Functional disability and death wishes in older Europeans: results from the EURODEP concerted action.
Ontology highlight
ABSTRACT: Purpose
Physical illness has been shown to be a risk factor for suicidal behaviour in older adults. The association between functional disability and suicidal behaviour in older adults is less clear. The aim of this study was to examine the relationship between functional disability and death wishes in late life.Methods
Data from 11 population studies on depression in persons aged 65 and above were pooled, yielding a total of 15,890 respondents. Level of functional disability was trichotomised (no, intermediate, high). A person was considered to have death wishes if the death wish/suicidal ideation item of the EURO-D scale was endorsed. Odds ratios for death wishes associated with functional disability were calculated in a multilevel logistic regression model.Results
In total, 5 % of the men and 7 % of the women reported death wishes. Both intermediate (OR 1.89, 95 % CI 1.42; 2.52) and high functional disability (OR 3.22, 95 % CI 2.34; 4.42) were associated with death wishes. No sex differences could be shown. Results remained after adding depressive symptoms to the model.Conclusions
Functional disability was independently associated with death wishes in older adults. Results can help inform clinicians who care for older persons with functional impairment.
SUBMITTER: Mellqvist Fassberg M
PROVIDER: S-EPMC4143593 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Associations between disability and depression have been shown to be consistent across cultures among middle-aged adults. In later life the association between disability and depression is much more substantial and may be amenable to influences by health care facilities as well as economic and sociocultural factors. Fourteen community-based studies on depression in later life in 11 western European countries contribute to a total study sample of 22,570 respondents aged 65 years or older. Measures are harmonised for depressive symptoms (EURO-D scale) and disability. Using multilevel modelling to control for the stratified data structure we examined whether the association between disability and depressive symptoms is modified by national health care and mental health care availability, national economic circumstances, demographic characteristics and religious tradition. The association between depressive symptoms and disability is attenuated by health care expenditure and availability of mental health care and also by gross domestic product; it was more pronounced in countries with high levels of orthodox religious beliefs. Higher levels of depressive symptoms are found in countries with a larger gross domestic product (per capita) and higher health care expenses but are interpreted with care because of measurement differences between the centres. The findings from this contextual perspective indicate that general and mental health care should be geared to one another wherever possible.
| S-EPMC5547688 | biostudies-other
Project description:European women live longer, but they experience more old age-related disability than men. Disability is related to social factors, among which is poverty, through various pathways. While women's poverty has been pointed up as a challenge for Europe, our study investigates to what extent and in which countries a greater exposure to economic hardship is associated with older women's disability disadvantage. We used the 2014 EU-SILC data in 30 European countries for men and women aged 50-79 years (N?=?[1179-17,474]). Disability was measured by self-reported activity limitation and economic hardship by difficulties in "making both ends meet" and "facing unexpected expenses". Country-specific nested logistic regressions measured the women's disability disadvantage and its association with economic hardship. We found that activity limitations and economic hardship varied substantially across Europe, being the lowest in Sweden and Norway. We found gender gaps in activity limitations in 23 countries, always to women's disadvantage. After adjusting for age, this disadvantage was significant in 19 countries. In 11 of these countries, women's excess disability is associated with excess economic hardship in women, especially in Iceland, France, Sweden, and Austria. Women's excess disability and social factors such as economic hardship are linked, even in protective countries. These situations of double disadvantage for women deserve attention when designing policies to reduce health inequalities and to promote healthy ageing.
| S-EPMC6797682 | biostudies-literature
Project description:More than two decades of research has consistently indicated that feelings of loneliness among older people are more common in southern Europe than in its northern parts, with the lowest rates in Denmark and Sweden. Our analyses based on analysis of 2004-2006 data from 8,787 individuals aged 65 years or older in the SHARE project replicate, update, and extend these findings. We found, similar to previous studies, that the prevalence of feelings of loneliness was more common in the Mediterranean countries than in Northern Europe. Living together with a spouse/partner was consistently associated with the lower prevalence of loneliness across countries. The combination of living alone and having bad health was associated with 10 times higher odds of feeling lonely as compared with living together with someone and having good health. With regard to gender and health, we found signs of differences between countries in how these factors were related to loneliness. Our results indicate the importance of both contextual features and cultural expectations in interpreting reported loneliness, that is, loneliness across Europe has both nomothetic and idiographic features.
| S-EPMC5547349 | biostudies-other
Project description:Background and objectivesScreening for functional disability is a promising strategy to identify high-need older adults. We compare 2 disability measures, activities of daily living (ADLs), and life space constriction (LSC), in predicting hospitalization and mortality in older adults.Research design and methodsWe used the nationally representative National Health and Aging Trends Study of 30,885 observations of adults aged 65 years and older. Outcomes were 1-year mortality and hospitalization. Predictors were ADLs (receiving help with bathing, eating, dressing, toileting, getting out of bed, walking inside) and LSC (frequency of leaving home).ResultsOf respondents, 12.4% reported 3 or more ADLs and 10.8% reported rarely/never leaving home. ADL disability and LSC predicted high rates of 1-year mortality and hospitalization: of those with 3 or more ADLs, 46.4% died and 41.0% were hospitalized; of those who never/rarely left home, 40.7% died and 37.0% were hospitalized. Of those with both 3 or more ADLs and who never/rarely left home, 58.4% died. ADL and LSC disability combined was more predictive of 1-year mortality and hospitalization than either measure alone. ADL disability and LSC screens identified overlapping but distinct populations. LSC identified more women (72.6% vs 63.8% with ADL disability), more people who live alone (40.7% vs 30.7%), fewer who were White (71.7% vs 76.2%) with cancer (27.6% vs 32.4), and reported pain (67.1% vs 70.0%).Discussion and implicationsLSC and ADLs both independently predicted mortality and hospitalization but using both screens was most predictive. Routine screening for ADLs and LSC could help health systems identify those at high risk for mortality and health care use.
| S-EPMC7817111 | biostudies-literature
Project description:ObjectivesSixty-five per cent of older people have hypertension, but little is known about their preferences and concerns regarding hypertension management. Guidelines on hypertension lack consensus on how to treat older people without previous cardiovascular disease (CVD). This asks for explicit consideration of patient preferences in decision making. Therefore, the aim of this study was to explore older peoples' experiences, preferences, concerns and perceived involvement regarding hypertension management.DesignQualitative interview study.SettingParticipants were selected from 11 general practitioner (GP) practices in the Netherlands and purposively sampled until data saturation was achieved. Semistructured interviews were conducted, audio recorded and analysed by two researchers using thematic analysis.ParticipantsFifteen community dwelling older people aged 74-93 years with hypertension and without previous CVD participated.ResultsInterviewees rarely started the conversation about hypertension management with their GP, although they did have concerns. Reasons for not discussing the subject included low priority of hypertension concerns, reliance on GPs or trust in GPs to make the right decision on their behalf. Also, interviewees anticipated regret of reducing medication, fearing vascular incidents. Interviewees would like to discuss tailoring treatment to their needs, deprescription of medication and ways to reduce side effects. They expected GPs to be more transparent on treatment effects.ConclusionOlder people describe having little involvement in hypertension management, although they have several concerns. Since GPs are also known to be hesitant to bring up this subject, we signal a conspiracy of silence about antihypertensive medication. Through breaking this silence, GPs can facilitate shared decision-making on hypertension management and better tailored care.
| S-EPMC6701601 | biostudies-literature
Project description:Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.
| S-EPMC4441205 | biostudies-literature
Project description:We study whether grandparenthood is associated with older people's subjective well-being (SWB), considering the association with life satisfaction of having grandchildren per se, their number, and of the provision of grandchild care. Older people's education may not only be an important confounder to control for, but also a moderator in the relation between grandparenthood-related variables and SWB. We investigate these issues by adopting a cross-country comparative perspective and using data from the Survey of Health, Ageing and Retirement in Europe covering 20 countries. Our results show that grandparenthood has a stronger positive association with SWB in countries where intensive grandparental childcare is not common and less socially expected. Yet, this result is driven by a negative association between grandparenthood without grandparental childcare and SWB that we only found in countries where intensive grandparental childcare is widespread. Therefore, in accordance with the structural ambivalence theory, we argue that in countries where it is socially expected for grandparents to have a role as providers of childcare, not taking on such a role may negatively influence SWB. However, our results show that grandparental childcare (either intensive or not) is generally associated with higher SWB. Overall, we do not find support for a moderating effect of education. We also do not find striking differences by gender in the association between grandparenthood and SWB. The only noteworthy discrepancy refers to grandmothers being often more satisfied when they provide grandchild care.
| S-EPMC6156724 | biostudies-literature
Project description:The purpose of the study was to describe the prevalence of hearing difficulties, vision difficulties and dual sensory difficulties in 11 European countries, and to study whether sensory difficulties are associated with social inactivity in older Europeans. This cross-sectional study is based on the 2004 data collection of the Survey of Health, Ageing and Retirement in Europe comprising 27,536 men and women aged 50 years and older. Hearing and vision difficulties, as well as participation in seven different social activities were assessed using a structured computer-assisted personal interview. Logistic regression models were used for analyses. Altogether, 5.9 % of the participants reported both hearing and vision difficulties (dual sensory loss), 10.2 % vision difficulties only, and 13.5 % hearing difficulties only. More than two-thirds (68.6 %) of the participants with dual sensory loss were socially inactive compared to half of those who reported no sensory difficulties. The participants who reported dual sensory loss had 2.18 (95 % CI 1.83-2.59) times higher odds for social inactivity compared to persons without hearing or vision difficulties. In a model adjusted for age, gender, mobility, depressive symptoms, cognition, education and wealth the corresponding odds ratio was 1.21 (95 % CI 1.00-1.47). According to our results, sensory difficulties were associated with social inactivity, but the higher likelihood for social inactivity among persons with sensory difficulties was attenuated by other health and socio-economic indicators. Our results suggest that various preventive and rehabilitative actions targeting older persons' sensory functions may enhance their social activity.
| S-EPMC5549142 | biostudies-other
Project description:Community-dwelling older persons often experience hindering health complaints that disturb daily activities. If general practitioners (GPs) are unaware of such complaints, this could lead to a mismatch in provided care and needed or expected care. In this qualitative study with community-dwelling older persons we investigated how older persons experience hindering health complaints, how they deal with them, and what they expect from their GP.Participants (aged ?80 years) with pain and/or problems with walking/standing were invited to participate in a (group)interview about hindering health problems and expectations from general practice. Data were analysed using the framework method and results were discussed with a client panel.Participants experienced various hindering health complaints in addition to pain and/or problems with walking/standing. Complaints affecting social activities were experienced as the most hindering. Participants actively tried to remain independent and, to achieve this, GPs were expected to be involved and be easily accessible. However, they did not expect specific help from their GP for pain or problems with walking/standing. Suggestions for improvement of care from GPs included optimisation of accessibility (continuous availability by telephone), a yearly check including medication review, open communication, and empathy and support during major life events.According to older persons with hindering health complaints, GPs could improve their accessibility/relationship with patients by: 1) continuous telephonic availability, 2) initiating regular contact with medication reviews, and 3) initiating support during major life events. This might lower the reported barriers to contact the GP for hindering health complaints.
| S-EPMC6049904 | biostudies-other
Project description:Using SHARE data, this study was based on an earlier analysis that derived social network types among adults aged 65 and over in Europe. The current effort investigated the transitions that occurred across these network types after 4 years (N = 13,767). Four general network transition patterns were identified according to network type (close-family networks and other networks) and whether a network transition occurred. The associations between network type, network transitions and well-being (depression and life satisfaction) were examined. We regressed depressive symptoms and a life satisfaction measure on the network transition patterns, controlling for socio-demographic background, health and country. The results revealed that a majority of older Europeans experienced a range of network transition, while close-family-based networks tended to prevail over time. Moreover, respondents who remained in or transitioned to close-family networks had fewer depressive symptoms and better life satisfaction than those in other network types. The study, thus, underscores the varied effects of network types and network changes on emotional well-being in late life. It also demonstrates that beneficial changes can be made in one's social network in old age, especially with regard to greater family closeness.
| S-EPMC7292846 | biostudies-literature