Effects of functional decline on quality of life among the Japanese elderly

Resting-state Functional Connectivity of the Motor and Cognitive Areas is Preserved in Masters Athletes

Aging is characterized by a decline in physical and cognitive functions, often resulting in decreased quality of life. Physical activity has been suggested to potentially slow down various aspects of the aging process, a theory that has been supported by studies of Masters Athletes (MA). For example, MA usually have better cognitive and physical functions than age-matched sedentary and healthy older adults (OA), making them a valuable model to gain insights into mechanisms that promote physical and cognitive function with aging. The purpose of this study was to identify differences in resting-state functional connectivity (rs-FC) of motor and cognitive regions between MA and OA and determine if these differences in the resting brain are associated with differences in cognitive and physical performance between groups. Fifteen MA (9 males) and 12 age-matched OA (six males) were included. rs-FC images were compared to identify significant between-groups differences in brain connectivity. There was higher connectivity between the cognitive and motor networks for the OA group, whereas the MA group had stronger connectivity between different regions within the same network, both for the cognitive and the motor networks. These results are in line with the literature suggesting that aging reduces the segregation between functional networks and causes regions within the same network to be less strongly connected. High-level physical activity practiced by the MA most likely contributes to attenuating aging-related changes in brain functional connectivity, preserving clearer boundaries between different functional networks, which may ultimately favor maintenance of efficient cognitive and sensorimotor processing.

Successful Aging in the Indian Socio-cultural Milieu

There is a growing recognition of the importance of subjective definitions of successful aging from a clinical and policy perspective, and for their social and cultural relevance. However, the voices of older Indians remain largely underrepresented in the emerging body of qualitative literature on successful aging. Given this gap, and India's burgeoning older population, the present study set out to examine their subjective perception of successful aging. Using convenience sampling, data was collected from older men and women (N = 63, M Age = 71.21) living in the community, and in old age homes in Delhi NCR, through face-to-face interviews and focus group discussions. Reflexive thematic analysis resulted in four primary themes and eight sub-themes - Successful Aging as Personal Well-being, Tensions between Agency and Fatalism, comprising three sub-themes viz. the person as an active agent, co-existence of agency and fatalism, and negotiating with the invisible powers; Linked Lives comprising two sub-themes viz. the aging parent and the adult child, and spousal interrelationship; and The Social and Built Environment comprising three sub-themes, viz. complexity of social life: the health interface, social life in the neighborhood, and the good house. These findings provide a culture-specific view of successful aging in the Indian context, and reveals the multifaceted conceptualization of successful aging of older Indians - one that encompasses various biopsychosocial components.

Factors Affecting the Life Satisfaction of Older People with Care Needs Who Live at Home

The number of older people is increasing rapidly, and the number of older people with care needs who live at home is also increasing in Japan. Maintaining their life satisfaction has been a primary challenge. This study aimed to identify factors affecting the life satisfaction of older people with care needs. The study was conducted among older people using homecare services; 126 participants (mean age, 79.33 ± 7.51 years, 54 male) were included in the analysis. Logistic regression analysis with adjustment for age, sex, and economic status was conducted with life satisfaction as the objective variable and the Japanese version of occupational gaps questionnaire (OGQ-J), sense of coherence, functional independence measure, and environmental factors as explanatory variables. The variables that significantly affected life satisfaction were the OGQ-J (p = 0.0352, OR 0.90, 95% CI 0.81–0.99) and environmental factors (p = 0.0083, OR 4.41, 95% CI 1.52–14.11). This study’s results indicate the importance of focusing on environmental factors and facilitating the participation of older people with care needs in activities they want to do to maintain and improve their life satisfaction.

Life satisfaction in late adult span: the contribution of family relationships, health self-perception and physical activity

BACKGROUND

Life satisfaction is a crucial facet of subjective well-being, being impacted by different factors, such as cognitive and physical health, and social functioning.

AIMS

This study intended to investigate the impact of satisfaction with family ties, education, negative mood and health self-perception on life satisfaction in late adulthood.

METHODS

One hundred fifteen cognitively intact 75-101-year-old participants competed a battery of tools assessing cognitive efficiency and self-referent measures of life satisfaction, perceived physical health, negative mood and satisfaction with family relations.

RESULTS

A series of step-wise regression analyses showed that satisfaction with family ties with and without perceived physical health predicted different indexes of life satisfaction. Moreover, more physically active participants reported fewer depressive symptoms and better life satisfaction with their time occupied in leisure activities than more sedentary respondents.

CONCLUSION

Perceived emotional connection with family members and a physically active lifestyle represent the most significant protective factors to boost self-reported life satisfaction in late adulthood.

The importance of a training program on active aging from the perspective of elderly individuals

OBJECTIVE

to assess the results of a training program focused on the well-being of elderly individuals from the perspective of users, through the opinion on the program impact on their active aging.

METHODS

a qualitative research, carried out from an intentional sample, consisting of 10 elderly women. Interview conducted by focus group, recorded and transcribed, which constituted the corpus of analysis. Lexical analysis of textual data was performed using the Alceste software.

RESULTS

from the analysis, three classes emerged: 1) Health-Activity; 2) Activity-Expectation; 3) Mind-Body Unit. The Activity-Expectation class stands out.

CONCLUSIONS

the research revealed that elderly individuals consider it important to have expectation, which results in satisfaction and involvement with life as well as the ability to remain active in a perspective of mind-body unit. Future projects should focus on enhancing mental and physical functions to promote active and healthy aging.

Randomized Controlled Trial on the Effects of a Combined Intervention of Computerized Cognitive Training Preceded by Physical Exercise for Improving Frailty Status and Cognitive Function in Older Adults

(1) Objective: This study examined the effects of a combined intervention of Brainastic computerized cognitive training (CCT) preceded by physical exercise (PE) for improving frailty status and cognitive function in older adults. (2) Methods: Older adults aged 50 years or older attending elderly centers, without frailty/history of cognitive impairment, were randomly allocated into either a 12-week (i) multi-domain CCT + PE (n = 117), (ii) two-domain CCT + PE (n = 116) or (iii) video watching + PE (i.e., control, n = 114). Brainastic is an online application for cognitive training through video games. The multi-domain CCT targeted memory, attention, executive function, flexibility and visuospatial ability while the two-domain CCT targeted memory and attention. PE included both aerobic and resistance exercises. Outcomes were changes in frailty levels as measured with a simple frailty questionnaire (FRAIL), global cognition as measured with the Rapid Cognitive Screen (RCS), total learning and verbal memory abilities as measured with the Hong Kong List Learning Test (HKLLT), and executive functions as measured with the Frontal Assessment Battery (FAB) over 12 weeks. (3) Results: Participants in the intervention groups (multi-/two-domain CCT + PE) showed greater improvements in frailty status, total learning ability and verbal memory ability than control participants (all p < 0.05). The multi-domain CCT did not outperform the two-domain CCT in improving frailty status or cognitive function. The training effects were independent of the baseline cognition of the participants. (4) Conclusions: A combined intervention of multi-/two-domain CCT preceded by PE seemed to convey benefit over video watching preceded by PE in improving frailty status and cognitive function among older adults attending elderly centers.

Health-Related Quality of Life and Treatment of Older Adults with Acute Myeloid Leukemia: a Young International Society of Geriatric Oncology Review Paper

PURPOSE OF REVIEW

The treatment landscape for older patients with acute myeloid leukemia (AML) is evolving. Many treatments have comparable efficacy making their impact on quality of life (QoL) an important differentiating factor. In this review, we discuss QoL in older adults with AML, focusing on therapeutic and observational trials that have incorporated QoL assessments.

RECENT FINDINGS

Health-related quality of life (HRQoL) is a multi-dimensional concept incorporating physical, mental, emotional, and social functioning domains. HRQoL components overlap with components of geriatric assessment, a multidisciplinary diagnostic process that identifies underlying vulnerabilities of older adults and guides subsequent management strategies. HRQoL questionnaires may be general, cancer-specific, leukemia-specific, or symptom-focused. Therapeutic and observational cohort studies suggest HRQoL improves, or at least remains stable, during intensive and lower-intensity therapies. Nonetheless, HRQoL is not routinely incorporated in AML therapeutic trials. HRQoL assessments can inform both decision-making and management for older adults with AML.

Changes in instrumental activities of daily living functioning associated with concurrent common mental disorders and physical multimorbidity in older adults

Introduction: Instrumental activities of daily living (IADL) are key indicators of general functional status that are frequently used to assess the autonomy of older adults living in the community.Aims: To evaluate the changes in IADL in community-living older adults and the role of common mental disorders and physical multimorbidity in predicting these changes.Method: A secondary analysis including participants from the Longitudinal Survey on Senior's Health and Health Services. Self-reported sociodemographic and clinical information on chronic conditions were obtained at baseline interview (n = 1615). Measures of IADL were obtained at two time points, 3 years apart. Administrative data on physician diagnoses of chronic diseases were linked to self-reported information. Logistic and multinomial regression models were used to study the outcomes of interest.Results: More than one-third of participants reported disability. Significant increase in global and specific IADL tasks disability were observed over time. Concurrent mental and physical chronic conditions predicted persistent and future incidence of disability.Conclusions: We draw attention to the synergistic effect of mental and physical co-morbidities on IADL functioning and to the importance of the simultaneous management of these conditions in order to prevent disability, future decline and the associated health and societal burden.Implications for RehabilitationBy establishing the prevalence of global and specific IADL disability, we can better recognize the needs of older adults and inform health and social care planning.Influenced by the morbidity profile, older adults may experience decline, improvement or maintenance of autonomy in IADL over time.The presence of synergistic effect of physical and mental chronic conditions on functioning suggests that their simultaneous management is crucial in delaying or preventing disability.Reports of significant impairment in tasks such as taking medication calls attention to the need for increased accessibility to programs on medication management.The progressive loss of ability to take medication among multimorbid patients emphasize the need for therapeutic plans that circumvent polypharmacy.

Bio-social determinants of health-related quality of life of middle aged (45-59 years) population in India

Purpose

Inadequate research on midlife health-related quality of life particularly in low-and-middle-income countries has often led to poor recognition of the issues in health programmes and policy. To address these concerns, this study was aimed at examining health-related quality of life and its determinants in middle-aged (45–59 years) men and women in low-resource settings in India.

Methods

Data on health-related quality of life and other relevant parameters were collected from 1112 individuals between 45 and 59 years of age from an urban agglomeration of Pune, India. Independent t-test was used to determine the association between means of Short Form-12 and other variables. Multilinear regression analyses were conducted to study the direction of these associations.

Results

The mean physical and mental component scores were 45.33 (±8.88) and 51.48 (±9.87), respectively. After adjusting for other variables, functional impairment emerged as a common factor that was negatively associated with physical and mental component scores of men (PCS: −5.557, 95%CI = −6.793 to −4.322; MCS:−1.816, 95% CI = −3.443 to −0.189) and women (PCS: −7.985, 95%CI = −9.782 to −6.188; MCS;  = −2.289, 95% CI = −4.160–0.419). Good life satisfaction was positively associated with physical scores in men (2.300, 95%CI =  1.180 to 3.421) and mental scores in women (3.066, 95%CI  =  1.333 to 4.798). Unemployment, sitting hours (>3) and no physical activity affected men, while lower education, marital status, body mass index and chronic illness affected health-related quality of life of women at midlife.

Conclusions

Functional decline, level of life satisfaction and stress affected health-related quality of life of middle-aged individuals in India.

The importance of physical function as a clinical outcome: Assessment and enhancement

The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.

Interventions to improve the health and wellbeing of older people living alone: a mixed-methods systematic review of effectiveness and accessibility

The global population is ageing and the likelihood of living alone increases with age. Services are necessary to help older people living alone to optimise health and wellbeing. This systematic review aimed to summarise the effectiveness and accessibility of interventions to improve the health and wellbeing of older people living alone. Relevant electronic databases (CINAHL, MEDLINE, PsycINFO and Scopus) were searched for all years up to August 2018. Studies were included if they involved older people (aged ⩾55 years) living alone, and an intervention with measured health and wellbeing outcomes. All study types were included. The Theory of Access was used to assess interventions across dimensions of accessibility, availability, acceptability, affordability, adequacy and awareness. Twenty-eight studies met the eligibility criteria; 17 studies focused on ageing safely in place and 11 on psychological and social wellbeing. Studies comprised quantitative (N = 19), qualitative (N = 4) and mixed-methods (N = 5) approaches. Dimensions from the Theory of Access were poorly addressed in the studies, particularly those of higher-quality methodology. Studies were heterogeneous, preliminary in scope and lacked consistent study design, methodology or measurement. Services that do not address user accessibility in design or evaluation may be limited in their uptake and impact. It is recommended that dimensions of access and co-creation principles be integrated into service design processes and be evaluated alongside clinical effectiveness.

Depression, negative relating with the oldest child, and the mediating role of resilience in community elders' psychological well-being: a pilot study in Greece

AIM

This study examined the role of both positive and negative aspects of social relationships with partners, friends, and children on the psychological well-being of Greek elders, as well as the potential mediating role of resilience.

METHODS

The sample included 100 Greek older community-dwellings recruited from three care centres. They completed questionnaires consisted of the Scales of Psychological Well-Being, the shortened Family Members' Interrelating Questionnaire, the Significant Others Scale, the Brief Symptom Inventory, and the Brief Resilience Scale.

RESULTS

The findings suggested that mental health (i.e. depression), rather than physical frailty, and a negative relationship with the oldest child, rather than a lack of social support from family or friends in general, have detrimental effects in elders' well-being. In contrast, resilience has a positive effect on well-being that mediates the association between negative relating with the oldest child and well-being. Elderly parents perceived their child's relating more negatively than their own relating towards the child, and it was the child's negative relating to them, rather than their relating toward the child, that predicted their psychological well-being. An interdisciplinary approach to the care of the geriatric population is highlighted.

CONCLUSIONS

To improve elders' well-being and enhance successful ageing, the determinants of well-being should be key targets of ageing research. Policy, prevention, and intervention actions should address the modifiable variables of any underlying emotional and social issues among elderly people (i.e. depression, negative relating with children, and resilience).

Advance care planning for vulnerable older adults within an Accountable Care Organization: study protocol for the IMPACT randomised controlled trial

INTRODUCTION

Patients with multimorbidity plus additional impairments (eg, mobility limitations, disability, cognitive impairments or frailty) are at the highest risk for poor healthcare outcomes. Advanced care planning (ACP) provides patients and their surrogates the opportunity to discuss their goals, values and priorities for healthcare-particularly in the context of end-of-life care. ACP discussions promote more person-centred care; however, it is currently underused. There is a tremendous need for systematic, scalable approaches to individualised ACP that promotes patient and family engagement. Here we describe the study protocol for a randomised effectiveness trial of a nurse navigator and informatics intervention designed to improve the documentation and quality of ACP discussions.

METHODS AND ANALYSIS

This is a randomised, pragmatic, effectiveness trial; patients aged 65 years and older who have multimorbidity plus impairments in either physical function (eg, mobility limitations or disability) or cognition, and/or frailty within an affiliated Accountable Care Organization were eligible. The electronic health record was used to develop an automatic prescreening system for eligible patients (n=765) and participants were randomised in a 1:1 ratio to either the nurse navigator-led ACP pathway or usual care. Our primary outcomes are documentation of ACP discussions within the EHR along with the quality of ACP discussions. Secondary outcomes include a broad range of ACP actions (eg, usage of ACP billing codes, choosing a surrogate decision-maker and advance directive documentation). Outcomes will be measured over 12 months of follow-up.

ETHICS AND DISSEMINATION

This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards. The results of this study will inform a scalable solution to ACP discussions throughout our healthcare system and statewide.

TRIALS REGISTRATION NUMBER

NCT03609658.

Do psychosocial factors modify the negative association between disability and life satisfaction in old age?

CONTEXT

Many assume that having poor physical health in old age lowers life satisfaction, but in fact there are large differences in life satisfaction among older people who experience disability.

OBJECTIVE

To investigate whether psychosocial factors modify the negative association between disability and life satisfaction in older people and whether these differ across the life course.

DESIGN

Cross sectional study.

SETTING

66,561 community-dwelling Survey of Health, Ageing, and Retirement in Europe (SHARE) participants aged 50-106 with a mean age of 67.8 ± 9.9 (SD) years from 17 European countries and Israel.

METHODS

Psychosocial factors included depression (EURO-D scale), perceived loneliness, having a spouse, having children, contact with children, and participation in social activities. Disability was assessed by limitations in (Instrumental) Activities of Daily Living ((I)ADL) and life satisfaction by Cantril's ladder. We also ran the analyses with the Control Autonomy Self-realization Pleasure (CASP-12) Index, a normative measure of quality of life. We used multiple linear regressions to estimate associations and proportion of variance explained.

RESULTS

The variance in life satisfaction that could be attributed uniquely to ADL and IADL disability was 0.17% and 0.33% respectively (both p < 0.001). The impact of (I)ADL disabilities on life satisfaction was strongest at age 50 and gradually decreased with increasing age (p trend < 0.001). Mental health explained more variance; 5.75% for depressive symptoms and 2.50% for loneliness and for social resources this ranged from 0.09% to 0.47% (all p < 0.001). While disability has a negative effect on life satisfaction, the effect was not stronger in older persons who were depressed, neither in those who felt lonely nor in those without social resources. Similar outcomes were found when using CASP-12 as the explained variable.

CONCLUSION

The impact of (I)ADL disabilities on life satisfaction in community-dwelling older people decreases with age. These associations are not affected by psychosocial factors and these patterns cannot be explained by people changing their norms and values.

Lifestyle and psychosocial factors and a decline in competence in daily living among Japanese early elderly people: from an age-specified community-based cohort study (NISSIN project)

Background

To let the early elderly live well, understanding how lifestyle and psychosocial factors related to a decline in competence in daily living is important.

Methods

We investigated the associations between lifestyle and psychosocial factors at age 64 years and a decline in the Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≥ 2 points at age 70 years among the participants in comprehensive medical check-ups living in a city in Japan. Multivariable logistic regression analyses were performed separately for men and women.

Results

Of the 1113 eligible men and 1203 eligible women, 110 men and 80 women showed a deteriorated competence in daily living during the 6 years. In men, risk was increased with ≥ 2 nighttime awakenings (multivariable odds ratio [mOR] 2.14, 95% confidence interval [CI] 1.19–3.86) and living alone (mOR 4.68, 95% CI 1.22–18.0), whereas risk was significantly decreased with a medium or fast gait (mOR 0.37 and 0.21, 95% CI 0.21–0.67 and 0.08–0.58) and high academic achievement (mOR 0.32 and 0.43, 95% CI 0.19–0.53 and 0.25–0.72). In women, risk was decreased with high life satisfaction (mOR 0.39, 95% CI 0.16–0.91) and participation in community activities (mOR 0.50, 95% CI 0.29–0.86) but increased with depressive mood (mOR 1.86, 95% CI 1.09–3.18).

Conclusion

Living alone for men and low life satisfaction for women at age 64 years were markedly associated with the risk of a subsequent declining competence in daily living.

Individual- and state-level factors associated with functional limitation prevalence among Colombian elderly: a multilevel analysis

This study aimed to identify the main regional factors associated with variations in the prevalence of functional limitation on the older adult in Colombia adjusted by individual characteristics. This multilevel study used cross-sectional data from 23,694 adults over 60 years of age in the SABE, Colombia nationwide survey. State-level factors (poverty, development, inequity, violence, health coverage, and access to improved water sources), as well as individual health related, socioeconomic and demographic characteristics, were analyzed. The overall prevalence of functional impairment for the basic activities of daily living (ADL) was 22%. The presence of comorbidities, low educational level, physical inactivity, no participation in social groups, mistreatment and being over 75 years old were associated with functional limitation. At the group level, the analysis showed significant differences in the functional limitation prevalence across states, particularly regarding the socioeconomic status measured according to the Human Development Index (median OR = 1.22; 95%CI: 1.13-1.30; p = 0.011). This study provides evidence on the impact of socioeconomic variation across states on FL prevalence in the Colombian elderly once adjusted for individual characteristics. The findings of this study, through a multilevel approach methodology, provide information to effectively address the conditions that affect the functionality in this population through the identification and prioritization of public health care in groups with economic and health vulnerability.

Associations between body mass index, mid-arm circumference, calf circumference, and functional ability over time in an elderly Taiwanese population

Background

Anthropometric measurements such as body mass index (BMI), mid-arm circumference (MAC), and calf-circumference (CC) are assessed with ease during regular health visits, but the associations between these anthropometric parameters and functional ability in elderly population over time has not been studied in detail. This study aimed to examine the associations between functional ability and the anthropometric parameters BMI, MAC, and CC in Taiwanese adults ≥ 65 years old.

Methods

Data were obtained from the Taiwan Longitudinal Study of Aging and analyzed retrospectively.

Results

Functional decline over a 4- and 8-year period was noted in approximately 14% and 21% of study participants, respectively. BMI was negatively associated with participants’ current Activities of Daily Living (ADL) scores, and was positively associated with 4-year ADL scores in adults ≥ 65 years old (β = -1.19 and 1.14, P = 0.0010 and 0.0420, respectively). MAC and CC were negatively associated with current ADL scores (β = -1.46, P < 0.0001 and β = -4.68, P < 0.0001, respectively). The association between CC and current ADL score was stronger than the association between current ADL score and either BMI or MAC. For adults ≥ 65 years old, a high BMI increased the risk of ADL decline over 4 and 8 years by 4-fold and 3-fold (adjusted odds ratio = 4.23 and 2.64, 95% confidential interval = 1.95–9.19 and 1.22–5.71, P = 0.0003 and 0.0141, respectively).

Conclusions

BMI is a significant predictor of decline of functional ability in Taiwanese adults ≥ 65 years old. CC is an important anthropometric indicator of current functional ability among older adults.

Development in self-rated health among older people as determinant of social relations

Aim: The purpose of this study was to analyse whether development in self-rated health (SRH) over four years was associated with the structure of and satisfaction with social relations, at four and eight years follow-up, among elderly women and men. Methods: A longitudinal questionnaire-based study was undertaken of non-institutionalized Danes, aged 70 - 95 years, with baseline in 1986. The response rate at baseline was 69%, n=1,231. First follow-up was carried out in 1990, with 91% of eligible individuals participating (n=911). Second follow-up took place in 1994, where 83% of eligible individuals participated (n=542). The association was studied between development in SRH from 1986 to 1990 and social relations in 1990 and in 1994. Results: A sustained poor SRH predicted low contact frequency OR=1.7 (1.1 - 2.6), small contact diversity OR=1.6 (1.0 - 2.6) and low contact satisfaction OR=3.4 (2.3 - 5.2) in the two-point analyses. Furthermore, a deterioration in SRH predicted poor contact satisfaction OR=2.8 (1.7 - 4.5). All analyses were adjusted for age, gender, mental health, functional ability, cohabitation status, and a measure of social relations at baseline. Results for the three-point analyses were similar to those for the two-point analyses. The associations were weaker for contact satisfaction OR=2.8 (1.7 - 4.7), but stronger for contact frequency OR=2.5 (1.4 - 4.4) and diversity OR=2.1 (1.2 - 3.6). Conclusion: Sustained poor SRH and, to some degree, deterioration in SRH were predictors of poor social relations after four and eight years.

National survey of family physicians to define functional decline in elderly patients with minor trauma

Background

Failing to assess elderly patients for functional decline at the time around a minor injury may result in adverse health outcomes. This study was conducted to define what constitutes clinically significant functional decline and the sensitivity required for a clinical decision instrument to identify such functional decline after an injury in previously independent elderly patients.

Methods

After a thorough development process, a survey questionnaire was administered to a random sample of 178 family physicians. The surveys were distributed using a modified Dillman technique.

Results

From 143 eligible surveys, we received 67 completed surveys (response rate, 46.9 %). Respondents indicated that a drop of at least 3 points on the 28-point Older Americans Resources and Services (OARS) ADL Scale was considered clinically significant by 90 % of physicians. Ninety percent (90 %) of physicians would be satisfied with a sensitivity of 90 % or more for a clinical decision instrument to detect patients at risk of functional decline at 6 months following an injury. The majority of family physicians do not routinely assess the majority of the tasks on the OARS scale for injured elderly patients.

Conclusions

A high proportion of physicians (90 %) would consider a drop of 3 points on the OARS ADL Scale as significant to define functional decline and would be satisfied with a sensitivity of 90 % for a clinical decision instrument to detect such a decline. Any instrument to identify patients at elevated risk for subsequent decline should consider these outcome measures to be clinically useful.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0520-1) contains supplementary material, which is available to authorized users.

National Survey of Geriatricians to Define Functional Decline in Elderly People with Minor Trauma

Background

This study was designed to determine a clinically significant point drop in function to define functional decline and the required sensitivity for a clinical decision tool to identify elderly patients at high risk of functional decline following a minor injury.

Methods

After a rigorous development process, a survey questionnaire was administered to a random sample of 178 geriatricians selected from those registered in a national medical directory. The surveys were distributed using a modified Dillman technique.

Results

We obtained a satisfactory response rate of 70.5%. Ninety percent of the geriatricians required a sensitivity of 90% or less for a clinical decision tool to identify injured seniors at high risk of functional decline 6 months post injury. Our results indicate that 90% of the respondents considered a drop in function of at least 2 points in activities of daily living (ADL) as clinically significant when considering all 14 ADL items. Considering only the 7 basic ADL items, 90% of physicians considered a 1 point drop as clinically significant.

Conclusions

A tool with a sensitivity of 90% to detect patients at risk of functional decline at 6 months post minor injury would meet or exceed the sensitivity required by 90% of geriatric specialists. These findings clearly define what is a clinically significant decline following a “minor injury.”

Functional fitness norms for community-dwelling older adults in Hong Kong

OBJECTIVE

This study aimed to establish normative data for older adults in Hong Kong and explore age and sex differences in functional fitness.

METHODS

A sample of 944 independent community-dwellers, aged 65-74 years, was evaluated using the Senior Fitness Test battery in addition to hand grip and single leg stance tests. Normative data were reported for the 10th, 25th, 50th, 75th, and 90th percentiles in 5-year age groups.

RESULTS

Except for upper extremity muscle strength in women and body mass index (BMI) in both sexes, ageing-associated degradation was observed in all testing parameters especially in flexibility, balance, and agility. Significant sex differences were found in all testing parameters with the exception of BMI and static balance with eyes open. Moreover, men demonstrated higher capacities for muscle strength, agility, balance, and aerobic endurance, whereas women showed superior flexibility.

CONCLUSION

The normative values enable the evaluation of individual performance regarding the fitness status of older adults in Hong Kong.

Level of physical activity and quality of life: a comparative study among the elderly of rural and urban areas

Objective : To investigate if the relationship between physical activity level (PAL) and quality of life (QOL) is affected by living environment (rural or urban). Method : A quantitative, observational and cross-sectional study was performed. Of the 40 participants of both genders, 20 were residents of urban areas and 20 were residents of rural areas in the town of Pimenta Bueno (RO), Brazil. The WHOQOL BREF and IPAQ Long Version questionnaires were used to assess QOL and PAL, respectively. Mann Whitney and Fisher's Exact were used to statistically compare groups for QOL and PAL scores. The correlation between the two was tested by the Spearman test. A significance level of p<0.05 was used. Results : No differences between the rural and urban areas for QOL or PAL were found. In the rural group a positive and significant correlation was found between PAL and the physical, psychological and complete QOL domains. In terms of PAL, elderly persons from the rural area who were regularly active had higher total QOL and physical domain scores than insufficiently active elderly individuals from the rural area. When place of residence was compared, insufficiently active elderly in the urban area had higher scores on the social component of QOL than insufficiently active elderly from the rural group. Among regularly active seniors, those living in the rural area had higher physical QOL scores. Conclusion : According to the results, level of physical activity exerts a differential influence on the QOL of elderly people from rural and urban areas.

National Survey of Emergency Physicians to Define Functional Decline in Elderly Patients with Minor Trauma

BACKGROUND

There are a number of screening tools to predict return to the emergency department (ED) in elderly trauma patients, but none exist to specifically screen for functional decline after a minor injury. The objective of this study was to identify outcome measures for a possible future clinical decision rule to be used in the ED to identify previously independent patients at high risk of functional decline at six months post minor injury.

METHODS

After a rigorous development process, a survey instrument was administered to a random sample of 178 emergency physicians using the Dillman's Tailored Design Method.

RESULTS

Of 156 eligible surveys, we received 81 completed surveys (response rate 51.9%). Considering all 14 activities of daily living (ADL) items, 90% of physicians deemed a minimal clinically important difference (MCID) in function to be at least three points on the 28-point Older Americans Resources and Services (OARS) ADL Scale as clinically significant. A tool with a sensitivity of 93% to detect patients at risk of functional decline at six months post injury would meet or exceed the sensitivity deemed to be required by 90% of physicians. The majority of emergency physicians do not assess elderly injured patients for the majority of the tasks.

CONCLUSIONS

A drop of three points on the 28-point OARS ADL Scale would be deemed clinically important by the vast majority of emergency physicians. Further, a sensitivity of 93% for a clinical decision tool would satisfy the MCID requirements of the vast majority of emergency physicians. There appears to be a gap between physician knowledge and actual practice. We intend to use these findings in the development of a clinical decision rule to identify high-risk elderly trauma patients.

Quality of Life, Perceptions of Change, and Psychological Well-Being of the Elderly Population in Small Rural Towns in the Midwest

This study examines the quality of life of the elderly residents of two rural Nebraska towns, both having experienced a large increase in population. The study examines how the residents' perception of changes in the community affect their view of quality of life, and identifies determinants of psychological well-being for these elderly residents. The results are compared to the non-elderly residents of these two communities for purposes of contrast. A face-to-face survey of the residents addressed physical, social/cultural, economic, and service issues. Both correlation and regression were used to analyze the data. The quality of life of the elderly residents in our study, in terms of satisfaction with the various components of general well-being–home and neighborhood, accessibility and adequacy of services (including transportation), health and safety–were very positive or satisfactory; this applies equally to the non-elderly population, with the exception of access to public transportation.

[Average and healthy life expectancies and self-rated health in the European country]

AIM

When considering the health of elderly individuals, extending a healthy lifespan as well as the average life expectancy has been discussed. In general, life expectancy is determined by biological health, socioeconomic factor, and social disparities. However, the effects of fatal diseases, such as cancer, socioeconomic factor, and self-rated health on the average life expectancy and healthy life expectancy have not been fully elucidated.

METHODS

In the present study, a multiple regression analysis was used to clarify the relationships between the lifespan and socio-economic conditions, such as the GDP, GiNi index, age-adjusted mortality from cancer, suicide rate and self-rated health in 27 European countries.

RESULTS

According to the multiple regression analysis, the average life expectancy was significantly correlated with mortality from cancer (β=-0.816, P=0.001), whereas the healthy life expectancy was significantly correlated with self-rated health (β=0.759, p=0.001) in males. In females, the average life expectancy was significantly correlated with mortality from cancer (β=-0.470, p=0.004), whereas the healthy life expectancy was significantly correlated with self-rated health (β=0.605, p=0.001).

CONCLUSIONS

These findings indicate that there is a significant correlation between cancer and life expectancy. Meanwhile, self-rated health is an important factor for increasing the longevity of a healthy life expectancy.

Differences in physical fitness and subjectively rated physical health in Vietnamese and German older adults

This cross-sectional study aims to investigate the differences in physical fitness and subjectively rated physical health of Vietnamese and German older adults in a community dwelling. The Vietnamese sample was a random sample of 96 community-dwelling individuals aged 60 to 80 years; 50 % were women. Education is 0 % less than 5 years, 23.95 % 5 to 9 years, 47.91 % 10 to 12 years, and 28.12 % more than 12 years. The German sample was a random sample of 159 community-dwelling persons aged 59 to 90 years; 79.8 % were women. Education is 1.25 % less than 5 years, 40.25 % 5 to 9 years, 38.84 % 10 to 12 years, and 21.38 % more than 12 years. Senior Fitness Test and Short Form-36 were used as outcome measures. The Vietnamese sample shows significantly higher performance levels in motor abilities, i.e., aerobic fitness, strength, and flexibility. The Vietnamese sample indicates a lower difference in performance levels between age groups than the German sample. No differences in subjectively rated physical health factors were found. The higher performance levels of the Vietnamese sample might reflect a more active lifestyle throughout the life span, especially in socially mediated domains like living arrangements or labor work. Lower performance levels in the studied age groups of the German sample might lead to higher risks of cardiovascular diseases and proneness of falls. A more active lifestyle after retirement could contribute to a healthier, more capable, and more independent individual and collective aging. Subjectively rated health stated is a culturally mitigated domain and therefore might be independent of actual physical fitness levels.

Change in quality of life of medically hospitalized patients--a one-year follow-up study

OBJECTIVES

To examine changes in quality of life (QOL) among elderly medically hospitalized patients one year after hospitalization, and to explore factors associated with the changes.

METHODS

A one-year follow-up study included 363 (175 men) medical inpatients with age range 65-98 (mean 80.2, SD 7.5) years. Information was collected at baseline and follow-up using the WHOQOL-BREF questionnaire assessing the physical, psychological, social and environment domain of QOL as the dependent variable, and the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and instrumental activities of daily living, the Hospital Anxiety and Depression scale and assistance in living as the independent variables.

RESULTS

The mean score of the physical domain of QOL had increased (mean change 0.6, SD 2.5; p < 0.01); the mean score of the environmental domain had decreased (mean change -2.1, SD 1.2; p < 0.01); and, the mean scores of the psychological and social domains of QOL were unchanged (mean change -0.2, SD 1.8 and mean change -0.1, SD 1.5, respectively) at follow-up. Improved individual QOL at a one-year follow-up was associated with improved health (cognitively, physically and emotionally) after hospitalization, and with health situation at baseline. Being in need of assistance was associated with reduced QOL.

CONCLUSION

Good cognitive, physical and emotional health at baseline and follow-up were associated with improved QOL in previously hospitalized elderly patients independent of their need for assistance in living.

Associations between functional ability and life satisfaction in the oldest old: results from the longitudinal population study Good Aging in Skåne

Objectives

To describe change in functional ability in the oldest-old population during 3 years and examine its relation to life satisfaction (LS). A total of 681 individuals aged 78 and older from the population-based study Good Aging in Skåne took part.

Methods

Functional ability was assessed using Sonn and Åsberg’s Activities of Daily Living (ADL) scale and related to LS assessed by Neugarten et al’s Life Satisfaction Index A (LSI-A).

Results

Fifty-one percent of 87–93-year-olds reported ADL decline during 3 years. Individuals reporting impaired ADL had a mean LSI-A value of 23.0 compared to 26.4 in those unchanged. ADL decline had a stronger negative effect on LS in the younger group (78–84 years), r = 0.207, P < 0.001. In a multiple regression model, one score’s decline in ADL capacity corresponded to 1.5 scores lower LS (P < 0.001).

Discussion

Effort put into keeping the oldest old on a high level of functional ability has the potential to maintain the LS of this population.

Subjective well-being amongst community-dwelling elders: what determines satisfaction with life? Findings from the Dublin Healthy Aging Study

BACKGROUND

Life satisfaction is a subjective expression of well-being and successful aging. Subjective well-being is a major determinant of health outcomes in older people. The aim of this study was to determine which factors predicted well-being in older people living in the community as measured by their satisfaction with life.

METHODS

The relationship between life satisfaction, as measured by the Life Satisfaction Index (LSI-A) and physical, cognitive and demographic variables was examined in 466 older people living in the community using a stepwise regression model.

RESULTS

Depression, loneliness, neuroticism, extraversion, recent participation in physical activity, age and self-reported exhaustion, were the independent predictors of life satisfaction in our elderly cohort.

CONCLUSION

Subjective well-being, as measured by the Life Satisfaction Scale, is predicted by depression, loneliness, personality traits, recent participation in physical activity and self-reported exhaustion. The mental and emotional status of older individuals, as well as their engagement in physical activity, are as important as physical functionality when it comes to life satisfaction as a measure of well-being and successful aging. These areas represent key targets for intervention.

Impacto da tontura na qualidade de vida de idosos com vestibulopatia crônica

TEMA: impacto da tontura na qualidade de vida (QV) em idosos vestibulopatas crônicos. OBJETIVO: avaliar a associação entre o impacto da tontura na QV de idosos com disfunção vestibular crônica e variáveis demográficas e clínicas. MÉTODO: estudo prospectivo em que 120 idosos com disfunção vestibular crônica submeteram-se à versão brasileira do Dizziness Handicap Inventory (DHI). Foram utilizados os testes de Mann-Whitney, Kruskal-Wallis e Coeficiente de Correlação de Spearman para verificar a associação de QV e as variáveis demográficas e clínicas. RESULTADOS: ocorreram associações significantes entre a presença de tontura rotatória e não rotatória com o escore total do DHI (p = 0,010) e subescala física (p = 0,049) e funcional (p = 0,009); entre quedas recorrentes com o DHI total (p = 0,004) e subescalas física (p = 0,045), funcional (p = 0,010) e emocional (p = 0,011). Correlações significantes foram encontradas entre incapacidade funcional e o DHI total (ρ = + 0,557; p < 0,001) e subescalas física (ρ = + 0,326; p < 0,001), funcional (ρ = + 0,570; p < 0,001) e emocional (ρ = + 0,521; p(0,001). CONCLUSÕES: o impacto da tontura na QV é maior nos idosos com tontura rotatória e não rotatória, quedas recorrentes e incapacidade funcional.

THE ASSOCIATION OF SOCIAL SUPPORT AND ACTIVITIES WITH HEALTH IN SOUTH KOREA: DIFFERENCES IN AGE AND GENDER

This study investigated gender difference in the effects of social support, including emotional support and instrumental support (such as help when sick and financial assistance), and social activities on perceived health of middle-aged and older adults in South Korea. Data were acquired from 3771 men and 4954 women aged 40 years and older who participated in the 2005 cross-sectional survey of the Seoul Citizens Health and Social Indicators Survey. Using multiple regression analysis, both age- and gender-specific differences related to social support and engagement in social activities and self-rated poor health were examined. Poor emotional support from close friends, relatives or someone with whom one could talk about worries was strongly associated with poor self-rated health in men, with the greatest effect in older men. Lack of engagement in social activities was associated with self-rated poor health in older adults, especially in older men. Poor instrumental support was associated with perceived poor health only in middle-aged women. As a health improvement strategy for men aged 65 years and older especially, emotional support should be considered. Measures should be considered for encouraging social activities by older adults, particularly older men.

Meaning of quality of life for older adults: importance of human functioning components

This study explored the perceptions and lived experience of community-dwelling older adults about their quality of life (QOL) in regards to personal factors, social participation and environment. A qualitative design was used to extend existing work on QOL focusing on human functioning components and advanced QOL conceptualization. Based on a semi-structured interview guide, two individual in-depth interviews were conducted with 18 participants (aged 63-92; 12 women) having various levels of ability and QOL. Personal factors, such as health, inner life and behavioral abilities, were found to be essential for QOL. Being occupied and doing activities associated with good health habits are also important. Accomplishment of social roles is, for the majority of participants, more significant than daily activities. The physical and social environment must be adapted to the person's needs and preferences. Participants' perceptions differed only slightly according to their ability and QOL levels. Findings show the critical role of adaptation to disabilities and aging for better QOL. A sense of control over one's own life also has beneficial effects. These results point up the importance of considering perceptions about personal factors, social participation and environmental factors in older adults' QOL. Other theoretical as well as methodological implications for further QOL study are highlighted.

Do quality of life, participation and environment of older adults differ according to level of activity?

BACKGROUND

Activity limitation is one of the most frequent geriatric clinical syndromes that have significant individual and societal impacts. People living with activity limitations might have fewer opportunities to be satisfied with life or experience happiness, which can have a negative effect on their quality of life. Participation and environment are also important modifiable variables that influence community living and are targeted by health interventions. However, little is known about how quality of life, participation and environment differ according to activity level. This study examines if quality of life, participation (level and satisfaction) and perceived quality of the environment (facilitators or obstacles in the physical or social environment) of community-dwelling older adults differ according to level of activity.

METHODS

A cross-sectional design was used with a convenience sample of 156 older adults (mean age = 73.7; 76.9% women), living at home and having good cognitive functions, recruited according to three levels of activity limitations (none, slight to moderate and moderate to severe). Quality of life was estimated with the Quality of Life Index, participation with the Assessment of Life Habits and environment with the Measure of the Quality of the Environment. Analysis of variance (ANOVA) or Welch F-ratio indicated if the main variables differed according to activity level.

RESULTS

Quality of life and satisfaction with participation were greater with a higher activity level (p < 0.001). However, these differences were clinically significant only between participants without activity limitations and those with moderate to severe activity limitations. When activity level was more limited, participation level was further restricted (p < 0.001) and the physical environment was perceived as having more obstacles (p < 0.001). No differences were observed for facilitators in the physical and social environment or for obstacles in the social environment.

CONCLUSION

This study suggests that older adults' participation level and obstacles in the physical environment differ according to level of activity. Quality of life and satisfaction with participation also differ but only when activity level is sufficiently disrupted. The study suggests the importance of looking beyond activity when helping older adults live in the community.

Happiness and congruence in older adulthood: a structural model of life satisfaction

The purpose of this study was to determine how health impairment, socioeconomic status, and social support relate to life satisfaction in later life. Using data from a sample of 320 older adults from The Georgia Centenarian Study, we constructed a structural model of life satisfaction. LISREL analysis was performed to test a two-factor model that included Happiness and Congruence and to determine the relationship of health impairment, socioeconomic status (SES), and social support to Happiness and Congruence, two measures of the Life Satisfaction Index-A (LSI-A). Data were found to provide a satisfactory fit of the model (GFI = 0.94; AFGI = 0.91). Social support and SES were found to have direct effects on health impairment. Health impairment was a key predictor and mediating variable of Happiness and Congruence. Findings also support a relationship between social resources and subjective well-being in later life. In particular, the association between social resources and life satisfaction was mediated through health impairment. These findings offer understanding relative to how health and social resources influence past and present assessments of subjective well-being among the elderly.

Effect of knee osteoarthritis on the perception of quality of life in Venezuelan patients

OBJECTIVE

To measure the perception of quality of life in Venezuelan patients with knee osteoarthritis and to identify those variables that may influence it.

METHODS

A multicenter, cross-sectional study of 126 mestizo patients with knee osteoarthritis recruited from 8 rheumatology centers in Venezuela. We used a Spanish-translated version of the Arthritis Impact Measurement Scales (AIMS), as adapted in Venezuela. One-way analysis of variance was used to compare the AIMS mean total score among subgroups of knee pain, anatomic stage, and socioeconomic status (SES); a post-hoc test was performed to identify significant intragroup differences. Pearson's correlation coefficient was used to examine correlations between age, body mass index (BMI), disease duration, knee pain, and AIMS score. Associations between radiologic stage, SES, and AIMS scores were examined using Spearman's rank correlation. Multiple regression analysis was used to estimate predictor factors of AIMS scores.

RESULTS

A significant correlation was found between total AIMS scores and knee pain, age, and socioeconomic status, but not with BMI, disease duration, or anatomic stage. Patients with severe knee pain differed from those with mild and moderate pain, and the highest AIMS mean total score was seen in patients within the severe knee pain subset. Patients in the highest socioeconomic levels differed from those within lowest categories. Patients classified as being at the levels of relative and critical poverty showed the highest AIMS scores. Multiple regression analysis showed that knee pain was the only variable that exerted an independent effect on the quality of life in our patients.

CONCLUSION

The perception of quality of life is negatively affected by increasing levels of joint pain, old age, and low socioeconomic status in Venezuelan patients with knee osteoarthritis. Our study supports the need for an early and vigorous approach to treat pain in this group of patients.