Nutrition and quality of life in the aged: the Jerusalem 70-year olds longitudinal study

Inadequate nutrition is a major problem of elderly people today. Yet, despite the prevalence and significance of the problem, there is little information on the nutritional status of elderly persons in the community, and its impact on their quality of life. During 1990-1991, as part of a first cross-section in a longitudinal medical and social study of 70-year olds in Jerusalem, we surveyed the nutritional status of this population. During the first phase, 605 people were examined in their homes; data were collected regarding socioeconomic status, education, self-perceived health state, use of medications and health services, and ADL. During the second stage, a sub-group of 463 people was examined in a geriatric outpatient clinic; all subjects underwent medical history, physical examination, cognitive assessment, psychiatric questionnaire, blood and urine tests, electrocardiogram, and pulmonary function tests. In addition, general hospital admissions and morbidity and mortality in the two years following the study were studied. The nutritional status of the participants was determined according to nutritional assessment (NA) scale, based on the Mini Nutritional Assessment (MNA). The majority of the study population lived at home, was without cognitive disturbance (86%), and was independent in ADL (83%). Based on NA > 24, 91% of the study population were in good nutritional state, 8.3% were at risk of undernutrition, and 0.7% were malnourished. There was a significant positive relationship between NA score and ADL as well as cognitive state. In addition, a strong negative relation was found between NA score and visits to the family physician in the previous fortnight, visits to the emergency room in the previous year, and hospital admissions in the following two years. An inverse relation, although not significant, was found between NA score and two-year post-study mortality. These results suggest that the nutritional status of the studied population is inadequate, and that the nutritional state is one of the major determinants of the quality of life in the elderly and therefore, should be part of any geriatric assessment. Elder population surveys are needed to identify and treat at risk elders.     

Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study

BACKGROUND: Numerous studies examining the prevalence and natural history of dyspepsia in the general population have been conducted. However, few have reported the effect of quality of life on the development of dyspepsia. A 10-year longitudinal follow-up study examining the effect of quality of life on subsequent dyspepsia was performed. METHODS: Individuals originally enrolled in a population-screening programme for Helicobacter pylori were contacted through a validated postal dyspepsia questionnaire. Baseline demographic data, quality of life at original study entry, and dyspepsia and irritable bowel syndrome (IBS) symptom data were already on file. Consent to examine primary-care records was sought, and data regarding non-steroidal anti-inflammatory drugs (NSAID) and aspirin use were obtained from these. RESULTS: Of 8407 individuals originally involved, 3912 (46.5%) provided symptom data at baseline and 10-year follow-up. Of 2550 (65%) individuals asymptomatic at study entry, 717 (28%) developed new-onset dyspepsia at 10 years, an incidence of 2.8% per year. After multivariate logistic regression, lower quality of life at study entry (OR 2.63; 99% CI 1.86 to 3.71), higher body mass index (OR per unit 1.05; 99% CI 1.02 to 1.08), presence of IBS at study entry (OR 3.1; 99% CI 1.51 to 6.37) and use of NSAIDs and/or aspirin (OR 1.32; 99% CI 0.99 to 1.75) were significant risk factors for new-onset dyspepsia. CONCLUSIONS: The incidence of new-onset dyspepsia was almost 3% per year. Low quality of life at baseline exerted a strong effect on the likelihood of developing dyspepsia at 10 years.     

Impact of running on lumbar bone density: a 5-year longitudinal study.

Our study was designed to examine associations of longterm physical impact (running) with changes in lumbar bone mineralization. Study subjects were a volunteer sample of 14 members of a running club now aged 55 to 77 years and 14 matched controls undergoing computerized scans of the first lumbar vertebra both at baseline and after 5 years. Separate analyses included data from 23 runners available over the entire 5-year period. A decrease in bone mineral density (BMD) over time was statistically significant in both runners and controls. Among runners bone loss was most pronounced in those decreasing their running habits substantially. At the 5-year mark, runners maintained greater BMD. A highly significant correlation was found between change in lumbar BMD and average time spent running (min/week) over the 5-year period. Furthermore, changes in BMD were positively correlated with changes in run min/week. We conclude that regular running appears to reduce age related bone loss both in women and men over 50 years of age. However, substantial decreases in physical weight bearing activity are associated with important bone loss in the lumbar spine.     

Health-related quality of life following single or bilateral lung transplantation: a 7-year comparison to functional outcome

OBJECTIVES: To compare long-term health-related quality of life (HRQL) in single and bilateral lung transplant recipients independent of the underlying disease, and in a subset of patients with native pulmonary emphysema. METHODS: Forty-four lung transplant recipients (mean [+/- SD] age, 44.8 +/- 11.6 years) were followed up for > 2 years after single lung transplantation (LTx) [14 recipients] or bilateral LTx (30 recipients). Data were prospectively collected, before undergoing LTx and annually after undergoing LTx, measuring FEV1, 6-min walk test (6MWT) results, and quality of life using the St. George respiratory questionnaire (SGRQ) and a visual analog scale (VAS). The SGRQ addresses three domains, namely, respiratory symptoms, accomplishment of routine activities, and disease impact on daily life. RESULTS: Statistically significant correlation coefficients were found comparing the SGRQ and the VAS (r = 0.812; p < 0.0001), the SGRQ and the 6MWT (r = 0.610; p < 0.0001), and the SGRQ and the FEV1 (r = 0.523; p < 0.0001) in all patients. Significant improvements on the FEV1, 6MWT, and SGRQ were observed after LTx in both single and bilateral LTx recipients. Increased risk for the development of bronchiolitis obliterans syndrome (BOS) [relative risk, 2.86; 95% confidence interval, 1.22 to 6.67; p = 0.03] and significantly lower FEV1 values were observed in patients following a single graft, compared to that in patients following a bilateral graft (p < 0.01). In contrast, the 6MWT and the SGRQ scores were not significantly different between recipients of single and double LTx. The same patterns of results were observed in comparisons between single and bilateral lung recipients with prior pulmonary emphysema. CONCLUSIONS: Despite poorer FEV1 recovery and increased risk of BOS after LTx, single lung transplant recipients had comparable long-term exercise tolerance and quality-of-life scores as patients who received bilateral transplants. These results suggest the limited influence of functional performance on objective and subjective markers of HRQL recovery after LTx.     

A 3-year longitudinal study of asthma quality of life in undiagnosed and diagnosed asthma patients.

SETTING: Juniper's Asthma Quality of Life Questionnaire with standardised activities (AQLQ(S)) is commonly used to evaluate the effect of interventions in pharmaceutical trials, but rarely, if ever, used clinically in long-term follow-up of undiagnosed or diagnosed asthma patients. DESIGN: The AQLQ(S) was administered to 493 asthma patients who were randomised to treatment in primary or specialist care over a 3-year period. RESULTS: Of the 493 patients, 249 had not been diagnosed before screening and 244 had a doctor's diagnosis of asthma. At entry, known patients had a lower total AQLQ(S) score (median 6.03, 95%CI 3.9-7.0) than undiagnosed patients (median 6.54, 95%CI 4.8-7.0, P < 0.001). Treatment with inhaled corticosteroids induced lower scores (median 5.7, 95%CI 3.5-7.0) than no treatment (median 6.5, 95%CI 4.8-7.0, P < 0.01). Half of the patients (n = 260) were randomly invited to participate in a follow-up survey in a specialist setting. In the first 3 months of follow-up, a decrease in AQLQ(S) score among the undiagnosed patients (median -0.24, 95%CI -1.6-0.9, P = 0.02) was observed. After 3 years, the score improved significantly (by >0.5 points) in 45% of the undiagnosed patients (n = 107) compared to 26% of the known patients (n = 116, P < 0.05). CONCLUSION: The initial total AQLQ(S) score was higher in undiagnosed asthma patients. After diagnosis the AQLQ(S) initially decreased but then increased, followed by an overall improvement that exceeded that of the known asthma patients.     

Predictors and characteristics of Erikson's life cycle model among men: a 32-year longitudinal study

To assess Erikson's life cycle model, 86 men, initially selected for health, were prospectively studied at age 21, and reassessed 32 years later at age 53. Using the Vaillant and Milofsky (1980) modification of Erikson's model, 48 men (56%) achieved generativity, an advanced developmental stage, at follow-up. Results generally support Erikson's model and show that generativity was significantly associated with successful marriage, work achievements, close friendships, altruistic behaviors, and overall mental health. Successful young adult predictors of Erikson's model at midlife included a warm family environment, an absence of troubled parental discipline, a mentor relationship, and, most importantly, favorable peer group relationships. Significant predictors of Erikson's model were of moderate effect size and involve young adult social relationships rather than physical symptoms or parental social class standing.     

Donor quality of life after living donor liver transplantation: a prospective study

Background/purpose

It is important to determine the health-related quality of life of live donors in liver transplantation.

Materials and methods

We reviewed 35 live liver donors and prospectively and longitudinally evaluated their health-related quality for 1.5?years post-surgery based on the Short Form-36 version 2 questionnaire. Scores of the donors stratified by the clinical data were analyzed. The study was approved by the University of Tokyo Institutional Review Board (No. 1533).

Results

There was no donor mortality in the donor population studied. The percentage of major complications greater than Clavien??s classification grade III was 8.6%. The physical component summary score decreased to 42.9 (p?Conclusions The findings from this survey suggest that liver harvesting does not decrease the donor??s quality of life during the 1.5 years following the surgery.     

The impact of dialysis modality on quality of life: a systematic review

Background: This systematic review aims to generate evidence on which dialysis modality (in‐centre haemodialysis HD, or peritoneal dialysis, PD) improves the quality of life (QOL) of end stage renal disease (ESRD) patients. Methods: MEDLINE, CINAHL and EMBASE were searched from their inception to July 2010 for studies that compared QOL in both HD and PD patients. Results: Only 26 of the 574 studies identified were included in this review. These were crosssectional, longitudinal or retrospective in design. QOL tools used include SF‐36, Kidney Disease Quality of Life (KDQOL) and CHOICE Health Experience Questionnaire (CHEQ). PD patients mostly rate their QOL higher than HD patients. Yet HD patients may enjoy a relatively better QOL in the physical dimensions over time. Mental health components are comparable between both dialysis populations. Conclusion: There is no simple ‘yes’ or ‘no’ answer to the question of which dialysis modality improves QOL. However a good understanding of the evidence base will facilitate individual decision‐making.     

Health-related quality of life in Crohn''s disease: a prospective longitudinal study in 231 patients

OBJECTIVE: The aim of this work was to assess the quality of life (QoL) of patients with Crohn's disease (CD) prospectively over 1 yr and to determine factors of influence. METHODS: A total of 231 CD patients were included. At month 0 (M0), M3, M6, M9, and M12, patients were given a validated QoL questionnaire (self-administered) to fill in and a clinical form referring to the period of 3 months before the visit. The QoL questionnaire was made up of the Short-Form-36 and the Rating Form of Inflammatory Bowel Disease Patients Concerns. The impact on QoL of the following factors was analyzed: age, gender, CD duration and localization, presence of extradigestive manifestations or concomitant disease, disease course, medical treatments, and surgery. We studied the correlations between QoL and disease activity assessed by both patients and investigators by a visual analog scale. RESULTS: At M0, all the scores of the Short-Form-36 were significantly lower than those of a standard population, nevertheless improving between M0 and M12. Patients' main worries were first "having an ostomy bag" followed by "uncertain nature of the disease," "energy level." and finally "having surgery." QoL was better correlated with assessment of disease course by the patient than by the investigator. Significant factors of impairment in QoL were female gender, tobacco, active CD, involvement of the colon, hospitalization, corticoid treatment, and surgery in the past 3 months. Conversely, intake of immunosuppressors improved QoL. CONCLUSION: Patients' QoL is impaired by CD and is underestimated by doctors. Tobacco, hospitalization, and use of corticoids have a negative impact on QoL. Conversely, the use of immunosuppressors is associated with a better QoL.     

Health-related quality of life of pediatric patients receiving allogeneic stem cell or bone marrow transplantation: results of a longitudinal, multi-center study

The results of a 5-year longitudinal prospective study about the health-related quality of life (HRQL) of pediatric patients receiving allogeneic bone marrow or stem cell transplantation (BMT) are described. The patients' HRQL was assessed twice before, and five times after BMT, the end point being 1 year after BMT. For the measurement of HRQL, standardized questionnaires were completed by patients, parents and physicians. The final sample consisted of 68 patients aged 4-18 years, of which 19 were lost in the course of the study owing to relapse, transplant rejection and/or death. The worst HRQL was seen shortly after transplant and HRQL thereafter improved steadily, although the improvement was not always linear and not all patients drew benefit from this average positive evolution. Compromised emotional functioning, a high level of worry and reduced communication during the acute phase of treatment had a negative impact on HRQL 1 year after BMT. Nausea and pain during the acute phase of treatment did not have an effect on later HRQL. The interobserver agreement of HRQL reports between parents and their children was moderate to good, and generally better than child-physician and parent-physician agreement.     

Effect of age factors on health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: A 1-year longitudinal study

PurposeTo examine age-related factors influencing health-related quality of life (HR-QOL) among patients with lower rectal cancer during the 12-month period after sphincter-saving surgery (SSS).Material and methodsIn this 1-year longitudinal study, 137 patients (120 patients completed, and 82 aged ≥60 years) answered the European Organization for Research and Treatment of Cancer questionnaire (EORTC-C30/CR38) assessing their HR-QOL and related factors during the 12 months after SSS.ResultsNo significant differences in HR-QOL were found before surgery. Only among those aged ≥60 years, global health status/QOL and cognitive functioning showed a significant decrease one month after surgery. At one month after SSS, the role functioning of groups <60 years old (which is negatively related to defecation problems, insomnia, and financial difficulties) was lower compared to those aged ≥60 years; and role functioning was significantly related to global health status/QOL. Six months after SSS, the global health status/QOL had recovered. In both groups, global health status/QOL was related to role and social functioning. Among participants aged <60 years, global health status/QOL was significantly related to emotional functioning, which is related to future perspective. Among participants aged ≥60 years only, global health status/QOL was significantly related to cognitive functioning; pain, financial difficulties, and defecation problems negatively influenced HR-QOL. Symptoms specific after SSS: defecation problems (in both group), micturition problems (only ≥60 years), and sexual problems (only<60 years) influenced HR-QOL.ConclusionHealth care providers should assess the influence of age-related factors during the early post-operative period after SSS to improve HR-QOL.     

Body composition analysis in chronic dialysis patients: a longitudinal study

ObjectiveNutritional status is an important determinant of morbidity and mortality in dialysis patients. Body composition analysis bioelectrical impedance techniques are becoming commonplace in the clinical setting. Our objective is to report our clinical experience using bioelectrical impedance analysis for the prospective nutritional surveillance of dialysis patients.MethodsA total of 204 patients, 157 on hemodialysis and 47 on peritoneal dialysis were followed for a median of 21 months. Values from the first trimester were averaged and compared to those obtained in the last trimester. Bioelectrical impedance values were obtained using a single frequency (50 kHz) bioimpedance analyzer.ResultsBaseline values for body weight, height, body mass index and body surface area were similar in both treatment modalities. Hemodialysis patients lost a discreet amount of body weight (1.5%, p=0.0334). Body weight did not change in peritoneal dialysis patients. Significant decreases in resistance (p=0.l0023) and phase angle (p=0.0481) were noted in hemodialysis but not peritoneal dialysis patients. A small but significant decrease in fat free (1.8%; p=0.0028) and body cell free (3.3%; p=0.0036) mass was noted in hemodialysis but not peritoneal dialysis patients.Conclusions1. Bioelectrical impedance analysis may detect losses in fat free mass and body cell mass that are not apparent by body weight monitoring. 2. Bioelectrical impedance analysis is a practical clinical tool for evaluating body composition in dialysis patients.