Associated factors for fear of COVID-19 scale in long-term care settings in Spain.

OBJECTIVE: To examine the relationship between the Fear of COVID-19 Scale (FCV-19S) score and sociodemographic, health, emotional and behavioural factors, in a cross-sectional observational study in 447 older adults living in long-term care (LTC) settings in Madrid (Spain). METHODS: The sample was stratified by nursing home ownership, geographical location, and size. Multiple linear regression analysis was used using backward elimination to identify factors that explained associations with fear, and logistic regression models were used to examine its role as a predictor of adherence to preventive measures. RESULTS: The mean age of the participants was 83.8 years, most were female, had had COVID-19, and were worried about the pandemic. The average score of the FCV-19S was 18.36 (SD: 8.28; range: 7-35), and the variables associated in the multiple linear regression model (explained variance: 34.00%) were being female, lower level of education, satisfaction with life and the residential home, and higher worry about the pandemic. The logistic regression models showed that fear of COVID-19 was a predictor of adherence to preventive measures like wearing facemasks, washing hands, and avoiding physical contact. CONCLUSIONS: fear of COVID-19 was significantly related with sex and subjective factors as life satisfaction and worry; and it influences older people's preventive behaviour. Interventions aimed at reducing fear and promoting adherence to preventive measures would improve their mental health and well-being.

[Prevalence of loneliness among older people living in rural areas. Differences by ethnic group and predictor variables]. / Prevalencia de la soledad en las personas mayores que viven en zonas rurales. Diferencias por grupos étnicos y variables predictivas.

BACKGROUND: Loneliness is one of the most recurrent public health problems in older people. However, there is little data available in Chile on its prevalence in people over 60 years of age living in rural areas and belonging to native or Afro-descendant groups. AIM: To examine the prevalence of loneliness among older people living in rural areas by ethnic group and to analyze the socio-demographic, family, and health variables related to loneliness. METHODS: We interviewed 1,692 elderly people living in Chilean rural areas of the regions of Arica and Parinacota, Tarapacá, Antofagasta, Atacama, Coquimbo, Valparaíso, Los Lagos, Aisén and Magallanes. The instruments applied were the DJGLS-6 loneliness scale, Family-APGAR, questionnaire of 13 most frequent health problems in Chilean older people, and Barthel index. RESULTS: We found a high prevalence of loneliness (over 55%) among Afro-descendants, Quechua, Atacameño, Colla, Chango, Huilliche, Kawesqar and non-indigenous people. Emotional loneliness is the most prevalent among indigenous and non-indigenous older people living in rural areas (≥ 71%). Variables associated with loneliness were being female, age, not having a partner, living alone, family dysfunctionality, and having health problems. CONCLUSIONS: Loneliness in rural areas is higher in older people, and this situation becomes more complex at the crossroads of ethnic-cultural diversity; it is necessary to continue to address this problem that affects biopsychosocial well-being in old age.

A systematic review of ageing in place among Indigenous People in Canada, USA, México, Chile and New Zealand.

The ageing in place (AIP) model enjoys widespread recognition in gerontology and has been strongly encouraged through social policy. However, progress remains to be made in terms of analysing AIP for minority groups and groups with diverse life pathways in old age. This systematic review aims to identify studies that address the AIP model in indigenous communities, answering the following questions: In which geographical contexts and for which Indigenous Peoples have AIP been researched? Which physical dimensions are considered in the assessment of AIP? Which social dimensions are considered in the assessment of AIP? This systematic review applied the SALSA (Search, Appraisal, Synthesis and Analysis) method to AIP among Indigenous older adults on the Web of Science, PsycINFO, MEDLINE and Scopus digital platforms for publications from 2011 to 2021. We identified 12 studies conducted in five countries in North and South America and Oceania. The results show that the following elements of the physical environment are assessed: household, neighbourhood, local surroundings or reserve and native territories. Meanwhile, assessed elements of the social environment are as follows: personal characteristics, attachment to place, social networks, social participation and social policies. There is discussion of the need to develop AIP in order to promote successful ageing among Indigenous older adults.

[Studying loneliness and social support networks among older people: a systematic review in Europe.] / La investigación sobre soledad y redes de apoyo social en las personas mayores: una revisión sistemática en Europa.

OBJECTIVE: During the ageing process the loss of family and social relationships is frequent which conditions loneliness, similarly the current COVID-19 pandemic has generated more social limitations in this age group and has increased the risk factors to trigger feelings of loneliness. This paper aimed to examine how loneliness among older people had been studied in Europe over the last ten years. Specific objectives were: i) to describe the methodological aspects; ii) to identify the scales or questions for the assessment of loneliness; iii) what were the main variables or dimensions that were related to loneliness in old age. METHODS: A total of 1,591 articles were found in WoS and Scopus digital platforms. After initial assessment of titles and abstracts, full text reading and review of the established criteria, 42 scientific articles were finally included in the systematic review. RESULTS: The countries that had carried out the most studies were the Netherlands and Spain. Most of the research was quantitative and uses the De Jong Gierveld Loneliness Scale (DJGLS) and the University of California at Los Angeles (UCLA) Loneliness Scale. The most analysed variables were: marital status, household structure, social support networks, social participation, depression, health problems, co-morbidity and physical functioning. CONCLUSIONS: The scientific interest in studying loneliness, with a focus on social support networks, in older people in Europe and strategically addressing loneliness as a public health problem is confirmed.

OBJETIVO: Durante el proceso de envejecimiento es frecuente la pérdida de relaciones familiares y sociales, lo cual condiciona la soledad. Además, la actual pandemia de la COVID-19 ha generado más limitaciones en las relaciones sociales de este grupo de edad y ha aumentado los factores de riesgo para desencadenar sentimientos de soledad. Este trabajo tuvo el objetivo de examinar cómo se había estudiado la soledad en las personas mayores en Europa en los últimos diez años. Se propusieron como objetivos específicos: i) describir los aspectos metodológicos; ii) identificar las escalas o preguntas para la valoración de la soledad; iii) cuáles eran las principales variables o dimensiones que se relacionaban con la soledad en la vejez, priorizando el rol de las redes de apoyo social. METODOS: Se encontraron 1.591 artículos en total en las plataformas digitales WoS y Scopus. Tras la valoración inicial de los títulos y resúmenes, lectura de texto completo y revisión de los criterios establecidos, al final se incluyeron en la revisión sistemática 42 artículos científicos. RESULTADOS: Los países que más estudios habían realizado eran Países Bajos y España, en su mayoría las investigaciones eran cuantitativas y utilizaban las escalas De Jong Gierveld Loneliness Scale (DJGLS) y University of California at Los Angeles (UCLA) Loneliness Scale. Las variables más analizadas fueron: estado civil, estructura del hogar, redes de apoyo social, participación social, depresión, problemas de salud, comorbilidad y funcionalidad física. CONCLUSIONES: Se confirma el interés científico por estudiar la soledad, con un énfasis central en las redes de apoyo social, en las personas mayores en Europa y abordar estratégicamente la soledad como un problema de Salud Pública.

Social Image of Old Age, Gendered Ageism and Inclusive Places: Older People in the Media.

Ageism promotes the exclusion of older people from society by generating a negative image that they also internalize. The aim of this article is to investigate older people's social self-image, through statements broadcast on a national Spanish radio program aimed at this group. A qualitative analysis was conducted for a random sample from the sound archive for the Radio Nacional de España program Juntos Paso a Paso (Together, Step by Step) (2008-2021), using codes based on the pillars and determinants of active ageing and the three dimensions of ageism. Intercoder agreement was calculated. There were significant findings regarding ageism, gendered ageism and ageing in place, with differences according to size of municipal area. The program in question can be considered a viable secondary source for the research aim. Ageism is most commonly manifested through implicit opinions and invisibilization in family and social contexts. Care activities play a notably central role in responses related to gendered ageism. In relation to ageing in place, older people prefer their habitual environment when they have moderate care needs and accept moves to nursing homes when their needs increase.

The Impact of COVID-19 on Nursing Homes: Study Design and Population Description.

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.

Validation of the Spanish Version of the Fear of COVID-19 Scale (FCV-19S) in Long-Term Care Settings.

Fear of coronavirus disease 2019 (COVID-19) is one of the main psychological impacts of the actual pandemic, especially among the population groups with higher mortality rates. The Fear of COVID-19 Scale (FCV-19S) has been used in different scenarios to assess fear associated with COVID-19, but this has not been done frequently in people living in long-term care (LTC) settings. The present study is aimed at measuring the psychometric properties of the Spanish version of the FCV-19S in residents in LTC settings, following both the classical test theory (CTT) and Rasch model frameworks. The participants (n = 447), aged 60 years or older, were asked to complete the FCV-19S and to report, among other issues, their levels of depression, resilience, emotional wellbeing and health-related quality of life with validated scales. The mean FCV-19S score was 18.36 (SD 8.28, range 7−35), with higher scores for women, participants with lower education (primary or less) and higher adherence to preventive measures (all, p < 0.05). The Cronbach's alpha for the FCV-19S was 0.94. After eliminating two items due to a lack of fit, the FCV-19S showed a good fit to the Rasch model (χ2 (20) = 30.24, p = 0.019, PSI = 0.87), with unidimensionality (binomial 95% CI 0.001 to 0.045) and item local independency. Question 5 showed differential item functioning by sex. The present study shows that the FCV-19S has satisfactory reliability and validity, which supports its use to effectively measure fear in older people living in LTC settings. This tool could help identify risk groups that may need specific health education and effective communication strategies to lower fear levels. This might have a beneficial impact on adherence to preventive measures.

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak.

The most vulnerable residential settings during the COVID-19 pandemic were older adult's nursing homes, which experienced high rates of incidence and death from this cause. This paper aims to ascertain how institutionalized older people assessed their residential environment during the pandemic and to examine the differences according to personal and contextual characteristics. The COVID-19 Nursing Homes Survey (Madrid region, Spain) was used. The residential environment assessment scale (EVAER) and personal and contextual characteristics were selected. Descriptive and multivariate statistical analysis were applied. The sample consisted of 447 people (mean age = 83.8, 63.1% = women, 50.8% = widowed, 40% = less than primary studies). Four residential assessment subscales (relationships, mobility, residential aspects, privacy space) and three clusters according to residential rating (medium-high with everything = 71.5% of cases, low with mobility = 15.4%, low with everything = 13.1%) were obtained. The logistic regression models for each cluster category showed to be statistically significant. Showing a positive affect (OR = 1.08), fear of COVID-19 (OR = 1.06), high quality of life (OR = 1.05), not having suspicion of depression (OR = 0.75) and performing volunteer activities (OR = 3.67) were associated with the largest cluster. It is concluded that a better residential evaluation was related to more favourable personal and contextual conditions. These results can help in the design of nursing homes for older adults in need of accommodation and care to facilitate an age-friendly environment.

Active ageing profiles among older adults in Spain: A Multivariate analysis based on SHARE study.

BACKGROUND: Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age. METHODS: A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA). RESULTS: Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life. DISCUSSION AND CONCLUSIONS: The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Influence of Active and Healthy Ageing on Quality of Life Changes: Insights from the Comparison of Three European Countries.

This study aimed to analyze the determinants of quality of life (QoL) in older people in three European countries (Portugal, Spain and Sweden). A sample of 7589 participants in waves 4 (2011) and 6 (2015) of the Survey on Health, Aging, and Retirement in Europe (SHARE) project, aged 50 and over and living in Portugal, Spain and Sweden, was included. The CASP-12 scale was used to measure QoL. A principal component analysis was performed to group preselected variables related to active and healthy ageing into the dimensions of health, social participation, and lifelong learning. A linear regression model was built using the change in CASP-12 scores over the 4-year follow-up as the dependent variable, including the interactions between country and each independent variable in the model. After four years, the average QoL increased in Portugal (difference = 0.8, p < 0.001), decreased in Spain (-0.8, p < 0.001), and remained constant in Sweden (0.1, p = 0.408). A significant country-participation component interaction (p = 0.039) was found. In Spain, a higher participation (ß = 0.031, p = 0.002) was related to a higher QoL improvement at 4 years, but not in Sweden or Portugal. Physical health and emotional components (ß = 0.099, p < 0.001), functional ability (ß = 0.044, p = 0.023), and cognitive and sensory ability (ß = 0.021, p = 0.026) were associated with QoL changes over time in all countries. The country-specific associations between health, social participation and QoL should be taken into account when developing public health policies to promote QoL among European older people.

Environmental and Psychosocial Interventions in Age-Friendly Communities and Active Ageing: A Systematic Review.

Background: The academic literature contains little information regarding the interventions that create age-friendly cities and communities in order to promote active ageing. Objectives: A systematic review was carried out to determine the available empirical evidence in relation to the characteristics, content and effectiveness of interventions aimed at improving environmental and psychosocial risk factors for older people, from the perspective of age-friendly communities and the promotion of active ageing. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the studies retained in this review were identified through a systematic search of the academic literature in selected electronic databases including Web of Science and Scopus. Independent critical appraisal and data extraction were conducted by two reviewers. The checklist was used to assess the quality of the articles. Findings: The search identified 1020 potentially eligible documents, of which 11 satisfied the established criteria. Non-exhaustive practices prevailed over rigorous investigations, with a high proportion of studies observed to be of low methodological quality and at high risk of bias. This reflected the predominance of uncontrolled interventions. Environmental interventions were focused on reducing risk and adapting the everyday environmental setting, while psychosocial interventions prioritised social strategies (behavioural changes, promotion of participation) and training. Interventions were more effective in certain domains of age-friendly cities and communities such as transportation and housing, followed by increased participation as a lifestyle-related behavioural change. The inferred changes were associated with providing information and enhancing skills; modifying access, barriers, exposures, and opportunities; enhancing services and support; continuity and effectiveness of changes over time; and modifying policies based on the bottom-up approach of age-friendly cities and communities (AFCC). Discussion and conclusion: Interventions focused on personal and organisational aspects might have positive effects in the longer term. However, fewer changes would be observed in interventions revolving around changing lifestyles owing to the impact of complex multi-causal factors. The relative effectiveness in terms of health calls into question the design of interventions and the supposed "friendliness" of certain communities. There is a need to encourage sound longitudinal research aimed at providing key knowledge for the implementation and evaluation of public policies, and to encourage age-friendly community programmes to promote active ageing.

[Financial fraud and health: a qualitative approach]. / Fraudes financieros, salud y calidad de vida: un estudio cualitativo.

During the economic crisis, developed countries have experienced financial fraud, with effects on the physical and mental health of the people affected, and on social domains. Based on the theoretical framework in literature reviews and in quantitative studies, this paper aims to obtain evidence on the effects of financial fraud on health and on the family and social environments of those affected. An intentional sample of 32 people affected by abusive and multi-currency mortgages, preferred and swap stock in Madrid was approached. In-depth interviews were conducted, and the resulting data was analysed using content analysis. Fraud-affected individuals had conditions of age, sex, educational level and occupations that possibly allowed them to accumulate economic resources throughout the course of their lives and, predictably in many cases, to take out fraudulent financial products, based on trust in the financial institutions. Financial fraud has led to the emergence of various processes of anomia and adverse health effects. The consequences on health were physical ailments (symptoms and diseases in various systems and parts of the body) and mental disorders (anxiety, depression, suicidal ideation), all affecting lifestyles, behaviour and personal and social relationships, both in affected individuals and their families. The increase in the use of medical drugs and health services serves as a final corollary to the imbalances on the affected people's health. Individuals and the Spanish society demand public health policy measures to mitigate the effects on health and the recovery of their confidence in the banking and political system.

Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe.

PURPOSE: Loneliness and social isolation have detrimental effects on health in old age; however, the prospective associations with quality of life (QoL) remain unclear. Furthermore, despite the existence of a European north-south gradient in the distribution of loneliness and social isolation, little is known whether the associations are context-specific. We investigated the relationships between loneliness, social isolation and QoL of older adults residing in the North (Sweden) and South (Spain) of Europe. METHODS: Study sample consisted of 2995 Swedish and 4154 Spanish older adults who participated in waves six and seven of the Study on Health, Aging and Retirement in Europe (SHARE). Loneliness and social isolation were measured at the baseline, and QoL was measured at the baseline and follow-up using CASP-12. Prospective associations were assessed via multivariate linear regression. RESULTS: In Sweden, subjects with higher vs. lower loneliness had 1.01 (95% CI: -1.55, -0.40) units lower QoL, while every standard deviation increase in social isolation was associated with a 0.27 (95% CI: -0.42, -0.09)-unit decrease in QoL. In Spain, every standard deviation increase in social isolation was associated with a 0.66 (95% CI: -1.11, -0.22)-unit decrease in QoL. The association was stronger in subjects aged ≤65 years old and those with no chronic diseases. The association with loneliness was not statistically significant in Spain. CONCLUSION: Loneliness and social isolation are prospectively associated with decreased QoL among older adults, yet the associations are contextually bound. Future interventions should target both exposures, among others, in order to increase QoL in this group.

[Validation of the functional independence scale]. / Validación de la Escala de Independencia Funcional.

OBJECTIVE: To assess the psychometric quality of an instrument designed to measure functional independence (Functional Independence Scale [FIS]) in several activities of daily living domains and to be applied by trained non-health-related interviewers. The study was carried out in the autonomous region of Madrid in community-dwelling elders. METHODS: We performed a cross-sectional validation study. In addition to the FIS, Pfeiffer's questionnaire, the Depression Subscale of the Hospital Anxiety and Depression Scale, the Comorbidity Index, the Barthel Index, and EQ-5D were used. These measures were cross-sectionally applied to community-dwelling elders (n=500) and outpatients in a general hospital (n=100) aged 65 years. The following FIS psychometric attributes were analyzed: acceptability, scaling assumptions, internal consistency, construct validity, and precision. RESULTS: A fully computable FIS total score was obtained in 94.3% of the subjects. A ceiling effect (60.65%), but no floor effect (0.22%) was evident in the community-dwelling elders. No floor or ceiling effects were detected in the hospital sample. Scaling assumptions and internal consistency were satisfactory (item-total correlations: 0.57-0.91; Cronbach's alpha: 0.94). Factor analysis identified three factors that explained 74.3% of the variance. Indexes of convergent, internal, and known-groups validity were satisfactory. The scale's precision, determined by the standard error of measurement (2.49; 95%CI=4.88), was also satisfactory. CONCLUSION: The FIS is an easy-to-use instrument with appropriate metric attributes. This scale can be usefully applied in broad samples of non-institutionalized elders by non-health related personnel.

The Disease Burden Morbidity Assessment in older adults and its association with mortality and other health outcomes.

The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan-Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan-Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions.

[Sociodemographic and health factors explaining emotional wellbeing as a quality of life domain of older people in Madrid, Spain. 2005]. / Factores sociodemográficos y de salud en el bienestar emocional como dominio de calidad de vida de las personas mayores en la Comunidad de Madrid. 2005.

BACKGROUND: The study of the emotional state and personal coping resources has drawn an increasing interest in the Quality of Life (QoL) field. Diverse researches have demonstrated its contribution to satisfaction with life, and the interconnection with other life domains of great importance in ageing, as health is. The aim of this work is to analyze the relationships of emotional wellbeing (in terms of affects and coping resources) with sociodemographic and health factors. METHODS: A survey on QoL among older people living in family housing of Madrid province (CadeViMa-2005) was used. Multivariate analyses were applied for generating an indicator of emotional wellbeing which integrated positive and negative affects, as well as personal coping resources. A logistic regression model was created to explain a positive emotional wellbeing, according to sociodemographic and health characteristics. RESULTS: People without anxiety or depression problems were around three times more likely to evaluate their emotional wellbeing positively than those who had problems. Older adults whose health was better than in the previous 12 months, seemed to be five times more likely to report a high emotional wellbeing, compared to those who experienced a health decline. Individuals with a very good perceived health status were 26 times more likely of having a high emotional wellbeing than people with a negative health perception. Those with middle and upper social class were three times more likely to experience a positive emotional wellbeing than those belonging to a low social class. CONCLUSIONS: Health greatly influences emotional wellbeing with a relevant role of the subjective experience of health, together with social class as an indicator of educational level and socioeconomic status.

Rasch Analysis and Construct Validity of the Disease Burden Morbidity Assessment in Older Adults.

Purpose of the Study: The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire in which participants rate the disease burden caused by a number of medical conditions. This paper studies the measurement properties of the DBMA, using Rasch analysis. Design and Methods: We used data of 1,400 community-dwelling adults aged 50 years and older participating in the Ageing in Spain Longitudinal Study, Pilot Survey (ELES-PS). Test of fit to the Rasch model, reliability, unidimensionality, response dependency, category structure, scale targeting, and differential item functioning (DIF) were studied in an iterative way. Construct validity of the linear measure provided by the Rasch analysis was subsequently assessed. Results: To achieve an adequate fit to the Rasch model, all items were rescored by collapsing response categories. Reliability (Person Separation Index) was low. The scale was unidimensional and neither response dependency nor relevant DIF were found. The linear measure had a correlation of -0.48 with physical functioning, -0.47 with perceived health, 0.32 with depression, and -0.24 with quality of life (QoL) and displayed satisfactory known-groups validity by sex and age groups. Relative precision analysis showed that the linear measure discriminated better between age groups than the original raw score, but for sex no difference was found. Implications: Despite some limitations, support was found for the validity of the DBMA in older adults. Its linear scores may be useful to assess strategies aimed at improving the QoL of patients with multimorbidity. More research is needed in a hospital-based sample.

Prevalencia de la soledad en las personas mayores que viven en zonas rurales. Diferencias por grupos étnicos y variables predictivas

Antecedentes: La soledad es uno de los problemas de salud pública más recurrentes en las personas mayores, sin embargo, en Chile se disponen de escasos datos sobre su prevalencia en personas mayores a 60 años que viven en zonas rurales y que pertenecen a pueblos originarios o al tribal afrodescendiente. Objetivo: Examinar la prevalencia de la soledad entre personas mayores que viven en zonas rurales por grupo étnico; y analizar las variables sociodemográficas, familiares y de salud que se relaciona con soledad. Material y Métodos: Se aplicó la escala de soledad DJGLS-6, APGAR-familiar, cuestionario de 13 problemas de salud más frecuentes en personas mayores chilenas, e índice de Barthel a 1.692 personas mayores que residen en zonas rurales de las regiones de Arica y Parinacota, Tarapacá, Antofagasta, Atacama, Coquimbo, Valparaíso, Los Lagos, Aisén y Magallanes. Resultados: Se observa una alta prevalencia de la soledad (sobre el 55%) en personas de los pueblos: Afrodescendiente, Quechua, Atacameño, Colla, Chango, Huilliche, Kawesqar y no indígenas. Siendo la soledad emocional la más prevalente entre personas mayores indígenas y no indígenas que viven en zonas rurales (≥ 71%). Las variables que se asocian con soledad son: ser mujer, edad, no tener pareja, vivir solo(a), disfuncionalidad familiar y tener problemas de salud. Conclusiones: La soledad en zonas rurales es más alta en las personas mayores y esta situación se complejiza en el cruce de diversidad étnico cultural, es necesario seguir abordando este problema que afecta el bienestar biopsicosocial en la vejez.

Background: Loneliness is one of the most recurrent public health problems in older people. However, there is little data available in Chile on its prevalence in people over 60 years of age living in rural areas and belonging to native or Afro-descendant groups. Aim: To examine the prevalence of loneliness among older people living in rural areas by ethnic group and to analyze the socio-demographic, family, and health variables related to loneliness. Methods: We interviewed 1,692 elderly people living in Chilean rural areas of the regions of Arica and Parinacota, Tarapacá, Antofagasta, Atacama, Coquimbo, Valparaíso, Los Lagos, Aisén and Magallanes. The instruments applied were the DJGLS-6 loneliness scale, Family-APGAR, questionnaire of 13 most frequent health problems in Chilean older people, and Barthel index. Results: We found a high prevalence of loneliness (over 55%) among Afro-descendants, Quechua, Atacameño, Colla, Chango, Huilliche, Kawesqar and non-indigenous people. Emotional loneliness is the most prevalent among indigenous and non-indigenous older people living in rural areas (≥ 71%). Variables associated with loneliness were being female, age, not having a partner, living alone, family dysfunctionality, and having health problems. Conclusions: Loneliness in rural areas is higher in older people, and this situation becomes more complex at the crossroads of ethnic-cultural diversity; it is necessary to continue to address this problem that affects biopsychosocial well-being in old age.

Disease burden morbidity assessment by self-report: Psychometric properties in older adults in Spain.

AIM: To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory. METHODS: A sample of 707 community-dwelling adults aged 65 years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. RESULTS: The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item-total corrected correlation ranged 0.10-0.49, item homogeneity index was 0.09 and Cronbach's alpha was 0.72. Disease burden correlated strongly with physical functioning (r = -0.56) and perceived health (r = -0.56), and moderately with depression (r = 0.41) and the Personal Wellbeing Index (r = -0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance. CONCLUSIONS: The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties. Geriatr Gerontol 2017; 17: 1102-1108.

Chronic conditions, disability, and quality of life in older adults with multimorbidity in Spain.

BACKGROUND: As the population ages, the prevalence of multimorbidity also increases, with consequences to several health outcomes such as disability and quality of life (QoL). This study aimed at analyzing the relationships between chronic conditions, disability, and QoL of older adults with multimorbidity in Spain. METHOD: Data on older adults aged 65 years or more, with at least two chronic health conditions were drawn from three cohort studies. Sample size was 705, 443, and 4995, respectively. For each cohort, the impact of the following chronic health conditions was analyzed: asthma, cancer, cardiac, diabetes, hypertension, mental health disorders, osteoarticular conditions, and stroke. Disability and QoL measures varied according to the survey. RESULTS: In older adults with multimorbidity, the most prevalent conditions were osteoarticular (59.08-67.80%) and hypertension (50.64-60.03%). The presence of disability was significantly associated to having osteoarticular (OR range: 1.53 to 2.646), diabetes (OR: 1.86 to 1.71), or mental health disorders (OR: 2.19 to 3.36) in most cohorts. Disability (OR: 1.67 to 7.67), osteoarticular conditions (OR: 3.37 to 5.10), and mental health disorders (OR: 1.83 to 4.27) showed the highest effects on lower QoL than the population. CONCLUSION: The presence of disability and diverse chronic conditions has a negative effect on QoL of older adults affected by multimorbidity in Spain. Public health and primary care interventions focusing on the integrated care of older adults with multimorbidity might give special attention to mental health and osteoarticular conditions.