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In health care, high-fidelity simulation has been shown to result in increased student learning outcomes when compared to low-fidelity simulation. With educational facilities investing significant amounts of money into purchasing high-fidelity simulators, it is imperative to identify if the midlevel simulator, which is less costly, will result in the same learning outcomes. In this study, we examined the effect of midlevel-fidelity simulation versus low-fidelity simulation on Bachelor of Science in Nursing nursing students' knowledge, self-confidence, and skill performance. A quasi-experimental design examined the effects of midlevel-fidelity simulation ( n = 37) versus low-fidelity simulation (case study) ( n = 37) in junior-level nursing students. There was a significant difference for both groups in knowledge and skill performance (measured with a mini Objective Structured Clinical Examination), but not between the groups. Unexpectedly, the case-study group had a higher level of self-confidence (self-reported). The results of this study indicate that further research is needed to support faculties' selection of learning strategies with the lowest cost and highest effectiveness in achieving the desired learning outcomes. [ABSTRACT FROM AUTHOR]

Objectives:There are many stereotypes about ageing and later life. We looked at the association between expectations and stereotyping of loneliness in old age and actual self-reported loneliness status 8 years later in English Longitudinal Study of Ageing (ELSA). Method:Data from 4465 ELSA core members aged over 50 who responded to Waves 2 (2004) did not report loneliness in Wave 2, and responded to loneliness questions at least once between Waves 3 and 6 (2006–2012) were used in multivariable repeated measures logit regression analysis to estimate relationship between perceived stereotypes and expectation of loneliness in older age and actual loneliness reported within 8 years of follow-up. Results:Twenty-four per cent of respondents from the analytical sample agreed at Wave 2 that old age is time of loneliness and 33% expected to be lonely in old age. Loneliness was reported by 11.5% of respondents at Waves 3–6. Both stereotypes and expectation were significantly associated with later reported loneliness (OR 2.65 (95% CI 2.05–3.42) for stereotypes and 2.98 (95% CI 2.33–3.75) for expectations in age-sex adjusted analysis). Both variables significantly predicted future loneliness even when socio-demographic circumstances were taken into account and both variables were mutually adjusted although the effect was reduced (OR's 1.53 (95% CI 1.16–2.01) for stereotypes and 2.38 (95% CI 1.84–3.07) for expectations). Conclusions:Stereotypes and expectations related to loneliness in the old age were significantly associated with reported loneliness 8 years later. Interventions aimed at changing age-related stereotypes in population may have more impact on reducing loneliness than individually based services. [ABSTRACT FROM PUBLISHER]

Objectives: Ascertaining the quality of life (QoL) in people with dementia is important for evaluating service outcomes and cost-effectiveness. This paper identifies QoL measures for people with dementia and assesses their properties. Method: A systematic narrative review identified articles using dementia QoL measures. Electronic databases searched were AMED, CINAHL, EMBASE, Index to Theses, IBSS, MEDLINE, PsycINFO, Sociological Abstracts, and Web of Science. All available years and languages (if with an English language abstract) were included. Results: Searches yielded 6806 citations; 3043 were multiple duplicates (759 being true duplicates). Abstracts were read; 182 full papers were selected/obtained, of which 126 were included as relevant. Few measures were based on rigorous conceptual frameworks. Some referenced Lawton's model (Dementia Quality of Life [DQOL] and Quality of Life in Alzheimer's Disease [QOL-AD]), though these tapped part of this only; others claimed relationship to a health-related QoL concept (e.g. DEMQOL), though had less social relevance; others were based on limited domains (e.g. activity, affect) or clinical opinions (Quality of Life in Late-Stage Dementia [QUALID]). Many measures were based on proxy assessments or observations of people with dementia's QoL, rather than their own ratings. The Bath Assessment of Subjective Quality of Life in Dementia (BASQID) was developed involving people with dementia and caregivers, but excluded some of their main themes. All measures were tested on selective samples only (ranging from community to hospital clinics, or subsamples/waves of existing population surveys), in a few sites. Their general applicability remains unknown, and predictive validity remains largely untested. Conclusion: The lack of consensus on measuring QoL in dementia suggests a need for a broader, more rigorously tested QoL measure. [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: Promoting quality of life in older age is an internationally recognized priority, requiring valid measurement. We present a short version of the established Older People''s Quality of Life questionnaire (OPQOL-brief). The full OPQOL-35 was original in being developed from the perspectives of older people, assessed conceptually, and validated with a population sample using gold-standard psychometric assessment. The OPQOL-brief was also developed by asking older people to prioritize the most important items from the OPQOL-35, next assessed psychometrically with a population sample, and also statistically against the discarded 22 items. The aim was to assess the psychometric properties of the short, 13-item version of the OPQOL (OPQOL-brief), and to compare the performance of included and discarded items. The method was a national population survey of people aged 65+ living at home. The measures were OPQOL-brief, WHOQOL-QOL and CASP-19. The OPQOL-brief was found to be a highly reliable and valid, short measure of quality of life in older age. The OPQOL-brief is of value in assessment of interventions where a rigorously tested, short measure is required. The grounded development of the instrument is consistent with international policy emphasis on user involvement in shaping policy and research. [Copyright &y& Elsevier]

Objectives To assess whether preferences for patients with angina changed at 18-month follow-up using the Patient Preferences Questionnaire for Angina treatment (PPQA). Background Evidence suggests that patients want information about treatment options. Reliable measurement of patient preferences for treatment is important for empowering patients. Design Postal self-administered questionnaire survey at baseline and follow-up. The preference questionnaire comprised 18 items about the main treatments for angina: medication, angioplasty and coronary artery bypass grafting (CABG). Setting and participants Patients with diagnosed angina from seven participating general practices across England. The sample comprised 222 patients with angina who responded to both baseline and follow-up treatment preference questionnaires. Results Most patients' condition and preferences scores for treatment remained stable over 18 months. An exception was angioplasty preference scores, which indicated more negative attitudes towards this procedure over time. People aged over 75 years least preferred angioplasty. There were no associations between any changes in condition and changes in preferences. However, within-subject agreement could vary by ±5 to 7 points between baseline and follow-up, with stability apparently worst for the medication and best for surgery sub-scales, raising the question of what represents reasonable stability. Conclusion These results suggest preferences are relatively stable, even where there are changes in health, and provide further evidence of the utility (in particular, reliability) of the PPQA. However, this stability in scores did mask some movement in scale scores and in patients' first-ranked treatment choices, showing changing preferences largely from angioplasty to CABG and vice versa, indicating the complexity of preferences. [ABSTRACT FROM AUTHOR]

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]

There is limited knowledge on the relationship between the living conditions of community-dwelling older people and their quality of life (QOL) considered in all its specific domains. The purpose of this study was to determine (1) which dimensions of QOL were independently associated with living alone and (2) the independent correlates of these dimensions of QOL amongst older outpatients. We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009 (response rate 93%). Subjects underwent a comprehensive geriatric assessment including QOL, which was evaluated by using the Older People's QOL questionnaire. In multivariate logistic regression analyses, living alone was associated with the lowest score-based tertile of two specific dimensions of QOL out of seven, namely 'social relationships and participation' [odds ratio (OR) 2.73, 95% confidence interval (CI) 1.08-6.91] and 'home and neighbourhood' (OR 4.96, 95% CI 1.75-14.07), independently of the main demographic, social, functional and clinical characteristics of the subjects. Amongst the 107 subjects living alone, independent correlates of these dimensions of QOL were depression, having no caregiver and having never been married. Depression, having no caregiver and having never been married could provide a valuable means of identifying older people living alone who are at greater risk of a poor QOL and who would most benefit from effective social and medical interventions. [ABSTRACT FROM AUTHOR]

Aim. To document population perceptions of well-being and predictors of self-assessed well-being.Methods. National face-to-face interview survey of adults aged ≥16 years, conducted by the Office for National Statistics for their Omnibus Survey in Britain (response 58%; 1049 of 1823 eligible).Results. People aged 65+ years were more likely than younger people to define well-being as being able to continue to do the things they had always done. Most men and women, in all age groups, rated their well-being and mental well-being positively. Self-rated health, mental health symptoms, long-standing illness and social support were the main drivers of overall well-being in all age groups. Mental health symptoms, long-standing illness and social support were the main drivers of mental well-being. For example, in reduced multivariable models, those who reported no long-standing illness had almost twice the odds of others, of good, rather than not good, overall well-being, and over three times the odds of good, rather than not good, mental well-being. The odds of good versus not good overall well-being were also multiplied by 1.002 for each additional available person for comfort and support and similarly by 1.073 in relation to mental well-being.Conclusions. Understanding the drivers of well-being among adults, including older adults, is of high policy importance. Attention should be focused on improvements in population health and functioning and on encouraging younger and older people to develop and maintain social support networks and engagement in social activities. [ABSTRACT FROM PUBLISHER]

Background Most measures of quality of life (QoL) are based on 'expert' opinions. This study describes a new measure of QoL in older age, the Older People's QoL Questionnaire (OPQOL), which is unique in being derived from the views of lay people, cross-checked against theoretical models for assessment of comprehensiveness. Its performance was assessed cross-sectionally and longitudinally. It was compared with two existing QoL measures in the cross-sectional studies in order to identify the optimal measure for use with older populations. Methods Data were taken from three surveys of older people living at home in Britain in 2007-2008: one population survey of people aged 65+, one focused enumeration survey of ethnically diverse older people aged 65+, one follow-up of a population survey of people aged 65+ at baseline in 1999/2000. Measures were QoL (using OPQOL, Control, Autonomy, Satisfaction, Pleasure - 19 items (CASP-19), World Health Organization Quality of Life questionnaire - version for older people (WHOQOL-OLD)), health, social and socioeconomic circumstances. The CASP-19 and WHOQOL-OLD were not administered to the longitudinal sample in order to reduce respondent burden. Results Psychometric tests were applied to each QoL measure. The OPQOL, CASP-19 and WHOQOL-OLD performed well with the cross-sectional samples; however, only the OPQOL met criteria for internal consistency in the Ethnibus samples. Conclusion The OPQOL is of potential value in the outcome assessment of health and social interventions, which can have a multidimensional impact on people's lives. Further research is needed to examine whether differences by ethnicity reflect real differences in QoL, methodological issues, variations in expectations or cultural differences in reporting. [ABSTRACT FROM AUTHOR]

Background: Public policies aim to promote well-being, and ultimately the quality of later life. Positive perspectives of ageing are underpinned by a range of appraoches to successful ageing. This study aimed to investigate whether baseline biological, psychological and social aproaches to successful ageing predicted future QoL. Methods: Postal follow-up in 2007/8 of a national random sample of 999 people aged 65 and over in 1999/2000. Of 496 valid addresses of survivors at follow-up, the follow-up response rate was 58% (287). Measures of the different concepts of successful ageing were constructed using baseline indicators. They were assessed for their ability to independently predict quality of life at follow-up. Results: Few respondents achieved all good scores within each of the approaches to successful ageing. Each approach was associated with follow-up QoL when their scores were analysed continuously. The biomedical (health) approach failed to achieve significance when the traditional dichotomous cut-off point for successfully aged (full health), or not (less than full health), was used. In multiple regression analyses of the relative predictive ability of each approach, only the psychological approach (perceived self-efficacy and optimism) retained significance. Conclusion: Only the psychological approach to successful ageing independently predicted QoL at follow-up. Successful ageing is not only about the maintenance of health, but about maximising one's psychological resources, namely self-efficacy and resilience. Increasing use of preventive care, better medical management of morbidity, and changing lifestyles in older people may have beneficial effects on health and longevity, but may not improve their QoL. Adding years to life and life to years may require two distinct and different approaches, one physical and the other psychological. Follow-up health status, number of supporters and social activities, and self-rated active ageing also significantly predicted QoL at follow-up. The longitudinal sample bias towards healthy survivors is likely to underestimate these results. [ABSTRACT FROM AUTHOR]

Objective To use semi-structured interviews to ascertain patterns in patients’ expectations of health care and the extent to which these expectations were met or not. Background In health policy it is important to evaluate health services from varying perspectives including consumers’. One concept of emerging importance in this regard is that of patient expectations. Whether expectations are met or not have been found to be related to general patient satisfaction with treatment and treatment compliance. However, there is conceptual and methodological uncertainty and little informing empirical work regarding what is an ‘expectation’ and how it should be measured. Design A qualitative study using semi-structured interviews to elicit 20 GP patients’ expectations prior to their consultation. A post consultation interview gauged the extent to which these expectations had been met. Setting and participant Twenty patients of a GP practice in Norfolk (UK). Results Results suggest several different expectations, concerned with the doctor-patient interaction, the specific processes of the consultation, outcomes, and issues to do with time and space. Conclusions This research has used an innovative exploratory approach to address the expectations of GP patients and has implications for how doctors ought to manage their consultations. These results will be used to inform the development of a quantitative expectations questionnaire so as to develop a validated measure of expectations. Such an instrument has great potential to aid in health care research and practice. [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]

Background: There is a lack of knowledge concerning the relationship between two closely-linked multidimensional variables: frailty and quality of life (QOL). The aim of this study was to investigate dimensions and correlates of QOL associated with frailty status among community-dwelling older outpatients. Methods: We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009. Participants underwent a comprehensive geriatric assessment, including assessment of their frailty status according to the Study of Osteoporotic Fractures (SOF) criteria, and QOL, which was evaluated by using the Older People's QOL (OPQOL) questionnaire. One-way ANOVA and chi-squared tests were used to find correlates of frailty, including QOL dimensions, after stratification of participants in the "robust" (n = 72), "pre-frail" (n = 89) and "frail" (n = 78) groups. Multiple linear regression analyses were performed to find correlates of QOL in the overall sample and among "frail" and "robust" participants. Results: A negative trend of QOL with frailty status was found for almost all dimensions of QOL (health, independence, home and neighbourhood, psychological and emotional well-being, and leisure, activities and religion) except for social relationships and participation and financial circumstances. Independent correlates of a poor QOL in the total sample were "reduced energy level" (SOF criterion for frailty), depressive status, dependence in transferring and bathing abilities and money management (adjusted R squared 0.39); among "frail" participants the associations were with depressive status and younger age, and among "robust" participants the association was with lower body mass index. Conclusions: Five out of seven dimensions of QOL were negatively affected by frailty, but only one SOF criterion for frailty was independently related to QOL, after correction for age, functional status and depression. A more advanced age as well as a better affective status were correlates of a better QOL among frail elders. Interventions targeting the QOL in frail community-dwelling older outpatients should consider as outcomes, not only health-related QOL, but also other domains of the QOL. [ABSTRACT FROM AUTHOR]

Objective: to identify perceptions of, and associations with, active ageing among ethnically diverse and homogeneous samples of older people in Britain. [ABSTRACT FROM PUBLISHER]

Objective: to identify predictors of mortality among a national sample of elderly widowed people 28 years post-baseline interview. Design and setting: face to face home interview survey across England. Measures: physical, psychological, social, and socio-economic status and circumstances. Results: excess risk of mortality, which had been noted up to six months post bereavement among males aged 75+, had disappeared. In contrast to findings up to 13 years post-bereavement, neither psycho-social factors, social circumstances nor social class independently predicted differentials in mortality when analysed up to 28 years post-bereavement. The most significant, independent predictors, up to the 28-year term, were, as would be expected, male sex, older age, poorer physical functioning, and expressed 'relief at the death of the spouse'. When the sample was split by duration of widow(er)hood male sex and older age retained significance. Conclusion: the increasing frailty of the sample overall, and reduced statistical power in split-sample analyses, may explain the loss of significance of physical functioning and 'expressed relief at the death' in the split-sample results. The psycho-social risk factors for mortality after bereavement reduce over time, although further examination of expressed relief would be worthwhile. [ABSTRACT FROM AUTHOR]

Purpose. To present the psychometric properties of a new measure of quality of life in older age, the Older People's Quality of Life (OPQOL) Questionnaire, compared with the CAPSE-19 and theWHOQOL-OLD. Design and Methods. The vehicle was three national population surveys of older people living at home in Britain, including a survey of ethnically diverse older people. Results. The OPQOL had acceptable levels of reliability and validity in British population samples of older people, but more modest in the ethnically diverse population sample. The CASP-19 and WHOQOL-OLD had acceptable levels of reliability and validity in the British population sample, but not in the ethnically diverse sample. Implications. The OPQOL has potential for use as a multidimensional population surveillance instrument for use with older populations, or as an outcome measure of multisector policy. Its strengths are that its development was embedded firmly in the perspectives of older people, integrated with theory. [ABSTRACT FROM AUTHOR]

Objective: to identify socio-psychological predictors of mortality during a 20-year follow-up period among people aged 65 to <85 and 85+ at baseline interview. Study design and setting: elderly people living at home in East London and mid-Essex, who responded to surveys of successful survival in older age in the late 1980s; their mortality was traced through the National Health Central Registry. Results: adjusted analyses show that, as expected, the hazard rate for mortality over a 20-year follow-up was reduced for younger respondents and increased for less functionally able respondents. The hazard ratio for males was almost one and a half times that of females. The hazard rate was also reduced with each categorical increase in life satisfaction and was consistently reduced for those who undertook crafts, social visiting and activities regularly. There was some variation by age and sex. Conclusion: the results show that social participation is associated with lower risks of death, particularly among people aged 65 to <85, and that life satisfaction is also protective, particularly among females and people aged 85+, even when health status and socio-demographic circumstances are controlled. The study thus provides support for the hypothesised influence of social participation and subjective well-being on survival in older age. [ABSTRACT FROM AUTHOR]

Background: Access to cardiac treatments has been documented to vary with patients' age. It is unknown whether these variations reflect patients' treatment preferences. We aimed to investigate patients' preferences for cardiology treatments and develop a Patients' Preferences Questionnaire. Methods: Semi-structured interviews with primary care patients with diagnosed angina with postal follow-up. The resulting Patients' Preferences Questionnaire was tested with newly admitted inpatients with acute coronary syndrome and with patients in primary care. Results: The Patients' Preferences Questionnaire was psychometrically sound. Analyses of preference subscale scores showed that the most positive preference scores were for medication. Angioplasty scored highest at the negative end of the scale. Detailed analyses showed that older people and women were less likely to prefer coronary artery bypass surgery (CABG), reflecting its greater level of invasiveness. Older people (aged over 75 years, compared to people aged under 75 years), but not women, were also more cautious in their strength of preference for angioplasty. More positive attitudes towards CABG surgery, and more negative attitudes towards medication, were associated with greater impact of the condition on life. Conclusions: The research resulted in a psychometrically sound Patients' Preferences Questionnaire. There was some evidence to support the view that older people's weaker preferences for CABG may contribute slightly to variations in the provision of re-vascularization. There was also variation in preferences within age groups, cautioning against the assumption that all or most older people are more reluctant than younger people to undergo invasive procedures. [ABSTRACT FROM AUTHOR]

Objective To measure preferences for angina treatments among patients admitted from accident and emergency with acute coronary syndrome. Background Evidence suggests variability in treatment allocations amongst certain socio-demographic groups (e.g. related to age and sex), although it is unclear whether this reflects patient choice, as research on patients’ treatment preferences is sparse. Given current policy emphasis on ‘patient choice’, providers need to anticipate patients’ preferences to plan appropriate and acceptable health services. Design Self-administered questionnaire survey. Setting In-patients in a UK hospital. Participants A convenience sample of 53 newly admitted patients with acute coronary syndrome. Exclusion criteria were: a previous cardiologist consultation (including previous revascularization); a clinical judgement of too ill to participate; post-admission death; non-cardiac reasons for chest pain. Main outcome measures Patients’ preferences for coronary artery bypass graft (CABG); angioplasty; and two medication alternatives. Results Angioplasty was the preferred treatment (for 80% of respondents), and CABG was second (most preferred by 19%, but second most preferred for 60%). The two least preferred (and least acceptable) treatments were medications. The majority of patients (83%) would ‘choose treatment based on the extent of benefits’ and ‘accept any treatment, no matter how extreme, to return to health’. There were some differences in preference related to age (>70 years preferred medication to a greater degree than <70 years) and sex (males preferred CABG surgery more than females). Conclusions There was general preference for procedural interventions over medication, but most patients would accept any treatment, however extreme, to return to former health. There was some evidence of differences in preferences related to age and sex. Furthermore, most patients preferred to have some input into treatment choice (e.g. nearly half wanted to share decision responsibility with their doctor), with only 4% preferring to leave the decision entirely to their doctor. Given these findings, and past findings that suggest there may be variability in treatment allocation according to certain socio-demographic factors, this study suggests a need to develop and use preference measures, and makes a step towards this. [ABSTRACT FROM AUTHOR]

Objective: To identify older people's perceptions of active ageing, and to compare them with the literature, and with older people's perceptions of successful ageing and quality of life. Design: Face-to-face interview survey with 337 people aged 65+ living at home in Britain. Results: The most common perceptions of active ageing were having/maintaining physical health and functioning (43%), leisure and social activities (34%), mental functioning and activity (18%) and social relationships and contacts (15%). A third rated themselves as ageing 'Very actively', and almost half as 'Fairly actively'. Independent predictors of positive self-rated active ageing were optimum health and quality of life. Discussion: Main sub-themes of active ageing included exercising the body and mind in order to maintain health and functioning. People's views focussed on basic definitions such as social, physical and mental health and activity, probably reflecting the novelty of the concept to them, thereby excluding frail older people from active ageing. Comparisons with definitions of successful ageing and quality of life showed overlap, but the latter were portrayed as 'states of being'. This is consistent with models which propose quality of life as the end-point of active ageing. [ABSTRACT FROM AUTHOR]

This paper presents findings from a national survey of quality of life (QoL) in older age. The main aim of the analyses was to examine the definitions of quality of life given by people aged 65 or more years and the underlying reasons. Open-ended questions were used to elicit their perceptions of QoL. These were followed by structured measures of self-rated QoL overall, and of domains of QoL commonly reported in the literature. The main things said by the respondents to give their lives quality were categorised into 'themes'. These were: social relationships; social roles and activities; leisure activities enjoyed alone; health; psychological outlook and wellbeing; home and neighbourhood; financial circumstances; and independence. The reasons people gave to explain why these things were important to their QoL focused on: the freedom to do the things they wanted to do without restriction (whether in the home or socially); pleasure, enjoyment and satisfaction with life; mental harmony; social attachment and having access to companionship, intimacy, love, social contact and involvement, help; social roles; and feeling secure. This paper also presents data that demonstrates the ability of theoretically informed, structured survey indicators of QoL to predict respondents' self-rated overall QoL. Logistic regression analyses showed that most of these indicators were strong, independent predictors of self-ratings of QoL, although those that were not significant in the model did not fully incorporate lay reasons of QoL in their measurement scales. In conclusion, the indicators which were not significant in the model did not fully incorporate lay values in their measurement properties. It is also likely that those indicators that were significant could have been improved. [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 investigate the apparently incongruous coupling of poor physical functioning with high QoL. Study design and setting: face-to-face interview survey of random sample of 999 people aged 65+ across Britain. Results: twenty-one per cent of respondents reported fairly to very severe levels of functional difficulty, and 62% of these rated their QoL as 'good'. Better self-rated health, lower burden of chronic disease, not having fallen, higher social engagement and higher levels of perceived control over life, distinguished between people who had difficulties with physical functioning and who perceived their QoL to be 'good', rather than 'not good'. The open-ended survey responses broadly supported the quantitative findings. Conclusion: people with difficulties with physical functioning, who perceived their QoL to be 'not good', as opposed to 'good', were adversely affected by a higher burden of disease and having fewer socio-psychological resources to help them to cope effectively. [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]

Background: there is increasing interest in how to age 'successfully' and in reaching consensus over its definition. Objective: to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1. Setting: community, settings in Britain. Methods: five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based. Results: the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) - 2.655-11.364]. Conclusion: the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relation between perceived neighbourhood environment, social contact and support, and self efficacy, on the health of older people. Design: British cross sectional population survey of people aged 65 and over. Participants: 999 people aged 65 plus living at home in Britain. Results: Regression modelling showed that high self efficacy had a strong independent association with better self rated health status and physical functioning. Indicators of perceived neighbourhood environment that showed strong associations with both good health and functioning were: perceptions of good quality facilities in the area (social/leisure, facilities for people aged 65+, rubbish collection, health services, transport, closeness to shops, somewhere nice to walk), and high levels of neighbourliness (knows/trusts people). Perceptions of problems in the area (noise, crime, air quality, rubbish/litter, traffic, graffiti) were also predictive of poorer health. Measures of social contact and support did not show any independent associations with health or functioning. Conclusions: The unique value of this paper is in the simultaneous analysis of associations between perceived neighbourhood, social contact and support, self efficacy, and health. The consistent strength of older people's perceptions of the quality of facilities in their neighbourhoods shows that responsive reinforcement of local infrastructures might have wider health benefits. Also of interest was the strength of self efficacy as a predictor of self rated health and physical functioning. The results have implications for both neighbourhood level interventions and self management programmes in chronic illness. [ABSTRACT FROM AUTHOR]

The article discusses the concept of successful ageing. The criteria for successful ageing include theoretical definitions such as life expectancy, personal growth, and social function. A broader interpretation of the concept with lay definitions such as financial security, sense of purpose, and spirituality will impact biomedical models and relations between health professionals and the elderly population. Studies on ageing are mentioned.

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]

The concept of quality of life is elusive and this paper reports on a study that has tried to deconstruct the concept in order to better understand what older people say quality of life means to them. The focus here is on the transport dimension where quality of life is broken down into mobility patterns, locality and social networks. The paper first sets the scene with a summary of secondary data and it then systematically presents data from interviews carried out with 1000 older people as part of the British Office for National Statistics Omnibus Surveys in Britain under the three headings mentioned above. A substantial amount of diversity and variation is found in the data by quality of life ratings and the expectations of the respondents. It is argued that both the active (travel related) and passive (locality and social networks) elements need to be brought together so that the quality of life for the elderly can be better understood. [Copyright &y& Elsevier]

This study aimed to explore older peoples' definitions of, and priorities for, a good quality of life for themselves and their peers. Nine hundred and ninety-nine people aged 65 and over, living at home in Britain, were interviewed for the study. Good social relationships were the most commonly mentioned constituent that gave respondents' lives quality (mentioned by 81 percent). Other important factors were social roles and activities, health, psychological outlook and well-being, home and neighborhood, finances, and independence. Poor health was most often mentioned as taking quality away from life (by 50 percent). Social relationships and health were judged to be the most important areas. Having health and enough money were the two most frequently mentioned things that would improve the quality of their own lives and those of their peers (though in different order of magnitude). The need for dynamic, multidimensional, and integrated models of quality of life in older age is suggested by these results. [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.

Objective: to investigate the clinical management of heart disease and determine whether there was age‐ and sex‐related bias in the use of investigations and interventions. [ABSTRACT FROM PUBLISHER]

The aim of the analyses presented here was to explore subjective and objective components and predictors of self-rated quality of life (QoL). The vehicle for the study was a questionnaire module on perceptions of quality of life, which was commissioned by the authors for inclusion in the Office of National Statistics (ONS) Omnibus Survey in Great Britain. For the survey, 2033 randomly sampled adults aged 16 and over were interviewed in their own homes (77% response rate). Multiple regression analyses showed that relatively little of the variance in overall QoL ratings was explained by the objective, socio-demographic indicators (5%), and the addition of the health status indicator (reported longstanding illness) contributed nothing. The subjective ratings of life in self-nominated areas of importance explained the most, with those who did not prioritise the area at all as the referent (relationships, finances, own health, others' health, work and social life). These variables contributed over twice as much as the objective and health status variables, indicating the relative importance of self-nominated ‘important areas of life’ over theoretically important, objective variables and reported illness. However, the final model still only explained a modest amount of the variance in quality of life ratings (16%), confirming the amorphous nature of quality of life. [ABSTRACT FROM AUTHOR]

Describes associations with changes in functional ability among very elderly people who were interviewed first in 1987 when they were aged 85 and above, and followed up in 1990. Focus on persons with severe difficulties in Activities of Daily Living (ADL); Use of health and social services by elderly with chronic problems.

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]

This article presents the analyses of mortality rates of elderly people in a randomized controlled trial of nursing home and long-stay ward care in hospital. No statistically significant differences between settings were found in relation to mortality rates. Ages, accident rate and existence of cognitive impairment were associated with mortality with bivariate analyses, although they were found to explain very little of the variation between survival and mortality when logistic regression analysis was employed. In both settings, those who had some cognitive impairment had just over twice the relative risk of dying than others, although this difference was not statistically significant. [ABSTRACT FROM AUTHOR]

This article reports findings from a longitudinal survey of very elderly people living at home in London. The research aimed to identify social, psychological and physical characteristics associated with positive ageing and successful survival in the community in later life and its converse-negative ageing-as well as the associated policy implications. Association with psychiatric morbidity, measured using the General Health Questionnaire, among sample members without cognitive impairment between the baseline interviews in 1987 and at follow-up, two and a half years later in 1990, are reported. Twenty-five per cent of survivors scored over the threshold of the GHQ in 1987 and 30% scored over the threshold in 1990. Half of those with a score over the threshold in 1990 also scored over the threshold in 1987. Hierarchical regression (using residualized change analysis) was used to estimate the effects of the independent variables on changes in psychiatric morbidity. The most significant predictor of psychiatric morbidity (GHQ score) in 1990 was baseline GHQ score, followed by health and functional status scores. Health and functional status were also the strongest predictors of baseline (1987) GHQ scores. The uniqueness of the study lies in the collection of follow-up data on a sample of very elderly people, given that most surveys are cross-sectional and contain too few people aged 85 + to merit separate analysis. It contributes to the small body of literature on outcome of depression. The lack of consistent associations with recovery form psychiatric morbidity in the literature enhances the importance of studies aiming to identify factors associated with different outcomes. [ABSTRACT FROM AUTHOR]

Research evidence concerning the contributions of social networks and support to the subjective wellbeing (i.e. life satisfaction) of older persons is not consistent. This article reports the results of an investigation of social network type and health status and their effects on life satisfaction in relation to 1415 elderly people from three independent but comparable surveys: two in City and Hackney, London (urban area) and one in Braintree, Essex (semi-rural area). The percentages of the total variation in overall life satisfaction which was explained by the model ranged from 22% to 33% between samples. The most variation was explained among the sample aged 85+ living in inner London. Although most of the variance remains unexplained, health status was a more powerful predictor of life satisfaction among respondents living in City and Hackney, but not those living in Braintree. [ABSTRACT FROM AUTHOR]

Focuses on the prevalence and treatment of injuries among dancers in Great Britain. Body mass index of women dancers; Sites of chronic injuries; Necessity for rest as treatment of the injury.

Investigates changes in functional ability and associations with these changes in relation to physical health, psychiatric morbidity, life satisfaction, service use and social circumstance among elderlies. Relationship of physical functioning and use of rehabilitative and medical services; Importance of maintaining levels of functioning in old age.

Discusses a study of the parentage of feral (wild) horses living in the Great Basin to help make decisions on reproductive management. Blood sample tests; Blood typing data; Ages of stallions and mares; Recommendations for the management of population growth in wild horses.

Examines the prevalence of locomotor disabilities on elderly people in London, England. Cost effectiveness of providing aids for daily living of aged by the screening intervention programme; Association between the incidence of chronic disease and disability; Types of disability.

Presents the views of a nationally representative sample of adults in Great Britain on priorities for health services. Interview survey based on a random sample of people aged 16 and over; Response rate to the survey; Treatments for children with life threatening illness; Special care and relief for people who are dying.