Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life

Educational Attainment and Perceived Need for Future ADL Assistance

The current study examined whether educational attainment was associated with perceived need of assistance with future activities of daily living (ADL) among middle-aged and early older-aged adults in the United States. Data for 54,946 adults aged 40-65 years from the 2011-2014 National Health Interview Survey (NHIS) were analyzed using ordered logistic regression. Adults with more education will on average need less ADL assistance than adults with less education. Paradoxically, this study found that higher levels of formal education were associated with perceiving more need for future ADL assistance. This association was also found to vary between males and females. Building knowledge of long-term care planning into existing public educational structures and providing this knowledge to adults no longer involved in the formal educational system through medical providers may lead to better anticipation of future care needs.

Following Physician's Advice in Late Life: The Roles of Health Beliefs and Health Status

Objective

This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults.

Methods

A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used.

Results

Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence.

Conclusion

This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults.

Understanding the Value of a Proactive Telecare System in Supporting Older Adults' Independence at Home: Qualitative Interview Study Among Key Interest Groups

BACKGROUND

Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare.

OBJECTIVE

This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are.

METHODS

Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis.

RESULTS

A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service.

CONCLUSIONS

This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources.

Aging in Place: Connections, Relationships, Social Participation and Social Support in the Face of Crisis Situations

OBJECTIVES

We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica.

METHODS

Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic.

RESULTS

Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies.

CONCLUSIONS

Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".

Aging all over the place: a multidisciplinary framework that considers place and life trajectories of older adults within their communities

Purpose

This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.

Design/methodology/approach

The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.

Findings

Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment; welcoming, caring, mobilized and supportive community; spatiotemporal life and care trajectories; and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.

Social implications

Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.

Originality/value

Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.

Impact of economic factors, social health and stressful life events on physical health-related quality of life trajectories in older Australians

PURPOSE

Physical health-related quality of life (HRQoL) is associated with adverse health outcomes, including hospitalizations and all-cause mortality. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health or stressful life events impact physical HRQoL trajectories.

METHOD

A cohort of 12,506 relatively 'healthy' community-dwelling Australians aged ≥ 70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Economic factors, social health and life events in the last 12 months were assessed through a questionnaire at baseline. Physical HRQoL was measured by using the 12-item short form at baseline and annual follow-ups. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors.

RESULTS

Four physical HRQoL trajectories were identified-stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having a lower household income, no paid work, no voluntary work, loneliness and stressful life events (i.e. spousal illness, friend/family illness, financial problem) were associated with a 10%-152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group.

CONCLUSION

Specific stressful life events had a greater impact on adverse physical HRQoL trajectories in older people than other factors. Volunteering may prevent physical HRQoL decline and requires further investigation.

The Role of Wisdom in the Cross-Cultural Adaptation of Chinese Visiting Scholars to Canada: A Mediation Model

This study examines the role of wisdom in the cross-cultural adaptation of Chinese visiting scholars in Canada, as mediated by different coping styles. Path analysis was used to for hypotheses testing. The findings suggest that (1) wisdom measured by 3D-WS and Adult Self-Transcendence Inventory (ASTI), independently had direct correlation with social and psychological adaptation, and positively associated with engaged coping (active coping and proactive–reflective coping); (2) the independent effects of 3D-WS and ASTI on social adaptation, psychological adaptation, and life satisfaction were mediated by proactive–reflective coping; (3) wisdom, when measured by 3D-WS, promoted positive psychological adaptation through decreasing passive coping. This study shows that wisdom is a critical factor affecting cross-cultural adaptation, and the use of proactive–reflective coping is a wise way of handling future life challenges.

Feasibility and acceptability of the community-based program: Plan Ahead

OBJECTIVES

In this article, we assess the feasibility and acceptability and the effect of the Plan Ahead for community dwelling older adults. In addition, we investigated the effects of the program. In addition, we aimed to examine whether the completion of the specific Future Care Planning depended on the participants' competence level.

METHODS

In this single group feasibility study, trained facilitators delivered the program to a sample of 234 community-residing older adults. Participants completed both pre, post assessments about the acceptability of the program and their completion of the recommended future care planning activities.

RESULTS

Based on participant's report on the usefulness and satisfaction of the program after the completion of the program, we found that participants reported high levels of acceptance of the program. Participation rates also confirmed the feasibility of the program. In terms of effects of program implementation, statistically significant changes were noted for several outcomes, such as resource building and FCP activities. In particular, we found that these gains were particularly robust for participants in the low competence group.

CONCLUSION

Pilot program results suggest the feasibility of a short community program enhancing proactive planning for future care needs among older adults residing in their community.

Prevalence of healthy aging among community dwelling adults age 70 and older from five European countries

Background

To compare the prevalence of healthy aging among adults age 70 and older from 5 European countries recruited for the DO-HEALTH clinical trial. Participants were selected for absence of prior major health events.

Methods

Cross-sectional analysis of DO-HEALTH baseline data. All 2,157 participants (mean age 74.9, SD 4.4; 61.7% women) were included and 2,123 had data for all domains of the healthy aging status (HA) definition. HA was assessed based on the Nurses` Health Study (NHS) definition requiring four domains: no major chronic diseases, no disabilities, no cognitive impairment (Montreal Cognitive Assessment, MoCA ≥25), no mental health limitation (GDS-5 <2, and no diagnosis of depression). Association between HA and age, BMI, gender, and physical function (sit-to-stand, gait speed, grip strength) was assessed by multivariate logistic regression analyses adjusting for center.

Results

Overall, 41.8% of DO-HEALTH participants were healthy agers with significant variability by country: Austria (Innsbruck) 58.3%, Switzerland (Zurich, Basel, Geneva) 51.2%, Germany (Berlin) 37.6%, France (Toulouse) 36.7% and Portugal (Coimbra) 8.8% (p <0.0001). Differences in prevalence by country persisted after adjustment for age. In the multivariate model, younger age (OR = 0.95, 95% CI 0.93 to 0.98), female gender (OR = 1.36, 95% CI 1.03 to 1.81), lower BMI (OR = 0.94, 95% CI 0.91 to 0.96), faster gait speed (OR = 4.70, 95% CI 2.68 to 8.25) and faster performance in sit-to-stand test (OR = 0.90, 95% CI 0.87 to 0.93) were independently and significantly associated with HA.

Conclusions

Despite the same inclusion and exclusion criteria preselecting relatively healthy adults age 70 years and older, HA prevalence in DO-HEALTH varied significantly between countries and was highest in participants from Austria and Switzerland, lowest in participants from Portugal. Independent of country, younger age, female gender, lower BMI and better physical function were associated with HA.

Trial registration

DO-HEALTH was registered under the protocol NCT01745263 at the International Trials Registry (clinicaltrials.gov), and under the protocol number 2012–001249-41 at the Registration at the European Community Clinical Trial System (EudraCT).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02755-8.

The role of goal and meaning in life for older adults facing interpersonal stress

Interpersonal stressful events (ISE) have been shown to be potent predictors of major depressive symptoms among older adults. This study examines the relationships between recent ISE and depressive symptoms in late life and explores whether having coping cognitive resource (e.g. finding meaning and goal in life) can buffer the effects of ISE on depressive symptoms for older adults. We utilized a sample of residents in Florida retirement communities (N = 588) who participated in a long-term-panel study using yearly assessments for six years. Additionally, we modeled within-person differences in ISE and depressive symptoms simultaneously with multilevel modeling. Then, we tested the moderating effect of coping resource (i.e. meaning in life and goal in life) in the association between ISE and depressive symptoms. We found that the mean level of ISE is associated with higher depressive symptoms and lower life satisfaction. In addition, higher levels of within-person meaning and goal buffered the negative effect of ISE on depressive symptoms for older adults. Similarly, within-person meaning and goal also attenuated the negative effect of ISE on life satisfaction.

Altruistic Attitudes Among Older Adults: Examining Construct Validity and Measurement Invariance of a New Scale

Background and Objectives

Scholarly research has established the role of altruism in facilitating human cooperation and prosocial behaviors and highlighted its contribution to psychological well-being. Given the health significance of altruistic attitudes and orientations, we developed a valid and reliable measure of this construct that is suitable for use with older adults.

Research Design and Methods

Based on data from a long-term panel study on adaptation to frailty among older adults (n = 366; mean age = 86 years), we used confirmatory factor analysis to perform construct validation of a five-item Elderly Care Research Center Altruism Scale among older adults (e.g., “Seeing others prosper makes me happy”). Moreover, we examined the invariance of the scale’s factor structure across time and gender using nested models.

Results

Composite reliability (coefficient omega = 0.78), factor loadings (>0.45 with eigenvalue = 2.84) from exploratory factor analysis, and model fit indices (e.g., comparative fit index = 0.999) from confirmatory factor analysis suggest a single factor, supporting a unidimensional reliable construct of altruistic orientation at baseline. The results provided support for configural, metric, and scalar invariance across time. Findings pertaining to measurement invariance across gender confirmed full configural invariance but only offered support for partial metric, scalar, and residual invariance at baseline. Strong correlations among the altruism scale, salient personality traits, psychological well-being, religiosity, and meaning in life help establish construct validity.

Discussion and Implications

The availability of a reliable and valid measure of altruistic attitudes enables a comprehensive evaluation of altruism’s influence on later-life health and well-being.

Mental health and motor efficiency of older adults living in the Sardinia's Blue Zone: a follow-up study

OBJECTIVES

The main aim of this study was to examine the impact of age-related changes on mental health, metacognitive, and motor functioning in late adulthood, while controlling for the effect of gender. Additionally, this investigation intended to study the association between motor efficiency indexes and self-reported psychological well-being, depression and cognitive failures over a period of 24 months.

DESIGN

Prospective longitudinal study: post hoc analysis.

PARTICIPANTS

Ninety-one community-dwelling older participants (mean age = 78.7 years, SD = 5.6) were recruited in a rural village of the Sardinian Blue Zone - an area of exceptional longevity located in the central-eastern region of Sardinia, an Italian island in the Mediterranean Sea.

MEASUREMENTS

All respondents completed a battery of tests and questionnaires assessing motor and general cognitive efficiency, self-reported psychological well-being, negative affect, and cognitive failures.

RESULTS

The adoption of a multilevel modeling approach highlighted the significative impact of time on psychological well-being, as well as on mobility parameters like gait speed and cadence, while controlling for the gender effect. Overall, psychological well-being and motor swing significantly increase at follow-up, whereas the further above-mentioned measures decreased after 24 months. Moreover, compared to the national cut-off, at baseline and follow-up, participants reported higher perceived emotional well-being. Finally, significant relationships between motor scores and self-reported mental health and metacognitive measures were found both at baseline and follow-up.

CONCLUSIONS

The maintenance of motor efficiency and preserved mental health seems to contribute to the successful aging of older people living in the Sardinian Blue Zone.

Homeostasis Revisited: Patterns of Stability and Rebalancing in Older Adults' Social Lives

OBJECTIVES

To examine patterns of change in later-life social connectedness: (a) the extent and direction of changes in different aspects of social connectedness, including size, density, and composition of social networks, network turnover, and three types of community involvement and (b) the sequential nature of these changes over time.

METHOD

We use three waves of nationally representative data from the National Social Life, Health, and Aging Project, collected from 2005/2006 to 2015/2016. Respondents were between the ages of 67 and 95 at follow-up. Types of changes in their social connectedness between the two successive 5-year periods are compared to discern over-time change patterns.

RESULTS

Analyses reveal stability or growth in the sizes of most older adults' social networks, their access to non-kin ties, network expansiveness, as well as several forms of community involvement. Most older adults experienced turnover within their networks, but losses and additions usually offset each other, resulting in generally stable network size and structural features. Moreover, when older adults reported decreases (increases) in a given form of social connectedness during the first half of the study period, these changes were typically followed by countervailing increases (decreases) over the subsequent 5-year period. This general pattern holds for both network and community connectedness.

DISCUSSION

There is an overwhelming tendency toward either maintaining or rebalancing previous structures and levels of both personal network connectedness and community involvement. This results in overall homeostasis. We close by discussing the need for a unifying theoretical framework that can explain these patterns.

The Utility of Solution-Oriented Strategies to Support Grandparents Raising Grandchildren

Objectives: The purpose of this article is to evaluate the effectiveness of a psychosocial intervention program to improve the health and social psychological outcomes for grandparents raising grandchildren using the theory of Selection, Optimization, and Compensation (Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). Cambridge University Press. doi:10.1017/CBO9780511665684.003). Methods: Fifty-two grandparents were randomly assigned either to a 6-session solution-oriented goal-setting program or to a waiting list control condition who subsequently received the intervention. Results: Grandparents in the intervention group, in comparison to the waiting list control group, reduced their level of depression, improved their parental efficacy, overall psychosocial adjustment, and increased their ability to choose effective goals. For the most part, findings were replicated in the waiting list control analyses. Discussion: While these findings are consistent with previous studies using psychosocial interventions with parents and grandparent caregivers, they also provide support for strength-based proactive behavioral approaches to improve the quality of life of grandparent caregivers.

Positivity effect and decision making in ageing

Across various contexts, older adults demonstrate a positivity effect - an age-related increase in a relative bias toward positive emotional stimuli as compared to negative stimuli. Previous research has demonstrated how this effect can influence decision making processes, specifically information search and choice satisfaction. However, the potential impact of the positivity effect and resulting age differences in information acquisition on decision quality has not been conclusively determined. We conducted an online decision making study comprising choices among charitable organisations with 152 younger and 152 older adults to investigate this relationship. We did not observe the positivity effect defined as higher positivity bias in older compared to younger adults. On the contrary, younger adults showed a slightly higher positivity bias. We also did not observe a link between a bias in information search toward positive or negative stimuli and decision quality. The results replicate the link between positivity bias and decision satisfaction. Older and younger adults did not differ in their decision quality. Finally, the findings did not support a potential influence of loss prevention orientation. Further research is required to address the factors that could influence the positivity effect in decision making.

Driving Cessation in Old Age: Gender Influences on Mortality

Objective: This study examined health and social support as mediators of the association between driving cessation and 10-year mortality among older men and older women. Method: Data were drawn from a prospective panel survey of 1000 community-dwelling older adults with follow-ups over a 10-year period. Extended Cox proportional hazard regression models were used to estimate the relative risk of driving cessation on mortality. Results: Mortality risk was 1.36 (CI = [1.06, 1.73]) times higher for nondrivers than drivers. This relationship was significantly mediated by health status in the overall sample. Physical health and cognitive health fully mediated the association between driving cessation and mortality among older men, whereas the mediation effects were partial among older women. Discussion: Gender differences in driving patterns may account for the differential mediation effects in the association between driving cessation and mortality.

Loving Others: The Impact of Compassionate Love on Later-Life Psychological Well-being

OBJECTIVES

Existing scholarship in social gerontology has paid relatively little attention to broader loving emotions, such as compassionate and altruistic love, as potentially meaningful mechanisms for improving later-life psychological well-being outside a family framework.

METHOD

Drawing from a 3-wave longitudinal survey of community-dwelling older residents (n = 334) of Miami, Florida, we utilized generalized estimating equation models to examine the influence of changes in compassionate love (i.e., feeling love toward other persons and experiencing love from others) on depressive symptoms over time. We also explored cross-sectional relationship between compassionate love and positive and negative affects.

RESULTS

An increase in the feeling of being loved (β = -0.77, p < .001) and feeling love for others (β = -0.78, p < .001) led to a decline in odds of reporting greater levels of depressive symptoms over time. The odds of reporting higher level of positive affect were significantly greater for older adults who reported feeling loved by others (β = .63, p < .001) and expressed love for other people (β = 0.43, p < .05). Older adults who felt loved and expressed love for other people, respectively, had 0.71 and 0.54-point lower ordered log odds of reporting higher negative affect than those who reported lower levels of love. The statistically significant impact of feeling loved on all well-being outcomes was maintained even after adjustment for altruistic attitudes and emotional support. Except for depressive symptoms, such adjustments explained the positive influence of love for others on well-being outcomes.

DISCUSSION

Our findings underscore the powerful influence of both receiving and giving loving emotions for the maintenance of later-life psychological well-being.

Perspectives on Aging-Related Preparation

When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.

"I Could Do Stereotypical Old People Things … but I Feel Like I Would Get Bored With That Stuff": College Students' Proactive Steps to Avoid Negative Aspects of Aging

The preventive and corrective proactivity model explores how internal and external resources mediate age-related stressors to counter negative outcomes of aging. Older adults' proactivity about their future is consistently associated with higher quality of life, but research has not explored younger adults' perceptions of their aging. We used interpretive phenomenology analysis to analyze 24 students' essays from the beginning and end of an introductory gerontology course to understand anticipated adaptation to their 75-year-old self. The superordinate theme proactive steps to avoid negative aspects of aging comprised five subordinate themes (being productive, exercising and eating right, being financially stable, being socially connected, and the roles of older adults). Students presented unrealistically positive selves at 75 and discussed how to maintain and adapt to redefine their aging experience. Findings have implications for research on adaption, proactivity, and the future-self, and suggest that pedagogy incorporates realistic expectations of aging.

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Stressful Events in Old Age: Who are Most Exposed and Who are Most Likely to Overcome Them

Objectives: This study investigated self-reported events that were rated as stressful and being affecting wellbeing among older people. It also examined the variables associated with the perception of overcoming these stressful events. Methods: Face-to-face survey on a representative sample of 1,431 older people in Santiago-Chile. Instruments included open-ended questions for distinguishing events as losses, problems, conflicts, and others’ difficulties. The associations between the occurrence and overcoming of events with individual and social characteristics were examined through multivariate logistic regression. Results: 39.5% mentioned at least one stressful event, being mostly perceived as solvable problems rather than losses. Higher-income, better health, self-efficacy, and social support were associated with a higher perception of event overcoming. Conclusion: The occurrence and the probability of events’ overcoming does not increase in old-old age in this sample group. Better health and individual and social resources such as self-efficacy and social support, are protective resources for overcoming the stressful events, but they are not generally considered in public policies.

Psychological Factors that Lessen the Impact of COVID-19 on the Self-Employment Intention of Business Administration and Economics' Students from Latin America

BACKGROUND

The 2019 coronavirus disease epidemic (Covid-19) is a public health emergency of international concern and poses a challenge to the labor market. The pandemic has a devastating and disproportionate effect on young workers, their interest in entrepreneurship, and their mental health. Research is needed to develop evidence-based strategies to improve coping and reduce adverse psychological problems. The objective of this study was to analyze the impact that Covid-19 pandemic perception and psychological need satisfaction have on university students and their self-employment intention. In addition, we also analyzed the role of moderation played by psychological aspects. These psychological factors (i.e., Optimism and Proactiveness) can also improve young people's mental health and well-being.

METHODS

An explorative study (online survey) was conducted in March 2020 934 university students from Latin America. Regression analysis models were built to examine the relationships between Covid-19 pandemic perception, personality variables, and entrepreneurial intention. Mediation models, through the bootstrapping method, were performed to analyze the mediating role of proactiveness and optimism.

RESULTS

Results indicate that students' perception of Covid-19 and psychological need satisfaction are associated with entrepreneurial intention. Additionally, the present study argues that proactiveness and optimism mediate these relationships.

CONCLUSIONS

This study identifies psychological factors associated with a lower level of Covid-19 impact and that can be used for psychological interventions that result in an improvement in the mental health of these vulnerable groups during and after the Covid-19 pandemic. Theoretical and practical implications are discussed.

Racial differences in future care planning in late life

Objectives: Although many older adults fear frailty and loss of independence in late life, relatively few make plans for their future care. Such planning is particularly limited among racial minorities. Given the benefits of future care planning (FCP), it is important to understand factors that facilitate or hamper FCP in late life. Our study explored racial, demographic, and dispositional influences on thinking about and engagement in FCP among community-dwelling older adults.Design: This study utilized data from the Elderly Care Research Center's longitudinal study of successful aging based on interviews with 409 older adults. Along with race, education and other demographic factors, we explored dispositional influences of optimism and religiosity on FCP using logistic regression.Results: African American older adults had significantly lower odds of executing FCP (β = 0.36, p < .05) when compared to White older adults. However, this estimate was no longer statistically significant after controlling for education, disability status, optimism, and religiosity. Older adults with higher education had significantly higher odds of thinking about and executing FCP. Higher level of optimism was associated with lower odds of FCP.Conclusions: Limited educational resources and the greater prevalence of dispositions of religiosity and optimism among African American older adults may contribute to their reluctance to engage in FCP in comparison to their white counterparts. Our findings offer practice implications indicating a need for interventions to encourage older adults, particularly racial minorities, to recognize and actively plan for their future care needs.

Attitudes Towards and Use of Information and Communication Technologies (ICTs) Among Older Adults in Italy and Sweden: the Influence of Cultural Context, Socio-Demographic Factors, and Time Perspective

This study examined determinants of attitudes towards and use of information and communication technologies (ICTs) in older adults, including variations in cultural context, socio-demographic factors (age, education, and gender) and the individual's time perspective. Towards this end, 638 older adults in Italy (n = 262, M = 71.7 years) and Sweden (n = 376, M = 69.9 years) completed the Swedish Time Perspective Inventory (S-ZTPI), the Attitude toward Technologies Questionnaire (ATTQ), and questions regarding use of specific digital technologies (e.g. Internet, Skype, Facebook); data were collected in 2013-2014. The results showed more positive attitudes toward ICTs in Swedish compared with Italian elderly as well as more frequent use of technologies. Regardless of nationality, younger age and higher levels of educational attainment was positively associated with attitudes towards ICTs. Male gender was associated with higher ATTQ scores in the Italian, but not in the Swedish, sample. Time perspective accounted for significant variance beyond the foregoing variables. S-ZTPI Past Negative, Future Negative and Present Fatalistic in particular, were (negatively) related to ATTQ scores, with a similar pattern for ICT use. Future Positive and Present Hedonistic were positively associated with ATTQ scores, across the samples. In conclusion, between-person differences in time perspective organization are an important factor to account for variability in attitudes towards and use of ICTs in old age, and appears to exert an influence over and beyond other significant predictors, such as cultural context, age/cohort membership, and educational level.

Proactive Aging Among Holocaust Survivors: Striving for the Best Possible Life

Objectives

To investigate methods that older Holocaust survivors and their age peers use in order to maintain the best possible life and to examine associations between these methods and subjective well-being.

Method

Participants were 481 older Israelis (mean age 77.4 ± 6.7 years): Holocaust survivors (n = 164), postwar immigrants (n = 183), and prewar immigrants (n = 134). Measures included sociodemographics and indicators of health and well-being. Respondents were asked to answer an open-ended question: "What are the methods you use to maintain the best possible life?". Answers were coded into eight categories.

Results

Holocaust survivors were significantly less likely to mention methods coded as "Enjoyment" (32.3%) relative to postwar (43.7%) and prewar (46.2%) immigrants and significantly more likely to mention methods coded as "Maintaining good health" (39.0%) relative to postwar (27.9%) and prewar (21.6%) immigrants. Controlling for sociodemographics and health status, Holocaust survivors still differed from their peers.

Discussion

Aging Holocaust survivors tended to focus on more essential/fundamental needs (e.g., health), whereas their peers tended to focus on a wider range of needs (e.g., enjoyment) in their effort to maintain the best possible life. Our findings may add to the proactivity model of successful aging by suggesting that aging individuals in Israel use both proactive (e.g., health) and cognitive (e.g., accepting the present) adaptation methods, regardless of their reported history during the war.

Autism aging

Many people perceive autism spectrum disorder (ASD) as a childhood disorder, yet ASD is a lifelong condition. Although little is known about the mental and physical health issues of aging individuals with ASD, there are increasing numbers of older adults being diagnosed with ASD. Although there has been a recent "call to action" (to address lack of knowledge and the dearth of services and programs for aging individuals with autism, the authors think it is also important for those who are involved in educational programs related to gerontology and geriatrics settings to be aware of "autism aging." This term conceptualizes the demographics, person and contextual factors, and intellectual awareness of the trends and patterns of ASD as a life course challenge and opportunity for well-being and quality of life. The purposes of this article are to (1) provide a general overview of autism issues and to examine several dimensions of ASD in the context of the emergent and relevant scholarship in the adult and aging domain, (2) propose how to address the "gap" in the literature on autism and aging in terms of a conceptual model and by improving the methodology, and (3) to discuss the implications of these dimensions for educators in gerontology and geriatrics, and for those professionals who work in clinical and health care services. It is the goal of the authors to have this article represent a general introduction to ASD and to be a part of the foundation for educational awareness for educators in gerontology and geriatrics.

Late life disability and experienced wellbeing: Are economic resources a buffer?

BACKGROUND

Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.

OBJECTIVE

Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.

METHODS

We use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.

RESULTS

We find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.

CONCLUSIONS

Future research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.

Subjective well-being key elements of Successful Aging: A study with Lifelong Learners older adults from Costa Rica and Spain

Subjective well-being is a major psychological construct in the research tradition. Along with literature, authors have distinguished between hedonic and eudaimonic well-being. The aim of this study is to determine the role of some psychosocial variables plays in the perceived well-being is conceived from a hedonic or a eudaimonic perspective. The sample consisted of 1016 people of 55 years and older in a Spanish sample and 277 people of 55 years old or older from a Costa Rican sample. Both samples were part of the Longitudinal Older Learners (LOL) study. A structural model with latent variables was estimated with Mplus. The results point out that, the traditional variables included on successful aging models are relevant for explaining older adults' well-being in both countries with some differences on the hedonic and eudaimonic approach of successful aging on the Latin cultural context studied.

Feasibility and Effect of a Multidimensional Support Program to Improve Gerotranscendence Perception and Depression for Older Adults: A Pragmatic Cluster-Randomized Control Study

Improving perception of gerotranscendence can increase life satisfaction in older adults to achieve successful aging. The purpose of this study was to evaluate the feasibility and effect of a multidimensional support program (MSP) on gerotranscendence and depression in community-dwelling older adults. Using a cluster-randomized control trial design, four sites (98 participants) were randomly assigned to a MSP or control group. The Gerotranscendence Scale and Geriatric Depression Scale were administered pre- and postintervention. A total of 91 participants completed the study. The mean attendance rates in the MSP and control groups were 85.5% and 84.3%, respectively. The MSP was found to significantly enhance the perception of gerotranscendence in older adults but not their level of depression. This study demonstrated the MSP is a feasible and effective program to improve perception of gerotranscendence and may potentially lead to positive psychological well-being for older adults. [Res Gerontol Nurs. 2019; 12(3):148-158.].

A Self-Reliant Umbrella: Defining Successful Aging Among the Old-Old (80+) in Shanghai

The Chinese old-old (80+) population has steadily increased in recent years; however, limited studies have examined how this group ages. The purpose of this study is to explore how the old-old in urban China define successful aging. Guided by grounded theory, we conducted semi-structured, in-depth interviews with community-dwelling old-old participants (N = 97). Participants identified self-reliance as the goal of successful aging, which was supported by four proactive behaviors: physical activity, financial security, community connectedness, and willing acceptance of reality. In our model, we conceptualized these four proactive behaviors to constitute the ribs of an umbrella, supporting a canopy to protect the pole of self-reliant successful aging. This study offers new understanding of the dynamic and nuanced ways that the old-old in urban China age successfully and of their valiant efforts to maintain self-reliance.

Analysis of the Differential Relationship between the Perception of One's Life and Coping Resources among Three Generations of Bedouin Women

Bedouin society has undergone rapid changes over the past decade. The younger generation of Bedouin women is better educated, which has enabled them to enter different professions, increased their incomes and elevated their social status. We examined the sense of coherence (SOC) and its components of meaningfulness, manageability and comprehensibility as well as the use of coping strategies among Bedouin women from three age groups. We also investigated the coping resources and strategies before determining the relationships between these variables in the three groups. One hundred ninety-six women participated in the study. Differences were found mostly between the oldest age group (61 years and older) and the two younger groups (21⁻40 and 41⁻60 years old). The oldest women reported less meaningfulness and used less positive reframing, planning, humor and acceptance. In terms of coping strategies, venting was used more by the youngest group whereas behavioral disengagement was used more by the oldest group. In the younger groups, SOC and its components were positively correlated with the use of coping strategies that are considered to be adaptive and with emotional support. However, the correlations between these factors were negative among the oldest group, which points to non-adaptive coping strategies used by these women. These results are discussed in light of the salutogenic, stress-appraisal and coping theories.

Social support and verbal interaction are differentially associated with cognitive function in midlife and older age

Social engagement is associated with healthy aging and preserved cognition. Two dimensions of engagement, verbal interactions and perceived support, likely impact cognition via distinct mechanistic pathways. We explored the cognitive benefit of each construct among enrollees (N = 1,052, mean age = 60.2 years) in the Wisconsin Registry for Alzheimer's Prevention study, who provide neuropsychological and sociobehavioral data at two-year intervals. Outcomes included six cognitive factor scores representing key domains of executive function and memory. Key predictors included self-reported perceived social support and weekly verbal interaction. Results indicated that after adjusting for lifestyle covariates, social support was positively associated with Speed and Flexibility and that verbal interactions were associated with Verbal Learning and Memory. These findings suggest that support, which may buffer stress, and verbal interaction, an accessible, aging-friendly form of environmental enrichment, are uniquely beneficial. Both are integral in the design of clinical and community interventions and programs that promote successful aging.

Digital Pathways to Positive Health Perceptions: Does Age Moderate the Relationship Between Medical Satisfaction and Positive Health Perceptions Among Middle-Aged and Older Internet Users?

Objectives

We explored the influence of e-trust, e-health literacy, e-health information seeking, and e-health information consumerism on medical satisfaction and positive health perceptions.

Methods

Our sample consisted of 499 randomly selected panel members aged 40–93. We employed hierarchical ordinary least squares (OLS) regression analyses and structural equation modeling (SEM). We examined the moderating role of age on the relationship between medical satisfaction and positive health perceptions.

Results

A significant interaction was found between age and medical satisfaction in predicting positive health perceptions in the OLS regression models. Medical satisfaction has a stronger association with self-care, health-related quality of life, and health status in the older adult sample as compared with the middle-aged sample. SEM analyses revealed that e-health information seeking has an indirect effect on both medical satisfaction and positive health perceptions through its significant direct effect on e-health information consumerism. Both e-trust and e-health consumerism were significant predictors. The e-health literacy and e-trust measures were significant predictors of the positive health perception index in the OLS regression models.

Discussion

The results contribute to our understanding of the potential benefits information technologies have for the health and well-being of computer-connected aging adults.

Depressive Symptoms and the Buffering Effect of Resilience on Widowhood by Gender

Background and Objectives

Spousal loss is a stressful life event that often results in significant depressive symptoms, with men often experiencing more significant depressive symptoms than women. Recent research suggests that psychological resilience may play a role in shaping how well people recover from the loss of a spouse. This study examined the moderating effect of resilience on widowhood in relation to changes in depressive symptoms for men and women.

Research Design and Methods

This study used data from the Health and Retirement Study to examine a change in depressive symptoms for men and women who experience spousal loss compared to those who remain continuously married (N = 5,626). We used the Simplified Resilience Score, which is based on measures drawn from the psychosocial and lifestyle questionnaire. Ordinary least squares regression was used to assess depression following reported spousal loss for widows relative to their continuously married counterparts.

Results

Results show resilience moderated depressive symptoms following spousal loss, but these effects varied by gender. Resilience was significantly and negatively associated with depressive symptoms for married but not for widowed women. However, for widowed men, resilience was significantly and negatively associated with depressive symptoms, and a high resilience score buffered the effect of widowhood.

Discussion and Implications

Our study suggests that having high levels of resilience prior to spousal loss may help offset persistent depressive symptoms, especially for men. Implications for future research and clinical practice are discussed.

Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: randomized clinical trial

BACKGROUND

Physical activity (PA) promotes cardiovascular health and health related quality of life (HRQoL), although the effect of that on blood pressure (BP) control has rarely been studied in hypertensive subjects. Our aim was to evaluate the effectiveness of a PA intervention programme on cardiovascular disease (CVD) risk, HRQoL and BP control in hypertensive subjects.

METHODS

A randomized clinical trial, with a PA intervention programme of 9 months duration, comprising a walking group of 120 min/week, supervised, and with socio-cultural activities. Participants were 207 hypertensive subjects (68.2 years, 76.8% women). PA (IPAQ-s), diet, CVD risk, BP, BMI, smoking, and HRQoL (SF-36) were assessed at baseline and at the end of the intervention. Changes in CVD risk and in HRQoL during the intervention was calculated (end-baseline score). Multivariate models were applied.

RESULTS

In multivariate models, the PA intervention programme, with no modification of the diet, decreased CVD risk (- 1.19 points) and the systolic BP (- 8.68 mmHg), and increased some areas of HRQoL (4.45 to 14.62 points). An increase in the percentage of subjects with controlled BP was observed by the PA programme itself (OR 5.395 to 5.785 according to multivariate models), and by the changes during the intervention in the decrease in CVD risk (OR 0.609) and in the increase in the HRQoL in physical component summary (OR 1.041), role physical (OR 1.010), and bodily pain (OR 1.014), independently of controlled BP at baseline.

CONCLUSIONS

This PA intervention programme improved cardiovascular health and HRQoL, and favoured BP control in primary care users with hypertension.

TRIAL REGISTRATION

Clinicaltrials.gov ID NCT02767739 ; Trial registered on May 5th, 2016. Retrospectively registered.

Whose advocacy counts in shaping elderly patients' satisfaction with physicians' care and communication?

Purpose

The purpose of this article was to examine the relative importance of patients’ self-advocacy and perceived physicians’ advocacy for impacting patients’ satisfaction in terms of physician communication and physician–patient relationship. We also examine the influence of physicians’ emotional support and patients’ demographic as well as health characteristics on patients’ satisfaction.

Sample

Our sample includes interviews with 806 community dwelling older adults (mean age =77.82 years, SD=8.41). The sample included residents of a large retirement community in Clearwater, FL, USA. Respondents were also included from representative samples of older adults living in Orlando and Miami, FL, USA, and Cleveland, OH, USA.

Methods and results

Using multiple hierarchical regression analyses, we found that patients’ age and functional limitations were negatively associated with their care satisfaction. When compared with White patients, African-American patients were less satisfied with their physicians while Latino patients expressed greater satisfaction with their medical care. We found limited evidence of patients’ self-advocacy and such advocacy did not serve as a significant predictor of satisfaction with physicians. In contrast, patients’ perception of physicians’ readiness to act as patient advocates was a significant predictor of patients’ satisfaction. Emotional support of physicians was also associated with patients’ satisfaction.

Conclusion

These findings raise questions about consumer empowerment among older adults and underscore their desire for and appreciation of physicians’ advocacy. Findings are discussed in the context of power imbalance between elderly patients and their doctors.

Differential effects of chronic stress in young-adult and old female mice: cognitive-behavioral manifestations and neurobiological correlates

Stress-related psychopathology is highly prevalent among elderly individuals and is associated with detrimental effects on mood, appetite and cognition. Conversely, under certain circumstances repeated mild-to-moderate stressors have been shown to enhance cognitive performance in rodents and exert stress-inoculating effects in humans. As most stress-related favorable outcomes have been reported in adolescence and young-adulthood, this apparent disparity could result from fundamental differences in how aging organisms respond to stress. Furthermore, given prominent age-related alterations in sex hormones, the effect of chronic stress in aging females remains a highly relevant yet little studied issue. In the present study, female C57BL/6 mice aged 3 (young-adult) and 20-23 (old) months were subjected to 8 weeks of chronic unpredictable stress (CUS). Behavioral outcomes were measured during the last 3 weeks of the CUS protocol, followed by brain dissection for histological and molecular end points. We found that in young-adult female mice, CUS resulted in decreased anxiety-like behavior and enhanced cognitive performance, whereas in old female mice it led to weight loss, dysregulated locomotion and memory impairment. These phenotypes were paralleled by differential changes in the expression of hypothalamic insulin and melanocortin-4 receptors and were consistent with an age-dependent reduction in the dynamic range of stress-related changes in the hippocampal transcriptome. Supported by an integrated microRNA (miRNA)-mRNA expression analysis, the present study proposes that, when confronted with ongoing stress, neuroprotective mechanisms involving the upregulation of neurogenesis, Wnt signaling and miR-375 can be harnessed more effectively during young-adulthood. Conversely, we suggest that aging alters the pattern of immune activation elicited by stress. Ultimately, interventions that modulate these processes could reduce the burden of stress-related psychopathology in late life.

Occupational Determinants of Successful Aging in Older Physicians

OBJECTIVES

Demographic, physical and psychological associations of successful aging (SA) have been evaluated, but occupational factors have not. Nor has SA been evaluated in a specific occupational group. The aims of this study were to examine the occupational associations of SA in older physicians, and to explore the concept of occupational SA.

METHODS

Physicians aged 55+ years completed self-ratings of occupational and personal SA on a 10-point visual analogue scale (VAS; 1 being "least successful" and 10 "most successful"). Associations between occupational and personal SA (defined as 8-10 on the VAS), respectively, and demographic and practice characteristics; health; social and financial resources; cognitive, emotional and motivational resources; work centrality; and anxiety about aging were examined.

RESULTS

Rates of occupational SA (69.2%; 95% CI: 66.3-72.0) were significantly higher than personal SA (63.1%; 95% CI: 60.1-66.0) in the sample of 1,048 physicians. Occupational and personal SA were strongly positively correlated (r = 0.73, N = 1,041, p < 0.001). Personal SA was predicted by demographic (older age, female, international medical graduate, urban practice), physical (better self-rated health), psychological (less depression, better cognitive, emotional and motivational resources, and greater anxiety about aging), and occupational (higher work centrality, fewer practice adaptations and not intending to retire) factors.

CONCLUSIONS

Occupational factors are central to physicians' self-conceptualization of SA. That greater work centrality, fewer work adaptations and less retirement planning were associated with personal SA suggests older physicians' sense of "success" is intertwined with continuing practice. There is a need for educating physicians to adapt to aging and retirement.

An Examination of Resilience and Coping in the Oldest Old Using Life Narrative Method

We aimed to identify aspects of late-life resilience and sense of self-identity and locate them within a life narrative to provide insights into methods of coping with the challenges of aging. To do this, in-depth interviews were conducted with 20 oldest-old adults (aged 88-98 years) recruited from the Australian Longitudinal Study of Ageing. Design, analysis, and interpretation of the study were informed by McAdams' life narrative theory, using concepts of redemption and contamination. Participants discussed their autobiographies and recounted significant life events. Interviews drew on McAdams' approach to elicit positive, negative, vivid, and turning point experiences. Analysis involved coding transcripts of the emergent personal narratives specifically to understand a "resilience story." This included data immersion and review of interview transcripts. Emergent codes were identified and discussed among the researchers. Although no contamination events were narrated, we identified the following themes: Adapting to aging-related physical challenges; Changing social networks; Continuity in sense of identity to maintain unity and life's purpose; and Redemptive capacity to cope positively with life challenges. This study fills a gap in knowledge on resilience from a personal perspective by the oldest old. Older people may benefit from interventions that harness positive coping strategies and foster social connections and meaningful activities, especially at times of loss or grief.