The association between alcohol use and long-term care placement among older Canadians: A 14-year population-based study

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.     

Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study

BACKGROUND: The health-related quality of life is impaired in patients with functional gastrointestinal disorders seen in referral centres. AIM: To determine whether the health-related quality of life is impaired in subjects with functional disorders in the community and whether any differences can be explained by psychological co-morbidity. METHODS: In a population-based, nested, case-control study, subjects reporting symptoms of either dyspepsia or irritable bowel syndrome and healthy controls were interviewed and completed a battery of psychological measures plus a validated, generic, health-related quality of life measure (Medical Outcomes Study 36-item short form health survey, SF-36). The association between irritable bowel syndrome and dyspepsia and the physical and mental composite scores of SF-36 were assessed with and without adjustment for psychological state. RESULTS: One hundred and twelve cases (30 dyspepsia, 39 irritable bowel syndrome, 32 dyspepsia and irritable bowel syndrome and 11 gastrointestinal symptoms but not dyspepsia or irritable bowel syndrome) and 110 controls were enrolled. In the unadjusted linear regression models, irritable bowel syndrome (but not dyspepsia) was negatively associated with the physical composite score (P < 0.05); in an adjusted model, the association between the physical health-related quality of life and irritable bowel syndrome was explained by the Symptom Checklist-90 somatization score alone. In unadjusted models, irritable bowel syndrome and dyspepsia were each negatively associated with the mental composite score (P < 0.05). The association between the mental health-related quality of life and dyspepsia remained after adjusting for psychological covariates, but the association between this and irritable bowel syndrome was not significant after adjustment. CONCLUSIONS: In the community, health-related quality of life is impaired in subjects with irritable bowel syndrome and dyspepsia; however, much of this association can be explained by psychological factors.     

Measuring health-related quality of life in older patient populations: a review of current approaches

The changing demographic profile of the world's population towards old age and evidence of people living for longer with less time spent in ill health highlight the importance of addressing quality-of-life (QOL) assessment issues for older people. The assessment of health-related QOL (HR-QOL) has received considerable attention in the last 2-3 decades, with a wide variety of assessment instruments available. These instruments can be either generic or disease specific, health profiles or preference based.The literature was reviewed systematically to identify studies measuring HR-QOL in older patient groups. A total of 37 studies were identified, 11 of which were randomised, controlled trials/evaluations, 14 were prospective studies that did not involve a randomised, controlled intervention, and 12 were cross-sectional studies. Studies were summarised in terms of the study aim, patient population characteristics, the instrument used to measure HR-QOL, and HR-QOL findings. A majority of studies used a generic HR-QOL instrument, the single most commonly used being the 36-Item Short-Form Health Survey. In many cases, a second disease-specific measure was used in combination with the generic measure. In a majority of studies involving interventions, significant improvements in HR-QOL were noted. In prospective studies, a negative impact of health conditions (e.g. myocardial infarction and chronic heart failure) was also identified using HR-QOL assessments.None of the studies in this review used HR-QOL measurement instruments that were old-age specific. Using instruments that are not specific to a particular age group enables comparisons to be made with other age groups, i.e. younger or middle-aged groups. However, the questionnaire items of HR-QOL instruments tend to be phrased predominantly in relation to physical function and thus may inadvertently discriminate against older persons, whose physical function is likely to be not as good as that of younger people. Particular issues in the assessment of HR-QOL in older patient populations include the persistent finding of a poor relationship between QOL and disability/disease severity, the dynamic nature of QOL, and the importance of valid proxy ratings for those unable to make decisions or communicate for themselves.It is important, therefore, that assessment of HR-QOL incorporates issues of importance to individual older people by broadening the scope of the measurement instruments, thus representing more validly the HR-QOL status of older patient groups. Future research in HR-QOL must incorporate the perspective of the individual in order to enable valid conclusions to be derived based on content that is relevant to the individual being assessed, thus informing management decisions, policy and practice more meaningfully.     

Alcohol use and psychosocial well-being among older adults.

OBJECTIVE: The objective of this study was to examine the relationships of three dimensions of alcohol consumption (frequency of drinking, usual total weekly consumption and quantity per occasion) with social and leisure status, stress and psychological well-being among people ages 65 and older. METHOD: Nurse interviewers completed in-house surveys with 826 older persons (65% women) in one community (67% response rate of the census sample). RESULTS: Overall, relationships tended to be modest or nil. Those relationships between negative functioning and heavier alcohol use that did emerge tended to be associated with higher quantity drinking (i.e., drinks per drinking day) and to some extent volume, but not with frequency of drinking. Of the psychosocial variables, poorer psychological well-being, especially depression, was most highly correlated with heavier drinking. These results were the same controlling for sex, age, education, health and use of depressant medications. CONCLUSIONS: Higher quantity and volume of alcohol use among older people show a modest positive association with poorer psychological well-being, independent of other potentially confounding variables such as sex, age, health or use of depressant medications. Frequency of drinking, however, was not related to psychosocial status.     

Effects of home medication review on drug-related problems and health-related quality of life among community-dwelling older adults in China

BackgroundThere is a lack of research on the nature of drug-related problems (DRPs) in older adult communities in China and the impact of home medication review on DRP reduction and health-related quality-of-life (HRQoL) improvement.ObjectivesTo identify and categorize DRPs in older adults in China and to assess the impact of home medication review.MethodsThe prospective study was conducted in 2 community health service centers in Shanghai, China from December 2018 to December 2019. Eligible patients received a home medication review by a clinical pharmacist to assess for DRPs and adherence, propose pharmaceutical interventions, and measure outcomes of HRQoL. All enrolled patients were followed up for 3 months.ResultsMedication use in 412 patients was analyzed. A total of 362 DRPs were identified, an average of 0.88 per patient. Treatment effectiveness was the primary DRP type (249; 68.8%). The most common causes of DRPs were patient-related (35.1%) and drug selection (31.0%). Pharmacists made 733 interventions, an average of 2 per DRP. A total of 82.1% of these interventions were accepted. At a 3-month follow-up, home medication review led to a statistically significant reduction in the mean number of DRPs (0.4 vs. 0.88, P < 0.001) and an increase in medication adherence (1.42 vs. 0.85, P < 0.001). Both HRQoL indicators also improved, EuroQol 5 Dimension scale (0.75 vs. 0.78, P < 0.001) and EuroQol–visual analog scale (70 vs. 77.65, P < 0.001).ConclusionHome medication review is a practical means to optimize drug therapy and improve patients’ HRQoL in community settings.     

Predictors of reduced health-related quality of life in adults with coeliac disease

BACKGROUND: Data available on predictors of reduced health-related quality of life in coeliac disease are not consistent. AIM: To test predictors of reduced health-related quality of life, described in the literature, by a multivariate approach. METHODS: 1000 adult coeliacs of the German Coeliac Society completed a medical and a sociodemographic questionnaire, the Short-Form Health Survey (SF-36), the Coeliac Disease Questionnaire and the Hospital Anxiety and Depression Scale within a postal survey. Predictors of reduced health-related quality of life were tested for by logistic regression analysis. RESULTS: Physical comorbidities (beta = -0.41; OR = 0.66, P < 0.001) and mental disorder (beta = 0.88; OR = 2.4, P = 0.03) were associated with a reduced physical summary score of the SF-36. Mental disorder (beta = 2.5; OR = 11.9, P < 0.001), physical comorbidities (beta = -0.26; OR = 0.77, P = 0.004) and younger age at diagnosis (beta = -0.10; OR = 0.91, P = 0.05) predicted a reduced mental summary score of the SF-36. Mental disorder (beta = 0.90; OR = 2.5, P = 0.03), non-compliance with gluten-free diet (beta = 0.44; OR = 1.6, P = 0.009), active medical comorbidities (beta = -0.28; OR = 0.76, P = 0.007) and dissatisfaction with doctor-patient communication (beta = 0.55; OR = 1.7, P = 0.03) were associated with reduced Coeliac Disease Questionnaire scores. CONCLUSIONS: Reduced health-related quality of life in coeliac disease is associated not only with physical and mental comorbidities, but also with non-compliance with gluten-free diet and dissatisfaction with doctor-patient communication.     

Benefits,risks and impacts on quality of life of medications used in multimorbid older adults: a Delphi study

International Journal of Clinical Pharmacy - Background Multimorbidity and polypharmacy are common in older people. Despite the existence of quality criteria for medication use among this...     

Alcohol consumption and physical health-related quality of life in older women using the transformation of SF-36 to account for death.

Moderate alcohol consumption has been associated with health benefits in several studies, but few studies investigating such association for elders have been done. So, we explored the relationship between alcohol intake and changes in physical health-related quality of life (HRQoL). As analyses of longitudinal HRQoL data excluding diseased participants produced overestimated results, we compared the methods with and without incorporating death and estimated valid physical HRQoL and its decline over time. Study subjects were women from the Australian Longitudinal Study on Women's Health, ages 70-75 years at Survey 1 in 1996 (n = 12,432), and were followed-up at 3 yearly intervals for 6 years. Alcohol consumption was divided into seven categories to identify harmful alcohol levels for older women. We measured Physical Component Score (PCS) of Medical Outcomes Study Short-Form (SF-36), and applied the transformed PCS incorporating death as a valid score to estimate HRQoL changes for each alcohol group with adjustment for potential confounders. Significant declines of values were observed and the values of 'non-drinker' and 'rare drinker' were lower than the other groups during 6 years in both PCS and the transformed PCS. Analysis of the PCS showed significant Alcohol x Time interaction effects for non-drinker and rare drinker groups, as the scores were overestimated towards higher values at Survey 2 due to loss to follow-up of women who died. In the transformed PCS, these interaction effects diminished, and a clearer dose-response relationship between alcohol and physical HRQoL was observed at the third survey. We examined the influence of deaths on the study conclusions with using PCS and its transformed value which included deaths. Being a nondrinker of alcohol was associated with greater risk of mortality and poorer physical HRQoL. Moderate alcohol consumption was not harmful, and may carry some health benefits for older women.     

Alcohol consumption and quality of life among young adults: a comparison among three European countries

The study aims to investigate the relationship between alcohol consumption and quality of life (QoL) on a representative sample of adults aged 25-34 living in France, Italy, and the Netherlands (4,841 subjects). The data was collected in 2008 using telephone interviews and analyzed with cluster analysis using Ward's method. Results show that the impact of alcohol consumption on QoL depends mainly on predominant consumption style and drinking culture that should be investigated further to identify protective factors.     

Stimulant use trajectories and the longitudinal risk of heavy drinking: findings from a rural population-based study

The extant literature offers little information about the longitudinal course of alcohol use among stimulant users, particularly those in rural areas, but it is plausible that reductions in stimulant use are accompanied by increases in heavy drinking. The objective of this study was to examine the longitudinal relationships between heavy drinking days and latent trajectories of powder cocaine, crack cocaine, and methamphetamine use. Participants (n = 710) were identified via Respondent-Driven Sampling in 3 rural communities in each of 3 states, with interviews conducted every 6 months over 3 years. Latent trajectory classes for powder cocaine, crack cocaine, and methamphetamine use were identified by conducting latent class growth analysis (LCGA). Generalized linear models (GLM) were conducted to examine how these latent classes were associated with the number of heavy drinking days in the past 30 days. Heavy drinking days did not significantly change over time when adjusting for covariates. Compared to those with a “fast low” trajectory of crack use, those with “steady high” and “declining” trajectories had more heavy drinking days. Compared to those with a “fast low” trajectory of powder cocaine use, those with a “steady moderate” trajectory had more heavy drinking days. Trajectories of methamphetamine use were not significantly associated with heavy drinking days. In conclusion, heavy alcohol use changes little over time among rural stimulant users. Many rural cocaine users could potentially benefit from interventions aimed at curtailing heavy drinking.     

Onychomycosis: health-related quality of life considerations

The symptoms of onychomycosis and their impact on personal appearance are important determinants of patients' perceptions of their own health. The effect of onychomycosis is greater on psychosocial than physical functioning and is directly related to the extent of nail involvement. This review identified a number of disease-targeted questionnaires that have been developed to assess the impact of onychomycosis and its treatment on health-related quality of life (HR-QOL). The instruments differ considerably in the extent to which they have been psychometrically tested. Most have been shown to provide both valid and reliable measurement of HR-QOL in patients with onychomycosis of the toes. However, not all have been tested in patients with fingernail disease. The generic and disease-targeted scales of most of the available questionnaires exhibit poor variability, which may limit their responsiveness to clinically important change. Only one instrument, the Onychomycosis Disease-Specific Questionnaire, has been incorporated into a clinical trial. Thus, information relating to the impact of onychomycosis treatment on HR-QOL is limited. Future efforts should focus on the systematic evaluation of existing questionnaires in all populations for which they were developed. In addition, it is important that disease-targeted measures be included in future clinical trials so that a better understanding of the impact of onychomycosis treatment on patient HR-QOL may be gained.     

Weekly marijuana use and health-related measurements among adults in the United States: a longitudinal study

Abstract

The present study aims to investigate the associations of weekly marijuana use with health-related measurements, including overall, physical, and mental health, and quality of life among adults, in a single research effort with panel analysis. The two latest Waves (2014–2015 and 2015–2016) of the Population Assessment of Tobacco and Health study (PATH) were used for this work. Weekly marijuana use was defined as marijuana use at least one time per week. Propensity score matching was applied at the previous wave to control selection bias and unobservable differences. Logistic regressions were estimated to investigate the associations of weekly marijuana use with health-related measurements. The analysis also considered the interaction of race and weekly marijuana use. The majority of participants reported good health outcomes. Based on the regression models without the interaction term, weekly marijuana use was only negatively associated with mental health and overall health, but was not associated with physical health and quality of life. With the interaction effect of race in the overall sample, weekly marijuana use was negatively associated all with health measurements. However, weekly marijuana use among non-white respondents was positively associated with health outcomes (all ps?<?0.01), except mental health. Further policy and research directions are discussed.     

The adult eosinophilic oesophagitis quality of life questionnaire: a new measure of health-related quality of life

Aliment Pharmacol Ther 2011; 34: 790–798

Summary

Background Eosinophilic oesophagitis (EoO) is a chronic disease characterised by significant symptoms and challenging treatment regimens. Health‐related quality of life (HRQOL) is a useful way to direct patient care. EoO symptoms and treatment may impact patient HRQOL. Currently, there is no reliable and valid measure of adult EoO patient HRQOL. Aim To validate the Adult Eosinophilic Oesophagitis Quality of Life (EoO‐QOL‐A) questionnaire as a measure of HRQOL in this population. Methods The EoO patients aged 18–70 recruited via an out‐patient GI clinic and two EoO advocacy groups completed the preliminary EoO‐QOL‐A, demographic and clinical information, and measures of general HRQOL, psychological distress and EoO symptom severity. A subset of patients completed test–retest assessments. Scale reliability, internal consistency, factor structure, concurrent and convergent validity were evaluated. Results A total of 201 patients have participated. The study sample was primarily Caucasian, college‐educated, and evenly split by gender. The average duration of disease was 7 years with duration of symptoms of 26 months prior to diagnosis. Patients reported were using both pharmacological and dietary treatments. Factor analysis yielded a 37‐item, 5‐factor structure: Eating/Diet Impact, Social Impact, Emotional Impact, Disease Anxiety and Choking Anxiety. The EoO‐QOL‐A demonstrated excellent internal consistency, split‐half and test–retest reliability. Concurrent and convergent validity were supported by moderate correlations with established HRQOL measures, psychological distress and oesophageal symptoms. Conclusions The EoO‐QOL‐A is a valid and reliable disease‐specific HRQOL measure for adult EoO patients. Developing the Adult Eosinophilic Oesophagitis Quality of Life is an important step in guiding treatment practices, improving disease education and standardising research protocols.     

Epidemiology of chronic atrophic gastritis: population-based study among 9444 older adults from Germany

BACKGROUND: Epidemiological data on chronic atrophic gastritis from general population samples are sparse in Germany. AIM: To assess prevalence of chronic atrophic gastritis according to potential risk factors and clinical outcomes in a large-scale population-based study. METHODS: In the baseline examination of ESTHER, a population-based cohort study conducted in Germany, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were taken in 9444 women and men aged 50-74 years. Information on potential risk factors and medical history were obtained by questionnaire. RESULTS: With the definition used in the EUROGAST study (PG I < 25 ng/mL), prevalence of chronic atrophic gastritis increased from 4.8% in age group 50-54 to 8.7% in age group 70-74. An alternative definition of chronic atrophic gastritis (PG I < 70 ng/mL and PG I/PG II < 3), used in multiple studies from Japan, revealed a greater increase with age (from 2.7% to 9.1%) and a strong association with H. pylori infection (adjusted odds ratio: 2.9, 95% confidence interval: 2.4-3.7). With both definitions, a strong inverse association with heartburn was observed. CONCLUSIONS: Overall chronic atrophic gastritis prevalence is low among older adults in Germany, but it strongly increases with age and H. pylori infection.