Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study

HRQoL is an indicator of individuals' perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.; This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.; We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.; Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life

Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research

Despite the many positive outcomes, excessive mobile phone use is now often associated with potentially harmful and/or disturbing behaviors (e.g., symptoms of deregulated use, negative impact on various aspects of daily life such as relationship problems, and work intrusion). Problematic mobile phone use (PMPU) has generally been considered as a behavioral addiction that shares many features with more established drug addictions. In light of the most recent data, the current paper reviews the validity of the behavioral addiction model when applied to PMPU. On the whole, it is argued that the evidence supporting PMPU as an addictive behavior is scarce. In particular, it lacks studies that definitively show behavioral and neurobiological similarities between mobile phone addiction and other types of legitimate addictive behaviors. Given this context, an integrative pathway model is proposed that aims to provide a theoretical framework to guide future research in the field of PMPU. This model highlights that PMPU is a heterogeneous and multi-faceted condition

Quality of Life and Depression of Korean American Cancer Patients and Their Family Caregivers.

Purpose: Despite the high cancer incidence and mortality among Korean Americans, little is known about their quality of life (QOL) and depression after a cancer diagnosis. The purpose of this dissertation was to describe the quality of life and depression in Korean American cancer patients and their family caregivers and to examine factors related to these outcomes. The study was guided by socio-cultural stress coping theoretical framework. Methods: Data were collected from Korean American cancer patients and one of their family caregivers living in Midwest (N=60 dyads). Matched t-tests and one-sample t-tests were used to examine differences between patients and caregivers and comparative samples in other studies. Multiple regression was used to examine predictors among selected variables to QOL and depression. Results: The review of existing literature indicated that the key variables related to QOL and depression were social support, communication, and acculturation. The descriptive study found no differences between patients and caregivers on selected variables. Patients had better overall QOL than other groups of cancer patients but family caregivers had lower overall QOL than other groups of family caregivers of cancer patients. From multiple regression analyses, higher social support and less negative appraisal of illness predicted better overall QOL in patients. Less negative appraisal of illness also predicted less depression among patients. Older age, endorsing more modern values, and less traditional Korean values predicted better overall QOL in caregivers. Furthermore, having higher modern values also predicted less depression among family caregivers. Conclusion: Based on the research findings, clinicians need to be more culturally sensitive to the needs of Korean American cancer patients and their family caregivers. Health professionals need to be aware that somatic complaints may be a sign of depression. Collaborating with ethnic community agencies that provide Koreans with assistance may help to improve patients’ and caregivers’ sources of formal and informal social support. Future research needs to focus on development of interventions that will improve patient’s positive perception of the illness and assist their caregivers to gain more self-reliance, autonomy, and confidence which will help to increase their QOL and lower their incidence of depression.PhDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113294/1/hyojiny_1.pd

표현형 종단 자료에 대한 유전적 영향의 정량화

학위논문(박사)--서울대학교 대학원 :자연과학대학 협동과정 생물정보학전공,2020. 2. 원성호.The main goal is to identify the progressing effect of SNPs on the important health related phenotypic traits, and lung function specific traits by calculating SNP heritability with longitudinal data. The total 16 prominent health-related phenotypic traits were observed biennially for each subject during 10 years, and 12 spirometric measures were biennially observed for 14 years. SNP-based heritabilities for those phenotype averages and annual change were estimated. Since linear mixed models with two random effects are computationally very intensive, here, we proposed and applied two-stage model. First, the phenotypic average and annual change for each subject were estimated with a linear model, and then both regression coefficients were used as responses to estimate SNP heritability with GCTA software. This approach provides a reasonable and easy method to estimate heritability in longitudinal data and potentially assess both heritability of the phenotypic averages and changes through several periods. In the 16 health-related phenotypes analysis, results show that that significant SNP heritability is objectively confirmed for longitudinal changes in lung function decline including FEV1 in comparison with other health-related indices. In the 12 lung function specific analysis, SNP heritabilities of the annual change rate of FEV1 % predicted and FEV1/FVC were significantly high (hdecline2=0.105, p-value=0.004 for FEV1 % predicted; hdecline2=0.157, p-value=7.25×〖10〗^(-5)for FEV1/FVC). In subgroup analsysis, POST FEV1/FVC (hdecline2=0.399, p-value=0.009) were in never smokers significant high than in ever smokers.유전체 정보(SNP)의 대량생산이 가능해지며 질환의 원인을 규명하고자 질환 또는 위험요인에 대한 유전체 정보를 기반을 둔 전장 유전체 연관성 분석(GWAS)은 지속해서 활발히 진행됐고, 지역 또는 인종에 따라 다양하게 나타나고 있어 국내에서도 많은 결과가 발표되고 있다. 그러나, 실제 질환과 연관 있다고 보고된 SNP들의 설명력은 높지 않았다. 이러한 설명되지 않은 유전적 경향성(missing heritability)에 대한 문제점을 보완하기 위한 유전율 추정 방법들이 제안되고 있고, 최근에는 인구집단 기반(population-based)을 둔 유전율 추정이 많이 진행되고 있다. 현재까지 대부분 population-based 유전율 추정은 단면연구(cross-sectional study)에 집중되어 연구가 진행됐으나 반복측정자료(longitudinal data)를 이용한 유전율 추정 및 유전자-환경, 유전자-시간의 상호작용으로 인한 유전율 추정 분석은 많이 진행되지 않았다. 본 논문에서는 한국인 질병 관련 임상역학의 종단자료 및 유전체 자료를 기반 표현형에 대한 상염색체 공통변이(common variant) 유전적 영향의 추정에 목적을 두어 16가지의 표현형에 대하여 유전율 추정 및 GWAS를 진행하였고, 추가로 12가지의 폐기능관련 표현형에 대하여 유전율 추정을 진행 하였다. 또 표현형과 유전변이의 상호작용으로 인한 유전율에 대한 영향을 추정하였고 종단자료 특성상 분석이 어려운 것을 해결하기 위하여 two-stage 방법론을 제안하여 특정 표현형이 시간으로 인한 변화에 연관된 유전자들을 성공적으로 발굴하였다. 본 연구는 다량의 질병 관련 표현형 종단자료의 분석에 활용될 수 있을 것으로 기대된다.1 Introduction 1 1.1 The background on genetic association studies 1 1.1.1 Overview of genome-wide association studies 1 1.1.2 Single SNP-based analysis in GWAS 3 1.2 The background on heritability estimation 5 1.2.1 Overview of heritability estimation 5 1.2.2 Summary of heritability estimation methods 6 1.3 Overview of GxE analysis 7 1.4 Overview of longitudinal analysis 8 1.5 The purpose of this study 9 1.6 Outline of the thesis 10 2 An overview of genetic effect quantifying analysis with longitudinal data 11 2.1 Challenges of genetic effect quantifying analysis with longitudinal data 11 2.2 Review methods of longitudinal data analysis 13 2.3 Method applied in this paper with longitudinal data analysis 16 3 Identifying progressing effect of SNPs on 16 phenotypic traits with longitudinal data 19 3.1 Introduction 19 3.2 Methods 21 3.2.1 KARE cohort data 21 3.2.2 Genotype data 23 3.2.3 Calculation of phenotype averages and annual changes for each subject 25 3.2.4 Heritability estimation 26 3.2.5 GWAS analysis 26 3.3 Results 26 3.3.1 Estimation of heritability 26 3.3.2 Genome-wide association studies 40 3.4 Discussion 48 4 Heritability analysis reveal the significant effect of SNPs on lung function decline rate 53 4.1 Introduction 53 4.2 Methods 58 4.2.1 Study population and outcome definition 58 4.2.2 Lung functions 58 4.2.3 Genotyping, quality-control and imputation 59 4.2.4 Statistical analysis 60 4.3 Results 62 4.3.1 Characteristics of study subjects 64 4.3.2 The heritability of 12 pulmonary function traits 64 4.3.3 The heritability of smoking subgroups 73 4.4 Discussion 77 5 Summary and Conclusions 80 Bibliography 83 Abstract (Korean) 92Docto

Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia

Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials

AGED PEOPLE'S PERCEPTION ABOUT THE TRANSITIONAL CARE PROVIDED BY A MULTIPROFESSIONAL HOME-BASED ASSISTANCE TEAM

Objective: to understand the aged people's perception about the care provided by a Multiprofessional Home-based Assistance Team in the city of São Paulo - Brazil.Method: a qualitative study using oral life stories. The data were collected between August 2020 and October 2021 by means of semi-structured interviews. The sample consisted of nine aged women assisted by the Multidisciplinary Home-based Assistance Team. The data were treated according to oral life stories, presented in the form of narratives and categorized.Results: seven thematic categories emerged from the narratives. The participants' perception of the health care provided by the team was positive and necessary, mainly because it favored access to the resources provided by the Unified Health System.Conclusion: the importance of home-based care for care continuity for aged people is highlighted. The study reinforced the need to include the finitude process in the planning of care actions in health services

Aging in place among home-dwelling older adults in Canton Basel-Landschaft: the INSPIRE Population Survey

Due to medical and technological advancements, many individuals in countries around the world are living longer (1). In Switzerland between 2020 and 2050, a rise from 18% to 26% for those aged 65 years or older and from 5% to 11% for those aged 80 years and older is foreseen (2). The gains in life expectancy, although a positive outcome, are not always enjoyed in full health and free of limitations. As individuals age, many of them may suffer from the presence of multi-morbidity and frailty (3, 4). Functional limitations as well as isolation and loneliness are also frequently reported among this population (3, 5-7). Moreover, these individuals usually receive care from different providers across various settings which can lead to their care being fragmented (8). Fragmentation of care is characterized by gaps in provision of care which could cause confusion and distress for older adults and their caregivers, as well as higher costs associated with unnecessary use of services (9). Despite challenges associated with aging, many older individuals prefer to remain living in their own environments for as long as possible (10, 11), an objective known as aging in place (12). Aging in place is linked to the ability to maintain independence and live a thriving and highly qualitative life within an individual’s own environment (13). It can therefore be fostered by designing environments that facilitate the mobility and engagement in social activities, which are important components for the health and quality of life of older adults (14). There is also an opportunity for countries to exploit existing and new assistive technologies, another pertinent facilitator of aging in place (15). Assistive technologies are an umbrella term including any device, equipment, instrument or software whose purpose is to maintain or improve an individual’s functional status and independence (16). To assist older adults to age in place and address their complex needs, the World Health Organization (WHO) has proposed an integrated care approach to support older adults’ independence and make aging in place possible (8, 17). Integrated care models are complex, dynamic interventions targeting multiple levels of the healthcare system, which often entail behavior change in the way various health and social care providers provide joint care (18, 19). To successfully develop and implement an integrated model of care, not only the perspectives of the healthcare providers, social care professionals or policymakers are essential, but also the needs and preferences of older adults and their informal caregivers (15, 20). Understanding the demographic and social characteristics of a target population, is also fundamental in planning, developing and implementing integrated care for older people (21). In 2018, an opportunity for integrated care for home-dwelling older adults was put forward by a new care law in Canton Basel-Landschaft in Switzerland (22). The INSPIRE project is working together with the local policymakers to support the development, implementation and evaluation of an integrated care model for home-dwelling adults aged 75 and above living in this region (23). The INSPIRE project is an implementation science project, positioned within the three phases (development, feasibility and effectiveness evaluation) of the Medical Research Council (MRC) for developing and implementing complex interventions (18). The project incorporates the recommendations of the MRC framework with several implementation science components such as contextual analysis, stakeholder involvement, as well as using implementation strategies and implementation outcomes to ensure the successful implementation and sustainability of the care model in Canton BL. During the development phase, an understanding of the context aids in ensuring the suitability of the intervention components for the implementation setting (23, 24). Therefore, we conducted the INSPIRE Population Survey (25, 26) as part of the contextual analysis, with the aim to understand the needs and preferences of older adults, as well as the support and services they currently require and anticipate needing in the future to maintain their independence and make aging in place possible. The overall goals of this dissertation are threefold. First, we aimed to describe the development of the INSPIRE Population Survey and the marketing strategy we used to reach as many home-dwelling older adults as possible, a population that is known to be challenging to recruit in research (27). Second, we used an ecological approach to dive deeper into the health-related quality of life of this population, as one of the main goals of aging in place. Finally, we investigated factors associated with openness to use assistive technologies that can facilitate independence among home-dwelling older adults and support them to age in place. Chapter 1 provides a general overview of challenges associated with caring for an aging population as well as the opportunities for integrated care for aging in place among home-dwelling older adults. The current literature on the concepts of quality of life and health-related quality of life, as well as the current state of the art on assistive technologies facilitating the autonomy of older adults is also provided. Chapter 2 follows with the dissertation aims. Chapter 3 chronicles the research conducted to develop the INSPIRE Population Survey, as well as an outline of the variables and measurements used in the survey (25). The work also describes the marketing strategy used for disseminating the survey and briefly reports on the response rate and participant characteristics. This population-based survey achieved a response rate of 30.7%, which is considerably high for postal surveys (28), particularly in those involving older adults (27). This accomplishment can be credited to the ongoing stakeholder involvement strategies we used, including early engagement of all stakeholders during the development of the questionnaire as well as its marketing. In Chapter 4, we evaluated HRQoL and factors related to it using an ecological outlook. The participants of our survey reported a high HRQoL, similar to findings from previous research (29, 30). We specifically looked at multilevel factors at the micro, meso and macro level related to how home-dwelling older adults perceived their HRQoL. This ecological perspective permitted the investigation of variables associated not only with the individual, but also with the environment around the older adult. We confirmed that among home-dwelling older adults, having a higher income, supplementary insurance, better education and generally a greater socio-economic status were associated with a higher HRQoL (31, 32). Our findings also validated previous studies indicating that individuals who report to be more frequently involved in one or more social activities, correspondingly report a higher HRQoL (33, 34). We also confirmed factors that negatively impact home-dwelling older adults’ HRQOL, as previously researched, like being older and female, having multimorbidity and polypharmacy, and being lonely or socially isolated (35-46). Chapter 5 presents the results from our study aiming to describe the current and anticipated use of assistive technologies among our participants, namely telemedicine, phone/SMS, wearables and assistive robots; as well the factors associated with openness to use such assistive technologies. We showcased that the current use of assistive technologies was rather low amid participants, compared to findings from two other surveys conducted on this topic among Swiss older adults (47, 48). Our results highlight a new finding that compared to current use, a higher percentage of home-dwelling older adults were open to using wearables and telemedicine in the future. We also found that openness to use assistive technologies in this population was positively associated with their current use, and also with receiving support from a spouse or a partner. Similar to the two previous surveys in Switzerland, openness to use assistive technologies was negatively associated with older age and with being female (47, 48). Chapter 6 presents a summary of the findings from the three preceding chapters and interprets them in the context of the current literature. Furthermore, methodological strengths and limitations of these studies are discussed. At last, reflections on the implication of this thesis for future research, policy and practice are presented. In conclusion, this dissertation was part of the development phase of an implementation science project aiming to implement and sustain an integrated care model for home-dwelling older adults. Our findings provide some important insight into the areas requiring the attention of care professionals and policymakers. We brought forward the need for considering the role the environment and the social network surrounding home-dwelling older adults play in fostering care that augments their quality of life and supports them in maintaining their desired independence. We also showed the potential assistive technologies have in attaining this goal, possibly also alleviating some of the burden of informal caregivers who are providing care and support for home-dwelling older adults. From a research, practice and policy position, we believe our findings have the prospective to provide a better scientific and policy approach in assuring older adults are reaching their goal to age in place