title: A protective personal factor against disability and dependence in the elderly: an ordinal regression analysis with nine geographically-defined samples from Spain.
abstract: Sense of Coherence (SOC) is defined as a tendency to perceive life experiences as comprehensible, manageable and meaningful. The construct is split in three major domains: Comprehensibility, Manageability, and Meaningfulness. SOC has been associated with successful coping strategies in the face of illness and traumatic events and is a predictor of self-reported and objective health in a variety of contexts. In the present study we aim to evaluate the association of SOC with disability and dependence in Spanish elders.
  
  
  
  A total of 377 participants aged 75 years or over from nine locations across Spain participated in the study (Mean age: 80.9 years; 65.3% women). SOC levels were considered independent variables in two ordinal logistic models on disability and dependence, respectively. Disability was established with the World health Organization-Disability Assessment Schedule 2.0 (36-item version), while dependence was measured with the Extended Katz Index on personal and instrumental activities of daily living. The models included personal (sex, age, social contacts, availability of an intimate confidant), environmental (municipality size, access to social resources) and health-related covariates (morbidity).
  
  
  
  High Meaningfulness was a strong protective factor against both disability (Odds Ratio [OR] = 0.50; 95% Confidence Interval [CI] = 0.29-0.87) and dependence (OR = 0.33; 95% CI = 0.19-0.58) while moderate and high Comprehensibility was protective for disability (OR = 0.40; 95% CI = 0.22-0.70 and OR = 0.39; 95%CI = 0.21-0.74), but not for dependence. Easy access to social and health resources was also highly protective against both disability and dependence.
  
  
  
  Our results are consistent with the view that high levels of SOC are protective against disability and dependence in the elderly. Elderly individuals with limited access to social and health resources and with low SOC may be a group at risk for dependence and disability in Spain.
authors.affiliation: National Centre for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain. j.virues-ortega@auckland.ac.nz.|School of Psychology, The University of Auckland, Room 335B Level 3 Bldg 301 Science Centre 23 Symonds St Private Bag 92019, Auckland, 1010, New Zealand. j.virues-ortega@auckland.ac.nz.
authors.forename: Javier
authors.identifier: 0000-0003-1713-012X
authors.initials: J
authors.lastname: Virues-Ortega
authors.affiliation: Arévalo Health Centre, Avila, Spain.
authors.forename: Saturio
authors.initials: S
authors.lastname: Vega
authors.affiliation: Neurology Unit, Salnés Hospital, Pontevedra, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Seijo-Martinez
authors.affiliation: Department of Medicine and Psychiatry, Zaragoza University, Zaragoza, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Saz
authors.affiliation: Neurology Unit, Segovia Hospital, Segovia, Spain.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Madrid Regional Health Authority, Madrid, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Rodriguez-Laso
authors.affiliation: Llodio Health Center, Day Medical Center, Oroityu-Getxo-Vizcaya, Spain.
authors.forename: Susana Perez
authors.initials: SP
authors.lastname: de Las Heras
authors.affiliation: Psychiatry Department, University of Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Raimundo
authors.initials: R
authors.lastname: Mateos
authors.affiliation: National Centre for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Martin
authors.affiliation: National Centre for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahillo-Fernandez
authors.affiliation: Girona Biomedical Research Institute Institut d'Assistència Sanitària, Salt, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Garre-Olmo
authors.affiliation: Dementia Diagnosis and Treatment Unit, Neurology Department, Bellvitge University Teaching Hospital, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gascon
authors.affiliation: Geriatrics Unit. Virgen del Valle Geriatric Hospital, Toledo, Spain.
authors.forename: Francisco Jose
authors.initials: FJ
authors.lastname: Garcia-Garcia
authors.affiliation: Neurology Unit, Virgen del Camino Hospital, Pamplona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Fernandez-Martinez
authors.affiliation: Neurology Department, 12 de Octubre University Teaching Hospital and CIBERNED, Madrid, Spain.
authors.forename: Felix
authors.initials: F
authors.lastname: Bermejo-Pareja
authors.affiliation: Department of Neurology, Hospital Universitario Donostia, San Sebastián Guipuzcoa, Spain.|Biodonostia Research Institute, Area of Neurosciences, and CIBERNED, Carlos III Health Institute, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bergareche
authors.affiliation: Neurology Department, 12 de Octubre University Teaching Hospital and CIBERNED, Madrid, Spain.
authors.forename: Julian
authors.initials: J
authors.lastname: Benito-Leon
authors.affiliation: National Centre for Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: de Pedro-Cuesta
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012044:Regression Analysis; D057566:Self Report; D060685:Sense of Coherence; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Dependence; Disability; Katz index; Sense of coherence; WHODAS 2.0