Health-related quality of life in low-income older African Americans

This study examined the relationships among comorbid conditions, symptom stress, depression, functional status and health-related quality of life (HRQOL) in low-income older African Americans with chronic diseases. A convenience sample of 83 older African American adults living in subsidized housing for elders participated in the study. Data were collected in face-to-face interviews. Participants reported lower scores on HRQOL than the SF-36 norms for age 60 or older in the general U.S. population. Comorbid conditions, symptom distress, depression, and functional status significantly predicted both the physical (F = 38.92, p < .001) and mental (F = 23.21, p < .001) health components of HRQOL, accounting for 63% of variance in the SF-36 physical health score and 55% of the variance in the SF-36 mental health score. The findings suggested that developing interventions to assist older African Americans to better manage their symptoms and depression are of prime importance for improving HRQOL.     

Effects of a multicomponent physical exercise programme on perceived health-related quality of life and on depressive symptoms in older adults living in long-term nursing homes

ObjectivesThis study aimed to investigate the impact of a multicomponent exercise programme on perceived health-related quality of life (HRQoL) and depressive symptomatology in older people living in a long-term nursing home (LTNH).MethodsA quasi-experimental study was conducted. Forty-one older people were conveniently selected from the largest LTNH in the Basque Country. The participants were assigned to either an intervention group (n = 21) or a control group (n = 20). The intervention group participated in 50-min moderate intensity multicomponent physical exercise sessions (strength and balance, three sessions a week for 3 months). The control group participants continued their usual activities in the LTNH. Assessments were completed at baseline and reassessed after the 12-week intervention by the same nurse researchers who filled out the questionnaires: the 36-item Short Form Survey (SF-36) and the Geriatric Depression Scale (GDS).ResultsThirty-eight participants completed the study (19 participants in each group). In the SF-36 parameters, physical functioning increase in the intervention group tends with a mean increase of 11.06 units (a 17.2% increase over the pre). In the role-emotional, the increase in the intervention group is with a mean increase of 5.27 units (a 29.1% increase over the pre) (P < 0.05). In social functioning, the increase in the control group is significant with a mean increase of 13.16 units (a 15.4% increase over the pre) (P < 0.05). There are no significant changes in the rest of the parameters, there are no differences between groups in the evolutionary pattern either.ConclusionsAs for the effects of the multicomponent exercise programme on HRQoL and depressive symptomatology, no statistically significant effects were obtained in the outcome data among older adults living in LTNHs. An increase in the sample size could confirm the trends obtained. The results may help inform the design of future studies.     

Perceptions of Living Alone Among Older Adult Women

This exploratory study examines older women's perceptions of living alone. Older adult women (N = 53) living alone were interviewed. Findings show tremendous variability in the perceptions of this sample. Whereas some women showed significant levels of loneliness and depression, many did not. Thirteen percent of the participants (n = 7) negatively perceived living alone, 49.1% (n = 26) neutrally perceived living alone, and 37.7% (n = 20) positively perceived living alone. Participants' most enjoyed aspects of living alone were being one's own boss/being independent (51%) and keeping one's own schedule (49%). Common responses for least enjoyable aspects of living alone were lack of companionship (62%), no one to help with housework (36%), and fear of falling or getting hurt (30%). Nurses should be aware that although some have perceived older adult women living alone as a vulnerable population, one cannot make assumptions based on living arrangements.     

Health-Related Quality of Life in Low-Income Older African Americans

This study examined the relationships among comorbid conditions, symptom stress, depression, functional status and health-related quality of life (HRQOL) in low-income older African Americans with chronic diseases. A convenience sample of 83 older African American adults living in subsidized housing for elders participated in the study. Data were collected in face-to-face interviews. Participants reported lower scores on HRQOL than the SF-36 norms for age 60 or older in the general U.S. population. Comorbid conditions, symptom distress, depression, and functional status significantly predicted both the physical (F = 38.92, p < .001) and mental (F = 23.21, p < .001) health components of HRQOL, accounting for 63% of variance in the SF-36 physical health score and 55% of the variance in the SF-36 mental health score. The findings suggested that developing interventions to assist older African Americans to better manage their symptoms and depression are of prime importance for improving HRQOL.     

An examination of social support influences on participation for older adults with chronic health conditions

Abstract

Social support can improve participation in everyday activities among older adults with chronic health conditions, but the specific types of support that are needed are unclear. Purpose: This study examined the types of social support that most strongly predict participation in everyday activities. Method: Two hundred and twenty-seven participants completed a self-administered cross-sectional survey. The sample included adults aged 60 years or more with arthritis, diabetes, chronic obstructive pulmonary disease and/or heart disease. Participation was defined as satisfaction with participation in 11 life areas. Social support was defined as availability of tangible, affectionate, emotional/informational and positive social interaction support. Results: Multiple regression analyses showed that participants who perceived greater tangible support and positive social interaction support had higher satisfaction with participation than participants with lower levels of these types of support. Conclusions: Targeting and developing tangible and social interaction support may help to facilitate satisfaction with participation for older adults with chronic conditions. Creating networks for companionship appears equally as important as providing support for daily living needs.

• Implications for Rehabilitation

• Varying types of social support can improve participation in older adults with chronic health conditions.

• Tangible support and positive social interaction support are the strongest predictors of participation.

• Creating networks for companionship may be equally as important as providing support for daily living needs.

     

Living Arrangements,Social Networks,Health, Mobility,and Balance of Older Women

ABSTRACT

Background: The aim of this study is to add to the literature research-based documentation by comparing a variety of characteristics of older women of 75 years or more in Oslo who live alone with women who live with a partner regarding demographic factors, their social networks, health, and mobility. Methods: In a cross-sectional study, a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) and living at home were interviewed and tested regarding demographic factors, their social networks, health, mobility, and balance. Results: The mean age of the women was 80.8 years, and 76.5% of them were living alone. Fewer years of education, less frequent outdoor walking, difficulty in keeping their balance while walking, more frequently feeling their hearts pounding and suffering from shortness of breath, feeling lonely, and having a low score on the Timed Up and Go (TUG) test are factors independently associated with living alone. The strongest independent relationship existed between feelings of loneliness and living alone. Conclusion: Women living alone reported more frequently feeling lonely, have less years of education, were frailer, and had worse mobility problems than women living with a partner.     

Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey

Objectives: There is limited information on effective balance training techniques including virtual reality (VR)-based balance exercises in residential settings and no studies have been designed to compare the effects of VR-based balance exercises with conventional balance exercises in older adults living in nursing homes in Turkey. The objective of our study was to investigate the effects of VR-based balance exercises on balance and fall risk in comparison to conventional balance exercises in older adults living in nursing homes. Methods: A total sample of 18 subjects (65–82 years of age) with fall history who were randomly assigned to either the VR group (Group 1, n = 7) or the conventional exercise group (Group 2, n = 11) completed the exercise training. Results: In both groups, Berg balance score (BBS), timed up & go duration, and left leg stance and tandem stance duration with eyes closed significantly improved with time (p < 0.05), but changes were similar in both groups (p > 0.05) after training, indicating that neither the exercise method was superior. Conclusion: Similar improvements were found in balance and fall risk with VR-based balance training and conventional balance training in older adults living in the nursing home. Both exercise trainings can be preferable by health care professionals considering fall prevention. Appropriate patient selection is essential.     

Quality of life of patients with Duchenne muscular dystrophy: from adolescence to young men

Purpose: This study investigated quality of life (QOL) in adolescent and young men with Duchenne muscular dystrophy (DMD).

Methods: Health-related QOL and global QOL were assessed with the Short Form 36 (SF-36) and World Health Organization Quality of Life-BREF (WHOQOL-BREF). Associations between functional status and QOL were assessed.

Results: All domains of the SF-36 were below Taiwan norms (effect size: ?14.2 to ?0.5), especially Physical Function, Role Physical, and Social Function. Three of the four domains of the WHOQOL-BREF were below Taiwan norms (effect size: ?2.0 to ?0.7). The Physical Function of the SF-36 was moderately correlated with functional status (mobility, basic activities of daily living, and arm function). The Social Function of the SF-36 and Social Relationships of the WHOQOL-BREF were also moderately correlated with functional status (impairment, basic activities of daily living, and arm function).

Conclusion: The adolescent and young men with DMD had poor health-related and global QOL. Poor QOL was related to both physical condition and social health. We suggest that rehabilitation programs focus on using assistive devices to facilitate arm function and encouraging participation in social activities to improve the QOL of patients with DMD.

• Implications for rehabilitation

• Duchenne muscular dystrophy (DMD) is a progressive muscle weakness disease that not only impacts physical health but also leads to poor quality of life in many domains.

• A valuable rehabilitation goal for patients with DMD is to encourage participation in social activities. Medical care and educational programs should plan a formal transition processes for patients with DMD from pediatric to adult care to maximum their quality of life.

• Arm function is associated with many domains of global quality of life, so a key element in improving quality of life may be to improve arm function.

     

Learning from the lived experience of functionally healthy older adults: What does it mean to be “healthy”?

BackgroundReports of older adults’ perceptions of ageing and health generally do not consider individual health status, instead presenting large cohort data or focussing on specific population groups. Moreover, qualitative studies have largely included participants with suboptimal health.AimThis study aimed to examine functionally healthy older adults’ perceptions of health and healthy ageing.MethodTwenty-two functionally healthy older adults living independently in the community (aged 61–83 years; 68% female) participated in six focus groups to explore their perceptions about “health” and “healthy ageing”. Quantitative measures were used to describe participants’ health status.FindingsSeven themes describing participants’ experiences of healthy ageing were identified: “know thyself”, “knowledge and information management”, “choices, agency, and control”, “autonomy and flexibility”, “being strategic”, “community connections”, and “getting more out of life”. Key competencies for healthy ageing were subsequently derived, drawing connections between beliefs, behaviours, and knowledge about healthy ageing.DiscussionThe identified health behaviours perceived to be important for healthy ageing align with previous reports. The subsequent overarching healthy-ageing competencies (“recognise opportunity”, “strategise”, “maximise benefits”, and “active participation”) present important pillars underpinning the process of healthy ageing that have not been previously considered in this context.ConclusionThe behaviours perceived to influence older adults’ health are varied, and the competencies identified in this study present a broad framework underpinning these behaviours. The identified competencies have the potential to inform public health initiatives, practice, and policy, empowering individuals to optimise their health.     

Health situation and perceived health status among women experiencing homelessness: A longitudinal study in Spain

The paper analyses the health situation and the perceived health status of a sample of women experiencing homelessness (n = 138) in Madrid, Spain. All participants were adults, and the night before the baseline interview, they had slept on the street, at a shelter or any facility provided to care for people living homeless. The information was collected using structured interviews, repeated twice a year for a 3-year follow-up period. The findings of this study show that women experiencing homelessness presented poor health, particularly in comparison with the general Spanish population. Over half of the women questioned claimed to have a diagnosed serious or chronic illness, with a correlation between these conditions and the age, time spent homeless or high levels of drug use. There was a positive correlation found between women's perceived health status and being younger and having access to independent accommodation, while having suffered a number of stressful life events and having spent long periods of time living homeless presented a negative correlation with a good perceived health status.     

Self-care ability among home-dwelling older people in rural areas in southern Norway

Scand J Caring Sci; 2012; 26; 113–122
Self‐care ability among home‐dwelling older people in rural areas in southern Norway Introduction: The growing number of older people is assumed to represent many challenges in the future. Self‐care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self‐care ability is closely related to perceived health, sense of coherence and nutritional risk. Aim: The aim of this study was to describe self‐care ability among home‐dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. Methods: A cross‐sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health‐related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. Results: A total of 780 persons were found to have higher self‐care ability and 240 to have lower self‐care ability using the Self‐care Ability Scale for the Elderly. Self‐care ability was found to be closely related to health‐related issues, self‐care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self‐care ability were to have higher self‐care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. Conclusions: When self‐care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.     

Use,non-use and perceived unmet needs of assistive technology among Swedish people in the third age

Purpose: To describe the most prominent use of or perceived unmet need of assistive technology (AT) and to compare the characteristics of users, non-users and those expressing perceived unmet need with respect to overall health, independence in everyday life, environmental barriers and socio-demographic features. Method: The study is based on data collected in the “Home and Health in the Third Age Project”. In all, 371 individuals participated and data were collected during home visits in southern Sweden by interviewers trained specifically for this project. The data collection comprised well-proven self-report scales and observational formats on the home environment and health indicators as well as questions about basic demographics and socio-structural data. Results: The proportion of users constituted almost half of the total sample. The most common types of AT used were for furnishing/adaptation (35%) and the highest perceived unmet need concerned AT for communication, in total 8%. Those cohabiting were to a higher extent users of AT for furnishing/adaptation, compared to those who lived alone. A higher perceived unmet need was seen among those who lived alone compared with cohabiting people. Conclusions: These findings are of importance for future planning and development of policy to improve health services for the new generation of elderly.

• Implications for Rehabilitation

• In order to support the ageing process, the need for assistive technology has to be monitored in the third age.

• Assistive technology for furnishings and adaptation are frequently used by individuals in their third age and are important to support ageing in the home.

• Not only do health aspects impact the use of assistive technology, but gender, living conditions and social situation also matter – older men especially need to be monitored thoroughly according to their perceived unmet needs as well as do older persons living alone.

     

Reablement in a community setting

Abstract

Purpose: When older adults experience a decrease in functional independence including decreased ability to perform activities of daily living (ADL) tasks, rehabilitation services are required. The aim of this pilot study was to evaluate if a home-based reablement program influenced the ADL ability of older adults. Methods: Ninety-one older adults (80?±?9 years) were allocated to a 12-weeks home-based reablement program consisting of ADL task performance training by a home carer supervised by an occupational therapist. ADL ability was measured at baseline, at 12 weeks and at follow-up (range: 310–592?d) using the ADL-Interview (ADL-I). Results: Overall, ADL ability improved significantly over time (p?=?0.041). Post-hoc t-tests indicated that the improvements occurred between baseline and end of intervention (p?=?0.042) and were maintained at follow-up 10 months after intervention (p?=?0.674). There were no effects related to age (p?=?0.787) or to whether the older adult had received help previously (p?=?0.120). Conclusion: A 12-weeks home-based reablement program was found to improve ADL ability among older adults regardless of whether they previously received help. This implies that receiving home care services should not be considered a barrier to participation in a reablement program.

• Implications for Rehabilitation

• Older adults, motivated for obtaining independence within performance of ADL tasks, will potentially benefit from participation in the reablement program.

• Older adults, already receiving home care services, will also have the potential to benefit from participation in the reablement program.

     

Perceived health status as measured by the SF-36 in patients with multiple sclerosis: a review

This review of literature gives an overview of recent studies about perceived health status as measured by the Short-Form-36 (SF-36) Health Survey in patients with multiple sclerosis (MS). The SF-36 is one of the tools measuring health status in patients used in international research and clinical practice. It measures two main health concepts – physical and mental. The SF-36 represents a valid instrument able to detect differences in perceived health status in patients. A computer-aided search in Medline and PsycINFO resulted in 504 articles in English published from 1996 to August 2006. After the screening process on the basis of abstracts, eight articles consisting of empirical studies remained in which perceived health status was evaluated using the SF-36 Health Survey. Seven studies focused on disability and perceived health status in the SF-36. Two studies focused on the relationship between depression and perceived health status. These studies showed that MS patients with low disability and minor depression scored significantly better than patients with high disability and major depression in the SF-36 health dimensions. Gender seems to have no influence on perceived health status in MS patients. The longer the disease duration and the more severe the disease, the lower the patients scored in perceived health status. The more disabled, the more depressive and the older the patients, the poorer their perceived health status was. Health providers supporting appropriate treatment might pay more attention to more disabled and more depressive patients, with longer disease duration. Perceived health status can be a predictor of prognosis and intervention outcomes. The study shows the importance of measuring perceived health status in MS patients with implications for their quality of life and provision of care.     

Factors influencing the adaptation to skilled nursing facilities among older Korean adults

This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong‐gi‐do, South Korea. The measures were a demographic form, Health Self‐Rating Scale, Activities of Daily Living Scale, Self‐Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R² was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (β = ?0.564), followed by self‐efficacy (β = 0.321), quality of the facility (β = 0.164), depression (β = 0.133), decision to enter a skilled nursing facility (β = 0.122), perceived health status (β = 0.064) and age (β = ?0.010). This cross‐sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self‐efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility.     

A comparison of the factors influencing life satisfaction between Korean older people living with family and living alone

SHIN S.H. & SOK S.R. (2012) A comparison of the factors influencing life satisfaction between Korean older people living with family and living alone. International Nursing Review 59 , 252–258 Background: As the global population of older people continuously increases, many countries are beginning to experience health problems associated with older age. These countries may be interested in knowing and understanding the health problems experienced by the older Korean population, which is projected to age the most rapidly. Aim: This study aimed to compare and examine the factors that influence the life satisfaction between older people living with their family and those living alone. Methods: A cross‐sectional survey was conducted. The participants comprised a total 300 older Koreans (150 living with their family, 150 living alone) aged 65 years or over who met the eligibility criteria. All measures were self‐administered. Data were analysed using the SAS statistical software program version 6.12 (SAS Institute Inc., Cary, NC). Results: The older people living with their family were better than the older people living alone in perceived health status, self‐esteem, depression and life satisfaction. Perceived health status, self‐esteem, depression, age and monthly allowance were found to be the factors related to the life satisfaction of older people living with their family and those living alone. The factors that were found to have the greatest influence on the life satisfaction of older people living with their family and those living alone were depression and perceived health, respectively. Conclusions: This study may help healthcare providers to understand the factors that can influence the life satisfaction among older people living with their family and living alone in Korea.     

Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial

BACKGROUND AND PURPOSE: Tai chi, a Chinese exercise derived from martial arts, while gaining popularity as an intervention for reducing falls in older adults, also may improve health status. The purpose of this study was to determine whether intense tai chi (TC) exercise could improve perceived health status and self-rated health (SRH) more than wellness education (WE) for older adults who are transitionally frail. SUBJECTS: Study subjects were 269 women who were >or=70 years of age and who were recruited from 20 congregate independent senior living facilities. METHODS: Participants took part in a 48-week, single-blind, randomized controlled trial. They were randomly assigned to receive either TC or WE interventions. Participants were interviewed before randomization and at 1 year regarding their perceived health status and SRH. Perceived health status was measured with the Sickness Impact Profile (SIP). RESULTS: Compared with WE participants, TC participants reported significant improvements in the physical dimension and ambulation categories and borderline significant improvements in the body care and movement category of the SIP. Self-rated health did not change for either group. DISCUSSION AND CONCLUSION: These findings suggest that older women who are transitionally frail and participate in intensive TC exercise demonstrate perceived health status benefits, most notably in ambulation.     

Construct Validation of the Health Enhancement Lifestyle Profile (HELP) with Quality of Life among Community-Dwelling Older Adults

ABSTRACT

Objective: This study aimed to provide evidence of construct validity of the health enhancement lifestyle profile (HELP) by exploring its relationship with health-related quality of life. Method: Both the HELP and RAND-36 health survey were administered with a sample of 158 community-dwelling older adults. Pearson r and multiple regression were performed to analyze the correlations between different scales of the two instruments. Results: Bivariate correlations between the HELP scale scores and the overall RAND-36 ranged from low to high (r is from 0.39 to 0.69). Multiple regression revealed that five of seven HELP scales served as significant predictors for the RAND-36 (R² = 0.69, p < 0.0001). The patterns of the multiple correlations persisted even after the inclusion of two potential contributing factors, age and chronic conditions. Conclusion: The construct validity of the HELP was supported. The HELP holds promise as a comprehensive measure for monitoring health promotion and risk behaviors and determining the outcome of lifestyle interventions conducive to quality of life in older adults.     

Hardiness, self-care practices and perceived health status in older adults

The purpose of this study was to examine the relationship among hardiness, self-care practices and perceived health status in older adults A random sample of older adults ( n = 72) was selected from the population of a small north-eastern town in the United States Self-report data were obtained on the Health-Related Hardiness Scale as a measure of hardness, the Personal Lifestyle Questionnaire as a measure of self-care practices and the Visual Analogue Scale as a measure of perceived health status It was hypothesized that older adults who had higher levels of hardness and self-care practices would have a higher perceived health status and that hardness and self-care practices combined would explain more of the variance in perceived health status than either variable taken individually Statistical analyses supported the three hypotheses The obtained significant correlation between hardness and perceived health status was –068( P <0 001) (hardiness negatively scored) For self-care practices and perceived health status, the correlation was 0 46 ( P < 0 001) The illness index, income and living circumstance accounted for 46% of the variance in perceived health status scores Hardness and self-care practices accounted for an additional 10% of the variance in perceived health status once these demographic and illness variables were controlled Implications for nursing practice, education and research are discussed Recommendations included replication of the study with a larger, more heterogeneous population Suggestions for further investigation of the relationship between resistance resources such as hardness and self-care practices and health status are presented