Quality of life and multimorbidity of elderly outpatients

Construction of a quality of life scale for older individuals with neuro-co-cardiological diseases

PURPOSE

This study aimed to develop a Quality of Life (QOL) assessment scale for older patients with Neuro-co-Cardiological Diseases (NCCD) and to evaluate the reliability and validity of the scale.

METHOD

The study participants were derived from the Elderly Individuals with NCCD Registered Cohort Study (EINCCDRCS), a multicenter registry of patients with NCCD. The preliminary testing of the questionnaire was conducted among 10 older individuals aged 65 years and older who had NCCD and were recruited from the registry. Other patients who met the inclusion criteria participated in the field testing. After verifying the unidimensionality, local independence, and monotonicity assumptions of the scale, we employed the Rasch model within Item Response Theory framework to assess the quality of the scale through methods including internal consistency, criterion validity, Wright map, and item functioning differential. Subsequently, we assessed the construct validity of the scale by combining exploratory factor analysis with confirmatory factor analysis.

RESULTS

Based on well-validated scales such as the short-form WHOQOL-OLD, HeartQOL, IQCODE, and SF-36, an original Neuro-co-Cardiological Diseases Quality of Life scale (NCCDQOL) was developed. 196 individuals from the EINCCDRCS were included in the study, with 10 participating in the preliminary testing and 186 in the field testing. Based on the results of the preliminary testing, the original questionnaire was refined through item deletion and adjustment, resulting in an 11-item NCCDQOL questionnaire. The Rasch analysis of the field testing data led to the removal of 21 misfitting individuals. The NCCDQOL demonstrated a four-category structure, achieved by combining two response categories. This structure aligned with the assumptions of unidimensionality, local independence, and monotonicity. The NCCDQOL also exhibited good validity and reliability.

CONCLUSION

The revised NCCDQOL questionnaire demonstrated good reliability and validity in the Rasch model, indicating promising potential for clinical application.

An investigation on the prevalence and patterns of multi-morbidity among a group of slum-dwelling older women of Kolkata, India

BACKGROUND

Multi-morbidity is a pervasive and growing issue worldwide. The prevalence of multi-morbidity varies across different populations and settings, but it is particularly common among older adults. It poses substantial physical, psychological, and socio-economic burdens on individuals, caregivers and healthcare systems. In this context, the present study aims to provide an insight on the prevalence and degree of multi-morbidity; and also, on the relationship between level of multi-morbidity and morbid conditions among a group of slum-dwelling older women.

METHODS

This community based cross-sectional study was conducted in the slum areas of urban Kolkata, West Bengal, India. It includes total 500 older women, aged 60 years or above. Pre-tested schedules on so-demographic and morbidity profile have canvassed to obtain the information by door-to-door survey. To determine the relationship between the level of multi-morbidity and morbid conditions, correspondence analysis has performed.

RESULTS

The study revealed three most prevalent morbid conditions- back and/or joint pain, dental caries/cavity and hypertension. The overall prevalence of multi-morbidity was 95.8% in this group of older women. It was highly over-represented by the oldest-old age group (80 years and above). Majority were found to suffer from five simultaneous morbid conditions that accounted for 15.2% of the total respondents. All of the oldest-old women of this study reported to suffer from more than two medical conditions simultaneously. Three distinct groups were formed based on the inter-relationship between level of multi-morbidity and morbid conditions. The group 1 and 2 represents only 27.8% and 18% of the total sample. Whereas, group 3 comprises the highest level of morbidities (≥ 6) and 52.8% of total sample, and strongly related with general debilities, cardiac problems, asthma/COPD, gastrointestinal, musculoskeletal problems, neurological disorders, hypothyroidism and oral health issues.

CONCLUSION

The findings confirmed the assertion that multi-morbidity in slum living older adults is a problem with high prevalence and complexity. This study proposes an easily replicable approach of understanding complex interaction of morbidities that can help further in identifying the healthcare needs of older adults to provide them with healthy and more productive life expectancy.

Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study

BACKGROUND

India is experiencing a rising burden of chronic disease multimorbidity due to an aging population and epidemiological transition. Older adults residing in urban slums are especially vulnerable due to challenges in managing multimorbidity amid deprived living conditions. This study aimed to assess the prevalence of multimorbidity, associated health literacy, and quality of life impact in this population.

METHODS

A community-based cross-sectional study was conducted among 800 adults aged ≥ 65 years in an urban slum in Gujarat, India. Data on sociodemographics, physical and mental health conditions, health literacy (HLS-SF-47), quality of life (Short Form-12 scale), and social determinants of health were collected. Multimorbidity is ≥ 2 physical or mental health conditions in one person.

RESULTS

The prevalence of multimorbidity was 62.5% (500/800). Multimorbidity was significantly associated with lower physical component summary (PCS) and mental component summary (MCS) scores on the SF-12 (p < 0.001). After adjusting for sociodemographic variables, the odds ratio of 0.81 indicates that for every 1 unit increase in the health literacy score, the odds of having multimorbidity decrease by 19%. Older age within the older adult cohort (per year increase) was associated with greater odds of multimorbidity (AOR 1.05, 95% CI 1.02-1.09). Physical inactivity (AOR 1.68, 95% CI 1.027-2.77) and lack of social support (AOR 1.57, 95% CI 1.01-2.45) also increased the likelihood of multimorbidity.

CONCLUSION

There is a substantial burden of multimorbidity among urban slum dwellers aged ≥ 65 years in India, strongly linked to modifiable risk factors like poor health literacy and social determinants of health. Targeted interventions are essential to alleviate this disproportionate burden among urban slum older adults.

Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

PURPOSE

Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs.

METHODS

Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.

RESULTS

The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient - 5.89; 95% CI - 6.83, - 4.95), 3 (- 8.35; - 9.63, - 7.06), 4 (- 10.87; - 12.37, - 9.36), and ≥ 5 (- 13.48; - 15.91, - 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).

CONCLUSION

A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

Association between Internet Usage and Quality of Life of Elderly People in England: Evidence from the English Longitudinal Study of Ageing (ELSA)

The WHO has stated that the number of senior citizens above age 65 across the world will double by the year 2050: in the UK, the whole population is projected to grow by about 2.5% over a decade, from mid-2018. Although people are living longer, they are not healthier in old age, and there is an increasing number of illnesses and disabilities in the ageing population, which have an impact on their overall well-being and quality of life (QoL). Alongside these trends, Internet technologies have improved and provide a wide range of information, including on medical and health issues. This study aimed to examine the association between the utilisation of the internet among older people in England and their QoL. This study utilised the English Longitudinal Study of Aging (ELSA), a longitudinal study of a representative sample of people aged 50 and over in England. The data from Wave 9 were analysed using bivariate analysis and logistic regression. The results show a strong association between QoL and utilisation of the Internet in older people, even when adjusting for demographic variables and health. Higher use of the internet was associated with older people being less likely to have higher QoL. The excessive use of the internet for communication and gathering information also contributed to lower QoL. From the findings, poorer QoL was also found in people in older age groups, in those who are married, and those who never suffer from chronic diseases. Our findings suggest that the quality of life in older people might not only be associated with the frequency of usage but also the purpose for which the internet is used; however, this relationship is complex and further research should explore this in greater depth. Further research should also investigate how older people's use of the Internet changed during the COVID-19 pandemic and the effects of this on the QoL in older age.

Identifying multimorbidity patterns of non-communicable diseases in paediatric inpatients: a cross-sectional study in Shanghai, China

OBJECTIVES

To enhance the understanding of non-communicable disease (NCD) multimorbidity in children who are inpatients by delineating the characteristics of and identifying patterns among paediatric inpatients with multimorbidity in China.

DESIGN

Cross-sectional study.

SETTING

Paediatric wards (n=17) in Pudong New Area, Shanghai, China.

PARTICIPANTS

A total of 193 432 paediatric inpatients in the electronic health record systems of 17 hospitals from 2011 to 2016 participated in the study, and 91 004 children with NCDs were extracted and classified based on International Classification of Diseases, 10th version codes.

MAIN OUTCOME MEASURES

Number of the NCDs and multimorbidity patterns of the paediatric inpatients.

RESULTS

In total, 47.05% (95% CI 46.83 to 47.27) of the paediatric inpatients had one or more chronic diseases, and 16.30% (95% CI 16.14 to 16.46) had multimorbidity. Congenital anomalies accounted for 19.43% (95% CI 19.25 to 19.61) of the principal diagnoses among the paediatric inpatients. Five common multimorbidity patterns were identified: a neurological-respiratory cluster, a neurological-respiratory-ear cluster, a cardiovascular-circulatory cluster, a genitourinary cluster (boy group) and a musculoskeletal-connective cluster (10-18 years age group).

CONCLUSIONS

Multimorbidity in paediatric inpatients suggests that decisions about reasonable allocation of paediatric inpatient resources should be fully considered. Multimorbidity patterns in paediatric inpatients revealed that prevention, including innovative treatments targeting children, should be further studied.

Safety and efficacy of retrograde intrarenal surgery in geriatric patients by age groups

PURPOSE

To evaluate the effects of aging on the success rate of retrograde intrarenal surgery (RIRS) and the development of medical and surgical complications by dividing geriatric patients into subgroups based on their chronological age.

METHOD

Data of the patients who underwent RIRS due to kidney stones at our clinic between June 2014 and January 2020 were retrospectively reviewed. Patients were divided into three groups based on age: 65-74 years (Group 1), 75-84 years (Group 2), and ≥ 85 years (Group 3). The comorbid diseases of patients were evaluated using the Charlson Comorbidity Index (CCI), total Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score, and CIRS severity index (CIRS-G SI). RIRS success rates and complications were evaluated based on age groups.

RESULTS

A total of 336 patients were included in the study. The mean age of the patients was 72.7 ± 6.59 years. Stone-free rate was 81.5% in patients aged > 65 years and did not change with age. The modified Clavien-Dindo grade I/II complication rates for surgical complications were similar in all three groups (p = 0.818). In the evaluation of ROC analysis for medical complications, it was observed that the cut-off values were 76.5 years, CIRS-G score of 4.5, CCI score of 2.5, and CIRS-SI score of 1.18 (p < 0.001).

CONCLUSION

RIRS is an effective and safe treatment option for kidney and proximal ureteral stones in geriatric patients. Although there is an increase in medical complications post-RIRS with aging, surgical complications and stone-free rates remain unchanged.

Multimorbidity and quality of life: Systematic literature review and meta-analysis

Multimorbidity is typically defined as the co-existence of two or more chronic diseases within an individual. Its prevalence is highest among the elderly, with poor quality of life (QoL) being one of the major consequences. This study aims to: (1) understand the relationship between multimorbidity and QoL or health-related quality of life (HRQoL) through systematic literature review; (2) explore the strength of this association by conducting the first meta-analysis on the subject. Following PRISMA, Medline/PubMed, Embase, CINAHL and PsycINFO were searched for studies published through September 1st, 2018. Original studies with clear operationalization of multimorbidity and validated QoL (or HRQoL) measurement were retained. For random-effect meta-analysis, a minimum of three studies with the same multimorbidity tool (e.g. number of diseases or equal comorbidity index) and the same QoL tool were required. Number of diseases was most common and the only measure on which meta-analysis was carried out. The outcome of interest was the linear regression slope between increasing number of diseases and QoL. Heterogeneity was explored with meta-regression. Out of 25,890 studies initially identified, 74 studies were retained for systematic review (total of 2,500,772 participants), of which 39 were included in the meta-analysis. The mean decrease in HRQoL per each added disease, depending on the scale, ranged from: -1.55% (95%CI: -2.97%, -0.13%) for the mental component summary score of pooled SF-36, -12 and -8 scales to -4.37% (95%CI: -7.13%, -1.61%) for WHOQoL-BREF physical health domain. Additional studies considering severity, duration and patterns of diseases are required to further clarify this association.

Health related quality of life in multimorbidity: a primary-care based study from Odisha, India

BACKGROUND

Multimorbidity, the coexistence of two or more chronic conditions is increasingly prevalent in primary care populations. Despite reports on its adverse impact on health outcomes, functioning and well-being, it's association with quality of life is not well known in low and middle income countries. We assessed the health-related quality of life (HRQoL) of primary care patients with multimorbidity and identified the influencing factors.

METHODS

This cross-sectional study was done across 20 public and 20 private primary care facilities in Odisha, India. Data were collected from 1649 adult out-patients using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). HRQoL was assessed by the 12-item short-form health survey (SF-12). Both physical (PCS) and mental components scores (MCS) were calculated. Multiple regression analysis was performed to determine the association of HRQoL with socio-demographics, number, severity and typology of chronic conditions.

RESULTS

Around 28.3% [95% CI: 25.9-30.7] of patients had multimorbidity. Mean physical component scope (PCS) and mental component score (MCS) of QoL in the study population was 43.56 [95% CI: 43.26-43.86] and 43.69 [95% CI: 43.22-44.16], respectively. Patients with multimorbidity reported poorer mean PCS [43.23, 95% CI: 42.62-43.84] and MCS [41.58, 95% CI: 40.74-42.43] compared to those without. After adjusting for other variables, morbidity severity burden score was found to be negatively associated with MCS [adjusted coefficient: -0.24, 95% CI - 0.41 to - 0.08], whereas no significant association was seen with PCS. Hypertension and diabetes with arthritis and acid peptic diseases were found to be negatively related with MCS. Within multimorbidity, lower education was inversely associated with mental QoL and positively associated with physical QoL score after adjusting for other variables.

CONCLUSION

Our findings demonstrate the diverse negative effects of multimorbidity on HRQoL and reveal that apart from count of chronic conditions, severity and pattern also influence HRQoL negatively. Health care providers should consider severity as an outcome measure to improve QoL especially in individuals with physical multimorbidity. Given the differences observed between age groups, it is important to identify specific care needs for each group. Musculoskeletal clusters need prioritised attention while designing clinical guidelines for multimorbidity.

Frailty state among Indonesian elderly: prevalence, associated factors, and frailty state transition

Background

Information about frailty status and its transition is important to inform clinical decisions. Predicting frailty transition is beneficial for its prevention. While Indonesia is the 4th largest geriatric population in Asia, data about frailty transition is limited. This study aimed to obtain data on prevalence of frailty, its risk factors, frailty state transition and its prognostic factors, as well as to develop prognostic score for frailty state transition.

Methods

Multicenter study on subjects aged ≥60 years old was done to obtain the prevalence of frailty status and to identify risk factors of frailty. Prospective cohort over 12 months was done to obtain data on frailty state transition. Multiple logistic regression analysis was performed to identify its prognostic factors from several clinical data, which then were utilized to develop prognostic score for frailty state worsening.

Results

Cross-sectional data from 448 subjects showed that 25.2% of the subjects were frail based on Frailty index-40 items. Risk factors of frailty were age (OR 2.72; 95% CI 1.58–4.76), functional status (OR 2.89; 95% CI 1.79–4.67), and nutritional status (OR 3.75; 95% CI 2.29–6.13). Data from the 162 subjects who completed the cohort showed 27.2% of the cohort had frailty state worsening. Prognostic factors for frailty state worsening were being 70 years or older (OR 3.9; 95% CI 1.2–12.3, p < 0.05), negative QoL, i.e., fair and poor QoL (OR 2.5; 95% CI 1.1–5.9, p < 0.05), and slow gait speed (OR 2.8; 95% CI 1.3–6.4, p < 0.05). The internal validation of the prognostic score consisted of those three variables showed good performance.

Conclusion

The prevalence of frailty in this study among Indonesian elderly in outpatient setting was 25.2%. The risk factors of frailty were age, functional status and nutritional status. The prognostic factors for frailty state worsening were being 70 years old or older, negative QoL (fair or poor quality of life), and slow gait speed. A prognostic score to predict frailty state worsening in 12 months had been developed.

Coexisting Frailty With Heart Failure

People over 65 years of age constitute over 80% of patients with heart failure (HF) and the incidence of HF is 10 per 1,000 in people aged above 65 years. Approximately 25% of older patients with HF exhibit evidence of frailty. Frail patients with cardiovascular disease (CVD) have a worse prognosis than non-frail patients, and frailty is an independent risk factor for incident HF among older people. Planning the treatment of individuals with HF and concomitant frailty, one should consider not only the limitations imposed by frailty syndrome (FS) but also those associated with the underlying heart disease. It needs to be emphasized that all patients with HF and concomitant FS require individualized treatment.

Relationship of different domains of physical activity practice with health-related quality of life among community-dwelling older people: a cross-sectional study

OBJECTIVE

To analyse the association between different domains of physical activity (PA) and health-related domains of health-related quality of life (HRQoL) in older adults, independent of confounding variables.

DESIGN

Cross-sectional study.

PARTICIPANTS

In total, 400 individuals 60 years or above were randomly selected to participate in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

PA was assessed by a questionnaire in three different domains (work/occupational, sports/gym and leisure time) and total PA. The 36-Item Short Form Health Survey was used to evaluate HRQoL. The variables socioeconomic condition, marital status and presence of health professional-diagnosed comorbidities were self-reported.

RESULTS

The mean age of the sample was 71.5 (±8.4) years, of whom 58% (n=232) were female. Male older adults showed higher scores of PA in sports, leisure time and in total PA than female adults. Older adults who were more physically active in the work/occupational domain were associated with better scores in functional capacity (OR=1.73, 95% CI 1.02 to 2.93) and general health perception (OR=1.61, 95% CI 1.02 to 2.56). Those who presented a higher score in the sports/gym domain had better scores in functional capacity, even after adjustment for comorbidities (OR=1.72, 95% CI 1.01 to 2.96). Individuals with higher activity in leisure time were more likely to have better scores in functional capacity (OR=1.75, 95% CI 1.03 to 2.98), body pain (OR=1.74, 95% CI 1.09 to 2.78) and mental health (OR=1.67, 95% CI 1.03 to 2.69). Older adults who were more active in total PA were 77% more likely to have better scores in functional capacity (OR=1.77, 95% CI 1.04 to 3.02).

CONCLUSION

Physically active older adults in the different domains of PA presented better HRQoL parameters, reinforcing the importance of studies analysing PA in different contexts and in countries with low and medium socioeconomic conditions.

Predictors of health related-quality of life among elderly with disabilities

AIM

There have been no previous studies of health-related quality of life (HRQOL) among adults aged 65 years and older with disabilities in Serbia. The aim of study was to identify predictors of HRQOL in the context of sociodemographic characteristics, disability aetiology, comorbid diseases, indices of comorbidities, realization of social rights, and domestic violence.

METHODS

The cross-sectional study involved 275 consecutive elderly outpatients with disabilities. They were recruited by general practitioners at Primary Health Centers in Belgrade, Serbia, from March to May 2015. Data were acquired through face-to-face interviews and general practitioners' charts, while the generic 36-item Short Form Health Survey was used to assess HRQOL. In statistical analysis, Student's t-test, Z-test, Spearman's correlation test, and both univariate and multivariate linear regression were performed.

RESULTS

Multivariate analysis revealed that a higher Functional Comorbidity Index (β = -0.194, P < 0.01) and not asking for realization of right to assistance and care financial benefits (β = -0.142, P < 0.05) were predictors of a lower scores Mental Composite Score (F = 9.262; P < 0.001). Not asking for realization of right to assistance and care financial benefits (β = -0.187, P < 0.01), congestive heart failure (β = -0.123, P < 0.05), and stroke (β = -0.120, P < 0.05) were predictors of a lower Physical Composite Score (F = 7.169, P < 0.001).

CONCLUSIONS

This study provides valuable data for better understanding the underlying factors associated with the HRQOL of elderly persons with disabilities, and currently, these are the only available data of their kind in Serbia. National authorities could identify predictors of HRQOL as a basic starting point for improving the social welfare and health-care systems. Better prevention and management of clinical factors, increased access to social services, and enhanced delivery of social services will improve the ageing process and HRQOL of this vulnerable population.

John P, Menec V. The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data

BACKGROUND

Multimorbidity can be defined as the presence of more than one chronic condition in an individual. Research on multimorbidity has predominantly focused on older adults and few studies have examined multimorbidity in middle-aged people. The objectives of this study were to: 1) examine the prevalence of multimorbidity among middle-aged Canadians; and 2) examine the association between lifestyle factors (smoking, alcohol intake, physical activity) and multimorbidity in this age group.

METHODS

In this analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data, we extracted data from 29,841 participants aged 45-64 years from a database of 51,338 people aged 45-85 years. Self-reported data on 27 chronic physical health conditions were used to derive different multimorbidity definitions. We estimated the prevalence of 3+ to 5+ chronic physical health conditions in different subgroups for descriptive purposes. Multivariable logistic regression analyses were performed to determine the association between socio-demographic and lifestyle factors, and multimorbidity using a 3+ multimorbidity case definition.

RESULT

We found that 39.6% (99% CI 38.4-40.7) of participants had three or more chronic conditions with a mean number of chronic condition of 2.41 (99% CI 2.37-2.46). The prevalence of multimorbidity increased with age from 29.7% in the 45-49-year-old age group to 52% in individuals aged 60-64 years. The prevalence of 4+ and 5+ chronic conditions was 24.5 and 14.2% respectively. Analyses indicated that female sex and low income were associated with higher odds of multimorbidity, whereas daily or weekly alcohol intake were associated with lower odds of multimorbidity. Exercise was not associated with multimorbidity. Results were similar when analyses were conducted separately for women and men.

CONCLUSIONS

Multimorbidity is not limited to older adults, but is a common phenomenon among middle-aged people. Longitudinal research is needed to better understand the temporal relationship between lifestyle factors and multimorbidity.

Heart Failure and Problems with Frailty Syndrome: Why it is Time to Care About Frailty Syndrome in Heart Failure

Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15–74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.

Factors influencing quality of life (QOL) amongst elderly caregivers of people living with HIV/AIDS in Phayao province, Thailand: a cross-sectional study

Background: There are many impacts on quality of life among elderly people living with HIV patients. This study aimed to assess factors influencing quality of life among elderly people living with HIV/AIDS in a northern province of Thailand. Methods: This cross-sectional study was conducted in Phayao province, Thailand. A systematic sampling technique was employed to select study participants. 152 elderly participants aged 60 years and older with a family member living with HIV/AIDS were recruited to the study. They were interviewed using the World Health Organization Quality of Life-Older Adults Module (WHOQOL-OLD) questionnaire. Stepwise multiple regression analysis was performed to determine the factors influencing quality of life among elderly people affected by family member living with HIV/AIDS. Results: The results of the study showed the mean age of elderly participants was 67.20 + 52 years, most of which were female (97 persons, 63.8%). The mean time taking care of HIV/AIDS patients was 6.61 + 4.96 years. In term of health status among the elderly participants, the majority did not have chronic diseases (61.4%), amongst those with chronic diseases (38.6%), hypertension and diabetes were the most common. The average quality of life score was at a fair level.  The time taking care of HIV/AIDS patients and health status were significant predictors of quality of life among participants 8.1 % ( R 2 =.081; p < .05). Conclusion: In order to improve quality of life among elderly caregivers to family member living with HIV/AIDS, time taking care of HIV/AIDS patients and health status should be focused on, amongst other factors. Help and support from the government, community, health organizations, academic research, and family members can help improve quality of life amongst the elderly.

Development of a Patient-Reported Outcome Measure for Geriatric Care: The Older Persons and Informal Caregivers Survey Short Form

BACKGROUND

The Older Persons and Informal Caregivers Minimum Data Set (TOPICS-MDS) is a standardized data set that was developed to evaluate the quality of multidimensional geriatric care. There is an inherent need to reduce the number of TOPICS-MDS survey items to core outcomes to allow it to be more easily applied as a patient-reported outcome measure in clinical settings.

OBJECTIVES

To create a TOPICS-short form (TOPICS-SF) and examine its validity.

METHODS

Data in the TOPICS-MDS from persons aged 65 years and older in the Netherlands were used for the following analyses. Multiple linear regression analyses were performed to select the items and to derive domain weights of TOPICS-SF. A priori hypotheses were made on the basis of psychometric properties of the full-length TOPICS-MDS preference-weighted score (TOPICS-CEP). The validity of TOPICS-SF was evaluated by 1) examining the meta-correlation of the TOPICS-SF score with TOPICS-CEP and two quality-of-life measures, that is, the Cantril Ladder score and the EuroQol five-dimensional questionnaire utility index, and 2) performing mixed multiple regression of TOPICS-SF scores across key sociodemographic characteristics.

RESULTS

TOPICS-SF scores were strongly correlated with the TOPICS-CEP (r = 0.96) and had stronger correlation with the EuroQol five-dimensional questionnaire utility index compared with the Cantril Ladder (r = 0.61 and 0.38, respectively). TOPICS-SF scores were higher among older persons who were married, living independently, and having higher levels of education.

CONCLUSIONS

We have developed the 22-item TOPICS-SF and demonstrated its validity, supporting its use as a patient-reported outcome measure in geriatric care.

Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: a cross-sectional study

Objective

The aim of this cross-sectional study was to determine the associations between frailty and multimorbidity on the one hand and quality of life on the other in community-dwelling older people.

Methods

A questionnaire was sent to all people aged 70 years and older belonging to a general practice in the Netherlands; 241 persons completed the questionnaire (response rate 47.5%). For determining multimorbidity, nine chronic diseases were examined by self-report. Frailty was assessed by the Tilburg Frailty Indicator, and quality of life was assessed by the World Health Organization Quality of Life Instrument-Older Adults Module.

Results

Multimorbidity, physical, psychological, as well as social frailty components were negatively associated with quality of life. Multimorbidity and all 15 frailty components together explained 11.6% and 36.5% of the variance of the score on quality of life, respectively.

Conclusion

Health care professionals should focus their interventions on the physical, psychological, and social domains of human functioning. Interprofessional cooperation between health care professionals and welfare professionals seems necessary to be able to meet the needs of frail older people.

Multimorbidity of four cardiometabolic and chronic pulmonary disease groups: prevalence and attributable fraction in US adults, 2007-2012

BACKGROUND

Cardiometabolic and chronic pulmonary diseases may be associated with modifiable risk factors that can be targeted to prevent multimorbidity.

OBJECTIVES

(i) Estimate the prevalence of multimorbidity across four cardiometabolic and chronic pulmonary disease groups; (ii) compare the prevalence of multimorbidity to that of one disease and no disease; and (iii) quantify population attributable fractions (PAFs) for modifiable risk factors of multimorbidity.

DESIGN

Data from adults aged 18-79 years who participated in the US National Health and Nutrition Examination Survey 2007-2012 were examined. Multimorbidity was defined as ≥2 co-occurring diseases across four common cardiometabolic and chronic pulmonary disease groups. Multivariate-adjusted PAFs for poverty, obesity, smoking, hypertension, and low high-density lipoprotein (HDL) cholesterol were estimated.

RESULTS

Among 16,676 adults, the age-standardized prevalence of multimorbidity was 9.3%. The occurrence of multimorbidity was greater with age, from 1.5% to 5.9%, 15.0% and 34.8% for adults aged 18-39, 40-54, 55-64 and 65-79 years, respectively. Multimorbidity was greatest among the poorest versus non-poorest adults and among blacks versus other races/ethnicities. Multimorbidity was also greater in adults with obesity, hypertension, and low HDL cholesterol. Risk factors with greatest PAFs were hypertension (38.8%; 95% confidence interval [CI] 29.4-47.4) and obesity (19.3%; 95% CI 10.2-28.2).

CONCLUSIONS

In the USA, 9.3% of adults have multimorbidity across four chronic disease groups, with a disproportionate burden among older, black, and poor adults. Our results suggest that targeting two intermediate modifiable risk factors, hypertension and obesity, might help to reduce the prevalence of multimorbidity in US adults.

SOCIOECONOMIC AND HEALTH CONDITIONS ASSOCIATED WITH QUALITY OF LIFE OF ELDERLY QUILOMBOLAS

ABSTRACT This study aimed to identify the socioeconomic and health conditions associated with quality of life of elderly quilombolas. Cross-sectional, epidemiological and census study, conducted with 427 elderly individuals of a quilombola population enrolled in Family Health Strategies of 17 quilombas communities in Vitória da Conquista, Bahia, four districts of the region. Data collection was performed using tools and analyzed based on descriptive statistics and Spearman correlation (rsp). The factors associated with some areas of Quality of Life and the General Quality of Life Index included the per capita income, the self-assessment of health status and the classification of depression cases, which most strongly affected the quality of life of the elderly quilombolas investigated. The expanded access to health services and the integrality of health care for this group are essential, particularly involving Family Health Teams.

Factors Influencing the Quality of Life (Qol) Among Thai Older People in a Rural Area of Thailand

BACKGROUND

The population prevalence of older people has been growing worldwide. Quality of Life (QoL) among older people is a significant public health concern. Hence, this study aimed to assess level of QoL and factors influencing QoL among rural Thai older people.

METHODS

The study was undertaken in Phayao Province where is one of the top ten provinces with the highest index of Thai aging. A district in this province was purposively selected to be the study area and the quota-sampling technique was used for sample collection, totally 400 older people participated according to Taro Yamane. The WHO QoL-Old was employed to interview elderly QoL. Multivariate linear regression was performed to determine the factors influencing QoL among the older people.

RESULTS

Over two-thirds of older people (68.5%) had QoL at fair level. The vast majority (96%) had high scores for Activity Daily Living (ADL). Approximately one-fifth (20.5%) reported current smoking and 31.7% reported ever drinking during previous year. Following univariate analysis, nine factors - gender, age, education, working, income, present illness, drinking, ADL, and participating in elderly club were identified as being significantly associated with QoL (P <0.05). Multivariate analysis revealed four factors predictive of QoL among elderly: ADL, income, alcohol drinking, and present illness (P < 0.01).

CONCLUSION

Physical function, health status and financial were the predictor of QoL among elderly. Noticeably, drinking was one predictive factor of QoL but only among moderate drinkers. Hence, healthy life style should be considered as key areas in attempts to promote QoL among elderly people.

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

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

Quality of life in rural and urban adults 65 years and older: findings from the National Health and Nutrition Examination survey

PURPOSE

The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen's behavioral model to examine quality of life (QOL) in a nationally representative sample of community-dwelling adults 65 years and older according to geographic location. Specifically, associations between 3 dimensions of QOL (health-related QOL [HQOL], social functioning, and emotional well-being) and needs and health behaviors were examined.

METHODS

The 2005-2006 National Health and Nutrition Examination survey was linked with the 2007 Area Resources File via the National Center for Health Statistics' remote access system. Frequencies and distribution patterns were assessed according to rural, adjacent, and urban locations.

FINDINGS

Older adults reported high levels of QOL; however, rural older adults had lower social functioning than their urban counterparts. Older blacks and Hispanics had lower scores than whites on 2 dimensions of QOL. Associations between QOL and needs and health behaviors varied. Although activities of daily living were associated with all 3 dimensions, others were associated with 1 or 2 dimensions.

CONCLUSIONS

The lower scores on social functioning in rural areas suggest that rural older adults may be socially isolated. Older rural adults may need interventions to maintain physical and mental health, strengthen social relationships and support, and increase their participation in the community to promote QOL. In addition, older blacks and Hispanics seem more vulnerable than whites and may need more assistance.

Factors associated with quality of life in older adults in the United States

PURPOSE

According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen's behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 years and older.

METHODS

A representative sample from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) was used. NHANES over-samples persons 60 years and older, African Americans, and Hispanics. Frequencies and distribution patterns were assessed, followed by bivariate and multiple regression analyses.

RESULTS

These older adults reported high levels of QOL. However, associations between needs and health behaviors and QOL varied across dimensions. Activities of daily living (ADL) were associated with all three dimensions. Depression was associated with two dimensions and memory problems with one dimension. Physical activity was linked to social functioning, and health care utilization was linked to emotional well-being.

CONCLUSIONS

The differences in associations with different dimensions of QOL confirm that this is a multidimensional concept. Since depression, memory problems, and ADL function were all associated with some dimension of QOL, future interventions to improve QOL in older adults should include screening and treatment for these problems.

Impact of a program to promote health and quality of life of elderly

OBJECTIVE

To evaluate the effect on quality of life of elderly people enrolled in GAMIA - Multidisciplinary Care Group to Outpatient Elderly Subjects (Grupo de Assistência Multidisciplinar ao Idoso Ambulatorial) of the Geriatric Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo.

METHODS

Between 2000 and 2002, 83 elderly participants of GAMIA were assessed by the World Health Organization Quality of Life scale (WHOQOL-bref) at the beginning and the end of the program. Functionality was assessed by Katz and Lawton scales and sociodemographic data were obtained from medical charts.

RESULTS

Females predominated (79.5%) and overall mean age was 69.30 years. Data analysis showed a reduction in the physical domain of WHOQOL-bref (p = 0.014) and increased psychological health and environment domains (p = 0.029 and p = 0.007, respectively), detecting a trend of increase in social relationships and in general domains (p = 0.062 and p = 0.052, respectively).

CONCLUSIONS

The clinical evaluation of the elderly detected previously unknown diseases and determination of the use of new drugs, which might have been the predominant factor for the deterioration of their perception in the physical domain. Improvement in psychological health and the environment can be related to psychological and social support that the elderly received from peers and professionals and the benefits of group activities, as well as the upward trend observed in social relationships and general domains. Participation in a program to promote healthy aging was effective in improving the quality of life of the elderly.