Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey

The Relationship Between the Number of Chronic Diseases and Health-Related Quality of Life Among Middle-Aged and Older Adults in Rural Areas of Yunnan Province, China: moderating Effect of Health Lifestyle

Purpose

With population aging, individuals in underdeveloped areas may experience a higher prevalence of chronic non-communicable diseases (NCDs), a lower level of health-related quality of life (HRQoL), and distinct lifestyles. However, this triadic association remains inadequately studied, particularly regarding the role of health lifestyle. This study aims to examine the relationship between the number of NCDs and HRQoL, while considering the moderating effect of health lifestyle among middle-aged and older adults residing in resource-limited areas.

Methods

This cross-sectional study was conducted in Yunnan Province from July to December 2022. Participants completed a self-report questionnaire related to socio-demographic information, NCDs conditions, health lifestyle status, and HRQoL, which was assessed using the EuroQol five-dimension five-level (EQ-5D-5L) scale. Hierarchical regression and simple slope tests were used to examine the moderating effect of health lifestyle.

Results

Out of the total 2704 participants, 57.91% presented at least one NCD. The mean scores for health lifestyle and health utility value were 11.109 and 0.944 respectively. The number of NCDs was negatively associated with health utility value, while positively correlated with the health lifestyle score (P<0.001). The results of hierarchical regression indicated that health lifestyle exerted a negative moderating effect on the relationship between the number of NCDs and HRQoL (β=0.006, P<0.001), which was also observed for specific health-related behaviors such as sleep duration (β=0.013, P<0.001), physical examination attendance (β=0.006, P<0.05) and physical activity (β=0.013, P<0.001).

Conclusion

These findings highlight the crucial role of a healthy lifestyle in attenuating the association between the number of NCDs and HRQoL. Recognizing the potential modulating influence of a healthy lifestyle in this relationship could be pivotal for developing effective interventions for this population, even within resource-constrained rural settings.

The impact of social support, physical and psychological performance on sleep outcomes in Iranian older adults: a case-control study

BACKGROUND

Sleep quality is one of the most important factors to improve the quality of life in older adults and physical and mental health plays an essential role in better sleep quality. This study aimed to determine the impact of social support, and physical and psychological performance on sleep outcomes in Iranian older adults.

METHODS

In this case-control study, 400 elder people, who were exposed to sleep problems, and 400 people without sleep problems were randomly selected during 2016-2017 in Amirkola, Iran. Subjects in the case and control groups were matched in terms of gender and age. The demographic characteristics, Duke Social Support Questionnaire (DSSI), Physical Activity Scale for the Elderly (PASE), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Mini-Mental State Examination (MMSE), and Pittsburgh Sleep Quality Questionnaire (PSQI) questionnaires were used to collect data. T-test, Chi-square, Pearson Correlation coefficient, and multiple Logistic regression were used for data analysis.

RESULTS

The mean score of DSSI and its domains including social interaction (DSSI.Int) and social satisfaction (DSSI.Sat) were 28.15 ± 3.55, 9.31 ± 1.23, and 18.84 ± 2.88 in the case group and 28.87 ± 3.20, 9.48 ± 1.10, and 19.83 ± 2.44 in the control group, respectively. In this study, the mean scores of MMSE, PASE, ADL, and IADL were 25.36 ± 3.95, 101.71 ± 56.99, 13/97 ± 0.37, 20.59 ± 2/79; respectively. There was a significant inverse correlation between poor sleep quality with DSSI score (rho = -0.165, P < 0.0001), DSSI.Int (rho = -0.113, P < 0.001), DSSI.Sat (rho = -0.160, P < 0.0001), PASE (rho=-0.160, P < 0.0001), and IADL (rho = -0.112, P < 0.001) score. Therefore, more social support and physical activity improved the quality of sleep. There was a significant negative relationship between DSSI, and its domains with sleep quality in terms of gender. DSSI (rho = 0.25, P < 0.0001), DSSI.Int (P < 0.0001, rho=-0.18), and DSSI.Sat (P < 0.0001, rho=-0.22) was significant in men but not in women. The results of the adjusted logistic regression revealed a significant association between sleep quality problems and DSSI (p < 0.045, OR = 1.40), the use of hypnotic drugs (p < 0.0001, OR = 7.56), and occupation (p <0.03, OR= 12.66).

CONCLUSIONS

The results of the present study suggest that low social support and all its domains, PASE, IADL, and using hypnotic drugs may play a role in the development of sleep problems. It can be used as an effective, safe, and low-cost strategy for promoting sleep quality in older adults.

Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis

Objective

To present a systematic review of randomized controlled trials which summarizes the effects of community-based resistance, balance, and multi-component exercise interventions on the parameters of functional ability (e.g., lower extremities muscle strength, balance performance and mobility).

Methods

This PROSPERO-registered systematic review (registration no. CRD42023434808) followed the PRISMA guidelines. Literature search was conducted in Cochrane, Embase, Ovid Medline, PEDro, Pubmed, Science Direct, Scopus and Web of Science. We included RCTs that investigated the following interventions: lower extremity strengthening, balance and multi-component exercise interventions on ambulatory community-dwelling adults aged ≥65 years.

Results

Lower extremity strengthening exercises revealed significant effects on the strength of lower extremity, balance outcomes and mobility. Balance exercises reduce the rate of injurious falls, improve static, dynamic and reactive balance, lower extremity strength as well as mobility. Multi-component exercise training reduces medically-attended injurious falls and fallers, incidence of falls, fall-related emergency department visits as well as improves mobility, balance, and lower extremity strength.

Conclusion

Physical exercises are effective in improving the components of balance, lower extremity strength, mobility, and reducing falls and fall-related injuries. Further research on fall prevention in low-income countries as well as for older adults in vulnerable context is needed.

Comparing the effect of individual and group cognitive-motor training on reconstructing subjective well-being and quality of life in older males, recovered from the COVID-19

While the message emanating from physiological and psychological research has extolled the general advantages of exercise in physical and cognitive health, the social distancing and the impossibility of group exercises have revealed more complex conditions. Therefore, we performed an experimental study comparing the effect of individual and group cognitive-motor training on reconstructing subjective well-being (SWB) and quality of life (QOL) in older males who recovered from COVID-19. The study's design is a single-blind, randomized controlled trial (RCT). The participants, 36 older men (65-80 yrs.) recovering from COVID-19, were randomly divided into (1) Group A (cognitive-motor training, G-CMT); (2) Group B (individual cognitive-motor training, I-CMT); and (3) Group C (control). Both training interventions involved performing a training protocol (cognitive-motor training) twice a week for four weeks. The outcomes included an assessment of the SWB and QOL of participants by SWB scale and world health organization QOL scale at baseline and two weeks after interventions. Except for the effect of age and number of children variables on QOL, other demographic variables had no significant effect on the results of SWB or WHOQOL of participants (P > 0.05). The SWB results in G-CMT were better than I-CMT and control groups in emotional and social well-being domains. Also, WHOQOL test results in G-CMT were better than control groups in domains of psychological and social relationships, whereas I-CMT performed better than G-CMT and control groups in domains of cognitive well-being, physical health, and environment. The results revealed that the mean test scores of SWB and WHOQOL in G-CMT and I-CMT were better than the control group (P ≤ 0.001). The positive effects of cognitive-motor training on reconstructing SWB and QOL are associated with the synchronicity of cognitive and motor components in these exercises. We suggest that the emotional, social, and psychological benefits of cognitive-motor training override cognitive, physical, and environmental changes. The future line of the present study will include pathophysiology and further clinical aspect of recovering from COVID-19.

Elderly Users’ Emotional and Behavioral Responses to Self-Service Technology in Fast-Food Restaurants

While COVID-19 has accelerated digital transformation, increasing labor costs and 52-h workweek rules are replacing human labor with self-service technologies (SSTs). Self-service technology is increasingly being implemented in restaurant settings. However, the elderly, who have relatively lower levels of digital literacy, are being excluded from services that can alleviate the economic and social difficulties of their daily lives. This study thus aims to explain how elderly users feel about and respond to SST in fast-food restaurants. An off-site survey was conducted with individuals who had experience using SST. We analyzed the data using the partial least squares structural equation modeling method by SmartPLS 3.0. The results showed that SST’s reduction, perceived ease of use of SST, and perceived time pressure significantly influenced users’ negative emotions toward the SST. However, perceived physical condition and perceived crowding did not have significant influences on users’ emotions. In empirically investigating individuals’ negative emotions toward and coping strategies for challenges posed by SST, this study emphasizes the development of a nationwide digital inclusion policy that can help bridge the digital divide.

Examining the relationship between health literacy and quality of life: evidence from older people admitted to the hospital

INTRODUCTION

Literacy has become an increasingly serious problem, especially as it relates to health care. In this regard, health literacy (HL), as a cognitive skill, has proven to be an influential factor to improve of the quality of life (QOL). This study aimed to examine the level of HL and its relationship with the QOL of older people at the time of discharge from the hospital in the south of Iran.

METHODS

This descriptive-analytical cross-sectional study included 300 older people admitted and treated in 10 teaching-therapeutic hospitals affiliated with the Shiraz University of Medical Sciences in 2021. The standard Health Literacy for Iranian Adults (HELIA) questionnaire and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) were used to collect the required data. Data were analyzed with SPSS software version 23 software using descriptive and inferential statistics, Pearson's correlation coefficient, T-test, ANOVA, and multiple linear regression at p = 0.05.

RESULTS

The mean scores of Hl and QOL for older people were 48.22 ± 9.63 (out of 100) and 61.59 ± 12.43 (out of 120), respectively. Moreover, there was a significant direct correlation between the participants' HL and their QOL (r=0.388, p<0.001). All dimensions of HL, including comprehension (β=0.461, p<0.001), decision-making and behavior (β=0.434, p<0.001), access (β=0.397, p<0.001), reading skill (β=0.362, p=0.002), and assessment (β=0.278, p=0.004), were significant relationship with QOL. A statistically significant difference was revealed between the mean scores of HL regarding the participants' gender (p=0.04) and level of education (p=0.001). Furthermore, the mean scores of QOL were significantly different with regard to older people's gender (p=0.02), marital status (p=0.03), level of education (p=0.002), and income (p=0.01).

CONCLUSION

The findings revealed the participants' inadequate HL and average QOL. Considering the relationship of HL with QOL, it is recommended to develop comprehensive programs and effective interventions to develop HL skills and subsequently improve QOL among older people.

A Comparison between Healthy Lifestyle Behaviors and Physical Activity Levels of Elderly İndividuals Residing in the City Center and Rural, and Analyzing Their Relationship with Depression

ABSTRACT Purpose: Our study aimed to determine the differences in the levels of physical activity and healthy lifestyle behaviours in elderly individuals living in urban and rural and to examine their relationship with depression. Methods: Individuals who are over 65 and residing in the city and rural were included in the study. The Healthy Lifestyle Behaviour’s Scale-II, the Physical Activity Scale for the Elderly, and the Geriatric Depression Scale-15 were used on the participants Results: Healthy Lifestyle Behaviour’s Scale-II scores was no significant difference between the two groups (p=0.430). Physical Activity Scale for the Elderly score in rural (p= 0.001); Geriatric Depression Scale-15 score was statistically higher in the city (p= 0.01). While the relationship between the Healthy Lifestyle Behaviour’s Scale-II and Geriatric Depression Scale-15 scores was significant in both groups (p= 0.001 and p= 0.03), the relationship between the Elderly Physical Activity Scale-II and Geriatric Depression Scale-15 scores was significant only in the rural (p= 0.001). Conclusion: The elderly individuals in rural are more physically active than in city, the elderly living in city have higher depression levels. The factors affecting depression in the elderly living in cities need to be examined in detail.

Perceived health competence and health education experience predict health promotion behaviors among rural older adults: A cross-sectional study

Background

Health promotion behaviors are key determinant of health and well-being, and also play an important role in promoting successful aging. This study investigated levels of engagement in health promotion behaviors among Chinese rural older adults, and explored effects of perceived health competence, health education activities experience and sociodemographic variables on health promotion behavior in this population.

Methods

A multicenter cross-sectional survey was performed. Participants were recruited by a multistage, stratified, cluster-sampling procedure from Nanbu County, Sichuan Province, China. All participants completed four paper questionnaires: sociodemographic characteristics and health care status survey, the Chinese version of the health promoting lifestyle profile-II (HPLP-II), perceived health competence scale and Lubben social network scale. Data were collected from July to August 2021. Stepwise multiple linear regression analysis was performed to analyze the effects of different factors on health promotion behaviors.

Results

A total of 425 rural older adults with an average age of 72.7 years were included in analysis. The overall average score of HPLP-II was 101.6. The stepwise multiple linear regression analysis results showed that those who had higher perceived health competence (β = 0.66, P < 0.001), experienced health education activities (β = 0.254, P < 0.001), had physical examination (β = 0.107, P < 0.001), was married (β = 0.189, P < 0.001), had primary school education or above (β = 0.189, P < 0.001), and had a per capita monthly household income of more than 1000¥ (β = 0.085, P = 0.007), have higher levels of engagement in health promotion behaviors; while the level of health promotion behaviors of the older adults living alone was lower than that of living with their spouse or others (β = -0.192, P < 0.001). Combination of the above variables accounted for a total of 69.1% of the variance in health promotion behaviors. Conclusions: The level of health promotion behaviors among Chinese rural older adults is low. Perceived health competence and health education activities experience are two strong determinants of health promotion behaviors. Comprehensive health promotion programs aimed at improving perceived health competences and health literacy through health education activities may be an important part of optimizing the level of health promotion behaviors among rural older adults.

Attitudes of health professionals toward elderly patients during the COVID-19 pandemic

The perceptions and attitudes of health professionals toward a certain group of society are among the factors affecting the quality of health service. This study aimed to investigate the attitudes of physicians and nurses about ageism in the COVID-19 pandemic. An easy face-to-face survey was used to collect the data. It involves the questions about demographic information and geriatric perspectives, and they were taken from the University of California at Los Angeles Geriatrics Attitudes Scale (UCLA-GAS). In the study, 58.1% of participants were over 35 years old, 76.6% were women, and 50% were physicians out of 308 in total. It was found that most of the participants have worked in inpatient services and intensive care units for the longest time, where the triage issue was the most discussed topic during the pandemic. An average of 75% of the participants stated that they did not witness any ageist attitude in health care provided. In the comparative analyses conducted with the UCLA-GAS sub-dimensions, statistically significant results, which were anti-ageist and prioritized human life, were obtained. In the extraordinary periods such as pandemic, especially physicians should be able to give the treatment without feeling any social or legal concerns during their medical applications with the light of guidelines accepted scientifically, legally, and morally. Thus, health professionals will not only be away from legal concerns such as malpractice but also will not be exhausted mentally and they can provide more sufficient health service by working under these conditions.

Neighborhood Social Cohesion and Dementia-Related Stigma Among Mothers of Adolescents in the Pre- and Current COVID-19 Period: An Observational Study Using Population-Based Cohort Data

Background: Middle-aged adults may be the ideal target group for dementia-related stigma reduction interventions to encourage the utilization of services among those who may become family caregivers. Neighborhood social cohesion may diminish dementia-related stigma, particularly in terms of perceived public attitudes. The COVID-19 pandemic can further negatively impact perceived public stigma. Objective: To investigate the association between neighborhood social cohesion and dementia-related stigma during the pre- and current COVID-19 period. Methods: We employed a cross-sectional design using data from a large population-based cohort, the Tokyo Teen Cohort, in Japan. Overall, 2,469 mothers of 16-year-old adolescents self-completed a questionnaire comprising nine dementia-related stigma questions evaluating perceived public and personal attitudes. Neighborhood social cohesion was assessed using a five-item instrument. The participants were divided into two groups according to the time of assessment: prior to the pandemic’s onset (February 2019–March 2020) and during the pandemic (April 2020–July 2021). A multiple regression analysis of stigma was performed using neighborhood social cohesion as an independent variable, and caring experience, age, educational level, and working status as covariates. Results: Personal and perceived public stigma were significantly lower in participants who perceived greater neighborhood social cohesion. However, level of personal and perceived public stigma did not differ between pre- and during the pandemic period. Conclusion: Neighborhood social cohesion may be a modifiable factor for dementia-related stigma. A localized intervention to enhance social cohesion in the neighborhood community would promote the utilization of services among those who may become family caregivers.

Fear of COVID-19 and quality of life: the mediating role of loneliness among older Turkish adults

The novel coronavirus (COVID-19) outbreak has affected living standards around the world, and pandemic anxiety has changed social habits. In this context, this paper investigates the relationship between fear of COVID-19 and quality of life, and assesses the mediating effect of loneliness on this relationship among a sample of older adults in Turkey. The study considers data from approximately 400 people, all of whom completed the CASP-19 Quality of Life Scale in Older People, the Loneliness Scale for the Elderly and the Fear of COVID-19 Scale. Confirmatory factor analyses were performed to confirm a one-factor structure for each instrument. Subsequently, mediation analysis, correcting for age as a continuous covariate, was performed to assess the nature of the relationship between fear and quality of life, and the extent to which that relationship is mediated by loneliness. Our study showed that there is a negative and direct relationship between loneliness and quality of life. Another important finding of our research is that fear of COVID-19 has a significant effect on loneliness. Finally, loneliness mediates the relation between fear of COVID-19 and quality of life. This finding strongly suggests that fear of COVID-19 influences quality of life via loneliness. This result is noteworthy, as we could not find any similar finding in the literature.

Does Spiritual Well-Being Affect Medication Adherence in Individuals Diagnosed with Mental Illness in Turkey?

Spiritual well-being has been evaluated as an important factor for both physical and mental recovery. The aim of this study was to determine the correlation between spiritual well-being and medication adherence in individuals diagnosed with mental illness. The study was conducted as a correlational descriptive study. The study sample consisted of 410 individuals diagnosed with mental illness. The study was conducted in the psychiatry clinic of a university hospital. The data were collected using a descriptive information form, the spiritual well-being scale, and the Morisky medication adherence scale. There was a statistically significant positive correlation between spiritual well-being and treatment adherence (r = 0.856, p = 0.002). Patient spiritual well-being was significant in explaining medication adherence (R² = 0.48, p = 0.000). This study showed that spiritual well-being affected medication adherence in individuals diagnosed with mental illness.

Association between healthy lifestyle score changes and quality of life and health-related quality of life: a longitudinal analysis of South Korean panel data

OBJECTIVES

We aimed to determine the influence of changes in the aggregate score of healthy lifestyle factors on health-related quality of life (HRQOL) and overall quality of life (QOL) in the Korean older adult population.

DESIGN

This study used a longitudinal design.

SETTING AND PARTICIPANTS

Data on 9474 participants aged 45 years or older were extracted from the Korean Longitudinal Study on Aging for the period 2006-2016. A composite score of four lifestyle factors (smoking, drinking, physical activity and body mass index) was calculated, and biennial changes in aggregate score were computed.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were HRQOL and QOL.

RESULTS

Generalised estimating equation analysis results showed that those with healthy lifestyle score changes from 'Low-High' (β =-0.987, p=0.002; β =-1.288, p<0.0001), 'High-Low' (β =-1.281, p<0.0001; β =-1.952, p<0.0001) and 'Low-Low' (β =-1.552, p<0.0001; β =-2.398, p<0.0001) groups were more likely to be have lower HRQOL and QOL estimates than those in 'High-High' group. Female gender, older age and depression had a more negative impact on HRQOL, while male gender and younger age had a more negative impact on QOL, especially in the Low-Low group. The relationship between changes in scores and HRQOL and QOL varied across different elements of healthy lifestyle scores. Changes in physical activity, drinking and smoking status were significantly associated with lower HRQOL and QOL.

CONCLUSION

The findings suggest an association between a low healthy lifestyle score and poor quality of life, in both general and health-related aspects. Strategies targeting the Korean ageing demographic to promote a healthier lifestyle should be encouraged.

Exploring the influencing factors of quality of life among the empty nesters in Shanxi, China: a structural equation model

Background

As China’s aging trend intensifies and the proportion of empty nests increases, the health-related quality of life of the elderly is the focus of social attention. Previous studies focused on the quality of life of the elderly, rather than empty nesters, and lacked the discussion of the mechanism of influencing factors. Thus, this study aimed to explore the influencing factors of the quality of life (QOL) and interaction mechanisms among empty nesters in Shanxi Province, China, so as to provide practical reference for improving the QOL of empty nesters.

Methods

A total of 4901 empty nesters in Shanxi Province, China, were selected using multi-stage random cluster sampling method in this cross-sectional study. The quality of life was assessed with the Short Form 36 Health Survey (SF-36). Multiple linear regression analysis (stepwise) was performed to examine the factor associated with QOL. Structural equation model (SEM) approach was conducted to test the direct and indirect association between QOL influencing factors with QOL.

Results

The average QOL score of empty nesters was 63.34 (SD = 17.23). The multiple linear regression revealed that gender, age, education, monthly income, drinking status, exercise frequency, physical examination frequency, attention to daily nutritional health, relationship with a spouse and relationship with children were significant predictors of the empty nester’s QOL (P < 0.05) (R² = 0.128). SEM showed that behavioral lifestyle had a direct effect on QOL (β = 0.446, P < 0.001). Socio-economic status had an indirect effect (β = 0.288, P < 0.001) on QOL through behavioral lifestyle. The family relationship had an indirect effect (β = 0.115, P < 0.001) on QOL.

Conclusion

Behavioral lifestyle was the strongest influencing factor in the quality of life among empty nesters, followed by socio-economic status and family relationships. Thus, maintaining a healthy behavioral lifestyle was important to improve the QOL of the empty nesters. Our findings provide a concrete and strong reference for the formulation of targeted intervention strategies.

Effective Interventions on Improving Elderly's Independence in Activity of Daily Living: A Systematic Review and Logic Model

This systematic review aimed to investigate the types and characteristics of effective interventions when improving the independence of the elderly during activities of daily living. After developing a search strategy, the various databases, including PubMed, Scopus, Cochrane Library, Science Direct, Proquest, and Embase, were searched up to October 16, 2019. The Review Manager 5.1 software was used to determine the risk of bias. The randomized clinical trials were reviewed to find if their interventions' main goal was to improve the elderly's independence in activities of daily living. Data were extracted independently by two authors. Eight randomized controlled trials were included in the final analysis. Three types of interventions were identified and categorized as cognitive training, physical exercises, and multicomponent interventions. All reviewed studies provided evidence of the effectiveness of interventions in improving older people's ability to perform the activities of daily living. However, the lack of uniform measurement indicators to identify and compare the most effective interventions forced us to develop a conceptual framework for designing future interventional research. This conceptual framework included designing tailored interventions, creating an age-friendly environment as well as financial, psychological, and social support. The proposed conceptual framework can also help develop future systematic reviews focusing on a particular intervention type.

Social Capital and Its Predictive Role in Quality of Life among the Elderly Referring to Health Centers in Tabriz, Iran: A Community- Based Study

Introduction: Paying attention to the quality of life (QOL) in the elderly life is an important issue, given the criticality of this period. The Objective of the present study is to determine social capital and its predictive role on QOL among elderly people living in Tabriz, East- Azerbaijan province, Iran. Methods: The present cross-sectional study was accomplished in 2018 on 522 elderly people referred to the health centers in city of Tabriz. A multi-stage random cluster sampling was implemented. The data were collected, using a demographical questionnaire, Onyx-Bullen social capital, and WHOQOL-BREF QOL questionnaires. Then, they were analyzed by SPSS software version 15 and descriptive (frequency, percentage, mean (SD) and inferential statistics (Pearson, and Multivariate linear regression) were provided. Results: The mean age of the participants was 65.7 years, 58% were women, 85.5% were married, and 37.5% were illiterate. The mean )SD (of social capital score was 71.87 (10.51) (in the range of 36-144) and for QOL, it was 64.64 (10.81) (in the range of 0-100). Social capital had positive and direct relation with QOL. Out of all the variables studied; marital status, education, economic status, health status, the absence of cardiovascular diseases (CVDs), and joint pains had significant relation with QOL. By some modifications in context factors, social capital was considered to be a predictive factor for QOL [β (95%CI): 0.28 to 0.36)]. Conclusion: For the promotion of QOL among the elderly, certain strategies must be implemented by health policy makers to enhance social capital among elderly people.

Physical Activity Changes and Its Risk Factors among Community-Dwelling Japanese Older Adults during the COVID-19 Epidemic: Associations with Subjective Well-Being and Health-Related Quality of Life

Psychological distress caused by decreased physical activity (PA) is a growing concern among the elderly due to public health measures since the coronavirus disease (COVID-19). We aimed to (1) assess how public health restrictions impact PA, subjective well-being (SWB), and health-related quality of life (HRQoL) of community-dwelling elderly, and (2) investigate risk factors that lead to a decline in PA. Self-administered questionnaires assessed the changes in PA, SWB, HRQoL. Multivariate logistic regression analysis was performed to identify significant associated risk factors for decreased PA. Of 165 participants (valid response rate, 41.3%; mean age, 78.5 ± 8.0 years), 47.3% became less active, 23.0% became more active, and 29.7% maintained PA levels. There was a significant decrease in SWB at baseline and follow-up after COVID-19 restrictions in the less active group (p < 0.01). Higher levels of moderate or strenuous exercise/sports activity at baseline (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.01–1.24), and lower mental component HRQoL scores at baseline (OR, 0.96; 95% CI, 0.93–0.99) were associated with an increased risk of decreased PA. Public health restrictions impact the PA of the elderly, especially those who had higher levels of exercise/sports activity and lower HRQoL before COVID-19. Decreased PA was strongly associated with lower SWB.

The relationship between preference-based health-related quality of life and lifestyle behavior: a cross-sectional study on a community sample of adults who had undergone a health check-up

Background

Preference-based Health-Related Quality of Life (HRQL) is one of the most important indicators for calculating QALY (Quality-Adjusted Life Years) in a cost-effectiveness analysis. This study aimed to collect data on healthy individuals’ HRQL based on the preferences of Japanese people who had undergone a comprehensive health check-up, and to examine the influence of relevant factors, such as blood biochemical data and lifestyle behavior.

Methods

We conducted a cross-sectional study targeting people who had undergone a comprehensive health check-up in 2015. Participants were asked to respond to a medical interview sheet. We then examined the utility value, as well as lifestyle habits such as alcohol intake, smoking, and exercise. HRQL was examined using EQ-5D-5L. Using a multiple regression analysis, we examined the influence of related factors, such as lifestyle and biochemical test data.

Results

We collected 2037 responses (mean age = 54.98 years; 55.0% female). The average preference-based health-related HRQL was 0.936 ± 0.087. A total of 1167 people (57.2%) responded that they were completely healthy. The biochemical test data that were recognized to correlate with HRQL were hemoglobin, total cholesterol, creatinine, all of which were weak (r = − 0.045–0.113). The results of multiple regression analysis showed that significant facts were: being female, age (≧70 year-old), drinking alcohol (sometimes), activity (very often), and lack of sleep.

Conclusions

The HRQL of participants who had undergone a comprehensive health check-up was generally high, and only declined for those over 70 years of age. It is suggested that preference-based HRQL is related to physical activity, and that decrease of activity and lack of sleep leads to a decrease in HRQL.

The effects of a temporal processing-based auditory training program on the auditory skills of elderly users of hearing aids: a study protocol for a randomized clinical trial

Background: One of the most important effects of age-related declines in neural processing speed is the impairment of temporal resolution, which leads to difficulty hearing in noisy environments. Since the central auditory system is highly plastic, by designing and implementing a temporal processing-based auditory training program, we can help the elderly improve their listening skills and speech understanding in noisy environments.

Methods: In the first phase of this research, based on the theoretical framework of temporal processing, an auditory training solution was developed as a software program. In the second phase, which will be described in the present study, the effects of the designed program on the listening skills of the elderly users of hearing aids (age: 60-75 years) will be studied in the control and intervention groups. In the intervention group, the auditory training program will be implemented for three months (36 sessions), and the results of central tests (GIN, DPT, QuickSIN) and the electrophysiological speech-ABR test will be compared in both groups before, immediately and one month after the intervention.

Discussion: Since temporal processing is not sufficient in auditory training programs for the elderly with hearing impairments, implementation of a temporal processing-based auditory training program can reduce hearing problems in noisy environments among elderly users of hearing aids.

Trial registration: This study was registered as a clinical trial in the Iranian Registry of Clinical Trials ( IRCT20190921044838N1) on December 25, 2019.

Relationship between Morbidity and Health Behavior in Chronic Diseases

This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors.

Moderating effect of social support on depression and health promoting lifestyle for Chinese empty nesters: A cross-sectional study

BACKGROUND

Health promoting lifestyle (HPL) may be a facilitator for empty nesters' active aging against depression. Social support (SS) may improve their HPL. This study aimed to examine moderating effect of SS and its three sources of SS on relationship between depression and HPL among empty nesters. The compensating role of socioeconomic status (SES) for lack of SS was examined, too.

METHODS

A cross-sectional survey of empty nesters (n = 1593) was conducted in six districts of Taiyuan, China, using a stratified random cluster sampling method. Hierarchical multiple linear regression analyses were performed to assess moderation models by SS and its three sources.

RESULTS

The findings indicated that low depression (p < 0.001) and sufficient perceived SS (p < 0.001) could directly predict better HPL among empty nesters. The effect of SS on HPL declined with the raise of educational level (p < 0.001). Family support (β = 0.083, p < 0.001), friends support (β = 0.085, p < 0.001) and others support (β = 0.098, p < 0.001) expressed significant negative buffer effects on depression and HPL individually.

LIMITATIONS

There was a cross-sectional study that limited the moderating effect of SS on depression and HPL just for empty nesters in Taiyuan, China. The results cannot explain the causal relationships among the study variables.

CONCLUSIONS

SS might be a protective factor of empty nesters' health in China. Three sources of SS all showed moderating effect on the relationship between depression and HPL among empty nesters, and should be integrated to achieve maximum utility. Friends support/ others support could play complement role for lack of family support. SES expressed partial compensatory for lack of SS.

Causes and Predictors of Hospital-Death among Elderly Patients in Western Iran; a Hospital-Based Cross-Sectional Study

Introduction

Identifying the death reasons amongst elderly, may help prioritizing the research projects and interventions.

Objective

This study purpose was to determine the death pattern and causes, and also its likely associated factors, in a mega hospital in western Iran.

Method

This retrospective cross-sectional study, conducted on elderly died from April 2011 to March 2016, in Imam Reza hospital in Kermanshah, Iran. The data were collected about the demographic characteristics, medical information, and the main death causes. The causes-of-death was classified adopting the International Classification of Diseases, Tenth Revision (ICD-10). The relationships between outcome and predicting variables were assessed by using Chi-square and Tukey's test in SPSS.

Results

Totally, 2415 died elderly were registered during the study period. The participants mean age at the time of their death was 75.35±9.15 years old. The diseases of circulatory system (dominancy of stroke), infectious diseases (leading by septicaemia and septic shock, respectively), and respiratory system diseases were the most common death causes, respectively. Age was the most important associated factor for the all-cause mortality related to the cardiovascular diseases (p=0.001).

Conclusion

The majority of deaths were the premature, which requires paying more attention. Although, cardiovascular diseases were the leading death causes and that is predictable, but the fatality of infectious diseases is still causing concerns.

Effects of the senior welfare center exercise program on body shape, physical fitness level, and cardiovascular health-related factors in old man from Korean rural areas

The purpose of this study was to investigate changes in body shape, physical fitness, and cardiovascular health-related factors after a 1-year combined exercise program in rural old men. Subjects were fourteen old men with more than 65 years of age living in Korean rural areas. The combined exercise program consisted of 90-min dynamic and static exercise sessions at a frequency of 3 days per week. Body shape (body weight [BW], body fat percentage [%BF], muscle mass [MM], body mass index [BMI], waist hip ratio [WHR]) and physical fitness levels (grip strength, standing up-right, one leg standing, sit and reach, and 2-min walking) were measured before, 6 months and 1 year after the program started. Cardiovascular health-related factors, including blood glucose, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and triglyceride (TG) were measured. There were no significant changes in BW, BMI, %BF, and MM after the training. WHR was significantly decreased at 6 months and 1-year follow-up points compared to baseline. There was no statistically significant difference in grip strength, but there was a significant increase after 6 months and 1 year after standing up right, one leg standing, sit and reach, and 2-min walking tests. There were no significant differences in the levels of glucose, SBP, DBP, TC, LDL-c, and TG, but there was a significant increase in HDL-c after 1-year.

Development and psychometric properties of the Healthy Aging Activity Engagement Scale (HAAE)

OBJECTIVES

Accumulating research indicates that engaging in healthy lifestyle behaviors (e.g. exercise, cognitive and social engagement, stress reduction) can prevent illness and disability as people age and improve mental health. The Healthy Aging Activity Engagement (HAAE) scale was developed to holistically assess an individual's level of engagement in healthy aging behaviors across multiple health domains.

METHODS

Participants were 275 healthy younger, midlife and older adults. Participants rated engagement in 38 healthy aging lifestyle behaviors over the past 7 days on a scale from 1 (strongly disagree) to 5 (strongly agree).

RESULTS

Traditional measurement analysis and Rasch modelling techniques resulted in a 32-item scale with three subscales representing biologic health, social and cognitive strategies, and health safeguard behaviors. With the exception of the health safeguard subscale, the HAAE total score and subscales demonstrated good internal consistency, test-retest reliability, convergent and discriminant validity, and responsiveness to a program designed to promote engagement in healthy brain aging behaviors.

DISCUSSION

With further validation, the HAAE may be useful for holistic clinical assessment of behaviors that promote healthy aging, support brain and mental health, and for treatment planning. Furthermore, the HAAE can be used to measure the outcome of multi-domain lifestyle interventions.

Social Network Types and Health among Older Adults in Rural China: The Mediating Role of Social Support

This study aimed to identify social network types among older adults in rural China, to explore the relationship between social network types and the health of the older adults, and further, to examine the mediating role of social support in this relationship. A cross-sectional survey method was employed to investigate the health of adults aged 60 or older in rural areas of Hubei Province from 5 September 2018 to 15 October 2018; 405 samples were obtained. First, using k-means clustering analysis, we found five robust network types: diverse, restricted, family, friends and a specific type—family-restricted. Second, the results of multiple linear regression analysis showed that social network types were significantly associated with depressive symptoms and self-rated health in older adults. Older people with diverse friend networks were significantly associated with lower levels of depressive symptoms, whereas those with restricted and family-restricted networks were significantly associated with higher levels of depressive symptoms and lower levels of self-rated health. Finally, the results of multiple linear regression analysis confirmed that social support partially mediated the association of the identified social network types with depressive symptoms and self-rated health. Enriching the social network relationships of older adults and providing them with more social support should be conducive to promoting their mental and physical health.

The effects of sociodemographic factors on quality of life among people aged 50 years or older are not unequivocal: comparing SF-12, WHOQOL-BREF, and WHOQOL-OLD

Objective

The effects of sociodemographic factors on quality of life in older people differ strongly, possibly due to the fact that different measurement instruments have been used. The main aim of this cross-sectional study is to compare the associations of sex, age, marital status, education, and income with quality of life assessed with the Short-Form Health Survey (SF-12), the World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF), and the World Health Organization Quality of Life Questionnaire-Older Adults Module (WHOQOL-OLD).

Methods

The associations between sociodemographic factors and eleven quality of life domains were examined using a sample of 1,492 Dutch people aged ≥50 years. Participants completed the “Senioren Barometer”, a web-based questionnaire including sociodemographic factors, the SF-12, the WHOQOL-BREF, and the WHOQOL-OLD.

Results

All the sociodemographic factors together explained a significant part of the variance of all the quality of life domains’ scores, ranging from 5% to 17% for the WHOQOL-BREF, 5.8% to 6.7% for the SF-12, and 1.4% to 26% for the WHOQOL-OLD. Being a woman and being older were negatively associated with two and four quality of life domains, respectively. Being a woman, being married or cohabiting, and having higher education and a higher income were positively associated with six, six, one, and eleven quality of life domains, respectively.

Conclusion

Our study showed that the associations of sociodemographic factors and quality of life in middle-aged and older people depend on the instruments used to assess quality of life. We recommend that health care and welfare professionals focus particularly on people with a low income and carry out interventions aimed at improving their quality of life.

The Effect of Fun Physical Activities on Sarcopenia Progression among Elderly Residents in Nursing Homes: a Randomized Controlled Trial

Introduction: Immobilization in the elderly can reduce the size and strength of muscle mass and ultimately lead to sarcopenia, the severity and progression of which can be prevented by exercise. However, due to physical and mental conditions, the elderly may be unable to take full advantage of regular exercise. Therefore, fun exercise through motivation and effective participation of older adults is likely to have positive effects on decreasing the volume and power of muscle mass. The aim of this study was to determine the effect of fun physical activities on the progression of sarcopenia among elderly residents in nursing homes.

Methods: This study was a two-group randomized controlled trial conducted in 2014. Sixty three older adults were recruited by the random sampling. The elderly in the fun physical exercise group did the exercise for 8 weeks, three times a week for 20 minutes at a time, and in the control group, the adults did the routine exercises. The Berg Balance Scale, a dynamometer, and the Six-Minute Walk Test were used to measure sarcopenia criteria (balance, muscle strength, distance traveled).The statistical analysis was done by SPSS version 13.

Results: The results showed that the mean score of the sarcopenia criterion (balance, distance walked, muscles strength) was significantly increased in the fun physical exercise group than in the control group.

Conclusion: The fun physical activity reduces sarcopenia progression through improving balance, increasing distances walked, and strengthening muscles.

Health-Promoting Behaviors and Their Predictors in Iranian Women of Reproductive Age: A Cross-Sectional Study

Health-promoting behaviors are one of the main determinative components of health in the prevention of many diseases. This cross-sectional study aimed to determine health-promoting behaviors and their relationship to sociodemographic variables on 330 women of reproductive age admitted to the selected primary health-care centers in Qom city (one of the biggest cities in Iran) from March 2016 to July 2016. Data were collected using the health-promoting lifestyle profile II (HPLP-II) questionnaire and the sociodemographic characteristics and also were analyzed by one-way analysis of variance, with post hoc (if necessary), and multivariable linear regression. The total HPLP-II mean score of women was 136.64 ± 22.37. The highest score in the HPLP-II subscales of women was found for interpersonal relations subscale (26.43 ± 4.21) and the lowest score for physical activity subscale (14.66 ± 4.62). The educational level and income had significant association with some subscales ( p < .05).

Social networks, health promoting-behavior, and health-related quality of life in older Korean adults

In this cross-sectional, descriptive study, we compared the sociodemographic characteristics, social networks, health-promoting behavior, and the health-related quality of life of older Korean adults living in South Korea to those of older Korean adult immigrants living in the USA. A total of 354 older adults, aged 65 years or older, participated. Data were collected through self-directed questionnaires, and analyzed using a two way analysis of variance, t-tests, χ² -tests, and Pearson's correlation coefficient. The association between four sociodemographic characteristics and health-related quality of life was significantly different between the two groups. For the older Korean adults living in South Korea, positive correlations existed between a measure of their social networks and both health-promoting behavior and health-related quality of life. For the older Korean immigrants, the findings revealed a positive correlation only between social networks and health-promoting behavior. The study findings support the important association social networks can have with health-related quality of life, and their possible relationship to health-promoting behaviors of older Korean adults. We suggest that health policy-makers and healthcare providers develop comprehensive programs that are designed to improve older adults' social networks.

Demographic and Socioeconomic Determinants of Self-Efficacy: An Empirical Study of Korean Older Adults

This study conceptualizes the dimensions of older adults' self-efficacy and identifies its determinants by using panel data collected by the National Pension Research Institute in Korea. The analysis supported the conceptualization of older people's self-efficacy as a multidimensional construct and found strong support for the three subscales. For older adults in Korea, general self-efficacy was condensed into a sense of competence. Older adults' social self-efficacy was delineated into two subscales: inward social self-efficacy and interactive social self-efficacy. Inward social self-efficacy could be characterized as a set of inward-looking social capabilities, whereas interactive self-efficacy could be considered as a set of relation-oriented capabilities with various groups of individuals. Of the three regression models representing dimensions of older people's self-efficacy, each model uncovered its own set of variables that played a decisive role in perceived self-efficacy. Demographic variables were more effective determinants of older adults' self-efficacy than socioeconomic factors.

The relationship between attitudes toward aging and health-promoting behaviours in older adults

BACKGROUND

Identifying the factors that are associated with health-promoting behaviours in older adults is necessary to increase their willingness and motivation to participate in health-promotion activities. Understanding context-specific attitudes in relation to their influence on health-promoting behaviours is crucial in designing efficient interventions that foster health-promoting behaviours among older adults.

AIM

This study aimed to examine the relationships between attitudes towards aging and health-promoting behaviours in older adults in Turkey.

METHODS

The study used a descriptive-correlational design. A convenience sample of 448 community-dwelling older adults who were 65 years and older and cognitively intact were selected from 6 family health centres in the city of Denizli in Turkey. The data were collected between March and June of 2014 using the Attitudes to Aging Questionnaire and the Health-Promoting Lifestyle Profile II. Multiple linear regression analysis was performed to explore the predictors of health-promoting behaviours.

FINDINGS

Attitudes toward aging, the psychosocial loss subscale, and education were statistically significant predictors of health-promoting behaviours. Attitudes toward aging were the strongest predictor of health-promoting behaviours in older adults.

CONCLUSION

Attitude towards aging is a factor that affects health-promoting behaviours, and it should be considered during interventions for improving health promoting behaviours.

Gender differences in health promotion behaviors and quality of life among community-dwelling elderly

The differences of basic attributes, health promotion behaviors, and quality of life between elderly males and females in Taiwan were compared. Several scales were used to examine the gender differences and the factors associated with quality of life. Regression analysis revealed that gender, education level, depression level, and healthy diet were key factors influencing the overall quality of life. The education level of females was lower, and their depression level was higher; however, females had healthier diets. With regards to their satisfaction in the quality of life, elderly males scored higher than females in both the physical and psychological domains.

Evaluation of Effective Indexes on Quality of Life Related to Health in Western Iran in 2013

BACKGROUND

Today, indexes regarding longevity and life expectancy have increased; the most important issue now is how to spend time loving or in other words quality of life.

OBJECTIVES

This study was aimed to evaluate effective indexes on quality of life related to health in western Iran in 2013.

MATERIALS AND METHODS

In this cross-sectional research, 918 families were selected among different counties of Ilam Province by multi-stage clustering sampling. The data collection instrument was a questionnaire used to measure the general economic and quality of life: the SF-36 health status questionnaire. Data were analyzed using multivariate regression models.

RESULTS

The mean age of the study participants was 32.97 ± 9.5 years, and the mean score for their quality of life was 61.74 ± 12.31. There was a significant statistical relationship between people's quality of life and their marital status, province of residency, income, economic situation, and life satisfaction (P < 0.05). Also, there was a significant and inverse correlation between people's age and quality of life (r = 0.21), physical health summary (r = 0.21) and mental health summary (r = 0.08).

CONCLUSIONS

The mean quality of life among the individuals studied was in the middle level, however, it is important to consider the different dimensions of their living situations, such as economic protections, social cooperation, ability to present suitable behaviors to solve problems, and living situation, especially among deprived people.

Quality of urban life among older adults in the world major metropolises: a cross-cultural comparative study

The concept of quality of urban life (QoUL) can be interpreted quite differently across different cultures. Little evidence has shown that the measure of QoUL, which is based on Western culture, can be applied to populations cross-culturally. In the current study, we use data from the 2006 Assessing Happiness and Competitiveness of World Major Metropolises study to identify underlying factors associated with QoUL as well as assess the consistency of the QoUL measurement among adults, aged 60 and older, in ten world major metropolises (i.e. New York City, Toronto, London, Paris, Milan, Berlin, Stockholm, Beijing, Tokyo and Seoul). Exploratory factor analysis and multiple-group confirmatory factor analysis (CFA) are used to analyse the data. Findings of the study suggest that the measure of QoUL is sensitive to socio-cultural differences. Community factor and intrapersonal factor are two underlying structures that are related to QoUL among older adults in ten metropolises cross-culturally. Results from the CFA indicate that Toronto is comparable with Beijing, New York City, Paris, Milan and Stockholm in QoUL, while other cities are not. The results provide insights into the development of current urban policy and promotion of quality of life among older residents in major metropolitan areas. Future researchers should continue to explore the relationship between QoUL and socio-cultural differences within international urban settings, while remaining cautious when making cross-cultural comparisons.

The Relationship Between Health-Promoting Behaviors and Metabolic Syndrome in Community-Dwelling Older Adults

BACKGROUND

Poor health-promoting behaviors increase the risk of chronic disease and disability in older adults. Nevertheless, the predictors of health-promoting behaviors and their relationship with metabolic syndrome have been poorly characterized in older Taiwanese adults.

OBJECTIVE

To explore the determinants of health-promoting behaviors in community-dwelling older adults in Taiwan and the relationship of health-promoting behaviors with metabolic syndrome.

METHODS

A cross-sectional design was used. A convenience sample of 200 community residents aged 60 years and over was recruited from two large communities in New Taipei City, Taiwan. Data collection included physical examination and a structured questionnaire including measures of health status, health-promoting behaviors, self-efficacy, social support, and metabolic syndrome.

RESULTS

Metabolic syndrome was found in 60% of older Taiwanese adults. These participants had higher scores in interpersonal relationships but lower scores in physical activity. Half of the health-promoting behaviors were explained by behavior-specific cognitions and affect, and 44% of behavior-specific cognitions and affect was explained by the health status of the older adult.

CONCLUSIONS

Physical activity should be promoted in older Taiwanese adults. Positive behavior-specific cognitions and affect and better health status might impact the health-promoting behaviors of these adults.

The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point

Background

This study explored the effectiveness of a pro-active, integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes: health outcomes (experienced health, mental health and social functioning); functional abilities; and quality of life (general, health-related and well-being).

Methods

The design of this study was quasi-experimental. In this study, 184 frail older patients of three GP practices that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practices that provided care as usual. In the Walcheren Integrated Care Model, community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator, and care needs were assessed with the EASYcare instrument. The GP practice functioned as single entry point from which case management was provided, and the GP was the coordinator of care. The entire process was supported by multidisciplinary meetings, multidisciplinary protocols and web-based patient files. The outcomes of this study were obtained at baseline, after 3 months and after 12 months and analyzed with linear mixed models of repeated measures.

Results

The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life. The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group. No significant differences were found on health outcomes such as experienced health, mental health, social functioning and functional abilities.

Conclusions

The results indicated that pro-active, integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities. Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care, considering the specific content of this care, and to allow for the heterogeneity of frail older people in evaluation research.

Trial registration

Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.

A cross-sectional study on quality of life among the elderly in non-governmental organizations' elderly homes in Kuala Lumpur

Background

There is a rapid increase in the population of the elderly globally, and Malaysia is anticipated to become an ageing nation in 2030. Maintaining health, social participation, reducing institutionalization, and improving quality of life of the elderly are public health challenges of the 21^st century. Quality of life among elderly in Elderly Homes in Malaysia is under researched. This study aims to determine the quality of life and its associated factors among the Elderly in Elderly Homes in Kuala Lumpur.

Methods

This was a cross-sectional study among 203 residents aged 60 years or more in eight randomly selected Elderly Homes in Kuala Lumpur in September 2014. Stratified simple random sampling was used to select participants. Study instruments included World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF), Multidimensional Scale for Perceived Social Support, and a questionnaire for Socio-demographic variables. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant.

Results

The mean (Standard deviation) for the physical domain was 14.3 (±2.7), 13.7 (±2.5) for the psychological domain, 10.8 (±3.4) for the social domain, and 13.0 (±2.5) for the environment domain. Factors significantly associated with quality of life included age, gender, level of education, economic status, outdoor leisure activity, physical activity, duration of residence, type of accommodation, co-morbidities, and social support.

Conclusion

This study confirms that multiple factors are associated with quality of life among elderly in elderly homes. Social support, chronic co-morbidities, gender and outdoor leisure activity were significantly associated with all the domains of quality of life. Among the four domains of quality of life, the physical domain had the highest score while the social domain had the lowest score. This emphasizes the need for more social support-related interventions in these homes.

The outcomes of psychiatric inpatients by proportion of experienced psychiatrists and nurse staffing in hospital: New findings on improving the quality of mental health care in South Korea

Readmission rates for mental health care are higher in South Korea than other Organization for Economic Development (OECD) countries. Therefore, it is worthwhile to continue investigating how to reduce readmissions. Taking a novel approach, we determined the relationship between psychiatrist experience and mental health care readmission rates. We used National Health Insurance claim data (N=21,315) from 81 hospitals to analyze readmissions within 30 days of discharge for "mood disorders" or "schizophrenia, schizotypal and delusional disorders" during 2010-2013. In this study, multilevel models that included both patient and hospital-level variables were analyzed to examine associations with readmission. Readmissions within 30 days of discharge accounted for 1079 (5.1%) claims. Multilevel analysis demonstrated that the proportion of experienced psychiatrists at a hospital was inversely associated with risk of readmission (OR: 0.79, 95% CI: 0.74-0.84 per 10% increase in experienced psychiatrists). Readmission rates for psychiatric disorders within 30 days of discharge were lower in hospitals with a higher number of nurses (OR: 0.95, 95% CI: 0.94-0.96 per 10 nurses). In conclusion, health policymakers and hospital managers should make an effort to reduce readmissions for psychiatric disorders and other diseases by considering the role that physician experience plays and nurse staffing.