Quality of life attenuates age-related decline in functional status of older adults

A systematic review of quality of life (QoL) studies using the CASP scale in older adults

PURPOSE

A systematic review of the use of the CASP Quality of Life (QoL) scale in older adults was carried out.

METHODS

Articles were searched using PsycINFO, Web of Science (WOS), Scopus and Medline databases. Observational or experimental studies using any version of the CASP to analyze QoL in adults aged 50 and over and studies focusing on the psychometric properties of the CASP instrument or identifying factors associated with QoL scores. The quality of the studies was assessed using COSMIN and STROBE.

RESULTS

A total of 519,339 participants were considered in the 51 studies selected. The 19- and 12-item CASP versions showed high internal consistency and low-to-moderate convergent validity. Best construct validity was reported for the 12-item short version generating a three-factor model (control/autonomy, pleasure & self-realization) and only modest evidence is provided for their cross-cultural validity. Longitudinal and cross-sectional evidence showed (1) a significant decrease in CASP scores at very old ages; (2) an absence of relationship with gender, which, however, may play a moderating role between QoL and health; (3) significant associations between CASP scores and health, psychosocial and socio-economic outcomes.

CONCLUSION

The quality of the results was hindered by the lack of relevant information in some studies as well as by the proliferation of versions of the instrument. Nevertheless, we conclude that the CASP scale can capture the complex and multidimensional nature of QoL in older adults by reporting satisfaction of needs that go beyond that go beyond those related to health.

Experiencing Cerebrovascular Diseases like Stroke and Fear of Falling: Longitudinal Results from the Survey of Health, Ageing and Retirement in Europe

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, "For the past six months at least, have you been bothered by any of the health conditions on this card", with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual's FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies.

Perioperative complications of legally blind patients undergoing total knee arthroplasty: A national inpatient sample database study

Introduction

Vision impairment is a significant health concern that leads to increased morbidity and mortality globally. Significantly, legally blind (LB) patients have higher rates of hospitalization, cost, and orthopedic-related complications. Total knee arthroplasty (TKA) is commonly used to treat advanced knee osteoarthritis. However, there is limited literature reporting the demographic and hospitalization characteristics and operative outcomes of patients with LB who underwent TKA. This study addresses this gap in literature.

Method

We conducted a retrospective study using a Nationwide Inpatient Sample database. We assessed perioperative complications, length of stay (LOS), and healthcare expenditure among legally blind and control cohort patients who underwent TKA. Propensity matching was conducted to identify factors associated with perioperative complications.

Results

Between 2016 and 2020, there were 558,371 patients underwent TKA, with 0.1% of patients documented as legally blind. Of this cohort, the average age was significantly older than the control, 70.01 years versus 66.72 years (p < 0.001), respectively. Patients from the LB cohort had a longer length of stay (2.9 ± 1.7 days) than those from the control cohort (2.4 ± 1.3 days) (p < 0.001). Significantly, patients in the legally blind group incurred higher expenditures than those in the control group ($68,936 versus $64,808, respectively; p < 0.001). (Table 2). Propensity matching yields similar results. Analysis of TKA-associated operative complications suggested that legally blind patients had a higher proportion of blood loss anemia (20.97%, p < 0.05), required blood transfusions secondary to surgery (3.1%, p < 0.05), and periprosthetic fractures (2.6%, p < 0.05) than the control group (15.3%, 1.5%, and 0.42%, respectively).

Conclusion

We report that LB patients are, on average, older and have an extended LOS, higher expenditure, and higher rates of specific TKA-associated operative complications than those without legal blindness. To date, this is the first study of its kind to provide large, population-based data on the demographics, costs, and TKA-operative complications in patients with LB and, as such, provides a purposeful basis for future research.

Late life depression and concepts of aging: an emerging paradigm

Late life depression (LLD) is an emerging challenge, and recognized as a significant barrier to long-term healthy aging. Viewed within the context of the medical/biological model, advances in brain sciences over the last several decades have led to a deeper understanding of the biology of LLD. These advances in current knowledge include the description of aging brain pathophysiology; the biology and biochemistry of neurotransmitters; the correspondence between changes in neurological structure, function, and neural network; the description of neural, hormonal and inflammatory biomarkers; and identification of typical phenotypic subtypes of LLD. Despite these advances, current treatment of LLD, which remains largely pharmacological with accompanying cognitive and behavioral interventions, has poor success rate for long-term remission among older people. A wider perspective, in keeping with several emerging aging concepts, is suggested as an alternative framework within which to view LLD. A growing body of research supports the important role in LLD of frailty, resilience, intrinsic capacity, and functional integrity. Similarly, important social determinants need to be addressed in the etiology of LLD, rooted largely in negative stereotypes of aging, with consequent repercussions of reduced participation and inclusion, growing social isolation, with loss of identity, meaning and hope. This perspective suggests the importance of a wider integrative conceptualization of depression, set against a background of emerging aging concepts.

Oral health, anxiety symptoms and depressive symptoms: findings from the survey of health, ageing and retirement in Europe

BACKGROUND

There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge.

METHODS

Cross-sectional data were used from wave 5 of the pan-European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro-D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis.

RESULTS

Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (β = 0.11, P < 0.001) and higher depressive symptoms (β = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (β = 0.02, P < 0.001) and higher depressive symptoms (β = 0.02, P < 0.001) - and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (β = -0.35, P < 0.001) and lower depressive symptoms (β = -0.36, P < 0.001).

CONCLUSION

Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required.

Asymmetric effects of obesity on loneliness among older Germans. Longitudinal findings from the Survey of Health, Ageing and Retirement in Europe

OBJECTIVES

The aim of this longitudinal study was to examine whether the onset and the end of obesity was associated with loneliness.

METHOD

Nationally representative longitudinal data from Germany were taken from the Survey of Health, Ageing and Retirement in Europe (wave 5 to wave 7; n = 10,446 observations in the analytical sample). Using the three item loneliness scale (UCLA), loneliness was measured. According to the WHO thresholds, obesity was defined as BMI ≥ 30 kg/m². Asymmetric fixed effects (FE) regressions were used.

RESULTS

Conventional FE regression analysis revealed that changes in obesity status were associated with changes in loneliness (men: β = -.19, p < .05; women: β = .19, p < .05). Asymmetric FE regressions showed that in men the onset of obesity was associated with a decrease in loneliness (β = -.31, p < .05), whereas the end of obesity was not associated with loneliness. Asymmetric FE regressions showed that in women, the onset of obesity was associated with an increase in loneliness (β = .33, p < .01), whereas the end of obesity was not associated with loneliness.

CONCLUSION

Findings showed that the onset of obesity has different consequences in terms of loneliness for older women and men in Germany, whereas the end of obesity was not associated with changes in loneliness scores. We recommend that future studies should distinguish between the onset and the end of obesity - which comes along with important practical implications. When older women report transitions to obesity, efforts to prevent loneliness may be of importance.

Personality and functional impairment. Evidence from the Survey of Health, Ageing and Retirement in Europe

BACKGROUND

To date, only a few studies have investigated the association between personality and functional impairment. Therefore, our purpose was to add to this knowledge.

METHODS

Data from wave 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used (70 028 individuals in the analytical sample). Personality was measured using the 10-item Big Five Inventory (BFI-10). Functional impairment was quantified using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Multiple linear regressions were conducted.

RESULTS

Regressions showed that an increased likelihood of limitations in ADL was associated with higher extraversion, higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience. Similarly, an increased likelihood of limitations in IADL was associated with higher agreeableness, lower conscientiousness, higher neuroticism, and higher openness to experience (only with one IADL index).

CONCLUSIONS

This knowledge of associations between personality and functional limitations may help in determining individuals at risk for increased functional impairment (e.g., individuals with low conscientiousness or high neuroticism). Future research is needed to clarify the underlying mechanisms.

Mental component of health-related quality of life is an independent predictor of incident functional disability among community-dwelling older people: a prospective cohort study

PURPOSE

Previous studies have reported a positive association between poor health-related quality of life (HRQOL) and disability mainly in relation to the physical component of HRQOL. Given the mental component's responsivity to interventions, this study aimed to investigate whether the mental component of HRQOL independently predicted functional disability.

METHODS

We targeted all residents aged ≥ 65 years in one municipality and analyzed 3858 men and 4475 women without disability at baseline (November 2016). HRQOL was measured using the physical component summary (PCS) and mental component summary (MCS) of the SF-8 Health Survey. At 3-year follow-up (October 2019), incident functional disability was measured, defined as a new certification according to the Japanese long-term care insurance system. Multivariable Poisson regression models stratified by gender were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for functional disability.

RESULTS

Among both genders, there was a significant dose-response relationship between better MCS and lower risk of functional disability, independent of potential confounders including the PCS (P for trend = 0.026 in men and 0.003 in women). Compared with the worst MCS group, the CIRs (95% CIs) for functional disability in the second worst, the middle, the second best, and the best MCS quintile groups were 1.09 (0.80-1.48), 0.58 (0.40-0.85), 0.90 (0.59-1.37), and 0.70 (0.48-1.02) for men, and 0.76 (0.58-1.00), 0.62 (0.46-0.84), 0.73 (0.53-0.99), and 0.63 (0.48-0.85) for women, respectively.

CONCLUSION

The MCS is an independent predictor of functional disability among high-functioning older adults. This suggests that strategies focused on mental HRQOL are important for realizing a healthy, long-lived society.

Do postponed dental visits for financial reasons reduce quality of life? Evidence from the Survey of Health, Ageing and Retirement in Europe

Background

There is a lack of studies investigating the impact of postponed dental visits due to financial constraints on quality of life.

Aims

The aim of this study was to identify whether these factors are associated longitudinally.

Methods

Data were derived from waves 5 and 6 of the “Survey of Health Ageing and Retirement in Europe” (SHARE). The analysis focused on Germany (n = 7506). The widely used CASP-12 was used to quantify the quality of life. Postponed dental visits for financial reasons in the preceding 12 months (no, yes) were used as the main explanatory variable. Socioeconomic and health-related covariates were included in regression analysis.

Results

Gender stratified regression analysis showed that quality of life decreased with the presence of postponed dental visits due to financial reasons in men. Furthermore, quality of life decreased with the worsening of self-rated health in both men and women. The outcome measure was not associated with age, marital status, income, and chronic diseases in both sexes.

Discussion

Study findings suggest that postponing dental visits due to financial constraints contributes to a decreased quality of life among older men.

Conclusion

Efforts to avoid these circumstances might help to maintain the quality of life in older men.

Postponed Dental Appointments Due to Costs Are Associated with Increased Loneliness-Evidence from the Survey of Health, Ageing and Retirement in Europe

As is already well known, demographic changes will presumably lead to a rising number of old aged individuals and loneliness is a tremendous concern in aging populations. Poor health can be a potential consequence of loneliness, as well as a determining factor. Thus, the objective of the current study was to determine whether postponed dental appointments due to costs affect loneliness longitudinally. Focusing on Germany, data from two waves (waves 5 and 6) of the “Survey of Health Ageing, and Retirement in Europe” (SHARE) were analyzed (n = 7703). The three-item loneliness scale (modified version of the revised UCLA Loneliness scale) was used to quantify loneliness. The presence of postponed dental appointments due to costs in the past 12 months (no; yes) served as a key independent variable. Socioeconomic factors as well as health-related factors were adjusted in the longitudinal regression analysis. After adjusting for confounding variables, regression analyses revealed that loneliness increased with decreases in self-rated health among men. Among women, loneliness increased when self-rated health decreased, when fewer chronic diseases and postponed dental appointments due to costs were reported. Among older women, postponed dental appointments due to costs are associated with feelings of loneliness. The study results add evidence that proper dental care (i.e., regular and appropriate visits to the dentist) is vital not only to one’s oral health, but also plays a role in one’s physical and emotional health.

Connection Through Calls: The Impact of a Seniors Center Without Walls on Older Adults' Social Isolation and Loneliness

The Edmonton Seniors Centre Without Walls program provides free health, psychosocial, and educational telephone programming for older adults who experience multiple barriers to traditional in-person programming. The aim of this program evaluation was to assess outcomes of participation using validated scales of loneliness and psychosocial and health quality of life. Telephone interviews were conducted pre (n = 160) and post (n = 99) with participants. Given the variation in average attendance, results were assessed by level of participation: Low, Moderate, and High Users. There was statistically significant improvement in all participants' attitudes towards their self-realization and towards energy levels, and EQ-5D-5L anxiety/depression scale after participation, along with a significant reduction in feelings of social isolation. The highest rates of improvement were seen within High Users. These findings suggest that telephone-based programs could be a useful intervention to improve the wellbeing and socially connectedness of older adults.

Does the selective attrition of a panel survey of older people affect the multivariate estimations of subjective well-being?

PURPOSE

The increased population aging has resulted in a growing need for longitudinal studies about the quality of life among older people. Nevertheless, the results of these investigations could be biased because more disadvantaged people leave the original sample. The purpose of this study is to examine how the selective attrition observed in a panel survey affect multivariate models of subjective well-being (SWB). The question is if we could do reliable longitudinal investigations concerning the predictors of SWB in old age.

METHODS

This paper examines attrition in a panel of older people in Chile. Attrition was evaluated in the variables that affect elderly SWB. Probit models were fitted to compare dropouts with nondropouts. Then, multivariate probit models were estimated on satisfaction and depressive symptoms, comparing dropouts and nondropouts. Finally, we compared weighted and unweighted multivariate probit models on SWB.

RESULTS

The attrition rate in 2 years was 38.8%, including deaths and 32.9%, excluding them. Survey dropouts had lower satisfaction but not higher depressive symptoms. Among SWB predictors, people without a partner and with lower self-efficacy abandoned more the study. When applying the Becketti, Gould, Lillard, and Welch test, the probit coefficients of the predictor variables on SWB outcome variables were similar for dropouts and nondropouts. Finally, the comparison of multivariate models on SWB with weighting methods did not find substantial differences in the explanatory coefficients.

CONCLUSION

Although some predictors of attrition were associated with SWB, attrition did not produce biased estimates in multivariate models of life satisfaction life or depressive symptoms in old age.

Which factors contribute to loneliness among older Europeans? Findings from the Survey of Health, Ageing and Retirement in Europe: Determinants of loneliness

BACKGROUND

While previous studies have examined the determinants of loneliness (i) using a longitudinal approach and (ii) using data from nationally representative samples, only few studies have done both at once. Hence, the purpose of our study was to clarify which factors are associated with loneliness longitudinally based on nationally representative data.

METHODS

Data were taken from wave 5 to 7 of the "Survey of Health Ageing, and Retirement in Europe "(SHARE; covering 27 European countries and Israel in total) (in our analytical sample, n = 101,909 observations). Loneliness was assessed using the three-item loneliness scale. As explanatory variables, we included age, marital status, income, self-rated health, depressive symptoms, functional decline, cognitive functioning and chronic diseases. Exploiting the features of panel data and mitigating the problem of unobserved heterogeneity, linear FE regressions were used.

RESULTS

FE regressions showed that loneliness increased with increasing age (β = .02, p < .001), changes from married and living together with spouse/registered partnership to another marital status (β=-.71, p < .001), decreases in log income (β=-.01, p < .05), worsening self-rated health (β = .04, p < .001), functional decline (β = .09, p < .001), increases in depressive symptoms (β = .13, p < .001) and decreases in cognitive functioning (β=-.01, p < .001), whereas it was not associated with changes in chronic diseases.

CONCLUSION

Our longitudinal study based on nationally representative SHARE data contributed to identify the determinants of loneliness among older Europeans using panel data methods. Tackling the identified risk factors may assist in avoiding loneliness in older adults living in Europe.

Determinants of Postponed Dental Visits Due to Costs: Evidence from the Survey of Health, Ageing, and Retirement in Germany

High costs are an important reason patients postpone dental visits, which can lead to serious medical consequences. However, little is known about the determinants of postponing visits due to financial constraints longitudinally. Thus, the purpose of this study was to examine the determinants of postponing dental visits due to costs in older adults in Germany longitudinally. Data from wave 5 and 6 of the Survey of Health, Ageing, and Retirement in Europe was used. The occurrence of postponed dental visits due to costs in the last 12 months served as the outcome measure. Socioeconomic and health-related explanatory variables were included. Conditional fixed effects logistic regression models were used (n = 362). Regressions showed that the likelihood of postponing dental visits due to costs increased with lower age, less chronic disease, and lower income. The outcome measure was neither associated with marital status nor self-rated health. Identifying the factors associated with postponed dental visits due to costs might help to mitigate this challenge. In the long term, this might help to maintain the well-being of older individuals.

Reciprocal relationship between psychosocial work stress and quality of life: the role of gender and education from the longitudinal study of the Survey of Health, Ageing and Retirement in Europe

OBJECTIVE

To investigate the reciprocal relationship between psychosocial work stress and quality of life (QoL) and to examine whether the relationship can be moderated by gender or education.

DESIGN

Longitudinal, population-based study.

SETTING

The Survey of Health, Ageing and Retirement in Europe (SHARE).

PARTICIPANTS

The study population was derived from the SHARE, and there were 2006 participants with good QoL at baseline, 1109 with high job control and 1072 with high job reward, respectively, who were followed up for 2 years to detect incidence of poor QoL, low job control and low job reward.

MAIN OUTCOME MEASURES

Logistic regression models were employed to explore the reciprocal relationship between psychological work stress and QoL. Stratification analyses by gender and education were performed.

RESULTS

Participants with low reward (OR=1.53, 95% CI 1.26 to 1.88) and low control (OR=1.40, 95% CI 1.14 to 1.71) at baseline were at higher risk of poor QoL over the 2-year follow-up. The combination of low reward and low control further increased the risk (OR=1.90, 95% CI 1.46 to 2.48). Stratified analyses revealed that these associations were more pronounced among those who had high levels of education. Further, individuals with poor QoL were at significantly higher risk of having low reward (OR=2.14, 95% CI 1.55 to 2.96) but not low control (OR=1.33, 95% CI0.98 to 1.79) at the 2-year follow-up, especially among those who had medium levels of education. No gender differences were found.

CONCLUSIONS

There is a reciprocal relationship between psychological work stress and poor QoL. Education may play an important role in the relationship.

The Reciprocal Relationship Between Social Connectedness and Mental Health Among Older European Adults: A SHARE-Based Analysis

OBJECTIVES

The current study aimed to understand the reciprocal relationship between social networks and mental health in old age. It explored the dynamic aspects of that relationship and assessed the influence of social networks on mental health, as well as a concurrent influence of mental health on change in social connectedness.

METHOD

The data came from two measurement points in the Survey of Health, Aging and Retirement in Europe (SHARE). The analytic sample was composed of adults aged 65 years and above (N = 14,706). Analyses were conducted via latent change score models.

RESULTS

Analyses showed a reciprocal association between social networks and mental health; baseline social connectedness led to mental health improvements and a better initial mental state led to richer social networks. The results further indicated that the relative effect of mental health on change in social network connectedness was greater than the corresponding effect of social network connectedness on change in mental health. No gender differences were found regarding the reciprocal associations.

DISCUSSION

The results of this study demonstrate the dynamic inter-relationship of social networks and mental health. It highlights the need to take into account both directions of influence when studying the impact of social relationships on mental health.

Social network changes among older Europeans: the role of gender

This study examined changes in the social networks of older Europeans. It utilizes the framework of the socioemotional selectivity theory and the convoy model to explore the social networks' changes over time, as well as the turnover of specific social network members. Furthermore, the study analyzed gender as a predictor of these transformations. The inquiry focused on older adults aged 65+ who participated in the fourth and sixth waves of the Survey of Health, Ageing, and Retirement in Europe (n = 13,938). The findings reveal a general trend of network expansion over time, with addition of new members and a higher proportion of family ties. These trends mask considerable individual variability in change trajectories, however. A series of OLS and Poisson regressions revealed that women were more likely to report network growth via addition of new social network members, and lower family involvement. These findings underscore the dynamic nature of older Europeans' interpersonal milieu. They also underscore the role of gender in social network transformations and show that the dynamics of older Europeans' personal networks differ for men and women.

Grip strength and quality of life in the second half of life: hope as a moderator

OBJECTIVES

The purpose of the current study was to investigate grip strength, hope, and their interaction as predictors of quality of life four years later in a nationally representative sample of older adults.

METHOD

Data were derived from the first (2005-2006) and second wave (2009) of the Israeli component of the Survey of Health Ageing and Retirement in Europe (SHARE; N = 344). Hope was measured by three items from the Hope   Scale, and quality of life was measured by the CASP-12 (Control, Autonomy, Self-Realization, and Pleasure). Multiple regression analyses were conducted.

RESULTS

Grip strength at T1 predicted QoL in T2, but hope was not a significant predictor. Furthermore, hope moderated the effect of handgrip on QoL, such that the effect was weaker for higher levels of hope.

CONCLUSION

As hypothesized, hope acted as a moderator, such that poor grip strength was associated with worse QoL for less hopeful older adults, but grip strength was not associated with QoL for more hopeful older adults. Findings are consistent with a theoretical conceptualization of hope as a buffer between physical challenges and negative outcomes like QoL. Encouraging a hopeful perspective could enhance QoL for older adults with decreased muscle strength.

Association of Physical Morbidity and Health-Related Quality of Life in a Representative Sample of Older German People

Abstract. The association between health-related quality of life (HRQoL; Short-Form Health Survey-12; SF-12) and patient-reported morbidity-related symptoms measured by the Patient Health Questionnaire-15 (PHQ-15) is analyzed in a representative sample of older people in the general German population. Data from 1,659 people aged 60 to 85 years were obtained. Latent class analysis identified six classes of patients, which optimally categorize clusters of physical symptoms the participants reported: musculoskeletal impairments (39.8%), healthy (25.7%), musculoskeletal and respiratory/cardiac impairments (12.8%), musculoskeletal and respiratory impairments, along with bowel and digestion problems (12.9%), general impairments (4.9%), and general impairments with no bowel and digestion problems (4.8%). The participants’ SF-12 Physical Health Scores (η2 = .39) and their Mental Health Scores (η2 = .28) are highly associated with these latent classes. These associations remain virtually identical after controlling for age. The results provide evidence that profiles of patient-reported physical impairments correspond strongly with reduced HRQoL independently from aging processes.

Nutritional Risk and Quality of Life in Community-Dwelling Elderly: A Cross-Sectional Study

OBJECTIVES

To evaluate the association between nutritional risk and quality of life in community-dwelling elderly.

METHOD

A cross-sectional study of individuals aged 60 years or older living in the Brazilian state of Minas Gerais was conducted. Nutritional status was evaluated using the Mini Nutritional Assessment, and quality of life was determined using the WHOQOL-bref and WHOQOL-old. The absolute and relative frequency distributions for each domain were calculated, and chi-square tests were used to examine the association between nutritional risk and quality of life (dichotomous variables). Poisson regression was used to perform univariate and multivariate analyses.

RESULTS

789 (27.9%) of the 2823 elderly patients in the sample were at nutritional risk. The risk of malnutrition was associated with the physical, environment, psychological, sensory abilities, social participation and intimacy domains of quality of life [(PR= 1.42, 95%CI 1.23-1.63); (PR= 1.28, 95%CI 1.12-1.47); (PR= 1.18, 95%CI 1.03-1.36); (PR= 1.36, 95%CI 1.20-1.54); (PR= 1.29, 95%CI 1.13-1.46); (PR= 1.14, 95%CI 1.01-1.29); respectively].

CONCLUSION

The present findings contribute to the understanding of nutritional risk, and support the association between quality of life and nutritional status. These factors should be considered in the diagnosis, monitoring and treatment of nutritional disorders, and may contribute to the prevention and reduction of nutritional risk in this especially vulnerable population.

Are newly added and lost confidants in later life related to subsequent mental health?

BACKGROUND

This study examined internal changes in the personal social networks of older people and the relationship between these changes and mental health over time. It focused on two key aspects: emotional closeness and contact frequency with lost and newly added confidants.

METHODS

The study was based on data from the fourth (2011) and sixth (2015) waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). The study sample consisted of respondents aged 65 years and older who participated in both waves (n = 14,101). We performed OLS regressions in which the scores on two mental health indicators over time - depressive symptoms (Euro-D) and perceived quality of life (CASP-12) - were regressed on the relationship with lost and newly added confidants, controlling for baseline social networks, socio-demographic, and health variables.

RESULTS

The nature of the relationship with the lost and newly added confidants was associated with mental health, beyond the number of these confidants. Emotional closeness with newly added confidants was related to improved mental health in both indicators (B = -0.09, CI = -0.14 to -0.04 for depression; B =1.13, CI = 0.67-1.60 for quality of life). Losing frequently contacted confidants was associated with higher depressive symptoms (B = 0.09, CI = 0.02-0.15).

CONCLUSIONS

The results show the positive mental health implications of adding emotionally close confidants to older adults' social milieus, and the negative effects of losing frequently contacted confidants. Practitioners are advised to pay attention to the quality of such changing relationships, due to their mental health consequences.

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

BACKGROUND

Polypharmacy has been associated with increased morbidity and mortality in the older population.

OBJECTIVES

The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia.

METHODS

This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models.

RESULTS

A total of 1256 participants were included with a median (interquartile range) age of 69(63-74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation.

CONCLUSION

A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.

Joint Association of Obesity and Hypertension with Disability in the Elderly-- A Community-Based Study of Residents in Shanghai, China

BACKGROUND

Although both obesity and hypertension are known risk factors for disability, the joint association of obesity and hypertension with risk of disability is unknown. This paper is aim to examine the joint association of obesity and hypertension with risk of disability.

METHODS

Cross-sectional study with 8060 elderly community-dwelling individuals participating in the survey initiated by Shanghai Health and Family Planning Commission from March to September 2013. Obesity was measured using the body mass index (BMI) in World Health Organization (WHO) Asia criteria. Hypertension, based on the doctor's diagnosis, was obtained through face-to-face interview. Disability was measured using the self-reported physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scale developed by Lawton and Brody.

RESULTS

A total of 8.97% of participants reported ADL disability, and 15.18% for IADL disability. After adjusting social demographics and chronic conditions, the risk of ADL disability was progressively greater in obese persons with hypertension (OR=1.40, 95% CI=1.05-1.89), underweight persons without hypertension (OR=2.05, 95% CI=1.29-3.25), and underweight persons with hypertension (OR=2.14, 95% CI=1.36-3.36). For IADL disability, only underweight persons with hypertension were significantly associated (OR=1.65, 95% CI=1.23-2.21).

CONCLUSIONS

Low or extremely high BMI, independent of its metabolic consequences, is a risk factor for disability among the elderly. Simple hypertension wasn't significantly associated with disability. In addition, having hypertension significantly increased the risk of ADL disability in obese individuals and IADL disability in underweight individuals.

Depression and associated variables in people over 50 years in Spain

INTRODUCTION

Depression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability.

OBJECTIVES

To determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries.

MATERIAL AND METHODS

There were 5,830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life).

STATISTICAL ANALYSIS

Bivariate, and binary logistic.

RESULTS

The variables associated with depression in the binary logistic regression (EURO-D ≥4) were poor self-perceived physical health (OR=13.34; 95% CI: 9.74-18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR=4.46; 95% CI: 3.13-6.34) and female gender (OR=2.16; 95% CI: 1.83-2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%).

CONCLUSIONS

The most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender.

Quality of life in people aged 65+ in Europe: associated factors and models of social welfare-analysis of data from the SHARE project (Wave 5)

PURPOSE

To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+ and to examine the relationship with models of social welfare in Europe.

METHODS

This was a cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). The instruments used in the present study were as follows: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis included bivariate and multilevel analyses.

RESULTS

In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared to Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4).

CONCLUSIONS

Perceived quality-of-life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live.

Changes in Quality of Life in 7 Older Adult Patients Receiving Activator Methods Chiropractic Technique

OBJECTIVE

The purpose of this case series is to report on symptomatic and quality of life (QoL) changes in 7 older adult chiropractic patients who were receiving care using Activator Methods Chiropractic Technique (AMCT).

CLINICAL FEATURES

Seven patients were selected from 2 chiropractic offices in Auckland, New Zealand. Patients were included if they were older adults receiving AMCT care and for whom at least 2 QoL assessments had been performed. The patients, aged 69-80 years, primarily received care for a variety of musculoskeletal complaints.

INTERVENTION AND OUTCOMES

The patients reported improvements in their presenting complaints as well as a number of nonmusculoskeletal symptoms. Each patient demonstrated clinical improvements in their RAND 36-Item Short Form Health Survey (SF-36) results. The average improvement in QoL measured using a SF-36 questionnaire was 8.0 points in the physical component and 4.1 points in the mental component. Four cases had a second progress evaluation using the SF-36 and showed an overall improvement of 5.2 in the physical and 9.8 in the mental components from baseline.

CONCLUSION

This case series describes an improvement in QoL, as measured by the SF-36 instrument, as well as subjectively reported improvements in both musculoskeletal and nonmusculoskeletal symptoms in 7 older adults receiving chiropractic care.

Longitudinal Predictors of Functional Impairment in Older Adults in Europe--Evidence from the Survey of Health, Ageing and Retirement in Europe

Objective

To examine time-dependent predictors of functional impairment in older adults in Europe longitudinally.

Methods

Data were derived from the Survey of Health Ageing, and Retirement in Europe (2004–2013). Functional impairment was assessed by using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Fixed effects regressions were used to estimate the effects of sociodemographic factors (age, marital status, living situation, and income deciles (median split)), lifestyle factors (smoking status and alcohol consumption per week), depression, cognitive function and chronic diseases on the outcome variables.

Results

Longitudinal regressions revealed that functional impairment increased significantly with age, the occurrence of depression, cognitive impairment, the number of chronic conditions, and less than daily alcohol consumption in the total sample and in both sexes. Moreover, the onset of smoking and living without a spouse/partner in household increased functional impairment in the total sample. The effect of depression on functional impairment was significantly more pronounced in men.

Conclusion

Our findings highlight the relevance of changes in age, depression, cognitive function, smoking and chronic diseases for functional impairment. Since particularly depression and smoking may be avoidable, developing strategies to prevent depression or stop smoking might be useful approaches to postpone functional impairment in older adults.