Didi M. W. Kriegsman

Direct and buffer effects of social support and personal coping resources in individuals with arthritis

The direct and buffer effects of various aspects of social support and personal coping resources on depressive symptoms were examined. The study concerned a community-based sample of 1690 older persons aged 55-85 yrs, of whom 719 had no chronic disease, 612 had mild arthritis and 359 had severe arthritis. Persons with arthritis reported more depressive symptoms than persons with no chronic diseases. Irrespective of arthritis, the presence of a partner, having many close social relationships, feelings of mastery and a high self-esteem were found to have direct, favourable effects on psychological functioning. Mastery, having many diffuse social relationships, and receiving emotional support seem to mitigate the influence of arthritis on depressive symptoms, which is in conformity with the buffer hypothesis. Favourable effects of these variables on depressive symptomatology were only, or more strongly, found in persons suffering from severe arthritis.

Social Network, Social Support, and Loneliness in Older Persons with Different Chronic Diseases

Objectives:This study examines whether patterns of social network size, functional social support, and loneliness are different for older persons with different types of chronic diseases. Methods:In a community-based sample of 2,788 men and women age 55 to 85 years participating in the Longitudinal Aging Study Amsterdam, chronic diseases status, social network size, support exchanges, and loneliness were assessed. Results:Social network size and emotional support exchanges were not associated with disease status. The only differences between healthy and chronically ill people were found for receipt of instrumental support and loneliness. Disease characteristics played a differential role: greater feelings of loneliness were mainly found for persons with lung disease or arthritis, and receiving more instrumental support was mainly found for persons with arthritis or stroke. Discussion:The specifics of a disease appear to play a (small) role in the receipt of instrumental support and feelings of loneliness of chronically ill older persons.

Psychological status among elderly people with chronic diseases: Does type of disease play a part?

Psychological status, including depressive symptoms, anxiety, and mastery, was measured in a community-based sample of 3,076 persons aged 55 to 85 with various chronic diseases. Strong, linear associations were found between the number of chronic diseases and depressive symptoms and anxiety, indicating that psychological distress among elderly people is more apparent in the presence of (more) diseases. Furthermore, in contrast to general assumptions that mastery is a relatively stable state, our results indicate that mastery is affected by having chronic diseases. The 8 groups of chronically ill patients (with cardiac disease, peripheral atherosclerosis, stroke, diabetes, lung disease, osteoarthritis, rheumatoid arthritis, or cancer) did differ in their associations with psychological distress. Psychological distress is most frequently experienced by patients with osteoarthritis, rheumatoid arthritis, and stroke, whereas diabetic and cardiac patients appear to be the least psychologically distressed. Differences in disease characteristics, such as functional incapacitation and illness controllability, may partly explain these observed psychological differences across diseases.

The association of physical health and depressive symptoms in the older population: age and sex differences

Physical health and depression are closely related in the elderly. This has been found in both cross-sectional and longitudinal studies. In this study the relation between four aspects of physical health and depressive symptom levels were studied in a community-based sample of older inhabitants of a small town in the Netherlands (n=224). Results indicated that depression as measured with the CES-D is sufficiently different from physical health to be distinguished from it, and that it is sufficiently related to physical health to be relevant for further study. The more subjective measures of physical health used in this study (pain and subjective health) appeared to have a much stronger relation with depression than the more objective health measures (chronic diseases and functional limitations). Physical health and aspects of the social environment such as marital status appeared to have independent effects on mood. In this study these effects were moderated by age and sex. In women and the young-old (55–64) none of the associations between physical health and depression were significant. In men and the old-old (75+) all associations were highly significant.

Gender Differences in Health-Related Quality of Life Among Asthma Patients

Objective. To identify and explain differences between men and women with asthma regarding health-related quality of life (HRQoL). Methods. A cross-sectional study was performed among 967 asthma patients recruited from general practice. Data were collected by means of a pulmonary function assessment, a face-to-face interview, and a written questionnaire. Results. Women with asthma reported lower scores on HRQoL in the age groups 16–34 and 56–75 years but not in the age group 35–55 years. In all age groups, women reported more severe dyspnea but had higher levels of pulmonary function. The poorer HRQoL reported by women could be explained by a more severe dyspnea and a higher level of medication use in women. Conclusions. The finding that women with asthma aged 16–34 and 56–75 years report poorer HRQoL than men is not due to a more severe disease state in terms of pulmonary obstruction but does seem to be related to a more severe subjective disease state in women than in men.

Quality of care for patients with Type 2 diabetes mellitus—a long‐term comparison of two quality improvement programmes in the Netherlands

Aim  To compare two intervention programmes, aimed at improving the quality of care provided for patients with Type 2 diabetes in the longer term.

The influence of differing social ties on decline in physical functioning among older people with and without chronic diseases: The Longitudinal Aging Study Amsterdam

Background and aims: Global social support measures have been shown to be related to several health outcomes. However, little is known about the effects of differing social ties and their support on the risk for decline in physical functioning among older people, without as compared with those with chronic diseases. This study examines whether differing types of social ties and support differentially mitigate the negative effects of chronic diseases on decline in physical functioning. Methods: Using data from two cycles of the Longitudinal Aging Study Amsterdam (N=2357), logistic regression analyses adjusted for baseline functioning, age, gender, and incidence of chronic diseases were conducted, to assess the effect of differing social ties for subgroups with different numbers of chronic diseases. Information about the presence of differing social ties included partner status and numbers of daughters, sons, other family members, and non-kin relationships. Social support included instrumental and emotional support, and the experience of loneliness. Decline in physical functioning was determined by substantial change after three years on a 6-item self-report scale. Results: Although having a partner had a protective effect on decline in physical functioning in people without chronic diseases at baseline, this was not the case for those with chronic diseases. Total network size had an adverse effect in older people without chronic diseases, but a positive effect when chronic diseases were present, mainly due to a positive effect of the number of daughters and non-kin relationships. Conclusions: Our results provide evidence that differing types of social relationships and the support they provide, differentially influence decline in physical functioning in older people, with or without chronic diseases.

Somatic chronic diseases and 6-year change in cognitive functioning among older persons

The influence of seven highly prevalent somatic chronic diseases on changes in cognitive functioning is investigated in older persons in a prospective design covering a 6-year follow-up period. The data were collected as part of the Longitudinal Aging Study Amsterdam (LASA). The associations between chronic diseases and cognitive functioning during 6 years of follow-up were analyzed among 1358 respondents (age 62-85) using generalized estimated equations (GEE). Cognitive tests were used to assess: general cognitive functioning, fluid intelligence, information processing speed and memory performance. In the fully adjusted models diabetes mellitus, stroke and peripheral artherosclerosis were associated with cognitive decline during a 6-year follow-up period in older persons. In the unadjusted models cardiac disease was negatively associated with memory function. However, after the correction for possible confounders this association became positive. Cancer was also associated with better memory function. A faster decline in especially memory function was found for diabetes mellitus, stroke, cancer, and peripheral artherosclerosis. The study shows that in older persons specific chronic diseases (diabetes mellitus, stroke, cancer, and peripheral artherosclerosis) are associated with decline in one or more domains of cognitive functioning during a 6-year follow-up period. These findings further stress that careful clinical evaluation of cognitive functioning in older persons with these diseases is required in order to provide adequate care.

Voluntary active euthanasia and doctor-assisted suicide: knowledge and attitudes of Dutch medical students

The objective of the study was to gain insight into the knowledge of and attitudes towards voluntary active euthanasia and doctor‐assisted suicide (EEDAS) of Dutch medical students, and to determine whether knowledge and attitudes change after a 1–day informative conference about EDAS.

Determinants of albuminuria in people with Type 2 diabetes mellitus

This study sought to identify determinants of albuminuria in people with Type 2 diabetes. In 335 primary care patients, we assessed albumin-creatinine ratio (ACR) in two 24-h urine samples, and its cross-sectional associations with protein and alcohol intake, cigarette smoking, body weight and height, glycosuria, blood pressure, hypoglycaemic and antihypertensive treatment, gender, age, age at diagnosis, diabetes duration, family history of diabetes and cardiovascular diseases, ethnic origin, and education. The prevalence of micro- or macro-albuminuria (ACR> or =2.0 mg/mmol) was 33%. Among these patients, compared to those with normo-albuminuria, there were more men, protein intake (g/kg) estimated from urinary urea as well as systolic blood pressure and glycosuria were higher, there were more smokers, men were shorter, and a family history of diabetes was less prevalent (all P<0.05). In linear and logistic regression (n=270) albuminuria was independently associated (P<0.05 unless indicated otherwise) with systolic blood pressure (OR(10 mmHg)=1.32), smoking (OR(ex/never)=2.36, OR(current/never)=4.89), glycosuria (OR(> or =7/<1 g/l)=2.41), gender (OR(men/women)=2.50), age in men (OR(10 year)=1.60) (P<0.10) and, inversely, in women (OR(10 year)=0.63) (P>0.10). On aggregation, the modifiable determinants systolic blood pressure, smoking and glycosuria explained 12% of the variation in albuminuria. These factors thus are, although to a moderate extent only, potential determinants of albuminuria. We also observed an independent, inverse association with body height (OR(0.10 m)=0.47). This is in line with the hypothesis that development in utero or during early life influences kidney function in later life.