The choices, choosing model of quality of life: description and rationale

Gurland, Barry J.; Gurland, Roni V.

doi:10.1002/gps.2110

Cited by 13 publications

(13 citation statements)

References 31 publications

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“…The relative weighting of these goals could be derived from patient preferences and clinical efficacy. Fundamental challenges to research lie in describing, understanding, and influencing the interaction between the person’s qualitative evaluations of choices and the quantitative building of desired choices for a better QoL (Gurland and Gurland, 2009a, 2009b). …”

Section: Discussionmentioning

confidence: 99%

Quality of life impacts on 16‐year survival of an older ethnically diverse cohort

Gurland

Teresi

Eimicke

et al. 2013

Int J Geriat Psychiatry

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Objective The objective of this study is to examine the prediction of mortality, over 16 years, by the domains and domain elements underlying generic measures of quality of life (QoL). Methods The method used was an analysis of mortality in an older (65 + years) representative sample (N = 2130) of a multicultural community in North Manhattan. Five conventional QoL domains were measured by in-home, rater-administered, and computer-assisted questionnaire: depressed mood, pain, self-perceived health, and function and social relationships. Results Some domain scales that qualitatively express distress, such as depressed mood and widespread pain, significantly predicted lower mortality (were protective) and felt isolation trended in that direction, whereas domains indicating quantitative limitations such as impairment of functioning in daily tasks, stair climbing, as well as social disengagements and lack of support network significantly predicted higher mortality. Domain elements also mattered; contrary to their domain predictions, increased mortality was predicted by the domain elements of somatic symptoms of depression. Self-perceived poor health reflected the predictive (higher mortality) direction of the limitations cluster. Conclusions The internal complexity of QoL is underscored by differential impacts of domains and elements on mortality. Clinical implications include setting distress domains as important clinical goals, whereas strengthening limiting domains could result in lengthening life and secondarily relieving distress. The relative weighting of these goals could be derived from patient preferences and clinical efficacy. Fundamental implications lie in the interaction between the person’s qualitative evaluations of choices and the quantitative building of desired choices for a better QoL.

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Section: Discussionmentioning

confidence: 99%

Quality of life impacts on 16‐year survival of an older ethnically diverse cohort

Gurland

Teresi

Eimicke

et al. 2013

Int J Geriat Psychiatry

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“…The discussions entail uncertainty, changes in quality of life, death and dying, palliative and hospice care, as well as the nuanced risks and benefits of therapeutic choices. For most clinicians, effective communication is a skillset that must be learned and honed, especially for patients often limited by sensory, cognitive, and language limitations (33,34). …”

Section: Elements Of Geriatric Cardiologymentioning

confidence: 99%

What to Expect From the Evolving Field of Geriatric Cardiology

Bell

Orr

Dodson

et al. 2015

Journal of the American College of Cardiology

106

108

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The population of older adults is expanding rapidly and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. While some assume a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, and thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients.

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“…Indeed, providing choices to patients has become a central tenet of good quality clinical care. Accordingly, rather than focusing on the multiple measures that are employed to define quality of life and the various domains that are hypothesized to define a good quality of life, focusing on the process of how individuals access choices and choose among them [90,91] may provide important guidance for clinicians in understanding how best to apply the multitude of cardiovascular procedures that are increasingly being offered to older adults. Such an approach may prove essential in evaluating the optimal approach for an individual with a complex physiologic state, in whom treating the host is preferable to treating the disease.…”

Section: Novel Approaches For Studymentioning

confidence: 99%

Changing Nature of Cardiac Interventions in Older Adults

Dodson

Maurer

2011

Aging Health

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Older adults represent a rapidly growing segment of the population in developed countries. Advancing age is the most powerful risk factor for the development of cardiovascular disease (CVD), and CVD-related mortality increases markedly in older individuals. Procedures for patients with CVD, including percutaneous coronary intervention, aortic valve replacement and implantable cardioverter defibrillators were all initially validated in younger individuals but are increasingly being applied in older adults who for the most part have been significantly understudied in clinical trials. While advanced age alone is not a contraindication to these procedures, with the advent of less invasive methods to manage CVD including percutaneous techniques to treat both coronary artery disease and valvular heart disease, future research will need to weigh the potential harms of intervention in a population of older adults with multiple medical comorbidities and complex physiologic phenotypes against outcomes that include preventing functional decline and improving quality of life.

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The choices, choosing model of quality of life: description and rationale

Cited by 13 publications

References 31 publications

Quality of life impacts on 16‐year survival of an older ethnically diverse cohort

Quality of life impacts on 16‐year survival of an older ethnically diverse cohort

What to Expect From the Evolving Field of Geriatric Cardiology

Changing Nature of Cardiac Interventions in Older Adults

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