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Sexual activity and enjoyment are considered to be important components of quality of life (QOL) for adults of all ages. However, limited data are available on the effects of health status on sexual activity in women and men older than 50 years. Thus, our aim was to explore the perceived effects of health status on sexual activity in women and men older than 50 years. For this purpose we used data from an age and gender matched control study initially designed to study QOL in patients with low-energy wrist fracture. We investigated patients with wrist fractures older than 50 years (n = 181), as well as age- and gender-matched controls (n = 226), who participated in the QOL study. There were minimal differences between patients and controls, thus the groups were pooled (mean age 67 years (8 SD)). Health-related quality of life (HRQOL) was assessed using SF-36 and 15D, and the global quality of life using the Quality of Life Scale (QOLS). To assess perceived effects of health status on sexual activity we used the question on sexuality from the 15D questionnaires. Group comparisons and logistic regression analyses were conducted. The 15D question on sexuality was not answered by 25% of the participants. Health status having a large negative effect on sexual activity was reported by only 13% of the participants. In the multivariate analyses a large negative effect of health status on sexual activity was associated with higher age (60-69 years: OR = 5.7, 95% CI = 1.62-29.2; 70-79 years: OR = 3.60, 95% CI = 0.94-13.9; >=80 years: OR = 9.04, 95% CI = 1.29-63.4), male gender (OR = 10.8, 95% CI = 3.01-38.9), weight (OR = 1.03, 95% CI = 1.00-1.07), low SF-36 PCS score (OR = 0.88, 95% CI = 0.37-0.93) and a low SF-36 MCS score (OR = 0.92, 95% CI = 0.88-0.96). Only a small proportion of the participants reported their health status to have a large negative effect on sexual activity. Furthermore, health status having a negative effect on sexual activity was associated with decreased HRQOL. Insights into this important topic may increase our awareness as health care workers and help us to address this aspect of QOL in this age group.
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R E S E A R C H Open Access
Perceived effects of health status on sexual
activity in women and men older than 50 years
Gudrun Rohde
1,2*
, Kari Hansen Berg
1,2
and Glenn Haugeberg
1,2
Abstract
Background: Sexual activity and enjoyment are considered to be important components of quality of life (QOL) for
adults of all ages. However, limited data are available on the effects of health status on sexual activity in women
and men older than 50 years. Thus, our aim was to explore the perceived effects of health status on sexual activity
in women and men older than 50 years.
Methods: For this purpose we used data from an age and gender matched control study initially designed to
study QOL in patients with low-energy wrist fracture. We investigated patients with wrist fractures older than
50 years (n = 181), as well as age- and gender-matched controls (n = 226), who participated in the QOL study. There
were minimal differences between patients and controls, thus the groups were pooled (mean age 67 years (8 SD)).
Health-related quality of life (HRQOL) was assessed using SF-36 and 15D, and the global quality of life using the
Quality of Life Scale (QOLS). To assess perceived effects of health status on sexual activity we used the question on
sexuality from the 15D questionnaires. Group comparisons and logistic regression analyses were conducted.
Results: The 15D question on sexuality was not answered by 25% of the participants. Health status having a large
negative effect on sexual activity was reported by only 13% of the participants. In the multivariate analyses a large
negative effect of health status on sexual activity was associated with higher age (6069 years: OR = 5.7, 95% CI =
1.6229.2; 7079 years: OR = 3.60, 95% CI = 0.9413.9; 80 years: OR = 9.04, 95% CI = 1.2963.4), male gender
(OR = 10.8, 95% CI = 3.0138.9), weight (OR = 1.03, 95% CI = 1.001.07), low SF-36 PCS score (OR = 0.88, 95% CI =
0.370.93) and a low SF-36 MCS score (OR = 0.92, 95% CI = 0.880.96).
Conclusion: Only a small proportion of the participants reported their health status to have a large negative effect
on sexual activity. Furthermore, health status having a negative effect on sexual activity was associated with
decreased HRQOL. Insights into this important topic may increase our awareness as health care workers and help
ustoaddressthisaspectofQOLinthisagegroup.
Keywords: Health status, Sexual activity, Quality of life, Elderly
Background
Quality of life (QOL) can be defined in various ways
and may have different meanings or perspectives in
studies. However, it is agreed that QOL is a subjective
and multidimensional concept, which has physical, psy-
chological, social and spiritual dimensions [1]. Sexual
activity and enjoyment are considered to be compo-
nents of these QOL dimensions, particularly the phys-
ical and psychological dimensions [1,2]. As people age,
their physical and mental health decline, thus impaired
health may also affect sexual activity both in women
and men [3].
Previous studies in women and men older than 50 years
have indicated that high QOL is associated with a higher
level of sexual enjoyment [4] and sexual activity [5]. Regular
sexual activity appears to be associated with younger age,
higher income, being in a significant relationship and a
lower body mass index (BMI), while satisfaction with sexual
activity was associated with African-American race, low
BMI and a higher mental score [6]. Furthermore, sexual
problems seem to be associated with decreased QOL [7].
* Correspondence: gudrun.e.rohde@uia.no
1
Faculty of Health and Sport sciences, University of Agder, Servicebox 422,
Kristiansand 4604, Norway
2
Department of Rheumatology, Hospital of Southern Norway Trust,
Kristiansand, Servicebox 416, Kristiansand 4604, Norway
© 2014 Rohde et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Rohde et al. Health and Quality of Life Outcomes 2014, 12:43
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There is a lack of knowledge on the relationship be-
tween perceived health status and sexual activity, in par-
ticular in the population of women and men older than
50 years. Thus, our aim was to explore the effects of per-
ceived health status on sexual activity in women and men
in this age group.
Methods
Study population and data collection
The subjects were recruited from a prospective casecon-
trol QOL study of patients with low-energy wrist fractures
and controls who were assessed at the osteoporosis center
of a regional hospital in southern Norway. In this study
a low-energy wrist fracture was defined as a fracture
followed by minimal trauma falling from standing height
or less. The patients were recruited in a two years period,
2004 and 2005, and were matched for age and gender with
controls from the background population. The final study
population comprised 181 wrist fracture patients (161
women and 20 men) and 226 controls (192 women and
34 men).
In the two year inclusion period, 324 patients with low-
energy wrist fractures were treated at the hospital, and 249
of the patients were clinically examined at the Osteopor-
osis Centre. Among the 75 patients not examined at the
osteoporosis centre, 14 patients were ineligible for bone
mineral density (BMD) assessment because of poor mental
or physical health, 13 patients were tourists, three patients
were not invited for assessment for other reasons, and 45
patients declined to be assessed. Of the 249 patients exam-
ined at the Osteoporosis Centre, 181 met the inclusion
criteria and were willing to enroll in this study. Of the 68
patients assessed at the osteoporosis centre but not in-
cluded in the study, 17 were not able to self-report their
health status because of dementia or confusion. Another
two patients were tourists who did not reside in the geo-
graphic area, three patients were not invited to participate
in the study for other reasons and 46 patients declined to
participate, which give a response rate of 66%. The median
time between fracture and examination at the osteoporosis
centre for the 181 wrist fracture patients was 10 days.
Controls were randomly identified in the national registry
for the catchment area and were consecutively invited to
participate in the study by mail [8-10]. The study protocol
collected a broad spectrum of demographic and clinical
data, which also included three QOL questionnaires: 15D,
SF-36 and the Quality of Life Scale (QOLS) [8-11].
The patients were at inclusion asked to report the status
of their demographic and clinical variables, and QOL,
prior to their fractures. The controls were also asked
about their status and habits at the time prior to inclusion.
The data collected included demographic and clinical
data, exercise levels (greater than 30 min exercise three
times each week), smoking habits, co-morbidities (heart
diseases, pulmonary diseases, neurological disorders, uro-
genital disorders, gastro-intestinal disorders, endocrine
disorders, inflammatory joint disorders, connective tissue
disorders, cancer, and mental disorders) and bone mineral
density measure at femoral neck, total hip and lumbar
spine (L2L4) using dual-energy X-ray absorptiometry, as
listed in Table 1. We also computed a summed score for
co-morbidities to consider the number of diseases in each
participant. The QOL data were collected as described
below.
QOL and health status measures
Item 15 in the 15D questionnaire was used to study the ef-
fect of health status on sexual activity [12]. The 15D ques-
tionnaire is a generic, multidimensional, standardized tool
for evaluating health-related quality of life (HRQOL),
which is used primarily as a single index measure but it
can also be used as a profile utility measure. The 15D
questionnaire captures the health status by assessing 15
dimensions: mobility, vision, hearing, breathing, sleeping,
eating, speech, elimination, usual activities, mental func-
tion, discomfort and symptoms, depression, distress, vital-
ity and sexual activity [2]. Each dimension is assessed by
one question using five response categories. The question-
naire has been tested for psychometric properties in other
studies, within several countries, including Norway [2,13].
Item 15 addresses the effects of health on sexual activ-
ity with the following response options.
My state of health:
1. has no adverse effect on my sexual activity;
2. has a slight effect on my sexual activity;
3. has a considerable effect on my sexual activity;
4. makes sexual activity almost impossible;
5. makes sexual activity impossible.
To analyze the effects of health on sexual activity, we di-
chotomized the five responses to item 15 in the 15D in-
strument, which were related to sexual activity. Responses
1and2weregroupedintono/little effectsand the other
three categories were grouped into large effects.
HRQOL was also assessed using SF-36, which is a self-
reported, generic questionnaire. SF-36 has eight domains:
general health, bodily pain, physical functioning, role limi-
tations (physical), mental health, vitality, social functioning
and role limitations (emotional), which can be combined
into a physical and mental sum scale that reflects physical
and mental health. The physical component summary
(PCS) and mental component summary (MCS) scales
were used in this study. For incomplete questionnaires,
substitution of missing values is based on the scale in-
structions given by the developers of the questionnaire
[14,15]. The SF-36 scales were scored according to pub-
lished scoring procedures and each was expressed as a
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value from 0 to 100 where 100 represented excellent
health [14,15]. The questionnaire has been thoroughly
tested for psychometric properties in other studies, within
several countries, including Norway [14-16].
The global quality of life (GQOL) was assessed using
QOLS, which is a 16-item, domain-specific instrument
[17-19]. In QOLS, GQOL is understood as a broad range
of human experiences related to ones overall well-being
and satisfaction [17,20]. The items are rated using a 7-
point satisfaction scale. If 80% of the questions had been
completed, the missing values in incomplete questionnaires
were replaced with the mean value of answers given by re-
spondents [21]. The questionnaire was scored by adding
up the items to obtain a total score, which ranged from a
minimum of 16 to a maximum of 112. Higher scores indi-
cate better QOL [17]. The questionnaire has been tested
for psychometric properties in other studies, within several
countries including Norway [17,22].
The Modified Health Assessment Questionnaire (MHAQ)
was used to measure a patients ability to perform daily
living activities [23,24]. MHAQ comprises eight items
that cover daily activities, including skills that demand a
Table 1 Demographic, clinical, health status, health-related quality of life and global quality of life variables for all
participants, i.e., respondents and non-respondents to item 15 on the 15D questionnaire
All (n = 407) Respondents (n = 306) Non-respondents (n = 101) p-values
Demograhpic
Age (years) 67 (8) 65 (9) 73 (9) <0.001
Age groups (years)
50-59 121 (30%) 106 (35%) 15 (15%) <0.001
60-69 131 (32%) 111 (36%) 20 (20%)
70-79 122 (30%) 78 (25%) 44 (43%)
80- 33 (8%) 11 (3%) 22 (22%)
Women 353 (87%) 256 (84%) 97 (96%) <0.001
Weight (kg) 72.0 (13.7) 73.3 (13.6) 68.3 (13.3) 0.001
BMI (kg/m2) 26.1 (4.3) 26.2 (4.3) 25.6 (4.4) 0.235
Menopause age (years) 49.3 (4.2) 49.2 (4.4) 49.5 (3.8) 0.522
Higher education (>13 years) 103 (25%) 90 (31%) 13 (13%) 0.001
Married/cohabiting 247 (61%) 215 (71%) 32 (32%) <0.001
Regular exercise* 303 (75%) 237 (78%) 66 (66%) 0.022
Currently smoking 59 (15%) 48 (16%) 11 (11%) 0.231
Co-morbidity
Mean total score for co-morbidity (range 06) 0.9 (0.9) 0.8 (0.9) 1.2 (1.1) <0.001
Clinical status
Osteoporoses** 97 (24%) 58 (19%) 39 (39%) <0.001
1 fall in the previous year 142 (35%) 101 (39%) 41 (47%) 0.191
Previous fracture 194 (47%) 140 (46%) 54 (54%) 0.299
Health status
Mean MHAQ*** 1.05 (0.20) 1.04 (0.17) 1.09 (0.26) 0.015
Health related quality of life
SF-36- PCS**** 51 (9) 52 (9) 49 (10) 0.001
SF-36-MCS**** 51 (9) 51 (9) 49 (11) 0.112
Global quality of life
QOLS***** 95 (10) 96 (9) 93 (12) 0.042
*= more than 30 min three times each week.
**Osteoporosis at total hip and/or spine L2L4.
***The MHAQ score ranges from 1 to 4 where 1 indicates a higher perception of the ability to perform daily living activities.
****The score for SF-36 ranges from 0 to 100 where 100 indicates a high HRQOL.
*****The QOLS score ranges from 16 to 112 where 112 indicates a high GQOL.
PCS = physical component summary, MCS = mental component summary, MHAQ = Modified Health Assessment Questi onnaire, QOLS = quality of life scale.
Continuous variables are expressed as the mean and with standard deviation (SD) in brackets while categorical variables are expressed as numbers and
percentage (%) in brackets. In the group comparisons, independent samples t-tests were used for continuous variables and chi-squared tests were used for
categorical variables.
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good arm function, e.g., dressing, lifting a full cup or
glass to the mouth, and washing and drying the entire
body. The total mean score range is 14where1repre-
sents without any difficultyand 4 is impossible
[23,24]. For incomplete questionnaires, the missing
values were replaced with the mean value of the an-
swered questions of the respondent when at least 6 out
of 8 items had valid response, which is based on the
scale instructions given by the developers of the ques-
tionnaire. A validated Norwegian version of the ques-
tionnaire was used [24,25].
Statistical analysis
Statistical analyses were carried out using the Statistical
Package for Social Sciences (SPSS) for Windows (version
19.0). Differences between two groups were analyzed using
chi-squared tests for categorical variables and using t-tests
for continuous variables. Independent samples t-tests were
used to compare the differences in MHAQ scores, SF-36
scores and QOLS scores between respondents and non-
respondents, and respondents reporting no/little effect
versus large effect for item 15 in the 15D instrument.
Logistic regression analyses using the two comparison
groups (respondents reporting large effect/little effect
for item 15 in the 15D instrument) as the dependent
variables were employed to identify significant associa-
tions (demographic, clinical and HRQOL variables;
Table 1), which were retained for the final multivariate
analysis of the effect of health status on sexual activity.
Multivariate associations were explored by logistic regres-
sion analyses (backward procedure, clinically based), in-
cluding the variables that were significant at a level of 0.15
in the bivariate analyses. The final model included the in-
dependent variables retained from the last step of the
backward procedure in the logistic regression analyses.
The R square was assessed by Nagelkerke R square. Asso-
ciations were also tested for result consistency using enter
and forward methods by logistic regression. The level of
significance was set at p < 0.05.
Ethics
The study was approved by the Regional Committee for
Medical Research Ethics and by the National Data
Inspectorate.
Results
Participants
Among all study participants, 101 (25%) did not answer
the question on sexual activity (men 7%, women 28%, p =
0.001). There were no significant differences between wrist
fracture patients and controls who answered the question
on sexual activity, this tested for all (25% vs 24%, p = 0.80)
and for men (5% vs 9%, p = 0.60) and women separately
(28% vs 27%, p = 0.86). Furthermore, with regard to
demographic and clinical differences between wrist frac-
ture patients and controls there were only minor differ-
ences. Wrist fracture patients had more osteoporosis (p =
0.001), else there were no statistical significant differences
between the two groups [9,10]. Thus, we present the re-
sults for patients and controls as a pooled group. The re-
sponse rates for the other 14 questions in 15D ranged
from 96.3% to 99.5%.
The socio-demographic, clinical and QOL characteristics
of all participants, i.e., respondents and non-respondents to
item 15 in the 15D questionnaire, are shown in Table 1.
Non-respondents were characterized as follows: signifi-
cantly older (p < 0.001), more likely women (p < 0.001),
weighed less (p = 0.001), less highly educated (p = 0.001),
more likely to live alone (p = 0.001), exercised less (p =
0.022), more osteoporosis(p<0.001) and suffered more from
other diseases (p < 0.001), and reported higher MHAQ
(p = 0.015), lower SF-36 PCS (p = 0.001) and lower QOLS
(p = 0.042).
Health status and sexual activity
Of the 306 respondents to item 15 in the 15D question-
naire, no effect on sexual activity was reported by 68%
(wrist fracture patients 76% and controls 62%), little ef-
fect by 19% (wrist patients 14% and controls 23%), con-
siderable effect by 7% (wrist patients 5% and controls
9%), while 2% (wrist patients 2% and controls 2%) re-
ported that sexual activity was almost impossible and 4%
(wrist patients 3% and controls 4%) reported that sexual
activity was impossible. The chi-squared test detected
no significant difference between the wrist fracture pa-
tients and controls (data not shown). Figure 1 shows the
results for the age-groups (p = 0.058).
No\little versus large negative effect on sexual activity
The socio-demographic, clinical and QOL characteristics
of respondents who reported no/little effect of health sta-
tus on sexual activity versus respondents who reported
large effect are described in Table 2. Respondents who re-
ported that their health status had a large effect compared
with respondents who reported no/little effect on sexual
activity were: older (p = 0.004), more likely to be men (p =
0.032), weighed more (p = 0.007), had a higher BMI (p =
0.018) and exercised less (p= 0.001); they also reported
lower SF-36 PCS (p < 0.001), lower SF-36 MCS (p = 0.001)
and lower QOLS (p < 0.001).
In the multivariate analyses (backward method), a
large negative effect of health status on sexual activity
was associated with higher age (6069 years: OR = 5.7,
95% CI = 1.6229.2; 7079 years: OR = 3.60, 95% CI =
0.9413.9; 80 years: OR = 9.04, 95% CI = 1.2963.4),
male gender (OR = 10.8, 95% CI = 3.0138.9), weight
(OR = 1.03, 95% CI = 1.001.07), low SF-36 PCS score
(OR = 0.88, 95% CI = 0.370.93) and a low SF-36 MCS
Rohde et al. Health and Quality of Life Outcomes 2014, 12:43 Page 4 of 8
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score (OR = 0.92, 95% CI = 0.880.96) (Table 3). The
same patterns were obtained using enter and forward
methods in the multiple logistic regression analyses.
Discussion
The main findings of this QOL study of a relatively
healthy population of women and men older than 50 years
(mean age 67 years) were that only a small proportion
(13%) reported that their health status had a large negative
effect on sexual activity. A large negative effect on sexual
activity was associated with being older, male gender, in-
creased weight and lower physical and mental health.
Of those who answered the question on sexual activity,
the majority reported that their health status had no/little
effect on their sexual activity. It is most likely that the par-
ticipants in our study included a relatively healthy group
of women and men older than 50 years and our findings
are influenced by that [10,11]. In a Finnish national health
survey (n = 6681), 12.5% of subjects reported sexual prob-
lems [26], which is in line with our findings. This contrasts
with the study by Helland et al. [12], which found that as
many as 31% of a rheumatoid arthritis (RA) cohort (21%
non-respondents) reported that their health status had a
significant negative impact on sexual activity [12]. This
highlights the severe effects of RA on HRQOL and sexual
activity. In our study increased co-morbidity did not show
a significant association with health status having a large
negative effect on sexual activity (p = 0.06). Previous stu-
dies have indicated that co-morbidities such as cardio-
vascular disorders, diabetes, ankylosing spondylitis (AS)
and mental health problems are correlated with sexual
problems and dysfunctions [27,28].
Previous studies have reported sexual problems to in-
crease with age [3], which partly agrees with our study.
As shown in Figure 1 there was a greater tendency for the
oldest age-group of subjects to report that health status
had a negative effect on sexual activity compared with the
younger one. It is important to note that sexual activity re-
mains a significant part of relationships also in later life
[3]. In our study, increased weight was independently as-
sociated with health status having a large negative effect
on sexual activity. This finding agrees with Addis et al.
who reported a significant association between low BMI
and regular sexual activity, and low BMI and satisfaction
with sexual activity [6], which was also reported by
Heiman [27].
In our study, reduced physical and mental HRQOL
were independently associated with health status having
a negative effect on sexual activity, whereas there was
no significant association with GQOL. This might be at-
tributed to the phrasing of the sexual activity item,
which focuses on health status rather than the GQOL
or overall QOL [15,17,20]. These associations between
HRQOL and sexual activity have also been reported in
other studies [3,7,29].
The low number of patients reporting their health status
to have a large negative effects on sexual activitymay
have weakened the multivariable regression model. The
consequence of this is broad and overlapping confidence
intervals e.g. in the age groups. This limitation should
therefore be taken into account when interpreting our
results.
Itmaybesurprisingthatasmanyas25%ofthesub-
jects did not answer the question on sexual activity, al-
though they participated in a QOL study. This may
partly be explained by that these subjects did not con-
sider this question to be relevant to their life, or that the
participants found this question on their sexual activity
to be too sensitive. This view is supported by that the
response rate for the other 14 questions in 15D ranged
from 96.3% to 99.5%. The relatively low response rate
on sexuality has also been reported by others. In the
study of RA patients with mean age of 58.5 years and
disease duration of 13.4 years, Helland et al. [12] found
that 20% of the patients did not respond to the question
on sexuality in the 15D questionnaire, while Healy at al
[28] in their study found that 10% of their AS patients
did not complete the questions about their sexual rela-
tionship. Finding a suitable partner, age and the rela-
tionship status have been reported to have significant
effects on having regular sexual activity [7]. Addis et al.
[6] reported that younger age and having a significant
relationship were associated with having regular sexual
activity. The gender differences were also striking in our
study. We found that significantly more men (92%) than
women (73%) answered the question on sexual activity.
The findings might reflect the fact that females tend to
outlive their partners, and hence lack of applicability
Figure 1 The effect of health status on sexual activity (item 15
in the 15D questionnaire), stratified for age-groups.
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may be the main reason that women did not responded
to the question [28]. This has also been observed by
other studies [12].
There is a methodological limitation in our study as
fracture patients at inclusion were asked to report their
health condition prior to fracture. This is important as
retrospective evaluations can be biased by recall prob-
lems and response shifts due to the fracture [9-11]. This
may have influenced our results. However because the
data were collected shortly after the fracture, in median
10 days, we believe this may have had limited impact on
the results. The minor differences between fracture pa-
tients and the controls support this view.
The strengths of this study were that all the participants
were consecutively recruited from the same geographical
area and the numbers of participants were relatively high.
The pooling of wrist fracture patients and controls is justi-
fied as there were only minor differences between wrist
fracture patients and the matched controls [8-10].
A major limitation of our study was the cross-sectional
study design, which does not permit any causal interpreta-
tions and can only establish associations between dependent
Table 2 Demographic, clinical, health status, health-related quality of life and global quality of life variables for all
participants who reported that their health status had no/little effect and a large effect on their sexual activity
No\little effect (n = 267) Large effect (n = 39) p-values***
Demograhpic
Age (years) 64 (9) 69 (8) 0.004
Age groups (years)
50-59 101 (38%) 5 (13%) 0.015
60-69 93 (35%) 18 (46%)
70-79 65 (24%) 13 (33%)
80- 8 (3%) 3 (8%)
Women 228 (85%) 28 (72%) 0.032
Weight (kg) 72.5 (13.0) 78.7 (16.3) 0.007
BMI (kg/m2) 26.0 (4.1) 27.8 (5.1) 0.018
Menopause (years) 49.2 (4.5) 49.6 (3.9) 0.658
Higher education (>13 years) 81 (32%) 9 (24%) 0.375
Married/cohabiting 186 (70%) 29 (74%) 0.593
Regular exercise* 215 (81%) 22 (56%) 0.001
Currently smoking 43 (16%) 5 (13%) 0.592
Co-morbidity
Mean total score for co-morbidity (range 06) 0.8 (0.9) 1.1 (0.9) 0.062
Clinical status
Osteoporois** 49 (18%) 9 (23%) 0.489
1 fall in the previous year 89 (39%) 12 (39%) 0.958
Previous fracture 122 (46%) 18 (46%) 0.545
Health status
Mean MHAQ*** 1.0 (0.2) 1.1 (0.2) 0.567
Health related quality of life
SF-36 - PCS**** 53 (8) 44 (9) <0.001
SF-36 MCS**** 52 (8) 44 (12) 0.001
Global quality of life
QOLS***** 97 (9) 89 (11) <0.001
*= more than 30 min three times each week.
**Osteoporosis at total hip and/or spine L2L4.
***The MHAQ score ranges from 1 to 4 where 1 indicates a higher perception of the ability to perform daily living activities.
****The score for SF-36 ranges from 0 to 100 where 100 indicates a high HRQOL.
*****The QOLS score ranges from 16 to 112 where 112 indicates a high GQOL.
PCS = physical component summary, MCS = mental component summary, MHAQ = Modified Health Assessment Questi onnaire, QOLS = quality of life scale.
Continuous variables are expressed as the mean and with standard deviation in brackets (SD) while categorical variables are expressed as numbers and
percentage (%) in brackets. In the group comparisons, independent samples t-tests were used for continuous variables and chi-squared tests were used for
categorical variables.
Rohde et al. Health and Quality of Life Outcomes 2014, 12:43 Page 6 of 8
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and independent variables. Furthermore, the study was fe-
male dominant due to a higher prevalence of wrist fractures
among women. We recruited the participants consecutively
andnonewereexcludedduetogender.Thefemaledomi-
nance might limit the ability to generalize the findings to all
subjects aged 50 years and older. A third limitation is that
the effect of health status on sexual activity was captured by
only one survey item. Sexual activity and enjoyment are
complex phenomena, which should ideally be measured
using several items to capture various aspects [3,6,29]. And
fourth, the participants were relatively healthy women and
men older than 50 years. The exclusion criteria applied in
this study meant that the non-participants were older and a
more nuanced picture may have emerged if these patients
hadbeenincludedinthestudy.Andatlast,theparticipants
were recruited to a study of QOL in fracture patients and
theaimofthepresentstudyisoneoutofseveral\more
focuses.
Conclusion
In our study only a minority of the participants reported
that their health status had a large negative effect on
their sexual activity. A large negative effect on sexual
activity was associated with being older, male gender, in-
creased weight and lower physical and mental health,
and it seems to be associated with HRQOL. Further
studies are required to elucidate sexual activity as a
component of QOL, especially in elderly individuals.
Abbreviations
AS: Ankylosing spondylitis; BMD: Bone mineral density; BMI: Body mass index;
GQOL: Global quality of life; HRQOL: Health-related quality of life;
MCS: Mental component summary; PCS: Physical component summary;
RA: Rheumatoid arthritis; SF-36: Short form-36; s-score: Standard difference
score; SPSS: Statistical package for social sciences; QOLS: Quality of life scale.
Competing interests
The authors declare that they have no competing interests.
Authorscontributions
GR analyzed the data and wrote the manuscript. GH was the principal
investigator for the study. GH and KHB contributed to the content of the paper.
All authors critiqued revisions of the paper and approved the final manuscript.
Acknowledgements
We appreciate the expert technical assistance and help with data collection
provided by our osteoporosis nurses, Hanne Vestaby, Ann Haestad and Tove
Kjøstvedt, as well as Secretary Eli Jensen. Further we thank Are Hugo Pripp at
the Unit for Biostatistics and Epidemiology, Oslo University Hospital for help
with statistics. We also appreciate the critical comments to the manuscript from
Elsa Almås and Esben Esther Pirelli Benestad, both professors in sexology at the
University of Agder, Norway. This work was supported and funded by the
Competence Development Fund of Southern Norway, Hospital of Southern
Norway Trust and Health Southern Norway Regional Trust.
Received: 30 October 2013 Accepted: 22 March 2014
Published: 27 March 2014
Table 3 Multivariate logistic regression model showing the adjusted associations between demographic, clinical and
quality of life variables and reporting that health status had a large effect on sexual activity in the 15D question
Full model or (95% CI) p-value Final model or (95% CI) p-value
Age groups (years)
5059 ref- 0.031 0.037
6069 6.78 (1.8325.1) 0.004 5.70 (1.6229.2) 0.007
7079 4.33 (1.0717.6) 0.040 3.60 (0.9413.9) 0.062
80 8.10 (0.8974.0) 0.064 9.04 (1.2963.4) 0.027
Men 4.78 (1.4316.0) 0.001 10.8 (3.0138.9) <0.001
Weight (kg) 1.04 (1.001.08) 0.028 1.03 (1.001.07) 0.041
Higher education (>13 years) 1.61 (0.544.81) 0.392
Married/cohabiting 1.69 (0.555.27) 0.363
Regular exercise* 1.75 (0.634.87) 0.283
Mean total score for co-morbidity (range 06) 0.58 (0.331.03) 0.061
Wrist fracture group 0.76 (0.272.11) 0.597
SF-36 PCS** 0.89 (0.830.94) <0.001 0.88 (0.370.93) <0.001
SF-36 MCS** 0.93 (0.880.98) 0.007 0.92 (0.880.96) 0.001
QOLS*** 0.98 (0.921.04) 0.506
R
2
44.5% 41.0%
*= exercise for more than 30 min three times each week.
**The score for SF-36 ranges from 0 to 100 where 100 indicates a high HRQOL.
***The QOLS score ranges from 16 to 112 where 112 indicates a high GQOL.
PCS = physical component summary, MCS = mental component summary, QOLS = quality of life scale.
The full model included all of the selected variables entered into the model while the final model included variables in the final step using the
backward procedure.
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Cite this article as: Rohde et al.:Perceived effects of health status on
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Quality of Life Outcomes 2014 12:43.
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... Por otro lado, entre los factores influyentes del deseo sexual se consideran, y enfatizan según autores, el estado de salud (Gervás y de Celis, 2000;Rohde et al., 2014) y determinados estados emocionales ocasionados por diferentes circunstancias en función del ciclo vital: el estrés y cansancio que produce la carga familiar, la corresponsabilidad del ámbito laboral y familiar, la pérdida del cónyuge, etc. (Carmenate et al., 2006). Se citan también los mitos y creencias sociales alrededor de la sexualidad, como el tabú de la sexualidad en la vejez o la pérdida de deseo que acompaña a la menopausia (López y Olazábal, 2006). ...
... La segunda dimensión es el estado de salud, compuesto por variables objetivas (enfermedades, discapacidad y medicamentos) y subjetivas (autovaloración), para observar cómo la salud interviene en las prácticas sexuales. De la bibliografía consultada se extrae que el estado de salud es determinante para el mantenimiento de la actividad sexual en edades longevas (López y Olazábal, 2006;Rohde et al., 2014). En este sentido, ciertas dolencias pueden afectar al desarrollo de una vida sexual plena, como, por ejemplo, aquellas relacionadas con las alteraciones hormonales: la osteoporosis y las alteraciones reumatoides, la cardiopatía isquémica o los procesos neoplásicos, así como tratamientos farmacológicos inhibidores del deseo (Gervás y de Celis, 2000). ...
... Among the factors influencing sexual desire, many authors emphasize the individual's state of health (Gervás and de Celis, 2000;Rohde et al., 2014) and certain emotional states connected to circumstances related to the life cycle: the stress and fatigue caused by the weight of family responsibilities, dualisation in work and family spheres, the loss of a partner, etc. (Carmenate et al., 2006). They also cite myths and social beliefs concerning sexuality, such as taboos about older people having sex or the loss of desire accompanying menopause (López and Olazábal, 2006). ...
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... The 15D instrument has been used in different patient groups when the focus is HRQoL (2,14), and has shown favourable clinometric performance (13,15). ...
... In a large study of 612 AS patients (men 72%) with a mean age of 51 years, 38% reported that their sexual relationships were affected 'moderately', 'quite a bit', or 'extremely' by their AS (3). Sexual problems in AS have been reported to be associated with physical impairment/pain (3,27), disease activity (28), morning stiffness (29), limited joint mobility (30), anxiety and depression (30,31), impaired HRQoL (14,24), and sexual relationship/intercourse (3,32). Previous studies have shown that urogenital disorders may affect sexual function in males (33); however, few patients in our cohort reported urogenital disorders, and none of the male patients reported a varicocele. ...
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Objectives: To characterize sexuality in elderly people of an urban area of Portugal and explore its relationship with quality of life. Type of study: Observational, cross-sectional and descriptive study, with analytical component. Local: Family Health Unit Ramalde, West Porto Group of Health Centres. Population: Patients enrolled in the Family Health Unit Ramalde, aged 65 years or over. Methods: A random sample was obtained using the electronic tool available at www.random.org. The sample size was calculated using OpenEpi®. Users were invited to participate in the study by telephone. For those who agreed to participate, a personal interview was organised using a questionnaire structured in two parts: one prepared by researchers (sociodemographic variables and variables related to sexuality); another corresponding to the SF-12 questionnaire. Data analysis included descriptive and inferential statistics, using the SPSS® v. 24 program. Results: The sample included 213 users, mostly women (59.2%), with a mean age of 73 years (standard deviation=5.96). Half of the users had active sex life (mostly men) and 75% reported being satisfied with their sex life. Males attributed a greater importance to their sex life. There was an association between an active sex life and some dimensions of the SF-12 in both genders. Women's satisfaction with their sex life was associated to the ‘mental health’ dimension. Conclusion: This pioneering study focused on a topic that has been neglected. The importance of sexuality in an age that is sometimes considered ‘asexual’ has been demonstrated, as well as its impact on the quality of life, thus reinforcing the relevance of addressing these issues in primary care consultations.
... La segunda dimensión es el estado de salud, medido a través de variables objetivas (enfermedades, discapacidad y medicamentos) y subjetivas (autovaloración del estado de salud y de la discapacidad), para observar cómo la salud interviene en las prácticas sexuales. De la bibliografía consultada se extrae que el estado de salud es determinante para el mantenimiento de la actividad sexual en la vejez (López & Olazábal, 2006;Rohde, Berg & Haugeberg, 2014). En este sentido, ciertas dolencias pueden afectar al desarrollo de una vida sexual plena como, por ejemplo, aquellas relacionadas con las alteraciones hormonales: la osteoporosis y las alteraciones reumatoides, la cardiopatía isquémica o los procesos neoplásicos, así como tratamientos farmacológicos inhibidores del deseo (Gervás & De Celis, 2000). ...
Article
Objective To examine the prevalence of self-reported problems with sexual activity among psoriatic arthritis (PsA) patients, and to explore potential associations of such problems with various demographic, musculoskeletal, and dermatological disease variables. Method Consecutive PsA patients were recruited from an outpatient clinic. Data collected included demographics, measures of musculoskeletal and skin disease activity, and treatments. Perceived effect of health status on sexual activity was assessed using question number 15 from the health-related quality of life instrument 15D; this was explored in univariate and multivariate logistic regression analyses. Results The study assessed 135 patients (mean age 52.1 years, disease duration 8.7 years, 51.1% male). Mean scores included Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) 2.9, Disease Activity index for PSoriatic Arthritis (DAPSA) 18.2, patient global assessment (PGA) 36.0 mm, pain 33.7 mm, fatigue 45.1 mm, modified Health Assessment Questionnaire (mHAQ) 0.42, Psoriasis Area Severity Index (PASI) 2.5, and Dermatology Life Quality Index (DLQI) 3.4. Twenty-four patients (17.8%) reported that their health status had a large negative effect and 111 (82.2%) that it had no or little effect on their sexual activity. In univariate analyses, a statistically significant association with impaired sexual activity was found for longer disease duration and higher MASES, DAPSA, PGA, fatigue, and mHAQ scores, but not for demographic variables or variables reflecting skin psoriasis involvement (PASI, DLQI). In adjusted analyses, only PsA disease duration remained independently associated with impaired sexual activity. Conclusion One in five PsA patients perceived that their health status had a negative impact on sexual activity. Disease duration and measures reflecting musculoskeletal involvement, but not measures reflecting skin psoriasis involvement, appeared to be associated with impaired sexual activity.
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Changes in patient-reported outcomes like health related quality of life (HRQOL) and global quality of life (GQOL) in patients with low-energy distal radius fracture might be related to fracture, or be within the normal range of variation in an elderly population. Hence, the present study aims to examine: Whether patients with low-energy distal radius fracture attain their pre-fracture levels in HRQOL and GQOL one year after the fracture and compare these levels with age- and sex-matched controls; and whether objective factors predict changes in HRQOL and GQOL during the same one year period. We examined 160 patients and 169 age- and sex matched controls, respectively (mean +/- SD) 67 +/- 9 and 66 +/- 9 years of age. HRQOL was assessed by the Modified Health Assessment Questionnaire (MHAQ) and the Short-Form 36 (SF-36). The Quality of Life Scale (QOLS) assessed GQOL. Paired sample t-tests and multiple linear regression analyses were applied. After one year no differences were found in HRQOL (assessed as arm functions, physical health and mental health) compared to pre-fracture level in the patient group. Both patients with distal radius fracture and controls reported a reduced GQOL after one year (p < 0.001). Low-energy distal radius fracture did not predict worsened HRQOL or GQOL one year after inclusion, and few predictors of changes were identified. Worsened arm function was predicted by low BMI (B = -0.20, p = 0.019) at baseline, worsened physical health was predicted by low education (B = 1.37, p = 0.017) at baseline, and living with someone predicted worsened mental health (B = 2.85, p = 0.009) Patients with a distal radius fracture seem to manage well despite the fracture, and distal radius fracture is not an independent predictor of worsened HRQOL and GQOL.
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Quality of life studies form an essential part of the evaluation of any treatment. Written by two authors who are well respected within this field, Quality of Life: The Assessment, Analysis and Interpretation of Patient-reported Outcomes, Second Edition lays down guidelines on assessing, analysing and interpreting quality of life data. The new edition of this standard book has been completely revised, updated and expanded to reflect many methodological developments emerged since the publication of the first edition. Covers the design of instruments, the practical aspects of implementing assessment, the analyses of the data, and the interpretation of the results Presents all essential information on Quality of Life Research in one comprehensive volume Explains the use of qualitative and quantitative methods, including the application of basic statistical methods Includes copious practical examples Fills a need in a rapidly growing area of interest New edition accommodates significant methodological developments, and includes chapters on computer adaptive testing and item banking, choosing an instrument, systematic reviews and meta analysis This book is of interest for everyone involved in quality of life research, and it is applicable to medical and non-medical, statistical and non-statistical readers. It is of particular relevance for clinical and biomedical researchers within both the pharmaceutical industry and practitioners in the fields of cancer and other chronic diseases. Reviews of the First Edition - Winner of the first prize in the Basis of Medicine Category of the BMA Medical Book Competition 2001: "This book is highly recommended to clinicians who are actively involved in the planning, analysis and publication of QoL research." CLINICAL ONCOLOGY "This book is highly recommended reading." QUALITY OF LIFE RESEARCH.
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The SF-36 was translated into Norwegian following the procedures developed by the International Quality of Life Assessment (IQOLA) Project. To test for the appropriateness of the Norwegian Version 1.1 of the SF-36 in patients with rheumatoid arthritis (RA), 1552 RA patients were mailed the form. Psychometric methods used in previous U.S. and Swedish studies were replicated. The response rate was 66%. The sample (mean age 62 years, mean disease duration 13 years) was over-represented by females (79%). Totally, 74% of the questionnaires were complete. Missing value rates per item ranged from 0.4% to 9.0% (mean 4.2%). In the Role-Emotional scale, all three items had missing value rates above average and higher than reported in the U.S. and Swedish studies. Tests of scaling assumptions confirmed the hypothesized structure of the questionnaire, but results were suboptimal in the General Health scale. In all scales the Cronbach’s alphas exceeded the 0.70 standard for group comparisons. In the Physical Functioning scale, Cronbach’s alpha exceeded the 0.90 standard for individual comparisons. There was good evidence for the construct validity of the questionnaire. Generally, the Norwegian SF-36 version 1.1 distributed to RA patients held the psychometric properties found in other countries and in normal populations. The translations of items in the General Health and Role-Emotional scales were reassessed. Minor deficiencies were detected and changed (SF-36 Norwegian Version 1.2).
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To examine and compare the two utility and health-related quality-of-life (HRQOL) measures 15D and (SF-6D) in fragility wrist and hip fracture patients and controls, study the responsiveness of 15D and SF-6D, and examine the impact of these fractures on changes in 15D and SF-6D scores over 2 years. A total of 152 wrist fracture patients and 164 controls and 61 hip fracture patients and 61 controls with 15D and SF-6D scores were studied. The mean 15D score decreased significantly in wrist fracture patients between baseline and 2-year follow-up (P=0.003). A wrist fracture was a significant predictor of a decrease in 15D scores 2 years after fracture (B=-0.016; P=0.049), along with low body mass index (B=-0.002; P=0.009). In hip fracture patients, both 15D and SF-6D scores decreased significantly (P<0.001). A hip fracture was a significant predictor of a decrease in 15D (B=-0.060; P=0.001) and SF-6D (B=-0.096; P=0.001) scores. Our data suggest that a fragility wrist fracture has a long-term negative effect on HRQOL, but not as strong as for fragility hip fractures. 15D seems to be more responsive than SF-6D when assessing HRQOL in patients with fragility fractures.
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Presents a progress report on developing and applying a research approach to improve the quality of life. Steps in the plan include (a) the empirical definition of the quality of life of adults, (b) surveys of 3 age groups (30-, 50-, and 70-yr-olds) showing their ratings of importance and assessments of needs met for the 15 factors defining quality of life, (c) a study of the specific factors tending to make 85% of American adults report their quality of life as good or better, (d) illustrations showing the advantages of using in-depth studies of individuals to identify the determiners of quality of life, and (e) development of a simulation model to evaluate proposals for improving the quality of life. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The principle methods for developing and validating new questionnaires are introduced, and the different approaches are described. These range from simple global questions to detailed psychometric and clinimetric methods. We review traditional psychometric techniques including summated scales and factor analysis models, as well as psychometric methods that place emphasis upon probabilistic item response models. Whereas psychometric methods lead to scales for QoL that are based upon items reflecting patients' level of QoL, the clinimetric approach makes use of composite scales that may include symptoms and side-effects of treatment.
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The aim of this study was to understand the association between sense of purpose in life and sexual well-being in a cohort of midlife women. Participation in partnered sexual activities and indicators of sexual well-being (the engagement in and enjoyment of sexually intimate activities) were measured in a longitudinal cohort of 677 eligible women aged 40 to 65 years. At a single time point, women completed the Life Engagement Test, a measure of life purpose. Univariable and multivariable mixed models were used to assess the association between the Life Engagement Test and longitudinal sexual well-being. A higher sense of purpose in life was associated with higher levels of enjoyment (coefficient = 2.89, P < 0.001) but not with participation in partnered sexual activity (coefficient = 0.49, P = 0.63) or engagement in partnered sexually intimate activities (coefficient = 1.0, P = 0.30). Participation was associated with younger age, lower body mass index, being married, reporting any vaginal dryness, and better emotional well-being. Hormone therapy use approached, but did not reach significance in association with participation, with P = 0.05. Engagement in sexually intimate activities was associated with younger age, more social support, and better emotional well-being. Higher levels of enjoyment were associated with more social support, better emotional well-being, and less vaginal dryness. Menopause status was not associated with engagement or enjoyment, and only being 5 years or more postmenopausal was related to decreased participation. Higher sense of purpose in life is associated with more enjoyment of sexually intimate activities, adjusting for other known factors that influence sexual well-being and independent of demographic factors and menopause or hormone therapy status.