Spanish Validation of the MacArthur Competence Assessment Tool for Clinical Research Interview for Assessing Patients' Mental Capacity to Consent to Clinical Research.

The aim of the study was to assess a Spanish adaptation of a method that determines the categorical capacity status of potential participants in research projects. The sample consisted of 120 subjects (40 general medicine inpatients, 40 psychiatric inpatients, and 40 healthy controls). The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) interview and Mini-Mental State Examination (MMSE) were used. A feasibility study was carried out and reliability and validity calculations were made against the expert-judgment gold standard. The mean duration of the MacCAT-CR was 13 min. For the MacCAT-CR understanding, appreciation, reasoning, and expressing a choice subscales, the intraclass coefficient correlation (interrater reliability) was .93, .88, .90, and .50, respectively, and internal consistency (Cronbach's alpha) was .96, .94, and .95, respectively. Patients considered to be incompetent for expert-judgment obtained lower scores in the MacCAT-CR interview. The Spanish version of the MacCAT-CR is feasible, reliable, and valid for assessing the capacity of patients to give consent in research.

Validación española de la entrevista MacArthur Competence Assessment Tool for Treatment para evaluar la capacidad de los pacientes para consentir tratamiento / Spanish validation of the MacArthur Competence Assessment Tool for Treatment interview to assess patients competence to consent treatment

Fundamento y objetivo: Validar al español la entrevista MacArthur Competence Assessment Tool for Treatment (MacCAT-T), que valora la capacidad de los pacientes para consentir tratamiento examinando 4 áreas (comprensión, apreciación, razonamiento y expresión de una elección). Pacientes y método: La muestra se componía de 160 sujetos (80 ingresados en Medicina Interna, 40 ingresados en Psiquiatría y 40 controles sanos). Se utilizaron los instrumentos MacCAT-T y Mini-Mental State Examination (MMSE). Se llevó a cabo un estudio de factibilidad, cálculo de fiabilidad y validez (contragold standard del experto clínico). Resultados: La duración media de la entrevista MacCAT-T fue de 18 min. Respecto a la fiabilidad interobservador, el coeficiente de correlación intraclase fue para Comprensión = 0,98, Apreciación = 0,97, Razonamiento = 0,98 y Expresión de una elección = 0,91. La consistencia interna (alfa de Cronbach) fue: Comprensión = 0,87, Apreciación = 0,76 y Razonamiento = 0,86. Los pacientes considerados incapaces (gold standard) obtienen puntuaciones menores en todas las áreas de la MacCAT-T. Un rendimiento bajo en la MacCAT-T se relaciona con el deterioro cognitivo evaluado por MMSE. Conclusiones: La versión española de la MacCAT-T es fiable, factible y válida para la evaluación de la capacidad de los pacientes para consentir tratamiento (AU)

Background and objective: To validate the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) Spanish version, which assesses the mental capacity of patients to consent treatment, by examining 4 areas (Understanding, Appreciation, Reasoning and Expressing a choice). Patients and method: Sample: 160 subjects (80 Internal Medicine inpatients, 40 Psychiatric inpatients and 40 healthy controls). Instruments: MacCAT-T, Mini-Mental Status Examination (MMSE). Procedure: Feasibility study, reliability and validity calculations (against to gold standard of clinical expert). Results: Mean duration of the MacCAT-T interview was 18 min. Inter-rater reliability: Intraclass correlation coefficient for Understanding = 0.98, Appreciation = 0.97, Reasoning = 0.98, Expressing a choice = 0.91. Internal consistency (Cronbach’s alpha): Understanding = 0.87, for Appreciation = 0.76, for Reasoning = 0.86. Patients considered to be incapable (gold standard) scored lower in all the MacCAT-T areas. Poor performance on the MacCAT-T was related to cognitive impairment assessed by MMSE. Conclusions: Spanish version of the MacCAT-T is feasible, reliable, and valid for assessing the capacity of patients to consent treatment (AU)

[Spanish validation of the MacArthur Competence Assessment Tool for Treatment interview to assess patients competence to consent treatment]. / Validación española de la entrevista MacArthur Competence Assessment Tool for Treatment para evaluar la capacidad de los pacientes para consentir tratamiento.

BACKGROUND AND OBJECTIVE: To validate the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) Spanish version, which assesses the mental capacity of patients to consent treatment, by examining 4 areas (Understanding, Appreciation, Reasoning and Expressing a choice). SAMPLE: 160 subjects (80 Internal Medicine inpatients, 40 Psychiatric inpatients and 40 healthy controls). INSTRUMENTS: MacCAT-T, Mini-Mental Status Examination (MMSE). PROCEDURE: Feasibility study, reliability and validity calculations (against to gold standard of clinical expert). RESULTS: Mean duration of the MacCAT-T interview was 18min. Inter-rater reliability: Intraclass correlation coefficient for Understanding=0.98, Appreciation=0.97, Reasoning=0.98, Expressing a choice=0.91. Internal consistency (Cronbach's alpha): Understanding=0.87, for Appreciation=0.76, for Reasoning=0.86. Patients considered to be incapable (gold standard) scored lower in all the MacCAT-T areas. Poor performance on the MacCAT-T was related to cognitive impairment assessed by MMSE. CONCLUSIONS: Spanish version of the MacCAT-T is feasible, reliable, and valid for assessing the capacity of patients to consent treatment.

Relación entre el consumo de ansiolíticos y antidepresivos y la sintomatología psiquiátrica en ancianos / Association between anxiolytic and antidepressant consumption and psychiatric symptoms in the elderly

IntroducciónMuchos estudios apuntan que existe un excesivo consumo de psicotropos en la población geriátrica, pero no hay estudios que relacionen este consumo con la sintomatología psiquiátrica y los trastornos del sueño en pacientes mayores de 65 años en el ámbito comunitario de España.Material y métodosEs un estudio transversal de una muestra representativa (9.739 sujetos) de la población mayor de 55 años de la ciudad de Zaragoza del año 2001, en el que se entrevistó finalmente a 3.715 sujetos mayores de 65 años. Los datos pertenecen al proyecto ZARADEMP.ResultadosLa edad media en nuestra muestra fue de 76,9 años, con un 59,2% de mujeres y un 40,8% de varones.ResultadosEn nuestra muestra hay un 22,6% de sujetos que consumen ansiolíticos o antidepresivos. Un 12,9% de los sujetos tiene diagnóstico de depresión, un 1,6% de ansiedad y un 36% de insomnio.ResultadosEncontramos que existe un consumo alto de ansiolíticos, sobre todo en sujetos con depresión (42,2%), y un consumo bajo de antidepresivos, especialmente en personas con diagnóstico de depresión (15,4%) y en aquellos con síntomas depresivos (8,2%).ConclusionesEs importante realizar un diagnóstico psiquiátrico correcto previo a la utilización de psicotropos para conseguir una idoneidad en el tratamiento de los ancianos con sintomatología psiquiátrica(AU)

IntroductionMany studies have reported excessive consumption of psychotropic drugs in the elderly but none have related psychotropic drug use to psychiatric symptoms and sleep disorders in community-dwelling patients aged more than 65 years old in Spain.Material and methodsWe performed a cross sectional study in a representative sample (9,739 persons) from the population aged more than 55 years old in the city of Zaragoza in 2001. A total of 3,714 persons aged more than 65 years old were interviewed. The data belonged to the ZARADEMP project.ResultsThe mean age of the sample was 76.9 years (59.2% women and 40.8% men).ResultsAnxiolytics or antidepressants were consumed by 22.6% of the sample. A diagnosis of depression was made in 12.9%, anxiety in 1.6% and insomnia in 36%.ResultsWe found high consumption of anxiolytics, especially in persons with depression (42.2%) and low consumption of antidepressants, especially in persons with a diagnosis of depression (15.4%) and in those with depressive symptoms (8.2%).ConclusionsA correct psychiatric diagnosis is essential before psychotropic drugs are used to ensure appropriate treatment of the elderly with psychiatric symptoms(AU)

[Association between anxiolytic and antidepressant consumption and psychiatric symptoms in the elderly]. / Relación entre el consumo de ansiolíticos y antidepresivos y la sintomatología psiquiátrica en ancianos.

INTRODUCTION: Many studies have reported excessive consumption of psychotropic drugs in the elderly but none have related psychotropic drug use to psychiatric symptoms and sleep disorders in community-dwelling patients aged more than 65 years old in Spain. MATERIAL AND METHODS: We performed a cross sectional study in a representative sample (9,739 persons) from the population aged more than 55 years old in the city of Zaragoza in 2001. A total of 3,714 persons aged more than 65 years old were interviewed. The data belonged to the ZARADEMP project. RESULTS: The mean age of the sample was 76.9 years (59.2% women and 40.8% men). Anxiolytics or antidepressants were consumed by 22.6% of the sample. A diagnosis of depression was made in 12.9%, anxiety in 1.6% and insomnia in 36%. We found high consumption of anxiolytics, especially in persons with depression (42.2%) and low consumption of antidepressants, especially in persons with a diagnosis of depression (15.4%) and in those with depressive symptoms (8.2%). CONCLUSIONS: A correct psychiatric diagnosis is essential before psychotropic drugs are used to ensure appropriate treatment of the elderly with psychiatric symptoms.

[Excessive consumption of alcohol by the geriatric population and its relationship with psychiatric drugs]. / Consumo excesivo de alcohol en la población geriátrica y su relación con los psicofármacos.

OBJECTIVE: To describe excessive alcohol consumption in the geriatric population and its association with treatment with psychiatric drugs. DESIGN: Transversal, descriptive study. SETTING: Community. PARTICIPANTS: A representative sample of the population over 59 years old in the city of Zaragoza, Spain. MAIN MEASUREMENTS: Using a personal clinical questionnaire, we collected the following data: age, sex, marital status, educational status, economic level, occupation, people who live together, and drug, psychiatric drug, and alcohol consumption. RESULTS: In our sample there were 2.4% with excessive alcohol consumption. This excessive alcohol consumption was associated with sex (men) (P< .001), with age (higher in young patients) (P< .001), with marital status (P< .001), with educational status (P=.009), with economic level (P=.002), with occupation (P< .001) and with people who live together (P< .001). On correcting these variables by sex, we found that there was a statistically significant association with age and economic level in men, and with marital status in women. Patients with excessive alcohol consumption used fewer drugs and psychiatric drugs than patients without excessive alcohol consumption, though the figure for psychiatric drugs had no statistical significance. CONCLUSIONS: Excessive alcohol consumption is higher in men, in separated and divorced people, and in those with a high economic level and becomes lower with age. Patients with excessive alcohol consumption use fewer drugs and psychiatric drugs.

Consumo excesivo de alcohol en la población geriátrica y su relación con los psicofármacos / Excessive consumption of alcohol by the geriatric population and its relationship with psychiatric drugs

Objetivo. Describir el consumo excesivo de alcohol en individuos geriátricos y su relación con el tratamiento con psicofármacos. Diseño. Estudio descriptivo, transversal. Emplazamiento. Comunitario. Participantes. Muestra representativa de la población mayor de 59 años de la ciudad de Zaragoza. Mediciones principales. Mediante una entrevista clínica personal se recogieron las siguientes variables: edad, sexo, estado civil, nivel de estudios, nivel económico, vida laboral, convivencia y consumo de medicamentos, psicofármacos y alcohol. Resultados. En la muestra hemos encontrado un 2,4% de sujetos bebedores excesivos de alcohol. El consumo excesivo de alcohol tiene relación con el sexo (varones) (p < 0,001), la edad (mayor en jóvenes) (p < 0,001), el estado civil (p < 0,001), el nivel de estudios (p = 0,009), el nivel económico (p = 0,002), la vida laboral (p < 0,001) y la convivencia (p < 0,001). Al corregir estas variables según el sexo, mantienen una asociación estadísticamente significativa la edad y el nivel económico en varones, y el estado civil en mujeres. Los sujetos con un consumo excesivo de alcohol utilizan menos medicamentos y psicofármacos que los que no son consumidores excesivos de alcohol, aunque los primeros de forma estadísticamente no significativa. Conclusiones. El consumo excesivo de alcohol es mayor en varones, separados o divorciados y de nivel económico alto, y en los más jóvenes. Los sujetos con un consumo excesivo de alcohol son menos consumidores de medicamentos y psicofármacos

Objective. To describe excessive alcohol consumption in the geriatric population and its association with treatment with psychiatric drugs. Design. Transversal, descriptive study. Setting. Community. Participants. A representative sample of the population over 59 years old in the city of Zaragoza, Spain. Main measurements. Using a personal clinical questionnaire, we collected the following data: age, sex, marital status, educational status, economic level, occupation, people who live together, and drug, psychiatric drug, and alcohol consumption. Results. In our sample there were 2.4% with excessive alcohol consumption. This excessive alcohol consumption was associated with sex (men) (P<.001), with age (higher in young patients) (P<.001), with marital status (P<.001), with educational status (P=.009), with economic level (P=.002), with occupation (P<.001) and with people who live together (P<.001). On correcting these variables by sex, we found that there was a statistically significant association with age and economic level in men, and with marital status in women. Patients with excessive alcohol consumption used fewer drugs and psychiatric drugs than patients without excessive alcohol consumption, though the figure for psychiatric drugs had no statistical significance. Conclusions. Excessive alcohol consumption is higher in men, in separated and divorced people, and in those with a high economic level and becomes lower with age. Patients with excessive alcohol consumption use fewer drugs and psychiatric drugs