Goal setting in later life: an international comparison of older adults' defined goals

BACKGROUND

Studies of goal setting in later life tend to focus on health-related goal setting, are pre-determined by the researcher (i.e., tick box), and/or are focused on a specific geographical area (i.e., one country). This study sought to understand broader, long-term goals from the perspective of older adults (65 + years) from Australia, New Zealand (NZ), United Kingdom (UK), Ireland, Canada, and the United States of America (USA).

METHODS

Through a cross-sectional, online survey (N = 1,551), this exploratory study examined the qualitative goal content of older adults. Thematic analysis was used to analyze the qualitative data, and bivariate analyses were used to compare thematic differences between regions and by participants' sex.

RESULTS

Over 60% of the participants reported setting goals, and participants from the Australia-NZ and Canada-USA regions were more likely to set goals than the UK-Ireland region. The following six overarching themes were identified from the 946 goals reported: health and well-being; social connections and engagement; activities and experiences; finance and employment; home and lifestyle; and attitude to life.

CONCLUSIONS

This study supports previous research that demonstrates that older adults can and do set personal goals that are wide ranging. These findings support the need for health professionals to consider different methods for elucidating this important information from older adults that builds rapport and focuses on aspects viewed as more important by the older adult and therefore potentially produces improved health outcomes.

Impact of mobility restrictions on active aging; cross-sectional associations and longitudinal changes parallel to COVID-19 restrictions

BACKGROUND

Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak.

METHODS

AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, composite and sub-scores of active aging were computed. Neighborhood mobility was assessed as frequency of moving in or beyond own neighborhood (limited, regular, daily=reference). Associations were studied using Generalized Linear Models (cross-sectionally, n = 1007) and General Estimating Equations (prospectively, n = 774).

RESULTS

Participants with limited baseline neighborhood mobility had lower active aging scores than those with daily mobility, but the decline over time was similar. Some item scores on opportunity to act and extent of doing, e.g. for making one's day more interesting and advancing matters of faith or worldview, were better retained amid COVID-19 by those with limited mobility, attenuating group differences.

CONCLUSIONS

Active aging scores were somewhat compromised in individuals with limited neighborhood mobility, but opportunities for and engagement in several activities seemed to be better retained amid COVID-19 than for those with daily mobility. Thus, active aging may be possible despite mobility restriction.

Adapting a whole health model to home-based primary care: Bridging person-driven priorities with veteran and family-centered geriatric care

Through the integration of Whole Health for Life into the Department of Veterans Affairs (VA) health care system, the VA aims to transform health care delivery from a disease management approach to one that embraces person-centered care. The home-based primary care (HBPC) program is a care model that, within the VA, provides holistic primary care services to homebound veterans with multiple chronic medical conditions, mental health issues, and functional declines. These veterans may have limited access to VA programs delivered in a traditional outpatient format. This article describes adaptations to the whole health model of care that could improve its accessibility and applicability to HBPC veterans, caregivers, and the interdisciplinary teams that serve this population. These modifications are informed by whole-person geriatric and gerontological and family-systems theories and address population-based differences in the focus and approach to care. The focus on care is expanded to (a) reflect the importance of attending to caregiver needs and well-being and (b) shift from a preventative model to one that prioritizes resilience and maintenance. The approach to care emphasizes alternative modes of delivery, adaptations to interventions, and integration of geriatric-specific medical considerations into the self-care domains and more directly centers the collaboration between family, the VA, and community partners. This adapted model also addresses the unique needs of health care teams providing in-home services to medically complex veterans and offers suggestions for enhancing self-care and preventing burnout. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Association Between Comorbidity, Frailty, and Outdoor Mobility Loss Among Community-Dwelling Individuals 60 Years of Age and Above in Moscow

To determine the prognostic value of frailty and comorbidity for outdoor mobility loss and mortality in the elderly. The retrospective study was conducted among outpatients aged ≥60 years. Patients with ≥3 chronic illnesses were treated by doctors who had undergone a 72-hour geriatric training. The outdoor low-mobility group comprised patients who failed to visit a doctor because of decreased outdoor mobility during the 3-year follow-up period. The outdoor high-mobility group comprised participants with no outdoor mobility loss. 5678 patients with a mean age of 71.0 ± 0.1 years were included in the study. The risk of outdoor mobility loss rose by 4% per year with men developing it 30% more than women. The effect of frailty was of particular importance because it increased the risk of developing outdoor mobility loss by 70%. Comorbidity was not associated with a higher risk of outdoor mobility loss, but the investigators did not take into account all possible illnesses, or the severity of disease. The loss of outdoor mobility was associated with increase in mortality. Early detection of frailty can help predict outdoor mobility loss and could reduce mortality among older people.

The Use of Mobility Devices and Personal Assistance: A Joint Modeling Approach

Objective: To examine whether mobility device use substitutes for personal assistance among U.S. older adults. Method: Using the National Health and Aging Trends Study, we identified 3,211 community-living older adults (aged 65 and older) who reported mobility difficulties at baseline. We used recursive bivariate probit models to simultaneously estimate the effect of covariates on the likelihood of using (a) mobility devices and (b) personal assistance to accommodate mobility difficulty. Independent variables included age, gender, race, physical/mental health status, cognition, and comorbidities. Results: Predictors of the use of personal assistance and mobility devices exhibit important similarities and differences. Device use reduced the odds of receiving personal assistance by 50% (odds ratio [OR] = 0.50, 95% confidence interval [CI] = [0.29, 0.86]). Discussion: Findings suggest device use substitutes for personal assistance. Practitioners and policymakers should promote the appropriate use of mobility devices while recognizing the importance of assistance with some groups and the potential of increasing mobility device use.

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people

BACKGROUND

As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility.

AIMS

We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one's goals) and flexible goal adjustment (FGA; adjusting one's goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people.

METHODS

Participants (n = 186) were aged 79-93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA.

RESULTS

General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations.

CONCLUSIONS

Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life.

Fear of Crime in Old Age: A Sample Case of Resilience?

Objectives

Research on fear of crime (FOC) in adulthood has often shown a positive age relation, whereas the risk of criminal victimization decreases with age. The present study distinguishes three dimensions of FOC (affective, cognitive, and behavioral component) and attempts to investigate possible explanations for differential age correlations by referring to processes of adaptation and resilience. In particular, the functionality of FOC and its impact on the individual's well-being is assumed to be influenced by the individual's capacity to accommodate to adverse circumstances.

Method

These hypotheses are investigated within a cross-sectional assessment using questionnaire data (1,792 participants between 18 and 98 years of age).

Results

As predicted, age was a strong predictor of the behavioral but not affective and cognitive component of FOC. In particular, the results support a twofold adaptive function of accommodation: Accommodation facilitates cautious behavior with increasing age and, at the same time, dampens the impact of FOC on depressivity.

Discussion

The adaptive role of cautious behavior in advanced age and accommodation is discussed within a developmental regulation framework.

Assimilative and Accommodative Coping and Older People's Leisure Activities

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite low physical performance, people with high TGP had close to mean level of leisure activity participation, whereas low TGP was associated with very little activity. Most notably, people without high TGP had fewer outdoor activities and group activities outside home. Similar effects were not found for FGA. Discussion: Persistency, rather than flexibility, in goal pursuit appears to help older people be active in their leisure time.

Age-related differences in the goals and concerns that motivate real-life prospective memory tasks

Prospective memory tasks are tasks that one must remember to perform in the future, such as keeping a dentist appointment or locking the door when leaving home. There has been little research to date on the question of what motivates real-life prospective memory tasks, and this is true both generally and within the subfield of aging and prospective memory. In the current study, we investigated whether the prospective memory tasks of younger and older adults were motivated by different personal goals and concerns, a question that has not been addressed in past research. Participants completed a questionnaire on current prospective memory tasks and the higher level goals and concerns that motivated these tasks. In general, younger and older adults reported prospective memory tasks motivated by different goals and concerns that reflected different social age systems or developmental tasks. Specifically, younger adults were more likely to report prospective memory tasks related to goals for education, profession, property, self, and leisure, and related to concerns about education and profession. In contrast, older adults were more likely to report prospective memory tasks related to concerns about world issues and war/terrorism. We also examined prospective memory task motivation more generally as approach motivation (goal-relatedness) and avoidance motivation (concern-relatedness). Both measures showed a gender by age group interaction. That is, older males showed especially low approach motivation and especially high avoidance motivation for their real-life prospective memory tasks. We suggest that a new approach to prospective memory research that incorporates motivational influences would enhance the ecological validity of prospective memory and aging research and may inform more effective memory interventions.

Environmental, Individual and Personal Goal Influences on Older Adults' Walking in the Helsinki Metropolitan Area

Physical activity is a fundamental factor in healthy ageing, and the built environment has been linked to individual health outcomes. Understanding the linkages between older adult’s walking and the built environment are key to designing supportive environments for active ageing. However, the variety of different spatial scales of human mobility has been largely overlooked in the environmental health research. This study used an online participatory mapping method and a novel modelling of individual activity spaces to study the associations between both the environmental and the individual features and older adults’ walking in the environments where older adult’s actually move around. Study participants (n = 844) aged 55+ who live in Helsinki Metropolitan Area, Finland reported their everyday errand points on a map and indicated which transport mode they used and how frequently they accessed the places. Respondents walking trips were drawn from the data and the direct and indirect effects of the personal, psychological as well as environmental features on older adults walking were examined. Respondents marked on average, six everyday errand points and walked for transport an average of 20 km per month. Residential density and the density of walkways, public transit stops, intersections and recreational sports places were significantly and positively associated with older adult’s walking for transport. Transit stop density was found having the largest direct effect to older adults walking. Built environment had an independent effect on older adults walking regardless of individual demographic or psychological features. Education and personal goals related to physical activities had a direct positive, and income a direct negative, effect on walking. Gender and perceived health had an indirect effect on walking, which was realized through individuals’ physical activity goals.

Life resources and personal goals in old age

It has been theorized that life resources influence goal engagement. The aim of the present study was to examine whether personal characteristics, and socio-economic, social and health resources are associated with personal goal content in old age. The participants were 824 community-dwelling people aged 75-90 from the Life-Space Mobility in Old Age project. Personal goals were elicited using a revised version of the Personal Project Analysis in a structured interview. Cross-sectional bi- and multivariate analyses using logistic regression modelling were conducted. The results showed that the most commonly reported goals were health maintenance related. People with better health resources were more likely to report goals related to leisure-time, social and physical activities and less likely to report goals related to recovery of health. Those with poor social resources were at risk for having no personal goals in their lives. The results are in line with theorizing on the influence of life resources on goal setting in old age. Further longitudinal studies are needed on whether resource loss precedes goal modification, and how goal setting strategies influence both mental and physical well-being in old age.

Refining a Web-based goal assessment interview: item reduction based on reliability and predictive validity

BACKGROUND

Goals are an important basis for patients' cognitive appraisal processes underlying quality-of-life (QOL) assessment because they are the foundation to one's frame of reference. We sought to identify the best of six goal delineation items and relevant themes for two new versions of the QOL Appraisal Profile: an interview tool using a subset of the best open-ended goal delineation items, and a shorter close-ended version for use in survey research.

METHODS

This is a secondary analysis of longitudinal data (n = 1126) of participants in the North American Research Committee on Multiple Sclerosis (MS) registry. The open-ended data were coded by at least two trained coders with moderately high inter-rater agreement. There were 31 themes reflecting goal content such as health, interpersonal, independence, mental health, and financial themes. Descriptive statistics identified most prevalent themes. Reliability analysis (alpha, item-total correlations) and hierarchical linear modeling identified the best goal items.

RESULTS

Based on these qualitative and quantitative analyses, Solve (item 2) is the best single item because it is clear anchor for about a third of the goal themes, and explains the most variance in outcomes and demographic characteristics, suggesting that it taps into and reveals diversity in the sample. The next best items are Accomplish and Maintain (items 1 and 4), which are useful in tapping into and revealing diversity among people reporting cognitive deficits (Accomplish), and demographic factors (both Accomplish and Maintain items).

CONCLUSIONS

The goal delineation items identified as best performers in this study will be used to develop a shorter open-ended version of the QOL Appraisal Profile, and an entirely close-ended version of the QOL Appraisal Profile for use in more standard survey research settings. These tools will enable coaching patients in medical decision making as well as investigations of appraisal and response shift in QOL research.