Alcohol drinking patterns and risk of functional limitations in two cohorts of older adults.

BACKGROUND & AIMS: Several studies have found that moderate alcohol intake is associated with lower risk of functional limitations in older adults. However, no previous investigation has assessed this association in older adults from Mediterranean countries, who show characteristic drinking patterns. METHODS: Data were taken from the UAM and the Seniors-ENRICA cohorts in Spain, comprising community-dwelling people aged ≥60 years. At baseline, participants in both cohorts were classified as non-drinkers, ex-drinkers, moderate drinkers and heavy drinkers (the threshold between moderate and heavy intake was ≥40 g/day in men and ≥24 g/day in women). The Seniors-ENRICA cohort allowed assessment of a Mediterranean Drinking Pattern (MDP), defined as moderate alcohol intake, with wine preference (≥80% of alcohol consumed as wine) and drinking only with meals. The incidence of limitation in mobility, agility, and instrumental activities of daily living (IADL) was ascertained in each cohort at the end of a 3.5-year follow-up. Analyses were adjusted for sex, age, education, lifestyle, BMI, chronic conditions, and functional limitations at baseline others than the studied limitation. RESULTS: Compared with non-drinkers, ex-drinkers showed a higher risk of IADL limitation (pooled adjusted odds ratio [paOR]: 1.63; 95% confidence interval [CI]: 1.04-2.21). By contrast, moderate drinkers had a lower risk of limitations in mobility (paOR: 0.80; 95% CI: 0.63-0.97), agility (paOR: 0.82; 95% CI: 0.65-0.99) and IADL (paOR: 0.54; 95% CI: 0.39-0.69). Among individuals reporting poor or fair health, the MDP was associated with lower risk of mobility limitation (aOR: 0.51; 95% CI: 0.27-0.97). CONCLUSION: In older adults, moderate alcohol consumption, as well as the MDP in specific subgroups, is associated with lower risk of functional limitation. These results should not serve to promote alcohol intake, because older adults are particularly vulnerable to its harmful effects.

Social Inequalities in Cardiovascular Risk Factors Among Older Adults in Spain: The Seniors-ENRICA Study.

INTRODUCTION AND OBJECTIVES: To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain. METHODS: A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions. RESULTS: In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men. CONCLUSIONS: There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population.

Leptin concentration and risk of impaired physical function in older adults: the Seniors-ENRICA cohort.

BACKGROUND: leptin resistance, which may develop during the ageing process, stimulates the production of pro-inflammatory cytokines and insulin resistance that could impair the muscle function. However, the role of leptin on physical functioning among older adults has not yet been elucidated. OBJECTIVE: to examine the association between serum leptin levels and physical function impairment in older adults. DESIGN AND SETTING: prospective study of 1,556 individuals 60 years and older from the Seniors-ENRICA cohort, who were free of physical function limitation at baseline. MAIN OUTCOME MEASURE: serum leptin was measured in 2008-10, and incident functional limitation was assessed through 2012. Self-reported limitations in agility and mobility were assessed with the Rosow and Breslau scale, limitation in the lower extremity function was measured with the Short Physical Performance Battery, and impairment in the overall physical performance with the physical component summary of the SF-12. RESULTS: after adjustment for potential confounders and compared to individuals in the lowest quartile of leptin concentration, those in the highest quartile showed increased risk of impaired physical function; the odds ratio (95% confidence interval) and P-trend was: 1.95 (1.11-3.43), P = 0.006 for self-reported impaired mobility; 1.76 (1.08-2.87), P = 0.02 for self-reported impaired agility; 1.48 (1.02-2.15), P = 0.04 for limitation in the lower extremity function; and 1.97 (1.20-3.22), P = 0.01, for decreased overall physical performance. These associations were only modestly explained by C-reactive protein and insulin resistance. Moreover, the associations held across groups with varying health status and were independent of estimated total body fat. CONCLUSIONS: higher leptin concentration was associated with increased risk of impaired physical function. Preserving metabolic function during the old age could help delaying physical function decline.

Serum uric acid concentrations and risk of frailty in older adults.

OBJECTIVES: To evaluate for the first time the longitudinal relationship between serum uric acid concentrations and risk of frailty. METHODS: Prospective cohort study of 2198 non-institutionalized individuals aged ≥60years recruited in 2008-2010. At baseline, information was obtained on socio-demographic factors, health behaviors and morbidity, while serum uric acid was determined in 12-h fasting blood samples. Study participants were followed-up through 2012 to assess incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. RESULTS: During a mean 3.5-year follow-up, 256 cases of incident frailty were identified. After multivariate adjustment, the odds ratios (95% confidence interval) of frailty comparing the second and third tertiles of uric acid to the lowest tertile were, respectively: 1.18 (0.83-1.68) and 1.57 (1.11-2.22); p-linear trend=0.01. The corresponding result for a 1mg/dL increase in serum uric acid concentration was 1.12 (1.00-1.24). Similar associations were observed across subgroups defined by sex, age, body mass index, and physical activity. As regards each frailty component, the odds ratios (95% confidence interval) per 1mg/dL increase in serum uric acid were 1.10 (0.99-1.23) for low physical activity, 1.08 (0.95-1.23) for low walking speed, 1.08 (0.67-1.73) for exhaustion and 0.91 (0.81-1.02) for weakness. CONCLUSIONS: Serum uric acid concentrations are positively associated with the risk of frailty in older adults. Further studies are needed to evaluate whether specific dietary recommendations or pharmacological strategies aimed at lowering serum uric acid would be beneficial to prevent the development of this syndrome.

Patterns of alcohol consumption in the older population of Spain, 2008-2010.

BACKGROUND: Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe. OBJECTIVE: The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010. MAIN OUTCOME MEASURE: Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2. STATISTICAL ANALYSIS PERFORMED: The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design. RESULTS: The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake. CONCLUSIONS: Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

Habitual yogurt consumption and health-related quality of life: a prospective cohort study.

BACKGROUND: Health-related quality of life (HRQL) is a global indicator of perceived health status, which includes physical and mental domains. Several biological mechanisms might support an association between consumption of yogurt and better HRQL. OBJECTIVE: Our aim was to assess the association between habitual yogurt consumption and HRQL in the general adult population. DESIGN: We conducted a prospective study with 4,445 individuals aged 18 years and older who were recruited in 2008 to 2010 and were followed up to 2012. Habitual yogurt consumption was assessed at baseline with a validated diet history. HRQL was measured with the Physical Composite Summary and the Mental Composite Summary of the Spanish version of the SF-12 Health Survey. The analysis of the association between baseline yogurt consumption and HRQL at 2012 was performed with linear regression and adjusted for the main confounders, including baseline HRQL. RESULTS: Mean follow-up was 3.5 years (standard deviation=0.6 years). Compared with nonconsumers of yogurt, the Physical Composite Summary scores were similar in habitual consumers of ≤6 servings/week (ß=.40; P=0.20) and in consumers of ≥1 serving/day (ß=.25; P=0.45). A suggestion of tendency toward a lower Mental Composite Summary score was found among daily yogurt consumers (ß=-.65; P=0.09; P for trend across categories=0.07). Results were similar among individuals without morbidity, never smokers, and individuals with higher adherence to the Mediterranean diet. CONCLUSIONS: Habitual yogurt consumption did not show an association with improved HRQL.

The association of major patterns of physical activity, sedentary behavior and sleep with health-related quality of life: a cohort study.

OBJECTIVE: To examine the prospective association of patterns of physical activity, sedentary behavior and sleep with health-related quality of life (HRQL) in the general population of Spain. METHODS: A cohort study with 4271 individuals aged ≥ 18 years was recruited in 2008-2010 and followed-up prospectively through 2012. Activity patterns were derived from factor analysis. HRQL was assessed with the SF-12 questionnaire, and suboptimal HRQL was defined as a score below the sex-specific sample median. RESULTS: Three main activity patterns were identified. A higher adherence to the pattern named "vigorous activity-seated at the computer" was inversely associated with a suboptimal score in the physical-composite summary (PCS) of the SF-12 (multivariate adjusted odds ratio [aOR] for the highest vs. the lowest quartile 0.71; 95% confidence interval [IC] 0.55-0.90; p-trend=0.003). The "light activity-seated for reading" pattern was inversely associated with a suboptimal score in the mental-composite summary (aOR=0.73; 95% CI=0.61-0.89; p-trend=0.002). However, a higher adherence to the "seated for watching TV-daytime sleeping" pattern was directly associated with suboptimal PCS (aOR=1.35; 95% CI=1.10-1.66; p-trend=0.008). CONCLUSION: Patterns including any physical activity were associated with better physical or mental HRQL. However, a pattern defined by sedentary behavior with diurnal sleep showed worse HRQL and should be a priority target of preventive interventions.

Mediterranean diet and risk of frailty in community-dwelling older adults.

BACKGROUND AND OBJECTIVE: Low intake of certain micronutrients and protein has been associated with higher risk of frailty. However, very few studies have assessed the effect of global dietary patterns on frailty. This study examined the association between adherence to the Mediterranean diet (MD) and the risk of frailty in older adults. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008-2010 in Spain. MEASUREMENTS: At baseline, the degree of MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS) score and the Mediterranean Diet Score, also known as the Trichopoulou index. In 2012, individuals were reassessed to detect incident frailty, defined as having at least 3 of the following criteria: exhaustion, muscle weakness, low physical activity, slow walking speed, and weight loss. The study associations were summarized with odds ratios (OR) and their 95% confidence interval (CI) obtained from logistic regression, with adjustment for the main confounders. RESULTS: Over a mean follow-up of 3.5 years, 137 persons with incident frailty were identified. Compared with individuals in the lowest tertile of the MEDAS score (lowest MD adherence), the OR (95% CI) of frailty was 0.85 (0.54-1.36) in those in the second tertile, and 0.65 (0.40-1.04; P for trend = .07) in the third tertile. Corresponding figures for the Mediterranean Diet Score were 0.59 (0.37-0.95) and 0.48 (0.30-0.77; P for trend = .002). Being in the highest tertile of MEDAS was associated with reduced risk of slow walking (OR 0.53; 95% CI 0.35-0.79) and of weight loss (OR 0.53; 95% CI 0.36-0.80). Lastly, the risk of frailty was inversely associated with consumption of fish (OR 0.66; 95% CI 0.45-0.97) and fruit (OR 0.59; 95% CI 0.39-0.91). CONCLUSIONS: Among community-dwelling older adults, an increasing adherence to the MD was associated with decreasing risk of frailty.

Household physical activity and mortality in older adults: a national cohort study in Spain.

OBJECTIVE: To examine the association between household physical activity (HPA) and all-cause mortality in a cohort of older adults from Spain, and the role of sedentary time on this association. METHOD: Prospective cohort study of 2874 individuals aged ≥ 62 years. In 2003, the time spent in HPA and the time spent seated were self-reported. The association of HPA with all-cause mortality through 2011 was assessed with Cox regression. RESULTS: During the follow-up, 970 participants died. In men, HPA was inversely associated with the risk of death only among those with longer sitting time (≥ 8 h/d): compared to those who did not do HPA, the mortality hazard ratio (HR) was 0.80 (95% confidence interval (CI): 0.60-1.08) and 0.43 (95% CI: 0.27-0.69) for those who spent >0 to 2h/d and >2h/d in HPA, respectively (P for trend<0.001). In women, sitting time did not modify the study association. Thus, compared to women who spent <2h/d in HPA, the HR for mortality was 0.72 (95% CI: 0.56-0.93) and 0.52 (95% CI: 0.39-0.70) for those who spent >2 to 4h/d, and >4h/d in HPA, respectively (P for trend<0.001). CONCLUSION: In women, HPA is associated with reduced mortality regardless of sitting time. HPA may also contribute to longer survival among men with longer sitting time.

Reach and equity of primary care-based counseling to promote walking among the adult population of Spain.

OBJECTIVES: Some controlled trials have shown that brief counseling in primary care settings can increase walking. We examined the prevalence of primary care-based counseling to promote walking and assessed its reach and equity in Spain. DESIGN: Data were taken from a cross-sectional study conducted in 2008-2010 among 11,951 individuals representative of the non-institutionalized population aged 18-years and older in Spain. METHODS: Information on whether advice was received, adherence to advice, and time spent walking was self-reported. Analyses were adjusted for proxies of the need for physical activity (age, subjective health, and classic cardiovascular risk factors, including physical activity other than walking and body mass index), equity (sex and educational level), and factors enabling counseling (use of primary care services). RESULTS: Overall, 46.2% (95% confidence interval [CI] 45.0-47.4) of adults in Spain received counseling to promote walking. Older adults, those with worse subjective health, lower physical activity, with overweight or obesity, and higher use of primary care services were more likely to be counseled. For equal need, counseling was less frequent in men and those with lower socioeconomic position. A total of 69.2% (95% CI 67.8-70.6) of adults who received counseling reported following it. There was no difference in the time spent walking between those who received and did not receive counseling (+0.4 min/day; 95% CI -0.1 to 0.9). CONCLUSIONS: A substantial proportion of Spanish adults has been encouraged to walk by primary care physician and nurses, but counseling did not translate into longer walking time.

Life-course socioeconomic position and change in quality of life among older adults: evidence for the role of a critical period, accumulation of exposure and social mobility.

BACKGROUND: This study evaluates the influence of socioeconomic position (SEP) over the life course on change in health-related quality of life (HRQoL) in older adults. METHODS: A prospective cohort of 2117 individuals aged 60 years and over. In 2001, SEP was measured over the life course as social class in childhood (approximated by father's occupation), as educational level completed and as adult social class (occupation of household head). HRQoL was measured with the SF-36 health questionnaire. Changes from 2001 to 2003 in the scores for the physical component summary (PCS) and the mental component summary (MCS) of the SF-36 were calculated, and individuals were classified into three categories: decline (decrease of >5 points), no change (change of -5 to +5 points) and improvement (increase of >5 points) in HRQoL. RESULTS: After adjustment for baseline HRQoL, lifestyle, chronic illness, educational level and adult social class, low childhood social class was associated with a higher risk of both a decline and an improvement in the SF-36 PCS and MCS. The risk of decline in PCS and MCS and of improvement in MCS increased with the cumulative number of adverse SEP over the life course. Subjects who rose in social class from childhood to adulthood showed the greatest improvement on the SF-36 PCS and MCS. CONCLUSION: These results on the relation between SEP and changes in HRQoL in older adults support the three models proposed to explain health inequalities over the life course: the existence of critical periods, the accumulation of adverse SEP and social mobility.

Socioeconomic variation in the magnitude of the association between self-rated health and mortality.

PURPOSE: To assess socioeconomic variation in the association between self-rated health (SRH) and mortality and to determine whether socioeconomic inequalities in SRH and socioeconomic inequalities in mortality differ in magnitude. METHODS: We used data from a cohort of Spanish people 60 years of age and older with an 8-year follow-up of mortality. The association between SRH at baseline and mortality was estimated by the age-adjusted relative risk of mortality in people with low, medium, and high education. The measures of health inequalities were the prevalence ratio of poor SRH and the age-adjusted relative risk of mortality according to educational level. The validity of SRH to reflect life-threatening and non-life-threatening health conditions was summarized with the likelihood ratio for poor SRH in each educational category. RESULTS: The relative risk of mortality according to SRH in subjects with high and low education was 3.24 and 1.62 in men and 2.25 and 1.50 in women, respectively. Inequalities in poor self-rated health were larger than inequalities in mortality: -1.63 versus 1.07 in men and 1.45 versus 1.30 in women. The highest likelihood ratio for SRH was seen in persons with high education in the case of life-threatening conditions, and for those with low education, in the case of non-life-threatening conditions. CONCLUSIONS: Socioeconomic variation in the validity of SRH to reflect life-threatening and non-life-threatening conditions could explain the greater ability of SRH to predict mortality in persons with high education and why inequalities in poor SRH are larger than inequalities in mortality.

Change in health-related quality of life as a predictor of mortality in the older adults.

PURPOSE: We examined whether changes in health-related quality of life (HRQL) predict subsequent mortality among the Spanish elderly. METHODS: Prospective cohort study of 2,373 persons, representative of the Spanish population aged 60 and older. HRQL was measured in 2001 and 2003 using the SF-36 health questionnaire. Cox regression models were used to examine the association of changes in the physical and mental component summary (PCS and MCS) scores of HRQL from 2001 to 2003 with all-cause mortality through 2007. RESULTS: Two hundred twelve deaths were ascertained from 2003 to 2007. The hazard ratios for mortality across categories of PCS change were as follows: 2.12 (95% confidence interval [CI] 1.39-3.24) for a > 10-point decline; 1.51 (1.01-2.28) for a 6- to 10-point decline; 1 for the reference category, a change of -5 to +5 points; 0.83 (0.51-1.34) for a 6- to 9-point improvement and 0.68 (0.42-1.09) for a > 10-point improvement; P for linear trend <0.001. The associations between changes in the MCS and mortality showed the same direction, but were of a lower magnitude and attained statistical significance (P < 0.05) only for a > 10-point decline in MCS. CONCLUSIONS: Changes in HRQL predict mortality in the older adults. A decline in HRQL should alert to a worse vital prognosis and stimulate the search for the possible determinants of such decline.

Functional status and use of health care services: longitudinal study on the older adult population in Spain.

BACKGROUND: Follow-up studies on the association between functional status and use of health care services among the older people are scarce and have studied only a few types of service. OBJECTIVE: To examine prospectively the relationship between limitation in instrumental activities of daily living (IADL) and utilization of a wide variety of health care services among older adults in Spain. METHODS: Prospective study from 2001 to 2003 of a cohort of 2806 persons, representative of the non-institutionalized Spanish population aged 60 years and over. Limitation in IADL was measured in 2001 using the Lawton and Brody's test. Data on the use of health care services were collected in 2003 and classified into home services (home visits by physicians and nurses) and non-home services (visits to primary care physicians, visits to hospital specialists, hospital admissions, emergency care, and influenza vaccination). Analyses were performed with logistic regression and adjusted for the main confounders. RESULTS: Compared to men with no limitation in IADL, a higher percentage of those with limitation in one IADL in 2001 made use of both home (odds ratio [OR] 2.64; 95% confidence interval [95% CI] 1.73-4.03) and non-home services (OR 2.02; 95% CI 1.04-3.93) in the period 2001-2003. Limitation in one IADL among women was associated with a greater utilization of home services (OR 1.50; 95% CI 1.05-2.14) and visits to hospital specialists (OR 1.61; 95% CI 1.21-2.15). In women, however, a greater number of limited IADL at baseline was inversely associated with visits to primary care physicians in the 2-year follow-up (p for linear trend <0.001). CONCLUSION: Population aging will increase the demand for health services in general, and for home services in particular.

Gender differences in the utilization of health-care services among the older adult population of Spain.

BACKGROUND: Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. METHODS: Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. RESULTS: As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07-1.44), received home medical visits (OR: 1.67; 95% CL: 1.34-2.10) and took > or = 3 medications (OR: 1.54; 95% CL: 1.34-1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of > or = 3 medications was 1.24 (1.06-1.45). After adjustment for HRQL, the OR was 1.03 (0.89-1.21) for visits to medical practitioners, 1.24 (0.98-1.58) for home medical visits, 0.71 (0.58-0.87) for hospitalization, and 1.14 (0.97-1.33) for intake of > or = 3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56-0.84). CONCLUSION: The factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women.

Cognitive assessment of the non-demented elderly community dwellers in Spain.

OBJECTIVE: The prevalence of cognitive impairment and population normative values for cognitive function were assessed, for the first time, in 2,630 subjects representative of the non-demented community dweller population > or =65 years in Spain, a southern European country with a sizable proportion of illiterate senior citizens. METHODS: Data were collected cross-sectionally by interview, using a structured questionnaire. Cognitive function was assessed using the Mini-Examen Cognoscitivo (MEC; Spanish-validated version of the Mini-Mental State Examination). RESULTS: A total of 22.4% of the subjects presented with cognitive impairment (MEC < or =22). The proportion of subjects with cognitive impairment was double in women versus men, rose to 46.2% in subjects aged > or =85 years and to 34.8% in subjects with no formal education, and was higher among those who had limitations in instrumental activities of daily living (p < 0.001). In subjects with no formal education, 25% registered mean MEC scores compatible with probable cognitive impairment. CONCLUSIONS: One of every 5 Spanish senior citizens presents with cognitive impairment, a proportion that increased among women, subjects with no formal education and with higher age.

Differences in quality of life between women and men in the older population of Spain.

The objective of the study was to examine the contribution of sociodemographic factors, lifestyle, social network, chronic morbidity and use of healthcare services to the poorer health-related quality of life (HRQL) of women, as compared to that of men, among the older population of Spain. Data were collected by home-based personal interview and physical examination of 3260 subjects representative of the Spanish non-institutionalized population aged 60 years and over. HRQL was assessed with the SF-36 health questionnaire. Relative differences in HRQL between women and men were summarized using odds ratios of suboptimal health (score < 100) on each scale of the SF-36, obtained from logistic regression. The contribution of the variables of interest to the relative differences in HRQL between the sexes was evaluated as the percentage change in the odds ratio before and after adjustment for such variables. The odds ratio of suboptimal health among women versus men was higher than 2 (p < 0.0001) on all SF-36 scales. Adjustment for sociodemographic variables led to a reduction of 23% (95% confidence limits (CL): -38 to -5%) in the odds ratio on the social functioning scale, while adjustment for lifestyle reduced the odds ratio on the general health and social functioning scales by 45% (95%CL: -64 to -15%) and 29% (95%CL: -42 to -13%), respectively. Adjustment for the social network, chronic morbidity and use of healthcare services variables did not lead to significant changes in the odds ratios on any of the SF-36 scales. In general, the contribution of the study variables to differences in HRQL between the sexes was smaller in the oldest age groups. We conclude that sociodemographic and lifestyle factors may explain a substantial part of the differences between women and men in certain HRQL dimensions. Some of these factors, such as the lower educational level and the higher frequency of sedentary lifestyles and obesity among women, are potentially modifiable.

[Physical activity and quality of life in older adults in Spain]. / Actividad física y calidad de vida de la población adulta mayor en España.

BACKGROUND AND OBJECTIVE: This study examined the relationship between leisure-time physical activity (LTPA) and health-related quality of life (HRQL) in the older adult population of Spain. SUBJECTS AND METHOD: Household cross-sectional survey on 3,066 subjects representatives of the non-institutionalized Spanish population aged 60 years and over. Data on LTPA was obtained with a structured questionnaire and HRQL was measured with the SF-36 instrument. Analyses were done through linear regression, where the dependent variable was each of the eight scales of the SF-36 and the main independent variable was LTPA. Analyses were adjusted for sociodemographic and social network variables, health habits, health services use, and chronic diseases. RESULTS: A total of 42.7% subjects had a sedentary activity, 54.2% light LTPA and 3% moderate/intense LTPA. As compared with sedentary activity, light LTPA was associated with a higher score in all SF-36 scales, except for the physical role and emotional role, among men and women. For subjects with light LTPA the increase in score was over 3 points in most SF-scales, which is usually considered as a clinically relevant change in HRQL. Results did not vary materially by age, level of education, obesity or chronic disease. The higher LTPA, the better HRQL (p for linear trend < 0.05 in most scales of the SF-36 questionnaire). CONCLUSIONS: Light LTPA is associated with better HRQL than sedentary activity. Because this association did not change with age, level of education, obesity or chronic disease, it is suggested that most older adults could improve their HRQL with, at least, a light LTPA.

The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports.

AIMS: To systematically evaluate the published evidence regarding the effectiveness of disease management programmes (DMPs) reducing hospital re-admissions among elderly patients with heart failure (HF). METHODS AND RESULTS: Computerised search of MEDLINE (1966 to 31 August 2003) and EMBASE (1966 to 31 August 2003). The Cochrane Library was also searched, and reference lists of review articles on the topic, and of all relevant studies identified, were scanned. Search and selection of studies, data-extraction using standardised forms, and assessment of study quality was performed by two reviewers. The end-point was the proportion of persons who underwent hospital re-admission, and pooled relative risks (RR) were used to summarise the effectiveness of DMPs. The meta-analysis included 54 articles, comprising 27 randomised and 27 non-randomised controlled studies. Randomised studies consistently suggested that, in comparison with usual care, DMP reduced the frequency of re-admission for HF or cardiovascular disease by 30% (pooled RR 0.70; confidence interval (CI) 95% 0.62-0.79), all-cause re-admission by 12% (pooled RR 0.88, 95% CI: 0.79-0.97), and the combined event of re-admission or death by 18% (pooled RR 0.82, 95% CI: 0.72-0.94). The results displayed no substantial variation when only DMPs with home visits, out-patient visits to a clinic, or patient follow-up longer than 6 months were included. For DMPs with out-patient clinical visits, however, the reduction in re-admission for HF or cardiovascular disease, and for all causes, did not attain statistical significance. The magnitude of DMP benefits reported by non-randomised studies was more than double that reported by randomised studies. Practically all the non-randomised studies failed to control for confounding factors, such as severity, co-morbidity and drug therapy. CONCLUSION: DMPs are effective at reducing re-admissions among elderly patients with HF. Their effectiveness is close to that observed in clinical trials evaluating drugs for HF, such as angiotensin-converting enzyme inhibitors, beta-blockers or digoxin. However, since none of the DMP studies compared different interventions directly, we do not know the relative effectiveness of types of healthcare delivery within the DMP.