Socio-cognitive skills as a determinant of life satisfaction in aged persons.

The purpose of this study was to explore the viability of a revised model of elderly life satisfaction, specifically evaluating the contribution of socio-cognitive skills. The role of such skills in relation to life satisfaction among aged persons has not been explored in research to date. Pilot data gathered from 60 community-living aged individuals indicated that numerous variables (e.g., subjective/objective health, education, financial satisfaction, role participation, subjective integration) significantly correlated with life satisfaction. However, the combined effects of two variables, persons' feelings of loneliness and isolation from their families and a measure of socio-cognitive skill, accounted for 49 percent of the variability in elderly life satisfaction. The effects of each on life satisfaction were unique however. Implications of these data and possible interventions for increasing elderly persons' life satisfaction are discussed.     

Quality of life and Parkinson's disease

BACKGROUND: People with Parkinson's disease (PD) have a progressive loss of function eventually leading to severe disability. Although PD would be expected to have a profound impact on an individual's psychosocial health, there is relatively limited research on its psychosocial effect. The purposes of this study were (a) to examine the relationships between physical disability, depression, and control beliefs and quality of life in people with PD and (b) to characterize how these psychosocial variables differ by stage of disease. METHODS: Eighty-six individuals from five stages based on clinical disability, ages 51-87, were interviewed. Established instruments were used to measure physical disability, depression, and control beliefs. Quality of life (QOL) was rated on a 5-point Likert scale. RESULTS: A multivariable regression model including physical disability, stage of disease, depression, mastery, and health locus of control predicted QOL (R2 = 0.48), with mastery as the only significant predictor (p = .0001). There were significant differences by PD stage for all variables (p < .05). CONCLUSIONS: Mastery predicted quality of life in individuals with PD even when depression and physical disability were included in the model. Differences in psychosocial variables by stage of PD suggest that the psychosocial profile of PD patients may change as the disease progresses.     

Quality of life in elderly patients with cerebral vascular disease and Parkinson's disease]

We developed a questionnaire for the study of background factors and quality of life (QOL) in elderly patients with cerebral vascular disease (CVD) and Parkinson's disease (PD). The questionnaire covered the background factors and four sections such as physical, functional, psychological and social health sections. Each section had 15 questions and disease-specific questions for CVD or PD were included in the physical health section. We analyzed 107 patients with CVD (76 elderly patients, aged 65 or more, 31 non-elderly patients under 65) and 136 patients with PD (91 elderly, 45 non-elderly). In the background section, of a total of 243 patients with CVD and PD, the elderly patients needed the assistance of their spouse and their sons wives more frequently than non-elderly patients. With regard to rehabilitation, non-elderly CVD patients had rehabilitation more frequently than the elderly CVD patients, while a higher percentage of elderly patients with PD had rehabilitation training more frequently than the non-elderly PD patients. In the QOL section, there was no difference between elderly and non-elderly CVD patients, while elderly PD patients were statistically more significantly disabled physically and weak-minded psychologically. The physical disabilities of the elderly PD patients in this statistical investigation included slow motion, stooped posture, frozen gait, difficulty in turning and standing up, constipation and dysuria. The psychological problems of elder PD patients included forgetfulness and a feeling of aging. These patients had significantly fewer consultations by family and relatives than the non-elderly PD patients. The overall tendency of QOL in patients with CVD and PD was similar to that of PD patients.     

Factors associated with oral health-related quality of life in community-dwelling elderly persons with disabilities

OBJECTIVES: To examine, in community‐dwelling elderly persons with disabilities, the association between oral health—related quality of life (OHRQOL) as measured using the 14‐item Oral Health Impact Profile (OHIP‐14) and specific oral health, health, and disability status variables; life satisfaction; living alone; and low income. DESIGN: Observational cross‐sectional. SETTING: A Medicare demonstration conducted in 19 counties in three states. PARTICIPANTS: Six hundred forty‐one disabled, cognitively intact, community‐dwelling individuals aged 65 and older. MEASUREMENTS: The subjects' OHRQOL was assessed using the OHIP‐14, which was scored using three different methods. Data on oral health, health and functional status, life satisfaction, prior health services use, and sociodemographics were collected using interviewer‐administered questionnaires. RESULTS: The participants' mean age was 79.1, and they were dependent in an average of 1.8 activities of daily living (ADLs); 43.1% were edentulous, 77.4% wore a denture, 40.4% felt that they were currently in need of dental treatment, and 64.7% had not had a dental examination in the previous 6 months. Seven of the 16 variables of interest had significant bivariate relationships using three OHIP scoring methods. Logistic regression analysis found that poor OHRQOL was significantly associated with perceived need for dental treatment (odds ratio (OR)=2.61), poor self‐rated health (OR=2.29), poor (OR=2.00) and fair (OR=1.73) mental health, fewer than 17 teeth (OR=1.74), and relatively poor cognitive functioning (OR=1.52). CONCLUSION: OHRQOL is associated with some (perceived need for dental treatment, poor self‐rated health, worse mental health, fewer teeth, and relatively poor cognitive status) but not all (e.g., ADL and instrumental ADL dependence) measures of oral health, health, and disability status and not with life satisfaction, living alone, or low income.     

Knee extension strength is a significant determinant of static and dynamic balance as well as quality of life in older community-dwelling women with osteoporosis

BACKGROUND: Determinants of balance have not been well studied in women with osteoporosis yet falls are the major cause of fracture in this population. OBJECTIVE: To describe the associations among knee extension strength, medication history, medical history, physical activity and both static and dynamic balance in women diagnosed with osteoporosis. METHODS: We assessed health history, current medication and quality of life by questionnaire in 97 community-dwelling women with osteoporosis. Static balance was measured by computerized dynamic posturography (Equitest), dynamic balance by timed figure-eight run, and knee extension strength by dynamometry. RESULTS: The 97 participants (mean (SD) age 69 (3.2) years) had a mean lumbar spine BMD of T = -3.3 (0.7) and total hip BMD of -2.9 (0.4). In stepwise linear regression, the significant determinants of static balance that explained 18% of total variance were knee extension strength (10%, p < 0.001), age (5%, p < 0.01) and tobacco use (3%, p < 0.05). The significant predictors of dynamic balance were knee extension strength (26%, p < 0.001), medications (6%, p < 0.05), age (4%, p < 0.05), height (4%, p < 0.001), as well as years of estrogen use (2%), tobacco use (2%) and weight (2%) (all p < 0.05). Knee extension strength was also associated with quality of life (r(2) = 0.12, p < 0.001). Based on these models, a 1 kg/cm ( approximately 3%) increase in mean knee extension strength was associated with 1.2, 2.4 and 3.4% greater static balance, dynamic balance and quality of life, respectively. CONCLUSIONS: Knee extension strength is a significant determinant of performance on static and dynamic balance tests in 65- to 75-year-old women with osteoporosis. In this cross-sectional study, knee extension strength explained a greater proportion of the variance in balance tests than did age. Investigation into the effect of intervention to improve knee extension strength in older women with osteoporosis is warranted.     

Daily electromyography in females with Parkinson's disease: A potential indicator of frailty

Females with Parkinson's disease (PD) are at increased risk for frailty, yet are often excluded from frailty studies. Daily electromyography (EMG) recordings of muscle activity can dissociate stages of frailty and indicate functional decline in non-neurological conditions. The purpose of this investigation was to determine whether muscle activity can be used to identify frailty phenotypes in females with PD. EMG during a typical 6.5-h day was examined in biceps brachii, triceps brachii, vastus lateralis and biceps femoris on less-affected PD side. Muscle activity was quantified through burst (>2% maximum exertion, >0.1 s) and gap characteristics (<1% maximum exertion, >0.1 s). Differences across frailty phenotype (nonfrail, prefrail, frail) and muscle (biceps brachii, BB; triceps brachii, TB; vastus lateralis, VL; biceps femoris, BF) were evaluated with a 2-way repeated measure ANOVA for each burst/gap characteristic. Thirteen right-handed females (mean = 67 ± 8 years) were classified as nonfrail (n = 4), prefrail (n = 6), and frail (n = 3) according to the Cardiovascular Health Study frailty index (CHSfi). Frail females had 73% decreased gaps and 48% increased burst duration compared with nonfrail. Decreased gaps may be interpreted as reduced muscle recovery time, which may result in earlier onset fatigue and eventually culminating in frailty. Longer burst durations suggest more muscle activity is required to initiate movement leading to slower movement time in frail females with PD. This is the first study to use EMG to dissociate frailty phenotypes in females with PD during routine daily activities and provides insight into how PD-associated motor declines contributes to frailty and functional decline.     

Sleep problems as a risk factor for fall in community-dwelling older persons

Background: Falls cause serious problems for the elderly. Sleep problems impair the control of postural balance and cause falls, and lack of sleep induces sleepiness, which in turn causes inattentiveness. The present study aims to clarify the relation between sleep disorders and falls among the community-dwelling elderly and to determine whether or not sleep disorder is an independent risk factor for falls.

Methods:

Methods: Of 2274 community-dwelling persons aged 65 and older who participated in the first study in July 1998, 1771 (77.9%) who responded to the questions concerning sleep disorders were the subjects in the present study.

Results:

Results: There were 1521 persons (85.9%) who had not experienced any fall during the past year, 194 (11.0%) who had one or two falls, 27 (1.5%) had three to four falls and 29 (1.6%) had more than five falls. The relation between the history of falls and the sleep problems indicates that the odds ratio for the history of falls was significantly higher if the nocturnal sleep disorder was more intense ( P < 0.001) and the sleep hours during the day were longer ( P < 0.01). In order to determine the independent risk factors for falls, the general linear model analysis was conducted using the significantly different background. The nocturnal sleep problems ( F = 4.05; P = 0.018), the daytime sleep ( F = 4.17; P = 0.016) and nocturnal sleep problems and interaction between (*) daytime sleep ( F = 2.54; P = 0.038) were significant independent explanatory variables as the age ( F = 14.4; P < 0.001), difficulty in walking ( F = 4.30; P = 0.038), history of stroke ( F = 64.1; P < 0.001) and arthralgia ( F = 5.31; P = 0.021).

Conclusion:

Conclusion: The data emphasize that the sleep disorder is closely related to falls.     

The burden of symptoms among community-dwelling older persons with advanced chronic disease

BACKGROUND: Little is known about the frequency and range of symptoms experienced by community-dwelling older persons with advanced chronic disease who are not enrolled in hospice. The objectives of our study were to determine (1) the prevalence of a range of symptoms among older persons with advanced chronic disease and (2) whether the prevalence of symptoms is similar across diagnoses. METHODS: This was a cross-sectional study of the symptoms reported by 226 community-dwelling persons 60 years or older with advanced chronic obstructive pulmonary disease (COPD), cancer, or congestive heart failure (CHF). Symptoms were assessed using the Edmonton Symptom Assessment System. RESULTS: Virtually all participants (86%) experienced at least 1 symptom that rated moderate or severe, and most (69%) experienced 2 or more symptoms. The symptoms reported by the greatest proportion of participants were limited activity (61%), fatigue (47%), and physical discomfort (38%). Participants with COPD had a higher unadjusted mean +/- SD number of moderate or severe symptoms (3.3 +/- 2.1) than did participants with cancer (2.6 +/- 1.8; P = .03) or CHF (2.0 +/- 1.7; P<.001). After we adjusted for sociodemographic factors, compared with participants with CHF, participants with cancer experienced 38% (95% confidence interval, 9%-75%) more moderate or severe symptoms and participants with COPD experienced 71% (95% confidence interval, 37%-114%) more moderate or severe symptoms. CONCLUSIONS: Most community-dwelling older persons with advanced COPD, cancer, or CHF experienced multiple moderate or severe symptoms. The clinical care of community-dwelling older persons with advanced chronic illnesses would be enhanced by the identification and alleviation of the range of symptoms they experience.     

Self-help and life quality in persons with HIV disease

This study examined factors contributing to life quality in persons with HIV disease. Selected concepts and statements in a model designed to explain self-help and life quality in persons with chronic conditions were tested. Eighty-three persons with a diagnosis of HIV disease 58 with AIDS completed a demographic profile and four instruments to measure dependence for help with daily living, enabling skills, self-help and life quality. The instruments had been used by researchers testing the Self-Help Model on persons with other chronic diseases. Direction and magnitude of the relationships, revealed through causal modelling procedures, were consistent with previous tests of the model. Diagnosis of AIDS explained 29 of the variance in dependency, but had no explanatory value for enabling skill. Enabling skill b 5 0.32 and dependency b 5 2 0.49 explained 33 of the variance in self-help. Self-help b 5 0.59 explained 34 of the variance in life quality. Results suggest that self-help is influenced negatively by dependency and positively by enabling skill. Enabling skill appears to mediate the negative effect of dependency on self-help and can be a target of interventions to improve quality of life in persons with HIV disease.     

衰弱表型和衰弱指数评估老年人衰弱效果的初步研究

目的探讨衰弱表型定义和衰弱指数(FI)这两种衰弱评估法筛查老年人衰弱的效果,为临床和科研应用提供参考。方法选择2015年北京医院参加老年医学门诊体检的106例老年人为研究对象,年龄(79.5±7.6)岁,在完成常规体检的基础上进行综合评估,计算FI并完成衰弱表型定义的评估。比较两种衰弱评估方法筛查同一老年人群的结果并分析两种方法的相关性或一致性,同时评价不同FI临界值对衰弱的筛检价值。结果本组老年人的FI值为0.19±0.07,根据表型定义分期,衰弱前期65例(61.3%),衰弱15例(14.2%),无衰弱26例(24.5%)。两种评估方法均表明衰弱程度随老年人年龄增长而增加。F1值与衰弱表型定义的分期呈正相关(r=0.433,P=0.000)。采用0.09~0.25的FI分级与表型定义分期的一致性Kappa值为0.143(P=0.029),曲线下面积(AUC)为0.760(95%CI:0.616~0.905,P=0.001);而采用0.20~0.35的F1分级与表型定义分期对衰弱评估的一致性Kappa值为0.178(P=0.002),AUC为0.774(95%CI:0.629~0.919,P=0.001)。适合评估该组老年人衰弱水平的FI临界值为0.19~0.27。结论该组老年人中处于衰弱前期者比例较高,衰弱程度随年龄增长而增加。FI值和表型定义分期呈中度正相关,两种F1分级方法均有筛检价值,但准确性并不是很高。     

Spousal caregivers of persons with Alzheimer's and Parkinson's disease dementia: a preliminary comparison

Dementia occurs as a primary component of Senile Dementia of the Alzheimer's type (SDAT) and as a secondary component of Parkinson's Disease (PD) in a subset of PD patients. We compared caregiver distress subsequent to the unique features of these dementing illnesses. Self- and other-rated depression was compared in spousal caregivers for 23 SDAT patients, 23 PD with dementia patients, and 23 control subjects. The two caregiving groups were similar in the length of time they had been providing assistance and in caregiver distress, and both caregiver groups were more depressed than comparison subjects.     

Depressive symptoms as a risk factor for disabling back pain in community-dwelling older persons

OBJECTIVES: To determine whether the presence of depressive symptoms is an independent risk factor for disabling back pain in community-dwelling older persons. DESIGN: Prospective cohort study with a 12-month follow-up period. SETTING: General community. PARTICIPANTS: Seven hundred forty-four members of a large health plan who were aged 70 and older and independent in bathing, walking, dressing, and transferring at baseline. MEASUREMENTS: The presence of depressive symptoms, defined as a score of 16 or greater on the Center for Epidemiologic Studies-Depression Scale, was documented during a comprehensive baseline assessment that also included information regarding participants' demographic, medical, and physical/cognitive status. The occurrence of disabling back pain was ascertained during monthly telephone interviews. RESULTS: Depressive symptoms were present in 153 (20.6%) participants at baseline. Over the 12-month follow-up period, 186 participants (25.0%) reported disabling back pain during 1 to 2 months and 91 (12.2%) during 3 or more months. After adjustment for potential confounders, the presence of depressive symptoms was independently associated with the occurrence of disabling back pain (adjusted odds ratio (AOR)=2.3 (95% confidence interval (CI)=1.2-4.4) for 1 to 2 months with disabling back pain; AOR=7.8 (95% CI=3.7-16.4) for 3 or more months with disabling back pain). CONCLUSION: The presence of depressive symptoms is a strong, independent, and highly prevalent risk factor for the occurrence of disabling back pain in community-dwelling older persons.