2004 con respecto a 1995-1999 con valores que oscilaron por comarcas entre el 46-58% y el 57-65% en hombres y mujeres, respectivamente. Se observó un exceso de riesgo de muerte en pacientes de Bizkaia (ERR= 1,06; IC95%: 1,03-1,09, efecto que se observo en casi todas sus comarcas. Por el contrario, en Gipuzkoa, sólo las comarcas Gipuzkoa y Tolo-sa mostraron diferencias significativas (ERR=1,07; IC95%: 1,02-1,13 y ERR=0,91; IC95%: 0,84-0,98, respectivamente), las cuales desaparecieron al ajustar el modelo. Conclusiones: dentro del Pais Vasco fueron los pacientes de Bizkaia, a excepción de la comarca Uribe, los que presentaron peor pronóstico

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models.

Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults