The relationship between frailty and diabetes: An investigation of self-rated health,depression symptoms and quality of life in the Study of Health Aging and Retirement in Europe

AimsTo assess the impact of diabetes and frailty on self-rated health, depressive symptoms and quality of life (QoL).MethodsData were pooled for participants aged ≥50 years from five waves of the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes (self-reported), physical frailty (≥3/5 criteria), low self-rated health (SRH; “poor” or “fair”), depression (screened using the EURO-D ≥4) and low QoL (CASP-12 <35). Logistic regression was used to adjust for confounding.ResultsParticipants with diabetes (n=11,661/97,691) were more likely to be older (68 vs. 64 years, p<0.001), male (50% vs. 45%, p<0.001) and frail (21% vs. 8%, p<0.001). Age, sex, diabetes and frailty were all independently associated with low SRH, depression and low QoL. Frailty had the highest adjusted odds ratios for low SRH (9.43; 95% CI:8.89–10.02), depression (6.39; 95% CI:6.07–6.71) and low QoL (9.65; 95% CI:9.17–10.16). For diabetes, the adjusted odds ratios were 2.82 (2.70–2.95), 1.49 (1.42–1.56) and 1.67 (1.60–1.74), respectively. Participants with both diabetes and frailty reported the worst self-rated health, the most depression symptoms and the lowest QoL.ConclusionsFrailty was prevalent in older people with diabetes and independently associated with low self-rated health, depressive symptoms and low QoL. Prompt identification and management of frailty should be a key consideration in diabetes care.     

Multilevel analysis of effects of individual characteristics and household factors on self‐rated health among older adults in rural Vietnam

Aim: This paper aims to describe self‐rated health (SRH) status among older adults in a rural community of Vietnam, and examine individual and household‐level factors associated with good health rating among the study populations. Methods: The study was carried out in the Bavi district, a rural community located 60 km west of Hanoi, the capital, within the Epidemiological Field Laboratory of Bavi (FilaBavi) in Vietnam in 2006. All people aged 50 years and over who lived within the district were surveyed. Face‐to‐face household interviews were conducted by trained surveyors using standard World Health Organization/INDEPTH network questionnaire–summary version. A logistic multilevel modeling approach was applied to analyze the association between SRH and both individual and household‐level factors. Results: The proportion of people aged 50 years and older in FilaBavi reported having good/very good health and poor/very poor health was 15.1% and 24.8%, respectively. SRH status was reported to be better among: (i) men; (ii) younger people; (iii) people with higher education; (iv) people who were currently in marital a partnership; (v) those from wealthier households; and (vi) those who were living in riverside/island or highland areas compared to those of other categories of the same variable. Conclusion: The findings reveal that there exist problems of inequality in health among older adults in the study setting by sex, age, education, wealth status and place of residence. We also found a considerable contribution of the household‐level factors to SRH of the study populations..     

Social capital and oral health: The association of social capital with edentulism and chewing ability in the rural elderly

ObjectiveThe association between social capital and oral health had been reported in various ways, but still remains unclear. We investigated the association between the social capital of the elderly living in a rural region and their edentulism and chewing ability.MethodsA total of 241 elderly aged ≥ 70 years living in a rural city of Korea participated in this cross-sectional study. Their social capital was surveyed by questionnaire assessing its network and trust dimensions. Their edentulism and chewing ability were assessed by oral examination and chewing gum whose color changes based on the mastication performance.ResultsThe mean age of the participants was 82.7 (ranged 71 to 101) years and 68.8% of them were female. In the binomial regression analysis, the general network aspect of the network dimension was significantly associated with chewing ability, of which the prevalence ratio was 1.88 (95% CI: 1.16-3.06) in the age, sex, education and marital status-adjusted model.ConclusionOur findings suggest that social capital, such as a poor social network, is associated with poor chewing ability in the elderly living in rural areas.     

Thirteen Dimensions of Health in Elderly Sri Lankans: Results from a National Sri Lanka Aging Survey

OBJECTIVES: To explore age and sex differences in distribution of 13 health dimensions with a focus on self-rated health (SRH) and the association between SRH and other health dimensions in elderly Sri Lankans.
DESIGN: Sri Lanka Aging Survey, a nationally representative cross-sectional survey.
SETTING: Community based.
PARTICIPANTS: Inhabitants of 13 districts in Sri Lanka aged 60 and older (N=2,413).
MEASUREMENTS: Self-reported SRH, hearing, activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility, physical disability, chronic diseases, stress and worry, mood, cognition, social participation, social support, and financial health.
RESULTS: The prevalence of being "healthy" in most health dimensions, including SRH, declined with age. Men were more likely to report better SRH; independence in ADLs, IADLs, and mobility; absence of physical disability and chronic diseases; and good mental health. Absence of chronic diseases, independence in ADLs and IADLs, freedom from stress and worry, and absence of depression were associated with positive (excellent/very good/good) SRH. The male SRH advantage was not significant in adjusted analyses, and sex did not modify the association between SRH and other health dimensions.
CONCLUSION: Several of the dimensions associated with positive SRH are to a certain extent modifiable and therefore provide a potential for improvement in SRH of elderly Sri Lankans. Differences between this study and studies from elsewhere in the associations between different health dimensions and SRH, and in how sex modifies these associations, suggest that some of the associations may depend on cultural context.     

Determinants of Change in Quality of Life in the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD)

ObjectiveLittle is known about parameters that lead to improvement in QoL in individual patients. We analysed the data of the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD) in order to answer the question of how and to what extent change in health-related QoL during up-titration with bisoprolol vs. carvedilol is influenced by clinical and psychosocial factors in elderly patients with heart failure.MethodsThis is a QoL analysis of CIBIS-ELD, an investigator-initiated multi-center randomised phase III trial in elderly patients (65 years or older) with moderate to severe heart failure. Clinical parameters such as New York Heart Association functional class, heart rate, left ventricular ejection fraction (LVEF), 6-min walk distance, as well as the physical and psychosocial component scores on the short-form QoL health survey (SF36) and depression were recorded at baseline and at the final study visit.ResultsFull baseline and follow-up QoL data were available for 589 patients (292 in the bisoprolol and 297 in the carvedilol group). Mean physical and psychosocial QoL improved significantly during treatment. In regression analyses, changes in both SF36 component scores from baseline to follow-up were mainly predicted by baseline QoL and depression as well as change in depression over time. Changes in cardiac severity markers were significantly weaker predictors.ConclusionMean QoL increased during up-titration of bisoprolol and carvedilol. Both baseline depression and improvement in depression over time are associated with greater improvement in QoL more strongly than changes in cardiac severity measures.     

Self-rated health (SRH) and socioeconomic position (SEP) among urban home-dwelling older adults

The main purpose of this study was to examine the association of education and adequacy of income with self-rated health (SRH) among home-dwelling older people aged 75 and over living in the urban area. A cross-sectional survey from 2008 was used to study 1395 older adults aged 75 and over living in one of the central areas of the city center of Helsinki, the capital of Finland. Associations of SRH with, education and adequacy of income were tested using ordinal regression model. Those with a lower level of education had higher level of poor health. Self-assessed adequacy of income had also a strong association with SRH. For the oldest respondents this association was even stronger than the association between education and SRH. Subjective evaluation of financial situation should be used as a key indicator of socioeconomic position (SEP) in studies examining inequalities in health especially among older adults.     

Associated Covariates of Functional Limitation Among Older Adults in India: an Exploration

Using the Longitudinal Ageing Study in India 2010 pilot survey data, the present study examines the covariates and risk factors associated with functional limitations among older adults (45+ ages) in India. Functional limitation is defined as the difficultly in performing some basic activities of daily livings (ADLs) viz. bathing, eating, walking, dressing, toileting and getting in/out of bed. Result suggests that one in every seven older adults in India has at least one of the functional limitations. Among all the activities of daily livings, the most reported problem is difficulty in getting in and out of bed (7 %) followed by walking (6.6 %) and toileting (5.5 %). Age and physical functionality is inversely correlated; older adults aged 60 years report more functional limitations and this becomes more noticeable for older adults aged 75 years and above. We found inverse association between functional limitations and education level and positive association with wealth possession. The multivariate results also corroborate the findings of bivariate results that older adults at higher age, females and older adults with low education are more likely to have functional limitations than their counterpart groups. The likelihood of functional limitations increases significantly in the presence of chronic diseases and smoking tobacco. These finding calls for devising policy to ensure the social security and health care requirements of aged, uneducated, females, poor and those suffering from chronic diseases.     

Factors influencing the subjective well being (SWB) in a sample of older adults in an economically depressed area of China

While the majority of older persons in China live in rural areas, research on the SWB of older individuals is generally scarce in China, and is particularly lacking as regards those who reside in remote areas. The present study investigated 360 elderly individuals in an economically depressed area of Hunan, China. The results of ANOVA showed correlation between income, level of education, social support, self-rated health (SRH) and SWB. The results of the logistic regression analysis demonstrated that education, income and social support showed unique and significant effects in predicting SWB, whereas the SRH approached significance. It was further demonstrated through pathway analysis that income and SRH directly predicted SWB, whereas education did so indirectly. These results suggest that the low SWB of elderly individuals in economically depressed areas of China could be improved through some interventions addressing the economic status, health and education. More specifically, a highly structured nursing intervention is recommended, as there is an urgent need for systematic approaches to improve public health services available to the elderly in poor and remote areas of China.     

Social Network and Mental Health Among Older Adults in Rural Uttar Pradesh,India: A Cross-Sectional Study

The rapid growth of the older population in India draws attention to the factors that contribute to their changing health realities. However, there has hardly been any study in India that has looked at the effects of specific social networks with children, relatives, friends and confidant on depression among older adults. The objective of the study is to investigate the association between social network and depression among the rural elderly. The study population comprised over 630 older adults (aged 60 and above) from the rural areas of Varanasi, Uttar Pradesh. We adopted Berkman's theoretical model of the impact of social relations on depression among the elderly in the Indian context. Results of the Confirmatory Factor Analysis (CFA) demonstrated that the four specific social network types: children, relatives, friends and confidant were tenable. The results showed that a better social network with 'friends/neighbours' was protective against depression among the rural elderly. This clearly points to the need for more social network centres for older adults, so that they can interact with friends within the community or between communities and participate in group activities.     

Quality of life in adults living in the community with previous self-reported myocardial infarction

AimQuality of life (QoL) is one of the most important patient-reported outcomes in chronic diseases. Using a population-based cohort, our objective was to assess health-related QoL in individuals with a previous myocardial infarction (MI).MethodsThis study was conducted on a large database representative of the adult Portuguese population aged 18 years or over, living in the community. Participants were assessed through telephone interview. A standardized questionnaire was applied to every individual about self-reported chronic diseases, including previous MI. QoL was assessed with the EQ-5D-3L version of EuroQol. The prevalence of previous MI was calculated and linear regression analysis was performed.ResultsThe estimated prevalence of previous MI in the adult Portuguese population was 1.1%. These patients were older and more often male, had lower income and lower education levels, and were more often from urban areas. Respondents with self-reported MI assigned a lower self-perception to their health status in all domains, particularly in mobility and anxiety/depression. The mean EQ-5D-3L score in patients with MI was 0.73±0.34, significantly lower than in patients without MI (0.78±0.29). Also, the number of chronic diseases was significantly higher in patients with MI (5.0±2.2 vs. 1.7±1.8). Previous MI was not independently associated with QoL, which was related to age, gender and number of comorbidities.ConclusionsAdults with previous MI have a worse self-perceived health status and QoL. Previous MI was not an independent predictor of health-related QoL after controlling for age, gender and associated chronic diseases.     

Improvements in quality of life in septuagenarians versus octogenarians undergoing trans-catheter aortic valve replacement

Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement (TAVR) when one considers the potential improvement in the quality of life (QoL) on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. Methods This prospective cohort study included 136 elderly patients (70 to 89 years of age), who underwent transfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups: septuagenarians (n = 67) and octogenarians (n = 69). Preoperative and early postoperative clinical parameters were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. Results Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association (NYHA) class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group (P = 0.02, 0.01, 0.03, respectively). Conclusion Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the quality of life and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.     

Self-rated health (SRH) as a predictor of mortality in elderly men living in a medium-size city in Brazil

The objective was to examine the role of SRH as a predictor of mortality in elderly men in a medium-size Brazilian city. In 2 years of follow-up, 120 deaths occurred in the study population, with the following main causes: cardiovascular diseases (40%), neoplasms (22.5%), and respiratory diseases (10%). In practically all of the target variable strata, elderly men with fair or poor SRH showed a higher risk of dying as compared to those with excellent or good SRH. In the final model, the variables fair/poor SRH (hazard risk = HR = 1.88, 95% confidence interval = 95%CI = 1.29-2.72), age (HR = 1.05, 95%CI = 1.03-1.08), public health system as the regular source of care (HR = 1.69, 95%CI = 1.10-2.60), current smoking (HR = 1.94, 95%CI = 1.24-3.04), and acute cardiovascular disease (HR = 1.62, 95%CI = 1.06-2.47) were associated with mortality. We concluded that SRH proved to be a predictive variable for mortality in elderly men after 2 years of follow-up, with nearly a twofold risk of death among men that reported fair or poor health, after adjusting for age, regular use of the public health system, current smoking, and acute cardiovascular disease. Given the importance of poor SRH for predicting mortality in elderly men, health services should incorporate this indicator into health assessments in this population.     

Clinical assessment and health status in standard care in Indian and Iranian patients suffering from rheumatoid arthritis (RA)

Disease activity and quality of life (QOL) including functional status in rheumatoid arthritis (RA) is influenced by several ethnic, cultural and other factors. Standard of care management should cater for country specific needs.ObjectivesTo assess and compare clinical disease characteristics and health status in patients with RA from two countries, India and Iran.Material and methodsA cross-sectional survey of 140 RA patients (Indian70 and Iranian70) was chosen from rheumatology outpatients (Bandar Abbas, Iran and Pune, India) in random manner. One of the authors evaluated all patients under Rheumatologist supervision. Standard evaluation was as per current American College of Rheumatology guidelines and included a 68/66 joint count and laboratory tests. Health assessment questionnaire (CRD Pune version HAQ) and SF36v2 was utilized to assess functional and health status. While Iranian patients were all Muslims, the Indian patients were predominantly Hindu.ResultsThe groups matched well for age, gender, duration of disease and rheumatoid factor. Patients in Iran had less years of education as compared to patients from India (p < 0.001), Pains and SF 36 domains (barring vitality, social function and mental health) and sedimentation rate (ESR) scored significantly higher in the Iranian group. Swollen joint counts, global disease assessment and blood hemoglobin were higher in the Indian group. The overall DAS 28 (disease activity score) index, general health (VAS), HAQ and SF 36 Mental health domain scores did not differ significantly in two groups.ConclusionsThough there were some important differences in pain perception, joint counts and QOL, the study cohorts of RA belonging to the Iranian and Indian ethnicity were similar for disease activity (DAS) and functional status (HAQ).     

Effect of cognitive and structural social capital on depression among older adults in Ghana: A multilevel cross-sectional analysis

Evidence from existing studies suggests social capital has mixed effects on depression and other common mental disorders. There is little knowledge of the possible association between social capital and depression among the growing older population in sub-Saharan Africa. This study investigates the effect of cognitive social capital (trust and sense of safety) and structural social capital (social participation or engagement in social activities) on depression among older adults in Ghana. Utilizing multilevel mixed-effect analysis, we investigate the effect of individual-level and neighborhood-level social capital (cognitive and structural) on depression using data from the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE) survey (Wave 1). The findings show that at an individual level, older adults who felt safe at home were less likely to have depression. We observed mixed results for elements of structural social capital at the individual level. Older adults who frequently engaged in club or group meetings, worked with neighbors and engaged in social outings were more likely to have depression; while attending public meetings and socializing with co-workers were associated with reduced likelihood of having depression. At the neighborhood level, increased trust in neighbors was associated with an increased likelihood of having depression (OR = 1.01, p < 0.05) while higher levels of neighborhood safety and structural social capital were associated with a reduced likelihood of having depression. The findings suggest that the differential associations between elements of social capital and depression may be the result of contextual factors.     

Importance of self-rated health and mental well-being in predicting health outcomes following total joint replacement surgery for osteoarthritis

Objective

The determinants of outcomes and the scope of outcomes examined in total joint replacement (TJR) typically have been limited to aspects of physical health. We investigated mental well‐being, physical and social health, and self‐rated health (SRH) as predictors of future health status within a cohort undergoing a TJR for hip or knee osteoarthritis. We also investigated the interrelationships among these health dimensions as they relate to SRH.

Methods

Participants (n = 215 hip, n = 234 knee) completed measures presurgery and 3 and 6 months postsurgery, including pain, physical function, fatigue, anxiety, depression, social participation limitations, passive/active recreation, community mobility, and SRH. Structural equation modeling was used to investigate the interrelationship between 3 latent health dimensions (physical, mental, social) and the predictive significance of SRH for future health status.

Results

The mean age was 63.5 years (range 31–88 years) and 60% were women. Prior dimension status strongly predicted future status. Adjusted for prior dimension scores, comorbidity, and sociodemographic characteristics, SRH predicted future scores for all 3 health dimensions. Worse prior SRH predicted less improvement at all time points. The effects of physical and social health on SRH were fully mediated through mental well‐being. Only mental well‐being significantly predicted SRH, within and across time.

Conclusion

Mental well‐being is critical for understanding the relationship between physical health and SRH. In addition, SRH significantly predicts TJR outcomes, above and beyond prior physical health. The exclusive focus on any one health dimension may lead to missed opportunities for predicting and improving outcomes following surgery, and likely improving overall health generally.     

Labor force participation and human capital increases in an aging population and implications for U.S. research investment

The proportion of the United States labor force >/=65 years of age is projected to increase between 2004 and 2014 by the passing of age 65 of the large post-World War II baby boom cohorts starting in 2010 and their greater longevity, income, education, and health [Toossi M (2005) Mon Labor Rev 128(11):25-44]. The aging of the U.S. labor force will continue to at least 2034, when the largest of the baby boom cohorts reaches age 70. Thus, the average health and functional capacity of persons age 65+ must improve for sufficient numbers of elderly persons to be physically and cognitively capable of work. This will require greater investments in research, public health, and health care. We examine how disability declines and improved health may increase human capital at later ages and stimulate the growth of gross domestic product and national wealth.     

福州城市社区老年人抑郁状况及与生活质量的关系

目的 了解福州城市社区老年人的抑郁状况及其与生活质量的关系.方法 采用分层随机抽样方法,应用老年抑郁量表(GDS)和SF-36健康调查简表对福州市12个社区共3285例≥60岁的老年人进行问卷调查.结果 福州城市社区老年人抑郁症状者1981例,发生率为60.3％,老年女性抑郁症状发生率高于男性(x2=7.561,P＜0...     

Family ties and functional limitation in the elderly: Results from the Survey of Health Ageing and Retirement in Europe (SHARE)

ObjectivesTo examine if family ties are strong predictors of functional limitation in older adults in Europe.MethodsCross sectional data were used and included 14 European countries from the second wave (w2) of the survey on Health, Ageing, and Retirement in Europe. 13,974 adults aged 50+ (45.2% males and 54.8%females) were included in the study. Functional limitation was assessed using activities of daily living (ADL), instrumental activities of daily living (i-ADL) and mobility sensory index. Family ties were based on a customized model of family structural aspects. Multiple logistic regression analyses were used to examine the risk of functional limitations.ResultsFunctional limitation was associated with females, age, self-rated health, and an increased number of chronic conditions, disease symptoms and depressive symptoms but not with few family ties. After controlling for potential confounders, respondents with lower family contacts showed higher risk for functional limitation. Southern and Mediterranean countries have both closer family ties and adults with higher functional limitation.ConclusionFunctional limitation is associated with biological and demographic factors as well as little contact with family members. Further longitudinal research is required in order to determine the association and the causal relationship between functional limitation and family ties.