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      Health-related quality of life and associated factors in functionally independent older people

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          Abstract

          Background

          Health-related quality of life (HRQL) is a key indicator of elderly people’s health status that can be affected by different factors. However, little is known about which variables are associated with it in functionally independent elderly people. The aim of this project was to study HRQL and a wide variety of health, lifestyle, social and contextual aspects and their relation to HRQL in a sample of functionally independent, non-cognitively impaired community-dwelling adults, over 65 years of age, from a northern region of Spain.

          Methods

          A cross-sectional study for which data was collected by face-to-face interviews with the selected individuals. HRQL was measured with the EuroQol-5D scale, consisting of a 5 item descriptive system and a visual analogue scale (VAS). VAS values lower than 70 were considered poor HRQL. Binary logistic regression was used to identify factors related to the outcome.

          Results

          Six hundred and thirty-four individuals were included in the study. The mean age was 74.8 (SD 6.7) years, 55% of the participants were women and 46% rated their HRQL as poor. Several variables were found to be significantly associated with a poor HRQL in the multivariate model, adjusted for age and sex: polypharmacy (OR: 2.32, 95% CI: 1.62–3.31), the presence of sensory impairment (OR: 1.83, 95% CI: 1.24–2.69), not being engaged in cognitively stimulating activities (OR: 2.51, 95% CI: 1.03–6.16), or in group social activities (OR: 1.57, 95% CI: 1.11–2.22), low level of social support (OR: 3.12, 95%CI: 1.78–5.46) and the presence of obstacles in the closest home environment (OR: 1.83, 95%CI: 1.11–3.02).

          Conclusions

          The study identified a set of health, social and contextual variables as strongly related to HRQL in functionally independent community-dwelling older people. The results highlight the multidimensional nature of HRQL. They also reveal the importance of a comprehensive assessment of HRQL when designing adequate health-related programmes aiming to enhance active and healthy ageing and delay the onset of dependence.

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          Most cited references35

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          Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes.

          Our model proposes a taxonomy or classification scheme for different measures of health outcome. We divide these outcomes into five levels: biological and physiological factors, symptoms, functioning, general health perceptions, and overall quality of life. In addition to classifying these outcome measures, we propose specific causal relationships between them that link traditional clinical variables to measures of HRQL. As one moves from left to right in the model, one moves outward from the cell to the individual to the interaction of the individual as a member of society. The concepts at each level are increasingly integrated and increasingly difficult to define and measure. AT each level, there are an increasing number of inputs that cannot be controlled by clinicians or the health care system as it is traditionally defined.
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            The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients.

            A 14-item, self-administered, multidimensional, functional social support questionnaire was designed and evaluated on 401 patients attending a family medicine clinic. Patients were selected from randomized time-frame sampling blocks during regular office hours. The population was predominantly white, female, married, and under age 45. Eleven items remained after test-retest reliability was assessed over a 1- to 4-week follow-up period. Factor analysis and item remainder analysis reduced the remaining 11 items to a brief and easy-to-complete two-scale, eight-item functional social support instrument. Construct validity, concurrent validity, and discriminant validity are demonstrated for the two scales (confidant support--five items and affective support--three items). Factor analysis and correlations with other measures of social support suggest that the three remaining items (visits, instrumental support, and praise) are distinct entities that may need further study.
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              Systematic review of health-related quality of life models

              Background A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models. Methods Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria. Results Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice. Conclusions Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.
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                Author and article information

                Contributors
                +34943006086 , monica.machonsobrado@osakidetza.eus
                ilarranaga@euskadi.eus
                m-dorronsoro@euskadi.eus
                kalliopi.vrotsoukanari@osakidetza.eus
                mariaiciar.vergaramitxeltorena@osakidetza.eus
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                14 January 2017
                14 January 2017
                2017
                : 17
                : 19
                Affiliations
                [1 ]Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Osakidetza, Instituto Biodonostia, Paseo Doctor Beguiristian s/n, San Sebastián, 20014 Spain
                [2 ]Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
                [3 ]Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
                [4 ]Departamento de Salud, Delegación Territorial de Gipuzkoa, Gobierno Vasco, San Sebastián, Spain
                [5 ]Dirección de Salud Pública y Adicciones, Gobierno Vasco, Vitoria, Spain
                [6 ]CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
                Article
                410
                10.1186/s12877-016-0410-3
                5237562
                28088178
                3bfe6628-9158-4338-9240-1bc998299496
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 9 November 2016
                : 31 December 2016
                Funding
                Funded by: the Basque Foundation for Social and Health Care Innovation-ETORBIZI
                Award ID: BIOEFF11/FVSS/3.1
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Geriatric medicine
                health-related quality of life,older people,living conditions,euroqol-5d
                Geriatric medicine
                health-related quality of life, older people, living conditions, euroqol-5d

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