Depression and variables associated with quality of life in people over 65 in Spain and Europe. Data from SHARE 2013

Interplay of health-related quality of life and comorbidities in people with type 2 diabetes mellitus treated in primary care settings in Austria: a countrywide cross-sectional study

OBJECTIVES

This study assessed the health-related quality of life (HRQoL) and its relationship with clinical factors and comorbidities in people with type 2 diabetes mellitus (T2DM) treated in primary care settings.

DESIGN

Cross-sectional study design: This study assessed the HRQoL using a 36-item Short Form Survey (SF-36) tool in eight domains. The HRQoL scores ranged from 0% to 100% for each domain, with higher scores indicating better HRQoL. Linear regression was used to assess the association of HRQoL domain scores with clinical covariates and comorbidities.

SETTING

A countrywide study was conducted on individuals with established T2DM (N=635) attending primary healthcare services for various conditions across nine federal states of Austria from 2021 to 2023.

PARTICIPANTS

A total of 635 individuals, aged above 50 years and diagnosed with T2DM, were recruited by the attending physician to evaluate their HRQoL in relation to T2DM and its associated comorbidities.

RESULTS

The mean SF-36 scores for physical functioning (69±28), role-physical (62±42), mental health (72±20), role-emotional (73±41), social functioning (79±25), bodily pain (67±28) and vitality (55±22) were satisfactory, except for general health (41±10). Age and body mass were inversely associated with physical, mental and social HRQoL (p<0.05). Women had lower mental health (β: -5.44 [95% CI -9.43 to -1.44], p<0.05) than men. Smokers and those with cardiovascular and chronic lung diseases reported worse general, mental and physical health and vitality (p<0.05 each). Depression (p<0.001) and multimorbidity (p<0.05) severely deteriorated all HRQoL domains: physical functioning (Depression:-25.34 [95% CI -33.84 to -16.84], p<0.001); (Multimorbidity: -19.37 [95% CI -26.30 to -12.44], p<0.001), physical role limitations (-22.96 [95% CI -36.65 to -9.27], p<0.001); (-18.53 [95% CI -29.59 to -7.48], p<0.001), social functioning (-24.38 [95% CI -32.41 to -16.35], p<0.001); (-8.86 [95% CI -15.66 to -2.07], p<0.05), emotional well-being (-19.80 [95% CI -26.22 to -13.38], p<0.001); (-9.54 [95% CI -14.95 to -4.13], p<0.001), emotional role limitations (-28.26 [95% CI -41.01 to -15.52], p<0.001); (-8.15 [95% CI -18.78 to 2.49], p=0.133), bodily pains (-23.09 [95% CI -32.21 to -13.97], p<0.001); (-14.52 [95% CI -22.08 to -6.95], p<0.001), fatigue (-16.47 [95% CI -23.40 to -9.55], p<0.001); (-13.71 [95% CI -19.39 to -8.03], p<0.001), general health (-7.09 [95% CI -10.40 to -3.78], p<0.001); (-7.14 [95% CI -9.83 to -4.46], p<0.001).

CONCLUSIONS

Our analysis showed that advanced age, obesity, depression, cardiovascular disease, chronic lung diseases and multimorbidity were associated with poor HRQoL of individuals with T2DM at the primary care level. These findings highlight the need for strengthening holistic management in primary care to address the diverse physical, social and emotional needs of individuals with T2DM.

The Relationships Between Activities of Daily Living, Depression, and Quality of Life in Older Adults with Multiple Chronic Conditions: A Path Analysis

OBJECTIVES

This study was conducted to determine the relationships between activities of daily living (ADL), depression, and quality of life. Specifically, the study aimed to evaluate the potential mediating role of depression in the relationship between activities of daily living and quality of life in a sample of Iranian older adults.

METHODS

This cross-sectional study recruited 118 older adult adults with multiple chronic conditions in Iran from December 2022 to September 2023. Data were collected using a demographic and health information questionnaire, the Katz Index, the Lawton scale, Old-World Health Organization Quality of Life, and the Geriatric Depression Scale. Path analysis was used to test the hypothesis.

RESULTS

Participants' average age was 70.15 ± 6.91 years. BADL (B = 0.2, p = .02), and depression (B = -0.25, p = .004) were significantly related to the quality of life. The standardized indirect effect of BADL on quality of life was 0.08 (p = .006).

CONCLUSIONS

According to the results of this study, functional status can directly and also, indirectly affect the quality of life of older adults with multiple chronic conditions through depression.

CLINICAL IMPLICATIONS

Health care providers are advised to carefully assess older adults' mental health and functional status and consider their relationships to quality of life.

Changes in Social Relationships and Physical Functions in Community-Dwelling Older Adults

BACKGROUND

Social relationships are associated with physical function. However, little scholarly attention has been focused on the effect of changing social factors on physical function.

PURPOSE

This study was designed to examine the effects on physical function of changes in social relationships in adults aged 65 years and older.

METHODS

This study is part of a longitudinal, prospective cohort study that was conducted on community-dwelling older adults in a suburban area of central Japan. Baseline self-report data were collected in 2011, and a follow-up survey was conducted in 2017. Social relationships were assessed using the Index of Social Interaction, and physical function was evaluated using a subscale of the Kihon Checklist. Chi-square tests, Mann-Whitney U tests, and multiple logistic regression analysis were used to analyze data from 442 older adults who were functionally independent at baseline.

RESULTS

After controlling for covariates in 2011, negative changes in social relationships (odds ratio [ OR ] = 3.20, 95% CI [1.18, 8.69]) were found to be associated with physical function decline. Moreover, 1-point increases in the different social-relationship values between baseline and follow-up were associated with protective effects against functional decline ( OR = 0.71, 95% CI [0.63, 0.80]). Furthermore, median trends between baseline and follow-up revealed associations between decreasing ( OR = 4.18, 95% CI [1.53, 11.39]) and continuously low ( OR = 2.98, 95% CI [1.42, 6.28]) social relationships and physical function decline.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support a strong association between negative changes in social relationships and physical function decline and highlight the importance of promoting social relationships to delay physical function decline in older adults.

Quality of Life in European Older Adults of SHARE Wave 7: Comparing the Old and the Oldest-Old

CASP-12 (Control, Autonomy, Self-realization, and Pleasure scale) is one of the most common internationally used measures for quality of life in older adults, although its structure is not clearly established. Current research aims to test the factor structure of the CASP-12, so as to provide evidence on reliability and external validity, and to test for measurement invariance across age groups. Data from 61,355 Europeans (≥60 years old) from the Survey of Health, Ageing and Retirement in Europe wave 7 were used. CASP-12, EURO-D (European depression scale), self-perceived health, and life satisfaction measurements were included. Reliability and validity coefficients, competing confirmatory factor models, and standard measurement invariance routine were estimated. A second-order factor model with the original factor structure was retained. The scale showed adequate reliability coefficients except for the autonomy dimension. The correlation coefficients for external validity were all statistically significant. Finally, CASP-12 is scalar invariant across age. We conclude that the best-fitting factor structure retained allows using CASP-12 either by factors, or as an overall score, depending on the research interests. Findings related to CASP-12 measurement invariance encourage its use in the oldest-old too. When comparing the dimensions across age groups, as people age, autonomy slightly increases and the rest of the dimensions decline.

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.

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.

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.