Multiple trajectories of successful aging of older and younger cohorts

Effect of multi-level social risk factors on developmental trajectories of sexual risk behaviors among Bahamian middle-to-late adolescents

Background

Few studies have examined how multi-level social factors interact and affect developmental patterns of sexual risk among middle-to-late adolescents who are at risk of experiencing sexual risk behaviors. We examined developmental trajectories of sexual risk behaviors of boys and girls in middle-to-late adolescence and the effects of exposure to three social risk factors (poor parental monitoring, peer risk, and neighborhood risk).

Methods

We followed 2,332 Bahamian adolescents every six months from Grades 10-12. We used group-based trajectory modeling to identify distinct trajectories of sexual risk behaviors for boys and girls.

Results

We identified three trajectories each for boys and girls. Peer risk and neighborhood risk predicted a high sexual-risk trajectory for boys, and peer risk (alone or combined with other risk factors) had the greatest impact on the membership of moderate-to-high-risk trajectory for girls. Parental monitoring had a relatively small effect on adolescents' sexual risk behavior.

Conclusion

Our results underscore the importance of early identification of adolescents with sexual risk behavior and development of targeted prevention interventions to improve adolescent health outcomes.

Life Satisfaction Trajectories and Associated Factors in Middle-Aged and Older Mexican Adults

BACKGROUND

Given the importance of understanding psychosocial well-being as part of aging characteristics and processes, the present study aimed to describe life satisfaction among middle-aged and older adults in Mexico, according to sociodemographic, economic, psychosocial, and health factors.

METHODS

Data were obtained from the Mexican Health and Aging Study (MHAS), a longitudinal, nationally representative survey of adults aged 50 years and older. Data from the 2012, 2015, and 2018 waves were analyzed for this study. Life satisfaction in the MHAS is assessed using the Spanish version of the Satisfaction with Life Scale (SWLS). For the construction of the trajectories over six years of follow-up, quartiles of the scale were calculated for each wave. Multinomial regression models were then estimated to determine significant factors associated with each trajectory.

RESULTS

A total of 8,376 individuals aged 50 years and older met our study criteria for complete data in the three follow-up waves. Four life satisfaction trajectories were identified over six years of follow-up: high-constant, high-low, low-high, and low-constant. Subjective or psychosocial characteristics such as depressive symptoms, self-reported health, and functional ability were highly significant factors associated with life satisfaction trajectories, while multimorbidity was not significant.

CONCLUSIONS

This research contributes to the understanding of psychosocial well-being in Mexican older adults by exploring life satisfaction trajectories and their associated factors. The study shows that psychosocial and economic factors, along with functional abilities, have a much greater impact on life satisfaction, beyond the presence of comorbidity.

Successful ageing is associated with falls among older adults in India: a large population based across-sectional study based on LASI

BACKGROUND

Falls are common in the elderly and can lead to adverse consequences, like injuries, hospitalization, disability even mortality. Successful ageing emerged in sight to assess physical, psychological and social status of older adults. This study is conducted to explore the association between them in a large Indian community-dwelling population.

METHODS

Data were based on the wave 1 survey of the Longitudinal Ageing Study in India (LASI). People aged 60 and above with complete information were included. The elderly met five standards including absence of chronic diseases, freedom from disability, high cognitive ability, free from depressive symptoms and active social engagement, were classified into successful agers. The assessment of falls, fall-related injuries and multiple falls depended on interview. Multivariate logistic regression was conducted to find the associations between falls, fall-injury, multiple falls and successful ageing after adjusting both socio-demographic and biological covariates. The log-likelihood ratio test was calculated interactions in subgroups.

RESULTS

31,345 participants in LASI were finally included in our study. Of them, 20.25% reported fall, and 25% were classified into successful agers. After full adjustment, successful ageing was negatively associated with falls (OR 0.70; 95%CI 0.65-0.76) and multiple falls (OR 0.70; 95%CI 0.63-0.78). And the association did not show the significance in older adults with fall-related injuries (OR 0.86; 95%CI 0.72-1.04).

CONCLUSIONS

Successful ageing was negatively associated with falls and multiple falls, but not fall-related injuries in older people in India. Future studies are demanded to explore the causal relationship and to reveal the underlying mechanism.

Symptom patterns of comorbid depression and anxiety among older adults in China and their predictors

Comorbid depression and anxiety causes serious psychological and physiological damage for older people. This study aimed to identify heterogeneous classes of comorbid depression and anxiety (CDA) among older people in China and to ascertain predictors of latent class membership. Cross-sectional data of 10,919 cases were extracted from the Chinese Longitudinal Healthy Longevity Survey. Latent profile analysis (LPA) was used to identify symptom patterns of comorbid depression (measured by the 10-item Center for Epidemiologic Studies Depression Scale) and anxiety (measured by the Generalized Anxiety Disorder 7-item Scale). Multinomial logistic regressions following bivariate analyses were used to explore the relationship between the derived classes and individual- and social-level factors. Four patterns of CDA were identified: low symptoms of depression and anxiety (30.52%; n = 3333), mild depression only (53.26%; n = 5815), moderate depression and anxiety (13.82%; n = 1509), and severe depression and anxiety (2.40%; n = 262). Older people who are male, suffer from multimorbidity, and lack a healthy lifestyle are more likely to have problematic symptom profiles. While intimate relationships with partners and children significantly predicted CDA patterns, the effects of sibling relationships, daily life, and emotional support from the community were insignificant. LPA identified four distinct CDA patterns among a representative sample of older Chinese people. While restless sleep, lack of positive emotions, uselessness, and weak concentration are salient across all profiles, "difficult to relax" is prominent in profiles high in anxiety. In addition to individual-level variables, social-level factors, especially intimate relationships with partners and children rather than general links to siblings or the community, have unneglectable impacts on whether and to what extent older Chinese adults suffer from CDA in the cultural context of relationism, patriarchy, and filial piety.

A study protocol for identifying aging trajectories toward chronic neurodegenerative diseases by means of Marche regional administrative databases - TREND project

Background

People are living longer but an increasing number of older people experience chronicity and disability in the latest years of their life. The Marche region is one of the Italian regions where people live the longest lives; therefore, the number of people with age-related chronic diseases is expected to be at least similar, if not higher, compared to the rest of Italy. The identification of the aging trajectories is of huge interest in the arena of public health. Administrative healthcare databases represent valuable reservoirs for reconstructing the trajectories of aging. Here, we present the protocol for a study (TREND project) aimed to integrate existing administrative databases into a Marche regional dataset in order to estimate the prevalence and incidence rates of age-related neurodegenerative diseases (ND), with a specific focus on Parkinsonism and Dementia.

Methods

The TREND Project is a retrospective cross-sectional study. The source population includes permanent residents in the Marche region aged 40 years and older. A minimal dataset has been built up linking data on drug prescriptions, outpatient services, and diagnosis for hospital admission, from 2014 to 2021 in the Marche Region. Data on clinical outcomes (re-hospitalization, mortality, comorbidities), and therapeutic approaches (drugs and medicines) have been integrated with state-of-the-art statistical methods to define patients into different risk clusters and to analyze the aging trend by assessing the Comorbidity Index (CI) as a proxy for chronicity.

Discussion

Our research contributes to the integration of existing administrative databases on ND to create a Marche regional ND database, support regional health policy, and better understand patients' needs and their aging trajectories. This approach could be implemented also at the National level. Moreover, by linking different administrative data sources, this study sheds light on important issues related to ND, such as early-onset dementia; ethical aspects such as anticipated wills; problems of dementia in patients still in the job market, etc. The results of this study will contribute to the successful implementation of integrated care for patients affected by ND at regional or national levels.

Living in poverty and accelerated biological aging: evidence from population-representative sample of U.S. adults

BACKGROUND

Biological aging reflects a decline in the functions and integrity of the human body that is closely related to chronological aging. A variety of biomarkers have been found to predict biological age. Biological age higher than chronological age (biological age acceleration) indicates an accelerated state of biological aging and a higher risk of premature morbidity and mortality. This study investigated how socioeconomic disadvantages influence biological aging.

METHODS

The data from the National Health and Nutrition Examination Survey (NHANES) IV, including 10 nationally representative cross-sectional surveys between 1999-2018, were utilized. The analytic sample consisted of N = 48,348 individuals (20-84 years). We used a total of 11 biomarkers for estimating the biological age. Our main outcome was biological age acceleration, indexed by PhenoAge acceleration (PAA) and Klemera-Doubal biological age acceleration (KDM-A). Poverty was measured as a ratio of family income to the poverty thresholds defined by the U.S. Census Bureau, adjusted annually for inflation and family size (5 categories). The PAA and KDM-A were regressed on poverty levels, age, their interaction, education, sex, race, and a data collection wave. Sample weights were used to make the estimates representative of the U.S. adult population.

RESULTS

The results showed that higher poverty was associated with accelerated biological aging (PAA: unstandardized coefficient B = 1.38 p <.001, KDM: B = 0.96, p = .026 when comparing the highest and the lowest poverty level categories), above and beyond other covariates. The association between PAA and KDM-A and age was U-shaped. Importantly, there was an interaction between poverty levels and age (p <.001), as the effect of poverty was most pronounced in middle-aged categories while it was modest in younger and elderly groups.

CONCLUSION

In a nationally representative US adult population, we found that higher poverty was positively associated with the acceleration of biological age, particularly among middle-aged persons.

Living arrangement of Indian elderly: a predominant predictor of their level of life satisfaction

OBJECTIVE

This article aims to examine the level of life satisfaction (LS) among Indian older adults and to determine whether their living arrangement is one of the potential determinants of their level of LS.

METHODS

Data was drawn from the first and most recent wave of Longitudinal Ageing Study in India conducted in 2017-18. Using the Satisfaction with Life Scale, the level of LS was assessed for 30,370 elderly aged 60 + . Bivariate analysis was carried out to see the variation in the level of LS across elderlies with different socio-demographic characteristics. To investigate the association between LS and living arrangements and the selected socio-demographic factors multinomial logistic regression model was fitted.

RESULT

The findings reveal that 25.4% and 45.5% of the elderlies have reported having a low and high level of LS, respectively. Living alone was associated with low level of LS. Co-residing with a spouse was associated with a higher likelihood of reporting high level of LS. The study also found that having both spouse and children as coresident increases the likelihood of reporting high level of LS (RRR = 3.15, 95%CI = 2.3-4.28). Elderly with self-reported poor health, limitation in more than two activities of daily living and presence of depressive symptoms were significantly associated with reporting low level of LS. However, being diagnosed with more than three chronic illnesses was associated with high level of LS (RRR = 1.41, 95%CI = 1.25-1.59). Older adults with the following characteristics were more likely to report a lower level of LS: male, 60-64 years old, no or few years of schooling, unmarried, working, rural resident, living in a poor household, Scheduled Caste and Tribe.

CONCLUSION

The level of life satisfaction in Indian older adults is significantly associated with their living arrangements, thus suggesting that the LS of older adults could be facilitated through interventions that consider their living arrangements. Older adults with various personal and household characteristics were identified as vulnerable groups, who should be the prime targets of the existing welfare policies.

Multivariate decomposition of gender differentials in successful aging among older adults in India

BACKGROUND

Rowe and Kahn define successful aging as a high physical, psychological, and social functioning in old age without major diseases. It is considered a viable solution to the burdens placed on healthcare systems and financial and social security in societies with aging population. The present study aimed to determine the prevalence of successful aging and explore the factors contributing to gender differentials in successful aging among older adults in India.

METHODS

This study utilized data from the nationally representative Longitudinal Ageing Study in India, conducted in 2017-18. The study is based on a sample of 15,098 older men and 16,366 older women aged 60 years and above. The outcome variable was a dichotomous measure of successful aging with six components including absence of chronic diseases, free from disability, high cognitive ability, free from depressive symptoms, active social engagement in life and free from obesity. Older adults satisfying all these conditions were considered aging successfully. Descriptive and bivariate analyses were carried out. Proportion test was used to evaluate the gender differentials and reflect the statistical significance in the associated factors. Multivariate decomposition analysis was conducted to identify covariates' contribution in explaining the gender differences in successful aging.

RESULTS

There was a significant gender difference in successful aging among older adults in India (Difference: 8.7%; p-value < 0.001] with 34.3% older men and 25.6% older women experiencing successful aging. A proportion of 88% of gender difference in successful aging was explained by the differences in the distribution of characteristics (Coef: 0.082; p-value < 0.05). Considerable gender gap in successful aging would be reduced if women had similar levels of work status (28% reduction) to their male counterparts. Bringing the level of frequent physical activity in women to the same levels observed in men would reduce the gender gap by 9%.

CONCLUSIONS

The findings suggest that women had a lower score in successful aging, which is attributed to several socioeconomic and behavioural factors including not working status and physical inactivity. More studies must be done to explore the reasons for such differences and what particular factors in low-income countries create differences among older men and women in achieving successful aging.

Biologia Futura: four questions about ageing and the future of relevant animal models

Understanding how active and healthy ageing can be achieved is one of the most relevant global problems. In this review, I use the "Four questions" framework of Tinbergen to investigate how ageing works, how it might contribute to the survival of species, how it develops during the lifetime of (human) individuals and how it evolved. The focus of ageing research is usually on losses, although trajectories in later life show heterogeneity and many individuals experience healthy ageing. In humans, mild changes in cognition might be a typical part of ageing, but deficits are a sign of pathology. The ageing of the world's populations, and relatedly, the growing number of pathologically ageing people, is one of the major global problems. Animal models can help to understand the intrinsic and extrinsic factors contributing to ageing.

Self-assessment of the home environment to plan for successful ageing: Report from a digital health co-design workshop

Many middle aged and older people will need to adapt or modify their home in order to age in place. Arming older people and their families with the knowledge and tools to assess their home and plan simple modifications ahead of time will decrease reliance on professional assessment. The objective of this project was to co-design a tool which enables people to assess their own home environment and make future plans for ageing in the home. We recruited members of the public who were aged 60 or older to attend a series of two co-design workshops. Thirteen participants worked through a series of discussions and activities including appraising different types of tools available and mapping what a digital health tool might look like. Participants had a good understanding of the main types of home hazards in their own homes and the types of modifications which may be useful. Participants believed the concept of the tool would be worthwhile and identified a number of features which were important including a checklist, examples of good design which was both accessible and aesthetically pleasing and links to other resources such as websites which provide advice about to make basic home improvements. Some also wanted to share the results of their assessment with family or friends. Participants highlighted that features of the neighbourhood, such as safety and proximity to shops and cafes, were also important when considering the suitability of their home for ageing in place. Findings will be used to develop a prototype for usability testing.

Effects of Health-Related Behaviors and Changes on Successful Aging among Indonesian Older People

Whether changes in health behaviors can improve successful aging has not been well explored. The purpose of this study was to assess the effects of health-related behaviors and changes on successful aging in Indonesian older adults. Data were from the fourth and fifth waves of the Indonesia Family Life Survey (IFLS), the participants were aged 60 years and older and who completed both waves (n = 1289). Successful aging indicators were defined as no chronic diseases, no physical function difficulties, no depressive symptoms, intact cognitive function, with social support, and with social participation. Health-related behaviors focused on smoking, physical activities, and protein intake. A logistic regression analysis was conducted. The overall successful aging rate in 2007 was 23.6%, and it had decreased to 5.6% by 2014. There were gender differences in smoking, physical activities, and behavioral changes, including promoting increased physical activity, no smoking/smoking cessation, and adequate protein intake by older adults. Quitting smoking, performing medium physical activity, and increasing protein intake were protective factors for successful aging, but the effects of behavioral changes differed by gender. Health-related behaviors and changes may impact successful aging among older adults. A healthy lifestyle is suggested to be adopted as early as possible in one's life course.

Frequency of data collection and estimation of trajectories of physical functioning and their associations with survival in older men: analyses of longitudinal data from the Manitoba Follow-Up Study

OBJECTIVE

In studies of trajectories of physical functioning among older people, the data cannot be measured continuously, but only at certain time points in prespecified cycles. We examine how data collection cycles can affect the estimation of trajectories and their associations with survival.

STUDY DESIGN AND SETTING

Longitudinal data from the Manitoba Follow-Up Study (MFUS), with 12 measurements collected annually from 2004 to 2015, are analysed using a summary measures of physical functioning from the Short Form-36 questionnaire. Based on the joint models of the functioning trajectories and risk of death, we compare the estimations among models using different frequency of data collection (annually, biennially and triennially).

RESULTS

Our 2004 baseline includes 964 men who were survivors from the original MFUS cohort with mean age of 84 years and range between 75 and 94 years. Results from analysis of annual data indicate that the mean physical functioning is significantly decreasing over time. Further, the rate of decline is increasing over time. The current value of physical functioning is significantly associated with the hazard of death (p<0.001), whereas the association between the change rate and mortality is marginally significant (p<0.10). Results from analysis of biennial and triennial data reveal similar trajectory patterns of physical functioning, but could not reveal the association between the change rate of physical functioning and mortality. The frequency of data collection also impacts substantially on the estimation of heterogeneity of functioning trajectory. The prediction of mortality risk obtained using annual measurements of physical functioning are better than using biennial or triennial measurements, while the predictions obtained using biennial or triennial measurements are almost equivalent.

CONCLUSION

The impact of frequency of data collection depends on the shape of functional trajectories and its linking structure to survival outcome.

Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults

Background

Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.

Methods

We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.

Results

We identified four distinct multidimensional trajectory groups: (1) Minimal Impairment with Low Multimorbidity (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) Minimal Impairment with High Multimorbidity (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) Multidomain Impairment with Intermediate Multimorbidity (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) Multidomain Impairment with High Multimorbidity (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two Multidomain Impairment classes.

Conclusions

There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.

The Role of Optimism on the Relationship Between Activity Limitations and Life Satisfaction Among Middle-Aged and Older Adults in the United States: A Growth Curve Model of Changes Over Time

Activity limitations can diminish life satisfaction. This study explored the role of optimism on the relationship between changes in activities of daily living and instrumental activities of daily living (ADL/IADL) limitations and life satisfaction over time among middle-aged and older adults. Growth curve modeling accounting for intra- and inter-individual changes in life satisfaction was applied to the 2008-2018 waves of the Health and Retirement Study Leave Behind Survey subsample (n = 39,122 person-years). After controlling for sociodemographic factors, physical functioning decline adversely affected life satisfaction (β_ADL = -0.12, β_IADL = -0.13, p < 0.001), but the negative consequences reduced slightly through optimism (β_ADL = -0.11, β_IADL = -0.12, β_optimism = 0.47, p < 0.001). Increasing optimism could reduce the negative consequences of ADL/IADL limitations on life satisfaction among middle-aged to older adults.

Successful Aging in East Asia: Comparison Among China, Korea, and Japan

OBJECTIVES

Heterogeneity in successful aging has been found across countries. Yet, comparable evidence is sparse except in North America and Europe. Extending prior research, this study examined the prevalence and correlates of successful aging in East Asia: China, Korea, and Japan.

METHOD

We used harmonized data sets from national surveys. A total of 6,479 participants (aged between 65 and 75) were analyzed. Using Rowe and Kahn's (1987, 1997) model, successful aging was defined as having no major diseases, no difficulty performing activities of daily living, obtaining a median or higher score on tests of cognitive function, and being actively engaged.

RESULTS

The average prevalence of successful agers was 17.6%. There were variations in the global and specific measures of successful aging within and across countries, even after controlling for individual sociodemographic factors (age, gender, and education). The odds of aging successfully were highest in Japan and lowest in China, especially in the rural areas. Being younger and males were associated with a higher likelihood of successful agers in both global and specific measures.

DISCUSSION

This study observed heterogeneity in successful aging in East Asia. To identify policy implications, future research should explore potential societal factors influencing individuals' opportunities for successful aging.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession

OBJECTIVES

To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession.

METHODS

We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression.

RESULTS

We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy.

DISCUSSION

Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

Effects of subjective successful aging on emotional and coping responses to the COVID-19 pandemic

BACKGROUND

Middle-aged and older adults are more vulnerable to hospitalization and mortality if they are infected with the COVID-19 virus. The present study investigates the longitudinal effects of subjective successful aging on middle-aged and older adults' emotional and coping responses to the COVID-19 pandemic, and explores an underlying mechanism through perceived time limitation during the pandemic.

METHODS

A sample of 311 Hong Kong Chinese middle-aged and older adults (M_age = 64.58, SD = 10.14, Range = 45-90 years) were recruited from an Adult Development and Aging Project and participated in a questionnaire study via an online platform or phone interview. Their levels of subjective successful aging, perceived time limitation, and emotional and coping responses to the pandemic were measured.

RESULTS

The respondents who perceived themselves as more successful in aging process reported more positive and fewer negative emotions compared with their counterparts with lower levels of subjective successful aging. The mediation analysis showed that perceived time limitation could partially account for the effects of subjective successful aging on emotional and coping responses.

CONCLUSIONS

Findings of this study unveil the beneficial effects of subjective views of successful aging on emotional and coping responses to the pandemic through alleviating their perception of time limitation.

Healthy aging predicts mortality risks: Results from the Korean longitudinal study of aging (2006-2014)

INTRODUCTION

While there has been some gerontological research on healthy aging, few studies have identified a reasonable health status for the older adults. Guided by the four healthy aging concepts in studies from the US and Spain, this study sought to determine a useful definition for Korean older adults by examining the associations between each of the four healthy aging definitions and mortality.

METHODS

A longitudinal analysis was conducted based on the 2,960 older people (65 years or older) who participated in the Korean Longitudinal Study of Aging (2006-2014). Four healthy aging gradient definitions (Rowe and Kahn, Group Ⅰ, Group II, and Group III) were determined: absence of disease, free of disability, physical and cognitive function, and engagement with life.

RESULTS

The young old who failed to achieve healthy aging were found to have a higher risk of mortality in all four healthy aging gradient definitions in both males (HR range from 4.15 to 5.39) and females (HR range from 4.07 to 9.55). In old old, however, the unhealthy aging mortality risk in Rowe and Kahn's definition was disappeared, but predominant mortality risks were found in Group III for both male (HR = 3.16, 95% CI 1.67 - 5.98) and female (HR = 3.65, 95% CI 1.36 - 9.81) CONCLUSION: To promote healthy aging, we suggest that the definition for the young old includes rigid disease criteria, and old old emphasize functional ability. Age-specific aims for healthy aging may be useful for defining healthy aging.

The Effect of Material and Social Deprivation on Well-Being of Elderly in Europe

In this work, attention is paid to 2 explanatory factors of successful aging. The first is material deprivation. There is growing evidence that poverty is associated with the onset of physical and mental disorders and, broadly, with aspects such as life satisfaction and happiness. The second factor is social deprivation. Social exclusion affects health due to lack of emotional and concrete support; moreover, participation in social activities among older people is associated with greater longevity and a lower risk of disability. The study describes the effect of material and social deprivation on depression (measured through the EURO-D scale) and quality of life (through CASP-12 scale), for individuals aged 50 and older in 14 European countries. Data is derived from Wave 5 of the SHARE project. To estimate the effect of material and social deprivation on outcomes and to determine whether it is moderated by the country in which people live, we apply 2 multi-group path models, respectively, for people aged 65 or younger and for those aged 66 years or older. Findings indicate that higher material and social deprivation is associated with greater levels of stress and worse quality of life. The effect of social deprivation would be stronger than that of material deprivation, and this result seems to be valid in all countries considered, although their intensity varies significantly between them.

Poor Appetite and Eating Difficulties Can Predict the Long-Term Risk of Falling: A Longitudinal Study in Middle-Aged and Older Adults

OBJECTIVES

This study investigates whether self-reported nutritional status affects falling among middle-aged and older adults.

METHOD

We used 8-year follow-up data from the Taiwan Longitudinal Study on Aging. At baseline, respondents' appetite, changes in amount of food intake, and eating difficulties were assessed in a questionnaire-based survey in addition to anthropometric measurements (body mass index, mid-arm circumferences, and involuntary body weight loss). Their associations with falls in the follow-up were examined using multivariable log-binomial regression.

RESULTS

The study included 2,519 respondents aged 50 years and older. Poor appetite (prevalence ratio [PR] = 1.25, 95% confidence interval [CI] = [1.07, 1.46]) and eating difficulties (PR = 1.16, 95% CI = [1.02, 1.32]) significantly predicted falling 8 years later with adjustments for sociodemographics, health behaviors, comorbidities, and anthropometric measures by taking into account probabilities of follow-up.

CONCLUSION

Poor appetite and eating difficulties can predict falling in the long-term independent of anthropometric measurements among middle-aged and older adults.

Trajectories of Aging Among U.S. Older Adults: Mixed Evidence for a Hispanic Paradox

OBJECTIVES

A well-documented paradox is that Hispanics tend to live longer than non-Hispanic Whites (NHW), despite structural disadvantages. We evaluate whether the "Hispanic paradox" extends to more comprehensive longitudinal aging classifications and examine how lifecourse factors relate to these groupings.

METHODS

We used biennial data (1998-2014) on adults aged 65 years and older at baseline from the Health and Retirement Study. We use joint latent class discrete time and growth curve modeling to identify trajectories of aging, and multinomial logit models to determine whether U.S.-born (USB-H) and Foreign-born (FB-H) Hispanics experience healthier styles of aging than non-Hispanic Whites (NHW), and test how lifecycle factors influence this relationship.

RESULTS

We identify four trajectory classes including, "cognitive unhealthy," "high morbidity," "nonaccelerated", and "healthy." Compared to NHWs, both USB-H and FB-H have higher relative risk ratios (RRR) of "cognitive unhealthy" and "high morbidity" classifications, relative to "nonaccelerated." These patterns persist upon controlling for lifecourse factors. Both Hispanic groups, however, also have higher RRRs for "healthy" classification (vs "nonaccelerated") upon adjusting for adult achievements and health behaviors.

DISCUSSION

Controlling for lifefcourse factors USB-H and FB-H have equal or higher likelihood for "high morbidity" and "cognitive unhealthy" classifications, respectively, relative to NHWs. Yet, both groups are equally likely of being in the "healthy" group compared to NHWs. These segregations into healthy and unhealthy groups require more research and could contribute to explaining the paradoxical patterns produced when population heterogeneity is not taken into account.

La gérontopsychiatrie à l’Hôpital en santé mentale Albert-Prévost : favoriser la résilience des patients âgés grâce à la psychiatrie positive

La population québécoise est vieillissante, et ce phénomène ne fera que s’accroître au cours des prochaines décennies. Alors qu’en 2017 près d’une personne sur 5 appartenait au groupe des 65 ans et plus, il en sera ainsi pour le quart des Québécois en 2031, et près du tiers d’entre eux en 2061.

Par ailleurs, les trajectoires de vieillissement sont uniques à chacun et dépendront de différents facteurs, tels les vulnérabilités et forces de l’individu et son interaction avec les proches et la société. Malheureusement, la vieillesse s’illustre souvent comme un cumul de pertes dans différents registres. Cela crée des contraintes qui diminuent l’autonomie et augmentent la dépendance. La maladie peut confronter l’individu vieillissant à une diminution des capacités de réparation, et devenir un rappel de la mort inéluctable qui se rapproche et peut devenir parfois une certaine forme de traumatisme. Ce processus invite alors les soignants à réfléchir à un projet thérapeutique favorisant la résilience, concept qui va au-delà de l’ajustement à l’épreuve, et qui suggère un potentiel de développement et de rebond psychologique.

À l’Hôpital en santé mentale Albert-Prévost, la clientèle en gérontopsychiatrie cumule souvent une triple vulnérabilité : troubles cognitifs, incapacités physiques et maladie psychiatrique chronique ou de novo. Les besoins sont donc multiples et complexes.

C’est ainsi que dès 2017, nous avons élaboré une approche de psychiatrie positive dans notre service de gérontopsychiatrie. Notre objectif est de promouvoir le bien-être et la résilience de nos patients selon différents niveaux d’interventions positives. Les stratégies peuvent alors aller de la simple orientation positive pendant l’entretien psychiatrique à la psychothérapie positive, en passant par la psychoéducation, la bibliothérapie et la prescription de certaines interventions de psychologie positive (IPP).

Bayesian estimation and model selection in group-based trajectory models

We develop a Bayesian group-based trajectory model (GBTM) and extend it to incorporate dual trajectories and Bayesian model averaging for model selection. Our framework lends itself to many of the standard distributions used in GBTMs, including normal, censored normal, binary, and ordered outcomes. On the model selection front, GBTMs require the researcher to specify a functional relationship between time and the outcome within each latent group. These relationships are generally polynomials with varying degrees in each group, but can also include additional covariates or other functions of time. When the number of groups is large, the model space can grow prohibitively complex, requiring a time-consuming brute-force search over potentially thousands of models. The approach developed in this article requires just one model fit and has the additional advantage of accounting for uncertainty in model selection. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Aging Well on the Autism Spectrum: An Examination of the Dominant Model of Successful Aging

There is a gap in our knowledge of aging with autism. The present study examined the applicability of the popular gerontology concept of "aging well" to autistic adults. Using survey data, a model of "aging well" was operationalised and applied to 92 autistic adults and 60 controls. A very small proportion (3.3%) of autistic adults were found to be aging well. Significantly less autistic adults were "maintaining physical and cognitive functioning" and "actively engaging with life" in comparison to controls. Whilst important differences in health and functioning status were found, the current dominant model of "aging well" is limited for examining autistic individuals. Suggested adjustments include development of a broader, more flexible and strengths -based model.

Highways to Ageing - Linking life course SEP to multivariate trajectories of health outcomes in older adults

OBJECTIVES

Ageing is a temporal, multi-faceted process subject to interacting factors. In this study, we used life course and multidimensional approaches to elucidate the association between socioeconomic forces across a lifetime and the developmental origins in health and disease of the Mexican elderly.

METHODS

Data stemmed from the Mexican Health and Ageing Study, constituting a sample of older adults (N= 5169, ≥50 years). With retrospective information on early, intermediary and contemporaneous socioeconomic indicators, life course typologies of socioeconomic position were identified using Latent Class Analysis. Based on prospective data of functional mobility, number of chronic conditions and self-rated health, multivariate trajectories of health outcomes were uncovered with Group Based Trajectory Model. Links between the extracted SEP and multivariate health latent constructs were explored with multinomial logistic regression.

RESULTS

Life course SEP classes were heterogeneous, yet a large proportion of subjects was characterized by persistent socioeconomic adversity throughout life. The health outcomes' patterns of co-evolution were diverse too, shedding light on the nature of their developmental links, while revealing variable synchronicity in their temporal decline. A graded association was observed between the life course SEP classes and ageing trajectories.

CONCLUSION

The results primarily backed the cumulative advantage/disadvantage life course framework, while finding some indication for age as a leveller hypothesis. Variability in patterns of dynamic co-action among the health outcomes depicts ageing as a naturally variable process of interconnected changes. Life course evidence for the ways socio-economic forces are differentially linked to distinct developmental profiles of ageing is provided.

Joint trajectories of cognition and gait speed in Mexican American and European American older adults: The San Antonio longitudinal study of aging

OBJECTIVES

Cognitive decline and gait speed slowing are independent predictors of disability and mortality. While both factors increase in prevalence with advancing age, little is known about their combined patterns of change. The study goal was to identify joint trajectories of cognition and gait speed within an aging bi-ethnic cohort of Mexican Americans and European Americans.

METHODS/DESIGN

Participants included 182 Mexican Americans and 188 European Americans, ages 65 to 74, who were followed over a mean of 9.5 years. Cognition was assessed with the mini-mental state examination and gait speed was examined with a timed 10-ft walk. Joint trajectory classes of cognition and gait speed were identified with latent growth mixture modeling. Odd-ratios assessed predictors for trajectory classes.

RESULTS

Three latent trajectory classes were identified: (a) relatively stable cognition and gait (termed stable cognition and gait class, 65.4%); (b) deteriorating cognition and gait (termed cognitive and physical vulnerability class, 22.2%); (c) stable cognition and deteriorating gait (termed physical vulnerability class, 12.4%). The odds of classification in the cognitive and physical vulnerability class vs stable cognition and gait class was associated with Mexican American ethnicity (OR = 3.771, P = .016), age (OR = 1.186, P = .017), income (OR = 0.828, P = .029), education (OR = 0.703, P < .001), and diabetes (OR = 4.547, P = .010). The odds of classification in the physical vulnerability class was associated with female sex (OR = 6.481, P = .004) and body mass index (OR = 1.118, P = .025).

CONCLUSIONS

The trajectories of cognition and gait speed were generally parallel, suggesting the two domains may act synergistically to shape important health outcomes. Socioeconomic disparities and Mexican American ethnicity independently conferred risk for accelerated decline.

Psychological characteristics and stress differentiate between high from low health trajectories in later life: a machine learning analysis

Objective: This study set out to empirically identify joint health trajectories in individuals of advanced age. Predictors of subgroup allocation were investigated to identify the impact of psychological characteristics, stress, and socio-demographic variables on more favorable aging trajectories.Method: The sample consisted of N = 334 older adults (M_AGE=68.31 years; SD = 9.71). Clustered health trajectories were identified using a longitudinal variant of k-means and were based on health and satisfaction with life. Random forests with conditional interference were computed to examine predictive capabilities. Key predictors included psychological resilience resources, exposure to childhood adversities, and chronic stress. Data was collected via a survey, at two different time points one year apart.Results: Two different clustered health trajectories were identified: A 'constant high health' (low number of health-related symptoms, 65.6%) and a 'maintaining low health' profile (high number of symptoms, 34.4%). Over the one-year study period, both symptom profiles remained stable. Random forest analyses showed chronic stress to be the most important predictor in the interaction with other risk and also buffering factors.Conclusion: This study provides empirical evidence for two stable health trajectories in later life over one year. These results highlight the importance of chronic stress, but also psychological resilience resources in predicting aging trajectories.

Pre-frailty factors in community-dwelling 40-75 year olds: opportunities for successful ageing

BACKGROUND

There is little known about pre-frailty attributes or when changes which contribute to frailty might be detectable and amenable to change. This study explores pre-frailty and frailty in independent community-dwelling adults aged 40-75 years.

METHODS

Participants were recruited through local council networks, a national bank and one university in Adelaide, Australia. Fried frailty phenotype scores were calculated from measures of unintentional weight loss, exhaustion, low physical activity levels, poor hand grip strength and slow walking speed. Participants were identified as not frail (no phenotypes), pre-frail (one or two phenotypes) or frail (three or more phenotypes). Factor analysis was applied to binary forms of 25 published frailty measures Differences were tested in mean factor scores between the three Fried frailty phenotypes and ROC curves estimated predictive capacity of factors.

RESULTS

Of 656 participants (67% female; mean age 59.9 years, SD 10.6) 59.2% were classified as not frail, 39.0% pre-frail and 1.8% frail. There were no gender or age differences. Seven frailty factors were identified, incorporating all 25 frailty measures. Factors 1 and 7 significantly predicted progression from not-frail to pre-frail (Factor 1 AUC 0.64 (95%CI 0.60-0.68, combined dynamic trunk stability and lower limb functional strength, balance, foot sensation, hearing, lean muscle mass and low BMI; Factor 7 AUC 0.55 (95%CI 0.52-0.59) comprising continence and nutrition. Factors 3 and 4 significantly predicted progression from pre-frail to frail (Factor 3 AUC 0.65 (95% CI 0.59-0.70)), combining living alone, sleep quality, depression and anxiety, and lung function; Factor 4 AUC 0.60 (95%CI 0.54-0.66) comprising perceived exertion on exercise, and falls history.

CONCLUSIONS

This research identified pre-frailty and frailty states in people aged in their 40s and 50s. Pre-frailty in body systems performance can be detected by a range of mutable measures, and interventions to prevent progression to frailty could be commenced from the fourth decade of life.

Successful Present, Successful Future? Assessment of a Nonbinary Model of Successful Aging

PURPOSE

Though many models of successful aging exist, there is a need for assessments of the empirical validity of these models and their measures. This study tests the validity of the multidimensional model of successful aging presented by Young and colleagues.

DESIGN AND METHODS

Expanding on an earlier validation study, this analysis uses 1,211 respondents from the Americans' Changing Lives (ACL) study to determine predictive and discriminant validity. Respondents were surveyed in 1986, 1989, and 1994, providing an opportunity to assess if a baseline 5-point successful aging scale is associated with present and future outcomes. Validators include self-report items and interviewer recorded observations. In addition, a survival analysis of 24 years of ACL mortality data is conducted to confirm that baseline successful aging decreases risk of all-cause mortality.

RESULTS

Results illustrate that, in some cases as far as 8 years in the future, low successful aging scores correspond with higher risk of future hospitalization and depressive episodes, interviewer observed difficulty moving around, low self-rated health, and decreased life satisfaction. Lowest scorers also had a 356% higher risk of mortality compared to individuals with the highest scores.

IMPLICATIONS

These findings provide further evidence that Young and colleagues' successful aging construct is empirically valid and could be applied in future research and practice. Most respondents had middling scores, suggesting that future analyses should be cautious about concealing heterogeneity by operationalizing successful aging as a binary outcome.

The impact of leisure activities on older adults' cognitive function, physical function, and mental health

Engagement in leisure activities has been claimed to be highly beneficial in the elderly. Practicing such activities is supposed to help older adults to preserve cognitive function, physical function, and mental health, and thus to contribute to successful aging. We used structural equation modeling (SEM) to analyze the impact of leisure activities on these constructs in a large sample of Japanese older adults (N = 809; age range 72–74). The model exhibited an excellent fit (CFI = 1); engaging in leisure activities was positively associated with all the three successful aging indicators. These findings corroborate previous research carried out in Western countries and extend its validity to the population of Eastern older adults. Albeit correlational in nature, these results suggest that active engagement in leisure activities can help older adults to maintain cognitive, physical, and mental health. Future research will clarify whether there is a causal relationship between engagement in leisure activities and successful aging.

Development of Comprehensive Satisfaction Index (ComSI) and Its Association with WHOQOL-BREF

BACKGROUND

Comprehensive satisfaction in life may be considered as a significant contributor to health for everyone, including the aging population (individuals aged 45 years and above). For understanding the comprehensive satisfaction, an assessment measure with various psychometric properties may be useful. During a longitudinal study of aging and geriatric mental health, a 26-item tool was developed in Hindi for the assessment of satisfaction. This article aimed to analyze the items of Comprehensive Satisfaction Index (ComSI) applying Varimax rotation and to find out its association with World Health Organization Quality of Life Brief (WHOQOL-BREF).

METHODS

Data of 260 subjects were extracted from the longitudinal study to analyze the psychometric properties of the tool named as Comprehensive Satisfaction Index and its association with various domains of WHOQOL-BREF. Varimax rotation was applied after computing Kaiser-Meyer-Olkin and Bartlett's test of sphericity. Furthermore, the association between various components of ComSI and various domains of WHOQOL-BREF was explored.

RESULTS

Of the total 26 items of the tool, item no. 17 was excluded due to its -ve/ <0.31 value. A total of three components were generated with >1 eigenvalues; maximum items were loaded in component 1 (19) followed by components 2 (4) and 3 (2). Each of these factors has been significantly correlated with each other. Furthermore, these components also were compared with various domains of WHOQOL-BREF, and positive correlation was obtained for most of them.

CONCLUSION

There is a positive association between ComSI and WHOQOL-BREF. This tool will help in identifying the satisfaction level of the aging subjects promptly and efficiently, which would further help in making strategies for interventions.

Determinants of Health Trajectories in England and the United States: An Approach to Identify Different Patterns of Healthy Aging

Background

Aging is a multidimensional process with a remarkable interindividual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Sociodemographic and health determinants of these trajectories are also identified.

Methods

Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories.

Results

The health score generated showed an adequate ability to predict mortality over 10 years in ELSA (AUC = 0.74; 95% CI: 0.72, 0.75) and HRS (AUC = 0.74; 95% CI: 0.73, 0.75). By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies.

Conclusion

The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level, and household wealth could be considered as determinants associated to these trajectories.

Healthy ageing trajectories and lifestyle behaviour: the Mexican Health and Aging Study

Projections show that the number of people above 60 years old will triple by 2050 in Mexico. Nevertheless, ageing is characterised by great variability in the health status. In this study, we aimed to identify trajectories of health and their associations with lifestyle factors in a national representative cohort study of older Mexicans. We used secondary data of 14,143 adults from the Mexican Health and Aging Study (MHAS). A metric of health, based on the conceptual framework of functional ability, was mapped onto four waves (2001, 2003, 2012, 2015) and created by applying Bayesian multilevel Item Response Theory (IRT). Conditional Growth Mixture Modelling (GMM) was used to identify latent classes of individuals with similar trajectories and examine the impact of physical activity, smoking and alcohol on those. Conditional on sociodemographic and lifestyle behaviour four latent classes were suggested: high-stable, moderate-stable, low-stable and decliners. Participants who did not engage in physical activity, were current or previous smokers and did not consume alcohol at baseline were more likely to be in the trajectory with the highest deterioration (i.e. decliners). This study confirms ageing heterogeneity and the positive influence of a healthy lifestyle. These results provide the ground for new policies.

Lifestyle predictors of successful aging: A 20-year prospective HUNT study

BACKGROUND

Lifestyle factors predicting successful aging as a unified concept or as separate components of successful aging are important for understanding healthy aging, interventions and preventions. The main objective was to investigate the effect of midlife predictors on subsequent successful aging 20 years later.

MATERIALS AND METHODS

Data were from a population-based health survey, the Nord-Trøndelag Health Study (HUNT), with an average follow-up of 22.6 years. Individuals free of major disease at baseline in 1984-86 with complete datasets for the successful aging components in HUNT3 in 2006-08, were included (n = 4497; mean age at baseline 52.7, range 45-59, years). Successful aging was defined either as a unified category or as three components: being free of nine specified diseases and depression, having no physical or cognitive impairment, and being actively engaged with life. The midlife predictors (smoking, physical activity, alcohol consumption, obesity and social support) were analysed both as separate predictors and combined into a lifestyle index controlling for sociodemographic variables, using multivariable regression analysis.

RESULTS

Successful aging as a unified concept was related to all the lifestyle factors in the unadjusted analyses, and all except alcohol consumption in the adjusted analyses. The individual components of successful aging were differently associated with the lifestyle factors; engagement with life was less associated with the lifestyle factors. Non- smoking and good social support were the most powerful predictors for successful aging as a unified concept. When the lifestyle factors were summed into a lifestyle index, there was a trend for more positive lifestyle to be related to higher odds for successful aging.

CONCLUSIONS

Lifestyle factors predicted an overall measure of SA, as well as the individual components, more than 20 years later. Modifiable risk factors in midlife, exemplified by social support, may be used for interventions to promote overall health and specific aspects of health in aging.

Successful aging, cognitive function, socioeconomic status, and leukocyte telomere length

In a rapidly greying world, the notion that some individuals maintain successful aging trajectories, viz. high physical, cognitive, emotional, and social functioning in older age, is increasingly germane. Biomarkers of such successful aging are increasingly sought. Leukocyte telomere length (LTL), an emerging yardstick of cellular aging that is influenced by but distinct from chronological age, may also be associated to successful aging. Furthermore, given that socio-economic status (SES) influences successful aging trajectories, socioeconomic status may also moderate the association between chronological age and LTL. The goals of this study are to examine 1) whether successful aging is associated with LTL; 2) whether successful aging accounts for age-related LTL and 3) whether SES moderates the effect of age on LTL. Singaporean Chinese (n = 353) aged 65-80 completed a multidimensional assessment of successful aging and provided blood samples for LTL analysis. Results show that LTL negatively correlates with chronological age and positively correlates with successful aging. Successful aging mediates the association between chronological age and LTL. Moderated mediation analyses show that lower SES is associated with stronger negative associations of chronological age with successful aging and LTL. Moreover, the cognitive functioning dimension of successful aging is uniquely associated with LTL and its association with chronological age is moderated by SES. This study provides evidence that among older Singaporean Chinese with lower SES, declines in successful aging and in cognitive functioning are linked to age-related LTL shortening and hence to accelerated aging at the cellular level.

Binary and Nonbinary Measures of Successful Aging: Do They Yield Comparable Conclusions?

Recently, some researchers have employed nonbinary measures of successful aging. Little has been done to determine whether these newer measures yield similar findings compared to traditional binary measures. To test for differences, three measures of successful aging were constructed within five waves of the Americans' Changing Lives data set. A number of demographic, behavioral, and psychosocial predictors were used to predict each outcome, examining whether estimates of effect sizes and statistical significance were similar across measures. Although many effect sizes were similar, conclusions regarding statistical significance were inconsistent. For instance, the binary measure downplayed income gradients, the ordinal measure found more racial disparities, and the continuous measure was most likely to detect effects for stressful life events. These differences may be due to the statistical techniques used to handle each outcome. Results imply that uneven application of operationalization approaches may complicate replication efforts, suggesting a need for consistent measurement standards.

Sixteen-year predictors of successful aging from a Southern Brazilian cohort The PALA study

Successful aging (SA) is a current positive aging-related perspective and it is important to determine the variables associated with this concept. Most longitudinal population-based studies on predictors of SA were carried out in developed countries.

Communicative Predictors of Older Adults’ Successful Aging, Mental Health, and Alcohol Use

We examined how older adults’ communication about age-related topics is related to aging efficacy, successful aging, and well-being. Guided by the communicative ecology model of successful aging, three profiles of “environmental chatter”—that is, patterns of accommodation and overaccommodation older adults received from relational partners—were identified: positive, mixed-positive, and negative. Four profiles of individuals’ own age-related communication were identified, including a new profile: gloomy agers. Chatter profile membership and own age-related communication profile membership indirectly predicted successful aging, depressive symptoms, loneliness, and perceptions of unhealthy alcohol consumption via aging efficacy, but not self-reported alcoholic drinks consumed. Communication by both older adults and their relational partners may be consequential to experiences of successful aging and well-being.

Perceptions of Successful Aging among Older Adults in Bangladesh: An Exploratory Study

To analyze older adults' definitions of successful aging in Bangladesh. The purposively selected study sample comprised twelve participants who were aged over 60. Interviews using in-depth semi-structured questionnaires were conducted based on participants' chosen mode, either face-to-face, or by phone. Findings of this study support that successful aging is multidimensional - that is - for Bangladeshis successful aging encompasses dimensions such as adaptation to an aging body, financial security, family and intergenerational care, and social participation. Older adults' emphases on all these dimensions were qualitatively different from those relevant in western societies. Bangladeshis see disease and disability as a normal part of aging and do not emphasize freedom from disease or longevity as much as North Americans and the US-focused successful aging discourses do. Family care is a key component of successful aging in Bangladesh. While in western models functional independence has been emphasized, for Bangladeshi older adults' adaptations to changing body, co-residing with children, being financially, physically, and emotionally dependent on family and receiving their care are viewed as normal and appropriate. Cross-cultural comparisons in this study suggest that what it means and entails to age well differ across cultures. This study highlights the need among health professionals to understand Bangladeshi culture, with its specific beliefs and values, as it relates to the views of aging well.

Testing a Model of Successful Aging in a Cohort of Masters Swimmers

Due to their high physical functioning, masters athletes are regularly proposed to exemplify successful aging. However, successful aging research on masters athletes has never been undertaken using a multidimensional successful aging model. To determine the best model for future successful aging research on masters athletes, we had masters swimmers (N = 169, M age = 57.4 years, 61% women) self-report subjective successful aging, and physical, psychological, cognitive, and social functioning. Using this data we tested one hypothesized and three alternative successful aging models. The hypothesized model fit the data best (-2LL = 2052.32, AIC = 1717) with physical (β = 0.31, SE = 0.11), psychological (β = 0.25, SE = 0.11), and social (β = 1.20, SE = 0.63) functioning factors significantly loading onto a higher order successful aging latent factor. Successful aging should be conceptualized as a multidimensional phenomenon in future masters athlete research.

Comparison of self-rated and objective successful ageing in an international cohort

Understanding predictors of successful ageing is essential to policy development promoting quality-of-life of an ageing population. Initial models precluded successful ageing in the presence of chronic disease/functional disability; however, this is discrepant with self-reported successful ageing. Indicators of social, psychological and physical health in 1,735 people aged 65–74, living in Canada, Columbia, Brazil or Albania, were analysed in the International Mobility in Ageing Study. Multiple logistic regression analysis was performed to estimate the change in self-rated successful ageing in relation to physical health, depression, social connectedness, resilience and site, while controlling for age, gender and income sufficiency. Sixty-five per cent of participants self-rated as ageing successfully; however, this was significantly different across sites (p < 0.0005, range 17–85%) and gender (p = 0.019). Using objective measures, 6 per cent were classified as ‘successful’, with significant variability amongst sites (p < 0.0005, range 0–12%). Subjective successful ageing was associated with fewer (not absence of) chronic diseases, absence of depression and less dysfunction in activities of daily living, but not with objective measures of physical dysfunction. Social connectedness and resilience also aligned with self-rated successful ageing. Traditional definitions of objective successful ageing are likely too restrictive, and thus, do not approximate self-rated successful ageing. International differences suggest that site could be a surrogate for variables other than physical/mental health and social engagement.

Stages of Biological Development across Age: An Analysis of Canadian Health Measure Survey 2007-2011

Introduction

The stages of biological development are not clearly defined despite the fact that they have been used to refer to concepts such as adolescence and aging. This study aimed to (1) propose and test a framework to search for stages of representative components and determine stages of stability and transition, (2) identify stages of biological development based on health questionnaire and biomarker data, and (3) interpret the major trajectories in a health and biomarker database.

Methods

This study analyzed the data on the Canadian Health Measures Survey (CHMS) interviewees from cycle 1 to 3 (2007–2013) in Canada. We selected 282 variables containing information from questionnaire and on biomarkers after removing redundant variables based on high correlation. Fifty-nine nominal variables were replaced by 122 binominal variables, leaving 345 variables for analysis. Principal component (PC) analysis was conducted to summarize the data and the loadings were used to interpret the PCs. A stable stage was assumed to be the age groups without significantly different values of PCs.

Results

The CHMS interviewed 16,340 Canadians. Of all, 51.25% were female. The age ranged from 6 to 79 years (mean = 34.41 years, 95% CI = 34.74–34.08). The proportions of total variance explained by the first three PCs were 12.14, 4.03, and 3.19%, respectively. The differences of the first PC were not significant, especially between age 22 and 33, 34 and 40, 41 and 45, 46 and 71, and 72 and 79 years (adjusted p > 0.05 for all). The leading variable, in terms of the variance contributed to PC1, was time spent in physical activities, followed by variables related to alcohol consumption, and smoking. The 13 leading contributors to PC2 variances were all lung function measures.

Discussion and conclusion

There are stages of stability and transition across all age groups based on the first PCs. The first and second PCs are related to physical development and lung function. The identification of stable stages is the first step to understanding how human biology develops in a population perspective and will be important for research that relies on a research population with similar characteristics to draw samples for observation or intervention.

Capturing the Diversity of Successful Aging: An Operational Definition Based on 16-Year Trajectories of Functioning

Purpose of the Study

To determine the prevalence and extent of successful aging (SA) when various suggestions proposed in the previous literature for improving models of SA are incorporated into one holistic operational definition. These suggestions include defining and measuring SA as a developmental process, including subjective indicators alongside more objective ones, and expressing SA on a continuum.

Design and Methods

Data were used from 2,241 respondents in the Longitudinal Aging Study Amsterdam, a multidisciplinary study in a nationally representative sample of older adults in the Netherlands. Latent class growth analysis was used to identify successful 16-year trajectories within nine indicators of physical, cognitive, emotional, and social functioning. SA was quantified as the number of indicators in which individual respondents showed successful trajectories (range 0-9).

Results

Successful trajectories were characterized by stability, limited decline, or even improvement of functioning over time. Of the respondents, 39.6% of men and 29.3% of women were successful in at least seven indicators; 7% of men and 11% of women were successful in less than three indicators. Proportions of successful respondents were largest in life satisfaction (>85%) and smallest in social activity (<25%). Correlations of success between separate indicators were low to moderate (range r = .02-.37).

Implications

Many older adults age relatively successfully, but the character of successful functioning over time varies between indicators, and the combinations of successful indicators vary between individuals.

Feasibility of Classifying Life Stages and Searching for the Determinants: Results from the Medical Expenditure Panel Survey 1996-2011

Background

Life stages are not clearly defined and significant determinants for the identification of stages are not discussed. This study aims to test a data-driven approach to define stages and to identify the major determinants.

Methods

This study analyzed the data on the Medical Expenditure Panel Survey interviewees from 1996 to 2011 in the United States. This study first selected features with the Spearman’s correlation to remove redundant variables and to increase computational feasibility. The retained 430 variables were log transformed, if applicable. Sixty-four nominal variables were replaced with 164 binominal variables. This led to 525 variables that were available for principal component analysis (PCA). Life stages were proposed to be periods of ages with significantly different values of principal components (PCs).

Results

After retaining subjects followed throughout the panels, 244,089 were eligible for PCA, and the number of civilians was estimated to be 4.6 billion. The age ranged from 0 to 90 years old (mean = 35.88, 95% CI = 35.67–36.09). The values of the first PC were not significant from age of 6 to 13, 30 to 41, 46 to 60, and 76 to 90 years (adjusted p > 0.5), and the major determinants were related to functional status, employment, and poverty.

Conclusion

Important stages and their major determinants, including the status of functionality and cognition, income, and marital status, can be identified. Identifying stages of stability or transition will be important for research that relies on a research population with similar characteristics to draw samples for observation or intervention.

Contribution

This study sets an example of defining stages of transition and stability across ages with social and health data. Among all available variables, cognitive limitations, income, and poverty are important determinants of these stages.

Poverty, deprivation and life satisfaction among Hong Kong older persons

This investigation examines the association of four measures of poverty (income-based, expenditure-based and asset-based poverty, and material deprivation) with life satisfaction. Perceived life satisfaction was measured among 1,410 older Chinese persons aged 65 and over. Besides life satisfaction and measures of poverty, the study assessed socio-demographic variables, financial strain, health indicators, and social and community resources. Those who faced expenditure-based poverty, material deprivation and asset-based poverty reported a significantly lower level of perceived life satisfaction, while the association between expenditure-based poverty and life satisfaction was found to be the strongest. Other factors that had an impact on life satisfaction included gender, education and marital status; financial strain; social support; the number of close family members and friends; self-rated health; functional capacity; perceived memory; pain; sleep quality; neighbourhood collective efficacy; and engagement in cultural and entertainment activities. From the theoretical perspective, the findings have strong implications for the understanding of the factors that shape the perception of quality of life in old age. Our results also have important policy implications for the official measurement of poverty, monitoring of the poverty situation and the development of anti-poverty measures to help older persons living in poverty to improve the quality of their lives.