[Evolution of disability and dependency. An international perspective]

Restrictions on persons with disabilities for participating in family and community activities

OBJECTIVE

To identify the influence of functional impairments and limitations activities for persons with disabilities to particípate in family and community activities.

METHODS

This is a cross-sectional study with 4 044 persons with disabilities, selected using probabilistic sampling and a door-to-door active search model in 5 towns in the District of Barranquilla. The data were processed with univariate analysis and bivariate analysis to determine the relationship between the study variables.

RESULTS

55.9% of the population were males, 41.6% were between 15 and 44 years of age, and 92.9% belonged to the lower socioeconomic stratum. 82.9% reported mobility limitations and 99% reported barriers to access non-formal learning activities, 98.6% to access public activities, and 97.5% to access productive activities. Individuals with that a lower limitation in exercising the power of reason, particularly thinking, can increase participation in activities with family and friends (OR, 0.8; 95% CI, 0.6-0.9), with the community (OR, 0.7; 95% CI, 0.6-0.9), religious or spiritual activities (OR, 0.8; 95% CI, 0.7-0.9).

CONCLUSIONS

There is a directly proportional relationship between structural impairment with the development of dependency and limited family, social, and work participation in the persons with disabilities.

Moving around a Large City in Latin America: The Mobility Challenges Faced by Older Adults with Disabilities

A growing body of research has shown that barriers in the urban environment can be disabling by reducing the ability of older people to manage independently in the community, but also because they can negatively affect health by limiting the possibilities to move outside the home. In this study, we ask how obstacles in the urban environment are associated with the need for help to go to places in the community. To respond to this question, we used the Annual Household Survey of the City of Buenos Aires, Argentina 2018, which had a specific questionnaire for people with disabilities. From this sample, we selected adults aged 65 years or older with difficulties in at least one of six domains: vision; hearing; upper and lower body mobility; cognition; self-care; and communication. The final sample consisted of 513 persons (weighted = 109,316). First, we conducted a principal component analysis identifying three factors from variables of obstacles to access and use the urban environment: transportation; outdoor spaces; and information. Second, through a logistic regression model, we observed a direct relationship between these factors and the need for help to move in the community, controlling for sociodemographic characteristics, health status, and number of disabilities. This paper provides evidence on the significance of improving urban spaces to reduce dependent mobility. In Latin America, cities still face many challenges in becoming more age-friendly.

Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis

OBJECTIVES

To analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged 50+ in Mexico.

DESIGN

Multistate life table analysis of data from a longitudinal cohort survey.

SETTING

Data came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico.

PARTICIPANTS

10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves.

PRIMARY AND SECONDARY OUTCOME MEASURES

Disability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE).

RESULTS

46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9).

CONCLUSIONS

In Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

The contribution of social participation to differences in life expectancy and healthy years among the older population: A comparison between Chile, Costa Rica and Spain

We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age.

The Influence of Pain on Frailty among the Elderly: Based on Korea Health Panel

Background:

Interests between pain and frailty have been increasing in aging or aged societies. This study aimed to identify the prevalence of pain and frailty and to find the influence of pain on frailty.

Methods:

Subjects were selected with aged 65 yr or older among pooled Korea Health Panel data from 2009 to 2013. The prevalence of pain was determined by combining some pain and extreme pain and also, frailty was defined when subjects had at least one of the following 6-domain frailty: physical inactivity, mobility reduction, dependence of daily life, depression, multimorbidity, and disability.

Results:

The prevalence of pain and frailty was 56.1% and 59.8%. It was significantly higher in female (66.1% and 65.2%) and the oldest-old (69.4% and 71.8%). After adjusting for gender, age group, spouse, illiteracy, and economic activity, odds ratios of frailty for some pain and extreme pain were 2.8 (95% CI 2.6–3.0) and 10.5 (95% CI 8.0–13.8) in total subjects. The odds ratios of each 6-domain frailty for some and extreme pain were also significant. Among them, mobility reduction was 5.1 (95% CI 4.5–5.8) and 16.5 (95% CI 13.6–20.1), and dependence of daily life was 3.9 (95% CI 3.5–4.5) and 12.4 (95% CI 10.2–15.1).

Conclusion:

Among the elderly, prevalence of frailty (59.8%) was somewhat higher than that of pain (56.1%). Female and oldest-old had higher prevalence of pain and frailty. In addition, some pain and extreme pain had a decisive influence on frailty and each 6-domain frailty. Therefore, pain control is essential to prevent or manage frailty.

Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of Nariño, Colombia

INTRODUCTION

Ethnicity in Latin America is a factor of poverty and social exclusion. Like in developed countries, demographic, medical, psychosocial, global cognitive, and functional variables interact in a complex relationship on the elderly population. Such interaction should be considered to determine cognitive and functional performance using screening tests. The aim of this study was to evaluate the demographic, medical, and psychosocial factors affecting global cognitive performance as well as functional activities.

METHODS

The study was conducted in a Colombian elderly indigenous population which included a sample of 518 adults. This research employed a structural model of latent factors to assess the effects of demographic, medical, and psychosocial factors on cognitive and functional performance. The model was estimated by least squares and used a maximum-likelihood procedure, and it was determined RMSEA, TLI, and CFI to assess the model's goodness of fit. The categorical variables used in the model were as follows: (1) demographics, (2) psychosocial factors, (3) medical condition, (4) global cognition, and (5) functional factors.

RESULTS

Demographics, in addition to medical and psychosocial factors, were related to global cognition and functional factors (RMSEA = 0.051, CI 90% 0.045-0.057, CFI = 0.901, and TLI = 0.881).

CONCLUSION

These results provide strong evidence about the complex relationships among demographics, medical conditions, and psychosocial factors and their influence on global cognition and functional performance in Colombian indigenous elderly population.

Necesidades de acceso a servicios institucionales de familias con hijos con discapacidad intelectual

Este artículo presenta los resultados de una investigación de enfoque cuantitativo y diseño descriptivo transversal, que tiene como propósito de identificar el nivel de acceso a los servicios que ofrecen las instituciones gubernamentales y privadas a las familias de niños en condición de discapacidad intelectual. Se contó con la participación de 82 familias de las ciudades de Bogotá D.C, Cali y Putumayo, 16 papás y 66 mamás a cargo de 54 niños y 28 niñas con edades entre dos y 17 años. Se aplicó el instrumento de FNA versión Colombia y se corrió un análisis de varianza (ANOVA). Los resultados muestran como la necesidad más alta, los servicios educativos para los hijos y como más baja, la comprensión familiar dentro de las creencias espirituales. Así mismo diferencias 1) por sexo: las familias con niños (M=3,46) presentan más necesidades que las familias con niñas (M=3,10), y 2) por edad en dos grupos: el primero con resultados más altos entre los dos a 10 años, y el segundo de 11 a 17 años muestra que las familias con hijos adolescentes (M=3,60) presentan mayor necesidad de acceso a servicios que las familias con niños y niñas (M=3,23).

Regional differences in the profile of disabled community-dwelling older adults: A European population-based cross-sectional study

The main objective of this work was to estimate the prevalence of disability in European community-dwelling older adults, as well as to investigate differences in the profile of disabled older adults between European regions (Northern, Central, Eastern and Southern). A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted. Community-dwelling participants aged 65-84 were selected (n = 33,369). Disability was defined as presenting at least one functional limitation in basic activities of daily living (BADL). Sociodemographic, health services, lifestyle and health-related variables were analyzed. Statistical analysis was carried out through the Chi-square and ANOVA tests for bivariate analysis, and Poisson regression for multivariate analysis. Overall prevalence of disability was 13.8%: 9.4% in the Northern region, 13.1% in the Southern region, 13.6% in the Central region, and 16.6% in the Eastern region. Portugal, Poland, Estonia and Belgium showed the highest prevalence of BADL limitations, while Sweden, Denmark, Greece and Switzerland showed the lowest prevalence. Besides, disabled older adults from East Europe presented the most disadvantaged health profile, followed by the Southern region. On the other hand, disabled older adults living in the Northern region showed the most advantaged characteristics of most variables, except for smoking and polypharmacy.

Dietary Assesment of Free-Living Elderly Spanish People with Disabilities

Nutritional research in elderly disabled is difficult in noninstitutionalized people. The dietary intake of a noninstitutionalized disabled population of the eastern region of Spain was evaluated to detect possible nutritional deviations. A total of 329 participants aged 65 and over were recruited. Most participants were overweight. Carbohydrates did not reach 50% of total Kcal/day. Insufficient micronutrient intakes and high consumption of simple carbohydrates and saturated fats (SFA) were found. A decreasing trend of water intake (p < .05) as well as an increasing trend of alcohol consumption (p < .05) with increasing age was found. The area of residence had a relevant impact on nutritional, dietary, and anthropometric characteristics of our population.

Gender and socio-economic inequalities in health and living conditions among co-resident informal caregivers: a nationwide survey in Spain

AIMS

To explore the associations between social determinants, caregiver's network support, burden of care and their consequences in health and living conditions of informal caregivers.

BACKGROUND

The socio-demographic trends regarding population ageing and changes in family models trigger an increased demand for care.

DESIGN

Cross-sectional study based on the 2008 edition of the National Disability, Independence and Dependency Situations Survey (DIDSS-2008) conducted by the National Statistics Institute in Spain.

METHODS

Analyses focused on persons identified as primary caregivers who co-reside with the dependent person. The associations between social determinants of caregivers, burden of care, support network and problems attributed to informal care (impaired health, depression, professional, economic and personal issues) were estimated by fitting robust Poisson regression models. Analyses were conducted separately for women and men.

RESULTS

The study sample included 6923 caregivers, 73% of women and 27% of men. Gender and socio-economic inequalities were found in assumption of responsibilities and burden of caring for dependents, which tend to fall more on women and persons of lower socio-economic level, who in turn have less access to formal support. These aspects translate into a higher prevalence of health, professional, economic and personal problems.

CONCLUSIONS

The study highlights gender and socio-economic inequalities in informal caregiving and its negative consequences. These findings may be useful in the design of policies and support programmes targeting the most affected groups of informal caregivers.

Risk factors for functional decline in a population aged 75 years and older without total dependence: A one-year follow-up

OBJECTIVES

estimation of functional loss incidence and identification of risk factors associated with new disability onset in people aged 75 and older without severe dependence in a rural primary care setting.

PATIENTS AND METHOD

Prospective cohort study of a representative sample of people aged 75 years or older without severe dependence (Barthel Index>20 and Lawton Index>1) at a primary care center, with a 12-month follow-up. The baseline geriatric assessment recorded activities of daily living (ADL), sociodemographic information, numbers of drugs prescribed, previous hospital admissions and falls, cognitive function, hearing and visual capacity, body mass index, blood pressure, and the Short Physical Performance Battery to evaluate lower limb function. ADL was re-assessed after 12 months, defining functional loss as a fall of ≥10 points on the Barthel Index and/or ≥2 instrumental activities of the Lawton Index. Bivariate and multivariate analyses using logistic regression models were conducted to identify factors independently associated with functional loss.

RESULTS

Mean age was 81.7 years, 58.7% of patients were men, and 23.4% presented functional loss at the 12-month follow-up. Variables identified as independent predictors of functional loss were hospital admissions (aOR 3.92; 95%CI: 1.35-11.39), cognitive impairment (aOR 2.60; 95%CI: 1.39-4.92) and lower limbs functional limitation (aOR 2.01; 95%CI: 1.02-3.97).

CONCLUSIONS

Our results support the use of performance batteries in primary care for identifying elderly persons at risk of functional decline; and they also highlight the relevance of appropriate management of hospital admissions and planned discharges in order to preserve patients' functional status.

Functional decline over 2 years in older Spanish adults: evidence from the Survey of Health, Ageing and Retirement in Europe

AIM

To evaluate the social, educational, health and behavioral predictors of physical functional decline in older Spanish adults.

METHODS

A 2-year longitudinal study based on 699 community-dwelling Spanish adults aged over 65 years participating in the Survey of Health, Ageing and Retirement in Europe was carried out. Several predictors of a combined measure of functional disability were examined using logistic regressions.

RESULTS

A decline in function was experienced by 166 individuals. Functional decline in men was associated with an increased number of chronic diseases (OR 2.25, 95% CI 1.21-4.19) and depressive symptoms (OR 5.05, 95% CI 2.42-10.54) over a 2-year period, whereas among women it was associated with decreased numeracy score (OR 1.88, 95%CI 1.05-3.34).

CONCLUSIONS

Longitudinal changes in predictors are strongly associated with longitudinal changes in function between baseline and a 2-year follow up, most clearly among men. A decrease in cognitive functioning and increased depressive symptoms are associated with a decline in physical functioning, and can serve as useful clinical predictors to prevent disability in older Spanish adults.

Oral health care activities performed by caregivers for institutionalized elderly in Barcelona-Spain

Objectives: To describe the frequency of brushing teeth and cleaning of dentures, performed by caregivers, for institutionalized elderly people. Methods: A cross-sectional study in a sample of 196 caregivers of 31 health centers in Barcelona. The dependent variables were frequency of dental brushing and frequency of cleaning of dentures of the elderly by caregivers. The independent variables were characteristics of caregivers and institutions. We performed bivariate and multivariate descriptive analyses. Robust Poisson regression models were fitted to determine factors associated with the dependent variables and to assess the strength of the association. Results: 83% of caregivers were women, 79% worked on more than one shift, 42% worked only out of necessity, 92% were trained to care for elderly persons, 67% were trained in oral hygiene care for the elderly, and 73% recognized the existence of institutional protocols on oral health among residents. The variables explaining the lower frequency of brushing teeth by caregivers for the elderly, adjusted for the workload, were: no training in the care of elderly persons (PRa 1.7 CI95%: 1.6-1.8), not fully agreeing with the importance of oral health care of the elderly (PRa 2.5 CI95%: 1.5-4.1) and not knowing of the existence of oral health protocols (PRa 1.8 CI95%: 1.2-2.6). The variables that explain the lower frequency of cleaning dentures, adjusted for the workload, were lack of training in elderly care (PRa 1.7 CI95%: 1.3-1.9) and not knowing of the existence of protocols (PRa 3.7 CI95%: 1.6-8.7). Conclusion: The majority of caregivers perform activities of oral health care for the elderly at least once per day. The frequency of this care depends mainly on whether caregivers are trained to perform these activities, the importance given to oral health, the workload of caregivers and the existence of institutional protocols on oral health of institutionalized elderly persons.

Key words:Institutionalized elderly, caregivers, oral hygiene, long-term care, oral health.

La interface del cuidado de enfermería con las políticas de atención al anciano

Se objetivó hacer una explanación sobre la interface del cuidado de enfermería con las políticas de atención al anciano. Presenta-se el envejecimiento como una realidad mundial y una victoria de la sociedad moderna; la situación de las personas ancianas en España y las consecuencias sociales del envejecimiento en España; dependencia y necesidades de asistencia; situación de las personas ancianas en Brasil; comparación entre España y Brasil; niveles de dependencia; las soluciones que suministran las enfermeras y atención domiciliaria como base de un mejor futuro. Las consideraciones apuntadas son: La atención a la dependencia debe ser abordada de inmediato, considerar los fracasos en otros países, para no caer en los mismos errores, instar a la población mayor al mantenimiento de su independencia con promoción de la salud.