Quality of life in old age described as a sense of well-being, meaning and value

Age, quality of life and mental well-being in adolescent population: a network model tree analysis

This study presents the results of a network-based analysis of health related quality of life (HRQoL) among Slovenian adolescents. The study aimed to examine the relationship between HRQoL and mental well-being among adolescents of different age and gender groups. A cross-sectional study was conducted from November 2019 to January 2020 in 16 primary and 9 secondary schools in Slovenia. The KIDSCREEN-27 scale was used to collect the data on HRQoL, and the Warwick-Edinburgh Mental Well-being Scale to collect data on mental well-being. We used network model trees to demonstrate differences in psychometric network structure measuring correlations between different concepts in adolescent HRQoL. A total of 2972 students aged 10-19 years participated in the study. The significant split in the network tree (p < 0.001) indicated differences in relations between HRQoL subscale scores and mental well-being score among adolescents younger than 12 years old. In comparison to older adolescents the correlation between mental well-being and mood scores was significantly weaker in this group of the youngest participants (p < 0.001). A network model tree analysis also uncovered an interesting pattern based on gender and age (p < 0.013) where a correlation between mood and family support became weaker for female at the age of 12 and for male at the age of 16. Data mining techniques have recently been used by healthcare researchers and professionals. Network-based analysis is an innovative alternative to classical approaches in HRQoL research. In this study we demonstrate the significant differences in the perceptions of HRQoL and mental well-being among adolescents in different age and gender groups that were discovered using tree-based network analysis.

Which life domains are people with major depression satisfied or dissatisfied with? An individual patient data meta-analysis

BACKGROUND

People with depression tend to score low on measures of subjective quality of life (SQoL) which has been suggested to reflect a general negative bias of perception. However, studies do not tend to investigate specific life domains. This study investigated satisfaction with life domains in people with major depression and explored influential factors.

METHODS

A one-step individual patient data meta-analysis combined data of 1710 people with major depression from four studies. In all studies, SQoL was measured on the Manchester Short Assessment of Quality of Life, which provides satisfaction ratings with 12 life domains. Associations between individual characteristics and satisfaction ratings were investigated using univariable and multivariable models.

RESULTS

Mean satisfaction ratings varied across life domains. Participants expressed dissatisfaction with several domains but expressed satisfaction with others, mainly for domains associated with close relationships. Some of the investigated characteristics were consistently associated with satisfaction ratings across the domains.

LIMITATIONS

The primary limitation of this study was in the analysis of individual characteristics, which were chosen based on identification in existing literature and availability in our datasets, and of which several were dichotomised to have sufficiently large numbers which may have resulted in lost nuance in the results.

CONCLUSIONS

People with major depression distinguish between their satisfaction with different life domains and are particularly satisfied with their close relationships. This challenges the notion of a general negative appraisal of life in this group, and highlights the need to evaluate satisfaction with different life domains separately.

'I like to feel needed, you know?': a qualitative examination of sense of purpose in older care home residents

OBJECTIVES

To explore older care home residents' experiences of maintaining a sense of purpose in life: a core component of psychological wellbeing.

METHODS

Fifteen residents (9 female; 6 male), aged 60-95 years, from four care homes, were interviewed about their sense of purpose. Interview transcripts were analysed using inductive thematic analysis.

RESULTS

Theme 1 ('Experiencing Loss') comprises two sub-themes that describe the impact of age-related losses on residents' sense of purpose (sub-theme 1) and the different responses that participants had to these losses (sub-theme 2). Theme 2 ('The Protective Effects of Social Connections') describes how social relationships could provide a sense of purpose, as well as the difficulties participants experienced in forming these relationships. Finally, theme 3 ('The Roles of Activities') describes the types of activities that could help residents to maintain a sense of purpose.

CONCLUSION

Care home residents experience losses and barriers that make it more difficult to maintain a sense of purpose. However, with appropriate support and opportunities, residents are able to engage in activities and relationships that provide a sense of purpose. To support residents' mental health and wellbeing, care homes should offer varied opportunities for residents to engage in purposeful activities.

The relationship between big five personality and quality of life of people with disabilities: The mediating effect of social support

Objective

The quality of life of people with disabilities is of great significance to social stability and development. Increasing the quality of life among the disabled has become a worldwide topic. This study aims to examine the relationship between the big five personality and quality of life and the mediating effects of social support indicators in people with disabilities.

Methods

This was a cross-sectional study with 358 people with disabilities (193 women and 165 men). A questionnaire was utilized to measure big five personality, social support, and quality of life variables. Pearson's correlation analysis and structural equation modeling were used to examine the relation among big five personality, social support, and quality of life.

Results

QOL was positively correlated with social support (r = 0.402, p < 0.001), extraversion (r = 0.324, p < 0.001), agreeableness (r = 0.474, p < 0.001), conscientiousness (r = 0.482, p < 0.001), and openness (r = 0.498, p < 0.001). QOL was negatively correlated with neuroticism (r = -0.186, p < 0.001). The mediating effect of social support on the relationship between neuroticism and the quality of life of people with disabilities was not significant. Social support significantly mediated the relationship between extraversion, agreeableness, conscientiousness, openness, and quality of life. Overall, positive personality traits (extraversion, agreeableness, conscientiousness, and openness) in the Big Five Personality of people with disabilities could increase their quality of life by Perceiving social support. But social support could not significantly mediate the relationship between neuroticism and the quality of life of people with disabilities.

Conclusion

These new findings suggest that combining individual factors (personality) and environmental factors (social support) can better improve the quality of life of people with disabilities.

The impact of social support on the quality of life among older adults in China: An empirical study based on the 2020 CFPS

Background

As aging issues become serious, how to guarantee and improve the quality of life among older adults has become a hot topic in China. This article is aimed to discuss the impact of formal and informal social support on the quality of life among older adults and the differences in gender and urban-rural areas.

Methods

The data used in this article are from the 2020 China Family Panel Studies (CFPS). Quality of life is measured from three dimensions of life: satisfaction, self-rated health, and mental state. This article uses the ordered logistic regression model to analyze the impact of social support on life satisfaction and self-rated health, and the binary logistic regression model to analyze the impact of social support on the mental state. The method of Shapley value decomposition further analyzes the contribution of influencing factors to the quality of life.

Results

The activities of daily living (ADL) and income significantly impact the quality of life among older adults. Formal and informal social support positively improved the quality of life among older adults, but the effect of informal social support is greater than that of formal social support. The male older adults are significantly better than the female adults across all three dimensions of quality of life. The mental state of urban older adults is better than that of rural older adults.

Conclusion

Formal and informal social support should be strengthened to improve the income of older adults. Older adults should be encouraged to participate in social activities and good interpersonal relationships should be established actively. Female older adults should be paid more attention. The proportion of female older adults participating in insurance should be increased, and the family and intergenerational care burden for female older adults should be reduced. The leisure life of urban older adults should be enriched. The basic social insurance and health service systems in rural areas should be improved.

Effects of Family Doctor Contract Services on the Health-Related Quality of Life Among Individuals With Diabetes in China: Evidence From the CHARLS

Background

Family doctor contract services (FDCS) has played a key role in diabetes management in China since 2016. The influence of FDCS on the physiological indexes of individuals with diabetes has been examined. However, little attention has been paid to its effect on the Health-Related Quality of Life (HRQoL). This study aims to fill this knowledge gap by evaluating the effect of FDCS on the HRQoL of individuals with diabetes.

Methods

We identified 382 individuals with diabetes receiving all follow-up surveys in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS). The HRQoL of the included individuals was estimated using results from the Short Form 36 (SF-36) questionnaire. The propensity score matching with the difference-in-differences (PSM-DID) approach was applied to quantify the effect of FDCS on the HRQoL among individuals with diabetes. A robust test was performed by setting the 2015 data as the treatment group for the placebo test.

Results

The mean score of role-emotional (RE) increased from 54.25 to 61.63 among those who signed up to receive FDCS, while the corresponding score decreased from 57.77 to 51.04 among those who did not receive FDCS. Results from the regression analysis indicated that the use of FDCS was associated with significant improvement in RE (+14.10, p = 0.04) among individuals with diabetes. We did not find a statistically meaningful association between the FDCS and any of the other HRQoL domains: physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), and mental health (MH), respectively. The robustness analysis of the model indicated that the results were robust.

Conclusion

The FDCS for diabetes in China was associated with a significant improvement in RE. Due to a limited time since the launch of FDCS (i.e., 2016), the recipient's physical health did not show marked improvement. In the future, FDCS should pay more attention to the physiological health of individuals with diabetes. Moreover, psychological services also need to be maintained and not slackened. At the same time, it is strongly recommended to pay more attention to the HRQoL of individuals with diabetes and more comprehensive health.

A comparison of health-related quality of life and personal, social, and environmental factors of older adults according to a residential area: a propensity score matching analysis

PURPOSE

This study identified individual, social, and environmental factors affecting the health-related quality of life (HRQoL) of older individuals living in urban and non-urban areas of the Republic of Korea and investigated their effects on HRQoL.

METHODS

A secondary data analysis study was conducted using raw data from Korea's 2017 Community Health Survey. Propensity score matching (PSM) was performed to compare the individual, social, and environmental characteristics of older individuals living in urban and non-urban areas (16,695 and 29,106 individuals, respectively). Statistical analyses were performed using R program 4.0.5. The differences between variables were analyzed using chi-squared and t-tests, whereas factors influencing HRQoL were analyzed using multiple regression analysis.

RESULTS

Among the individual factors, the living arrangement (p = 0.001, confidence interval [CI] = 0.00-0.02) was an influencing factor in urban areas, whereas it showed no statistical significance in non-urban areas. Moreover, Helping their neighbors (p = 0.001, CI = 0.00-0.01) among the social factors and satisfaction with the living environment (p = 0.011, CI = 0.00-0.02) and with healthcare services (p = 0.047, CI = 0.00-0.01) among the environmental factors were influencing factors in urban areas, whereas they showed no statistical significance in non-urban areas.

CONCLUSION

Satisfaction with the living environment and with healthcare services was positively associated with HRQoL among older individuals living in urban areas. Therefore, factors associated with regional health inequality should be identified, and health equality sought through the development of local government policies that consider diversity in population composition and health indicators by region.

Role Value, Occupational Balance, and Quality of Life: A Cross-Sectional Study on Exploring the Urban Older People Perspective in South Korea

The purpose of this study was to investigate the role value, occupational balance, and quality of life among urban older adults in South Korea. We recruited 90 urban older adults in Seoul, Gyeonggi-do and Chungcheong-do. Assessments used (1) Role Checklist, (2) Life Balance Inventory (LBI), and (3) WHO Quality of Life Scale abbreviated version (WHOQOL-BREF). Our results showed that the roles that were perceived as very valuable were as family members, housekeepers, and guardians (in descending order). The roles that were perceived as less valuable were students, volunteers, and organizational members (in descending order). The activities that individuals were actively pursuing were hygiene management, rest, and healthy eating (in descending order). By contrast, the activities that were not being actively pursued were composing (music, poetry), preparing for event planning, dancing, yoga, and taekwondo. The total score of the Role Checklist and WHOQOL-BREF total (r = 0.343, p < 0.01), K-LBI total and WHOQOL-BREF total (r = 0.386, p < 0.01), and role value total and K-LBI (r = 323, p < 0.01) showed a statistically significant correlation. As a result of the regression analysis, the sub-item of work balance that affected the quality of life was managing appearance (R2 = 51.7, p < 0.001). These data showed that the role of urban older adults in Korea was mainly played within the family. The level of participation was low in the areas of instrumental daily life activities, work, leisure, and social participation. We propose that this population needs to be provided with opportunities for active aging through broader professional participation.

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

PURPOSE

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Long-Term Conditions in Older People are Linked with Loneliness, but a Sense of Coherence Buffers the Adverse Effects on Quality of Life: A Cross-Sectional Study

BACKGROUND

The impact of disability, long-term conditions, rurality, living alone, and being a carer on health has some evidence base, but the extent to which a strong sense of coherence (SoC), a factor hypothesised to promote wellbeing, may moderate these associations is unknown. A model of physical, environmental and social factors on quality of life was tested, with particular emphasis on whether a strong SoC buffered (mitigated) these determinants of quality of life.

MATERIAL AND METHODS

A cross-sectional postal survey was undertaken of a random sample of 1471 respondents aged over 65 years, across a population of rural individuals. Physical, environmental, and psychological variables were assessed against quality of life using ANOVA and a generalised linear model including the interaction effects of SoC.

RESULTS

ANOVA demonstrated that age, gender, long-term conditions or disability (LTC-D), living alone, >20 hours unpaid care for others per week, SoC, and loneliness, were associated with lower quality of life (p<0.01). There were strong correlations (p>0.01), between age and LTC-D, living alone, and poor SoC. Living alone was correlated with emotional and social loneliness; but those with higher SoC were less likely to experience loneliness. In an adjusted generalised linear model, significant associations with a lower quality of life were observed from: LTC-D, emotional loneliness and social loneliness (B= -0.44, -0.30, and -0.39, respectively, all p<0.001). The only interaction with SoC that was statistically significant (at p<0.05) was LTC-D. A stronger sense of coherence buffered the negative effects of long-term condition/disability on quality of life.

DISCUSSION

The physical, environmental and social factors examined, identified LTC-D and loneliness to be the strongest factors associated with poor quality of life.

CONCLUSION

SoC somewhat buffered the adverse effect of LTC-D on quality of life, but did not do so for loneliness.

Assessment of the Psychophysical Sphere and Functional Status of Women Aged 75-90 Living Alone and in Nursing Homes

Aim: To assess the psychophysical sphere and functional status of women aged 75–90 living alone and in nursing homes. Methods: 23 women living in nursing homes (NH) and 20 living alone (HOME) underwent the following tests: Up and Go Test, Chair Stand Test, assessment of daily physical activity levels using pedometers, Mini-Mental State Examination, Groningen Activity Restriction Scale, Geriatric Depression Scale, and WHOQOL-Bref. Results: It was shown that the subjects living by themselves performed a greater amount of daily physical activity, although there was not significant difference between the two groups in the Up and Go Test result. There were not statistically significant differences in the self-assessment of the mental sphere, but significant differences were found in the self-evaluation of the physical sphere. In the NH group, subjects with and without depression did not differ in terms of the amount of daily physical activity and functional test results. Women with depression from the HOME group were less physically active and had worse functional fitness. Conclusions: Women living alone performed a greater amount of daily physical activity, but the functional status of women in both groups did not differ in a statistically significant way. The groups didn’t differ statistically significantly in terms of psychological self-assessment.

Enhancing Older Adults' Well-Being and Quality of Life through Purposeful Activity: A Systematic Review of Intervention Studies

BACKGROUND AND OBJECTIVES

Population aging represents a significant challenge for health and social care services. Older adults who engage in activities that offer a sense of purpose have significantly better physical and psychological health outcomes. However, age-related functional limitations and losses of social roles can present barriers to engaging in purposeful activity, especially for those older adults within the 'oldest old' age range (i.e. 80 years and over). This review aimed to determine the nature and effectiveness of purposeful activity interventions in older adults, aged ≥80 years, with respect to well-being and quality of life outcomes.

RESEARCH DESIGN AND METHODS

Three databases were searched from their inception to April 2020. The search yielded 8,916 records, which resulted in eight eligible studies.

RESULTS

The interventions were divided into two groups: (1) interventions that gave participants a specific functional role, such as volunteer or mentor (n=5); (2) interventions that supported participants to develop a new skill (n=3). The quality of the evidence was variable. The strongest evidence was for interventions that assigned a functional role, which appeared to be somewhat effective in improving well-being outcomes.

DISCUSSION AND IMPLICATIONS

There is preliminary evidence that purposeful activity interventions, particularly those that involved taking on a functional role, can improve well-being and quality of life outcomes in older adults aged 80 years and over. These findings have implications for professionals and carers to support older adults to access more purposeful social roles and create opportunities for helping and reciprocation.

Sustainable Care and Factors Associated with Quality of Life among Older Beneficiaries of Social Services

Population aging has led to an increased recognition of the problems encountered by older persons. As a consequence, the most recent years have been marked by a series of changes with regard to the organization and provision of social services for dependent older people. The aim of this article is to identify factors associated with the quality of life in old age, using a logistic regression applied to the data collected following a field survey among the beneficiaries of social services. The analysis revealed that men are more likely to appreciate that life does not make sense, compared to dependent elderly women. Age is also a significant factor that influences the quality of life: the older the people are, the more they tend to think in a positive manner about their life. Health, social participation and food are also important factors that influence the perception regarding the quality of life.

Validity and reliability of the Korean version of the world health organization quality of life instrument-older adults module

The World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) is a scale that measures quality of life (QoL) based on the characteristics of older adults. This study aimed to evaluate the reliability and validity of the Korean version of the WHOQOL-OLD. It was administered to 273 older adults by convenience sampling in Jeonbuk, South Korea. The six-factor model was validated by confirmatory factor analysis (χ²=462.52 [p<.001], normed χ²=1.95, comparative fit index=0.94, Tucker-Lewis index=0.92, standardized root mean residual=0.06, root mean square error of approximation=0.059). Concurrent validity was demonstrated with the WHOQOL-BREF (r = 00.708), SF-12 (r = 0.508) and the Depression, Anxiety and Stress Scale (r=-0.499). In addition, the Korean version of the WHOQOL-OLD was evaluated for known group validity. Cronbach's alpha coefficient for the total scale was 0.897. The Korean version of the WHOQOL-OLD showed acceptable validity and reliability for measuring QoL in older Korean adults.

Associations of combinations of housing tenure status and household structure with subjective happiness among community-dwelling elderly people: A cross-sectional study with stratified random sampling

AIM

Subjective happiness is an important marker of successful aging, and is associated with housing tenure status and household structure. However, the associations between subjective happiness and combinations of housing tenure status and household structure have not yet been clarified. Therefore, we examined which combinations of housing tenure status and household structure are associated with high or low subjective happiness among community-dwelling elderly people.

METHODS

Subjects were enrolled by stratified random sampling, and comprised of 1602 elderly persons aged ≥65 years as of January 2017 in Fukushima Prefecture, Japan. The subjects' data were collected via a self-completed questionnaire (effective response rate: 53.4%), and the associations between subjective happiness and combinations of housing tenure status and household structure were analyzed by chi-squared test and logistic regression analysis, controlling the confounding variables such as care support needs, subjective economic status and health status.

RESULTS

The subjects reported significantly decreased subjective happiness when they were a renter living alone (odds ratio [OR] = 0.427 and 95% confidence interval [CI] = 0.249, 0.732) and with others (OR = 0.420 and 95% CI = 0.256, 0.687) after adjustment for confounding variables, compared with owner-occupier living with others (referent).

CONCLUSIONS

The results of the current study revealed significantly decreased subjective happiness when the subjects were renters regardless of household structure. Therefore, housing tenure status may be a stronger determinant of subjective happiness among community-dwelling elderly people than household structure. Geriatr Gerontol Int 2020; ••: ••-••.

Comparative Effect between Infiltration of Platelet-rich Plasma and the Use of Corticosteroids in the Treatment of Knee Osteoarthritis: A Prospective and Randomized Clinical Trial

Objectives  This study aimed to analyze the efficacy of platelet-rich plasma obtained from the peripheral, autologous blood of the patients in pain complaints reduction and functional improvement of knee osteoarthritis compared with the standard treatment with injectable corticosteroid, such as triamcinolone.

Methods  The patients were followed-up clinically at the preinfiltrative visit, with quantitative evaluation using the Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Kellgren and Lawrence scales. In addition, they were reevaluated with the same scales after 1 month and 6 months of intervention with 2.5 mL of triamcinolone acetate or 5 mL of platelet-rich plasma. The study was performed on 50 patients with knee osteoarthritis treated at the Medical Specialty Center and randomly divided into equivalent samples for each therapy.

Results  The present study verified the reduction of pain scores, such as the WOMAC score, and elevations of functional scales, such as the KSS, evidenced in 180 days when using platelet-rich plasma, a therapy that uses the autologous blood of the patient and has fewer side effects.

Conclusion  Although both platelet-rich plasma and corticosteroid therapies have been shown to be effective in the reduction pain complaints and functional recovery, there was a statistically significant difference between them at 180 days. According to the results obtained, platelet-rich plasma presented longer-lasting effects within 180 days in the treatment of knee osteoarthritis.

Qualitative analyses of nursing home residents' quality of life from multiple stakeholders' perspectives

PURPOSE

Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for "good" quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses.

METHODS

Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life.

RESULTS

Overall, the majority of residents perceived their quality of life as "good," though differences were noted in their main contributing factors when compared to staff members' and management's perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives.

CONCLUSIONS

Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.

Evaluating the Effectiveness of the Health Management Program for the Elderly on Health-Related Quality of Life among Elderly People in China: Findings from the China Health and Retirement Longitudinal Study

The world’s rapidly aging population brings serious challenges which could be addressed by changes in behaviour and policy that promote good health in older age. However, these cheap and simple interventions are not available in many countries. China is one of the fastest-ageing countries in the world. The health management programs for the elderly in basic public health services was introduced by the government to promote the health of the elderly in China and address the challenges related to ageing. However, the effectiveness of the program is uncertain. So, we use a propensity score matching difference-in-difference (PSM-DID) model to analyse the causal effect of the health management program for the elderly in basic public health services on the health-related quality of life (HRQoL) of the elderly in China. The result shows that the program has improved the physical health of the elderly but has had no significant impact on mental health. Expanding the program to cover mental health could further benefit the HRQoL of the elderly. The program is a cost-effective approach to tackle the challenges of ageing and is a good example for other developing countries facing the same ageing challenges.

Impacts of Leisure and Tourism on the Elderly’s Quality of Life in Intimacy: A Comparative Study in Japan

Highly social activities like leisure and tourism are considered to have positive effects on the elderly’s mental health. Taking Japan as a case study, this research aims to clarify how leisure and tourism contribute to the elderly’s quality of life (QOL) in the domains of leisure and intimacy by comparing populated and depopulated areas. Such research has strong implications for achieving Sustainable Development Goals (SDGs) through healthy aging, but relevant efforts are quite limited. In this study, leisure and tourism behaviors are captured by visit frequency, travel party and expenditure. Quality of life is measured by happiness and life satisfaction in different life domains, in line with the life-oriented approach. Data were collected in 2014 via a nationwide online survey in Japan. Applying a structural equation model (SEM) approach, it is found that leisure behavior contributes to maintaining the elderly’s QOL in leisure life and intimacy domains. Tourism behavior only contributes to QOL in populated areas. Leisure activities strongly enhance QOL in terms of intimacy and improve the neighborhood relationship of the elderly in depopulated areas and family life in populated areas. Enriching daily leisure activities for the elderly would improve their intimate relationships in depopulated areas.

Subjective well-being of visually impaired older adults living in the community

OBJECTIVES

Vision impairment is one of the most common disabilities among older adults, and it has a substantial impact on well-being. The present study constructs an integrative model to identify which variables derived from four dimensions of life (physical/functional, social, psychological and environmental) combined with sociodemographic variables explain the overall subjective well-being (SWB) visually impaired older adults living in the community.

METHOD

A total of 121 severe visually impaired persons, aged 60 and over (M = 77.4, range 60-95), participated in the study. Personal, face-to-face interviews were conducted with participants at social centers or at their homes. Research tools consisted of valid and reliable questionnaires.

RESULTS

Five variables explained the older adults' variability in SWB: self-rated health, sense of meaning in life, functional independence in activity of daily living (ADL), sense of control of one's environment (Mastery) and the participant's age. The explained variance percentage was found to be high (61%). In contrast to expectations, social-environmental variables proved to be only of secondary significance in explaining SWB variability.

DISCUSSION

Variables derived from the psychological dimension appear more significant than the social-environmental variables in explaining SWB among visually impaired older adults. These variables should be considered when developing intervention programs intended to increase SWB within this unique population group.

Hopelessness, life dissatisfaction and boredom among older people

Identifying frail older people, and in particular, people who are psychologically frail in a community setting is difficult. This article investigates predictors of psychological frailty and constructs a short and effective pre-detection tool for highly psychologically frail older people. The Belgian Ageing Studies, a cross-sectional study (n=28.245) was used. Measures included four items of the Geriatric Depression Scale, the psychological domain of the Comprehensive Frailty Assessment Instrument. First bivariate analyses were used. Afterwards, Chi-squared automatic interaction detector (CHAID) analysis was applied to gain an insight into the hierarchical order of predictors for high psychological frailty. Findings indicate that the combination of hopelessness and life dissatisfaction predicts high psychological frailty in 68.4% of cases. Early detection of frailty offers opportunities to start early interventions, and can delay or reduce frailty. In order to detect older people who are psychologically frail, a simple two question pre-detection tool was developed. To conclude: if a patient answers 'yes' to feeling hopeless and 'no' to having life satisfaction, this predicts with great probability (68.4%) high psychological frailty.

The Role of Meaning in Life for the Quality of Life of Community-Dwelling Chinese Elders With Low Socioeconomic Status

Objectives: There is limited research on the meaning in life among Chinese elders. This study aims to examine the association among functional disabilities, meaning in life, social network, and quality of life in community-dwelling Chinese elders with low socioeconomic status. Methods: A cross-sectional survey was used to collect data from 339 poor community-dwelling Chinese elders aged 60 and above. Results: The results showed that meaning in life and social network were significantly related to quality of life. Moreover, social network was a mediator to the relationship between functional disability and quality of life, and meaning in life was a partial mediator to the relationship between social network and quality of life. Conclusion: Workshops should be organized by the elderly service providers for Chinese elders facing deterioration in health and activity levels to learn to live intentionally and purposefully. A social network among elders should also be fostered in the community.

Aging With Purpose: Systematic Search and Review of Literature Pertaining to Older Adults and Purpose

Purpose can provide a sense of intentionality, guide behavior to achieve personal aims and living objectives, and may offer insight into how and why certain people remain healthy over time. A review of the literature sought to identify contemporary research pertaining to purpose and older adults. Thirty-one studies were selected for evaluation based on inclusion criteria. Research outcomes suggest that greater reported purpose is related to a range of better health and well-being outcomes for older adults. With few exceptions, the literature demonstrates that purpose declines with age. Nevertheless, the potential to experience purpose persists across the life span, by providing opportunities for older adults to continue contributing roles, participate in meaningful activities, and sustain their social value and sense of relevance. Further research could explore how purpose is experienced by the oldest-old age-group, those living within noncommunity settings, and people with age-related cognitive impairment such as dementia.

The gendered impact of the National Pension Scheme on late-life economic well-being: evidence from the Korean retirement and income study

Purpose

The purpose of this paper is to analyse the effect of the National Pension Scheme (NPS) on the economic well-being of older people in South Korea.

Design/methodology/approach

It analyses older people aged 60 and over sampled from the third wave of the Korean retirement and income study.

Findings

The analysis shows a gendered effect. The NPS is positively associated with the economic well-being of only older men. This gendered impact is probably attributable to the inherent patriarchal structure of the NPS that is based on the strong male bread-winner model.

Originality/value

The results suggest that promoting the female labour market participation, and also reforming the gender structure of the NPS and South Korean labour market, can be a potential policy option to amend gendered economic well-being in later life.

Psychometric Properties of the Persian Version of Care Dependency Scale in Nursing Homes

PURPOSE

The purpose of the study was to examine the psychometric properties of the Persian version of the Care Dependency Scale (CDS) in nursing homes.

DESIGN

Instrument development.

METHODS

The English version of the CDS was translated into Persian. A convenience sample of 140 (100 older people without dementia and 40 patients with dementia) Persian-speaking people were selected from the nursing homes in Ahvaz, Iran. Cronbach's alpha, discriminant validity, and construct validity (exploratory factor analysis) were examined.

FINDINGS

Exploratory factor analysis indicated that the CDS has two factors, including psychosocial and somatic factors. Discriminant validity showed that the CDS can differentiate patients with dementia from the older adults without dementia.

CONCLUSIONS

The results of the study showed that the Persian CDS is a reliable and valid scale when used in nursing homes.

CLINICAL RELEVANCE

The Persian version of the CDS can help clinicians and nurses to assess patients' need and the degree of care dependency among older adults in Persian-speaking areas.

Healthy ageing, narrative method and research ethics

The purpose of this article is to describe research and teaching activities related to healthy ageing, narrative methods and research ethics at the Nordic School of Public Health NHV during 1999 - 2012. Healthy ageing was conceived in terms of The World Health Organization's (WHO) model of active ageing and of quality of life defined as a sense of well-being, meaning and value. Qualitative research on ageing and health conducted at NHV showed how elderly people themselves experience health and what they perceive to be health promoting. Narrative method was one the qualitative methods used in research at NHV. By adopting holistic and categorical content analysis the life stories of elderly Finnish migrants, the stories of home-dwelling persons about falls, and working persons' stories of alcohol use were studied. The courses on research ethics took their point of departure in a model that describes the role of scientific, economic, aesthetic and ethical values in research.

Perspectives on the Happiness of Community-Dwelling Elderly in Korea

OBJECTIVE

A community survey was performed to investigate the factors and perspectives associated with happiness among the elderly in Korea (≥60 years).

METHODS

Eight hundred volunteers selected from participants in the Ansan Geriatric study (AGE study) were enrolled, and 706 completed the survey. The Happiness Questionnaire (HQ), which asks four questions about happiness, was administered. To explore the relationship between happiness and depression, the Geriatric Depression Scale (GDS) and the Beck Depression Inventory (BDI) also were administered.

RESULTS

The participants' average level of happiness, determined using a 100-mm visual analogue scale (VAS) of the HQ, was 64.7±26.0. The happiest situations for most people were "getting together with family" (23.8%) and "living in peace with family members (well-being)" (13.2%). Frequent reasons for not being happy were "worsened health condition" (28.7% of the not-happy group), "economic problems of their own" (16.5%), and "economic problems of their children" (14.8%). The participants' choices regarding the essential conditions for happiness were "good health" (65.3%) and "being with family" (20.5%). The BDI and GDS scores were negatively related to the happiness score. A preliminary scale [Happy (Haeng-Bok, ) aging scale] based on the HQ for measuring the happiness level of the Korean elderly was suggested for follow-up studies.

CONCLUSION

The most important factors determining the happiness of the community-dwelling elderly in Korea were good family relationships, economic stability, and good health. A higher depression score negatively impacted happiness among Korean elders. Further studies on the factors in their happiness are required.

The lifelong struggle of Finnish World War II veterans

OBJECTIVES

In many countries veterans from World War II are growing old. Research has shown that war experiences continue to impact those who have been involved in war for a long time. The present study targets old injured war veterans from World War II in Finland. The aim of this study was to produce knowledge of the impact of war experiences and injuries on the lifespan of Finnish war veterans.

METHOD

The method used was grounded theory. Data were collected by interviewing 20 aged war veterans in their homes.

RESULTS

The analysis resulted in four categories, with also subcategories: (1) lost childhood and youth; (2) war traumas impacting life; (3) starting life from scratch; and (4) finding one's own place. A substantive theory of war veterans' lifelong struggle for freedom throughout the lifespan was outlined.

CONCLUSION

The war overshadowed the whole lifespan of the veterans, but in old age they finally felt free. Since war experiences vary depending on historical context, a formal theory would require additional research.

Quality of life in old age - a concept analysis

AIM

To identify existing definitions of quality of life in old age and to determine the most suitable for evaluating outcomes of nursing care for older adults.

BACKGROUND

Promoting quality of life is a central concern of nursing care for older persons. There is, however, a lack of clarity about the meaning of this concept. Attributes of quality of life are often confused with those factors influencing them.

DESIGN

Concept analysis according to Walker and Avant.

METHOD

A search was carried out in the databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO(®) and Gerolit for the years 1992-2013. Excerpts dealing with definitions, antecedents, consequences and empirical referents of the concept were compiled.

RESULTS

Three basic concepts for quality of life were identified: satisfying life conditions, subjective general well-being and subjective fulfilment of dimensions of human life.

DISCUSSION

Satisfying life conditions are antecedent to the other concepts. It is not suitable to view such conditions as an outcome of nursing care for older adults because an outcome has to be a consequence. General well-being is likely to remain stable over time and changing conditions due to adaptation taking place. Fulfilment of dimensions of human life as a multidimensional inner state may be more sensitive to changing conditions.

CONCLUSION

Fulfilment of dimensions of human life is the most suitable definition of quality of life in old age as an outcome of nursing care. Studies are needed to decide whether it is responsive to changing circumstances.

IMPLICATIONS FOR PRACTICE

Fulfilment of dimensions of human life should be assessed to provide care that meets the needs of clients.

‘Old but not that old’: Finnish community-dwelling people aged 90+ negotiating their autonomy

Autonomy is a pervasive concept in Western lifestyles today. However, people in the fourth age are assumed not to be autonomous but dependent on other people. The data of this study consisted of interviews with Finnish community-dwelling 90–91-year-old people. The study aim was to examine how these people see their own autonomy in their everyday lives. The analysis was based on membership categorisation analysis. Our respondents considered their autonomy through three distinct themes. Functional ability was considered in terms of being physically capable of managing daily tasks. Independence in decision making was based on material and financial self-sufficiency and on the respondents' supposition that they were capable of making decisions due to an absence of memory disorders. Additionally, autonomy was considered as contesting norms of age-appropriateness. Among respondents, chronological age seemed to have been replaced by functional and cognitive ability as a definer of categorisations; age-others became ability-others. Our study revealed that the perceptions of autonomy also included gendered features as they were linked with differing gendered ideals, roles and life domains of women and men. The results highlight the internal diversity among the oldest old and challenge the third/fourth age division. Instead, they suggest the existence of a certain ‘grey area’ within old age, and urge an analysis on the subtle meaning making involved in older people's constructions of age-categorisations.

Sense of coherence and health of community-dwelling older adults in Spain

BACKGROUND

In light of the demographic aging trend in Europe, investigation into successful aging is a public health priority. This paper describes the sense of coherence (SOC) of a sample of community-dwelling older adults in Spain and analyzes the relationship between SOC and both health and sociodemographic variables. SOC measures the extent to which an individual conceptualizes the world as comprehensible, manageable, and meaningful. Strong SOC may promote good health.

METHODS

The study followed a cross-sectional design involving a nationally representative sample of 1,106 community-dwelling adults aged 60 years and older in Spain. The sample was collected by geographically based proportional stratified sampling. RESULTS are based on responses to a questionnaire requesting sociodemographic information and including the following validated scales: SOC, Barthel index (BI), functional independence scale (FIS), personal wellbeing index (PWI), EQ-5D dimensions (mobility, personal care, daily activities, pain/discomfort, anxiety/depression), and the depression subscale of the hospital anxiety and depression scale (HADS-D). A multivariate linear regression model analyzed determinants of SOC.

RESULTS

Personal wellbeing (b = -0.32), depression (b = 0.26), and educational level (b = -0.06) were significant determinants of SOC. Lower SOC was associated with problems in all EQ-5D dimensions and moderate/severe disability as measured by the BI.

CONCLUSIONS

SOC in older adults is related to functional status, mental health status, personal wellbeing, and educational level. Public health initiatives should work to reduce the psychological and physiological impact of aging by focusing on the conditions that facilitate the coping of older adults.

Improving the quality of life for older people in long-term care settings

Many governments across Europe and America set maintaining the quality of life (QoL) of older people living in long-term care as a key policy objective; however, much of the evidence reveals that life in many care environments is still routinized and institutionalized. QoL is a term that is widely used but poorly defined and understood. The focus of this Review is on identifying the components of QoL and reviewing strategies for improving QoL in long-term care. Six components of QoL were consistently identified across studies: autonomy, environment, connectedness, meaningful activity, independence and sense of self. A review of strategies for improving QoL revealed that the evidence of effectiveness across studies remains inconclusive. The judgment of quality was often hampered by inadequate details on the study design and the use of nonspecific and wide-ranging QoL tools. Furthermore, high-quality studies are required to determine effectiveness.

Caregiver Well-Being: Intersections of Relationship and Gender

We know much about caregiving women compared with caregiving men and caregiving spouses compared with caregiving adult children. We know less about the intersections of relationship and gender. This article explores this intersection through the well-being (burden and self-esteem) of caregivers to family members with dementia. Throughout British Columbia, Canada, 873 caregivers were interviewed in person for on average, over 1½ hours. The results reveal that daughters experience the highest burden but also the highest self-esteem, suggesting the role is less salient for their self-identities. Wives emerge as the most vulnerable of the four groups when both burden and self-esteem are considered. The data confirm the usefulness of the intersectionality framework for understanding co-occupancy of more than one status and indicate that positive cognitive well-being and negative affective well-being can be differentially related. Multivariate analyses confirm the importance of caregiver, not patient, characteristics for burden and self-esteem.

The psychometric properties of the German version of the WHOQOL-OLD in the German population aged 60 and older

Background

The WHOQOL-OLD is an instrument for the assessment of subjective quality of life in elderly people. It is based on the WHO definition of quality of life and is available in more than 20 languages. However, in most countries, the psychometric properties of the WHOQOL-OLD have been assessed only on the basis of small local samples and not in representative studies. In this study, the psychometric properties of the WHOQOL-OLD are evaluated based on a representative sample of Germany’s elderly population.

Methods

Face-to-face interviews with 1133 respondents from the German population aged 60 years and older were conducted. Quality of life was assessed by means of the WHOQOL-BREF, the WHOQOL-OLD and the SF12. Moreover, the GDS, the DemTect and the IADL were applied for the assessment of depressive symptoms, cognitive capacities and capacity for carrying out daily activities. Psychometric properties of the WHOQOL-OLD were evaluated by means of classical and probabilistic test theory, confirmatory factor analysis and multivariate regression model.

Results

Cronbach’s alpha was found to be above 0.85 for four and above .75 for two of the six facets of the WHOQOL-OLD. IRT analyses indicated that all items of the WHOQOL-OLD contribute considerably to the measurement of the associated facets. While the six-facet structure of the WHOQOL-OLD was well supported by the results of the confirmatory factor analysis, a common latent factor for the WHOQOL-OLD total scale could not be identified. Correlations with other quality of life measures and multivariate regression models with GDS, IADL and the DemTect indicate a good criterion validity of all six WHOQOL-OLD facets.

Conclusions

Study results confirm that the good psychometric properties of the WHOQOL-OLD that have been found in international studies could be replicated in a representative study of the German population. These results suggest that the WHOQOL-OLD is an instrument that is well suited to identify the needs and the wishes of an aging population.

Health capital in everyday life of the oldest old living in their own homes

As more people experience old age as a time of growth and productivity, more research is needed that explores how they master everyday life. This paper reports on a qualitative study that explored how ten older women age 90 years or more experience and cope with the challenges of everyday life with a salutogenic perspective. The findings suggest that health resources such as positive expectation, reflection and adaptation, function and active contribution, relations and home, contribute to the health capital of women. These health resources were of importance for the women's experience of comprehensibility, manageability and meaningfulness in daily life. Health capital is a meaningful concept for understanding coping in everyday life by older people.

Dementia and well-being: A conceptual framework based on Tom Kitwood’s model of needs

The topic of well-being is becoming increasingly significant as a key outcome measure in dementia care. Previous work on personhood of individuals with dementia suggests that their subjective well-being can be described in terms of comfort, inclusion, identity, occupation and attachment. The study aimed to examine Tom Kitwood’s model of psychological needs and well-being in dementia based on the self-report of individuals with moderate or severe dementia and to differentiate and elaborate this model in the light of the empirical qualitative data. Nineteen inhabitants of a special long-term care unit were interviewed using a semi-structured interview. Data were analysed using content analysis. Thirty components within Kitwood’s model have been identified. A conceptual framework of subjective well-being in dementia was developed based on a theoretical background. The study was able to find indications that Kitwood’s model has empirical relevance. Nevertheless, it requires to be extended by the domain agency. Furthermore, the study suggests that individuals with dementia are important informants of their subjective well-being.

Meaning-in-life in nursing-home patients: a correlate with physical and emotional symptoms

AIMS AND OBJECTIVES

To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population.

BACKGROUND

Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health.

DESIGN AND METHODS

The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended.

RESULTS

The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed.

CONCLUSIONS

The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being.

RELEVANCE TO CLINICAL PRACTICE

Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes.

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.

Meaning-in-Life in Nursing Home Patients: A Validation Study of the Purpose-in-Life Test

Background: The experience of meaning has been found to be a strong individual predictor of life satisfaction and an important psychological variable that promotes well-being. Therefore, a valid and reliable measurement of meaning-in-life among nursing home patients is highly warranted. Aims: This study intended to further investigate (a) the factor structure of the Purpose-in-Life test (PIL), (b) the reliability of PIL scores, and (c) the construct validity of the PIL test in a nursing home population. Methods: Participants were 202 cognitively intact nursing home patients representing 44 different Norwegian nursing homes. Concerning the dimensionality of the PIL, the following 3 measurement models were tested using confirmatory factor analysis; the original 1-factor, a 2-factor, and a 3-factor model. Results: With the exclusion of 10 items, a previously published and supported 2-factor construct for the PIL by Morgan and Farsides (2007) provided a good fit for older nursing home patients, demonstrating good measurement reliability and construct validity. Conclusion: The 2-factor model by Morgan and Farsides, comprising 10 items, is an improvement over the original 20-items PIL, based on these nursing home data. The measure yielded highly significantly factor loadings, good values for average variance extracted and composite reliability, as well as significant correlations in the expected direction for relevant selected measures; all supporting the construct validity.

Hospitalized older peoples' views of health and health promotion

Older peoples' health varies considerably and the number of older people who need hospital care will increase in the future. Traditionally, the focus of nursing care in hospitals is oriented towards diagnosis and treatment of disease, although health and health promotion are inherent in theories and definitions of nursing. This is an important issue in health politics, in new laws and regulations in Norway. However, it was difficult to find research-based knowledge about how nurses work with health promotion and health related to older hospitalized patients. This study aimed at describing older hospitalized patients' experiences of health and health promotion. The study used a descriptive and explorative qualitative design, with an interpretative-phenomenological approach. Ten older hospitalized patients, recruited through purposeful sampling, were interviewed during their hospital stay. The informants described health as Being able to be the person I am, to do what I want to do, and feel well and have strength. Health promotion was described as Being enabled through being the person I am, through information and knowledge and through hope and motivation. The findings may be applied to nursing practice in order to focus on promotion of health as an individual process built upon the unique person's life and situation, supported by nursing care and medical treatment.

Quality of life in older people: a structured review of self-assessed health instruments

A range of terms (including quality of life, health-related quality of life and health status) describe a broad set of aspects of self-reported health that can be captured by questionnaires and related instruments. Health in older people particularly requires attention to broader aspects of the impact of health on physical, social and psychological function. A structured review was performed to assess how well such issues are measured by available instruments. A total of 45 instruments were identified that have received some degree of evaluation to establish their use in assessing the health of older individuals. Two types of instruments were included in the review: generic and older-people-specific instruments. The SF-36 has by far the largest evidence base to support its use in older people. The OMFAQ has the best evidence base amongst older-people-specific instruments. Many instruments have only minimal evidence of measurement properties. Concepts such as quality of life are still defined and used in a variety of ways, and major questions must be addressed before uniform practice emerges in this important area of health policy.

What is the quality of life in the oldest old?

BACKGROUND

Maintaining and improving quality of life has become a major focus in geriatric medicine, but the oldest old have received limited attention in clinical investigations. We aimed to investigate the relationship between self-perceived and caregiver-perceived quality of life (QOL), cognitive functioning, and depressive symptoms in the oldest old.

METHODS

This IRB-approved prospective study recruited community dwellers aged 90-99 years old. Collected data included neurological evaluation, DSM III-R criteria for dementia, Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Geriatric Depression Scale (GDS), Record of Independent Living (ROIL), and QOL assessment using the Linear Analogue Self Assessment (LASA).

RESULTS

Data on 144 subjects (56 cognitively normal (normal), 13 mild cognitive impairment (MCI), 41 dementia (DEM), 34 dementia with stroke and parkinsonism (DEMSP)) over a three-year period were analyzed. Mean ages ranged from 93 to 94 years, and the majority were female with at least high school education. Overall functional ability was higher in groups without dementia (p < 0.0001). All subjects reported high overall QOL (range 6.76-8.3 out of 10), regardless of cognitive functioning. However, caregivers perceived the subjects' overall QOL to be lower with increasing severity of cognitive impairment (p < 0.0001). Lower GDS scores correlate with higher self-perceived overall QOL (ρ = -0.38, p < 0.0001).

CONCLUSIONS

In our community sample of the oldest old, there was a fairly high level of overall QOL, whether or not cognitive impairment exists. Individuals perceive their QOL better than caregivers do, and the difference in subjects' and caregivers' perception is more pronounced for the groups with dementia. QOL is more strongly correlated with depressive symptoms than with dementia severity.

The influence of neighborhood factors on the quality of life of older adults attending New York City senior centers: results from the Health Indicators Project

PURPOSE

To examine the association between self-assessed quality of life (QOL) and perceived neighborhood safety, social cohesion, and walkability among older adults in New York City (NYC).

METHODS

We used data from the 2008 Health Indicators Project, a cross-sectional survey of 1,870 older adults attending 56 NYC senior centers. QOL, a binary measure, was created by dichotomizing a 5-point Likert-scaled global assessment. Neighborhood safety, social cohesion, and walkability were multi-component scale variables that were standardized due to varying response metrics. Multivariate binomial logistic regression analysis was performed on 1,660 participants with complete data.

RESULTS

After adjusting for covariates, QOL was significantly associated with neighborhood safety and social cohesion. A one-standard deviation increase in neighborhood safety and social cohesion increased the log odds of having higher QOL by 30% (odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.14, 1.48; P ≤ 0.001) and 36% (OR = 1.36; 95% CI = 1.16, 1.59; P ≤ 0.001), respectively. Higher QOL was not significantly associated with neighborhood walkability.

CONCLUSION

The results of this study underscore the need for initiatives that focus on enhancing age-friendly neighborhood features in large urban centers such as NYC and beyond.