Nutritional form for the elderly is a reliable and valid instrument for the determination of undernutrition risk,and it is associated with health-related quality of life

Undernutrition is a common problem associated with clinical complications such as impaired immune response, reduced muscle strength, impaired wound healing, and susceptibility to infections; therefore, it is an important treatment target to reduce morbidity and mortality associated with chronic diseases and aging. The aim of the present study was to apply a reliable and valid instrument for the determination of undernutrition risk in an in-hospital patient population and to describe possible associations between risk of undernutrition and some aspects of health-related quality of life in patients with chronic diseases. Fifty-six adult patients with different chronic diseases were interviewed with NUFFE questionnaire and the EQ-5D. Anthropometric measurements were performed. Reliability and validity of the NUFFE instrument was tested, and its correlation with EQ-5D was calculated. Euro-Qol scores correlated significantly with the total NUFFE scores and with the items constructing the most important factor of the instrument, explaining 53.74% of its variance. Nutritional form for the elderly was shown to be a reliable instrument in the study group because its internal consistency measured by Cronbach α was 0.62, and the item-total score correlations were significant for the half of the items. Criterion-related validity, concurrent validity, and construct validity of NUFFE were established. We have shown that impaired level of health-related quality of life is an important determinant of risk for undernutrition. Nutritional form for the elderly is an appropriate instrument to estimate undernutrition risk in a general, in-hospital patient population with various chronic diseases and to identify “at risk” patients who may benefit from professional dietary interventions to reduce undernutrition-related complications.     

乌鲁木齐市老年结核患者健康相关生命质量评价

目的 了解乌鲁木齐市老年结核病患者的生命质量状况。方法 选取2016年4月 - 2017年4月乌鲁木齐市204名60岁以上确诊结核病人,根据年龄、性别、民族1∶2匹配对照组,采用SF - 36量表进行问卷调查并收集两组基本信息,采用统计分析系统SAS 9.4软件对数据进行多重线性回归分析影响老年结核病患者生命质量的因素。结果 SF - 36量表各维度评分显示除BP维度（z = 1.064,P = 0.288）外,其余维度及PCS、MCS、总评分上2组差异均有统计学意义（P＜0.05)。单因素分析,性别、文化程度、退休前职业、婚姻状况、个人收入、独居、饮酒、吸烟、体育锻炼、糖尿病史和冠心病史对老年结核患者的生命质量有不同程度的影响。多重线性回归显示个人收入会影响BP和MH维度（F = 4.38,P = 0.038和F = 7.60,P = 0.006）,独居是GH的影响因素（与配偶居住F = 9.29,P = 0.003;与子女居住F = 5.92,P = 0.016）,吸烟会影响RE、MCS和总评分（F = 4.89,P = 0.028;F = 8.71,P = 0.004和F = 7.21,P = 0.008）,冠心病史是PF、RP的影响因素（F = 9.01,P = 0.003;F = 5.74,P = 0.018）,而体育锻炼会影响PF、PCS及总评分（F = 29.09,P＜0.001;F = 8.62,P = 0.004;F = 6.50,P = 0.012）。结论 老年肺结核患者的健康相关生命质量较低,相关因素的改善有助于提高老年肺结核患者的生命质量。     

Assessing quality of life in eating disorder patients

Objective: To examine quality of life among subgroups of eating disorder patients. Method: Self-report questionnaires which included two quality of life measures were completed by 87 individuals referred for treatment to the Australian Capital Territory Eating Disorders Day Program. Health-related quality of life, as measured by the Medical Outcomes Study 12-item Short Form Mental Component Summary scale, and subjective quality of life, as measured by subscales of the World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF), were compared among individuals who received the diagnosis of anorexia nervosa purging subtype (n=15), anorexia nervosa restricting subtype (n=19), bulimia nervosa (n=40) and binge eating disorder (n=10), and among a general population sample of young adult women employed as a control group (n=495). Results: Eating disorder patients, when considered together, showed marked impairment in both health-related and subjective quality of life relative to normal control subjects. However, in both domains, restricting anorexia nervosa patients reported significantly better quality of life than other patient groups, after controlling for levels of general psychological distress. Scores on the Social Relationships subscale of the WHOQOL-BREF among individuals in this subgroup were similar to those of normal control subjects. Conclusions: Reliance on any one instrument is likely to be misleading in assessing the quality of life of eating disorder patients. Careful consideration needs to be given to the assessment of restricting anorexia nervosa patients in particular.     

空巢老年人健康相关生存质量及空巢社会因素研究

目的 分析≥60岁空巢老年人健康相关生存质量现状及空巢相关社会因素,为制定健康老龄化相关策略和措施提供依据.方法 采用整群抽样方法 选取浙江省部分地区城乡≥60岁老年人4995名.采用逐步logistic回归进行空巢社会因素的多因素分析.用多元线性回归模型在校正混杂因素后,比较空巢和非空巢老年人的健康相关生存质量.结果 逐步logistic回归分析显示,与非空巢老年人相比较,空巢老年人年龄多集中在70～79岁(P=0.0417),文化程度高(P＜0.0001),以及居住于农村(P＜0.0001)和低收入者(P=0.0178,P=0.0049)趋向于空巢的概率较大.空巢老年人较非空巢者对生活的满意度较高(P=0.0070,P=0.0035),情绪状态较好(P=0.0371).多元线性回归在校正了年龄、性别、婚姻状况、文化程度、居住地、个人年收入以及生活满意度评分和情绪评分等因素后,结果 显示空巢老年人在生理领域中的躯体疼痛(P=0.0032)维度,心理领域的情感所致功能限制(P=0.0033)维度以及心理领域(P=0.0342)的得分较非空巢老年人低.结论 空巢老年人的健康相关生存质量低于非空巢者,尤其体现在心理功能方面.空巢老年人具有高文化程度、低收入以及居住于农村等特征,是实施健康老龄化需要重点关注的对象.     

Coping,meaning in life,and quality of life in congestive heart failure patients

OBJECTIVE: The present study examined (1) whether particular coping strategies used to deal with congestive heart failure (CHF) are related to meaning in life across time, and (2) whether meaning in life mediates the effect of coping on health-related quality of life. METHODS: A sample of 155 CHF patients received questionnaire packets at two time points, 6 months apart. Main outcome measures included Meaning in Life and Mental and Physical Health-Related Quality of Life (HRQOL). RESULTS: Coping (particularly acceptance/positive reinterpretation and religious coping) was not only related to meaning in life, but also to increased meaning over time. Further, meaning in life was related to both mental and physical components of HRQOL. However, coping was minimally related to HRQOL and its effects were not mediated by meaning in life. CONCLUSIONS: These results add to accumulating evidence that life meaning is important in the context of living with a chronic, life-threatening illness. Further, coping--especially acceptance and religious coping--is related to increased life meaning over time in the context of life limiting illness.     

Individual quality of life in the healthy elderly

Quality of life research with the elderly has usually focused on the impact of decline in function, and used a pre-determined model of quality of life in old age. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) allows individuals to nominate, weigh and assess those domains of greatest relevance to their quality of life. The SEIQoL was administered to 56 healthy elderly community residents at baseline and 12 months later. Quality of life levels were significantly higher at baseline (t=–2.04; p=0.04) than that of a previously studied sample of healthy adults below 65 years of age, and did not change significantly over the study period. The domains nominated by both samples as relevant to their quality of life differed notably. Health status was not correlated with the perceived importance of health at baseline, and showed only a low correlation (r=0.27) at 12 months. The weight placed on health did not increase over the study period despite a significant decline in health status. The value of allowing the individual to define personal quality of life values in a research context is explored.Funding for this study was provided by Ciba Ltd, the Dhole Bursary of the British Geriatrics Society and by the Royal College of Surgeons in Ireland.     

Health-related quality of life (HRQoL) in patients with cancer and other concurrent illnesses

This study analyzed the impact of eight common chronic medical conditions on cancer patients' health-related quality of life (HRQoL) as measured by the functional living index-cancer (FLIC). The FLIC was administered to a population of 405 people in 14 communities in the North Central US within 4-8 weeks of diagnosis with breast or colorectal cancer. At that time, patients also self-reported any other health conditions for which they had been receiving medical treatment. The impact of the selected chronic conditions on the FLIC scores was analyzed using Student's t-tests and linear multiple regression. In the bivariate analysis, patients with heart/circulation problems had lower FLIC total scores (p < 0.05), physical well-being subscale scores (p < 0.05), and nausea subscale scores (p < 0.01). Patients with diabetes had lower nausea subscale scores (p < 0.05). The social well-being subscale score was higher with the report of arthritis/joint problems (p = 0.001). In multivariate analysis adjusted for age, arthritis/joint problems were predictive of the social well-being (p < 0.01) and hardship due to cancer (p < 0.05) subscale scores; heart/circulation problems (p < 0.001) and diabetes were predictive of the nausea subscale scores. ECOG performance status was significant predictor for the FLIC total and all of the subscale scores. HRQoL as measured with the FLIC scores in patients with cancer is impacted by the presence of other concurrent health conditions; this finding has implications for HRQoL theory and application.     

Health-related quality of life as a predictor of mortality among community-dwelling older persons

Health-related quality of life (HRQOL) measures predict cause-specific mortality, but few studies have explored whether generic self-reported HRQOL measures are independently associated with mortality in community-dwelling older persons. We postulated that a general measure of HRQOL, the short form 36-item questionnaire (SF-36), would be independently predictive of mortality among community-dwelling older persons. To evaluate this hypothesis, we followed a fixed cohort of 4,424 community-dwelling older persons recruited from a 2000 population-based survey in Taiwan until 2003 and investigated whether HRQOL was predictive of 3-year mortality, even after adjusting for traditional clinical risk variables. The data were collected via a door-to-door survey, and interviewers collected information on the subjects’ demographics, medical history, utilization of health services, functional ability, falls, and self-reported physical and mental symptoms. Of the 6053 eligible subjects, 4,424 residents agreed to participate in the baseline survey and were contacted in 2003. During the 3-year period, the 3-year cumulative mortality rate for the study population was 5%. Mortality was significantly higher among males (5.57% vs. 4.27%, p = 0.049), and cumulative mortality increased with age (χ ²-test for trend; χ ² = 7.734, p = 0.001). For all scales except bodily pain, there was a significant relationship between a 10-point lower baseline score and mortality. Our primary multivariate risk model, which included two summary measures of HRQOL and significant clinical variables, demonstrated that a 10-point decrease in either the baseline Physical Component Summary (PCS) score or the baseline Mental Component Summary (MCS) score was associated with higher mortality (PCS: RR: 1.60, 95% CI: 1.39–1.83; p < 0.001; MCS: RR: 1.16, 95% CI: 1.01–1.34; p = 0.036). The findings suggested that low baseline PCS and MCS scores were important independent risk factors for 3-year mortality among community-dwelling older persons, even after adjusting for other risk factors.     

The Nottingham Health Profile as a measure of quality of life in zoster patients: convergent and discriminant validity

The main symptoms of zoster, a disease caused by the reactivation of the varicella zoster virus (that causes chicken-pox) are: rash, associated with pain, burning, or itching, and pain that outlasts the rash sometimes by months or years. The uncomfortable and long-lasting symptoms of herpes zoster are likely to compromise the patient's quality of life. However, the impact of zoster on health-related quality of life has not previously been measured directly. Recent papers have demonstrated the ability of generic measures to discriminate among patients with different clinical symptoms. In this paper, we demonstrate the convergent validity for zoster of a generic measure, the Nottingham Health Profile (NHP), by measuring its correlation with rash progression, pain levels, and pain medications. The discriminant validity of the NHP was demonstrated by its ability to distinguish between different levels of pain severity. The NHP dimensions most highly correlated with the pain measures, were pain (0.42–0.50), energy (0.34–0.38) and sleep (0.32–0.38). The NHP scores in all six dimensions show large differences at different levels of pain severity that are statistically significant. These results demonstrate the NHP's validity as a measure of health-related quality of life in zoster patients.     

四川省空巢老人生命质量及影响因素研究

目的 了解四川省空巢老人的生命质量现状并探讨其影响因素,为提高空巢老人生命质量提供参考依据。 方法 本资料来源于2018年国家第六次卫生服务调查四川省调查数据,健康相关生命质量用EQ-5D效用值和EQ-VAS得分进行衡量。采用两水平方差成分模型探索空巢老人生命质量的影响因素。结果 共调查4587名空巢老人, EQ-5D 效用值平均为(74.05±1.39) 分,VAS评分平均为(66.54±0.278) 分。年龄较小、文化程度较高、就业状态为在业、12个月内未饮酒、经常参加体育锻炼、无高血压和糖尿病的空巢老人EQ-5D效用值较高。结论 空巢老人的生命质量整体偏低。可通过倡导健康行为、提高健康意识、加强慢性病防控等途径来提高空巢老人生命质量。     

Factors associated with health-related quality of life: the role of social relationships among the elderly in an Italian region

OBJECTIVES: This study examines the association between social relationships and health-related quality of life (HRQL) in the elderly in Lazio Region, Italy, a Mediterranean country where the shape and role of social links has dramatically changed. METHODS: Data were extracted from a national cross-sectional survey in Italy, representative of the non-institutionalised population aged 60 years and over resident in Lazio Region during 1999--2000. HRQL was measured with the Short Health Survey Questionnaire (SF-12). Data analysis was performed using multiple linear regression models using adjustment for the main confounders. RESULTS: Among the sample, 40.4% of the elderly were not married and 27.1 % were living alone. While being married and not living alone were associated with higher scores in the physical and mental quality-of-life components (P-value<0.001), more frequent visiting/seeing friends was likely to be associated with higher scores in both the physical and the mental health components (P-value<0.05). Multiple logistic regression analysis demonstrated that low physical health scores were associated with a low frequency of meeting with relatives and with living far from relatives. CONCLUSIONS: In a region covering 9.2% of the whole Italian population, only a small proportion of the elderly lack frequent social ties, yet low frequency of relationships with friends is associated with a decline in quality of life measured through mental and physical scores. Our findings will be useful for drawing up welfare strategies both at the national and at the Mediterranean level, in countries, like Italy, where the primacy of family support of the elderly has been decreasing in recent years.     

Adolescent health-related quality of life and perceived satisfaction with life

Purpose: To explore the relationship between perceived satisfaction with life and health-related quality of life (HRQOL) in a state-wide sample of 13–18-year-old adolescents (n=4914) in South Carolina, USA. Methods: Questions were added to the self-report Centers for Disease Control (CDC) Youth Risk Behavior Survey (YRBS) asking about perceived life satisfaction in six domains (self, family, friends, living environment, school, and overall) and HRQOL (self-rated health; and the number of poor physical health days, poor mental days, and activity limitation days during the past 30 days). Results: Adjusted logistic regression analyses and multivariate models constructed separately revealed that self-rated health, poor physical days (past 30 days), poor mental health days (past 30 days), and activity limitation days (past 30 days) were significantly related (p < 0.05) to reduced life satisfaction, regardless of race or gender. Moreover, as the number of reported poor health days increased, the greater the odds of reporting life dissatisfaction. Conclusions: This is the first study to document the relationship between poor physical health and perceived life satisfaction. This adds to the mounting evidence that life satisfaction is related to a variety of adolescent health behaviors and that life satisfaction may add additional information in longitudinal databases that track adolescent health because it appears to be related to HRQOL.     

Psychological acceptance and quality of life in the elderly

Many changes occur as people enter old age (e.g., declining productivity), and these changes may at times decrease quality of life. Do some people maintain high subjective quality of life despite these changes? This study investigated the influence of psychological acceptance (PA) on quality of life in a sample of 187 elderly from a home nursing service, a retirement village and various community groups. Average age was 78 years old with a range from 65 to 96. We administered a measure of psychological acceptance and The Comprehensive Quality of Life Scale (COMQol). As hypothesised, people higher in PA also had higher quality of life in the areas of health, safety, community participation and emotional well-being. In addition, individuals high in PA had less adverse psychological reactions to decreasing productivity. Interventions that increase PA may lead to improved quality of life and resilience amongst the elderly.     

Health-related quality of life and health utility for the institutional elderly in Taiwan

Objective: To explore the health-related quality of life (HRQOL) and health utility in an institutional elderly population. Methods: Four hundred sixty-five elderly persons living in long-term care institutions in Taiwan were interviewed using Taiwans abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF), rating scale (RS) and the Time-Trade-Off (TTO) utility measurement. Results: The WHOQOL-BREF showed acceptable internal consistency ( range: 0.75–0.80 across domains) and validity. The sexual activity facet had the lowest response rate. Educational level, number of chronic diseases, physical performance, and number of caregivers had significant (p < 0.05) impacts on the domain scores of the WHOQOL-BREF. Physical performance had the strongest impact on the physical domain (R²=0.40) and accounted for significant percentages of the variance on the other three domains (R²=0.06–0.13). The mean RS score (score 0–100) was 61.3 ± 16.2 (mean ± SD). The mean TTO utility (score 0–1) was 0.92 ± 0.22. Conclusions: Results indicate that the WHOQOL-BREF, excepting the sexual activity item, is useful for evaluating HRQOL of conscious elderly in institutions. The validity of TTO utility for studying the institutionalized elderly needs further evaluation.     

Order effects in the assessment of quality of life in cancer patients

Methodological studies and outcome research often include several health-related quality of life (HRQoL) measurement scales in one questionnaire. Psychological studies have previously demonstrated that changing the sequential order of measurement scales within a questionnaire can alter the pattern of responses. Little is known, however, about whether there are order effects on the assessment of HRQoL in cancer patients. Here we address this issue in a study of 190 Singaporean cancer patients who were assessed using two different HRQoL instruments placed in alternating sequence within a questionnaire package. Measurement properties of the instruments, including the number of missing values, means, variability, known-group validity and internal consistency, were compared in the two samples representing different presentation orders. The HRQoL instruments administered in different sequential orders appeared to be equivalent in several aspects. No major effect of presentation order on outcomes was shown. The reasons and implications of the absence of an order effect are discussed. We conclude that presentation order is unlikely to alter the responses to the two HRQoL instruments.     

河北省老年人生存质量现状及影响因素

目的 了解影响河北省老年人生活质量的因素,为采取相应的干预措施提供依据.方法 采用世界卫生组织编制的《世界卫生组织生存质量测定表简表》(WHOQOL-BREF)和自编一般情况问卷对唐山、张家口820名老年人(≥60岁)进行问卷调查.结果 河北省老年人生存质量的生理领域、心理领域、社会领域、环境领域得分分别为(59.05±16.89)、(59.27±14.94)、(63.57±15.04)、(56.61±14.70)分,除社会领域外其他均显著低于常模水平(P＜0.01).城乡、年龄、文化程度、婚姻状况、收入、家庭居住方式、家庭功能和慢性疾病与河北省老年人生活质量有密切关系.结论 河北省老年人的生活质量整体较差,我们应更多地关注无配偶、独居、低收入、受教育程度低、患有慢性疾病的老年人.     

Validation of the EQ-5D quality of life instrument in patients after myocardial infarction

Background: We assessed cross-sectional validity of EQ-5D after myocardial infarction (MI). Methods: We compared EQ-5D, SF-36, quality of life After MI (QLMI), and Canadian Cardiovascular Society Anginal Classification (CCSG) scores. Correlation and regression techniques were used to assess convergent validity. SF-36 and alternate Rand-36 scoring were compared. CCSG class was used to evaluate discriminative validity and clinical difference in health state scores. Results: Of 99 patients: mean age 64; median 176.5 days post-MI; 80% had one MI; 74% were CCSG I. 1/3 to 1/2 reported mobility, self-care, pain, and emotional difficulties on EQ-5D. Median health state was 0.73. EQ-5D and SF-36 (or Rand-36) strongly correlate in overall health (0.75), emotional health (0.75), pain (0.68), and activity/ functional (0.5–0.63). EQ-5D and QLMI strongly correlate in activities/ self esteem (0.56), emotional health (0.64), anxiety/depression – restriction (0.53), and overall health (0.5–0.57). EQ-5D self-care correlates weakly with all domains. Domain scores from each general instrument contributed to each other’s overall health score (adjusted R² 0.61–0.69) and to disease specific score (0.45 adjusted R²). EQ-5D discriminates among CCSG classes (p < 0.000). Physicians detected a 0.16 difference in health state scores. Conclusion: The EQ-5D provides valid general HrQOL measurement post-MI.     

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.