Abstract
BackgroundThe demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness.MethodsData from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness.ResultsPhysical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty.ConclusionsCardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.
Highlights
The impact of geographic factors on health outcomes, for persons affected by chronic health conditions, has long been of concern
The Hunter Community Study (HCS) is a study of persons aged 55–85 years residing in the major regional city of Newcastle and the Australian Rural Mental Health Study (ARMHS) is a study of persons aged 18 years and older residing in non-metropolitan areas of New South Wales (NSW)
Primary analysis: the influence of remoteness on health related quality of life (HRQoL) impairment associated with cardiovascular and affective conditions from the eXtending Treatments (xTEND) study For the N = 4364 participants aged 55 and over who provided adequate data for inclusion in the current analyses overall descriptive statistics are reported in Table 1 and are compared by cohort membership
Summary
The impact of geographic factors on health outcomes, for persons affected by chronic health conditions, has long been of concern. Rural areas are often characterised by poor access to health services, increased risk of injury, and stress due to adverse environmental conditions and socioeconomic disadvantage [1,2,3,4]. There is increasing evidence that contextual effects, such as availability of health services, socio-economic deprivation [14,15], aggregate social capital [16,17,18,19] and remoteness [20,21,22] influence the experience of disease and health. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness
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