Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile.

BACKGROUND: Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown. OBJECTIVE: To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile. METHOD: Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile. RESULTS: Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively). CONCLUSIONS: This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.

The first genome-wide association study in the Argentinian and Chilean populations identifies shared genetics with Europeans in Alzheimer's disease.

INTRODUCTION: Genome-wide association studies (GWAS) are fundamental for identifying loci associated with diseases. However, they require replication in other ethnicities. METHODS: We performed GWAS on sporadic Alzheimer's disease (AD) including 539 patients and 854 controls from Argentina and Chile. We combined our results with those from the European Alzheimer and Dementia Biobank (EADB) in a meta-analysis and tested their genetic risk score (GRS) performance in this admixed population. RESULTS: We detected apolipoprotein E ε4 as the single genome-wide significant signal (odds ratio  = 2.93 [2.37-3.63], P = 2.6 × 10-23 ). The meta-analysis with EADB summary statistics revealed four new loci reaching GWAS significance. Functional annotations of these loci implicated endosome/lysosomal function. Finally, the AD-GRS presented a similar performance in these populations, despite the score diminished when the Native American ancestry rose. DISCUSSION: We report the first GWAS on AD in a population from South America. It shows shared genetics modulating AD risk between the European and these admixed populations. HIGHLIGHTS: This is the first genome-wide association study on Alzheimer's disease (AD) in a population sample from Argentina and Chile. Trans-ethnic meta-analysis reveals four new loci involving lysosomal function in AD. This is the first independent replication for TREM2L, IGH-gene-cluster, and ADAM17 loci. A genetic risk score (GRS) developed in Europeans performed well in this population. The higher the Native American ancestry the lower the GRS values.

Life expectancy by ethnic origin in Chile.

Background: Ethnic and racial differences in life expectancy have been well established in different societies. However, even though an important part of the population of Latin America is Indigenous, there is little knowledge about them. Objective: Determine if there are ethnic differences in life expectancy at birth and at 60 years in Chile, and if the Mapuche (largest Indigenous ethnic group) have similar life expectancy to other Indigenous peoples. Method: Life tables for the Mapuche and other Indigenous groups and non-Indigenous people were built using the 2017 census. Specifically, we used the questions of the number of live children born and the number of surviving children. With this information, using the indirect method of own children we determined infantile mortality. Then, using the relational logit model and the model life table (west), we estimated the survival function for all ages. Results: Indigenous Chileans have seven years lower life expectancy at birth than the non-Indigenous population (76.2 vs. 83.2 years). The differential at age 60 is 6 years (20.3 vs. 26.4 years). We also found that Mapuche have an even greater disadvantage in survival than other ethnic groups. This is reflected in 2 years less life expectancy, both at birth and at 60 years. Discussion: Our results ratify the existence of marked ethnic-racial inequality in the extension of life in Chile and demonstrate a greater disadvantage in terms of survival of the Mapuche compared to other Indigenous and non-Indigenous groups. It is thus of great relevance to design policies that would decrease the existing inequalities in lifespan.

The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations.

Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.

Grip Strength Trajectories and Cognition in English and Chilean Older Adults: A Cross-Cohort Study.

Growing evidence about the link between cognitive and physical decline suggests the early changes in physical functioning as a potential biomarker for cognitive impairment. Thus, we compared grip-strength trajectories over 12-16 years in three groups classified according to their cognitive status (two stable patterns, normal and impaired cognitive performance, and a declining pattern) in two representative UK and Chilean older adult samples. The samples consisted of 7069 UK (ELSA) and 1363 Chilean participants (ALEXANDROS). Linear Mixed models were performed. Adjustments included socio-demographics and health variables. The Declined and Impaired group had significantly lower grip-strength at baseline when compared to the Non-Impaired. In ELSA, the Declined and Impaired showed a faster decline in their grip strength compared to the Non-Impaired group but differences disappeared in the fully adjusted models. In ALEXANDROS, the differences were only found between the Declined and Non-Impaired and they were partially attenuated by covariates. Our study provides robust evidence of the association between grip strength and cognitive performance and how socio-economic factors might be key to understanding this association and their variability across countries. This has implications for future epidemiological research, as hand-grip strength measurements have the potential to be used as an indicator of cognitive performance.

Fuerza de prensión manual. Un sencillo, pero fuerte predictor de salud en población adulta y personas mayores / Handgrip strength as a predictor of adverse health outcomes

Muscle strength can be measured through different methods and handgrip strength is one of the most used techniques in epidemiological studies. Given its easy application, high reliability, and low cost, it is considered an important health biomarker. Handgrip strength is associated with adverse health outcomes such as mortality and risk of developing chronic diseases, cardiovascular, respiratory, cancer and dementia. There is a paucity of evidence in Chile about the association of handgrip strength with these health outcomes limiting its visibility and implementation in clinical settings. Therefore, this narrative review summarizes the scientific evidence about the association of grip strength with non-communicable chronic diseases and mortality in middle age and older adults.

Subjective Assessments of Quality of Life Are Independently Associated with Depressive Symptoms among Older Adults Enrolled in Primary Care in Chile.

In Chile, depressive symptoms are highly prevalent among Chilean older adults, and research that examines the factors associated with them is scarce. This study aimed to determine if subjective assessments of quality of life are associated with positive screen for depressive symptoms among older adults enrolled in primary care in Chile. The participants of the study were people aged 70 years or more enrolled in primary care centers in three Chilean cities. The 15-item Geriatric Depression Scale was used to determine depressive symptoms. Multivariate logistic models were used to determine the associations. Overall, 17.28% men, and 26.47% women (p = 0.003) screened positive for depression. Subjective assessments of quality of life, including self-perceived health, memory, quality of life, and pain, were associated with a positive screen for depression. Only 17.65% of men and 43.55% of women who screened positive for depressive symptoms reported a diagnosis of depression. Assessments of quality of life in health checks of older adults in primary care could contribute to narrow the diagnosis and treatment gap by improving the ability to identify those who are more likely to experience depressive symptoms.

Exploring the Association between Vitamin D and Changes in Cognitive Function in Chilean Older Adults: Evidence from the ALEXANDROS Cohort Study.

Background: The increasing aging of the population with the consequent increase of age-associated cognitive disorders pose the challenge of controlling its preventable risk factors, among which vitamin D deficit is a putative factor. Thus, our objective is to explore the association between vitamin D and cognitive performance in a cohort study of community-dwelling Chilean older people. Material and Methods: Cohort study of 955 (69.7% female), community-dwelling older Chileans free of cognitive impairment from the Alexandros cohorts, with 25(OH)D measurement at baseline. Cognitive Function was evaluated with the Mini Mental State Examination (MMSE) short-form questionnaire. Plasma levels of 25(OH)D were classified as Normal > 30 ng/mL Insufficiency 20−29 ng/mL, Deficiency 20−12 ng/mL and Severe Deficiency < 12 ng/mL. Penalized regressions models were made to assess associations. Results: Mean age of the sample was 66.6 + 4.5 years, with 8.5 + 4.7 years of education. After a mean follow-up of 9.6 years, 54 new cases of Mild Cognitive Impairment (MCI)were identified (Incidence density rate = 5.9 per 1000 person/years). Mean vitamin D plasma levels were lower in people with MCI than in the normal cognitive ones (23.0 + 12.75 vs. 28.35 + 15.17 ng/mL, p < 0.01). In the fully adjusted model only severe deficiency of vitamin D was associated with MCI (RR = 2.33; 95% CI: (1.03−5.26). Conclusions: In this longitudinal study, our results confirm that low Vitamin D is a risk factor for MCI, and that people with severe deficiency have more than double the risk of MCI people with normal Vitamin D levels. Considering the high frequency of vitamin D deficiency in older people, and its preventability, these results are very valuable for future public health programmes.

Frailty in Aging and the Search for the Optimal Biomarker: A Review.

In the context of accelerated aging of the population worldwide, frailty has emerged as one of the main risk factors that can lead to loss of self-sufficiency in older people. This syndrome is defined as a reduced state of physiological reserve and functional capacity. The main diagnostic tools for frailty are based on scales that show deficits compared to their clinical application, such as the Fried frailty phenotype, among others. In this context, it is important to have one or more biomarkers with clinical applicability that can objectively and precisely determine the degree or risk of frailty in older people. The objective of this review was to analyze the biomarkers associated with frailty, classified according to the pathophysiological components of this syndrome (inflammation, coagulation, antioxidants, and liver function, among others). The evidence demonstrates that biomarkers associated with inflammation, oxidative stress, skeletal/cardiac muscle function, and platelet function represent the most promising markers of frailty due to their pathophysiological association with this syndrome. To a lesser extent but with the possibility of greater innovation, biomarkers associated with growth factors, vitamins, amino acids, and miRNAs represent alternatives as markers of this geriatric syndrome. Likewise, the incorporation of artificial intelligence represents an interesting approach to strengthening the diagnosis of frailty by biomarkers.

Characterization by Gender of Frailty Syndrome in Elderly People according to Frail Trait Scale and Fried Frailty Phenotype.

Background: Frailty has emerged as one of the main geriatric syndromes to be prevented in order to improve quality of health and life in the elderly. In this sense, the characterization of this syndrome through reliable and feasible diagnostic tools for clinical use, such as the Frail Trait Scale 5 (FTS-5) and Frail Trait Scale 3 (FTS-3), represents the basis for this objective. Objectives: To characterize the frailty syndrome in a population of older adults using FTS-5, FTS-3, and Fried phenotype (FP) as frailty diagnostic tools. Design: Cross-sectional study. Participants: 300 adults ≥65 years recruited from different Family Health Centers and community groups of older people in Talca, Chile. Methods: The diagnosis of frailty was made according to FP, FTS-5, and FTS-3 tools. Data about sociodemographic characteristics and anthropometric measurements were collected by a clinical interview by a previously trained health professional. Results: A total prevalence of frailty according to the FP of 19.7% was observed; while in the group of women and men it was 21.4% and 15.0%, respectively. Concerning the FTS-5 tool, the total prevalence of frailty was 18%, while in the group of women and men was 18.0% and 17.5%, respectively. The FTS-3 tool shows a total prevalence of frailty of 23.3%, while in the group of women and men a prevalence of 22.7% and 25.0%, respectively. A significant difference is observed with respect to the presence of the Fried criteria of "weakness" (women: 21.4%, men: 38.8%) and "weight loss" (women: 16.8%, men: 7.5%; p < 0.05). A significant difference is observed concerning the average score of "Handgrip" criteria, "walking time", and "Physical Activity Scale for the Elderly" (PASE) between the group of women and men. Frailty, diagnosed by FTS-3, is significantly associated with the risk factors of overweight (body mass index ≥ 25) (OR: 10.225, 95% CI: 1.297−80.617) and advanced age (age ≥ 75 years) (OR: 1.839, 95% CI: 1.040−3.250). Conclusion: The prevalence of frailty observed with the FTS-5 (18%) and FTS-3 (23.3%) tools are similar to the prevalence observed through the FP (19.7%) and those reported in other observational studies. Considering the similar prevalence of frailty diagnosed with the three tools, FTS-3 should be a valuable tool for the screening of frailty in the community.

Social participation and 5-year all-cause mortality in older Chilean people.

We aimed to examine the degree to which social participation is associated with mortality risk in older adults in Chile. We used the Chilean National Survey on Elderly Dependency, which is linked to vital statistics, in order to obtain death records. Four proportional risk regression models were estimated. Even with controlled sociodemographic, economic, family, and health variables, older adults who participate in social activities had a 22% lower risk of death than those who do not participate. We concluded that social participation is a strong and significant protective factor for mortality in Chilean older adults. Social participation should thus be promoted from a life course perspective considering its effect on mortality in older adults who maintained an active social life.

Forecasting Healthy Life Expectancy Among Chilean Community-Dwelling Older Adults With and Without Sarcopenia.

BACKGROUND: Sarcopenia is an important risk factor for disability and dependency at old age. The prevalence of sarcopenia among the Chilean older population is high. OBJECTIVE: To estimate life expectancy, healthy life expectancy and unhealthy life expectancy among sarcopenic and non-sarcopenic older adults from Santiago, Chile. METHODS: A sample of 1,897 community-dwelling older adults aged 60 years or more, living in Santiago, was observed between 5-15 years. Disability was defined as the unhealthy state, assessed through self-reported difficulties in activities of daily living. Sarcopenia was determined via HTSMayor software. Total and marginal life expectancies were estimated using the Interpolated Markov Chain method "IMaCh". RESULTS: At 60 years, estimated life expectancy for sarcopenic and non-sarcopenic older adults was similar (22.7 and 22.5 years, respectively). The proportion of years to be lived with disability was three times greater in sarcopenic adults, compared to non-sarcopenic people. This difference was observed up to 80 years. Non-sarcopenic women had a higher proportion of years to be lived with disabilities compared to non-sarcopenic men of the same age, but this proportion was higher among sarcopenic men, compared to sarcopenic women until 70 years of age. DISCUSSION: People with sarcopenia expect to live a higher proportion of years with disabilities. Sarcopenic men until 70 years expected to live a higher proportion of years with disability, compared to sarcopenic women. Monitoring sarcopenia among older people may help to identify individuals with higher risk of disability onset. Future research should focus on disentangling the mechanisms explaining sex differences.

Dynamic relationships between body fat and circulating adipokine levels from adolescence to young adulthood: The Santiago Longitudinal Study.

BACKGROUND AND AIMS: Adipose tissue secretes adipokines such as adiponectin and leptin, playing important roles in energy metabolism. The longitudinal associations between such adipokines and body fat accumulation have not been established, especially during adolescence and young adulthood and in diverse populations. The study aims to assess the longitudinal association between body fat measured with dual X-ray absorptiometry and plasma adipokines from adolescence to young adulthood. METHODS AND RESULTS: Among Hispanic/Latino participants (N = 537) aged 16.8 (SD: 0.3) years of the Santiago Longitudinal Study, we implemented structural equation modeling to estimate the sex-specific associations between adiposity (body fat percent (BF%) and proportion of trunk fat (PTF)) and adipokines (adiponectin and leptin levels) during adolescence (16 y) and these values after 6 years of follow-up (22 y). In addition, we further investigated whether the associations differed by baseline insulin resistance (IR) status. We found evidence for associations between 16 y BF% and 22 y leptin levels (ß (SE): 0.58 (0.06) for females; 0.53 (0.05) for males), between 16 y PTF and 22 y adiponectin levels (ß (SE): -0.31 (0.06) for females; -0.18 (0.06) for males) and between 16 y adiponectin levels and 22 y BF% (ß (SE): 0.12 (0.04) for both females and males). CONCLUSION: We observed dynamic relationships between adiposity and adipokines levels from late adolescence to young adulthood in a Hispanic/Latino population further demonstrating the importance of this period of the life course in the development of obesity.

[Handgrip strength as a predictor of adverse health outcomes]. / Fuerza de prensión manual. Un sencillo, pero fuerte predictor de salud en población adulta y personas mayores.

Muscle strength can be measured through different methods and handgrip strength is one of the most used techniques in epidemiological studies. Given its easy application, high reliability, and low cost, it is considered an important health biomarker. Handgrip strength is associated with adverse health outcomes such as mortality and risk of developing chronic diseases, cardiovascular, respiratory, cancer and dementia. There is a paucity of evidence in Chile about the association of handgrip strength with these health outcomes limiting its visibility and implementation in clinical settings. Therefore, this narrative review summarizes the scientific evidence about the association of grip strength with non-communicable chronic diseases and mortality in middle age and older adults.

Genetic determinants of metabolic biomarkers and their associations with cardiometabolic traits in Hispanic/Latino adolescents.

BACKGROUND: Metabolic regulation plays a significant role in energy homeostasis, and adolescence is a crucial life stage for the development of cardiometabolic disease (CMD). This study aims to investigate the genetic determinants of metabolic biomarkers-adiponectin, leptin, ghrelin, and orexin-and their associations with CMD risk factors. METHODS: We characterized the genetic determinants of the biomarkers among Hispanic/Latino adolescents of the Santiago Longitudinal Study (SLS) and identified the cumulative effects of genetic variants on adiponectin and leptin using biomarker polygenic risk scores (PRS). We further investigated the direct and indirect effect of the biomarker PRS on downstream body fat percent (BF%) and glycemic traits using structural equation modeling. RESULTS: We identified putatively novel genetic variants associated with the metabolic biomarkers. A substantial amount of biomarker variance was explained by SLS-specific PRS, and the prediction was improved by including the putatively novel loci. Fasting blood insulin and insulin resistance were associated with PRS for adiponectin, leptin, and ghrelin, and BF% was associated with PRS for adiponectin and leptin. We found evidence of substantial mediation of these associations by the biomarker levels. CONCLUSIONS: The genetic underpinnings of metabolic biomarkers can affect the early development of CMD, partly mediated by the biomarkers. IMPACT: This study characterized the genetic underpinnings of four metabolic hormones and investigated their potential influence on adiposity and insulin biology among Hispanic/Latino adolescents. Fasting blood insulin and insulin resistance were associated with polygenic risk score (PRS) for adiponectin, leptin, and ghrelin, with evidence of some degree of mediation by the biomarker levels. Body fat percent (BF%) was also associated with PRS for adiponectin and leptin. This provides important insight on biological mechanisms underlying early metabolic dysfunction and reveals candidates for prevention efforts. Our findings also highlight the importance of ancestrally diverse populations to facilitate valid studies of the genetic architecture of metabolic biomarker levels.

Sarcopenic metabolomic profile reflected a sarcopenic phenotype associated with amino acid and essential fatty acid changes.

INTRODUCTION: Although sarcopenia greatly affects health and quality of life in older people, its pathophysiological causes are not fully elucidated. To face this challenge, omics technologies can be used. The metabolome gives a vision of the interaction between the genome and the environment through metabolic networks, thus contributing in clarifying the pathophysiology of the sarcopenic phenotype. OBJECTIVES: The main goal of this study was to compare the plasma metabolome of sarcopenic and non-sarcopenic older people. METHODS: Cross-sectional study of 20 sarcopenic and 21 non-sarcopenic older subjects with available frozen plasma samples. Non-targeted metabolomic study by ultra-high-performance liquid chromatography-electrospray ionization tandem mass spectrometry (UHPLC-ESI-MS/MS) analysis with later bioinformatics data analysis. Once the significantly different metabolites were identified, the KEGG database was used on them to establish which were the metabolic pathways mainly involved. RESULTS: From 657 features identified, 210 showed significant differences between the study groups, and 30 had a FoldChangeLog2 > 2. The most interesting metabolic pathways found with the KEGG database were the biosynthesis of amino acids, arginine and proline metabolism, the biosynthesis of alkaloids derived from ornithine, linoleic acid metabolism, and the biosynthesis of unsaturated fatty acids. CONCLUSIONS: The study results allowed us to confirm that the concept of "sarcopenic phenotype" is also witnessed at the plasma metabolite levels. The non-targeted metabolomics study can open a wide view of the sarcopenic features changes at the plasma level, which would be linked to the sarcopenic physiopathological alterations.

[The role of social integration in the consumption of fruit and vegetables among the elderly]. / Rol de la integración social en el consumo de frutas y verduras en la adultez mayor.

This study investigates the extent to which aspects of the social integration of the elderly are linked to higher levels of fruit and vegetable consumption. It involved a cross-sectional study based on data from the National Study of Dependency in the Elderly, with a sample of 3278 elderly individuals. The variables of social integration considered were: frequency of meeting with close relatives, other relatives and neighbors and friends in the last 12 months; participation in recreational activities and in community groups, in addition to housing arrangements and marital status. The number of servings of fruit and vegetables consumed per day was the dependent variable. Logistic regression analysis was then conducted. In the adjusted model, more frequent encounters with siblings, in-laws and nephews, participation in community groups or organizations, are factors that increase the possibility of consuming two or more servings of fruit and vegetables a day, versus 1 serving or none; the opposite was observed when living alone. The variables of social integration that can increase the possibility of attaining the recommendation of consumption of fruit and vegetables daily (5 or more) in the adjusted model are frequency of encounters with siblings, in-laws and nephews and living alone.

Se investiga la medida en que aspectos de la integración social de adultos mayores están vinculados con los niveles de consumo de frutas y verduras. Estudio transversal a partir de datos del Estudio Nacional de la Dependencia en las Personas Mayores, con muestra de 3.278 adultos mayores. Las variables de integración social fueron: frecuencia de encuentro con familiares cercanos, otros familiares y vecinos y amigos en los últimos 12 meses; participación en actividades recreativas y en grupos comunitarios, además de arreglos de vivienda y estado marital. El número de porciones de frutas y verduras consumidas al día fue la variable dependiente. Se realizó análisis de regresión logística ordinal. En el análisis ajustado, mayor frecuencia de encuentros con hermanos, cuñados y sobrinos, participación en grupos comunitarios son factores que aumentan la posibilidad de consumo de dos o más porciones de frutas y verduras al día frente a ninguna o 1 porción; efecto contrario presenta vivir solo. Mayor frecuencia de encuentros con hermanos, cuñados y sobrinos y vivir sólo aumentan la posibilidad de alcanzar la recomendación de consumo de frutas y verduras diaria (5 o más), en el modelo ajustado.

Calidad de vida en personas mayores con depresión y dependencia funcional: validez del cuestionario SF-12 / Quality of life of older people with depression and dependence: validity of the SF-12 (short form health survey) questionnaire

Background: Depression and dependence have a great impact on the quality of life of older people. Aim: To validate the SF-12 (short-form) health related quality of care questionnaire (HRQOL) as an alternative of the SF-36 to estimate health-related quality of life (HRQoL) and its association with depression and dependence in Chilean older people living in the community. Material and Methods: The questionnaire was answered by 4,124 Chilean older people (61% women). HRQoL was evaluated with the SF-36 questionnaire. The SF-12 questionnaire includes 12 items from the SF-36. Results: The internal consistency of the SF-12 questionnaire was high (0.88). The effect size of the differences in the averages of the SF-12 and SF-36 scales was small (0.06-0.41). Good agreement was found between the physical and mental components of the SF-12 and SF-36 (0.94 and 0.89). Logistic regressions determined that people with dependence and depression have a higher risk of poor HRQoL. The figures for the physical component were, mild depression: odds ratio (OR) (95% confidence intervals (CI) = 3.28 (2.74-3.93), severe depression: OR (IC95%CI) = 4.66 (3.55-6.11), mild to moderate dependence: OR (95CI%) = 3.67 (2.97-4.54), severe dependence: OR (95%CI) = 13.06 (7.23-23.61). For the mental component, the figures were: mild depression: OR (95CI%) = 6.11(5.05-7.38), severe depression: OR (95CI%) = 22.01(14.47-33.49), mild to moderate dependence: OR (95CI%) = 1.59 (1.28-1.97), severe dependence: OR (95CI%) = 1.60 (1.04-2.47), adjusting for sociodemographic and health-related variables. Conclusions: The validity of the SF-12 for measuring HRQoL was demonstrated. People with depression and dependence have a worse physical and mental quality of life.