Associated factors for fear of COVID-19 scale in long-term care settings in Spain.

OBJECTIVE: To examine the relationship between the Fear of COVID-19 Scale (FCV-19S) score and sociodemographic, health, emotional and behavioural factors, in a cross-sectional observational study in 447 older adults living in long-term care (LTC) settings in Madrid (Spain). METHODS: The sample was stratified by nursing home ownership, geographical location, and size. Multiple linear regression analysis was used using backward elimination to identify factors that explained associations with fear, and logistic regression models were used to examine its role as a predictor of adherence to preventive measures. RESULTS: The mean age of the participants was 83.8 years, most were female, had had COVID-19, and were worried about the pandemic. The average score of the FCV-19S was 18.36 (SD: 8.28; range: 7-35), and the variables associated in the multiple linear regression model (explained variance: 34.00%) were being female, lower level of education, satisfaction with life and the residential home, and higher worry about the pandemic. The logistic regression models showed that fear of COVID-19 was a predictor of adherence to preventive measures like wearing facemasks, washing hands, and avoiding physical contact. CONCLUSIONS: fear of COVID-19 was significantly related with sex and subjective factors as life satisfaction and worry; and it influences older people's preventive behaviour. Interventions aimed at reducing fear and promoting adherence to preventive measures would improve their mental health and well-being.

The Impact of COVID-19 on Nursing Homes: Study Design and Population Description.

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.

Social Image of Old Age, Gendered Ageism and Inclusive Places: Older People in the Media.

Ageism promotes the exclusion of older people from society by generating a negative image that they also internalize. The aim of this article is to investigate older people's social self-image, through statements broadcast on a national Spanish radio program aimed at this group. A qualitative analysis was conducted for a random sample from the sound archive for the Radio Nacional de España program Juntos Paso a Paso (Together, Step by Step) (2008-2021), using codes based on the pillars and determinants of active ageing and the three dimensions of ageism. Intercoder agreement was calculated. There were significant findings regarding ageism, gendered ageism and ageing in place, with differences according to size of municipal area. The program in question can be considered a viable secondary source for the research aim. Ageism is most commonly manifested through implicit opinions and invisibilization in family and social contexts. Care activities play a notably central role in responses related to gendered ageism. In relation to ageing in place, older people prefer their habitual environment when they have moderate care needs and accept moves to nursing homes when their needs increase.

Validation of the Spanish Version of the Fear of COVID-19 Scale (FCV-19S) in Long-Term Care Settings.

Fear of coronavirus disease 2019 (COVID-19) is one of the main psychological impacts of the actual pandemic, especially among the population groups with higher mortality rates. The Fear of COVID-19 Scale (FCV-19S) has been used in different scenarios to assess fear associated with COVID-19, but this has not been done frequently in people living in long-term care (LTC) settings. The present study is aimed at measuring the psychometric properties of the Spanish version of the FCV-19S in residents in LTC settings, following both the classical test theory (CTT) and Rasch model frameworks. The participants (n = 447), aged 60 years or older, were asked to complete the FCV-19S and to report, among other issues, their levels of depression, resilience, emotional wellbeing and health-related quality of life with validated scales. The mean FCV-19S score was 18.36 (SD 8.28, range 7−35), with higher scores for women, participants with lower education (primary or less) and higher adherence to preventive measures (all, p < 0.05). The Cronbach's alpha for the FCV-19S was 0.94. After eliminating two items due to a lack of fit, the FCV-19S showed a good fit to the Rasch model (χ2 (20) = 30.24, p = 0.019, PSI = 0.87), with unidimensionality (binomial 95% CI 0.001 to 0.045) and item local independency. Question 5 showed differential item functioning by sex. The present study shows that the FCV-19S has satisfactory reliability and validity, which supports its use to effectively measure fear in older people living in LTC settings. This tool could help identify risk groups that may need specific health education and effective communication strategies to lower fear levels. This might have a beneficial impact on adherence to preventive measures.

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak.

The most vulnerable residential settings during the COVID-19 pandemic were older adult's nursing homes, which experienced high rates of incidence and death from this cause. This paper aims to ascertain how institutionalized older people assessed their residential environment during the pandemic and to examine the differences according to personal and contextual characteristics. The COVID-19 Nursing Homes Survey (Madrid region, Spain) was used. The residential environment assessment scale (EVAER) and personal and contextual characteristics were selected. Descriptive and multivariate statistical analysis were applied. The sample consisted of 447 people (mean age = 83.8, 63.1% = women, 50.8% = widowed, 40% = less than primary studies). Four residential assessment subscales (relationships, mobility, residential aspects, privacy space) and three clusters according to residential rating (medium-high with everything = 71.5% of cases, low with mobility = 15.4%, low with everything = 13.1%) were obtained. The logistic regression models for each cluster category showed to be statistically significant. Showing a positive affect (OR = 1.08), fear of COVID-19 (OR = 1.06), high quality of life (OR = 1.05), not having suspicion of depression (OR = 0.75) and performing volunteer activities (OR = 3.67) were associated with the largest cluster. It is concluded that a better residential evaluation was related to more favourable personal and contextual conditions. These results can help in the design of nursing homes for older adults in need of accommodation and care to facilitate an age-friendly environment.

Active ageing profiles among older adults in Spain: A Multivariate analysis based on SHARE study.

BACKGROUND: Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age. METHODS: A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA). RESULTS: Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life. DISCUSSION AND CONCLUSIONS: The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Influence of Active and Healthy Ageing on Quality of Life Changes: Insights from the Comparison of Three European Countries.

This study aimed to analyze the determinants of quality of life (QoL) in older people in three European countries (Portugal, Spain and Sweden). A sample of 7589 participants in waves 4 (2011) and 6 (2015) of the Survey on Health, Aging, and Retirement in Europe (SHARE) project, aged 50 and over and living in Portugal, Spain and Sweden, was included. The CASP-12 scale was used to measure QoL. A principal component analysis was performed to group preselected variables related to active and healthy ageing into the dimensions of health, social participation, and lifelong learning. A linear regression model was built using the change in CASP-12 scores over the 4-year follow-up as the dependent variable, including the interactions between country and each independent variable in the model. After four years, the average QoL increased in Portugal (difference = 0.8, p < 0.001), decreased in Spain (-0.8, p < 0.001), and remained constant in Sweden (0.1, p = 0.408). A significant country-participation component interaction (p = 0.039) was found. In Spain, a higher participation (ß = 0.031, p = 0.002) was related to a higher QoL improvement at 4 years, but not in Sweden or Portugal. Physical health and emotional components (ß = 0.099, p < 0.001), functional ability (ß = 0.044, p = 0.023), and cognitive and sensory ability (ß = 0.021, p = 0.026) were associated with QoL changes over time in all countries. The country-specific associations between health, social participation and QoL should be taken into account when developing public health policies to promote QoL among European older people.

Are Loneliness and Social Isolation Associated with Quality of Life in Older Adults? Insights from Northern and Southern Europe.

PURPOSE: Loneliness and social isolation have detrimental effects on health in old age; however, the prospective associations with quality of life (QoL) remain unclear. Furthermore, despite the existence of a European north-south gradient in the distribution of loneliness and social isolation, little is known whether the associations are context-specific. We investigated the relationships between loneliness, social isolation and QoL of older adults residing in the North (Sweden) and South (Spain) of Europe. METHODS: Study sample consisted of 2995 Swedish and 4154 Spanish older adults who participated in waves six and seven of the Study on Health, Aging and Retirement in Europe (SHARE). Loneliness and social isolation were measured at the baseline, and QoL was measured at the baseline and follow-up using CASP-12. Prospective associations were assessed via multivariate linear regression. RESULTS: In Sweden, subjects with higher vs. lower loneliness had 1.01 (95% CI: -1.55, -0.40) units lower QoL, while every standard deviation increase in social isolation was associated with a 0.27 (95% CI: -0.42, -0.09)-unit decrease in QoL. In Spain, every standard deviation increase in social isolation was associated with a 0.66 (95% CI: -1.11, -0.22)-unit decrease in QoL. The association was stronger in subjects aged ≤65 years old and those with no chronic diseases. The association with loneliness was not statistically significant in Spain. CONCLUSION: Loneliness and social isolation are prospectively associated with decreased QoL among older adults, yet the associations are contextually bound. Future interventions should target both exposures, among others, in order to increase QoL in this group.

Environmental and Psychosocial Interventions in Age-Friendly Communities and Active Ageing: A Systematic Review.

Background: The academic literature contains little information regarding the interventions that create age-friendly cities and communities in order to promote active ageing. Objectives: A systematic review was carried out to determine the available empirical evidence in relation to the characteristics, content and effectiveness of interventions aimed at improving environmental and psychosocial risk factors for older people, from the perspective of age-friendly communities and the promotion of active ageing. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the studies retained in this review were identified through a systematic search of the academic literature in selected electronic databases including Web of Science and Scopus. Independent critical appraisal and data extraction were conducted by two reviewers. The checklist was used to assess the quality of the articles. Findings: The search identified 1020 potentially eligible documents, of which 11 satisfied the established criteria. Non-exhaustive practices prevailed over rigorous investigations, with a high proportion of studies observed to be of low methodological quality and at high risk of bias. This reflected the predominance of uncontrolled interventions. Environmental interventions were focused on reducing risk and adapting the everyday environmental setting, while psychosocial interventions prioritised social strategies (behavioural changes, promotion of participation) and training. Interventions were more effective in certain domains of age-friendly cities and communities such as transportation and housing, followed by increased participation as a lifestyle-related behavioural change. The inferred changes were associated with providing information and enhancing skills; modifying access, barriers, exposures, and opportunities; enhancing services and support; continuity and effectiveness of changes over time; and modifying policies based on the bottom-up approach of age-friendly cities and communities (AFCC). Discussion and conclusion: Interventions focused on personal and organisational aspects might have positive effects in the longer term. However, fewer changes would be observed in interventions revolving around changing lifestyles owing to the impact of complex multi-causal factors. The relative effectiveness in terms of health calls into question the design of interventions and the supposed "friendliness" of certain communities. There is a need to encourage sound longitudinal research aimed at providing key knowledge for the implementation and evaluation of public policies, and to encourage age-friendly community programmes to promote active ageing.

Self-perceived health status, gender, and work status.

This study analyzes the relationship between gender and self-perceived health status in Spanish retirees and housewives from a sample of 1,106 community-dwelling older adults. A multivariate linear regression model was used in which self-perceived health status was measured by the EQ-5D visual analogue scale and gender according to work status (retired men and women and housewives). Retired males reported a significantly better health status than housewives. Self-perceived health status was closely associated with physical, mental, and functional health and leisure activities. Finally, being a woman with complete dedication to domestic work is associated with a worse state of self-perceived health.

Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia.

OBJECTIVES: Active ageing, considered from the perspective of participation in leisure activities, promotes life satisfaction and personal well-being. The aims of this work are to define and explain leisure activity profiles among institutionalized older adults, considering their sociodemographic characteristics and objective and subjective conditions in relation to their quality of life. METHODS: Two samples of institutionalized people aged 60 and over were analysed together: 234 older adults without dementia and 525 with dementia. Sociodemographic, economic, family and social network, and health and functioning variables were selected. Cluster analysis was applied to obtain activity profiles according to the leisure activities, and ordinal regression models were performed to analyse factors associated to activity level. RESULTS: The sample was clustered into three groups of people: active (27%), moderately active (35%) and inactive people (38%). In the final regression model (Nagelkerke pseudo R(2) = 0.500), a higher level of activity was associated with better cognitive function (Pfeiffer scale), self-perceived health status and functional ability, as well as with a higher frequency of gathering with family and friends, and higher educational level. CONCLUSION: The decline in physical and mental health, the loss of functional capabilities and the weakening of family and social ties represent a significant barrier to active ageing in a context of institutionalization.

Quality of life in older people with dementia: a multilevel study of individual attributes and residential care center characteristics.

AIM: To analyze how the characteristics of institutionalized older people with dementia and residential care centers are associated with the individual's quality of life (QoL). METHODS: Data were collected from a survey carried out on 525 elderly people aged 60 years or older in 14 nursing care homes across Spain. Multilevel linear analysis to assess the differences in QoL level between centers and individuals was carried out. RESULTS: The characteristics of the individuals that were associated with a higher QoL were functional independence, health status and gathering with family, friends or neighbors. In contrast, higher levels of dementia, depression and the length of institutionalization had a negative effect on QoL. In relation to the residential care center characteristics, the availability of geriatricians was associated with higher QoL, compared with those centers with no geriatricians on staff. In addition, public centers (public ownership and publicly-funded residents) were also associated with higher QoL than private/mixed centers. The multilevel analysis showed that the 16.4% of the differences in QoL was related to residence factors. CONCLUSION: These results reflect the importance of the functional, social, mental and residential dimensions in the QoL of older adults with dementia. Actions devoted to improving these key dimensions would contribute to promote the well-being of this vulnerable population.

Quality of life across three groups of older adults differing in cognitive status and place of residence.

BACKGROUND: Health-related quality of life (HRQOL) in older adults is determined by personal conditions, as well as by the social and physical environment. The purpose of the present study was to describe the factors related to health conditions and residential environment that influence HRQOL of older adults. METHODS: Data from 1815 cases came from three cross-sectional surveys on quality of life in older adults in Spain: non-institutionalized older adults (n = 1106), institutionalized older adults without dementia (n = 234) and institutionalized older adults with dementia (n = 475). Assessment instruments used were: Barthel Index, Short Portable Mental Status Questionnaire, Comorbidity Index, EQ-5D-3L (5 dimensions, EQ-index and EQ-VAS), and information about sociodemographic characteristics and social networks. Partial correlation and multivariate logistic regression analyses were carried out. RESULTS: In group comparisons, institutionalized older adults showed a higher percentage of problems in the EQ-5D-3L dimensions than the non-institutionalized ones. Also, older adults with dementia presented less pain/discomfort and anxiety/depression than the other groups, but showed more problems in mobility, self-care and usual activities. EQ-Index showed a high association with functional independence, perceived health status and comorbidity. According to the logistic regression models, the Barthel Index was the most common determinant for most of EQ-5D-3L dimensions in all groups. CONCLUSION: Institutionalized older adults with dementia presented lower HRQOL than the other groups. Functional independence, comorbidity and cognitive status were the main HRQOL determinants in all groups. Maintenance and improvement of the functional condition might be translated into a higher HRQOL of older adults.

Change and predictors of quality of life in institutionalized older adults with dementia.

PURPOSE: This study aims to assess the change in and predictive factors of the quality of life (QoL) of institutionalized older adults with dementia over a 20-month period. METHODS: Information was used from a follow-up study conducted over an average period of 19.61 ± 1.93 months on a sample of 274 institutionalized older adults aged 60 or over, diagnosed with dementia. Two linear regression models were built to predict change in the EQ-5D index and the quality of life in Alzheimer's disease (QOL-AD) scale, taking as independent variables: sociodemographic characteristics and measures of functional ability (Barthel Index), depression in dementia (Cornell Scale), number of chronic health problems, cognitive level (MEC, the Spanish Mini-Mental State Examination) and severity of dementia (Clinical Dementia Rating) at baseline. RESULTS: The majority of the participants were women (81.75 %) with an average age of 84.70 ± 6.51 years, single (78.15 %), with severe dementia and moderate functional dependence. There was a significant decrease on the EQ-5D, EQ-VAS and QOL-AD between baseline and follow-up scores. The main predictors of QoL of the institutionalized older adults with dementia were the number of chronic problems and baseline scores of the QoL measures. CONCLUSIONS: A significant decrease in the QoL of institutionalized older adults was observed over a 20-month period. Results suggest that interventions aimed at reducing the number of chronic medical conditions may have a beneficial effect on older adults' QoL.

Self-perceived health and quality of life by activity status in community-dwelling older adults.

AIM: The present study aimed at analyzing whether activity status is associated with self-perceived health status and quality of life (QoL) in community-dwelling older adults. METHODS: We used a cross-sectional design based on a semi-structured QoL questionnaire in a representative sample of 1106 community-dwelling adults aged 60 years and older in Spain. Logistic regression models were used to explain the association of activity status with self-perceived health status and QoL, assessed by means of the EQ-5D-3L index, controlling for the influence of sociodemographic, social and support network variables, and health indicators. RESULTS: The mean age ± standard deviation was 72.1 ± 7.8 years. For the activity status, 8.5% were working people, 53.7% retirees, 30.6% homemakers and 7.2% pensioners. All homemakers and 93.6% pensioners were women. In the model to assess perceived health status, when controlling for sociodemographic, social and support network variables, we found that working people rated their health better than the retired group. In this model, pensioners rated their health status worst, whereas homemakers did not show any significant difference compared with the retired group. However, there were no differences in the model of QoL by activity status. CONCLUSION: Activity status was associated with self-perceived health status, but not with QoL. This study draws attention to the need of considering the activity of older adults for actions aimed at maintaining and improving their health.

Individual's perspective of local community environment and health indicators in older adults.

AIM: This study evaluated the relationship between individual's perspective of local community environment and health in older people. METHODS: A survey about quality of life in older adults in Spain was applied to a representative sample of 1106 community-dwelling people (mean age±SD = 72.07±7.83 years, 43.67% males). Local community (Community Wellbeing Index, neighborhood problems, time in the neighborhood), psychosocial and sociodemographic measures were considered. Four health outcomes (self-perceived health status, functional independence, depression and number of chronic medical conditions) were studied. Multivariate logistic analyses were carried out. RESULTS: At least two local community measures were independently associated with each health outcome. Satisfaction with community services significantly contributed to all models; it was positively related with self-rated health and functional independence, and negatively associated with depression and chronic medical conditions. CONCLUSION: The individual's perspective of the local community environment was associated with health outcomes in older adults. This can be useful in the development of policies committed to promoting social integration and active aging in the community.

Propiedades psicometricas del Cuestionario de Apoyo Social Funcional y de la Escala de Soledad en adultos mayores no institucionalizados en Espana / Psychometric properties of the Functional Social Support Questionnaire and the Loneliness Scale in non-institutionalized older adults in Spain

Objetivos Este estudio analiza las propiedades psicometricas del Cuestionario de Apoyo Social Funcional Duke-UNC (DUFSS, Duke-UNC Questionnaire of Functional Social Support) y de la Escala de Soledad de De Jong-Gierveld en una muestra de adultos mayores no institucionalizados. Métodos Muestra de 1106 adultos mayores no institucionalizados incluidos en una encuesta nacional sobre calidad de vida. Ambas escalas se analizaron segun la teoria clasica de los tests (aceptabilidad, consistencia interna, validez interna, validez convergente, validez discriminativa y precision) y analisis Rasch. Resultados Las puntuaciones medias (..) (AU)

Objectives To examine the psychometric properties of the Social Support Questionnaire Duke-UNC (DUFSS) and the De Jong-Gierveld Loneliness Scale in a sample of non-institutionalized older adults. Methods The sample consisted of 1,106 non-institutionalized older adults included in a national survey on quality of life. Both scales were analyzed according to classical test theory (acceptability, internal consistency, internal validity, convergent validity, discriminant validity and accuracy) and Rasch analysis. Results The mean ± standard deviation scores were 44.95 ± 8.9 for the DUFSS and 1.92 ± 1.83 for the Loneliness Scale. Cronbach's alpha was 0.94 for the DUFSS and 0.77 for the Loneliness Scale. Factor analysis identified two factors in each scale (explained variance: 73.8% for the DUFSS and 67.7% for the Loneliness Scale). The instruments showed a correlation of -0.59 with each other. Rasch analysis of the DUFSS identified two dimensions with a good model fit, whereas the Loneliness Scale did not fit the Rasch model. Conclusions The DUFSS, with some modifications, meets the Rasch assumptions and provides linear measures. However, more Rasch analysis studies are needed for the Loneliness Scale. According to classical test theory, the DUFSS has good internal consistency for comparisons among people and the Loneliness Scale for comparisons among groups. Both scales have satisfactory construct validity (AU)

Health status and well-being of older adults living in the community and in residential care settings: are differences influenced by age?

The objective is to identify the differences and the main factors influencing health status and well-being variables between institutionalized and non-institutionalized older adults, as well as the interaction effect of institutionalization and age. Data on a total of 468 older adults from a national survey on non-institutionalized and from a study on institutionalized older people were analyzed. Socio-demographic variables and measures on well-being (Personal Well-being Index, PWI), health status (EQ-5D), functional ability (Barthel Index), depression (Hospital Anxiety and Depression Scale-Depression subscale), loneliness and comorbidity were used. Analysis of variance and Kruskal-Wallis tests to examine differences between groups and multiple regression analyses to identify factors associated to health and well-being were performed. Significant differences in health status variables, but not in well-being were detected between groups. Controlling for age, differences in health status (EQ-VAS) were found to be not significant in both groups. In the non-institutionalized group, people aged 78 years or more reported a significantly lower well-being (PWI) than younger counterparts. Step-wise multiple regression analysis showed that depression, functional dependence, loneliness and sex were associated with health status; while depression, health status, loneliness and the interaction of age-institutionalization were related to well-being. The results suggest that age influences community-dwelling older adults' well-being to a greater extent than it does to institutionalized older people. This finding has implications for resource allocation and interventions addressed to improve health and well-being in older adults.