Associative participation of older adults and subjective quality of life: exploring self-selection bias

Active ageing policies seek to increase the quality of life of older people in three areas: health, security and participation. This paper focuses on a specific type of participation: associations. Its objective is to explore the possible self-selection effects of this type of participation, using global subjective quality of life indicators (satisfaction with life) and domain-specific indicators (satisfaction with leisure, community social integration and emotional resources). For this, a structural equation modelling analysis was conducted, taking into account bi-directional relationships between the variables of interest. The data come from a conditions and quality of life survey conducted in 2008 among a sample of 1,106 individuals aged 60 or over, living in community-dwellings in Spain. The results illustrate a complex model of relationships in which associative participation is not statistically significantly associated with the satisfaction measures used. This highlights the importance of self-selection effects and raises the issue of the effectiveness of associative participation as a tool to enhance the life satisfaction of older adultsPeer reviewe

EQ-5D rated by proxy in institutionalized older adults with dementia: Psychometric pros and cons

Aim: Measurement of health-related quality of life in people with dementia is a challenge, because of their special characteristics and the difficulties that this term entails itself. The present study aimed at assessing the psychometric properties of the EQ-5D rated by a familiar or a professional caregiver of institutionalized older adults with dementia. Methods: We analyzed the EQ-5D psychometric properties from 525 questionnaires rated by proxy, in a sample of institutionalized older adults with dementia. Results: The mean EQ-5D index score was 0.11 0.38, and 51.54 21.47 for the visual analog scale. The intraclass correlation coefficient was 0.72. Regarding internal consistency, Cronbach’s alpha was 0.64, and the item-total correlation ranged from 0.33 to 0.53. Exploratory factor analysis identified a functional and a subjective factor, accounting for 67.35% of the variance. Convergent validity of EQ-5D with Quality of Life Alzheimer’s Disease by proxy and Quality of Life in Late-stage Dementia scales was satisfactory (r = 0.36–0.58). The EQ-5D showed appropriate discriminative validity among patients grouped into several categories. Multiple linear regression models, using EQ-index and visual analog scale as dependent variables, identified dependence level, proxy characteristics, leisure and comorbidity as determinants of quality of life. Conclusions: Despite some limitations in the more subjective dimensions, the proxy-rated EQ-5D showed satisfactory psychometric properties in the present study, suggesting that it is a valid and alternative instrument to assess quality of life in institutionalized older people with dementia.Peer reviewe

Calidad de vida y estado de salud en personas mayores de 60 o más años con demencia institucionalizadas

Revista Española de Salud Pública, 2015, 89, 1-10que componen la calidad de vida (CdV) en las personas con demencia que viven en residencias. El objetivo de este estudio fue describir la CdV e identificar los factores relacionados con ella. Métodos: Muestra compuesta por 525 personas con demencia mayores de 60 años en 14 residencias de España. La CdV se evaluó mediante el EQ-5D (índice y escala visual analógica, EQ-EVA) y Quality of Life in Alzheimer’s Disease (QoL-AD versiones residente y cuidador). También se utilizaron Clinical Dementia Rating Scale (CDR), el índice de Barthel, la escala Cornell de depresión en demencia (CSDD), una versión adaptada de la Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Short Portable Mental Status Questionnaire (SPMSQ) y el Mini Examen Cognoscitivo (MEC). Para determinar la asociación entre variables se utilizó el coeficiente de correlación de Pearson y la prueba t de Student. Resultados: Las escalas presentaron entre ellas correlaciones de 0,17 a 0,50. La puntuación QoL-AD cuidador fue mejor en varones con menos discapacidad y depresión (28,94±4,91, 29,91±4,74 y 28,44±4,94, respectivamente; (p<0,01) y correlacionó con el índice de Barthel 0,45 y con la CSDD -0,36. El QoL-AD residente fue mejor en ausencia de depresión (29,29±6,03). El índice EQ-5D fue mayor en varones (0,19±0,33) con menos discapacidad (0,42±0,32) y su coeficiente de correlación con el índice de Barthel fue de 0,79. Conclusiones: En personas mayores con demencia institucionalizadas en residencias la calidad de vida se relaciona con el estado funcional y la depresión.Peer reviewe

Quality of life in older people with dementia: A multilevel study of individual attributes and residential care center characteristics

Aim: To analyze how the characteristics of institutionalized older people with dementia and residential care centers are associated with the individual’s quality of life (QoL). Methods: Data were collected from a survey carried out on 525 elderly people aged 60 years or older in 14 nursing care homes across Spain. Multilevel linear analysis to assess the differences in QoL level between centers and individuals was carried out. Results: The characteristics of the individuals that were associated with a higher QoL were functional independence, health status and gathering with family, friends or neighbors. In contrast, higher levels of dementia, depression and the length of institutionalization had a negative effect on QoL. In relation to the residential care center characteristics, the availability of geriatricians was associated with higher QoL, compared with those centers with no geriatricians on staff. In addition, public centers (public ownership and publicly-funded residents) were also associated with higher QoL than private/mixed centers. The multilevel analysis showed that the 16.4% of the differences in QoL was related to residence factors. Conclusion: These results reflect the importance of the functional, social, mental and residential dimensions in the QoL of older adults with dementia. Actions devoted to improving these key dimensions would contribute to promote the well-being of this vulnerable populationPeer reviewe