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

Discrepancies Regarding the Quality of Life of Patients with Alzheimer¿s Disease: A Three-Year Longitudinal Study

Cross-sectional studies report notable discrepancies between patient and caregiver ratings of the quality of life of patients (QoL-p) with Alzheimer¿s disease (AD). This study aimed to identify the factors associated with any changes in QoL-p ratings and any discrepancies between patient and caregiver ratings of QoL-p. Three-year follow-up of a cohort of non-institutionalized patients (n = 119). QoL-p was assessed by the Quality of Life in AD (QoL-AD) scale. We analyzed the influence of functional and cognitive status and behavioral problems in patients, and burden and mental health in caregivers. Repeated measures analysis was applied to the scores of patients and caregivers on the QoL-AD, and to the discrepancies between them. Generally, patients¿ own ratings remained stable over time (F 3,116 = 0.9, p = 0.439), whereas caregiver ratings showed a decline (F 3,116 = 9.4, p < 0.001). In the analysis of discrepancies, patients with anosognosia gave higher ratings (F 1,117 = 11.9, p = 0.001), whereas caregiver ratings were lower when the patient showed greater agitation (F 1,117 = 13.0, p < 0.001), apathy (F 1,117 = 15.4, p < 0.001), and disabilities (F 1,117 = 17.1, p < 0.001), and when the caregiver experienced greater burden (F 1,117 = 9.0, p = 0.003) and worse mental health (F 1,117 = 10.1, p = 0.003). Patient ratings of QoL-p remain generally stable over time, whereas those of caregivers show a decline, there being significant discrepancies in relation to specific patient and caregiver factors

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: an exploratory comparative design

BACKGROUND: Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences. OBJECTIVES: The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers. DESIGN: Cross-sectional analytic study. SETTINGS: All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain). PARTICIPANTS: Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers. METHODS: The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers. RESULTS: The results show greater burden among adult-child caregivers (p<.05), who experience more feelings of guilt (p<.001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p<.001). Living with the patient has a notable influence on burden among adult children (p<.001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p<.05) and progressively worse mental health (p<.01). However, the correlations between burden and mental health were strongest in daughters (p<.001). CONCLUSION: The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle

Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers

Aims To compare care recipient and caregiver perceptions of quality of life in patients (QoL-p) with Alzheimer"s disease (AD). To identify associated factors, and the concordances-discrepancies. Method Cross-sectional analytic study of 236 patients and their carers using the Quality of Life in Alzheimer"s Disease(QoL-AD) scale, socio-demographic data and clinical examination. Results Patients scored the QoL-AD more favourably than did caregivers (34.4 vs 31.3, p<0.001). Cognitive deterioration did not affect the perception of QoL-AD (rho¼ 0.05, p¼0.394). The neuropsychiatric symptoms was associated with a negative perception of the QOL-AD in both patients (rho¼ 0.22, p<0.01) and caregivers (rho¼ 0.47, p<0.001). Greater functional autonomy was associated with a better perception of the QOL-AD in patients (rho¼0.17, p<0.01) and even more so in caregivers (rho¼0.56, p<0.001). In carers, burden (rho¼ 0.56, p<0.001) and mental health (rho¼0.31, p<0.001) were inversely associated with the QoL-AD. QoL-AD scores of both patients and caregivers were higher for men, married subjects, those who lived with their spouse and those living in their own home. When the carer was a spouse both patients and caregivers scored the QoL-AD higher than when the carer was a son or daughter (35.5 vs 33.4 and 33.7; 32.9 vs 30.5 and 27.7, p<0.001). Conclusions Patients have a better perception of QoL-p. Caregivers give a more negative evaluation of neuropsychiatric symptoms, but have a more positive view of functional autonomy. Carers who are spouses have a better perception of QoL-p than do carers who are sons or daughters

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

Hacia una evaluación de las capacidades instrumentales de los ancianos validada en nuestro entorno

Activitats de la vida diària; Majors de 80 anys; Enquestes i qüestionarisActividades de la vida diaria; Mayores de 80 años; Encuestas y cuestionariosActivities of Daily Living; Aged, 80 and over; Surveys and QuestionnairesEl envejecimiento progresivo de la población mundial es incuestionable, el número de personas mayores de 60 años se ha triplicado en los últimos 50 años y está previsto que se multiplique por 5 durante los próximos 50 años. A pesar de la importancia que tiene el concepto de fragilidad, no existe un claro consenso sobre la definición operativa de dicho constructo. Mientras que algunos autores consideran que la presencia de discapacidad funcional forma parte de la definición de fragilidad, otros abogan por eliminar la discapacidad funcional de dicha definición argumentando que la presencia de discapacidad o dependencia funcional es una consecuencia de la fragilidad del individuo.Cada vez existe mayor evidencia de que la atención primaria a través de una valoración geriátrica integral consigue aumentar la supervivencia de estos pacientes en sus propios domicilios con una reducción de costes en comparación con la atención médica habitual

Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study

Fàrmac antidepressiu; Càncer; Síndrome depressiuFármaco antidepresivo; Cáncer; Síndrome depresivoAntidepressant drug; Cancer; Depressive syndromeObjective: This study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort.Methods: A community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality.Results: The cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11–4.44) and women (HR = 3.69; 95% CI = 1.69–8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46–3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10–6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76–4.90) only in the male population.Conclusion: C-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality.Objectiu: aquest estudi pretenia avaluar l'associació de símptomes depressius somàtics (SDS), símptomes depressius cognitius/emocionals (C-EDS) i tractament antidepressiu sobre la mortalitat per càncer i altres causes en una cohort comunitària. Mètodes: una mostra basada en la comunitat reclutada el 1995, 2000 i 2005 d'entre 35 i 75 anys es va examinar en dues onades i es va seguir durant una mitjana de 6,7 anys. Els fenotips SDS i C-EDS es van avaluar mitjançant el Patient Health Questionnaire-9. Es van recollir els medicaments utilitzats pels participants. Durant el seguiment es van registrar les morts i les seves causes. Es van realitzar models de risc proporcional de Cox estratificats per sexe per determinar l'associació entre fenotips depressius i mortalitat. Resultats: La cohort estava formada per 5.646 individus (53,9% dones) amb una edat mitjana de 64 anys (DE = 11,89). Durant el seguiment es van registrar 392 defuncions, de les quals el 27,8% van ser per càncer. El fenotip C-EDS es va associar amb un augment del risc de mortalitat per càncer tant en homes (HR = 2,23; IC 95% = 1,11-4,44) com en dones (HR = 3,69; IC 95% = 1,69-8,09), i el SDS es va associar significativament. amb mortalitat no per càncer en homes (HR = 2,16; IC 95 % = 1,46–3,18). Els inhibidors selectius de la recaptació de serotonina (ISRS) es van associar significativament tant amb el càncer (HR = 2,78; IC 95% = 1,10-6,98) com amb la mortalitat no per càncer (HR = 2,94; IC 95% = 1,76-4,90) només a la població masculina. Conclusió: el fenotip C-EDS es va relacionar amb un augment del risc de mortalitat per càncer als 6 anys. A més, l'ús d'ISRS a la població masculina es va associar amb càncer i mortalitat per totes les causes.This study was supported by the research grant STL006/17/00234 from the Strategic Plan for Health Research and Innovation (PERIS) 2016–2020 of the Department of Health, Government of Catalonia. The funding sources played no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript

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

Early parental death and psychosocial risk factors for dementia: A case-control study in Europe

Objectives: To assess the association between early parental death and the risk of dementia in adult life, and to examine the risk factors associated with early parental death in people with and without dementia. Methods / Design: A population-based case-control study of a sample of 65,997 participants from the Survey of Health, Ageing and Retirement in Europe study. Early parental death was operationalized as parental death at the age of ≤ 16 years. Main analyses were conducted using bivariate and multivariate logistic regression analyses. Results: The odds ratio (OR) for dementia in individuals who experienced early parental death (father or mother) at the age of ≤ 16 years was 1.83 (95%CI 1.61-2.09) and 1.54 (95%CI 1.35-1.76) adjusted for age, gender, and education. In the multivariate logistic regression analysis carried out with the whole sample, early parental death increased the risk of dementia (OR = 1.50, 95%CI 1.31-1.72), along with older age (OR = 5.92, 95%CI 4.86-7.17), neuroticism (OR = 2.94,95%CI 2.61-3.31), low education level (OR = 1.84, 95%CI 1.64- 2.05) and low income (OR = 1.49, 95%CI 1.34-1.67). Discussion: Early parental death (< 16 years) was associated with an increased risk of dementia. We discuss the neurobiological markers associated with adverse childhood experiences (ACEs) and dementia as well as interventions to counteract the negative health effects on adults