Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people.

BACKGROUND: Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status. METHODS: We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998-1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models. RESULTS: The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70-1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46-0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98-1.86). The median life expectancy increased by 1.8 years (95% CI: -3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6-10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms. CONCLUSIONS: The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.

[Communication, diagnosis and treatment of urinary incontinence in the elderly in a basic health area]. / Comunicación, diagnóstico y tratamiento de la incontinencia urinaria en los ancianos de una zona básica de salud.

OBJECTIVE: To investigate the frequency in which aged people who suffers on urinary incontinence (UI) talk about this problem with primary care professionals, variables related to no healthcare-seeking as well as diagnostic and therapeutic habits of these professionals. DESIGN: Cross-sectional study.Location. Basic Health Zone of Cabra (Córdoba, Spain). PATIENTS: A random age-stratified sample of 869 patients selected from a total of 5139 persons >= 65 years of age.Interventions. Home interview. MEASUREMENTS: Proper questionnaire with questions about reporting of incontinence to health professionals and the procedures used for routine screening as well as diagnostic and therapeutic assessment of incontinence. A logistic regression model was elaborated to identify explanatory factors for reporting incontinence to healthcare professionals. RESULTS: Of 330 incontinents, only 32% reported their problem to healthcare professionals. The remaining 68% did not report their incontinence because most thought it was a minor problem and/or part of the ageing process. The explanatory factors for seeking medical help were the frequency, duration and impact of incontinence, and dependence in self-care. Physicians performed routine screening for incontinence in 10% of 827 inquired aged. In 1 out of 5 incontinents, the physician did not take any diagnostic or therapeutic measures. CONCLUSIONS: Seeking of UI medical help was very limited and depends on variables related to perception in symptom's changes. Diagnosis and treatment done by professionals was suboptimal. Severity of UI conditions diagnosis and treatment.

Comunicación, diagnóstico y tratamiento de la incontinencia urinaria en los ancianos de una zona básica de salud / Communication, diagnosis and treatment of urinary incontinence in the elderly in a health district

Objetivo. Conocer la frecuencia con que las personas ancianas con incontinencia urinaria (IU) comunican este problema a los profesionales de atención primaria, las variables asociadas a la no comunicación y los hábitos diagnósticos y terapéuticos de dichos profesionales. Diseño. Estudio transversal. Emplazamiento. Zona Básica de Salud de Cabra (Córdoba).Pacientes. Un total de 869 seleccionados entre 5.139 personas de 65 años mediante muestreo aleatorio estratificado por grupos de edad. Intervenciones. Encuesta domiciliaria. Mediciones. Cuestionario propio con preguntas sobre la comunicación de la incontinencia a los sanitarios y sobre el cribado rutinario y la evaluación diagnóstica y terapéutica de la incontinencia por dichos profesionales. Modelo de regresión logística para identificar los factores explicativos de la búsqueda de ayuda profesional. Resultados. Un 32 por ciento de los 330 incontinentes del estudio comunicó su problema a los sanitarios y el 68 por ciento restante no lo hizo, porque en su mayoría piensan que la incontinencia tiene escasa importancia y/o que ocurre con la vejez. Los factores explicativos de la comunicación fueron la frecuencia, la duración y el impacto de la incontinencia, y la dependencia en el autocuidado. Los médicos habían investigado rutinariamente la existencia de incontinencia en un 10 por ciento de los 827 encuestados. En uno de cada 5 incontinentes el médico no adoptó ninguna medida diagnóstica ni terapéutica. Conclusiones. La búsqueda de ayuda médica para la IU fue escasa y depende de variables relacionadas con la percepción en los cambios de los síntomas. El diagnóstico y el tratamiento que realizan los profesionales es subóptimo. La severidad de la IU condiciona el diagnóstico y el tratamiento (AU)

[Use of devices for urinary incontinence among the elderly of the basic health area of Cabra (Córdoba)]. / Uso de accesorios para incontinencia urinaria en los ancianos de la Zona Básica de Salud de Cabra (Córdoba).

AIMS: To study the proportion and characteristics of elderly people who use aids for urinary incontinence, and the economic cost of pads. DESIGN: Cross-sectional study. INTERVENTIONS: A specific questionnaire on urinary incontinence and Barthel and Lawton indexes; and economic analysis of the number of pads used. LOCATION: Basic Health Zone of Cabra (Córdoba). PATIENTS: 827, among a total of 5139 > or = 65 years-old subjects, by means of a random sampling, classified in age groups. MEASUREMENTS: Two sources of data were used: a home health interview gathering information about the use of aids; the register which controls the prescription of pads in the Basic Health Zone of Cabra. MAIN RESULTS: Urinary incontinence was detected in 36% of elderly people. Sixty-three percent of the incontinent people used some sort of aid, 8.1% used pads and 2.9% used an urethral catheter. The use of aids was related to advanced age, female gender and functional dependence. In 1996, the cost of the pads was 19,416,298 pesetas and 51,659 pesetas per incontinent person. CONCLUSIONS: The overall prevalence of the use of aids was greater than or similar to that of other studies whereas the use of pads was less. During 1996 the average cost of the pads per elderly person amounted to 49% of the theoretical maximum cost permitted by the health authority.

Prevalence and psychosocial impact of urinary incontinence in older people of a Spanish rural population.

BACKGROUND: The prevalence and the psychosocial impact of urinary incontinence in older people of a rural population were investigated. METHODS: A cross-sectional study was made by means of a home health interview in a representative sample of people aged 65 years and older in the Basic Health Zone of Cabra (Córdoba). A questionnaire was used with two questions to detect urinary incontinence and further questions regarding its duration, frequency, volume, severity and psychosocial impact. Data were analyzed with basic statistics. A logistic regression model was created to identify which factors affect people's lifestyles. RESULTS: Among the 827 respondents the prevalence of incontinence reached 36% [95% confidence interval (CI): 34%-38%] and was higher (p < .001) in women (42%; 95% CI: 39%-45%) than in men (29%; 95% CI: 25%-38%). The most frequent duration of incontinence was from 1 to 5 years (16.8%). Fifteen percent had daily episodes and 10.6% estimated the volume of urine loss as high. Incontinence was severe in 9% of the affected subjects. Half the incontinent subjects expressed social limitations and negative feelings related to incontinence, and 21% admitted that incontinence negatively affected their lives. In the logistic regression model, both volume of urine loss [odds ratio (OR) = 5.61; 95% CI: 2.76-11.42] and being married (OR = 2.34; 95% CI: 1.03-5.33) were the factors statistically associated with a negative influence of incontinence on lifestyle. CONCLUSIONS: Urinary incontinence is a very frequent symptom in our population. Half the incontinent subjects suffer from some degree of psychosocial limitation. The volume of urine loss and being married are the most important factors with psychosocial impact.

Uso de accesorios para incontinencia urinaria en los ancianos de la zona básica de salud de Cabra (Córdoba) / Use of accessories for urinary incontinence in the elderly of the cabra health area (cordoba)

Objetivos. Estudiar la proporción y características de los ancianos que utilizan accesorios para incontinencia urinaria y calcular el coste económico de los absorbentes. Diseño. Estudio transversal. Emplazamiento. Zona Básica de Salud de Cabra (Córdoba). Pacientes. Un total de 827, entre 5.139 personas >= 65 años, seleccionados mediante muestreo aleatorio estratificado por grupos de edad. Mediciones y resultados principales. Cuestionario específico sobre incontinencia urinaria e índices de Barthel y de Lawton. Análisis económico de los absorbentes consumidos. Se utilizaron dos fuentes de datos: encuesta domiciliaria, con recogida de información sobre uso de accesorios y el fichero de visado de absorbentes de la Zona Básica de Salud de Cabra. Se detectó incontinencia urinaria en un 36 por ciento de los ancianos. El 63 por ciento de los incontinentes utilizaba algún accesorio, un 8,1 por ciento usaba absorbentes y el 2,9 por ciento catéter uretral. El uso de accesorios se asoció a edad avanzada, género femenino y dependencia funcional. En 1996 el coste de los absorbentes en la Zona Básica de Salud de Cabra fue de 19.416.298 pts. y de 51.639 por anciano incontinente. Conclusiones. La prevalencia global del uso de accesorios fue superior o similar a la de otros estudios sobre incontinencia y la de absorbentes menor. El coste medio de los absorbentes por anciano durante 1996 representó un 49 por ciento del coste máximo permitido por la Inspección Sanitaria (AU)

[Drug consumption by the elderly: results of population studies]. / Consumo de medicamentos en los ancianos: resultados de un estudio poblacional.

BACKGROUND: To evaluate the magnitude, nature and chronicity of the use of medications on the part of non-institutionalized elderly individuals as well as the complexity of their treatment routine. METHOD: Cross-section study through door-to-door survey of all individuals age 65 or above. Municipality of Villanueva de los Castillejos (Huelva). The surveyor asked the person to show him/her all of the medications he/she was using without overlooking any, recorded the brand name, dosage and frequency with which the medication in question was taken, and the approximate length of time, in months or in years, over which said medication had been taken. Measurement methods were included for the purpose of assessing the complexity of the treatment routine. RESULTS: Information was gathered from 362 subjects (83.8% of the actual population). Of all those surveyed, 83.1% was taking one or more medications daily, for an average (standard deviation) of 2.6 (2.0). Those used most were antihypertensive drugs (41.8%), peripheral vasodilators for circulation to the brain (21.3%), benzodiazepine derivatives (17.4%) and nonsteroid antiinflammatory drugs (14.1%). 91.3% and 46.1% of the subjects who were taking medication daily, had been taking one or more drugs for at least 1 and 5 years, respectively. The medication in question was taken on the average of one to two times a day. Approximately 20% of the population surveyed was taking medication solely when certain symptoms arose, and 7.3% of the drugs were prescribed regularly, but not daily. CONCLUSIONS: The quantity and chronicity of the consumption of medications is high, although comparable to that of other Spanish studies conducted employing similar means and methods. The routine prescribed seems simple for seniors.

Previous disability as a predictor of outcome in a geriatric rehabilitation unit.

BACKGROUND: Functional status at admission has been shown consistently to predict rehabilitation results, but the impact of previous disability has been seldom considered. METHODS: A prospective follow-up study of elderly patients admitted to a geriatric rehabilitation unit in Madrid, Spain, was carried out. The study population comprised 135 subjects aged 65 years or older, who were consecutively admitted during a 7-month period. Outcome variables included the Barthel Index (BI) at discharge, the improvement in BI from admission to discharge, the achieved percentage of potential gain, and the efficiency of gains. Previous BI, admission BI, diagnosis, source (hospital/others), mental status, age, and gender were examined as explanatory variables. RESULTS: In multiple regression analysis, previous BI was the only significant independent predictor for all the outcome variables. For each 5-point increase in previous BI, the increase in BI at discharge was 1.7 (p = .007). Corresponding values for the achieved percentage of potential gain and for the efficiency of gains were 0.05 (p = .01) and 0.05 (p = .04), respectively. Except for the achieved percentage of potential gain, admission BI and source of referral were also independent significant predictors of outcome. CONCLUSIONS: Previous functional situation of elderly people is important to predict rehabilitation outcome, even after taking into account information on disability at admission. As a consequence, a measure of the achieved percentage of potential gain corrected by the preadmission functional status is proposed, especially in the case of elderly patients.

[Dependence on self-care and walking of the aged in a rural community]. / Dependencia en el autocuidado y deambulación en los ancianos de una comunidad rural.

OBJECTIVE: To evaluate the dependence on 5 basic daily activities (BDA) and on walking, and their relationship to the frequency of attendance at the family doctor. DESIGN: A crossover study using a home survey of health. SETTING: Town of Villanueva de los Castillejos in Huelva. PARTICIPANTS: Those 65 or over. INTERVENTIONS: The dichotomous form of the Katz Index, with the incontinence item excluded (scores from 0-5), was used. Walking was assessed by the Functional Walking Categories (FWC) of Massachusetts General Hospital. RESULTS: Information on 139 men and 231 women was obtained (85.6% of the actual population). 15.3% (95% CI, 11.3-19.0), 12.4% of the men and 16.9% of the women (p > 0.05), stated their dependence in one or more BDA. 22.5% of the population (95% CI, 18.2-26.8), 8.9% of the men and 30.6% (p = 0.001) of the women, said they found it difficult to walk. CONCLUSIONS: There is a high rate of dependence in the population group. Light dependence is associated with more frequent medical consultations than either independence or severe dependence.