Health-Related Quality of Life in Older Adults at Risk for Disability

doi:10.1016/j.amepre.2007.04.031

American Journal of Preventive Medicine

Volume 33, Issue 3, September 2007, Pages 214-218

https://doi.org/10.1016/j.amepre.2007.04.031 Get rights and content

Background

The number of older adults living in the United States continues to increase, and recent research has begun to target interventions to older adults who have mobility limitations and are at risk for disability. The objective of this study is to describe and examine correlates of health-related quality of life in this population subgroup using baseline data from a larger intervention study.

Methods

The Lifestyle Interventions and Independence for Elders-Pilot study (LIFE-P) was a randomized controlled trial that compared a physical activity intervention to a non-exercise educational intervention among 424 older adults at risk for disability. Baseline data (collected in April–December 2004, analyzed in 2006) included demographics, medical history, the Quality of Well-Being Scale (QWB-SA), a timed 400-m walk, and the Short Physical Performance Battery (SPPB). Descriptive health-related quality of life (HRQOL) data are presented. Hierarchical linear regression models were used to examine correlates of HRQOL.

Results

The mean QWB-SA score for the sample was 0.630 on an interval scale ranging from 0.0 (death) to 1.0 (asymptomatic, optimal functioning). The mean of 0.630 is 0.070 lower than a comparison group of healthy older adults. The variables associated with lower HRQOL included white ethnicity, more comorbid conditions, slower 400-m walk times, and lower SPPB balance and chair stand scores.

Conclusions

Older adults who are at risk for disability had reduced HRQOL. Surprisingly, however, mobility was a stronger correlate of HRQOL than an index of comorbidity, suggesting that interventions addressing mobility limitations may provide significant health benefits to this population.

Introduction

Impaired mobility, with mobility defined as the ability to walk safely and independently,¹ has been shown to predict subsequent broader disability involving independent daily living activities.2, 3 Using these findings, researchers identified a subgroup of older adults that are at risk for developing disability.4, 5, 6, 7 These older adults are characterized by a sedentary lifestyle and impaired mobility. They walk more slowly and have reduced strength and balance. They are considered “at risk for disability” because they have reduced mobility, but can still perform daily living activities.

Mobility and daily living are important elements of the broader concept of health-related quality of life (HRQOL)8, 9 and most measures of generic HRQOL include questions about mobility.10, 11, 12, 13 The HRQOL of older adults is usually described in association with specific diseases, demographic characteristics, and/or healthy epidemiologic samples,14, 15, 16 but few, if any, studies describe the HRQOL of older adults who share functional limitations. The objective of this study is to describe and examine correlates of HRQOL in older adults considered at risk for disability.

Section snippets

Methods

This article describes baseline questionnaire data (collected April–December 2004, analyzed in 2006) from all Lifestyle Interventions and Independence for Elders-Pilot (LIFE-P) study participants. The study has been described in detail elsewhere.17, 18

Results

Mean baseline scores are presented in Table 1. There were no missing data for the QWB-SA and other health variables. Table 2 presents QWB-SA scores for a variety of samples from published studies. However, the samples differ on factors often related to HRQOL (age, gender).

Regression analyses examining correlates of HRQOL are presented in Table 3. Ethnicity was the only demographic variable retained. The comorbidity index and ethnicity variable tested in the second block were both retained. Of

Discussion

The mean QWB-SA score for a sample of older adults considered at risk for disability was lower than a mean score found for healthy older adults³⁷ Although these samples differ slightly, this difference (0.704 – 0.634=0.07) is substantial, and well beyond the minimally clinically important difference (MCID) of 0.03 estimated for the QWB-SA.41, 42

The decrement of 0.07 is more than the amount attributed to a variety of diseases including colitis, migraine, arthritis, stroke, ulcer, asthma, and

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Brief reportHealth-Related Quality of Life in Older Adults at Risk for Disability

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Contemp Clin Trials

Ann Thorac Surg

Control Clin Trials

J Affect Disord

J Cataract Refract Surg

Chest

J Clin Epidemiol

Urology

Am J Prev Med

Dimensions of mobility: defining the complexity and difficulty associated with community mobility

J Aging Phys Act

Preclinical mobility disability predicts incident mobility disability in older women

J Gerontol A Biol Sci Med Sci

Maintaining mobility in late lifeI. Demographic characteristics and chronic conditions

Am J Epidemiol

Characteristics of nondisabled older persons who perform poorly in objective tests of lower extremity function

J Am Geriatr Soc

Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability

N Engl J Med

Targeting high-risk older adults into exercise programs for disability prevention

J Aging Phys Act

A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission

J Gerontol

Health status: types of validity and the index of well-being

Health Serv Res

The MOS short-form general health surveyReliability and validity in a patient population

Med Care

EuroQol—a new facility for the measurement of health-related quality of life

Health Policy

Multi-attribute health status classification systemsHealth Utilities Index

Pharmacoeconomics

The quality of well-being scale: rationale for a single quality of life index

The quality of well-being scale: comparison of the interviewer-administered version with a self-administered questionnaire

Psychol Health

The Beaver Dam Health Outcomes Study: initial catalog of health-state quality factors

Med Decis Making

One thousand health-related quality-of-life estimates

Med Care

Brief report
Health-Related Quality of Life in Older Adults at Risk for Disability