Is the overall survival for older adults with AML finally improving?

Older adults with acute myeloid leukemia (AML) traditionally have very poor survival outcomes. Those who receive only supportive care have worse overall survival than those who undergo treatment, regardless of treatment type, and improvements in overall survival in the last several decades are largely attributable to the increasing decision to treat rather than offer only supportive care. However, there are a few newer agents that appear promising; these include CPX-351 (a liposomal product with cytarabine and daunorubicin), glasdegib (a selective Hedgehog signaling pathway inhibitor), and venetoclax (potent small molecule inhibitor of BCL2). A systematic review and meta-analysis is being completed to help clinicians optimize standard therapies for older AML patients.     

Does quality of life evidence assist in the selection of patients for resynchronization therapy?

Results from clinical trials of cardiac resynchronization therapy with biventricular pacemakers have demonstrated improvements in a variety of clinical parameters measured in patients over short-term follow-up. While not all approved medical therapies for heart failure improve quality of life, biventricular pacemakers offer a substantial opportunity for improving functional status and quality of life in patients with severe symptoms. This paper explores the evidence for routine measures of self-reported functional status and quality life as measures by which physicians might select individuals for resynchronization therapy. Data sources suggest approximately 50% of those individuals eligible for biventricular pacing have reduced quality of life at baseline, and hence, have considerable room for symptomatic improvement after implantation. Since baseline assessment of quality of life further predicts one-year mortality or hospitalization, it is likely that use of self reported quality of life, in addition to other factors as a guide for selection criteria, will result in improved event-free survival with biventricular pacing. In conclusion, assessment of quality of life before device implantation is necessary in order to select those individuals who are most likely to benefit from cardiac resynchronization therapy.     

Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV?

PURPOSE: Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being "known as a person" and receipt of highly active antiretroviral therapy (HAART), adherence to HAART, and health outcomes among patients with HIV. STUDY DESIGN: Cross-sectional analysis. SUBJECTS: One thousand seven hundred and forty-three patients with HIV. MEASUREMENTS: Patient reports that their HIV provider "knows me as a person" and 3 outcomes: receipt of HAART, adherence to HAART, and undetectable serum HIV RNA. RESULTS: Patients who reported that their provider knows them "as a person" were more likely to receive HAART (60% vs 47%, P<.001), be adherent to HAART (76% vs 67%, P=.007), and have undetectable serum HIV RNA (49% vs 39%, P<.001). Patients who reported their provider knows them "as a person" were also older (mean 38.0 vs 36.6 years, P<.001), reported higher quality-of-life (mean LASA score 71.1 vs 64.8, P<.001), had been followed in clinic longer (mean 64.4 vs 61.7 months, P=.008), missed fewer appointments (mean proportion missed appointments 0.124 vs 0.144, P<.001), reported more positive beliefs about HAART therapy (39% vs 28% strongly believed HIV medications could help them live longer, P<.008), reported less social stress (50% vs 62% did not eat regular meals, P<.001) and were less likely to use illicit drugs or alcohol (22% vs 33% used drugs, P<.001; 42% vs 53% used alcohol, P<.001). Controlling for patient age, sex, race/ethnicity, quality-of-life, length of time in clinic, missed appointments, health beliefs, social stress, and illicit drug and alcohol use, patients who reported their provider knows them "as a person" had higher odds of receiving HAART (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19 to 1.65), adhering to HAART (OR 1.33, 95% CI 1.02 to 1.72), and having undetectable serum HIV RNA (1.20, 95% CI 1.02 to 1.41). CONCLUSIONS: We found that a single item measuring the essence of patient-centeredness-the patients' perception of being "known as a person"-is significantly and independently associated with receiving HAART, adhering to HAART, and having undetectable serum HIV RNA. These results support the hypothesis that the quality of patient-physician relationship is directly related to the health of patients.     

Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults?

IntroductionCharacteristics of a built neighborhood may aggravate agravett to fear of falling in older adults and this knowledge are important to contribute to developing strategies aimed at reducing fear of falling and their consequences.ObjectiveTo verify the association between self-perception of built neighborhood characteristics and fear of falling in community-dwelling older adults.Materials and MethodsThis was a cross-sectional study including 308 community-dwelling older adults. The outcome was fear of falling evaluated through Falls Efficacy Scale International. Older adults were classified with high fear of falling when they obtained values ≥ 23 points and classified as low fear of falling with score < 23 point. The built neighborhood variables were evaluated by the adapted Neighborhood Environment Walkability Scale. Multivariable logistic regression was performed to verify associations between the variables.ResultsThe prevalence of fear of falling was 48.40%. Significant negative associations were observed between residing near a bus stop, outdoor gyms, safe places to walk during the day, and positive associations between garbage accumulation and/or open sewers and high crime rates and fear of falling.ConclusionThe association between self-perceived characteristics of built neighborhoods and fear of falling points to the need for improvements in urban infrastructure, especially public spaces, in order to reduce fear of falling in community-dwelling older adults.     

Are coping strategies and locus of control orientation associated with health-related quality of life in older adults with and without depression?

The aim of this study was to investigate relationships between coping and health related quality of life (HRQoL) in older adults (aged ≥60 years) with and without depression. This cross-sectional study included 144 depressed inpatients from seven psychogeriatric hospital units in Norway and 106 community-living older adults without depression. HRQoL was measured using Euro Qol Group’s EQ-5D Index and visual analog scale (EQ-VAS). Two aspects of coping were of primary interest for HRQoL: locus of control (LOC) and ways of coping (WOC). Measures of depressive symptoms, cognitive functioning, instrumental activities of daily living, and general physical health were included as covariates. In linear regression analyses adjusted for age, stronger external LOC was associated with poorer HRQoL in both depressed and non-depressed older adults. In the fully-specified regression models for both groups, the association between stronger external LOC and poorer HRQoL remained significant for the EQ-VAS score but not the EQ-5D Index. WOC was not associated with HRQoL in either group. Total amount of explained variance in fully-specified models was considerably lower in the sample of depressed, hospitalized older adults (17.1% and 15.5% for EQ-5D index and EQ-VAS, respectively), than in the sample of non-depressed, community-based older adults (45.8% and 48.9% for EQ-5D Index and EQ-VAS, respectively). One aspect of coping (LOC orientation) was associated with HRQoL in both depressed and non-depressed older adult samples, and therefore may be an important target for intervention for both groups. Differences in the amount of variance explained in models for the two groups warrant further research.     

Is health-related quality of life among older,chronically ill patients associated with unplanned readmission to hospital?

Background : Assessment of health-related quality of life (HRQL) is being used increasingly to assess the impact of treatment.
Aims : To determine if HRQL, assessed shortly after acute hospitalisation, is associated with readmission to hospital.
Methods : In a prospective, longitudinal study, 163 chronically ill, medical and surgical patients (mean age 67.0±16.3 years) discharged to home following acute hospitalisation were studied. HRQL was assessed at one month post-hospital discharge using the MOS 36-Item Short-Form Health Survey (SF-36). Patients were followed-up for six months thereafter to determine subsequent incidence of unplanned readmission.
Results : HRQL as measured by the eight health dimensions of the SF-36, for the entire cohort, was lower relative to age and gender matched norms for the local population ( p <0.01). During study follow-up, 47 (35%) patients had an unplanned readmission and one patient died. Patients who had an unplanned readmission demonstrated both significantly lower physical (32.2±9.8 vs 38.6±10.1: p <0.001) and mental (45.1±12.7 vs 49.9±12.3: p =0.03) health component scores in comparison to the remainder of the cohort. On multivariate analysis, independent correlates of unplanned readmission were: 1) presence of formal home assistance (OR 6.4: p <0.01), 2) ≥five prescribed medications (OR 2.4: p =0.04), 3)≥two admissions in the six months before follow-up (OR 4.3: p <0.01) and 4) an SF-36 physical component score of ≤40 (OR 2.2: p =0.05).
Conclusions : In this cohort of predominantly older and chronically ill patients recently discharged from acute hospital care, relatively lower SF-36 physical health component scores were independently associated with an increased risk of subsequent unplanned readmission.     

Is gout associated with reduced quality of life? A case-control study

Objectives. To compare quality of life (QOL) between gout casesand controls in a primary care population and to investigatewhether impaired QOL in gout is secondary to co-morbid factorsor to intrinsic factors related to gout itself. Methods. A postal questionnaire was sent to all adults agedover 30 yrs registered with two general practices. The questionnaireassessed a history of gout (doctor diagnosed, or episodes suggestiveof acute crystal synovitis) and medical and musculoskeletalco-morbidities. QOL was assessed using the WHOQoL-Bref instrument.Possible cases of gout attended for clinical assessment wherethe diagnosis was verified on clinical grounds. Overall QOL,satisfaction with health and QOL across four domains were comparedbetween gout cases and controls and then entered into a linearregression model adjusting for gout, age, gender, body massindex and medical and musculoskeletal co-morbidities. Results. Of 13 684 questionnaires mailed, 3082 completed questionnaireswere returned (23%). From 289 suggested cases of gout, 137 caseswere confirmed by clinical assessment. Compared with controls,cases had impaired overall QOL (15.67 vs 16.41, P = 0.003),satisfaction with health (13.16 vs 14.45, P < 0.001) andphysical health-related QOL (14.08 vs 15.95, P < 0.001).On multi-variate analysis, gout remained associated with impairedphysical health-related QOL (ß = –0.059, P =0.001) but not overall QOL (ß = –0.024, P =0.198) or satisfaction with health (ß = –0.028,P = 0.142). Conclusions. Gout associates with poor overall QOL mainly resultingfrom associated co-morbidity. Physical health-related QOL, however,remains impaired after adjustment for co-morbidities. KEY WORDS: Gout, Quality of life, General practice Submitted 11 January 2007; revised version accepted 2 May 2007.     

Is grip strength associated with health-related quality of life? Findings from the Hertfordshire Cohort Study

OBJECTIVE: to investigate the relationship between grip strength and health-related quality of life (HRQoL). DESIGN: cross-sectional survey within a cohort study design. SETTING: the county of Hertfordshire in the UK. PARTICIPANTS: a total of 2,987 community-dwelling men and women aged 59-73 years of age. MEASUREMENTS: grip strength was used as a marker of sarcopaenia and measured using a Jamar dynamometer. HRQoL was assessed using the eight domain scores of the Short Form-36 (SF-36) questionnaire, and subjects in the lowest sex-specific fifth of the distribution were classified as having 'poor' status for each domain. RESULTS: men and women with lower grip strength were significantly more likely to report a poor as opposed to excellent to fair overall opinion of their general health (GH) [odds ratio (OR) per kilogram decrease in grip strength = 1.13, 95% CI = 1.06-1.19, P < 0.001 in men, 1.13, 95% CI = 1.07-1.20, P < 0.001 in women]. Among men, after adjustment for age, size, physical activity and known co-morbidity, decreased grip strength was associated with increased prevalence of poor SF-36 scores for the physical functioning (PF) (OR per kilogram decrease in grip strength = 1.03, 95% CI = 1.01-1.06, P = 0.007) and GH domains (OR = 1.03, 95% CI = 1.01-1.05, P = 0.01). Similar associations were seen in women. CONCLUSIONS: our findings suggest that lower grip strength is associated with reduced HRQoL in older men and women. This does not appear to be explained by age, size, physical activity or co-morbidity and may reflect the link between sarcopaenia and generalised frailty. Individuals with sarcopaenia may benefit from interventions to improve muscle mass and strength before the onset of chronic disorders usually associated with impaired HRQoL.     

Why evaluate the quality of life in patients with bronchial obstruction?

Quality of life, more precisely health related quality of life, is gaining basic importance in evaluating of patient's health status and results of medical interventions. On the example of patients with bronchial obstruction is demonstrated that quality of life evaluation, although not usually used in clinical practice yet, is in significant correlation with some of usual clinical measures; moreover, it brings otherwise inaccessible information about patient's subjective assessment of his disease and his health situation.     

How do personality traits manifest in daily life of older adults?

The present study examined how personality traits manifest in daily life of older adults and distinguished between the manifestations of experiences and behaviors. We used data from an ambulatory assessment study over 10 days with assessments of trait-related experiences and behaviors obtained from 136 older adults aged between 60 and 91 years (41.2% male; M = 70.45 years). Multilevel models revealed that on average, 61.2% of variance in trait-related experiences and 39.6% of variance in behaviors were due to consistent differences between persons. Older adults were rather variable and diverse in their trait manifestations, while they also showed relative stability in trait manifestations. Across older age, some age effects for trait manifestations were found. Moreover, within-person variation of experiences and behaviors showed, with one exception, joint fluctuations in daily life. The findings portray a nuanced picture of trait manifestations in older adulthood. The findings complement the literature on within-person variability in older adulthood and might encourage further studies from a within-person perspective to better understand how older adults navigate through daily life.Supplementary InformationThe online version contains supplementary material available at (10.1007/s10433-020-00598-z).     

The role of personal and household members’ substance use in health-related quality of life in women living with HIV/AIDS

Advances in HIV treatments have led to a greater focus on health-related quality of life (HRQOL) among people living with HIV/AIDS. The current study examined factors associated with HRQOL among 378 women in HIV care. HRQOL was measured using a modified version of the 12-Item Short Form Health Survey; scores were derived for the mental and physical composite summaries (MCS and PCS). We measured personal alcohol use and drug use. Household members’ substance use were assessed by asking participants about the alcohol/drug status of persons with whom they live. Multivariate generalized linear models were used to estimate the linear association between MCS and PCS scores and personal and household members’ alcohol and drug use. We found lower MCS scores were significantly associated with personal alcohol use and living with someone with alcohol or/and drug problems. Lower PCS scores were not significantly associated with personal alcohol use or living with someone with alcohol or/and drug problems. Findings suggest that universal screening and targeted interventions for alcohol use by the patient or household members may offer potential strategies for improving mental health quality of life among women living with HIV/AIDS.     

Health status versus quality of life in older patients: does the distinction matter?

PURPOSE: Although health-related quality of life in older people is generally assessed by measuring specific domains of health status, such as activities of daily living or pain, the association between health-status measures and patients' perceptions of their quality of life is not clear. Indeed, it is controversial whether these health-status measures should be considered measures of quality of life at all. Our objective was to determine the association between health-status measures and older patients' perceptions of their global quality of life. SUBJECTS AND METHODS: We performed a cross-sectional study of 493 cognitively intact patients 80 years of age and older, interviewed 2 months after a hospitalization. We measured patients' self-assessed global quality of life and four domains of health status: physical capacity, limitations in performing activities of daily living, psychological distress, and pain. RESULTS: Each of the four scales was significantly correlated with patients' global perceptions of their quality of life (P <0.001). The ability of the health-status scales to discriminate between patients with differing global quality of life was generally good, especially for the physical capacity (c statistic = 0.72) and psychological distress scales (c statistic = 0.70). However, for a substantial minority of patients, scores on the health-status scales did not accurately reflect their global quality of life. For example, global quality of life was described as fair or poor by 15% of patients with the highest (best tertile) physical capacity scores, 25% of patients who were independent in all activities of daily living, 21% of patients with the least psychological distress (best tertile), and by 30% with no pain symptoms. Similarly, global quality of life was described as good or better by 43% of patients with the worst physical capacity (worst tertile), 49% of patients who were dependent in at least two activities of daily living, 47% of patients with the most psychological distress (worst tertile), and 51% of patients with severe pain. CONCLUSION: On average, health status is a reasonable indicator of global quality of life for groups of older patients with recent illness. However, disagreement between patients' reported health status and their perceptions of their global quality of life was common. Therefore, assumptions about the overall quality of life of individual patients should not be based on measures of their health status alone.     

Is persistence of metabolic syndrome associated with poor health-related quality of life in non-diabetic Iranian adults? Tehran Lipid and Glucose Study

Aims/Introduction

Previous research showed the association between health-related quality of life and metabolic syndrome (MetS). The present study aimed to examine the impact of persistence of MetS on health-related quality of life in non-diabetic Iranian adults.

Materials and Methods

This was a cross-sectional study. A representative sample of 643 non-diabetic individuals (67% female), aged ≥20 years, who participated in the Tehran Lipid and Glucose Study in 2005–2007 were recruited for the study, and categorized into four groups, those without, with transient, with intermittent and with persistent MetS. Health-related quality of life was assessed using the Iranian version of the Short Form Health Survey. MetS was diagnosed using the Joint Interim Statement criteria.

Results

Women with transient, intermittent and persistent MetS scored lower on the Physical Component Summary than those without the syndrome (51.03 ± 1.41, 48.16 ± 1.46 and 46.58 ± 1.29 vs 52.18 ± 1.20) after adjusting for potential confounders (P = 0.04). In women, there was also a significant decreasing trend in the scores of bodily pain (P for trend = 0.006) and general health (P for trend = 0.005) across the study groups. Compared with women without MetS, the odds ratio of reporting poor health-related quality of life for women with intermittent MetS was 2.75 (95% confidence interval 1.19–6.37, P = 0.01). Among men, however, no significant difference was observed in any of the health-related quality of life domains.

Conclusions

Compared with women without, with transient and with persistent MetS, those with intermittent MetS reported poorer physical health-related quality of life.