Assessing quality of life in women living with HIV infection

The purpose of this study was to examine the impact of demographic, clinical and psychosocial variables on health-related quality of life in women living with human immunodeficiency virus infection. Subjects included 82 women 18 years of age or older who were currently seeking treatment at an outpatient clinic. The Medical Outcomes Study-Short Form 20 (SF-20) assessment consisted of patient self-ratings on 20 items measuring six distinct health dimensions. Additional data were collected on age, ethnicity, education, employment status, length of time since HIV diagnosis, CDC stage of disease, total CD4 count, number of symptoms, Karnofsky Performance Scores, social support and discrimination. Multiple regression analyses were performed using each of the six health dimension scores as dependent variables and a combination of ten demographic, clinical and psychosocial variables as independent variables. All of the six multiple regression equations were statistically significant, with R(2) values ranging from 0.35 to 0.44. Age, Karnofsky Performance Score and social support were statistically significantly related to several scale scores (p < 0.05). These results provide baseline data on clinical, demographic and psychosocial determinants of quality of life in a female patient population. Quality of life information can assist programme planners in developing social and medical service delivery for women in the community thus facilitating the development of treatments, programmes and interventions aimed at increasing quality of life for this population.     

Assessing health differences in an elderly population: a five-year follow-up

A sample of several hundred elderly residents of Alameda County was recontacted after 5 years to determine the effects over time of different social support and demographic variables on health status. The follow-up investigation demonstrated a strong relationship between respondents' social support resources in 1980 and their subsequent self-rated health. Indeed, social contacts in 1980, together with age and financial need, enabled us to correctly "predict" respondents' subsequent health status in close to two-thirds of the cases. As anticipated, however, the variable most strongly associated with self-rated health in the earlier cross-sectional study--illness of a mate during the preceding 6 months--disappeared as a predictor variable in the longitudinal study. This finding is in keeping with the literature on bereavement and other stressful life events which demonstrates that the health impact of such stressors is in most cases time-limited. The study findings support earlier research demonstrating the important role of social support for health maintenance and disease prevention in the elderly. They further underscore the need for intervention strategies designed to strengthen the network resources of those elders at high risk for social isolation.     

Knowledge of aging and life satisfaction among older adults

Four hundred young-, middle-, and old-old adults responded to a battery of quizzes dealing with life satisfaction and objective aging knowledge in the physical, psychological, and social domains. Analyses incorporated domains of aging knowledge, life satisfaction, age, gender, and demographic variables. Both means difference and regression analyses were computed. Significant age group, gender, and life satisfaction differences were found for the three aging knowledge domains. For successive age groups, knowledge of aging decreased, with females knowing less than males. The greater knowledge of aging, the higher the life satisfaction. The demographic variables education, financial status, health, living arrangement, and volunteerism were significant covariates for knowledge of aging. Results from this study indicate that knowledge of aging in specific domains varies among older adult age groups and is associated with life satisfaction.     

Testing a published model of health-related quality of life in heart failure

BACKGROUND: Health-related quality of life (HRQOL) in patients with heart failure is compromised and associated with increased mortality and rehospitalization. Inadequate conceptualization of variables related to HRQOL has hampered clinicians' efforts to enhance HRQOL. The purpose of this study was to test the Wilson and Cleary model (WCM) of HRQOL in patients with heart failure. METHODS AND RESULTS: Data from 293 patients with heart failure were analyzed to determine the best multivariate HRQOL model given variables derived from WCM. HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Health perception, symptom status, and age predicted the total MLHFQ (P < .0001) and the emotional scale (P < .0001), and health perception, symptom status, New York Heart Association predicted the physical scale (P < .0001). Health perception was a mediator of the effect of symptom status on HRQOL. Functional status was not a mediator of the effect of symptom status on health perception. CONCLUSION: The most influential variables associated with HRQOL were the subjective variables: health perception and symptom status. Objective variables proposed by WCM to drive the model were not significant predictors. Mediator effects hypothesized in the WCM were not fully demonstrated in this sample. Thus modification of the WCM is warranted.     

Biopsychosocial mediators and moderators of stress-health relationships in patients with recently diagnosed rheumatoid arthritis

OBJECTIVE: To investigate the mediating and moderating roles of social support, coping, and physiological variables in the relationship between life events and health status. METHODS: Psychological and biological measurements were taken in 54 patients (38 women, 16 men, mean age +/- SD 56 +/-14.4 years) with recently diagnosed rheumatoid arthritis (RA). RESULTS: Life events were correlated with psychological distress, but not with disease activity. No mediators for the relationship of life events with psychological well-being and disease activity were observed. In 40 tests, 4 moderators were found: Problem-focused coping, perceived support, diastolic blood pressure, and total number of lymphocytes were moderators of the relationship between daily hassles and health status (P < or = 0.05). CONCLUSION: Our study provides limited support for the notion that the interactions of life stress with biopsychosocial variables have an impact on health. None of these variables were found to be crucial mediators of stress-health associations in recently diagnosed patients with RA, but some provocative evidence was given that biopsychosocial variables may have a minor impact on stress-health relationships.     

A path analysis of self-care of elderly women in a rural area of southern Taiwan

For rural elderly women in Taiwan, in addition to poor economic situations and limited health resources, changing traditional roles and responsibilities and changing family structures further aggravate their conditions of health. Self-care was considered as a strategy or a form of coping to enhance the health and quality of life of these women during their aging process. To design an effective health-promotion program for elderly women, therefore, understanding their self-care model is important for health care professionals. The purpose was to use a path analysis to test a model of self-care in predicting the direct and indirect effects of selected key variables on self-care among rural elderly women. A non-experimental, cross-sectional study was designed to test the proposed hypotheses and the paths in a causal model of self-care. Of the 200 elderly women invited to participate, 192 completed all interview questions. The proposed causal model was tested with a path analysis, using the LISREL 8 program. The resultant model showed that the chi square was 3.65 with four degrees of freedom. The p-value for the resultant model was 0.46, revealing that the model fit the data and it was, therefore, retained. In addition to the chi 2 test, other fit indices also indicate the model fit the data well. In the resultant model, 56.0% of the total variance in self-care was accounted for by age, socioeconomic status, perceived health status, and social support (p < 0.001); 16.4% of the total variance in social support was accounted for by age, socioeconomic status, and marital status (p < .001); and 7.3% of the total variance in perceived health status was accounted for by social support (p < .001). The implications of nursing practice and research were discussed based on the findings.     

Individual differences in well-being in older breast cancer survivors

Older women who survive breast cancer may differ significantly in their long-term well-being. Using a risk and protective factors model, we studied predictors of well-being in 127 women age 70 and above with a history of at least 1 year's survival of breast cancer. Mean post-cancer survivorship was 5.1 years. Using life satisfaction, depression and general health perceptions as outcome variables, we assessed whether demographic variables, cancer-related variables, health status and psychosocial resources predicted variability in well-being using correlational and hierarchical regression analyses. Higher age predicted increased depression but was not associated with life satisfaction or general health perceptions. Cancer-related variables, including duration of survival, and type of cancer treatment, were not significantly associated with survivors' well-being. Poorer health status was associated with poorer well-being in all three dependent variables. After controlling for demographics, cancer-related variables, and health status, higher levels of psychosocial resources including optimism, mastery, spirituality and social support predicted better outcome in all three dependent variables. While many older women survive breast cancer without severe sequelae, there is considerable variability in their well-being after survivorship. Successful intervention with older breast cancer survivors might include greater attention not only to cancer-specific concerns, but also attention to geriatric syndromes and functional impairment, and enhancement of protective psychosocial resources.     

Differentials in mortality up to 20 years after baseline interview among older people in East London and Essex

Objective: to identify socio-psychological predictors of mortalityduring a 20-year follow-up period among people aged 65 to <85and 85+ at baseline interview. Study design and setting: elderly people living at home in EastLondon and mid-Essex, who responded to surveys of successfulsurvival in older age in the late 1980s; their mortality wastraced through the National Health Central Registry. Results: adjusted analyses show that, as expected, the hazardrate for mortality over a 20-year follow-up was reduced foryounger respondents and increased for less functionally ablerespondents. The hazard ratio for males was almost one and ahalf times that of females. The hazard rate was also reducedwith each categorical increase in life satisfaction and wasconsistently reduced for those who undertook crafts, socialvisiting and activities regularly. There was some variationby age and sex. Conclusion: the results show that social participation is associatedwith lower risks of death, particularly among people aged 65to <85, and that life satisfaction is also protective, particularlyamong females and people aged 85+, even when health status andsocio-demographic circumstances are controlled. The study thusprovides support for the hypothesised influence of social participationand subjective well-being on survival in older age.     

Race, socioeconomic status, and the subjective well-being of older Americans

Causal examination of factors influencing life satisfaction among older Americans can provide knowledge important to social policy development. Using rotated factor analysis, this study isolates two dimensions of life satisfaction, labeled happiness and morale, using data from the 1981 Harris survey on aging. Race, SES characteristics, and the two intervening variables of self-assessed health status and problems experienced are tested through path analysis on the two attributes of life satisfaction. Most of the effects of race and SES are mediated by self-assessed health status and problems experienced, and these two intervening variables are the strongest direct predictors of happiness and morale. Of particular significance are results which demonstrate that racial background has a strong influence on problems experienced, and that education is more influential than income on the life satisfaction factors tested in this study.     

Association between social support and health outcomes: a meta-analysis

The purpose of this study was to examine the relationship between social support and health outcome variables, and the effect size of social support on health outcomes. Meta-analysis was used to synthesize the primary studies identified initially from a computer search of the literature in Taiwan. Through preliminary screening related to the inclusion criteria, 165 dissertations and theses and 43 journal articles were included in this study. Finally, 182 primary studies, including 145 dissertations and theses and 37 journal articles, were retained after eliminating outliers of each outcome variable to achieve homogeneity. Based on Smith's four modes of health, 16 health outcome variables were used. Health status, physical symptoms and responses, psychologic symptoms and responses, and depression were categorized as clinical variables. Role function and behaviors and role burden were categorized as role-function variables. Physical adjustment, psychosocial adjustment, adjustment of life, coping behavior, and stress were categorized as adaptive variables. Health belief, health promotion behavior, quality of life, well-being, and self-actualization were categorized as eudemonistic variables. Other than physical adjustment, social support could significantly predict all health outcomes (p < 0.0001). The results provided information not only on the magnitude of the sample size required to achieve statistical significance between social support and each outcome variable as a measure of health in future studies, but also on strategies to guide further intervention programs and to evaluate their effectiveness.     

农村老年人生活质量构成指标关系的探讨

利用因子分析，线性回归模型的统计方法对生活质量构成指标间的关系进行分析，结果表明：构成生活质量的诸因素可概括为五个基本因子，残疾因子、社会支持因子、满意度因子、躯体健康因子和视听因子；各因素间存在着复杂的因果关系，指标间既存在直接间接作用，影响工的因素集资为经济状况，躯体健康，功能健康，而心理健康状况受躯体健康，经济状况，功能水平的作用，分析结果还证实，线性结构模型是分析多个复杂变量间相互关系的非     

The social determinants of depression in elderly Korean immigrants in Canada: does acculturation matter?

Depression in old age significantly decreases the quality of life and may lead to serious consequences, such as suicide. Existing literature indicates that elderly Korean immigrants may experience higher levels of depression than other racial ethnic group elders. The purpose of this exploratory study was to investigate factors that influence depression among older Korean immigrants in Toronto. A total of 148 participants, ages 60 years or older (mean age = 74.01, SD = 8.24), completed face-to-face interviews in Korean language. Hierarchical regression analyses were conducted by adding variables in three steps: (1) demographic variables; (2) acculturation variables (years of immigration and English proficiency); and (3) social determinants (social integration variables, physical health, and financial satisfaction). Results showed that acculturation factors were not associated with depression. Instead, social determinants variables, including lower physical health status and lower financial status, living alone, and lower level of social activity, predicted higher level of depressive symptoms, along with lower education. The final regression model explained about 37% of variance of depression in the sample. These results suggest that social determinants, not acculturation, are important factors explaining the levels of depression in Korean immigrant elders living in a metropolitan city in Canada. Implications for practice are discussed.     

The influence of life events and social support in a psycho-educational intervention for women with depression

OBJECTIVE: To investigate the influence of social support and adverse life events on depression symptoms, before and after therapy (15-30 days) and during follow-up (4 months) of a psycho-educational intervention for depression. MATERIAL AND METHODS: The study population consisted of 254 women with depression symptoms selected among those seeking treatment for their symptoms in three community mental health centers and in one Ministry of Health center, all of them in Mexico City, between January 1998 and December 2000. The intervention has been proved effective previously in reducing depression symptoms. Symptoms were assessed using Radloff's CES-D scale, while specifically designed scales were used for events and social support. Hierarchical regression analyses were carried out to test various models. RESULTS: Model I: effect of variables: life events, social support, and socio-demographic variables (age, education level, income, and work status) on CES-D pre-treatment. The model was significant (p<0.000) and the first two variables and age were included in the model. Model 2: effect of the same predictive variables on CES-D post-treatment. The model was significant (p<0.001) and included social support and life events. Model 3: effect of the same variables on CES-D during follow-up. The model was significant (p<0.000) and included life events and educational achievement. Model 4: effect of social support and life events during follow-up on CES-D during follow-up. The model was also significant (p<0.000) and both variables were included in the model. Additional analyses for models 2 and 3 adding CES-D pre-treatment as a predictor showed that only the latter was significant. CONCLUSIONS: Life events and social support are associated with initial depression symptoms and also predict the reduction of symptoms following the psycho-educational intervention. This may be due to the high correlation of life events and social support with CES-D pre-treatment. Life events and social support following the intervention also have an effect on CES-D in this same stage. The English version of this paper is available at: http://www.insp.mx/salud/index.html.     

Predicting perceived health in Angolan elderly: The moderator effect of being oldest old

The objective of this study was to test the predicting effects of variables measuring social support, dependence/active perceptions, and generativity, on this facet of well-being when controlled for socio-demographic variables (age, gender, marital status, and institutionalization). The research tries to extend previous literature by assessing them in a multivariate context, studying differential effects of these variables in young old and oldest old, and offering evidence of the scarcely studied population of Angola. The sample was formed by 737 young old and 266 oldest old. It was built a hierarchical regression, in which, among the different predictors, interactions effects between age and the psychosocial factors were included. Results provide evidence of the qualitative different perceived health and well-being of the young old and oldest old. When predicting perceived health of the Angolan oldest old, psychosocial factors lose much of its importance, and age itself and the limitations that accompanied it seem to be the key point.     

Contributions of Psychological Well-Being and Social Support to an Integrative Model of Subjective Health in Later Adulthood

This study examined the contributions of psychological well-being and social support to an integrative model of subjective health among older adults. Structural equation modeling was used to test the proposed model of subjective health which included age, education, physical health problems, functional status, psychological well-being and social support. Partial support for the model was found. Psychological well-being had both a direct effect on subjective health and an indirect effect mediated by physical health problems. Social support had an indirect association with subjective health via its effect on psychological well-being. Functional status had only a weak effect on subjective health. Longitudinal data at a six-year interval revealed the same direct and/or indirect effects of these variables on subjective health. This study sheds light on how psychological and social resources are linked with subjective health in later adulthood.     

Health status in patients awaiting hip replacement for osteoarthritis

BACKGROUND: Hip osteoarthritis is a major cause of pain and disability, especially in the elderly. As part of a study investigating factors that could be associated with advanced osteoarthritis of the hip, we compared the health status of patients awaiting arthroplasty for hip osteoarthritis with controls. We further investigated the interaction of hip osteoarthritis with other variables (age, gender, social class and concurrent pain) in relation to health status. METHODS: A case-control study was performed in two English health districts (Portsmouth and North Staffordshire) during 1993-1995. A total of 611 patients (210 men and 401 women) listed for hip replacement because of osteoarthritis over an 18-month period formed the case group and were compared with an equal number of controls selected from the general population and individually matched for age, gender and general practice. Cases and controls completed a structured interviewer-administered questionnaire, which included queries about their medical condition, occupation (from which a measure of social class was derived), and general health status using the SF36. RESULTS: Physical function (t=32.1, P<0.001), social function (t=16.8, P<0.001) and perceived general health (t=4.1, P<0.001) were worse in the case group, but energy/vitality and mental health showed little difference between cases and controls. Cases were more likely to report knee pain than controls, but case-control status was not associated with pain in the fingers or shoulders, or with social class. However, differences in physical and social function between cases and controls did vary with socio-demographic factors and concurrent knee pain status. CONCLUSION: Patients awaiting hip-replacement because of osteoarthritis were more likely to be restricted in their physical and social life than adults in the general population, but mental state and vitality appear unimpaired in this group. This contrasts with findings from other chronic pain disorders. Manual social class is not linked to being on a waiting list for osteoarthritic hip replacement but does add to the burden on health status, particularly social functioning in those with osteoarthritis of the hip.     

Psychosocial distress and perceived health status among elderly users of a health maintenance organization

A variety of measures was used to assess the relationship of psychosocial distress and perceived health status among 1,034 older (65+) members of an HMO. Distress was measured by recent life events, four types of social strain, and the CES-D, a measure of depression/demoralization. The distributions of these measures and perceived health status indicate that this sample was relatively healthy and undistressed. The strength of the associations within each group of variables is significant but generally modest. Using hierarchical multiple regression analysis with demographic variables, social support, and religiosity as controls, the strongest associations are between health status and the CES-D, life events, financial strain, and the strain of being single (unmarried respondents only).     

Physical, mental and social factors affecting self-rated verbal communication among elderly individuals

Background:   Satisfactory verbal communication is necessary to improve the quality of life in elderly individuals. However, few studies have directly analyzed the factors that influence the ability to achieve satisfactory verbal communication. The purpose of the present study was to identify the physical, mental and social factors that affect self-rated verbal communication.
Methods:   A cross-sectional survey was used to obtain the required data from 197 elderly (75.5 ± 8.3 years of age) individuals in the southern area of Japan who independently carried out basic activities of daily living. Subjective evaluation on verbal communication, general health status, oral function and hearing ability were assessed using a self-administered questionnaire. Age, sex, instrumental activities of daily living, intellectual activity, social activity, cognitive status, the number of present teeth, maximum phonetic time and status regarding the use of dentures and hearing aids were also evaluated.
Results:   In bivariate analyses, self-rated verbal communication ability was significantly related to age, instrumental activities of daily living, intellectual activity, social activity, cognitive function, maximum phonation time, the number of present teeth, the wearing of dentures, self-rated general health and oral function. However, self-rated hearing ability and the wearing of hearing aids were not significantly related to self-rated verbal communication. The backward logistic regression analysis was refined until it included only two independent variables: social activity and self-rated general health status.
Conclusion:   These results suggest that social activity and self-rated general health status are the most influential factors of satisfactory verbal communication in the present model, and that self-rated verbal communication is not related to hearing factors.     

Effects of functional decline on quality of life among the Japanese elderly

The effects of functional decline upon social networks, life satisfaction, and depression were observed and statistically tested in a longitudinal prospective design. Subjects were 692 Japanese elderly, aged sixty-five years or older, with high functional capacity at baseline. During a two-year period of follow-up, 12.3 percent of the subjects experienced functional decline. Repeated-measure analyses of covariance with statistical tests for simple main effects revealed that changes in the criterion variables significantly differed along with changes in functional health status when the effects of age, gender, and socioeconomic status were controlled. The subjects who experienced functional decline showed a larger decrease in the number of relatives, friends, and neighbors having frequent contacts, a larger decline in life satisfaction, and a larger increase in depression than those without functional decline. The results seem to confirm further the importance of functional health status as a prerequisite for higher quality of life in old age.     

Socioeconomic gradient in old age mortality in Wuhan, China

OBJECTIVES: The vast majority of studies on socioeconomic status (SES) and old age mortality are based on data derived from developed nations. This research examined the SES differentials in old age mortality in China, a developing nation. METHODS: Hazard rate models in conjunction with ordinary least squares and logistic regression analyses were used to ascertain the gross, direct, indirect, and interaction effects of SES on mortality during a 3-year period in a probability sample of 2,943 persons aged 60 years or older in Wuhan, China. RESULTS: Education, household economic well being, and urban-rural residence showed statistically significant gross effects on old age mortality. Education influenced mortality directly and indirectly. Household economic well being and urbanicity exerted indirect effects on mortality through mediating variables such as stress, social relations, and baseline health status. The mechanism through which education affected mortality differed between men and women, but SES differentials in mortality did not interact with age. DISCUSSION: SES differentials in old age mortality may be extended to a developing nation such as China. The observed gender by SES interaction effect on old age mortality has important implications for intervention. In particular. improving education among women in underdeveloped areas must remain a high priority, for policy makers in efforts to extend the life expectancy of women.