Patterns of health complaints among people 75+ in relation to quality of life and need of help
Introduction
Knowledge is needed of older people’s, especially the oldest old, health complaints as clusters of problems rather than in isolation. This is so since it is rare that an older person has one problem only; various problems may interact with each other. Such knowledge is also needed since it is well known that various health complaints play a more significant role in older people’s quality of life (QoL) than the disease per se (Hellstrom and Hallberg, 2001, Hellstrom et al., 2004). It is rather the effect of the disease, or in the case of elderly people, several diseases, than the diseases itself that causes the restrictions in daily life and in the long run perhaps the need of help from others to manage their daily living by themselves. Thus, the complexity of comorbidity and the consequences shown as health complaints are of great importance for providing effective and high-quality care, especially for the very old or oldest old.
Previous research has focused on various health complaints, mainly in isolation, and few have tried to identify the patterns of health complaints to better understand their complexity and coexistence (Stuck et al., 1999). Furthermore, few studies have included the oldest old and those living in special accommodation, which distorts knowledge in favour of the healthier part of the older population. Single health complaints studied and known to be common and in some cases found to be related to low QoL include pain (Sengstaken and King, 1993, Brattberg et al., 1996) hearing problems (Davis, 1990), mobility problems (Ahacic et al., 2000) or depression (Livingstone et al., 1990, Neville et al., 1995). However, the prevalence of several problems simultaneously was shown in a Swedish study of people (>75 years, n = 448), living in the community. The respondents suffered from a median of 10 health complaints out of 26. Musculoskeletal pain, impaired mobility, vision and hearing problems and dizziness were most common (Hellstrom and Hallberg, 2001). Also, an Italian study among people living at home (mean age 81.3 years, S.D. 4.4, n = 747) reported on average six health complaints (S.D. 3.3) out of 20. The most frequent were psychological symptoms, pain, nutrition and vision problems, memory loss and constipation (Visentin et al., 1998). The coexistence and patterns of these health complaints were, however, not investigated and nor did this sample include people living in nursing homes or comparable accommodation.
Most diseases in old age cannot be cured and the person has to live with the consequences of diseases and treatment. Thus the care has its focus on relieving or palliating the effects of diseases and thereby improving or helping the older person to maintain QoL. Quality of life has been defined as an individual’s own perception of the position in life in the context of cultural value systems and in relation to personal goals, expectations, standards and concerns. It is a broad-ranging concept incorporating a complex of a person’s physical health, psychological state, level of independence, social relationship and personal beliefs (WHO, 1994). Various health complaints have been shown to have negative impact on QoL (Grimby and Svanborg, 1997), for instance pain (Jakobsson and Hallberg, 2002), mobility limitations (Noro and Aro, 1996), difficulties in sleeping (Giron et al., 2002) and poor vision (Noro and Aro, 1996). Besides these, socio-economic factors, especially in women, may also have an impact on QoL (Burstrom et al., 2001). However, in the study by Hellstrom and Hallberg (2001) and that of Hellström et al. (2004) the number of health complaints played a significant role in explaining low general QoL as well as health-related QoL. Since a most important end point of care of older people is to maintain or improve their QoL, knowledge is required as to how various health complaints interfere in terms of low QoL.
The interaction between various clusters of health complaints and needing help from others to manage daily living may provide insights as to what to focus on in primary and secondary prevention as well as in rehabilitation of older people. It is well known that older people in need of help from others to manage daily living are at greater risk of low QoL (Hellstrom and Hallberg, 2001, Koltyn, 2001). Whether that is an effect of health complaints that go along with not being able to carry out personal or instrumental care or an effect of the loss of autonomy, or both is not well understood. Older people’s inability to manage daily living by themselves is probably a result of interaction between physical and mental health complaints. Studies have shown associations between decline in cognitive function and need of formal care (Rockwood et al., 1996). Furthermore, depression, comorbidity, limitation in the function of lower extremities, few social contacts, low physical activity, poor self-perceived health and vision impairment were found to be predictors of dependency in a systematic review of 78 articles (Stuck et al., 1999). It has also been found that the impact of various health complaints differs between those living without help and those receiving help to manage daily living, suggesting that the valuation of various aspects of life may differ (Hellström et al., 2004). Knowledge of the interaction between patterns of health complaints would be informative in rehabilitative actions as well as in care. The ultimate goal is to maintain or achieve independence and thus to preserve or improve their QoL. Such knowledge is especially needed about the oldest old since they will be an even larger part of the population in most countries and they have not previously been very much in focus, which means that the knowledge base is weak.
The aim of this study was to investigate the type, degree and patterns of health complaints, need of help and health-related QoL, across gender among persons aged 75–105 years.
A further aim was to identify how patterns of health complaints, gender, age and socio-economic factors relates to need of help with daily activities and QoL.
Section snippets
Sample
The sample consisted of 4277 persons (62% women and 38% men), stratified for age, who answered a postal questionnaire addressed to 8500 persons living in the south of Sweden, selected from the National Population Register and also including people living in special accommodation. The stratification was done with the aim of getting enough people needing help for activities of daily living (ADL) in the younger age group using the following intervals, 75–79, 80–84, 85–89 and 90 years and above,
Results
The mean age was 83.6 years (S.D. 5.7). Those who lived in bigger cities accounted for 42.8%, in villages or densely built-up areas 52.8%, in rural areas 5.2%. Women were more often widows (63.3% versus 24.9%, P < 0.0001), lived alone (73.9% versus 33.1%, P < 0.0001), in special accommodation (15.9% versus 6.6%, P < 0.0001) and were over-represented among the low-income work, i.e. housewife and blue-collar work (78.3% versus 55.4%, P < 0.0001) compared to men. Additionally women reported lower
Discussion
This study included a large sample of very old people with a mean age of 84 years. In general women had a more vulnerable situation than men; for instance they were older, more often lived alone as widows and in special accommodation, had had a low-income job, had low PCS and MCS, were dependent in PADL as well as in IADL and had more diseases and health complaints. Health complaints could be understood from a functional view as communication, mobility, elimination, psychosocial,
Conclusions
Elderly people reported several health complaints that coexisted in certain clusters that could be described in a functional perspective and could be used to reveal factors predicting for need of help with ADL and low QoL. From a clinical perspective, interventions against health complaints in coexisting patterns, i.e. dysfunctions, would be an alternative in elderly care in order to improve functions and thus QoL. Interventions need especially to focus on the complexity of mobility and
Acknowledgements
This study was performed with financial support from Vårdalstiftelsen grant no. 2000 026, Greta and Johan Kock’s Foundation, Region Skåne and Johanniterorden. Special thanks to my colleagues in the research group for help with data collection, support and advice, Magdalena Andersson RN, Gunilla Borglin RN, Anna Ekwall RN, Ylva Hellström RN, Ann-Christin Janlöv RN, Ulf Jakobsson RN, Bibbi Thomé RN. Thanks also to Per Nyberg for help and advice in statistical matters and to Alan Crozier, Ph.D.,
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