A comparison of physical health status, self-esteem, family support and health-promoting behaviours between aged living alone and living with family in Korea

Younger Older Americans and Sarcopenic Obesity: The Moderating Role of Living Alone

OBJECTIVES

Previous studies have indicated that compared to older adults, younger older adults (e.g., baby boomers) are more susceptible to obesity, but their risk decreases as they age. However, there is a lack of research on how individuals experience sarcopenic obesity, which increases in later life and is a mortality risk factor. This study examined how younger cohorts of older Americans and their demographic traits are related to sarcopenic obesity.

METHODS

Generalized estimating equations were used to analyze participants aged 65 years and older, stratified by sex using data from the 2006-2016 Health and Retirement Study, with survey weights (n = 2,896 men and n = 4,268 women).

RESULTS

The findings indicate that the youngest cohort (born between 1948 and 1953) had greater odds of sarcopenic obesity than older cohorts (born before 1931). However, the youngest cohort did not have significantly different risks from those born between 1931 and 1947. Unexpectedly, the youngest cohort of older women living alone tended not to have sarcopenic obesity compared to the older cohorts living alone. These results remained significant even after adjusting for various covariates, including marital status, race, education level, wealth, and other factors.

DISCUSSION

This paper contributes to the existing literature on population health and demographic change in 2 ways. First, the risk of sarcopenic obesity is higher among younger cohorts of older Americans relative to older cohorts (born before 1931). Second, living alone may not necessarily be considered a worse health condition, particularly for younger female cohorts.

Association of living alone and living alone time with hypertension among Chinese men aged 80 years and older: a cohort study

Objective

There is little evidence of the influence of living alone on hypertension risk among men 80 years or older. Additionally, the influence of living alone duration on hypertension risk lacks thorough investigation. Hence, this cohort study examines living alone and its duration's link to hypertension risk in this specific group.

Methods

We included 2009 older men aged ≥80 years without hypertension from the Chinese Longitudinal Healthy Longevity Survey in the 2008 wave. Follow-up was conducted in the 2011 wave. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) to assess hypertension risk related to living alone and living alone time.

Results

We included 2,009 older men, with a mean age of 90.7 years (standard deviation: 6.8). Over a median follow-up of 2.9 (1.3-3.0) years, 573 participants (28.5%) developed hypertension. Living alone was significantly associated with a higher hypertension risk than living with family (HR: 1.42; 95% CI 1.11-1.80). When compared to living with family, the hypertension risk was increased in the first quartile of living alone time (0-6.1 years) (HR: 1.76; 95% CI 1.16-2.66), the second quartile (6.1-10.6 years) (HR: 1.56; 95% CI 1.07-2.29), and the third quartile (10.6-19.3 years) (HR: 1.66; 95% CI 1.08-2.55). Surprisingly, no significant association was found in the fourth quartile (≥19.3 years) with hypertension risk. Stratified and Interaction analyses indicated no significant interaction effects between subgroups. Sensitivity analyses yielded consistent results.

Conclusion

Living alone was independently associated with an increased risk of hypertension in older men. The highest risk was found in those with the least time alone. These findings imply that social isolation and lack of companionship could be pivotal in hypertension development. Furthermore, the study highlights the need to consider living alone duration when assessing its impact on health outcomes.

AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care

STUDY DESIGN

Modified Delphi study.

OBJECTIVE

Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile.

METHODS

The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively.

RESULTS

The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type. Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (I-CVIr 0.78-1.00; Ave-CVI 0.92) appropriateness, relevance and usefulness.

CONCLUSIONS

The present study, is first to provide a universally applicable multimodal ASD patient profile to methodically describe patients. Physicians are encouraged to assess ASD patients holistically using this profile and not just based on radiographic findings.

Investigating food insecurity, health lifestyles, and self-rated health of older Canadians living alone

BACKGROUND AND OBJECTIVES

There is a large number of older of this demographic fact. Although many studies have investigated the association between living arrangements and health, little is known about potential underlying mechanisms regarding how living alone may predict older Canadians' health. In this study, we address this research gap intending to contribute to offering policy suggestions for older Canadians who live alone.

RESEARCH DESIGN AND METHODS

We applied Cockerham's health lifestyle theory to explore to what degree living alone predicts worse health lifestyles and, further, to what degree these lifestyles can explain the association between living alone and older Canadians' health. We used the 2017-2018 Canadian Community Social Survey (Annual Component) which has a response rate of 58.8%. We focused on respondents aged 60 and above, and the analytical sample size is 39,636.

RESULTS

Older Canadians living alone are more likely to have food insecurity problems and higher possibilities of smoking cigarettes compared to those living with spouses/partners with or without children. Compared to those living with spouses/partners only, the odds of solo-living older Canadians drinking regularly is significantly lower. There also exists a significant difference between older Canadians living alone and their counterparts living with spouses/partners that the former reported lower self-rated health compared to the latter. Moreover, food insecurity and the three health lifestyle variables are significantly associated with respondents' self-rated health; food insecurity, cigarette smoking, and alcohol drinking can partially explain the difference in self-rated health due to living arrangements.

DISCUSSION AND IMPLICATIONS

According to our findings, health officials are recommended to pay more attention to food insecurity and heavy smoking problems facing older Canadians who live by themselves. Local communities and other stakeholders are suggested to provide older adults living alone with more opportunities for social engagement and involvement since regular drinking may have played such a role in enhancing social life quality of the aged.

Exploring the Influencing Factors on Living Alone and Social Isolation among Older Adults in Rural Areas of Thailand

Older adults living alone present a vulnerable physical and mental health group with public health and service needs. This situation has risen and is therefore expected to increase calls for urgent attention from concerned authorities. This article focuses on the study of factors related to different living arrangements of older adults and also examines the extent to which baseline variables explained the association between living alone and social isolation characteristics. A questionnaire survey restricted to respondents aged 60 years and over, living in Ban Phaeo, Samutsakhon, Thailand, was scoped for data collection. Older adults living alone and in co-residence (living together) constitute a total of 1162 samples. The binary logistic regression model was applied to examine the association between living alone and social isolation characteristics. The result found that factors relating to older adults' different living arrangements are marital status, household members numbers, level of dependency, and type of caregivers. An association was found between the characteristics of living alone and social isolation in three relative variables, which are age, activities of daily living (ADLs), and type of caregivers. In conclusion, household living arrangements have different related factors like marital status, where a single or divorced person is more likely to live alone. Furthermore, it is also influenced by the need for caregiving on the part of the older adult or family members; particularly, their children typically emerge as the unpaid assistance from families. When only a sample of older adults living alone with social isolation is considered, it was discovered that with the advancing age of older adults living alone, whether single or married, encountered problems with the activities of daily living (ADLs). This set of people rarely goes out to perform activities outside their home and seldom attend social and physical activities. This could lead to a risk of social isolation with a greater risk of physical and mental health problems, including the well-being of older adults living alone in later life. Thus, family caregivers play a key role as a primary source of support to prevent older adults from being socially isolated, which has become an integral part of our healthcare system in promoting physical, mental, and functional health among older adults in a positive way.

Depressive Symptoms and Suicidal Ideation in Individuals Living Alone in South Korea

This study compared the prevalence of depressive symptoms and suicidal ideation in individuals living alone compared with those living with others and assessed the contribution of socio-demographic factors and physical health to these differences. We analyzed 2221 individuals living alone and 19,397 individuals living with others aged 20–80 years, drawn from the Korean National Health and Nutrition Examination Survey dataset in South Korea. The study group divided into three subgroups based on age to determine whether there were differences in mental health according to age. Depressive symptoms and suicidal ideation were evaluated by self-reported questionnaires. The sex- and age-adjusted prevalence rates of depressive symptoms and suicidal ideation were higher in those living alone than those living with others. The proportion of socio-economic status and physical health explaining the differences of depressive mood and suicidal ideation between the two groups was greater in the age group over 35 years old. Considering the difference in factors that explain depressive symptoms and suicidal ideation among individuals living alone in the age group over 35 years of age and younger groups under 34 years of age, policies should be developed that will address the mental health needs of each age group.

Significantly Increased Risk of All-Cause Mortality Among Type 2 Diabetes Patients Living Alone

Background

There is a lack of studies evaluating the association between living status and subsequent outcomes in patients with type 2 diabetes (T2DM).

Objectives

This study aimed to assess the association between living alone and the risk of all-cause mortality in T2DM patients.

Methods

We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was all-cause mortality. Multivariable Cox proportional hazard models was used to analyze and compare the hazard ratios (HRs) in patients living alone and with one or more adults.

Results

This study included 10,249 patients with T2DM. Of these, 2,078 (20.28%) were living alone and 8,171 (79.72%) lived with one or more adults. Over a median total follow-up of 8.8 years, 1,958 patients developed the primary endpoint. The all-cause mortality rates in patients living alone or living with one or more adults were 23.24 and 18.05%, respectively. Cox proportional hazard analysis showed that T2DM patients living alone had significantly higher rate of all-cause mortality than those living with others (HR, 1.34; 95% confidence interval [CI], 1.20–1.48; p < 0.001). After multivariable adjustment, living alone was an independent risk factor for all-cause mortality in patients with T2DM (adjusted HR, 1.27; 95% CI, 1.14–1.41; p < 0.001). Furthermore, the risks of both congestive heart failure (CHF) and fatal coronary heart disease (CHD) among 4,050 propensity score-matched patients were higher for patients living alone (respectively HR, 1.37; 95% CI, 1.08–1.74; p = 0.010; and HR, 1.16; 95% CI, 1.00–1.34; p = 0.047).

Conclusions

The risk of all-cause mortality was significantly higher in T2DM patients living alone than in those living with one or more adults.

Factors affecting health promoting behavior among older women in Korea: a structural equation model

The purpose of this study was to explain the health promoting behaviors of older women in South Korea using a structural equation model. The health promotion model developed by Pender was used. A survey using self-administered questionnaires was carried out between 2 October 2016 and 26 November 2016, with 252 older women ≥65 years living in Korea. The data were analyzed using structural equation modeling. The fitness parameters of the modified model (χ2 = 227.243, df = 176, χ2/df = 1.29, p = 0.006, root mean square error of approximation = 0.034, goodness of fit index = 0.927, Tucker-Lewis Index = 0.979, comparative fit index = 0.984, normed fit index = 0.933) indicated its suitability as the research model. Perceived benefits of action and social support directly influenced health promoting behavior, and prior related behavior indirectly influenced health promoting behavior. Interventions should aim to directly improve social support and perceived benefits to increase health promoting behaviors.

The determinants of caregiver use and its costs for elderly inpatients in Korea: a study applying Andersen's behavioral model of health care utilization and replacement cost method

Objectives

The average annual healthcare expenditure among elderly patients in Korea is increasing rapidly in indirect healthcare sectors, requiring an understanding of factors related to the use of both formal and informal caregivers. This study analyzed the characteristics of caregiver use and caregiving costs among elderly patients hospitalized due to acute illness or exacerbation of chronic diseases.

Methods

A total of 819 study participants were selected from the 2017 Korea Health Panel Study Data. Replacement costing methods were applied to estimate the hours of informal caregiver assistance received by elderly inpatients. Elderly inpatients’ predisposing, enabling, and need factors were studied to identify the relationship between caregiver uses, based on Andersen’s behavior model. A two-part model was applied to analyze the factors related to care receipt and to estimate the incremental costs of care.

Results

Elderly inpatients who used tertiary hospitals (OR: 2.77, p-value < 0.00) and received financial support (OR: 2.68, p-value < 0.00) were more likely to receive support from a caregiver. However, elderly inpatients living alone were lesser to do so (OR: 0.49, p-value < 0.00). Elderly inpatients with Medicaid insurance (β:0.54, p-value = 0.02) or financial aid (β: 0.64, p-value < 0.00) had a statistically positive association with spending more on caregiving costs. Additionally, financial support receivers had incremental costs of $627 in caregiving costs than nonreceivers.

Conclusions

This study presented significant socioenvironmental characteristics of formal and informal caregiver use and the related expenditures. Healthcare management plans that encompass multiple social levels should be implemented to ease the caregiver burden.

Trial registration

Retrospectively registered.

Health-Related Quality of Life in Older Adults: Its Association with Health Literacy, Self-Efficacy, Social Support, and Health-Promoting Behavior

This cross-sectional study aimed to explore the relationships among sociodemographics, health literacy, self-efficacy, social support, health-promoting behavior, and health-related quality of life (HRQOL) in older adults. A total of 240 older adults aged >65 years were recruited from three community senior welfare centers in South Korea. Standardized self-administered questionnaires measuring sociodemographic characteristics, health literacy, social support, self-efficacy, health-promoting behavior, and health-related quality of life were distributed to older adults. Multiple regression analyses with stepwise selection was used to determine the factors affecting health-related quality of life. Factors affecting a higher physical component score of HRQOL were a higher comprehension level of and numeracy in health literacy, physical health-promoting behavior, perceived emotional-informational support, and a lesser number of comorbidities. Factors affecting a higher mental component score of HRQOL were a higher comprehension level of and numeracy in health literacy, self-efficacy, physical health-promoting behavior, perceived emotional-informational support, and a lesser number of comorbidities. To improve HRQOL among older adults, nursing interventions are required to measure health literacy, empower physical health-promoting behavior and self-efficacy, and enhance emotional-informational support from family or other resources.

Perceived social support and health-related quality of life in older adults who have multiple chronic conditions and their caregivers: a dyadic analysis

RATIONALE

Patients who have multiple chronic conditions (MCCs) and their informal caregivers experience poorer health-related quality of life (HRQOL). Perceived social support has been shown to influence HRQOL.

OBJECTIVES

This study aimed at identifying the differences between patients' and caregivers' physical and mental HRQOL; and determining the association between their perception of social support from different sources, and their own and their dyad partner's HRQOL.

METHOD

Patients with MCCs and their caregivers (345 dyads) were enrolled in a multicenter cross-sectional study conducted in Italy. The Multidimensional Scale of Perceived Social Support measured perceived social support from family, friends, and significant others, and the 12-Item Short-Form Health Survey measured the physical and mental component of HRQOL in dyads. The dyadic analysis was conducted using the Actor-Partner Interdependence Model through structural equation modelling.

RESULTS

Family support perceived by each member of the dyad was associated positively with their own mental HRQOL, and that family support perceived by caregivers was also associated positively with patients' mental HRQOL. Greater family support perceived by caregivers was also associated with better physical HRQOL in both caregivers and patients. Moreover, greater friend-support perceived by each member of the dyad was positively associated with own physical HRQOL.

CONCLUSIONS

The study suggests the reciprocal influence of perceived social support from family and friends on physical and mental HRQOL in MCC dyads. Healthcare professionals should identify those people who are the main sources of support for each member of the dyad, and develop care plans that promote the maintenance and enhancing of this support.

The health and well-being of older women living alone in the United Kingdom and beyond: a scoping review

In the United Kingdom (UK), women are more likely to live alone in later life. Social factors such as household composition have been shown to affect health and wellbeing as we age. The health and well-being of older women who live alone are of interest to researchers, care providers, health organizations, and policymakers. This article contributes to the literature by detailing a scoping review, establishing the current evidence in this field. The purpose and context of the review are given. The methodology and resulting data are described. Gaps in the literature and implications for practice and research are given.

Factors Affecting Health-Promoting Lifestyle Among Older Women With Chronic Disease

The current cross-sectional descriptive study applies the Health Promotion Model to explore associations among sociodemographics, psychological factors (self-esteem), self-efficacy, perceptions of current health, and social support affecting older women with at least one chronic disease in South Korea. Convenience sampling of 232 older women aged ≥65 from a welfare center in South Korea showed that a health-promoting lifestyle is significantly and positively correlated with self-esteem, self-efficacy, perception of current health, and social support. Multiple regression analysis revealed that social support had the greatest effect on health-promoting lifestyle, explaining 49% of the dependent variable variance. Nurses serve a crucial role in providing care for older women by helping them within community settings to find resources for senior fitness, encouraging them to pursue health-related habits, and strengthening support systems by encouraging participation in social activities and maintaining strong relationships and interactions with family and friends. [Journal of Gerontological Nursing, 45(10), 29-38.].

Effects of individual, family and community factors on the willingness of institutional elder care: a cross-sectional survey of the elderly in China

OBJECTIVE

To investigate the effects of the willingness to live in elder care institutions associated with individual factors, family environment and the community environment in the elderly in China.

DESIGN

Cross-sectional survey.

SETTING

Heilongjiang Province, China.

PARTICIPANTS

A total of 1003 elderly people were selected through multistage sampling in Heilongjiang Province.

PRIMARY AND SECONDARY OUTCOME MEASURES

A multistage, stratified sampling design was employed. Differences in health status, family environment and community environment of the respondents were compared with the t-test and χ² test. Logistic regression analysis was performed to assess key determinants of willingness to live in institutions.

RESULTS

This study showed that 45.4% of respondents were willing to live in elder care institutions in the future. Factors influencing willingness to live in elder care institutions were age, house ownership, living with spouse and children, disease caregivers and availability of home healthcare services. The elders who had no property (OR=2.37, 95% CI 1.750 to 3.200, p<0.01) and those aged 80 or above (OR=2.25, 95% CI 1.490 to 3.400, p<0.01) were, respectively, 2.370 and 2.250 times more receptive to living in elder care institutions than their control groups. However, those living with a spouse (OR=0.47, 95% CI 0.287 to 0.762, p<0.01), living with children (OR=0.25, 95% CI 0.158 to 0.402, p<0.01) or living with a spouse and children (OR=0.29, 95% CI 0.160 to 0.509, p<0.01) were less willing to live in elder care institutions.

CONCLUSIONS

These results suggest that the willingness to enter elder care institutions is affected by individual, family environmental and community environmental factors. We should vigorously develop community-centred intensive home-based elder care services by improving the quality and availability of home health services by expanding investment in the community.

Factors That Influence the Relationship Between Social Support and Health-Related Quality of Life of Older People Living in the Community

As the proportion of older people in Greece grows and the need for promoting healthy aging is apparent, it becomes increasingly important to investigate the relationship between social support and health-related quality of life (HRQoL) of older people in the community. A cross-sectional study was conducted in 451 older people living in the community in greater Athens, Greece, with an anonymous questionnaire, including demographics, and the EQ5D including EuroQol-visual analogue scale (EQ-VAS) and the Multidimensional Scale of Perceived Social Support. Multivariate linear regression analysis was applied to identify independent factors related to perceived social support and HRQoL. The majority of older people were women, married or widowed, living with their family or alone. Perceived social support was medium and higher from significant others and family. A statistically significant positive relationship was found between social support from significant others/friends and HRQoL, as well as between social support from friends/family/significant others and EQ-VAS. In conclusion, HRQoL of older people is influenced by the received social support.

Living alone and positive mental health: a systematic review

BACKGROUND

Living alone has become more common in today's societies. Despite the high number of the population living alone, research directed towards the mental wellbeing issues related to living alone has been limited. This systematic literature review aimed to assess the association between living alone and positive mental health.

METHODS

We conducted searches in Medline, Web of Science, Cochrane Library, CINAHL, PsycINFO, and other complementary databases from January 1998 to May 2019. Randomised trials and observational studies investigating adults over 18 years of age and living alone (defined as living in a single household or a household size of one person) were eligible. The primary outcome was positive mental health, defined as comprising both hedonic and eudaimonic elements of mental wellbeing, and it was measured with the Warwick-Edinburgh Mental Well-being Scale and/or theWHO-5 Index. Two reviewers independently screened and selected data; one reviewer extracted data, and the second checked the extracted data. A narrative synthesis described the quality and content of the evidence. Included studies were appraised using relevant Joanna Briggs Institute checklist.

RESULTS

A total of 4 cross-sectional studies (22,591 adult participants) were included after screening of 341 titles and abstracts and 46 full-text articles. These studies were conducted in Europe and were published between 2014 and 2017. The studies differed in their measurements of positive mental health (WHO-5 Well-Being Index, 3 studies; WEMWBS, 1 study), sources of data (1 regional, 1 national, and 2 European-level studies), and study populations (regional study, adults over 65 years of age; national-level study, mental health nurses over 21 years of age; European-level studies, employees between 15 and 65 years of age and adults over 18 years of age). A potential association between living alone and low positive mental health was found in three out of the four studies. Our findings were limited as the number of included studies was low and the quality of evidence varied across studies.

CONCLUSIONS

This review allows a limited look at the association between living alone and positive mental health. Because the number of included studies was low and the quality of evidence varied across studies, further research is warranted.

Health promotion interventions for older people living alone: a systematic review

AIMS

The aim of this systematic literature review was to identify health promotion interventions for older people living alone and to describe the effectiveness of these interventions.

METHODS

A literature search was conducted using five databases, including CINAHL, Ovid MEDLINE, PubMed, Cochrane, Scopus, and Web of Science, and this comprehensive literature search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Potentially relevant studies were evaluated and selected by two authors. Studies were assessed based on inclusion criteria. The Standardised Critical Appraisal Tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to appraise the methodological quality of these studies.

RESULTS

Of the 2852 unique studies identified in the systematic search, the full texts of three studies meeting the inclusion criteria were reviewed. The results showed that the level of physical activity and self-efficacy for physical activity, activities of daily living, food enjoyment, and energy intake increased and leisure engagement decreased with health promotion interventions.

CONCLUSION

The findings of this review indicate that interventions to improve health promotion positively affect the health of older people living alone and enhance their quality of life. There is a need for further research involving multidimensional interventions for older people living alone.

Comparisons of Health Promoting Behavior, Depression, and Life Satisfaction Between Older Adults in Rural Areas in South Korea Living in Group Homes and at Home

Background:

In South Korea, population aging is advancing at a more rapid rate in rural areas than urban areas, leading to a particularly high percentage of rural-dwelling older adults.

Purpose:

The aim of this study was to examine and compare health promoting behaviors, depression, and life satisfaction between rural-dwelling older adults who live, respectively, in group homes and at home.

Methods:

A cross-sectional descriptive study design was employed. Study participants included 160 older adults aged 65 years and older who were living in group homes (n = 80) and at home (n = 80) in Gyeonggi province, South Korea. The Health Promotion Lifestyle Profile-II was used to examine health promoting behaviors, the Korean Geriatric Depression Screening Scale was used to examine depression, and the Life Satisfaction Index was used to examine life satisfaction. Data were analyzed using SPSS Version 21.0.

Results:

The data showed significant differences between the two groups in terms of health promoting behaviors (t = −9.035, p < .001), depression (t = 20.861, p < .001), and life satisfaction (t = −12.153, p < .001).

Conclusions/Implications for Practice:

The mean scores for health promotion behaviors and life satisfaction were higher, and the mean score for depression was lower in the group-home group than the at-home group. The findings from this study may be employed as basic data for establishing residence-appropriate nursing intervention protocols for older adults living in rural areas.

Perceived quality of life and living arrangements among older rural South Africans: do all households fare the same?

This study explores how living arrangements influence perceived quality of life in an elderly population in rural South Africa. We use data from the longitudinal World Health Organization Study of Global Ageing and Adult Health Survey (WHO-SAGE) and from the Agincourt Health and Socio-Demographic Surveillance System (HDSS). On average, older men and women who reside in single-generation and complex-linked multigenerational households report worse quality of life than those in two-generation and linear-linked multigenerational households. However, after controlling for prior wellbeing status, we find living arrangements to have a significant impact on women's perceived quality of life only, and that it is moderated by age. We conclude that not all multigenerational arrangements are protective of older adults’ wellbeing and highlight the gendered impact of living arrangements on quality of life. These results suggest the necessity to understand how living arrangements influence the social roles of older adults and change with age.

Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households: A study protocol

AIMS

To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore.

BACKGROUND

In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people.

DESIGN

A stratified randomized control trial with process evaluation is proposed.

METHODOLOGY

The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme.

DISCUSSION

The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senior-only households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life.

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.

Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study

BACKGROUND

Multimorbidity has a high prevalence in the primary care context and it is frequently associated with worse health-related quality of life (HRQoL). Few studies evaluated the variables that could have a potential effect on HRQoL of primary care patients with multimorbidity. The purpose of this study, the first of its kind ever undertaken in Portugal, is to analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care.

METHODS

Multicentre, cross-sectional survey conducted among primary care patients with multimorbidity. It included 521 participants (64.1 % females) who met the inclusion criteria. HRQoL was evaluated using the Portuguese Short Form-12 Health Status Questionnaire. The Portuguese Family APGAR was used to measure the perceived family support. A patients' unmet health needs questionnaire was used. The unmet needs for medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid was assessed. Descriptive and multivariate analyses were performed.

RESULTS

The sample had an overall average of 4.5 chronic health problems. Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Some variables were confirmed as playing a role on health-related quality of life. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their health needs.

CONCLUSION

To improve the quality of life of multimorbid patients, within primary care practices and health delivery systems, one should take into special account the sex of the patient, the perceived family support and the self-perceived economic status because of their relationship with both physical and mental health. Limitations and recommendations are discussed.

Culture and Healthy Eating: The Role of Independence and Interdependence in the United States and Japan

Healthy eating is important for physical health. Using large probability samples of middle-aged adults in the United States and Japan, we show that fitting with the culturally normative way of being predicts healthy eating. In the United States, a culture that prioritizes and emphasizes independence, being independent predicts eating a healthy diet (an index of fish, protein, fruit, vegetables, reverse-coded sugared beverages, and reverse-coded high fat meat consumption; Study 1) and not using nonmeat food as a way to cope with stress (Study 2a). In Japan, a culture that prioritizes and emphasizes interdependence, being interdependent predicts eating a healthy diet (Studies 1 and 2b). Furthermore, reflecting the types of agency that are prevalent in each context, these relationships are mediated by autonomy in the United States and positive relations with others in Japan. These findings highlight the importance of understanding cultural differences in shaping healthy behavior and have implications for designing health-promoting interventions.

STRATEGIES DEVELOPED BY COMMUNITY-DWELLING ELDERLY PEOPLE TO LIVE ALONE

ABSTRACT The aim of this study was to analyze strategies developed by the elderly in order to live alone. A qualitative, exploratory research was conducted with 14 elderly individuals, who lived in a community that belongs to the area assisted by a basic health unit in a city in southern Brazil. Data were collected through interviews and analyzed by means of the thematic content analysis technique. In order to analyze the strategies, three categories were constructed, according to the identified behaviors. Strategy 1: behaviors in search of social support; strategy 2: behaviors in search of keeping active; strategy 3: behaviors in search of religiosity. The analysis of the strategies developed by the elderly enabled us to understand how they use the available resources to handle difficulties that are inherent to the process of aging.

Quality of Life Is Related to Social Support in Elderly Osteoporosis Patients in a Chinese Population

OBJECTIVE

To explore the association between quality of life and social support in elderly osteoporosis patients in a Chinese population.

METHODS

A total of 214 elderly patients who underwent bone mineral density screening were divided into two groups: elderly patients with primary osteoporosis (case group, n = 112) and normal elderly patients (control group, n = 102). Quality of life and social support were compared between the two groups.

RESULTS

Quality of life and social support were significantly different between the case and control groups. The physical function, role-physical, bodily pain, general health, vitality, social-functioning, role-emotional and mental health scores in case group were significantly lower than those in the control group (P < 0.01). The objective support, subjective support, utilization of support, and total scores in case group were significantly lower than those in the control group (P < 0.01). Quality of life and social support were positively correlated in the case group (r = 0.672, P < 0.01).

CONCLUSION

Quality of life and social support in elderly patients with osteoporosis in China were poorer than in elderly patients without osteoporosis and were positively correlated. Our findings indicate that increased efforts to improve the social support and quality of life in elderly osteoporosis patients are urgently needed in China. Further longitudinal studies should be conducted to provide more clinical evidence to determine causative factors for the observed association between risk factors and outcomes.

The effect of health promoting intervention on healthy lifestyle and social support in elders: a clinical trial study

Background:

Many of the problems pertaining to old age originate from unhealthy lifestyle and low social support. Overcoming these problems requires precise and proper policy-making and planning.

Objectives:

The aim of the current research is to investigate the effect of health promoting interventions on healthy lifestyle and social support in elders.

Patients and Methods:

This study was conducted as a clinical trial lasting for 12 months on 464 elders aged above 60 years who were under the aegis of health homes in Tehran, Iran. Participants were selected through double stage cluster sampling and then divided into intervention and control groups (232 individuals in each). Tools for gathering data were a demographic checklist and two standard questionnaires called Health-Promoting Lifestyle Profile version 2 and personal resource questionnaire part 2. Data were analyzed using descriptive and analytical tests including paired t test, analysis of covariance (ANCOVA) and Pearson correlation coefficient.

Results:

The average age of elders in this study was 65.9 ± 3.6 years (ranging between 60 and 73 years old). Results showed that the differences between the mean post-test scores of healthy lifestyle and its six dimensions as well as perceived social support and its five dimensions in the control and intervention groups were statistically significant (P value < 0.0001).

Conclusions:

Aging is an inevitable stage of life. However, effective health promoting interventions can procrastinate it, reduce its consequences and problems, and turn it into a pleasant and enjoyable part of life.

An educational program based on the successful aging approach on health-promoting behaviors in the elderly: a clinical trial study

Background:

Many criteria of successful aging are directly connected with Health-Promoting Behaviors.

Objectives:

The current study aimed to evaluate the effect of an educational program based on the successful aging approach on health promoting behaviors in the elderly.

Patients and Methods:

This clinical trial study was conducted on 464 Iranian elderly people over 60 years who were admitted at Health Houses for 12 months. Participants were selected through a two-stage cluster sampling and were placed in the control and intervention groups (232 participants in each group). The data collection tools included: a demographic checklist, Palmore Facts on Aging Quiz and the second version of Health Promoting Lifestyle Profile. The intervention was designed based on adult strategy education in five 45-minute sessions. The data obtained 3 months after the intervention were compared with the data obtained before the intervention. The data were analyzed using the descriptive and analytical tests such as paired T-test with SPSS version 20, at the statistical significant level 0.05.

Results:

The mean age of the participants in this study was 65.9 ± 3.6 (range 60-73). Results showed a statistically significant difference between the intervention and control group after the intervention in the mean scores of awareness of aging facts and score of health promoting behaviors.

Conclusions:

Focusing on successful aging and adopting HPBs can prevent and decrease aging problems which in turn decreases the financial burden and related costs. This is especially important for the policy and decision makers of the health systems.

Environmental mobility barriers and walking for errands among older people who live alone vs. with others

Background

Walking is the most popular form of physical activity among older people and for community-dwelling older people walking for errands is especially important. The aim of this study is to examine the association between self-reported environmental mobility barriers and amount of walking for errands among older people who live alone compared to those who live with others.

Methods

This observational study is based on cross-sectional data on 657 people aged 75–81 living in Jyväskylä, Central Finland. Self-reports of environmental mobility barriers were collected under four categories: Traffic, Terrain, Distances and Entrance. Persons who reported walking for errands ≤ 1.5 km/week or at most once a week were categorized as having low amount of walking for errands (LOWER). High walking for errands (HIGWER) was defined as the highest quartile of kilometers walked per week (cut-off 8.5 km, referent). The rest were defined as having moderate amount of walking for errands (MODWER). Multinominal regression analysis was used to compare the odds for LOWER vs. HIGWER and MODWER vs. HIGWER, which were formed for each environmental mobility barrier separately.

Results

Participants walked on average 6.5 km (SD 5.2) and 4.0 times (SD 2.2) per week and 14% reported LOWER. Persons living alone (57% of the participants) reported environmental mobility barriers more often than those living with others. LOWER was more common among those living with others. Among those living with others, all the environmental mobility barriers increased the odds for LOWER. In turn, among those living alone, only Distance- and Entrance- related environmental mobility barriers increased the odds for LOWER. People living alone typically run errands by themselves and become better aware of the barriers to environmental mobility, while those living with others have less exposure to environmental mobility barriers, as their walking for errands is more likely to be low.

Conclusions

These findings emphasize the need to take living arrangements into account when analyzing the association between environmental mobility barriers and walking for errands. Future longitudinal studies are warranted to better understand the temporal order of events and to find ways to enhance walking for errands among older people.

Arranjos e rede de apoio familiar de idosos que vivem em uma área rural

O presente estudo identifica os arranjos familiares e descreve a rede de apoio familiar de idosos que vivem em uma área rural. Trata-se de um estudo transversal, realizado com 36 idosos, através de entrevistas no domicílio. Os resultados demonstraram um número maior de mulheres (80,6%) entre os idosos, com boas condições de moradia e renda. O arranjo familiar mais encontrado foi o tri geracional (50%), em que residem idosos, filhos e netos. Observou-se um processo de via dupla nas transferências informais entre idosos, chefes de família e outros familiares que residem com o idoso. Nas famílias em que o idoso não é o chefe familiar, os idosos recebem mais ajuda do que prestam, ocorrendo o inverso nas famílias em que o idoso é o chefe. Este estudo favorece o surgimento de ações para o idoso rural e suas famílias, que apresentam dificuldades de acesso aos serviços de saúde.