Life satisfaction among older adults with impairment in activities of daily living
TL;DR: In this paper, the authors examined the proportion of older adults with functional impairment reporting high life satisfaction and the predictors of high life-satisfaction, and identified several factors associated with high-life satisfaction, including not being lonely (38.2 vs 23.2), satisfied with family life (35.1 vs 12.8), and satisfied with financial situation.
Abstract: BACKGROUND Many older adults experience decline in function, but maintain high levels of life satisfaction. The factors associated with high life satisfaction among those with functional impairment are not well understood. OBJECTIVE Examine the proportion of older adults with functional impairment reporting high life satisfaction and the predictors of high life satisfaction. DESIGN Cross-sectional cohort study. SETTING Health and Retirement Study. SUBJECTS A total of 7,287 community-dwelling participants, 65 years or older, who completed the leave-behind questionnaire in 2014 or 2016. METHODS The main predictor was having difficulty or needing help in performing Activities of Daily Living (ADL). The primary outcome was reporting high life satisfaction, defined using a three-item Diener scale. Significant factors were identified using modified Poisson regression models adjusted for demographic characteristics. RESULTS Those with no ADL impairment were more likely to report high levels of life satisfaction than those with ADL difficulty or ADL dependence (54.4 vs 38.6 vs 27.6%, P < 0.001). Among those with ADL dependence, we identified several factors associated with high life satisfaction, including: not being lonely (38.2 vs 23.2%, ARR = 1.6 (1.2, 2.2)), satisfied with family life (35.1 vs 12.8%, ARR = 2.7 (1.6, 4.4)), and satisfied with financial situation (40.8 vs 16.6%, ARR = 2.5 (1.8, 3.6)). Similar associations were present among those with ADL difficulty. CONCLUSIONS A substantial proportion of older adults with ADL impairment report high life satisfaction, and it is associated with social and economic well-being. Understanding the factors associated with high life satisfaction can lead to clinical practices and policy guidelines that promote life satisfaction in older adults.
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TL;DR: In this paper , a multicenter observational study of Japanese rheumatoid arthritis patients from the FRANK Registry with data analyzed from March 2017 to August 2020 was conducted, which revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66] and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21).
Abstract: To further improve rheumatoid arthritis (RA) treatment, it is necessary to understand each RA patient's satisfaction and to identify the factors affecting their satisfaction. Despite the rise in medical costs for RA, little is known about the factors that influence patient satisfaction with the cost of treatment in RA patients.This is a multicenter observational study of Japanese RA patients from the FRANK Registry with data analyzed from March 2017 to August 2020. We collected data on demographic characteristics, clinical data, quality of life which was evaluated using the EuroQol 5-dimensional questionnaire (EQ5D), and patient satisfaction. The four categories of patient satisfaction were evaluated individually (i.e., cost, treatment efficacy, activities of daily living [ADL], and global treatment satisfaction). We analyzed the factors that affected each patient's satisfaction, such as age, sex, EQ5D, disease duration, disease activity, and treatment.This study included 2235 RA outpatients (406 males, 1829 females). In RA patients, "very satisfied" and "satisfied" were given for nearly half of each satisfaction aspect (cost 49%; efficacy 72%; ADL 58%; global treatment 66%) at the time of the initial registration. To investigate the factors influencing each satisfaction, multivariate analysis has revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66) and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21). Age (50-64 years; OR 0.91; 65-74 years, 0.55: ≥ 75 years, 0.35), female (OR 0.81), and history of musculoskeletal surgery (OR 0.60) all increased cost satisfaction. Patients with lower disease activity and higher EQ5D scores had higher levels of satisfaction in all areas.In this study, patient satisfaction in terms of cost, treatment effect, ADL, and overall treatment was generally higher, but some patients were dissatisfied. The cost of satisfaction increased with age and a history of musculoskeletal surgery, while it decreased with a lower EQ5D score and the use of b/tsDMARDs.
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TL;DR: The authors examined whether persons living with dementia perceive a lower level of satisfaction with life compared to their peers without dementia and whether the associations between individual characteristics and life satisfaction are different between individuals living with and without dementia.
Abstract: Despite possible major adverse cognitive, physical, social, and behavioral consequences, little is known about how persons living with dementia perceive satisfaction with life, a key component of well‐being. We sought to examine (i) whether persons living with dementia perceive a lower level of satisfaction compared to their peers without dementia and (ii) whether the associations between individual characteristics and life satisfaction are different between persons living with and without dementia.
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TL;DR: The Satisfaction With Life Scale (SWLS) as mentioned in this paper is a scale to measure global life satisfaction, which does not tap related constructs such as positive affect or loneliness, and has favorable psychometric properties, including high internal consistency and high temporal reliability.
Abstract: This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is Suited for use with different age groups, and other potential uses of the scale are discussed.
20,751 citations
TL;DR: A narrative review of current understanding of the definitions and distinguishing characteristics of each of these conditions, including their clinical relevance and distinct prevention and therapeutic issues, and how they are related is provided.
Abstract: Three terms are commonly used interchangeably to identify vulnerable older adults: comorbidity, or multiple chronicconditions,frailty, anddisability. However, in geriatricmedicine,there isagrowingconsensusthatthese are distinct clinical entities that are causally related. Each, individually, occurs frequently and has high import clinically. This article provides a narrative review of current understanding of the definitions and distinguishing characteristics of each of these conditions,including theirclinical relevance and distinct prevention and therapeutic issues, and how they are related. Review of the current state of published knowledge is supplemented by targeted analysesin selectedareas where no current publisheddataexists. Overall,the goalof this articleis to providea basis fordistinguishingbetweenthesethreeimportantclinicalconditionsinolderadultsandshowinghowuseofseparate, distinct definitions of each can improve our understanding of the problems affecting older patients and lead to development of improved strategies for diagnosis, care, research, and medical education in this area.
3,394 citations
TL;DR: The Satisfaction With Life Scale (SWLS) as discussed by the authors was developed to assess satis-faction with the respondent's life as a whole, which does not assess satisfaction with life domains such as health or finances but allows subjects to integrate and weight these domains in whatever way they choose.
Abstract: The Satisfaction With Life Scale (SWLS) was developed to assess satis-faction with the respondent’s life as a whole. The scale does not assess satisfaction with life domains such as health or finances but allows subjects to integrate and weight these domains in whatever way they choose. Normative data are presented for the scale, which shows good convergent validity with other scales and with other types of assessments of subjective well-being. Life satisfaction as assessed by the SWLS shows a degree of temporal stability (e.g., 0.54 for 4 years), yet the SWLS has shown sufficient sensitivity to be potentially valuable to detect change in life satis-faction during the course of clinical intervention. Further, the scale shows discrim-inant validity from emotional well-being measures. The SWLS is recommended as a complement to scales that focus on psychopathology or emotional well-being because it assesses an individuals’ conscious evaluative judgment of his or her life by using the person’s own criteria.
3,372 citations
TL;DR: Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
Abstract: Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
3,157 citations
TL;DR: The changes in activities of daily living function occurring before and after hospital admission in older people hospitalized with medical illness are described and the effect of age on loss of ADL function is assessed.
Abstract: OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function.
DESIGN: Prospective observational study.
SETTING: The general medical service of two hospitals.
PARTICIPANTS: Two thousand two hundred ninety-three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite).
MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge.
RESULTS: Thirty-five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70–74, 75–79, 80–84, 85–89, and ≥90, respectively, P < .001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged ≥90 compared with patients aged 70–74 = 1.26, 95% confidence interval (CI) = 0.88–1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged ≥90 compared with patients aged 70–74 = 2.09, 95% CI = 1.20–3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged ≥90 compared with patients aged 70–74 = 3.43, 95% CI = 1.92–6.12).
CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization
1,304 citations