Nutritional Risk and Health-Related Quality of Life in Older Adults Aging With HIV

Due to antiretroviral treatment success, individuals with HIV are living longer. People aging with HIV (PAWH, 50+) may be more likely to experience nutritional risk compared to their HIV-negative counterparts due to biopsychosocial factors. The DETERMINE checklist measure accounts for social and economic factors as well as aspects of the aging process that are not typically considered when examining nutritional risk and are important for PAWH. The current study examined nutritional risk and health-related quality of life (HRQoL) in PAWH using the DETERMINE checklist and PROMIS t-scores (mental and physical HRQoL) through secondary analyses of 158 participants in the Strengthening Therapeutic Resources in Older patients agiNG with HIV (STRONG) study. DETERMINE nutritional risk scores (0-21) were separated into 4 groups (low-risk [0-2, n=13], moderate-risk [3-5, n=28], high-risk [6-12, n=78], very high-risk [13-21, n=39]). The sample was 55% male, 94% Black/African American and had a mean age=59 (SD=5.5). Most of the sample (74%) were at high or very high nutritional risk and low HRQoL t-score: physical M=43.7 (SD=9.5), and mental M=45.7 (SD=10.1). Mental and physical HRQoL were significantly (p<.001) associated with nutritional risk group as tested through linear regressions. Means were as follows: physical HRQoL low-risk M=53.4 (SD=10.6), moderate-risk M=47.4 (SD=8.9), high-risk M=43.5 (SD=8.1), very high-risk M=38.4 (SD=8.9); mental HRQoL low-risk M=54.0 (SD=8.9), moderate-risk M=49.1(SD=7.9), high-risk M=46.1(SD=9.5), and very high-risk M=39.5 (SD=9.7). These associations remained significant after controlling for age and sex. Higher nutritional risk as measured by the DETERMINE checklist in PAWH was associated with poorer physical and mental HRQoL.

Health-Related Quality of Life according to Renal Function: Results from a Nationwide Health Interview and Examination Survey

<b><i>Background:</i></b> Most studies on health-related quality of life (HRQoL) in chronic kidney disease (CKD) focus on patients with end-stage kidney disease although they represent a small proportion of patients with CKD. We aimed to analyze HRQoL according to glomerular filtration rate (GFR) categories in a population-based sample of adults living in Germany. <b><i>Methods:</i></b> Data from the German health interview and examination survey conducted from 2008 to 2011 were used. Participants with valid interview and examination data aged 40–79 years were included (<i>n</i> = 5,159). Serum creatinine levels were used to calculate estimated GFR via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. We classified kidney function in GFR categories according to the Kidney Disease Improving Global Outcomes Initiative (KDIGO) guidelines on CKD: G1 (high): ≥90 mL/min/1.73 m², G2 (normal): 60–89 mL/min/1.73 m², G3a (mildly decreased): 45–59 mL/min/1.73 m², G3b (moderately decreased): 30–44 mL/min/1.73 m², G4/5 (severely decreased/end-stage kidney disease): &#x3c;30 mL/min/1.73 m². HRQoL was evaluated with the Short Form Health Survey (SF-36). Different multivariate linear and logistic regression models were used to analyze the association of HRQoL with GFR categories. <b><i>Results:</i></b> Overall, 5.9% had a GFR &#x3c;60 mL/min/1.73 m² (corresponding to categories G3a, G3b, and G4/5). Compared to category G2 linear regression showed a decline in physical HRQoL in categories G3a (−2.34, <i>p</i> = 0.004), G3b (−5.37, <i>p</i> = 0.009), and G4/5 (−4.82, <i>p</i> = 0.117). No decline in mental HRQoL was detected with increasing GFR categories. Categories G3a to G4/5 were significantly associated with a low perceived general state of health (G3a: odds ratio [OR] = 2.03, <i>p</i> = 0.001; G3b: OR = 3.01, <i>p</i> = 0.009; G4/5: OR = 8.70, <i>p</i> = 0.016) when compared to category G2. <b><i>Conclusion:</i></b> In a representative sample of adults living in Germany, both physical HRQoL and the perceived general state of health are already significantly reduced in category G3a.

Patient-Reported Outcomes in Long-Term Survivors of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma: Secondary Analysis of Two Randomized Controlled Trials on Survivorship Care Plans

Background: With advances in multiple myeloma therapy, approximately 1/3 rd of patients receiving frontline autologous hematopoietic cell transplantation (AHCT) are alive and progression-free at 8 years (Perrot et al. ASH. 2020). Although patient-reported outcomes (PROs) with induction therapy and early after AHCT are well-described, little is known regarding PROs in long-term disease-free survivors specifically in myeloma. The objective of our study was to assess health-related quality of life (HRQoL), distress, and healthcare care adherence (HCA) in myeloma survivors who are in a stable remission after AHCT. Methods: The data were obtained from two randomized controlled trials (RCTs), namely, SCP (Survivorship Care Plan) and INSPIRE (Internet and Social media Program for Long Term Hematopoietic Cell Transplant Survivors). Both RCTs enrolled patients who are in a stable remission 1-10 years after AHCT. Our primary objective was to evaluate patient-reported HRQoL, distress and HCA. The secondary objective was to examine association of PROs with available patient (age, sex, race, body mass index [BMI], and health behaviors) and transplant (time since AHCT) variables. BMI was categorized as obese (≥30), overweight (25-29.9), and normal/underweight (&lt;25). HRQoL was assessed by SF-12 v 2 as physical component summary (PCS) and mental component summary (MCS) T scores, with higher scores indicating better functioning and a general population mean of 50 (Standard Deviation [SD] 10). Distress was assessed by Cancer and Treatment-Related Distress (CTXD) instrument, which reports mean scores from 0 to 3, with higher scores indicating greater distress. A CTXD score &gt;1.10 was considered as clinically significant distress based on prior data. HCA was assessed by a standard questionnaire, with scores from 0-1, indicating the proportion of age/sex-specific recommendations adhered to. Results: A total of 345 patients were included, with the median age at AHCT of 61 years (range, 29-76). Median time from AHCT to study entry was 4 years (1.4-11.0). The mean (SD) PCS and MCS T-scores in the study population were 45.5 (±10.5) and 51.3 (± 10.1) respectively, compared to general population T-score of 50 (±10) for both (p-value for differences being &lt;0.001 and 0.021 resp.; Figure 1). The mean CTXD distress score was 0.9 (± 0.6), with 32% of patients having a score of ≥1.1, indicating clinically significant distress. The two CTXD domains with highest burden of clinically significant distress were "Health Burden" and "Uncertainty" (Figure 2). The proportion of patients who met guideline for tobacco, alcohol, exercise, sunscreen, and diet were 94%, 92%, 33%, 23%, and 13% respectively. The proportion of patients who were obese, overweight, normal weight, and underweight was 31.2%, 40.5%, 27.7%, and 0.6% respectively. On multivariable analysis (MVA), factors significantly associated with decreased PCS score were obesity (Parameter Estimate [PE]: -5.0 [±1.6]; p=0.002) and meeting alcohol guidelines (PE: -4.2 [±2.0]; p=0.039), while meeting exercise guidelines was associated with a higher PCS score (PE: 3.4 [±1.3]; p=0.007). Obesity was significantly associated with a decreased MCS score (PE: -3.0 [±1.5]; p=0.05) and meeting sunscreen guidelines was associated with an increased MCS score (PE: 3.0 [±1.4]; p=0.029). Factors associated with lower distress were years since AHCT (PE: -0.04 [±0.02]; p=0.024) and meeting sunscreen guidelines (PE: -0.21 [+/-0.8]; p=0.005). Notably, increased time since AHCT was associated with lower distress in all domains except for identity and medical demands. Better overall HCA was associated with older age (PE: 0.005 [±0.0001]; p&lt;0.001) and female sex (PE: 0.04 [±0.02]; p=0.01) on MVA. Conclusion: To our knowledge, this is the first study to characterize PROs in long-term myeloma survivors post-AHCT. Myeloma survivors have significantly worse physical HRQoL compared to general population but comparable mental HRQoL. Approximately 1/3rd are obese, with obesity being associated with worse physical and mental HRQoL. The inverse association between physical HRQoL and meeting alcohol guidelines could be secondary to abstinence from heavy drinking in those with poor physical functioning. Survivorship programs should address ongoing issues of health burden and uncertainty in myeloma survivors, encourage exercise and physical activity, and focus on groups at risk of poor HCA. Figure 1 Figure 1. Disclosures Devine: Johnsonand Johnson: Consultancy, Research Funding; Magenta Therapeutics: Current Employment, Research Funding; Orca Bio: Consultancy, Research Funding; Be the Match: Current Employment; Sanofi: Consultancy, Research Funding; Tmunity: Current Employment, Research Funding; Vor Bio: Research Funding; Kiadis: Consultancy, Research Funding. Shaw: mallinkrodt: Other: payments; Orca bio: Consultancy. Majhail: Incyte Corporation: Consultancy; Anthem, Inc: Consultancy.

Factors Associated with Health-Related Quality of Life amongst Employees in a Malaysian Public University

The current academic landscape has overwhelmed faculties and with demands to adopt tech-savvy teaching modes and accelerate scholarly works, administrative duties, and outreach programs. Such demands have deteriorated the health-related quality of life (HRQoL) among university employees. This study aimed to determine the factors associated with HRQoL among university employees in a Malaysian public university. This cross-sectional study was conducted among 397 employees from the Universiti Kebangsaan Malaysia (UKM) between April and June 2019. A self-administered questionnaire that consisted of socio-demographic items, risky health behaviors, health-related information, and validated scales for measuring employees’ physical inactivity, psychological states, and HRQoL was utilized. Descriptive and inferential statistics were calculated using SPSS version 23.0. Hierarchical multiple linear regression models were yielded to determine the factors associated with different domains of HRQoL. Mediation analysis was conducted using PROCESS MACRO (Model 4). Statistical significance was set to p < 0.05. Physical HRQoL scored the highest, while environmental HRQoL had the lowest score among the employees. Physical HRQoL was influenced by age, service duration, comorbid conditions, BMI, chronic diseases, and anxiety. Factors associated with psychological HRQoL were age, service duration, depression, and stress. Age, service duration, and chronic diseases affected employees’ social relationship HRQoL, while environmental HRQoL was associated with age, occupation type, chronic diseases, and depression. Socio-demographics, risky health behaviors, health profiles, and psychological attributes were significantly associated with employees’ HRQoL. Age was the only positively correlated factor across all HRQoL domains, while other factors deteriorated employees’ HRQoL.

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study

Background Cardiovascular diseases (CVDs) are among the most common causes of death worldwide, including in Iran. Considering the adverse effects of CVDs on physical and psychosocial health; this study aims to investigate the association between experience of CVDs and health-related quality of life (HRQoL) in adult participants of the Tehran Lipid and Glucose Study (TLGS). Methods The participants of this cross-sectional study were 7009 adults (≥ 20 years) who participated in the TLGS during 2014–2017. Demographic information and HRQoL data was collected through validated questionnaires by trained interviewers. HRQoL was assessed by the Iranian version of the SF-12 questionnaire. Data was analyzed using the SPSS software. Results The mean age of participants was 46.8 ± 14.6 years and 46.1% of them were men. A total of 9.0% of men and 4.4% of women had CVDs. In men, the mean physical HRQoL summary score was significantly lower in those with CVDs compared to those without CVDs (46.6 ± 0.8 vs. 48.5 ± 0.7, p > 0.001). In women, the mean mental HRQoL summary scores was significantly lower in those with CVDs compared to those without CVDs (42.8 ± 1.0 vs. 45.2 ± 0.5, p = 0.009). In adjusted models, men with CVDs were more likely to report poor physical HRQoL compared to men without CVDs (OR(95%CI): 1.93(1.32–2.84), p = 0.001); whereas for women, the chance of reporting poor mental HRQoL was 68% higher in those with CVDs than those without CVDs (OR(95%CI): 1.68(1.11–2.54), p = 0.015). Conclusion The findings of the current study indicate poorer HRQoL in those who experienced CVDs compared to their healthy counterparts with a sex specific pattern. While for men, CVDs were associated with more significant impairment in the physical dimension of HRQoL, women experienced a similar impairment in the mental dimension of HRQoL.

Health-Related Quality of Life, Depressive Symptoms, Anxiety, and Somatization Symptoms in Male and Female Patients with Chronic Tinnitus

Objective: To investigate the joint impact of tinnitus-related distress (TRD), anxiety, depressive symptoms, and other somatization symptoms on health-related quality of life (HRQoL) in female vs. male patients with chronic tinnitus. Method: Three-hundred-and-fifty-two patients with chronic tinnitus completed audiological testing and a psychological assessment battery that comprised—among other measures—German versions of the Tinnitus Questionnaire, Hospital Anxiety and Depression Scale, Somatic Symptom Scale-8, and Health-Related Quality of Life scale. Descriptive analyses examined associations as well as within- and between-gender differences of the measured variables. Gender-specific serial indirect effects analyses aimed to explain the impact of TRD on HRQoL through psychological processes, notably anxiety, depressive symptoms, and somatization symptoms. Results: Both female and male patients yielded lower mental than physical HRQoL and negative associations between the measured psychological variables and HRQoL. Compared to male patients, female patients reported higher levels of tinnitus-related- and wider psychological distress, other somatization symptoms (e.g., headaches), and impairments in mental and physical HRQoL. For each gender, depressive symptoms, anxiety, and somatization symptoms fully mediated the effect of TRD on mental and physical HRQoL. A double-dissociation revealed an interaction of somatization symptoms and depression on the TRD-HRQoL association in women, and of somatization symptoms and anxiety in men. Conclusions: In patients with chronic tinnitus, psychological constructs account for reported impairments in both mental and physical HRQoL. To improve patients’ HRQoL, treatment conceptualizations should consider gender-specific psychological expressions of low mood or anxiety.

Associations between health-related quality of life and physical function in older adults with or at risk of mobility disability after discharge from the hospital

Purpose To optimise the treatment for older adults after hospitalisation, thorough health status information is needed. Therefore, we aimed to investigate the associations between health-related quality of life (HRQOL) and physical function in older adults with or at risk of mobility disability after hospital discharge. Methods This cross-sectional study recruited 89 home-dwelling older people while inpatients within medical wards at a general hospital in Oslo, Norway. HRQOL [the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36)] and physical function [the Short Physical Performance Battery (SPPB)] were measured a median of 49 [interquartile range (IQR) 26–116] days after discharge. Simple linear regression analyses were conducted, and multivariable regression models were fitted. Results The mean age of the patients was 78.3 years; 43 (48.9 %) were females. Multivariable regressions showed positive associations between SPPB and the physical subscales {physical functioning [B (95% CI) 4.51 (2.35–6.68)], role physical [B (95% CI) 5.21 (2.75–7.67)], bodily pain [B (95% CI) 3.40 (0.73–6.10)] and general health [B (95% CI) 3.12 (1.13–5.12)]}. Univariable regressions showed no significant associations between SPPB and the mental subscales {vitality [B (95% CI) 1.54 (− 0.10–3.18)], social functioning [B (95% CI) 2.34 (− 0.28–4.96)], role emotional [B (95% CI) 1.28 (− 0.96–3.52)] and mental health [B (95% CI) 1.00 (− 0.37–2.36)]}. Conclusion The results reinforce that physical function and physical HRQOL are strongly linked, and interventions improving physical function might improve physical HRQOL. However, this hypothesis would have to be tested in a randomised controlled trial. Trial registration ClinicalTrials.gov. Registered 19 September 2016 (NCT02905383).

MO505IMPACT OF THE COVID-19 PANDEMIC ON SYMPTOMS OF ANXIETY AND DEPRESSION AND HEALTH-RELATED QUALITY OF LIFE IN OLDER PATIENTS WITH CHRONIC KIDNEY DISEASE

Background and Aims Older patients with advanced chronic kidney disease (CKD) are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced CKD. Method An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR &lt;20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May-June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally. Results The 82 included patients had a median age of 77.5 years (inter-quartile range 73.9-82.1), 77% was male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious for COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic (Figure 1). Higher COVID-19-related stress was associated with a lower education level (p=0.036), and patients who reported to feel more down due to COVID-19 were more often female (p=0.020). Anxiety scores were higher among females compared to males (median 4.0 [IQR 3.0-9.0] versus 2.0 [0.0-6.0], p=0.020), and weakly associated to a decline in eGFR (correlation coefficient 0.197, p=0.023). Compared to pre-COVID-19, presence of depressive symptoms had increased (11% to 22%; p=0.022) and physical HRQoL declined (40.4±10.1 to 36.1±10.4, p&lt;0.001). Mental HRQoL (50.3±9.6 to 50.4±9.9; p=0.913) and emotional symptoms remained similar. Males showed a greater decline in physical HRQoL (mean -5.3, SD 8.5) compared to females (mean -0.9, SD 5.7; p=0.039). Conclusion Our findings show that older patients with advanced CKD suffered from disease-related anxiety for COVID-19, increased depressive symptoms, and reduced physical HRQOL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental health problems during the pandemic is essential. More in-depth investigation on disease-related COVID-19 concerns and its implications for the CKD population is needed.

FC 112HEALTH-RELATED QUALITY OF LIFE (HRQOL) AND SYMPTOM BURDEN BEFORE AND AFTER START OF DIALYSIS IN OLDER PATIENTS

Background and Aims The number of older (≥65y) people with ESKD starting chronic dialysis increased substantially the past decade because of ageing of the population due to improved health care. In addition, older age is no longer a contraindication for dialysis. Finally, older individuals are more often ineligible for kidney transplantation. Many older people with stage 5 CKD non-dialysis have a low health-related quality of life (HRQOL) and high symptom burden. In this group, improving HRQOL and lowering symptom burden may be deemed more important than solely the prolongation of life. Little is known about the effect of dialysis treatment on HRQOL and symptom burden. Therefore, we investigated the evolution of HRQOL and symptoms before and after the start of dialysis in older ESKD patients. Method The European Quality (EQUAL) study is an ongoing European prospective multi-center follow-up study in late stage 4/5 CKD patients aged ≥65 years. For the present analyses, we included all patients who started dialysis. HRQOL was assessed every 3-6 months using the RAND-36 questionnaire, resulting in a physical component summary (PCS) and a mental component summary (MCS) score. Component scores ranged from 0-100 with higher scores indicating a better HRQOL. Kidney disease-related symptom burden was assessed every 3-6 months using the dialysis symptom index (DSI). The sum score for symptom number ranged from 0 to 30 and for symptom severity from 0 to 150, with higher scores indicating a higher symptom burden. We used linear mixed models (LMM) to explore the evolution of mental and physical HRQOL, symptom number and symptom severity during the year preceding and following dialysis initiation. Results In total, 571 older dialysis patients were included. At baseline (dialysis initiation), mean (SD) age was 76 (6) years, 74% were men, 47% had diabetes, 9% were current smokers, 34% had cardiovascular disease and the mean (SD) residual kidney function was 8.6 (4.4) ml/min/1.73m2. Mean (SD) MSC was 55 (23), PSC was 43 (21), and the number of symptoms was 15 (7) with a symptom severity of 88 (18). Overall, LMM showed that in the year preceding dialysis MCS decreased by 15.7 (95% CI: 11.9 to 19.5), PCS decreased by 12.0 (8.2 to 15.7), symptom number increased by 3.5 (2.5 to 4.6) and symptom severity increased by 5.3 (1.8 to 8.8). In the year following dialysis, MCS increased by 1.9 (-2.7 to 6.5), PCS decreased by 2.1 (-6.9 to 2.8), symptom number decreased by 0.9 (-0.3 to 2.1) and symptom severity decreased by 7.6 (2.8 to 12.4). Conclusion Both mental and physical HRQOL, as well as symptom number and severity, worsened considerably during the year preceding dialysis, but stabilized after dialysis initiation. These results could aid nephrologists in informing older ESKD patients who consider starting dialysis and improve the shared decision making process.

Neurocognitive impairment and health-related quality of life among people living with Human Immunodeficiency Virus (HIV)

The association between HIV-associated neurocognitive impairment (NCI) and health-related quality of life (HRQoL) is not well known. We investigated this association among the CNS (Central Nervous System) HIV Antiretroviral Therapy Effects Research (CHARTER) study participants. We performed factor analysis to distinguish physical and mental HRQoL, followed by general linear models. We analyzed 1,340 HIV participants, including 35.6% with NCI, 77.2% males, 70.5% unemployed, and 42.2% with depression. Impaired participants had lower (worse) mental and physical HRQoL mean scores compared to unimpaired participants. NCI was negatively associated with mental HRQoL in crude (mean difference: -4.38; 95% CI: -6.70 to -2.06) and adjusted analysis (-2.56, -4.83 to -0.30). NCI was also negatively associated with physical HRQoL in unadjusted analysis (-4.62, -7.45 to -1.78), though the association weakened in the adjusted analysis (-2.20, -4.81 to 0.40). The association between NCI and HRQoL was confounded mainly by employment and was partially mediated by depression. These findings suggest that future strategies aimed at improving HRQoL among HIV-infected patients with NCI might benefit from concurrent management of depression.