Purposiveness, physical activity, and perceived health in cardiac patients

Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study

BACKGROUND

Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions.

OBJECTIVE

This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults.

METHODS

Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (-4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data.

RESULTS

Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement.

CONCLUSIONS

MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition.

Examining the Impact of Race and Poverty on the Relationship Between Purpose in Life and Functional Health: Insights from the HANDLS Study

INTRODUCTION

While research has shown a positive association between a higher sense of purpose in life and functional health, there is a gap in understanding its benefits for racially minoritized and low SES individuals. This study aimed to investigate the correlation between purpose in life and physical functional health in a diverse sample, hypothesizing that purpose in life would be negatively associated with functional difficulties, with potentially stronger associations in White and high SES groups.

METHODS

Data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were utilized (166 participants, mean age 59.44 [SD = 8.28], 59.6% females, 65.06% Black participants, 40.36% below poverty). Purpose in life was measured by Ryff's Psychological Well-being Purpose in Life subscale. Functional health was measured by functional difficulties in mobility and daily living. Race (Black and White) and poverty status (above and below) were used as moderators to probe the purpose-functional health association using zero-inflated Poisson regression while adjusting for age, education, depressive symptomology, and previous functional difficulties in four hierarchical models.

RESULTS

Results showed that purpose in life was negatively associated with functional difficulty, indicating fewer difficulties in mobility and daily activities among those with a high sense of purpose. While the association did not remain significant after including previous functional difficulty as a covariate in Model 4, suggesting that race may not be a consistent moderator, poverty status remained a consistent moderator. The association was stronger for individuals above the poverty level.

DISCUSSION

These findings underscore the complex interplay between purpose in life, race, poverty status, and functional health, emphasizing the importance of considering socioeconomic factors in interventions aimed at eliminating functional health disparities among diverse adult populations.

Exploring physical activity preferences and motivation in long-term cardiac prevention: An Austrian cross-sectional survey

Cardiac rehabilitation (CR) patients often do not sustain physical activity (PA) behaviour in the long run, once they progress into a self-management stage of secondary prevention. This study aimed to explore former CR patients' PA preferences, determinants (i.e., influencing factors) and motivation for sustained PA engagement. We conducted a cross-sectional multi-centre survey using an original questionnaire based on prior qualitative interviews with cardiac patients. Five CR centres in Austria posted 500 questionnaires to former CR patients who had completed CR approximately three years prior, and 117 patients (23%) responded. Descriptive analysis was used to analyse closed-ended questions, and self-determination theory (SDT) was applied as a qualitative framework to analyse open-ended questions concerning motivation for PA engagement. Patients were generally physically active, but the majority (75.3%) did not fulfil the World Health Organisation's recommendations for aerobic PA and muscle strengthening. Most patients preferred being physically active outdoors (70%), engaging in aerobic-related (95%), individual and non-competitive exercises, with cycling (52%), walking (32%) and hiking (25%) among the most popular activities. Main determinants of PA were health, pain and motivation for 80%, 68%, 67% of patients, respectively. A subset of patients (77%) expanded on their motivations behind PA. According to SDT, most reasons (90%) were regulated by autonomous motivation (either extrinsically autonomously-regulated or intrinsic motivation) and stemmed mostly from health-related goals (e.g., fitness, general health, weight control), future quality-of-life aspirations (e.g., self-sufficiency in old age, presence for loved ones, preserving mobility) and enjoyment of PA. Patients' responses underscore the importance of promoting not only general PA, but also muscle strengthening training in CR interventions to maximise optimal health benefits. Our data further suggest that interventions which are aligned to patients' health goals and foster autonomous motivation may be particularly beneficial in increasing adherence to PA in the long-term.

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.

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.

Sense of purpose in life and motivation, barriers, and engagement in physical activity and sedentary behavior: Test of a mediational model

Purpose in life is associated with greater engagement in physical activity. The present research (N = 3473) addresses whether motivations and barriers to physical activity mediate this relation concurrently and prospectively early in the coronavirus pandemic. Higher purpose was associated with greater intrinsic, identified, and external motivation for physical activity and fewer barriers. Intrinsic motivation was a robust mediator of the relation between purpose and more physical activity and less sedentary behavior reported concurrently and prospectively; identified motivation mediated the relation with physical activity. Purpose in life is associated with being more physically active through both greater enjoyment and valuing its benefits.

Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally

BACKGROUND

Reactions to the COVID-19 pandemic are diverse, and both mental distress and existential crises can arise. The identification of protective and exacerbating factors and their progress over time is therefore highly relevant. The current study examined longitudinal protective effects of meaningfulness and exacerbating effects of crisis of meaning on general mental distress.

METHODS

N = 431 participants from Germany and Austria (mean age: 42 years) completed an online survey in both April/May (T1) and July/August 2020 (T2). After determining temporal stability or changes in meaningfulness, crisis of meaning, and general mental distress (PHQ-4), we examined whether (i) meaningfulness and (ii) crisis of meaning, measured at T1, incrementally predicted PHQ-4 at T2, beyond baseline levels of PHQ-4. We further tested (iii) a within-subject mediation of temporal changes in PHQ-4 by changes in crisis of meaning.

RESULTS

Meaningfulness prospectively predicted lower PHQ-4, and crisis of meaning predicted higher PHQ-4. From the first wave of the pandemic until a slowdown three months later, meaningfulness was stable, and crisis of meaning and PHQ-4 decreased. Changes in crisis of meaning mediated the changes in PHQ-4.

CONCLUSIONS

Meaningfulness appears to have a protective, and crisis of meaning an exacerbating effect on psychological distress, as shown here for the time of the first pandemic wave until three months later. Attention to existential experiences of meaningfulness and loss of meaning thus proves relevant to the clinical and public health context. Measures that support meaningfulness will help coping with crises of meaning, which in turn supports overcoming general mental distress.

Purpose in life and personal growth: The unique and joint contribution of physical activity and basic psychological needs

This study examined if physical activity (PA) and self-determination theory's basic psychological needs directly or interactively predict older adults' eudaimonic well-being. Participants aged ≥55 years completed five online surveys. At baseline (T₁ ), participants (N = 430) reported on autonomy, competence, and relatedness experienced during PA. PA was assessed prospectively using the Physical Activity Scale for Elderly (recall period = 7 days) for four consecutive weeks (T₂ , T₃ , T₄ , and T₅ ); weekly PA scores were averaged. At T₅ , purpose in life and personal growth were measured using Ryff's scales of psychological well-being. In regression analyses, PA was associated with purpose in life for those reporting low relatedness (b = .04, p = .02). Competence was associated with purpose in life only for those high in relatedness (b = .34, p < .001). Autonomy was positively associated with personal growth for those who also reported high competence. Multiple imputation analyses (N = 430) and sensitivity analyses (n = 304) yielded findings consistent with those from complete cases (n = 182). Encouraging older people to move more may not be sufficient to confer well-being. It may be necessary to help people engage in activities that support their basic psychological needs.

Physical activity for a meaningful and purposeful life in typical adults: a cross-sectional study

Abstract Introduction Physical activity is a part of life and an essential element for health and well-being. Investigating the meaning and purpose that physical activity adds to life will guide occupation-based interventions. Objective This cross-sectional study aimed to examine the relationship between physical activity level and meaning and purpose in life in typical adults. Method The study included a total of 300 typical adults (181 female, 119 male). Demographic characteristics of the participants, such as age, gender, and educational status, were recorded. The International Physical Activity Questionnaire, the Life Attitude Profile-Revised, and the Purpose in Life Test were used as measurement tools. Spearman correlation coefficient was used to analyse the relationship between nonparametric variables. Results A weak positive correlation was found between the physical activity total scores, meaning in life sub-scores and total scores (r=0.25, p<0.01), and purpose in life total scores (r=0.16, p<0.01). Conclusion Our findings revealed that people engaging in more physical activity had a sense of meaning and purpose in life. Physical activity must take place in occupational therapy practices as an occupation that adds meaning and purpose to an individual's life. Further research is needed on this subject.

Longitudinal Associations Between Physical Activity and Purpose in Life Among Older Adults: A Cross-Lagged Panel Analysis

Objective: The purpose of the current study was to examine the bidirectional relationship between physical activity (PA) and purpose in life in an older adult sample using longitudinal data. Method: Data were collected from three waves (2006, 2010, and 2014) of the Health and Retirement Study. A total of 4591 participants who had complete information of PA and purpose in life at baseline were included in the current study. A series of cross-lagged models were tested separately for vigorous-intensity PA, moderate-intensity PA, and light-intensity PA. Results: While higher levels of purpose in life were associated with more frequent engagement in future vigorous-intensity PA, moderate-intensity PA, and light-intensity PA, none of the PA variables predicted subsequent purpose in life. Discussion: The results did not support a reciprocal relationship between PA and purpose in life in older adults. It is more likely that purpose in life predicts PA, rather than vice versa.

Cardiovascular disease and meaning in life: A systematic literature review and conceptual model

OBJECTIVES

Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks.

METHODS

A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model.

RESULTS

The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers.

SIGNIFICANCE OF RESULTS

An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.

The bidirectional relationship between sense of purpose in life and physical activity: a longitudinal study

People with a greater sense of purpose in life may be more likely to engage in physical activity. At the same time, physical activity can contribute to a sense of purpose in life. The present research tests these hypotheses using a cross-lagged panel model in a nationally representative, longitudinal panel of American adults (N = 14,159, M_age = 68). An increase in sense of purpose in life was associated with higher physical activity four years later, above and beyond past activity levels. Physical activity was positively associated with future levels of sense of purpose in life, controlling for prior levels of purpose in life. Results held in a second national panel from the US with a nine-year follow-up (N = 4,041, M_age = 56). The findings demonstrate a bidirectional relationship between sense of purpose in life and physical activity in large samples of middle-aged and older adults tracked over time.

Health Promotion Among Long-Term ICU Patients and Their Families

Few patients are as helpless and totally dependent on nursing as long-term intensive care (ICU) patients. How the ICU nurse relates to the patient is crucial, both concerning the patients’ mental and physical health and well-being. Even if nurses provide evidence-based care in the form of minimum sedation, early mobilization, and attempts at spontaneous breathing during weaning, the patient may not have the strength, courage, and willpower to comply. Interestingly, several elements of human connectedness have shown a positive influence on patient outcomes. Thus, a shift from technical nursing toward an increased focus on patient understanding and greater patient and family involvement in ICU treatment and care is suggested. Accordingly, a holistic view including the lived experiences of ICU care from the perspectives of patients, family members, and ICU nurses is required in ICU care as well as research.

Considerable research has been devoted to long-term ICU patients’ experiences from their ICU stays. However, less attention has been paid to salutogenic resources which are essential in supporting long-term ICU patients’ inner strength and existential will to keep on living. A theory of salutogenic ICU nursing is highly welcome. Therefore, this chapter draws on empirical data from three large qualitative studies in the development of a tentative theory of salutogenic ICU nursing care. From the perspective of former long-term ICU patients, their family members, and ICU nurses, this chapter provides insights into how salutogenic ICU nursing care can support and facilitate ICU patients’ existential will to keep on living, and thus promoting their health, survival, and well-being. In a salutogenic perspective on health, the ICU patient pathway along the ease/dis-ease continuum reveals three stages; (1) The breaking point, (2) In between, and (3) Never in my mind to give up. The tentative theory of salutogenic long-term ICU nursing care includes five main concepts: (1) the long-term ICU patient pathway (along the salutogenic health continuum), (2) the patient’s inner strength and willpower, (3) salutogenic ICU nursing care (4), family care, and (5) pull and push. The salutogenic concepts of inner strength, meaning, connectedness, hope, willpower, and coping are of vital importance and form the essence of salutogenic long-term ICU nursing care.

Sense of Purpose in Life and Cardiovascular Disease: Underlying Mechanisms and Future Directions

PURPOSE OF REVIEW

In this review, we synthesize recent research that has reported associations of a higher sense of purpose in life with reduced risk of developing cardiovascular disease (CVD), and then explore mechanisms that might underlie these associations.

RECENT FINDINGS

Accumulating observational and experimental evidence suggests that having a higher sense of purpose might influence CVD risk through three pathways: (1) enhancement of other psychological and social resources that buffer against the cardiotoxic effects of overwhelming stress; (2) indirect effects through health behaviors; and (3) direct effects on biological pathways. A sense of purpose in life is emerging as an independent risk factor for incident CVD. A key remaining question is whether purpose causally effects CVD risk; in the "Future Research Directions" section, we focus on work needed to establish causality and provide suggestions for next steps.

Perceptions of Purpose in Life Within Spousal Care Dyads: Associations With Emotional and Physical Caregiving Difficulties

Background

Greater feelings of purpose in life are associated with better health and may reduce the negative impact of chronic stress. Yet little is known about how purpose in life may buffer the negative effects of caregiving, a common chronic stressor in middle and later life.

Methods

This cross-sectional study utilized a U.S. sample of 315 spousal caregivers and their partners with functional disability drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving to examine how both parties' perceptions of purpose in life are associated with caregivers' emotional and physical caregiving difficulties. We also evaluated whether care recipients' purpose in life moderates the association between caregivers' purpose in life and care-related difficulties. Finally, we considered whether these links differed by caregiver gender. Models controlled for caregivers' sociodemographics, care tasks, support resources, valued activity participation, and each care partner's health conditions.

Results

Caregivers' greater purpose in life was significantly linked to fewer physical caregiving difficulties. Caregivers' greater purpose in life was significantly associated with fewer emotional care-related difficulties among caregiving wives and when care recipients' purpose in life was low.

Conclusions

Although the associations between purpose in life and care-related difficulties are likely bidirectional, purpose in life may represent an important resource for combating the adverse consequences of caregiving. This study highlights the value of considering personal resources and their implications for caregivers' well-being within a dyadic context.

Brief report: Meaning in life is mediated by self-efficacy in the prediction of physical activity

Meaning and purpose in life are related to a reduced risk of mortality and cardiovascular events, and meaning has been established as a correlate of physical activity. However, it is not clear what mechanisms account for the relationship between meaning and physical activity. A cross-sectional analysis ( N = 94) indicated that self-efficacy in improving physical fitness is a statistically significant mediator of the relationship between meaning and physical activity.

Functions of reminiscence in later life: Predicting change in the physical and mental health of older adults over time

OBJECTIVE

Research has repeatedly shown that reminiscence affects the mental health and well-being of older adults contemporaneously and over time. Cross-sectional research also points to a link between reminiscence and physical health. The direction of this relationship is unclear, however. Does physical health affect how and why older adults think of themselves in the past? Or conversely, do various functions of reminiscence affect both mental and physical health now, and in future?

METHODS

Online responses were collected from a primarily Canadian sample of 411 older adults at three time points, separated by eight months on average. Participants responded to the Reminiscence Functions Scale at baseline and reported their health conditions, perceived state of health, life satisfaction, and psychological distress at subsequent points of measurement. A structural equation model was computed to identify direct and indirect associations between reminiscence functions and health over time.

RESULTS

Self-negative reminiscence functions at baseline (T1) predicted physical health 8 months later (T2), whereas self-positive reminiscence functions at T1 predicted both physical health and psychological distress at T2. The associations among self-positive functions and subsequent physical and mental health were maintained over time. Additionally, longitudinal crossover was observed in which psychological distress at T2 predicted physical health at T3, controlling for physical and mental health at T2.

CONCLUSIONS

Findings confirm longitudinal associations among reminiscence functions and subsequent indicators of health. For older adults, this extends to both physical and mental health. Future research should examine the physiological mechanisms by which autobiographical memory affects health over time.

Purpose in life and tobacco use among community-dwelling mothers of early adolescents

OBJECTIVES

The rising prevalence of tobacco use and tobacco-attributable deaths among women is of worldwide concern. In particular, smoking prevention for mothers in early midlife is a significant international public health goal. A higher sense of purpose in life (PIL) is thought to reduce detrimental health behaviours. However, little is known about the association between a sense of PIL and tobacco use. This study investigates this association among community-dwelling mothers of early adolescents.

DESIGN

This population-based cross-sectional study uses a self-reported questionnaire from the Tokyo Early Adolescence Survey, a large community-based survey conducted in Japan between 2012 and 2015.

SETTING

Participants were randomly recruited from the resident registries of three municipalities in Tokyo, Japan.

PARTICIPANTS

A total of 4478 children and their primary parents participated. Responses from 4063 mothers with no missing data were analysed (mean age=42.0 years (SD=4.2)).

MEASURES

Participants' tobacco use, including the number of cigarettes smoked per day, was documented using a questionnaire. PIL was assessed using a Purpose in Life scale derived from Ryff's Psychological Well-Being Scale.

RESULTS

Greater PIL was associated with a decreased likelihood of tobacco use, even when adjusted for confounders (OR=0.80, 95% CI 0.70 to 0.91). Multinomial logistic regression analyses revealed that PIL was inversely associated with tobacco consumption among mothers. These associations remained after controlling for psychological distress, socioeconomic factors and frequency of alcohol consumption among moderate to heavy smokers (OR=0.70, 95% CI 0.57 to 0.86), while attenuated among light smokers.

CONCLUSIONS

Increasing PIL may be a valuable intervention for reducing tobacco use among women in early midlife. This study can contribute to our understanding of the psychology of smoking behaviour and shed light on the targeted intervention to reduce tobacco use among early midlife mothers.

Mutuality and heart failure self-care in patients and their informal caregivers

BACKGROUND

Heart failure is a progressive condition characterized by frequent hospitalizations for exacerbated symptoms. Informal family caregivers may help patients improve self-care, which may in turn reduce hospitalizations. However, little is known about how mutuality, defined as the quality of the patient-caregiver relationship, and caregiver burden affect self-care.

OBJECTIVE

This study examines the associations among mutuality, patient self-care confidence (beliefs in abilities to engage in self-care behaviors) and maintenance (behaviors such as medication adherence, activity, and low salt intake), caregiver confidence in and maintenance of patient care, and caregiver perceived burden.

METHODS

This study used cross-sectional baseline data from a multi-site randomized clinical trial of a symptom and psychosocial care intervention. Patient-caregiver dyads ( N=99) completed self-report surveys of mutuality and self-care confidence and maintenance, and caregivers completed a measure of caregiver burden. Path analysis, with actor (effects within a person) partner (effects across the dyad) interdependence model paths and regression models were used to examine the associations among mutuality, caregiver burden, and self-care.

RESULTS

The majority of patients ( M age=66, 21% female) and caregivers ( M age=57, 81% female) were spouses (60%). The path model demonstrated significant actor effects; patients and caregivers with better mutuality were more confident in patient self-care ( p<.05). Partner effects were not significant. Regression models indicated that caregivers with greater mutuality reported less perceived burden ( p<.01).

CONCLUSIONS

Mutuality in patient-caregiver dyads is associated with patient self-care and caregiver burden and may be an important intervention target to improve self-care and reduce hospitalizations.

Outdoor group activity, depression, and subjective well-being among retirees of China: The mediating role of meaning in life

This study examined the effect of outdoor group activity on mental health and the potential mediating effect of meaning in life. Participants were 559 retired people. A self-developed questionnaire measured outdoor group activity; the Meaning in Life Scale, the Philadelphia Geriatric Center Morale Scale, and the Center for Epidemiological Studies-Depression assessed meaning in life, subjective well-being, and depression, respectively. Results indicated outdoor group activity significantly predicted subjective well-being and depression; meaning in life fully mediated the relationship between outdoor group activity and subjective well-being and partially mediated the relationship between outdoor group activity and depression. The implications and limitations were also discussed.

Physical inactivity among older adults across Europe based on the SHARE database

Background

Regular physical activity is one of the key components of a healthy lifestyle. It is associated with better physical and cognitive functioning in later life and with increased life expectancy. The purpose of this study was to evaluate the prevalence of, and factors related to, physical inactivity among older adults across Europe.

Methods

In this cross-sectional analysis, we used data from participants aged 55 or older in Wave 4 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) database, a multidisciplinary and cross-national panel database covering health, socioeconomic status, and social and family networks. Individuals included in this study were classified as physically active or physically inactive. Clinical, psychosocial and sociodemographic variables were evaluated for their association with physical inactivity.

Results

From the total of 58,489 individuals in SHARE, we selected 19,298 people age 55 or older (mean age 67.8 ± 8.9 years; 11,430 (59.2%) female). The overall prevalence of inactivity among individuals age 55 or older in the 16 included countries was 12.5%. The prevalence of physical inactivity varied between countries, ranging from 4.9% (Sweden) to 29% (Portugal). Increasing age, depression, physical limitations, poor sense of meaning in life, social support and memory loss were significant variables associated with physical inactivity.

Conclusions

Physical inactivity can be explained by physical, cognitive and psychological conditions. Interventions aimed at promoting physical activity among older people are needed to address this diversity of factors.

Purpose in life and cognitive functioning in adulthood

With an increasingly aging population, more work is needed to identify factors which may promote the maintenance of normal cognitive functioning. The current study tested the concurrent association between sense of purpose in life and the cognitive variables of episodic memory, executive functioning, and composite cognitive functioning in adults (N = 3489, M_age = 56.3 years, SD = 12.27, Range = 32-84 years) from the Midlife in the United States study (MIDUS). Correlational analyses suggested that purpose in life was associated with higher scores for memory, executive functioning, and overall cognition. Bootstrapping tests of moderation found no evidence for a moderating effect of age on purpose and the cognitive variables. Future studies should attempt to explain the mechanisms behind this relationship and explore the potential for interventions to promote healthy cognitive and purposeful aging.

Integrating positive psychology into health-related quality of life research

PURPOSE

Positive psychology is an increasingly influential force in theory and research within psychology and many related fields, including behavioral medicine, sociology, and public health. This article aims to review the ways in which positive psychology and health-related quality of life (HRQOL) research currently interface and to suggest fruitful future directions.

METHODS

This article reviews the basic elements of positive psychology and provides an overview of conceptual and empirical links between positive psychology and HRQOL. The role of one central aspect of positive psychology (meaning) within HRQOL is highlighted, and unresolved issues (e.g., lack of definitional clarity) are discussed.

RESULTS

Some research on HRQOL has taken a positive psychology perspective, demonstrating the usefulness of taking a positive psychology approach. However, many areas await integration.

CONCLUSIONS

Once conceptual and methodological issues are resolved, positive psychology may profitably inform many aspects of HRQOL research and, perhaps, clinical interventions to promote HRQOL as well.

Purpose in life is associated with physical activity measured by accelerometer

Previous research has shown that purpose in life, the belief that one’s life is meaningful and goal-directed, is associated with greater engagement in self-reported physical activity. The purpose of this study was to examine the relationship between purpose in life and accelerometer-measured physical activity. Community volunteers ( N = 104) completed measures of purpose in life and potential confounds and wore accelerometers for three consecutive days. Purpose in life was positively associated with objectively measured movement, moderate to vigorous physical activity, and with self-reported activity. These relationships were largely unchanged after controlling for potential confounds. These results suggest that purpose in life is a reliable correlate of physical activity.

Meaning-in-life in nursing-home patients: a correlate with physical and emotional symptoms

AIMS AND OBJECTIVES

To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population.

BACKGROUND

Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health.

DESIGN AND METHODS

The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended.

RESULTS

The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed.

CONCLUSIONS

The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being.

RELEVANCE TO CLINICAL PRACTICE

Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes.

Nurse-patient interaction is a resource for hope, meaning in life and self-transcendence in nursing home patients

BACKGROUND

Spiritual dimensions such as hope, meaning in life and self-transcendence have been found to be predictors of successful ageing, life satisfaction and well-being in older individuals. Connectedness and communicating with others have been seen to facilitate hope, meaning in life and self-transcendence among nursing home patients.

AIMS

This study aimed to investigate the associations between hope, meaning in life, self-transcendence and nurse-patient interaction in a nursing home population.

DESIGN AND METHODS

A cross-sectional design was employed, collecting data in 44 different Norwegian nursing homes (NHs) from 250 patients who met the inclusion criteria. Approval by all regulatory institutions dealing with research issues in Norway and the Management Unit at the 44 NHs was obtained. A sample of 202 cognitively intact nursing home patients responded to the Herth Hope Index, the Purpose in Life test, the Self-Transcendence Scale and the Nurse-Patient Interaction Scale. A structural equation model (SEM) of the hypothesized relationships between the constructs was tested.

RESULTS

The SEM model fit well with the present data. Significant direct relationships of nurse-patient interaction on hope, meaning in life and self-transcendence were displayed. Meaning and the interconnectedness dimension of hope appeared to be particularly dynamic resources, revealing significant influences on all the constructs in the SEM model tested.

CONCLUSION

Nurse-patient interaction influences hope, meaning in life and self-transcendence in cognitively intact nursing home patients and might be an important resource in relation to patients' health and global well-being. Thus, care providers are above all fundamental for nursing home patients. Advancing caregivers' interacting and communicating skills might facilitate patients' health and global well-being and inspire professional caregivers as they perform their daily care practices. More research of the effectiveness of such strategies is greatly needed.

LIMITATIONS

The SEM model tested comprised 20 variables, indicating a desirable sample size of n = 200, while the present effective sample was n = 187. Also, cross-sectional data do not allow making conclusion on the causality.

Meaning-in-Life in Nursing Home Patients: A Validation Study of the Purpose-in-Life Test

Background: The experience of meaning has been found to be a strong individual predictor of life satisfaction and an important psychological variable that promotes well-being. Therefore, a valid and reliable measurement of meaning-in-life among nursing home patients is highly warranted. Aims: This study intended to further investigate (a) the factor structure of the Purpose-in-Life test (PIL), (b) the reliability of PIL scores, and (c) the construct validity of the PIL test in a nursing home population. Methods: Participants were 202 cognitively intact nursing home patients representing 44 different Norwegian nursing homes. Concerning the dimensionality of the PIL, the following 3 measurement models were tested using confirmatory factor analysis; the original 1-factor, a 2-factor, and a 3-factor model. Results: With the exclusion of 10 items, a previously published and supported 2-factor construct for the PIL by Morgan and Farsides (2007) provided a good fit for older nursing home patients, demonstrating good measurement reliability and construct validity. Conclusion: The 2-factor model by Morgan and Farsides, comprising 10 items, is an improvement over the original 20-items PIL, based on these nursing home data. The measure yielded highly significantly factor loadings, good values for average variance extracted and composite reliability, as well as significant correlations in the expected direction for relevant selected measures; all supporting the construct validity.

Better self-perceived health is associated with lower odds of physical inactivity in older adults with chronic disease

Poor self-perceived health (SPH) is associated with lower levels of physical activity (PA) and the presence of chronic disease in older adults. The purpose of this study was to determine whether SPH is associated with PA levels in older adults with existing chronic disease and whether this differs by disease. Using logistic regressions on data from the Canadian Community Health Survey (N = 33,168) it was found that adjusted logistic regressions revealed that odds of physical inactivity were similar in those with good SPH who reported having respiratory, musculoskeletal, or other chronic disease compared with those with good SPH without these diseases. Those with good SPH who reported having cardiometabolic disease were at significantly greater risk of physical inactivity than those with good SPH without cardiometabolic disease. It is apparent from the current analysis that SPH plays an important role in PA levels of older adults with chronic disease and should be targeted in future interventions.