Factors associated with health care utilization by the elderly in a public health care system.

OBJECTIVE: The objective was to determine the factors associated with the use of health care services by the elderly residing in the community. METHODS: A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status. RESULTS: The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41). CONCLUSIONS: Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.

Situación funcional de los ancianos con cataratas / Functional condition of the elderly with cataracts

OBJETIVO: Describir el estado de la función visual y la capacidad para realizar actividades básicas de la vida diaria en los ancianos diagnosticados de cataratas, analizando la influencia que ejercen sus características sociosanitarias. DISEÑO: Estudio observacional de carácter transversal realizado mediante entrevista personal. EMPLAZAMIENTO: Centros Hospitalarios del Sistema Público existentes en el Área Sanitaria de Albacete. PACIENTES: 364 sujetos de 65 o más años de edad, diagnosticados de cataratas y en lista de espera para ser sometidos a cirugía, seleccionados consecutivamente. El tamaño muestral corresponde a una precisión de ñ 2,5 puntos en la escala de función visual utilizada, una desviación estándar de 25 puntos y un nivel de confianza del 95 per cent. RESULTADOS: El estado de la función visual se evaluó mediante la Escala de las Actividades Visuales de la Vida Diaria (ADVS) y la capacidad funcional global de los ancianos a través del índice de Katz. El resto de las variables consideradas fueron: estado cognitivo, visión autopercibida, agudeza visual, clasificación de la catarata, tensión ocular, datos de morbilidad y características sociodemográficas. El tiempo medio de evolución de las cataratas fue de cinco años. Considerando exclusivamente el ojo portador de la catarata, el 96,6 per cent presentaba una agudeza visual inferior a 0,5 (20/40), estando comprendida en el 51,1 per cent de los casos entre 0 (amaurosis) y 0,05 (20/400). El tipo de catarata predominante fue la madura o completa (43,5 per cent). La puntuación media de los ancianos en la escala ADVS fue de 52,9 puntos ñ 26,9 DE (IC 95 per cent: 50,09-55,65) (rango 0-100). Dicha puntuación fue significativamente inferior en mujeres, mayores de 74 años, viudos o solteros, analfabetos o con estudios primarios incompletos, ancianos con bajo rendimiento intelectual, con alguna enfermedad visual además de la catarata, con mala o muy mala visión autopercibida y con cifras de agudeza visual inferiores a 0,5. Respecto a la capacidad funcional, los ancianos mostraron una puntuación media en la escala ADVS significativamente inferior cuando eran dependientes de otras personas en actividades como bañarse o vestirse (p< 0,001). Mediante regresión múltiple, las variables que mostraron una asociación estadísticamente significativa con una puntuación superior en la escala de función visual fueron la agudeza visual (tanto en el ojo con mejor visión como en el ojo con catarata), una buena visión autopercibida, la independencia física, menor edad, procedencia urbana y sexo masculino. CONCLUSIONES: La ADVS presenta en nuestro medio unos adecuados índices de fiabilidad, por lo que puede considerarse como un método o instrumento apropiado y útil para valorar la pérdida de función visual percibida por los pacientes con cataratas. Prácticamente todos los ancianos de nuestra muestra presentaron en el ojo con catarata una cifra de agudeza visual inferior a 0,60 (20/30) y más de tres cuartas partes inferior a 0,20 (20/100) indicando un estado muy avanzado de la enfermedad en nuestro medio cuando se accede a la intervención. Los resultados muestran que los pacientes con cataratas presentan dificultades importantes para realizar las actividades dependientes de la visión y que, por lo tanto, son susceptibles de obtener beneficio con la intervención (AU)

[Quality of life of patients after radical surgery of bladder cancer]. / Calidad de vida de los pacientes tras la cirugía radical del cáncer vesical.

OBJECTIVE: To analyze the impact of surgery for bladder cancer on the patient's quality of life. METHODS: The SF-36 questionnaire was utilized to assess the quality of life of 53 cystectomized patients. Sociodemographic data, associated and surgery-related morbidity, type of urinary diversion, anatomopathological stage and current oncological status were analyzed. RESULTS: Patient mean age was 64.3 years. There were 46 males (86.8%), 33 (62.3%) had no schooling, 32 (68.1%) were social class IV and 35 (66.0%) had chronic associated conditions. External urinary diversion had been performed in 28 (52.8%) and bladder substitution in 21 (39.6%) patients. The early complication rate was 37.7% (n = 20) and the late complication rate was 86.8% (n = 46). Tumor stage was < or = pT2 in 28 cases (52.8%). Age correlated inversely with Physical Performance (r = -0.324; p = 0.018). Patients with chronic conditions had a lower score for Physical Performance, Vitality and SFI. Patients with tumor stage < or = pT2 scored higher for Physical Performance (p = 0.034), Vitality (p = 0.046), Mental Health (p = 0.036), Emotional Role (p < 0.05) and MSI (p < 0.05). Those with postoperative complications had a worse score for Physical Performance (p = 0.031), Vitality (p = 0.027), Emotional Role (p = 0.014), Mental Health (p = 0.012) and MSI (p = 0.015). The SF-36 showed no differences between the types of urinary diversion except that patients that had undergone orthotopic bladder substitution had a higher score for Physical Performance (p = 0.014) and FSI (p = 0.045). CONCLUSIONS: Although the quality of life of cystectomized patients is worse than that of the general population, it is better in younger patients without chronic associated conditions, no postoperative complications, lower tumor stage and those submitted to orthotopic bladder substitution.

Quality of life of patients on the waiting list for benign prostatic hyperplasia surgery.

OBJECTIVES: To assess the quality of life (QoL) of patients on the waiting list for benign prostatic hypertrophy (BPH) surgery and the relationship between prostate symptoms and QoL. MATERIALS AND METHODS: Our study included 189 BPH patients on the waiting list for surgery, during the period from January to December 1999. A survey was conducted to obtain information on sociodemographic characteristics, associated illnesses, prostate symptoms based on the International Prostate Symptoms Score (I-PSS), and QoL based on the 36-item Short Form Health Survey (SF-36). Moreover, the case history, prostate volume measured by ultrasound, and uroflowmetry results were considered. Descriptive, bivariate and multivariate analyses were conducted based on the scores recorded on the SF-36 scales and the other variables. RESULTS: The mean age was 68.8 +/- 6.9 SD. A total of 70.4% of the subjects had other chronic illnesses, 54.1% had severe symptoms (I-PSS > 19), and 69.8% reported that they were extremely dissatisfied with their symptoms. A total of 29.6% of the patients had urethral catheters. The SF-36 scale with the highest scores was social functioning (79.9, 95% CI: 76.5-83.4), whereas the lowest scores referred to role-physical (58.2, 95% CI: 52.3-64.1). Patients with more severe symptoms assigned lower scores to the physical functioning, vitality, social functioning, mental health, role-emotional and mental component summary (MCS) scales. Irritative symptoms were associated with lower vitality, social functioning, mental health and MCS. Patients with urethral catheters recorded lower scores on the physical functioning and role-physical scales. CONCLUSIONS: The QoL of BPH patients on the waiting list for surgery is poorer than that of the general population of the same age. The increased severity of prostate symptoms, particularly the irritative symptoms, leads to a poorer QoL in terms of nearly all aspects of QoL. However, this correlation was not observed for prostate volume nor uroflowmetry data.

[Factors associated with chronic drug consumption in the elderly]. / Factores asociados al consumo de medicación crónica en personas ancianas.

BACKGROUND: To determine chronic drug intake in the non-institutionalised elderly population and identify factors associated with polypharmacy. PATIENTS AND METHODS: Cross-sectional study by means of home interview. 1,015 elderly individuals were selected systematically from the 1991 municipal electoral list of Albacete, Spain (level of confidence 95%, precision 3%, response rate 93.8%). The questionnaire included, disability scales (Minimental test, index of Katz and Lawton-Brody, Yesavage scale and DUKE-UNC questionnaire), a self-preceivement of health, demographic data and qualitative and quantitative information about drug intake. We employed the anatomic classification of drugs to obtain a profile of consumption. RESULTS: 75% of those interviewed admitted to taking medication chronically (CI 95%: 72.6-78.6). The mean number of drugs was 3.17 +/- 1.94 SD. Intake was significantly higher in women (p = 0.01), widows (p = 0.04), those of lower social status (p = 0.01), greater age (p < 0.02), and a greater number of illnesses (p < 0.001), more frequent users of health resources (p < 0.001), those physically dependent (p < 0.001) and those suffering from depression or cognitive impairment (p = 0.001). The most commonly taken drugs were: cardioactive drugs (22.1%), diuretics (19.4%) and vasodilators (14.2%). Using logistic regression analysis we found that the factors associated with higher drug intake were: three or more ilnesses (OR = 2.24), poor self-assessed status of health (OR = 1.45), physical dependence (OR = 1.59), age greater than 74 years (OR = 1.63), depression (OR = 1.68), > or = 4 contacts with health providers over a three-month period (OR = 2.73) and previous hospital admissions (OR = 2.67). CONCLUSIONS: The high intake of drugs by the elderly is determined, among other factors, by sociodemographic considerations, the subject's perceived status of health and different forms of disability. These factors should be taken into account by health professionals when planning a rational use of drugs. There is a high consumption of peripheral vasodilators despite their scanty therapeutic value.

[Depression in older persons. Associated factors]. / Depresión en personas ancianas. Factores asociados.

OBJECTIVE: To determine the proportion of elderly people with depressive disorders and study the possible association with sociodemographic factors, self-perception of health, cognitive function, diseases suffered, drug consumption, sleep disorders and use of services. DESIGN: An observational crossover study using a home interview. SETTING: Community-based. PARTICIPANTS: 787 elderly people aged 65 and over, not institutionalised and living in the city of Albacete. MEASUREMENTS AND MAIN RESULTS: A questionnaire designed for the study was used to gather data on the sociodemographic variables, self-perception of health, diseases suffered, drug consumption, cognitive function, sleep disorders and contacts with the health service. The variables found by logistic regression to be associated independently to the presence of depressive disorders were: being female (OR = 2.75), habitually suffering sleep disorders (OR = 2.75), having self-perception of poor health (OR = 17.61) and cognitive deterioration (OR = 2.45). CONCLUSIONS: It would be advisable to apply a screening test to detect depressive disorders in elderly people with associated factors (being female, having sleep disorders, self-perception of poor health and cognitive deterioration), so that they could benefit from early diagnosis and adequate treatment.

[Visual and auditory difficulties expressed by the aged]. / Dificultades visuales y auditivas expresadas por los ancianos.

OBJECTIVE: To determine the proportion of the elderly who have difficulties in their perceptive functions (seeing and hearing) and associated factors in the area of health self-perception and functional capacity. DESIGN: Observational and crossover, using an interview. SETTING: Community. PARTICIPANTS: 787 elderly people not in institutions; 93.8% reply rate. MEASUREMENTS AND MAIN RESULTS: Using a questionnaire, data were obtained on deficiencies in their sense organs and self-perceived health. Validated scales to determine functional capacity (physical, psychic and social) were used: Katz, Lawton and Brody indexes, Cognitive mini-test, DUKE-UNC questionnaire and Geriatric Depression scale. A serious difficulty or inability to read or watch television was expressed in 17.3% of cases (CI 95%; 14.8-20.0) and to follow a normal conversation in 10.5% (CI 95%; 8.4-12.6). The proportion of the elderly dependent on others to carry out their normal daily activities was 2.2 times greater among those who displayed severe visual problems (CI 95%; 1.7-2.9) and 1.8 times greater if they had hearing difficulties (C.I. 95%; 1.4-2.3). There was a linear tendency between greater visual or auditory problems and less social support (p = 0.01), greater dependency on others for basic daily activities (p < 0.001) and worse perceived health (p < 0.001). CONCLUSIONS: The elderly, especially the oldest among them, frequently display hearing and visual problems, which are related to low self-perception of health and greater functional incapacity.

[Epidemiologic study of complicated urinary calculi: an analysis of 164 cases]. / Estudio epidemiológico de la litiasis urinaria complicada: análisis de 164 casos.

We report a clinical and epidemiological study of 164 cases of complex urinary calculi which were seen in our hospital between 1984 and 1988. The highest incidence was found in patients aged between 40 and 50 years, with a female:male ratio of 1.27/1. In 37% of patients there were first degree relatives with calculi. The most common type were calculi with a calcium component, with a remarkably high proportion of struvite calculi and a low one of uric acid. Housewives had a high rate of struvite calculi associated with infections during pregnancy. Qualified professions have been associated with calcium oxalate and phosphate calculi. 13% has congenital renoureteral malformations, 4% had hyperuricemia and 1.2% had hyperparathyroidism. Pain was the most consistent symptom, followed by fever and urinary tract infection. 50% of patients had previously passed stones. 90% of calculi were visible in the plain abdomen X-ray film. 65% of patients required aggressive therapy.

[Clinical and epidemiological features of hepatic cirrhosis. Analysis of 200 patients]. / Aspectos clinicoepidemiológicos de la cirrosis hepática. Análisis en 200 pacientes.

We have evaluated the clinical and epidemiological features of hepatic cirrhosis in a retrospective study of 200 patients admitted to our Area Hospital from 1984 to 1987. 77% of patients were 40-69 years old and 74% were males, with a M/F ratio of 2.84. 56% were caused by high alcohol intake, 25% were cryptogenic and 13% post-hepatitis. 29.2% were diagnosed in a compensated stage of the disease. 52.2% presented with ascites, and 30.5% with upper gastrointestinal hemorrhage. We found superimposed hepatocellular carcinoma in 4.5% of patients, all of them males, with a mean age of 63.5 years. 18% died during their hospital admission, 50% from hepatic coma, 19.4% from hypovolemic shock and 16.6% from hepatorenal syndrome. Survival from the time of diagnosis in the patients who died was shorter than one year in 41.5%.

[Benign unilateral hematuria causing anemia by mesangial deposit of IgM]. / Hematuria benigna unilateral anemizante por depósito mesangial de IgM.

We present a case of benign unilateral persistent hematuria, due to nephrectomy due to important anemia and requiring several blood transfusions. The only pathological finding obtained during the study of the kidney was the presence of mesangial deposits of IgM. This process is very rare due to its unilateral feature, relevance of the hematuria and from the paradoxical finding that a percutaneous biopsy revealed a normal kidney during a study prior to nephrectomy.