The effects of social pensions on nutrition-related health outcomes of the poor: Quasi-experimental evidence from Peru.

This paper exploits the discontinuity around a welfare index of eligibility to assess the impact of Peru's social pension program Pension 65 on nutrition-related health outcomes among elderly poor individuals. Overall, we find evidence of how a relatively inexpensive program can produce improvements in anemia and nutrition-related mortality risk markers. The effects appear to be driven by plausible underlying mechanisms, including via improved nutritional quality as well as greater food expenditures and healthcare utilization. These positive effects are only modestly countered by tentative signs of an increased obesity risk among women in the short term (<2 years), but not beyond this term. As the program evolves further, policymakers need to confront the challenge of continuing to ensure the health benefits in terms of reducing nutritional deficits while avoiding potential undesirable side effects in terms of over-nutrition in Peru. The findings may serve to highlight the wider benefits of similar pension policies for the poor also in other middle income countries, well beyond the immediate economic welfare effects that the policies have primarily been designed for.

Public support for tax policies in COVID-19 times: evidence from Luxembourg.

We study attitudes towards the introduction of hypothetical new taxes to finance the cost of the COVID-19 pandemic. We rely on survey data collected in Luxembourg in 2020. The survey asks for the agreement of respondents over: a one-time net wealth tax, an inheritance tax, a temporary solidarity income tax, and a temporary increase in VAT. All questions include different and randomly assigned tax attributes (tax rates and exemption amounts). We find a clear divide with relatively high support for new wealth and inheritance taxes on the one hand and a low support for increases in VAT and income taxes on the other hand. While 58% of respondents agree or strongly agree with a one-time tax levied on net worth, only 24% are in favor of a small increase in VAT. Support for any tax is however negatively associated with the size of the tax as measured by the predicted revenues. Our results indicate that a one-time wealth tax could raise substantial revenues and still garner public support. Supplementary Information: The online version contains supplementary material available at 10.1007/s10797-022-09744-y.

Pathways to care for people with dementia: An international multicentre study.

OBJECTIVE: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. METHODS: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant. RESULTS: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care. CONCLUSIONS: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally.

The Role of Nutrition and Literacy on the Cognitive Functioning of Elderly Poor Individuals.

Maintaining cognitive function is a prerequisite of living independently, which is a highly valued component in older individuals' well-being. In this article we assess the role of early-life and later-life nutritional status, education, and literacy on the cognitive functioning of older adults living in poverty in Peru. We exploit the baseline sample of the Peruvian noncontributory pension program Pension 65 and find that current nutritional status and literacy are strongly associated with cognitive functioning for poor older adults. In a context of rising popularity of noncontributory pension programs around the world, our study intends to contribute to the discussion of designing accompanying measures to the pension transfer, such as adult literacy programs and monitoring of adequate nutrition of older adults.

Psychiatric symptoms are not an independent mortality risk factor in community-living elderly people.

BACKGROUND: Mortality risk factors have attracted great research interest in recent years. Physical illness is strongly associated with mortality risk in elderly people. Furthermore, a relationship between mortality risk and psychiatric disease in the elderly has gained research interest. METHODS: This is a prospective longitudinal multicenter study. A sample of 324 participants was selected as a representative sample of community members aged 65 years and older and living in Huesca (Spain). The following information was collected: affiliation data, severity of physical illness, psychosocial, and psychiatric factors. Statistical analyses were completed with a multivariate analysis in order to control possible confounding variables related to mortality. RESULTS: Of the initially selected sample, 293 participants were assessed. Sixty-four participants died (21.8%, 95% CI [16.9%, 26.7%]), 5.3% annual rate, and 46.1% showed symptomatology of mental disorders. Older people have eight times greater risk of mortality. The risk increased 53 times in patients affected by several physical illness. No relationship between cognitive dysfunction and depressive symptomatology was observed. In fact, physical condition was associated with depression, and the percentage of participants with depressive symptoms increased according to the severity of physical illness. CONCLUSIONS: Severity of physical illness and age are independently and directly associated with mortality in the elderly people. Therefore, severity of physical illness seems to be a crucial factor in the bi-directional association between mortality and depression, acting as a risk factor independently for both. So the relationship between depression and mortality can be affected by the severity of physical illness.

[Risk of sarcopenia and malnutrition related to COVID-19 in an institutionalized population of Castilla-La Mancha (Spain): determined by R-MAPP.] / Riesgo de sarcopenia y desnutrición relacionado con COVID-19 en una población institucionalizada de Castilla-La Mancha: determinado por R-MAPP.

OBJECTIVE: Knowing the risk status of malnutrition and sarcopenia in institutionalized patients is essential to understand the current context after the impact of the coronavirus (COVID-19) pandemic. METHODS: This research used a retrospective, observational study. The results of the Remote Malnutrition APP test (R-MAPP) are described: risk factors for malnutrition (including COVID-19), the Malnutrition Universal Screening Tool (MUST) and the SARC-F, in a selected sample of 402 residents of Castilla-La Mancha (Spain) during 2021. An inferential analysis was performed to determine which factors were related to the MUST (≥2 points) and SARC-F (≥4 points) response measures. With the factors that obtained statistical significance, a multivariate regression model was performed, adjusting for each one. of those factors. RESULTS: Mean age was 84.2 years, 70.1% women. Most frequent risk factor for malnutrition was aging (85.1%). The mean body mass index was 26.5 (SD 11.6). MUST≥2 points was obtained in 16.2%, and a SARC-F≥4 in 69.9%. COPD (Chronic obstructive pulmonary disease / OR 0.35; 95% CI 0.13-0.92; p 0.03) was a protective factor against the risk of malnutrition. The risk of sarcopenia was related to aging (OR 8.16; 95% CI 4.13-16.20; p 0.00), COVID-19 (OR 1.96; 95% CI 1.17-3.29; p 0.01) and COPD (OR 2.44; 95% CI 1.21-4.89; p 0.01). CONCLUSIONS: No relationship is found between COVID-19 and high risk of malnutrition. Aging, COVID-19 and COPD are risk factors for sarcopenia.

OBJETIVO: Conocer el estado de riesgo de desnutrición y sarcopenia de las personas institucionalizadas es clave para entender el contexto actual tras la repercusión que ha tenido la pandemia por coronavirus (COVID-19). METODOS: Se realizó un estudio observacional retrospectivo. Se describen los resultados de la prueba Remote Malnutrition APP (R-MAPP): factores de riesgo de desnutrición (incluyendo la COVID-19), Malnutrition Universal Screening Tool (MUST) y la SARC-F, en una muestra seleccionada de 402 residentes de Castilla-La Mancha (España) durante 2021. Se llevó a cabo un análisis inferencial para determinar qué factores tenían relación con las medidas de respuesta MUST (≥2 puntos) y SARC-F (≥4 puntos). Con los factores que obtuvieron significación estadística se realizó un modelo de regresión multivariante ajustando por cada uno de esos factores. RESULTADOS: La edad media fue de 84,2 años, con un 70,1% de mujeres. El factor de riesgo de desnutrición más frecuente fue el envejecimiento (85,1%). El Índice de Masa Corporal medio fue 26,5 (DE 11,6). Se obtuvo un MUST mayor o igual a 2 puntos en un 16,2%, y un SARC-F igual o mayor de 4 en el 69,9%. Se observó, como factor protector, la EPOC (enfermedad pulmonar obstructiva crónica / OR 0,35; IC 95% 0,13-0,92; p 0,03) contra el riesgo de desnutrición. El riesgo de sarcopenia se relacionó con envejecimiento (OR 8,16; IC 95% 4,13-16,20; p 0,00), COVID-19 (OR 1,96; IC 95% 1,17-3,29; p 0,01) y EPOC (OR 2,44; IC 95% 1,21- 4,89; p 0,01). CONCLUSIONES: No se halla relación entre COVID-19 y riesgo alto de desnutrición. Envejecimiento, COVID-19 y EPOC son factores de riesgo de sarcopenia.

Inequality in old age cognition across the world.

Although cohort and country differences in average cognitive levels are well established, identifying the degree and determinants of inequalities in old age cognitive functioning could guide public health and policymaking efforts. We use all publicly available and representative old age surveys with comparable information to assess inequalities of cognitive functioning for six distinctive age groups in 29 countries. We document that cognitive inequalities in old age are largely determined by earlier educational inequalities as well as gender differential survival rates. For example, a one percentage point increase in the Gini index of past education is associated with an increase of 0.45 percentage points in the Gini index of delayed recall and 0.23 percentage points in the Gini of immediate recall. Results are robust to a variety of alternative explanations and persist even after controlling for gender-related biases in survival rates. Furthermore, we find evidence that unequal opportunities for education -captured by differences in parental background and gender- also have significant effects on inequality of old age cognition.

Detecting psychogeriatric problems in primary care: factors related to psychiatric symptoms in older community patients.

Objective The aim was to determine the relationship and influence of different variables on the psychiatric symptomatology of older people who reside in the community, as detected by family practitioners.Design A cross-sectional and multi-centre study.Setting Twenty-eight general practices and two psychiatric practices in Huesca, Spain, from 19 primary care health centres.Subjects A sample of 324 patients aged over 65 years, representative of the older people who reside in the community in the province of Huesca.Main outcome measures Symptoms of depression (Yesavage GDS), cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured by family practitioner and were detected following specific questions from the Geriatric Mental State (GMS-B) examination, following DSM-IV criteria, being defined as 'concern and fear of suffering, or the idea of having a serious disease based on the interpretation of somatic symptoms'. Sociodemographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in three phases: univariate, bivariate and multivariate with logistic regression.Results At the time of the study, 46.1% of the older people studied suffered from some psychiatric symptom; 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (prevalence ration (PR) 3.3) and anxiety (PR 3.9). Age was a factor associated with cognitive impairment (PR 4.4). Depression was significantly related to severity of the physical illness (PR 61.7 in extremely severe impairment). Isolation (PR 16.3) and being single (PR 13.4) were factors which were strongly associated with anxiety; living in a nursing home was associated with psychotic symptoms (PR 7.6).Conclusions Severity of physical illness, isolation, living in a nursing home and female gender, among others, are related to psychiatric symptoms in community-residing older people identified in primary healthcare centres.

Prevalence of psychiatric symptoms and mental disorders detected in primary care in an elderly Spanish population. The PSICOTARD Study: preliminary findings.

OBJECTIVES: To investigate the prevalence of mental health problems among the elderly attending Primary Care centres in the Province of Huesca (Spain). To detect factors associated with the psychopathology of the elderly, and to demonstrate that specific training for GPs (General Practitioners) in the use of psychogeriatric screening instruments significantly increases detection. METHODS: Sample selection was made by means of systematic random sampling, stratified by the participants' health centres. Two hundred and ninety-three patients over 65 were assessed with the Spanish version of the Mini-Mental State Examination, Clock Drawing Test, Verbal Fluency, Informant Questionnaire (detection of cognitive impairment), Yesavage Geriatric Depression Scale, Goldberg Anxiety and Depression Scale, and Geriatric Mental State Schedule (items for delusions, hallucinations, obsessive ideas and hypochondriacal ideas). RESULTS: Almost half the patients (46.1%) presented some type of psychiatric symptom at the time of assessment. The most prevalent disorders were: cognitive impairment (16.4%), anxiety (15.7%), depression (14.3%), psychosis (6.1%), obsessive symptoms (4.4%) and hypochondriacal ideas (7.2%). Women presented more psychopathological disorders than men (58.7% vs 34.0%). Age, severity of physical illness, poor social support and previous psychiatric comorbidity were associated with psychiatric disorders in the elderly. CONCLUSIONS: Only 29% of the elderly population studied had a previous psychiatric diagnosis, so the detection of mental problems in old age is low in Primary Care. When Family Doctors are trained in psychogeriatric screening instruments, detection and sensitivity in the recognition of these important health problems increases. Greater training in psychogeriatric assessment is required in Primary Care.