G.I.J.M. (Ruud) Kempen

The Relative Contribution of Domains of Quality of Life to Overall Quality of Life for Different Chronic Diseases

This study examined the contribution of the quality of life (QoL) domains physical, social and psychological functioning to the explanation of overall QoL. Various disorders may differentially affect QoL domains due to disease-specific factors and, consequently, the relationship between QoL domains and overall QoL may vary between diseases. We therefore studied this relationship for several diseases as well as the differential impact of these diseases on QoL. The present study had a cross-sectional design. We selected patients (aged 57 years and older) with one of the following eight chronic medical conditions: lung disorder, heart condition, hypertension, diabetes mellitus, back problems, rheumatoid arthritis, migraine, or dermatological disorders. The total group of respondents included 1457 patients and 1851 healthy subjects. Regression analyses showed that the domain of psychological functioning contributed to overall QoL for all disorders, whereas physical and social functioning contributed to overall QoL for some disorders. Differences were found between most patient groups and healthy subjects with respect to physical functioning; with respect to social and psychological functioning some groups differed from the healthy group. Explanations for the findings and implications for clinical practice are discussed.

Physical fitness related to age and physical activity in older persons

OBJECTIVE This study investigated physical fitness as a function of age and leisure time physical activity (LTPA) in a community-based sample of 624 persons aged 57 yr and older. METHODS LTPA during the last 12 months was assessed through personal interviews. A wide range of physical fitness components was measured using performance-based tests. RESULTS Physical fitness was associated with the interaction age by LTPA in only a few components, in a gender-specific way, with generally larger differences in fitness between active and less active persons with increasing age. All LTPA, including low intensity LTPA, is positively and age-independent associated with most physical fitness components. CONCLUSION The importance of LTPA typically participated in by the general population lies not so much in the delaying of the motor aging process but rather in a general, age-independent, positive effect.

Epidemiology of heart failure in a community-based study of subjects aged ≥57 years: Incidence and long-term survival

Survival data from hospital‐based or clinical trial studies of patients with chronic heart failure (CHF) do not represent survival in community‐based settings.

Gender-specific changes in quality of life following cardiovascular disease

Gender-specific changes in Quality of Life (QoL) following cardiovascular disease (CVD) were studied in 208 patients to determine whether gender-related differences in postmorbid QoL result from differences in disease severity, premorbid QoL, or different CVD-related recovery. Premorbid data were available from a community-based survey. Follow-ups were done at 6 weeks, 6 months, and 12 months after diagnosis. Results showed that females had worse QoL at all three postmorbid assessments compared to males. However, multivariate analyses adjusting for premorbid gender differences and disease severity showed no significant gender-related differences for physical and psychologic functioning. Therefore, gender differences in QoL following CVD mainly result from premorbid differences in QoL, age, comorbidity, and disease severity at the time of diagnosis, and do not appear to be the consequence of gender-specific recovery. However, in clinical practice it is important to acknowledge the poorer QoL of females following CVD.

Functional decline after congestive heart failure and acute myocardial infarction and the impact of psychological attributes. A prospective study

This article examines the influence of three pre-morbidly assessed psychological attributes (i.e. neuroticism, mastery and self-efficacy expectancies) on functional decline after congestive heart failure (CHF; n = 134) and acute myocardial infarction (AMI; n = 79) in late middle-aged and older persons. Due to the prospective design of the study initial baseline levels of functional disability and number of chronic medical conditions could be adjusted, next to age, gender and the severity of either CHF or AMI. Functional disability was re-assessed 8 weeks after the diagnosis of either CHF or AMI. Significant unique contributions of self-efficacy expectancies were found for functional decline after CHF, while mastery significantly contributes to functional decline after AMI: those patients with higher levels of mastery or self-efficacy expectancies showed less decline. In conclusion, pre-morbidly assessed psychological attributes substantially influence functional decline after cardiac disease in late middle-aged and older persons, but the impact of specific attributes is somewhat different for CHF and AMI.

Perceived control and long-term changes in disability in late middle-aged and older persons: an eight-year follow-up study.

This article examined the predictive role of perceived control in long-term changes in disability among 1541 independently living older persons. Disability referred to self-reported difficulties with (instrumental) activities of daily living. Perceived control referred to the extent to which one assumes oneself as having control over ones life chances, unlike the fatalistic assumption that ones life is ruled by external factors. Data on disability and perceived control were collected in 1993 and recollected in 2001. Covariates included age, gender, living arrangement, level of education, and the number of chronic medical conditions. Regression equations were estimated with disability in 2001 as outcome and the selected variables as predictors. The level of perceived control decreased and the level of disability increased significantly over an 8-year period. The predictive role of perceived control for subsequent change in disability was statistically significant but not very strong. The association between perceived control in 1993 and disability in 2001 was stronger for older persons (>65 years) compared to younger persons (≤65 years).

Gender differences in recovery from injuries to the extremities in older persons: A prospective study

Purpose : This paper examines gender differences in trajectories of basic activities of daily living after fall-related injuries to the extremities in independently living older people in the Netherlands. Method : The study comprised a prospective design. Data were collected from 31 men and 140 women at baseline, when they had not yet sustained injuries (hip fractures, other fractures or contortions and dislocations), and 8 weeks, 5 months and 12 months after their accident. Analysis of variance was used to test for differences in change in basic activities of daily living between baseline and follow-ups for men, for women and for the total study sample while adjusting for several covariates Results : The patients did not generally regain their pre-injury levels of functioning 12 months after their event. However, in contrast to the women, older men more closely reached their pre-injury levels of functioning. Although women deteriorated more than men, differences were not statistically significant at 8 weeks and 5 months post-injury. Long-term recovery, however, was significantly associated with gender when the impact of severity seemed to have expired. Conclusions : Recovery of basic activities of daily living one year after injuries to the extremities seems to be influenced by gender. Female patients recovered less well compared to males. These gender-related changes warrant concern and attention in clinical practice.

Effects and feasibility of a standardised orientation and mobility training in using an identification cane for older adults with low vision: design of a randomised controlled trial

BackgroundOrientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the clients needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision.Methods/designA parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out.DiscussionThe screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers.Trial registrationClinicalTrials.gov NCT00946062

Measuring rebelliousness and predicting health behaviour and outcomes: an investigation of the construct validity of the Social Reactivity Scale.

The Social Reactivity Scale is a questionnaire measure of individual differences in rebelliousness. The associations between rebelliousness, health behaviours and health outcomes were examined in two Dutch samples by means of cross-sectional survey data. We found moderate support for the reliability and construct validity of the scale. Findings were suggestive of rebelliousness, first, being associated with low control beliefs, second, being related to hostility and, third, also heightening the risk of engaging in unhealthy behaviours and that of poor health (perhaps through deliberately rejecting health education messages). Findings thus contribute to the ongoing emergence of an empirically viable theoretical construct.

Disablement process and the utilization of home care among non-institutionalized elderly people: contrasting results between cross-sectional and panel data

Purpose : In this article we studied the role of disablement process variables in home care utilization in a cross-sectional and in a panel approach among low-functioning community dwelling elderly people. Methods : We analysed data from a prospective follow-up study in The Netherlands ( n v = v 555) and used three outcome variables: professional home care (yes or no) measured in the same year as the process variables (cross-sectional approach), professional home care (yes or no) also after 2 years (panel-approach: no change) and the new users of professional home care 2 years later (panel-approach: change). Process variables were categorized as pathology, functional limitations, disability, risk factors and psychosocial attributes. Results : Trajectories of home care utilization can be divided into an unchanging part and a changing part. Both parts are not predicted by the same process variables. For instance disability did not predict the new users of professional home care 2 years later, but correlated strongly with the stable users. The changing part was predicted by the beginning of the process of disablement (i.c. pathology). In addition, far most predictors could be considered as additive in stead of interactive. Conclusions : It is important to take into consideration the design of the investigation in studying the disablement process: cross-sectional data and panel data provide different results.