Feeling hindered by health problems and functional capacity at 60 years and above

Translation, Cross-cultural Adaptation, and Psychometric Properties of the Turkish Version of the Self-care Ability Scale for the Elderly

Purpose

The Self-care Ability Scale for the Elderly (SASE) is a frequently used scale that was created in Sweden according to Orem’s self-care deficit theory and later modified according to Pörn’s theory of environment and purpose. This study translated and cross-culturally adapted the Turkish version of the SASE (T-SASE) and demonstrated its psychometric properties, including its reliability and construct validity.

Methods

This study recruited a total of 122 participants and applied international guidelines for the translation and adaptation of the scale. The test-retest reliability of the SASE was calculated at 1-week intervals. Internal consistency was analyzed using Cronbach’s alpha. For construct validity, we compared the T-SASE to the Nottingham Extended Activities of Daily Living Scale (NEADLS) and the Exercise of Self-Care Agency Scale (ESCAS).

Results

The mean age of the participants was 68.6±5.7 years. The test-retest reliability of the T-SASE was excellent (intraclass correlation coefficient=0.914; 95% confidence interval, 0.81–0.95). The internal consistency of the total T-SASE score was also excellent (Cronbach’s α=0.912), as were the Cronbach’s alpha scores for the individual items, ranging from 0.901 to 0.915. The items were also highly consistent with each other (Cronbach’s α>0.80). The construct validity of the T-SASE was acceptable (0.35<r<0.50) in a convergent manner. The T-SASE was also strongly correlated with the NEADLS and ESCAS (r₁=0.405, r₂=0.437, p<0.01).

Conclusions

The T-SASE was a reliable and valid tool for assessing the self-care ability of community-dwelling older adults. Owing to its multidimensional structure, the T-SASE is an essential tool for evaluating self-care in older adults.

Risk Factors for Depression in Empty Nesters: A Cross-Sectional Study in a Coastal City of Zhejiang Province and China

The elderly are susceptible to depression, especially empty nesters. This study investigated the risk factors associated with depression in empty nesters. The participants were selected via multi-stage random cluster sampling. Depression symptoms were assessed using the Geriatric Depression Scale. The questionnaire surveyed demographic characteristics, underlying diseases, behaviors and lifestyles, negative life experiences, social support, self-care ability, etc. Chronic health conditions, such as being overweight/obese, smoking cessation, cancer, and chronic pain, as well as negative life experiences, such as the death of a loved one and financial loss, increased the risk of depression in empty nesters. In addition, the incapability of performing self-care also increased the risk of depression in empty nesters. The prevalence of depression in empty nesters was high. Being overweight/obese, cancer, chronic pain, smoking cessation, the death of a loved one, financial loss, and the incapability to deliver self-care were risk factors for depression in empty nesters. It is recommended that comprehensive measures be taken to enhance health interventions for this population, including encouraging a proper diet and physical activity for weight control, providing psychological counseling after negative life experiences, and teaching correct methods of smoking cessation.

Cross-validation of the Self-care Ability Scale for Elderly (SASE) in a sample of Italian older adults

The assessment of self-care among older adults is important as it permits the tailoring of educational interventions directed to prevent health deterioration and contrast the effects of ageing. The Self-care Ability Scale for the Elderly (SASE) was developed to assess the perceived self-care ability in older adults. Its psychometric properties were tested only in Scandinavian countries and China. This research was a cross-validation of the SASE on 402 Italian adults aged 65 and older recruited in hospitals, clinics and homes, from September 2016 to February 2017. We performed exploratory and confirmatory factor analyses on two subsamples and identified three factors, self-care ability to perform ADLs, self-care ability to achieve well-being and self-care ability to set personal goals, with a good model fit (CFI > 0.93; RMSEA = 0.07; SRMR = 0.06). We eliminated four items, however, to improve the structural validity. Internal consistency for the three factors of the Italian version of the SASE (SASE-I) ranged from 0.72 to 0.92. The test-retest reliability indicated good stability of the scale (ICC coefficient = 0.92). We assessed convergent validity by comparing the SASE-I with the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale, showing moderate-to-strong correlations. In addition, the SASE-I discriminated the self-care ability in groups with different ages, levels of education and settings. Our study produced a 13-item version of the SASE with good psychometric properties that could be recommended for use in clinical practice and research after further validation on different populations and settings.

The use of case management for community-dwelling older people: the effects on loneliness, symptoms of depression and life satisfaction in a randomised controlled trial

AIM

To investigate the effects of a case management intervention for community-dwelling frail older people, with functional dependency and repeated contacts with the healthcare services, focusing on loneliness, depressive symptoms and life satisfaction.

DESIGN

A two-armed, nonblinded, randomised control trial with repeated follow-ups, of N = 153 participants at baseline allocated to an intervention (n = 80) and control (n = 73) group.

METHOD

Inclusion criteria were the following: ≥65 years of age, living in ordinary housing, in need of assistance in two or more self-reported activities of daily living, having at least two hospital admissions or at least four visits in outpatient care 12 months prior to enrolment. Case managers (nurses and physiotherapists) provided an intervention of general case management, general information, specific information and continuity and safety. The intervention ranged over 12 months with one or more home visit(s) being conducted per month. An intention-to-treat analysis was applied for the primary outcomes of loneliness, depressive symptoms and life satisfaction, along with complete case and sensitivity analyses.

RESULTS

During the trial period n = 12 died and n = 33 dropped out. No significant difference was found between the groups at baseline regarding sociodemographic characteristics, subjective health or primary outcomes. The intention-to-treat analysis did not result in any significant effects for the primary outcomes at any of the follow-ups (6 and 12 months). The complete case analysis resulted in a significant difference in favour of the intervention regarding loneliness (RR = 0.49, p = 0.028) and life satisfaction (ES = 0.41, p = 0.028) at 6 months and for depressive symptoms (ES = 0.47, p = 0.035) at 12 months.

CONCLUSIONS

The use of case management for frail older people did not result in clear favourable effects for the primary outcomes. However, the study indicates that case management may be beneficial in terms of these outcomes. Due to the complexity of the outcomes, an elaboration of the components and assessments is suggested.

Everyday Health among Older People: A Comparison between Two Countries with Variant Life Conditions

This study described health factors of importance for everyday health, such as pain, tiredness, and sleeping problems, in a cross-national context. Data for persons 60+ years were obtained from the Poverty and Health in Aging study, Bangladesh, and the Swedish National Study on Aging and Care-Blekinge. The strongest associations with everyday health in Sweden were found for pain and tiredness, while in Bangladesh they were financial status, tiredness, and sleeping problems. As similarities were found regarding the associations of tiredness on everyday health, tiredness may be a universal predictor of everyday health in older adults irrespective of country context.

Falls and subjective well-being. Results of the population-based German Ageing Survey

PURPOSE

The aim of the current study was to determine the relationship between falling in the past 12 months and subjective well-being in a broader sense.

METHODS

Cross-sectional data were gathered from a representative sample of community-dwelling individuals in the second half of life (40 to 95 years; n=7808) in Germany. While life satisfaction was quantified using the Satisfaction with Life Scale (SWLS), positive and negative affect was measured using the Positive and Negative Affect Schedule (PANAS).

RESULTS

The prevalence of falling in the preceding 12 months was 17.6%. After controlling for sociodemographic factors, various lifestyle factors, self-rated health, and morbidity, multiple linear regression analysis revealed that falling in the past 12 months was associated with higher negative affect (β=0.08, p<0.001), lower positive affect (β=-0.04, p<0.05) as well as lower life satisfaction (β=-0.12, p<0.001).

CONCLUSION

The present study stresses the relationship between falls and subjective well-being. Future longitudinal studies are needed to validate the findings of the present cross-sectional study and to better understand the nature of this relationship.

Coexisting with dependence and well-being: the results of a pilot study intervention on 75-99-year-old individuals

BACKGROUND

The objective of this study is to design and implement an intervention program centered on preventing functional dependence.

METHODS

A pre/post quasi-experimental (typical case) design study with a control group was conducted on a group of 75-90-year-old individuals with functional dependence (n = 59) at three nursing homes in Madrid (Spain). The intervention program consists of two types of activities developed simultaneously. Some focused on emotional well-being (nine 90-minute sessions, once per week), whereas others focused on improving participants' physical condition (two 30-minute sessions, twice per week). The simple randomized participants included 59 elderly individuals (Intervention Group = 30, Control Group = 29) (mean age 86.80) [SD, 5. 19].

RESULTS

Fifty-nine participants were analyzed. The results indicate that the program is effective in improving mood, lowering anxiety levels (d = 0.81), and increasing both self-esteem (d = 0.65) and the perception of self-efficacy (d = 1.04). There are improvements in systolic pressure and functional dependence levels are maintained. Linear simple regression (independent variable pre-Barthel) shows that the pre-intervention dependence level can predict self-esteem after the intervention.

CONCLUSION

We have demonstrated that the program is innovative with regard to bio-psychosocial care in elderly individuals, is based on actual practice, and is effective in increasing both self-esteem and self-efficacy. These variables positively affect functional capabilities and delay functional dependence.

Mobility impairment, social engagement, and life satisfaction among the older population in China: a structural equation modeling analysis

PURPOSE

Revealing the relationship between mobility impairment and life satisfaction can help to propose effective interventions to secure mobility and life satisfaction. However, the relationship remains unclear and lacks quantitative evidence in China. This study therefore assesses the association of mobility impairment, social engagement, and life satisfaction among the older population in China.

METHODS

Based on the sample of China Health and Retirement Longitudinal Survey database in 2013, a structural equation modeling is established. The sample size is 4245 with 55.9% with mobility impairment.

RESULTS

The model shows that the length of suffering from disability is significantly related to mobility impairment (β = 0.058, p < 0.001). Mobility impairment is inversely related to social engagement (β = -0.300, p < 0.001) and life satisfaction (β = -0.311, p < 0.001). Social engagement is positively related to life satisfaction (β = 0.211, p < 0.001). Moreover, the relationships have some differences for the seniors with different sociodemographic characteristics and living in different residential areas.

CONCLUSIONS

As seniors get older, they tend to have more severe mobility impairment and participate less in social activities. Those with higher mobility impairment are more likely to report lower life satisfaction partly because they usually participate less in social activities. Different strategies are suggested to be adopted to improve the life satisfaction of the older population from the aspects of promoting mobility and social engagement, including improving the design of transport facilitates, providing assistive facilities for the seniors with severe mobility impairment, promoting the accessibility of community leisure and healthcare services, and constructing more community senior activity centers.

Life satisfaction among older people in Italy in a gender approach

Over the last few decades, increasing attention has been paid to the issue of wellbeing among older people, and life satisfaction has been used as an indicator to evaluate older people's life conditions. This paper sheds some light on this topic with reference to Italy, a country characterised by an increasing ageing population. The aim is to examine life satisfaction among people aged 65 and older and its predictors. We adopt a gender approach to examine whether – as suggested by the literature – older men and women have different sources of satisfaction. We test this hypothesis in Italy, a country still characterised by an unbalanced public and private gender system. In doing this, we also control whether living arrangements – specifically living alone – influence the determinants of life satisfaction of older men and women. The data used are from the cross-sectional surveys ‘Aspects of Daily Life’, undertaken in Italy by the National Statistical Institute. The results do not show clear gender differences in the determinants of life satisfaction, with only some slight gender differences among those living alone. This suggests that the social and cultural environment may play a relevant role for older people's life satisfaction.

Health-related quality of life and activities of daily living in 85-year-olds in Sweden

Few studies have examined health-related quality of life (HRQoL) with respect to daily living and health factors for relatively healthy elderly individuals. To this end, this study examines 85-year-olds' reported HRQoL in relation to social support, perceived health, chronic diseases, healthcare use and instrumental activities of daily living (IADL). Data were collected from 360 participants (55% response rate) between March 2007 and March 2008 using a postal questionnaire and a home visit interview. HRQoL was assessed using the EQ-5D-3L. For the items in the EQ-5D-3L, more problems were related to lower HRQoL. Restricted mobility and occurrence of pain/discomfort was common. Lower HRQoL was associated with increased risk for depression, increased use of medication, increased number of chronic diseases and more problems with IADL. Healthcare use and healthcare costs were correlated with lower HRQoL. HRQoL is of importance to healthcare providers and must be considered together with IADL in the elderly population when planning interventions. These should take into account the specific needs and resources of the older individuals.

Factors associated with functional incapacity in elders living in long stay institutions in Brazil: a cross-sectional study

Background

The increase of the elderly population and the high prevalence of chronic diseases have contributed to the increasing importance of functional ability as a global public health problem. This study aimed to assess functional capacity in institutionalized elders, as well as undertake an exploratory analysis of its associated factors.

Methods

This is a cross-sectional study with institutionalized Brazilian elders. Functional capacity was assessed using the Katz Index for Activities of Daily Living (ADL) and the Lawton Scale for Instrumental Activities of Daily Living (IADL). The characteristics of dependent individuals were described and logistic regression models were developed for both scales. Multiple models that included all selected variables were developed using a hierarchical approach. We considered the results from the Wald test (p < 0.05) as a rule for progressing to the next level.

Results

A population of 760 elders was considered. The prevalence of dependence was 50.3% for ADL and 81.2% for IADL. We observed associations between ADL dependence and the following factors: self-report of stroke, difficulty of walking 400 meters, lower total scores in questions related to the temporal orientation section of the cognition test, and self-reports of frequently feeling upset. IADL dependence was associated with educational level, self-report of cancer, difficulty of walking 400 meters, use of glasses, and self-reported memory problems.

Conclusions

Sociodemographic and health conditions were associated with functional incapacity in institutionalized elders. Based on these findings, we emphasize the importance of both prevention and treatment of chronic conditions as well as social support in the maintenance of individuals’ autonomy.

Associations between functional ability and life satisfaction in the oldest old: results from the longitudinal population study Good Aging in Skåne

Objectives

To describe change in functional ability in the oldest-old population during 3 years and examine its relation to life satisfaction (LS). A total of 681 individuals aged 78 and older from the population-based study Good Aging in Skåne took part.

Methods

Functional ability was assessed using Sonn and Åsberg’s Activities of Daily Living (ADL) scale and related to LS assessed by Neugarten et al’s Life Satisfaction Index A (LSI-A).

Results

Fifty-one percent of 87–93-year-olds reported ADL decline during 3 years. Individuals reporting impaired ADL had a mean LSI-A value of 23.0 compared to 26.4 in those unchanged. ADL decline had a stronger negative effect on LS in the younger group (78–84 years), r = 0.207, P < 0.001. In a multiple regression model, one score’s decline in ADL capacity corresponded to 1.5 scores lower LS (P < 0.001).

Discussion

Effort put into keeping the oldest old on a high level of functional ability has the potential to maintain the LS of this population.

Life satisfaction and health related quality of life among low-income medical patients: the mediating influence of self-esteem

This study investigated the relationship between life satisfaction, self-esteem, and perceived health for an ethnically diverse, low SES sample of primary care patients. Results indicated that several specific domains of health-related quality of life (HRQL), including health perception, social functioning, mental health, and energy/fatigue, significantly predicted life satisfaction in this sample of 60 patients. Self-esteem mediated this relationship, partially with health perception and fully with the remaining three domains. The results of this study underscore the importance of healthcare interventions that consider the bidirectional relationship between physical and emotional well-being.

Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study

BACKGROUND

Malnutrition is a common problem among older people and associated with reduced functional and cognitive ability. Furthermore, malnutrition among people living in special housing, i.e. in nursing homes or sheltered accommodation, appears to be more common than among those living in regular housing, i.e. in their own homes. However, it is still unclear if the relationship between malnutrition and impaired cognitive ability is connected to living arrangement, i.e. if the relationship is stronger among those who live alone compared to those who cohabit in regular housing.

OBJECTIVES

The purpose with the present study was to describe the relationship between nutritional status and cognitive ability among people 60 years of age and above in Sweden, with a focus on housing and living arrangement.

DESIGN

Population-based cohort study.

SETTING AND PARTICIPANTS

The study focused on people living in regular or in special housing and comprised 1,402 randomly selected individuals (60-96 years of age) who lived in one municipality in south-eastern Sweden and participated in SNAC-B (the Swedish study on Aging and Care - Blekinge), 2001-2003.

METHODS

Data regarding demography, nutrition and functional and cognitive ability were collected through questionnaires, medical examinations and structured interviews.

RESULTS

The relationship was the strongest between cognitive ability and nutritional status among those living in special housing. Regardless of housing and living arrangement, older people with a moderate or severe cognitive impairment risked (OR 2.59-16.00) being malnourished, irrespective of functional ability.

CONCLUSION

This study highlights that those with a moderate and severe cognitive impairment suffer a risk of developing malnutrition, irrespective of living and housing arrangement. The findings suggest that nurses in the social service and health care system need to consider changes in weight and nutritional intake as well as the individual needs of older people with cognitive impairment to avoid malnutrition.

Consumer panel study on elderly people's wishes concerning services

This study informs on the wishes and needs of elderly people themselves regarding services for the elderly. The data for the study were gathered using a consumer panel method. Elderly people desire assistance in heavy cleaning chores, in outdoor activities and in carrying out their personal business. Elderly people felt that there should be more recreational services available. Elderly people link aging with feelings of insecurity and loneliness. Becoming a service user for the first time is felt to be a very difficult step to take, and so this decision is postponed as long as possible. The elderly people desire a service for assessing their individual service needs in an organized, expert and objective fashion. The study indicates that elderly people value the human contact gained through service provision. The consumer panel method for collecting data was successful.

Associations of personal and mobility resources with subjective well-being among older adults in Italy and Germany

The purpose of this study was to investigate the patterns of associations of personal and mobility resources with positive well-being in two sample populations of older adults from Germany (n=1518) and Italy (n=600). A correlation study showed which variables correlated the closest with the well-being components, then four logistic regression analyses were performed, one for each well-being component such as the positive and negative affect schedule (PANAS) positive scale, mobility satisfaction, health satisfaction and life satisfaction. High positive scores of PANAS and satisfaction scales were found both for Germany and Italy. As expected and in accordance with previous studies, components utilized as a measure of subjective well-being correlated significantly with each other in both countries, confirming their validity as instruments of evaluation for several different life domains. A considerable result of this study was that the driving car is an important predictor of well-being in both countries. The findings underlined a variety of associations among the mobility resources and the subjective perception of well-being. Our work supports the importance of being aware of the main variables influencing the positive dimension of well-being for creating a better understanding the needs and goals of older people. Moreover, the present study shows that individual-environment interaction should be considered in evaluating personal well-being, especially in older people.

The influence of nursing home residency on the capacities of low-dependency older adults

OBJECTIVE

With the growing number of low-dependency older adults in long-stay care and the lack of categorisation of these institutions in the Republic of Ireland, it can be asked if such facilities are truly beneficial. This paper presents an explorative investigation of the influence of the nursing home environment on the capacities of low-dependency older adults.

METHOD

The participants consisted of 50 community residents, as a control group, and 50 nursing home residents ranging in age from 65 to 95 years. The methodology was based on a triangulation of three data sources: a battery of cognitive, sensory, sensorimotor and psychological well-being assessments; a semi-structured participant interview; and an institutional questionnaire. Cluster analysis was then used to identify natural performance groupings within the assessment battery data.

RESULTS

There were two performance groupings within the dataset. Interestingly, two community residents were grouped with the majority of nursing home residents and six nursing home residents were grouped with the majority of community residents. The interpretation of the results was informed by the semi-structured interviews and the institutional questionnaires.

CONCLUSION

Although causality cannot be attributed, findings indicate an association between the nursing home environment and the capacities of older adult residents.

Life satisfaction in a sample of empty-nest elderly: a survey in the rural area of a mountainous county in China

OBJECTIVE

To estimate the life satisfaction and its predictors between the empty-nest and not-empty-nest elderly.

METHODS

A semi-structured questionnaire including socio-demographic characteristics, physical health, and the Life Satisfaction Index (LSI), UCLA Loneliness Scale (UCLA-LS), and Geriatric Depression Scale (GDS) was administered to 275 empty-nest and 315 not-empty-nest rural elderly in a Chinese county. Linear regression analysis was used to examine the predictors of LSI score.

RESULTS

The empty-nest elderly had lower life satisfaction, lower income, poorer relationships with children, less social support, higher prevalence of chronic diseases, and more feelings of depression and loneliness compared to the not-empty-nest elderly. "Empty-nest status" was negatively related with life satisfaction. Depression was the strongest predictor of life satisfaction in both groups. The second strongest predictor was loneliness among the empty-nest group, while it was chronic diseases among the not-empty-nest group. Marital status and income were correlated with life satisfaction only among the empty-nest elderly.

CONCLUSIONS

The empty-nest elderly were likely to have mental health problems and to feel unsatisfied with their life. These findings also emphasize the importance of mental health as the determinant of life satisfaction among the empty-nest elderly.

The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living

Background

Life satisfaction among residents of institutions is becoming an important issue in a rapidly aging population. The aim of this cross-sectional study was to investigate the links between life satisfaction and health-related behaviors amongst functionally independent elderly people who prefer institutional living in İstanbul, Turkey.

Methods

The socio-demographic characteristics, health-related behaviors, leisure-time activities and fall histories of 133 residents of an institution in Istanbul were assessed by a structured questionnaire during face-to-face interviews. A validated life-satisfaction index questionnaire (LSI-A) was completed.

Results

The mean age of the study group was 73.9 ± 8.0 (range 60–90 years). Within the group, 22.6% had never married and 14.3% had university degrees. The majority (71.4%) were in the low income bracket. The overall mean LSI-A score was 20.3 ± 5.9. Participants who declared moderate/high income levels had a significantly higher mean LSI-A score than those in the low-income bracket (p = 0.009). Multivariate analysis of the data suggested that leisure-time activities and participation in regular physical activities are significant predictors of LSI-A scores (R²: 0.112; p = 0.005 and p = 0.02, respectively).

Conclusion

The findings imply that regular physical activity and leisure-time activities are significantly related to life satisfaction among residents in institutions. Participation in physical activity and leisure-time activity programs may help to improve the life satisfaction of elderly people living in institutions.