title: Quality of life impacts on 16-year survival of an older ethnically diverse cohort.
abstract: OBJECTIVE
  The objective of this study is to examine the prediction of mortality, over 16 years, by the domains and domain elements underlying generic measures of quality of life (QoL).
  
  
  METHODS
  The method used was an analysis of mortality in an older (65 + years) representative sample (N = 2130) of a multicultural community in North Manhattan. Five conventional QoL domains were measured by in-home, rater-administered, and computer-assisted questionnaire: depressed mood, pain, self-perceived health, and function and social relationships.
  
  
  RESULTS
  Some domain scales that qualitatively express distress, such as depressed mood and widespread pain, significantly predicted lower mortality (were protective) and felt isolation trended in that direction, whereas domains indicating quantitative limitations such as impairment of functioning in daily tasks, stair climbing, as well as social disengagements and lack of support network significantly predicted higher mortality. Domain elements also mattered; contrary to their domain predictions, increased mortality was predicted by the domain elements of somatic symptoms of depression. Self-perceived poor health reflected the predictive (higher mortality) direction of the limitations cluster.
  
  
  CONCLUSIONS
  The internal complexity of QoL is underscored by differential impacts of domains and elements on mortality. Clinical implications include setting distress domains as important clinical goals, whereas strengthening limiting domains could result in lengthening life and secondarily relieving distress. The relative weighting of these goals could be derived from patient preferences and clinical efficacy. Fundamental implications lie in the interaction between the person's qualitative evaluations of choices and the quantitative building of desired choices for a better QoL.
authors.affiliation: Stroud Centre, Columbia University, New York, NY, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Gurland
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
mesh_terms: D000203:Activities of Daily Living; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality; D010146:Pain; D016016:Proportional Hazards Models; D011788:Quality of Life / Q000523:psychology*; D012934:Social Isolation; D012944:Social Support; D016019:Survival Analysis
keywords: 16-year mortality; fundamental and clinical implications; multicultural older community; quality of life domains