Lighten UP! A community-based group intervention to promote psychological well-being in older adults

Autonomy and identity: the role of two developmental tasks on adolescent's wellbeing

Developmental tasks theory suggests that the wellbeing of adolescents can be better understood by considering their developmental tasks, rather than just viewing it as a specific age. This concept has significantly influenced contemporary studies on the transition to adulthood. Study explains that psychosocial developmental tasks involve shifts in an individual's psychological state and social relationships, potentially disrupting their previous equilibrium. Authors stress the importance of forming personal identity and fostering a healthy sense of independence, especially concerning identity and autonomy tasks, as crucial elements for adolescent wellbeing analysis. In line with this, the study focuses on the concurrent and predictive relationship between identity process of commitment, emotional autonomy, and psychological wellbeing among adolescents. Four hundred fifty-four (454) participants with an age ranged from 15 to 19 years (m = 17.96) completed surveys measuring emotional autonomy, identity commitment, and psychological wellbeing. The findings revealed that both emotional autonomy and identity commitment predicted psychological wellbeing, but in different ways. The study revealed that emotional autonomy is inversely associated with psychological wellbeing in middle and late adolescents, indicating that their ability to establish independence from their parents or relinquish unrealistic parental expectations may be linked to a decline in their mental health. The results also indicated that identity commitment is moderately and positively related to psychological wellbeing, suggesting that when adolescents have a clear sense of their identity, they may experience greater wellbeing. This finding underscores the importance of encouraging adolescents to explore their values, interests, and goals, as well as providing them with support and guidance throughout the process. Additionally, the findings of the study revealed that emotional autonomy has a negative influence on psychological wellbeing when identity commitment is low or average. Specifically, when individuals have a low level of identity commitment, emotional autonomy significantly predicts lower psychological wellbeing. Similarly, when identity commitment is at an average level, emotional autonomy also has a detrimental effect on psychological wellbeing. Lastly, the study revealed that when individuals have a high level of identity commitment, emotional autonomy does not have a significant impact on psychological wellbeing. In simpler terms, when individuals possess a strong sense of commitment to their identity, their level of emotional autonomy does not play a significant role in influencing their psychological wellbeing.

Purpose in Daily Life: Considering Within-Person Sense of Purpose Variability

Sense of purpose refers to the extent to which one feels that they have personally meaningful goals and directions guiding them through life. Though this construct predicts a host of benefits, little is known regarding the extent to which sense of purpose fluctuates within an individual and the affective changes tied to those fluctuations. The current study uses daily diary data to addresses this gap by exploring (1) how much sense of purpose and different components of purpose fluctuate from one day to the next, (2) the extent to which these fluctuations correlate with positive and negative affect, and (3) whether dispositional sense of purpose and age correlate with greater variability. Participants (N = 354) reported on their sense of purpose and positive and negative affect every day for 10 days. Results suggest that approximately 45-61% of the variability in sense of purpose scores occurs between-person depending on how it is assessed. Furthermore, the within-person variability in sense of purpose is more strongly correlated with changes in positive affect relative to negative affect. Finally, higher levels of dispositional sense of purpose and age do not appear to be associated with how much variability an individual experiences in their purposefulness from one day to next. The discussion focuses on what these findings mean for the trait-like nature of sense of purpose, short-term sense of purpose measurement, lifespan development, and intervention efforts.

Community-based support to improve mental health and wellbeing in older sexually and gender diverse people: a scoping review

OBJECTIVES

This scoping review seeks to identify what community-based support is used by older sexually and gender diverse (SGD) people, that aims to improve mental health/wellbeing.

METHODS

A scoping review was conducted using the Arksey and O'Malley framework. APA PsycInfo, Embase, MEDLINE, PubMed, and Scopus were searched. Key information was extracted and entered into a structured coding sheet before being summarized.

RESULTS

Seventeen studies were included (41% observational qualitative and 35% observational quantitative). The most commonly used community-based support was lesbian, gay, bisexual and transgender (LGBT) social groups. A range of practices were reported in five studies, including in SGD affirming religious congregations and mind-body practices. Two studies reported the use of formal programmes, with one based on a group initiative. Positive outcomes included feeling connected, improved social support and mental health, and coping with illness. Five studies reported null or negative findings, including a lack of acceptance. Most studies used categories for sex and gender inaccurately, and lacked detail when describing community-based support.

CONCLUSION

The use of community-based support by older SGD people is underexplored. More interventions designed for and by this community are needed, along with experimental research to draw conclusions on effectiveness to improve mental health or wellbeing.

Considering Financial Assets When Promoting Sense of Purpose in Older Adulthood

Sense of purpose, a consistent promoter of successful aging across the lifespan, has been shown in previous research to decline during older adulthood. As such, research is needed to understand how to inform policies around promoting a sense of purpose for older adults, and which adults may need more assistance on this front. One potential mechanism for lower purpose in older adulthood could be due to the more limited financial assets many face following retirement. As such, the current study investigated the cross-sectional associations between different kinds of financial assets and sense of purpose among older adults from the 2006 and 2008 waves of the Health and Retirement Study (n = 9,380). Sense of purpose as well as four financial assets were assessed: physical assets, retirement account assets, investment account assets, and debts. Findings indicated that greater physical assets and retirement account assets predicted a higher sense of purpose, while debt and investment account assets did not. Furthermore, there were no moderating effects of different grouping variables, such as retirement status, race, marital status, subjective health, or wave, on the associations between total net worth and sense of purpose. Findings are discussed regarding why net worth matters for all, and why certain assets may be more important than others when promoting a sense of purpose.

Spiritual care for older people living in the community: A scoping review

BACKGROUND

The population of older people should be supported to enjoy optimal quality of life. Health professionals should consider a range of interventions that support the older population to maintain their quality of life. One such interventional approach involves spiritual care.

OBJECTIVE

To explore what is known about spiritual care approaches for older people living in the community.

METHODS

Scoping review informed by Joanna Briggs Institute guidelines. Eight electronic databases were searched: CINAHL, Ageline, PubMed, ProQuest Nursing & Allied Health, PsycINFO, Scopus, Garuda, and Neliti. The review included quantitative and qualitative primary peer-reviewed research studies focusing on spiritual care interventions for older people living in the community published between 2011 and 2021 in English or Bahasa Indonesia. The search was uploaded into an electronic citation manager and imported into Covidence for screening.

RESULTS

A total of 29 studies were included in the review. While the studies were conducted in five continents, most were reported from the Asian continent. Five key issues based on the outcome of interventions were found namely psychological, physical, spiritual, multidisciplinary approach, and social connection.

CONCLUSION

This scoping review identifies spiritual interventions conducted across many countries have been implemented for older people living in the community. Although there are review limitations and further research is needed, these spiritual interventions, both faith-based and non-faith-based, are identified as useful to support the well-being of older people.

Feasibility of a Multi-Component Strengths-Building Intervention for Caregivers of Persons With Heart Failure

Caregivers of persons with heart failure (HF) navigate complex care plans, yet support strategies often focus solely on meeting the needs of patients. We conducted a randomized waitlist control trial (N = 38) to test the feasibility and gauge initial effect size of the Caregiver Support intervention on quality of life, caregiver burden, and self-efficacy among HF caregivers. The intervention includes up to five remote, nurse-facilitated sessions. Components address: holistic caregiver assessment, life purpose, action planning, resources, and future planning. Caregivers were 93.3% female, 60% White, and 63.3% spouses. Average age was 59.4. Participants who completed the intervention reported high satisfaction and acceptability of activities. Between-group effect sizes at 16 and 32 weeks suggest improvement in quality of life (mental health) (.88; 1.08), caregiver burden (.31; .37), and self-efficacy (.63; .74). Caregivers found Caregiver Support acceptable and feasible. Findings contribute evidence that this intervention can enhance caregiver outcomes. Clinicaltrials.gov Identifier NCT04090749.

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

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

Mediterranean diet and psychological well-being intervention to reverse metabolic syndrome in Chile (CHILEMED trial)

Psychosocial status and lifestyle are key risk factors of non-communicable diseases (NCDs), which, in turn, are main drivers of healthcare costs and morbimortality worldwide, including Chile. Mediterranean diet (MedDiet) is one of the healthiest dietary patterns under study. However, its impact on high-risk conditions, such as metabolic syndrome (MetS), and NCDs outside the Mediterranean Basin remains mostly unexplored. Even though Central Chile has an environment, food production, and culinary traditions comparable to those present in Mediterranean countries, few studies -some with significant methodological limitations- have evaluated the effect of MedDiet on health and/or disease in Chilean subjects. Importantly, a Mediterranean lifestyle is a modus vivendi that integrates physical health with mental and social well-being. Psychological well-being (PWB) is associated with healthy behaviors, positive health outcomes, and longevity, thereby emerging as a novel healthcare goal. We report here an ongoing randomized controlled clinical trial in Chilean patients with MetS seeking to test whether (1) a PWB theory-based intervention facilitates induction to and increases long-term adherence to a locally adapted MedDiet, and (2) a MedDiet intervention -implemented alone or combined with well-being promotion- is more effective at reversing MetS compared to individuals following a low-fat diet without psychological support. The CHILEan MEDiterranean (CHILEMED) diet intervention study is a 1-year trial including patients with MetS living in Chile. Participants will be assigned randomly by a computer-generated random number sequence to one of the three intervention arms: a) low-fat diet as control group, b) MedDiet alone, and c) MedDiet plus well-being support. Patients will be followed-up by individual and/or group online nutritional sessions or phone cal as well as 6- and 12-month in-person re-assessment of medical history, medication use, food intake, PWB, anthropometrics/physical exam, and blood collection for laboratory analysis. The primary outcome of the trial will be the effect of the MedDiet -with or without PWB intervention- on overall reversal of MetS compared to low-fat diet alone. Based on a statistical superiority trial, expected impact, and patient loss, the estimated study sample is 339 subjects (113 individuals per arm in 3 equal-sized groups). Currently, we have enrolled 179 patients, predominantly women, evenly distributed by age (group means ranging from 45.7 to 48,9 years-old), 3/4 are obese with almost all of them showing abdominal obesity, 70% are hypertensive, whereas <10% exhibit diabetes. If findings turn out as expected (e.g., MedDiet -with or without PWB intervention- is better than the low-fat diet for reversion of MetS at 1-year follow-up), CHILEMED will provide further beneficial evidence of the MedDiet on NCD risk conditions beyond the Mediterranean region.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effectiveness of mental health interventions for older adults in South Asia: A scoping review

OBJECTIVE

Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research.

METHODS

We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

RESULTS

From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types- 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more.

CONCLUSION

Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

The PATHS to Purpose: A New Framework Toward Understanding Purpose Development

Academic and lay interest has accrued over recent years with respect to how people develop a purpose in life. However, few theoretical models exist for understanding this developmental process as well as how to connect one’s overarching purpose in life to their daily feelings of purposefulness. The current article presents the PATHS (Purpose As Trait, Habit, and State) model, borrowing from clinical and personality development literatures. This framework allows researchers to consider purpose as a more enduring life direction (trait level), as an automatized routine acting in accordance with one’s goals (habit level), and as a more momentary reflection or feeling that one is engaged in purposeful pursuits (state level). Using this framework provides researchers with a valuable tool toward explaining how people progress toward purpose, via natural development or intervention, as well as the potential influences in this process.

Reciprocal Associations between Depressive Symptoms, Life Satisfaction, and Eudaimonic Well-Being in Older Adults over a 16-Year Period

The dual-continua model of mental health distinguishes between mental illness (presence of mental disorders, such as depression) and mental well-being (presence of positive traits and abilities). This model also distinguishes between hedonic well-being (e.g., affect balance and life satisfaction) and eudaimonic well-being (i.e., optimal psychological and social functioning, as indicated for example by having a purpose in life). We examined the relationships between depressive symptoms (a common indicator of mental illness), life satisfaction, and eudaimonic well-being. The study used a sample of 17,056 participants from England whose data were collected at eight intervals of approximately two years over a 16-year period, from 2004 to 2019. The mean age of the sample in the first wave was 58.843 years, with a standard deviation of 12.617 years (women = 55.2%). We disentangled within- and between-person sources of variance to examine whether increases or decreases in one variable preceded changes in the other variables at the next time point. We found positive reciprocal relationships between life satisfaction and eudaimonic well-being and negative reciprocal relationships between the two well-being dimensions and depressive symptoms. These results suggest that within-person increases in well-being are followed by future decreases in depressive symptoms, and within-person increases in depressive symptoms are followed by future decreases in well-being. Therefore, low levels of mental well-being in older adults may be considered a risk factor for depression, and well-being interventions (such as those focused on meaning-making) may serve as a protective factor against depression in older adults.

Positive attributes in elderly people with different degrees of depression: a study based on network analysis

INTRODUCTION

Depression in aging may lead to loss of autonomy and worsening of comorbidities. Understanding how positive attributes contribute to healthier and happier aging has been one of the purposes of Positive Psychology. However, the literature still lacks studies that evaluate how depression in the elderly is related to constructs considered positive.

OBJECTIVE

The present study aimed comparing scores of constructs of spiritual well-being, social support, self-esteem, life satisfaction, affection, optimism, and hope in the elderly with minimal, mild, moderate, and severe depression and healthy controls in order to investigate possible indirect and mediated relationships between positive constructs and depression.

METHODS

A cross-sectional study was conducted with elderly, 62 of whom were diagnosed with different severity of Major Depression (DSM-V) (minimum, mild, moderate, and severe according to the Beck Depression Inventory - BDI) and 66 healthy controls matched by age, sex and schooling. The instruments used were adapted and validated versions of the Spirituality Self-Rating Scale, the Rosenberg Self-Esteem Scale, the Medical Outcomes Social Scale of Support, the Life Satisfaction Scale, the Positive and Negative Affect Schedule, the Revised Life Orientation Test, and the Adult Dispositional Hope Scale. After comparing the means of scores between groups, an analysis of normalized partial association networks was performed to investigate the direct and mediated relationships between depression and other evaluated constructs.

RESULTS

Scores of spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affects, and hope differed significantly between the control group and the degrees of depression (p < 0.001). The analysis of normalized partial association networks has shown that the relations of depression with the constructs of life satisfaction, self-esteem, and social support are mediated, while the constructs of dispositional hope, positive affect, spiritual well-being, and optimism are indirectly related to depression. The social class was also positively related to depression.

CONCLUSION

Depression in different degrees is associated with a reduction in the scores of instruments that evaluate positive attributes. The constructs directly associated with depression are spiritual well-being, optimism, positive affect, and dispositional hope. The others had mediated relationship. These results may contribute to the planning of future interventions for the prevention of depression among the elderly.

Engagement with life and psychological well-being in late adulthood: Findings from community-based programs in Portugal

OBJECTIVES

Human aging is a multidirectional, multidimensional, and multicausal process that reflects biological, psychological, and sociocultural influences, which act in distinct combinations throughout the life-span. Proactivity towards avoiding the usual aging process is needed. This study analyses the long-term effects of participation in Community-Based Programs on psychological well-being.

METHOD

A sample of 150 community-dwelling participants enrolled in Community-Based Programs, aged 55 to 84 years and living in three Portuguese localities were matched by age (55-64, 65-74, 75-84 years), gender, and locality with a comparison group of non-participants. We administered a multidimensional gerontological protocol which included socio-demographic information, measures of health/disease, functional ability, social network, cognitive performance and psychological well-being. Hierarchical regression models were used to test the effects of Community-Based Programs on psychological well-being adjusting for remaining variables.

RESULTS

Overall, psychological well-being is positively associated with household income and satisfaction with health. Nevertheless, in participants, psychological well-being builds predominantly upon social network and is not associated with a moderate inability or cognitive deficits, contrasting with psychological well-being in non-participants. After adjusting for background variables, psychological well-being was positively associated with health satisfaction and social network and negatively related to moderate inability. Further, a significant interaction of participation in Community-Based Programs with age, points out higher levels of psychological well-being in participants contrasting with a downward trend in non-participants. After stratification by age, psychological well-being increases with time attending Community-Based Programs in the oldest (75-84 years) contrasting with the remainder.

CONCLUSIONS

Participation in Community-Based Programs may improve the negative effects of the aging process on psychological well-being. This positive effect as age increases may be linked to a reinforcement of social network, valued more by participants in Community-Based Programs. Furthermore, the programs may act as a healing/maintenance strategy in persons with moderate inability and/or cognitive deficits.

Effects of a Multi-Component Psychological Intervention to Cultivate Mental Health in Older Adults

Introduction

Psychological interventions to cultivate mental health in older adults are scarce and tend to focus on and use a limited number of activities.

Objective

The aim of this study was to test the effects of an intervention based on Keyes' concept of positive mental health.

Methods

The intervention was conducted with 24 self-selected participants, while 34 were part of the control group. Positive mental health and distress outcomes were measured at baseline and at the end of the intervention. ANCOVA analysis and effect sizes were calculated.

Results

Results showed that the intervention increased mental health (F= 18.22, p<0.001, η²= 0.334, d= 1.45, power 0.986) and decreased psychiatric symptomatology in the experimental group versus the control group (F= 7.07, p= 0.011, η²= 0.16, d= 0.87, power= 0.736), which showed no change.

Discussion

Despite study limitations, the intervention effectively promoted older people's well-being. Future research, should evaluate the long-term effects of the intervention with varied older adult populations.

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

Background

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

Objectives

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

Methods

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

Conclusion

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

Positive interventions for stress-related difficulties: A systematic review of randomized and non-randomized trials

The effectiveness of positive psychology interventions in the treatment of stress-related difficulties have not been well established. To estimate the effectiveness of positive psychology interventions on the reduction of stress-related symptoms, a systematic review using PubMed, Scopus, Wiley, Psychinfo, Cochrane and Sage databases with no limitation of date of publication was conducted. We identified additional studies by searching positive psychology reviews and academic books. Only studies trying positive interventions that included measures of anxiety, stress, or posttraumatic stress disorder symptoms were reviewed. We extracted data using predefined data fields and study quality was assessed with the National Institutes of Health study quality assessment tools. Twenty-nine records were included in this study: 23 controlled trials and six pre-post studies. Every study showed significant improvement in at least one dimension. Several studies reported improvements in well-being as well. This review shows promising results of positive psychology interventions as a treatment for stress-related difficulties. However, important methodological biases and strong heterogeneity among the studies highlight the need for replication and better validation of positive psychology interventions.

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.

Technology-Enhanced 4Active Intervention Impacting Psychological Well-Being and Physical Activity among Older Adults: A Pilot Study

Background: To increase psychological well-being and physical activity (PA) behaviors, our pilot study used the social ecological model as the framework to design the 4Active intervention, focusing on multicomponent exercise group lessons at the interpersonal level and self exercise enhanced by activity trackers at the individual level. The purpose of this pilot study was to examine the effectiveness of the two-level 4Active intervention in improving psychological well-being and PA participation in older adults living in retirement communities. Methods: Participants were 27 older adults with a mean age of 85.9 ± 9.3 years. Based on the two-arm, quasi-experimental study design, fourteen older adults (2 men, 12 women) living in one retirement community (RC) were assigned into the intervention group receiving the two-level 4Active intervention, whereas 13 older adults (1 man, 12 women) living in another RC were allocated to the active control group receiving group exercise intervention alone for eight weeks. One week before and after the interventions, the participants were pre-tested and post-tested in psychological well-being (i.e., life satisfaction, subjective happiness, positive affect, and negative affect) and weekly PA minutes (i.e., weekly walking, vigorous, moderate, and total PA minutes). The data were analyzed be means of descriptive statistics, independent sample t-tests, and ANCOVA repeated measures. Results: The results of ANCOVA repeated measures indicated that both groups maintained their slightly high or very high levels of life satisfaction, happiness, and positive affect over times. However, the two-level 4Active intervention group showed significant decreases in negative affect (F = 4.78, p = 0.04, η2 = 0.23) and significance increases in weekly moderate PA (F = 10.355, p = 0.004, η2 = 0.310) compared with the active control group over time. Conclusion: It is concluded that engaging in the two-level 4Active intervention including group-based multicomponent exercises and technology-enhanced self-exercises is more effective in decreasing negative affect and increasing weekly moderate PA METS-min in physically and cognitively frail older adults over time, compared with attending the group exercises alone.

Propósito de vida e desempenho de atividades avançadas de vida diária em idosos mais velhos

Resumo Objetivo Verificar a associação entre propósito de vida (PV) e a realização de atividades avançadas e instrumentais de vida diária (AAVD e AIVD) em idosos. Método Estudo de corte transversal com participantes da avaliação de seguimento do estudo FIBRA (Fragilidade em Idosos Brasileiros) nas cidades de Campinas e Ermelino Matarazzo (SP), Brasil, nos anos de 2016 e 2017. Participaram 187 idosos com 80 anos e mais recrutados em domicílios familiares. O protocolo incluiu a aplicação de um teste de rastreio de deficit cognitivo sugestivo de demência, escala para avaliação das AAVD, a Escala de Lawton e Brody avaliando AIVD, a Escala de Depressão Geriátrica e a Escala de Propósito de Vida de Ryff e Keyes (1995). Resultados Os participantes tinham em média 83,81 (±3,60) anos, 4,38 (±3,76) anos de escolaridade e tinham renda mensal média de 3,49 salários mínimos (±2,61) e 125 (66,8%) eram mulheres. Análises de regressão hierárquica mostraram associações estatisticamente significativas entre PV, sintomas depressivos e pontuação mais alta em AAVD (p=0,003) e sem associação significativa com AIVD (0,580), em modelo ajustado para variáveis sociodemográficas, avaliação subjetiva de saúde, desempenho cognitivo e depressão. Conclusões Os idosos com maior escore de PV e menor número de sintomas depressivos foram mais propensos a realizar AAVD, mas não AIVD, que se associaram à idade, sexo, sintomas depressivos e desempenho cognitivo. PV pode colaborar para a manutenção do estado funcional no idoso, contribuindo para um envelhecimento saudável.

Purpose in life and performance of advanced activities of daily living among the oldest old

Abstract Objective To verify the association between purpose in life (PL) and the performance in advanced (AADL) and instrumental (IADL) activities of daily living. Methods Cross-sectional community-based study which analyzed data from the follow-up assessment of the FIBRA Study (Frailty in Elderly Brazilians) in the cities of Campinas and Ermelino Matarazzo (SP), Brazil, in 2016 and 2017. Participants were 187 community dwelling persons aged 80 years and older. The protocol included the application of a cognitive deficit screening test suggestive of dementia, an inventory assessing AADL, the Lawton and Brody scale (IADL), the Geriatric Depression Scale and the Ryff and Keyes’ (1995) Purpose in Life Scale. Results Participants had an average of 83.81 (±3.60) years, 4.38 (± 3.76) years of schooling, 3.49 minimum wages (±2.61) of income, 125 (66.8%) being women. Hierarchical linear regression analyzes showed that PV and depressive symptoms were significantly associated with a higher number of AADL (p=0.003) and no significant association with IADL scores (0.580), in a model adjusted for sociodemographic variables, self-rated health, cognitive performance and depression. Conclusions The results suggest that older adults with higher PL and lower number of depression symptoms are more likely to perform a higher number of AADL. This association was not observed for IADL, which were associated with age, sex, depression and cognitive performance. PL may have an impact on complex levels of functional status in the elderly, thus contributing to healthy aging.

The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana

Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP), designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting and problem-solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults are feasible, and have important policy implications for mental health and social care in sub-Saharan Africa.

Cross-lagged relationships between sense of purpose in life, memory performance, and subjective memory beliefs in adulthood over a 9-year interval

OBJECTIVES

Previous studies have found a positive association between having a sense of purpose in life and memory functioning in old age. We extend these findings by examining the relationships between sense of purpose, memory performance, and subjective memory beliefs over time in a large sample of adults in mid to later adulthood.

METHOD

We used data from 3633 participants of the second and third wave of the MIDUS study. Cross-lagged panel analysis investigated the relationships between the variables at the two points, which were approximately 9 years apart, while controlling for gender, age, education, positive and negative affect, and self-rated health.

RESULTS

Sense of purpose in life, memory performance, and subjective memory beliefs were all cross-sectionally related to each other at both times. Longitudinally, sense of purpose was a positive predictor of subjective memory beliefs. Memory performance and subjective memory beliefs positively predicted each other over time. Furthermore, all three variables showed correlated changes over time. Exploratory analyses suggest that the covariates of affect and self-rated health are possible mediators or confounders in respectively the relationship between subjective memory beliefs and later sense of purpose, and sense of purpose and later objective memory performance.

CONCLUSION

Our findings underscore once more the relevance of sense of purpose in life as a predictor of positive late life functioning, as it is related to both performance-based and subjective cognitive outcomes. More work is needed to understand mechanisms underlying the purpose-memory association in order to develop and implement purpose interventions.

Fostering Positive Communities: A Scoping Review of Community-Level Positive Psychology Interventions

Historically, positive psychology research and practice have focused on studying and promoting well-being among individuals. While positive psychology interventions focusing on the well-being of communities and marginalized groups have recently been developed, studies reporting on their nature and characteristics are lacking. The aim of this paper is to examine the nature of community-level positive psychology interventions. It reviews the target populations, intervention modalities, objectives, and desired effects of 25 community-level positive psychology interventions found in 31 studies. This scoping review shows that community-level programs based on positive psychology vary greatly in all these aspects. However, most interventions are aimed at individual-level changes to achieve target group outcomes. Contextual issues such as social conditions, values, and fairness affecting well-being are rarely considered. Discrepancies between community-level positive psychology interventions and community psychology in terms of values and social change are discussed.

Psychological Well-Being of Living Kidney Donors and Recipients

OBJECTIVES

Previous research has indicated that kidney transplantation is associated with longer and better quality of life and can also have psychological impacts to both recipients and living donors. This study aimed to examine the psychological well-being of kidney transplant recipients and living donors in the first Ethiopian kidney transplant program using a psychological well-being framework developed by Ryff.

MATERIALS AND METHODS

All 82 kidney recipients and living donors who underwent medical screening for transplantation or living donation at the St. Paul's Hospital Millennium Medical Transplant Center between the establishment of the Center (September 2015)and the data collection end date (December 2018) were selected using medical records. Seventyfive recipients and 64 donors participated in the study. This study used a cross-sectional study design. Demographic questionnaires and Ryff's 84-item psychological well-being assessment were used. Collected data were analyzed through frequency, percentages, means, t tests, and analyses of variance.

RESULTS

Approximately 83% of study recipients scored in the upper 3 quartiles for composite psychological well-being scores, and 50% of study donors scored in the middle 2 quartiles for composite psychological well-being scores, with roughly 20% in the highest quartile. We found no significant mean difference between recipient and donor subscales, excluding the Personal Growth Subscale, which showed a significant mean difference between recipients (mean [SD] of 69.01[8.39]) and donors (mean [SD] of 65.89 [8.84]). This study revealed no significant psychological mean differences between kidney recipients and donors regarding the demographic characteristics of sex, age, marital status, and education.

CONCLUSIONS

Our single-center study cohort of kidney transplant recipients and living donors revealed overall psychological well-being scores similar to established transplant centers in other countries. Psychological well-being subscore data can provide meaningful information about the experiences of recipients and donors.

Health Benefits of Social Participation Interventions among Community-Dwelling Older Persons: A Review Article

BACKGROUND

Social disengagement among older persons may result from accumulated physical impact and social stressors experienced throughout life. Conversely, interventions that enhance social participation addresses social isolation with positive influences on health. This article, therefore, aimed to review the range of published studies that evaluated the health benefits of interventions on social participation among community-dwelling older persons.

METHOD

We conducted a search using the databases CINAHL, MEDLINE, EBSCOhost, PubMed, ProQuest, SAGE, ScienceDirect, SpringerLink, Web of Science, and Open repository/archive.

RESULTS

Twenty-five studies from Asia, Europe and America were selected. Included articles described randomized controlled trials (9), quasi-experimental studies (9), mixed-methods studies (2), participatory action research (3), and community-based intervention research (2). Social interventions described are group or cultural activities, personal/group monitoring and discussion, and communications devices. Intervention designed utilized theories, models, concepts, principles, and evidence from published literature.

CONCLUSION

Most social intervention studies evaluating health outcomes have been conducted in North America and Western Europe. Group-based activities were most commonly employed, but personal/group discussions, home visits and technology-based interactions have also been used. While social isolation is now a widely accepted risk factor for ill-health, research evidence for improvement of health through reduction of social isolation remains limited.

The Conceptual Structure of the Management by Nurses of the Ego Integrity of Residents of Nursing Homes

BACKGROUND

The number of older people admitted to nursing homes has continued to rise with the recent expansion of the Republic of Korea's long-term care system. Maintaining ego integrity is a major task for older people approaching the end of life. As efforts to maintain ego integrity include the final stages of life, this concept is critically important for older people in nursing homes. This study was designed to assess issues related to ego integrity in the nursing home environment to determine how nurses should play a key role in managing this important life task.

PURPOSE

The management by nurses of the ego integrity of residents of nursing homes is a new phenomenon that is central to promoting long-term, quality care. This study was designed to clarify and conceptualize this management phenomenon in the context of nursing homes.

METHODS

A hybrid model of concept development was used to analyze the ways in which nurses manage the ego integrity of residents of nursing homes. In the theoretical phase, a working definition of the management by nurses of residents' ego integrity is developed using a literature review. In the fieldwork phase, in-depth interviews are conducted with eight nurses from six nursing homes in Seoul and three other provinces. Finally, in the final analytical phase, the theoretical and fieldwork findings are interpreted and compared.

RESULTS

Two components, assessment and intervention, of the approach by nurses to managing the ego integrity of residents of nursing homes were identified. Assessment incorporates 10 attributes in the following three dimensions: "identifying the extent to which residents' basic needs are being fulfilled," "determining how residents achieve friendly relationships with others," and "determining how each resident creates a harmonious view of his or her life." Intervention incorporates nine attributes in the following two dimensions: "helping residents develop a positive view of life" and "helping residents make the best use of their remaining functional abilities."

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

By managing the ego integrity of residents, nurses have a significant influence on residents' sociopsychological adaptation, especially in the challenging environment of a nursing home. This study supports that managing the ego integrity of residents of nursing homes is an important and practical component of the role played by nurses and of the aid and care they provide. Furthermore, the findings verify the effectiveness of intervention studies in examining assessment tools and developing guidelines for ego-integrity management.

Sense of Purpose Promotes Resilience to Cognitive Deficits Attributable to Depressive Symptoms

Objective

Individuals higher in depressive symptoms commonly present with neuropsychological deficits including poorer memory performance. Sense of purpose in life has been shown to promote resilience to cognitive impairment in older adulthood, but it is unclear whether it may also protect against cognitive deficits associated with higher depressive symptoms.

Method

Cognitive functioning among 4599 older American adults (M_age = 74.33 years, range = 65–104 years, 56.84% female) was examined across a 12-year follow-up period. Depressive symptomatology was assessed at each wave using the 8-item Center for Epidemiologic Studies Depression Scale. Multilevel models assessed the influence of depressive symptoms and the interaction with sense of purpose in life on changes in memory performance and mental status.

Results

Higher depressive symptoms were associated with poorer memory performance at baseline, but did not predict rate of change over time. A negative interaction was observed between sense of purpose in life and depressive symptoms such that individuals higher in purpose experienced a less negative association between depressive symptoms and baseline memory performance. No significant interaction of sense of purpose and depressive symptoms was observed on mental status.

Conclusion

Having a sense of purpose in life may help protect older adults from memory deficits associated with higher depressive symptoms. The present findings underscore the potential for sense of purpose to promote cognitive reserve in older adulthood, allowing individuals to maintain cognitive performance in the face of accruing neurological insults.

Maintaining sense of purpose in midlife predicts better physical health

OBJECTIVE

Having a sense of purpose in life is fundamental to psychological and physical well-being. Despite the benefits of purpose, it may be difficult to hold onto purpose as people age. The present research addressed four aims: (1) to estimate average change in sense of purpose during midlife; (2) to test associations between purpose levels and later physical health; (3) to test associations between purpose change and later physical health; (4) to examine the cross-cultural generalizability of findings.

METHODS

We used reliable change indices to estimate change in sense of purpose during midlife in three prospective cohorts: one comprised predominately of White participants in the U.S. (N = 2692), a second predominately of African American participants in the U.S. (N = 248), and a third of Japanese participants in Tokyo (N = 644). Next, we used linear regression to examine associations between purpose levels and purpose change and later self-reported general health and chronic health conditions.

RESULTS

At the group level, purpose declined slightly across time (Cohen's ds = -0.08 to -0.17). At the individual level, 10-14% of participants reliably decreased in purpose, whereas only 6-8% of participants reliably increased in purpose. Consistent with our preregistered hypotheses, higher purpose levels predicted better health in the two larger samples (βs = 0.10-0.18, small effects) and more positive purpose change predicted better health in all three samples (βs = 0.08--0.22., small to medium effects).

CONCLUSION

Together, these findings suggest that both having a sense of purpose and holding onto it may be important for physical health in middle to older adulthood.

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

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

Fostering Well-Being in the Elderly: Translating Theories on Positive Aging to Practical Approaches

This article overviews positive aging concepts and strategies to enhance well-being in the elderly and then presents a translation of theories on positive aging to practical approaches for Positive Aging. Drawing upon positive psychology and positive aging research and tools, this program is designed to help older adults improve their well-being by acquiring skills and strategies to cope with present and future challenges. The Mental Fitness Program for Positive Aging (MFPPA) can enhance seniors' quality of life by increasing their vital involvement and active engagement in life. This model is most appropriate for community dwelling individuals. It can easily be conducted in wide range of adult education programs in community centers, sheltered homes, and primary care clinics. It can also be conducted through online psychoeducational training.

Factors Associated with Happiness among Malaysian Elderly

Happiness is an essential component to experience healthy ageing. Hence, understanding the factors that contribute to happiness is important. This study aimed to determine the factors associated with happiness among the elderly population in Malaysia. In this study, 1204 respondents were recruited from urban and rural areas in Selangor. A face-to-face interview was conducted using the Bahasa Malaysia version of the Japan Gerontological Evaluation Study questionnaire. The inclusion criteria include Malaysians who are 60-years old and above and can converse in the Malaysian language. Those who encounter less than seven scores for the Abbreviated Mental Test were excluded from the study. Among the 1204 respondents, 953 (79.2%) were happy. Sociodemographic characteristics showed that being a men, age of 60 to 74 years, and living in urban areas were significantly associated with happiness. A logistic regression model showed that locality (aOR 1.61), income category (Bottom 40% aOR 0.49; Middle-class group 40% aOR 1.40), social engagement (active aOR 1.77; less active aOR 1.25), receiving emotional support (aOR 2.11) and handgrip strength (aOR 1.02) were significantly associated with happiness. Thus, ensuring the elderly population in receiving emotional support and active social engagement among them can enhance their happiness level.

Subjective Well-Being, Depression, and Delays in Care Among Older Adults: Dual-Eligible Versus Medicare-Only Beneficiaries

We aimed to (a) determine the role of subjective well-being and depression in care delays among Medicare beneficiaries and (b) examine whether subjective well-being and depression play a differential role among Medicare-only and dual-eligible beneficiaries. A nationally representative sample of 1,696 older adults participated in the study. Roughly, 22% of participants reported often or sometimes experiencing care delays, with more delays among dual eligibles. We found that higher levels of subjective well-being were significantly related to less frequent care delays. In contrast, higher levels of depression were significantly related to more frequent care delays. Moreover, as depression increased, the predicted probability of delays increased to a greater extent among dual eligibles than Medicare-only beneficiaries. These findings signify the importance of identifying and implementing strategies to enhance subjective well-being and reduce depression in older adults, particularly dual eligibles, to improve access to timely care.

Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties

INTRODUCTION

Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.

OBJECTIVE

The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).

METHODS

The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.

RESULTS

A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.

CONCLUSIONS

The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.

Moving beyond promoting 'Happiness' in gerontology interventions

Researchers have called for gerontologists to spend greater attention on promoting happiness in older adulthood, a point aligned with the general public's interest in finding the keys to being happy later in life. However, targeting and even defining happiness comes with several caveats and challenges, leaving researchers to make difficult decisions regarding measurement and intervention strategies. Instead, the current commentary suggests that gerontology interventions may fare better if researchers focus on specific components of positive psychological functioning. We present sense of purpose and life enjoyment as examples of two such components, and note the potential merit in developing these more focussed intervention programmes. As such, the commentary suggests the value of moving beyond targeting happiness when developing intervention programmes for older adult participants.

The Importance of a Sense of University Belonging for the Psychological and Academic Adaptation of International Students in Germany

Abstract. Although a sense of university belonging has been established as a crucial factor for students’ academic success and subjective well-being, little is known about its importance regarding the adaptation of international students in Germany. Likewise, few studies have addressed the long-term reciprocal relations of a sense of university belonging and psychological and academic outcomes. To close this research gap, we analyzed data from N = 3,837 international students with a set of cross-lagged panel models. The results showed that a high sense of belonging is beneficial for international students’ adaptation in Germany as it is related to better well-being, higher study satisfaction, and lower drop-out intention. Furthermore, these indicators of psychological and academic adaption predicted the development of a sense of university belonging across the study entrance period, which points to the dynamic relationship between both kinds of constructs. We discuss the theoretical implications and the implementation of interventions that promote a sense of university belonging to increase the psychological and academic adaptation of international students in Germany.

La gérontopsychiatrie à l’Hôpital en santé mentale Albert-Prévost : favoriser la résilience des patients âgés grâce à la psychiatrie positive

La population québécoise est vieillissante, et ce phénomène ne fera que s’accroître au cours des prochaines décennies. Alors qu’en 2017 près d’une personne sur 5 appartenait au groupe des 65 ans et plus, il en sera ainsi pour le quart des Québécois en 2031, et près du tiers d’entre eux en 2061.

Par ailleurs, les trajectoires de vieillissement sont uniques à chacun et dépendront de différents facteurs, tels les vulnérabilités et forces de l’individu et son interaction avec les proches et la société. Malheureusement, la vieillesse s’illustre souvent comme un cumul de pertes dans différents registres. Cela crée des contraintes qui diminuent l’autonomie et augmentent la dépendance. La maladie peut confronter l’individu vieillissant à une diminution des capacités de réparation, et devenir un rappel de la mort inéluctable qui se rapproche et peut devenir parfois une certaine forme de traumatisme. Ce processus invite alors les soignants à réfléchir à un projet thérapeutique favorisant la résilience, concept qui va au-delà de l’ajustement à l’épreuve, et qui suggère un potentiel de développement et de rebond psychologique.

À l’Hôpital en santé mentale Albert-Prévost, la clientèle en gérontopsychiatrie cumule souvent une triple vulnérabilité : troubles cognitifs, incapacités physiques et maladie psychiatrique chronique ou de novo. Les besoins sont donc multiples et complexes.

C’est ainsi que dès 2017, nous avons élaboré une approche de psychiatrie positive dans notre service de gérontopsychiatrie. Notre objectif est de promouvoir le bien-être et la résilience de nos patients selon différents niveaux d’interventions positives. Les stratégies peuvent alors aller de la simple orientation positive pendant l’entretien psychiatrique à la psychothérapie positive, en passant par la psychoéducation, la bibliothérapie et la prescription de certaines interventions de psychologie positive (IPP).

Longitudinal Health Consequences of Childhood Adversity: The Mediating Role of Purpose in Life

Early life adversity has long-term detrimental effects on physical health. Although biological, behavioral, and social factors have been explored as intermediate mechanisms, little research has explored psychosocial factors as potential mediators. This study examined whether purpose in life longitudinally mediates the relationship between childhood adversity and two measures of adult health. Data were obtained from 3,871 participants in the Midlife in the United States (MIDUS) study. We tested a longitudinal mediation model from childhood adversity to adult health via purpose in life, controlling for baseline measures of health. Results indicated that childhood adversity is associated with poorer adult health through direct and mediated paths. Childhood adversity may restrict individuals' sense of purpose in life, and reduced purpose in life is subsequently associated with poorer subjective health and increased likelihood of functional limitations. The findings of this study can be used to inform the development of psychosocial and therapeutic intervention programs and services for adults with a history of childhood adversity.

Psychological Well-Being and Youth Autonomy: Comparative Analysis of Spain and Colombia

The construct of autonomy appears in literature associated with individual psychological wellbeing. In Ryff’s model, autonomy is presented as one of the dimensions of wellbeing, along with self-acceptance, positive relationships with others, environmental mastery, purpose in life, and personal growth. The present study compared the levels of autonomy and psychological wellbeing between Spanish and Colombian young people. Ryff’s Scale of Psychological Wellbeing and the Transition to Adulthood Autonomy (EDATVA) scales were used on a sample of 1,146 young people aged between 16 and 21; 506 Spaniards and 640 Colombians. Results showed differences in autonomy and in two of the four dimensions proposed by the EDATVA: self-organization and critical thinking. Similarly, important differences were observed in the subscales of positive relations and purpose in life. The importance of contextual factors in the development of psychological well-being and autonomy in young people in transition to adulthood is discussed.

Elder Mistreatment and Psychological Well-Being among Older Americans

Elder mistreatment is a major public health issue both in the US and around the globe. While extensive research has elucidated the association between elder mistreatment and health in older adults, little is known about the relationship between elder mistreatment and more eudaimonic measures of psychological well-being. Using data from the 2011 wave of the Wisconsin Longitudinal Study, this project examined the association between older adults’ experience with varied forms of elder mistreatment and eudaimonic dimensions of psychological well-being including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Ordinary least squares regression analyses found significant associations between experiences of elder mistreatment and psychological well-being. In particular, older adults who reported feeling that someone was too controlling over their daily lives and older adults who reported making donations to organizations they later worried were not legitimate reported significantly lower scores on all six psychological well-being dimensions. The results of this study suggest the negative effects of elder mistreatment can extend to more eudaimonic feelings of well-being, and programs designed to treat victims of elder mistreatment should incorporate strategies that help strengthen psychological well-being.

Optimal Well-being, Depression, and Caregiving: An Explorative Investigation

OBJECTIVES

Recent studies documented the protective role of hedonic and psychological well-being for mental and physical health of aging individuals. However, the combination of these two dimensions of well-being (conceptualized as optimal well-being) has been rarely evaluated in association with providing caregiving. This exploratory investigation aimed to: (1) cluster a group of community dwellers according to levels of hedonic and psychological well-being (low well-being-LWB; moderate well-being-MWB; high well-being HWB); and (2) to identify their psychosocial correlates of their optimal well-being, including providing daily caregiving.

METHODS

217 community dwellers (60-90 years) completed questionnaires concerning psychological well-being, life satisfaction, and caregivers' distress. They were classified into three groups (LWB, MWB, HWB), following a k mean cluster analysis. Chi-square and GLM were used to compare the three clusters. Regression analyses were performed to evaluate the correlates of hedonic and psychological well-being.

RESULTS

Fifty-two individuals belonged to the HWB cluster, 68 to the LWB cluster and 97 to the MWB cluster. Individuals in the LWB cluster showed higher levels of anxiety and depression, and 61 of them reported to provide caregiving. Members of the HWB cluster were the oldest. Psychological and hedonic well-being negatively correlated with depression and caregiving.

CONCLUSIONS

These results indicate that only a small proportion of community dwellers reported optimal well-being.

CLINICAL IMPLICATIONS

Addressing depression and alleviating caregiver distress may constitute ingredients for promoting optimal well-being among older community dwellers.

Sense of purpose in life and five health behaviors in older adults

Accumulating evidence shows that a higher sense of purpose in life is associated with lower risk of chronic conditions and premature mortality. Health behaviors might partially explain these findings, however, the prospective association between sense of purpose and health behaviors is understudied. We tested whether a higher sense of purpose at baseline was associated with lower likelihood of developing unhealthy behaviors over time. Prospective data were from the Health and Retirement Study, a national sample of U.S. older adults. Our sample included 13,770 adults assessed up to five times across eight years. Among people who met recommended guidelines for a given health behavior outcome at baseline, those in the top versus lowest quartile of purpose in life had 24% lower likelihood of becoming physically inactive (95% CI: 0.68-0.85), 33% lower likelihood of developing sleep problems (95% CI: 0.58-0.79), and 22% lower likelihood of developing unhealthy body mass index (BMI) (95% CI: 0.69-0.87) in sociodemographic-adjusted models. Further there was a marginal reduction in smoking relapse (HR = 0.65, 95% CI: 0.41-1.03) and no association with heavy alcohol use (HR = 1.02, 95% CI: 0.81-1.29). Findings for physical inactivity, sleep problems, and unhealthy BMI remained evident after further adjusting for baseline health status and depression. Our results, suggest that a sense of purpose in life might emerge (with further research) as a valuable target to consider for interventions aimed at helping older adults maintain some health behaviors.

Effects of a Community-Based Multicomponent Positive Psychology Intervention on Mental Health of Rural Adults in Ghana

BACKGROUND

There is growing evidence that positive psychology interventions (PPIs) enhance positive mental health and lead to a decrease in symptoms of psychopathology. This study examines the effectiveness of a 10-week multicomponent PPI (the Inspired Life Program; ILP) in promoting positive mental health and reducing symptoms of depression and negative affect in a sample of rural poor adults in Ghana.

METHODS

Using a quasi-randomized controlled trial design, participants from four rural poor communities were randomly allocated to intervention (n = 40) or control (n = 42) conditions. The intervention group participated in the 10-week ILP. Both groups completed a battery of mental health measures, including the Mental Health Continuum-Short Form, at pre-intervention, immediately after the intervention, and at 3 months follow-up. Hierarchical linear modeling was applied to evaluate whether the intervention was effective.

RESULTS

There was a greater improvement in positive mental health, with a marked reduction in symptoms of depression in the intervention group compared to the control group, immediately and 3 months after the intervention. There were also larger increases in the proportion of flourishers in the intervention group compared to the control group, immediately and three months after the intervention.

CONCLUSIONS

The observed effects of the ILP intervention program suggest that group-based PPIs can promote positive mental health and buffer against psychopathology among people living in rural poor communities in sub-Saharan Africa.

Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions

PURPOSE

Loneliness is increasingly recognised as the next critical public health issue. A plausible reason for this concern may be related to emerging societal trends affecting the way we relate, communicate, and function in our social environment. In 2006, a prominent review of the clinical significance of loneliness was published. However, there has not been a comprehensive update on known and emerging risk factors and correlates of loneliness since then. Furthermore, there is no conceptual model that has been developed to better account for the complexity of loneliness and to inform the development of evidence-based solutions as we challenge the issues of the twenty-first century.

METHODS

We reviewed the current literature to identify either known or emerging risk factors and correlates of loneliness since 2006. This includes new or known evidence on: (1) demography; (2) health, including physical health; mental health; cognitive health; brain, biology, and genetics; and (3) socio-environmental factors including digital communication and the workplace.

RESULTS

We synthesized the literature according to a new proposed conceptual model of loneliness which showed the interplay between known and emerging correlates and risk factors from demography, health, to socio-environmental factors. In the conceptual model of loneliness, we illustrated how solutions can be delivered and tailored to an individual based on their life circumstances and preferences.

CONCLUSION

We concluded by making specific recommendations in advancing our scientific understanding of loneliness. Our knowledge can only be deepened if we increase scientific rigour via accounting for confounding variables and using longitudinal, multi-disciplinary, and multiple methodologies in research. We also call for the rigorous evaluation of programs targeting loneliness.

Well-being and Long-term Physical Activity Participation in Midlife Adults: A Latent Class Analysis

Background

Despite the benefits of physical activity, a large majority of adults fail to get the recommended amount of regular exercise, and interventions to increase physical activity typically achieve only temporary improvements. The potential contribution of positive psychological functioning to the maintenance of physical activity has not been widely examined.

Purpose

To test the hypothesis that psychological well-being would increase the likelihood of sustained physical activity in adults using a person-centered approach with longitudinal data.

Methods

Participants (N = 2,214) were from the longitudinal Survey of Midlife Development in the United States (MIDUS). Continuous latent variables representing physical activity at three waves of MIDUS were used to partition respondents into distinct (categorical) classes based on longitudinal activity profiles.

Results

Latent class analyses identified three distinct physical activity profiles: sustained, consistently low, and declining activity (the normative class). Multinomial logistic regression analyses showed that the odds of membership in the sustained activity class were significantly higher for those with higher eudaimonic well-being (OR = 1.08 [1.03-1.13], p = .001), after adjustment for diverse covariates. Supplemental analyses revealed similar associations for specific subdomains of eudaimonic well-being.

Conclusion

This study provides evidence that greater well-being may help sustain physical activity in the long term. These results suggest that improving well-being may be a useful addition to interventions aimed at increasing long-term physical activity participation.

The Community-Academic Aging Research Network: A Pipeline for Dissemination

BACKGROUND/OBJECTIVES

The Community-Academic Aging Research Network (CAARN) was created to increase the capacity and effectiveness of Wisconsin's Aging Network and the University of Wisconsin to conduct community-based research related to aging. The purpose of this article is to describe CAARN's infrastructure, outcomes, and lessons learned.

DESIGN

Using principles of community-based participatory research, CAARN engages stakeholders to participate in the design, development, and testing of older adult health interventions that address community needs, are sustainable, and improve health equity.

SETTING

Academic healthcare and community organizations.

PARTICIPANTS

Researchers, community members, and community organizations.

INTERVENTION

CAARN matches academic and community partners to develop and test evidence-based programs to be distributed by a dissemination partner.

MEASUREMENTS

Number of partnerships and funding received.

RESULTS

CAARN has facilitated 33 projects since its inception in 2010 (30 including rural populations), involving 46 academic investigators, 52 Wisconsin counties, and 1 tribe. These projects have garnered 52 grants totaling $20 million in extramural and $3 million in intramural funding. Four proven interventions are being prepared for national dissemination by the Wisconsin Institute for Healthy Aging: one to improve physical activity; one to reduce bowel and bladder incontinence; one to reduce sedentary behavior; and one to reduce falls risk among Latinx older adults. Additionally, one intervention to improve balance using a modified tai chi program is being disseminated by another organization.

CONCLUSION

CAARN's innovative structure creates a pipeline to dissemination by designing for real-world settings through inclusion of stakeholders in the early stages of design and by packaging community-based health interventions for older adults so they can be disseminated after the research has been completed. These interventions provide opportunities for clinicians to engage with community organizations to improve the health of their patients through self-management. J Am Geriatr Soc 68:1325-1333, 2020.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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