[Gender inequalities in the impacts of informal elderly caregiving in Gipuzkoa: CUIDAR-SE study]. / Desigualdades de género en los impactos del cuidado informal de mayores dependientes en Gipuzkoa: Estudio CUIDAR-SE.

OBJECTIVE: The provision of informal care determines the existence of health inequalities, as well as gender inequalities, because of women being the most frequent caregivers. The objectives of this study were to characterize the informal caregivers of elderly dependents in Gipuzkoa, to know the impact of caring on health and health related quality of life (HRQoL), and to explain the relationship between sex and consequences attributable to care. METHODS: Cross-sectional study analyzing health (self-perceived health and GHQ-12) and HRQoL (EQ-5D-5L) data of 123 women and 103 men who took care of a dependent elderly and participated in the first wave of the CUIDAR-SE study in Gipuzkoa. A descriptive study was performed, and a logistic regression analysis was carried out to examine the association between sex and the consequences attributable to care. RESULTS: Women and men were over 60 years old, married, with primary education or less, and took care of their parents mainly. Women presented worse perceived health (46.3% vs 32.0%) and mental health (23.3% vs 13.9%), and more problems in the dimensions of anxiety/depression (35.0% vs 21.4%) and pain/discomfort (52.8% vs 31.1%) of EQ-5D-5L.The regression model showed greater risk of fatigue (OR = 2.83; 95% CI:1.53-5.24) and burden (OR = 1.87; 95% CI: 1.06-3.29) among women than among men. CONCLUSIONS: There are gender inequalities in the provision of informal care to dependent elderly people in Gipuzkoa, with women having a greater impact on their health and HRQoL than men. Considering the organization of care in this province, it will be necessary to design improvement actions more suited to the needs of caregivers.

OBJETIVO: La prestación de cuidados informales determina la existencia de desigualdades en salud, a las cuales se suman las desigualdades de género por el papel mayoritario de las mujeres en dicha prestación. Los objetivos de este estudio fueron caracterizar a la población cuidadora informal de mayores dependientes en Gipuzkoa, conocer los impactos de cuidar sobre la salud y la calidad de vida relacionada con la salud (CVRS), y explicar la relación entre el sexo y las consecuencias atribuibles al cuidado. METODOS: Estudio transversal en el que se analizaron datos de salud (salud percibida y GHQ-12) y CVRS (EQ-5D-5L) de 123 mujeres y 103 hombres cuidadores de mayores dependientes que participaron en la primera oleada del estudio CUIDAR-SE en Gipuzkoa. Se realizó un estudio descriptivo, y un análisis de regresión logística para examinar la asociación entre el sexo y las consecuencias del cuidado. RESULTADOS: Mujeres y hombres tenían más de 60 años, estaban casadas/os, tenían educación primaria o inferior, y cuidaban a sus progenitores fundamentalmente. Las mujeres presentaban peor salud percibida (46,3% vs 32,0%) y mental (23,3% vs 13,9%), y más problemas en las dimensiones de ansiedad/depresión (35,0% vs 21,4%) y dolor/malestar (52,8% vs 31,1%) de laEQ-5D-5L. El modelo de regresión mostró mayor riesgo de cansancio (OR=2,83; IC95%:1,53-5,24) y sobrecarga (OR=1,87; IC95%:1,06-3,29) en mujeres que en hombres. CONCLUSIONES: Existen desigualdades de género en la provisión de cuidados informales a mayores dependientes en Gipuzkoa, mostrando las mujeres un mayor impacto en su salud y CVRS que los hombres. Considerando la organización del cuidado en esta provincia, será necesario el diseño de acciones de mejora más adecuadas a las necesidades de las personas cuidadoras.

Desigualdades de género en los impactos del cuidado informal de mayores dependientes en Gipuzkoa: Estudio CUIDAR-SE / Gender inequalities in the impacts of informal elderly caregiving in Gipuzkoa: CUIDAR-SE study

OBJETIVO: La prestación de cuidados informales determina la existencia de desigualdades en salud, a las cuales se suman las desigualdades de género por el papel mayoritario de las mujeres en dicha prestación. Los objetivos de este estudio fueron caracterizar a la población cuidadora informal de mayores dependientes en Gipuzkoa, conocer los impactos de cuidar sobre la salud y la calidad de vida relacionada con la salud (CVRS), y explicar la relación entre el sexo y las consecuencias atribuibles al cuidado. MÉTODOS: Estudio transversal en el que se analizaron datos de salud (salud percibida y GHQ-12) y CVRS (EQ-5D-5L) de 123 mujeres y 103 hombres cuidadores de mayores dependientes que participaron en la primera oleada del estudio CUIDAR-SE en Gipuzkoa. Se realizó un estudio descriptivo, y un análisis de regresión logística para examinar la asociación entre el sexo y las consecuencias del cuidado. RESULTADOS: Mujeres y hombres tenían más de 60 años, estaban casadas/os, tenían educación primaria o inferior, y cuidaban a sus progenitores fundamentalmente. Las mujeres presentaban peor salud percibida (46,3% vs 32,0%) y mental (23,3% vs 13,9%), y más problemas en las dimensiones de ansiedad/depresión (35,0% vs 21,4%) y dolor/malestar (52,8% vs 31,1%) de laEQ-5D-5L. El modelo de regresión mostró mayor riesgo de cansancio (OR=2,83; IC95%:1,53-5,24) y sobrecarga (OR=1,87; IC95%:1,06-3,29) en mujeres que en hombres. CONCLUSIONES: Existen desigualdades de género en la provisión de cuidados informales a mayores dependientes en Gipuzkoa, mostrando las mujeres un mayor impacto en su salud y CVRS que los hombres. Considerando la organización del cuidado en esta provincia, será necesario el diseño de acciones de mejora más adecuadas a las necesidades de las personas cuidadoras

OBJECTIVE: The provision of informal care determines the existence of health inequalities, as well as gender inequalities, because of women being the most frequent caregivers. The objectives of this study were to characterize the informal caregivers of elderly dependents in Gipuzkoa, to know the impact of caring on health and health related quality of life (HRQoL), and to explain the relationship between sex and consequences attributable to care. METHODS: Cross-sectional study analyzing health (self-perceived health and GHQ-12) and HRQoL (EQ-5D-5L) data of 123 women and 103 men who took care of a dependent elderly and participated in the first wave of the CUIDAR-SE study in Gipuzkoa. A descriptive study was performed, and a logistic regression analysis was carried out to examine the association between sex and the consequences attributable to care. RESULTS: Women and men were over 60 years old, married, with primary education or less, and took care of their parents mainly. Women presented worse perceived health (46.3% vs 32.0%) and mental health (23.3% vs 13.9%), and more problems in the dimensions of anxiety/depression (35.0% vs 21.4%) and pain/discomfort (52.8% vs 31.1%) of EQ-5D-5L.The regression model showed greater risk of fatigue (OR = 2.83; 95% CI:1.53-5.24) and burden (OR = 1.87; 95% CI: 1.06-3.29) among women than among men. CONCLUSIONS: There are gender inequalities in the provision of informal care to dependent elderly people in Gipuzkoa, with women having a greater impact on their health and HRQoL than men. Considering the organization of care in this province, it will be necessary to design improvement actions more suited to the needs of caregivers

Health-related quality of life in Spanish informal caregivers: gender differences and support received.

PURPOSE: We analyzed gender differences in health-related quality of life (HRQoL) and associated factors between informal male and female caregivers in Spain. It is important because of growing rates of dependent people and dwindling public resources. METHODS: We conducted a cross-sectional study of 610 informal caregivers (265 male and 345 female) using an ad hoc structured questionnaire. We performed a descriptive analysis and used multivariate logistic regression to analyze the risk of poor HRQoL, measured with the EQ-5D-5L, according to caregiver sex, sociodemographic characteristics of caregivers and dependents, caregiving circumstances, and support received. RESULTS: Male caregivers were older than women were, and cared more often for their partners. More women used family caregiving allowance (FCA), respite care services, and counseling services, while more men used paid help, home help, and other forms of instrumental help. Women had worse HRQoL than men, particularly in the pain/discomfort dimension. In addition to older age and poor previous health, caring for a partner (OR = 2.379), for a person with major dependence (OR = 1.917), low social class (OR = 1.634), and low social support (OR = 2.311) were factors associated with poor HRQoL. Receiving FCA was associated with better HRQoL (OR = 0.319). Controlling for all these variables, women had 131% more odds than men to have poor HRQoL. CONCLUSIONS: Male and female caregivers in Spain differ in received support and how their HRQoL is affected. These differences are important to design interventions to promote more equitable sharing of care responsibilities and better caregiver health.

Situación actual de la investigación sobre las condiciones de vida y el estado de salud de las personas mayores en España / Current situation of the research on living conditions and health status of elderly people in Spain

OBJETIVO: Analizar las dimensiones estudiadas en la investigación sobre las condiciones de vida y salud de las personas mayores no institucionalizadas en la literatura científica en el medio español. MÉTODO: Análisis de contenidos basado en fuentes secundarias, realizado mediante búsquedas bibliográficas de documentos en Pubmed y Embase en castellano y en inglés. La estrategia de búsqueda combinó términos o categorías relacionados con personas mayores, condiciones de vida y/o salud y España. Se incluyeron los estudios que evaluasen condiciones de vida y/o salud de las personas mayores en España. Se excluyeron los que analizaban un aspecto concreto de las condiciones de vida o salud y los que incluían o se centraban en la población institucionalizada. RESULTADOS: Para el análisis de contenidos se consideró un total de 14 estudios y/o informes como relevantes. Los trabajos localizados son habitualmente de ámbito local, de tipo transversal y la recogida de datos se realiza mediante entrevista al individuo. Se observó variabilidad en los aspectos analizados sobre las condiciones de vida y salud de las personas mayores. La valoración de las características sociodemográficas, el estado de salud y los hábitos de vida se estudiaron de forma habitual. Los aspectos relacionados con el estado del entorno de la vivienda fueron escasamente analizados. CONCLUSIONES: Este estudio permite conocer las dimensiones priorizadas en los estudios sobre condiciones de vida y salud realizados hasta el momento actual en el medio español. Además, aporta claves para el desarrollo de investigaciones futuras que articulen de manera integrada las condiciones de vida y el estado de salud de las personas mayores, aspectos estrechamente relacionados

OBJECTIVE: To analyse the dimensions studied with respect to living and health conditions of the non-institutionalised elderly in the scientific literature in Spain. Method: A content analysis based on secondary sources was carried out by literature searches in Pubmed and Embase in Spanish and English. The search strategies combined terms related to older people, health and/or living conditions and with Spain. All studies assessing living and/or health conditions of elderly in Spain were included. Studies analyzing a specific aspect of living or health conditions and those based on institutionalized population were excluded. RESULTS: A total of 14 studies were considered in the content analysis. The studies are usually local, cross-sectional and data collection is done by direct interview. Variability was observed in the aspects analysed about living and health conditions. All studies included: sociodemographic characteristics, health status and lifestyle habits. Issues related to the status of the out-of home environment are poorly analysed. CONCLUSIONS: This work allows knowing the dimensions prioritised in the studies carried out to date about health and living conditions in Spain. It also provides key elements for the development of future research aiming to integrate both living and health conditions of elderly population, both aspects closely related

[Current situation of the research on living conditions and health status of elderly people in Spain]. / Situación actual de la investigación sobre las condiciones de vida y el estado de salud de las personas mayores en España.

OBJECTIVE: To analyse the dimensions studied with respect to living and health conditions of the non-institutionalised elderly in the scientific literature in Spain. METHOD: A content analysis based on secondary sources was carried out by literature searches in Pubmed and Embase in Spanish and English. The search strategies combined terms related to older people, health and/or living conditions and with Spain. All studies assessing living and/or health conditions of elderly in Spain were included. Studies analyzing a specific aspect of living or health conditions and those based on institutionalized population were excluded. RESULTS: A total of 14 studies were considered in the content analysis. The studies are usually local, cross-sectional and data collection is done by direct interview. Variability was observed in the aspects analysed about living and health conditions. All studies included: sociodemographic characteristics, health status and lifestyle habits. Issues related to the status of the out-of home environment are poorly analysed. CONCLUSIONS: This work allows knowing the dimensions prioritised in the studies carried out to date about health and living conditions in Spain. It also provides key elements for the development of future research aiming to integrate both living and health conditions of elderly population, both aspects closely related.

Multimorbidity Patterns in Hospitalized Older Patients: Associations among Chronic Diseases and Geriatric Syndromes.

BACKGROUND/OBJECTIVES: The clinical status of older individuals with multimorbidity can be further complicated by concomitant geriatric syndromes. This study explores multimorbidity patterns, encompassing both chronic diseases and geriatric syndromes, in geriatric patients attended in an acute hospital setting. DESIGN: Retrospective observational study. SETTING: Unit of Social and Clinical Assessment (UVSS), Miguel Servet University Hospital (HUMS), Zaragoza (Spain). Year, 2011. PARTICIPANTS: A total of 924 hospitalized patients aged 65 years or older. MEASUREMENTS: Data on patients' clinical, functional, cognitive and social statuses were gathered through comprehensive geriatric assessments. To identify diseases and/or geriatric syndromes that cluster into patterns, an exploratory factor analysis was applied, stratifying by sex. The factors can be interpreted as multimorbidity patterns, i.e., diseases non-randomly associated with each other within the study population. The resulting patterns were clinically assessed by several physicians. RESULTS: The mean age of the study population was 82.1 years (SD 7.2). Multimorbidity burden was lower in men under 80 years, but increased in those over 80. Immobility, urinary incontinence, hypertension, falls, dementia, cognitive decline, diabetes and arrhythmia were among the 10 most frequent health problems in both sexes, with prevalence rates above 20%. Four multimorbidity patterns were identified that were present in both sexes: Cardiovascular, Induced Dependency, Falls and Osteoarticular. The number of conditions comprising these patterns was similar in men and women. CONCLUSION: The existence of specific multimorbidity patterns in geriatric patients, such as the Induced Dependency and Falls patterns, may facilitate the early detection of vulnerability to stressors, thus helping to avoid negative health outcomes such as functional disability.

[Cancer Survival between 1995 and 2004 in the Basque Country, Spain].

BACKGROUND: geographic differences described in the prognosis of cancer patients in the Basque Country have been attributed to a different incidence in tumours with different lethality. Therefore, cancer relative survival adjusted by case-mix was included to estimate cancer survival by provinces and health regions, using data from 1995 to 2004. METHODS: a total of 93 585 cases of malignant tumours were identified from a population-based cancer registry. The five-year relative survival (RS) was calculated using Ederer´s method. The five-year relative excess risk (RER) of death was estimated with a generalised linear model, standardized by age and adjusted for sex, date of diagnosis and case-mix. RESULTS: the five-year RS increased from period 1995-1999 to 2000-2004, this latter, with values ranging by health regions between 46-58% and 57-65% in men and women, respectively. There was an excess risk of death in Bizkaia (RER=1.06, CI95%: 1.03-1.09), this same effect being identified in almost all the health regions in the province. In contrast, in Gipuzkoa province, differences were only statistically significant in the Gipuzkoa and Tolosa health regions (RER=1.07; CI95%: 1.02-1.13 and RER=0.91; CI95%: 0.84-0.98, respectively), and even these disappeared after adjusting for potential confounders. CONCLUSIONS: cancer patients of Bizkaia, except for the Uribe health region, presented a worse prognosis.

Supervivencia del cáncer en el País Vasco entre 1995-2004 / Cancer survival between 1995 and 2004 in the Basque Country, Spain

Fundamentos: las diferencias geográficas descritas en el pronóstico de los pacientes de cáncer en el País Vasco han sido atribuidas a la diferente incidencia en tumores de diferente letalidad. Por ello, se incluye la supervivencia relativa del cáncer ajustada por la casuística para estimar la supervivencia del conjunto de los tumores malignos por provincias y comarcas sanitarias, utilizando los datos de 1995 a 2004. El objetivo del trabajo es estimar la supervivencia de los tumores malignos en el País Vasco por provincias y comarcas sanitarias durante el período 1995-2004. Métodos: se incluyeron 93.585 tumores malignos del registro poblacional de cáncer. Se calculó la supervivencia relativa (SR) a 5 años con el método de Ederer. Se estimó el exceso de riesgo relativo (ERR) de muerte a los 5 años con el modelo lineal generalizado, estandarizando por edad y ajustando por sexo, período de diagnostico y casuística. Resultados: la SR a los 5 años aumentó en el período 2000-2004 con respecto a 1995-1999 con valores que oscilaron por comarcas entre el 46-58% y el 57-65% en hombres y mujeres, respectivamente. Se observó un exceso de riesgo de muerte en pacientes de Bizkaia (ERR= 1,06; IC95%: 1,03-1,09, efecto que se observo en casi todas sus comarcas. Por el contrario, en Gipuzkoa, sólo las comarcas Gipuzkoa y Tolosa mostraron diferencias significativas (ERR=1,07; IC95%: 1,02-1,13 y ERR=0,91; IC95%: 0,84-0,98, respectivamente), las cuales desaparecieron al ajustar el modelo. Conclusiones: dentro del Pais Vasco fueron los pacientes de Bizkaia, a excepción de la comarca Uribe, los que presentaron peor pronóstico(AU)

Background: geographic differences described in the prognosis of cancer patients in the Basque Country have been attributed to a different incidence in tumours with different lethality. Therefore, cancer relative survival adjusted by case-mix was included to estimate cancer survival by provinces and health regions, using data from 1995 to 2004. Methods: a total of 93 585 cases of malignant tumours were identified from a population-based cancer registry. The five-year relative survival (RS) was calculated using Ederer's method. The five-year relative excess risk (RER) of death was estimated with a generalised linear model, standardized by age and adjusted for sex, date of diagnosis and case-mix. Results: the five-year RS increased fromperiod 1995-1999 to 2000- 2004, this latter, with values ranging by health regions between 46-58% and 57-65% in men and women, respectively. There was an excess risk of death in Bizkaia (RER=1.06, CI95%: 1.03-1.09), this same effect being identified in almost all the health regions in the province. In contrast, in Gipuzkoa province, differences were only statistically significant in the Gipuzkoa and Tolosa health regions (RER=1.07; CI95%: 1.02-1.13 and RER=0.91; CI95%: 0.84-0.98, respectively), and even these disappeared after adjusting for potential confounders. Conclusions: cancer patients of Bizkaia, except for the Uribe health region, presented a worse prognosis(AU)