Life In Community-dwelling Older Adults Research Articles

Associations of Sedentary Time and Breaks in Sedentary Time With Disability in Instrumental Activities of Daily Living in Community-Dwelling Older Adults.

This cross-sectional study was performed to examine associations of objectively measured sedentary time (ST) and breaks in sedentary time (BST) with instrumental activities of daily living (IADL) disability in Japanese community-dwelling older adults. The sample comprised 1634 older adults (mean age: 73.3 y, men: 38.4%). Sedentary behavior was measured using a triaxial accelerometer. Disability was defined as inability in at least 1 of the IADL tasks using the Tokyo Metropolitan Institute of Gerontology Index of Competence. After adjusting for potential confounders and moderate-to-vigorous physical activity (MVPA), longer ST was significantly associated with higher likelihood of IADL disability, whereas a greater number of BST was associated with lower likelihood of IADL disability. ST and BST remained statistically significant after mutual adjustment with odds ratio of 1.30 (95% confidence interval [CI)], 1.00-1.70) and 0.80 (95% CI, 0.65-0.99), respectively. This study first demonstrated that shorter ST and more BST were associated with lower risk of IADL disability independent of MVPA and that the association for ST was independent of BST and vice versa. These findings suggest not only total ST but also the manner in which it is accumulated may contribute to the maintenance of functional independence in older adults.

Linking Spiritual and Religious Coping With the Quality of Life of Community-Dwelling Older Adults and Nursing Home Residents.

Objective: This study examined the effect of Positive and Negative Spiritual and Religious Coping (SRC) upon older Brazilian’s quality of life (QOL). Method: A secondary analysis of data collected from 77 nursing home residents (NHRs; M age = 76.56) and 326 community-dwelling residents (CDRs; M age = 67.22 years) was conducted. Participants had completed the Brief SRC, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Quality of Life-OLD (WHOQOL-OLD). A General Linear Model regression analysis was undertaken to assess the effects of SRC upon 10 aspects of participants’ QOL. Results: Positive (F = 6.714, df = 10, p < .001) as opposed to Negative (F = 1.194, df = 10, p = .294) SRC was significantly associated with QOL. Positive SRC was more strongly associated with NHR’s physical, psychological, and environmental QOL, and their perceived sensory abilities, autonomy, and opportunities for intimacy. Conclusion: Positive SRC behaviors per se were significantly associated with QOL ratings across both study samples. The effect size of Positive SRC was much larger among NHRs across six aspects of QOL. Place of residence (POR) in relation to SRC and QOL in older age warrants further study.

Demographics, social position, dental status and oral health-related quality of life in community-dwelling older adults.

PurposeTo identify demographic, socioeconomic and dental clinical predictors of oral health-related quality of life (OHRQoL) in elderly people.MethodsCross-sectional study involving 613 elderly people aged 65–74 years in Manaus, Brazil. Interviews and oral examinations were carried out to collect demographic characteristics (age and sex) and socioeconomic data (income and education), dental clinical measures (DMFT, need of upper and lower dentures) and OHRQoL (GOHAI questionnaire). Structural equation modelling was used to estimate direct and indirect pathways between the variables.ResultsBeing older predicted lower schooling but higher income. Higher income was linked to better dental status, which was linked to better OHRQoL. There were also indirect pathways. Age and education were linked to OHRQoL, mediated by clinical dental status. Income was associated with dental clinical status via education, and income predicted OHRQoL via education and clinical measures.ConclusionOur findings elucidate the complex pathways between individual, environmental factors and clinical factors that may determine OHRQoL and support the application of public health approaches to improve oral health in older people.

Association between Drinking Behavior and Activities of Daily Living in Community-dwelling Older Adults

As the elderly are more vulnerable to drinking than young adults, elucidation of the relationship between drinking habits of old age and ADL is an important issue from the perspective of public health science. This study explores the relationship between drinking habits of the elderly and impaired Activities of Daily Living (ADL) and provides basic materials to prevent impaired ADL in the old age. This study analyzed a total of 4,134 elderly people over the age of 65 who participated in 2011 Korean Longitudinal Survey of Aging. Drinking habits were classified into 'no drinking (no drinking experience in lifetime)', 'past drinking (have drinking experience in the past but presently do not drink)' and 'currently drinking'. ADL were classified into ‘normal group’ and ‘Impaired ADL group’. To compare the relationship between alcohol drinking and impaired ALD, the odds ratio (OR) and 95% confidence intervals (CI) were presented using hierarchical logistic regression. As the result of multivariate analysis (adjusted model), even after all confounding variables were adjusted, drinking had significant relationship with ADL impairment. Past drinkers has 6 times more risk of ADL impairment (OR=5.86, 95% CI: 3.07-11.19) than nondrinkers and current drinkers 4 times more risk (OR=3.94, 95% CI: 2.08-7.48) (p<0.05). As drinking in old age is associated with impaired ADL, moderation is required on drinkers for healthy aging.

Does prospective memory influence quality of life in community-dwelling older adults?

Older adults commonly experience declines in prospective memory, which describes one’s ability to “remember to remember,” and can adversely affect instrumental activities of daily living and healthcare compliance. However, the extent to which prospective memory failures may influence quality of life in typically aging older adults is not well understood. One-hundred and four community-dwelling older Australians (aged 50 to 82 years) were administered a comprehensive, neuropsychological battery that included the Memory for Intentions Screening Test (MIST), Prospective and Retrospective Memory Questionnaire (PRMQ), Instrumental Activities of Daily Living Questionnaire (IADLQ), and World Health Organization Quality of Life-8 (WHOQOL-8). Multiple regressions controlling for negative affect, medical comorbidities, and other neurocognitive functions revealed an interaction between prospective memory and instrumental activities of daily living in the concurrent prediction of quality of life. Among the 39 older adults who reported multiple problems on the IADLQ, lower performance-based prospective memory (MIST) and higher self-reported prospective memory failures in daily life (PRMQ) were significantly associated with lower quality of life (WHOQOL-8). Conversely, no significant associations were observed between prospective memory and quality of life in the 65 participants without IADL problems. Prospective memory difficulties adversely impact quality of life in community-dwelling older adults who experience problems independently managing their instrumental activities of daily living. These findings extend prior literature showing that prospective memory plays a unique role in the real-world outcomes of older adults and clinical populations and highlight the need to develop effective strategies to enhance prospective memory functioning in these vulnerable groups.

Relationship Between Self-Rated Masticatory Ability and Independent Life in Community-Dwelling Older Adults.

Objective: The aim of the present study was to elucidate the influence of self-rated masticatory ability on independent living in community-dwelling older adults. Method: A total of 1,377 subjects aged 65 and over who lived in Kumamoto City, Japan were participated in a survey to investigate critical factors for self-reliance in older adults. In this study, we defined independent life in older adults as self-perceived adequate health without long-term care certification. Logistic regression analysis was used to assess self-perceived masticatory ability in relation to the independent life. Results: The population with adequate self-rated masticatory ability included a significantly higher proportion of subjects with good self-perceived health without long-term care (72.7%) than the remaining subjects (27.3%). A logistic regression analysis revealed that there was significant relationship between subjective adequate mastication and living a self-reliant healthy life (p < .001). Conclusion: Our results showed that satisfactory masticatory function was positively related to a self-reliant life with subjective healthy conditions in community-dwelling older adults, which was associated with an extended active life expectancy.

Health-related quality of life in community-dwelling older adults of Bojnurd in 2014

Health-related quality of life in community-dwelling older adults of Bojnurd in 2014

Risk for losing physical independence in older adults: The role of sedentary time, light, and moderate to vigorous physical activity

This study examined the association of a range of physical activity intensities and sedentary behavior with the risk of losing physical independence later in life in community-dwelling older adults. A total of 131 males and 240 females, aged 65–103 years, were enrolled. Physical activity (PA) and sedentary time were assessed with accelerometers and the risk for losing physical independence in later years was assessed with the self-reported composite physical function (CPF) scale adjusted for age. Participants were divided in two groups – high risk group (HRG) and low risk group (LRG), according current CPF. According to the multiple logistic regression analyses, sedentary time was not a significant predictor. The odds of a male participant being in the LRG were 12.19 times higher than those of a female (95% CI 5.06–29.39). Both, light PA (OR=1.01; 95% CI 1.01–1.02) and MVPA (OR=1.432; 95% CI 1.21–1.69) had a significant main effect on the risk of losing physical independence. Age and gender interacted with moderate to vigorous PA (MVPA) to predict the risk of losing physical independence. Thus, as age increases, participants that are more physically active became less likely (OR=0.997; 95% CI 0.995–0.999) to be in the HRG than younger participants. Similarly, the odds of a physically active women being physical independent in later life are higher (OR=0.94; 95% CI 0.91–0.96) than those of a physically active men. These new findings suggest that light PA, and MVPA are significantly associated with the risk of losing physical independence later in life, and age and gender combined with MVPA have an interaction effect on physical independence of older adults.

The effectiveness of peer support interventions for community-dwelling adults with chronic non-cancer pain: a systematic review

Review question/objective The objective is to identify the effectiveness of peer support interventions in community-dwelling adults with chronic non-cancer pain. More specifically, the objectives are to identify: The effectiveness of peer support interventions in function, pain, quality of life, self-efficacy and health service utilization for adults with chronic non-cancer pain dwelling in the community, compared to those receiving usual care or other self-management interventions. The specific review question is therefore: Is peer support more effective than usual care or other self-management interventions in reducing pain and health service utilization, and enhancing function, self-efficacy and quality of life in community-dwelling older adults with chronic non-cancer pain? Inclusion criteria Types of participants Since chronic pain affects adults of all ages there will be no upper limit set; we will include participants aged 18 or over. Chronic pain in children is often managed differently than in adults, with specific guidelines, 11 therefore participants under 18 are outwith the scope of this review. Cancer pain is also considered outwith the scope of this review due to its specific nature and management 14 which often differs from non-cancer related causes of chronic pain. Adults who are hospitalized or living in residential care will also be excluded from this review. Peer support interventions in these settings are likely to differ greatly from those designed for community dwelling adults; the focus of this review is on interventions designed for community-dwelling adults. Types of intervention(s)/phenomena of interest The review will consider studies that evaluate any peer support intervention or any intervention that includes a defined element of peer support. Peer support interventions can be aimed at individuals or groups, therefore both will be included in this review. Interventions will include support groups or clubs, email discussion groups, telephone calls, home visits, and any other intervention that can be considered to be peer support. Peers will have knowledge of chronic pain. They may be self-selected or selected by health professionals, and will have received a moderate amount of training to deliver an intervention, in keeping with the definition presented above. 2 People with no training are considered natural lay helpers and are excluded from this review. People who have undergone extensive training are considered paraprofessionals and are likewise excluded from this review. In cases where it is not possible to determine whether the support was provided by a natural lay helper, peer or paraprofessional, studies will be included in order to minimize the risk of omitting relevant data. Types of comparator This review will consider studies that have compared peer support interventions to other self-management interventions that are not delivered by peers. These will include one-on-one or group interventions delivered by paraprofessionals or by health professionals. This review will also consider studies that have compared peer support to usual care. Since there is no one agreed definition of usual care for long term management of adults with chronic pain, any study that provides a description of usual care as their comparator will be included. There may also be studies in which the self-management intervention is the same in the experimental and comparison group, the only difference being the addition of a peer support element to the experimental group; these studies will also be considered. Types of outcomes This review will consider studies that include the following quantitative measures: function, pain, quality of life, self-efficacy and health service utilization. This is in keeping with recommendations for outcome measurement in chronic pain and self-management research, 13,16-17 therefore these measures should be available for consideration. Measures of function may be specific to the region of chronic pain, eg Roland Morris Low Back Pain Disability Questionnaire and Oswestry Low Back Pain Disability Questionnaire, or more general measures, eg Pain Disability Index. In addition to these measures of physical function, measures of emotional function will also be considered, eg scales that measure depression, anxiety and loneliness. Any measure of pain will be included, eg Visual Analogue Scale and Multidimensional Pain Inventory. Any quality of life measure will be included eg SF-36, Euroqol. Any measure of self-efficacy will be included, eg self-care of chronic pain and self-efficacy questionnaires. In addition, where self-management knowledge and skills have been measured these will likewise be considered (eg Health Education Impact Questionnaire) Any measure of health service utilization will be considered, such as emergency room and physician visits. Economic evaluation is however outwith the scope of this review. Where possible, outcomes measured with similar scales will be pooled together.

Variables Explaining Health-Related Quality of Life in Community-Dwelling Older Adults

Although health-related quality of life (HRQL) has been linked to numerous factors in older adults, limited or conflicting studies have investigated variables explaining HRQL in healthy, community-dwelling older adults. The purpose of this study was to determine whether physical activity, gait speed, balance, strength, endurance, and flexibility were associated with HRQL in healthy, community-dwelling older adults. Participants of this cross-sectional, correlational research design study included residents of a senior living community, aged 60 years and older who were independent in at least unlimited household ambulation. These residents participated in tests of physical activity, gait speed, balance, strength, endurance, flexibility, and HRQL (Medical Outcomes Study Short-Form Health Survey, SF-36). The physical (PCS) and mental (MCS) component summary scores of the SF-36 were calculated. Data were collected on 84 participants (mean [SD] age = 78.6 (5.9) years, 54.8% women). Significant correlations were found between the PCS and fast gait speed (FGS) (r = 0.43; p < .001), the Fullerton Advanced Balance Scale (r = 0.44; p < .001), 8-ft up-and-go (r = -0.34; p = .002), and chair stand (r = 0.37; P = .001). Only body mass index (BMI) (r = 0.30; p = .007) was significantly correlated with MCS. Forward stepwise linear regression analyses were conducted, controlling for age, sex, and BMI, to identify factors associated with the PCS and MCS. In the model using PCS as the dependent variable, FGS accounted for 26% of the variance (R2 change) in PCS over and above age, sex, and BMI (R2 change = 0.03); for the full model, F = 5.37, p = .001. In the regression analysis using MCS as the dependent variable, only the 8-ft up-and-go was retained (R2 change = 0.06) over and above age, sex, and BMI (R2 change = 0.16); for the full model, F = 3.71, p = .01. Fast gait speed, balance, and lower body strength were associated with the PCS of the SF-36; however, FGS was the only variable that uniquely contributed to the variance in the PCS. Body mass index was associated with the MCS; however, only balance uniquely contributed to the variance in the MCS. Physical activity was not associated with the PCS or MCS. The results of this study support the assessment of FGS in community-dwelling older adults to gain insight into physical health status. Interventions directed toward FGS, balance, and BMI may contribute to optimum HRQL in this population.

Can Exercise Therapy Improve Health-Related Quality of Life in Community-Dwelling Older Adults?

The remarkable increase in life expectancy in the 20th century implies a need to focus on factors capable of promoting a high health ­ related qual­ ity of life (HRQOL) into old age. In fact, older individuals seem to prefer a high HRQOL rather than longevity. Advancing age is associated with numerous biological and psychological changes that make the individual susceptible to disease, cognitive disorders, mobility limitations and dis­ ability. HRQOL is a prominent subject in clinical medicine, health services and outcomes research, and represents those parts of quality of life that directly relate to an individual’s health. It is a subjective, multidimensional concept shaped by, but not entirely dependent upon, the effects of disease and treatment [1]. Studying the relation­ ship between exercise and HRQOL is interesting

Effect of Therapeutic Horseback Riding on Balance in Community-Dwelling Older Adults with Balance Deficits

Falls are an important cause of morbidity in older adults. Equine-assisted activities including therapeutic riding (TR) benefit balance and neuromuscular control in patients with neurological disabilities but have not been systematically studied in older adults at greater risk for falls due to balance deficits. The effect of an 8-week TR program on measures of balance and quality of life in community-dwelling older adults with established balance deficits was evaluated. This was a pretest-post-test single-group trial of a TR program on measures of balance and quality of life. The study was conducted at a Professional Association of Therapeutic Horsemanship (PATH) International Premier riding center. The subjects comprised 9 adults (5 female, 4 males) with a mean age 76.4 years (range 71-83 years). This included an 8-week observation period followed by an 8-week TR program consisting of 1 hour per week of supervised horseback riding and an 8-week follow-up period. SUBJECTS received balance testing at weeks 0, 8, 16, and 24 using the Fullerton Advanced Balance Scale (FABS), and quality of life was measured at weeks 8 and 16 using the Rand SF (short form) 36 quality-of-life measure. OUTCOME MEASURES were change in the FABS and Rand SF 36. There was no significant difference in balance scores between the start and end of the observation period. There was a significant improvement in the balance score and perception of general health from the start to the end of the intervention period, and no significant difference between the end of the intervention and the end of study, suggesting that improvements may have been sustained. TR is a safe activity for older adults with mild to moderate balance deficits and leads to both improvements in balance and quality of life. Longer and larger studies to assess the benefit of equine-assisted activities on improvements in balance and reduction in fall risk are needed.

P02.83. Mindfulness meditation in community dwelling older adults with postherpetic neuralgia

Purpose This pilot study compared usual care alone with usual care plus meditation in relation to anxiety, depression, pain, and quality of life in community-dwelling older adults with postherpetic neuralgia (PHN). PHN may occur after shingles, and has been described as one of the most intractable neuropathic pain disorders. Older adults develop PHN more often than younger adults. Mindfulness meditation, found to be beneficial in the management of some chronic pain conditions, has not been specifically examined in older adults with PHN.

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 60years 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.

Design, measures and sample characteristics of the CadeViMa-Spain survey on quality of life in community-dwelling older adults

The survey "Quality of life in older adults-Spain" (CadeViMa-Spain) was designed to obtain information about objective and subjective determinants of Quality of Life (QoL) in old age, from a multidimensional perspective. This paper presents the overall description, methodology, sample characteristics and reliability of the measures used. A cross-sectional survey was carried out in a representative sample of 1106 community-dwelling adults aged 60 years and over in Spain. The sample was obtained by a geodemographically-based proportional multistage stratified sampling. A home-based questionnaire included validated scales and questions about sociodemographic characteristics, global QoL, health, family and social networks, financial means and retirement, leisure and social participation, residential environment, and satisfaction with those issues. Face-to-face semi-structured interviews were conducted. Cronbach's α coefficients were used to assess internal consistency of the scales. This nationally representative survey furnishes information about global QoL, health-related QoL, resources availability, living conditions, and satisfaction with the assessed aspects, including life domains most valued by this group. In general, community-dwelling older adults reported positive assessments of health, living conditions, and high levels of satisfaction with the different aspects of QoL. The reliability of the measures in this population was good. This survey provides comprehensive and useful information, based on the view of older people themselves, with potential to contribute to health and social policies towards promoting active aging. The database is available for in-depth comparisons.

POOR RETURN OF FUNCTIONAL MOBILITY AFTER HIP FRACTURE IN OLDER PATIENTS—IT'S TIME TO IMPROVE ON HIP FRACTURE PREVENTION

To the Editor: Hip fractures are the most devastating of fragility fractures and are a major source of disability and mortality, because the individuals who experience them are frequently frail. The high cost of hip fractures includes perioperative, rehabilitative, and long-term nursing care and the need for community supports if individuals who experience them are discharged home. Up to three-quarters of total economic costs incurred by hip fracture are because of postoperative complications, rehabilitation, and nursing home placement, with up to one-third of costs incurred by physical rehabilitation alone.1,2 Hip fractures can significantly affect the functional ability of older people and their potential for independent living. This reduction in independence affects quality of life in community-dwelling older adults after hip fracture.3 The aim of this study was to examine the change in functional mobility and the discharge destination after hip fracture of older adults admitted to a large Dublin hospital. Demographic details, discharge destination, and functional outcome for all people experiencing hip fracture admitted over 15 months were reviewed from the hip fracture database. Patient mobility level was recorded at baseline and 30 and 120 days after fracture using a simple mobility scale to record the level of assistance needed. The need for walking aids was also documented at the same times. Place of residence and discharge destination were also recorded. Statistical analysis was done using SPSS version 9 (SPSS, Inc, Chicago, IL). Regression analysis and chi-square tests were performed. Details on 107 consecutive individuals were reviewed. Mobility data were available at 120 days for 78 individuals (73%). Results from this subgroup were analyzed. Mean age was 82 (range 53–100); 76% were female. Of individuals admitted to the hospital from home, 21% had been discharged to a nursing home for long-term care by 120 days. At 120 days, the overall number of individuals using one or more aids was 54% less than at baseline, but the number of individuals requiring more-supportive ambulatory aids (crutches, rollator, wheelchair) was 96% greater. Overall, 64% of patients required more aids at discharge than they were using on admission, and the number of patients who were wheelchair bound was four times as great. Of individuals who were fully independent outdoors at baseline, only 55% maintained this independence at 120 days. At follow-up, 16% of this group required help mobilizing indoors, and 8% were wheelchair bound. Regression analysis found age to be the only significant factor affecting mobility, with older age related to a worse mobility outcome (P=.008). Initial residence or place of rehabilitation did not significantly affect functional outcome. A previous study comparing patients admitted from long-term care and the community concluded that most long-term care residents did not regain prefracture function,4 but nursing home residents in this study were older and had more comorbidities including dementia that were likely to affect their rehabilitation potential. All patients in the current study participated in a coordinated multidisciplinary rehabilitation program with the specific aim of regaining sufficient function to return to their prefracture living arrangements. Despite this, a large proportion of individuals did not regain premorbid functional status, and not all returned to their premorbid residence; 38% were discharged to a long-term care facility, a figure that compares with other studies.5,6 These higher levels of care are costly and contribute to the hidden health economic burden of hip fracture. Furthermore, the reduction in social independence and function in these patients discharged to the community can significantly affect their quality of life.3,7 Although the current study had short follow-up, function at hospital discharge is a strong predictor of functional status at 1 year.8 The rising incidence of hip fractures reinforces the importance of preventing falls and fractures in older people. In 2008, the World Health Organization introduced the FRAX tool, which can be used to better identify people at high risk of fracture,9 and there is currently good evidence to support the use of many antiresorptive and anabolic drugs for fracture risk reduction. FRAX incorporates several known risk factors for fracture, along with bone mineral density T-score, if available, and calculates fracture probabilities from which treatment thresholds can be determined in individual countries. To encourage primary prevention of fracture at a national level, the use of FRAX should be encouraged among health professionals. To meet the challenges of increasing numbers of hip fracture in the future, strategies for management should encompass guidelines on prevention. Ongoing close liaison with orthopedic colleagues should continue to enhance the quality of care and recovery of older adults with hip fracture. Conflict of Interest: The authors report no conflicts of interest. No funding was received for this study. Author Contributions: Linda Brewer: data analysis and manuscript preparation. Ross Kelly: data analysis. Ciaran Donegan and Alan Moore: study design and acquisition of data. David Williams: manuscript preparation. Sponsor's Role: No sponsor.

Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

BackgroundEvidence on the relation between leisure-time physical activity (LTPA) and health-related quality of life (HRQoL) in older adults is based primarily on clinical trials of physical exercise programs in institutionalized persons and on cross-sectional studies of community-dwelling persons. Moreover, there is no evidence on whether leisure-time sedentary behavior (LTSB) is associated with HRQoL independently of LTPA. This study examined the longitudinal association between LTPA, LTSB, and HRQoL in older community-dwelling adults in Spain.MethodsProspective cohort study of 1,097 persons aged 62 and over. In 2003 LTPA in MET-hr/week was measured with a validated questionnaire, and LTSB was estimated by the number of sitting hours per week. In 2009 HRQoL was measured with the SF-36 questionnaire. Analyses were done with linear regression and adjusted for the main confounders.ResultsCompared with those who did no LTPA, subjects in the upper quartile of LTPA had better scores on the SF-36 scales of physical functioning (β 5.65; 95% confidence interval [CI] 1.32-9.98; p linear trend < 0.001), physical role (β 7.38; 95% CI 0.16-14.93; p linear trend < 0.001), bodily pain (β 6.92; 95% CI 1.86-11.98; p linear trend < 0.01), vitality (β 5.09; 95% CI 0.76-9.41; p linear trend < 0.004) social functioning (β 7.83; 95% CI 2.89-12.75; p linear trend < 0.001), emotional role (β 8.59; 95% CI 1.97-15.21; p linear trend < 0.02) and mental health (β 4.20; 95% CI 0.26-8.13; p linear trend < 0.06). As suggested by previous work in this field, these associations were clinically relevant because the β regression coefficients were higher than 3 points. Finally, the number of sitting hours showed a gradual and inverse relation with the scores on most of the SF-36 scales, which was also clinically relevant.ConclusionsGreater LTPA and less LTSB were independently associated with better long-term HRQoL in older adults.

Psychosocial factors and health as determinants of quality of life in community-dwelling older adults

It is important to understand the determinants of differences in quality of life in old age and to include a wide range of possible predictors. The present study investigated the determinants of quality of life in two groups of older adults for whom there was an unusually informative set of possible predictor variables. Participants were members of the Lothian Birth Cohorts of 1921 (n=550) or 1936 (n=1,091). Four facets of quality of life (QoL) and general QoL were measured using the WHOQOL-BREF. Possible determinants included personality traits, measured with the International Personality Item Pool (IPIP) scales; childhood and old age general cognitive ability, measured with the Moray House Test; minor psychological symptoms, measured with the Hospital Anxiety and Depression Scale (HADS); physical health, assessed by grip strength and cardiovascular disease history; and sociodemographic factors, assessed by interview. Linear regression analyses revealed that HADS depression had the greatest influence on quality of life. Personality traits, most notably Emotional Stability, also predicted quality of life to varying degrees, along with factors reflecting current life circumstances. There were differences between the two cohorts in the variables which predicted quality of life. There were different, conceptually relevant, contributions to the different QoL facets. Personality traits and minor depressive symptoms have an important influence on self-reported quality of life in old age. Quality of life may be influenced more by current than past circumstances, and this relationship may change with age.

Impact of Chronic Kidney Disease on Activities of Daily Living in Community-Dwelling Older Adults

Although chronic kidney disease (CKD) is associated with poor physical function, less is known about the longitudinal association between CKD and the decline of instrumental activities of daily living (IADL) and basic activities of daily living (BADL) among community-dwelling older adults. Participants were part of the prospective observational University of Alabama at Birmingham Study of Aging (n = 357). CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) using the Modification of Diet in Renal Disease equation. Primary outcomes were IADL and BADL decline defined as an increase in the number of activities for which participants reported difficulty after 2 years. Forward stepwise logistic regression was used to determine associations of baseline CKD and functional decline. Participants had a mean age of 77.4 (SD = 5.8) years, 41% were African American, and 52% women. IADL decline occurred in 35% of those with CKD and 17% of those without (unadjusted odds ratio, 2.62, 95% confidence intervals [95% CI], 1.59-4.30, p < .001). BADL decline occurred in 20% and 7% of those with and without CKD, respectively (unadjusted odds ratio, 3.37; 95% CI, 1.73-6.57; p < .001). Multivariable-adjusted odds ratio's (95% CI's) for CKD-associated IADL and BADL decline were 1.83 (1.06-3.17, p =.030) and 2.46 (1.19-5.12, p = .016), respectively. CKD Stage ≥3B (estimated glomerular filtration rate <45 mL/min/1.73 m(2)) was associated with higher multivariable-adjusted odds of both IADL (3.12, 95% CI, 1.38-7.06, p = .006) and BADL (3.78, 95% CI, 1.36-9.77, p = .006) decline. In community-dwelling older adults, CKD is associated with IADL and BADL decline.

Associations between objectively assessed physical activity levels and fitness and self-reported health-related quality of life in community-dwelling older adults

Previous studies investigated the associations between health-related quality of life (HRQoL) and self-reported physical activity (PA) and/or self-reported physical fitness which are not the most reliable methods to assess PA and fitness. Therefore, this study aimed to examine the associations between HRQoL and each of objectively assessed habitual PA and physical fitness. Eighty-five community-dwelling older adults (60-83years) completed assessments for PA (counts/min and steps/day using accelerometers), physical fitness (six-minute walk test [6MWT] and hand-grip strength), and self-reported HRQoL (using the eight subscales of the SF-36). In adjusted logistic regression models, the upper quartile was compared against the lower three quartiles of scores on each HRQoL subscale. Results report the odds ratios that were significant in the adjusted models at P<0.05. Individuals with higher PA levels assessed by counts/min were more likely to score higher on physical functioning (PF) subscale (OR=1.90). Individuals with superior 6MWT performance were more likely to score higher on PF (OR=1.87), role limitations due to physical problems (RP) (OR=1.95), and vitality (VT) (OR=1.79). Individuals with superior hand-grip strength were more likely to score higher on RP (OR=2.37) and VT (OR=1.83). Objectively assessed PA and physical fitness measures were positively associated with physical health HRQoL subscales as reported by community-dwelling older adults.