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Objectives Cognitive and emotional disturbances have been associated with the diagnosis and treatment of cancer. Autobiographical memory is one of the specific cognitive processes affected during this disease. The current study had two main aims: (1) to compare the functioning of autobiographical memory specificity and its related variables (executive functioning, depression and perceived stress) in a group of persons with cancer and a control group; and (2) to analyze whether the experience of cancer evolved into a self-defining memory in the sample of participants diagnosed with this disease. Method The study sample comprised 62 participants, 31 in the group with a cancer diagnosis and 31 in the control group. Autobiographical memory specificity, executive functions, depression, stress and self-defining memory were evaluated in the current study. Results Depressive symptomatology and reduced executive functioning, but not perceived stress levels, are related and are predictors of autobiographical memory specificity. In addition, the identified characteristics of the self-defining memories were associated with the cancer experience as a threat to physical integrity and an awareness of the meaning of life. Conclusion This emerging research line is especially important in view of its possible impacts on patients’ well-being, due to the importance of psychological processes in cancer disease.

Resumen Introduccion Estimar la prevalencia del consumo de ansioliticos e hipnoticos referido por los mayores de 65 anos e identificar posibles factores condicionantes del citado uso. Material y metodos Estudio transversal. La poblacion de estudio fue de 1.161 sujetos de ≥65 anos no institucionalizados con suficiente capacidad para llevar a cabo una entrevista personal. Seleccion mediante muestreo aleatorizado simple del listado de tarjeta sanitaria. Las principales variables evaluadas incluyeron: consumo referido de ansioliticos/hipnoticos y otros farmacos (segun el sistema de clasificacion ATC), estado animico (GDS-VE), estado cognitivo (cuestionario Pfeiffer), valoracion fisica-funcional sobre actividades basicas de la vida diaria (indice de Katz), problemas de salud (clasificacion CIAP-2 de la WONCA) y variables sociodemograficas. Resultados La prevalencia de uso referido de ansioliticos/hipnoticos fue del 16,6% (IC 95%: 14,5-18,7). El 90,5% fueron benzodiacepinas (BZD), fundamentalmente lorazepam (39,4% de las BZD). Las BZD de vida media prolongada supusieron el 24,7% de todas. Los hipnoticos representaron el 27,5% de los ansioliticos/hipnoticos. El uso de ansioliticos/hipnoticos se asocio independientemente con consumir otros farmacos no psicotropicos (OR: 6,8; IC 95%: 2,1-22,0), presentar depresion establecida (OR: 2,5; IC 95%: 1,0-5,9), presentar 4 o mas problemas de salud (OR: 2,0; IC 95%: 1,4-2,9), ser mujer (OR: 2,1; IC 95%: 1,5-3,1) y ser dependiente para las actividades basicas de la vida diaria (OR: 1,8; IC 95%: 1,1-2,9). Conclusiones La prevalencia de uso de ansioliticos/hipnoticos es elevada en mayores de Albacete. Diversos factores han sido identificados como potenciales condicionantes de su utilizacion. Seria importante mejorar el conocimiento sobre el mal uso de estos farmacos con el fin de desarrollar estrategias de prescripcion efectivas y seguras.

Objective: The aims of this study were to determine the true frequency of primary insomnia (PI), sleep disorder related to another mental disorder (SDMD) and sleep disorder due to a general medical condition (SDMC) in older adults and to establish their differentiating characteristics. Methods: This is a cross-sectional study. Participants were randomly selected samples of 951 subjects who are 65 years or older. Main measures were as follows: presence (according to DSM-IV-TR diagnostic criteria) of PI, SDMD, SDMC or other sleep disorders, co-morbidity and psychotropic consumption. Results: Of the subjects, 36.1% reported having sleep problems (95%CI:33.0–39.2) and 37.0% reported regularly consuming a psychotropic drug. The prevalence of PI was 8.9% (95%CI: 7.1–11.0), and according to the criteria for differential diagnosis, the prevalence of SDMD was 9.3% (95%CI: 7.5–11.4) and that of SDMC was 7.0% (95%CI: 5.4–8.9). A higher percentage of PI subjects had problems in falling asleep on most days (52.5%), had frequent night-time awakenings (66.3%) and early awakenings (51.3%). In subjects with any type of insomnia, the variables that showed a statistically significant association were female gender (OR: 2.21), consumption of psychotropic drugs (OR: 1.83), presence of four or more health problems (OR: 1.88) and being single, widowed or divorced (OR: 1.43). Conclusions: Our results provide a true picture of the prevalence of insomnia in older adults on the basis of diagnostic criteria and indicate that it is a widespread, significant health problem. The peculiarities of PI, SDMD and SDMC need to be appropriately differentiated in clinical practice, and each needs a different approach to obtain the best outcome. Copyright © 2011 John Wiley & Sons, Ltd.

ResumenObjetivosEstablecer la prevalencia y las características del insomnio y su relación con otros problemas de salud, consumo de fármacos, situación sociosanitaria y hábitos higiénicos en mayores de 65 años.DiseñoEstudio de prevalencia y asociación cruzada.EmplazamientoAlbacete (Castilla-La Mancha), 2004–2005.ParticipantesPoblación mayor de 65 años no institucionalizada (n=424).MétodoEntrevista semiestructurada. Variables de estudio: características del sueño, repercusiones sociofamiliares, hábitos higiénicos del sueño, problemas de salud, medicación, utilización de servicios sanitarios y variables sociodemográficas. Insomnio primario (IP) diagnosticado con criterios DSM-IV.ResultadosDeclaró problemas para dormir el 34,2%; en el 95,7% la alteración era crónica. La repercusión más frecuente fue sensación de descanso nocturno insuficiente (62,1%) y cansancio o somnolencia diurna (52,2%). El 20,3% (intervalo de confianza [IC] del 95%, 16,5–24,1) cumplía criterios de IP. El insomnio fue mayor en las mujeres, en los que tenían horarios irregulares e insatisfacción con las condiciones ambientales del dormitorio. El 26,9% (IC del 95%, 22,7–31,1) consumía de forma habitual psicofármacos. El número medio de problemas de salud fue superior en sujetos con insomnio (2,4±1,6 frente a 1,7±1,5; p

The objective is to determine the prevalence of hearing loss in people over 65 years of age, to describe the functional status of people with hearing loss and to identify the need for hearing aid use. In a cross-sectional study, a random sample of 1387 people aged 65 years and over was selected. The primary study variables were: hearing level by audiometric assessment, self-perceived hearing loss, screening for hypoacusia using the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and physical, cognitive and emotional functional status. Using the HHIE-S it was determined that 11.3% of the subjects had severe hearing handicap. According to the Ventry/Weinstein criteria 43.6% had hearing handicap. When asked about the use of hearing aids, 4.5% of the study subjects said they used them, although 41.9% had hearing loss of 35 dB or more in their better ear. The variables associated with the need for a hearing aid were age >75 years (odds ratio=OR=3.2), ADL dependence (OR=2.7), cognitive impairment (OR=2.0), multiple health problems (OR=1.8), male sex (OR=1.6) and single/widowed (OR=1.5). In conclusion, there is a high prevalence of hearing loss associated with other functional limitations. Of those people who would benefit from a hearing aid (more than a third of people over 65 years old), 89.3% do not own one. The screening of hearing loss needs to be improved.

To estimate the prevalence of self-reported anxiety/hypnotics use in adults 65 years and older and identify potential factors that determine the use of these drugs.Cross-sectional study conducted on a study population of 1,161 non-institutionalised adults 65 years old and older with enough ability to conduct a personal interview. Participants were randomly selected from health care registers. The main outcomes of interest included consumption of anxiolytics, hypnotics and other drugs (filed by ATC classification system), mood (based on the Yesavage geriatric depression scale), cognitive status (Pfeiffer questionnaire), physical-functional assessment of basic activities of daily living (Katz index), health problems (ICPC-2 classification WONCA), and sociodemographic variables.The prevalence of self-reported anxiety/hypnotics consumption was 16.6% (95% CI: 14.5 - 18.7), of which 90.5% were benzodiazepines (BZD), mainly lorazepam (39.4% of BZD). Long half-life BZD accounted for 24.7% of BZD. Hypnotics accounted for 27.5% of anxiolytics/hypnotics. The use of sedatives/hypnotics was independently associated with other drugs (non-psychotropics) consumption (OR 6.8, 95% CI: 2.1-22.0), presence of established depression (OR: 2.5; 95% CI: 1.0 -5.9), presence of 4 or more comorbidities (OR: 2.0; 95% CI: 1.4-2.9), being female (OR 2.1, 95% CI: 1.5-3.1) and being dependent for basic activities of daily living (OR: 1.8, 95% CI: 1.1-2.9).The prevalence of sedatives/hypnotics use in the elderly from Albacete is high. Several factors were identified as potential determinants of sedatives/hypnotics use in our study population. It will be important to evaluate the misuse of these drugs in order to develop effective, efficient and safe prescription strategies.

Fundamento y objetivo: Elaborar y validar una escala para detectar trastornos depresivos mayores (TDM) en ancianos que utilizan las consultas de atención primaria (Escala para la Detección de Depresión en Ancianos [EDDA]). Métodos: Estudio observacional transversal para validar una escala, administrada mediante entrevista personal, en 259 pacientes de 65 o más años. Tras revisar los instrumentos disponibles y elaborar los ítems, se realizó una primera prueba piloto o pretest. En una segunda prueba piloto se analizó la reproducibilidad del instrumento. El estándar de oro fue el resultado de una entrevista psiquiátrica estandarizada realizada por psiquiatras (criterios DSM-IV y entrevista SCAN). Resultados: Los coeficientes de correlación intraclase (CCI) correspondientes a la fiabilidad intra e interobservador fueron, respectivamente, de 0,858 (intervalo de confianza [IC] del 95%, 0,634-0,946) y 0,908 (IC del 95%, 0,726-0,969). El número de sujetos válidos para el estudio fue de 216 ancianos, en quienes se realizó, de forma ciega, una valoración en consultas de atención primaria y de psiquiatría. En éstas se objetivó la existencia de un TDM en 81 de ellos (37,5%; IC del 95%, 31,1-44,4). La EDDA mostró una elevada coherencia interna (* de Cronbach = 0,79). El análisis factorial determinó que existían 8 factores capaces de explicar el 55,8% de la varianza total. Para una puntuación mayor o igual a 15, la EDDA presenta una sensibilidad del 90,1% (IC del 95%, 80,95-95,33), una especificidad del 74,8% (IC del 95%, 66,48-81,71) y un cociente de probabilidad positivo de 3,58 (IC del 95%, 2,65-4,83). Conclusiones: La EDDA es un instrumento clínicamente útil para la detectar los TDM de los ancianos en la atención primaria.Background and objective: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). Methods: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). Results: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). Conclusions: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.

The aims of this study were to determine the true frequency of primary insomnia (PI), sleep disorder related to another mental disorder (SDMD) and sleep disorder due to a general medical condition (SDMC) in older adults and to establish their differentiating characteristics.This is a cross-sectional study. Participants were randomly selected samples of 951 subjects who are 65 years or older. Main measures were as follows: presence (according to DSM-IV-TR diagnostic criteria) of PI, SDMD, SDMC or other sleep disorders, co-morbidity and psychotropic consumption.Of the subjects, 36.1% reported having sleep problems (95% CI: 33.0-39.2) and 37.0% reported regularly consuming a psychotropic drug. The prevalence of PI was 8.9% (95% CI: 7.1-11.0), and according to the criteria for differential diagnosis, the prevalence of SDMD was 9.3% (95% CI: 7.5-11.4) and that of SDMC was 7.0% (95%CI: 5.4-8.9). A higher percentage of PI subjects had problems in falling asleep on most days (52.5%), had frequent night-time awakenings (66.3%) and early awakenings (51.3%). In subjects with any type of insomnia, the variables that showed a statistically significant association were female gender (OR: 2.21), consumption of psychotropic drugs (OR: 1.83), presence of four or more health problems (OR: 1.88) and being single, widowed or divorced (OR: 1.43).Our results provide a true picture of the prevalence of insomnia in older adults on the basis of diagnostic criteria and indicate that it is a widespread, significant health problem. The peculiarities of PI, SDMD and SDMC need to be appropriately differentiated in clinical practice, and each needs a different approach to obtain the best outcome.

En los meses de abril, julio y agosto de 2010, los autores de este artículo nos marcamos como objetivo conocer de primera mano la atención primaria en el Nacional Health Service (NHS). Así pues, la experiencia de participación activa de cada uno de nosotros en un modelo referente en atención primaria responde a una fuerte motivación personal, suponiendo un especial atractivo para la configuración de este artículo el poder extrapolar nuestras apreciaciones e impresiones, claramente marcadas por los diferentes momentos de nuestra trayectoria profesional en la valoración de las diferencias estructurales, organizativas, de los lugares de trabajo, del análisis de los equipos, de la formación y de la figura del que hoy por hoy es el principal protagonista de un modelo de salud pionero en Europa.

PURPOSE We wanted to design and validate the Hearing-Dependent Daily Activities (HDDA) Scale as a means of identifying the impact of hearing loss in older persons by measuring capacity to carry out hearing-dependent activities. METHODS We undertook a cross-sectional, observational study to validate a scale administered during a personal interview with 1,160 participants aged 65 years and older. When using the instrument to identify patients with hearing impairment, sensitivity and specificity were determined using an audiogram with Ventry and Weinstein criteria as the criterion standard. Standardized audiometries were performed blindly, without knowledge of results of the HDDA Scale. RESULTS According to the criterion standard, 506 participants had hearing impairment (43.6%; 95% confidence interval [CI], 40.8%–46.5%). The HDDA scale showed high internal consistency (Cronbach’s α =0.91). Regarding hearing impairment criteria, the HDDA scale obtained a sensitivity of 80.0% (95% CI, 76.3%–83.3%) and a specificity of 70.2% (95% CI, 66.5%–73.5%). CONCLUSIONS The HDDA scale constitutes a clinically useful instrument for identifying the impact of hearing loss on daily life in the elderly, a condition frequently overlooked during routine medical check-ups. This tool has acceptable psychometric properties and high internal consistency.

Insomnia causes psychological distress in the elderly. Besides primary insomnia (PI), illness, medications and psychosocial factors contribute to development of sleep disorders. Although elderly insomniacs usually complain of poorer daytime functioning, it is unknown whether the disorder affects capacity to carry out activities. To assess the relationship in the elderly between PI, level of physical functioning, depression and anxiety symptoms, state of psychological well-being and consumption of psychopharmaceuticals. Cross-sectional, observational study. Populational. About 424 non-institutionalized elderly patients. Subjects were interviewed at public Health Centres or at home. They were considered to have PI if DSM-IV criteria were met. The remaining variables measured were: depression and anxiety symptoms (The Goldberg’s Depression and Anxiety Scale), cognitive state (Short Portable Mental Status Questionnaire), physical functioning (The Katz Index and the Instrumental Activities of Daily Living Scale), life satisfaction (The Philadelphia Geriatric Center Morale Scale), health problems, consumption of pharmaceuticals and sociodemographic variables. About 34.2% of the elderly admitted to having problems with sleep, but only 20.3% (CI: 95%: 16.5–24.1) fulfilled the criteria for PI. The existence of an anxiety disorder, a score below the 50th percentile on The Philadelphia Geriatric Center Morale Scale (lower life satisfaction) and consumption of psychopharmaceuticals were variables associated with insomnia. Amongst the most common illnesses reported, only diabetes appeared with significantly higher frequency in the elderly with insomnia (24.4% vs. 14.7%) (p < 0.05). No statistically significant association was found between insomnia and level of dependence in carrying out basic or instrumental activities. Approximately one fifth of the non-institutionalized elderly meet the criteria for PI. Those affected present a poorer state of psychological and social well-being, although level of autonomy for conducting basic and instrumental activities does not appear to be modified by the disorder. The existence of an anxiety disorder, low life satisfaction and consumption of psychopharmaceuticals constitute variables associated with PI in the population we studied.