INTRODUCTION

Population aging is a demographic phenomenon of global reach^1,2, which often presents a variety of challenges for healthcare systems, as it requires maximizing the health and functional capacity of older adults, as well as their safety and participation in society^3,4, However, in this population, it is often identified that their needs and requirements are not being met^5,6, This has led to the growth of chronicity, whose approach is based on three end-of-life trajectories: oncologic diseases, dementia - frailty, and chronic organ failure⁷.

Advanced chronic organ failure may affect 1% of the adult population, and it is assumed that 75% of patients with progression of one or more organ failures will have fatal outcomes.⁸, For this reason, it not only involves a gradual deterioration of health but also changes in habits and daily life, functional and nutritional limitations, impairment of socio-family life, constant dependence on clinical follow-up and even existential conflicts and spiritual anguish, aspects that have a direct impact on the patient's quality of life^9,10.

Based on the quality of life, in Peru, in the year 2000, the "National Plan for Older Adults (PLANPAM)" was created, which promotes active and healthy aging through four national policies: "healthy aging", "employment, social security and social security", "participation and social integration" and "education, awareness and culture on aging and old age", thus encompassing human rights, gender equality and intergenerationality in older adults.¹¹.

Given the above, the scientific community made it essential to investigate those characteristics or features of exposure associated with the quality of life of older adults with advanced chronic organ failure, highlighting among the main factors age over 75 years, male sex, low level of education, presence of more than 2 comorbidities, time of illness over 3 years, frailty, polypharmacy, functional dependence, and severe clinical manifestations.^10,12,13.

However, these characteristics or features have been identified in international contexts, so considering that these are modifiable by the geographical distribution and public health policies of each country, it is necessary to conduct this research to establish evidence-based records for the evaluation of the needs of this population and respond to the most prevalent promptly, to increase the supply and intensity of care aimed at improving the quality of life, through scheduled care, accessibility of services, crisis prevention and emergency care. Therefore it must be taken into account to respond to the ethical challenges of promoting benefits and risk reduction, ensuring the exercise of patient rights; Therefore, the objective of this study was to establish the factors associated with quality of life in older adults with advanced chronic organ failure in a hospital in Lima-Peru.

MATERIALS AND METHODS

RESULTS

It was observed that (44) 44% of older adults were over 80 years old, (59) 59% were male, (30) 30% studied up to secondary level, (57) 57% were incumbents in the navy, comorbidities were observed as arterial hypertension (74) 74%, diabetes mellitus (34) 34%, hypothyroidism (15) 15%, among others, and (83) 83% had advanced chronic organ failure for more than one year (Table 1).

Among the most frequent geriatric syndromes in older adults were visual or hearing deficits (82) 82%, insomnia (59) 59%, constipation (52) 52%, malnutrition (47) 47%, fall in the last year (27) 27% and pressure injury (13) 13%. On the other hand, mild functional dependence was observed in (48) 48% of the older adults, severe dependence in (50) 50% and total dependence in (2) 2% (Tabla 2)

Figure 1 shows that 34% of older adults had a low quality of life, 63% had a medium quality of life and only 3% had a high quality of life.

Figure 1: Quality of life of older adults attended at the "Cirujano Mayor Santiago Távara" Naval Medical Center from April to July 2021. Source: obtained from application of the WHOQoL-Bref questionnaire 

Among the epidemiological factors related to low quality of life, it was found that age over 80 years (p = 0.032, PR = 1.818), female sex (p = 0.009, PR = 2.056), the degree of education given by illiteracy, primary and secondary (p = 0.025, PR = 1.930) and the relationship with the navy as family (p = 0.022, PR = 1.894) (Table 3).

Insomnia (p=0.034, PR=1.930), constipation (p=0.000, PR=3.560), pressure injury (p=0.000, PR=2.788) and severe functional dependence (p=0.000, PR=4.667) were geriatric syndromes associated with low quality of life (Table 4).

Finally, multivariate analysis showed that insomnia (p=0.002), pressure injury (p=0.016) and severe dependence (p=0.000) were the factors associated with quality of life in older adults attended at the "Cirujano Mayor Santiago Távara" Naval Medical Center (Table 5).

Model: (intersection), age > 80 years, sex, education level, relationship to navy, insomnia, constipation, pressure injury, severe dependence.

DISCUSSION

When analyzing 100 patients, it was possible to identify that most of the older adults had a medium quality of life, followed by those with a low quality of life, which coincides with the majority of related studies, both in the national and international environment^27,28,20. This would show that older adults, regardless of the geographical area in which they are, will have a quality of life related to the state in which they are, because sometimes they may have deficiencies generated by the physiological deterioration that occurs at this stage of life.

Bivariate and non-multivariate epidemiological factors associated with low quality of life in older adults were found to be age >80 years, as found by Vega²⁹who, when analyzing older adults with diabetes mellitus in Cajamarca, found that age between 70 and 79 years (p=0.001) was related to this level of quality of life, a similar situation was identified by Valdés³⁰who, after analyzing older adults in a health center in Arequipa, found that people aged 76-84 years (p=0.026) had a low quality of life. Thus, it could be said that the older the person is, the greater the deterioration of his or her quality of life will be. This could be due to the deterioration of their physiological and functional state, causing disability and limitations to perform their activities autonomously, leading to a decline in their quality of life³¹.

Another factor identified as associated with low quality of life, in a bivariate manner, was the degree of illiteracy/primary/secondary education. Similar results were found in related studies, which demonstrate that low educational level (p=0.000)²⁹as well as illiteracy (p=0.033)³⁰. This could be explained by the fact that the absence or lack of information on the importance of controlling comorbidities is a major limitation for self-care, since preventive measures are not applied, which is reflected in the low quality of life^32,33.

Being a family member of a Navy officer was the last bivariate epidemiological factor for a low quality of life. No studies have been found on this variable that affirm or contradict it, since studies in military institutions have not been identified. Other studies have been able to identify variables that have been considered as factors for low quality of life, these being male sex³⁴and widowed marital status²⁹.

In addition, insomnia and the presence of pressure sores were the geriatric syndromes that were independently associated with low quality of life. No studies have been found, both nationally and internationally, that have correlated these variables with quality of life, finding not only a lack of information, but also an opportunity for further research in this regard.

In relation to functional dependence, severe functional dependence was found to be an independent factor for low quality of life. Several studies also found this correlation in the international setting, such as Laredo et al.²⁸, which found in Mexican older adults that those with functional dependence were those who mainly had low quality of life, or in the national setting, where Castillo et al.³⁵, after carrying out his study in Juliaca, concluded that functional dependence had a significant influence on quality of life (p=0.000); a situation similar to that reported by Salluca and Velasquez³⁶who demonstrated the association of both variables in a significant and directly proportional manner. These associations are usually significant because when older adult has difficulty in performing their daily activities, is no longer fully autonomous, and cannot perform their roles, social and family tasks; they influence the impairment of their quality of life.²⁸

Subsequently, studies have analyzed the possible relationship between other variables and quality of life, such as the study by Polku et al.³⁷who found that perceived hearing difficulty was significantly associated with the overall quality of life score evaluated with the WHO short version, as well as with each of its domains (physical, psychological, social and environmental). While Liu et al.³⁸evaluating Chinese elderly, found that the greater the number of non-communicable diseases (NCDs) in the elderly, the greater the deterioration of quality of life, measured with the Chinese version of the Quality of Life-Old (1 NCD p<0.05, 2 NCDs and 3 to more NCDs p<0.001, respectively). And Kantow et al.³⁹, when analyzing older adults in northern Thailand identified that awareness of falls and falls itself were associated with quality of life, where those older adults who had a history of falling in the previous year had lower quality of life (p<0.001). With these studies it can be mentioned that various factors influence quality of life in older adults, that is, it is multifactorial, so it is relevant to expand the evidence both nationally and locally, with a broader population to identify those other factors that are involved in the reduction of this quality of life.

And Kantow et al.³⁹, when analyzing older adults in northern Thailand identified that awareness of falls and falls itself were associated with quality of life, where those older adults who had a history of falling in the previous year had lower quality of life (p<0.001). With these studies it can be mentioned that various factors influence quality of life in older adults, that is, it is multifactorial, so it is relevant to expand the evidence both nationally and locally, with a broader population to identify those other factors that are involved in the reduction of this quality of life.

The limitations found for this study is that there is scarce evidence and studies on organ failure and in the advanced stage under the same methodological approach, which influenced the adequate comparison of data with other environments. The evaluation of the quality of life in older people with advanced chronic organ failure is limited in general. The surveys limit their population to individuals suffering from specific pathologies, limiting the contrast, as is done in the present study.

Finally, it is concluded that insomnia, pressure injury, and severe functional dependence are factors associated with low quality of life in older adults with advanced chronic organ failure in a hospital in Lima-Peru.