Modelo de envejecimiento con éxito: la relevancia de los síntomas depresivos en las personas mayores chilenas / Model of successful ageing: the relevance of depressive symptoms among older Chileans people

Resumen: Antecedentes: Las diversas maneras de envejecer en Chile, especialmente determinadas por la identidad étnica indígena, son escasamente abordadas, siendo necesario dar cuenta de las variables personales, psicosociales y de salud que promueven el Envejecimiento con Éxito (EE). Objetivos: Explorar un modelo teórico explicativo del EE en una muestra de personas mayores indígenas y no indígenas, considerando diversas variables personales, psicosociales y de salud relacionas con EE. Asimismo, se busca contrastar el posible efecto de la pertenencia étnica - ser o no ser indígenaen este modelo. Método: Estudio cuantitativo y transversal que contó con la participación de 232 personas mayores del Pueblo Aymara y 545 no indígenas que viven en el extremo norte de Chile. Se utilizaron instrumentos previamente validados en población equivalente para medir envejecimiento con éxito, religiosidad y espiritualidad, apoyo social comunitario, problemas de salud, actividades de la vida diaria y depresión. Para comprobar el ajuste del modelo teórico a los datos se utilizó un análisis de ecuaciones estructurales. De manera específica, se estimó un modelo estructural multigrupo para personas indígenas y personas no indígenas. Resultados: Los resultados indican que existe invarianza en función de la etnia para el constructo EE. Tal como se muestra en el modelo hipotetizado y posteriormente contrastado, el EE se relaciona directamente con depresión y espiritualidad. La asociación de integración comunitaria, dependencia física en las actividades de la vida diaria y el apoyo social se percibido se produce a través de su asociación con depresión y espiritualidad. Conclusiones: Este estudio apoya la hipótesis de que el EE es un proceso multidimensional, relacionado con la pertenencia étnica y que la salud mental ocupa un rol importante en su comprensión.

Abstract: Background: The diverse ways of ageing in Chile, especially determined by indigenous ethnic identity, are scarcely addressed. It is necessary to account for the personal, psychosocial and health variables that promote Successful Ageing (SA). Objective: This research explores a theoretical explanatory model of successful ageing (SA) in a sample of indigenous and non-indigenous older people, considering several personal, psychosocial and health variables related to SA. It also seeks to contrast the possible effect of ethnicity - being or not being indigenous - in this model. Method: Quantitative, cross-sectional study with the participation of 232 elderly Aymara people and 545 non-indigenous people living in the extreme north of Chile. Instruments and scales previously validated in equivalent population were used to measure successful aging, religiosity and spirituality, community social support, health problems, dependence in activities of daily living and depression. Structural equation modeling (SEM) was used to estimate the adjutsment of the theoretical model to the data. Specifically, a multigroup analysis was performed to adjust the model for indignous and non-indigenous groups. Results: The results indicate that there is invariance in function of ethnicity for the SA construct. As shown in the hypothesized and subsequently contrasted model, SA is directly related to depression and spirituality. On the other hand, community integration, physical dependence and perceived social support relates indirectly with SA, through the association with depression and spirituality. Conclusions: This study support the hypothesis that SA is a multidimensional process, determining by ethnicity and that mental health plays an important role.

Salud en personas mayores afrodescendientes Chilenas / Health in older people of african-descendant in Chile

Chile recientemente ha reconocido al pueblo tribal afrodescendiente, se trata de un colectivo poco estudiado y con severas desventajas sociales y sanitarias. Este estudio tiene como objetivo describir el perfil de salud y el acceso a servicios sanitarios, junto con analizar la asociación entre las variables sociodemográficas, de salud y los síntomas depresivos en personas mayores afrodescendientes. Estudio piloto que contó con la participación de 60 personas mayores afrodescendientes, se aplicaron diversas escalas de valoración geriátrica. Los antecedentes de salud indicarían que el 78% es hipertenso, 57% tiene síntomas depresivos, el 30% es independiente en actividades de la vida diaria (AVD), y un 61% tiene riesgo leve de caídas. Respecto al acceso a salud: 84% está inscrito en un centro de salud, el 68% es beneficiario del programa de salud cardiovascular y un 71% está al día con la vacuna preventiva de la influenza. Las variables predictivas de depresión son ser beneficiario del programa de alimentación complementaria y la dependencia en AVD. Este estudio ratifica la relevancia de la inclusión de patologías específicas concorde al perfil epidemiológico de los grupos étnicos-raciales y seguir avanzando en estudios sanitarios específicos en minorías étnicas.

Chile has recently recognized the Afrodescendant tribal people, a little studied group with severe social and health disadvantages. This study aims to describe the health profile and access to health services, and to analyze the association between sociodemographic and health variables and depressive symptoms in older people of African descent. Pilot study with the participation of 60 elderly people of African descent, with the application of several geriatric assessment scales. Health history indicated that 78% are hypertensive, 57% have depressive symptoms, 59% are independent in activities of daily living (ADL), and 61% have a slight risk of falling. Regarding access to health care: 84% are enrolled in a health center, 68% are beneficiaries of the cardiovascular health program and 71% are up to date with the preventive influenza vaccine. The variables predictive of depression are being a beneficiary of the complementary feeding program and dependence in ADLs. Conclusion: This study ratifies the relevance of including specific pathologies according to the epidemiological profile of ethnic-racial groups and to continue advancing in specific health studies in ethnic minorities.

Calidad de vida en personas mayores de entornos rurales: diferencias entre hombres y mujeres

RESUMEN Objetivo: Analizar las diferencias entre hombres y mujeres en los diversos dominios de la calidad de vida (CdV) en personas mayores que residen en zonas rurales del extremo norte de Chile. Material y Método: Estudio cuantitativo, descriptivo, transversal realizado entre noviembre 2019 y febrero 2020 en diversas zonas rurales de la Región de Arica y Parinacota. Contó con un universo de 100 personas mayores de 60 años y sin deterioro cognitivo. Se aplicó el Cuestionario Breve de Calidad de Vida (CUBRECAVI). La investigación fue aprobada por la Escuela de Trabajo Social de la Universidad de Tarapacá. Resultados: 69% mujeres, 63% entre 60 y 69 años, 67% casado o en pareja y 58% indígena. Se confirman diferencias estadísticamente significativas en el dominio salud objetiva: tobillos hinchados, cansancio, dificultad para dormir, escape de orina y hormigueos; en el dominio salud psíquica: llorar con facilidad, sentimientos depresivos y problemas de memoria. Lo mismo se observa en integración social, en el nivel de satisfacción con la relación del cónyuge o pareja, con los familiares y con las amistades. Igualmente los hallazgos confirman diferencias en el dominio actividades, nivel de actividades, frecuencia camina y frecuencia hace manualidades. Por último, en el dominio calidad ambiental, en la satisfacción con la temperatura del hogar. Los resultados indican que las mujeres tienen peor CdV y las personas mayores perciben que el dominio salud es el más importante para valorar su CdV. Conclusión: Se confirma riesgo biopsicosocial para mujeres mayores que residen en zonas rurales del extremo norte de Chile. Enfermería y otras disciplinas de trato directo con las personas mayores deben conocer las distintas maneras de envejecer, diferenciando por sexo y especificidades del entorno rural.

ABSTRACT Objective: To analyze the differences between men and women in the different domains of quality of life (QoL) among elderly people living in rural areas of the north of Chile. Material and Method: Quantitative, descriptive, cross-sectional study conducted between November 2019 and February 2020 in various rural areas of the Region of Arica and Parinacota. The sample consisted of 100 people over 60 years old and without cognitive impairment. The Brief Quality of Life Questionnaire (CUBRECAVI) was applied. The research was approved by the School of Social Work of the Universidad de Tarapacá. Results: 69% were women, 63% were between 60 and 69 years old, 67% were married or had a relationship and 58% had indigenous origin. Statistically significant differences were confirmed in the objective health domain: swollen ankles, tiredness, sleep problems, urinary incontinence and tingling; in the psychic health domain: crying easily, depressive feelings and memory problems. This was similar in the field of social integration, in the level of satisfaction concerning the relationship with the spouse or partner, with family members and with friends. Moreover, the findings corroborate differences in the domain of activities, level of activities, frequency of walking and frequency of doing crafts. Finally, in the environmental quality domain, there are differences in satisfaction with room temperature. The results show that women have worse QoL and the elderly perceive that the health domain is the most important when assessing their QoL. Conclusion: There is a biopsychosocial risk for older women living in rural areas in the north of Chile. It is clear that nursing and other areas dealing directly with the elderly have to familiar with the different ways of aging, taking into account gender and specific rural setting.

RESUMO Objetivo: Analisar as diferenças entre homens e mulheres nos diversos domínios da qualidade de vida (QV) em idosos residentes em áreas rurais do norte do Chile. Material e Método: Estudo quantitativo, descritivo, transversal realizado entre novembro de 2019 e fevereiro de 2020 em diversas áreas rurais da Região de Arica e Parinacota. A amostra consistiu em 100 pessoas com mais de 60 anos e sem déficit cognitivo. Foi aplicado o Questionário Breve de Qualidade de Vida (CUBRECAVI). A pesquisa foi aprovada pela Escola de Serviço Social da Universidade de Tarapacá. Resultados: 69% eran mulheres, 63% tinham entre 60 e 69 anos, 67% estavam casadas ou tinham um relacionamento e 58% tinham origem indígena. Foram confirmadas diferenças estatisticamente significativas no dominio da saúde objetiva: tornozelos inchados, fadiga, dificuldade para dormir, perda de urina e formigamento; no domínio da saúde psíquica: choro com facilidade, sentimentos depressivos e problemas de memória. O mesmo foi observado na integração social, no nível de satisfação na relação com o cônjuge ou companheiro, com os familiares e com os amigos. Da mesma forma, os achados confirmam diferenças no domínio das atividades, nível de atividades, frequência de caminhadas e frequência de artesanato. Finalmente, no domínio da qualidade ambiental há diferenças no grau de satisfação com a temperatura da casa. Os resultados indicam que as mulheres apresentam pior QV e os idosos percebem que o domínio saúde é o mais importante para avaliar sua QV. Conclusão: O risco biopsicossocial é confirmado para mulheres idosas residentes em áreas rurais do extremo norte do Chile. A enfermagem e as demais disciplinas que lidam diretamente com o idoso devem conhecer as diferentes formas de envelhecer, diferenciando entre os sexos e as especificidades do meio rural.

Espiritualidad, religiosidad y síntomas depresivos en personas mayores del norte de Chile / Spirituality, religiosity, and depressive symptoms among elderly Chilean people in the north of Chile

Resumen: La depresión no es un trastorno inevitable en la vejez, aunque su prevalencia sea significativamente alta y, especialmente, en las personas mayores chilenas. De cara a la promoción de la salud mental y al tratamiento de los síntomas depresivos se vuelve relevante ahondar en aquellos factores que puedan inhibir su incidencia. Al respecto, este estudio analiza la asociación entre la religiosidad, la espiritualidad y la depresión en personas mayores de 60 años. Se dispone de una muestra de 777 personas mayores de la región de Arica y Parinacota, 65% son mujeres, 43% tiene entre 60 y 69 años (media: 69.93 años, DT=7.12), 48 tiene pareja (casado o convive) y la mayoría vive en la ciudad de Arica (87%). Se realizaron análisis descriptivos, bivariados y un modelo de regresión jerárquica para depresión. Los resultados comprueban que solo las experiencias espirituales se relacionan con menor incidencia de síntomas depresivos. Concluyendo, los hallazgos muestran que en el tratamiento de la depresión geriátrica se podrían incluir recursos personales/psicológicos que movilizan el afrontamiento, la resiliencia y el optimismo, como es el caso de la espiritualidad.

Abstract: Depression is not an inevitable disorder in old age, although its prevalence is significantly high and especially among elderly Chilean people. In order to promote mental health and the treatment of depressive symptoms it becomes relevant to delve into those factors that can inhibit their incidence. In this regard, this study analyses the association between religiosity, spirituality and depression in people over 60 years. The sample was made up of 777 older Chilean adults living in the region of Arica and Parinacota, 65% are women, 43% are between 60 and 69 years old (mean: 69.93 years, SD = 7.12), 48 have a partner (married or living together) and the majority live in the city of Arica (87%). Descriptive and bivariate analyses of the study variables and a hierarchical regression analysis was conducted for the depression variable. The results prove that only spiritual experiences are related to lower incidence of depressive symptoms. Concluding, the findings show that in the treatment of geriatric depression could be included personal/psychological resources that mobilize coping, resilience and optimism, as is the case of spirituality.

Multi-ethnic validation of 15-item Geriatric Depression Scale in Chile

Abstract Background: There has been scant research published regarding the assessment of depression in ethnic groups, and few studies have addressed the validation of scales for standardized assessment of depressive symptoms among indigenous minorities. Objective: The aim of this study was to analyze the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15) for a multi-ethnic sample of older Chilean adults.Methods: Cross-sectional study with a sample of 800 older people, 71% of whom were self-declared indigenous (Aymara/Mapuche).Results: The non-indigenous group had a higher total GDS-15 score and lower quality of life and wellbeing scores than the indigenous groups (p< 0.001). The GDS-15 had a KR-20 coefficient of 0.90 for the non-indigenous group, 0.80 for Aymara, and 0.85 for Mapuche. The homogeneity index was 0.38 for non-indigenous, 0.24 for Aymara, and 0.29 for Mapuche.Discussion: The GDS-15 showed satisfactory psychometric characteristics for the samples studied. However, the better results observed for the non-indigenous group suggest that some characteristics and content of the rating scale are not fully appropriate for the indigenous older population. Conclusions:There is a need to develop the transcultural validation of scales such as GDS-15, which are applied in a standardized manner in geriatric evaluations as part of primary healthcare.

Propiedades psicométricas de la escala APGAR-familiar en personas mayores residentes en zonas rurales multiétnicas chilenas / Psychometric properties of APGAR-family scale in a multiethnic sample of Chilean older people

Background: The APGAR-family scale is used for the assessment of family functioning in primary health care. Aim: To examine the psychometric properties of the family functioning scale APGAR-family, in a multi-ethnic sample of older Chilean adults. Material and Methods: The scale was applied to 800 participants aged more than 60 years, residing in rural areas of the regions of Arica and Parinacota and La Araucanía. Results: The Cronbach's alpha obtained was 0,992 for the scale composed of five items. The confirmatory factor analysis determined a unifactorial model, whose goodness of fit indices were satisfactory. Namely, weighted least square mean and variance adjusted-χ2 was 20.097 (p < 0.01), comparative fit index was 0.997, Tucker-Lewis index was 0.995 and Root Mean Square Error of Approximation was 0.079 (90% confidence intervals 0.049-0.091). Conclusions: The APGAR-family is a reliable and appropriate instrument to be applied in older people in Chile, specifically in elderly people residing in rural areas who belong to the Aymara and Mapuche indigenous communities.

Successful Aging and Personal Well-Being Among the Chilean Indigenous and Non-Indigenous Elderly / Envejecimiento exitoso y bienestar personal en adultos mayores chilenos indígenas y no indígenas / Envelhecimento bem-sucedido e bem-estar pessoal em idosos chilenos indígenas e não indígenas

ABSTRACT Objective: The aim of this research was to analyse the association between successful aging (SA) and subjective well-being (SWB) in different domains. Method: The study is quantitative and cross-sectional, with a sample consisting of 800 older people, including 569 indigenous (Aymara and Mapuche) participants living in northern and southern Chile. Results: Domains associated with SA are satisfaction with health, satisfaction with social relationships, satisfaction with future security, and satisfaction with spiritual and religious experiences. SA is also positively associated with being a woman, being young, and not being indigenous. Conclusion: The research has two main practical implications. First, SWB domains may be incorporated into socio-health interventions as they relate to elements that can be changed or improved (health, social inclusion, security, and beliefs). Second, this study suggests a situation of risk among older indigenous Chileans, confirming the premise that the life paths of indigenous Chileans at social risk give rise to a more socially unequal old age with; therefore, it is important to analyse positive aspects that promote better old age.

RESUMEN Objetivo: el objetivo de esta investigación consistió en analizar la asociación entre envejecimiento exitoso (SA) y bienestar subjetivo (SWB) en sus diferentes dominios. Metodología: se trata de un diseño cuantitativo y transversal, con una muestra compuesta por 800 adultos mayores, incluidos 569 indígenas (aymaras y mapuches), que viven en el norte y sur de Chile. Resultados: muestran que los dominios asociados con la SA son satisfacción con la salud, satisfacción con las relaciones sociales, satisfacción con la seguridad futura y satisfacción con las experiencias espirituales y religiosas. La SA también se asocia positivamente con ser mujer, ser joven y no ser indígena. Conclusión: la investigación tiene dos implicaciones prácticas principales. Primero, estos dominios del SWB pueden incorporarse a las intervenciones sociosanitarias, ya que se relacionan con elementos que se pueden cambiar o mejorar (salud, inclusión social, seguridad y creencias). En segundo lugar, este estudio sugiere una situación de riesgo entre los chilenos indígenas mayores, lo que confirma la premisa de que las trayectorias de vida de los indígenas chilenos que han enfrentado más riesgo social dan lugar a una vejez con más desigualdad social, por lo que es importante analizar aspectos positivos que promuevan un mejor envejecimiento.

RESUMO Objetivo: analisar a associação entre envelhecimento bem-sucedido e bem-estar subjetivo em seus diferentes domínios. Método: trata-se de um desenho quantitativo e transversal, com uma amostra composta por 800 idosos, incluídos 569 indígenas (aymaras e mapuches), que habitam no norte e no sul do Chile. Resultados: os domínios associados com o envelhecimento bem-sucedido são satisfação com a saúde, satisfação com as relações sociais, satisfação com a segurança futura e satisfação com as experiências espirituais e religiosas. Além disso, associa-se de forma positiva com ser mulher, jovem e não indígena. Conclusão: esta pesquisa tem duas implicações práticas principais. Na primeira, esses domínios do bem-estar subjetivo podem ser incorporados às intervenções sociossanitárias, já que estão relacionados com elementos que podem ser mudados ou melhorados (saúde, inclusão social, segurança e crenças). Em segundo lugar, este estudo sugere uma situação de risco entre os idosos chilenos indígenas, o que confirma a hipótese de que as trajetórias de vida dos indígenas chilenos que enfrentaram mais risco social levam a uma velhice com mais desigualdade social, razão pela qual é importante analisar aspectos positivos que promovam um melhor envelhecimento.

Validación del inventario de envejecimiento exitoso en personas mayores chilenas / Validation of the successful aging inventory in chilean older people

Background: There is a paucity of adequate and validated instruments for the measurement of successful aging for geriatric researchers in Chile. Aim: To validate the “Successful Aging Inventory” (SAI) in Chilean older people. Material and methods: SAI was answered by 777 older people aged 70 ± 7 years (63% women) living in urban and rural areas, including the highlands of a Northern desert region of Chile. Results: A Cronbach alfa of 0.92 was obtained for the general dimension of successful aging. The figures for each dimension included in the theoretical model (functional performance, intrapsychic factors, gero-transcendence; spirituality; purpose and life satisfaction), and ranged from 0.66 to 0.91. Confirmatory factorial analysis showed that the original inventory model, fits with the data collected from Chilean people. Conclusions: Successful Aging Inventory (SAI) is a reliable and adequate inventory, which can be used in Chilean older people.