Proximal predictors of change in quality of life at older ages

Quality of life in people with chronic kidney disease: focusing on modifiable risk factors

PURPOSE OF REVIEW

With ageing populations and rising prevalence of key risk factors, the prevalence of many long-term conditions including chronic kidney disease (CKD) is increasing globally. Health-related quality of life (HRQoL) is important to people living with CKD but not all HRQoL determinants are modifiable. This review summarizes recently identified potentially modifiable factors affecting HRQoL for people with CKD and recent trials incorporating HRQoL as an outcome.

RECENT FINDINGS

Considering a broad definition of 'potentially modifiable', many factors have been associated with HRQoL in recent observational studies. These include mental health conditions, symptoms, medications, health behaviours, weight-related issues, poor social support, lower education, limited literacy and directly CKD- related factors such as anaemia. Some potentially modifiable factors have been tested in CKD trials, though often with HRQoL as a secondary outcome, so may be underpowered for HRQoL. Interventions with evidence of effect on HRQoL include physical activity, education, some nutritional interventions and medications targeting CKD-related anaemia.

SUMMARY

Clinicians should consider the range of potentially modifiable factors influencing HRQoL as part of a holistic approach to CKD care. High-quality, adequately-powered trials, with HRQoL as a primary outcome, with interventions focusing on the other potentially modifiable factors identified are needed.

The association between medication use and health-related quality of life in multimorbid older patients with polypharmacy

PURPOSE

To explore the association between medication use-related factors and health-related quality of life (HRQoL) in older hospitalised multimorbid patients with polypharmacy.

METHODS

This cross-sectional study used the intervention arm data of the OPERAM trial (hospitalised patients ≥ 70 years with polypharmacy). HRQoL was assessed using the visual analogue scale (EQ-VAS) and the EQ-5D index score of the EuroQol questionnaire (EQ-5D-5L). Lower or higher EQ-VAS/EQ-5D was based on the median of the study population. Medication use-related factors included hyperpolypharmacy (≥ 10 medications), anticholinergic and sedative burden, appropriateness of medication (STOPP/START criteria), high-risk medication for hospital (re)admission, medication complexity and adherence. Multivariable logistic regression analysis was used to assess the association between medication use-related factors and HRQoL.

RESULTS

A total of 955 patients were included (mean age 79 years, 46% female, median EQ-VAS of 60, median EQ-5D of 0.60). Opioids use was associated with lower EQ-5D and EQ-VAS (aOR EQ-5D: 2.10; 95% CI 1.34-3.32, EQ-VAS: 1.59; 1.11-2.30). Hyperpolypharmacy (aOR 1.37; 1.05-1.80), antibiotics (aOR 1.64; 1.01-2.68) and high medication complexity (aOR 1.53; 1.10-2.15) were associated with lower EQ-VAS. A high anticholinergic and sedative burden (aOR 1.73; 1.11-2.69), presence of multiple prescribing omissions (aOR 1.94; 1.19-3.17) and benzodiazepine use (aOR 2.01; 1.22-3.35) were associated with lower EQ-5D. Especially in hyperpolypharmacy patients, high anticholinergic and sedative burden and medication complexity were associated with a lower HRQoL.

CONCLUSION

Several medication use-related factors are significantly associated with a lower HRQoL in hospitalised older patients. Medication complexity is a novel factor, which should be considered when evaluating medication use of older patients with hyperpolypharmacy.

The use of photovoice to explore the physical disability experience in older adults with mild cognitive impairment/early dementia

Although co-occurring cognitive impairment and physical disability in older adults is common, there is little understanding of how this group perceives their ability to do their daily activities. This study used photovoice to explore how older adults with MCI/early dementia and physical disability without and with care partners (dyads) perceive challenges with their daily activities. Photovoice is a visual research methodology to capture participants' insight on aspects of their daily lives. No known studies have taken this approach to explore the experiences of older adults with MCI/early dementia and co-occurring physical disability. We used a cross-sectional, exploratory research design to understand participants' (n = 12) experiences in their home environment. Photos and participant thoughts on the photos were categorized based on the Blackfoot Breath of Life Theory and the Hierarchy Model of Needs in Dementia, an adaptation of Maslow's Model. Notable findings included: awareness of physical/cognitive difficulties by older adults, solutions for ADL difficulty in persons with MCI/early dementia, care partners' difficulty recognizing pain without the presence of severe emotional or physical responses, reducing mood severity, and self-esteem needs met with structured, memory-issue adapted, meaningful activities. Older adults with co-occurring physical disability and MCI/early dementia identified both physiological and psychological needs despite challenges impacting their cognition. Photovoice evoked daily situations of these individuals and revealed the importance of developing individualized intervention elements for older adults with dementia and physical disability.

A model to forecast the two-year variation of subjective wellbeing in the elderly population

BACKGROUND

The ageing global population presents significant public health challenges, especially in relation to the subjective wellbeing of the elderly. In this study, our aim was to investigate the potential for developing a model to forecast the two-year variation of the perceived wellbeing of individuals aged over 50. We also aimed to identify the variables that predict changes in subjective wellbeing, as measured by the CASP-12 scale, over a two-year period.

METHODS

Data from the European SHARE project were used, specifically the demographic, health, social and financial variables of 9422 subjects. The subjective wellbeing was measured through the CASP-12 scale. The study outcome was defined as binary, i.e., worsening/not worsening of the variation of CASP-12 in 2 years. Logistic regression, logistic regression with LASSO regularisation, and random forest were considered candidate models. Performance was assessed in terms of accuracy in correctly predicting the outcome, Area Under the Curve (AUC), and F1 score.

RESULTS

The best-performing model was the random forest, achieving an accuracy of 65%, AUC = 0.659, and F1 = 0.710. All models proved to be able to generalise both across subjects and over time. The most predictive variables were the CASP-12 score at baseline, the presence of depression and financial difficulties.

CONCLUSIONS

While we identify the random forest model as the more suitable, given the similarity of performance, the models based on logistic regression or on logistic regression with LASSO regularisation are also possible options.

Enhancing the effectiveness of CBT for patients with unipolar depression by integrating digital interventions into treatment: A pilot randomized controlled trial

OBJECTIVE

Blended cognitive behavioral therapy (bCBT) combines face-to-face therapy with digital elements, such as digital health apps. This pilot study aimed to explore the effectiveness and safety of a novel bCBT application for treating unipolar depression in adults combined with cognitive behavioral therapy (CBT) compared to CBT alone in routine care.

METHODS

Patients (N = 82) were randomly assigned to bCBT (n = 42) or CBT (n = 40) over 12 weeks. bCBT consisted of weekly CBT sessions accompanied by the elona therapy depression module (a bCBT application for unipolar depression) for use between sessions. Standard CBT consisted of weekly CBT sessions. Outcomes (6,12 weeks) were analyzed with linear mixed models.

RESULTS

Improvements in depressive symptoms (BDI-II, PHQ-9) were descriptively larger for the bCBT group. Yet, this difference did not reach statistical significance. bCBT was superior to standard CBT in secondary outcome measures of psychological health (d = .50) and generalized anxiety symptoms (d = -.45). In other secondary outcomes (BAI, PSWQ, GSE, WHOQOL-BREF), improvements were descriptively larger for bCBT compared to CBT.

CONCLUSION

This pilot study provided preliminary evidence that bCBT might be advantageous in comparison to CBT alone in the treatment of depression, but larger RCTs of the bCBT application are needed.

Trajectories of generalized anxiety disorder, major depression and change in quality of life in adults aged 50 + : findings from a longitudinal analysis using representative, population-based data from Ireland

PURPOSE

To investigate the longitudinal association between trajectories (incidence, remission) of generalized anxiety disorder (GAD), major depression (MD) and change in quality of life (QoL) in adults aged 50 + , and to assess the symmetry in these relationships using observational study data.

METHODS

Data were derived from two waves of The Irish Longitudinal Study on Aging (2014-2015, wave 3: n = 6400; 2016, wave 4: n = 5715), a nationally representative cohort of community-dwelling adults aged 50 +. GAD and MD were assessed by means of the short form of the Composite International Diagnostic Interview. QoL outcomes were assessed using the Control, Autonomy, Self-realization, and Pleasure scale (CASP-12 with two domains control/autonomy and self-realization/pleasure). Covariate-adjusted, asymmetric fixed effects panel regressions and post-estimation Wald tests were used for statistical analysis.

RESULTS

Regarding incident disorders, only incident MD was significantly associated with a reduction in QoL over time (control/autonomy domain: b = - 0.74, SE: 0.30). Regarding remission, both remission of MD (b = 0.61, SE: 0.20) and remission of GAD (b = 0.61, 0.26) were significantly associated with an increase in the self-realization/pleasure domain over time. Subsequent Wald tests of the estimates were not significant, indicating symmetric effects.

CONCLUSION

Particularly the remission of GAD and MD was associated with a significant improvement in one of the QoL domains, indicating domain- and trajectory-specific differences. However, symmetric effects observed in this study indicate that gains and losses in QoL associated with remission and incidence of GAD and MD are of similar magnitude in adults aged 50 +.

Longitudinal effects of choir singing on aging cognition and wellbeing: a two-year follow-up study

Introduction

While increasing evidence points toward the benefits of musical activities in promoting cognitive and emotional well-being in older adults, more longitudinal studies are needed to establish their long-term effects and uncover the mechanisms through which musical activities affect well-being. Most previous research has focused on instrumental musical activities, but little is currently known about the long-term effects of singing, even though neuroimaging evidence suggests that it is a versatile activity for the brain, involving a multitude of neural processes that are potentially beneficial for well-being.

Methods

We conducted a 2-year follow-up study to assess aging-related changes in cognitive functioning and emotional and social well-being with self-report questionnaires and standardized tests in 107 older adult choir singers and 62 demographically matched non-singers. Data were collected at baseline (T1), and at 1-year (T2) and 2-year (T3) follow-ups using questionnaires on subjective cognitive functioning, depression, social engagement, and quality of life (QOL) in all participants and neuropsychological tests in a subgroup of participants (45 choir singers and 41 non-singers).

Results

The results of linear mixed model analysis showed that in verbal flexibility (phonemic fluency task), the choir singers had higher scores already at T1 and showed no change over time, whereas the non-singers showed enhancement from T1 to T3. Furthermore, active retrieval of word knowledge (WAIS-IV Vocabulary task) showed significantly different changes from T1 to T2 between the groups (enhancement in choir singers and decline in non-singers), however lacking significant change within groups. Similar opposite trajectories of QOL related to social inclusion and safety of the environment (WHOQOL-Bref Environmental subscale) were significant from T1 to T3, but these changes were not significant within groups or at each timepoint. Within the choir singers, shorter experience in choir singing was associated with greater improvement in the vocabulary task over the follow-up period, suggesting that initiation of choir singing at older age induces some verbal benefits. There were no group differences in any other questionnaire or neuropsychological measure over time.

Discussion

In conclusion, our results suggest that choir singing at older age is associated with a sustained enhancement of phonemic fluency, while the effects on other verbal skills and quality of life are less clear.

Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

BACKGROUND

HRQoL is an indicator of individuals' perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.

METHODS

This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.

RESULTS

We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.

CONCLUSIONS

Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life.

Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

BACKGROUND

This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany.

METHODS

Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly.

RESULTS

One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status.

CONCLUSIONS

Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.

Quality of Life among Indonesian during the COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic created major shifts around daily life across the globe. The rapid increase in cases throughout the world resulted in lockdown policies that resulted in the closure of schools and businesses, restrictions on movement or population mobilization, and restrictions on international travel. These changes affect the welfare of many communities, including the quality of life among community members. AIM: This cross-sectional study aims to determine the risk factors associated with poor quality of life during the COVID-19 pandemic. METHODS: Data were collected using an online questionnaire which collected information on demography, psychological responses, and quality of life. A total of 324 participants were recruited. Descriptive and statistical analyses were performed using Chi-square. RESULTS: The findings showed that anxiety is associated with quality of life (p = 0.03) and individuals who experience anxiety are at 2.0 times higher risk of experiencing poor quality of life compared to those who do not experience anxiety. CONCLUSION: Nurses can play a role in managing anxiety by providing education which helps people reframe their perspectives and direct people to information from trusted sources, exercising, or other activities which support well-being.

Can the internet mitigate the negative effect of widowhood on Quality of Life? A gender analysis

Widowhood often reduces the Quality of Life of individuals of advanced ages by negatively affecting their social network ties. Yet conversely, the Internet has also created new opportunities for communication and interaction, thus contributing to improved Quality of Life. This research analyses the role of the Internet in the relationship between widowhood and Quality of Life from a gender perspective.

This study focuses on 31,814 individuals aged 65 or over residing in 17 European countries who participated in Wave 6 of SHARE – the Survey of Health, Ageing and Retirement in Europe.

The linear regression analyses highlighted that the role of the Internet in the relationship between widowhood and Quality of Life varies according to gender. More specifically, in Europe, the Quality of Life for widowed women aged 65+ using the Internet is .414 higher (CI=.006 to .0822) than widows who do not use the Internet and married women or women in a de facto relationship whether or not they use the Internet. The results have relevant implications for the development of social policies and suggest a need to develop digital inclusion projects targeting older people, particularly widows, to help promote their Quality of Life.

Loneliness as a gender-specific predictor of physical and mental health-related quality of life in older adults

PURPOSE

Health-related quality of life (HRQOL) in older persons is influenced by physical and mental health, as well as by their social contacts and social support. Older women and men have disparate types of social networks; they each value social ties differently and experience loneliness in unique and personal ways. The aim of this study is, therefore, to determine the longitudinal association between loneliness and social isolation with HRQOL in older people-separated by gender.

METHODS

Data stem from the third and fourth follow-up of the ESTHER study-a population-based cohort study of the older population in Germany. A sample of 2171 older women and men (mean age: 69.3 years, range 57-84 years) were included in this study; HRQOL was assessed by using the Short Form-12 questionnaire (SF-12). Data on physical and mental health, loneliness, and social networks were examined in the course of comprehensive home visits by trained study doctors. Gender-specific linear regression analyses were performed to predict physical quality of life (measured by the PCS, physical component score of the SF-12) and mental quality of life (measured by the MCS, mental component score) after three years, adjusted by socioeconomic variables as well as physical, mental, and social well-being.

RESULTS

At baseline, PCS was 41.3 (SD: 10.0) in women and 42.2 (SD: 9.6) in men (p = .04). MCS was 47.0 (SD: 10.2) in women and 49.6 (SD: 8.6) in men (p < .001). In both genders, PCS and MCS were lower three years later. Loneliness at t0 was negatively associated with both PCS and MCS after three years (t1) among women, and with MCS but not PCS after three years among men. In both genders, the strongest predictor of PCS after three years was PCS at t0 (p < .001), while the strongest predictors of MCS after three years were MCS and PCS at t0.

CONCLUSION

HRQOL in elderly women and men is predicted by different biopsychosocial factors. Loneliness predicts decreased MCS after three years in both genders, but decreased PCS after three years only in women. Thus, a greater impact of loneliness on the health of older women can be surmised and should therefore be considered in the context of their medical care.

Socioeconomic Status, Physical Functioning and Mortality: Results From a Cohort Study of Older Adults in Hong Kong

OBJECTIVES

It is inconsistent in the literature on whether inequalities of health in older age widen or narrow over time. We assessed the associations of socioeconomic status (SES), physical functioning, and mortality in an older age cohort in Hong Kong.

DESIGN

Longitudinal cohort study.

SETTING AND PARTICIPANTS

We recruited 2032 older adults aged 70+ in 1991 to 1992 and followed them for 10 years.

METHODS

SES was operationalized as education, baseline individual income, and longest-held occupation in lifetime. Physical functioning was measured by Barthel's Index for activities of daily living (ADL), from which disability was defined as ADL score <20. Mortality data were obtained from the Death Registry. Bayesian joint modeling with 2 sub-models, mixed-effect, and Cox proportional hazard model, were used to respectively model the associations of SES and disability, and SES and mortality, accounting for selection by mortality.

RESULTS

Education and income at baseline were not clearly related to disability, but those with lower education level and income at baseline tended to have their risks increased with time. Older adults who had been mostly economically inactive or unemployed in their lifetime had higher risk of disability [odds ratio 3.24; 95% credible interval (95%CrI) 1.29 to 7.97], and such risk increased over time. For mortality, older adults with no schooling were at higher risk compared with those with secondary education or above (hazard ratio 1.25; 95%CrI 1.00 to 1.57). Income at baseline and longest-held occupation in lifetime were not clearly related to mortality.

CONCLUSIONS AND IMPLICATIONS

We observed inequalities of health of older adults in Hong Kong that widened as they age. Community and medical interventions targeting the older adults with the lowest SES would be important to prevent their more rapid decline in physical functioning.

Does the selective attrition of a panel survey of older people affect the multivariate estimations of subjective well-being?

PURPOSE

The increased population aging has resulted in a growing need for longitudinal studies about the quality of life among older people. Nevertheless, the results of these investigations could be biased because more disadvantaged people leave the original sample. The purpose of this study is to examine how the selective attrition observed in a panel survey affect multivariate models of subjective well-being (SWB). The question is if we could do reliable longitudinal investigations concerning the predictors of SWB in old age.

METHODS

This paper examines attrition in a panel of older people in Chile. Attrition was evaluated in the variables that affect elderly SWB. Probit models were fitted to compare dropouts with nondropouts. Then, multivariate probit models were estimated on satisfaction and depressive symptoms, comparing dropouts and nondropouts. Finally, we compared weighted and unweighted multivariate probit models on SWB.

RESULTS

The attrition rate in 2 years was 38.8%, including deaths and 32.9%, excluding them. Survey dropouts had lower satisfaction but not higher depressive symptoms. Among SWB predictors, people without a partner and with lower self-efficacy abandoned more the study. When applying the Becketti, Gould, Lillard, and Welch test, the probit coefficients of the predictor variables on SWB outcome variables were similar for dropouts and nondropouts. Finally, the comparison of multivariate models on SWB with weighting methods did not find substantial differences in the explanatory coefficients.

CONCLUSION

Although some predictors of attrition were associated with SWB, attrition did not produce biased estimates in multivariate models of life satisfaction life or depressive symptoms in old age.

Self-Efficacy Mediates the Association Between Physical Function and Perceived Quality of Life in Individuals with Mild Cognitive Impairment

BACKGROUND

Research has shown that individuals with mild cognitive impairment (MCI) value quality of life (QoL) above and beyond cognitive function or other potential outcomes in MCI. There is evidence supporting the negative impact of poor physical function on QoL ratings.

OBJECTIVE

The study explored whether a modified measure of self-efficacy for managing MCI and education mediated and/or moderated the relationship between physical function and QoL in persons with MCI.

METHODS

Baseline data from 200 participants with MCI were obtained from a larger study assessing the effectiveness of a behavioral intervention. Physical function was assessed by the Short Physical Performance Battery. QoL was assessed with the Quality of Life in Alzheimer's Disease scale. Memory-related self-efficacy was assessed using a modified 9-item version of the Chronic Disease Self-Efficacy Scales. Mediation and moderation analyses tested the hypotheses that self-efficacy and education alter the association between physical function and QoL in individuals with MCI. All analyses were adjusted for age, cognitive severity, and sex.

RESULTS

Self-efficacy for managing MCI was a significant mediator of the association between physical function and perceived QoL. Individuals with better physical function reported higher self-efficacy which was associated with higher QoL ratings.

CONCLUSIONS

Greater self-efficacy for managing MCI mediated the negative association between physical function and quality of life in this exploratory study. Interventions aimed at enhancing memory self-efficacy in MCI may improve perceived QoL, even in the presence of poor physical function. Future research is needed to investigate this further.

Relationships Between Depressive Symptoms, Other Psychological Symptoms, and Quality of Life

Depressive disorders are common, heterogeneous conditions involving physical and psychological symptoms, and substantial impairment in quality of life (QoL). However, relationships between depressive symptoms and QoL are poorly understood, and little research has directly compared relationships between subtypes of depressive symptoms, other psychological symptoms and QoL. This research aimed to examine how symptoms of depression and other mental health conditions are related to QoL. Participants (N=559) completed the World Health Organization Quality of Life - BREF questionnaire, demographic information, the Brief Symptom Inventory, the Beck Depression Inventory II, and the Depression, Anxiety and Stress Scales. Relationships between psychological symptoms and QoL were assessed using correlations and linear multiple regressions. QoL was inversely related to all types of psychopathology. Depressive symptoms were the strongest predictors of lower overall QoL. Both somatic and psychological depressive symptoms negatively predicted QoL, with somatic symptoms being stronger predictors. Conclusions: While many types of psychological symptoms were negatively correlated with QoL, depressive symptoms, particularly somatic symptoms, were the strongest predictors of impaired QoL. These findings provide new information about specific relationships between symptom profiles and QoL which may lead to greater understanding of the underlying mechanisms and to improved interventions.

Country-level welfare-state measures and change in wellbeing following work exit in early old age: evidence from 16 European countries

Background

Although the effects of individual-level factors on wellbeing change following work exit have been identified, the role of welfare-state variables at the country level has yet to be investigated.

Methods

Data on 8037 respondents aged 50 years and over in 16 European countries were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA). We employed multilevel models to assess determinants of change in wellbeing following work exit, using CASP-12 change scores. After adjusting for institutionally defined route and timing of work exit, in addition to other individual-level variables, we tested country-level variables including welfare-state regime and measures of disaggregated welfare spending to determine their associations with wellbeing change and the proportion of between-country variance explained.

Results

Individuals whose exit from paid work was involuntary or diverged from the typical retirement age experienced declines in wellbeing. Country effects accounted for 7% of overall variance in wellbeing change. Individuals residing in countries with a Mediterranean welfare regime experienced more negative changes in wellbeing, with a difference of –2.15 (–3.23, –1.06) CASP-12 points compared with those in Bismarckian welfare states. Welfare regime explained 62% of between-country variance. National per-capita expenditure on non-healthcare in-kind benefits (services) was associated with more positive wellbeing outcomes.

Conclusions

National expenditure on in-kind benefits, particularly non-healthcare services, is associated with more favourable wellbeing change outcomes following work exit in early old age. Welfare-state effects explain the majority of between-country differences in change in wellbeing.

Quality of life, level of functioning, and its relationship with mental and physical disorders in the elderly: results from the MentDis_ICF65+ study

Background

An ageing population worldwide needs to investigate quality of life (QoL) and level of functioning (LoF) in the elderly and its associated variables. We aimed to study the relationship between Quality of Life (QoL) and Level of Functioning (LoF) in an elderly population in Europe.

Method

As part of the Ment_Dis65+ European Project, 3142 community-dwelling adults aged 65–84 years in six countries were assessed by using the adaptation for the elderly of the Composite International Diagnostic Interview (CIDI65+) to provide psychiatric diagnosis according to the International Classification of Diseases (10th edition) (ICD-10 Classification of Mental and Behavioural Disorders). Socio-demographic and clinical interviews, and two self-report tools, the World Health Organization QoL assessment (WHO QoL BREF), to assess QoL, and the WHO Disability Assessment Schedule -II (WHODAS-II), to assess LoF, were also administered.

Results

Most subjects reported good levels of QoL (56.6%) and self-rated health (62%), with no or mild disability (58.8%). There was a linear decrease of the QoL and the LoF by increase of age. Elderly with ICD-10 mental disorder (e.g. somatoform, affective and anxiety disorders) had poorer QoL and lower LoF. There were a number of predictors of lower levels of QoL and disability, including both socio-demographic variables (e.g. male gender, increase in age, poor financial situation, retirement, reduced number of close significant others), ICD-10 psychiatric diagnosis (mainly anxiety, somatoform disorders) and presence of medical disorders (mainly heart and respiratory diseases).

Conclusions

The study indicates that QoL and LoF were quite acceptable in European elderly people. A series of variables, including psychiatric and somatic disorders, as well as socio-demographic factor influenced in a negative way both QoL and LoF. More specific links between mental health, social and health services dedicated to this segment of the population, should be implemented in order to provide better care for elderly people with conditions impacting their QoL and functioning.

The prospective association between frequency of contact with friends and relatives and quality of life in older adults from Central and Eastern Europe

PURPOSE

Studies suggest that frequent contact with friends and relatives promote mental wellbeing in later life, but most evidence comes from Western populations. We investigated the prospective relationship between frequency of contact with friends and relatives and quality of life (QoL) among older Central and Eastern European (CEE) adults and whether depressive symptoms mediated the hypothesised longitudinal relationship.

METHODS

Data from 6106 participants from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study were used. Frequency of contact with friends and relatives was measured at baseline. QoL, at baseline and follow-up, was measured by the Control, Autonomy, Self-realisation, and Pleasure (CASP) 12-item scale. After assessing the prospective association using multivariable linear regression, the mediational hypothesis was tested using path analysis.

RESULTS

There was a significant prospective association between frequency of contact with friends and relatives and CASP-12 score (0-36) in fully adjusted models. Per every one unit increase in frequency of contact, there was a 0.12 (95% CI 0.06, 0.17) increase in CASP-12 score at follow-up, accounting for sociodemographic, health-related and baseline QoL. Pathway results showed that 81% of the longitudinal effect of frequency of contact on QoL was mediated through depressive symptoms.

CONCLUSIONS

Frequent contact with friends and relatives improves QoL of older Central and Eastern European adults, partly through buffering against depressive symptoms. Interventions to improve QoL at older ages should incorporate effective management of common mental disorders such as depression.

Educational Attainment and Quality of Life among Older Adults before a Lung Cancer Diagnosis

Background: Demographic and contextual factors are associated with quality of life (QoL) in older adults and prediagnosis QoL among older adults has important implications for supportive care in older cancer patients. Objective: To examine whether lower educational attainment is associated with poorer QoL among community dwelling older adults just before their diagnosis of lung cancer in a nationally representative sample. Design: This study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) dataset, which provides cancer registry data linked with survey data for Medicare Advantage enrollees. Subjects: Adults 65 years and older at time of diagnosis with first or only primary lung cancer and with at least one survey before their cancer diagnosis. Measurements: Level of education attained was categorized as less than high school (<HS) or at least a high school diploma (≥HS). QoL was calculated based on individual subscale scores from the 36-item Short Form Health Survey (SF-36) until 2006 (Veteran's RAND 12-Item Survey [VR-12] after 2006). Demographic covariates as well as number of comorbidities were adjusted for in multivariable models. Results: Higher education was positively associated with prediagnosis mental and physical QoL. Other factors associated with lower QoL were Medicaid status and number of comorbidities. Conclusions: Particular attention should focus on identifying and addressing QoL needs among vulnerable older adults to bolster QoL to mitigate its potential impact on prognosis following a lung cancer diagnosis.

Quality of Life in Partners of Young and Old Breast Cancer Survivors

BACKGROUND

Partners of breast cancer survivors experience the effects of a spouse's cancer years after treatment. Partners of younger survivors (YPs) may experience greater problems than partners of older survivors (OPs), just as younger survivors experience greater problems than their older counterparts.

OBJECTIVES

The aims of this study were to (1) compare quality of life (QoL) in YPs and OPs and (2) determine contributing factors to each group's QoL.

METHODS

Cross-sectional data were collected from YPs (n = 227) and OPs (n = 281) through self-report. Multivariate analysis of variance was used to determine differences between YPs and OPs on QoL while controlling for covariates. Multiple regression analyses were conducted to determine what contributes to each group's QoL.

RESULTS

Partners of younger survivors reported better physical function (effect size [ES], -0.57), lower marital satisfaction (ES, 0.39), and lower overall QoL (ES, 0.43) than OPs. Predictors of QoL also differed between partner groups. For YPs, overall QoL was predicted by greater physical functioning, fewer depressive symptoms, higher marital satisfaction, higher parenting satisfaction, and more personal resources (R = 0.47, F5,195 = 35.05, P < .001). For OPs, overall QoL was predicted by fewer depressive symptoms, higher parenting satisfaction, higher spirituality, and greater social support from the breast cancer survivor spouse (R = 0.33, F4,244 = 29.80, P < .001).

CONCLUSION

Partners of older survivors reported greater QoL than YPs. Common factors contributing to QoL between YPs and OPs were fewer depressive symptoms and higher parenting satisfaction.

IMPLICATIONS FOR PRACTICE

Partners of breast cancer survivors may need support coping with their spouse/partner's cancer. Partners of younger survivors may require more support than OPs.

Predicting change in quality of life from age 79 to 90 in the Lothian Birth Cohort 1921

PURPOSE

Quality of life (QoL) decreases in very old age, and is strongly related to health outcomes and mortality. Understanding the predictors of QoL and change in QoL amongst the oldest old may suggest potential targets for intervention. This study investigated change in QoL from age 79 to 90 years in a group of older adults in Scotland, and identified potential predictors of that change.

METHOD

Participants were members of the Lothian Birth Cohort 1921 who attended clinic visits at age 79 (n = 554) and 90 (n = 129). Measures at both time points included QoL (WHOQOL-BREF: four domains and two single items), anxiety and depression, objective health, functional ability, self-rated health, loneliness, and personality.

RESULTS

Mean QoL declined from age 79 to 90. Participants returning at 90 had scored significantly higher at 79 on most QoL measures, and exhibited better objective health and functional ability, and lower anxiety and depression than non-returners. Hierarchical multiple regression models accounted for 20.3-56.3% of the variance in QoL at age 90. Baseline QoL was the strongest predictor of domain scores (20.3-35.6% variance explained), suggesting that individual differences in QoL judgements remain largely stable. Additional predictors varied by the QoL domain and included self-rated health, loneliness, and functional and mood decline between age 79 and 90 years.

CONCLUSIONS

This study has identified potential targets for interventions to improve QoL in the oldest old. Further research should address causal pathways between QoL and functional and mood decline, perceived health and loneliness.

The impact of health on economic and social outcomes in the United Kingdom: A scoping literature review

This is the first review of the evidence, based on longitudinal studies in the United Kingdom, on the association of ill health at any life stage and later social and economic outcomes. The review included a wide range of physical and mental health exposures, both self-reported and objectively measured, as well as social (e.g. life satisfaction) and economic (e.g. employment) outcomes. We searched the Web of Science, key longitudinal datasets based in the UK, major economic journals, Google Scholar and reference lists of relevant publications. The review includes 80 studies. There was strong evidence for the association between early mental health, mainly attention deficit hyperactivity disorder, and lifetime educational, occupational and various social outcomes. Also, both poor physical and mental health in early and middle adulthood, tended to be associated with unemployment and lower socioeconomic status. Among older adults, the evidence quite consistently indicated an association between mental health, chronic conditions, disability/functional limitations, self-rated general health and quality of life, life satisfaction and early retirement. Overall, mental health was consistently found to be associated with a range of social and economic outcomes throughout the lifespan. The evidence for the association between physical health and later outcomes is more inconsistent. A number of methodological challenges need to be addressed, particularly related to causal inference, to produce robust evidence with potential to inform public health policy.

Associations of anthropometric measures of obesity with physical limitations in older adults

Introduction: Physical limitations are associated loss of independence, lower quality of life, greater healthcare costs, and mortality. Changes in body composition during the aging process contribute to the decline in physical functioning. Body mass index is commonly used to quantify adiposity; however, measurements that better capture abdominal obesity may confer better advantage for risk of physical limitations.Methods: We used data from the 2013-2014 National Health and Nutrition Examination Survey to compare the associations of (1) body mass index, (2) sagittal abdominal diameter, and (3) waist circumference with physical limitations in adults 60-80 years (n = 1258). We used weighted logistic regression models to allow for estimates that are representative of the US population.Results: All three anthropometric measures were significantly associated with physical limitations. Abdominal fat measurements (sagittal abdominal diameter and waist circumference) were more strongly associated with physical limitations in men. However, they were not independently associated with physical limitations after controlling for body mass index. All three measurements did not differ in their ability to distinguish presence of physical limitations.Conclusions: Our data suggest that abdominal fat measurements are not independently associated with physical limitations after accounting for body mass index. Body mass index, waist circumference, and sagittal abdominal diameter are all of equal practical value for identifying older adults at risk for physical limitations.IMPLICATIONS FOR REHABILITATIONOur data suggest that both sagittal abdominal diameter and waist circumference are not independently associated with physical limitations after accounting for body mass index.Strategies to manage overall body weight may be the most effective goal of primary prevention of disability and to support the rehabilitation process.Body mass index, waist circumference, and sagittal abdominal diameter are all of equal practical value for health professionals to identify older adults at higher risk for physical limitations.Practitioners should consider the measures that are most feasible and easiest to obtain in the clinical setting.

Health-related quality of life of patients with inflammatory bowel disease in Singapore

BACKGROUND/AIMS

Inflammatory bowel disease (IBD) is associated with considerable impairment of patients' health-related quality of life (HRQoL). Knowledge of factors that significantly affect IBD patients' HRQoL can contribute to better patient care. However, the HRQoL of IBD patients in non-Western countries are limited. Hence, we assessed the HRQoL of Singaporean IBD patients and identified its determinants.

METHODS

A prospective, cross-sectional study was conducted at Singapore General Hospital outpatient IBD Centre. The HRQoL of IBD patients was assessed using the short IBD questionnaire (SIBDQ), Short Form-36 physical and mental component summary (SF-36 PCS/MCS) and EuroQol 5-dimensions 3-levels (EQ-5D-3L) and visual analogue scale (VAS). Independent samples t-test was used to compare HRQoL between Crohn's disease (CD) and ulcerative colitis (UC). Determinants of HRQoL were identified through multiple linear regression.

RESULTS

A total of 195 IBD patients (103 UC, 92 CD) with a mean disease duration of 11.2 years were included. There was no significant difference in HRQoL between patients with UC and CD. Factors that significantly worsened HRQoL were presence of active disease (b=-6.293 [SIBDQ], -9.409 [PCS], -9.743 [MCS], -7.254 [VAS]), corticosteroids use (b=-7.392 [SIBDQ], -10.390 [PCS], -8.827 [MCS]), poor medication adherence (b=-4.049 [SIBDQ], -1.320 [MCS], -8.961 [VAS]), presence of extraintestinal manifestations (b=-13.381 [PCS]), comorbidities (b=-4.531 [PCS]), non-employment (b=-9.738 [MCS], -0.104 [EQ-5D-3L]) and public housing (b=-8.070 [PCS], -9.207 [VAS]).

CONCLUSIONS

The HRQoL is impaired in this Asian cohort of IBD. The magnitude of HRQoL impairment was similar in UC and CD. Clinical characteristics were better determinants of patients' HRQoL than socio-demographic factors. Recognizing the factors that impact patients' HRQoL would improve the holistic management of IBD patients.

Confidant Network and Quality of Life of Individuals Aged 50+: The Positive Role of Internet Use

Studies on the quality of life (QoL) of older adults have tended to focus on sociodemographic, economic, and health characteristics and, more recently, have analyzed the importance of confidant networks. The Internet has redesigned individuals' daily lives and has become one of the main means of communication. In addition to the aforementioned variables, research must also gauge the importance of this technology and how it can influence the relationship between confidant networks and QoL of older adults. This article aims to analyze the contribution of the Internet on the QoL of older adults as well as the manner that it affects the aforementioned relationship. The present study focuses on a sample of 1,906 individuals aged 50+ who are resident in Portugal and were surveyed in the context of the SHARE project (Survey of Health, Ageing and Retirement in Europe), wave 4. The results of the regression analyses reveal the importance of the Internet on the QoL of older adults. The data also underline the moderating role played by the Internet on the relationship between the confidant network and the QoL of individuals aged 50+, in particular the fact that this technology optimizes the positive impact of confidant networks on QoL. The results obtained thus reinforce the importance of policies aimed at the e-inclusion of older adults as a way to promote their QoL.

Quality of life at the retirement transition: Life course pathways in an early 'baby boom' birth cohort

Promoting quality of life (QoL) in later life is an important policy goal. However, studies using prospective data to explore the mechanisms by which earlier events influence QoL in older age are lacking. This study is the first to use prospective data to investigate pathways by which a range of measures of life-course socioeconomic status contribute to later-life QoL. The study uses data from the Newcastle Thousand Families Study cohort (N = 1142), an early 'baby-boom' birth cohort born in 1947 in Newcastle upon Tyne, an industrial city in north-east England. Using prospective survey data collected between birth and later adulthood (N = 393), a path analysis investigated the effects and relative contributions of a range of life-course socioeconomic factors to QoL at age 62-64 measured using the CASP-19 scale. Strong positive effects on later-life QoL were found for advantaged occupational status in mid-life and better self-reported health, employment and mortgage-freedom in later adulthood. Significant positive indirect effects on QoL were found from social class at birth and achieved education level, mediated through later-life socioeconomic advantage. Experiencing no adverse events by age five had a large total positive effect on QoL at age 62-64, comprising a direct effect and indirect effects, mediated through education, mid-life social class and later-life self-reported health. Results support a pathway model with the effects of factors in earlier life acting via later-life factors, and an accumulation model with earlier-life factors having large total, cumulative effects on later-life QoL. The presence of a direct effect of adverse childhood events by age five on QoL suggests a 'critical period' and indicates that policies across the life-course are needed to promote later-life QoL, with policies directed towards older adults perhaps too late to 'undo the damage' of earlier adverse events.

When helping helps: exploring health benefits of cancer survivors participating in for-cause physical activity events

BACKGROUND

Over 15.5 million Americans live with cancer and 5-year survival rates have risen to 69%. Evidence supports important health benefits of regular physical activity for cancer survivors, including increased strength and quality of life, and reduced fatigue, recurrence, and mortality. However, physical activity participation among cancer survivors remains low. Cancer organizations provide various resources and support for cancer survivors, including emotional, instrumental, informational, and appraisal support. Many cancer organizations, like the LIVESTRONG Foundation, support the cancer community by sponsoring and hosting for-cause physical activity events, providing opportunities for anyone (including cancer survivors) to "help"/support those living with cancer. The concept of helping others has been positively related with wellbeing, physical activity, and multiple health behaviors for those helping. However, the role of helping others has not been examined in the context of being physically active to help others or its relationship with overall physical activity and quality of life among those helping. Therefore, we developed a path model to examine relationships between cancer survivors' (1) desire to help others with cancer, (2) physically active LIVESTRONG participation to help others, (3) regular physical activity engagement, and (4) quality of life.

METHODS

In 2010, 3257 cancer survivors responded to an online survey sent to all people involved with the LIVESTRONG organization at any level. The hypothesized path model was tested using path analysis (Mplus 8).

RESULTS

After list-wise deletion of missing responses, our final sample size was 3122 (61.8% female, mean age: 48.2 years [SD = 12.7]). Results indicated that the model yielded perfect fit indexes. Controlling for age, sex, income, and survivorship length, desire to help was positively related with physically active LIVESTRONG participation (β = .11, p < .001), which was positively related with regular physical activity (β = .30, p < .001), and regular physical activity was positively related with quality of life (β = .194, p < .001).

CONCLUSIONS

Results suggest that cancer survivors can benefit from participating in for-cause physical activity events, including more regular physical activity. Researchers need to further investigate the role of helping others when examining health behaviors and outcomes, and cancer organizations should continue encouraging cancer survivors to help others by participating in physical activity events.

The decision to work after state pension age and how it affects quality of life: evidence from a 6-year English panel study

Background

despite an increasing proportion of older people working beyond State Pension Age (SPA), little is known about neither the motivations for this decision nor whether, and to what extent, working beyond SPA affects quality of life (QoL).

Methods

QoL was measured using the CASP-19 scale. Respondents in paid work beyond SPA were distinguished based on whether they reported financial constraints as the main reason for continuing in work. Linear regression models were used to assess the associations between paid work beyond SPA and CASP-19 scores among men aged 65-74 and women aged 60-69 (n = 2,502) cross-sectionally and over time using Wave 4 and Wave 7 of the English Longitudinal Study of Ageing.

Results

approximately, one in five respondents were in paid work beyond SPA, one-third of whom reported financial issues as the main reason. These individuals reported significantly lower CASP-19 scores (β = -1.21) compared with those who retired at the expected/usual age. Respondents who declared being in paid work beyond SPA because they enjoyed their work or wanted to remain active, reported significantly higher QoL (β = 1.62). Longitudinal analyses suggest that those who were working post-SPA by choice, but who had stopped working at follow-up, also reported marginally (P < 0.10) higher CASP-19 scores.

Conclusions

potential QoL benefits of working beyond SPA need to be considered in light of individual motivations for extending working life. Given the trend towards working longer and the abolishment of mandatory retirement ages, it is important that older people maintain control over their decision to work in later life.

Effectiveness of Aromatherapy Massage and Inhalation on Symptoms of Depression in Chinese Community-Dwelling Older Adults

OBJECTIVES

Geriatric depression is a major public health problem in China. The study compared the intervention and follow-up effects of aromatherapy massage and inhalation on symptoms of depression in community-dwelling older adults after an 8-week intervention.

DESIGN

A prospective, randomized controlled trial was conducted on community-dwelling adults ≥60 years old, with symptoms of depression. Participants were randomly assigned, by Latin Square, to aromatherapy massage, inhalation, or control groups (each n = 20).

INTERVENTIONS

The aromatherapy massage group received 30 min of aromatherapy massage with 5 mL oil, twice weekly for 8 weeks. The oil contained 50 μL (one drop) of compound essential oils (lavender [Lavandula angustifolia], sweet orange [Citrus sinensis], and bergamot (Citrus bergamia in a 2:1:1 ratio)], diluted in sweet almond oil to a concentration of 1%. The aromatherapy inhalation group received 30 min of nasal inhalation of 50 μL of the compound essential oils blended in 10 mL of purified water, twice weekly for 8 weeks. The control group received no intervention.

OUTCOME MEASURES

The Geriatric Depression Scale Short Form (GDS-SF) and Patient Health Questionnaire-9 (PHQ-9) were used for assessment at pretest, posttest, and 6- and 10-week follow-ups in all groups. 5-Hydroxytryptamine (5-HT) concentration was assessed pretest and posttest.

RESULTS

Postintervention, the aromatherapy massage and inhalation groups demonstrated significantly lower GDS-SF and PHQ-9 scores than control participants. Compared with the pretest, the GDS-SF and PHQ-9 scores for depressive symptoms in both experimental groups remained lower at posttest (8 weeks), 6-week (14 weeks), and 10-week (18 weeks) follow-ups. However, the GDS-SF and PHQ-9 scores did not differ among the four time points in the control group. The posttest 5-HT concentrations in the aromatherapy massage and inhalation groups were increased over pretest values.

CONCLUSIONS

Both aromatherapy massage and aromatherapy inhalation may have important implications for intervening depression in older adults.

Everyday Health among Older People: A Comparison between Two Countries with Variant Life Conditions

This study described health factors of importance for everyday health, such as pain, tiredness, and sleeping problems, in a cross-national context. Data for persons 60+ years were obtained from the Poverty and Health in Aging study, Bangladesh, and the Swedish National Study on Aging and Care-Blekinge. The strongest associations with everyday health in Sweden were found for pain and tiredness, while in Bangladesh they were financial status, tiredness, and sleeping problems. As similarities were found regarding the associations of tiredness on everyday health, tiredness may be a universal predictor of everyday health in older adults irrespective of country context.

The role of social relationships among elderly community-dwelling and nursing-home residents: findings from a quality of life study

AIM

In Western countries, older adults' needs are often managed through institutionalization. Based on the assumption that quality of life, particularly social relationships, may be perceived differently according to residential setting, the aims of this study were to compare World Health Organization Quality of Life brief version (WHOQOL-BREF) scores of elderly community-dwelling residents and nursing home residents.

METHODS

A sample of 207 older adults (135 community-dwelling residents, 72 nursing home residents) was evaluated with Mini-Mental State Examination (MMSE), WHOQOL-BREF, and Geriatric Depression Scale (GDS).

RESULTS

Nursing home residents achieved lower WHOQOL-BREF scores on the physical health scale only (P = 0.002). In a linear regression model, physical score correlated negatively with GDS score (P = 0.0001) and Mini-Mental State Examination score (P = 0.04), but positively with male gender (P = 0.02) and community-dwelling residence (P = 0.001); psychological score correlated negatively with GDS score (P = 0.0001) and being married (P = 0.03), but positively with male gender (P = 0.009) and being unmarried (P = 0.03). The social relationships score correlated negatively with the GDS score (P = 0.0001) and male gender (P = 0.02), but positively with high education level (P = 0.04). The environment score negatively correlated with GDS score (P = 0.0001). In a logistic regression model, living in a nursing home correlated with female gender (P = 0.001), age (P = 0.0001), a lower physical score (P = 0.0001), and a higher social relationships score (P = 0.02).

CONCLUSION

Depressive symptoms correlated with low scores in all WHOQOL-BREF domains. The variables that correlated with living conditions in a nursing home were older age, male gender, lower physical domain scores, and higher social relationship scores. Opportunities for socialization in nursing homes may thus improve perception of quality of life in this domain.

Associations of self-neglect with quality of life in older people in rural China: a cross-sectional study

BACKGROUND

Elder self-neglect (ESN) has become a public health issue globally. Limited studies have focused on ESN, as well as the relationship between ESN and quality of life (QoL) in developing countries. The study's objective is to explore the association between ESN and QoL among rural elderly in China.

METHODS

A cross-sectional study was conducted among 3,182 elder adults aged 60 years or older, using a cluster-sampling technique in one township in Dangtu, a county in Anhui province. All participants completed face-to-face interview in their household. QoL was assessed using a brief form of the World Health Organization's quality of life questionnaire (WHOQOL-BREF), and ESN was assessed using the Scale of the Elderly Self-neglect (SESN). Hierarchical linear regression models were used to analyze the associations between the ESN scores and QoL scores after adjusting for sociodemographic, social support, and physical and psychological variables.

RESULTS

The scores of overall ESN and five domains were significantly correlated with the scores of four QoL domains (p < 0.001). After adjusting for sociodemographic characteristics, social support, and physical and psychological health characteristics, elders who reported higher overall self-neglect scores had significantly lower scores in the four QoL domains (p < 0.001). Education, economic level, physical health, ADL, depression, and cognitive function are consistent predictors across all QoL domains.

CONCLUSIONS

ESN is an independent risk factor for poor QoL in elderly people in rural China. Understanding the role of ESN and its influence on QoL is important for the management of and intervention in ESN.

Effects of different amounts of exercise on preventing depressive symptoms in community-dwelling older adults: a prospective cohort study in Taiwan

OBJECTIVES

To compare the effects of four different amounts of exercise for preventing depressive symptoms in community-dwelling older adults.

DESIGN

Prospective cohort study.

SETTING

A nationally representative sample in Taiwan.

PARTICIPANTS

Four waves of the survey 'Taiwan Longitudinal Study on Aging (TLSA)' from 1996 to 2007 were analysed. A total of 2673 older adults aged 65 years and over were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Four different types/amounts of exercise were examined including: (1) 3 times/week, 15 min/time; (2) 3 times/week, 30 min/time; (3) 6 times/week, 15 min/time; and (4) 6 times/week, 30 min/time. All exercise types were required to have at least moderate intensity. The impacts of different amounts of exercise on depressive symptoms were analysed using generalised linear mixed models.

RESULTS

More than one-fifth of the elder individuals under consideration had depressive symptoms (CESD ≥10). About 38.6% of older adults met the lowest criteria for exercise type 1, and fewer (28.0%) met the highest criteria for type 4. Only exercise type 4 in the current survey was initially related to lower depressive symptoms (OR=0.8, 95% CI 0.66 to 0.95). However, after considering the interaction between time and changes in exercise patterns, the results showed that all persistent exercise models, even if a very low amount (3 times/week, 15 min/time), had significantly preventive effects on depressive symptoms (OR=0.56~0.67).

CONCLUSION

Consistent exercise with at least 15 min per time, three times a week of moderate intensity is significantly associated with lower risk of depressive symptoms. This low amount of exercise may be easier to promote at the community and population level than other alternatives.

TRIAL REGISTRATION

Registry number 104040 of the Institutional Ethics Committee of Chia-Yi Christian Hospital.

The effect of laughter therapy on the quality of life of nursing home residents

AIMS AND OBJECTIVES

To evaluate the effect of Laughter therapy on the quality of life of nursing home residents.

BACKGROUND

By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance.

DESIGN

Quasi-experimental design.

METHOD

The study was conducted between 2 March - 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection.

RESULTS

After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest.

CONCLUSION

Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention.

RELEVANCE TO CLINICAL PRACTICE

The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.

Older Age- and Health-related Quality of Life in Inflammatory Bowel Diseases

BACKGROUND

The burden of inflammatory bowel disease (IBD) in the older population is increasing. Older-onset disease is associated with reduced use of immunosuppressive medications. In addition, older patients may be more vulnerable to the effect of disease-related symptoms and consequently may experience worse health-related quality of life (HRQoL) compared with younger patients.

METHODS

This prospective study included a cohort of patients with Crohn's disease and ulcerative colitis recruited from a single center. All patients completed the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and the short form-12 (SF-12) questionnaire yielding general physical health (PCS) and mental health component scale subscores (MCS). Patients older than 60 years were compared with those younger than 60 years using multivariable regression analysis.

RESULTS

Our study included 1607 patients, among whom 186 were older than 60 at the time of assessment. Older patients were more likely to have isolated colonic disease and less likely to use immunosuppressive therapy. On multivariable analysis, older patients with IBD had higher SIBDQ (2.34, 95% confidence interval, 0.82-3.87) and SF-12 mental subscores (3.78, 95% confidence interval, 2.26-5.30), but lower physical HRQoL (-1.80, 95% confidence interval, -3.21 to -0.38). There was no difference in the SIBDQ and PCS scores between older patients and newly diagnosed IBD or with established disease.

CONCLUSIONS

Older age was associated with modestly higher SIBDQ and mental HRQoL scores, but lower physical HRQoL. Comprehensive care of the older patient with IBD should include assessment of factors impairing physical quality of life to ensure appropriate interventions.

Social networks and quality of life of elderly persons: a review and critical analysis of literature

Abstract Several studies have documented the importance of social networks for quality of life (QL) in old age. This article presents a review and critical analysis of the literature on the relationship between the social networks of the elderly and their QL/well-being. A survey using interdisciplinary search engines [Web of Knowledge, Scopus, Scholar Google, Science Direct and Online Knowledge Library (b-on)], followed by an in-depth examination of the 37 documents subsequently identified, selected based on content, the geographical context of the study and its publication date, suggested a number of tendencies. In the first place, networks of friends have a greater impact on the QL/well-being of elderly persons than family networks. Secondly, the positive effect of the existence of more than one type of relationship was revealed (such as simultaneous friendships and family relationships). Finally, literature suggests emotional closeness has a positive impact on QL/well-being. The present study exposed the lack of longitudinal studies into the causality between network characteristics and QL/well-being. It also revealed the lack of research on the relationship between social networks and QL/well-being in elderly persons living alone. One problematic aspect relates to the fact that few studies provide a definition of the QL measures they adopt, or the rationale behind the manner of their operationalization of the concept.

Age Differences in the Effects of Self-Esteem

Abstract. This study examined the link between physical symptoms, affect, and self-esteem in everyday life across adulthood. The sample consisted of young, middle-aged, and older adults. Results indicated a significant Self-Esteem × Physical Symptoms interaction on positive affect (PA). The effect of self-esteem on PA was lower with increasing physical symptoms. For negative affect (NA), the Self-Esteem × Physical Symptoms × Age interaction was significant. In older adults, the effect of self-esteem on NA was lower with increasing physical symptoms. Thus, the effect of self-esteem ran opposite to the expected buffering effect. In addition, the age difference in the effect of self-esteem on NA presents potential challenges to the adaptive capacity of older adults in emotional well-being.

Minority population group status and QOL change: The case of older Israelis

This study explores minority group status in relation to change in Quality of Life (QOL) among three population groups in Israel-Veteran Jews, Arab-Israelis and immigrants from the Former Soviet Union (FSU)-controlling for a set of known predictors. The study uses panel data from two waves (2009/10 and 2013) of the Israeli component of the Survey of Health, Ageing and Retirement in Europe, (N=1,590). A set of Ordinary Least Squares regressions is used to predict positive QOL change over the two waves. Interaction terms in a number of selected areas are considered. The results show that minority group status (Arab-Israelis and FSU immigrants) is negatively related to positive QOL change, compared to the majority group (Veteran Jews). Moreover, being employed was found to improve QOL for older FSU immigrants, underscoring the realm of work in the well-being of this population group. In comparison, it was exchange with family members that had a positive effect on QOL change among the Arab-Israelis, emphasizing the importance of that particular aspect of their lives in older age. In sum, the results highlight the risk of minority group status to well-being in late life and confirms the observation that positive QOL change correlates with characteristically different factors among different population groups.

Levels of depressive symptoms may modify the relationship between the WHOQOL-BREF and its determining factors in community-dwelling older adults

BACKGROUND

Depression is closely associated with quality of life (QOL) in older adults. Being elderly and exhibiting mild depressive symptoms may not lead to a depression diagnosis, but these attributes are clinically important. However, the extent to which these factors influence QOL and its determinants in older adults remains unclear.

METHODS

Questionnaires were administered to people aged 65 years or older at community senior centers in Taiwan to collect socio-demographic information and to assess results from the brief version of the World Health Organization's Quality of Life instrument (WHOQOL-BREF), Modified Barthel Index (MBI), 15-item Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Levels of depressive symptoms were classified as no depressive symptoms (NDS), lower level of depressive symptoms (LLDS), and higher level of depressive symptoms (HLDS), corresponding to GDS = 0, 1≦GDS≦5, and GDS>5, respectively. Multiple linear regression analyses were conducted to assess associations between the WHOQOL-BREF and its covariates for different levels of depressive symptoms.

RESULTS

A total of 454 older adults participated. The GDS and MBI scores significantly affected the WHOQOL-BREF physical and psychological domain scores in the LLDS group. Gender influenced the WHOQOL-BREF scores in the NDS group, and increased age demonstrated protective effects on the three domains in the HLDS group. Moreover, the association between the WHOQOL-BREF and its covariates varied for different levels of depressive symptoms.

CONCLUSIONS

Treatment for depressive symptoms is of high priority, and early recognition of and appropriate intervention for mild depressive symptoms may improve community-dwelling older adults' QOLs.

Structural and functional measures of social relationships and quality of life among older adults: does chronic disease status matter?

PURPOSE

To evaluate the relative importance of structural and functional social relationships for quality of life (QoL) and the extent to which diagnosed chronic disease modifies these associations.

METHODS

Multivariate linear regression was used to investigate time-lagged associations between structural and functional measures of social relationships and QoL assessed 5 years apart by CASP-19, in 5925 Whitehall II participants (mean age 61, SD 6.0). Chronic disease was clinically verified coronary heart disease, stroke, diabetes or cancer.

RESULTS

Social relationships-QoL associations were consistent across disease status (P-values for interaction: 0.15-0.99). Larger friend network (β = 1.9, 95% CI 1.5-2.3), having a partner (β = 1.2, 95% CI 0.5-1.7), higher confiding support (β = 2.2, 95% CI 1.8-2.7) and lower negative aspects of close relationships (β = 3.3, 95% CI 2.8-3.8) were independently related to improved QoL in old age. The estimated difference in QoL due to social relationships was equivalent to up to 0.5 SD of the CASP-19 score and was stronger than the effect of chronic disease (coronary heart disease β = 2.0, 95% CI 1.4-2.6).

CONCLUSIONS

We found that beneficial aspects of social relationships in relation to QoL were, in order of importance: avoiding negative aspects of close relationships, having confiding support, having a wide network of friends and having a partner. These associations were not modified by chronic disease. Thus, despite inevitable physical deterioration, we may be able to enhance a satisfying late life by optimizing our social relationships.

Mid-life occupational grade and quality of life following retirement: a 16-year follow-up of the French GAZEL study

OBJECTIVES

This article aims to contribute to the literature on life course influences upon quality of life by examining pathways linking social position in middle age to quality of life following retirement in French men and women.

METHOD

Data are from the GAZEL cohort study of employees at the French national gas and electricity company. A finely grained measure of occupational grade in 1989 was obtained from company records. Annual self-completion questionnaires provided information on quality of life in 2005, measured with the CASP-19 scale, and on participants' recent circumstances 2002-2005: mental health, physical functioning, wealth, social status, neighbourhood characteristics, social support and social participation. Path analysis using full information maximum likelihood estimation was performed on 11,293 retired participants.

RESULTS

Higher occupational grade in 1989 was associated, in a graded relationship, with better quality of life 16 years later. This association was accounted for by individuals' more recent circumstances, particularly their social status, mental health, physical functioning and wealth.

CONCLUSION

The graded relationship between occupational grade in mid-life and quality of life after labour market exit was largely accounted for by more recent socio-economic circumstances and state of health. The results support a pathway model for the development of social disparities in quality of life, in which earlier social position shapes individual circumstances in later life.

A decade of research using the CASP scale: key findings and future directions

Since the publication of A Measure of Quality of Life in Early Old Age: The Theory, Development and Properties of a Needs Satisfaction Model (CASP-19) just over 10 years ago, the scale has gone on to be used in a wide variety of studies in over 20 countries across the world and the original paper has become the most highly cited paper for Aging and Mental Health. Therefore it was felt that it was a good time to look back and reflect on the developments in the use of the scale as well as to look forward to what new research is being done and could be done with the measure. To this end we are extremely grateful for the editors for allowing us to bring together a collection of papers that represent cutting edge research using the CASP scale. These papers cover a wide variety of issues, from working conditions to religiosity, from a range of countries, covering Western and Eastern Europe as well as Africa. Each makes an important individual contribution to our understanding of the factors that influence quality of life in later life as well as pointing to the limitations of the measure and future work that can be done in this area.

Depression Affects the Scores of All Facets of the WHOQOL-BREF and May Mediate the Effects of Physical Disability among Community-Dwelling Older Adults

BACKGROUND

Geriatric depression is associated with the overall quality of life (QOL). However, how depressive symptoms affect the different domains and facets of QOL in older adults, and whether depressive symptoms mediate the relationship between physical disability and QOL in older adults are unclear.

METHODS

A total of 490 ambulatory community-dwelling older adults aged 65 years or above were interviewed using the brief version of the World Health Organisation Quality of Life instrument (WHOQOL-BREF), the Modified Barthel Index (MBI), the 15-item Geriatric Depression Scale (GDS-15), and the Mini-Mental State Examination (MMSE). Sequential models for multiple linear regressions were analysed to determine if the MBI, GDS-15 and MMSE scores predict the WHOQOL-BREF scores. The potential mediation effects of depression (as determined by the GDS-15) on the relationship between MBI and WHOQOL-BREF were also analysed.

RESULTS

The GDS-15 score was predictive of the scores of the four domains and all 26 facets of the WHOQOL-BREF. The significant predictive effects of the MBI score on 15 of the 26 facets of the WHOQOL-BREF were reduced to three after the adjustment for the GDS-15 score. Depression (as assessed by the GDS-15) is a mediator of the relationship between MBI and the physical, psychological and environmental domains of the WHOQOL-BREF.

CONCLUSIONS

Depression (assessed by the GDS-15) may affect the scores of every domain and all facets of the WHOQOL-BREF in the elderly. Furthermore, it may mediate the relationship between the MBI and on QOL scores. We recommend taking depressive symptoms into consideration when measuring community-dwelling older adults' QOL and providing active ageing programs.

Quality of life attenuates age-related decline in functional status of older adults

PURPOSE

In the present study, we aimed to examine the total and moderating effects of needs-satisfaction-driven quality-of-life (QoL) measure on age-related change in functional status.

METHODS

Participants in the Survey of Health and Retirement in Europe (N = 18,781 at Wave 1) completed a measure of QoL (CASP-12) at baseline and reported their functional status across subsequent three waves using activities of daily living (ADL), instrumental activities of daily living (IADL), and functional limitation indices.

RESULTS

Growth-curve model estimates revealed that aged individuals with lower QoL scores at baseline had a steeper increase in disability deficits accumulation and functional limitation progression than their counterparts with a higher sense of QoL. The effects were more pronounced in ADL and IADL disability scales in which QoL moderated both linear and quadratic age-related changes.

CONCLUSIONS

Higher QoL attenuates processes of functional decline in late adulthood. Practitioners may seek strategies for improving and enhancing patients' QoL, as its salutary effects diffuse beyond psychological experience and include long-term effects on physical functioning.