A higher level of education amplifies the inverse association between income and disability in the Spanish elderly

Sociodemographic Factors Associated with Physical Functioning in Elderly Males and Females from Serbia: Population-Based Modeling Study

Background and aim: During the past few decades, the aging population has increased. With aging, there is an increase in functional limitations. The aim of this study was to analyze sociodemographic factors associated with physical functioning impairment in elderly males and females. Methods: This population-based modeling study based on a data from a third national study of health of Serbian inhabitants from 2013 in Serbia included 3540 elderly participants 65 years of age and above from Serbia. Physical functioning for both genders was categorized as follows: PF1-walking half a kilometer on level ground without the assistance of any mobility aids and PF2-walking up or down 12 steps. Modeling of physical functioning for both genders was categorized as follows: Model 1: inability to perform PF1, Model 2: some/a lot of difficulty in performing PF1, Model 3: inability to perform PF2, and Model 4: some/a lot of difficulty in performing PF2. Further variables were evaluated: age, education level, marital status, body mass index (BMI), wealth index, and place of residence. Logistic regression was performed to identify the variables that are factors associated with PF1 and PF2 in elderly males and females. Results: Statistically significant factors were as follows: age (Model 1 (male OR: 2.591; female OR: 4.708); Model 2 (male OR: 1.791; female OR: 2.354); Model 3 (male OR: 2.386; female OR: 4.985); Model 4 (male OR: 1.883; female OR: 2.772)); BMI (Model 2 (female OR: 1.348); Model 4 (female OR: 1.329)), marital status (Model 2 (female OR: 0.713); Model 4 (male OR: 0.688)); education level (Model 1 (male OR: 0.626; female OR: 0.537); Model 2 (male OR: 0.811; female OR: 0.653); Model 3 (male OR: 0.697; female OR: 0.494); Model 4 (male OR: 0.784; female OR: 0.639)); wealth index (Model 2 (male OR: 0.823; female OR: 0.740); Model 3 (male OR: 0.724); Model 4 (male OR: 0.787; female OR: 0.731)); and place of residence (Model 1 (female OR: 1.704); Model 3 (female OR: 1.575)). Conclusions: Increased age, being single, a lower education level, and a lower wealth index were factors associated with functional disability in the elderly of both genders, while an increased BMI and living in another place than a city were factors associated with functional disability in elderly females. Specific social strategies bearing in mind possible gender differences should be created and implemented in order to optimize the physical functioning, mobility, and participation of the elderly.

Socioeconomic Inequalities as a Cause of Health Inequities in Spain: A Scoping Review

The objectives of this review were to identify the population groups most frequently studied, to determine the methods and techniques most commonly used to show health inequities, and to identify the most frequent socioeconomic and health indicators used in the studies on health inequities due to socioeconomic inequalities that have been carried out on the Spanish healthcare system. A scoping review was carried out of the studies conducted in the Spanish State and published in literature since 2004, after the publication of the Law of Cohesion and Quality of the National Health System. The PRISMA extension for scoping reviews was followed. The methodological quality of the studies was assessed using the critical reading guides of the Joanna Briggs Institute and an adaptation of the STROBE guide for ecological studies. A total of 58 articles out of 811 articles were included. Most of the articles were (77.59%, n = 45) cross-sectional studies, followed by ecological studies (13.8%, n = 8). The population group used was uneven, while the main geographical area under investigation was the whole state (51.7%, n = 30) compared to other territorial distributions (48.3%, n = 28). The studies used a multitude of health and socioeconomic indicators, highlighting self-perception of health (31.03%, n = 19) and social class (50%, n = 29). The relationship between better health and better socioeconomic status is evident. However, there is variability in the populations, methods, and indicators used to study health equity in Spain. Future health research and policies require greater systematization by public institutions and greater cooperation among researchers from disciplines such as sociology, economics, and health.

Functional difficulties and toileting among older adults in Ghana: evidence from the World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 1

Ghana's older population is projected to increase in coming decades and as a result will see increasing care needs. Understanding the functional difficulties older adults experience, and the associated factors, will help identify relevant intervention to assist older adults in meeting their care needs. This study aimed to analyse the prevalence of functional difficulties among older adults in Ghana, and examine how the World Health Organization International Classification of Functioning, Disability and Health (WHO-ICF) conceptual framework can relate to toileting difficulty to understand the factors that increase older adults’ care needs. Data were for 5,096 adults aged ⩾50 years from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1. Difficulties were assessed using self-reported difficulty on 22 functional items, including toileting. Multivariate logistic regression tested associations between toileting and other factors as related to the WHO-ICF conceptual framework. Older adults reported climbing one flight of stairs without resting as a common functional difficulty. Difficulty eating was the item least identified. Toileting difficulty was ranked second among five total activities of daily living difficulties. Age, marital status, self-reported health, memory, bodily pain, short- and far-distance vision, obesity, stroke, chronic lung disease, trust at individual and neighbourhood level, toilet facility type, socialising with co-workers, and public and religious meeting attendance were statistically significantly associated with toileting difficulty in the final parsimonious model. Post-hoc analysis testing interaction revealed that interaction existed between female sex and never married marital status (p = 0.04), and obesity and widowed marital status (p = 0.01), with toileting as the outcome. A significant level of functional difficulty existed among Ghanaian older adults in this sample. Toileting difficulty was associated with factors across different components in the WHO-ICF, emphasising functional, social and environmental factors related to this fundamental human activity.

The relationships among self-efficacy, social support, and self-care behavior in the elderly patients with chronic pain (a STROBE-compliant article)

The relationships among the self-efficacy, social support and self-care behavior in the elderly patients with chronic pain has not been reported. Therefore, we explored the relationships among self-efficacy, social support and self-care behavior in the elderly patients with chronic pain.General data questionnaire, self-efficacy scale, social support scale and self-care behavior scale were performed in 1032 elderly patients with chronic pain from Shenyang city between February and December 2017. The relationships among self-efficacy, social support and self-care behavior, and self-efficacy as a mediator between the social support and self-care behavior were analyzed by Pearson correlation analysis and Bootstrap method.In these elderly patients with chronic pain, the total scores of the self-efficacy, social support and self-care behavior were 35.59 ± 12.38, 65.64 ± 19.68 and 50.52 ± 15.26, respectively. The self-efficacy was positively correlated with the self-care behavior (r = 0.414, P < .001), the self-efficacy was positively correlated with the social support (r = 0.293, P < .001) and the social support was positively correlated with the self-care behavior (r = 0.322, P < .001). The mediating effect of self-efficacy was 0.121 which accounted for 27.31% of the total effects.The self-efficacy plays a mediating effect between social support and self-care behavior in the elderly patients with chronic pain.

[Socioeconomic inequalities in health among the elderly population in Spain]

OBJECTIVE

To examine socioeconomic inequalities in health in the older population in Spain.

METHOD

A systematic search and review of the literature published between 2000 and 2017 in English and Spanish was conducted in Social Science Citation Index, Sociology Database, Scopus, PubMed and Embase. Primary and secondary studies analysing these inequalities in Spain were included. Two researchers were responsible for the selection of the studies and the extraction of the information (first author, year of publication, region, design, population/sample, socioeconomic and health indicators used, and main results).

RESULTS

A total of 89 articles were included, corresponding to 87 studies. Of the studies, 81.6% were cross-sectional, 88.5% included only non-institutionalised population and 35.6% were carried out at a national level. The studies analysed social inequalities in the following health indicators: functional status (n=29), morbidity (n=19), self-perceived health (n=18), mental and emotional health (n=10), cognitive status (n=7), quality of life (n=9), mortality (n=15) and life expectancy (n=2). Socioeconomic inequalities were detected in all of them, although the magnitude varied depending on the socioeconomic and health indicator used. The educational level and the ecological indexes were the indicators that detected more inequalities in health. The impact of inequalities by sex was different in functional status, morbidity, self-perceived health, mental and emotional health and mortality.

CONCLUSION

There are socioeconomic inequalities in health among the elderly population and their magnitude varies by sex in some of the health indicators. The increase in educational level and the maintenance of sufficient pensions can be key policies that contribute to the reduction of inequalities in this population group.

[Social inequalities in health among the elderly population: review of indicators used in Spain]

OBJECTIVE

To identify the indicators of social position used to evaluate inequalities in health among the population aged 65 and over in Spain.

METHOD

A systematic search of the literature published in English and Spanish since 2000 in health and social databases was carried out. Primary and secondary studies analyzing these inequalities in Spain were included. The indicators used were identified, as well as the advantages and limitations pointed out by the authors. The main findings were synthesized in a review of the literature.

RESULTS

We included 87 studies, described in 89 articles. The socioeconomic indicators employed were both individual and ecological. Among the former, educational level was the most analyzed socioeconomic variable (n=73). Other individual variables used were occupation (n=17), objective economic level (n=16), subjective economic level (n=4), housing and household material wealth (n=6), relationship with work activity (n=5), and mixed measures (n=5). Among the ecological indicators, simple (n=3) and complex indices (n=7) were identified. The latter had been constructed based on several indicators, such as educational level and unemployment. Inequalities in multiple health indicators were analyzed, self-perceived health being the only indicator assessed according to all the socioeconomic indicators described.

CONCLUSIONS

A wide variety of indicators is identified for the evaluation of social inequalities in health among the elderly population. There have not been sufficiently assessed from a gender perspective; this is a line of interest for future research.

Successful Aging in Colombia: The Role of Disease

Objective: This study aimed to determine the prevalence of successful aging (SA) and identify its predictive factors in a cohort of older people in the Colombian Andes Mountain. Method: Data were drawn from a prospective longitudinal study of community-dwelling elderly people in Manizales. SA encompassed indicators in four domains: physical, cognitive, emotional, and social functioning. Results: The prevalence of SA was 24.4%. The independent predictors were good and very good self-rated health, middle–high/high-income level, absence of chronic conditions, married status, high educational level, and very high spirituality. Discussion: The prevalence of SA was low: One of 10 people older than 65 years showed SA when presence of diseases was included in the criteria, compared with one of four when such an item was excluded. The identification of predictive factors allows distinguishing this population in primary care services and promoting strategies that ensure high functionality levels for as long as possible.

Socioeconomic position and disability: "The Belo Horizonte, Brazil Health Study"

This study aims to investigate the association of socioeconomic status and comorbidities of self-reported disability. Data were obtained from a population survey in Belo Horizonte from 2008 to 2009. The sample was probabilistic and stratified by conglomerates in three stages: census tracts, households and individuals. The outcome variable was disability, defined by the self-reported problems in bodily functions or structures. The explanatory variables were gender, age, self-reported morbidity and socioeconomic status index that included variables mother and respondent schooling and household income. The factorial analysis was used to evaluate the socioeconomic status index and logistic regression. The prevalence of disability was 10.43% (95% CI: 9.1-11.7%). Self-reported disability was associated with age (OR = 1.02; 95% CI: 1.01-1.03) and reporting of two or more diseases (OR = 3.24; CI 95%; 2.16-4.86) and socioeconomic status index (OR = 0.96; 95% CI: 0.95-0.97). The worse socioeconomic status and occurrence of diseases appear to contribute to the occurrence of disability. These results show health inequities among people with disabilities, and BPC relevance supporting vulnerable populations.