The overall and domain-specific quality of life of Chinese community-dwelling older adults: the role of intrinsic capacity and disease burden

Abstract

ObjectiveThis study aimed to investigate the impact of the different domains of intrinsic capacity (IC) and chronic disease burden on health-related quality of life (HRQoL) and domain-specific HRQoL in Chinese community-dwelling older adults.DesignA cross-sectional observational study of a community-based cohort.ParticipantsWe evaluated Chinese older adults (n = 429, mean age, 72.91 ± 7.014 years; female proportion, 57.30%).MeasurementsIC contains five domains, namely locomotion, vitality, cognition, psychological, and sensory capacity. Locomotion dysfunction was defined as grip and/or gait decline. Vitality decline was defined if two of the following three parameters were present: fatigue, physical inactivity, and weight loss or overweight. Cognition was classified into normal cognition, pre-mild cognitive impairment (pre-MCI), and MCI according to the normative z-scores of the neuropsychological test battery. Psychological dysfunction was diagnosed based on depressive symptoms. Sensory dysfunction was defined as hearing and/or vision impairment. HRQoL was assessed using the AQoL-8D scale, which comprised physical (including independent living, senses, and pain) and psychosocial (including mental health, happiness, self-worth, coping, and relationships) dimensions. Low HRQoL (HRQoL score or subscores in the highest quintile) was used as a dependent variable in logistic regression analyses adjusted for demographic, health-related, and psychological confounders.ResultsSensory impairment was an independent determinant of senses, and locomotion impairment was significantly associated with overall HRQoL, independent living, and pain in the physical dimension of HRQoL. Cognition was an independent determinant of the senses. Vitality was independently associated with overall HRQoL, senses, and pain in the physical dimension and mental health and relationships in the psychological dimension of HRQoL. The psychological domain of IC was independently associated with overall and domain-specific HRQoL apart from senses after adjustment for all confounders. The number of multimorbidities mainly had a significant impact on independent living after adjustment for all confounders.ConclusionIC domains and chronic disease burden had heterogeneous influences on overall and domain-specific HRQoL. The impairment of sensory and locomotion domains had a synergistic impact on the overall and physical dimensions of HRQoL. The vitality and psychological domains of IC had more profound effects on HRQoL. Older people with high morbidity might have a higher risk of poor independent living.

The effects of sensorial and mobility frailty on the overall and domain-specific cognition performance of Chinese community-dwelling older adults

“…Sensorial frailty mainly affects the domains of senses, and mobility affects the domains of independent living and pain. [ 42 ] In this study, our results indicated that both sensorial and mobility frailty had a significant influence on overall and domain-specific cognitive function, even if the influence of mobility frailty was stronger than that of sensorial frailty. Thus, in order to unify the dimensions of frailty and IC, we suggest that sensory and mobility dimensions of IC should be integrated into the physical frailty phenotype to facilitate clinical research and healthcare, and improve the sensitivity of physical frailty screening instrument.…”

“…Although vitality decline had an extensive negative impact on health-related quality of life, including overall health-related quality of life, the domains of senses and pain in the physical dimension, and the domains of mental health and relationships in the psychosocial dimension after adjustment for demographic, health-related, and psychological confounders, [ 42 ] we did not find an adverse impact of vitality on overall and domain-specific cognitive function. The impact of vitality on cognitive function needs to be investigated using a longitudinal cohort with a large sample and validated assessment tools of vitality.…”

“…The demographic characteristics and health-related factors, including smoking, alcohol intake, and the number of comorbidities, of the 429 participants are reported in our recently published paper (Supplementary Table 1, http://links.lww.com/MD/M790 ). [ 42 ] In the present paper, the proportion of chronic diseases, domain-specific cognitive impairment scores, NPI-Q scores, and global cognitive and social dysfunction scores among all groups are presented in Table 1 . Significant differences among groups were observed in MMSE, Boston naming, animal fluency, digit span forward, social dysfunction scores, and the proportion of diabetes mellitus and stroke.…”

“…[ 34 ] In our previous study, we found that depression had a significant negative impact on overall health-related quality of life; the domains of independent living and pain in the physical dimension but not the senses domain; and all domains of the psychosocial dimension, including mental health, happiness, self-worth, coping, and relationships. [ 42 ]…”