Development of a vision-targeted health-related quality of life item measure

Purpose

To develop a vision-targeted health-related quality of life (HRQOL) measure for the NIH Toolbox for the Assessment of Neurological and Behavioral Function.

Methods

We conducted a review of existing vision-targeted HRQOL surveys and identified color vision, low luminance vision, distance vision, general vision, near vision, ocular symptoms, psychosocial well-being, and role performance domains. Items in existing survey instruments were sorted into these domains. We selected non-redundant items and revised them to improve clarity and to limit the number of different response options. We conducted 10 cognitive interviews to evaluate the items. Finally, we revised the items and administered them to 819 individuals to calibrate the items and estimate the measure’s reliability and validity.

Results

The field test provided support for the 53-item vision-targeted HRQOL measure encompassing 6 domains: color vision, distance vision, near vision, ocular symptoms, psychosocial well-being, and role performance. The domain scores had high levels of reliability (coefficient alphas ranged from 0.848 to 0.940). Validity was supported by high correlations between National Eye Institute Visual Function Questionnaire scales and the new-vision-targeted scales (highest values were 0.771 between psychosocial well-being and mental health, and 0.729 between role performance and role difficulties), and by lower mean scores in those groups self-reporting eye disease (F statistic with p < 0.01 for all comparisons except cataract with ocular symptoms, psychosocial well-being, and role performance scales).

Conclusions

This vision-targeted HRQOL measure provides a basis for comprehensive assessment of the impact of eye diseases and treatments on daily functioning and well-being in adults.     

Biological risk of older adults with visual impairments

Objectives  

To investigate whether biological markers of health differ among older adults with visual impairment compared to those with normal vision.     

Measuring the impact of cataract surgery on generic and vision-specific quality of life

Purpose

Cataracts are the leading cause of blindness worldwide and cause visual impairment for millions of adults in the United States. We compared the sensitivity of a vision-specific health-related quality of life (HRQOL) measure to that of multiple generic measures of HRQOL before and at 2 time points after cataract surgery.

Methods

Participants completed 1 vision-specific and 5 generic quality of life measures before cataract surgery, and again 1 and 6 months after surgery. Random effects modeling was used to measure changes over the three assessment points.

Results

The NEI-VFQ25 total score and all 11 subscales showed significant improvements during the first interval (baseline and 1 month). During the second interval (1–6 months post-surgery), significant improvements were observed on the total score and 5 of 11 NEI-VFQ25 subscales. There were significant increases in HRQOL during the first interval on some preference-based generic HRQOL measures, though changes during the second interval were mostly non-significant. None of the SF-36v2? or SF6D scales changed significantly between any of the assessment periods.

Conclusions

The NEI-VFQ25 was sensitive to changes in vision-specific domains of QOL. Some preference-based generic HRQOL measures were also sensitive to change and showed convergence with the NEI-VFQ25, but the effects were small. The SF-36v2? and SF-6D did not change in a similar manner, possibly reflecting a lack of vision-related content. Studies seeking to document both the vision-specific and generic HRQOL improvements of cataract surgery should consider these results when selecting measures.     

Health-related quality of life among adults 65 years and older in the United States, 2011–2012: a multilevel small area estimation approach

PurposeThe purpose of this study was to develop county-level estimates of poor health-related quality of life (HRQOL) among aged 65 years and older U.S. adults and to identify spatial clusters of poor HRQOL using a multilevel, poststratification approach.MethodsMultilevel, random-intercept models were fit to HRQOL data (two domains: physical health and mental health) from the 2011–2012 Behavioral Risk Factor Surveillance System. Using a poststratification, small area estimation approach, we generated county-level probabilities of having poor HRQOL for each domain in U.S. adults aged 65 and older, and validated our model-based estimates against state and county direct estimates.ResultsCounty-level estimates of poor HRQOL in the United States ranged from 18.07% to 44.81% for physical health and 14.77% to 37.86% for mental health. Correlations between model-based and direct estimates were higher for physical than mental HRQOL. Counties located in the Arkansas, Kentucky, and Mississippi exhibited the worst physical HRQOL scores, but this pattern did not hold for mental HRQOL, which had the highest probability of mentally unhealthy days in Illinois, Indiana, and Vermont.ConclusionsSubstantial geographic variation in physical and mental HRQOL scores exists among older U.S. adults. State and local policy makers should consider these local conditions in targeting interventions and policies to counties with high levels of poor HRQOL scores.     

Older Adults Coping With Vision Loss

Age-related vision loss is one of the most commonly cited disabling impairments of adult life. Stressors presented by vision loss can create barriers, threatening the well-being of the individual. This qualitative study of 30 older adults (65 to 95 years of age) investigated vision loss and coping strategies. All participants experienced unexpected sight loss during their adult years. The Adaptation to Age-Related Vision Loss (AVL) Scale was used in this study to examine psychosocial adaptation to vision impairment. The coping strategies of vision impairment were assessed by collecting self-reported reflections toward vision loss and how the change impacted the participant's life. Given the correct balance of support, confidence, and acceptance, older adults can confront the existing barriers and focus on the ability to optimize function with vision loss. Health care service providers and practitioners can provide needed assistance and a helpful guide to assist older adults in successfully coping with vision impairment.     

中国9省市中老年人群体重指数与健康相关生命质量的关系

目的 研究中国中老年人BMI与健康相关生命质量(HRQOL)的关系.方法 汇集9省市(汀苏、安徽、甘肃、青海、福建、北京、吉林、江西、河南)横断面健康状况调查中老年人群数据共9539例.采用秩和检验比较BMI分类不同的中老年人生命质量的差异;用多元logistic回归模型检验排除性别、年龄、婚姻状况、学历、运动水平和慢性病史等混杂因素后,中老年人BMI分类与生命质最的相关性.结果 与体重正常的中老年人相比,体重过轻组SF-36的生理领域(P<0.001)、心理领域(P<0.01)及其8个维度(生理机能、精神健康,P<0.05;生理职能、躯体疼痛、健康状况、精力、社会功能、情感职能,P<0.01)生命质量均显著较差;超重组心理领域生命质量显著较好(P<0.05);肥胖组生理机能维度显著较差(P<0.01),心理领域(P<0.05)、精神健康维度(P<0.01)显著较好.排除已知的混杂因素后,体重过轻组在生理领域(OR=1.67,95%CI:1.35～2.06)、心理领域(OR=1.39,95%CI:1.13～1.70)以及所有8个维度生命质量减损的危险度显著增高;超重组心理领域(OR=0.86,95%CI:0.78～0.95)及其生理职能、精力、社会功能、情感职能、精神健康维度生命质最受损的危险度显著降低;肥胖组生理机能维度(OR=1.51,95%CI:1.27～1.80)受损的危险度显著增高,心理领域(OR=0.71,95%CI:0.60～0.85)及其精力、情感职能、精神健康维度生命质量受损的危险度显著降低.结论 BMI分类不同的中老年人其SF-36各领域生命质量不同,体重过轻组生理领域和心理领域生命质量均较差,超重和肥胖组心理领域生命质最较好,肥胖组生理领域生命质量较差.超重和肥胖的中老年人生命质量的减损与慢性疾病有关.     

Risk of type 2 diabetes mellitus among adults aging with vision impairment: The role of the neighborhood environment

BackgroundVision impairment (VI) affects approximately 1 in 28 Americans over the age of 40 and the prevalence increases sharply with age. However, experiencing vision loss with aging can be very different from aging with VI acquired earlier in life. People aging with VI may be at increased risk for diabetes due to environmental barriers in accessing health care, healthy food, and recreational resources that can facilitate positive health behaviors.ObjectiveThis study examined the relationship between neighborhood characteristics and incident type 2 diabetes mellitus (T2DM) among a cohort of 22,719 adults aging with VI.MethodsData are from Optum® Clinformatics® DataMart, a private administrative claims database (2008–2017). Individuals 18 years of age and older at the time of their initial VI diagnosis were eligible for analysis. VI was determined using vision impairment, low vision, and blindness codes (ICD-9-CM, ICD-10-CM). Covariates included age, sex, and comorbidities. Cox models estimated adjusted hazard ratios (HRs) for incident T2DM. Stratified models examined differences in those aging with (age 18–64) and aging into (age 65+) vision impairment.ResultsResidence in neighborhoods with greater intersection density (HR = 1.26) and high-speed roads (HR = 1.22) were associated with increased risk of T2DM among older adults with VI. Living in neighborhoods with broadband internet access (HR = 0.67), optical stores (HR = 0.62), supermarkets (HR = 0.78), and gyms/fitness centers (HR = 0.63) was associated with reduced risk of T2DM for both younger and older adults with VI.ConclusionsFindings emphasize the importance of neighborhood context for mitigating the adverse consequences of vision loss for health.     

A comparison of health-related quality of life for individuals with mental health disorders and common chronic medical conditions

OBJECTIVES: The purpose of this study was to compare the burden of disease experienced by people with mental health conditions with people who have common medical disorders. Three prevalent medical disorders--the burden of disease of back/neck problems, diabetes, and hypertension--were compared with the mental health category of depression, anxiety, or emotional problem. METHODS: This study used data from the nationally representative 2003-2004 National Health and Nutrition Examination Survey for respondents aged 18 or older (n = 4,833). The measurement of health-related quality of life (HRQOL) used was the Healthy Days Measures developed by the Centers for Disease Control and Prevention. Unadjusted and adjusted HRQOL were compared for individuals reporting each of the four conditions. Adjusted HRQOL was assessed using ordinary least squares regression, which controlled for gender, age, race/ethnicity, education, marital status, comorbidity, and income. RESULTS: Individuals with mental health conditions experienced 17.6 total unhealthy days per month, while those with back and neck problems and those with hypertension experienced 12.2 total unhealthy days per month, and those with diabetes experienced 12.3 total unhealthy days per month. After adjusting for socioeconomic and demographic characteristics as well as comorbid conditions, mental health conditions were responsible for a 6.8-day decrease in healthy days per month compared with average adults (p < 0.001). Mental health conditions resulted in significantly lower HRQOL than back or neck problems (p = 0.053), diabetes, (p = 0.002), and hypertension (p = 0.012). CONCLUSIONS: There were significant differences between the HRQOL found in mental and medical conditions, with mental health conditions being responsible for significantly greater impairment of HRQOL. An efficient health-care system should consider the relative disease burden of specific conditions when allocating public health resources.     

Self-reported visual function in healthy older people in Britain: an exploratory study of associations with age, sex, depression, education and income

BACKGROUND: Tractable but undetected visual impairment in older people may be relatively common, particularly amongst the very old and in more deprived populations. Measurement of visual acuity is unlikely to be helpful in identifying this impairment, but targeted assessment of visual function may be beneficial. There is uncertainty about the defining characteristics of the target group. OBJECTIVE: To explore factors associated with self-reported visual impairment in community dwelling older people. METHODS: Design: secondary cross sectional analysis of baseline data from a randomised controlled trial. Setting: three large group practices in outer London. Participants: older people aged 65 and over enrolled in a study of health risk appraisal. Method: postal questionnaire using questions from the National Eye Institute Visual Function questionnaire. RESULTS: Moderate or extreme visual function loss occurred in 4 to 12% of community-dwelling older people in this population reporting less than excellent vision, depending on which aspect of visual function is considered. Visual function loss in this subgroup increases in prevalence with advancing age, but is not associated with female sex, low educational attainment or low income. It is associated with depressed mood. CONCLUSION: Questions about visual function identify a group of older people whose vision and mental state needs further investigation.     

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p < 0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p < 0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p < 0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p < 0.01) less likely to have a functional limitation due to vision.     

Disparities in mental health,social support and coping among individuals with mobility impairment

BackgroundCDC estimated that 19.4 million (7.8%) US adults are living with mobility impairment, who are unable to walk a quarter mile. Individuals with physical disability reported greater depression and, in some cases, insufficient social support.ObjectivesThis study explores the extent of disparities in psychological health, social support, and coping mechanisms among those with mobility impairment as compared to those without such impairment, and the longitudinal effect of onset of mobility impairment on subsequent psychosocial health and coping.MethodsIndividuals with mobility impairment were matched to controls from a nationally representative sample, using the propensity score method. The final sample included 345 matched pairs. Regression models with robust standard errors were used to assess disparities in outcomes by mobility status. Autoregressive models were used to assess the longitudinal effect of the onset of mobility limitation on these outcomes.ResultsThose with impaired mobility fared significantly higher on negative affect (p < .05) and pessimism (p < .05), and significantly lower on life satisfaction (p < .05) and positive affect (p = .001). In terms of coping, they showed disparities in health locus of control (self) (p < .05), planning (p < .05), active coping (p < .05), and problem-focused coping (p < .05), as compared to those without mobility limitation. The onset of mobility impairment had significant effects in similar psychological and coping domains.ConclusionOur work revealed a piece of reality of individuals living with mobility impairment and will inform designing effective interventions to mitigate psychosocial health disparities in this population.     

Tracking Healthy Days — A Window on the Health of Older Adults

In collaboration with its partners in the public health and aging services communities, the Centers for Disease Control and Prevention (CDC) Health Care and Aging Studies Branch has developed and validated a brief set of health-related quality of life (CDC HRQOL) measures for tracking the perceived physical and mental health of adults over time. For the past 12 years, these measures — also called the Healthy Days measures — have been used in an expanding set of population health surveys, surveillance systems, performance report cards, and evaluation studies, and they have provided useful disease and disability burden data to inform decision making and provide new insights for prevention research.

Although now used continuously to assess health-related quality of life for Americans aged 12 years and older, the measures and population data have been especially valuable in applications affecting older adults, for which health-related quality of life is an outcome of primary importance. The CDC HRQOL measures are recommended to public health and social service professionals as a feasible way to assess perceived physical and mental health needs of older adults and to document the effects of policies and interventions.

     

Association of insomnia with quality of life, work productivity, and activity impairment

Purpose  To assess the association of insomnia with health-related quality of life (HRQOL), work productivity, and activity impairment. Methods  Data were obtained from the 2005 US National Health and Wellness Survey. Subjects were assigned to the insomnia group (diagnosed insomnia experienced at least a few times a month) or the noninsomnia group (no insomnia or sleep symptoms). HRQOL was assessed using the short form 8 (SF-8) (mental and physical scores). The work productivity and activity impairment questionnaire (WPAI) assessed absenteeism (work time missed), presenteeism (impairment at work), work productivity loss (overall work impairment), and activity impairment. Linear regression models were used to control for potential confounders. Results  A total of 19,711 adults were evaluated (5,161 insomnia, 14,550 noninsomnia). Subjects in the insomnia group had significantly lower SF-8 physical (−5.40) and mental (−4.39) scores and greater activity impairment scores (+18.04) than subjects in the noninsomnia group (P < 0.01 for all). Employed subjects in the insomnia group had greater absenteeism (+6.27), presenteeism (+13.20), and work productivity loss (+10.33) scores than those in the noninsomnia group (P < 0.01 for all). Conclusions  Insomnia is significantly associated with poorer physical and mental quality of life and work productivity loss and activity impairment.     

Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogotá, Colombia

This study examines associations between neighborhood environment attributes and health related quality of life (HRQOL) and self-rated health (SRH) among older adults (60 years and over) in Bogotá, Colombia. Perceived and objective neighborhood environmental characteristics were assessed in a cross sectional multilevel design with 1966 older adults within 50 neighborhoods. Outcome variables included HRQOL (physical and mental dimensions) and SRH measured with the Spanish version of the Short Form 8 (SF-8). Independent variables included perceived and objective neighborhood characteristics as well as self-reported levels of walking. Hierarchical linear and logistic regression models were used for the analysis. Among perceived neighborhood characteristics, safety from traffic was positively associated with both HRQOL dimensions and SRH. Having safe parks was positively associated with the mental dimension of HRQOL and with SRH. Street noise was negatively associated with both HRQOL dimensions. Regarding objective neighborhood characteristics, residing in areas with more than eight percent of land covered by public parks was positively associated with SRH. Objective and perceived neighborhood characteristics could provide insight into potential interventions among older adults from rapidly urbanizing settings in Latin America.     

Perceived stress,resilience, and health‐related quality of life among Parkinson's disease caregivers in Mexico

The stress process model of caregiving posits that caregivers' internal psychosocial resources may serve as buffers between the stress associated with caregiving and well‐being. Empirical support for the stress process model exists for several caregiving contexts, but little research has investigated the Parkinson's disease caregiving experience in Mexico. Using a cross‐sectional, correlational design, the objective of this study was to examine whether resilience moderates the relation between perceived stress and health‐related quality of life (HRQOL) among Parkinson's disease caregivers in Mexico. Data were collected from April 2015 to February 2016 during outpatient neurology appointments in Mexico City, Mexico. Participants included informal caregivers (N = 95) for a family member with Parkinson's disease. Participants completed a battery of questionnaires assessing their level of perceived stress, resilience, and HRQOL. Regression analyses indicated that resilience moderated the inverse relation between perceived stress and mental HRQOL. However, contrary to hypotheses, resilience did not moderate the relation between stress and physical HRQOL. Findings shed light on resilience as a potential protective factor for mental HRQOL among Parkinson's disease caregivers in Mexico and indicate that resilience may be beneficial to target in mental health promotion interventions.     

Peer Reviewed: A Latent Class Modeling Approach to Evaluate Behavioral Risk Factors and Health-Related Quality of Life

Introduction

The Behavioral Risk Factor Surveillance System (BRFSS) monitors multiple health indicators related to 4 domains: risky behaviors, health conditions, health care access, and use of preventive services. When evaluating the effect of these indicators on health-related quality of life (HRQOL), conventional analytical methods focus only on individual risks and thus are not ideally suited for analyzing complex relationships among many health indicators. The objectives of this study were to 1) summarize and group multiple related health indicators within a health domain by using latent class modeling and 2) analyze how 24 health indicators in 4 health domains were associated with 2 HRQOL outcomes to identify Rhode Island adult populations at highest risk for poor HRQOL.

Methods

The 2008 Rhode Island BRFSS, a population-based, random-digit–dialed telephone survey, collected responses from 4,786 adults aged 18 years or older. We used latent class modeling to assign 24 health indicators to high-, intermediate-, and low-risk groups within 4 domains. The effects of all risks on HRQOL were then assessed with logistic regression modeling.

Results

The latent class model with 3 classes fitted the 4 domains best. Respondents with more health conditions and limited health care access were more likely to have frequent physical distress. Those with more health conditions, risky behaviors, and limited health care access were more likely to have frequent mental distress. Use of preventive health services did not affect risk for frequent physical or mental distress.

Conclusion

The latent class modeling approach can be applied to identifying high-risk subpopulations in Rhode Island for which interventions may have the most substantial effect on HRQOL.     

Social Isolation and Self-Reported Cognitive Decline Among Older Adults in Japan: A Longitudinal Study in the COVID-19 Pandemic

ObjectivesWe aimed to examine the association between the transition to social isolation and cognitive decline in older adults during the coronavirus disease 2019 (COVID-19) pandemic.DesignLongitudinal study.Setting and ParticipantsThe study included participants from a community in a semiurban area of Japan. We conducted a mailed questionnaire survey of 2000 noninstitutionalized older adults who were randomly sampled. Of those who completed both the baseline and follow-up surveys in March and October 2020, respectively, participants aged ≥70 years without cognitive impairment at baseline were included in the analysis.MethodsParticipants were classified into 4 groups based on their baseline and follow-up social isolation status, which were as follows: “remained nonisolated,” “isolated from nonisolation,” “nonisolated from isolation,” and “consistent isolation.” Self-reported cognitive function was assessed using the Cognitive Performance Scale, and level 2 (mild impairment) or higher (moderate to severe impairment) was defined as cognitive impairment.ResultsUltimately, 955 older adults were analyzed. The mean age of the participants was 79.6 years (standard deviation = 4.7) and 54.7% were women. During the follow-up period, 54 (5.7%) participants developed cognitive impairment. Multivariable logistic regression analysis revealed that compared with the group that remained nonisolated, the isolated from nonisolation and consistent isolation groups were significantly associated with the onset of cognitive impairment [isolated from nonisolation: odds ratio (OR) = 2.74, 95% confidence interval (CI) = 1.13-6.61, P = .026; consistent isolation: OR = 2.33, 95% CI = 1.07-5.05, P = .033].Conclusions and ImplicationsSocial isolation during the COVID-19 pandemic was associated with a decline in cognitive function among older adults. Attention to the social isolation process during the pandemic may be necessary to protect older adults’ cognitive health.     

Factors associated with quality of life in older adults in the United States

Purpose  

According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen’s behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 years and older.     

Vision-specific health-related quality of life: Content areas for nursing home residents

Nursing home residents have a high prevalence of remediable visual impairment and blindness. Future research on the effectiveness of providing eye care to nursing home residents will need to include a vision-targeted health-related quality of life (HRQOL) instrument appropriate for this population. The purpose of this study was to identify the core content areas for such an instrument. In-depth interviews on vision-related issues were conducted with 40 residents. Interviews were audio-taped, transcribed, and coded using a standardized protocol. Binocular distance and near visual acuity were assessed using the resident's walking around correction to examine whether one vision-specific HRQOL measure could address the needs of residents with good and poor vision. Overall 1070 vision-related comments were identified. Residents mentioned 315 problem comments that were grouped into 13 categories, including ocular symptoms (18% of comments), reading (15%), general vision (13%), psychological distress (12%), and activities of daily living (ADLs) (7%). Compared to published data on vision-specific content areas most relevant to community based persons, nursing home residents focused more on ocular symptoms and basic ADLs, with no mention of issues related to driving, home care, and finances. The majority of categories mentioned did not differ on the proportion of comments made by those with good and poor visual acuity, suggesting that one vision-specific HRQOL instrument would be appropriate for residents with varying levels of visual acuity. Future work will focus on developing a vision-specific HRQOL instrument for nursing home residents.     

Association of smoking status and health-related quality of life: difference among young,middle-aged,and older adults in Shandong,China

Purpose

Few studies explored the relationship between smoking status and health-related quality of life (HRQOL) among adults in China. This study aims to explore the relationship between smoking status and HRQOL among adults (18?+) and examine whether there is a difference in this relationship among young, middle-aged, and older adults in China.

Methods

A total of 23,021 respondents were included in this study. The HRQOL is measured by EQ-5D-3L. The smoking status is divided into never smokers, current smokers, and former smokers. Tobit regression and Logistic regression are employed to explore the association between smoking status and HRQOL. The interaction term is included to explore the difference among young, middle-aged, and older adults.

Results

This study finds smoking status is significantly associated with HRQOL. An interaction analysis shows that the association between smoking status and HRQOL is significantly different among young, middle-aged, and older adults (P?<?0.05). The smoking status is only significantly associated with HRQOL in middle-aged and older adults, but not for young adults. Compared with never smokers, former smokers report significantly lower EQ-5D-3L utility value in middle-aged adults (coefficient?=????0.089; 95%CI???0.128 to???0.050), current smokers report significantly higher EQ-5D-3L utility value in older adults (coefficient?=?0.041; 95%CI 0.005 to 0.076).

Conclusions

This study demonstrates a significant association between smoking status and HRQOL among adults in China, and there is a difference in this relationship among young, middle-aged, and older adults. The government should take efforts to formulate a variety of measures to control tobacco use among adults.