A comparison of health-related quality of life between older adults with heart failure and healthy older adults

BACKGROUND: Health-related quality of life (HRQOL) in older adults with heart failure may be affected by a variety of variables including aging. It is important to determine the unique impact of heart failure to more effectively improve HRQOL in this population. OBJECTIVE: The purpose of this study was to compare HRQOL and physical, psychologic, clinical, and sociodemographic status in older adults with and without heart failure. METHODS: The HRQOL of 90 older adults with heart failure and 116 healthy older adults was compared. The factors best associated with HRQOL in each group were determined using multiple regression model. RESULTS: HRQOL was substantially worse among older adults with heart failure than among healthy older adults. Older adults with heart failure had more severe physical and emotional symptoms, poorer functional status, and worse health perceptions. Physical symptom status was the strongest predictor of HRQOL in both groups. In addition, in older adults with heart failure, physical symptom status, age, and anxiety were related to HRQOL. CONCLUSION: The poor HRQOL seen in patients with heart failure is not just a reflection of aging. Comprehensive interventions targeted toward the factors that specifically negatively impact HRQOL are essential in older adults with heart failure.     

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.     

A drink to healthy aging: The association between older women's use of alcohol and their health-related quality of life

OBJECTIVES: To assess the relationship between alcohol intake and mortality in a cohort of women aged 70 and older and to explore the relationship between level of alcohol use and changes in physical and mental health-related quality of life. DESIGN: National longitudinal surveys from 1996 to 2002. SETTING: Community based. PARTICIPANTS: A national random sample of 12,432 Australian women aged 70 to 75 at baseline. MEASUREMENTS: Alcohol consumption was the factor of interest, and the main outcome measures were survival and health-related quality of life, with adjustment for potential confounders. RESULTS: Women who did not consume alcohol or who drank rarely were more likely to die (nondrinkers' hazard (HR) = ratio 1.94, 95% confidence interval (CI) = 1.4-2.6; rare drinkers' HR = 1.58, 95% CI = 1.2-2.1) than women in the low-intake reference category (1-2 drinks per day, 3-6 days per week), or if they survived, they had lower health-related quality-of-life scores on the General Health and Physical Functioning subscales of the Medical Outcomes Study 36-item Short Form Survey after adjustment for smoking, comorbidity, education, body mass index, and area of residence. Nondrinkers also scored lower on the Mental Health and Social Functioning subscales. CONCLUSION: Being a nondrinker of alcohol was associated with greater risk of death and poorer health-related quality of life. Results for other levels of intake were consistent with current Australian alcohol consumption recommendations for women and indicated that moderate alcohol intake may carry some health benefits for older women in terms of survival and quality of life.     

Hip fracture outcomes: quality of life and functional status in older adults living in the community

Abstract Background : People who return to living in the community after a hip fracture are considered to have the best outcome. However, their quality of life (QOL) and its relationship with function over the longer term have not been fully assessed.
Aims : This case control study of community dwelling subjects six to 12 months post hip fracture aims to investigate their QOL and functional independence.
Method : The Short Form-36 (SF-36) was utilised to measure QOL. The Modified Barthel Index (MBI), the Frenchay Activities of Daily Living Index (FAI), the Timed `Up & Go' (TUG), and the Berg Balance Scale (Berg) were used to measure functionality.
Results : Ninety-two subjects and 92 controls were recruited. Despite being age and gender matched, the hip fracture subjects scored significantly ( p <0.05) worse than the controls in all measures of function. The fracture group was slower on the TUG (19 vs 10.5 seconds), had more difficulties with balance (46 vs 54 out of 56), and was less active and more dependant than the control group (FAI 24 vs 31 out of 42). The SF-36 has eight domains: physical function, role physical, bodily pain, mental health, role emotional, social function, general health and vitality. The control group had a higher ( p <0.05) perception of their QOL in all domains.
Conclusion : The effects of impaired balance and mobility along with reduced functional and social independence are reflected in the diminished QOL perceived by the fracture group. This indicates that many do not return to their pre-fracture lifestyle.     

Day care centre attendance and quality of life in depressed older adults living in the community

Late-life depression is associated with disabled functioning and a poor quality of life (QOL). The aim of this cross-sectional study was to find out whether the attendance of a day care centre (DC) was associated with QOL in community-dwelling older adults suffering from a depressive disorder without dementia. The study enrolled 149 depressed older adults aged 70 or older, who consecutively underwent a comprehensive geriatric assessment from April to July 2008 at the Geriatric Medicine Unit of the Fondazione Ospedale Maggiore Policlinico in Milan, Italy. QOL was evaluated by means of the European Quality of Life Visual Analogue Scale (EuroQol VAS). DC attendance was quantified as number of days of attendance per week in the past month. Participants attending a DC at least once a week (n = 17) had a higher mean EuroQol VAS score than non-attendants (n = 132) (mean ± SD 58.8 ± 19 vs. 45.3 ± 22.5; P = 0.019). In multiple linear regression analysis a higher weekly attendance of DCs was related to a better quality of life according to the EuroQol VAS score (unstandardized coefficient 3.048, 95% CI 0.063–6.033, P = 0.045) after correction for age, sex, balance and gait abilities, comorbidity, pharmacotherapy, living alone, and severity of depression. Therefore, in older outpatients suffering from a depressive disorder without dementia the attendance of a DC was an independent correlate of the QOL. A randomized controlled longitudinal study will be necessary to determine whether attending a DC is really effective on the QOL in the management of late-life depression.     

Oral health-related quality of life and loneliness among older adults

Loneliness is a serious concern in aging populations. The key risk factors include poor health, depression, poor material circumstances, and low social participation and social support. Oral disease and tooth loss have a significant negative impact on the quality of life and well-being of older adults. However, there is a lack of studies relating oral health to loneliness. This study investigated the association between oral health-related quality of life (through the use of the oral impact on daily performances—OIDP—measure) and loneliness amongst older adults living in England. Data from respondents aged 50 and older from the third (2006–2007) and fifth (2010–2011) waves of the English Longitudinal Study of Ageing were analyzed. In the cross-sectional logistic regression model that adjusted for socio-demographic, socio-economic, health, and psychosocial factors, the odds of loneliness were 1.48 (1.16–1.88; p < 0.01) higher amongst those who reported at least one oral impact compared to those with no oral impact. Similarly, in the fully adjusted longitudinal model, respondents who reported an incident oral impact were 1.56 times (1.09–2.25; p < 0.05) more likely to become lonely. The association between oral health-related quality of life and loneliness was attenuated after adjusting for depressive symptoms, low social participation, and social support. Oral health-related quality of life was identified as an independent risk factor for loneliness amongst older adults. Maintaining good oral health in older age may be a protective factor against loneliness.     

The relationship between expectations for aging and physical activity among older adults

BACKGROUND: New strategies to increase physical activity among sedentary older adults are urgently needed. OBJECTIVE: To examine whether low expectations regarding aging (age-expectations) are associated with low physical activity levels among older adults. DESIGN: Cross-sectional survey. PARTICIPANTS: Six hundred and thirty-six English- and Spanish-speaking adults aged 65 years and above attending 14 community-based senior centers in the Los Angeles region. Over 44% were non-Latino whites, 15% were African American, and 36% were Latino. The mean age was 77 years (range 65 to 100). MEASUREMENTS: Self-administered written surveys including previously tested measures of age-expectations and physical activity level in the previous week. RESULTS: Over 38% of participants reported <30 minutes of moderate-vigorous physical activity in the previous week. Older adults with lower age-expectations were more likely to report this very low level of physical activity than those with high age-expectations, even after controlling for the independent effect of age, sex, ethnicity, level of education, physical and mental health-related quality of life, comorbidity, activities of daily living impairment, depressive symptoms, self-efficacy, survey language, and clustering at the senior center. Compared with the quintile of participants having the highest age-expectations, participants with the lowest quintile of age-expectations had an adjusted odds ratio of 2.6 (95% confidence intervals: 1.5, 4.5) of reporting <30 minutes of moderate-vigorous physical activity in the previous week. CONCLUSIONS: In this diverse sample of older adults recruited from senior centers, low age-expectations are independently associated with very low levels of physical activity. Harboring low age-expectations may act as a barrier to physical activity among sedentary older adults.     

The impact of hearing loss on quality of life in older adults

PURPOSE: The authors investigate the impact of hearing loss on quality of life in a large population of older adults. DESIGN AND METHODS: Data are from the 5-year follow-up Epidemiology of Hearing Loss Study, a population-based longitudinal study of age-related hearing impairment conducted in Beaver Dam, WI. Participants (N = 2,688) were 53-97 years old (mean = 69 years) and 42% were male. Difficulties with communication were assessed by using the Hearing Handicap for the Elderly-Screening version (HHIE-S), with additional questions regarding communication difficulties in specific situations. Health-related quality of life was assessed by using measures of activities of daily living (ADLs), instrumental ADLs (IADLs) and the Short Form 36 Health Survey (SF-36). Hearing loss measured by audiometry was categorized on the basis of the pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz. RESULTS: Of participants, 28% had a mild hearing loss and 24% had a moderate to severe hearing loss. Severity of hearing loss was significantly associated with having a hearing handicap and with self-reported communication difficulties. Individuals with moderate to severe hearing loss were more likely than individuals without hearing loss to have impaired ADLs and IADLs. Severity of hearing loss was significantly associated with decreased function in both the Mental Component Summary score and the Physical Component Summary score of the SF-36 as well as with six of the eight individual domain scores. IMPLICATIONS: Severity of hearing loss is associated with reduced quality of life in older adults.     

The interplay between life stressors and depressive symptoms among older adults

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.     

The relationship between sociodemographic factors and oral health-related quality of life in dentate and edentulous community-dwelling older adults

OBJECTIVES: To quantify the associations between sociodemographic factors and oral health-related quality of life (OHRQoL) in dentate and edentulous community-dwelling older adults. DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural). PARTICIPANTS: Two hundred eighty-eight participants (Dental Study subjects) aged 65 and older were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in older African Americans and non-Hispanic whites. MEASUREMENTS: Dental Study subjects were queried on their OHRQoL and sociodemographic status and classified into two categories: dentate and edentulous. Bivariate analyses were used to quantify associations between sociodemographic variables and OHRQoL after excluding participants with severe depression. Variables included age, sex, race, marital status, veteran status, residence, income, education, and transportation difficulties. RESULTS: Dentate and edentulous subjects had similar OHRQoL across age, sex, marital status, veteran status, and residence. Analyses suggested a strong association between OHRQoL and race, education, income, and transportation difficulties in dentate subjects. Sociodemographic factors were less strongly associated with OHRQoL in edentulous participants. CONCLUSION: OHRQoL decrements were prevalent in dentate and edentulous subjects. Of dentate persons, African Americans and those with a 6th-grade education or less, with income less than 16,000 dollars/year, and with transportation difficulties were more likely to have decrements in OHRQoL. In edentulous persons, these associations were not statistically significant or were weaker. These findings suggest differential associations between sociodemographic factors and OHRQoL when stratified according to dentate status.     

Components and determinants of quality of life in community-dwelling older adults

The objectives of this study are to detect the main components of global quality of life (QoL) of community-dwelling older adults from their own perspective and to identify determinants of health-related and global QoL in the same population. This is a cross-sectional study covering a representative sample of 1,106 community-dwelling adults aged 60 years and older residing in Spain. The survey collected information on QoL through a face-to-face interview asking for QoL components in free-format, as well as the completion of two QoL measures, the EQ-5D and the Personal Wellbeing Index. The most important QoL dimensions, according to the participants of this study, were health, family, and finances. Depression was the main determinant of both QoL indices, while functional independence and social support specifically influenced health-related and global QoL, respectively. Based on the perspective of the older adults as well as on statistical analysis, this work emphasizes the importance of health, family, and social support as areas of special interest in aging. There was a discrepancy when comparing findings related to the importance of financial status. Results also support that global and health-related QoL share some common determinants, but with different weights for functional independence and social support.     

Combined effects of frailty status and cognitive impairment on health-related quality of life among community dwelling older adults

ObjectivesThe aim of the present study was to investigate the combined association of frailty/pre-frailty and cognitive impairment with health related quality of life (HRQOL) among community dwelling older adults.MethodsData came from a cross-sectional study of community-dwelling older adults aged 65 years or older, who participated in the 2013 National Health Interview Survey in Taiwan. Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. The Mini-Mental State Examination was used to assess cognitive function. HRQOL was measured using the European Quality of Life-5 Dimensions questionnaire (EQ-5D) that assesses three levels of functioning for the dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Poisson regression models were performed to estimate prevalence ratios (PR) and 95 % Confidence Intervals (95 % CI) for health problems in all EQ-5D domains.ResultsIn this study, 11.0 % of participants aged 65 years and older had co-occurring frailty/pre-frailty and cognitive impairment. After adjustment for other factors, compared with participants who were physically robust with normal cognition, participants with co-occurring frailty/pre-frailty and cognitive impairment had PRs of 10.38 (95 % CI 7.56–14.26), 9.66 (95 % CI 6.03–15.48), 9.37 (95 % CI 6.92–12.68), 3.04 (95 % CI 2.53–3.64), and 5.63 (95 % CI 3.83–8.28) for reporting problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, respectively.ConclusionsThere is a high prevalence of co-occurrence of frailty/pre-frailty and cognitive impairment in older adults, and this co-occurrence was strongly associated with self-reported health problems across all EQ-5D domains.     

The aging process and potential interventions to extend life expectancy

Aging is commonly defined as the accumulation of diverse deleterious changes occurring in cells and tissues with advancing age that are responsible for the increased risk of disease and death. The major theories of aging are all specific of a particular cause of aging, providing useful and important insights for the understanding of age-related physiological changes. However, a global view of them is needed when debating of a process which is still obscure in some of its aspects. In this context, the search for a single cause of aging has recently been replaced by the view of aging as an extremely complex, multifactorial process. Therefore, the different theories of aging should not be considered as mutually exclusive, but complementary of others in the explanation of some or all the features of the normal aging process. To date, no convincing evidence showing the administration of existing “anti-aging” remedies can slow aging or increase longevity in humans is available. Nevertheless, several studies on animal models have shown that aging rates and life expectancy can be modified. The present review provides an overlook of the most commonly accepted theories of aging, providing current evidence of those interventions aimed at modifying the aging process.     

The association between frailty and quality of life when aging in place

Background and objectivesAdvanced age is often associated with frailty, which in turn is associated with low quality of life. This study explores to what extent multidimensional frailty is associated with multidimensional quality of life.Material and methodsA cross-sectional survey study was conducted in a sample of 336 Flemish older people aging in place. Data were collected between 2014 and 2016 using two multidimensional self-reporting instruments; the Comprehensive Frailty Assessment Instrument to assess frailty and the World Health Organization Quality of Life Instrument-Short Version to assess quality of life. Bivariate analyses were used to explore the relationship between quality of life, associated factors of quality of life and frailty.ResultsThe mean age of the respondents was 74.9 years and 71.7% were woman. An inverse correlation was found between frailty and quality of life (r = −.683) and the corresponding subdomains. Nevertheless, some respondents perceived their quality of life as high, although they were defined as mild to high frail. Further analysis indicated that neither socio-demographic factors nor being ill contributed to quality of life.Discussion and implicationsPsychological frailty contributed the most to quality of life. However, the results indicate that frailty does not inevitably leads to a lower quality of life and that other factors, besides frailty, play an important role in determining quality of life. Knowledge about these factors and their mutual relationship can help policymakers and services in providing client-centered care to increase or maintain the quality of life of people aging in place.     

The association of activity and participation with quality of life between Japanese older adults living in rural and urban areas

Background/PurposeQuality of life (QOL) is an important health outcome of the aged population, and it is determined by many factors. Evidence shows that the place where older people live is associated with their health and QOL; however, the environmental factors of QOL have not been clearly investigated. Therefore, the purpose of our study was to verify the difference in QOL between Japanese elderly people living in rural and urban areas and the role of activity and participation routine in their QOL.MethodsParticipants were 830 community-dwelling older adults recruited in a municipal college in an urban area (n = 550, age = 68.5 ± 4.3 years) and in a health center in a rural area (n = 280, age = 69.8 ± 7.8 years), both in Japan. QOL was assessed by WHOQOL-BREF and WHOQOL-OLD, both developed by the World Health Organization. The occupational routine was measured by a questionnaire concerning frequency of engagement in several activities. Variables were compared by t test, Chi-square test and the Mann–Whitney U test. Additionally, multiple regression analysis was used to verify the relation between QOL and occupational routine.ResultsParticipants living in the urban area had higher QOL scores than those living in the rural area (BREF urban = 3.68 ± 0.42 vs. rural = 3.43 ± 0.40, p < 0.01; OLD urban = 3.56 ± 0.42 vs. rural = 3.46 ± 0.41, p < 0.05). In WHOQOL-BREF, physical, work, and reading and writing activities were positively related with QOL in the urban group; and physical and art activities in rural participants. In WHOQOL-OLD, no difference was found; however, social activity was important for both groups.ConclusionOur findings showed that QOL states and related occupational routine differed between urban and rural areas. Urban participants had better QOL scores than rural ones and (among the activities) physical, work, and reading and writing activities were associated with their QOL. For the rural group, physical and art activities were important. Furthermore, social activity was an important activity for QOL in both populations.