Maria João Forjaz

Factors Associated With Loneliness of Noninstitutionalized and Institutionalized Older Adults

Objectives: First, to seek if sociodemographic and health factors contribute differentially to the explanation of loneliness in institutionalized and noninstitutionalized older adults; and second, to analyze the influence of institutionalization on loneliness. Method: This work was based on two surveys of older adults aged 60 years or more in Spain. A group of 234 community-dwelling people and 234 nursing homes residents were selected (n = 468). Logistic regression models were applied using the six-item De Jong Gierveld Loneliness Scale as dependent variable. Results: Depression was associated with loneliness in both populations. Sex and marital status contributed to explain loneliness among those living at home, whereas gathering with family, friends, and neighbors showed a significant effect in the institutionalized group. Institutionalization per se showed a strong effect on loneliness. Discussion: Findings have potential implications for targeting older adults at risk for loneliness.

Health-related quality of life and mental health in the medium-term aftermath of the Prestige oil spill in Galiza (Spain): a cross-sectional study

BackgroundIn 2002 the oil-tanker Prestige sank off the Galician coast. This study analyzes the effect of this accident on health-related quality of life (HRQoL) and mental health in the affected population.MethodsUsing random sampling stratified by age and sex, 2700 residents were selected from 7 coastal and 7 inland Galician towns. Two exposure criteria were considered: a) residential exposure, i.e., coast versus interior; and b) individual exposure-unaffected, slightly affected, or seriously affected-according to degree of personal affectation. SF-36, GHQ-28, HADS and GADS questionnaires were used to assess HRQoL and mental health. Association of exposure with suboptimal scores was summarized using adjusted odds ratios (OR) obtained from logistic regression.ResultsFor residential exposure, the SF-36 showed coastal residents as having a lower likelihood of registering suboptimal HRQoL values in physical functioning (OR:0.69; 95%CI:0.54–0.89) and bodily pain (OR:0.74; 95%CI:0.62–0.91), and a higher frequency of suboptimal scores in mental health (OR:1.28; 95%CI:1.02–1.58). None of the dimensions of the other questionnaires displayed statistically significant differences.For individual exposure, no substantial differences were observed, though the SF-36 physical functioning dimension rose (showed better scores) with level of exposure (91.51 unaffected, 93.86 slightly affected, 95.28 seriously affected, p < 0.001).ConclusionAlmost one and a half years after the accident, worse HRQoL and mental health levels were not in evidence among subjects exposed to the oil-spill. Nevertheless, some of the scales suggest the possibility of slight impact on the mental health of residents in the affected areas.

Psychometric attributes of the Hospital Anxiety and Depression Scale in Parkinson's disease

The Hospital Anxiety and Depression Scale (HADS) has been used in Parkinsons disease (PD) but information about its psychometric properties in this context is limited. The aim of this study is to assess the psychometric properties of the HADS in PD. In an observational, cross‐sectional analysis, HADS data quality, acceptability, scaling assumptions, internal consistency, construct validity, and precision were explored. From a sample of 387 PD patients, 22% and 14% scored ≥11 points (definite case) on the HADS anxiety and depression subscales, respectively. Cronbachs alpha was 0.81 and 0.83 for these subscales. Factor analysis revealed two factors (49.8% of the variance) representing anxiety and depression. The HADS closely correlated with health‐related quality of life (HRQL) measures and displayed satisfactory discriminative validity for patients grouped by severity level, disease duration, HRQL status, and treatment. The SEM was 1.84 for HADS‐Anxiety and 1.72 for HADS‐Depression. The HADS is an acceptable, consistent, valid, precise, and potentially responsive scale for use in PD.

Quality of life and burden in caregivers for patients with Parkinson's disease: concepts, assessment and related factors.

Caregivers of Parkinson’s disease patients face responsibilities stemming from providing assistance to a person, usually a family member, who suffers a progressively disabling disease characterized by both motor and nonmotor symptoms. These circumstances impact on the physical, emotional and psychosocial aspects of the caregivers’ lives and, therefore, on their quality of life (QoL). Studies have identified factors related to caregivers’ global QoL and health-related QoL, causing caregivers distress and affecting their QoL. These factors are related to patients’ and caregivers’ characteristics and may be classified as sociodemographic, psychological and disease related. Caregiver’s burden refers to the multiplicity of difficulties ensuing as a consequence of caring, including, for example, health problems, modification of habits, economic loss and QoL deterioration. Therefore, burden-related factors are also briefly reviewed. The implementation of effective interventions to preserve the caregiver’s wellbeing and allow the patients to remain at home and be properly assisted is a pragmatic consequence of this knowledge.

Metric attributes of the unified Parkinson's disease rating scale 3.0 battery: Part I, feasibility, scaling assumptions, reliability, and precision

This article sought to assess the feasibility, scaling assumptions, reliability, precision, and factor analysis of the three most widely used rating scales in Parkinsons disease (PD): modified Hoehn and Yahr (HY), Schwab and England (SE), and Unified Parkinsons Disease Rating Scale (UPDRS). A multicenter sample of 1,136 PD patients was assessed. The percentage of missing data was 8% for SE, HY, and UPDRS mentation, and almost negligible (<2%) for the other UPDRS subscales. A high floor effect was found for UPDRS mentation (23%) and complications scales (36%). Item content validity, measured by multitrait scaling analysis, was adequate for all UPDRS subscales (scaling successes > 90%). Internal consistency coefficients for the UPDRS scales ranged from 0.79 (mentation) to 0.92 (activities of daily living and motor). Factor structure of the UPDRS mentation, activities of daily living, and complications subscales was replicated. As a whole, the HY, SE, and UPDRS are acceptable, consistent, and potentially sensitive rating scales.

The clinical impression of severity index for Parkinson's disease: International validation study

This study sought to provide further information about the psychometric properties of the Clinical Impression of Severity Index for Parkinsons Disease (CISI‐PD), in a large, international, cross‐culturally diverse sample. Six hundred and fourteen patients with PD participated in the study. Apart from the CISI‐PD, assessments were based on Hoehn & Yahr (HY) staging, the Scales for Outcomes in PD‐Motor (SCOPA‐M), ‐Cognition (SCOPA‐COG) and ‐Psychosocial (SCOPA‐PS), the Cumulative Illness Rating Scale‐Geriatrics, and the Hospital Anxiety and Depression Scale. The total CISI‐PD score displayed no floor or ceiling effects. Internal consistency was 0.81, the test–retest intraclass correlation coefficient was 0.84, and item homogeneity was 0.52. Exploratory and confirmatory factor analysis (CFI = 0.99, RMSEA = 0.07) confirmed CISI‐PDs unifactorial structure. The CISI‐PD showed adequate convergent validity with SCOPA‐COG and SCOPA‐M (rS = 0.46–0.85, respectively) and discriminative validity for HY stages and disease duration (P < 0.0001). In a multiple regression model, main CISI‐PD predictors were SCOPA‐M, disease duration, and depression. The results obtained were not only comparable to but also extended those yielded by the preliminary validation study, thus showing that the CISI‐PD is a valid instrument to measure clinical impression of severity in PD. Its simplicity and easy application make it an attractive and useful tool for clinical practice and research.

Health related quality of life in colorectal cancer patients: state of the art.

BackgroundColorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females with a progressive increase in prevalence in industrialized countries. The loss of health due to the cancer and/or the consequence of the treatment may result in psychophysical, functional and social impairment; all of these affect health-related quality of life (QoL).DescriptionThe most frequently CRC-specific QoL questionnaires is the FACT-C. QoL is not only important for the well-being of cancer patient but it also influences survival and response to therapy. Many studies investigated various determinants involved in the assessment of QoL in CRC, suggesting that symptoms, surgical procedures and the number of comorbidity significantly affected QoL.ConclusionDespite that CRC patients have a relatively good QoL compared with the general population, a wide range of intervention could be undertaken to improve their QoL. The finding of this review may be useful for cancer clinicians in taking therapy and surveillance-related decisions. However, future research should be directed to large-scale prospective studies using well validated QoL instruments to facilitate comparison of results.

Rasch analysis of the hospital anxiety and depression scale in Parkinson's disease†‡

The hospital anxiety and depression scale (HADS) is commonly used to assess mood in Parkinsons disease (PD) patients. Very few studies analyze the scale from the standpoint of item response theory. This article sought to analyze how the HADS fits the Rasch model in PD. The HADS was administered to 387 PD patients. Three sets of Rasch analyses were performed for the HADS total score, and anxiety and depression subscales (HADS‐T, ‐A, and ‐D, respectively). Although the HADS‐T and HADS‐A displayed a good fit, with little threshold disordering and no differential item functioning, the HADS‐D failed to fit the model. The person separation index, a reliability measure, was 0.87 (HADS‐T) and 0.80 (HADS‐A). Both HADS‐T and HADS‐A showed unidimensionality. Our results supported the use of HADS‐T as a measure of psychological distress in PD patients. Moreover, the HADS‐A was also an adequate anxiety measure. Further research is required to address the use of HADS‐D in PD.

Independent validation of the scales for outcomes in Parkinson’s disease‐autonomic (SCOPA‐AUT)

Background and purpose:  Autonomic dysfunction is common in Parkinson’s disease (PD) and causes a great impact in health‐related quality of life (HRQL) and functional status of patients. This study is the first independent validation of the Scales for Outcomes in PD‐Autonomic (SCOPA‐AUT).

Residential satisfaction, sense of belonging and loneliness among older adults living in the community and in care facilities ☆

The aim of this study was to analyze the influence of residential satisfaction and sense of belonging on loneliness in old age in two different contexts: the community and the residential care facility. We used two surveys of 1106 non-institutionalized and 234 institutionalized older adults, aged 60 years or more in Spain. Results from structural equation modeling and path analysis suggest that residential satisfaction would positively affect sense of belonging and would be negatively associated with loneliness in both residential environments, thus playing a protective role against the experience of loneliness.