Effectiveness of Physical Exercise in Older Adults With Mild to Moderate Depression.

PURPOSE: We sought to compare the effectiveness of physical exercise with that of treatment with antidepressant drugs routinely used in clinical practice, in terms of decreasing depressive symptomatology in patients aged ≥65 years who present with clinical criteria of a depressive episode. METHODS: We conducted a randomized clinical trial in a primary care setting. A total of 347 patients aged ≥65 years with a clinically significant depressive episode were randomized to participation in a supervised physical exercise program or to receive antidepressant treatment by their general practitioners. RESULTS: Intention-to-treat analysis showed that the cumulative incidence of improvement in depressive symptomatology (Montgomery-Åsberg Depression Rating Scale score <10) in the physical activity (PA) group after 1 month was not significantly different from that in the antidepressant treatment (AT) group. However, the proportion of those who showed improvement was significantly greater (P <.01) in the AT group (60.6% and 49.7%) compared to the PA group (45.6% and 32.9%) at the end of 3 and 6 months, respectively. The number of withdrawals was greater in the PA group (39.2% and 58.2%) compared to the AT group (22.6% and 40.0%) at 3 and 6 months, respectively, yet the proportion of participants with adverse side effects was greater in the AT group (8.9% vs 22.5%; P = .007). CONCLUSION: Although improvement was initially similar in both treatment groups, AT was superior in the medium term, despite giving rise to a greater number of adverse effects.

Factors Associated With Cancer Worry Among People Aged 50 or Older, Spain, 2012-2014.

INTRODUCTION: Cancer worry varies among patients and may influence their participation in preventive activities. We tested whether sociodemographic characteristics, lifestyle, locus of control, comorbidity, and perceived health status were associated with the level of cancer worry among adults aged 50 or older. METHODS: We conducted an observational cross-sectional study of 666 adults in Spain aged 50 or older. Participants were selected by simple random sampling and asked to visit their designated health center for a personal interview. The study variables were level of cancer worry (measured by Cancer Worry Scale [CWS]), sociodemographic characteristics, lifestyle, personal history or family history of cancer, comorbidity, self-perceived health, locus of control, and social support. RESULTS: More than half of participants, 58.1%, were women; mean age was 60.5 years (standard deviation [SD], 6.8 y). Measurement of the frequency and severity of cancer worry (possible scale of 6-24 points) yielded a mean CWS score of 9.3 (95% confidence interval, 9.0-9.5); 31.9% of participants reported being concerned about cancer. Scores were higher among women (9.7 [SD, 3.3]) than men (8.7 [SD, 2.7]) (P < .001) and among participants in rural settings (10.0 [SD, 3.4]) than in urban settings (9.0 [SD, 3.0]) (P < .001). Multiple linear regression showed a greater degree of cancer worry among people with personal or family history of cancer, more health problems, worse self-perceived health, and lower social support. CONCLUSION: Cancer worry is frequent among older adults, and the level of such concern is related not only to personal characteristics but also to lifestyle and health status. Further research is required to understand how contextual factors can influence cancer worry and how such concern changes behavior patterns related to cancer prevention activities.

Study of the factors influencing the preparation of advance directives.

The aim of the study is to analyze the factors influencing the decision to prepare advance directives (AD) related to socio-demographic situation, health status, degree of dependence, healthcare characteristics and psychosocial aspects. This is a case-control study conducted using a personal interview. We compared 123 subjects who had completed AD with 123 subjects who had not and who belonged to two health centers in the Albacete Health District. Study variables included self-perceived health, functional status, morbidity, socio-demographic characteristics, use of health services, attitudes toward AD and psychosocial aspects. We found a predominance of women (64.2%) among those who prepared AD, with a mean age of 53.3 years. Preparing AD was associated with secondary or higher education (OR=2.5), a lifestyle other than living with a partner and with children (OR=2.5), chronic medication use (OR=3.2), higher than average number of specialist visits (OR=4.0), a longer-term relationship with the family physician (OR=3.5), a family history of having AD (OR=17.3) and with lower levels of social interaction (OR=3.0). The results suggest that several factors, resulting from both the socio-demographic situation and health or functional status, can affect the decision to formalize AD.

Development and validation of a questionnaire to evaluate attitudes toward family medicine.

A questionnaire that evaluates medical students' knowledge of and attitudes towards primary care and family medicine was developed and validated in order to analyze changes during medical training. A 34 items questionnaire with 5 options on a Likert-type scale was designed. Based on this, a 21 item version was developed and validated. The internal consistency, using Cronbach's alpha test, was estimated, and the questionnaire was analyzed by Rasch model. One hundred and fifty nine students responded to the brief questionnaire (95.78% of those enrolled). Cronbach's alpha was 0.72. Rasch analysis showed high adjustment of the items to the pattern, whit an average reliability of the estimates of the items of 0.97 and of the people of 0.68. Our questionnaire has shown acceptable internal consistency and good construct validity.

[Fear of falling in elderly community-dwelling individuals]. / Miedo a las caídas en las personas mayores no institucionalizadas.

OBJECTIVE: To determine the association between fear of falling and health status, a history of previous falls and personal characteristics in a representative sample of elderly people. METHOD: We conducted an observational, cross-sectional prevalence study in the community setting in Albacete (Spain) of 921 people older than 65 years old selected through simple randomization. Participants underwent semi-structured interviews about their history of falls, fear of falling, illnesses and sociodemographic characteristics. Multivariate analysis was used to evaluate the association between fear of falling and its possible conditioning factors. RESULTS: In the previous year, 26.3% of interviewees had fallen and 49.4% expressed a strong fear of falling. A high proportion (78.9%) considered the consequences of falls to be very serious, but only 44.7% believed that most of these falls could be prevented. The variables associated with a greater fear of falling were female sex (OR=5.5; 95% CI: 3.9-7.6), age more than 75 years old (OR=2.0; 95% CI: 1.5-2.8), illiteracy or lack of education beyond reading/writing skills (OR= 1.5; 95% CI: 1.1-2.1), taking psychotropic medication (OR=1.6; 95% CI: 1.1-2.2), and having cardiocirculatory disease (OR=1.5; 95% CI: 1.1-2.2), disorders of the locomotor system (OR=2.2; 95% CI: 1.5-3.1) and a history of falls (OR=1.9; 95% CI: 1.3-2.7). CONCLUSIONS: Approximately half of the interviewees expressed strong concern about falls. The factors associated with a fear of falling were a history of falls and certain clinical and sociodemographic characteristics. Most of the interviewees considered that falls had serious consequences but less than half believed that a large proportion of falls could be avoided.

Effect of the evaluation of recall on the rate of information recalled by patients in Primary Care.

OBJECTIVE: To analyse whether asking the patient to restate the recommendations they receive before leaving the surgery improves the recall rate once the consultation is finished. METHODS: Observational study in 37 Primary Care Consultant (PCC) in health centres of the city of Albacete. The final sample had 963 patients. RESULTS: The mean rate of recommendations remembered after leaving the surgery was better in the group of patients that restated the recommendations before finishing the doctor-patient encounter than in the group where there was no restatement (p = 0.000). The amount of recommendations showed a negative correlation with the recall rate (r = -0.215). CONCLUSION: Asking patients to repeat treatment recommendations is an effective method of improving the recall of these prescriptions at the end of doctor-patient encounter. PRACTICAL IMPLICATIONS: The importance of communication between health-care professionals and patients justifies the performance of studies so that it can be improved and, according to the results of this study, it would be advisable to use the method proposed on a more regular basis by the PCC as a way of improving communication and recall of medical advice.

Changes in the knowledge of and attitudes toward family medicine after completing a primary care course.

BACKGROUND AND OBJECTIVES: The study's objective was to determine medical students' knowledge of and attitudes toward family medicine before and after completing a course in primary care. METHODS: Before and after a course in primary care, 81 medical students were asked to respond to a self-administered, anonymous questionnaire, comprising 34 items that measured students' attitudes and knowledge about primary care that uses a 5-point Likert response scale. RESULTS: Forty-four (54.3%) students completed both the pre-course and post-course questionnaires. Before the course, 38.6% looked favorably upon the specialty of family medicine. After the course, the percentage increased to 70.4%. Nevertheless, only 11.4% initially considered family medicine as a first career option, and their attitude did not change after the course. CONCLUSIONS: After completing the course, the students showed an improvement in their knowledge of and attitudes toward family medicine and primary care, but only a small percentage considered a career in family medicine as a first-choice option.

Visual function versus visual acuity in older people.

PURPOSE: To determine visual function (VF) status in older people, to establish its degree of correlation with visual acuity (VA), and to assess its association with other physical and mental functional limitations. PARTICIPANTS: A sample of 1,160 persons aged 65 years or over were selected by simple randomization. METHODS: The participants' VF (The Visual Function Index - VF-14), VA, self-reported vision, mental and physical function (Katz Index, Pfeiffer's test, and Geriatric Depression Scale), and socio-demographic data were determined. Multiple linear regression was used to assess the association between VF and its conditioning factors. Statistical adjustment was made for the possible confounding variables. RESULTS: Of the studied subjects, 6.3% (95% confidence interval (CI) = 4.93-7.82) had VA of less than 6/18 in the better eye and 20.9% (95% CI = 18.6-23.3) had VA of less than 6/12. The best corrected VA of each participant demonstrated moderate correlation with his or her VF-14 score (r = 0.416; p < 0.001). Using multiple regression analysis, the variables associated with VF status were: visual impairment, self-reported poor vision, dependence in daily activities, cognitive impairment, depressive symptoms, female gender and older age. These independent variables explain 34.4% (r(2) = 0.344) of the variation in the data. CONCLUSIONS: VF impairment is common in older persons and when associated with other limitations, it may be considered a major health problem with important consequences. As a complement to the preventive care guidelines on VA in older persons, assessment of VF impairment in clinical practice, using appropriate visual screening tools, is advisable.

[Sleep disorders and environmental conditions in the elderly]. / Trastornos del sueño y condiciones ambientales en mayores de 65 años.

OBJECTIVES: To establish the prevalence and characteristics of insomnia and its relationship to other health problems, medication, socio-health status and sleep hygiene in the elderly over 65 years of age. DESIGN: Cross sectional study of prevalence. SETTING: Albacete (Castilla-La Mancha), 2004-2005. PARTICIPANTS: A non-institutionalized elderly patient population (n=424). METHOD: Semi-structured interview. Study variables were: sleep characteristics, socio-familial repercussions, sleep hygiene, health problems, medication, health care utilization and socio-demographic variables. Primary insomnia (PI) was diagnosed according to DSM-IV criteria. RESULTS: Reported sleeping difficulties, 34.2%; in 95.7% the sleep disturbance was chronic. The most frequent repercussions were: sensation of insufficient night-time sleep (62.1%) and daytime tiredness or sleepiness (52.2%). 20.3% (95% CI, 16.5-24.1) met criteria for PI. Insomnia rates were significantly higher in females and in subjects maintaining irregular hours and expressing dissatisfaction with bedroom environmental conditions. Psychopharmaceuticals were regularly consumed by 26.9% of the subjects (95% CI, 22.7-31.1). The average number of health problems was higher in subjects with insomnia (2.4+/-1.6 compared with 1.7+/-1.5 in non-insomniacs; P<.001). By means of logistic regression, female gender (OR=2.8; 95% CI, 1.6-4.8) and the existence of 2 or more health problems (OR=2; 95% CI. 1.2-3.4) were associated with PI. CONCLUSIONS: PI affects approximately one fifth of people over the age of 65. It is more frequent in females and is related to the existence of other health problems, medication and inadequate sleep hygiene.

The Hearing-Dependent Daily Activities Scale to evaluate impact of hearing loss in older people.

PURPOSE: We wanted to design and validate the Hearing-Dependent Daily Activities (HDDA) Scale as a means of identifying the impact of hearing loss in older persons by measuring capacity to carry out hearing-dependent activities. METHODS: We undertook a cross-sectional, observational study to validate a scale administered during a personal interview with 1,160 participants aged 65 years and older. When using the instrument to identify patients with hearing impairment, sensitivity and specificity were determined using an audiogram with Ventry and Weinstein criteria as the criterion standard. Standardized audiometries were performed blindly, without knowledge of results of the HDDA Scale. RESULTS: According to the criterion standard, 506 participants had hearing impairment (43.6%; 95% confidence interval [CI], 40.8%-46.5%). The HDDA scale showed high internal consistency (Cronbach's alpha =0.91). Regarding hearing impairment criteria, the HDDA scale obtained a sensitivity of 80.0% (95% CI, 76.3%-83.3%) and a specificity of 70.2% (95% CI, 66.5%-73.5%). CONCLUSIONS: The HDDA scale constitutes a clinically useful instrument for identifying the impact of hearing loss on daily life in the elderly, a condition frequently overlooked during routine medical check-ups. This tool has acceptable psychometric properties and high internal consistency.

Functional status in the elderly with insomnia.

BACKGROUND: Insomnia causes psychological distress in the elderly. Besides primary insomnia (PI), illness, medications and psychosocial factors contribute to development of sleep disorders. Although elderly insomniacs usually complain of poorer daytime functioning, it is unknown whether the disorder affects capacity to carry out activities. OBJECTIVE: To assess the relationship in the elderly between PI, level of physical functioning, depression and anxiety symptoms, state of psychological well-being and consumption of psychopharmaceuticals. DESIGN: Cross-sectional, observational study. SETTING: Populational. SUBJECTS: About 424 non-institutionalized elderly patients. METHODS: Subjects were interviewed at public Health Centres or at home. They were considered to have PI if DSM-IV criteria were met. The remaining variables measured were: depression and anxiety symptoms (The Goldberg's Depression and Anxiety Scale), cognitive state (Short Portable Mental Status Questionnaire), physical functioning (The Katz Index and the Instrumental Activities of Daily Living Scale), life satisfaction (The Philadelphia Geriatric Center Morale Scale), health problems, consumption of pharmaceuticals and sociodemographic variables. RESULTS: About 34.2% of the elderly admitted to having problems with sleep, but only 20.3% (CI: 95%: 16.5-24.1) fulfilled the criteria for PI. The existence of an anxiety disorder, a score below the 50th percentile on The Philadelphia Geriatric Center Morale Scale (lower life satisfaction) and consumption of psychopharmaceuticals were variables associated with insomnia. Amongst the most common illnesses reported, only diabetes appeared with significantly higher frequency in the elderly with insomnia (24.4% vs. 14.7%) (p < 0.05). No statistically significant association was found between insomnia and level of dependence in carrying out basic or instrumental activities. CONCLUSIONS: Approximately one fifth of the non-institutionalized elderly meet the criteria for PI. Those affected present a poorer state of psychological and social well-being, although level of autonomy for conducting basic and instrumental activities does not appear to be modified by the disorder. The existence of an anxiety disorder, low life satisfaction and consumption of psychopharmaceuticals constitute variables associated with PI in the population we studied.