Health-related Quality Of Life In Elderly Patients Research Articles

The early predictive value of frailty for health-related quality of life among elderly patients with cancer receiving curative chemotherapy.

Changes in health-related quality of life (HRQOL) among elderly patients with cancer before and after receiving curative treatment, such as chemotherapy, have always been an important consideration in physician-patient treatment decision-making. Although frailty assessment can help predict the effects of chemotherapy, there is a lack of relevant literature on its effectiveness in predicting post-chemotherapy HRQOL. Therefore, this study investigated the early predictive value of pre-chemotherapy frailty assessment for post-chemotherapy HRQOL among elderly patients with cancer receiving curative chemotherapy. From September 2016 to November 2018, this study enrolled elderly patients with cancer aged ≥ 65 years (N = 178), who were expected to receive chemotherapy at three hospitals in Taiwan. The mean age of patients was 71.70 years (SD = 5.46 years) and half of them were female (n = 96, 53.9%). A comprehensive geriatric assessment was performed to measure frailty in 178 participants one week before receiving chemotherapy (T0). Further, the HRQOL of the elderly patients with cancer was assessed again, four weeks after chemotherapy (T1). After controlling for demographic variables, this study evaluated the predictive value of frailty for HRQOL using a hierarchical regression analysis. A total of 103 (57.9%) participants met the frailty criteria. The results showed that 31.1%-56.7% of the variance in the seven domains of HRQOL could be explained by demographic variables and the presence or absence of frailty. This suggests that the presence or absence of frailty is an important predictor of the illness burden domain (β = 9.5; p < .05) of HRQOL. Frailty affects the illness burden domain of HRQOL in elderly patients with cancer. Finally, the administration of frailty assessments before treatment is recommended as a reference for patient treatment decision-making.

Moderated-mediation analysis of multimorbidity and health-related quality of life among the Chinese elderly: The role of functional status and cognitive function

To investigate the relationship between multimorbidity and health-related quality of life (HRQoL), and explore the effects of functional status and cognitive function on Chinses elderly behind this relationship. The Multivariate logistic regression and Tobit regression models were used to determine the influence of multimorbidity on HRQoL. Bootstrap analysis was used to probe the mediating effects of functional status and the moderating role of cognition on multimorbidity and HRQoL. Results of the 2,887 participants age ≥ 60 years included in the analysis, 51.69% had chronic diseases. Stroke (β = -0.190; 95% confidence interval [CI], -0.232, -0.149; p < 0.001) and the combination of hypertension and stroke (β = -0.210; 95% CI, -0.259, -0.160; p < 0.001) had the greatest influence on HRQoL. Functional status partially mediated the relationship between the number of non-communicable diseases (No. of NCDs) and HRQoL, while cognitive function had a moderating effect not only in the A-path (No. of NCDs to functional status, β = 0.143; t = 7.18; p < 0.001) and but also in the C-path (No. of NCDs to HRQoL, β = 0.007; t = 6.08; p < 0.001). Functional status partially mediated the relationship between multimorbidity and HRQoL in older adults. And cognitive function, if declined, may strengthen this relationship. These findings suggested that improving cognitive function and functional status in those who developed multimorbidity could be a viable prevention or treatment strategy to improve HRQoL in elderly patients.

The Relationship between Experienced Respiratory Symptoms and Health-Related Quality of Life in the Elderly with Chronic Obstructive Pulmonary Disease.

Background Chronic obstructive pulmonary disease (COPD) is one of the diseases that usually present at an advanced age. Respiratory symptoms in patients with COPD are the most important for making treatment decisions and understanding the adverse effects on health-related quality of life (HRQoL). This study aimed to investigate HRQoL in elderly patients with COPD and examine the relationship between this in relation to respiratory symptoms experienced by them and their demographic characteristics. Methods This is a descriptive, correlational study of elderly patients with COPD who were hospitalized in five different hospitals in an urban area of Iran. A consecutive sampling method was used. Demographic data form, the respiratory symptoms component of St. George's Respiratory Questionnaire (SGRQ), and the Short Form 36 Health Survey Questionnaire (SF-36) were applied for data collection. Results The patients (n = 217) reported low HRQoL, and this impairment was more observed in the physical component. There was a significant inverse relationship between the experienced respiratory symptoms and physical (p=0.03) and mental (p < 0.001) components of HRQoL. Moreover, the female gender, the low level of education, the increased duration of the disease, the increased number of hospitalizations during the past year, and the use of two classes of drugs simultaneously were associated with the impaired HRQoL. Conclusion Our findings inform healthcare providers about the negative impacts of respiratory symptoms and other related factors on the HRQoL of elderly patients with COPD. Nurses and other healthcare providers should proactively identify respiratory symptoms and design appropriate caring strategies to improve HRQoL among this group.

Health-related quality of life in elderly patients with bronchiectasis

Background: Chronic lung diseases such as bronchiectasis (BR) can adversely affect health-related quality of life (HRQOL), but there are limited studies conducted to investigate HRQOL in elderly BR patients. This study aims to investigate the HRQOL in elderly patients with BR and to assess its relationship with clinical outcomes and radiological findings. Materials and Methods: A total of 74 elderly BR patients involved in the study. BR was diagnosed using high-resolution computed tomography, and all patients were evaluated with the Short Form-36 (SF-36) questionnaire. Symptoms, pulmonary function tests, BR Severity Index (BSI), Reiff's score, and medical treatments were recorded. Results: The mean age of the patients was 70.1 ± 5.0 (range: 65–89) years, and 41 (55.4%) were men. The mean SF-36 Physical Component Summary (PCS) and Mental Health Component Summary (MCS) scores of the 74 elderly patients with BR were 36.6 ± 11.2 (range: 16.3–70) and 44.8 ± 8.9 (range: 23–59.6), respectively. All of the SF-36 subscale results except physical functioning subscale were lower in elderly patients with BR than in the normal Turkish elderly population. There was a major difference in the pain domain between males and females (57.9 ± 27.7 vs. 43.9 ± 27.6, respectively; P = 0.035), but there was no other significant difference between SF-36 domains by gender. The BSI was strongly correlated with all SF-36 subscales. There were statistically significant correlations between Reiff's score, forced expiratory volume in 1 s percent predicted value, forced vital capacity percent predicted value, and number of admissions to the emergency room in the previous year and some SF-36 subscales (P Conclusion: Our study demonstrated that elderly patients with BR had poorer HRQOL scores. The BSI, Reiff's score, and pulmonary function tests were correlated with the SF-36 domains.

Changes in cognitive functions and quality of life in patients after transcatheter aortic valve implantation.

IntroductionTranscatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for patients with severe aortic stenosis (AS). However, an association between cognitive functions (CF) and health-related quality of life (HRQoL) in TAVI patients is still unclear.AimTo assess the long-term changes in CF and HRQoL in elderly patients with AS after TAVI.Material and methodsA total of 259 patients who underwent cardiological and psychological TAVI qualification were enrolled and divided into the normal (n = 174) and impaired cognition group (n = 85). CF and HRQoL characteristics assessed at baseline and 13 months were compared between groups. The analysis of multiple linear regression was performed to identify the association between HRQoL and CF and to assess the influence of TAVI on HRQoL.ResultsThere was no difference in CF between baseline and follow-up. However, an improvement in attention functions and memory skills in the cognitively impaired group was noted at follow-up. In addition, HRQoL scores increased in both groups. An independent predictor associated with HRQoL was global CF (β = –213, p = 0.01), which explained 7% of CF variation. Improvements in all five dimensions of HRQoL, from 4.8% in self-care and up to 33.6% in pain/discomfort, were found. At follow-up, 60% of TAVI patients had improved health, 12% had worse health, 4% showed no change and 24% had a “mixed” change.ConclusionsTAVI is associated with positive changes in the functioning of elderly patients at long-term follow-up.

Verification of phycological factors related to health-related quality of life in elderly knee osteoarthritis: A prospective cohort study

BackgroundIn recent years, locomotive syndrome, which is a condition requiring nursing care due to musculoskeletal disease, has been reported, and interest in knee osteoarthritis has been increasing. Several studies have reported the physical factors influencing the relationship between knee osteoarthritis and health-related quality of life (HRQOL), but there have been no reports verifying the changes over time in the relationship between psychosocial factors and HRQOL. This study aimed to investigate the influence of psychosocial factors on HRQOL in elderly patients with knee osteoarthritis. MethodsEvaluations were conducted at four time points: before exercise therapy intervention, 1 month into intervention, 3 months into intervention, and 1 month after completion of intervention. The items investigated were (1) Japanese Orthopedic Association (JOA) score, (2) Kellgren-Lawrence (K-L) grading system, (3) Fall Efficacy Scale (FES), (4) Frenchay Activities Index (FAI), (5) Geriatric Depression Scale (GDS), and (6) Short Form-8 (SF-8). ResultsNo significant differences were seen between each time point of exercise therapy intervention in depression and HRQOL scale but a significant improvement was seen in instrumental ADL and fear of falling at 3 months into intervention. On multiple regression analysis with SF-8 subscales, fear of falling and degree of depression were determined as significant factors affecting physical and mental summary scores. ConclusionElderly patients with knee osteoarthritis require not only intervention for knee function, but also psychological intervention to address decreased activity and depression to improve their HRQOL.

Kumaraswamy Distribution in Analyzing the Health-related Quality of Life and Effective Factors in Elderly Patients with Epilepsy

Background: Epilepsy, which develops in the elderly, is recognized as a major health burden. Although health-related quality of life (HRQoL) is an essential element in the medical treatment of elderly patients with epilepsy, it is a question whether epilepsy and its treatment effectively influence the quality of life (QoL) in the elderly. Objectives: The current study aimed at evaluating the relationship between demographic and clinical aspects of epilepsy in HRQoL of elderly patients. Since HRQoL scores are bounded, the Kumaraswamy (Kum) regression model was used to analyze the data. Methods: The current study was conducted on 766 elderly patients diagnosed with epilepsy taking at least one antiepileptic drug (AED) selected from six neurologic clinics in Iran. In addition to demographic information, the Liverpool seizure severity scale (LSSS), medication adherence report scale (MARS-5), and quality of life in epilepsy (QoLIE-31) questionnaire were completed for patients. Data were analyzed using multiple linear regression (MLR) and the Kum regression models. Results: Most of the patients included in the study had focal (70.2%) epilepsy. Mean duration of disease was 17.71 ± 4.56 years and the average number of seizures was 3.4 ± 3.2 episodes per month. The Kum regression model indicated that seizure frequency (β = -0.157, P < 0.0001) and LSSS score (β = -0.003, P = 0.009) were significant and negative predictors of overall QoLEI-31 score; MARS-5 score was a positive predictor of overall QoLEI-31 score (β = 0.014, P = 0.002). However, disease duration and serum AED level had no significant effects on overall QoLEI-31 score. Conclusions: The findings suggested that increased seizure frequency and severity were associated with lower QoL and medication adherence was directly associated with HRQoL. The Kum regression could be a suitable alternative to the methods currently used in the analysis of HRQoL data.

Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients with Diabetes in Korea.

A critical goal in the management of elderly patients with diabetes is to improve their health-related quality of life (HRQOL). This study aimed to identify the factors affecting HRQOL in elderly Korean patients with diabetes. Participants were 365 elderly patients with diabetes who were treated in a general hospital in Korea. The data were analysed using independent t-tests, Pearson correlations, and stepwise multiple regression. The mean total HRQOL score was 74.77, and HRQOL showed positive correlations with activities of daily living (ADL), instrumental activities of daily living (IADL), and the Summary of Diabetes Self-care Activities (SDSA). There was a negative correlation between HRQOL and Short Geriatric Depression Scale (SGDS). Lower SGDS scores, higher SDSA scores, and being male were associated with higher HRQOL, with these variables explaining 57.5% of the variance in participants' HRQOL. Improvement in the HRQOL of elderly patients with diabetes requires the development of interventions for depression, and improvements in methods of diabetes self-care and gender-dependent managerial measures.

Age-Related Differences in Clinical Characteristics and Esophageal Motility in Patients with Dysphagia.

Dysphagia in elderly patients has a major effect on nutrition and quality of life (QOL). Although several studies have shown that aging itself is associated with changes in esophageal motility, the impact of these changes on dysphagia symptoms and QOL is unknown. This study assessed the manometric diagnoses of elderly patients with dysphagia compared with diagnoses in younger counterparts. Participants included 116 consecutive patients examined for dysphagia from 2007 to 2014. We divided patients into three groups by age: Group A, 66years and older (24 men, 23 women); Group B, 45-65years (18 men, 24 women); and Group C, 44years and younger (15 men, 12 women). The three groups were compared in regard to symptoms, esophageal motility, and health-related QOL (HRQOL). All patients underwent esophageal manometry examination and completed a self-administered questionnaire concerning their symptoms; HRQOL assessment was based on results of the Short Form-8 General Health Survey. Symptoms rated≥4 points on the Likert scale were defined as significant. Although all patients had dysphagia as a major symptom, more elderly patients reported globus sensation, whereas more young patients reported heartburn as the primary symptom. Manometric diagnoses were generally similar across the three groups. Ineffective esophageal motility was more prevalent in Groups A and C than in Group B, although the difference was not statistically significant. No significant differences in manometric parameters or HRQOL were detected among the three groups. Despite differences in symptom patterns, broad manometric diagnoses and impairment of HRQOL in elderly patients with dysphagia are similar to those in younger counterparts.

Changes in quality of life after radiation therapy for localized prostate cancer after dissemination of intensity modulated radiation therapy

Objective It is unclear whether the adoption of intensity-modulated radiation therapy (IMRT) for prostate cancer is associated with improved health-related quality of life (HRQOL). Therefore, we examined the HRQOL of elderly patients who had undergone external beam radiation therapy (EBRT) during two eras: 1998–2001, when 3D-CRT was the standard of care for EBRT, and 2006–2009, when IMRT was the dominant form of EBRT.

Haemoglobin levels and health-related quality of life in young and elderly patients on specialized predialysis care

In predialysis patients, the optimal treatment choices for controlling haemoglobin (Hb) are unknown, because targeting high Hb levels has negative effects--poorer survival--but possible positive effects as well--better health-related quality of life (HRQOL). Moreover, these effects may be different in specific subgroups (e.g. young versus elderly). In the PREPARE-2 follow-up study, incident predialysis patients were included (2004-2011) when referred to 1 of the 25 participating Dutch outpatient clinics. HRQOL was assessed at 6-month intervals with the short form-36 (SF-36) questionnaire [physical/mental summary measure and eight subscales (range 0-100)]. A linear mixed model was used to associate Hb [<11, ≥ 11 to <12 (reference), ≥ 12 to <13 and ≥ 13 g/dL] with HRQOL, stratified by prescription of anaemia medication (erythropoietin-stimulating agent (ESA)/iron) and age (young: <65 years and elderly: ≥ 65 years). Only elderly patients (n = 214) not prescribed ESA/iron and with a high Hb (≥ 13 versus ≥ 11 to <12 g/dL) had a statistically significant (P < 0.05) and/or clinically relevant (>3-5 points) higher physical [11.9, 95% confidence interval (CI) 1.7, 22.2] and mental (6.4, 95% CI -1.7, 14.6) summary score. High Hb was not associated with a higher HRQOL in elderly patients who were prescribed ESA/iron. However, only young patients (n = 157) prescribed ESA/iron and with a high Hb (≥ 13 versus ≥ 11 to <12 g/dL) had a higher physical (8.9, 95% CI 2.1, 15.8) and mental (6.2, 95% CI -0.4, 12.8) summary score. The association of Hb levels with HRQOL differs by age and use of ESA/iron medication on predialysis care. Therefore, medical care should aim for shared decision-making regarding the appropriate Hb target leading to more individualized care.

Health-related quality of life in elderly patients hospitalized with chronic heart failure

BackgroundChronic heart failure is a very common condition in the elderly, characterized not only by high mortality rates, but also by a strong impact on health-related quality of life (HRQOL). Previous studies of HRQOL in elderly heart failure subjects have included mostly outpatients, and little is known about determinants of HRQOL in hospitalized elderly population, especially in Serbia. In this study, we tried to identify factors that influence HRQOL in elderly patients hospitalized with chronic heart failure in Serbia.MethodsThe study population consisted of 136 patients aged 65 years or older hospitalized for chronic heart failure. HRQOL was assessed using the Minnesota Living with Heart Failure questionnaire. Predictors of HRQOL were identified by multiple linear regression analysis.ResultsUnivariate analysis showed that patients with lower income, a longer history of chronic heart failure, and longer length of hospital stay, as well as those receiving aldosterone antagonists and digoxin, taking multiple medications, in a higher NYHA class, and showing signs of depression and cognitive impairment had significantly worse HRQOL. Presence of depressive symptoms (P<0.001), higher NYHA class (P=0.021), lower income (P=0.029), and longer duration of heart failure (P=0.049) were independent predictors of poor HRQOL.ConclusionDepressive symptoms, higher NYHA class, lower income, and longer duration of chronic heart failure are independent predictors of poor HRQOL in elderly patients hospitalized with chronic heart failure in Serbia. Further, there is an association between multiple medication usage and poor HRQOL, as well as a negative impact of cognitive impairment on HRQOL. Hence, measures should be implemented to identify such patients, especially those with depressive symptoms, and appropriate interventions undertaken in order to improve their HRQOL.

Factors Associated With Health-Related Quality of Life in Elderly Korean Patients With Heart Failure

Heart failure (HF) is a debilitating chronic disease with incidence and prevalence increasing worldwide. People with HF experience deteriorating functional status, severe fatigue, dyspnea, and repeated hospital admissions, which negatively affect health-related quality of life (HRQoL). Therefore, 1 of the primary goals of HF management is to improve HRQoL. The purpose of this study was to describe the relationship among sociodemographics, clinical factors, functional status, depression, and HRQoL in elderly Korean patients with HF. A descriptive, cross-sectional study design was used. We enrolled 134 HF patients from outpatient cardiology clinics at an academic-affiliated hospital and a tertiary care academic referral medical center in Cheonan, South Korea. We obtained sociodemographic and psychosocial variables from face-to-face interviews and obtained clinical variables from medical record reviews. We used the Minnesota Living With Heart Failure Questionnaire to measure HRQoL. Using hierarchical multiple regression analysis and after controlling for sociodemographic and clinical factors, we determined that HRQoL was independently influenced by depression (β = .443, P < .001), New York Heart Association classification (β = .148, P < .05), and functional status (β = -.403, P < .001). Depression and functional status explained about 26% of the variance in HRQoL. Depression and functional status were significantly associated with HRQoL in elderly patients with HF. Our findings emphasize the need for careful clinical screening of both depression and functional status in older patients with HF. More research needs to be conducted to develop effective intervention strategies to improve HRQoL and, in turn, HF outcomes.

Investigation of health-related quality of life and impact factors in elderly patients with COPD in Beijing

Objective To assess the health-related quality of life ( HRQoL) of elderly patients with COPD in Beijing and to explore the impact factors. Methods 100 outpatients diagnosed with irreversible COPD in Beijing completed the SF-36 questionnaire. The scores of 8 dimensions of questionnaire in elderly patients with COPD were calculated and compared with those of the rural general elderly people in Tianjin. Multiple regression analysis was applied to determine the impact factors of different dimensions of SF-36. Results The scores of all the dimensions in the patients were significantly lower than those in general old rural people of Tianjin. The correlations between the different dimensions of the SF-36 and variables were: Physical functioning was well correlated with ADL, ability to carrying activities (6MWD) and anxiety. Role-physical was well correlated with anxiety, admission times in a year and nutrition ( BMI). Body pain was well correlated with anxiety. General health was well correlated with depression, social support, the number of combination chronic disease, ability to carrying activities (6MWD) and the severity of disease (FEV1. 0%). Vitality was well correlated with depression. Social functioning was well correlated with ADL, carrying activities (6MWD), social support and depression. Mental heath was well correlated with depression ,anxiety and nutrition (BMI).No variable showed significant correlation with the Role-emotional dimension. Conclusions The HRQoL of elderly patients with COPD is declined compared with general elderly people. There are a range of factors that impact different dimensions of HRQoL, chiefly emotional status and carrying activities. Targeted measures of health interventions could be carried out to improve the HRQoL of elderly patients with COPD. Key words: COPD; Elderly; HRQoL; Impact factors; SF-36 questionnaire

Health-Related Quality of Life After Coronary Artery Bypass Grafting: A Review of Randomized Controlled Trials

Objective outcome measures (i.e., survival, mortality, morbidity, complication rate, symptom recurrence, and need for re-interventions) have long been used as benchmarks for successful cardiac surgery, including coronary artery bypass grafting (CABG). Along with these objectively measurable outcome indicators, acquired improvement by cardiac surgery in subjectively experienced health-related quality of life (HRQoL) has gained importance during the last decade in cardiac surgical research. If an increasing proportion of adult patients referred for CABG are elderly, octogenarians or even nonagenarians, the acquired HRQoL benefit from bypass surgery should be considered to be at least as important an outcome measure as potentially marginal improvement in life expectancy or longevity alone. To achieve the maximal HRQoL benefit and to optimize patient selection, a comprehensive analysis and understanding of contributors that affect pre- and postoperative self-perceived HRQoL is essential. These include patient-related characteristics (e.g., demographics and underlying comorbidities), surgical technique-related factors, and healthcare-related attributes. In this paper we review the randomized controlled trials published during the last ten years to analyze the effect of CABG on HRQoL. Specifically, we focus on the differences between the on-pump and off-pump (OPCAB) bypass techniques, investigate the factors that contribute to post-CABG HRQoL, and study post-CABG HRQoL in elderly patients.

Health-related quality of life of patients with hip fracture before and after rehabilitation therapy: discrepancies between physicians’ findings and patients’ ratings

Health-related quality of life (HrQoL) is broadly accepted as an evaluation criterion of medical therapy effects. The major objectives of this work are a) measuring of the effects of rehabilitation therapy on the HrQoL of elderly patients after hip fracture, and b) study of discrepancies between the physician's findings on one hand and subjective ratings of patients on the other, and their influence on HrQoL, depression, and independence in activities of daily living. The study sample consisted of 95 patients surgically treated after a fall-induced hip fracture (mean age=82 years; range=61-97). Using the median as splitting criterion, ratings of patients and physicians concerning disturbance-specific functional capacity were subdivided into positive and negative. This led to separation of the sample into four subgroups: the fortunate (congruent positive ratings), satisfaction paradox (positive subjective, negative objective ratings), dissatisfaction dilemma (negative subjective, objective positive ratings), and the unfortunate (congruent negative ratings). The four patient subgroups diverged in their estimations. The subgroups of the fortunate and satisfaction paradox have had the highest subjective gains in HrQoL. The subgroups of dissatisfaction dilemma and the unfortunate estimated their gains as similarly low on most of the tested scales. Results stress the importance of subjective factors in processes concerning therapy evaluations and their influence on HrQoL. The objective success of therapy is not of primary importance for the extent of the HrQoL, but subjective evaluation of it is.

A Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy for Elderly Stroke Survivors: Changes in Motor Impairment, Daily Functioning, and Quality of Life

Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Objective To examine the benefits of modified constraint-induced movement therapy (mCIMT) on motor function, daily function, and health-related quality of life (HRQOL) in elderly stroke survivors. Design Two-group randomized controlled trial, with pretreatment and posttreatment measures. Setting Rehabilitation clinics. Participants Twenty-six elderly stroke patients (mean age, 72y) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident. Interventions Twenty-six patients received either mCIMT (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for a period of 3 weeks. Main Outcome Measures Outcome measures included the Fugl-Meyer Assessment (FMA), FIM instrument, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The FMA evaluated the severity of motor impairment; the FIM instrument and MAL reported daily function; and the SIS detected HRQOL. Results The mCIMT group exhibited significantly greater improvements in motor function, daily function, and the physical domain of HRQOL than the traditional rehabilitation group. Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group. Conclusions These findings suggest mCIMT is a promising intervention for improving motor function, daily function, and physical aspects of HRQOL in elderly patients with stroke. The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program.

Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents

Bruyere O, Wuidart M-A, Di Palma E, Goulay M, Ethgen O, Richy F, Reginster J-Y. Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Objective To investigate the effects of whole body vibration in the elderly. Design Randomized controlled trial. Setting Nursing home. Participants Forty-two elderly volunteers. Interventions Six-week vibration intervention plus physical therapy (PT) (n=22) or PT alone (n=20). Main outcome measures We assessed gait and body balance using the Tinetti test (maximum scores of 12 for gait, 16 for body balance, 28 for global score), motor capacity using the Timed Up & Go (TUG) test, and health-related quality of life (HRQOL) using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results After 6 weeks, the vibration intervention group improved by a mean ± standard deviation of 2.4±2.3 points on the gait score compared with no score change in the control group ( P<.001). The intervention group improved by 3.5±2.1 points on the body balance score compared with a decrease of 0.3±1.2 points in the control group ( P<.001). TUG test time decreased by 11.0±8.6 seconds in the treated group compared with an increase of 2.6±8.8 seconds in the control group ( P<.001). The intervention group had significantly greater improvements from baseline on 8 of 9 items on the SF-36 compared with the control group. Conclusions Controlled whole body vibration can improve elements of fall risk and HRQOL in elderly patients.

Is the loss of health-related quality of life during renal replacement therapy lower in elderly patients than in younger patients?

Previous studies have reported that elderly (aged 65 years or over) end-stage renal disease (ESRD) patients have poorer health-related quality of life (HRQOL) than both younger patients and healthy subjects of the same age. The aim of present study was to evaluate the effect of ESRD and its treatment on the HRQOL, and to determine the effects of age and gender. A cross-sectional multicentric study was carried out with 485 haemodialysis and renal-transplant patients, using the SF-36 Health Survey to evaluate their HRQOL. SF-36 scores were standardized by age and gender using Spanish normative data. Karnofsky scale score (KS), socio-demographic, and clinical data were also collected. In renal-replacement therapy (RRT), chronic haemodialysis, and renal-transplant patients, SF-36 standardized scores of elderly patients were higher than in younger patients. Therefore the reduction in HRQOL of elderly patients, in relationship with that of the general population of the same age and gender, was lower than in younger patients. In the case of renal-transplant patients, standardized scores in elderly patients were higher than in the general population for all parameters. Using standardized scores, elderly patients on renal replacement therapy (haemodialysis and kidney transplant) had relatively better HRQOL than younger patients, and in the case of transplant patients, they had even better HRQOL than in the general population of the same age and gender.