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PubMed2002

Financial strain and life satisfaction in Hong Kong elderly Chinese: moderating effect of life management strategies including selection, optimization, and compensation.

For many Hong Kong Chinese elderly, financial strain is quite a common occurrence. This study examines the moderating effect of life management strategies including selection, optimization, and compensation in the relationship between financial strain on life satisfaction. The data came from a survey of a representative community sample of 421 elderly respondents in Hong Kong. Using multiple regression models, the authors found that selection and optimization of life management strategies moderated the linkage between financial strain and life satisfaction even after controlling socio-demographic variables, but sense of control over finances did not. Findings suggest that life management strategies should be enhanced to protect older people under chronic financial strain from low level of life satisfaction

Aged↗
PubMed2002

Use of family proxies in quality of life research for cancer patients at the end of life: a literature review.

One of the main goals of end-of-life care is to achieve the best quality of life (QOL) for patients and their families. Quality of life, therefore, represents a significant outcome indicator to evaluate end-of-life care interventions. However, nonresponse bias and nonrandom missing data in QOL research at the end-of-life limits the generalizability and threatens the internal validity of the study findings. The use of family proxy of patients' QOL has been suggested as a solution. Demonstration of satisfactory levels of agreement between proxies and patients is warranted before family caregivers' or other proxies' assessments can be employed when patients cannot provide their own information. Contrary to the conclusion made by Sprangers and Aaronson [The Role of Health Care Providers and Significant Others in Evaluating the Quality of Life of Patients with Chronic Disease: A Review. J. Clin. Epidemiol. 1992, 45, 743-760], it is suggested from this review of literature that terminal cancer patients and their family caregivers agreed at least moderately well on the patients' QOL. The bias introduced by the use of family informants is generally of a modest magnitude. When discrepancies existed, without exception, family caregivers held a more negative view of patients' QOL than did patients. When using family proxies, this is important to remember. The degree of agreement between terminal cancer patients' and their family caregivers' assessments varies as a function of the dimensions of QOL being measured and the patient's health status. However, the accuracy of family caregivers' assessments can be improved by assessing both patients and family caregivers concurrently over time. Several suggestions for future research are provided to better understand the influencing factors of agreement between patients and family assessments and to enhance the quality of statistical analyses on this topic.

Attitude to Health↗
PubMed1977

Life graphs and life events.

The present study investigates changes in personal satisfaction over the whole life course by means of life graphs and their determinants. The life graphs were administered within a 4-year interval to 371 individuals (age 45-70). A modified version of the Holmes and Rahe life events scale, administered in the second interview, was used to ascertain the occurrence of four kinds of events: (1) children leaving home, (2) ill health, (3) death of family or friends, and (4) changes in work. Differences in height between the peak of the graph and the height at the current age is the measurement technique used with the life graphs. Events are found to play a different role at different stages of life and seem to be measured against an implicit schedule according to which the events are seen as traumatic or acceptable. Thus, the same event has different effects on perception of emotional state according to age.

Age Factors↗
PubMed1979

Life changes and perceptions of life and death among older men and women.

Although social scientists have suggested that feelings about life and death may be related, for the most part, theories of social gerontology have developed independently of conceptions of death and finitude. This study examines whether life changes are associated with concurrent life and death attitude types among older men and women. Data were analyzed from structured interviews conducted with 214 men and 354 women during the second phase of a longitudinal study of the aged in small towns. Individuals were identified as positivists, negativists, activists, and passivists. Controlling for sex and income, changes in four life areas were examined in relation to these perceptions of life and death. Some of the patterns varied by sex, suggesting that the same changes have different implications for the well-being of men and women in late life. In general, those who had experienced discontinuity were more frequently negativists or passivists, while continuity tended to characterize positivists and activists.

Aged↗
PubMed1991

The role of time orientation in life satisfaction across the life span.

Relating contentment to different points in life can provide the construct of life satisfaction with an essential time orientation. The Self-Anchoring Scale was used to rate life in the present, the past (five years before), and the future (five years ahead). Subjects were the respondents of five national surveys in Israel. The findings showed an age-related configuration where progressive age was associated with declining ratings for the future, a milder decline for the present, and a relative increase for the past. In addition to rating levels, a structural modeling approach was used to explore the relative salience of these time referents, considered as indicators of the construct of life satisfaction. LISREL estimates of the indicator loadings in two related models showed the present as most salient and the past as least salient in most age groups. The salience of the past increased in later life, when that of the future did as well. The time-related construct of life satisfaction (which fit the data in all age groups) highlights the yet undetermined role of the future in the subjective well-being of the elderly.

Adolescent↗
PubMed2000

End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment.

OBJECTIVE: To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn. STUDY DESIGN: Prospective case series of 53 consecutive patients who died after the withdrawal of life-sustaining treatment in the pediatric intensive care unit at three teaching hospitals in Boston. Data on the reasons why medications were given were obtained from a self-administered anonymous questionnaire completed by the critical care physician and nurse for each case. Data on what medications were given were obtained from a review of the medical record. RESULTS: Sedatives and/or analgesics were administered to 47 (89%) patients who died after the withdrawal of life-sustaining treatment. Patients who were comatose were less likely to receive these medications. Physicians and nurses cited treatment of pain, anxiety, and air hunger as the most common reasons, and hastening death as the least common reason, for administration of these medications. Hastening death was viewed as an "acceptable, unintended side effect" of terminal care by 91% of physician-nurse matched pairs. The mean dose of sedatives and analgesics administered nearly doubled as life-support was withdrawn, and the degree of escalation in dose did not correlate with clinician's views on hastening death. CONCLUSION: Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.

Analgesics↗
PubMed1996

Development of the multidimensional index of life quality. A quality of life measure for cardiovascular disease.

OBJECTIVES: The purpose of this study was to design a multidimensional measure of health-related quality of life appropriate for patients with cardiovascular disease that was psychometrically sound, brief, and easy to administer. METHODS: Qualitative interviews conducted with healthy subjects and patients with cardiovascular diseases identified nine major quality of life domains. Based on the responses of 129 cardiovascular disease patients recruited from hospitals and clinics, a criterion-based approach was used to select 35 questionnaire items that best tapped these domains. Psychometric properties of the Multidimensional Index of Life Quality (MILQ) were tested with a sample of 348 patients with various cardiovascular diseases. RESULTS: Cronbach's alpha was 0.76 or higher for eight of the nine MILQ domains. Test-retest reliability coefficients were 0.73 or greater in all but two domains. Individual domain scores as well as a weighted overall quality of life index were correlated highly with self-assessed health and the number of heart-related symptoms. CONCLUSIONS: The Multidimensional Index of Life Quality is a psychometrically reliable and valid instrument for measuring quality of life in patients with cardiovascular diseases. The MILQ also may be a suitable measure for other types of chronic diseases.

Adult↗
PubMed1990

A comparison of a short half-life marker (low-dose isoniazid), a long half-life pharmacological indicator (low-dose phenobarbitone) and measurements of a controlled release 'therapeutic drug' (metoprolol, Metoros) in reflecting incomplete compliance by volunteers.

1. Although, long half-life compounds appear to be more appropriate pharmacological indicators of compliance with treatment, short half-life markers or measurements of short half-life therapeutic drugs are frequently used. 2. We have compared the usefulness of low-dose phenobarbitone (a long half-life indicator), low dose isoniazid (a short half-life marker) and controlled release metoprolol (Metros) (a controlled release formulation of a short half-life 'therapeutic' drug) in seven volunteers with simulated partial (two thirds) compliance. 3. Detection of isoniazid metabolites in urine had an 83% sensitivity and 94% specificity for detecting ingestion within the previous 24 h and 100% sensitivity and 82% specificity for detecting ingestion within the past 6 h but gave no indication of the longer term pattern of compliance. 4. At 28 days (a time when steady-state would be obtained for all three drugs) phenobarbitone plasma levels were 70% (66-76%)--median and interquartile range--of the expected steady-state level if compliance had been complete. Corresponding figures for metoprolol were 82% (37-100%). 5. Measurement of phenobarbitone was much superior to isoniazid or metoprolol measurements in reflecting partial compliance over the previous 1 to 4 weeks.

Administration, Oral↗
PubMed2006

Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia.

OBJECTIVES: To explore the extent to which commonly used measures of specific outcomes in dementia are an appropriate proxy for quality of life in dementia. METHODS: This was a cross sectional study set in communities in London and Nottingham, comprising 101 people with dementia and their 99 main family caregivers. The main outcome measures were health related quality of life in dementia (measured by the DEMQOL-Proxy), cognition (Mini Mental State Examination), functional impairment (Barthel Index), behavioural and psychological symptoms in dementia (Neuropsychiatric Inventory; NPI), and carer mental health (General Health Questionnaire). RESULTS: On univariate analysis, decreased quality of life was statistically significantly correlated with higher levels of behavioural and psychological disturbance (NPI total score and its agitation, depression, anxiety, disinhibition, and irritability subscales); younger age of the person with dementia; and poorer mental health of the carer. Quality of life was not statistically significantly associated with cognition or carer age. In a multivariate model, psychological and behavioural disturbance and patient age remained statistically significantly associated with quality of life. Carer mental health was no longer statistically significantly associated, and cognition and functional limitation remained statistically insignificant. CONCLUSIONS: These data suggest that quality of life in dementia is complex, and that simple proxy substitutions of discrete measures such as cognition or function are likely to miss important factors.

Activities of Daily Living↗
PubMed1999

Comparison of 50-mg and 100-mg sustained-release isosorbide mononitrate in the treatment of stable angina pectoris: effects on quality-of-life indices. Dutch Mononitrate Quality of Life (DUMQOL) Study Group.

High-dosage nitrates are more effective for the management of anginal symptoms but produce more adverse effects, including development of tolerance and the zero-hour effect (rebound angina at the end of the dosing interval). Such effects may reduce the beneficial effect of treatment on quality of life. In a self-controlled, 6-month study, the effects on symptoms and quality of life of 50 mg and 100 mg sustained-release isosorbide mononitrate (SR ISMN), administered once daily, on anginal symptoms and quality of life (QOL) were assessed in 453 patients with stable angina pectoris. QOL was assessed by means of a test battery based on the Medical Outcomes Short-Form 36 Health Survey and the Angina Pectoris Quality of Life Questionnaire. The internal consistency and reliability of the multiitem scales were estimated by use of Cronbach's alpha coefficient. Based on their improvements in New York Heart Association (NYHA) angina classification, patients who received 100 mg daily showed greater improvement than those who received 50 mgdaily; the mean difference between treatments was consistent with a significantly greater improvement of mobility and angina indices. Adverse effects, as estimated by side-effect index, including rebound angina at times of rest, and by patient compliance rating, differed slightly between the two treatment regimens and were even less problematic with the higher dosage than with the lower dosage. Psychological distress index and life satisfaction scores also were significantly higher with 100 mg than with 50 mg daily. The results of this study suggest that SR ISMN 100 mg once daily provided a better NYHA angina classification than SR ISMN 50 mg did and did not produce further adverse effects. In addition SR ISMN 100 mg improved various QOL indices more than SR ISMN 50 mg did, particularly the mobility index and certain life satisfaction scores, which are the most important indicators of QOL in this category of patients.

Aged↗
PubMed1995

The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability.

This is the first report on the McGill Quality of Life Questionnaire (MQOL), a questionnaire relevant to all phases of the disease trajectory for people with a life-threatening illness. This questionnaire differs from most others in three ways: the existential domain is measured; the physical domain is important but not predominant; positive contributions to quality of life are measured. This study was conducted in a palliative care setting. Principal components analysis suggests four subscales: physical symptoms, psychological symptoms, outlook on life, and meaningful existence. Construct validity of the subscales is demonstrated through the pattern of correlations with the items from the Spitzer Quality of Life Index. The importance of measuring the existential domain is highlighted by the finding that, of all the MQOL subscales and Spitzer items, only the meaningful existence subscale correlated significantly with a single item scale rating overall quality of life.

Adult↗
PubMed1993

Life satisfaction, life review, and near-death experiences in the elderly.

When 145 senior citizens living independently in the community were surveyed for incidence of near-death experiences (NDEs), 46 of the seniors believed they had had a "close call" with death. Twelve of those reported that they had had an unusual experience during their close call and were subsequently interviewed. Their stories were evaluated using research criteria to document sufficient number of characteristics of an NDE for inclusion in research data and if that set of characteristics of the NDE included a life review component. They were also compared to a non-NDE group on the Life Satisfaction Index, to determine if life review in the context of an NDE helped older people feel more satisfied with life. There was no correlation, because surprisingly, although older people do have NDEs at least as often as other groups, the life review does not seem to be a part of it. So the reasons for scores on the LSI-A are not attributable to the life review. Reasons for this finding are discussed.

Aged↗
PubMed2005

Predictive and treatment validity of life satisfaction and the quality of life inventory.

The clinical and positive psychology usefulness of quality of life, well-being, and life satisfaction assessments depends on their ability to predict important outcomes and to detect intervention-related change. These issues were explored in the context of a program of instrument validation for the Quality of Life Inventory (QOLI) involving 3,927 clients from various clinical settings. Clinical norms were also generated that supplement existing nationwide norms. The predictive validity of the QOLI and life satisfaction in a university counseling center was supported in terms of its ability to predict academic retention both by itself and in conjunction with cumulative grade point average 1 to 3 years in advance. The QOLI was also found to be sensitive to treatment-related change in two naturalistic clinical settings and samples. The interpretation and intervention utility of measures of quality of life, well-being, and life satisfaction are discussed with respect to clinical and positive psychology research.

Achievement↗
PubMed2005

[Evaluation of quality of life in anal incontinence: validation of the questionnaire FIQL (Fecal Incontinence Quality of Life)].

BACKGROUND: Anal incontinence causes physical and psychological incapacity, determining impact on quality of life. However, there are no specific tools to quantify this impact in our population. AIM: The evaluation of quality of life in anal incontinence, through validation of the FIQL ("Fecal Incontinence Quality of Life Scale"). FIQL is a questionnaire composed of 29 questions, grouped into four domains: lifestyle, behavior, depression and embarrassment. For each question, the scale ranges from 1 to 4, except questions 1 and 4, which ranges from 1-5 and 1-6, respectively. MATERIAL AND METHOD: FIQL scale underwent both translation and cultural adaptation processes, giving rise to a final Portuguese version. This version was then used in a validation study to test measurement properties (reproducibility and validity). The reproducibility was tested through application of FIQL questionnaire by two observers in 50 patients with anal incontinence. After a period of 7 to 10 days, the questionnaire was applied again by one of the observers. The constructive validity was assessed by correlating the FIQL questionnaire results with both, a generic questionnaire for quality of life (SF-36) and the Jorge-Wexner incontinence score results. The discriminative validity was evaluated comparing the results of the FIQL to incontinence group with two other groups: healthy volunteers and patient with chronic idiopathic constipation. RESULTS: The correlation among results domains of FIQL questionnaire and results of short form-36 and the incontinence score were statistically significant. The quality of life is impaired in all of domains of FIQL for incontinent patients: lifestyle: 2.4 behaviour: 2.0, depression: 2.5 and embarrassment: 1.9, when compared to healthy volunteers (3.9, 3.9, 4.1 and 4.0), and patients with chronic constipation (3.7, 3.8, 3.6 and 3.8), respectively. CONCLUSION: The FIQL questionnaire is effective and reproducible in its measuring properties, and it can be useful as an instrument to assess quality of life in anal incontinence in our population.

Adolescent↗
PubMed2003

[Satisfaction with life overall and with specific life domains among elderly persons with a lower limb amputation].

OBJECTIVE: To examine a group of elderly persons who had had a lower limb amputation and who were receiving care at the outpatient clinic of a teaching hospital in Campinas, São Paulo, Brazil, in order to: 1) identify relationships between their perceived overall life satisfaction and their functional capacity; 2) assess their perceived satisfaction with the domains of health, physical functioning/dependence, mental health, and social integration/involvement; and 3) identify relationships between overall life satisfaction and satisfaction with the specific domains. METHODS: An assessment was done of a group of 40 elderly persons (30 men and 10 women) who had had an amputation above the malleolus at least 1 year earlier and who were undergoing rehabilitation between June 1994 and June 1999. Their mean age was 74.5 years (range, 60 to 79 years). A questionnaire was used for data collection to assess: 1) functional capacity (Barthel index); 2) general life satisfaction (Cantrill model); and 3) satisfaction with the domains of health, physical functioning/dependence, mental health, and social integration/involvement, with the 40 elderly persons assessing themselves both in individual terms and in comparison to other persons of the same age group. RESULTS: Among the 40 elderly persons, the level of general life satisfaction was high. Measured on a scale of 1 to 10, the mean was 7.1 and the median 7.5, with a standard deviation of 2.73. There was no correlation between overall life satisfaction and functional capacity. There was no significant difference between individual perceived satisfaction with the specific domains and the perception of these domains in comparison to other persons of the same age group; in both of these cases, the elderly persons who had had an amputation reported a high degree of satisfaction. A positive correlation was found only between overall life satisfaction and the domains of health (individual and comparative) and of physical functioning (comparative). CONCLUSIONS: These results suggest that this group of elderly persons who had had an amputation tended to assess their situation positively. This finding provides new insights into the rehabilitation of elderly persons with lower limb amputations. Taken together with the dearth of studies concerning the subject, this finding also indicates the need for additional research focusing on the subjective well-being of the elderly.

Aged↗
PubMed2004

Sleeping habit and other life styles in the prime of life and risk for ossification of the posterior longitudinal ligament of the spine (OPLL): a case-control study in Japan.

BACKGROUND: Although the average age of onset of ossification of the posterior longitudinal ligament of the spine (OPLL) is at around 50 years, the onset of the symptoms is insidious and the progression is very slow. The etiology of OPLL has not been elucidated in detail. Previous studies have suggested that a high-salt diet and low consumption of animal protein, glucose intolerance and high body mass are risk factors for OPLL. However, there is little information about the relationship between OPLL and life styles in the prime of life (between 30 and 50 years). METHODS: To facilitate early prediction and prevention of OPLL, we analyzed life styles such as sleeping habit, physical exercise, smoking, alcohol drinking and hangover in subjects in the prime of life. Self-administered questionnaires were obtained from patients with OPLL and their sex- and age-matched controls. Sixty-nine patients diagnosed with OPLL within 3 years previously and 138 sex- and age-matched controls without backbone diseases, randomly selected from participants in a health checkup in a local town, were enrolled. RESULT: Moderate amount of sleep (6-8 hours vs. 5 hours or shorter and 9 hours or longer; odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.06, 0.54) and a regular sleeping habit (i.e., going to bed and getting up at regular time) (OR=0.44, 95% CI=0.22, 0.90) were associated with a decreased risk of OPLL even after adjusting for other factors. On the other hand, moderate physical exercise (once a week or more v.s. less than once a week: OR=0.97, 95% CI=0.42, 2.26), smoking (OR=1.41, 95% CI=0.67, 2.97), drinking (OR=1.08, 95% CI=0.53, 2.20) and hangover (OR=1.12, 95% CI=0.43, 2.94) in the prime of life showed no correlation with risk of OPLL. CONCLUSION: Good sleeping habits in the prime of life may decrease the risk of OPLL.

Activities of Daily Living↗
PubMed2001

Unidimensionality of life satisfaction and its relation to social desirability: a confirmatory study of a short form of the Life Satisfaction Scale.

This study investigated construct validity of a short version of the Life Satisfaction in the Elderly Scale developed from an exploratory factor analysis in 1990 of the original version of Salamon and Conte's Life Satisfaction scale. First, a confirmatory factor analysis (maximum likelihood method) was conducted on 149 adult and elderly Italians to assess whether the latent variable of the Life Satisfaction Short Form scale was adequately represented by one factor. Analysis showed a good fit for the proposed unidimensional model, the items achieved good internal consistency on the scale, and no age differences arose in the score for the Life Satisfaction factor. Second, the correlations between the items measuring Life Satisfaction and the Eysenck 1985 Lie scale indicated that the items on the Life Satisfaction Short Form are largely independent of social desirability for younger and older adults.

Adult↗
PubMed1994

Quality of life during induction treatment of acute myeloid leukaemia. A comparison of three intensive chemotherapy regimens using three instruments for quality of life assessment.

From a main study describing quality of life in patients with acute myeloid leukaemia (AML) over time, 22 patients who had received induction treatment with POCAL (prednisone, vincristine, doxorubicin, Ara-C, thioguanine), MEA (mitoxantrone, etoposide, Ara-C) or TAD (daunorubicin, Ara-C, thioguanine) chemotherapy regimens were selected. Their quality of life was assessed with Karnofsky performance scale (KPS) and Vitagram as well as with life ingredient profile (LIP), a new instrument for assessing quality of life during chemotherapy treatment. The patients' quality of life was found to be affected for short periods during induction treatment. The POCAL regimen seemed to lead to the least deterioration in quality of life, whereas the MEA treatment had more pronounced effects in this respect. In patients treated according to the TAD regimen gastrointestinal side-effects were mild compared to those of the other regimens. However, to show significant differences between treatment regimens larger multicentre studies are needed. The LIP instrument appeared to display a superior capacity for evaluating the distress of patients compared with the other instruments.

Acute Disease↗