ABSTRACT
BACKGROUND: The aim of this study was to evaluate the associations between carer's wellbeing and stressors and to assess if these associations are different for spousal and children carers of disabled elderly. METHODS: Information was collected by home interviews of a population sample of carers (N = 195), who were providing assistance in activities of daily living to a community-dwelling population over 65. Associations between indicators of wellbeing (number of depressive symptoms, number of physical symptoms, self-perceived health and life satisfaction) and caring stressors were examined, controlling for carer's socio-economic characteristics and health status. Hierarchical logistic regressions were used to fit the data. Religion and social support were included as resources and spousal and children differential associations were tested. RESULTS: The four indicators of wellbeing are moderately correlated, indicating a common underlying concept. Spousal carers have lower socio-economic status, poorer health and lower levels of wellbeing than children carers. However, children carers bear a significantly greater burden. In the multivariate analysis of the associations between wellbeing and stressors, the similarities between spouse and adult child carers are more striking than the differences. Emotional support was consistently associated with higher levels of wellbeing while the associations of religiosity and instrumental support with wellbeing did not reach statistical significance. CONCLUSION: As formal care services are being developed in Spain, their ability to work in a supportive way with family networks should be taken into account. Research should be carried out on patterns of formal care interventions that use the resources in the natural support network of the family.
Subject(s)
Caregivers/psychology , Caregivers/statistics & numerical data , Disabled Persons , Health Status , Parent-Child Relations , Spouses/psychology , Aged , Depressive Disorder/etiology , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Personal Satisfaction , Psychiatric Status Rating Scales , Self Concept , Socioeconomic Factors , Spain , Stress, Physiological/etiology , Stress, Physiological/psychologyABSTRACT
The objectives of this study were to describe follow-up dynamics in a longitudinal study on aging conducted in Spain between 1993 and 1997, and to identify the demographic, behavioral and health characteristics of persons who would later refuse to continue participating, move out of the area or be hard to locate (i.e., become lost to follow-up subjects). Data from the 1993 baseline survey were used to predict the probabilities of being lost to follow-up in the 1995 and 1997 waves. Structural multiple logistic regressions were fitted and mean probabilities were estimated to identify patterns of loss to follow-up. After 4 years, 52% of baseline participants remained in the study, 24% had died, 17% refused to continue participating, and 8.7% were impossible to locate. In the multivariate analysis, advanced age and living alone were independent predictors of loss to follow-up, and none of the health status variables remained significant. However, participation status in previous waves and the number of nonresponse items were strong independent predictors of further non-participation. Our results suggest that an attitude against participation in surveys may be an independent predictor of losses to follow-up and efforts should be made to retain this subgroup of the population in the study. Further research on reasons why people are unwilling to participate in surveys and strategies to retain people in longitudinal studies is needed.
Subject(s)
Aging , Follow-Up Studies , Health Services for the Aged , Health Status , Long-Term Care , Patient Dropouts/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Longitudinal Studies , Male , Patient Selection , Spain/epidemiologyABSTRACT
OBJECTIVE: To analyse the informal system of caring for people with neuro-degenerative disease: what it consists of and the characteristics of main carers, the type of care given, and the consequences for the main carer of assuming these functions. DESIGN: Descriptive cross-sectional study conducted by means of a home-filled questionnaire. SETTING: Autonomous Community of Andalusia. PARTICIPANTS: 72 main carers of someone with neuro-degenerative disease, chosen from a sub-sample of 1000 homes in which at least one dependent person lives and receives care from a member of his/her family or social network with whom he/she resides. This sub-sample was based on a random sample of 3160 Andalusian homes stratified proportionately according to province and size of dwelling. MAIN RESULTS: In 86.1% of the 72 homes polled, health care was provided only by the informal system network. In over half the homes, care was provided by just one person, the main carer. The main carer was usually a woman (87.4%), with an average age of 54.52, house-wife and close family member of the sick person. In our study the beneficiaries of care had an average age of 77.63, a low level of autonomy in daily activities, and had had a neuro-degenerative disease for an average of 8.16 years. The main kinds of care provided in the home for people with neuro-degenerative disease were help in instrumental activities, care related to daily activities, observation/company and supervision of medicines. Main carers believed that undertaking this work had seriously affected their health (72.2%), the use they made of their time (84.7%), their social life (83.3%) and their economic position (44.4%). CONCLUSIONS: People with neuro-degenerative disease make considerable demands on health care provision, which is mainly covered at home by the immediate family network. In most cases this network consists of just one person, the main carer, on whom falls the entire burden of care. The assumption of this role directly affects the health of a large number of carers, as well as other areas of their lives, in particular the possibility of conducting a social life and using their time for themselves or for activities other than caring.
Subject(s)
Caregivers , Neurodegenerative Diseases/therapy , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
Objetivo. Analizar el sistema informal de cuidados de personas con enfermedad neurodegenerativa, en cuanto a su composición y a las características de los cuidadores principales, el tipo de cuidados que presta y las consecuencias que tiene para el cuidador principal asumir estas funciones. Diseño. Estudio descriptivo de corte transversal realizado mediante cuestionario domiciliario. Emplazamiento. Comunidad Autónoma de Andalucía. Participantes. Setenta y dos cuidadores principales de alguna persona con enfermedad neurodegenerativa, seleccionados de una submuestra de 1.000 hogares en los que vive al menos una persona dependiente por alguna razón y que recibe cuidados de algún miembro de su red familiar o social con el que reside. Esta submuestra se obtuvo a partir de una muestra aleatoria de 3.160 hogares andaluces, estratificada proporcionalmente según provincia y tamaño de hábitat. Resultados principales. En un 86,1 por ciento de los 72 hogares encuestados, los cuidados de salud son prestados sólo por la red el sistema informal. En más de la mitad de los hogares los cuidados son realizados por una sola persona, el cuidador principal. Éste suele ser una mujer (87,4 por ciento), con una edad media de 54,52 años, ama de casa y familiar cercano de la persona afectada. Los beneficiarios de nuestro estudio tienen una edad media de 77,63 años, un nivel bajo de autonomía para actividades de la vida diaria y enfermedad neurodegenerativa desde hace una media de 8,16 años. Los principales cuidados que se prestan en el hogar a personas con enfermedad neurodegenerativa son ayuda en actividades instrumentales, cuidados relacionados con actividades de la vida diaria, vigilancia/acompañamiento y administración de la toma de medicamentos. Las cuidadoras principales consideran que desempeñar este trabajo ha afectado de forma importante a su salud (72,2 por ciento), al uso que hacen de su tiempo (84,7 por ciento), a su vida social (83,3 por ciento) y a su situación económica (44,4 por ciento). Conclusiones. Las personas con enfermedad neurodegenerativa presentan una importante demanda de cuidados de atención a la salud, que en gran parte es cubierta en el hogar por su red familiar inmediata. En la mayoría de los casos esta red se halla configurada por una sola persona, la cuidadora principal, sobre la que recae toda la carga de los cuidados. Para un importante grupo de cuidadoras, asumir este rol afecta de forma directa a su salud, así como a otras áreas de su vida y, en especial, a sus posibilidades de tener relaciones sociales y de usar el tiempo para sí mismas o para otras actividades diferentes a cuidar (AU)
Subject(s)
Middle Aged , Aged , Aged, 80 and over , Male , Female , Humans , Caregivers , Neurodegenerative Diseases , Cross-Sectional StudiesABSTRACT
OBJECTIVE: To develop and assess the consistency and validity of simple cognitive function measures for an elderly population with low levels of formal education for use in a longitudinal study of dementia. METHODS: Data were from the population longitudinal study 'Growing old in Leganés' (Spain). In 1993, a random sample of 1540 people over 65 was drawn from the City Roll of Leganés from which 1284 (83%) were successfully interviewed. Measures of memory and orientation were based on the SPMSQ (Short Portable Mental Status Questionnaire), the Barcelona test and the short story from EPESE (Established Populations Epidemiologic Studies of the Elderly). Non-response to a test item was coded as an error. Internal consistency was assessed by factor analysis and Cronbach's alpha. Construct validity was examined with multiple linear regressions of the proposed measurements on variables chosen from the existing literature on cognitive function. RESULTS: Two factors, memory and orientation, emerged from the factor analysis. Internal consistency of the proposed indexes for memory and orientation was acceptable. Memory and orientation scores were summed into one summary index of cognition. Associations between covariates and both cognitive indexes were in the expected direction. Among those highly functional, orientation was influenced by illiteracy due to higher error rates in the time orientation items based on dates; however, memory and summary scores were not significantly different by literacy status. A large proportion of the variance in IADL was explained by the memory and orientation measures. CONCLUSION: The memory and orientation indexes are valid and reliable measurements of cognitive function for use in a population of community dwelling elderly with low levels of formal education and high rates of illiteracy.
Subject(s)
Alzheimer Disease/epidemiology , Geriatric Assessment/statistics & numerical data , Mass Screening , Neuropsychological Tests/statistics & numerical data , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Female , Humans , Longitudinal Studies , Male , Psychometrics , Reproducibility of Results , Spain/epidemiologyABSTRACT
BACKGROUND: The objective of this study was to estimate the relationship between the levels of air pollution and the daily mortality in the city of Huelva for the 1993-1996 period using the EMECAM methodology. METHODS: The number of daily deaths for all causes except external ones, the death rate of those over age 69, due to diseases of the circulatory system and for respiratory diseases were used as rate indicators. Four pollutants--SO2, PM10, NO2 and CO--were analyzed, the daily levels of which were furnished by the air pollution monitoring network in Huelva. Autoregressive Poisson regression models were constructed controlling by tendency, seasonality, temperature, humidity, flue and events out of the ordinary. RESULTS: For the mortality rate for all causes, a significant association impact was found to exist for the NO2 for the entire period (RR10 microgram/m3: 1.0414; CI95%: 1.0047-1.0794) and for the particles (PM10) for the cold half of the year (RR10 microgram/m3: 1.0358; CI95%: 1.007-1.0722). For the mortality in people over age 69, a significant relationship was found to exist for SO2 throughout the entire period (RR10 microgram/m3: 1.0606; CI95%: 1.0020-1.1227). A significant relationship to the mortality from respiratory disease particles (PM10) was found to exist for the cold half of the year (RR10 microgram/m3: 1.1412; IC95%: 1.0300-1.2644). There was no association of contaminants with cardiovascular mortality; also there was no association between levels of CO and mortality indicators. CONCLUSIONS: In Huelva, significant relationships have been found to exist between the current levels of air pollution resulting from particles, SO2 and NO2 and the daily mortality. The impact of these pollutants on the mortality is coherent with scientific literature, although in the case of Huelva, the extremely small number of daily deaths due to its small population and other factors limit the consistency thereof.
Subject(s)
Air Pollution/adverse effects , Mortality/trends , Urban Population/statistics & numerical data , Aged , Air Pollutants/adverse effects , Air Pollutants/analysis , Air Pollution/statistics & numerical data , Cause of Death , Humans , Poisson Distribution , Regression Analysis , Risk , Seasons , Spain/epidemiology , Time FactorsABSTRACT
BACKGROUND: As part of the EMECAM Project, the objective of this study is that of assessing the impact of air pollution on the daily mortality in Seville throughout the 1992-1996 period. METHODS: During the 1992-1996 period, readings were taken daily of the amounts of SO2, particles in suspension (PM10) and NO2 present in the air in the city of Seville, in addition to the number of deaths daily due to different causes. For analyzing this data, a multivariable Poisson regression model was used for modeling each one of the causes of death in terms of the air immission readings, controlling other confusion-causing variables. RESULTS: A relationship was found to exist between the rises in the NO2 levels and the daily death rate throughout the months of May to October. For each 10 micrograms/m3 rise, the risk of death or all causes showed a 2% rise, the same rise in the NO2 levels leading to a 3% rise in the risk of death resulting from cardiovascular diseases. CONCLUSIONS: A relationship exists between the levels of NO2 air pollution and the daily death rate in Seville. The findings provide scientific knowledge and information which can be of use for preventing the impact of air pollution on human health.
