Quality of Life in Community-Dwelling Older People with Functional and Nutritional Impairment and Depressive Symptoms: A Comparative Cross-Sectional Study in Brazil and Portugal

Round 1

Reviewer 1 Report

This is an interesting manuscript of “Quality of life in community-dwelling elderly individuals with functional and nutritional impairment and depressive symptoms: a comparative cross-sectional study in Brazil and Portugal”. It is a cross-sectional study using the convenience sampling method. The findings of this study can be applied to public health interventions, particularly for older people and will be of interest to the readers of Geriatrics. However, to strengthen the manuscript, I would like to suggest the followings.

 

In the method section,

QoL (page 4, the line from 163 – 167): It would be nice if the authors could report (in brief) how to calculate the eight domains and two dimensions of SF-36.

Data collection (page 4): Did the authors conduct the interrater reliability between interviewers? If yes (or have a similar approach), please add this information in this data collection section.

 

For table 2,

Regarding the table name “Association of QoL between Brazil and Portugal”, it is difficult to understand for readers although I understand what the authors mean here. Actually, it is the quality of life of participants according to the countries (i.e. Brazil and Portugal), Quality of life differences between Brazil and Portugal or the association between QoL and countries (i.e. Brazil and Portugal). If the authors want, it can be mentioned that “P-values refer to the difference in QoL and sub-domains between Brazil and Portugal” in the footnote of table 2. Additionally, for both tables 2 and 4, it would be better if the authors could report “the median (25^th percentile – 75^th percentile)” rather than using the current format (i.e. 25^th – 50^th – 75^th percentile).

 

Results

For statistical analysis of the associations between “QoL” and “other functional declines, nutrition, and depressive symptoms”, I would like to suggest using additional tests (i.e. correlation and scatter plots and/or regression – adjusting for other confounding variables) to improve the quality of this research paper. Please kindly consult with statisticians on which advanced statistical tests would be the most suitable for these data.  

 

Discussion

I would like to suggest adding (a) the strengths, and (b) implications sections in the discussion.

In the limitation part, the authors could add “small sample size” and “imbalance sample size between Brazil and Portugal”. Add more details about the drawback of convenience sampling and cross-sectional study design and their consequences.

 

Minor:

In the following sentences of the abstract, “cross-sectional” and “our” should be written in capital letters

“Methods: cross-sectional, comparative study with primary data occurred …….”

 

“Results: our sample had a total of 150 PHC users”   

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The manuscript focuses on studying the association between quality of life, functional status, nutritional status and depression in older people. In general, the text is clear and the manuscript has the required sections. However, it must be said that the object of study has high evidence, it is not new, although it compares two countries, but with a very small sample.

Comments to the authors:

It would be interesting to describe the variables related to the presence of chronic diseases such as the number of diseases, and above all to highlight the frequency and percentage of people with cancer and neurological diseases, since they are clearly related to nutritional and functional status, respectively.

In relation to the results, age descriptors are not indicated (mean, median, standard deviation and interquartile range). The authors have dichotomized age into two very different groups, the average age overall and by group is unknown.

No hypothesis is indicated, although the design is cross-sectional which does not allow establishing cause-effect, there are many variables related to the quality of life from the age of 65 that are superficially described or not described and that belong to the group of determinants of the health

The results compare the situation of two very different countries at a cultural, social level and with different health systems. This allows these data to be discussed and/or expanded in the limitations section.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Well Done. Authors