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)

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.

Quality-of-life in older adults: its association with emotional distress and psychological wellbeing

BACKGROUND

There is consistent evidence of the impact of depression and health on Quality of Life in older adults. However, the influence of anxiety or psychological wellbeing aspects has been less extensively studied. This study aims to assess the association between quality of life and sociodemographic characteristics (gender, age), levels of health, emotional distress (anxiety and depression) and psychological wellbeing (personal growth and purpose in life).

METHODS

The survey was conducted with 361 older adults (mean age = 68.44 years) This study was of cross-sectional design.

RESULTS

We found that the older adults' quality of life increased when increased the levels of health, personal growth and purpose in life and when there were lower scores in anxiety and depression. This model explained 63.2% of variance. In contrast, sociodemographic characteristics did not show any association with quality of life.

CONCLUSIONS

A better understanding of the factors associated with quality of life could help health professionals to develop interventions that enhance it. Efforts to address older adults' quality of life focusing on older adults' perceived health and emotional status should be considered.

A Structural Equation Model for Understanding the Relationship between Cognitive Reserve, Autonomy, Depression and Quality of Life in Aging

In recent years, aging has become a focal point of scientific research and health policies due to the growing demographic trend of an aging worldwide population. Understanding the protective and risk factors that influence aging trajectories is crucial for designing targeted interventions that support healthy aging and improve people's quality of life. The aim of this study was to explore the relationships between variables of aging. A total of 103 Italian participants (55-75 years old) underwent multidimensional assessments that covered cognitive, functional, emotional, and quality of life dimensions. Structural equation modeling was used to analyze the data and elucidate the relationships between depression, quality of life, cognitive reserve, executive functions, and daily autonomy. The findings revealed that a higher quality of life was associated with reduced depressive symptoms. In addition, cognitive reserve emerged as a protective factor positively correlated with both quality of life and daily autonomy. In this study, quality of life was determined using physical health, psychological, social relationships, and environmental domains. Identifying the significant relationships between these variables in a sample of late adults and young-aged people has given us useful elements for designing psycho-educational interventions that can be aimed at preventing frailty in later old age or supporting healthy longevity.

The association between living arrangements and health-related quality of life in Korean older people: a nationwide repeated cross-sectional study

BACKGROUND

This study investigated the association between living arrangements and healthrelated quality of life (HRQoL) in older people.

METHODS

A secondary analysis was conducted of 6,153 participants (aged ≥60 years) from the seventh Korean National Health and Nutrition Examination Survey (2016 to 2018). HRQoL was measured using the 3-level version of the EuroQol 5-dimensional questionnaire. The chi-square test, t-test, and multiple regression were used, applying sampling weights for the analysis.

RESULTS

The proportion of respondents living alone was 18.0%, with a higher prevalence among women and older age groups (p<0.001). The overall HRQoL was lower in groups living alone than in groups living with others (p<0.001). Older people living alone showed higher impairments in all dimensions of the 3-level version of the European Quality of Life 5-Dimensional Questionnaire (EQ-5D-3L) than those living with others, including mobility (p<0.001), self-care (p<0.001), usual activities (p<0.001), pain/discomfort (p<0.001), and depression/anxiety (p<0.001). Problems with mobility were most prevalent (42.8%), followed by pain/ discomfort (41.9%) in respondents living alone. Living alone was significantly associated with a lower HRQoL index score (b=-0.048, p<0.001) after adjusting for age, gender, education, exercise, perceived stress, and perceived health status.

CONCLUSION

Living alone was negatively associated with HRQoL. Based on this study, future care planning for older people should consider their living arrangements. The need to strengthen and expand care programs targeting those living alone should also be addressed.

How older adults experience the age-friendliness of Skopje: Results of the validation of the AFCCQ for use in North Macedonia and a representative survey

Hundreds of cities and communities in the world have joined the WHO's Global Network for Age-Friendly Cities and Communities since 2010. In order to do quantitative assessments of the age-friendliness of cities, the Age-Friendly Cities and Communities Questionnaire (AFCCQ) was developed for the Dutch municipality of The Hague. The purpose of this study was first to translate and test the validity and reliability of the AFCCQ for use in North Macedonia and second to explore perceptions on age-friendliness of the bicultural and bilingual City of Skopje. The AFCCQ proved valid for use in North Macedonia. Overall, older adults in Skopje experience the age-friendliness of the city as neutral (in seven out of nine domains). The best score ("slightly satisfied") was found in the domain of Housing domain, which was rated positive in all ten municipalities. The lowest total score ("slightly dissatisfied") was found in the domain of Outdoor spaces and buildings scoring, which received negative scores in eight out ten municipalities. In five out of nine domains differences were observed between the Albanian and Macedonian communities. The Albanian sample has slightly higher scores in two domains: 1) Housing and 2) Civic Participation and Employment, while the Macedonian sample scored higher in three domains: 1) Communication and Information; 2) Outdoor Spaces and Buildings and 3) Transportation. A hierarchical cluster analysis further revealed the presence of six distinct age-friendly typologies that can be used for a better understanding of subpopulations in the city and draft policies and action programs on the city level.

Influence of Social Determinants of Health on the Quality of Life of Older Adults in Europe: A Sex Analysis

Introduction

The global aging population poses challenges for society such as health inequalities among older persons and between genders.

Objectives

To determine how Social Determinants of Health (SDH) influence the quality of life (QoL) of individuals over 50 years old in various European countries, taking a gender perspective in a longitudinal study.

Materials and methods

Sample of 11,493 individuals from 13 European countries from Waves 5 (2013), 6 (2015), and 7 (2017) of the SHARE study. Instruments: CASP-12 (QoL), EURO-D (depression), SDH: gender, age, educational level, socioeconomic status, ethnicity, place of residence, and European region. Sociodemographic and clinical variables. Statistical analysis: Bivariate and multivariate mixed linear models.

Results

The bivariate analysis showed higher economic hardship and lower education in women compared to men. The CASP-12 score was higher in men than in women. In the multivariate analysis, the variables associated with lower QoL scores among men and women from Wave 5 to Wave 7 were: (β:-0.196, 95% CI: -0.345; -0.047) vs (β:0.038, 95% CI: -0.122; 0.197); economic hardship; and the European region between South and North (β: 2.709, 95% CI: 2.403; 3.015) vs men (β: 2.224, 95% CI: 1.896; 2.551).

Conclusions

The main SDH associated with poorer QoL were female gender, advanced age, economic hardship, educational level, and geographic location within Europe. Depression in women and in Southern Europe were associated with a decrease in QoL scores.

Associations of the serotonin transporter gene polymorphism, 5-HTTLPR, and adverse life events with late life depression in the elderly Lithuanian population

Late-life depression (LLD) is a multifactorial disorder, with susceptibility and vulnerability potentially influenced by gene-environment interaction. The aim of this study was to investigate whether the 5-HTTLPR polymorphism is associated with LLD. The sample of 353 participants aged 65 years and over was randomly selected from the list of Kaunas city inhabitants by Residents' Register Service of Lithuania. Depressive symptoms were ascertained using the EURO-D scale. The List of Threatening Events Questionnaire was used to identify stressful life events that happened over the last 6 months and during lifetime. A 5-HTTLPR and lifetime stressful events interaction was indicated by higher odds of depression in those with s/s genotype who experienced high stress compared to l/l carriers with low or medium stress, while 5-HTTLPR and current stressful events interaction analysis revealed that carriers of either one or two copies of the s allele had increased odds of depressive symptoms associated with stress compared to participants with the l/l genotype not exposed to stressful situations. Although no significant direct association was found between the 5-HTTLPR short allele and depression, our findings demonstrated that lifetime or current stressful life events and their modification by 5-HTTLPR genotype are risk factors for late-life depression.

Trajectories of generalized anxiety disorder, major depression and change in quality of life in adults aged 50 + : findings from a longitudinal analysis using representative, population-based data from Ireland

PURPOSE

To investigate the longitudinal association between trajectories (incidence, remission) of generalized anxiety disorder (GAD), major depression (MD) and change in quality of life (QoL) in adults aged 50 + , and to assess the symmetry in these relationships using observational study data.

METHODS

Data were derived from two waves of The Irish Longitudinal Study on Aging (2014-2015, wave 3: n = 6400; 2016, wave 4: n = 5715), a nationally representative cohort of community-dwelling adults aged 50 +. GAD and MD were assessed by means of the short form of the Composite International Diagnostic Interview. QoL outcomes were assessed using the Control, Autonomy, Self-realization, and Pleasure scale (CASP-12 with two domains control/autonomy and self-realization/pleasure). Covariate-adjusted, asymmetric fixed effects panel regressions and post-estimation Wald tests were used for statistical analysis.

RESULTS

Regarding incident disorders, only incident MD was significantly associated with a reduction in QoL over time (control/autonomy domain: b = - 0.74, SE: 0.30). Regarding remission, both remission of MD (b = 0.61, SE: 0.20) and remission of GAD (b = 0.61, 0.26) were significantly associated with an increase in the self-realization/pleasure domain over time. Subsequent Wald tests of the estimates were not significant, indicating symmetric effects.

CONCLUSION

Particularly the remission of GAD and MD was associated with a significant improvement in one of the QoL domains, indicating domain- and trajectory-specific differences. However, symmetric effects observed in this study indicate that gains and losses in QoL associated with remission and incidence of GAD and MD are of similar magnitude in adults aged 50 +.

Associations between Physical Activity and Health-Related Quality of Life among Community-Dwelling Older Adults: A Cross-Sectional Study in Urban Greece

Physical activity is an important factor in achieving healthy aging, offering older persons multiple benefits in terms of maintaining and improving their health and wellbeing. The aim of this study was to investigate the effect of physical activity on the quality of life of older adults. A cross-sectional study was conducted from February to May 2022, using the Short-Form Health Survey (SF-36) and the International Physical Activity Questionnaire (IPAQ). A total of 124 people aged 65 and over participated in the survey. The average age of the participants was 71.6 years, and 62.1% were women. Participants showed a moderate quality of life with regard to the physical health dimension (mean score 52.4) and a higher quality of life with regard to the mental health dimension (mean score 63.1) compared to the expected values of the population. Low levels of physical activity were recorded among older adults, reaching a rate of 83.9%. A moderate or high level of physical activity has been found to contribute to a better physical functioning (p = 0.03), vitality (p = 0.02) and general health (p = 0.01). Finally, comorbidity had a negative impact on physical activity (p = 0.03) and quality of life regarding mental and physical health in older adults. The study showed very low levels of physical activity in older Greek adults. The management of this problem, which was intensified during the COVID-19 pandemic, should be a high priority in public health programs focusing on healthy aging, as physical activity affects and promotes many of the basic aspects of quality of life.

Impact of a public open-access community-based physical activity and fall prevention program on physical performance in older adults

BACKGROUND

In older adults, physical activity (PA) is important in maintaining physical performance. Data on the effectiveness of public open-access community-based programs on physical performance and fall prevention are scarce.

METHODS

Prospective observational controlled study in community centers providing an open-access public prevention program. Retirees aged ≥60 years who chose to participate in weekly PA workshops for 3 months were compared to those who chose the cognitive stimulation (CS) workshops. Collected data: handgrip strength, five times sit-to-stand, single-leg stance, Timed Up and Go tests, gait speed, short physical performance battery (SPPB) and frailty status at baseline (M0) and at 3 months (M3). The proportion of participants reporting a history of falls was assessed at baseline and using follow-up telephone interviews (F-Up).

RESULTS

Two hundred eighty-eight participants (age 73.8 years, 87% women) were included. The sit-to-stand test, single-leg stance and SPPB scores improved significantly between M0 and M3 in both groups. A greater SPPB increase was observed in the PA than in the CS group (+0.39 vs. +0.32 points, P = 0.02) after adjustment for age, sex, number of sessions attended, fall history and SPPB at baseline. During F-Up (median 22 months), the proportion of participants reporting at least one fall decreased from 55% to 31% (P = 0.01) in the PA group and from 27% to 19% (P = 0.12) in the CS group.

CONCLUSION

In a public open-access community-based program participants improved physical performance and reduced fall incidence when participating in the PA or the CS workshops. Older adults may benefit most from multifaceted prevention programs.

Physical activity and psychological adjustment among retirees: a systematic review

BACKGROUND

Health-related behaviors may change after retirement and induce changes in the mental health. This systematic review aimed to investigate the nature of changes in physical activity and leisure activities, as well as the relationship between physical activity, leisure, and psychological adjustment among retirees.

METHODS

Search of papers was done in three electronic databases of PubMed, ISI Web of Science, and Scopus without constraints on time, geographical regions, or languages in February 2022. The papers that had examined the relationship between physical activity and adjustment among retirees using observational design (cross-sectional or longitudinal) were included in the present study. To evaluate the methodological quality of cross-sectional studies, Joanna Briggs Institute (JBI) Critical Appraisal Checklist, and for longitudinal studies, Newcastle-Ottawa Scale (NOS) were used.

RESULTS

The search results identified 1458 records. Twenty-six papers were included in this review based on the inclusion and exclusion criteria. The findings of most of these studies indicated a significant positive correlation between physical activity, leisure, and psychological adjustment in retirees. Retirees were mostly engaged in passive leisure activities such as reading, watching TV and movies, and less engaged in physical activities, sport, or physical exercise. General organized assessment of the total physical activity among retirees was not possible.

CONCLUSIONS

Based on the study findings, it can be stated that there is a positive correlation between physical activity, leisure, and the retirees' adjustment. Usage of the same and valid measurement method specific to old age and retirement period can be useful in more precise assessment of physical activity and its association with adjustment among retirees.

Sex differences in quality of life and depressive symptoms among middle-aged and elderly Europeans: results from the SHARE survey

OBJECTIVES

We examine sex differences in quality of life (QoL) and depressive symptoms across age and European regions.

METHODS

We performed a large cross-sectional study based on 64,552 women and 53,647 men aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Linear and logistic regression models were used to examine associations with QoL (CASP-12) and depressive symptoms (EURO-D).

RESULTS

Women reported slightly lower QoL (coefficient -0.78, 95% CI -0.92; -0.65) and more depressive symptoms (odds ratio (OR) 2.23, 95% CI 2.13; 2.34) than men. Sex differences in QoL increased with advancing age, whereas sex differences in depressive symptoms were stable across age groups. No overall sex difference in QoL was found in Northern Europe, but women had lower QoL than men in Western (coefficient -0.49, 95% CI -0.69; -0.29), Southern (coefficient -1.35, 95% CI -1.61; -1.09) and Eastern (coefficient -0.72, 95% CI -1.05; -0.39) Europe. However, sex differences varied within the specific CASP-12 items, with women having overall lower control and autonomy, but more self-realisation, than men. Women reported more depressive symptoms than men in all regions, with the largest overall sex difference in Southern Europe (OR 2.62, 95% CI 2.40; 2.86). A female disadvantage was found for most of the EURO-D items, with the largest sex differences for 'tearfulness', 'depression' and 'sleep'.

CONCLUSION

Middle-aged and elderly European women report lower QoL and more depressive symptoms than European men, lending support for the male-female health survival paradox.

Oral health and quality of life: findings from the Survey of Health, Ageing and Retirement in Europe

BACKGROUND

The aim of this study was to clarify the link between oral health and quality of life among older adults in Europe.

METHODS

Cross-sectional data from wave 5 (n = 59,048 observations) were used from the representative Survey of Health, Ageing and Retirement in Europe. Oral health was quantified by three questions: presence of all natural teeth (yes; no); among individuals with missing natural teeth, the number of missing teeth and the extent of replaced natural teeth were quantified. Quality of life was quantified using the widely used CASP-12. Multiple linear regressions were used to determine the association between oral health and quality of life, adjusting for various potential confounders.

RESULTS

Multiple linear regressions showed that higher quality of life was associated with (1) the presence of all natural teeth and among individuals with missing natural teeth, with (2) a lower number of missing natural teeth and (3) completely replaced natural teeth. Additionally, quality of life was positively associated with younger age, being female, being married or in a partnership, higher income, higher educational level, not currently smoking, a lower number of functional impairments, better self-rated health, a lower number of depressive symptoms and a lower number of chronic diseases.

CONCLUSION

Study findings showed an association between oral health and quality of life among older adults in Europe. Thus, the importance of good oral health for successful ageing was stressed. Future research is required to clarify the underlying mechanisms. Moreover, longitudinal studies are required to confirm our current findings.

Individual and country-level factors associated with self-reported and accelerometer-based physical activity in old age: a cross-national analysis of European countries

This study aimed to investigate associations between individual-level (personality traits, quality of life) and country-level (gross domestic product per capita, number of policies and action plans for physical activity) factors with self-reported and accelerometer-based physical activity and cross-level interactions among European countries. Based on the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2019-2020, self-reported physical activity (N = 46,617 from 27 countries) and accelerometer-based average acceleration and intensity gradient (N = 855 from 10 countries) were analyzed. Mixed-model regressions with two levels (individuals nested within countries) were used for analyses. Between countries differences accounted for relatively small portions of the variability in self-reported physical activity (intraclass correlation, ICC = 7.5%), average acceleration (ICC = 3.5%), and intensity gradient (ICC = 1.9%). There were more associations between individual- and country-level factors and self-reported physical activity than with accelerometer-based physical activity. The association between individual-level variables and accelerometer-based physical activity did not differ between countries. Cross-level interactions suggested that associations between some personality traits and self-reported physical activity were stronger in countries with lower GDP. Both individual- and country-level factors are related to participation in more intensive physical activities. Adults with less resilient personality traits living in countries with lower resources are at the highest risk for physical inactivity.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00737-8.

Can the internet mitigate the negative effect of widowhood on Quality of Life? A gender analysis

Widowhood often reduces the Quality of Life of individuals of advanced ages by negatively affecting their social network ties. Yet conversely, the Internet has also created new opportunities for communication and interaction, thus contributing to improved Quality of Life. This research analyses the role of the Internet in the relationship between widowhood and Quality of Life from a gender perspective.

This study focuses on 31,814 individuals aged 65 or over residing in 17 European countries who participated in Wave 6 of SHARE – the Survey of Health, Ageing and Retirement in Europe.

The linear regression analyses highlighted that the role of the Internet in the relationship between widowhood and Quality of Life varies according to gender. More specifically, in Europe, the Quality of Life for widowed women aged 65+ using the Internet is .414 higher (CI=.006 to .0822) than widows who do not use the Internet and married women or women in a de facto relationship whether or not they use the Internet. The results have relevant implications for the development of social policies and suggest a need to develop digital inclusion projects targeting older people, particularly widows, to help promote their Quality of Life.

Exploring the Association between Welfare State and Mental Wellbeing in Europe: Does Age Matter?

Previous research reports show mixed results regarding the age gradient in population mental wellbeing, which may be linked to the role that welfare states play. In this study, we investigate whether an age gradient exists in relation to the association between welfare state and mental wellbeing within the adult population in Europe. We combine individual level data from Round 6 of the European Social Survey and country level data on welfare state and use multilevel regression analyses to explore population mental wellbeing. Subjective and psychological wellbeing dimensions were analyzed, and different approaches to measuring welfare state were explored, including a regime typology and composite welfare state measures constructed on the basis of a set of eight individual indicators. We found the age gradient for mental wellbeing to differ between welfare states, with the positive impact of the welfare state increasing with age. A universal and generous welfare state seems to be particularly important for older adults, who are also more likely to be in higher need of transfers and services provided by the welfare state.

Grandparenting, health, and well-being: a systematic literature review

Whether grandparenting is associated with improved health or well-being among older adults is a salient question in present-day aging societies. This systematic review compiles studies that consider the health or well-being outcomes of grandparenting, concerning (1) custodial grandparent families, where grandparents are raising grandchildren without parental presence; (2) three-generation households, where grandparents are living with adult children and grandchildren; and (3) non-coresiding grandparents, who are involved in the lives of their grandchildren. Review was based on literature searches conducted in September 2019 via Web of Science, PubMed, PsycINFO, and Ebsco. We screened 3868 abstracts across four databases, and by following the PRISMA guidelines, we identified 92 relevant articles (117 studies) that were published between 1978 and 2019. In 68% of cases, custodial grandparenting was associated with decreased health or well-being of grandparents. The few studies considering the health or well-being of grandparents living in three-generation households provided mixed findings (39% positive; 39% negative). Finally, in 69% of cases, involvement of non-coresiding grandparents was associated with improved grandparental outcomes; however, there was only limited support for the prediction that involved grandparenting being causally associated with grandparental health or well-being. Despite this, after different robustness checks (counting all nonsignificant results, taking into account the representativeness of the data and causal methodology), the main finding remains the same: the most negative results are found among custodial grandparents and three-generation households and most positive results among non-coresiding grandparents.

Physical demands at work and physical activity are associated with frailty in retirement

BACKGROUND: The relationship between occupational physical activity and frailty is complex and understudied. OBJECTIVE: We explore whether moderate-vigorous physical activity (MVPA) in retirement and main lifetime occupation physical demands (OPD) are associated with frailty in retirement. METHODS: Retired adults aged 50 + who participated in waves 3-4 of the Survey of Health, Ageing and Retirement in Europe were included. We constructed a 65-item frailty index (FI; Wave 4). Linear regressions tested the independent associations between OPD (Wave 3) and retirement MVPA (Wave 4) with FI (B: 95% CI) controlling for occupation characteristics (Wave 3) and demographics (Wave 4). These models were repeated across country groups (Nordic; Mediterranean; Continental) and sexes. RESULTS: We included 8,411 adults (51.1% male) aged 72.4 years (SD 8.0). Frequent MVPA was consistently associated with lower FI (-0.09 : 0.10–-0.08, p < .001) while OPD was associated with higher FI (0.02 : 0.01-0.03, p < .001). The MVPA*OPD interaction (-0.02: -0.04–-0.00, p = .043) was weakly associated with FI, but did not explain additional model variance or was significant among any country group or sex. CONCLUSIONS: For a sample of European community-dwelling retirees, a physically demanding main lifetime occupation independently predicts worse frailty, even in individuals who are physically active in retirement.

The impact of grandchild care provision on grandparents’ depressive symptoms across Europe using multi-level analysis: do the grandchild caring patterns and the country’s economy matter?

Little research has examined the cross-national differences in the impact of grandchild care provision on the grandparents’ depression, by taking into account of both macro- and micro-level factors. This study used a unique grandchild caring pattern variable in order to examine the effect of the changes in the intensity of grandchild caring on the grandparents’ depressive symptoms in European countries, and whether the grandparents’ country level economy influenced such effect. Longitudinal data derived from the Survey of Health, Ageing, and Retirement in Europe 2010–2018 covered 13 countries and 24,656 grandparents aged 50–90. Multi-level linear regression analyses with REML estimation were used. This study found that providing grandchild care had a protective effect against grandparents’ depressive symptoms in both lower and higher income countries. Moreover, providing more intensive grandchild care reduced the grandparents’ depressive symptoms to a greater extent in lower income countries than higher income countries. In addition, grandmothers benefited more from grandchild caring than grandfathers, and the gender gap in the effects of grandchild care provision on one’s depressive symptoms was wider in lower income countries than higher income countries in Europe. Future research can further investigate the mechanisms behind such results. The research findings can be used to develop targeted interventions aimed at grandparents providing childcare of different intensity.

Trajectory of Quality of Life Before and After Entering a Nursing Home: A Longitudinal Study

OBJECTIVES

The objective of this longitudinal study was to compare the trajectory of subjective quality of life in 2 groups of older adults: those who entered a nursing home and those who remained living in the community with similar clinical conditions.

METHOD

PAQUID is a prospective population-based study. It included, at baseline, 3777 community-dwelling participants aged 65 years and over. Participants were followed-up for up to 27 years. Among people living at home at baseline, 2 groups were compared: participants who entered a nursing home over a 20-year follow-up (n = 528) and those who remained community dwellers (n = 2273). We used latent process mixed models to estimate the relationship between mean trajectory of subjective quality of life and admission into a nursing home. We computed univariate and multivariate models taking into account potential confounders (age, gender, education, income, comorbidities, dementia, disability and depression).

RESULTS

Nursing home placement was significantly associated with a drop in quality of life between the last visit before and after institutionalization. Nevertheless, we found no difference in quality of life trajectory after this initial drop.

CONCLUSION

Older adults exhibit an acute drop in quality of life after nursing home admission, probably reflecting the associated psychological distress. Even though their quality of life does not go back to pre-admission levels, the residents do not show a steeper decline when compared to the "natural" evolution of quality of life in older adults living in the community, which suggests a relative adaptation to their new living conditions.

The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe

OBJECTIVE

To estimate whether becoming widowed had a significant effect on individual's health status as well as on healthcare and non-healthcare resources use, compared to people who remained in a couple in Europe.

DATA AND METHOD

It was used the Survey of Health, Aging and Retirement in Europe from 2004 to 2015. The statistical technique used was genetic matching which analysed the differences in wellbeing, mental health, health status, risk of death, health care resources and long-term care utilization of people who have become widowed, comparing with people who remained married or with a partner. We considered shortterm and medium-term effects.

RESULTS

In the short term, those who became widowed had a worse wellbeing and mental health, in addition to a greater probability of receiving formal care and informal care from outside the household. There seems to be a significant effect in the use of formal and informal care from outside the household in the medium term.

CONCLUSIONS

The results might help to concentrate a major effort of any policy or strategy, not only in the field of health but also in the provision of long-term care, immediately after the negative shock occurs.

The Health Effects of Workforce Involvement and Transitions for Europeans 50–75 Years of Age: Heterogeneity by Financial Difficulties and Gender

A prominent demographic trend throughout the industrialized world is population aging. Concerns about economic growth and labour force shortages have led many European nations to enact policies aimed at prolonging working life. Understanding how paid work among late-middle-aged and senior adults is associated with health is therefore important. Using a sample of persons who were 50–75 years of age in 2015 from waves six (2015) and seven (2017) of the Survey of Health, Ageing and Retirement in Europe (n = 38,884), this study shows how a comprehensive set of six workforce involvement/transitions patterns are associated with health. The results show benefits of paid work, especially among respondents having financial difficulties. There is further heterogeneity by gender. The more fragmented employment histories of 50–75-year-old women are associated with stable paid work being of less benefit for addressing financial difficulties and with their health being especially vulnerable to unemployment while they are undergoing financial troubles.

The Road from Money to Happiness

Nowadays, companies must be concerned with the levels of satisfaction and happiness of employees. Hence, this paper proposes to investigate the links between salary and happiness through an exploratory study with a quasi-experimental design. The sample included 376 respondents, and we employed structured equation modeling (SEM) in ADANCO. Prior to evaluating the structural model, the goodness of fit shows moderate/excellent values. Our empirical results show a positive relationship between salary and happiness, salary and life satisfaction, salary and financial satisfaction, financial satisfaction and life satisfaction, and financial satisfaction and happiness. Thus, we consider that our research contributes to the literature by analyzing the relationship between income and happiness in a developing country such as Romania. Congruent with previous findings, we consider that our results provide evidence of the road from salary to happiness in developing countries.

Effect of a multi-domain intervention on the quality of life in older adults with major neurocognitive disorder: A pilot study

PURPOSE

Major neurocognitive disorders (MND) have multiple negative consequences on patients' lives and on their caregivers' health. Occupational therapy and cognitive stimulation have failed to show any significant efficacy on quality of life (QoL), cognitive functioning and behavioural symptoms. Bretonneau Hospital's Day Care Unit offers personalized and structured multi-domain interventions to cognitively impaired older patients on a weekly basis, for a 3-month period.

OBJECTIVES

Our objective was to determine whether a specific rehabilitation day care unit (RDCU) could influence the QoL of cognitively impaired community-dwelling elderly patients. We also aimed to better understand the characteristics of patients who had the most benefited from the RDCU.

METHODS

Retrospective study based on a sample of outpatients participating in RDCU during three months. All patients underwent a cognitive (MMS), functional (IADl, ADL) and behavioral (NPI) assessment. We compared QoL using the QoL-Alzheimer's Disease (QoL-AD) scale before and after RDCU.

RESULTS

Overall, we included 60 outpatients in our study (mean age 83.3±5.8; women=70%). We found a statistically significant improvement of QoL-AD scores after RDCU (31.8±4.9 to 32.9±5.2, P=0.008). Patients who benefitted the most from RDCU were older (P=0.01) and had lower baseline QoL (P=0.04). We did not find any other characteristics associated with QoL-AD score improvement in our population.

CONCLUSION

RDCU showed positive effects on QoL in this uncontrolled pilot study of older adults with MND. These findings should be confirmed in a future randomized controlled trial to corroborate the potential benefits of RDCU on QoL in older cognitively impaired patients.

Influence of Active and Healthy Ageing on Quality of Life Changes: Insights from the Comparison of Three European Countries

This study aimed to analyze the determinants of quality of life (QoL) in older people in three European countries (Portugal, Spain and Sweden). A sample of 7589 participants in waves 4 (2011) and 6 (2015) of the Survey on Health, Aging, and Retirement in Europe (SHARE) project, aged 50 and over and living in Portugal, Spain and Sweden, was included. The CASP-12 scale was used to measure QoL. A principal component analysis was performed to group preselected variables related to active and healthy ageing into the dimensions of health, social participation, and lifelong learning. A linear regression model was built using the change in CASP-12 scores over the 4-year follow-up as the dependent variable, including the interactions between country and each independent variable in the model. After four years, the average QoL increased in Portugal (difference = 0.8, p < 0.001), decreased in Spain (-0.8, p < 0.001), and remained constant in Sweden (0.1, p = 0.408). A significant country-participation component interaction (p = 0.039) was found. In Spain, a higher participation (β = 0.031, p = 0.002) was related to a higher QoL improvement at 4 years, but not in Sweden or Portugal. Physical health and emotional components (β = 0.099, p < 0.001), functional ability (β = 0.044, p = 0.023), and cognitive and sensory ability (β = 0.021, p = 0.026) were associated with QoL changes over time in all countries. The country-specific associations between health, social participation and QoL should be taken into account when developing public health policies to promote QoL among European older people.

One slope does not fit all: longitudinal trajectories of quality of life in older adulthood

PURPOSE

Maintaining or improving quality of life (QoL) in later life has become a major policy objective. Yet we currently know little about how QoL develops at older ages. The few studies that have modelled QoL change across time for older adults have used 'averaged' trajectories. However, this ignores the variations in the way QoL develops between groups of older adults.

METHODS

We took a theoretically informed 'capabilities approach' to measuring QoL. We used four waves of data, covering 6 years, from the New Zealand Health, Work and Retirement Study (NZHWR) (N = 3223) to explore whether distinct QoL trajectories existed. NZHWR is a nationally representative longitudinal study of community-dwelling adults aged 50 + in New Zealand. Growth mixture modelling was applied to identify trajectories over time and multinomial regressions were calculated to test baseline differences in demographic variables (including age, gender, ethnicity, education and economic living standards).

RESULTS

We found five QoL trajectories: (1) high and stable (51.94%); (2) average and declining (22.74%); (3) low and increasing (9.62%); (4) low and declining (10.61%); (5) low and stable (5.09%). Several differences across profiles in baseline demographic factors were identified, with economic living standards differentiating between all profiles.

CONCLUSIONS

The trajectory profiles demonstrate that both maintaining and even improving QoL in later life is possible. This has implications for our capacity to develop nuanced policies for diverse groups of older adults.

More Frequent Internet Use during the COVID-19 Pandemic Associates with Enhanced Quality of Life and Lower Depression Scores in Middle-Aged and Older Adults

Concerns have been raised regarding middle-aged and older adults' mental health during the coronavirus outbreak. The aim of the current study was to characterise associations between internet use (frequency and purpose), depression symptoms and Quality of Life (QoL) during the pandemic, in individuals aged 55-75. Data (N = 3491) were drawn from the English longitudinal study of ageing (ELSA) cohort study collected in June/July 2020 (while social distancing measures were in place). Associations with frequency of use were tested using analysis of covariance (ANCOVAS), controlling for covariates such as wealth and education. Type of internet use (for communication, information search) was also analysed amongst frequent users. Significant effects of frequency of use were observed (p = 0.01 for depression, p < 0.001 for QoL), with lower depression symptoms and higher QoL scores amongst more frequent users. Regarding purpose of use, those who reported using the internet for communication purposes had higher QoL. However, use for health-related or Government services information searching was associated with more depression symptoms. Results provide important information regarding the potential benefits of internet use for middle-aged and older people, suggesting that strategies to increase internet usage (particularly for communication) might benefit middle-aged and older adults' mental health and counter isolation as the coronavirus crisis continues to evolve.

Relationship between Active Aging and Quality of Life in Middle-Aged and Older Koreans: Analysis of the 2013-2018 KNHANES

With the increase in the aging population worldwide, social interest in having a vibrant and valuable old age has been increasing with changes in the perspectives on old age. This study aimed to determine the relationship between active aging and health-related quality of life (HRQOL) in middle-aged and older Korean using national data. The subjects were 14,117 adults aged ≥55 years. HRQOL was evaluated using the EuroQol-5 Dimension (EQ-5D) questionnaire, and active aging was defined based on the health factors, participation factors, and security factors. The average EQ-5D score was 91.04 ± 0.143. Hierarchical multiple regression analysis sequentially inputting the health, participation, and security factors showed that health factors had the strongest influence on HRQOL (F = 216.656, p < 0.001). In the final model, which included all variables, activity limit (B = -10.477, p < 0.001) and subjective health status (B = -7.282, p < 0.001) were closely related to the HRQOL. In addition, economic activity, income level, home ownership, private health insurance, and unmet healthcare needs were associated with HRQOL. The R2 of the model was 38.2%. To improve the HRQOL of middle-aged and older people, it is necessary to consider active aging factors. Furthermore, follow-up studies using various indicators reflecting active aging should be conducted.

Anxiety, Depression and Quality of Life in Older Adults: Trajectories of Influence across Age

This study focuses on the influence of anxiety and depression on individual trajectories of quality of life in old age through a longitudinal approach. A representative sample of adults aged 50+ living in Portugal and participating in wave 4 (W4) and wave 6 (W6) of the Survey of Health, Ageing and Retirement in Europe (SHARE) project was considered. Participants, 1765 at baseline (W4) and 1201 at follow up (W6), were asked about their quality of life (CASP-12) and emotional status (Euro-D scale; five items from the Beck Anxiety Inventory). Linear Mixed Effects models were performed to identify factors associated with changes in quality of life across age. Increasing age was found to have a significant negative effect on quality of life. Lower education and higher levels of depression and anxiety at baseline were also associated with worse quality of life; 42.1% of the variation of CASP-12 across age was explained by fixed and random effects, being depression followed by anxiety as the factors that presented with the highest relative importance. Both depression and anxiety play an important role in quality of life in older adults and must be acknowledged as important intervention domains to foster healthy and active aging.

Psychosocial Factors and Personality Traits and the Prevalence of Arterial Hypertension Among 35- and 55-Year-Old Men and Women in Sweden and Estonia: a SWESTONIA Longitudinal Study

INTRODUCTION

Psychosocial factors influence the risk of developing hypertension. Personality traits have a modulating effect against the harmful influences of psychosocial factors.

AIM

Through a longitudinal clinical study consisting of men and women aged 35 and 55 at the baseline in Estonia and Sweden, to assess the influence of psychosocial factors and personality traits resulting in arterial hypertension.

METHODS

Data analysis based on the cross-sectional study with 2 assessments over 13 years of a sample comprising 158 individuals from Estonia and 213 individuals from Sweden. The Pearlin Mastery Scale, Rosenberg Self-esteem Scale, Depression Model and Gothenburg Quality of Life Instrument were used.

RESULTS

Throughout the follow-up period, a higher depressive mood and lower self-assessed quality of life score prevailed among the 35-year-old and 55-year-old Estonians compared with the Swedish study participants (p < 0.001). Among the 55-year-old Estonian study participants with diagnosed hypertension, but not among the Swedish, negative stressful life events had a significantly stronger effect (p < 0.001) on the risk of developing hypertension. In addition, lower mastery (p < 0.05) dominated among study participants diagnosed with hypertension.

CONCLUSIONS

The combined effects of psychosocial factors and personality traits are important variables in predicting the risk of developing arterial hypertension. The study results are relevant to clinical practice and provide suggestions for employing successful preventive measures.

The role of individual resources, health behaviour and age perception as determinants of sports participation in older age

Sports participation contributes to maintaining health and wellbeing in old age, hence a deeper understanding of its various determinants is necessary. Previous research has primarily focused on either the effects of individual resources or age-specific attitudes to sports participation. However, a deeper understanding of the inter-relationships between these variables is required to develop effective policies to promote sports participation in ageing societies. To address the hypothesised inter-relationships, we consider both individual resources as well as age-specific attitudes and behaviours in order to integrate them simultaneously in our analysis. Furthermore, the analysis will be differentiated according to the three social status groups. The sample contains 1,560 retired persons, aged 65 years and older, based on the fifth wave (2014) of the German Ageing Survey. Multiple Poisson regression models were estimated to test our hypotheses. After adjusting for demographic variables, greater individual resources are associated with more regular sports participation. The findings also reveal that positive age perception and healthy behaviours are related to sports participation. Slight mediation effects between the different variables can be observed. Furthermore, the effect structures vary across different social status groups. The findings show that both individual resources and age-specific behaviours and attitudes are independent determinants of sports participation in older age. Our results confirm slight inter-relationships between socio-economic resources and age-specific attitudes.

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.

Associations of childhood health and financial situation with quality of life after retirement - regional variation across Europe

Many studies have shown that childhood circumstances can have long term consequences that persist until old age. To better understand the transmission of early life circumstances, this paper analyses the effects of health and financial situation during childhood on quality of life after retirement as well as the mediating role of later life health, educational level, and income in this association. Moreover, this study is the first to compare these pathways across European regions. The analyses are based on data of 13,092 retirees aged ≥ 60 and ≤ 85 years from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE) with full information on childhood and later life measures of health, educational level, financial situation, and quality of life as well as relevant covariates. Five European regions are studied: Central-Western Europe (Austria, Germany), Central-Eastern Europe (Czech Republic, Estonia, Slovenia), Northern Europe (Denmark, Sweden), Southern Europe (Italy, Spain), and Western Europe (Belgium, France, The Netherlands). Path analysis is used to identify the direct and indirect effects of childhood measures on quality of life. We find retirees' quality of life to be associated with childhood finances and health in all five European regions. While both the direct and indirect effects of childhood health are rather moderate and homogeneous across regions, especially the direct effects of childhood finances on quality of life after retirement display a distinct North-South gradient being strongest in Southern Europe. Potential explanations for the regional variations are differences in the countries' welfare systems.

Course of depressive symptoms and associated factors in people aged 65+ in Europe: A two-year follow-up

BACKGROUND

The epidemiology of depressive disorders presents notable differences among European countries. The objectives of the study are to determine the prevalence, incidence, persistence and remission rates of depressive symptoms and to identify risk factors and differences between four European regions.

METHOD

Prospective cohort design using data from waves 5 and 6 (2013-15) of the Survey of Health, Ageing and Retirement in Europe. Sample size included 31,491 non-institutionalized adults aged 65+. Depressive symptoms were assessed using the EURO-D.

RESULTS

The prevalence of depressive symptoms (EURO-D ≥4) was 29.8% and 31.5%in waves 5 and 6, respectively. The risk factors associated depressive symptoms were poorer self-rated health, loneliness, impairment in ADL, female gender and financial difficulties. Incidence was 6.62 (99.9% CI: 6.61-6.63)/100 person-years and the persistence and remission rates were 9.22 and 5.78, respectively. Regarding the differences between European regions, the incidence (4.93 to 7.43) and persistence (5.14 to 11.86) rates followed the same ascending order: Northern, Eastern, Continental and Southern. The remission presented higher rates in the Eastern and Southern (6.60-6.61) countries than in the Northern and Continental (4.45-5.31) ones.

LIMITATIONS

The EURO-D scale is unable to distinguish between clinically relevant depressive symptoms and major depression.

CONCLUSION

The risk factors related to the incidence of depressive symptoms differed across European regions. In countries of eastern and southern Europe the most important predictors were female gender and impairment in ADL. Poorer self-rated health and older age were more relevant in the Northern countries, and chronic diseases were a key factor in the Continental region.

Factor structure of depressive symptoms using the EURO-D scale in the over-50s in Europe. Findings from the SHARE project

OBJECTIVES

The aims of this study are: to analyze the factor structure of the EURO-D depression scale; to explore the variables associated with depressive symptoms in the total sample and in the EURO-D factors; and to compare the presence of depressive symptoms and the factor distribution in 15 European countries.

METHOD

62,182 participants in Wave 5 (2013) of the Survey of Health, Aging and Retirement in Europe (SHARE) were included.

INSTRUMENTS

The SHARE study and the EURO-D scale. Factor, bivariate and multilevel analyses were performed.

RESULTS

Higher levels of depressive symptoms were associated with a poorer self-perception of physical health (η² = 0.22) and economic difficulties (η² = 0.07). Factor analysis of the EURO-D identified two factors: Suffering and Motivation. Higher levels of depressive symptoms were associated with female gender and younger age (≤60) in the Suffering factor, and with less activity and exercise, older age (≥71), widowhood and lower educational level in the Motivation factor. Poorer self-perception of physical health and economic difficulties were associated with higher depressive symptomatology in both factors.

CONCLUSIONS

Poorer self-perception of physical health, female gender, economic difficulties, widowhood, lower levels of activity and exercise and lower educational level were associated with higher depressive symptomatology. In the countries of southern Europe, the Motivation factor predominated.

Factors associated with perceived quality of life in older adults: ELSI-Brazil

OBJECTIVE

To identify factors associated with perceived quality of life in a representative national sample of the population aged 50 or over.

METHODS

Data from 7,651 participants of the baseline ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between 2015 and 2016, were used. The perceived quality of life was measured by the CASP-19 scale - (CASP - control, autonomy, self-fulfillment and pleasure), considering the highest tertile as good quality of life. The independent variables included socio-demographic characteristics, mobility, loneliness, and indicators of sociability (social network, social support and social participation). The associations were tested using multivariate Poisson regression.

RESULTS

The best perceived quality of life showed a positive and independent association with the frequency of contacts with friends (PR = 1.25 for at least once every 2-3 months and PR = 1.36 for at least once a week), instrumental support from spouse or partner in the household (PR = 1.69), and emotional support from other relatives (PR = 1.45), children or children in law (PR = 1.41) and spouse or partner (PR = 1.33). Negative associations were observed for participants aged 80 and over (RP = 0.77), with 4 to 7 or 8 or more years of schooling (PR = 0.78 and 0.75, respectively) and with difficulty in mobility (PR = 0.83).

CONCLUSIONS

In addition to age and schooling, mobility, sociability and instrumental and emotional support are associated with perceived quality of life among older Brazilian adults. These characteristics must be considered when actions are taken, aiming to promote quality of life in this population.

Exploring predictors of life satisfaction and happiness among Siberian older adults living in Tomsk Region

Despite the growing interest in studying factors affecting subjective well-being of older adults, little research has been conducted on vast territory of Siberia (Russia) with large population. To address this lack of evidence, we explored the relationship between subjective well-being and social aspects (social and emotional support, social network, and social activities), living conditions (standards of living and residence area), self-reported health, and demographic characteristics in older adults living in Tomsk Region, Siberia. Subjective well-being was measured by life satisfaction and happiness (each measured with one 11-point question). Sample included 489 community-dwelling respondents, aged 65 or older. We found that mean life satisfaction and happiness reported by our respondents were lower than those of European countries. Higher quality of social interaction, better standards of living, and being satisfied with own health were associated with higher life satisfaction and happiness. This study provides original data on a region barely investigated and suggests that Siberian older adults receive strong benefits from social support and from social network and that similar factors are related to subjective well-being both in Siberian and Eastern European older adults. Future studies should further explore the relationship between different kinds of social support (e.g., psychological vs. material support) and subjective well-being in different Siberian ethnic groups or regions.

Rapid socio-economic changes, psychosocial factors and prevalence of hypertension among men and women aged 55 years at baseline in Estonia: a 13-year follow-up study

BACKGROUND

Hypertension is an important public health problem which causes premature morbidity and mortality. Cardiovascular diseases are responsible for about 55% of deaths in Estonia.

THE PURPOSE OF THE STUDY

was to assess, through a follow-up period, the prevalence of hypertension and to observe which risk factors of cardiovascular disease impact the occurrence of the disease. The second aim of the study was to evaluate the role of psychosocial factors and personality traits among individuals with a diagnosis of hypertension.

MATERIALS AND METHODS

The 330 subjects from Estonia, aged 55 years at baseline, from among whom 219 participated at follow-up. A cross-sectional study based on a self-reported questionnaire was conducted.

RESULTS

Over 13 years, the prevalence of hypertension increased from 4% to 53%. Obese (body mass index ≥30 kg/m²) individuals were four times more likely to belong to the hypertension group (p < .01). Among individuals with hypertension the depressed mood score was ≥4 points (max. 9 points) in 54.3% of participants. Depressed mood was linked with experiencing negative stressful life events (B = 0.047, 95% CI 0.016; 0.079; p < .01). Mastery had a protective impact on depressed mood. The self-rated quality of life score was lower among subjects with hypertension than among those who were not diagnosed with hypertension (p < .05).

CONCLUSIONS

According to the 13-year follow-up study, rapid socio-economic changes in Estonia have affected psychosocial health factors among 55-year-old individuals with a diagnosis of hypertension. There is a significant relationship between obesity and the development of hypertension.

Variations in disability and quality of life with age and sex between eight lower income and middle-income countries: data from the INDEPTH WHO-SAGE collaboration

Background

Disability and quality of life are key outcomes for older people. Little is known about how these measures vary with age and gender across lower income and middle-income countries; such information is necessary to tailor health and social care policy to promote healthy ageing and minimise disability.

Methods

We analysed data from participants aged 50 years and over from health and demographic surveillance system sites of the International Network for the Demographic Evaluation of Populations and their Health Network in Ghana, Kenya, Tanzania, South Africa, Vietnam, India, Indonesia and Bangladesh, using an abbreviated version of the WHO Study on global AGEing survey instrument. We used the eight-item WHO Quality of Life (WHOQoL) tool to measure quality of life and theWHO Disability Assessment Schedule, version 2 (WHODAS-II) tool to measure disability. We collected selected health status measures via the survey instrument and collected demographic and socioeconomic data from linked surveillance site information. We performed regression analyses to quantify differences between countries in the relationship between age, gender and both quality of life and disability, and we used anchoring vignettes to account for differences in interpretation of disability severity.

Results

We included 43 935 individuals in the analysis. Mean age was 63.7 years (SD 9.7) and 24 434 (55.6%) were women. In unadjusted analyses across all countries, WHOQoL scores worsened by 0.13 points (95% CI 0.12 to 0.14) per year increase in age and WHODAS scores worsened by 0.60 points (95% CI 0.57 to 0.64). WHODAS-II and WHOQoL scores varied markedly between countries, as did the gradient of scores with increasing age. In regression analyses, differences were not fully explained by age, socioeconomic status, marital status, education or health factors. Differences in disability scores between countries were not explained by differences in anchoring vignette responses.

Conclusions

The relationship between age, sex and both disability and quality of life varies between countries. The findings may guide tailoring of interventions to individual country needs, although these associations require further study.

Implications of using the Hearing Aids on quality of life of elderly

PURPOSE

To evaluate through standardized questionnaires the quality of life of elderly people with hearing loss diagnosed with and without the use of hearing aids (HA) and elderly without hearing complaints.

METHODS

This is a cross-sectional study with non probabilistic sample, divided into three groups divided as follows: 30 elderly people with diagnosed hearing loss and indication for use of individual sound amplification devices (hearing aids), but have not yet made use of the prosthesis; 30 individuals with hearing impairment who used hearing aids and 30 elderly without hearing complaints. Participants completed a questionnaire investigating sociodemographic and family data, the Hearing Handicap Inventory for the Elderly Screening Version (HHIE-S) and the World Health Organization Quality of Life - Short version (WHOQOL-BREF). In addition to the descriptive analysis of the data were performed tests to compare the three groups by applying analysis of variance (ANOVA) and the Bonferroni post hoc test.

RESULTS

The three groups differed significantly in all domains of quality of life. The group of the elderly people with hearing loss diagnosed and with indication for the use of hearing aids presented lower scores and the group of the elderly with hearing disabilities that used the hearing aid and that the reference group. The AASI group presented the best quality of life results.

CONCLUSION

The hearing loss affects the quality of life of the elderly. The effective use of hearing aid is beneficial to this population, improving their living and health conditions.