Caring for disabled older adults with musculoskeletal conditions: A transactional model of caregiver burden,coping strategies,and depressive symptoms

ObjectivesThis study investigated the mediating role of coping strategies in the relationship between caregiver burden and depressive symptoms among family caregivers caring for disabled older adults with musculoskeletal (MSK) conditions.MethodsThe cross-sectional data were from a quota sampling of 494 pairs of disabled older adults and their primary family caregivers in Shanghai, China. The disabled older adults had MSK conditions and limitations in activities of daily living. The mean ages of the older adults and their caregivers were 83.9 and 62.6 years. Path analysis was conducted to test the proposed hypotheses.ResultsCaregivers of adults with MSK conditions were more likely to use active coping to handle time dependence (β [SD] = 0.182 [0.055]) and physical burden (β [SD] = 0.226 [0.071]) and to use avoidant coping to handle developmental burden (β [SD] = 0.414 [0.061]). Both coping strategies were used to handle social burden(active: β [SD] = 0.179 [0.078]; avoidant: β [SD] = 0.241 [0.073]). Experiencing emotional burden reduced the likelihood of using both coping strategies (active: β [SD] = −0.266 [0.066]; avoidant: β [SD] = −0.373 [0.062]). Active coping had a protective impact on depressive symptoms (β [SD] = −0.228 [0.050]), whereas avoidant coping had an adverse impact on depressive symptoms (β [SD] = 0.232 [0.053]).ConclusionsThe findings confirm the mediating effects of coping strategies in the relationship between caregiver burden and depressive symptoms.     

Developing and testing a model of quality of life among chronically-ill,community-dwelling older adults: A structural equation model

PurposeAlthough healthy ageing aims for better quality of life, the inability of older adults to adequately care for themselves and their health impair the realization of such objective. Moreover, in a collectivist community like the Philippines, the family, community, and Transcendent are inseparable in promoting quality of life. This study developed and tested a model of quality of life (QoL) among chronically-ill, community-dwelling older adults.Materials and MethodsFrom August to November 2017, a cross-sectional study of 304 chronically-ill, community-dwelling older adults from selected rural communities in the Philippines was conducted. Respondents completed a five-part survey packet composed of the socio-demographic profile, modified Older People’s Quality of Life, Spirituality Assessment Scale, Hypertension Self-Care Profile, and Diabetes Self-Management Questionnaire.ResultsSocio-demographics, community satisfaction, spirituality, and disease self-management accounted 29.00% of QoL, generating a good model (χ²/df = 1.44, RMSEA = 0.038, and PNFI = 0.64). Spirituality (β = 0.34, p < 0.01) was the strongest predictor of QoL, while community satisfaction had both direct (β = 0.26, p < 0.01) and indirect (β = 0.08, p < 0.01) effects. Disease self-management directly (β = 0.15, p = 0.016) influenced QoL. In contrast, longer chronicity and larger family size impair QoL.ConclusionQuality of life among chronically-ill, community-dwelling older adults is a multi-faceted health construct influenced by socio-demographics, disease self-management, community satisfaction, and spirituality. The presented model highlights the positive effect of disease self-management, community satisfaction, and spirituality which can be utilized in developing appropriate community-based geriatric strategies, policies, and programs. Further, forming collaborative groups with socially-active community elderly and community-based self-care programs can be ventured to address the needs of older adults.     

Dispositional hope and life satisfaction among older adults attending lifelong learning programs

BackgroundThe aim of this study is to explore the indirect effects of dispositional hope in the life satisfaction of older adults attending a lifelong learning program at the University of Valencia, Spain. We examine the mediating impact of dispositional hope regarding its ability to impact life satisfaction while considering affective and confidant social support, perceived health and leisure activities, consciousness and spirituality as predictors.MethodsAnalysis were based on survey data (response rate 77.4%) provided by 737 adults 55 years old or more (Mean age = 65.41, SD = 6.60; 69% woman). A structural model with latent variables was specified and estimated in Mplus.ResultsThe results show the ability of just a few variables to sum up a reasonable model to apply to successful aging population. All these variables are correlated and significantly predict hope with the exception of health. The model additionally includes significant positive indirect effects from spirituality, affective support and consciousness on satisfaction. The model has a good fit in terms of both the measurement and structural model. Regarding predictive power, these comprehensive four main areas of successful aging account for 42% of hope and finally for one third of the life satisfaction variance.ConclusionsResults support the mediating role of dispositional hope on the life satisfaction among older adults attending lifelong learning programs. These findings also support the MacArthur model of successful aging adapted to older adults with high levels of functional, social and cognitive ability. Dispositional hope, perceived health, and social support were the strongest predictors of satisfaction with life.     

Depression,functional disability and quality of life among Nigerian older adults: Prevalences and relationships

BackgroundAgeing is associated with increased morbidity, depression and decline in function. These may consequently impair the quality of life (QoL) of older adults.PurposeThis study was used to investigate the prevalence of functional disability, depression, and level of quality of life of older adults residing in Uyo metropolis and its environs, Nigeria.MethodThis cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of 69.8 ± 6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation coefficient, at 0.05 alpha level.Results45.5% of participants had depression, and at least 30% had functional disability in at least one domain, but their quality of life was fairly good (>60.0%) across all domains. Significant correlation existed between depression scores and individual quality of life and functional disability domains and between overall QoL and each functional disability domain (p < 0.001).ConclusionsDepression and functional disability were quite prevalent among sampled older adults but their QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at depression and functional status may invariably enhance the quality of life of the older adults.     

Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility,accomplishment of social activities and frequency of leisure activities in older adults having disabilities

BackgroundSocial participation, a determinant of health in older adults, requires innovative interventions. The personalised citizen assistance for social participation (APIC) involves weekly three-hour personalised stimulation sessions targeting significant social and leisure activities difficult to accomplish. Recently adapted for older adults, the APIC’s impact on this population is unknown.ObjectiveThis study explored the impact of APIC on older adults with disabilities.MethodsA mixed-method design including a pre-experimental component was used with 16 participants (11 women) aged 66–91 (79.4 ± 8.7) with disabilities, living at home. They completed functional autonomy, social participation, leisure and quality of life questionnaires, and semi-structured interviews.ResultsAPIC increased older adults’ functional autonomy (p = 0.02), accomplishment (p < 0.01) and satisfaction (p = 0.02) with social participation, and frequency of leisure practice (p < 0.01). Post-intervention, participants wished to modify the practice (p < 0.01) and frequency (p < 0.01) of leisure activities, and difficulties in their social environment diminished (p = 0.03). Their attitude toward leisure (p = 0.04) as well as their health (p < 0.01) and psychological (p = 0.03) quality of life improved. Older adults thought APIC helped them resume, maintain, explore and experiment with significant social activities. It also increased their psychological and physical well-being, feeling of control, connectedness, self-esteem and motivation to accomplish activities. Finally, APIC can compensate for an unavailable and crumbling social network.ConclusionAPIC is a promising intervention that leads to new opportunities for older adults to increase community integration and enhance the social component of their lives. It can also optimise how the needs of older adults are met, including utilisation of personal and environmental resources.     

Self-perception of uselessness and mortality among older adults in China

BackgroundNegative self-perceptions of aging among older adults have been associated with higher mortality in developed countries. However, it is unclear whether an association exists in developing countries where living to older age is more selective.Design and methodsUsing five waves of data (2000, 2002, 2005, 2008, and 2011) from a national survey of adults aged 65 and older in China (n = 30,948), this study investigates how self-perceived feelings of uselessness are associated with subsequent mortality. Analyses were stratified by sex and age group (65–79, 80–89, 90–99, and 100+), and adjusted for a wide range of covariates.ResultsCompared with women who never reported perceived uselessness, results from adjusted models shows that women who always reported perceived uselessness had 42% (p < 0.001), 31% (p < 0.001), and 24% (p < 0.001) higher risks of mortality in each of the three oldest age groups, respectively. These associations were only slightly attenuated when covariates were adjusted, but non-significant once baseline health was further controlled for. For men, compared with those who never reported perceived uselessness, the adjusted models for those who always reported perceived uselessness had 62% (p < 0.001), 62% (p < 0.001), 69% (p < 0.001), and 25% (p < 0.1) higher risks of mortality in each of the four sequential age groups, respectively. The association was only slightly diminished—and many remained statistically significant—with further adjustments for psychological disposition and baseline health.ConclusionsSelf-perceived uselessness is associated with higher mortality risks in older adults in China. The association is stronger in men than in women and persists at very old ages.     

Relating wrist accelerometry measures to disability in older adults

ObjectiveThis analysis assessed the extent to which: (1) wrist accelerometer measures were associated with difficulty performing specific activities of daily living and instrumental activities of daily living and (2) these measures contributed important information about disability beyond a typical self-reported vigorous activity frequency question.MethodsWe used data from the National Social Life, Health and Aging Project (NSHAP) accelerometry sub-study (n = 738). Activity was assessed using two wrist-accelerometer measures assessed over 3 days (routine activity expressed as mean count/15 s epoch during wake time, and immobile time expressed as the proportion of wake time spent immobile), and self-reported average vigorous activity frequency. The association between routine activity, immobile time and difficulty performing fourteen activities of daily living (ADLs) and instrumental activities of daily living (IADLs) plus two summary measures (any ADL or IADL difficulty), was assessed using logistic regression models, with and without controlling for self-reported vigorous activity.ResultsSelf-reported activity was mildly correlated with routine activity (r = 0.27) and immobile time (r = −0.21). Routine activity, immobile time, and self-reported vigorous activity were significantly associated with twelve, ten, and fourteen disability measures, respectively. After controlling for self-reported activity, significant associations remained between routine activity and eight disabilities, and immobile time and six disabilities.ConclusionWrist accelerometry measures were associated with many ADL and IADL disabilities among older adults. Wrist acclerometry in older adults may be useful to help assess disability risks and set individualized physical activity targets.     

Serum high-density lipoprotein cholesterol concentration and functional state: The Korean Urban Rural Elderly (KURE) Study

BackgroundFunctional state and cholesterol metabolism are important for older adults; however, this association has not been fully investigated among community-dwelling older adults. Thus, we investigated the association of HDL cholesterol with multiple functional state measures in an elderly Korean population.MethodsThis cross-sectional analysis included 3514 participants, aged 65 years or older, who participated in baseline health assessment for the Korean Urban Rural Elderly cohort study from 2012 to 2015. HDL cholesterol concentration was analyzed using both continuous and categorical variables. Functional state was assessed by the mini-mental state examination (MMSE), activities of daily living (ADL) scale, instrumental activities of daily living (IADL) scale, timed up-and go (TUG) test, and chair-rise test (CRT). Multiple logistic regression models were used to investigate independent association between HDL cholesterol and functional state, after adjusting for sex, age, body mass index, systolic blood pressure, fasting glucose, lipid-lowering drug, history of cancer and cardiovascular disease, and health behaviors.ResultsHDL cholesterol concentration was significantly associated with MMSE, ADL, IADL, TUG, and CRT in the unadjusted model. After adjustment for covariates, the association remained significant for MMSE (standardized β = 0.059, p = 0.001), ADL (standardized β = −0.053, p = 0.004), and CRT (standardized β = −0.037, p = 0.037). In fully-adjusted model, Participants who had a lower HDL concentration (<40 mg/dL) showed significantly increased odds for having MMSE decline (OR 1.451, 95% CI 1.119–1.883) and ADL dependency (OR 2.251, 95% CI 1.119–4.526), compared reference group (≥60 mg/dL).ConclusionsHigher HDL cholesterol concentration was associated with better functional state among Korean older adults.     

Challenging the motor control of walking: Gait variability during slower and faster pace walking conditions in younger and older adults

BackgroundGait variability is a measure of motor control of gait. Little is known about age-related changes in the motor control of gait (gait variability) during challenging walking conditions, such as slower and faster pace walking.ObjectiveThe purpose of this study was to examine the impact of challenging walking conditions (slower and faster speeds) on gait variability in younger and older adults.DesignThis study was a cross-sectional, observational design.MethodsForty younger (mean age = 26.6 ± 6.0 years) and 111 community-dwelling older adults (mean age = 77.3 ± 6.0 years), independent in ambulation, were studied. Gait characteristics were collected using a computerized walkway (GaitMat II™). Step length, step width, step time, swing time, stance time and double support time variability were derived as the standard deviation of all steps across the 4 passes.ResultsCompared to younger, older adults had a significant change in their gait variability from usual to slower in step width (-0.006 ± 0.003), step time (0.028 ± 0.006), swing time (0.023 ± 0.004), stance time (0.042 ± 0.008), and double support time (0.024 ± 0.005). Changes in gait variability from usual to faster were not significantly different between younger and older adults.LimitationGait variability was examined during self-selected over-ground walking, where subjects directed to walk “slower”, “usual” and “faster”.ConclusionsWalking slowly is more challenging to the motor control of gait and may be more sensitive to age-related declines in gait than usual and faster speed walks.     

Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease

IntroductionDifferent studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL.Patients and methodsSubjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test.ResultsIn all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p = 0.005), mood disorder (p = 0.004), anxiety disorder (p = 0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p = 0.01). Major depressive disorder (p = 0.004), social phobia (p = 0.03), PTSD (p = 0.02), and Generalized Anxiety Disorder (p < 0.001), were found to be significantly associated with lower QoL.ConclusionsIBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.     

Predictors of functional disability with focus on activities of daily living: A community based follow-up study in older adults in India

BackgroundDisability in activities of daily living is a growing concern among older populations all over the world. India has one of the rapidly ageing populations and predicted burden of functional disability is higher for Indian older adults as compared to other ageing Asian countries.MethodsTotal 1140 aged 60 years and over participated in a baseline study. 560 of them participated in the prospective cohort study conducted in the city of Pune, India. An interview and functional assessment using a questionnaire and Pune-FAAT tool was carried out in 2013–14. Binary logistic regression was used to obtain the factors that increased the odds of having ADL disability at follow-up.ResultsThe mean age of the study population was 69.73 ± 5.48 years. Squatting, walking and climbing functions were affected significantly. Total 376 participants (67.1%) reported difficulties and/or disability in performing activities of daily living (ADL) at follow-up. Hospitalization (OR = 3.6; 95% CI: 1.9–6.7), being female (OR = 2.3; 95% CI: 1.5–3.5), presence of two or more chronic diseases (OR = 1.7; 95% CI: 1.1–2.7), experience of memory loss (OR = 1.9; 95% CI: 1.2–3.0) and feeling of loneliness (OR = 2.3; 95% CI: 1.0–5.3) increased the odds of being in the “With disability” group at follow-up. Apart from this, self-rated health and self-reported depression were associated with limitations in ADL.ConclusionHospitalization and being female appeared to be the most significant risk factors for disability in urban older adults in India. Rehabilitation services after hospitalization, physical exercise, effective control on chronic illness, and social participation to reduce loneliness is recommended.     

Diabetes,peripheral neuropathy,and lower-extremity function

ObjectiveDiabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes–physical function relationship.Research Design and MethodsThis study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations.Results and ConclusionOne hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β = − 0.99; p < 0.01), decreased walking speed (β = − 0.1 m/s; p < 0.01), decreased nerve conduction velocity (β = − 1.7 m/s; p < 0.01), and increased neuropathy (β = 0.25; p < 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF.     

The use of step aerobics and the stability ball to improve balance and quality of life in community-dwelling older adults – a randomized exploratory study

ObjectiveTo explore the use of step aerobics (SA) and the stability ball (SB) as tools for balance improvement in community-dwelling older adults.MethodForty-two women (age: 72.2 ± 5.8 years) who attended a community day center volunteered to participate in the study. Following the first assessment session, 28 women were assigned randomly to one of two experimental groups (the use of either SA or SB). The other 14 participants, who were engaged in a ceramic class, served as the control group. The study design was based on four assessment sessions and eight weeks of intervention. Assessment included four balance tests: Timed Up and Go (TUG), One-Leg Stand, Functional Reach, and the Performance-Oriented Assessment of Mobility (POMA). Quality of life was assessed by the use of the Short Form-36 Health Survey questionnaire.ResultsThe TUG and POMA intervention improved significantly (d = .83 and d = .95, respectively) following the SA. In addition, general health perception following both the SA and SB interventions improved significantly relative to the control condition (d = .62 and d = .22, respectively).DiscussionThe findings of this study may imply that trainers should consider the inclusion of SA and SB as components of physical activity programs for seniors, aimed at improving balance ability and quality of life.     

Dual-task training in older adults: The effect of additional motor tasks on mobility performance

ObjectivesDual-task (DT) performance is common to most activities of daily living and difficulties in DT activities may reduce quality of life in older adults. This study investigated the effect of DT training in a sample of older adults.MethodsSixty older adults (mean = 74.4 ± 3.1 years) participated in the study. Twenty-two older adults were included in the control (CG), 19 in the single-task (ST) training and 19 in DT training group. ST group received balance and walking training twice a week for16 weeks, while DT training group performed the same training with additional motor tasks. Data were gathered on 6 m timed walk (6MTW), timed up and go test (TUG) and four square step test (FSST). DT conditions required participants to complete 6MTW, TUG and FSST, either (i) while carrying a glass of water or (ii) while carrying a ball on a round tray.ResultsA significant Group x Time interaction was found in TUG (F [2,57] = 29.5; p < 0.01; partial η² = 0.51) and in FSST (F [2,57] = 23.2; p < 0.01; partial η² = 0.44). After intervention DT showed better scores in overall TUG (mean difference = 1.21 s [95% CI, 0.82–1.60]; p < 0.05) and FSST (mean difference = 2.51 s [95% CI, 1.67–3.35]; p < 0.01), whereas CG and ST did not exhibit significant changes.ConclusionOur results suggested that 16 weeks of motor DT training, using motor additional tasks as manipulation of common objects of everyday life, could improve mobility in older age.     

Brain-derived neurotrophic factor plasma levels are increased in older women after an acute episode of low back pain

BackgroundLow back pain (LBP) is a growing public health problem in old age, and it is associated with disabling pain and depressive disorders. We compared brain-derived neurotrophic factor (BDNF) plasma levels, a key neurotrophin in pain modulation, between older women after an acute episode of LBP and age-matched pain-free controls, and investigated potential differences in BDNF levels between controls and LBP subgroups based on pain severity, presence of depressive symptoms and use of analgesic and antidepressant drugs.MethodsA total of 221 participants (154 with LBP and 67 pain-free) were studied. A comprehensive assessment of sociodemographic and clinical variables was conducted including pain severity (11-point NRS), depressive symptoms (GDS-15), age, body mass index, physical activity and total number of comorbidities and medications in use.ResultsBDNF levels in LBP group were significantly higher than controls (7515.9 ± 3021.2; Md = 7116.0 vs 6331.8 ± 3364.0; Md = 5897.5 pg/mL, P = 0.005). LBP subgroups exhibited higher BDNF levels than controls, regardless of pain severity, presence of depressive symptoms and use of analgesic drugs. BDNF levels were significantly higher in LBP subgroup without use of antidepressant drugs compared to both controls and LBP subgroup with use of antidepressant drugs.DiscussionThis study provides evidence that older women with acute low back pain exhibit higher BDNF plasma levels compared to pain-free controls. Subgroup comparisons suggest that use of pain-relief drugs may influence BDNF levels. The study results offer a novel target for research on mechanisms of back pain in older adults.     

Neurocognitive and quality of life study in perinatally HIV-infected young people and their peers. NeuroCoRISpeS study

BackgroundAssessing the role of HIV and non-HIV related factors is essential for a better understanding of the neurocognitive outcomes in perinatally HIV-infected (PHIV+) young people. The aim of our study was to assess cognition and quality of life (QoL) of a PHIV+ cohort of young people and to compare it with a control group.MethodsThirty PHIV+ and 30 HIV(−) healthy young adults matched by age, sex and socioeconomic status completed a protocol that included neurocognitive tests, a psychosocial semi-structured interview and a QoL questionnaire (PedsQL). Neurocognitive domain-specific and domain-general (NPZ-5) Z-scores were calculated. CDC AIDS-defining category C or not C (PHIV+/C, PHIV+/noC) was considered to evaluate differences within the PHIV+ group. Univariate and multivariate analysis were performed.ResultsSixty patients were included; 67% were female; median age (IQR) 19 years (18–21). Regarding PHIV+ young people, 27% showed CDC C category (none encephalopathy), 93% were on ART and 77% had undetectable viral load. No differences regarding occupation were found, although the HIV(−) group repeated less grades (p = 0.028) and had a higher education level (p = 0.021).No differences were found between PHIV+/noC and HIV(−) participants. However, the PHIV+/C group showed poorer performance than PHIV+/noC (NPZ-5, p = 0.037) and HIV(−) subjects (crystallised intelligence, p = 0.025; intelligence quotient, p = 0.016). Higher nadir CD4+ T-cell count was related to better Z-score in memory (p = 0.007) and NPZ-5 (p = 0.025). Earlier and longer exposure to ART resulted in better performance in memory (p = 0.004) and executive functions (p = 0.015), respectively.ConclusionsNo significant differences were found in the neurocognitive profile nor QoL between PHIV+/noC and HIV(−) adolescents; however, PHIV+/C participants obtained lower scores. The use of longer and earlier ART seems to have a beneficial effect.     

Illness perceptions and quality of life in families with child with atopic dermatitis

ObjectiveTo assess the Quality of Life (QoL) of children with Atopic Dermatitis (AD) and their families and the impact of the mothers’ illness perceptions on the family QoL.Materials and methodsSeventy-five children with AD (54 infants and 21 children) and their mothers participated in the study. The following questionnaires were administrated: 1. Brief Illness Perception Questionnaire (Brief IPQ); 2. Infant's Dermatitis Quality of Life Index (IDQOL); 3. Children's Dermatology Life Quality Index (CDLQI); 4. Dermatitis Family Impact Questionnaire (DFIQ) and 5. The Severity Scoring of Atopic Dermatitis (SCORAD).ResultsAtopic dermatitis had a moderate impact on the QoL of the infants (6.67 ± 5.30), children (7.86 ± 7.19) and their families (9.42 ± 7.03). The DFIQ was associated with certain dimensions of the Brief IPQ, specifically, with Illness Identity (greater symptom burden) (r = 0.615, p = 0.000), beliefs about the Consequences of the illness (r = 0.542, p = 0.000), the Concerns (r = 0.421, p = 0.000) and the Emotional Representations (r = 0.510, p = 0.000). Correlation was demonstrated between IDQOL and DFIQ (r = 0.662, p = 0.000) and between CDLQI and DFIQ (r = 0.832, p = 0.000), and a weaker correlation between SCORAD and DFIQ (r = 0.255, p = 0.035). The chronicity of the AD showed negative association with DFIQ (p < 0.001).ConclusionsThe QoL of families with a child with AD is associated with the mother's illness perceptions about AD, the children's QoL and with both the severity and the chronicity of the disease. Therefore, clinicians should pay attention not only to the clinical characteristics of the children, but also to the parents’ beliefs and emotions, to improve the family QoL.     

Prevalence,characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey

ObjectiveThe aim of this study was to investigate the prevalence, characteristics, and acute care utilization of community dwelling disabled older adults with an absence of help for activities of daily living (ADL).MethodsWe analyzed cross-sectional data from a nationally representative sample of people aged 65 years and over (n = 2904) participating in the 2009 National Health Interview Survey in Taiwan. Disability was defined as self-reporting a lot of difficulty or complete inability to carry out one or more ADL tasks. Participants with disability were asked whether they received help in the form of personal assistance or assistive devices to complete ADL tasks, with a yes response indicating the presence of help and a no response indicating the absence of help. Hospitalization and emergency department visits was assessed as a dichotomous variable (any or none), respectively.ResultsAn absence of available help for ADL disability was reported in 16.6% of disabled older adults. Disabled older adults reporting an absence of help were more likely to be female. After adjustment for other factors, compared to older adults without disability, older adults with disability not receiving help for ADL tasks were highly related to hospitalization (OR = 4.57; 95%CI = [1.51–13.82]) and emergency department visits (OR = 3.52; 95%CI = [1.15–10.76]) during the past year, respectively.ConclusionsWe found that there is high prevalence of absence of help to perform ADL tasks in older adults with disability, and that this absence of help for ADL disability is associated with a greater burden of acute care utilization than those without disability.     

Comparison effectiveness of acute coronary syndrome treatments on geriatric function

ObjectivesThe study objectives were to compare short time complications, mortality, and effectiveness of primary Percutaneous Coronary Intervention (PCI) with optimal medical therapy in older adults with acute coronary syndromes (ACS).MethodsA prospective cohort study, which patients 60 years old and over with ACS were collecting by face to face interview and assessment of the electronic document, in two educational hospitals of Tehran medical university from May 2018 to Jan. 2019. Patients were evaluated in two groups (primary PCI and medical) in terms of complications, mortality and effectiveness, 24 hours and 30 days after treatment. Initially, 312 patients were enrolled in the study that 192 were excluded for different reasons. In the final, 120 patients have met all inclusion criteria.ResultsOne hundred and twenty patients were collected with mean age 71.2 ± 8.2 years old. In both groups every 1 point increase in Instrumental Activity Daily Living (IADL), the Major Adverse Cardiac Effect (MACE) was significantly reduced up to 88% (P = 0.007). Short-term mortality was significantly higher in the optimal medical therapy group (P = 0.006). In comparison complications 24 hours between two groups, atrial fibrillation was significantly higher in the medical group which risk increased 11 times (OR = 10.93, CI 95% = 1.38–87.04, P = 0.02).ConclusionsNotwithstanding, primary PCI reduced poor outcomes, and improve quality of life, but a lesser option for older adult patients. Primary PCI in older adult patients could maintain independence in functional daily living that results in reduced mortality and MACE considerably.