Subjective well-being amongst community-dwelling elders: what determines satisfaction with life? Findings from the Dublin Healthy Aging Study

Does lifelong learning matter for the subjective wellbeing of the elderly? A machine learning analysis on Singapore data

Our study explores whether lifelong learning is associated with the subjective wellbeing among the elderly in Singapore. Through a primary survey of 300 individuals aged 65 and above, we develop a novel index to capture three different aspects of subjective wellbeing, which we term "Quality of Life", "Satisfaction with Life" and "Psychological Wellbeing". Utilizing both supervised and unsupervised machine learning techniques, our findings reveal that attitudes towards lifelong learning are positively associated with quality of life, while participation in class activities is positively associated with all three measures of wellbeing. Although the study does not establish causality, it highlights a connection between lifelong learning and the perceived wellbeing of the elderly, offering support for policies that encourage lifelong learning among this population.

Relationship Between Life Satisfaction and Psychological Characteristics Among Community-Dwelling Oldest-old: Focusing on Erikson's Developmental Stages and the Big Five Personality Traits

OBJECTIVE

To clarify the relationship between life satisfaction and the psychological characteristics of the oldest-old, and explore the factors for achieving mental health and longevity.

DESIGN

This cross-sectional study conducted questionnaire surveys and face-to-face interviews as part of a larger prospective cohort study.

SETTING

Arakawa Ward, a district in Tokyo, Japan.

PARTICIPANTS

A total of 247 oldest-old individuals from two age groups, 85+ (aged 85-87 years) and 95+ (aged 95 years or older).

MEASUREMENTS

Life satisfaction was assessed using the Satisfaction with Life Scale (SWLS), developmental stages of the elderly (Erikson's 8th and 9th stages, i.e., ego integrity, and gerotranscendence), and the Big Five personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism) using the NEO-Five Factor Inventory. Multiple regression analyses were performed to examine the relationship between the SWLS scores and each assessment, controlling for age, sex, education, activities of daily living, depressive symptoms, and cognitive function.

RESULTS

The SWLS scores of 85+ were positively correlated with scores of ego integrity, extraversion, and conscientiousness. Contrastingly, the SWLS scores of 95+ were positively correlated with gerotranscendence scores.

CONCLUSIONS

Psychological characteristics associated with the level of life satisfaction among community-dwelling oldest-old individuals were identified, but a causal relationship between these factors and life satisfaction was not established. Ego integrity, extraversion, conscientiousness, and gerotranscendence may be associated with enhanced life satisfaction and mental health in the oldest-old. Further, the factors associated with life satisfaction in the 85+ and 95+ age groups varied, suggesting that life satisfaction among the oldest-old has different foundations in different age groups.

Lifestyle factors and subjective well‑being among older adults in China: A national community-based cohort study

There has been limited research on the relationship between health habits and subjective well-being (SWB) among Chinese oldest older adults. This study aims to explore lifestyle factors associated with SWB in this population. We analyzed data from three waves (2008-2014) of the CLHLS, including 28,683 older adults. Lifestyle factors analyzed included fruit and vegetable intake, smoking, alcohol consumption, physical exercise, and social participation. Results suggested that high frequency of fruit and vegetable intake, current and past physical exercise, and high levels of social participation were associated with increased SWB. SWB was lower in older adults who never smoked compared to persistent smokers and in those who never drank alcohol or ceased drinking compared to persistent drinkers. We encourage older adults to enhance SWB through increased fruit and vegetable intake, physical exercise, and social participation. However, quitting smoking and drinking may not necessarily improve SWB, particularly in the context of China.

The impact of epidemic infectious diseases on the relationship between subjective well-being and social class identity in older adults: The mediating role of Self-rated health

BACKGROUND

The purpose of this paper is to explore the relationship between subjective well-being, social class identity, and Self-rated health among older persons,. Focusing on the mediating role of health and the impact of epidemic infectious diseases on these relationships.

METHODS

Based on the 2018 and 2021 China General Social Survey (CGSS) databases, the data were screened, and processed. Using Stata17, we employed ordered probit regression to examine the relationships among variables and Bootstrap methods to assess mediation effects, and the CGSS data for 2018 and 2021 were compared and analyzed.

RESULTS

Our results revealed that factors such as social class identity, health status, and personal income significantly positively impact older persons' subjective well-being (P<0.01). Notably, there was a partial mediating effect of health status between the subjective well-being of the elderly and social class identity. And findings showed that when older adults were affected by epidemic diseases, their subjective well-being, social class identity, and Self-rated health remained significantly positively correlated. Subjective well-being, social class identity. What is more noteworthy is that when affected by epidemic infectious diseases, older adults' subjective well-being, social class identity, and Self-rated health remained significantly positively correlated. The mediating role of self-rated health in older adults' subjective well-being and social class identity increased from 9.6% to 12.4%.

CONCLUSIONS

In the face of epidemic infectious diseases, we need to pay more attention to the Self-rated health of the elderly, and the Chinese government should take effective measures to improve their health level, which will in turn improve the subjective well-being of the elderly and realize the goal of healthy aging.

Enhancing understanding of healthy aging based on time-varying dependencies among multidimensional health, life satisfaction, and health behaviors of older adults aged 60 years and over

BACKGROUND

Healthy aging is a process of not only achieving good health but also increasing the life satisfaction of older adults aged 60 years and over, in which health behaviors play an important role. There is a lack of research on the time-varying dependencies between health, life satisfaction, and health behaviors, impeding a deeper understanding of healthy aging.

PURPOSE

To develop an integrated framework for modeling the interrelationships among the components of healthy aging between multiple time slices.

METHODS

Based on the Chinese Longitudinal Healthy Living Survey (CLHLS) data in the three waves of 2011/2012, 2014, and 2017/2018, Bayesian network and dynamic Bayesian network are jointly employed to study the relationships among the components of healthy aging within one time slice, as well as to explore the time-varying dependencies among the components between time slices.

RESULTS

The results of structure learning reveal the direction of effects between different dimensions of health, with mental health and social health affecting physical health and self-rated health affecting both physical and mental health. In addition, health behaviors are found to affect mental health and social health, while self-rated health can influence life satisfaction. The parameters learned from the data show the magnitude and direction of concurrent effects, one-period lagged effects and two-period lagged effects between the factors, which find that the time-varying dependencies vary but are generally positive, long-term, and accumulative over time. In addition, the results of autoregressive effects show the positive predictive effects of health and life satisfaction.

CONCLUSIONS

It confirms the influence pathway from health behaviors to multidimensional health to life satisfaction, and the time-varying dependencies among the components of healthy aging, which facilitates a deeper understanding of healthy aging. Combining the results of autoregressive effects and descriptive statistics, it further indicates that healthy aging is a comprehensive result arising from interactions of multiple factors. Policymakers should guide older adults aged 60 years and over to adopt healthier behaviors and ensure the long-term sustainability and continuity of policies.

A study on the impact of health shocks on subjective wellbeing of middle-aged people and older adults-Evidence from China

Introduction

The health issues that afflict middle-aged people and older individuals are a significant factor that affects their quality of life. It is crucial to investigate the impact of health shocks on the subjective wellbeing of this demographic and the mechanisms that underlie this impact to promote healthy aging.

Methods

This study utilized data from the China Family Panel Study in 2018 and 2020 to analyze the effects of HSs and their categories on the subjective wellbeing of middle-aged people and older individuals using the propensity score matching difference-in-differences method. Additionally, the study explored the mediating role of social participation.

Results

The findings indicate that health shocks, both chronic and acute, diminish the subjective wellbeing of middle-aged people and older adults. Furthermore, these shocks have a more significant negative effect on the subjective wellbeing of individuals aged 60 and above, women in the middle-aged and older demographic, individuals in rural areas who belong to the middle-aged and older age groups, and individuals possessing activities of daily living. The mechanism analysis revealed that health shocks, both chronic and acute, reduce the subjective wellbeing of middle-aged people and older individuals by disrupting partnerships.

Discussion

Lowering the possibility of health shocks, the government should build a strong health management system and improve the health insurance system to enable timely treatment for persons suffering from health shocks. Individuals and families should live healthy lives and engage in social activities to avoid health shocks and improve subjective wellbeing.

Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern

BACKGROUND

Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status.

METHODS

This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used.

RESULTS

The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased.

CONCLUSIONS

Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.

Do the integrated theories of self-determination and planned behavior explain the change in active life engagement following a motivational counseling intervention among older people?

BACKGROUND

An integrated model based on self-determination and planned behavior theories has been used to explain physical activity and other health-related behaviors mainly among younger populations, not older adults. The present study aimed to conduct a secondary analysis to explore whether changes in theory-based constructs explain a change in activity level (including 17 activities in essential life areas) among 75- and 80-year-old individuals.

METHODS

Data came from the Promoting well-being through active aging (AGNES) study, a two-arm single-blinded randomized control trial, where participants in the intervention group (n = 101) received year-long individualized counseling between 2017-19 in Jyväskylä, Finland. Activity frequency was assessed using the University of Jyväskylä Active Aging Scale (UJACAS) activity sub-score, perceived autonomy support with the Health Climate Questionnaire, autonomous motivation with a sub-scale from the Self-Regulation Questionnaire, and attitude with three items. Subjective norm, perceived behavioral control, and intention were each assessed with one item. Change in variables between baseline and the 12-month follow-up was specified via latent factors. Various structural equation models were tested to assess whether the basic or modified model, including additional paths from baseline variables to change factors, provided a better data fit.

RESULTS

In the modified integrated model, baseline attitude and change in attitude directly explained the change in activity frequency. Moreover, statistically significant indirect paths were observed from baseline autonomous motivation through baseline attitude, and from activity frequency through change in attitude to change in activity frequency.

CONCLUSIONS

The theoretical integrated model did not account for the change in active life engagement. The modified integrated model revealed significant change paths, highlighting autonomous motivation and attitudes as influential change constructs. For future intervention design, the modified integrated model appears useful in identifying behavior change pathways for older adults.

12-week concurrent brisk walking and Taijiquan (Tai Chi) improve balance, flexibility, and muscular strength of Chinese older women

Healthy aging is a global goal to enhance the quality of life for older persons. This study evaluated the benefits of 12-week concurrent brisk walking and Taijiquan. Healthy Chinese women aged 60 years and above were enrolled to the control (n = 26) and intervention (n = 25) groups. Participants in the intervention group engaged in three exercise sessions per week for 12 weeks, whereas control group engaged in free-living activities. Each exercise session consisted of 20-45 minutes of walking and 20-45 minutes of Yang style 24-form Taijiquan. 12-week exercise improved (p < 0.05) the sit and reach test (within-group mean difference: +5.6 cm; Hedges' g = 0.77), handgrip strength (mean difference: +3.1 kg; g = 0.89), arm curl (mean difference: +2.1 repetitions; g = 0.69), chair stand (mean difference: +2.6 repetitions; g = 0.63), and one-legged standing (mean difference: +2.2 seconds; g = 1.07). There was no improvement in the circulatory health, body composition, or life satisfaction. Therefore, this concurrent brisk walking and Taijiquan training, which targets major whole-body muscle groups, could improve aging-critical flexibility, muscular fitness, and balance in older women. The exercise meets the current WHO guideline, is safe to perform, and could be campaigned as a health promotion for older persons.

Reciprocal Effects between Sleep Quality and Life Satisfaction in Older Adults: The Mediating Role of Health Status

OBJECTIVES

to examine the causal relationship between sleep quality and life satisfaction and explore the mediating role of health status on the relationship between sleep quality and life satisfaction.

METHODS

A total of 1856 older Chinese people participating in 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. A cross-lagged panel analysis (CLPA) combined with mediator analysis was utilized.

RESULTS

The average sleep quality levels for the years 2011, 2014, and 2018 were 3.70, 3.63, and 3.47 out of 5, respectively. The corresponding average levels of health status were 3.47, 3.44, and 3.39 out of 5, and the average levels of life satisfaction were 3.75, 3.86, and 3.87 out of 5, respectively. In addition, sleep quality at prior assessment points was significantly associated with life quality at subsequent assessments, and vice versa. Also, health status partially mediated this prospective reciprocal relationship.

CONCLUSIONS

There is a nonlinear decreased trend in sleep quality and health status, while there exists a nonlinear increased trend in life satisfaction for older adults from 2011 to 2018. Reciprocal positive effects between sleep quality and life satisfaction in older adults exist and are mediated by health status.

Is There Evidence of an Association Between Acute Health Care Utilization and Function in Older Adults Over Time? A Population-Based Cohort Study

Background and Objectives

Acute health care use varies by age, with older adults the highest users of acute health care services. Using data from The Irish Longitudinal Study on Ageing (TILDA), the aim of this study was to investigate the association between acute health care utilization (emergency department [ED] visit with or without hospitalization) at baseline and subjective and objective measures of function measured at 4-year follow-up.

Research Design and Methods

This study represents a secondary analysis of a prospective cohort study, where data from Wave 1 (baseline) and Wave 3 of TILDA were analyzed in conjunction with a public and patient involvement group of older adults. Acute health care utilization was defined as an ED visit with or without hospitalization in the previous 12 months. Function was assessed objectively using the Timed Up and Go (TUG) test and a measure of grip strength, and subjectively using self-report limitations in activities of daily living (ADL) and instrumental ADL (IADL).

Results

A total of 1 516 participants met the study inclusion criteria. Mean age was 70.9 ± 4.6 years and 48% were male. At baseline, 1 280 participants reported no acute health care use. One hundred and eighteen indicated an ED visit but no hospitalization in the previous 12 months and 118 reported both an ED visit and hospitalization. Adjusting for all covariates, compared to those with no acute health care utilization, those with an ED visit with no hospital admission had poorer TUG performance at follow-up (β = 0.67, 95% confidence interval: 0.34, 1.29, p = .039).

Discussion and Implications

This paper supports previous research that acute health care events, specifically ED usage, are associated with reduced function for older adults as assessed by TUG at follow-up. No associations were observed for grip strength, ADL, or IADL. Further research is required in this area, exploring ED visits and the possible benefits of evaluating older adults at this stage.

Subjective well-being predicts Covid-19 risk in the elderly: a case-control study

BACKGROUND

Covid-19 is a serious public health concern. Previous studies have shown that although there are concerns about the subjective well-being (SWB) of older people in the Covid period, the link between SWB and the risk of Covid-19 is still unclear. This study aimed to investigate the predictive effect of SWB on the Covid-19 risk in the elderly as well as the determinants of SWB.

METHODS

This case-control study was performed in the elderly over 60 years of age. The case group consisted of all hospitalized patients with COVID-19 and the control group from the same population with no history of COVID-19 matched by age, sex, and place of residence. Data collection tools included a demographic questionnaire and SWB scale of Keyes and Magyarmo to measure emotional, psychological and social well-being. All data were analyzed via SPSS and STATA software. Multiple binary logistic regression was run to predict the probability of Covid-19 risk on the values of total SWB and its three subscales and multiple linear regression to identify SWB determinants.

RESULTS

The results showed that increasing one unit in total SWB reduces the risk of Covid-19 by 4% (OR = 0.969, CI = 0.947-0.991, p = 0.006). Emotional well-being with 0.823 had the highest odds ratio for predicting Covid-19 risk, followed by social well-being with an odds ratio of 0.981. Increasing age and education, better economic status, marriage against celibacy, lack of comorbidity, and a better understanding of own health were associated with greater SWB.

DISCUSSION

This study provides evidence for the protective effect of SWB on Covid-19 risk. To promote SWB, we need to focus on the elderly with higher financial worries and comorbidities, as well as those with less education, health perception and SWB. Therefore, it will be important for the elderly to determine strategies to improve SWB during the epidemic.

Patterns of Muscle-Related Risk Factors for Sarcopenia in Older Mexican Women

Early detriment in the muscle mass quantity, quality, and functionality, determined by calf circumference (CC), phase angle (PA), gait time (GT), and grip strength (GSt), may be considered a risk factor for sarcopenia. Patterns derived from these parameters could timely identify an early stage of this disease. Thus, the present work aims to identify those patterns of muscle-related parameters and their association with sarcopenia in a cohort of older Mexican women with neural network analysis. Methods: Information from the functional decline patterns at the end of life, related factors, and associated costs study was used. A self-organizing map was used to analyze the information. A SOM is an unsupervised machine learning technique that projects input variables on a low-dimensional hexagonal grid that can be effectively utilized to visualize and explore properties of the data allowing to cluster individuals with similar age, GT, GSt, CC, and PA. An unadjusted logistic regression model assessed the probability of having sarcopenia given a particular cluster. Results: 250 women were evaluated. Mean age was 68.54 ± 5.99, sarcopenia was present in 31 (12.4%). Clusters 1 and 2 had similar GT, GSt, and CC values. Moreover, in cluster 1, women were older with higher PA values (p < 0.001). From cluster 3 upward, there is a trend of worse scores for every variable. Moreover, 100% of the participants in cluster 6 have sarcopenia (p < 0.001). Women in clusters 4 and 5 were 19.29 and 90 respectively, times more likely to develop sarcopenia than those from cluster 2 (p < 0.01). Conclusions: The joint use of age, GSt, GT, CC, and PA is strongly associated with the probability women have of presenting sarcopenia.

The mechanisms underlying the negative effect of depression on life satisfaction among the elderly: the roles of ostracism and economic income

OBJECTIVES

Depression is prevalent among older persons, which seriously threatens their life satisfaction. This study aimed to explore the internal mechanisms by which depression influences life satisfaction among the elderly, as well as the mediating and moderating effects of ostracism and economic income, respectively, in a sample of rural older adults across China.

DESIGN

This was a cross-sectional survey conducted as part of the project "Thousands of People and Hundreds of Villages (2019)."

SETTING

Participants were rural older adults from 31 provincial-level administrative units across China.

PARTICIPANTS

The sample composed of 1,754 participants aged 60 years and over.

MEASUREMENTS

Depression was assessed with the depression subscale of the Depression Anxiety Stress Scales, life satisfaction with the Satisfaction with Life Scale, ostracism with the Ostracism Experience Scale (OES), and economic income and other control variables with related demographic scales. Moderation and mediation analyses were performed using the regression-based approach as conducted by Hayes ().

RESULTS

Depression negatively predicted life satisfaction among the elderly. Ostracism played a partially mediating role between depression and life satisfaction. Economic income moderated the effect of depression and ostracism on life satisfaction: High economic income weakened the negative effect of depression on life satisfaction and enhanced the negative effect of ostracism on life satisfaction.

CONCLUSION

Improving depressed elderly people's interpersonal relationships and financial support could improve their life satisfaction.

Neighborhood Attributes and Well-Being Among Older Adults in Urban Areas: A Mixed-Methods Systematic Review

Expanding urbanization rates have engendered increasing research examining linkages between urban environments and older adults' well-being. This mixed-methods systematic review synthesizes the evidence for the influence of urban neighborhoods' attributes on older adults' well-being. We searched for literature published up to December 2020 across six databases and performed quality assessment and thematic analysis. The results, based on 39 identified studies, showed that natural areas in neighborhoods and a sense of community are the attributes most often associated with positive effects on well-being. Transit-related variables, urban furniture, and access to healthcare are also positively related to well-being. Neighborhoods may promote well-being more effectively when these elements are considered. However, almost half of the studies did not include all environmental dimensions simultaneously, and self-reported instruments were largely preferred over more objective assessments of the environment. Future research should thus holistically examine physical, social, and service-related attributes to produce more robust evidence.

Loneliness and social isolation among the older person in a Swiss secure institution: a qualitative study

BACKGROUND

A pandemic of loneliness is hitting the aging population. As COVID19 forced us to isolate ourselves, we are in a better position to understand consequences of social distancing. The recent literature showed that older incarcerated adults are particularly at risk of health-related complications due to isolation in the prison environment, reducing their social capital. Mental and physical health can be severely affected by loneliness and social isolation, especially in prison.

METHODS

Our qualitative study investigates the view of older persons deprieved of their liberty on loneliness and social isolation pertaining to their mental health. We interviewed 57 older participants, including imprisoned individuals and forensic patients, following a semi-structured interview guide. During the data management and data analysis process, we excluded 7 interviews which were of poorer quality. Thereafter, we analyzed the remainders following a thematic approach.

RESULTS

Most interviewees experience loneliness following lack of significant human relationships in prison. Making friends appears to be a challenge for all the participants, because, for one thing, they do not find people with similar interests. Also, secure institution setting aggravates isolation due to the restrictions of movement placed such as rules concerning movement between floors, hindering intimate relationship, and separation between friends. Moreover, contact with prison personnel is limited and lack social capital (e.g. trust).

CONCLUSION

To our knowledge, this study is one of the first to present incarcerated persons' perspective on loneliness, social isolation and poor social capital in the Swiss prison setting. These has been reported to cause health problems both somatic and psychological. Our participants experience these deleterious factors in detention. As prisons have the possibility to become a health-promoting environment through connectedness, friendship, and trust promotion, stakeholders need to better their social capital.

Do opposite ends of same factors underlie life satisfaction vs. depressive symptoms among older people?

Background

Although depressive symptoms are more common among older than younger age groups, life satisfaction tends to remain stable over the life course, possibly because the underlying factors or processes differ.

Aim

To study whether the factors that increase the likelihood of high life satisfaction also decrease the likelihood of depressive symptoms among older people.

Methods

The data were a population-based probability sample drawn from community-dwelling people aged 75, 80, and 85 years (n = 1021). Participants’ life satisfaction was measured with the Satisfaction with Life Scale and depressive symptoms with the Centre for Epidemiologic Studies Depression Scale (CES-D). Physical performance, perceived financial situation, executive functions, loneliness, self-acceptance, and having interests in one’s life were studied as explanatory variables. The data were analyzed using cross-sectional bivariate linear modeling.

Results

Better physical performance, not perceiving loneliness, having special interests in one’s life, and higher self-acceptance were associated with higher life satisfaction and fewer depressive symptoms. Better financial situation was related only to life satisfaction. Executive functions were not associated with either of the outcomes.

Discussion

The opposite ends of the same factors underlie positive and negative dimensions of mental well-being.

Conclusion

Further studies are warranted to better understand how people maintain life satisfaction with aging when many resources may diminish and depressive symptoms become more prevalent.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-020-01765-z.

Does the psychological variables predict life satisfaction and purpose in life in brazilian elderly?

Aims: the present study aimed to investigate the association between indicatives of stress, anxiety and depression with life satisfaction and purpose in life among Brazilian older adults.Methods: this cross-sectional study was conducted with 654 Brazilian older adults who responded the Life Satisfaction Scale, Purpose in Life Scale, Perceived Stress Scale, Geriatric Anxiety Inventory and the Geriatric Depression Scale. Data were analyzed through independent t-test, Cohen’s D, Pearson Correlations and Multivariate Regression Analysis (p<0.05).Results: results indicated slightly higher levels of stress and anxiety for women when compared to men (p<0.05); indicatives of stress, anxiety and depression were inversely correlated to life satisfaction and purpose (r = -0.19 to -0.44; p<0.05); stress (β=-0.29) and depression (β=-0.36) were significant predictors of life satisfaction (R2=0.31; p<0.01), and life purpose (R2=0.18; p<0.01) was predicted by stress (β=-0.15), anxiety (β=0.10) and depression (β=-0.39).Conclusion: It can be concluded that stress and depression are significant factors hindering older adults’ satisfaction and purpose in life.

Physical Health and Quality of Life among Older People in the Context of Chinese Culture

Population aging has become a crucial problem in China. Recently, the Chinese government has adopted many strategies and policies to solve this problem and improve the quality of life of older individuals. The present study aimed to examine the effect of physical health on quality of life among older individuals in the context of Chinese culture and explore the potential mediating roles of positive cognition and negative emotions in the association between physical health and quality of life. Data were from the wave of 2017-2018 of the Chinese Longitudinal Healthy Longevity Survey. Data on physical health, quality of life, positive cognition, and negative emotions of 15,874 older people were included in the present study. Pathway analysis was conducted by using IBM SPSS AMOS 21.0, and double verified using PROCESS Macro for SPSS 3.5.3. Results showed that physical health was positively associated with quality of life among older individuals in the context of Chinese culture. The effect size was small to moderate. Positive cognition and negative emotions independently and serially mediated the linkage of physical health and quality of life. These findings provided empirical evidence for the activating event-belief-consequence theory of emotion and hierarchy of needs theory and indicated that Chinese older people focused more on physical health rather than mental health. Practitioners could teach older individuals strategies of emotion regulation and cognitive appraisal to improve the quality of life of older individuals.

Sociodemographic, health-related, and social predictors of subjective well-being among Chinese oldest-old: a national community-based cohort study

BACKGROUND

There is still a lack of systematic investigation of comprehensive contextual factors of subjective well-being (SWB) among Chinese oldest-old. This study aimed to explore sociodemographic, health-related, and social predictors of SWB among Chinese oldest-old using a large and representative sample.

METHODS

The study included 49,069 individuals aged 80 and older from the Chinese Longitudinal Healthy Longevity Survey, a prospective, nationwide, community-based study conducted from 1998 to 2014. SWB was measured by eight items covering life satisfaction, positive affect (optimism, happiness, personal control, and conscientiousness), and negative affect (anxiety, loneliness, and uselessness). Generalized estimating equation models were used to explore the predictors of SWB.

RESULTS

We found that age, gender, ethnic group, education, primary occupation before retirement, current marital status, and place of residence were sociodemographic predictors of SWB among the Chinese oldest-old. The health-related predictors included self-rated health, visual function, hearing function, diet quality, smoking status, drinking status, and exercise status. SWB was influenced by some social factors, such as the number of biological siblings, the number of children, leisure activities, financial independence, and access to adequate medical service. In particular, self-rated health, access to adequate medical services, exercise status, and place of residence exert a stronger effect than other factors.

CONCLUSIONS

SWB in the oldest-old is influenced by a large number of complex sociodemographic, health-related, and social factors. Special attention should be paid to the mental health of centenarians, women, rural residents, widowed, physically disabled, and childless oldest-old people. Relevant agencies can improve physical activities, leisure activities, financial support, and medical services to promote the well-being of the oldest-old.

Expanding Social, Psychological, and Physical Indicators of Urbanites' Life Satisfaction toward Residential Community: A Structural Equation Modeling Analysis

Attention on, and interest in, life satisfaction has increased worldwide. However, research on life satisfaction focused toward the urban dwellers' residential community is mainly from western countries, and the limited research from China is solely focused on the geriatric population via a narrowly constrained research perspective. This study, therefore, aimed to investigate urbanites' life satisfaction toward their community, combining the psychological (behavioral community engagement, mental state of flow, and cognitive community identity), physical (PREQIs-perceived residential environment quality indicators: e.g., green area), and social perspectives (social capital). The proposed conceptual model was tested on a regionally representative sample of 508 urban community residents in the city of Chengdu, Sichuan province, China. Data were analyzed via a structure equation modelling approach in AMOS software. Findings suggested that all of the psychological, physical and social factors contributed to a prediction of life satisfaction. Specifically, social capital mediated the path from community engagement and flow to life satisfaction, and community identity mediated the path from flow experience and green area to life satisfaction. Additionally, social capital contributed to predict life satisfaction through its influence on community identity. Findings provide suggestions for urban designers and policymakers to focus on creating an urban community equipped with green area, which helps to promote physical activities that are flow-productive, to enhance residents' identification to their residential community and, therefore, increase life satisfaction.

Wheelchair satisfaction among elderly Arab and Jewish patients - a cross-sectional survey

PURPOSE

To evaluate patient satisfaction with their wheelchairs among Jewish and Arab older adults.

MATERIALS AND METHOD

A cross-sectional study based on personal interviews. Participants were confined to a wheelchair (WC) Level 3. The Quebec User Evaluation of Satisfaction (scales 1-5) evaluated patient satisfaction. T test evaluated differences between continuous variables and χ2 or a Fisher's exact test between categorical variables. The contribution of background variables to the overall satisfaction with the wheelchair and related service was evaluated by multivariate regression.

RESULTS

A total of 74 Jewish and 24 Arab (mean age 78.4 ± 14.1), participated in the study. The overall satisfaction score was moderate/high (3.97 ± 0.8) with no difference between the groups. The most important items for all participants were WC safety, comfort and weight. Participants from the Arab sector were less educated, had higher BMI and were less satisfied with the chair dimensions.

CONCLUSIONS

A WC Level 3 may be effective and meets most of the basic needs of both Jewish and Arab patients at older ages. Higher BMI may result in difficulty to adopt to WC dimensions and can explain the less satisfaction of Arab patients with this component. A routine initial phone call follow-up is recommended to all patients after receiving a wheelchair. Those with problems will be scheduled for home visit. It is recommended to perform a study that will include more types of assistive devices and other groups of patients.Implication For RehabilitationApparently, despite lack of home visit follow-up, overall satisfaction with wheelchaires is relatively high. Therefore, initial phone calls may be monitored to all patients and home visits may be scheduled only for those unsatisfied with their chair.Converting a home visit to phone call can reduce the costs associated with routine home visits for all patients as is currently the case in some counties. This counts for both Jewish and Arab patients.

The Role of Self-Esteem in the Relationship Between Loneliness and Life Satisfaction in Late Adulthood: Evidence from Poland

Background

The life satisfaction of elderly persons has been extensively investigated and discussed. However, a literature review shows that relatively few studies have focused on the effect of loneliness on the life satisfaction of older adults. Some researchers have acknowledged that the character of the relationship between loneliness and life satisfaction is still unclear, and this association is much more complex that it appears to be. Therefore, the main purpose of the current study was to understand how loneliness is associated with satisfaction, and whether self-esteem and educational involvement in the University of the Third Age (U3A) courses can affect this relationship among elderly people.

Methods

The research was conducted on a group of 179 elderly adults (65% women). We measured loneliness, satisfaction, and self-esteem. The data were collected via the paper-and-pencil format through convenience sampling, just before the COVID-19 pandemic began.

Results

The results obtained show that loneliness correlated negatively with self-esteem and life satisfaction. Self-esteem was associated positively with life satisfaction. Self-esteem acted as a suppressor between loneliness and life satisfaction. The participation of older adults in U3A moderated the strength of the relationship between loneliness and life satisfaction (direct effect) and between loneliness and life satisfaction mediated by self-esteem (indirect effect).

Conclusion

The mediatory role of self-esteem and the moderating role of educational activities in the relationship between loneliness and life satisfaction in late adulthood have important developmental and social implications. It appears that although feelings of loneliness and social isolation have a negative association on the life satisfaction of older adults, this relationship may be altered by empowering seniors’ self-esteem through their involvement in lifelong learning. Such a solution supports the functioning of older people also at the social level.

Understanding subjective well-being: perspectives from psychology and public health

Background

Individual subjective well-being (SWB) is essential for creating and maintaining healthy, productive societies. The literature on SWB is vast and dispersed across multiple disciplines. However, few reviews have summarized the theoretical and empirical tenets of SWB literature across disciplinary boundaries.

Methods

We cataloged and consolidated SWB-related theories and empirical evidence from the fields of psychology and public health using a combination of online catalogs of scholarly articles and online search engines to retrieve relevant articles. For both theories and determinants/correlates of SWB, PubMed, PsychINFO, and Google Scholar were used to obtain relevant articles. Articles for the review were screened for relevance, varied perspectives, journal impact, geographic location of study, and topicality. A core theme of SWB empirical literature was the identification of SWB determinants/correlates, and over 100 research articles were reviewed and summarized for this review.

Results

We found that SWB theories can be classified into four groups: fulfillment and engagement theories, personal orientation theories, evaluative theories, and emotional theories. A critical analysis of the conflicts and overlaps between these theories reveals the lack of a coherent theoretical and methodological framework that would make empirical research systematically comparable. We found that determinants/correlates of SWB can be grouped into seven broad categories: basic demographics, socioeconomic status, health and functioning, personality, social support, religion and culture, and geography and infrastructure. However, these are rarely studied consistently or used to test theories.

Conclusions

The lack of a clear, unifying theoretical basis for categorizing and comparing empirical studies can potentially be overcome using an operationalizable criterion that focuses on the dimension of SWB studied, measure of SWB used, design of the study, study population, and types of determinants and correlates. From our review of the empirical literature on SWB, we found that the seven categories of determinants/correlates identified may potentially be used to improve the link between theory and empirical research, and that the overlap in the determinant/correlates as they relate to multiple theory categories may enable us to test theories in unison. However, doing so in the future would require a conscious effort by researchers in several areas, which are discussed.

Prediction of Life Satisfaction in People with Parkinson's Disease

Introduction

People with Parkinson's disease (PD) have lower life satisfaction (LS) than healthy peers. No study has yet identified predictors of LS in people with PD. Such information would be valuable for health care and future interventions that aim to maintain or increase LS.

Aim

To examine how LS evolved in people with PD over a 3-year period, as well as to identify predictive factors of LS.

Methods

We used data from baseline assessments and a 3-year follow-up of 163 people with PD (baseline, mean age 68 years; median PD duration 8 years, 35% women). LS was assessed with item 1 of the Life Satisfaction Questionnaire (LiSat-11). Dichotomized LS data from the 3-year follow-up were used as the dependent variable in multivariable logistic regression analyses. In the first step, independent variables included baseline information on sex, education, general self-efficacy, motor symptoms, perceived walking difficulties, fall-related activity avoidance, and difficulties with/need help in activities of daily living. At the second step, depressive symptoms were added as an independent variable.

Results

The proportion of those who reported being satisfied with their lives reduced from 63.2% at baseline to 49.7% 3 years later (p=0.003). When depressive symptoms were not included in the analysis, general self-efficacy (odds ratio, OR = 1.081; 95% CI = 1.019–1.147) and perceived walking difficulties (OR = 0.962; 95% CI = 0.929–0.997) were significant (p < 0.05) predictors of LS 3 years later. With depressive symptoms included, the influence of walking difficulties diminished, and depressive symptoms (OR = 0.730; 95% CI = 0.607–0.877) and general self-efficacy (OR = 1.074; 95% CI = 1.010–1.142) were the only significant predictors of LS 3 years later.

Conclusions

LS is reduced over a 3-year period. The study suggests that perceived walking difficulties, general self-efficacy, and depressive symptoms are important predictors of LS in people with PD.

Psychological correlates of multimorbidity and disability accumulation in older adults

BACKGROUND/OBJECTIVES

attitudes toward life and health are emerging as important psychological contributors to health heterogeneity in ageing. We aimed to explore whether different psychological factors were associated with the rate of chronic disease and disability accumulation over time.

DESIGN

population-based cohort study between 2001 and 2010.

SETTING

Swedish National study on aging and care in Kungsholmen.

SUBJECTS

adults aged 60 and older (N = 2293).

METHODS

linear mixed models were employed to study the association of life satisfaction, health outlook, resistance to illness, sickness orientation, and health worry with the rate of accumulation of chronic diseases and impaired basic and instrumental activities of daily living. Models were adjusted for demographic, clinical, social, personality and lifestyle factors. Analyses were repeated after excluding individuals with multimorbidity or disability at baseline.

RESULTS

high life satisfaction and positive health outlook were consistently associated with a lower rate of accumulation and progression of multimorbidity (β -0.064 95% confidence interval [CI] -0.116, -0.011; β -0.065 95% CI -0.121, -0.008, respectively) and disability (β -0.063 95% CI -0.098, -0.028; β -0.042 95% CI -0.079, -0.004, respectively) over time. This was true even for people without multimorbidity or disability at baseline and after adjusting for all covariates.

CONCLUSIONS

positive attitudes toward life in general and health in particular may be especially important in old age, when the cumulative effects of biological and environmental deficits lead to accelerated health decline. These findings should encourage researchers to use measures of psychological well-being to better understand the multifactorial and diverse process of ageing.

The economic recession and subjective well-being in older adults in the Republic of Ireland

OBJECTIVE

Subjective well-being in older people is strongly associated with emotional, physical and mental health. This study investigates subjective well-being in older adults in Ireland before and after the economic recession that commenced in 2008.

METHODS

Cross-sectional data from the biennial European Social Survey (2002-2012) were analysed for two separate groups of older adults: one sampled before the recession and one after. Stratification and linear regression modelling were used to analyse the association between subjective well-being, the recession and multiple potential confounders and effect modifiers.

RESULTS

Data were analysed on 2013 individuals. Overall, subjective well-being among older adults was 1.30 points lower after the recession compared with before the recession (s.e. 0.16; 95% confidence interval 1.00-1.61; p&lt;0.001) [pre-recession: 16.1, out of a possible 20 (s.d. 3.24); post-recession:14.8 (s.d. 3.72)]. Among these older adults, the pre- and post-recession difference was especially marked in women, those with poor health and those living in urban areas.

CONCLUSIONS

Subjective well-being was significantly lower in older adults after the recession compared with before the recession, especially in women with poor health in urban areas. Policy-makers need proactively to protect these vulnerable cohorts in future health and social policy. Future research could usefully focus on older people on fixed incomes whose diminished ability to alter their economic situation might make them more vulnerable to reduced subjective well-being during a recession.

Successful aging in Spanish older adults: the role of psychosocial resources

ABSTRACTBackground:Psychological and social resources such as extraversion, optimism, social support, or social networks contribute to adaptation and to successful aging. Building on assumptions derived from successful aging and from the developmental adaptation models, this study aims to analyze the joint impact of different psychosocial resources, such as personality, social relations, health, and socio-demographic characteristics on life satisfaction in a group of people aged 65 years-old and older from Spain.

METHOD

A cross-sectional survey using non-proportional quota sampling was carried out. The sample comprised 406 community-dwelling older adults (M = 74.88, SD = 6.75). In order to collect the data, face-to-face interviews were individually conducted. A structural equation model (SEM) was carried out using the PLS software.

RESULTS

The results of the SEM model showed that, within this sample, psychosocial variables explain 47.4% of the variance in life satisfaction. Social relations and personality, specifically optimism, were strongly related with life satisfaction, while health status and socio-demographic characteristics were modestly associated with life satisfaction.

CONCLUSIONS

Findings support the view that psychosocial resources are important for successful aging and therefore should be included in successful aging models. Furthermore, interventions aimed at fostering successful aging should take into account the role of psychosocial variables.

Genetic risk for neuroticism predicts emotional health depending on childhood adversity

BACKGROUND

Existing evidence for gene × environment interaction (G × E) in neuroticism largely relies on candidate gene studies, although neuroticism is highly polygenic. This study aimed to investigate the long-term associations between polygenic risk scores for neuroticism (PRSN), objective childhood adversity and their interplay on emotional health aspects such as neuroticism itself, depressive symptoms, anxiety symptoms, loneliness and life satisfaction.

METHODS

The sample consisted of reared-apart (TRA) and reared-together (TRT) middle- and old age twins (N = 699; median age at separation = 2). PRSN were created under nine p value cut-off thresholds (pT-s) and the pT with the highest degree of neuroticism variance explained was chosen for subsequent analyses. Linear regressions were used to assess the associations between PRSN, childhood adversity (being reared apart) and emotional health. G × E was further investigated using a discordant twin design.

RESULTS

PRSN explained up to 1.7% (pT &lt; 0.01) of phenotypic neuroticism in the total sample. Analyses across two separation groups revealed substantial heterogeneity in the variance explained by PRSN; 4.3% was explained in TRT, but almost no effect was observed in TRA. Similarly, PRSN explained 4% and 1.7% of the variance in depressive symptoms and loneliness, respectively, only in TRT. A significant G × E interaction was identified for depressive symptoms.

CONCLUSIONS

By taking advantage of a unique sample of adopted twins, we demonstrated the presence of G × E in neuroticism and emotional health using PRSN and childhood adversity. Our results may indicate that genome-wide association studies are detecting genetic main effects associated with neuroticism, but not those susceptible to early environmental influences.

Extraversion personality, perceived health and activity participation among community-dwelling aging adults in Hong Kong

Activity participation is essential to the wellbeing of aging adults. Divergent levels of activity participation within aging populations have been explained from diverse perspectives, but the interaction effects of key determinants, such as personality and health, are often ignored. This study examines the effects of extravert personality on aging adults' activity levels by addressing its interaction with perceived physical health and mental health. A sample of 304 adults aged 50 and older was selected using systematic sampling from participants of an institute for promoting active aging at a university in Hong Kong in 2017. Data on socio-demographic characteristics, perceived physical and mental health, extraversion personality traits, and level of activity participation were collected using a telephone survey. Most participants (46.7%) reported moderate activity levels and over a quarter (26.6%) reported high or low activity levels. Multi-nominal logistic regression analyses show that extraversion was associated with an increased likelihood of reporting moderate (OR = 1.85, p = .036) but not high (p > .05) activity levels when adjusted for perceived physical and mental health and socio-demographics, with low activity levels being the constant comparison. Meanwhile, extraversion predicted both moderate (OR = 3.84, p = .014) and high (OR = 5.06, p = .032) activity levels for participants with poor or average perceived mental health. However, the interaction effects of extraversion with perceived physical health or mental health were not significant in predicting either moderate or high activity levels (p > .05). The implications for enhancing activity participation among aging adults are discussed in view of both personality and perceived health status.

Minor positive effects of health-promoting senior meetings for older community-dwelling persons on loneliness, social network, and social support

Objective

The aim of this study was to evaluate the 1-year effect of the health-promoting intervention "senior meetings" for older community-dwelling persons regarding loneliness, social network, and social support.

Methods

Secondary analysis of data was carried out from two randomized controlled studies: Elderly Persons in the Risk Zone and Promoting Aging Migrants' Capabilities. Data from 416 participants who attended the senior meetings and the control group at baseline and the 1-year follow-up in the respective studies were included. Data were aggregated and analyzed with chi-square test and odds ratio (OR) to determine the intervention effect.

Results

The senior meetings had a positive effect on social support regarding someone to turn to when in need of advice and backing (OR 1.72, p=0.01). No positive intervention effect could be identified for loneliness, social network, or other aspects of social support.

Conclusion

Health-promoting senior meetings for older community-dwelling persons have a minor positive effect on social support. The senior meetings might benefit from a revision to reinforce content focused on loneliness, social network, and social support. However, the modest effect could also depend on the lack of accessible social resources to meet participants' identified needs, a possible hindrance for a person's capability. This makes it necessary to conduct further research to evaluate the effect of the senior meetings and other health-promoting initiatives on social aspects of older community-dwelling people's lives, since these aspects are of high importance for life satisfaction and well-being in old age.

The relationships among Muslim Uyghur and Kazakh disabled elders' life satisfaction, activity of daily living, and informal family caregiver's burden, depression, and life satisfaction in far western China: A structural equation model

1 Hypothesis Disabled elders' activities of daily living, caregiver burden, caregiver depression, and caregivers' life satisfaction are significantly related to the life satisfaction of elderly people with disability. 2 Hypothesis There are direct and indirect effects between the life satisfaction of elders, disabled elders' activities of daily living, and family caregivers' factors. This study explored the interrelationships of disabled elders' life satisfaction and activities of daily living, caregivers' factors (burden, depression, and life satisfaction) through a structural equation model. In total, 621 dyads of disabled elders and informal family caregivers completed questionnaires during face-to-face interviews in Xinjiang Uyghur Autonomous Region from September 2013 to January 2014. Activity of daily living exerted a direct effect on life satisfaction of disabled elders and 30.4% indirect effect through caregivers' factors. Caregiver burden had a 60.0% direct effect on life satisfaction of disabled elders and a 40.0% indirect effect through the caregiver depression. Caregiver depression showed 76% direct effect on life satisfaction of disabled elders and 24% indirect effect through caregivers' life satisfaction. Direct relationships between activity of daily living and caregiver burden, caregiver burden and caregiver depression, and caregiver depression and caregivers' life satisfaction were observed. Activity of daily living had a 91.3% indirect effect on caregiver depression mediated by caregiver burden; caregiver burden had a 40.0% indirect effect on caregivers' life satisfaction mediated by caregiver depression. Results provide useful information for nurses and policymakers and shed light on the need to consider caregivers' factors in improving care recipients' life satisfaction.

Avaliação das Relações Familiares por Idosos com Diferentes Condições Sociodemograficas e de Saúde

Resumo O objetivo deste estudo foi investigar relações entre avaliações do funcionamento familiar feitas por idosos e suas condições sociodemograficas e de saúde. Participaram 134 idosos, submetidos a medidas de autorrelato sobre a satisfação com as relações familiares e o clima familiar, sexo, idade e configuração familiar. Os dados passaram por análise de conglomerados. Resultaram três agrupamentos para cuja diferenciação mais contribuíram as variáveis independência funcional (R2 = 0,816) e satisfação com as relações familiares (R2 = 0,642). Foram observadas relações entre independência funcional, ausência de depressão e ansiedade, satisfação com as relações familiares e avaliação positiva do clima familiar; depressão e ansiedade, insatisfação com as relações familiares e avaliação negativa do clima familiar; dependência funcional, depressão e ansiedade, satisfação com as relações familiares e avaliação negativa do clima familiar, sugerindo que dependência e distúrbios emocionais podem funcionar como condições de risco à funcionalidade familiar.

Life Satisfaction Index among Elderly People Residing in Gorgan and Its Correlation with Certain Demographic Factors in 2013

BACKGROUND

Aging is a universal phenomenon that will present itself as a dominant social and welfare challenge.

AIM

This study was to examine life satisfaction among people residing in Gorgan and its correlation with certain demographic factors in 2013.

METHODS

A total of 250 elder people were selected for the study through the convenience sampling during 4 months. Data collected through life satisfaction index-A (LSIA). This instrument consists of 5 subscales, including, zest for life, resolution and fortitude, congruence between desired and achieved goals, positive self-concept and mood tone. The Multiple Linear Regression analysis was used in order to determine factors influencing the overall LSIA.

RESULTS

The overall LSIA score was 22.1 ± 7.5 with the maximum and minimum mean scores pertaining to the resolution and fortitude (6.1 ± 2.5) and the positive self-concept (3.1 ± 1.2) subscales, respectively. Level of education, type of living and gender were variables influencing the overall LSIA (P<0.05).

CONCLUSION

Given the overall LSIA, it appears that future plans for this age group should be seriously revised along with cultural plans for promoting reverence for old age in the general public.

Sex differences in the association of physical function and cognitive function with life satisfaction in older age: The Rancho Bernardo Study

OBJECTIVES

This study examines the cross-sectional associations of cognitive and physical function with life satisfaction in middle-class, community-dwelling adults aged 60 and older.

STUDY DESIGN

Participants were 632 women and 410 men who had cognitive function tests (CFT) and physical function tasks (PFT) assessed at a clinic visit between 1988 and 1992, and who responded in 1992 to a mailed survey that included life satisfaction measures. Cognitive impairment was defined as ≤24 on MMSE, ≥132 on Trails B, ≤12 on Category Fluency, ≤13 on Buschke long-term recall, and ≤7 on Heaton immediate recall. Physical impairment was defined as participants' self-reported difficulty (yes/no) in performing 10 physical functions. Multiple linear regression examined associations between life satisfaction and impairment on ≥1 CFT or difficulty with ≥1 PFT.

MAIN OUTCOME MEASURES

The Satisfaction with Life Scale (SWLS; range:0-26) and Life Satisfaction Index-Z (LSI-Z; range:5-35).

RESULTS

Participants' average age was 73.4 years (range=60-94). Categorically defined cognitive impairment was present in 40% of men and 47% of women. Additionally, 30% of men and 43% of women reported difficulty performing any PFT. Adjusting for age and impairment on ≥1 CFT, difficulty performing ≥1 PFT was associated with lower LSI-Z and SWLS scores in men (β=-1.73, -1.26, respectively, p<0.05) and women (β=-1.79, -1.93, respectively, p<0.01). However, impairment on ≥ 1 CFT was not associated with LSI-Z or SWLS score after adjusting for age and difficulty with ≥1 PFT.

CONCLUSIONS

Limited cognitive function was more common than limited physical function; however, limited physical function was more predictive of lower life satisfaction. Interventions to increase or maintain mobility among older adults may improve overall life satisfaction.

Depression and Quality of Life in Older Persons: A Review

BACKGROUND

Depression is a prevalent and disabling condition in older persons (≥ 60 years) that increases the risk of mortality and negatively influences quality of life (QOL). The relationship between depression, or depressive symptoms, and QOL has been increasingly addressed by research in recent years, but a review that can contribute to a better understanding of this relationship in older persons is lacking. Against this background, we undertook a literature review to assess the relationship between depression and QOL in older persons.

SUMMARY

Extensive electronic database searches revealed 953 studies. Of these, 74 studies fulfilled our criteria for inclusion, of which 52 were cross-sectional studies and 22 were longitudinal studies. Thirty-five studies were conducted in a clinical setting, while 39 were community-based epidemiological studies. A clear definition of the QOL concept was described in 25 studies, and 24 different assessment instruments were employed to assess QOL. Depressed older persons had poorer global and generic health-related QOL than nondepressed individuals. An increase in depression severity was associated with a poorer global and generic health-related QOL. The associations appeared to be stable over time and independent of how QOL was assessed.

KEY MESSAGES

This review found a significant association between severity of depression and poorer QOL in older persons, and the association was found to be stable over time, regardless which assessment instruments for QOL were applied. The lack of a definition of the multidimensional and multilevel concept QOL was common, and the large variety of QOL instruments in various studies make a direct comparison between the studies difficult.

What prevents old people living alone from feeling lonely? Findings from the KORA-Age-study

OBJECTIVES

Living alone in later life is an important risk factor of loneliness for elderly people unless they have resources to compensate for that. The aim of this investigation was to identify these resources.

METHOD

Data were drawn from the population-based KORA-Age-study (KOoperativen Gesundheitsforschung in der Region Augsburg) conducted in the Region of Augsburg, Germany in 2008/2009 with 1079 elderly men and women (64-94 years). Loneliness was measured by the short version of the UCLA-Loneliness-Scale in a face-to-face interview. Multiple logistic regression analyses were conducted to identify associations between loneliness and potential protecting resources.

RESULTS

A total of 346 (32%) subjects reported to be living alone, among them 70% (n = 241) expressed no feelings of loneliness. Participants with a stable social network had a fourfold higher chance (OR 4.08, 95% CI 1.20-13.88, p = 0.025) and with the absence of depression a threefold higher chance (OR 3.04, 95% CI 1.59-5.78, p-value < 0.001) of not feeling lonely. Physical or mental resources were not correlated with lower levels of loneliness.

CONCLUSION

Absence of depression and a functioning social network are the most important protecting resources against loneliness for elderly people living alone, while income, level of education and age-related limitations have no impact. These findings should be considered when supporting the elderly in successful aging.

Urban and rural factors associated with life satisfaction among older Chinese adults

OBJECTIVE

This study compared urban and rural factors associated with life satisfaction among older adults in mainland China.

METHOD

Study data were extracted at random from 10% of the Sample Survey on Aged Population in urban/rural China in 2006 for 1980 participants aged 60 and older, including 997 from urban cities and 983 from rural villages.

RESULTS

In this study, 54.6% of urban older adults and 44.1% of rural older adults reported satisfaction with their lives. Binary logistic regression analysis showed that financial strain, depressive symptoms, filial piety, and accessibility of health services were significantly associated with life satisfaction for both urban and rural participants, but age and financial exchange with children were only associated with life satisfaction among urban older adults.

CONCLUSION

Findings are consistent with some previous studies that indicated the importance of financial strain, depressive symptoms, filial piety, and accessibility of health services to life satisfaction among the older adults in both urban and rural areas. This study also demonstrated the importance of age and family financial exchange to the life satisfaction of urban older adults.

Multimorbidity and functional decline in community-dwelling adults: a systematic review

BACKGROUND

Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline.

METHODS

A systematic literature search (1990-2014) and narrative analysis was conducted.

INCLUSION CRITERIA

Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool.

RESULTS

A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures.

CONCLUSIONS

The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.

Multimorbidity and functional decline in community-dwelling adults: a systematic review

BACKGROUND

Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline.

METHODS

A systematic literature search (1990-2014) and narrative analysis was conducted.

INCLUSION CRITERIA

Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool.

RESULTS

A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures.

CONCLUSIONS

The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.

Associations of self-perceived successful aging in young-old versus old-old adults

BACKGROUND

The aim of this research was to compare associations of self-perceived successful aging (SPSA) among Young-Old (Y-O; age 50-74 years) versus Old-Old (O-O; 75-99 years) community-dwelling adults. To our knowledge, this is the first study to compare respondents' self-perceptions of successful aging among O-O relative to Y-O adults.

METHODS

Participants included 365 Y-O and 641 O-O adults. The two age groups were compared in terms of the association of SPSA with other preselected measures including sociodemographic information, physical and mental functioning, objective and subjective cognitive functioning, emotional health, and positive psychological constructs.

RESULTS

The O-O group reported higher levels of SPSA than the Y-O group. In multiple regression modeling examining predictors of SPSA in each group, there was a tendency toward lower associations in the O-O group overall. Most notably, the associations between physical and mental functioning with SPSA were significantly lower in the O-O versus Y-O group. There were no associations with SPSA that were significantly higher in the O-O versus Y-O group.

CONCLUSION

The lower predictive power of physical and mental functioning on SPSA among O-O relative to Y-O adults is particularly noteworthy. It is apparent that SPSA is a multidimensional construct that cannot be defined by physical functioning alone. Continuing to clarify the underlying factors impacting SPSA between groups may inform tailored interventions to promote successful aging in Y-O and O-O adults.

"Successful aging," gerontological theory and neoliberalism: a qualitative critique

This article is a critique of the successful aging (SA) paradigm as described in the Rowe and Kahn book, Successful Aging (1998). The major point of this article is that two key ideas in the book may be understood as consonant with neoliberalism, a social perspective that came into international prominence at the same time the SA paradigm was initially promoted. These two key ideas are (a) the emphasis on individual social action applied to the nature of the aging experience and (b) the failure to provide a detailed policy agenda for the social and cultural change being promoted and, particularly, for older adults who may be left behind by the approach to change the book suggests. The article provides no evidence for a direct connection between SA and neoliberalism, but rather shows how similarities in their approaches to social change characterize both of them. In sum, the article shows (a) how the implicit social theory developed in the book, in a manner similar to neoliberalism, elevates the individual as the main source of any changes that must accompany the SA paradigm and (b) the focus on SA as individual action does not provide for those older adults who do not or will not age "successfully." This, we conclude, implicitly sets up a two-class system of older adults, which may not be an optimal means of addressing the needs of all older adults. The article also reviews a number of studies about SA and shows how these, too, may emphasize its similarities to neoliberalism and other issues that the SA paradigm does not adequately address.

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

BACKGROUND

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

METHODS/DESIGN

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

DISCUSSION

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

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

BACKGROUND

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

METHODS/DESIGN

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

DISCUSSION

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

Temperament and character as determinants of well-being

OBJECTIVES

We aimed to evaluate the effects of Temperament and Character Inventory (TCI) personality measures on well-being scores in a sample of 49-51 year old New Zealanders. Previous research has linked high self-directedness (SD) and low harm avoidance (HA) with well-being. We hypothesised that SD and HA would have predictive power for Warwick-Edinburgh Mental Well-being Scale (WEMWBS) well-being. We anticipated that character profiles with high SD and cooperativeness (CO) would be associated with higher well-being scores while high self transcendence (ST) scores would have less of an influence on well-being in a secular population such as New Zealand. Additionally we aimed to describe and assess the performance of a well-being measure, the WEMWBS and we intended to clarify the factors that underlie the questionnaire.

METHODS

A cohort of 404 randomly selected participants in a study of ageing had WEMWBS means calculated and with principal component analysis used to investigate the factors that underlie the WEMWBS. Multiple hierarchical regression was used to predict WEMWBS scores from socio-demographic and TCI personality variables. ANOVA were used to explore the non-linear effects of personality profiles on well-being.

RESULTS

Principal components analysis revealed one significant factor which explained 54.34% of the variance. After initial univariate analysis current depression, marital status and standard of living were entered at the first step of the multivariate regression. They explained 20% of the variance. In step two the seven TCI personality variables were added to the model, explaining a total of 49% (R(2) change=0.29). Low HA, high SD and the absence of current depression were the main predictors of WEMWBS scores. Character profiles featuring high SD produced significantly higher scores on the WEMWBS. Total WEMWBS scores were normally distributed, and the mean was 52.83 (95% CI 51.96-53.70).

CONCLUSIONS

The key determinants of well-being were absence of current depression and personality variables, especially low HA and high SD. The WEMWBS has face validity and the New Zealand results were very similar to the UK results.

Renal function is a determinant of subjective well-being in active seniors but not in patients with subjective memory complaints

BACKGROUND

During our whole life span, factors influencing health and functioning are accumulated. In chronic kidney disease, quality of life is adversely affected. We hypothesized that biomarkers of renal function could also be determinants of subjective well-being (SWB) in Swedish elderly subjects. SWB was assessed by the Psychological General Well-Being index (PGWB index) in two study groups: Active seniors (AS) consisted of community-dwelling elderly Swedes leading an active life (n = 389), and the DGM cohort (n = 300) consisted of subjects referred to the Memory Unit at the Department of Geriatrics for memory problems, Serum creatinine, cystatin C, and eGFR (CKD-EPI) were used as biomarkers of renal function.

RESULTS

There were no significant differences in cystatin C and eGFR values between the two cohorts: cystatin C medians 0.88 vs 0.86 mg/L and eGFR 73 vs 80 mL/min/1.73 m2 (AS vs DGM). In the AS cohort cystatin C was negatively related to PGWB index in women (P < 0.001, R2 ≈ 5%), and the covariates age and BMI did not improve the models. The renal biomarkers were unrelated to the PGWB index in the DGM cohort. Cystatin C in the AS cohort was adversely related to the PGWB subdimensions anxiety, depressed mood, positive well-being, and vitality in women, but in men only to depressed mood (P < 0.006; R2 ≈ 6%). In the DGM cohort, depressed mood in men was also significantly related to cystatin C (P = 0.050), but not in women.

CONCLUSIONS

Renal function even within the normal range, measured by serum cystatin C concentration, has significant and sex specific associations with subjective well-being and its subdimensions in healthy elderly subjects. Maintenance of good renal function in aging may be of importance in maintaining a high subjective well-being.