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Biomedical subjects

G I Kempen

Publications and source records attributed to G I Kempen.

At least 19 recordsLinked to original sources
PubMed2001

Chronic disease in elderly couples: are women more responsive to their spouses' health condition than men?

OBJECTIVE: The aim of the present study is to increase knowledge regarding associations between couples' health condition and psychological distress in both spouses considering gender as well as patient/spouse status. METHOD: We examined a community-based sample of 995 elderly couples in which either both spouses were healthy, one of them suffered from chronic disease or both spouses were ill. Both spouses filled out the Hospital Anxiety and Depression Scale. RESULTS: In line with our hypotheses, the results showed an association between women's psychological distress and their own as well as their spouse's health condition, whereas men's psychological distress was associated only with their own health condition. CONCLUSION: The findings demonstrate the need for awareness of gender and patient/spouse differences in psychological distress among elderly couples confronted with chronic disease.

Aged↗
PubMed2001

Changes in health-related quality of life in older patients with acute myocardial infarction or congestive heart failure: a prospective study.

OBJECTIVES: To study changes in health-related quality of life (HR-QL) following acute myocardial infarction (AMI) or congestive heart failure (CHF) in older people (> or = 57 yr). DESIGN: Prospective cohort study. SETTING: Primary healthcare registers. PARTICIPANTS: Patients were enrolled on the basis of primary healthcare records. Eighty-nine AMI patients (mean age = 69.5) and 119 CHF patients (mean age = 74.5) were included for analysis. MEASUREMENTS: HR-QL was conceptualized and measured by means of physical (activities of daily living (ADL), instrumental activities of daily living (IADL)), psychological (depressive symptoms, anxiety), social, and role functioning. Premorbid data (TO) were available from a 1993 community-based survey. Incident AMI and CHF cases, developed after 1993, were prospectively followed for 12 months. Assessments were performed at 6 weeks (T1) and 6 (T2) and 12 months (T3) after diagnosis. RESULTS: At the premorbid assessment, AMI patients did not significantly differ on HR-QL from a reference group of older people, whereas CHF patients were on average older and had worse HR-QL compared to the reference group. Although CHF had not yet been diagnosed at TO, symptoms were already present and resulted in decreased levels of functioning. At T1, all HR-QL measures showed worse functioning compared with TO, except for depressive symptoms that presented later (at T2). In contrast to the delay in depressive symptoms, a significant increase in anxiety was already seen at T1. The effect of the somatic conditions was the largest on physical functioning. Effects on psychological and social functioning were less pronounced but still significant. Effects were maintained during the 12 months of follow-up. CONCLUSION: The negative consequences on HR-QL in both AMI and CHF patients are not temporary. No recovery of function was seen in AMI patients, and functioning of CHF patients continued to decline in the first year after diagnosis.

Activities of Daily Living↗
PubMed2001

Recovery of physical function after limb injuries in independent older people living at home.

OBJECTIVES: to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people. DESIGN: prospective cohort study, including a pre-injury assessment and post-injury assessments at 8 weeks and 5 and 12 months. SETTING: the study is part of the larger, population-based prospective and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over, who are living independently in the north of the Netherlands. SUBJECTS: 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessments (66% of the eligible population). Patients were grouped according to injury site. OUTCOME MEASURE: self-reported grades of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale. RESULTS: 1 year after the injury, pre-injury (mean) levels of functioning were not regained in any of the groups studied. However, only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment. Furthermore, of the 44 subjects with wrist fractures, seven (15.9%) needed help with at least one relevant activity at baseline and 18 (40.9%) at 12 months. Of the 34 subjects with hip fractures, four (11.8%) needed help with at least one activity at baseline and 18 (52.9%) at 12 months. Practically no changes were found in any of the groups after 5 months post-injury. CONCLUSIONS: not only hip fractures, but also wrist fractures may reduce older people's chances of remaining independent. Prospects of further recovery are minimal 5-6 months after the injury.

Activities of Daily Living↗
PubMed2001

Social predictors of recovery in late middle-aged and older persons after injury to the extremities: a prospective study.

OBJECTIVES: The impact of educational level and social support on short-term and long-term recovery of activities of daily living and instrumental activities of daily living after injuries to the extremities was examined in a prospective study concerning late middle-aged and older persons. METHODS: Patients (N = 171) who had sustained fall-related injuries (hip fractures, other fractures, or sprains and dislocations) participated in the study. Disability scores were collected at baseline (before the injury) and 8 weeks, 5 months, and 12 months after the injury. The authors used analysis of variance to assess possible differences between 3 levels of education and social support with respect to changes in disability scores from baseline to the 3 follow-up measurements while adjusting for covariates. RESULTS: Preinjury assessed educational level or social support did not play a role in short-term changes in disability. In the long term (5 and 12 months after the injury), recovery was significantly associated with social support: Those with higher levels of support had a better recovery. Although patients with high levels of education most closely approached their pre-event level of disability as well, differences did not reach statistical significance. Short-term changes in disability appeared to be determined by the severity of the injury. Social support began to influence recovery only when the impact of severity expired. DISCUSSION: Patients recovering from fall-related injuries who had reported high levels of social support before their injury had recovered better at 5 and 12 months. Encouragement and special attention given by health professionals to maintain social support may be beneficial for rehabilitation after fall-related injuries in older persons.

Activities of Daily Living↗
PubMed2000

Which chronic conditions are associated with better or poorer quality of life?

The objective of the present study is to compare the QL of a wide range of chronic disease patients. Secondary analysis of eight existing data sets, including over 15,000 patients, was performed. The studies were conducted between 1993 and 1996 and included population-based samples, referred samples, consecutive samples, and/or consecutive samples. The SF-36 or SF-24 were employed as generic QL instruments. Patients who were older, female, had a low level of education, were not living with a partner, and had at least one comorbid condition, in general, reported the poorest level of QL. On the basis of rank ordering across the QL dimensions, three broad categories could be distinguished. Urogenital conditions, hearing impairments, psychiatric disorders, and dermatologic conditions were found to result in relatively favorable functioning. A group of disease clusters assuming an intermediate position encompassed cardiovascular conditions, cancer, endocrinologic conditions, visual impairments, and chronic respiratory diseases. Gastrointestinal conditions, cerebrovascular/neurologic conditions, renal diseases, and musculoskeletal conditions led to the most adverse sequelae. This categorization reflects the combined result of the diseases and comorbid conditions. If these results are replicated and validated in future studies, they can be considered in addition to information on the prevalence of the diseases, potential benefits of care, and current disease-specific expenditures. This combined information will help to better plan and allocate resources for research, training, and health care.

Chronic Disease↗
PubMed2000

Models of health-related quality of life in a population of community-dwelling Dutch elderly.

OBJECTIVE: Though health-related quality of life (HRQoL) is now commonly measured as an outcome in clinical trials, the relationships between its components remain unclear. The relation of physical symptoms, physical function, and psychological symptoms to each other and to overall quality of life is of special interest. METHOD: Cross-sectional data from 5,279 community-dwelling elders who participated in the Groningen Longitudinal Aging Study were analyzed using structural equation modeling techniques. Three models were examined. One "Linear" model included: number of chronic medical conditions, physical symptoms, physical functioning, activity interference, social function, perceived health and overall quality of life in a simple linear progression. Another 'non-linear' model included these variables, but allowed effects between non-adjacent variables. A third 'non-linear' model included these variables plus anxiety and depressive symptoms. RESULTS: The Linear Model did not satisfactorily account for the observed data [X2(15df) = 2946.96], so the saturated Non-Linear Model, incorporating paths between non-adjacent components, is described. When anxiety and depressive symptoms were added to this Non-Linear Model, they fit best in a position mediating the relation between perceived health and overall quality of life [X2(5df) = 136.78]. CONCLUSIONS: Overall quality of life appears to be related to symptom status as directly as it is related to functional status. Anxiety and depressive symptoms appear to mediate the relation between general health perceptions and overall quality of life. Quality of life measures should therefore include assessments of physical and psychological symptom severity as well as functional status if they are to truly reflect what matters to patients. The disability-adjusted life year (DALY) measure used by the WHO may inadequately reflect the effect of symptoms on patient's quality of life.

Aged↗
PubMed2000

Functional decline after congestive heart failure and acute myocardial infarction and the impact of psychological attributes. A prospective study.

This article examines the influence of three pre-morbidly assessed psychological attributes (i.e. neuroticism, mastery and self-efficacy expectancies) on functional decline after congestive heart failure (CHF; n = 134) and acute myocardial infarction (AMI; n = 79) in late middle-aged and older persons. Due to the prospective design of the study initial baseline levels of functional disability and number of chronic medical conditions could be adjusted, next to age, gender and the severity of either CHF or AMI. Functional disability was re-assessed 8 weeks after the diagnosis of either CHF or AMI. Significant unique contributions of self-efficacy expectancies were found for functional decline after CHF, while mastery significantly contributes to functional decline after AMI: those patients with higher levels of mastery or self-efficacy expectancies showed less decline. In conclusion, pre-morbidly assessed psychological attributes substantially influence functional decline after cardiac disease in late middle-aged and older persons, but the impact of specific attributes is somewhat different for CHF and AMI.

Aged↗
PubMed1999

Do psychological factors influence pain following a fracture of the extremities?

We studied the role of psychological factors on pain following a fracture of the extremities in older adults (n = 111) using a prospective design. Pain and psychological variables measured at baseline, postfracture anxiety and depression, and demographic variables were used to predict pain two months after the fracture. Both moderately severe and serious fractures lead to an increase in pain. Pain at baseline and postinjury anxiety were associated with pain following a fracture of the extremities.

Aged↗
PubMed1999

The relationship of functional limitations to disability and the moderating effects of psychological attributes in community-dwelling older persons.

This paper examines the moderating effects of three psychological attributes (neuroticism, self-efficacy expectancies and mastery) on the association between functional limitations (motor and cognitive limitation, vision and hearing loss) and disability ((instrumental) activities of daily living, role function and social function) in a sample of 624 community-dwelling older persons. In contrast to our hypothesis, we did not find any evidence for interaction effects. This means that low levels of psychological resources do not exacerbate the effect of functional limitation on disability in community-dwelling older persons. We found significant unique contributions of the psychological attributes to disability. Even when all three psychological attributes were taken into account, neuroticism and mastery had unique effects on social and role function, and self-efficacy expectancies had unique effects on (instrumental) activities of daily living. We conclude that the effects of functional limitation and psychological attributes on disability can be considered as additive. Older persons with less psychological resources are particularly at risk in developing disability.

Activities of Daily Living↗
PubMed1999

Morbidity and quality of life and the moderating effects of level of education in the elderly.

The moderating effect of level of education (as an indicator of socioeconomic status) on the associations between chronic medical morbidity and six domains of health-related quality of life (physical function, role function, social function, health perceptions, bodily pain and mental health) is studied in a large community-dwelling elderly sample (N = 5279). The results showed that health-related quality of life is substantially affected by chronic medical morbidity, and that level of education has weak, but significant unique contributions to physical function, social function, health perceptions, and mental health. We did not find substantial evidence for the differential vulnerability hypothesis. At best, low education might amplify the negative effects of the number of chronic medical conditions on mental health only, but this result was not confirmed in four specific disease groups.

Aged↗
PubMed1999

The impact of psychological attributes on changes in disability among low-functioning older persons.

We studied the impact of four psychological attributes (neuroticism, extraversion, mastery or perceived control, and general self-efficacy expectancies) on changes in disability in a community-based sample of 575 low-functioning elderly persons between 1993 and 1995. Unlike elderly persons with low or medium levels of mastery and general self-efficacy expectancies, older persons with high levels of such attributes showed no significant increase of disability between 1993 and 1995. However, multivariate analyses showed only unique contributions of mastery to changes in disability. Neuroticism and extraversion were found to be not related to changes in disability, supporting previous research outcomes. Findings highlight that, particularly, feelings of perceived control are crucial for maintaining functional ability in later life.

Activities of Daily Living↗
PubMed1999

Performance-based and self-reported physical functioning in low-functioning older persons: congruence of change and the impact of depressive symptoms.

This prospective cohort study examines the impact of depressive symptoms on changes in self-reported physical functioning in 574 low-functioning older persons. The data were collected in two waves in 1993 and 1995. Initial levels of depressive symptoms were not predictive for subsequent change in self-reported physical functioning. Changes in self-reported physical functioning were only moderately associated with changes in performance-based physical functioning. The strongest congruence of measured change between self-reported and performance-based physical functioning was found in older persons with increased depressive symptoms. The results suggest that preventing an increase in depressive symptoms may help prevent further deterioration in physical functioning in poorly functioning older persons.

Aged↗
PubMed1998

The impact of physical performance and cognitive status on subsequent ADL disability in low-functioning older adults.

OBJECTIVES: The purpose of this study was to examine the independent contributions of physical performance and cognitive status to subsequent levels of ADL disability in low-functioning non-institutionalized older adults. METHODS: A prospective cohort study included 416 women and 141 men 57 years or older who were living in the community and who reported substantial physical limitation. Physical performance and cognitive status were assessed at baseline in 1993. ADL disability was assessed at baseline and in two follow-ups in 1994 and 1995. Data were analysed with correlation analyses and linear multiple regressions. RESULTS: Both physical performance and ADL disability at baseline were highly predictive of subsequent ADL disability. Although cognitive status was slightly related to (subsequent) ADL disability, we found no independent contributions of cognitive status to subsequent ADL disability. CONCLUSIONS: Measures of both physical performance and ADL disability may identify older low-functioning adults who may benefit from interventions to prevent them from further disablement.

Activities of Daily Living↗
PubMed1998

Relationship of domain-specific measures of health to perceived overall health among older subjects.

The associations between nine domain-specific measures of health (e.g., depressive symptoms, psychological distress, mental health, physical functioning, role functioning, social functioning, bodily pain, somatic symptoms, and chronic medical morbidity) and a single-item measure for perceived overall health were studied in an extensive community-based sample of elderly persons (n = 5279). The results showed that: (1) the discriminative power of perceived overall health compared to domain-specific measures of health was moderate to large only at the fair/poor end of the perceived overall health spectrum; (2) a single-item measure of perceived overall health did not cover domain-specific measurements of health since only 41.8% of the variance in perceived overall health was explained by all domain-specific measures; and (3) the affective domains of functioning (psychological distress, mental health) were weakly related to perceived overall health. Bodily pain, chronic medical morbidity and, to a lesser extent, physical functioning were more strongly related to perceived overall health. These results were fairly consistent for men and women and for three age groups. We conclude that a global, single-item measure of perceived health and domain-specific health measures are not exchangeable in evaluation, survey, or epidemiological research.

Activities of Daily Living↗
PubMed1998

Psychological well-being in older adults suffering from chronic headache.

OBJECTIVE: The aim of this study was to examine two components of psychological well-being--life satisfaction and affective well-being--in community-dwelling elderly with (n = 321) and without chronic headache (n = 4955). METHODS: A checklist of chronic medical conditions was used to determine whether respondents were suffering from headache. Cantril's ladder was employed to measure life satisfaction. The subscale, Mental Health, from the MOS SF-20 was used to assess affective well-being. RESULTS: Headache sufferers reported lower life satisfaction as well as lower affective well-being. However, the difference in life satisfaction between the two groups disappeared after controlling for comorbidity. The difference in affective well-being disappeared after controlling for neuroticism. CONCLUSIONS: Lower life satisfaction in patients with chronic headache is caused by more comorbid diseases in the headache group. Lower affective well-being in headache sufferers is due to higher levels of neuroticism in the headache group.

Aged↗
PubMed1998

Physical fitness related to age and physical activity in older persons.

OBJECTIVE: This study investigated physical fitness as a function of age and leisure time physical activity (LTPA) in a community-based sample of 624 persons aged 57 yr and older. METHODS: LTPA during the last 12 months was assessed through personal interviews. A wide range of physical fitness components was measured using performance-based tests. RESULTS: Physical fitness was associated with the interaction age by LTPA in only a few components, in a gender-specific way, with generally larger differences in fitness between active and less active persons with increasing age. All LTPA, including low intensity LTPA, is positively and age-independent associated with most physical fitness components. CONCLUSION: The importance of LTPA typically participated in by the general population lies not so much in the delaying of the motor aging process but rather in a general, age-independent, positive effect.

Age Factors↗
PubMed1998

Functioning, well-being, and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions.

OBJECTIVES: To expand the landmark Medical Outcomes Study (MOS) and World Health Organization (WHO) findings on the unique association of symptoms of depression with multiple domains of functioning, health perception, and well-being in consulting populations to the late middle-aged and older community-dwelling population and to contrast this unique association to that of specific chronic medical conditions and sensory and cognitive impairment (collectively denoted as medical conditions (MCs)). DESIGN: Population-based, cross-sectional health survey. SETTING AND PARTICIPANTS: A total of 5279 noninstitutionalized late middle-aged and older persons living independently or in residential homes for older people housing in the northern part of The Netherlands. MEASUREMENTS: Behavioral: physical functioning, (Independent) Activities of Daily Living ((1)ADL), and role functioning. Subjective: health perception, life satisfaction and well-being. Mixed: discretionary activities and activity level. Two aspects of the association were examined: the unique risk (adjusted difference in mean outcome between those with the condition and those without, expressed in SD units) and the unique contribution (adjusted proportion of variance in outcome accounted for by the condition). The latter takes the prevalence of the condition into account. RESULTS: Among both individuals with MCs and those without, persons with symptoms of depression did worse on all outcomes than those without. Depressive symptoms were more consequential for subjective and mixed outcomes compared with behavioral outcomes. For all outcomes, none of the unique contributions of MCs exceeded that of depressive symptoms, whereas the unique contribution of depressive symptoms typically outranked those of the MCs. For behavioral outcomes, the unique risks associated with neurological conditions, persistent back problem, arthritis, and stroke exceeded that of depressive symptoms, but risk associated with depressive symptoms exceeded that of nine of 18 MCs, on average. For the mixed and subjective outcomes, none of the unique risks associated with MCs exceeded that of depressive symptoms, but risks of depressive symptoms exceeded those of 16 of the 18 MCs, on average. The effects of depressive symptoms and medical conditions were largely additive although depressive symptoms amplified the effect of some medical conditions on (I)ADL. The pattern of unique risks and contributions was similar across all ages (57-64, 65-74, 75+). CONCLUSION: The unique contribution of depressive symptoms in dysfunction, poor health perception, and well-being typically exceeds that of medical conditions because depressive symptoms combine a moderately large unique risk with a rather high prevalence. Results expand the MOS and WHO findings to the community-dwelling late middle-aged and older population and to additional outcomes as well. Results underscore the importance of detection and management of (comorbid) symptoms of depression in older people.

Activities of Daily Living↗