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Health risk appraisal in older people 3: prevalence, impact, and context of pain and their implications for GPs
- Authors:
- CARMACIU Claudia, et al
- Journal article citation:
- British Journal of General Practice, 57(541), August 2007, pp.630-635.
- Publisher:
- Royal College of General Practitioners
This stud aimed to assess the extent to which older people experience pain, and to explore the relationships between self-reported pain and functional ability and depression. A total of 1090 community-dwelling non-disabled people aged 65 years and over from three group practices in suburban London were included in this study. Main outcome measures were pain in the last 4 weeks and the impact of pain, measured using the 24-item Geriatric Pain Measure; depression symptoms captured using the 5-item Mental Health Inventory; social relationships measured using the 6-item Lubben Social Network Scale; Basic and Instrumental Activities of Daily Living and self-reported symptoms. Forty-five per cent of women and 34% of men reported pain the previous 4 weeks. Pain experience appeared to be less in the 'oldest old': 27% of those aged 85 years and over reported pain compared with 38-53% of the 'younger old'. Those with arthritis were four times more likely to report pain. Pain had a profound impact on activities of daily living, but most of those reporting pain described their health as good or excellent. Although there was a significant association between the experience of pain and depressed mood, the majority of those reporting pain did not have depressed mood. It is concluded that a multidimensional approach to assessing pain is appropriate. Primary care practitioners should also assess the impact of pain on activities of daily living.
Comparison of health-related quality of life and associated psychological factors between younger and older patients with established rheumatic disorders
- Authors:
- GOULIA Panagiota, et al
- Journal article citation:
- Aging and Mental Health, 14(7), September 2010, pp.819-827.
- Publisher:
- Taylor and Francis
The cross-sectional study involved 320 patients with various rheumatic disorders who were attending a follow-up clinic at the University Hospital of Ioannina. HRQOL (health-related quality of life) was assessed by the 26-item World Health Organisation Quality of Life Instrument (WHOQOL-BREF), and functional limitations, psychological distress, defence mechanisms, sense of coherence, and interpersonal difficulties were also assessed. The results showed that older patients presented more impaired physical HRQOL and social relationships HRQOL independent of disease type, education, and pain. Functional limitations were more prominent in the older group. Pain, functional limitations, and psychological distress were independently associated with physical HRQOL in both groups. Psychological distress was the only common independent correlate of social relationships HRQOL. Personality factors were significant correlates of physical and social relationships HRQOLs only in the younger group, while the impact of pain in physical HRQOL was greater for younger than older patients. The article concludes that older patients with rheumatic diseases experience more impaired HRQOL than the younger ones, and the management and prevention of functional limitations and psychological distress should be a priority.
Functional status and depressive symptoms among older adults from residential care facilities in the Czech Republic
- Authors:
- VANKOVA Hana, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(5), May 2008, pp.466-471.
- Publisher:
- Wiley
Depressive symptoms are common among older adults, particularly those living in long-term care facilities. However, little is known about factors associated with depressive symptoms among long-term care residents in the Czech Republic and in other Eastern European countries. Moreover, the role of mobility and pain in depressive symptoms among long-term care residents is relatively understudied. This study examined the relationship between functional status and depressive symptoms in 308 older adults from residential care facilities (RCFs) in the Czech Republic. Baseline data was used from two randomized controlled trials testing the effects of dance and reminiscence therapies on quality of life in older RCF residents. Functional status was measured as cognitive function, general ability to perform basic Activities of Daily Living (ADLs), mobility, and functional limitation by pain. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. In multiple regression analyses adjusted for sociodemographic factors and taking antidepressants, results found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to perform basic ADLs and mobility were also related to depressive symptoms.
A pilot study on perceived stress and PTSD symptomatology in relation to four dimensions of older women's physical health
- Authors:
- LAGANA Luciana;, REGER Stacy L.
- Journal article citation:
- Aging and Mental Health, 14(4), May 2010, pp.396-404.
- Publisher:
- Taylor and Francis
Posttraumatic stress disorder (PTSD) symptomatology and stress of a nontraumatic nature from a variety of sources can have an adverse impact on physical wellbeing. This study used selected demographics and self-reported stress reactions as potential predictors of older women’s distinct physical health dimensions. It hypothesised that, together with more advanced age and lower income, higher PTSD symptomatology and perceived stress (of a nontraumatic nature and beyond health status) would predict lower scores of physical health. The participants, 53 cognitively high-functioning and ethnically diverse women age 65-105 years, were assessed using 5 instruments measuring various predictors encompassing PTSD symptomatology, perceived stress, age and income, in relation to 4 dimensions of physical health: general health; physical functioning; physical role limitations; and bodily pain. The results showed that perceived stress was a significant predictor of lower levels of general health, but not of physical role limitations or physical functioning. Conversely, PTSD symptomatology predicted more limitations in role fulfilment (and, to a lesser extent, impaired physical function), but not lower levels of general health. As expected, age and income were predictive of some physical health dimensions. The hypothesised predictors failed to account for a significant portion of variance in pain scores. The article concludes that PTSD symptomatology and perceived stress might influence older women's physical health dimensions differentially.
Dementia, pain, depression, behavioral disturbances, and ADLs: toward a comprehensive conceptualization of quality of life in long-term care
- Authors:
- CIPHER Daisha J., CLIFFORD P. Andrew
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(8), August 2004, pp.741-748.
- Publisher:
- Wiley
Quality of life in long-term care settings is a multidimensional construct that includes functional, cognitive, behavioral, and psychological variables. Quality of life variables have been found to be related to one another, but directional influences have not been tested. The purpose of this study was to develop and compare two competing path models composed of quality of life variables, including dementia, pain, behavioral disturbances, and ADLs. Path analytic results revealed that cognitive, emotional, and behavioral variables interact with one another to predict patients' activities of daily living. Pain levels did not influence activities of daily living directly, but rather influenced behavioral disturbances and depression, which in turn influenced activities of daily living. These preliminary findings suggest that in order to assist long-term care residents in improving their activities of daily living, decreasing pain is likely to yield the greatest overall improvements. Future research on the relationships between quality of life variables is recommended to further develop multidimensional treatment models for healthcare providers in long-term care.
Variations in subjective wellbeing: the mediating role of a psychological resource
- Authors:
- WINDLE Gill, WOODS Robert E.
- Journal article citation:
- Ageing and Society, 24(4), July 2004, pp.583-602.
- Publisher:
- Cambridge University Press
This study examines the mediating role of psychological resources on life satisfaction, an indicator of subjective wellbeing. The evidence identifies several life events and changing circumstances that can be potentially detrimental to the wellbeing of older adults. Based on the literature, a theoretical model was developed with the hypothesis that adaptation to potentially adverse events draws on psychological resources central to the self. The study participants were a random sample of 423 community-dwelling people aged 70 years and over. All respondents were interviewed in their own homes using a structured schedule. Quantitative data were obtained on age, gender, social support, marital status, physical functioning, bodily pain, loneliness, isolation and housing difficulties. Subjective well-being was assessed by the life satisfaction index, and the psychological mediator was conceptualised as a measure of environmental mastery. The first round of analyses found that variations in well-being were associated with housing difficulties, isolation, loneliness, physical functioning, pain, support networks and marital status. The full model established perfect mediation by environmental mastery occurred for the variables housing problems and physical functioning, and partial mediation occurred for the variable loneliness – supporting the original hypothesis. The results add to the evidence from an increasing number of studies that demonstrates how psychological resources underlie the processes of adaptation to the changing situations that accompany increasing age and prevent negative outcomes.