Search

Background: The demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness. Methods: Data from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness. Results: Physical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty. Conclusions: Cardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes. [ABSTRACT FROM AUTHOR]

Background: The Assessment of Quality of Life - 6D scale (AQoL-6D) is a self-report instrument designed to provide a sensitive multidimensional evaluation of health related quality of life. The current paper assesses the construct, concurrent and convergent validity of the AQoL-6D in a combined longitudinal population sample drawn from across urban, regional and remote areas of Australia. Methods: The AQoL-6D was administered within the Hunter Community Study and the Australian Rural Mental Health Study over time (mean years lag = 3.90, SD = 1.30). Observations with sufficient data were used to confirm the construct validity of the AQoL-6D domains and higher-order structure using confirmatory factor analyses (CFA, N = 7915). The stability of this structure across cohorts and over time was assessed using multi-group CFA. Additionally, the concurrent validity (against the SF-36) and convergent validity of AQoL-6D domains and factors were assessed. Results: The construct validity of the AQoL-6D domains was considered satisfactory. Two higher-order factors, representing the physical and psychological components of quality of life were identified (CFA model fit: RMSEA = .07, SRMR = .03; TLI = .96, CFI = .98). These factors displayed group and temporal invariance, as well as concurrent and convergent validity against a range of measures. Recommendations for the derivation of summary scores are provided, together with a provisional set of norms. Conclusions: The AQoL-6D is a useful tool for assessing quality of life impairment in epidemiological cohort studies, both cross-sectionally and over time. It displays appropriate levels of construct, concurrent and convergent validity. Conceptualisation of higher-order factors as representing the physical and psychological aspects of quality of life impairment may increase the sensitivity and appeal of the AQoL-6D, particularly for studies examining predictors of and changes in social and psychological outcomes. [ABSTRACT FROM AUTHOR]

Background: The Assessment of Quality of Life - 6D scale (AQoL-6D) is a self-report instrument designed to provide a sensitive multidimensional evaluation of health related quality of life. The current paper assesses the construct, concurrent and convergent validity of the AQoL-6D in a combined longitudinal population sample drawn from across urban, regional and remote areas of Australia.Methods: The AQoL-6D was administered within the Hunter Community Study and the Australian Rural Mental Health Study over time (mean years lag = 3.90, SD = 1.30). Observations with sufficient data were used to confirm the construct validity of the AQoL-6D domains and higher-order structure using confirmatory factor analyses (CFA, N = 7915). The stability of this structure across cohorts and over time was assessed using multi-group CFA. Additionally, the concurrent validity (against the SF-36) and convergent validity of AQoL-6D domains and factors were assessed.Results: The construct validity of the AQoL-6D domains was considered satisfactory. Two higher-order factors, representing the physical and psychological components of quality of life were identified (CFA model fit: RMSEA = .07, SRMR = .03; TLI = .96, CFI = .98). These factors displayed group and temporal invariance, as well as concurrent and convergent validity against a range of measures. Recommendations for the derivation of summary scores are provided, together with a provisional set of norms.Conclusions: The AQoL-6D is a useful tool for assessing quality of life impairment in epidemiological cohort studies, both cross-sectionally and over time. It displays appropriate levels of construct, concurrent and convergent validity. Conceptualisation of higher-order factors as representing the physical and psychological aspects of quality of life impairment may increase the sensitivity and appeal of the AQoL-6D, particularly for studies examining predictors of and changes in social and psychological outcomes. [ABSTRACT FROM AUTHOR]

Background: The demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness.Methods: Data from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness.Results: Physical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty.Conclusions: Cardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes. [ABSTRACT FROM AUTHOR]