Trajectories of Late-Life Disability Vary by the Condition Leading to Death.

BACKGROUND: Previous research suggested that there might be distinct patterns of functional decline in the last years of life depending on the condition leading to death, but the validity of these results and hence the explanatory value of the condition leading to death for late-life disability are uncertain. METHODS: A total of 636 decedents from a cohort of 754 community-living persons, 70+ years of age (Yale PEP Study) provided 33 700 monthly observations of self-/proxy-reported disability during the last 5 years of life. Nonlinear trajectories and short-term fluctuations of late-life disability by condition leading to death (cancer, organ failure, frailty, severe dementia, sudden death, other) were estimated with flexible mixed spline regression models. RESULTS: Disability trajectories at the end of life varied distinctively by the condition leading to death. Estimated disability trajectories among cancer deaths increased gradually up until about 6 months before death, after which a steep terminal decline set in. Among those with organ failure, frailty, and dementia, in contrast, disability was higher, increased more gradually, and there was no clear-cut terminal phase. Adding the condition leading to death to other known risk factors increased the amount of explained between-person variation in late-life disability from R2 = 0.35 to 0.49. Short-term fluctuations in disability were not specific for decedents with organ failure. CONCLUSIONS: The condition leading to death is an important determinant of trajectories of late-life disability. These trajectories follow distinct patterns partially resembling a previously outlined theoretical typology.

Predictors of Fall Protective Behaviors Among Iranian Community-Dwelling Older Adults: An Application of the Protection Motivation Theory.

PURPOSE: The protection motivation theory (PMT) is a common framework understanding the use of protective behaviors. The aim of this study was to assess the predictors of fall protective behaviors among community-dwelling older adults, Iran. METHODS: The cross-sectional study was conducted in Qom, Iran, from May to October 2018. Three hundred older people were selected from retirement centers via stratified sampling method. Data were collected by a questionnaire containing items on socio-demographic information, Falls Behavioral (FaB) Scale, and PMT constructs scale. Data analysis was performed using descriptive statistics and structural equation modeling. RESULTS: The mean (SD) age of the participants was 64.6 (5.5) and the majority were male (77.7%). Level of perceived fall threat was lower than perceived efficacy of fall protective behaviors. There was a significant relationship between protection motivation and fall protective behaviors (ß= 0.515, t-value= 13.650). Coping appraisals (ß= 0.409, t-value= 7.352) and fear (ß= 0.194, t-value= 2.462) were associated with motivation. The model explained approximately 27% of the variance in fall protective behaviors. The goodness of fit index of 0.48 indicating the model good fit. CONCLUSION: The results indicated that protection motivation, coping appraisals and reasonable fear are considered as the strongest predictors of fall protective behaviors among older people. The results can help health care providers to develop appropriate interventions to fall prevention among older people.

Frailty index predicts geriatric psychiatry inpatient mortality: a case-control study.

BACKGROUND: Many geriatric psychiatry patients suffer from complex psychiatric and medical problems and a minority of patients dies in-hospital. We assess whether a frailty index (FI) predicts inpatient mortality. METHODS: Electronic health records from 276 patients of a geriatric psychiatry department over 3 years (2015-2017) in Austria were analysed using logistic regression analysis. RESULTS: Mortality rate was 4.2%. The adjusted effect of frailty (per 0.1 FI) on mortality was odds ratio = 3.25 (95% CI = 2.29-4.79). The area under the curve of 0.81 (95% CI = 0.76-0.86) suggested acceptable predictive accuracy. CONCLUSIONS: We found that a non-negligible minority of geronto-psychiatric patients died in-hospital, which can be usefully predicted by the FI derived from routine electronic patient records.

[Mortality of gerontopsychiatric inpatients in Graz, Austria-a retrospective case-control study]. / Mortalität von Patientinnen und Patienten auf einer Abteilung für Alterspsychiatrie in Graz, Österreich ­ Eine retrospektive Fall-Kontroll-Studie.

BACKGROUND: Despite the demographic development and the increasing number of psychiatric diseases in older people, there are only few scientific investigations on the characteristics of patients in gerontopsychiatry and their mortality. In this retrospective case control study patient data were examined in order to establish which features of patients who died in a department of gerontopsychiatry show differences to those of patients who were discharged. METHOD: A total of 284 patient files from the department of gerontopsychiatry and geriatric psychotherapy of the State Hospital Graz II were evaluated. Between 1 January 2015 and 31 December 2017, a total of 51 women and 91 men died (= cases) in hospital. These patients were compared with 142 sex-matched patients (control group) who were discharged during the same period of time. The evaluation was carried out using logistic regression models. RESULTS: Patients who died on the geriatric psychiatry ward were clearly older and were in a clearly poorer physical state of health than the discharged patients. The deceased patients had a 2.7-fold higher chance of an ischemic cardiac disease as well as a 2.5-fold and 3.5-fold higher chance of being referred from a nursing home or hospital, respectively. They also had a threefold higher chance for a lower functional status, a fourfold increased chance of higher C­reactive protein (CRP) values and a diagnosis of delirium compared to discharged patients. CONCLUSION: The deceased patients had a substantially poorer state of health and tended to suffer more from delirium compared to the discharged patients. Structural health policy precautions must be undertaken so that unnecessary transfers to gerontopsychiatry departments do not become necessary.

Health concepts of elementary school pupils in Austria : An explorative study using the draw and write technique.

Studies analysing health concepts of children are scarce. Thus, the aim of this study was to analyse health concepts of elementary school children in Austria. In all, 240 pupils in grades 2 (7 or 8 years old) and 4 (9 or 10 years old) of three rural and three urban elementary schools in Styria took part in this explorative study. Differences were analysed using multivariate analyses. Girls associated health more often with nature than did boys, and pupils in grade 2 drew illness-related symbols more often than those in grade 4. Children attending an urban elementary school signalled preventive behaviour more often than children in rural areas. Our results showed that children in Austria, overall, have a positive concept of health, but they also reveal differing health concepts between the groups. Public health programs should take into account the differences in health concepts to implement more effective preventive intervention programs in schools.

Validity and Reliability Evaluation of the Persian Version of the Heart Failure-Specific Health Literacy Scale.

BACKGROUND: Health literacy (HL) has important implications for health outcomes in heart failure (HF) patients. Studying health literacy requires culturally appropriate and valid instruments. The aim of the study was validation of the Persian version of the heart failure-specific health literacy scale (HF-Specific HL Scale). METHODS: One hundred patients with heart failure were selected in Qom, Iran in 2017. The 'forward-backward' procedure was applied to translate the questionnaire from English into Persian. Content validity, face validity, construct validity have been employed to validate the prepared scale. Cronbach's alpha coefficients and the test-retest were used to assess the scale reliability. Data were analyzed using SPSS, version 16, and Smart PLS 3.0 software. RESULTS: Confirmatory factor analysis completely supported the three-factor model of the HL scales. Convergent validity was satisfied in that all factor loadings and the average variance extracted exceeded 0.5. The divergent validity was verified using Fornel and Larcker method. R-square and path coefficient were higher than 0.43 and 0.65 respectively, indicating the good structural model. Composite reliability and Cronbach's α coefficient for all of the constructs were over the recommended threshold of 0.70, ensuring adequate internal consistency of the scale. The test-retest reliability ranged from 0.78-0.90, which indicated a good level of stability. CONCLUSION: The findings indicated that the Persian HF-specific HL scale is reliable and valid for measuring health literacy among heart failure patients. Further research is required to measure the sensitivity and specificity of the scale.

Risk factors for falls in Iranian older adults: a case-control study.

Falls are an important cause of morbidity and mortality in older adults. Identifying potential risk factors would provide a considerable public health benefit. The objective of this retrospective study was to determine the risk factors for falling among Iranian older adults. Two hundred eighty community-dwelling elders, with and without a history of falls, participated in the study. Elders aged 60 or over referred to retirement centres completed a multi-section questionnaire on demographic information, behavioural, environmental, and medical factors of fall from May to September 2018. Data analysis was performed with descriptive statistics and logistic regression using the Stata version 14 software. Sedentary activity level (OR: 2.14; 95% CI: 1.85, 3.23), hearing loss (OR: 2.17; 95% CI: 1.23, 3.83), vertigo or dizziness (OR: 2.24; 95% CI: 1.02, 4.91) and visual impairment (OR: 1.63; 95% CI: 1.01, 2.67) were important predictors of falls. No significant associations were observed between falls with demographic factors and medication. This study indicates several modifiable risk factors may be associated with falls that affect the health of older adults. Appropriate interventions are necessary to reduce modifiable risk factors of falls of high-risk elders.

Individual and country-level determinants of nursing home admission in the last year of life in Europe.

BACKGROUND: Previous research has focussed on individual-level determinants of nursing home admission (NHA), although substantial variation in the prevalence of NHA between European countries suggests a substantial impact of country of residence. The aim of this analysis was to assess individual-level determinants and the role of country of residence and specifically a country`s public institutional long-term care infrastructure on proxy-reported NHA in the last year of life. METHODS: We analysed data from 7,018 deceased respondents (65+) of the Survey of Health, Ageing and Retirement in Europe (2004-2015, 16 countries) using Bayesian hierarchical logistic regression analysis in order to model proxy-reported NHA. RESULTS: In total, 14% of the general older population utilised nursing home care in the last year of life but there was substantial variation across countries (range = 2-30%). On the individual-level, need factors such as functional and cognitive impairment were the strongest predictors of NHA. In total, 18% of the variance of NHA was located at the country-level; public expenditure on institutional care strongly affected the chance of NHA in the last year of life. CONCLUSION: On the individual-level, the strong impact of need factors indicated equitable access to NHA, whereas differences in public spending for institutional care indicated inequitable access across European countries.

[The Impact of Migration Background on Health: Results of the Austrian Health Interview Survey (ATHIS 2014)]. / Die Bedeutung des Migrationshintergrunds für die Gesundheit. Ergebnisse der österreichischen Gesundheitsbefragung (ATHIS 2014).

OBJECTIVES: Previous research has shown migrants to have a poorer health status than those without a migration background in many respects. So far, it is not completely clear whether the poorer health results of migrants are mainly the cause of their socioeconomic status (SES), which on average is lower than the SES of people without a migration background. The present study explores the question whether the fact of having a migration background has an impact on health, even though SES and health-related behavior are taken into account. METHODS: Based on data from the current Austrian Health Interview Survey (ATHIS 2014) multiple linear regression models, adjusted for age and stratified by gender, were conducted. The dependent variables were physical quality of life, psychological quality ofZ life, self-perceived health, body-mass-index (BMI), headaches/musculoskeletal pain, and diabetes/cardiovascular diseases (n=15,748). RESULTS: We found differences in health between men and women with migration background and men and women without migration background. After adjusting for age, SES and health-related behavior, almost all of the revealed differences got smaller. The strongest link between migrant status and health status was detected for migrants from countries with a lower Inequality-adjusted Human Development Index (IHDI) in comparison to Austria. CONCLUSION: The results lead to the conclusion that although SES and health-related behavior do not fully explain health differences between people with migration background and those without, they can explain the differences to a large extent. However, for the health status of migrants who stem from countries with a lower standard of living and a weaker distributive justice in comparison to Austria, further factors might play a role. With respect to this group of migrants, differences in health compared to non-migrants are not solely attributable to SES and health-related behavior.

Nursing professionals' attitudes toward use of physical restraints in Styrian nursing homes Austria.

BACKGROUND: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals' attitudes toward this practice. AIM: Since nursing professionals' views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals' attitudes concerning use of physical restraints in nursing homes of Styria (Austria). METHOD: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. RESULTS: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny "good reasons" for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals' views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. CONCLUSIONS: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

Impact of migration background on health of children and adolescents in Austria. Results of the Austrian Health Survey 2014.

OBJECTIVE: The present study examines the question as to whether the wellbeing of children and adolescents in Austria and the use of vaccination are influenced by migration background. METHODS: The data was extracted from the Austrian Health Survey 2014 (ATHIS 2014). It contains health-related information of 5,277 children and adolescents aged 0 to 17 years. The analysis was based on logistic regression models. RESULTS: To stem from a migration background had no influence on the assessment of health or the assessment of complaints. Regarding vaccination, the results showed that the children of study participants born in non-EU foreign countries had twice the chance of being vaccinated as the children of Austria-born parents. No difference existed between the children of Austria-born parents and the children of parents born in non-EU countries. CONCLUSIONS: The analysis suggests that children and adolescents with a migration background in Austria are not worse off in terms of their physical wellbeing and vaccination status than children without a migration background. Some thought should, however, be given to the fact that the notion of migration background refers to a heterogenic population. To analyse the risks and chances of children and adolescents from different migrant backgrounds, a more differentiated survey of their migrant background and social situation and a more differentiated survey of health parameters will be required.

Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach.

BACKGROUND: Frailty constitutes an important risk factor for adverse outcomes among older adults. In longitudinal studies on frailty, selective sample attrition may threaten the validity of results. OBJECTIVE: To assess the impact of sample attrition on frailty index trajectories and gaps related to socio-economic status (education) therein among older adults in Europe. METHODS: A total of 64,143 observations from 21,044 respondents (50+) from the Survey of Health, Ageing and Retirement in Europe across 12 years of follow-up (2004-2015) and subject to substantial sample attrition (59%) were analysed. We compared results of a standard linear mixed model assuming missing at random (MAR) sample attrition with a joint model assuming missing not at random sample attrition. RESULTS: Estimated frailty trajectories of both the mixed and joint models were identical up to an age of 80 years, above which modest underestimation occurred when a standard linear mixed model was used rather than a joint model. The latter effect was larger for men than women. Substantial education-based inequality in frailty continued throughout old age in both the mixed and joint models. CONCLUSION: Linear mixed models assuming MAR sample attrition provided good estimates of frailty trajectories up until high age. Thus, the validity of existing studies estimating frailty trajectories based on standard linear mixed models seems not threatened by substantial sample attrition.

Social-emotional aspects of quality of life in multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory auto-immune disease of the central nervous system. It leads to many impairments including physical, cognitive, psychological, and social challenges. Our study examined gender and cultural associations with quality of life (QoL), personal characteristics, and benefits from having MS among those with MS. The study was conducted in Austria and the United States. The sample included 128 participants, 64 in each country, of whom 78 were women and 50 were men aged between 20 and 57 years. We used standard statistical tests, including analyses of covariance (ANCOVA) and partial correlations for the analysis of quantitative data. For the qualitative part of the survey we used semi-structured interviews, which we transcribed and coded to identify categories in the answers for qualitative analyses. Austrian participants with MS perceived a higher social-emotional QoL in comparison to American participants. American participants expressed a higher self-esteem in comparison to Austrian participants. Men reported a lower ability to express love than women. Independent of sex/gender and nationality, participants reported benefits through the disease, especially with regard to improved compassion, mindfulness, improved family relations and lifestyle gains. The qualitative interviews revealed additional gender differences for coping with the illness; and in experiences, expectations, and challenges related to MS. These insights can be used to develop targeted psychological and social support interventions aimed toward improving social-emotional QoL for persons with MS.

Sex and gender matters : A sex-specific analysis of original articles published in the Wiener klinische Wochenschrift between 2013 and 2015.

BACKGROUND: The variables sex and gender are significantly related to health and disease of women and men. Aiming at quality research, biomedical publications need to account for the key variables sex and gender. METHODS: All original articles published in the Wiener klinische Wochenschrift between 2013 and 2015 were extracted into a database. As a result, the 195 published articles were selected for review led by the Sex and Gender Equity in Research Guidelines (SAGER) by the European Association of Science Editors (EASE). The slightest indications of mentioning sex and/or gender were assessed by two reviewers independently from one another. RESULTS: Of the 195 publications 4 specified sex and/or gender in the title, and 62 in the abstract. None of the authors reported whether the variables sex and/or gender may have relevance and were taken into account in the design of the study. Of the 195 publications 48 mentioned the potential implications of sex and/or gender on the study results. CONCLUSION: In the time span studied most of the selected articles of this journal did not account for the variables sex and/or gender systematically or adequately. For future research the existing guidelines can help authors and editors to overcome gender bias due to inadequate methods. Applying sex and gender-sensitive methods to biomedical and health research is necessary for high quality and as a precondition for results which are generalizable and applicable to both women and men.

The moderating role of personal resources in the relationship between psychosocial job demands and health: a cross-sectional study.

OBJECTIVE: The main objective of this research was to investigate the buffering effects of an individual's physical, mental and social resources in the relationship between psychosocial job demands and (1) health symptoms, (2) mental strain and (3) the body mass index (BMI), respectively. METHODS: We performed moderated regression analysis to examine data from a large cross-sectional survey of an Austrian employee sample (n=9434). RESULTS: The results revealed a robust association between psychosocial job demands and health symptoms as well as mental strain, but only a weak relationship between psychosocial job demands and BMI. Although the personal resources showed a positive effect on health symptoms and mental strain, only weak evidence was found for the hypothesised interaction with psychosocial job demands. Solely the physical fitness of a person was found to mitigate the impact of psychosocial job demands on health symptoms. CONCLUSIONS: In conclusion, personal resources substantially accounted for the prediction of health. However, the interactions between psychosocial job demands and personal resources only slightly contributed to explaining the variation in health.

Attitudes towards end-of-life decisions in case of long-term care dependency: a survey among the older population in Austria.

BACKGROUND: Research on attitudes towards end-of-life decisions (ELDs) contextually most often refers to the very end of life, that is, to situations of terminally ill patients or severe pain, but it is rarely applied to the broader context of long-term care dependency in old age. METHODS: In a representative survey among older Austrians (50+, n=968), respondents were asked about their approval of assisted suicide and euthanasia (EUT) when requested by an older, severely care-dependent person. The influence of sociodemographics, care-related experiences and expectations, religiosity, trust, locus of control and concerns regarding constrictions of old age on the approval of both these ELDs was assessed through logistic regression analyses. RESULTS: 42% and 34% of the respondents approved assisted suicide and EUT, respectively, in case of care dependency. Non-religious individuals, less trusting respondents and those concerned about constrictions associated with old age were more likely to approve both these ELDs. CONCLUSIONS: Widespread concerns regarding long-term care dependency in old age should be addressed in information campaigns, and public discourse about ELDs should pay more attention to situations of long-term care dependency.

Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004-2013).

BACKGROUND: Whether or not, and how, health inequalities change throughout older age is currently under debate. The goal of this study was to assess the net impact of education, occupational class, income and wealth on frailty trajectories among older adults in Continental Europe. METHODS: We modelled frailty index trajectories within a repeated cohort design among the community-dwelling population (50+) in 10 countries, using growth curve models based on 54 036 observations from 20 965 respondents in 4 waves (2004-2013) of the Survey of Health, Ageing and Retirement in Europe. RESULTS: Gaps in frailty due to education, occupational class and wealth continued throughout old age, while the gap due to income, smaller in comparison, converged. Frailty levels were higher and trajectories steeper in later birth cohorts, and the impact of education increased over time. Frailty levels and growth curves were higher in Southern European countries, and results were consistent across countries regarding the continuous effect of education and occupation and more mixed regarding wealth and income. CONCLUSIONS: Health inequalities due to education, occupational class and wealth tend to persist throughout old age, whereas the negligible effect of income declines with age, which, substantially, highlights the importance of social conditions on the pace of physiological decline in older Europeans and, methodologically, highlights the need to assess multiple measures of socioeconomic position.

The Role of Personal and Job Resources in the Relationship between Psychosocial Job Demands, Mental Strain, and Health Problems.

Recent research highlights the importance of both job resources and personal resources in the job demands-resources model. However, the results of previous studies on how these resources are related to each other and how they operate in relation to the health-impairment process of the job demands-resources model are ambiguous. Thus, the authors tested an alternative model, considering job and personal resources to be domains of the same underlying factor and linking this factor to the health-impairment process. Survey data of two Austrian occupational samples (N 1 = 8657 and N 2 = 9536) were analyzed using confirmatory factor analysis (CFA) and structural equation modeling (SEM). The results revealed that job and personal resources can be considered as indicators of a single resources factor which was negatively related to psychosocial job demands, mental strain, and health problems. Confirming previous studies, we further found that mental strain mediated the relationship between psychosocial job demands and health problems. Our findings suggest that interventions aimed at maintaining health in the context of work may take action on three levels: (1) the prevention of extensive job demands, (2) the reduction of work-related mental strain, and (3) the strengthening of resources.

Passive Suicide Ideation Among Older Adults in Europe: A Multilevel Regression Analysis of Individual and Societal Determinants in 12 Countries (SHARE).

OBJECTIVES: Passive suicide ideation (PSI) is common among older adults, but prevalences have been reported to vary considerably across European countries. The goal of this study was to assess the role of individual-level risk factors and societal contextual factors associated with PSI in old age. METHOD: We analyzed longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) on 6,791 community-dwelling respondents (75+) from 12 countries. Bayesian logistic multilevel regression models were used to assess variance components, individual-level and country-level risk factors. RESULTS: About 4% of the total variance of PSI was located at the country level, a third of which was attributable to compositional effects of individual-level predictors. Predictors for the development of PSI at the individual level were female gender, depression, older age, poor health, smaller social network size, loneliness, nonreligiosity, and low perceived control (R (2) = 25.8%). At the country level, cultural acceptance of suicide, religiosity, and intergenerational cohabitation were associated with the rates of PSI. DISCUSSION: Cross-national variation in old-age PSI is mostly attributable to individual-level determinants and compositional differences, but there is also evidence for contextual effects of country-level characteristics. Suicide prevention programs should be intensified in high-risk countries and attitudes toward suicide should be addressed in information campaigns.

Educational inequality as a predictor of rising back pain prevalence in Austria-sex differences.

BACKGROUND: Back pain (BP) represents a widespread public health problem in Europe. The morbidity depends on several indicators, which must be investigated to discover risk groups. The examination of trends in socioeconomic developments should ensure a better understanding of the complex link between socioeconomic-status and BP. Therefore, the role of social inequalities for BP has been investigated among Austrian subpopulations over a 24-year period. METHODS: Self-reported data from nationally representative health surveys (1983-2007) were analyzed and adjusted for self-report bias (N=121 486). Absolute changes (ACs) and aetiologic fractions (AF) were calculated to measure trends. To quantify the extent of social inequality, the relative index of inequality was computed based on educational levels. RESULTS: The prevalence of BP nearly doubled between 1983 and 2007. When investigating educational groups, subjects with low educational level were most prevalent. Obese persons generally showed higher rates of BP than non-obese subjects. Continuously rising trends across the different educational groups were more evident in men. The AC was highest in obese men with high education (+32.9%). Education-related inequalities for BP were more evident in men than women. CONCLUSION: Educational level is an important social indicator for BP. A gradient for low to high educational level in the trends of BP prevalence was clearly identified and stable only among men. We presume that the association 'education' and 'physical workload leading to BP' is more relevant for men than for women. The implementation of effective approaches to BP, in combination with target group-specific interventions focusing on educational status, is recommended.