Successful aging defined by health-related quality of life and its determinants in community-dwelling elders

Sleep and Healthy Aging: A Systematic Review and Path Forward

OBJECTIVES

The purpose of this systematic review was to synthesize research examining the cross-sectional and longitudinal associations between sleep and healthy aging in late-life.

METHODS

A systematic search was conducted via both PubMed and PsychINFO databases using terms related to "sleep" and "healthy aging." Studies which examined the association between healthy aging and one or more sleep parameters were included in the present review.

RESULTS

Fourteen relevant studies, nine cross-sectional and five longitudinal, were identified. Overall, cross-sectional studies revealed that positive indicators of sleep were generally associated with a greater likelihood of healthy aging. In contrast, a limited number of existing longitudinal studies revealed mixed and inconclusive results.

CONCLUSIONS

Findings suggest that adequate sleep is more likely to coincide with relevant markers of healthy aging in late-life and underscores the need for additional research investigating the longitudinal associations between sleep and healthy aging.

CLINICAL IMPLICATIONS

Healthy sleep, consisting of moderate sleep duration and good quality, shows promise for the promotion of healthy aging. Consequently, poor sleep should be identified and intervened upon when necessary.

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Healthy Aging and its Determinants Among Community-dwelling Older Persons in East Coast, Malaysia: A Multidimensional Assessment

Objectives

Exploring the possibility of healthy aging among older persons is crucial for achieving optimal health in the growing older population. This study aimed to determine the prevalence, pattern, and determinants of healthy aging among older persons in Terengganu, Malaysia.

Methods

We conducted a community-based cross-sectional study involving older persons aged % 60 years. An interviewer-guided questionnaire, anthropometric measurements, and physical assessments were administered to operationalize healthy aging based on a multidimensional concept.

Results

Among the 765 older persons surveyed, only 14.1% (95% CI: 11.64?"16.59) were classified as healthy agers. Multiple logistic regression analysis revealed that superior intrinsic religiosity (odds ratio (OR) = 3.42; 95% CI: 1.34?"8.73), higher social interaction (OR = 2.82; 95% CI: 1.32?"6.04), larger calf circumference (OR = 2.05; 95% CI: 1.24?"3.38), taking water intake % 5 cups per day (OR = 2.01; 95% CI: 1.23?"3.30), better gait speed (OR = 1.71; 95% CI: 1.04?"2.80), having savings (OR = 1.71; 95% CI: 1.10?"2.66), and normal waist circumference (OR = 1.63; 95% CI: 1.04?"2.55) were found positively associated with healthy aging.

Conclusions

Only one in 10 older persons in the state met all the criteria for healthy aging. Specific aspects of religious status, social interaction, socioeconomic, behavioral, physical, and nutritional factors were found to predict healthy ageing in this population. These important determinants should be considered in developing a well-defined and comprehensive public health policy to promote healthy aging in the nation.

Perspectives of Rural Older Women on the Determinants of Successful Ageing in Southeast Nigeria

As the global population of older persons continues to increase, the need for improved quality of life and increased life satisfaction has made successful ageing a critical discourse. The concept of successful ageing is subject to socio-cultural interpretations; thus, our study delved into the perspectives of rural older women on the determinants of successful ageing. Data were collected through semi-structured interviews with 15 rural older women aged 65 years and above in Awgu Local Government Area, Enugu State, Southeast Nigeria. Data collected were analysed thematically, and findings revealed that positive social and spiritual relationships were the most critical determinants of successful ageing. Access to and utilisation of digital technology to maintain social ties were also recognised as crucial to the successful ageing of rural older women. Thus, interventions towards successful ageing should focus on improving healthy spirituality, positive social relations and improved connection with social ties through increased access to digital technology.

Association between bidirectional intergenerational support and successful aging in China: Evidence from CHARLS 2018

Aging has gradually accelerated in China, and achieving successful aging of older adults has become a public health concern. Intergenerational support is crucial for Chinese older adults in later life due to the culture of filial piety. However, the association between successful aging and intergenerational support remains poorly understood in China. This study aimed to examine the association between patterns of intergenerational support and successful aging of older adults in China. The present study is a secondary analysis of data obtained from the follow-up survey of the China Health and Retirement Longitudinal Study 2018. Data were analyzed using descriptive statistics and logistic regressions. Bidirectional intergenerational support was associated with successful aging in the participants. In addition, there was an association between different intergenerational financial, caring, and emotional support patterns and elements of successful aging.

Understanding the impact of digital technology on the well-being of older immigrants and refugees: A scoping review

Background

The fast-paced development of digital technologies in the areas of social media, pet robots, smart homes, and artificial intelligence, among others, profoundly influence the daily lives of older adults. Digital technology can improve the well-being and quality of life of older adults, older immigrants and refugees who suffer migration-associated stress, loneliness, health and psychosocial challenges.

Aims

The aim of this scoping review is to map out extant empirical literature that has examined the implication of digital technology among older refugees and immigrants.

Methods

Using a1 five-stage framework, we conducted a scoping review of peer-reviewed empirical studies published in English with no time restrictions. We searched nine databases for the reviews, and abstracts were reviewed using Rayyan QCRi(c) before the full-text review. The comprehensive database search yielded 4134 articles, of which 15 met the inclusion criteria.

Results

The results of the review suggest that digital technology is essential to the well-being, quality of life of older immigrants and refugees, especially for maintaining and building new social support networks, navigating opportunities, coping with migration-induced stress through e-leisure, and staying connected to their culture. The literature also revealed poor utilisation of digital technologies amongst older immigrants and refugees, suggesting barriers to access.

Conclusion

The study concluded by highlighting the need for more research and interventions that focus on multiple strategies, including education for increased access to and utilisation of digital technology to ensure that more older migrants can benefit from the advantages of digital technology in a safe way.

Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

BACKGROUND

This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany.

METHODS

Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly.

RESULTS

One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status.

CONCLUSIONS

Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.

Differences reported in the lifespan and aging of male Wistar rats maintained on diets containing fat with different fatty acid profiles (virgin olive, sunflower or fish oils) are not reflected by histopathological lesions found at death in central nervous and endocrine systems

The present study was designed to examine if dietary fat sources that have shown differences in lifespan and if some aging-related aspects can modulate the range of histopathologic changes in central nervous and endocrine systems that occur during the lifespan of Wistar rats. Moreover, it was attempted to gain insight into the relationship between longevity and the development of the different pathological changes, as well as possible interaction with diet. In order to achieve this, male Wistar rats were randomly assigned to three experimental groups fed semisynthetic and isoenergetic diets from weaning until death with different dietary fat sources, namely virgin olive, sunflower, or fish oil. An individual follow-up until death of each animal was performed. Incidence, severity, and burden of specific or group (i.e., neoplastic or non-neoplastic proliferative and non-proliferative) of lesions was calculated along with individual's disease and individual organ lesion burden. Most of the histopathological lesions found have been described in previous studies. Neoplasms, and in particular pituitary adenomas followed by brain tumors, were the most prevalent lesions found in the rats and the main cause of death involving both systems. Incidence of brain lesions was associated with age-at-death. Assayed dietary fats did not present differential effects on pathological changes occurring in endocrine and central nervous systems throughout rat lifespan.

Americans Aging With Disabilities Are More Likely to Have Multiple Chronic Conditions

Using data from the 2010 to 2017 National Health Interview survey, bivariate and multivariate regression analyses were utilized to estimate the percentage and odds of having multiple chronic conditions (two or more, three or more) among U.S. adults ages 65 and over with and without disabilities, controlling for sociodemographic factors and presence of psychological distress. Older adults with and without disabilities in the United States most frequently reported having hypertension, arthritis, and diabetes. Regression results indicate that older adults with disabilities are significantly more likely to experience two or more and three or more chronic conditions than older adults without disabilities, controlling for sociodemographic factors and health behaviors. These findings highlight a need for improvement in coordinated care that considers both disability and multiple chronic conditions in the management of patient health to support well-being in aging.

Prospective Study of Ageing Trajectories in the European DO-HEALTH Study

INTRODUCTION

Ageing trajectories range from delayed ageing with extended health to accelerated ageing, with an increased risk of frailty. We evaluated the prevalence and prospective change between health states among community-dwelling European older adults.

METHODS

This prospective study is a secondary analysis of DO-HEALTH, a randomized trial that included adults aged 70 years and older across 5 European countries. Healthy agers (HA) fulfilled the Nurses' Health Study healthy ageing criteria and accelerated agers were non-HA being at least pre-frail according to the Fried frailty criteria. We assessed the proportion of participants changing between health states over 4 assessments and evaluated the odds of changing to a more favourable category. To increase reliability and avoid regression to the mean, we averaged the first 2 years and compared them to the average of the last 2 years.

RESULTS

Of 2,157 participants, 12.4% were excluded for meeting both healthy ageing and pre-frailty criteria simultaneously. Among the remaining 1,889 participants (mean age 75.1 years, 60.9% female), 23.1% were initially HA, 44.4% were non-HA but not pre-frail, and 32.6% were pre-frail or frail. Subsequently, 65.3% remained in the same health state, 12.0% improved to a healthier state, and 22.8% progressed to a less advantageous state. After adjusting for sex, study centre, treatment, and body mass index, each year of age was associated with 6% lower odds of improving health states. Women had 35% higher odds than men of following a disadvantageous trajectory.

CONCLUSION

We observed dynamic trajectories of ageing where transitioning to a healthier state became less likely with advancing age and among women.

Utilization of ADCCs and quality of life among older adults: ethno-regional disparities in Israel

Background

Adult day care centers (ADCCs) are a common service provided for frail older adults in the community. We examined the influence of older adults’ utilization of ADCC’s on their quality of life (QoL), and whether ethno-regional disparities are factors in the gaps found concerning QoL in different regions and between different ethnic groups.

Methods

Cross sectional data were collected through structured interviews with 360 older adults attending ADCCs. Participants represented three ethnic groups and three regions in Israel. QoL was assessed by SF-36 questionnaire.

Results

The results revealed a positive correlation between weekly hours at the ADCC, satisfaction with attending ADCC, and QoL. Older adults living in the central region had higher QoL than those living in the southern and northern regions. Veteran Israeli Jews reported higher QoL than FSU immigrants Israeli Arabs in all regions. Connection to one’s residential area was also correlated with QoL. A significant moderating effect of the interaction (ethnicity*area of residence) on QoL was also revealed.

Conclusions

Attending ADCC is a vital community services to promote QoL in later life. Gaps in ADCC utilization between ethnic groups and residential region may cause disparities in QoL, specifically, in minority groups and those living in peripheral regions. Service providers should minimize the disparities by improving accessibility and availability for each person regardless of ethnicity and region of residence.

Successful ageing in the oldest old: objectively and subjectively measured evidence from a population-based survey in Germany

Despite rapid increase of people aged 80 and over, concepts of successful ageing (SA) are primarily examined for people below that age. Therefore, successful ageing was examined in a population-based representative sample of N = 1863 people aged 80 to 102 (NRW80+) with 11% living in institutionalized settings. In this survey on quality of life and well-being, multiple linear and logistic regression models were used to calculate the distribution of successful agers. According to Rowe and Kahn's objective definition, 9% of the sample aged successfully, but one-third (33%) still met four to five SA criteria. This is in line with the theoretical a priori criterion of 10% in a normal distribution of a sample, while 80% age normally and 10% pathologically. However, averages of life satisfaction, affective well-being, positive ageing experience and valuation of life were high. The majority of the oldest old (65%) are successful agers in their own subjective perception, which is not in line with objective measurements. Moreover, 11% of objectively measured successful agers do not meet subjective criteria. These empirical findings reveal a remarkable discrepancy between objective and subjective criteria of SA. Future research on concepts that define successful ageing for the oldest old should consider more holistic markers of success, e.g., outcomes of productive social engagement.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10433-021-00609-7.

The relationship between sleep quality and quality of life in aging: a systematic review and meta-analysis

This study examined the available literature concerning the association between sleep quality and quality of life (QoL) in autonomous older people with no sleep disorders. A systematic review and meta-analysis were conducted on studies identified in the PsycInfo, PubMed and Scopus databases that examined the associations between QoL and sleep quality in older adults. Our systematic literature search identified 23 studies concerning a total of 21,092 participants (range of mean ages: 58-79 years). The results showed that self-reported sleep quality, but not objective sleep quality, correlated positively with QoL with a moderate effect size (for self-reported sleep quality, the overall estimate of the average effect size was a Pearson's r = .28 [95% CI: .34, .23]; for objective sleep quality, it was r = .01 [.12, -.09]). This also applied to the main domains of QoL concerning physical and psychological health, social relationships and environmental aspects (the estimated average effect sizes ranged from Pearson's r = .13 to r = .35). These findings highlight the influence of sleep quality, and particularly of self-reported sleep quality, on QoL (as a whole and in its specific domains) in older adults with normal aging and no insomnia. This influence should therefore be investigated systematically when examining QoL.

Successful Aging Among Community-Dwelling Older Adults in Urban Areas of Liaoning Province: The Crucial Effect of Visual Ability

Purpose

Successful aging is an effective approach to coping with population aging; however, the definition and associated factors vary due to culture and demographic distribution differences. This study was designed to assess successful aging of the older adults in China and explore the associated factors.

Methods

A community-based cross-sectional study was performed in Liaoning, China. After double-cognitive function screening, 3558 older adults (1656 males and 1902 females) ≥65 years of age served as our subjects. Successful aging was assessed based on the following: physical disability; cognitive function; activities of daily living; and self-rated psychological/mood status.

Results

The rate of successful aging was 31.7% in males and 29.4% in females. After adjustment for age, multivariate logistic regression showed that successful aging was significantly associated with, in odds ratio sequence, visual ability, self-rated chronic disease, marital status, and filial piety in males, and with visual ability, self-rated chronic disease, watching television, and ethnicity in females.

Conclusion

The level of successful aging in China is lower than in other countries. Demographic characteristics, health status, individual behavior, and social-psychological factors are all associated with successful aging. Overall, visual ability had the most crucial role in successful aging for the older adults, whether males or females.

Association of quality of life with structural, functional and molecular brain imaging in community-dwelling older adults

BACKGROUND

As the population ages, maintaining mental health and well-being of older adults is a public health priority. Beyond objective measures of health, self-perceived quality of life (QoL) is a good indicator of successful aging. In older adults, it has been shown that QoL is related to structural brain changes. However, QoL is a multi-faceted concept and little is known about the specific relationship of each QoL domain to brain structure, nor about the links with other aspects of brain integrity, including white matter microstructure, brain perfusion and amyloid deposition, which are particularly relevant in aging. Therefore, we aimed to better characterize the brain biomarkers associated with each QoL domain using a comprehensive multimodal neuroimaging approach in older adults.

METHODS

One hundred and thirty-five cognitively unimpaired older adults (mean age ± SD: 69.4 ± 3.8 y) underwent structural and diffusion magnetic resonance imaging, together with early and late florbetapir positron emission tomography scans. QoL was assessed using the brief version of the World Health Organization's QoL instrument, which allows measuring four distinct domains of QoL: self-perceived physical health, psychological health, social relationships and environment. Multiple regression analyses were carried out to identify the independent global neuroimaging predictor(s) of each QoL domain, and voxel-wise analyses were then conducted with the significant predictor(s) to highlight the brain regions involved. Age, sex, education and the other QoL domains were entered as covariates in these analyses. Finally, forward stepwise multiple regressions were conducted to determine the specific items of the relevant QoL domain(s) that contributed the most to these brain associations.

RESULTS

Only physical health QoL was associated with global neuroimaging values, specifically gray matter volume and white matter mean kurtosis, with higher physical health QoL being associated with greater brain integrity. These relationships were still significant after correction for objective physical health and physical activity measures. No association was found with global brain perfusion or global amyloid deposition. Voxel-wise analyses revealed that the relationships with physical health QoL concerned the anterior insula and ventrolateral prefrontal cortex, and the corpus callosum, corona radiata, inferior frontal white matter and cingulum. Self-perceived daily living activities and self-perceived pain and discomfort were the items that contributed the most to these associations with gray matter volume and white matter mean kurtosis, respectively.

CONCLUSIONS

Better self-perceived physical health, encompassing daily living activities and pain and discomfort, was the only QoL domain related to brain structural integrity including higher global gray matter volume and global white matter microstructural integrity in cognitively unimpaired older adults. The relationships involved brain structures belonging to the salience network, the pain pathway and the empathy network. While previous studies showed a link between objective measures of physical health, our findings specifically highlight the relevance of monitoring and promoting self-perceived physical health in the older population. Longitudinal studies are needed to assess the direction and causality of the relationships between QoL and brain integrity.

Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors

BACKGROUND

Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors.

METHODS

In total, 693 participants aged 66-97 were sampled from two US locales in 2005-2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles.

RESULTS

More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC).

CONCLUSIONS

Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

From an aging person to an elegant senior: a humanistic approach to viewing older adults

The continuing growth in the number of adults aged 60-plus has raised global alertness of population restructuring. This demographic change, on the one hand, reduces productivity and increases public expenditure due to aging, resulting in prejudice, bias, misrepresentation, and discrimination against them. On the other hand, it develops a specific consumer market segment and extends the availability and accessibility of the elderly through employment, volunteering, or grandparenting. This study argues against the stigmatization of this age group from a functional perspective that damages social cohesion. It advocates a humanistic view toward seniors to eradicate marginalization and promotes the manageability of the senior population. With the aid of advanced technology and health equity, senior adults can retain everyday competence for self-care with dignity, as well as gracefully attain physical and psychological health, autonomy, and well-being in their later life. All these considerations give medical and nursing professionals insight into how to take care of the elderly.

Quality of life after hip fracture: a 12-month prospective study

BACKGROUND

Hip fracture is an important and frequent health problem worldwide. To date, there are still limited studies focused on the analysis of health-related quality of life (HRQOL) after a hip fracture in the Spanish population, especially with long-term follow-up.

OBJECTIVE

To determine the HRQOL at 12 months after hip fracture and to identify potential factors associated with HRQOL.

DESIGN

Prospective observational study.

SETTING

Traumatology units of two university hospitals in province Cáceres (Spain).

PARTICIPANTS

A total of 224 patients were admitted to the unit and required immediate surgery due to a hip fracture.

METHODS

HRQOL was measured with the EuroQol-5D questionnaire (EQ-5D) and the SF-12 Health Survey.

RESULTS

Scores from the visual analog scale EQ-5D decreased significantly (p < 0.001) from 72.8 at baseline to 48.3 after 1 month, to 48.2 after 6 months and to 46.1 after 12 months. The EQ-5D index score showed a similar significant reduction (p < 0.001) from 0.6 to 0.1, 0.3 and 0.3, respectively. Values of the physical component summary (PCS-12) significantly decreased (p < 0.001) from 38.6 at baseline to 31.0, 33.1 and 33.5. The mental component summary (MCS-12) decreased from 46.5 to 44.8 after 6 months (p = 0.022) and 44.3 after 12 months (p = 0.005). Factors potentially associated with HRQOL at 12 months after hip fracture were depression status after 12 months (B = 0-1.876; 95% CI [-2.409 to -1.343]; p < 0.001), functional ambulation classification after 12 months (B = -12.133; 95% CI [-17.970 to -6.297]; p < 0.001), EQ-5D VAS at baseline (B = 0.223; 95% CI [0.115-0.330]; p < 0.001), and age (B = -0.323; 95% CI [-0.594 to -0.053; p = 0.015).

CONCLUSIONS

Patients experience a significant impairment in HRQOL H after a hip fracture, especially in self-care, pain/discomfort, usual activities, mobility and anxiety/depression. The decline in the HRQOL is effective the first month and lasts at least 12 months after the surgical intervention.

The paradox of aging and health-related quality of life in Asian Chinese: results from the Healthy Aging Longitudinal Study in Taiwan

Background

Declines in health, physical, cognitive, and mental function with age suggest a lower level of health-related quality of life (HRQoL) in late life; however, previous studies found that the associations were weak and varied, depending on the study designs and cohort characteristics.

Methods

The present study examined the paradox of aging in an East Asian context by regressing the age patterns of objective health indicators (physical, cognitive, and mental function), and subjective HRQoL (12-item Short Form, SF-12), on the independent and interactive effects of age and physical function in a cohort study of 5022 community-dwelling adults aged 55 and older in Taiwan.

Results

Age patterns differed across measures. The SF-12 mental health score (MCS) showed a slight positive association with age and this effect remained stable after controlling for various age-related covariates. The SF-12 physical health score (PCS), in turn, was negatively associated with age. Age differences in PCS were fully explained by age decrements in objective physical health. However, consistent with the so-called paradox of aging, the association between objective and subjective physical health weakened with age.

Conclusion

These findings add to prior evidence indicating that — in spite of objective health decrements — subjective HRQoL is maintained in later life among Asian Chinese. Also, these paradoxical patterns appear to vary for mental and physical components of HRQoL, and future research is needed to explore the underlying mechanism.

Trial registration

Healthy Aging Longitudinal Study in Taiwan (HALST) is retrospectively registered at ClinicalTrials.gov on January 24, 2016 with trial registration number NCT02677831.

Domains and Measurements of Healthy Aging in Epidemiological Studies: A Review

Purpose of the Study

Few studies have recommended the essential domains of healthy aging and their relevant measurement to assess healthy aging comprehensively. This review is to fill the gap, by conducting a literature review of domains and measures of healthy aging in epidemiological studies.

Design and Methods

A literature search was conducted up to March 31, 2017, supplemented by a search of references in all relevant articles in English. We made a final selection of 50 studies across 23 countries or regions.

Results

Nineteen studies applied Rowe and Kahn’s three standards to assess healthy aging. Thirty-seven studies measured physical capabilities mainly by (instrumental) activities of daily living. Cognitive functions were included in 33 studies. Nineteen of them applied Mini-Mental State Examination (MMSE). Twenty-six studies considered metabolic and physiological health, but they mainly asked the self-reported absence of diseases. Twenty-four studies assessed psychological well-being by employing diverse scales. Questions about participation in social activities were mainly asked to measure social well-being in 22 studies. Sixteen studies considered individuals’ general health status, which was mainly measured by self-rated health. Security questions were asked in five studies. Health behaviors were taken into account by three studies. Fifteen studies either applied SF-12/36 or developed health indices to assess healthy aging.

Implications

This review summarizes detailed scales or methods that have been used to assess healthy aging in previous epidemiological studies. It also discusses and recommends the essential domains of healthy aging, and the relevant instruments for further epidemiological research to use in the assessment of healthy aging.

Successful ageing in older persons belonging to the Aymara native community: exploring the protective role of psychosocial resources

Objectives: The aim of this study is to analyse the process of successful ageing in older persons who state their belonging to a native Chilean ethnic group. There has recently been a notable increase in interest regarding analysis of the cultural processes and variables associated with successful ageing. However, there is a lack of studies analysing successful ageing in native ethnic groups; that is, ethnic communities living in their natural environmental surroundings.

Methods: A cross-sectional research design was used. The sample was composed by 232 indigenous Aymara persons aged over 60 years who live in the far north of Chile. Data were collected using a questionnaire made up of validated measurement scales for successful ageing, community support, quality of life, religiousness/spirituality, and health.

Results: The results suggest that indigenous persons age successfully, particularly in the context of physical functionality. Successful ageing is positively related with community integration, social support from informal systems (social groups), quality of life, and religiousness (forgiveness). In contrast, successful ageing is negatively related with depression.

Conclusions: Cultural practices and an active lifestyle are ethnic cultural resources enabling persons to successfully cope with ageing. The results suggest that interventions would benefit from incorporating actions within a context of community integration. Particular attention to preventing deterioration in mental health would help to foster a successful ageing process.

The Concept of Successful Aging: A Review Article

Background

With the increasing number of elderly people in the world, usage of concepts and terminology related to this phenomenon has substantially increased. One concept in this context is successful aging. The purpose of the present study is to extract and introduce a common concept to be used in studies on measuring successful aging.

Methods

This is a review study. First, by searching the databases of Magiran, Noormags, Medlib, Irandoc, Iranmedex, Barakat Knowledge Network System, Civilica, SID, ISI Web Of Science, PubMed, Scopus, Science Direct and search engines, Google Scholar and Elmnet as well as using standard keywords such as elder, elderly, aging, and successful aging, all related published articles during the period 1995 to 2017 were retrieved. A total of 3417 documents were retrieved. By removing 3390 unrelated, duplicate and unusable documents, 27 articles were included in the study after quality control.

Results

The findings of the study were categorized in three areas: “defining successful aging by focusing on dimensions”, “successful aging principles” and “factors influencing successful aging”. Reviewing various studies, we found that the definition of successful aging deals with cognitive action, perception, control, life satisfaction, and ethics. Successful aging is also defined as having inner feelings of happiness and satisfaction with life for the present and the past. Sometimes successful aging is also considered to be survival with health.

Conclusion

Health care professionals as community health supporters can use the results from the present study for providing the grounds for successful aging. Then, they can use the designed successful aging program for preserving and promoting active and healthy aging for every elderly person in old age.

Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis

PURPOSE

Frailty is an important predictor of adverse health events in older people, and improving quality of life (QOL) is increasingly recognised as a focus for services in this population. This systematic review synthesised evidence of the relationship between frailty and QOL in community-dwelling older people, with an emphasis on how this relationship varied across QOL domains.

METHODS

We conducted a systematic review with meta-analysis. We searched five databases for reports of QOL in older people with frailty and included studies based on pre-defined criteria. We conducted meta-analyses comparing "frail" and "not frail" groups for each QOL scale where data were available. We compared pooled results to distribution-based and known-group differences to enhance interpretation. We summarised reported cross-sectional and longitudinal analyses.

RESULTS

Twenty-two studies (24,419 participants) were included. There were medium or larger standardised mean differences for 24 of 31 QOL scales between frail and not frail groups, with worse QOL for frail groups. These scales encompassed constructs of health-related quality of life as well as psychological and subjective well-being. There were similar findings from mean difference meta-analyses and within-study analyses.

CONCLUSIONS

The association between frailty and lower QOL across a range of constructs is clear and often substantial. Future research should establish whether causal mechanisms link the constructs, which aspects of QOL are most important to older people with frailty, and investigate their tractability. Services focused on measuring and improving QOL for older people with frailty should be introduced.

Factors associated with health-related quality of life (HRQoL): differential patterns depending on age

PURPOSE

The aims of this study were: (1) to analyze age differences in health-related quality of life (HRQoL) between the young old (aged 65-84) and the oldest old (aged 85 and over), and (2) to investigate three types of predictors: (a) physical health [Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living, comorbidity, use of medication], (b) global cognitive ability and (c) psychosocial factors, specifically personality traits, social support and emotional functioning (positive and negative affect and life satisfaction), which may influence the HRQoL of both the young old and the oldest old.

METHOD

A cross-sectional study was conducted with 257 healthy community-dwelling elderly people. HRQoL was assessed using the SF-36 Health Survey. Functional and health status, global cognitive ability and psychosocial variables were also assessed.

RESULTS

Age differences were found in HRQoL, with the oldest old scoring lower for this variable. Multiple stepwise hierarchical linear regression analyses revealed that, in relation to the physical health component, use of medication, BADL and positive affect had the greatest influence among the young old (65-84), whereas among the oldest old, neuroticism and the BADL were the most influential factors. As regards the mental health component, neuroticism, use of medication and positive affect were the main predictor variables among the young old, while neuroticism and negative affect had the greatest influence among the oldest old group.

CONCLUSION

The oldest old had a poorer HRQoL in both dimensions measured (physical and mental). There appear to be differences between the determinants of HRQoL for young old and oldest old adults, suggesting that these associations change with age.

A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?

Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.

Determinants of Successful Aging in a Cohort of Filipino Women

This study describes a multidimensional measure of successful aging (SA) and examines the relationship with chronic disease status and self-reported health. Using data from the 2015 Cebu Longitudinal Health and Nutrition Survey of 1568 Filipino women, we created a four domain measure of SA (physiological, mental health, cognitive, sociological). We explored age-stratified associations of each domain and total SA with various health behaviors, chronic disease status, and correlations with self-reported health measures. Both age groups reported aging well, but younger women had higher mean SA scores. Association patterns between domain and total SA and sociodemographic and health behaviors were similar across age groups. Physiological score was associated with hypertension for all ages, and with diabetes in younger women. Total SA was moderately correlated with self-reported health measures. Participants reported aging successfully despite chronic disease status. Future studies should use a multidimensional definition of SA which incorporates elders’ perspective.

Successful Aging and Frailty: A Systematic Review

The terms successful aging (SA) and frailty appear to have much in common, both in terms of overlapping constructs and common challenges with consensus and operationalization. The aim of this review is to summarize existing literature that defines that relationship. Primary and secondary source articles that used either term in the title or abstract were systematically reviewed for relevance to the study objective. Of 61 articles that met these criteria, 30 were secondary source, and of these four were highly relevant. Four of the remaining 31 original research articles were selected, and the prevalence of frailty and SA in populations with different characteristics were described and compared. The same model of frailty was used in all primary studies, but definitions for successful aging were heterogeneous. The prevalence of frailty ranged from 11.8% to 44.0% and that of SA ranged from 10.4% to 47.2%. The definitions used for each, especially the extent of multidimensionality, appeared to reflect the degree of overlap between SA and frailty. Whether frailty and SA are part of the same or different constructs, there is a pressing need for an ordered taxonomy to advance research that translates into clinical practice.

Successful Aging in Colombia: The Role of Disease

Objective: This study aimed to determine the prevalence of successful aging (SA) and identify its predictive factors in a cohort of older people in the Colombian Andes Mountain. Method: Data were drawn from a prospective longitudinal study of community-dwelling elderly people in Manizales. SA encompassed indicators in four domains: physical, cognitive, emotional, and social functioning. Results: The prevalence of SA was 24.4%. The independent predictors were good and very good self-rated health, middle–high/high-income level, absence of chronic conditions, married status, high educational level, and very high spirituality. Discussion: The prevalence of SA was low: One of 10 people older than 65 years showed SA when presence of diseases was included in the criteria, compared with one of four when such an item was excluded. The identification of predictive factors allows distinguishing this population in primary care services and promoting strategies that ensure high functionality levels for as long as possible.

Factors associated with perceived quality of life in older adults: ELSI-Brazil

OBJECTIVE

To identify factors associated with perceived quality of life in a representative national sample of the population aged 50 or over.

METHODS

Data from 7,651 participants of the baseline ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between 2015 and 2016, were used. The perceived quality of life was measured by the CASP-19 scale - (CASP - control, autonomy, self-fulfillment and pleasure), considering the highest tertile as good quality of life. The independent variables included socio-demographic characteristics, mobility, loneliness, and indicators of sociability (social network, social support and social participation). The associations were tested using multivariate Poisson regression.

RESULTS

The best perceived quality of life showed a positive and independent association with the frequency of contacts with friends (PR = 1.25 for at least once every 2-3 months and PR = 1.36 for at least once a week), instrumental support from spouse or partner in the household (PR = 1.69), and emotional support from other relatives (PR = 1.45), children or children in law (PR = 1.41) and spouse or partner (PR = 1.33). Negative associations were observed for participants aged 80 and over (RP = 0.77), with 4 to 7 or 8 or more years of schooling (PR = 0.78 and 0.75, respectively) and with difficulty in mobility (PR = 0.83).

CONCLUSIONS

In addition to age and schooling, mobility, sociability and instrumental and emotional support are associated with perceived quality of life among older Brazilian adults. These characteristics must be considered when actions are taken, aiming to promote quality of life in this population.

Tai Chi with music improves quality of life among community-dwelling older persons with mild to moderate depressive symptoms: A cluster randomized controlled trial

Depression leads to a poorer quality of life (QOL) which is a determinant of healthy ageing. Cost-effective solutions for enhancing QOL in the older population are much needed in China, with its rapidly ageing population. We conducted a randomized controlled trial involving 112 community-dwelling older participants with mild to moderate depression, to evaluate the effect of Tai Chi with music on QOL (57 in intervention group, 55 in control group). WHO Quality of Life-BREF was used to measure QOL at baseline and at every month for three months. Following the adjustments for sociodemographic data, the effect of intervention on QOL was assured (F = 25.145, P < 0.001, η_p²= 0.435, F = 18.696, P < 0.001, η_p²= 0.364, F = 17.473, P< 0.001, η_p²= 0.348, and F = 29.576, P < 0.001, η_p²= 0.475 for physical, psychological, social, and environment domains respectively). This intervention represents an economically viable solution to better QOL and healthy ageing in a highly populous developing nation.

Comparison of self-rated and objective successful ageing in an international cohort

Understanding predictors of successful ageing is essential to policy development promoting quality-of-life of an ageing population. Initial models precluded successful ageing in the presence of chronic disease/functional disability; however, this is discrepant with self-reported successful ageing. Indicators of social, psychological and physical health in 1,735 people aged 65–74, living in Canada, Columbia, Brazil or Albania, were analysed in the International Mobility in Ageing Study. Multiple logistic regression analysis was performed to estimate the change in self-rated successful ageing in relation to physical health, depression, social connectedness, resilience and site, while controlling for age, gender and income sufficiency. Sixty-five per cent of participants self-rated as ageing successfully; however, this was significantly different across sites (p < 0.0005, range 17–85%) and gender (p = 0.019). Using objective measures, 6 per cent were classified as ‘successful’, with significant variability amongst sites (p < 0.0005, range 0–12%). Subjective successful ageing was associated with fewer (not absence of) chronic diseases, absence of depression and less dysfunction in activities of daily living, but not with objective measures of physical dysfunction. Social connectedness and resilience also aligned with self-rated successful ageing. Traditional definitions of objective successful ageing are likely too restrictive, and thus, do not approximate self-rated successful ageing. International differences suggest that site could be a surrogate for variables other than physical/mental health and social engagement.

Masters Athletes: Exemplars of Successful Aging?

Global population aging has raised academic interest in successful aging to a public policy priority. Currently there is no consensus regarding the definition of successful aging. However, a synthesis of research shows successful aging can be defined as a late-life process of change characterized by high physical, psychological, cognitive, and social functioning. Masters athletes systematically train for, and compete in, organized forms of team and individual sport specifically designed for older adults. Masters athletes are often proposed as exemplars of successful aging. However, their aging status has never been examined using a comprehensive multidimensional successful aging definition. Here, we examine the successful aging literature, propose a successful aging definition based on this literature, present evidence which suggests masters athletes could be considered exemplars of successful aging according to the proposed definition, and list future experimental research directions.

Comparison of quality of life among community-dwelling older adults with the frailty phenotype

PURPOSE

To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty.

METHODS

Cross-sectional analysis of baseline data of the "Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults" (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception.

RESULTS

There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001).

CONCLUSIONS

Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.

Effect of Residence in Temporary Housing After the Great East Japan Earthquake on the Physical Activity and Quality of Life of Older Survivors

OBJECTIVE

This study aimed to compare the physical activity level and health-related quality of life (HRQOL) between older survivors residing in temporary housing after the Great East Japan Earthquake (GEJE; temporary housing group) and older individuals residing in their own homes (control group) and to clarify whether mobility function and muscle strength were correlated with physical activity among older temporary housing residents.

METHODS

Subjects were recruited to the temporary housing group (n=64, 19 men and 45 women) or control group (n=64, 33 men and 31 women) according to their residence. Physical activity was assessed by the number of walking steps determined by using a triaxial accelerometer, mobility function by the Timed Up and Go test, muscle strength by the grasping power test, and HRQOL by the Medical Outcome Study 36-Item Short Form Survey v2.

RESULTS

In the temporary housing group, reduced physical activity and correlation between physical activity and mobility function in men, and muscle strength in both men and women, were observed. There was no significant difference in HRQOL between groups except for bodily pain in women.

CONCLUSION

Support for older evacuees should focus on maintaining their physical activity level as well as on HRQOL to avoid deterioration of health in these survivors. (Disaster Med Public Health Preparedness. 2017;11:701-710).

Alcohol Energy Intake Is Related to Low Body Mass Index in Japanese Older Adults: Data from the 2010-2011 National Health and Nutrition Survey

OBJECTIVE

The objective of this study was to identify lifestyle and nutritional factors associated with low BMI in Japanese older adults, with a focus on alcohol energy intake.

DESIGN

Cross-sectional study.

PARTICIPANTS

Data from 1,093 respondents (711 men and 382 women) to the National Health and Nutrition Survey aged 65 years and older were included in this study.

MEASUREMENTS

Data were analyzed for associations between BMI and lifestyle, energy, and nutrient intake. Alcohol energy intake was calculated from total energy and participants were categorized into BMI quartiles. Energy-adjusted nutrient intakes were calculated as residuals from a regression model, with BMI as the independent variable and lifestyle factors and nutrient intake as dependent variables. Between-BMI quartile differences were assessed for each sex using multivariate logistic regression analysis. In addition, the nutrient intakes of men consuming more than 280 kcal and less than 280 kcal of alcohol energy per day were compared.

RESULTS

Men and women in the lowest BMI quartile had lower total energy intake but higher alcohol energy intake than men in the other BMI quartiles. In multivariate logistic regression analysis, the lowest BMI quartile was associated with total energy (OR: 0.81, p = 0.0310) and alcohol energy intake (OR: 1.22, p = 0.0472) in men. In men, protein, carbohydrate, fat, calcium, iron, and vitamin intakes were less in those that consumed ≥ 280 kcal than in those that consumed < 280 kcal of alcohol per day.

CONCLUSION

Our results demonstrate an association between alcohol energy intake and low BMI in older Japanese individuals.

Parenting style, resilience, and mental health of community-dwelling elderly adults in China

BACKGROUND

Given the increasing elderly population worldwide, the identification of potential determinants of successful ageing is important. Many studies have shown that parenting style and mental resilience may influence mental health; however, little is known about the psychological mechanisms that underpin this relationship. The current study sought to explore the relationships among mental resilience, perceptions of parents' parenting style, and depression and anxiety among community-dwelling elderly adults in China.

METHODS

In total, 439 community-dwelling elderly Chinese adults aged 60-91 years completed the Personal and Parents' Parenting Style Scale, Connor-Davidson Resilience Scale, Zung Self-Rating Depression Scale, and Zung Self-Rating Anxiety Scale.

RESULTS

Elderly adults whose parents preferred positive and authoritative parenting styles had higher levels of mental resilience and lower levels of depression and anxiety. Elderly adults parented in the authoritarian style were found to have higher levels of depression and anxiety, with lower mental resilience.

CONCLUSIONS

The findings of this study provide evidence related to successful ageing and coping with life pressures, and highlight the important effects of parenting on mental health. The results suggest that examination of the proximal determinants of successful ageing is not sufficient-distal factors may also contribute to the 'success' of ageing by modifying key psychological dispositions that promote adaptation to adversity.

The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults

Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001–2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5–6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation.

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Social participation is a component of healthy aging.

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Population-based studies can explore associations amenable to intervention.

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Walking speed and social participation were significantly associated.

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Strength and balance were not associated with social participation.

Development of a Multidimensional Functional Health Scale for Older Adults in China

A first step to achieve successful aging is assessing functional wellbeing of older adults. This study reports the development of a culturally appropriate brief scale (the Multidimensional Functional Health Scale for Chinese Elderly, MFHSCE) to assess the functional health of Chinese elderly. Through systematic literature review, Delphi method, cultural adaptation, synthetic statistical item selection, Cronbach's alpha and confirmatory factor analysis, we conducted development of item pool, two rounds of item selection, and psychometric evaluation. Synthetic statistical item selection and psychometric evaluation was processed among 539 and 2032 older adults, separately. The MFHSCE consists of 30 items, covering activities of daily living, social relationships, physical health, mental health, cognitive function, and economic resources. The Cronbach's alpha was 0.92, and the comparative fit index was 0.917. The MFHSCE has good internal consistency and construct validity; it is also concise and easy to use in general practice, especially in communities in China.

Chronic pruritus in the elderly: pathophysiology, diagnosis and management

Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.