Factors associated with health care utilization by the elderly in a public health care system.

OBJECTIVE: The objective was to determine the factors associated with the use of health care services by the elderly residing in the community. METHODS: A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status. RESULTS: The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41). CONCLUSIONS: Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.

[Puerperal depression. Related factors]. / Depresión puerperal. Factores relacionados.

OBJECTIVE: To find the prevalence of postnatal depression in puerperal women in the city of Albacete and to analyse its association with social and demographic factors, morbidity and social and affective support. DESIGN: An observational crossover study with a home interview. SETTING: Community. PATIENTS: 304 women who gave birth at Albacete General Hospital between May and November 1995. MEASUREMENTS AND MAIN RESULTS: The presence of possible depression between the sixth and eighth weeks after giving birth was measured with a self-administered test, the Edinburgh Postnatal Depression Scale (EPDS), on which scores of 13 or more are considered to signal depression. 15.8% (C.I. 11.8%-19.8%) of the women surveyed suffered a probable depressive disorder according to the EPDS. A significant association was found between puerperal depression and history of depression before pregnancy (p = 0.00001), during pregnancy (p = 0.00005) and immediately after delivery (p = 0.00001). Puerperal depression was also associated with stated chronic illness (p = 0.0003), scant help with domestic tasks (p = 0.003) and low family affective support (p = 0.0003). CONCLUSIONS: Between 11.8% and 19.8% of women between the sixth and eighth week of the puerperal period display a probable depression, which is linked to depression immediately after delivery. This disorder needs to be detected during the puerperal visit.

[Factors associated with chronic drug consumption in the elderly]. / Factores asociados al consumo de medicación crónica en personas ancianas.

BACKGROUND: To determine chronic drug intake in the non-institutionalised elderly population and identify factors associated with polypharmacy. PATIENTS AND METHODS: Cross-sectional study by means of home interview. 1,015 elderly individuals were selected systematically from the 1991 municipal electoral list of Albacete, Spain (level of confidence 95%, precision 3%, response rate 93.8%). The questionnaire included, disability scales (Minimental test, index of Katz and Lawton-Brody, Yesavage scale and DUKE-UNC questionnaire), a self-preceivement of health, demographic data and qualitative and quantitative information about drug intake. We employed the anatomic classification of drugs to obtain a profile of consumption. RESULTS: 75% of those interviewed admitted to taking medication chronically (CI 95%: 72.6-78.6). The mean number of drugs was 3.17 +/- 1.94 SD. Intake was significantly higher in women (p = 0.01), widows (p = 0.04), those of lower social status (p = 0.01), greater age (p < 0.02), and a greater number of illnesses (p < 0.001), more frequent users of health resources (p < 0.001), those physically dependent (p < 0.001) and those suffering from depression or cognitive impairment (p = 0.001). The most commonly taken drugs were: cardioactive drugs (22.1%), diuretics (19.4%) and vasodilators (14.2%). Using logistic regression analysis we found that the factors associated with higher drug intake were: three or more ilnesses (OR = 2.24), poor self-assessed status of health (OR = 1.45), physical dependence (OR = 1.59), age greater than 74 years (OR = 1.63), depression (OR = 1.68), > or = 4 contacts with health providers over a three-month period (OR = 2.73) and previous hospital admissions (OR = 2.67). CONCLUSIONS: The high intake of drugs by the elderly is determined, among other factors, by sociodemographic considerations, the subject's perceived status of health and different forms of disability. These factors should be taken into account by health professionals when planning a rational use of drugs. There is a high consumption of peripheral vasodilators despite their scanty therapeutic value.

[Depression in older persons. Associated factors]. / Depresión en personas ancianas. Factores asociados.

OBJECTIVE: To determine the proportion of elderly people with depressive disorders and study the possible association with sociodemographic factors, self-perception of health, cognitive function, diseases suffered, drug consumption, sleep disorders and use of services. DESIGN: An observational crossover study using a home interview. SETTING: Community-based. PARTICIPANTS: 787 elderly people aged 65 and over, not institutionalised and living in the city of Albacete. MEASUREMENTS AND MAIN RESULTS: A questionnaire designed for the study was used to gather data on the sociodemographic variables, self-perception of health, diseases suffered, drug consumption, cognitive function, sleep disorders and contacts with the health service. The variables found by logistic regression to be associated independently to the presence of depressive disorders were: being female (OR = 2.75), habitually suffering sleep disorders (OR = 2.75), having self-perception of poor health (OR = 17.61) and cognitive deterioration (OR = 2.45). CONCLUSIONS: It would be advisable to apply a screening test to detect depressive disorders in elderly people with associated factors (being female, having sleep disorders, self-perception of poor health and cognitive deterioration), so that they could benefit from early diagnosis and adequate treatment.

[Visual and auditory difficulties expressed by the aged]. / Dificultades visuales y auditivas expresadas por los ancianos.

OBJECTIVE: To determine the proportion of the elderly who have difficulties in their perceptive functions (seeing and hearing) and associated factors in the area of health self-perception and functional capacity. DESIGN: Observational and crossover, using an interview. SETTING: Community. PARTICIPANTS: 787 elderly people not in institutions; 93.8% reply rate. MEASUREMENTS AND MAIN RESULTS: Using a questionnaire, data were obtained on deficiencies in their sense organs and self-perceived health. Validated scales to determine functional capacity (physical, psychic and social) were used: Katz, Lawton and Brody indexes, Cognitive mini-test, DUKE-UNC questionnaire and Geriatric Depression scale. A serious difficulty or inability to read or watch television was expressed in 17.3% of cases (CI 95%; 14.8-20.0) and to follow a normal conversation in 10.5% (CI 95%; 8.4-12.6). The proportion of the elderly dependent on others to carry out their normal daily activities was 2.2 times greater among those who displayed severe visual problems (CI 95%; 1.7-2.9) and 1.8 times greater if they had hearing difficulties (C.I. 95%; 1.4-2.3). There was a linear tendency between greater visual or auditory problems and less social support (p = 0.01), greater dependency on others for basic daily activities (p < 0.001) and worse perceived health (p < 0.001). CONCLUSIONS: The elderly, especially the oldest among them, frequently display hearing and visual problems, which are related to low self-perception of health and greater functional incapacity.

[Tetanus vaccination in adults: the situation in primary care]. / Vacunación antitetánica en adultos: situación en atención primaria.

OBJECTIVE: To describe the strategies adopted to increase anti-tetanus vaccination coverage in people over 24, as well as the record systems which exist in Castilla-La Mancha health centres. In addition, to determine those factors involved in achieving greater coverage which depend on the primary care team (PCT). DESIGN: An observational study of a crossover type. SETTING: Primary care. PARTICIPANTS: The PCT in Castilla-La Mancha existing in 1993. 72.5% reply rate. MEASUREMENTS AND MAIN RESULTS: The average coverage achieved, weighted according to population, was 10.55%. The main risk groups in which strategies to increase coverage were put into practice were: the chronically ill (49.5%), professionals at risk (37.6%) and pregnant women (32.6%). Patients were summoned for follow-up doses by 41.3% of PCTs as a matter of habit and by 41.3% occasionally. Normally the vaccination was recorded in the Medical Notes by 41.9% of PCTs. A linear tendency between a higher vaccination rate and, on the other hand, both greater insistence that patients attend for revaccination (p = 0.01) and better recording in the medical notes (p = 0.04) was confirmed. Vaccination coverage was significantly greater in health centres where less people were seen (p < 0.001) and which were more modern (p = 0.003). CONCLUSIONS: The low anti-tetanus vaccination coverage found justifies setting up initiatives of demonstrated efficacy to increase anti-tetanus immunisation. Better records and insistence on patients' attendance for follow-up doses are factors linked to greater vaccination coverage.