Greater age-related decline in markers of physical, mental and cognitive health among Israeli older adults exposed to lifetime cumulative adversity

Can countries shape the association between cumulative adversity and old-age health?

Introduction

The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age.

Methods

Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel.

Results

The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level.

Discussion

The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.

Financial Hardship on Food Security in Ageing Populations

Objective: This study investigated the prevalence of food security, and the association of food security with financial hardship and socio-demographic characteristics among the ageing population in Thailand. Methods: The study extracted data on 1,197 persons age 60 years or older from a nationally-representative sample survey of Thai households. The food security data were collected using the Food Insecurity Experience Scale (FIES), developed by the Food and Agriculture Organization. Multiple regression analysis was used to investigate the association between financial hardship, socio-demographic characteristics, and food security. Results: Of the total sample, 71% had food security. The least probability of having food security was observed in the respondents who sometimes and often had income problems (p < 0.001), and felt dissatisfied with their financial situation (p < 0.001). The respondents who were female, at oldest-old age, with lower than primary school education and in the Northeast were less likely to have food security. Conclusion: These findings suggest the need for government assistance for those who are experiencing financial hardship to help them manage their finances and food security more effectively, taking into account different socio-demographic characteristics.

Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study

OBJECTIVE

To investigate the accumulation of adversities (duration of exposure to any, economic, psychosocial) across the lifecourse (birth to 63 years) on cognitive function in older age, and the mediating role of mental health.

DESIGN

National birth cohort study.

SETTING

Great Britain.

PARTICIPANTS

5362 singleton births within marriage in England, Wales and Scotland born within 1 week of March 1946, of which 2131 completed at least 1 cognitive assessment.

MAIN OUTCOME MEASURES

Cognitive assessments included the Addenbrooke's Cognitive Examination-III, as a measure of cognitive state, processing speed (timed-letter search task), and verbal memory (word learning task) at 69 years. Scores were standardised to the analytical sample. Mental health at 60-64 years was assessed using the 28-item General Health Questionnaire, with scores standardised to the analytical sample.

RESULTS

After adjusting for sex, increased duration of exposure to any adversity was associated with decreased performance on cognitive state (β=-0.39; 95% CI -0.59 to -0.20) and verbal memory (β=-0.45; 95% CI -0.63 to -0.27) at 69 years, although these effects were attenuated after adjusting for further covariates (childhood cognition and emotional problems, educational attainment). Analyses by type of adversity revealed stronger associations from economic adversity to verbal memory (β=-0.54; 95% CI -0.70 to -0.39), with a small effect remaining even after adjusting for all covariates (β=-0.18; 95% CI -0.32 to -0.03), and weaker associations from psychosocial adversity. Causal mediation analyses found that mental health mediated all associations between duration of exposure to adversity (any, economic, psychosocial) and cognitive function, with around 15% of the total effect of economic adversity on verbal memory attributable to mental health.

CONCLUSIONS

Improving mental health among older adults has the potential to reduce cognitive impairments, as well as mitigate against some of the effect of lifecourse accumulation of adversity on cognitive performance in older age.

Trauma-informed patient and public-engaged research: Development and evaluation of an online training programme

INTRODUCTION

As patients, members of the public, and professional stakeholders engage in co-producing health-related research, an important issue to consider is trauma. Trauma is very common and associated with a wide range of physical and behavioural health conditions. Thus, it may benefit research partnerships to consider its impact on their stakeholders as well as its relevance to the health condition under study. The aims of this article are to describe the development and evaluation of a training programme that applied principles of trauma-informed care (TIC) to patient- and public-engaged research.

METHODS

A research partnership focused on addressing trauma in primary care patients ('myPATH') explicitly incorporated TIC into its formation, governance document and collaborative processes, and developed and evaluated a free 3-credit continuing education online training. The training was presented by 11 partners (5 professionals, 6 patients) and included academic content and lived experiences.

RESULTS

Training participants (N = 46) positively rated achievement of learning objectives and speakers' performance (ranging from 4.39 to 4.74 on a 5-point scale). The most salient themes from open-ended comments were that training was informative (n = 12) and that lived experiences shared by patient partners were impactful (n = 10). Suggestions were primarily technical or logistical.

CONCLUSION

This preliminary evaluation indicates that it is possible to incorporate TIC principles into a research partnership's collaborative processes and training about these topics is well-received. Learning about trauma and TIC may benefit research partnerships that involve patients and public stakeholders studying a wide range of health conditions, potentially improving how stakeholders engage in co-producing research as well as producing research that addresses how trauma relates to their health condition under study.

PATIENT OR PUBLIC CONTRIBUTION

The myPATH Partnership includes 22 individuals with professional and lived experiences related to trauma (https://www.usf.edu/cbcs/mhlp/centers/mypath/); nine partners were engaged due to personal experiences with trauma; other partners are community-based providers and researchers. All partners contributed ideas that led to trauma-informed research strategies and training. Eleven partners (5 professionals, 6 patients) presented the training, and 12 partners (8 professionals, 4 patients) contributed to this article and chose to be named as authors.

Stress, anxiety, and depression in times of COVID-19: Gender, individual quarantine, pandemic duration and employment

Objectives

This study explores the inter-relationship between emotional distress in adults and gender, quarantine experiences, pandemic duration, and employment.

Methods

An online cross-sectional online survey comprised 943 Israelis. The link to the survey was distributed via different personal and academic social networking sites (e.g., Facebook, WhatsApp, and Twitter). The survey was administered using the online survey portal Google Forms. Participants addressed questions about their socio-demographic characteristics (e.g., gender, age, family status, employment, and quarantine experiences) and ranked their levels of stress, anxiety, and depression using the Hebrew version of the Depression, Anxiety and Stress Scale-DASS-21.

Results

The majority of the respondents (72%) were women, 39% experienced quarantine, and 55% were unemployed. About 42% experienced a short-term pandemic (one lockdown), and the rest experienced a continuous pandemic (two lockdowns). The MANCOVA results, controlling for family status, indicated that women and unemployed participants reported higher stress, anxiety, and depression levels than men and employed participants. Participants who experienced individual quarantine reported higher anxiety and depression. Furthermore, there was a significant interaction between gender, employment, and pandemic duration. The experience of individual quarantine intensified the stress, anxiety, and depression for both employed and unemployed women. Conversely, the quarantine intensified stress, anxiety, and depression only for unemployed men, whereas the quarantine did not affect stress, anxiety, and depression among employed men.

Conclusions

Employment is a critical factor regarding men's emotional state during such stressful situations as the COVID-19 pandemic. Furthermore, individual quarantine and long-term pandemics are associated with opposite outcomes regarding individual mental health. The individual quarantine is associated with increased anxiety and depression, while a long-term, continuous pandemic is associated with decreased stress.

“In the Middle, between Anxiety Victims and PTSD, There Are People That Have Some Kind of a Disorder That Has No Name Yet” Insights about the Traumatic Stress Consequences of Exposure to Ongoing Threat

Current diagnostic criteria for post-traumatic stress disorder (PTSD) do not include symptoms resulting from exposure to ongoing traumatic stress. Thus, existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. We aimed to enumerate the symptoms associated with ongoing exposure to stress and to evaluate the need for a new comprehensive tool designed to assess traumatic stress in these situations. Study methods included focus group sessions, interviews, and a content expert’s workshop. Thematic analysis yielded three main themes: 1. PTSD in its current definition does not capture the whole “traumatic picture” observed in ongoing exposure to threat, 2. Some DSM-5 criteria are not applicable in ongoing exposure to threat, 3. The need for a new tool or modifications of commonly used assessment tools. This study supports the notion that PTSD assessment practices are lacking when assessing traumatic stress in ongoing exposure to threat and highlights the need for a new tool specifically designed for these situations.

Lifetime cumulative adversity and physical health deterioration in old age: Evidence from a fourteen-year longitudinal study

BACKGROUND

Although several studies have demonstrated the associations between lifetime cumulative adversity and late-life physical health, many of them were conducted at a single time point and examined events that occurred in childhood only. Less is known about the effect of lifelong adversity on the aging process over time. This study aimed to investigate the impact of cumulative adversity on the accelerated deterioration in health over time - mobility limitation and self-rated state of health in old age.

METHODS

This study provides a 14-year, 6-time-point follow-up on a representative sample of Europeans using the SHARE Project - longitudinal survey panel. The sample included a total of 7195 respondents aged 65 and older from nine countries in Europe. The outcome measurements were the number of mobility limitations and self-rated health - trajectories along 6 measurements. The independent variable was Lifetime Cumulative Adversity, and the analyses included also control variables - age, gender, socioeconomic status, depression, and country.

RESULTS

Time-based Latent Growth Curve Modeling has demonstrated that the effects of Lifetime Cumulative Adversity were significant on both health measures, by means of the intercepts and the slopes: Greater experience of adversities correlated with a higher physical health impairment at baseline and a higher decline along time. The effects of self-rated health were weaker than the effects of mobility limitations.

CONCLUSIONS

Given that the populations of numerous countries are rapidly aging, understanding the risk factors associated with health deterioration is important, especially for policymakers and medical health care experts, to raise awareness of the relationship between lifelong adversity and health decline and to build preventive interventions to deal with these consequences.

Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats

BACKGROUND

Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria.

OBJECTIVES

To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties.

METHOD

We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS).

RESULTS

On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct.

CONCLUSIONS

These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

Introducing two types of psychological resilience with partly unique genetic and environmental sources

Psychological resilience is indicated when individuals demonstrate good mental health despite exposure to significant stress or adversity. Good mental health may involve low levels of illbeing and/or high levels of wellbeing. There is still very limited knowledge about the potential differences between these outcomes in relation to stressors. We propose a distinction between type 1 and type 2 resilience, examine their underlying genetic and environmental architecture, and identify modifiable resilience factors. The data come from a population-based twin sample (N = 1987, mean age = 63) in the Norwegian Twin Registry. Type 1 and type 2 resilience are operationalised as the residual of anxiety/depression symptoms and life satisfaction, respectively, after lifetime cumulative adversity has been regressed out. We used biometric modelling and cotwin-control linear mixed models to estimate underlying factors and identify predictors while controlling for genetic confounding. The results support the notion of two separate, but partly overlapping types of resilience. We find heritabilities of 0.30 (type 1) and 0.24 (type 2) and a genetic correlation of 0.43. Potentially causal resilience factors include, but are not limited to, meaning in life, physical activity, positive affect and relationship satisfaction. Whereas some factors are associated with both resilience types, other factors are unique to each type.

Positive mental health moderates the association between PTSD symptoms and subjective accelerated aging among older adults

Posttraumatic stress disorder (PTSD) symptoms are known for predicting accelerated aging. However, it has not been examined whether individuals are subjectively aware of this process. The present study examined whether PTSD symptoms predict subjective accelerated aging and whether positive mental health status moderates this relationship. One hundred and thirty-two community-dwelling older adults (M = 66.85, SD = 9.13) who were sampled through random dialing of Jewish residents in the south of Israel completed the questionnaire twice: At Wave 1 after the flare-up of an Israeli-Palestinian conflict, and at Wave 2, a year later. Participants reported their PTSD symptoms, positive mental health, and on their subjective accelerated aging a year later. Higher levels of PTSD symptoms and lower levels of positive mental health were separately related to increased subjective accelerated aging. Participants with a lower level of positive mental health demonstrated a stronger association between PTSD symptoms and subjective accelerated aging. These findings emphasize that individuals who suffer from higher levels of PTSD symptoms and specifically those with lower levels of positive mental health status tend to feel they are aging faster. This finding adds to previous research suggesting that alongside the physiological process of accelerated aging there is also a subjective similar process.

Do past and prospective adversities intersect? Distinct effects of cumulative adversity and the hostile-world scenario on functioning at later life

Objectives: Studies have barely juxtaposed the effect of cumulative adversity over one's past life on health in later life with the related effect of one's actual or anticipated adversities. The latter adversities, anchored in the individual's present and future, are referred to by the concept of the hostile-world scenario (HWS). The aim of the current study was to examine the distinct effects of cumulative adversity and the HWS on changes in health over time using various markers of physical and mental health.Method: The study examined a subsample of 1,081 three-wave survivors drawn from SHARE-Israel using a cumulative adversity measure at Wave 1, a HWS measure at Wave 3, and six health markers at the three waves (with four-year intervals).Results: Cumulative adversity was associated with health markers at Wave 1, but it did not predict almost any short or long-term change in the health markers. The HWS showed unique associations with all concurrent health markers as well as with their changes over the last 8 years. In one emerging interaction, the advantage of lower HWS to better cognitive functioning decreased as cumulative trauma increased.Conclusion: These findings demonstrate the dialectical experience of potential trauma survivors, combining both vulnerability and resilience in the face of past adversity and prospective challenges. It seems that the HWS has a significantly adaptive role in identifying one's functional status at present as well as functional changes that have occurred over time.

Warfare exposure in later life and cognitive function: The moderating role of social connectedness

This study examined the influence of warfare exposure on older adults' cognitive functioning and explored the protective role of social connectedness. The study used cross-sectional data from the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) collected in 2015. We focused on a composite scale of social connectedness and on the exposure to war-related events during the 2014 Israel-Gaza conflict. Social connectedness and warfare exposure were used to predict three indicators of cognitive functioning. The results showed that warfare exposure was related to worse cognitive functioning, after controlling for socio-demographic and health covariates. However, social connectedness moderated this association. Persons who were highly connected did not suffer from worse cognitive functioning in recall (immediate and delayed) following warfare-related events and their fluency score increased. The results suggest that experiencing war-related events is associated with poorer cognitive functioning, but social connectedness moderates the strength of the negative association. These findings can inform intervention initiatives for adults exposed to warfare events, encouraging them to strengthen their social connections.

Accumulated lifecourse adversities and depressive symptoms in later life among older men and women in England: a longitudinal study

This paper investigates the association between accumulated major lifecourse adversities and later-life depressive symptoms among older people in England, both at a single point in time (prevalence) and the onset over time during later life (incidence), using data from the English Longitudinal Study of Ageing. Using retrospective data on the experience of major life adversities from childhood onwards, five latent classes were identified: no/few lifecourse adversities (58.6%), lost relationship (27.0%), chained adversities (2.4%), childhood adversities (6.3%) and war-related adversities (5.7%). Older people who had experienced ‘chained adversities’, ‘childhood adversities’ and ‘a lost relationship’ had higher odds of presenting current depressive symptoms in 2006, even after controlling for socio-demographic characteristics, health-risk behaviours and social resources. Longitudinal analysis indicated that amongst respondents who were clear of depression in 2006, those older people who had experienced childhood adversities, a lost relationship and war-related adversities experienced a higher risk of having a new case of depressive symptoms. Results further indicate that women's mental health in later life is more sensitive to earlier life adversities than men's. The study shows that intervention earlier in the lifecourse may have benefits for the individual both contemporaneously and over the longer term.

Childhood Adversity and Adult Health: The Role of Developmental Timing and Associations With Accelerated Aging

Childhood adversity has been associated with poor adult health. However, it is unclear whether timing of adversity matters in this association and whether adversity is related to poorer age-related physical health status. A representative sample of the adult Dutch population ( N = 3,586, age M = 54.94, age range = 18-92) completed surveys on health and diagnoses of age-related diseases. Information about weight and fat percentage was collected using weighing scales and childhood experiences were assessed retrospectively. Adversity was associated with higher body mass index and fat percentage, more physical problems, and high cholesterol, and this association was most pronounced in individuals with experiences of adversity during early adolescence. In addition, individuals with adversity more often reported physical problems or a medical diagnosis at a younger age. This study indicates that (1) timing of exposure to adversity matters in the relationship between experienced childhood adversity and health and (2) adversity is associated with a higher prevalence of age-related diseases at earlier ages.

Social connectedness moderates the relationship between warfare exposure, PTSD symptoms and health among older adults

Objective: The goal of the current study is to examine whether social connectedness among older adults mitigates the risk of poor health due to exposure to warfare and related symptoms of posttraumatic stress disorder (PTSD). Prior research has indicated a protective role for social connectedness in the face of trauma in general. However, this same association has not been examined among older adults exposed to warfare, even though they are potentially a more vulnerable population with unique social needs. Method: The study used cross-sectional data from the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE-Israel; N = 1,557, mean age = 69.03, age range = 50 to 105). It employed a composite scale of social connectedness, data on exposure to war-related events during the 2014 Israel-Gaza conflict, and ensuing symptoms of PTSD. Social connectedness, warfare exposure, and PTSD symptoms were used to predict physical and mental health, as well as engagement in health behaviors. Results: Warfare exposure and PTSD symptoms were related to worse health. Moreover, social connectedness moderated this association, such that persons suffering from PTSD symptoms suffered less from worse health when they were highly connected. This trend was found for physical and mental health and in relation to health behaviors. Conclusions: While war-related PTSD is indeed related to poorer health, social connectedness moderates the strength of the association. Practitioners should be aware of the protective role of social connectedness in the context of warfare exposure in old age, and intervention programs with this population should strive toward bolstering social connections.

A light in a sea of darkness: the moderating role of emotional complexity in the PTSD symptoms-successful aging association

OBJECTIVES

This study aimed to assess the underexplored effects of posttraumatic stress disorder (PTSD) symptoms on objective and subjective successful aging and to inquire whether emotional complexity moderates these effects.

METHODS

Community-dwelling older adults (N = 127, mean age = 67.86, SD = 11.07) rated their PTSD symptoms and completed measures of objective and subjective successful aging. They further reported their emotions on a daily basis over 14 days.

RESULTS

After controlling for background characteristics, self-rated health and cumulative lifetime adversity, results showed that higher PTSD symptoms were related to less successful aging, both objective and subjective. However, this relationship existed only amongst older adults with low emotional complexity, but not amongst those with high emotional complexity.

CONCLUSION

The findings suggest that high emotional complexity buffers against the negative effects of PTSD symptoms on successful aging. Interventions that empower emotional complexity amongst traumatized older adults may attenuate these negative effects.

Differences in posttraumatic stress characteristics by duration of exposure to trauma

Ongoing exposure of civilian populations to war and terror is associated with adverse responses beyond those specified in DSM-5 for PTSD. Current PTSD assessment practices are not fully sensitive to the complex symptomatic picture observed among individuals exposed to ongoing stress and are therefore limited for use in these situations. The current survey aimed to portray the posttraumatic characteristics most salient to ongoing exposure to political conflict. A questionnaire enquiring about various aspects of the posttraumatic consequences of ongoing exposure to political conflict as compared with those associated with a single exposure to trauma was disseminated to therapists throughout the country. Participants were asked to rank 75 posttraumatic characteristics for their relevance to each trauma type (about the symptom frequency and severity) and item mean scores were compared. The sample consisted of 66 responses valid for analysis. Our findings pinpoint some of the posttraumatic characteristics most salient to ongoing exposure to political conflict and highlight the complexity of the posttraumatic picture observed in these situations. Incorporating these in post trauma assessment tools will allow for the development of standardized, reliable definitions, which in turn will allow for more accurate diagnosis and more effective treatment protocols.

Quality of life in people aged 65+ in Europe: associated factors and models of social welfare-analysis of data from the SHARE project (Wave 5)

PURPOSE

To analyse the clinical, sociodemographic and socioeconomic factors that influence perceived quality of life (QoL) in a community sample of 33,241 people aged 65+ and to examine the relationship with models of social welfare in Europe.

METHODS

This was a cross-sectional study of data from Wave 5 (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE). The instruments used in the present study were as follows: sociodemographic data, CASP-12 (QoL), EURO-D (depression), indicators of life expectancy and suicide (WHO), and economic indicators (World Bank). Statistical analysis included bivariate and multilevel analyses.

RESULTS

In the multilevel analysis, greater satisfaction in life, less depression, sufficient income, better subjective health, physical activity, an absence of functional impairment, younger age and participation in activities were associated with better QoL in all countries. More education was only associated with higher QoL in Eastern European and Mediterranean countries, and only in the latter was caring for grandchildren also related to better QoL. Socioeconomic indicators were better and QoL scores higher (mean = 38.5 ± 5.8) in countries that had a social democratic (Nordic cluster) or corporatist model (Continental cluster) of social welfare, as compared to Eastern European and Mediterranean countries, which were characterized by poorer socioeconomic conditions, more limited social welfare provision and lower QoL scores (mean = 33.5 ± 6.4).

CONCLUSIONS

Perceived quality-of-life scores are consistent with the sociodemographic and clinical characteristics of participants, as well as with the socioeconomic indicators and models of social welfare of the countries in which they live.

The Role of the Hostile-World Scenario in Predicting Physical and Mental Health Outcomes in Older Adults

OBJECTIVE

The hostile-world scenario (HWS) denotes a personal belief system regarding threats to one's physical and mental integrity. We examined whether the HWS predicted health among older adults.

METHOD

The Israeli branch of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) provided data on 1,286 participants, aged 50+, interviewed in two waves 4 years apart. A special measure assembled items pertinent to the HWS throughout the SHARE survey. Nine outcomes indicated physical health (e.g., activities of daily living, medical conditions) and mental health (e.g., depressive symptoms, satisfaction with life).

RESULTS

The HWS at Wave 1 predicted all physical and mental outcomes at Wave 2, except cognitive functioning, beyond effects of sociodemographics and the respective outcome's baseline at Wave 1. This predictive effect was stronger among older participants.

DISCUSSION

The results support the conception of the HWS as a psychological monitor that senses approaching functional declines in later life.

A cross-cultural longitudinal examination of the effect of cumulative adversity on the mental and physical health of older adults

Self-oriented adversity refers to traumatic events that primarily inflict the self, whereas other-oriented adversity refers to events that affect the self by primarily targeting others. The present study aimed to examine whether cultural background moderates the effects of self-oriented and other-oriented adversity on mental and physical health of older adults. Using longitudinal data from the Israeli component of the Survey of Health and Retirement, we focused on 370 Jews and 239 Arabs who reported their exposure to various adversities across the life span, and completed questionnaires regarding mental and physical health. Results showed that the effect of self-oriented adversity on health did not differ among Jews and Arabs. However, other-oriented adversity showed a stronger effect on Arabs' mental and physical health than on Jews' health. Our findings suggest that the accumulation of adverse events that affect the self by primarily targeting others may have a stronger impact in collectivist cultures than in individualist cultures.

Quality of life attenuates age-related decline in functional status of older adults

PURPOSE

In the present study, we aimed to examine the total and moderating effects of needs-satisfaction-driven quality-of-life (QoL) measure on age-related change in functional status.

METHODS

Participants in the Survey of Health and Retirement in Europe (N = 18,781 at Wave 1) completed a measure of QoL (CASP-12) at baseline and reported their functional status across subsequent three waves using activities of daily living (ADL), instrumental activities of daily living (IADL), and functional limitation indices.

RESULTS

Growth-curve model estimates revealed that aged individuals with lower QoL scores at baseline had a steeper increase in disability deficits accumulation and functional limitation progression than their counterparts with a higher sense of QoL. The effects were more pronounced in ADL and IADL disability scales in which QoL moderated both linear and quadratic age-related changes.

CONCLUSIONS

Higher QoL attenuates processes of functional decline in late adulthood. Practitioners may seek strategies for improving and enhancing patients' QoL, as its salutary effects diffuse beyond psychological experience and include long-term effects on physical functioning.