Older people's sense of coherence: relationships with education, former occupation and living arrangements

Sense of Coherence and Incident Dementia in Older Japanese Adults: The Japan Gerontological Evaluation Study

OBJECTIVES

The sense of coherence refers to effectively using available resources to manage stress and promote overall health. Previous studies have linked it to various health outcomes; however, evidence regarding its association with the risk of incident dementia is limited. Hence, this study aimed to fill this research gap using data from a large-scale population survey.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

This study included 31,556 participants aged 65 years and older who were free from dementia and disabilities. The participants were enrolled in the 2010 baseline survey of the Japan Gerontological Evaluation Study, and were followed up until the end of 2019.

METHODS

The sense of coherence was assessed using a 6-item short-version questionnaire. Incident dementia cases were ascertained through the public long-term care insurance database in Japan.

RESULTS

During a median follow-up of 8.3 years, 4326 incident dementia cases were identified. After adjusting for conventional risk factors, the hazard ratios (95% CIs) for each quintile compared to the lowest quintile of the sense of coherence were 0.82 (0.75-0.90), 0.75 (0.68-0.83), 0.76 (0.68-0.84), and 0.78 (0.70-0.87), respectively. The multivariable hazard ratio (95% CI) per 1-SD increment was 0.91 (0.88-0.95). These inverse associations did not exhibit any gender differences (P for gender interaction = .11) and were further confirmed after excluding early incident cases. Similar associations were found for its components; the corresponding multivariable hazard ratios (95% CIs) per 1-SD increment were 0.94 (0.91-0.97) for comprehensibility, 0.92 (0.89-0.95) for manageability, and 0.93 (0.90-0.97) for meaningfulness.

CONCLUSIONS AND IMPLICATIONS

Moderate and above sense of coherence was associated with the lower risk of dementia among the older population, suggesting a beneficial role of stress management in maintaining the cognitive health of older adults.

Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies

Objectives

The breast cancer stigma affects Health-related quality of life (HRQoL), while general resilience resources (GRRs), namely, sense of coherence (SOC), social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer.

Methods

In this cross-sectional study, Stigma Scale for Chronic Illness 8-item version (SSCI-8), SOC-13, Medical Outcome Survey- Social Support Scale (MOS-SSS), Brief COPE, and Functional Assessment of Cancer Therapy-Breast (FACT-B) were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson's correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL.

Results

An analysis of 221 women (response rate of 87.5%) with the mean age of 47.14 (9.13) showed that stigma was negatively correlated to all HRQoL's dimensions (r = -0.27∼0.51, p < 0.05), SOC (r = -0.26∼0.35, p < 0.01), social support (r = -0.23∼0.30, p < 0.01), and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support (except for tangible), and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery.

Conclusion

While GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn.

Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis

Objectives: During the COVID-19 pandemic, older adults experience various challenges, including information uncertainties, financial pressure, and visit restrictions, which may lead to anxiety about the future. As a protective factor, sense of coherence (SOC) may play a role to reduce some psychological discomfort. This study aimed to analyze the relationships of SOC with anxiety, digital health literacy (DHL), information, and financial satisfaction among older adults during the outbreak.Methods: This is part of a large-scale DHL study with a cross-sectional survey across 41 countries. This study extracted data from three Asian countries (China, the Philippines, and Singapore) and included people aged ≥60. Structural equation modeling with path analysis was utilized to examine the relationships of SOC with anxiety about the future and other variables.Results: A total of 266 older adults were included, with 43.2% expressed anxiety about the future. DHL (β=-0.13, p < 0.05) and SOC (β=-0.26, p = 0.01) were negatively associated with anxiety, while financial and information satisfaction were not. However, financial satisfaction (β = 0.34, p < 0.01) and DHL (β = 0.32, p = 0.01) were positively associated with SOC. Higher SOC further mediated the negative relationships of DHL (β= -0.11, p = 0.004) and financial satisfaction (β= -0.12, p = 0.004) on anxiety of older adults.Conclusions: SOC had direct negative effect on anxiety and mediated the relationships between anxiety and DHL/financial satisfaction. Strategies should be developed to enhance SOC and DHL among older adults, as these capacities may help to manage anxiety during the pandemic.

The Impact of Place of Residence on the Sense of Coherence of Population Aged 60–89: Evidence from Poland

Place of living is one of the most important socio-demographic factors which characterizes the lives of older people. The importance of with whom and under what conditions older adults live to a large extent determines their health and standard of living. The goal of the study was to find the relationship between the place of residence and housing condition of older adults in Poland and their sense of coherence and health problems. The 29-item Antonovsky SOC questionnaire was used. In the research 303 people (76% women and 24% men) aged 60–89 were evaluated: 158 lived in their own houses/flats, while 145 resided in Daily Homes of Social Assistance (DPS). The overall result for the sense of coherence was 129.65 for older adults living in their own homes and 126.48 for these living in DPS. Statistical dependence between the place of residence and sense of manageability and meaningfulness was found. There is no dependence between gender and the overall score, nor the three components of the sense of coherence. Statistical dependence was determined in the criterion of age. A higher level of meaningfulness was observed in people aged 60–74. Taking into account the place of residents, 52% of the respondents living in their own houses/flats experience loneliness and among the people living in Daily Homes of Social Assistance, 46% experience loneliness. The type of place of residence is one of the most important personal factors affecting the sense of coherence, chronic health problems, and sense of loneliness. The last factor, especially, can adversely affect community sustainability and undermine social cohesion.

The Sense of Coherence, Self-Perception of Aging and the Occurrence of Depression Among the Participants of the University of the Third Age Depending on Socio-Demographic Factors

Purpose

The aim of the study was to assess the relationship between the sense of coherence and self-perception of aging and the risk of depression among attendees of the University of the Third Age (U3A). The influence of socio-demographic factors was studied.

Participants and Methods

The study involved 315 attendees of the U3A aged on average 68.4 years, age range 60–82 years old. The overwhelming majority were women (91.7%). Cross-sectional research was conducted using standardized questionnaires – the SOC-29 scale, the Geriatric Depression Scale (GDS – brief version) and the author’s own questionnaire regarding self-perception of aging.

Results

The study participants showed an average level of sense of coherence (130.7± 23.2). The highest number of people obtained average results of sense of coherence, both in terms of global SOC (75.2%) and its components. The highest scores on the SOC-29 scale were found for the sense of comprehensibility (41.3%). The mean value of the self-perception of aging was 69.0±16.0 and indicates the lower range of results for positive attitude. Nearly ¾ (72.1%) of the respondents had a positive self-perception of aging. The values of the scale of self-perception of aging showed a statistically significant relation to the global level of sense of coherence and its components (p<0.001). In people without depression, positive self-perception of aging was significantly more frequent than among participants with depression of increasing intensity. Education was significantly correlated with the results of the SOC-29 scale, the self-perception of aging scale and the GDS scale.

Conclusion

From the U3A research group, better educated elderly people have a higher sense of coherence and show a more positive self-perception of aging. Moreover, these people are less likely to show signs of senile depression.

The influence of domestic living arrangement and neighborhood identity on mental health among urban Chinese elders

OBJECTIVES

The primary purposes of the present study were (1) to assess the living arrangements among urban Chinese elders, (2) to examine the relationship between household living arrangement and elders' mental health, and (3) to investigate how individuals' neighborhood identity affects their mental health.

METHOD

The random sample was collected in 2011, including 939 respondents aged 60 and above who lived in the Jing'an district of Shanghai, China. The study examined well-being and depression of elders. The domestic living arrangements were assessed by a single item with five options: 'With whom are you living together?' The neighborhood identity was measured by four items: the sense of belonging, the sense of pride, volunteer work, and monetary donation for the neighborhood.

RESULTS

Urban Chinese elders' living arrangement had transited from a traditional intergenerational co-residence pattern to a more self-independent style. However, living with children was positively associated with elders' mental health after controlling for demographic variables. Although the neighborhood identity had no interaction with living arrangement, it also contributed to elders' mental health.

CONCLUSION

The study highlighted the importance of living with children and spouse, the sense of belonging, volunteer work, and the feelings of pride on elders' mental health. Results of the current study suggested implications for both government and non-governmental organizations to design family-based support for eldercare and improve neighborhood identity for elders.

Sense of coherence changes with aging over the second half of life

Sense of coherence (SOC), a concept reflecting meaningfulness, comprehensibility, and manageability of life, has been demonstrated to have strong connections to positive outcomes such as good health. However, less is known about how SOC changes over the second half of life as age-related deficits accumulate. We used longitudinal samples of mature adults that included the oldest-old to track change in SOC from age 55 to 101. Growth curves using an accelerated longitudinal design were estimated for 1809 individuals who contributed 4072 observations from five national Swedish surveys between 1991 and 2010/11. Results indicated that deficits in health and social resources were largely responsible for the precipitous decline in SOC after age 70. When controlling for these deficits, SOC increased continuously into advanced old age. We conclude that the capacity to comprehend, manage, and find meaning in life--the component elements of SOC--strengthens over the last years of life, suggesting a positive ontogenic development that runs parallel but opposite to the negative impact of health and social decline.

Health capital in everyday life of the oldest old living in their own homes

As more people experience old age as a time of growth and productivity, more research is needed that explores how they master everyday life. This paper reports on a qualitative study that explored how ten older women age 90 years or more experience and cope with the challenges of everyday life with a salutogenic perspective. The findings suggest that health resources such as positive expectation, reflection and adaptation, function and active contribution, relations and home, contribute to the health capital of women. These health resources were of importance for the women's experience of comprehensibility, manageability and meaningfulness in daily life. Health capital is a meaningful concept for understanding coping in everyday life by older people.

Inner strength in relation to age, gender and culture among old people--a cross-sectional population study in two Nordic countries

OBJECTIVES

The theoretical framework for the study was the Model of Inner Strength, and the Inner Strength Scale (ISS)developed based on the Model was used. The aim was to examine inner strength in relation to age, gender and culture among old people in Sweden and Finland.

METHOD

This study forms part of the GErontological Regional DAtabase (GERDA)-Botnia project that investigates healthy ageing with focus on the dignity, social participation and health of old people. The participants (N = 6119) were 65-, 70-, 75- and 80-year old and living in two counties in Sweden or Finland. The ISS consists of 20 items relating to four interrelated dimensions of inner strength, according to the Model of Inner Strength. The range of possible ISS scores is 20-120, a higher score denoting higher inner strength.

RESULT

The result showed that the 65-year-old participants had the highest mean ISS score, with a decrease in score for every subsequent age. The lowest score was achieved by the 80-year-old participants. Women had slightly but significantly higher mean ISS scores than men. Only small differences were found between the counties.

CONCLUSION

The study population came from Sweden and Finland; still, despite the different backgrounds, patterns in the distribution of inner strength were largely similar. The present study provides basic and essential information about inner strength in a population of old people.

Keeping disease at arm's length – how older Danish people distance disease through active ageing

Many older people live with a range of chronic diseases. However, these diseases do not necessarily impede an active lifestyle. In this article the author analyses the relation between the active ageing discourse and the way older people at two Danish activity centres handle disease. How does active ageing change everyday life with chronic disease, and how do older people combine an active life with a range of chronic diseases? The participants in the study use activities to keep their diseases at arm's length, and this distancing of disease at the same time enables them to engage in social and physical activities at the activity centre. In this way, keeping disease at arm's length is analysed as an ambiguous health strategy. The article shows the importance of looking into how active ageing is practised, as active ageing seems to work well in the everyday life of the older people by not giving emphasis to disease. The article is based on ethnographic fieldwork and uses vignettes of four participants to show how they each keep diseases at arm's length.

Balancing risk prevention and health promotion: towards a harmonizing approach in care for older people in the community

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky's salutogenic framework, different perspectives between professionals and clients on the pathways that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others' perspective, and have a dialogue with each other, taking the life narrative of clients into account.

Aging Populations’ Everyday Life Perspectives on Healthy Aging

Population aging makes policy makers face the challenge of supporting people as they age. Strategies designed to promote healthy aging should take the viewpoints of this target group into account. To strengthen interventions on healthy aging, this study aims to investigate how aging individuals experience healthy aging in their locality. A salutogenic background is used to ensure a broad perspective on health. Data collected from 79 in-depth interviews (using an appreciative inquiry approach) in the Netherlands were analyzed for interviewees’ experiences on healthy aging. Results indicate that healthy aging is perceived within the context of everyday life, and interviewees who are content with their health often have an assets-based and positive view on health. Often, however, interventions and facilities address isolated health themes, and such an approach does not match well with these perceptions. Framing interventions positively in terms of assets, resources, and everyday life may increase their effectiveness.

Healthy ageing in a salutogenic way: building the HP 2.0 framework

Healthy ageing is influenced by a variety of interacting determinants. Because no one agency can tackle all these determinants, the promotion of healthy ageing requires an intersectoral approach. The aim of this article is to describe a theoretical basis, the development and possible applications of a framework within a municipality in the Netherlands. This framework supports intersectoral collaboration by guiding and stimulating the development, implementation and evaluation of health promotion activities for healthy ageing. It is based on the principles of health promotion and on the theory of salutogenesis and built upon three interrelated central concepts: (1) sense of coherence, (2) resources for health, and (3) health. The framework visualises the interrelationships of the three concepts within health promotion and salutogenesis. This visualisation makes explicit the value and the contribution with respect to content of intersectoral collaboration and the participation of older people in health promotion. The relationships between the concepts of the framework also indicate the need to undertake different types of research and gather different kinds of data to develop, implement and evaluate healthy ageing strategies.

The effects of a physical activity programme on the psychological wellbeing of older people in a residential care facility: an experimental study

This experimental study aimed to analyse the effects of an aerobic activity intervention delivered by specially trained instructors to a sample of Italian older people living in a residential care facility. We assessed intervention effects on general health perception, perception that one's health represents a limitation for moderate and heavy physical activity, and positive and negative self-perception. The 36-item Short Form Health Survey Questionnaire (SF-36) was administered at pre-test and post-test to a sample of 22 older people (ten in the control group and 12 in the intervention group) of both genders with an average age of 80.6 years. The findings showed that: (a) the perception that one's health can limit moderate and heavy physical activity decreased significantly in the older people belonging to the intervention group between pre- and post-test, while it increased in the control group; (b) positive self-perception was found to be stable in the intervention group, while it decreased in the control group; and (c) there was no interaction between group and time with respect to both general health perception and negative self-perception. The exercise programme seemed to have a particularly positive effect on older people's beliefs about their ability to master successfully the activities of daily living such as walking and moving objects.

The Coping Orientation and Resources of Teachers Educating Learners with Intellectual Disabilities

Stress in the teaching profession is a well-recognized phenomenon and, in addition, research has found special education to be more demanding than mainstream education. A literature study to date revealed that international and South African research on special education teachers and their coping with stress is sparse. We therefore aimed to explore and describe the coping orientation and resources of teachers educating learners with intellectual disabilities. An exploratory, descriptive survey design was employed in the study. Antonovsky's Orientation to Life Questionnaire (SOC-29) and Hammer and Mailing's Coping Resources Inventory (CRI) was administered to 59 special education teachers in the Nelson Mandela Metropole, South Africa. Key findings revealed fairly high mean scores on the SOC-29 and average mean scores on the CRI. Significant positive correlations between the SOC-29 and the CRI total mean score and some of the subscale scores of the CRI were also evident.