Method and Description of the Aging in Manitoba Project: A 20-Year Longitudinal Study

Factors Associated with Postrelapse Rehabilitation Use in Multiple Sclerosis: A Pilot Survey

Background

Most people with multiple sclerosis (MS) have periodic and unpredictable relapses as part of their disease course. Relapses often affect functional abilities, resulting in diminished productivity and lower quality of life. Considering the effects, rehabilitation can play an important role in facilitating recovery; yet, the current literature suggests a lack of postrelapse rehabilitation services use. This study aims to document postrelapse rehabilitation services use and estimate the extent to which predisposing characteristics, perceived need, and enabling resources were associated with postrelapse rehabilitation services use in adults with MS.

Methods

This cross-sectional study used convenience sampling, and data from 73 adults with MS who recently had a relapse in the United States and Canada were analyzed.

Results

A total of 25 participants (34.2%) reported using postrelapse rehabilitation services. The regression model identified three variables associated with postrelapse rehabilitation services use: age (odds ratio [OR], 1.075), self-reported quality of life (considerably affected by the most recent relapse [OR, 5.717]), and presence of helpful health care providers (for obtaining postrelapse rehabilitation services [OR, 5.382]).

Conclusions

Most participants experienced a range of symptoms or limitations because of their most recent relapse, affecting their daily activity and quality of life. However, only one-third of the participants reported using postrelapse rehabilitation services, which focused on the improvement of their physical health. Regression modeling revealed that three population characteristics of the Andersen Behavioral Model of Health Services Utilization were associated with postrelapse rehabilitation services use.

Attributions for physical activity in very old adults: predicting everyday physical activity and mortality risk

OBJECTIVES

Although physical activity is recognised as a health-promoting behaviour for older adults, notable barriers exist that may reduce physical activity in this age group. Limited research has explored causal beliefs (attributions) as a barrier to physical activity. Our study assessed associations between older adults' attributions about physical activity and objective health outcomes.

METHODS

We examined the role of attributions as a predictor of everyday physical activity (EPA) and subsequent mortality risk over a 10-year period (2006-2016) in a sample of older adults (M_age = 87, N = 261).

RESULTS

OLS and Cox proportional hazard regression analyses revealed older adults who endorsed more internal and uncontrollable attributions for limited activity (physical incapacity) when feeling unwell had lower subsequent EPA (β = -0.18), and higher 10-year mortality risk (HR = 1.46). Other attributions with different dimensional properties (e.g. internal and controllable) were not associated with EPA or mortality.

DISCUSSION

Findings suggest that causal beliefs older adults have about their physical activity can influence their future behaviour and longevity. Psychological treatments designed to discourage maladaptive attributional thinking for older populations who face barriers to physical activity may be an important avenue for future research.

Paradoxical Effects of Perceived Control on Survival

Objectives

Appraising health as controllable is typically thought to be adaptive, but recent evidence suggests the paradoxical possibility that perceived control (PC) can be detrimental. We considered the premise that high PC should have a survival benefit when it is part of an adaptive mindset involving high value (importance) for health, but it might be detrimental when it is part of a mindset comprised of low health value (HV). In addition, we examined whether the survival consequences of PC and HV vary with advancing age.

Method

Interviews were conducted with a heterogeneous sample of community-dwelling adults (n = 341; 72-99 years) to assess appraisals of control and value in the domain of health. Mortality data were obtained over 12 years from a provincial health registry.

Results

Both age and HV moderated the PC effect on mortality. The predicted beneficial and detrimental PC effects emerged at younger ages: higher PC predicted longer survival times when health was highly valued but shorter survival times when health was less highly valued.

Discussion

These findings deepen the knowledge regarding the conditions under which PC is or is not adaptive, suggesting the consequences depend on age and the extent to which health is valued.

A healthy dose of realism: The role of optimistic and pessimistic expectations when facing a downward spiral in health

RATIONALE AND OBJECTIVES

Whether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health.

METHOD

This 18-year-long study of community-dwelling older Canadians (n = 132, 72-98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality.

RESULTS

Support was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic).

CONCLUSION

These findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.

Stability in Perceived Control

Objective: Our purpose was to examine how stability/variability in perceptions of control (PC) relate to a variety of health-related variables. Design: PC stability/variability across multiple domains was assessed in a longitudinal design including 318 adults, 72 to 99 years of age. Method: PC and health-related measures were obtained during in-person interviews conducted approximately 3 months apart. PC variability was assessed in relation to self-reported health outcomes (perceived health, chronic health conditions, functional status) and objective measures of physician visits and hospitalizations recorded over a 4-year period in a highly reliable and comprehensive database. Results: PC variability was associated with poorer health, poorer functional status, and more physician visits and hospital admissions, even after statistically controlling for mean PC level and direction-of-change in PC. Implications: Our findings suggest that health and well-being among very old individuals may be compromised by fluctuating levels of PC, or conversely, that stability in PC enhances health.

A Longitudinal Analysis of Discrete Negative Emotions and Health-Services Use in Elderly Individuals

Objective: To test the hypothesis that everyday, discrete negative emotions—anger, frustration, sadness, and fear—relate to health-service use in later life. Method: Community-dwelling adults ( n= 345) ages 72 to 99 were interviewed about the frequency of recently experienced emotions. Physician visits and hospital admissions in the subsequent 2 years were outcomes. Covariates included prior use of health services, chronic illness, functional status, and demographics. Results: Age, education, and gender moderated relations between negative emotions and health care use. More frustration was associated with fewer physician visits among older individuals. Sadness was associated with more hospital admissions for women. Among those with more education, frequent anger was associated with more physician visits. Projected effects of negative emotions resulted in increases in health-service use, ranging from 18% to 33%. Discussion: The interactions indicate the importance of negative emotions and the larger social and developmental context in health care services use among elderly individuals.

The Paradoxical Role of Perceived Control in Late Life Health Behavior

Research has established the health benefits of psychological factors, including the way individuals appraise outcomes. Although many studies confirm that appraising outcomes as controllable is adaptive for health, a paradoxical possibility is largely ignored: Perceived control may be detrimental under some conditions. Our premise was that appraising health as controllable but at the same time ascribing little value to it might signal a dysfunctional psychological mindset that fosters a mistaken sense of invincibility. During face-to-face interviews with a representative sample of older adults (age range = 72–99), we identified individuals with such a potentially maladaptive “invincible” mindset (high perceived control and low health value) and compared them to their counterparts on several outcomes. The findings were consistent with our hypotheses. The invincibles denied future risks, they lacked the activating emotion of fear, and they visited their physicians less often over a subsequent five-year period. Moreover, in contrast to their counterparts, the invincibles did not appear strategic in their approach to seeking care: Even poor health did not prompt them to seek the counsel of a physician. The recognition that psychological appraisals are modifiable highlights the promise of remedial methods to alter maladaptive mindsets, potentially improving quality of life.

Predicting stability and change in loneliness in later life

This study examined potential discriminators of groups of older adults showing different patterns of stability or change in loneliness over 5 years: those who became lonely, overcame loneliness, were persistently lonely, and were persistently not lonely. Discriminant function analysis results showed that the persistently lonely, compared with the persistently not lonely, were more often living alone, widowed, and experiencing poorer health and perceived control. Moreover, changes in living arrangements and perceived control predicted loneliness change. In conclusion, perceiving that one is able to meet social needs is a predictor of loneliness and loneliness change and appears to be more important than people's friendships. Because the predictors were better able to predict entry into loneliness, results point to the promise of prevention approaches to loneliness interventions.

Performance measures rather than self-report measures of functional status predict home care use in community-dwelling older adults

BACKGROUND

Occupational therapists frequently assess functional status (FS) to determine the home care (HC) service requirements of older adults. However, it is unclear which type of FS measure is most effective for this purpose.

PURPOSE

This study investigated the predictive ability of three measures of FS (a self-report measure of usual behaviour, a self-report measure of capacity, and an observational performance measure-the Performance Assessment of Self-Care Skills [PASS]) on formal HC utilization.

METHOD

A secondary analysis of 2001 Aging in Manitoba Longitudinal Study (AIM) data was conducted.

FINDINGS

The odds of receiving HC within the 30-month follow-up period were 1.32 times (or 30%) higher for each increase in the number of dependent tasks based upon a standardized performance measure. The self-report measures did not predict HC utilization.

IMPLICATIONS

This study suggests that standardized performance measures-in particular, the PASS-are more predictive of formal HC use in community-dwelling older adults than self-report measures.

Attributing heart attack and stroke to “Old Age”: Implications for subsequent health outcomes among older adults

This study assessed the extent to which older adults attribute a recent heart attack/stroke to “old age,” and examined consequences for subsequent lifestyle behavior and health-care service utilization. Community-dwelling adults ( N = 57, ages 73–98 years) were interviewed about their heart attack/stroke, and an objective health registry provided data on health-care utilization over a 3-year period. Endorsement of “old age” as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years. Findings suggest the importance of considering “old age” attributions in the context of cardiovascular health events.

Secondary Control Belief Combinations (Adjustment and Acceptance) and Well-Being in Older Adults

Peu d’études sur les personnes âgées ont evalué directement les croyances de contrôle secondaires, défini auparavant par Morling et Evered en 2006 comme une combinaison de l’ajustement psychologique et de l’acceptation. Nous avons classé les personnes âgées (n = 223, M – age de 85 ans, 62% femmes) en trois catégories, selon leurs croyances de contrôle secondaires: l’ajustement psychologique seulement, l’ajustement psychologique et l’acceptation, et ni l’ajustement psychologique ni l’acceptation. Par rapport aux personnes qui ont insisté sur croyances au sujet de l’ajustement psychologique seulement, ceux qui ont souligné une combinaison de croyances de contrôle secondaires—incluant à la fois l’ajustement psychologique et l’acceptation—ont rapporté les émotions positives plus fréquentes, une plus grande satisfaction de vie et les maladies chroniques moins sévères. Nos résultats ont des implications dans les deux contextes, théoriques et appliquées. Théoriquement, nos résultats s’étendent la réflexion contemporaine sur le contrôle secondaire. Dans les paramètres appliqués, ils suggèrent des façons de penser qui peuvent améliorer le bien-être parmi les tres vieux.

Downward social comparison and subjective well-being in late life: the moderating role of perceived control

OBJECTIVE

Drawing from Heckhausen and Schulz's Motivational Theory of Life-span Development, this study examined perceived control as a moderator of the protective relationship between downward social comparison and subjective well-being among older adults.

METHODS

Community-dwelling older adults (N = 97, 63% female, ages 79-97) were interviewed in their own homes at three time-points over a nine-year period. Interviews assessed older adults' perceived control over daily tasks, their use of downward social comparison in response to task restriction, and their subjective well-being.

RESULTS

Regression analyses yielded a significant interaction between downward social comparison and perceived control for three subjective well-being outcomes: life satisfaction, perceived stress, and depressive symptoms. Follow-up analyses revealed that downward social comparison was associated with greater subjective well-being at low levels of perceived control; but was unrelated to subjective well-being at high levels of perceived control.

CONCLUSION

These findings corroborate Heckhausen and Schulz's theorized goal-opportunity congruence premise and have implications for quality-of-life interventions to assist community-dwelling older adults.

Sense of Control in Late Life

Believing that one can influence outcomes presumably fosters a psychological sense of control. So too, however, might adaptive ways of thinking known as secondary control (SC) processes that operate when outcomes are believed to be unattainable. Using a 5-year prospective design and a representative sample of adults (ages 79-98), folk beliefs (e.g., “negative experiences can be a blessing in disguise”) were used to assess SC processes. The authors expected SC Folk Beliefs would predict Sense of Control (Hypothesis 1) which, in turn, would predict self-rated health, hospital admissions, and survival (Hypothesis 2). An indirect relationship was hypothesized: SC Folk Beliefs were expected to predict outcomes through the Sense of Control (Hypothesis 3). Support was found for all hypotheses providing insights into the antecedents and consequences of a sense of control and about how SC beliefs and a sense of control function in the context of health.

Attributing illness to 'old age:' consequences of a self-directed stereotype for health and mortality

Stereotypic beliefs about older adults and the aging process have led to endorsement of the myth that 'to be old is to be ill.' This study examined community-dwelling older adults' (N = 105, age 80+) beliefs about the causes of their chronic illness (ie, heart disease, cancer, diabetes, etc.), and tested the hypothesis that attributing the onset of illness to 'old age' is associated with negative health outcomes. A series of multiple regressions (controlling for chronological age, gender, income, severity of chronic conditions, functional status and health locus of control) demonstrated that 'old age' attributions were associated with more frequent perceived health symptoms, poorer health maintenance behaviours and a greater likelihood of mortality at 2-year follow-up. The probability of death was more than double among participants who strongly endorsed the 'old age' attribution as compared to those who did not (36% vs. 14%). Findings are framed in the context of self-directed stereotypes and implications for potential interventions are considered.

A profile of support group use and need among middle-aged and older adults with multiple sclerosis

This study compared middle-aged and older adults with multiple sclerosis (MS, N = 1,275) according to their use of support groups and identified factors associated with perceived need. Over 64.6% (n = 824) of participants had attended a MS support group meeting at least once. Individuals who had never attended a group were more likely to reside in urban or suburban communities, report lower symptom interference, and fewer activity limitations. Women, individuals without a helper, and people with greater symptom interference were more likely to perceive a need for a support group. Findings raise questions for professionals involved in developing and implementing multiple sclerosis support groups.

Changes Over Time in Long-Term Care Use, ADL and IADL Among the Oldest-Old Participants of the Aging in Manitoba Longitudinal Study

Vers 2031, les personnes les plus âgées (85 ans et plus) pourraient composer 4 pourcent de la population totale du Canada. Ce document relève les changements constates dans le domaine de l'utilisation des soins de longue durée, des activités de la vie quotidienne (AVQ) et des activités instrumentales de la vie quotidienne (ATVQ) chez les participants les plus âgés du Aging in Manitoba Longitudinal Study, d'après trois éléments répartis sur 13 ans. Parmi les participants, 38,4 pour cent n'avaient pas eu recours aux soins de longue durée pendant la période examinée; entre 75 et 88 pour cent des participants pouvaient continuer à manger, à se déplacer dans leur maison et à se mettre au lit et à en sortir sans aide. En ce qui a trait aux activités instrumentales de la vie quotidienne, la proportion des gens qui n'avait pas besoin d'aide allait de 3 pour cent (réparations dans la maison) à 58 pour cent (se préparer une tasse de thé ou de café). Les résultats de ces analyses signalent l'hétérogénéité des aptitudes fonctionnelles des personnes très âgées et viennent enrichir la documentation portant sur cette tranche de la population.

The Psychology of Aging: Canadian Research in an International Context

The psychology of aging includes a variety of theoretical perspectives, methodological conventions, and techniques and targets of application. Psychological aging-related processes include phenomena from such disparate domains as neurological, sensory, physiological, physical health, mental health, cognition, personality and affect, social, family, interactional, and coping and adjustment. Canadian researchers actively contribute to these and other research topics and professional issues. We summarize a broad and inclusive model of the psychology of aging and highlight some of the ways in which Canadian research and training reflects and advances numerous pertinent scholarly agendas.

Use of physical therapy services among middle-aged and older adults with multiple sclerosis

BACKGROUND

There is limited understanding of the utilization of and perceived need for physical therapy services among middle-aged and older adults with multiple sclerosis (MS). The resulting knowledge gap compromises efforts for physical therapy service planning for this population.

OBJECTIVE

The purpose of this study was to examine the use of and need for physical therapy services in a sample of adults with MS living in the Midwestern United States.

DESIGN

This was a cross-sectional, descriptive study.

METHODS

Data from telephone interviews with 1,065 people with MS, aged 45 to 90 years, were used for the study. A multinomial regression model was used to determine factors associated with use of physical therapy services (never, within the past year, more than a year ago). Logistic regression analysis examined factors associated with unmet needs for these services.

RESULTS

Thirty-six percent of the sample reported never using physical therapy services, 33% reported using physical therapy services within the past year, and 31% reported using physical therapy services more than a year prior to the interview. Factors associated with recent use of physical therapy services included living in an urban or suburban community, deteriorating MS status, experiencing problems with spasticity (ie, hypertonicity), having difficulty moving inside the house, being hospitalized in the past 6 months, and seeing a family physician. These same factors were associated with unmet needs. Limitations Physical therapy service use was self-reported. Data were collected in 5 Midwestern states from people 45 years of age or older, which may limit generalizability.

CONCLUSIONS

Factors associated with use of and need for physical therapy services reflect issues of access (geographical, referrals), MS status, and mobility difficulties.

Integrating a Performance-Based Observation Measure of Functional Status into a Population-Based Longitudinal Study of Aging

Over the past 15 to 20 years there has been discussion and debate in the gerontological literature about the relative merits of self-report versus performance-based observational (PBO) measures of functional status. In 2001 the Aging in Manitoba Longitudinal Study had the opportunity to add a PBO measure of functional status and use it together with two self-report measures on a sub-sample of 138 participants. The PBO measure that was used was the Performance Assessment of Self-Care Skills, Version 3.1 (Home). Using ranks of the proportion of participants who were independent in nine different tasks, no significant correlations were found between the performance measure scores and either of the self-report measures. This finding suggests that using self-report data rather than performance data could lead program developers and policy makers to different conclusions about the extent of need for assistance among older adults.

Loneliness among Older Adults in the Netherlands, Italy, and Canada: A Multifaceted Comparison

Loneliness is experienced in many cultures. To properly assess cross-cultural differences, attention should be paid to the level, determinants, and measurement of loneliness. However, cross-cultural studies have rarely taken into account more than one of these. Differences in the level of loneliness were hypothesized on the basis of national differences in partnership, kinship, and friendship, which were assumed to be related to cultural standards within a society. Differences were examined among married and widowed older adults aged 70 to 89 years living independently in the Netherlands (N = 1,847), Tuscany, Italy (N = 562), and Manitoba, Canada (N = 1,134). Loneliness was measured with an 11-item scale. The Manitobans were high on emotional loneliness and the Tuscans were high on social loneliness. Partner status excepted, the determinants were nearly the same across the three locations. Differential item functioning (DIF) related to the three locations was observed for most items. Interactions with gender and the availability of a partner relationship were observed.

Reported causal antecedents of discrete emotions in late life

Valuable insights about emotional well-being can be learned from studying older adults who have wrestled with differentiating and regulating their emotions while they navigate through the many joys and traumas of a lifetime. Our objective was to document the underlying reasons for older adults' (n = 353, ages 72 -99) emotional experiences. Using a phenomenological approach, we identified participants' reported reasons (i.e., antecedents) for a broad variety of positive and negative emotions, classifying them into thematic categories through a content analysis. The array of thematic categories that emerged for some emotions was more differentiated than for others. For example, 14 antecedent categories were required to account for the emotion of happiness; whereas, only 4 categories were needed to capture all antecedents for anger. Our analysis provided a rich description of what older adults report as the causes of their emotions, showing that later life is characterized as a time when the loss of love ones elicits sadness, self-limitations elicit frustration, and others' transgressions elicit anger. Yet, our data show that old age can be portrayed even more so as a time when a variety of positive emotions are elicited by social factors (interactions and relationships), achievements, and personal attributes. Finally, in an analysis of the most common antecedents for pride (accomplishments) and anger (other's transgression), we suggest that pride over accomplishments is most likely elicited by internal attributions to skill and effort; whereas, anger over others' transgressions is most likely elicited by controllable attributions to the transgressor's inconsiderate or offensive behavior. Overall, this shows the utility of applying Weiner's attributional framework (Weiner, 1985) to an analysis of emotion antecedents in late life.

Regret in Later Life: Exploring Relationships between Regret Frequency, Secondary Interpretive Control Beliefs, and Health in Older Individuals

The present study examined what older people regret, and the relationships between regret, health and life satisfaction. The study also explored the role of secondary interpretive control beliefs in relation to regret. Participants ( N = 228; 79–98 years old) were asked to report on the content and frequency of their regret, secondary interpretive control beliefs (e.g., beliefs in finding the “silver lining” in a dark cloud), health, and life satisfaction. A content analysis revealed that participants most commonly reported feeling regret due to things they had not done, the death of a loved one, and their own or others' health problems. Regression analyses indicated that experiencing regret more frequently was associated with poorer health and life satisfaction. Moreover, evidence for an emotion-modifying role of secondary interpretive control beliefs was shown through its negative association with regret. Results suggest that older adults may be experiencing age-related regrets that differ in content from those experienced at younger ages and that certain control beliefs may serve to lessen regret.

Exploring the commonalities between adaptive resources and self-enhancement in older adults' comparative judgments of physical activity

Objective. This study examines the extent to which optimism, control beliefs and motivation, and downward social comparison contribute independently to the maintenance of older adults positive self-evaluations in a functional domain. Method. Adaptive resources/strategies and life satisfaction were measured in personal interviews with 164 community-dwelling older adults. Participants judged their physical activity compared with the average person of their age and wore an accelerometer for 24 hours. Commonality analysis was used to estimate unique versus shared effects of the resource/strategy variables on a residual measure of self-enhancement, obtained by adjusting the comparative judgments for participants' age and objectively measured physical activity. Results. Self-enhancement was positively related to life satisfaction. Perceived control and optimism had shared positive effects on self-enhancement, whereas downward social comparison had a unique positive effect. Discussion. Self-enhancement of physical activity plays a part in at least two adaptive profiles with implications for older adults' well-being and health.

Everyday physical activity as a predictor of late-life mortality

PURPOSE

The present study hypothesized that simple, everyday physical activity (EPA) would decline with advancing age; that women would have a more favorable EPA profile than would men; and that EPA would have a survival benefit.

DESIGN AND METHODS

Community-dwelling participants (aged 80-98 years, n = 198) wore mechanical actigraphs in order for EPA to be assessed. Individuals were classified as active, inactive, and sedentary based on their level of EPA exhibited over a substantial part of the day. Survival status was available at approximately 2 years.

RESULTS

Mean EPA scores decreased with advancing age and, in contrast to men, women in their early eighties appeared to be protected from declining EPA. This partially supported the hypothesis that women would have a more favorable EPA profile. What is most important is that mean EPA scores predicted mortality. Moreover, when compared with their less sedentary counterparts, sedentary adults were more than three times as likely to be deceased 2 years later.

IMPLICATIONS

Researchers need to conduct new trials to determine whether or how physical activity is associated with mortality.

Differential determinants of men's and women's everyday physical activity in later life

OBJECTIVES

The present study of a representative sample of older adults quantified everyday physical activity (EPA) by having participants wear actigraphs. Our objectives were to examine whether poor health may partly explain why older adults become less physically active with advancing age and whether gender might moderate the extent to which health status predicts EPA.

METHODS

We performed multiple regression analyses on a sample of older, community-dwelling adults (aged 80-98 years, N = 198; women = 63.1%).

RESULTS

The results imply that age-related declines in EPA may be partially accounted for by health (in men) and by living arrangements (in women).

DISCUSSION

We consider reasons why poorer health might erode EPA for men (but not women) and why living alone might erode EPA for women (but not men).

Comparative risk and perceived control: implications for psychological and physical well-being among older adults

As older adults become more susceptible to certain health crises, their preoccupation with their risk of suffering such events increases. Understanding the implications of risk perceptions is critical because they may have consequences for psychological and physical well-being in later life. In the present study of older adults living in the community, the authors examined participants' comparative risk estimates (CREs)--their perceptions of their own risk relative to a similar other's risk--of suffering a hip fracture. Using multiple regression analyses, the authors examined the role of CREs on psychological well-being (negative emotions, life satisfaction) and self-rated physical well-being (general physical health, recent physical health). The authors expected perceived control (PC) to moderate the relationship between CREs and well-being. The predicted interaction did occur: Among individuals with high PC, comparative optimism (perceiving a comparatively low risk) was associated with better psychological well-being (fewer negative emotions and greater life satisfaction) and better physical well-being (general and recent physical health) relative to comparative pessimism (perceiving a comparatively high risk). Among individuals with low PC, there were no differences in well-being between comparative optimists and comparative pessimists. These findings suggest that the protective effect of comparative optimism on well-being is limited to older adults who have a strong sense of control.

Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis

The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45-90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45-90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating.

Detrimental effects of falling on health and well-being in later life: the mediating roles of perceived control and optimism

Falling is common among older adults, often resulting in decreased functional ability and quality of life. To understand processes underlying the fall/health and well-being relationship, it is important to identify psychosocial mediators. The current study examined the impact of falling on subsequent physical health, negative emotions and physical activity among 231 young-old (<85) and old-old (85+) community-dwelling adults, and the mediating effects of global perceived control (PC) and optimism. Regression results indicated that falling predicted poorer physical health, greater negative emotions and less physical activity among old-old but not young-old adults. Falling negatively predicted PC and optimism, which mediated the effects of falling on health and well-being among the old-old group. Findings have implications for enhancing recovery from falling via bolstering PC and optimism.

Ethnic differences in self-rated health among older adults: a cross-sectional and longitudinal analysis

The objectives of this study were to examine whether self-rated health differs among older adults of different ethnic backgrounds and to explore what factors may account for potential differences. The study was based on the 1983 and 1996 waves of the Aging in Manitoba study. A self-report measure of ethnic background was used to categorize participants into four groups: British/Canadian, Northern/Central European, Eastern European, and Other. In both 1983 and 1996, older Eastern European adults had significantly reduced odds of rating their health as good or excellent relative to British/Canadian adults. Controlling for demographic variables, socioeconomic status, language spoken, and health status attenuated but did not eliminate the difference. Global, subjective ratings of health are frequently used to measure health. The ethnic differences found here suggest, however, that ratings may be influenced by cultural factors, which may warrant some caution in making comparisons across ethnic groups.

Risk factors for falling among people aged 45 to 90 years with multiple sclerosis

OBJECTIVE

To determine the factors associated with an increased likelihood of reporting a fall in the past 6 months among people between the ages of 45 and 90 who have multiple sclerosis (MS).

DESIGN

Cross-sectional descriptive design by using telephone surveys.

SETTING

States of Minnesota, Wisconsin, Illinois, Indiana, and Michigan.

PARTICIPANTS

Total of 1089 people with MS identified through the National Multiple Sclerosis Society and the MS registry maintained by the North American Research Committee on Multiple Sclerosis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Self-reported fall to the ground in the past 6 months.

RESULTS

Exactly 52.2% of participants reported a fall in the past 6 months. Factors associated with an increased risk of a fall included being male, fear of falling, variable or deteriorating MS status in the past year, never or occasional use of a wheelchair, problems with balance or mobility, poor concentration or forgetfulness, and incontinence of bladder.

CONCLUSIONS

There are a number of factors associated with an increased risk of falling among people aging with MS that are amenable to intervention and therefore warrant the attention of health care providers serving that population.

Primary- and secondary-control strategies in later life: Predicting hospital outcomes in men and women

Community-dwelling individuals (n = 143, 73-98 years old) were assessed to consider if their use of task-specific control strategies predicted hospital outcomes in the subsequent 2 years. The authors were interested in whether men and women facing health-induced task restrictions benefited equally from the use of primary- and secondary-control strategies. Gender interacted with primary-control strategies; men's more frequent use of these proactive strategies generally related to fewer hospital admissions. Gender also interacted with secondary-control strategies; women's more frequent use of compensatory (self-protective) strategies corresponded to fewer hospital admissions and shorter hospital stay durations. Taken together, our findings suggest that men benefit by adopting certain primary-control strategies and women benefit by adopting certain compensatory secondary-control strategies.

Emotional and self-evaluative effects of social comparison information in later life: How are they moderated by collective self-esteem?

This study examined how the emotional and self-evaluative effects of social comparison in 162 community-dwelling older people were moderated by individual differences in their collective self-esteem (CSE), a trait that reflects valuing and identifying with reference groups. In our experimental simulation, administered 6 years after participants' CSE was measured, those with higher CSE reported significantly more positive emotions and self-evaluations only after downward comparison (i.e., with a worse-off peer), and significantly more negative emotions only after upward comparison (i.e., with a better-off peer). These findings contradict the possibility that an adaptive advantage of high CSE might result from the propensity to identify strategically with upward comparison targets. However, contrast with downward targets presents a viable alternative explanation for this advantage.

Optimistic social comparisons of older adults low in primary control: a prospective analysis of hospitalization and mortality

Social comparison can be used strategically to bolster the self-concept. Such use may constitute secondary striving for control, when primary striving through action is unattainable. On the basis of the life span theory of control, the authors hypothesized and found that social comparison judgments would predict physical health outcomes among older adults with low primary control perceptions in the health domain. Only among such respondents, after age, sex, activities of daily living, chronic conditions, and prior hospitalization were adjusted for, did more positive social comparison judgments predict significantly lower odds of hospitalization and death over the next 2--6 years as reported in provincial health records. In later life, optimistic social comparisons may contribute to better health by providing secondary control.

Activities of daily living (ADL) and instrumental activities of daily living (IADL) items were stable over time in a longitudinal study on aging

OBJECTIVE

The purpose of this analysis was to examine the stability over time of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items in the Aging in Manitoba (AIM) Longitudinal Study and to evaluate the existence of differential item functioning across settings (home, nursing home).

STUDY DESIGN AND SETTING

The study used data from 607 participants of the AIM Longitudinal Study who were more than 85 years of age in 1996 and who had complete data from 1983, 1990, and 1996 for all ADL and IADL items. Rasch analysis was used to examine how the rating scale of the ADL and IADL items was used by participants, and to determine if the ordering of items remained stable across three time periods (1983, 1990, 1996) and the two different settings (home, nursing home).

RESULTS

The rating scale worked best when dichotomized into "received no assistance" and "receives assistance." Except for four items (making tea, making meals, doing nursing care, and going outside in any weather), the items were stable across administration periods, and across settings.

CONCLUSION

The AIM can be used to evaluate changes in disability over time and may have the potential to identify those at risk for transitions in care.

A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies

OBJECTIVES

Longitudinal studies of the elderly are complicated by the loss of individuals between waves due to death or other dropout mechanisms. Factors that affect dropout may well be similar from one study to another. This article systematically reviews all large population-based studies of the elderly (published 1966-2002) that report on differences in individual characteristics between people who remain and people who dropout at follow-up.

STUDY DESIGN AND SETTING

A systematic review of articles that investigate attrition after baseline interview.

RESULTS

Twelve studies were found that investigated dropout other than death using unadjusted, multivariable methods or both. The unadjusted analyses showed many significant factors related to attrition. Multivariable analyses showed two main independent factors were related to increased attrition: increasing age and cognitive impairment. People who were very ill or frail had higher dropout rates, and people in worse health were less likely to be recontactable.

CONCLUSIONS

Multivariable methods of analyzing attrition in longitudinal studies show consistent patterns of dropout between differing studies, with a small number of key relationships. These findings will assist researchers when planning studies of older people, and provide insight into the possible biases in longitudinal studies introduced by differential dropout.

The relation between everyday activities and successful aging: a 6-year longitudinal study

OBJECTIVES

Activity has long been thought to be related to successful aging. This study was designed to examine longitudinally the relation between everyday activities and indicators of successful aging, namely well-being, function, and mortality.

METHODS

The study was based on the Aging in Manitoba Study, with activity being measured in 1990 and function, well-being, and mortality assessed in 1996. Well-being was measured in terms of life satisfaction and happiness; function was defined in terms of a composite measure combining physical and cognitive function.

RESULTS

Regression analyses indicated that greater overall activity level was related to greater happiness, better function, and reduced mortality. Different activities were related to different outcome measures; but generally, social and productive activities were positively related to happiness, function, and mortality, whereas more solitary activities (e.g., hand-work hobbies) were related only to happiness.

DISCUSSION

These findings highlight the importance of activity in successful aging. The results also suggest that different types of activities may have different benefits. Whereas social and productive activities may afford physical benefits, as reflected in better function and greater longevity, more solitary activities, such as reading, may have more psychological benefits by providing a sense of engagement with life.

Discrete emotions in later life

More positivity than negativity is demonstrated in this analysis of discrete emotions among 353 community-dwelling individuals from 72 to 99 years old. A complexity in positive emotions was displayed, with more happiness, contentment, and gratitude reported than frustration, sadness, and anger. Our results also imply that another individual's presence may elicit negative emotions such as anger and guilt, whereas perceptions of support may elicit various positive emotions. As expected, certain negative emotions were associated with poor health, with a link between sadness and sickness being most prominent. Of note, poor health did not undermine positive emotions. These findings provide an optimistic view of emotions in later life, even among individuals who are poor, not well educated, and/or physically unwell.

Compensating for losses in perceived personal control over health: a role for collective self-esteem in healthy aging

Collective self-esteem (CSE) refers to an individual's self-evaluation of his or her social identity. We speculate that a positive social identity, or high CSE, facilitates accommodation to negative health-related circumstances in later life, especially when one feels unable to alter these circumstances directly. Accordingly, we hypothesized that CSE would be associated with fewer chronic conditions and greater perceived health for those with low perceived control. Hierarchical regression analyses of data from 1,267 respondents (60% women, aged 69-101) in the 1996 Aging in Manitoba survey confirmed the predicted CSE x Perceived Control interaction on both measures of health status. These findings persisted when respondents' self-rated loneliness was controlled. CSE may compensate to protect the health of older adults whose perceived personal control over health is low. Secondary control and alternative mechanisms for this protective effect are discussed.

Changes predicting long-term care use among the oldest-old

PURPOSE

The aim of this study was to identify health-related changes occurring between 1983 and 1990 that characterize and differentiate 1996 long-term care outcomes (no services, home care, nursing home) among people aged 85 years and older.

DESIGN AND METHODS

Variables capturing health-related changes between 1983 and 1990 in a cohort (N = 616) of Aging in Manitoba Longitudinal Study participants aged 85 years and older were used in a series of logistic regression models to identify factors that best predicted the use of long-term care services in 1996, controlling for age and sex.

RESULTS

Factors predicting home care use relative to no services included changes in self-rated health, income adequacy, and railings outside of the house. Factors predicting nursing home use relative to home care included age and changes in general life satisfaction. Factors predicting nursing home use relative to no services included age; previous service use; length of time in the community; and changes in income adequacy, type of housing, and state of mind.

IMPLICATIONS

These findings challenge assumptions about the linearity of the continuum of long-term care services, because different factors were shown to predict home care use than were shown to predict nursing home use.

Gender differences in the relationship between marital status transitions and life satisfaction in later life

This study examined life satisfaction among individuals who had undergone a transition in marital status and those whose marital status remained stable over a 7-year period. In particular, using data from a large-scale, longitudinal study we assessed life satisfaction as measured in 1983 and 1990 among 2,180 men and women between the ages of 67 and 102. Groups of individuals were identified on the basis of whether a spouse was present or absent at the two measurement points. This allowed for a classification of groups who experienced stability or transitions in marital status. Among those individuals whose marital status remained stable over the 7 years, women's life satisfaction declined and men's remained constant. Among those who experienced a transition--in particular, the loss of a spouse--a decline in life satisfaction was found for both men and women, decline being more predominant for men. In addition, men's life satisfaction increased over the 7-year period if they gained a spouse, whereas the same was not true for women. Generally, these findings imply that the relationship between marital status transitions or stability differs for men and women.

Social relationships and health as predictors of life satisfaction in advanced old age: results from a Swedish longitudinal study

This longitudinal study examines the relationship between family and friend social support, health, and life satisfaction for a single cohort of eighty-year-old persons living in Lund, Sweden. Results indicate that participants who remained in the study are healthier and score higher on life satisfaction when compared with those who either drop-out or die prior to age eighty-three. Even though well-integrated with family and friends, the number of friends decreases significantly from eighty to eighty-three years; those who reported no close friends nearly doubled from eighty to eighty-three years. However, for those with close friends, contact with friends increases with age. In contrast to previous research, a correlational analysis indicates that neither child nor friend support is related to life satisfaction at either eighty or eighty-three years. However, health measures and satisfaction with sibling contact are related to total life satisfaction at age eighty-three only. These findings indicate the multidimensionality of both social support and life satisfaction for the old-old.