Anne-Sofie Helvik

A psychometric evaluation of the Hospital Anxiety and Depression Scale for the medically hospitalized elderly

Background: Few psychometric studies of the Hospital Anxiety and Depression Scale (HADS) scale have been performed with clinical samples of elderly individuals. Methods: The participants were 484 elderly (65–101 years, 241 men) patients in an acute medical unit. The HADS, the Montgomery–Aasberg Depression Rating Scale (MADRS) and questionnaires assessing quality of life, functional impairment, and cognitive function were used. The psychometric evaluation of the HADS included the following analyses: 1) the internal construct validity by means of principal component analysis followed by an oblique rotation and corrected item–total correlation; 2) the internal consistency reliability by means of the alpha coefficient (Cronbachs) and 3) concurrent validity by means of Spearmans rho. Results: We found a two-factor solution explaining 45% of the variance. Six of seven items loaded adequately (≥0.40) on the HADS-A subscale (item 7 did not) and five of seven items loaded adequately on the HADS-D subscale (items 8 and 10 did not). Cronbachs alpha for the HADS-A and HADS-D subscale was 0.78 and 0.71, respectively. The correlation between HADS-D and the MADRS, a measure of the concurrent validity, was 0.51. Conclusion: The HADS appears to differentiate well between depression and anxiety. The internal consistency of the HADS in a sample of elderly persons was as satisfactory as it is in samples with younger persons. In contrast to younger samples, item 8 (“I feel as if I have slowed down”) did not load adequately on the HADS-D subscale. This may be attributed to the way elderly people experience and describe their symptoms.

Psychological well-being of adults with acquired hearing impairment

Aim. To study psychological well-being (health-related quality of life) in a population of adults 20 years and over with hearing impairment (HI) and its relation to audiological factors, consequences of the HI, sense of humour, and use of communication strategies. Subjects and methods. Consecutive adults (n = 343) at the outpatient Unit of Audiology of a Norwegian university hospital answered the Psychological General Well-being inventory (PGWB), Hearing Disability and Handicap Scale (HDHS), Sense of Humour Questionnaire-6 (SHQ-6), and Communication Strategies Scale (CSS) in relation to an audiological examination and medical consultation. Results. Mean PGWB index for the whole sample was 81.4 (SD 14.3) and females reported a significantly lower psychological well-being. In multiple linear regression analyses well-being was negatively associated with high levels of activity limitation and participation restriction. PGWB index was positively associated with high sense of humour, but was neither explained by audiological factors nor use of communication strategies. Conclusions. Psychological well-being was associated with the outcome of a standard HI assessment of activity limitation and participation restriction, but not with degree of HI and use of communication strategies.

Coping and Depression in Old Age: A Literature Review

Background/Aims: The interest in the relation between coping and depression in older persons is growing, but research on the concepts and instruments of coping in relation to depression among older persons is scarce and systematic reviews are lacking. With this background, we wanted to gain a systematic overview of this field by performing a systematic literature search. Methods: A computer-aided search in MEDLINE, CINAHL, PsycINFO, Embase, PubMed and www.salutogenesis.fi was conducted. We systematically searched for studies including coping and depression among persons 60 years of age and above. The included studies were evaluated according to predefined quality criteria. Results: Seventy-five studies, 38 clinical and 37 community settings, were included. Of these, 44 were evaluated to be of higher quality. Studies recruiting samples of older persons with a major depressive disorder, moderate or severe cognitive impairment or those who were dependent on care were scarce, thus the research is not representative of such samples. We found a huge variety of instruments assessing resources and strategies of coping (55 inventories). Although we found the relation between resources and strategies of coping and depression to be strong in the majority of studies, i.e. a higher sense of control and internal locus of control, more active strategies and positive religious coping were significantly associated with fewer symptoms of depression both in longitudinal and cross-sectional studies in clinical and community settings. Conclusion: Resources and strategies of coping are significantly associated with depressive symptoms in late life, but more research to systematize the field of coping and to validate the instruments of resources and strategies of coping in older populations is required, especially among older persons suffering from major depression and cognitive decline.

Activity limitation and participation restriction in adults seeking hearing aid fitting and rehabilitation

Purposes: We first aimed to describe demographic and audiological characteristics of adults referred to a university hospital for hearing aid (HA) fitting and rehabilitation. Our second aim was to employ an inventory that assesses life consequences of hearing impairment (HI) in terms of perceived activity limitation and participation restriction for the first time in a Norwegian adult outpatient population. A third aim was to study life consequences by audiological and demographic characteristics. Subjects and methods: During one year consecutive patients (n = 343) were requested to answer the Hearing Disability and Handicap Scale (HDHS) assessing activity limitation and participation restriction in relation to an audiological examination and medical consultation. The mean threshold of hearing (MTH) was ascertained by pure tone thresholds at 0.5 – 1 – 2 – 4 kHz in the better ear. Results: Activity limitation and participation restriction were both higher for HA experienced than HA naïve subjects ( p < 0.01). In a multivariable model, the explained adjusted variance of activity limitation (R2) was 43.4% with MTH, perceived duration, and severity of hearing problems as predictor variables. Correspondingly, the explained adjusted variance of participation restriction was 28.4% for a model with MTH, age, gender and perceived severity of hearing problems as predictors. Conclusions: As a standard supplement to audiometric tests, HDHS may be successfully applied as a clinical tool among similar hearing impaired outpatients in order to assess activity limitation and participation restriction as part of audiological rehabilitation.

Why do some individuals with objectively verified hearing loss reject hearing aids

We investigated, in new hearing aid candidates, whether or not the use of coping strategies and the life situation, in terms of activity limitation, participation restriction and psychological well-being, were associated with the outcome of audiological counselling, i.e. the patients’ acceptance or rejection of a hearing aid (HA). The study included 173 consecutive adult patients (104 men and 69 women) with a need for audiological rehabilitation including HA-fitting. Use of communication strategies (Communication Strategies Scale, CSS), experience of activity limitation and participation restriction (Hearing Disability and Handicap Scale, HDHS), and general psychological well-being (Psychological General Well-being scale, PGWB) were assessed by self-report inventories. The hospital records, reviewed 1.5 years after the first consultation, showed that 39 patients (25 men and 14 women, 23%) had not accepted a hearing aid. In crude and adjusted logistic regression analyses a low report (high scores) of maladaptive behaviour in communication was associated with a three-times higher odds for rejecting a hearing aid, while a highly perceived activity limitation and participation restriction were related to lower odds for rejection. Patients who felt they had few problems with their hearing or overlooked or repressed their shortcomings, rejected HAs more often.

Screening for depression in elderly medical inpatients from rural area of Norway: prevalence and associated factors.

The present investigation screened for depression in order to assess the prevalence of depression and to study the associated factors with depression in elderly medically hospitalised patients from a rural area in Norway.

The quality of life and factors associated with it in the medically hospitalised elderly.

Aim: The present study describes the quality of life (QOL) and explores health-related factors associated with domains of the QOL in the acutely ill and hospitalised elderly. Method: In all, 484 elderly (65–101 years, 241 men) patients hospitalised in an acute medical unit participated. Their QOL (in its overall and physical, psychological, social and environmental domains) was assessed with the World Health Organisations WHOQOL-BREF. The QOL was explored with multiple linear regression analysis. Health-related variables controlled for socio-demographic background were the independent variables. Results: The overall QOL was good in two-thirds of the elderly patients. In multiple linear regression models, lower physical QOL was significantly associated with a number of medications, impaired personal activities of daily living (PADL), impaired cognition, depression and anxiety. Lower psychological QOL was significantly associated with impaired PADL, impaired cognition, depression and anxiety. Lower social QOL was significantly associated with depression and anxiety. Lower environmental QOL was significantly associated with female gender, impaired PADL, depression and anxiety. Conclusion: Our results indicate that improvement in the medical state, functional status and/or emotional condition of elderly medically hospitalised patients may improve their QOL.

Hearing loss and risk of early retirement. The HUNT study

Background: We explore the possible consequences of measured hearing impairment (HI) and perceived hearing difficulties for early retirement in a large population-based study. Furthermore, we study whether having a part-time position was associated with measured HI and perceived hearing difficulties in the same population. Methods: This study included 25 740 persons from the Nord-Trøndelag Health Study (HUNT) aged 20–54 years at baseline in HUNT1 (1984–1986) who also participated in the follow up, HUNT2, including a hearing examination 11 years later. Logistic regression analysis was conducted for men and women separately and in two age strata. Effects of low-, middle- and high-frequency hearing levels were explored, adjusting for each other. Further adjustment was made for socio-economic class and general health in HUNT1. Results: The risk of early retirement increased with degree of loss of low-frequency hearing in young and middle-aged men and middle-aged women. The middle-aged men and women experiencing hearing disability had an increased risk of early retirement. Degree of hearing level was not associated with part-time work, but in middle-aged men, awareness of having a hearing loss was associated with part-time employment. Conclusions: Degree of low-frequency hearing loss was associated with early retirement but not with part-time work. Perceived hearing disability increased the risk of early retirement in middle-aged men and women and also the risk of part-time work in middle-aged men.

A comparison of life satisfaction in elderly medical inpatients and the elderly in a population-based study: Nord-Trøndelag Health Study 3

Aim: To compare the quality of life (QOL) in terms of overall life satisfaction in elderly medical inpatients and elderly persons in a large population-based study in Norway, and to study the odds for dissatisfaction, controlling for demographic, health, and social variables. Methods: This cross-sectional observation study included 484 medical inpatients and 10,474 persons from the Nord-Trøndelag Health Study 3 (HUNT 3 Study). All participants were 65 years and older. Their life satisfaction was assessed with a single-item measure with seven response categories. For analytical purposes the variable was dichotomised; i.e. dissatisfied vs. satisfied with life. Results: In the logistic regression analysis controlled for demographic, health, and social variables, the odds for experiencing dissatisfaction with life was significantly increased in the hospital sample compared to the participants in the population-based study (OR 1.4). Poor general health, depression, and anxiety were strongly associated with being dissatisfied with life. Furthermore, disability, previous psychological distress, having no friends who could help, and not participating in activities were all associated with dissatisfaction with life. Conclusions: The hospitalisation of the elderly has implications for the QOL in terms of life satisfaction, but general physical and psychological health seems to have an even stronger impact on life satisfaction. The prevention of the deterioration of physical and mental health in old age seems to be essential for a good life.

Socioeconomic Inequalities in Hearing Loss in a Healthy Population Sample: The HUNT Study

We assessed socioeconomic position and hearing loss in a Norwegian population of 17 593 men and women aged 30-54 years in 1984-1986 who were followed for 11 years. We used analysis of variance, logistic regression, and population-attributable fraction analyses to examine associations. Significant socioeconomic inequalities in hearing loss were found among men. Adjusted odds ratios for hearing loss were approximately 1.3 to 1.9 for semi- and unskilled manual workers compared with participants with high occupational class.