How do you feel today?:The use of a Dynamic Systems approach in the conceptualization and analysis of Health Related Quality of Life in the older adults

The western world is facing a demographic revolution. The slowdown of the birth rate together with the increasing number of older adults generates a change in the population pyramid: a thinner basis (infants and children) carries an increasingly big peak (older adults). This provides a challenge for society: it becomes increasingly important that old people remain healthy and independent as long as possible. This study aims to generate knowledge to address this challenge. It focusses on the development of Health Related Quality of Life (HRQOL) as a central concept in the ageing process. HRQOL is a person-centered concept, referring to the social, physical and mental domain. The general aim of the thesis is to study the development of HRQOL from a dynamic systems approach in order to get insight in the developmental trajectories and their characteristics, and to analyze developmental trends in older adults. We developed a conceptual model of HRQOL. This model describes the development of HRQOL as an iterative process in which individual characteristics are assumed to affect the development in a complex and nonlinear way. As a next step, a mathematical model is developed based on the conceptual one. Such a model includes parameters that represent the relevant individual characteristics, and allows us to explore the possible developmental trajectories of different individuals in different conditions. First validation tests are promising, but much more validation is needed. Once validated, the model can be a big help in the development of interventions and guidance of the older adults

Physical frailty, disability, and dynamics in health perceptions: A preliminary mediation model

Anna Mulasso, Mattia Roppolo, Emanuela Rabaglietti Department of Psychology, University of Torino, Torino, Italy Purpose: Frailty is a condition characterized by loss of functional reserve and altered homeostatic capacity. The aging process is related with complex indicators of physiological state. This study aims, with a preliminary mediation model, to reveal the possible role of mediator of health perceptions variability in the relationship between frailty and disability. Patients and methods: A longitudinal study (100 days) was performed. Data from 92 institutionalized older adults were used in the analysis. Frailty was assessed in baseline using the Italian version of the Survey of Health, Ageing and Retirement in Europe – Frailty Instrument; health perceptions were assessed on a daily basis by three visual analog scale questions; and disability was measured in baseline and post-test using the Katz Activities of Daily Living questionnaire. The product-of-coefficient mediation approach was used to test direct and indirect effects of frailty. Results: Results showed that daily variability of health perceptions plays the role of mediator between frailty and disability. In all the steps, statistically significant results were found. Conclusion: This preliminary result may indicate that physical frailty increases the variability in health perceptions contributing to disability. Keywords: functional decline, loss of autonomy, variability, health outcomes, dynamic system

Effects of a Multicomponent Exercise Program on Prevalence and Severity of the Frailty Syndrome in a Sample of Italian Community-Dwelling Older Adults

Background: Frailty is a well-known condition that leads to a lack of resilience, with a reduced homeostatic capacity and a consequent higher risk of suffering adverse health outcomes. This study investigated the effectiveness of an exercise program to improve and reverse physical frailty amongst Italian older adults. Methods: One hundred and twenty-three community dwelling older adults (mean age 74 years, SD = 6; 64% women) were involved in an experimental (EG; n = 62) and a control (CG; n = 61) group. Frailty was assessed at baseline and after the intervention using an adapted version of the frailty phenotype. The EG took part in a 16-week exercise program, consisting of endurance, strength, balance and flexibility exercises, while the CG maintained the same routine. Results: After the exercise program, the EG was more robust than the CG (F = 43.51, p < 0.001). Within the EG, 46% of pre-frail and 50% of frail people reached the robust and pre-frail levels, respectively. Effects of training were higher in frail and pre-frail people (reduction of frailty of 0.67 and 0.76 points, respectively) compared to robust ones (who frailty levels increased by 0.23 points; F = 11.32, p < 0.001). Conclusions: A multicomponent exercise program may be effective at improving and reverting frailty, specifically for frail and pre-frail people