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[Health and utilization of health services in the elderly, according to the level of living arrangements].

OBJECTIVE
To assess the association between living arrangements (living alone, with company or in a nursing home) and the health status and the use of health and social services among the population over seventy with the purpose to help establishing health policies for the elderly.


METHODS
A cross sectional survey was performed, interviewing a random sample of 110 institutionalised and 290 community elderly of Castelldefels. Subjects and carers answered the following questionnaires: health status self-perception (SF-36), level of autonomy (test de Barthel), anxiety and depression levels (HAD), cognitive deficit (Short Portable Mental Status Questionnaire), availability and use of housing facilities an social and health resources.


RESULTS
77.2% of the institutionalised, and 92% of those coming from the community answered the questionnaire. 60 lived alone, 208 accompanied and 85 in nursing homes. The 67% were women and those living alone (77 +/- 4.8 years), or with company (78.3 +/- 6.4 years) where younger than the institutionalised ones (83.1 +/- 6.9 years) (p < 0.01). Housing facilities was similar in the three groups, although those living in the community had a higher level of use. The proportion of handicapped grew progressively from those living alone, with company or in institutions (13.3%; 19.6%. 86.7%; p < 0.01), as well as the cognitive deficit (7.8%; 15.3%; 20.8%, p < 0.01). Every group had similar health status, only those living with the family experienced higher scores in the emotional role or social function (SF-36). Non institutionalised population received support from relatives, friends and primary care services. Those institutionalised received health care in a more intensive and selective way, and benefited from formal cares.


CONCLUSIONS
Nursing homes host the population with highest level of cognitive deficit and dependence. The need of increasing formal care in the community, in special to people living alone, and of reorienting health services towards elderly care has been identified.