Continuity and change in social support between young-old and old-old or very-old age

Social support and links to quality of life among middle-aged and older autistic adults

LAY ABSTRACT

Social support can take many forms, such as practical help, time spent socially with others, or the satisfaction with personal relationships. Social support is known to affect quality of life (QoL) in both non-autistic older and autistic young adults. QoL reflects how satisfied an individual is with their life either overall or in a certain area. We know little about middle-aged and older autistic adults' experiences of social support or QoL. In this study, 388 adults aged 40-83 years old, completed online questionnaires asking about background such as age and sex, depression and anxiety symptoms, QoL (physical, psychological, social, environmental, and autism-specific), and different types of social support. Even after taking into account background, depression, and anxiety, social support was important for individuals' QoL. To our knowledge this is the first paper to examine the relationship between social support and QoL in middle-aged and older autistic adults. Improving social support may have a significant impact on the QoL of older autistic adults. Future studies should examine whether age-related changes in social support (size, content, and arrangement of social networks) that are common in non-autistic aging, also occur among older autistic adults.

The Physical, Mental, and Social Health of Middle-Aged and Older Adults without Close Kin in Canada

OBJECTIVES

We examine whether adults 45+ lacking a partner and children are disadvantaged in terms of physical, mental, and social aspects of health. Then we test whether the importance of family structure for these outcomes varies by age, gender, and educational attainment.

METHODS

We examine aging and social network modules from the Canadian General Social Survey to estimate associations between family structure and physical, mental, and social health, with the last measured as communication with relatives and friends, civic participation, and loneliness.

RESULTS

Results show that middle-aged and older adults without partners have lower levels of physical and mental health and higher levels of loneliness than those with partners. Those without partners and children (the "kinless") interact less with relatives than those who have children but not partners, but more with friends, showing some substitution. In terms of civic participation, kinless middle-aged and older adults have significantly lower odds of this type of engagement than peers with close kin. Our interaction models find some differences by age, gender, and education, which vary by the outcome.

DISCUSSION

Our results highlight some concerns about the well-being of kinless adults in Canada, especially as related to physical and mental health and two aspects of social health, loneliness, and civic participation. We find some substitution occurring, whereby middle-aged and older adults without family are interacting more with friends than comparable peers, but such substitution is marginal.

Changes in family composition and their effects on social capital in old age: evidence from a longitudinal study conducted in Switzerland

Previous studies have shown that family networks evolve over time. Nonetheless, little research has linked family expansion or shrinking to the levels of available family-based social capital in older adults’ family networks. To address this research gap, this paper explores the following question: to what extent are changes in family composition and family-related life events associated with current levels of family-based social capital in later years? We use the two waves of the longitudinal CIGEV-LIVES Vivre-Leben-Vivere study, a large survey addressing the family and health conditions of older people in Switzerland. We combine data on life events occurring during old age and family configurations. We find that family networks are indeed highly dynamic, with distinct patterns of losses and gains observed among respondents. Adding and omitting significant family members has distinct significant effects on social capital, while family-related life events only have marginal effects.

Proactive Personality and Social Support With Pre-retirement Anxiety: Mediating Role of Subjective Career Success

The main objective of this paper is to investigate the mediating role of subjective career success (SCS) in the relationship between proactive personality, social support (SS), and pre-retirement anxiety. Using a two-wave longitudinal design, 624 pre-retirees were sampled (M = 56.49 years; SD = 4.56); of these, 237 (37.98%) were males and 387 (62.02%) were females. Measurement model and mediation test were performed using the SmartPLS and IBM SPSS Amos software. The result indicated that proactive personality, SS, and SCS showed negative relationships with the dimensions of pre-retirement anxiety (financial preparedness, social obligation, and social alienation). Subjective career success mediated the relationship between proactive personality and pre-retirement anxiety.

Psychometric properties of modified MOS social support survey 5-item (MSSS-5-item) among Iranian older adults

BACKGROUND

Social support is a key factor in public health. Since the precise evaluation of it is critical, the current study has been developed to evaluate the psychometric properties of the MOS-SSS questionnaire's abbreviated form (MSSS-5-item) among the Iranian older adults.

METHODS

This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The questionnaire was first translated into Persian through the Forward & Backward method based on WHO guidelines. Next, the validity of scales was investigated by calculating face validity, content validity, Known-group validity, explanatory factor analysis, and confirmatory factor analysis indices. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability. Moreover, the scalability of the questionnaire was checked through the Mokken scale analysis. The software packages SPSS version 22, AMOS version 22, and R (Mokken package) were employed to analyze the data.

RESULTS

the face validity was conducted using interviews with older adults and gathering the specialists' opinions. Then, the items were grammatically and lexically corrected accordingly. The CVI index of the overall scale was 0.94, and for every single item above 0.89. The results of the independent t-test showed that the current questionnaire well distinguished between the older adults who do and do not feel lonely (p < 0.001). Two components were recognized according to the explanatory factor analysis. They together explained 67.78% of the total variance of the questionnaire. The CFA showed that the two-factor model had acceptable fit indices. The questionnaire had desirable internal consistency (α = 0.78), stability (ICC = 0.98), and absolute reliability (SEM = 0.56, MDC = 1.57). Furthermore, the Mokken scale proved that MSSS-5-item was a strong scale (H = 0.51, se = 0.03).

CONCLUSION

The present study results showed that the MSSS-5-item questionnaire had suitable validity and reliability to be used among Iranian older adults.

Predicting change in perceived social support in late life: The role of personality and gender

OBJECTIVES

Perceived social support (PSS) has a uniquely beneficial effect on physical and mental health in older adults, yet relatively little is known about patterns of change in PSS during late life. The purpose of this study was to identify risk factors related to individual-level change in PSS, with a focus on personality (specifically Neuroticism and Extraversion) and gender as primary variables of interest.

METHOD

The study sample consisted of 409 community-dwelling, healthy older adults (56.5% female) who were followed annually for up to five years. Personality traits were analyzed independently and as combined Neuroticism-Extraversion quadrants. Linear mixed effect models (LMEM) and Cox proportional hazards regression were used to examine continuous change and incidence of decline in PSS, respectively. Analyses were conducted for the entire sample and in stratified models in order to explore the potential moderating effect of gender.

RESULTS

Personality was identified as a significant predictor of PSS change, including personality quadrants and High Neuroticism alone. Stratified models revealed significant gender differences, with High Neuroticism-Low Extraversion and High Neuroticism alone consistently linked to PSS decline in males, while Low Neuroticism-Low Extraversion was linked to PSS decline in females.

CONCLUSION

Patterns in LMEM and Cox model results suggest that PSS decline in males is likely associated with High Neuroticism, while PSS decline in females may be associated instead with Low Extraversion. Future clinical implications include earlier identification of individuals who are at risk for decreased social support, and its related impact on health.

Longitudinal stability of medial temporal lobe connectivity is associated with tau-related memory decline

The relationship between Alzheimer's disease (AD) pathology and cognitive decline is an important topic in the aging research field. Recent studies suggest that memory deficits are more susceptible to phosphorylated tau (Ptau) than amyloid-beta. However, little is known regarding the neurocognitive mechanisms linking Ptau and memory-related decline. Here, we extracted data from Alzheimer's Disease Neuroimaging Initiative (ADNI) participants with cerebrospinal fluid (CSF) Ptau collected at baseline, diffusion tensor imaging measure twice, 2 year apart, and longitudinal memory data over 5 years. We defined three age- and education-matched groups: Ptau negative cognitively unimpaired, Ptau positive cognitively unimpaired, and Ptau positive individuals with mild cognitive impairment. We found the presence of CSF Ptau at baseline was related to a loss of structural stability in medial temporal lobe connectivity in a way that matched proposed disease progression, and this loss of stability in connections known to be important for memory moderated the relationship between Ptau accumulation and memory decline.

Insecurity about getting old: age-contingent self-worth, attentional bias, and well-being

Objectives: Older adulthood has often been recognized as a time of increased well-being and positive cognitive biases. However, older adults can also experience many social and identity challenges. We sought to investigate which older adults might be most vulnerable to these difficulties. We propose that to the extent an older adult has age-related contingent self-esteem they will be at risk for lower well-being and negative attentional biases.Methods: Across three studies, we measured older adults' self-reported aging self-worth contingencies, as well as various measures of well-being including subjective stress. We then had participants complete a cued-dot probe task, where each trial either began with an aging threat or not.Results: In an initial pilot study, we found that older adults reporting specific cognitive decline contingencies held an attentional bias toward rejection, primarily when cued with the word senile. In Study 1, we found general aging contingencies to be associated with lower well-being and a rejection bias when cued with old. In Study 2, we found that a stronger rejection bias, particularly when cued with old, was associated with greater stress.Conclusions: These findings demonstrate that older adults who are insecure about aging may have lower well-being and negatively biased social cognitive patterns. Negatively biased attentional patterns may play a key role in maintaining feelings of insecurity. Importantly, our research sheds light on those older adults who may not experience a positivity effect.

A Framework on Division of Work Tasks between Humans and Robots in the Home

This paper analyzes work activity in the home, e.g., cleaning, performed by two actors, a human and a robot. Nowadays, there are attempts to automate this activity through the use of robots. However, the activity of cleaning, in and of itself, is not important; it is used instrumentally to understand if and how robots can be integrated within current and future homes. The theoretical framework of the paper is based on empirical work collected as part of the Multimodal Elderly Care Systems (MECS) project. The study proposes a framework for the division of work tasks between humans and robots. The framework is anchored within existing research and our empirical findings. Swim-lane diagrams are used to visualize the tasks performed (WHAT), by each of the two actors, to ascertain the tasks’ temporality (WHEN), and their distribution and transitioning from one actor to the other (WHERE). The study presents the framework of various dimensions of work tasks, such as the types of work tasks, but also the temporality and spatiality of tasks, illustrating linear, parallel, sequential, and distributed tasks in a shared or non-shared space. The study’s contribution lies in its foundation for analyzing work tasks that robots integrated into or used in the home may generate for humans, along with their multimodal interactions. Finally, the framework can be used to visualize, plan, and design work tasks for the human and for the robot, respectively, and their work division.

Understanding Computer-Mediated Support Groups: A Revisit Using a Meta-Analytic Approach

The increasing popularity of computer-mediated support groups (CMSGs) has drawn scholarly attention in recent decades. Fifteen empirical controlled studies have been published since Rains and Young's meta-analysis, showing mixed results, with a large variation of effect sizes ranging from -.77 to 1.33 in Cohen's d. To provide a better understanding of CMSGs, the current study meta-analyzed these 15 newly published studies along with the studies included in Rains and Young's meta-analysis, and tested study design and demographic moderators that have not been examined before. In addition, the study also revisited group size as a moderator and provided updated results with a larger sample size. Theoretical and practical implications of findings are discussed.

Social Support and Life Satisfaction of Ethnic Minority Elderly in China

Previous studies indicate that Han and ethnic minority groups in China are not homogeneous. However, little research has examined potential heterogeneity in the association between social support and life satisfaction across Han and ethnic minority elderly. Based on data from the 2014 China Longitudinal Aging Social Survey, this study uses ordered logit models with interaction terms to examine the relationship between social support and the life satisfaction of ethnic minority elderly and of elderly Han Chinese. We find that support from families and friends has a stronger association with the life satisfaction of ethnic minority elderly than their Han peers. For ethnic minority elderly, the patterns of family support varied according to rural or urban residence, with family support being less important to the life satisfaction of ethnic minority elderly living in urban communities than in rural areas. Our findings suggest that social policy should take this heterogeneity between ethnic groups into account.

Aging: Lessons for Elderly People from Monkeys

As life expectancy increases, health in the elderly is a growing issue. Health is linked to remaining socially active, but the elderly typically narrow their social networks. The social life of aging monkeys shows interesting parallels, indicating social patterns may be rooted in evolution.

Assessing Change in Social Support During Late Life

The purpose of this study is to evaluate change in 14 measures of social support with data provided by a nationwide longitudinal study of older adults. The findings reveal that fairly substantial change took place during the three-year follow-up period. More important, the data indicate that change is not uniform or systematic across the entire study sample. Instead, there appears to be considerable individual-level change taking place. The implications of these findings for the development of conceptual models as well as support-based interventions are discussed.

What Are Friends for? Friendships and Loneliness Over the Lifespan—From 18 to 79 Years

Preventing and reducing loneliness is crucial to well-being and good health. Social relationships protect people against loneliness. Friendship qualities like intimacy and frequency of contact may vary throughout a person’s lifespan. This study explores aspects of friendship and loneliness among people in different age groups: 18 to 29, 30 to 49, 50 to 64, and 65 to 79 years old. Data are from the Norwegian Life Course, Gender and Generations study ( N = 14,725). Young people see their friends most often. The proportion of people without confidant friends is higher among older age groups. However, older age groups report higher levels of satisfaction with their contact with friends. Multivariate regression analyses show that the aspiration for contact with friends is more significant to loneliness than actual contact in all age groups. Dissatisfaction with contact with friends is strongly related to loneliness in all age groups.

The Impact of Support Received and Support Provision on Changes in Perceived Social Support among Older Adults

The current study uses longitudinal data from the 1993 U.S. Midwest floods to examine the influence of support received and support provision on changes in perceived social support among older adults exposed to an acute stressor. Results indicated that flood exposure and higher levels of social support at Time 1 were positively associated with both receiving social support and providing social support specific to the food. Individuals with higher levels of support provision and received support in turn reported higher levels of perceived support post disaster. Women were more likely to have received flood specific support and to have perceived higher social support post flood. This study provides support and elaboration of earlier findings that link disaster exposure to post-disaster changes in perceived social support.

The Influence of Living Alone on Depression in Elderly Persons

The mental health effects of living alone on elderly persons are not well known. Using multiple regression models, the authors attempted to distinguish the influence of living alone on depressive symptoms from the influence of other highly relevant variables: social support, stressors, age, sex, and marital status. The data derive from a stratified community probability sample of persons 50 years of age and older. The authors find that elderly persons who live alone have higher levels of depressive symptomatology; and this relationship is independent of the influence of expressive support from friends, face-to-face interaction with friends, undesirable life events, disability, and financial strain. The depressive influence of living alone is greater on men than women. Undesirable health events have a stronger impact on those who live alone, particularly women. Marital status influences depression indirectly through its influence on living alone. Implications of these and other findings are discussed.

Patterns of Social Relationships and Psychological Well-being among the Elderly

On the premise that social relationships among elderly adults differ in terms of the most significant, dominant figure, this study aimed to examine: (1) whether there were qualitative differences in supportive functions between family-dominant and friend-dominant affective relationships, and (2) whether “lone wolves”, who were deficient in human resources, had difficulties in maintaining their well-being. A total of 148 Japanese, over the age of 65, both living in communities and in institutions were individually interviewed about their social relationships using a self-report type method, the Picture Affective Relationships test, and their well-being was assessed using Depression, Self-esteem, Life satisfaction, and Subjective health scales. Results showed that there were no differences in psychological well-being between family-dominant and friend-dominant participants, but those who lacked affective figures had lower scores in subjective well-being than did their family-dominant and friend-dominant counterparts. The generalisation of these findings to other cultures is discussed.

Predictors of Perceived Support Quality in Visually Impaired Elders

Although there is a strong empirical link between support quality and health in later life, research on the predictors of support quality is lacking. Significant predictors of components of kin and non-kin perceived support quality were identified and compared in 241 visually impaired elders reporting on their closest friend and closest family member. Results revealed differ ential patterns of predictors for family and friend support components. Having a spouse as closest family member was associated with higher perceived affective and instrumental family support. Significant interactions for family relationship type and sex showed that for males, but not females, having a spouse as closest family member was associated with lower perceived affective and informational friendship support. Participant age was positively associated with instrumental family support, but negatively associated with instrumental and affective friendship sup port. Overall, functional disability had a negative association with support quality. Strategies for increasing support quality are discussed.

Very-Old Rural Adults: Functional Status and Social Support

This 20-year follow-up study examined the physical, psychological, and social outcomes, and social supports of 49 survivors of an original sample of 418 rural adults who were aged 65 years and older in 1976. The majority of adults lived alone but received regular assistance. Families, especially adult children, were their primary social supports. Very few formal supports were used. Psychological well-being among the very-old was good as expressed through life satisfaction and morale, despite multiple health problems and moderate levels of dependence on others for activities of daily living and instrumental activities of daily living. Both the cross-sectional and the longitudinal data from this study support the need to rethink issues of social support, independence, and family relationships in very-old age.

Projection of young-old and old-old with functional disability: does accounting for the changing educational composition of the elderly population make a difference?

This study compares projections, up to year 2040, of young-old (aged 60-79) and old-old (aged 80+) with functional disability in Singapore with and without accounting for the changing educational composition of the Singaporean elderly. Two multi-state population models, with and without accounting for educational composition respectively, were developed, parameterized with age-gender-(education)-specific transition probabilities (between active, functional disability and death states) estimated from two waves (2009 and 2011) of a nationally representative survey of community-dwelling Singaporeans aged ≥60 years (N=4,990). Probabilistic sensitivity analysis with the bootstrap method was used to obtain the 95% confidence interval of the transition probabilities. Not accounting for educational composition overestimated the young-old with functional disability by 65 percent and underestimated the old-old by 20 percent in 2040. Accounting for educational composition, the proportion of old-old with functional disability increased from 40.8 percent in 2000 to 64.4 percent by 2040; not accounting for educational composition, the proportion in 2040 was 49.4 percent. Since the health profiles, and hence care needs, of the old-old differ from those of the young-old, health care service utilization and expenditure and the demand for formal and informal caregiving will be affected, impacting health and long-term care policy.

Transitions in Relationships With Older Parents: From Middle to Later Years

OBJECTIVE

Although intergenerational relationships have been extensively examined, studies applying dynamic multidimensional treatments are rare. Employing the life course framework and the intergenerational solidarity and ambivalence paradigms, a typology of intergenerational relationships was derived and propositions about dynamics of intergenerational relationships were tested.

METHOD

Using latent transition analysis, we modeled 4 waves of panel data spanning 18 years from the Longitudinal Study of Generations to examine how older parent-child relationships (N = 938) transitioned in and out of complex relational configurations.

RESULTS

We derived 5 relationship types roughly corresponding to those found in earlier research. Transitions in relationship type occurred mostly when both generations were relatively young, and along the lines of what attachment, ambivalence, and latent kinship theories would predict. When change did occur, it was primarily structured by factors affecting the availability of adult children, as well as circumstances that elevated the dependency of older parents and promoted both positive and negative reactivity in their adult children.

DISCUSSION

This study has demonstrated how typological analysis captures both the complexities and dynamics of intergenerational relationships in mature families. By including behavioral, emotional, and normative aspects of later life intergenerational relationships, we told a story that was more about continuity than change.

Who are Lonely? Loneliness in Different Age Groups (18–81 Years Old), Using Two Measures of Loneliness

This study asks if the prevalence of loneliness in the population varies depending on the measures used, with special focus on loneliness among the elderly. The study compares loneliness in different age groups between 18 and 81 years old ( N = 14,743) using two measures of loneliness: the (indirect) six-item De Jong Gierveld Loneliness Scale and a single-item, direct question about loneliness. Data are from the Norwegian LOGG (Life Course, Generation, and Gender) study. We compare the findings on loneliness according to age, gender, health, and partner status. Overall, the two loneliness measures indicate a similar prevalence of loneliness, but attribute loneliness to somewhat different people. When using a direct measure, loneliness is more prevalent among women; when using the (indirect) De Jong Gierveld Scale, loneliness is more prevalent among men. Also, the association between age and loneliness differed when using the direct and the indirect measure.

Changes in support networks in late middle age: the extension of gender and educational differences

OBJECTIVES

This paper tests whether differences by gender and by educational attainment in contact with friends and family and in support expected from friends and family narrow or widen in late middle age.

METHODS

The data are drawn from about 4,800 members of the Wisconsin Longitudinal Survey who answered questions about their frequency of contact with social ties and expectations of 3 kinds of help in both 1993, when they were in their early 50s, and again in 2004.

RESULTS

Using lagged dependent variable models, we find that between their 50s and 60s women's network advantages over men and college graduates' network advantages over high school graduates in frequency of social contact widened. The same was roughly true as well for expectations of social support, although here the divergences depended partly on the type of the support: Women gained relative to men in "talk" support and in help from nonkin if ill, but lost ground in financial support. The college-educated gained ground in all sorts of support from nonkin.

DISCUSSION

These results reinforce concern that late middle age is a period when men and the less educated become yet more disadvantaged in social support, making attention to connectedness yet more critical.

Total hip arthroplasty for hip fractures: 5-year follow-up of functional outcomes in the oldest independent old and very old patients

INTRODUCTION

This study aimed to determine the dislocation and reoperation rate, functional outcomes, and the survival rate of the unique subset of very old but lucid and independent patients with hip fractures following a total hip arthroplasty (THA) and geriatric team-coordinated perioperative care.

METHOD

Between 2000 and 2006, previously independent ambulatory patients ≥80 years old presenting with an intracapsular hip fracture were given THAs under the care of an integrated orthopedic surgery-geriatric service. Their fracture-related complications, ambulation, mental status, and survival were followed for 5 to 11 years postinjury.

RESULTS

Five years postinjury, 57 (61.3%) patients of the original study group were living. In all, 3 (3.2%) patients had postoperative hip dislocations (and 2 patients had dislocation twice) and 2 reoperations were needed within the first postoperative month. There were no hip dislocations or reoperations after the first year. Radiographs obtained on 88% of the surviving patients at 5 years postoperatively showed that all remained unchanged from their immediate postoperative images. Nearly half of the patients were still able to ambulate as they did preoperatively and their mixed-model equation was statistically unchanged.

CONCLUSION

This study of patients >80 years old with previously good functional status demonstrates that with appropriate surgical (best prosthesis, good operating technique, and regional anesthesia) and geriatric (pre- and postoperative assessments, close follow-up, medication adjustments, and fall-prevention instruction) care, they have few hip dislocations and reoperations, survive postfracture at least as long as their noninjured contemporaries, and continue to function and ambulate as they did prior to their injury.

Psychosocial stressors in inter-human relationships and health at each life stage: A review

Currently, psychosocial stressors' impacts on health are increasing. Among these stressors, this review focused on inter-human relationships. Since social supports could be protective against ill health, consequences contributing to psychosocial stressors are discussed here in relation to social supports for each stage of childhood, adulthood and elderly status.For childhood, parental divorce/isolation, and child abuse/neglect appeared to be determinants of healthy development at either the initial or later stages. According to prospective studies, such stressors, especially those occurring until around 3 years of age, were associated with later adverse life quality in adulthood. Therefore, nationwide preventive strategies were developed in each country to monitor protective social programs.For adulthood, job strain was focused on Karasek's job strain model, effort-reward imbalance, employment grade and working hours. These psychosocial stressors were shown to affect not only the physical health but also the mental health of working people. These days, since Karoshi and even suicide related to excessive workloads are taking a toll on workplace organization, stress-coping abilities such as a sense of coherence were introduced from the individual-social interaction aspect.For elderly status, retirement, caring for the elderly, and spouse bereavement were discussed as psychosocial stressors. Some evidence indicates that these stressors could be determiants of health. Finally, social supports have been demonstrated to promote health and protect the elderly against diseases and death.

The risk to enduring relationships following the move to a care home

Aim.  To explore findings from a study which investigated the meanings that older people attributed to their experiences of living in a care home and consequently the risks that they identify in this. Background.  There is evidence from this and other studies that being able to engage in long-time friendships is important to older people. The move to a care home has the potential to disrupt these relationships and there is a risk of breakdown of the friendships that have been valued throughout life. Method.  A hermeneutic inquiry that explored the meaning that eight older people ascribed to their life in the care home. This paper focuses on the narratives that concerned relationships with long-time friends and the risks to these relationships. Results.  The paper highlights the importance of engaging in meaningful relationships with other people. The participant's stories illuminated the importance of maintaining friendships following the move to a care home and how these had had a positive impact on their lives in that setting. With advancing age and increasing frailty the participants were acutely aware that their friendships were vulnerable to breakdown and they implemented a range of strategies to sustain their relationships with these people. Conclusion.  The findings point to the importance of acknowledging the value of long-time friendships to older people and the need to support them in their efforts to sustain these relationships and reduce risks to them.

Changes in social support within the early recovery period and outcomes after acute myocardial infarction

OBJECTIVE

To examine changes in social support during early recovery after acute myocardial infarction (AMI) and determine whether these changes influence outcomes within the first year.

METHODS

Among 1951 AMI patients enrolled in a 19-center prospective study, we examined changes in social support between baseline (index hospitalization) and 1 month post-AMI to longitudinally assess their association with health status and depressive symptoms within the first year. We further examined whether 1-month support predicted outcomes independent of baseline support. Hierarchical repeated-measures regression evaluated associations, adjusting for site, baseline outcome level, baseline depressive symptoms, sociodemographic characteristics, and clinical factors.

RESULTS

During the first month of recovery, 5.6% of patients had persistently low support, 6.4% had worsened support, 8.1% had improved support, and 80.0% had persistently high support. In risk-adjusted analyses, patients with worsened support (vs. persistently high) had greater risk of angina (relative risk=1.46), lower disease-specific quality of life (β=7.44), lower general mental functioning (β=4.82), and more depressive symptoms (β=1.94) (all p≤.01). Conversely, patients with improved support (vs. persistently low) had better outcomes, including higher disease-specific quality of life (β=6.78), higher general mental functioning (β=4.09), and fewer depressive symptoms (β=1.48) (all p≤.002). In separate analyses, low support at 1 month was significantly associated with poorer outcomes, independent of baseline support level (all p≤.002).

CONCLUSION

Changes in social support during early AMI recovery were not uncommon and were important for predicting outcomes. Intervening on low support during early recovery may provide a means of improving outcomes.

Are changes in financial strain associated with changes in alcohol use and smoking among older adults?

OBJECTIVE

This study aimed to assess whether changes in levels of financial strain are associated with changes in alcohol use and smoking among older adults.

METHOD

Multilevel analyses were conducted using longitudinal data from a randomly selected national sample of older adults (N = 2,352; 60% female). The data were collected in six waves during the period of 1992-2006. We estimated associations between within-person changes in levels of financial strain and the odds of engaging in heavy drinking and smoking, while also testing for the moderating effects of gender, education, and age.

RESULTS

A direct association was observed between changes in levels of financial strain and the odds of heavy drinking, particularly among elderly men (odds ratio [OR] = 1.31) and those with low levels of education (OR = 1.27). A direct association between changes in levels of financial strain and the odds of smoking was also evident, particularly among the young-old (i.e., age 65 at baseline; OR = 1.44).

CONCLUSIONS

Exposure to financial strain places some groups of older adults at increased risk for unhealthy drinking and smoking. If the current global financial crisis leads to increases in experiences of financial strain among older adults, alcohol and smoking problems can also be expected to increase in this population.

Better With Age: Social Relationships Across Adulthood

Older adults typically report higher levels of satisfaction with their social relationships than younger adults. The present paper integrates current developmental research to explain why social relationships are generally more positive with age. We discuss actions by older adults that contribute to more positive social experiences. We also include social role changes that may provide advantages for older adults when navigating their relationships. Next, we turn to interactional processes between older adults with their social partners. We review literature indicating that: (a) older adults engage in strategies that optimize positive social experiences and minimize negative ones by avoiding conflicts, and (b) social partners often reciprocate by treating older adults more positively and with greater forgiveness than they do younger adults.

Social Support and Family Care of the Elderly

Cet article traite des différentes facettes du support social dans le contexte de l'aide familiale aux personnes âgées. Il met l'accent sur la nécessité de faire preuve d'une plus grande précision empirique et théorique lorsqu'on rapporte les types spécifiques de réponses symboliques et concrètes aux exigences des aidants familiaux confrontés à de lourdes tâches. Cet article, en outre, met en lumière trois sujets vitaux pour la recherche futur: (1) examiner de quelle façon le soutien social et familial est affecté par ceux qui vivent un stress chronique (et comment il les affecte à leur tour); (2) examiner les déterminants du support familial réel ou possible; (3) établir le cadre général des interventions conçues pour amplifier l'aide assurée aux aidants familiaux et enfin procéder à l'évaluation de ces interventions.

Le veuvage chez les hommes et les femmes âgés, une étude exploratoire des significations et des stratégies adaptatives

L'objectif principal de cette étude exploratoire était de mettre au point, à partir d'un devis qualitatif inspiré de la méthode ethnographique, une approche de recherche facilitant la compréhension de l'expérience du veuvage et le choix des stratégies adaptatives utilisées suite à la perte du conjoint chez les hommes et les femmes âgés. Des entrevues de type ethnographique ont été réalisées au domicile d'informateurs-clés a l'aide d'un guide semi-dirigé élaboré à partir d'un cadre conceptuel inspiré d'un modèle de gestion du stress. Les entrevues ont été enregistrées, le verbatim retranscrit, et les données ont été codées par deux juges indépendants à partir du cadre conceptuel de l'étude ainsi que des nouvelles catégories générées au moment de l'analyse. Les resultats montrent que la signification du veuvage et le choix des stratégies adaptatives sont influencés par des facteurs personnels reliés à la trajectoire de vie, à la centralité du conjoint et à une perception d'auto-efficacité; des facteurs contextuels tels les standards normatifs et les valeurs culturelles qualifient de fagon différentielle le veuvage des hommes et des femmes. Parmi les stratégies adaptatives utilisées, le recours au soutien social paraît tributaire de caractéristiques qualitatives telles la réciprocité et la fiabilité des sources d'aide. L'approche développée dans le cadre de ce projet permet une meilleure compréhension des facteurs contextuels qui expliquent la variabilité des réactions que développent, sur le plan de la santé mentale, les personnes âgées confrontées à la perte de leur conjoint ainsi qu'à d'autres stresseurs de leur vie quotidienne.

Health and Happiness for Elderly Institutionalized Canadians

Cette étude explore les facteurs déterminants de l'autoévaluation de la santé et du bonheur chez les aîné(e)s vivant en établissement d'après l'Enquête nationale sur la santé de la population de 1994/95. On a établi des modèles distincts de régression de logistique ordinale pour l'autoévaluation de la santé et du bonheur dans un sous-échantillonnage de 780 aîné(e)s vivant en établissement. Les résultats indiquent que les aîné(e)s canadien(ne)s vivant en établissement évaluent leur santé et leur bonheur à divers degrés et que l'on peut prédire les variations en fonction des caractéristiques démographiques, des facteurs de maladie, de l'invalidité et de l'intégration sociale. Une évaluation positive de la santé et du bonheur est toujours associée à un plus grand âge, à un degré réduit de maladie chronique, à un faible degré perçu de difficultés de mémoire et à moins de douleur. Alors que la bonne santé se joint à un plus grand degré d'instruction et de liberté de déplacement, le bonheur se relie à un meilleur réflexe d'agrippement, à une plus forte fréquentation des activités communes de l'établissement et de la communauté et à un horaire plus flexible. Ces résultats entraînent des conséquences importantes puisque plusieurs des facteurs relevés peuvent être modifiés par des programmes de rééducation ou des interventions infirmières.

Differential Psychological Ageing: Profiles of the Old and Very Old

Theoretical positions which argue for age-related and individual variation in profiles of psychological functioning and patterns of predictive relationships are reviewed in the context of the three domains investigated by the Psychology Unit of the Berlin Aging Study (BASE): intelligence and cognition, self and personality, and social relationships. To illustrate the potential of BASE, we report initial data for a small set of variables from these three psychological domains for the first wave of study participants (N = 360, age range 70 to 103 years). Our analyses of these data were targeted toward three key questions about differential psychological ageing: namely, the extent of age/cohort-related differences and individual variation within each domain, possible age differences in the structural relationships between the three domains, and subgroup variations in cross-domain profiles of functioning. Within domains, individual differences in general were very large. Chronological age accounted for a sizeable proportion of the variance only in the domain of cognitive performance. The structural relationships between the domains of psychological functioning were similar for the old and very old age groups and reflected much domain independence. Examination of subgroup variations in cross-domain profiles of functioning revealed ten subgroups. All subgroups showed an uneven, that is, age-selective group membership: five subgroups included more of the very old, two more of the old, and three were age-specific. Preliminary explorations of these subgroups suggested substantial links to selected health-related variables, supporting proposals for multi-disciplinary research into differential ageing.

Quality of life of elderly persons with cancer: a 6-month follow-up

The aim of this study was to investigate possible changes in quality of life (QoL) in elderly persons diagnosed with cancer (65 years and above), in relation to age, contact with the health-care system, activities of daily living, hope, social network and support. The investigation points were at time of diagnosis (baseline), and again 3 and 6 months after the diagnosis. The study also aimed to investigate which of the aforementioned factors predicted deteriorated QoL in elderly persons with cancer from baseline to the 6-month investigation. At baseline, the sample consisted of 101 individuals aged (age 65+) recently diagnosed with cancer (74 women, 27 men), but was reduced to 75 (57 women, 18 men) by the 6-month investigation point. EORTC QLQ C30, Katz ADL, Nowotny's Hope Scale and Interview Schedule for Social Interaction were used in structured personal interviews and questionnaires. Emotional function improved significantly over time, and complaints of nausea and vomiting decreased. Contact with a district nurse at baseline predicted deteriorated QoL from baseline to 6 months later. Support from grandchildren increased significantly. About 30% of the total sample deteriorated in QoL, by the significant >/=10 units, from baseline to 6-month follow-up, while about 70% remained stable in QoL from baseline. The majority of the elderly persons with cancer showed an ability to adjust to the new condition. However, in clinical practice, specific attention should be paid to the most vulnerable groups of elderly persons with cancer: those with advanced disease and decreased hope, and those with increased need of both informal and formal assistance.

Marital disruptions and loss of support in later life: a longitudinal study of the United Kingdom

Marital disruption (i.e. due to death, divorce or separation) at older ages is an important issue as it removes the usual primary source of help and support: a husband or wife. To date, few studies have investigated the support implications (both informal, here defined as perceived support and social embeddedness and formal, defined as use of domiciliary care services) of marital disruptions in later life. This issue needs addressing as widow(er)hood and divorce are increasingly occurring at older ages. Employing data from the longitudinal British Household Panel Survey (BHPS) (1991-2003) we investigated the association between marital disruption and first loss of (a) perceived support and (b) at least weekly contact with at least one non-relative friend, among those aged 50 and over. We also examined first use of domiciliary care services (i.e. health visitor or district nurse, home help or meals-on-wheels) among those aged 70 and over. Our findings show that marital separation increased the odds of losing perceived support whereas widow(er)hood showed no significant association among people aged 50 and over. Separation and widow(er)hood increased the odds of losing weekly contact with non-relative friends (although the odds were greater for separation) in this age group. Finally, widow(er)hood increased the odds of using domiciliary care services among respondents aged 70 and over.

Effects of racist provocation and social support on cardiovascular reactivity in African American women

It has been speculated that exposure to the chronic stress of racism contributes to the high rates of hypertension among African Americans. Social support may buffer the effects of stress on cardiovascular (CV) health by attenuating stress-induced CV responses that have been linked to hypertension. In this study we investigated the effects of racism and social support on CV reactivity in African American women. Participants showed greater increases in CV and emotional responses while responding and listening to racist provocation. Augmented blood pressure (BP) persisted through recovery following racial stress. Participants receiving no support showed the greatest increases in anger during racist provocation. No significant effects were seen for support on CV reactivity. These results provide some of the first evidence that interactive confrontation with racism elicits significant increases in CV reactivity and emotional distress. Furthermore, individuals receiving less support may be at greater risk for the potentially health-damaging effects of racial stress. These findings may have significant implications for the health of African Americans.

Chronic pain self-management for older adults: a randomized controlled trial [ISRCTN11899548]

BACKGROUND

Chronic pain is a common and frequently disabling problem in older adults. Clinical guidelines emphasize the need to use multimodal therapies to manage persistent pain in this population. Pain self-management training is a multimodal therapy that has been found to be effective in young to middle-aged adult samples. This training includes education about pain as well as instruction and practice in several management techniques, including relaxation, physical exercise, modification of negative thoughts, and goal setting. Few studies have examined the effectiveness of this therapy in older adult samples.

METHODS/DESIGN

This is a randomized, controlled trial to assess the effectiveness of a pain self-management training group intervention, as compared with an education-only control condition. Participants are recruited from retirement communities in the Pacific Northwest of the United States and must be 65 years or older and experience persistent, noncancer pain that limits their activities. The primary outcome is physical disability, as measured by the Roland-Morris Disability Questionnaire. Secondary outcomes are depression (Geriatric Depression Scale), pain intensity (Brief Pain Inventory), and pain-related interference with activities (Brief Pain Inventory). Randomization occurs by facility to minimize cross-contamination between groups. The target sample size is 273 enrolled, which assuming a 20% attrition rate at 12 months, will provide us with 84% power to detect a moderate effect size of.50 for the primary outcome.

DISCUSSION

Few studies have investigated the effects of multimodal pain self-management training among older adults. This randomized controlled trial is designed to assess the efficacy of a pain self-management program that incorporates physical and psychosocial pain coping skills among adults in the mid-old to old-old range.