Socioeconomic status, loneliness, and depression among older adults: a cross-sectional study in Spain.

BACKGROUND: The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness. METHODS: A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson's r) and logistic regression analyses. RESULTS: The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced. CONCLUSION: Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.

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

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.

Income inequalities, social support and depressive symptoms among older adults in Europe: a multilevel cross-sectional study.

This study analysed the association between income inequality and depression from a multilevel perspective among older adults in Europe, including an examination of the role of social support. The data came from Eurostat's European Health Interview Survey (EHIS). Selected participants were aged 65 years or above (n = 68,417) and located in 24 European countries. The outcome variable (depression) was measured using the eight-item Patient Health Questionnaire (PHQ-8). The resulting dataset included individual-level (level-1) and aggregate-level (level 2) exposure variables. Level-1 included income quintiles and social support as exposure variables and sex, age, living alone, limitation in activities of daily living and general activity limitation as control variables. Level 2 included the Gini coefficient, healthcare expenditure and dependency ratio. A multilevel linear regression analysis was performed with maximum likelihood (ML) estimation. All the income quintiles from 1 to 4 showed higher average scores for depression than quintile 5 (the highest). Higher social support scores were associated with lower scores for depression. An interaction was found between income quintile and social support, with higher levels of social support associated with lower scores for depression in quintiles 1 and 2. Higher Gini coefficient scores were associated with higher scores for depression. A significative random slope for social support was also found, meaning that the relationship between social support and depression differed across countries. No significant interaction was found between the Gini coefficient and social support. The study findings suggest that more unequal societies provide a less favourable context for the mental health of older adults. There are also significant country-dependent differences in terms of the relationship between support and mental health among older adults. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00670-2.

Salud en personas mayores afrodescendientes Chilenas / Health in older people of african-descendant in Chile

Chile recientemente ha reconocido al pueblo tribal afrodescendiente, se trata de un colectivo poco estudiado y con severas desventajas sociales y sanitarias. Este estudio tiene como objetivo describir el perfil de salud y el acceso a servicios sanitarios, junto con analizar la asociación entre las variables sociodemográficas, de salud y los síntomas depresivos en personas mayores afrodescendientes. Estudio piloto que contó con la participación de 60 personas mayores afrodescendientes, se aplicaron diversas escalas de valoración geriátrica. Los antecedentes de salud indicarían que el 78% es hipertenso, 57% tiene síntomas depresivos, el 30% es independiente en actividades de la vida diaria (AVD), y un 61% tiene riesgo leve de caídas. Respecto al acceso a salud: 84% está inscrito en un centro de salud, el 68% es beneficiario del programa de salud cardiovascular y un 71% está al día con la vacuna preventiva de la influenza. Las variables predictivas de depresión son ser beneficiario del programa de alimentación complementaria y la dependencia en AVD. Este estudio ratifica la relevancia de la inclusión de patologías específicas concorde al perfil epidemiológico de los grupos étnicos-raciales y seguir avanzando en estudios sanitarios específicos en minorías étnicas.

Chile has recently recognized the Afrodescendant tribal people, a little studied group with severe social and health disadvantages. This study aims to describe the health profile and access to health services, and to analyze the association between sociodemographic and health variables and depressive symptoms in older people of African descent. Pilot study with the participation of 60 elderly people of African descent, with the application of several geriatric assessment scales. Health history indicated that 78% are hypertensive, 57% have depressive symptoms, 59% are independent in activities of daily living (ADL), and 61% have a slight risk of falling. Regarding access to health care: 84% are enrolled in a health center, 68% are beneficiaries of the cardiovascular health program and 71% are up to date with the preventive influenza vaccine. The variables predictive of depression are being a beneficiary of the complementary feeding program and dependence in ADLs. Conclusion: This study ratifies the relevance of including specific pathologies according to the epidemiological profile of ethnic-racial groups and to continue advancing in specific health studies in ethnic minorities.

[Effect of guardianship on the quality of life of people with disabilities in Spain.] / Efecto de la tutela en la calidad de vida de personas con discapacidad en España.

OBJECTIVE: Despite the unquestionable progress in the treatment and legal and social recognition of persons with disabilities with modified capacity,the role and social position of the collective still hinders the development of a full life. The objective was to know the possible effect of the guardianship exercise on the quality of life of persons with disabilities who reside permanently in residential centres and whose ordinary guardianship falls to the public FASAD Foundation. METHODS: Correlational quantitative study. The GENCAT quality of life scale adapted so that the population under study itself was in charge of assessing the areas and dimensions related to their bio-psycho-social well-being. The starting hypothesis is was that exists a better perception of the levels of quality of life with a longer time of guardianship protection. In addition, the research questions were, What effects does the tutelary protection exercised by the FASAD Foundation have on the perception of the quality of life of the interviewed subjects? How do the variables (sex, place of residence and time of guardianship) affect the perception of quality of life? What dimensions present in the quality of life analysis are most affected by the variable time of guardianship? For the analysis of the statistical data, was used the SPSS® Statistics 22.0, a descriptive and bivariate exploration was carried out that showed the level of association and correlation between the variables studied. RESULTS: People under guardianship for a period of more than 3 years present better results in all the dimensions studied -except for rights- regardless of their sex or place of residence. Women under guardianship for a period less than 3 years obtained a general percentile of quality of life of 13.6, while those who were under guardianship for a period greater than 3 years obtained 18.9, in the same way it happened with men (14.1 vs 20.7) The ANOVA statistic and the Pearson correlation table confirm the association and relationship between the variable time of care and the general percentiles of quality of life. CONCLUSIONS: The exercise of guardianship has a positive effect on all the dimensions that integrate the quality of life construct. In addition, knowing the self-perception of the quality of life of the people under guardianship favors knowing the true impact of a support and promotion mechanism such as guardianship.

OBJETIVO: Pese al incuestionable avance en el tratamiento y reconocimiento jurídico y social de las personas con discapacidad con la capacidad modificada, el rol y la posición social que ocupa el colectivo aún sigue dificultando el desarrollo de una vida plena. El objetivo fue conocer el posible efecto del ejercicio tutelar sobre la calidad de vida en personas con discapacidad que residen de forma permanente en centros residenciales y cuya tutela ordinaria recae sobre la Fundación de carácter público FASAD. METODOS: Estudio de carácter cuantitativo de tipo correlacional. Se adaptó la escala de calidad de vida GENCAT para que fuese la propia población objeto de estudio la encargada de valorar las áreas y dimensiones relacionadas con su bienestar bio-psico-social. La hipótesis de partida fue que existe una mejor percepción sobre los niveles de calidad de vida a mayor tiempo de protección tutelar. Además, las preguntas de investigación fueron, ¿Qué efectos tiene la protección tutelar ejercida por la Fundación FASAD en la percepción de la calidad de vida de los sujetos entrevistados? ¿Cómo afectan las variables (sexo, lugar de residencia y tiempo de tutela) en la percepción de la calidad de vida? ¿Qué dimensiones presentes en el análisis de la calidad de vida se ven más afectadas por la variable tiempo de tutela? Para el análisis de los datos estadísticos se utilizó el SPSS® Stadistics 22.0, se efectuó una exploración descriptiva y bivariada que mostró el nivel de asociación y correlación entre las variables estudiadas. RESULTADOS: Las personas tuteladas por un período superior a 3 años presentan mejores resultados en todas las dimensiones estudiadas -excepto en derechos- independientemente de su sexo o lugar de residencia. Las mujeres tuteladas por un periodo inferior a 3 años obtuvieron un percentil general de calidad de vida de 13,6, mientras que las que se encontraban tuteladas por un periodo superior a 3 años obtuvieron un 18,9, de la misma forma ocurrió con los hombres (14,1 frente al 20,7). El estadístico ANOVA y la tabla de correlaciones de Pearson refrendan la asociación y relación existente entre la variable tiempo de tutela y los percentiles generales de calidad de vida. CONCLUSIONES: El ejercicio de la tutela tiene un efecto positivo en todas las dimensiones que integran el constructo calidad de vida. Además, conocer la autopercepción sobre la calidad de vida de las propias personas tuteladas favorece conocer el verdadero impacto de un mecanismo de apoyo y promoción cómo es la tutela.

Propiedades psicométricas de la escala APGAR-familiar en personas mayores residentes en zonas rurales multiétnicas chilenas / Psychometric properties of APGAR-family scale in a multiethnic sample of Chilean older people

Background: The APGAR-family scale is used for the assessment of family functioning in primary health care. Aim: To examine the psychometric properties of the family functioning scale APGAR-family, in a multi-ethnic sample of older Chilean adults. Material and Methods: The scale was applied to 800 participants aged more than 60 years, residing in rural areas of the regions of Arica and Parinacota and La Araucanía. Results: The Cronbach's alpha obtained was 0,992 for the scale composed of five items. The confirmatory factor analysis determined a unifactorial model, whose goodness of fit indices were satisfactory. Namely, weighted least square mean and variance adjusted-χ2 was 20.097 (p < 0.01), comparative fit index was 0.997, Tucker-Lewis index was 0.995 and Root Mean Square Error of Approximation was 0.079 (90% confidence intervals 0.049-0.091). Conclusions: The APGAR-family is a reliable and appropriate instrument to be applied in older people in Chile, specifically in elderly people residing in rural areas who belong to the Aymara and Mapuche indigenous communities.

Successful Aging and Personal Well-Being Among the Chilean Indigenous and Non-Indigenous Elderly / Envejecimiento exitoso y bienestar personal en adultos mayores chilenos indígenas y no indígenas / Envelhecimento bem-sucedido e bem-estar pessoal em idosos chilenos indígenas e não indígenas

ABSTRACT Objective: The aim of this research was to analyse the association between successful aging (SA) and subjective well-being (SWB) in different domains. Method: The study is quantitative and cross-sectional, with a sample consisting of 800 older people, including 569 indigenous (Aymara and Mapuche) participants living in northern and southern Chile. Results: Domains associated with SA are satisfaction with health, satisfaction with social relationships, satisfaction with future security, and satisfaction with spiritual and religious experiences. SA is also positively associated with being a woman, being young, and not being indigenous. Conclusion: The research has two main practical implications. First, SWB domains may be incorporated into socio-health interventions as they relate to elements that can be changed or improved (health, social inclusion, security, and beliefs). Second, this study suggests a situation of risk among older indigenous Chileans, confirming the premise that the life paths of indigenous Chileans at social risk give rise to a more socially unequal old age with; therefore, it is important to analyse positive aspects that promote better old age.

RESUMEN Objetivo: el objetivo de esta investigación consistió en analizar la asociación entre envejecimiento exitoso (SA) y bienestar subjetivo (SWB) en sus diferentes dominios. Metodología: se trata de un diseño cuantitativo y transversal, con una muestra compuesta por 800 adultos mayores, incluidos 569 indígenas (aymaras y mapuches), que viven en el norte y sur de Chile. Resultados: muestran que los dominios asociados con la SA son satisfacción con la salud, satisfacción con las relaciones sociales, satisfacción con la seguridad futura y satisfacción con las experiencias espirituales y religiosas. La SA también se asocia positivamente con ser mujer, ser joven y no ser indígena. Conclusión: la investigación tiene dos implicaciones prácticas principales. Primero, estos dominios del SWB pueden incorporarse a las intervenciones sociosanitarias, ya que se relacionan con elementos que se pueden cambiar o mejorar (salud, inclusión social, seguridad y creencias). En segundo lugar, este estudio sugiere una situación de riesgo entre los chilenos indígenas mayores, lo que confirma la premisa de que las trayectorias de vida de los indígenas chilenos que han enfrentado más riesgo social dan lugar a una vejez con más desigualdad social, por lo que es importante analizar aspectos positivos que promuevan un mejor envejecimiento.

RESUMO Objetivo: analisar a associação entre envelhecimento bem-sucedido e bem-estar subjetivo em seus diferentes domínios. Método: trata-se de um desenho quantitativo e transversal, com uma amostra composta por 800 idosos, incluídos 569 indígenas (aymaras e mapuches), que habitam no norte e no sul do Chile. Resultados: os domínios associados com o envelhecimento bem-sucedido são satisfação com a saúde, satisfação com as relações sociais, satisfação com a segurança futura e satisfação com as experiências espirituais e religiosas. Além disso, associa-se de forma positiva com ser mulher, jovem e não indígena. Conclusão: esta pesquisa tem duas implicações práticas principais. Na primeira, esses domínios do bem-estar subjetivo podem ser incorporados às intervenções sociossanitárias, já que estão relacionados com elementos que podem ser mudados ou melhorados (saúde, inclusão social, segurança e crenças). Em segundo lugar, este estudo sugere uma situação de risco entre os idosos chilenos indígenas, o que confirma a hipótese de que as trajetórias de vida dos indígenas chilenos que enfrentaram mais risco social levam a uma velhice com mais desigualdade social, razão pela qual é importante analisar aspectos positivos que promovam um melhor envelhecimento.

[Psychometric properties of APGAR-family scale in a multiethnic sample of Chilean older people]. / Propiedades psicométricas de la escala APGAR-familiar en personas mayores residentes en zonas rurales multiétnicas chilenas.

BACKGROUND: The APGAR-family scale is used for the assessment of family functioning in primary health care. AIM: To examine the psychometric properties of the family functioning scale APGAR-family, in a multi-ethnic sample of older Chilean adults. MATERIAL AND METHODS: The scale was applied to 800 participants aged more than 60 years, residing in rural areas of the regions of Arica and Parinacota and La Araucanía. RESULTS: The Cronbach's alpha obtained was 0,992 for the scale composed of five items. The confirmatory factor analysis determined a unifactorial model, whose goodness of fit indices were satisfactory. Namely, weighted least square mean and variance adjusted-χ2 was 20.097 (p < 0.01), comparative fit index was 0.997, Tucker-Lewis index was 0.995 and Root Mean Square Error of Approximation was 0.079 (90% confidence intervals 0.049-0.091). CONCLUSIONS: The APGAR-family is a reliable and appropriate instrument to be applied in older people in Chile, specifically in elderly people residing in rural areas who belong to the Aymara and Mapuche indigenous communities.

[Validation of the successful aging inventory in chilean older people]. / Validación del inventario de envejecimiento exitoso en personas mayores chilenas.

BACKGROUND: There is a paucity of adequate and validated instruments for the measurement of successful aging for geriatric researchers in Chile. AIM: To validate the “Successful Aging Inventory” (SAI) in Chilean older people. MATERIAL AND METHODS: SAI was answered by 777 older people aged 70 ± 7 years (63% women) living in urban and rural areas, including the highlands of a Northern desert region of Chile. RESULTS: A Cronbach alfa of 0.92 was obtained for the general dimension of successful aging. The figures for each dimension included in the theoretical model (functional performance, intrapsychic factors, gero-transcendence; spirituality; purpose and life satisfaction), and ranged from 0.66 to 0.91. Confirmatory factorial analysis showed that the original inventory model, fits with the data collected from Chilean people. CONCLUSIONS: Successful Aging Inventory (SAI) is a reliable and adequate inventory, which can be used in Chilean older people.

Validación del inventario de envejecimiento exitoso en personas mayores chilenas / Validation of the successful aging inventory in chilean older people

Background: There is a paucity of adequate and validated instruments for the measurement of successful aging for geriatric researchers in Chile. Aim: To validate the “Successful Aging Inventory” (SAI) in Chilean older people. Material and methods: SAI was answered by 777 older people aged 70 ± 7 years (63% women) living in urban and rural areas, including the highlands of a Northern desert region of Chile. Results: A Cronbach alfa of 0.92 was obtained for the general dimension of successful aging. The figures for each dimension included in the theoretical model (functional performance, intrapsychic factors, gero-transcendence; spirituality; purpose and life satisfaction), and ranged from 0.66 to 0.91. Confirmatory factorial analysis showed that the original inventory model, fits with the data collected from Chilean people. Conclusions: Successful Aging Inventory (SAI) is a reliable and adequate inventory, which can be used in Chilean older people.