Negative Self-perception of Aging and Mortality in Very Old Chinese Adults: The Mediation Role of Healthy Lifestyle

How Perceptions of Aging Influence Physical Activity and Exercise in Older Age: Exploring the Behavior of People Aged 70+ Years Engaged in Fall Prevention Activities

For older people, physical inactivity increases fall risk as well as other preventable health conditions. Despite the well-documented benefits of physical activity, uptake and adherence continue to challenge efforts aimed at increasing physical activity and reducing falls. Nested within a randomized controlled trial, this study reports on the factors influencing the physical activity behavior of people, aged between 70 and 90 years, engaged in StandingTall, a home-based balance exercise program proven to reduce falls in the community. The perception of aging, physical activity in older age, and the delivery of exercise were identified as major themes, with the perception of aging an overarching theme influencing both preferences for physical activity in older age and exercise delivery. Findings demonstrate the importance of considering the role of aging, the influence aging has on physical activity and exercise behavior, and how aging influences the delivery and design of exercise programs including falls prevention activities for older people.

A cohort study of self-perception of ageing and all-cause mortality among older adults in China: a multiple mediators analysis

BACKGROUND

Positive self-perception of aging (SPA) is a well-known predictor of longevity, while how and to what extent SPA is linked with all-cause mortality among older adults is still unclear. This study aims to elucidate the relationship between positive SPA and all-cause mortality and its potential mediators among Chinese older adults.

METHODS

This is a 20-year dynamic cohort study conducted among 22,957 older adults aged ≥ 65 years old from a nationally representative sample. Positive SPA was measured using a validated 7-item scale. Potential mediators including health behaviors and social participation were collected using a self-reported questionnaire. Cox proportional hazards regression models were conducted to examine the association between positive SPA and all-cause mortality. A mediation analysis was conducted to determine whether health behaviors and social participation mediated the association between SPA and all-cause mortality.

RESULTS

Throughout follow-up (median [interquartile range], 46 [21-84] months), all-cause mortality was 87.4%. Compared with older adults with the lowest quartile positive SPA, hazard ratio(HR) of all-cause mortality among older adults with the second, third, and fourth quartile of positive SPA was 0.96(95%CI:0.93-1.00), 0.93(95%CI:0.90-0.99), and 0.92(95%CI:0.87-0.96) respectively after controlling for all potential mediators and covariates. The mediation analysis showed that regular daily vegetable intake, physical activity, and high social participation explained 41.1-48.5% of the variance in the association between positive SPA and all-cause mortality.

CONCLUSIONS

In this cohort study, we found that high positive SPA was associated with decreased all-cause mortality directly, and indirectly through healthy lifestyle behaviors and social participation. These findings suggest that interventions targeted at promoting or maintaining positive SPA may contribute to healthy ageing among older adults in China.

What do we really know about age-related stereotypes and well-being of older adults? A commentary on the state of the art

There is a considerable body of literature on harmful consequences of age-related stereotypes-including consequences on physical and mental health. However, this commentary critically argues that the current state of the art disregards consequences of these stereotypes specifically for the well-being of older adults (i.e., outcome that is not to be confounded with mental health). To this end, the content of age-related stereotypes and the mechanisms through which they operate on physical and mental health are first outlined. The commentary then focuses on the very scarce evidence documenting how and when the well-being of older adults (as assessed directly and not as inferred from other indicators) is influenced by self-directed stereotypes. After setting out possible ways well-being may be involved in the relationship between self-directed stereotypes and physical and mental health of older adults, the present commentary argues that a better understanding of well-being would benefit strategies targeting the reduction of age-related stereotypes. Overall, this commentary on the state of the art highlights that future research is still needed to better understand both the direct and indirect relationships between age-related stereotypes and well-being that is not reducible to positive experiences of life (or hedonic well-being) but also comprises an eudaimonic component.

Association Between Self-Perception of Aging and Long-Term Mortality in Elderly Patients with Hypertension in Rural China: A Possible Beneficial Effect of Nut Intake

Purpose

Previous research has consistently shown that self-perception of aging (SPA) is an important predictor of health and longevity, while Chinese rural elderly patients with hypertension had poorer SPA. Whether it was associated with their mortality kept unknown. The objective of this study was to investigate the long-term mortality and analyze the association between SPA and this mortality in the specific context of rural elderly patients with hypertension.

Patients and Methods

This study is a longitudinal investigation of the mortality in elderly patients with hypertension in rural Suzhou, China. Sociodemographic and clinical data, SPA, and six-year mortality were investigated. We used binary logistic regression and subgroup analyses to assess the effect of SPA at baseline on six-year mortality.

Results

A total of 280 hypertensive patients aged 60 years and older participated in the study, of whom 21 died, with a six-year mortality rate of 7.5%. After controlling for covariates, the "Emotional representation" dimension (OR=2.824, 95% CI:1.034-7.712) in SPA remained a risk factor for death. In subgroup analyses of the group aged 75 years and older, high scores on the "Timeline cyclical" (OR=14.125, 95% CI: 1.258-158.593) and "Emotional representations" (OR=2.567, 95% CI:1.066-6.182) dimensions were associated with a higher risk of death, while weekly nut intake may have mitigated the negative SPA effect on mortality.

Conclusion

Poorer self-perception of aging was associated with a high risk of mortality in rural elderly patients with hypertension, while the habit of weekly nut intake might help reduce this risk in the group aged 75 years or older.

Association between self-perception of aging and cognitive function in Chinese older adults: The mediation effect of health behaviors

OBJECTIVE

To investigate the association between self-perception of aging (SPA) and cognitive function in Chinese older adults, and to explore the mediating role of health behaviors.

METHODS

This study included 5,445 Chinese older adults from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Correlation, linear regression and mediation effect analysis were employed to evaluate the association.

RESULTS

SPA is significantly related to the health behaviors (r = 0.160, P < 0.01) and cognition (r = 0.086, P < 0.01), and health behaviors exhibited a positive correlation with cognition (r = 0.179, P < 0.01). SPA and health behaviors significantly impacted cognition (β = 0.032, P = 010; β = 0.103, P < 0.001). Health behaviors partially mediated the effect of SPA on cognitive function, accounting for 27.12 % of the total effect.

CONCLUSION

Health behaviors mediate the association between SPA and cognitive function. Healthcare providers should prioritize addressing SPA of older adults and encourage them to engage in health behaviors for cognitive health.

Perceived Characteristics of the Built Neighborhood Environment and Negative Self-Rated Health in Brazilian Community-Dwelling Older Adults

INTRODUCTION

Research indicates that self-rated health is associated with worse health outcomes in older adults. Thus, it is important to assess the association between built neighborhoods and self-rated health to establish strategies to improve the quality of life in the older adult population.

OBJECTIVE

To evaluate the association between the perceived characteristics of the built neighborhood and the negative self-rated health in Brazilian community-dwelling older adults.

METHODS

A cross-sectional study for finite random samples was performed with older adults who used the municipal public health service. The outcome was negative self-rated health using the question "How do you perceive your health?" The regular, bad, and very bad responses were grouped as negative self-perception. The exposure variables were the perceived characteristics of the built neighborhood, which was evaluated by the adapted version of the Neighborhood Environment Walkability Scale.

RESULTS

A total of 308 older adults were analyzed. Living close to food establishments (OR: 0.46; 95% CI: 0.25;0.85), fitness/bodybuilding gyms and/or clubs (OR: 0.51; 95% CI: 0.28;0.93), and safety to walk during the day (OR: 0.37; 95% CI: 0.16;0.87) and night (OR: 0.47; 95% CI: 0.26;0.84) were protective against negative self-rated health.

CONCLUSION

Therefore, living in neighborhoods with better characteristics was less associated with negative self-rated health, demonstrating the importance of promoting strategies to improve the neighborhood infrastructure and this population's perception of health.

Combatting ageism in the Western Pacific region

The present viewpoint examines the manifestation of ageism, defined as stereotypes, prejudice and discrimination towards people because of their age, in the Western Pacific region. Research is still equivocal concerning the nature of ageism in the Western Pacific region, especially in East and South-East Asia (e.g., Eastern countries). There has been plenty of research to support as well as question the general notion of Eastern cultures and countries as being less ageist compared to Western cultures and countries at individual, interpersonal, and institutional levels. Although varied theoretical explanations have aimed to explain East-West differences in ageism such as the modernization theory, the pace of population aging, the proportion of older people in the country, cultural hypothesis, and GATEism, none of these theories fully accounts for the mixed findings. As such, it is safe to conclude that targeting ageism should be an important step in ensuring a world for all ages in Western Pacific countries.

Explaining the process of formation of ageism among the iranian older adults

BACKGROUND

Ageism is considered as one of the consequences of the industrialization of societies, which appears in various forms in different cultures. This study aimed to explain the process of formation of ageism among the older adults people.

METHODS

The research was conducted using grounded theory method. Data were collected from 28 participants using in-depth semi-structured interviews and field notes. Data were analyzed using open, axial, and selective coding.

RESULTS

Fear of loneliness and rejection striving to tackle ageism "was identified as the core category of the study. Concepts such as "family context" and "cultural context" were relevant. After identifying the strategies used by the older adults in response to the context ("maintaining integrity", "socio-cultural care" and "proper health care", "striving to tackle ageism") was the most important process in ageism by the Iranian older adults.

CONCLUSION

Findings of this study indicated that individual, family and social factors play an important role in the process of ageism among the older adults. These factors sometimes exacerbate or moderate the process of ageism. By recognizing these factors, various social institutions and organizations (including the health care system and the national media (radio and television)) can help the older adults achieve successful aging by emphasizing the issues related to the social aspect.

To help or not: negative aging stereotypes held by younger adults could promote helping behaviors toward older adults

Aging stereotypes affect older adults' behaviors, however, it is unclear whether and how (negative) aging stereotypes influence younger adults' behaviors toward older adults. Two possibilities arose, such that aging stereotypes would reduce helping behaviors according to TMT and SIT; while based on the BIAS map, we would expect the opposite. The present study aimed to further compare the two possibilities by examining the effect of negative aging stereotypes on younger adults' helping behaviors, and testing which theory would fit the data better. In a cross-sectional study (Study 1), 112 Chinese younger adults (M = 22.67, SD = 2.56) were recruited. Aging stereotypes were measured by the Ambivalent Ageism Scale and the abbreviated ageism questionnaire. And their prosocial behaviors were measured by the modified third-party punishment task. The results revealed that high benevolent ageism would increase helping behaviors toward older adults. In the following experiment with aging stereotype priming (positive, neutral vs. negative) among 130 Chinese younger adults (M = 26.82, SD = 3.70), we confirmed the influence of negative aging stereotypes on prosocial behaviors measured by both third-party punishment and Social Value Orientation tasks. Study 2 further demonstrated that pity might mediate the association between negative aging stereotypes and behaviors. Our results indicated that younger adults' negative aging stereotypes could increase their prosociality toward older adults through pity in line with BIAS maps. It also had significant theoretical and practical implications for future research. For example, with more education and intergenerational contact in younger generation which could evoke pity feelings for older adults, could help to build harmonious intergenerational relations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04371-0.

"Aging is beautiful and graceful:" Exploring college students' perceptions of aging, older adults, and future older selves

Perception of one's own age and the aging process can influence healthy aging and encourage younger adults to be more proactive in taking care of themselves. There is a shortage of literature on college students' self-perceptions of aging and old age. This descriptive qualitative study explored how short-term aging research training and activities influenced college students' perceptions of aging, older adults, and their future older selves. Students were exposed to discussions about aging, the aging process, myths, a brief TED talk, and a video on positive age stereotypes in preparation for their encounter with older adults in a more extensive photovoice aging research project. Data for the study were collected using weekly guided reflections and drawing. Findings show that college students improved perceptions of aging and older adults after the short-term research training. We found cultural differences in self-perception of the onset of old age. Students perceived healthy aging in terms of biological, psychological, spiritual, and social dimensions of health. Students presented a hopeful, positive picture of their future older self as opposed to the negative stereotypic views they initially had of older adults. Reflections on one's own aging may be crucial in encouraging younger adults to be more proactive in taking care of themselves for a healthier life in later adulthood.

Existential ageing and dying: A scoping review

BACKGROUND

After significant early interest in aging and dying, recent empirical studies have been few and theoretically fragmented.

OBJECTIVE

The aims of this review were to map what is empirically known about the intersections between existential aging (a sense of passing years that evoke a sense of nearness-to-death) and dying identity and to describe the available evidence.

METHOD

Articles were reviewed employing PRISMA guidelines. Seven data bases were searched resulted in 165 records. Of these 165 records a final selection of 24 studies that met the criteria were examined.

RESULTS

Evidence from the review found that the formation of the identity of dying alongside existential aging was associated with personal changes related to self/gerotranscendence, self-concerns about the inevitability of death (mortality salience), self-concerns about the prospect of death (death anxiety), attitudes toward the older self as a moderator of attitudes to death (aging attitudes), or simply anticipating the death of self (the future). Collectively, these studies found that death and dying were threats or challenges to life as an increasingly aging identity and that this seems to require compensation or accommodation.

CONCLUSION

These studies confirm the importance of nearness-to-death on identity formation and psychological change in older populations. However, most of the studies were quantitative and tested for pre-existing ideas and concepts. There is a need for more qualitative studies to search for wider or parallel meanings about identity change in the face of aging and death, more longitudinal designs, and greater attention to mixed methods approaches, especially for populations for whom talk or writing may be restrictive.

Latent profile analysis of self-perceptions of ageing among Chinese community-dwelling older adults

BACKGROUND

Self-perceptions of ageing (SPA) is an important predictor for physical and mental health of older adults in successful ageing. SPA is mainly studied from negative or positive perspectives using variable-centred methodologies. The aim of the current study was to explore distinct profiles of SPA among Chinese community-dwelling older adults using a person-centred method and validate the SPA profiles by examining associations with psychological outcomes.

METHODS

Participants aged 65 and over were randomly divided into test and validation samples (n = 451, respectively). SPA was measured by the Brief Ageing Perceptions Questionnaire using latent profile analysis.

RESULTS

Three SPA profiles were identified. One adaptive subgroup was designated as 'Low ageing awareness and high positive control' (LAPC, 84.7% and 75% in both samples, respectively). Two maladaptive SPA subgroups were designated as 'Low positive consequences and control' (LPCC, 3.9% and 8.2% in both samples, respectively), and 'High ageing awareness and negative control' (HANC, 11.4% and 16.8% in both samples, respectively). Similar to negative/positive SPA, the HANC and LAPC subgroups showed the highest and lowest levels of depressive symptoms and cognitive decline. Low cognitive function was found in the LPCC subgroup.

CONCLUSIONS

These findings highlight the heterogeneity of older adults' SPA. SPA profiles may aid community healthcare providers in China to identify individuals with high risk of maladaptive SPA and to tailor targeted interventions for psychological health in later life. Distinct SPA profiles require different interventions targeting negative or positive control or both aspects. More positive control strategies might be beneficial for cognitive functioning in older adults from the LPCC subgroup.

Nine-year changes in self-reported problems with vision and hearing among older adults: do subjective age views matter?

OBJECTIVES

So far, little is known about linkages between subjective age views and long-term changes in vision and hearing.

METHOD

We examined the predictive role of two key measures of subjective age views (attitude toward own aging [ATOA]; aging-related cognitions comprising continuous growth, social loss, and physical decline) for changes in self-reported problems with vision and hearing over a period of up to 9 years. A subsample of the German Ageing Survey was used, consisting of 2,499 older adults.

RESULTS

Controlling for socio-demographic characteristics, self-rated health, and depressive symptoms, we found that with increasing age, more favorable ATOA scores, as well as higher scores on continuous growth and lower scores on physical decline, were associated with fewer self-reported vision problems at baseline. With advancing age, more favorable ATOA scores were also related with fewer hearing problems at baseline. However, among individuals with an older baseline age, more favorable ATOA scores were associated with a steeper increase in vision problems. Higher scores on continuous growth were related with less increase in hearing problems, independent of age.

CONCLUSION

Our findings suggest that subjective age views predict individuals' self-reported vision and hearing problems.

Association of lifestyle with mortality and the mediating role of aging among older adults in China

OBJECTIVES

1) examine the association between lifestyle and mortality; 2) examine the association between two aging measures and mortality; 3) evaluate the mediating effect of the two aging measures on the association between lifestyle and mortality among older Chinese adults.

METHODS

We used data from 2039 older adults (≥ 65 years) from the 2011/2012 biomarker substudy of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We created a healthy lifestyle index based on 5 factors (exercise, smoking, drinking, diet, and BMI, range: 0-5). We calculated two aging measures, the Klemera and Doubal method-biological age (KDM-BA) and physiological dysregulation (PD), based on 10 blood-based biomarkers using algorithms developed previously. A Cox proportional hazards model, general linear regression model, and formal mediation analysis were performed.

RESULTS

After adjustment for age and sex, compared to participants without any healthy lifestyle factors, those with 5 healthy lifestyle factors had an 85% lower risk of mortality (hazard ratio [HR] = 0.15, 95% confidence interval [CI]: 0.04, 0.60). PD, but not KDM-BA, was significantly associated with mortality (HR = 1.69, 95% CI: 1.25, 2.29). The healthy lifestyle index was negatively associated with PD (β = -0.021, P = 0.012). PD mediated 9% (95% CI: 1%, 52%, P = 0.043) of the total effect of the healthy lifestyle index on mortality.

CONCLUSIONS

In the older Chinese population, healthy lifestyle reduces mortality risk and aging partially mediates this association. The findings highlight the importance of adherence to a healthy lifestyle for promoting phenotypic aging even in late life.

Intergenerational support and subjective wellbeing among oldest-old in China: the moderating role of economic status

Backgrounds

The oldest-old population is increasing sharply in China, and intergenerational support has been their primary source of caregiving. Although intergenerational support has been found to be associated with wellbeing of older people in previous study, most analysis were from the perspective of children’s characteristics and exchange patterns. This study aims to investigate the impact of different types of intergenerational support on subjective wellbeing among Chinese oldest-old and the variation across groups of different economic status, based on their five-tier of needs (physiological needs, safety needs, love/belonging needs, esteem needs, and self-actualization needs).

Methods

We included older adults aged ≥ 80 years from the 2018 Chinese longitudinal Healthy Longevity Survey (CLHLS). We assessed older people’s subjective wellbeing by their life satisfaction and psychological health. We evaluated four types of intergenerational support: parents provide financial support, receive financial, instrumental and emotional support. We applied binary logistic regression analysis to analyze the association between different intergenerational support and older people’s subjective wellbeing and the moderating effect of self-rated economic status on this relationship.

Results

A total of 8.794 participants were included, with a mean age of 91,46 years (standard deviation:7.60). Older adults who provide financial support (OR: 1.37, 95% CI: 1.01, 1.85) and receive emotional support (OR: 1.99, 95% CI: 1.40, 2.83) report better subjective wellbeing. However, receiving instrumental support depressed psychological health (OR: 0.67, 95% CI: 0.56, 0.79) while improved life satisfaction (OR: 1.42, 95% CI: 1.04, 1.55). Receiving emotional support promoted parents’ psychological health among all combinations of support, and receiving all the three types together raised their subjective wellbeing most.

Conclusions

Our study recognizes that higher level of subjective wellbeing for oldest-old is related to providing financial support, receiving emotional and certain instrumental support. In addition, higher economic status can moderate these associations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02204-y.

Impact of self-perception of aging on mortality of older patients in oncology

OBJECTIVE

Several studies show that self-perception of aging (SPA) is a significant predictor of mental and physical health. In this study, we analyze the effect of SPA on mortality in the specific context of geriatric oncology.

METHODS

The sample constituted of 140 individuals aged 65 years and older suffering from a recent nonmetastatic cancer (breast, lung, gynecological, or hematological), followed up to 6 years. We used Cox proportional hazards model to assess the effect of SPA at baseline on mortality. It was adjusted for age, gender, educational and cognitive level, oncological information (the site and kind of cancer), number of comorbidities, and physical and mental health at baseline.

RESULTS

Patients were aged 73 years at diagnosis and were more often women (85.7%). Individuals with more negative SPA were 3.62 times more likely to die than those with a more positive SPA, with control of gender, age, education and cognitive level, mental and physical health, the category (breast, lung, gynecological, or hematological), and kind (initial or recurrence) of cancer.

CONCLUSIONS

These findings suggest that SPA influence the mortality of older people in the particular context of oncology. Therefore, the need to change our attitudes toward aging and older people implied indirectly by these results is discussed.

Adherence to a healthy lifestyle counteracts the negative effects of risk factors on all-cause mortality in the oldest-old

In the study, we examined the extent to which the harmful effects of risk factors on all-cause mortality can be counteracted by healthy lifestyle practices in the oldest-old (80 years of age and older). A total of 17,660 oldest-old from China were followed up for up to 10 years. The data were analyzed using the Cox proportional hazard model with adjustment for potential confounders. We found that having a rural residence, not being married, having lower economic status, physical disability, impaired cognitive function, or comorbidity were all associated with an elevated risk of mortality. Using these factors, we computed a weighted "risk score." Because never smoking, never drinking, doing physical exercise, having an ideal diet, and a normal weight were independently associated with lower mortality, we also combined them to compute a weighted "protection score." Both scores were divided into lowest, middle, and highest groups using their tertiles. In joint effect analyses, participants with the combined highest-risk score and lowest-protection score profile had a nearly threefold higher joint death risk. These analyses show that adherence to a healthy lifestyle counteracts the negative effect of risk factors on all-cause mortality in the oldest-old by more than 20%.