Quality of Life for Elderly Residents in Nursing Homes

The Hidden Toll of Psychological Distress in Australian Adults and Its Impact on Health-Related Quality of Life Measured as Health State Utilities

BACKGROUND

Psychological distress (PD) is a major health problem that affects all aspects of health-related quality of life including physical, mental and social health, leading to a substantial human and economic burden. Studies have revealed a concerning rise in the prevalence of PD and various mental health conditions among Australians, particularly in female individuals. There is a scarcity of studies that estimate health state utilities (HSUs), which reflect the overall health-related quality of life in individuals with PD. No such studies have been conducted in Australia thus far.

OBJECTIVE

We aimed to evaluate the age-specific, sex-specific and PD category-specific HSUs (disutilities) in Australian adults with PD to inform healthcare decision making in the management of PD.

METHODS

Data on age, sex, SF-36/SF6D responses, Kessler psychological distress (K10) scale scores and other characteristics of N = 15,139 participants (n = 8149 female individuals) aged >15 years were derived from the latest wave (21) of the nationally representative Household, Income and Labor Dynamics in Australia survey. Participants were grouped into the severity categories of no (K10 score: 10-19), mild (K10: 20-24), moderate (K10: 25-29) and severe PD (K10: 30-50). Both crude and adjusted HSUs were calculated from participants' SF-36 profiles, considering potential confounders such as smoking, marital status, remoteness, education and income levels. The calculations were based on the SF-6D algorithm and aligned with Australian population norms. Additionally, the HSUs were stratified by age, sex and PD categories. Disutilities of PD, representing the mean difference between HSUs of people with PD and those without, were also calculated for each group.

RESULTS

The average age of individuals was 46.130 years (46% male), and 31% experienced PD in the last 4 weeks. Overall, individuals with PD had significantly lower mean HSUs than those likely to be no PD, 0.637 (95% confidence interval [CI] 0.636, 0.640) vs 0.776 (95% CI 0.775, 0.777) i.e. disutility: -0.139 [95% CI -0.139, -0.138]). Mean disutilities of -0.108 (95% CI -0.110, -0.104), -0.140 (95% CI -0.142, -0.138), and -0.188 (95% CI -0.190, -0.187) were observed for mild PD, moderate PD and severe PD, respectively. Disutilities of PD also differed by age and sex groups. For instance, female individuals had up to 0.049 points lower mean HSUs than male individuals across the three classifications of PD. There was a clear decline in health-related quality of life with increasing age, demonstrated by lower mean HSUs in older population age groups, that ranged from 0.818 (95% CI 0.817, 0.818) for the 15-24 years age group with no PD to 0.496 (95% CI 0.491, 0.500) for the 65+ years age group with severe PD). Across all ages and genders, respondents were more likely to report issues in certain dimensions, notably vitality, and these responses did not uniformly align with ageing.

CONCLUSIONS

The burden of PD in Australia is substantial, with a significant impact on female individuals and older individuals. Implementing age-specific and sex-specific healthcare interventions to address PD among Australian adults may greatly alleviate this burden. The PD state-specific HSUs calculated in our study can serve as valuable inputs for future health economic evaluations of PD in Australia and similar populations.

Effect of Physical Performance Levels of Elderly Living in Urban and Rural Areas on Social Participation, Social Functioning, and Quality of Life: A Cross-sectional Study from the Mediterranean Region of Turkey

BACKGROUND

Social interaction is a very important subject for the elderly, especially in the context of active aging.

AIM

This study aims to investigate the effect of physical performance levels of the elderly living in rural and urban areas on social participation, social functioning, and quality of life.

METHODS

A total of 418 volunteer elderly aged 65 and over, living in rural (42.3%) and urban (57.7%) areas, participated in this study. The Mini-Mental State Examination, Short Physical Performance Battery, the World Health Organization Quality of Life Scale for Older Adults, Social Functioning Scale, and the Community Integration Questionnaire were applied to participants.

RESULTS

The scores of social functioning (P = 0.027) and the social network subscale of social participation (P = 0.001) were significantly higher among participants living in urban areas compared to those living in rural areas. Physical performance was positively correlated with social participation (r = 0.404) and social functioning (r = 0.324) at a moderate level (P = 0.000), and with quality of life at a low level (r = 0.158) (P = 0.001). Social participation was positively correlated with social functioning at a high level (r = 0.572) and with quality of life at a moderate level (r = 0.300) (P = 0.000). Social functioning was positively correlated with quality of life at a low level (r = 0.234) (P < 0.01).

CONCLUSION

To increase social participation, social functioning, and quality of life among the elderly, it is necessary to keep physical performance levels higher. In addition, in the planning of social participation, it is crucial to take into account where the elderly live in.

Does lower quality of life and daily living activity increase nutritional risk of elderly residing in care home facilities?

INTRODUCTION

Aging is a predictable phenomenon that its prevalence is increasing dramatically in the world. There is an association between quality of life, functional independence, and nutritional risk in elderlies, so the aim of the current study is the evaluation of the quality of life and functional independence's effects on nutritional status.

METHODS

A total of 160 elderly people that had a hospitalization for at least 6 months in the care home facilities were selected from 2 care home facility centers to participate in the study. Quantitative and qualitative data were gathered using questionnaires for demographic characteristics, health data, eating habits, quality of life (WHOQOL-BREF), functional assessment (Barthel Index), and mini-nutrition assessment (MNA) throughout the face-to-face interview.

RESULTS

The overall quality of life score, age, weight, and BMI differed significantly between malnourished and well-nourished subjects. Also, the daily living activity score of subjects who were well-nourished was higher than malnourished participants. Higher daily living activity decreased the risk of being malnourished (OR _{malnutrition/well-nourished} = 0.306, P < 0.001). There was also a significant relationship between BMI (OR _{malnutrition/well-nourished} = 0.731, P = 0.001; OR _{at-risk/well-nourished} = 0.786, P = 0.003) and marital status with MNA score (OR _{single/married} = 1.460, P = 0.001 for malnutrition; OR _{single/married} = 1.183, P = 0.004 for being at risk of malnutrition).

CONCLUSIONS

The elderly living in nursing homes are exposed to nutritional risks and mental disorders. So with timely assessment and interventions to improve the quality of life and physical and mental health of elder dwellers, their malnutrition can be prevented.

The Connections between Attitudes towards Nursing Home Placement, Intergenerational Solidarity, and the Conflict between Tradition and Modernity among Three Generations of Arab Muslim Families in Israel

The goal of this study was to examine three generations of Arab Muslims in Israel, to investigate the relationships between their attitudes regarding the placement of an older relative in a nursing home, intergenerational solidarity, and to ultimately proceed with the nursing home placement. The backdrop to this examination was the increasing sociocultural tension between modernization tendencies and the long-established traditions and norms in the Arab Muslim society in Israel. The sample included a total of 126 university students, as well as one parent and one grandparent of each student. All participants completed identical questionnaires examining the attitudes towards the nursing home placement of an elder relative. The findings of the study indicate a strong objection among the youngest generation, whose attitudes were more similar to those of their grandparents than to those of their parents. Psychosocial mechanisms in the Arab Muslim population, such as intergenerational solidarity, has been the subject of increased scrutiny and debate over recent years, given the intensive pace of modern developments, which has called into question the familiar norms, thus constituting a threat to the tradition that has guided the population throughout numerous centuries and generations.

EQ-5D-3L for Assessing Quality of Life in Older Nursing Home Residents with Cognitive Impairment

BACKGROUND

Quality of life (QoL) is recognized as an important patient-reported outcome measure. Assessing QoL in older people with cognitive impairment is a challenge due to discrepancies in the collection of data via proxies versus self-report. This study aimed to assess the psychometric properties of the self-reported EQ-5D (including the EQ index and EQ visual analog scale (VAS)) in nursing homes residents with cognitive impairment and to analyze its validity based on scales included in the comprehensive geriatric assessment.

METHODS

Cross-sectional, multicenter study analyzing the feasibility, acceptability, reliability, and validity of the EQ-5D based on 251 self-administered questionnaires in a sample of nursing home residents with cognitive impairment. Reference scales were those from the comprehensive geriatric assessment, equivalent to the five dimensions of the EuroQol.

RESULTS

The EQ index was 0.31 (0.37) and the EQ VAS was 35.96 (29.86), showing adequate acceptability and feasibility. Cronbach's alpha was 0.723. The EQ index and EQ VAS, as outcome variables for multiple linear regression models including CGA titration scales, showed better validity for the EQ index than the EQ VAS.

CONCLUSIONS

As a self-administered generic scale, the EQ-5D-3L could be a good tool for QoL assessment in nursing home residents with cognitive impairment.

Factors associated with quality of life in patients with depression: A nationwide population-based study

Background

Depression, one of the most costly and common mental disorders, is reported to be associated with lower quality of life (QoL) in several studies. Improved understanding of the associated factors with QoL is necessary to optimize long-term outcomes and reduce disability in patients with depression. Therefore, the aim of this study was to identify factors that are associated with lower QoL among patients with depression.

Methods

The study was based on the Korea National Health and Nutrition Examination Survey, a cross-sectional health examination, years 2008 to 2014. The final analyzed sample consisted of a total of 1,502 study subjects who had been diagnosed by clinicians as having depression. A multivariate logistic regression model was performed to exam the association between the clinical characteristics (age, sex, demographic and health-related characteristics) and QoL. Analysis of covariance was also used to analyze EQ-5D according to mental health.

Results

Older age, lower level of education, lower income, worse subjective perception of health, unemployment, obesity and mental health struggles were found to be significantly associated with low QoL in depressive individuals after adjustment for multiple covariates.

Conclusions

This study has outlined grounding data in identifying patients who are at risk of QoL impairment. Policy makers should direct their interests to these individuals and provide appropriate management.

Loneliness in the Context of Quality of Life of Nursing Home Residents

Background

Numbers of the elderly have been on a steady increase both in Poland and other countries of the world. As they age, their health declines and they need help with their housekeeping. This, coupled with the transformation of intergenerational into single-generation or nuclear family structures, causes a markedly rising demand for institutional care. Holistic care of an elderly nursing home resident requires a comprehensive approach and consideration for their feelings. Loneliness and solitude are increasingly common among these feelings, undoubtedly affecting quality of life.

Method

250 elderly residents of seven nursing home situated in Mazovia, Poland, have been examined using: De Jong Gierveld Loneliness Scale, WHOQOL-BREF Questionnaire, Basic Hope Scale (BHI-12), Satisfaction with Life Scale (SWLS), Acceptance of Illness Scale (AIS).

Results

Loneliness affects nearly 40% residents of the homes surveyed. Quality of their residents’ lives is reduced. Relations with their families and levels of motor efficiency imply a sense of loneliness. Degrees of illness acceptance, ability to adjust to change, and life satisfaction influence the level of loneliness felt.

Conclusion

40% of nursing home residents exhibit a sense of loneliness, while the greater loneliness and solitude, the lower the quality of life.

Individual and institutional factors associated with functional disability in nursing home residents: An observational study with multilevel analysis

Background

High prevalence of functional limitations has been previously observed in nursing homes. Disability may depend not only on the characteristics of the residents but also on the facility characteristics. The aims of this study were: 1, to describe the prevalence of functional disability in older people living in Spanish nursing homes; and 2, to analyze the relationships between individual and nursing home characteristics and residents’ functional disability.

Methods

A cross-sectional study with data collected from 895 residents in 34 nursing homes in the province of Albacete (Spain) was conducted. Functional status was assessed by the Barthel Index. Taking into account both levels of data (individual and institutional characteristics) we resorted to a multilevel analysis in order to take different sources of variability in the data.

Results

The prevalence of functional disability of the total sample was 79.8%. The best fitting multilevel model showed that female gender, older age, negative self-perception of health, and living in private nursing homes were factors significantly associated with functional disability. After separating individual and institutional effects, the institutions showed significant differences.

Conclusions

In line with previous findings, our study found high levels of functional dependence among institutionalized elders. Gender, age, self-perception of health, and institution ownership were associated with functional status. Disentangling individual and institutional effects by means of multilevel models can help evaluate the quality of the residences.

The Isfahan Comprehensive Elderly Study: Objectives, research design, methodology, and preliminary results

BACKGROUND

This paper presents the objectives, research design, methodology, and primary findings of the Isfahan Comprehensive Elderly Study (ICES).

MATERIALS AND METHODS

In this cross-sectional study, 603 elderly persons (aged 60 and over) were selected by multistage cluster sampling method from Isfahan, Iran, in 2016 comprehensive questionnaires along with a detailed interview were used to collect information on personal, family, socioeconomic, health and social services characteristics, life styles, physical illnesses and chronic diseases, mental, emotional and cognition disorders, quality of life, disabilities, sleep quality, social supports, life satisfaction, self-efficacy, and of participants.

RESULTS

The mean ± standard deviation (SD) age of participants was 69.66 ± 6.31 years, consisting of 50.75% females. About 23% of elderly persons were at the risk of malnutrition and 4.5% were current smoker. Severe and mild depression were documented in 9.3% and 30.2% among included study subjects, respectively. About half of the participants had hypertension, and 26.8% suffered from cardiovascular disease. The mean ± SD of total score of Geriatric Depression Scale, Perceived Stress Scale, Older People's Quality of Life, Physical Activity Scale for the Elderly and Pittsburg Sleep Quality Index was 8.84 ± 6.79, 14.76 ± 5.92, 133.99 ± 10.55, 142.04 ± 120.53, and 6.17 ± 3.44, respectively. Elderly males had significantly higher life satisfaction and self-efficacy and better cognitive function than females (P < 0.01).

CONCLUSION

The findings of current study provided a comprehensive overview of the current health status and lifestyle of older adults in Isfahan city. The ICES could help policy makers to design appropriate prevention and interventional programs and policies to cover the specific needs of the elderly population.

Evaluation of the Criteria for Quality of Life of Elderly Health Care Centers in Tehran Province, Iran

Background and Objectives:

The objective of this study was to evaluate the elderly quality of life of people covered by the healthcare centers in Tehran and its influencing demographic and background factors.

Method:

This is a cross-sectional study of quality of life of the elderly population covered by healthcare centers and bases in Tehran, as well as the influential background and demographic factors. Sampling was performed using simple random stratified sampling proportionate to the size of strata. Data were collected using the Iranian version of the standard questionnaire Short Form Health Survey (SF-36).

Results:

According to the findings, 240 (60%) of the cases were men and 160 (40%) were women. Regarding age distribution, 76.3% fell in the 60-69 age range and 87.2% were illiterate. 18% of the elderly stated that they have financial problems and 19.5% did not express any financial problems. While studying the relationship between financial status and health status with the mean scores of quality of life, statistically significant differences were observed in all domains (p=0.032<0.001). The mean quality of life was lower in women compared to men.

Conclusions:

The findings of the present study indicate that the health-related quality of life in the elderly population is influenced by their health status and demographic and background variables.