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Self-reporting quality of life: preventing heart-related deaths

A world-first study has linked older people's self-reported quality of life as a predictor of future cardiovascular disease and other adverse health implications. 

Every day, 118 Australians pass away due to a heart-related illness, and the risks increase with age.

The study, led by researchers from the Monash School of Public Health and Preventive Medicine, followed over 16,000 healthy older people over 65 living independently in Australia and America.

Over nearly five years they looked at how their health-related quality of life (HRQoL) changed and how these changes predicted their wellbeing and health in the future.

They found that those who reported a lower physical quality of life were 50 per cent more likely to develop cardiovascular disease than those reporting high physical HRQoL.

"That's huge, and above the traditional risk factors for these health outcomes," senior researcher Dr Rosanne Freak-Poli says.

Quality of life is the degree to which someone feels comfortable and is able to enjoy life.

To measure that, the team used the 12-item Short Form Survey, which rates someone's physical and mental abilities across eight domains, such as bodily pain and vitality.

"The tool is well-established and frequently used internationally," Rosanne says.

"With the SF-12, we examined how health deterioration can happen over a long period and how that influences our quality of life.

"So we're predicting what it might look like in the future when we look at an older person's self-reported quality of life."

Across the physical and mental domains, the study also found that better physical HRQoL predicted lower risks of cardiovascular disease (14%) and reduced mortality (17%).

Likewise, a higher mental score was associated with lower chances of cognitive decline (12%) and developing dementia (15%).

But not everyone's quality of life is affected in the same way after experiencing a cardiovascular incident or illness, Rosanne says.

"For example, two people can have a heart attack, and for one of them, that heart attack can severely impact their quality of life, while for the other person, it doesn't."

While interest in self-reported tools is growing in Australian healthcare, most research still focuses on younger people who are already living with an illness.

Yet research that measures older people's HRQoL to predict health outcomes can be particularly beneficial since they may be at greater risk of disease and mortality.

"We are the first studies to have shown these strong predictions specifically in older adults," Rosanne says.

"The group were all in general good health, and there was nothing they could foresee that would impact their health within the next five years.

"Of course, over these years, some of our participants passed away, developed dementia or had heart attacks. 

"But many people in the future will survive to older adulthood without adverse health issues."

Currently, the aged care sector relies mainly on clinical indicators, such as a person's weight, blood pressure and medical history.

By incorporating self-reported scores into healthcare, we can capture risks and adverse health outcomes and start intervening early, according to Rosanne.

"The main implication of our research is that we have become more aware of patient-reported outcomes in healthcare and how beneficial that can be for reducing adverse outcomes in the future.

"For nursing homes, in particular, we can start intervening before it becomes a problem – that's the aim."

The research was co-funded by the Heart Foundation and Monash University. 

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