Successful ageing in adversity: the LASER-AD longitudinal study

Abstract

Background: Most models of successful ageing do not allow for the possibility of living ''successfully,'' despite some degree of cognitive or physical impairment. We reviewed the successful ageing and related quality of life literature to identify their potential predictors. We then tested our hypotheses that wellbeing in adversity would be predicted by mental health (anxiety and depression) and social factors rather than physical health and that it would be stable over time. Method: We interviewed 224 people with Alzheimer's disease (AD) and their family carers, recruited to be representative of those living with AD in the community. We re-interviewed 122 (73.1% of eligible) participants 18 months later. Our main outcome measure was the perception of the person with AD on their life as a whole. Results: Mean ''wellbeing in adversity'' scores did not change significantly over time (t = 0.23). Social relationships, subjective mental health, health perception, activities of daily living and baseline wellbeing in adversity were the significant correlates of wellbeing in adversity on univariate analysis. Only baseline wellbeing in adversity and mental health score were significant predictors in our regression analysis. In a well fitting structural equation model, less severe dementia and better health perception predicted fewer mental health problems and social relationships, but were not direct predictors of wellbeing in adversity at 18 months. Conclusion: Successful ageing was common among a cohort of people with dementia. The most important predictors of this were mental health and social relationships, which fully mediated the relationship we found between health perception and wellbeing 18 months later.Successful ageing may not only be about escaping illness but also of having a positive attitude towards one's life despite poor health.

Self-Perceived Quality of Life Among Patients with Alzheimer’s Disease: Two Longitudinal Models of Analysis

“…It should also be noted that certain clinical factors (depression, functional ability, and neuropsychiatric symptoms) were shown to be significantly associated with this between-group variability in the QoL-Baseline model. These results support our initial hypothesis and the findings of previous studies in community samples [6,7,9] regarding the superiority of the QoL-Baseline model for the analysis of data, as well as the good predictive ability of the baseline QoL score.…”

“…It should also be noted that the severity of dementia does not seem to affect QoL scores [12,13]. Baseline QoL appears to have a predictive value, although studies report contrasting results as regards the direction of the effect: While some studies have found that higher QoL at baseline was associated with better QoL at follow-up [2,6,7,9,15,16], others, mostly in residential settings, report a reduction in perceived QoL among those with higher baseline QoL scores [4,14,17].…”

“…The majority of these studies have found, when considering samples as a whole, that mean QoL scores remain relatively stable over time [2][3][4][5][6][7][8][9][10][11][12][13][14], although some research conducted in residential settings has reported a decrease [15][16][17].…”

“…Greater depression appears to be the most relevant aspect and it is associated with a deteriorating QoL over time [2,[6][7][8]18]. A greater number of neuropsychiatric symptoms (higher scores on the NPI) is also associated with poorer perceived QoL [5,11,17], whereas better functional ability correlates with higher QoL scores [3,6] Cognitive changes appear to have only a weak or no effect [12,19].…”

“…The combined data of five community studies [3,[7][8][9]13], with a total sample of 417 people, indicate that QoL scores deteriorated in 28.2%, remained stable in 35.9%, and improved in 35.7%. Across six studies carried out in residential care settings [2,4,[14][15][16][17], with a total sample of 906 elders, QoL scores deteriorated in 41%, remained stable in 27.2%, and improved in 31.7%.…”