The differences in self-perceptions of aging, health-related quality of life and their association between urban and rural Chinese older hypertensive patients

The Association of Self-Perception of Aging and Quality of Life in Older Adults: A Systematic Review

BACKGROUND AND OBJECTIVES

Self-perception of aging is an important psychosocial factor that can influence quality of life in older age. This review aimed to synthesize findings on the association between self-perception of aging and quality of life among older adults aged 60 and above.

RESEARCH DESIGN AND METHODS

A systematic search was conducted in 4 electronic databases (Ovid Medline, PsycInfo, CINAHL, and Web of Science). Studies conducted in English and including measures on the perception of aging and quality of life were included in this review. A total of 32 observational studies (21 cross-sectional, 8 longitudinal, 2 mixed-method, and 1 qualitative) met the inclusion criteria. Outcomes reported in the included studies were quality of life, physical health and functioning, psychological health, mental health, and general well-being.

RESULTS

Overall, 20 quantitative studies indicated a strong association between positive perception of aging and increased quality of life. Similarly, 9 quantitative studies demonstrated that negative perception of aging is associated with lower quality of life. Results of the mixed-method and qualitative studies indicated that older adults with higher morale and good physical capability had more positive perceptions of health.

DISCUSSION AND IMPLICATIONS

These results suggest that promoting a positive perception of aging and a self-care attitude would help to enhance older adults' quality of life and should be incorporated into future health promotions and interventions.

Association Between Self-Perception of Aging and Long-Term Mortality in Elderly Patients with Hypertension in Rural China: A Possible Beneficial Effect of Nut Intake

Purpose

Previous research has consistently shown that self-perception of aging (SPA) is an important predictor of health and longevity, while Chinese rural elderly patients with hypertension had poorer SPA. Whether it was associated with their mortality kept unknown. The objective of this study was to investigate the long-term mortality and analyze the association between SPA and this mortality in the specific context of rural elderly patients with hypertension.

Patients and Methods

This study is a longitudinal investigation of the mortality in elderly patients with hypertension in rural Suzhou, China. Sociodemographic and clinical data, SPA, and six-year mortality were investigated. We used binary logistic regression and subgroup analyses to assess the effect of SPA at baseline on six-year mortality.

Results

A total of 280 hypertensive patients aged 60 years and older participated in the study, of whom 21 died, with a six-year mortality rate of 7.5%. After controlling for covariates, the "Emotional representation" dimension (OR=2.824, 95% CI:1.034-7.712) in SPA remained a risk factor for death. In subgroup analyses of the group aged 75 years and older, high scores on the "Timeline cyclical" (OR=14.125, 95% CI: 1.258-158.593) and "Emotional representations" (OR=2.567, 95% CI:1.066-6.182) dimensions were associated with a higher risk of death, while weekly nut intake may have mitigated the negative SPA effect on mortality.

Conclusion

Poorer self-perception of aging was associated with a high risk of mortality in rural elderly patients with hypertension, while the habit of weekly nut intake might help reduce this risk in the group aged 75 years or older.

Symptom perception and self-care practice for uraemic pruritus in patients receiving haemodialysis

BACKGROUND

Due to the recurrent nature of uraemic pruritus among patients receiving haemodialysis, self-care can offer patients a means to ameliorate this symptom. Qualitative data on self-care of uraemic pruritus are limited.

OBJECTIVE

To explore how patients on haemodialysis perceive uraemic pruritus, implement self-care practice, and appraise the outcome of self-caring uraemic pruritus.

DESIGN

The Common Sense Model of Self-Regulation guided the study design.

PARTICIPANTS AND APPROACHES

Data were collected through face-to-face interviews with 30 patients receiving haemodialysis who were aged from 50 to 89 years and had had uraemic pruritus for more than 6 weeks. Interviews were audio recorded, and verbatim transcriptions of interviews were analysed.

FINDINGS

Our participants generally used life-related analogies to describe uraemic pruritus, which they reviewed as a momentarily controllable symptom with an endless timeline. Most participants reported limited knowledge of the aetiology and multifaceted impacts of uraemic pruritus on their daily life and emotional status. The impacts on daily life included decreased zest for activities and sleep disturbances. Physical management of uraemic pruritus involved daily substance use and interventions employed during pruritic episodes. Psychological managements involved preferences for indoor activities and a fatalistic outlook. Unsatisfactory outcomes and psychological burdens from self-care practice were reported.

CONCLUSIONS

Life experiences shape symptom presentation and self-care practice in patients on haemodialysis. The modalities for self-caring for uraemic pruritus are diverse but not remarkably effective. Performing self-care tasks places a substantial burden on patients. Individualised educational programs should be developed to improve the outcome of self-care practice.

Frailty trajectories in ICU survivors: A comparison between the clinical frailty scale and the Tilburg frailty Indicator and association with 1 year mortality

PURPOSE

To test the agreement of the Clinical Frailty Scale (CFS) and the Tilburg Frailty Indicator (TFI), their association with 3, 6 months and 1-year mortality and the trajectory of frailty in a mixed population of ICU survivors.

MATERIAL AND METHODS

This is a prospective, multicenter, longitudinal study on ICU survivors ≥18 years old with an ICU stay >72 h. For each patient, sociodemographic and clinical data were collected. Frailty was assessed during ICU stay and at 3, 6, 12 months after ICU discharge, through both CFS and TFI.

RESULTS

124 patients with a mean age of 66 years old were enrolled. The baseline prevalence of frailty was 15.3% by CFS and 44.4% by TFI. Baseline CFS and TFI correlated but showed low agreement (Cohen's K = 0.23, p < 0.001). Baseline CFS score, but not TFI, was significantly associated to 1 year mortality. Moreover, CFS score during the follow-up was independently associated 1-year mortality (OR = 1.43; 95% CI: 1.18-1.73).

CONCLUSIONS

CFS and TFI identify different populations of frail ICU survivors. Frail patients before ICU according to CFS have a significantly higher mortality after ICU discharge. The CFS during follow-up is an independent negative prognostic factor of long-term mortality in the ICU population.

Combatting ageism in the Western Pacific region

The present viewpoint examines the manifestation of ageism, defined as stereotypes, prejudice and discrimination towards people because of their age, in the Western Pacific region. Research is still equivocal concerning the nature of ageism in the Western Pacific region, especially in East and South-East Asia (e.g., Eastern countries). There has been plenty of research to support as well as question the general notion of Eastern cultures and countries as being less ageist compared to Western cultures and countries at individual, interpersonal, and institutional levels. Although varied theoretical explanations have aimed to explain East-West differences in ageism such as the modernization theory, the pace of population aging, the proportion of older people in the country, cultural hypothesis, and GATEism, none of these theories fully accounts for the mixed findings. As such, it is safe to conclude that targeting ageism should be an important step in ensuring a world for all ages in Western Pacific countries.

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain

INTRODUCTION

Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers.

AIMS

To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA).

METHODS

We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes.

RESULTS

Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals.

CONCLUSION

Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Socio-demographic disparities in health-related quality of life after hip fracture in China: evidence from the China Health and Retirement Longitudinal Study

This study analyzed the impact of hip fractures on people's health-related quality of life and its socio-demographic disparities in China.

PURPOSE

Hip fractures cause high mortality and worsened health-related quality of life (HRQoL). This study aimed to investigate whether socio-demographic-related inequities in post-hip fracture participants' HRQoL exist in China.

METHODS

Data from the China Health and Retirement Longitudinal Study (waves 2013, 2015, and 2018) were used. The measurement of HRQoL in this study focused on 5 health dimensions: depression, body pain, mobility, basic activities of daily living, and instrumental activities of daily living. A difference-in-differences (DID) analysis with multiple time periods was performed to gauge the impact of hip fracture on HRQoL. A multivariate regression approach was used to explore socio-demographic-related factors associated with inequities of HRQoL.

RESULTS

A total of 23,622 individuals were included, and 341 participants reported hip fracture events during the survey period. In participants with hip fracture, the presentation rate of body pain increased by 14% (p < 0.01) and the HRQoL of other health dimensions worsened (p ≤ 0.01) after hip fracture. The DID analysis showed that hip fracture had a negative impact on all HRQoL dimensions (p < 0.01). Socioeconomic-related factors of HRQoL inequities included school education level and location of residence. Study participants with hip fracture with greater educational attainment or living in urban areas had higher (p < 0.05) levels of HRQoL. In addition, comorbidities also correlated with a worse HRQoL (p < 0.05).

CONCLUSION

Hip fracture significantly affects people's HRQoL in China, and the impact is more profound for those with lower educational attainment or living in rural areas. Targeted interventions should be designed to narrow this inequity.

Understanding perspectives on health-promoting behaviours among older adults with hypertension

Purpose

Health-promoting behaviours (HPBs) are considered the key to determining health among older adults with hypertension. Increasing our understanding of older adults’ views on HPBs could facilitate the development of interventions aimed at improving their quality of life. This study aims to describe the perceptions of older adults with high blood pressure concerning their HPBs and associated factors.

Methods

Semi-structured interviews with 40 individuals in Thailand were used to collect the data, which were analysed using thematic analysis.

Results

The results were categorized into five main themes related to personal, social, and environmental factors. Older adults explained that their experiences with HPBs involve taking responsibility for controlling blood pressure by following a doctor’s prescription, modifying their lifestyles to be healthier, sustaining social relationships, and experiencing spiritual growth through religious practices for inner peace. Older adults also identified environmental factors that influenced their engagement in HPBs depending on their residential areas.

Conclusions

The findings of this study highlight the importance of practices in which professionals support and encourage older adults to perform HPBs to maintain health and improve their well-being.

Development of a short-form Chinese health literacy scale for low salt consumption (CHLSalt-22) and its validation among hypertensive patients

Background

With the accelerated pace of people’s life and the changing dietary patterns, the number of chronic diseases is increasing and occurring at a younger age in today’s society. The speedily rising hypertensive patients have become one of the main risk factors for chronic diseases. People should focus on health literacy related to salt consumption and reach a better quality of life. Currently, there is a lack of local assessment tools for low salt consumption in mainland China.

Objective

To develop a short-form version of the Chinese Health Literacy Scale For Low Salt Consumption instrument for use in mainland China.

Methods

A cross-sectional design was conducted on a sample of 1472 people in Liaoxi, China. Participants completed a sociodemographic questionnaire, the Chinese version of the CHLSalt-22, the measuring change in restriction of salt (sodium) in the diet in hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS) to test the hypothesis. Exploratory factor analysis and confirmatory factor analyses were performed to examine the underlying factor structure of the CHLSalt-22. One month later, 37 patients who participated in the first test were recruited to evaluate the test-retest reliability.

Results

The CHLSalt-22 demonstrated adequate internal consistency, good test-retest reliability, satisfactory construct validity, convergent validity and discriminant validity. The CHLSalt-22 count scores were correlated with age, sex, body mass index (BMI), education level, income, occupation, the Measuring Change in Restriction of Salt (sodium) in Diet in Hypertensives (MCRSDH-SUST), the Brief Illness Perception Questionnaire (BIPQ), and the Benefit-Finding Scales (BFS).

Conclusion

The results indicate that the Chinese Health Literacy Scale For Low Salt Consumption (CHLSalt-22) version has good reliability and validity and can be considered a tool to assess health literacy related to salt consumption in health screenings.

The Impact of Physical Activity Levels and Functional Fitness Status on the Quality of Life Perceived by Older Adults Living in Rural and Urban Areas: The Portuguese Inland Case

Health-related quality of life (HRQoL) is influenced by several factors, such as living place, physical activity (PA), and functional fitness levels. Evidence shows that functional fitness and PA levels are strongly associated with positive HRQoL, especially in the older population. However, the impact of the living place has not been investigated as an influencing variable in this context. Therefore, this study aimed to investigate the relationship between the HRQoL, PA, and functional fitness of older adults living in rural and urban areas of Portugal. A cross-sectional study was performed with community-dwelling adults aged 65 years and over (n = 261) living in the city of Guarda. The participants were assessed for sociodemographic, anthropometric, clinical health, HRQoL, PA levels, and functional fitness status. The results showed that rural residents presented higher scores of HRQoL and functional fitness than older individuals living in urban areas. Regression models showed that functional fitness variables influence the HRQoL overall score and mental and physical subcomponents of HRQoL, regardless of the living place. In contrast, PA levels only influenced the HRQoL score in rural residents. The findings suggest that intervention programs to improve the physical health, quality of life, and well-being of the older population need to consider the country’s different geographical areas.

Differences in Health-Related Quality of Life and Its Associated Factors Among Older Adults in Urban and Rural Areas

Purpose

Urban-rural health disparity is one of the most prominent challenges in China today. The goal of this study is to find differences in health-related quality of life (HRQoL) and its associated factors among older people in urban and rural areas.

Methods

A multi-stage stratified sampling method was conducted in Shanxi Province, with a total of 3250 older adults participated in this cross-sectional survey. HRQoL was assessed using the Chinese version of the EQ-5D-5L. Tobit regression models were employed to identify associated factors for HRQoL.

Results

The mean EQ-5D utility score of the total sample was 0.87± 0.23, with a statistically significant difference observed between urban (0.89 ± 0.22) and rural areas (0.86 ± 0.23). Obesity (Coe=−0.10, p=0.021) and nutrition awareness (Coe=−0.14, p=0.009) were two unique associated factors to rural older adults’ HRQoL. While, age (Urban: Coe=0.13, p=0.001; Rural: Coe=−0.019, p<0.001), socioeconomic status (Urban: Coe=0.13, p<0.001; Rural: Coe=0.14, p<0.001), number of chronic non-communicable diseases (Urban: Coe=−0.20, p<0.001; Rural: Coe=−0.15, p<0.001), sleep quality (Urban: Coe=−0.22, p<0.001; Rural: Coe=0.15, p<0.001) and daytime sleepiness (Urban: Coe=−0.13, p<0.001; Rural: Coe=−0.13, p<0.001) were found to be associated with HRQoL regardless of the residential area.

Conclusion

This study suggested that rural older adults are facing HRQoL disadvantages compared to those in urban area. Accordingly, more attention should be devoted to rural older adults’ HRQoL, particularly to the unique factors like body weight and nutrition awareness. Targeted policies and interventions should be implemented to improve HRQoL and bridge the urban-rural HRQoL gap.

Health related behaviours and physical activity level of hypertensive individuals during COVID-19 pandemic

During the COVID-19 pandemic, all countries implemented lockdown to prevent transmission of coronavirus. The prolonged stay-at-home process created some unfavourable effects like unhealthy lifestyle, physical inactivity and sedentary behaviour especially in patients with cardiovascular risk. Hypertensive individuals are also affected in the pandemic because of limited access to healthcare services, screening, and altered lifestyles. We aimed to investigate physical activity (PA) level, sedentary behaviour, mental health and healthy lifestyle behaviours in patients with hypertension and compare these parameters with healthy controls. This prospective, cross-sectional study included 40 hypertensive and 40 age-sex matched healthy controls. We assessed PA with the International Physical Activity Questionnaire long-form, quality of life with Short-Form 36 (SF-36) questionnaire, anxiety and depression with Hospital Anxiety and Depression Scale (HADS) and lifestyle behaviours with Health-Promoting Lifestyle Profile Scale-II (HPLP-II). Moderate and vigorous PA levels of hypertensives' were statistically lower than healthy controls (P = 0.001; P = 0.003, respectively). Hypertensive patients exhibited lower SF-36 physical function (P = 0.001), energy/vitality (P = 0.042), body pain scores than those of healthy controls (P = 0.007). Although HADS-anxiety, depression scores were similar (P > 0.05), the depression ratio (45%) was more common in the hypertensive group during the lockdown. The main findings are that hypertensive patients have lower PA levels and worse quality of life than healthy controls during the pandemic. In addition, the presence of depression is more common among hypertensive patients. Considering unhealthy lifestyles, governments, and health professionals should take some precautions and plan interventions against physical inactivity. As known, providing regular physical activity is a keystone to fighting against cardiovascular disease.

Latent profile analysis of self-perceptions of ageing among Chinese community-dwelling older adults

BACKGROUND

Self-perceptions of ageing (SPA) is an important predictor for physical and mental health of older adults in successful ageing. SPA is mainly studied from negative or positive perspectives using variable-centred methodologies. The aim of the current study was to explore distinct profiles of SPA among Chinese community-dwelling older adults using a person-centred method and validate the SPA profiles by examining associations with psychological outcomes.

METHODS

Participants aged 65 and over were randomly divided into test and validation samples (n = 451, respectively). SPA was measured by the Brief Ageing Perceptions Questionnaire using latent profile analysis.

RESULTS

Three SPA profiles were identified. One adaptive subgroup was designated as 'Low ageing awareness and high positive control' (LAPC, 84.7% and 75% in both samples, respectively). Two maladaptive SPA subgroups were designated as 'Low positive consequences and control' (LPCC, 3.9% and 8.2% in both samples, respectively), and 'High ageing awareness and negative control' (HANC, 11.4% and 16.8% in both samples, respectively). Similar to negative/positive SPA, the HANC and LAPC subgroups showed the highest and lowest levels of depressive symptoms and cognitive decline. Low cognitive function was found in the LPCC subgroup.

CONCLUSIONS

These findings highlight the heterogeneity of older adults' SPA. SPA profiles may aid community healthcare providers in China to identify individuals with high risk of maladaptive SPA and to tailor targeted interventions for psychological health in later life. Distinct SPA profiles require different interventions targeting negative or positive control or both aspects. More positive control strategies might be beneficial for cognitive functioning in older adults from the LPCC subgroup.

Quality of life in health Iranian elderly population approach in health promotion: A systematic review

BACKGROUND

The quality of life (QOL) is essential in all different stages of life; however, It is more important for older people as it can be effective in promoting their health. Therefore, the present study aimed to review the literature on the QOL in the Iranian elderly population.

MATERIALS AND METHODS

The study was carried out as a systematic review. For this purpose, all databases were searched in March 2021. The keywords used for the search were "quality of life, elderly, older adults, aging, seniors, and Iran" along with the Persian equivalents. PRISMA protocol was used to screen articles. After removing duplicate and irrelevant items, two evaluators appraised the articles separately based on a researcher-made checklist derived from the SBEM and STROBE Statement standard checklists.

RESULTS

The initial search yielded 3734 studies on the QOL in the Iranian elderly population. After screening and assessing the studies based on inclusion and exclusion criteria, 22 articles remained in the study. Most of the studies (cross-sectional) were conducted in Tehran using a 36-item Short-Form Health Survey to assess the QOL. The studies investigated sociodemographic determinants, physical and health-related behaviors, and spirituality and psychological determinants of the QOL. The sociodemographic determinants were the most common factors under study. The results showed that the role of gender and socioeconomic status was the strongest among the sociodemographic characteristics. A significant association was found between the QOL in the Iranian elderly population and factors such as depression and religious confrontation.

CONCLUSION

In addition to chronic diseases, diseases of the oral and dental, as well as an unhealthy diet, should be considered in the elderly. Therefore, attention should be paid to all social, physical, and psychological variables that affect the QOL of older people.

Differences in the Potential Accessibility of Home-Based Healthcare Services among Different Groups of Older Adults: A Case from Shaanxi Province, China

With the increase of the aging population and the lack of family care, home-based healthcare services have gradually become the main model to cope with aging, so local governments have invested heavily in the construction of home-based healthcare services. However, healthcare services still have problems such as low resource utilization and imbalanced development. The reason is that the supply and demand of healthcare services are not matched and the potential accessibility is low. Therefore, based on the supply and demand of healthcare services, this article pulls out the spatial and social factors that affect the potential accessibility, and tests the influence of individual factors on the potential accessibility among different groups of older adults. It is found that the perceived vulnerability of the older adults will reduce the potential accessibility of healthcare services. The psychosocial status, income and education level with the willingness to use healthcare services of the older adults are directly proportional, while residence has a negative impact on the potential accessibility. Finally, based on this finding, this article puts forward feasible suggestions from the perspective of policy content, publicity, and implementation.