Physical activity enhances long-term quality of life in older adults: Efficacy,esteem, and affective influences

Background: Physical activity has been effective in enhancing quality of life (QOL) of older adults over relatively short periods of time. However, little is known about the longterm effects of physical activity and even less about the possible mediators of this relationship.Purpose: We examined the mediating effects of psychological variables on the relationship between physical activity and global QOL (satisfaction with life) in older adults over a 4-year period.Methods: Participants (N = 174, M age = 66.7 years) completed a battery of psychosocial measures at 1 and 5 years following enrollment in a 6-month randomized controlled exercise trial.Results: Panel analysis conducted within a covariance modeling framework indicated that physical activity was related to self-efficacy, physical self-esteem, and positive affect at 1 year, and in turn, greater levels of self-efficacy and positive affect were associated with higher levels of QOL. Analyses indicated that changes in physical activity over the 4-year period were related to increases in physical self-esteem and positive affect, but only positive affect directly influenced improvements in QOL.Conclusions: The findings lend support to the position that physical activity effects on QOL are in part mediated by intermediate psychological outcomes and that physical activity can have long-term effects on well-being. Funding for this study was provided by the National Institute on Aging (AG 12113).     

Pathways from Physical Activity to Quality of Life in Older Women

Background  In spite of consistent evidence to suggest that being more physically active is associated with enhanced quality of life (QOL), there have been remarkably few attempts to determine the possible underlying mechanisms in this relationship. Purpose  To prospectively examine the roles played by self-efficacy and physical and mental health status in the physical activity and QOL relationship in older women. Method  Older women (M age = 68.12 years) completed measures of physical activity, self-efficacy relative to balance, mental and physical health status, and global QOL at baseline (N = 249) and 24-month follow-up (N = 217). Demographics and general health information were assessed at baseline. A panel analysis within a covariance modeling framework was used to analyze the data. Results  Analyses indicated that changes in physical activity over time were associated with residual changes in self-efficacy. Changes in self-efficacy were significantly associated with residual changes in physical and mental health status. Only changes in mental health status were significantly related to residual changes in global QOL. Conclusion  Results from this study support the role of self-efficacy in the relationship between physical activity and QOL. Future physical activity promotion programs should include strategies to enhance self-efficacy for physical activity to be most effective for this population.     

Physical Activity, Self-Efficacy, and Quality of Life in Multiple Sclerosis

Background Quality of life (QOL) is compromised among individuals with multiple sclerosis (MS). Self-efficacy and physical activity have been positively associated with QOL in persons with MS, and based on a social cognitive perspective, the relationship between physical activity and QOL might be indirect and accounted for by self-efficacy. Purpose We tested the hypothesis that physical activity would be indirectly associated with QOL through a pathway that included self-efficacy. Methods Participants were 133 individuals with a definite diagnosis of MS who completed the Godin Leisure-Time Exercise Questionnaire, Multiple Sclerosis Self-Efficacy scale, and Multiple Sclerosis Impact Scale. Results Path analysis indicated that those with MS who were more physically active had greater self-efficacy for function and control, and self-efficacy for function and control were associated with greater physical and psychological components of QOL. Conclusions Our findings support physical activity as a possible modifiable behavior for mitigating reductions of QOL by improving self-efficacy in individuals with MS.     

The mediating effect of self-efficacy on the relationship between health literacy and health status in Korean older adults: A short report

Objectives: Limited health literacy has been shown to be associated with poor health status. However, research to date has not elucidated the factors that mediate the relationship between low literacy and poor health outcomes. The purpose of this study was to examine the mediating effect of self-efficacy on the relationship between health literacy and health status in Korean older adults.

Method: A cross-sectional study of 103 community-dwelling Korean older adults was conducted from June 2007 to September 2007.

Results: The study found that low health literacy was associated with poorer physical and mental health status, and the effect of health literacy on physical and mental health status was mediated through self-efficacy.

Conclusion: The study suggests that interventions to improve the delivery of care for older adults with low health literacy need to include not only improving the readability of health-related materials, but also enhancing the self-efficacy of each individual.     

Perceived ease of activity (but not strategy use) mediates the relationship between self-efficacy and activity engagement in midlife and older adults

Abstract

Objectives: Activity participation is associated with a range of positive outcomes in older adults but tends to decline with age. Understanding protective factors is important to facilitate activity in later life. Social cognitive theory suggests that having high self-efficacy may promote activity because individuals with higher self-efficacy perceived their activities to be easier and use adaptive strategies to overcome barriers to activity. Despite considerable research linking self-efficacy and activity, limited research has examined the proposed mechanisms behind this association. This study therefore examined whether perceived ease of activity and use of adaptive strategies account for the association between self-efficacy and activity.

Method: Participants were 412 adults aged 50–93 years who completed a cross-sectional survey. Structural equation modelling was used to examine whether the effects of self-efficacy on activity were mediated by perceived ease of activity and use of adaptive strategies.

Results: Perceived ease of activity mediated the positive associations between self-efficacy and social (0.04 [0.02, 0.07]) and physical activity (0.16 [0.08, 0.25]), but not mental activity (0.01 [0.000, 0.03]). For physical activity, this effect was stronger for adults aged 70+ years than those aged 50–69 years (older a₂*b₂ - younger a₂*b₂ 0.13 [0.04, 0.24]). Use of adaptive strategies was not a significant mediator in any model.

Conclusion: This study suggests that self-efficacy may influence older adults' perception of activities and, in turn, the activities they choose to participate in. This has potential implications for the development of interventions aimed at promoting activity engagement in later life.     

The role of coping humor in the physical and mental health of older adults

Objectives: This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults.

Method: Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.

Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures.

Conclusion: The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.     

Caregivers' assessments of preference-based quality of life in Alzheimer's disease

BackgroundThis study was designed to evaluate the feasibility, reliability, and validity of use of caregivers' ratings of two health preference measures as outcomes for cost-effectiveness analyses in persons with very mild to moderate Alzheimer's disease (AD).MethodsCaregivers completed ratings of preference for AD patients' health by use of the EuroQol-5D system (EQ-5D) and the Health Utilities Index Mark 2 (HUI2). They also rated patients' cognition, mood, burden, AD-specific and generic health-related quality of life (QOL), and activities of daily living.ResultsCaregivers' HUI2 scores were reliable. Neither the caregiver ratings of the patients' health by use of the EQ-5D nor the HUI2 had a relationship with severity of cognitive impairment. Both the EQ-5D and the HUI2 had expected relationships with caregivers' assessments of patients' function, AD-specific QOL, and physical and mental health and selected subscales of the measures of AD-specific QOL and overall health. In addition, caregiver scores showed relationships with patient self-rated function, mood, and physical health but not AD-specific QOL. Caregiver burden was associated with caregivers' scores.ConclusionsCaregiver-completed ratings of preference for patients' health made by use of the EQ-5D and the HUI2 have many of the characteristics of valid preference measures. However, the lack of association with patient Mini-Mental Status Exam scores and patient self-rated AD-specific QOL and the associations with caregiver subjective burden might present limitations to their use as proxy measures for cost-effectiveness analyses.     

Association of quality of life with laboratory measurements and lifestyle factors in community dwelling older people in Taiwan

Objectives: Little is known about the influence of routine laboratory measurements and lifestyle factors on generic quality of life (QOL) at older ages. We aimed to study the relationship between generic QOL and laboratory measurements and lifestyle factors in community dwelling older Chinese people.

Methods: We conducted a cross-sectional analysis. Six hundred and ninety nine elders were randomly selected from the examinees of the annual health examination in Taipei City, Taiwan. Blood, urine and stool of the participants were examined and lifestyle data were collected. Participants completed the CASP-19 (control, autonomy, self-realization, pleasure) questionnaire, a 19-item QOL scale. The relationship between QOL and laboratory results and lifestyle factors was explored, using multiple linear regression and profile analysis.

Results: The mean age of the participants was 75.5 years (SD = 6.5), and 49.5% were female. Male gender standardized β coefficients (β = 0.122) and exercise habit (β = 0.170) were associated with a better QOL, whereas advanced age (β = ?0.242), blurred vision (β = ?0.143), depression (β = ?0.125), central obesity (β = ?0.093), anemia (β = ?0.095), rheumatoid arthritis (β = ?0.073), Parkinsonism (β = ?0.079), malignancy (β = ?0.086) and motorcycle riding (β = ?0.086) were associated with a lower QOL. Profile analysis revealed that young–old males, social drinkers, regular exercisers and car drivers had the best QOL (all p < 0.001).

Conclusion: Of the many laboratory measurements, only anemia was associated with the lower QOL. By contrast, several lifestyle factors, such as social drinking, exercise habit and car driving, were associated with better QOL, whereas abdominal obesity and motorcycle riding were associated with lower QOL.     

Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life

Objectives: Using the Proactivity Model of Successful Aging, we examined how internal and external resources contribute to the maintenance of psychological well-being and social activities among older adults who experience normative stressors of aging. Outcome variables in this study are collectively referred to as quality of life (QOL). We also examined the mediating role of proactive adaptations between internal and external resources and QOL indicators.

Method: Based on five annual interviews of a sample of 1000 community-dwelling older adults in Florida (effective N?=?561), we tested the lagged effects of stressors on two indicators of QOL, four years later. In the full longitudinal model, using structural equations, we estimated the direct effects of internal and external resources on QOL, along with indirect effects through proactive adaptations.

Results: Stressors negatively influenced QOL four years later. Internal and external resources led to better QOL four years later, both directly and indirectly through proactive adaptations of marshaling support and planning for the future.

Conclusion: These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (i.e., exercise, planning ahead, and marshaling support) as proximate influences on QOL outcomes (i.e., depressive symptomatology and social activities). Findings suggest that older adults can maintain successful aging even in the face of health-related and social stressors by invoking accumulated resources to deal actively with the challenges of aging.     

Factors supporting quality of life over time for individuals with amyotrophic lateral sclerosis: the role of positive self-perception and religiosity

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease with no known cure. Maintaining quality of life (QOL) as the disease progresses is an important treatment goal.Purpose: The purpose of this study is to identify factors that support QOL as ALS progresses.Methods: Changes in QOL were monitored in 162 individuals with ALS at 3- to 4-month intervals. Forty-nine of the participants survived in the study for over 1 year and were included in a longitudinal comparison. The 49 long-term participants were younger and stronger at Time 1 than were the participants who died before reaching the 1-year point. The McGill Quality of Life Scale demonstrated a high and stable QOL despite physical deterioration.Results: Patients maintained a positive self-perception of their health despite the physical deterioration. Over time, self-perception of health and religiosity were shown to be significantly correlated with QOL.Conclusions: Results support the need for better instrumentation to enable future studies to more precisely measure multiple dimensions of ALS-related QOL, to identify reference points for self-ratings of both health and QOL, and to capture the religious and spiritual mechanisms related to QOL as individuals face the end of life.     

Individual, social environmental, and physical environmental influences on physical activity among black and white Adults: A Structural Equation Analysis

Background: Social ecological models suggest that conditions in the social and physical environment, in addition to individual factors, play important roles in health behavior change. Using structural equation modeling, this study tested a theoretically and empirically based explanatory model of physical activity to examine theorized direct and indirect effects of individual (e.g., motivation and self-efficacy), social environmental (e.g., social support), and physical environmental factors (e.g.), neighborhood quality and availability of facilities).Method: A community-based sample of adults (N = 910) was recruited from 2 public health centers (67% female, 43% African American, 43% < $20,000/year, M age = 33 years) and completed a self-administered survey assessing their current physical activity level, intrinsic and extrinsic motivation for physical activity, perceived social support, self-efficacy, and perceptions of the physical environment.Results: Results indicated that (a) perceptions of the physical environment had direct effects on physical activity, (b) both the social and physical environments had indirect effects on physical activity through motivation and self-efficacy, and (c) social support influenced physical activity indirectly through intrinsic and extrinsic motivation. For all forms of activity, self-efficacy was the strongest direct correlate of physical activity, and evidence of a positive dose-response relation emerged between self-efficacy and intensity of physical activity. Conclusions: Findings from this research highlight the interactive role of individual and environmental influences on physical activity. This research was supported by grant R06/CCR71721602 from the Centers for Disease Control and Prevention, and the CDC/ASPH Minority Fellowship Program (U48/CCU710806, Prevention Research Centers Program). We also thank Drs. Nancy Krieger and Karen Emmons for their review of early drafts of this article.     

Physical activity counseling in primary care and patient well-being: Do patients benefit?

Background: Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease. Benefits to health-related quality of life (HRQL) and subjective well-being may be as important and take less time to accrue.Purpose:We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial (ACT), both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention.Methods: In ACT, 395 female and 479 male inactive patients ages 35 to 75 years were randomized to one of: physician advice, advice plus behavioral counseling during primary care visits, or advice plus behavioral counseling that also included telephone contact and behavioral classes. Participants were assessed at baseline, 6 months, and 24 months. HRQL was assessed as perceived quality of life, perceived stress, depression, and general health. Satisfaction with function and appearance, self-efficacy, and social support were also assessed.Results: At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms. These results mirrored V0₂max changes observed per group. Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months.Conclusions: Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy.     

Typology of religiosity/spirituality in relation to perceived health,depression, and life satisfaction among older Korean immigrants

Objectives: The objectives of this study were (1) to identify distinct subtypes of older Korean immigrants based on their levels of religiosity/spirituality (R/S) and (2) to determine if the identified subtypes differed by demographic characteristics, perceived health, depression, and life satisfaction.Method: Factor mixture models were evaluated with a nonprobability sample of older Korean immigrants (N = 200) residing in the New York City area in 2009 to classify typologies of R/S. Multiple regression was used to test the associations between the R/S subtypes and outcomes (perceived health, depression, and life satisfaction) while controlling for demographics.Results: Two substantively distinct latent profiles were identified: normally religious/spiritual (‘average R/S’) and minimally religious/spiritual (‘low R/S’). The average R/S subgroup (74.4%) showed higher means than those in the low R/S subgroup (25.6%) on all six R/S class indicators. Subtypes did not differ on age, education, income, marital status, living arrangements, or years in the USA. However, males were more likely than females to be ‘average R/S.’ The ‘average R/S’ subtype had significantly greater life satisfaction than their ‘low R/S’ counterpart. No differences between the two subtypes were found on perceived health or depression.Conclusion: Findings highlight the importance of the classifications of R/S for mental health outcomes, and they indicate that relationships among R/S, various demographic characteristics, and physical/mental health are complex. Future research should validate and refine this classification of R/S in order to help identify particular sources of health risks/behaviors, relevant treatments, and health-promoting interventions within homogenous subtypes of older Korean immigrants.     

Factors associated with the quality of life of family carers of people with dementia: A systematic review

IntroductionFamily carers of people with dementia are their most important support in practical, personal, and economic terms. Carers are vital to maintaining the quality of life (QOL) of people with dementia. This review aims to identify factors related to the QOL of family carers of people with dementia.MethodsSearches on terms including “carers,” “dementia,” “family,” and “quality of life” in research databases. Findings were synthesized inductively, grouping factors associated with carer QOL into themes.ResultsA total of 909 abstracts were identified. Following screening, lateral searches, and quality appraisal, 41 studies (n = 5539) were included for synthesis. A total of 10 themes were identified: demographics; carer–patient relationship; dementia characteristics; demands of caring; carer health; carer emotional well-being; support received; carer independence; carer self-efficacy; and future.DiscussionThe quality and level of evidence supporting each theme varied. We need further research on what factors predict carer QOL in dementia and how to measure it.     

Quality of life and menopause: Developing a theoretical model based on meaning in life, self-efficacy beliefs, and body image

Goal: There are various views on variables that influence quality of life, such as meaning in life, self-efficacy, and body image (including body area satisfaction, health evaluation, and appearance evaluation), in menopausal women. This study looked at the relationships among these variables both in terms of their codetermination and intensity of relationship to quality of life.

Methods: The research study included menopausal women (45–55 years old) who lived in the city of Tehran and had at least a high school education. The sample consisted of 349 women selected at random from the attendees of cultural centers in the city of Tehran during June 2009–December 2009. Each participant completed four questionnaires, including a questionnaire on meaning in life [Salehi, M. (1994). Evaluating the issue of adolescents and the youth from the view of humanistic psychologists (Psychology PhD dissertation). Islamic Azad University, Research and Sciences Campus, Tehran.], general self-efficacy, multidimensional relation of self and body, and quality of life (sf-36). Structural equation modeling was used to analyze the relationships among variables. Path analysis was used to study the direct and indirect effects of variables as cause. A primary hypothetical model was developed that included the expected relationships among the variables. Confirmation or rejection of the expected relationships in the model was determined after executing the questionnaires and scoring the data.

Results: The model fitness was analyzed using various methods. Results showed that there is a significant direct relationship between quality of life and meaning in life, self-efficacy, body area satisfaction, and health evaluation. In addition, the model predicted 33% of quality of life variance in menopausal women. The best predictors were body area satisfaction, health evaluation, and self-efficacy. Step-by-step regression analysis confirmed the results.

Conclusion: Based on our results, there is a direct and meaningful relationship between the independent variables of this study and the quality of life. Therefore, in order to improve the quality of life in menopausal women, one or all of these variables needs to be improved.     

The association between loneliness and health – a survey-based study among middle-aged and older adults in Denmark

ABSTRACT

Background: While the association between overall poor health and loneliness among older adults continues to be examined closely, less attention has been given to middle-aged adults. This paper examines the relationship between loneliness and health as measured by self-rated health, physical ability and multi-morbidity in a large sample of Danish adults between the ages of 52–92 years. Furthermore, it identifies vulnerable groups with regard to the year of birth and gender.

Method: We apply the survey-study method, using data collected by The Danish National Centre for Social Research in 2012. We analysed the association between loneliness and health in 9154 Danish adults through multi-variate regression analyses adjusting for the year of birth, gender, marital status, cohabitation status, employment status and home ownership.

Results: We found that loneliness was associated with increased risks of poor self-rated health (OR, 2.58; 95% Cl, 1.20–3.35), limited physical abilities (OR, 1.91; 95% Cl, 1.58–2.32) and multiple diagnoses (OR, 1.77; 95% Cl, 1.48–2.12). Lonely middle-aged adults (52–62 years of age) had an increased risk of having limited physical abilities.

Conclusion: Among middle-aged and older Danish adults, loneliness was strongly associated with poor self-rated health, limited physical ability and multi-morbidity.     

Resilience,stress, and life quality in older adults living with HIV/AIDS

Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living with HIV/AIDS (OPLWHA).

Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).

Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.

Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.     

Environment patterns and mental health of older adults in long-term care facilities: the role of activity profiles

Abstract

Objectives: This study adopts the International Classification of Functioning, Disability and Health (ICF) model to determine extent to which the clustered patterns of long-term care (LTC) environment and activity participation are associated with older residents’ mental health.

Method: This study enrolled a stratified equal probability sample of 634 older residents in 155 LTC institutions in Taiwan. Latent profile analysis and latent class analysis were conducted to explore the profiles for environment and activity participation. Multilevel modeling was performed to elucidate the hypothesized relationships.

Results: Three environment profiles (Low-, Moderate-, and High-Support Environment) based on physical, social, and attitudinal environment domains and two activity profiles (Low- and High-Activity Participation) across seven activity domains were identified. Compared to the Low-Support class, older adults in the Moderate- and High-Support Environment classes had better mental health. Older residents in those two classes were more likely to be in the “High Activity Participation” class, which in turn, exhibited better mental health.

Conclusion: Environment and activity participation directly relate to older residents’ mental health. Activity participation also mediates the link between environment and mental health. A combination of enhanced physical, social, and attitudinal environments, and continual engagement in various activities may optimize older LTC residents’ mental health.     

Quality of life and depressive symptoms in patients with major depression and end-stage renal disease: a matched-pair study

OBJECTIVE: To compare the quality of life (QOL) and depressive symptoms of outpatients with major depression with that of nondepressed individuals undergoing hemodialysis (matched for age, gender, and ethnicity). METHODS: We used the WHOQOL BREF and the Beck Depression Inventory (BDI). RESULTS: After univariate analyses, depressed patients' QOL scores were significantly lower (P<.0001) in all the assessed domains (i.e., physical health, psychological, social relationships, environmental, and global QOL). Additionally, there was a significant difference in the severity of depression among the study groups (P<.0001). Finally, after multiple regression analysis, the QOL profile of depressed subjects remained significantly worse even when controlling for depression scores and diagnostic status. CONCLUSION: The subjective QOL of patients with major depression is significantly lower than that of subjects undergoing hemodialysis.     

Physical activity and mental health outcomes during menopause: A randomized controlled trial

Background: Many women experience detriments in mental health during the menopausal transition. Physical activity may attenuate these adverse outcomes but few studies investigating such effects exist.Purpose: This study examined the effects of a 4-month randomized controlled exercise trial on mental health outcomes in 164 previously low-active middle-aged women (M age=49.9; SD=3.6).Methods and Results: Participants completed body composition and fitness assessment and a battery of psychological measures at the beginning and end of a 4-month randomized controlled exercise trial with three arms: walking, yoga, control. The results indicated that walking and yoga were effective in enhancing positive affect and menopause-related QOL and reducing negative affect. Women who experienced decreases in menopausal symptoms across the trial also experienced improvements in all positive mental health and QOL outcomes and reductions in negative mental health outcomes. Whether menopausal symptoms increased or decreased across the trial appeared to be determined in part by whether there were increases or decreases in cardiorespiratory fitness.Conclusions: Physical activity appears to enhance mood and menopause-related QOL during menopause, however, other aspects of mental health may be affected only as a result of reduction in menopausal symptoms. Increasing cardiorespiratory fitness could be one way to reduce menopausal symptoms. This material is based on work conducted at the University of Illinois and was supported by the National Institute of Mental Health under Award No. MH073255-01, National Institute on Aging under Award No. AG12113, American College of Sports Medicine, Life Fitness Academy, and Paul D. Doolen Scholarship for the Study of Aging.