Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave.

The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.

Aging, Dependence, and Long-Term Care: A Systematic Review of Employment Creation.

Population aging is an economic and social challenge in most countries in the world as it generates higher dependency rates and increased demand for long-term care. Undertaking the care of older dependent adults can result in new opportunities for job creation. There is limited knowledge of the impact of dependent care and long-term care on employment. We examined this impact through a systematic review. Countries with conditional cash benefits show job creation, and countries with unconditional economic benefits reveal the development of a grey care market with high participation of migrant labor. Migrant employment in developed countries affects the development of the labor market in the countries of origin. The employment created to care for dependent persons is generally precarious. In conclusion, global aging will increase long-term care worker demand, but the variations in policies can determine what kind of employment is created.

Socioeconomic and Lifestyle Factors Related to Cost and Frequency of Hospitalization in European Older Adults.

Individuals' lifestyles play an important role in healthcare costs. A large part of these costs is derived from hospitalizations. With the aim of determine the relationship between lifestyle and the likelihood of hospitalization and associate costs in older adults, this study used the Survey of Health, Aging, and Retirement in Europe. Generalized regression models for panel data were developed and adjusted hospitalization costs derived from the length of hospital stay were also estimated. The average adjusted cost of hospitalization was I$ 9901.50 and the analyses showed that performing weekly physical activity significantly reduces the probability of hospitalization (OR: 0.624) and its costs (I$ 2594.5 less per person per year than subjects who never performed physical activity). Muscle strength plays an important role in this relationship and eating habits are not of great significance. Furthermore, we found interesting differences in the frequency and costs of hospitalization between subjects by country.

Socioeconomic Factors Related to Job Satisfaction among Formal Care Workers in Nursing Homes for Older Dependent Adults.

Population ageing is increasing the demand for dependent care. Aged care nursing homes are facilities that provide formal care for dependent older persons. Determining the level of job satisfaction among workers in nursing homes and the associated factors is key to enhancing their well-being and the quality of care. A cross-sectional survey was administered online to nursing home workers (n = 256) in an inland region of Spain over the period from February to May 2017. The questionnaire collected data on sociodemographic variables and others related to training and job satisfaction. The results show that most of the care is delivered by women with a medium level of education. A total of 68% of workers had received formal training, although a significant percentage (65%) thought this was not useful. The highest level of satisfaction was found to be related to users and co-workers. Our factor analysis revealed that the satisfaction components are decision-making, working conditions-e.g., schedule-and the work environment-e.g., relationship with coworkers-. Length of service and working with highly dependent persons are negatively associated with these components. Working in social health care is negatively related to decision-making and working conditions. Training, in contrast, is positively associated with these components. Care is a job that requires appropriate training and preparation to provide quality assistance and to guarantee workers' well-being.

[Diet quality in a population aged over 65 and related socioeconomic factors]. / Calidad de la dieta en mayores de 65 años y factores socioeconómicos relacionados.

INTRODUCTION: The consumption of certain foods and healthy eating habits are related to preventing and suffering from a number of chronic diseases. These foods tend to be included in food pyramids, such as that proposed by the Spanish Society for Community Nutrition. One method of analysing diet quality is the use of indices that assess the frequency of consumption of different food groups. AIM: To analyse diet quality in a Spanish population of persons aged over 65years using the Healthy Eating Index and to determine how sociodemographic factors affect scores on the index. DESIGN: A cross-sectional, descriptive study was conducted on the diet followed at home by Spanish population aged over 65years, using the Healthy Eating Index and taking information from the 2014 European Health Interview Survey in Spain. Multiple linear regression analysis was used to determine the socioeconomic factors associated with diet quality. RESULTS: Of the study population, 89.6% need to make changes in their diet, while only 8.2% follow a healthy diet. Suffering from chronic diseases, overweight and occasional physical exercise were associated with higher scores on the Healthy Eating Index. CONCLUSION: Most of the population aged 65years or over need to make changes in their dietary patterns. Those with potential health risks are more careful about their diet. These findings confirm the need to promote guidelines for healthy eating in the non-clinical population.

Effectiveness of a Dog-Assisted Therapy Program to Enhance Quality of Life in Institutionalized Dementia Patients.

The aim of this study was to assess the effectiveness of a dog-assisted therapy intervention to enhance quality of life in persons with dementia institutionalized in a public care home and to study its effect on the use of psychotropic medications. A dog-assisted therapy intervention was designed, in which 34 residents of a public care home in Cuenca (Spain) participated. The participants were assigned to two groups, an experimental and a control group. The program consisted of one 50-min session per week during 9 months. Analysis of covariance (ANCOVA) was used to compare post-training values between groups, using baseline values as covariates. Our findings do seem to support the hypothesis that Animal-Assisted Therapy may contribute to enhancing quality of life for residents in an aged care home. However, aspects such as the format, time, and content of the sessions as well as their possibilities of reducing psychotropic medication require more research.

The reverse mortgage: a tool for funding long-term care and increasing public housing supply in Spain.

Population ageing is one of the most significant challenges facing the world in the twenty-first century. Furthermore, people aged over 65 typically have a level of income below the national average, but the homeownership rate among those in this age group tends to be high. Equity release schemes, specifically reverse mortgages, can help cover increased care costs and ensure a reasonable level of income, thus guaranteeing the well-being of older adults. However, this product has not been greatly developed by private entities. If the State were to implement this financial operation through public administrations, it could obtain homes that might then be included in public housing stocks. Thus, our paper aims to contribute to the literature on government-based reverse mortgage systems. Under our assumptions, the results showed that if 313,833 homes were reverse-mortgaged, the investment by the public administration would be around 0.73% GDP, with this being a feasible proposal. This work helps to create alternative methods to finance problems related with the ageing of societies from a public perspective.

Correction: Social determinants of food group consumption based on Mediterranean diet pyramid: A cross-sectional study of university students.

[This corrects the article DOI: 10.1371/journal.pone.0227620.].

Effects of a practical training programme on burnout among professional caregivers in a care home for older adults with dementia: a pilot study.

AIM: As the number of persons with dementia has increased so has the need for both specialized care and long-term care centres. Professional caregivers working in these centres encounter specific problems, including stress, burnout, and feelings of dissatisfaction, each which can affect the quality of care. Due to the nature of their work, they are more likely to experience stress, which may lead to burnout syndrome. Therefore, the aim of this work was to assess the results of a practical training programme with regard to burnout among direct care professionals in a nursing home for people with dementia. METHODS: A practical training programme was conducted for caregivers at the Sagrado Corazón de Jesús Nursing Home in Cuenca, Spain. The programme used a dynamic, interactive methodology to provide training related to concepts and strategies for dementia care. Weekly 2-h sessions were held over 9 months, from April 2016 to January 2017, with the post-test administered in February. Pretest and post-test measures were taken for a sample of 36 caregivers. An anova was used to analyze the differences in means before and after training. An ancova was also performed to determine the effects of the intervention. RESULTS: The results revealed a significant difference between pre- and post-intervention emotional exhaustion and depersonalization scores. Personal accomplishment scores improved, but the changes were not significant. CONCLUSION: A practical training programme for direct care professionals working with dementia patients can decrease burnout levels.

Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment.

Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. METHODS: The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. RESULTS: The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3955, 1 million (0.38% of GDP). CONCLUSION: This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.

Catastrophic long-term care expenditure: associated socio-demographic and economic factors.

OBJECTIVE: An increasing number of persons across the world require long-term care (LTC). In Spain, access to LTC involves individuals incurring out-of-pocket (OOP) expenditure. There is a large body of literature on the incidence of catastrophic OOP payments in access and participation in health systems, but not in the field of LTC nor the determinants of these expenses. Our aim was to analyse the socio-demographic and economic factors associated with different levels of catastrophic LTC expenditure in the form of private out-of-pocket payments among dependent persons in Spain. MATERIALS AND METHODS: The study used the Spanish Disability and Dependency Survey (SDDS) conducted by the Spanish National Statistics Institute to obtain the socioeconomic, demographic and health profiles. The households were classified into those below the poverty threshold and those above the threshold of catastrophe, using measures of impoverishment and catastrophe. We estimated two logistic regression models, one binary (impoverishment) and one ordinal (catastrophe). RESULTS: The results show that OOP expenditure on LTC increases the probability of impoverishment by 18.90%. The factors associated with higher probability of experiencing catastrophe were age, being single, widowed or separated, lower levels of household income and education, higher level of dependence and living in an autonomous community with lower per capita income. CONCLUSIONS: These findings highlight the need to include exemptions or insurance in the design of LTC policies to protect dependent persons from the risk of financial burden.

Socioeconomic, demographic and lifestyle-related factors associated with unhealthy diet: a cross-sectional study of university students.

BACKGROUND: Food habits are important to promote and maintain good health throughout life, and unhealthy diet is a modifiable and preventable risk factor. University students are a key group of adults among whom to promote healthy lifestyles. The aim of this study is to determine the factors associated with unhealthy diet in a sample of university students. METHODS: An electronic cross-sectional survey was conducted with university students (n=593) from inland Spain, during the 2016-2017 academic year. The survey collected information on the participants' food habits using an annual food frequency questionnaire. We also collected socioeconomic and demographic data and lifestyle-related information. A multivariate logistic regression was used for analysis. RESULTS: The multivariate logistic regression revealed that the factors associated with an unhealthy diet were: being male, being underweight compared to the reference category (normal weight), having a mother of low socioeconomic status, the family home not being in the university city and, finally, studying a non health-related course CONCLUSION: Among students of the University of Castilla-La Mancha, being male, being underweight, the family home not being in the university city, having a mother of low socioeconomic status, and, finally, not studying a health-related course are the factors associated with a lower quality diet. Following a healthy diet is key in reducing the health costs of non-communicable diseases, and ensuring an acceptable long-term quality of life in populations.

Mediterranean diet and health outcomes: a systematic meta-review.

Background: The Mediterranean diet (MeDi) is considered a healthy dietary pattern, and greater adherence to this diet may improve health status. It also may reduce the social and economic costs of diet-related illnesses. This meta-review aims to summarize, synthesize and organize the effects of MeDi pattern on different health outcomes. Methods: This meta-review was performed following the PRISMA guidelines. A systematic search was conducted in the electronic databases PubMed, Web of Science and Scopus. Two researchers screened all the records to eliminate any duplicate, and they selected the articles to be fully reviewed. A third researcher was consulted to resolve discrepancies and so reach a consensus agreement. Results: Thirty-three articles were included, nine were systematic reviews and twenty-four were meta-analyses. Most of the diseases analysed are catalogued as non-communicable diseases (NCD), and the impact of these in populations may have major financial consequences for healthcare spending and national income. The results showed that the MeDi may improve health status, and it also may reduce total lifetime costs. Conclusion: MeDi has been shown to be a healthy dietary pattern that may reduce risk related to NCD. The effect is larger if the pattern is combined with physical activity, and tobacco and excessive alcohol consumption are avoided. Promoting the MeDi as a healthy dietary pattern presents challenges which need the collaboration of all levels of society.

Costes asociados a la desnutrición previa a la enfermedad y la desnutrición relacionada con la enfermedad en ancianos: una revisión sistemática.

INTRODUCTION: Malnutrition is a health problem which affects a high percentage of old people since the physical and psychosocial changes common to this period of life favor it in this group. In addition, aging population has a high prevalence of chronic illnesses and acute pathologies which can affect their nutritional state negatively, leading to malnutrition related to illness. OBJECTIVE: The aim of this systematic revision was to analyze the economic costs related to malnutrition in old people and to discover whether there were differences between economic costs of pre-existing malnutrition prior to illness and malnutrition because of disease. METHOD: A bibliographic search was carried out in the databases of Pubmed, Web of Science and Scopus, for the period between 2000 and 2016. RESULTS: A total of 1,001 articles were found and 19 were selected using inclusion criteria. Of these, eleven analyzed the costs of pre-existing malnutrition prior to illness, seven analyzed the costs of malnutrition related to illness and one, both situations. CONCLUSIONS: In general, malnutrition increased health costs as a result of hospital admissions, greater number of readmissions and greater demand on health resources. Moreover, in the studies analyzed, pre-existing malnutrition prior to illness implied greater costs than those related to the actual illness; therefore, it would be convenient to establish selection and preventive policies on malnutrition in old people.

[The co-payment of the dependence from the structural reform of 2012 in Spain]. / El copago de dependencia en España a partir de la reforma estructural de 2012.

OBJECTIVE: The objective of this piece of work is to establish the cost of dependency and the cost of financing it. Specifically, we will determine the cost of co-payment for individual users following the modification introduced by the 13th of July 2012 Resolution as well as its allocation by the autonomous regions. METHODS: The degree and level of dependency was established using the Survey on Disability, Personal Autonomy and Dependency Situations, 2008. The cost of dependency according to degree and level and autonomous regions was established with information from the System for Personal Autonomy and Care of Dependent Persons. The co-payment was established according to applicants' purchasing power. The rating of these services, and the contribution of individual users were done in agreement with 2012 legislation and with common indicators and benchmarks for the whole national territory. RESULTS: The total estimated cost is 10,598.8 million euros (1.03% of GDP), and Andalusia, the Valencian Community and Catalonia are those regions with the greatest costs. The average national co-payment per individual user is 53.54%, with differences due to degrees and levels of disability and autonomous regions, although, generally speaking, all of the users fund more than half of the care they receive. CONCLUSIONS: This change in legislation has meant that co-payment is higher than the 33% established by this law and that co-payments prior to 2012 were about 20%. If we add to this the differences in autonomous regions, it would be useful to reflect on the uneven application of the law.

[Costs associated to informal caregiving hours for older people living in rural communities [Spain]]. / Costes asociados a las horas de cuidado informal de los mayores dependientes en un ámbito rural.

OBJECTIVES: To determine the costs associated with the variables that best predict hours of informal care among people living at home with some level of dependency for activities of daily living (ADL). METHODS: We performed a crosssectional observational study of 241 men and women aged more than 64 years old living in rural communities (men 37.8%, women 62.2%). The mean (standard deviation) age was 81.07 (7.07) years. Through the Resident Assessment Instrument Home Care (RAI-HC) questionnaire, sociodemographic variables, ADL dependencies and caregiving hours were assessed. Multiple linear regression analysis was applied. RESULTS: The predictive variables in the multiple linear regression model were living alone and requiring assistance for eating, meal preparation, bed mobility, and outdoor mobility. These predictive variables explained 46.3% of the total variation in caregiving hours. Standardized b coefficients were obtained from needing help to eat (0.272) and prepare meals (0.205). Needing help to eat represented an increment of 275 annual caregiving hours and its associated cost was 2,406.15 euro/year. Becoming dependent for meal preparation represented an increment of 307.2 h and a cost of 2688.18 euro/year. Dependency had a cost of between 4,972.72 and 21,479.15 euro/year, depending on ADL limitations. CONCLUSIONS: Almost 50% of the costs related to the care giving hours that may be required by an elderly person with some degree of dependency can be attributed to the fact of living alone and to some ADL that can be easily evaluated, such as eating, cooking, bed mobility, and outdoor mobility.