Quality of life in dependent older adults living at home

Primary outcome reporting in clinical trials for older adults with depression

BACKGROUND

Findings from randomised controlled trials (RCTs) are synthesised through meta-analyses, which inform evidence-based decision-making. When key details regarding trial outcomes are not fully reported, knowledge synthesis and uptake of findings into clinical practice are impeded.

AIMS

Our study assessed reporting of primary outcomes in RCTs for older adults with major depressive disorder (MDD).

METHOD

Trials published between 2011 and 2021, which assessed any intervention for adults aged ≥65 years with a MDD diagnosis, and that specified a single primary outcome were considered for inclusion in our study. Outcome reporting assessment was conducted independently and in duplicate with a 58-item checklist, used in developing the CONSORT-Outcomes statement, and information in each RCT was scored as 'fully reported', 'partially reported' or 'not reported', as applicable.

RESULTS

Thirty-one of 49 RCTs reported one primary outcome and were included in our study. Most trials (71%) did not fully report over half of the 58 checklist items. Items pertaining to outcome analyses and interpretation were fully reported by 65% or more of trials. Items reported less frequently included: outcome measurement instrument properties (varied from 3 to 30%) and justification of the criteria used to define clinically meaningful change (23%).

CONCLUSIONS

There is variability in how geriatric depression RCTs report primary outcomes, with omission of details regarding measurement, selection, justification and definition of clinically meaningful change. Outcome reporting deficiencies may hinder replicability and synthesis efforts that inform clinical guidelines and decision-making. The CONSORT-Outcomes guideline should be used when reporting geriatric depression RCTs.

Addictive Behaviors, Depression, and Quality of Life among Korean Fishermen

This study investigated addictive behaviors (alcohol dependence and gambling tendencies), depression, and quality of life (QoL) among Korean fishermen in the Jeju Island region, Korea. The study utilized the Alcohol Use Disorder Identification Test-Korean version, the Korean version of the Canadian Problem Gambling Index, the Center for Epidemiological Studies Depression Scale, and the Korean version of the World Health Organization QOL-BREF to measure the study variables. The results showed that 18.1% of the fishermen had alcohol dependence and 9.9% abused alcohol, 13.6% were categorized as problem gamblers, 15.2% were moderate risk gamblers, and 14.4% were low-risk gamblers; 25.1% and 20.8% suffered from severe and mild depression, respectively. The mean QoL score was 3.13 ± 0.56, and the psychological health section scored the highest. The degree of alcohol dependence varied by age, education level, and job satisfaction; gambling tendency varied by age, job position, and job satisfaction; depression varied by religion and job satisfaction; QoL varied by religion and job satisfaction. Alcohol dependence, gambling tendency, and depression were significantly negatively correlated with QoL. Specifically, higher levels of alcohol dependence were associated with lower QoL scores in the subcategories of physical health and psychological health, while higher levels of gambling tendencies were associated with lower QoL scores in the subcategories of physical health, psychological health, social relationships, and general subcategories. Finally, higher levels of depression were associated with lower QoL scores across all five subcategories. Overall, participants exhibited remarkably elevated levels of alcohol dependence, gambling tendencies, and depression, and lower QoL compared with the general population. Further efforts are required to increase Korean fishermen's job satisfaction to improve these problems. In addition, public health policies must address and promote fishermen's QoL.

Evaluation of quality of life and self-efficacy in adolescents with amblyopia

Amblyopia is an acquired defect due to a lack of visual stimulation. Self-efficacy is one of the factors affecting the quality of life (QoL) of individuals. Low self-efficacy can decrease cognitive and behavioral functioning, whereas increased self-efficacy leads to a change in treatment acceptance behavior and, subsequently, physical and mental health. This study aimed to determine the QoL and self-efficacy in adolescents with amblyopia. This descriptive cross-sectional study was performed on 300 patients referred to hospitals affiliated with Mashhad University of Medical Sciences, Iran, between 2015 and 2016. Data collection tools included: 1) demographic questionnaire, 2) general self-efficacy scale, and 3) WHO QoL questionnaire. Data were analyzed using SPSS software 24 using descriptive statistics. The results showed that the mean percentage in QoL was 45.43% (weak), and the mean score in self-efficacy was 21.66%, with a standard deviation of 8.10. There was also a positive and significant relationship between patients' self-efficacy and QoL on each dimension. This study showed that demographic characteristics had no significant relationship with any of the variables of QoL and self-efficacy. However, data analysis showed a significant and positive relationship between self-efficacy and QoL.

Effect of an eHealth intervention on older adults' quality of life and health-related outcomes: a randomized clinical trial

BACKGROUND

By 2030, the number of US adults age ≥65 will exceed 70 million. Their quality of life has been declared a national priority by the US government.

OBJECTIVE

Assess effects of an eHealth intervention for older adults on quality of life, independence, and related outcomes.

DESIGN

Multi-site, 2-arm (1:1), non-blinded randomized clinical trial. Recruitment November 2013 to May 2015; data collection through November 2016.

SETTING

Three Wisconsin communities (urban, suburban, and rural).

PARTICIPANTS

Purposive community-based sample, 390 adults age ≥65 with health challenges.

EXCLUSIONS

long-term care, inability to get out of bed/chair unassisted.

INTERVENTION

Access (vs. no access) to interactive website (ElderTree) designed to improve quality of life, social connection, and independence.

MEASURES

Primary outcome: quality of life (PROMIS Global Health). Secondary: independence (Instrumental Activities of Daily Living); social support (MOS Social Support); depression (Patient Health Questionnaire-8); falls prevention (Falls Behavioral Scale). Moderation: healthcare use (Medical Services Utilization). Both groups completed all measures at baseline, 6, and 12 months.

RESULTS

Three hundred ten participants (79%) completed the 12-month survey. There were no main effects of ElderTree over time. Moderation analyses indicated that among participants with high primary care use, ElderTree (vs. control) led to better trajectories for mental quality of life (OR=0.32, 95% CI 0.10-0.54, P=0.005), social support received (OR=0.17, 95% CI 0.05-0.29, P=0.007), social support provided (OR=0.29, 95% CI 0.13-0.45, P<0.001), and depression (OR= -0.20, 95% CI -0.39 to -0.01, P=0.034). Supplemental analyses suggested ElderTree may be more effective among people with multiple (vs. 0 or 1) chronic conditions.

LIMITATIONS

Once randomized, participants were not blind to the condition; self-reports may be subject to memory bias.

CONCLUSION

Interventions like ET may help improve quality of life and socio-emotional outcomes among older adults with more illness burden. Our next study focuses on this population.

TRIAL REGISTRATION

ClinicalTrials.gov ; registration ID number: NCT02128789.

Outcomes reported in randomised controlled trials of major depressive disorder in older adults: protocol for a methodological review

INTRODUCTION

Major depressive disorder (MDD or depression) is prevalent among adults aged 65 years and older. The effectiveness and safety of interventions used to treat depression is often assessed through randomised controlled trials (RCTs). However, heterogeneity in the selection, measurement and reporting of outcomes in RCTs renders comparisons between trial results, interpretability and generalisability of findings challenging. There is presently no core outcome set (COS) for use in RCTs that assess interventions for older adults with MDD. We will conduct a methodological review of the literature for outcomes reported in trials for adults 65 years and older with depression to assess the heterogeneity of outcome measures.

METHODS AND ANALYSIS

RCTs evaluating pharmacotherapy, psychotherapy, or any other treatment intervention for older adults with MDD published in the last 10 years will be located using electronic database searches (MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials). Reviewers will conduct title and abstract screening, full-text screening and data extraction of trials eligible for inclusion independently and in duplicate. Outcomes will be synthesised and mapped to core outcome-domain frameworks. We will summarise characteristics associated with trials and outcomes.

ETHICS AND DISSEMINATION

We hope that findings from our methodological review will reduce variability in outcome selection, measurement and reporting and facilitate the development of a COS for older adults with MDD. Our review will also inform evidence synthesis efforts in identifying the best treatment practices for this clinical population. Ethics approval is not required, as this study is a literature review.

PROSPERO REGISTRATION NUMBER

CRD42021244753.

Comparison of life quality in older adults living in traditional family versus nursing home: a systematic review and meta-analysis

To assess and compare the QoL of the older people dwelling in traditional family versus nursing home/institution. A comprehensive literature search was performed on 10 January 2018 to identify studies that investigated the QoL of older adults dwelling in family versus nursing home settings. Analyses were run using random-effects meta-analyses. A total of six cross-sectional studies with 1623 people were included. The quality of included studies was moderate. Meta-analysis showed that compared with nursing home support, the family support could significantly improve the physical health (6 studies, SMD = 0.50, 95%CI: 0.32-0.68, p < 0.05), mental status (6 studies, SMD = 0.45, 95%CI: 0.26-0.65, p < 0.05), and social relationship (5 studies, SMD = 0.51, 95%CI: 0.19-0.83, p < 0.05). Traditional family support model demonstrated a significant improvement in the physical health, psychological status and social relationships among older adults. The conclusions were driven by cross-sectional studies, Larger, adequately powered RCTs are required to confirm our finding.

Persian version of the brief Older People's Quality of Life questionnaire (OPQOL-brief): the evaluation of the psychometric properties

BACKGROUND AND OBJECTIVE

Quality of life (QoL) is a multi-dimensional concept and its assessment is one of important themes of care for older people. Assessing QoL in older people needs specific scales. The aim of this study was to culturally adapt and investigate the psychometric properties of the Persian version of brief Older People's Quality of Life questionnaire (OPQOL-brief) in an Iranian older population.

METHODS

This methodological cross-sectional study was conducted among 525 Persian-speaking older people (aged 60 and over), living in Isfahan, Iran. Translation of the OPQOL-brief questionnaire was performed using forward-backward method. Test-retest reliability was evaluated through Intra Class Correlation (ICC) coefficient and internal consistency by using Cronbach's α. Construct validity was investigated by using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Latent class analysis (LCA). Criterion, convergent and discriminant validities were also assessed.

RESULTS

Persian version of the OPQOL-brief showed good test-retest reliability (ICC = 0.842, 95% CI = 0.73-0.91; P < 0.001). Persian OPQOL-brief scale demonstrated high internal consistency (Cronbach's α = 0.83). It showed good discriminant validity and differentiated old patients from healthy older individuals (P < 0.001). Construct validity based on EFA led to extraction of three dimensions ("socioeconomic", "emotional", and "physical" well-being) and the CFA confirmed the adequacy of extracted construct from EFA (CFI = 0.909, PCFI = 0.52, PNFI = 0.5, CMIN/DF = 3.012, and RMSEA = 0.08). LCA classified participants into three classes in terms of QoL level (low (16%), middle (67%), and high (17%)). Criterion validity and convergent validity revealed significant positive correlations between OPQOL-brief and physical and psychological dimensions of the SF-36.

CONCLUSION

The Persian version of the OPQOL-brief is a reliable and valid instrument for assessing QoL with applicability in a broad range of older Persian language population.

Long-Term Care Quality-of-Life Scale utility in community home care

This study aimed to test the utility of the Long-Term Care Quality-of-Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality-of-Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long-Term Care Quality-of-Life scale to have good test-retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long-Term Care Quality-of-Life and World Health Organization Quality-of-Life scales' scores suggesting moderate-to-strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long-Term Care Quality-of-Life scale monitoring in home and residential care can identify opportunities for quality-of-life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality-of-life assessment scale that can be used across care contexts to support evidence-based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.

Prevalence of geriatric depression in the Kavre district, Nepal: Findings from a cross sectional community survey

BACKGROUND

The increasing elderly population worldwide is likely to increase mental health problems such as geriatric depression, which has mostly been studied in high-income countries. Similar studies are scarce in low-and-middle-income-countries like Nepal.

METHODS

A cross-sectional, population-based, door-to-door survey was conducted in randomly selected rural and urban population clusters of the Kavre district, Nepal. Trained nurses (field interviewers) administered structured questionnaires that included a validated Nepali version of the Geriatric Depression Scale short form (GDS-15) for identifying geriatric depression among the elderly (≥60 years) participants (N = 460). Those scoring ≥6 on GDS-15 were considered depressed. Logistic regression analysis explored the associations of geriatric depression with regard to socio-demographic information, life style, family support and physical well-being.

RESULTS

Of the total 460 selected elderly participants, 439 (95.4%) took part in the study. More than half of them were females (54.2%). The mean age was 70.9 (± 8.6) years. Approximately half (50.6%) were rural inhabitants, the majority (86.1%) were illiterate, and about three-fifths (60.1%) were living with their spouses. The gender-and-age adjusted prevalence of geriatric depression was 53.1%. Geriatric depression was significantly associated with rural habitation (AOR 1.6), illiteracy (AOR 2.1), limited time provided by families (AOR 1.8), and exposure to verbal and/or physical abuse (AOR 2.6).

CONCLUSION

Geriatric depression is highly prevalent in Kavre, Nepal. The findings call for urgent prioritization of delivery of elderly mental health care services in the country.

Impacts of Leisure and Tourism on the Elderly’s Quality of Life in Intimacy: A Comparative Study in Japan

Highly social activities like leisure and tourism are considered to have positive effects on the elderly’s mental health. Taking Japan as a case study, this research aims to clarify how leisure and tourism contribute to the elderly’s quality of life (QOL) in the domains of leisure and intimacy by comparing populated and depopulated areas. Such research has strong implications for achieving Sustainable Development Goals (SDGs) through healthy aging, but relevant efforts are quite limited. In this study, leisure and tourism behaviors are captured by visit frequency, travel party and expenditure. Quality of life is measured by happiness and life satisfaction in different life domains, in line with the life-oriented approach. Data were collected in 2014 via a nationwide online survey in Japan. Applying a structural equation model (SEM) approach, it is found that leisure behavior contributes to maintaining the elderly’s QOL in leisure life and intimacy domains. Tourism behavior only contributes to QOL in populated areas. Leisure activities strongly enhance QOL in terms of intimacy and improve the neighborhood relationship of the elderly in depopulated areas and family life in populated areas. Enriching daily leisure activities for the elderly would improve their intimate relationships in depopulated areas.

Quality of life and physical activity in an older working-age population

Objective

Physical activity can be an effective means of prevention and therapy of many psychosomatic disorders. It can also have a significant impact on the quality of life of older working-age people. The aim of the present study was to assess the relationships between quality of life and physical activity in older working-age people from Wrocław, Poland.

Materials and methods

The study group comprised 1,013 people, including 565 women and 448 men, aged 55–64 years (59.1±2.9 years). The study took form of a questionnaire survey. The participants assessed their physical activity and quality of life using the International Physical Activity Questionnaire Short Version (IPAQ-SF) and the World Health Organization Quality of Life (WHOQOL-BREF), respectively.

Results

The highest mean indices of general quality of life, perceived health status, and quality of life in the physical, psychological, social, and environmental domains were shown by respondents whose intensity of physical activity was the highest. Moreover, the odds of high assessment of overall quality of life increased with respondents’ higher levels of physical activity.

Conclusion

Quality of life improvement programs should also involve increased physical activity components.

Nursing Care of Elderly People at Home and Ethical Implications: an experience from Istanbul

Elderly people are a particularly vulnerable group in society and have special health problems. The world population of older people is increasing. People who are 65 years or older constitute 6% of the Turkish population, 90% of whom have chronic health problems. In Turkey, there is a high possibility that elderly people’s requirements are not met by today’s health care system in the way they would wish. They prefer not to be hospitalized when they have health problems. From a wider perspective, various countries are still seeking how to provide the best care for elderly people. Our goal was to characterize home-based care for elderly people using an ethical approach as an area of interest for nurses and other health care professionals now and in the future, both for Turkey specifically and from a global perspective. We studied four case histories and then prepared a composite scenario and a short questionnaire for elderly people living in a specific district of Istanbul to evaluate their expectations from the health care system. We compared our findings with situations in other countries and have proposed some practical solutions. The results showed that these older people preferred to receive nursing care at home instead of in hospital in Turkey, and also in many other countries. In this article we discuss our findings, comparing them with those in the literature, and suggest that there should be nursing care at home with insurance coverage while using a proper ethical approach.

A systematic review of instruments for measuring outcomes in economic evaluation within aged care

BACKGROUND

This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector.

METHODS

Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000.

RESULTS

The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care.

CONCLUSION

In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.

Quality of life and attitudes to ageing in Turkish older adults at old people's homes

OBJECTIVES

The purpose of this study was to investigate quality of life (QOL) and attitudes to ageing in Turkish older adults at two old people's homes (nursing homes) and to explain relationship between QOL and attitudes to ageing.

METHODS

This study is a quantitative and descriptive exploratory study of QOL and attitudes to ageing of older adults in nursing homes in a developing country.

INSTRUMENTS

Two international data measurement tools were used for data collection. Data measurement instruments in this study are The World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) and the WHO - Attitudes to Ageing Questionnaire (AAQ). The WHOQOL-OLD module consists of 24 items assigned to six facets (sensory abilities, autonomy, past, present and future activities, social participation, death and dying and intimacy) AAQ consists of 24 items classified in three domains (psychosocial loss, physical change and psychological growth) with eight items each.

PARTICIPANTS

The Turkish version of the WHOQOL-OLD and AAQ was administered to 120 older (>65 years) adults living in two old people's homes in Samsun Province, Turkey. This study was conducted and planned between on 1 November 2011 and on 31 November, 2011.

RESULTS

The results indicated that there was significant relationship between QOL and attitudes to ageing of older adults. In this study, the highest significant relationship is between psychological growth subscale of attitudes to ageing and sensory abilities subscale of QOL (r = 0.579; P < 0.01). Overall QOL and overall attitudes to ageing had a significant and positive relationship (r = 0.408; P < 0.01). The dimensions of attitudes to ageing (psychosocial loss, physical change and psychological growth) were significant predictors for QOL in older adults in Turkey. It was found that the gender does not affect overall QOL in older adults. However, happiness is significant variable for overall QOL in this study.

CONCLUSION

The results suggest that QOL is a complex, multidimensional concept that should be studied at different levels of analysis in Turkey and other developing countries. The results of this study emphasize the importance of QOL in older adults in older people's homes in Turkey and attitudes to ageing of nursing home residents in Turkey.

Quality of Life (QOL) and Attitudes Toward Aging in Older Adults in Şanlıurfa, Turkey

Objectives: The purpose of this study was to investigate quality of life (QOL) and attitudes toward aging in older adults in a province in Turkey. Methods: This is a quantitative and descriptive study of QOL and the attitudes toward aging in older adults. Instruments: The data measurement instruments used in this study are the World Health Organization (WHO) Quality of Life Instrument–Older Adults Module (WHOQOL-OLD) and the WHO–Attitudes to Ageing Questionnaire (AAQ). Participants: The Turkish versions of the WHOQOL-OLD and AAQ were administered to 550 older adults living in şanlıurfa Province, Turkey. Results: The results indicated a significant relationship between QOL and attitudes toward aging in older adults. Two dimensions of attitudes toward aging (physical change and psychological growth) were significant predictors of QOL in older adults. It was found that gender, literacy, social security, age, and marital status affect some dimensions of QOL and some subscales of attitudes toward aging.

Depression and related factors in older people in China: a systematic review

China has an increasing ageing population. Depression, as one of the most common problems in older people, is a concern that merits attention. This paper reviewed published studies of the prevalence of depression and its related factors in older people in China. Seventeen papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Whilst prevalence varied across studies, health status, social support, financial status, living arrangements and some demographic factors were consistently related to older people's depression. Further well-designed studies are needed to explore depression in older people in China to identify more culture-specific contributors to maximize well-being.

Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments

OBJECTIVE

This study used the Brief Version of The World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF) to assess and compare the quality of life in older people who live at home and older people who live in public assisted-living facilities for the elderly.

DESIGN

Cross-sectional.

SETTING

Data were collected by a research nurse in each home and in the assisted living facility.

PARTICIPANTS

PARTICIPANTS were 60 years old and older. The sample included 37 people who were living in a public assisted-living facility and 37 elderly people living in their own homes.

MEASUREMENT

The WHOQOL-BREF was used to measure participants' quality of life.

RESULTS

The groups were similar according to gender, literacy, existence of chronic diseases, and general perceived health. However, quality of life scores for social relationships and environment domains were lower in those living in an assisted living facility than those living in their own homes. The scores for elderly females staying in the assisted living facility were lower compared to the scores of males in the facility.

CONCLUSION

The results suggest that social and environmental domains of life quality are low in elderly assisted living facilities. Social activities should be diversified for elderly people staying in assisted living facilities to improve social relationships. Physical and psychological health of females in assisted living facilities should be comprehensively supported by professionals. Alternatively, elderly people may be professionally supported to live in their own homes.

Trait Routinization, Functional and Cognitive Status in Older Adults

This study examined the associations between trait routinization and functional and cognitive as well as demographic indicators. A sample of American older adults living independently in a retirement community ( n = 80) were assessed regarding their functional status, cognitive status, and preference for routine. Robust associations between functional status and trait routinization were found, as well as correlations between education, age, and routinization. No association between routinization and cognitive status was found. The results suggest that trait routinization is linked with various aspects of well-being in older age. Various explanations regarding the role of trait routinization and its validity are presented.

Geriatric psychiatry home treatment (GHT): a pilot study on outcomes following hospital discharge for depressive and delusional patients

Elderly people with mental health problems receive much worse outpatient care than younger people. Although the health-promoting factors are known, there are hardly any studies on effective biopsychosocial care models. A 1-year longitudinal study examined the effectiveness of the GHT presented below. For this purpose, 12 depressive and delusional patients discharged from inpatient gerontopsychiatric care received mental and social treatment and care at home for 1 year. Functionality was surveyed by means of the Global Assessment of Functioning Scale (GAF) and psychiatric symptoms by means of the Brief Psychiatric Rating Scale (BPRS). Subjective quality of life (QoL) was surveyed by means of the WHOQOL-BREF self-report questionnaire. The main findings were as follows: (1) no patient had to receive inpatient psychiatric care or be admitted to a nursing home during the study period; (2) mental QoL had improved significantly after 1 year; (3) functionality remained stable; (4) the BPRS scores did not deteriorate. We see this as confirmation that GHT is an effective instrument for extramural care of elderly people with psychiatric disorders. The limitations of the pilot study necessitate further studies to back up the findings.

Contribuição dos domínios físico, social, psicológico e ambiental para a qualidade de vida global de idosos

Este estudo investigou a contribuição de cada domínio da qualidade de vida (físico, social, psicológico e ambiental) na qualidade de vida global e em que extensão esses domínios explicam a qualidade de vida global de idosos residentes no município de Teixeiras, na Região Sudeste do Brasil. Trata-se de um estudo observacional de corte transversal, sendo a amostragem aleatória estratificada por sexo, uso do Programa Saúde da Família e microárea de saúde (n = 211, indivíduos com idade igual ou superior a 60 anos), representando 14,28% do total de idosos do município em estudo. O instrumento utilizado foi o Word Health Organization Quality of Life Instrument Bref (WHOQOL-Bref), proposto pela Organização Mundial de Saúde, aplicado por um único entrevistador, devidamente treinado. As análises de regressão linear mostraram que nenhuma das variáveis sociodemográficas interferiu significativamente no domínio global da qualidade de vida, e, entre os quatro domínios, o que mais explicou a qualidade de vida global foi o físico, seguido do ambiental e do psicológico. O domínio social não mostrou contribuição significativa na qualidade de vida global. As possíveis explicações para os resultados encontrados foram discutidas.

Older persons' experience of being assessed for and receiving public home help: do they have any influence over it?

The aim of this qualitative study was to explore older persons' experience of participation in and influence on decisions about public home help/care when undergoing needs assessment and receiving public home help. A purposive sample of 28 home help recipients over the age of 75 were selected. Data were collected by means of in-depth interviews. A content analysis revealed one overarching category: 'Having to be satisfied, adjust, and walk a fine line when balancing between needs and available help'; and three principal categories: Balancing the comfort and guilt--receiving help from the family at the limits of their capacity; 'A necessary evil'--balancing feelings and resources against having no choice but to accept; Incorporating the home help into daily life to gain a sense of continuity. The findings indicate that older persons have difficulties coping and adapting to their new life situation and have no actual influence over the decisions about their home help. The officer told them what was available. This implies a need to pay attention to the frail persons' mental state in the needs assessment and to ensure adequate understanding of information. Further, it suggests that the needs assessment and the home help officer should to a larger extent focus on individual needs as a whole, involve and encourage the older person to strengthen his or her sense of being in control.

Quality of life and symptoms among older people living at home

AIM

This paper reports a study comparing the socio-demographic data, quality of life (QoL) and symptoms of older people living at home with and without help.

BACKGROUND

Despite growing numbers of older people worldwide, little is know about the differences between older people receiving help to live at home and those not receiving this, especially as regards QoL and symptoms. Not only symptoms but also dependency on others per se may reduce older people's QoL. From a nursing perspective, knowledge about such issues is important because the impact of symptoms may be reducible, even when diseases cannot be cured.

METHOD

A postal questionnaire was sent to an age-stratified random sample of 1866 people aged 75 years or over. Of the respondents (n = 1248) 448 received help and 793 did not.

RESULTS

The group receiving help had a significantly higher age, more women, more people widowed and living alone, more children, a higher number of self-reported diseases and symptoms, greater inability to remain alone at home and lower QoL. Loneliness, depressed mood and abdominal pain were significantly related to low QoL in both groups. Living alone, not being able to remain alone at home without help, and fatigue were also predictive of low QoL among those receiving help, and number of diseases and sleep problems in those without.

CONCLUSION

Receiving help with daily living seems to be significantly related to low QoL and goes along with a high number of symptoms that need to be considered in nursing care. Through regular visits, systematic assessment and intervention, especially focusing on older people's symptoms, nurses may contribute to improved QoL for this section of the population.

Determinants and characteristics of help provision for elderly people living at home and in relation to quality of life

The aim of this study was to investigate determinants of help from informal or formal caregivers or a combination of both among people aged 75 or more and living at home, and the characteristics of the recipients, the help they received and their quality of life (QoL). The sample for this study was 448 elderly people, 75-99 years of age, living at home and receiving help with activities for daily living, instrumental or both instrumental and personal. Regression analysis showed high QoL not to be significantly related to who was providing the help, whilst it was related to higher age, living with someone, lower number of complaints and managing to be alone at home. Multinomial regression analysis showed age, number of children, number of complaints, the ability to stay alone at home and living alone to predict receiving help from different kinds of caregivers. Recipients receiving help from informal caregivers were younger, more often married and living together with someone, whilst those receiving help from both informal and formal caregivers had more help with instrumental and personal activities for daily living and were not able to stay alone at home as much as those receiving help from other kinds of caregivers. Those receiving help from formal caregivers had fewer children, were single and were living alone more often than the other recipients. Thus the responsibility for help for elderly people rests heavily on informal caregivers, whom it seems essential to support. As public service at home is preferably given to those living alone or able to stay alone at home, those without relatives may not be able to remain at home when their need of help increases.

Anxiety and well-being in older people after discharge from hospital

BACKGROUND

A previous study using the State-Trait Anxiety Inventory (STAI) has documented a very high prevalence of anxiety symptoms among older inpatients. The STAI produced two main concepts on factor analysis -'Nervousness' and 'Well-being'- and high scores on both caused the high overall score in these patients.

AIM

To investigate how the scorings on the STAI evolve after discharge in older patients in order to understand better the reasons for their high scorings while in hospital.

METHODS

Sixty-three patients who had been scored on the STAI during their stay in an elder care department were followed up at 1-3 and 12 months after discharge. Data were analysed by ancova for unbalanced designs.

RESULTS

The mean STAI sum score increased significantly (3.5 points adjusted for the baseline scoring, age and gender, P < 0.001) from the first follow-up while in hospital to 1-3 months after discharge, with no significant change between the second and the last follow-up. This increase resulted primarily from a significant worsening of the score on 'well-being'. The score on 'nervousness' remained unchanged. Age did not influence the scores, while females scored higher. No interaction effects were observed, indicating that the evolvement of nervousness and anxiety after discharge is independent of gender and age. Item analysis showed that the worsening of the score on 'well-being' in these patients during the first 1-3 months after discharge was primarily caused by a lower score on the item 'I feel secure'.

CONCLUSION

The study does not support the hypothesis that a high level of nervousness and lack of well-being among hospitalized older patients results from acute illness and hospitalization. The worsening in the score on well-being after discharge of such patients is primarily caused by low levels of feelings of security. This represents a challenge to nurses providing home-based care.

Aspects of quality of life in persons with pre-lingual deafness using sign language: subjective wellbeing, ill-health symptoms, depression and insomnia

This study investigated health-related quality of life, expressed as subjective wellbeing and the prevalence of depressive symptoms and insomnia, among elderly pre-lingually deaf persons using sign language. Comparisons were made with elderly hearing people. Forty-five pre-lingually deaf persons, 65 years or older, took part (a response rate of 46%). Subjective wellbeing was assessed with the Gothenburg Quality of Life (GQL) instrument. Depressive symptoms were rated with the 15-item version of the geriatric depression scale (GDS), and insomnia was measured with Livingston's sleep scale. Ratings of subjective wellbeing among elderly pre-lingually deaf people were generally high. One third of the deaf persons demonstrated depressive symptoms and nearly two thirds suffered from insomnia. There was substantial correlation between insomnia, depressive symptoms and lower subjective wellbeing. The results strengthened the assumption that depressive symptoms and sleep disturbance are more frequent among elderly pre-lingually deaf people using sign language than among hearing people. On the other hand, and contrary to our expectations, this did not imply significantly lower perceived subjective wellbeing compared with hearing elderly people. Results must be interpreted with caution due to limitations in the study.