Health status versus quality of life in older patients: does the distinction matter?

Hereditary gelsolin amyloidosis: a rare cause of cranial, peripheral and autonomic neuropathies linked to D187N and Y447H substitutions

INTRODUCTION

Hereditary gelsolin (AGel) amyloidosis is a systemic disease that is characterised by neurologic, ophthalmologic, dermatologic, and other organ involvements. We describe the clinical features with a focus on neurological manifestations in a cohort of patients with AGel amyloidosis referred to the Amyloidosis Centre in the United States.

METHODS

Fifteen patients with AGel amyloidosis were included in the study between 2005 and 2022 with the permission of the Institutional Review Board. Data were collected from the prospectively maintained clinical database, electronic medical records and telephone interviews.

RESULTS

Neurologic manifestations were featured in 15 patients: cranial neuropathy in 93%, peripheral and autonomic neuropathy in 57% and bilateral carpal tunnel syndrome in 73% of cases. A novel p.Y474H gelsolin variant featured a unique clinical phenotype that differed from the one associated with the most common variant of AGel amyloidosis.

DISCUSSION

We report high rates of cranial and peripheral neuropathy, carpal tunnel syndrome and autonomic dysfunction in patients with systemic AGel amyloidosis. The awareness of these features will enable earlier diagnosis and timely screening for end-organ dysfunction. The characterisation of pathophysiology will assist the development of therapeutic options in AGel amyloidosis.

Predictors of quality of life in patients within the first year of commencing haemodialysis based on baseline data from the PIVOTAL trial and associations with the study outcomes

BACKGROUND

Impaired quality of life is common in patients with end-stage kidney disease. We report the baseline quality of life measures in participants from the PIVOTAL randomized controlled trial and the potential relationship with the primary outcome (all-cause mortality, myocardial infarction, stroke, and heart failure hospitalisation), and associations with key baseline characteristics.

METHODS

This was a post hoc analysis of 2141 patients enrolled in the PIVOTAL trial. Quality of life was measured using EQ5D index, Visual Analogue Scale, and the KD-QoL [Physical Component Score and Mental Component Score].

RESULTS

Mean baseline EQ5D index and visual analogue scale scores were 0.68 and 60.7 and 33.7 (Physical Component Score) and 46.0 (Mental Component Score), respectively. Female sex, higher Body Mass Index, diabetes mellitus, history of myocardial infarction, stroke or heart failure were associated with significantly worse EQ5D index and visual analogue scale. Higher C-reactive protein levels and lower transferrin saturation were associated with worse quality of life. Haemoglobin was not an independent predictor of quality of life. A lower transferrin saturation was an independent predictor of worse physical component score. A higher C-reactive protein level was associated with most aspects of worse quality of life. Impaired functional status was associated with mortality.

CONCLUSION

Quality of life was impaired in patients starting haemodialysis. A higher C-reactive protein level level was a consistent independent predictor of the majority of worse quality of life. Transferrin saturation ≤ 20% was associated with worse physical component score of quality of life. Baseline quality of life was predictive of all-cause mortality and the primary outcome measure.

EUDRACT REGISTRATION NUMBER

2013-002267-25.

When Functional Impairment Develops Early: Perspectives from Middle-Aged Adults

BACKGROUND

Difficulty performing basic daily activities such as bathing and dressing ("functional impairment") affects more than 15% of middle-aged people, and this proportion is increasing. Little is known about the experiences and needs of individuals who develop functional impairment in middle age.

OBJECTIVE

To examine the experiences and needs of adults who developed functional impairment in middle age.

DESIGN

Qualitative study using semi-structured interviews.

PARTICIPANTS

Forty patients aged 50-64 years who developed functional impairment in middle age, recruited from four primary care clinics in San Francisco.

APPROACH

Interviews included open-ended questions about participants' daily life, ability to perform activities of daily living (ADLs), and needs related to functional impairment. We analyzed interviews using qualitative thematic analysis.

KEY RESULTS

Interviews revealed several themes related to the psychosocial and physical impacts of developing functional impairment in middle age. Participants noted that losses associated with functional impairment, such as loss of independence, control, and social roles, caused conflict in their sense of identity. To cope with these losses, participants used strategies including acceptance, social comparison, adjusting standards, and engaging in valued life activities. Participants reflected on the intersection of their functional impairment with the aging process, noting that their impairments seemed premature compared to the more "natural" aging process in older adults. In terms of physical impacts, participants described how a lack of accommodations in the built environment exacerbated their impairments. While participants used behavioral strategies to overcome these challenges, unmet needs remained, resulting in downstream physical and psychological impacts including safety risks, falls, frustration, and fear.

CONCLUSIONS

Unmet psychosocial and physical needs were common among middle-aged adults with functional impairment and led to negative downstream effects. Eliciting and addressing unmet needs may help mitigate downstream health consequences for this growing population, optimizing function and quality of life.

Quality of Life Assessment in Older Adults with Dementia: A Systematic Review

INTRODUCTION

In the absence of a cure, dementia is often managed by minimizing risk factors contributing to quality of life (QOL). Attitudes to dementia in older adults may differ from those in relatively younger adults. The aim was to conduct a systematic review of the literature to determine how QOL was assessed in adults, 65 years and older with dementia, and identify factors that influence the reported scores.

METHODS

A systematic review of full-text articles addressing QOL in older adults with dementia, published in English from January 1995 to September 2020, was conducted using PubMed and PsycINFO. We included studies that assessed QOL and involved participants 65 years and older. Studies were evaluated for inclusion by 2 independent pairs of reviewers. We assessed the quality of the studies using the Joanna Briggs Institute's Critical Appraisal Checklist. Study characteristics and findings were summarized. Analysis was by narrative synthesis. We identified social and clinical factors influencing QOL scores.

RESULTS

Of the 1,010 articles identified, 19 met the inclusion criteria. These 19 studies involved 6,279 persons with dementia, with sample sizes from 32 to 1,366. Mean age of participants ranged from 77.1 to 86.6 years. Five measurement tools were identified; Quality of Life in Alzheimer Disease (QOL-AD), Alzheimer Disease-Related Quality of Life (ADRQL), Quality of Life in Late-Stage Dementia (QUALID), QUALIDEM (a dementia-specific QOL tool), and DEMQOL (health-related QOL for people with dementia). Self-ratings of QOL were higher than proxy ratings. Factors commonly influencing self-ratings of QOL included depression, functional impairment, and polypharmacy. Common factors that influenced proxy ratings included functional impairment, presence of neuropsychiatric symptoms, cognitive impairment, and caregiver burden.

CONCLUSION

In evaluating QOL in dementia, self- and proxy reports may complement each other to ensure that all perspectives are addressed.

The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use

OBJECTIVE

The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA).

METHODS

Surveys of 334 adults with knee and/or hip OA were analyzed in this cross-sectional study. Familiarity with and perceptions of benefits/risks of NSAID use were measured to assess associations with the use of prescription and nonprescription oral NSAIDs. Multinomial logistic regression models were adjusted for sociodemographic and clinical variables.

RESULTS

In this sample, 35.9% and 35.6% reported use of oral prescription and nonprescription-only NSAIDs, respectively. Hispanic participants, compared with non-Hispanic White participants, had lower perceived benefit (P = 0.005) and risk (P = 0.001) of prescription NSAIDs. The following were associated with prescription NSAID use instead of no NSAID use: having family/friends who used prescription (relative risk ratio [RRR] 3.91; 95% confidence interval [CI] 2.05-7.47) and over-the-counter (OTC) (RRR 3.10; 95% CI 1.65-5.83) NSAIDs for OA, understanding the consequences of using both prescription (RRR 3.50; 95% CI 1.79-6.86) and OTC (RRR 2.80; 95% CI 1.39-5.65) NSAIDs, higher perceived benefit of both prescription (RRR 2.51; 95% CI 1.71-3.66) and OTC (RRR 1.44; 95% CI 1.01-2.06) NSAIDs, and lower perceived risk of both types of NSAIDs (prescription: RRR 0.63 [95% CI 0.46-0.87]; OTC: RRR 0.53 [95% CI 0.37-0.75]). Similar results were found when we assessed the relationship between these variables and OTC NSAID use versus no oral NSAID use.

CONCLUSION

Adults with knee and/or hip OA were more likely to use NSAIDs if they were more familiar with, had an increased perceived benefit of, and had a decreased perceived risk of these drugs. Patients' perceptions and beliefs about NSAIDs should be evaluated when considering them for treatment.

Effects of Postpartum Fatigue and Depressive Cognitions on Life Satisfaction and Quality of Life in Arab Postpartum Women: The Intervening Role of Resourcefulness

The purpose of this study is to explore the relationships among postpartum fatigue (PPF), depressive cognitions, resourcefulness, quality of life, and life satisfaction in Arab postpartum mothers. A conceptual framework is used in this study based on the middle range theory of resourcefulness, which Zauszniewski developed in 2006. The study is a cross-sectional descriptive design with 123 postpartum women who had given birth within the past six months. used WhatsApp and Facebook for recruitment. developed the self-administered online survey in Qualtrics and collected data from 6 January 2017, to 6 February 2017. Correlation analysis is used to address the research aim and used the P value of 0.05 to determine the significance of the results. There were significant correlations among depressive cognitions and resourcefulness, life satisfaction, and quality of life; there were also significant correlations between PPF and life satisfaction, as well as among resourcefulness, quality of life, and life satisfaction. The results of this study emphasized the importance of assessing depressive symptoms and PPF in mothers early in the postpartum period. The results may contribute to designing future intervention studies aimed toward decreasing the risk of mothers with PPF developing more serious depressive symptoms.

Association of Patients' Familiarity and Perceptions of Efficacy and Risks With the Use of Opioid Medications in the Management of Osteoarthritis

OBJECTIVE

While opioids are known to cause unintended adverse effects, they are being utilized by a number of patients with osteoarthritis (OA). The aim of this study was to evaluate the association of patient familiarity and perceptions regarding efficacy and risks with opioid medication use for OA.

METHODS

A total of 362 adults with knee and/or hip OA were surveyed in this cross-sectional study. Patients' familiarity with and perceptions of benefits/risks of opioid medications were measured to evaluate potential associations with the utilization of opioid medications for OA within the last 6 months. Logistic regression models were adjusted for sociodemographic and clinical variables.

RESULTS

In this sample, 28.7% (100/349) reported use of an opioid medication for OA-related symptoms in the last 6 months. Those who were on an opioid medication, compared to those who were not, were younger (mean age 62.5 vs 64.8 yrs), were more likely to have a high school education or lower (48.0% vs 35.3%), and had higher mean depression (Patient Health Questionnaire [PHQ]-8 7.2 vs 4.9) and OA-related pain (Western Ontario and McMaster Universities Arthritis Index [WOMAC] 54.8 vs 46.8) scores. After adjustment for sociodemographic and clinical variables, the following were associated with opioid medication use: higher perception of medication benefit (OR 1.68, 95% CI 1.18-2.41), lower perception of medication risk (OR 0.67, 95% CI 0.51-0.88), and having family or friends who received the medication for OA (OR 3.88, 95% CI 1.88-8.02).

CONCLUSION

Among adults with knee/hip OA, opioid use was associated with being familiar with the treatment, as well as believing that the medication was beneficial and low-risk.

Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults

BACKGROUND

A classic consequence of short-term bed rest in older adults is the significant loss in skeletal muscle mass and muscle strength that underlies the accelerated physical performance deficits. Structured exercise programmes applied during acute hospitalization can prevent muscle function deterioration.

METHODS

A single-blind randomized clinical trial conducted in an acute care for elders unit in a tertiary public hospital in Navarre (Spain). Three hundred seventy hospitalized patients [56.5% female patients; mean age (standard deviation) 87.3 (4.9) years] were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training programme performed during 5-7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed. The main endpoints were change in maximal dynamic strength (i.e. leg-press, chest-press, and knee extension exercises) and maximal isometric knee extensors and hip flexors strength from baseline to discharge. Changes in muscle power output at submaximal and maximal loads were also measured after the intervention.

RESULTS

The physical exercise programme provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 19.6 kg [95% confidence interval (CI), 16.0, 23.2; P < 0.001] on the one-repetition maximum (1RM) in the leg-press exercise, 5.7 kg (95% CI, 4.7, 6.8; P < 0.001) on the 1RM in the chest-press exercise, and 9.4 kg (95% CI, 7.3, 11.5; P < 0.001) on the 1RM in the knee extension exercise over usual-care group. There were improvements in the intervention group also in the isometric maximal knee extension strength [14.8 Newtons (N); 95% CI, 11.2, 18.5 vs. -7.8 N; 95% CI, -11.0, -3.5 in the control group; P < 0.001] and the hip flexion strength (13.6 N; 95% CI, 10.7, 16.5 vs. -7.2 N; 95% CI, -10.1, -4.3; P < 0.001). Significant benefits were also observed in the exercise group for the muscle power output at submaximal loads (i.e. 30% 1RM, 45% 1RM, 60% 1RM, and 75% 1RM; all P < 0.001) over usual-care group.

CONCLUSIONS

An individualized, multicomponent exercise training programme, with special emphasis on muscle power training, proved to be an effective therapy for improving muscle power output of lower limbs at submaximal loads and maximal muscle strength in older patients during acute hospitalization.

Moving prevention of functional impairment upstream: is middle age an ideal time for intervention?

To live independently, individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, and transferring out of a bed or chair. When older adults develop difficulty or the need for help performing ADLs, they experience decreased quality of life and an increased risk of acute care utilization, nursing home admission, and death. For these reasons, slowing or preventing the progression to functional problems is a key focus of the care of older adults. While preventive efforts currently focus mainly on older people, difficulty performing basic ADLs (“functional impairment”) affects nearly 15% of middle-aged adults, and this prevalence is increasing. People who develop functional impairment in middle age are at increased risk for adverse outcomes similar to those experienced by older adults. Developing ADL impairment in middle age also impacts work force participation and health expenditures, not just in middle age but also older age. Middle-aged adults have a high capacity for recovery from functional impairment, and many risk factors for developing functional impairment in middle and older age have their roots in mid-life. Taken together, these findings suggest that middle age may be an ideal period to intervene to prevent or delay functional impairment. To address the rising prevalence of functional impairment in middle age, we will need to work on several fronts. These include developing improved prognostic tools to identify middle-aged people at highest risk for functional impairment and developing interventions to prevent or delay impairment among middle-aged people. More broadly, we need to recognize functional impairment in middle age as a problem that is as prevalent and central to health outcomes as many chronic medical conditions.

Nonsteroidal Anti-Inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity

PURPOSE

Our objective was to determine if there are ethnic differences in the use of over-the-counter (OTC) and prescription oral nonsteroidal anti-inflammatory drugs (NSAIDs) and if observed ethnic differences persist after adjustment for sociodemographic and clinical factors.

METHODS

Knee and hip osteoarthritis study participants were identified. Surveys were administered to collect sociodemographics, clinical information, and oral treatment methods for arthritis. Multivariable logistic regression models were created using a fully conditional method.

RESULTS

Hispanics (n = 130), compared to non-Hispanic whites (n = 204), were less likely to have a high school education (26.9% vs 63.2%, P <0.001), less likely to have private medical insurance (P <0.001), and more likely to have worse health (P = 0.004). OTC oral NSAID use was less common (52.9% vs 66.3%, P = 0.019), whereas prescription oral NSAID use was more common (43.4% vs 31.7%, P = 0.042) among Hispanics than non-Hispanic whites in the last 6 months. The ethnic difference in using an OTC NSAID instead of not using any oral NSAID was attenuated and no longer significant when adjusted for age, sex, education, and medical insurance (odds ratio [OR] 0.54 [95% confidence interval [CI]: 0.28-1.02]). The odds of using a prescription instead of an OTC NSAID remained significantly higher among Hispanics than non-Hispanic whites when adjusted for the same variables (odds ratio 2.17 [95% confidence interval: 1.16-4.05]).

CONCLUSIONS

Among patients with osteoarthritis, OTC NSAIDs were less commonly used but prescription NSAIDs were more commonly used by Hispanics than non-Hispanic whites. Sociodemographic factors partially mediate ethnic differences in the use of oral NSAIDs.

Operationalizing the Disablement Process for Research on Older Adults: A Critical Review

Self-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.

Inter-individual variability in response to exercise intervention or usual care in hospitalized older adults

BACKGROUND

Exercise protocols applied during hospitalization can prevent functional and cognitive decline in older adults. The purpose of this study was to examine the individual response of acutely hospitalized patients to usual care and to physical exercise on functional capacity, muscle strength, and cognitive function and to assess the relationship with mortality at 1 year post-discharge.

METHODS

In a single-blind randomized clinical trial, 370 hospitalized patients [56.5% women; mean age (standard deviation) 87.3 (4.9) years] were allocated to an exercise intervention group (IG, n = 185) or a control group (CG, n = 185). The participants were older adults aged 75 years or older in an acute care unit in a tertiary public hospital in Navarra, Spain. The usual care group received habitual hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized multicomponent exercise training programme performed during 5-7 consecutive days (two sessions/day). Functional capacity was assessed with the Short Physical Performance Battery (SPPB) test and the Gait Velocity Test (GVT). Handgrip strength and cognitive function were also measured at admission and discharge. Patients in both groups were categorized as responders (Rs), non-responders (NRs), and adverse responders (ARs) based on the individual response to each treatment during hospitalization.

RESULTS

The prevalence of Rs was higher and the prevalence of NRs and ARs was lower in the intervention group than in the control group for functional capacity (SPPB IG: Rs 85.3%, NRs 8.7%, ARs 6.0% vs. CG: Rs 37.9%, NRs 28.8%, ARs 33.3% and GVT IG: Rs 51.2%, NRs 47.3, ARs 1.6% vs. CG: Rs 18.0%, NRs 67.7%, ARs 14.3%), muscle strength (IG: Rs 62.3%, NRs 26.5%, ARs 11.3% vs. CG: Rs 20.0%, NRs 38.0%, ARs 42.0%), and cognition (IG: Rs 41.5%, NRs 57.1%, ARs 1.4% vs. CG: Rs 13.8%, NRs 76.6%, ARs 9.7%) (all P < 0.001). The ARs for the GVT in the control group and the ARs for the SPPB in the intervention group had a significantly higher rate of mortality than the NRs and Rs in the equivalent groups (0.01 and 0.03, respectively) at follow-up.

CONCLUSIONS

Older patients performing an individualized exercise intervention presented higher prevalence of Rs and a lower prevalence of NRs and ARs for functional capacity, muscle strength, and cognitive function than those who were treated with usual care during acute hospitalization. An adverse response on functional capacity in older patients to physical exercise or usual care during hospitalization was associated with mortality at 1 year post-discharge.

Disability and quality of life in heart failure patients: a cross-sectional study

BACKGROUND

Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life.

AIM

To assess the degree of disability and quality of life in HF patients attended at family medicine centres.

DESIGN AND SETTING

Cross-sectional study of a cohort of HF patients attended at family medicine centres.

METHODS

Disability was assessed with the WHODAS 2 questionnaire, which provides a global and six domain scores that is understanding and communication, getting around, self-care, getting along with people, life activities and participation in society. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, which furnishes a global and two domain scores, physical and emotional.

RESULTS

A breakdown of the results showed that 28% of patients had moderate disability and 16.7% had severe disability, with the most important areas affected being: life activities, 8.9% extreme disability and 30.3% severe disability; getting around, 34.6% severe disability and 2% extreme disability; and participation in society, 53.3% moderate-severe disability. Quality of life was mildly affected. New York Heart Association (NYHA) Functional Classification and sex were the major determinants of disability and quality of life. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists were associated with better scores in the "getting around" and "life activity" domains.

CONCLUSION

HF patients in primary care show an important degree of disability and an acceptable quality of life.

Do psychosocial factors modify the negative association between disability and life satisfaction in old age?

CONTEXT

Many assume that having poor physical health in old age lowers life satisfaction, but in fact there are large differences in life satisfaction among older people who experience disability.

OBJECTIVE

To investigate whether psychosocial factors modify the negative association between disability and life satisfaction in older people and whether these differ across the life course.

DESIGN

Cross sectional study.

SETTING

66,561 community-dwelling Survey of Health, Ageing, and Retirement in Europe (SHARE) participants aged 50-106 with a mean age of 67.8 ± 9.9 (SD) years from 17 European countries and Israel.

METHODS

Psychosocial factors included depression (EURO-D scale), perceived loneliness, having a spouse, having children, contact with children, and participation in social activities. Disability was assessed by limitations in (Instrumental) Activities of Daily Living ((I)ADL) and life satisfaction by Cantril's ladder. We also ran the analyses with the Control Autonomy Self-realization Pleasure (CASP-12) Index, a normative measure of quality of life. We used multiple linear regressions to estimate associations and proportion of variance explained.

RESULTS

The variance in life satisfaction that could be attributed uniquely to ADL and IADL disability was 0.17% and 0.33% respectively (both p < 0.001). The impact of (I)ADL disabilities on life satisfaction was strongest at age 50 and gradually decreased with increasing age (p trend < 0.001). Mental health explained more variance; 5.75% for depressive symptoms and 2.50% for loneliness and for social resources this ranged from 0.09% to 0.47% (all p < 0.001). While disability has a negative effect on life satisfaction, the effect was not stronger in older persons who were depressed, neither in those who felt lonely nor in those without social resources. Similar outcomes were found when using CASP-12 as the explained variable.

CONCLUSION

The impact of (I)ADL disabilities on life satisfaction in community-dwelling older people decreases with age. These associations are not affected by psychosocial factors and these patterns cannot be explained by people changing their norms and values.

Modifiable Determinants of Exercise Use in a Diverse Ethnic Population With Osteoarthritis

OBJECTIVE

To determine the extent of ethnic differences in the use of exercise for therapy and identify relevant modifiable determinants of exercise use among patients with knee/hip osteoarthritis (OA).

METHODS

Knee/hip OA study participants were identified. Surveys were administered to collect patient sociodemographic and clinical information, and beliefs and attitudes about providers and treatments. Final multivariable logistic regression models were created using a fully conditional method.

RESULTS

Hispanic participants (n = 130), compared to non-Hispanic participants (n = 232), were less likely to have private medical insurance (9.2% versus 31.0%) or to report having excellent/very good health (40.7% versus 52.6%). They were also less likely to report using exercise for OA treatment in the last 6 months (56% versus 73%; P = 0.003). When adjusted for age and disease severity, the difference in exercise use among ethnicities remained significant (odds ratio [OR] 0.59 [95% confidence interval (95% CI) 0.36-0.99]). In a multivariable logistic regression model designed to determine the most important determinants of exercise use for OA treatment, in the last 6 months the following were all associated with exercise use: having knee instead of hip OA (OR 2.83 [95% CI 1.51-5.29]), having family/friends who exercise (OR 3.20 [95% CI 1.76-5.84]), having a good understanding of what happens after exercise (OR 2.19 [95 CI 1.15-4.19]), and higher perceived benefit of exercise (OR 2.24 [95% CI 1.64-3.04]).

CONCLUSION

Among patients with knee/hip OA, Hispanics were less likely to exercise for OA treatment. Increased knowledge about the benefits of exercise for treatment and improved familiarity with exercise as treatment for OA may increase exercise use.

Role of muscle power output as a mediator between gait variability and gait velocity in hospitalized older adults

Acute illness requiring hospitalization is a sentinel event leading to functional decline and frequently, long-term disability in older adults. Although functional decline has become a key outcome during and after hospitalization, there is currently no gold standard for measuring functional impairment. The purpose of this study was to compare gait characteristics and muscle performance endpoints of hospitalized older adults based on the Short Physical Performance Battery (SPPB) score (0-12 points) obtained at admission, and to determine the association underlying the gait impairment. A total of 130 hospitalized older adults (aged ≥75) were included. The primary endpoints were differences in functional capacity between groups, assessed with the 6-m Gait Velocity Test (GVT), verbal and arithmetic GVT, followed by gait pattern data recorded using an inertial sensor unit. Maximal muscle strength (MS) and muscle power (MP) were also measured as muscle performance endpoints. A mediation analysis was performed to understand gait disorders. The walking parameters measured at admission were related to functional status and showed significant differences among phenotype groups (disabled, frail, and prefrail groups), as well as muscle performance endpoints (p < 0.05). Finally, the indirect effect was significant (-0.27; 95%CI, -0.59 to -0.05), confirming the mediation role of MP between gait variability and gait velocity in this model. MP slightly weakens the relationship between gait variability and gait velocity. In addition to MS and MP, gait velocity and gait pattern parameters are distinguishing factors among acutely hospitalized older adults.

Ethical implications of population ageing in the intensive care unit

Population ageing has significant ethical implications in the management of elderly patients in the intensive care unit (ICU). In the aspects of beneficence and non-maleficence, conflicting evidence has long existed regarding an association of older age with poorer prognosis, but elderly patients who have poor prognosis in the ICU may have a worse outcome if not admitted. More randomised controlled studies are needed to study the benefits of ICU admission to different subgroups of critically ill elderly patients. The acute care for the elderly unit could be developed to provide more comprehensive care to the elderly. ICU resource rationing should follow clear guidelines with a pluralistic strategy of distributive justice, which incorporates the core proposition of "veil of ignorance" with the anti-ageist and equalist view so that age itself should not be a criterion but any associated risks with age confirmed by studies should be taken into account of assessing prognosis and outcome. There may be a need for improvement in protection for patients' right to autonomy in the ICU.

Increased Incidence of Fatigue in Patients with Primary Immunodeficiency Disorders: Prevalence and Associations Within the US Immunodeficiency Network Registry

INTRODUCTION

Patients with primary immunodeficiency (PID) often report fatigue, yet this symptom has not been studied in PID. Fatigue affects 6-7.5% of healthy adults. The goal of this study is to estimate the prevalence of fatigue in patients with PID and investigate its associated factors.

METHODS

We analyzed 2537 PID patients registered in USIDNET to determine responses to the field "fatigue" in the core registry form. Demographics, immune phenotypes, and comorbid conditions were compared between fatigued and non-fatigued patients to identify relevant associations and potential drivers. A focused analysis was performed for patients with predominantly antibody deficiency disorders (PADs).

RESULTS

Fatigue was reported in 25.9% (95% CI 23.7-28.3) of PAD patients, compared to 6.4% (95% CI 4.9-8.2) of non-PAD. Patients with common variable immunodeficiency (CVID) had the highest prevalence of fatigue (p < 0.001) among all PID diagnoses. Other factors that were associated with a higher rate of fatigue among PAD patients included female sex, higher BMI, depression, bronchiectasis, and autoimmunity. Additionally, fatigued PAD patients had lower absolute lymphocyte, CD3, CD4, and CD8 counts compared to non-fatigued patients.

CONCLUSION

Our findings suggest that fatigue is overrepresented in PAD patients. Prospective studies to estimate prevalence, risk factors, and fatigue etiology in PID are warranted, so therapeutic interventions can be considered.

Disability in the Individual ADL, IADL, and Mobility among Older Adults: A Prospective Cohort Study

OBJECTIVES

To examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability.

DESIGN AND SETTING

A prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands.

MEASUREMENTS

Disability was assessed using the Katz-15 Index of Independence in Basic Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and one mobility item. Disability in any of these activities was defined as the inability to perform the activity without assistance. The risk of disability by age for each individual ADL, IADL, and for mobility was assessed using Generalized mixed models.

RESULTS

Disability in activities as household tasks, traveling, shopping, and continence had the highest risk and increased rapidly with age. The risk traveling disability among people aged 65 with two comorbidities increase from 9% to 37% at age 85. Disability in using the telephone, managing medications, finances, transferring, and toileting, had a very low risk and hardly increased with age. Compared to those without chronic conditions, those with ≥ 3 chronic conditions had a 3 to 5 times higher risk of developing disability. Males had a higher risk of disability in managing medication (P=0.005), and preparing meals (P=0.019), whereas females had a higher risk of disability with traveling (P=0.001). No association between education and disability on the individual ADL, IADL, and mobility was observed.

CONCLUSIONS

Older adults were mostly disabled in physical related activities, whereas disability in more cognitive related activities was less often experienced. The impact of multimorbidity on disability in each activity was substantial, while education was not.

Supplementation of Mussel Peptides Reduces aging Phenotype, Lipid Deposition and Oxidative Stress in D-Galactose-Induce Aging Mice

OBJECTIVES

Aging is associated with glucose and lipid metabolism disorder. We aimed to examine the effects of mussel peptides on protecting against aging by regulating glucose and lipid metabolism.

METHODS

For the aging model, d-galactose (200 mg/kg) was administered subcutaneously to 8-month-old mice for 8 weeks. Mussel peptides (1,000 mg/kg) were simultaneously administered by intragastric gavage. The glucose and lipid metabolism profiles, aging phenotype and peroxisome proliferator-activated receptors (PPARs) expression in the liver and adipose tissue of ICR mice were measured.

RESULTS

D-galactose-treated mice showed pronounced fat deposition and impaired glucose and lipid homeostasis, along with increased oxidative damage and aging. Mussel peptides improved metabolic status by reducing serum glucose and triglyceride levels, insulin resistance and hepatic free fatty acid, as well as enhancing serum high-density lipoprotein (HDL) level and hepatic glycogen content, accompanied with amelioration of aging phenotype and fat deposition. Moreover, mussel peptides ameliorated oxidative stress in aged liver tissues and promoted expression of peroxisome proliferator activated receptors alpha (PPARα) and gamma (PPARγ) in liver and adipose tissues.

CONCLUSIONS

These results indicate that mussel peptides protect against lipid metabolic disorders associated with aging via maintaining oxidative stress homeostasis and elevated expression levels of PPARs.

Impact of physical and mental health on life satisfaction in old age: a population based observational study

Background

It is widely assumed that poor health lowers life satisfaction when ageing. Yet, research suggests this relationship is not straightforward. This study investigated how older people evaluate their life when facing disease and disabilities.

Methods

The Leiden 85-plus Study, a prospectively followed cohort of a cohort of a middle-sized city in the Netherlands, all aged 85 years, that was age-representative of the general population, was used. Those with severe cognitive dysfunction were excluded (n = 501). Comorbidities, physical performance, cognitive function, functional status, residual lifespan, depressive symptoms and experienced loneliness were measured during home visits. Life satisfaction was self-reported with Cantril’s ladder. All analyses were performed using regression analysis.

Results

Participants reported high life satisfaction (median 8 out of 10 points) despite having representative levels of disease and disability. Comorbidity, low cognitive function, and residual lifespan as markers of health were not associated with life satisfaction. Poor physical performance and low functional status were weakly but significantly associated with lower life satisfaction (p < 0.05 respectively p < 0.001), but significance was lost after adjustment for depressive symptoms and perceived loneliness. Depressive symptoms and perceived loneliness were strongly related to lower life satisfaction (both p < 0.001), even after adjustment for physical health characteristics.

Conclusion

Poor physical health was hardly related to lower life satisfaction, whereas poor mental health was strongly related to lower life satisfaction. This indicates that mental health has a greater impact on life satisfaction at old age than physical health, and that physical health is less relevant for a satisfactory old age.

The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning, Disability, and Health

BACKGROUND

The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time.

METHODS

Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined.

RESULTS

The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective.

CONCLUSION

This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery. Implications for Rehabilitation A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements. Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed. This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set.

Hip fractures in the elderly: The role of cortical bone

INTRODUCTION

Osteoporosis is characterised by poor bone quality arising from alterations to trabecular bone. However, recent studies have also described an important role of alterations to cortical bone in the physiopathology of osteoporosis. Although dual-energy X-ray absorptiometry (DXA) is a valid method to assess bone mineral density (BMD), real bone fragility in the presence of comorbidities cannot be evaluated with this method. The aim of this study was to evaluate if cortical thickness could be a good parameter to detect bone fragility in patients with hip fracture, independent of BMD.

METHODS

A retrospective study was conducted on 100 patients with hip fragility fractures. Cortical index was calculated on fractured femur (femoral cortical index [FCI]) and, when possible, on proximal humerus (humeral cortical index [HCI]). All patients underwent densitometric evaluation by DXA.

RESULTS

Average value of FCI was 0.43 and of HCI was 0.25. Low values of FCI were found in 21 patients with normal or osteopenic values of BMD, while low values of HCI were found in three patients with non-osteoporotic values of BMD.

DISCUSSION AND CONCLUSION

Cortical thinning measured from X-Ray of the femur identifies 21% additional fracture cases over that identified by a T-score <-2.5 (57%). FCI could be a useful tool to evaluate bone fragility and to predict fracture risk even in patients with normal and osteopenic BMD.

Determinants of quality of life in community-dwelling older adults: comparing three cut-offs on the excellent-to-poor spectrum

PURPOSE

The aim of this study was to identify modifications in health, economic and social determinants of quality of life (QoL) in community-dwelling older adults when using different cut-offs to defining favorable QoL.

METHODS

Data of year 2011 annual assessment in 1003 older men and women from the Lc65+ cohort study were used. Overall QoL was self-rated as 'excellent,' 'very good,' 'good,' 'fair,' or 'poor.' To identify significant health (self-rated health, SF-12v2 physical and mental health), economic (financial situation), and social (living with others, being socially supported, emotional support, group activities participation) determinants of QoL, a cut-off was set at three different positions to define favorable QoL on the 'excellent' to 'poor' spectrum: at least 'good' (model 1); at least 'very good' (model 2); and 'excellent' only (model 3).

RESULTS

In all three models, bivariable analyses indicated significant associations between QoL and at least one variable from each health, economic, and social dimension. In multivariable analyses, only health-related variables remained significantly associated with QoL in model 1. Model 3 additionally retained financial situation. In model 2, QoL was positively associated with physical health [odds ratio (OR) 1.10, p < 0.001], mental health (OR 1.12, p < 0.001), self-rated health (OR 2.43, p < 0.001), group activities participation (OR 1.43, p = 0.037), being socially supported (OR 1.58, p = 0.024), and not reporting financial difficulties (OR 1.76; p = 0.036).

CONCLUSIONS

Using different cut-offs to defining favorable QoL results in important changes in the number and type of significant health, economic and social determinants. A cut-off between 'good' and 'very good' appears to best reflect the multidimensional nature of QoL.

Association of age with health-related quality of life in a cohort of patients with systemic lupus erythematosus: the Georgians Organized Against Lupus study

Objective

To examine whether older age was associated with lower health-related quality of life (HRQOL) among patients with systemic lupus erythematosus (SLE) and whether differential disease-related damage and activity explained these associations.

Methods

We used cross-sectional data on 684 patients with SLE aged ≥20 years from the Georgians Organized Against Lupus cohort to estimate the associations between age (categorised as 20–39, 40–59 and ≥60 years) and HRQOL (Short Form-12 norm-based domain and physical component summary (PCS) and mental component summary (MCS) scores), using multivariable linear regression. We then examined the effect of disease-related damage and activity on these associations.

Results

The mean age of the cohort was 48.2±13.1 years (range, 20–88 years), with 28.0%, 52.9% and 19.1% of participants being aged 20–39, 40–59 and ≥60 years, respectively; 79.0% were African-American and 93.7% were female. The mean PCS score was 39.3 (41.8, 38.7 and 37.4 among those aged 20–39, 40–59 and ≥60 years, respectively), while the mean MCS score was 44.3 (44.2, 43.8 and 46.1, respectively). In general, lower physical but not mental HRQOL scores were associated with older age. With adjustment, older ages (40–59 and ≥60, respectively, vs 20–39) remained associated (β (95% CI)) with lower PCS (−2.53 (−4.58 to −0.67) and −3.57 (−6.19 to −0.96)) but not MCS (0.47 (−1.46 to 2.41) and 1.20 (−1.52 to 3.92)) scores. Associations of age with HRQOL domain and summary scores were not substantially changed by further adjustment for disease-related damage and/or activity.

Conclusions

Nearly one in five participants in this large, predominantly African-American cohort of patients with SLE was at least 60 years old. The associations of older age with lower physical, but not mental, HRQOL were independent of accumulated SLE damage and current SLE activity. The results suggest that studies of important geriatric outcomes in the setting of SLE are needed to inform patient-centred clinical care of the ageing SLE population.

Use of the World Health Organization Quality of Life Assessment Short Version in Mild to Moderate Parkinson Disease

OBJECTIVE

To investigate the distribution, internal consistency reliability, and convergent and discriminant validity of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) in persons with mild to moderate Parkinson disease (PD).

DESIGN

Cross-sectional.

SETTING

Movement disorders center.

PARTICIPANTS

Convenience sample of people with PD (n=96) recruited from a movement disorders center and controls (n=60) recruited from the community (N=156).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

WHOQOL-BREF.

RESULTS

The WHOQOL-BREF domain data were relatively normally distributed, and internal consistency reliability was acceptable (α=.65-.85). Participants with PD reported lower quality of life (QOL) than controls in all except the environment domain, and physical QOL was the most impaired domain in the PD group. Age, fatigue, and physical activity limitations predicted physical QOL; depression, fatigue, and apathy predicted psychological QOL; education, executive dysfunction, and apathy predicted social QOL; and age, education, depression, and apathy predicted environment QOL.

CONCLUSIONS

The WHOQOL-BREF is a suitable tool to assess QOL in patients with mild to moderate PD. It is relatively normally distributed and internally consistent; effectively discriminates between individuals with and without PD; and correlates with relevant demographic characteristics, PD-related impairments, and activity limitations.

Gallstones

Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin ('pigment') stones. Black pigment stones can be caused by chronic haemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and overnutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.

Knowledge of healthy lifestyle in Iran: a systematic review

Introduction

Lifestyle is a set of goals, plans, values, attitudes, behaviors, and beliefs manifested in the personal and family life of the individual and in her or his social interactions. It is an interdisciplinary concept that involves a health-oriented view of the physical, psychological, social, and spiritual domains of life. Despite their great importance, there is not much knowledge in Iran about healthy lifestyles. The present study is an attempt to address the knowledge of healthy lifestyle in Iran through a review of the literature on the subject.

Methods

The present systematic review searched Elsevier, SID, Pub Med, Magiran, IranMedex, and Google Scholar databases for relevant articles published between 2000 and 2014. We used various keywords for the searches, including knowledge, lifestyle, health, and Iran. As a result, 62 articles were included in the study.

Results

There has been a dramatic increase in the publication of articles on lifestyle in Iran over the past 10 years. The results obtained showed that 64% of the articles addressed physical health, 14% addressed psychological health, 10% addressed social health, and 12% addressed spiritual health. Most lifestyle studies conducted in Iran have focused on physical health, and a few have examined the psychological, social, and spiritual aspects of lifestyle. None of the studies has examined the knowledge map of healthy lifestyles in Iran.

Conclusion

Given the changes in the causes of mortality from infectious and chronic diseases that impose greater medication and treatment costs on the society, and since diseases caused by unhealthy lifestyles have become the leading cause of death, it is essential for health researchers to focus on the root cause of these diseases, i.e., lifestyle and human behaviors.

Intervals between response choices on a single-item measure of quality of life

Background

A single overall rating of quality of life (QoL) is a sensitive method that is often used in population surveys. However, the exact meaning of response choices is unclear. In particular, uneven spacing may affect the way QoL ratings should be analyzed and interpreted. This study aimed to determine the intervals between response choices to a single-item QoL assessment.

Methods

A secondary analysis was conducted on data from the Lc65+ cohort study and two additional, population-based, stratified random samples of older people (N = 5,300). Overall QoL was rated as excellent, very good, good, fair or poor. A QoL score (range 0–100) was derived from participants’ answers to a 28-item QoL assessment tool. A transformed QoL score ranging from 1 (poor) to 5 (excellent) was calculated. The same procedure was repeated to compute seven domain-specific QoL subscores (Feeling of safety; Health and mobility; Autonomy; Close entourage; Material resources; Esteem and recognition; Social and cultural life).

Results

Mean (95 % confidence intervals) QoL scores were 96.23 (95.81–96.65) for excellent, 93.09 (92.74–93.45) for very good, 81.45 (80.63–82.27) for good, 65.44 (62.67–68.20) for fair and 54.52 (45.31–63.73) for poor overall QoL, corresponding to transformed QoL scores of respectively 5.00, 4.70, 3.58, 2.05, and 1.00. Ordinality of the categories excellent to poor was preserved in all seven QoL subscores.

Conclusions

The excellent-to-poor rating scale provides an ordinal measure of overall QoL. The intervals between response choices are unequal, but an interval scale can be obtained after adequate recoding of excellent, very good, good, fair and poor.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-016-0443-5) contains supplementary material, which is available to authorized users.

Home Help Service Staffs’ Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care

The study aimed to explore how home help service staff described their role in improving the abilities of older people, in particular, older women with chronic pain who are dependent on formal care, to perform everyday activities. Three focus group interviews were conducted, and a qualitative inductive thematic content analysis was used. The analysis resulted in one theme: struggling to improve the care recipients’ opportunities for independence but being inhibited by complex environmental factors. By encouraging the care recipients to perform everyday activities, the staff perceived themselves to both maintain and improve their care recipients’ independence and quality of life. An important goal for society and health care professionals is to improve older people’s abilities to “age in place” and to enable them to age independently while maintaining their quality of life. A key resource is home help service staff, and this resource should be utilized in the best possible way.

Symptom Prevalence, Symptom Severity, and Health-Related Quality of Life Among Young, Middle, and Older Adults With Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a chronic, life threatening illness that affects primarily women. The purpose of this study was to describe the prevalence of PAH symptoms and to determine whether there are differences in symptom severity and HRQOL in PAH symptoms among young, middle, and older adults with PAH. A cross sectional design was utilized. For all the age groups, shortness of breath (SOB) on exertion and fatigue were the two most prevalent symptoms. SOB on exertion had the highest symptom severity scores followed by fatigue for all groups. Symptom severity was significantly different among the groups for palpitations, abdominal swelling and nausea. For components of HRQOL, physical functioning worsened with age. All groups had diminished general health, role physical and vitality levels. There are some differences in symptom prevalence, symptom severity and HRQOL among young, middle and older adults. Awareness of these differences is important for healthcare providers to know and assess overtime. Palliative care should be an integral part of caring for patients with PAH.

Understanding what matters most to people with multiple myeloma: a qualitative study of views on quality of life

BACKGROUND

Multiple myeloma is an incurable haematological cancer that affects physical, psychological and social domains of quality of life (QOL). Treatment decisions are increasingly guided by QOL issues, creating a need to monitor QOL within clinical practice. The development of myeloma-specific QOL questionnaires has been limited by a paucity of research to fully characterise QOL in this group. Aims of the present study are to (1) explore the issues important to QOL from the perspective of people with multiple myeloma, and (2) explore the views of patients and clinical staff on existing QOL questionnaires and their use in clinical practice.

METHODS

The 'Issues Interviews' were semi-structured qualitative interviews to explore the issues important to QOL in a purposive sample of myeloma patients (n = 20). The 'Questionnaire Interviews' were semi-structured qualitative interviews in a separate purposive sample of myeloma patients (n = 20) to explore views on existing QOL questionnaires and their clinical use. Two patient focus groups (n = 7, n = 4) and a focus group of clinical staff (n = 6) complemented the semi-structured interviews. Thematic content analysis resulted in the development of a theoretical model of QOL in myeloma.

RESULTS

Main themes important to QOL were Biological Status, Treatment Factors, Symptoms Status, Activity & Participation, Emotional Status, Support Factors, Expectations, Adaptation & Coping and Spirituality. Symptoms had an indirect effect on QOL, only affecting overall QOL if they impacted upon Activity & Participation, Emotional Status or Support Factors. This indirect relationship has implications for the design of QOL questionnaires, which often focus on symptom status. Health-service factors emerged as important but are often absent from QOL questionnaires. Sexual function was important to patients and difficult for clinicians to discuss, so inclusion in clinical QOL tools may flag hidden problems and facilitate better care. Patients and staff expressed preferences for questionnaires to be no more than 2 pages long and to include a mixture of structured and open questions to focus the goals of care on what is most important to patients.

CONCLUSION

Existing QOL questionnaires developed and validated for use in myeloma do not capture all that is important to patients and may not be well suited to clinical use.

Hip osteoarthritis and osteoporosis: clinical and histomorphometric considerations

Although an inverse relationship between osteoarthritis (OA) and osteoporosis (OP) has been shown by some studies, other reports supported their coexistence. To clarify this relationship, we analyzed the interplay between clinical and histomorphometric features. Bone mineral density (BMD) and histomorphometric structure were assessed in 80 patients of four different age-matched groups undergoing hip arthroplasty for severe OA or OP-related femoral fracture. Harris Hip Score was also performed. Surgical double osteotomy of the femoral head was performed and microscopic bone slice samples analysis was performed by using a BioQuant Osteo software. Bone volume fraction (BV/TV) was lower (P < 0.01) in subjects with femoral neck fracture (20.77 ± 4.34%) than in subjects with nonosteopenic OA (36.49 ± 7.73%) or osteopenic OA (32.93 ± 6.83%), whereas no difference was detected between subjects with femoral neck fractures and those with combined OA and OP (20.71 ± 5.23%). Worse Harris Hip Score was found in those patients with the lowest BMD and BV/TV values. Our data support recent evidences indicating the possibility of impaired bone volume fraction in OA patients, with a high risk of developing OP, likely for their decreased mobility. Further studies are needed in order to investigate biomolecular pathway and/or growth factors involved in bone volume impairment in OA patients.

Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents

OBJECTIVES

To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays.

DESIGN

Longitudinal study using Medicare and Minimum Data Set (MDS) assessments.

SETTING

National sample of long-stay NH residents.

PARTICIPANTS

NH residents who were hospitalized for the seven most-common inpatient diagnoses (N = 40,128). Each hospital admission was at least 90 days after any prior hospitalization and had at least two preceding MDS assessments.

MEASUREMENTS

The MDS ADL long-form score, a simple sum of seven self-care variables coded from 0 (independent) to 4 (totally dependent) was used to indicate resident ADL function. Scores ranged from 0 to 28, with higher scores indicating greater impairment. A linear mixed model describing ADL trajectories was jointly estimated with time-to-event models for mortality and hospital readmission.

RESULTS

Before hospitalization, the most common trajectory was stable (53.7%), with 27.5% of residents worsening and 18.8% improving. ADL function after hospital discharge was most often characterized as stable (43.1%) or worsening (39.2%). Mortality (20.3%) was higher for those with worsening prehospital ADL function (28.9%) than for those with stable (19.1%) or improving (11.3%) trajectories. Hospital diagnosis was associated with amount of ADL worsening and rate of subsequent ADL change. Most residents with the best initial function continued to worsen after hospital discharge. Cognitive impairment was associated with poorer ADL function and accelerated worsening of ADLs.

CONCLUSION

For many long-stay NH residents, substantial and sustained ADL worsening accompanies acute hospitalization, so acute hospitalization presents an opportunity to revisit care goals; the results of the current study can help inform decision-making.

The ETHICA study (part I): elderly's thoughts about intensive care unit admission for life-sustaining treatments

PURPOSE

To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments.

METHODS

Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-living facilities. The participants were interviewed at their place of residence after viewing films of scenarios involving the use of non-invasive mechanical ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of invasive mechanical ventilation (RRT after IMV). Demographic, clinical, and quality-of-life data were collected. Participants chose among four responses regarding life-sustaining treatments: consent, refusal, no opinion, and letting the physicians decide.

RESULTS

The sample size was 115 and the response rate 87 %. Mean participant age was 84.8 ± 3.5 years, 68 % were female, and 81 % and 71 % were independent for instrumental activities and activities of daily living, respectively. Refusal rates among the elderly were 27 % for NIV, 43 % for IMV, and 63 % for RRT (after IMV). Demographic characteristics associated with refusal were married status for NIV [relative risk (RR), 2.9; 95 % confidence interval (95 %CI), 1.5-5.8; p = 0.002] and female gender for IMV (RR, 2.4; 95 %CI, 1.2-4.5; p = 0.01) and RRT (after IMV) (RR, 2.7; 95 %CI, 1.4-5.2; p = 0.004). Quality of life was associated with choices regarding all three life-sustaining treatments.

CONCLUSIONS

Independent elderly individuals were rather reluctant to accept life-sustaining treatments, especially IMV and RRT (after IMV). Their quality of life was among the determinants of their choices.

Understanding older patients' self-management abilities: functional loss, self-management, and well-being

PURPOSE

This study aimed to increase our understanding of self-management abilities and identify better self-managers among older individuals.

METHODS

Our cross-sectional research was based on a pilot study of older people who had recently been admitted to a hospital. In the pilot study, all patients (>65 years of age) who were admitted to the Vlietland hospital between June and October 2010 were asked to participate, which led to the inclusion of 456 older patients at baseline. A total of 296 patients (65% response rate) were interviewed in their homes 3 months after admission. Measures included social, cognitive, and physical functioning, self-management abilities, and well-being. We used descriptive, correlations, and multiple regression analyses. In addition, we evaluated the mediation effect of self-management abilities on well-being.

RESULTS

Social, cognitive, and physical functioning significantly correlated with self-management abilities and well-being (all p ≤ 0.001). After controlling for background characteristics, multiple regression analysis indicated that social, cognitive, and physical functioning still related to self-management abilities (β = 0.17-0.25; all p ≤ 0.001). Older people with low levels of social, cognitive, and physical functioning were worse self-managers than were those with higher levels of functioning.

CONCLUSIONS

Self-management abilities mediate the relationship between social, cognitive, and physical functioning and well-being. Interventions to improve self-management abilities may help older people better deal with function losses as they age further.

The relationship between older adults' self-management abilities, well-being and depression

This study aimed to identify the relationship between self-management abilities, well-being and depression. Our study was conducted among older adults (>65 years of age) who were vulnerable to loss of function after hospital discharge. Three months after hospital admission, 296/456 patients (65 % response rate) were interviewed in their homes. The 30-item Self-Management Ability Scale was used to measure six self-management abilities: taking initiative, investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality, being self-efficacious and having a positive frame of mind. Well-being was measured with the Social Production Function (SPF) Instrument for the Level of Well-being (SPF-IL) and Cantril's ladder. The Geriatric Depression Scale was used to assess depression. Correlation analyses showed that all self-management abilities were strong indicators for well-being (p < 0.001 for all). Regression analyses revealed that investing in resources for long-term benefits, taking care of a variety of resources, taking care of resource multifunctionality and being self-efficacious were associated with well-being. While no significant relationship was found between well-being and having a positive frame of mind or taking initiative, regression analyses revealed that these self-management abilities were related to depression. Investing in resources for long-term benefits and taking care of a variety of resources were significantly related to depression. This research showed that self-management abilities are related to well-being and depression among older adults. In addition, this study identified key self-management abilities for older adults who had recently been discharged from a hospital.

Health-related Quality of Life in Retired Older People in Tehran City

Population aging has become an important social issue worldwide and the biggest challenge is improving older people’s quality of life. We aimed to determine the quality of life (QOL) of retired older adults in Tehran using the SF-36. About 321 men and 146 women, aged 60 to 69 (62%) and 70 or older (38%), participated. In the older group, the total QOL score was lower than in the younger group, but the older group scored higher in the mental domain. Education had a significant relationship with the mental domain of QOL, as did gender with the physical and mental domains. The income sufficiency state was significantly related to both domains of QOL. The findings can be useful in designing intervention studies that could eventually lead to application of strategies to promote QOL in retired older adults in Iran and other countries with similar sociocultural and economic backgrounds.

Cluster analysis of symptoms in pulmonary arterial hypertension: a pilot study

BACKGROUND

Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary artery pressures leading to right heart failure and death.

AIMS

The aim of this study was to use cluster analysis to describe the symptom profile in PAH and differences in the health outcomes of health status, health-related quality of life (HRQoL) and psychological states in the cluster groups.

METHODS

A cross-sectional descriptive design was used. A convenience sample completed a socio-demographic and clinical data form, a PAH Symptom Severity and Interference Scale, the Medical Outcomes Study Short Form (SF-36), the United States Cambridge Pulmonary Hypertension Outcome Review (US CAMPHOR) and the Short Form of the Profile of Mood States (POMS).

RESULTS

Of the 151 participants, the mean age was 53.5 ± 15.1 with the majority female (n = 128, 85%). Fifty-eight (41%) were disabled and 67 (44%) were Functional Class IV. The most prevalent symptoms were shortness of breath with exertion (n = 149, 99%) and fatigue (n = 144, 93%). Three clusters emerged: Cluster 1 diffuse symptoms (n = 93), Cluster 2 severe cardiopulmonary symptoms (n = 32) and Cluster 3 moderate cardiopulmonary symptoms (n = 26). Overall, on the SF-36 the participants had poor general health, reduced physical function, role physical, vitality, and a low composite score for physical health. On the POMS the sample had limited vigor and increased fatigue. Cluster 2 Severe Cardiopulmonary Symptoms had worse SF-36, US CAMPHOR and POMS scores than the other cluster groups.

CONCLUSIONS

Patients with PAH are experiencing a constellation of symptoms that are interfering with their life and emerging clusters were present.

Reflecting on whiplash associated disorder through a QoL lens: an option to advance practice and research

PURPOSE

To examine the constructs of quality of life (QoL) as applied to whiplash associated disorder (WAD), its current state of measurement and suggestions for future application.

METHOD

Narrative literature review.

RESULTS

The burden of WAD on the healthcare system is substantive. Assessment of QoL issues for people with WAD may provide a broader understanding of the patient experience. No consistent framework for QoL in WAD has been adopted, nor has preference for any QoL instrument been established. Inconsistent use of terminology for what is being measured, and the measures themselves hamper clarity on the issue. Options for assessing QoL currently include a meaningful condition-specific scale that has not undergone sufficient psychometric evaluation (Whiplash Disability Questionnaire (WDQ), or generic scales with strong psychometric properties that have not undergone sufficient relevancy evaluation (e.g. SF-36, WHOQOL BREF). Generic measures can measure overlapping constructs including heath status, utility, health-related quality of life or generic QoL. The inter-relationships between these in WAD have not been defined.

CONCLUSIONS

Given the impact of WAD on QoL, additional clarity on tools and approaches are needed. There is a need for research on the relevance and clinical measurement properties of available condition-specific and generic tools to define a preferred measurement approach in WAD.

[The influence of sociosanitary conditions on the quality of life of the elderly in a municipality in the Southeast of Brazil]

This study sought to evaluate sociosanitary conditions and their impact on the quality of life of the elderly living in the Teixeiras Municipality in the Southeast Region (MG) of Brazil. Two questionnaires were used: one created specifically to characterize the population in terms of sociosanitary conditions, and WHOQOL-bref, to evaluate quality of life. The correlation between the sociosanitary conditions and quality of life scores were analyzed by logistic regression analysis. Among the variables with a strong correlation with quality of life scores the following stand out: use of medication, need of medical care, lack of private health insurance, comorbidities, sleep problems, and retirement. The results of this study indicate that sociosanitary conditions are high risk factors for low quality of life scores in the elderly. This must be taken into consideration to establish health strategies and policies for this age group.

Evaluation design of a reactivation care program to prevent functional loss in hospitalised elderly: a cohort study including a randomised controlled trial

Background

Elderly persons admitted to the hospital are at risk for hospital related functional loss. This evaluation aims to compare the effects of different levels of (integrated) health intervention care programs on preventing hospital related functional loss among elderly patients by comparing a new intervention program to two usual care programs.

Methods/Design

This study will include an effect, process and cost evaluation using a mixed methods design of quantitative and qualitative methods. Three hospitals in the Netherlands with different levels of integrated geriatric health care will be evaluated using a quasi-experimental study design. Data collection on outcomes will take place through a prospective cohort study, which will incorporate a nested randomised controlled trial to evaluate the effects of a stay at the centre for prevention and reactivation for patients with complex problems. The study population will consist of elderly persons (65 years or older) at risk for functional loss who are admitted to one of the three hospitals. Data is prospectively collected at time of hospital admission (T0), three months (T1), and twelve months (T2) after hospital admission. Patient and informal caregiver outcomes (e.g. health related quality of life, activities of daily living, burden of care, (re-) admission in hospital or nursing homes, mortality) as well as process measures (e.g. the cooperation and collaboration of multidisciplinary teams, patient and informal caregiver satisfaction with care) will be measured. A qualitative analysis will determine the fidelity of intervention implementation as well as provide further context and explanation for quantitative outcomes. Finally, costs will be determined from a societal viewpoint to allow for cost effectiveness calculations.

Discussion

It is anticipated that higher levels of integrated hospital health care for at risk elderly will result in prevention of loss of functioning and loss of quality of life after hospital discharge as well as in lower burden of care and higher quality of life for informal caregivers. Ultimately, the results of this study may contribute to the implementation of a national integrated health care program to prevent hospital related functional loss among elderly patients.

Trial registration

The Netherlands National Trial Register: NTR2317

The self-reported personal wellbeing of a sample of Australian injecting drug users

AIMS

To examine the self-reported personal wellbeing of a sample of Australian injecting drug users (IDU) using a standardized instrument and determine the key correlates of variations in self-reported personal wellbeing.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional survey of 881 Australian IDU.

MEASUREMENTS

Self-reported personal wellbeing collected using the Personal Wellbeing Index (PWI).

FINDINGS

IDU scored significantly lower than the general Australian population on the PWI and all subscales. Lower PWI scores were associated with a range of socio-demographic, drug use and other health and social characteristics. Across all PWI subscales, lower personal wellbeing scores were associated with unemployment, past 6-month mental health problems and more frequent injecting (all P < 0.05).

CONCLUSIONS

The PWI is sufficiently sensitive to distinguish between IDU and the general population, and to identify key correlates of PWI among IDU. Some domains canvassed within the scale, such as health, standard of living and life achievements, are well within the scope of current intervention strategies, such as pharmacotherapy maintenance treatment and housing and employment support services. This suggests that the PWI could be useful in clinical settings by allowing structured identification of the areas of a person's life to be addressed as a part of a treatment regimen. In order to inform targeted prevention and intervention efforts, longitudinal studies of PWI and its correlates among IDU are required.

Health and quality of life among older rural people in Purworejo District, Indonesia

INTRODUCTION

Increasing life expectancy and longevity for people in many highly populated low- and middle-income countries has led to an increase in the number of older people. The population aged 60 years and over in Indonesia is projected to increase from 8.4% in 2005 to 25% in 2050. Understanding the determinants of healthy ageing is essential in targeting health-promotion programmes for older people in Indonesia.

OBJECTIVE

To describe patterns of socio-economic and demographic factors associated with health status, and to identify any spatial clustering of poor health among older people in Indonesia.

METHODS

In 2007, the WHO Study on global AGEing and adult health (SAGE) was conducted among 14,958 people aged 50 years and over in Purworejo District, Central Java, Indonesia. Three outcome measures were used in this analysis: self-reported quality of life (QoL), self-reported functioning and disability, and overall health score calculated from self-reported health over eight health domains. The factors associated with each health outcome were identified using multivariable logistic regression. Purely spatial analysis using Poisson regression was conducted to identify clusters of households with poor health outcomes.

RESULTS

Women, older age groups, people not in any marital relationship and low educational and socio-economic levels were associated with poor health outcomes, regardless of the health indices used. Older people with low educational and socio-economic status (SES) had 3.4 times higher odds of being in the worst QoL quintile (OR = 3.35; 95% CI = 2.73-4.11) as compared to people with high education and high SES. This disadvantaged group also had higher odds of being in the worst functioning and most disabled quintile (OR = 1.67; 95% CI = 1.35-2.06) and the lowest overall health score quintile (OR = 1.66; 95% CI = 1.36-2.03). Poor health and QoL are not randomly distributed among the population over 50 years old in Purworejo District, Indonesia. Spatial analysis showed that clusters of households with at least one member being in the worst quintiles of QoL, functioning and health score intersected in the central part of Purworejo District, which is a semi-urban area with more developed economic activities compared with other areas in the district.

CONCLUSION

Being female, old, unmarried and having low educational and socio-economic levels were significantly associated with poor self-reported QoL, health status and disability among older people in Purworejo District. This study showed the existence of geographical pockets of vulnerable older people in Purworejo District, and emphasized the need to take immediate action to address issues of older people's health and QoL.

Quality-of-life trajectories at the end of life: assessments over time by patients with and without cancer

OBJECTIVES

To compare quality-of-life (QOL) ratings of terminally ill patients with and without cancer over time.

DESIGN

Secondary analysis of prospective data from a randomized clinical trial.

SETTING

Trial conducted with terminally ill patients in Seattle, Washington, testing the efficacy of massage and guided meditation in improving patients' QOL.

PARTICIPANTS

One hundred sixty-seven trial participants, of whom 127 provided follow-up data and died before data analysis.

MEASUREMENTS

At enrollment, participants reported demographic characteristics, symptom distress, QOL, and primary life-limiting diagnosis. At enrollment and at follow-up interviews after every two study-provided treatment sessions, participants rated their perceived quality of life on a scale from 0 (no quality of life) to 10 (perfect quality). At the end of the study, the investigators added measures of patient's survival status, number of days between study enrollment and death, and receipt of hospice services to the data set.

RESULTS

Multilevel models showed significantly steeper QOL declines for patients with cancer than for those without after adjustment for time between study enrollment and death. Over a 4-month before-death period, the average patient without cancer was estimated to experience a QOL decline of approximately 0.6 on a scale from 0 to 10, compared with a 1.2-point decline for patients with cancer.

CONCLUSION

Patients with cancer face more-precipitous end-of-life challenges to quality of life than do other terminally ill persons. Therefore, clinicians must address QOL issues-not just symptom burden and distress. By introducing and discussing expected QOL declines at the end of life, clinicians may help to prepare, support, and reassure patients and their families.

Advances in measuring quality-of-life outcomes in cancer care

OBJECTIVE

To provide practical guidance for the selection and use of quality-of-life (QOL) instruments for research and clinical practice.

DATA SOURCES

Published articles, books, and web resources.

CONCLUSION

Even among instruments designed specifically to measure QOIL, there are vast differences in what they actually measure. The choice of instrument can make the difference between whether real changes in QOL are captured or not.

IMPLICATIONS FOR NURSING PRACTICE

QOL outcomes are ideal for determining the efficacy and impact of cancer care. Incorporating QOL into standard clinical practice holds great promise for improving communication with health care providers, with a resultant improvement in patient outcomes.

Trajectories of quality of life in older persons with advanced illness

OBJECTIVES

To examine subjective ratings of quality of life (QoL) in older adults with advanced illness.

DESIGN

Observational cohort study with interviews at least every 4 months for up to 2 years conducted between December 1999 and December 2002.

SETTING

Participants' homes.

PARTICIPANTS

One hundred eighty-five community-dwelling individuals aged 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease.

MEASUREMENTS

Participants were asked how they would rate their overall QoL.

RESULTS

Of participants who died, 46% reported good or best possible QoL at their final interview, 21% reported improvement in QoL from their penultimate to final interview, and 39% reported no change. Forty-nine percent of participants reported two or more changes in the direction of their QoL trajectories (e.g., QoL improved then declined). As measured over time in a multivariable longitudinal regression analysis, greater activity of daily living disability (adjusted odds ratio (AOR)=0.85, 95% confidence interval (CI)=0.75-0.95) and depressed mood (AOR=0.42, 95%CI=0.27-0.66) were associated with poorer QoL, whereas better self-rated health (AOR=4.79, 95% CI=2.99-7.69) and having grown closer to one's church (AOR=1.99, 95% CI=1.17-3.39) were associated with better QoL.

CONCLUSION

Although declining QoL is not an inevitable consequence of advancing illness, individuals' ratings of QoL are highly variable over time, suggesting that temporary factors may influence subjective QoL. Functional status, depression, and connection to one's religious community are shared determinants of QoL.