[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.

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.