M. Dello Buono

LEIPAD, an Internationally Applicable Instrument to Assess Quality of Life in the Elderly

A questionnaire to assess quality of life in the elderly was developed under the auspices of the European office of the World Health Organization. Stages in construction of the instrument, which was designed for international application, particularly at the primary level, are described. The latest version of the questionnaire is composed of 49 self-assessment item, 31 of which can be grouped into 7 subscales: Physical Function, Self-Care, Depression and Anxiety, Cognitive Functioning, Sexual Functioning, and Life Satisfaction. The remaining 18 items serve as moderators for assessing the influence of social desirability factors and personality characteristics on the individual scores for the 7 core instrument subscales. The questionnaire has been administered to 586 individuals aged 65 years and over recruited in communities in Italy (Padua and Brescia), the Netherlands (Leiden), and Finland (Helsinki). The main psychometric characteristics of the instrument, together with its concurrent validity with the Rotterdam Questionnaire, are illustrated.

The role of psychopathology and suicidal intention in predicting suicide risk: a longitudinal study

Objective: In this study, we describe psychological symptoms, any relationship with suicidal intention in a sample of subjects recently attempting suicide and the predictive value of this association in later completed suicide. Methods: An assessment was made of 467 suicidological consultations carried out by the Suicidology Unit of the Department of Neurology and Psychiatry, University of Padua, on 421 patients admitted to hospital following attempted suicide in the 5-year period 1990–1994. Suicidal intention was appraised by the Intent Score Scale (ISS). Suicide mortality was assessed after a mean follow-up period of 3.5 years. Results: Psychiatric evaluation was completely negative in only 8% of cases. The most commonly identified symptom was depressed mood (79% of cases, 22% severe depression), followed by anxiety (43% of cases, 32% severe anxiety). From the study, it emerged that psychopathology seemed to influence suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms appeared to have a secondary role. Assessments of suicidal intent showed that intention heightened as the number of symptoms increased. The symptom ‘anxiety’ did not prove to have a significant bearing on assessment of the seriousness of suicidal intention, whereas severely depressed mood did. The total number of subsequent suicide victims was 5.5%. During consultation relating to the index parasuicide, these subjects did not manifest a discriminate psychopathological profile (the only distinguishing characteristic was anxiety, which was less frequently identified in suicide victims), but did present a more positive personal and family psychiatric history. Conclusions: In subjects who had recently attempted suicide, the psychopathological profile appeared to be related to suicidal intent, where this was characterized by severe depression. Anxiety and other symptoms seemed to have a secondary role. Nonetheless, both total scores and subscores should be taken into consideration when assessing suicidal intention through the ISS. The psychopathological profile and ISS score following attempted suicide do not appear to permit prediction, in the medium to long term, of subsequent completed suicide.

Sexual feelings and sexual life in an Italian sample of 335 elderly 65 to 106-year-olds

Summary This study analyses various aspects of sexual interest and activity in a sample of 335 elderly people, recruited at the consulting rooms of 21 general practitioners in the town of Padua (Italy) among elderly subjects taking part in an international, multicentric study on the quality of life, conducted in cooperation with the World Health Organization (Quality of life assessment, instrument to measure self-perceived functioning and well-being in the elderly. LEIPAD Project) and considers a complete age range, including subjects of both sexes, aged between 65 and 106 years, with a view to providing a global, reliable image of sexuality up to a very advanced age. Roughly one-third of the subjects in the sample reported being still interested in sex. Results of logistic analysis demonstrate the most important variables in maintenance of sexual activity; they are listed as follows: being male, married, younger and cognitively unimpaired, in addition to having a higher educational level, being self-sufficient and satisfied with the present life. Educational level, age and social functioning, on the other hand, lose importance in the case of sexual interest, which remains more present than activity, even in very advanced age. Analyzing males and females separately, moreover, the absence of arthrosis, and maintenance of good social-relational functions gain predictive importance for men, and absence of depression and anxiety for women, in relation to both sexual interest and activity.

Influence of cognitive status on the sexual life of 352 elderly Italians aged 65-105 years.

Background: Various factors are considered to influence sexual behavior in the elderly, but the role played by preservation of adequate cognitive functioning has not been adequately explored. Objective: The aim of this research, conducted on 352 older adults aged between 65 and 105 years, was to identify the specific role played by cognitive functioning in sexual activity and sexual interest in the elderly. Methods: The data were collected from elderly people attending the surgeries of 21 general practitioners in the city of Padua (Italy). Analysis of sexual functioning was based on two items, from the LEIPAD questionnaire: ‘Are you interested in sex?’ and ‘Do you have sexual relations?’. Subjects cognitive status was assessed objectively through the Mini Mental State Examination (MMSE) and subjectively by the LEIPAD subscale on cognitive functioning. Results: Subjects who were sexually active and interested in sex were more highly represented among the married elderly. The elderly who reported being active and interested in sex were significantly younger and had a significantly superior educational level and MMSE score. Mean scores for cognitive functioning and all quality-of-life indicators were in general significantly better for the active and interested. Univariate logistic regression analysis indicated that a higher MMSE score and cognitive functioning score influenced the maintenance of sexual interest. Conclusions: One third of the subjects reported being still sexually active and 40% being still interested in sex. This study seems to suggest that a significant role may be played by cognitive functioning in the maintenance of sexual interest in the elderly, especially older females in whom this dimension is evidently linked to far more diversified experiences than their male peers.

Assessment of quality of life in the oldest-olds living in nursing homes and at home

Summary The aim of the study was to assess any differences in perception of quality of life in oldest-old subjects living in nursing homes and at home. The elderly people staying in the Nursing Home for the Elderly of Padova or at home were interviewed, after a recruitment at recreational centers for the aged from the same town. Twenty-nine oldest-old people resident in nursing homes (mean age 95.0 ± 6.42 years) and 37 oldest-old people resident at home [mean age 95.8 ±7.4) were included in the study. The data were collected through administration of two questionnaires designed to assess quality of life in the elderly (PEQOL and LEIPAD). The two groups of subjects produced overlapping scores in all comparable scales in the two questionnaires on the quality of life, except for the LEIPAD self care scale, corresponding to PEQOLs ADL and IADL scales, for which there are statistically significant differences between institutionalized subjects and those living at home. On the LEIPAD self care scale, institutionalized subjects report greater impairment of self-sufficiency (p

Cognitive performance and quality of life in a sample of 220 nondemented elderly people

Summary The aim of the study was to analyze the influence of cognitive performance, assessed objectively through administration of the mini mental state examination (MMSE), on the subjective perception of quality of life, in a sample of nondemented elderly people, interviewed at the consulting rooms of general practitioners. A questionnaire on the quality of life directly designed for the elderly (LEIPAD) was administered to 220 subjects aged 65 years and over. In the sample, 100 men and 120 women were included. The women produced lower (worse) mean scores than their male counterparts for all the variables considered. Concerning marital status, the most unsatisfied groups in terms of sexual interest and life satisfaction appeared to be people living alone (bachelors/spinsters and the widowed). The mean MMSE score was 26.91 ± 2.15 (range 24–30) for the total sample, 26.82 ± 2.17 (range 24–30) for the females,and 27.03 ± 2.12 (range 24–30) for the males. Analysis of the covariance between the mean global score and subscale scores and age, educational level and MMSE scores, was conducted for the total sample, the subsamples of males and females and of subjects with and without a somatic pathology. High MMSE scores are linked to a lower tendency to refer anxious-depressive and cognitive disorder symptoms and a better perception of quality of life in general, suggesting that cognitively unimpaired elderly people have superior adaptive skills, especially the males. The presence of a clinically significant somatic pathology appears to bring about a change in the relationship between cognitive status and self-perception of quality of life. In this case, the very awareness of the somatic problem is what appears to most objectively influence the various subscales, thereby reducing the role of cognitive performance in favor of educational level.

Assessment of quality of life in the elderly assisted at home through a Tele-Check service.

This study evaluates the effects of a Tele-check/Tele-emergency service on the quality of life in the elderly. Through telephone interviews a questionnaire has been repeatedly administered to explore various psychological, somatic, and social aspects in a random sample of 574 subjects aged 65 years and over (mean = 76.8 years). The findings suggest that the elderly helped by the service (in its ‘control’ functioning) make less demands on health facilities (GPs visits, number of days in hospital) as compared to controls. Implications are presented and discussed.

LEIPAD Questionnaire: A cross-cultural instrument to assess the quality of life in the elderly

The Sickness Impact Profile (SIP) is an instrument designed to measure sickness-related behavioural dysfunction that contains 136 items divided in 12 categories. The SIP was cross-culturally translated into Spanish (ICE) and the items of the adapted version were re-scaled following the same procedures as the original. Results suggest crosscultural equivalence with the original SIP. As a part of the adaptation process, validity and reliability studies done with the original version are currently replicated for the adapted version being tested. In the present paper assessment of reliability of the I’CE is presented. Reliability of the PCE was assessed administering the questionnaire twice to 129 subjects (re-test), following the same methods and patient groups than for the original version: (1) administration of the second questionnaire 24 h after the initial administration; (2) four trained interviewers; (3) three different procedures of administration (self-administration, interviewer administration, and the combination of both); and (4) four subsamples of patients who differed in type and severity of dysfunction were included (outpatients with chronic problems, severely handicapped posttraumatic patients in rehabilitation and speech pathology patients. For the analysis, the following reliability measures were calculated: Cronbach’s alpha internal consistency coefficient, test-retest correlations, and the overall agreement per cent. Overall Cronbach’s alpha internal consistency coefficient for the PCE was 0.94; for categories it ranged between 0.32 and 0.87. Test-retest correlations were 0.96 for overall I’CE, and they ranged from 0.86 to 0.96 according to categories, and from 0.93 to 0.99 according to the interviewer, the administration procedure, and the type of patient. All correlations were significantly different from 0 (p<O.OOl). Agreement per cent was 0.71 for overall PCE, and varied from 0.61 to 0.81 according to categories, and from 0.65 to 0.77 according to the interviewer, the administration procedure, and the subsample of patient. Sixteen of 129 patients (12%) reported slight changes in overall health. Analyses excluding these individuals yielded higher levels of reliability. The results provide evidence of the reliability of the Spanish version of SIP (ICE) under a variety of administration conditions and patients. Reliability found for the PCE is at least as high as that described for the original. If valid, the Spanish version of the SIP will be a useful instrument for measuring dysfunction in Spain.