Aspirations for Older Age in the 21st Century: What is Successful Aging?

Tele-rehabilitation service delivery journey from prototype to robust in-home use

PURPOSE

The purpose of this study is to present a retrospective study on clients with Acquired Brain Injury (ABI) enrolled in a tele-motion-rehabilitation service program for two or more months.

METHODS

Data from 82 clients (46 males; 74 with ABI), aged 22-85 years, are reported. The Kinect-based CogniMotion System (ReAbility Online, Gertner Institute, Tel Hashomer, Israel) provided services that included 30-min biweekly sessions. Participants were evaluated prior to and 2 months following the commencement of service with clinical assessments that measured movements and function of the weaker upper extremity and cognitive abilities.

RESULTS

Clients enrolled in the service had intact or mild cognitive impairment, mild-moderate motor impairment but little use of their weak upper extremity for daily activities. They were satisfied with the service and reported high levels of system usability. Post-intervention clinical assessments were performed on about half of the participants after 2 months; significant improvements in active movements of the weak upper extremity, shoulder flexion range of motion and in the Trail Making Test were found (p < 0.05).

CONCLUSIONS

The service appears to be feasible for people with ABI and effective in important clinical outcomes related to improvements in upper extremity function. Implications for Rehabilitation Tele-rehabilitation provided with Microsoft Kinect 3D sensor virtual reality tracking system is feasible for people with Acquired Brain Injury. People with Acquired Brain Injury in the chronic stage were satisfied with the tele-rehabilitation service and perceived it as beneficial to improve their motor and cognitive abilities The CogniMotion System service appears to be effective in important clinical outcomes related to improvements in upper extremity function.

Successful aging among Chinese near-centenarians and centenarians in Hong Kong: a multidimensional and interdisciplinary approach

OBJECTIVES

This study applied a multidimensional model on a continuum to examine successful aging (SA) and investigated whether SA is associated with biomedical and psychosocial-demographic factors among Hong Kong Chinese near-centenarians and centenarians.

METHOD

A cross-sectional data analysis was performed on a geographically representative sample of 120 near-centenarians and centenarians with an age range of 95-108 years. We developed an integrated and cumulative Successful Aging Index (SAI) based on participants' performance in four dimensions: (1) physical and functional health (PF), (2) psychological well-being and cognition (PC), (3) social engagement and family support (SF), (4) economic resources and financial security (EF). To examine the criterion validity of SAI, we conducted a multiple binary logistic regression with interviewer-rated health. A multiple regression model was ran to investigate the independent biomedical and psychosocial-demographic correlates of SAI.

RESULTS

Results show that only 5.8% of participants attained SA in all four dimensions. PF had the least achievers, whereas the proportion was the highest in PC. SAI was significantly associated with interviewer-rated health and a high level of high-density lipoprotein cholesterol. Living with family or friends, high level of optimism, fewer diseases, and barriers to social activities were independent predictors of SAI score.

CONCLUSION

In the light of the lack of consensus on the constituents and assessment of SA especially among very old adults, our findings add to the extant literature by underscoring the importance of the multidimensional nature and the utility of an integrated and cumulative-based assessment of SA at the extreme of longevity.

Comparison of the Rowe-Kahn Model of Successful Aging With Self-rated Health and Life Satisfaction: The West of Scotland Twenty-07 Prospective Cohort Study

PURPOSE OF THE STUDY

With increasing longevity in industrialized populations, there is growing interest in what defines "successful aging" (SA). Various SA measures have been proposed but no consensus has been reached and many have been criticized for not representing the views and priorities of older people. We consider whether the Rowe-Kahn SA model captures older individual's perceptions of their own health and aging.

METHODS

Using two cohorts of 886 and 483 men and women from the West of Scotland Twenty-07 Study, aged around 57 and 76, respectively, we explored associations between Rowe-Kahn SA dimensions (absence of disease/disability; good physical/cognitive functioning; good interpersonal/productive social engagement) and four aspects of self-rated health and satisfaction (current general health; health for age; satisfaction with health; satisfaction with life).

RESULTS

Respondents' self-rated health and satisfaction was generally good but few had all six Rowe-Kahn dimensions positive, the conventional definition of SA. All individual positive SA dimensions were associated with better self-rated health and satisfaction. This was consistent across age, gender, manual/nonmanual occupations, and personality. The prevalence of good self-rated health and satisfaction increased with increasing numbers of positive SA dimensions.

IMPLICATIONS

The Rowe-Kahn model provides a functional definition of SA. Future work on ageing should include all Rowe-Kahn dimensions and consider SA as a continuum.

Associations of Successful Aging With Socioeconomic Position Across the Life-Course: The West of Scotland Twenty-07 Prospective Cohort Study

Objective: The aim of this study is to investigate how socioeconomic position (SEP) is associated with multidimensional measures of successful aging (SA), and how this varies and accumulates across the life-course. Method: Using data from 1,733 Scottish men and women from two cohorts aged around 57 and 76, respectively, we explored associations of SA, based on the Rowe–Kahn model, with 10 measures of SEP measured in childhood and, distally and proximally, in adulthood. Results: Individual SEP associations with SA score were generally consistent across different indicators and life stages: Respondents with the most versus least favorable SEP had two additional positive SA dimensions. There was also a strong association between SA and cumulative SEP based on all 10 measures combined; respondents with the most versus least favorable lifelong SEP had four additional positive SA dimensions. Conclusion: SEP advantages/disadvantages act and accumulate across the life-course, resulting in widening socioeconomic inequalities in SA in later life.

Perceptions of Successful Ageing Among Iranian Elders: Insights From a Qualitative Study

The aim of this article is to explore the perceptions of successful ageing among Iranian elderly. The data were collected in Tehran city on 60 older adults using a semistructured interview. The collected data were analyzed using directed content analysis. The findings revealed various dimensions of successful ageing among Iranian older adults. Social well-being is the most prevalent dimension of successful ageing, followed by psychological well-being, physical health, spirituality and transcendence, financial security, and an elder-friendly environmental and social context. Also, the findings from this study provide a new understanding of successful ageing in the context of Iran and contribute additional elements. This qualitative study highlights the importance of multidimensional and contextual viewpoints to successful ageing. In conclusion, to achieve multidimensional successful ageing, the interaction between all levels of successful ageing such as individual, family, and environment must be considered.

Health, frailty and disability after ninety: Results of an observational study in France

BACKGROUND

In spite of their increasing demographic weight, health characteristics of the oldest old remain poorly described in epidemiological studies.

OBJECTIVE

To describe the health of people aged 70 years and over included in the SIPAF study, and to compare the prevalence of health indicators including successful aging, frailty, and disability between three age groups including the oldest old.

METHODS

The study population is composed of 2350 retired people recruited between 2008 and 2010, of whom 512 are aged 90 and over (21.8%). A comprehensive geriatric assessment was performed at home by trained nurses. The prevalence of health and functional indicators, as well as the distribution of people among successful ageing, frailty, and disability, were described by age group (70-79, 80-89, 90+) and sex.

RESULTS

Compared to their younger counterparts, people aged 90 years and over were more likely to experience functional limitations, sensory impairment, cognitive impairment, poor mood, and frailty. One third of the nonagenarians needed help in at least one basic activity of daily living and 25% met the frailty criteria. In contrast, the prevalence of most chronic diseases did not increase after ninety. Successful ageing concerned 9% of the oldest old. Women were less likely to experience successful ageing and more likely to be frail or dependent.

CONCLUSION

This study shows the diversity of health states in very old age and points out that one quarter of the people aged 90 and over said frail are likely to take advantage of preventive actions of disability.

Ballroom Dance: Linking Serious Leisure to Successful Aging

OBJECTIVE

This study explored ballroom dance as serious leisure and successful aging in a sample of community-dwelling older adults.

METHODS

Qualitative procedures were used to explore stories of ballroom dance and successful aging.

RESULTS

Participants described positive successful aging and active leisure engagement. Three themes emerged from thematic analyses: (a) Ballroom Dance as Serious Leisure: Its Dimensions; (b) Ballroom Dance: Its Link to Successful Aging; (c) The Affinity: We Love to Dance!.

CONCLUSION

The participants' ballroom dance revealed serious leisure characteristics in conjunction with their successful aging. They loved to dance, self-identified as ballroom dancers, and orchestrated their dance activities within its social world. Future research should examine the relation of successful aging to the social world of ballroom dance.

Association between nighttime sleep and successful aging among older Chinese people

OBJECTIVE

This study aims to assess the association between sleep and successful aging among Chinese ≥60 years of age.

METHODS

Data were collected from the baseline survey of the China Health and Retirement Longitudinal Study. Two self-reported questions about sleep quality and duration were examined. Successful aging was defined following Rowe and Kahn's multidimensional model. To assess the adjusted association between sleep and successful aging, multivariable logistic regression was applied.

RESULTS

The average number of self-reported hours of sleep was 6.2 ± 2.0 among older Chinese people. Successful aging was related to sleep duration, with the proportion of those adults considered to be aging successfully falling into the following sleep duration categories (<6 h - 7.8%; 6 h - 16.3%; 7 h - 19.1%; 8 h - 14.7%; and ≥9 h - 12.8%). The plots between sleep duration and successful aging were an inverse U-shape. Participants who slept less than 6 h per day had lower odds ratios of successful aging [odds ratio (OR) = 0.52, 95% confidence interval (CI) 0.40-0.67] relative to those who slept for 7 h per day. Compared with those who reported poor sleep less than once a week, older people who reported poor sleep five to seven days a week showed a lower ratio of successful aging (OR = 0.29, 95% CI 0.21-0.39).

CONCLUSION

Older age, shorter or longer sleep, and poor sleep were related to lower odds of, rates of successful aging. Most older Chinese adults experience insufficient sleep and poor sleep quality, which could be an important influential factor in successful aging.

Interleukin-6 and C-reactive protein, successful aging, and mortality: the PolSenior study

BACKGROUND

In the elderly, chronic low-grade inflammation (inflammaging) is a risk factor for the development of aging-related diseases and frailty. Using data from several thousand Eastern Europeans aged 65 years and older, we investigated whether the serum levels of two proinflammatory factors, interleukin-6 (IL-6) and C-reactive protein (CRP), were associated with physical and cognitive performance, and could predict mortality in successfully aging elderly.

RESULTS

IL-6 and CRP levels systematically increased in an age-dependent manner in the entire study group (IL-6: n = 3496 individuals, p < 0.001 and CRP: n = 3632, p = 0.003), and in the subgroup of successfully aging individuals who had never been diagnosed with cardiovascular disease, myocardial infarction, stroke, type 2 diabetes, or cancer, and had a Mini Mental State Examination (MMSE) score ≥24 and a Katz Activities of Daily Living (ADL) score ≥5 (IL-6: n = 1258, p < 0.001 and CRP: n = 1312, p < 0.001). In the subgroup of individuals suffering from aging-related diseases/disability, only IL-6 increased with age (IL-6: n = 2238, p < 0.001 and CRP: n = 2320, p = 0.249). IL-6 and CRP levels were lower in successfully aging individuals than in the remaining study participants (both p < 0.001). Higher IL-6 and CRP levels were associated with poorer physical performance (lower ADL score) and poorer cognitive performance (lower MMSE score) (both p < 0.001). This association remained significant after adjusting for age, gender, BMI, lipids, estimated glomerular filtration rate, and smoking status. Longer survival was associated with lower concentrations of IL-6 and CRP not only in individuals with aging-related diseases/disability (HR = 1.063 per each pg/mL, 95 % CI: 1.052-1.074, p < 0.001 and HR = 1.020 per each mg/L, 95 % CI: 1.015-1.025, p < 0.001, respectively) but also in the successfully aging subgroup (HR = 1.163 per each pg/mL, 95 % CI: 1.128-1.199, p < 0.001 and HR = 1.074 per each mg/L, 95 % CI: 1.047-1.100, p < 0.001, respectively). These associations remained significant after adjusting for age, gender, BMI, lipids and smoking status. The Kaplan-Meier survival curves showed similar results (all p < 0.001).

CONCLUSIONS

Both IL-6 and CRP levels were good predictors of physical and cognitive performance and the risk of mortality in both the entire elderly population and in successfully aging individuals.

Social Structural Influences on Healthy Aging: Community-Level Socioeconomic Conditions and Survival Probability of Becoming a Centenarian for Those Aged 65 to 69 in South Korea

This study estimated the associations between community-level socioeconomic conditions and survival probability of becoming a centenarian (SPBC) for those aged 65 to 69 in South Korea to determine the social structural influences on healthy aging. The indicators of socioeconomic and data of centenarians were obtained from Statistics Korea database 2014: population census and social survey. Significant positive correlations were found between SPBC and community-level socioeconomic conditions (minimum cost of living and economically active population, water supply and sewerage, pave a road with asphalt, and urbanization). SPBC male and female predictors had higher economic level and base facilities (R2)=0.578, p<.001). The study provides evidence that community-level socioeconomic conditions are important correlates of SPBC for those aged 65 to 69 in South Korea. These strategies should include social structural influences on successful aging in the overall socioeconomic conditions.

Depictions of nursing home residents in US newspapers: successful ageing versus frailty

The media shape both what people consider significant and how people think about key issues. This paper explored the cultural beliefs and stereotypes that underlie media portrayals of nursing homes. The analysis of texts of 157 articles about nursing homes published from 1999 to 2008 on the front pages of four major-market American newspapers (The New York Times, Chicago Tribune, Los Angeles Times and The Washington Post) was conducted using a qualitative approach inspired by comparative narrative and critical discourse analysis. Results suggest two major themes, each with several narrative components: (a) managing disposable lives (bodies outliving bank accounts; making frailty affordable; and the economics of triage); and (b) retaining purchasing power as successful ageing (consumption as a sign of market participation, spending money as an indicator of autonomy; and financial planning as preparation for future decline). Thus, the results indicate that nursing home residency in-and-of-itself is not a marker of unsuccessful ageing. This, instead, depends, in part, on the extent of choice available as a result of the level of financial solvency. This study shines light on the betwixt and between zone that distinguishes the Third and Fourth Ages; that is, independence versus dependence in old age. If individuals in a nursing home retain control over the management of their lives through the maintenance of financial independence, even if physically frail, association of nursing home residence with the Fourth Age may be ameliorated.

Successful aging: Advancing the science of physical independence in older adults

The concept of 'successful aging' has long intrigued the scientific community. Despite this long-standing interest, a consensus definition has proven to be a difficult task, due to the inherent challenge involved in defining such a complex, multi-dimensional phenomenon. The lack of a clear set of defining characteristics for the construct of successful aging has made comparison of findings across studies difficult and has limited advances in aging research. A consensus on markers of successful aging is furthest developed is the domain of physical functioning. For example, walking speed appears to be an excellent surrogate marker of overall health and predicts the maintenance of physical independence, a cornerstone of successful aging. The purpose of the present article is to provide an overview and discussion of specific health conditions, behavioral factors, and biological mechanisms that mark declining mobility and physical function and promising interventions to counter these effects. With life expectancy continuing to increase in the United States and developed countries throughout the world, there is an increasing public health focus on the maintenance of physical independence among all older adults.

Clinical and laboratory characteristics of active and healthy aging (AHA) in octogenarian men

OBJECTIVES

To investigate clinical and laboratory variables associated with good subjective and objective health ("active and healthy aging", AHA) in a cohort of octogenarian men.

DESIGN

Cross-sectional analyses of a longitudinal study.

SETTING

The Helsinki Businessmen Study in Finland.

PARTICIPANTS

A socioeconomically homogenous cohort of men (baseline n = 3293), born in 1919-1934, has been followed up from the 1960s. From 2000, the men have been regularly sent mailed questionnaires and mortality has been retrieved from national registers.

MEASUREMENTS

In 2010 survey, AHA was defined as independently responding to the mailed survey, feeling happy without cognitive or functional impairments and without major diseases. In 2010/11, a random subgroup men was clinically investigated and survivors with healthy and nonhealthy aging were compared.

RESULTS

By 2010, 1788 men of the baseline cohort had died, and 894 men responded to the mailed survey. 154 (17.2 %) of those fulfilled the present AHA criteria. Increasing number of criteria were negatively (P < 0.001) related to short-term mortality. In 2011, a random sample of 458 men were clinically investigated, 90 of them with AHA. Men with AHA had higher serum LDL cholesterol and diastolic blood pressure (partially explained by less frequent drug use) but no significant difference was observed in other risk factors. Men with AHA had significantly faster walking speed (P < 0.001), stronger handgrip (P = 0.017), better self-rated health and less phenotypic frailty (P = 0.02).

CONCLUSION

Less than 5 % enjoyed active and healthy aging over their life course, which was significantly related to markers of frailty but not to the traditional vascular risk factors.

Psychosocial Links Between Internet Use and Mental Health in Later Life: A Systematic Review of Quantitative and Qualitative Evidence

Research on the role of information and communication technology (ICT) use for active aging is limited. The aim of this systematic review is to investigate the link between Internet use and mental health among older adults. The review was conducted based on searches in 9 electronic databases (2002-2014). A meta-synthesis approach was applied, examining quantitative (18) and qualitative (14) studies. The findings from the synthesis of quantitative statistical data indicate an overall positive association between Internet use and mental health and its psychosocial covariates in later life. The psychosocial links between Internet use and mental health identified from the qualitative data were (a) enhanced interpersonal interaction at individual level, (b) increased access to resources within the community, and (c) empowered social inclusion at society level. The results highlight the multi-level psychosocial links between Internet use and mental health, which may be applied in initiatives targeting healthy aging in various settings.

An intervention to support professional driver retirement transition: Results of a pilot study for older taxi drivers in Singapore

Introduction

Older taxi drivers in Singapore face mandatory retirement at 73 years of age, often marked by the simultaneous loss of the worker and driver roles. The Driver Retirement Program was developed as an intervention to support this transition.

Method

A pre- and post-experimental design was conducted with retired 73-year-old, male taxi drivers ( n = 15) to investigate the hypotheses: (i) the Driver Retirement Program would increase activity participation (e.g. time use) and wellbeing (e.g. mood) outcomes at immediate post-intervention and (ii) maintain these changes at 3 months’ follow-up. Non-parametric tests were used to compare changes between (i) pre- and post-intervention and (ii) 3 months follow-up to post-intervention. Participants’ feedback on the Driver Retirement Program was obtained using a semi-structured questionnaire.

Results

The Driver Retirement Program significantly improved mood, self-efficacy and satisfaction with individualised goals at post-intervention and maintained these changes at 3 months’ follow-up. A significant decrease in time spent alone was found at follow-up compared with post-intervention. Participants rated high satisfaction with the Driver Retirement Program but also recommended a shorter programme without compulsory group sessions.

Conclusion

The Driver Retirement Program was useful to support some aspects of work and driver retirement transition. Further work to enhance sensitivity to cultural and gender issues is indicated.

Improving the experience of dementia and enhancing active life--living well with dementia: study protocol for the IDEAL study

BACKGROUND

Enabling people with dementia and carers to 'live well' with the condition is a key United Kingdom policy objective. The aim of this project is to identify what helps people to live well or makes it difficult to live well in the context of having dementia or caring for a person with dementia, and to understand what 'living well' means from the perspective of people with dementia and carers.

METHODS/DESIGN

Over a two-year period, 1500 people with early-stage dementia throughout Great Britain will be recruited to the study, together with a carer wherever possible. All the participants will be visited at home initially and again 12 months and 24 months later. This will provide information about the way in which well-being, life satisfaction and quality of life are affected by social capitals, assets and resources, the challenges posed by dementia, and the ways in which people adjust to and cope with these challenges. A smaller group will be interviewed in more depth.

DISCUSSION

The findings will lead to recommendations about what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia.

Improving the experience of dementia and enhancing active life--living well with dementia: study protocol for the IDEAL study

BACKGROUND

Enabling people with dementia and carers to 'live well' with the condition is a key United Kingdom policy objective. The aim of this project is to identify what helps people to live well or makes it difficult to live well in the context of having dementia or caring for a person with dementia, and to understand what 'living well' means from the perspective of people with dementia and carers.

METHODS/DESIGN

Over a two-year period, 1500 people with early-stage dementia throughout Great Britain will be recruited to the study, together with a carer wherever possible. All the participants will be visited at home initially and again 12 months and 24 months later. This will provide information about the way in which well-being, life satisfaction and quality of life are affected by social capitals, assets and resources, the challenges posed by dementia, and the ways in which people adjust to and cope with these challenges. A smaller group will be interviewed in more depth.

DISCUSSION

The findings will lead to recommendations about what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia.

Individual and social determinants of self-rated health and well-being in the elderly population of Portugal

This article aims to identify the main determinants of self-rated health and well-being in the elderly Portuguese population, using a set of dimensions including demographic and socioeconomic indicators, characteristics of interpersonal networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to analyze the explanatory value of the interrelated dimensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partially offsetting the effect of socioeconomic factors and illness associated with age.

Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age

OBJECTIVES

This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS

We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS

We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION

Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

Reliability and validity of a self-rated analogue scale for global measure of successful aging

OBJECTIVE

Dimension-specific objective measures are criticized for their limited perspective and failure to endorse subjective perceptions by respondents, but the validity and correlates of a subjective global measure of successful aging (SA) are still not well established. We evaluated the reliability and validity of a self-rated analogue scale of global SA in an elderly Singaporean population.

DESIGN

Cross-sectional data analysis using a comprehensive questionnaire survey.

PARTICIPANTS AND SETTING

489 community-dwelling Singaporeans aged 65 years and over.

MEASUREMENTS

Self-rated SA on an analogue scale from 1 (least successful) to 10 (most successful) was analyzed for its relationship to criterion-based measures of five specific dimensions (physical health and function, mental well-being, social engagement, psychological well-being, and spirituality/religiosity), as well as outcome measures (life satisfaction and quality of life).

RESULTS

Self-rated SA was significantly correlated to measures of specific dimensions (standardized β from 0.11 to 0.39), most strongly with psychological functioning (β = 0.391). The five dimension-specific measures together accounted for 16.7% of the variance in self-rated SA. Self-rated SA best predicted life satisfaction (R(2) = 0.26) more than any dimension-specific measure (R(2) from 0.05 to 0.17). Self-rated SA, vis-à-vis dimension-specific measures, was related to a different set of correlates, and was notably independent of chronological age, sex, education, socioeconomic status, and medical comorbidity, but was significantly related to ethnicity.

CONCLUSION

The self-rated analogue scale is a sensitive global measure of SA encompassing a spectrum of underlying dimensions and subjective perspectives and its validity is well supported in this study.

Life review based on remembering specific positive events in active aging

OBJECTIVE

The aim of this study is to evaluate the effectiveness of life review (LR) based on specific positive events in non-depressed older adults taking part in an active aging program.

METHOD

Fifty-five older adults were randomly assigned to an experimental group or an active control (AC) group. A six-session individual training of LR based on specific positive events was carried out with the experimental group. The AC group undertook a "media workshop" of six sessions focused on learning journalistic techniques. Pre-test and post-test measures included life satisfaction, depressive symptoms, experiencing the environment as rewarding, and autobiographical memory (AM) scales.

RESULTS

LR intervention decreased depressive symptomatology, improved life satisfaction, and increased specific memories.

DISCUSSION

The findings suggest that practice in AM for specific events is an effective component of LR that could be a useful tool in enhancing emotional well-being in active aging programs, thus reducing depressive symptoms.

Operational definitions of successful aging: a systematic review

BACKGROUND

Half a century after the inception of the term "successful aging (SA)," a consensus definition has not emerged. The current study aims to provide a comprehensive snapshot of operational definitions of SA.

METHODS

A systematic review across MedLine, PsycInfo, CINAHL, EMBASE, and ISI Web of Knowledge of quantitative operational definitions of SA was conducted.

RESULTS

Of the 105 operational definitions, across 84 included studies using unique models, 92.4% (97) included physiological constructs (e.g. physical functioning), 49.5% (52) engagement constructs (e.g. involvement in voluntary work), 48.6% (51) well-being constructs (e.g. life satisfaction), 25.7% (27) personal resources (e.g. resilience), and 5.7% (6) extrinsic factors (e.g. finances). Thirty-four definitions consisted of a single construct, 28 of two constructs, 27 of three constructs, 13 of four constructs, and two of five constructs. The operational definitions utilized in the included studies identify between <1% and >90% of study participants as successfully aging.

CONCLUSIONS

The heterogeneity of these results strongly suggests the multidimensionality of SA and the difficulty in categorizing usual versus successful aging. Although the majority of operationalizations reveal a biomedical focus, studies increasingly use psychosocial and lay components. Lack of consistency in the definition of SA is a fundamental weakness of SA research.

How important is health status in defining quality of life for older people? An exploratory study of the views of older South Australians

BACKGROUND

Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health.

OBJECTIVE

To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians.

METHODS

Older adults (n=21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People's Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT.

RESULTS

Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman's Rho: 0.730; p<0.01), but not ASCOT. Approximately half (52.4%) of the participants ranked either 'health' or 'psychological and emotional well-being' as the domain most important to their quality of life. However, one-third (33.3%) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life.

CONCLUSIONS

Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life.

Successful Aging From the Viewpoint of Older Adults

The purpose of this study was to investigate older adults’ perceptions of successful aging within the context of the theory of successful aging to validate and further inform this theory. This research was a secondary, qualitative analysis of data from two earlier studies in which participants were asked to provide a response to the open-ended question, “What does successful aging mean to you?” Content analysis using multiple coding was independently conducted by the investigators. Eight broad themes emerged: active independence, relationships with people, relationship with God, comfort resources, health, beneficial contribution, positive perspective/coping, and freedom. Differences and similarities of themes by study subgroups were also explored. The coping processes, functional performance mechanisms, and intrapsychic factors from the theory of successful aging were well represented in the findings of this study. The coping process of spirituality was less frequently represented, whereas that of gerotranscendence was slightly more often described. Interventions that enhance these factors associated with successful aging have the potential to improve quality of life and provide appealing, meaningful activities for older adults.

Self-rated quality of life of city-dwelling elderly people benefitting from social help: results of a cross-sectional study

Background

The percentage of people aged 65 or older living in Poland is 13.6%, but 17.2% in Łódź. The aim of the study was to identify factors correlating with the self-rated quality of life of elderly inhabitants of cities applying for social help, on the basis of a cross-sectional study.

Methods

The study was conducted in Łódź, a large Polish city, between September 2011 and February 2012 in a group of people applying for help in the Municipal Social Welfare Centre. Four hundred and sixty-six respondents aged 65 or older were included in the study. The tool used in the study was an interview questionnaire. The respondents answered questions on their demographic situation, living conditions, financial, health and social situation. The authors also applied the WHOQOL-BREF Questionnaire, the Activities of Daily Living Scale (ADL) and the Geriatric Depression Scale (GSOD). For statistical purposes, the authors used single- and multiple-factor regression and the Statistica 9.0 Program. The results were presented as an odds ratio (OR) with a 95% confidence interval (CI); the adopted significance level was p < 0.05. The authors applied the Pearson’s x² test in order to evaluate the structure of the studied group and the subpopulation, who were aged 65 or older and using social help, throughout the city.

Results

Logistic regression confirmed that a high quality of life depends on the following variables: university education (OR = 2.31; p < 0.05), an income which is sufficient to live (OR = 1.63; p < 0.05), no heart palpitations (OR = 2.32; p < 0.05), stable blood pressure (OR = 2.32; p < 0.05), no headaches (OR = 1.55; p < 0.05), no pain in the chest (OR = 1.51; p < 0.01), no shortness of breath (OR = 1.51; p < 0.01), no tiredness (OR = 2.08; p < 0.05), a score on the Geriatric Depression Scale pointing to a lack of suspected depression (OR = 9.88; p < 0.001 if the person does not suffer from depression and OR = 6.33; p < 0.001 if there is uncertain depression) as well as not using nursing services, a score on the ADL Scale confirming the person’s fitness and participation in family gatherings.

Conclusions

A subjective evaluation of the quality of life of the elderly depends on many factors. An identification of these factors might be helpful in implementing steps aimed at improving the quality of life of elderly people who, as a consequence, will need less social help: particularly nursing services.

Staying well in old age: Predicting older adults’ wellness

In an ageing world, the potential for ageing well in older people is still relatively unexplored. Literature has suggested that a sense of coherence (SOC) is an important factor with regard to retaining a good quality of life in old age. To explore whether satisfaction with life (SWL), as well as sociodemographic, health- and lifestyle-related variables, are predictors of SOC in a community-dwelling sample of older adults and to assess significant differences in SOC amongst the four nationalities studied. Cross-national research encompassing a community-dwelling sample of 454 older adults aged 75 years and above was undertaken. Sense of coherence was assessed using the Orientation to Life Questionnaire and Satisfaction with Life (SWL) was measured using the Satisfaction with Life Scale. Structural equation modelling was used to investigate a structural model of the self-reported SOC, comprising sociodemographic variables (age, gender, marital status, professional status, educational level, family’s annual income and standard of living arrangements), as well as SWL, lifestyle and health-related (physical activity and recent disease) characteristics. Significant predictors were physical activity (β = 0.804; p < 0.001), recent disease (β = 0.501;p < 0.001) and SWL (β = 0.07; p = 0.004). These variables accounted for approximately 57.5% of the variability of SOC. Moreover, differences with regard to SOC were also found amongst the four nationality groups (F(3) = 5.204; p = 0.002). Physical activity is the strongest predictor of self-reported SOC. Other predictors are the absence of a recent disease and SWL. The four nationalities presented significant differences with regard to SOC. This study highlighted the need for understanding the potential factors (in particular physical activity and further health-related characteristics) that impact on older adults’ SOC.In ’n wêreld wat aan die verouder is, is die potensiaal van bejaardes om goed te verouder steeds relatief onbekend. ’n Toenemende literatuurbasis stel voor dat koherensiesin belangrik is om ’n goeie lewensgehalte vir bejaardes te verseker. Om te verken of lewenstevredenheid, sosio-demografiese, gesondheids- en lewenstylverwante veranderlikes voorspellers is van die koherensiesin in ’n steekproef van bejaardes wat nie in tehuise woon nie, asook om die beduidende verskille tussen die vier nasionaliteite met betrekking tot die koherensiesin te evalueer. Kruis-nasionale navorsing bestaande uit ’n steekproef van 454 volwassenes, 75 jaar of ouer, wat nie in tehuise woon nie. Koherensiesin is met behulp van die lewensoriëntasievraelys beoordeel en lewenstevredenheid is met behulp van die lewenstevredenheidskaal gemeet. Strukturele vergelykingsmodellering is gebruik om ’n strukturele model van die self-gerapporteerde koherensiesin te ondersoek. Die model bestaan uit sosio-demografiese veranderlikes (ouderdom, geslag, huwelikstatus, professionele status, opvoedkundige vlak, gesin se jaarlikse inkomste en lewensomstandighede), asook lewenstevredenheid, lewenstyl- en gesondheidsverwante (fisiese aktiwiteitsvlak en onlangse siekte) eienskappe. Beduidende voorspellers is fisiese aktiwiteitsvlak (β = .804; p < 0.001), onlangse siekte (β = .501; p < 0.001) en lewenstevredenheid (β = .07; p = 0.004). Die veranderlikes verklaar onderskeidelik 57.5% van die wisselvalligheid van die koherensiesin. Verder is daar ook verskille tussen die vier nasionaliteite met betrekking tot koherensiesin (F(3) = 5.204; p = 0.002) gevind. Fisiese aktiwiteitsvlak is die sterkste voorspeller van self-gerapporteerde koherensiesin. Ander voorspellers is lewenstevredenheid en die afwesigheid van onlangse siekte. Die vier nasionaliteite het duidelike verskille ten opsigte van koherensiesin getoon. Hierdie studie beklemtoon die noodsaaklikheid om die potensiële faktore − veral fisiese aktiwiteitsvlak en verdere gesondheidsverwante eienskappe − wat bejaardes se koherensiesin beïnvloed, te verstaan.

Factors associated with self-rated health (SRH) of a University of the Third Age (U3A) class participants

INTRODUCTION

A U3A is a way of making elderly people active. Our study aims to investigate the association between socioeconomic variables, selected symptoms, disorders and the SRH of participants of classes at the U3A.

MATERIALS AND METHODS

The study was conducted in 2011 in a group of participants of classes at the U3A in Plock, Poland. The authors examined 250 people aged 60 or older. A survey questionnaire was the study tool. Statistica 9.0. was used for statistical analysis, including ordinal regression models.

RESULTS

Being younger (65-69) increases the chance of returning a good SRH score to over five times compared to being 75 and over (odds ratio (OR)=5.30, confidence interval (CI)=1.76-15.97), p<0.01). The chance of a good SRH score is almost four times more likely in subjects with a disposable income which satisfies basic needs compared to that which does not (OR=3.97, CI=1.12-14.04, p<0.05). Furthermore, lack of symptoms and disorders have a strong influence on good SRH (no leg edema - OR=4.06, CI=1.63-10.12, p<0.01; no headache - OR=2.75, CI=1.34-5.62, p<0.01; no toothache - OR=4.32, CI=1.12-16.68, p<0.05; no hypertension - OR=1.78, CI=1.02-3.14, p<0.05; no degenerative disease - OR=1.88, CI=1.08-3.27, p<0.05). Feeling happy raised the chance of reporting good SRH by almost three times (OR=2.91, CI=1.35-6.27, p<0.01).

CONCLUSIONS

A subjective evaluation of health by the elderly constitutes an important indicator of their health and quality of life. It can become a basis for implementing activities of gerontological prophylaxis and leveling out health inequalities.

Self-respect through ability to keep fear of frailty at a distance: successful ageing from the perspective of community-dwelling older people

With population ageing, there is an increased interest in how to promote a good old age. A predominant concept in these discussions is successful ageing, which is mainly based on researchers’ definitions. This article aims to explore successful ageing from the perspective of community-dwelling older people (24 persons aged 77–90 years). Individual open interviews were conducted and analysed according to qualitative content analysis. An overarching theme was formulated as “self-respect through ability to keep fear of frailty at a distance”. This embraced the content of four categories: “having sufficient bodily resources for security and opportunities”, “structures that promote security and opportunities”, “feeling valuable in relation to the outside world”, and “choosing gratitude instead of worries”. Ageing seems to be a dynamic process rather than a static structure and might therefore be susceptible to actions. Paying attention to attitudes and treating the older person with respect, particularly with regard to worries about increasing vulnerability, can lead to better ways of promoting successful ageing.

[Sexuality of the elderly: a survey and management]

OBJECTIVE

To evaluate sexuality in elderly couples and have the knowledge of its specific therapeutic options.

MATERIAL AND METHODS

Review of articles published on this subject in the Medline database, selected according to their scientific relevance together with a reflexion from our own experience.

RESULTS

Due to increased life expectancy and the changes in society leading to a life with more than one consecutive partner, couples expect to continue sexual activity after the age of 65. Clinicians are asked to address this issue frequently. With age the frequency of genital sexual relations decreases. Sexual activity should be higher both for males and females. The quality of the relationship of the couple is a key element in maintaining sexual relations in this age group. Sexual satisfaction depends on the understanding, by both partners, of the physical and psychological changes due to increased age.

CONCLUSION

The sexuality of the elderly couple must be analysed using specific criteria. The clinician's task is to explain to the patients the physiological change due to aging and give them advice on how to adapt their sexual behavior accordingly. Management will, at the same time, include pharmacological treatment, notably for erectile dysfunction, in order to restore satisfactory sexual relations. For women, vaginal lubrication products are essential. This global management should allow many elderly couples wishing to continue sexual relations, to enjoy this period of their lives in harmony with what they desire.

Is there successful aging for nonagenarians? The vitality 90+ study

Objectives. This study was designed (1) to estimate the prevalence of successful aging among nonagenarians based on six different models and (2) to investigate whether successful aging is associated with socio-demographic factors. Methods. A mailed survey was conducted with people aged 90+ in Tampere in 2010. Responses were received from 1283 people. The prevalence of successful aging was measured by six multidimensional models including physical, social, and psychological components. Age, sex, marital status, level of education, and place of living were studied as factors associated with successful aging. Results. The prevalence of successful aging varied from 1.6% to 18.3% depending on the model applied. Successful aging was more prevalent in men, and also more prevalent among community-living people. In most models, successful aging was also associated with younger age, being married, and a higher level of education. Discussion. Models which emphasize the absence of disease and activity as criteria for successful aging may not be the most relevant and applicable in oldest old. Instead, preference should be given to models that focus more on autonomy, adaptation and sense of purpose. Age-sensitive approaches would help us better understand the potential of successful aging among individuals who already have success in longevity.