Health, Work, and Social Problems in Spanish Informal Caregivers: Does Gender Matter? (The CUIDAR-SE Study).

(1) Background: The aim of this study was (i) to analyze problems faced by informal caregivers in three areas of their life: health, work and finances, and family and social relationships, (ii) to investigate the main determinants of these problems, and (iii) to explore differences between men and women. (2) Methods: The study population consisted of people aged ≥18 years living in a family home who were providing unpaid care to a dependent person in the same or another home and who were registered as caregivers with the Primary Health Care District of Granada or the Provincial Council of Gipuzkoa. Several logistic regression models were built to analyze the likelihood of caregivers experiencing health, work-related, or social problems as a result of their caregiving responsibilities. (3) Results: Informal female caregivers were more likely to experience problems attributed to caregiving than their male counterparts, particularly in the areas of health and work. Additional factors associated with an increased likelihood of problems were low perceived social support, performance of ungratifying tasks, and fewer years as a caregiver. (4) Conclusions: Informal caregivers in Spain face significant problems as a result of their caregiving duties, and the impact on men and women is different. Policies and interventions to mitigate the negative effects of unpaid caregiving should incorporate differential strategies to meet the specific needs of male and female caregivers in different caregiving contexts.

Determinants of Burden and Satisfaction in Informal Caregivers: Two Sides of the Same Coin? The CUIDAR-SE Study.

The aim of this study conducted in Spain was to analyze and compare burden, severe burden, and satisfaction among informal caregivers in relation to health-related quality of life (HRQoL), type and duration of caregiving, perceived social support, and use of social and health care services. We performed multivariate analyses to identify variables associated with caregiver burden, severe burden, and satisfaction with caregiving, stratified by gender. The results showed that secondary or third-level education, performance of ungratifying tasks, negative coping with caregiving, and more years providing care were associated with greater burden. Variables with protective effect were better perceived health of the person being cared for, better caregiver HRQoL, and high perceived social support. Women were 75% more likely to experience severe burden compared with male caregivers. Burden was reduced by high perceived social support in the case of women and by high caregiver HRQoL in the case of men. The main determinant of caregiving satisfaction for both men and women was perceived social support (OR = 3.11 and OR = 6.64). This study shows the need for interventions that promote gender equality and social support as a means of relieving burden and severe burden and improving satisfaction in both male and female caregivers.

[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.

Cumplimiento de los indicadores NAOS en los menús escolares de Gipuzkoa. Curso 2011/2012 / NAOS strategy's indicators observance by Gipuzkoa's school menus: Course 2011-2012

Fundamentos: las políticas dirigidas a prevenir la obesidad recomiendan una alimentación saludable y equilibrada. Objetivo: valorar el seguimiento de las recomendaciones de la Estrategia NAOS, en los menús ofertados a la población de 3 a 16 años en los centros escolares del Territorio de Gipuzkoa. Método: estudio descriptivo transversal realizado en el curso 2011-2012 sobre una muestra de 80 centros, a partir de las hojas de los menús escolares que se distribuyen a los padres. Resultados: Todos los comedores incluyen semanalmente una ración de legumbres y pescado. En el 100% de los centros públicos y en el 97% de los privados no se sirve más de una ración semanal de platos precocinados. El 98% de centros públicos y el 17% de los privados ofrecen 4 raciones semanales de verduras y hortalizas. El 85% de los centros ofrecía como máximo 3 piezas de fruta por semana. Conclusiones: de forma general los menús cumplen los indicadores recomendados por la Estrategia NAOS para prevenir la obesidad, exceptuando la fruta, que en el 100% de los menús incumplen el indicador NAOS y no alcanza las 4piezas semanales. Es necesario impulsar el consumo de fruta fresca en los menús escolares

Fundamentals: Policies aimed at preventing obesity advisea healthy and balanced eating. Goal: NAOS Strategy compliance assessment on menus offered to 3-16 years old pupils in Gipuzkoa. Methods: cross-sectional study conducted during 2011-2012 on a sample of 80 schools, from school menus distributed to parents of schoolchildren who use the school canteen. Results: all canteens include a weekly portion of vegetables and fish. In most cases no more than one portion of ready-to-eat meals is served per week. 98% of public schools and 17% of private schools offer 4 portions of vegetables per week.85% of centres offer a maximum of 3 pieces of fruit perweek. Conclusions: in general, menus meet the NAOS recommendations strategy to prevent the obesity but in case fruit. 100% of the schools do not fulfil the suggested 4 pieces offresh fruit per week recommended. It is convenient to foster fresh fruit inclusion in school menus

Cuestionamiento de la eficacia de los protectores de cadera en la prevención de las fracturas de cadera de los ancianos / Are hip protectors effective in preventing hip fractures in the elderly?

Objetivo. Presentar resultados actualizados de una revisión sistemática acerca del grado de evidencia de la eficacia de los protectores de cadera y su evolución actual, basado en ensayos clínicos aleatorizados y finalizados.Diseño. Revisión sistemática con metaanálisis.Fuente de datos. Registro de Ensayos Clínicos del Grupo Cochrane de Lesiones Óseas, Articulares y Musculares (enero 2005), Registro central de Cochrane de ensayos clínicos controlados (Cochrane Library Isuue 1, 2005), Medline (1966 a enero 2005), Embase (1988 a enero 2005) y CINAHL (1982 a diciembre 2004). Búsqueda en otras bases de datos y listados bibliográficos de artículos relevantes y contacto con algunos de los investigadores.Método de revisión. Comparación de la incidencia estimada en ensayos clínicos aleatorizados o semialeatorizados de fracturas de cadera, pelvis y otras fracturas en personas ancianas usuarias de protector de cadera en relación con los no usuarios del grupo control.Resultados. Catorce ensayos clínicos aleatorizados o semialeatorizados presentaron resultados de fracturas. Los datos procedentes de 11 ensayos realizados en instituciones o centros residenciales, incluyendo 6 estudios aleatorizados por conglomerados, mostraron evidencia en la reducción de la incidencia de fracturas de cadera pero con una significación estadística marginal (riesgo relativo [RR]: 0,77; intervalo de confianza [IC] del 95%, 0,62-0,97). Los datos agrupados de 3 ensayos clínicos aleatorizados individualmente, que incluían 5.135 participantes residentes en la comunidad, no mostraron reducción en la incidencia de fracturas de cadera en los casos provistos de protector (RR: 1,16; IC del 95%, 0,85-1,59). No se observó evidencia alguna acerca de efectos de los protectores en la incidencia de fracturas pélvicas u otras fracturas. No se registró efecto adverso importante atribuible a los protectores de cadera, si bien el grado de aplicación de éstos fue bajo, especialmente a largo plazo.Conclusión. Los protectores de cadera se recomendaron previamente en función de resultados de ensayos clínicos anteriores. La evidencia acumulada indica que los protectores de cadera son una intervención ineficaz en los residentes en su hogar y su eficacia es incierta en las personas institucionalizadas