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To describe the process of developing a cognitive rehabilitation intervention for patients with post-stroke cognitive impairment (PSCI) and to describe the intervention prior to evaluation in a pilot randomised controlled trial (RCT).

Background and Purpose: Cognitive impairment no dementia (CIND) and dementia are common stroke outcomes, with significant health and societal implications for aging populations. These outcomes are not included in current epidemiological models. We aimed to develop an epidemiological model to project incidence and prevalence of stroke, poststroke CIND and dementia, and life expectancy, in Ireland to 2035, informing policy and service planning. Methods: We developed a probabilistic Markov model (the StrokeCog model) applied to the Irish population aged 40 to 89 years to 2035. Data sources included official population and hospital-episode statistics, longitudinal cohort studies, and published estimates. Key assumptions were varied in sensitivity analysis. Results were externally validated against independent sources. The model tracks poststroke progression into health states characterized by no cognitive impairment, CIND, dementia, disability, stroke recurrence, and death. Results: We projected 69 051 people with prevalent stroke in Ireland in 2035 (22.0 per 1000 population [95% CI, 20.8–23.1]), with 25 274 (8.0 per 1000 population [95% CI, 7.1–9.0]) of those projected to have poststroke CIND, and 12 442 having poststroke dementia (4.0 per 1000 population [95% CI, 3.2–4.8]). We projected 8725 annual incident strokes in 2035 (2.8 per 1000 population [95% CI, 2.7–2.9]), with 3832 of these having CIND (1.2 per 1000 population [95% CI, 1.1–1.3]), and 1715 with dementia (0.5 per 1000 population [95% CI, 0.5–0.6]). Life expectancy for stroke survivors at age 50 was 23.4 years (95% CI, 22.3–24.5) for women and 20.7 (95% CI, 19.5–21.9) for men. Conclusions: This novel epidemiological model of stroke, poststroke CIND, and dementia draws on the best available evidence. Sensitivity analysis indicated that findings were robust to assumptions, and where there was uncertainty a conservative approach was taken. The StrokeCog model is a useful tool for service planning and cost-effectiveness analysis and is available for adaptation to other national contexts.

Introduction Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995–2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1–12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I2 statistic. Results A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI = 32–43%] (I2=92.5%, p 2=0%, p = 0.99), with a similar pooled prevalence (39%, 95%CI = 35–42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time. Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.

Introduction: Cognitive impairment (CI) is a frequent consequence of stroke and is associated with increased costs and reduced quality of life. However, its inclusion in model-based economic evaluation for stroke is limited. Objective: To identify, review, and critically appraise current models of stroke for use in economic evaluation, and to identify applicability to modeling poststroke CI. Methods: PubMed, EMBASE, and the NHS Economic Evaluations Database (NHS EED) were systematically searched for papers published from January 2008 to August 2018. Studies that described the development or design of a model of stroke progression intended for use in economic evaluation were included. Abstracts were screened, followed by full text review of potentially relevant articles. Models that included CI were retained for data extraction, and among the remainder, models that included both stroke recurrence and disability were also retained. Relevance and potential for adaptation for modeling CI were assessed using a standard questionnaire. Results: Forty modeling studies were identified and categorized into 4 groups: Markov disability/recurrence (k = 29); CI (k = 2); discrete event simulation (k = 4), and other (k = 5). Only 2 modeling studies included CI as an outcome, and both focused on narrow populations at risk of intracranial aneurysm. None of the models allowed for disease progression in the absence of a stroke recurrence. None of the included studies carried out any sensitivity analysis in relation to model design or structure. Conclusions: Current stroke models used in economic evaluation are not adequate to model poststroke CI or dementia, and will require adaptation to be used for this purpose.

Introduction Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement. The aim of this project is to develop a core minimum dataset for use in the new Irish National Audit of Stroke (INAS), which aims to improve the standard of stroke care in Ireland. This paper outlines the protocol for conducting a scoping review of international practice and guidelines in auditing acute and non-acute stroke care. Objective Identify data items that are currently collected by stroke audits internationally, and identify audit guidelines that exist for recommending inclusion of content in stroke audit datasets. Methods and analysis This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Grey literature will also be searched for relevant materials, as will relevant websites. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third. Data charting and synthesis will involve sub-dividing relevant sources of evidence, and synthesising data into three categories: i) acute stroke care; ii) non-acute stroke care; and iii) audit data collection procedures and resourcing. Data will be charted using a standardised form specific to each category. Consultation with knowledge users will be conducted at all stages of the scoping review. Discussion This scoping review will contribute to a larger project aimed at developing an internationally benchmarked stroke audit tool that will be used prospectively to collect data on all stroke admissions in Ireland, encompassing both acute and non-acute data items.

Background Post-stroke cognitive impairment (PSCI) is a frequent consequence of stroke, and reduces quality of life and increases care needs. We aimed to evaluate the impact of a hypothetical cognitive rehabilitation intervention on PSCI outcomes using the StrokeCog epidemiological model. Methods We developed a probabilistic Markov model to project and track incidence and prevalence of PSCI in the Irish population aged 40–89 years to 2035. Data sources included official population and hospital episode statistics, and longitudinal cohort studies. Drawing on available systematic review evidence, we hypothesized that cognitive rehabilitation would reduce the risk of cognitive impairment no dementia (CIND) at 1 year post-stroke by 18% (scenario 1, S1, small effect) or by 54% (scenario 2, S2, medium effect) relative to usual care. Results In usual care, the projected prevalence of post-stroke CIND in Ireland in 2035 was 6.7 per 1000 general population (95% CI 5.6–7.8), or 35% of stroke survivors (95% CI 30.5–38.8) (n=21026 prevalent cases). In S1 (small effect) the projected prevalence was reduced to 32.0% (95% CI 28.6–36.4) of stroke survivors (n=19652), and in S2 (medium effect) to 29.1% (95% CI 25.2–33.2) of stroke survivors (n=17672). The number of years of life lived free of cognitive impairment were increased by 6.3% in S1 (small effect) and 15.1% in S2 (medium effect). Conclusion The StrokeCog model provides a tool for policy-makers and researchers to evaluate the potential impact of cognitive rehabilitation at different levels of intervention effectiveness. The model was based on conservative assumptions, and a less conservative approach could lead to a greater projected reduction in burden. Our next steps include analysis of quality of life outcomes and costs.

Post&ndash, stroke cognitive impairment (PSCI) is a common consequence of stroke. Epidemiological evidence indicates that, with an ageing population, stroke and PSCI are likely to increase in the coming decades. This may have considerable implications for the demand for nursing home placement. As prevalence estimates of both cognitive impairment and dementia on admission to nursing home among residents with and without stroke have not yet been compared, they were estimated and compared in this study. We performed a cross&ndash, sectional survey to establish the admission characteristics of 643 residents in 13 randomly selected nursing homes in Ireland. The survey collected data on resident&rsquo, s stroke and cognitive status at the time of nursing home admission. The survey found, among nursing home residents that experienced stroke prior to admission, prevalence estimates for cognitive impairment (83.8%, 95% CI = 76.9&ndash, 90.6%) and dementia (66.7%, 95% CI = 57.9&ndash, 75.4%) were significantly higher compared to residents that had not experienced stroke prior to admission (cognitive impairment: 56.6%, 95% CI = 52.4&ndash, 60.8%, X2 (1) = 28.64, p &lt, 0.001, dementia: 49.8%, 95% CI = 45.6&ndash, 54.1%, X2 (1) = 10.47, 0.01). Since the prevalence of PSCI is likely to increase in the coming decades, the findings highlight an urgent need for health service planning for this increased demand for nursing home care to meet the care needs of these stroke survivors.

Introduction Improvements in stroke survival have resulted in increasing numbers of people living with stroke, and with a rapidly evolving evidence-base for stroke prevention and management, there is a need for robust data and evidence to inform future policy decision-making. Population-based modelling and economic evaluation of alternative policy options is a useful tool to support decision making. However, this process must be aligned to key stakeholder priorities. The aim of the proposed research is to engage with stakeholders in Ireland to identify their priorities for the development of stroke prevention and management strategies and policies. Methods The design is iterative, based on mixed methods. Phase 1 involves a qualitative approach for initial priority gathering, based on an open-ended online survey (target sample: 100-120) and interviews (target sample: 34-40). Stakeholders will include: 1) stroke survivors and family member/main carers, 2) healthcare professionals (HCPs) providing stroke care and 3) people working in stroke research, policy and advocacy. These data will be analysed qualitatively, with the aim of identifying a long-list of specific interventions. Phase 2 involves an interim priority setting exercise, based on a quantitative online survey. Participants will be asked to rank the interventions on the initial long-list. These rankings will be used to inform a final priority-setting workshop (Phase 3), where a small stakeholder group will decide on the final set of priorities. Discussion The rich and detailed quantitative and qualitative data, based on the views of diverse stakeholders, will be directly relevant to policy makers and service planners involved in developing and improving stroke care in Ireland. The information provided will also be essential to inform the Scenario and Intervention Modelling in Ireland for Stroke (SIMI-Stroke) project, a population-based economic and epidemiological modelling study aimed at identifying cost-effective interventions for stroke across the prevention, acute and post-acute care continuum.

Background The impact of a diminished level of kidney function on the well-being of an older individual is poorly understood. We sought to determine the association between estimated glomerular filtration rate (eGFR) and overall quality of life (QoL) among older adults. Methods Cross-sectional analysis of 4293 participants from the Irish Longitudinal Study on Ageing, a population-based study of community-dwelling adults ≥50 years of age. We used multivariable negative binomial regression to model the relationship between categories of cystatin C eGFR (eGFRcys) or creatinine eGFR (eGFRcr) and the number of QoL deficits from the Control, Autonomy, Self-realization and Pleasure (CASP-19) scale, a holistic measure of QoL among older adults (range 0–57). We further explored this relationship across age strata. Results Median age was 61 [interquartile range (IQR) 55–68] years, 53% were female, mean (SD) CASP-19 score was 44.8 (7.4) and median eGFRcys was 81 (IQR 68–93) mL/min/1.73 m2. After multivariable adjustment, participants with eGFRcys

Background Post-stroke cognitive impairment (PSCI) is a common consequence of stroke, leading to reduced quality of life and increased care needs. However, rehabilitation services for this condition in Ireland are very limited. The aim was to apply estimates of PSCI incidence to the Irish population and project the number with PSCI in the population in 2025. Methods We developed a deterministic Markov model to estimate future incidence of PSCI in the population aged 40–89 years living in Ireland up to 2025. Population data, estimates and projections to 2025 were obtained from the Irish Central Statistics Office. Data from the Irish Longitudinal Study on Ageing were used to estimate age and sex specific stroke prevalence in 2014. Age and sex specific stroke incidence was estimated using 2015 public hospital discharge data (n=6,155). Transition probabilities across six health states defined by cognitive impairment, physical disability, dementia and death were estimated using data from stroke survivors in the English Longitudinal Study on Ageing (n=490) (2002–2011). Published data from the South London Stroke Register were used to estimate annual stroke recurrence. Results The Irish population aged 40–89 years in 2015–2025 (n=2.7m) is projected to have a cumulative incidence of stroke of approximately 2.3% by 2025 (n=63,100). Of these incident strokes, approximately 22.5% are estimated to have died due to stroke (n=14,200), and 23.8% to have died of another cause (n=15,000) by 2025. Of the survivors in 2025 (n=30600), approximately 50.9% are predicted to have cognitive impairment without dementia (n=15500), and 19.4% to have dementia (n=5900). The total number of stroke survivors is projected to increase from 26700 in 2015 to 41400 in 2025, equivalent to a 55% increase in numbers, and the number with post-stroke dementia is projected to more than double from 3900 in 2015 to 8700 in 2025. Discussion In 2025, over two thirds of Irish people who have survived a stroke in the preceding 10 years will have cognitive impairment. The number of people with post-stroke dementia is set to double between 2015 and 2025. The model is limited by its deterministic nature, and the assumption that age-specific disease incidence will remain stable. The model will be further developed to include a probabilistic sensitivity analysis, to model alternative scenarios for trends in disease incidence, and to extend the projections to 2035. The model will also be used in an economic evaluation of alternative strategies for stroke management, including cognitive rehabilitation.

Background Measures of quality of life (QOL) must be appropriate for specific groups but comparable across groups. In this paper, we compared how QOL is measured in research with older adults with and without an intellectual disability (ID).Methods Measures used in 2 population studies of older adults with and without ID (Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing [IDS-TILDA], and The Irish Longitudinal Study on Ageing [TILDA]) were examined. Framed by Schalock’s Quality of Life Framework, conceptual content of measures of emotional wellbeing and self-determination were compared. The acceptability and concurrent validity of IDS-TILDA measures were evaluated.Results The same measures of emotional wellbeing were identified in both surveys. However, measures of self-determination captured different aspects of the construct. Concurrent validity between self-determination and emotional wellbeing measures in IDS-TILDA was weak.Conclusions Research with adults with and w...

Introduction: Admission to long-term care (LTC) post-stroke can be a significant source of costs. Studies evaluating the effect of cognitive impairment (CI) and dementia on risk of LTC admission post-stroke have not been systematically reviewed. The aim of this paper was to conduct a systematic review and meta-analysis of studies of the association between post-stroke CI/dementia and admission to LTC. Patients and methods: PubMed, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for peer-review articles in English published January 2000-June 2018. Included studies were population-based or hospital-based studies assessing the relationship between CI or dementia, and admission to LTC post-stroke. Abstracts were screened, followed by full-text review of potentially relevant articles. Relevant data was extracted using a standard form and the Crowe Critical Appraisal Tool was used for quality appraisal. Results were pooled using random-effects meta-analysis and heterogeneity was assessed using the I² statistic. Results: 18 articles were included in the review and 12 in a meta-analysis. 14/18 studies adjusted for covariates including functional impairment. Increased odds of admission to LTC was associated with post-stroke CI [Odds Ratio (CI 95%): 2.36 (1.18, 4.71), I²=77%] and post-stroke dementia [Odds Ratio (CI 95%): 2.58 (1.38 to 4.82), I²=60%]. Discussion and conclusion: Post-stroke CI and dementia increase odds of admission to LTC post-stroke, independent of functional impairment. This indicates the potential for interventions that reduce post-stroke CI and dementia to also reduce risk of admission to LTC post-stroke, and ultimately costs.

The objective of this study was to measure consensus among expert stakeholders on a set of positive aging outcome indicators in Ireland. Stakeholders from academic, public, and voluntary sectors and older people participated in a 3-round, online Delphi study to evaluate indicators for participation, security, healthy aging, attitudes to aging, and information access. Evaluation criteria included: acceptability, utility, accessibility, ranking, and balance and coherence. Consensus was achieved on 56 key indicators that are aligned with action areas in the National Positive Ageing Strategy. These indicators will be reported on a biannual basis to monitor progress in positive aging in Ireland.

IntroductionStroke is one of the primary causes of death and disability worldwide, leaving a considerable proportion of survivors with persistent cognitive and functional deficits. Despite the prevalence of poststroke cognitive impairment, there is no established treatment aimed at improving cognitive function following a stroke. Therefore, the aims of this systematic review are to identify psychological interventions intended to improve poststroke cognitive function and establish their efficacy.Methods and analysisA systematic review of non-randomised controlled studies that investigated the efficacy of psychological interventions aimed at improving cognitive function in stroke survivors will be conducted. Electronic searches will be performed in the PubMed, Embase and PsycINFO databases, the search dating from the beginning of the index to February 2017. Reference lists of all identified relevant articles will be reviewed to identify additional studies not previously identified by the electronic search. Potential grey literature will be reviewed using Google Scholar. Titles and abstracts will be assessed for eligibility by one reviewer, with a random sample of 50% independently double-screened by second reviewers. Any discrepancies will be resolved through discussion, with referral to a third reviewer where necessary. Risk of bias will be assessed with the Risk of Bias in Non-randomized Studies of Interventions tool. Meta-analyses will be performed if studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of the evidence regarding cognitive function will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review will collect secondary data only and as such ethical approval is not required. Findings will be disseminated through presentations and peer-reviewed publication. This review will provide information on the effectiveness of psychological interventions for poststroke cognitive impairment, identifying which psychological interventions are effective for improving poststroke cognitive function.PROSPERO registration numberCRD42017069714.

Objective Recently controversy has surrounded the dimensionality of the Hospital Anxiety and Depression Scale (HADS). We assessed the dimensionality of the HADS in a large international sample of patients with ischaemic heart disease (IHD) using confirmatory factor analysis (CFA). The analysis of an international sample enabled the current study to broaden knowledge gained from existing studies with small, regional samples. Methods Data from the HeartQoL study of patients with IHD (n = 6241, 22 countries speaking 15 languages) were analyzed using CFA. Results CFA indicated a hierarchical bifactor solution, with mostly strong item loadings on a general factor (explaining 73% of the variance), and weak to very weak loadings on orthogonal depression (16%) and anxiety (11%) subscales. The bifactor model fits the data significantly better than both the original bidimensional model and Dunbar's higher-order three-factor model. Conclusion These results, from a large international sample of patients with IHD, suggest that the HADS scale is dominated by a single general distress factor. Although the best CFA model fit was a hierarchical bifactor solution, the subscales had weak item loadings, providing little psychometric evidence of the ability of the HADS to differentiate anxiety and depressive symptoms. It is argued that clinicians and researchers working with patients with IHD should abandon the HADS and use alternative measures of depression and anxiety.

ObjectiveCognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy.DesignSystematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment.Data sourcesElectronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017.Eligibility criteriaAll non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life.MethodsThe current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre–post studies.ResultsResults indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre–post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions.ConclusionsThis review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored.PROSPERO registration numberCRD42017069714.

Background and purpose: this paper examines the impact of demographic change from 2007 to 2021 on the total cost of stroke in Ireland and analyses potential impacts of expanded access to stroke unit care and thrombolytic therapy on stroke outcomes and costs. Methods: total costs of stroke are estimated for the projected number of stroke cases in 2021 in Ireland. Analysis also estimates the potential number of deaths or institutionalised cases averted among incident stroke cases in Ireland in 2007 at different rates of access to stroke unit care and thrombolytic therapy. Drawing on these results, total stroke costs in Ireland in 2007 are recalculated on the basis of the revised numbers of incident stroke patients estimated to survive stroke, and of the numbers estimated to reside at home rather than in a nursing home in the context of expanded access to stroke units or thrombolytic therapy. Results: future costs of stroke in Ireland are estimated to increase by 52–57% between 2007 and 2021 on the basis of demographic change. The projected increase in aggregate stroke costs for all incident cases in 1 year in Ireland due to the delivery of stroke unit care and thrombolytic therapy can be offset to some extent by reductions in nursing home and other post-acute costs.

Background stroke is a leading cause of death and disability globally. The economic costs of stroke are high but not often fully quantified. This paper estimates the economic burden of stroke and transient ischaemic attack (TIA) in Ireland in 2007. Methods a prevalence-based approach using a societal perspective is adopted. Both direct and indirect costs are estimated. Results total stroke costs are estimated to have been €489-€805 million in 2007, comprising €345-€557 million in direct costs and €143-€248 million in indirect costs. Nursing home care and indirect costs together account for the largest proportion of total stroke costs (74-82%). The total cost of TIA was approximately €11.1 million in 2007, with acute hospital care accounting for 90% of the total. Conclusions the chronic phase of the disease accounts for the largest proportion of the total annual economic burden of stroke. This highlights the need to maximise functional outcomes to lessen the longer term economic and personal impacts of stroke.

Background Post-stroke cognitive impairment (PSCI) is a common consequence of stroke, leading to reduced quality of life and increased care needs. However, cognitive impairment receives less attention in stroke rehabilitation relative to physical disability. We aimed to apply estimates of PSCI incidence to the Irish population and project the number of patients who could potentially benefit from cognitive rehabilitation. Methods We developed the StrokeCog deterministic model to estimate incidence of PSCI in the population aged 40–89 years living in Ireland in 2015, and project cumulative incidence in this cohort over 10 years. Population data, estimates, and projections to 2025 were obtained from the Central Statistics Office. Age-specific and sex-specific stroke incidence was estimated with 2015 stroke hospital discharge data (n=6155). Transition probabilities across five health states defined by cognitive impairment, physical disability, and dementia were estimated with data from participants reporting stroke in the English Longitudinal Study on Ageing (n=523). An annual stroke recurrence risk of 5% was assumed. Findings Projections show that the Irish population aged 40–89 years in 2015 (2·05 million) will have a cumulative incidence of stroke of 3·7% by 2025 (74 948), of whom 19 082 (25·5%) will die from stroke and 20 580 (27·5%) from another cause. Of 35 287 survivors, 17 614 (49%) are predicted to have cognitive impairment without dementia, and 8677 (24·6%) to have dementia. Interpretation In 2025, three quarters of Irish people who have survived a stroke in the preceding 10 years will have cognitive impairment and could potentially have benefited from cognitive rehabilitation. The model will be developed further to project yearly incidence and prevalence of PSCI in the Irish population to 2046, and to include a probabilistic sensitivity analysis to allow for uncertainty in any estimates; it will also be used to evaluate cost-effectiveness of cognitive rehabilitation. The model could also be adapted for use with UK populations. Funding Health Research Board in Ireland (grant number ICE-2015-1048 and award RL-15-1579).

The effect of chronic disease status on quality of life (QoL) has been well established. However, less is known about how chronic diseases affect QoL. This article examines impairment in three domains of the WHO International Classification of Functioning, Health and Disability (ICF) - body function, activity and participation, as well as affective well-being, - as potential mediators of the relationship between chronic disease and QoL.A cross-sectional sample (n = 4961) of the general Irish community-dwelling population aged 50+ years was obtained from the Irish Longitudinal Study of Ageing (TILDA). The CASP measure of QoL was examined as two dimensions - control/autonomy and self-realisation/pleasure. Structural equation modelling was used to test the direct and indirect effects of chronic disease on QoL, via variables capturing body function, activity, participation and positive affect.A factor analysis showed that indicators of body function and activity loaded onto a single overall physical impairment factor. This physical impairment factor fully mediated the effect of chronic disease on positive affect and QoL. The total effect of chronic disease on control/autonomy (-0.160) was primarily composed of an indirect effect via physical impairment (-0.86), and via physical impairment and positive affect (-0.45). The decomposition of effects on self-realisation/pleasure was similar, although the direct effect of physical impairment was weaker. The model fitted the data well (RMSEA = 0.02, TLI = 0.96, CFI = 0.96).Chronic disease affects QoL through increased deficits in physical body function and activity. This overall physical impairment affects QoL both directly and indirectly via reduced positive affect.

Background This paper aimed to develop a short version of the 32-item Ageing Perceptions Questionnaire (APQ), a multi-dimensional measure based on Leventhal's self-regulation model. Ageing perceptions are a key area of interest for large-scale surveys of ageing populations. As these studies capture a broad range of health and social variables, included instruments need to be as concise as possible. Methods Data from the Irish Longitudinal Study of Ageing (TILDA), a representative sample of community-dwelling individuals aged 50+ (n = 6,718), was used to revise the scale. Items for exclusion were identified by examining conceptual content, descriptive statistics, and by detecting sources of poor model fit using confirmatory factor analysis (CFA). Potential combinations of dimensions were also tested using CFA. Finally, we identified any dimensions that could be excluded without limiting the conceptual coverage and coherence of the scale. Model modifications were done sequentially and with regard to theoretical considerations. Internal consistency and construct validity of the concise scale were compared with the longer version. Results Initially, 11 items were excluded on the basis of conceptual and empirical overlap with other items. CFA indicated that the negative-control and negative-consequences dimensions could be combined, allowing us to exclude a further item from this dimension. The 5-item timeline-cyclical dimension was also excluded, as it was less well-established conceptually and empirically than the other dimensions. The final 17-item, 5-dimension model was consistent with the original conceptual model and fit the data well (chi-sq = 1433.54, df(109), p

Objectives: To compare the role of different life domains in determining quality of life (QoL) in Ireland with international results. Design: Cross-sectional study of responses to The Irish Longitudinal Study of Ageing. Setting: Individuals aged 50 and older living in private residential addresses in the Republic of Ireland. Participants: Eight thousand five hundred four individuals living in 6,279 households in the Republic of Ireland (response rate 62%) were interviewed and completed a self-completion questionnaire. Measurements: Quality of life was measured using the Control, Autonomy, Self-realization and Pleasure measure (CASP-19). The domains of physical and mental health, social participation, economic resources, and sociodemographic status were measured using a large number of indicators. Ordinary least squares regression models were used to estimate the effect of factors on CASP-19, with the relative contribution of different domains to total explanation measured using a measure of statistical fit. Results: The mean CASP-19 score for the sample was 43.8 (95% confidence interval = 43.6�44.1), significantly higher than the mean score for the English Longitudinal Study of Ageing (mean 42.5: 42.3�42.7). In unadjusted analyses, CASP-19 was curvilinear with age, peaking at 67 and falling thereafter. Controlling for predictors of QoL, CASP-19 continued to rise, at a decreasing rate, with age. Mental health independently explained the largest proportion of variance in CASP-19 (7.6%), but no single domain of life dominated in terms of explanation. Conclusion: Increasing longevity can be associated with increasing QoL as long as it is accompanied by reasonable levels of mental and physical health, high-quality relationships, and social participation. Even if physical health becomes poor, evidence suggests that QoL can often remain high as individuals find value and enjoyment in other dimensions of life.

This study aims to evaluate the validity of current measurement models for the control, autonomy, self-realisation, and pleasure (CASP) measure of quality of life (QoL)—a second-order four-factor CASP-19 model and a second-order three-factor CASP-12 version—in a recent population survey. A previous large sample study did not report good fit for these measurement models. The study also aims to re-develop the model and propose a well-fitting alternative. To evaluate the current measurement models, confirmatory factor analysis (CFA) was used. A cross-sectional sample (n = 6,823) representative of the Irish community-dwelling population aged 50 and over was obtained from the Irish Longitudinal Study of Ageing (TILDA). Model revision was based on descriptive statistics, exploratory factor analysis and examination of fit diagnostic statistics. Revised models were tested using CFA. The results of the CFA did not support the validity of the established measurement models. A reformulated 12-item, two-factor model comprising control/autonomy and self-realisation/pleasure, with residual covariances for negatively worded items, had excellent fit to the data (χ2 161.90, df = 44, p

Objective To explore whether distance to and density of food outlets within the local area have an impact on individual dietary quality, controlling for the socioeconomic characteristics of individuals and their households. Methods An analysis of the Survey of Lifestyle, Attitudes and Nutrition in Ireland (SLAN), a two-stage clustered sample of 10 364 individuals aged 18+ from the Republic of Ireland. Socioeconomic status was measured using net household income and highest level of education. Diet was assessed via a food frequency questionnaire and the results scored in terms of cardiovascular risk. Food availability was measured in terms of distance to (Euclidean and network) and density of different types of food outlets. Dietary quality was decomposed using fixed effects regression models. Results There is a pronounced gradient in distances to nearest food store and quality of diet by socioeconomic status. Controlling for individual and household socioeconomic status and demographic characteristics, individuals who live closer to a larger food outlet or who live in an area with a higher density of larger food outlets have a significantly better diet in terms of cardiovascular risk. Conclusions Studies outside of North America have failed to find that the physical availability of food plays a significant role in socioeconomic gradients in diet and nutrition. This study suggests that food availability in the Republic of Ireland plays a small but statistically significant role in influencing the diets of individuals and communities and, as such, may also influence socioeconomic inequalities in health.

Introduction Dietary quality is an important predictor of health outcome and plays a prominent role in premature death from a number of chronic health conditions including cardiovascular disease and some cancers. Socio-economic gradients in food consumption are observed worldwide. Inadequate nutritional intake and poor dietary habits are also associated with food poverty, a well documented global public health problem, which is a complex and multi-faceted problem, with widespread consequences for dietary intake. Many definitions of food poverty have appeared in the literature, the majority of which include, to a more or lesser extent, the issues of food affordability, access to and availability of a healthy and nutritious diet to be consumed in a socially and acceptable way. Much of the published literature on the associations between access to and availability of healthy diets focuses on the food environments and individual dietary components for example, fruit and vegetables. However, due to the complex nature of the determinants of dietary habits, measuring dietary quality using an overall dietary index may provide additional insight. The physical availability of food has been shown to be a significant predictor of dietary quality. Objectives This paper investigates the influence of the economic and physical availability of food on individual dietary quality. Methods Data are drawn from a two-stage clustered sample of 10 364 individuals aged 18+ from the Republic of Ireland. Diet is assessed via a food frequency questionnaire and the results scored in terms of cardiovascular risk. Food availability is measured in terms of distance to and density of different types of food outlets. Dietary quality is decomposed using fixed effect multi-level regression models. Results More socio-economically advantaged individuals are likely to live closer to a larger food store and to consume a better diet. Controlling for individual and household characteristics, individuals who live closer to a larger food outlet or who live in an area with a higher density of larger food outlets have a significantly better diet. Conclusions There are significant and pronounced socio-economic gradients in diet and nutrition in the Republic of Ireland that may contribute to health inequalities. Food availability may also be a significant contributor to poorer dietary quality with the result that poorer households in poor areas are doubly disadvantaged.