A harmonized measure of activities of daily living was a reliable and valid instrument for comparing disability in older people across countries.

BACKGROUND AND OBJECTIVES: Our aim was to construct a harmonized measure of activities of daily living (ADL) across six countries, and to evaluate the reliability and validity of this measure. METHODS: A population of 9,297 persons, aged 65-89 years, was drawn from the Comparison of Longitudinal European Studies on Aging (CLESA) study, which includes data from five European countries and Israel. Because the number, type, and response format of the ADL items differed across the six studies, a four-item scale was constructed to harmonize the data, using items common to most countries. A procedure was devised to substitute or construct items that were not available in two of the countries. RESULTS: Cronbach's alpha for the four-item ADL measure varied from 0.81 in Spain to 0.92 in Finland, and was similar to the alpha of scales including five or six items. Kappa scores between substituted or constructed items and the actual items varied from 0.50 to 0.78. In all countries, the percentage of persons with ADL disability differed significantly across age and was associated with chronic diseases, poor self-rated health, global disability, and home help utilization. CONCLUSION: The harmonized four-item ADL measure seems a reliable and valid instrument for comparing ADL disability in older people across countries.

Disability-free life expectancy: a cross-national comparison of six longitudinal studies on aging. The CLESA project.

Disability-free life expectancy (DFLE) was compared in six countries taking part in the Cross-national Determinants of Quality of Life and Health Services for the Elderly (CLESA) project. Data from six existing longitudinal studies were used: TamELSA (Tampere, Finland), CALAS (Israel), ILSA (Italy), LASA (The Netherlands), Aging in Leganés (Leganés, Spain) and SATSA (Sweden). A harmonised four-item disability measure (bathing, dressing, transferring, toileting) was used to calculate DFLE; the harmonised measure was dichotomised into 'independent in all four activities' vs. 'dependent in at least one'. Calculations of DFLE were made using the multistate life table approach and the IMaCh program (INED/EuroREVES, http://eurorevesinedfr/imach/) for subjects aged 65-89 years. Prevalence ratios of disability varied significantly across countries, with Italy and Leganés having the highest percentages among men and among women, respectively, while The Netherlands presented the lowest for both sexes. At 75 years of age the estimated total life expectancy among men ranged from 7.8 years in Tampere and Sweden to 9.0 years in Israel; among women it ranged from 9.5 years in Israel to 11.6 years in Italy. For both sexes Italy showed the lowest total life expectancy without disability (72% among men, 61% among women) and Sweden the highest (89% among men and 71% among women). The results yielded a north/south gradient, with residents in Tampere, The Netherlands and Sweden expected to spend a higher percentage of their lives without disability than those in Italy, Israel and Leganés.

Self-rated health as a predictor of mortality among persons with cardiovascular disease in Sweden.

AIMS: This study analyses the association between cardiovascular diseases with and without drug treatment, self-rated health, and all-cause mortality during a 12-year period. METHODS: Genetic and familial environmental effects were controlled for in subsets of the analyses. Data for these analyses were collected in 1984, 1987, 1990, and 1993 as part of the Swedish Adoption/Twin Study of Aging (SATSA), and through record linkage to mortality data from the National Cause of Death Register through 1996. RESULTS: In multivariate analyses, both cardiovascular disease and low self-rated health were associated with higher mortality. Age, sex, lifestyle, diabetes, respiratory problems, cancer, depression, marital status, and social network were controlled for in the analyses. Furthermore, development of cardiovascular disease and/or drug use is associated with a decline in perceived health and higher mortality rates. The co-twin control analyses suggest that drug-treated cardiovascular disease has a marginal effect on survival beyond the effects of bad self-rated health and genetic liability to a certain survival time. CONCLUSIONS: This study shows that subjective health ratings are important predictors of mortality for persons with cardiovascular disease.

Hypertension and health-related quality of life. an epidemiological study in Sweden.

The aim of this study was to describe the relationship between hypertension and health-related quality of life (HRQL) in a Swedish general population using the 36-item short form questionnaire (SF-36). The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that those with hypertension scored lower in the linear regression analyses in most of the eight domains of the SF-36 than those without hypertension after controlling for age, sex, sociodemographic factors, and comorbidity. Diabetes and angina pectoris were related to lower scores in most of the domains of the SF-36. Previous myocardial infarction was associated with lower general health and vitality. Those with a previous stroke had lower scores in physical functioning, general health, vitality, and social functioning. The findings suggest that hypertensives represent a vulnerable population that merits special attention from health care providers and systems. This is especially important given that low HRQL can be a risk factor for subsequent cardiovascular events or complications.

Self-reported side-effects of antihypertensive drugs: an epidemiological study on prevalence and impact on health-state utility.

The aim in this study was to assess the frequency and type of self-reported side-effects among hypertensives in a general population, and to estimate the relationship between drug use and side-effects and health utility using the Rating Scale (RS) method. The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that nearly 20% of the users of antihypertensive drugs reported side-effects. Men and women reported side-effects to nearly the same extent. In the linear regression analyses, those with hypertension, with or without medication, rated lower health utilities (-6.0 and -7.1 respectively) than did normotensives after controlling for age and sex. The lowest value, -8.7, was found among drug users who experienced side-effects. Side-effects causing impotence and emotional distress, i.e. insomnia, tiredness and depression had the strongest negative impact on health utility. To conclude, the study showed that side-effects among hypertensives are common. Both the disease and the drug treatment adversely affect the patient's well-being. However, drug treatment was of less importance than that found in prior studies. The findings here stress that side-effects should be taken into greater consideration when evaluating drug treatment.