How are personality traits related to preparation for future care needs in older adults?

Racial differences in the effect of verbal and nonverbal memory on concrete planning for future care needs among older adults: a multi-group structural equation modeling approach

Concrete planning for future care needs may positively impact older adults' subsequent mental health and quality of life. However, the cognitive factors that facilitate concrete planning among Black and White older adults are still poorly understood. We investigated whether there are significant differences between Black (n = 159) and White (n = 262) older adults in concrete planning and explored racial differences in the relationship between verbal and nonverbal episodic memory and concrete planning. Results revealed that Blacks showed lower engagement in concrete planning and lower scores than Whites on each verbal and nonverbal memory task. For Blacks, but not Whites, verbal memory and nonverbal memory performance predicted concrete planning with higher nonverbal memory relating to less concrete planning and higher verbal memory associated with more concrete planning. Our findings suggest racial differences exist in how episodic verbal and nonverbal memory affect concrete planning, a crucial factor for older adults' preparation for future care.

Important Factors Influencing Willingness to Participate in Advance Care Planning among Outpatients: A Pilot Study in Central Taiwan

Advance care planning (ACP) and advance directives (ADs) ensure patient autonomy in end-of life care. The number of ADs made and followed in Taiwan is still lacking. This study aimed to determine the factors that influence the willingness to participate in ACP among outpatients in Taiwan. In this study, we conducted a cross-sectional survey based on convenient sampling methods. The questionnaire included questions about participants' basic sociodemographic information, knowledge of ACP, and awareness of ACP. A total of 198 adults who were outpatients of a family medicine clinic in an affiliated hospital in Taiwan were recruited. The associations between each variable were evaluated using the χ2 test. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the logistic regression method to examine the influence of each variable on willingness to participate in ACP. Being happy and being a healthcare professional were positively correlated with ACP participation. A lack of ACP knowledge (OR = 0.30 in model A and OR = 0.42 in model C), valuing "Reducing families' end-of-life decision-making burden" (OR = 2.53 in model B and OR = 2.65 in model C), and a "Belief in a good death" (OR = 4.02 in model B and OR = 4.10 in Model C) were the main factors affecting subjects' willingness to participate in ACP. Knowing which factors influence willingness to participate in ACP helps in the promotion of ACP. Continuously educating both the general public and healthcare professionals strengthens knowledge about the right to autonomy, about its associated laws, and about the ACP process, and thus, programs should be created to provide this education. Additionally, taking into account the differences between cultures can be helpful.

Perspectives on Aging-Related Preparation

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

Preparation for Future Care Needs in Middle-Aged and Older Adults: What Promotes Feeling of Preparedness?

OBJECTIVE

To examine whether demographic, dementia-related, and control-related variables predict preparation for future care needs (PFCN) in a sample of middle-aged and older adults. PFCN is defined in this study as a self-perceived sense of preparedness for one's own future care needs, including general awareness of future care needs, gathering relevant information, decision-making about care preferences, concrete planning, and non-avoidance of care planning.

METHODS

Participants (N = 122; age 40 to 88 years: M = 65.83, SD = 9.80) completed self-report measures in an in-person study. Hierarchical multiple regression was calculated to predict PFCN.

RESULTS

Being female, having more positive dementia attitudes, higher attribution to powerful others for health condition(s), and more completed end-of-life (EOL) planning significantly predicted greater PFCN.

CONCLUSION

Findings indicate a positive relationship between objective (completed EOL planning items) and subjective (PFCN) components of planning, thus highlighting the importance of taking concrete steps in EOL planning to yield greater feelings of preparedness, which has been associated with positive psychological outcomes.

Gaining Longitudinal Accounts of Carers' Experiences Using IPA and Photograph Elicitation

Fluctuations in positive and negative caregiving experiences remain only partially explained as the significant variability over time of potential predictive factors themselves is understudied. The current study aims to gain considerable insight into caregiving experiences and perceptions over time by using photovoice methodology to support semi-structured interviews. A case study, longitudinal design is taken with three female caregivers who provide detailed insight into their caregivers' experiences over a 12 month period. The interview transcripts were analyzed using IPA- Interpretative Phenomenological Analysis. This innovative combination of methods resulted in the emergence of three related themes which included consuming the role, feeling consumed by the role, and letting go of the role. The idiographic approach taken allowed both within case differences to be examined over time, and also between carer differences to be highlighted. Implications of illness type and its characteristics, and of attachment and relationship quality with the care recipient were seen in terms of how and when the caregivers moved between the themes identified. The use of others' support or respite care is examined vis-a vis caregiver's own beliefs, emotions, relationship attachment and motivations to care. Caregivers self-efficacy beliefs also shifted over time and were influential in caregiver experience as the care recipient condition or needs changed. No previous studies have found that negative caregiving consequences are, in part, under volitional control and yet our data on the underlying reasons for consuming caregiving or allowing themselves to consume, would suggest this may in part be true. This is important because it suggests that interventions to support caregivers should address relational and motivational factors more fully.

Personality and individual attitudes toward vaccination: a nationally representative survey in the United States

Background

Although past studies have identified factors associated with individual perceptions of vaccination, limited attention has been paid to the role of personality in individual attitudes toward vaccination. This study aimed to evaluate the effect of personality as measured by the Big Five personality traits on individual attitudes toward vaccination using a nationally representative survey in the United States.

Methods

A cross-sectional study was conducted with a sample of 3276 American citizens who were aged 18 and above and lived in 50 U.S. states and Washington D.C. from the American National Election Studies. The survey was collected through face-to-face and online interviews using structured questionnaires in 2016. The multistage stratified cluster sampling procedure was used for face-to-face interview, whereas the USPS DSF was used to select the sample for online interview. Multivariable ordinal logistic regression was used to assess how personality traits (extraversion, agreeableness, conscientiousness, emotional stability, and openness to experience) as main explanatory variables influence the outcome variables – individual attitudes toward health benefits of vaccination and support for school vaccination.

Results

More than two-thirds of respondents perceive health benefit of vaccination and support vaccination requirements for school entry, whereas about one-tenth of respondents have safety concerns about vaccination and oppose the vaccination requirements. After adjusting for ideology, insurance status, and demographic variables, the traits of agreeableness, conscientiousness and emotional stability remain significantly associated with attitude toward vaccination; conscientiousness is significantly associated with support for school vaccination. The odds of reporting health benefits of vaccination associated with one-point increase in agreeableness, conscientiousness and emotional stability are 1.05 (95% confidence intervals [CI] = 1.01–1.08), 1.05 (95% CI = 1.02–1.09) and 1.03 (95% CI = 1.00–1.06), respectively. For a one-point increase in conscientiousness, the odds of supporting school vaccination increase by 1.08 (95% CI = 1.05–1.12).

Conclusions

People high in agreeableness, conscientiousness and emotional stability are more likely to regard vaccination as beneficial, whereas those high in conscientiousness are more likely to support school-based vaccine requirement. This study highlights the importance of personality in shaping individual attitudes toward vaccination. More research is needed to understand the role of personality in individual health attitudes and behavior.

The Big Five Personality Traits as Predictors of Loneliness among Older Men in Israel

Loneliness may have complex implications for the mental and physical health of older people. It could have unique expressions among older men due to the social construction of gender, which raises an expectation that men should be strong, assertive, and capable of independently coping with their difficulties. As a result, older men suffering from loneliness may avoid talking about it and seeking help for this matter. The Big Five personality traits were found to be associated with many life domains, including loneliness, yet this issue has received limited research attention with regard to older adults in general and older men in particular. Therefore, the current study explores the contribution of the Big Five personality traits to understanding loneliness among older men in Israel, while controlling for several demographic factors. The data were collected through structured questionnaires administered to a sample of 392 older men. The results indicate that agreeableness, emotional stability, and openness to experiences were negatively associated with older men's loneliness. In addition, no association was found between extraversion and conscientiousness and respondents' loneliness, and no significant association was found between age and loneliness, and being employed and being in a relationship were associated with lower levels of loneliness. The conclusion is that it is important that professionals working with older men utilize the Big Five personality traits to understand loneliness and offer them interventions for reducing their loneliness. Furthermore, it is essential to promote social awareness of the importance of intimate relationships, as well as of employment, in the old age.

The Role of Personality in Becoming Aware of Age-Related Changes

Awareness of age-related change (AARC) refers to an individual's conscious knowledge about the gains and losses resulting from growing older. Personality traits reflect dispositional patterns of behavior, perception, and evaluation and should therefore influence the experience of AARC. The 4.5-year longitudinal study examines this association between personality traits and AARC in a sample of 423 individuals aged 40 to 98 years (M = 62.9 years) using latent change analyses. After controlling for sex, health, and education, a different pattern of associations for cross-sectional vs. longitudinal relations. Cross-sectionally, neuroticism was positively related to AARC losses, whereas openness, conscientiousness, and neuroticism were positively related to AARC gains. Longitudinally, the impact of personality traits on change in AARC was rather limited with only higher conscientiousness acting as a predictor of decreases in AARC losses over time. Overall, the findings add to the existing literature on associations between personality traits and subjective aging. Specifically, the results indicate that personality traits are differentially related to awareness of age-related gains in comparison to awareness of age-related losses.

Curiosity in old age: A possible key to achieving adaptive aging

Curiosity is a fundamental part of human motivation that supports a variety of human intellectual behaviors ranging from early learning in children to scientific discovery. However, there has been little attention paid to the role of curiosity in aging populations. By bringing together broad but sparse neuroscientific and psychological literature on curiosity and related concepts (e.g., novelty seeking in older adults), we propose that curiosity, although it declines with age, plays an important role in maintaining cognitive function, mental health, and physical health in older adults. We identify the dopaminergic reward system and the noradrenergic system as the key brain systems implicated in curiosity processing and discuss how these brain systems contribute to the relationship between curiosity and adaptive aging.

Correlates of preferences for autonomy in long-term care: results of a population-based survey among older individuals in Germany

PURPOSE

Thus far, there is little evidence concerning the factors associated with preferences for autonomy in long-term care. Therefore, the aim of the present study was to investigate the correlates of preferences for autonomy in long-term care among older individuals in Germany.

METHODS

Data were gathered from a population-based survey of the German population aged ≥65 years in 2015 (N=1,006).

RESULTS

Multiple logistic regressions revealed that preferences for freedom of choice for foods were positively associated with living with partner or spouse (OR: 1.5 [1.0-2.2]), being born in Germany (OR: 1.9 [1.1-3.3]), and lower self-rated health (OR: 1.3 [1.1-1.6]). Preferences for freedom in choosing bedtime and sleep duration were positively associated with lower age (OR: 1.1 [1.0-1.1]) and having children (OR: 2.2 [1.0-4.9]). Preferences for customized living space were positively associated with being female (OR: 2.5 [1.4-4.5]) and being born in Germany (OR: 3.7 [1.9-7.1]). Neither preferences for decent and sanitary housing nor preferences for shared decision-making were associated with any of the independent variables.

CONCLUSION

Various independent variables were associated with preferences for autonomy in long-term care. This suggests that preferences for care-related autonomy are complex. Knowing these might help refine long-term care health services.

Subjective remaining lifetime and concreteness of the future as differential predictors of preparation for age-related changes

Demographic changes have been linked to the expectation of cuts in government-provided social security services, emphasizing individual responsibility to prepare for old age and concomitant challenges and changes. Accordingly, the identification of psychological variables predicting preparation is a matter of theoretical as well as practical importance. We thus consider different aspects of a person's future time as theoretically prominent psychological predictors of preparation. The subjectively perceived quantity of remaining lifetime, the concreteness of future time, and preparation for life domains indicative of an active third age as well as of a more dependent fourth age were assessed in a longitudinal study in a core sample of N = 593 participants (30-80 years old at T₁) at two measurement occasions 4 years apart. The quantity of subjective remaining lifetime predicted subsequent changes in preparation, but this effect was restricted to preparation for the fourth age. In contrast, a more open and concrete outlook on ones' personal future predicted changes in preparation for an active third age. Our findings highlight the importance of distinguishing between different aspects of future time-its quantity versus its relation to goals and action plans-when predicting specific facets of developmental self-regulation.

Factors associated with preferences for long-term care settings in old age: evidence from a population-based survey in Germany

BACKGROUND

Long-term care is one of the most pressing health policy issues in Germany. It is expected that the need for long-term care will increase markedly in the next decades due to demographic shifts. The purpose of this study was to investigate the factors associated with preferences for long-term care settings in old age individuals in Germany.

METHODS

Based on expert interviews and a systematic review, a questionnaire was developed to quantify long-term care preferences. Data were drawn from a population-based survey of the German population aged 65 and over in 2015 (n = 1006).

RESULTS

In multiple logistic regressions, preferences for home care were positively associated with providing care for family/friends [OR: 1.6 (1.0-2.5)], lower self-rated health [OR: 1.3 (1.0-1.6)], and no current need of care [OR: 5.5 (1.2-25.7)]. Preferences for care in relatives' homes were positively associated with being male [OR: 2.0 (1.4-2.7)], living with partner or spouse [OR: 1.8 (1.3-2.4)], having children [OR: 1.6 (1.0-2.5)], private health insurance [OR: 1.6 (1.1-2.3)], providing care for family/friends [OR: 1.5 (1.1-2.0)], and higher self-rated health [OR: 1.2 (1.0-1.4)]. Preferences for care in assisted living were positively associated with need of care [OR: 1.9 (1.0-3.5)] and higher education [for example, University, OR: 3.5 (1.9-6.5)]. Preferences for care in nursing home/old age home were positively associated with being born in Germany [OR: 1.8 (1.0-3.1)] and lower self-rated health [OR: 1.2 (1.0-1.4)]. Preferences for care in a foreign country were positively associated with lower age [OR: 1.1 (1.0-1.2)] and being born abroad [OR: 5.5 (2.7-11.2)].

CONCLUSIONS

Numerous variables used are sporadically significant, underlining the complex nature of long-term care preferences. A better understanding of factors associated with preferences for care settings might contribute to improving long-term care health services.

Personality Traits in College Students and Caregiving for a Relative with a Chronic Health Condition

The purpose of this study was to investigate among college students the relationship between personality traits and willingness to care for a relative with a chronic health condition. 329 undergraduate students completed an online questionnaire. Hierarchical multiple regressions found that after controlling for demographics personality traits explained 10% of the variance in willingness to provide emotional care, 7% in instrumental care, and 7% in nursing care. Within these models, greater empathy was uniquely associated with willingness to provide emotional, instrumental, and nursing care for a family member in the future. Similarly, participants with high agreeableness were more willing to provide emotional care, and participant older age was a unique predictor of instrumental care. The results can help shape research on interventions that incorporate perspective taking, motivational interviewing, and training in life skills as a means of boosting college students' willingness to provide care for a relative with a chronic health condition.

The effects of familism on intended care arrangements in the process of preparing for future care among one-child parents in urban China

Guided by Sörensen and Pinquart's model of preparation for future care, this study investigated the relationship between familism and intended care arrangements. Ordinal logistic regression was performed on a sample of 516 urban Chinese one-child parents aged 45–65 with an equal gender ratio to examine the associations between five care expectations, familism (filial obligation and child gender) and future care planning constructs (awareness, information gathering and avoidance). Awareness and information gathering were positively associated with service-focused care arrangements. Avoidant planners were more inclined to rely on adult children. Participants with a stronger filial obligation had greater expectations for ageing at home with the aid of a spouse, siblings or helper. Child gender was not significantly associated with intended care arrangements. The model of preparation for future care was useful when predicting service-focused care arrangements. Familism was a powerful predictor of family-focused care arrangements. Females were more likely to rely on children regardless of child gender but less likely to rely on spouses and siblings. The study enriches researchers' understanding of urban Chinese older adults' intended care arrangements in the context of fading familism and single-child families.

Trait Hope and Preparation for Future Care Needs among Older Adult Primary Care Patients

We examined associations between trait hope and preparation for future care needs (PFCN) among 66 older adult primary care patients in western New York. Participants completed a questionnaire assessing PFCN (awareness, information gathering, decision-making, concrete planning, and avoidance), and the Adult Trait Hope Scale. In multivariate regressions, lower hope, particularly less agency, was associated with more awareness of needing care, whereas higher hopefulness, particularly pathways thinking, was associated with increased decision-making and concrete planning. Greater hopefulness appears to be linked to goal-directed planning behaviors, although those with lower hope may actually be more aware of the need for planning. Evidence-based programming that encourages learned hopefulness may contribute to enhanced health planning and decision-making among older adult primary care patients.

Associations Between Personality and End-of-Life Care Preferences Among Men With Prostate Cancer: A Clustering Approach

CONTEXT

Increased focus on patient-centered care models has contributed to greater emphasis on improving quality of life at the end of life through personalized medicine. However, little is known about individual-level factors impacting end-of-life care preferences.

OBJECTIVES

To examine whether the five-factor model of personality explains variation in preferences for end-of-life care in men with prostate cancer.

METHODS

Two hundred twelve men with a prostate cancer diagnosis (mean age = 62 years) completed a measure of the five-factor model of personality--spanning the personality dimensions of neuroticism, agreeableness, extraversion, openness, and conscientiousness--and reported on end-of-life care preferences. Cluster analyses were used to partition the sample into groups with similar care preferences. Analyses of variance and Chi-square tests were used to evaluate differences in care preferences among the groups.

RESULTS

Cluster analyses revealed three groups of participants: "comfort-oriented patients," "service-accepting patients," and "service-reluctant patients." Most (67%) were comfort oriented, preferring palliative care and opposing life support services. A subset of patients were service accepting (17%), preferring both palliative care and life support, or were service reluctant (16%), preferring neither. Service-reluctant patients endorsed significantly higher levels of neuroticism (emotional instability and negativity) than comfort-oriented patients. Comfort-oriented patients endorsed significantly higher levels of agreeableness than service-accepting patients and service-reluctant patients.

CONCLUSION

Findings suggest that personality traits are associated with specific health care preferences. Individuals high on neuroticism are likely to report reluctance toward all forms of end-of-life care and may benefit from in-depth information about the process and likely outcomes of receiving life support and palliative care services.

Hoping for the Best or Planning for the Future: Decision Making and Future Care Needs

Research has shown that relatively few older adults make plans for future care needs. In this study, we explore the thinking processes involved in planning or failing to plan for the future. Interviews were carried out with 39 older adults ( M age = 81 years) who were experiencing disability and illness but who lived in their own home. Guiding questions for the interview focused on present living circumstances, but for the present qualitative analysis, all references to the future, and to future residence changes, were extracted. This approach allowed us to observe how older adults spontaneously address issues of future planning when not constrained to do so. Results supported the use of a positivity bias, as well as a risk-aversive decision-making style. These older adults seemed to be prioritizing present emotional well-being by avoiding thoughts of future risks and thereby eschewing proactive coping.

The Role of Anticipated Gains and Losses on Preferences About Future Caregiving

OBJECTIVES

A growing amount of research has suggested that caregiving is not only associated with burden but entails also the potential for positive outcomes. By contrast, less is known about the roles of gain-loss-anticipations on future caregiving.

METHOD

We conducted a web-based study in which we compared three groups with differing preferences on future caregiving: being willing to provide care (potential caregivers; n = 189), remaining indecisive about whether to provide care (undecided; n = 121), and rejecting the idea to provide care (unwilling; n = 62). In addition, actual caregivers (n = 113) served as a reality check for these expectations. We assessed gain-loss anticipations with a newly developed instrument (k = 12) and offer information on its reliability and validity.

RESULTS

Groups reveal different patterns of gain-loss-anticipations. Potential caregivers resembled actual caregivers and highlighted the potential benefits of caregiving, whereas those who were undecided or unwilling to provide care perceived fewer gains and more losses.

CONCLUSION

Preferences about future caregiving are not described solely by socio-demographic aspects but are also colored by anticipations of both gains and losses. Findings point to the need to focus on motivational factors to enhance our understanding in the context of caregiving decisions.

Older Women Discuss Planning for Future Care Needs

Objective: This study expands upon existing narrative data concerning health care preparation by developing a multi-theme framework of plans for future care needs. Method: Inductive content analysis was conducted on 185 interviews with European American and African American older women. Results: An explanatory framework emerged of five themes, describing varied approaches to planning for future care needs: (a) Autonomous Care Planners, (b) Externally Reliant Planners, (c) Aware of Preference, (d) Wishful Thinkers, and (e) Avoidant. A distinct group included women performing only end-of-life planning. Barriers to planning included low-perceived vulnerability, financial constraints, being uninformed of needed actions, and fear of burdening. Discussion: Although the majority undertook active steps to prepare for future care needs, many missed key steps or achievement of planning goals recommended by experts. Findings may be applied to long-term care planning research by providing added, rich detail on how aging women construct their options, make choices, and address this important area for future well-being.

Optimism and Planning for Future Care Needs among Older Adults

Aging is associated with an increase in need for assistance. Preparation for future care (PFC) is related to improved coping ability as well as better mental and physical health outcomes among older adults. We examined the association of optimism with components of PFC among older adults. We also explored race differences in the relationship between optimism and PFC. In Study 1, multiple regression showed that optimism was positively related to concrete planning. In Study 2, optimism was related to gathering information. An exploratory analysis combining the samples yielded a race interaction: For Whites higher optimism, but for Blacks lower optimism was associated with more planning. High optimism may be a barrier to future planning in certain social and cultural contexts.

Preparation for old age in different life domains

We investigated preparation for age-related changes from a multidimensional, life span perspective and administered a newly developed questionnaire to a large sample aged 30–80 years. Preparing for age-related changes was organized by life domains, with domain-specific types of preparation addressing obstacles and opportunities in the respective domains. Preparing for a third (focusing on activities, leisure, work, fitness, appearance) and a fourth age (focusing on emergencies, dependence/independence, housing, financial arrangements) emerged as superordinate categories of preparation. Different age gradients were obtained for the factors, the former peaking around the age of 65, whereas the latter increased linearly up to the age of 80. Furthermore, preparation factors were characterized by distinct personality profiles. The findings attest to the importance of a differentiated view on preparation for age-related changes and its relevance across the life span.

Later Life Care Planning Conversations for Older Adults and Families

While most older adults have thought about their future care needs, few have discussed their preferences with family members. We interviewed older persons (24), adult children (24), health professionals (23), and representatives of stakeholder associations (3) to understand their views and experiences on later life care (LLC) planning conversations, in terms of (a) their respective roles, and (b) barriers and facilitators that should be taken into account when having these conversations. Roles described included that of information user (older persons), information seeker (family members), and information provider (health care providers). The study identified practical and emotional considerations relevant to LLC planning conversations. This study found strong support for planning for LLC before the need arises, as well as important potential benefits for older adults, family members, and health professionals. There is interest in, and need for, resources to guide families in LLC planning.

Do personality traits moderate the impact of care receipt on end-of-life care planning?

PURPOSE OF THE STUDY

This study examines (a) the association between being a care recipient and end-of-life care planning (EOLCP) and (b) the extent to which personality traits moderate the relationship between care receipt and EOLCP.

DESIGN AND METHODS

Data are drawn from the Wisconsin Longitudinal Study, a survey of Wisconsin high school graduates from 1957 to 2004. We used data on EOLCP among older adults in the most recent (2003-2004) wave of this survey. Hierarchical logistic regression models are used to estimate the effects of care receipt and the moderating effects of personality.

RESULTS

Compared with their peers who are not receiving care, care recipients are more likely to engage in informal discussion on EOLCP. This association between care receipt and informal EOLCP is strengthened when the individual scores high on openness.

IMPLICATIONS

Health practitioners should take into account older adults' care needs and differing personality traits while helping older adults make successful EOLCP.

Preparedness for Alzheimer's disease and its determinants among laypersons in Israel

BACKGROUND

Despite the increasing prevalence of Alzheimer's disease (AD), very few studies have examined advanced preparation for the possibility of becoming sick with AD, and these few studies indicate a general lack of preparation. This study aimed to expand knowledge regarding preparedness for AD among younger and older Israeli laypersons, and to explore the determinants of such preparedness, in terms of knowledge and beliefs concerning AD.

METHODS

This study was based on a national representative sample of 632 Israeli laypersons. Participants were interviewed by telephone to assess their preparedness for AD, beliefs related to AD in terms of vulnerability, worry, fear, and perceptions about the importance of planning for the future, and their perceived knowledge of AD.

RESULTS

Low levels of preparation for AD were reported, especially among younger participants. Multivariate analyses indicated that for both older and younger participants, taking actual steps to prepare oneself for AD was significantly associated with a general sense of preparedness, and that a general sense of preparedness was associated with perceptions regarding the importance of planning for the future. For older participants, a general sense of preparedness was also associated with greater knowledge of AD.

CONCLUSIONS

Findings indicate that Israeli laypersons are not preparing for AD, and that attitudes and beliefs play an important role in this preparation. Thus, measures should be taken to emphasize the importance of planning for the future contingency of AD in younger and older persons and to expand the knowledge of older persons regarding the disease.

Trajectories of preparation for future care among first-degree relatives of Alzheimer's disease patients: an ancillary study of ADAPT

PURPOSE

 This study examines the longitudinal patterns of Preparation for Future Care (PFC), defined as Awareness, Avoidance, Gathering Information, Decision Making, and Concrete Plans, in first-degree relatives of people with Alzheimer's disease (AD). 

DESIGN AND METHODS

 Eight time points across 6.5 years from a subsample of adults aged 70 years and older who were participating in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) were analyzed using latent growth modeling. Baseline attitudes toward planning for future care and demographic variables functioned as predictors in the conditional analyses. 

RESULTS

 Awareness, Gathering Information, Decision Making, and Concrete Planning increased across time, but Avoidance did not. Covariates were more often associated with the initial levels of planning behavior than with change across time. Women engaged in more initial Decision Making than men. Education was associated with more initial Gathering Information, Decision Making, and less Avoidance. Favorable attitudes toward planning were more predictive of baseline Awareness, Gathering Information, Avoidance, and less so for Decision Making or Concrete Planning. 

IMPLICATIONS

 Older adults with an elevated risk for AD increase in positive PFC behaviors gradually across time. Demographic characteristics and attitudes predict initial levels of planning, making it possible to identify individuals who might need help progressing to more advanced levels of planning. Future studies are needed to understand rates of change in planning behaviors.

Personality and medication non-adherence among older adults enrolled in a six-year trial

OBJECTIVES

Personality factors parsimoniously capture the variation in dispositional characteristics that affect behaviours, but their value in predicting medication non-adherence is unclear. We investigated the relationship between five-factor model personality factors (Conscientiousness, Neuroticism, Agreeableness, Extraversion, and Openness) and medication non-adherence among older participants during a six-year randomized placebo-controlled trial (RCT).

DESIGN

Observational cohort data from 771 subjects aged ≥ 72 years enrolled in the Ginkgo Evaluation of Memory study, a RCT of Ginkgo biloba for prevention of dementia.

METHODS

Random effects logistic regression analyses examined effects of NEO Five-Factor Inventory scores on medication non-adherence, determined via pill counts every 6 months (median follow-up 6.1 years) and defined as taking <80% of prescribed pills. Analyses adjusted for covariates linked with non-adherence in prior studies.

RESULTS

Each 5 year increment in participant age was associated with a 6.7% greater probability of non-adherence (95% confidence interval, CI [2.4, 11.0]). Neuroticism was the only personality factor associated with non-adherence: a 1 SD increase was associated with a 3.8% increase in the probability of non-adherence (95% CI [0.4, 7.2]). Lower cognitive function was also associated with non-adherence: a 1 SD decrease in mental status exam score was associated with a 3.0% increase in the probability of non-adherence (95% CI [0.2, 5.9]).

CONCLUSIONS

Neuroticism was associated with medication non-adherence over 6 years of follow-up in a large sample of older RCT participants. Personality measurement in clinical and research settings might help to identify and guide interventions for older adults at risk for medication non-adherence.

Planning and Decision Making for Care Transitions

The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults' lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions.