title: Application of a health-related quality of life conceptual model in community-dwelling older Chinese people with diabetes to understand the relationships among clinical and psychological outcomes.
abstract: OBJECTIVE
  The present study applied the Wilson-Cleary model of health-related quality of life (HRQOL) by using the structural equation modeling (SEM) approach to understand the interrelationships among clinical, sociodemographic and psychological characteristics in older people with diabetes.
  
  
  METHODS
  This was a cross-sectional study with 452 Chinese older people with diabetes recruited from three primary care clinics. A series of assessments were made, including four instruments: the Chinese version of the Short Form 36 Health Survey, Older American Resources and Services Multidimensional Functional Assessment Questionnaire, Rand Mental Health Inventory and Medical Outcomes Study Social Support Survey; and clinical outcomes (diabetes-related characteristics and physiological data).
  
  
  RESULTS
  In the present study, we identified six patient individual and environmental characteristics, namely, age, sex, physical activity, psychological distress, social support and adequacy of income, that significantly influence HRQOL directly or by way of physical functional status and general health perception.
  
  
  CONCLUSIONS
  Improving social and financial support as well as providing interventions to promote physical activity and to cope with psychological distress in this patient population might be effective to eventually enhance their HRQOL. The present findings add to the literature the underlying complex biological and psychological processes of HRQOL, and take the body of knowledge in HRQOL of older people with diabetes to a theoretical level, and provide insights for development of appropriate strategies to optimize their HRQOL.
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong Shatin, Hong Kong SAR, China.
authors.forename: Ann Tak Ying
authors.initials: AT
authors.lastname: Shiu
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong Shatin, Hong Kong SAR, China.
authors.forename: Kai Chow
authors.initials: KC
authors.lastname: Choi
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong Shatin, Hong Kong SAR, China.
authors.forename: Diana Tze Fan
authors.initials: DT
authors.lastname: Lee
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong Shatin, Hong Kong SAR, China.
authors.forename: Doris Sau Fung
authors.initials: DS
authors.lastname: Yu
authors.affiliation: The Nethersole School of Nursing, The Chinese University of Hong Kong Shatin, Hong Kong SAR, China.
authors.forename: Wai
authors.initials: W
authors.lastname: Man Ng
keywords: Diabetes; Quality of life; Structural equation modeling