Self-rated health, multimorbidity and depression in Mexican older adults: Proposal and evaluation of a simple conceptual model

Health self-perception is associated with life-styles and comorbidities and its effect on mortality is confounded by age. A population based study

Background

Health self-perception (HSP) is the individual and subjective concept that a person has of their state of health. Despite its simplicity, HSP is considered a valid and relevant indicator employed in epidemiological research and in professional practice as an overall measure of health.

Objectives

(1) To describe and analyze the associations between HSP and demographic variables, lifestyle and diseases prevalent in a population and (2) to investigate the relationship between HSP and mortality.

Materials and methods

In a primary care setting, we conducted a longitudinal study of a random populational sample of a Galician municipality, stratified by decade of life. A total of 1,516 adults older than 18 years, recruited by the 2013-2015 AEGIS study, were followed-up for more than 5 years. During the clinical interview, data were collected on lifestyle and prevalent diseases. The HSP was grouped into 2 categories (good/poor). The statistical analysis consisted of a logistic regression, Kaplan-Meier curves and Cox regression.

Results

A total of 540 (35.6%) participants reported poor HSP. At the end of the follow-up, 78 participants had died (5.1%). The participants with increased age and body mass index and chronic diseases (anxiety, depression, ischemic heart disease, diabetes, and cancer) presented a poorer subjective health. A high level of physical activity and moderate alcohol consumption were associated with better HSP. A poorer HSP was associated with increased mortality, an association that disappeared after adjusting for the rest of the covariates (HR, 0.82; 95% CI 0.50-1.33).

Conclusion

(1) Health self-perception is associated with age, lifestyle, and certain prevalent diseases. (2) A poorer HSP is associated with increased mortality, but this predictive capacity disappeared after adjusting for potential confounders such as age, lifestyle, and prevalent diseases.

Content validity of the nursing diagnosis low self-efficacy in health

PURPOSE

The purpose of this study was to verify the validity of the content of the proposal for the nursing diagnosis of low self-efficacy in health.

METHODS

Content validation study using the approach proposed by Lopes, a panel of 47 experts on the phenomenon of interest analyzed the content of the diagnosis using a Likert-type scale to evaluate the relevance of 16 clinical indicators and 18 etiological factors of the nursing diagnosis under investigation. These components were previously identified and defined through a middle-range theory. Based on the predictive diversity model, the experts' verifications were weighted according to their level of expertise. The pseudomedian and 95% confidence intervals were calculated. A content validity index above 0.9 was considered valid, and the Wilcoxon test was used to validate each pseudomedian with a p-value above 0.05.

FINDINGS

Thirteen clinical indicators were considered relevant, demonstrating the importance of these elements for the clinical identification of low self-efficacy in health. Three clinical indicators were excluded because they were not representative for this diagnosis. The eighteen etiological factors analyzed were considered relevant.

CONCLUSION

The findings of the present study may help nurses to identify low self-efficacy in health early and direct effective interventions to increase people's confidence in their abilities to promote their health.

IMPLICATIONS FOR NURSING PRACTICE

A new diagnostic framework is presented with peer-reviewed content, representing a phenomenon frequently reported by clinicians. This new diagnosis can guide nursing care and produce better health outcomes that depend on patients' confidence in their ability to take care of their own health.

Health-related quality of life in women aged 20-64 years with urinary incontinence

Introduction and hypothesis

Urinary incontinence (UI) in women is a frequent and invisible clinical situation that affects several aspects in the lives of patients. The aim of this study is to assess the impact of urinary incontinence on different dimensions of quality of life.

Methods

Cross-sectional observational study. The sample brings together 381 women living in the Metropolitan Region of Chile, who answered a survey between June 2020 and June 2021, with questions about the sociodemographic situation, obstetric history and the EQ5D-3L questionnaire Chilean version and urinary incontinence variables. For the analysis of association between variables were used a correlation coefficient and logistic regressions.

Results

The mean age of the sample was 39.9 (SD: 12.6) years, with 68.5% of multiparous women and 42.5% had a history of vaginal delivery. Fifty percent of the respondents belong to a medium-high socioeconomic level according to the health insurance proxy. The analysis adjusted for age, health insurance and obstetrics variables showed that women with a frequency of moderate/severe urine loss had a 72% greater probability of suffering from moderate/severe pain/discomfort compared to women with nothing/little urine loss. In turn, the self-perception of affectation of urine loss was significantly associated with problems in the dimensions of mobility, anxiety/depression and health status.

Conclusions

This research contributes with evidence that makes visible the affectation on physical and psychological dimensions in women with urinary incontinence, allowing decision-makers to prioritize resources and design health programs that include clinical management.

Impact of functional capacity on change in self-rated health among older adults in a nine-year longitudinal study

The aims of the present study were to estimate the frequency of change in self-rated health (SRH) among community-dwelling older adults, between two measures taken at a 9-year interval; and determine factors associated with a decline and an improvement in SRH, in relation to aspects of physical/emotional health and subjective wellbeing. Data were derived from a community-based study on frailty among Brazilian elderly. Associations were investigated using Pearson’s chi-square test and relative risk ratios were estimated using multinomial logistic regression analysis. 39.3% of participants did not change their SRH at both assessment times, 21.7% rated it as worse and 39.0% rated it as better. The relative risk ratio of an improvement in SRH for individuals with disability in basic activities of daily living (ADLs) was lower than for individuals with independence in basic ADLs (IRR=0.22; IC95%: 0.08-0.63). Understanding the complex interactions between self-rated health and the dimensions that influence the improvement of health perception may shed light on key determinants of the wellbeing among older adults.

Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population.

DATA EXTRACTION AND SYNTHESIS

Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued.

RESULTS

From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I²: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I²: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I²: 99.9%); this raised to 52% (95% CI: 33% to 70%; I²: 99.9%) for reports including self-reported and objective diagnosis.

CONCLUSIONS

Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported.

PROSPERO REGISTRATION NUMBER

CRD42020196177.

Prevalence of multimorbidity in subjects aged ≥60 years in a developing country

Background

Aging is one of the most prominent features in recent population dynamics around the world. As populations age, the prevalence of simultaneous chronic diseases increases, which is known as multimorbidity.

Objective

The aim of the present study was to determine the prevalence of multimorbidity and associated factors in a sample of elderly Mexican subjects.

Materials and methods

A cross-sectional descriptive study was performed on a convenience sample of 139 subjects aged ≥60 years. The dependent variable was the multimorbidity diagnosis performed by a physician, which was categorized as 0 for subjects with no chronic disease or only 1 disease and 1 for subjects with 2 or more chronic diseases. Questionnaires were used to collect the information on the different variables. A statistical analysis was performed in Stata 11.0.

Results

The mean age was 79.06±9.78 years, and 69.1% of the subjects were women. A total of 69.1% (95% confidence interval =61.3–76.8) reported at least 1 morbidity. The mean morbidity by subject was 1.04±1.90. Cardiovascular diseases (25.9%), hypertension (20.1%), musculoskeletal disorders (19.4%), and diabetes (13.7%) were the most frequently reported conditions. The prevalence of multimorbidity (2 or more diseases) was 27.3% (95% confidence interval =19.8–34.8). No significant differences were observed in the independent variables.

Conclusion

In conclusion, the prevalence of multimorbidity in this sample of elderly Mexican subjects was relatively low. The distribution across the included variables was not significantly different. Interventions focused on the health care of older adults with multimorbidity should pay special attention to cardiovascular diseases, hypertension, and musculoskeletal disorders.