Quality Of Life In Older Adults Research Articles

The Relationships Among Family Functioning, Sleep Quality and Quality of Life in Chinese Community-Dwelling Older Adults with Insomnia: A Structural Equation Model

ABSTRACT Objectives The proportion of individuals with insomnia is increasing, and many older adults have insomnia. This study aimed to explore the relationships between family functioning and quality of life (QOL) among community-dwelling older adults with insomnia, as well as to explore the mediating role of sleep quality in this relationship. Methods The participants were 225 older adults with insomnia from community health service centers in Chongqing, China. The Family Care Index (APGAR) was used to assess family functioning, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the 36-item Short-Form Health Survey (SF-36) was used to assess QOL. Results The results showed that family functioning would be positively associated with QOL (p = .005) and that this relationship would be partially mediated by higher sleep quality (p < .001). Conclusions Family functioning has a direct effect on QOL and an indirect effect on QOL through the regulation of sleep quality. Maintaining good family functioning is important for improving sleep quality and QOL in older adults with insomnia. Clinical Implications Developing family functioning-based assessments and targeted intervention strategies could be beneficial for older adults with insomnia.

Investigating drivers of telecare acceptance to improve healthcare quality for independently living older adults.

Contemporary telecare systems facilitate the ability for older adults to age in place, keeping them out of residential care facilities and providing numerous quality-of-life advantages for both care receivers (CRs) and caregivers (CGs). However, despite the acceptance of digital health interventions among older adults and their CGs, telecare adoption has been slower than expected. This paper aimed to compare attitudes toward adopting telecare systems between CRs (aging adults) and their CGs (family/friends). Data were collected via an online survey. Respondents included aging adults concerned about their care (CRs) and older adults who cared for an aging loved one (CGs). Analysis of covariance and partial-least-squares techniques were used to examine the relationships between healthcare concerns for older adults, functional telecare benefits, and telecare acceptance. Concerns for healthcare status, mainly driven by CRs, positively impacted telecare acceptance. However, concerns for mental and physical stimulation had a negative relationship with telecare acceptance, while CGs showed a neutral relationship. Telecare's ability to improve healthcare quality and cognitive stimulation positively impacted its acceptance. CGs mainly drove the impact of healthcare quality on telecare acceptance, while the relationship was not significant for CRs. CRs' age reduced telecare acceptance, and higher educational levels of CGs increased telecare acceptance. We found significant differences in telecare acceptance and its drivers between CGs and CRs in the USA. In addition, we discerned that not all healthcare concerns or functional telecare characteristics influenced telecare acceptance equally between the two. Consequently, telecare providers must consider the different needs of constituencies interested in telecare to support the life quality of older adults.

Quality of Life Among Older Adults With Frailty: A Structural Equation Modeling.

Frailty is a complex age-related clinical condition among older adults. Quality of life (QOL) among older adults with frailty is an important topic of interest. The current cross-sectional study aimed to develop a structural equation model to identify factors affecting QOL. A total of 180 older adults with frailty were recruited from general units in two hospitals in Fuzhou, China. Data were collected using the World Health Organization Quality of Life Brief Version, Pittsburgh Sleep Quality Index, Geriatric Depression Scale-15, and Simplified Coping Style Questionnaire. Structural equation modeling was used to analyze data. The final model exhibited a good fit. Poor sleep quality was associated with depression, passive coping style, and poor QOL. Depression was also associated with poor QOL. Passive coping style was associated with better QOL. This study demonstrated that sleep quality has direct and indirect effects on QOL of older adults with frailty through depression and passive coping style. Recommendations are that care providers pay attention to biological and physiological variables, symptom status, and functional status of older adults with frailty. This study also provides a theoretical basis for developing interventions that may lead to improvements in QOL among older adults with frailty. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 49-55.].

Enhanced Health Management: Tailored Solutions for Elderly Care

Abstract: In an era characterized by a globally aging pop- ulation, the imperative to address the comprehensive health needs of older adults has intensified. Among these needs, dietary wellness emerges as a fundamental aspect crucial for sustaining vitality and managing age-related conditions. Recognizing this imperative, our work introduces a pioneering personalized health ecosystem tailored to the unique dietary requirements of seniors. Through the utilization of advanced data science and machine learning methodologies, our platform presents a holistic solution aimed at enhancing dietary habits and overall well-being among seniors. Therefore, our health management system endeavors to foster healthy eating practices and augment the quality of lifefor older adults, thereby cultivating a proactive ethos of wellness and self-care.

Association of depression and sleep quality with frailty: a cross-sectional study in China.

With the rapid growth of global aging, frailty has become a serious public health burden, affecting the life quality of older adults. Depressive symptoms (depression hereafter) and sleep quality are associated with frailty, but the pathways in which sleep quality and depression affect frailty remain unclear. This cross-sectional study included 1866 community-dwelling older adults. Demographic characteristics and health-related data of them was collected, and we also assessed frailty, depression, and sleep quality. Descriptive statistics were carried out and ordinal logistic regression analysis was used to identify the factors correlated with frailty. Spearman correlation analysis and mediation analysis were employed to assess associations between sleep quality, depression and frailty. Two-sided p < 0.05 was considered as significant. The results showed that 4.1% older adults were frail and 31.0% were pre-frail. Ordinal logistic regression showed that age, consumptions of vegetables, exercise, sleep quality, depression, number of chronic diseases, chronic pain, and self-rated health were correlated with frailty. Spearman correlation analysis revealed that frailty was associated with depression and sleep quality. There was a mediation effect that sleep quality was a significant and positive predictor of frailty (total effect = 0.0545, 95% boot CI = 0.0449-0.0641), and depression was a mediator between sleep quality and frailty (mediation effect = 60.4%). Depression and poor sleep quality may be early indicators of frailty in older adults. Improving the sleep quality and psychological state of older adults can improve frailty, which is beneficial for healthy aging.

Role of handgrip strength in predicting the quality of life in older adults: A cross-sectional study.

Quality of life (QOL) is a vital component in assessing the standard of living for seniors. Hand grip strength (HGS) is a widely used measure to diagnose muscle strength decline that often occurs due to age-related loss of skeletal muscle mass and function. This study focuses on the HGS in predicting the QOL of older adults who are referred to retirement centers in Guilan Province. In 2021, a cross-sectional analytical study was conducted among 115 older adults who were residing in retirement centers located in Guilan Province, Northern Iran. The participants were selected using a two-stage sampling method, where three retirement centers were randomly chosen followed by convenience sampling from each center. The selected retirement centers were situated in Langrod, Sowme'eh Sara, and Rasht cities in the east, west, and center of the province, respectively. The data were collected through a demographic information questionnaire, QOL scale (CASP-19), and HGS measurement using a dynamometer. Of the participants, 57.4% were male, 51.3% had middle income, and 96.5% were categorized as young elderly. The mean overall QOL score was found to be 37.026 ± 6.123, while the mean HGS level was 31.74 ± 7.45 and 18.48 ± 5.13 among males and females, respectively. There was a significant association between the level of education and QOL (P = 0.002). Moreover, there was a positive and significant correlation between HGS and QOL (r = 0.54, P = 0.001). The results of the multiple linear regression identified HGS as a predictor of QOL (Adj R2 = 0.44, βHGS = 0.79). Given that HGS has been identified as a predictor of QOL in older adults, improving this factor through exercise can lead to enhancement in their QOL. Therefore, regular sports exercises can be recommended as a means of improving HGS and subsequently enhancing the QOL of older adults.

Biopsychosocial determinant of quality of life of older adults in Pakistan and Canada.

The rapidly rising average age of the older adults has brought various global healthcare challenges. A core challenge is how to enhance their quality of life (QoL). The objective of the current study was to test the significance of biopsychosocial determinants of quality of life of older adults in Pakistan and Canada. A cross-sectional survey was carried out on a conveniently approached purposive sample of 1,005 older adults (Pakistani = 557 and Canadian = 448) of age range between 60 years and 80 years. The data were collected via demographic datasheet, World Health Organization Quality of Life Brief Scale, Health and Lifestyle Questionnaire, General Self-Efficacy Scale, Rosenberg Self-Esteem Scale, and Berlin Social Support Scale. The results of hierarchical regression analysis showed that biopsychosocial factors (viz., health and lifestyle, chronic illness, self-efficacy, self-esteem, and social support) significantly predicted (R 2 = .27, and.68) quality of life of older adults in Pakistan and Canada, respectively, after controlling the demographic variables. Significant differences were found between Pakistani and Canadian older adults on biopsychosocial factors: Canadian older adults scored significantly higher on health and lifestyle, self-efficacy, and quality of life, and older adults in Pakistan scored significantly higher on self-esteem and social support. A significant amount of better QoL of older adults can be achieved through enhancing the biopsychosocial correlates of their QoL, both in Pakistan and Canada.

Quality of life and influencing factors in older adults with benign prostatic hyperplasia

AbstractThe aim of this study was to investigate the relationship between the quality of life (QoL) and self‐efficacy in older adults with benign prostatic hyperplasia (BPH), as well as the factors affecting their QoL. Previous research has shown that self‐efficacy is one of the factors affecting the QoL of individuals. Diminished self‐efficacy can impair cognitive and behavioural function, while heightened self‐efficacy can drive changes in treatment acceptance behaviour and, subsequently, physical and mental health. Although past research has investigated QoL among patients with BPH, no known studies have investigated the impact of self‐efficacy on QoL, specifically among the Chinese aged population who may have a different disease status. The study followed a cross‐sectional design and included 372 older adults with BPH. The Chinese version of the Benign Prostatic Hyperplasia QoL Scale (BPH‐QLS), the Chinese version of the Self‐rated Abilities for Health Practices Scale (SRAHP) and General Survey Questionnaire were used. One‐way ANOVA and multiple regression analysis were employed to identify factors influencing QoL and evaluate the relationship between self‐efficacy and QoL. The results indicated a positive correlation between QoL and self‐efficacy. Educational level, sexual intercourse, disease duration, marital status, monthly family income and self‐efficacy were identified as factors influencing QoL in older adults with BPH. Multiple linear regression analysis revealed that self‐efficacy for health responsibility had the most significant impact on QoL scores. To enhance QoL in older adults with BPH, active measures are needed. Future studies should focus on intervention programmes that target self‐efficacy, which is a modifiable factor with significant potential for improvement.

Association between social capital and quality of life in older adults with subjective cognitive decline: A cross-sectional study

BackgroundSubjective cognitive decline (SCD) is increasingly recognized as a clinical and medical risk factor for mild cognitive impairment (MCI) and dementia. Currently, there is little evidence regarding the quality of life (QoL) in older adults with SCD and the impact of social capital on their QoL. AimsTo examine the perceptions of social capital and QoL among older adults with SCD. MethodsA total of 325 participants (92.9 % response rate) with a self-reported diagnosis of SCD completed the Chinese version of the 36-item Short-Form Health Survey, the Chinese Shortened Social Capital Scale and the Generalized Anxiety Disorder Scale. A t-test was used to compare the QoL score of our sample with the Chinese norm. Pearson correlation analysis and multivariate linear regression analysis were used to assess the association of social capital with QoL. ResultsSocial capital were strongly correlated with the total QoL, as well as its physical component summary and mental component summary. The QoL score of older adults with SCD was significantly lower than the Chinese norm (P < 0.001). Multivariate analysis showed that social capital, physical activity, nutrition and anxiety symptoms were factors associated with QoL among older SCD population (P < 0.05). ConclusionThe findings of the current study suggest that older adults with SCD may experience lower QoL. Social capital is associated with the QoL in older adults with SCD. These findings have implications for clinicians who work with older adults with SCD.

THE IMPACT OF FAR-INFRARED TECHNOLOGY ON QUALITY OF LIFE IN OLDER ADULTS

Abstract Identifying methods of pain amelioration to meet the unique demands of older adults (OA) may be crucial to increasing quality of life (QOL) for this population. This study aimed to examine the effects of far-infrared heat (FIR) on pain management and QOL in OA. FIR utilizes a long light wavelength that simulates dry sauna-like conditions. Examining the relationship between FIR and pain is important due to the increased prevalence of chronic pain associated with aging and the corresponding impact it has on QOL and physical performance. Seventeen OA completed the study. Participants were randomly assigned to either a convective heat group (CON) or a convective and far-infrared heat (FIR) group, with convective heat set to 60℃ (140℉.) Participants received six, 30-minute sessions. Physical assessments were measured (range of motion, gait speed, timed up-and-go, and hand grip strength) as well as pain severity and its interference with daily life, and the impact pain had on overall QOL. T-tests were used to compare pre- and post-assessment measures. Results indicated that pain severity was significantly reduced (from 3.31 to 2.5, P &amp;lt; 0.05) in the FIR group and that pain interference was significantly reduced (from 1.26 to 0.43, P &amp;lt; 0.05) in the CON group. Findings suggest that heat therapy successfully reduced pain over time, but that FIR heat specifically was not superior to that of convective heat alone. Further research is required to correctly identify the relationship between QOL and the use of FIR.

SOCIAL ENGAGEMENT AMONG COMMUNITY-DWELLING OLDER ADULTS: A QUALITY-OF-LIFE ANALYSIS

Abstract Older adults are living longer without sufficient efforts from health and social service systems to improve their quality of life (QoL). QoL is a nuanced, dynamic aspect to analyze. Literature shows that higher levels of social engagement provide a range of benefits to physical, mental, and cognitive health, all broad indicators of overall QoL. Social engagement comprises the person’s subjective experience of the richness of their relationships. The purpose of this study was to examine empirically the connection among this richness of relationships — specifically social engagement and perceived quality of relationships — and overall QoL among older adults. The study used a large sample (N=746) of non-institutionalized adults, ages 65 and older, from the nationally representative, AARP Social Engagement and Brain Health Survey. Two primary independent variables (IVs) were quantifiable measures of social engagement and perceived quality of social relationships; covariance controlled for several demographic factors (e.g., sex, ethnicity, income) and general health measures of physical, mental, and emotional health. The outcome variable was a composite score from a popular QoL measure. Analyses involved bivariate regression for the primary IVs, then multivariate OLS regression with each IV to predict quality of life. Results showed that QoL significantly regressed with predictors of social engagement (positively); each health variable (positively); unmarried status; ethnicity of Black/African American or Asian; and male gender. These results enhance our understanding of the relationship between social engagement, relationship quality, and QoL in older adults, particularly those who identify within the aforesaid demographic brackets. Implications are discussed.

NEIGHBORHOOD CONTEXT AND QUALITY OF LIFE OF OLDER ADULTS IN EASTERN NEPAL: A CROSS-SECTIONAL STUDY

Abstract Introduction Increased life expectancy has resulted in population aging and subsequently entails addressing the needs of older adults. Shifting family structures from multigenerational to nuclear have had a significant effect on the older adults’ livelihood and their ways of interaction with community members. This research aims to comprehend the relationship between neighborhood context and older adults’ quality of life (QoL) in Nepal. Methods A total of 847 non-institutionalized older adults (≥60 years) from eastern Nepal were interviewed in 2021. The QoL was measured by13-item version of the Older People’s Quality of Life questionnaire (OPQOL-brief), and each item was measured on a 5-point Likert scale. The OPQoL mean score &amp;lt; 3 was recoded as low, and ≥3 was high QoL. Ethnic diversity, monthly income, connection with family, friends, and neighbors, cultural connection, residential instability, and accessibility were measured to see the effect of neighborhood context. Multivariable logistic regression assessed the relationship between neighborhood context and QoL. Results More than 20% of older adults reported low QoL. Participants engaged in occupation [OR=2.63], not consuming tobacco [OR=1.78], living in communities with higher ethnic diversity [OR=1.03], frequently in contact with family [OR=4.77] and neighbor [OR=13.79], and stable residence [OR=5.43] had significant associations with better QoL. Conclusion In this study, neighborhood context was a determinant of better QoL in older adults. Therefore, engagement in income generation activities, and strengthening families and neighborhood ties bring good QoL among older adults.

Do physical fitness and cognitive function mediate the relationship between basic activities of daily living and quality of life in older adults with dementia?

PurposeIndependence in activities of daily living (ADLs) is associated with quality of life (QoL) in individuals with dementia. However, the contribution of physical and cognitive functions to this relationship needs further examination. This study aims to examine the mediating effect of physical fitness and cognitive function in the relationship between independence in basic ADLs and QoL among older adults with dementia.MethodsThis cross-sectional study included 107 older adults with dementia (74.8% women; age 78.21 ± 7.70 years). Independence in basic ADL and QoL were evaluated using the Barthel Index (BI) and QoL- Alzheimer’s Disease Scale, respectively. The Alzheimer’s Disease Assessment Scale–Cognitive Subscale and the Mini-Mental State Examination were applied to assess cognitive function. Physical fitness was evaluated using the 30-s chair stand, 2-min step and the Timed-Up and Go tests. A structural equation modelling (SEM) with bootstrapping estimation was conducted to determine the relationship between all variables.ResultsIndependence in basic ADL positively affected QoL and this association was mediated by physical fitness (β = 0.242, p = 0.011). No statistically significant results were observed when testing cognitive function as a mediator between BI and QoL (β = 0.009, p = 0.345).ConclusionsPhysical fitness (i.e., lower body strength, aerobic capacity, and mobility) plays a role in the relationship between basic ADL independence and QoL of older adults with dementia, reinforcing the need to improve and monitor these parameters throughout the disease progression. Future longitudinal studies should explore the temporal relationship between physical and cognitive function and its contribution to basic ADL independence and QoL.

Evaluating an intergenerational art and storytelling program with older adults and medical students

Older adults in residential communities face loneliness and isolation, challenges exacerbated by COVID-19, leading to adverse physical and mental health outcomes. Intergenerational arts and humanities programs have been successful in addressing these challenges while also enabling medical learners to better understand aging populations. Draw YOUR Story, a program at a Houston residential senior living community, connects premedical and medical student volunteers with older adults through an art and storytelling activity. To evaluate the program, we conducted a focus group with older adults and pre and post-volunteering student surveys with questions about attitudes towards older adults and an Interpersonal Reactivity Index. Student surveys (n = 18) showed increased comfort working with older adults after volunteering (p = 0.02). Students who spent less time volunteering reported a decline in their perceptions of older adult quality of life, when compared to more frequent volunteers (p = 0.02). Older adults shared that the program encouraged learning new skills, offered time for reflection, connected them to medicine, and furthered desire for community. Draw YOUR Story benefitted students and older adults, increasing student comfort with older adults, providing aging adults opportunities to learn new skills and reflect, and building intergenerational connections.

Socioeconomic status and quality of life among older adults with hypertension in rural Shandong, China: a mediating effect of social capital.

Improving the quality of life (QoL) of older adults is becoming an important global issue. However, very few studies have been focused on the relationship between socioeconomic status (SES) and QoL in older adults with hypertension. The purpose of this study is to investigate (a) the status of QoL and (b) the mediating effect of social capital in the relationship between SES and QoL, among rural older adults with hypertension in China. Using multistage stratified random sampling, a face-to-face questionnaire survey was conducted among rural older adults with hypertension in Shandong province of China from June to July 2021. Three typical measures representing SES were used, namely, annual household income, educational level, and employment status. Individual social capital and QoL were assessed by the Resource Generator-China Scale (RG-China) and a 34-item simplified Patient Report Outcome (PRO)-specific scale for older adults with hypertension, respectively. A total of 950 rural older adults with hypertension were included in the analysis. The mediation model based on bootstrap analyses was employed to explore the relationship between SES and QoL and the mediating role of social capital in the SES-QoL nexus. The sampled rural older adults with hypertension had an upper-middle level of QoL, and the average score was 132.57 ± 19.40. SES was positively correlated with both QoL and individual social capital; individual social capital was significantly positively correlated with QoL. Controlling for sociodemographic variables, SES was still significantly associated with individual social capital (β = 0.140, P < 0.001), and the higher the individual social capital, the better QoL (β = 0.153, P < 0.001). Individual social capital played a partially mediating role in the association between SES and QoL (indirect effect = 0.021, 95% CI: 0.010-0.038), which accounted for 9.38% of the total effect. This study provides evidence that the effect of SES on QoL was partially mediated by individual social capital among rural older adults with hypertension in China. The government should pay more attention to the rural older hypertensive population with lower SES and strive to reduce the negative impact of poor SES on their QoL, based on effective strategies including improving their individual social capital.

Psychometric Properties of the Hindi Version of the World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) Module in Dehradun, India.

The perception of quality of life (QOL) is a subjective concept; however, attempts have been made to discern the key points and to give a metric view of this concept. The World Health Organization Quality of Life Questionnaire-Older Adults (WHOQOL-OLD) module is an international and cross-cultural tool that quantifies the QOL in older adults. This study aimed to assess the psychometric properties of the Hindi version of the WHOQOL-OLD module by calculating its reliability and validity among the elderly residing in the Dehradun district of India. This cross-sectional study was conducted among 440 elderlies from the rural and urban areas of Dehradun by using the Hindi version of the WHOQOL-OLD questionnaire. The mean and standard deviations were calculated for QOL scores. Reliability was checked by calculating Cronbach's alpha (α), and factor analysis was done for the validity of the questionnaire. Mean (±SD) for total QOL score was 54.3 (±9.3). The death and dying facet had the maximum mean score, whereas the minimum mean score was calculated in the autonomy facet. Cronbach's alpha reliability coefficient for the overall QOL score was calculated as 0.86 which shows good internal consistency of the items in the questionnaire. To measure the construct validity, exploratory factor analysis (EFA) by principal components analysis (PCA) was performed on the 24 items of the WHOQOL-OLD module, and a six-factor model was identified. Satisfactory goodness-of-fit statistics were found on the confirmatory factor analysis (CFA). QOL is a multidimensional concept. The Hindi version of the WHOQOL-OLD module is reliable and valid. QOL in the elderly population can be measured by using the WHOQOL-OLD module in India.

Associations between change in physical activity and sedentary time and health-related quality of life in older english adults: the EPIC-Norfolk cohort study

BackgroundNo previous studies have examined the associations between changes in objectively-measured physical behaviours with follow-up QoL in older adults. Based on cross-sectional evidence, it is biologically plausible that such associations exist. If so, this bolsters the case for the commissioning of activity interventions and for including QoL as an outcome in trials of such interventions.MethodsWe assessed physical behaviours (total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, total sedentary time and prolonged sedentary bout time) for 7 days using hip-worn accelerometers at baseline (2006–2011) and follow-up (2012–2016) and health-related quality-of-life (QoL) using EQ-5D questionnaires at follow-up in 1433 participants (≥ 60 years) of the EPIC (European Prospective Investigation into Cancer)-Norfolk study. The EQ-5D summary score was used, with 0 as the worst to 1 as best perceived quality-of-life. We evaluated the prospective associations of baseline physical behaviours with follow-up QoL, and of changes in behaviours with follow-up QoL using multi-level regression.ResultsOn average, MVPA decreased by 4.0 min/day/year (SD 8.3) for men and 4.0 min/day/year for women (SD 12.0) between baseline and follow-up. Total sedentary time increased by an average 5.5 min/day/yr (SD 16.0) for men and 6.4 min/day/yr (SD 15.0) for women between baseline and follow-up. Mean (SD) follow-up time was 5.8 (1.8) years.We found that higher baseline MVPA and lower sedentary time was associated with higher subsequent QoL (e.g. 1 h/day greater baseline MVPA was associated with 0.02 higher EQ-5D score, 95% CI 0.06, 0.36). More pronounced declines in activity were associated with worse Hr-QoL (0.005 (95% CI 0.003, 0.008) lower EQ-5D per min/day/yr decrease in MVPA). Increases in sedentary behaviours were also associated with poorer QoL (0.002 lower EQ-5D, 95% CI -0.003, -0.0007 per hour/day/yr increase in total sedentary time).ConclusionsPromotion of physical activity and limiting sedentary time among older adults may improve quality-of-life, and therefore this relationship ought to be included in future cost effectiveness analyses so that greater commissioning of activity interventions can be considered.

0536 Impact of Positive Airway Pressure Therapy on Clinical Outcomes in Older Veterans with Comorbid COPD and OSA: An Update

Abstract Introduction Cognitive impairment in older Veterans is an independent predictor of subsequent mortality and disability. Pilot data indicate that patients with OSA-COPD Overlap Syndrome (OVS) may have reduced sleep quality, cognitive function and quality of life (QoL). However, there are no prior systematic studies evaluating treatment paradigms in patients with OVS. Our ongoing clinical trial is investigating whether positive airway pressure (PAP) therapy alleviates sleep disturbances, sleepiness, and improves cognitive function and QoL in older adults with OVS. Methods The design is a prospective parallel group randomized controlled trial in Veterans 60 years and older, with moderate-to-severe OSA with concomitant COPD (OVS). 225 eligible participants will be randomized to two treatment groups (PAP and conservative care) in 2:1 ratio for a duration of 6 months. Participants on the conservative care arm are required to follow good sleep habits and sleep hygiene, and on the PAP arm, in addition, are required to be adherent to PAP treatment (CPAP or Bilevel PAP, as required). Sleep questionnaires are administered to evaluate sleepiness, sleep quality, and general and disease specific QoL. Cognitive function is evaluated using Trail Making Test Part A and B, Paced Auditory Serial Addition Test, Stroop Task, Digit Coding, Hopkins Verbal Learning Test-R, Weschler Abbreviated Scale Intelligence II, Weschler Memory Scale IV, and Psychomotor Vigilance Test, respectively. All tests are administered at baseline visit, 3 months, and 6 months. Results In year-2 of the study, we have screened 7878 Veterans, enrolled 137 participants, randomized 34 participants (31 males, 3 females; age: 70.7±6.6 years, BMI: 29.6±6.7 kg/m2, AHI: 47±22 events/hr, spirometry FEV1: 60.8±11.7% predicted, arterial blood gas (n=22) pCO2:41.2 ±3.6 mmHg, ESS: 1.9 ±2.4); 15 have completed the study per the protocol. Analysis of data will be completed at the end of the RCT. Conclusion Our research seeks to systematically study the effects of treating a novel target (OVS) to maximize daytime function and QoL, while also providing a framework for early treatment of mild cognitive impairment in vulnerable older Veterans. Support (if any) VHA RR&amp;D Merit Award # 1I01RX003124-01

The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus

BackgroundAt present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM.MethodsIn this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM.ResultsDecreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%.ConclusionMedication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.

Emergency General Surgery Procedures in Older Adults: Where You Live Matters!

Neighborhood location and its built environment are important social determinants of health that impact health outcomes. Older adults (OAs) represent the fastest growing population in the United States with many requiring emergency general surgery procedures (EGSPs). The aim of this study was to evaluate whether neighborhood location, represented by zip code, influences mortality and disposition in OAs undergoing EGSPs in Maryland. A retrospective review was undertaken of hospital encounters in the Maryland Health Services Cost Review Commission from 2014 to 2018 of OAs undergoing EGSPs. Older adults residing in the 50 most affluent (MANs) and 50 least affluent (LANs) neighborhoods based on zip codes were compared. Data collected included demographics, all patient-refined (APR)-severity of illness (SOI), APR-risk of mortality (ROM), Charlson Comorbidity Index, complications, mortality, and discharge to a higher level of care. Of the 8661 OAs analyzed, 2362 (27.3%) resided in MANs and 6299 (72.7%) in LANs. Older adults in LANs were more likely to undergo EGSPs, had higher APR-SOI and APR-ROM, and experienced more complications, discharge to higher level of care, and mortality. Living in LANs was independently associated with discharge to higher level of care (OR 1.56, 95% CI: 1.38-1.77, P < .001) and increased mortality (OR 1.35, 95% CI: 1.07-1.71, P = .01). Mortality and quality of life in OAs undergoing EGSPs are dependent on environmental factors likely determined by neighborhood location. These factors need to be defined and incorporated in predictive models of outcomes. Public health opportunities to improve outcomes for those who are socially disadvantaged are necessary.