Effect of financial stress on self-rereported health and quality of life among older adults in five developing countries: a cross sectional analysis of WHO-SAGE survey

A Bio-Psycho-Social Approach to Understanding Optimism and Pessimism in Response to Stress

Stress is widely known to have debilitating effects on physical health and mental wellbeing, particularly on one's coping styles, personality traits, and outlook on life. Cumulative and chronic stress, which can serve as a triggering or aggravating factor for many pathological disorders if left unaddressed, has been linked to many life-threatening diseases. While many studies have looked at how optimism and pessimism are used as a form of coping mechanism, few have examined how different bio-psycho-social reactions to stress shape the level of optimism and pessimism. Using a sample of adult individuals aged 18 and older in the United States (n = 3361), this study addressed the following research questions: (1) What types of stress are predictive of optimism and pessimism? (2) Which responses to stress and coping mechanisms are most predictive of optimism and pessimism? (3) Do optimism and pessimism share the same stress-related risk and protective factors? Overall, this study found that while optimism and pessimism share conceptual similarities, they are not necessarily influenced by the same stress mechanisms. Stress, whether personal or financial, was associated with a negative outlook on life. This study showed that having good sleep quality and a lower number of psychological stress symptoms was linked to increasing optimism and reducing pessimism, while overeating or eating unhealthily was connected to both optimism and pessimism. Additionally, this study found that exercise/walking and emotional support mediated the effects of the responses to stress on the respondents' level of optimism and pessimism.

An EQ-5D-5L Value Set for Ghana Using an Adapted EuroQol Valuation Technology Protocol

OBJECTIVES

Ghana's economic evaluation reference case recommends quality-adjusted life-years as an outcome measure for the conduct of cost-utility analysis. There is no Ghanaian value set available to be used in estimating quality-adjusted life-years. This study aimed to develop a value set for Ghana using the EQ-5D-5L instrument.

METHODS

Face-to-face preference data were collected from 300 adults across 3 regions of Ghana using the adapted version of the EuroQol valuation technology (EQ-VT) standardized valuation protocol; with composite time-trade-off (cTTO) and discrete-choice experiments (DCEs) elicitation techniques. The cTTO and DCE data were modeled individually or together to provide complementary results on respondents' utility preferences. Models explored were generalized least squares, Tobit, heteroskedastic, logit, and hybrid. The best-fitting model for the value set was selected based on its logical consistency, accounting for left-censored and heteroscedasticity data, and the statistical significance of parameters.

RESULTS

The 300 interviews provided 4500 cTTO responses and 4200 DCE responses. The preferred model chosen for the Ghana value set was the Hybrid Tobit random effect heteroscedastic-constrained model. The predicted value for the worst attainable health state (55555) was -0.493 and the best health state (11112) was 0.969. The largest decrement was registered for level 5 mobility (0.369) followed by pain/discomfort (0.312), self-care (0.273), anxiety/depression (0.271), and usual activities (0.268).

CONCLUSIONS

This is the first Ghanaian EQ-5D-5L value set based on social preference derived from a nationally representative sample. The value set will play a key role in the use of economic evaluation studies to inform priority setting in Ghana where different health technologies can be compared.

Factors Associated with Subjective Successful Aging Among Iranian Older Adults: A Cross-Sectional Analysis

Background

Subjective Successful Aging (SSA) refers to individuals' self-rating of their aging process. Demographics, socioeconomic status, and health conditions of older adults can shape their aging process and their self-evaluation of it. This study aimed to explore the status of SSA and its related factors among a sample of Iranian older adults in 2022.

Materials and Methods

This cross-sectional study was conducted with 410 older adults in Bojnurd, Iran, who were selected by a multi-stage sampling method. Data were collected through a four-part questionnaire consisting of objective socioeconomic status, subjective socioeconomic status (Subjective Social Status (SSS) and Perceived Income Adequacy (PIA)), health status (Self-Related Health (SRH) and number of chronic diseases), and the SSA six-question scale. The data were analyzed using SPSS (version 22). Bivariable and multiple linear regression analyses were run to identify the factors associated with SSA.

Results

The mean (standard deviation) age of the participants was 68 (7.33). The mean (standard deviation) of the SSA score was 60.69 (17.85). Only 132 individuals (32.20%) considered themselves successful. According to regression analysis, among the investigated variables, the predictors of SSA were SRH (β = 0.40, p < 0.001), PIA (β = 0.23, p < 0.001), SSS (β = 0.18, p < 0.001), and age (β = -0.11, p = 0.009), respectively.

Conclusions

Regarding the low percentage of participants who considered themselves successful seniors, it is necessary to pay more attention to promoting the aspect of successful aging and its related determinants. According to the results, promoting perceived health and reducing financial concerns, especially in older people, could finally increase SSA among Iranian older adults.

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19

OBJECTIVES

This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group.

METHOD

A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested.

RESULTS

The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively.

CONCLUSION

This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

Compounded Effects of Multiple Global Crises on Mental Health: A Longitudinal Study of East German Adults

The early 2020s witnessed an unprecedented overlap of multiple global crises. This longitudinal study examined the compounded effects of multiple intersecting global crises on mental health outcomes in a representative cohort of East German adults. We investigated how perceived threats (PT) from climate change (PT-CLC), COVID-19 (PT-COV), the Russia-Ukraine War (PT-RUW), and rising costs of living (PT-RCL) will impact various aspects of mental health from 2021 to 2022. This research question addresses whether these crises exacerbate mental health issues and how their effects differ across various mental health outcomes. Methods: We conducted a longitudinal study with 319 participants (mean age 49.9 years, 54.5% female) from the Saxony Longitudinal Study. Data were collected in two waves: March-July 2021 and September-December 2022. We used linear mixed-effects models to analyze both unadjusted group trends and adjusted individual-level effects on physical complaints, mental distress, sleep problems, life satisfaction, and self-rated health. Results: Unadjusted analyses revealed significant increases in mental distress and sleep problems over time, whereas physical complaints, life satisfaction, and self-rated health remained stable at the group level. Adjusted analyses showed that higher PT-RCL and PT-COV were significantly associated with increased physical complaints, mental distress, sleep problems, and decreased life satisfaction, even when group-level changes were not significant. Conclusions: This study highlights the complex impact of intersecting global crises on mental health, emphasizing the importance of considering both population-level trends and individual perceptions. The findings suggest that economic and pandemic-related stressors have more immediate effects on mental health outcomes compared to more distant threats, such as climate change or geopolitical conflicts.

Men's Social Connectedness in Later Life: A Qualitative Study with Older Men

This qualitative study aimed to understand men's social connectedness in later life in Portugal focusing on their perceptions, obstacles, strategies, and impact on well-being. The sample included 104 older Portuguese men over 65 years of age (Mage = 70.76 years). The qualitative data were the direct transcriptions of the answers given by participants to the electronic interview using thematic analysis. Findings revealed six overarching themes encompassing 18 subcategories: definitions of social connectedness (social support, community identity, mental health promotion, use of community structures), difficulties/obstacles in maintaining social connectedness (ageism, lack of initiative, physical limitations, psychological traits, resources), strategies/actions or resources to establish social connections (use of technology, use of community groups, leisure and sport activities, church/religion), negative impact of difficulties in establishing relevant social connections (mental health, physical health, relationships), positive actions from being socially connected (positive prescriptions to promote social connectedness), and concerns from being socially disconnected (health risks). These findings indicate that the lack of social connectedness creates social vulnerability in later life, and social support is needed to ensure safer aging among older men.

Evaluating the Quality of Life of Beneficiaries After Providing Financial Aid by a Multi-specialty Tertiary Care Hospital

Background Financial aid programs offered by multi-specialty tertiary care hospitals play a crucial role in ensuring equitable access to healthcare. This study investigates the effect of financial aid on the quality of life (QoL) of beneficiaries, aiming to provide a comprehensive understanding of the multifaceted relationship between healthcare support and overall well-being. Aim The study's objectives included assessing changes in pre- and post-aid QoL, identifying influencing factors, understanding beneficiary experiences, and evaluating the effectiveness of financial aid programs. Methods The study adopted quantitative assessments through QoL questionnaires developed based on the WHO BREF questionnaire and insights obtained through interviews. A representative sample of beneficiaries was selected, informed consent was obtained, and an institutional ethical certificate was also obtained. Results The findings overwhelmingly support the alternative hypothesis. The alternative hypothesis was that after receiving financial support, recipients' quality of life would increase. Quantitative analysis revealed a statistically significant enhancement in the QoL of beneficiaries across physical, mental, and social well-being domains. The quality of life scores of patients before and after receiving the support was statistically tested using a paired t-test, and the quality of life score has improved significantly with a p-value of 4.156 × 10-28 (p value<0.001). The comparison of quality of life scores of the control group with the patient's group before getting the support was tested using an independent sample t-test and found to be non-significant (p=0.496), while a similar comparison between the control group and the patient's group after receiving the support was found to be statistically highly significant with a p-value of 8.721 × 10-28 (p-value<0.001). Conclusions This research demonstrates the substantial impact of financial aid on the QoL of beneficiaries in a multi-specialty tertiary care hospital setting. It underlines the importance of addressing economic barriers and providing patient-centered, holistic support. These insights have broader implications for healthcare policy and practice, promoting a more comprehensive approach to patient well-being.

The impact of food insecurity on mental health among older adults residing in low- and middle-income countries: A systematic review

Over the past few years, food insecurity has been increasing globally due to the COVID-19 pandemic, climate change, economic downturns and conflict and a number of other intersecting factors. Older adults residing in low- and middle-income countries are more vulnerable to food insecurity. While the impacts of food insecurity on physical health outcomes have been thoroughly researched, the effect on mental health outcomes remains under-researched, especially among older adults. Hence, this systematic review aims to investigate existing literature to assess how food insecurity impacts the mental health of older persons residing in LMICs. A systematic search of six databases and Google for studies was conducted. The search was limited to studies written in English and published between 2000 to the present. We identified 725 studies, out of which 40 studies were selected for a full-text review and 12 studies were included for a final analysis. The significant finding in all the included studies was that food insecurity is associated with the worsening mental health of older adults. We also found a complex interplay of factors such as gender, age, rural/urban and health conditions associated with the aggravation of several mental health outcomes. The findings of this study illuminate the need for improved food programs to improve food security and, consequently, mental health among older adults.

Mental health effects associated with COVID-19 financial assistance in South Korea: a comparison of employment status

BACKGROUND

COVID-19 has created tensions across different sectors of the society, but the impact has been unequal. Vulnerable people have been most affected, especially those with insecure employment and who have experienced economic hardships due to unemployment and lost wages. The combination of social change and economic hardships due to the pandemic increases the risk of poor mental health. Some countries have utilized financial assistance to alleviate economic hardships caused by COVID-19, and in South Korea, the central and local governments have implemented COVID-19 financial assistance. This study analysed the impact of financial assistance on mental health associated with working status during the COVID-19 pandemic in South Korea.

METHODS

The participants of this study were randomly selected from residents of Gyeonggi-do after being proportionally allocated by resident registration population status. A total of 1,000 adult males and females aged 19 years or older in Gyeonggi-do who received financial assistance from the central and local governments were selected. A retrospective pre-post-study design was applied, and mental health surveys including the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7) were applied.

RESULTS

The results show that depression scores averaged 5.5 and anxiety scores averaged 4.4 before COVID-19 Financial Assistance. It is similar to the national average of 5.1 and 4.5 respectively at that time. After the assistance, depression scores dropped to 4.5, and anxiety scores dropped to 3.2. Before the assistance, depression and anxiety were higher among temporary day labourers with less job security, and they showed the most significant improvement in mental health. For full-time workers, there was no significant change in anxiety or depression after receiving the assistance.

CONCLUSIONS

Financial assistance can provide material resources and also positively affect mental health. In particular, it had a greater impact on the relatively vulnerable groups, such as those in unstable employment.

Catastrophic health expenditure and health-related quality of life among older adults in Shandong, China: the moderation effect of daily care by adult children

BACKGROUND

Catastrophic health expenditure (CHE) has a considerable impact on older people in later life, but little is known about the relationship between catastrophic health expenditure and health-related quality of life (HRQOL). The aim of this study was to examine the relationship between catastrophic health expenditure and health-related quality of life in older people, and to explore whether the daily care provided by adult children is a moderator in this relationship.

METHODS

Data from the sixth National Health Services Survey in Shandong Province, China. The sample consisted of 8599 elderly people (age ≥ 60 years; 51.7% of female). Health-related quality of life was measured by the health utility value of EQ-5D-3 L. Interaction effects were analyzed using Tobit regression models and marginal effects analysis.

RESULTS

The catastrophic health expenditure prevalence was 60.5% among older people in Shandong, China. catastrophic health expenditure was significantly associated with lower health-related quality of life (β= - 0.142, P < 0.001). We found that adult children providing daily care services to their parents mitigated the effect of catastrophic health expenditure on health-related quality of life among older people (β = 0.027, P = 0.040).

CONCLUSIONS

Our findings suggested that catastrophic health expenditure was associated with health-related quality of life and the caring role of older adult children moderated this relationship. Reducing the damage caused by catastrophic health expenditure helps to improve health-related quality of life in older people. Adult children should increase intergenerational contact, provide timely financial and emotional support to reduce the negative impact of catastrophic health expenditure on health-related quality of life.

Factors related to quality of life in community-dwelling adults in Sleman Regency, Special Region of Yogyakarta, Indonesia: Results from a cross-sectional study

BACKGROUND

Quality of life studies in low- and middle-income countries have demonstrated the influence of socioeconomic factors on the quality of life (QoL). However, further studies are required to confirm this association in developing countries with rapidly ageing populations. Using Ferrans et al.'s QoL model, this study aimed to identify the factors associated with the QoL of community-dwelling adults in Indonesia.

METHODS

A cross-sectional study among 546 community-dwelling adults aged 50+ years was conducted in Yogyakarta, Indonesia, in 2018. QoL was measured using the Short Form 12 questionnaire, which consists of a summary of physical and mental health. We performed stepwise logistic regression analyses to determine odds ratios (ORs) with 95% confidence intervals (CIs) and examined the association between the QoL (physical and mental health) and demographic characteristics, socioeconomic status, financial management behaviour, multimorbidity status, nutritional status, cognitive impairment status, depression status, and independence. Statistical significance was set at p<0.05.

RESULTS

Among the respondents, 15% reported poor physical health, and 9.2% reported poor mental health. Good physical health was significantly associated with the absence of chronic disease (OR 2.39; 95% CI: 1.07-5.33), independence in activities of daily living (OR 3.90; 95% CI 1.57-9.67) and instrumental activities of daily living (OR 4.34; 95% CI 2.28-8.26). Absence of depression was significantly associated with good mental health (OR 2.80; 95% CI 1.3-5.96).

CONCLUSION

The QoL of community-dwelling adults in Indonesia is associated with activities of daily living and instrumental activities of daily living, as well as the absence of chronic disease and depression. Efforts should be made to prevent chronic disease and delay functional decline through healthy lifestyles and routine physical and mental health screenings.

Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices

OBJECTIVES

This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression.

METHODS

Data were from the Leave-Behind Questionnaire in the 2016 (N = 4293) and 2018 (N = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples.

RESULTS

Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders.

CONCLUSION

This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.

Healthy Aging and its Determinants Among Community-dwelling Older Persons in East Coast, Malaysia: A Multidimensional Assessment

Objectives

Exploring the possibility of healthy aging among older persons is crucial for achieving optimal health in the growing older population. This study aimed to determine the prevalence, pattern, and determinants of healthy aging among older persons in Terengganu, Malaysia.

Methods

We conducted a community-based cross-sectional study involving older persons aged % 60 years. An interviewer-guided questionnaire, anthropometric measurements, and physical assessments were administered to operationalize healthy aging based on a multidimensional concept.

Results

Among the 765 older persons surveyed, only 14.1% (95% CI: 11.64?"16.59) were classified as healthy agers. Multiple logistic regression analysis revealed that superior intrinsic religiosity (odds ratio (OR) = 3.42; 95% CI: 1.34?"8.73), higher social interaction (OR = 2.82; 95% CI: 1.32?"6.04), larger calf circumference (OR = 2.05; 95% CI: 1.24?"3.38), taking water intake % 5 cups per day (OR = 2.01; 95% CI: 1.23?"3.30), better gait speed (OR = 1.71; 95% CI: 1.04?"2.80), having savings (OR = 1.71; 95% CI: 1.10?"2.66), and normal waist circumference (OR = 1.63; 95% CI: 1.04?"2.55) were found positively associated with healthy aging.

Conclusions

Only one in 10 older persons in the state met all the criteria for healthy aging. Specific aspects of religious status, social interaction, socioeconomic, behavioral, physical, and nutritional factors were found to predict healthy ageing in this population. These important determinants should be considered in developing a well-defined and comprehensive public health policy to promote healthy aging in the nation.

The Cost-Benefit of Aging: Financial Capability and Well-Being across Age Groups in Brazil

A large proportion of older persons in developing countries do not have access to pension, which also constrains their ability to afford healthcare services and entails extensive challenges to the well-being of older people. This study aimed to analyze the financial preparedness of different age groups for retirement in Brazil. Data were derived from a survey to empirically validate the proposed relationships between preparedness for retirement and resilience for the future (financial well-being (FWB) outcomes) on the one hand and among demographic and socioeconomic aspects, behaviors and attitudes, knowledge and experience, and "key" psychological factors on the other hand. The sample consisted of 412 individuals aged between 22 and 79 years. FWB was measured using the financial capability and well-being model and regressed on a number of sociodemographic and psychological variables using linear regression analyses. The results demonstrated that preparedness for retirement was strongly related to older age. Additionally, age was correlated with resilience for the future close to zero, which indicates no relationship. Knowledge and the psychological factors of self-control and confidence were positively and strongly related to better financial behavior for all age groups. In addition, grit and resilience for the future were positively related to better financial behavior in the older age group. Furthermore, the variables of retirement contribution were seemingly not viewed as important to the older group compared with their young and mature counterparts. Multidimensional interventions, especially targeting behaviors and psychological patterns, could, therefore, be recommended in advance to young and mature groups to prepare them to secure their old age and achieve FWB.

How fear of intimacy affects infertile men's neuropsychological functioning through mental toughness

OBJECTIVE

There is a significant need in Pakistan to investigate the psychological effects of infertility on the mental health of infertile men. The current study examined how fear of intimacy affects neuropsychological impairment and evaluated its relationship to other variables including quality of life and mental toughness.

METHOD

An analytical cross-sectional study was carried out on infertile male patients in various healthcare settings in Punjab, Pakistan. The participants were recruited using a non-probability (purposive) sampling strategy. The sample size was 120 infertile. SPSS 26 was used to analyze the data.

RESULTS

Fear of intimacy was found significant impact on neuropsychological impairment (r = 0.40; ***p < 0.001), as well as fear of intimacy, significantly associated with emotional problems (r = 0.48; **p < 0.01), learning problems (r = 0.33; **p < 0.01), sensory and motor problem (r = 0.55; **p < 0.01), concentration problem (r = 0.21; **p < 0.01), mental & physical in coordination (r = 0.37; **p < 0.01) and depression (r = 0.22; **p < 0.01). Fear of intimacy has negative impact on QoL (r = -0.25; *p > 0.05). Similarly, neuropsychological impairment was found to be negatively associated with QoL (r = -0.52; **p > 0.01). The relationship between fear of intimacy and neuropsychological impairment was found to be significantly mediated by QoL. Furthermore, the findings revealed that mental toughness significantly moderated the relationship between fear of intimacy and neuropsychological impairment.

CONCLUSION

Overall, infertile men in Pakistan had relatively high levels of fear of intimacy, which largely caused neuropsychological impairment. This study can help neuropsychological researchers, mental health professionals, as well as policymakers in improving clinical mental health practices for infertile patients.

Relationships between anthropometric and body composition characteristics and age in Polish women over 60 as affected by their socioeconomic and health status and physical activity levels

Background: Little is known about changes in anthropometric and body composition (A&BC) characteristics during the aging process. Research indicates that body composition can be linked with socioeconomic status (SES), health status (HS), and physical activity (PA) levels. Aim: The aim of this study was to evaluate age-related changes in A&BC characteristics in female seniors aged 60+ in view of their SES, HS, and PA levels. Methods: The survey was conducted in November and December 2022 on a total of 661 female seniors. A questionnaire survey was conducted to obtain information about the participants' socioeconomic status (chronic diseases, health status, marital status, membership in social organizations, financial status, place of residence, education). The respondents' PA levels were assessed with the International Physical Activity Questionnaire (IPAQ), and their A&BC characteristics were determined in a bioelectrical impedance analysis with the InBody 270 body composition analyzer. The relationships between A&BC characteristics and age were evaluated based on the values of the Pearson correlation coefficient (r). Results: The mean values of Percent Body Fat (PBF), Body Mass Index (BMI), and the waist-hip ratio (WHR) were relatively high (37.2%, 28.5 kg/m², and 0.8, respectively) and indicative of overweight and gynoid obesity. A higher number of significant negative correlations between A&BC characteristics and age were observed in seniors with lower values of SES, HS, and PA, which points to more rapid involutional changes in this group of respondents. A segmental analysis also revealed significantly lower values of fat-free mass (FFM) and body fat mass (BFM) (both indicators were calculated in percentage and kg), in particular in the upper limbs, in women with lower SES, HS, and PA levels. Conclusion: Environmental factors, including biological, physiological, environmental, psychological, behavioral, and social factors, are significantly associated with aging in women. Age-related changes in A&BC characteristics tend to proceed more rapidly in female seniors with low values of SES and HE and insufficient PA levels.

Inequalities in the Access to Health Services Among Older Migrants: Evidence From the China Migrant Dynamic Monitoring Survey

Objectives: To identify differences in healthcare use between older migrant workers (OMWs) and older migrants (OMs) and explore associated factors and paths of healthcare use. Methods: The data came from the 2015 China Migrant Dynamic Monitoring Survey (CMDMS). CMDMS used a multi-stage stratified probability proportionate to size method as the sampling technique and conducted a desk review. The samples include OMWs, OMs for caring offspring (N = 4,439), and OMs for receiving care from family (N = 4,184). We built logistic regression and path analysis models to analyze the data. Results: Social health insurance (SHI) in current place of residence is associated with less expenditure among all subgroups. OMWs and OMs for receiving care from family with SHI in current place of residence are more likely to use healthcare. Conclusion: OMWs are particularly vulnerable in healthcare use and socioeconomic status. Having SHI registered in current place of residence helps decrease expenditure among OMs. We urge policymakers to consider a united health financing scheme across OMWs and other urban employees and streamline policies for migrants to enroll in SHI in current place of residence.

Do Loneliness and Per Capita Income Combine to Increase the Pace of Biological Aging for Black Adults across Late Middle Age?

In a sample of 685 late middle-aged Black adults (M age at 2019 = 57.17 years), we examined the effects of loneliness and per capita income on accelerated aging using a newly developed DNA-methylation based index: the DunedinPACE. First, using linear, mixed effects regression in a growth curve framework, we found that change in DunedinPACE was dependent on age, with a linear model best fitting the data (b = 0.004, p < 0.001), indicating that average pace of change increased among older participants. A quadratic effect was also tested, but was non-significant. Beyond the effect of age, both change in loneliness (b = 0.009, p < 0.05) and change in per capita income (b = -0.016, p < 0.001) were significantly associated with change in DunedinPACE across an 11-year period, accounting for significant between person variability observed in the unconditional model. Including non-self-report indices of smoking and alcohol use did not reduce the association of loneliness or per capita income with DunedinPACE. However, change in smoking was strongly associated with change in DunedinPACE such that those reducing their smoking aged less rapidly than those continuing to smoke. In addition, both loneliness and per capita income were associated with DunedinPACE after controlling for variation in cell-types.

Conjoint analyses of patients’ preferences for primary care: a systematic review

Background

While patients’ preferences in primary care have been examined in numerous conjoint analyses, there has been little systematic effort to synthesise the findings. This review aimed to identify, to organise and to assess the strength of evidence for the attributes and factors associated with preference heterogeneity in conjoint analyses for primary care outpatient visits.

Methods

We searched five bibliographic databases (PubMed, Embase, PsycINFO, Econlit and Scopus) from inception until 15 December 2021, complemented by hand-searching. We included conjoint analyses for primary care outpatient visits. Two reviewers independently screened papers for inclusion and assessed the quality of all included studies using the checklist by ISPOR Task Force for Conjoint Analysis. We categorized the attributes of primary care based on Primary Care Monitoring System framework and factors based on Andersen’s Behavioural Model of Health Services Use. We then assessed the strength of evidence and direction of preference for the attributes of primary care, and factors affecting preference heterogeneity based on study quality and consistency in findings.

Results

Of 35 included studies, most (82.4%) were performed in high-income countries. Each study examined 3–8 attributes, mainly identified through literature reviews (n = 25). Only six examined visits for chronic conditions, with the rest on acute or non-specific / other conditions. Process attributes were more commonly examined than structure or outcome attributes. The three most commonly examined attributes were waiting time for appointment, out-of-pocket costs and ability to choose the providers they see. We identified 24/58 attributes with strong or moderate evidence of association with primary care uptake (e.g., various waiting times, out-of-pocket costs) and 4/43 factors with strong evidence of affecting preference heterogeneity (e.g., age, gender).

Conclusions

We found 35 conjoint analyses examining 58 attributes of primary care and 43 factors that potentially affect the preference of these attributes. The attributes and factors, stratified into evidence levels based on study quality and consistency, can guide the design of research or policies to improve patients’ uptake of primary care. We recommend future conjoint analyses to specify the types of visits and to define their attributes clearly, to facilitate consistent understanding among respondents and the design of interventions targeting them.

Word Count: 346/350 words.

Trial registration

On Open Science Framework: https://osf.io/m7ts9

Quality of Life Among Geriatric Community Members Following the Kaohsiung Gas Explosion: A 5-Year Cross-Sectional Study

OBJECTIVE

The aim was to conduct a follow-up study of the quality of life (QoL) and to measure lifestyle factors among the aging survivors of a petrochemical gas explosion in Taiwan 5 years after the event.

METHODS

A community-based survey with cross-sectional assessments was conducted with residents of a community who experienced a petrochemical gas explosion 5 years after the disaster. Short Form 12v2 (SF-12v2) was used to survey a representative sample of participants.

RESULTS

The risk factors for different QoL subscales were stressors and chronic physical illness, and the protective factors were higher income and better diet and exercise habits. The elderly participants had better diet and exercise habits than the younger participants in this survey. Aging had a negative impact on the physical QoL subscales [physical functioning (PF), bodily pain (BP), general health (GH), Physical Component Summary (PCS)] but a positive impact on psychological QoL subscales [vitality (VT), social functioning (SF), emotional problems (RE), mental health (MH), Mental Health Component Summary (MCS)].

CONCLUSIONS

While participants' psychiatric status had improved after 5 years, their QoL continued to be affected, especially in those with stress and physical illness. The elderly groups maintained a relatively acceptable QoL in terms of psychological aspects. Postdisaster treatment and follow-up should be addressed to a greater degree, especially in victims with mental illness or chronic illness and those with fewer socioeconomic resources.

Abuse and Discrimination Experienced by Older Women in the Era of COVID-19: A Two-Wave Representative Community Survey in Hong Kong

Although there is a growing volume of research on violence against women, violence against older women has received little attention to date. Little is known about the experience of elder abuse, discrimination, loneliness, and health among older women, in particular in the era of COVID-19 when our lives have been changed drastically. Using two waves of survey data (N = 1,498), this study compared the estimates of elder abuse and age discrimination before and during the COVID-19 pandemic, examined their associations with physical and mental health, and explored the mediating effects of loneliness on the associations in two independent samples of older women in Hong Kong. Reductions in some forms of abuse and discrimination against older women during the pandemic were observed. Findings from regression analyses show that elder abuse and age discrimination were associated with poorer health, and these associations were mediated by loneliness.

Evaluation of the Predictors of the Quality of Life in the Postpartum Period: A Cross-Sectional Study

BACKGROUND

It is necessary to study the predictors of life quality in the early postpartum period. Early diagnosis, timely care and intervention can improve the health of mother and baby. We aimed to evaluate the predictors of the quality of life in the postpartum period.

METHODS

This cross-sectional study was conducted on 407 eligible women aged 18 to 47 yr, in the postpartum period, selected from clinics affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran in 2018. Data were collected using a demographic and obstetric questionnaire and Maternal Postpartum Quality of Life (MAPP-QOL) with Cronbach's alpha coefficients of 0.96 to assess personal details and postpartum quality of life. Data analyzed using SPSS. Linear regression analysis was performed to examine the relationship between maternal predictors and quality of life in the postpartum period.

RESULTS

The postpartum quality of life had a significant relationship with income status (P<0.001), Number of Children (P=0.031), mother's education(P=0.009) and maternal complications (P<0.001).

CONCLUSION

This study confirmed the relationship between maternal predictors and the postpartum quality of life. It could facilitate clinicians and educators to improve the quality of life for postpartum women.

Relationship between Self-Reported Neighborhood Safety and Happiness and Life Satisfaction among Women in Low-Middle Income Countries

Measures related to subjective well-being such as perceived happiness and life satisfaction are becoming increasingly popular among health researchers due to their strong correlation with longevity and all-cause mortality. Previous studies have focused on the role of environmental safety on female empowerment. However, not much is known about the impact of environmental risk factors such as perceived safety on subjective well-being, especially in the low-middle-income countries (LMICs). The present study aims to investigate the association between self-reported safety and self-reported happiness and life satisfaction among women in selected LMICs in Asia and Africa. Methods: We analyzed cross-sectional data from eleven countries on 186,388 women aged 15–49 years from the sixth round of the Multiple Indicator Cluster Survey. The outcome measures were self-reported happiness and life satisfaction, and their associations with the safety indicators (i.e., feeling unsafe in the neighborhood and at home) were calculated using generalized ordered logit models by adjusting for relevant sociodemographic factors. Results: The highest percentage of feeling very unsafe both in the neighborhood (39.3%) and at home (26.5%) was reported in Iraq, while Tonga had the highest percentage of reporting both feeling very safe in the neighborhood (55.3%) and at home (54.9%). The odds of self-reported worsening life satisfaction were higher among women who reported feeling very unsafe in the neighborhood [OR = 1.43, 95% CI = 1.36,1.50] and at home [OR = 1.13, 95% CI = 1.08,1.19]. Feeling of being very unsafe in the neighborhood [OR = 1.16, 95% CI = 1.10,1.22] and at home [OR = 1.65, 95% CI = 1.57,1.74] also showed strong positive association with self-reported unhappiness. Conclusions: Our findings from eleven LMICs across Asia and Africa indicate that lack of environmental safety may negatively impact subjective well-being among women. Further research is necessary to explore the root causes of insecurity and design intervention programs aiming to promote women’s psychosocial health and well-being.

Self-reported wellbeing and health-related quality of life of Aboriginal and Torres Strait Islander people pre and post the first wave of the COVID-19 2020 pandemic

OBJECTIVE

Quantify change in wellbeing and health-related quality-of-life (HRQoL) in Aboriginal and Torres Strait Islander adults pre and post Australia's initial COVID-19 lockdown.

METHODS

Aboriginal and Torres Strait Islander adults completed an online survey at Time 1 (October-November 2019; before the initial Australian COVID-19 outbreak) and Time 2 (August-September 2020; after the first Australian lockdown). We assessed wellbeing using a visual analogue scale (VAS) and HRQoL using the Assessment of Quality of Life (AQoL-4D) instrument. Participants who completed both surveys (n=42) were included to quantify change in outcomes over time and by comorbidity and demographic factors.

RESULTS

Mean reduction in wellbeing over time was 6.4 points (95%CI -14.2 to 1.4) and was associated with age (18-54yo), financial instability and mental health comorbidity. Mean reduction in HRQoL over time was 0.06 (95%CI -0.12 to 0.01) and was associated with financial instability, high physical comorbidity level and mental health comorbidity.

CONCLUSIONS

Aboriginal and Torres Strait Islanders aged 18-54yo, who were financially unstable or had elevated comorbidity during COVID lockdowns experienced greater reductions in wellbeing and HRQoL.

IMPLICATIONS FOR PUBLIC HEALTH

As the COVID-19 pandemic continues in Australia, both urgent and forward planning is needed, especially for the priority groups identified.

Financial Worry and Psychological Distress Among Immigrants in the United States, 2013-2018

The coronavirus disease 2019 (COVID-19) pandemic has highlighted links among economic stability, health outcomes, and migration. The facets of financial worry and their associated psychological burden have been understudied among the immigrant population. The goal of this study was to determine the specific facets of financial worry and associated psychological burden in immigrants. This cross-sectional study, which used data from the 2013 to 2018 National Health Interview Survey (NHIS), examined patient-reported measures of worry regarding financial strain. The NHIS is a household survey of noninstitutionalized, nonmilitary adults in the United States. Multivariable ordinal logistic regressions were used to define adjusted odds ratios (AORs) for financial worry and psychological distress, adjusting for various sociodemographic variables. Among 131,669 US-born and 26,155 non-US-born participants who responded to all 6 questions on the 6-item Kessler Psychological Distress Scale (K6), the overall prevalence of participants reporting any serious psychological distress (K6 score ≥13) was 3.0% and 2.25%, respectively. Despite these overall prevalence data, there were specific areas of financial worries that were higher in non-US-born participants than in US-born participants. Compared with US-born participants, non-US-born participants had higher rates of financial worries regarding retirement [75.78% vs. 69.08%, AOR=1.37, 95% confidence interval (CI) 1.29-1.45, P<0.001], medical costs due to illness (worry about not being able to pay medical costs of a serious illness or accident) (74.94% vs. 65.27%, AOR=1.37, 95% CI: 1.29-1.45, P<0.001), standard of living (74.25% vs. 65.29%, AOR=1.42, 95% CI: 1.34-1.51, P<0.001), and medical cost of health care (worry about not having enough to pay medical costs for normal health care) (66.52% vs. 52.67%, AOR=1.51, 95% CI: 1.43-1.60, P<0.001), among other costs. Notably, serious psychological distress in non-US-born individuals was associated with increased financial worry relative to US-born individuals with a similar level of psychological distress. Further research is needed to evaluate the role physicians can play in mitigating psychological distress in patients with increased financial worry.

Financial Stressors and Resources Associated With Financial Exploitation

Background and Objectives

The prevalence of older adult financial exploitation (FE) is increasing. Population-based survey estimates of FE in the older adult population range from 5% to 11%. Given the growing prevalence of FE victimization in older adult populations, understanding the population's vulnerability to FE has increased in importance. This study investigates a conceptual framework in an attempt to understand how financial stressors and resources are associated with substantiated FE in a sample consisting largely of Black older adults.

Research Design and Methods

The study uses a cross-sectional design to investigate group differences among a total sample of 142 community-dwelling older adult participants, 62 of whom sought services to address FE and 80 with no history of FE.

Results

The group of older adults who sought services to address FE was more likely to be unmarried and had fewer years of education. Measures of financial literacy and perceived financial vulnerability had protective and risk effects, respectively.

Discussion and Implications

The present study found that sociodemographic and financial stress and resource measures have significant relationships with FE. These findings support the conceptual framework describing their relationship. This new conceptual framework provides a guiding factor in better understanding vulnerability to FE in older adults. The study also adds to the paucity of research completed on FE with Black older adults.

An exploration of the sociodemographic and health conditions associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults

Objective

To identify sociodemographic factors and health conditions associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults. Participants were recruited via investigator networks and an online panel provider with an established nationwide panel of Aboriginal and Torres Strait Islander adults. Those interested were invited to complete a survey that included an assessment of wellbeing using a visual analogue scale. Data was collected from October–November 2019 and August–September 2020. Exploratory analyses were conducted to ascertain factors associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults.

Results

Having more than enough money to last until next pay day, full-time employment, completion of grade 12, having a partner, and living with others were significantly associated with higher wellbeing among Aboriginal and Torres Strait Islander adults. A self-reported history of depression, anxiety, other mental health conditions, heart disease, or disability were associated with lower self-rated wellbeing scores. Our findings indicate a need for further investigation among these socioeconomic and patient groups to identify how to improve and support the wellbeing of Aboriginal and Torres Strait Islander adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05794-3.