Unequal chances for reaching 'a good old age'. Socio-economic health differences among older adults from a life course perspective

This article provides an overview of the socioeconomic inequality in physical and psychological health of older adults between 55 and 85 years of age, with a focus on the older adults whose socioeconomic status (SES) remains at a low level all their life. Data are derived from 1471 men and 1568 women, participating in the Longitudinal Aging Study Amsterdam (LASA) in 1992/1993. Based on the parental and own level of education, respondents are divided in four categories: those with a life time low level of SES, those with downward or upward mobility in SES, and those with a life time high level of SES. Logistic regression analyses showed that older adults with upward SES mobility and life time high SES, had a lower risk for functional limitations, chronic diseases (men only), 6-year mortality, depression and loneliness, compared with the older adults with life time low SES. The disadvantaged position of the low SES persons with regard to age, health and psychosocial conditions explained the SES differences in depression, but SES differences in mortality (for men) and in functional disability (for men and women) are not explained by the risk factors under study. SES differences in loneliness were attributed to differences in psychosocial conditions. Lifestyle did not add to the explanation of any of the SES differences. There were only small differences between those with a life time low SES and those with downward mobility in SES. It is concluded that a low level of education (regardless of the parental level) contributes to restricted psychosocial conditions, health problems and low well-being in old age, thereby decreasing the chances for a 'good old age' considerably.     

Follow-up Study of Patients With Cerebral Palsy

Of 319 patients with cerebral palsy recalled for reevaluation 15 years after the initial visit, 10 percent had died. Of the living, 55 percent had spasticity, 32 percent had athetosis, 4 percent had ataxia and 9 percent had mixed spasticity and athetosis; 38 percent had an intelligence quotient (IQ) less than 50, 24 percent between 50 and 79, and 38 percent had IQ above 80. There was a high correlation between overall functional outcome and intellectual level. Severity of physical disability, as measured by hand use, mobility and speech, also correlated with dependence, in part because increased severity of the disability was associated with decreased intellectual capacity generally.Twenty-five years after the initial visit, parental attitudes and personality intactness were evaluated (using the Minnesota Multiphasic Personality Inventory [MMPI]) and were correlated with satisfaction with status in life in 28 persons predicted to be independent on the 15-year study. Twenty (72 percent) of the 28 were satisfied with their status in life and of these, 16 were evaluated (with the MMPI) with 70 percent scoring in the normal range; 13 (65 percent) had parents with a positive attitude. Positive attitude was defined as parental feelings that the handicapped child was a worthy, valuable person, to be encouraged and assisted but not isolated from the world of nonhandicapped people.Careful serial assessment by professional teams combined with repeated long-term counseling of families can result in optimal outcome for the disability level involved, due to the primary role parents play in the development of a child''s character and behavior.     

Life satisfaction in persons of the third age after retirement

The aim of this research was to determine the role of gender, type of residence, living arrangement, self-rated health status, loneliness, and sense of humor in self-reported life satisfaction in elderly retirees. The study included 300 elderly retirees from Zagreb, Croatia. Demographic data were collected with a structured questionnaire, whereas data on self-reported health status, loneliness, and sense of humor were collected with the UCLA Loneliness Scale, Life Satisfaction Index, HOPA-86, and SF-36 Health Survey. Participants living in a retirement home showed higher life satisfaction than those who lived in their own households. Those who had children showed greater life satisfaction No differences in life satisfaction were found with respect to gender, marital status, or living arrangement. The investigated demographic variables, self-rated health status, self-rated loneliness, and a sense of humor explained 52.8% of variance in life satisfaction. An active sense of humor was the most significant predictor. Living in a retirement home, having children, and having an active sense of humor had a positive influence on self-reported life satisfaction, whereas poorer self-rated health and loneliness had a negative influence. Taking into account the predictors of life satisfaction in preventive activities may contribute to successful aging.     

Quality of life in families of Croatian veterans 15 years after the war

Exposure to war trauma with its consequences such as post traumatic stress disorder (PTSD) and disability due to combat injuries poses a significant problem for modern Croatian society. However, this is also a public health problem requiring continuous study of effective treatment strategies to achieve an increase in quality of life of most war-affected groups. Aim of this study was to examine the quality of life of population most affected by war - families of Croatian veterans. Present study included 126 female participants, who agreed to complete physical and psychiatric examination organized by the Ministry of Family, War Veterans and Intergenerational Solidarity. Included were participants with status of either wife of war veteran suffering from PTSD, wife who lost her husband in war circumstances or wife of war veteran with physical disabilities resulting from war activities. All three groups were asked to fill out the World Health Organization Quality of Life Questionnaire - short form (WHOQOL-BREF). Results indicate that assumed intensity of secondary trauma is not associated with quality of life. Namely, the highest level of satisfaction was found in wives of the most seriously affected invalids of war (M=3.77; sd=0.741), folowed by the wives of deceased soldiers (M=3.5; sd= 0.697), while the lowest quality of life results were found in wives of veterans suffering from PTSD (M=3.12; sd=0.608). Our results confirm that, nearly 15 years after the war, wives of disabled or killed Croatian soldiers have a (comparatively) satisfactory quality of their everyday lives, compared to the wives of veterans suffering from PTSD.     

Case-control cohort study of patients' perceptions of disability in mastocytosis

Background

Indolent forms of mastocytosis account for more than 90% of all cases, but the types and type and severity of symptoms and their impact on the quality of life have not been well studied. We therefore performed a case-control cohort study to examine self-reported disability and impact of symptoms on the quality of life in patients with mastocytosis.

Methodology/Principal Findings

In 2004, 363 mastocytosis patients and 90 controls in France were asked to rate to their overall disability (OPA score) and the severity of 38 individual symptoms. The latter was used to calculate a composite score (AFIRMM score). Of the 363 respondents, 262 were part of an ongoing pathophysiological study so that the following data were available: World Health Organization classification, standard measures of physical and psychological disability, existence of the D816V KIT mutation, and serum tryptase level. The mean OPA and AFIRMM scores and the standard measures of disability indicated that most mastocytosis patients suffer from disabilities due to the disease. Surprisingly, the patient''s measurable and perceived disabilities did not differ according to disease classification or presence or absence of the D816V KIT mutation or an elevated (≥20 ng/mL) serum tryptase level. Also, 32 of the 38 AFIRMM symptoms were more common in patients than controls, but there were not substantial differences according to disease classification, presence of the D816V mutation, or the serum tryptase level.

Conclusions

On the basis of these results and for the purposes of treatment, we propose that mastocytosis be first classified as aggressive or indolent and that indolent mastocytosis then be categorized according to the severity of patients'' perceived symptoms and their impact on the quality of life. In addition, it appears that mastocytosis patients suffer from more symptoms and greater disability than previously thought, that mastocytosis may therefore be under-diagnosed, and that the symptoms of the indolent forms of mastocytosis might be due more to systemic release of mediators than mast cell burden.     

Disability status differentials across fifteen Asian and Pacific Islander groups and the effect of nativity and duration of residence in the U.S

This study examines disparities in disability status across 15 Asian and Pacific Islander American (API) subpopulations and how nativity and duration in the U.S. influence these differences. Employing three disability questions (work limitations, mobility limitations, and self-care limitations) from the 1990 PUMS, the authors find substantial heterogeneity in disability status across API subgroups: while Japanese American adults have the most favorable outcomes, Other Southeast Asian adults (Laotians, Hmong, and Cambodians), followed by Vietnamese and Pacific Islander adults, suffer from a high risk of disabilities. Many of the disparities in disability status across API subpopulation adults are attributable to differentials in demographic characteristics and SES. The inclusion of an interaction term of age and nativity/duration of residence in the U.S. in multivariate regression analyses demonstrates that the effect of nativity/duration plays a different role across age, net of demographic, and SES risk factors. The overall findings are also consistent with previous studies on the relationship between immigrant health and nativity/duration. That is, immigrants with short duration in the U.S. have superior health status, measured by risk of disability, than longer-term immigrants and their U.S.-born counterparts.     

Inequality in Disability in Bangladesh

Objective

To investigate inequality in disability in Bangladesh.

Methods

The study used both household level and individual level data from a large nationally representative data set, Bangladesh’s Household Income and Expenditure Survey - 2010. Principal component analysis was used to construct a wealth index based on household assets from household level data. Then, using data from 49,809 individuals aged 5 years and over, chi-square tests and logistic regression were performed to test the association between wealth level and disability.

Findings

Women and older people are significantly more likely to report having disabilities than men and younger people. For middle and rich families, respectively, there is a 14 percent lower likelihood of reporting disabilities than for poor families. Changes in the probability of having disabilities are linear with increasing wealth. In addition, the study identifies some significant factors affecting disability, namely, age, sex, education, marital status, and place of residence including divisional differences.

Conclusion

In Bangladesh, worse health among the poor argues for policies prioritizing this group while at the same time giving special attention to women and the elderly.     

Should Schools Expect Poor Physical and Mental Health,Social Adjustment,and Participation Outcomes in Students with Disability?

The literature on whether students with disabilities have worse physical and mental health, social adjustment, and participation outcomes when compared to their peers without disabilities is largely inconclusive. While the majority of case control studies showed significantly worse outcomes for students with disabilities; the proportion of variance accounted for is rarely reported. The current study used a population cross-sectional approach to determine the classification ability of commonly used screening and outcome measures in determining the disability status. Furthermore, the study aimed to identify the variables, if any, that best predicted the presence of disability. Results of univariate discriminant function analyses suggest that across the board, the sensitivity of the outcome/screening tools to correctly identify students with a disability was 31.9% higher than the related Positive Predictive Value (PPV). The lower PPV and Positive Likelihood Ratio (LR⁺) scores suggest that the included measures had limited discriminant ability (17.6% to 40.3%) in accurately identifying students at-risk for further assessment. Results of multivariate analyses suggested that poor health and hyperactivity increased the odds of having a disability about two to three times, while poor close perceived friendship and academic competences predicted disability with roughly the same magnitude. Overall, the findings of the current study highlight the need for researchers and clinicians to familiarize themselves with the psychometric properties of measures, and be cautious in matching the function of the measures with their research and clinical needs.     

Disability Mediates the Impact of Common Conditions on Perceived Health

Background

We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health.

Methods and Findings

WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects.Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2–51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions.

Conclusions

More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.     

Assessment of Disability among the Elderly in Xiamen of China: A Representative Sample Survey of 14,292 Older Adults

Background

The unprecedented number of elderly individuals in China presents a serious public health challenge. Limited data are available on the prevalence of disability or factors resulting in disability among the elderly in China.

Objective

We aimed to assess the prevalence of disability and related risk factors among the elderly of Xiamen, China.

Methods

A cross-sectional study was performed on individuals who were ≥60 years of age. The subjects were recruited by multi-stage sampling; a total of 14,292 valid questionnaires were received. Study measurements included activities of daily living (ADL), demographics, and health status. The ADL was assessed by the Katz Index Scale to evaluate disability. Chi-square tests and binary logistic regression were used to identify factors associated with disabilities.

Results

Among the valid participants, 4.27% had at least one disability. Bathing was the most frequently reported disability and feeding was the least frequently reported disability. Disabilities were significantly associated with female gender, older age, unmarried status, living with family, urban residence, illiteracy, poor economic status, self-rated bad health, chronic illnesses, lower life satisfaction, bad mood, and feelings of loneliness.

Conclusion

Functional disability among the elderly requires more public attention. Culturally appropriate policies and programs are also needed to address the care for the disabled elderly.     

What the snake leaves in its wake: Functional limitations and disabilities among snakebite victims in Ghanaian communities

BackgroundThe estimated five million snakebites per year are an important health problem that mainly affect rural poor populations. The global goal is to halve both mortality and morbidity from this neglected tropical disease by 2030. Data on snakebite morbidity are sparse and mainly obtained from hospital records.MethodsThis community-based study was conducted among 379 rural residents with or without a history of snakebite in the Ashanti and Upper West regions of Ghana. All participants in the snakebite group were bitten at least six months before the day of survey. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Buruli Ulcer Functional Limitation Score were used to obtain patient-reported measure of functioning and disability. Long-term consequences were evaluated based on the severity of the symptoms at the time of the snakebite.FindingsThe median (IQR) time since the snakebite was 8.0 (3.5–16.5) years. The relative risk of disability was 1.54 (95% CI, 1.17–2.03) in the snakebite group compared to the community controls. Among patients with clinical symptoms suggesting envenoming at the time of bite, 35% had mild/moderate disabilities compared to 20% in the control group. The disability domains mainly affected by snakebite envenoming were cognition level, mobility, life activities and participation in society. A combination of the severity of symptoms at the time of the bite, age, gender and region of residence most accurately predicted the odds of having functional limitations and disabilities.ConclusionThe burden of snakebite in the community includes long-term disabilities of mild to moderate severity, which need to be considered when designing appropriate public health interventions. Estimating the total burden of snakebite is complicated by geographic differences in types of snakes and their clinical manifestations.     

Patterns of impairment and disability related to social handicap in young people with cerebral palsy and spina bifida

This paper explores the inter-relationships between impairment and disability in a sample of 119 teenagers in relation to their psychological adjustment and quality of social life. Poor psychological adjustment and extreme social isolation are associated not so much with individual functional limitations as with particular configurations of impairments and disabilities. It seems that social handicap is not a direct consequence of any impairment or disability but arises generally from severe functional loss and is shaped by dependency on others, restricted choices, physical barriers and adverse reactions of others.     

Measured versus self-reported body height

Students (105 males and 298 females) of the Faculty of Natural Sciences of University of Wrocław of 19–28 years of age were examined. The questionnaire and body height measurements were conducted in February and March of the year 2000. The measured as well as self — reported body height were analyzed depending on socio — economic variables such as the students' parents' education, the students' place of residence and their families' financial status, until the students' 14 year of age. The analysis of the mean self — reported and measured body height values demonstrated insignificant differences for men and the significant ones for women. Tall women declare greater than actual body height and only tall men appeared to be insignificantly taller than their questionnaire answers suggested. The analysis of the mean differences with regard to the size and kind of the place of residence didn't show significant differences. Similarly, neither the educational level nor the financial status constitute a differentiating factor with regard to the analyzed characteristics.     

Charting the progression of disability in parkinson disease: study protocol for a prospective longitudinal cohort study

Background  

People with Parkinson disease (PD), even in the presence of symptomatic relief from medical, surgical, and rehabilitative interventions, face a persistent worsening of disability. This disability is characterized by diminished quality of life, reduced functional mobility, declining performance in activities of daily living and worsening neurological impairments. While evidence has emerged supporting the clinically meaningful benefits of short-term exercise programs on these underlying factors, assertions regarding the effects of sustained programs of exercise and physical activity on the trajectory of disablement in PD are made in the absence of direct evidence. Indeed, the natural decline in quality of life and functional mobility in people diagnosed with PD is poorly understood. Moreover, outcome measures commonly used in clinical exercise trials typically do not capture the full spectrum of disability as defined by the World Health Organization (WHO).     

Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis.

OBJECTIVES: To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a clinician using Kurtzke''s expanded disability status scale and a non-clinically qualified assistant using the Office of Population Census and Surveys'' (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire; and to compare the scores of patients for each domain of the SF-36 with control data matched for age and sex. DESIGN: Cross sectional study. SETTING: Clinical department of neurology, Edinburgh. SUBJECTS: 42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation. MAIN OUTCOME MEASURES: Scores on the SF-36; EuroQol; Kurtzke''s expanded disability status scale; the OPCS disability scale. RESULTS: Patients and clinicians disagreed on which domains of health status were most important (chi 2 = 21, df = 7, P = 0.003). Patients'' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians'' assessment (r = -0.87, P < 0.001) and the non-clinical assessment (r = -0.90, P < 0.001). However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol, Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls. CONCLUSIONS: Patients with multiple sclerosis and possibly those with other chronic diseases are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment.     

Disability prevalence among healthy weight,overweight, and obese adults

Objective:

Obesity is associated with adverse health outcomes in people with and without disabilities. However, little is known about disability prevalence among people who are obese. The purpose of this study is to determine the prevalence and type of disability among adults who are obese.

Design and Methods:

Pooled data from the 2003‐2009 National Health Interview Survey (NHIS) were analyzed to obtain national prevalence estimates of disability, disability type and obesity. The disability prevalence was stratified by body mass index (BMI): healthy weight (BMI 18.5‐<25.0), overweight (BMI 25.0‐<30.0), and obese (BMI ≥ 30.0).

Results:

In this pooled sample, among the 25.4% of US adults who were obese, 41.7% reported a disability. In contrast, 26.7% of those with a healthy weight and 28.5% of those who were overweight reported a disability. The most common disabilities among respondents with obesity were movement difficulty (32.5%) and work limitation (16.6%).

Conclusions:

This research contributes to the literature on obesity by including disability as a demographic in assessing the burden of obesity. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs.     

"As long as you're healthy and have your husband". An empirical analysis of the personal well-being of 75-year olds in Flanders

Using data from a 2002 representative survey of Flemish 75-year olds (N = 1457), the aim of the present study is to identify the structures in and causes of subjective well-being. The analyses reveal the great importance of good health. Respondents with a good physical and mental condition, who have a great deal of functional mobility and independence, do feel much better. Secondly, findings indicate that respondents who faced the loss of their partner, experience lower well-being. This explains the found gender differences. Women have lower perceived quality of life, mainly because of their greater susceptibility to widowhood. Furthermore, missing the former job and work role also contributes to lower levels of well-being. Finally, respondents who can cope financially, who feel satisfied with their social contacts and who spend their time in an active way, have higher personal well-being.     

Contribution of chronic disease to the burden of disability

Background

Population ageing is expected to lead to strong increases in the number of persons with one or more disabilities, which may result in substantial declines in the quality of life. To reduce the burden of disability and to prevent concomitant declines in the quality of life, one of the first steps is to establish which diseases contribute most to the burden. Therefore, this paper aims to determine the contribution of specific diseases to the prevalence of disability and to years lived with disability, and to assess whether large contributions are due to a high disease prevalence or a high disabling impact.

Methodology/Principal Findings

Data from the Dutch POLS-survey (Permanent Onderzoek Leefsituatie, 2001–2007) were analyzed. Using additive regression and accounting for co-morbidity, the disabling impact of selected chronic diseases was calculated, and the prevalence and years lived with ADL and mobility disabilities were partitioned into contributions of specific disease. Musculoskeletal and cardiovascular disease contributed most to the burden of disability, but chronic non-specific lung disease (males) and diabetes (females) also contributed much. Within the musculoskeletal and cardiovascular disease groups, back pain, peripheral vascular disease and stroke contributed particularly by their high disabling impact. Arthritis and heart disease were less disabling but contributed substantially because of their high prevalence. The disabling impact of diseases was particularly high among persons older than 80.

Conclusions/Significance

To reduce the burden of disability, the extent diseases such as back pain, peripheral vascular disease and stroke lead to disability should be reduced, particularly among the oldest old. But also moderately disabling diseases with a high prevalence, such as arthritis and heart disease, should be targeted.     

1590名农村中老年人生存质量调查分析(英文)

目的:采用SF-36量表中文版评价农村中老年人生存质量,并为提高农村中老年人的生存质量和健康水平提供科学依据和建议。方法:采用随机抽样的方法,采用面对面访谈的形式,记分方法参照国际生存质量评价计划(IQOLA)的制定标准,评价其生理和心理健康状况。结果:1590名农村中老年人男性生存质量得分高于女性。经济水平对农村中老年人的生理健康的影响大于对其心理健康的影响。配偶健在的农村中老年人的各维度得分均高于无配偶者。农村中老年人的各维度得分随教育水平的升高呈升高趋势。结论:农村中老年人的生存质量与年龄成负相关,同时也受文化程度和经济水平等多个因素的影响。因而,对农村中老年人这一弱势群体应该给予更多关注。