Purpose in life and use of preventive health care services

Agentive steadfastness as trait marker in relation to temperament and character

BACKGROUND

Agentive steadfastness was identified as a potential trait marker with which to anticipate prognostically that a patient will persevere steadfastly and take congruent action in facing the demands of living. Taken as an enduring expression of personality, this study investigated agentive steadfastness among adult social media respondents (n = 511) in relation to temperament and character as captured in Cloninger's psychobiological model of personality.

METHODS

Participants recruited though snowball sampling on social media platforms, applied the 27-item Agentive Steadfastness Index (ASI) and the 240-item Temperament and Character Inventory (TCI-R-240).

RESULTS

Agentive steadfastness was statistically predicted by the Self-directedness (β = 0.634), Self-transcendence (β = 0.119), Harm Avoidance (β = -0.142) and the Reward Dependence (β = 0.071) scales, accounting for 63.3 % of the variance in one stepwise regression model. In another stepwise model for the TCI-R-240 subscales, the Purposeful (β = 0.359), Anticipatory Worry (β = -0.353), and the Responsibility (β = 0.259) subscales accounted for respectively 56.8 %, 11.2 % and 2.8 % of the variance in ASI scores.

LIMITATIONS

Results are limited to adult social media respondents who were willing to participate.

CONCLUSIONS

Agentive steadfastness may serve as a trait marker of well-being and the good prognostic associations that have been established for high self-directedness, low harm avoidance, as well as resilience, and character strengths. It may be assessed clinically to anticipate prognostically the extent to which a patient will persevere steadfastly and take congruent action in facing the demands of living and adversity.

Sense of purpose in life and extending the cognitive healthspan: evidence from multistate survival modeling

Having a sense of purpose in life predicts better maintenance of cognitive function in older adulthood and reduced risk of mild cognitive impairment (MCI) and dementia. However, little research has examined its influence on the rate of cognitive decline and length of cognitive healthspan. This study evaluated the role of sense of purpose on the risk and timing of transitions between normal cognition, MCI, and dementia. Older adults from the Memory and Aging Project (MAP; n = 1821) and the Health and Retirement Study (HRS; n = 10,542) were followed annually for 19 years and biennially for 12 years, respectively. Multistate survival models assessed whether sense of purpose predicted transitions across normal cognition, MCI, dementia, and death. More purposeful older adults had lower risk of developing MCI (HR = 0.82 in MAP; HR = 0.93 in HRS), higher likelihood of cognitive improvement, and longer cognitively healthy life expectancies. Results suggest sense of purpose may extend the cognitive healthspan.

An exploration of neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older black adults

OBJECTIVES

While existing research has shown that Black adults have worse cognitive functioning than their White counterparts, the psychosocial correlates of cognitive functioning for Black older adults are understudied. The objective of this study was to investigate the relationships among perceived neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older Black adults.

METHODS

Data were from 3,191 Black adults ages 51+ in the 2008-2016 waves of the Health and Retirement Study to examine associations among neighborhood characteristics, psychosocial resilience (sense of purpose, mastery, and social support), and cognitive functioning among Black adults. Multilevel linear regression models assessed direct effects of neighborhood characteristics and psychosocial resources on cognitive functioning. We then tested whether psychosocial resources moderated the association between neighborhood characteristics and cognitive functioning.

RESULTS

Mean levels of cognitive functioning, sense of purpose, social support, and mastery were significantly related to neighborhood disorder and discohesion. Regression results showed that levels of neighborhood disorder and high discohesion were significantly associated with cognitive functioning. Sense of purpose was positively associated with cognitive functioning, net of neighborhood characteristics. However, only social support moderated the association between neighborhood discohesion and cognition.

CONCLUSIONS

These findings demonstrate the importance of examining psychosocial and contextual risk and resilience resources among midlife and older Black adults. This work may inform the development of cognitive behavioral interventions aimed at increasing sense of purpose to promote and enhance cognitive resiliency among Black adults. Altogether, this work may have implications for policy aimed at advancing cognitive health equity.

A review of the literature on wellbeing and modifiable dementia risk factors

Wellbeing-defined broadly as experiencing one's life as enjoyable and fulfilling-has been associated with lower risk for Alzheimer's disease and related dementias. The mechanisms underlying this association are largely unknown. However, prior research and theory suggest that wellbeing impacts health behaviors and biological systems that are relevant to cognitive and brain health. Several of these factors have also been identified by the 2020 Lancet Commission on Dementia Prevention, Intervention, and Care as modifiable dementia risk factors. In the current review, we summarize and evaluate the evidence for associations between wellbeing and each of the 12 Lancet Commission risk factors. We found relatively consistent evidence for associations between higher wellbeing and lower levels of most of the risk factors: physical inactivity, social isolation, smoking, depression, hypertension, diabetes, hearing loss, traumatic brain injury, and air pollution. By contrast, we found evidence for only modest associations between wellbeing and education and mixed evidence for associations of wellbeing with alcohol use and body weight. Although most of the reviewed evidence was observational, longitudinal and experimental evidence suggests that many of the observed associations are likely bidirectional. These findings suggest that modifiable dementia risk factors may be mediators (i.e., intermediate steps in the causal chain) and/or confounders (i.e., variables that impact both wellbeing and dementia, and thus could induce a spurious association) of the association between wellbeing and dementia. We conclude by discussing next steps to test mediation hypotheses and to account for potential confounding in the relation between wellbeing and dementia.

Bidirectional associations between meaning in life and the health, emotional ill-being and daily life functioning outcomes among older adults

OBJECTIVE

Meaning and purpose in life are recognised health determinants. Evidence on the factors contributing to the experience of meaning and purpose in life is limited. The bidirectional associations between the experience of meaning in life and physical health, emotional ill-being and daily life functioning from a 6-year perspective are examined.

METHODS AND MEASURES

Longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed using generalised estimating equations. The sample included 16,361 middle-aged and older adults from 13 countries.

RESULTS

Living a meaningful life was found to be associated with subsequent reduced risks of depression, loneliness, limitations in activities of daily living, and heart attack (at the 6-year follow-up). It was also found that prior experience of depression, loneliness and limited activities of daily living were associated with subsequent reduced sense of meaningful life. These associations were independent of demographics, socioeconomic status, personality, prior history of diseases and lifestyle. The sensitivity analyses provided evidence for the robustness of these associations.

CONCLUSIONS

Evidence for health practitioners and policymakers on factors that may hamper the development and maintenance of meaningful life as well as on the role of sense of meaning in life for healthy aging was presented.

Purpose in Life as an Explicit Outcome of Occupational Therapy

Purpose in life is increasingly understood to be important to health and well-being. Despite occupational therapy's long history of using occupations to advance health and the linkage between a subclass of occupations and purpose in life, the term is nearly absent from the American Occupational Therapy Association's documents and the profession's empirical literature. We propose that the profession explicitly name purpose in life as among our intervention outcomes and address disruptions of purpose in life in practice. This can be accomplished by first investing in purpose in our own lives, discussing the topic with colleagues and students, identifying possible purpose disruptions in our clients, and using direct or indirect intervention approaches to help clients reconnect to purpose in their lives. By explicitly naming purpose in life as part of the domain of occupational therapy, we become poised to leverage human occupation to address both a broad societal gap and our clients' needs for a renewal of purpose in life.

Leisure Activity, Leisure Satisfaction, and Hedonic and Eudaimonic Well-Being Among Older Adults With Cancer Experience

Older adults with cancer experience are more likely to encounter a notable reduction of participation in physical and social leisure activities, which may threaten their overall well-being. The purpose of this study was to explore how specific types of leisure activities and leisure satisfaction were linked to hedonic and eudaimonic well-being among older adults who had experienced cancer. A nationally representative sample of 2,934 older adults with lifetime cancer experience was retained from the Health and Retirement Study. The results of regression analysis revealed that walking for 20 minutes was reported as the only type of leisure activity related to hedonic well-being for the oldest-old (85+ years old). The current study also found that TV watching was significantly, but negatively associated with eudaimonic well-being for the young-old (50-74 years of age). In contrast, using a computer was positively linked to hedonic and eudaimonic well-being among the young-old and old-old (75-84 years of age). The current study made a significant contribution to build the body of knowledge that the different age groups of older adults who had experienced cancer can enhance eudaimonic and hedonic well-being by participating in different types of leisure activities. Implications for further research are discussed.

Changes in Purpose in Life and Low-Grade Chronic Inflammation Across Older Adulthood

Background: Older adults often experience an increase in low-grade chronic inflammation. Purpose in life could act as a protective factor as it is associated with beneficial health outcomes. Purpose in life may exert part of its adaptive function by promoting persistence in goal pursuit. During older adulthood, however, when many individuals experience an increase in intractable stressors and declining resources, the adaptive function of purpose could become reduced. Purpose: We examined whether the association between inter- and intra-individual differences in purpose in life and chronic inflammation differed across older adulthood. Method: We assessed four waves of data among 129 older adults (63-91 years old) across 6 years. Results: Hierarchical linear modeling demonstrated that within-person increases in purpose in life predicted reduced levels of chronic inflammation in early old age (25th percentile or 73 years, coefficient = -.016, p < .01), but not in advanced old age (75th percentile or 81 years, coefficient = .002, p = .67). Between-person differences in purpose were not related to chronic inflammation. Conclusions: These results suggest that greater within-person increases in purpose may protect health processes particularly in early old age but become less effective in advanced old age.

Structural Sexism and Preventive Health Care Use in the United States

Preventive health care use can reduce the risk of disease, disability, and death. Thus, it is critical to understand factors that shape preventive care use. A growing body of research identifies structural sexism as a driver of population health, but it remains unknown if structural sexism is linked to preventive care use and, if so, whether the relationship differs for women and men. Gender performance and gendered power and resource allocation perspectives lead to competing hypotheses regarding these questions. This study explores the relationship between structural sexism and preventive care in gender-stratified, multilevel models that combine data from the Behavioral Risk Factor Surveillance System with state-level data (N = 425,454). We find that in states with more structural sexism, both men and women were less likely to seek preventive care. These findings support the gender performance hypothesis for men and the gendered power and resource allocation hypothesis for men and women.

Purpose in life and stress: An individual-participant meta-analysis of 16 samples

Background

Purpose in life is a psychological resource that has been associated with better regulation of stress. The present research reports a coordinated analysis of the association between purpose in life and subjective stress and evaluates potential sociodemographic and mental health moderators of this association.

Methods

With individual participant data from 16 samples (total N=108,391), linear regression examined the association between purpose in life and general subjective feelings of stress, controlling for sociodemographic characteristics.

Results

Greater purpose in life was associated with less subjective stress (meta-analytic estimate=-.228, 95% Confidence Interval=-.292, -.164; p<.001). Interaction terms between sociodemographic factors and purpose tested in the individual samples and synthesized with meta-analysis were not significant, which indicated that the association between purpose and stress was similar across age, sex, race, ethnicity, and education. The association was also not moderated by psychological distress. Meta-regressions further indicated that this association was generally similar across scale length, content of the purpose measure, and across samples from Eastern and Western countries.

Limitations

The associations reported are observational. Experimental work is needed to evaluate causality.

Conclusions

Purpose in life is associated with less subjective stress across populations. Less subjective stress may be one mechanism through which purpose contributes to better mental and physical health.

Exploring Predictors of Social Media Use for Health and Wellness during COVID-19 among Adults in the US: A Social Cognitive Theory Application

During COVID-19, SM media was relied upon for health-related information-seeking and activity support. This study uses the social cognitive theory (SCT) and a representative dataset of the population in the US to explore the factors influencing patients' perceptions of SM for health-related activities. As per SCT, consolidated factors comprised personal factors (sociodemographic, health perception, self-efficacy) and environmental factors (social isolation, purpose in life). Multivariate logistic regression analysis was conducted. Among the 6252 respondents, 95.15% rarely use SM to share personal health-related information, and 90.44% rarely use it to share general health-related information. Older individuals and Whites are less likely to consider SM for healthcare decisions. Education levels influence SM's perceived reliability. Those with positive health perceptions find SM more suitable for healthcare discussions. Socially-isolated individuals are less likely to use SM for healthcare. Those with a strong sense of purpose are less inclined to trust it for health decisions and may question its accuracy. SM-based interventions should address sociodemographic differences. Our findings contribute to the literature by SCT relevance validation in identifying the antecedents of SM use in healthcare. Our results also help to understand the challenges to its adoption. This can help enhance SM-based communication strategies and interventions.

Economic Resources and Health: A Bi-Directional Cycle for Resilience in Old Age

Objectives: The paper offers an expanded framework for conducting empirical research on resilient aging. Methods: We review the conceptual frameworks for resilient aging and incorporate the role of economic factors as resources that contribute to resilience, in addition to social and psychological factors emphasized in the existing literature. Moreover, the idea of reinforcing cycles of resilience is incorporated in the framework. Existing empirical evidence that supports the conceptual arguments is presented. Results: Examples from Mexico and other low-middle-income countries are included, as well as from high-income countries. Data requirements for applying the conceptual framework in empirical analysis and the state of data availability are examined. We illustrate the measures that are available for this purpose using the Mexican Health and Aging Study. Discussion: We discuss and conclude that the state of the field is rich in data to conduct empirical work on resilience in old age.

Contributions of Eudaimonic Well-Being to Mental Health Practice

Purpose

Synergies between a eudaimonic model of psychological well-being (Ryff, 1989) and mental health practice are examined. The model grew out of clinical, developmental, existential, and humanistic perspectives that emphasized psychological strengths and capacities, in contrast to the focus on emotional distress and dysfunction in clinical psychology.

Design/Approach

Conceptual foundations of the eudaimonic approach are described, along with the six components positive functioning that are used to measure well-being. These qualities may be important in facilitating the recovery experiences, which are of interest in Mental Health and Social Inclusion.

Findings

Four categories of empirical evidence about eudaimonia are reviewed: (1) how it changes with aging, (2) how it matters for health, (3) what are its biological and neurological underpinnings, and (4) whether it can be promoted. Major contemporary forces against eudaimonia are also considered, including ever-widening inequality, the enduring pandemic, and world-wide strife. In contrast, encounters with the arts and nature are put forth as forces for eudaimonia. The relevance of these ideas for mental health research and practice is considered.

Originality

Mental health is often defined as the absence of mental illness. The novelty of the eudaimonic approach is to define mental health as the presence of well-being, assessed with different components of positive functioning.

Practical Implications

Enormous suffering defines our contemporary world. Such realities call for greater attention to factors that undermine as well as nurture the realization of human potential, the core of eudaimonic well-being.

Sense of purpose among transgender adults in the United States: comparisons of levels and health correlates

Given the increased threats to health and well-being faced by transgender individuals, research is needed to understand potential protective factors. Recent work has suggested that a sense of purpose may be one of the health-promoting resources available to marginalized groups, and levels of purpose are often similar or even higher among these groups. However, research is limited regarding whether this factor manifests differently among transgender adults. The current study (n = 1968 U.S. adults; 4.3% identified as transgender) asked participants to complete surveys for sense of purpose, self-rated health, life satisfaction and the type of purposes they deemed important. The findings suggest no difference in levels of sense of purpose between transgender and non-transgender adults. Transgender adults reported slightly lower levels of importance across multiple purposes, which merits further investigation into whether they perceive greater obstacles toward those goals. Of central importance, sense of purpose positively correlated with self-rated health (r = .50) and life satisfaction for transgender adults (r = .77), at similar or even greater magnitudes than for the non-transgender adults. These results point to the potential of exploring sense of purpose as an intervention target for promoting transgender health and well-being, and future directions should focus on the multiple pathways by which transgender identity may influence purpose development.

Healthy Eating as Potential Mediator of Inverse Association between Purpose in Life and Waist Circumference: Emerging Evidence from US and Chilean Cohorts

High sense of purpose in life, a fundamental domain of eudaimonic well-being, has been consistently associated with lower risk for various obesity-related chronic diseases. Although this psychological feature correlates with some health behaviors as potential mediators, its association with healthy eating remains less explored. In addition, studies of these psycho-behavioral and health relationships in the South American population are lacking. This research sought to assess: (1) the cross-sectional association between self-reported purpose in life and overall healthy eating patterns, and (2) healthy food intake as a potential mediator of the inverse relationship between purpose in life and waist circumference. Data collected of 2060 US adults from the MIDUS study (5 ± 12 years, 55% women, mostly white people, and 42.5% obese) and 223 Chilean adults from the CHILEMED study (46.6 ± 9 years, 58.3% women, and 71.3% obese) were used. Anthropometric and sociodemographic variables were collected. Sense of purpose was assessed using the purpose in life subscale of the Ryff's psychological well-being questionnaire. Diet quality was evaluated using healthy eating or low-fat diet indexes, according to extant food intake data in each cohort. The relationship between these variables was estimated by bivariate and multivariate linear regressions with appropriate adjustments. To establish whether a better diet quality could mediate a link of purpose in life and improved nutritional status (assessed by waist circumference), the association between these three variables was tested by bootstrapping-based mediation analysis. Our results show significant associations of sense of purpose with healthy eating and low-fat dietary patterns in both US and Chilean cohorts, respectively, even after adjusting for sociodemographic variables. According to the mediation analysis, the relationship between sense of purpose and waist circumference, as an indicator of abdominal obesity, appears to be partially mediated by healthier food intake in both samples. In conclusion, our findings suggest a plausible mechanism underlying the favorable impact of this well-being dimension on physical health. Given its protective effects, interventions aimed at increasing purpose in life may facilitate adherence to better dietary patterns, which, in turn, will reduce the risk for obesity-related chronic diseases.

Stress and well-being in autistic adults: Exploring the moderating role of coping

The wider stress literature points to negative associations between stress and well-being. Similarly, the use of engagement coping strategies and disengagement coping strategies in the face of stress are related to improved and reduced well-being respectively. However, in the autistic population stress and coping research is limited to date, and the extent to which coping may moderate the relationship between stress and well-being is not known. Using data from an Australian online study, we explored the potential moderating (i.e. buffering or exacerbating) role of coping in the relationship between stress and well-being in a sample of autistic adults (N = 86). Our findings indicated that increased stress was associated with lower well-being. Further, moderation analyses showed that while both engagement coping (e.g. problem solving, positive appraisal) and disengagement coping (e.g., self-distraction, being in denial) strategies had significant positive and negative direct effects on well-being respectively; engagement coping also moderated the relationship between stress and well-being, buffering the impact of stress on well-being. Our results illustrate the different underlying mechanisms by which coping strategies may be associated with stress and well-being. They also highlight the potential protective role of engagement coping strategies, which can be incorporated into the promotion and maintenance of well-being in autistic adults.

Analysis of action planning, achievement and life purpose statements in an intervention to support caregivers of persons with heart failure

BACKGROUND

Caregivers of persons living with heart failure (HF) experience uncertainty related to heart failure trajectory and caregiving demands. Caregiver Support is a nurse-led intervention consisting of a well-being assessment, development of a life purpose statement, and action planning related to self-care and support for caregivers.

OBJECTIVES

The goal of this study was to describe the caregivers' action plans, action plan achievement and life purpose statements.

METHODS

We used inductive content analysis to code life purpose statements and action plans by 2 coders. Descriptive statistics were used to describe the average number of action plans set per caregiver, the average number of themes coded per action plan and life purpose statement, and the status of goal achievement (i.e., by thematic domain, subdomains). Goal achievement was defined categorically: Achieved, not achieved, and not assessed. The achievement rate was calculated as the proportion of achieved action plans out of the total number of assessed action plans.

RESULTS

The sample (n = 22) was predominantly women, spousal caregivers, and an average age of 62±14.2 years. Thirty-six percent of caregivers were Black and 41% reported financial strain. Action plans comprised five categories: personal health and well-being, social support, home environment, instrumental support and other. The most common topics of life purpose statements were faith and self-care/actualization. Of 85 action plans, 69 were assessed and 66.7% were achieved.

CONCLUSIONS

These findings highlight the diversity of values and needs of caregivers and provides insights for additional person-centered support.

Association between subjective well-being and all-cause mortality among older adults in China

BACKGROUND

Although several studies in high-income countries have suggested a positive association between subjective well-being (SWB) and mortality, studies conducted in low- and middle-income countries, such as China, are scarce. The purpose of this study is to examine the association between SWB and all-cause mortality among the older Chinese population.

METHODS

Data were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a population-based longitudinal cohort study in 22 of 31 provinces in mainland China. A total of 13,282 individuals aged 65 ≥ years who were recruited in 2002 and followed-up until 2018 were included. SWB was assessed with an eight-item tool covering life satisfaction, positive affect (including optimism, happiness, personal control and conscientiousness) and negative affect (including anxiety, loneliness and uselessness). Cox proportional hazards regression methods were carried out to estimate the association between SWB and total mortality, adjusting for a wide range of potential confounders. Subgroup analyses and interaction analyses were further conducted.

RESULTS

During the 16.5 years of follow-up, 8459 deaths were identified. Greater SWB was independently associated with a reduced risk of all-cause mortality (adjusted hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.81-0.89) after adjustment for age, sex, marital status, education level, place of residence, smoking status, drinking, exercise, diet, BMI, hypertension, diabetes, heart disease, cerebrovascular diseases and cancer. Of the eight individual SWB symptoms, only 2 items, feelings of uselessness (adjusted HR = 0.94, 95% CI = 0.89-0.99) and happiness (adjusted HR = 0.91, 95% CI = 0.86-0.95), were significantly associated with total mortality. Associations remained significant across all subgroups regardless of different characteristics.

CONCLUSIONS

Higher SWB overall and 2 certain symptoms (feelings of uselessness and happiness) were independently associated with all-cause mortality risk among older Chinese adults. The association was consistent across different groups, suggesting that promoting a healthier SWB may be beneficial to all older individuals irrespective of their characteristics.

Unpacking Psychological Vulnerabilities in Deaths of Despair

Recent demographic findings show increased rates of death due to suicide, drug addictions, and alcoholism among midlife white adults of lower socioeconomic status (SES). These have been described as "deaths of despair" though little research has directly assessed psychological vulnerabilities. This study used longitudinal data from the Midlife in the U.S. (MIDUS) study to investigate whether low levels of eudaimonic and hedonic well-being predict increased risk of deaths of despair compared to other leading causes of death (cancer, heart disease). The investigation focused on 695 reported deaths with cause of death information obtained from 2004 to 2022 via NDI Plus. Key questions were whether risk for deaths due to despair (suicide, drug addiction, alcoholism) compared to deaths due to cancer or heart disease were differentially predicted by deficiencies in well-being, after adjusting for sociodemographic variables. Low levels of purpose in life, positive relations with others, personal growth and positive affect predicted significantly greater likelihood of deaths of despair compared to deaths due to heart disease, with such patterns prominent among better-educated adults. The findings bring attention to ongoing intervention efforts to improve psychological well-being.

Associations for Sense of Purpose with Smoking and Health Outcomes Among Adults with Diabetes

BACKGROUND

Health complications from diabetes place major strain on individuals, financially and emotionally. The onset and severity of these complications are largely driven by patients' behaviors, making psychosocial factors that influence behaviors key targets for interventions. One promising factor is sense of purpose or the degree to which a person believes their life has direction.

METHOD

The current study investigated whether sense of purpose predicts self-rated health, cardiovascular disease, and smoking status among adults with diabetes concurrently and prospectively. Moreover, it tested whether these associations held across multiple samples and cultures. Coordinated analysis using 12 datasets cross-sectionally and eight longitudinally (total N = 7277) estimated the degree to which sense of purpose is associated with subjective health, smoking status, and cardiovascular disease among adults with diabetes. Coordinated analysis allows for greater generalizability of results across cultures, time periods, and measurement instruments. Datasets were included if they concurrently included a measure of sense of purpose and diabetes status and at least one health measure: self-rated health, current smoking status, or heart condition status.

RESULTS

Sense of purpose was associated with higher self-rated health, smoking status, and cardiovascular disease cross-sectionally and self-rated health prospectively. Purpose was unassociated with changes in health over time.

CONCLUSION

These results highlight the relationship of a key individual difference, sense of purpose, to the behaviors and outcomes of adults with diabetes. While more research is needed to determine the boundaries of this relationship, it seems sense of purpose may be considered in the future as a potential target for intervention.

A Pilot Randomized Trial of a Purposeful and Stimulating Volunteer Opportunity: Program Satisfaction and Potential Impacts on Perceived Cognitive Change in a Neurologically Mixed Sample of Older Adults

BACKGROUND

Purposeful social interactions are important for healthy aging. We conducted a pilot trial of SPEAK! (Seniors Promoting English Acquisition and Knowledge), an intervention providing older volunteers with a safe, accessible opportunity to converse via webcam with English-language learners.

METHODS

A neurologically mixed sample of older adults was randomized to 8 weekly, webcam conversations with English-language learners or a waitlist control. Outcomes included the Cognitive Change Index (CCI) and surveys of program satisfaction. Here, we report on session completion, intervention satisfaction, and follow-up CCI scores. Exploratory analyses of CCI intervention effects controlled for baseline CCI scores and the interaction between group and baseline CCI.

RESULTS

Participants (N=38) were on average 70.8 years of age, 28/38 were White, and 16/38 demonstrated possible cognitive impairment on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Pairs completed 115/136 sessions (85%) and all volunteers said they would recommend the program. Controlling for the interaction between baseline CCI and randomization group, SPEAK! volunteers had better follow-up CCI scores than controls (P=0.018). Improvements in CCI were greater among participants with fewer baseline memory problems.

CONCLUSIONS

SPEAK! was feasible and appreciated by older adults with and without cognitive impairment. Larger studies should confirm benefits for memory and other determinants of quality of life.

Sense of purpose in life and allostatic load in two longitudinal cohorts

OBJECTIVE

Sense of purpose in life has been linked with better physical health, longevity, and reduced risk for disability and dementia, but the mechanisms linking sense of purpose with diverse health outcomes are unclear. Sense of purpose may promote better physiological regulation in response to stressors and health challenges, leading to lower allostatic load and disease risk over time. The current study examined the association between sense of purpose in life and allostatic load over time in adults over age 50.

METHODS

Data from the nationally representative US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) were used to examine associations between sense of purpose and allostatic load across 8 and 12 years of follow-up, respectively. Blood-based and anthropometric biomarkers were collected at four-year intervals and used to compute allostatic load scores based on clinical cut-off values representing low, moderate, and high risk.

RESULTS

Population-weighted multilevel models revealed that sense of purpose in life was associated with lower overall levels of allostatic load in HRS, but not in ELSA after adjusting for relevant covariates. Sense of purpose in life did not predict rate of change in allostatic load in either sample.

CONCLUSIONS

The present investigation supports sense of purpose predicting preserved differentiation of allostatic regulation, with more purposeful individuals demonstrating consistently lower allostatic load over time. Persistent differences in allostatic burden may account for divergent health trajectories between individuals low and high in sense of purpose.

Self-Rated Health and Mortality: Moderation by Purpose in Life

Poor self-rated health consistently predicts reduced longevity, even when objective disease conditions and risk factors are considered. Purpose in life is also a reliable predictor of diverse health outcomes, including greater longevity. Given prior work in which we showed that purpose in life moderated the association between chronic conditions and health-related biological factors, the aim of the current study was to examine the role of purpose in life in moderating the relationship between subjective health and mortality. We also examined potential differences in these associations by race/ethnicity. Data were from two large national longitudinal studies-the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study-with a 12- to 14-year follow-up period for mortality estimates. Results of logistic regression analyses showed that purpose in life and self-rated health were both significantly positively associated with longevity, and that purpose in life significantly moderated the relationship between self-rated health and mortality. Stratified analyses showed similar results across all racial/ethnic groups, with the exception of Black MIDUS participants. These results suggest that greater purpose in life may provide a buffer against the greater probability of mortality associated with poor subjective health.

Beyond Finding Purpose: Motivating a Translational Science of Purpose Acquisition

A broad interest in finding purpose is understandable, as having purpose is situated in notions of "the good life" and is linked in studies to greater health and wellbeing. Yet, the empirical basis for whether purpose is truly findable is inadequate, lacking guidance from theories predicting behavioral capacities that drive its acquisition. If feeling purposeful is as favorable as studies suggest, then more transparent and precise explanations of how it is derived are needed; otherwise, the field risks illuminating this resource while leaving the pathways to it unlit. Here, I call for a translational science of purpose acquisition directed at gathering and disseminating evidence of the processes by which this sense can be cultivated. I introduce a minimal viable framework for integrating basic and applied investigations into purpose by bridging laboratory research, intervention and implementation efforts, community-engaged practices, and policies to accelerate testing and strategies for enhancing this salubrious sense in people's lives.

Purpose in Life: Addressing Transdiagnostic Psychopathologies Concerning Patients' Sense of Purpose

ABSTRACT

Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.

Purpose in life and accelerometer-measured physical activity among older adults

OBJECTIVE

Purpose in life is associated with engagement in physical activity and better cognitive health. This study examines the association between purpose in life and patterns of physical activity measured with an accelerometer and whether these patterns mediate the association between purpose and episodic memory among older adults.

METHODS AND MEASURES

This research is a secondary analysis of data from the accelerometry sub-study of the National Health and Aging Trends Study. Participants (N = 747; mean age = 79.20) reported on their purpose, wore an accelerometer for eight days, and completed an episodic memory task.

RESULTS

Purpose in life was associated with healthier patterns of physical activity, including higher total activity counts (β = .10, p = .002), more active bouts per day (β = .11, p = .003), less activity fragmentation (β = -.17, p < .001) and more sedentary fragmentation (β = .11, p = .002). These associations were generally similar across age, sex, race and education. Higher total activity counts and less activity fragmentation were associated with better episodic memory and accounted for part of the association between purpose and episodic memory.

CONCLUSION

Purpose in life is associated with healthier patterns of physical activity measured through accelerometry among older adults and such patterns may be one factor in the pathway from purpose to healthier episodic memory.

Applying an Allportian Trait Perspective to Sense of Purpose

Sense of purpose captures the extent to which one feels that they have personally meaningful goals and directions guiding them through life. While this construct has illustrated its ability to robustly predict desirable outcomes-ranging from happiness to mortality-the nature of this construct remains unclear. I begin by describing different definitions and measures from the purpose literature. From there, I review the debates suggesting that it should be classified as a component of identity development, a facet of well-being, or even a virtue. In the current paper, I argue that sense of purpose could be best served when qualified as a trait, building from the eight components of defining a trait from Allport's (1931) paper: "What is a trait of personality?". Using this classic piece as a framework, I integrate empirical and theoretical work on purpose and personality to dive into whether sense of purpose is a trait. I conclude by discussing the challenges and implications of bolstering sense of purpose if it is best classified as a trait.

Purpose in life and physical health in older U.S. military veterans: Cross-sectional results from the National Health and Resilience in Veterans Study

General population studies suggest purpose in life (PIL) is associated with a number of positive outcomes, including better mental and physical health. At present, however, scarce research has examined how PIL relates to these outcomes in veterans. The goal of this study was to determine the current prevalence of different levels of PIL and their associations with reported physical health in a nationally representative sample of predominantly older U.S. veterans. Cross-sectional data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 4069; M_(age) = 62.2). Veterans were classified into low, average, and high PIL. Self-report assessments were administered to assess physical health conditions and physical functioning. Results showed most veterans endorsed average PIL (71.7%), while 16.0% endorsed low PIL and 12.3% endorsed high PIL. Low PIL was associated with lower overall self-reported health and physical and cognitive functioning, as well as higher bodily pain, somatic symptoms, and physical role limitations (Cohen's d = 0.06-0.77). Low PIL was also associated with elevated rates of several physical health conditions, including sleep disorders, as well as obesity and disability with activities of daily living (i.e., ADLs) or instrumental activities of daily living (i.e., IADLs). These results suggest low PIL is associated with physical health difficulties, and underscore the importance of assessing and monitoring PIL, and evaluating whether interventions to promote PIL may help improve physical health and vice versa.

Purpose in life promotes resilience to age-related brain burden in middle-aged adults

BACKGROUND

Disease-modifying agents to counteract cognitive impairment in older age remain elusive. Hence, identifying modifiable factors promoting resilience, as the capacity of the brain to maintain cognition and function with aging and disease, is paramount. In Alzheimer's disease (AD), education and occupation are typical cognitive reserve proxies. However, the importance of psychological factors is being increasingly recognized, as their operating biological mechanisms are elucidated. Purpose in life (PiL), one of the pillars of psychological well-being, has previously been found to reduce the deleterious effects of AD-related pathological changes on cognition. However, whether PiL operates as a resilience factor in middle-aged individuals and what are the underlying neural mechanisms remain unknown.

METHODS

Data was obtained from 624 middle-aged adults (mean age 53.71 ± 6.9; 303 women) from the Barcelona Brain Health Initiative cohort. Individuals with lower (LP; N = 146) and higher (HP; N = 100) PiL rates, according to the division of this variable into quintiles, were compared in terms of cognitive status, a measure reflecting brain burden (white matter lesions; WMLs), and resting-state functional connectivity, examining system segregation (SyS) parameters using 14 common brain circuits.

RESULTS

Neuropsychological status and WMLs burden did not differ between the PiL groups. However, in the LP group, greater WMLs entailed a negative impact on executive functions. Subjects in the HP group showed lower SyS of the dorsal default-mode network (dDMN), indicating lesser segregation of this network from other brain circuits. Specifically, HP individuals had greater inter-network connectivity between specific dDMN nodes, including the frontal cortex, the hippocampal formation, the midcingulate region, and the rest of the brain. Greater functional connectivity in some of these nodes positively correlated with cognitive performance.

CONCLUSION

Expanding previous findings on AD pathology and advanced age, the present results suggest that higher rates of PiL may promote resilience against brain changes already observable in middle age. Furthermore, having a purposeful life implies larger functional integration of the dDMN, which may potentially reflect greater brain reserve associated to better cognitive function.

Professional identity formation: linking meaning to well-being

Trainee distress and burnout continue to be serious concerns for educational programs in medicine, prompting the implementation of numerous interventions. Although an expansive body of literature suggests that the experience of meaning at work is critical to professional wellbeing, relatively little attention has been paid to how this might be leveraged in the educational milieu. We propose that professional identity formation (PIF), the process by which trainees come to not only attain competence, but additionally to "think, act and feel" like physicians, affords us a unique opportunity to ground trainees in the meaningfulness of their work. Using the widely accepted tri-partite model of meaning, we outline how this process can contribute to wellbeing. We suggest strategies to optimize the influence of PIF on wellbeing, offering curricular suggestions, as well as ideas regarding the respective roles of communities of practice, teachers, and formative educational experiences. Collectively, these encourage trainees to act as intentional agents in the making of their novel professional selves, anchoring them to the meaningfulness of their work, and supporting their short and long-term wellbeing.

Trust in purpose, or trust and purpose?: Institutional trust influences the association between sense of purpose and COVID-19 vaccination

OBJECTIVE

Having a sense of purpose is associated with a wide variety of positive health outcomes, largely because purposeful individuals appear to take better care of themselves physically. However, work is limited regarding the role of purpose during health crises, such as the COVID-19 pandemic.

METHOD

The current cross-sectional study investigated whether having a sense of purpose was associated COVID-19 vaccination rates and willingness, among a Swiss adult sample (n = 2328, Mean = 52.33 years), after accounting for participants' trust in different institutions.

RESULTS

Results found that adults with higher levels of institutional trust were more likely to be vaccinated (rs range from 0.06 to 0.13) or were willing to do so (rs range from 0.22 to 0.39). Sense of purpose was associated modestly with greater vaccination status (r = 0.06). However, sense of purpose moderated several associations between trust and vaccination outcomes. Namely, sense of purpose was associated with greater likelihood for vaccination when individuals reported greater trust in university research centers and political institutions.

CONCLUSION

Findings are discussed with respect to how they shape our understanding of purpose-health associations.

Managing burnout with lifestyle medicine principles

Burnout in health professionals gained attention during the COVID-19 pandemic. There have been numerous strategies in addressing this issue proving there is no one silver bullet to mitigate it. We need to find solutions for our health and for the benefit of patients to provide best care. Lifestyle medicine strategies have been proven to be beneficial in the management of Burnout.

Investigating the human spirit and spirituality in pediatric patients with kidney disease

Human spirit is an integral part of the medicinal art and science trifecta: body-mind-spirit, and it is contained in the World Health Organization definition of health. Human spirit is defined as our purpose in life, relationships with all living creatures or "Higher Power", and in general our place on planet Earth. Spirituality is a required part of patient care according to Joint Commission on Accreditation of Health Care Organizations. There is an abundant medical literature that documents discrepancies in the results between studies and populations, and points to the importance of cultural, ethnic, spiritual or religious differences. Validated questionnaires used in research for last several decades demonstrated an association of spirituality with clinical outcomes, coping, and quality of life in different adult chronic diseases. There are also validated scales to measure hope in children based on the premise that children are goal directed and that their goal-related thoughts can be understood, yet their purposefulness, meaning of life and spirit in pediatric nephrology remains mostly unexamined. Although pediatric nephrology has made significant advances in molecular techniques, artificial intelligence, machine learning, and started to address more broad social issues such as racism, health equity, diversity of our work force, etc, it lacks both systematic ways of studying and philosophical approach to fostering human spirit. This mini review examines the place and knowledge gaps in human spirit and spirituality in pediatric nephrology. We review the concept of the human spirit and medical literature pertaining to its role in pediatric nephrology.

Association of meaning in life with preventive healthcare use among Chinese adults: are there age and gender differences?

BACKGROUND

Meaning in life could be of clinical importance in stimulating healthy and preventive behaviors. The study aimed to investigate the association between meaning in life and preventive healthcare use among Chinese adults, and to assess their age and gender differences in the association.

METHODS

A cross-sectional online survey was conducted among 1444 adults aged 18-64 years in February 2020 in China. Logistic regression models were employed to examine the association of meaning in life with preventive health checkups and assess their age and gender differences.

RESULTS

The mean score of meaning in life was 5.801 (Standard Deviation = 1.349) out of 7. Each unit increase on the level of meaning in life was associated with 12.2% higher likelihood of using preventive health checkups (any type) (adjusted odds ratio 1.122, 95% confidence interval 1.015-1.241) after adjustment for sociodemographic factors, comorbidity and other psychological health factors. Meaning in life was significantly associated with the uses of X-ray (1.125, 1.010-1.253), B-ultrasound (1.176, 1.058-1.306), and blood testing (1.152, 1.042-1.274). The associations between meaning in life and these types of preventive healthcare increased with age, but there were no gender differences in these associations.

CONCLUSION

Higher meaning in life was independently related to more preventive health checkups. Strategies to strengthen health education and interventions to improve experience of meaning in life might be an important component to increase preventive healthcare use in China.

Pathways to reduced overnight hospitalizations in older adults: Evaluating 62 physical, behavioral, and psychosocial factors

As our society ages and healthcare costs escalate, researchers and policymakers urgently seek potentially modifiable predictors of reduced healthcare utilization. We aimed to determine whether changes in 62 candidate predictors were associated with reduced frequency, and duration, of overnight hospitalizations. We used data from 11,374 participants in the Health and Retirement Study—a national sample of adults aged >50 in the United States. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012–2014 (Cohort A) or 2014–2016 (Cohort B)). After robust covariate-adjustment, we observed that changes in some health behaviors (e.g., those engaging in frequent physical activity had 0.80 the rate of overnight hospital stays (95% CI [0.74, 0.87])), physical health conditions (e.g., those with cancer had 1.57 the rate of overnight hospital stays (95% CI [1.35, 1.82])), and psychosocial factors (e.g., those who helped friends/neighbors/relatives 100–199 hours/year had 0.73 the rate of overnight hospital stays (95% CI [0.63, 0.85])) were associated with subsequent hospitalizations. Findings for both the frequency, and duration, of hospitalizations were mostly similar. Changes in a number of diverse factors were associated with decreased frequency, and duration, of overnight hospitalizations. Notably, some psychosocial factors (e.g., informal helping) had effect sizes equivalent to or larger than some physical health conditions (e.g., diabetes) and health behaviors (e.g., smoking). These psychosocial factors are mostly modifiable and with further research could be novel intervention targets for reducing hospitalizations.

Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S

We examined the associations between a sense of purpose and all-cause mortality by gender and race/ethnicity groups. Data were from the Health and Retirement Study, a nationally representative cohort study of U.S. adults aged >50 (n = 13,159). Sense of purpose was self-reported at baseline (2006/2008), and risk of all-cause mortality was assessed over an 8-year follow-up period. We also formally tested for potential effect modification by gender and race/ethnicity. We observed the associations between higher purpose and lower all-cause mortality risk across all gender and race/ethnicity groups. There was modest evidence that the highest level of purpose (versus lowest quartile) was associated with even lower risk of all-cause mortality among women (risk ratio = 0.66, 95% confidence interval: 0.56, 0.77) compared to men (risk ratio = 0.80, 95% confidence interval: 0.69, 0.93; p-value for multiplicative effect modification =0.07). However, we observed no evidence of effect modification by race/ethnicity. Having a higher sense of purpose appears protective against all-cause mortality regardless of gender and race/ethnicity. Purpose, a potentially modifiable factor, might be a health asset across diverse populations.

Strategies for Improving the Utilization of Preventive Care Services: Application of Importance-Performance Gap Analysis Method

The utilization of preventive care services is limited. Previous studies based on communities have looked at many types of barriers to preventive care (i.e., why not do). This study aimed to gain an insight into the key factors and performance gaps (i.e., why do and how to do) of people who attended a regional teaching hospital to undergo health check-ups using a purposive sampling method to recruit people to complete a self-administered questionnaire. Paired sample t-tests and importance-performance gap and regression analyses were performed. The results indicated that the participants' wish to understand their health status, the quality of medical devices and the completeness of items, and process layout planning were the key factors that affect people's health check-up behavior. Promoting the effectiveness of hospital performance may improve the positive cycle of people's health check-up behavior from the community to the hospital. Continuing to promote the knowledge of preventive care services is necessary, and it is very important for people to have a good experience of undergoing health check-ups in the hospital. Important strategies for improving the utilization of preventive care services may include: meeting the person's personalization needs, improving the quality of medical devices and the completeness of items, and having appropriate process layout planning, a detailed interpretation of the results, and further follow-ups in the hospital.

Purpose in life (Ikigai) and employment status in relation to cardiovascular mortality: the Japan Collaborative Cohort Study

OBJECTIVES

To investigate whether having a purpose in life (Ikigai) is associated with risk of cardiovascular disease (CVD) mortality and whether the association varies by employment status.

DESIGN

Prospective cohort study.

SETTING

Residents in 45 municipalities, Japan.

PARTICIPANTS

29 517 men and 41 984 women aged 40-79 years, free of CVD and cancer at baseline from 1988 to 1990.

PRIMARY OUTCOME MEASURES

CVD mortality.

RESULTS

During the median follow-up of 19.1 years, 4680 deaths (2393 men and 2287 women) from total CVD were observed. Greater Ikigai was associated with a lower risk of CVD mortality, and the result was stronger for men than for women. Stratified by employment status, the inverse association was confined to unemployed persons. Among unemployed persons, the multivariable HRs of total CVD were higher for moderate and high versus low levels of Ikigai. Multivariable HRs (95% CIs) were 0.74 (0.57 to 0.97) and 0.69 (0.52 to 0.93), P for trend <0.044, respectively in men, and 0.78 (0.64 to 0.95) and 0.77 (0.61 to 0.97), P for trend=0.039 in women. No association was observed among the employed, including part-time workers, self-employed and homemakers for both men and women. Such an inverse association remained even after excluding early deaths within 5 years from the baseline survey.

CONCLUSION

Higher levels of Ikigai were associated with a lower risk of CVD mortality, especially for unemployed men and women.

Understanding the Pathways from Mindfulness to COVID-19 Vaccination Intention via Positive Psychology Attributes among Health Care Workers in China

OBJECTIVE

The present study aims to examine the association between mindfulness and COVID-19 vaccination intention, and the mediating role of presence of meaning in life and moral elevation in such association.

METHOD

In a cross-sectional study design, a total of 1733 health care workers (81.1% females, M_age = 34.16 ± 9.03) from four cities in China were recruited and completed an online survey that measured mindfulness, moral elevation, presence of meaning in life and COVID-19 vaccination intention.

RESULTS

It has been found that 73.1% of the participants reported an intention to receive COVID-19 vaccination. Mindfulness was positively associated with COVID-19 vaccination intention; Mediation analyses using structural equation modeling showed a significant indirect effect of mindfulness on COVID-19 vaccination intention, accounting for 42.4% of the total effect. Mindfulness was positively associated with COVID-19 vaccination intention directly via presence of meaning in life, and indirectly via moral elevation and presence of meaning in life.

CONCLUSIONS

The findings add knowledge of how mindfulness may increase COVID-19 vaccination intention, and underscore the potential need for mindfulness training, positive emotion promotion, presence of meaning in life interventions to improve acceptance of COVID-19 vaccination among health care workers.

Domains of life satisfaction and perceived health and incidence of chronic illnesses and hospitalization: evidence from a large population-based Chinese cohort

Background

Global life satisfaction has been consistently linked to physical health. A deeper and culturally nuanced understanding of which domains of satisfaction may be responsible for this association has implications for developing novel, scalable, and targeted interventions to improve physical health at the population level.

Objectives

This cohort study draws participants from the China Family Panel Studies (CPFS), a nationally representative cohort of 10,044 Chinese adults to assess the independent associations between three important domains of life satisfaction (and their changes) and indicators of physical health.

Results

A total of 10,044 participants were included in the primary analysis (4,475 female [44.6%]; mean [SD] age, 46.2 [12.1] years). Higher baseline levels of satisfaction with job, marriage, and medical services were independently associated with better perceived physical health (0.04 < β values < 0.12). Above and beyond their baseline levels, increases in satisfaction with job, marriage, and medical services were independently associated with better perceived physical health (0.04 < β values < 0.13). On the contrary, only higher baseline levels of and increases in satisfaction with marriage showed prospective associations with lower odds of incidence of chronic health condition and hospitalization (0.84 < ORs < 0.91).

Conclusions

These findings provide policymakers and interventionists interested in leveraging psychological health assets with rich information to rank variables and develop novel interventions aimed at improving wellbeing at the population level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14119-3.

What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach

Aims

Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults.

Methods

We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t₀;2006/2008 and t₁;2010/2012) were associated with purpose four years later (t₂;2014/2016) after adjustment for a rich set of baseline covariates.

Results

Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose.

Conclusions

Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life.

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Factors that lead to increased purpose in life in older adults remain unclear.

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We leveraged a large and prospective cohort of US adults aged >50.

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We evaluated associations between 61 predictors and subsequent purpose in life.

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Some health/well-being factors were associated with purpose in life 4 years later, but not others.

Being active for a purpose: Evaluating the bi-directional associations between monthly purpose and physical activity

BACKGROUND

Sense of purpose is a salient predictor of health outcomes, at least partially because individuals with a higher sense of purpose appear to engage in healthier lifestyle behaviors. Yet, little work has considered the role that greater physical activity may play in allowing individuals to maintain or develop a higher sense of purpose.

METHODS

Using five waves of monthly data (total n = 2337), the current study investigates the bi-directional association between sense of purpose and monthly reports of average time spent per day in moderate and vigorous physical activity utilizing Random Intercept Cross-Lagged Panel models.

RESULTS

Findings suggested differences based on physical activity intensity. For moderate physical activity, concurrent within-person associations revealed that during months when sense of purpose was higher relative to a person's usual level, they also spent more time than usual engaging in moderate physical activity. Bi-directional cross-lagged effects indicated that higher sense of purpose predicted more next-month moderate physical activity, and vice versa. Only between-person associations were evident for vigorous physical activity, such that people with a higher sense of purpose on average spent more time in vigorous physical activity on average. The discussion focuses on the methodological advances of the current study, as well as implications for future research.

Can adherence to moral standards and ethical behaviors help maintain a sense of purpose in life? Evidence from a longitudinal study of middle-aged and older adults

Personal factors, such as character strengths, have been shown to be favorably associated with concurrent and future well-being. Positive associations have also been reported between purpose in life and concurrent and subsequent health and well-being. Evidence on antecedents of purpose in life is, however, limited. This study examines whether the adherence to moral standards and ethical behaviors (AMSEB) is associated with subsequent purpose in life. Data from the Health and Retirement Study obtained from a sample of 8,788 middle-aged and older adults in the US (mean age = 64.9 years, age range 50–96 years) were used. The prospective associations between AMSEB and purpose in life were examined using generalized linear models. A rich set of covariates and prior outcomes were used as controls to reduce the risk of reverse causation. The robustness analyses included computation of sensitivity measures, E-values, and running a set of secondary analyses conducted on subsamples of respondents and using a limited set of covariates. It was found that middle-aged and older adults who demonstrated higher AMSEB reported a higher sense of purpose in life after the 4-year follow-up period. This association was found to be monotonic, moderately robust to potential unmeasured confounding and independent of demographics, prior socioeconomic status, prior health conditions, and health behaviors as well as prior psychological predispositions such as dispositional optimism and life satisfaction. It was also robust to missing data patterns. Policymakers and health practitioners may consider a predisposition to adherence to moral standards and ethical behaviors as a potential intervention target, as its improvement and/or maintenance has the potential to improve longevity and to help promote healthy and purposeful aging.

Happiness, depression, physical activity and cognition among the middle and old-aged population in China: a conditional process analysis

Background

Happiness is one variable of subjective well-being, which has been increasingly shown to have protective effects on health. Although the association between happiness and cognition has been established, the mechanism by which happiness leads to cognition remains unclear. Since happiness, depression, and physical activity may all be related to cognition, and happiness is related to depression and physical activity, this study explored the effect of depression and physical activity on the relationship between happiness and cognition among middle and old-aged individuals in China.

Methods

Data on 14,344 participants above 45 years of age were obtained from the 2018 China Family Panel Studies survey. A multiple linear regression analysis was performed to identify the correlation factors of cognition. The conditional process analysis was used to assess the mediatory effect of depression and physical activity on the relationship between happiness and cognition.

Results

Residence, age, sex, income level, social status, smoking, napping, reading, education, exercise times, satisfaction, happiness, and depression had associations with cognition. When other variables were held constant, cognition score increased by 0.029 standard deviation(SD) for every 1 SD increased in happiness. Mediation analysis showed that happiness had a significant positive total effect on cognition. The direct effect of happiness was significant and accounted for 57.86% of the total effect. The mediatory effect of depression (path of happiness→depression→cognition) accounted for 38.31% of the total effect, whereas that of physical activity (path of happiness→exercise times→cognition) accounted for 3.02% of the total effect.

Conclusion

Happiness has a positive correlation with cognitive function, and depression and physical activity play mediatory roles in this association. Effective interventions to improve happiness levels of middle and old-aged population will not only improve their subjective well-being but also improve their cognitive function, which carries great potential for reducing public health burdens related to cognitive aging.

Association between purpose in life and healthcare use among women and men in Germany: cross-sectional analysis of the nationally representative German Socio-Economic Panel (GSOEP) study

OBJECTIVES

It remains almost unknown whether purpose in life is associated with healthcare use (HCU) in general. Therefore, the goal of this study was to examine the association between purpose in life and HCU (in terms of frequency of outpatient physician visits and hospitalisation) stratified by sex.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A representative sample of the general adult population in Germany (n=1238; collected from September 2020 to February 2021); taken from the innovation sample of the German Socio-Economic Panel.

OUTCOME MEASURES

The frequency of outpatient physician visits in the past 3 months was used as first outcome measure. Hospitalisation in the last 12 months was used as the second outcome measure. Purpose in life was quantified by means of the subscale 'purpose in life' of the six-factor model of psychological well-being. Covariates were selected based on the Andersen model.

RESULTS

Average purpose in life equaled 4.5 (SD: 0.8; ranging on a scale from 1 to 6, with higher values indicating higher purpose in life). Adjusting for various potential confounders, regressions revealed that higher purpose in life was associated with an increased frequency of outpatient physician visits in the past 3 months among women (IRR 1.16, 95% CI:1.03 to 1.30), but not men (IRR 0.96, 95% CI 0.87 to 1.07). In contrast, higher purpose in life was associated with in an increased likelihood of hospitalisation among men (OR 1.40, 95% CI 1.02 to 1.93), but not women (OR 1.03, 95% CI 0.79 to 1.34).

CONCLUSION

Even after adjusting for various potential confounders, there was still a gender-specific association between higher purpose in life and increased HCU. This knowledge may assist in addressing individuals at risk for underuse or overuse of healthcare services.

Preliminary Efficacy of an Occupation-Oriented Purpose in Life Intervention After Breast Cancer

Background. Purpose in life is important to health and well-being; purpose disruption often goes unidentified after breast cancer. Purpose. To evaluate the efficacy of a purpose renewal intervention and utility of a screening question for identifying people with purpose-related distress. Method. In this prospective pretest-posttest study, participants with breast cancer received an 8-session purpose renewal group intervention (n = 35). Participants completed standardized measures of meaning and purpose at pretest, posttest, and two-month follow-up and a forced-choice Purpose Status Question (PSQ) at pretest. Findings. Participants made statistically significant pretest-to-posttest and pretest-to-follow-up improvements. The PSQ demonstrated construct validity: 40% of participants lacked purpose direction at pretest and this subgroup made significantly greater improvements than participants who reported purpose direction at pretest. Implications. The PSQ warrants further study as a screener to identify people with purpose-related distress. Many breast cancer survivors may benefit from a purpose in life intervention; a subgroup may benefit more.

The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina

Patients diagnosed with ischemia without obstructive coronary artery disease (INOCA) comprise the group of patients with primary microvascular angina (MVA). The pathophysiology underlying ischemia and angina is multifaceted. Differences in vascular tone, collateralization, environmental and psychosocial factors, pain thresholds, and cardiac innervation seem to contribute to clinical manifestations. There is evidence suggesting potential interactions between the clinical manifestations of MVA and non-cardiac conditions such as abnormal function of the central autonomic network (CAN) in the central nervous system (CNS), pain modulation pathways, and psychological, psychiatric, and social conditions. A few unconventional non-pharmacological and pharmacological techniques targeting these psychosocial conditions and modulating the CNS pathways have been proposed to improve symptoms and quality of life. Most of these unconventional approaches have shown encouraging results. However, these results are overall characterized by low levels of evidence both in observational studies and interventional trials. Awareness of the importance of microvascular dysfunction and MVA is gradually growing in the scientific community. Nonetheless, therapeutic success remains frustratingly low in clinical practice so far. This should promote basic and clinical research in this relevant cardiovascular field investigating, both pharmacological and non-pharmacological interventions. Standardization of definitions, clear pathophysiological-directed inclusion criteria, crossover design, adequate sample size, and mid-term follow-up through multicenter randomized trials are mandatory for future study in this field.

Relationships Between IKIGAI Well-Being and Motivation for Autonomous Regulation of Eating and Exercise for Health - Included the Relevance Between Sense of Coherence and Social Support

BACKGROUND

Self-regulated motivation is associated with better behavior change, health, and hedonic well-being in the health domain. Meanwhile, there are evidences that eudaemonic well-being contributes to health. As well as reducing lifestyle diseases, the promotion of IKIGAI well-being (encompassing hedonic and eudaemonic well-being) has been targeted in Japan. However, little is known about the impact of IKIGAI well-being on the motivation for health. This study explored the relationships between autonomous motivation for eating and exercise for health, IKIGAI well-being, sense of coherence, and social support.

METHODS

The participants were 622 Japanese (269 males and 353 females, aged 20 to 59 years). They completed a questionnaire on motivation for healthy eating (MHE), exercise motivation for health (EMH), sense of coherence, social support, and IKIGAI well-being.

RESULTS

IKIGAI well-being was positively associated to the relative autonomy index (RAI)-MHE and RAI-EMH. Social support exerted a positive effect on sense of coherence and IKIGAI well-being; sense of coherence positively affected IKIGAI well-being. The invariances of the model across groups, such as gender, age, and subjective economic status, were verified using multiple-group structural equation models.

CONCLUSION

With IKIGAI well-being as a mediating factor, social support and sense of coherence play important roles in promoting autonomous motivation for healthy eating and exercise.

Purpose in Life and Cognition Interact to Impact Healthcare and Financial Decision Making in Old Age

Objectives: Little is known about the contribution of positive psychological factors, such as purpose in life, to healthcare and financial decision making in aging. Here, we examined the relationship between purpose and decision making and tested the hypothesis that purpose benefits decision making, particularly when cognition is limited. Methods: Participants were 1081 community-based older adults without dementia. Healthcare and financial decision making was measured via a 12-item performance-based instrument. Purpose was measured via a 10-item scale. Results: In a linear regression model adjusted for age, sex, and education, higher global cognition was associated with better performance on the decision making measure, as expected. Purpose was not directly related to decision making. However, the interaction of purpose with cognition was significant, such that greater purpose was associated with better decision making among persons with lower cognition. Discussion: Purpose in life may promote better decision making among older adults with lower cognition.

Strengths-building through life purpose, self-care goal setting and social support: Study protocol for Caregiver Support

Background

For caregivers of people with heart failure, addressing a range of care recipient needs at home can potentially be burdensome, but caregivers may also gain meaning from caregiving. The Caregiver Support Program, a multicomponent strengths-based intervention, is designed to improve outcomes of heart failure caregivers.

Objectives

1) Test the feasibility and gauge an initial effect size of the Caregiver Support Program to improve caregiver quality of life (primary outcome), and fatigue and burden (secondary outcomes) from baseline to 16 weeks, 2) test whether fatigue and caregiver burden are associated with objective measures of resilience (sweat inflammatory cytokines (Il-6 and IL-10) and self-reported resilience, 3) evaluate changes in heart rate variability, IL-6 and IL-10, pre- and post-intervention.

Methods

This is a single-blind, two group, waitlist control trial. Eligible caregivers are 1) ≥ 18 years, 2) English speaking, 3) live with the person with heart failure or visit them at least 3 days per week to provide care, 4) provide support for at least 1 instrumental activity of daily living (IADL), 5) live within a 1 h driving radius of the Johns Hopkins Hospital, and 6) the care-recipient has been hospitalized within the last 6 months. Trial participants are randomized into the immediate intervention (n = 24) or waitlist control group (n = 24). Data collection is at baseline, 16 weeks, and 32 weeks.

Conclusion

The Caregiver Support program has the potential to increase quality of life and decrease fatigue and caregiver burden for caregivers of people with heart failure and multiple co-morbidities.