Quality of life and mortality in the general population: a systematic review and meta-analysis

Primary knee arthroplasty for osteoarthritis restores patients' health-related quality of life to normal population levels

This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population. This retrospective case-control study compared HRQoL data from two sources: patients undergoing primary KA in a university-teaching hospital (2013 to 2019), and the Health Survey for England (HSE; 2010 to 2012). Patient-level data from the HSE were used to represent the general population. Propensity score matching was used to balance covariates and facilitate group comparisons. A propensity score was estimated using logistic regression based upon the covariates sex, age, and BMI. Two matched cohorts with 3,029 patients each were obtained for the adjusted analyses (median age 70.3 (interquartile range (IQR) 64 to 77); number of female patients 3,233 (53.4%); median BMI 29.7 kg/m² (IQR 26.5 to 33.7)). HRQoL was measured using the three-level version of the EuroQol five-dimension questionnaire (EQ-5D-3L), and summarized using the Index and EuroQol visual analogue scale (EQ-VAS) scores. Patients awaiting KA had significantly lower EQ-5D-3L Index scores than the general population (median 0.620 (IQR 0.16 to 0.69) vs median 0.796 (IQR 0.69 to 1.00); p < 0.001). By one year postoperatively, the median EQ-5D-3L Index score improved significantly in the KA cohort (mean change 0.32 (SD 0.33); p < 0.001), and demonstrated no clinically relevant differences when compared to the general population (median 0.796 (IQR 0.69 to 1.00) vs median 0.796 (IQR 0.69 to 1.00)). Compared to the general population cohort, the postoperative EQ-VAS was significantly higher in the KA cohort (p < 0.001). Subgroup comparisons demonstrated that older age groups had statistically better EQ-VAS scores than matched peers in the general population. Patients awaiting KA for osteoarthritis had significantly poorer HRQoL than the general population. However, within one year of surgery, primary KA restored HRQoL to levels expected for the patient's age-, BMI-, and sex-matched peers.

Dose response relationship between food insecurity and quality of life in United States adults: 2016-2017

BACKGROUND

Food insecurity is associated with worse general health rating, but little research exists investigating whether there is a dose response relationship across levels of food security and mental and physical health domains at the population level.

METHODS

Data from the Medical Expenditure Panel Survey (2016-2017) with US adults aged 18 years and older was used. The physical component score (PCS) and mental component score (MCS) of Quality of Life, served as the outcome measures. Four categories of food insecurity (high, marginal, low, very low food security) served as the primary independent variable. Linear regression was used to run unadjusted followed by adjusted models. Separate models were run for PCS and MCS.

RESULTS

In a sample of US adults, 16.1% reported some degree of food insecurity. For PCS, marginal (β = - 2.54 (p < 0.001), low (β = - 3.41, (p < 0.001), and very low (β = - 5.62, (p < 0.001) food security was associated with worse PCS scores, compared to adults with high food security. For MCS, marginal (β = - 3.90 (p < 0.001), low (β = - 4.79, (p < 0.001), and very low (β = - 9.72, (p < 0.001) food security was associated with worse MCS scores, compared to adults with high food security.

CONCLUSION

Increasing levels of food insecurity were associated with decreased physical and mental health quality of life scores. This relationship was not explained by demographic factors, socioeconomic factors, insurance, or comorbidity burden. This study suggests work is needed to mitigate the impact of social risk, such as food insecurity, on quality of life in adults, and understand pathways and mechanisms for this relationship.

Clinical prediction model for prognosis in kidney transplant recipients (KIDMO): study protocol

BACKGROUND

Many potential prognostic factors for predicting kidney transplantation outcomes have been identified. However, in Switzerland, no widely accepted prognostic model or risk score for transplantation outcomes is being routinely used in clinical practice yet. We aim to develop three prediction models for the prognosis of graft survival, quality of life, and graft function following transplantation in Switzerland.

METHODS

The clinical kidney prediction models (KIDMO) are developed with data from a national multi-center cohort study (Swiss Transplant Cohort Study; STCS) and the Swiss Organ Allocation System (SOAS). The primary outcome is the kidney graft survival (with death of recipient as competing risk); the secondary outcomes are the quality of life (patient-reported health status) at 12 months and estimated glomerular filtration rate (eGFR) slope. Organ donor, transplantation, and recipient-related clinical information will be used as predictors at the time of organ allocation. We will use a Fine & Gray subdistribution model and linear mixed-effects models for the primary and the two secondary outcomes, respectively. Model optimism, calibration, discrimination, and heterogeneity between transplant centres will be assessed using bootstrapping, internal-external cross-validation, and methods from meta-analysis.

DISCUSSION

Thorough evaluation of the existing risk scores for the kidney graft survival or patient-reported outcomes has been lacking in the Swiss transplant setting. In order to be useful in clinical practice, a prognostic score needs to be valid, reliable, clinically relevant, and preferably integrated into the decision-making process to improve long-term patient outcomes and support informed decisions for clinicians and their patients. The state-of-the-art methodology by taking into account competing risks and variable selection using expert knowledge is applied to data from a nationwide prospective multi-center cohort study. Ideally, healthcare providers together with patients can predetermine the risk they are willing to accept from a deceased-donor kidney, with graft survival, quality of life, and graft function estimates available for their consideration.

STUDY REGISTRATION

Open Science Framework ID: z6mvj.

Association of preexisting psychiatric disorders with post-COVID-19 prevalence: a cross-sectional study

Evidence demonstrating the association of preexisting psychiatric disorders with post-COVID-19 is limited. We aim to investigate the association using larger sample sizes and more extended postinfection periods than previous studies. A total of 6015 (response rate = 77.5%) COVID-19 survivors were surveyed using a self-administered questionnaire from July to September 2021. Poisson regression analysis with robust error variance was performed to estimate post-COVID-19 prevalence ratios (PRs) with or without preexisting psychiatric disorders. Participants with preexisting psychiatric disorders numbered 1067 (17.7%), and with post-COVID-19 were 2149 (35.7%). Post-COVID-19 PR with preexisting psychiatric disorders was 1.09 (95% CI 1.02-1.18, p = 0.013). The interaction between preexisting psychiatric disorders and postinfection periods was significant (p for interaction < 0.001). The subgroup analysis showed that those with preexisting psychiatric disorders might be at greater prolonged risk of post-COVID-19 than those without the disorders. These findings suggested that preexisting psychiatric disorders were associated with an increased post-COVID-19 risk, and post-COVID-19 with preexisting psychiatric disorders might prolong even if time passes.

A Faith-Based Intervention to Address Social Isolation and Loneliness in Older Adults

ABSTRACT

The goal of this quality improvement project was to determine if virtually offered faith-based resources for socially isolated older adults could reduce loneliness and improve quality of life. A nurse-developed program of virtual spiritual and religious interventions, including mindfulness, prayer, Scripture meditation, gratitude practices, and online church services, was offered by local ministers to older adults at risk of social isolation or loneliness. A sample of 16 adults over age 55 from local communities participated in the 12-week intervention and follow-up. The intervention resulted in a significant decrease in perception of social loneliness and improved physical health quality of life.

Quality of life among community-dwelling older adults: evidence from a large population-based study in rural Sri Lanka

PURPOSE

Against the backdrop of the ever-increasing aging population in Sri Lanka and the scarcity of local evidence on quality of life (QoL) among rural elderly, this study was conducted to assess the QoL of the community-dwelling older adults in rural Sri Lanka.

METHODS

This cross-sectional study was conducted among community-dwelling older adults (60-74 years) in a selected rural setting in Sri Lanka. K-means cluster analysis was used to stratify participants into 'low' and 'high' levels of QoL and then significant associations between these clusters and underlying socio-demographic and self-reported health related factors were estimated using bivariate and subsequent multivariable binary logistic regression models.

RESULTS

The final sample consisted of 3573 community-dwelling older adults (response rate 97.8%). The mean (SD) age of the sample was 66.7 (4.3) years and the majority were females (n = 2130, 59.6%). Amongst the six QoL domains assessed (physical, psychological, social, functional, environmental and spiritual domains), the highest and the lowest mean (SD) scores were reported for the functional [63.4 (16.9)] and the physical [52.9 (15.0)] domains, respectively. Aged 70 years or more, either unmarried/widowed/divorced, lower educational levels and having chronic illnesses were statistically significant associations of QoL (p < 0.05).

CONCLUSION

The QoL among community-dwelling older adults in rural Sri Lanka is moderate. As having social support, absence of chronic diseases and good education level were found to be associated with better QoL, strengthening community-based interventions to improve these aspects by incorporating the evidence generated by other longitudinal studies is recommended.

Effectiveness of the non-face-to-face comprehensive elderly care application "smart silver care" for community-dwelling elderly: A randomized controlled trial

Background

Quality of life for the elderly has become an important issue, and services aimed at improving it have typically been provided face-to-face. However, coronavirus disease 2019 has limited the use of face-to-face services, and the need to convert such systems to online interfaces has emerged.

Objective

This study evaluates the effectiveness of a non-face-to-face comprehensive elderly care application called "Smart Silver Care."

Methods

This study was designed as a randomized controlled trial. Sixty community-dwelling elderly individuals were randomly assigned to experimental and control groups in a 1:1 ratio. The participants participated in the "Smart Silver Care" intervention using a tablet and smartwatch based on the programs we provided. The participants performed five tasks, five days a week, consisting of physical, emotional, and cognitive programs. Participants could communicate with the researchers in real-time from their homes, and the researchers could remotely supervise their performance.

Results

We found positive effects on the relevant scales testing fall risk (Activities-Specific Balance Confidence [ABC] Scale, p = 0.028; Timed Up and Go [TUG] test, p = 0.001). However, there was no time × group interaction between the experimental and control groups on the relevant scales for depression and quality of life (Short Form-Geriatric Depression Scale [SGDS]-K: p = 0.225; EuroQol five-dimension five-level [EQ-5D-5L], p = 0.172). While the SGDS-K and EQ-5D-5L did not show statistical significance, we found improvement trends in the experimental group.

Conclusions

The findings of this study show that Smart Silver Care significantly improved the participants' TUG and ABC scores in community-dwelling elderly, and a qualitative evaluation confirmed that it could be conveniently used by the elderly. Thus, Smart Silver Care offers a feasible intervention to improve the quality of life of the elderly, including physical aspects.

Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study

BACKGROUND

Associations of long-term exposure to air pollution and greenspace with health-related quality of life (HRQOL) are poorly studied and few studies have accounted for asthma-rhinitis status.

OBJECTIVE

To assess the associations of air pollution and greenspace with HRQOL and whether asthma and/or rhinitis modify these associations.

METHODS

The study was based on the participants in the second (2000-2002, n = 6542) and third (2011-2013, n = 3686) waves of the European Community Respiratory Health Survey (ECRHS) including 19 centres. The mean follow-up time was 11.3 years. HRQOL was assessed by the SF-36 Physical and Mental Component Summary scores (PCS and MCS). NO₂, PM_2.5 and PM₁₀ annual concentrations were estimated at the residential address from existing land-use regression models. Greenspace around the residential address was estimated by the (i) mean of the Normalized Difference Vegetation Index (NDVI) and by the (ii) presence of green spaces within a 300 m buffer. Associations of each exposure variable with PCS and MCS were assessed by mixed linear regression models, accounting for the multicentre design and repeated data, and adjusting for potential confounders. Analyses were stratified by asthma-rhinitis status.

RESULTS

The mean (SD) age of the ECRHS-II and III participants was 43 (7.1) and 54 (7.2) years, respectively, and 48 % were men. Higher NO₂, PM_2.5 and PM₁₀ concentrations were associated with lower MCS (regression coefficients [95%CI] for one unit increase in the inter-quartile range of exposures were -0.69 [-1.23; -0.15], -1.79 [-2.88; -0.70], -1.80 [-2.98; -0.62] respectively). Higher NDVI and presence of forests were associated with higher MCS. No consistent associations were observed for PCS. Similar association patterns were observed regardless of asthma-rhinitis status.

CONCLUSION

European adults who resided at places with higher air pollution and lower greenspace were more likely to have lower mental component of HRQOL. Asthma or rhinitis status did not modify these associations.

The impact of covid-19 lockdown on the Quality of life, meaningful activities, and frailty in community-dwelling octogenarians: A study in Belgium

OBJECTIVES

To investigate the impact of COVID-19 lockdown on quality of life (QoL), meaningful daily activities, and (pre)frailty in community-dwelling octogenarians.

METHODS

Cross-sectional design with bivariate and multiple linear regression modeling using a stepwise approach examining the level of QoL during the COVID-19 lockdown in a group of 215 community-dwelling octogenarians (M_age = 86.49 ± 3.02). A comprehensive set of biopsychosocial variables (FRAIL scale, general health, engagement in meaningful activities survey, questions on loneliness, and feelings) were used as explaining variables.

RESULTS

Particularly, a decrease in daily activities, social activities, and an increase in free times activities were observed, but the decrease in QoL could be explained by the meaningfulness in activities, together with experiencing emptiness in life, taking ≥ 4 medications a day and feeling down or depressed.

CONCLUSIONS

We tried to understand which components contribute to and might affect a person's QoL caused by restrictions imposed by the governance and its influence on the lives of the community-dwelling octogenarians. As such, this output could be a baseline for the development of minimally impacting countermeasures during future lockdowns.

CLINICAL IMPLICATIONS

Studying lifestyle changes and thus also variables related to QoL during a pandemic, may support policymakers and practitioners to develop relevant interventions.

Eveningness intensifies the association between musculoskeletal pain and health-related quality of life: a Northern Finland Birth Cohort Study 1966

ABSTRACT

People with an evening (E)-type preference (ie, chronotype) experience musculoskeletal (MSK) pain and reduced health-related quality of life (HRQoL) more often than morning (M) types. Musculoskeletal pain is a well-established contributor to reduced HRQoL. This study aimed to evaluate whether eveningness amplifies the association between MSK pain and HRQoL in contrast to morningness. Questionnaire data on MSK pain dimensions (intensity, disability at work, number of pain sites [NPSs], and frequency), chronotype, covariates (sex, sufficiency of sleep duration, mental distress, and presence of coexisting diseases), and HRQoL (measured by 15D) were collected among 46-year-old individuals belonging to the Northern Finland Birth Cohort 1966 (N = 4257). Individuals without any MSK pain were excluded. General linear models were conducted to estimate the associations between chronotypes, MSK pain dimensions, and HRQoL. The interaction terms (chronotype × pain dimension) were tested in the models. There were 13% E-types and 43% M-types in the study sample. Each pain dimension and chronotype were related to HRQoL. In the sex-adjusted chronotype-specific models, the reduction in HRQoL in relation to pain appeared to be stronger among E-types than among M-types in respect to all pain dimensions. After adjustments, this was particularly seen in terms of NPS and pain frequency. Our findings suggest that eveningness intensifies the association between MSK pain and HRQoL, and, thus, they are indicative of E-types being more sensitive than M-types to the consequences of MSK pain. As such, MSK pain treatment and rehabilitation actions to improve HRQoL should be especially targeted at E-types.

Social Support Mediates the Association between Health Anxiety and Quality of Life: Findings from a Cross-Sectional Study

This study aimed to test if perceived social support and cyberchondria mediate the association between health anxiety and quality of life (QoL) in a nonclinical sample. Cross-sectional research involved adult internet users (n = 538) between 16 May 2020 and 29 December 2020 in Poland who completed self-report questionnaires, including the cyberchondria severity scale (CSS-PL), the short health anxiety inventory (SHAI), the multidimensional scale of perceived social support (MSPSS) and the quality of life scale (QOLS). A mediation analysis was performed to examine the direct effects of health anxiety on cyberchondria, perceived social support and quality of life. Likewise, the effects of cyberchondria and perceived social support on QoL were analyzed. Hence, indirect effects of health anxiety on QoL through cyberchondria and perceived social support were explored. Health anxiety significantly impaired QoL both directly and indirectly through low-perceived social support. Perceived social support partly mediated the association between health anxiety and QoL. Cyberchondria did not have a significant direct effect on the latter. Thus, cyberchondria did not mediate the relationship between health anxiety and QoL. Boosting-perceived social support may mitigate the detrimental effect of health anxiety on QoL. Cyberchondria was not found to have a significant effect on QoL in contrast to health anxiety alone.

Health Literacy and Health-Related Quality of Life in Beijing Adolescents: A Path Analysis

BACKGROUND

Health literacy is a critical driver of achieving an equitable world for every child and adolescent. Although the relationship between health literacy and health-related quality of life (HRQoL) has been documented, little is known among adolescents. In addition, due to lack of theory-driven empirical research, it remains unknown about the full relationship between health literacy, its antecedents, and HRQoL.

OBJECTIVE

This study aimed to apply Manganello's framework to investigate how health literacy was associated with its antecedents and HRQoL in Beijing secondary students.

METHODS

A cross-sectional study was conducted with 650 students in years 7 to 9 from four secondary schools in Beijing. Based on Manganello's health literacy framework, a self-administered questionnaire was used to collect information on health literacy, its antecedents (i.e., sociodemographics, self-efficacy, social support, school and community environment), and HRQoL. The 8-item Health Literacy Assessment Tool was used to measure health literacy (score range 0-37), and the KIDSCREEN-10 was used to measure HRQoL (score range 10-50). Path analysis was conducted to examine the mediating role of health literacy in the relationship between its antecedents and HRQoL.

KEY RESULTS

Overall, the average score of students' health literacy and HRQoL was 26.37 (±5.89) and 37.49 (±5.78), respectively. Health literacy was positively correlated with HRQoL (r = 0.36, p < .01). In the final path model, health literacy was not associated with HRQoL. However, students' social support, school environment, and community environment were associated with HRQoL. Health literacy was affected by self-efficacy, social support, and school environment (all p < .05).

CONCLUSIONS

A range of intrapersonal, interpersonal, and environmental factors were associated with health literacy and HRQoL. A holistic approach is needed to improve health literacy and HRQoL through multilevel intervention strategies such as increasing personal self-efficacy, promoting social support, and creating positive environments. [HLRP: Health Literacy Research and Practice. 2022;6(4):e300-e309.] Plain Language Summary: We investigated how health literacy was related to its influencing factors and HRQoL among Beijing secondary students in years 7 to 9. Health literacy and HRQoL were independent outcomes affected by a range of social-ecological factors including self-efficacy, social support, and perceptions of school and community environments.

Impact of Lifestyle Modification on Quality of Life in Patients with Metabolic Syndrome: Findings from the CHANGE Program Intervention Study in Prince Edward Island, Canada

Purpose: To assess the modification in quality of life (QoL) of patients with metabolic syndrome (MetS) after participating in Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program and identify predictors of this modification in QoL among participants. Methods: A convenience sample of 100 patients with MetS completed the 12-month CHANGE program (diet and exercise regular counseling). 36-Item Short Form Health Survey (SF-36), International Physical Activity Questionnaire (IPAC), Physician Assessment and Clinical Education (PACE), and the Mediterranean Diet Score (MDS) questionnaires were employed to assess participants' QoL, physical activity (PA), sedentary behaviors, and quality of diet, respectively. In addition, physical fitness tests (6-Minute Walk Test, One-Leg Stance Test, and Grip Strength Test) were used. Medical history, blood tests, and anthropometric [height, weight, and waist circumference (WC)] and blood pressure measurements were performed by a nurse. Linear regression analysis was performed to identify predictors of QoL. Results: Participants' mean age was 58.3 ± 11.0, and 75.4% were females. After the CHANGE program, participants demonstrated significant reduction in the number of MetS criteria and significant improvement of physical and mental components of QoL. Moreover, there was significant increase in participants' PA, MDS, and physical fitness mean scores with corresponding significant reduction in sedentary behavior time, blood pressure, and WC measures. Linear regression analysis revealed that age, WC, screen time, PA, and physical fitness were significant predictors of QoL. Conclusion: The 12-month group-based diet and exercise counseling led to clinically significant improvement in MetS criteria and in important measures of health and fitness among participants, which improved their QoL. Age, fitness measures, and daily screen time were associated with QoL.

Dose-Response Association between Physical Activity and Health-Related Quality of Life in General Population: A Population-Based Pooled Study

Objective: The objective of this study was to examine the dose−response association between moderate-to-vigorous intensity physical activity (MVPA) and health-related quality of life (HRQoL) within the context of a large representative national survey from Wales, in the UK. Methods: Data for adults aged 16 years and older, living in Wales, UK, and participating in the Welsh Health Survey (WHS; 2011−2015) were employed. HRQoL was assessed using the 36-item short form (SF-36). Participants were categorized into six groups based on weekly minutes (min/week) of MVPA variable: none (no MVPA); very low (>0 to <90); low (≥90 to <150); sufficient (150 to <300); high (≥300 to <390); and very high (≥390). The association between MVPA and HRQoL was explored using multiple linear regression and generalized linear models. Results: Of the 74,578 adults in the survey cohort, 67,770 adults were included in the analyses. The results showed consistent direct curvilinear associations between MVPA and HRQoL for all SF-36 domains (p < 0.001), in both the minimally and maximally adjusted models; with the highest scores observed for those meeting the recommended physical activity guidelines (sufficient, high, and very high). The scores of the overall HRQoL and SF-36 domains demonstrated a consistent positive gradient from the very low level to the sufficient level, suggesting a dose−response relationship. Conclusions: The results showed a direct curvilinear association between MVPA and the overall HRQoL and SF-36 domains, with better scores observed for those meeting the recommended guidelines.

Correlation between Glycation-Related Biomarkers and Quality of Life in the General Japanese Population: The Iwaki Cross-Sectional Research Study

The correlation between diabetes-related biomarkers and quality of life (QOL) remains unclear. In this cross-sectional study, we investigated the correlation between diabetes-related biomarkers and QOL in a general Japanese population who underwent health checkups as a part of the Iwaki Health Promotion Project. Male and female participants aged ≥ 20 years from Iwaki District, Hirosaki City, Aomori Prefecture who participated in the 2019 medical evaluation were recruited. QOL was evaluated using the Short Form Health Survey 36 (SF-36). Fasting blood glucose, homeostatic model assessment-estimated insulin resistance (HOMA-IR), hemoglobin A1c (HbA1c), glycoalbumin, and plasma pentosidine were also evaluated as diabetes-related markers. Of the 1065 recruited participants, 1053 completed the clinical and QOL evaluations. Multivariate regression analysis revealed that upregulated diabetes-related markers levels were correlated with decreased SF-36 scores. Blood glucose, HOMA-IR, HbA1c, glycoalbumin, and plasma pentosidine levels were correlated with general health. Moreover, plasma pentosidine levels were correlated with role physical, social functioning, and role emotional in addition to general health. These results indicated that the levels of diabetes-related biomarkers, particularly the levels of plasma pentosidine, a glycation marker, were associated with QOL in our cohort.

Improving multimorbidity measurement using individualized disease-specific quality of life impact assessments: predictive validity of a new comorbidity index

Background

Interpretation of health-related quality of life (QOL) outcomes requires improved methods to control for the effects of multiple chronic conditions (MCC). This study systematically compared legacy and improved method effects of aggregating MCC on the accuracy of predictions of QOL outcomes.

Methods

Online surveys administered generic physical (PCS) and mental (MCS) QOL outcome measures, the Charlson Comorbidity Index (CCI), an expanded chronic condition checklist (CCC), and individualized QOL Disease-specific Impact Scale (QDIS) ratings in a developmental sample (N = 5490) of US adults. Controlling for sociodemographic variables, regression models compared 12- and 35-condition checklists, mortality vs. population QOL-weighting, and population vs. individualized QOL weighting methods. Analyses were cross-validated in an independent sample (N = 1220) representing the adult general population. Models compared estimates of variance explained (adjusted R²) and model fit (AIC) for generic PCS and MCS across aggregation methods at baseline and nine-month follow-up.

Results

In comparison with sociodemographic-only regression models (MCS R² = 0.08, PCS = 0.09) and Charlson CCI models (MCS R² = 0.12, PCS = 0.16), increased variance was accounted for using the 35-item CCC (MCS R² = 0.22, PCS = 0.31), population MCS/PCS QOL weighting (R² = 0.31–0.38, respectively) and individualized QDIS weighting (R² = 0.33 & 0.42). Model R² and fit were replicated upon cross-validation.

Conclusions

Physical and mental outcomes were more accurately predicted using an expanded MCC checklist, population QOL rather than mortality CCI weighting, and individualized rather than population QOL weighting for each reported condition. The 3-min combination of CCC and QDIS ratings (QDIS-MCC) warrant further testing for purposes of predicting and interpreting QOL outcomes affected by MCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-02016-7.

Baseline health-related quality of life predicts falls: a secondary analysis of a randomized controlled trial

PURPOSE

Among older adults, health-related quality of life (HRQoL) and falls are associated. Generic patient-reported outcomes measures (PROMs) assess individual's HRQoL. The role for PROMs, a potential tool for predicting subsequent falls, remains under-explored. Our primary aim was to determine whether a baseline PROMs assessment of HRQoL may be a useful tool for predicting future falls.

METHODS

A secondary analysis of a 12-month randomized clinical trial (RCT) of a home-based exercise program among 344 adults (67% female), aged ≥ 70 years, with ≥ 1 falls in the prior year who were randomized (1:1) to either a home-based exercise program (n = 172) or usual care (n = 172). A negative binomial regression model with total falls count as the dependent variable evaluated the main effect of the independent variable-baseline HRQoL (measured by the Short-Form-6D)-controlling for total exposure time and experiment group (i.e., exercise or usual care) for the total sample. For the usual care group alone, the model controlled for total exposure time.

RESULTS

For the total sample, the rate of subsequent total falls was significantly predicted by baseline HRQoL (IRR = 0.044; 95% CI [0.005-0.037]; p = .004). For the usual care group, findings were confirmed with wider confidence intervals and the rate of prospective total falls was significantly predicted by baseline HRQoL (IRR = 0.025; 95% CI [0.001-0.909]; p = .044).

CONCLUSION

These findings suggest the ShortForm-6D should be considered as part of falls prevention screening strategies within a Falls Prevention Clinic setting. Trial Registrations ClinicalTrials.gov Protocol Registration System. Identifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171 . Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596 .

Health-related quality of life among elderly breast cancer patients treated with adjuvant endocrine therapy: a U.S Medicare population-based study

OBJECTIVES

The evidence regarding the impact of individual adjuvant endocrine therapies (AET) on health-related quality of life (HRQoL) is limited. We aimed to assess the association between the type of AET and HRQoL and to examine the relationship between HRQoL and one-year mortality among women with breast cancer in the USA.

METHODS

This retrospective cross-sectional study used the 2006-2017 Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey database to identify older women with early-stage hormone receptor-positive breast cancer. Multivariate linear regressions were used to assess the association between types of AET (anastrozole, letrozole, exemestane, and tamoxifen) and HRQoL scores (physical component summary (PCS) and mental component summary (MCS)). Multivariate logistic regressions were used to predict the impact of PCS and MCS on one-year mortality.

RESULTS

Out of 3537 older women with breast cancer, anastrozole was the most commonly prescribed (n = 1945, 55.0%). Regarding PCS, there was no significant difference between the four AET agents. Higher MCS scores, which indicate better HRQoL, were reported in patients treated with anastrozole (vs. letrozole [β = 1.26, p = 0.007] and exemestane [β = 2.62, p = 0.005) and tamoxifen (vs. letrozole [β = 1.49, p = 0.010] and exemestane [β = 2.85, p = 0.004]). Lower PCS and MCS scores were associated with higher one-year mortality, regardless of type of AET initiated, except for tamoxifen in MCS.

CONCLUSION

Although there was no significant difference in physical HRQoL scores between AET agents, anastrozole and tamoxifen were associated with better mental HRQoL scores.

Worse health‐related quality of life, impaired functioning and psychiatric comorbidities are associated with excess mortality in patients with severe chronic pain

Background

Severe chronic pain that interferes with daily activities is associated with an increased risk of mortality. We assessed the overall mortality of tertiary chronic pain patients in comparison with the general population, with a special aim to analyse the association of health‐related quality of life (HRQoL) and its dimensions with the risk of death.

Methods

In this prospective observational follow‐up study, patients with non‐cancer chronic pain attended an outpatient multidisciplinary pain management (MPM) episode in a tertiary pain clinic in 2004–2012 and were followed until May 2019. Mortality between the patients and the general population was compared with standardized mortality ratios (SMR) in different age groups. Causes of death and comorbidities were compared among the deceased. Association of mortality and HRQoL and its dimensions, measured with the 15D instrument, was studied with Cox proportional hazards model.

Results

During a mean of 10.4‐year follow‐up of 1498 patients, 296 died. The SMR in the youngest age group (18–49 years) was significantly higher than that of the general population: 2.6 for males and 2.9 for females. Even elderly females (60–69 years) had elevated mortality (SMR 2.3). Low baseline HRQoL at the time of MPM, as well as poor ratings in the psychosocial dimensions of HRQoL, was associated with an increased risk of death.

Conclusions

Our results support the role of HRQoL measurement by a validated instrument such as the 15D in capturing both the physical and the psychological symptom burden, and consequently, an elevated risk of death, in patients with chronic pain.

Significance

Severe chronic pain is associated with elevated mortality. In patients in chronic pain under 50 years old, the mortality was 2.5–3 times higher than in the general population. Psychological distress appears to contribute to the increased mortality. Regular follow‐up by health‐related quality of life (HRQoL) measurement could be useful in identifying patients in chronic pain who are in need of intensive symptom management and to prevent early death.

Relationship between Depressive Symptoms and Cognitive, Psychological, and Physical Performance in Community-Dwelling Older People with Cognitive Impairment

INTRODUCTION

Dementia and depression often coexist. Understanding how concomitant comorbidities affect function can improve assessment and management strategies. We examined the relationship between cognitive, psychological, and physical function and depressive symptoms in people with cognitive impairment.

METHODS

Cross-sectional study using baseline data from the iFOCIS randomized controlled trial involving 309 participants with mild-moderate cognitive impairment. The association between cognitive (Addenbrooke's Cognitive Examination-III [ACE-III], Frontal Assessment Battery), psychological (Goldberg Anxiety Scale; Iconographical Falls Efficacy Scale), and physical (Physiological Profile Assessment; Short Physical Performance Battery [SPPB]) function, and quality of life (QoL), physical activity levels and activities of daily living, and depressive symptoms (15-item Geriatric Depression Scale [GDS]) were assessed (adjusted for age, sex, education, and ACE-III as appropriate).

RESULTS

Participants with depressive symptoms (GDS ≥4) had significantly more falls in the previous year and a higher number of comorbidities than people without depressive symptoms (GDS <4). Each point increase in the GDS was associated with better memory, higher levels of anxiety and concern about falling, poorer balance, slower gait speed, and reduced QoL. The relationship between the GDS and poor balance and QoL withstood additional adjustment for comorbidity tertiles. The relationship between GDS and concern about falls withstood additional adjustment for previous falls (12 months) and SPPB scores.

CONCLUSIONS

Depressive symptomatology is associated with poorer physical and psychological function and reduced QoL in people with cognitive impairment. These factors should be considered when assessing and intervening in this group. Future research could examine these relationships longitudinally to establish causality and examine intervention efficacy in this group.

Sleep Quality and Quality of Life Among Older Adults During COVID-19 Pandemic: A Cross-sectional Study

BACKGROUND

Although home confinement reduces the number of SARS-CoV-2 infections, it may negatively impact the psychological and physical health of older adults.

OBJECTIVE

The present study attempted to describe the quality of life (QoL) of older adults before and during the COVID-19 outbreak focus on evaluating QoL, physical activity, sitting time, and sleep quality during home confinement.

METHOD

The present study was conducted in 1,063 older adults (91% females) enrolled in a Brazilian social program. They were interviewed for QoL (EQ-5D), physical activity (international physical activity questionnaire-short vision), and sleep quality [Pittsburgh sleep quality index (PSQI)] after 11.6 ± 2.4 weeks of confinement. Logistic regression confirmed changes in QoL.

RESULTS

The QoL (86.5 ± 14.7) decreased significantly during confinement (66.0 ± 21.0; P < 0.001), whereas the PSQI global score was 6.8 ± 3.9 points. Older adults spent 18.7 ± 29.8 min/day in moderate to vigorous physical activity, whereas they spent 325.5 ± 144.4 min/day sitting. The PSQI global score [odds ratio (OR): 1.10], sitting time (OR: 1.001), and diseases (OR: 1.23) were significantly associated with low QoL (P < 0.05).

CONCLUSION

Confinement has a deleterious effect on QoL, which is influenced by quality of sleep, sitting time, and disease. Awareness regarding the significance of sleep and physical exercise in older adults can mitigate the damage to their health during confinement.

Sex and Gender in Glomerular Disease

There is increasing understanding that a multifaceted interplay of sex-dependent genetic and immune dysregulation underpins the development of glomerular disorders. Regional and ethnic variations in glomerular disease incidence make delineating the effects of sex and gender on disease pathophysiology more complex, but there is a marked paucity of research in this area. This review article presents a summary of the current understanding of sex and gender in glomerular disease, highlighting the broader effects of sex and gender on autoimmunity, clinical presentations, and pathophysiology of individual glomerular diseases, as well as exploring sex, gender, and glomerular disease within a wider socioenvironmental context. It is important to specifically consider the effects of sex and gender when presenting and analyzing clinical and scientific studies on glomerular disease. Failure to do so risks promoting disparities within health care provision, neglecting opportunities to identify sex-specific biomarkers, and potentially hindering the development of sex-specific therapies.

Sarcopenia reduces quality of life in the long-term: longitudinal analyses from the English longitudinal study of ageing

Aim

To examine the association between sarcopenia at baseline and changes in quality of life at 10 years follow-up in a large representative sample of older English adults.

Findings

After considering numerous confounders, sarcopenia at baseline was associated with a higher incidence of poor quality of life. People having sarcopenia at baseline reported significantly lower values in CASP-19 after ten years of follow-up.

Message

Sarcopenia is an important and independent risk factor for poor quality of life in older people.

Purpose

Mixed findings exist for sarcopenia/quality of life (QoL) relationship. Moreover, the majority of studies in this area have utilized a cross-sectional design or specific clinical populations. Therefore, the aim of the present study was to examine the association between sarcopenia at baseline and QoL at 10 years follow-up in a large representative sample of older English adults.

Methods

Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index. QoL was measured using the CASP (control, autonomy, self-realisation and pleasure)-19, with higher values reflecting higher QoL. Multivariable logistic regression analysis was conducted to assess prospective associations between sarcopenia at baseline and poor QoL at follow-up; generalized linear model with repeated measures was used for reporting mean changes during follow-up between sarcopenia and not.

Results

Among 4044 older participants initially included at baseline (mean age: 70.7 years; 55.1% females), 376 had sarcopenia. In the multivariable analysis, after adjusting for several potential confounders, sarcopenia at baseline was associated with a higher incidence of poor QoL (odds ratio, OR = 5.82; 95% confidence interval, CI 3.45–9.82). After matching for QoL values at baseline and adjusting for potential confounders, people with sarcopenia reported significantly lower values in CASP-19 (mean difference = − 3.94; 95% CI − 4.77 to − 3.10).

Conclusions

In this large representative sample of older English adults, it was observed that sarcopenia at baseline was associated with worse scores of QoL at follow-up compared to those without sarcopenia at baseline. It may be prudent to target those with sarcopenia to improve QoL.

The Association between Health-Enhancing Physical Activity and Quality of Life in Patients with Chronic Kidney Disease: Propensity Score Matching Analysis

We investigate the association between health-enhancing physical activity and the quality of life in patients with non-dialysis chronic kidney disease. We performed data analysis on 1618 of 2238 patients from 2011 to 2016, obtained from the KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease (KNOW-CKD). Health-related quality of life was measured using the Korean version 1.3 of Kidney Disease Quality of Life short-form questionnaire. Health-enhancing physical activity was defined as 150 min of moderate-intensity or 75 min of vigorous-intensity aerobic physical activity throughout the week. Propensity score matching analysis and linear regression was performed to estimate the effect of health-enhancing physical activity on health-related quality of life. The estimate of average treatment effects was 2.60 in the kidney component summary score, 4.45 in the physical component summary score, and 4.24 in the mental component summary score. In all component summary scores and most of their subscales, health-enhancing physical activity showed a significant association with health-related quality of life. Subgroup and sensitivity analyses also showed robust results. This study suggests that health-enhancing physical activity elevated quality of life in patients with non-dialysis chronic kidney disease. The results can contribute to encourage physical activity in patients with chronic kidney disease.

The association of care satisfaction and COVID-19 contact restrictions with quality of life in long-term care homes residents in Germany: a cross-sectional study

BACKGROUND

Quality of life (QoL) is a widely recognised outcome in residents of long-term care homes. However, little is known about the impact of care satisfaction on QoL. The aim of this study was to assess the association between care satisfaction and QoL in residents of long-term care homes. Additionally, we were able to assess the impact of the Covid-19 contact restrictions on QoL.

METHODS

We applied a cross-sectional study in N = 40 long-term care homes in Baden-Wuerttemberg, Germany. Using regression models, we analysed the association between QoL (operationalised through the World Health Organization Quality of Life Assessment-Old Module [WHOQOL-OLD]) and self-rated nursing care satisfaction. The date on which the questionnaire was completed was used to calculate whether the completion was prior the emergence of the Covid-19 contact restrictions. Further potential confounders were included in the analysis.

RESULTS

N = 419 residents of long-term care homes participated. Explained variance of QoL was low in our models at 2 to 16%. Self-rated nursing care satisfaction was the strongest predictor of QoL and positively linked to the following subdimensions of QoL: autonomy; past, present and future activities; social participation; intimacy. The Covid-19 contact restrictions were negatively linked to social participation.

CONCLUSION

Nursing care satisfaction was associated with QoL in residents of long-term care homes. Future research should focus on the direction of the association and different aspects of nursing care satisfaction with QoL. Furthermore, we showed the impact of contact restriction during the Covid-19 lockdown on social participation.

TRIAL REGISTRATION

WHO UTN: U1111-1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017/08/23).

Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people

Study objective

The aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality.

Methods

This study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial. PCS was assessed annually using the SF-12 (version-2) over a median 4.7-years (i.e. from baseline (2010-2014) till June 2017). Incident CVD events and all-cause mortality occurring after June 2017 until the second-year after the end of the trial were considered. Growth mixture and logistic regression modelling were used.

Results

Four PCS trajectories were identified: high (66.5%), intermediate (13.3%), decline (13.8%), and low (6.5%), and there was subsequently a total of 406 (2.50%) incident CVD events, 197 (1.17%) fatal CVD, and 751 (4.45%) deaths. The declining PCS trajectory group had the highest risk of incident CVD (adjusted OR, 1.51; 95% CI 1.14, 1.99), while the low PCS trajectory group had the greatest risk of fatal CVD (adjusted OR, 1.74; 95%CI 1.06, 2.85) and all-cause mortality (adjusted OR, 1.83; 95%CI 1.40, 2.40). After further adjustment for the baseline PCS score, only the association between declining PCS trajectory and incident CVD (adjusted OR, 1.51; 95%CI 1.11, 2.07) remained.

Conclusion

Our study strengthens the importance of PCS as a predictive measure of CVD and all-cause mortality in older people and also highlights that a declining PCS trajectory could be considered an early predictor of future CVD events.

Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany

Background

Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany.

Methods

The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling.

Results

The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]).

Conclusions

Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12303-5.

Participation in recreational activities varies with socioeconomic position and is associated with self-rated health and well-being

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This study shows social inequalitues in recreational activity participation (RAP).

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Regardless of educational level, RAP was associated with better self-rated health.

•

RAP may modify social inequality in self-rated health and quality of life.

Recreational activities may promote and maintain health and well-being, but empirical evidence is limited. The aim of this study was to explore socioeconomic variations in participation in recreational activities in the local community and to examine associations with health and well-being in the general population.

Participants ≥ 16 years from the Danish Capital Region Health Survey, conducted in 2017 (N = 55,185, response rate 52.6%) were included. Participation in community-based recreational activities, self-rated health, quality of life, and health status was assessed by questionnaire. Socioeconomic variables (educational level, occupational and marital status) were obtained from national registers. Multiple logistic regression models were used to examine associations.

Less than half of the population participated in community-based recreational activities. Individuals with a higher educational level were 55% more likely to participate in recreational activities compared to those with a lower educational level (OR = 1.55, CI:1.45–1.66). Individuals with a low educational level who participated in recreational activities, were more likely to have an excellent/good quality of life (OR = 2.03 (95% CI:1.86–2.21)) and an excellent/very good self-rated health (OR = 1.61 (95% CI:1.51–1.71)), than those who did not participate in recreational activities.

Regardless of educational level, recreational activity participation was associated with better self-rated health and quality of life. Thus, to counter-balance social inequality in health, a focus on participation in recreational activities is important when planning community public health interventions.

Association of Grip Strength with Quality of Life in the Chinese Oldest Old

Emerging studies have suggested an association between grip strength and health-related quality of life (QOL). However, evidence for which specific domains of QOL are associated with grip strength remains limited and inconsistent. Particularly, such evidence is scarce in the oldest old, who constitute one of the most vulnerable populations. This cross-sectional study aimed to examine the association between grip strength and overall QOL as well as specific domains in the oldest old. It included 400 community-dwelling older adults aged 80 years or older from Shanghai, China. QOL was assessed using the WHO Quality of Life of Older Adults instrument, and grip strength was measured using a digital spring-type dynamometer. On average, the overall QOL score was 54.68 (SD = 12.05). Estimates of risk-adjusted linear regressions indicated that higher grip strength was associated with better overall QOL (β = 4.40, p < 0.001) as well as the domains of autonomy (β = 6.74, p < 0.001); fulfillment with past, present, and future activities and achievements (β = 3.52, p = 0.004); and satisfaction with social participation (β = 6.72, p < 0.001). Our findings highlight the importance of maintaining or improving grip strength in delaying or reducing the decline in QOL among the community-dwelling oldest old. Also noteworthy is that the associations between grip strength and specific domains of QOL in the oldest old vary.

Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places

Despite significant advances in antiretroviral therapy, unmet basic needs can negatively impact health-related quality of life (HRQoL) in people living with HIV, especially as they age. We aimed to examine the effect of unmet basic needs across age groups on changes in HRQoL over a 4-year period in persons with HIV. Physical and mental HRQoL scores from the Positive Spaces, Healthy Spaces cohort interviewed in 2006 (n = 538), 2007 (n = 506), and 2009 (n = 406) were examined across three age groups according to their unmet needs for food, clothing, and housing. Individual growth curve model analyses were used to investigate changes over time, adjusting for demographics, employment, living conditions, social supports, HIV status, and health behavior risks. Low scores on physical and mental HRQoL were positively associated with higher number of unmet basic needs (β = −6.40, standard error (SE) = 0.87, p < 0.001 and β = −7.39, SE = 1.00, p < 0.001, respectively). There was a slight improvement in physical and mental HRQoL over 4 years in this HIV cohort, but the burden of unmet basic needs took its toll on those over 50 years of age. Regularly assessing unmet basic needs is recommended given the impact these can have on HRQOL for people living with HIV. Recognition of unmet needs is vital, as is the development of timely interventions.

Cognitive effects of chemotherapy: An integrative review

PURPOSE

An estimated 18.1 million new cancer cases (excluding nonmelanoma skin cancers) were diagnosed worldwide in 2020. Despite a rising incidence of cancers worldwide, in developed countries with strong healthcare systems, survival rates are improving as a result of early detection, improved treatments and survivorship care (World Health Organisation (WHO), 2021). Whilst living longer, cancer survivors are often living with side effects of treatment, including chemotherapy related cognitive impairment, often termed "chemobrain".

METHOD

An integrative review of contemporary literature answering the research question how does chemotherapy affect cognitive function? was undertaken utilising three computerised databases CINAHL, Medline and PUBMED, between 2015 and 2021. Data was thematically analysed to identify themes within published literature.

RESULTS

Thematic analysis identified four broad themes within the literature regarding chemotherapy induced cognitive impairment. Identified themes included; cognition as part of a complex scenario, proof of existence and searching for the cause, learning to play the game and timing of cognitive impairment.

CONCLUSIONS

Aggressive treatment with chemotherapy in the adjuvant setting has drastically improved the survival of cancer patients. Subsequent to aggressive treatments, side effects such as cognitive impairment have presented, which may persist in the long term. Despite the exact aetiology of chemotherapy induced cognitive impairment being largely unknown, the consequences of the condition are impacting cancer survivors and their quality of life.

Interactions of Comorbidity and Five Simple Environmental Unhealthy Habits Concerning Physical and Mental Quality of Life in the Clinical Setting

The objective of this study was to examine the interactions between comorbidity and five lifestyle single habits concerning different subscales of quality of life (QoL). For the study, 302 patients were consecutively recruited at the internal medicine department of a tertiary teaching hospital. Lifestyle habits, comorbidities and QoL were recorded according to validated questionnaires. Five single unhealthy habits, such as tobacco consumption, dietary intake of ultra-processed pastries, raw nuts or carbonated drinks, sleep time and physical activity patterns were selected according to previously published data. The main outcomes of the study were the scores of the eight subscales of the SF-36 QoL survey. The aggregate of unhealthy habits showed statistically significant association to every category in the SF-36 questionnaire, both in the univariate and the multivariate analysis when adjusting by age, sex and comorbidity. An interaction was found between comorbidity and unhealthy habits in both physical and mental summaries of SF-36. In conclusion, the lifestyle assessment according to five unhealthy habits is associated with a worse QoL. The interaction between comorbidity and unhealthy habits is especially clear in diseased patients due to the interplay between illness and lifestyle in the prediction of QoL.

The Utility of Assessing Health-Related Quality of Life to Predict Cognitive Decline and Dementia

BACKGROUND

Health-related quality of life (HRQoL) has been shown to predict adverse health outcome in the general population.

OBJECTIVE

We examined the cross-sectional association between HRQoL and cognitive performance at baseline. Next, we explored whether baseline HRQoL predicted 5-year incident cognitive decline and dementia and whether there were gender differences.

METHODS

19,106 community-dwelling participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, aged 65-98 years, free of major cognitive impairments, and completed the HRQoL 12-item short-form (SF-12) at baseline (2010-2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were calculated. The cognitive tests were assessed at baseline, year 1, 3, 5, and 7 or close-out visit. Cognitive decline was defined as > 1.5 SD drop from baseline on any of the cognitive tests. Dementia was adjudicated according to DSM-IV criteria. Linear and Cox proportional-hazards regressions were used to examine the cross-sectional and longitudinal associations respectively.

RESULTS

At baseline, higher PCS and MCS were associated with better cognition. Over a median 4.7-year follow-up, higher MCS was associated with a reduced risk of cognitive decline and dementia (12% and 15% respectively, per 10-unit increase) and a 10-unit higher PCS was associated with a 6% decreased risk of cognitive decline. PCS did not predict dementia incidence. Findings were not different by gender.

CONCLUSION

Our study found that higher HRQoL, in particular MCS, predicted a reduced risk of cognitive decline and dementia over time in community-dwelling older people.

Impact of post-tuberculosis lung disease on health-related quality of life in patients from two tertiary hospitals in Lagos, Nigeria

Background

Post-tuberculosis (TB) lung disease is a recognised cause of chronic respiratory disease, and its impact on health-related quality of life (HRQoL) has not been extensively described.

Objectives

To describe the clinical profile, spirometry impairment and impact of post-TB lung disease on HRQoL among patients attending two tertiary hospitals in Lagos, Nigeria.

Methods

We conducted a cross-sectional study and obtained data through interviews, chart reviews and physical examination. We measured dyspnoea severity using the Medical Research Council (MRC) scale, HRQoL with the St George’s respiratory questionnaire (SGRQ) and performed spirometry. Univariate regression was used to explore the associations between selected variables and HRQoL.

Results

A total of 59 participants were recruited and their median (interquartile range (IQR)) age was 45 (36 - 60) years. The most frequent symptom was cough (93.2%; n=55) and sputum production (91.5%; n=54). Less than two-thirds of the participants (62.4%; n=38) had received treatment for TB on more than one occasion, 50.8% (n=30) had moderate to very severe dyspnoea on the MRC scale and 88.7% (n=47/53) had abnormal spirometry with the mixed pattern predominating in 56.6% (n=30) of the participants. The mean (standard deviation (SD)) SGRQ component score for symptoms was 43.89 (18.66), followed by activity (42.50 (22.68)), impact (29.41 (17.82)) and total components (35.78 (17.25)). Dyspnoea, cough, sputum production and weight loss were associated with worsened HRQoL.

Conclusion

Post-TB lung disease was characterised by a high symptom burden, severe spirometry impairment and poor HRQoL. There is a need for increased recognition and development of guidelines for diagnosis and treatment of post-TB lung disease and for further studies to explore preventive strategies.

Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study

OBJECTIVES

To examine multiple objective and self-reported measures of motor function for their associations with mortality.

DESIGN

Prospective cohort study.

SETTING

UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave.

PARTICIPANTS

6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16.

MAIN OUTCOME MEASURES

All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function.

RESULTS

One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations.

CONCLUSION

Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.

Could the EQ-5D-3L predict all-cause mortality in older Chinese? Evidence from a 5-year longitudinal study in eastern China

PURPOSE

To assess the ability of the 3-level EQ-5D (i.e., EQ-5D-3L) in predicting all-cause mortality in older Chinese adults.

METHODS

The data were from a 5-year longitudinal study, Weitang Geriatric Diseases Study, including 4579 community-dwelling older people in eastern China, with the mean age of 72.5 years at baseline and female being 52.0%. Three multivariable logistic regression models were adopted to assess the associations of the baseline EQ-5D data [i.e., the EQ-5D problems, EQ-5D-3L index score, and EQ-5D visual analog scale (VAS) score] with the 5-year all-cause mortality, adjusting for socio-demographic characteristics, and subsequently, health conditions and lifestyle habits.

RESULTS

A total of 183 participants died over the 5-year study period. A larger proportion of the dead reported problems in physical dimensions (i.e., including three dimensions: mobility, self-care, and usual activities, p < 0.05 for all). The mean EQ-5D index score (0.928) and EQ-VAS score (79.7) of the living were higher than those of the dead (0.915 and 73.2, p < 0.05 for both). In multivariable logistic analyses, the EQ-5D health problems in the physical-related dimensions [odds ratio (OR) 2.16, p < 0.05] and the EQ-VAS score (OR: 0.97, p < 0.001) were associated with the 5-year all-cause mortality when adjusting for socio-demographic characteristics, health conditions, and lifestyle habits.

CONCLUSIONS

It appears that the EQ-5D-3L could predict mortality in general older Chinese, which could be used to detect high-risk older individuals in China.

Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study

PURPOSE

Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country.

METHOD

A prospective cohort of 19,106 individuals aged 65-98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010-2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS.

RESULTS

There were 1052 deaths over a median 4.7-years (interquartile range 3.6-5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed.

CONCLUSION

Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.

Association between Levels of Physical Activity, Sarcopenia, Type 2 Diabetes and the Quality of Life of Elderly People in Community Dwellings in Lebanon

There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22–0.84, p = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22–0.73, p = 0.003) by 60%, and higher scores of the physical (β = −7.65; −11.87, −3.43, p = 0.0004) and mental (β = −8.47; −13.08, −3.85, p = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population.

Effects of Polyphenol Supplementations on Improving Depression, Anxiety, and Quality of Life in Patients With Depression

Background: Increased prevalence of mental disorders has become a significant public health concern. Recent studies have linked nutrition to depression and anxiety, suggesting that dietary changes or nutritional supplementation may be beneficial in improving mental disorders. Polyphenols have anti-inflammatory and antioxidant properties that may counteract physiological changes in depression and anxiety. This study examined the effectiveness of polyphenol supplementation in improving depression, anxiety and quality of life (QoL). Methods: Randomized controlled trials in English and with polyphenol supplementation as the intervention were searched. The primary outcome was depression, and secondary outcomes were anxiety and QoL. Only studies of at least moderate quality based on the Physiotherapy Evidence Database tool were included. Comprehensive systematic review and meta-analysis were then used to determine the effect of polyphenol supplementations on improving depression, anxiety and quality of life (QoL) in patients with depression. Results: Nineteen studies with 1,523 participants were included; 18 studies (n = 1,523) were included in the depression meta-analysis, and 5 (n = 188) and 6 (n = 391) in the QoL and anxiety meta-analyses, respectively. Twelve of the 18 studies found significant improvements in depression with polyphenol use, while the meta-analyses results also indicated that polyphenol supplementation significantly improved depression score as compared to control conditions (MD: -2.280, 95% CI: -1.759, -0.133, I ² = 99.465). Although subgroup analyses were conducted a significantly high heterogeneity was still found amongst subgroups. Only 2 of the 5 studies found significant improvements in QoL following polyphenol supplementation and meta-analyses found that polyphenol use did not benefit QoL (MD: -1.344, p < 0.05, I ² = 55.763). For anxiety, 5 of the 6 studies found significant reductions in depression score following polyphenol use but meta-analyses found no significant differences in anxiety score (MD: -0.705, CI: -1.897, 0.487, I ² = 84.06) between polyphenol supplementation and control. Conclusion: The results suggest that polyphenol supplementation is effective in improving depression. Physical illness may act as a risk factor that worsens depression, suggesting the need for preventative supplementation to improve depression. Polyphenol types may have varying effects, which suggests that different populations with depression may benefit from different polyphenols.