Self-reported health complaints and their prediction of overall and health-related quality of life among elderly people

Unequal ageing: the quality of life of senior citizens in the EU before and after COVID-19. A multidimensional approach

Introduction

The ageing population presents a significant demographic and socio-economic challenge for the European Union (EU). Declining fertility rates, coupled with increasing life expectancy, have led to a growing proportion of older individuals within the population, raising concerns about their quality of life. This study aims to assess the quality of life for seniors across EU countries in the years 2015, 2019, and 2022, with a particular focus on the impact of the COVID-19 pandemic. The research seeks to answer the following question: How has the quality of life among seniors in the EU evolved over time, and how has the COVID-19 pandemic affected this trajectory? We hypothesize that the pandemic has exacerbated existing socio-economic inequalities, particularly affecting the most vulnerable older populations.

Methods

This study utilises the Synthetic Measure of Senior Quality of Life (SMSQoL) to evaluate the living conditions of seniors across four critical domains: health, finances, social relations, and environment. Data for the analysis were drawn from Eurostat and national statistical reports, complemented by pilot studies conducted in selected EU countries. The pilot studies focused on gathering qualitative data to supplement the quantitative measures, especially in areas where standardised data were incomplete or unavailable. The assessment spans three years: 2015 (pre-pandemic baseline), 2019 (immediate pre-pandemic), and 2022 (post-pandemic). The analysis includes 27 EU member states and uses both descriptive and inferential statistical methods to evaluate trends and disparities. Cross-sectional analysis was applied to examine the impact of differing social policies, levels of social security, access to healthcare, and economic strength across these countries.

Results

The analysis reveals significant disparities in the quality of life among seniors across EU countries, with pronounced differences between regions. In particular:Northern and Western Europe: seniors in these regions generally experienced improved overall life quality over the observed period. Countries such as Sweden and Germany reported gains in health, financial stability, and social relations, largely due to strong social policies and robust healthcare systems.Eastern Europe: Seniors in Eastern European countries, including Romania and Bulgaria, continued to face substantial challenges, with minimal improvements in quality of life. Economic instability, limited access to healthcare, and weaker social security systems were identified as key contributors to this stagnation.Impact of COVID-19: the pandemic exacerbated existing inequalities, particularly in the domains of social relations and finances. Seniors in economically vulnerable regions were disproportionately affected by social isolation and reduced income, intensifying the pre-existing challenges in their living conditions.Quantitative analysis confirmed that while some regions showed resilience, the most vulnerable populations experienced a sharp decline in their overall quality of life, particularly between 2019 and 2022.

Discussion

The findings from this study highlight the persistence of economic and social inequalities in the life conditions among seniors across the EU. While countries in Northern and Western Europe have made strides in improving senior living conditions, Eastern Europe continues to face significant challenges. The COVID-19 pandemic acted as a catalyst, exacerbating these inequalities, particularly in terms of social isolation and financial insecurity. These results align with previous studies that have highlighted the uneven impact of social policies and economic strength on senior well-being across Europe. The disparities underscore the need for more balanced and equitable policy interventions that can address the vulnerabilities of older populations, particularly in regions struggling with economic instability. Future research should focus on longitudinal studies that track the recovery trajectories of seniors post-pandemic and assess the effectiveness of policy measures aimed at mitigating these disparities.

A park-based group mobility program for older adults with difficulty walking outdoors: a qualitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

The Getting Older Adults Outdoors (GO-OUT) randomized controlled trial showed that a workshop and 10-week park-based outdoor walk group (OWG) was superior to the workshop and 10 weekly reminders (WR) with increasing walking capacity, but not outdoor walking activity, health-promoting behavior, or successful aging, among older adults with difficulty walking outdoors. The objective of this planned process evaluation was to explore participants' perceptions of mechanisms of impact of and contextual factors influencing experiences with the interventions to help explain the observed intervention effects on study outcomes.

METHODS

A qualitative descriptive study involving semi-structured interviews conducted at 6-months post-baseline was conducted. A directed content analysis was undertaken.

PARTICIPANTS

We interviewed 27 adults (52% male, 48% female, mean age 76 years) from the OWG (n = 13) and WR group (n = 14).

RESULTS

We identified two themes including: "Holding Me Accountable to Walk More Frequently", and "We Walked Farther, With More Ease and Confidence, and We Felt Better". Participants in both groups described how the OWG and WR programs provided some degree of structure and accountability to others that increased their motivation to walk outdoors. Participants described how the OWG led to improved walking capacity (e.g., increased walking distance) and confidence. Interacting with people during OWG sessions led to a sense of enjoyment, and well-being.

CONCLUSIONS

Community programs that incorporate structure, accountability, and opportunities for social interaction, can help improve motivation to increase outdoor walking activity and a sense of belonging for older adults with difficulty walking outdoors. Park-based OWG programs appear to convey additional important benefits related to improved physical function and well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Quality of life in assisted living facilities for seniors: A descriptive exploratory study

INTRODUCTION

Promoting individuals' health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home-like environment.

AIM

The aim of this descriptive exploratory study was to explore the quality of life as perceived by seniors who reside in assisted living facilities (ALFs).

DESIGN

This study utilized a descriptive exploratory design to investigate the quality of life of seniors living in ALFs.

METHODS

Seventeen residents from two ALFs were interviewed to gather their perspectives on the quality of their lives while living in an ALF. The interviews were conducted by the researcher and were audio-recorded and transcribed verbatim. The data were analysed using thematic analysis.

RESULTS

Three major themes surfaced from residents' descriptions: 'physical environment', 'social environment' and 'home-like atmosphere'. The quality of life in ALFs was found to be predominantly an outcome of the exchange between the personal capability of residents to adapt to changes and the capacity of the facility to meet residents' diverse needs.

PATIENT OR PUBLIC CONTRIBUTION

Participants who discussed their quality of life in ALFs provided profound insights into this aspect of their lives. The findings from this study can potentially enlighten ALF stakeholders and enhance the quality of life for seniors residing in these facilities.

Nurse-led self-care interventions for older adults with multiple chronic conditions: A protocol for a systematic review and network meta-analysis

The importance of self-care interventions is progressively recognized, marked by a rapidly aging population that results in growing demands on costly tertiary and institutional care services, placing substantial pressure on health and social care systems. Against this background, in this study, we will provide evidence for the impact of self-care interventions on health-related quality of life by focusing on interventions led by nurses who can employ integrated approaches. Several databases, including Ovid MEDLINE, Cochrane, CINAHL, Embase, and PubMed, will be searched along with gray literature to prevent biased results. There will be no time restrictions, and all literature with English abstracts will be included. Using the Template for Intervention Description and Replication framework, we will evaluate intervention characteristics. The primary outcome will be health-related quality of life, and the secondary outcomes will be symptom burden, physical function, and cost-effectiveness. Pairwise and network meta-analyses will be performed, and network geometry and the surface under the cumulative ranking curve will be used to determine which type of nurse-led self-care intervention is best for health-related quality of life for older adults with multiple chronic conditions. We will secure study quality through PRISMA, AMSTAR 2, RoB 2.0, and the GRADE checklist. To ensure the quality of network meta-analysis, similarity will be checked based on the PICO framework. The consistency of the network meta-analysis results will be checked to ensure transitivity by using the Bayesian hierarchical framework. The study protocol is registered with PROSPERO (CRD42022365467).

Improvement in quality of life among women and men aged 60 years and older following treatment for alcohol use disorder

BACKGROUND

Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults.

AIMS

In a clinical sample of older adults with DSM-5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow-ups. We also examined the effect of gender and explored interaction effects with gender on QoL.

METHODS

We utilized data from the "Elderly Study," a multi-national, single-blind, randomized, controlled trial of 693 adults aged 60+ with DSM-5 AUD. Alcohol use was assessed with the Form-90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4-, 12-, 26-, and 52-week follow-ups. Multilevel mixed-effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL.

RESULTS

Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1-year follow-up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4-3.9), psychological health (β: 3.5, 95% CI: 3.3-3.8), social relationships (β: 4.0, 95% CI: 2.5-5.6), and environmental health (β: 1.4, 95% CI: 0.4-2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05).

CONCLUSIONS

Among 60+ year-old adults receiving treatment for DSM-5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender.

Comparison of quality of life between elderly and non-elderly adult residents in Okuma town, Japan, in a post-disaster setting

With the growing elderly population who are susceptible to poor health, improvement of their quality of life is essential. In the post-disaster setting of the 2011 Fukushima Dai-ichi nuclear power plant (FDNPP) accident, affected municipalities such as Okuma town commenced their recovery processes and lifted evacuation orders in 2019. This study examines the differences in self-reported mental and physical health status, social functioning, risk perception, and intention to return between elderly (age ≥65 years) and non-elderly (age 20-64 years) residents. Questionnaires were distributed to current residents and evacuees of Okuma. Results revealed that the elderly had a 1.4 times higher odds ratio (95%CI 1.0-1.8, p = 0.034) for having anxiety regarding radiation-related health effects on future generations and a 1.3 times higher odds ratio (95%CI 1.1-1.5, p = 0.001) for wanting to know about the release of FDNPP-treated water into the environment than the younger group. Elderly residents also demonstrated a 2.2 times higher odds ratio for reporting poor physical health than younger residents. Clearing misconceptions and disseminating coherent information will reduce risk perception among this group. Further in-depth research regarding the disposal of FDNPP-treated water and its perceived risks is required. Health promotion through the encouragement of social participation, improvement of surroundings to facilitate healthy behaviors, and enhanced access to health services will improve the quality of life of elderly Okuma residents.

Local, collaborative, stepped, and personalized care management for older people with chronic diseases - results from the randomized controlled LoChro-trial

BACKGROUND

In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness.

METHODS

A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants' evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling.

RESULTS

We analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity.

CONCLUSION

Supporting patients' self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904.

Quality of life after treatment with immune checkpoint inhibitors for lung cancer; the impact of age

INTRODUCTION

Immune checkpoint inhibitors (ICIs) have revolutionized lung cancer treatment. However, it remains unclear as to whether changes in Health-Related Quality-of-Life (HRQoL) are associated with the age of lung cancer patients treated using ICIs. This study aimed to evaluate this possible association and to compare ICI-treated patients' HRQoL scores with normative data of an age-matched non-cancer general population.

METHODS

Lung cancer patients from the OncoLifeS data-biobank were included if they were treated with ICIs, irrespective of other treatments, at the University Medical Center Groningen between 2015 and 2021 and had completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTCQLQ-C30), both at the start of ICI treatment and after six months. Association of age as a continuous variable (per 10 years) and changes in HRQoL scores between baseline and 6 months was assessed using multivariable regression analyses. Clinical relevance of differences in HRQoL scores between OncoLifeS and the general population was classified into trivial, small, medium, and large, for three age groups (<60, 60-69 and ≥ 70 years).

RESULTS

151 patients were included with a mean age of 65.8 years. An increase in age per 10 years was associated with a larger decrease in the summary HRQoL score(β = -3.28,CI95%-6.42;-0.14), physical(β = -4.8, CI95% -8.71;-0.88), cognitive(β = -4.51,CI95%-8.24;-0.78), role functioning(β = -5.41,CI95%-10.78;-0.05), symptom burden(β = -3.66,CI95%-6.6;-0.73), and smaller negative changes in financial difficulties(β = 6.5 95 % CI 3.16; 9.85). OncoLifeS HRQoL scores were lower than those of the general population and differences were most often classified as large and medium.

CONCLUSION

Older lung cancer patients experience larger deteriorations in most HRQoL domains after 6 months of ICI treatment. Also, these patients showed significantly lower HRQoL scores compared to the general population.

Health-related quality of life in Welsh adults: psychometric properties of the SF-36v2 and normative data

OBJECTIVES

The use of normative data has become well-accepted and a common strategy to interpret individual's health outcome scores, which can help in making decisions. The objectives of this study were to obtain population normative data for the domains and component summaries of the 36-item SF-36® Health Survey (SF-36), and to evaluate its reliability and construct validity.

METHODS

This study was conducted using population-based data from the Welsh Health Survey (WHS; 2011-2015). This study used version 2 of the SF-36 (SF-36v2® Health Survey). The descriptive statistics and normative data for the eight domains and two summaries, physical component summary (PCS) and mental component summary (MCS), were calculated. Reliability assessment used internal consistency methods and construct validity assessment used known group comparisons and item-scale correlations.

STUDY DESIGN AND SAMPLE

We performed a secondary analyses of data from the Welsh Health Survey (WHS).

RESULTS

This study included 74,578 participants aged 16 years or older (53.6% were women). Participants aged 16-24 years scored higher on SF-36 scale than older groups on all domains. The SF-36 profiles by age group demonstrated lower scores for older age groups, with the most pronounced differences shown on the physical-related scales. Across the age groups, men had higher PCS and MCS scores than women. All SF-36 domains and PCS and MCS achieved a good to excellent internal consistency reliability exceeding 0.7. The scales demonstrated construct validity by showing associations with a range of factors known to be related to health.

CONCLUSIONS

This study provides SF-36 normative data for Wales based on a representative data and confirms the construct validity and reliability of the SF-36.

Long Term Physical Activity Improves Quality of Life Perception, Healthy Nutrition, and Daily Life Management in Elderly: A Randomized Controlled Trial

Physical activity (PA) is a key element in the management of successful aging. The aim of this paper was to show the effects of PA on the quality of life perception, nutritional status, and daily life management of 178 older adults (aged 63.87 ± 8.17) randomly assigned to an Experimental Group (EG), which performed moderate-to-high intensity aerobic and strengthening training, and a Control Group (CG) which performed low-impact PA, assessed after 6, 12, and 24 months. The Short-Form Health Survey (SF-36), Mini Nutritional Assessment (MNA), and Physical Activity Scale for the Elderly (PASE) were used for the study. In the SF-36 assessment, EG showed a good quality of life perception maintained after 24 months, while CG showed a worsening in the same period (p = 0.018). The EG reported a significant better nutritional status as compared to pre-intervention assessment (p = 0.003) and to CG (p < 0.001). Regarding the PASE, the EG showed a higher level of weekly activities than the CG after 24 months (p = 0.011), while the CG showed a worsening after 12 months (p = 0.008). The prolonged engagement in moderate-to high-intensity PA allowed the maintenance of a good quality of life perception, a good level of nutritional status, and daily life activities.

Factors Associated with Depressive Symptoms in Elderly Individuals Living in Urban Communities

Background

Depression is one of the most significant mental illnesses in the elderly population. Societal and economic changes in the social structure, particularly in urban communities, have led to a tendency toward depression in the elderly. Therefore, understanding the factors associated with depression among the elderly living in urban areas in Thailand is important to prevent and mitigate depression.

Objective

To investigate the proportion of depression and its associated factors in the elderly living in Bangkok.

Materials and Methods

This was a cross-sectional descriptive study with a sample size of 888 people living in Thai urban communities, including those in slum, urban, suburban, and high-rise building areas. A two-parts questionnaire was used: 1) the Thai Geriatric Depression Scale (TGDS) to assess depression and 2) associated factors.

Results

The overall percentage of depression in the sample population was 7.3%, and the proportion of depression was associated with community density (p = 0.031). The factors significantly associated with depression in the elderly included anxiety about an underlying disease [adjusted odds ratio (AOR) = 7.51; 95% CI 3.47–16.27], family conflict (AOR = 6.30; 95% CI 1.34–29.55), family history of psychiatric illness (AOR = 5.78; 95% CI 2.35–14.21), financial problems (AOR = 3.81; 95% CI 2.08–6.98), living separately from a spouse (AOR = 3.31; 95% CI 1.22–8.98), and less or no activity participation (AOR = 3.09; 95% CI 1.32–7.26 and AOR = 3.02; 95% CI 1.29–7.09).

Conclusion

To mitigate depression in the elderly, attention should be given to any underlying medical disease. The community also should promote more activities accessible to the elderly, especially income-earning activities. These activities might promote better relationships or ease conflict among elderly and other family members.

Effects of a Nurse-Led Telehealth Self-care Promotion Program on the Quality of Life of Community-Dwelling Older Adults: Systematic Review and Meta-analysis

BACKGROUND

In recent years, telehealth has become a common channel for health care professionals to use to promote health and provide distance care. COVID-19 has further fostered the widespread use of this new technology, which can improve access to care while protecting the community from exposure to infection by direct personal contact, and reduce the time and cost of traveling for both health care users and providers. This is especially true for community-dwelling older adults who have multiple chronic diseases and require frequent hospital visits. Nurses are globally recognized as health care professionals who provide effective community-based care to older adults, facilitating their desire to age in place. However, to date, it is unclear whether the use of telehealth can facilitate their work of promoting self-care to community-dwelling older adults.

OBJECTIVE

This review aims to summarize findings from randomized controlled trials on the effect of nurse-led telehealth self-care promotion programs compared with the usual on-site or face-to-face services on the quality of life (QoL), self-efficacy, depression, and hospital admissions among community-dwelling older adults.

METHODS

A search of 6 major databases was undertaken of relevant studies published from May 2011 to April 2021. Standardized mean differences (SMDs) and their 95% CIs were calculated from postintervention outcomes for continuous data, while the odds ratio was obtained for dichotomous data using the Mantel-Haenszel test.

RESULTS

From 1173 possible publications, 13 trials involving a total of 4097 participants were included in this meta-analysis. Compared with the control groups, the intervention groups of community-dwelling older adults significantly improved in overall QoL (SMD 0.12; 95% CI 0.03 to 0.20; P=.006; I2=21%), self-efficacy (SMD 0.19; 95% CI 0.08 to 0.30; P<.001; I2=0%), and depression level (SMD -0.22; 95% CI -0.36 to -0.08; P=.003; I2=89%).

CONCLUSIONS

This meta-analysis suggests that employing telehealth in nurse-led self-care promotion programs may have a positive impact on older adults, although more studies are needed to strengthen the evidence base, particularly regarding organization and delivery.

TRIAL REGISTRATION

PROSPERO (Prospective International Register of Systematic Reviews) CRD42021257299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299.

Development of an Electronic Tool to Assess Patient Preferences in Geriatric Polypharmacy (PolyPref)

PURPOSE

Medical decision-making in older adults with multiple chronic conditions and polypharmacy should include the individual patient's treatment preferences. We developed and pilot-tested an electronic instrument (PolyPref) to elicit patient preferences in geriatric polypharmacy.

PATIENTS AND METHODS

PolyPref follows a two-stage direct approach to preference assessment. Stage 1 generates an individual preselection of relevant health outcomes and medication regimen characteristics, followed by stage 2, in which their importance is assessed using the Q-sort methodology. The feasibility of the instrument was tested in adults aged ≥70 years with ≥2 chronic conditions and regular intake of ≥5 medicines. After the assessment with PolyPref, the patients rated the tool with regard to its comprehensibility and usability and assessed the accuracy of the personal result. Evaluators rated the patients' understanding of the task.

RESULTS

Eighteen short-term health outcomes, 3 long-term health outcomes, and 8 medication regimen characteristics were included in the instrument. The final population for the pilot study comprised 15 inpatients at a clinic for geriatric rehabilitation with a mean age of 80.6 (± 6.0) years, a median score of 28 (range 25-30) points on the Mini-Mental State Examination, and a mean of 11.6 (± 3.6) regularly taken medicines. Feedback by the patients and the evaluators revealed ratings in favor of understanding and comprehensibility of 86.7% to 100%. The majority of the patients stated that their final result summarized the most important aspects of their pharmacotherapy (93.3%) and that its ranking order reflected their personal opinion (100%). Preference assessment took an average of 35 (± 8.5) min, with the instrument being handled by the evaluator in 14 of the 15 participants.

CONCLUSION

Preference assessment with PolyPref was feasible in older adults with multiple chronic conditions and polypharmacy, offering a new strategy for the standardized evaluation of patient priorities in geriatric pharmacotherapy.

Life Satisfaction, Positive Affect, and Sleep Impairment in Masters Athletes: Modulation by Age, Sex, and Exercise Type

Introduction

The masters athlete has been proposed as a model of successful aging. Research studies investigating psychological outlook in older athletes have primarily addressed negative affects including depression, anxiety, and stress. The impact of lifelong exercise on positive affect and life satisfaction as well as sleep impairment that could impact on these psychological states is largely unknown.

Methods

A series of questionnaires (general life satisfaction, positive affect, and sleep-related impairment) were administered to 240 masters athletes participating in the World Masters Athletics Championships. Total raw scores were converted into T scores for comparison with the general population. Meaningful difference was defined by the PROMIS^® as one-half standard deviation from the centering sample.

Results

Meaningful differences were observed for improved general life satisfaction and reduced sleep impairment for all masters athletes. Positive affect did not reach the meaningful difference threshold. No significant sex differences were found for any of the questionnaires (all p > 0.05). Similarly, no significant differences were found between endurance, sprint, and strength/power sports for general life satisfaction (p = 0.18), positive affect (p = 0.46), and sleep impairment (p = 0.77). In general, life satisfaction increased with age (r = 0.15, p = 0.02), and sleep impairment trended towards reduction with age (r = −0.13, p = 0.05). Positive affect demonstrated no correlation with age (r = 0.09, p = 0.18).

Conclusion

This study demonstrates that the lifestyles of masters athletes contribute to improved general life satisfaction and reduced sleep impairment but not improved positive affect. The beneficial effects were observed irrespective of age, gender, and sporting types.

The Life Satisfaction Index-A (LSI-A): Normative Data for a General Swedish Population Aged 60 to 93 Years

PURPOSE OF STUDY

To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60-93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment.

MATERIALS AND METHODS

The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies' "Good Aging in Skåne" (GÅS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires.

RESULTS

Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS.

CONCLUSION

Norm values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS.

Further Evidence of Benefits to Mood and Working Memory from Lipidated Curcumin in Healthy Older People: A 12-Week, Double-Blind, Placebo-Controlled, Partial Replication Study

Curcumin (a flavonoid isolated from turmeric) affects several processes involved in neurocognitive aging. We have previously reported that short term (4-weeks) administration of a highly bioavailable curcumin preparation (Longvida©) improved working memory and reduced fatigue and stress reactivity in a healthy older cohort. The present trial (ACTRN12616000484448) was a partial replication study, evaluating similar effects at 4 and 12-weeks Longvida© supplementation. A double-blind, placebo-controlled, parallel-groups trial was conducted. Eighty participants aged 50-80 years (mean = 68.1, SD = 6.34) were randomised to receive Longvida© (400 mg daily containing 80 mg curcumin) or a matching placebo. Assessment took place at baseline then following 4 and 12 weeks treatment. Outcome measures included cognitive performance, mood and biomarkers. Compared with placebo, curcumin was associated with several significant effects. These included better working memory performance at 12-weeks (Serial Threes, Serial Sevens and performance on a virtual Morris Water Maze), and lower fatigue scores on the Profile of Mood States (POMS) at both 4 and 12-weeks, and of tension, anger, confusion and total mood disturbance at 4-weeks only. The curcumin group had significantly elevated blood glucose. These results confirm that Longvida© improves aspects of mood and working memory in a healthy older cohort. The pattern of results is consistent with improvements in hippocampal function and may hold promise for alleviating cognitive decline in some populations.

Social Determinants of Health-Related Quality of Life: A Recreation Setting Analysis

Objective. To determine if significant differences between park users and non-park users are associated with scores on a composite health-related quality of life (HRQoL) index. Methods. Data for this study were collected based on random intercept of a cross section of eligible Monroe County, Indiana, residents at four selected public recreational parks, as well as nonpark locations from July to December 2017. Based on data collected using validated survey items, we created a composite HRQoL index. Statistical analysis included independent-samples t test, chi-square cross-tabulation, bivariate regression, and multivariate regression. Results. Frequent park users were significantly different from nonfrequent park users in various respects. The most leisure-time physical activity (LTPA) experiences of frequent park users occurred at a park location. Body mass index and park-based LTPA were significantly positively associated with HRQoL scores in a linear regression model. Conclusion. Frequent park use was shown to be positively associated with increased park-based LTPA and HRQoL. It is therefore possible that increasing park visitation will result in more members of a community who report experiencing their LTPA at a park location. Study outcomes lend support to the validity of a composite HRQoL index for population health assessments.

Impact of a Nurse-Led Health Promotion Intervention in an Aging Population: Results From a Quasi-Experimental Study on the "Community Health Consultation Offices for Seniors"

Objective: The study evaluated the nurse-led intervention "Community Health Consultation Offices for Seniors (CHCO)" on health-related and care needs-related outcomes in community-dwelling older people (⩾60 years). Method: With a quasi-experimental design, the CHCO intervention was evaluated on health-related and care needs-related outcomes after 1-year follow-up. Older people who received the intervention were frail, overweight, or were smoking. The comparison group received care as usual. In both groups, similar data were collected on health status, falls and fractures, and care needs. In the intervention group, additional data were collected on biometric measures and health-related behavior. Results: The intervention group and the care-as-usual group included 403 seniors and 984 seniors, respectively. Health-related outcomes, behaviors, and biometric measures, remained stable. After 1 year, care needs increased for both groups, but at a lower rate for the care-as-usual group. Discussion: The CHCO intervention showed no significant improvement on health-related outcomes or stability in care needs-related outcomes.

Determinants of health-related quality of life in older primary care patients: results of the longitudinal observational AgeCoDe Study

BACKGROUND

In older patients with chronic diseases, focusing on subjective, patient-relevant outcomes, such as health-related quality of life (HRQoL), is more pertinent than pursuing clinical or laboratory target values.

AIM

To investigate factors influencing the course of HRQoL in older (aged ≥78 years) primary care patients and to derive non-pharmacological recommendations for improving their quality of life.

DESIGN AND SETTING

A population-based prospective longitudinal observational study featuring data analysis from waves 2 to 5 of the AgeCoDe study, which was conducted in six cities in Germany.

METHOD

The HRQoL of 1968 patients over the course of 4.5 years was observed. Patients were, on average, aged 82.6 (±3.4) years and their HRQoL was measured using the EQ-5D visual analogue scale in a face-to-face assessment. Fixed-effects regression models were calculated to examine impact of change in potential influencing factors. This method allows unobserved heterogeneity to be controlled.

RESULTS

The course of the participants' HRQoL declined with increasing age, walking and incident hearing impairment. Increasing the number of physical activities improved the HRQoL. These findings were modified by sex, education level, and depression. Especially in females and patients with rather low education levels, increased physical activity improved the subjects' HRQoL, while hearing impairment decreased it. Moving to an institution only improved the HRQoL in patients without depression or those with a low level of education (primary education).

CONCLUSION

Motivating patients to increase their weekly physical activity and to focus on preserving their ability to walk are promising approaches to improving HRQoL in older age. Less-educated patients and those without depression can also benefit from moving into an institution (for example, a care or retirement home).

Sex differences in the association of physical function and cognitive function with life satisfaction in older age: The Rancho Bernardo Study

OBJECTIVES

This study examines the cross-sectional associations of cognitive and physical function with life satisfaction in middle-class, community-dwelling adults aged 60 and older.

STUDY DESIGN

Participants were 632 women and 410 men who had cognitive function tests (CFT) and physical function tasks (PFT) assessed at a clinic visit between 1988 and 1992, and who responded in 1992 to a mailed survey that included life satisfaction measures. Cognitive impairment was defined as ≤24 on MMSE, ≥132 on Trails B, ≤12 on Category Fluency, ≤13 on Buschke long-term recall, and ≤7 on Heaton immediate recall. Physical impairment was defined as participants' self-reported difficulty (yes/no) in performing 10 physical functions. Multiple linear regression examined associations between life satisfaction and impairment on ≥1 CFT or difficulty with ≥1 PFT.

MAIN OUTCOME MEASURES

The Satisfaction with Life Scale (SWLS; range:0-26) and Life Satisfaction Index-Z (LSI-Z; range:5-35).

RESULTS

Participants' average age was 73.4 years (range=60-94). Categorically defined cognitive impairment was present in 40% of men and 47% of women. Additionally, 30% of men and 43% of women reported difficulty performing any PFT. Adjusting for age and impairment on ≥1 CFT, difficulty performing ≥1 PFT was associated with lower LSI-Z and SWLS scores in men (β=-1.73, -1.26, respectively, p<0.05) and women (β=-1.79, -1.93, respectively, p<0.01). However, impairment on ≥ 1 CFT was not associated with LSI-Z or SWLS score after adjusting for age and difficulty with ≥1 PFT.

CONCLUSIONS

Limited cognitive function was more common than limited physical function; however, limited physical function was more predictive of lower life satisfaction. Interventions to increase or maintain mobility among older adults may improve overall life satisfaction.

The Relationship between Levels of Physical Activity and Quality of Life among Students of the University of the Third Age

AIM

The assessment of quality of life (QoL) among elderly people is of great importance when preparing health care programmes for this social group. Many researchers indicate that poor health is less frequently observed in senior citizens who display levels of physical activity (PA) prescribed by WHO. The aim of the study was to investigate the relationship between the level of PA among students of the University of the Third Age (U3A) and their self-assessment concerning their QoL.

METHODS

The research sample consisted of 131 students from three U3A in West Pomeranian Voivodeship in Poland. PA was assessed with the aid of a short Polish version of the International Physical Activity Questionnaire (IPAQ). The assessment of QoL was conducted with the use of a Polish version of the WHO Quality of Life--BREF instrument (WHOQOL-BREF).

RESULTS

The present study has shown that highly active U3A students declare high QoL in the psychological and social domains more often than other respondents.

CONCLUSION

The level of PA recommended by WHO has a positive impact on the perceived QoL. Possible differences are visible mostly in the assessment of different domains of life in relation to the presented levels of PA.

Self-Reported Hindering Health Complaints of Community-Dwelling Older Persons: A Cross-Sectional Study

Purpose

Proactive care for community-dwelling older persons targeting self-reported hindering health complaints might prevent a decline in function. We investigated the spectrum of self-reported hindering complaints of community-dwelling older persons, the association with functional outcomes, and help-seeking behavior for these complaints.

Methods

Within the ISCOPE trial, participants (aged ≥75 years) received the ISCOPE screening questionnaire, including the open-ended question “At the moment, which health complaints limit you the most in your day-to-day life?”. After coding the answers with the ICPC-1-NL, we examined the prevalence and the association between the number and type of complaints and functional outcomes (Groningen Activities Restriction Scale, quality of life measured on Cantril’s Ladder, Mini-Mental State Examination, Geriatric Depression Scale-15, and De Jong Gierveld Loneliness Scale). Electronic patient registers were searched for the most reported complaints.

Results

7285 participants (median age: 81.0 years [IQR 77.8–85.3], 38.6% males) reported 13,524 hindering complaints (median 1, range 0–18); 32.7% reported no complaints. Participants mostly reported problems with walking/standing (22.1%), pain (20.8%) or weakness/tiredness (8.5%). These complaints were mentioned in the electronic patient registers in 28.3%, 91.3% and 55.5%, respectively. Higher numbers of hindering complaints were related to poorer scores on the number of domains with problems, Cantril’s Ladder for quality of life, Groningen Activities Restriction Scale, Geriatric Depression Scale, and De Jong Gierveld Loneliness Scale. Self-reported weakness, problems with walking/standing, visual limitations, cognitive problems, dyspnea and back complaints were associated with poorer scores on the number of domains with problems, Groningen Activities Restriction Scale, MMSE or Geriatric Depression Scale.

Conclusion

One third of the participants reported no hindering complaints. Problems with walking/standing, pain, and weakness/tiredness were most reported, but not always found in electronic patient registers. A higher number of, and specific self-reported hindering complaints, were associated with poorer scores on functional outcomes. It may be helpful for general practitioners to ask about these complaints and their influence on daily life.

Health-Related Quality of Life and Pain Intensity Among Ethnically Diverse Community-Dwelling Older Adults

Chronic pain is highly prevalent in older adults and often negatively associated with health-related quality of life (HRQoL). This study compared HRQoL, including physical health and mental health, in persons of differing ethnicities, and identified factors associated with pain intensity and HRQoL in ethnically diverse older adults. Older adults with chronic pain from four ethnic groups (African Americans, Afro-Caribbeans, Hispanics, and European Americans) were recruited from the Florida Atlantic University Healthy Aging Research Initiative (HARI) registry. The Medical Outcomes Study Short Form-36 (SF-36) was used to evaluate HRQoL, including functional status, emotional well-being, and social functioning. Of 593 persons in the four ethnic groups in the registry, 174 met the inclusion criteria (pain level of four or higher on an 11-point scale, lasting 3 months or longer). Among these 174, African Americans reported the highest level of pain intensity, followed by Afro-Caribbeans, Hispanics, and European Americans. Hispanics reported the highest physical health scores and the lowest mental health scores. In contrast, African Americans reported the highest mental health scores and the lowest physical health scores. Multivariate linear regression analysis revealed that ethnicity, lower physical health scores, and lower mental health scores were significantly (p ≤ .01) associated with pain intensity. Understanding ethnic variations in response to pain intensity may address gaps in knowledge about HRQoL to reduce disparities in optimal care. Health care providers should consider ethnic norms and cultural diversity to provide optimal interventions for this population.

Personality, psychosocial and health-related predictors of quality of life in old age

OBJECTIVES

Beyond its well-documented association with depressive symptoms across the lifespan, at an individual level, quality of life may be determined by multiple factors: psychosocial characteristics, current physical health and long-term personality traits.

METHOD

Quality of life was assessed in two distinct community-based age groups (89 young adults aged 36.2 ± 6.3 and 92 older adults aged 70.4 ± 5.5 years), each group equally including adults with and without acute depressive symptoms. Regression models were applied to explore the association between quality of life assessed with the World Health Organization Quality of Life - Bref (WHOQOL-Bref) and depression severity, education, social support, physical illness, as well as personality dimensions as defined by the Five-Factor Model.

RESULTS

In young age, higher quality of life was uniquely associated with lower severity of depressive symptoms. In contrast, in old age, higher quality of life was related to both lower levels of depressive mood and of physical illness. In this age group, a positive association was also found between quality of life and higher levels of Openness to experience and Agreeableness personality dimensions.

CONCLUSION

Our data indicated that, in contrast to young cohorts, where acute depression is the main determinant of poor quality of life, physical illness and personality dimensions represent additional independent predictors of this variable in old age. This observation points to the need for concomitant consideration of physical and psychological determinants of quality of life in old age.

The association of health-promoting lifestyle with quality of life among the Iranian elderly

BACKGROUND

As individuals live a longer life, health-promoting lifestyle (HPL) becomes even more essential, particularly with regard to maintaining functional independence and improving quality of life (QoL).

OBJECTIVES

This study aimed to determine the association between QoL and HPL in the Iranian elderly living in Shiraz.

MATERIALS AND METHODS

This analytical cross-sectional study was conducted in 2013 at retirement centers of Shiraz City, Iran. The sample included 500 elderly who aged > 60 years. Proportional stratified random sampling was used to select the elderly from retirement centers. QoL was assessed by the Farsi version of Short Form Health Survey questionnaire (SF-36) and HPL was measured by health-promoting lifestyle profile (HPLP II). Data were analyzed using independent-samples t test, one-way ANOVA, Pearson's correlation, and stepwise multiple regression using SPSS 21.

RESULTS

There were significant differences in QoL in terms of sex, age, education, and marital status. There were significant differences in HPL in terms of gender, age and education (P < 0.05) There was a statistically significant association between QoL and HPL in the elderly (r = 0.42, P < 0.05). Based on HPLP II constructs, the significant predicting factors of QoL in the elderly consisted of spiritual growth, stress management, and physical activity (P < 0.05).

CONCLUSIONS

Health providers should improve the QoL in the elderly by facilitating HPL through health-promoting interventions, which will maintain and increase physical activity, stress management, and spiritual growth.

What can local authorities do to improve the social care-related quality of life of older adults living at home? Evidence from the Adult Social Care Survey

Local authorities spend considerable resources on social care at home for older adults. Given the expected growth in the population of older adults and budget cuts on local government, it is important to find efficient ways of maintaining and improving the quality of life of older adults. The ageing in place literature suggests that policies in other functions of local authorities may have a significant role to play. This study aims to examine the associations between social care-related quality of life (SCRQoL) in older adults and three potential policy targets for local authorities: (i) accessibility of information and advice, (ii) design of the home and (iii) accessibility of the local area. We used cross-sectional data from the English national Adult Social Care Survey (ASCS) 2010/2011 on service users aged 65 years and older and living at home (N=29,935). To examine the association between SCRQoL, as measured by the ASCOT, and three single-item questions about accessibility of information, design of the home and accessibility of the local area, we estimate linear and quantile regression models. After adjusting for physical and mental health factors and other confounders our findings indicate that SCRQoL is significantly lower for older adults who find it more difficult to find information and advice, for those who report that their home design is inappropriate for their needs and for those who find it more difficult to get around their local area. In addition, these three variables are as strongly associated with SCRQoL as physical and mental health factors. We conclude that in seeking to find ways to maintain and improve the quality of life of social care users living at home, local authorities could look more broadly across their responsibilities. Further research is required to explore the cost-effectiveness of these options compared to standard social care services.

Associations between cognitive abilities and life satisfaction in the oldest-old. Results from the longitudinal population study Good Aging in Skåne

INTRODUCTION

Studies on the associations between cognitive abilities and life satisfaction (LS) in the oldest-old are few. The aim of this study was to explore whether abilities in six different cognitive domains could predict LS in the oldest-old 3 years later.

METHODS

The study population consisted of 681 individuals aged 78-98 years, drawn from the longitudinal population study "Good Aging in Skåne," which is part of a national survey (The Swedish National Study on Aging and Care). Scores on 13 cognitive tests were related to scores on Neugartens' LS index A (LSI-A) 3 years later. The cognitive tests were added into six different cognitive domains. A multiple regression analysis was constructed for each cognitive domain separately, with scores on the LSI-A as the dependent variable. The model was adjusted stepwise for sex, age, education, functional capacity, and depressive mood.

RESULTS

Significant correlations were found between digit cancellation, word recall, verbal fluency (VF) A, VF animals, VF occupations, and mental rotations at baseline, as well as LSI-A at follow-up. The domains of spatial abilities (B = 0.453, P = 0.014) and processing speed (B = 0.118, P = 0.020) remained significantly associated with LSI-A 3 years later after adjustment.

CONCLUSION

The cognitive domains of spatial abilities and processing speed predicted LS 3 years later in the oldest-old. Clinical implications are discussed.

Self-perceived health among older women living in their own residence

Aim.  The aim was to characterize women who perceived themselves as healthy and to compare them with women who perceived themselves as less healthy with regard to demographical, social, medical and functional factors. Another aim was to describe changes within the healthy group after one year. Background.  Self-perceived health is influenced by several factors, of which diseases and illness are only a part. Method and participants.  Two hundred and seventy-eight women, 75 and 80 years old, of which 50% (n = 139) perceived themselves as healthy and less healthy, respectively. Data were collected by using the Nottingham Health Profile, Geriatric Depression Scale, Mini Nutritional Assessment, Mini Mental State Examination and Philadelphia Geriatric Center Multilevel Assessment Instrument, in two examinations at intervals of one year. Results.  The women in the healthy group were characterized as having no or low depression symptoms (P = 0.016), better physical mobility (P = 0.029) and better physical health (P < 0.001). Furthermore no or less pain, fewer doctor visits, more energy and fewer negative emotional reactions were predictors for self-perceived health in the healthy group at the one-year follow-up. Conclusion.  The most important predictors associated with perceiving oneself as healthy were no or few depression symptoms, physical mobility and good physical health. Relevance to clinical practice.  Attention has to be paid to women's mood, physical health, mobility, pain and energy to help them stay healthy.

Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial

CONTEXT

Yoga as a life-style practice has demonstrated beneficial effects. The role of yoga in the elderly for such benefits merits investigation.

AIMS

The aim of this study is to examine the effects of yoga intervention on quality-of-life (QOL) and sleep quality in the elderly living in old age homes.

SETTINGS AND DESIGN

Single blind controlled study with block randomization of elderly homes.

MATERIALS AND METHODS

A total of 120 subjects from nine elderly homes were randomized in to yoga group (n=62) and waitlist group (n=58). Subjects in the yoga group were given yoga intervention daily for 1 month and weekly until 3 months and were encouraged to practice yoga without supervision until for 6 months. Subjects in waitlist group received no intervention during this period. Subjects were evaluated with World Health Organization Quality of Life (WHOQOL)-BREF for measuring QOL and Pittsburgh Sleep Quality Index for sleep quality in the baseline and after 6 months.

STATISTICAL ANALYSIS

Independent t-test and repeated measures analysis of covariance respectively was used to measure the difference in outcome measures between the two groups at baseline and after the study period.

RESULTS

Subjects in the yoga group had significantly higher number of years of formal education. Subjects in the yoga group had significant improvement in all the domains of QOL and total sleep quality after controlling for the effect of baseline difference in education between the two groups.

CONCLUSION

Yoga intervention appears to improve the QOL and sleep quality of elderly living in old age homes. There is a need for further studies overcoming the limitations in this study to confirm the benefits of yoga for elderly in QOL and sleep quality.

A theoretical model of efficacy beliefs, functional status and quality of life for older people during rehabilitation: testing causal relationships

AIMS

Structural equation modelling tested hypothesized causal relationships between age, gender, pain, depression, self-efficacy, outcome expectations, functional status and quality of life in older Australians post-orthopaedics surgery across three stages of their rehabilitation.

BACKGROUND

Self-efficacy is important in forming personal beliefs about capabilities to perform functional activities, which is believed to maintain individual's quality of life. Research examining how efficacy beliefs influence functional status in older people following orthopaedic events is limited.

DESIGN

A descriptive, longitudinal method was used for this study.

METHODS

A convenience sample of 101 older people with orthopaedic surgery to lower extremities was recruited from private rehabilitation units in Brisbane, Australia. Data were collected from September 2008-November 2009. Standardized questionnaires were used to measure efficacy beliefs, functional status, and quality of life.

RESULTS

Structural equation modelling revealed that depression, efficacy beliefs, age, and gender significantly influenced quality of life, as self-efficacy and gender have a direct relationship on functional status. Across three stages in the model, outcome expectation at stage 2 was the most significant predictor of functional recovery after discharge. Older men with higher quality of life at admission was positively related to self-efficacy and negatively associated with depression at stage 2: quality of life influenced outcome expectations and pain positively at stage 3.

CONCLUSION

Rehabilitation programmes play a significant role in assisting older people in resuming functional activities and quality of life following orthopaedic surgery. Enhancing self-efficacy may facilitate older people's participation and adherence to rehabilitation programmes during hospitalization and following discharge.

The psycho-social dimension of pain and health-related quality of life in the oldest old

BACKGROUND

Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health-related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce.

AIMS

  The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho-social) and health-related quality of life as well as to compare sex and age groups in people aged 80 years and over.

METHODS

In this cross-sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho-social dimension of pain was measured using the Multidimensional Pain Inventory-Swedish language version (MPI-S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health-related quality of life was measured using the Short Form Health Survey-12 (SF-12).

RESULTS

Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI-S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80-85 years had higher pain severity than those aged≥86. Participants with a lower health-related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life.

CONCLUSIONS

Older people with prolonged pain suffered from a low health-related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people's physical, mental and social health.

Health-related Quality of Life in Retired Older People in Tehran City

Population aging has become an important social issue worldwide and the biggest challenge is improving older people’s quality of life. We aimed to determine the quality of life (QOL) of retired older adults in Tehran using the SF-36. About 321 men and 146 women, aged 60 to 69 (62%) and 70 or older (38%), participated. In the older group, the total QOL score was lower than in the younger group, but the older group scored higher in the mental domain. Education had a significant relationship with the mental domain of QOL, as did gender with the physical and mental domains. The income sufficiency state was significantly related to both domains of QOL. The findings can be useful in designing intervention studies that could eventually lead to application of strategies to promote QOL in retired older adults in Iran and other countries with similar sociocultural and economic backgrounds.

Prevalence of sleep problems and pain among the elderly in Sweden

BACKGROUND/OBJECTIVES

Sleep problems and pain are common among the elderly and have been shown to affect quality of life. The objectives were to determine the prevalence of sleep problems and pain among the elderly and to compare the two factors in relation to age and gender.

DESIGN

A cross-sectional study based on baseline material collected by the Swedish National Study on Aging and Care in Blekinge (SNAC-Blekinge).

SETTING

The data were gathered from questionnaires distributed between the years 2001 and 2003 in the municipality of Karlskrona, Sweden.

PARTICIPANTS

The participants comprised 1402 Swedish men and women aged 60-96.

RESULTS

Of all the participants 70 percent met the criteria for sleep problems and 62 percent indicated some experience of pain during the preceding 4 weeks. Both sleep problems and pain were more frequent among women than men and sleep problems tended to be more common with increasing age. Among the participants who experienced pain during the preciding 4 weeks 77 percent suffered from sleep problems.

CONCLUSIONS

Sleep problems and pain are common among older people. Furthermore it is common to suffer from sleep problems when pain has been experienced during the preciding 4 weeks.

[Changes in the quality of life of older people living at home: does type of care play a role?]

PURPOSE

To determine whether a change in physical, psychological and social dimensions of quality of life of older people living at home is associated with receiving formal care, compared to informal care and no care.

METHOD

Data from the observation cycles in 1998 and 2001 of the Longitudinal Aging Study Amsterdam (LASA) were used. Older people receiving formal homecare in 1998 were compared to older people receiving informal care and to older people receiving no care at all in 1998 on subjective scores on 3-year changes in self-perceived health, loneliness, positive affect and satisfaction with life. The data were analysed using linear regression analysis and ANOVA.

RESULTS

In all groups there is a change for the worse between 1998 and 2001 in the four aspects of quality of life. Self-perceived health declines significantly more in the group receiving formal care compared to the group without care, but this is explained by a higher score on functional limitations in 1998. Loneliness increases significantly more in the group receiving formal care, even after correction for confounders. In the group receiving formal care the satisfaction with life decreases significantly more compared to the group receiving no care and the group with informal care. An interaction effect with gender was found, showing that after correction for confounders this difference is maintained for the women but not for the men. There is no significant difference between the three care groups regarding changes in positive affect.

CONCLUSION

Older men and women who receive formal home care experience an increase in loneliness, and older women who receive formal care experience less satisfaction with life, compared to women who receive informal care or no care. Future research should confirm these results and investigate the mechanisms underlying these changes.

Validation and test-retest reliability of a health measure, health as ability of acting, based on the welfare theory of health

The aim of this study was to conduct a validation and assess the test-retest reliability of the health questionnaire based on Nordenfelt's Welfare Theory of Health (WTH). The study used a questionnaire on health together with the Short Form 12-Item Health Survey (SF-12) questionnaire, and 490 pupils at colleges for adult education participated. The results of the study are in accordance with Nordenfelt's WTH. Three hypotheses were stated, and the first was confirmed: People who were satisfied with life rated higher levels than those who were dissatisfied with life concerning both mental and physical health, measured with the SF-12. The second hypothesis was partially confirmed: People with high education were more often satisfied with life than those with low education, but they were not healthier. The third hypothesis, that women are unhealthy more often than men, was not confirmed. The questionnaire on health showed acceptable stability.

Relationship between age and symptoms of pain and fatigue in adults undergoing treatment for cancer

BACKGROUND

Pain and fatigue are 2 of the most common symptoms experienced by individuals undergoing treatment for cancer. It has been hypothesized that older adults experience lower levels of severity and interference from pain and fatigue when compared with younger adults.

OBJECTIVE

The purpose of this study was to identify how pain and fatigue, severity, and interference may vary between younger and older adults undergoing cancer treatment over time.

METHODS

This study is a secondary analysis of data of 2 different randomized controlled trials that examined the symptom experience in adults undergoing treatment for cancer. A linear mixed model analysis was used to determine the differences based on age across 6 contacts over 8 weeks.

RESULTS

Results indicate that pain severity is significantly (P < .01) related to age. Age was not found to be significantly related to the level of interference associated with pain or the severity or interference associated with fatigue.

CONCLUSION

Symptoms of pain and fatigue are prevalent across age groups and will vary across time. Older and younger adults do not necessarily experience symptoms differently. Interference associated with pain and fatigue impacts all age groups; interference may not be directly related to the level of severity.

IMPLICATIONS FOR PRACTICE

This study highlights the importance of assessing both severity and interference associated with symptoms in all adults undergoing treatment for cancer. Further research is needed to better understand the relationship between age and symptoms in individuals undergoing treatment for cancer.

Mobility, functional ability and health-related quality of life among people of 60 years or older

BACKGROUND AND AIMS

Knowledge about Health-Related Quality of Life (HRQoL) in advanced age is sparse. This study investigated to what extent mobility factors explained older people's HRQoL when age, gender and functional ability (ADL) were controlled for.

METHODS

Subjects were 1128 people aged 60-96 participating in a Swedish longitudinal multi-center cohort study. Besides descriptive and correlation statistics, a three-tier multiple logistic regression analysis was performed, which included the ADL scale, mobility tests and items, with physical and mental HRQoL as outcome variables.

RESULTS

In the models containing the control variables, functional ability was found to be associated with both physical and mental HRQoL. In the models including both functional ability and mobility factors, the importance of functional ability remained for mental but not for physical HRQoL. The mobility factors were found to have a stronger negative influence on HRQoL, i.e., physical and mental, than functional ability in itself.

CONCLUSIONS

For optimal identification of various types of disabilities and their impact on older people's HRQoL, the ADL scale should be used together with more targetspecific tests of disabilities. However, in certain situations, it appears that one mobility factor alone - the ability to walk - has the capacity to pick up changes in both physical and mental HRQoL. Thus, it is important that healthcare professionals should focus activities toward maintaining older people's mobility as a means of enhancing their HRQoL.

Predicting Positive Well-Being in Older Men and Women

The purpose of this study was to examine the effects of background, psychological, and social variables on older adults' well-being, and how this may differ for men and women. Participants included 800 adults from the 2002 Health and Retirement Study (HRS), aged 60 to 101 years old ( M = 71.22, SD = 8.46), who completed the optional positive well-being module. Gender-based regression models revealed that for men, marital status, self-rated health, and depression were significant predictors and accounted for 32% of the variability in positive well-being. Similar to men, self-rated health and depression were significant predictors of well-being for women. Additional significant predictors for women included age, the importance of religion, and volunteer work. Combined, these variables explained 35% of the variance in women's positive well-being. These results can help us understand which variables are important to target when developing interventions to improve the well-being of older men and women.

A cross-sectional study on health and physical functioning in relation to coping strategies among community-dwelling, ethnically diverse older women

BACKGROUND

Although empirical evidence is available on the coping-health link in older age, research on this topic is needed with non-clinical samples of ethnically diverse older women. To contribute to filling such a research gap, we tested whether these women's general health and functional limitations were associated with specific coping strategies (selected for their particular relevance to health issues) and with known health-related demographics, i.e., age, ethnicity, income, and married status.

METHODS

In this cross-sectional study, respondents were recruited at community facilities including stores and senior centers. The sample consisted of 180 community-dwelling women (age 52-98) screened for dementia; 64% of them reported having an ethnic minority status. The assessment battery contained the Mini-Cog, a demographics list, the Brief COPE, and the Medical Outcome Study 36-Item Short-Form Health Survey.

RESULTS

Hierarchical multiple regression analyses showed that older women who used behavioral disengagement and, to a smaller degree, self-distraction as a form of coping reported lower levels of general health. The opposite was the case for positive reframing and, to a lesser degree, substance use. Moreover, lower income was related to worse general health and (together with more advanced age) physical functioning. None of the coping strategies achieved significance in the physical functioning model.

CONCLUSIONS

These cross-sectional findings need corroboration by longitudinal research prior to developing related clinical interventions. Based on the initial evidence provided herein, clinicians working with this population should consider establishing the therapeutic goal of increasing the use of positive reframing while diminishing behavioral disengagement.

Quality of life in patients aged 80 or over after ICU discharge

Introduction

Our objective was to describe self-sufficiency and quality of life one year after intensive care unit (ICU) discharge of patients aged 80 years or over.

Methods

We performed a prospective observational study in a medical-surgical ICU in a tertiary non-university hospital. We included patients aged 80 or over at ICU admission in 2005 or 2006 and we recorded age, admission diagnosis, intensity of care, and severity of acute and chronic illnesses, as well as ICU, hospital, and one-year mortality rates. Self-sufficiency (Katz Index of Activities of Daily Living) was assessed at ICU admission and one year after ICU discharge. Quality of life (WHO-QOL OLD and WHO-QOL BREF) was assessed one year after ICU discharge.

Results

Of the 115 consecutive patients aged 80 or over (18.2% of admitted patients), 106 were included. Mean age was 84 ± 3 years (range, 80 to 92). Mortality was 40/106 (37%) at ICU discharge, 48/106 (45.2%) at hospital discharge, and 73/106 (68.9%) one year after ICU discharge. In the 23 patients evaluated after one year, self-sufficiency was unchanged compared to the pre-admission status. Quality of life evaluations after one year showed that physical health, sensory abilities, self-sufficiency, and social participation had slightly worse ratings than the other domains, whereas social relationships, environment, and fear of death and dying had the best ratings. Compared to an age- and sex-matched sample of the general population, our cohort had better ratings for psychological health, social relationships, and environment, less fear of death and dying, better expectations about past, present, and future activities and better intimacy (friendship and love).

Conclusions

Among patients aged 80 or over who were selected at ICU admission, 80% were self-sufficient for activities of daily living one year after ICU discharge, 31% were alive, with no change in self-sufficiency and with similar quality of life to that of the general population matched on age and sex. However, these results must be interpreted cautiously due to the small sample of survivors.

Relationship of dietary intake and lifestyle factors to health-related quality of life in the community-dwelling elderly

Quality of life (QOL) encompasses a broad notion of health and is increasingly used to evaluate the effectiveness of health care services. The purpose of this cross-sectional study was to assess health-related quality of life (HR-QOL) in the community-dwelling elderly (mean age, 72.7±0.3 y; female 46.4%, n=179) in Japan and to explore diminished factors. We assessed HR-QOL by the 36-Item Short-Form Health Survey (SF-36), maximum walking speed, step counts, Tokyo Metropolitan Institute of Gerontology (TMIG) index, dietary intake and blood biochemistry. Two summary scores of the SF-36 were calculated (physical component score: PCS, mental component score: MCS). We divided participants into two groups based on the standard values of PCS and MCS classified by age (high and low group), which was further stratified into a high PCS and high MCS (BH) group and a low PCS and low MCS (BL) group. Mean maximum walking speed and daily step counts were 207.7±2.8 cm/s and 7,008±289. Eighty-one percent of the participants had full scores in the TMIG index. Daily intake of energy and protein were 2,081±33 kcal and 74.5±0.9 g. The maximum walking speed, TMIG index, alcohol consumption and chewing ability were significantly higher in the BH group than those in the BL group, but not dietary intake. Stepwise logistic regression analysis indicated that maintaining maximum walking speed might be associated with sustaining HR-QOL in the healthy elderly.

Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial

BACKGROUND

Orientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the client's needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision.

METHODS/DESIGN

A parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out.

DISCUSSION

The screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00946062.

Is health-related quality of life associated with the risk of low-energy wrist fracture: a case-control study

BACKGROUND

Some risk factors for low-energy wrist fracture have been identified. However, self-reported measures such as health-related quality of life (HRQOL) have not been examined as potential risk factors for wrist fracture. The aims of this study were to compare HRQOL prior to a low-energy wrist fracture in elderly patients (>or= 50 years) with HRQOL in age- and sex-matched controls, and to explore the association between HRQOL and wrist fracture after adjusting for known risk factors for fracture such as age, weight, osteoporosis and falls.

METHODS

Patients with a low-energy wrist fracture (n = 181) and age- and sex-matched controls (n = 181) were studied. Shortly after fracture (median 10 days), patients assessed their HRQOL before fracture using the Short Form 36 (SF-36). Statistical tests included t tests and multivariate logistic regression analysis.

RESULTS

Several dimensions of HRQOL were significantly associated with wrist fracture. The direction of the associations with wrist fracture varied between the different sub-dimensions of the SF-36. After controlling for demographic and clinical variables, higher scores on general health (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.10-1.56), bodily pain (OR = 1.18, 95% CI = 1.03-1.34) and mental health (OR = 1.39, 95% CI = 1.09-1.79) were related to an increased chance of being a wrist fracture patient rather than a control. In contrast, higher scores on physical role limitation (OR = 0.87, 95% CI = 0.79-0.95) and social function (OR = 0.65, 95% CI 0.53-0.80) decreased this chance. Significant associations with wrist fracture were also found for living alone (OR = 1.91, 95% CI 1.07-3.4), low body mass index (BMI) (OR = 0.92, 95% CI 0.86-0.98), osteoporosis (OR = 3.30, 95% CI 1.67-6.50) and previous falls (OR = 2.01, 95% CI 1.16-3.49).

CONCLUSION

Wrist fracture patients perceive themselves to be as healthy as the controls before fracture. Our data indicate that patients with favourable and unfavourable HRQOL measures may be at increased risk of wrist fracture.

Health worry, physical activity participation, and walking difficulty among older adults: a mediation analysis

This study examined the effect of health worry (i.e., cognitive aspect of anxiety resulting from concern for health) on walking difficulty in a nationally representative sample (N = 7,527) of older adults (M age = 76.83 years). The study further tested whether physical activity mediates the effect of health worry on walking difficulty in a 6-year follow-up design. Results of a mediation analysis using structural equation modeling showed that people with a high degree of health worry engaged in less physical activity (beta = -.24, p < .001), and people who participated in less physical activity were more likely to report walking difficulty at the 6-year follow-up (beta = -.22, p < .001). There was a significant indirect effect from health worry to walking difficulty through physical activity (beta = .05, p < .001), controlling for demographic, psychosocial, and health related factors. Results suggested that inducing threat and worry may not be effective for physical activity promotion in the older population. More promising coping and regulation strategies are discussed.

Wait times for publicly funded outpatient and community physiotherapy and occupational therapy services: implications for the increasing number of persons with chronic conditions in ontario, Canada

BACKGROUND

Timely access to publicly funded health services has emerged as a priority policy issue across the continuum of care from hospitals to the home and community sector. The purpose of this study was to examine wait lists and wait times for publicly funded outpatient and community occupational therapy (OT) and physical therapy (PT) services.

METHODS

A mailed self-administered questionnaire was sent in December 2005 to all publicly funded sites across Ontario that deliver outpatient or community OT or PT services (N = 374). Descriptive statistics were used to describe the study sample and to examine wait lists and wait times by setting and client condition.

RESULTS

Overall response rate was 57.2% (n = 214). More than 10,000 people were reported to be waiting for OT or PT services across Ontario. Of these, 16% (n = 1,664) were waiting for OT and 84% (n = 8,842) for PT. Of those waiting for OT, 59% had chronic conditions and half were waiting for home care rehabilitation services. Of those waiting for PT, 73% had chronic conditions and 81% were waiting at hospital outpatient departments.

CONCLUSIONS

Individuals with chronic conditions experience excessive wait times for outpatient and community OT and PT services in Ontario, particularly if they are waiting for services in hospital outpatient departments.