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Abstract Background The current international interest in well-being indicators among governmental agencies means that many quality of life scales are potential components of such national indicator sets. Measuring well-being in minority groups is complex and challenging. Scales are available that have been validated in specific parts of the population, such as older people. However, validation among combinations of minority groups, such as older adults of ethnic minority backgrounds, is lacking. Findings We pooled data from two surveys of older adults in Great Britain: one conducted among White British people, and one among four ethnic minority groups. Quality of life was measured by the Older People's Quality of Life (OPQOL); Control, Autonomy, Self-realisation, Pleasure (CASP-19); and World Health Organization Quality of Life scale for older people (WHOQOL-OLD). We found differences, some significant, between groups in terms of self-reported importance of various aspects of quality of life. A regression model of each total quality of life scale revealed greater unexplained variability in the White British group than the others. Principal components analysis within each ethnic group's data showed considerable differences in the correlation structures. Conclusions There are differences between ethnic groups that are consistent across the three scales and are not explained by a battery of predictor variables. If scales such as these are used to compare quality of life between ethnic groups, or equivalently between geographical regions, the different results in each group are liable to bias any comparison which could lead to inequitable policy decisions.

This paper recounts the process of undertaking a randomised controlled trial which was designed to examine the effectiveness of an intervention for socially isolated older people aged 75 years and over. It describes the reasons for early cessation of the study and raises the implications of this outcome for policy, practice and research. The intervention under investigation was designed to alleviate loneliness and foster companionship. It involves participants being linked with a small group of others through a teleconferencing system with each group being facilitated by trained volunteers. There was a requirement to recruit and train a minimum of 30 and a maximum of 60 volunteers over 1 year to facilitate 20 friendship groups to meet the number of older people required to be recruited to the study. Problems with recruiting and retaining the volunteer workforce by the voluntary sector organisation, who were commissioned to do so, led to the study closing even though older people were recruited in sufficient numbers. The paper draws upon analysis of various data sources from the study to identify the potential reasons. The discussion raises considerations regarding the extent of infrastructure required to deliver community services to vulnerable user groups at scale, identifies some of the issues that need to be addressed if such volunteer-initiated services are to be successful and informs future research programmes in this area. [ABSTRACT FROM AUTHOR]

Purpose: To investigate associations between baseline frailty status and subsequent changes in QOL over time among community-dwelling older people. Methods: Among 363 community-dwelling older people ≥65 years, frailty was measured using Frailty Index (FI) constructed from 40 deficits at baseline. QOL was measured using Older People's Quality of Life Questionnaire (OPQOL) six times over 2.5 years. Two-level hierarchical linear models were employed to predict QOL changes over time according to baseline frailty. Results: At baseline, mean age was 73.1 (range 65-90) and 62.0 % were women. Mean FI was 0.17 (range 0.00-0.66), and mean OPQOL was 130.80 (range 93-163). The hierarchical linear model adjusted for age, gender, ethnicity, education, and enrollment site predicted that those with higher FI at baseline have lower QOL than those with lower FI (regression coefficient = -47.64, p < 0.0001) and that QOL changes linearly over time with slopes ranging from 0.80 (FI = 0.00) to -1.15 (FI = 0.66) as the FI increases. A FI of 0.27 is the cutoff point at which improvements in QOL over time change to declines in QOL. Conclusions: Frailty was associated with lower QOL among British community-dwelling older people. While less frail participants had higher QOL at baseline and QOL improved over time, QOL of frailer participants was lower at baseline and declined. [ABSTRACT FROM AUTHOR]

Objective: to develop and validate a prediction model for incident locomotor disability after 7 years in older adults.Setting: prospective British cohort studies: British Women's Heart and Health Study (BWHHS) for development and the English Longitudinal Study of Ageing (ELSA) for validation.Subjects: community-dwelling older adults.Methods: multivariable logistic regression models after selection of predictors with backward elimination. Model performance was assessed using metrics of discrimination and calibration. Models were internally and externally validated.Results: locomotor disability was reported in BWHHS by 861 of 1,786 (48%) women after 7 years. Age, a history of arthritis and low physical activity levels were the most important predictors of locomotor disability. Models using routine measures as predictors had satisfactory calibration and discrimination (c-index 0.73). Addition of 31 blood markers did not increase the predictive performance. External validation in ELSA showed reduced discrimination (c-index 0.65) and an underestimation of disability risks. A web-based calculator for locomotor disability is available (http://www.sealedenvelope.com/trials/bwhhsmodel/).Conclusions: we developed and externally validated a prediction model for incident locomotor disability in older adults based on routine measures available to general practitioners, patients and public health workers, and showed an adequate discrimination. Addition of blood markers from major biological pathways did not improve the performance of the model. Further replication in additional data sets may lead to further enhancement of the current model. [ABSTRACT FROM PUBLISHER]

Background Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and costeffectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention. Methods Participants aged >74 years, with good cognitive function, living independently in one UK city were recruited through general practices and other sources, then randomised to: (1) 6 weeks of short one-to-one telephone calls, followed by 12 weeks of group telephone calls with up to six participants, led by a trained volunteer facilitator; or (2) a control group. The main trial required the recruitment of 248 participants in a 1-year accrual window, of whom 124 were to receive telephone befriending. The pilot specified three success criteria which had to be met in order to progress the main trial to completion: recruitment of 68 participants in 95 days; retention of 80% participants at 6 months; successful delivery of telephone befriending by local franchise of national charity. The primary clinical outcome was the Short Form (36) Health Instrument (SF-36) Mental Health (MH) dimension score collected by telephone 6 months following randomisation. Results We informed 9,579 older people about the study. Seventy consenting participants were randomised to the pilot in 95 days, with 56 (80%) providing valid primary outcome data (26 intervention, 30 control). Twenty-four participants randomly allocated to the research arm actually received telephone befriending due to poor recruitment and retention of volunteer facilitators. The trial was closed early as a result. The mean 6-month SF-36 MH scores were 78 (SD 18) and 71 (SD 21) for the intervention and control groups, respectively (mean difference, 7; 95% CI, -3 to 16). Conclusions Recruitment and retention of participants to a definitive trial with a recruitment window of 1 year is feasible. For the voluntary sector to recruit sufficient volunteers to match demand for telephone befriending created by trial recruitment would require the study to be run in more than one major population centre, and/or involve dedicated management of volunteers. Trial registration ISRCTN28645428. [ABSTRACT FROM AUTHOR]

Background: the evaluation of the determinants of change over time in health-related quality of life (HR-QoL) in older people is limited. This study aims to identify patterns of change in HR-QoL over 7 years and their determinants using data from the British Women's Heart and Health Study, a representative sample of older women (n = 4286).Methods: longitudinal latent class analysis was used to identify subpopulations of women with similar HR-QoL trajectories from 1999–2000 to 2007. HR-QoL was measured using the EQ-5D. Multivariate multinomial logistic regression was used to model the association of identified trajectories with baseline predictors after multiple imputation of missing data.Results: four distinct EQ-5D trajectories were suggested: high (19% of women), high decline (22%), intermediate (42%) and low decline (16%). Prevalent arthritis (OR = 13.4; 95% CI: 8.8, 20.5), diabetes (OR = 4.6; 95% CI: 1.5, 14.2) and obesity (OR = 3.9; 95% CI: 2.5, 6.0) were the strongest predicting health conditions of adverse changes in HR-QoL and physical activity the strongest predicting lifestyle factor (OR = 2.8; 95% CI: 2.0, 3.9).Conclusions: findings suggest that older women without obesity or pre-existing health conditions who undertake more physical activity are more likely to experience high HR-QoL, reinforcing the importance of these factors for healthy ageing. [ABSTRACT FROM PUBLISHER]

Abstract: This paper explores independence in later life and its relations with mobility, or embodied movements through physical space on the basis of a review of a range of academic literature and in-depth interviews with community-dwelling adults aged 70 and more in the UK. We suggest that independence is a complex and fuzzy notion that is best thought of as a qualitative multiplicity and as an unstable achievement fabricated out of dependencies on bodies, technologies, infrastructures, social networks and other elements. Yet we also find that the study participants understand independent mobility as avoiding lifts provided by next of kin, friends or others for getting around. This is tied to the enactment of particular forms of embodiment and ageist subject positions for older people and implies that older adults are inadvertently complicit in the perpetuation of the connotations of dependency in later life with passivity, burden and undesirability. To counteract these tendencies, we end this paper by elaborating more inclusive and broader conceptualisations of dependence, independence and independent mobility in later life. [Copyright &y& Elsevier]

Longitudinal studies of loneliness among older people are comparatively rare. At 8 years after the initial survey in 1999–2000, we followed up on the 999 people aged 65+ years who were living in the community in the United Kingdom. We found that 583 participants were still alive, and 287 (58%) participated in the follow-up survey. The overall prevalence of loneliness at both time points was very similar, with 9% reporting severe loneliness; 30% reporting that they were sometimes lonely, and 61% reporting that they were never lonely. We developed a 12-category typology to describe changes in loneliness across the follow-up period and report that 60% of participants had a stable loneliness rating, with 40–50% rating themselves as never lonely, and 20–25% rating themselves as persistently lonely; 25% demonstrated decreased loneliness, and approximately 15% demonstrated worse loneliness. Changes in loneliness were linked with changes in marital status, living arrangements, social networks, and physical health. Importantly improvements in physical health and improved social relationships were linked to reduced levels of loneliness. This result suggests that strategies to combat loneliness are not confined to the arena of social interventions such as befriending services, which aim to build and support social embeddedness, but may also result from the treatment of chronic and long-term health conditions. [ABSTRACT FROM AUTHOR]

Aim To examine fears about dying in an ethnically diverse population sample, and a more homogeneous population sample, aged 65 and over. Methods Personal interviews with people aged 65+ living at home responding to two Office for National Statistics Omnibus Surveys in Britain, and two Ethnibus Surveys of ethnically diverse populations in Britain. Results Ethnically diverse respondents were more likely than British population respondents to express fears about dying on all measures used. Respondents in both samples with better, compared with worse, quality of life had significantly reduced odds of having extreme fears of dying (ethnically diverse sample, OR 0.924 (95% CI 0.898 to 0.951); British population sample, OR 0.981 (95% CI 0.966 to 0.996); both p<0.001). In the latter sample only, older age was protective (OR 0.957; 95% CI 0.930 to 0.985; p<0.001), whereas in the Ethnibus sample, having a longstanding illness (OR 2.024; 95% CI 1.158 to 3.535; p<0.05) and having more relatives to help them (OR 1.134; 95% CI 1.010 to 1.274; p<0.05) increased fears about dying. Conclusions Enabling older people to express fears about dying is likely to be important when planning supportive end-of-life care. Practitioners should not assume that fears about dying are the same in different social groups, or that extensive family support is protective against such anxiety. Older people from ethnic minorities had more anxieties about dying than others, and were more likely to express fears the more extensive their family support. These findings have implications for commissioners and practitioners of primary and secondary care. [ABSTRACT FROM AUTHOR]

Abstract: The objective was to investigate associations between type of area, individuals’ perceptions of their neighbourhoods, and indicators of social and physical functioning. Social functioning was measured using numbers of social activities and frequency of social contacts in the past month. Physical functioning was measured with Townsend''s Activities of Daily Living scale. The study was a British cross-sectional population survey of people aged 65 plus living at home. Multilevel analyses indicated that respondents who lived in affluent areas were less likely to have low levels of social activity independently of individual demographic and socio-economic characteristics. Individuals’ perceptions of the area as neighbourly and having good facilities were also independently associated with lower likelihood of low social activities. Affluence of the area and perceived neighbourhood were associated with physical functioning, although these associations disappeared once adjustment was made for individuals’ characteristics. Both objective and more subjective measures of the neighbourhood independently contributed to our understanding of the determinants of social and physical functioning in older age. The unique value of this paper is its inclusion of the influence of perceived neighbourhood on the social and physical functioning of an older population, which are key components of active ageing. [Copyright &y& Elsevier]

The literature on successful aging reveals a wide range of definitions, generally reflecting the academic discipline of the investigator. Biomedical models primarily emphasise physical and mental functioning as successful aging; socio-psychological models emphasise social functioning, life satisfaction and psychological resources as successful aging. Several studies also identify these factors as the precursors of successful aging. Moreover, research shows that older people consider themselves to have aged successfully, but classifications based on traditional medical models do not. Fewer studies have explored lay views, and most of these have been exploratory or restricted to specific groups of areas. A model of successful aging needs to be multi-dimensional, incorporate a lay perspective for social significance, use a continuum rather than dichotomous cut-offs for "success" and lack of, and distinguish clearly between predictor and constituent variables. [ABSTRACT FROM AUTHOR]

Objective: To examine gender-specific and gender-sensitive factors associated with psychological health and morbidity. Design: Face-to-face home interview survey of random sample of 999 people aged 65 and over living in Britain. Results: A fifth of respondents had symptoms of psychological morbidity. Men with high self-efficacy had over six times the odds of men with lower levels, of scoring as a non-case with the 12-item General Health Questionnaire (GHQ-12). Women with excellent to good health status had over five times the odds of those in worse health of scoring as a non-case. Self-efficacy and mobility were the strongest independent predictive variables of GHQ score among men; health status and subjective QoL were the strongest, independent predictors among women. Discussion: This paper is unique in examining in detail the independent, gender-specific and gender-sensitive predictors of psychological morbidity in a national random sample of older adults. Optimism, self-efficacy, quality of life and mobility were gender-specific predictors, and health status was a gender-sensitive predictor of psychological morbidity. These differences suggest that interventions aiming to improve the mental health outcomes of older people need to be guided by evidence on risk factors by gender. [ABSTRACT FROM AUTHOR]

Chronological age can be an unsatisfactory method of discriminating between older people. The lay concept of how old people actually feel may be more useful. The aim of the analyses reported in this paper was to investigate indicators of age-identity (or subjective age) among a national random sample of people aged 65 or more years living at home in Britain. Information was initially collected by home interview and a follow-up postal questionnaire 12–18 months later. The age that respondents felt was a more sensitive indicator than chronological age of many indicators of the respondents' health, psychological and social characteristics. Multiple regression analysis showed that baseline health and functional status, and reported changes in these at follow-up, explained 20.4 per cent of the variance in self-perceived age. Adding baseline mental health (anxiety/depression), feelings and fears about ageing at follow-up explained a further 0.8 per cent of the variance, making the total variance explained 21.2 per cent. It is concluded that measures of physical health and functional status and their interactions influenced age-identity. Mental health status and psychological perceptions made a small but significant additional contribution. [ABSTRACT FROM AUTHOR]

This paper is based on the results of a national survey of the quality of life of 999 randomly sampled people aged 65 and over, living at home in Britain. The survey was semi-structured, and a sample of survey respondents was followed up and interviewed in-depth in order to explore their perceptions of quality of life in full. Comparisons are made here between the results of (i) a hierarchical multiple regression model based on theoretically derived indicators of survey respondents' ratings of their overall quality of life, with (ii) the same respondents' own definitions of quality of life, categorized from their responses to open ended survey questions, and (iii) the views of a sub-sample of these survey respondents who were subsequently interviewed in greater depth. Respondents were asked the open ended questions on quality of life at the outset of the survey interview in order to prevent any respondent bias from the structured measures used. The core components, and the central planks, of quality of life, which were consistently emphasized by the three approaches, were psychological characteristics and outlook, health and functional status, personal and neighborhood social capital. The lay models also emphasized the importance of financial circumstances and independence, which need to be incorporated into a definition of broader quality of life. [ABSTRACT FROM AUTHOR]

This paper report results from a national survey of quality of life (QoL), based on 999 people aged 65 or more years living in private households in Britain. The study produced both qualitative and quantitative interview data. The 999 survey respondents were interviewed in their own homes with a semi-structured survey instrument, and 80 were followed-up in greater depth at one and two years after the baseline interview. The material from the in-depth interviews is presented here. The main QoL themes that emerged were: having good social relationships, help and support; living in a home and neighbourhood that is perceived to give pleasure, feels safe, is neighbourly and has access to local facilities and services including transport; engaging in hobbies and leisure activities (solo) as well as maintaining social activities and retaining a role in society; having a positive psychological outlook and acceptance of circumstances which cannot be changed; having good health and mobility; and having enough money to meet basic needs, to participate in society, to enjoy life and to retain one's independence and control over life. The results have implications for public policy, and supplement the growing body of knowledge on the composition and measurement of quality of life in older age. [ABSTRACT FROM AUTHOR]

Presents a study that measured whether older people living in Great Britain would be willing to give up their place on the cardiac surgery waiting list for a younger person. Increase in willingness to cede priority with older age; Methodology; Results and discussion.

Psychiatric morbidity, using the General Health Questionnaire, which detects mainly anxiety and depression, was examined in three samples of elderly people at baseline and at follow-up 2&frac;12-3 years later. One sample comprised all people aged 85 plus who could be traced from Family Health Services Authority records living in an East End district of London (City and Hackney) and the other two samples were representative random samples of people aged 65-85, one sample from the same inner city area and the other from a semi-rural area for comparison with the younger sample (Braintree, Essex). The analyses reported here relate to changes in psychiatric morbidity at follow-up 2&frac;-3 years later. Previous analyses showed that poor health and functional ability were the strongest predictors of baseline psychiatric morbidity. The results from the follow-up data show that the most significant predictor of changes in psychiatric morbidity at follow-up was baseline psychiatric status, followed by health status. Poor health and functional ability explained 15% of the variance between the groups among the 85 plus sample and 17% and 16% in the two younger 65 plus samples. The strength of the study is its longitudinal design and verification of the results in three samples of elderly people. including one very elderly group. It contributes to the small body of literature on outcome of psychiatric morbidity. The lack of consistent associations with recovery from psychiatric morbidity (eg depression) in the literature enhances the importance of studies which aim to identify factors associated with different outcomes. [ABSTRACT FROM AUTHOR]

The mortality rates of a national sample of 505 elderly people who were widowed in 1979 were analysed. Over the 13¼-year period analysed, 62% of the sample had died. Although earlier analyses had indicated excess mortality in the first 6 months of bereavement for men aged 75+, there were no other significant excess mortality rates over the 13¼-year period. Mortality was analysed in relation to the demographic characteristics of the whole sample and in relation to the interview data on physical, social and psychological characteristics of the responders in 1979. Logistic regression analysis showed that age, sex and functional ability were the strongest predictors of mortality, and frequency of telephone contacts was only significant for the younger widowed. [ABSTRACT FROM AUTHOR]