Mobility predicts change in older adults’ health-related quality of life: evidence from a Vancouver falls prevention prospective cohort study

Health and Quality of Life Outcomes

Teresa Liu-Ambrose²  Kelly A. Vertes¹  Caitlin Gomez¹  Chun Liang Hsu²  Linda C. Li⁴  John R. Best²  Stirling Bryan³  Jennifer C. Davis³ 

[1] Aging, Mobility, and Cognitive Neuroscience Lab, University of British Columbia, 2211 Wesbrook Mall, Vancouver V6T 2B5, BC, Canada;Center for Hip Health and Mobility, University of British Columbia & VCHRI, 828 West 10th Avenue, Vancouver V5Z 1E2, BC, Canada;Centre for Clinical Epidemiology and Evaluation, University of British Columbia and Vancouver Coastal Health Research Institute (VCHRI), 828 West 10th Avenue, Vancouver V6T 2B5, BC, Canada;Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond V6X 2C7, BC, Canada

关键词: Older adults;    Falls;    Quality of life;    Mobility;   

Others  :  1223863
DOI  :  10.1186/s12955-015-0299-0

 received in 2014-11-26, accepted in 2015-07-06,  发布年份 2015

【 摘 要 】

Background

Older adults with mobility impairments are prone to reduced health related quality of life (HRQoL) is highly associated with mobility impairments. The consequences of falls have detrimental impact on mobility. Hence, ascertaining factors explaining variation among individuals’ quality of life is critical for promoting healthy ageing, particularly among older fallers. Hence, the primary objective of our study was to identify key factors that explain variation in HRQoL among community dwelling older adults at risk of falls.

Methods

We conducted a longitudinal analysis of a 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 148 to 286 depending on the analysis). We constructed linear mixed models where assessment month (0, 6, 12) was entered as a within-subjects repeated measure, the intercept was specified as a random effect, and predictors and covariates were entered as between-subjects fixed effects. We also included the predictors by sex and predictor by sex by time interaction terms in order to investigate sex differences in the relations between the predictor variable and the outcome variable, the EQ-5D.

Results

Our primary analysis demonstrated a significant mobility (assessed using the Short Performance Physical Battery and the Timed Up and Go) by time interaction (p < 0.05) and mobility by time by sex interaction (p < 0.05). The sensitivity analyses demonstrated some heterogeneity of these findings using an imputed and a complete case analysis.

Conclusions

Mobility may be an important predictor of changes in HRQoL over time. As such, mobility is a critical factor to target for future intervention strategies aimed at maintaining or improving HRQoL in late life.

【 授权许可】

   
2015 Davis et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Bilotta C, Bowling A, Nicolini P, Case A, Pina G, Rossi SV et al.. Older People’s Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up. A prospective cohort study on older outpatients living in the community in Italy. Health Qual Life Outcomes. 2011; 9:72. BioMed Central Full Text
• [2]Masel MC, Graham JE, Reistetter TA, Markides KS, Ottenbacher KJ. Frailty and health related quality of life in older Mexican Americans. Health Qual Life Outcomes. 2009; 7:70. BioMed Central Full Text
• [3]Masel MC, Ostir GV, Ottenbacher KJ. Frailty, mortality, and health-related quality of life in older Mexican Americans. J Am Geriatr Soc. 2010; 58:2149-2153.
• [4]Puts MT, Shekary N, Widdershoven G, Heldens J, Lips P, Deeg DJ. What does quality of life mean to older frail and non-frail community-dwelling adults in the Netherlands? Qual Life Res. 2007; 16:263-277.
• [5]Zaninotto P, Falaschetti E, Sacker A. Age trajectories of quality of life among older adults: results from the English Longitudinal Study of Ageing. Qual Life Res. 2009; 18:1301-1309.
• [6]Stubbs B, Binnekade T, Eggermont L, Sepehry AA, Patchay S, Schofield P. Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Arch Phys Med Rehabil. 2014; 95:175-187.
• [7]Stubbs B, Schofield P, Patchay S. Mobility limitations and fall-related factors contribute to the reduced health-related quality of life in older adults with chronic musculoskeletal pain. Pain Pract. 2014.
• [8]Movsas B, Moughan J, Sarna L, Langer C, Werner-Wasik M, Nicolaou N et al.. Quality of life supersedes the classic prognosticators for long-term survival in locally advanced non-small-cell lung cancer: an analysis of RTOG 9801. J Clin Oncol. 2009; 27:5816-5822.
• [9]Pedersen SS, Martens EJ, Denollet J, Appels A. Poor health-related quality of life is a predictor of early, but not late, cardiac events after percutaneous coronary intervention. Psychosomatics. 2007; 48:331-337.
• [10]Tsai YC, Hung CC, Hwang SJ, Wang SL, Hsiao SM, Lin MY et al.. Quality of life predicts risks of end-stage renal disease and mortality in patients with chronic kidney disease. Nephrol Dial Transplant. 2010; 25:1621-1626.
• [11]Chang NT, Chi LY, Yang NP, Chou P. The impact of falls and fear of falling on health-related quality of life in Taiwanese elderly. J Community Health Nurs. 2010; 27:84-95.
• [12]Murray C, Lopez A. Global and regional descriptive epidemiology of disability: incidence, prevalence, health expectancies, and years lived with disability. In: The global burden of disease. Murray C, Lopez A, editors. The Harvard School of Public Health, Boston; 1996: p.201-246.
• [13]Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988; 319:1701-1707.
• [14]Pluijm S, Smit J, Tromp E, Stel V, Deeg D, Bouter L et al.. A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporosis International. 2006; 17:417-425.
• [15]Formiga F, Navarro M, Duaso E, Chivite D, Ruiz D, Perez-Castejon JM et al.. Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone. 2008; 43:941-944.
• [16]Rockwood K, Stolee P, McDowell I. Factors associated with institutionalization of older people in Canada: testing a multifactorial definition of frailty. Journal of the American Geriatrics Society. 1996; 44:578-582.
• [17]Dai B, Ware WB, Giuliani CA. A structural equation model relating physical function, pain, impaired mobility (IM), and falls in older adults. Arch Gerontol Geriatr. 2012; 55:645-652.
• [18]Fagerstrom C, Borglin G. Mobility, functional ability and health-related quality of life among people of 60 years or older. Aging Clin Exp Res. 2010; 22:387-394.
• [19]Davis JC, Marra CA, Najafzadeh M, Liu-Ambrose T. The independent contribution of executive functions to health related quality of life in older women. BMC Geriatr. 2010; 10:16. BioMed Central Full Text
• [20]Davis JC, Marra CA, Liu-Ambrose TY. Falls-related self-efficacy is independently associated with quality-adjusted life years in older women. Age Ageing. 2011; 40:340-346.
• [21]Heydarnejad S, Dehkordi AH. The effect of an exercise program on the health-quality of life in older adults. A randomized controlled trial. Dan Med Bull. 2010; 57:A4113.
• [22]Redondo-Sendino A, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health. 2006; 6:155. BioMed Central Full Text
• [23]Lord S, Sherrington C, Menz H. A physiological profile approach for falls prevention. In: Falls in older people Risk factors and strategies for prevention. Cambridge University Press, Cambridge; 2001: p.221-238.
• [24]Whitney JC, Lord SR, Close JC. Streamlining assessment and intervention in a falls clinic using the timed up and go test and physiological profile assessments. Age Ageing. 2005; 34:567-571.
• [25]Gibson MJ, Andres RO, Isaacs B, Radebaugh T, Worm-Petersen J. The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly. Danish Medical Bulletin. 1987; 34:1-24.
• [26]Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005; 58:595-602.
• [27]Yesavage JA. Geriatric depression scale. Psychopharmacol Bull. 1988; 24:709-711.
• [28]Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M et al.. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982; 17:37-49.
• [29]van Marwijk HW, Wallace P, de Bock GH, Hermans J, Kaptein AA, Mulder JD. Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract. 1995; 45:195-199.
• [30]Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332:556-561.
• [31]Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80:896-903.
• [32]Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995; 332:556-562.
• [33]Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003; 83(3):237-52.
• [34]Lord S, Clark R, Webster I. Physiological factors associated with falls in an elderly population. Journal of American Geriatrics Society. 1991; 39:1194-1200.
• [35]Lord S, Ward J, Williams P, Anstey K. Physiological factors associated with falls in older community-dwelling women. Journal of American Geriatrics Society. 1994; 42:1110-1117.
• [36]Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR. Determinants of disparities between perceived and physiological risk o falling among elderly people: cohort study. British Medical Journal. 2010; 341:c4165.
• [37]Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189-198.
• [38]Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I et al.. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53:695-699.
• [39]Marra CA, Esdaile JM, Guh D, Kopec JA, Brazier JE, Koehler BE et al.. A comparison of four indirect methods of assessing utility values in rheumatoid arthritis. Med Care. 2004; 42:1125-1131.
• [40]Dolan P. Modeling valuations for EuroQol health states. Med Care. 1997; 35:1095-1108.
• [41]Oostenbrink JB, Al MJ. The analysis of incomplete cost data due to dropout. Health Econ. 2005; 14:763-776.
• [42]Oostenbrink JB, Al MJ, Rutten-van Molken MP. Methods to analyse cost data of patients who withdraw in a clinical trial setting. Pharmacoeconomics. 2003; 21:1103-1112.
• [43]Briggs A, Clark T, Wolstenholme J, Clarke P. Missing… presumed at random: cost-analysis of incomplete data. Health Econ. 2003; 12:377-392.
• [44]Briggs AH, Gray AM. Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess. 1999; 3:1-134.
• [45]Satterthwaite FE. An approximate distribution of estimates of variance components. Biometrics Bulletin. 1946; 2:110-114.
• [46]Wolitzky-Taylor KB, Arch JJ, Rosenfield D, Craske MG. Moderators and non-specific predictors of treatment outcome for anxiety disorders: a comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology. 2012; 80(5):786.
• [47]Fredriksen-Goldsen KI, Kim HJ, Shiu C, Goldsen J, Emlet CA. Successful aging among LGBT older adults: physical and mental health-related quality of life by age group. Gerontologist. 2015; 55(1):154-68.
• [48]Davis JC, Bryan S, McLeod R, Rogers J, Khan K, Liu-Ambrose T. Exploration of the association between quality of life, assessed by the EQ-5D and ICECAP-O, and falls risk, cognitive function and daily function, in older adults with mobility impairments. BMC Geriatr. 2012; 12:65. BioMed Central Full Text
• [49]Oh B, Cho B, Choi HC, Son KY, Park SM, Chun S et al.. The influence of lower-extremity function in elderly individuals’ quality of life (QOL): an analysis of the correlation between SPPB and EQ-5D. Arch Gerontol Geriatr. 2014; 58:278-282.