Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

Effects of Sequential Participation in Evidence-Based Health and Wellness Programs Among Older Adults

Background and Objectives

Evidence suggests participation in evidence-based programs by older adults is effective, yet most studies focus on participation in a single evidence-based program, leaving repeated participation insufficiently understood. We aimed to compare participation in multiple evidence-based programs (repeaters) versus a single evidence-based program (nonrepeaters).

Research Design and Methods

Secondary data analysis was conducted on pre–post longitudinal data targeting older adults participating in evidence-based program(s) in Texas (2013–2016). Surveys included sociodemographic and health-related indicators (e.g., self-rated health, health behaviors, and falls-risks). Mixed-effects models examined pre–post changes in health-related indicators.

Results

Of the 734 study-eligible participants, 145 (20%) participated in two or more evidence-based programs. The participants’ average age was 74 years, and the majority was female (80%), non-Hispanic White (79%), or lived in urban or large rural cities/towns (79%). At baseline, repeaters reported less depressive symptomology (p = .049), fewer chronic conditions (p = .048), and less concern of falling (p = .030) than nonrepeaters. Repeaters had better workshop attendance and completion rates (p < .001). Compared to nonrepeaters, repeaters showed significantly-better improvements in communication with physicians (p = .013).

Discussion and Implications

Study findings suggest potential benefits of participation in multiple evidence-based program workshops, but repeaters may have different health profiles than nonrepeaters in natural settings. Future evaluations should consider participants’ past participations in evidence-based programs. Further research is needed to build more comprehensive evidence about the incremental benefits of participation in multiple evidence-based programs.

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

AIM

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

DESIGN

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Fatigue as a long-term risk factor for limitations in instrumental activities of daily living and/or mobility performance in older adults after 10 years

Objectives

Decline in the performance of instrumental activities of daily living (IADL) and mobility may be preceded by symptoms the patient experiences, such as fatigue. The aim of this study is to investigate whether self-reported non-task-specific fatigue is a long-term risk factor for IADL-limitations and/or mobility performance in older adults after 10 years.

Methods

A prospective study from two previously conducted cross-sectional studies with 10-year follow-up was conducted among 285 males and 249 females aged 40–79 years at baseline. Fatigue was measured by asking “Did you feel tired within the past 4 weeks?” (males) and “Do you feel tired?” (females). Self-reported IADLs were assessed at baseline and follow-up. Mobility was assessed by the 6-minute walk test. Gender-specific associations between fatigue and IADL-limitations and mobility were estimated by multivariable logistic and linear regression models.

Results

A total of 18.6% of males and 28.1% of females were fatigued. After adjustment, the odds ratio for fatigued versus non-fatigued males affected by IADL-limitations was 3.3 (P=0.023). In females, the association was weaker and not statistically significant, with odds ratio being 1.7 (P=0.154). Fatigued males walked 39.1 m shorter distance than those non-fatigued (P=0.048). For fatigued females, the distance was 17.5 m shorter compared to those non-fatigued (P=0.479).

Conclusion

Our data suggest that self-reported fatigue may be a long-term risk factor for IADL-limitations and mobility performance in middle-aged and elderly males but possibly not in females.

Occupation-focused interventions for well older people: an exploratory randomized controlled trial

OBJECTIVE

The aim of this exploratory randomised controlled trial (RCT) was to evaluate three different occupation-focused interventions for well older people by estimating effect sizes for leisure engagement and ability in activities of daily living (ADL) and thereby identifying the most effective interventions.

METHODS

One hundred and seventy seven persons, 77-82 years old, living alone and without home help, were randomized to a control group (CG), an individual intervention (IG), an activity group (AG), and a one-meeting discussion group (DG). All interventions focused on occupational engagement and how persons can cope with age-related activity restrictions in order to enhance occupational engagement. Data were collected by blinded research assistants at baseline, three, and 12 months. Ordinal outcome data were converted, using Rasch measurement methods, to linear measures of leisure engagement and ADL ability. Standardized between-group effect sizes, Cohen's d, were calculated.

RESULTS

While all groups showed a decline in leisure engagement and ADL over time, the IG and the DG were somewhat effective in minimizing the decline at both three and 12 months. However, the effect sizes were small.

CONCLUSIONS

The findings indicate that occupation-focused interventions intended to minimize a decline in leisure engagement and ADL were sufficiently promising to warrant their further research.

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

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

Sensory impairments in community health care: a descriptive study of hearing and vision among elderly Norwegians living at home

Background

Hearing and vision impairments increase with age and are common risk factors for functional decline reduced social participation and withdrawal.

Objective

Describe the hearing and vision of home care patients older than 80 years.

Methods

Ninety-three older adults (80+ years) receiving home care were screened for hearing and vision in their homes. Data were collected using a HEINE Mini 3000^® Otoscope to examine the eardrum and presence of earwax, an Entomed SA201-IV portable pure-tone audiometer to measure the pure-tone average (PTAV), a logarithm of the minimum angle of resolution chart to measure visual acuity (VA), and the Combined Serious Sensory Impairment interview guide.

Results

Slight and moderate hearing impairments were found in 41% and 47% of the population, respectively (mean PTAV =40.4 dB for the better ear), and 40% and 56% had impaired and slightly impaired vision, respectively (mean VA =0.45 for the better eye). The participants’ self-assessments of hearing and vision were only weakly correlated with PTAV and VA values. The visual function was significantly worse in men than in women (P=0.033). Difficulty in performing instrumental activities of daily living because of hearing and vision impairments was experienced by 17% of the participants, whereas 76% experienced no difficulties. When many people were present, 72% of the participants found it difficult to understand speech. Nearly 30% found it tiring to read, and 41% could not read very small print.

Conclusion

The patients’ self-assessments of their hearing and vision did not correlate strongly with their VA and PTAV scores. Asking the elderly about their overall hearing and vision ability is not sufficient for detecting sensory impairment, and asking more specific questions about what they could not hear and see was not an adequate indicator of the patients’ hearing and vision problems. To detect hearing and vision impairments among elderly home care patients, standardized measurements of their hearing and vision are necessary.

Factors associated with change in Internet usage of Swedish older adults (2004-2010)

The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group.

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

BACKGROUND

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

OBJECTIVES

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

DESIGN

Population-based cohort study.

SETTING AND PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Fatigue in older adults: an early indicator of the aging process?

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

Mobility disability and life satisfaction in elderly people

The objective of this descriptive and analytical study is to examine mobility disability and life satisfaction in elderly people living in nursing home residences and analyze the relationship between them. The study was conducted over 78 elderly people in two nursing home residences. The data of this study were obtained through a personal information form (PIF), the Rivermead mobility index (RMI) and the life satisfaction scale (LSS). It was detected that life satisfaction levels of elderly people were average, a great majority of them went through mobility disability and there was a significant correlation between mobility and life satisfaction. It was established that in elderly people mobility was affected by the age, gender and chronic diseases while life satisfaction was related to age, education level and health perception level. Disability is a factor that has a significant effect on the life satisfaction of elderly people. The findings of this study will be useful for planning interventions to improve mobility and satisfaction with life among nursing home elders in Turkey.