The prediction of subjective wellness among the old-old: implications for the "fourth-age" conception

Existential well-being for the oldest old in nursing homes: a meta-ethnography

Ideas of well-being in old age are often anchored in the successful ageing paradigm, foregrounding independence, activeness and autonomy. However, for those oldest old living in nursing homes, these goals are largely out of reach. In this article, we use the meta-ethnographic method to explore and reinterpret existing findings on the ways in which well-being is experienced (or not) by the oldest old in institutional care settings. We frame our findings in existential well-being theory, which understands wellbeing as a sense of ‘dwelling-mobility’. Our analysis resulted in the following themes: (a) institutionalisation as both restrictive and liberating; (b) reciprocity and mattering: the importance of being seen; (c) the need for kinship and the problem of ruptured sociality; (d) rethinking agency: situated, delegated and supported; and (e) lowered expectations: receiving care is not a passive act. We conclude that while institutional care environments are not always conducive to well-being, this does not have to be so. By shifting our focus from successful ageing ideals onto relationally situated care practices, a possibility for existential well-being opens up, even in situations of decline and care dependency.

The ABC Model of Happiness-Neurobiological Aspects of Motivation and Positive Mood, and Their Dynamic Changes through Practice, the Course of Life

Simple Summary

This article proposes a new model for exploring happiness primarily from a neurobiological perspective. Such understanding includes the dynamics of positive mood states and how they change throughout life. Happiness is not a cognitive construct: it is an immediate emotional experience—a feeling that relies on neurophysiological activation in the brain’s reward system. With this in mind, three types of happiness are proposed: (A) wanting, approaching, and pleasure, (B) avoiding, departing, and relief, (C) non-wanting, staying, and satisfaction. Behind this is a sophisticated (neuro)biological dynamic, ranging from the search for autonomy and ecstasy, which is particularly characteristic of young people, to the way we cope with stress, as we find it pronounced in the middle-aged, to deep contentment, peace, and inner joy, as it is mainly attributed to older people. Paradoxically, it is in fact the elderly who appear to be the happiest and most content—this phenomenon is also known as the “satisfaction paradox”. Apparently, these dynamic changes in happiness can be amplified with practice. Happiness is biological in this context, but can still be “learned”. Contemplative practices can serve as an example here to demonstrate this trainability, and they may themselves influence the course of happiness.

Abstract

Background: Happiness is a feeling, an immediate experience, not a cognitive construct. It is based on activity in the brain’s neurobiological reward and motivation systems, which have been retained in evolution. This conceptual review provides an overview of the basic neurobiological principles behind happiness phenomena and proposes a framework for further classification. Results: Three neurobiologically distinct types of happiness exist: (A) wanting, (B) avoiding, and (C) non-wanting. Behind these types lies a dynamic gradation, ranging from the more youthful anticipation, pleasure and ecstasy (A), to stress processing, escape and relief (B) as we find them accentuated in the middle-aged, to deep satisfaction, quiescence and inner joy (C), which is particularly attributed to older people. As a result, the development of happiness and satisfaction over the course of life typically takes the form of a U-curve. Discussion: The outlined triad and dynamic of happiness leads to the paradoxical finding that the elderly seem to be the happiest—a phenomenon that is termed “satisfaction paradox”. This assumed change in happiness and contentment over the life span, which includes an increasing “emancipation” from the idea of good health as a mandatory prerequisite for happiness and contentment, can itself be changed—it is trainable. Conclusions: Programs for mindfulness, contemplation, or stress reduction, including positive psychology and mind–body/behavioral medicine training, seem to be capable of influencing the course happiness over time: Happiness can be shaped through practice.

Mental health symptoms and verbal fluency in elderly people: Evidence from the Spanish longitudinal study of aging

OBJECTIVES

Depression and loneliness are highly prevalent in old age. Moreover these mental health symptoms adversely affect the verbal fluency of the elderly. We examined the relationship between depression and loneliness with verbal fluency in people aged 50 years or older.

METHOD

Research data were collected during the pilot study of the Longitudinal Aging Study in Spain (ELES) in which a representative sample of non-institutionalized Spanish older people was assessed. Here, the cross-sectional data for 962 participants were analysed using hierarchical regressions, controlling for age, education level, overall cognitive functioning, social networks and satisfaction with family.

RESULTS

Higher levels of cognitive functioning were associated with higher verbal fluency. Females showed higher levels of phonological fluency. Neither depression nor loneliness were significant predictors of phonological fluency but loneliness was a significant predictor of semantic fluency. For mild levels of loneliness, the rate of decline in semantic fluency slows in the oldest ages. In contrast, for severe loneliness the rate of decline in semantic fluency increases in the oldest ages.

CONCLUSIONS

Depressive symptoms, loneliness and cognitive impairment are all prominent in ageing and therefore their impact on ageing needs to be better understood. Early detection of loneliness, along with the implementation of intervention for individuals diagnosed with loneliness is advisable in order to avoid negative repercussions for the verbal fluency of these individuals.

Predictors of Self-Rated Health: Does Education Play a Role Above and Beyond Age?

Objectives

Previous studies have demonstrated that while health factors lose importance for the individual conceptualization of self-rated health (SRH) with advancing age, subjective well-being (SWB) factors gain in importance. The present study examined whether this age-related pattern differs between educational groups.

Method

Longitudinal data of adults aged 40 years and older of the German Ageing Survey was used (N = 6,812). The role of education in age-related changes in the predictive value of different health and SWB facets for SRH was investigated with a cross-lagged panel regression model.

Results

Physical conditions were a stronger predictor in lower than in higher educated individuals while the association did not change with age. In contrast, positive affect and life satisfaction only gained in importance with advancing age for higher educated individuals. Negative affect was an equally strong predictor independent of education, and loneliness had a stronger association with SRH in people with lower education compared to those with high education while the associations did not change with age.

Discussion

The findings highlight the importance of considering the multidimensionality of SWB and the educational background of individuals for the study of SRH and indicate possible limits to adjustment to age-related declines in health.

Depression Moderates the Frailty-Subjective Health Link among Chinese Near Centenarians and Centenarians

OBJECTIVE

Very old adults may be physically frail, but they do not necessarily experience poor subjective health. The authors hypothesized that the relationship between frailty and subjective health is moderated by depression for very old people.

METHODS

In a cross-sectional study, a survey administered was by a face-to-face interview to 129 community-dwelling older adults aged 95-108. Measurements included the five-item FRAIL scale, the Geriatric Depression Scale Short-Form (GDS), and a subjective health rating. Hierarchical multiple regressions were conducted to test the moderation effects, adjusting for age, gender, living arrangement, perceived socioeconomic status, and cognition.

RESULTS

The interaction effect between frailty and depression was significant. Inspection of the simple slopes revealed that those who were more depressed had a more negative frailty-subjective health relationship. There was no significant moderation effect for a withdrawal-apathy-vigor dimension of the GDS.

CONCLUSION

Our findings suggest a protective psychological mechanism may enable very old adults to maintain an optimistic view of their health despite their increasing physical and functional limitations.

The Impact of Socioeconomic Conditions, Social Networks, and Health on Frail Older People's Life Satisfaction: A Cross-Sectional Study

It has been shown that frailty is associated with low levels of well-being and life satisfaction. Further exploration is needed, however, to better understand which components constitute life satisfaction for frail older people and how satisfaction is related to other life circumstances. The aim of this study was to examine relationships between frail older people’s life satisfaction and their socioeconomic conditions, social networks, and health-related conditions. A cross-sectional study was conducted (n=179). A logistic regression analysis was performed, including life satisfaction as the dependent variable and 12 items as independent variables. Four of the independent variables made statistically significant contributions: financial situation (OR 3.53), social contacts (OR 2.44), risk of depression (OR 2.26), and self-rated health (OR 2.79). This study demonstrates that financial situation, self-rated health conditions and social networks are important components for frail older people’s life satisfaction. Health and social care professionals and policy makers should consider this knowledge in the care and service for frail older people; and actions that benefit life satisfaction – such as social support – should be promoted.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life?

PURPOSE OF THE STUDY

In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability.

DESIGN AND METHODS

This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score.

RESULTS

Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability.

IMPLICATIONS

Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.