Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores / Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly

Objetivo: El principal objetivo del estudio es determinar los factores relacionados con la fragilidad y el desequilibrio de la estabilidad psicosocial en los mayores que residen en la comunidad. Métodos: Estudio prospectivo multicéntrico sobre una muestra representativa de las personas mayores de 75 años que residen en la comunidad en la provincia de Huesca. Seguimiento a 5 años con evaluaciones periódicas semestrales. Entrevista individual estandarizada realizada por médicos de atención primaria entrenados para evaluar depresión, ansiedad, deterioro cognoscitivo, síntomas psicóticos, sarcopenia, red de apoyo social, dependencia para las actividades básicas e instrumentales de la vida diaria, gravedad física, riesgo de dependencia y calidad de vida. Evaluación a los 2 y 5 años después para cuantificar acontecimientos adversos: institucionalización, dependencia funcional o mortalidad. Se valorarán posibles factores de riesgo: sexo, edad, situación social, situación funcional, situación psíquica y gravedad física. Se diseñarán modelos predictivos y de cuantificación del riesgo individual para definir finalmente las personas mayores con alta fragilidad psicosocial y riesgo de desestabilización. Conclusiones: Conociendo los posibles factores de riesgo, sería posible definir al anciano con gran riesgo o mayor fragilidad psicosocial, y aplicarlo a actividades preventivas dirigidas a reducir la fragilidad y los acontecimientos adversos asociados (institucionalización, mortalidad, etc.) (AU)

Objective: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. Methods: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. Conclusions: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.) (AU)

[Estimation of arterial oxygen saturation in relation to altitude]. / Estimación de la saturación arterial de oxígeno en función de la altitud.

BACKGROUND AND OBJECTIVES: Arterial Oxygen Saturation (AOS) predicts altitude sickness. OBJECTIVES: To estimate the AOS values with relation to altitude. Furthermore, make a graph to use during activity which assesses the AOS for each altitude and the normal range. PATIENTS AND METHOD: Values of AOS were assessed during eight high mountain activities in the Alps, Himalaya, Caucasus and Andes; 53 mountaineers participated, 17 of them in more than one activity; 761 measurements of AOS were registered. RESULTS: A Logistic Regression Model was made to estimate the AOS values dependent on altitude, adjusted to possible related factors. A strong lineal relationship exists between altitude and AOS (R2=.83, P<.001); .7 points more in women. The AOS in a particular altitude is not related to age, weight, height, smoking, heart rate, or even with previous experiences in mountains. The calculation of the AOS responds to the follow equation: Blood Oxygen Saturation=103.3-(altitude × .0047)+(Z), being Z=.7 in men and 1.4 in women. A scatter plot was made to relate the estimated altitude with the AOS, with their normal limits values: percentiles 2.5 and 97.5. CONCLUSIONS: The simple calculation of the AOS estimated for a particular altitude with the proposed graphic can help in the early decision-making onsite.

[Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly]. / Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores.

OBJECTIVE: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. METHODS: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. CONCLUSIONS: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.).

Estimación de la saturación arterial de oxígeno en función de la altitud / Estimation of arterial oxygen saturation in relation to altitude

Fundamento y objetivos. La saturación arterial de oxígeno (SAO) es capaz de predecir el desarrollo de mal de altura. Objetivos: estimar los valores de SAO en función de la altitud y, adicionalmente, diseñar un gráfico para usar sobre el terreno que muestre la saturación esperada para cada altitud y sus límites de normalidad. Pacientes y método. Se registraron valores de SAO a los participantes de 8 actividades de alta montaña en los Alpes, el Himalaya, el Cáucaso y los Andes. Participaron 53 montañeros; 17 de ellos repitieron en más de una actividad. Se registraron 761 mediciones de SAO. Resultados. Se diseñó un modelo de regresión lineal múltiple para estimar los valores de SAO en función de la altitud, ajustados por distintos posibles factores relacionados. Existe una fuerte relación lineal entre altitud y SAO (R2=0,83, p<0,001), dando valores 0,7 puntos mayores en mujeres. La SAO a una determinada altitud no se relaciona con la edad, el peso, la talla, el tabaquismo, la frecuencia cardíaca ni con la experiencia previa en montaña. El cálculo de la estimación de la SAO responde a la siguiente ecuación: SAO=103,3-(altitud×0,0047)+(Z), siendo Z=0,7 en hombres y 1,4 en mujeres. Se ha diseñado una gráfica de coordenadas que relaciona la altitud con los valores estimados de SAO con sus límites de normalidad: percentiles 2,5 y 97,5. Conclusiones. La sencillez en el cálculo de la SAO estimada para una determinada altitud mediante la gráfica propuesta ayudará en la toma de decisiones precoces sobre el terreno (AU)

Background and objectives. Arterial Oxygen Saturation (AOS) predicts altitude sickness. Objectives: To estimate the AOS values with relation to altitude. Furthermore, make a graph to use during activity which assesses the AOS for each altitude and the normal range. Patients and method. Values of AOS were assessed during eight high mountain activities in the Alps, Himalaya, Caucasus and Andes; 53 mountaineers participated, 17 of them in more than one activity; 761 measurements of AOS were registered. Results. A Logistic Regression Model was made to estimate the AOS values dependent on altitude, adjusted to possible related factors. A strong lineal relationship exists between altitude and AOS (R2=.83, P<.001); .7 points more in women. The AOS in a particular altitude is not related to age, weight, height, smoking, heart rate, or even with previous experiences in mountains. The calculation of the AOS responds to the follow equation: Blood Oxygen Saturation=103.3-(altitude × .0047)+(Z), being Z=.7 in men and 1.4 in women. A scatter plot was made to relate the estimated altitude with the AOS, with their normal limits values: percentiles 2.5 and 97.5. Conclusions. The simple calculation of the AOS estimated for a particular altitude with the proposed graphic can help in the early decision-making onsite (AU)

Validación española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoración de los cambios de personalidad en pacientes con daño cerebral adquirido / Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury

Introducción. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de características (énfasis en las funciones motivacionales y emocionales, evaluación de las funciones ejecutivas ‘cognitivas’ en la vida cotidiana, estimación de la personalidad premórbida, valoración de la fiabilidad del informador) que hacen muy interesante su utilización tanto en la clínica como en la investigación. Objetivo. Validar en castellano la IRSPC para la evaluación de los ‘cambios de personalidad’ secundarios a las lesiones cerebrales de la corteza prefrontal en general y del área ventromedial en particular. Pacientes y métodos. Tras el proceso de traducción y adaptación de la guía de la escala al castellano, se realizó un estudio de validación con 31 pacientes con daño cerebral traumático y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmación. La validez del instrumento es confirmada por la validez concurrente (comparándolo con el inventario neuropsiquiátrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y después del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y válido para la exploración clínica, en el contexto de una evaluación integral de los síntomas derivados de las enfermedades neurológicas en general, y en particular de aquéllas en las que se encuentra involucrada la corteza prefrontal ventromedial (AU)

Introduction. The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the ‘cognitive’ executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. Aim. The aim of this study was the Spanish validation of the IRSPC, which evaluates the ‘personality changes’ secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. Patients and methods. After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. Results. The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). Conclusions. The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury (AU)

[Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury]. / Validacion española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoracion de los cambios de personalidad en pacientes con daño cerebral adquirido.

INTRODUCTION: The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the 'cognitive' executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. AIM: The aim of this study was the Spanish validation of the IRSPC, which evaluates the 'personality changes' secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. PATIENTS AND METHODS: After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. RESULTS: The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). CONCLUSIONS: The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury.

TITLE: Validacion española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoracion de los cambios de personalidad en pacientes con daño cerebral adquirido.Introduccion. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de caracteristicas (enfasis en las funciones motivacionales y emocionales, evaluacion de las funciones ejecutivas 'cognitivas' en la vida cotidiana, estimacion de la personalidad premorbida, valoracion de la fiabilidad del informador) que hacen muy interesante su utilizacion tanto en la clinica como en la investigacion. Objetivo. Validar en castellano la IRSPC para la evaluacion de los 'cambios de personalidad' secundarios a las lesiones cerebrales de la corteza prefrontal en general y del area ventromedial en particular. Pacientes y metodos. Tras el proceso de traduccion y adaptacion de la guia de la escala al castellano, se realizo un estudio de validacion con 31 pacientes con daño cerebral traumatico y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmacion. La validez del instrumento es confirmada por la validez concurrente (comparandolo con el inventario neuropsiquiatrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y despues del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y valido para la exploracion clinica, en el contexto de una evaluacion integral de los sintomas derivados de las enfermedades neurologicas en general, y en particular de aquellas en las que se encuentra involucrada la corteza prefrontal ventromedial.

Trastornos de la empatía en el daño cerebral traumático / Empathy disorders in traumatic brain damage

Introducción. La cognición social es un concepto teórico complejo que engloba muchas funciones mentales superiores de elevado nivel. Dentro de ella se incluye la empatía, que es un aspecto fundamental y suficientemente relevante para ser evaluado de forma independiente; sin embargo, ha sido una de las áreas menos estudiadas en el campo del daño cerebral traumático. Pacientes y métodos. Se estudia una muestra amplía de afectados de daño cerebral traumático, evaluando en ellos la disminución de la capacidad empática. Para ello, hemos utilizado uno de los instrumentos validados en nuestro medio: el Interpersonal Reactivity Index. El estudio se ha completado utilizando parcialmente el modelo de ejecutores sociales de Eslinger, por considerar que la personalidad premórbida y otros factores influyen en la expresión clínica de los cambios en la respuesta empática observados en los afectados de un daño cerebral traumático. Resultados y conclusiones. Respecto al porcentaje de afectados con disminución de la capacidad de empatía, nuestro resultado es similar a los documentados en los escasos estudios existentes sobre el tema. De acuerdo con los resultados obtenidos, el modelo de ejecutores sociales se ha constatado como un modelo válido para realizar un estudio longitudinal y analítico de los trastornos neuropsiquiátricos, en este caso de la empatía; objetivando cómo la personalidad y la inteligencia premórbida modulan la capacidad de empatizar en los afectados de una lesión traumática. Por último, las lesiones traumáticas derechas pueden ser un signo de alarma de los trastornos de la cognición social postraumáticos (AU)

Introduction. Social cognition is a complex theoretical concept that includes many great high level mental functions. Within this concept is included the empathy, which is so significant and relevant to be evaluated separately but it has been one of the least studied areas in traumatic brain injury. Patients and methods. A large sample of patients with a traumatic brain injury has been studied. The aim was to evaluate the decrease of the empathic ability. One of the validated instruments in our area has been used: the Interpersonal Reactivity Index. The study has been completed by using partially the Eslinger’s social executors model as we consider that clinic display of the empathic response changes observed in those with a traumatic brain injury are influenced by previous personality and other different factors. Results and conclusions. With regard to the percentage of empathic ability decrease our results are similar to those documented in the few existing studies on this subject. According to the results the Eslinger’s social executors model has been confirmed as a suitable model to carry out a longitudinal and analytical study of neuropsychiatric disorders like the empathy. We have realized that the empathic ability in traumatic brain injury is modulated by previous personality and intelligence. Finally, right hemisphere traumatic damage could be a warning signal in posttraumatic social cognition hanges (AU)

[Empathy disorders in traumatic brain damage]. / Trastornos de la empatia en el dano cerebral traumatico.

INTRODUCTION: Social cognition is a complex theoretical concept that includes many great high level mental functions. Within this concept is included the empathy, which is so significant and relevant to be evaluated separately but it has been one of the least studied areas in traumatic brain injury. PATIENTS AND METHODS: A large sample of patients with a traumatic brain injury has been studied. The aim was to evaluate the decrease of the empathic ability. One of the validated instruments in our area has been used: the Interpersonal Reactivity Index. The study has been completed by using partially the Eslinger's social executors model as we consider that clinic display of the empathic response changes observed in those with a traumatic brain injury are influenced by previous personality and other different factors. RESULTS AND CONCLUSIONS: With regard to the percentage of empathic ability decrease our results are similar to those documented in the few existing studies on this subject. According to the results the Eslinger's social executors model has been confirmed as a suitable model to carry out a longitudinal and analytical study of neuropsychiatric disorders like the empathy. We have realized that the empathic ability in traumatic brain injury is modulated by previous personality and intelligence. Finally, right hemisphere traumatic damage could be a warning signal in posttraumatic social cognition changes.

Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado / Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests

Objetivo: Estimar la prevalencia de deterioro cognitivo (DC) en ancianos de la comunidad. Evaluar el rendimiento diagnóstico de los principales test de cribado cognitivo usados en atención primaria: miniexamen cognoscitivo (MEC), test del reloj (TR), test de fluencia verbal (TFV) y test del informador (TIN). Calcular la concordancia entre ellos y su validez como pruebas de cribado. Diseño: Estudio descriptivo transversal. Participantes: Doscientos noventa y tres personas de ambos sexos, mayores de 64 años, residentes en la provincia de Huesca, seleccionados mediante muestreo aleatorizado sistemático. Marco muestral: base de datos de Tarjeta Sanitaria Individual. Ámbito provincial. Mediciones: Variables sociodemográficas básicas, y exploración del DC con MEC, TR, TFV y TIN. Resultados: En función del MEC y los diagnósticos previos, la prevalencia de DC es del 18,1% (IC del 95%: del 15,3 al 24,4%). Resultados: La concordancia del MEC con el resto de los test de cribado es moderada: con el TR kappa (κ)=0,40, con el de TFV: 0,33, con el TIN: 0,36. Resultados: La concordancia global del conjunto de los test cognitivos es moderada-baja: κ (Jackknife)=0,35 (IC del 95%: 0,269 a 0,444). Resultados: Considerando patrón de oro al MEC junto con el diagnóstico previo de DC, el TR presenta una sensibilidad del 78,3% y una especificidad del 76,9%; el TFV presenta el 80 y el 70%, respectivamente, y el TIN presenta el 76,7 y el 71,4%, respectivamente. El área bajo la curva ROC (receiver operating characteristics) del TFV es significativamente superior al resto. Conclusión: La concordancia entre los distintos test de cribado cognitivo es moderada. El TFV es el que mejor rendimiento diagnóstico presenta (AU)

Objective: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. Design: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. Participants: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. Participants: Main measurementsWe analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. Results: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3–24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. Conclusions: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy (AU)

[Diagnostic yield of cognitive tests applied in primary care. Consistency and validity of screening tests]. / Rendimiento diagnóstico de los test cognitivos aplicados desde atención primaria. Concordancia y validez de los test de cribado.

OBJECTIVE: To estimate the prevalence of cognitive impairment in elderly people living in the community. To assess the diagnostic yield of the main cognitive screening tests in Primary Care: the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Verbal Fluency Test (VFT) and the Informant Questionnaire test (IQ). We also calculated their correlation and validity. DESIGN: Descriptive study based on a personal interview by professionals using a standardised method to assess cognitive impairment. PARTICIPANTS: A total of 293 men and women, who were older than 64 years old and residing in the province of Huesca. The sample was recruited by systematic random sampling from the database of personal health care card. MAIN MEASUREMENTS: We analysed social and demographic variables (age, educational level, marital status) and the assessment of cognitive impairment by means of MMSE, CDT, VF, IQ tests. RESULTS: The prevalence of cognitive impairment with MMSE was 18.1% (95% CI: 15.3-24.4%). The correlation between MMSE and the other cognitive screening tests was moderate: CDT kappa=0.40; VF kappa=0.33; IQ kappa=0.36. Using the MMSE as a gold standard and the prior diagnosis of CI, the sensitivity of CDT was 78.3% and the specificity was 76.9%, 80%; there was 70% sensitivity and 76.7% specificity for the VF; and 71.4% for IQ respectively. The area under the VF ROC curve was significantly higher than the other tests. CONCLUSIONS: The agreement between cognitive impairment screening tests was moderate. The VF yielded better diagnostic accuracy.

[Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)]. / Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD).

OBJECTIVES: To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. DESIGN: Descriptive study based on personal interviews by professionals using a standardised method. SETTING: Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. PARTICIPANTS: Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. INTERVENTION: Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). MAIN MEASUREMENTS: The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). DISCUSSION: The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study.

Detección de factores relacionados con el desarrollo de trastornos mentales en la población geriátrica (PSICOTARD) / Screening for factors relating to the development of mental disorders in the geriatric population (PSICOTARD)

Objetivos. Detectar factores físicos, psíquicos, sociodemográficos y funcionales asociados con el desarrollo de trastornos mentales en los ancianos, determinar su magnitud, estimar el riesgo individual y preparar el terreno para un posterior estudio longitudinal que nos permita en el futuro definir el anciano con fragilidad psíquica en la comunidad y el diseño de modelos predictivos de deterioro mental en el anciano. Diseño. Estudio descriptivo mediante entrevistas personales realizadas por profesionales estandarizados. Emplazamiento. En total, 28 centros de salud de la provincia de Huesca (índice de envejecimiento > 24,6%). Participantes. Participarán 326 personas mayores de 64 años residentes en la provincia de Huesca (España). Intervención. Entrevista personal por profesionales estandarizados (30 médicos de familia y un becario psicólogo). Se valorará la presencia de deterioro cognitivo (Mini-Examen Cognoscitivo), depresión (Escala de depresión geriátrica de Yesavage), ansiedad (Subescala de ansiedad del test de Goldberg) y alucinaciones, ideas delirantes, obsesiones e ideas hipocondríacas (Geriatric Mental State-GMS). Mediciones principales. Se estimará la prevalencia de factores de riesgo: variables sociodemográficas (edad, sexo, estado civil, nivel educativo, convivencia), situación funcional (índice de Barthel), gravedad física (índice acumulativo de enfermedad), antecedentes patológicos (somáticos y psíquicos) y acontecimientos vitales estresantes en el último año. Se ajustará un modelo de regresión logística para determinar la magnitud del efecto de cada factor ajustado para todos los demás. Se estimará el riesgo individual para el desarrollo de cada enfermedad (depresión, ansiedad, deterioro cognitivo/demencia, síntomas psicóticos, ideas obsesivas). Discusión. La fiabilidad del cuestionario se garantiza con el empleo de tests diagnósticos de comprobada validez y fiabilidad, la estandarización de los investigadores y la realización de un pilotaje del cuaderno de recogida de datos

Objectives. To detect the physical, psychological, social-demographic, and functional factors that may involve risk of developing mental disorder in the elderly, to determine the magnitude of each factor and to do the groundwork for a future longitudinal study that will enable us to define the elderly with psychological fragility in the autonomous region and to design predictive models for mental deterioration in the elderly. Design. Descriptive study based on personal interviews by professionals using a standardised method. Setting. Twenty-eight primary care health centres in the province of Huesca, Spain, with an ageing rate over 24.6%. Participants. Three-hundred and twenty-six patients over 64 years and resident in the province of Huesca, Spain. Intervention. Personal interview conducted by health professionals (30 family doctors and a trainee psychologist). The following will be appraised: the presence of cognitive impairment (Mini-Mental State Examination), depression (Yesavage Geriatric Depression Scale), anxiety (Goldberg Scale of Anxiety), and presence of delusions, hallucinations, obsessions and hypochondria (Geriatric Mental State-GMS). Main measurements. The prevalence of the risk factors will be calculated: social and demographic variables (age, sex, marital status, education, living alone), functional status (Barthel index), the severity of physical disability (Cumulative Illness Rating Scale), pathological records (somatic and psychological), and stressful life events in the preceding year. A logistical regression model will be calculated to determine the weight of the effect of each factor adjusted for all the rest. Individual risk will be calculated for the development of each mental disorder (depression, anxiety, cognitive deterioration/dementia, psychotic symptoms, obsessions). Discussion. The reliability of the questionnaire is ensured by use of diagnostic tests of proven validity and reliability, prior training of researchers and use of a data-gathering pilot study