Quality of life among older people with a disability: the role of purpose in life and capabilities

Mediated relationships between coping style and social support on the quality of life of disabled older adults

OBJECTIVE

This study aimed to explore the relationship between coping styles, social support and quality of life among disabled older adults and to examine the mediating role of coping styles in the relationship between social support and quality of life.

METHODS

Using a purposive sampling method, three investigators conducted a face-to-face questionnaire survey of eligible participants in the geriatric department of a tertiary care hospital in one of the largest cities in southern China between August 2021 and March 2022. A total of 187 questionnaires were collected, of which 176 were valid, with an effective response rate of 94.1%.

RESULTS

Social support and positive coping were positively related to disabled older adults' quality of life, while negative coping was negatively related to both social support and disabled older adults' quality of life. According to the mediating effect analysis after covariate adjustment, positive coping completely mediated the relationship between social support and older adults' quality of life (p < 0.01), with the mediating effect size accounting for 76.9% of the total effect. Negative coping had some mediating effect on the relationship between social support and older adults' quality of life (p < 0.01), with the mediating effect size accounting for 13.0% of the total effect.

CONCLUSION

The quality of life of disabled older adults is low, which is closely related to their social support and coping styles. Therefore, it is important to recognize and emphasize the key role that social support systems play in improving the quality of life of this population, broaden their access to social support and guide them to adopt positive coping styles.

Trajectories of Purpose in Life Across Diagnosis of Alzheimer's Disease or Related Dementias in Older Adulthood

Objectives: Sense of purpose serves as a psychological resource for late-life health. Limited research has examined how purpose changes across chronic illness diagnoses, including a diagnosis of Alzheimer's disease and related dementias (ADRD).Method: This study leverages data from the National Health and Aging Trends Study (NHATS; N = 831) to establish trajectories of purpose across ADRD diagnosis using three-year (pre-diagnosis, year of diagnosis, post-diagnosis) timespans and two comparison groups (heart disease diagnosis, no diagnosis). Results: We observed a longitudinal decrease in purpose in the ADRD diagnosis group, t = 3.85, p = .003, d = -0.258. This contrasts with heart disease diagnosis and no diagnosis groups, where purpose did not change over time. Discussion: Older adults who receive an ADRD diagnosis may be vulnerable to a decreasing sense of purpose across their diagnosis experience. We consider social, psychological, and clinical antecedents for this trend.

Independent living, emotional well-being, and quality of life in people with disabilities: the mediator role of self-determination and satisfaction with participation

Background

In the field of disability and rehabilitation, participation in society has become an important therapeutic objective due to its potential impact on rehabilitation, prognosis, and patient's mid and long-term well-being. However, only a few studies have explored this issue in relation with the subjective perspective of individuals with disabilities about their decision-making capacity and satisfaction with the activities in which they participate.

Objective

Our aim is to analyze the relationship between participation in society of people with disabilities and both emotional well-being and quality of life, including variables about subjective perspective of participation (satisfaction) and the ability to decide and pursue their own preferences.

Method

The cross-sectional study presented here includes 424 participants with disabilities over 18-years-old from Spain. This research is part of a larger ongoing longitudinal cohort study called Participa (https://participa.guttmann.com/en/). Participants were asked to complete several on-line surveys to explore quality of life, emotional well-being, participation in society, self-determination, and independent living.

Results

The results revealed an association between the dimensions of participation satisfaction, self-determination, and levels of independent living with both quality of life and emotional well-being. Mediation models indicated that satisfaction and self-determination partially mediated the relationship between independent living and both quality of life and emotional well-being.

Conclusion

The level of independent living, self-determination, and satisfaction with participation are fundamental aspects for promoting a high quality of life and emotional well-being in people with disabilities. These findings carry significant implications for health and social services, as well as policies guidelines, highlighting the need to prioritize empowerment and self-determination in all interventions designed for people with disabilities.

The relationship between purpose in life and depression and anxiety: A meta-analysis

Purpose in life consists of having a sense of meaning and purpose regarding one's activities as well as an overall sense that life is meaningful. This study reports a comprehensive assessment of the relationship of purpose in life with depression and anxiety. A meta-analysis (total n = 66,468, total k = 99) investigated the association of purpose in life with depression and anxiety. Across samples, greater purpose in life was significantly associated with lower levels of depression and anxiety. The mean weighted effect size between purpose in life and depression was r = -0.49, [95% confidence intervals, CIs: -0.52, -0.45], p < 0.001. For the purpose in life and anxiety the mean weighted effect size was r = -0.36, [95% CIs: -0.40, -0.32], p < 0.001. The association of purpose in life with mental health was stronger for clinical populations, especially with regard to the relationship with anxiety. Both approach deficits and avoidance motivation are argued to play a role in the relationship between purpose and psychopathology, with greater purpose potentially limiting avoidance tendencies and reducing the effects of depression and anxiety. Understanding the role that purpose in life may play in depression and anxiety could help to inform current conceptualizations of these disorders and improve treatment outcomes.

Important Correlates of Purpose in Life in a Diverse Population-Based Cohort: A Machine Learning Approach

BACKGROUND

Purpose-in-life (PiL) refers to the tendency to derive meaning and purpose from daily life experiences. Individuals with higher PiL were more likely to have better physical, mental, and cognitive health in prospective studies. Here, we aimed to identify important correlates of PiL among people of diverse backgrounds.

METHODS

Participants were recruited by the population-based Health and Retirement Study and provided information on 34 different sociodemographic and psychosocial factors through psychometrically validated measures. To identify important correlates of PiL, we employed regularized regression implemented by Elastic Net on the entire cohort as well as among self-identified black participants only and white participants only, respectively.

RESULTS

A total of 6,620 participants were included in this study, among whom 913 were black and 5,707 were white. We identified 12 and 23 important sociodemographic and psychosocial correlates of PiL among black and white participants, respectively. Notably, all the 12 correlates in black participants were also correlates among white participants. Interestingly, when we examined both black and white participants together, being black was associated with having higher PiL. The correlates with the largest effect on PiL that were shared among black and white participants were hopelessness, perceived constraint on personal control, and self-mastery.

CONCLUSION

Several sociodemographic and psychosocial factors most strongly associated with PiL were shared among black and white participants. Future studies should investigate whether interventions targeting correlates of PiL can lead to higher sense of life purpose in participants of diverse backgrounds.

Biopsychosocial Factors That Influence the Purpose in Life among Working Adults and Retirees

This study aimed to identify and characterize biopsychosocial factors that impact the purpose in life (PIL) among adults that are working or already retired. This cross-sectional study includes a sample of 1330 participants, of whom 62.2% were female, with ages ranging from 55 and 84 years, with a mean of 61.93 years and a standard deviation of 7.65. Results suggest that the education level, stress, spirituality (religion) and optimism, social support from friends, and quality of life related to physical health seem to contribute positively to the PIL for both groups. However, some variables such as age, marital status and environmental quality of life help explain the PIL of retired people and the quality of life related to social support helps explain the PIL of working adults. Overall, the reported findings suggest that the purpose in life is strongly related to physical, psychological, social and environmental health factors. It is highlighted that working adults and retired people have their purpose in life related to similar factors and others specific to each life stage, suggesting the need for crucial interventions to promote a healthier and more positive aging process.

Associations between frailty, sociodemographic characteristics and quality-of-life among community-dwelling older adults: A cross-sectional study

AIM

To explore the quality-of-life among community-dwelling older adults in China and to examine the associations between frailty, sociodemographic characteristics and quality-of-life.

DESIGN

A cross-sectional correlational study was adopted.

METHODS

Questionnaire study of 311 community-dwelling older adults using the Life Satisfaction Questionnaire and FRAIL scale.

RESULTS

Highest quality-of-life was found for the physical symptoms factor and the lowest for quality of everyday activities/fun. Frailty was associated with total quality-of-life and the physical symptoms and sickness impact factors. For total quality-of-life, the odds of being in the group with a median score or more decreased for frail older people (OR 0.30) versus non-frail and increased for those with medical insurance from employer versus basic (OR 2.30) and those doing exercise ≥30 min 3 days/week or more versus less (OR 2.12). Registered nurses caring for community-dwelling older adults should screen for and prevent frailty and encourage exercise to improve their quality-of-life.

Association between quality of life, sleep quality and mental disorders in Iranian older adults

Aging as a major challenge can affect the development and growth of countries all around the world. This study aimed to identify the subgroups of the elderly based on the quality of life (Qol), sleep quality, and common mental disorders and assess the role of demographic characteristics on the membership of participants in each latent class. This cross-sectional study was conducted on 1064 people over the age of 60 years. The sample was selected through cluster sampling in northern Iran. All participants completed six sets of checklists and questionnaires. Data analysis was performed using latent class analysis. Three latent classes were identified; namely, (1) healthy (66.8%), (2) anxious and with poor sleep quality (28.6%), and unhealthy (4.6%). Being Female significantly increased the odds of membership in classes 2 and 3 compared to class 1. Furthermore, living in urban areas increased the odds of belonging to class 2 and class 3 compared to class 1. Illiteracy was also shown to increase the odds of being in class 3 in comparison to class 1. Results from the present indicate that the co-occurrence of health problems in 33.2% of the elderly was observed in various forms. The results of this study can be used in prioritizing health programs for the elderly and emphasizing high-risk groups.

Factors influencing participation among adults aging with long-term physical disability

BACKGROUND

People aging with long-term physical disability (AwPD) experience barriers to participation and independent living. There are currently limited evidence-based interventions that address issues regarding participation for people AwPD.

OBJECTIVE

This study examined factors influencing participation in personal and life activities among people AwPD to inform future interventions.

METHODS

A cross-sectional study within an ongoing, community-based cohort study of participation was conducted. A purposive sample of people AwPD aged 45-65, living with a physical disability for at least five years, and who speak English was recruited through disability organizations, aging organizations, and social media. Participants answered open-ended questions about what supports they needed to successfully participate in nine activity categories derived from the Health and Retirement Study participation items (e.g., employment, community leisure). A content analysis was conducted using NVivo to categorize responses, and member checking occurred with four additional people AwPD.

RESULTS

A total of 215 participants completed the survey. Eight categories of factors emerged from the data: physical environment factors, social factors, symptoms, economic factors, policy factors, body structure and functions, mental and emotional state, and temporal factors. Participant responses illuminated a combination of environmental and individual factors. Physical effects of disability and accelerated aging, such as pain and fatigue, paired with environmental factors, such as accessibility of transportation, were reported as influencing participation.

CONCLUSIONS

People AwPD experience a range of factors that substantially impact their ability to remain independent and participate in society. By identifying barriers to participation, new interventions addressing these barriers may be developed, resulting in more effective service provision, enhanced participation in personal and life activities, and improved health and well-being.

Viewpoint: An Information Extraction Framework for Disability Determination Using a Mental Functioning Use-Case (Preprint)

Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the complexity of measuring and modeling mental health and illness. The use of NLP to support management of mental health conditions is a viable topic that has not been explored in depth. This paper provides a framework for the advanced application of NLP methods to identify, extract, and organize information on mental health and functioning to inform the decision-making process applied to assessing mental health. We present a use-case related to work disability, guided by the disability determination process of the US Social Security Administration (SSA). From this perspective, the following questions must be addressed about each problem that leads to a disability benefits claim: When did the problem occur and how long has it existed? How severe is it? Does it affect the person’s ability to work? and What is the source of the evidence about the problem? Our framework includes 4 dimensions of medical information that are central to assessing disability—temporal sequence and duration, severity, context, and information source. We describe key aspects of each dimension and promising approaches for application in mental functioning. For example, to address temporality, a complete functional timeline must be created with all relevant aspects of functioning such as intermittence, persistence, and recurrence. Severity of mental health symptoms can be successfully identified and extracted on a 4-level ordinal scale from absent to severe. Some NLP work has been reported on the extraction of context for specific cases of wheelchair use in clinical settings. We discuss the links between the task of information source assessment and work on source attribution, coreference resolution, event extraction, and rule-based methods. Gaps were identified in NLP applications that directly applied to the framework and in existing relevant annotated data sets. We highlighted NLP methods with the potential for advanced application in the field of mental functioning. Findings of this work will inform the development of instruments for supporting SSA adjudicators in their disability determination process. The 4 dimensions of medical information may have relevance for a broad array of individuals and organizations responsible for assessing mental health function and ability. Further, our framework with 4 specific dimensions presents significant opportunity for the application of NLP in the realm of mental health and functioning beyond the SSA setting, and it may support the development of robust tools and methods for decision-making related to clinical care, program implementation, and other outcomes.

Social environment and quality of life among older people with diabetes and multiple chronic illnesses in New Zealand: Intermediary effects of psychosocial support and constraints

Purpose: In older people with diabetes, multimorbidity is highly prevalent and it can lead to poor quality of life. The overall purpose of this study was to examine the association between the social environment, psychosocial support and constraints, and overall quality of life among older people with and without with diabetes and multiple chronic illnesses.Methods: Self-reported data from participants in a cohort study of older New Zealanders was analysed. Responses from 380 older people diagnosed with diabetes and multiple chronic illnesses were compared with 527 older people with no health issues on indicators related to the associations of neighbourhood, health and ageing, using structural equation modelling.Results: The final model suggests that social provision, purpose in life and capabilities mediated between the social environment and quality of life, indicate that older people with positive social environment (i.e., neighbourhood advantage, residential stability) are much less likely to experience depression due to having good social support, meaningful life purpose and opportunities to engage.Conclusions: Perceived neighbourhood advantages, such as positive neighbourhood qualities, social cohesion and housing satisfaction, along with the focus on increasing social support, enhancing purpose in life and supporting one's capability to achieve, may serve as protective factors against depression.IMPLICATIONS FOR REHABILITATIONEnvironmental and personal circumstances can contribute to quality of life among older people with diabetes and multimorbidity.By providing older people with diabetes and multiple chronic illnesses a socially just environment that challenges ageism and other forms of oppression, this could reduce social disparities in health, improve inclusion and access to resources.Social and healthcare professionals are encouraged to design clinical care guidelines and rehabilitation goals from a wholistic and person/client centred approach to support older people with diabetes and multiple chronic illnesses.