Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway

Daily walking kinematic characteristics of the elderly in different residential settings: experimental study on Chinese community-living elderly and long-term nursing home residents

BACKGROUND

Long-term nursing home (NH) care helps NH residents with their daily activities and improves their quality of life, but negatively affects their independent physical activities and increases the risk of dangerous events. Dangerous events in the elderly usually occur in the conversion of walking periods when forward striding has already happened, but the body has not yet entered a completely steady walking.

OBJECTIVES

Compare the gait characteristics in Chinese long-term NH residents and community-living elderly during the walking Transitional Period (TP) and Stabilization Period (SP).

METHODS

32 long-term NH residents and 33 age- and sex-matched community-living elderly were recruited. The 30-Second Chair Stand Test (30-s CST), Timed Up and Go Test (TUGT), and Modified Falls Efficacy Scale (MFES) were used to assess their body function. The Xsens MVN BIOMECH system was used to collect and analyze the gait parameters of participants.

RESULTS

Compared to community-living elderly, NH residents had fewer numbers of 30-s CST, took more time to complete TUGT, and lower MEFS scores. NH residents showed slower gait speed (P < 0.001), less peak hip flexion (P = 0.022) and extension (P = 0.003), knee internal rotation (P = 0.023), and ankle plantarflexion (P = 0.001) and internal rotation (P = 0.007) angles during walking. When walking progressed from TP to SP, NH residents showed increased ankle dorsiflexion (P < 0.001), decreased hip internal rotation (P < 0.001), and community-living elderly had increased hip extension (P = 0.005) angles.

CONCLUSIONS

Chinese long-term NH residents had reduced lower extremities strength and postural balance, and higher fear of falling compared to community-living elderly. Their walking performance also showed high fall risk. Besides, long-term NH residents adopted a distal strategy to propel the body forward, which may be a compensatory measure to compensate for inadequate proximal joint control from forward walking to stable walking, and long-term NH residents have reduced postural stability during this process.

Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes

BACKGROUND AND OBJECTIVES

The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C).

RESEARCH DESIGN AND METHODS

Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability.

RESULTS

A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70).

DISCUSSION AND IMPLICATIONS

This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.

Trajectory of Quality of Life Before and After Entering a Nursing Home: A Longitudinal Study

OBJECTIVES

The objective of this longitudinal study was to compare the trajectory of subjective quality of life in 2 groups of older adults: those who entered a nursing home and those who remained living in the community with similar clinical conditions.

METHOD

PAQUID is a prospective population-based study. It included, at baseline, 3777 community-dwelling participants aged 65 years and over. Participants were followed-up for up to 27 years. Among people living at home at baseline, 2 groups were compared: participants who entered a nursing home over a 20-year follow-up (n = 528) and those who remained community dwellers (n = 2273). We used latent process mixed models to estimate the relationship between mean trajectory of subjective quality of life and admission into a nursing home. We computed univariate and multivariate models taking into account potential confounders (age, gender, education, income, comorbidities, dementia, disability and depression).

RESULTS

Nursing home placement was significantly associated with a drop in quality of life between the last visit before and after institutionalization. Nevertheless, we found no difference in quality of life trajectory after this initial drop.

CONCLUSION

Older adults exhibit an acute drop in quality of life after nursing home admission, probably reflecting the associated psychological distress. Even though their quality of life does not go back to pre-admission levels, the residents do not show a steeper decline when compared to the "natural" evolution of quality of life in older adults living in the community, which suggests a relative adaptation to their new living conditions.

Views of Greenery and Psychological Well-Being in Residential Aged Care Facilities: Longitudinal Associations

OBJECTIVES

This study examined associations of objectively measured views of greenery in residential aged care facilities (RACFs) with changes in multiple psychological well-being measures among residents who were newly admitted to RACFs.

METHODS

Data were collected from 52 residents (mean age: 84, 73% women) of 13 RACFs, located in Melbourne, Australia. The outcomes were changes in depression, stress, anxiety, and quality of life (QoL) between baseline and 8-week follow-up. The exposure measures were the amount and presence of greenery visible from participant's bedroom and common areas (lounge, dining). Greenery was categorized as being either within or beyond the RACF perimeter.

RESULTS

Regression analyses found that greenery visible from participant's bedroom was not associated with any outcomes. The amount of greenery visible from common areas within the RACF perimeter was adversely related to stress, unexpectedly: Each additional 1 m² of greenery was associated with a greater increase in stress (b = 0.05; 95% CI [0.07, 0.94]). However, greenery visible from common areas beyond the perimeter contributed favorably to stress and QoL. The presence of such greenery was associated with a lower increase in stress (b = -3.99; 95% CI [-7.75, -0.23]; reference: no greenery), and a 1 m² increment was associated with a greater increase in QoL (b = 0.07; 95% CI [0.02, 0.11]).

CONCLUSION

Views of greenery outside of the RACF from lounge and dining areas may be protective against residents' stress increase and improve their QoL. Locating residents in areas with such outdoor views may prevent their psychological condition from worsening.

Self-Esteem, Anxiety, and Depression in Older People in Nursing Homes

Background: Social environment and type of care may influence mental health in late life. The aim of this study was to assess the associations between depression, anxiety, and self-esteem in older people. Methods: The study evaluated mental health in people older than 65 years of age in Zadar County, Croatia. The participants were interviewed using the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Rosenberg Self-Esteem Scale. Multiple linear regressions were used to assess the correlations between depression, anxiety, and self-esteem. Results: Compared with elderly people living in their own homes, elderly people in nursing homes reported lower self-esteem, higher depression, and higher anxiety. The level of self-esteem decreased with increased levels of depression. Anxiety was significantly associated with depression, while depression strongly increased with an increase in anxiety. Older age was associated with depression, while widowhood was a negative predictor of self-esteem. Institutionalization was borderline significantly associated with anxiety, while gender was associated with anxiety. Conclusions: The study found associations between self-esteem, anxiety, and depression in the elderly. The strategy of humanization in nursing care for older people should be applied equally in nursing homes and in community-dwelling states. Public health programs aimed at maintaining the mental health of older people are needed.

Despite Symptom Severity, do Nursing Home Residents Experience Joy-of-Life? The Associations Between Joy-of-Life and Symptom Severity in Norwegian Nursing Home Residents

Background: Finding new approaches to increase health and well-being among nursing home (NH) residents is highly warranted. From a holistic perspective, several Norwegian municipalities have implemented the certification scheme framed "Joy-of-Life Nursing Home" Aims: In a holistic perspective on NH care, this study investigated if NH residents despite potential symptom severity experience joy-of-life (JoL). Therefore, we examined the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents. Methods: A cross-sectional design was employed. Using the QLQ-C15-PAL quality-of-life questionnaire, hospital anxiety and depression scale, and JoL scale, a total of 188 cognitively intact NH residents participated. Results: Symptom severity was high; 54% reported fatigue, 52% reported constipation, 45% reported pain, 43% reported dyspnea, 32% reported insomnia, 22% reported appetite loss, and 20% reported nausea, while 20% reported anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related to the quality of life and negatively associated with anxiety and depression.

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.

SF-36 normative values according to level of functioning in older women

PURPOSE

The 36-item Medical Outcome Study Short Form (SF-36) survey measures health-related quality of life. Age and disease-specific normative values have been published, but a focus on level of functioning may be more meaningful in case of multimorbidity. We estimated normative values for Australian women aged 79-90 years according to levels of functioning.

METHODS

Data were from 6127 (aged 79-84 in 2005) and 3424 (aged 85-90 in 2011) participants in the Australian Longitudinal Study on Women's Health. Surveys included the SF-36 and information on housing. Record linkage to assessment data for access to the national program for aged care support was used to obtain information on participants' need for assistance with 10 activities. Normative values were calculated for physical component (PCS), mental component (MCS), and subscale scores for subsamples defined by types of assistance needed.

RESULTS

At the ages of 79-84, the mean (95% confidence interval) PCS and MCS values for women not any needing assistance were 37.5 (37.2-37.9) and 53.0 (52.8-53.3) compared to 29.0 (27.8-30.2) and 45.9 (44.4-47.4) for women needing any assistance. At ages 85-90, the corresponding PCS values were 34.9 (34.5-35.4) vs. 28.2 (27.4-29.0) and the corresponding MCS values were 53.2 (52.8-53.6) vs. 48.7 (47.8-49.6). Values were higher for participants living in the community or retirement village vs. nursing homes/hostels. The PCS, MCS and 8 subscale values decreased as the need for assistance with more basic activities increased.

CONCLUSIONS

These normative values facilitate meaningful interpretation of SF-36 scores from the perspective of level of functioning.

Joy of life in nursing homes: A qualitative study of what constitutes the essence of Joy of life in elderly individuals living in Norwegian nursing homes

BACKGROUND

Finding new approaches to increase positive health and well-being of elderly individuals living in nursing homes (NH) is highly warranted. Several Norwegian municipalities have implemented the certification scheme framed 'Joy of Life Nursing Home' (JOLNH). JOLNH is based on a health-promoting perspective directing elderly individuals' resources. Through health promotion, preventive and social activities across generations, NH care promotes respect, well-being, health and cultural experiences among elderly individuals.

AIMS

The aims of this study were to explore the phenomenon of Joy of life (JOL) among elderly individuals living in NHs and to provide a deeper understanding of which dimensions constitute JOL in this population.

METHODS

The present study explored the JOL phenomenon using qualitative methodology. Data were collected between December 2015 and May 2016 by individual qualitative research interviews of 29 elderly individuals who met the inclusion criteria. The informants were living in ten different NHs in two large municipalities in Norway. Prior approval was obtained from all regulatory institutions dealing with research issues and the management in both municipalities.

RESULTS

The results showed that (i) positive relations, (ii) a sense of belonging, (iii) sources of meaning, (iv) moments of feeling well, and (v) acceptance constituted the conceptualisation of the JOL phenomenon.

CONCLUSION

The dimensions constituting the JOL concept correspond to the concepts of well-being and flourishing. Knowledge of the JOL phenomenon may help professionals to target elderly individuals' health and well-being more precisely and thereby increase flourishing, JOL and well-being among them.

Differences in the Perception of Social Support Among Rural Area Seniors-A Cross-Sectional Survey of Polish Population

Introduction and objective: Social support constitutes an important determinant of an elderly person’s health and of functioning in his or her living environment. It depends on available support networks and the type of help received. Measurement of social support should encompass both its structure and the functions it fulfills, which enables detailed assessment of the phenomenon. The aim of the study was to compare the perception of social support among rural area seniors provided with institutional care with those living in a home setting. Material and method: Using the diagnostic survey method and the technique of the distribution of a direct questionnaire, 364 respondents from rural areas were examined: those living in an institutional environment (n = 190) and those living in their home (natural) environment (n = 174). The respondents were selected on the basis of a combined sampling method: proportionate, stratified, and systematic. Variables were measured with the following questionnaires: Courage Social Network Index (CSNI) and Social Support Scale (SSS). Results: The living environment has been proved to differentiate average values of support both in the structural and functional dimensions in a statistically significant way (p < 0.001). An untypical phenomenon was higher average values pertaining to emotional bonds, frequency of direct contacts, and help received in the group of respondents living in an institutional environment. Conclusions: The living environment and demographic variables affect the perception of social support among elderly people. Full-time institutional care of a senior citizen leads to the deterioration of social support; therefore, keeping an elderly person in a home environment should be one of the primary goals of the senior policy.

Relation to functional and nutritional status among hospitalized elderlies

Introduction: Adding years to life is a great achievement when this is accompanied by a good level of health and well-being and independence. Major indicators for prediction mortality risk in older adults are the nutrition status and physical functional ability. The aim of this study is to present the nutritive and functional status among institutionalized elderlies and the relatedness with certain risk factors. Material and methods: Cross-sectional study has been conducted at certain nursing homes with participation of individuals over 60 years old. As for the research Scale of Daily Living Activities (ADL) has been used to present the functional capacity of the elderly and MNA has been used to detect the nutrition status. Results: The results from the research conducted among elderlies have shown the following socio-demographic characteristics: out of 127 participants, most of them were females-77% and 69% at the age between 75 and 84. Most of the elderlies (in 68%) have completed secondary education. The results from MNA have shown that 69,2% are wellnourished, 27,6% are at risk for malnutrition and 3,2% are malnourished. There is a relatedness of the nutrition status with the gender (p < 0,001) and the level of education (p < 0,001).ADL scale among 127 elderly participants has shown that 37% are independent, 45% are with a moderate impairment and 18% are with severe functional impairment. In comparison with the females, the males show higher level of functional ability in all ADL components except the continence. Conclusion: The results from the research have shown that the nutrition status among elderlies is satisfactory, emphasizing the factors such as gender, education level and functional ability as key points for the level of nutrition status at the elderlies.

Association between social support and health-related quality of life among Chinese rural elders in nursing homes: the mediating role of resilience

PURPOSE

This study aims to confirm the relationship between social support and health-related quality of life (HRQOL) among rural Chinese elders in nursing homes, and to examine the mediating role of resilience in the impact of social support on HRQOL.

METHODS

A cross-sectional survey of 205 elders aged 60 and above was conducted in five rural public nursing homes. Sociodemographic characteristics, the SF-36 questionnaire, and information about social support and resilience were collected. The researchers administered the questionnaires to the participants in a face-to-face setting. Descriptive analysis and a correlation matrix were used to indicate characteristics of the participants and bivariate correlations, respectively. The mediation analyses, composed of regression analysis and PROCESS analysis, were preformed to test both direct and indirect effects of social support on HRQOL, namely the mediating role of resilience.

RESULTS

Social support was positively related to HRQOL (β = 0.303, p < 0.001) among Chinese rural elders in nursing homes. The mediating role of resilience in the relationship between social support and HRQOL was confirmed (a*b bootstrapped 95% confidence interval = [0.098, 0.257]), which revealed that social support had an indirect effect on HRQOL through resilience.

CONCLUSIONS

Resilience partially mediates the relationship between social support and HRQOL. The mediation model provides a better understanding of how social support and resilience work together to affect HRQOL, and it could guide the interventions in health care for promoting HRQOL among Chinese rural elders in nursing homes.

Nursing home care quality: a cluster analysis

Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients' perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents ( n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ² tests and one-way between-groups ANOVA were performed to characterise the clusters ( p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents' care quality perceptions.

Quality-of-life: a many-splendored thing? Belgian population norms and 34 potential determinants explored by beta regression

PURPOSE

To identify determinants of health-related quality-of-life in the Belgian population and to provide age-specific population norms of health-related quality-of-life.

METHODS

Between September 2010 and February 2011, a representative sample of 1774 persons (age 0-99) was surveyed using the standard Euroqol questionnaire (EQ-5D-3L) with a Visual Analogue Scale (VAS). Significant determinants were identified using multivariate beta (VAS) and one-inflated beta (EQ-5D) regression, the latter modelling the probability to be in perfect health separately from the average EQ-5D score if not in perfect health.

RESULTS

Health-related quality-of-life depends largely on age and experience with severe disease. The probability to be in perfect health is highest for children. For 0-2 years children who are not in perfect health, proxies report EQ-5D and VAS scores as low as that of the elderly. Also smoking behaviour, educational attainment, pet ownership, working or having worked in health care, and potentially household size and 60+ living on their own (yes/no) are associated with health-related quality-of-life, whereas no association was found with gender, living in a single-parent home, educational attainment of mothers, alcohol consumption of 60+, having (grand-) children and the frequency of seeing them. The same determinants are significant for VAS and the probability to be in perfect health, but not for the average EQ-5D score if not in perfect health.

CONCLUSIONS

The population norms provided can be used directly as input in health economic evaluations. Estimating health-related quality-of-life in children and developing statistical tools capturing the particular features of health-related quality-of-life measures are important areas for future research.

Psychometric properties of the Orientation to Life Questionnaire in nursing home residents

AIM

Older residents of nursing homes have several illnesses and face various challenges regarding losses of physical and mental functioning. Thus, coping and the quality of life are vital aspects in long-term care. Sense of coherence is considered an important resource for coping and the quality of life, and sense of coherence therefore needs to be validly and reliably measured in this population. We investigated the dimensionality, reliability and construct validity of the Orientation to Life Questionnaire in assessing sense of coherence among cognitively intact nursing home (NH) residents.

METHODS

We collected cross-sectional data from 227 cognitively intact NH residents (30 NHs) with one-on-one interviews. We performed confirmative factor analysis and correlations with the selected construct.

RESULTS AND CONCLUSION

In accordance with the salutogenic theory of sense of coherence, the three-factor model revealed the best fit to our data. In particular, item OLQ2, defined as 'concerns the experience of being surprised by the behaviour of people whom you know well', seemed troublesome. Removing this item resulted in good fit to the present data. Rewording or deleting item OLQ2 seems needed to get a reliable instrument measuring sense of coherence among nursing home residents.

Resident health-related quality of life in Swiss nursing homes

BACKGROUND

Health-related quality of life (HRQOL) levels and their determinants in those living in nursing homes are unclear. The aim of this study was to investigate different HRQOL domains as a function of the degree of cognitive impairment and to explore associations between them and possible determinants of HRQOL.

METHOD

Five HRQOL domains using the Minimum Data Set - Health Status Index (MDS-HSI) were investigated in a large sample of nursing home residents depending on cognitive performance levels derived from the Cognitive Performance Scale. Large effect size associations between clinical variables and the different HRQOL domains were looked for.

RESULTS

HRQOL domains are impaired to variable degrees but with similar profiles depending on the cognitive performance level. Basic activities of daily living are a major factor associated with some but not all HRQOL domains and vary little with the degree of cognitive impairment.

LIMITATIONS

This study is limited by the general difficulties related to measuring HRQOL in patients with cognitive impairment and the reduced number of variables considered among those potentially influencing HRQOL.

CONCLUSION

HRQOL dimensions are not all linearly associated with increasing cognitive impairment in NH patients. Longitudinal studies are required to determine how the different HRQOL domains evolve over time in NH residents.

Clinical use of sensory gardens and outdoor environments in norwegian nursing homes: a cross-sectional e-mail survey

Gardens and outdoor environments offer multiple therapeutic possibilities for the residents in nursing homes. Web-based questionnaires were sent to 488 nursing home leaders and 121 leaders responded. The clinical impressions of the leaders and staff regarding the benefits of sensory gardens (SGs) to the residents were consistent with previous research. SGs facilitated taking residents outdoors, offered convenient topics for communication and facilitated social privacy for relatives. For improved clinical use of SGs and outdoor environments, systematic assessment of residents' interests, performance and experiences when outdoors, implementation of seasonal clinical programmes and educational programmes for leaders and staff are recommended.

Quality of life of older adults in Turkey

The purpose of this study was to examine the factors affecting the quality of life of the elderly people in Turkey. Three-hundred community-dwelling older adults (Mage=68.35, SD=5.80 years) participated in this study. The quality of life was examined through World Health Organization Quality of Life Questionnaire-Older Adults Module Turkish Version (WHOQOL-OLD Turkish). Analysis of Variances (ANOVA) showed significant age differences in sensory abilities, social participation, and intimacy sub-scale scores. Post hoc Scheffe Test results indicated that elderly people aged 75 years and over differed from other age groups; although their scores in social participation and intimacy were lower; they had higher scores in sensory abilities than those aged 60-65 and 66-74 years. There were significant differences between the educational levels of these elderly people in sensory abilities, autonomy, past-present-and-future activities, social participation, and death-and-dying sub-scales. The autonomy, past-present-and-future activities, social participation, and death-and-dying scores of those with high school education were higher than that of those with secondary school or less education except in sensory abilities scores. There were differences found between the variable of with whom the elderly people lived and of QOL sub-scales of the elderly people's sensory abilities, past-today-and-future activities, death-and-dying, social participation, and intimacy. In addition, the total average score of the QOL sub-scales with the sufficiency of income of the elderly people were interconnected. In conclusion, the findings revealed that gender, age, education, marital status, childbearing, social insurance, health status, living arrangement and income variables are the determinant to improving the quality of life of elderly people.

Does the care dependency of nursing home residents influence their health-related quality of life?-A cross-sectional study

BACKGROUND

Studies on health-related quality of life (HRQOL) are missing for nursing home residents independent from their health conditions or interventions after admission. Our aim was to analyse if the care dependency of nursing home residents influence their HRQOL and to describe HRQOL of nursing home residents at the time of admission.

METHOD

Eleven German nursing homes were randomly selected for a cross-sectional multicentre study from April 2008 until December 2009. HRQOL was measured with the Nottingham Health Profile (NHP) in the six domains "Physical Mobility", "Energy", "Pain", "Social Isolation", "Emotional Reaction" and "Sleep". Domain scores range from zero (good subjective health status) to 100 (poor subjective health status). Care dependency was evaluated using the Care Dependency Scale, age, sex, cognitive status and diseases were documented by the research assistants. Multivariate regression analysis was performed to quantify the influence of care dependency on HRQOL.

RESULTS

120 residents were included in total. HRQOL was mostly reduced in the domains "Physical Mobility" and "Energy" (mean scores >43.0), while impairment differences in the domains "Pain", "Social Isolation", "Emotional Reaction" and "Sleep" were only moderate (≤25.0). HRQOL was not influenced by the age. Women (n = 85) had a significantly poorer HRQOL in the domain "Pain" than men (mean score women: 29.5 ± 31.5; males: 14.9 ± 17.2; p = 0.011). Care dependency had an influence on the domain "Sleep" (ß = -0.195, p = 0.031), while the other domains were not influenced by care dependency. Residents with a low care dependency scored significantly lower (better HRQOL) in the domain "Sleep" than residents with a high care dependency (mean score 15.3; SD ± 19.0 versus mean score 32.8 SD ± 33.2; p < 0.02).

CONCLUSION

The level of care dependency has no influence on the HRQOL from the nursing home residents' perspective apart from the domain "Sleep". High care dependency residents have a lower HRQOL in the domain "Sleep" compared to moderate and low care dependency residents. We found a significantly lower HRQOL in women compared to men in the domain "Pain".

Perceived health among the medically hospitalized elderly: a one-year follow-up study

AIM

To examine perceived health of elderly medically hospitalized patients 1 year after hospitalization, and to explore factors associated with the perceived health at follow-up.

METHODS

A one-year follow-up study included 363 (175 men) elderly previously medical inpatients with age range 65-98 (mean 80.2, SD 7.5) years. Information was collected at baseline and follow-up, where perceived health--the dependent variable--was measured by one self-report item. The independent variables were assessed by the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination (MMSE), Lawton and Brody's scales for physical self-maintenance and performance of the instrumental activities of daily living (PSMS and I-ADL).

RESULTS

The proportion of elderly people assessing their health as good at baseline was 43.3% (n = 157) and at 12 months 41.3% (n = 150). Of those with poor health at baseline, 34% (n = 70) experienced good health at 12 months. In the analysis controlling for physical health, perceived health, physical and instrumental functioning, and depression at baseline, an increase in the level of physical and instrumental functioning and reduced symptom level of depression were independently associated with good perceived health at 12 months.

CONCLUSIONS

Improvement in performing the activities of daily living and a reduction of depressive symptoms are important factors for the perception of health one year after hospitalization. The rehabilitation of medically ill elderly patients could be the means of achieving this improvement.

Suitability of the WHOQOL-BREF and WHOQOL-OLD for Spanish older adults

BACKGROUND

People are living longer and healthier than at any other time point in history. Therefore, in the last decade, international interest has focussed on the study of quality of life (QoL) in older people. Our aim was to study the psychometric properties of the generic QoL measure WHOQOL-BREF (WHOQOL, World Health Organization Quality of Life) and specific older adult module WHOQOL-OLD in a sample of 286 Spanish elderly.

METHODS

Participants were 60 years and older from community centres, primary care centres, family associations and nursing homes. The following information was collected: demographics, self-perception of health, depressive symptoms (Geriatric Depression Scale, GDS-30), functional status (SF-12) and QoL (WHOQOL-BREF and WHOQOL-OLD). Analysis was performed using classic psychometric techniques with SPSS v15.0.

RESULTS

We found no ceiling and floor effects, and missing data was low. The internal consistency measured by Cronbach's alpha was 0.90 for the WHOQOL-BREF total scale and 0.80 for the WHOQOL-OLD. A priori expected associations were found between WHOQOL-BREF and WHOQOL-OLD with the SF-12 and the GDS-30, indicating good construct validity. WHOQOL-BREF and WHOQOL-OLD domain scores differentiated between participants with lower and higher level of education, and between groups of older people (healthy vs. unhealthy; non-depressed vs. depressed; non-carers vs. carers and non-residents vs. residents).

CONCLUSIONS

The WHOQOL-BREF and WHOQOL-OLD questionnaires demonstrate acceptable psychometric performance in a convenience sample of Spanish older people. They are valuable measures of QoL for use with older people.

Gender differences in predictors of nursing home placement in the elderly: a systematic review

BACKGROUND

In recent decades a substantial number of studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of gender-differences in predictors of NHP from population-based, longitudinal studies worldwide.

METHODS

Relevant articles were identified by a systematic search of literature. The articles based on prospective studies with representative samples of community-living elders identified predictors by gender-specific multivariate analyses.

RESULTS

Eleven studies were identified. We found gender differences in the prediction of NHP for marital status, living situation, housing and car availability and urinary incontinence. For both genders the risk of NHP did not differ substantially for age, functional impairment, cognitive impairment, dementia, and depression. The male to female ratio of admission rates ranged between 1 to 1.4 and 1 to 1.6.

CONCLUSIONS

Only a few studies analyzed gender-specific predictors of NHP, probably owing to the associated statistical difficulties. However, gender differences in prediction of NHP do actually exist, and this should encourage further research activities in this area using appropriate statistical methods.

Sense of coherence as a resource in relation to health-related quality of life among mentally intact nursing home residents - a questionnaire study

BACKGROUND

Sense of coherence (SOC) is a strong determinant of positive health and successful coping. For older people living in the community or staying in a hospital, SOC has been shown to be associated with health-related quality of life (HRQOL). Studies focusing on this aspect among nursing home (NH) residents have been limited. This study investigated the relationship between SOC and HRQOL among older people living in NHs in Bergen, Norway.

METHODS

Based on the salutogenic theoretical framework, we used a descriptive correlation design using personal interviews. We collected data from 227 mentally intact NH residents for 14 months in 2004-2005. The residents' HRQOL and coping ability were measured using the SF-36 Health Survey and the Sense of Coherence Scale (SOC-13), respectively. We analyzed possible relationships between the SOC-13 variables and SF-36 subdimensions, controlling for age, sex, marital status, education and comorbidity, and investigated interactions between the SOC and demographic variables by using multiple regression.

RESULTS

SOC scores were significantly correlated with all SF-36 subscales: the strongest with mental health (r = 0.61) and the weakest with bodily pain (r = 0.28). These did not change substantially after adjusting for the associations with demographic variables and comorbidity. SOC-13 did not interact significantly with the other covariates.

CONCLUSION

These findings suggest that more coping resources improve HRQOL. This may indicate the importance of strengthening the residents' SOC to improve the perceived HRQOL. Such knowledge may help the international community in developing nursing regimens to improve HRQOL for older people living in NHs.