Subjective Age and Health in Later Life: The Role of Posttraumatic Symptoms

War-Related Life Course Stress and Late-Life Subjective Age in Northern Vietnam

Background and Objectives

The role of early life stressors in subjective aging is weakly understood, especially in low- to middle-income countries. This paper investigated how early life stressors encountered in armed conflict influence subjective age among Vietnamese older adults who experienced war over decades of their early life.

Research Design and Methods

We analyzed survey data from the 2018 Vietnam Health and Aging Study involving 2,447 Vietnamese older adults who encountered diverse war-related stressors in early adulthood. The analytical sample (N = 2,341) included 50.9% women and 49.1% men, with an average age of 69.8. 41.1% are military veterans. We conducted survey-adjusted multinomial logistic regression analyses with mediation to predict the probability of feeling younger or older than one's chronological age. We examined how childhood adversity (i.e., childhood hunger and low parental SES) and wartime stressors (i.e., war-related violence, malevolent environment, and military service) influenced late-life subjective age, both directly and as mediated by late-life mental, functional, and physical health.

Results

We found significant associations between early adulthood war-related stressors and subjective age. Formal military service significantly lessened the relative risk of feeling subjectively old, and more plentiful wartime violence exposures significantly increased the risk of feeling younger than one's chronological age. Violence exposure's effects were both direct and indirect through functional and mental health. Conversely, greater exposure to wartime malevolent conditions (e.g., shortages of clean water and evacuations) and multiple episodes of severe hunger in childhood increased the risk of feeling older, effects both direct and mediated by late-life functional and mental health.

Discussion and Implications

Results suggest wartime stressors, especially war's malevolent environments and severe childhood hunger, experienced in many conflict-affected populations globally, have the potential to subjectively "age" survivors. Yet, not all war exposures are equal, and some may yield psychological and socioeconomic resources that support healthy aging.

The association between looming cognitive style and posttraumatic stress symptoms: The case of older Holocaust survivors

The looming cognitive style (LCS) refers to a tendency to produce mental illustrations and images of adverse events and potentially threatening situations with perceived accumulating threat and danger. LCS is a well-known cognitive vulnerability for anxiety, nevertheless few studies examined the relationship between LCS and posttraumatic reactions. Among the existing studies, a higher LCS was reported in Holocaust survivors relative to matched comparisons, and directly associated with posttraumatic stress symptoms (PTSS) in older Holocaust survivors. The current study aimed to expand the understanding of the relationship between LCS with PTSS in general, and among older Holocaust survivors in particular. Moreover, whether the number of Holocaust experiences encountered by Holocaust survivors moderated this relationship. The sample consisted of 153 older Holocaust survivors (Mage = 82.42, SD = 5.75). Participants were interviewed regarding their background characteristics, PTSS, LCS, and number of Holocaust experiences. Participants reporting higher LCS showed higher PTSS. There was an interaction between LCS and number of Holocaust experiences for predicting PTSS, suggesting that LCS was associated with higher PTSS to a stronger degree among Holocaust survivors who experienced a smaller number of Holocaust experiences. The findings indicate that Holocaust trauma may have influenced the LCS of Holocaust survivors throughout their lives and into old age. The results provide insight for mental health practitioners treating older Holocaust survivors in focusing on reducing schematic processing biases for threat information and anxiety to enhance better mental health for those suffering from posttraumatic stress symptoms.

The Role of Subjective Age in Predicting Post-Hospitalization Outcomes of Older Adults

INTRODUCTION

Studies of community-dwelling older adults find subjective age affects health and functional outcomes. This study explored whether younger subjective age serves as a protective factor against hospital-associated physical, cognitive, and emotional decline, well-known consequences of hospitalization among the elderly.

METHODS

This study is a secondary data analysis of a subsample (N = 262; age: 77.5 ± 6.6 years) from the Hospitalization Process Effects on Mobility Outcomes and Recovery (HoPE-MOR) study. Psychological and physical subjective age, measured as participants' reports on the degree to which they felt older or younger than their chronological age, was assessed at the time of hospital admission. Independence in activities of daily living, life-space mobility, cognitive function, and depressive symptoms were assessed at hospital admission and 1 month post-discharge.

RESULTS

The odds of decline in cognitive status, functional status, and community mobility and the exacerbation of depressive symptoms were significantly lower in those reporting younger vs. older psychological subjective age (odds ratio [OR] = 0.68, 95% CI = 0.46-0.98; OR = 0.59, 95% CI = 0.36-0.98; OR = 0.64, 95% CI = 0.44-0.93; OR = 0.64, 95% CI = 0.43-0.96, respectively). Findings were significant after controlling for demographic, functional, cognitive, emotional, chronic, and acute health predictors. Physical subjective age was not significantly related to post-hospitalization outcomes.

CONCLUSION

Psychological subjective age can identify older adults at risk for poor hospitalization outcomes and should be considered for preventive interventions.

The experience of aging before one's time during the coronavirus pandemic among war veterans in Israel

Subjective age, the personal sense of how old one feels, is an important concomitant of posttraumatic outcomes in the second half of life. The present study aims to disentangle the interrelationships between posttraumatic stress disorder symptoms (PTSS) and subjective age, during the COVID-19 pandemic, among a sample of Israeli older adults who are veterans of the 1973 Yom Kippur War. Participants were interviewed in 2015 (T1; N = 259; mean age = 65.23, SD = 5.32) and in 2020, during the COVID-19 outbreak in Israel (T2). We assessed subjective age, PTSS, fear of COVID-19, self-rated health, and COVID-19 related accelerated subjective aging. A cross-lagged path analysis showed that while higher PTSS at T1 were associated with an increase in subjective age from T1 to T2, subjective age at T1 was not associated with PTSS at T2. PTSS at T1, but not subjective age, were associated with higher COVID-19 related accelerated subjective aging at T2. Older adults with continued PTSS due to past traumas, might be susceptible to the stressors of COVID-19 expressed in the personal subjective experience of having aged quickly in a short period of time. Our findings also suggest that in the context of stress and trauma, subjective age is more appropriately conceived as an outcome variable rather than a predictor of PTSS.

Subjective age, worry and risk-related perceptions in older adults in times of a pandemic

During the Covid-19 pandemic, older people have been in the spotlight of the public debate. Given their higher risk of severe outcomes of the disease, they have been described as especially vulnerable and as a burden to others and society. We thus wanted to investigate how older people’s perception of their own age, that is their subjective age, as well as their Covid-19 related risks and worries were related during the pandemic and whether these relationships varied according to participants’ subjective health. We used data from the longitudinal CRISIS study which was conducted in the Grand-Duchy of Luxembourg in June and October 2020. Participants were aged 60–98 and responded on questionnaires regarding their subjective age, worry of falling ill with Covid-19, perceived risk of contracting the virus, perceived risk of falling seriously ill if they contracted Covid-19, as well as their subjective health and covariates. Three cross-lagged panel models were constructed to explore the longitudinal, bidirectional relationships between the variables. Cross-sectionally, a higher subjective age was related to more perceived risk of a serious course of disease. Longitudinally, subjective age and worry did not show any significant association over time, and neither did subjective age and perceived risk of contracting the virus. However, subjective health significantly moderated the relationship of worry and subjective age, showing different trajectories in the relationship depending on whether subjective health was good or bad. Higher perceived risk of falling seriously ill increased subjective age over time. Again, subjective health moderated this relationship: the perceived risk of falling seriously ill affected subjective age only for those with better subjective health. Our findings show the interactive relationship between subjective age and Covid-19 related cognitions and emotions and provide guidance for identifying older people that are most susceptible for negative age-related communication during the pandemic.

Aging together in the aftermath of war: marital adjustment and subjective age of veterans and their spouses

OBJECTIVES

Trauma has long-term effects on those directly exposed to it, but it also impacts those closest to them, particularly one's spouse, as the marital relationship is of central importance for late-life development. Furthermore, traumatic experiences have been shown to be involved in an acceleration of aging, whether through physical health, or via psychological pathways, through an older subjective age. The present work seeks to examine the mutual connections between marital adjustment and the psychological accelerated aging of both spouses among military veterans of the Israeli 1973 Yom Kippur War.

METHOD

Data from two assessments were drawn from a larger longitudinal study. In 2008 (T1) and again in 2015 (T2), 247 veterans and their wives were interviewed on their subjective age, marital adjustment, and PTSD symptoms.

RESULTS

An actor-partner interdependence model combined with an autoregressive cross-lagged model, controlling for T1 PTSD symptoms revealed that men's subjective age at T1 was associated with women's subjective age at T2, and women's subjective age at T1 was associated with men's subjective age at T2. Women's marital adjustment at T1 was associated with men's marital adjustment at T2 but not the other way around.

CONCLUSION

Spousal relationships are an important arena in the lives of older adult veterans. The present study contributes new knowledge regarding the paths that predict subjective age by taking account of the subjective age of one's spouse, as well as levels of marital adjustment. Insights regarding secondary traumatization, as well as gender differences, for the aging process are discussed.

Feeling Younger, Rehabilitating Better: Reciprocal and Mediating Effects between Subjective Age and Functional Independence in Osteoporotic Fracture and Stroke Patients

INTRODUCTION

The current study aimed to find reciprocal effects between subjective age and functional independence during rehabilitation from osteoporotic fractures and stroke and whether these effects can be mediated by indicators of well-being.

METHODS

Participants were 194 older adults (mean age = 78.32 years, SD = 7.37; 64.8% women) who were hospitalized following an osteoporotic fracture or stroke. Participants completed measures of subjective age and well-being (i.e., optimism, self-esteem, and life satisfaction) several times during rehabilitation. Functional Independence Measure (FIM) was completed by nursing personnel at admission and at discharge.

RESULTS

Younger subjective age at admission predicted higher FIM scores at discharge. The reverse effect, that is, of FIM scores at admission on subjective age at discharge, was nonsignificant. Optimism during hospitalization mediated the effect of subjective age on subsequent FIM scores while self-esteem and life satisfaction did not. Sensitivity analyses further showed that the effect of subjective age on FIM was significant for both fracture and stroke patients.

DISCUSSION

The findings highlight the effect of subjective age on rehabilitation outcomes among osteoporotic fractures and stroke patients and suggest several potential mechanisms behind this effect. Rehabilitation outcomes following osteoporotic fractures or strokes could improve if subjective age and an optimistic outlook are taken into consideration.

The Association Between Views of Aging and Subjective Cognitive Complaints in Older Adults: Findings From Two Samples

This cross-sectional study examined whether views of aging (VoA) relate to subjective cognitive complaints in two separate cohorts of older adults. Ageist attitudes, attitudes to aging (psychological loss, physical change, and psychological growth), subjective age, and subjective successful aging were examined. A moderating effect of chronological age was also examined. Samples included 572 adults aged 50 or older (Sample 1; mean age = 67.63, SD = 11.39, 49.4% female) and 224 adults aged 65 or older (Sample 2; mean age = 81.50, SD = 6.61, 75.3% female). More negative VoA (higher ageist attitudes, lower psychological growth, lower physical change, older subjective age, and less successful aging) were associated with more subjective cognitive complaints after controlling for covariates. An increase in chronological age strengthened some of these associations. Findings suggest that improving dimensions of VoA may have a complementary positive effect on subjective cognitive complaints in older adults.

The Moderating Role of Views of Aging in the Longitudinal Relationship Between Physical Health and Mental Distress

OBJECTIVES

Some degree of mental distress is commonly present in old age, and it is often exacerbated in later life following changes in physical health. This work presents in 2 studies among samples that have been exposed to stressful experiences in the past, a prospective examination of how the association between physical health and mental distress is attenuated by 2 forms of views on aging, evaluations of age, and evaluations of one's future.

METHOD

Study 1 (N = 226) was conducted in 2008 (Time 1) and 2014 (Time 2), among Israeli war veterans (mean age 64.90, SD = 5.04); Study 2 (N = 132) was conducted in 2014 (Time 1) and 2015 (Time 2) among older adults who were exposed to ongoing rocket fire in the south of Israel (mean age 66.44, SD = 9.77). Participants reported on their subjective age, subjective life expectancy (SLE [in Study 1]/distance to death [DtD; in Study 2]), health, and mental distress.

RESULTS

Both studies showed that after controlling for exposure to trauma and for Time 1 mental distress, Time 1 subjective age, but not SLE/DtD, moderated the association between Time 1 physical health and Time 2 mental distress.

DISCUSSION

Subjective age and SLE represent distinct features of views of aging. Subjective age may reflect perceptions of one's aging process, associated more directly with health-related outcomes over time. SLE reflects future, death-related perceptions, therefore perhaps less directly associated with such outcomes.

Subjective accelerated aging moderates the association between COVID-19 health worries and peritraumatic distress among older adults

BACKGROUND

The present study examined whether subjective accelerated aging moderated the relationship between COVID-19 health worries and COVID-19 peritraumatic distress among older adults.

METHOD

The sample consisted of 277 older adults (M = 69.58, s.d. = 6.73, range 60-92) who answered an online questionnaire during the outbreak of COVID-19 pandemic in Israel. Participants completed the measures of background characteristics, exposure to COVID-19, COVID-19 health worries, subjective accelerated aging and COVID-19-based peritraumatic distress.

RESULTS

Higher levels of COVID-19 health worries were correlated with higher levels of peritraumatic distress symptoms among older adults. Moreover, those reporting accelerated aging also reported a higher level of peritraumatic distress. Finally, the interaction between COVID-19 health worries and subjective accelerated aging predicted peritraumatic distress, suggesting that COVID-19 worries were associated with peritraumatic distress to a stronger degree among older adults who felt they were aging faster.

CONCLUSIONS

These findings indicate that negative views of aging may serve as an amplifying factor for traumatic distress during the COVID-19 pandemic. Although preliminary, the findings provide insight for potential screening and interventions of older adults at risk of developing peritraumatic distress symptoms during the global pandemic.

Changes in Subjective Age During COVID-19

BACKGROUND AND OBJECTIVES

To examine the change in subjective age with the emergence of coronavirus disease 2019 (COVID-19). Two competing hypotheses were tested: (a) people felt increasingly older due to the stress generated by the pandemic and (b) people felt increasingly younger due to psychological distancing from older age, a vulnerability to COVID-19.

RESEARCH DESIGN AND METHODS

An age- and sex-stratified sample of adults from across the United States (baseline N = 3,738) was assessed on 3 occasions: before the COVID-19 outbreak in late January/early February and during the outbreak in late March and again in late April. Multilevel modeling analysis examined the change in subjective age and tested potential moderators of individual differences in the trajectory of subjective age.

RESULTS

The average trajectory of subjective age followed a concave curve, with a nadir (feeling younger) during the second assessment in late March. Older age, negative expectations about aging, absence of preexisting conditions, and less stress during COVID-19 were associated with feeling younger but did not predict the rate of change. The only significant predictor of change in subjective age was the belief that the "coronavirus is only a threat to older adults": The more individuals agreed with this statement, the more likely it was that they felt increasingly younger at follow-up.

DISCUSSION AND IMPLICATIONS

Subjective age changed during a global health crisis, with people feeling younger with the emergence of COVID-19. The findings support the hypothesis that subjective age partly reflects a coping process of psychological distancing from older age, the age group most vulnerable to COVID-19.

Psychological aging, depression, and well-being

Aging is a multifactorial process, which affects the human body on every level and results in both biological and psychological changes. Multiple studies have demonstrated that a lower subjective age is associated with better mental and physical health, cognitive functions, well-being and satisfaction with life. In this work we propose a list of non-modifiable and modifiable factors that may possibly be influenced by subjective age and its changes across an individual's lifespan. These factors can be used for a future development of individual psychological aging clocks, which may be utilized as a sensitive measure for health status and overall life satisfaction. Furthermore, recent progress in artificial intelligence and biomarkers of biological aging have enabled scientists to discover and evaluate the efficacy of potential aging- and disease-modifying drugs and interventions. We propose that biomarkers of psychological age, which are just as important as those for biological age, may likewise be used for these purposes. Indeed, these two types of markers complement one another. We foresee the development of a broad range of parametric and deep psychological and biopsychological aging clocks, which may have implications for drug development and therapeutic interventions, and thus healthcare and other industries.

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

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

Subjective Age and Emotion Covariation: Findings From Two Daily Experience Studies

OBJECTIVES

This article focuses on an aspect of emotional complexity as seen in the covariation between positive affect (PA) and negative affect (NA). Lifespan theories predict distinctive patterns of change in emotion covariation with chronological age. Nevertheless, research shows mixed evidence with most studies failing to find a significant connection between chronological age and emotion covariation. We propose to look beyond chronological age and assess the relationship between subjective age and emotion covariation. Subjective age refers to how old one perceives oneself to be, and therefore may be more pertinent to one's emotional experience than chronological age. We further explored whether the relationship between subjective age and emotion covariation is modified by chronological age.

METHOD

We used data from 2 daily diary study samples (N = 188, mean age = 57.84, range = 29-100, and N = 334, mean age = 58.15, range = 30-90).

RESULTS

Multilevel models showed that individuals who perceived themselves as older showed stronger inverse PA-NA relationship, reflecting lower emotional complexity. Chronological age (net of subjective age) and emotion covariation were unrelated in both samples. Moreover, in Study 2 there was a 3-way interaction between PA, subjective age and chronological age, suggesting that subjective age is more strongly related to emotion covariation among older adults than among younger adults.

DISCUSSION

The relationship between subjective age and emotion covariation is discussed in light of lifespan theories.

Variables Connecting Parental PTSD to Offspring Successful Aging: Parent-Child Role Reversal, Secondary Traumatization, and Depressive Symptoms

The effects of parental trauma on offspring of Holocaust survivors (OHS) are debated in the literature. Recently, scholars suggested that it may be more productive to ask when and via which mechanisms such effects are observed. Following, the current study examines if parental Holocaust-related posttraumatic stress disorder (PTSD) symptoms are linked with the aging processes of their middle-aged offspring. Beyond this association, we also suggested a putative mediation path, indicating three underlying mechanisms by which parental trauma lingers on: perceived parent-child role reversal, secondary traumatization, and depressive symptoms. Using a convenience sample of 682 community-dwelling participants, comprising 341 older adult parent-middle-aged offspring dyads (M age = 81.71 and 54.58 for parents and offspring, respectively) to address this issue. Parents reported PTSD with the valid measure of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. OHS reported perceived parent-child role reversal, secondary traumatization, depressive symptoms, and completed indices of successful aging. Based on parents' reports, we divided the parent-offspring dyads into three groups: OHS whose parents had probable PTSD (n dyads = 43), OHS whose parents did not have PTSD (n dyads = 161), and comparison with parents who did not undergo the Holocaust (n dyads = 137). Findings reveal that OHS with parents suffering from probable PTSD aged less successfully than comparisons. Serial mediation analyses validated the aforementioned putative pathway (perceived parent-child role reversal, secondary traumatization, and depression) linking parental PTSD with offspring successful aging. Our findings are discussed through a vignette depicting a fictional OHS character. These underlying mechanisms suggest that different types of interventions, each geared towards a specific mechanism, may mitigate the lingering effect of parental PTSD on diminished OHS successful aging.

Posttraumatic Stress Disorder in Older Adults: A Conceptual Review

Objectives: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. Methods: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. Results: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). Conclusions: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. Clinical Implications: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.

The Interrelations of Physical and Mental Health: Self-Rated Health, Depression, and PTSD Among Female IPV Survivors

Researchers have found that intimate partner violence (IPV) is associated with low self-rated health (SRH), which is correlated with increased medication usage, and has tremendous social consequences. IPV and low SRH are associated with posttraumatic stress disorder (PTSD) and depression, and the current study examined the interrelations between these variables among 505 Israeli women in shelters. To assess mediation, three regressions were designed. Traumatic events, Russian ethnicity, and chronic illness all contributed to low SRH. The direct effect of depression on SRH was insignificant when PTSD entered the regression. Our findings suggest that PTSD is a more fundamental factor than depression when predicting SRH among IPV survivors.

What doesn't kill you makes you feel older: lifespan adversity and its association with subjective age among former prisoners of war

Background: Subjective age (SA) is an indicator of aging that has been empirically associated with health impediments and hindered longevity. Studies show that adverse life events may result in relatively older SA, but have not addressed the differential contribution of life events across the lifespan and the course of posttraumatic psychopathology on the SA of aging survivors of extreme trauma. Objective: Filling this gap, the current study explored the differential contribution of (1) adverse experiences in various life-stages and (2) trajectories of posttraumatic stress disorder (PTSD) to the prediction of SA in a sample of former prisoners-of-war as they enter old age. Method: A cohort of Israeli former prisoners-of-war of the 1973 Yom Kippur War (N = 103) was assessed at four points throughout four decades after the war. A linear hierarchical regression was utilized to assess the contribution of negative life events during childhood, participation in other wars, combat exposure, suffering in captivity, life events since the war and the trajectories of PTSD for predicting SA 42-years post-repatriation. Results: Lifespan adversity explained 50% of the variance in SA, with trajectories of PTSD making the largest contribution, followed by life events since the war. Negative life events in childhood added to the explained variance only when PTSD trajectories were accounted for. Exposure to combat, participation in additional wars and the severity of specific experiences during captivity did not reach significance, though the latter marginally contributed to the explained variance (p = .069). Conclusions: This study demonstrates the importance of considering the prolongation of posttraumatic psychopathology together with life adversities and their differential implications when addressing SA after extreme trauma. The findings suggest that early life adversity may be a latent factor that increases vulnerability to posttraumatic premature aging processes.

Parental Holocaust Exposure, Related PTSD Symptoms and Subjective Aging Across the Generations

Objectives

Traumatic exposure and posttraumatic stress disorder (PTSD) are related to less favorable perceptions of aging. The current study examined parental PTSD and perceptions of aging among old Holocaust survivor (HS) parents and their middle-aged offspring.

Method

Parents (mean age = 81.79) and their offspring (mean age = 55.41) reported PTSD symptoms, attitudes toward aging and subjective age. Offspring also rated how they perceive both their parents’ aging and subjective age. Dyads were divided into three groups: HS with probable PTSD (n = 21 dyads), HS without probable PTSD (n = 65 dyads), and comparison parents without probable PTSD (n = 57 dyads).

Results

Relative to parents and offspring from other groups, HS parents with probable PTSD and their offspring had both less favorable attitudes toward their own aging as well as reporting feeling older. Offspring of posttraumatic HS also held less favorable attitudes toward parents’ aging and perceived their own parents as being older. Serial mediation models showed that the effect of parental PTSD on offspring’s subjective aging was serially mediated by parental subjective aging and offspring’s perception of parents’ aging.

Discussion

The study provides the first evidence that posttraumatic distress is related to less favorable perceptions of aging across generations in HS families. Possible mechanisms for such intergenerational effect and the implication for interventions are discussed.

Understanding the long-term connections between posttraumatic stress, subjective age, and successful aging among midlife and older adults

Background: The nature of the reciprocal relationships between posttraumatic stress disorder (PTSD) symptoms, proportional subjective age, and their effects on successful aging are important issues that have been so far under-studied. Clarifying the relationships between these variables has many theoretical and practical implications for the understanding of how individuals age in the shadow of traumatic exposure. Objective: The present study examined the reciprocal relationships between PTSD symptoms and proportional subjective age in a longitudinal design, and how these variables predict successful aging. Method: Using in-region random digit dialling, we collected a stratified sample of community-dwelling older adults residing in the south of Israel. Of that sample, 132 midlife and older adults (T1 age range = 50-87, mean age = 65.84, SD = 9.12) were interviewed three times across a period of two years and four months (2014-2016). Participants completed measures of PTSD symptoms and proportional subjective age in the first two interviews (T1 and T2) and successful aging indices in the third interview (T3). PTSD symptoms and proportional subjective age measured at both T1 and T2 served as predictors and outcomes in a cross-lagged model and as predictors of successful aging at T3. Results: T1 PTSD symptoms predicted an older proportional subjective age at T2, whereas the reverse relationship (i.e. T1 proportional subjective age to T2 PTSD symptoms) was non-significant. Moreover, higher PTSD symptoms and an older proportional subjective age at T2 predicted lower successful aging at T3. Conclusions: In addition to clarifying the temporal sequencing of PTSD and proportional subjective age, the study further suggests that PTSD and proportional subjective age identity could each render midlife and older adults more susceptible to less successful aging. Accordingly, we advocate to further explore the mechanisms underlining these complicated relationships.

On the edge: The association between extreme values of proportional felt-age and functioning

The present study examined whether endorsing a felt-age that is extremely divergent from one's actual age (whether older or younger) is related to worse functioning four years later. Data were drawn from 4938 participants, who completed the 2008 and 2012 questionnaires of the Health-and-Retirement-Study (HRS). Participants were divided into four groups according to their reported proportional-felt-age: the normative-young (N = 2229), reported a normative felt-age at the median or younger; normative-old (N = 2226), reported normative felt-age at the median and older; and the extremely young and extremely old proportional-felt-age (upper and lower 5% of felt-age; N's = 242 and 241, respectively). These groups were compared on chronic medical conditions, depressive symptoms, activities of daily living (ADL), instrumental activities of daily living (IADL), functional limitations, and loneliness. While extremely younger proportional-felt-age participants did not reveal worse (or better) outcomes compared with the normative-young group, extremely old proportional-felt-age participants reported worse physical health, mental health, and functioning in cross-sectional, as well as longitudinal comparisons. Extreme values of older proportional-felt-age are usually not reported randomly and reflect less adaptive adjustment. The findings underscore the importance of studying participants at the extreme values of felt-age, especially extreme old proportional-felt-age, and the need for further inspection of the mechanisms underlying these evaluations.

Traumatic stress and cellular senescence: The role of war-captivity and homecoming stressors in later life telomere length

BACKGROUND

Telomere length (TL) serves as a biomarker of cellular senescence and is a robust predictor of mortality. The association between traumatic stress and TL erosion is rapidly realized, as are the complexities of this relation that include links to posttraumatic stress disorder (PTSD), depression, and psychosocial factors. Nevertheless, the relation between specific stressors in early adulthood and TL in later life, specifically among populations that have undergone extreme stress in early adulthood are largely uninvestigated.

METHOD

Examining 99 Israeli former prisoners of war (ex-POWs) 18 and 42 years after repatriation, the current study investigated the role that specific stressors during captivity (i.e., physical abuse, nourishment deprivation and solitary confinement) and homecoming (i.e., received social-support, loss of place in the family, loneliness and sense of being accused) play in predicting TL 42 years post-repatriation. Intercorrelations analysis and a hierarchical linear regression were utilized. Variables that have been empirically associated with TL: age, BMI, physical activity, smoking, substance abuse, negative life events since repatriation, depression and PTSD symptoms were controlled for in the regression.

RESULTS

Solitary confinement during captivity, and loss of place in the family, loneliness and being accused at homecoming predicted shorter telomeres in later life. The remaining stressors did not significantly predict TL.

CONCLUSION

These findings suggest that an adequate understanding of TL after trauma must consider the unique contributions of specific types of stressors across the lifespan, and particularly account for interpersonal deficits. The findings may inform preventive interventions aimed at improving ex-POWs' longevity and well-being.

Subjective Age as a Moderator in the Reciprocal Effects Between Posttraumatic Stress Disorder Symptoms and Self-Rated Physical Functioning

It is now widely acknowledged that physical decline may increase among middle-aged and older adults who suffer from posttraumatic stress disorder (PTSD). Much less is known about the temporal sequencing of PTSD and physical decline relationship over time. While PTSD can lead to physical decline, physical decline may preserve or augment existing PTSD symptoms. Both problems can also mutually affect each other forming a vicious cycle. Additionally, it is important to address variables that can mitigate these longitudinal effects. Following the recovery capital framework, we consider how the existence or lack of capital in the form of young age identity may affect the recovery process. Therefore, the current study aimed to examine the reciprocal effects of PTSD symptoms and self-rated physical functioning and further test whether one's subjective age moderates these effects. Using in-region random digit dialing, we collected a stratified sample of community dwelling older adult residing in south Israel. Of that sample (N at T1 = 339), 132 older adults (age range = 51-88, mean age = 66.90, SD = 9.14) were interviewed 4 months after the 2014 Israel-Gaza conflict (T2) and 1 year later (T3). Participants responded to PTSD symptoms scale, and reported their physical functioning and subjective age. PTSD symptoms and self-rated physical functioning were tested as both predictors and outcomes in a cross-lagged model. The moderating effect of subjective age was assessed by examining whether T2 variables interacted with subjective age in predicting T3 outcomes. Results showed that higher PTSD symptoms at T2 were associated with subsequent lower self-rated physical functioning at T3, yet self-rated physical functioning at T2 did not predict PTSD symptoms at T3, thereby highlighting the PTSD self-rated physical function direction. Moreover, subjective age moderated this latter association, so that this relationship was significant only for those who felt relatively older. In addition to clarifying the temporal sequencing of the PTSD self-rated physical functioning association, the study further suggests that an older subjective age (i.e., lack of recovery capital) could render middle-aged and older adults more susceptible to physical decline following PTSD symptoms. We therefore propose to develop interventions aimed at coping with an older age identity and facilitating a younger age identity among traumatized older individuals.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Psychological vulnerability and resilience of Holocaust survivors engaged in creative art

Although evidence demonstrates that engagement in art promotes favorable coping with trauma, this subject is underexplored among Holocaust survivors. Thus, the present study explored whether Holocaust survivors engaged in art differed from survivors not engaged in art in various markers of psychological vulnerability and resilience. The study further included non-Holocaust survivor comparisons, some engaged in art and some not, in order to assess whether engagement in art among Holocaust survivors relates to a unique psychological profile beyond art engagement in general. A sample of 154 community-dwelling older adults (mean age = 81.67, SD = 5.33, range = 73-97) reported exposure to the Holocaust, current engagement in art, posttraumatic stress disorder (PTSD) symptoms, general psychological distress, resilience and subjective perceptions of age and aging. Holocaust survivors (regardless of whether they engaged in art or not) reported higher PTSD symptoms relative to comparisons. However, Holocaust survivors who engaged in art reported higher resilience than all other groups (survivors not engaged in art and comparisons engaged and not engaged in art). To the best of our knowledge, these findings are the first quantitative evidence pointing toward a link between engagement in art and positive coping with the Holocaust. These findings have important implications for clinicians working with Holocaust survivors.

Telomere Length and Depression Among Ex-Prisoners of War: The Role of Subjective Age

Objectives

Exposure to captivity increases the risk for multiple disturbances that may intensify during old age. In later phases of life, former-prisoners-of-war (ex-POWs) may suffer from depression as well as from accelerated aging, manifested in older subjective age and leukocyte telomere shortening. The current study assesses the link between these varied facets of increased vulnerability during old age and explores (a) the associations between subjective age and telomere length; (b) the mediating role of changes in subjective age over time within the associations between depression and telomere length.

Methods

Eighty-eight ex-POWs were assessed prospectively 30 (T1), 35 (T2), and 45 (T3) years after the 1973 Israeli Yom-Kippur War. Depression was assessed at T1; subjective age was assessed at T2 and T3; and telomere length and control variables were assessed at T3.

Results

Older subjective age at T3 was associated with concurrent shorter telomeres, beyond the effect of chronological age. Change in subjective age between T2 and T3 mediated the relations between depression at T1 and shorter telomeres at T3 beyond the effects of control variables.

Discussion

Findings suggest that the detrimental ramifications of accelerated subjective age involve premature cellular senesces, and may explain the relation between depression and accelerated aging processes among trauma victims. Hence, clinical interventions may seek to address accelerated subjective age among trauma survivors who suffer from depression.

“Caught in a Generation Gap”: A Generation Perspective on Refugees Getting Old in Denmark—A Qualitative Study

Purpose: Older non-Western migrants in Europe are a vulnerable population, due to old age and multiple disadvantages related to language barriers and different understandings of care, health, and disease. Our aim was to gain a better understanding and insight into the care needs of families with refugee background Method: The study was designed as a qualitative exploration using semistructured individual interviews and family group interviews. Results: The results illustrate how vulnerability can “transmit” from one family member to another. Discrepancies between the older person’s expectations and needs and society’s expectations trap family members in ethical and moral dilemmas. This divides and stresses the family and results in difficult decision making, increased stress, and vulnerability. Conclusion and Implication: Migration and displacement can lead to ambivalent feelings among younger relatives regarding their role in caring for older relatives. Health professionals need to address and acknowledge this to be able to provide culturally congruent health care.

Parental Post-traumatic Stress Disorder Symptoms Are Related to Successful Aging in Offspring of Holocaust Survivors

A fascinating, yet underexplored, question is whether traumatic events experienced by previous generations affect the aging process of subsequent generations. This question is especially relevant for offspring of Holocaust survivors (OHS), who begin to face the aging process. Some preliminary findings point to greater physical dysfunction among middle-aged OHS, yet the mechanisms behind this dysfunction need further clarification. Therefore, the current studies assess aging OHS using the broad-scoped conceptualization of successful aging, while examining whether offspring successful aging relates to parental post-traumatic stress disorder (PTSD) symptoms and offspring’s secondary traumatization symptoms. In Study 1, 101 adult offspring (mean age = 62.31) completed measures of parental PTSD, secondary traumatization, as well as successful aging indices – objective (medical conditions, disability and somatic symptoms) and subjective (perceptions of one’s aging). Relative to comparisons and OHS who reported that none of their parents suffered from probable PTSD, OHS who reported that their parents suffered from probable PTSD had lower scores in objective and subjective measures of successful aging. Mediation analyses showed that higher level of secondary traumatization mediated the relationship between parental PTSD and less successful aging in the offspring. Study 2 included 154 dyads of parents (mean age = 81.86) and their adult offspring (mean age = 54.48). Parents reported PTSD symptoms and offspring reported secondary traumatization and completed measures of objective successful aging. Relative to comparisons, OHS whose parent had probable PTSD have aged less successfully. Once again, offspring secondary traumatization mediated the effect. The findings suggest that parental post-traumatic reactions assessed both by offspring (Study 1) and by parents themselves (Study 2) take part in shaping the aging of the subsequent generation via reactions of secondary traumatization in the offspring. The studies also provide initial evidence that these processes can transpire even when offspring do not have probable PTSD or when controlling offspring anxiety symptoms. Our findings allude to additional behavioral and epigenetic processes that are potentially involved in the effect of parental PTSD on offspring aging, and further imply the need to develop interdisciplinary interventions aiming at promoting successful aging among offspring of traumatized parents.