Terminal decline in well-being: The role of social orientation

The ABC Model of Happiness-Neurobiological Aspects of Motivation and Positive Mood, and Their Dynamic Changes through Practice, the Course of Life

Simple Summary

This article proposes a new model for exploring happiness primarily from a neurobiological perspective. Such understanding includes the dynamics of positive mood states and how they change throughout life. Happiness is not a cognitive construct: it is an immediate emotional experience—a feeling that relies on neurophysiological activation in the brain’s reward system. With this in mind, three types of happiness are proposed: (A) wanting, approaching, and pleasure, (B) avoiding, departing, and relief, (C) non-wanting, staying, and satisfaction. Behind this is a sophisticated (neuro)biological dynamic, ranging from the search for autonomy and ecstasy, which is particularly characteristic of young people, to the way we cope with stress, as we find it pronounced in the middle-aged, to deep contentment, peace, and inner joy, as it is mainly attributed to older people. Paradoxically, it is in fact the elderly who appear to be the happiest and most content—this phenomenon is also known as the “satisfaction paradox”. Apparently, these dynamic changes in happiness can be amplified with practice. Happiness is biological in this context, but can still be “learned”. Contemplative practices can serve as an example here to demonstrate this trainability, and they may themselves influence the course of happiness.

Abstract

Background: Happiness is a feeling, an immediate experience, not a cognitive construct. It is based on activity in the brain’s neurobiological reward and motivation systems, which have been retained in evolution. This conceptual review provides an overview of the basic neurobiological principles behind happiness phenomena and proposes a framework for further classification. Results: Three neurobiologically distinct types of happiness exist: (A) wanting, (B) avoiding, and (C) non-wanting. Behind these types lies a dynamic gradation, ranging from the more youthful anticipation, pleasure and ecstasy (A), to stress processing, escape and relief (B) as we find them accentuated in the middle-aged, to deep satisfaction, quiescence and inner joy (C), which is particularly attributed to older people. As a result, the development of happiness and satisfaction over the course of life typically takes the form of a U-curve. Discussion: The outlined triad and dynamic of happiness leads to the paradoxical finding that the elderly seem to be the happiest—a phenomenon that is termed “satisfaction paradox”. This assumed change in happiness and contentment over the life span, which includes an increasing “emancipation” from the idea of good health as a mandatory prerequisite for happiness and contentment, can itself be changed—it is trainable. Conclusions: Programs for mindfulness, contemplation, or stress reduction, including positive psychology and mind–body/behavioral medicine training, seem to be capable of influencing the course happiness over time: Happiness can be shaped through practice.

Subgroups in Late Adulthood Are Associated With Cognition and Wellbeing Later in Life

Objectives: In this study, we aim to discover whether there are valid subgroups in aging that are defined by modifiable factors and are determinant of clinically relevant outcomes regarding healthy aging.

Method: Data from interviews were collected in the Longitudinal Aging Study Amsterdam at two measurement occasions with a 3-year interval. Input for the analyses were seven well-known vulnerability and protective factors of healthy aging. By means of community detection, we tested whether we could distinguish subgroups in a sample of 1478 participants (T1-sample, aged 61–101 years). We tested both the external validity (T1) and predictive validity (T2) for wellbeing and subjective cognitive decline. Moreover, replicability and long-term stability were determined in 1186 participants (T2-sample, aged 61–101 years).

Results: Three similar subgroups were identified at T1 and T2. Subgroup A was characterized by high levels of education with personal vulnerabilities, subgroup B by being physically active with low support and low levels of education, and subgroup C by high levels of support with low levels of education. Subgroup C showed the lowest wellbeing and memory profile, both at T1 and T2. On most measures of wellbeing and memory, subgroups A and B did not differ from each other. At T2, the same number of subgroups was identified and subgroup profiles at T1 and T2 were practically identical. Per T1 subgroup 47–62% retained their membership at T2.

Discussion: We identified valid subgroups that replicate over time and differ on external variables at current and later measurement occasions. Individual change in subgroup membership over time shows that transitions to subgroups with better outcomes are possible.

Changes in social, psychological and physical well-being in the last 5 years of life of older people with cancer: a longitudinal study

BACKGROUND

older people with cancer are at risk of complex and fluctuating health problems, but little is known about the extent to which their well-being changes in the last years of life.

OBJECTIVE

to examine changes in physical, psychological and social well-being in the last 5 years of life of older people with cancer.

DESIGN

prospective cohort study.

SETTING

Belgium, the Netherlands.

PARTICIPANTS

people with a new primary diagnosis of breast, prostate, lung or gastrointestinal cancer, aged ≥70 years, life expectancy >6 months, were recruited from nine hospitals. We analysed data of deceased patients.

METHODS

data were collected from participants around diagnosis, and after 6 months, 1, 3 and 5 years through structured questionnaires administered through interviews or as self-report. Outcomes were physical, emotional, social, role functioning (EORTC QLQ-C30), depressive symptoms (GDS-15), emotional and social loneliness (Loneliness Scale). We conducted linear mixed model analyses.

RESULTS

analysing 225 assessments from 107 deceased participants (assessments took place between 1,813 and 5 days before death), mean age at baseline 77 years (standard deviation: 5.2), we found statistically significant deterioration in physical functioning (b = 0,016 [95%confidence interval 0.009-0.023]), depressive symptoms (b = -0,001 [-0.002 to 0.000]) and role functioning (b = 0.014 [0.004-0.024]). Changes over time in emotional and social functioning and in social and emotional loneliness were smaller and statistically non-significant.

CONCLUSIONS

care towards the end of life for older people with cancer needs to put their social and psychological well-being at the centre, alongside physical needs. Future research should focus on understanding inter-individual variation in trajectories.

Late Life in the Living Room: Room Décor, Functional Limitations, and Personality

BACKGROUND AND OBJECTIVES

Environmental gerontology and environmental psychology theories address adaptations of living space for disability and individual preferences. This study combines these perspectives to examine how room décor (i.e., furnishings, design, decoration) corresponds with functional limitations and personality in late life.

RESEARCH DESIGN AND METHODS

Older adults aged 65+ (N = 286) completed interviews regarding living arrangements, functional limitations, personality and depressive symptoms. Participants provided three to four photographs of the room where they spend the most time. Raters coded photographs for physical adaptations for functional limitations and 19 features of décor (e.g., crowding, color), fitting three categories: a) newness, b) comfort, and c) cheerfulness. We estimated linear regression models to examine how functional limitations or personality are associated with room décor, and whether living arrangement moderates these links. We also assessed whether room décor moderates functional limitations or personality predicting depressive symptoms.

RESULTS

Functional limitations were associated with greater clutter, and less brightness. Extraversion was associated with newness and cheerfulness (but not comfort); conscientiousness with newness and comfort (but not cheerfulness). Openness was associated with more newness and cheerfulness for those who live alone. Moderation models revealed functional limitations were associated with fewer depressive symptoms if the room was more cluttered. Conscientiousness was negatively associated with depressive symptoms when the room was higher on newness or comfort.

DISCUSSION

Findings generally supported environmental psychology and environmental gerontology perspectives, and suggest "goodness of fit" between functional abilities, personal desires and room characteristics may contribute to benefits of aging in place.

Association of Low Systolic Blood Pressure with Postmortem Amyloid-β and Tau

BACKGROUND

Vascular mechanisms may contribute to the accumulation of AD pathology.

OBJECTIVE

We examined whether the burden of vascular risk factors proximate to death is associated with amyloid-β and tau levels or modified their known association.

METHODS

We examined the brains of 1, 585 participants from two longitudinal community-based studies of older adults. Amyloid-β and tau were quantified by postmortem examination. The burden of vascular risk factors was summarized by calculating the Framingham general cardiovascular risk score (FRS) proximate to death. Using linear regressions, we examined the association of the FRS with the amyloid-β and tau levels and examined if the FRS modified the association of the amyloid-β with tau.

RESULTS

On average, participants were nearly 90 years old and two-thirds were women. The FRS was not associated with amyloid-β (Spearman r  = -0.00, p  = 0.918) or tau (r = 0.01, p = 0.701). However, the FRS as a whole (estimate = -0.022, SE = 0.008, p = 0.009), and specifically the systolic blood pressure (SBP) component (estimate = -0.033, SE = 0.012, p = 0.009), modified the association of the amyloid-β with tau. Further analysis showed that the association between amyloid-β and tau was stronger at lower levels of SBP.

CONCLUSION

Late-life vascular risk scores were not related to postmortem levels of amyloid-β or tau. However, lower levels of vascular risk scores and SBP were associated with a stronger association between amyloid-β and tau. These data suggest that vascular risk factors may modify the relation of AD pathology markers to one another.

Functioning profiles in a nationally representative cohort of Spanish older adults: A latent class study

Ageing well involves individuals continuing participating in personal, social and civic affairs even in older age. From this standpoint, limitations in individual's functioning (beyond the mere absence of disease) may drastically impact on how well people becoming older. This study aimed to identify functional status profiles in a nationally representative sample of older adults, using latent class analysis methods. Moreover, it intended to study the how identified classes would be related to health-related outcomes later in life, as a way to provide some evidence on predictive validity. Data from a nationally representative sample of Spanish older adults (N = 2,118; 56.18% women; M = 71.50 years, SD = 7.76), were used. Profiles were identified according to a large set of functioning indicators from multiple domains using latent class analysis. Outcomes were studied over a 3-year follow-up, considering both the individual (quality of life, well-being and mortality) and institutional level (health service utilisation). As a result, seven profiles were identified: normative profile (showed by most participants), limited cognitive functioning class, limited global functioning class, limited mental and mobility functioning class, poor self-reported health class, limited sensory functioning class and limited objective functioning class. All the profiles with limitations across domains showed poor outcomes. Multidimensional limitations were related to the worst outcomes, especially when psychosomatic complaints and high feelings of loneliness were reported. To sum up, latent class analysis constitutes a suitable alternative to study population heterogeneity, providing relevant evidence to help making decision in public and community health.

The Relationship between Just World Beliefs and Life Satisfaction

An important and often unexplored factor shaping life satisfaction is one’s perception of the world as a “just” place. The “just world hypothesis” is predicated on the idea that the world works as a place where people get what they merit, an idea that often serves as a means for people to rationalize injustices. The research addressing just world beliefs has expanded into a four-factor model that categorizes just world beliefs for self and others into subcategories of distributive and procedural justice. Distributive justice involves evaluations of the fairness of outcomes, allocations, or distribution of resources, while procedural concerns evaluations of the fairness of decision processes, rules, or interpersonal treatment. This study explored the relationship between the four just world beliefs subscales and overall satisfaction with life and examined their associations with demographic variables including ethnicity, age, gender, religion, and social class. The relationships of demographic factors with justice beliefs and life satisfaction generally yielded very small effect sizes. However, respondents who identified themselves as middle and upper class reported higher levels of life satisfaction than those who identified themselves as lower class, with a medium effect size. Consistent with the results of earlier research, regressing life satisfaction on the four justice beliefs subscales indicated that the two self-subscales (distributive and procedural) were significantly predictive of life satisfaction, but the two other subscales (distributive and procedural) were not.

Conscientiousness, Activity Engagement, and Momentary Affect in Oldest-Old Adulthood

OBJECTIVES

Remaining engaged with life is a hallmark of aging well and pursuing personally meaningful activities is presumably important for late-life affect. We examined how moment-to-moment variability in meaning and degree of challenge ascribed to daily activities relate to positive and negative affect in very old adults. Possible moderating effects of between-person differences in conscientiousness on meaning-affect associations were also examined.

METHODS

Participants were 73 adults aged 89 years on average from the Australian Daily Life Time-Sampling module of the Australian Longitudinal Study of Aging. Participants provided self-report data on activity engagement (meaning and challenge associated with activities) and affect, on 5 occasions per day for a period of 7 consecutive days.

RESULTS

Within-person associations of activity meaning with affect varied as a function of within-person challenge ratings. Specifically, gains in positive affect associated with meaningful activity were more strongly evident when activities were regarded as more challenging. In contrast, meaningful activity was associated with higher negative affect when activities were regarded as more challenging and lower negative affect when activities were regarded as less challenging. Conscientiousness did not moderate associations of activity meaning with affect.

DISCUSSION

Our findings shed light on the intricate interplay between maintaining meaningful engagement and daily emotional experiences in very old age. We discuss theoretical and practical implications and consider the role of late-life conscientiousness for self- and emotion regulation.

Well-being is more than happiness and life satisfaction: a multidimensional analysis of 21 countries

Background

Recent trends on measurement of well-being have elevated the scientific standards and rigor associated with approaches for national and international comparisons of well-being. One major theme in this has been the shift toward multidimensional approaches over reliance on traditional metrics such as single measures (e.g. happiness, life satisfaction) or economic proxies (e.g. GDP).

Methods

To produce a cohesive, multidimensional measure of well-being useful for providing meaningful insights for policy, we use data from 2006 and 2012 from the European Social Survey (ESS) to analyze well-being for 21 countries, involving approximately 40,000 individuals for each year. We refer collectively to the items used in the survey as multidimensional psychological well-being (MPWB).

Results

The ten dimensions assessed are used to compute a single value standardized to the population, which supports broad assessment and comparison. It also increases the possibility of exploring individual dimensions of well-being useful for targeting interventions. Insights demonstrate what may be masked when limiting to single dimensions, which can create a failure to identify levers for policy interventions.

Conclusions

We conclude that both the composite score and individual dimensions from this approach constitute valuable levels of analyses for exploring appropriate policies to protect and improve well-being.

Poor glucose regulation is associated with declines in well-being among older men, but not women

Glucose regulation is a key aspect of healthy aging and has been linked to brain functioning and cognition. Here we examined the role of glucose regulation for within-person longitudinal trajectories of well-being. We applied growth models to data from the Berlin Aging Study II (N = 955), using insulin resistance as an index of glucoregulatory capacity. We found that poor glucose regulation (higher insulin resistance) was consistently associated with lower levels of well-being among older men but not women. Our study provides novel evidence for the relevance of glucose regulation for well-being among older men. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Social Integration and Terminal Decline in Life Satisfaction Among Older Japanese

Objectives

Well-being typically exhibits pronounced deteriorations with approaching death, with sizeable interindividual variations in levels and changes. It is less well understood how psychosocial factors contribute to these individual differences. We examined whether and how social integration is associated with terminal trajectories of well-being, indexed as life satisfaction.

Method

Data were drawn from 1,119 deceased Japanese participants of a 15-year longitudinal study (age at death: M = 79.2 years; SD = 7.7 years; 43.1% women). Life satisfaction, structural and functional features of social integration (e.g., frequency of contact with family and nonfamily, and perceived overall support, respectively), sociodemographic characteristics, and physical function were assessed.

Results

Social integration predicted individual differences in terminal decline in life satisfaction, after controlling for age at death, gender, education, and physical function: More diverse social relationships were associated with higher levels of life satisfaction at 1 year before death. In addition, individuals who exhibited more decline in social participation and perceived less support showed more pronounced decline with increasing proximity of death.

Discussion

This study suggests that social integration plays a protective role in late-life well-being and that sustaining an active social life and supportive social interactions may help mitigate terminal decline in well-being.

[Self-design and prevention potential for older people in institutional long-term care]

Healthcare in inpatient long-term care facilities (nursing homes) should not be limited to medical curative measures, but should also include strengthening social participation, autonomy, self-responsibility and joint responsibility of the residents. Prevention and rehabilitation should therefore be even more integrated into care concepts.This article first introduces various areas of prevention physical activity, nutrition, cognitive competence, psychosocial health, abuse, and freedom-removing measures and then discusses their evidence. Essential for the implementation and the success of such measures is the ability and willingness of people in need of care to engage actively in these therapies; here, appropriate and motivating information plays an important role.Subsequently, geriatric rehabilitation is referred to. In the 2013-2017 empirical study Organization and Rehabilitation for Residents in the Nursing Home to Improve Independence and Participation (ORBIT), 215 people in need of care participated in three-month therapeutic interventions, which were followed by three-months of rehabilitative care. Improvements in mobility and quality of life (Barthel index, QOL-AD) could be demonstrated compared to a control group (n = 28). The results have to be considered against the background of a worsening health and reduced functional capacities in old age. A stronger integration of prevention and rehabilitation services into long-term institutional care is functional for strengthening participation and independence - an important condition for the residents' certainty that their dignity will be respected, competence and strive for self-responsibility and self-determination.

Levels of and changes in life satisfaction predict mortality hazards: Disentangling the role of physical health, perceived control, and social orientation

It is well documented that well-being typically evinces precipitous decrements at the end of life. However, research has primarily taken a postdictive approach by knowing the outcome (date of death) and aligning, in retrospect, how well-being has changed for people with documented death events. In the present study, we made use of a predictive approach by examining whether and how levels of and changes in life satisfaction prospectively predict mortality hazards and delineate the role of contributing factors, including health, perceived control, and social orientation. To do so, we applied shared parameter growth-survival models to 20-year longitudinal data from 10,597 participants (n = 1,560 [15%] deceased; age at baseline: M = 44 years, SD = 17, range = 18-98 years) from the national German Socio-Economic Panel Study. Our findings showed that lower levels and steeper declines of life satisfaction each uniquely predicted higher mortality risks. Results also revealed moderating effects of age and perceived control: Life satisfaction levels and changes had stronger predictive effects for mortality hazards among older adults. Perceived control was associated with lower mortality hazards; however, this effect was diminished for those who experienced accelerated life satisfaction decline. Variance decomposition suggests that predictive effects of life satisfaction trajectories were partially unique (3%-6%) and partially shared with physical health, perceived control, and social orientation (17%-19%). Our discussion focuses on the strengths and challenges of a predictive approach to link developmental changes (in life satisfaction) to mortality hazards, and considers implications of our findings for healthy aging. (PsycINFO Database Record

Illuminating the Psychological Experience of Elderly Loneliness from a Societal Perspective: A Qualitative Study of Alienation between Older People and Society

Loneliness is a common experience among older people that is associated with health risks and negative well-being. As a psychological phenomenon, it has typically been defined in Western research literature as the discrepancy between desired and actual interpersonal relations. In our qualitative study in Hong Kong, we offer insight into ageing and loneliness in an urban environment of the non-Western world and propose to reconceptualise loneliness by exploring older people's experience of alienation at the societal level as an important but often neglected dimension of their loneliness. Thirty-seven community-dwelling, Chinese adults aged 65 and above were interviewed in focus groups and their accounts analysed and interpreted using a phenomenological approach. Findings revealed that focus group participants perceived insufficient care for older people, a growing distance between themselves and society, and their disintegrating identity in society to be primary sources of societal alienation. In response, older people adopted a more passive lifestyle, attributed marginalisation and inequality to old age, and developed negative feelings including unease towards ageing, vulnerability and helplessness, and anger. The emergence of these key components and underlying themes of societal alienation illuminated neglected facets of the psychological phenomenon of loneliness and highlighted new implications for policy, practice, and research from a societal perspective to address older people's loneliness in urban settings.

Health sensitivity: Age differences in the within-person coupling of individuals' physical health and well-being

Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals' well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50-109 year olds; 55% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity-on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect-and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record