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Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period
Background
The prevalence of multimorbidity is increasing worldwide, and older people with multimorbidity are frequent users of health care services. Since multimorbidity has a significant negative impact on Health-related Quality of Life (HrQoL) and is more common in older age it would be expected that factors related to HrQoL in this group might have been thoroughly researched, but this is not the case. Furthermore, it is important to look at old people living at home, considering the shift from residential to home-based care. Therefore, we aim to investigate factors that are related to HrQoL in older people with multimorbidity and high health care consumption, living at home.
Methods
This is a secondary analysis of a RCT study conducted in a municipality in south-eastern Sweden. The study had a longitudinal design with a two-year follow-up period assessing HrQoL, symptom burden, activities of daily living, physical activity and depression.
Results
In total, 238 older people with multimorbidity and high health care consumption, living at home were included (mean age 82, 52% female). A multiple linear regression model including symptom burden, activities of daily living and depression as independent variables explained 64% of the HrQoL. Higher symptom burden, lower ability in activities of daily living and a higher degree of depression were negatively related to HrQoL. Depression at baseline and a change in symptom burden over a two-year period explained 28% of the change in HrQoL over a two-year period variability. A higher degree of depression at baseline and negative change in higher symptom burden were related to a decrease in HrQoL over a two-year period.
Conclusion
In order to facilitate better delivery of appropriate health care to older people with high health care consumption living at home it is important to assess HrQoL, and HrQoL over time. Symptom burden, activities of daily living, depression and change in symptom burden over time are important indicators for HrQoL.
Trial registration
Clinicaltrials.gov identifier:
NCT01446757
, the trial was registered prospectively with the date of trial registration October 5
th
, 2011.
Journal Article
So you want to be a modern homesteader? : all the dirt on living the good life
\"The dream of rural living can be romantic and rewarding, it is also packed with challenges. [This book] offers an in-depth 'look before you leap' examination of what you need to consider before moving 'back to the land'\"-- Provided by publisher.
Book
Differences in quality of life in home-dwelling persons and nursing home residents with dementia – a cross-sectional study
Background
Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.
Methods
The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.
Results
Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.
Conclusion
The study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.
Journal Article
The gift of European thought and the cost of living
European thought is often said to be a gift to the rest of the world, but what if there is no gift as such? What if there is only an economy where every giving is also a taking, and every taking is also a giving? This book extends the question of economies by making a case for an \"economy of thought\" and a \"political economy.\" It argues that all thinking and doing presupposes taking, and therefore giving, as the price to pay for taking; or that there exists a \"cost of living,\" which renders the idea of free thinking and living untenable. The argument is developed against the Enlightenment directive to think for oneself as the means of becoming autonomous and shows that this \"light,\" given to the rest of the world as a gift, turns out to be nothing.
eBook
Farm + Land's back to the land : a guide to modern outdoor life
A spectacular treehouse suspended above a lush forest. A cozy cabin perched on a mountainside. A small farm growing heirloom vegetables in the high desert. These are the extraordinary stories of the modern-day back-to-the-land-movement, a movement that embraces slow living, sustainability, and the value of doing things with your own two hands. Here are remarkable narratives, essential how-tos, and hundreds of breathtaking photographs from people who have embraced lives of adventure in wild places. Delivered in a handsome volume that inspires feelings of wanderlust, this book is a must-have for outdoor enthusiasts and anyone who has ever dreamed of escaping to a simpler way of life.
Book
Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace
BackgroundAll community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care.ObjectiveTo examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.DesignStratified randomized controlled trial.ParticipantsIntegrated care and support according to the “Embrace” model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles (“Robust,” “Frail,” and “Complex care needs”), and randomized to Embrace or control groups.InterventionEmbrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile.MeasurementsPrimary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals’ perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care.Key resultsOlder adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the “Frail” and “Complex care needs” risk profiles. We found no significant advantages for the “Robust” risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71).ConclusionsThis study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals.
Journal Article
The frugal homesteader : living the good life on less
\"Equip your homesteading dreams with all the affordable DIY innovations, tips, and stories you need to successfully get you started growing your own food, connecting yourself and your kids with nature, and consuming less while producing more! A fun, inspirational, and educational guide to help you save money while living off the land\"--Provided by publisher.
Book
Future of evidence ecosystem series: 3. From an evidence synthesis ecosystem to an evidence ecosystem
The “one-off” approach of systematic reviews is no longer sustainable; we need to move toward producing “living” evidence syntheses (i.e., comprehensive, based on rigorous methods, and up-to-date). This implies rethinking the evidence synthesis ecosystem, its infrastructure, and management. The three distinct production systems—primary research, evidence synthesis, and guideline development—should work together to allow for continuous refreshing of synthesized evidence and guidelines. A new evidence ecosystem, not just focusing on synthesis, should allow for bridging the gaps between evidence synthesis communities, primary researchers, guideline developers, health technology assessment agencies, and health policy authorities. This network of evidence synthesis stakeholders should select relevant clinical questions considered a priority topic. For each question, a multidisciplinary community including researchers, health professionals, guideline developers, policymakers, patients, and methodologists needs to be established and commit to performing the initial evidence synthesis and keeping it up-to-date. Encouraging communities to work together continuously with bidirectional interactions requires greater incentives, rewards, and the involvement of health care policy authorities to optimize resources. A better evidence ecosystem with collaborations and interactions between each partner of the network of evidence synthesis stakeholders should permit living evidence syntheses to justify their status in evidence-informed decision-making.
Journal Article