Integrational model of quality of life in older age. Results from the ESRC/MRC HSRC quality of life survey in Britain

This paper is based on the results of a national survey of the quality of life of 999 randomly sampled people aged 65 and over, living at home in Britain. The survey was semi-structured, and a sample of survey respondents was followed up and interviewed in-depth in order to explore their perceptions of quality of life in full. Comparisons are made here between the results of (i) a hierarchical multiple regression model based on theoretically derived indicators of survey respondents’ ratings of their overall quality of life, with (ii) the same respondents’ own definitions of quality of life, categorised from their responses to open ended survey questions, and (iii) the views of a sub sample of these survey respondents who were subsequently interviewed in greater depth. Respondents were asked the open ended questions on quality of life at the outset of the survey interview in order to prevent any respondent bias from the structured measures used. The core components, and the central planks, of quality of life, which were consistently emphasised by the three approaches, were psychological characteristics and outlook, health and functional status, personal and neighbourhood social capital. The lay models also emphasised the importance of financial circumstances and independence, which need to be incorporated into a definition of broader quality of life

Quality of life from the perspectives of older people

This paper report results from a national survey of quality of life (QoL), based on 999 people aged 65 or more years living in private households in Britain. The study produced both qualitative and quantitative interview data. The 999 survey respondents were interviewed in their own homes with a semi-structured survey instrument, and 80 were followed-up in greater depth at one and two years after the baseline interview. The material from the in-depth interviews is presented here. The main QoL themes that emerged were: having good social relationships, help and support; living in a home and neighbourhood that is perceived to give pleasure, feels safe, is neighbourly and has access to local facilities and services including transport; engaging in hobbles and leisure activities (solo) as well as maintaining social activities and retaining a role in society; having a positive psychological outlook and acceptance of circumstances which cannot be changed; having good health and mobility; and having enough money to meet basic needs, to participate in society, to enjoy life and to retain one's independence and control over life. The results have implications for public policy, and supplement the growing body of knowledge on the composition and measurement of quality of life in older age

Lay theories of quality of life in older age

This paper presents findings from a national survey of quality of life (QoL) in older age. The main aim of the analyses was to examine the definitions of quality of life given by people aged 65 or more years and the underlying reasons. Open-ended questions were used to elicit their perceptions of QoL. These were followed by structured measures of self-rated QoL overall, and of domains of QoL commonly reported in the literature. The main things said by the respondents to give their lives quality were categorised into 'themes'. These were: social relationships; social roles and activities; leisure activities enjoyed alone; health; psychological outlook and wellbeing; home and neighbourhood; financial circumstances; and independence. The reasons people gave to explain why these things were important to their QoL focused on: the freedom to do the things they wanted to do without restriction (whether in the home or socially); pleasure, enjoyment and satisfaction with life; mental harmony; social attachment and having access to companionship, intimacy, love, social contact and involvement, help; social roles; and feeling secure. This paper also presents data that demonstrates the ability of theoretically informed, structured survey indicators of QoL to predict respondents' self-rated overall QoL. Logistic regression analyses showed that most of these indicators were strong, independent predictors of self-ratings of QoL, although those that were not significant in the model did not fully incorporate lay reasons of QoL in their measurement scales. In conclusion, the indicators which were not significant in the model did not fully incorporate lay values in their measurement properties. It is also likely that those indicators that were significant could have been improved

Pregabalin, the lidocaine plaster and duloxetine in patients with refractory neuropathic pain: a systematic review

Abstract Background Patients frequently fail to receive adequate pain relief from, or are intolerant of, first-line therapies prescribed for neuropathic pain (NeP). This refractory chronic pain causes psychological distress and impacts patient quality of life. Published literature for treatment in refractory patients is sparse and often published as conference abstracts only. The aim of this study was to identify published data for three pharmacological treatments: pregabalin, lidocaine plaster, and duloxetine, which are typically used at 2nd line or later in UK patients with neuropathic pain. Methods A systematic review of the literature databases MEDLINE, EMBASE and CCTR was carried out and supplemented with extensive conference and grey literature searching. Studies of any design (except single patient case studies) that enrolled adult patients with refractory NeP were included in the review and qualitatively assessed. Results Seventeen studies were included in the review: nine of pregabalin, seven of the lidocaine plaster, and one of duloxetine. No head-to-head studies of these treatments were identified. Only six studies included treatments within UK licensed indications and dose ranges. Reported efficacy outcomes were not consistent between studies. Pain scores were most commonly assessed in studies including pregabalin; trials of pregabalin and the lidocaine plaster reported the proportion of responders. Significant improvements in the total, sensory and affective scores of the Short-form McGill Pain Questionnaire, and in function interference, sleep interference and pain associated distress, were associated with pregabalin treatment; limited or no quality of life data were available for the other two interventions. Limitations to the review are the small number of included studies, which are generally small, of poor quality and heterogeneous in patient population and study design. Conclusions Little evidence is available relevant to the treatment of refractory neuropathic pain despite the clinical need. There is a notable lack of high-quality comparative studies. It is evident that there is a need for future, high quality trials, particularly "gold-standard" RCTs in this refractory patient population.</p

A systematic review and mixed treatment comparison of the efficacy of pharmacological treatments for fibromyalgia

Objectives. To review the literature on pharmacological treatments for fibromyalgia. Methods. Relative efficacy was estimated in terms of outcome measures highlighted by the Outcome Measures in Rheumatology Network using a Bayesian mixed treatment comparison (MTC) meta-analysis. Randomized controlled trials reporting treatments for fibromyalgia were identified by systematically reviewing electronic databases (Cochrane Library, Medline, EMBASE; accessed February 2008) and conducting manual bibliographic searches. Results. Forty-five randomized controlled trials met the prespecified inclusion criteria for the systematic review. There were limited robust clinical data for some therapeutic classes (tricyclic antidepressants, analgesics, sedative hypnotics, monoamine oxidase inhibitors) and only 21 studies met the more stringent criteria for inclusion in the MTC. The majority of studies included in the MTC assessed the anticonvulsant pregabalin (n = 5) or the serotonin norepinephrine reuptake inhibitors (SNRIs) duloxetine (n = 3) and milnacipran (n = 3). Licensed doses of pregabalin and duloxetine were significantly (P < 0.05) more efficacious than placebo in terms of absolute reduction in pain, number of “responders” (≥30% reduction in pain), or change in Fibromyalgia Impact Questionnaire score (pregabalin 450 mg/d only). There was no significant difference between licensed doses of pregabalin and duloxetine for these outcomes. However licensed doses of pregabalin produced significantly greater improvements in sleep compared with milnacipran (as measured by Medical Outcomes Study Sleep Scale). Conclusions. The current study confirms the therapeutic efficacy of pregabalin and the SNRIs, duloxetine and milnacipran, in the treatment of fibromyalgia. Given their different modes of action, combination therapy with pregabalin plus an SNRI should be investigated in future research