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Avoiding the normative language of ’successful’ or ’positive’ ageing, this book suggests that the quality of life of older persons is related to whether they can pursue their engagements, maintain the social relationships they find suitable and find a satisfying evolution of their dynamic patterns while supporting an orientation to the future. This chapter suggests that a changing landscape of care is likely to constitute a landscape of affordances for older persons, from which they can draw resources to support their development. It then reflects on the issues of moving house as part of the dynamics of ageing in place; moving may actually be part of developmental dynamics. This leads to the question of the right place to age and the timing of moving. The chapter further highlights the many shapes that living in place can take; finally, the chapter concludes with a series of recommendations.
Symptoms associated with chronic inflammation have a negative impact on quality of life (QOL) in adults with inflammatory bowel disease (IBD). Dietary changes may assist in improving symptoms; however, they can be difficult to implement, causing increased stress and decreased QOL. The purpose of this narrative review was to investigate the impact of dietary interventions on QOL in adults with IBD. EBSCOhost was used to simultaneously search eight databases using the search terms ‘inflammatory bowel disease’ or ‘IBD’ or ‘ulcerative colitis’ or ‘Crohn’s disease’ AND ‘dietary interventions’ or ‘dietary advice’ or ‘dietary recommendations’. Inclusion criteria included adults with IBD and a validated QOL measure. After screening 1054 studies, 15 clinical trials were identified. Among these studies, dietary interventions included the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (n = 4), Immunoglobulin G (IgG) diet (n = 2), Anti-Inflammatory Diet (AID) (n = 1), highly restricted organic diet (n = 1), Autoimmune Protocol Diet (AIP) (n = 1), Dietary Modified Program (DMP) (n = 1), Dietary Modified Framework (DMF) (n = 1), Mediterranean diet (n = 2), and a high fibre diet (n = 2). QOL was measured using various validated questionnaires. Significant improvements in QOL were found in two of the low FODMAP diet studies, both IgG diet studies, the DMP, and one high fibre diet study. The Anti-inflammatory Diet, Dietary Modified Framework, Autoimmune Protocol Diet, highly restricted organic diet, and Mediterranean diet did not significantly improve QOL. Future research should focus on comparing dietary interventions, longer study durations, diet adherence and QOL. Due to the complexity in the various diets, dietitians with expertise in IBD are needed to assist with diet management.
Neuromuscular disorders (NMDs) are a heterogeneous group of conditions characterized by progressive muscle weakness, motor impairment and risk of malnutrition, affecting the quality of life (QoL) of patients. While pharmacological treatments are essential for the management of symptoms, the role of diet, nutrition and other lifestyle factors remains underexplored. This narrative systematic review, performed on PubMed, Web of Science, and Scopus following PRISMA guidelines, aimed to investigate the relationship between lifestyle, the progression of NMDs and the QoL. A total of 30 studies (n=5055 patients) met inclusion criteria. According to our search strategy, the most representative lifestyle factors were diet (70%), physical activity (53.3%) and emotional perception and care (36.7%); 7 papers (23.3%) evaluated three or more lifestyle aspects. Overall, both quantitative and qualitative deficiencies emerged: calories, proteins, lipids and fibres, as well as vitamin C, vitamin E, zinc, selenium and calcium were lower than recommended. A reduced consumption of fruits, vegetables, legumes, nuts and seeds, replaced by ultra-processed foods, was detected. Diets optimised for calorie and nutrients intake, rich in anti-inflammatory foods, have shown benefits both in mitigating oxidative stress and muscle degeneration. Regarding other aspects of lifestyle, although physical activity was associated with improved motor performance and QoL, adherence was low, particularly among females. Negative emotional status emerged as a critical factor influencing patients’ overall well-being. Even in the most complex neuromuscular disease settings, addressing nutrition and dietary habits, in the context of lifestyle, could support patients and their families throughout the disease course and improve their QoL.
This study investigates the relationships between family burden, perceived social support, quality of life and happiness among mothers of individuals with intellectual and developmental disabilities (IDDs).
Aims
This study aimed to examine the relationship between family burden and maternal happiness, and to investigate the serial mediating roles of perceived social support and family quality of life in mothers of children with IDDs.
Method
The study sample comprised 250 mothers of children with IDDs. Data were collected using validated instruments: The Multidimensional Scale of Perceived Social Support, a family burden scale, the Beach Center Family Quality of Life Scale and the Oxford Happiness Questionnaire Short Form. Descriptive statistics, correlation analyses and structural equation modelling were conducted with software SPSS 26.0 and JASP 0.16.4.
Results
Perceived social support and family quality of life were positively associated with happiness and negatively associated with caregiving burden; structural equation modelling indicated that their sequential mediation fully explained the link between family burden and happiness.
Conclusions
The findings underscore the critical role of social support and family quality of life in mitigating the negative impact of caregiving burden on maternal happiness.
This study examines the determinants of veterinary clinic closures across urban and rural communities in the United States, analyzing a unique longitudinal dataset of over 11,000 veterinary practices. Findings indicate that large-animal clinics are more likely to close than small or mixed-animal practices, especially in rural areas. Larger clinics and those in metropolitan counties have improved survival rates. The presence of local amenities – particularly shopping outlets and higher-quality schools – is associated with lower closure rates. The results highlight the importance of community amenities in supporting veterinary practice sustainability and access to veterinary care.
The PReDicT study showed that predictive algorithm-guided antidepressant treatment reduces anxiety and improves functioning in patients with depression.
Aims
To estimate the costs, outcomes and cost-effectiveness of the PReDicT test compared with treatment as usual (TAU) for primary depression care in five European countries.
Method
Within-trial economic analysis was conducted over 24 weeks from the health/social care and societal perspectives alongside the PReDicT trial (NCT02790970) in France, Germany, The Netherlands, Spain, and the UK, according to Consolidated Health Economic Evaluation Reporting Standards guidelines. We calculated quality-adjusted life-years (QALYs) based on the EQ-5D-5L, capability-weighted life-years based on the Oxford Capabilities Questionnaire – Mental Health (OxCAP-MH) (Germany and UK only), and costs for 2018 (€). Multiple imputation for missing data, multivariable regression for cost and outcome differences, and bootstrapping and sensitivity analyses for uncertainty were conducted.
Results
There were significant outcome improvements (EQ-5D-5L PRedicT: +0.139; TAU: +0.140) and societal cost reductions (PRedicT: −€2589; TAU: −€2602) in both groups (N = 913) between the before and during trial periods. In the UK and Germany (n = 619), the PReDicT group showed significant additional capability well-being gains (OxCAP-MH: +2.127, p = 0.021). Cost-effectiveness probabilities ranged from 46 to 59% at trial level, but exceeded 80% in the UK. Results remained stable across different sensitivity analyses, with societal cost-effectiveness improved for those (self-)employed.
Conclusions
We observed potentially meaningful health and economic benefits of closely monitored antidepressant treatment, as implemented in both treatment and control arms of the PReDicT trial. The PReDicT test itself had some added benefits in improved capabilities and productivity, however, with great uncertainty and country-level variations in cost-effectiveness.
This study aimed to compare Merocel and Surgicel nasal packing following inferior turbinoplasty, focusing on post-operative bleeding, pain, discomfort and nasal obstruction.
Methods
A randomised controlled trial (2017–2021) was conducted in the Department of Otolaryngology, Changi General Hospital, Singapore. Sixty adults undergoing inferior turbinoplasty and/or septoplasty were randomised to receive Merocel or Surgicel packing. Standardised surgical and post-operative protocols were used. Outcomes—bleeding, pain, discomfort and nasal obstruction—were assessed on post-operative day 1 and post-operative days 5–7 using validated scales.
Results
Fifty-eight patients completed the study (Merocel = 30; Surgicel = 28). On post-operative day 1, Surgicel had significantly lower nasal obstruction scores (1.57 ± 0.74 vs 2.10 ± 0.71; p = 0.008). By post-operative days 5–7, Merocel showed significantly less bleeding (0.77 ± 0.63 vs 1.18 ± 0.86; p = 0.044). Pain and discomfort were comparable.
Conclusion
Merocel provided superior sustained haemostasis, while Surgicel offered better early comfort. Both materials have comparable outcomes.
The objective was to identify, critically appraise, and synthesize evidence on the effectiveness of dance interventions on quality of life (QoL) for adults aged 60+ living in long-term care (LTC).
Methods
A systematic review, initiated and co-led by patient partners, was conducted following a search across eight electronic databases. Eligible studies included randomized controlled trials, quasi-experimental, and observational designs reporting QoL or health-related QoL outcomes. Reviewers independently completed title/abstract and full-text screening. Data extraction included study characteristics, intervention details, outcome measures, use of theory, proposed mechanisms of action, and intervention effectiveness.
Findings
Seven studies involving 429 participants were included. Six studies reported improvements in QoL or health-related QoL. Five studies used a dance intervention targeted to a specific country or cultural group. Two studies identified potential mechanisms of action.
Discussion
Dance interventions may improve QoL in older adults living in LTC. Research with more theory-driven, mixed methods, and/or co-created designs is needed.
The Mediterranean Diet (MedDiet) and physical activity (PA) can enhance mood and support psychological wellbeing in adults. However, the combined effect is relatively unknown. MedWalk aimed to determine the combined effect on wellbeing, psychological health and quality of life (QoL), compared to a control group.
Design:
This is an analysis of secondary outcomes from the MedWalk 12-month cluster-randomised controlled trial. Participants completed the Total and Secure Flourishing Index (FI), the four domain General Health Questionnaire (GHQ-28) and the 8-domain Assessment of Quality of Life (AQoL-8D). Data were analysed using general linear models using change scores (FI and AQoL-8D) or generalised linear mixed models with a time × group interaction effect (GHQ-28).
Setting:
Independent living facilities across South Australia and Victoria in 2021–2022.
Participants:
One hundred and sixty-one older men and women.
Results:
Participants were 74·9 ± 5·9 years of age and predominantly female (74 %). A greater improvement was found for the MedWalk group (marginal means (MM) = 1·65, se = 1·36) than the control group (MM = –2·50, se = 1·32) for the Total Flourish score (P = 0·003) and Secure Flourish score (P = 0·009) ((MM = 1·06, se = 1·65) v. (MM = –3·34, se = 1·61)) from baseline to 6 months. The MedWalk group (MM = 0·021, se = 0·014) had more positive changes (P = 0·048) to the Mental Health AQoL-8D domain than the control group (MM = –0·007, se = 0·014). No significant group × time interactions were identified for the GHQ-28.
Conclusions:
Combined MedDiet and walking interventions can modify psychological health, wellbeing and QoL in relatively healthy populations.
The importance of Financial Distress (FD) for German cancer patients is rising and data on FD is increasingly being collected in clinical trials. However, the role of FD in German early benefit assessments (EBAs) remains unclear. We systematically analyze the role of FD in EBAs for oncology drugs in Germany by investigating how often and for what reasons FD is excluded for EBA by pharmaceutical companies, how often and in which ways FD is referenced in scientific assessments by German HTA authorities (IQWiG and G-BA), and how FD influences added benefit decisions.
Methods
Our analysis covered all completed, currently valid German EBAs of oncology drugs from 2011 to 2024. We calculated exclusion rates, reference rates and benefit decisions, stratified by drug type, FD results, exclusion and reference status. In qualitative analyses, we inductively categorized reasons for FD exclusion and types of FD references.
Results
FD currently plays at most a subordinated role for German EBAs across all involved stakeholders. Almost half of dossier submissions excluded FD from EBA, even though data on FD was collected. The IQWiG referenced FD in only 25 percent of their scientific assessments. Furthermore, the G-BA referenced FD in only three out of 215 justifications of resolution. HTA authorities have divergent and inconsistent approaches to FD.
Conclusions
German HTA authorities should strengthen the role of patient-reported outcomes and provide clearer methodological guidance for integrating psychosocial dimensions such as FD. Future research should focus on refining measurement strategies to better capture the multidimensional nature of FD.
Individuals with severe mental illnesses (SMIs) experience anxiety that impairs functioning and quality of life. This cluster randomized trial evaluated exposure-based cognitive behavioral therapy (ebCBT) integrated into assertive community treatment (ACT) teams to reduce anxiety.
Methods
Fifteen ACT teams were allocated to ebCBT + ACT (k = 8, n = 50) or ACT-only (k = 7, n = 43). The intervention followed four steps: situation identification, four-component analysis (behavior, cognition, emotion, physical symptoms), psychoeducation, and graded exposure. Staff received 50 h training and bimonthly supervision over 12 months. Co-primary outcomes were trait and social anxiety; secondary outcomes were psychiatric symptoms, functioning, quality of life, and recovery.
Results
The ebCBT + ACT group showed significant improvements in State–Trait Anxiety Inventory–Trait scores at 12 months (AMD = −5.30, 95% CI = −8.71 to −1.90, p = 0.002, d = −0.64) and 18 months (AMD = −7.22, 95% CI = −12.1 to −2.34, p = 0.004, d = −0.60). Brief Fear of Negative Evaluation scores showed near-significant improvement at 18 months (AMD = −3.70, 95% CI = −7.44 to 0.04, p = 0.052, d = −0.40). Secondary outcomes, including global functioning, recovery, and quality of life, also improved. Cost-effectiveness analyses indicated favorable cost-effectiveness for anxiety outcomes.
Conclusions
Embedding ebCBT within ACT services may reduce anxiety-related fear and avoidance and enhance recovery-related outcomes in individuals with SMI. These findings support the feasibility and clinical value of integrating structured psychological interventions into intensive community-based outreach services.
To examine the relationships between patient activation, depressive symptoms, and quality of life among older adults receiving palliative oncology care.
Methods
A cross-sectional correlational study was conducted among 145 adults aged ≥60 years receiving palliative oncology care at King Khalid Hospital, Saudi Arabia, using stratified random sampling. Data were collected via a demographic and clinical questionnaire, the Patient Activation Measure-13 (PAM-13), the Patient Health Questionnaire-9 (PHQ-9), and the McGill Quality of Life Questionnaire–Revised (MQOL-R). Descriptive statistics, Pearson correlation, independent t-tests, one-way ANOVA, and multiple linear regression were performed using SPSS version 26.
Results
All participants demonstrated Level 2 patient activation, with a mean PAM-13 score of 50.83 (SD = 1.04). Moderate depressive symptoms were prevalent (mean PHQ-9 = 13.56, SD = 3.48), and overall quality of life was moderate (mean MQOL-R = 55.21, SD = 10.14). Patient activation was weakly but significantly inversely correlated with depressive symptoms (r = −0.179, p < 0.05). No significant associations were found between patient activation and quality of life, or between depressive symptoms and quality of life. Regression analysis showed that patient activation, depressive symptoms, and demographics accounted for only 3.2% of the variance in quality of life (R2 = 0.032, p = 0.714).
Significance of results
Patient activation may modestly reduce depressive symptoms but is not sufficient to improve quality of life in older adults receiving palliative oncology care. Quality of life appears influenced by broader multidimensional factors beyond activation and mood, highlighting the need for comprehensive interventions in palliative care settings.
Quality of life (QoL) is an important clinical outcome in mental health. However, evidence on its progression and predictors in individuals at clinical high risk for psychosis (CHR-P) remains limited. This meta-analysis examined correlates, impact, and longitudinal changes in QoL among CHR-P individuals.
Methods
Following PRISMA guidelines (PROSPERO: CRD42024560092), we systematically searched multiple databases from inception to 27 May 2025. Eligible studies included CHR-P participants assessed with validated QoL instruments. Data extraction was performed independently, and meta-analyses, meta-regressions, heterogeneity, and publication bias analyses were conducted. Risk of bias was evaluated using a modified Newcastle–Ottawa Scale (NOS).
Results
Thirty-one studies were included (2,288 CHR-P individuals; mean age = 21.47 years; 48.9% female). Compared with healthy controls (HC), CHR-P participants showed significantly poorer QoL (Hedges’ g = 1.39, 95% CI = 0.97–1.83). Longitudinal analyses indicated QoL improvements after 1 year (Hedges’ g = 1.40, 95% CI = 0.74–2.07) and at 2–3 years follow-up (Hedges’ g = 3.24, 95% CI = 0.73–5.75). Substantial heterogeneity was observed across analyses. Meta-regressions showed no significant influence of age, sex, functioning, symptom severity, or study quality. Study quality scores ranged from 1 to 8 (median = 6, mean = 5.8, SD = 1.13).
Conclusions
Individuals at CHR-P present markedly poorer QoL compared with healthy controls. Longitudinal data suggest possible improvements over time; however, heterogeneity and limited long-term evidence warrant cautious interpretation. Further longitudinal studies are needed to better characterize QoL trajectories and identify subgroups requiring sustained intervention.
Hepatocellular carcinoma (HCC) is associated with high mortality and imposes substantial symptom and psychological burdens; however, the impact of different treatment modalities on quality of life (QoL) and mental health remains underexplored. This study aimed to examine the associations among symptom distress, depression, and QoL across various HCC treatments.
Methods
A cross-sectional study was conducted with 101 inpatients at a regional hospital in Taiwan (October 2020–December 2021). Patients received hepatic resection (HR), radiofrequency ablation (RFA), transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), or immunotherapy (IT). Data were collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), the Hospital Anxiety and Depression Scale (HADS), and the Brief Symptom Rating Scale (BSRS).
Results
RFA patients reported better functional scores (96.13 ± 7.55) and lower HADS scores (18.31 ± 4.92) than those treated with TACE, HAIC, or IT (function: 87.77 ± 17.77; HADS: 23.26 ± 7.66). These differences may reflect earlier disease stage and better baseline health in RFA recipients. Older age and advanced stage were associated with poorer global health (p < 0.05), while female gender (β = − 7.38, p = 0.014) and disease recurrence (β = − 6.48, p = 0.019) were associated with lower functional status.
Significance of results
Treatment type, disease stage, and demographics significantly shape QoL and mental health in HCC patients. Minimally invasive therapies like RFA may preserve QoL in early-stage disease, while invasive or palliative treatments necessitate greater psychosocial support.
Human papillomavirus (HPV) infection has a negative impact on quality of life (QoL) and sexual function, mainly owing to increased levels of anxiety and distress.
Aims
To examine the potentially moderating effects of general psychological health on the relationships between (a) HPV-related psychosocial burden and QoL and (b) HPV-related psychosocial burden and sexual function.
Method
The HPV Impact Profile, Female Sexual Function Index, General Health Questionnaire-28 and Life Satisfaction Inventory questionnaires were completed by 151 women.
Results
HPV-related psychosocial burden and general psychological health accounted for 23.2% of QoL variability. There was not strong evidence for a moderating effect of general psychological health on the relationship between HPV-related psychosocial burden and QoL. Higher HPV-related psychosocial burden predicted worse sexual function on average. However, HPV-related psychosocial burden accounted for only 4.1% of sexual function variability.
Conclusions
Higher HPV-related psychosocial burden is associated with lower QoL as well as worse sexual function. General psychological health predicts changes in QoL over and above HPV-related psychosocial burden; thus, a deep understanding of emerging mental health issues soon after diagnosis is crucial to improve counselling and enhance women’s mental empowerment to achieve a better psychological response.
Emotional-approach coping (EAC), including emotional expression (EE) and emotional processing (EP), may impact stress and quality of life (QOL) in cancer populations, with some evidence that EAC effects vary by sex.
Methods
Men (n = 85) and women (n = 63) with renal cell carcinoma (RCC) completed the EAC Scale, Perceived Stress Scale (PSS), and 36-item Medical Outcomes Study Short Form Survey (SF-36) physical component scale (PCS) and mental component scale (MCS) at study entry and 10 months later. The PROCESS macro (model 7) was used to examine the indirect effect of baseline EAC (EE, EP) on 10-month QOL (PCS, MCS) via baseline PSS, with sex as a moderator of the association between EAC and PSS (i.e., four models of moderated mediation).
Results
Bootstrap estimates of indirect effects revealed significant moderated mediation, such that, for female participants, greater EE at study entry was associated with lower PSS, which in turn was associated with higher PCS and MCS 10 months later; whereas for males, EE was not associated with PSS and was not indirectly associated with physical and mental health-related QOL via PSS. Models examining the indirect effects of EP on QOL via PSS were nonsignificant for male and female participants.
Significance of results
EE is an important correlate of perceived stress for females but not males with RCC. Perceived stress early in treatment has a robust association with subsequent health-related QOL. Interventions aimed at supporting EE for females with RCC may have long-term QOL benefits.
Cardiac arrest survivorship is a burgeoning phenomenon, largely driven by advances in intensive care and widespread public health campaigns aimed at improving resuscitation outcomes. However, the specific risk factors, mediators, and effective interventions that support long-term survivorship and recovery remain insufficiently understood and are the focus of ongoing research. Survivors of cardiac arrest face multifaceted challenges that affect various aspects of health, including physical, cognitive, psychological, and social well-being. Psychological distress, cardiac anxiety, and the stability of the family unit following cardiac arrest emerge as key factors influencing recovery. Targeted interventions that address the distinct phases of critical illness and recovery following cardiac arrest are crucial and warrant further investigation and implementation.