Depression is the predominant factor contributing to morale as measured by the Philadelphia Geriatric Morale Scale in elderly Chinese aged 70 years and over

Morale in Old Age and Its Association with Sociodemographic, Social, and Health-Related Factors in Different Age Groups

Morale can be viewed as a future-oriented optimism or pessimism regarding challenges associated with aging and is closely related to subjective well-being. Promoting morale in old age could be considered to have important implications for aging well, and increased knowledge about morale in different stages of old age is needed. Hence, the aim of this study was to investigate factors associated with morale in different age groups among old people. Data were derived from a survey conducted in 2016, as a part of the Gerontological Regional Database (GERDA). The sample consisted of 9,047 individuals aged between 65 and 86 years from Ostrobothnia and Southern Ostrobothnia in Finland, and Västerbotten in Sweden. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS) and regressed upon a number of sociodemographic, social, and health-related factors using linear regression analyses. The results showed that older age was an independent factor explaining lower level of morale. Additionally, the sociodemographic, social, and health-related variables could explain a large proportion of the variance in morale. Perceived loneliness, having gone through a crisis in life, poor self-rated health, and depression were associated with lower morale, and sleeping well with higher morale, in all age groups. Furthermore, the oldest age groups seem to be more exposed to several risk factors of lower morale identified in this study. Multidimensional interventions targeting especially social and mental health and the oldest-old could therefore be recommended.

Risk factors for a decrease in high morale in very old people over a 5-year period: data from two Nordic countries

High morale could be considered to be an essential part of aging well and increased knowledge of how to prevent a decrease in high morale in very old age could have important implications for policy, and social and health care development. The objective was to identify social and health-related risk factors for a decrease in morale over 5 years in very old people among those with high morale at baseline. The study is based on data derived from the Umeå85+/GERDA study conducted in Northern Sweden and Western Finland. The final sample consisted of 174 individuals who were 85 years and older at baseline and who had completed the follow-up 5 years later. Morale was measured with The Philadelphia Geriatric Center Morale Scale (PGCMS). A set of social and health-related variables were used to test which factors were associated with a decrease in morale over 5 years. Linear regression was used for the multivariable analyses. The sample had a mean change of − 1.3 (SD = 2.5) in PGCMS scores from T1 to T2. The results from the regression analyses showed that development of depressive disorders, increased feelings of loneliness and the death of a child during the follow-up period were associated with a decrease in morale. The results from our study indicate that preventing the development of depressive disorders and increasing loneliness are key factors in preventing a decrease in high morale. Additionally, very old people who have recently lost an adult child should receive adequate psychosocial support.

Higher morale is associated with lower risk of depressive disorders five years later among very old people

OBJECTIVE

The aim of this study was to investigate whether higher morale, i.e. future-oriented optimism, at baseline was associated with lower risk of depressive disorders five years later among very old people.Methods The Umeå85+/GErontological Regional Database, a population-based study with a longitudinal design, recruited participants in Sweden and Finland aged 85, 90 and ≥95 years. The sample in the present study included 647 individuals (89.1±4.4 years (Mean±SD), range 85-103). After five years, 216 were alive and agreed to a follow-up (92.6±3.4 years, range 90-104). The Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale. The depressive disorder diagnosis was determined according to DSM-IV based on medical records and interview data including assessment scales for depressive disorders. A number of sociodemographic, functional and health-related variables were analysed as possible confounders.Results For those with no depressive disorders at baseline, the only baseline variable significantly associated with depressive disorders five years later was the PGCMS score. A logistic regression model showed lower risk of depressive disorders five years later with higher baseline PGCMS scores (odds ratio 0.779 for one point increase in PGCMS, p<0.001). The association remained after adjusting for social isolation (p<0.1 association with depressive disorders five years later).Conclusion Our results indicate that the higher the morale, the lower the risk of depressive disorders five years later among very old people. The PGCMS seems to identify those very old individuals at increased risk of depressive disorders five years later. Preventive measures could befocused on this group.

Association of quality of life with laboratory measurements and lifestyle factors in community dwelling older people in Taiwan

OBJECTIVES

Little is known about the influence of routine laboratory measurements and lifestyle factors on generic quality of life (QOL) at older ages. We aimed to study the relationship between generic QOL and laboratory measurements and lifestyle factors in community dwelling older Chinese people.

METHODS

We conducted a cross-sectional analysis. Six hundred and ninety nine elders were randomly selected from the examinees of the annual health examination in Taipei City, Taiwan. Blood, urine and stool of the participants were examined and lifestyle data were collected. Participants completed the CASP-19 (control, autonomy, self-realization, pleasure) questionnaire, a 19-item QOL scale. The relationship between QOL and laboratory results and lifestyle factors was explored, using multiple linear regression and profile analysis.

RESULTS

The mean age of the participants was 75.5 years (SD = 6.5), and 49.5% were female. Male gender standardized β coefficients (β = 0.122) and exercise habit (β = 0.170) were associated with a better QOL, whereas advanced age (β = -0.242), blurred vision (β = -0.143), depression (β = -0.125), central obesity (β = -0.093), anemia (β = -0.095), rheumatoid arthritis (β = -0.073), Parkinsonism (β = -0.079), malignancy (β = -0.086) and motorcycle riding (β = -0.086) were associated with a lower QOL. Profile analysis revealed that young-old males, social drinkers, regular exercisers and car drivers had the best QOL (all p < 0.001).

CONCLUSION

Of the many laboratory measurements, only anemia was associated with the lower QOL. By contrast, several lifestyle factors, such as social drinking, exercise habit and car driving, were associated with better QOL, whereas abdominal obesity and motorcycle riding were associated with lower QOL.

Usefulness of the Geriatric Depression Scale 15-item version among very old people with and without cognitive impairment

OBJECTIVES

The aim of this population-based study was to investigate the usefulness of the Geriatric Depression Scale 15-item version (GDS-15) to assess depressive symptoms among very old people with differing levels of cognitive function.

METHODS

The 834 participants were aged 85 and over. Feasibility of GDS-15 was evaluated as the proportion of people who completed the scale. Concurrent criterion validity was evaluated by calculating correlations between GDS-15 and Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS measures psychological wellbeing which is closely related with depressive symptoms. Correlations were calculated within groups according to cognitive function assessed with Mini-Mental State Examination (MMSE); 0-4, 5-9, 10-14, 15-19, 20-24, 25-27, and 28-30, using Pearson's two-sided correlation and compared using Fisher r-to-z transformation. Internal consistency of the GDS-15 was evaluated by calculating Cronbach's α in each group.

RESULTS

In total, 651 (78%) of the 834 participants completed the GDS-15. For the two MMSE-groups with scores of <10, the proportion who completed GDS-15 were 1% and 42%, respectively, compared to 65-95% in the MMSE-groups with scores of ≥10. Cronbach's α in each MMSE-group ranged from 0.636 (MMSE 28-30) to 0.821 (MMSE 5-9). The level of correlation between GDS-15 and PGCMS did not significantly differ between MMSE-groups with scores of 5-27 compared to the MMSE-group with scores of 28-30.

CONCLUSIONS

The GDS-15 seems to have an overall usefulness to assess depressive symptoms among very old people with an MMSE score of 10 or more. More studies are needed to strengthen the validity of GDS-15 among older people with MMSE scores of 10-14. For older people with MMSE scores lower than 10, there is a need to develop and validate other measurements.

Quality of life of older people in China: a systematic review

The quality of life (QoL) of older people is of increasing interest in China, due to its ageing population. A systematic review of published QoL studies was undertaken to examine different measurements and related factors of QoL of older people in China. Papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Fifteen studies were included in the review, using eight different QoL measurement tools. Health status, psychological well-being, social well-being, housing and socio-demographic factors were identified as important related factors of QoL. Further studies are needed using valid measurement tools to explore more factors, especially culturally specific contributors, to the QoL of older people.

Coping mediates the association between Type D personality and perceived health in Chinese patients with coronary heart disease

BACKGROUND

Increasing evidence show that Type D personality is a risk factor for morbidity, mortality, and quality of life of patients with coronary vascular disease. Few studies examined coping as a potential behavioral mechanism to explain the harmful effect of Type D personality.

PURPOSE

This study examined the association between Type D personality, coping, and perceived health among Chinese patients with coronary heart disease (CHD).

METHODS

One hundred seventeen CHD patients completed the assessments on Type D personality, coping, perceived severity of CHD, and morale.

RESULTS

There was no difference on severity of coronary artery stenosis between Type D and non-Type D patients. Compared to the non-Type D patients, the Type D patients perceived higher severity of CHD (5.31 ± 2.41 versus 4.45 ± 2.17, p < 0.05) and lower morale (12.67 ± 4.71 versus 15.00 ± 4.43, p < 0.05), and used less confrontation (16.90 ± 5.39 versus 20.88 ± 4.95, p < 0.001) and more acceptance-resignation coping (10.16 ± 3.50 versus 8.35 ± 3.48, p < 0.05). Mediation analyses showed that confrontation coping mediated the association between Type D personality and perceived severity of disease, and acceptance-resignation coping mediated the association between Type D personality and morale after controlling for age, gender, and clinical variables.

CONCLUSION

The Type D patients used maladaptive coping in response to disease. These coping strategies fully mediated the association between Type D personality and perceived health. Implications for integrating coping training into the intervention for patients with a Type D personality are discussed.

Assessment of factors influencing morale in the elderly

Background

We examined the relationship between morale measured by the Philadelphia Geriatric Morale Scale (PGC) and disability, social support, religiosity, and personality traits. Instruments predicting morale were then tested against PGC domains.

Methods

The study utilized a cross-sectional survey with a multistage cluster sampling design. Instruments used were disability (disease burden; WHO Disability Score-II, WHODAS-II), social support (Duke Social Support Scale, DUSOCS; Lubben Social Network Scale, LSNS-6; Medical Outcomes Study Social Support Survey, MOS-SSS), religiosity (Revised Intrinsic-Extrinsic Religious Orientation Scale, I/E-R), and personality (Ten-Item Personality Inventory, TIPI). These were plotted as bar charts against PGC, resolved with one-way ANOVA and Kruskal-Wallis tests, then corrected for multiple comparisons. This process was repeated with PGC domains. Contribution of factors was modeled using population attributable risk (PAR) and odds ratios. Effect of confounders such as gender, age, and ethnicity were checked using binary logistic regression.

Results

All instruments showed clear relationships with PGC, with WHODAS-II and DUSOCS performing well (ANOVA p<0.001). For PGC domains, attitude toward aging and lonely dissatisfaction trended together, while agitation did not. PAR, odds ratios, and Exp(β) were disability (WHODAS-II: 28.5%, 3.8, 2.8), social support (DUSOCS: 28.0%, 3.4, 2.2), religiosity (I/E-R: 21.6%, 3.2, 2.1), and personality (TIPI: 27.9%, 3.6, 2.4). Combined PAR was 70.9%.

Conclusions

Disability, social support, religiosity, and personality strongly influence morale in the elderly. WHODAS-II and DUSOCS perform best in measuring disability and social support respectively.

Subjective well-being, social support, and age-related functioning among the very old in China

OBJECTIVE

Previous research has suggested that social support and functional status influence the subjective well-being of the elderly. However, few studies have investigated whether these associations influence well-being in the very old.

METHODS

In this population-based, cross-sectional study, 1401 persons aged 90 years or over were located in Du Jiang Yan city, Sichuan, China. Among them 732 were willing to participate and provided data on a battery of standardized questionnaire inventories. The 23-item Philadelphia Geriatric Center Morale Scale (PGCMS) was examined as an index of subjective well-being. Functional status was assessed using the physical self-maintenance scale (PSMS) and the instrumental activities of daily living (IADL) scales. The mini-mental state examination (MMSE) was used to measure cognitive function. Social support was assessed using the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) scale and the social support requirement scale (SSRS).

RESULTS

The mean age was 93.7 +/- 3.4 years for the participants, of whom 68% were female. PGCMS total scores were significantly correlated with the Family APGAR and Objective Support subscale of the SSRS, as well as with scores on the MMSE and PSMS scales. However, in a multiple regression analysis, only MMSE and Family APGAR scores were independent predictors of PGCMS scores.

CONCLUSION

Both social support from family members and cognitive function appear to be key factors associated with quality of life among the very old in China. Further research is needed among very old populations to confirm the importance of these variables and to examine potential cross-cultural differences.

Gender-associated differences in dyspnoea and health-related quality of life in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES

Recent studies have reported several gender-associated differences among patients with COPD, but gender-associated differences in health-related quality of life (HRQoL) in patients with COPD have not yet been clarified. This study evaluated gender differences in dyspnoea and HRQoL in patients with COPD.

METHODS

Study participants were 156 patients with COPD (men 117, women 39); men were individually matched to women by age and FEV(1)% predicted to give a ratio of 3:1 (male : female). Study participants were evaluated for dyspnoea and completed HRQoL questionnaires. An oxygen cost diagram (OCD) was used to assess the degree of dyspnoea and Morale Scale was used to assess subjective well-being. St. George's Respiratory Questionnaire (SGRQ) and SF-36 were used for HRQoL evaluation. The findings in the male and female groups were compared.

RESULTS

The OCD and Morale Scale showed significantly lower values for female patients with COPD. Disease-specific HRQoL assessed by SGRQ was significantly worse, except for symptoms, in female patients with COPD. Generic HRQoL assessed by SF-36 was also significantly worse, except for general health and social functioning. Stepwise multiple regression showed OCD, Morale Scale and 6-min walking distance to be significantly associated with total SGRQ score in the male group, and Morale Scale and 6-min walking distance were significant associations in the female group.

CONCLUSIONS

Gender differences exist in dyspnoea and HRQoL in patients with COPD. These need to be considered when designing treatment strategies for COPD patients.