Exploring Life Satisfaction in Exceptional Old Age: The Mediating Role of Positive and Negative Affect

This study involved 137 centenarians from Phase 3 of the Georgia Centenarian Study. Path analysis using Mplus Version 6.11 was used to explore how positive and negative affect mediate the association between perceived and functional health status, cognition, fatigue, and distal life event stress on life satisfaction. The final path model fit the data: MLR χ² (4, N = 137) = 5.84, p = .21, CFI = .97; RMSEA = .06; SRMR = .03. Perceived health (γ = ?.23, p < .01) and cognition (γ = ?.16, p < .05) had a negative direct association with negative affect, whereas functional health (γ = .20, p < .05) and fatigue (γ = .24, p < .001) maintained positive direct associations. Relative to positive affect, perceived health (γ = .21, p < .01) had a direct positive association with positive affect, but fatigue (γ = ?.38, p < .001) had a negative direct association. In addition, negative affect (β = ?.19, p < .05) and fatigue (β ?.19, p < .05) maintained direct negative associations with life satisfaction. Indirect associations between perceived health (.064, [CI = .006, .121]), functional health (?.055, [CI = ?.109, ?001]), and fatigue (?.068, [CI = ?.124, ?.011]) and life satisfaction emerged in the presence of negative affect but not positive affect. It appears that life satisfaction among long-lived persons depends on the extent to which negative emotions are experienced. This has implications in addressing the impact of negative affect on the well-being of long-lived persons.     

Physical Activity Over the Life Course and Its Association with Cognitive Performance and Impairment in Old Age

OBJECTIVE: To determine how physical activity at various ages over the life course is associated with cognitive impairment in late life. DESIGN: Cross‐sectional study. SETTING: Four U.S. sites. PARTICIPANTS: Nine thousand three hundred forty‐four women aged 65 and older (mean 71.6) who self‐reported teenage, age 30, age 50, and late‐life physical activity. MEASUREMENTS: Logistic regression was used to determine the association between physical activity status at each age and likelihood of cognitive impairment (modified Mini‐Mental State Examination (mMMSE) score >1.5 standard deviations below the mean, mMMSE score≤22). Models were adjusted for age, education, marital status, diabetes mellitus, hypertension, depressive symptoms, smoking, and body mass index. RESULTS: Women who reported being physically active had a lower prevalence of cognitive impairment in late life than women who were inactive at each time (teenage: 8.5% vs 16.7%, adjusted odds ratio (AOR)=0.65, 95% confidence interval (CI)=0.53–0.80; age 30: 8.9% vs 12.0%, AOR=0.80, 95% CI=0.67–0.96); age 50: 8.5% vs 13.1%, AOR=0.71, 95% CI=0.59–0.85; old age: 8.2% vs 15.9%, AOR=0.74, 95% CI=0.61–0.91). When the four times were analyzed together, teenage physical activity was most strongly associated with lower odds of late‐life cognitive impairment (OR=0.73, 95% CI=0.58–0.92). However, women who were physically inactive as teenagers and became active in later life had lower risk than those who remained inactive. CONCLUSIONS: Women who reported being physically active at any point over the life course, especially as teenagers, had a lower likelihood of cognitive impairment in late life. Interventions should promote physical activity early in life and throughout the life course.     

Co-Morbidity,Body Mass Index and Quality of Life in COPD Using the Clinical COPD Questionnaire

Introduction: Quality of life is an important patient-oriented measure in COPD. The Clinical COPD Questionnaire (CCQ) is a validated instrument for estimating quality of life. The impact of different factors on the CCQ-score remains an understudied area. The aim of this study was to investigate the association of co-morbidity and body mass index with quality of life measured by CCQ. Methods: A patient questionnaire including the CCQ and a review of records were used. A total of 1548 COPD patients in central Sweden were randomly selected. Complete data were collected for 919 patients, 639 from primary health care and 280 from hospital clinics. Multiple linear regression with adjustment for sex, age, level of education, smoking habits and level of care was performed. Subanalyses included additional adjustment for lung function in the subgroup (n = 475) where spirometry data were available. Results: Higher mean CCQ score indicating lower quality of life was statistically significant and independently associated with heart disease (adjusted regression coefficient (95%CI) 0.26; 0.06 to 0.47), depression (0.50; 0.23 to 0.76) and underweight (0.58; 0.29 to 0.87). Depression and underweight were associated with higher scores in all CCQ subdomains. Further adjustment for lung function in the subgroup with this measure resulted in statistically significant and independent associations with CCQ for heart disease, depression, obesity and underweight. Conclusion: The CCQ identified that heart disease, depression and underweight are independently associated with lower health-related quality of life in COPD.     

糖尿病延伸护理与居家护理干预对糖尿病患者生活质量和护理满意度的影响

目的 研究糖尿病延伸护理和居家护理干预对糖尿病患者生活质量与护理满意度的相关影响.方法 选取该院内分泌科2018年9月—2019年5月收治的85例糖尿病患者作为研究对象,按入院编号的单双数将85例糖尿病患者分为对照组(单数)和观察组(双数),其中对照组43例,观察组42例.给予对照组患者常规方法进行护理干预,而观察组患...     

The Oldest Old in the Last Year of Life: Population-Based Findings from Cambridge City over-75s Cohort Study Participants Aged 85 and Older at Death

OBJECTIVES: To characterize people of advanced old age in their last year of life and compare those dying in their late 80s with those dying aged 90 and older to inform policy and planning.
DESIGN: Retrospective analysis of prospectively collected population-based data from the Cambridge City over-75s Cohort (CC75C) Study, United Kingdom.
PARTICIPANTS: Men and women aged 85 and older at death who died less than 1 year after taking part in any CC75C survey (N=321).
MEASUREMENTS: Physical health, functional disability, self-rated health, cognitive status.
RESULTS: Functional and cognitive impairments were markedly higher for those who died aged 90 and older— predominantly women—than for those who died aged 85 to 89. At least half (49.4–93.6%) of subjects aged 90 and older needed maximum assistance in virtually every daily activity; those aged 85 to 89 needed this only for shopping and laundry. Disability in basic and instrumental activities rose from 59.1% before to 85.4% after the age of 90 and cognitive impairment (Mini-Mental State Examination score ≤21) from 41.7% to 69.4%. Despite this and proximity to death, 60.5% and 67.0%, respectively, rated their health positively. Only one in five reported needing more help.
CONCLUSION: This study provides new data identifying high levels of physical and cognitive disability in very old people in the year before death. As the very old population rises, so will support needs for people dying in extreme old age. The mismatch between health perceptions and functional limitations suggests that these vulnerable older adults may not seek help from which they could benefit. These findings have major policy and planning implications for end-of-life care for the oldest old.     

Body composition in adults with Type 1 diabetes at onset and during the first year of insulin therapy.

AIMS: To describe body composition in patients with Type 1 diabetes at diagnosis and during the first year after initiation of insulin therapy. RESEARCH DESIGN AND METHODS: In 10 (eight male and two female) newly onset Type 1 patients, age 31.5 +/- 3.2 years (27-37 years) (sd and range), body mass index (BMI) 20.8 +/- 1.6 (19.2-23.4) kg/m2, body composition was estimated by means of dual-energy X-ray absorptiometry (DXA) whole body scanning supplemented by estimation of total body water (TBW) (isotope dilution technique with 3H2O) at diagnosis and after 1, 3, 6 and 12 months of insulin therapy. RESULTS: During the first year after onset of diabetes body weight (BW) increased 4.3 +/- 2.9 (0.1-8.3) kg (P = 0.0012) distributed as a 13.3% (1.6 kg) increase in total fat mass (FM) and 4.9% (2.5 kg) increase in lean body soft tissue mass (LBM). The self-reported weight loss at onset was 6.3 +/- 2.5 kg (1.5-10.0 kg). Compared with two reference populations the Metropolitan Life Insurance Co. and a healthy age and sex-matched local DXA scanned group the initial body composition data demonstrated BW 6.2 kg below ideal weight and a significant reduction of the FM (25% or -0.87 sd), whereas LBM was within the expected range. CONCLUSIONS: During the first year after onset of Type 1 diabetes the mean increase in BW is 6.5% with a 13.3% increase in FM and a 4.9% increase in LBM. Self-reported data on premorbid BW suggest an approximately 10% reduction in BW at onset of Type 1 diabetes. Compared with a healthy reference population initial body composition data demonstrate a 25% reduction of the FM, whereas only a minor and non-significant reduction in the LBM is encountered. These data indicate that uncontrolled diabetes is rather a fat catabolic state than, as previously believed, a protein catabolic state.     

The association of self-perception of body fat changes and quality of life in the Women's Interagency HIV Study

Body fat changes are of concern to HIV-seropositive adults on highly active antiretroviral therapy (HAART). Studies examining the association of body fat changes and quality of life (QOL) in the setting of HIV infection have been conducted predominately in men. We examined the relationship of self-perceived body fat change with QOL among 1671 HAART-using HIV-seropositive women (mean age 40±8 years; 54% African-American, 24% reporting <95% HAART adherence) from the Women's Interagency HIV Study. Self-perception of any fat loss was associated with lower overall QOL. Report of any peripheral fat loss was strongly associated with nearly all QOL domains (i.e., physical functioning, role functioning, energy/fatigue, social functioning, pain, emotional well-being, health perception, and perceived health index) except cognitive functioning, whereas report of any central fat loss was significantly associated with lower social and cognitive functioning. Report of any central fat gain was associated with lower overall QOL, but only physical functioning, energy/fatigue, and cognitive functioning were significantly affected. A significant association of report of any peripheral fat gain with overall QOL was not observed, however, peripheral fat gain was significantly associated with lower physical functioning and pain. We found that any report of fat loss, especially in peripheral body sites was associated with lower QOL, as was any report of central fat gain. Ultimately health providers and patients need to be informed of these associations so as to better support HIV-seropositive women who live with these effects.     

Evaluation of the association between the EQ-5D (health-related utility) and body mass index (obesity) in hospital-treated people with Type 1 diabetes, Type 2 diabetes and with no diagnosed diabetes.

AIMS: The purpose of this study was to characterize the impact of body mass index (BMI) on health-related utility for patients with Type 1 and Type 2 diabetes and those without diabetes. METHODS: The study was conducted in Cardiff and the Vale of Glamorgan, Wales, UK. Health-related utility was measured using the EQ-5D(index). Patients from the Health Outcomes Data Repository (HODaR) were surveyed by postal questionnaire either 6 weeks post discharge for in-patients or at out-patient clinics between January 2002 and July 2003. BMI was calculated from self-reported data within the survey. Patients with diabetes were identified by a previous history of an in-patient admission with diabetes or as an out-patient with diabetes recorded as a coexisting diagnosis. RESULTS: Questionnaires were returned from 27 924 patients of whom 2575 had diabetes. Increasing BMI was found to reduce utility in all three groups. BMI was significantly greater for those with Type 2 diabetes compared with those with Type 1, and those without diabetes (P < 0.001). Multiple regression analysis demonstrated that both BMI and diabetes status had a significant effect on utility. However, the rate of change of utility attributable to BMI was not found to be significantly different between the various groups. CONCLUSIONS: Obesity negatively impacts upon health-related utility and thus quality of life for all patient groups. There was no significant difference in the effect of obesity on utility between those with and without diabetes.     

The Role of Self-Efficacy in the Alzheimer's Family Caregiver Stress Process: A Partial Mediator between Physical Health and Depressive Symptoms

Physical health has been commonly regarded as an outcome in caregiving research; however, it may act as a predictor of depressive symptoms of caregivers. This current study investigated the relationship between physical health and depression in family caregivers of persons with Alzheimer's disease. Also, it examined caregiving self-efficacy as a possible mediator of the relationship. One hundred thirty-four family caregivers were interviewed. The caregivers self-reported their current physical health status, depressive symptoms, and perceived self-efficacy. Using a self-efficacy measure consisting of three subscales, path analyses were conducted to specifically assess these domains of caregiving self-efficacy. The results showed that poorer perceived physical health was directly and indirectly associated with increased depressive symptoms. The indirect path was mediated by the specific domain of caregivers' self-efficacy. These findings suggest that caregiving self-efficacy may function as a mechanism through which perceived physical health influences depressive symptoms, and this mechanism can be domain-specific.     

Persistence and Variation in Overweight and Obesity Among the Pre-school Population of the Community of Madrid After 2 Years of Follow-up. The ELOIN Cohort

Introduction and objectives

The childhood obesity epidemic is a worldwide public health problem which starts at very early ages. The aim of this study was to determine the persistence of and variation in overweight and obesity among a cohort of children followed up from 4 to 6 years of age.

房室结双径路慢径消融时连续AV非1∶1比例与短暂房室传导阻滞的相关性

目的分析房室结双径路导管射频消融时出现连续AV非1∶1比例与房室传导阻滞(AVB)发生的相关性及放电导致AVB的特点,为消融时预防AVB提供思路与方法。方法回顾113例房室结双径路的导管消融电生理资料,分析放电时AV的比例、波幅比值及患者性别、年龄等因素与出现AVB的相关性。结果放电时出现连续AV非1∶1比例时,短暂AVB的发生率显著高于无AV非1∶1比例者(36.84%vs 0.52%,P<0.05)。靶点腔内心电图呈小A大V,A波较宽、碎裂,不带有H波,在此基础上放电是否出现AVB与AV波幅比值无关(P>0.05)。女性AVB的发生率高于男性(34.78%vs 6.82%,P<0.05)。随访中未见AVB发生及室上性心动过速复发。结论放电时出现连续AV非1∶1比例可能发生AVB,须立即停止放电;女性患者更易出现AVB。