[Predictive value of the quality of life questionnaire in the elderly]. / Validez predictiva de mortalidad del cuestionario de calidad de vida en ancianos.

OBJECTIVE: To evaluate the predictive value of the quality of life (QOL) questionnaire at 8 years and analyse which of its 5 dimensions better predict adverse results in health. DESIGN: Descriptive, longitudinal, and retrospective study. SETTING: Three basic health areas in Cuenca province, Spain. PARTICIPANTS: We randomly selected 519 subjects over 64 years, taking addresses in which more than 1 person over 64 years resided as a sample marker. MAIN MEASUREMENTS: The QOL questionnaire was used to evaluate the quality of life of the subjects in 1994 and in 2002. Main results. Between 1994 and 2002, 25% of the participants died, 2.6% were institutionalised and there 3.6% losses. The QOL questionnaire has a mortality predictive capacity at 8 years, the cut off point of its global index being situated around 13 points. The sensitivity of the model is poor (41.5%), with a high specificity (93.5%) and a good classification percentage of 80.3%. The positive and negative probability ratios were 6.36 and 0.62, respectively. Using a Cox regression model, it is seen that of the 5 dimensions of the QOL test, activities of daily living show a relationship with mortality (risk ratio or OR=1.3; 95% confiance interval [CI], 1.049-1.611), mental health (OR=1.048; 95% CI, 1.054-1.620), and economic resources (OR=0.806; 95% CI, 0.648-1.003). CONCLUSIONS: The QOL questionnaire has a mortality predictive capacity at 8 years.

Validez predictiva de mortalidad del cuestionario de calidad de vida en ancianos / Predictive value of the quality of life questionnaire in the elderly

Objetivo. Evaluar la validez predictiva del cuestionario calidad de vida en ancianos (CVA) a 8 años y analizar cuál o cuáles de sus 5 dimensiones predicen mejor los resultados adversos en salud. Diseño. Estudio descriptivo, longitudinal y retrospectivo. Emplazamiento. Tres zonas básicas de salud de la provincia de Cuenca. Participantes. Se incluyeron 519 individuos mayores de 64 años seleccionados aleatoriamente tomando como marco muestral los domicilios en los que residía al menos una persona mayor de 64 años. Mediciones principales. Se utilizó el cuestionario CVA para evaluar la calidad de vida de los individuos en 1994 y en 2002. Resultados principales. Entre 1994 y 2002, falleció el 25% de los participantes, fue ingresado en instituciones un 2,6% y se produjo un 3,6% de pérdidas. El cuestionario CVA tiene capacidad predictiva de mortalidad a 8 años, y el punto de corte de su índice global se sitúa en torno a los 13 puntos. La sensibilidad del modelo es pobre (41,5%), con una especificidad alta (93,5%) y un porcentaje de buenas clasificaciones del 80,3%. Las razones de probabilidad positiva y negativa fueron 6,36 y 0,62, respectivamente. Mediante un modelo de regresión de Cox se aprecia que de las 5 dimensiones del test CVA tienen relación con la mortalidad las actividades de la vida diaria (razón de riesgos o HR = 1,3; intervalo de confianza [IC] del 95%, 1,049-1,611), la salud mental (HR = 1,048; IC del 95%, 1,054-1,620) y los recursos económicos (HR = 0,806; IC del 95%, 0,648-1,003). Conclusiones. El cuestionario CVA posee capacidad para predecir la mortalidad a 8 años

Objective. To evaluate the predictive value of the quality of life (QOL) questionnaire at 8 years and analyse which of its 5 dimensions better predict adverse results in health. Design. Descriptive, longitudinal, and retrospective study. Setting. Three basic health areas in Cuenca province, Spain. Participants. We randomly selected 519 subjects over 64 years, taking addresses in which more than 1 person over 64 years resided as a sample marker. Main measurements. The QOL questionnaire was used to evaluate the quality of life of the subjects in 1994 and in 2002. Main results. Between 1994 and 2002, 25% of the participants died, 2.6% were institutionalised and there 3.6% losses. The QOL questionnaire has a mortality predictive capacity at 8 years, the cut off point of its global index being situated around 13 points. The sensitivity of the model is poor (41.5%), with a high specificity (93.5%) and a good classification percentage of 80.3%. The positive and negative probability ratios were 6.36 and 0.62, respectively. Using a Cox regression model, it is seen that of the 5 dimensions of the QOL test, activities of daily living show a relationship with mortality (risk ratio or OR=1.3; 95% confiance interval [CI], 1.049-1.611), mental health (OR=1.048; 95% CI, 1.054-1.620), and economic resources (OR=0.806; 95% CI, 0.648-1.003). Conclusions. The QOL questionnaire has a mortality predictive capacity at 8 years

[Social inequality and changes in quality of life among the elderly in rural areas of the Province of Cuenca (Spain) between 1994 and 2002]. / Desigualdades sociales y cambios en la calidad de vida de los ancianos en el medio rural de Cuenca entre 1994 y 2002.

OBJECTIVE: To evaluate changes in quality of life (QoL) in a sample of elderly community-dwelling individuals. Overall QoL was evaluated, in addition to the dimensions of physical health (PH), mental health (MH), activities of daily living (ADL), economic resources (ER) and social resources (SR). MATERIALS AND METHODS: Of a sample of 918 persons aged more than 64 years old in the Province of Cuenca (Spain), QoL was measured in 519 in 1994 by means of the Quality of Life for the Elderly (QLE) questionnaire, developed from the OARS-MFAQ Older Americans Resources and Services Multidimensional Functional Assesment Questionaire. In 2002, with a 3.6% loss, the QLE was administered again in all participants that were still alive and non-institutionalized. The results were compared for the two periods and the factors associated with variation in QoL were estimated by means of multiple regression analysis. RESULTS: Of the 519 participants at baseline, 130 died (25%) and 14 (12.7%) were institutionalised. Elderly individuals who were still alive in 2002 showed a general worsening in their overall QoL, specifically in the variables of ADL, PH and MH. However, after adjusting for age, we found that overall QoL was better in 2002 than in 1994. Logistic regression revealed that the factors associated with a lesser decrease in QoL were education, being male, lower age, and being widowed. CONCLUSIONS: QoL in community-dwelling elderly individuals in the Province of Cuenca improved between 1994 and 2002.

Desigualdades sociales y cambios en la calidad de vida de los ancianos en el medio rural de Cuenca entre 1994 y 2002 / Social inequality and changes in quality of life among the elderly in rural areas of the province of Cuenca (Spain) between 1994 and 2002

Objetivo: valorar los cambios en la calidad de vida de una muestra de ancianos que viven en la comunidad, tanto de forma global (IGCV), como en las dimensiones de salud física (SF), salud mental (SM), actividades de la vida diaria (AVD), recursos económicos (RE) y recursos sociales (RS).Material y métodos: de una muestra de 918 individuos mayores de 64 años de la provincia de Cuenca, se midió, en 1994, la calidad de vida de 519, mediante el cuestionario de calidad de vida en ancianos (CVA) desarrollado a partir del OARS-MFAQ (Older Americans Resources and Services Multidimensional FunctionalAssesment Questionaire). En 2002, con un 3,6% de pérdidas, se administró de nuevo el CVA a aquellos que permanecían vivos y no institucionalizados. Se compararon los resultados en los dos períodos de estudio, y mediante análisis de regresión múltiple seestiman los factores asociados a la variación de la calidad de vida.Resultados: de los 519 participantes del estudio, 130 (25%) fallecieron y 14 (2,7%) fueron institucionali-zados. Los ancianos que permanecían vivos en 2002 empeoraron su CV en general y, más concretamente, en las dimensiones de AVD, SF y SM. Sin embargo, ajustando por edad, el IGCV mejoró en 2002 respecto a 1994. Mediante regresión logística encontramos asociados a unmenor empeoramiento en la CV tener estudios, ser varón, tener una edad inferior y estar viudo.Conclusiones: la calidad de vida de los ancianos no institucionalizados de Cuenca mejoró entre los años 1994 y 2002

Objective: to evaluate changes in quality of life (QoL) in a sample of elderly community-dwelling individuals. Overall QoL was evaluated, in addition to the dimensions of physical health (PH), mental health (MH), activities of daily living (ADL), economic resources (ER) and social resources (SR).Materials and methods: of a sample of 918 persons aged more than 64 years old in the Province of Cuenca (Spain), QoL was measured in 519 in 1994 by means of the Quality of Life for the Elderly (QLE) questionnaire, developed from the OARS-MFAQ Older Americans Resources and Services Multidimensional Functional Assesment Questionaire. In 2002, with a 3.6% loss, the QLE was administered again in all participants that were stillalive and non-institutionalized. The results were compared for the two periods and the factors associated with variation in QoL were estimated by means of multiple regression analysis.Results: of the 519 participants at baseline, 130 died (25%) and 14 (12.7%) were institutionalised. Elderly individuals who were still alive in 2002 showed a general worsening in their overall QoL, specifically in the variables of ADL, PH and MH. However, afteradjusting for age, we found that overall QoL was better in 2002 than in 1994. Logistic regression revealed that the factors associated with a lesser decrease in QoL were education, being male, lower age, and being widowed.Conclusiones: QoL in community-dwelling elderly individuals in the Province of Cuenca improved between 1994 and 2002

[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