Quality of life in old age - a concept analysis

Measurement invariance and differential item functioning of a care staff proxy measure of nursing home resident dementia-specific quality of life (DEMQOL-CH): do care aides' first language, and care aides' and residents' ethno-cultural background matter?

Quality of life (QoL) is a priority goal of dementia care, but measuring QoL becomes increasingly difficult as a person's ability to self-report declines. QoL measurement is particularly challenging among Nursing home (NH) residents, due to their often advanced cognitive impairment. The DEMQOL-CH is a validated tool to assess NH residents' QoL, using care staff proxy reports. Care staff and residents often have diverse ethno-cultural backgrounds, which may affect the measurement of QoL. Our objective was to assess measurement invariance and differential item functioning (DIF) of the DEMQOL-CH based on care staff ethno-cultural background, language, and resident ethno-cultural background. In a convenience sample of 9 NHs in the Canadian province of Alberta, research assistants conducted structured interviews with 119 care staff between July and September 2021 to complete DEMQOL-CH assessments of 612 residents. We performed confirmatory factor analyses, multiple group item response theory analyses, and DIF analyses. Measurement of the overall DEMQOL-CH score was affected by care staff ethno-cultural background and language (lack of scalar measurement invariance), but not by resident ethno-cultural background. Six of the 31 DEMQOL-CH items had DIF based on both, care staff ethno-cultural background and language, 2 items had DIF based on care staff ethno-cultural background, 4 items had DIF based on care staff language. Resident ethno-cultural background did not lead to DIF. The lack of measurement invariance and the presence of DIF affects the comparability of DEMQOL-CH assessments collected from care staff with diverse ethno-cultural and/or language backgrounds. However, the extent of the issues identified is small and the tool's other psychometric properties are robust. Therefore, we suggest that it is reasonable to continue to use the DEMQOL-CH in its current form, with careful consideration of methods to deal with and adjust for measurement invariance.

Differential cross-lagged relations of frailty predicting later depression in older women versus men

This study aimed to investigate autoregressive and lagged associations over 2 years between frailty, depression and quality of life, and to examine sex differences in these longitudinal associations among European men and women aged ≥50 years. The analyses included 10,077 individuals (5589 women) from 12 European countries. Women attested to a higher frailty and depression score and lower quality of life than men. For both sexes, frailty and depression correlated positively cross-sectionally and longitudinally (2 years later), while quality of life correlated negatively with frailty and depression cross-sectionally and longitudinally. With regard to lagged associations, for both men and women, frailty proved to be a predictor of depression 2 years later. In turn, depression did not predict frailty and quality of life 2 years later in women, but it did among men.

Concept analysis of diabetes-related quality of life

BACKGROUND

Quality of life (QoL) is a common indicator of outcomes in people living with diabetes, but the concept of diabetes-related QoL (DRQoL) remains unclear. Clarifying core knowledge of DRQoL was the goal of this paper.

METHODS

A concept analysis was conducted according to Walker and Avant's framework. A systematic search of the published literature was conducted between 2002 and 2022 based on resource availability, current relevancy, and the quality of recent studies. Three major databases were used to identify the attributes, antecedents, consequences, and measures for DRQoL. Only articles investigating DRQoL among adult or elderly people living with diabetes that were published in English in peer-reviewed journals were analyzed.

RESULTS

In total, 4342 articles were screened, and only 401 articles underwent eligibility assessment. A total of 183 articles were included in the analysis. Most (59.78%) of them were observational studies and DRQoL as a primary outcome. We identified four critical components of DRQoL: (a) general health, (b) diabetes-related satisfaction, (c) diabetes impact, and (d) diabetes self-management. The antecedents were classified according to their contributions to DRQoL as follows: 25 positive-induced, 4 neutral-based, and 19 negative-induced antecedents. The consequences of DRQoL were mortality risk, personal health, satisfaction with health care, hospitalization risk, and failure to return to work. The referents varied widely, and 32 tools were found for DRQoL measurement. Furthermore, 12 scales for disease-specific DRQoL and 17 tools for general QoL were identified.

CONCLUSION

This paper provides a definition of DRQoL as well as its attributes, antecedents, consequences, and measures in adults with diabetes. The attributes of DRQoL included general health, diabetes-related satisfaction, diabetes impact, and diabetes self-management. A comprehensive understanding of DRQoL can improve the quality of care and can aid in the recognition of the needs of care among people living with diabetes.

A qualitative study regarding older people's goals of care in relation to frailty status: finding meaning in 'smaller things' in life

BACKGROUND

Increasingly frailty assessment is part of the shared decision-making process of older patients. However, little is known of the role of frailty in goals of care among the diverse group of older persons.

OBJECTIVE

To explore the role of frailty in older people's perspectives on goals of care in case of acute and/or severe disease.

METHODS

We conducted semi-structured interviews with people aged ≥70 years in the Netherlands (n = 26), which were purposively sampled based on a self-reported Clinical Frailty Scale. The interviews were analysed using thematic content analysis to compare frailty subgroups.

RESULTS

Three themes regarding goals of care emerged: (1) preserving well-being in one's lifeworld through life goals; (2) goals related to care, as access to appropriate care, good contact with care professionals and a dignified end-of-life; (3) differences in attainment and adaptation of goals of care according to frailty status. The first two themes appeared to be independent of frailty status. However, differences were seen in theme 3, as fit older people primarily strengthened their capacity to attain goals of care, while frail older people primarily adapted the meaning ascribed to goals of care and had higher acceptance of the life cycle.

CONCLUSION

Goals of care that older people want to attain are driven by life goals, independent of frailty. Therefore, older people with varying frailty status could be treated similarly in goal-setting and life goals. However, different support may be needed for the attainment and adaptation of their goals of care.

Health-related quality of life of children and adolescents with sickle cell disease: An evolutionary concept analysis

The concept of Health-Related Quality of life (HRQOL) of children and adolescents with Sickle cell disease (SCD) is not clearly understood due to the lack of available studies. This review aimed to elucidate various attributes and related concepts of HRQOL in children and adolescents with SCD using Rodgers' et al. (2018) concept analysis framework. A systematic search was performed to identify studies reporting the attributes, antecedents, consequences, surrogate terms, and related concepts of HRQOL in children and adolescents with SCD. The review included 75 articles, including 70 quantitative, two mixed-methods, and three qualitative studies. These were categorized into attributes, antecedents, consequences, surrogate terms, related concepts, and an exemplar of HRQOL in children and adolescents with SCD. The review identified nine important attributes. It includes multidimensional and dynamic concepts, acknowledging the illness, maintaining emotional balance and self-control, coping with the disease, pain management, stigma and discrimination, treatment burden, palliative care and personal resilience. The antecedents were knowledge and attitude toward the disease, self-efficacy, social support, spirituality and spiritual well-being, disease severity, access to healthcare, environmental factors, and financial considerations. The consequences were independence in personal life, improved physical health outcomes, psychological well-being, family and caregiver well-being, improved family, social and peer relationships and social interactions, improved school performance, and improved overall HRQOL and long-term outcomes. This analysis provides an overview of HRQOL concepts related to children and adolescents with SCD, guiding further research into nursing care and clinical practice.

The Mediating Role of Physical Activity and Self-Rated Health in the Association Between Depression and Quality of Life in Older Europeans: An Analysis Differentiated by Sex

Objectives: This study investigates the mediating role of moderate physical activity (MPA), vigorous physical activity (VPA), and self-rated health (SRH) in the association between depression and quality of life (QoL) in a large sample of Europeans aged 50 and over, differentiated by sex. Methods: Data from the 2017 Survey of Health, Ageing and Retirement in Europe were analyzed, including 11,986 individuals (6843 women) aged 50 and older. All information was collected through face-to-face interviews: sociodemographic data, SRH, physical activity levels, depression (EURO-D scale), and QoL (CASP-12). Results: Comparatively, women reported a higher prevalence of depression, a lower perception of QoL, and slightly lower levels of SRH, MPA, and VPA. Parallel mediation models revealed, for both sexes, that an increase in VPA levels was more effective in benefiting SRH; and MPA proved to be a better promoter of QoL. When comparing sexes, only the path depression → VPA → QoL showed a significant difference (p < 0.001). Conclusions: These results provide valuable insights for developing physical activity interventions capable of improving mental health and promoting QoL in older European adults.

Psychometric Properties of the World Health Organization Quality of Life Scale for Older Adults (WHO-QoL-Old) in a Mexican Population

BACKGROUND/OBJECTIVE

The present study aimed to contribute to analyzing the psychometric properties of the WHO Quality of Life Scale for Older Adults (WHO-QoL-Old) in a sample of older adults in Michoacán, Mexico.

METHODS

111 older adults from Michoacán, Mexico, participated in the study. Confirmatory factor analysis (CFA) was conducted to test the fit of various models. Data analysis was performed using R Studio, considering the ordinal nature of the items in the model estimation method. Internal consistency was evaluated using the alpha coefficient (α) and McDonald's omega coefficient (ω).

RESULTS

The CFA indicated that the six-correlated-factor model proposed theoretically showed a very good fit (χ2: 397.11, p < 0.001; CFI: 0.958; SRMR: 0.079; RMSEA: 0.079). The factors within the model demonstrated acceptable internal consistency, with an alpha coefficient ranging from 0.739 to 0.874 and an omega coefficient ranging from 0.748 to 0.882.

CONCLUSIONS

It is concluded that the WHO-QoL-Old scale presents good psychometric properties for the Mexican older adult population.

Occupational Therapy Interventions to Improve the Quality of Life of Older Adults with Dementia Living in Nursing Homes: A Systematic Review

The increase in older adults with dementia presents challenges in promoting research to improve the quality of life of this population. The objective of this study was to assess the scientific evidence on the effectiveness of occupational therapy interventions in improving the quality of life of older adults over 65 years old with dementia living in nursing homes. The databases used were PubMed, Web of Science, OTSeeker, clinicaltrials.gov, Dialnet, Scopus, Cochrane, and SciELO between 2013 and 2023. The studies were selected and evaluated according to the Cochrane guidelines. The review was carried out following the PRISMA 2020 Statement. Sixteen articles met the inclusion criteria and were categorized into four groups according to the focus of the intervention: "meaningful activities/occupations", "physical, cognitive and sensory functioning", "performance areas", and "physical and social environment and staff training". The strength of evidence was moderate, and the risk of bias was low. The findings revealed that occupational therapy interventions based on participation in recreational activities, reminiscence, performance-based activities and the physical and social environment, and specialized staff training, could improve the perceived quality of life of older adults with dementia living in nursing homes.

The effects of resistance exercises interventions on quality of life and glycemic control in patients with type 2 diabetes: Systematic review and meta-analysis of randomized controlled trials

AIMS

The global burden of diabetes mellitus is escalating rapidly, and the complex comorbidities contribute to a marked decline in patients' quality of life. This review assesses the impact of resistance training on quality of life in type 2 diabetes patients, addressing the ongoing debate over its role in diabetes management and the potential to enhance clinical outcomes.

METHODS

Systematic review and meta-analysis of randomized controlled trials regarding assessing effects from resistance training on quality of life among diabetic patients. We systematically searched PubMed, Medline, Web of Science and Embase and the register of controlled trials searched to February 2021. All included studies were randomized controlled trials in adults with type 2 diabetes that assessed the effect of a resistance training on glycemic control and change in health-related quality of life (HRQOL). The HRQOL was measured by validated questionnaires, covering physical and mental components scores, and pooled standardized effect sizes were calculated. Glycemic control measured by the level of Glycated Hemoglobin (HbA1c), and pooled weighted effect sizes were calculated.

RESULT

9 randomized controlled trials were eligible for the systematic review and our meta-analysis, with 557 participants completed randomized programs data. With random effects meta-analyses model, there was no significant pooled estimate of the standardized mean difference of PCS of quality of life (0.73, 95%CI: -1.19 to 2.65), while in our sensitivity analysis, resistance training had a marginally significantly positive effect on physical components among diabetic patients (0.21, 95%CI: -0.02 to 0.45). Additionally, resistance exercise was non-significantly related with improvement in mental components scores of HRQOL compared with control group (standardized mean difference, (-0.01 (95%CI: -1.25 to 1.23)). With random effects meta-analyses, constructed resistance training intervention did not significantly change the level of HbA1c compared with the control group (-0.22, 95%CI: -0.98 to 0.54) CONCLUSION: The resistance/strength training might have the slight positive effect on the PCS of HRQOL among patients with type 2 diabetes, but was non-significantly beneficial for MCS of HRQOL and glycemic control.

Adaptation and Validation of the Spanish Version of Kogan's Attitude toward Older People Scale (KAOP)

It is essential to understand the behavior and attitudes of nurses towards older people to improve clinical practice and quality of care in the gerontological sector. A clearer understanding of the attitudes that drive nurses toward the desire to work with older people would be a good starting point to encourage the development of positive and nurturing attitudes. A cross-sectional study with non-probabilistic sampling and a self-administered questionnaire was conducted among 381 nursing students of the Faculty of Nursing at the University of Castilla La-Mancha to evaluate the psychometric properties of the Spanish Version of the Kogan's Attitudes Towards Older People Scale (KAOP-S). Construct validity, internal consistency, and reliability were assessed. In total, 298 females and 83 males completed the questionnaires. Their mean age was 20.42 years. The results revealed a Cronbach's alpha coefficient of 0.75 for the scale, which is comparable with other published versions of the KAOP Scale. The results of the exploratory factor analysis established that the scale has a two-factor solution and an explained variance of 25% in the sample. The KAOP-S was found to be a reliable and valid tool with good content and construct validity for assessing nursing students' attitudes towards older people.

The Czech version of the life satisfaction index for the third age-short form (LSITA-SF12): Psychometric properties

BACKGROUND

Evaluation of life satisfaction of older people using standardised tools can play a crucial role in evaluating the effectiveness of policy measures aimed at mitigating the effects of population aging.

OBJECTIVES

The aim of the study was to verify the psychometric properties of the Czech version of a 12-item scale (the Life Satisfaction Index for the Third Age) for older people living in the community.

METHODS

The research involved 1113 older people from the Moravian-Silesian Region over 60 years of age living in a home environment. For the newly created Czech version of LSITA-SF12, we tested validity (construct validity and convergent validity) and reliability (internal consistency).

RESULTS

We confirmed a single-factor model for the LSITA-SF12 scale (χ²  = 71.33, p <  .001, CFI = 0.995, TLI = 0.994, RMSEA = 0.065, SRMR = 0.056, GFI = 0.999) by confirmatory factor analysis and load factor analysis (values of explorations ≥0.45). The internal consistency of the scale was satisfactory (α = 0.878). Furthermore, there was a medium correlation rate (r = 0.592; p <  .001) between the overall score of the LSITA-SF and quality-of-life score (OPQoL-Brief).

CONCLUSIONS

We found the Czech version of the LSITA-SF12 questionnaire to have satisfactory psychometric properties. The questionnaire is suitable for use in research and clinical practice to evaluate the effectiveness of preventive measures.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov. PRS Protocol Registration and Results System; NCT05637177.

IMPLICATION FOR PRACTICE

The LSITA_SF12 questionnaire can beadministered by a community gerontological nurse and can be used in clinicalpractice and research.

What makes older adults feel good?

BACKGROUND AND AIM

To inform health promotion interventions, there is a need for large studies focusing specifically on what makes older adults feel good, from their own perspective. The aim was to explore older adults' views of what makes them feel good in relation to their different characteristics.

METHODS

A qualitative and quantitative study design was used. Independently living people (n = 1212, mean age 78.85) answered the open-ended question, 'What makes you feel good?' during preventive home visits. Following inductive and summative content analysis, data was deductively sorted, based on The Canadian model of occupational performance and engagement, into the categories leisure, productivity, and self-care. Group comparisons were made between: men/women; having a partner/being single; and those with bad/good subjective health.

RESULTS

In total, 3117 notes were reported about what makes older adults feel good. Leisure activities were the most frequently reported (2501 times), for example social participation, physical activities, and cultural activities. Thereafter, productivity activities (565 times) such as gardening activities and activities in relation to one's home were most frequently reported. Activities relating to self-care (51 times) were seldom reported. There were significant differences between men and women, having a partner and being single, and those in bad and good health, as regards the activities they reported as making them feel good.

DISCUSSION AND CONCLUSIONS

To enable older adults to feel good, health promotion interventions can create opportunities for social participation and physical activities which suit older adults' needs. Such interventions should be adapted to different groups.

Comparison of the quality of life of patients with liver cirrhosis before and during the COVID-19 lockdown in Slovakia

Liver cirrhosis is associated with a poor quality of life (QOL). The COVID-19 pandemic has led to several restriction measures and psychosocial consequences whose impact on QOL has combined with that of cirrhosis in an unknown way. Therefore, we have used our cirrhosis registry to assess the quality of life before the pandemic (on the first admission to the tertiary liver unit) and during the most pronounced phase of the first lockdown. In this cross-sectional study conducted during the first lockdown in Slovakia (from April to May 2020), we have repeated the QOL measurement of QOL in cirrhotic patients previously enrolled in the RH7 registry. Patients who were alive (according to the national registry of deaths) were identified and contacted by phone with a structured and standardized interview led by trained professionals. The tool used for both QOL measurements (at enrolment in RH7 and during lockdown) was a standardized and validated EuroQOL-5D (EQ-5D) questionnaire. The study included 97 patients, of which 37 (38.1%) were women and 60 (61.9%) were men. Responses were achieved from 75 patients (68.18%). In general, patients scored their quality of life significantly higher during the pandemic compared to examination at admission to RH7 (that is, at admission to our tertiary liver unit with cirrhosis) (p = 0.005). In particular, of the domains included in EQ-5D: (1) self-care was better during lockdown compared to the first record on admission to RH7 (p < 0.001). (2) the ability to perform daily activities has also improved during lockdown (p = 0.002). On the other hand, (3) pain and discomfort did not change significantly during the lockdown compared to the previous measurement (p = 0.882). (4) anxiety and depression were lower during lockdown compared to admission to RH7 (p = 0.01). The quality of life in patients with liver cirrhosis was better during the lockdown of SARS-CoV-2 compared to the previous measurement at admission to the tertiary liver unit.

Promoting Digital Proficiency and Health Literacy in Middle-aged and Older Adults Through Mobile Devices With the Workshops for Online Technological Inclusion (OITO) Project: Experimental Study

BACKGROUND

Digital inclusion and literacy facilitate access to health information and can contribute to self-care behaviors and informed decision-making. However, digital literacy is not an innate skill, but rather requires knowledge acquisition.

OBJECTIVE

The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program aimed at community dwellers.

METHODS

The program targeted the recruitment of people aged 55 and older that owned mobile devices with an internet connection in 3 cities in northern Portugal (Paredes de Coura, Guimarães, and Barcelos). The program was titled the Workshops for Online Technological Inclusion (OITO) project and, in each city, was promoted by the coordinator of municipal projects and organized as an in-person 8-workshop program, using mobile devices, smartphones, or tablets. A quasi-experimental design was used with a nonrandomized allocation of participants in each set of 8 workshops. Sociodemographic, health status, and mobile use information were collected at baseline. Digital and health literacy were measured via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively, at baseline (T1), program completion (T2), and a 1-month follow-up (T3). A self-reported measure of autonomy was evaluated at T1 and T2 using a visual scale.

RESULTS

Most participants were women with primary schooling (up to 4 years) aged between 65 and 74 years and retired. The intervention had an 81% (97/120) recruitment rate, 53% (43/81) adherence, and 94% (67/71) satisfaction rate, with 81 participants completing the entire 8-workshop program. Most participants had owned their mobile device for more than one year (64/81, 79%), were frequent daily users (70/81, 86%), and had received their mobile device from someone else (33/64, 52%). Over 80% (71/81) of the participants who completed the intervention used Android smartphones. At baseline, participants had low baseline scores in digital literacy, but medium-high baseline scores in health literacy. They showed significant improvement in digital literacy at T2 and T3 compared to T1, but without a significant difference between T2 and T3, regardless of sex, age, or schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline.

CONCLUSIONS

The feasibility indicators showed that the OITO project methodology had a substantial rate of recruitment and satisfaction. Program participants had significant improvement in digital literacy after 8 workshops and maintained their score 1 month after completing the intervention. There was no significant change in health literacy during the project period.

Occupational Therapy Interventions for the Improvement of the Quality of Life of Healthy Older Adults Living in Nursing Homes: A Systematic Review

Objective

To evaluate current scientific evidence on the effectiveness of occupational therapy interventions for the improvement of the quality of life of healthy adults over 65 years old living in nursing homes.

Data source

PubMed, Web of Science, Dialnet, Scopus, Cochrane, Cinahl and SciELO databases searched between 2012 and 2022.

Study Inclusion and Exclusion Criteria

a) Studies involving occupational therapy interventions in residential settings (nursing homes or community residential settings), b) Studies conducted on a population of healthy adults over 65 years old, c) Studies with a level of evidence 1a-1b to 3a-3b, d) Studies containing the MeSH descriptors in the keyword list.

Data Extraction

For each study included in the review, key information was collected and entered into a data extraction form based on Cochrane recommendations, using Microsoft Excel v.16.16.21 software.

Data Synthesis

Descriptive summary of study characteristics and summarized methodological quality of the studies.

Results

Six of the articles met the inclusion criteria and were categorised into “promotion of active ageing” and “meaningful activities and quality of life”. Overall, the strength of evidence was moderate, and the risk of bias was low.

Conclusion

Occupational therapy intervention programmes structured around the opportunity to choose meaningful activities can improve the perceived quality of life of healthy older adults living in nursing homes.

Exploring Mediation Effects of Gait Speed, Body Balance, and Falls in the Relationship between Physical Activity and Health-Related Quality of Life in Vulnerable Older Adults

The present study aimed to examine whether gait speed (GS), body balance (BB), and falls mediated the relationship between physical activity (PA) and health-related quality of life (HRQoL) in community-dwelling older adults. This is a cross-sectional study that included 305 men and 314 women (69.5 ± 5.6 years), residing in the Autonomous Region of Madeira, Portugal. HRQoL and PA were assessed using the SF-36 and Baecke Questionnaires, respectively. While BB was obtained by the Fullerton Advance Balance (FAB) scale, GS by the 50-foot (15 m) walk test, and the frequency of falls was obtained by self-report. According to the analyses, when GS and BB were placed concomitantly as mediators, the direct effect revealed by the model revealed a non-significant relationship between PA and falls. Thus, in the context of falls, GS and BB partially mediated the association between PA and HRQoL in approximately 29.7%, 56%, and 49.2%, respectively. The total HRQoL model explained a variance of 36.4%. The results can help to understand the role that GS, BB, and falls play in the relationship between PA and HRQoL of the vulnerable older adult population.

Muscle Strength and Balance as Mediators in the Association between Physical Activity and Health-Related Quality of Life in Community-Dwelling Older Adults

Lower extremity muscle strength (LEMS) and body balance (BB) are essential for older adults to maintain an upright posture and autonomously perform their basic activities of daily living. This study aimed to examine whether LEMS and BB mediate the relationship between physical activity (PA) and health-related quality of life (HRQoL) in a large sample of community-dwelling older adults. This is a cross-sectional study carried out with 802 individuals, 401 males and 401 females (69.8 ± 5.6 years), residents of the Autonomous Region of Madeira, Portugal. PA and HRQoL were assessed by the Baecke Questionnaire and e SF-36, respectively. LEMS was assessed by the Senior Fitness Test and BB by the Fullerton Advance Balance (FAB). The serial mediation pathway model pointed out that LEMS and BB partially mediated the association between PA and HRQoL in approximately 39.6% and 47%, respectively. The total variance in HRQoL explained by the entire model was 98%. Our findings may indicate the role that LEMS and BB play in the relationship between PA and HRQoL in the older population.

Development and Assessment of the Validity and Reliability of the Short-Form Life Satisfaction Index (LSI-SF) among the Elderly Population

Background: Elderly care should focus on not only prolonging life but also satisfaction with elderly life. Our study investigated the reliability and validity of the Short-Form Life Satisfaction Index (LSI-SF). Method: Data were drawn from the 2015 Taiwan Longitudinal Study on Aging. Internal consistency reliability was used to confirm that the items measured the targeted characteristics. Construct validity was established by confirmatory factor analysis (CFA). Criterion-related validity was examined with the WHO-5 Well-Being Index as an indicator of quality of life. Known-group validity was determined from the difference between frailty stage and quality of life. Results: The high consistency reliability supported the reliability of the LSI-SF. Rigorous CFA validated the construct validity of the LSI-SF. Perfect convergent and discriminant validity supported the validity of the LSI-SF. In addition, there was a significant correlation between the LSI-SF and the WHO-5 Well-Being Index. The LSI-SF appears to be a reliable measure of quality of life in the elderly. We found that frailty status was associated with lower life satisfaction, which supported the known-group validity. Life satisfaction was highest in the non-frailty stage and lowest in the frailty stage. Conclusions: The LSI-SF appears to be a valid and reliable measure of satisfaction with elderly life.

Canine Geriatric Syndrome: A Framework for Advancing Research in Veterinary Geroscience

Biological aging is the single most important risk factor for disease, disability, and ultimately death in geriatric dogs. The effects of aging in companion dogs also impose significant financial and psychological burdens on their human caregivers. The underlying physiologic processes of canine aging may be occult, or early signs of aging may be ignored because of the misconception that biological aging is natural and therefore inevitable. The ability to detect, quantify, and mitigate the deleterious processes of canine aging would greatly enhance veterinary preventative medicine and animal welfare. In this paper we propose a new conceptual framework for aging in dogs, the Canine Geriatric Syndrome (CGS). CGS consists of the multiple, interrelated physical, functional, behavioral, and metabolic changes that characterize canine aging as well as the resulting clinical manifestations, including frailty, diminished quality of life, and age-associated disease. We also identify potential key components of a CGS assessment tool, a clinical instrument that would enable veterinarians to diagnose CGS and would facilitate the development and testing of interventions to prolong healthspan and lifespan in dogs by directly targeting the biological mechanisms of aging. There are many gaps in our knowledge of the mechanisms and phenotype of aging in dogs that must be bridged before a CGS assessment tool can be deployed. The conceptual framework of CGS should facilitate identifying these gaps and should stimulate research to better characterize the processes and effects of aging in dogs and to identify the most promising preventative strategies to target these.

Concepts of health in different contexts: a scoping review

The rationale of our study was that the World Health Organization's (WHO) definition of health from 1947 which includes "… complete physical, mental and social wellbeing…" does not fit the current societal viewpoints anymore. The WHO's definition of health implies that many people with chronic illnesses or disabilities would be considered unhealthy and complete wellbeing would be utopian and unfeasible for them. This is no longer uniformly accepted. Many alternative concepts of health have been discussed in the last decades such as 'positive health', which focusses on someone's capability rather than incapability,. However, the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings. The objective of our study was to create a structured overview of published concepts of health from different perspectives by conducting a scoping review using the PRISMA-ScR guideline. A literature search was conducted in Pubmed and Cinahl. Articles eligible for inclusion focussed on the discussion or the conceptualisation of health or health-related concepts in different contexts (such as the perspective of care workers' or patients') published since 2009 (the Dutch Health Council raised the discussion about moving towards a more dynamic perspective on health in that year). Seventy-five articles could be included for thematic analyses. The results showed that most articles described a concept of health consisting of multiple subthemes; no consensus was found on one overall concept of health. This implies that healthcare consumers act based on different health concepts when seeking care than care workers when providing care. Having different understandings of the concepts of health can lead to misunderstandings in practice. In conclusion, from every perspective, and even for every individual, health may mean something different. This finding stresses the importance that care workers' and healthcare consumers' meaning of 'health' has to be clear to all actors involved. Our review supports a more uniform tuning of healthcare between healthcare providers (the organisations), care workers (the professionals) and healthcare consumers (the patients), by creating more awareness of the differences among these actors, which can be a guide in their communication.

Experienced Quality of Life and Cultural Activities in Elderly Care

We investigated if cultural activities are associated with improved quality of life experiences of older people. In 2012, older people in five care units were invited to participate more cultural activities (study group) than usual. Each person in the study group had a tailored cultural plan integrated into the care plan. Older people in traditional care units (control group) did not have such cultural plans.

One hundred sixty-one persons from care units in two cities in Finland participated in 2012 and 161 persons in 2014 in a cross-sectional study. Their quality of life was assessed with the World Health Organization’s Quality of Life WHOQOL-BREF (Field Tríal Version) enquiry. The quality of life variable contained four domains: physical, psychosocial, social and environment. The values of these domains underwent multivariate analysis of variance of the following explanatory variables: intervention group, age (</= to 80 compared to >80 years old), education background, marital status, gender and comorbidities. The domains of the participants’ self-rated experience were also assessed.

The quality of life experience was similar at baseline in 2012 in both study groups. In 2014 the study group rated the quality of life (p<0.0001 respectively) and satisfaction with health (p=0.001 respectively) higher than the control group.

Older people in care units need cultural activities as a necessary part of their care. The care provided in the care units does not put enough emphasis on this need. With individually tailored cultural activities set down in a cultural plan, care providers can ensure a better quality of life for older people.

Determinants of Subjective Loneliness and Quality of Life among Community-Dwelling Older Adults in Gorgan, Iran

The purpose of this study was to identify the determinants of, and relationship between, subjective loneliness, general health and quality of life (QoL) among lonely community-dwelling older adults. A cross-sectional study was carried out among a sample of lonely (i.e. live alone without any assistance) older adults living in Gorgan city, Iran. The older adults were invited through a census sampling technique to complete six questionnaires, namely a 20-item UCLA loneliness scale, a six-item Lubben Social Network Scale, a 12-item Multidimensional Scale of Perceived Social Support, a 17-item Self-care Ability Scale for the Elderly (SASE), a General Health Questionnaire-12, and a Control, Autonomy, Self-Realization and Pleasure (CASP-19) questionnaire. Hierarchical multiple linear regressions were done with subjective loneliness and QoL as outcome variables. In total, 213 (91% females) lonely older adults (mean age: 68.2 ± 6.2) participated. Hierarchical multiple linear regressions yield socio-demographic characteristics (p < 0.001), predictor group 1 (p < 0.001), predictor group 2 (p < 0.001) explained 12.5, 13.5 and 46.6% of the observed variance in loneliness, respectively. Moreover, socio-demographic characteristics (p < 0.001), predictor group 1 (p < 0.001), predictor group 2 (p < 0.001) and feeling of loneliness (p < 0.001) accounted for 16.9, 21.1, 48.6 and 55.3% of the observed variance in quality of life, respectively. Both subjective loneliness and QoL were moderate in our sample. We suggest the presence of a probable causal inference between subjective loneliness, general health, and QoL; implying the need of population strategies for correcting subjective loneliness for its own sake as well as to help have an improved general health and QoL among older adults. Beside several non-modifiable factors (such as age, ethnic groups), we suggest that corrective measures should be based on social support and networking, self-care behavior, leisure activities, adapted for age, literacy and racial specifications. Given its population health relevance, there should be increased research and intervention on loneliness among older adults.

Balance in life as a prerequisite for community-dwelling older adults' sense of health and well-being after retirement: an interview-based study

Purpose

This study aimed to describe community-dwelling older adults’ perceptions of health and well-being in life after retirement.

Methods

This study is part of a larger project using a mixed-methods design to address lifestyles’ influence on community-dwelling older adults’ health. Individual semi-structured interviews were conducted with 18 older adults in age 70 to 95 years. Data were analysed according to a phenomenographic approach.

Results

The results encompass four categories describing variations in community-dwelling older adults’ perceptions of health and well-being after retirement: feeling well despite illness and disease, interacting with and being useful for oneself and others, independently embracing opportunities and engaging in life, and maintaining a healthy lifestyle.

Conclusions

The absence of illness and disease is not a clear prerequisite for a sense of health and well-being. To promote and preserve health and well-being after retirement, older adults strived for—and coached themselves to uphold—a balance in life, focusing on not burdening others. This life orientation after retirement must be acknowledged by society at large, especially from an ageist perspective, and in health and social care to preserve and promote health and well-being.

Experience and Perceptions of Changes in the Living Environment by Older People Losing Their Autonomy: A Qualitative Study in the Caribbean

Rationale

Although the literature recognizes the importance of older individuals’ subjective perceptions about their living environments, past studies on the subject have been primarily restricted to nursing home settings.

Objective

This study aimed to better understand the experiences, perceptions, coping mechanisms, and needs of older people living in Martinique who had to modify their living environment because of a decline of autonomy.

Design

Qualitative study using content analysis.

Methods

Semi-structured one-on-one interviews were conducted with older people living in three different types of environment i) at home with professional support, ii) in a foster care family, iii) in a nursing home. Interviews were conducted until data saturation was reached. A conventional content analysis approach was used.

Results

Thirty-four participants were interviewed. Subjects perceived ageing as a factor leading to changes in their living environment. However, they did not spontaneously evoke their functional/structural impairments nor their activity limitations as if the change of living environment could reduce the perceived loss of autonomy by maintaining an acceptable participation. Participants mostly experienced change as both inevitable and as a relief as it took them out of isolation and domestic hardship. This reaction was somewhat facilitated by spiritual beliefs as the changes were interpreted as the will of spiritual forces. Family and social relationships appeared to be more important determinants of participants’ perception of changes in living environment than was health status. We found differences between the three groups regarding familial relationship, fear of death, acceptance of change, and unmet needs. Unmet needs were particularly expressed by those living in foster care. The concept of “feeling at home”, which emerged as essential for all participants, was lacking in foster care families.

Conclusion

Perceived autonomy, including not only functional/structural impairments, but also, social interactions, should be carefully considered when developing support services for older individuals.

Significados de ser feliz na velhice e qualidade de vida percebida segundo idosos brasileiros

Resumo Objetivo Identificar associações entre significados atribuídos ao conceito “ser feliz na velhice” e qualidade de vida percebida em amostra de idosos recrutados na comunidade. Métodos Os dados foram extraídos dos bancos da linha de base (LB; 2008-2009) e do seguimento (SG; 2016-2017) do Estudo Fibra Campinas, de base populacional, sobre fragilidade em idosos. Participaram 211 indivíduos com idade média de 81,0±4,3 anos no SG, com registro de respostas a uma questão aberta sobre felicidade na velhice na LB e à escala CASP-19 de qualidade de vida percebida (SG). Os registros da LB foram submetidos a análise de conteúdo; os do SG a medidas de frequência, posição e dispersão, e ambos a análises de regressão logística. Resultados Da análise de conteúdo foram derivados quatro temas: saúde e funcionalidade (o mais mencionado), bem-estar psicológico, relações interpessoais e recursos materiais. As categorias mais citadas foram autodesenvolvimento e relações familiares. Prevaleceram altas as pontuações na CASP-19, que foram mais prováveis entre os idosos que não mencionaram recursos materiais (OR=2,44; IC95%:1,20-4,43), nem saúde e funcionalidade (OR=2,03; IC95%:1,22-4,22), e entre os que citaram relações interpessoais (OR=1,92; IC95%:1,08-3,41) na LB. Altas pontuações no fator Autorrealização/Prazer foram mais prováveis entre os de 80-84 anos (OR=1,93; IC95%:1,01-3,68) e entre os que não citaram saúde e funcionalidade (OR=1,98; IC95%:1,00-1,98) na LB. Conclusão Felicidade na velhice e qualidade de vida referenciada a necessidades psicológicas são construtos relacionados. Sua avaliação capta vivências que excedem condições materiais e de saúde, predominantes nas medidas clássicas de qualidade de vida na velhice.

Perceived Physical Functioning and Gait Speed as Mediators in the Association Between Fear of Falling and Quality of Life in Old Age

Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = -.27; 95% CI [-0.007, -0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = -.03; 95% CI [-0.06, -0.001]; R² = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.

Brazilian Children's Understanding of the Quality of Life in Their Living Environment: A Qualitative Study

(1) Objective: To understand the perception of Brazilian children about the Quality of Life (QoL) considering their living environment. (2) Methods: This is a qualitative study conducted with children aged 6–10 years, from a medium-sized Brazilian municipality, recruited from public and private schools. An adaptation of the “draw, write, and say” method was used to collect data. At first, all children (n = 252) drew a “neighborhood with QoL”. On the same day, the researcher analyzed the graphic elements of the representations and intentionally selected the two best-detailed drawings from each class (n = 49) and the children were invited to narrate them. The narratives were analyzed through content analysis. (3) Results: Two major themes emerged from the content analysis, namely, the physical environment and social environment. The first included the needs to live in a community, such as housing, places of leisure, essential services, and natural elements. The second was relationships with family and friends. (4) Conclusion: The children presented the meaning of an environment with QoL, pointing out essential items to have this ideal environment. The social environment and the physical environment were perceived interdependently; that is, any change in one of these aspects may affect children’s QoL.

Associations of City-Level Active Aging and Age Friendliness with Well-Being among Older Adults Aged 55 and Over in Taiwan

This study aims to identify the typology of city-level active aging and age-friendliness across cities in Taiwan and examine their effects on well-being in terms of life satisfaction (aged 55 and over) and health-related quality of life (HRQoL) (aged 65 and over) among older adults. The data were from the 2017 Taiwan Senior Citizen Condition Survey. Available indicators of Taiwan’s Active Aging Index and city age-friendliness were selected, and mixed linear models were analyzed. Active aging cities were classified into four categories—content, developed, participatory, and pioneer—and age-friendly cities into insecure, infrastructural, and tranquil. Life satisfaction was rated higher in content and participatory cities compared with the pioneer city, and related to individuals’ active aging status. Physical HRQoL was rated higher in infrastructural and tranquil cities, compared with insecure cities. City types of active aging and age-friendliness have different effects on well-being, but the effects are weaker than those of individuals’ characteristics.

Enjoyable, engaging and individualised: A concept analysis of meaningful activity for older adults with dementia

AIM

The term "meaningful activity" is widely used in policy, practice and the research literature. However, definition and use of the term is unclear and inconsistent. A concept analysis was conducted to explore the fundamental attributes that make an activity meaningful for older adults with dementia and propose a conceptual model for understanding "meaningful activity" in this population.

METHODS

This study followed Walker and Avant's method of concept analysis. Searches were conducted in the Scopus, MEDLINE, CINAHL, PubMed, Academic Search Elite and Web of Science databases for literature using the term "meaningful activity." Papers published before 1996 were excluded.

RESULTS

Twenty-nine papers concerned with "meaningful activity" were analysed. This analysis identified five attributes that make activities meaningful for people with dementia: (a) enjoyable; (b) suited to the individual's skills, abilities and preferences; (c) related to personally relevant goals; (d) engaging; and (e) related to an aspect of identity. The conceptual model illustrates how individual and opportunity factors influence participation in "meaningful activity" and the consequences of this participation as discussed in the existing literature.

CONCLUSION

The findings of this concept analysis provide insight into what characteristics make an activity meaningful. Specific activities that are meaningful are different for each person and participation in personally 'meaningful activities' has the potential to positively impact the lives of people with dementia.

IMPLICATIONS FOR PRACTICE

This understanding of 'meaningful activity' can be used by those involved in research, planning or delivery of services and care for people with dementia to encourage and support participation in activities that are meaningful to individuals.

Applying dignity of risk principles to improve quality of life for vulnerable persons

OBJECTIVES

Freedom of choice impacts quality of life. Expressed through dignity of risk (DoR), nursing home (NH) residents should be afforded the dignity to take risks to enhance well-being. How DoR is understood and implemented in the context of aged care remains largely unknown. This study explored the meaning and the barriers and facilitators to applying DoR to NH residents.

METHODS

Qualitative study, comprising semistructured interviews. Senior policy makers and advocate guardians working in the aged care or disability sector were invited to participate. Recruitment continued until data saturation was reached. Two researchers coded interviews, applying inductive and thematic analysis.

RESULTS

Fourteen participants took part during 2016-2017. Analysis demonstrated uniformity in participants' description of DoR, comprising four elements: (a) individuals are at the centre of decision making; (b) life involves risk; (c) individuals must have choice; and (d) DoR is a continuum of experiences. Three main barriers for implementing DoR into practice were identified: (a) balancing autonomy with risks; (b) situational nature of DoR; and (c) taking responsibility for risk.

CONCLUSION

The novel findings provide an explicit understanding of DoR and the facilitators and barriers to applying the principle in the NH setting. These findings inform those who engage in making and implementing choices in the presence of risk for vulnerable clients. To translate the multifaceted elements of DoR into practice requires the development of unambiguous policies/guidelines about who will be responsibility for potential risks that may arise from residents' choices. Further, education programmes supporting care staff/management to enact resident choices in the presence of real or perceived risk are required.

Concepts of health in long-term home care: An empirical-ethical exploration

BACKGROUND

Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-term home care and discussed these empirical perspectives regarding moral responsibilities.

OBJECTIVES

To identify the subjective concepts of the health of non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-term home care and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals' responsibilities and rights concerning health.

RESEARCH DESIGN

A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-eight interviews were conducted with non-professionals and professionals in long-term home care arrangements in Northern Germany.

ETHICAL CONSIDERATIONS

Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16).

FINDINGS

Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it.

DISCUSSION

Normative guidelines applicable to practice in long-term home care discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals' subjective concepts of health.

CONCLUSION

Individuals' concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively.

Comparative assessment of quality of life of patients with schizophrenia attending a community psychiatric centre and a psychiatric hospital

BACKGROUND

Over the past few decades, there has been an emphasis on the de-institutionalisation of psychiatric care with a focus on community care. With Quality of Life (QoL) as an outcome measure, this study compared the QoL of patients with schizophrenia attending a psychiatric hospital and a community psychiatric centre.

DESIGN

This was a cross-sectional study in two psychiatric facilities.

METHODS

Data were obtained through a socio-demographic and clinical questionnaire; the QoL was assessed with the WHOQOL-BREF and patient satisfaction with care with CPOSS. Total and domain scores of WHOQOL-BREF for each group were calculated and compared with each other and other group characteristics. Diagnosis of schizophrenia was based on ICD-10.

RESULTS

Participants from the two centres did not differ significantly on any of the socio-demographic characteristics measured. Similarly, there was no significant difference in their overall mean WHOQOL-BREF scores as well as the mean WHOQOL-BREF of domain scores. However, the married and females from both centres significantly had higher mean WHOQOL-BREF scores than their male counterparts. Patients in remission for more than two years or those on a single type of medication (either oral or depot preparation) from both centres significantly had higher mean WHOQOL-BREF score compared with those who had less than two years of remission or on both oral and depot preparations.

CONCLUSION

Overall QoL of patients managed at the two centres was comparable, with similar socio-demographic as well as clinical variables influencing QoL. This suggests that patients with schizophrenia can be well managed at community psychiatric centres.

FUNDING

None declared.

Sense of place attitudes and quality of life outcomes among African residents in a multicultural Australian society

The study examines the association between sense of place (SOP) attitudes (e.g., place attachment, place identity, and place dependence) and health-related quality of life (HQOL) in a sample of 261 African residents in New South Wales (Australia). Participants completed measures of the Sense of Place Scale, the World Health Organization Quality of Life-BREF questionnaire, and demographic variables. Study findings are as follows: (a) levels of SOP and place attachment are positively associated with all outcomes of HQOL; (b) place identity is also positively related to HQOL in terms of better environmental health, psychological health, and physical health, but not statistically significant for social relationship and general QOL; (c) place dependence is statistically associated with outcomes of HQOL, except for general QOL which remained insignificant in both the unadjusted and adjusted models. Further ad hoc analyses suggest that African residents from Eastern Africa are more likely to develop the "aussie" place identity than those from Central Africa; and (e) African migrants who have been residents of Australia for more than 5 years, and those who are less educated are more likely to have a stronger SOP and to develop place attachment and behavioral place commitments compared with newly arrived and educated migrants, respectively. Study limitations and implications are carefully discussed.

Older people’s travel and mobility needs: a reflection of a hierarchical model 10 years on

Purpose

In 2010, the authors published a model of older people’s travel and mobility needs in the Quality of Ageing and Older Adults journal (Musselwhite and Haddad, 2010b). The model comprises three levels, practical (the need to get from A to B as quickly, cheaply and efficiently as possible), psychosocial (the need for independence, control and status) and aesthetic needs (the need for travel for its own sake), all which need to be fulfilled to achieve wellbeing and quality of life. Since then, the model has been translated into different languages and been cited 119 times across different formats. The paper aims to discuss this issue.

Design/methodology/approach

Using ten years of analysing feedback that includes articles that cited the model, discussions with academics, policy makers and practitioners as well as from older people themselves, this paper reflects on the original model.

Findings

Five key themes are generated from the re-examination: the validity of the model; the utility and usefulness of needs in understanding travel behaviour and turning them into policy or practice; application of the model to different contexts; understanding the relationship between travel needs and health and wellbeing; and fitting the model to future changes in transport and social policy.

Originality/value

This reflection on this well-cited and well-used model allows a re-adjustment of the model, updating it to be used in conjunction with policy and practice, especially highlighting the need to further distinguish mobility for aesthetic needs.

Comfort, well-being and quality of life: Discussion of the differences and similarities among the concepts

Highlights

The distinction among the concepts of comfort, well-being and QoL is often unclear.This ambiguity can lead to redundancies, gaps, and knowledge dispersion.The concepts are not surrogate terms but related concepts sharing common attributes.

Aim

To analyze the differences and similarities of the concepts of comfort, well-being and quality of life (QoL).

Methods

Review of concept analysis research on PubMed, Cinahl (full text) and Scielo, using the search terms "Comfort", "Well-being", "Quality of Life" and "Concept Analysis".

Results

Eighteen studies were included. Comfort is a broader holistic concept while well-being is mainly related to psycho-spiritual dimensions. QoL reflects the individual perception of satisfaction with life.

Conclusions

The concepts are not surrogate terms, but related concepts sharing common attributes. Caution should be taken in further research, particularly as regards the correct use and framing of the concepts.