Depression subtypes and 5-years risk of mortality in aged 70 years: a population-based cohort study.

AIMS: To estimate the mortality risk related to different mood disorders in a geriatric sample of subjects aged 70 years and over without dementia. METHOD: All non-demented subjects at baseline who participate on a second phase of a population-based cohort study were included. Adjusted Cox proportional hazards models were used to determine the association between depression and 5-year survival of 451 elderly people without dementia originally recruited for a representative community dementia cohort study. Baseline evaluation included the Cambridge Mental Disorders of the Elderly Examination Schedule. Depressive disorders (major and minor episode) were assessed according DSM-IV criteria and classified according the age of onset (late vs. early). The late-onset depression was classified according to the presence or absence of depression-executive dysfunction syndrome (DEDS). RESULTS: The initial cohort size was 451 subjects, among which 10.9% (n = 49) suffered a major depressive episode and 10.4% (n = 47) a minor depressive disorder. Among the total affective disorders, 77.9% (n = 74) were late-onset depressions and 29.5% (n = 28) had executive dysfunction. After 5 years, the vital status of 94% (n = 424) of the participants was known and the mortality was 18.9% (n = 80). Late-onset major depressive episode with executive dysfunction was related to mortality after adjustment by age, gender, marital status, level of education, comorbidity (or health global status) and cognitive impairment (HR = 3.70; 95% CI = 1.55-8.83). The executive dysfunction was found to be an independent mortality risk factor (HR = 2.05; 95% CI = 1.15-3.64). CONCLUSIONS: There is a statistically significant association between mortality and late-onset major depression with executive dysfunction.

Valor económico anual de la asistencia informal en la enfermedad de Alzheimer / Annual economic cost of informal care in Alzheimer’s disease

Introducción. El coste indirecto asociado a la atención de los pacientes con enfermedad de Alzheimer (EA) lo asume principalmente la familia. Objetivo. Describir el coste asociado al tiempo de dedicación, su evolución anual, las características y la carga del cuidador asociada. Sujetos y métodos. Pacientes diagnosticados de EA no institucionalizados, seguidos ambulatoriamente en una unidad de diagnóstico y sus cuidadores principales. Estudio prospectivo y observacional de 12 meses de evolución. Se evaluaron las características clínicas del paciente a través del Cambrigde Cognitive Examination Revised, para la capacidad cognitiva; el Disability Assessment in Dementia, para la capacidad funcional, y el inventario neuropsiquiátrico, para los trastornos no cognitivos. Se recogieron los datos sociodemográficos a través del Cambridge Examination for Mental Disorders of the Elderly Revised. Se registró la dedicación del cuidador, sus características sociodemográficas y la carga (a través de la escala de Zarit). Resultados. La muestra estuvo formada por 169 pacientes y 169 cuidadores. El coste en el momento basal fue de 6.364,8 €/año, asociado principalmente al apoyo en actividades instrumentales. A los 12 meses se observó un incremento global del 29% (1.846,8 €/año). El incremento del coste se asoció a la discapacidad física (F = 25,2; gl = 1; p < 0,001), el deterioro cognitivo (F = 8,5; gl = 1; p = 0,004), la edad del paciente (F = 9,2; gl = 1; p = 0,003) y si el cuidador era o no el único (F = 20,4; gl = 1; p < 0,001). El coste de la asistencia explicó el 6,7% de la varianza total de la carga percibida por los cuidadores. Conclusiones. El coste indirecto medio de la atención fue de 6.364,8 €/año, con un incremento del 29% anual que se asoció a la discapacidad física y cognitiva, a la edad del paciente y a tener un solo cuidador (AU)

Introduction. The indirect cost associated with the care of patients with Alzheimer’s disease is taken on primarily by the family. Aim. To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. Subjects and methods. Non-institutionalized patients diagnosed with Alzheimer’s disease who are managed on an outpatient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient’s clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver’s dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. Results. Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 €/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 €/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. Conclusions. Care has a mean indirect cost of 6364.2 €/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver (AU)

[Annual economic cost of informal care in Alzheimer's disease]. / Valor económico anual de la asistencia informal en la enfermedad de Alzheimer.

INTRODUCTION: The indirect cost associated with the care of patients with Alzheimer's disease is taken on primarily by the family. AIM: To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. SUBJECTS AND METHODS: Non-institutionalized patients diagnosed with Alzheimer's disease who are managed on an out-patient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient's clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver's dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. RESULTS: Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 euro/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 euro/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. CONCLUSIONS: Care has a mean indirect cost of 6364.2 euro/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver.

Cross-cultural adaptation and psychometric validation of a Spanish version of the Quality of Life in Late-Stage Dementia Scale.

PURPOSE: The aim of the study was to develop a cross-cultural adaptation and to evaluate the validity and reliability of a Spanish version of the Quality of Life in Late-Stage Dementia (QUALID) scale. METHODS: Observational and cross-sectional validation study. The QUALID was translated according to standardised procedures. Internal consistency was assessed using Cronbach's alpha. The QUALID structure was assessed using a Principal Component Analysis (PCA). Inter-respondent (one rater asking two respondents) and inter-rater (two raters asking one respondent) reliability was assessed using the Intraclass Correlation Coefficient (ICC). The criterion validity (concurrent) was assessed by Spearman's correlation between the QUALID score and the QoL-Visual Analogue Scale (QoL-VAS) score. The construct validity (convergent) was assessed by Spearman's correlations between QUALID score and scores on the Pain-Visual Analogue Scale (Pain-VAS), on the Mini-Mental State Examination (MMSE) and on the Neuropsychiatric Inventory-Nursing Home (NPI-NH). RESULTS: A total of 160 elderly residents and 152 respondents at 8 long-term care centres in the province of Girona (Spain) participated in the study. Results showed satisfactory levels of internal consistency (Cronbach's alpha coefficients 0.74) and evidenced the multidimensionality of the scale. Three factors were identified (behavioural signs of discomfort, behavioural signs of social interaction and signs of negative affective mood). Acceptable inter-respondent reliability (ICC = 0.74) and high inter-rater reliability (ICC = 0.95) were found. The QUALID score was associated with the QoL-VAS score, suggesting a good concurrent criterion validity, and also with the Pain-VAS, the MMSE and the NPI-NH scores, suggesting good construct validity. CONCLUSIONS: Our evaluation of the psychometric properties of the Spanish version of the QUALID indicates that it is a reliable and valid instrument with an adequate capacity to distinguish between different clinical status.

Prevalence and risk factors of suspected elder abuse subtypes in people aged 75 and older.

OBJECTIVES: To assess the prevalence of suspected elder abuse subtypes and to identify related factors. DESIGN: Cross-sectional, population-based, descriptive study. SETTING: Eight rural villages in Girona, Spain. PARTICIPANTS: Six hundred seventy-six inhabitants aged 75 and older. MEASUREMENTS: All participants were interviewed in their homes using the study protocol, which includes an abuse screen used in previous elder abuse studies and questions about demographic, social, physical, psychiatric, cognitive, and social services variables. RESULTS: The mean age of the participants was 81.7 +/- 4.8; 58.2% were female. Prevalence of suspected neglect abuse was 16.0% (95% confidence interval (CI)=13.2-18.9), prevalence of psychosocial abuse was 15.2% (95% CI=12.8-18.2), prevalence of financial abuse was 4.7% (95% CI=3.0-6.4) and prevalence of physical abuse was 0.1% (95% CI=0.004-0.8). Psychosocial abuse was positively associated with depressive symptoms (odds ratio (OR)=1.65, 95% CI=1.01-2.72), social isolation (OR=0.35, 95% CI=0.18-0.69), and frequent bladder incontinence (OR=2.44, 95% CI=1.23-4.86). Neglect abuse was positively associated with social isolation (OR=0.52, 95% CI=0.27-0.99), use of social services (OR=1.83, 95% CI=1.05-3.20), and living arrangements (OR=5.29, 95% CI=2.65-10.56). Financial abuse was associated with marital status (OR=0.15, 95% CI=0.04-0.59), age 85 and older, (OR=3.84, 95% CI=1.70-8.68), and Mini-Mental State Examination score (OR=0.85, 95% CI=0.78-0.94). CONCLUSION: After adjustment for confounding factors, each subtype of suspected elder abuse was associated with different variables. The results of this study suggest that elder abuse cannot be analyzed as a unitary concept and that risk factors must be assessed for each abuse subtype.