Quality of life: a possible health index for the elderly

Activities of daily living decrease similarly in hospital-treated patients with a hip fracture or a vertebral fracture: a one-year prospective study in 151 patients

Aims: A hip fracture is commonly regarded as the most devastating fragility fracture, as regards both morbidity and mortality, while a vertebral fracture is usually regarded as having lower general morbidity. The purpose of this study was to investigate whether hospitalized patients with a hip or a vertebral fracture experience similar functional deterioration following the fracture as regards activity of daily living (ADL) and experienced quality of life (QOL). Methods: Eighty-seven women and 22 men, mean age 81 (range 66 - 96), with a hip fracture and 34 women and 8 men, mean age 81 (range 68 - 92), with a vertebral fracture were followed up for 12 months. ADL before fracture and at 4 and 12 months after the fracture were evaluated as well as QOL at 4 and 12 months after the fracture, by questionnaires. Results: A hip and a vertebral fracture in community dwellers within the same age range confers a similar decrease in ADL during the four months following the fracture. No restoration was seen in ADL or total QOL during the year following the fracture. Patients with a vertebral fracture had a lower QOL than patients with a hip fracture 4 and 12 months after the fracture. Conclusion: The need for external community assistance for patients with a vertebral fracture that forces them to have hospital treatment may be similar to the need following a hip fracture.

An evaluation of transition in functional states among the elderly in Beijing, China

OBJECTIVES

The goal of the present study was to describe the changes in activities of daily living (ADL) of community-dwelling Beijing elderly people (n=3,257), observed for 8 years, and to identify the demographic characteristic that predict the functional change.

METHODS

Two sets of interview data (1992 and 2000) were used to evaluate changes among the elderly in reports of limitation in ADL management.

RESULTS

The prevalence of disability increased over 8 years both in IADL and BADL disability. The patterns of ADLs change were bi-directional. A large proportion (74.7%) of the elderly were found to remain active in their functional states, 20.4% of the elderly declined, 3.4% of the elderly remained disabled, and 1.5% showed improvement in functional states. The transition rates from non-disability and disability states to various functional states showed different characteristic, a high disability rate accompanied a high mortality rate. The demographic factors that affected the level of disability among different kinds of population manifested similar trends.

CONCLUSION

Age was the most significant predictor for functional limitations. In addition, demographic variables played an important role in estimating functional outcomes. It is recommended that the demarcation factor for the evaluation of ADLs should be 75 years of age.

Patient-reported physical activity questionnaires: a systematic review of content and format

Background

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.

Methods

Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers.

Results

104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories.

Conclusions

A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.

Heterogeneity in self-assessed health status among the elderly in India

The authors examine the observed heterogeneity in self-assessed health (SAH) among the aged in India using data on health and living conditions of the elderly in India from the 60th Round of National Sample Survey (2004-2005). Results indicate that almost one fourth of the old in India rate their health as poor, and there exists considerable interstate variations in SAH ratings. Based on hypotheses framed on the basis of preliminary evidence, the article uses ordered probit models to find that probabilities of reporting poor health are increasingly clustered and more likely among the poor, single, lower-educated, and economically inactive groups among the elderly, with those states with a higher proportion of older people reporting poor subjective health status. Physical mobility appears to have a strong and direct bearing on SAH. The authors also identify unobserved heterogeneity among the states and also among the health rating categories.

Changes in active life expectancy among older thais: results from the 1997 and 2004 national health examination surveys

This study aims to determine the disability prevalence and changes in active life expectancy of the Thai older people between 1997 and 2004. Data on disability of older people aged ≥60 years were obtained from the National Health Examination Surveys. Disability refers to one or more restrictions on the activities of daily living. The Sullivan method was used to calculate active life expectancy. A total of 4048 older people in 1997 and 19 372 older people in 2004 were included in the analysis. Active life expectancy at age 60 of men was 16.5 years in 1997 and 17.6 years in 2004, whereas that of women was 17.9 and 19.9 years, respectively. Women spent a greater proportion of the remaining life with disability. The proportion of active life for both genders also increased during the 7-year period suggesting an evidence of the compression of morbidity in Thai older people.

Self-rated health and social role as predictors for 6-year total mortality among a non-disabled older Japanese population

We examined whether social role and self-rated health in an older population were predictors for 6-year total mortality among a non-disabled community-dwelling older population in Saku City, Nagano Prefecture, Japan, surveyed in 1992 and 1998. A total of 8090 men and women aged 65-99 years who reported no disability in performing activities of daily living (ADL) at the time of the survey in 1992 and provided information on their survival status at follow-up 6 years later were analyzed in this study. One dependent variable was survival status in 1998 and independent variables were various factors potentially associated with total mortality, which were obtained from a questionnaire survey at the baseline. During the 6-year interval, having poor self-rated health and poor social roles were identified as significant predictors for total mortality among both men and women. This study revealed that social role and self-rated health are independent predictors for 6-year total mortality for non-disabled Japanese aged 65 years or older.

Working late: the impact of work after 70 on longevity, health and function

BACKGROUND AND AIMS

Although many older persons choose to postpone retirement, the health consequences of this decision are still debated. This study aimed at determining the impact of continued employment on life-style, well-being, health and survival in a cohort of community-dwelling 70-year-olds.

METHODS

A longitudinal study of a homogeneously aged cohort was conducted in two stages. Data from extensive interviews, physical examinations and clinical laboratory information were obtained from west Jerusalem residents born in 1920-1 through home-based examinations. In 1990-1, 162 women and 218 men were examined, at age 70, and in 1997-8, 390 women and 398 men at age 77. Two hundred and thirty one subjects participated in both study stages and were available for longitudinal analysis. For each subject at each study stage, a comprehensive profile detailed social characteristics, including life-style and personal functions, and medical status including illnesses and use of medical services. At each stage, employed subjects were compared with those who neither worked for compensation nor as volunteers. Logistic regression compared health outcomes at age 77 for subjects who worked at age 70 with those of subjects who had not.

RESULTS

At age 70, 37 women and 98 men were gainfully employed, whereas 125 women and 120 men did not work. At age 77, wage-earners numbered 26 women and 95 men, and non-workers 364 women and 303 men. In the cross-sectional analyses at ages 70 and 77, work correlated with better perceived health and greater independence for both women and men. Independent of pre-existing economic difficulties, education, illnesses, functional dependence and self-assessed health, workers at age 70 after seven years were in better health (OR 2.12, 95% CI 1.04, 4.30), had more ADL independence, (OR 2.60, 95% CI 1.08, 6.29) and increased survival rates (OR 2.13, 95% CI 1.06, 4.28).

CONCLUSIONS

Independent of baseline status, working at age 70 correlates with health, self-sufficiency and longevity.

Effects of cognitive function on functional decline among community-dwelling non-disabled older Japanese

This study examined whether cognitive impairment, falls, and urinary incontinence (UI) were independent predictors of functional decline using a 2-year observation of a non-disabled older Japanese cohort living in a community from 1999 to 2001. A total of 139 men and 214 women aged 70-94 years at the baseline who were independent in both activities of daily living (ADL) and instrumental activities of daily living (IADL) were analyzed in this study. Independent variables, such as cognitive impairment, falls, UI, and other possible factors associated with functional decline were obtained from an interview survey at the baseline. A dependent variable was functional status in ADL and IADL obtained at the time of the 2-year follow-up. During the 2-year follow-up, cognitive function was a significant predictor for both IADL dependence and ADL and/or IADL dependence. Using a group of subjects with Mini Mental State Examination (MMSE) scores of 30-27 points as a reference group, a significant correlation was identified between lower MMSE scores and an increased odds ratio for functional decline. Lower cognitive function was a significant predictor of functional decline, even among those older Japanese whose cognitive function was deemed to be within the normal range.

Psychological well-being and associated factors among elderly Hansen's Disease patients in leprosaria

OBJECTIVES

We investigated psychological well-being and associated factors among elderly Hansen's Disease (HD) patients in three national leprosaria in Japan.

METHODS

Three questionnaires on physical and social factors, and psychological well-being based on the 12-item of General Health Questionnaire (GHQ-12) were used to survey all HD patients admitted to three leprosaria in Japan. The number of respondents over 65 years old who completed all 12 items of GHQ-12 was 754 (459 men and 295 women) with a response rate of 80.9%. Data were analyzed by t-test and analysis of covariance (ANCOVA) to determine factors associated with psychological well-being.

RESULTS

The impairment in 8 physical functions, walking, eating, and toileting for both men and women, bathing for men, and vision, dressing and grooming for women, were significantly related to high GHQ-12 scores by t-test and ANCOVA. Having no close friends, less frequent contact with neighbors, and no or less frequent participation in group activities in men, and inactive daily life style in male and female HD patients, were related to high GHQ-12 scores by both analyses.

CONCLUSION

The present results showed that physical factors and inactive daily life style were related to psychological well-being for both men and women. Social factors were related to psychological well-being among elderly male HD patients in Japan. Further follow-up study is necessary to examine the causal relationships among psychological well-being and associated factors.

The effect of aging on functional decline among older Japanese living in a community: a 5-year longitudinal data analysis

BACKGROUND AND AIMS

Using longitudinal data analyses, we examined the effects of aging on functional decline, based on activities of daily living (ADL) and instrumental activities of daily living (IADL) during a 5-year follow-up among older people living in a community in Japan.

METHODS

The baseline survey in July 1988 involved all elderly residents aged 60 or older in Saku City, Nagano, Japan (N=13418). All survivors of this cohort were asked to participate in follow-up surveys conducted in 1989, 1990, 1991, 1992 and 1993. Five items of ADL and five of IADL were measured on each survey. A generalized estimating equations (GEE) analysis was used to examine the effects of aging on the increase of the proportion of subjects with functional dependence.

RESULTS

These results indicated that the proportion of subjects who were dependent in ADL increased during the 5-year period by 2.2 times (p<0.001) and the proportion of those who were dependent in either ADL or IADL increased during the same period by 1.8 times (p<0.001). Gender did not appear to be significantly associated with functional decline.

CONCLUSIONS

The GEE analysis in this study identified the statistically significant effect of aging on the increase of the proportion of subjects with functional dependence based on ADL and IADL.

Social support exchange and quality of life among the Korean elderly

This study examined the impact of providing and receiving support on the quality of life (QOL) of the elderly. Trained interviewers conducted face-to-face interviews with 714 rural community residents aged 60 and over in Korea. Subjects were asked a series of structured questions including age, sex, living arrangement, physical functions, and the frequency of providing and receiving support in their network (spouse, children, and friends). The Philadelphia Geriatric Center Morale Scale was used to measure degree of QOL. Results indicated that respondents had family-centered support networks. We found a significant correlation between support and physical functions and, less strongly, between support and age. When physical function was controlled, ANOVAs (Analyses of Variance) showed that providing support to their children and friends was more strongly related to QOL score than receiving support from the in both males and females. Overall, the elderly who exchanged support frequently, both providing and receiving support, showed the highest QOL in most situations. Researchers and policy makers should explore the potential benefits of providing support as well as receiving support.

Functional transitions and active life expectancy for older Japanese living in a community

We examined functional transitions in both the activities of daily living (ADL), and instrumental activities of daily living (IADL), over a 1-year interval among older Japanese living in a community, then estimated their physically active life expectancy (PALE) and instrumentally active life expectancy (IALE). In 1992, all residents aged 65 or older who lived in Saku City, Nagano, Japan, were followed-up over the 1-year interval. A self-administrated questionnaire, which involved age, sex, five ADL items, and five IADL items, was used for each survey in both 1992 and 1993. Of the baseline cohort (n=10,098), we received 9533 analyzable questionnaires at the follow-up survey in 1993. During the follow-up, 92 and 87% of subjects who were initially independent in ADL and IADL remained independent, respectively. PALE for men and women were estimated to be 16.0 and 18.9 at 65 years of age, respectively. IALE for men and for women were estimated to be 12.8 and 14.6 at the age of 65, respectively. Proportions of the PALE to total life expectancy (TLE) at any age did not greatly differ between men and women; however, men had a slightly larger proportion of IALE to TLE at any given age than women.

Active life expectancy for people over 65 years old in a local city in the northern part of Tohoku district

Life expectancy does not necessarily match quality of life (QOL). A cohort study involving a population of 10,107 in a certain city of Japan was conducted to evaluate active life expectancy (ALE), which has a direct relationship with QOL. The ALE that took functional recovery rates into account was 17.20 and 19.08 years for males and females respectively, at the age of 65. These values increased by 2.98 and 3.87 years for men and women, respectively, compared with when functional recovery rates were not considered. ALE may serve as an indicator for the objective evaluation of various public health services provided by local governments.

Predictors for functional decline among nondisabled older Japanese living in a community during a 3-year follow-up

OBJECTIVES

To examine predictors for functional decline in basic activities of daily living (BADL) as well as predictors for decline in instrumental activities of daily living (IADL) among nondisabled older Japanese people living in a community during a 3-year interval from 1992 to 1995.

DESIGN

A prospective cohort study.

SETTING

A community-based environment.

PARTICIPANTS

A total of 583 men and women aged 65 to 89 at baseline who were independent in both BADL and IADL.

MEASUREMENTS

Independent variables regarding various factors potentially associated with functional decline were obtained from an interview survey and medical examinations at baseline. Dependent variables were functional status in BADL and IADL obtained at the time of the 3-year follow-up.

RESULTS

During the 3-year follow-up, significant predictors for functional decline in BADL and only IADL decline included (1) age of > or = 75, (2) less hand-grip strength, and (3) a history of hospitalization during the past 1 year. In addition, having poor intellectual activities and having poor social roles were identified as significant predictors for functional decline in only IADL during the 3-year follow-up. Furthermore, not having the habit of taking a walk was identified as a significant predictor of functional decline in BADL during the 3-year interval.

CONCLUSION

Having a high level hand-grip strength, good intellectual activities, and good social roles are strongly associated with remaining independence in IADL for the nondisabled Japanese persons aged > or = 65.

Chewing ability and quality of life among the elderly residing in a rural community in Japan

The present study statistically evaluates the relationship between chewing ability and quality of life (QOL) in elderly Japanese residents. We used a subjective evaluation and a mastication score determined by the food intake status to evaluate chewing ability. The PGC morale scale was used to evaluate the QOL level. The mastication score was significantly related to the QOL level in the subject group (P<0.05). The relationship between the subjective evaluation of chewing ability and the score on the PGC morale scale showed a similar tendency. In the section of the PGC morale scale that assesses agitation, attitude towards own aging, and lonely dissatisfaction, chewing ability was correlated with attitude toward own aging in particular (P<0.05). These results have suggested that the chewing ability is closely related to the QOL of the elderly residing in a rural community in Japan.