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Sivertsen HE, Helvik AS, Gjøra L, Haugan G. Psychometric validation of the Hospital Anxiety and Depression Scale (HADS) in community-dwelling older adults. BMC Psychiatry 2023; 23:903. [PMID: 38053095 PMCID: PMC10696870 DOI: 10.1186/s12888-023-05407-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVES The Hospital Anxiety and Depression Scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults 70 + living at home in a large Norwegian city. METHODS In total, 1190 inhabitants ≥ 70 (range 70 - 96) years completed the HADS inventory in the population-based Trøndelag Health Study (HUNT), termed "HUNT4 70 + " in Trondheim, Norway. Confirmatory factor analyses were performed to test the dimensionality, reliability, and construct validity. RESULTS The original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6D ("I feel cheerful") along with a correlated error term between item 2D ("I still enjoy the things I used to enjoy") and 12D ("I look forward with enjoyment to things") improved the fit substantially. Good to acceptable measurement reliability was demonstrated, and the construct validity was acceptable. CONCLUSIONS The HADS involves some items that are not reliable and valid indicators for the depression construct in this population, especially item 6 is problematic. To improve the reliability and validity of the Norwegian version of HADS, we recommend that essential aspects of depression in older adults should be included.
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Affiliation(s)
- Heidi Emly Sivertsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Ding JY, Wu WT, Liang Z, Yu C, Xiao XH. Depression and activities of daily living in elderly people applying for admission to public nursing facilities. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-6. [PMID: 36757805 DOI: 10.1080/23279095.2023.2169828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The present study aims to (1) investigate the prevalence of positive screening for depression among elderly people applying for admission to public nursing facilities in Shenzhen and (2) to explore the correlation between depression and activities of daily living (ADL) among the elderly. METHODS Visual and hearing acuity, ADL (obtained using the Barthel index), cognition and depression levels, and communication and social interaction skills were assessed in all elderly adults aged ≥60 years who applied for admission to public nursing facilities in Shenzhen between April 1, 2018, and December 31, 2019. RESULTS A total of 1,113 elderly adults, 34.95% of whom were assessed as being depressed, were evaluated. Regarding dependence on the care of others, the ADL assessment results showed that 11.86% of the study subjects were fully dependent, 10.51% were severely dependent, 12.58% were moderately dependent, 42.86% were mildly dependent, and only 22.19% were fully capable of self-care. The univariate analysis suggested that gender, cognition level, visual and hearing acuity, and communication and social interaction skills were all correlated with the occurrence of depression. The prevalence of positive screening for depression was relatively high among subjects with an ADL score of ≤65; With an ADL score of ≤65, the prevalence of depression increased by 6% with every 1-point ADL score decrease. CONCLUSION The prevalence of depression among elderly adults applying for admission to public nursing facilities in Shenzhen was high. For this reason, nursing facility caregivers should focus on screening elderly adults (especially subjects with impaired ADL function) for depression in order to improve their quality of life.
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Affiliation(s)
- Jing-Yun Ding
- Department of Geriatrics, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei-Tao Wu
- Department of Geriatrics, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhen- Liang
- Department of Endocrinology, The 2nd Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Cong Yu
- Department of Nursing, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiao-Hua Xiao
- Department of Geriatrics, First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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An Exploratory Study to Assess the Impact of a Chair-Based Dance Intervention Among Older People With Depressive Symptoms in Residential Care. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Melo ATL, Menezes KVRS, Auger C, Barbosa JFDS, Menezes WRDS, Guerra RO. SPPB as a predictor of functional loss of hospitalized older adults. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Immobility is associated with adverse outcomes such as loss of functional capacity and longer hospitalization. Objective: To assess intra-hospital mobility at admission as a predictor of loss of functional capacity during older adults´ hospitalization. Methods: A prospective cohort study was conducted, and personal and hospital related risk factors were assessed at admission and discharge. To determine whether Short Physical Performance Battery (SPPB) on admission could predict loss of functional capacity during hospitalization, a ROC curve was performed and area under the curve (AUC) was calculated. Binary logistic regression models were used to identify predictors of loss of functional capacity. Model 1 contained only SPPB. Model 2 SPPB was matched with age, sex, instrumental activity of daily living (IADL), cognition, depression and surgery. Data were entered into SPSS version 18.0. Results: 1,191 patients were included with a mean age of 70.02 (± 7.34). SPPB cutoff point of 6.5 (sensitivity 62%, specificity 54%) identified 593 (49.8%) patients at risk for functional loss. In logistic regression, SPPB alone showed prediction of functional loss (p < 0.001, OR 1.8, 95% CI = 1.5-2.5) between admission and discharge. Model 1 explained between 22 to 32% of the variation in functional capacity. In Model 2, three variables contributed to the loss. SPPB 6.5 increased 1.8 times (95% CI = 1.3-2.4), being a woman increased 1.4 times (95% CI = 1.0-1.8) and not having surgery increased 2 times (95% CI = 1.4-2.8) the chance of having functional loss during hospitalization. Conclusion: SPPB is a good instrument to predict loss of functional capacity in hospitalized older adults.
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Zenebe Y, Akele B, W/Selassie M, Necho M. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Ann Gen Psychiatry 2021; 20:55. [PMID: 34922595 PMCID: PMC8684627 DOI: 10.1186/s12991-021-00375-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age. OBJECTIVE This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age. METHOD A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger's publication bias plot test were checked for the occurrence of publication bias. RESULT A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%. CONCLUSION A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.
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Affiliation(s)
- Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Baye Akele
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulugeta W/Selassie
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Applying Intervention Mapping to Improve the Applicability of Precious Memories, an Intervention for Depressive Symptoms in Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245163. [PMID: 31861209 PMCID: PMC6950488 DOI: 10.3390/ijerph16245163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022]
Abstract
Precious memories (PM) is a life review intervention for depression in older adults with no to mild cognitive decline that has been implemented in multiple nursing homes (NHs) in the Netherlands. Previous research suggested its relevance but questioned its applicability. Therefore, this research aimed to (1) investigate the applicability of PM, and (2) increase its applicability, if necessary. Intervention mapping (IM) was used to achieve these goals: process evaluation through semi-structured interviews with psychologists (n = 11) and clients (n = 2) to identify potential improvements for PM and to set an improvement goal (IM-step 1); three focus groups with stakeholders (n = 20) to specify behaviors necessary to reach the improvement goal (IM-step 2); and selection of behavior change techniques and applications to facilitate attainment of these behaviors (IM-step 3). Results showed that psychologists perceived a high drop-out rate, which was partly due to PM being provided to clients that did not belong to the target group. Although PM was generally considered relevant, psychologists articulated its longer-term effects should be improved. To improve PM’s applicability, concrete maintenance strategies were developed aiming to maintain clients’ well-being by stimulating positive contact with others. Future research must pilot, implement and evaluate these strategies.
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Helvik AS, Barca ML, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Borza T. The course of depressive symptoms with decline in cognitive function - a longitudinal study of older adults receiving in-home care at baseline. BMC Geriatr 2019; 19:231. [PMID: 31443638 PMCID: PMC6708209 DOI: 10.1186/s12877-019-1226-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time. Methods In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. Results The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously. Conclusion The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, NO-7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė-Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tom Borza
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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Grimsland F, Seim A, Borza T, Helvik A. Toileting difficulties in older people with and without dementia receiving formal in-home care-A longitudinal study. Nurs Open 2019; 6:1055-1066. [PMID: 31367431 PMCID: PMC6650701 DOI: 10.1002/nop2.289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/21/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022] Open
Abstract
AIM To estimate the prevalence of toileting difficulties over time among older people (≥70 years) with and without dementia receiving formal in-home care at baseline and to explore whether dementia at baseline was associated with toileting difficulties at the last assessment when adjusting for relevant covariates. We hypothesize that those with dementia have a higher prevalence and that baseline dementia is associated with toileting difficulties at last follow-up. DESIGN A longitudinal observational study with three assessments over 36 months. Older people (≥70 years) from 19 Norwegian municipalities with in-home care needs were included. The participants and their next of kin were interviewed. METHOD In total, 1,001 (68% women) persons with a mean (SD) age 83.4 (5.7) years participated at baseline. Toileting difficulties were assessed using Lawton and Brody's Physical Self-Maintenance Scale and Individual Nursing and Care Statistics. Information on physical comorbidity, number of prescribed drugs, cognitive function and formal care given was included. Dementia was diagnosed based on all information gathered. RESULTS At all time points, toileting difficulties were more prevalent in people with than without dementia. In adjusted analyses, dementia at baseline was associated with toileting difficulties at the last assessment. Nursing home admission was associated with increased odds for toileting difficulties.
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Affiliation(s)
- Frida Grimsland
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Arnfinn Seim
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Tom Borza
- Centre for Old Age Psychiatric ResearchInnlandet Hospital TrustOttestadNorway
| | - Anne‐Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- St Olavs University HospitalTrondheimNorway
- Norwegian National Advisory Unit on Ageing and HealthVestfold Health TrustTønsbergNorway
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Borza T, Benth JŠ, Helvik AS. Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging Ment Health 2018; 22:379-388. [PMID: 28051894 DOI: 10.1080/13607863.2016.1262817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. METHOD In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). RESULTS At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. CONCLUSION LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental Health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway.,e National School of Public Health, Fundação Oswaldo Cruz , Rio , Brazil
| | - Deborah Bezerra Maia
- f Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU)
| | - Tom Borza
- d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway
| | - Jūratė Šaltytė Benth
- g St Olav's University Hospital , Trondheim , Norway.,h Institute of Clinical Medicine, Campus Ahus, University of Oslo , Norway
| | - Anne-Sofie Helvik
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,i HØKH, Research Centre , Akershus University Hospital , Norway
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Zis P, Daskalaki A, Bountouni I, Sykioti P, Varrassi G, Paladini A. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging 2017; 12:709-720. [PMID: 28461745 PMCID: PMC5407450 DOI: 10.2147/cia.s113576] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aging is an inevitable process and represents the accumulation of bodily alterations over time. Depression and chronic pain are highly prevalent in elderly populations. It is estimated that 13% of the elderly population will suffer simultaneously from the two conditions. Accumulating evidence suggests than neuroinflammation plays a critical role in the pathogenesis of both depression and chronic pain. Apart from the common pathophysiological mechanisms, however, the two entities have several clinical links. Their management is challenging for the pain physician; however, both pharmacologic and nonpharmacologic approaches are available and can be used when the two conditions are comorbid in the elderly patients.
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Affiliation(s)
- Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Argyro Daskalaki
- Department of Neurology, Evangelismos General Hospital, Athens, Greece
| | - Ilia Bountouni
- Belgrave Liaison Team, Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Panagiota Sykioti
- Belgrave Liaison Team, Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
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IsHak WW, Collison K, Danovitch I, Shek L, Kharazi P, Kim T, Jaffer KY, Naghdechi L, Lopez E, Nuckols T. Screening for depression in hospitalized medical patients. J Hosp Med 2017; 12:118-125. [PMID: 28182810 DOI: 10.12788/jhm.2693] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed and PsycINFO for published, peer-reviewed articles in English (1990-2016) using search terms designed to capture studies that tested the performance of depression screening tools in inpatient settings and studies that examined associations between depression detected during hospitalization and clinical or utilization outcomes. Two investigators reviewed each full-text article and extracted data. The prevalence of depression ranged from 5% to 60%, with a median of 33%, among hospitalized patients. Several screening tools identified showed high sensitivity and specificity, even when self-administered by patients or when abbreviated versions were administered by individuals without formal training. With regard to outcomes, studies from several individual hospitals found depression to be associated with poorer functional outcomes, worse physical health, and returns to the hospital after discharge. These findings suggest that depression screening may be feasible in the inpatient setting, and that more research is warranted to determine whether screening for and treating depression during hospitalization can improve patient outcomes. Journal of Hospital Medicine 2017;12:118-125.
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Affiliation(s)
- Waguih William IsHak
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Cedars-Sinai Medical Center, Department of Health Sciences, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Katherine Collison
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Purdue University, West Lafayette, Indiana, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
| | - Lili Shek
- Cedars-Sinai Medical Center, Department of Internal Medicine, Los Angeles, CA, USA
| | - Payam Kharazi
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
| | - Tae Kim
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Western University, Los Angeles, CA, USA
| | - Karim Y Jaffer
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Cairo University School of Medicine, Cairo, Egypt, USA
| | - Lancer Naghdechi
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
- Western University, Los Angeles, CA, USA
| | - Enrique Lopez
- Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, Los Angeles, CA, USA
| | - Teryl Nuckols
- Cedars-Sinai Medical Center, Division of General Internal Medicine, Los Angeles, CA, USA
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Apóstolo J, Bobrowicz-Campos E, Rodrigues M, Castro I, Cardoso D. The effectiveness of non-pharmacological interventions in older adults with depressive disorders: A systematic review. Int J Nurs Stud 2016; 58:59-70. [DOI: 10.1016/j.ijnurstu.2016.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 11/24/2022]
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Saraçlı Ö, Akca ASD, Atasoy N, Önder Ö, Şenormancı Ö, Kaygisız İ, Atik L. The Relationship between Quality of Life and Cognitive Functions, Anxiety and Depression among Hospitalized Elderly Patients. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2015; 13:194-200. [PMID: 26243848 PMCID: PMC4540029 DOI: 10.9758/cpn.2015.13.2.194] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/11/2015] [Accepted: 03/06/2015] [Indexed: 12/02/2022]
Abstract
Objective Older people seek not only a longer life, but also a better quality of life (QOL). Our aim was to find out the relationship between QOL and socio-demographic factors, social activities, cognitive status, depression and anxiety symptoms among medically ill and hospitalized elderly people in Turkey. Methods Two hundred forty three patients age 65 years or older were examined. The Socio-demographic Data Survey, the Mini Mental State Examination (MMSE), the Geriatric Depression Scale-short form (GDS-15), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) were applied to participants. The independent samples t-test and analysis of variance (ANOVA) were used to analyze quantitative data. Pearson’s correlation and linear regression analysis were performed. Results The total score for QOL was significantly higher for those who saw their family members and relatives frequently rather than rarely (p=0.002), who were always busy with social activities rather than rarely or never (p<0.001), who had more years of education (p=0.003), and who were frequently exercising (p=0.023). According to linear regression analysis, the WHOQOL-OLD total score increased by 0.295 and −0.936 units, while MMSE and GDS-15 scale scores increased one unit respectively (β=0.295, t=1.979, p=0.04; β=−0.936, t=−4.881, p<0.001). Conclusion Cognitive disabilities, depression, and other psychiatric problems along with medical disease negatively affect the QOL of elderly patients. While performing medical assessment regarding elders, detecting and treating cognitive disabilities and depression is very valuable in improving the QOL of elderly patients.
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Affiliation(s)
- Özge Saraçlı
- Departments of Psychiatry, Bulent Ecevit University Faculty of Medicine, Turkey
| | - Ayşe Semra Demir Akca
- Departments of Family Medicine, Bulent Ecevit University Faculty of Medicine, Turkey
| | - Nuray Atasoy
- Departments of Psychiatry, Bulent Ecevit University Faculty of Medicine, Turkey
| | | | - Ömer Şenormancı
- Departments of Psychiatry, Bulent Ecevit University Faculty of Medicine, Turkey
| | - İsmet Kaygisız
- Departments of Psychiatry, Bulent Ecevit University Faculty of Medicine, Turkey
| | - Levent Atik
- Departments of Psychiatry, Bulent Ecevit University Faculty of Medicine, Turkey
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Apóstolo J, Queirós P, Rodrigues M, Castro I, Cardoso D. The effectiveness of nonpharmacological interventions in older adults with depressive disorders: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513060-00015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Helvik AS, Høgseth LD, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Selbæk G. A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care. BMC Geriatr 2015; 15:47. [PMID: 25888187 PMCID: PMC4406178 DOI: 10.1186/s12877-015-0047-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/31/2015] [Indexed: 12/01/2022] Open
Abstract
Background There have been few studies of how personal and instrumental activities of daily living (P-ADL and I-ADL) develop over time in older people receiving domiciliary care. This study aimed at assessing variables associated with the development of P-ADL and I-ADL functioning over a 36-month follow-up period, with a particular focus on cognitive functioning. Method In all, 1001 older people (≥70 years) receiving domiciliary care were included in a longitudinal study with three assessments of P-ADL and I-ADL functioning during 36 months. P-ADL and I-ADL were assessed using the Lawton and Brody’s Physical Self-Maintenance Scale and Instrumental Activities of Daily Living Scale, respectively. Mini Mental State Examination (MMSE), diagnosis of dementia and MCI, neuropsychiatric symptoms and use of psychotropic medication were also evaluated during the three assessments. Baseline demographic and general medical health information and information of being a nursing home resident at follow-up were recorded. Linear mixed models were estimated. Results There was a significant decline in P-ADL and I-ADL functioning throughout the follow-up. A lower MMSE sum-score, diagnosed MCI and dementia, a higher level of neuropsychiatric symptoms and the use of antipsychotics and antidepressants recorded at each assessment were associated with a decline in both P-ADL and I-ADL functioning. Furthermore, a decline in P-ADL and I-ADL functioning at follow-ups was associated with being male, a higher baseline age and in poorer medical health as well as residing in a nursing home at follow-up. Conclusion P-ADL and I-ADL functioning in older people worsened over time. The worsening was associated with lower MMSE sum-score, diagnosed MCI and dementia, poorer medical health, neuropsychiatric symptoms, use of psychotropic medication and being transferred to nursing home care. Clinicians should pay close attention to the assessment and treatment of these factors to help older people maintain their level of functioning for as long as possible.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, NO7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Lisbeth D Høgseth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Jūratė Šaltytė-Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway. .,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Faculty of Health, Care and Nursing, Gjøvik University College, Gjøvik, Norway.
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Akershus University Hospital, Lørenskog, Norway.
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Admi H, Shadmi E, Baruch H, Zisberg A. From research to reality: minimizing the effects of hospitalization on older adults. Rambam Maimonides Med J 2015; 6:e0017. [PMID: 25973269 PMCID: PMC4422456 DOI: 10.5041/rmmj.10201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.
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Affiliation(s)
- Hanna Admi
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - Hagar Baruch
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
| | - Anna Zisberg
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
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Chen CM, Huang GH, Chen CCH. Older patients’ depressive symptoms 6 months after prolonged hospitalization: Course and interrelationships with major associated factors. Arch Gerontol Geriatr 2014; 58:339-43. [DOI: 10.1016/j.archger.2013.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Helvik AS, Engedal K, Benth JS, Selbæk G. A 52 month follow-up of functional decline in nursing home residents - degree of dementia contributes. BMC Geriatr 2014; 14:45. [PMID: 24720782 PMCID: PMC3985541 DOI: 10.1186/1471-2318-14-45] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/01/2014] [Indexed: 01/31/2023] Open
Abstract
Background Few have studied how personal activities of daily living (P-ADL) develop over time in nursing home residents with dementia. Thus, the aim was to study variables associated with the development of P-ADL functioning over a 52-month follow-up period, with a particular focus on the importance of the degree of dementia. Method In all, 932 nursing home residents with dementia (Clinical Dementia Rating–CDR- Scale ≥1) were included in a longitudinal study with four assessments of P-ADL functioning during 52 months. P-ADL was measured using the Lawton and Brody’s Physical Self-Maintenance Scale. Degree of dementia (CDR), neuropsychiatric symptoms and use of psychotropic medication were assessed at the same four time points. Demographic information and information about physical health was included at baseline. Linear regression models for longitudinal data were estimated. Results Follow-up time was positively associated with a decline in P-ADL functioning. Degree of dementia at baseline was associated with a decline in P-ADL functioning over time. The association between degree of dementia and P-ADL functioning was strongest at baseline, and then flattened over time. A higher level of neuropsychiatric symptoms such as agitation and apathy and no use of anxiolytics and antidementia medication were associated with a decline in P-ADL functioning at four time points. Higher physical co-morbidity at baseline was associated with a decline in P-ADL functioning. Conclusion P-ADL functioning in nursing home patients with dementia worsened over time. The worsening was associated with more severe dementia, higher physical comorbidity, agitation, apathy and no use of anxiolytics and antidementia medication. Clinicians should pay attention to these variables (associates) in order to help the nursing home residents with dementia to maintain their level of functioning for as long as possible.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Helvik AS, Engedal K, Selbæk G. Sense of coherence and quality of life in older in-hospital patients without cognitive impairment--a 12 month follow-up study. BMC Psychiatry 2014; 14:82. [PMID: 24645676 PMCID: PMC3995424 DOI: 10.1186/1471-244x-14-82] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relation between sense of coherence (SOC) and quality of life (QoL) among older persons has been found in some, but not all, studies and mostly in studies with cross-sectional design. We wanted to study if SOC was associated with domains of QoL at hospitalization and one year later among persons 65 years and above without cognitive impairment. METHOD At hospitalization (T1) and 12 month follow-up (T2) QoL and cognitive status were assessed using the WHOQOL-BREF and the Mini-Mental State Examination. At baseline, the 13-item version of the SOC scale was used to assess coping, the Hospital Anxiety and Depression Scale (HADS) was used to assess depressive and anxiety symptoms. Level of functioning was rated using Lawton and Brody's scales for physical self-maintenance and instrumental activities of daily living (personal and instrumental ADL). RESULTS In total, 165 (80 men) persons with a mean age of 77.7 (SD 6.9) years were included. The proportion of people rating their overall QoL as high had decreased from T1 to T2. The mean score on QoL- physical domain had increased, while the mean score of QoL-environmental domain had decreased. In adjusted regression analyses at T1, a high level of SOC was positively associated with QoL in three of four domains, i.e. physical, psychological and environmental, but level of SOC assessed at T1 was not associated with any domain of QoL at T2. Personal ADL was associated with some domains of QOL at T1 and T2. CONCLUSION The SOC level was associated with older adult's QoL during hospitalization but not their QoL one year after the hospital stay.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Institutt for samfunns medisin, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim NO-7491, Norway.
| | - Knut Engedal
- National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway,Akershus University Hospital, Lørenskog, Norway
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Helvik AS, Skancke RH, Selbæk G, Engedal K. Nursing home admission during the first year after hospitalization - the contribution of cognitive impairment. PLoS One 2014; 9:e86116. [PMID: 24497936 PMCID: PMC3908879 DOI: 10.1371/journal.pone.0086116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The importance of cognitive and physical functioning for nursing home admission among medically hospitalized older patients is rarely studied in a one-year follow-up perspective. This study aims to explore the association between patient characteristics and nursing home admission within one year after hospitalization in persons 65 years or more. DESIGN A one-year longitudinal study. METHODS We included 463 (234 women) persons aged 65 years or more from internal medical wards in a rural area of Norway. Cognitive function was assessed using the Mini Mental State Examination; physical and instrumental functional status was assessed using the physical self-maintenance scale and instrumental activities of daily living scale of Lawton and Brody. Comorbidity was measured with the Charlson index. Admission to nursing home within one year (yes versus no) was analyzed using logistic regression analysis and Cox proportional hazard regression analysis. RESULTS The mean age of the sample was 80.5 (SD 7.4) years, mean Mini Mental State Examination score was 24.1 (SD 3.8) (maximum score is 30). In adjusted analysis participants with cognitive impairment (a Mini Mental State Examination score <25) or impaired physical functioning at baseline had higher risk of admission to nursing home within one year (OR 3.0, 95%CI 1.5-6.2 and OR 3.5, 95%CI 1.8-9.6, respectively). The time before admission was also associated with cognitive impairment and impaired physical functioning in the adjusted analysis (HR 2.6 95%CI 1.4-4.8 and HR 3.7, 95%CI 1.5-8.9, respectively). CONCLUSION Impaired cognitive and physical functioning increased the risk for nursing home admission within one year after hospitalization. However, putative regressors, such as education and social network were not included in the analysis.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St Olav's University Hospital, Trondheim, Norway
- Innlandet Hospital Trust, Division Tynset, Tynset, Norway
- * E-mail:
| | - Randi Helene Skancke
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Innlandet Hospital Trust, Division Tynset, Tynset, Norway
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Akershus University Hospital, Lørenskog, Norway
- The Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
| | - Knut Engedal
- The Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Gur-Yaish N, Zisberg A, Sinoff G, Shadmi E. Effects of instrumental and psychological support on levels of depressive symptoms for hospitalized older adults. Aging Ment Health 2013; 17:646-53. [PMID: 23330681 DOI: 10.1080/13607863.2012.758234] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To explore the effects of four types of support (psychological support, instrumental support, supervision of instrumental support, and explanation of medical care) on the level of depressive symptoms among hospitalized older adults. METHOD The sample consisted of 468 older adults admitted to the internal medicine units of a large tertiary care medical center in northern Israel. Respondents filled out self-report questionnaires upon admission and discharge. Information regarding severity of illness, chronic health status, and length of hospital stay was gathered from their medical records. Multivariate regression was used to test the association between the four types of caregiving support and depressive symptoms. RESULTS Psychological support from informal caregivers was found to be negatively related to depressive symptoms, and instrumental support to be positively related to depressive symptoms among respondents who were more independent in their functioning before the hospitalization. These relationships remained significant after controlling for previously-identified precursors of depressive symptoms: age, gender, education, widowhood, functional and cognitive status, severity of illness, co-morbidities, and length of hospital stay. Supervision of instrumental support and explanation of medical care were not related to depressive symptoms. CONCLUSION Results of this study suggest that functional status, the kind of support, and the setting in which it is given are important in understanding the influence of informal support on the well-being of older adults. The potentially positive as well as negative consequences of various types of support in the hospital setting should be recognized and addressed.
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Affiliation(s)
- Nurit Gur-Yaish
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel.
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Helvik AS, Selbæk G, Engedal K. Cognitive decline one year after hospitalization in older adults without dementia. Dement Geriatr Cogn Disord 2013; 34:198-205. [PMID: 23128048 DOI: 10.1159/000343932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS We studied cognitive functioning 1 year after hospitalization (T2) in patients at least 65 years old without cognitive impairment at baseline (T1). METHODS Cognition was assessed using the Mini-Mental State Examination (MMSE) at both time points. We included 211 (114 women) patients with a mean age of 78.3 (SD 7.0) years and an MMSE score of 24 and above. RESULTS At T2, 69 (32.7%) patients had an MMSE score below 24. In participants with MMSE 24-26 at T1, cognitive decline was related to impaired physical self-maintenance, a decline in the performance of the instrumental activities of daily living, impaired hearing and less reading ability. In participants with MMSE 27-30, cognitive decline was associated with higher comorbidity (Charlson Index) and impaired physical self-maintenance and hearing. CONCLUSION A reduced functioning level and increased comorbidity predicted a decline in cognitive functioning.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Helvik AS, Selbæk G, Engedal K. Functional decline in older adults one year after hospitalization. Arch Gerontol Geriatr 2013; 57:305-10. [PMID: 23806790 DOI: 10.1016/j.archger.2013.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 11/29/2022]
Abstract
We studied the change in personal ability to perform the activities of daily living (P-ADL) one year after hospitalization (T2) of patients at least 65 years old at baseline (T1). The study included 363 (175 men) medical inpatients with age range 65-98 (mean 80.2, SD 7.5) years. Information was collected at baseline and at a 12 month follow-up using Lawton and Brody's physical self-maintenance scale (PSMS) (termed the P-ADL score), as the dependent variable, and the mini-mental state examination (MMSE), the hospital anxiety and depression scale (HAD) and the WHOQOL-BREF questionnaire as independent variables. For the total sample, the mean P-ADL was significantly worsened from T1 to T2 (mean change 0.5, SD 2.8; p<0.01). In a fully adjusted linear regression analysis, worsened P-ADL from T1 to T2 was independently associated with cognitive impairment at T1, increasing cognitive impairment from T1 to T2, the tendency to fall between T1 and T2, increase in depressive symptoms from T1 to T2, poor physical QOL at T1 and change toward a poorer QOL from T1 to T2. In conclusion, worse P-ADL at T2 was, independently of age and baseline P-ADL, associated with impaired cognitive function and QOL related to physical ability at baseline, as well as worsening depression, cognition and QOL from T1 to T2. Our findings highlight the importance of applying results from screening measures of cognitive function and emotional health when planning care for older people after hospitalization.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Helvik AS, Engedal K, Selbæk G. Change in quality of life of medically hospitalized patients--a one-year follow-up study. Aging Ment Health 2013; 17:66-76. [PMID: 22928816 DOI: 10.1080/13607863.2012.715137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To examine changes in quality of life (QOL) among elderly medically hospitalized patients one year after hospitalization, and to explore factors associated with the changes. METHODS A one-year follow-up study included 363 (175 men) medical inpatients with age range 65-98 (mean 80.2, SD 7.5) years. Information was collected at baseline and follow-up using the WHOQOL-BREF questionnaire assessing the physical, psychological, social and environment domain of QOL as the dependent variable, and the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and instrumental activities of daily living, the Hospital Anxiety and Depression scale and assistance in living as the independent variables. RESULTS The mean score of the physical domain of QOL had increased (mean change 0.6, SD 2.5; p < 0.01); the mean score of the environmental domain had decreased (mean change -2.1, SD 1.2; p < 0.01); and, the mean scores of the psychological and social domains of QOL were unchanged (mean change -0.2, SD 1.8 and mean change -0.1, SD 1.5, respectively) at follow-up. Improved individual QOL at a one-year follow-up was associated with improved health (cognitively, physically and emotionally) after hospitalization, and with health situation at baseline. Being in need of assistance was associated with reduced QOL. CONCLUSION Good cognitive, physical and emotional health at baseline and follow-up were associated with improved QOL in previously hospitalized elderly patients independent of their need for assistance in living.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Helvik AS, Engedal K, Selbæk G. Perceived health among the medically hospitalized elderly: a one-year follow-up study. Scand J Public Health 2013; 41:421-8. [PMID: 23474953 DOI: 10.1177/1403494813480278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To examine perceived health of elderly medically hospitalized patients 1 year after hospitalization, and to explore factors associated with the perceived health at follow-up. METHODS A one-year follow-up study included 363 (175 men) elderly previously medical inpatients with age range 65-98 (mean 80.2, SD 7.5) years. Information was collected at baseline and follow-up, where perceived health--the dependent variable--was measured by one self-report item. The independent variables were assessed by the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination (MMSE), Lawton and Brody's scales for physical self-maintenance and performance of the instrumental activities of daily living (PSMS and I-ADL). RESULTS The proportion of elderly people assessing their health as good at baseline was 43.3% (n = 157) and at 12 months 41.3% (n = 150). Of those with poor health at baseline, 34% (n = 70) experienced good health at 12 months. In the analysis controlling for physical health, perceived health, physical and instrumental functioning, and depression at baseline, an increase in the level of physical and instrumental functioning and reduced symptom level of depression were independently associated with good perceived health at 12 months. CONCLUSIONS Improvement in performing the activities of daily living and a reduction of depressive symptoms are important factors for the perception of health one year after hospitalization. The rehabilitation of medically ill elderly patients could be the means of achieving this improvement.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Helvik AS, Engedal K, Selbæk G. Change in sense of coherence (SOC) and symptoms of depression among old non-demented persons 12 months after hospitalization. Arch Gerontol Geriatr 2013; 56:314-20. [DOI: 10.1016/j.archger.2012.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/29/2022]
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Helvik AS, Engedal K, Selbæk G. Three-year mortality in previously hospitalized older patients from rural areas--the importance of co-morbidity and self-reported poor health. BMC Geriatr 2013; 13:17. [PMID: 23419167 PMCID: PMC3600034 DOI: 10.1186/1471-2318-13-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/14/2013] [Indexed: 11/13/2022] Open
Abstract
Background The risk factors for mortality after hospitalization in older persons are not fully understood. The aim of the present study was to examine the three-year (1,096 days) mortality in previously hospitalized older patients from rural areas, and to explore how objectively and self-reported health indicators at baseline were associated with mortality. Methods The study included 484 (241 men) medical inpatients with age range 65–101 (mean 80.7, SD 7.4) years. Baseline information included the following health measures: the Charlson Index, the Mini-Mental-State Examination, Lawton and Brody’s scales for physical self-maintenance and the instrumental activities of daily living, the Hospital Anxiety and Depression scale, self-reported health (one item), and perceived social functioning (one item) and assistance in living at discharge. Results In all, 172 (35.5%) of those patients included had died within the three years of the follow-up period. Three-year mortality was associated with a high score at baseline on the Charlson Index (HR 1.73, 95%CI 1.09-2.74) and poor self-reported health (HR 1.52, 95%CI 1.03-2.25) in a Cox regression analysis adjusted for age, gender, other objectively measured health indicators, and perceived impaired social functioning. Conclusion In a study of older adults admitted to a general hospital for a wide variety of disorders, we found co-morbidity (as measured with the Charlson Index) and poor self-reported health associated with three-year mortality in analysis adjusting for age, gender, and other health-related indicators. The results suggest that self-reported health is a measure that should be included in future studies.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postboks 8905, Trondheim NO-7491, Norway.
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Helvik AS, Engedal K, Selbaek G. Depressive symptoms among the medically hospitalized older individuals -- a 1-year follow-up study. Int J Geriatr Psychiatry 2013; 28:199-207. [PMID: 22505371 DOI: 10.1002/gps.3811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/14/2012] [Indexed: 11/07/2022]
Abstract
AIM The present follow-up study of older medically hospitalized patients from a rural area in Norway assessed the prevalence of depressive symptoms at 1-year follow-up and furthermore explored whether depressive symptoms at follow-up was associated with change in the medical, functional or emotional situation between baseline and follow-up. METHODS A 1-year follow-up study included 363 (175 men) older medical inpatients with age range 65-98 (mean = 80.2; standard deviation (SD) = 7.5) years. Information was collected at baseline and follow-up using the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and performance of the instrumental activities of daily living. RESULTS The prevalence of depressive symptoms, as defined by a score ≥ 8 at HAD-D, was 10% at baseline and 7% at follow-up. Of those with depressive symptoms at baseline, 78% had experienced remission. The incidence of depressive symptoms at follow-up was 5%. In logistic regression analyses adjusted for age, gender, and depressive symptoms at baseline, becoming or being in need of assistance from nursing or social services (odds ratio (OR) = 8.1, 95% CI: 1.9-34.2 and OR = 4.4, 95% CI: 1.1-17.4, respectively), having a cognitive decline (OR = 1.1, 95% CI: 1.0-1.3), and exhibiting poorer physical self-maintenance (OR = 1.2, 95% CI: 1.0-1.3), becoming vision impaired (OR = 8.3, 95% CI: 2.8-25.0), and with increased anxiety (OR = 1.2, 95% CI: 1.0-1.3) during follow-up was associated with depressive symptoms at follow-up. CONCLUSION The 1-year follow-up study of older medical inpatients contributes to the research body regarding risk factors of depression in older people.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Helvik AS, Engedal K, Bjørkløf GH, Selbaek G. Factors associated with perceived health in elderly medical inpatients: a particular focus on personal coping recourses. Aging Ment Health 2012; 16:795-803. [PMID: 22360716 DOI: 10.1080/13607863.2011.651436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM We wanted to unveil associations between perceived health and physical health, function in activity of daily living, anxiety, depression and coping resources in terms of sense of coherence (SOC) in elderly (≥65 years) in-hospital patients without cognitive impairment. METHOD In a cross-sectional study, we evaluated 217 hospitalized elderly patients with an age range 65-95 (mean 77.9) years. Perceived health was rated on a four-point scale. Physical health was measured with the Charlson index; functional status was rated using the Lawton and Brody's scale for self-maintaining and instrumental activities of daily living; and, anxiety and depression were rated using the Hospital Anxiety and Depression scale. Finally, the 13-item version of the SOC scale was used to assess coping, and cognitive state was assessed using the Mini-mental State Examination. RESULTS In all, 40% of the patients reported good perceived health. In an adjusted logistic regression analysis, the main outcome good perceived health was associated with increasing age: odds ratio (OR) 1.06 (95% CI 1.01-1.11); good physical health: OR 2.49 (95% CI 1.22-5.07); and, medium high and high SOC: OR 2.48 (95% CI 1.20-5.13), and OR 2.43 (95% CI 1.11-5.28), respectively. Explained variance was 22.2%. CONCLUSION Good coping resources and low severity of co-morbid disorders are the two most important factors that explain why elderly inpatients rate their health as good. Since coping may be equally important as poor physical health for perception of health, coping should be recognized and measured in clinical practice.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Helvik AS, Engedal K, Krokstad S, Stordal E, Selbæk G. A comparison of depressive symptoms in elderly medical inpatients and the elderly in a population-based health study (the Nord-Trøndelag Health Study 3). Nord J Psychiatry 2012; 66:189-97. [PMID: 21958367 DOI: 10.3109/08039488.2011.614958] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To compare depression in a sample of the medically hospitalized elderly with elderly people participating in a population-based health study in Norway and further to study the odds for depression, controlling for demographic and health differences between the two samples. METHOD This cross-sectional observational study evaluated 484 medical inpatients from rural areas and 10,765 drawn from the Nord-Trøndelag Health Study 3 (HUNT-3 Study) including participants from rural and urban areas. All participants were elderly (≥65 years) with a mean (± standard deviation) age of 80.7 ± 7.4 and 73.3 ± 6.3 years, respectively. Symptoms of depression were screened by the Hospital Anxiety and Depression Scale (HAD). RESULTS The prevalence of symptoms indicating mild, moderate or more severe depression (depression score ≥8) was about the same in both groups. In regression analyses, adjusting demographic and health differences, the odds for depression was lower for the elderly in the hospital sample than in the HUNT-3 Study. Older age, male gender, perceiving general health as poor, having impaired ability to function in daily life, previous consultation or treatment for emotional problems and anxiety (anxiety score ≥8) were associated with increased odds for depression in the elderly independent of being hospitalized or not. CONCLUSION Surprisingly, we found the odds for depression after controlling for demographic and health variables to be lower in the hospitalized elderly individuals than in the elderly participating in the population-based health study. The health variables that were most strongly associated with an increased risk of depression were poor physical health and anxiety.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Anne-Sofi
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Helvik AS, Engedal K, Skancke RH, Selbæk G. A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly. Nord J Psychiatry 2011; 65:338-44. [PMID: 21341979 DOI: 10.3109/08039488.2011.560684] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few psychometric studies of the Hospital Anxiety and Depression Scale (HADS) scale have been performed with clinical samples of elderly individuals. METHODS The participants were 484 elderly (65-101 years, 241 men) patients in an acute medical unit. The HADS, the Montgomery-Aasberg Depression Rating Scale (MADRS) and questionnaires assessing quality of life, functional impairment, and cognitive function were used. The psychometric evaluation of the HADS included the following analyses: 1) the internal construct validity by means of principal component analysis followed by an oblique rotation and corrected item-total correlation; 2) the internal consistency reliability by means of the alpha coefficient (Cronbach's) and 3) concurrent validity by means of Spearman's rho. RESULTS We found a two-factor solution explaining 45% of the variance. Six of seven items loaded adequately (≥0.40) on the HADS-A subscale (item 7 did not) and five of seven items loaded adequately on the HADS-D subscale (items 8 and 10 did not). Cronbach's alpha for the HADS-A and HADS-D subscale was 0.78 and 0.71, respectively. The correlation between HADS-D and the MADRS, a measure of the concurrent validity, was 0.51. CONCLUSION The HADS appears to differentiate well between depression and anxiety. The internal consistency of the HADS in a sample of elderly persons was as satisfactory as it is in samples with younger persons. In contrast to younger samples, item 8 ("I feel as if I have slowed down") did not load adequately on the HADS-D subscale. This may be attributed to the way elderly people experience and describe their symptoms.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Helvik AS, Engedal K, Krokstad S, Selbæk G. A comparison of life satisfaction in elderly medical inpatients and the elderly in a population-based study: Nord-Trondelag Health Study 3. Scand J Public Health 2011; 39:337-44. [PMID: 21459872 DOI: 10.1177/1403494811405093] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare the quality of life (QOL) in terms of overall life satisfaction in elderly medical inpatients and elderly persons in a large population-based study in Norway, and to study the odds for dissatisfaction, controlling for demographic, health, and social variables. METHODS This cross-sectional observation study included 484 medical inpatients and 10,474 persons from the Nord-Trøndelag Health Study 3 (HUNT 3 Study). All participants were 65 years and older. Their life satisfaction was assessed with a single-item measure with seven response categories. For analytical purposes the variable was dichotomised; i.e. dissatisfied vs. satisfied with life. RESULTS In the logistic regression analysis controlled for demographic, health, and social variables, the odds for experiencing dissatisfaction with life was significantly increased in the hospital sample compared to the participants in the population-based study (OR 1.4). Poor general health, depression, and anxiety were strongly associated with being dissatisfied with life. Furthermore, disability, previous psychological distress, having no friends who could help, and not participating in activities were all associated with dissatisfaction with life. CONCLUSIONS The hospitalisation of the elderly has implications for the QOL in terms of life satisfaction, but general physical and psychological health seems to have an even stronger impact on life satisfaction. The prevention of the deterioration of physical and mental health in old age seems to be essential for a good life.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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