Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning.

OBJECTIVES: The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability. METHODS: Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses. RESULTS: The sample was composed of 503 participants aged ≥ 75 years. Alzheimers disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74). CONCLUSIONS: Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression.

A new autopsy interview for the assessment of factors potentially related to death in depressed medical patients.

This study tests the reliability and validity of the Bio-Psycho-Social Autopsy (BPSA), a new interview to assess physical, psychopathological, and social factors potentially related to mortality in depressed medical patients. The authors completed special procedures to provide support for the face and content validity of the interview. They built the psychopathological and social sections on the Standardized Polyvalent Psychiatric Interview (SPPI) but gave self-neglect special emphasis. They tested the BPSA on close relatives of 48 deceased patients, both depressed and nondepressed. They calculated interrater reliability coefficients and took preliminary steps to document the construct validity by means of epidemiological and clinical variables. Interrater reliability coefficients were acceptable (M kappa = 0.82). In support of the construct validity, a multivariate analysis showed that BPSA items in the psychopathological section were able to differentiate the expected direction between deceased patients who were depressed and nondepressed. Therefore, the authors considered the BPSA interview to be a reliable assessment of factors potentially associated with death in depressed medical patients, and data presented support the validity of the psychopathological section.

National context of healthcare, economy and religion, and the association between disability and depressive symptoms in older Europeans: results from the EURODEP concerted action.

Associations between disability and depression have been shown to be consistent across cultures among middle-aged adults. In later life the association between disability and depression is much more substantial and may be amenable to influences by health care facilities as well as economic and sociocultural factors. Fourteen community-based studies on depression in later life in 11 western European countries contribute to a total study sample of 22,570 respondents aged 65 years or older. Measures are harmonised for depressive symptoms (EURO-D scale) and disability. Using multilevel modelling to control for the stratified data structure we examined whether the association between disability and depressive symptoms is modified by national health care and mental health care availability, national economic circumstances, demographic characteristics and religious tradition. The association between depressive symptoms and disability is attenuated by health care expenditure and availability of mental health care and also by gross domestic product; it was more pronounced in countries with high levels of orthodox religious beliefs. Higher levels of depressive symptoms are found in countries with a larger gross domestic product (per capita) and higher health care expenses but are interpreted with care because of measurement differences between the centres. The findings from this contextual perspective indicate that general and mental health care should be geared to one another wherever possible.