The impact of spirituality on health-related quality of life among Chinese older adults with vision impairment

The goals of this study were to examine the impact of spirituality on both generic and vision-specific health-related quality of life (HRQOL) and the role of spirituality in the linkage between vision impairment and HRQOL outcomes among Chinese older adults with visual problems. A sample of 167 urban older adults with visual problems were interviewed using a structured questionnaire to assess self-reported visual functioning, general health, spirituality and both generic and vision-specific HRQOL. Objective visual function was clinically measured by ophthalmologists in terms of distance visual acuity. It was found in the study that spirituality was positively associated with both general physical health and general mental health, with a higher correlation with general mental health than that with general physical health. Moreover, spirituality was associated significantly with vision-specific HRQOL, including multiple domains. The results showed that spirituality played a mediating role in the linkage between vision impairment and general mental health. These results suggest that spirituality is significantly associated with multiple domains of HRQOL and may play an important role in the process of adaptation to age-related vision loss among Chinese older adults with vision impairment.     

Role of depressive symptoms and comorbid chronic disease on health-related quality of life among community-dwelling older adults

Objective

This study examined the influence of depressive symptoms on health-related quality of life (HRQOL) among community-dwelling older adults suffering from various categories of chronic comorbidity.

Methods

A population-based survey in adults aged 60 years or more was conducted within a random sample of 1085 beneficiaries of the Mexican Institute of Social Security in Mexico City. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, and chronic comorbidity was determined with self-reports concerning prior medical diagnoses and the HRQOL Short Form-36 health survey. We carried out a stratified analysis by comorbidity category, evaluating the impact of depressive symptoms on HRQOL through an analysis of variance and modeling the independent association of depression symptoms with HRQOL using multiple linear regression analyses adjusted for comorbidity and other covariables.

Results

HRQOL scores were low in the presence of depressive symptoms, while their impact increased when chronic diseases were also present. The group with the poorest HRQOL was older adults suffering from both depressive symptoms and two or more chronic diseases (P<.05). The stratified analysis by comorbidity and multivariate analysis, adjusted for covariables, indicated that depressive symptoms and comorbidity had cumulative negative effects on HRQOL.

Conclusion

The HRQOL of older adults deteriorated when depressive symptoms were present and decreased even further with the simultaneous occurrence of chronic illnesses. Identifying depression symptoms—either alone or along with chronic conditions—is crucial for implementation of measures aimed at improving elderly people's HRQOL.     

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.     

Mood, personality, and health-related quality of life in epileptic and psychogenic seizure disorders

PURPOSE: Patients with psychogenic nonepileptic seizures (PNES) rate their health-related quality of life (HRQOL) more poorly than those with epileptic seizures (ES). This has been explained in part by mood state. We sought to investigate whether HRQOL differences between diagnostic groups (PNES vs. ES) can be explained by additional, perhaps chronic, aspects of mood and personality. An understanding of these relationships may inform treatment designed to improve HRQOL in ES or PNES. METHODS: One-hundred fourteen individuals (69 ES and 45 PNES) completed the quality of life in Epilepsy-89. The profile of mood states (POMS) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were employed to measure current and chronic mood symptoms, respectively. Multiple regression analyses determined the contribution of chronic mood symptoms to HRQOL beyond the variance accounted for by current mood state and seizure diagnosis. RESULTS: Similar to previous reports, individuals with PNES reported poorer HRQOL than those with ES. Current mood state was strongly related to HRQOL and appeared to moderate the relationship between seizure diagnosis and HRQOL. However, when more chronic psychological symptoms, such as somatization and emotional distress, were included in a model, the moderating role of mood state was not significant. CONCLUSION: Analyzed independently, mood state is related to HRQOL, but when chronic indicators of psychological symptoms are included in a model mood is related to HRQOL, but, the moderating effect of mood is no longer significant. Treatments designed to improve HRQOL among individuals with intractable seizures should also address chronic psychological distress and symptoms associated with high levels of somatization.     

Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults,with and without dementia

Objectives: Active ageing, considered from the perspective of participation in leisure activities, promotes life satisfaction and personal well-being. The aims of this work are to define and explain leisure activity profiles among institutionalized older adults, considering their sociodemographic characteristics and objective and subjective conditions in relation to their quality of life.

Methods: Two samples of institutionalized people aged 60 and over were analysed together: 234 older adults without dementia and 525 with dementia. Sociodemographic, economic, family and social network, and health and functioning variables were selected. Cluster analysis was applied to obtain activity profiles according to the leisure activities, and ordinal regression models were performed to analyse factors associated to activity level.

Results: The sample was clustered into three groups of people: active (27%), moderately active (35%) and inactive people (38%). In the final regression model (Nagelkerke pseudo R² = 0.500), a higher level of activity was associated with better cognitive function (Pfeiffer scale), self-perceived health status and functional ability, as well as with a higher frequency of gathering with family and friends, and higher educational level.

Conclusion: The decline in physical and mental health, the loss of functional capabilities and the weakening of family and social ties represent a significant barrier to active ageing in a context of institutionalization.     

The influence of personality factors on health-related quality of life of patients with inflammatory bowel disease

OBJECTIVE: The aim of the study was to examine the influence of personality factors on health-related quality of life (HRQOL) in patients with inflammatory bowel disease (IBD). METHODS: A total of 120 individuals, 60 with ulcerative colitis and 60 with Crohn's disease, filled out the Inflammatory Bowel Disease Questionnaire, the Rosenberg Self-Esteem Scale, the Neuroticism scale of the Eysenck Personality Inventory, and a scale about difficulty describing feelings to other people. Sociodemographic and clinical information was also collected. RESULTS: Results of hierarchical regression analysis, after controlling for possible confounder effects of demographic and clinical variables, showed the predictive power of the block of personality variables, accounting for significant amounts (13-22%) of variance across the four HRQOL measures. Except for self-esteem, which was the factor most closely related to social functioning, neuroticism seemed to be the most closely related to the four indicators of quality of life. It was also found that greater difficulty in describing feelings was linked to poorer HRQOL. CONCLUSION: In summary, some personality factors are useful for understanding the process of HRQOL in patients with IBD. Recognizing these differences may enrich clinical research and may be crucial when designing interventions aimed at treatment effectiveness.     

Urban and rural factors associated with life satisfaction among older Chinese adults

Objective: This study compared urban and rural factors associated with life satisfaction among older adults in mainland China.

Method: Study data were extracted at random from 10% of the Sample Survey on Aged Population in urban/rural China in 2006 for 1980 participants aged 60 and older, including 997 from urban cities and 983 from rural villages.

Results: In this study, 54.6% of urban older adults and 44.1% of rural older adults reported satisfaction with their lives. Binary logistic regression analysis showed that financial strain, depressive symptoms, filial piety, and accessibility of health services were significantly associated with life satisfaction for both urban and rural participants, but age and financial exchange with children were only associated with life satisfaction among urban older adults.

Conclusion: Findings are consistent with some previous studies that indicated the importance of financial strain, depressive symptoms, filial piety, and accessibility of health services to life satisfaction among the older adults in both urban and rural areas. This study also demonstrated the importance of age and family financial exchange to the life satisfaction of urban older adults.     

A cross-validation Delphi method approach to the diagnosis and treatment of personality disorders in older adults

Introduction: The Delphi method is a consensus-building technique using expert opinion to formulate a shared framework for understanding a topic with limited empirical support. This cross-validation study replicates one completed in the Netherlands and Belgium, and explores US experts' views on the diagnosis and treatment of older adults with personality disorders (PD).

Methods: Twenty-one geriatric PD experts participated in a Delphi survey addressing diagnosis and treatment of older adults with PD. The European survey was translated and administered electronically.

Results: First-round consensus was reached for 16 out of 18 items relevant to diagnosis and specific mental health programs for personality disorders in older adults. Experts agreed on the usefulness of establishing criteria for specific types of treatments. The majority of psychologists did not initially agree on the usefulness of pharmacotherapy. Expert consensus was reached following two subsequent rounds after clarification addressing medication use.

Conclusions: Study results suggest consensus among regarding psychosocial treatments. Limited acceptance amongst US psychologists about the suitability of pharmacotherapy for late-life PDs contrasted with the views expressed by experts surveyed in Netherlands and Belgium studies.     

Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits

Abstract

Purpose and aim: The overall aim of the present study was to examine quality of life in attention deficit hyperactivity disorder (ADHD) patients age ≥60 years. First, we compared older adults with ADHD to both healthy controls of the same age and younger adults with ADHD. Second, we examined executive functioning as a possible underlying factor for quality of life among older adults with ADHD.

Methods: The study included 158 participants in three groups: (1) older adults (60–75 years of age) with ADHD (n?=?42), (2) healthy controls of the same age (n?=?58), and (3) younger adults (age 18–45 years of age) with ADHD (n?=?56). The patients with ADHD were clinically-referred. Quality of life was examined through self-ratings and executive functioning was examined using both self-ratings and tests.

Results: Older adults with ADHD differed significantly from controls the same age on all aspects of quality of life, with large effect sizes. However, they showed similar levels of quality of life compared to younger adults with ADHD. The exception was psychological health, for which older adults displayed better quality of life compared to younger adults with ADHD. Executive deficits measured through self-ratings, especially working memory, were related to quality of life, sometimes also beyond the influence of ADHD symptom levels.

Conclusions: Older adults with ADHD show serious impairments in quality of life, that are comparable to the levels found for younger adults. Impairments may increase further as these individuals grow older and clinics need to meet the needs of this increasingly larger group of patients.     

Shyness,hormones, and quality of life among adults with schizophrenia

Objective: Although individual differences in personality are known to influence quality of life in individuals with schizophrenia, relatively few studies have attempted to identify putative links underlying this relation.

Methods: Here, we examined associations among temperamental shyness, hormones (ie baseline salivary cortisol and testosterone), and quality of life (QoL) measured in 42 stable outpatient adults with schizophrenia.

Results: We found that baseline cortisol, but not testosterone, moderated the relation between shyness and QoL (ß?=?1.09, p?=?0.004). Among individuals with relatively low baseline cortisol, higher shyness was associated with lower Intrapsychic Foundations QoL. Individuals with relatively higher baseline cortisol reported similar QoL scores irrespective of level of shyness.

Conclusion: These preliminary results suggest that relatively lower baseline cortisol may be helpful to understanding the relation between temperament and Intrapsychic Foundations QoL in schizophrenia. The present findings are consistent with previous studies implicating relatively lower baseline cortisol levels in nonclinical samples of people who are shy and the negative downstream effects resulting from HPA axis dysregulation, and extends these prior findings to people with schizophrenia who are also shy.     

Resilience,stressful life events,and depressive symptomatology among older Chinese adults

Objective: The association between exposure to stressful life events (SLEs) and late-life depression is well-documented. However, the role of resilience as a buffer against the adverse mental health effects of SLEs in late life has not been convincingly demonstrated. In this paper, the moderating effect of resilience in the relationship between SLEs and depressive symptomatology in older Chinese adults is investigated.

Method: A population sample of 385 community-dwelling older Chinese adults aged ≥60 years responded to questionnaires on resilience (Connor–Davidson resilience scale), depressive symptomatology (Geriatric Depression Scale, GDS-15) and SLEs.

Results: Increased numbers of SLEs (β = 0.343, p < .001) and lower levels of resilience (β = –0.137, p < 0.001) were significantly associated with higher levels of depressive symptomatology. There was a significant interaction of resilience and number of SLEs on depressive symptomatology (p = 0.003). The sense of personal competence and optimism was the principal underlying resilience dimension moderating the relationship for both the young–old (aged 60–69) and the old–old (aged 70 and above).

Conclusion: The finding of significant interaction supported the role of resilience in moderating the adverse effect of SLEs in terms of depressive symptoms among older Chinese adults.     

The long-term impact of childhood abuse on internalizing disorders among older adults: The moderating role of self-esteem

Objectives: First, to determine if childhood experiences of abuse have an impact on internalizing disorders (e.g., anxiety and depressive disorders) among older adults. Second, we wish to determine if self-esteem plays a role in explaining the relationship between abuse and internalizing disorders.

Method: First, we conducted an analysis on a population sample of participants aged 50 years or older (mean age = 67 years; SD = 10.3) assessed at two time points, three years apart (Wave 1, N = 1460; Wave 2, N = 1090). We examined the relationship between reports of childhood abuse (physical, emotional, and sexual) and internalizing disorders. Second, we determined the role self-esteem played in explaining the relationship.

Results: We found that childhood experiences of abuse assessed at Wave 1 predicted the number of DSM-IV internalizing disorders occurring three years later. Demonstrating the specificity of self-esteem; we found self-esteem, but not emotional reliance, to moderate the relationship between abuse and internalizing disorders such that childhood abuse had more negative effects on those with low self-esteem compared to those with higher self-esteem. Contrary to prediction, self-esteem did not mediate the relationship between abuse and internalizing disorders.

Conclusion: The negative effects of childhood abuse persist for many years, even into older adulthood. However, contrary to the findings in younger adults, self-esteem was not correlated with childhood abuse in older adults. Moreover, childhood abuse only had a negative effect on those who had low self-esteem. It may be through the process of lifespan development that some abused individuals come to separate out the effects of abuse from their self-concept.