Life In Community-dwelling Older Adults Research Articles

Risk and protective factors of a wish to die and suicidal ideation in community-dwelling, older, Flemish adults: results of the Belgian ageing studies

Objectives This study aims to increase the understanding of suicidality in older adults by investigating the prevalence, characteristics, risk and protective factors of suicidal phenomena in community-dwelling older adults (60+) in Flanders, specifically of a current wish to die (WTD) and lifetime suicidal ideation and behaviour (LSIB). Method Cross-sectional data from the Belgian Ageing Studies (BAS) is used (N = 3050). The BAS aims to monitor the needs and quality of life of community-dwelling older adults through a standardised survey. Statistical methods used are bivariate analyses and binary logistic regression. Results Prevalence rates of 4.8% for WTD and 8.2% for LSIB are found. LSIB is the biggest predictor of a current WTD, followed by requiring support on three domains, elder abuse, depression and subjective cognitive complaints, and elder abuse were significant risk factors for both WTD and LSIB. Limited effects of protective factors were found. Conclusion Previous research regarding risk factors to be confirmed in this study, and new insights on the effect of elder abuse, subjective indicators of cognitive complaints and requiring support are added. Further research into protective factors and underlying mechanisms is required.

Effects of sleep quality and physical activity measured by a Fitbit and self-rated questionnaire on the health-related quality of life in community-dwelling older adults: A cross-sectional study

Purpose: This study aimed to identify influencing factors on health-related quality of life by examining relationships among sleep quality, physical activity, and health-related quality of life in older adults living in the community using a Fitbit and self-rated questionnaire. Methods: The participants were adults aged 65 years and above who were recruited from one senior university and three senior citizen centers. A total of 106 participants were included in the analysis. The data were analyzed with t-test, ANOVA, Pearson’s correlations, and multiple regression analysis. Results: According to multiple regression analysis regarding objectively measured sleep quality and physical activity using a Fitbit, the factors affecting the health-related quality of life were age (β=-.30, p=.006), subjective health status as ‘moderate’ (β=.33, p=.001), and subjective health status as ‘good’ (β=.41, p=.001). In terms of using a self-rated questionnaire, the factors affecting health-related quality of life were age (β=-.27, p=.010), subjective health status as ‘moderate’ (β=.32, p=.001), subjective health status as ‘good’ (β=.37, p=.001), and physical activity (β=.18, p=.030). Conclusion: Although the findings may not be generalizable to community-dwelling older adults due to our convenience samples, this study suggests that customized physical activity programs are required to improve health-related quality of life in community-dwelling older adults of different age groups.

Functional oral status and oral health-related quality of life in community-dwelling older adults in Singapore.

The objectives were to investigate the association between oral functional status (defined by the number of functional teeth and functional occluding units [FOUs]) on oral health-related quality of life (OHRQoL). It also aimed to determine if dentures could compensate for the loss of FOUs in terms of OHRQoL in community-dwelling older adults in Singapore. Community-dwelling older adults, aged 60 years and above, were recruited from a community-based oral health functional screening programme from 1 May 2018 to 31 December 2019. During the screening, an Oral Health Impact Profile-14 (OHIP-14) questionnaire and oral examination were administered. Statistical analysis was performed using the chi-square test, univariate logistic regression and multivariate predictive modelling. Data from 1037 participants were analysed (52% female; mean age 71.5 (SD 7.15)). The mean OHIP-14 score was 4.5 ± 7.2. The OHIP-14 scores were significantly associated with the number of functional teeth and the number of FOUs (p < .001). Having at least 20 functional teeth or 10 FOUs was associated with a significantly lower OHIP-14 score. Those with no FOUs had higher OHIP-14 scores compared to those with at least 10 FOUs, even in the presence of a satisfactory denture. Maintaining at least 20 functional teeth or 10 FOUs was associated with better OHRQoL among community-dwelling older adults in Singapore. Dentures may have limited compensatory ability in terms of replacing natural functional occlusal units and maintaining OHRQoL.

Sex difference in the association between excessive daytime sleepiness and health-related quality of life in community-dwelling older adults: The Yilan study, Taiwan

ObjectivesThe association between excessive daytime sleepiness and health-related quality of life among older adults and at-risk individuals remains unclear. This study examined relationships between excessive daytime sleepiness and unfavorable health-related quality of life and explored the moderating effect of sex. Study designThis was a community-based study of adults aged 65 years or more. Excessive daytime sleepiness was defined as a score exceeding 10 on the Epworth Sleepiness Scale. Multiple logistic regression analyses were used to examine the relationships between excessive daytime sleepiness and health-related quality of life. The moderating effect of sex was examined by testing interaction terms. Main outcome measuresHealth-related quality of life was measured using the Short Form 12 Health Survey, which includes a physical component summary and a mental component summary. Unfavorable health-related quality of life was defined as the lowest tertile of the scores for both components. ResultsIn total, 3788 individuals participated. After controlling for covariates, older adults with excessive daytime sleepiness did not have an unfavorable physical component summary but were more likely to have an unfavorable mental component summary (odds ratio 1.96; 95 % confidence interval 1.47–2.61). When stratified by sex, excessive daytime sleepiness was associated with a poor physical component summary in men (odds ratio 1.77, 95 % confidence interval 1.00–3.13) but not in women. ConclusionsExcessive daytime sleepiness was associated with a poor mental component summary in both sexes; however, the association with a poor physical component summary was specific to men.

The effectiveness of a home-based dietetic intervention for community-dwelling older adults.

The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention. Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature.

Effects of semi-immersive virtual reality exercise on the quality of life of community-dwelling older adults: Three-month follow-up of a randomized controlled trial.

This study aimed to examine the effects of semi-immersive virtual reality (VR)-based exercise on the quality of life of older adults. It used a randomized controlled trial design. Older adults (mean age: 72.16 ± 4.9 years) were randomly assigned to experimental (n = 48) and control (n = 50) groups. The experimental group engaged in semi-immersive VR exercise for 75-90 min, twice a week, for 12 weeks and partook in no other intervention between the end of the exercise intervention and follow-up. Control group members did not participate in any similar program during the intervention or follow-up periods. Both groups completed three assessments: at baseline (pre-test), post-intervention (post-test), and 3 months later (follow-up). Quality of life was assessed using the World Health Organization Quality of Life Instrument-Older Adults Module. Generalized estimating equation analyses indicated that the experimental group exhibited significant post-intervention improvements in quality of life in terms of sensory ability, autonomy, social participation/isolation, death and dying domain, and overall quality of life scores. However, none of these significant effects were maintained 3 months after exercise intervention cessation. Semi-immersive VR exercise may be a feasible strategy toward enhancing the quality of life of older adults. However, the participants' quality of life was not maintained upon exercise cessation, indicating that older adults need to be encouraged to exercise regularly to maintain a good quality of life. VR may need to be combined with other modes of intervention in the future to facilitate long-term quality-of-life improvement in older adults.

Physical Activity and its Relationship with Mental Health and Quality of Life Among Community-Dwelling Older Adults

Introduction: The global population is aging rapidly, accompanied by high rates of physical inactivity among older adults. Physical inactivity in later life can negatively impact physical function, mental health, and quality of life. Gardening meets physical activity guidelines for older adults (150-300 minutes of moderate activity per week). This study examined relationships between physical activity levels, mental health, and quality of life in community-dwelling older adults. Methods: A cross-sectional study was conducted with 150 adults aged ≥ 60 years (mean 65.65 ± 6.54 years). Physical activity levels, mental health, and quality of life were assessed using validated questionnaires. Spearman’s rank correlation coefficients were calculated to assess relationships between variables. Data were analyzed using SPSS version 26.0. Results: There was a statistically significant, negative, fair correlation between physical activity levels and mental health scores (r=-0.21, p&lt;0.05), indicating higher physical activity was associated with better mental health. Physical activity levels positively correlated with quality of life (r=0.19, p&lt;0.05). Conclusion: Higher physical activity levels were associated with better mental health and higher quality of life in community-dwelling older adults. Gardening may be an effective activity to improve health outcomes in this population. Further research should examine causal relationships and gardening interventions.

Changes in the health status and health-related quality of life of community-dwelling older adults living alone: one-year follow-up from a cohort study.

The percentage of older adults living alone is rapidly increasing, improving the health status and health-related quality of life (HRQoL) in this group is becoming a more significant public health issue. This study aimed to examine the changes in the HRQoL of older South Korean adults living alone and identify the factors that affect their HRQoL. A longitudinal study design was followed. Data were collected at baseline and 1-year follow-up. Participants consisting of 789 older adults living alone in S*City aged>65 years completed a cohort survey regarding health status and HRQoL from August 2018 to August 2019. Trained interviewers conducted face-to-face interviews with the participants using a validated questionnaire (physical health, mental health, social health, and HRQoL). Generalized estimating equations were used to assess the change in health status and the interaction effect of time and gender. Then, a stepwise multiple logistic regression analysis was performed to identify factors related to HRQoL. Time differences were observed in the subjective evaluation of health status (SEH), IPAQ scores, frailty, nutritional status, and depression. Gender differences were observed in the SEH, IPAQ, frailty, loneliness, depression, and social support. The interaction between time and gender was observed in the IPAQ and HRQoL. At baseline, SEH, depressive symptoms, gender, frailty, and age were associated with HRQoL. After one year, HRQoL was associated with SEH, frailty, depressive symptoms, cost of living, suicidal thoughts, gender, social support, loneliness, and suicide attempts. Our results highlight that HRQoL is associated with physical health, mental health, and social support. Future detailed studies are needed to determine whether governments and communities can prevent depression, loneliness, and suicidal thoughts through psychological support and provide economic support to improve the quality of life of older adults living alone.

Impact of Care-Recipient Relationship Type on Quality of Life in Community-Dwelling Older Adults With Dementia Over Time.

Maintaining quality of life (QoL) has been identified as the primary goal of care services for person living with dementia (PLWD). A secondary analysis was conducted on five rounds of the National Health and Aging Trends Study (NHATS) over 4years. A generalized estimating equation (GEE) was used to examine the prediction of relationship type on older adults' QoL through four domains: mental health, general health, functional limitations, and pain. older adults cared for by an adult-child or multiple caregivers predicted increased risk for functional limitations after adjustment for their socio-demographic and dementia status (IRR = 1.53, CI [1.26, 1.86]; IRR = 1.36, CI [1.14, 1.61], respectively). The interaction between the relationship type and education was significant. Older adults with a high school education or below, who were cared for by an adult child, had a significantly higher risk of increasing functional limitations over 4years compared to those cared for by a spouse/partner (contrast = .50, P = .01, 95% CI [.07, .93]; contrast=.52, P = .03, 95% CI [.03, 1.02]; respectively). Similarly, older adults with a high school education, who were cared for by multiple caregivers, also experienced a significantly higher risk of increasing functional limitations than those cared for by a spouse/partner (contrast = .44, P = .03, 95% CI [.02, .85]). Our findings provide evidence of the significant contribution of relationship type on PLWD's QoL changes over time. They also help to prioritize resource allocation while addressing PLWD's demands by socio-demographics such as education level.

The Effects of Nursing Case Management on Self-Care Behaviors, Clinical Outcomes, and Quality of Life Among Community-Dwelling Older Adults with Poorly Controlled Type 2 Diabetes in Thailand

ABSTRACT This study evaluated the effectiveness of nursing case management on self-care, clinical outcomes, and quality of life in community-dwelling older adults with poorly controlled type 2 diabetes in Thailand. The research employed a quasi-experimental, single-group, pretest – posttest design. Methods: Twenty-three participants participated in a 12-week nursing case management program, which was tailored to the individual’s needs and abilities, as well as their family, community, and healthcare context. Self-care behaviors increased significantly (p = .000) after implementation of the case management program, while waist circumference, fasting capillary blood glucose, and hemoglobin A1c decreased significantly (p = .001, p = .000, p = .003, respectively) from pre-intervention values. Quality of life was significantly better after the program (p = .000) than before. Results suggest that implementing tailored nursing case management could increase self-care behaviors and quality of life while decreasing waist circumference, fasting capillary blood glucose, and hemoglobin A1c in community-dwelling older adults with poorly controlled type 2 diabetes. The effectiveness of nursing case management depends on the healthcare context, the training and expertise of case managers, as well as the patient’s needs and preferences. Furthermore, the availability of families and communities can influence the nursing case management outcomes.

Comparison between the effects of virtual supervision and minimal supervision in a 12-week home-based physical exercise program on mental health and quality of life of older adults: Secondary analysis from a randomized clinical trial.

The objective of this study was to compare the effects of virtual supervision and minimal supervision in a 12-week home-based physical exercise program on the mental health and quality of life of community-dwelling older adults. This study presents a secondary analysis of a randomized clinical trial conducted during the COVID-19 pandemic. The sample comprised 38 elderly men and women (81.6% women, mean age 68 ± 6.4 years; mean weight 69.8 ± 12.1 km) without physical and/or cognitive impairments. The volunteers were divided into two groups: one group received virtual supervision (monitored via videoconference), while the other group received minimal supervision (monitored through weekly text messages). Both groups followed the same home-based physical exercise program, consisting of three sessions per week, differing only in the supervision strategy. Mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS-21) in conjunction with the POMS questionnaire, which evaluates mood, and quality of life was assessed using the WHOQOL-OLD questionnaire. Our findings demonstrated statistically significant superiority of virtual supervision compared with minimal supervision in relation to depression (-2.92, 95% confidence interval = -5.22 to -0.63). Conversely, minimal supervision exhibited superiority over virtual supervision regarding quality of life (-6.70, 95% confidence interval = -11.66 to -1.73). Virtual supervision yielded better outcomes for the depression indicator, while minimal supervision favored the quality of life of older adults at the conclusion of the 12-week home-based physical exercise program. Geriatr Gerontol Int 2023; 23: 864-870.

Advanced Activities of Daily Living in Community-Dwelling Older Adults: A Cross-Sectional Study of the Mexican Health and Aging Study (MHAS 2018).

The advanced activities of daily living (AADLs) in old age is a key indicator of the mobility domain for the intrinsic capacity of older adults living in the community; for this reason, it is relevant to know the prevalence and risk factors related to performing fewer AADLs in different populations. To determine the prevalence and factors associated with the ability to perform AADLs in older adults reported in the Mexican Study of Health and Aging (MSHA 2018). A secondary cross-sectional analysis of the MSHA 2018 data was carried out, including a convenience sample of 6474 subjects ≥ 60 years of age, for both sexes, without cognitive deficits. Nine questions related to AADLs were selected from the database. Multiple logistic regression analysis was performed to determine factors associated with <3 AADLs, including sociodemographic, lifestyle, and health status factors. The prevalence of the ability to perform <3 AADLs was 63%. Age is the most important risk factor for <3 AADLs, which increases by the decade, followed by sedentary lifestyle (OR = 2.15, 95% CI: 1.91-2.42, p < 0.0001). Our findings suggest that age, schooling, urban residence, sedentary lifestyle, and comorbidity are the main risk factors for <3 AADLs in older Mexican adults.

Fear of falling as a mediator in the association between social frailty and health-related quality of life in community-dwelling older adults

BackgroundSocial frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL.MethodsIn this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable.ResultsSocial frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, “going out less frequently” was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL.ConclusionsSocial frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults.

Effect of Physical Activity on Association between COVID-19 and Personal Life in Community-Dwelling Older Adults

Our study investigated whether changes in physical activity due to COVID-19 mediate the association between quarantine or hospitalization due to COVID-19 and COVID-19 life impact score. A total of 154 participants (0.23%) were quarantined or hospitalized due to COVID-19. There were mediating effects of changes in physical activity due to COVID-19 (β = −1.63, 95% confidence interval = −0.77 to −2.42). This study suggests that measures to minimize lifestyle changes during the pandemic are required to reduce negative consequences.

Home-Based Exergame Program to Improve Physical Function, Fall Efficacy, Depression and Quality of Life in Community-Dwelling Older Adults: A Randomized Controlled Trial.

This study aimed to investigate the effects of home-based exergame programs on physical function, fall efficacy, depression, and health-related quality of life in community-dwelling older adults. Fifty-seven participants aged 75 years or older were divided into control and experimental groups. The experimental group received a home-based exergame program that included balance and lower-extremity muscle strength for 8 weeks. The participants exercised at home for 50 min three times a week and were monitored through a video-conference application. Both groups received online education on musculoskeletal health once a week, whereas the control group did not exercise. Physical function was assessed using the one-leg standing test (OLST), Berg balance scale (BBS), functional reaching test (FRT), timed up-and-go test (TUGT), and five-times sit-to-stand (FTSTS). Fall efficacy was assessed using the modified falls efficacy scale (MFES). Depression was assessed using the geriatric depression scale (GDS). Health-related quality of life was assessed using a 36-item short-form health survey (SF-36). The experimental group showed an overall improvement in OLST, BBS, FRT, TUGT, and FTSTS (p < 0.05). MFES was significantly increased in the experimental group after the intervention (p < 0.05). The GDS significantly decreased in the experimental group after the intervention (p < 0.05). In SF-36, role limitations due to physical health, general health, and fatigue (energy and fatigue) items improved in the experimental group after intervention (p < 0.05). An 8-week home-based exergame program improved physical function, fall efficacy, depression, and health-related quality of life in older adults. The study was registered on ClinicalTrials.gov (NCT05802537).

Social and Health Determinants of Quality of Life of Community-Dwelling Older Adults in Malaysia.

Quality of life (QOL) of older adults is a complex issue that requires an understanding of the intersection between socioeconomic and health factors. A poor quality of life (QOL) is frequently reported as sub-optimal among older adults whereby concerted and collective actions are required through an evidence-based approach. Hence, this cross-sectional study aims to determine the social and health predictors of the QOL of a community-dwelling older adult Malaysian population through a quantitative household survey using multi-stage sampling. A total of 698 respondents aged 60 years old and older were recruited and the majority of them had a good quality of life. Risk of depression, disability, living with stroke, low household income, and lack of social network were identified as the predictors of a poor QOL among the community-dwelling older Malaysians. The identified predictors for QOL provided a list of priorities for the development of policies, strategies, programmes, and interventions to enhance the QOL of the community-dwelling older Malaysians. Multisectoral approaches, especially collective efforts from both social and health sectors, are required to address the complexities of the ageing issues.

Correlates of Health-Related Quality of Life in Community-Dwelling Older Adults in Guadeloupe (French West Indies): Results from the KASADS Study.

The aim of this study was to determine the correlates of health-related quality of life (HRQoL) in community-dwelling older adults in Guadeloupe. We used the Karukera Study of Aging-Drugs Storage (KASADS), an observational, cross-sectional study on community-dwelling older people living in Guadeloupe. A visual analogue scale ranging from 0 to 100 was used to assess HRQoL. The study sample consisted of 115 patients aged 65 years or older; 67.8% were women. Participants were 76 (±7.8) years old with a mean HRQoL of 66.2 (±20.3). The correlates of HRQoL were complaints of pain (p < 0.001) and IADL dependency (p = 0.030) after adjustment. We found no significant interactions between HRQoL and other variables such as marital status, socio-educational level and cognitive decline. Pain and IADL dependency were independently associated with lower HRQoL in community-dwelling older people in Guadeloupe.

Family function, social support and quality of life in community-dwelling older adults: the moderating role of gender

Family function, social support and quality of life in community-dwelling older adults: the moderating role of gender

The Stroll Safe outdoor falls prevention program: Participant experiences in eight community sites

Background and objectivesOutdoor falls can negatively impact the quality of life of community-dwelling older adults. Although there are differences in risk factors for indoor and outdoor falls, none of the existing evidence-based fall prevention programs specifically targets outdoors falls. To fill this gap, the Stroll Safe program was developed. The purpose of this study was to explore participant's experiences in the Stroll Safe program Research design and methodsIn this qualitative study, we conducted focus groups at eight community program sites with Stroll Safe program participants. Thematic analysis, with both deductive and inductive coding were used. Researcher triangulation was employed to increase trustworthiness of the findings ResultsFour major themes emerged from the data, including (1) Precipitants of behavioral change, (2) Behavioral change, (3) Program design, and 4) Enjoyment of program experience. Several sub-themes were also uncovered Discussion and implicationsAlthough the qualitative findings are consistent with the quantitative findings from the efficacy trial, the results also reveal benefits that were not captured by the quantitative analysis. In addition, the findings related to the influence of the group leader and program design can be used to guide future implementation science studies.

Are quality of life, functional capacity, and urinary incontinence associated with fecal incontinence? The Fibra-BR Study

Objective: To assess the prevalence of fecal incontinence and its association with clinical, functional, and cognitive-behavioral variables, medication use, frailty, falls, and quality of life in community-dwelling older adults (aged 65 years or older). Methods: Cross-sectional, multicenter study carried out across 16 Brazilian cities. The question “In the last 12 months, did you experience fecal incontinence or involuntary passage of stool?” was defined as the indicator variable for fecal incontinence. Bivariate analyses were carried out to assess the prevalence of fecal incontinence and sociodemographic characteristics, comorbidities, cognition, functional capacity, depression, frailty, quality of life, and falls. Logistic regression analysis was also performed, with fecal incontinence as the dependent variable. Results: Overall, 6855 subjects were evaluated; 66.56% were female, 52.93% white, and the mean age was 73.51 years. The prevalence of fecal incontinence was 5.93%. It was associated with worse self-care (OR 1.78 [1.08–2.96]), dependence for basic activities of daily living (OR 1.29 [1.01–1.95]), and urinary incontinence (OR 4.22 [3.28–5.41]). Furthermore, the absence of polypharmacy was identified as a protective factor (OR 0.61 [0.44–0.85]). Conclusion: The overall prevalence of fecal incontinence was 5.93%. On logistic regression, one quality of life variable, dependence for basic activities of daily living, and polypharmacy were significantly associated with fecal incontinence.