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PubMed2005

Life-extension and the Malthusian Objection.

Dramatically extending the human lifespan seems increasingly possible. Many bioethicists object that life-extension will have Malthusian consequences as new Methuselahs accumulate, generation by generation. I argue for a Life-Years Response to the Malthusian Objection. If even a minority of each generation chooses life-extension, denying it to them deprives them of many years of extra life, and their total extra life-years are likely to exceed the total life-years of a majority who do not want life-extension. This is a greater harm to those who want extended life than the Malthusian harms to those who refuse extended life, both because losing an extra year of life is worse than enduring a year of Malthusian conditions, and because the would-be Methuselahs have more life-years at stake. Therefore, even if life-extension seems likely to cause severe overcrowding and resource shortages, that threat is not sufficient to justify society in restricting the development or availability of life-extension.

Bioethical Issues↗
PubMed2002

Hysterectomy status and life satisfaction in older women.

OBJECTIVES: This cross-sectional, population-based study examines the long-term effect of hysterectomy on life satisfaction in 1177 women aged 55-94 years. METHODS: A 1992 mailed survey obtained information on menopausal history, including hysterectomy and oophorectomy status, and estrogen use. Two standardized measures ascertained general life satisfaction: the Life Satisfaction Index-Z (LSI-Z) and the Satisfaction with Life Scale (SWLS). A separate question asked participants to rate life satisfaction (better, the same, or worse) after menopause or hysterectomy compared with before. RESULTS: Twenty-three percent of the women reported hysterectomy with bilateral oophorectomy an average of 24 years earlier, and 26% reported hysterectomy with ovarian conservation an average of 28 years earlier. Women who were 20 or more years posthysterectomy or postmenopause were significantly more likely to rate their life satisfaction as better than were women 5 or fewer years posthysterectomy or postmenopause (p < 0.01). Among women with a hysterectomy, 53% with oophorectomy and 60% with ovarian conservation rated life satisfaction better after hysterectomy. Only 42.2% of women without a hysterectomy rated life satisfaction as better after menopause (p < 0.001). Differences persisted after adjustment for age and other covariates: p < 0.01 for hysterectomy with ovarian conservation and p < 0.001 for hysterectomy with bilateral oophorectomy vs. no hysterectomy. Even among women who had never used estrogen, a significantly greater proportion of those who had a hysterectomy with ovarian conservation rated their life satisfaction as better compared with women who did not have a hysterectomy (p < 0.05). There were no differences in standard life satisfaction scores (LSI-Z or SWLS) by hysterectomy status. CONCLUSIONS: There are no long-term adverse effects of hysterectomy on life satisfaction. When queried specifically, women report increased life satisfaction following hysterectomy. Relief from symptoms necessitating hysterectomy may be responsible for this increase. This difference may be specific to hysterectomy because there were no differences in general life satisfaction as assessed with standardized measures.

Adaptation, Psychological↗
PubMed2006

Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy.

CONTEXT: Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited. OBJECTIVE: To compare estimated life-years saved with screening colonoscopy in very elderly vs younger persons. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted among 1244 asymptomatic individuals in 3 age groups (50-54 years [n = 1034], 75-79 years [n = 147], and > or =80 years [n = 63]) who underwent screening colonoscopy at a US teaching hospital and clinic. MAIN OUTCOME MEASURES: Prevalence of various types of colon neoplasia; estimated gain in life expectancy, calculated as life expectancy--(life expectancy during polyp lag time + life expectancy after colorectal cancer diagnosis); and comparison of mean gain in life expectancy across the 3 groups. Life expectancy and mortality data were derived from life tables, previous studies, and national databases. RESULTS: The prevalence of neoplasia was 13.8% in the 50- to 54-year-old group, 26.5% in the 75- to 79-year-old group, and 28.6% in the group aged 80 years or older. Despite higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older than in the 50- to 54-year-old group (0.13 vs 0.85 years). In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than in the younger patients; alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly than in the younger patients. CONCLUSIONS: Even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons (aged > or =80 years) results in only 15% of the expected gain in life expectancy in younger patients. Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.

Aged↗
PubMedDate not supplied

Quality of life and diabetes.

Quality of life is an important health outcome in its own right, representing the ultimate goal of all health interventions. This paper reviews the published, English-language literature on self-perceived quality of life among adults with diabetes. Quality of life is measured as physical and social functioning, and perceived physical and mental well-being. People with diabetes have a worse quality of life than people with no chronic illness, but a better quality of life than people with most other serious chronic diseases. Duration and type of diabetes are not consistently associated with quality of life. Intensive treatment does not impair quality of life, and having better glycemic control is associated with better quality of life. Complications of diabetes are the most important disease-specific determinant of quality of life. Numerous demographic and psychosocial factors influence quality of life and should be controlled when comparing subgroups. Studies of clinical and educational interventions suggest that improving patients' health status and perceived ability to control their disease results in improved quality of life. Methodologically, it is important to use multidimensional assessments of quality of life, and to include both generic and disease-specific measures. Quality of life measures should be used to guide and evaluate treatment interventions.

Adult↗
PubMed2003

Predictors of life satisfaction in retired physicians and spouses.

BACKGROUND: With the current demographic changes, adjustment to retirement has become a major concern for physicians. Yet information on adjustment to retirement gathered from retired physicians is sparse. Information on physician spouses following retirement is currently not available. Therefore, we conducted a survey of a multi-disciplinary group of retired physicians and their spouses on adjustment to retirement. METHODS: A mail survey was sent to 1834 alumni who graduated from medical school prior to 1965. Responses were received from 795 (43 %) physicians and 455 spouses. Of the physicians, 678 indicated that they were retired or semi-retired. Life satisfaction was measured on a 9-point Likert scale. RESULTS: Levels of life satisfaction were high for both physicians and spouses. Approximately 88 % of both groups reported being mostly satisfied or better with their lives. Factors associated with better life satisfaction for physicians included better health, optimism, feelings of financial security, participation in activities and hobbies and a good sexual relationship. For spouses, good health, having a husband willing to help with chores, quality of relationships including sexual relationship and attending theatre or sporting events were associated with higher levels of life satisfaction. Spouses who had never worked reported higher levels of life satisfaction than spouses who had worked and were now retired. For changes in life satisfaction since physician retirement, predictors for both physicians and spouses were similar to those for life satisfaction. However, for physicians, both younger age and more years in retirement were independently associated with improved life satisfaction. Issues regarding loss of role and methods and reasons for retirement influenced satisfaction in the early retirees. For spouses, major challenges involved coping with changes in the marital relationship. CONCLUSIONS: Physicians and their spouses reported high levels of life satisfaction. The factors predicting life satisfaction and change in life satisfaction following retirement differed for physicians and spouses. For physicians, life satisfaction and change in life satisfaction were affected by time since retirement.

Adaptation, Psychological↗
PubMed2006

What does the WHOQOL-Bref measure? Measurement overlap between quality of life and depressive symptomatology in chronic somatoform pain disorder.

INTRODUCTION: Quality of life has become an important outcome criterion for psychiatric interventions. Especially in chronic disorders with no complete recovery, the improvement of quality of life is an important treatment goal. Nevertheless, there are methodological problems in assessing quality of life. There is a possible measurement overlap between quality of life and psychopathology, especially depression, which may invalidate research results. This study addresses the quality of life of patients with chronic somatoform pain and its relation to depressive symptoms. METHOD: One hundred out-patients with somatoform pain disorder at the Behavioural Medicine Pain Clinic in the Department of Psychiatry of the Medical University of Vienna were diagnosed using the SCID for Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). The patients filled out the World Health Organisation Quality of Life Assessment-Bref (WHOQOL-Bref) and the Beck Depression Inventory (BDI). Pain intensity (average pain, maximum pain, minimal pain) and disability (work, leisure and family life) were assessed using visual analogue scales. RESULTS: Quality of life in somatoform pain disorder was reduced compared to the norm population, especially in the physical and psychological domains. There were highly significant negative correlations between, on the one hand, depressive symptomatology (BDI) and, on the other hand, the physical quality of life domain (r=-0.655, p<0.01), the psychological domain (r=-0.735, p<0.01), the social domain (r=-0.511, p<0.01) and the environmental domain (r=-0.561, p<0.01). In all domains of the WHOQOL-Bref and in the global score, significant differences between the group of patients with severe or very severe depressive symptoms and the group with no or only mild depressive symptoms were found. DISCUSSION: While the WHOQOL-Bref showed a poor quality of life of patients with chronic somatoform pain disorder in general and especially in the physical and in the psychological domains, the high correlation of physical and psychological quality of life scores with depressive symptomatology points to a measurement overlap. It is suggested that assessment of subjective quality of life should always be checked for the influence of depressive symptomatology on the quality of life score.

Chronic Disease↗
PubMed2002

Comparison of quality of life and anorectal function after artificial sphincter implantation.

PURPOSE: Quality of life, a major outcome parameter in the treatment of anal incontinence, has not been assessed after artificial sphincter implantation. The purpose of this single-center, prospective, nonrandomized study was to assess quality-of-life differences in patients before and after artificial sphincter implantation and compare them with clinical incontinence scores and anal manometry. METHODS: Quality of life was assessed in 16 patients (14 females; mean age, 43 years) consecutively implanted with an Acticon Neosphincter. The Fecal Incontinence Quality of Life Scale, a quality-of-life instrument specifically designed for analysis of anal incontinence, included 27 items grouped in four domains: lifestyle, coping/behavior, depression/self-perception, and embarrassment. Fecal Incontinence Quality of Life Scale score (0 to 1, with 1 indicating better quality of life) was calculated preoperatively and postoperatively and compared with the Fecal Incontinence Score (on a scale of 0 to 120, with 120 being complete incontinence), an evacuation score, and maximal resting pressure. RESULTS: At a mean (standard deviation) of 25 (15) months,12 patients had an activated device, and 11 had satisfactory anorectal function. Significant improvement was observed postoperatively in the four separate quality-of-life domains. Mean (standard deviation) Fecal Incontinence Quality of Life Scale scores increased from 0.44 (0.14) preoperatively to 0.86 (0.18), 0.94 (0.06), and 0.83 (0.16) at 6, 12, and 24 months after implantation, respectively. For the same time periods, the mean (standard deviation) Fecal Incontinence Scores were 105 (14), 24 (26), 32 (35), and 32 (28), respectively (P< 0.05). A linear correlation was found between the improvement over time in quality of life measured by the Fecal Incontinence Quality of Life Scale and clinical evaluation of incontinence measured by the Fecal Incontinence Score (r2 = 0.97; P = 0.03). Mean (standard deviation) maximal resting pressure increased similarly from 42 (24) cm H2O preoperatively to 97 (23) cm H2O at the end of follow-up (P < 0.0001). CONCLUSION: After artificial sphincter implantation, quality of life as assessed by a new Fecal Incontinence Quality of Life Scale instrument was significantly improved. These results correlated with clinical assessment of anal incontinence and were associated with a significant increase in maximal anal resting pressure on manometry.

Adult↗
PubMed2006

Results of lateral internal sphincterotomy for chronic anal fissure with particular reference to quality of life.

PURPOSE: The aim of this study was to investigate the effects of lateral internal sphincterotomy on quality of life in patients with chronic anal fissure using the Gastrointestinal Quality of Life Index and the Fecal Incontinence Quality of Life Scale. METHODS: Adult patients with chronic anal fissure underwent lateral internal sphincterotomy with the open technique. Two hundred forty-four patients completed the Gastrointestinal Quality of Life Index questionnaire at admission and at 12 months postoperatively. The Fecal Incontinence Severity Index score was calculated preoperatively and at 2 and 12 months postoperatively. The Fecal Incontinence Quality of Life Scale was administered to any patient who had a Fecal Incontinence Severity Index score greater than 0 at 12 months postoperatively. RESULTS: The mean preoperative Gastrointestinal Quality of Life Index score was 118.34 +/- 6.33, which developed to 140.74 +/- 2.38 postoperatively (P< 0.001). At the two-month follow-up, 18 patients (7.38 percent) had a Fecal Incontinence Severity Index score greater than 0. By 12 months, the number of patients with Fecal Incontinence Severity Index score greater than 0 was reduced to seven (2.87 percent). These seven patients had a Gastrointestinal Quality of Life Index score similar to that of the group with postoperative Fecal Incontinence Severity Index score of 0, and only three patients (1.22 percent) had evident deterioration in the Fecal Incontinence Quality of Life Scale. The 12-month total Gastrointestinal Quality of Life Index score of the three patients who developed anal abscess/fistula after sphincterotomy (139.33 +/- 3.21) was similar to the Gastrointestinal Quality of Life Index score of those without complications. However, the Gastrointestinal Quality of Life Index score of the recurrent cases (111.53 +/- 3.53) was apparently low. CONCLUSION: The gastrointestinal quality of life improved significantly following lateral internal sphincterotomy, regardless of the surgical complications or postoperative disturbances of continence. Only 1.2 percent of the patients experienced deterioration in Fecal Incontinence Quality of Life Scale.

Adolescent↗
PubMed1999

Health status versus quality of life in older patients: does the distinction matter?

PURPOSE: Although health-related quality of life in older people is generally assessed by measuring specific domains of health status, such as activities of daily living or pain, the association between health-status measures and patients' perceptions of their quality of life is not clear. Indeed, it is controversial whether these health-status measures should be considered measures of quality of life at all. Our objective was to determine the association between health-status measures and older patients' perceptions of their global quality of life. SUBJECTS AND METHODS: We performed a cross-sectional study of 493 cognitively intact patients 80 years of age and older, interviewed 2 months after a hospitalization. We measured patients' self-assessed global quality of life and four domains of health status: physical capacity, limitations in performing activities of daily living, psychological distress, and pain. RESULTS: Each of the four scales was significantly correlated with patients' global perceptions of their quality of life (P <0.001). The ability of the health-status scales to discriminate between patients with differing global quality of life was generally good, especially for the physical capacity (c statistic = 0.72) and psychological distress scales (c statistic = 0.70). However, for a substantial minority of patients, scores on the health-status scales did not accurately reflect their global quality of life. For example, global quality of life was described as fair or poor by 15% of patients with the highest (best tertile) physical capacity scores, 25% of patients who were independent in all activities of daily living, 21% of patients with the least psychological distress (best tertile), and by 30% with no pain symptoms. Similarly, global quality of life was described as good or better by 43% of patients with the worst physical capacity (worst tertile), 49% of patients who were dependent in at least two activities of daily living, 47% of patients with the most psychological distress (worst tertile), and 51% of patients with severe pain. CONCLUSION: On average, health status is a reasonable indicator of global quality of life for groups of older patients with recent illness. However, disagreement between patients' reported health status and their perceptions of their global quality of life was common. Therefore, assumptions about the overall quality of life of individual patients should not be based on measures of their health status alone.

Activities of Daily Living↗
PubMed2006

Prospective, longitudinal evaluation of health related quality of life in the pediatric spina bifida population undergoing reconstructive urological surgery.

PURPOSE: Spina bifida, the most frequent permanently debilitating birth defect, results in major urological problems of voluntary bladder control and bowel function, which may impair quality of life. We prospectively assessed quality of life in patients with spina bifida using child and parent reports simultaneously. This study had 3 goals, that is to 1) document baseline health related quality of life in patients with spina bifida preoperatively, 2) study health related quality of life, reporting differences between parents and children, and 3) study changes in health related quality of life prospectively at preoperative and postoperative intervals. MATERIALS AND METHODS: Patients with spina bifida who were 2 to 18 years old and required reconstructive urological surgery in 2004 were included in the study. Demographic survey and the validated PedsQL 4.0 health related quality of life questionnaire were used preoperatively and postoperatively. A clinical outcomes data set was completed after the clinician saw the patient. PedsQL 4.0 subscales were scored using the algorithms provided. RESULTS: The response rate was 100%. Mean participant age was 10.3 years. Preoperatively child physical and psychosocial health and school functioning were significantly higher than parent reports (p <0.001). Overall health related quality of life in patients with spina bifida was lower than in healthy children (62.4 vs 85, p <0.001). Six weeks postoperatively significant differences in health related quality of life reporting between parents and children had lowered. Six months postoperatively child emotional and social functioning scores were higher than parent scores (p <0.001). No correlation was found between health related quality of life, and clinical and demographic factors due to insufficient sample size. CONCLUSIONS: Children with spina bifida recorded higher health related quality of life scores than parents/guardians. This health related quality of life study addresses concerns that impact daily quality of life in patients with spina bifida. Future health related quality of life studies in patients with spina bifida should use child self-reports.

Adolescent↗
PubMed1994

Measuring health related quality of life in men with prostate cancer.

Health related quality of life is one of several end points commonly studied in medical outcomes research. It refers to how well an individual is functioning in life and to his or her own perceptions of well being. Although health related quality of life variables concern subjective phenomena, their measurement is rigorously quantitative and based upon the well defined principles of psychometric research methodology. Health related quality of life data are collected with survey instruments, which may be self-administered or require a trained interviewer. Some are completed at a medical facility, while others are completed independently at home or by telephone. To yield useful information, such instruments must undergo extensive pilot testing and be shown to have sound psychometric properties. This testing determines whether an instrument can produce data that are reliable or reproducible, and valid or meaningful. Health related quality of life instruments typically contain several collections of items, called scales, that apply to particular dimensions of quality of life. These scales contribute to a qualitative profile of the health-related components of the daily life of a subject. General health related quality of life measures include broad issues that concern many types of patients, while disease-targeted measures address issues that are specific to the condition under study. Both are necessary to create a full and rich picture of patient quality of life. The field of health related quality of life research remains in its adolescence. Although several general measures are now well established, many disease targeted domains have been left unexplored. In men treated for prostate cancer, established general and cancer specific health related quality of life instruments may be combined with newly developed measures that assess the prostate related sexual, urinary and bowel domains in terms of degree of dysfunction and level of bother from that dysfunction. With the substantially increased patient role in directing treatment for prostate cancer, the importance of examining health related quality of life outcomes in addition to survival has been underscored. It is the responsibility of the urological community to include health related quality of life when assessing new and established prostate cancer therapies, and when counseling patients.

Attitude to Health↗
PubMed2003

Evaluation of quality of life in patients with cataract in Hong Kong.

PURPOSE: To evaluate the quality of life in patients in a public hospital in Hong Kong before and after cataract surgery using a new questionnaire. SETTING: Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, China. METHODS: One hundred ten Chinese patients having cataract extraction were evaluated for surgical outcomes and quality of life using a questionnaire modified to reflect the local culture and environment in Hong Kong. The questionnaire consisted of 20 questions divided into 4 domains: distance vision, near vision, social function, and cataract-related symptoms. The test-retest reliability of the questionnaire was assessed in another 15 patients by weighted kappa and internal consistency tested with the Cronbach alpha. Construct validity was tested by correlating visual acuity with quality of life and subjective visual improvement and satisfaction with quality-of-life improvement. The preoperative and 4-month postoperative quality of life were evaluated, and the association with the patients' characteristics, type of surgery performed, presence of systemic or ocular diseases, and subjective patient satisfaction was analyzed. RESULTS: The preoperative visual acuity in the operated eye had a low correlation (0.11) with the quality-of-life score; visual acuity in the better eye had a higher correlation (0.29). Quality-of-life improvement was moderately correlated with visual acuity improvement and patient satisfaction. Overall, quality-of-life scoring improved in all domains after surgery, with an overall effect size of 0.68. Quality-of-life scores improved postoperatively in 83.6% of patients, did not change in 3.6%, and were worse in 12.7%. Visual acuity improved in 94.5%, remained the same in 2.7%, and was worse in 2.7%. There was no difference in quality-of-life improvement between extracapsular cataract extraction and phacoemulsification at 4 months. Patients with systemic or ocular diseases and those who were phakic in the fellow eye had lower quality-of-life improvement; however, this was statistically significant for systemic diseases only. Age and sex did not affect quality of life or its improvement. CONCLUSIONS: The quality of life and surgical outcomes in cataract patients were assessed by a simple questionnaire. The local culture and environment should be taken into consideration in the questionnaire design.

Aged↗
PubMed1999

Quality of life in allergic rhinitis.

OBJECTIVE: This review will furnish the reader current information on the importance of quality of life evaluation in patients suffering from allergic rhinitis, the different types of quality of life instruments used, and how they can be used in judging different pharmaceutical therapies. DATA SOURCES: Computer-assisted MEDLINE searches for articles assessing "quality of life" and "outcomes" in rhinitis. Also MEDLINE searches evaluating health-related quality of life in relationship to different pharmacologic treatments in allergic rhinitis. STUDY SELECTIONS: Pertinent abstracts and articles in two broad areas were selected. The first groups were articles in the fields of outcomes, quality of life, allergic rhinitis, and its relationship to health-related quality of life. The second group of articles evaluated different pharmacologic agents' effect on the health-related quality of life of rhinitis patients. Both sets of articles were critically analyzed with important representative studies selected for this review. RESULTS: Health-related quality of life of patients with allergic rhinitis is impaired as measured by both generic and specific health-related quality of life instruments. Use of second generation antihistamines, intranasal corticosteroids, and intranasal ipratropium bromide have been shown to improve the health-related quality of life of sufferers of allergic rhinitis. CONCLUSIONS: The measuring of health-related quality of life is assuming a primary position in outcomes analysis in the patient with allergic rhinitis. Studies have documented the validity of using generic and specific health-related quality of life instruments in allergic rhinitis. Each type has its own weaknesses and strengths that the user needs to appreciate. Appraising the role of different pharmacologic agents in allergic rhinitis in improving the patient's quality of life is an important part of proving the medication's worth to the health care community.

Adolescent↗
PubMed1999

Quality of life in newly diagnosed cancer patients.

The aim of this study was to examine which domains of quality of life are most strongly affected in patients with newly diagnosed cancer, and to examine if quality of life was related to gender, age, educational level, cohabitation, time since diagnosis, treatment or type of cancer in these patients. Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation Evaluation System, short form, were completed by 131 newly diagnosed Norwegian adult cancer patients. The patients had different cancer diagnoses, with breast cancer being the most common type. None of them were terminally ill, and 80% had been diagnosed within the last 6 months. The patients turned out to be satisfied with their lives, especially with the family and marital domains. They were least satisfied with health, functioning and sex life. Analyses of variance and multiple regression analysis were conducted to examine the impact on quality of life of cohabiting, age, gender, educational level, cancer diagnosis, treatment and time since diagnosis. Those cohabiting had significantly higher quality of life compared with those living alone. In contrast the younger group (19-39 years) living alone had significantly lower quality of life than the older groups living alone. Although age was only significantly associated with quality of life in one sub-scale, the elderly people reported their quality of life to be better in almost all sub-scales. Time since diagnosis was not associated with quality of life, while treatment was associated with quality of life as measured by Ferrans and Powers Quality of Life Index. Gender and educational level were only associated with one or two domains in quality of life, respectively.

Activities of Daily Living↗
PubMed2002

The significance of personality factors for various dimensions of life quality among older people.

Quality of life has various dimensions with multiple meanings for people. One vital issue is whether a person's subjective experienced quality of life correlates with his or her personality. Several studies show a correlation between personality and quality of life, life satisfaction or well-being. The aim of this study was to examine the relationship between personality and life quality, in particular the way in which multi-dimensional conceptualization of personality relates to a multi-dimensional definition of life quality. Seventy-eight elderly individuals completed a quality of life questionnaire, the Lund Gerontology Centre's Life Quality Questionnaire (LGC), and a personality questionnaire, the Gordon Personal Profile Inventory (GP:A). Discriminant analysis showed that various personality characteristics relate to different aspects of life quality. Vigour alone predicted current quality of life, while emotional stability was related to psychological well-being and satisfaction with significant relationships. Ascendancy and ability to maintain personal relations were related to an optimistic outlook on life and absence of psychosomatic symptoms. Original thinking and sociability related to increased psychosomatic symptoms and sociability also correlated negatively with satisfaction with significant relationships. The results support the idea that various personality characteristics are related to various life quality dimensions in the investigated group, increasing the understanding of unique experience of life quality for each individual.

Aged↗
PubMed1999

Trends in dementia-free life expectancy among elderly members of a large health maintenance organization.

BACKGROUND: This study examined the secular trends of life expectancy without dementia among elderly American members of a health maintenance organization, and observed if an increased life expectancy is accompanied by an increase in the duration of life with dementia. METHODS: The data derived from two chronological 9-year prospective cohort studies of members of the Kaiser Permanente Medical Care Program of Northern California. The first and second cohorts included 2,702 and 2,926 people aged > or =65 years free from dementia at baseline. Life expectancy without dementia or dementia-free life expectancy (DemFLE) is defined as the average number of years a person is expected to live without dementia. Total life expectancy is equal to the sum of DemFLE and life expectancy with dementia. Estimations of DemFLE were based on mortality data and incidence of dementia, using double-decrement life tables. RESULTS: Between the first and second cohorts, all-cause mortality rates declined, while the incidence of dementia remained constant in both men and women. Among the males, total life expectancy increased at a higher rate than DemFLE. Consequently, the duration of life with dementia was extended in the second cohort. Conversely, among the females DemFLE increased at a higher rate than total life expectancy, thus the duration of life with dementia decreased in the second cohort. The median age of dementia onset was postponed by 2-3 years in the second cohort for females, and did not show any specific difference between the two cohorts in males. CONCLUSION: The trends of health expectancies suggest an extension of the duration of life with dementia for males and a compression of dementia for females. A decreased incidence of risk factors for dementia among females in the second cohort such as stroke may explain these trends.

Age Distribution↗
PubMed2002

Quality of life instruments for caregivers of patients with cancer: a review of their psychometric properties.

The quality of life of caregivers of patients with cancer is an important construct given the substantial impact of caring on the physical, psychological, social, and financial well-being of caregivers. Moreover, caring for patients with cancer also affects family functioning and places burdens on caregivers. The reliability and validity of instruments used to assess the quality of life of caregivers of patients with cancer were reviewed to aid in the selection of the most appropriate measures for research and practice. (1980-2000) and (1982-2000) searches located relevant quality of life instruments using the keywords "cancer and quality of life" and "caregiver or spouse or partner." The search identified the following instruments: the Caregiver Quality of Life Index-Cancer Scale, the Caregiver Quality of Life Index, the Quality of Life Tool, and the Quality of Life Index-Cancer Version. Quality of life instruments developed specifically to measure the quality of life of caregivers of patients with cancer had the best psychometric properties. The Caregiver Quality of Life Index-Cancer Scale, in particular, met or exceeded minimum psychometric criteria for reliability and validity. The development of reliable and valid caregiver quality of life measures is an important factor in developing interventions to enhance quality of life of caregivers of patients with cancer.

Caregivers↗
PubMed1992

Factors related to quality of life 12 months after discharge from an intensive care unit.

OBJECTIVE: To perform an analysis of the quality of life of survivors after ICU discharge. DESIGN: Prospective study. SETTING: Medical-surgical ICU of a Spanish reference hospital. PATIENTS: Patients (n = 606) admitted in a 6-month period. METHOD: A questionnaire regarding quality of life issues was completed at the time of admission by patients or surrogates (n = 606). The questionnaire was given again 12 months after ICU discharge to 444 surviving patients. Both questionnaires evaluated the patient's ability to function and communicate for the previous 3 months. A Quality of Life score of 0 corresponded to no limitations. An increasing score indicated a reduction in function. A score of greater than 10 points implied a severe physical handicap. Information was also collected on the severity of illness and the diagnosis that prompted ICU admission. RESULTS: The mean Quality of Life score of all survivors worsened from a mean of 4.62 at the time of ICU admission to a mean of 6.11 at 12 months after ICU discharge (p less than .01) and was most evident for patients greater than 75 yrs of age (from a mean of 6.33 to a mean of 9.54). However, patients with the highest initial Quality of Life scores had a significant improvement at 12 months (14.61 +/- 0.50 to 12.48 +/- 0.78 points [p less than .05]). A higher severity of illness score corresponded to a higher Quality of Life score, but a multivariate analysis indicated that the factors with the greatest influence on the post-discharge Quality of Life score were the initial Quality of Life score and age. CONCLUSIONS: Twelve months after discharge from the ICU, a patient's functional status, as measured by the Quality of Life score, is influenced most by age and their Quality of Life score at the time of ICU admission. While there is an overall decrease in the Quality of Life score for survivors, admission and treatment in an ICU do not always result in deterioration of the Quality of Life score. This study indicates that Quality of Life scores could become a routine part of patient evaluation.

Age Factors↗