Cognition,daily living,and health-related quality of life in 85-year-olds in Sweden

ABSTRACT

This study investigates how cognition influences activities of daily living and health-related quality of life in 85-year-olds in Sweden (n?=?373). Data collection included a postal questionnaire comprising demographics and health-related quality of life measured by the EQ-5D. The ability to perform personal activities of daily living (PADL) was assessed during a home visit that included administering the Mini Mental State Examination (MMSE). Cognitive impairment was shown in 108 individuals (29%). The majority were independent with respect to PADL. A larger number of participants with cognitive impairment reported that they needed assistance in instrumental activities of daily living (IADL) compared to the group without cognitive impairment. Impaired cognition was significantly related to problems with IADL. Significant but low correlations were found between cognition and health-related quality of life – higher ratings on perceived quality of life correlated with higher results on the MMSE.     

Gender differences in health-related quality of life

In 1986 the life expectancy at birth was 71.3 years for males and 78.3 years for females--providing a 7-year advantage for women. Although women live longer, it has been reported that they paradoxically experience more physical and psychological illnesses. In this article, we estimate the expected well-years or quality-adjusted life years for men and women in the general population. The data were obtained in a random sample of 1,034 residents of San Diego. The well-life expectancy uses standard life expectancies with adjustments for quality of life. The well-life expectancy for men was 59.8 years; for women, it was 62.7 years. Thus, the quality adjustment had significantly more impact on women (15.6 years) than on men (11.5 years). Age-specific estimates of health-related quality of life suggested a male advantage before age 45 and a female advantage after age 45. The benefits of well-years of life as a public health statistic are discussed.     

Morningness-eveningness and health-related quality of life among adolescents

Accumulating evidence suggests that evening-type adolescents are exposed to a number of determinants that might have a negative impact on their health condition. Given that few studies have investigated the association between chronotype and quality of life measures in large samples of adolescents, the aim of this study was to assess the relationship between morningness-eveningness and health-related quality of life among 1600 adolescents (aged 12-16 years). Adolescents completed the Ve?u et Santé Per?ue de L'adolescent (VSP-A) and the Morningness-Eveningness Scale for Children (MESC). Girls and older adolescents reported worse health indicators and were more evening oriented. Evening-type adolescents obtained lower scores on vitality, physical and psychological well-being, body image, relations with parents, relations with teachers, school work and global health scale.     

Exercise training and health-related quality of life in generalized anxiety disorder

ObjectiveTo quantify the effects of six-weeks of resistance (RET) and aerobic exercise training (AET) on quality of life (QoL) among sedentary women with Generalized Anxiety Disorder (GAD).DesignData from our published randomized controlled trial of the effects of six-weeks of either RET or AET among GAD patients were analyzed.MethodThirty women with GAD were randomized to either six weeks of twice-weekly lower-body weightlifting or cycling, or wait-list control (WL). SF-36 subscales assessed dimensions of QoL. Hedges’ d effect sizes (95%CIs) quantified the magnitude of change in response to exercise training compared to WL.ResultsRET significantly improved role-physical (d = 1.04; 95%CI: [0.11–1.97]), role-emotional (d = 0.96; [0.04–1.89]), and mental health (d = 1.05; [0.11–1.98]). AET resulted in significant improvements in physical function (d = 1.31; [0.34–2.27]) and vitality (d = 0.93; [0.01–1.85]).ConclusionsExercise training improves dimensions of QoL among GAD patients. The largest effects were observed for role impairments, physical function, vitality, and mental health.     

General self-efficacy and health-related quality of life after myocardial infarction

Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.     

Single-item vs multiple-item measures of health-related quality of life

Many survey instruments measure health-related quality of life. Researchers can choose from instruments ranging in length from one to several hundred items. A small sample of 35 chronically ill adults self-administered the Short-form General Health Survey of the Medical Outcomes Study, a 20-item health-related quality-of-life measure with established reliability and validity. One specific item on the MOS questionnaire can serve as a single-item measure of health-related quality of life. This one item correlated positively and significantly with the over-all score for health-related quality of life. The results of this analysis support the use of this single-item measure of health-related quality of life when multiple-item instruments are not suitable due to limitations of resources or sample size.     

Executive functioning and health-related quality of life in pediatric sickle cell disease

Research consistently indicates that children with sickle cell disease (SCD) face multiple risk factors for neurocognitive impairment. Despite this, no empirical research to date has examined the impact of neurocognitive functioning on quality of life for this pediatric group. Thus, the current study aims to examine the relationship between executive functioning and quality of life in a sample of children with SCD and further explore psychosocial and family/caregiver resources as moderators of this relationship. A total of 45 children with SCD aged 8 to 16 years and their caregivers completed measures of quality of life, behavioral ratings of executive functioning, and psychosocial functioning. Hierarchical linear regression models were utilized to determine the impact of executive functioning on quality of life and further test the interaction effects of proposed moderating variables. Controlling for age, pain, and socioeconomic status (SES), executive functioning was found to significantly predict child- and parent-reported quality of life among youth with SCD. Psychosocial resources of the primary caregiver or family was not found to moderate the relationship between executive functioning and quality of life. These results provide the first empirical evidence that lower executive skills negatively predict quality of life for children with SCD, supporting clinical and research efforts which aim to establish efficacious interventions that target cognitive decrements within this pediatric population.     

Anxiety,depression, and health-related quality of life in aging people living with HIV compared to diabetes patients and patients with minor health conditions: a longitudinal study

HIV infection has evolved from a fatal to a treatable condition, leading to an increase in the rate of elderly People Living with HIV (PLWH). However, little is known about the psychosocial burden of elderly PLWH. Thus, the aim of this longitudinal multi-center cohort study was to investigate whether elderly PLWH experience more anxiety and depression and reduced health related quality of life (HRQOL) compared to elderly patients with other chronic conditions. PLWH were compared to diabetes patients (DM) and patients with minor health conditions (MHC), e.g. patients with hypertension or allergic conditions. All patients were over 50 years old. Anxiety and depression (HADS) as well as HRQOL (SF-36) were assessed at baseline and after 12 months. 218 PLWH, 249 DM and 254 MHC were included. At baseline, the study groups did not differ in anxiety, depression, and physical HRQOL. However, PLWH indicated lower mental HRQOL than DM and MHC patients (p = 0.001). We did not obtain any moderating effects showing a differential effect of patient characteristics on anxiety, depression, and HRQOL in the three patient groups. At follow-up, the level of anxiety, depression, and HRQOL did not change significantly. The prevalence of anxiety ranged between 27 and 35%, and that of depression between 17 and 28%. Thus, the results of our investigation tentatively suggest that the psychosocial adaptation to HIV among elderly PLWH resembles those of other chronic diseases. There may be some subtle impairments, though, as PLWH experienced lower mental HRQOL.     

Stress, health-related behavior and quality of life on depressive symptomatology in a sample of adolescents.

This study examined the correlations of 21 variables categorized into sociodemographic, subjective quality of life, stress, problem behavior, and health behavior predictors of at-risk and low-risk depressive symptomatology for a sample of 1056 adolescents attending public school. Discriminant function analysis showed lower life satisfaction, higher stress, and perceived unattractiveness as major discriminating variables for at-risk (CES-Depression score greater than 23) versus low-risk depressed adolescents. Only two problem behaviors were significant, smoking for girls and hard drug use for boys.     

Measurement issues in health-related quality of life: Challenges for health psychology

Abstract

Quality of life assessment is a central element of clinical trials and related forms of evaluative research. Early efforts to establish appropriate methods of measuring quality of life drew on psychometric principles and emphasised the need for validated measures. However, it is increasingly clear that, whilst still a central requirement of quality of life measures, validity needs to be emphasised alongside a number of other essential properties that have become clearer as the field has developed. Moreover formal psychometric methodology has to be adapted to take account of the specific needs of evaluative research. Research is beginning to develop more appropriate methods of outcome assessment in this area. Further lines of research are suggested to examine psychometric with other approaches to measurement of health-related quality of life.     

The role of body mass index,weight change desires and depressive symptoms in the health-related quality of life of children living in urban disadvantage: Testing mediation models

Objectives: This study was undertaken to ascertain whether or not the body mass index (BMI) of urban disadvantaged children indirectly affects their health-related quality of life (HRQoL) through weight change desires and depressive symptoms and whether such mediation is conditional upon age and gender.

Design: A total of 255 children aged 7–12 years (50% male) were recruited from 7 schools in urban disadvantaged districts in Ireland using consecutive sampling. A prospective longitudinal design was employed whereby children completed, at two time points, the Kidscreen-27, the Children’s Depression Inventory, and the Health Related Behaviour Questionnaire, and had their BMI measured. The analyses involved multiple-, half-longitudinal- and moderated-mediation.

Results: Results showed that the depressive symptoms of children wanting to change their weight may have lead, in large part, to poorer HRQoL (specifically psychological well-being when considering longitudinal data) rather than weight status per se. The mediation effect of weight change desires occurred regardless of age or gender.

Conclusions: Childhood obesity programmes that traditionally focus on the negatives of obesity and the need to control weight may need to take a more positive approach to health and well-being by, for example promoting intuitive eating, an active lifestyle, body acceptance and good mental health.     

Parental knowledge and adolescent adjustment: substance use and health-related quality of life

This study analyses two models (maternal and paternal) in which parental care and sources of parental knowledge moderated the relationship between parents' knowledge about their adolescents' lives and adolescents' substance use and health-related quality of life. The sample was made up of 15942 Spanish adolescents who participated in the 2006 edition of Health Behavior in School-aged Children Study. Results showed that increased parents' knowledge about their adolescents' lives reduced adolescents' substance use and increased their quality of life. With respect to the moderation relationship, a limited effect was found. However, parental care and sources of parental knowledge used by both parents generally had main effects on adolescents' substance use and health-related quality of life, with care being the most relevant variable in the health-related quality of life, while knowledge was the most relevant one for substance use.     

Relation of perceived emotional intelligence and health-related quality of life of middle-aged women

This study examined the relationship between perceived emotional intelligence and health-related quality of life in middle-aged women. 99 middle-aged Spanish women, who studied in two adult schools, volunteered to participate. 49 were premenopausal and 45 were postmenopausal. These women completed the Trait Meta-Mood Scale and Health Survey SF-36. Scores were analyzed according to social, physical, and mental health, menopausal status, and scores on perceived emotional intelligence. Then, the data regarding the mental and physical health of the premenopausal and postmenopausal women were compared after controlling for age. No associations between menopausal status and health-related quality of life were found. Perceived skill at mood repair was significantly associated with scores on health-related quality of life in these middle-aged women. These findings provide empirical evidence that aspects of perceived emotional intelligence may account for the health-related quality of life in midlife including social, physical, and psychological symptoms.     

Sleep quality in healthy and mood-disordered persons predicts daily life emotional reactivity

Disordered sleep has been linked to impaired emotional functioning in healthy and depressed individuals. Little is known, however, about how chronic sleep problems influence emotional reactivity in everyday life. Participants with major or minor unipolar depressive disorder (n?=?60) and healthy controls (n?=?35) reported on sleep and emotional responses to daily life events using a computerised Experience Sampling Method. We examined whether impaired sleep quality influenced emotional reactivity to daily events, and if this relationship was altered by unipolar mood disorders. Among healthy individuals, sleep difficulties were associated with enhanced negative affect (NA) to unpleasant events and a dulled response to neutral events. However, among mood-disordered persons, sleep difficulties were associated with higher NA across all types of everyday life events. Impaired sleep quality differentially affects daily life emotional reactions as a function of depression.     

Executive function, intellectual decline and daily living skills

Understanding the cognitive changes associated with compromised daily living skills in elderly individuals is important for making appropriate recommendations about the capacity for independent functioning. To this end, we retrospectively examined data from 92 elderly individuals presenting with cognitive decline who were administered measures of executive functioning, general intelligence, and daily living skills. Multiple regression analyses were used to examine the relationship between executive functioning and daily living skills, while controlling for age, depression, and either IQ decline or current IQ. Executive functioning accounted for additional variance in a broad range of daily living skills after controlling for IQ decline. When FSIQ was used in the regression model rather than IQ decline, executive functioning was no longer uniquely associated with daily living skills. Executive functions appear to be important for daily living skills until a critical threshold of low intellectual functioning is reached, reflecting the combined influence of premorbid ability and the extent of intellectual decline. Our results suggest that understanding the relative contribution of different cognitive domains to functional decline in elderly individuals should take into account general intellectual functioning and estimated decline, and that the initiation and/or persistence of self-directed cognitive processes may be important for adaptive daily functioning. These findings have implications for making more evidence-based recommendations about the capacity for independent living.     

Episodic remembering in young adults, 73-year-olds, and 82-year-olds

Younger adults (mean age = 20.6), 73-year-olds, and 82-year-olds were examined in free and cued recall of words preceded by standard instructions or organizational instructions. The younger adults outperformed the elderly groups in free and cued recall preceded by standard instructions. When organizational instructions were provided, recall differences between the younger adults and the 73-year-olds were eliminated, while both these groups outperformed the 82-year-olds. Within-group comparisons showed that the younger group was relatively independent of contextual support at encoding (organizational instructions) and retrieval (cues) respectively. Furthermore, the group of 73-year-olds was able to utilize support at both stages of remembering, whereas the group of 82-year-olds utilized contextual support only at retrieval. The results were compared with research on memory development in childhood through the application of Ribot's law.