Is the 23-valent pneumococcal polysaccharide vaccine useful in preventing community-acquired pneumonia?

Although bacteremic pneumococcal pneumonia is the most severe form of pneumonia, non-bacteremic forms are much more frequent. Laboratory methods for the diagnosis of nonbacteremic pneumococcal pneumonia have a low sensitivity and specificity, and therefore all-cause pneumonia has been proposed as a suitable outcome to evaluate vaccination effectiveness. This work reviews the epidemiology of community-acquired pneumonia (CAP) and evaluates the effectiveness of the 3-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing CAP requiring hospitalization in people aged ≥65 years. We performed a case-control study in patients aged ≥65 years admitted through the emergency department who presented with clinical signs and symptoms compatible with pneumonia. Weincluded 489 cases and 1,467 controls and it was obtained a vaccine efectiveness of 23.6 (0.9-41.0). Our results suggest that PPV-23 vaccination is effective and reduces hospital admissions due to pneumonia in the elderly, strengthening the rationale for vaccination programmes in this age group.

Is the 23-valent pneumococcal polysaccharide vaccine useful in preventing community-acquired pneumonia?

Although bacteremic pneumococcal pneumonia is the most severe form of pneumonia, non-bacteremic forms are much more frequent. Laboratory methods for the diagnosis of nonbacteremic pneumococcal pneumonia have a low sensitivity and specificity, and therefore all-cause pneumonia has been proposed as a suitable outcome to evaluate vaccination effectiveness. This work reviews the epidemiology of community-acquired pneumonia (CAP) and evaluates the effectiveness of the 3-valent pneumococcal polysaccharide vaccine (PPV-23) in preventing CAP requiring hospitalization in people aged ≥65 years. We performed a case-control study in patients aged ≥65 years admitted through the emergency department who presented with clinical signs and symptoms compatible with pneumonia. Weincluded 489 cases and 1,467 controls and it was obtained a vaccine efectiveness of 23.6 (0.9-41.0). Our results suggest that PPV-23 vaccination is effective and reduces hospital admissions due to pneumonia in the elderly, strengthening the rationale for vaccination programmes in this age group.

Elders and the ITCs use to communicate with children and grandchildren

Past research in using ICTs (Information and Communication Technologies) in interpersonal communication showed that age plays an important role. There is a general assumption that the elderly are left behind regarding the adoption and the use of ICTs. Furthermore, elders tend to use ICTs mainly for instrumental purposes and the use is rather non-sophisticated. When elders are using ICTs to maintain their social network, similar patterns could be found: They start using internet, or intensify its use, when their children move abroad while they might decrease using the tool if the motivation ends. In this research we explore elders' incentives to go online and use internet services to communicate; the type of agencies they use to communicate with children and grandchildren abroad; and the situations that make them stop using the ICTs or even reject internet mediated communications. We base our discussion on the empirical evidence the two authors gathered in different cities and countries: Barcelona, Romania, Toronto, Los Angeles, Montevideo and Lima, through semi-structured interviews and observation, with people aged 60 years old and over. The results show that the ability for using ICT tools in an autonomous way is a better explanation than age. In this, we distinguish between assisted users and autonomous users. We found that oldest seniors and those seniors who are less socially active are more likely to be assisted users than those who are socially or professionally active. For them communication with their children and grandchildren abroad follows no agency or it is mediated by significant others from their local social network, who are able to use ICTs and select specific information to share, in the second step, with the elder. For some younger participants the use of ICTs is rather situational and imposed by their children or grandchildren, who installed the tool in the first place and assisted them in using it. Finally, other elders describe a proficient and independent use of ICTs so they use the devices and services the way they want to.We discuss the implications of the patterns in using ICTs, for elders' social life and their relationships with children and grandchildren. First, we emphasis the fact that those elders rejecting the ICTs or being unskilled in using them to communicate might be left out from their family circle, particularly when children are abroad -they would experience more isolation. Second, we underline the fact that when children and grandchildren are the ones that control the ICTs used by their parents and grandparents, they are controlling also the information flow and this will redefine the power relations between elders and their younger relatives.

Visual impairment and multimorbidity in a representative sample of the Spanish population

BACKGROUND: In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning. METHODS: Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity. RESULTS: The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. CONCLUSIONS: Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Multimorbidity patterns in a national representative sample of the Spanish adult population.

BACKGROUND: In the context of population aging, multimorbidity has emerged as a growing concern in public health. However, little is known about multimorbidity patterns and other issues surrounding chronic diseases. The aim of our study was to examine multimorbidity patterns, the relationship between physical and mental conditions and the distribution of multimorbidity in the Spanish adult population. METHODS: Data from this cross-sectional study was collected from the COURAGE study. A total of 4,583 participants from Spain were included, 3,625 aged over 50. An exploratory factor analysis was conducted to detect multimorbidity patterns in the population over 50 years of age. Crude and adjusted binary logistic regressions were performed to identify individual associations between physical and mental conditions. RESULTS: THREE MULTIMORBIDITY PATTERNS ROSE: 'cardio-respiratory' (angina, asthma, chronic lung disease), 'mental-arthritis' (arthritis, depression, anxiety) and the 'aggregated pattern' (angina, hypertension, stroke, diabetes, cataracts, edentulism, arthritis). After adjusting for covariates, asthma, chronic lung disease, arthritis and the number of physical conditions were associated with depression. Angina and the number of physical conditions were associated with a higher risk of anxiety. With regard to multimorbidity distribution, women over 65 years suffered from the highest rate of multimorbidity (67.3%). CONCLUSION: Multimorbidity prevalence occurs in a high percentage of the Spanish population, especially in the elderly. There are specific multimorbidity patterns and individual associations between physical and mental conditions, which bring new insights into the complexity of chronic patients. There is need to implement patient-centered care which involves these interactions rather than merely paying attention to individual diseases.

Built environment and elderly population health: a comprehensive literature review

Global population aging over recent years has been linked to poorer health outcomes and higher healthcare expenditure. Policies focusing on healthy aging are currently being developed but a complete understanding of health determinants is needed to guide these efforts. The built environment and other external factors have been added to the International Classification of Functioning as important determinants of health and disability. Although the relationship between the built environment and health has been widely examined in working age adults, research focusing on elderly people is relatively recent. In this review, we provide a comprehensive synthesis of the evidence on the built environment and health in the elderly.

La repercussió de l'onada de calor de 2003 en la població major de 65 anys de Barcelona i l'àrea metropolitana

Les onades de calor eren un fenomen desconegut per la població fins fa pocs anys, i tot i que avui dia ja son més populars, les seves conseqüències passen molt més desapercebudes que la d’altres catàstrofes naturals. En aquest estudi, a partir de l’episodi que va patir la península durant l’agost de 2003, es pretén aprofundir en els factors que van fer propiciar que la mortalitat entre les persones majors de 65 anys augmentés de manera notable en comparació amb anys anteriors. Els resultats de l’estudi mostren que un dels grups més vulnerables son les persones grans que viuen soles i per tant caldria tenir en compte aquest factor a l’hora de fer plans d’acció, així com també que els pics de màxima mortalitat es corresponen amb dies posteriors als de la pujada de temperatura, ja que aquesta agreuja patologies prèvies de les persones i moren temps després. També seria interessant un consens internacional a l’hora d’establir uns criteris estàndards per tal de tenir així uns registres més fiables que permetin extreure noves mesures per lluitar contra les onades de calor.

Les tecnologies de la comunicació al servei de la gent gran

Aquest informe mira de documentar el projecte GeriaTic, que desenvolupa l'Ajuntament de Barcelona al districte 22@. L'informe fa una anàlisi de la situació de la gent gran en relació amb les tecnologies de la informació i la comunicació en el sector de la salut, el control de l'entorn i el lleure. L'anàlisi de la documentació trobada i la informació extreta d'un grup de discussió amb persones grans usuàries de les TIC permeten identificar el mercat existent, els productes i serveis, les necessitats no cobertes i les bones pràctiques relacionades amb els tres sectors estudiats. Les conclusions de l'estudi assenyalen tres aspectes clau: la necessitat que la tecnologia s'incorpori a la vida quotidiana de les persones, perquè aparegui com a quelcom necessari i útil; la cura en cercar un disseny modular, escalable i integrat de la tecnologia que acompanyi les característiques específiques de la persona i els canvis al llarg del seu cicle vital, i, finalment, la consideració que la incorporació de les TIC en l'àmbit de la gent gran no tan sols involucra la persona, sinó també el conjunt de professionals i la societat en general. Aquests tres aspectes permeten plantejar l'exigència que la incorporació de la tecnologia en la vida de la gent gran abandoni el model assistencial i es presenti a la persona i a la societat com una font de noves possibilitats i una oportunitat per al canvi.

Relation between temperature and mortality in thirteen Spanish cities

In this study we examined the shape of the association between temperature and mortality in 13 Spanish cities representing a wide range of climatic and socio demographic conditions. The temperature value linked with minimum mortality (MMT) and the slopes before and after the turning point (MMT) were calculated. Most cities showed a V-shaped temperature-mortality relationship. MMTs were generally higher in cities with warmer climates. Cold and heat effects also depended on climate: effects were greater in hotter cities but lesser in cities with higher variability. The effect of heat was greater than the effect of cold. The effect of cold and MMT was, in general, greater for cardio-respiratory mortality than for total mortality, while the effect of heat was, in general, greater among the elderly

Sustainable and equitable retirement in a life course perspective

We argue that long term sustainability of social security systems requires not only better equilibrium between the proportion in retirement and in employment but also an equitable distribution of the additional financial burden that aging inevitably will require. We examine how a proportional fixed ratios model of burden sharing between the aged and non-aged will establish inter-generational equity. Additionally we address the question of intra-generational equity and argue that the positive association between lifetime income and longevity requires more progressive financing of pensions and of care for the elderly.

Social Security in Theory and Practice (II): Efficiency Theories, Narrative Theories, and Implications for Reform

166 countries have some kind of public old age pension. What economic forces create and sustain old age Social Security as a public program? Mulligan and Sala-i-Martin (1999b) document several of the internationally and historically common features of social security programs, and explore "political" theories of Social Security. This paper discusses the "efficiency theories", which view creation of the SS program as a full of partial solution to some market failure. Efficiency explanations of social security include the "SS as welfare for the elderly" the "retirement increases productivity to optimally manage human capital externalities", "optimal retirement insurance", the "prodigal father problem", the "misguided Keynesian", the "optimal longevity insurance", the "government economizing transaction costs", and the "return on human capital investment". We also analyze four "narrative" theories of social security: the "chain letter theory", the "lump of labor theory", the "monopoly capitalism theory", and the "Sub-but-Nearly-Optimal policy response to private pensions theory". The political and efficiency explanations are compared with the international and historical facts and used to derive implications for replacing the typical pay-as-you-go system with a forced savings plan. Most of the explanations suggest that forced savings does not increase welfare, and may decrease it.

Social security in theory and practice (II): Efficiency theories, narrative theories and implications for reform

166 countries have some kind of public old age pension. What economic forcescreate and sustain old age Social Security as a public program? Mulligan and Sala-i-Martin (1999b) document several of the internationally and historically common features of social security programs, and explore "political" theories of Social Security. This paper discusses the "efficiency theories", which view creation of the SS program as a full of partial solution to some market failure. Efficiency explanations of social security include the "SS as welfare for the elderly" the "retirement increases productivity to optimally manage human capital externalities", "optimal retirement insurance", the "prodigal father problem", the "misguided Keynesian", the "optimal longevity insurance", the "governmenteconomizing transaction costs", and the "return on human capital investment". We also analyze four "narrative" theories of social security: the "chain letter theory", the "lump of labor theory", the "monopoly capitalism theory", and the "Sub-but-Nearly-Optimal policy response to private pensions theory".The political and efficiency explanations are compared with the international and historical facts and used to derive implications for replacing the typical pay-as-you-go system with a forced savings plan. Most of the explanations suggest that forced savings does not increase welfare, and may decrease it.

Social security in theory and practice (I): Facts and political theories

166 countries have some kind of public old age pension. What economic forcescreate and sustain old age Social Security as a public program? We document some of the internationally and historically common features of Social Security programs including explicit and implicit taxes on labor supply, pay-as-you-go features, intergenerational redistribution, benefits which areincreasing functions of lifetime earnings and not means-tested. We partition theories of Social Security into three groups: "political", "efficiency" and "narrative" theories. We explore three political theories in this paper: the majority rational voting model (with its two versions: "the elderly as the leaders of a winning coalition with the poor" and the "once and for all election" model), the "time-intensive model of political competition" and the "taxpayer protection model". Each of the explanations is compared with the international and historical facts. A companion paper explores the "efficiency" and "narrative" theories, and derives implicationsof all the theories for replacing the typical pay-as-you-go system with a forced savings plan.

Gerontocracy, retirement, and social security

Why are the old politically successful? We build a simple interest group model in which political pressure is time-intensive, showing that in the political competitive equilibrium each group lobbies for government policies that lower their own value of time but the old do so to a greater extent and as a result are net gainers from the political process. What distinguishes the elderly from other political groups (and what makes them more succesful) is that they have lower labor productivity and/or that we are all likely to become elderly at some point, while we are relatively unlikely to change gender, race, sexual orientation, or even ocupation, The model has a variety of implications for the design of social security programs, which we test using data from the Social Security Administration. For example, the model predicts that social security programs with retirement incentives are larger and that the old are more "single-minded" in their politics, implications which we verify using cross-country government finance data and cross-country political participation surveys. Finally, we show that the forced savings programs intended to "reform" the social security system may increase the amount of intergenerational redistribution. As a model for evaluating policy reforms, ours has the attractive feature that reforms must be time time consistent from a political point of view rather than a public interest point of view.