title: Disability, support and long-term social care of an elderly Spanish population, 2008-2009: an epidemiologic analysis.
abstract: Though poorly known, relationships between disability, need of help (dependency) and use of social services are crucial aspects of public health. The objective of this study was to describe the links between disability, officially assessed dependency, and social service use by an industrial population, and identify areas of inequity.
  
  
  
  We took advantage of a door-to-door survey conducted in the Cinco Villas district, Spain, in 2008-2009, which provided data on disability, morbidity, and service use among 1216 residents aged ≥50 years, and officially assessed dependency under the 2006 Dependency Act (OAD). Using logistic regression, we combined data collected at homes/residences on 625 disability screened-positive participants, and administrative information on degree of OAD and benefits at date of visit.
  
  
  
  Based on 163 disabled persons, the prevalence of residential/community-care users was 13.4% overall, with 6.0% being market-provided, 2.5% supported by the 2006 Act, and 4.9% supported by other public funds. Of 111 OAD applicants, 30 had been assigned an OAD degree; in 29 cases this was the highest OAD degree, with 12 receiving direct support for residential care and 17 receiving home care. Compared to unassessed dependency, the highest OAD degree was linked to residential care (OR and 95% CI) 12.13 (3.86-38.16), declared non-professional care 10.99 (1.28-94.53), and publicly-funded, non-professional care 26.30 (3.36-205.88). In contrast, 43 persons, 58% of the severely/extremely disabled, community-dwelling sample population, 81% of whom were homebound, including 10 persons with OAD but no implemented service plan, made no use of any service, and of these, 40% lacked a non-professional carer.
  
  
  
  Formal service use in the Cinco Villas district attained ratios observed for established welfare systems but the publicly-funded proportion was lower. The 2006 Act had a modest, albeit significant, impact on support for non-professional carers and residential care, coexisting with a high prevalence of non-use of social services by severely disabled persons.
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Science and Innovation, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Almazán-Isla
authors.affiliation: School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Comín-Comín
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Science and Innovation, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Alcalde-Cabero
authors.affiliation: School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Ruiz
authors.affiliation: School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Franco
authors.affiliation: School of Health Sciences, University of Zaragoza, Zaragoza, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Magallón
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Science and Innovation, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Damián
authors.affiliation: National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain. jpedro@isciii.es.|Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Ministry of Science and Innovation, Madrid, Spain. jpedro@isciii.es.
authors.forename: J
authors.initials: J
authors.lastname: de Pedro-Cuesta
authors.affiliation: Department of Social Services and Family, Aragon Regional Authority, Zaragoza, Spain.
authors.forename: L A
authors.initials: LA
authors.lastname: Larrosa-Montañes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012947:Social Work / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology
keywords: Disability; Functional dependence; ICF; Prevalence; Public health services; Social services; WHODAS 2.0