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Pauly T, Drewelies J, Kolodziejczak K, Katzorreck M, Lücke AJ, Schilling OK, Kunzmann U, Wahl HW, Ditzen B, Ram N, Gerstorf D, Hoppmann CA. Positive and negative affect are associated with salivary cortisol in the everyday life of older adults: A quantitative synthesis of four aging studies. Psychoneuroendocrinology 2021; 133:105403. [PMID: 34536776 DOI: 10.1016/j.psyneuen.2021.105403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/27/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Research on time-fluctuating links between positive affect and cortisol is inconsistent and mostly based on young to middle-aged samples. The current project investigated how moment-to-moment changes in positive and negative affect are associated with moment-to-moment changes in cortisol levels in older adults' daily lives and whether those associations are moderated by differences in health status (as indicated by the number of comorbidities). Affect and cortisol data collected in four separately conducted momentary assessment studies with parallel protocols were pooled to obtain a sample of N=476 individuals aged 56-88 years (Mage=71.9, SD=6.6; 52% female). Participants provided affect reports and collected salivary cortisol 5-7 times a day for a 7-day period and reported the presence of 13 different health conditions. Data were analyzed using multilevel models, with time since waking, daily behaviors associated with cortisol secretion, age, and sex controlled. Feeling more positive affect than usual was associated with lower momentary cortisol. In contrast, feeling more negative affect than usual was associated with higher momentary cortisol. Associations of momentary positive and negative affect with cortisol were weaker among participants in worse as compared to those in better health. Trait positive affectivity was associated with more curvature of waking cortisol profiles and trait negative affectivity was associated with smaller cortisol awakening responses. Findings suggest that HPA axis responses fluctuate with everyday changes in positive and negative affect in older adults, and that higher HPA reactivity may indicate preserved health in this age group.
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Affiliation(s)
- Theresa Pauly
- Department of Psychology, University of Zurich, Binzmühlestr. 14/14, CH-8050 Zurich, Switzerland.
| | - Johanna Drewelies
- Department of Psychology, Humboldt University Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Karolina Kolodziejczak
- Department of Psychology, Humboldt University Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Martin Katzorreck
- Department of Psychology, Humboldt University Berlin, Rudower Chaussee 18, 12489 Berlin, Germany; Department of Psychology, Leipzig University, Neumarkt 9-19, 04109 Leipzig, Germany
| | - Anna J Lücke
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Oliver K Schilling
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Ute Kunzmann
- Department of Psychology, Leipzig University, Neumarkt 9-19, 04109 Leipzig, Germany
| | - Hans-Werner Wahl
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University, Bergheimer Str. 20, 69115 Heidelberg, Germany
| | - Nilam Ram
- Departments of Psychology and Communication, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305-2050, USA
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Christiane A Hoppmann
- Department of Psychology, The University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada; Centre for Hip Health and Mobility, The University of British Columbia, 2635 Laurel St, Vancouver, BC V5Z 1M9, Canada
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Tur-Sinai A, Soskolne V. Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1461-1472. [PMID: 33094541 DOI: 10.1111/hsc.13205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009-2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.
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Affiliation(s)
- Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Varda Soskolne
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
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Machón M, Mosquera I, Larrañaga I, Martín U, Vergara I. [Socioeconomic inequalities in health among the elderly population in Spain]. GACETA SANITARIA 2020; 34:276-288. [PMID: 31563284 DOI: 10.1016/j.gaceta.2019.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/29/2019] [Accepted: 06/19/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Mónica Machón
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, San Sebastián (Guipúzcoa), España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián (Guipúzcoa), España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Kronikgune - Centro de Investigación en Cronicidad, Barakaldo (Vizcaya), España
| | - Isabel Mosquera
- Departamento de Sociología 2, Facultad de Ciencias Sociales y de la Comunicación, Universidad del País Vasco UPV/EHU, Leioa (Vizcaya), España; OPIK - Grupo de investigación en Determinantes Sociales de la Salud y Cambio Demográfico, Universidad del País Vasco UPV/EHU, Leioa (Vizcaya), España.
| | - Isabel Larrañaga
- Departamento de Salud, Delegación Territorial de Gipuzkoa, Gobierno Vasco, San Sebastián (Guipúzcoa), España
| | - Unai Martín
- Departamento de Sociología 2, Facultad de Ciencias Sociales y de la Comunicación, Universidad del País Vasco UPV/EHU, Leioa (Vizcaya), España; OPIK - Grupo de investigación en Determinantes Sociales de la Salud y Cambio Demográfico, Universidad del País Vasco UPV/EHU, Leioa (Vizcaya), España
| | - Itziar Vergara
- Unidad de Investigación de Atención Primaria-OSIs Gipuzkoa, San Sebastián (Guipúzcoa), España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián (Guipúzcoa), España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Kronikgune - Centro de Investigación en Cronicidad, Barakaldo (Vizcaya), España
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Bunda K, Busseri MA. Subjective Trajectories for Self-Rated Health as a Predictor of Change in Physical Health Over Time: Results from an 18-Year Longitudinal Study. SOCIAL COGNITION 2019. [DOI: 10.1521/soco.2019.37.3.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mosquera I, Machón M, Vergara I, Larrañaga I, Martín U. [Social inequalities in health among the elderly population: review of indicators used in Spain]. GACETA SANITARIA 2019; 34:297-304. [PMID: 30665691 DOI: 10.1016/j.gaceta.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Isabel Mosquera
- Departamento de Sociología 2, Facultad de Ciencias Sociales y de la Comunicación, Universidad del País Vasco UPV/EHU, Leioa (Vizcaya), España; Opik-Grupo de investigación en Determinantes Sociales de la Salud y Cambio Demográfico, Universidad del País Vasco UPV-EHU, Leioa (Vizcaya), España
| | - Mónica Machón
- Unidad de Investigación de Atención Primaria - OSIs Gipuzkoa, Osakidetza, San Sebastián (Guipúzcoa), España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián (Guipúzcoa), España; Kronikgune - Centro de Investigación en Cronicidad, Barakaldo (Vizcaya), España.
| | - Itziar Vergara
- Unidad de Investigación de Atención Primaria - OSIs Gipuzkoa, Osakidetza, San Sebastián (Guipúzcoa), España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto de Investigación Sanitaria Biodonostia, San Sebastián (Guipúzcoa), España; Kronikgune - Centro de Investigación en Cronicidad, Barakaldo (Vizcaya), España
| | - Isabel Larrañaga
- Departamento de Salud, Gobierno Vasco, San Sebastián (Guipúzcoa), España
| | - Unai Martín
- Departamento de Sociología 2, Facultad de Ciencias Sociales y de la Comunicación, Universidad del País Vasco UPV/EHU, Leioa (Vizcaya), España; Opik-Grupo de investigación en Determinantes Sociales de la Salud y Cambio Demográfico, Universidad del País Vasco UPV-EHU, Leioa (Vizcaya), España
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Acar Tek N, Karaçil-Ermumcu MŞ. Determinants of Health Related Quality of Life in Home Dwelling Elderly Population: Appetite and Nutritional Status. J Nutr Health Aging 2018; 22:996-1002. [PMID: 30272105 DOI: 10.1007/s12603-018-1066-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study aimed to examine nutritional risk factors such as poor appetite, malnutrition or obesity affecting health related quality of life in elderly. DESIGN AND PARTICIPANTS This is a cross-sectional population-based study consisted of 407 elderly (142 men and 265 women) mean aged 71.7±6.54 years. MEASUREMENTS Questionnaire including the demographic and general characteristics, health information, nutritional habits was performed by face-to-face interviews. Daily food consumption was assessed using 24-hour dietary recall. Mini Nutrition Assessment (MNA) and Mini Nutrition Assessment-Short Form (MNA-SF) were used for assessment of nutrition status. Appetite was evaluated using the Simplified Nutritional Appetite Questionnaire (SNAQ). Health related life quality scale (Short Form Health Survey -SF36) was used for evalution health related quality of life. RESULTS According to MNA and MNA-SF 6.1%; 4.2% of elderly people were malnutrition and 40.3%; 21.9% of them were at risk of malnutrition respectively. Accordingly, SNAQ 28.7% of elderly were risk at loss of weight. Health related quality of life scores of women were significantly lower than men. Good nutritional (MNA-SF) and good appetite (SNAQ) status, increased 1.69, 1.48 fold in the mental component summary scale scores respectively. SNAQ was the best determinant of physical component summary scale score had the greatest positive effect, good appetite status increased approximately 2.2 fold in physical scores. Polypharmacy and high BMI decreased health related quality of life in elderly. CONCLUSION Determinants of quality of life are preventable and treatable with early and appropriate interventions in elderly.
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Affiliation(s)
- N Acar Tek
- Nilüfer Acar Tek, Gazi University, Faculty of Health Science, Department of Nutrition and Dietetic, Ankara/Turkey. e-mail: acarnil@ hotmail.com
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Patrão AL, Alves VP, Neiva TS. Gender differences in psychosocial predictors of self-perceived health status in the elderly: Evidence from a Brazilian community study. J Women Aging 2017; 30:553-570. [PMID: 29200379 DOI: 10.1080/08952841.2017.1409269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article aims to identify the psychosocial factors associated with self-perceived health status in the Brazilian elderly population and to present differences related to gender. The data were collected by questionnaire, including sociodemographic and behavioral questions, and scales for psychological dimensions. Self-perceived health status is related to level of education, physical activity, and self-efficacy in the total population. Regarding gender differences, self-rated health status among men is related to education level and self-efficacy and in women to level of education, physical activity, social support, and self-efficacy. These results can inform future health promotion interventions.
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Affiliation(s)
- Ana Luísa Patrão
- a Institute of Collective Health , Federal University of Bahia , Salvador , BA , Brazil
| | - Vicente Paulo Alves
- b Graduate Program in Gerontology , Catholic University of Brasília , Brasília , DF , Brazil
| | - Tiago Sousa Neiva
- b Graduate Program in Gerontology , Catholic University of Brasília , Brasília , DF , Brazil
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Ferrer A, Formiga F, Padrós G, Badia T, Almeda J, Octabaix GE. [The Octabaix study. Baseline assessment and 5 years of follow-up]. Rev Esp Geriatr Gerontol 2017; 52:44-52. [PMID: 27133765 DOI: 10.1016/j.regg.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Abstract
This is a review of a prospective, community-based study with a follow-up period of 5years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijón test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group.
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Affiliation(s)
- Assumpta Ferrer
- Centro de Atención Primaria «El Pla» CAP-I, Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, España.
| | - Francesc Formiga
- Unidad de Geriatría, Servicio Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Gloria Padrós
- Laboratori Clínic l'Hospitalet, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España
| | - Teresa Badia
- Centro de Atención Primaria «Martorell Urbà», Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Martorell, Barcelona, España
| | - Jesús Almeda
- Unitat de Suport a la Recerca de Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut. CIBER Epidemiología y Salud Pública (CIBERESP), Cornellà de Llobregat, Barcelona, España
| | - Grupo Estudio Octabaix
- Centro de Atención Primaria «El Pla» CAP-I, Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, España
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Read S, Grundy E, Foverskov E. Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review. Aging Ment Health 2016; 20:529-42. [PMID: 25806655 PMCID: PMC4784497 DOI: 10.1080/13607863.2015.1023766] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. METHOD Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995-2013. RESULTS A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. CONCLUSION The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.
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Affiliation(s)
- Sanna Read
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom,Corresponding author.
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Else Foverskov
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
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Arroyo E, Renart G, Saez M. How the economic recession has changed the likelihood of reporting poor self-rated health in Spain. Int J Equity Health 2015; 14:149. [PMID: 26683211 PMCID: PMC4683862 DOI: 10.1186/s12939-015-0285-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Between 2006 and 2011 self-rated health (SRH) (the subjective report of an individual's health status) actually improved in Spain despite its being in the grips of a serious economic recession. This study examines whether the likelihood of reporting poor health has changed because of the global financial crisis. It also attempts to estimate the differences between SRH and other self-perceived measures of health among groups before and during the current economic crisis in Spain. METHODS Cross-sectional population-based surveys were conducted in Spain (ENSE 2006 and ENSE 2011) and in Catalonia (ESCA 2006 and ESCA 2011) in 2006 and again in 2011. In this research work we have used random effects logistic models (dependent variable SRH 1 Poor, 0 Good) and exact matching and propensity score-matching. RESULTS The results of the ENSE explanatory variables are the same in both 2006 and 2011. In other words, all diseases negatively affect SRH, whereas alcohol habits positively affect SRH and obesity is the only disease unrelated to SRH. ESCA explanatory variables' results show that in 2006 all diseases are significant and have large odds ratio (OR) and consequently those individuals suffering from any of these diseases are more likely to report poor health. In 2011 the same pattern follows with the exception of allergies, obesity, high cholesterol and hypertension, albeit they are not statistically significant. Drinking habits had a positive effect on SRH in 2006 and 2011, whereas smoking is considered as unrelated to SRH. The likelihood of reporting poor health in 2006 is added as a variable in with the logistic regression of 2011 and is not, in either the ENSE data or the ESCA data, significant. Furthermore, neither is it significant when controlling by age, gender, employment status or education. CONCLUSIONS The results of our analysis show that the financial crisis did not alter the likelihood of reporting poor health in 2011. Therefore, there are no differences between our perceived health in either 2006 or in 2011.
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Affiliation(s)
- Elena Arroyo
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain, Carrer de la Universitat de Girona 10, Campus Montilivi, 17071, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Gemma Renart
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain, Carrer de la Universitat de Girona 10, Campus Montilivi, 17071, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Spain, Carrer de la Universitat de Girona 10, Campus Montilivi, 17071, Girona, Spain. .,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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Gasull M, Pallarès N, Salcedo N, Pumarega J, Alonso J, Porta M. Self-rated health and chronic conditions are associated with blood concentrations of persistent organic pollutants in the general population of Catalonia, Spain. ENVIRONMENTAL RESEARCH 2015; 143:211-220. [PMID: 26505651 DOI: 10.1016/j.envres.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/09/2015] [Accepted: 10/05/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Self-rated health (SRH) is a powerful predictor of mortality, morbidity, and need for health services. SRH generally increases with educational level, and decreases with age, number of chronic conditions, and body mass index (BMI). Because human concentrations of most persistent organic pollutants (POPs) also vary by age, education, and BMI, and because of the physiological and clinical effects of POPs, we hypothesized that body concentrations of POPs are inversely associated with SRH. OBJECTIVES To analyze the relation between serum concentrations of POPs and SRH in the general population of Catalonia, Spain, taking into account sociodemographic factors and BMI, as well as chronic health conditions and mental disorders, measured by the General Health Questionnaire-12 (GHQ-12). METHODS POP serum concentrations were measured by gas chromatography with electron-capture detection in 919 participants of the Catalan Health Interview Survey. RESULTS Individuals with higher concentrations of POPs had significantly poorer SRH; e.g., the median concentration of HCB in subjects with poor SRH was twice as high as in subjects with excellent SRH (366 ng/g vs. 169 ng/g, respectively; p-value<0.001). In crude models and in models adjusted for sex and BMI, the POPs-SRH association was often dose-dependent, and the likelihood of poor or regular SRH was 2 to 4-times higher in subjects with POP concentrations in the top quartile. In models adjusted for age or for chronic conditions virtually all ORs were near unity. No associations were found between POP levels and GHQ-12. CONCLUSIONS Individuals with higher concentrations of POPs had significantly poorer SRH, an association likely due to age and chronic conditions, but not to sex, education, social class, BMI, or mental disorders.
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Affiliation(s)
- Magda Gasull
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Natàlia Pallarès
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Natalia Salcedo
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - José Pumarega
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jordi Alonso
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Catalonia, Spain
| | - Miquel Porta
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain.
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Predicting factors of health-related quality of life in octogenarians: a 3-year follow-up longitudinal study. Qual Life Res 2015; 24:2701-11. [DOI: 10.1007/s11136-015-1004-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
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Nielsen ABS, Jensen P, Gannik D, Reventlow S, Hollnagel H, Olivarius NDF. Change in self-rated general health is associated with perceived illness burden: a 1-year follow up of patients newly diagnosed with type 2 diabetes. BMC Public Health 2015; 15:439. [PMID: 25924731 PMCID: PMC4431173 DOI: 10.1186/s12889-015-1790-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/22/2015] [Indexed: 11/15/2022] Open
Abstract
Background Diabetic patients’ lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients’ daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice. Methods Change in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients’ daily lives one year later). Results At diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On average SRH improved by 0.46 (95% CI: 0.37; 0.55) during the first year after diagnosis without inclusion of covariates. Mental and practical illness burden was the only factor associated with change in SRH, independent of patients’ diabetes severity and medical treatment (p = 0.03, multivariate analysis). Compared to otherwise similar patients without illness burden, increase in SRH was marginally smaller among patients who expressed minor illness burden, but much smaller among patients with more pronounced illness burden. Conclusions Much as one would expect, many patients increased their SRH during the first year after diabetes diagnosis. This increase in SRH was not associated with indicators of illness severity or factors reflecting socio-demographic circumstances, but patients experiencing illness burden had a smaller increase than those who reported no illness burden. We suggest that during the diabetes consultation, general practitioners explore further how patients manage their illness burden. We further suggest that diabetes guidelines extend their current focus on clinical and social aspects of diabetes to include questions on patient’s perceived illness burden and SRH. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1790-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anni Brit Sternhagen Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Per Jensen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
| | - Dorte Gannik
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Hanne Hollnagel
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Jiménez-Redondo S, Beltrán de Miguel B, Gavidia Banegas J, Guzmán Mercedes L, Gómez-Pavón J, Cuadrado Vives C. Influence of nutritional status on health-related quality of life of non-institutionalized older people. J Nutr Health Aging 2014; 18:359-64. [PMID: 24676315 DOI: 10.1007/s12603-013-0416-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Health-related quality of life (HRQoL) is a multidimensional health measurement and a key to optimal aging. The aim of this study was to examine the association of nutritional status with HRQoL in the elderly. DESIGN Cross-sectional study. SETTING Villanueva Older Health Study, a community-based study in Villanueva de la Cañada (Madrid, Spain). PARTICIPANTS 83 (53 women) non-institutionalized inhabitants aged 80 years and above. MEASUREMENT HRQoL was assessed by EuroQoL-5D (EQ-5D) questionnaire, nutritional risk by Mini Nutritional Assessment (MNA) questionnaire and dietary intake by 24-hour dietary recall. Statistical significance was evaluated at 95% confidence level (P<0.05). RESULTS EQ-5D pointed out differences between men and women (0.782±0.235 and 0.633±0.247; p=0.02). Problems in mobility (total sample) and pain/discomfort (women) dimensions were most frequently reported. MNA (26.5±3.2 men and 24.3±3.2 women; p=0.03) revealed malnutrition in 3.3% of men and 1.9% of women, and risk of malnutrition in 6.7% and 37.7%, respectively. Total sample was at risk of folic acid, zinc, magnesium, vitamin D and vitamin E deficiency. EQ-5D was associated with MNA (p<0.001). EQ-5Dindex was associated with energy intake (p=0.04) and EQ-5Dvas was negatively correlated with body mass index (p=0.02). EQ-5D pain/discomfort dimension was associated with energy (p=0.006), protein (p=0.005), lipid (p=0.03), magnesium (p=0.032), phosphorus (p=0.012), selenium (p=0.043) and niacin (p=0.004) intake. CONCLUSIONS Women showed poorer HRQoL and higher malnutrition risk. A relationship between HRQoL and risk of malnutrition was observed. Results suggest that when energy and protein, lipid, phosphorus, magnesium, selenium and niacin intake increase, HRQoL is promoted, although the increase does not seem to have a strong direct effect on it. The limited influence of energy and nutrient intake on HRQoL observed requires further research.
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Affiliation(s)
- S Jiménez-Redondo
- S. Jiménez-Redondo, Pharmacy Faculty, Universidad Complutense, Department of Nutrition, Pza. de Ramón y Cajal, s/n., Madrid, 28040, Spain, +34 91 3941809, FAX: +34 91 3941810,
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do Rosário Oliveira Martins M, Rodrigues IC, Rodrigues TF. Projecting Health Outcomes for Portuguese Ageing Population: Challenges and Opportunities. Health (London) 2014. [DOI: 10.4236/health.2014.614220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pu C, Bai YM, Chou YJ. The impact of self-rated health on medical care utilization for older people with depressive symptoms. Int J Geriatr Psychiatry 2013; 28:479-86. [PMID: 22700167 DOI: 10.1002/gps.3849] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 05/16/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To test the hypothesis whether self-rated health alone can explain the relationship between depression and medical care utilization for the older people and to determine whether the explanatory power of self-rated health is greater than that of the explanatory power of a major disease and activities of daily living. METHODS This study used the data from 1572 older people obtained from the 2005 National Health Interview Survey in Taiwan. The data from the National Health Interview Survey were linked to the 2005 computerized claims data from the National Health Insurance, and from that, the outpatient expenditures and number of outpatient episodes were identified. The contribution of self-rated health, activities of daily living, the presence of major diseases, and self-rated health were estimated using ordinary least squares regressions. RESULTS Controlling for self-rated health alone almost eliminates the positive relationship between depressive symptoms and number of outpatient visits. After controlling for self-rated health, the utilization ratio of outpatient visits for older people with depressive symptoms reduced significantly to only 1.01 and became insignificant. A similar pattern was observed for total outpatient costs. CONCLUSIONS It was found that self-rated health is an important factor in the depressive symptoms-outpatient utilization relationship. To reduce medical costs for older people with depressive symptoms, it is essential that the self-rated health for this group is improved. Future studies should test the mechanism through which self-rated health impacts on medical utilization for older people with depressive symptoms.
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Affiliation(s)
- Christy Pu
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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Verropoulou G. Determinants of change in self-rated health among older adults in Europe: a longitudinal perspective based on SHARE data. Eur J Ageing 2012; 9:305-318. [PMID: 28804430 DOI: 10.1007/s10433-012-0238-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study aims at detecting factors which may predict a decline or an improvement in self-rated health (SRH) of older adults (persons aged 50 or higher) among socio-demographic characteristics, physical and mental health indicators and risky health behaviours. In the analysis, multinomial logistic regression models are applied to data from waves 1 and 2 of the Survey of Health Ageing and Retirement in Europe (carried out about 3 years apart); persons who report a decline or an improvement in SRH at wave 2 are compared to those who report no change while controlling for SRH at baseline and country of residence. The analysis was carried out for the whole sample and two subgroups, persons aged 50-64 and 65 or higher. The results indicate that female sex and higher educational attainment have a strong protective effect against decline in SRH. Worse health at baseline is an important predictor of subsequent decline but changes occurring between the waves have a more pronounced effect, implying that SRH is influenced more by recent developments. The findings also indicate that improvement in SRH is a more complex concept than decline and is strongly affected by factors other than health. Among behavioural risk factors, low levels of physical activity and a decrease in the levels of activity between the waves are significantly related to decline while frequent drinking seems associated with improvement. Differentiations by age are modest and probably suggest that advancing age is related to a milder view of one's health.
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Affiliation(s)
- Georgia Verropoulou
- Department of Statistics & Insurance Science, University of Piraeus, 80, Karaoli & Dimitriou Str, 185 34 Piraeus, Athens, Greece
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Gunasekara FI, Carter K, Blakely T. Comparing self-rated health and self-assessed change in health in a longitudinal survey: Which is more valid? Soc Sci Med 2012; 74:1117-24. [DOI: 10.1016/j.socscimed.2011.11.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 11/09/2011] [Accepted: 11/23/2011] [Indexed: 11/29/2022]
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Tigani X, Artemiadis AK, Alexopoulos EC, Chrousos GP, Darviri C. Self-rated health in centenarians: a nation-wide cross-sectional Greek study. Arch Gerontol Geriatr 2012; 54:e342-8. [PMID: 22360829 DOI: 10.1016/j.archger.2012.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/25/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
Self-rated health (SRH) is an inclusive measure of public health that is correlated with quality of life and subsequent mortality. Extensive literature has identified multiple determinants of SRH in different populations. However, such studies on centenarians are scarce and parsimonious. Our objective is to identify SRH determinants in centenarians. This is a nationwide cross-sectional study on 400 Greek centenarians that was carried out between 2007 and 2010. SRH was evaluated by a simple question with a 5-point scale. Three categories of SRH were formed (very good/good/poor), which served as the dependent variable in multinomial regression models. Various sociodemographic, disease-related, lifestyle and psychosocial variables were assessed as candidate determinants of SRH. According to our results, SRH ratings among centenarians were better than that expected according to previous studies showing worse SRH ratings with increasing age in Greece. The 22.4% of the variance in SRH among centenarians was predicted by gender, habitat region and status, financial problems, disease presence and autonomy. Among lifestyle and psychosocial variables, obesity, good relationships with children, lack of feelings of loneliness, high optimism, adaptability and an internal health locus of control profile were independently associated with good SRH. These results indicate that SRH in individuals of extreme longevity were related to specific personal psychosocial factors that contribute to healthy aging and thus support the biopsychosocial model of health promotion.
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Affiliation(s)
- Xanthi Tigani
- First Department of Pediatrics, Children's Hospital Aghia Sofia, School of Medicine, University of Athens, Thivon & Papadiamantopoulou Str., GR-115-27 Athens, Greece.
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Ferrer A, Badía T, Formiga F, Almeda J, Fernández C, Pujol R. [Gender differences in health status in a population of over 85 year-olds: the Octabaix study]. Aten Primaria 2011; 43:577-84. [PMID: 21377767 DOI: 10.1016/j.aprim.2010.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 09/17/2010] [Accepted: 09/17/2010] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine gender differences according to health status in the oldest old people of the community. DESIGN Cross-sectional multicentre study, within the framework of a clinical trial on falls and malnutrition. SETTING 7 primary health centres. PARTICIPANTS Non-institutionalised patients of 85 years or over. METHODS The data collected included, socioeconomic data, cardiovascular risk factors, Barthel Index (BI), cognitive status with the Mini-Mental State Examination (MMSE), Charlson Index to measure comorbidity, nutritional risk evaluated by Nutritional Assessment questionnaire (MNA), mean visual analogue self-rating scale in Euroqol- 5D (EQ-VAS) to assess health related quality life and, Gijón social risk test, and prescribed drugs. RESULTS A total of 312 subjects were included, of which 61.6% were women, 53% widows and a third of them lived alone. High blood pressure was observed in 76%, dyslipidemia in 51.2%, diabetes in 17.4%, median BI 95 (rank 0-100), MMSE 28 (0-35), Charlson index 1 (0-7), MNA 25 (10-30), Gijón test 10 (5-21), EQ-VAS 60 (0-100) and the mean prescription drugs 6.1±3.3. Women most frequently lived alone (P<.001), fell more (P<.006), had a greater nutritional (P<.016) and social risk (P<.001). Men were more likely to be married (P<.001), had better cognition (P<.003), better functional status (P<.018), and higher comorbidity (P<.001). CONCLUSION Being a 85 years old man is associated with being married, having better functionality and cognition, and a higher comorbidity. While being a woman is associated with living alone, a higher rate of falls, and nutritional and social risk. These results are important to help this group of elderly to maintain their position in the community.
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Affiliation(s)
- Assumpta Ferrer
- Centro de Atención Primaria El Plà CAP-I, Sant Feliu de Llobregat, Barcelona, España
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[A randomized clinical trial of falls and malnutrition prevention in community-dwelling elders aged 85 years old. The OCTABAIX study]. Rev Esp Geriatr Gerontol 2010; 45:79-85. [PMID: 20188443 DOI: 10.1016/j.regg.2009.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 11/02/2009] [Indexed: 11/24/2022]
Abstract
INTRODUCTION People aged 85 years old and older constitute a growing population group. Falls and malnutrition are common in the elderly. OBJECTIVE To determine the effectiveness of an individualized multifactorial intervention to reduce falls and malnutrition in community-dwelling persons aged 85 years old. MATERIAL AND METHODS The OCTABAIX study is a randomized controlled clinical trial lasting 3 years in primary care in Costa de Ponent (seven primary care teams). Community-dwelling elders born in 1924 who agreed to participate in the study have been included. Three in-home visits will be made annually by a trained nurse or physician and will be complemented by two biannual analytical studies. Participants will be followed-up for hospitalizations, falls and weight using a monthly calendar. The specifically-designed algorithm to detect risk factors for falls and malnutrition will be used to provide recommendations and specific, standardized interventions for risk reduction in a randomly selected intervention group. Two face-to-face interventions will be carried out and telephone calls will be made to reinforce adherence. The control group will follow routine primary care recommendations. The primary outcome is a decline in the rate of falls and malnutrition. RESULTS The OCTABAIX study aims to reduce the incidence of falls and the risk of malnutrition in the 328 patients included. CONCLUSIONS The OCTABAIX study will help to determine the characteristics of persons aged 85 years old as well as the rate of falls and nutritional risk. The effectiveness of the measures adopted to reduce these geriatric syndromes will also be assessed.
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[Health-related quality of life in nonagenarians: gender, functional status and nutritional risk as associated factors]. Med Clin (Barc) 2010; 134:303-6. [PMID: 20096892 DOI: 10.1016/j.medcli.2009.06.070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 06/23/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The group of age showing a faster growth is the most elderly people. The objective of this study is to describe the health related quality of life in elderly subjects older than 89 year and to identify related factors. PATIENTS AND METHODS A cross-sectional study was done at the third year of a longitudinal study (NonaSantfeliu). We evaluated all survived patients who scored >19 in the Spanish version of the Mental State Examination (MEC). Sociodemographic data were collected, functional status was determined by Lawton-Brody and Barthel Index (BI) and cognition with MEC. Charlson score was used to measure comorbidity and the nutritional risk was evaluated by the short version of Mini Nutritional Assessment questionnaire (short-MNA). Euroqol-5D (EQ-5D) was used to assess health related quality of life. RESULTS The final sample was composed by 37 subjects, 25 women (68%) and 12 men, with a mean age of 94.32 (2.9) years. The mean score in EQ-5D was 0,51 (0,2) and the mean visual analogue self-rating scale (EQ-VAS) was 63 (2,9). Three variables: female gender (p=0,011; regression Beta coefficient : 18,99; IC 95%: 4,66-33,33 , poor BI score (p=0.010; regression Beta coefficient 0.38; IC 95%: 0.09-0.67) and high nutritional risk in short-MNA (p=0.001; regression Beta coefficient: 3.95; IC 95%: 2.50-5.41) were associated with quality of life in the multivariate analyses. CONCLUSION A good health quality of life in the oldest old people was observed in this study. Gender, functional status and nutritional risk were associated with quality of life in nonagenarians.
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Contributions of Psychological Well-Being and Social Support to an Integrative Model of Subjective Health in Later Adulthood. AGEING INTERNATIONAL 2010. [DOI: 10.1007/s12126-009-9050-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prevalence and correlates of obsessive-compulsive disorder among older adults living in the community. J Anxiety Disord 2009; 23:858-65. [PMID: 19481413 DOI: 10.1016/j.janxdis.2009.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 04/21/2009] [Accepted: 04/21/2009] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to determine OCD prevalence among older adults living in the community and to examine its correlates. Data were drawn from a large population survey using a representative sample of older adults aged 65 years and over (N=2798). The 12-month prevalence rate of OCD was 1.5%. Results showed that older adults with OCD were more likely to be men compared to those having another anxiety disorder or a mood disorder. They were also more afflicted with difficulties in social functioning than respondents presenting another anxiety disorder. In spite of social disabilities, respondents with OCD had the lowest rate of health services use among those reporting anxiety or mood disorders. It is suggested that older adults with OCD did not feel the need to seek treatment because they perceived their physical and mental health more positively than others and because they were surrounded by supportive peers.
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Gender inequality in health among elderly people in a combined framework of socioeconomic position, family characteristics and social support. AGEING & SOCIETY 2009. [DOI: 10.1017/s0144686x08008349] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThis study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants: socio-economic position, family characteristics and social support. Data came from the 2006Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.
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Hudon C, Soubhi H, Fortin M. Relationship between multimorbidity and physical activity: secondary analysis from the Quebec health survey. BMC Public Health 2008; 8:304. [PMID: 18775074 PMCID: PMC2542369 DOI: 10.1186/1471-2458-8-304] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 09/05/2008] [Indexed: 12/21/2022] Open
Abstract
Background Abundant literature supports the beneficial effects of physical activity for improving health of people with chronic diseases. The relationship between multimorbidity and physical activity levels, however, has been little evaluated. The purpose of the current exploratory study was to examine the relationship between a) multimorbidity and physical activity levels, and b) long-term limitations on activity, self-rated general health, psychological distress, and physical activity levels for each sex in adults, after age, education, income, and employment factors were controlled for. Methods Data from the Quebec Health Survey 1998 were used. The sample included 16,782 adults 18–69 yr of age. Independent variables were multimorbidity, long-term limitations on activity, self-rated general health, and psychological distress. The dependent variable was physical activity levels. Links between the independent and dependent variables were assessed separately for men and women with multinomial regressions while accounting for the survey sampling design and household clustering. Results About 46% of the participants were men. Multimorbidity was not associated with physical activity levels for either men or women. Men and women with long-term limitations on activity and with poor-to-average self-rated general health were less likely to be physically active. No relationship between psychological distress and physical activity was found for men. Women with high levels of psychological distress were less likely to be physically active. Conclusion Multimorbidity was not associated with physical activity levels in either sex, when age, education, income, and employment factors were controlled for. Long-term limitations on activity and poor-to-average self-rated general health seem related to a reduction in physical activity levels for both sexes, whereas psychological distress was associated with a reduction in physical activity levels only among women. Longitudinal studies using a comorbidity or multimorbidity index to account for severity of the chronic diseases are needed to replicate the results of this exploratory study.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine, Sherbrooke University, Quebec, Canada.
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Heller DA, Ahern FM, Pringle KE, Brown TV. Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity. J Clin Epidemiol 2008; 62:177-87. [PMID: 18722090 DOI: 10.1016/j.jclinepi.2008.05.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 03/16/2008] [Accepted: 05/05/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the impact of changes in comorbidity--as measured by the Charlson comorbidity index--on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories. STUDY DESIGN AND SETTING Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions. RESULTS Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia. CONCLUSION Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.
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Affiliation(s)
- Debra A Heller
- First Health Services Corporation/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA.
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Kaplan GA, Baltrus PT, Raghunathan TE. The shape of health to come: prospective study of the determinants of 30-year health trajectories in the Alameda County Study. Int J Epidemiol 2007; 36:542-8. [PMID: 17376802 DOI: 10.1093/ije/dym008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Considerable evidence now exists indicating that incidence and progression of disease and disability are associated with socio-economic, behavioural, demographic and psychosocial factors. The emerging life course perspective suggests that these factors might be associated with not just the incidence of disease and death, but also trajectories of health over decades. METHODS Prospective study of a representative, population-based cohort studied on four occasions over 30 years. Trajectories of health over this period, combining self-rated health and date of death, were related to behavioural, psychosocial and socio-economic risk factors. RESULTS Trajectories of health were associated with behavioural, socioeconomic, and psychosocial risk factors, the strongest predictors being household income and physical activity. Those with an income 1 SD above the mean were approximately 25% more likely to die having previously consistently reported excellent health (Men: relative risk (RR) = 1.27, 95% CI = 1.10-1.46; Women: RR = 1.25, 95% CI = 1.06-1.47), were more likely to remain 'Alive in Excellent Health' (Men: RR = 1.35, 95% CI = 1.21-1.51; Women: RR = 1.30, 95% CI = 1.19-1.43) and were less likely to have shown an 'Unremitting Decline' (Men: RR = 0.72, 95% CI = 0.49-1.05; Women: RR = 0.71, 95% CI = 0.48-1.04). Those with low physical activity were approximately 50% less likely to die having consistently reported excellent health (Men: RR = 0.54, 95% CI = 0.39-0.76; Women: RR = 0.48, 95% CI = 0.33-0.71), and were five-times more likely to show an 'Unremitting Decline' (Men: RR = 5.05, 95% CI = 1.75-14.56; Women: RR = 5.00, 95% CI = 1.48-16.92). They were also less likely to be 'Alive in Excellent Health' (Men: RR = 0.41, 95% CI = 0.29-0.57; Women: RR = 0.44, 95% CI = 0.33-0.57). CONCLUSIONS The burden of illness associated with behavioural, socio-economic and psychosocial risk factors extends beyond shortening of life to poorer trajectories of health over decades.
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Affiliation(s)
- George A Kaplan
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48104, USA.
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Quail JM, Addona V, Wolfson C, Podoba JE, Lévesque LY, Dupuis J. Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over. Eur J Ageing 2007; 4:45-55. [PMID: 28794771 DOI: 10.1007/s10433-007-0042-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Self-rated health (SRH) is a measure of perceived health that has been shown to predict use of community services, functional decline, pain, and mortality. Many factors associated with SRH have been identified, but unmet need for physical assistance with activities of daily living (ADL) has not yet been examined. The objective of this paper is to examine the association between unmet need and SRH while accounting for the effects of other, previously identified, correlates of SRH. We conducted a secondary analysis of a population-based study of 839 residents of Montréal, Québec who were 75 years of age or older, not cognitively impaired, and living in the community. Multivariable logistic regression was used to evaluate the association between met and unmet personal ADL (PADL) and instrumental ADL (IADL) need for physical assistance with SRH. Among 508 disabled community-dwelling elderly, for each additional unmet IADL need, subjects were 1.70 (95% CI: 1.11-2.61) times more likely to report poorer SRH. For each additional unmet PADL need, subjects were 2.26 (95% CI: 1.31-3.91) times more likely to report poorer SRH. Subjects at increased risk of malnutrition, with greater comorbidity and whose income was insufficient to meet their needs were also more likely to report poorer SRH. After adjustment for important correlates, unmet PADL and IADL needs retain a statistically significant association with poorer SRH, with nutritional status, comorbid conditions, and income satisfaction being important confounders of the relationship.
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Affiliation(s)
- Jacqueline M Quail
- Division of Clinical Epidemiology (DICE), McGill University Health Centre (MUHC), 1025 Pine Avenue West, Montréal, QC Canada H3A 1A1.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC Canada H3A 1A2
| | - Vittorio Addona
- Department of Mathematics and Computer Science, Macalester College, 1600 Grand Avenue, Saint Paul, MN USA 55105
| | - Christina Wolfson
- Division of Clinical Epidemiology (DICE), McGill University Health Centre (MUHC), 1025 Pine Avenue West, Suite P2.028, Montréal, QC Canada H3A 1A1.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC Canada H3A 1A2
| | - John E Podoba
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montréal, QC Canada H3A 1A2.,Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital, 3755 Côte Ste-Catherine, Suite A114, Montréal, QC Canada H3T 1E2
| | - Louise Y Lévesque
- Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montréal, Canada
| | - Josette Dupuis
- Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis-Jewish General Hospital, 3755 Côte Ste-Catherine, Suite A114, Montréal, QC Canada H3T 1E2
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Zauszniewski JA, Eggenschwiler K, Preechawong S, Roberts BL, Morris DL. Effects of teaching resourcefulness skills to elders. Aging Ment Health 2006; 10:404-12. [PMID: 16798633 DOI: 10.1080/13607860600638446] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective of this study was to examine the effects of learned resourcefulness training (LRT) on health of elders in retirement communities (RCs). In a clinical trial, 46 elders in four randomly selected RCs received resourcefulness training and were compared to 43 elders in four RCs who participated in a focused reflection reminiscence (FRR) group. The two groups were similar at baseline. Repeated measures analysis of variance revealed no changes on anxiety or depression over time; however, both were significantly correlated with functional status (r's = 0.29 and 0.35, p's < 0.01), self-assessed health (r's = -0.18 and -0.26, p's < 0.05), and resourcefulness (r's = -0.24 and -0.21, p's < 0.05). Although main effects for group were not significant, interaction effects of group and time on self-assessed health and functional status were found. These findings suggest that although teaching resourcefulness to groups of elders in RCs may have beneficial effects on improving their perception of health and functioning over time, significant effects on mental health may not be apparent.
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Affiliation(s)
- J A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44016-4904, USA.
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Emmelin M, Nafziger AN, Stenlund H, Weinehall L, Wall S. Cardiovascular risk factor burden has a stronger association with self-rated poor health in adults in the US than in Sweden, especially for the lower educated. Scand J Public Health 2006; 34:140-9. [PMID: 16581706 DOI: 10.1080/14034940510032365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is an ongoing debate about the importance of biomedical and sociodemographic risk factors in the prediction of self-rated health. OBJECTIVES To compare the association of sociodemographic and cardiovascular risk factors and self-rated health in Sweden and the US. DESIGN Data from two population-based cross-sectional health surveys, one in Sweden and one in the US. SUBJECTS The surveys included questionnaire and measured data from 5,461 adults in Sweden and 7,643 in the US. Participants were between 35 and 65 years of age. RESULTS The odds ratios for poor self-rated health for the included cardiovascular risk factors were greater in the US. Low education was significantly more prevalent among those with self-rated poor health in the US, but not in Sweden. Using Swedes with high education as reference group (OR = 1), adults in the US with low education and 2+ risk factors had a greater than threefold risk (OR = 6.3) of self-rated poor health compared with Swedish low-educated adults with the same risk factor burden (OR = 1.9). The better-educated US adults with 2+ risk factors were significantly more likely to report poor health (OR = 3.4) compared with their Swedish counterparts (OR = 2.4). CONCLUSIONS The interaction between risk factors, education, and self-rated health suggests a frightening picture, especially for the US. Public health interventions for reducing cardiovascular risk factors need to include both population and individual measures. Taking people's overall evaluation of their health into account when assessing total health risk is important.
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Affiliation(s)
- Maria Emmelin
- Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Bambauer KZ, Aupont O, Stone PH, Locke SE, Mullan MG, Colagiovanni J, McLaughlin TJ. The effect of a telephone counseling intervention on self-rated health of cardiac patients. Psychosom Med 2005; 67:539-45. [PMID: 16046365 DOI: 10.1097/01.psy.0000171810.37958.61] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness. METHODS We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month postdischarge. Recruited patients were randomized into either an intervention or control group. Intervention patients received up to six 30-minute telephone-counseling sessions focused on identifying cardiac-related fears. Control patients received usual care. For both groups, we collected patients' responses to the HADS and to the Global Improvement (CGI-I) subscale of the Clinical Global Impressions (CGI) Scale at baseline and at 2, 3, and 6 months postbaseline using Interactive Voice Recognition (IVR) technologies. We used mixed-effects analysis to estimate patients' changes in CGI-I measures over the three time points of data collection postbaseline. RESULTS We enrolled 100 patients, and complete CGI-I measures were collected for 79 study patients. The mean age was 60 years (standard deviation = 10), and 67% of the patients were male. A mixed-effects analysis confirmed that patients in the intervention group had significantly greater improvements in self-rated health (SRH) between baseline and month 3 than the control group (p = .01). Between month 3 and month 6, no significant differences in SRH improvements were observed between the control and intervention groups. CONCLUSIONS Study patients reported greater SRH improvement resulting from the telephone-based intervention compared with control subjects. Future research should include additional outcome measures to determine the effect of changes in SRH on patients with comorbid physical and emotional disorders.
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Puigdollers E, Domingo-Salvany A, Brugal MT, Torrens M, Alvarós J, Castillo C, Magrí N, Martín S, Vázquez JM. Characteristics of heroin addicts entering methadone maintenance treatment: quality of life and gender. Subst Use Misuse 2004; 39:1353-68. [PMID: 15462234 DOI: 10.1081/ja-120039392] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To provide information on MMP patient's characteristics, particularly those related with Health Related Quality of Life (HRQoL) and gender. DESIGN Cross-sectional study. Data were collected on socio-demographic, toxicological variables, HIV risk behaviors, and HRQoL through the Nottingham Health Profile (NHP). PATIENTS AND SETTING Over a 30-month period (1996--1999) Barcelona's Municipal Drug Care Centres recruited 586 patients. MAIN RESULTS Mean age of patients was 31 years, 70% were males and 25% were HIV-infected. Rates of unemployment, criminal records and low educational level were high. Most poly-drug users used cocaine. NHP mean score was related with poly-drug use, educational level and HIV status. Consistent condom use was related with HIV status. Females' route of administration was less likely to be injection, even though they were more frequently HIV-positive and manifested contemporary poorer general health. CONCLUSIONS Patients QoL was poor. Nowadays harm reduction health strategies would need to face cocaine use, and sexual risk behaviors mainly among females and sexual partners.
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López-García E, Banegas JR, Graciani Pérez-Regadera A, Gutiérrez-Fisac JL, Alonso J, Rodríguez-Artalejo F. [Population-based reference values for the Spanish version of the SF-36 Health Survey in the elderly]. Med Clin (Barc) 2003; 120:568-73. [PMID: 12729524 DOI: 10.1016/s0025-7753(03)73775-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE The SF-36 Health Survey questionnaire is the most widely used instrument to measure health-related quality of life. Reference measures are needed to interpret its results in clinical and population studies. In 1996, a study provided population-based norms for Spain, but these were not disaggregated by age in subjects aged 75 years and over, even though health status changes with aging among those who overpass such age. Moreover, health status in elderly people from developed countries has improved over the last years. This study obtains population-based norms for the Spanish version of the SF-36 Health Survey in five-year age-groups for those aged 60 to 85 and over. SUBJECTS AND METHOD Cross-sectional survey on a sample of 3,949 non-institutionalised subjects representative of the Spanish population aged 60 years and over. Information on the SF-36 Health Survey was obtained through house-hold personal interviews. Central position and dispersion statistics, as well as percentiles, were calculated for each of the eight SF-36 scales by age and sex. Cronbach's alpha coefficients were calculated to assess the internal reliability of each scale. RESULTS Subjects reported higher scores for emotional role (mean [SD] 84.8 [32.9]), social functioning (79.2 [28.0]) and physical role (73.3 [41.1]). For all scales, mean scores were higher (better perceived health) among men than women (p < 0.0001). As age increased, mean scores in all scales decreased (p for linear trend < 0.001) except for mental health (p for linear trend = 0.29 in women, p for lineal trend = 0.14 in men), yet the decrease was greater for physical functioning and physical role. Reliability was very high for all scales (Cronbach's alpha from 0.84 to 0.95). RESULTS were similar to those of the study carried out in 1996. CONCLUSIONS These results extend those obtained in 1996 and facilitate the interpretation of the SF-36 Health Survey values in clinical and population studies in the Spanish population aged 60 years and older.
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Affiliation(s)
- Esther López-García
- Departamento de Medicina Preventiva y Salud Pública. Universidad Autónoma de Madrid. Madrid. España
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Abstract
We present an indicator of aging based on eight quantitative variables, measured during the periodical health examination offered by French social security to the general population in France. The used sample derived from the population examined each year. We selected a reference group of 24,510 adults older than 25 years (non-smokers, drinking less than 44 g alcohol per day, with body mass index less than 35, and not using medication). A multiple regression analysis by gender was used to select significant variables to predict age from all quantitative variables measured during the health examination. The resulting biological age could be calculated from the measured variables and the aging indicator was defined as the difference between the calculated age and the chronological age. By definition, this indicator is independent of age in the reference population and gives an indication of the difference between an individual's status in the process of aging and the mean status of people of the same chronological age. Associations between this indicator and life style habits such as tobacco and alcohol use, and occupational status were observed. A geographical analysis also exhibited significant variation over France. Such an indicator can be used at the individual level as a pedagogical tool to explain the observed individual health status. It is also of interest for the epidemiological studies, where it could contribute to a better understanding of the aging process and associated factors.
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Séculi E, Fusté J, Brugulat P, Juncà S, Rué M, Guillén M. [Health self-perception in men and women among the elderly]. GACETA SANITARIA 2001; 15:217-23. [PMID: 11423025 DOI: 10.1016/s0213-9111(01)71550-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyze the differences in health self-perception between men and women in the later stages of life and to assess their association with sociodemographic and health variables. METHODS Data on 1,459 men and 1,993 women aged 60 or older from the 1994 Catalan Health Survey, were collected and an analysis of health self-perception according to age, gender, social class, reporting of chronic disease and handicaps was performed. Multivariate logistic regression analysis was used, taking into account the survey design. RESULTS Of the women aged 60 and older, 57.3% reported poor health compared with 43.6% of men of the same age. The proportion of women with one or more handicaps was also greater (41.2%) than that of the men (28.7%), as was the case with chronic disease (92.2% in women and 85.6% in men). The multivariate model also revealed that health self-perception was poorer among women than among men. Other explanatory factors were the number of chronic diseases, having handicaps, and being a member of a lower social class. Age interacted with the number of chronic diseases to mitigate the effect of chronic diseases on perceived health status. CONCLUSIONS In the elderly population, poor health self-perception was greater among women, even when other significant explanatory variable (social class, age, handicaps and chronic disease) were adjusted for. The most important explanatory factors in health self-perception were having chronic disease and/or handicaps. The impact of chronic disease on poor health self-perception decreased in older age groups.
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Affiliation(s)
- E Séculi
- Subdirecció General de Planificació Sanitària. Departament de Sanitat i Seguretat Social, Barcelona, Spain.
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