Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports. Naylor, M., D., Hirschman, K., B., Hanlon, A., L., Abbott, K., M., Bowles, K., H., Foust, J., Shah, S., & Zubritsky, C. Journal of the American Medical Directors Association, AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc, 9, 2015.
abstract   bibtex   
OBJECTIVES: Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN: A prospective, observational, longitudinal cohort design. SETTING: Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS: A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT: Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS: Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS: Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.
@article{
 title = {Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports},
 type = {article},
 year = {2015},
 identifiers = {[object Object]},
 keywords = {Long-term care,assisted living,home- and community-based services,nursing home,quality of life},
 month = {9},
 publisher = {AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc},
 day = {26},
 city = {NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. Electronic address: naylor@nursing.upenn.edu.; NewCourtland Center for Transitions and Health; University of Pennsylvania School of N},
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 notes = {LR: 20151007; CI: Copyright (c) 2015; GR: R01 AG025524/AG/NIA NIH HHS/United States; JID: 100893243; OTO: NOTNLM; 2015/02/02 [received]; 2015/07/29 [revised]; 2015/07/31 [accepted]; aheadofprint},
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 abstract = {OBJECTIVES: Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN: A prospective, observational, longitudinal cohort design. SETTING: Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS: A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT: Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS: Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS: Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.},
 bibtype = {article},
 author = {Naylor, M D and Hirschman, K B and Hanlon, A L and Abbott, K M and Bowles, K H and Foust, J and Shah, S and Zubritsky, C},
 journal = {Journal of the American Medical Directors Association}
}

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