Comparing the determinants of health perception and quality of life over time in heart and lung diseases: structural equation modeling

PURPOSE: To estimate the longitudinal interrelationship between health, personal, and environmental predictors of Quality of life (QOL) and their impact on QOL among older adults with heart or pulmonary diseases. METHODS: This longitudinal study analyzed data from the International Mobility in Aging Study. Structural equation modeling, guided by Wilson and Cleary model, was used to estimate the relationships among baseline factors (depression, clinical and demographic variables), intermediate outcomes at two-year follow-up (self-efficacy, physical function, and health perception), and QOL at four-year follow-up. Multi-group analysis was conducted to assess differences in health predictors between lung and heart diseases. RESULTS: A total of 479 people were included, with 144 and 335 people reported having pulmonary and heart diseases, respectively. Among people with lung diseases, lower depression, multi-morbidity, and high self-efficacy, health perception, and physical function positively influenced QOL. Among people with heart diseases, lower depression, multi-morbidity, high level of hemoglobin, male gender, non-smoking, high self-efficacy, health perception, and physical function were positively associated with QOL. Heart and pulmonary conditions showed some variations in the strength and significance of these associations; however, multi-group analysis revealed no statistically significant differences between groups. CONCLUSION: QOL in older adults with heart or lung conditions is associated with a number of interrelated factors, including physical function, psychological factors, and health perception. The results highlight the importance of comprehensive assessment using patient-reported outcome measures and support multidisciplinary rehabilitation and self-management approaches that address physical and psychological burden.