Comparing the importance of different aspects of quality of life to older adults across diverse cultures

Women's environmental quality of life is key to their overall quality of life and health: Global evidence from the WHOQOL-100

Gender inequalities in health-related quality of life (QoL) are generally few and small, even in large surveys. Many generic measures limit assessment to QoL overall and its physical and psychological dimensions, while overlooking internationally important environmental, social, and spiritual QoL domains. Unique cross-cultural legacy data was collected using four WHOQOL-100 surveys of adults living in 43 cultures world-wide (17,608 adults; ages 15-101). It was first used to examined gender profiles of its five QoL international domains, and their component facets. Few significant gender differences (p < .001) were found. Women reported higher spiritual QoL than men on faith, and spiritual connection facets specifically. Men reported higher physical and psychological QoL domains than women. We aimed to identify those QoL dimensions that contribute to women's overall QoL in health, as this information could inform gender inequalities interventions in health. Environmental QoL explained a substantial 46% of women's overall QoL and health (n = 5,017; 17 cultures) (stepwise multiple regression adjusted for age, education, and marital status covariates). Five environmental QoL facets contributed significantly to this result; home environment offered most explanation. Age band analysis was conducted to understand when interventions might be best timed in the lifespan to improve women's QoL. Younger women (< 45 years) reported the poorest QoL across the lifetime, and on every domain. After 45, all domains except physical QoL increased to very good at about 60, and high levels were sustained beyond 75, especially environmental QoL. Global findings show that assessing environmental, social, and spiritual QoL domains are key to fully understanding women's QoL and health. These assessments should be prioritized in surveys that aim to improve international conservation, and public health policies.

Dynamics of Long-Term Quality of Life After Treatment for Esophageal Cancer: A Community-Based Patient Study

PURPOSE

To characterize the pattern of post-treatment quality of life (QoL) for esophageal cancer (EC) survivors and construct models predicting their long-term QoL.

METHODS

On the basis of a randomized trial in an EC high-risk region in China, we interviewed 363 EC survivors and 25,245 permanent residents matched with the survivors on age, sex, and township as the baseline. QoL was measured using three-level version of European Quality of Life 5-Dimensions instrument. We constructed piecewise mixed models estimating the QoL of EC survivors that varied by age, sex, patient type, hospital level, and therapy to ascertain QoL determinants.

RESULTS

The post-treatment QoL of EC survivors dropped by 15.7% within the first year and recovered by 9.3% between 1 and 9 years compared with the baseline. Therapy was found to be a determinant of QoL, and a series of therapy-specific models were fitted accordingly, which all showed the pattern of decreasing rapidly and recovering gradually. Endoscopic treatment had the least impact on post-treatment QoL (7.5% drop within 5 years) compared with esophagectomy (12.2% drop within 1 year) and chemoradiotherapy (37.8% drop within 2 years). The usual activities dimension showed the greatest impairment among those patients (34.4% drop within 1 year).

CONCLUSION

This community-based study described the long-term QoL trajectory for EC survivors after different therapeutic modalities and constructed models to predict therapy-specific QoL at different time points after treatment. It provided new insights into decision making in treatment for EC from the perspective of QoL protection, offering a convenient tool for estimating quality-adjusted life-years.

Patient-reported outcomes and functional exercise capacity in a real-life setting in non-small cell lung cancer patients undergoing stereotactic body radiotherapy: the Lung PLUS study

Introduction

To better understand the impact of stereotactic body radiotherapy (SBRT) and its treatment-related toxicity on early-stage non-small cell lung cancer (ES-NSCLC) patients, we conducted the Lung PLUS study in a real-world setting.

Methods

This is a monocentric prospective longitudinal study up to 12 months post-treatment, evaluating clinician- and patient-reported toxicity (resp. CTCAE and PRO-CTCAE), health-related quality of life (HRQoL) (EORTC QLQ-C30 and LC-13), activities of daily living (HAQ-DI) and functional exercise capacity (6 Minute Walking Test (6MWT)). A mixed model approach was applied to analyze the data.

Results

At baseline, clinicians and patients (n=51) reported mostly fatigue (63% vs 79%), cough (49% vs 75%) and dyspnea (65% vs 73%) of any grade. Dyspnea (p=.041) increased over time. Meaningful clinical improvements were particularly seen in pain, fatigue, and cough. Clinician reported clinically meaningful improvements and deteriorations over time in fatigue, cough, and dyspnea. Almost at every timepoint, more people reported deterioration to the clinician than improvement in aforementioned toxicities. Overall HRQoL (p=.014), physical (p=.011) and emotional (p<.001) functioning improved over time. At baseline, patients had a moderate daily functioning score and walked an average distance of 360 meters. No statistically significant differences were found in daily functioning and exercise capacity over time.

Conclusion

Our study showed an increase in patient-reported toxicity and dyspnea, without impacting functional status, following SBRT. Overall HRQoL, physical and emotional functioning improved over time. Understanding the impact of treatment on patient-reported outcomes is crucial to identify the needs/problems of patients to enhance their HRQoL.

The Relation between Patient-Centered Care and Quality of Life in Women with Endometriosis

OBJECTIVE

The objective of this study was to examine the hypothesis that experiences with patient-centered endometriosis care are related to the endometriosis-specific quality of life dimensions "emotional well-being" and "social support."

DESIGN

A secondary regression analysis of two cross-sectional studies was conducted. Participants/Materials: In total, data from 300 women were eligible for analysis. The participating women all had surgically proven endometriosis.

SETTING

The study was conducted in one secondary and two tertiary endometriosis clinics in the Netherlands. Questionnaires were disseminated between 2011 and 2016.

METHODS

Both included studies investigated patient-centeredness of endometriosis care and endometriosis-specific quality of life using, respectively, the ENDOCARE questionnaire (ECQ) and the Endometriosis Health Profile 30 (EHP-30). To increase power, the regression analysis focused on the previously found relation between the ten dimensions of the ECQ and the EHP-30 domains "emotional well-being" and "social support" rather than all five EHP-30 domains. After the Bonferroni correction to limit type 1 errors, the adjusted p value was 0.003 (0.05/20).

RESULTS

The participating women had a mean age of 35.7 years and had predominantly been diagnosed with moderate to severe endometriosis. None of the relations between patient-centered endometriosis care and the EHP-30 domain "emotional well-being" were significant. Three dimensions of patient-centered endometriosis care proved to be significantly related to the EHP-30 domain "social support": "information, communication, and education" (p < 0.001, beta = 0.436), "coordination and integration of care" (p = 0.001, beta = 0.307), and "emotional support and alleviation of fear and anxiety" (p = 0.002, beta = 0.259).

LIMITATIONS

This cross-sectional study identified relations rather than proving causality between experiencing less patient-centeredness of care and having lower quality of life. Nevertheless, it is very tangible that some causality exists, either directly or indirectly (e.g., through empowerment) and that by improving patient-centeredness, quality of life might be improved as well.

CONCLUSION

"Information, communication, and education"; "coordination and integration of care"; and "emotional support and alleviation of fear and anxiety" as dimensions of patient-centered endometriosis care are related to the quality of life domain "social support" of women with endometriosis. Improving the patient-centeredness of endometriosis care was already considered an important goal, but even more so given its relation with women's quality of life, which is increasingly considered the ultimate measure of health care quality. Quality improvement projects focusing on "information, communication, and education" are expected to impact women's quality of life the most.

The aging mind: A complex challenge for research and practice

Cognitive decline as part of mental ageing is typically assessed with standardized tests; below-average performance in such tests is used as an indicator for pathological cognitive aging. In addition, morphological and functional changes in the brain are used as parameters for age-related pathological decline in cognitive abilities. However, there is no simple link between the trajectories of changes in cognition and morphological or functional changes in the brain. Furthermore, below-average test performance does not necessarily mean a significant impairment in everyday activities. It therefore appears crucial to record individual everyday tasks and their cognitive (and other) requirements in functional terms. This would also allow reliable assessment of the ecological validity of existing and insufficient cognitive skills. Understanding and dealing with the phenomena and consequences of mental aging does of course not only depend on cognition. Motivation and emotions as well personal meaning of life and life satisfaction play an equally important role. This means, however, that cognition represents only one, albeit important, aspect of mental aging. Furthermore, creating and development of proper assessment tools for functional cognition is important. In this contribution we would like to discuss some aspects that we consider relevant for a holistic view of the aging mind and promote a strengthening of a multidisciplinary approach with close cooperation between all basic and applied sciences involved in aging research, a quick translation of the research results into practice, and a close cooperation between all disciplines and professions who advise and support older people.

Assessing Quality of Life with Community Dwelling Elderly Adults: A Mass Survey in Taiwan

BACKGROUND

With the growing life expectancy for older adults, this study aims to examine the correlation among sociodemographic characteristics and the combined effect of QoL-related domains including physical health, psychological health, social relationships, and environmental factors with the overall QoL level of older adults in Taiwan.

METHODS

The WHOQOL-BREF Taiwanese Version questionnaire was adopted and conducted using a randomized telephone interview system from community household elders. In total, 1078 participants aged 65 years and older were recruited. A multiple regression model was used to examine the statistical significance between the overall QoL score as the dependent variable and the sociodemographic characteristics, and 26 items of QoL-related questionnaires as the independent variables.

RESULTS

Categories including female, aged 85 years and above, higher education level, and better financial situation had significantly higher overall QoL level. Except the physical health domain and six items, the correlations among all other domains and their including items of questionnaires with overall QoL level were significant.

CONCLUSION

The Taiwanese WHOQOL-BREF questionnaire can be used to examine the overall QoL level of elders in Taiwan. Nevertheless, the robust systems of universal health care and long-term care in Taiwan may have led to the no significance of the six items.

The Effect of Ophthalmic Surgery for Graves' Orbitopathy on Quality of Life: A Systematic Review and Meta-Analysis

Background: Graves' orbitopathy (GO) has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia, and improve aesthetics. We sought to quantify the effect of different surgical approaches on quality of life. Methods: Electronic databases Ovid-MEDLINE and EMBASE were used from inception until March 22, 2021, to identify studies assessing quality of life pre- and postsurgical intervention for GO. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilized. Results: Ten articles comprising 632 patients with a mean age of 48.4 years (range 16-85 years) were included. All used the Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire. For GO-QOL appearance, the pooled standardized mean improvement for patients after surgery was +0.72 (95% confidence interval [CI 0.50-0.94]), I² = 69% [CI 52-80%]. For GO-QOL visual functioning, the pooled standardized mean difference (SMD) for patients after surgery was +0.41 [CI 0.25-0.58], I² = 60% [CI 36-74%]. For visual appearance, orbital decompression yielded the greatest improvement (SMD +0.84 [CI 0.54-1.13]) followed by eyelid surgery (SMD +0.38 [CI 0.05-0.70]), while strabismus correction had no significant effect (SMD +0.94 [CI -0.10 to 1.99]). Conversely strabismus correction was associated with the greatest improvement (SMD +1.25 [CI 0.29-2.21]) in visual functioning, outperforming orbital decompression (SMD +0.29 [CI 0.15-0.43]) and eyelid surgery (SMD +0.12 [CI -0.18 to 0.41]). A mean improvement in GO-QOL of greater than 10 points after orbital decompression surgery was achieved in 12/14 (86%) patient groups for appearance and 5/14 (36%) patient groups for visual functioning. A mean improvement of greater than 6 points was achieved in 5 of 6 (83%) patient groups for strabismus surgery for both appearance and visual functioning. A mean improvement of greater than 6 points after eyelid surgery was achieved in 2/3 (67%) patient groups and 0/3 patient groups for visual appearance and functioning, respectively. Conclusion: Ophthalmic surgery results in substantial improvements in quality of life in patients with GO, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance; strabismus surgery may benefit both visual appearance and function equally, whereas eyelid surgery benefits appearance alone.

Patients' preferences for quality-of-life aspects in sarcopenia: a best-worst scaling study

PURPOSE

As information on patients' preferences regarding quality-of-life aspects in sarcopenia is lacking, this study aims to assess the relative importance of the 14 items of a QoL questionnaire designed for sarcopenia (the SF-SarQoL) using a best-worst scaling (BWS) survey.

METHODS

Participants, aged 65 years or older and community dwelling, who previously participated in the SarcoPhAge study, received a BWS survey via the mail. An object case BWS was selected in which participants completed 12 choice tasks, picking the most and least important aspect from 4 out of 14 SF-SarQoL items for each task. Relative importance scores (RIS) were estimated using Hierarchical Bayes modelling. A cluster analysis was also conducted to investigate whether several profiles with regards to QoL preferences were present.

RESULTS

A total of 163 participants were included, aged 75 (IQR: 73-81) years old, and mostly women (n = 107; 65.6%). Two items were found to be significantly more important than others: "feeling a reduction of physical capacity" (RIS = 11.26), and "having balance problems" (RIS = 11.09). The least important items were "experiencing difficulty carrying heavy objects" (RIS = 2.89), and "feeling a reduction in muscle mass" (RIS = 3.82). We found relatively weak evidence for the presence of two clusters. One cluster prioritized items related to falls where the second prioritized items related to feeling physically capable.

CONCLUSION

Not all QoL aspects were equally important. The relative weight of each QoL aspect may be used to interpret QoL results obtained with the SF-SarQoL or to inform target outcomes in interventional studies.

Do Rural Residents in China Understand EQ-5D-5L as Intended? Evidence From a Qualitative Study

BACKGROUND

The 5-level EQ-5D (EQ-5D-5L) has been increasingly used in China to measure the health status of the general population and patients. However, its content validity among rural residents in China has not been formally evaluated. This qualitative study aims to assess the content validity of EQ-5D-5L among rural Chinese.

METHODS

Participants were recruited from four regions (North, South, East and West) across China. Eligible participants were those living in the rural area in last three years and making a living by agricultural operations. Semi-structured interviews were conducted. Interview transcripts were analysed to assess the comprehensibility, relevance, clarity and comprehensiveness.

RESULTS

Sixty-two participants were included, comparable to the national figures regarding age, sex and education. For comprehensibility, participants could understand the 'mobility', 'self-care' and 'usual activities' domains well, but some reported confusions in 'pain/discomfort' (n = 42) and 'anxiety/depression' (n = 35). Some also reported difficulties in understanding anxiety (n = 6) and depression (n = 9), possibly due to the formal wording used. For relevance, all domains were reported as health-related and participants' responses were based on their own health. For clarity, all could distinguish the five levels, but suggestions on reducing response levels and alternative wording for 'slight' were raised. For comprehensiveness, two aspects (fatigue/energy and appetite) were raised beyond the EQ-5D-5L domains. The 'mobility' domain was selected as the most important and 'anxiety/depression' as the least important.

CONCLUSION

Rural Chinese reported problems on the content validity of Chinese EQ-5D-5L. It might be sensible to consider some revisions to make it more understandable for rural residents.

Does quality of life feedback promote seeking help for undiagnosed cancer?

PURPOSE

Diagnosing cancer early is an imperative, as help-seeking delays affect survival. Quality of life (QoL) deteriorates after diagnosis, but decline may start when cancer is suspected at the earliest stage of the pathway to treatment. This study examined whether offering guided feedback about personal QoL to adults with potential cancer symptoms, living in deprived communities, changes QoL and promotes help-seeking in primary care.

METHODS

Visitors to a CRUK mobile cancer roadshow were recruited in 43 sites. A prospective longitudinal (2 × 2) repeated-measures design was applied. Where they presented a potential cancer symptom, and were 'signposted' to a GP, they were allocated to a symptom condition, or a lifestyle condition, if seeking cancer risk advice. Randomisation was to an Intervention group, who received feedback about personal QoL results (WHOQOL-BREF and WHOQOL importance measures), or a Control group who assessed QoL without feedback. Depression was screened.

RESULTS

Of 107 participants, the mean age was 53; 50% were women, 57% were without tertiary education, 66% were unemployed and 45% were currently ill. Over 10 weeks, 54% of all those with symptoms sought help from a medical source and 42% specifically from a GP. Thirty-one completed all three assessments. With symptoms present, psychological, social and environmental QoL were poor, becoming poorer over time. When the symptoms group received feedback, psychological QoL increased, but GP visits were unaffected. However, feedback increased help-seeking from informal social contacts. Lifestyle groups reported consistently good psychological and social QoL.

CONCLUSION

This early cancer research offers practical and theoretical implications for QoL interventions in deprived communities.

Quality of life profile in three cohorts of community-dwelling Swiss older people

Background

Quality of life (QoL) is a subjective and dynamic concept resulting from an interplay between importance of and satisfaction with different aspects of life. However, it is unclear whether social contexts experienced by individuals born at specific times in history (cohort effects) may influence QoL in old age. This study aimed to compare among older persons born before, during, and at the end of World War II: a) satisfaction with QoL, overall and per domains; b) importance of QoL domains.

Methods

This repeated cross-sectional study included representative samples of community-dwelling adults born in 1934–1938 (pre-war), 1939–1943 (war), and 1944–1948 (baby-boom) from the Lausanne cohort 65+. QoL was assessed overall, and in seven domains in 2011 and 2016. Two-by-two cohort comparisons were performed at ages 68–72 (war versus baby-boom) and 73–77 years (pre-war versus war).

Results

Overall satisfaction with QoL did not differ between cohorts despite increased education level across cohorts and a shift between pre-war and war cohorts towards lower morbidity and higher proportion living alone. However, “Feeling of safety” consistently showed significant improvements from earlier to later-born cohorts. Furthermore, the war cohort reported higher satisfaction than pre-war cohort in “Autonomy”. Conversely, no significant difference was observed between cohorts in importance of QoL domains, except increased importance given to “Health and mobility” in the war compared to pre-war cohort.

Conclusions

Societal changes reflected in the profile of successive elders’ cohorts did not appear to modify the overall satisfaction with QoL.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1112-4) contains supplementary material, which is available to authorized users.

The Relationship Between Quality of Life, Psychological Wellbeing, Satisfaction with Life and Acculturation of Immigrants in Greece

Few studies have examined the quality of life of immigrants in Greece and its relations to acculturation. This study explored the quality of life, psychological wellbeing and satisfaction with life among Albanian immigrants, Pontic Greeks in comparison to native Greeks. Furthermore, the relationship between quality of life, psychological wellbeing, satisfaction with life and acculturation of Albanian immigrants and Pontic Greeks was investigated. The study was based on 520 participants from broader area of Athens, 58.3% (303 people: 150 men and 153 women) native Greeks, 21.9% (114 people: 57 men and 57 women) Albanian immigrants and 19.8% (103 people: 50 men and 53 women) Pontic Greeks. Quality of life was measured by WHOQOL BREF-while wellbeing was measured with Satisfaction With Life Scale and The Affect Balance Scale. An adapted a version of Vancouver Index of Acculturation was used to assess acculturation of immigrants. The findings indicated three important factors contributed to quality of life and wellbeing of immigrants: ethnicity, heritage dimension of acculturation and gender. Albanian immigrants and Pontic Greeks scored lower on quality of life and satisfaction with life than native Greek.

Older Adults' Reasons for Participating in an eHealth Prevention Trial: A Cross-Country, Mixed-Methods Comparison

OBJECTIVES

To explore older adults' reasons for participating in a multinational eHealth prevention trial, and compare motivations between countries.

DESIGN

Cross-sectional mixed methods research using quantitative and qualitative approaches (the ACCEPT-HATICE study).

SETTING AND PARTICIPANTS

Substudy conducted during the recruitment phase of an 18-month RCT testing the efficacy of an eHealth intervention for self-management of risk factors for cardiovascular disease (CVD) and cognitive decline in older adults in Finland, France, and the Netherlands. Participants were 343 dementia-free community dwellers aged 65+ with basic computer literacy and either ≥2 cardiovascular risk factors or a history of CVD/diabetes.

MEASURES

Online questionnaire (quantitative data) and semistructured interviews (qualitative data).

RESULTS

Contributing to scientific progress, wanting to improve one's lifestyle, and benefiting from additional medical monitoring were the predominant reasons for participating. Altruistic reasons were particularly relevant among the French, whereas Finnish and Dutch participants mainly emphasized the benefits of lifestyle changes and regular medical checkups. During interviews, preventing functional dependency emerged as a key underlying motivation. Although some trial design features influenced the decision to participate, the use of an eHealth intervention was not an important motivator in this population.

CONCLUSIONS/IMPLICATIONS

Altruism and personal benefits motivated older adults to participate in the trial; emphasizing such aspects could facilitate recruitment in future RCTs. Additional medical monitoring may be particularly appealing when access to public health care is considered limited. Furthermore, maintaining autonomy and preventing functional dependency emerged as a key concern in this population of young older adults.

Adding two culture-specific 'bolt-on' dimensions on the Thai version of EQ-5D-5L: an exploratory study in patients with diabetes

BACKGROUND

This study explored whether addition of culture-specific bolt-on dimensions, 'interpersonal relationships (IR)' and 'activities related to bending knees (AK)' improves the relevance and validity of the EQ-5D among Thai patients with diabetes.

METHODS

A cross-sectional study was conducted among 200 diabetic patients. Ceiling/floor effects, known-groups validity and test-retest reliability were evaluated. Hierarchical multiple regressions was performed to evaluate the incremental value of the EQ-5D+AK+IR over the EQ-5D-5L in predicting utility measured by visual analog scale (VAS).

RESULTS

The EQ-5D+AK+IR reduced ceiling effects by 34%. For known-groups validity, women and lower educated patients reported more AK problems (p-value< 0.05); however, none of the IR dimension hypotheses were supported. Both IR and AK had the weighted kappa coefficients of 0.49, indicating good reliability. Hierarchical multiple regression found that adding AK (adjusted r²: 0.182 vs 0.156), but not IR (adjusted r²: 0.157 vs 0.156) significantly increased the explained variance in VAS score.

CONCLUSION

Preliminary findings suggest that AK, but not IR, may be a useful addition to the EQ-5D questionnaire for use with Thai patients. Further studies in diverse populations are needed to examine the impacts of the proposed new dimensions and determine if these cultural adaptations are justified.

Depression and cancer were independently associated with quality of life in Brazilian older people

OBJECTIVE

To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil.

METHODS

In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms.

RESULTS

After adjusting for potential confounders, we found that GDS score (β = -0.07; P = 0.04) and cancer (β = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score.

CONCLUSION

Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.

Using best-worst scaling choice experiments to elicit the most important domains of health for health-related quality of life in Singapore

Health-related quality of life (HRQOL) instruments are sometimes used without explicit understanding of which HRQOL domains are important to a given population. In this study, we sought to elicit an importance hierarchy among 27 HRQOL domains (derived from the general population) via a best-worst scaling survey of the population in Singapore, and to determine whether these domains were consistently valued across gender, age, ethnicity, and presence of chronic illnesses. We conducted a community-based study that sampled participants with quotas for gender, ethnicity, age, presence of chronic illness, and interview language. For the best-worst scaling exercise, we constructed comparison sets according to a balanced incomplete block design resulting in 13 sets of questions, each with nine choice tasks. Each task involved three HRQOL domains from which participants identified the most and least important domain. We performed a standard analysis of best-worst object scaling design (Case 1) using simple summary statistics; 603 residents participated in the survey. The three most important domains of health were: "the ability to take care of self without help from others" (best-worst score (BWS): 636), "healing and resistance to illness" (BWS: 461), and "having good relationships with family, friends, and others" (BWS: 373). The 10 top-ranked domains included physical, mental, and social health. The three least important domains were: "having a satisfying sex life" (BWS: -803), "having normal physical appearance" (BWS: -461), and "interacting with others (talking, shared activities, etc.)" (BWS: -444). Generally, top-ranked domains were consistently valued across gender, age, ethnicity, and presence of chronic illness. We conclude that the 10 top-ranked domains reflect physical, mental, and social dimensions of well-being suggesting that the sampled population's views on health are consistent with the World Health Organization's definition of health, "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".

Factors associated with quality of life among the elderly in the community of the southern triangle macro-region, Minas Gerais, Brazil

This study sought to establish the socioeconomic and health factors associated with quality of life among the elderly in the community. An analytical study with a cross-sectional and quantitative approach was conducted in 2012 and 2013 with 3430 senior citizens in 24 municipalities in the Southern Triangle Macro-region of the State of Minas Gerais in Brazil. A structured questionnaire was used for socioeconomic and health variables, as well as the Katz scale, the World Health Organization Quality of Life-Bref (WHOQOL-BREF) and the World Health Organization Quality of Life Assessment for Older Adults (WHOQOL-OLD). Descriptive, bivariate statistical analysis was performed and a multiple linear regression model (p < 0.05) was created. Lower quality of life (QoL) scores were found in the environment and autonomy domains associated with advanced age, lack of schooling and income, a negative perception of health and functional disability. The salient key factor was negative health perception. The conclusion drawn was that socioeconomic and health factors were associated with the quality of life of the elderly, highlighting the lowest scores in the environmental domain and from the aspect of autonomy, a key influencing factor being negative health perception.

Association between social support and health-related quality of life among Chinese rural elders in nursing homes: the mediating role of resilience

PURPOSE

This study aims to confirm the relationship between social support and health-related quality of life (HRQOL) among rural Chinese elders in nursing homes, and to examine the mediating role of resilience in the impact of social support on HRQOL.

METHODS

A cross-sectional survey of 205 elders aged 60 and above was conducted in five rural public nursing homes. Sociodemographic characteristics, the SF-36 questionnaire, and information about social support and resilience were collected. The researchers administered the questionnaires to the participants in a face-to-face setting. Descriptive analysis and a correlation matrix were used to indicate characteristics of the participants and bivariate correlations, respectively. The mediation analyses, composed of regression analysis and PROCESS analysis, were preformed to test both direct and indirect effects of social support on HRQOL, namely the mediating role of resilience.

RESULTS

Social support was positively related to HRQOL (β = 0.303, p < 0.001) among Chinese rural elders in nursing homes. The mediating role of resilience in the relationship between social support and HRQOL was confirmed (a*b bootstrapped 95% confidence interval = [0.098, 0.257]), which revealed that social support had an indirect effect on HRQOL through resilience.

CONCLUSIONS

Resilience partially mediates the relationship between social support and HRQOL. The mediation model provides a better understanding of how social support and resilience work together to affect HRQOL, and it could guide the interventions in health care for promoting HRQOL among Chinese rural elders in nursing homes.

The effect of laughter therapy on the quality of life of nursing home residents

AIMS AND OBJECTIVES

To evaluate the effect of Laughter therapy on the quality of life of nursing home residents.

BACKGROUND

By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance.

DESIGN

Quasi-experimental design.

METHOD

The study was conducted between 2 March - 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection.

RESULTS

After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest.

CONCLUSION

Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention.

RELEVANCE TO CLINICAL PRACTICE

The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.

Sexual dimorphism in Parkinson's disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females

INTRODUCTION

Sex-related differences in clinical manifestations and consequences of Parkinson's disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.

PATIENTS AND METHODS

A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares - Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.

RESULTS

While no sex difference was found in the total Unified Parkinson's Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference =2.2 [95% confidence interval, CI: 0.5-4.0], P=0.011), worse nutritional status (23.8 [standard deviation, SD =4.2] vs 25.8 [SD =2.6], P=0.003) and poorer QoL (28.3 [SD =15.7] vs 17.9 [SD =14.2], P<0.001). Based on multivariate discriminant analysis, emotional well-being, bodily discomfort, social support, mobility and communication domains of HRQoL, together with anxiety, depression and psychosocial functioning, were the strongest features with more severe/worse status in females after adjustment for potential statistical confounders.

CONCLUSION

Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD.

Use of instruments to measure quality of life among healthy and ill adults in community settings

International interest in quality of life (QoL) has been affected by patients' prolonged survival, the increasingly aging population, the increase in chronic conditions and the increasing costs of health care. This has also led to the development of QoL instruments that meet the psychometric criteria necessary for reliable and valid outcome measures in research, health policy decision-making and, increasingly, in clinical practice. Despite the proliferation of QoL instruments available to inform best practice, clinicians seldom routinely apply them. One of the barriers to using QoL instruments is the unfamiliarity nurses have with existing instruments. In order to increase community health nurses' familiarity with existing QoL assessments, the aim of this paper is to describe five instruments and modules that have been developed by the World Health Organization's Quality of Life Assessment Group for the assessment of QoL among healthy and ill adults and to describe how their applicability could enhance evidence-based practice in community nursing.

Quality of life in people with Parkinson's disease: the relevance of social relationships and communication

[Purpose] Maintaining high quality of life is crucial for the rehabilitation of patients with Parkinson’s disease. The quality of life scales currently in use do not assess all quality of life domains or their importance for each individual. Therefore, a new quality of life measure, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting, was used to investigate quality of life in people with Parkinson’s disease. [Subjects and Methods] Fifteen people with idiopathic Parkinson’s disaese (average age = 80.0 years, standard deviation = 10.3 years, Hoehn & Yahr stages 1–4) were interviewed using the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting. Its quality of life constructs were tested by comparing them against disease-specific quality of life (39-items Parkinson’s Disease Questionnaire), motor functioning (Unified Parkinson’s Disease Rating Scale Part III), and activities of daily living (Barthel Index). [Results] Social connections such as “family” and “friends” were revealed as important constructs of life satisfaction. The Schedule for the Evaluation of Individual Quality of Life-Direct Weighting was not significantly correlated with the 39-items Parkinson’s Disease Questionnaire, Unified Parkinson’s Disease Rating Scale Part III, or Barthel Index but was significantly correlated with the “communication” dimension of the 39-items Parkinson’s Disease Questionnaire. [Conclusion] The Schedule for the Evaluation of Individual Quality of Life-Direct Weighting detected various domains of quality of life, especially social relationships with family and friends. “Being heard” was also revealed as an essential component of life satisfaction, as it provides patients with a feeling of acceptance and assurance, possibly resulting in better quality of life.

Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

BACKGROUND

Patients receiving long-term dialysis have among the highest mortality and hospitalization rates. In the nonrenal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of kidney function has been observed in several studies, suggesting that functional dependence may contribute to both morbidity and mortality in dialysis patients.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

7,226 hemodialysis patients from 12 countries in the DOPPS (Dialysis Outcomes and Practice Patterns Study) phase 4 (2009-2011) with self-reported data for functional status.

PREDICTOR

Patients' ability to perform 13 basic and instrumental activities of daily living was summarized to create an overall functional status score (range, 1.25 [most dependent] to 13 [functionally independent]).

OUTCOME

Cox regression was used to estimate the association between functional status and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months.

RESULTS

The proportion of patients who could perform each activity of daily living task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (functional status = 13), and 14% of patients had high functional dependence (functional status < 8). Functionally independent patients were younger and had many indicators of better health status, including higher quality of life. Compared with functionally independent patients, the adjusted HR for mortality was 2.37 (95% CI, 1.92-2.94) for patients with functional status < 8.

LIMITATIONS

Possible nonresponse bias and residual confounding.

CONCLUSIONS

We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia, and multimorbidity, functional dependence was a strong consistent predictor of mortality.

Domains of importance to the quality of life of older people from two Swiss regions

BACKGROUND

Quality of life (QoL) is a subjective perception whose components may vary in importance between individuals. Little is known about which domains of QoL older people deem most important.

OBJECTIVE

This study investigated in community-dwelling older people the relationships between the importance given to domains defining their QoL and socioeconomic, demographic and health status.

METHODS

Data were compiled from older people enrolled in the Lc65+ cohort study and two additional, population-based, stratified random samples (n = 5,300). Principal components analysis (PCA) was used to determine the underlying domains among 28 items that participants defined as important to their QoL. The components extracted were used as dependent variables in multiple linear regression models to explore their associations with socioeconomic, demographic and health status.

RESULTS

PCA identified seven domains that older persons considered important to their QoL. In order of importance (highest to lowest): feeling of safety, health and mobility, autonomy, close entourage, material resources, esteem and recognition, and social and cultural life. A total of six and five domains of importance were significantly associated with education and depressive symptoms, respectively. The importance of material resources was significantly associated with a good financial situation (β = 0.16, P = 0.011), as was close entourage with living with others (β = 0.20, P = 0.007) and as was health and mobility with age (β = -0.16, P = 0.014).

CONCLUSION

The importance older people give to domains of their QoL appears strongly related to their actual resources and experienced losses. These findings may help clinicians, researchers and policy makers better adapt strategies to individuals' needs.

HEALTH SELECTION THEORY: AN EXPLANATION FOR THE PARADOX BETWEEN PERCEIVED MALE WELL-BEING AND MORTALITY

Paradoxically, men report better health and quality of life than women, but men experience higher mortality rates than women at most ages. One conclusion from these findings is that men have been selected to disregard signs of ill health, or even to deceive themselves about their health, to their detriment because presenting themselves as healthy has fitness benefits. We hypothesize that men have been sexually selected to present themselves to women as healthy but that the cost of not attending to their minor health problems results in earlier mortality than women. We present a review of the human and primate literature that supports health selection theory, the hypothesis that females have preferentially selected males who present themselves as healthy.

Evaluating a new methodology for providing individualized feedback in healthcare on quality of life and its importance, using the WHOQOL-BREF in a community population

PURPOSE

We conducted an evaluation to find out how a novel quality of life (QoL) intervention containing guided individualized feedback was appraised. The importance of QoL was matched with QoL assessment for each subjective dimension, using graphical feedback. We examined whether this information was acceptable, feasible and valued beyond the clinical context, among the community.

METHODS

Using a mixed-methods cross-sectional design, the intervention was piloted with 129 participants from communities and registered in primary care. WHOQOL-BREF and WHOQOL Importance scores were graphically matched by dimension. Results were inspected and interpreted with directed guidance to identify good and poor QoL. We report the post-intervention evaluation of feedback, including qualitative themes. Follow-up interviews among those expecting feedback to be helpful explored potential self-management and healthcare uses.

RESULTS

After feedback, 65 % reported changes in thoughts and perceptions of QoL, often describing insights as self-affirming. Goals or expectations changed for 34 %, and motivation to change was reported. Over 50 % evaluated the feedback as helpful in the short term or for the future. Follow-up interviews endorsed the value of the feedback and its usefulness in sharing with a healthcare professional (92 %), suggesting it would facilitate professionals' understandings of patients and enable health advice to be targeted.

CONCLUSIONS

The benefits of using this novel feedback can be extended to the general population, as directed guidance aids interpretation, thereby saving health service costs. This complex pilot intervention needs testing in a blinded fully randomized controlled trial. Beyond independent self-management, graphs could be used during clinical decision-making.

Health-Related Quality of Life, Gender, and Culture of Older People Users of Health Services in the Multicultural Landscape of the City of Ceuta (Spain): A Cross-Sectional Study

INTRODUCTION

Perceptions of health-related quality of life (HRQOL) are influenced by sociodemographic variables and by cultural-religious concepts of health, disease, and old age, among others.

PURPOSE

To assess the HRQOL of older people in a population with a long history of multiculturalism, the city of Ceuta (Spain), and to compare the results with Spanish reference values.

METHOD

A total of 372 individuals (55.4% females) were interviewed using the Spanish version of the Short Form-36 questionnaire. The subjects' mean age was 70.9 (SD = 5) years: 253 were Christians, 93 Muslims, and 26 Jews, representing the proportions in the overall population of these cultural-religious groups.

RESULTS

HRQOL differs according to the cultural-religious affiliation, which specifically affects social and psychological dimensions.

DISCUSSION AND CONCLUSIONS

All groups obtained lower social function scores than the reference values, especially the Muslim and Jewish groups.

IMPLICATIONS FOR PRACTICE

Health care providers may consider integrating culturally sensitive interventions to improve HRQOL.

Quality of life as perceived by older persons with chronic illness in rural and urban Shandong, China

This qualitative study aimed to understand the meaning of quality of life to older persons with chronic illness in China, and to compare the perceptions of those living in rural and urban areas. Semi-structured interviews were conducted with 24 older Chinese, half residing in urban and half in rural areas in Shandong province. Through an inductive coding and categorization process, the study identified two shared domains of quality of life: basic necessities and family wellness. Two additional domains, physical health and mood and spirit, were endorsed predominantly by urban residents. Entertainment and leisure comprised a quality of life domain for urban residents only. Cohort experience and cultural values likely played a role in shared beliefs about quality of life, whereas socioeconomic context may account for differences in rural and urban conceptions. An implication of the findings is that for older Chinese with chronic illness, developing and sustaining programs to meet basic needs is critical to quality of life.

Evaluating recovery following hip fracture: a qualitative interview study of what is important to patients

OBJECTIVE

To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services.

DESIGN

Semistructured interviews exploring the experience of recovery from hip fracture at two time points-4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall.

PARTICIPANTS

31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice.

SETTING

Single major trauma centre in the West Midlands of the UK.

RESULTS

Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience.

CONCLUSIONS

Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within clinical trials.

Aging, Gender and Quality of Life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults

BACKGROUND

In Brazil, a rapidly aging country suffering from large inequalities, the study of the quality of life (QOL) of aged people is important for the future health. The aim of this study was to examine the associations among QOL, gender, and physical and psychosocial health in older Brazilian community-dwelling adults to identify factors that are associated with better QOL.

METHODS

The "Aging, Gender and Quality of Life (AGEQOL)" study, which included 2,052 respondents aged 60 or older, was conducted in Sete Lagoas, Brazil between January and July 2012. The respondents answered questions regarding their socioeconomic and demographic information, health and social situations, cognitive impairment, depressive symptoms and family satisfaction. The authors also applied the Brazilian version the World Health Organization Quality of Life QOL Assessment-Brief Instrument (WHOQOL-BREF) and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old). Ordinal logistic regression with the Proportional-Odds and Logit function was used to test the association between QOL and physical and psychosocial health according to age and socioeconomic status.

RESULTS

Older adults of both genders with five or more years of education, good self-rated health, an absence of depressive symptoms, and no family dysfunction reported better QOL. Retired men had a better QOL compared to non-retired men (OR = 2.2; 95% CI = 1.4-3.2), but this association was not observed in females. Men living in mixed arrangements (OR = 0.5; p = 0.033) and women who did not practice physical activity (OR = 0.7; p = 0.022) tended to have poorer QOL.

CONCLUSIONS

We conclude that there are gender differences related to better QOL in this sample. Women with good physical and psychosocial health are more likely to have a better QOL. For men, the best QOL was associated with high socioeconomic conditions and good physical and psychosocial health.

Development and validation of the Somali WHOQOL-BREF among refugees living in the USA

PURPOSE

This study is the first translation and validation of the WHOQOL-BREF for general use in Somali refugee populations.

METHODS

A community sample of 303 Somali refugees living in the USA responded to the WHOQOL-BREF following translation, adaptation, and validation guidelines established by the World Health Organization. Psychometric properties of the quality of life instrument were assessed including tests of the four-domain factor structure using multiple regression and principal component analysis.

RESULTS

Principal component analysis demonstrated an acceptable fit between PCA components and original WHOQOL-BREF domains. Four components had eigenvalues greater than one and explained 63.4% of the observed variance. Most scale items loaded like the original WHOQOL-BREF domains, with the notable difference among four items of physical health that loaded more strongly under the environment domain. Construct validity of the scale was confirmed by higher intercorrelations of each WHOQOL-BREF item with its intended domain (all r (2) > 0.50) than with other domains. Multiple regression analyses of the domain scores on overall quality of life (Q1) and health satisfaction (Q2) explained half of the observed variance in each measure. Item correlations showed good internal consistency (0.65 ≥ Cronbach's alpha ≤ 0.82).

CONCLUSIONS

Validation of this first Somali version of the WHOQOL-BREF provides further evidence that this instrument can be a valid measure for cross-cultural comparative studies of quality of life. Policies that address health disparities can be more broadly evaluated if quality of life is systematically measured in the community. This is particularly important for evaluating policy impact and implications for refugee populations.

Using guided individualised feedback to review self-reported quality of life in health and its importance

This pilot study investigated the effects of providing guided, individualised feedback on subjective quality of life (QoL), using results from the multidimensional WHOQOL-BREF profile. Participants (n = 129; 85 chronically ill) were recruited in the community, and primary care. They were randomised to receive written or verbal guidance on interpreting a new graphical summary profile, which simultaneously presented (a) their individual self-ratings of QoL and (b) the importance attributed to each QoL dimension. Before and after feedback, participants completed health status, subjective QoL, QoL Importance, goal-oriented QoL and mood measures. Receiving individualised feedback was associated with increased psychological QoL, with modest effect size. No effects were found for physical, social or environmental QoL or QoL importance, health status, mood or goal-oriented QoL. There were no differences between modes of delivering guidance, indicating equal effectiveness. Chronic illness participants reported poorer QoL, moved more slowly towards their QoL goals, and had larger differences between core QoL and QoL Importance than healthy participants. Guided individualised empirical feedback about QoL judgements could be used to promote psychological well-being. Although professional interpretation of feedback is unnecessary, if shared, patients' profiled WHOQOL information could support self-monitoring, self-management and clinical decision-making.

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.

The relationship between physical aspects of quality of life and extreme levels of regular physical activity in adults

This study aimed to check for any significant differences in perceived quality of life, specifically aspects of a physical nature, among volunteers who are more physically active and those less physically active in a university community. The sample consisted of 1,966 volunteers in a university community in Brazil. To assess physical activity levels, volunteers responded to the International Physical Activity Questionnaire (IPAQ), and to analyse the perception of quality of life they responded to WHOQOL-bref, which is classified into three groups according to level of physical activity, taking into account the metabolic equivalent index (MET) over a full week. For comparison, consideration was given to the first and third tertiles, respectively, namely groups of more and less active students. The results indicated that individuals who engaged in more physical activity had a more positive perception of quality of life compared to those who were less active in physical aspects related to the ability to work, energy for day-to-day activities and locomotion.

Condições de saúde e variáveis sociodemográficas associadas à qualidade de vida em idosas de um programa de atividade física de Curitiba, Paraná, Sul do Brasil

O presente estudo teve como objetivo analisar a associação entre variáveis sociodemográficas e condições de saúde com os domínios da qualidade de vida em idosas participantes do programa Idoso em Movimento. A amostra do estudo foi composta por 1.806 idosas, que foram avaliadas por meio de entrevista para os potenciais correlatos de qualidade de vida (WHOQOL-BREF e WHOQOL-OLD). O índice de massa corporal foi calculado após aferição do peso e da estatura. Os domínios da qualidade de vida foram classificados em tercis. Para análise dos dados, foi utilizada a regressão logística ordinal. Após ajustes para variáveis de confusão, a faixa etária, classe econômica, escolaridade, situação ocupacional e estado civil estiveram associados a alguns domínios da qualidade de vida (p < 0,05). Além disso, idosas obesas ou com problemas de saúde apresentaram menor razão de chance de estar nos escores mais elevados de qualidade de vida, e as idosas que usavam um ou dois medicamentos apresentaram maior razão de chance de estar nos escores mais elevados do domínio físico. Como conclusão, os fatores sociodemográficos e as condições de saúde estão associados com a qualidade de vida em idosas.

The impact of pensions on health and wellbeing in rural South Africa: does gender matter?

Unique to Africa, a means-tested non-contributory pension is available to South Africans. In 2006, women over 60 and men over 65 were pension-eligible. To explore the effect of the pension for health and wellbeing indicators of rural South African men and women, we analyze data from the WHO-INDEPTH Study of Global Ageing and Adult Health Survey, carried out in the Agincourt sub-district by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in 2006. Because pension receipt was not measured directly, our findings represent intent-to-treat (ITT) rather than treatment-on-the-treated (TOT) effects using age as an indicator for intent-to-treat. Overall, women report poorer wellbeing compared to men. However, women have a "honeymoon" period at ages 60-64, the first years of pension-eligibility, in which they report lower levels of worry and sadness, and higher overall happiness, life satisfaction, and quality of life as compared to younger and older women. For men, in contrast, reports of wellbeing worsen in the pre-pension years, followed by a similar but not as prominent pattern of favorable reports in the five years following pension-eligibility, and a decline in the next five-year period. Thus, while pensions continue to enhance financial wellbeing, our results suggest that their effect on social wellbeing may be gendered and transitory. Further research is needed to improve understanding of these dynamics.

Quality of Life (QOL) and Attitudes Toward Aging in Older Adults in Şanlıurfa, Turkey

Objectives: The purpose of this study was to investigate quality of life (QOL) and attitudes toward aging in older adults in a province in Turkey. Methods: This is a quantitative and descriptive study of QOL and the attitudes toward aging in older adults. Instruments: The data measurement instruments used in this study are the World Health Organization (WHO) Quality of Life Instrument–Older Adults Module (WHOQOL-OLD) and the WHO–Attitudes to Ageing Questionnaire (AAQ). Participants: The Turkish versions of the WHOQOL-OLD and AAQ were administered to 550 older adults living in şanlıurfa Province, Turkey. Results: The results indicated a significant relationship between QOL and attitudes toward aging in older adults. Two dimensions of attitudes toward aging (physical change and psychological growth) were significant predictors of QOL in older adults. It was found that gender, literacy, social security, age, and marital status affect some dimensions of QOL and some subscales of attitudes toward aging.

Femoral neck fractures in Lithuania and Sweden. The differences in care and outcome

PURPOSE

Hip fractures constitute a serious and common health problem from both individual and public health perspectives. Unified data collection and comparison between countries is recognised as an effective tool for care improvements. However, the variation in patients' demography, treatment methods and other local cultural aspects in different countries should be considered. The aim of our study was to compare femoral neck fracture patients treated in Kaunas and Lund, concerning functional outcome and quality of life.

METHODS

We investigated 99 patients treated by arthroplasty in Kaunas Clinics and 117 patients in Lund University Hospital. Patients were investigated according to the National Swedish Hip Fracture Register model and were followed up for a period of four months after the injury. The patient's place of residence, mobility, complaints of pain and additional hospital stay were recorded. The EQ-5D questionnaire was used to evaluate quality of life.

RESULTS

Patients in Kaunas were significantly younger, had lower ASA grade and were more mobile before trauma and at four moths follow-up. However, when comparing quality of life at four months follow-up between the institutions, Lund patients reported significantly better self care, felt less pain and discomfort, and had less symptoms of anxiety and depression.

CONCLUSIONS

The difference observed in quality of life rating between institutions might be related to local cultures of the countries and should be considered when comparing the data.

The Spanish SF-36 in Peru: factor structure, construct validity, and internal consistency

This study assessed the psychometric properties of the SF-36 questionnaire in a sample of 4344 Peruvian people aged 15 to 64 years. Internal consistency reliability was estimated using Cronbach's α coefficient, construct validity by known-groups comparison defined with respect to key sociodemographic characteristics, and factor structure by confirmatory factor analysis (CFA) at item level. Cronbach's α coefficient for the full questionnaire was 0.82 and ranged between 0.66 and 0.92 by scales. The 8 scales discriminated well between sexes, age, and socioeconomic groups. CFA showed that a model with 8 first-order factors and 2 second-order factors (namely, physical and mental health) was a feasible representation of the SF-36 factor structure and had better fit to data than alternative factor structures. The SF-36 showed appropriate psychometric properties regarding internal consistency, construct validity, and factor structure when tested in Peru. Future studies should focus on testing other psychometric properties of the SF-36, such as convergent and discriminant validity, test-retest reliability, and sensitivity to change.