Background
Method
Sample
Measures
Outcome measures
Psychological distress
Quality of life
Fixed and modifiable risk factors
Fixed risk factors
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Demographic factors: age, gender, usual annual household income (coded as < $30,000 per annum versus $30,000+ per annum) and residential status (nursing home/hostel/community).
Potentially modifiable risk factors
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Functional limitations: These were assessed using the Physical Functioning subscale of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36)[51]. This subscale has ten questions that examine limitations in usual role activities because of physical health problems. Activities include: lifting or carrying shopping, climbing stairs, walking, bending, stooping, kneeling, bathing and dressing. The Rand scoring method was applied [52], where all ten questions are scored on a scale from 0 to 100 (100 representing the highest level of functioning possible), and an average of the ten question scores is then calculated.
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Physical health burden: A health burden score was calculated based on the number of five major illnesses (cancer, cardiovascular disease, diabetes, stroke and Parkinson’s disease) endorsed by the survey respondent, whereby a history of a specific illness (“has the doctor ever told you that you have…”) contributed a score of one, yielding a final score out of five. This method of calculating physical health burden is similar to that used in other studies [53‐55].
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Activity level: Three questions from the Active Australia Survey (Australian Institute of Health and Welfare, 2003) were included. These examine the amount of time spent each week (minutes) ‘walking’ and participating in ‘moderate’ and ‘vigorous’ activities. In accordance with the Active Australia Survey scoring criteria, minutes spent in ‘vigorous’ activity are doubled. A final score is derived by adding the scores for ‘walking’, ‘moderate’ and ‘vigorous’ activity together.
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Hours of sleep: Participants were asked to assess: “about how many hours in each 24 hour day you usually spend sleeping (including at night and naps)?”.
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Time spent outdoors: Participants were asked: “about how many hours a day would you usually spend outdoors on a weekday” and “about how many hours a day would you usually spend outdoors on the weekend?” These measures were then totalled to give hours per week.
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Social support: Four questions from The Duke Social Support Index[56] were included. Three questions examined the number of times in the last week that time was spent with family and friends, talking on the phone with family or friends and taking part in group activities. The fourth question assessed the number of people outside of the family and within one hour of home that can be depended on. All items were recoded according to the guidelines in the Duke Social Support manual to give a score between 1 and 3 and are then summed to give a total score out of 12.
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Alcohol consumption: Participants were asked to assess the number of alcoholic drinks they consume each week.
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Time spent sitting: Participants were asked: “about how many hours in each 24 hour day do you usually spend sitting?”
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Psychological distress: Symptoms of psychological distress over the last four weeks were measured by the K10 (as described above).
Statistical analysis
Data transformations
Ethics approval
Results
Residential status | Group comparison | Multiple comparisons | |||||
---|---|---|---|---|---|---|---|
Nursing home (NH) | Hostel (H) | Community (C) | NH vsH Z | NH vsC Z | H vsC Z | ||
Gender (female) % (n) | 57.4 (62) | 58.0 (119) | 57.8 (181) | 0.0 | |||
Income (< $30,000 per annum) % (n) | 83.1 (59) | 75.0 (87) | 70.8 (165) | 4.3 | |||
QOL scores (good/v. good/excellent) % (n) | 56.3 (58) | 61.2 (115) | 83.8 (244) | 43.4** | 0.7 | 32.2b
| 31.3b
|
K10 score (10–50) med (IQR) | 14.0 (9.0) | 14.0 (7.0) | 12.0 (4.0) | 29.1** | −0.02 | −3.7b
| −4.9b
|
Age (years) med (IQR) | 83.2 (14.9) | 82.2 (12.6) | 80.8 (4.9) | 8.6* | −4.5 | −2.1 | −2.6a
|
Physical health burden (0–5) med (IQR) | 1.0 (2.0) | 1.0 (1.0) | 1.0 (1.0) | 6.7* | −1.1 | −0.9 | −2.6a
|
Functional limitations (0–100) med (IQR) | 10.0 (68.3) | 30.0 (50.0) | 70.0 (55.0) | 91.9** | −2.9b
| −7.2b
| −8.1b
|
Physical activity (mins per week) med (IQR) | 60.0 (420.0) | 150.0 (495.0) | 270.0 (629.0) | 32.2** | −2.0 | −5.1 | −4.1b
|
Sleep (hours per day) med (IQR) | 9.0 (5.0) | 8.0 (3.0) | 8.0 (2.0) | 12.4** | −1.5 | −3.2b
| −2.4a
|
Time outdoors (hours per week) med (IQR) | 7.0 (20.0) | 9.0 (18.8) | 16.0 (19.0) | 45.9** | −2.0 | −5.8b
| −5.1b
|
Social support (scaled scores) med (IQR) | 8.0 (3.0) | 8.0 (2.5) | 9.0 (2.0) | 27.6** | −0.2 | −3.6b
| −4.8b
|
Alcohol (drinks per week) med (IQR) | 0 (3.8) | 0 (3.0) | 2.0 (7.0) | 21.5** | −0.2 | −3.3b
| −4.1b
|
Sitting (hours per day) med (IQR) | 8.0 (7.0) | 7.0 (6.0) | 5.0 (3.0) | 34.3** | −1.4 | −5.4b
| −4.1b
|
Fixed risk factors
a) Comparison of residential and community samples
Psychological distress and QOL
Self-reported experience of depression and anxiety
Potentially modifiable risk factors
b) Predictors of psychological distress and quality of life
K10 | |
---|---|
rs
| |
Age
| 0.089* |
Sleep (hours per day) | 0.175** |
Social support (scaled scores) | −0.213** |
Activity (minutes per week) | −0.325** |
Time spent outdoors (hours per week) | −0.254** |
Alcoholic drinks (number per week) | −0.134** |
Time spent sitting (hours per day) | 0.143** |
Physical health burden (0–5) | 0.163** |
Functional limitations (0–100) | −0.430** |
Odds ratio | 95% CI | P | |
---|---|---|---|
Age
| 0.951 | 0.927–0.975 | < 0.001 |
Residential status
†
| 0.282 | 0.191–0.417 | < 0.001 |
Activity (minutes per week) | 1.002 | 1.001–1.003 | < 0.001 |
Physical health burden (0–5) | 0.685 | 0.566–0.830 | < 0.001 |
Functional limitations (0–100) | 1.036 | 1.029–1.044 | < 0.001 |
Time spent outdoors (hours per week) | 1.059 | 1.039–1.078 | < 0.001 |
Social support (scaled scores) | 1.349 | 1.207–1.509 | < 0.001 |
K10 (10–50) | 0.815 | 0.780–0.852 | < 0.001 |
Sleep (hours per day) | 0.837 | 0.762–0.919 | < 0.001 |
Alcoholic drinks (number per week) | 1.069 | 1.029–1.110 | 0.001 |
Time spent sitting (hours per day) | 0.885 | 0.840–0.933 | < 0.001 |
Multivariate analyses
Multivariate analyses for psychological distress
Adjusted for age and residential status | ||||
---|---|---|---|---|
Beta weight | t | Unique r2
| p | |
Fixed risk factors (block 1)
| ||||
Forced entry variables
| ||||
Age | −0.105 | −2.356 | 0.9 | 0.019 |
Residential status | −0.015 | −0.334 | 0.809 | |
Modifiable risk factors (block 2)
| ||||
Included variables
| ||||
Functional limitations | −0.347 | −7.142 | 8.1 | < 0.001 |
Sleep | 0.089 | 2.066 | 0.7 | 0.039 |
Total social support | −0.142 | −3.309 | 1.8 | 0.001 |
Excluded variables
| ||||
Physical health burden, Time spent outdoors, Alcoholic drinks, Time spent sitting | ||||
Total R
2
|
F (df)
|
p
| ||
17.6 | 21.0 (5,490) | < 0.001 |
Multivariate analyses for quality of life
Adjusted for age and residential status | |||
---|---|---|---|
Odds ratio | 95% CI | P | |
Fixed risk factors (block 1)
| |||
Age | 1.005 | 0.966–1.046 | 0.809 |
Residential status†
| 0.087 | 0.302–1.084 | 0.572 |
Modifiable risk factors (block 2)
| |||
Physical health burden | 0.821 | 0.605–1.113 | 0.204 |
Functional limitations | 1.025 | 1.013–1.037 | < 0.001 |
Time spent outdoors | 1.017 | 0.997–1.038 | 0.100 |
Social support | 0.989 | 0.835–1.170 | 0.894 |
K10 | 0.817 | 0.768–0.870 | < 0.001 |
Sleep | 0.961 | 0.835–1.106 | 0.581 |
Alcoholic drinks | 1.028 | 0.975–1.085 | 0.306 |
Time spent sitting | 1.030 | 0.949–1.118 | 0.479 |
Total R
2
| |||
34.8 |