Residential Environment and Health Conditions among Older-Adults in Community-Dwelling in Spain: What Influences Quality of Life?

The residential environment is considered the geographical space to which the population, especially older people, is most closely attached and where their daily life unfolds. Together with this, other personal and health and functioning conditions show their effect on satisfaction with life, as an indicator of quality of life in old age. In this context, the aim of this chapter was to understand the interrelationships of these quality of life variables and which of them are predictors of satisfaction with life in the older adult population living in family homes in Spain. The survey “Quality of life in older adults-Spain” (CadeViMa-Spain), conducted in 2008 among a representative sample of the population aged 60 or over (N=1,106 individuals), was used as the data source. The results showed a high level of satisfaction with life (69 out of 100), with 30% of its variance explained by a linear regression model, according to which overall life satisfaction is higher the larger the status of the household and satisfaction with living arrangements, the better one's health and the individual's perception of this, the lower the level of morbidity and depression and the higher the rating of the residential environment (in its three elements of housing, neighbourhood and neighbours). These results are of interest for the design and implementation of public policies concerning the adaptation of the residential environment to the circumstances and perceptions of its elderly residents, who live and want to age at home, in the environment where they have always lived with autonomy and independence.Peer reviewe

The COSMO-Spain Survey: Three First Rounds of the WHO Behavioral Insights Tool

Objective: To describe changes in knowledge, attitudes and preventive practices (KAP), risk perception, and psychological variables of Spanish population toward the COVID-19 pandemic from July to November 2020. Methods: Three samples, each of one composed by 1,000+ persons aged 18 years or older, were interviewed online in three rounds, every 2 months, from July to November 2020. Results: The level of knowledge on COVID-19 was high in the three rounds, with percentages above 95% of correct answers related to ways of contagion and correct use of face masks. The most accepted measure was the mandatory use of face masks (80-86% of agreement in the three rounds, p = 0.001), followed by the night curfew (63% of agreement). Most participants (>80%) consistently reported using face masks, ventilating spaces, and washing or disinfecting hands. However, risk perception and self-efficacy were low. Worry about losing a loved one, the health system overload and people who do not wear face masks was high (>85% of the samples). The percentage of respondents who felt depressed due to COVID-19 increased from round 1 to round 3 (p = 0.044). Conclusions: Spanish population has a high degree of KAP, but a relatively low risk perception and self-efficacy. These findings can help health authorities to guide containment measures and campaigns addressed to improve preventive practices.This work was funded by Carlos III Health Institute.S

Active Ageing Index: Application to Spanish regions

The World Health Organization definition for active ageing and the approach and measurement made by the UNECE/EC to define an Active Ageing Index (AAI) are the starting points for this work. This paper reflects on the proposed methodology of the European AAI for measuring and adapting it to sub-national spaces, in this case Spain and its regions. Consistently, evaluation of specific data sources and indicators that can be built from them, trying to homogenise with the national-level AAI, according to its calculation methodology, are also essential objectives of this paper. In general, Spanish data sources are broadly similar to those which have been used for calculating the AAI in Europe, while some limitations, difficulties for homogenization and distortions are inevitable due to the AAI specificity. These factors have conditioned the calculation of some indicators, tentatively replaced by other alternatives and approximations. The AAI for Spain, calculated on the basis of Spanish data sources, is consistent with the European AAI, although slightly lower. However, it is closely connected with other general indicators in Spain (Gross Domestic Product, Synthetic Quality of Life Index, New Index of Human Development) to differentiate the level of economic and social development of the Spanish regions. The future development of the AAI in Spain requires delving into the use of more adequate indicators and weights, and more crucially advancing its usefulness to assess the public policies for the elderly in Spain. In addition, it aims to extend its use to certain Latin American countries.This research was carried under the ELES Project (Ageing in Spain Longitudinal Study) funded by the Spanish Ministry of Science and Competitiveness (National R&D&I Plan, Ref. CSO2011-30210-C02-01, PI. V. Rodriguez-Rodriguez). It is connected with other ongoing projects: i) the thematic networks ENACTIBE (Active Ageing in Ibero-America) (MINECO, ref. CSO2015-71193-REDT, PI. V. Rodriguez-Rodriguez) and RIIIES (Ibero-American Research Network on Ageing and Society, PI. F. Villar); ii) ENVACES project (Building the Active Ageing in Spain: self-assessment, determinants and quality of life expectations) MINECO/FEDER/ UE, ref. CSO2015-64115-R; PI. F Rojo-Perez); iii) ENCAGE-CM programme (Active Ageing, Quality of Life and Gender) (Community of Madrid and European Social Fund; ref. S2015/HUM-3367; Coord. G. Fernandez-Mayoralas). The authors thank Asghar Zaidi and the Editorial Board of the International Seminar of the Active Ageing Index, the Editor of the Journal of Population Ageing, and the two anonymous referees for their valuable comments that have helped to improve this paper.Peer reviewe

Heath-related quality of life in Spanish breast cancer patients: a systematic review

<p>Abstract</p> <p>Background</p> <p>Breast cancer is one of the oncological diseases in which health-related quality of life (HRQL) has been most studied. This is mainly due to its high incidence and survival. This paper seeks to: review published research into HRQL among women with breast cancer in Spain; analyse the characteristics of these studies; and describe the instruments used and main results reported.</p> <p>Methods</p> <p>The databases consulted were MEDLINE, EMBASE, PsycINFO, Dialnet, IBECS, CUIDEN, ISOC and LILACS. The inclusion criteria required studies to: 1) include Spanish patients, and a breakdown of results where other types of tumours and/or women from other countries were also included; and, 2) furnish original data and measure HRQL using a purpose-designed questionnaire. The methodological quality of studies was assessed.</p> <p>Results</p> <p>Spain ranked midway in the European Union in terms of the number of studies conducted on the HRQL of breast cancer patients. Of the total of 133 papers published from 1993 to 2009, 25 met the inclusion criteria. Among them, only 12 were considered as having good or excellent quality. A total of 2236 women participated in the studies analysed. In descending order of frequency, the questionnaires used were the EORTC, FACT-B, QL-CA-Afex, SF-12, FLIC, RSCL and CCV. Five papers focused on validation or adaptation of questionnaires. Most papers examined HRQL in terms of type of treatment. Few differences were detected by type of chemotherapy, with the single exception of worse results among younger women treated with radiotherapy. In the short term, better results were reported for all HRQL components by women undergoing conservative rather than radical surgery. Presence of lymphedema was associated with worse HRQL. Three studies assessed differences in HRQL by patients' psychological traits. Psychosocial disorder and level of depression and anxiety, regardless of treatment or disease stage, worsened HRQL. In addition, there was a positive effect among patients who reported having a "fighting spirit" and using "denial" as a defence mechanism. One study found that breast cancer patients scored worse than did healthy women on almost all SF-12 scales.</p> <p>Conclusion</p> <p>Research into health-related quality of life of breast-cancer patients is a little developed field in Spain.</p

Evolution of the concerns, perceptions and attitudes of the Spanish population during the COVID-19 pandemic

[ES] En la pandemia de COVID-19, tanto el comportamiento individual como el colectivo son determinantes en el control de la propagación de la enfermedad, pero las restricciones adoptadas para atajar esta crisis de salud pública han afectado al bienestar físico y mental de la población. Conocer las percepciones y actitudes de los ciudadanos ayuda a identificar las necesidades de la población y adoptar medidas de respuesta a la pandemia más efectivas y participativas. El estudio COSMO-Spain analiza las preocupaciones, percepciones y actitudes de la población en relación a la pandemia, el grado de adherencia a las medidas preventivas y otras variables relacionadas, como la percepción de riesgo. Este estudio, impulsado por la OMS, se ha realizado desde julio de 2020 cada dos meses, a través de un cuestionario online a muestras representativas de la población española. Los resultados muestran que las actitudes de la población han ido cambiando en el tiempo influenciadas por factores individuales y contextuales. Debido la naturaleza evolutiva de esta pandemia, las campañas de educación y sensibilización deben ser dinámicas y actualizarse continuamente en función de los datos. [EN] Both individual and population behavior are determining factors in controlling the spread of the COVID-19 pandemic. However, the restrictions have impacted the mental and physical well-being of citizens, the social cohesion, the economic stability, as well as the community resilience. In this complex scenario, understanding the feelings and attitudes of the population helps us to identify their needs and adopt response measures to control the pandemic in a more consensual and effective way. The COSMO-Spain study explores the concerns, perceptions, and attitudes of the population about the pandemic to find out the acceptance and adherence to behavioral prevention measures, as well as to analyze the citizens’ risk perception, well-being and trust in information sources and institutions. The COSMO-Spain study has been carried out every two months since July 2020, through an online questionnaire to representative cross-sectional samples of the Spanish population, composed by 1000 people each. The results up to December 2021 show that the attitudes of the population are dynamic and evolve over time, influenced not only by individual factors, but also by contextual ones. Due to the changing nature of this pandemic, education and awareness campaigns need to be dynamic and continually updated based on real data.El estudio COSMO-Spain ha sido financiado por el Instituto de Salud Carlos III.S

Features and impact of missing values in the association of self-rated health with mortality in care homes: a longitudinal study

BACKGROUND: Self-rated health (SRH) is a health measure used in studies of older adults. The objective of this study is to analyze SRH as a predictor of mortality in the institutionalized older population and the characteristics of those who do not provide information about their SRH on health questionnaires. METHODS: This is a 15-year follow-up study of older adult residents in nursing or care homes in of Madrid, Spain. SRH was measured on a 5-point Likert type scale. The association between answering the SRH question and socio-demographic and health characteristics was evaluated through prevalence ratio (PR), estimated by Poisson regression models. Survival rates associated with SRH were studied through a multivariate Cox regression. RESULTS: The sample has a mean age of 83.4 (standard deviation, SD = 7.3), with 75.7% women. Twelve percent did not answer the SRH item. Those who did not answer showed a higher probability of disability (Barthel index, PR = 0.76, 95% confidence interval = 0.67-0.86) and/or dementia (PR = 8.03, 3.38-19.03). A trend for higher mortality was observed in those persons who did not respond (adjusted hazard ratio HR = 1.26, 0.75-2.11). The mortality rate was 32% higher for those who declared poor SRH in comparison with those who reported good SRH (adjusted HR = 1.32, 1.08-1.6). CONCLUSIONS: There is an elevated number of people who do not respond to the SRH item, mainly those with disabilities and cognitive deterioration. Lack of response to SRH is a good indicator of 15-year mortality for persons institutionalized in care or nursing homes.This work was supported by the Institute of Health Carlos III (grant number, PI15CIII00037) and partially supported by the ENCAGE-CM programme (ref: S2015/HUM-3367, co-funded by Madrid Community and FEDER). The funding bodies did not have any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.S

Association Between Pandemic Fatigue and Disease Knowledge, Attitudes, Concerns, and Vaccination Intention at Two Key Moments of the COVID-19 Pandemic

Objective: This study aimed to describe the change in knowledge, attitudes, concerns, perceptions, preventive practices, and vaccination intention at two key time points of the COVID-19 pandemic and to assess whether these changes varied by level of pandemic fatigue. Methods: Data included in this study came from the third and the ninth round of the COSMO-Spain cross-sectional study. A general linear model was used to investigate the interaction terms between rounds and levels of pandemic fatigue. Results: Changes between rounds were observed in knowledge, attitudes, concerns, perceptions, behaviours, and vaccination intention. Significant interactions between rounds indicated that those with low levels of pandemic fatigue had a greater increase in knowledge, lower decrease in concerns, greater decrease in agreement with the decisions made, and lower increase in vaccination intention compared with those with high pandemic fatigue. Conclusion: As a pandemic evolves, it becomes necessary to consider the level of pandemic fatigue of the population and how this affects knowledge, concerns, and agreement with the measures adopted, as they influence the population's adherence to public health recommendations aimed at controlling infections and protecting the most vulnerable.The research was funded by the Carlos III Health Institute. The funder had no role in the study design, the collection, analysis, and interpretation of data, writing of the paper, and/or decision to submit for publication.S

COVID-19 vaccine hesitancy in Spain and associated factors

Introduction: The present study explores the reasons of those who have not been vaccinated in the later stage of the vaccine rollout in Spain and its associated determinants. Methods: Cluster and logistic regression analyses were used to assess differences in claimed reasons for vaccine hesitancy in Spain using two samples of unvaccinated people (18-40 years old) gathered by an online cross-sectional survey from social networks (n = 910) and from a representative panel (n = 963) in October-November 2021. Results: The main reasons for not being vaccinated were believing that the COVID-19 vaccines had been developed too fast, they were experimental, and they were not safe, endorsed by 68.7% participants in the social network sample and 55.4% in the panel sample. The cluster analysis classified the participants into two groups. Logistic regression showed that Cluster 2 (individuals who reported structural constraints and health-related reasons such as pregnancy or medical recommendation) presented a lower trust in information from health professionals, had a lower willingness to get vaccinated in the future, and avoided less social/family events than those in Cluster 1 (reasons centered in distrust on COVID-19 vaccines, conspiracy thoughts and complacency). Conclusions: It is important to promote information campaigns that provide reliable information and fight fake news and myths. Future vaccination intention differs in both clusters, so these results are important for developing strategies target to increase vaccination uptake for those who do not reject the COVID-19 vaccine completely.The research was funded by Carlos III Health Institute. This study was also partially funded by RICAPPS (Carlos III Health Institute, ref: RD21CIII/0003/0002). The funder had no role in the study design; collection, analysis, and interpretation of data; writing of the paper; and/or decision to submit for publication.S

How patients with COVID-19 managed the disease at home during the first wave in Spain: a cross-sectional study.

Most patients with mild COVID-19 had to stay at home trying to implement an optimal quarantine. The aim of this study was to describe the COVID-19 cases during the first wave of the pandemic in Spain, how they managed the disease at home, focusing on differences by age, as well as differences in knowledge, attitudes and preventive practices, compared with the uninfected population. An online survey was used to conduct a cross-sectional study of individuals who were 14 years or older living in Spain during the COVID-19 lockdown. The main variable was a COVID-19 case. Logistic regression models for COVID-19 cases were obtained using a backward stepwise procedure to assess the association between social variables, disease knowledge, attitudes, prevention practices and emotional impact. 3398 people completed the survey. Participants' mean age was 49.6 (SD=14.3). COVID-19 was significantly more prevalent among married people (5.3%) and those currently doing an on-site work (8.7%). Most of the COVID-19 cases stayed at home (84.0%) during the episode. There were significant age-based differences with regard to self-isolation conditions at home during the disease. COVID-19 cases showed better attitudes, practices and knowledge about disease symptoms and transmission than the uninfected population. COVID-19 cases also felt more depressed (adjusted OR: 3.46, 95% CI 1.45 to 8.26) and had better preventive behaviour than the uninfected population, such as always wearing a mask outside the home (adjusted OR 1.58, 95% CI 1.06 to 2.30). COVID-19 cases found it difficult to comply with recommended home self-isolation conditions, with differences by age group. COVID-19 had an important impact on care dependency in non-hospitalised patients, who were mostly dependent on their families for care. It is necessary to reinforce social and health services and to be ready to meet the care needs of populations during the different waves or in future epidemics.This work was supported by Instituto de Salud Carlos III through the National Tropical Diseases Research Network (RD16CIII/003/001RICET). The funders had no role in study design or in the collection, analysis and interpretation of data, or the decision to submit the article for publication.S

Associative participation of older adults and subjective quality of life: exploring self-selection bias

Active ageing policies seek to increase the quality of life of older people in three areas: health, security and participation. This paper focuses on a specific type of participation: associations. Its objective is to explore the possible self-selection effects of this type of participation, using global subjective quality of life indicators (satisfaction with life) and domain-specific indicators (satisfaction with leisure, community social integration and emotional resources). For this, a structural equation modelling analysis was conducted, taking into account bi-directional relationships between the variables of interest. The data come from a conditions and quality of life survey conducted in 2008 among a sample of 1,106 individuals aged 60 or over, living in community-dwellings in Spain. The results illustrate a complex model of relationships in which associative participation is not statistically significantly associated with the satisfaction measures used. This highlights the importance of self-selection effects and raises the issue of the effectiveness of associative participation as a tool to enhance the life satisfaction of older adultsPeer reviewe