A Summary of Current Findings on Quality of Life Domains and a Proposal for Their Inclusion in Clinical Interventions

Whilst the assessment of quality of life (QoL) and well-being has burgeoned in the past 50 years, there still remains relatively little research into its treatment in psychology, in spite of the launching of such approaches as positive psychology to widen the ambit of interventions to promote well-being. We posit that there are a number of outstanding QoL areas that could be integrated into standard therapeutic procedures, and that this would this result in an increase in well-being as a therapeutic outcome. To investigate this an exploratory search of the literature was undertaken of associations between improvements in a life domain and increased well-being or QoL. Ten domains (relationships, work, money, health, and leisure, mindfulness, self-esteem, resolution of past life events, mental style and life management skills) were identified. In view of the substantial evidence of the cumulative impact of these domains upon well-being, it is proposed that conducting a unidimensional clinical intervention that focuses only on the presenting issue is not sufficient. Implications and possible therapeutic pathways are discussed and it is recommended that practitioners include such QoL domains in their assessment, case formulation, and intervention planning.

Demographic-Specific Rates for Life Events in the Cardiovascular Health Study and Comparisons With Other Studies

Purpose of the Study

(1a) We use the Cardiovascular Health Study (CHS), a multi-site heterogeneous sample of Medicare enrollees (N = 5,849) to provide rates for specific life events experienced within 6 months; (1b) We present rates for 29 other studies of community-residing older adults (N = 41,308); (2) For the CHS, we provide demographic-specific rates and predicted probabilities for age [young-old (65-75) vs old-old (≥75)], gender, race, marital status, and education.

Design/Methods

The CHS sample is 57.6% women, 84.2% white (15.8% black), and 66.3% married. Mean age is 72.8 years (standard deviation [SD] = 5.6, range = 65-100) and education is 13.7 years (SD = 4.8). Life events were interviewer-assessed. Regressions estimated associations of life event rates with demographic groups (e.g., age), controlling for other demographic variables (e.g., gender, etc.).

Results

(1a) CHS rates ranged from 44.7% (death of someone close) to 1.1% (retirement/work changes). (1b) Most life event studies used total scores and only 5 that met our inclusion criteria used time intervals <1 year; longer intervals were associated with higher rates. (2) In the CHS, the life event for illnesses was related to 5 demographic variables (net the other 4 demographic variables), difficulties caregiving to 4, and worse relationships to 3 demographic variables. Race was related to 8 life events, marital status to 7, education to 6, and age to 4 events.

Implications

By identifying demographic groups at highest risk for life events, this research focuses on older adults at greatest risk for health problems. These data are necessary for translating research into interventions, practice, and policy.

A phenomenological study of romantic love for women in late life

Romantic love in late life is often beneficial, though not without challenges. Financial concerns and objections of adult children can interfere with a late-life individual's decision to commit to a romantic relationship. In this study, the experience of romantic love for women who enter committed relationships in later life was examined. Fourteen women between the ages of 65 and 84 who had lived the experience of romantic love in late life were interviewed. By using Moustakas's qualitative Transcendental Phenomenological method, several themes emerged to provide a description of the phenomena. These themes included openness to experience, attraction, commitment, adjournment, and generativity. According to the findings of this study, women in late life who form committed romantic love relationships negate the physical and emotional effects of loneliness brought about by bereavement or single status in late-life women. In addition, this study found these women were attracted to partners to fulfill their needs for love, esteem, spiritual connection, and self-actualization.

Adapting to Unavoidable Loss During Adulthood

Older adults are expected to better differentiate functional from dysfunctional ways of dealing with unavoidable loss. We examined whether age-differential effects of strategies on affect could be found in a simulation task concerning unavoidable loss management. In an experimental study, we confronted 83 healthy young, middle-aged, and old adults with video vignettes of a person suffering from multiple sclerosis. Participants engaged in a thinking-aloud task on managing their life after learning about the fictitious diagnosis. Only the older participants’ striving for improvement was associated with an increase in negative affect after the thinking-aloud task, whereas their reorientation strategies led to enhanced affective well-being. Findings revealed age-differential effects of mentally simulating unavoidable loss.

Biological mechanisms of disease and death in Moscow: rationale and design of the survey on Stress Aging and Health in Russia (SAHR)

BACKGROUND

Prior research has revealed large differences in health and mortality across countries, socioeconomic groups, and individuals. Russia experiences one of the world's highest levels of all-cause and cardiovascular mortality, great mortality differences within the population, and a heavy burden of ill health. Psychological stress has been suggested as a likely explanation of health loss and premature death in Russia and Eastern Europe. However, physiological mechanisms connecting stress with health in Russia remain unclear since existing epidemiological data are scarce and limited to conventional risk factors.

METHOD AND DESIGN

The survey on Stress Aging and Health in Russia (SAHR) is addressing this knowledge gap by collecting an unusually rich database that includes a wide range of reported information, physical and cognitive health outcomes, and biomarkers in a sample of Muscovite men and women aged 55 and older. The total planned sample size is 2,000 individuals. The sample was randomly selected from epidemiological cohorts formed in Moscow between the mid-1970s and the 1990s and from medical population registers. The baseline data collection was carried out from December 2006 to June 2009. Interviews and medical tests were administered at hospital or at home according to standardized protocol. Questionnaire information includes health, socio-demographic characteristics, economic well-being, cognitive functioning, and batteries on stress and depression. Biomarkers include anthropometry, grip strength, resting ECG, conventional cardiovascular factors of risk such as lipid profile and blood pressure, and other biochemical parameters such as those related to inflammation, glucose and insulin resistance, coagulation, fibrinolysis, and stress hormones. In addition to these measurements, SAHR includes dynamic biomarkers provided by 24-hour ECG (Holter) monitoring. This method continuously registers the beat-to-beat heart rate in naturalistic conditions without restrictions on normal daily activities. It provides information about heart functioning, including heart rate variability and ischemic and arrhythmic events.Re-examination of the study subjects will be conducted in 2009-2011 and will focus on health, functional status, economic conditions, behaviors, and attitudes towards aging. The subjects are also followed up for mortality and non-fatal health events.

DISCUSSION

The SAHR will produce a valuable set of established and novel biomarkers combined with self-reported data for the international research community and will provide important insights into factors and biological mechanisms of mortality and health losses in Russia.

Stability in women's experiences of hassles and uplifts: a five-year follow-up survey

Hassles and uplifts, a concept used in measuring daily stress events, was applied to working mothers' everyday life. The aim was to explore the stability in working mothers' experiences in patterns of daily occupations, operationalized as hassles and uplifts, between the year 2000 (baseline) and the year 2005 (follow-up). Further, the intention was to reveal possible differences in the number, origins, and ratings of hassles or uplifts between baseline and follow-up. The baseline study comprised 100 women, of whom 77 agreed to participate in the follow-up study. At baseline the questionnaire THU-5 was applied in the form of an interview, and at follow-up it was adapted to a self-response questionnaire sent home to the respondents. Stability was explored qualitatively by investigating the reported causes of hassles and uplifts, and quantitatively by comparing the numbers and ratings of the experiences at baseline and at follow-up. The results indicate a certain amount of stability, although the cause of the experiences changes in line with changes in life stage. It was concluded that the methodology used (THU-5 and THU-3) was sensitive to these changes and could be applied in clinical settings, providing occupational therapists with a tool for detecting daily hassles that could be dealt with. Likewise, detected uplifts can be useful in the process of re-designing patterns of daily occupations affected by stress.