Evaluation of the quality of life of older people with diabetes.

INTRODUCTION AND OBJECTIVE: Diabetes is commonly classified as a chronic disease of affluence due to the frequency of its incidence and the rate of its spreading. The aim of the study was to evaluate the quality of life of geriatric patients with type 2 diabetes. MATERIAL AND METHODS: 294 seniors diagnosed with type 2 diabetes living in the Lower Silesian Province in south-western Poland took part in the study. The study used a self-developed questionnaire collecting clinical and socio-demographic data, the WHOQOL-Bref questionnaire, Acceptance of Illness Scale (AIS), Self-Care of Diabetes Inventory (SCODI) and the Geriatric Depression Scale (GDS). RESULTS: Significant relationships of QoL with BMI, level of education and place of residence, were observed. BMI was significantly negatively correlated with the psychological domain of functioning and the environmental functioning, the level of education was correlated with physical health, psychological and environmental functioning, while the place of residence was correlated with the perception of the QoL and environmental functioning. Acceptance of illness was positively correlated with the perception of QoL and one's physical health. The results of regression analyses in predicting QoL in all domains showed that all models were a good fit for the data (p < 0.001), and the single predictor was maintenance of self-care. The level of depression was negatively correlated to a statistically significant degree with the perception of QoL and one's health condition. CONCLUSIONS: BMI, level of education and place of residence had the highest impact on the quality of life of the participants. The quality of life of the participants improved with the increase in the acceptance of their illness. The higher the level of depression exhibited by the participants, the poorer they evaluated their quality of life.

Assessment of functional capacity of the elderly.

INTRODUCTION AND OBJECTIVE: Ageing is a continuous, progressive process of functional reserve loss. Physical fitness and mental state have a significant impact on the functionality level of the elderly population. Assessing the degree elderly people's of independence regarding self-care is an important aspect of the Comprehensive Geriatric Assessment (CGA). The aim of the study was to assess the functional capacity of people over 65 years of age. MATERIAL AND METHODS: The study involved 312 patients in hospital wards across Lower Silesia, south-west Poland. The criteria for participation were as follows: providing informed consent to participate in the study, intellectual capacity to be interviewed, and age over 65. The study applied the diagnostic survey method, together with the use of the VAS, Barthel, IADL and GDS scales. RESULTS: Among the respondents, 59.94% were in a moderately severe condition according to the Barthel scale, average IADL score - 20.56 points; according to the GDS scale, 58.97% had no symptoms of depression. Respondents suffered from multiple chronic diseases, the most common of which were hypertension (71.47%); they also reported some medical issues, mainly back pain (47.44). Assessment of the correlation of the Barthel and GDS scales, as well as the IADL and GDS, revealed a significant and negative correlation at -0.49 and -0.50. Assessment of the correlation between the number of diseases and the Barthel scale was -0.49, the number of symptoms and the Barthel scale -0.4; pain severity and the Barthel scale -0.41, number of diseases and IADL -0.58, and number of symptoms and IADL -0.52. CONCLUSIONS: The greater the seniors' independence regarding instrumental activities of daily living, the weaker the symptoms of depression. Multimorbidity and experiencing pain impaired independence among the elderly.

Impact of isolation on the biopsychosocial functioning of older people with COVID-19.

INTRODUCTION: COVID-19 is a highly contagious coronavirus disease that has had a significant impact on the functioning of society. On 11 March 2020, due to the rapid spread of the virus, the WHO declared a global pandemic. By the end of 2021, 5 variants of SARS-CoV-2 had been identified since the beginning of the pandemic. The course of the disease varied depending on the age of the patients and the presence of possible comorbidities. Most patients were asymptomatic or sparsely symptomatic of the infection; however, in about 6% of cases, the course of the disease was critical. Typical symptoms of COVID-19 include: fever, muscle pain and headache, lack of smell and taste, cough, dyspnea, diarrhoea and nausea. According to epidemic guidelines, infected patients were subjected to isolation, which harmed their mental state, especially the elderly. OBJECTIVE: The aim of the study was to assess the impact of isolation on the biopsychosocial functioning of elderly patients with COVID-19. MATERIAL AND METHODS: The study was conducted among 360 elderly patients in hospital wards operating as a unit in a hospital complex dedicated to patients infected with the SARS-CoV-2 virus. Data were collected using standardized questionnaires: ADL Scale, IADL, GDS, SF-36 Quality of Life Scale, Multidimensional Scale of Perceived Social Support, and supplementary questions about, among others, the oxygen therapy provided, length of stay in the unit, and the support received from relatives. RESULTS: Almost half (48%) of the subjects received oxygen therapy, and 36% had a length of disease of 7-14 days. A correlation was observed between the quality of life and the above-mentioned factors. Correlations of quality of life indicators with the length of illness were moderate (except for the level of pain) and positive, meaning that the longer the patients were ill, the lower their quality of life. Correlations of disease severity were moderate for pain, vitality, and emotional limitations, while vital for physical functioning and limitations and general and mental health. The intensity of oxygen therapy was moderately correlated with physical and emotional limitations and general health and strongly correlated with physical functioning, vitality and mental health. Correlations between functional status and mental status of elderly patients were also studied. Analysis of variance showed that the constructed model was an excellent fit to the data, F = 37.14; p < 0.001, explaining 42% of the variance in the dependent variable (R2= 0.42). As many as 80% of the respondents felt that isolation harmed their well-being. Examining the impact of quality of life on their well-being showed that most of the associations tested were statistically significant, and all were positive. Associations of moderate strength were shown for physical functioning, physical limitations and general health, while strong associations were shown for vitality, emotional limitations and mental health. Pain complaints were associated with changes in well-being at the level of statistical trend (p = 0.055). This means that the lower the patients' quality of life, especially in terms of vitality and mental health, the more significant the impact of isolation on their well-being. The study also investigated the effect of social support on mental state. The model proved to be an excellent fit to the data, F = 5.91, p = 0.002, and explained 23% of the variance in the dependent variable (Adjusted R² = 0.23). At the same time, support from friends turned out to be the only significant predictor (Beta = 0.53), and this means that the more support the subjects received from them, the lower the level of depression they manifested. CONCLUSIONS: 1) The better the functional state of a senior and the support received from relatives, the lower the severity of depression. 2) The lower the quality of a senior's life, especially in terms of mental state, the greater the negative impact on his/her well-being in isolation. 3) The low quality of life of a senior increased the likelihood of depression. 4) The quality of life of older Covid-19 patients was higher in those without chronic disease. 5) The quality-of-life level was lower in patients with a more severe course of COVID-19, and longer duration of disease and oxygen therapy.

Pain and symptoms of depression: international comparative study on selected factors affecting the quality of life of elderly people residing in institutions in Europe.

BACKGROUND: As the number of elderly people is on the rise in societies throughout the world, providing them with optimal care is becoming a major demand, especially in the context of rising interest in institutional care. Quality of life is multidimensional notion and its perception depends highly on pain and mood levels. The aim of this study was to perform a comparative analysis of pain and depression symptoms in elderly people living in nursing homes in France, Germany, and Poland. METHODS: The research carried out in years 2014-2016 involved female residents of nursing homes in France, Germany, and Poland: 190 women from each country, aged over 65 years and not previously diagnosed with advanced dementia, were included. Collection of medical, demographic, and anthropomorphic data from medical documentation was followed by interviews with each senior and her caregiver. A questionnaire of authors' own devising was used, along with the Beck Depression Inventory (BDI) and the scale of Behavioral Pain Assessment in the Elderly (DOLOPLUS). The results were subjected to statistical analysis, p < 0.05 was accepted as threshold of statistical significance. RESULTS: The main health complaints of nursing homes' residents were constipation, diarrhea, back pain and dizziness. 44,38% of the residents self-assessed their health status as bad and complained of suffering pain (83,33%) and sleeping problems (72,98%) within the last month. According to BDI the average score was 17.01 points and 44,38% of seniors were free from depression or depressed mood. The average DOLOPLUS result was 8.86 points. CONCLUSION: There are no significant differences, neither in prevalence of pain and symptoms of depression nor in average levels of quality of life, in elderly residents in institutions in the three studied European countries. The decrease in quality of life is mainly due to various complaints and pain and there is a close relationship between health status and quality of life. Further research should be performed in order to study interdependencies between the occurrence of pain and depression, including primary reasons leading to both phenomena. The recognition of factors that induce pain complaints and mood depression in elderly people will contribute to improving their comfort.

Health status, health behaviors, and the ability to perform everyday activities in Poles aged ≥65 years staying in their home environment.

BACKGROUND: The incidence of chronic diseases increases with age; about 73% of people who are aged ≥60 years suffer from at least 1 chronic disease, and among those older than 70 years, chronic diseases afflict more than >84% of the population. According to epidemiological data, at least 4 chronic disease types coexist in senior citizens, causing their disability. These are mainly cardiovascular diseases; motor system diseases; ophthalmological, auditory, neurological, and mental diseases; and mental impairment. They worsen or limit self-dependence in everyday activities. The process begins with complex activities and advances with age. At first, functional performance deficits are discreet; then, they may gradually lead to complete dependence on other people or institutions. OBJECTIVE: This study aimed to assess the relationship between diseases and health behaviors, as well as the everyday functioning of people aged ≥65 years staying in their home environment. METHODS: The research involved 504 elderly people. The inclusion criteria were age (≥65 years) and staying in one's own home environment. The direct interview technique was applied, as well as use of proprietary interview questionnaire and standardized tools used in geriatrics: Barthel scale, measuring performance in everyday activities, and the Instrumental Activities of Daily Living scale, assessing complex everyday activities. RESULTS: The most frequent disease among the responders was arterial hypertension (77.58%), followed by degenerative joint disease (62.10%), and circulatory failure (43.23%). Lower functional performance was associated with circulatory failure, cerebral stroke, atherosclerosis, Alzheimer's disease, diabetes, Parkinson's disease, degenerative joint disease, and bronchial asthma. Performance worsening significantly influenced the frequency of hospitalizations, with a mean score of 4.31 per person. Medical rehabilitation was practiced by 18.65% of the responders. CONCLUSION: Circulatory failure, cerebral stroke, atherosclerosis, bronchial asthma, diabetes, degenerative joint disease, Parkinson's disease, and Alzheimer's disease negatively affect functional performance in elderly people. Hospitalization rates increase with lowering independence in everyday functioning. Future research is needed with regard to the relationship between the practiced rehabilitation and independence in everyday functioning of the elderly.

Is independence of older adults safe considering the risk of falls?

BACKGROUND: Falls affect approx. 30% of elderly population per year. They cause major injuries and reduce independence of the older adults' functioning. The main objective of the study was to evaluate the degree of independence and find the fall risk factors in the study group. METHODS: The study included 506 - older adults. The study group included patients from GP clinics and members of two senior centers. The study duration was 12 months. Our study tools included EASY- Care Standard 2010 questionnaire, Abbreviated Mental Test Score (AMTS), Index Barthel, Instrumental Activities of Daily Living Scale (IADL), Geriatric Depression Scale (GDS), Timed Up and Go (TUG). RESULTS: The study included 357 (70.6%) female and 149 (29.4%) male subjects. The mean age of the study group patients was 75.7 years ± 8.0. Most of the older adult subjects were independent in both basic (Index Barthel) and instrumental (IADL) activities. Gait fluency evaluated in TUG scale found slow and unsteady gait in 33.7% of the subjects. 27.5% of the subjects used mobility aids when walking. In the Risk of falls scale, 131 subjects (25.89%) were at risk of falls. According to logistic regression the main risk of fall determinants (p <0.05) in the study group were: age, previous falls, feet problems, lack of regular care, impaired vision, urinary incontinence, pain, sleeping disorders, and lowered mood. CONCLUSIONS: Risk of falls increases in people less independent in terms of basic and complex life activities and in people with depression. Most of the risk factors can be modified. It is necessary to develop a standard procedure aimed at preventing falls in the elderly.

Analysis of spirometry results in hospitalized patients aged over 65 years.

INTRODUCTION AND OBJECTIVE: The growing population of the elderly, as well as the occurrence of coexisting diseases and polypharmacy, is the reason why diseases of patients aged $65 years belong to the major issues of the contemporary medicine. Among the most frequent diseases of the elderly, there are respiratory system diseases. They are difficult to diagnose because of the patient group specificity, which is the reason for increased mortality among seniors, caused by underdiagnosis. The study objective was to assess the factors influencing spirometry results in hospitalized patients aged ≥65 years with respiratory system disorders. MATERIAL AND METHODS: In the research, 217 (100%) patients aged ≥65 years who underwent spirometry at the Regional Medical Center of the Jelenia Góra Valley Hospital in Poland were analyzed. In the statistical analysis, the STATISTICA 9.1 program, the t-test, the Shapiro-Wilk test, the ANOVA test, and the Scheffé's test were applied. RESULTS: The majority of the patients (59.4%) were treated in the hospital. The most frequent diagnosis was malignant neoplasm (18%). The study showed a statistically significant dependence between the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC parameters and the time of hospitalization, as well as between the FVC and FEV1 parameters and the age of patients. The FVC parameter values turned out to be dependent on the main diagnosis. Highest results were noted in patients with the diagnosis of sleep apnea or benign neoplasm. A low FVC index can reflect restrictive ventilation defects, which was supported by the performed analyses. Highest FEV1/FVC values were observed in nonsmokers, which confirms the influence of nicotine addiction on the incidence of respiratory system diseases. CONCLUSION: The respondents' sex and the established diagnosis statistically significantly influenced the FVC index result, and the diet influenced the FEV1/FVC parameter result.

Socioeconomic Indicators Shaping Quality of Life and Illness Acceptance in Patients with Chronic Obstructive Pulmonary Disease.

Quality of life (QoL) combined with the acceptance of illness reflects the efficiency of therapy and the level of patients' satisfaction with medical care. Education, marital status, and place of residence were used as the socio-economic status indicators. The purpose of this study was to determine the relationship between the levels of QoL and acceptance of illness (AI) and the socio-demographic data in patients with chronic obstructive pulmonary disease (COPD). The study involved 264 adult COPD patients. The average duration of COPD was 9 years (Q1-Q3: 3.0-12.0). The duration of the disease was significantly shorter in patients from rural areas. QoL correlated positively with AI (r = 0.69, p < 0.0001). The general QoL and AI were most strongly influenced by education, gender, and age. Education is a strong predictor of QoL and AI, and the latter correlate with the socioeconomic status of COPD patients. It is recommended that COPD patients with a low level of education have regular medical check-ups and are included in the preventive programs by general practitioners to improve their somatic status and QoL level.