title: Medical, environmental and personal factors of disability in the elderly in Spain: a screening survey based on the International Classification of Functioning.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: CIBER de Enfermedades Neurodegenerativas Carlos III Institute of Health, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Virués-Ortega
authors.forename: Jesús
authors.initials: J
authors.lastname: de Pedro-Cuesta
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: del Barrio
authors.forename: Javier
authors.initials: J
authors.lastname: Almazan-Isla
authors.forename: Alberto
authors.initials: A
authors.lastname: Bergareche
authors.forename: Felix
authors.initials: F
authors.lastname: Bermejo-Pareja
authors.forename: Gloria
authors.initials: G
authors.lastname: Fernández-Mayoralas
authors.forename: Francisco Jose
authors.initials: FJ
authors.lastname: García
authors.forename: Josep
authors.initials: J
authors.lastname: Garre-Olmo
authors.forename: Jordi
authors.initials: J
authors.lastname: Gascon-Bayarri
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahillo
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Martín
authors.forename: Raimundo
authors.initials: R
authors.lastname: Mateos
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rodríguez
authors.forename: Fermina
authors.initials: F
authors.lastname: Rojo-Pérez
authors.forename: Fuencisla
authors.initials: F
authors.lastname: Avellanal
authors.forename: Pedro
authors.initials: P
authors.lastname: Saz
authors.forename: Manuel
authors.initials: M
authors.lastname: Seijo-Martínez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis; D002908:Chronic Disease; D003153:Community Health Services / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification*; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008609:Mental Status Schedule; D012931:Social Environment; D013030:Spain; D014944:World Health Organization