Total physical activity but not diet quality associated with postnatal depressive symptoms amongst women living in socioeconomically disadvantaged neighborhoods.

Lifestyle behaviors such as healthy diet and some forms of physical activity have been linked to lower risk of depressive symptoms in the general population. However, little is known regarding their associations with postnatal depressive symptoms. Given that postnatal women (particularly those living in socioeconomically disadvantaged neighborhoods) are more likely to have poorer diet quality, lower physical activity levels and greater risk of depressive symptoms, this study sought to determine the associations between diet quality, total and domain specific physical activity and depressive symptoms amongst postnatal women from socioeconomically disadvantaged neighborhoods. It was hypothesized that higher diet quality and levels of leisure-time physical activity would be associated with lower depressive symptoms. In 2007-2008, cross-sectional data were collected from 246 women living in socioeconomically disadvantaged neighborhoods in Victoria, Australia. Participants completed self-report measures of diet (using a 17 item dietary questionnaire), domain specific physical activity (International Physical Activity Questionnaire), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale). Linear regression analyses were used to determine the associations between diet quality, physical activity and postnatal depressive symptoms. There was a significant inverse association between total physical activity (B, -0.009; 95% CI, -0.016 to -0.001; P = .023) and postnatal depressive symptoms. No association was found between other domain-specific physical activity (i.e. leisure-time, domestic or transport-related physical activity), or diet quality and postnatal depressive symptoms. Acknowledging the cross-sectional nature of this study, these findings suggest that total physical activity may play a more important role than diet quality in the relationship with postnatal depressive symptoms.

Associations between access to alcohol outlets and alcohol intake and depressive symptoms in women from socioeconomically disadvantaged neighbourhoods in Australia.

BACKGROUND: This study examined associations between alcohol outlet access and alcohol intake, depressive symptoms score and risk of depression among women residing in disadvantaged neighbourhoods in Victoria, Australia. METHODS: Data on depressive symptoms, alcohol intake and socio-demographic characteristics were obtained from a sample of 995 adult women from Victoria, Australia who were surveyed as part of the Resilience in Eating and Activity Despite Inequality (READI) study. The location of all licensed alcohol outlets in Victoria was obtained from the Victorian Commission for Gambling and Liquor Regulation. Participant and alcohol outlet addresses were geocoded to calculate individual alcohol outlet access, defined as the number of outlets (all and by sub-type) within 0.4 km and 3 km of participants' homes. Separate regression models with clustered standard errors were fitted to examine associations between access and alcohol intake according to national recommended limits for short- and long-term harm, frequency of consumption above long-term harm guidelines, depressive symptoms score and risk of depression. RESULTS: Odds of consumption within short-term harm guidelines (≤4 drinks on any day) decreased with increasing access within 3 km, irrespective of outlet type. Typically, there was no evidence to support associations between access and consumption above long-term harm guidelines (>2 drinks on any day) unless considering frequency of consumption at this level where results showed decreased odds of 'don't drink' versus frequently drinking above long-term harm guidelines (i.e., >2 drinks at least once per week) with increasing access at either distance. Although there was no evidence of an association between any of the alcohol outlet access measures and depressive symptoms score, odds of being at risk of depression decreased with increasing access within 3 km. CONCLUSIONS: This study found some evidence to support an association between increasing alcohol outlet densities of all types and harmful levels of alcohol consumption, and the association appears to be dependent on the distance threshold considered, among women residing in socioeconomically disadvantaged neighbourhoods within Victoria, Australia. However, higher numbers of alcohol outlets appear to be associated with a slightly lower risk of depression, with further research needed to identify the direction and mechanisms underlying this unintuitive association.

A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors, Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults.

The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55-65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index.

Costs and advance directives at the end of life: a case of the 'Coaching Older Adults and Carers to have their preferences Heard (COACH)' trial.

BACKGROUND: Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs). METHODS: Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs. RESULTS: The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs. CONCLUSION: For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people. TRIAL REGISTRATION: This study was registered on 13/12/2007 with the Australian New Zealand Clinical Trial Registry ( ACTRN12607000638437 ).

Associations of diet quality with health-related quality of life in older Australian men and women.

This study investigated associations between diet quality measures and quality of life two years later. Adults 55-65 years participating in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 1150 men and n = 1307 women) completed a postal survey including a 111-item food frequency questionnaire in 2010. Diet quality in 2010 was assessed via the dietary guideline index (DGI), recommended food score (RFS) and Mediterranean diet score (MDS). The RAND 36-item survey assessed health-related quality of life in 2012. Associations were assessed using logistic regression adjusted for covariates. In men, DGI and RFS were associated with better reported energy (OR = 1.79, CI: 1.25, 2.55 and OR = 1.56, CI: 1.11, 2.19 respectively), and DGI was additionally associated with better general health (OR = 1.54, 95% CI: 1.08, 2.20), and overall mental component summary scale (OR = 1.51, CI: 1.07, 2.15) in the fully adjusted model. In women, associations between two indices of diet quality (DGI, RFS) physical function (OR = 1.66, CI: 1.19, 2.31 and OR = 1.70, CI: 1.21, 2.37 respectively) and general health (OR = 1.83, CI: 1.32, 2.54 and OR = 1.54, CI: 1.11, 2.14 respectively) were observed. DGI was also associated with overall physical component summary score (OR = 1.56, CI: 1.12, 2.17). Additional associations between emotional wellbeing and DGI (OR = 1.40, CI: 1.01, 1.93) and RFS (OR = 1.44, CI: 1.04, 1.99), and MDS and energy (OR = 1.53, CI: 1.11, 2.10) were observed in the fully adjusted model, in women only. Older adults with better quality diets report better health-related quality of life, with additional associations with emotional wellbeing observed in women.

How important is health status in defining quality of life for older people? An exploratory study of the views of older South Australians.

BACKGROUND: Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health. OBJECTIVE: To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians. METHODS: Older adults (n=21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People's Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT. RESULTS: Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman's Rho: 0.730; p<0.01), but not ASCOT. Approximately half (52.4%) of the participants ranked either 'health' or 'psychological and emotional well-being' as the domain most important to their quality of life. However, one-third (33.3%) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life. CONCLUSIONS: Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life.