The critical link between health-related quality of life and age-related changes in physical activity and nutrition

A Systematic Review of the Effect of Assistance Dog Ownership on Practical Support, Health, and Wellbeing: Implications for Older Adults

OBJECTIVES

While assistance dog use has received considerable recent attention, few studies have focused on benefits for older adults. The current review examined effects of assistance dog acquisition across practical, mental, physical, and social wellbeing domains for older adults. Further, it compared assistance dog types and identified potential barriers to acquisition.

METHODS

A systematic review was completed. Criteria focused on older adults with relevant disabilities (visual/hearing impairments, and PTSD), who received support from an assistance dog (guide, hearing or other assistance dog). Identified studies (n = 2,951) were screened, 256 assessed for eligibility, and 28 included, with key information extracted and summarized.

RESULTS

All dog types demonstrated benefits across all assessed domains. Disadvantages and acquisition barriers were identified. However, limited empirical evidence was available, and no studies focused exclusively on older adults, revealing the need for studies including this age-group.

CONCLUSIONS

While results indicated support for assistance dog acquisition, disadvantages and barriers require further attention. Methodologically improved research should focus on assistance dog acquisition for older persons.

CLINICAL IMPLICATIONS

The study indicated assistance dog acquisition could produce positive clinical impacts, including on mental health and everyday functioning. Thus, acquisition could be considered as part a multi-faceted treatment or recommended to appropriate older adults.

Few Structural Brain Changes Associated With Moderate-Intensity Interval Training and Low-Intensity Continuous Training in a Randomized Trial of Fitness and Older Adults

This study utilized a randomized control trial to examine whether structural changes in the precuneus, insula, caudate, hippocampus, and putamen were related to exercise. A total of 197 healthy older adults with no evidence of dementia participated in moderate-intensity interval training or low-intensity continuous training for 16 weeks. Size decreased in the right hippocampus such that the effect of time was significant but the interaction with condition was not. For the left hippocampus, size decreased in the low-intensity continuous training condition but increased in the moderate-intensity continuous training plus interval training condition at the trend level. Finally, there was a significant time-by-condition interaction such that the thickness of the left insula increased for low-intensity continuous training and decreased for moderate-intensity continuous training plus interval training. Few structural changes were associated with the exercise intervention. Future studies should examine the effects of exercise on brain structure in high-risk or clinical populations for a longer period of time.

Efficacy of dance for Parkinson's disease: a pooled analysis of 372 patients

BACKGROUND

Parkinson's disease (PD) is a neurodegenerative disorder that presents with motor and nonmotor symptoms such as bradykinesia, resting tremor, postural instability, and cognitive and neuropsychiatric manifestations. Dance therapy or complex motor activity, besides pharmacological treatment, may have benefits in PD patients.

OBJECTIVE

To assess the effect of dance in patients with PD.

METHODS

We searched for clinical trials in PubMed, Scopus, and Web of Science, and Cochrane till April 2020 using relevant keywords. Data were extracted and pooled as mean difference (MD) with 95% confidence interval (CI) by Review Manager 5.3.

RESULTS

Fourteen randomized controlled trials with 372 patients were included. Dance showed a significant improvement over the control group in term of the Unified Parkinson's Disease Rating Scale III (UPDRS III) after three (MD = - 4.49, 95% CI [- 6.78, - 2.21], p = 0.00001), six, (MD = - 5.96, 95% CI [- 8.89, - 3.02], p < 0.0001), and 12 months (MD = - 14.58, 95% CI [- 24.76, - 4.4], p = 0.005), and Mini-BES test after 12 months. Compared to exercise, dance showed a significant improvement in Timed Up and Go (TUG) test, Berg Balance Scale (BBS), and Mini-BES test.

CONCLUSION

In comparison to other types of exercise or no activity, dance improves the symptoms and outcomes in patients with PD, especially motor symptoms. Dance also has positive effects on balance, functional mobility, and cognition.

Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences

Background: The association between age and health-related quality of life (HRQoL) is still under debate. While some research shows older age is associated with better HRQoL, other studies show no or negative association between age and HRQoL. In addition, while the association between age and HRQoL may depend on race, ethnicity, gender, and their intersections, most previous research on this link has been performed in predominantly White Middle Class. Objective: To explore gender differences in the association between age and mental and physical HRQoL in a sample of economically disadvantaged African American (AA) older adults. Methods: This cross-sectional survey was conducted in South Los Angeles between 2015 to 2018. A total number of 740 economically disadvantaged AA older adults (age ≥ 55 years) were enrolled in this study, using non-random sampling. This includes 266 AA men and 474 AA women. The independent variable of interest was age. Dependent variables of interest were physical component scores (PCS) and mental component scores (MCS), two main summary scores of the HRQoL, measured using Short Form-12 (SF-12). Gender was the moderator. Socioeconomic status (educational attainment and financial difficulty) were covariates. Linear regression models were used to analyze the data. Results: AA women reported worse PCS; however, gender did not impact MCS. In the pooled sample, high age was associated with better PCS and MCS. In the pooled sample, a significant interaction was found between gender and age on PCS, suggesting a stronger effect of age on PCS for AA men than AA women. In gender-stratified models, older age was associated with better PCS for AA men but not AA women. Older age was similarly and positively associated with better MCS for AA men and women. Conclusions: There may be some gender differences in the implications of ageing for the physical HRQoL of AA older adults. It is unclear how old age may have a boosting effect on physical HRQoL for AA men but not AA women. Future research should test gender differences in the effect of age on physical health indicators such as chronic disease as well as cognitive processes involved in the evaluation of own's health in AA men and women.

Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care

OBJECTIVE

To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care.

DESIGN

Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group.

SETTING

Community based.

PARTICIPANTS

Individuals with idiopathic Parkinson disease (PD) (N=90).

INTERVENTIONS

The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities.

MAIN OUTCOME MEASURES

The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest).

RESULTS

Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation.

CONCLUSIONS

For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life.

State of the Art Review: Advances in Physical Activity and Mental Health: Quality of Life

Biomedical advances and the practice of preventive health behaviors have resulted in an unprecedented growth in the older population of the United States, a trend projected to continue during the next several decades. However, the addition of years to life is no guarantee that those years will be quality years. There is growing evidence to suggest that physical activity is a behavioral modality that is consistently associated with quality of life outcomes. However, there are numerous conceptual, theoretical, and definitional ambiguities associated with this literature. In this review, we examine the literature on physical activity and quality of life in older adults. Specifically, attention is given to the conceptualization of quality of life in the medical and psychological disciplines and how these differential viewpoints influence the outcomes measured and the nature of the relationships reported. We also address the question of whether a dose-response relationship exists between these constructs, as well as the extent to which physical activity is associated with important aspects of cognitive, physical, and psychosocial function. Finally, we propose a multidimensional model for examining the potential mediating and moderating factors in the physical activity and quality-of-life relationship and discuss the practical implications that such a model has for practitioners.

To dance or not to dance? A comparison of balance, physical fitness and quality of life in older Irish set dancers and age-matched controls

OBJECTIVE

The objective of this study is to determine if older adults regularly participating in Irish set dancing have superior balance, physical fitness and quality of life compared to age-matched controls.

STUDY DESIGN

This study used a community-based, observational cross-sectional design.

METHODS

Regular set dancers (n = 39) and age-matched controls (n = 33) were recruited. Participants were assessed using the physical activity scale for the elderly (physical activity levels), mini-BESTest (balance) and senior fitness test (battery of functional fitness tests). Quality of life was also assessed using the EuroQol EQ visual analogue scale.

RESULTS

When controlling for between-group differences in levels of physical activity (ANCOVA analysis), the dancers had significantly better balance, functional capacity and quality of life (all P < 0.05) compared to controls. No differences between the groups were observed in other measures of functional fitness.

CONCLUSION

The findings of this study suggest regular participation in set dancing is associated with health benefits for older adults. These results may inform future studies prospectively examining the role of set dancing for falls prevention, emotional well-being and cognitive function in community-dwelling older adults.

Prevalence and Association of Undernutrition with Quality of Life among Swedish People Aged 60 Years and Above: Results of the SNAC-B Study

OBJECTIVES

This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases.

DESIGN

A cross-sectional study design was used for this study. The baseline data (2001-2003) of "The Swedish National Study of Aging and Care-Blekinge (SNAC-B)" was used.

SETTING

This population-based study focused on both home-living and special-housing residents.

PARTICIPANTS

The participants (n=1402) were randomly selected and included both males and females 60-96 years of age residing in a municipality of south-east Sweden.

MEASUREMENTS

The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang's life satisfactions index A (LSIA), respectively.

RESULTS

According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18-4.52) and mental (OR 2.34, 95% CI 1.22-4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70-2.40).

CONCLUSION

The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings.

High prevalence of undernutrition in Dutch community-dwelling older individuals

OBJECTIVE

To examine the prevalence of undernutrition in community-dwelling older individuals (≥65 y) using data from various settings.

METHODS

A cross-sectional observational study was performed to examine the prevalence of undernutrition in three samples (all ≥65 y): 1) 1267 community-dwelling individuals participating in a large prospective population-based study, the Longitudinal Aging Study Amsterdam (LASA) in 1998/99; 2) 814 patients receiving home care in 2009/10; and 3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Undernutrition was assessed by the Short Nutritional Assessment Questionnaire 65+.

RESULTS

Mean age was 77.3 y (SD 6.7) in the LASA sample, 81.6 y (SD 7.4) in the home care sample, and 75.3 y (SD 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. The prevalence of undernutrition increased significantly with age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples; women were more likely to be undernourished in the general practice sample and men were more likely to be undernourished in the home care sample.

CONCLUSION

The prevalence of undernutrition in Dutch community-dwelling older individuals was relatively high, especially in home care patients.

Early determinants for the development of undernutrition in an older general population: Longitudinal Aging Study Amsterdam

Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older individuals. To achieve earlier detection or prevention of undernutrition, more information is needed about risk factors for the development of undernutrition in community-dwelling older individuals. The objective was to identify early determinants of incident undernutrition in a prospective population-based study. Baseline data (1992–3) on socio-economic, psychological, medical, functional, lifestyle and social factors of 1120 participants aged 65–85 years of the Longitudinal Aging Study Amsterdam were used. Undernutrition, defined as a BMI < 20 kg/m2 or self-reported involuntary weight loss ≥  5 % in the last 6 months, was assessed every 3 years during a 9-year follow-up period. Cox proportional-hazards regression analysis was used to investigate the association between early determinants at baseline and incident undernutrition. In 9 years, 156 participants (13·9 %) developed undernutrition. In univariate analyses, female sex, depressive symptoms, anxiety symptoms, multiple chronic diseases, high medication use (women), poor appetite, no alcohol use v. light alcohol use, loneliness, not having a partner, limitations in performing normal activities due to a health problem, low physical performance (participants aged < 75 years) and reporting difficulties walking stairs (participants aged < 75 years) were statistically significantly associated with incident undernutrition. In a multivariate model, poor appetite and reporting difficulties walking stairs (participants aged < 75 years) remained early determinants. The results of the present study can be used to identify subgroups of older individuals with increased risk of undernutrition and to identify modifiable determinants for the purpose of prevention of undernutrition.

Physical activity, obesity, nutritional health and quality of life in low-income Hispanic adults with diabetes

The study examined relationships among age, body mass index (BMI), physical activity, nutritional health, quality of life, and health-related quality of life in Hispanic adults with diabetes (N = 59) using the PRECEDE-PROCEED planning model as a framework. Data were collected through face-to-face interviews at clinics and communities. A regression model with predisposing factors (age, BMI), and behavior (nutritional health and physical activity) significantly predicted quality of life (R(2) = 0.21, F = 3.63, p < .05) explaining 21% of variance. Physical activity and nutrition were the strongest predictors. Culturally competent intervention strategies must include factors that improve and enhance quality of life.

Co-administration of l-cystine and l-theanine enhances efficacy of influenza vaccination in elderly persons: nutritional status-dependent immunogenicity

AIM

The immune response to influenza vaccine is attenuated in elderly persons, though they are at greatest risk for morbidity and mortality by influenza virus infection. Experimental studies demonstrate that co-administration of l-cystine and l-theanine enhanced antigen-specific production of immunoglobulin in aged mice infected with influenza virus. We thus investigated the effect of l-cystine and l-theanine on antibody induction by influenza vaccines in elderly persons.

METHODS

Residents in a nursing home were randomly allocated to l-cystine and l-theanine (n = 32) or placebo (n = 33). The test substances were administered p.o. for 14 days before immunization. Serum influenza virus antibody titers were measured before and 4 weeks after vaccination.

RESULTS

Vaccination significantly elevated hemagglutination inhibition (HI) titers for all the three strains of influenza viruses (A/New Caledonia [H1N1], A/New York [H3N2] and B/Shanghai) in both groups. HI titers after vaccination were not significantly different between the two groups for either strain. Also, the seroconversion rate was not significantly different between the two groups in the aggregate. A stratified analysis showed that the rate of seroconversion was significantly greater in the l-cystine and l-theanine group compared with the placebo group for influenza virus A (H1N1) among subjects with low serum total protein (63% vs 10%, P < 0.05) or low hemoglobin (71% vs 9%, P < 0.05).

CONCLUSION

Co-administration of l-cystine and l-theanine before vaccination may enhance the immune response to influenza vaccine in elderly subjects with low serum total protein or hemoglobin.

Nutritional problems in the elderly

Despite the high prevalence of malnutrition among elderly patients, nutritional problems are still not recognized as a priority forthem by health professionals. The need for nutritional assessment and intervention is particularly crucial in this age group, in whom the incidence of chronic illness is high and a myriad of socio-economic factors enhance the likelihood of malnutrition. Malnutrition could be considered as an element of frailty among the old, leading to increased risk of many geriatric syndromes such as falls, delirium, functional decline, depressed immunity, etcetera. However, detection of nutritional risk and nutritional intervention are effective in frail patients. Nutritional assessment should be part of routine clinical practice in elderly hospitalized patients. A comprehensive screening tool for assessment of nutritional status that is clinically relevant and cost effective to perform is therefore needed. If malnutrition is suggested by such screening tests, then a supplemental conventional nutritional assessment should be performed before treatment is planned.

Physical activity, menopause, and quality of life: the role of affect and self-worth across time

OBJECTIVE

Physical activity has been shown to enhance quality of life (QOL); however, few investigations of these effects exist in women undergoing the menopausal transition. The present study examined the long-term effects of physical activity on menopause-related QOL and tested the mediating effects of physical self-worth and positive affect in this relationship.

METHODS

Middle-aged women previously enrolled in a 4-month randomized controlled trial involving walking and yoga, and a control group completed a follow-up mail-in survey 2 years after the end of the trial. The survey included a battery of psychological and physical activity measures, including measures of menopausal symptoms and menopause-related QOL. Longitudinal linear panel analysis was conducted within a covariance modeling framework to test whether physical self-worth and positive affect mediated the physical activity-QOL relationship over time.

RESULTS

At the end of the trial, physical activity and menopausal symptoms were related to physical self-worth and positive affect, and in turn, greater levels of physical self-worth and positive affect were associated with higher levels of menopause-related QOL. Analyses indicated that increases in physical activity and decreases in menopausal symptoms over the 2-year period were related to increases in physical self-worth (betas = 0.23 and -0.52, physical activity and menopausal symptoms, respectively) and, for symptoms, also to decreased positive affect (beta = -0.47), and both physical self-worth (beta = 0.34) and affect (beta = 0.43) directly influenced enhancements in QOL (R = 0.775).

CONCLUSIONS

The findings support the position that the effects of physical activity on QOL are mediated, in part, by intermediate psychological outcomes and that physical activity can have long-term benefits for women undergoing the menopausal transition.

Cognitive-behavioral therapy, exercise, and older adults' quality of life

This study examined health-related quality of life (HRQL) at baseline and 6, 9, and 12 months after initiating exercise training in three groups of older adults. The conditions were cognitive-behavioral therapy, attention-control health promotion education, and a control group. Participants (N = 332) were mainly women (n = 252, 75.9%) with a mean age of 71.8 (SD = 5.1) years. Therapy participants were trained to modify their negative interpretations of exercise. Participants in the education group received information unrelated to exercise. After controlling for exercise behavior over time, the therapy group reported lower general health, more role limitations because of emotional problems, and somewhat less vitality than the control group did. The education group also reported lower general health and vitality than the control group did. Social interaction and discussion may heighten participants' awareness of these health aspects and influence their appraisal of HRQL. Findings demonstrate the complexities of HRQL and the challenge in developing effective methods for helping older adults adopt and maintain an active lifestyle.

Do Objective Measurements of Physical Function in Ambulatory Nursing Home Women Improve Assessment of Functional Status?

OBJECTIVE

To compare the functional status of ambulatory women in four academic nursing homes using standardized rating scales and physical performance measures used in community settings.

DESIGN

Observational cohort.

PARTICIPANTS

Women older than 65 years, ambulatory with or without an assistive device.

INTERVENTIONS

Direct comparison of the Functional Independence Measure and the Performance Self Maintenance Score with objective measure of the Get-up-and-go test, a six minute walk, and a six meter walk.

RESULTS

Two variables, the gait speed and creatinine clearance, correctly classified 80% of subjects with higher functional status defined by subjective rating scales.

CONCLUSION

Although gait speed calculated by a six meter walk is easily performed and highly correlated with subjectively assessed functional status, the majority of these ambulatory women nursing home residents exceeded the population means for each of the performance-based physical function measures.

The effects of nutrition-related factors on four-year mortality among a biracial sample of community-dwelling elders in the North Carolina piedmont

The purpose of this epidemiological study was to estimate mortality risk associated with poor diet quality (consumption of five food groups), extremes of body mass index (BMI), waist circumference, and impaired food-related activities of daily living among community-dwelling older Black and White men and women. The design of the current study was a retrospective-prospective cohort study. The sample included residents (n = 1920) of five North Carolina Piedmont counties. The dependent variable was four-year all-cause mortality. Analyses were stratified by gender and race, and controlled covariates included: age, living with others, income, smoking and alcohol use, cognitive status, and overall self-rated health. Data were self-reported to interviewers, except BMI and waist, which were measured by trained interviewers. Difficulty in fixing meals elevated the risk of mortality between 2.7 and 6.5 times across the four gender-race groups. Among older adults, inability to fix a meal conferred more risk of mortality than did lack of financial means. Adequate servings of vegetables were uniformly protective, although significant only among Black males. Neither BMI nor waist circumference conferred significant mortality risk. These population-based findings suggest relationships between nutrition risk factors and mortality that are unique and require further focused studies.

Physical activity, symptoms, esteem, and life satisfaction during menopause

OBJECTIVE

The present study examined the relationships among physical activity (PA), symptom reporting, self-esteem, and satisfaction with life (SWL) in 133 women (M age=51.12, S.D.=4.10) of varying menopausal status.

RESULTS

Multivariate analyses of co-variance (MANCOVA) revealed that independent of menopausal status, women who were more physically active reported significantly less severe vaso-somatic and general somatic symptoms, and higher levels of physical self-worth (PSW). Subsequent hierarchical regression analyses indicated that expended MET-h/week, reported symptoms (frequency and severity, respectively), and PSW accounted for significant variance in SWL (R2 model=0.32, for symptom frequency, and 0.33, for symptom severity). Physical activity was significantly related to SWL through the mediation of PSW. However, both reported symptom frequency and severity retained significant association with SWL after controlling for PSW, although the original associations were significantly reduced. Finally, both symptoms and MET-h/week were independent contributors to the variance in PSW (R2 model=0.33 and 0.34).

CONCLUSION

The results suggest that being physically active may reduce perceived severity of menopausal symptoms and enhance psychological well-being, and that the relationship between physical activity and QOL in mid-life women may be mediated by factors such as physical self-perceptions and menopausal symptoms.

Invited review: Aging and energy balance

Humans over 70 yr of age often lose weight. This appears to be due to a physiological anorexia of aging as well as a loss of lean mass (sarcopenia) and, to a lesser extent, fat mass. The causes of the physiological anorexia of aging include changes in taste and smell and a decrease in adaptive relaxation of the fundus of the stomach, which leads to more rapid antral filling and early satiation. In addition, basal and stimulated levels of the satiating hormone, cholecystokinin, are increased. In men, the decline in testosterone leads to an increase in leptin and a loss of lean mass. Although resting metabolic rate declines with aging, this is mainly due to the decline in lean body mass. Energy metabolism is also decreased due to a decline in Na+-K+-ATPase activity, decreased muscle protein turnover, and possibly changes in mitochondrial membrane protein permeability. Physical energy expenditure declines with aging. Meal-induced thermogenesis shows a delay to peak, possibly due to a delay in gastric emptying. Inadequate data are available on the effect of aging in humans on other energy-producing mechanisms such as adaptive thermogenesis. These physiological changes place older men and women at major risk of developing pathological weight loss when they develop disease states, especially those associated with cytokine elaboration.

Andropause:

There is increasing evidence that the common condition of hypogonadism in older men when associated with symptoms responds well to testosterone replacement. Over the last few years there has been a marked increase in the awareness and treatment of the andropause [137]. Long-term side effects of testosterone are uncertain with only eight people over 50 years having been studied for 10 years [138]. Testosterone needs to be considered a quality-of-life drug, similar to sildenafil, and at present it should be used only if it produces symptomatic improvement. There is a need for a men's health study to determine the long-term efficacy and safety of testosterone replacement in older persons.