Quality of life is the subject of much research. However it lacks an agreed theoretical basis. In studies with older populations(ill) health has been used as a proxy measure for quality of life (QoL). We have developed a needs satisfaction measure of QoL in early old age. Our measure has four ontologically grounded domains: conal, autonomy, pleasure, and self-realization. The measure was piloted with focus groups, a self-completion pilot, and cognitive interview testing. This produced a 22-item scale that was included in a postal questionnaire and sent to 286 people aged 65-75 years.A 92% response rate was achieved. The scale was reduced to 19 items on the basis of statistical analysis. The domains have Cronbach's alphas between 0.6 and 0.8. Correlations between the four domains range from 0.4 to 0.7. A second order factor analysis revealed a single latent QoL factor. The scores for the 19-item scale are well distributed along the range although they exhibit a slight negative skew. Concurrent validity was assessed using the Life Satisfaction Index--wellbeing. A strong and positive association was found between the two scales (r= 0.6, p = 0.01). The CASP-19 appears to be a useful scale for measuring QoL in older people.

A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19).

The relative contribution of genetic and environmental influences to the US black-white disparity in cardiovascular disease (CVD) is hotly debated within the public health, anthropology, and medical communities. In this article, we review evidence for developmental and epigenetic pathways linking early life environments with CVD, and critically evaluate their possible role in the origins of these racial health disparities. African Americans not only suffer from a disproportionate burden of CVD relative to whites, but also have higher rates of the perinatal health disparities now known to be the antecedents of these conditions. There is extensive evidence for a social origin to prematurity and low birth weight in African Americans, reflecting pathways such as the effects of discrimination on maternal stress physiology. In light of the inverse relationship between birth weight and adult CVD, there is now a strong rationale to consider developmental and epigenetic mechanisms as links between early life environmental factors like maternal stress during pregnancy and adult race-based health disparities in diseases like hypertension, diabetes, stroke, and coronary heart disease. The model outlined here builds upon social constructivist perspectives to highlight an important set of mechanisms by which social influences can become embodied, having durable and even transgenerational influences on the most pressing US health disparities. We conclude that environmentally responsive phenotypic plasticity, in combination with the better-studied acute and chronic effects of social-environmental exposures, provides a more parsimonious explanation than genetics for the persistence of CVD disparities between members of socially imposed racial categories.

https://groups.anthropology.northwestern.edu/lhbr/kuzawa_web_files/pdfs/Kuzawa%20and%20Sweet%20AJHB%20early%20view.pdf

Epigenetics and the embodiment of race: developmental origins of US racial disparities in cardiovascular health.

STUDY OBJECTIVE—To identify which of seven indicators of socioeconomic status used singly or combined with one other would be most useful in studies of health inequalities in the older population.
DESIGN—Secondary analysis of socioeconomic and health data in a two wave survey.
SETTING—Great Britain. Participants were interviewed at home by a trained interviewer.
PARTICIPANTS—Nationally representative sample of 3543 adults aged 55-69 interviewed in 1988/9, 2243 of whom were interviewed again in 1994.
METHODS—Desirable features of socioeconomic measurement systems for identifying health inequalities in older populations were identified with reference to the literature. Logistic regression was used to examine variations in self reported health by seven indicators of socioeconomic status. The pair of indicators with the greatest explanatory power was identified.
MAIN RESULTS—All indicators were significantly associated with differences in self reported health. The best pair of variables, according to criteria used, was educational qualification or social class paired with a deprivation indicator.
DISCUSSION—For a range of reasons the measurement of socioeconomic status is particularly challenging in older age groups. Extending our knowledge of which indicators work well in analyses and are relatively easy to collect should help both further study of health inequalities in the older population and appropriate planning.


Keywords: health inequalities; elderly people; socioeconomic status

https://jech.bmj.com/content/jech/55/12/895.full.pdf

The socioeconomic status of older adults: How should we measure it in studies of health inequalities?

This article aims to identify and analyse the lifecourse and contextual factors that influence the quality of life in early old age. We conceptualise quality of life as distinct from the factors which influence it, and employ a model of the quality of life that is derived from an explicit theory of human need. The operational measure (CASP-19) consists of 19 Likert-scaled items which cover four theoretical domains: control, autonomy, self-realisation and pleasure. A postal questionnaire was sent to 286 British people aged 65-75 years who were members of the sample for the 1930s Boyd-Orr study of health and diet and who had been followed up through retrospective interviews during the late 1990s. The 286 were broadly representative of their age group. The survey's response rate was 92 per cent. Respondents provided information on a number of contextual influences on their quality of life in early old age, notably social support and participation, the quality and quantity of social contact, feelings of trust and reciprocity about the local neighbourhood, health and financial security. In the analyses reported here, a series of conceptual and operational influences on quality of life in early old age is identified using block regression models. Finally, the relative impact of each predictor on CASP-19 is examined. The findings suggest that the legacy of the past tends to be best captured by people-Is feelings about the adequacy of their pensions and their status as owner-occupiers as well as a feeling that the area in which they live is deprived. The quality of the social contact people describe and how close they-feel to those around them will ameliorate the negative impacts of the past and the immediate environment. In addition I we must recognise that people remain vulnerable to the impact of loss: recent bereavement, and major illnesses can impact on a person's quality of life.

/pdf/quality-of-life-in-the-third-age-key-predictors-of-the-casp-4gki6i014l.pdf

Quality of life in the third age: key predictors of the CASP-19 measure

PURPOSE: This article examines resilience at older ages, focusing on the relationships between quality of life (qol) and adversity. Our objectives are to identify (a) the basis of adversity, (b) the characteristics of resilient individuals, and (c) the attributes that attenuate the full impact of adversity. DESIGN AND METHODS: Resilience is defined as flourishing despite adversity. Analysis is carried out in a subsample of the Boyd Orr cohort (aged between 68 and 82 years) using questionnaire data. Adversity was identified as circumstances that produce a significant average decrease in qol (CASP-19 scores). Participants were classified into resilient and vulnerable groups based on high or low qol (CASP-19 scores dichotomized at the median) in the face of significant adversity. Shared characteristics that define these outcomes are reported. Attributes that attenuate the negative impact of adversity were analyzed using stratified logistic regression. RESULTS: Adversity was typified by functional limitation; life getting worse in the domains of health, stress, and general living circumstances; and experiencing a negative life event. The resilient tended to report fewer multiple adversities. Indicators of protective attributes, which also characterized resilient outcomes relative to qol, included good quality relationships (5.105, confidence interval [CI] 95% 1.323-19.699), integration in the community (10.800, 95% CI 1.227-95.014), developmental coping (3.397, 95% CI 1.079-10.690), and adaptive coping styles (3.211, 95% CI 1.041-9.910). IMPLICATION: Overall results indicate that policies that offer access to protection and help minimize adversity exposure where possible will promote resilience.

L. Berney

Papers

Reconstructing the life course: health during early old age in a follow-up study based on the Boyd Orr cohort.

Reconstructing the life course