Virués-Ortega Javier, de Pedro-Cuesta Jesús, del Barrio Jose Luis, Almazan-Isla Javier, Bergareche Alberto, Bermejo-Pareja Felix, Fernández-Mayoralas Gloria, García Francisco Jose, Garre-Olmo Josep, Gascon-Bayarri Jordi, Mahillo Ignacio, Martínez-Martín Pablo, Mateos Raimundo, Rodríguez Fernanda, Rojo-Pérez Fermina, Avellanal Fuencisla, Saz Pedro, Seijo-Martínez Manuel
CIBER de Enfermedades Neurodegenerativas Carlos III Institute of Health, Madrid, Spain.
Gac Sanit. 2011 Dec;25 Suppl 2:29-38. doi: 10.1016/j.gaceta.2011.07.021. Epub 2011 Nov 15.
The International Classification of Functioning, Disability and Health (ICF) advocates a multifactorial and multifaceted conceptualization of disability. The objective of this study was to ascertain major medical, environmental and personal determinants of severe/extreme disability among the elderly population in Spain. The assessment scheme was consistent with the ICF model of disability.
Nine populations contributed probabilistic or geographically-defined samples following a two-phase screening design. The Mini-Mental State Examination and the 12-item version of the World Health Organization-Disability Assessment Schedule, 2(nd) ed. (WHO-DAS II), were used as cognitive and disability screening tools, respectively. Positively screened individuals underwent clinical work-up for dementia and were administered the 36-item version of the WHO-DAS II to estimate ICF disability levels. We used logistic regression for the purposes of data combination, adjusted for age and sex in all analyses.
The sample was composed of 503 participants aged ≥ 75 years. Alzheimeŕs disease and depression were highly predictive of severe/extreme disability (OR: 17.40, 3.71). Good access to social services was strongly associated with a low level or absence of disability (OR: 0.05 to 0.18). Very difficult access to services and having dementia or another psychiatric disorder were associated with an increase in disability (OR: 66.06). There was also a significant interaction effect between access to services and neurological disorders (OR: 12.74).
Disability is highly prevalent among the Spanish elderly and is influenced by medical, social and personal factors. Disability could potentially be reduced by ensuring access to social services, preventing dementia and stroke, and treating depression.
《国际功能、残疾和健康分类》（ICF）提倡对残疾进行多因素、多层面的概念化理解。本研究的目的是确定西班牙老年人群中严重/极度残疾的主要医学、环境和个人决定因素。评估方案与ICF残疾模型一致。
九个群体按照两阶段筛查设计提供了概率性样本或地理定义样本。简易精神状态检查表和世界卫生组织残疾评定量表第二版（WHO-DAS II）的12项版本分别用作认知和残疾筛查工具。筛查呈阳性的个体接受了痴呆症的临床检查，并接受了WHO-DAS II的36项版本以评估ICF残疾水平。我们使用逻辑回归进行数据合并，在所有分析中对年龄和性别进行了调整。
样本由503名年龄≥75岁的参与者组成。阿尔茨海默病和抑郁症是严重/极度残疾的高度预测因素（比值比：17.40，3.71）。良好的社会服务可及性与低水平残疾或无残疾密切相关（比值比：0.05至0.18）。服务可及性非常困难以及患有痴呆症或其他精神疾病与残疾增加相关（比值比：66.06）。服务可及性与神经疾病之间也存在显著的交互作用（比值比：12.74）。
残疾在西班牙老年人中非常普遍，并且受到医学、社会和个人因素的影响。通过确保社会服务可及性、预防痴呆症和中风以及治疗抑郁症，有可能减少残疾。
