Understanding ageing: fear of chronic diseases later in life

"Terror Is a Better Word": A Qualitative Analysis of Dementia-Related Anxiety

BACKGROUND AND OBJECTIVES

Dementia-related anxiety (DRA) is the fear of a current or future diagnosis of Alzheimer's disease or another type of dementia. Previous studies suggest diverse factors contribute to DRA, including emotional, social, and cognitive concerns. A mixed-methods investigation was designed to explore DRA's underlying causes; we present a thematic analysis of these causes.

RESEARCH DESIGN AND METHODS

A semistructured qualitative interview design was used to explore participant's thoughts, feelings, and reactions about dementia. Fifty community-dwelling adults (aged 58-89, M = 70.80, SD = 6.02) without dementia diagnoses were interviewed, with a focus on why dementias are anxiety-provoking diagnoses. We engaged in a reflexive inductive thematic approach.

RESULTS

We identified 7 themes positioned within previously established antecedents of DRA. Anticipated consequences were conveyed in statements identifying dementia as a feared diagnosis and its connection to how one would be treated if diagnosed. Low perceived control was associated with dementia's anticipated effects including the ability of dementia to undermine core aspects of one's personhood, limit independence, and increase reliance on others. Perceived risk was connected to past familial experiences with dementia and the implications of receiving different diagnoses with different trajectories and treatments.

DISCUSSION AND IMPLICATIONS

Findings offer insight into diverse factors contributing to DRA, which can be used to inform public health messaging and develop applicable and clinically relevant interventions to meet the needs of individuals experiencing DRA and their social support systems.

Evidence for the role of affective theory of mind in face-name associative memory

Poor face-name recall has been associated with age-related impairments in cognitive functioning, namely declines in episodic memory and executive control. However, the role of social cognitive function - the ability to remember, process, and store information about others - has been largely overlooked in this work. Extensive work has shown that social and nonsocial cognitive processes rely on unique, albeit overlapping, mechanisms. In the current study, we explored whether social cognitive functioning - specifically the ability to infer other people's mental states (i.e., theory of mind) - facilitates better face-name learning. To do this, a sample of 289 older and young adults completed a face-name learning paradigm along with standard assessments of episodic memory and executive control alongside two theory of mind measures, one static and one dynamic. In addition to expected age differences, several key effects emerged. Age-related differences in recognition were explained by episodic memory, not social cognition. However, age effects in recall were explained by both episodic memory and social cognition, specifically affective theory of mind in the dynamic task. Altogether, we contend that face-name recall can be supported by social cognitive functioning, namely understanding emotions. While acknowledging the influence of task characteristics (i.e., lures, target ages), we interpret these findings in light of existing accounts of age differences in face-name associative memory.

Perceived Threat of Alzheimer's Disease and Related Dementias Among Chinese Family Caregivers of Older Adults with Cognitive Impairment

Perceived threat of Alzheimer's disease and related dementias (ADRD) has been found a widespread phenomenon in developed countries, but has not yet been fully explored in developing countries. Analyzing data from 300 family caregivers of older adults with cognitive impairment in China, this study found caregiver burden was positively associated with the perceived threat of ADRD, and this association was buffered by higher family income and longer caregiving time. To alleviate undue ADRD concerns, it suggests expanding respite care and community elder care beds, and initiating education programs on reducing unnecessary worries about developing ADRD.

Experience of hope in older people with chronic illness: A meta-synthesis

BACKGROUND

The increase in life expectancy has contributed to an increase in the number of older people, but this population has to learn to live with at least one chronic illness. Thus, hope has become an important resource for the older adult to face the repercussions of chronic illness.

OBJECTIVE

To synthesise qualitative evidence on the experience of hope in older people with chronic illness.

METHODS

This meta-synthesis included qualitative studies which present the experiences of hope in older people diagnosed with at least one chronic illness. The searches were made from six databases, guided by the SPIDER tool. The identified articles were then independently screened by two reviewers. The results were analysed according to the thematic synthesis approach.

RESULTS

Eighteen articles were included, and four analytical themes were constructed. The results allow us to understand that older people live with long-term conditions and hope for an ordinary life. To react to new changes and to maintain hope, they create goals that motivate them in daily life. The treatment is initially seen as a salvation, but the information acquired with the evolution of the illness modifies this perception. In addition, the uncertainty about the success of the treatment creates conflict in their hope. In the support and care of older people in the new context of illness, meaningful relationships strengthen hope most of the time. There is still the hope of being reconciled with death, but there are times when suffering overcomes the hope of living.

CONCLUSIONS

This meta-synthesis highlights that the experience of hope in older people is dynamic and influenced by the context of changes related to illness, treatment, significant relationships and proximity to death.

IMPLICATIONS FOR PRACTICE

A better understanding of the role and characteristics of hope in older people with chronic illness may help to develop more effective interventions to promote and maintain hope.

Transgender and Gender Diverse People's Fear of Seeking and Receiving Care in Later Life: A Multiple Method Analysis

The purpose of the current research is to understand concerns about receiving care in a sample of transgender, gender nonbinary, and gender diverse (TGD) adults across the lifespan. A total of 829 participants, predominantly from the United States and Canada, aged 18-70, completed the Trans Metlife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (TMLS) section on caregiving and are included in this study. We found middle-aged adults, people of Color, and people living with a disability reported the highest level of concern for their ability to function independently because of financial resources, physical concerns, cognitive impairment, or a lack of someone to care for them. Researchers found five overarching thematic categories: (a) No concerns, (b) Anticipated discrimination, (c) Loss of control, (d) Quality of life, and (e) General concerns. Practice implications include recommendations for practitioners to develop care plans with TGD residents and clients to learn the best strategies for affirming their gender identity (e.g., clothing preferences) and to assist TGD residents and clients with the completion of advance directives to allow them to outline their end-of-life care plan, including instructions for gender affirmative care in the event of incapacitation (e.g., dementia, stroke).

Anticipated suicidal and death ideation in response to an imagined dementia diagnosis: A qualitative study

Alzheimer's disease and related dementias are prevalent, highly impactful, and feared diagnoses. A mixed methods study using semi-structured interviews was conducted to clarify causes of dementia-related anxiety. Fifty community-dwelling adults aged 58 to 89 (M = 70.92, SD = 6.08) were recruited from a university participant registry and Memory Clinic; none had dementia diagnoses. Analyses revealed that 42% (n = 21) of participants anticipated suicidal or death ideation if diagnosed with dementia. Among participants endorsing anticipated suicidal or death ideation, responses ranged from active, specific plans, including interest in physician-assisted suicide, to more passive wishes to hasten death rather than continue to live with dementia. Within reports of both anticipated suicidal and death ideation, three subthemes emerged. Participants reported concerns about becoming a burden to others, the devaluation of life/loss of self with dementia, and the desire for (and anticipated thwarting of) personal control as factors contributing to their anticipated responses to a dementia diagnosis. Statements of anticipated suicidal and death ideation were contingent on a dementia diagnosis and may reflect errors in affective forecasting. Nevertheless, given the prevalence of dementias and older adults' elevated rates of suicide, the intersection of these two public health issues warrants greater attention.

Adaptation of families of adult patients with brain tumor: Partial least squares structural equation modeling

Brain tumor patients experience physical, psychological, social, and cognitive changes. These changes are challenging for both the patients and their families. These patients and their families need to adapt together on the cancer treatment path. This study aimed to identify the factors affecting adaptation in families of adult patients with brain tumors. A quantitative, cross-sectional study of 165 families of adult patients with primary brain tumors was conducted using a self-administered questionnaire. Partial least squares structural equation modeling was used to test a hypothetical model. The results showed that family stress, family functioning, and family resources influenced on family adaptation in families of adult patients with primary brain tumors. Among these factors, family resources were identified to be the strongest factor associated with family adaptation. The results of this study may be utilized as a theoretical basis in nursing to improve the family adaptation of patients with brain tumors. Regarding nursing practices, the results suggest that nurses should provide family-centered nursing interventions and promote family resources to help brain tumor patients and their families to adapt.

Identifying pathways to religious service attendance among older adults: A lagged exposure-wide analysis

We used prospective data (spanning 8 years) from a national sample of older U.S. adults aged > 50 years (the Health and Retirement Study, N = 13,771) to evaluate potential factors that lead to subsequent religious service attendance. We applied a lagged exposure-wide epidemiologic design and evaluated 60 candidate predictors of regular subsequent religious service attendance. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. After rigorous adjustment for a rich set of potential confounders, we observed modest evidence that changes in some indices of physical health, psychological well-being, psychological distress, and social functioning predicted regular religious service attendance four years later. Our findings suggest that there may be opportunities to support more regular religious service attendance among older adults who positively self-identify with a religious/spiritual tradition (e.g., aid services for those with functional limitations, psychological interventions to increase hope), which could have downstream benefits for various dimensions of well-being in the later years of life.

Latent profile analysis of security among patients with COVID-19 infection in mobile cabin hospitals and its relationship with psychological capital

Aim

COVID-19 patients' security is related to their mental health. However, the classification of this group's sense of security is still unclear. The aim of our research is to clarify the subtypes of security of patients infected with COVID-19, explore the factors affecting profile membership, and examine the relationship between security and psychological capital for the purpose of providing a reference for improving patients' sense of security and mental health.

Methods

A total of 650 COVID-19 patients in a mobile cabin hospital were selected for a cross-sectional survey from April to May 2022. They completed online self-report questionnaires that included a demographic questionnaire, security scale, and psychological capital scale. Data analysis included latent profile analysis, variance analysis, the Chi-square test, multiple comparisons, multivariate logistical regression, and hierarchical regression analysis.

Results

Three latent profiles were identified-low security (Class 1), moderate security (Class 2), and high security (Class 3)-accounting for 12.00, 49.51, and 38.49% of the total surveyed patients, respectively. In terms of the score of security and its two dimensions, Class 3 was higher than Class 2, and Class 2 was higher than Class 1 (all P < 0.001). Patients with difficulty falling asleep, sleep quality as usual, and lower tenacity were more likely to be grouped into Class 1 rather than Class 3; Patients from families with a per capita monthly household income <3,000 and lower self-efficacy and hope were more likely to be grouped into Classes 1 and 2 than into Class 3. Psychological capital was an important predictor of security, which could independently explain 18.70% of the variation in the patients' security.

Conclusions

Security has different classification features among patients with COVID-19 infection in mobile cabin hospitals. The security of over half of the patients surveyed is at the lower or middle level, and psychological capital is an important predictor of the patients' security. Medical staff should actively pay attention to patients with low security and help them to improve their security level and psychological capital.

How Are Sociodemographic, Health, Psychological, and Cognitive Factors Associated with Dementia Worry? An Online Survey Study among Israeli and Australian Laypeople

BACKGROUND

Dementia worry is a widespread phenomenon and the most common emotional reaction elicited by the threat of developing dementia in the future. The cultural factors of dementia worry have not been examined widely, although dementia can be perceived differently between cultures and lead to varying levels of dementia worry. The purpose of this study was to examine the level of dementia worry and factors associated with it cross-nationally in Israel and Australia.

METHODS

A cross-sectional, online survey was conducted with two age-matched adult samples (447 participants in Israel and 290 in Australia). The primary outcome measure was the 12-item Dementia Worry Scale.

RESULTS

Israeli participants (mean age = 42.5 years; 50.1% female) reported statistically significantly (p < 0.05) higher levels of concern about developing dementia in comparison to Australian participants (mean age = 43.7 years; 49.8% female). Increased ageism and increased perceptions about the likelihood of developing dementia were the most important factors associated with increased worry.

CONCLUSIONS

Our findings suggest that country may not be the best criterion to assess cultural differences and should be accompanied by the participants' assessment of their cultural tendencies. Our study also stresses the importance of conceptualizing and assessing affective and cognitive aspects of dementia worry, as people from different cultures might perceive dementia worry cognitively differently but affectively similar and vice-versa.

Self-perceptions of ageing and perceived health status: the mediating role of cognitive functioning and physical activity

There is evidence that perceived health status is relevant for older adults' wellbeing, and at the same time perceived health status can be influenced by self-perceptions of ageing. There is a lack of studies on the relationship between these variables. The aim of this study was to explore attitudes towards ageing and self-perceptions of ageing among Spanish middle-aged and older people, and to identify possible mediators in the relationship between self-perceptions of ageing on perceived health status. The sample comprised 1,124 individuals from 50 to 98 years old (mean = 64.84, standard deviation = 10.12) from the Ageing in Spain Longitudinal Study database, Pilot Survey (ELES-PS). Almost 70 per cent of the participants stated that old age begins at a specific chronological age and half of them considered that society treats older people with indifference. Self-perceptions of ageing, physical activity, cognitive functioning and age were significant predictors, and together these variables explained 15.9 per cent in the variance of perceived health status. The multiple mediation analysis revealed that self-perceptions of ageing predicted cognitive functioning (B = 0.848, p < 0.01) and physical activity (B = 2.9046, p < 0.001), and mediated the association between self-perceptions of ageing and perceived health status (B = 0.1144, standard error = 0.0147, p < 0.01). Results from this study highlight the importance of perceptions and attitudes towards ageing for older adults' health and wellbeing, thus this study contributes to a better understanding of how these variables are related. In this sense, results from this study can be useful for designing interventions for fostering wellbeing. Addressing negative self-perceptions of ageing and negative attitudes towards ageing can be particularly useful because they are associated with more pessimistic expectancies about the ageing process.

Relationships of social support and attitudes towards death: A mediator role of depression in older patients on haemodialysis

AIM

To explore the mediating role of depression in older people receiving haemodialysis on social support and the attitude of participants towards death.

DESIGN

A cross-sectional questionnaire survey.

METHODS

Data were collected from older people undergoing dialysis (N = 209) at two regional hospitals in the north of Taiwan. Confirmatory factor analysis with structural equation model was used to clarify the strength of relationships and intermediary effects of three scales in which with 5,000 bootstrap samples using LISREL 9.31.

RESULTS

The final model provided a good fit for the data. Social support and depression have statistically significant effects on dialysis older person' negative death attitudes. The direct effect of social support on depression was the strongest (p<.001). Overall, depression completely mediates social support and positive death attitudes. Depression partially mediates social support and negative death attitude.

Multidisciplinary Clinicians and the Relational Autonomy of Persons with Neurodegenerative Disorders and an Advance Care Plan: A Thematic Analysis

Introduction

People diagnosed with neurodegenerative disorders often grapple with threats to their agency, prompting some to engage in advance care planning. Advance care plans are intended to protect autonomy by helping patients receive goal-consistent healthcare. Accordingly, there is a need to better understand factors associated with hospital doctors’ application of advance care plans to treatment decisions of this patient cohort.

Purpose

The purpose of this study was to explain the recommendations of multidisciplinary hospital-based clinicians about the benefits of advance care plans for people diagnosed with neurodegenerative disorders, and the elements that influence how doctors apply such plans.

Materials and Methods

Using a constructivist grounded theory informed thematic analysis, semi-structured interviews were conducted with purposively and theoretical sampled hospital-based clinicians: 16 doctors, six registered nurses and 10 allied health clinicians who self-reported having experience delivering healthcare to people with neurodegenerative disorders and an advance care plan. Allied health and nurse data helped to inform questions posed to doctors. Data were inductively analysed using open and focused coding.

Results

Analysis revealed two main themes: recommending agency through advance care plans; and limiting agency through advance care plans. These themes formed the basis of the core category: patient agency. All clinicians held positive attitudes towards advance care plans as a means to preserve patient voices and alleviate family of responsibility. However, the extent to which doctors shared decisions with family revealed a tension between individualistic agency associated with advance care plans and relational autonomy perceived by doctors as appropriate.

Conclusion

Although doctors expressed positive attitudes towards advance care plans, they typically practiced relational autonomy wherein they partner with family in contemporaneous healthcare decision on patients’ behalf. Accordingly, the healthcare preferences of hospitalised, incompetent people with neurodegenerative disorders are balanced against judgements of both doctors and family.

Factors that influence the emotional impact of memory problems in older adults: A qualitative descriptive study

BACKGROUND

Associations among psychological health and memory concerns in older adults are well-established, but much of this research is quantitative.

OBJECTIVES

This study examined how memory problems influence emotional well-being in older adults without dementia, and whether this differs by cognitive status and current depressive or anxiety symptoms.

METHODS

A qualitative descriptive design was used to examine our research questions. Community-dwelling older adults without dementia (n = 49, M_age  = 74.5[10.1], 63% women) completed a cognitive assessment, questionnaires and two semi-structured interviews. Content analysis was used to code and categorise the transcribed interview data, then identify themes within and across participant groups.

RESULTS

Five themes described the influence of memory problems on emotional well-being: Evoking Emotions, Fearing Future, Undermining Self, Normalising Problems and Adjusting Thinking. Memory problems' impact on emotional well-being varied by current anxiety symptoms, characteristics of the problem and personal experience with dementia.

CONCLUSION

The emotional impact of memory problems tended to differ by affective symptoms, not cognitive status. Older adults who report memory concerns without objective evidence of impairment may be at risk for negative impacts to mental health and well-being.

IMPLICATIONS FOR PRACTICE

Cognitive screening guidelines should consider best practices for responding to memory concerns when cognitive testing results are normal.

Factors Associated With Dementia Knowledge and Dementia Worry in the South Korean Elderly Population

OBJECTIVE

South Korea is one of the countries with a very fast aging rate, and the prevalence of dementia is rapidly increasing. However, there are relatively few studies pertaining to sociodemographic and physical health-related factors associated with dementia knowledge and dementia worry.

METHODS

This was a cross-sectional survey of a community in Seocho-gu, Seoul, Republic of Korea. Overall, 1,869 adults aged 60 years participated. Participants completed an online interview or face-to-face interview. Survey data comprised self-report questions including dementia knowledge, dementia worry, demographic, psychological, exercise, and cognitive activities. We conducted logistic regression analysis.

RESULTS

There was a significant positive association between dementia worry and knowledge. Family history of dementia, education, income, sleep problems, depressed mood and loss of volition, chronic diseases, and presence of a past job were associated with dementia knowledge or worry. Reading, art, or social cognitive activities had a significant positive association with dementia knowledge, and writing or musical cognitive activities had a negative association with dementia worry.

CONCLUSION

We found that people with more dementia knowledge and less dementia worry engaged more in cognitive activities that could prevent dementia. Public education should be planned to improve dementia knowledge and reduce dementia worry.

Fear about Alzheimer's disease among Israeli and German laypersons, persons with Mild Neurocognitive Disorder and their relatives: a qualitative study

OBJECTIVES

Alzheimer's disease (AD), the most common type of dementia, is one of the most feared diseases, obstructing help-seeking, and leading to discrimination. While research interest in fear of developing AD is increasing, little is known about its characterization, triggers, and consequences, especially among different cultures. In this study, we aimed at exploring and characterizing AD fear as experienced by laypersons (LP), persons with Mild Neurocognitive Disorder (MND), and their relatives, in Israel and Germany.

DESIGN

A qualitative study using focus groups (FGs) and semi-structured interviews was used. Thematic content analysis was conducted to extract key themes.

SETTING

Israeli and German not yet diagnosed people.

PARTICIPANTS

The study included a total of 130 participants (63 Israeli and 67 German participants) representing 3 groups: LP (n = 82), persons with MND (n = 28), and relatives of persons with MND (n = 20).

RESULTS

Two overarching themes were identified across groups and countries: fear of developing AD and fear of stigmatization. Other types of fear, such as fear of a person with AD, fear about the impact of a diagnosis of AD on family members, fear of becoming a caregiver, and fear of losing one's self-determination because of developing AD, were specific to a group type or country. Different types of fear were awakened by different triggers, and were dealt with different coping strategies.

Influence of mid-life cognitive activity on cognitive function among men aged 68 years or older

BACKGROUND

Cognitive activity in early and late life has been associated with increased cognitive function among older adults. There is less evidence on the effects of midlife cognitive activity.

AIMS

We examined the association of midlife cognitive activity with cognitive function after age 65.

METHODS

We studied 78 men 68 years old or older. We asked participants to assess their current and midlife cognitive activity using adaptations of a measure created by Wilson et al., which includes reading, writing letters, visiting museums and other leisure activities. Our outcomes were validated measures of cognitive and overall function. We compared midlife cognitive activity to our outcome measures in simple bivariable analyses, then adjusted for demographic characteristics using linear regression.

RESULTS

Our study population of older (mean age 74.8 years) men was primarily white (87%) and well-educated; 65% had at least some post high school education. Although 67% were retired, household income was high (24% < $30 k and 44% > $50 k). More midlife cognitive activity was related to more current cognitive activity (p =  < .0001, r2 = 0.55339). However, midlife activity was not associated with measures of cognitive or overall function, adjusted analyses gave similar results.

DISCUSSION

We did not find an association between midlife cognitive activity and later life function. However, the Wilson measure of cognitive activity that we used excludes instrumental cognitive activities such as dealing with finances or healthcare, likely underestimating cognitive activity for many participants.

CONCLUSION

Midlife cognitive activity was associated with late-life cognitive activity, suggesting efforts to increase late-life cognitive activity may need to start earlier in life. However, more robust measures of everyday cognitive activity might detect such an association.

Identifying the content for an item bank and computerized adaptive testing system to measure the impact of age-related macular degeneration on health-related quality of life

PURPOSE

We are developing an age-related macular degeneration (AMD) health-related quality of life (HRQoL) item bank, applicable to Western and Asian populations. We report primarily on content generation and refinement, but also compare the HRQoL issues reported in our study with Western studies and current AMD-HRQoL questionnaires.

METHODS

In this cross-sectional, qualitative study of AMD patients attending the Singapore National Eye Centre (May-December 2019), items/domains were generated from: (1) AMD-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with AMD patients (n = 27); and (4) written feedback from retinal experts. Following thematic analysis, items were systematically refined to a minimally representative set and pre-tested using cognitive interviews with 16 AMD patients.

RESULTS

Of the 27 patients (mean ± standard deviation age 67.9 ± 7.0; 59.2% male), 18 (66.7%), two (7.4%), and seven (25.9%) had no, early-intermediate, and late/advanced AMD (better eye), respectively. Whilst some HRQoL issues, e.g. activity limitation, mobility, lighting, and concerns were similarly reported by Western patients and covered by other questionnaires, others like anxiety about intravitreal injections, work tasks, and financial dependency were novel. Overall, 462 items within seven independent HRQoL domains were identified: Activity limitation, Lighting, Mobility, Emotional, Concerns, AMD management, and Work. Following item refinement, items were reduced to 219, with 31 items undergoing amendment.

CONCLUSION

Our 7-domain, 219-item AMD-specific HRQoL instrument will undergo psychometric testing and calibration for computerized adaptive testing. The future instrument will enable users to precisely, rapidly, and comprehensively quantify the HRQoL impact of AMD and associated treatments, with item coverage relevant across several populations.

The Psychological Impact of the COVID-19 Pandemic on Dentists in Germany

Since the announcement of the coronavirus 2019 (COVID-19) outbreak as a pandemic, several studies reported increased psychological distress among healthcare workers. In this investigation, we examined the association between psychological outcomes and various factors among German dentists. Dentists from all German federal states were invited to participate in this study through a self-administered online questionnaire between July and November 2020. This questionnaire collected information on demographics, Depression Anxiety Stress Scales (DASS-21), and the Impact of Events Scale-Revised (IES-R) instrument. The associations displayed between demographic and psychological outcomes of depression, anxiety, stress, intrusion, avoidance, and hyperarousal were evaluated. Seven-hundred-and-thirty-two dentists participated in the survey and reported overall scores of (4.88 ± 4.85), (2.88 ± 3.57), (7.08 ± 5.04), (9.12 ± 8.44), (10.68 ± 8.88) and (10.35 ± 8.68) for depression, anxiety, stress, intrusion, avoidance, and hyperarousal, respectively. For females, being between 50-59 years of age, being immune deficient or chronically ill, working at a dental practice, and considering the COVID-19 pandemic a financial hazard were reported as significant associated factors (p < 0.05) with higher DASS-21 and IES-R scores. These findings underline the aspects which need to be taken into attention to protect the mental wellbeing of dentists in Germany during the crisis.

Job Strain and Late-Life Cognition: Findings From the Puerto Rican Elderly Health Conditions Study

Objectives: We examined associations between job strain and cognitive aging in a sample of older Puerto Ricans. Methods: Members of the Puerto Rican Elderly: Health Conditions study, aged 60-100 years at baseline, participated. Job strain indicators were quantified from O*NET (n = 1632) and a matrix of Job Content Questionnaire scores (JCQ; n = 1467). Global cognition was assessed twice across 4 years. Results: Controlling for age, sex, depressive symptoms, financial problems, hypertension, diabetes, childhood economic hardship, low job control and high job strain were consistently associated with greater cognitive decline. Adding education attenuated these associations. High education strengthened the JCQ job control-cognitive change link. Discussion: Low job control and high job strain may accelerate cognitive aging in this population. However, it may be more difficult to disentangle the intersecting roles of education and job strain in cognitive aging among older Puerto Ricans relative to older adults from contiguous United States or Europe.

Health-related quality of life among elderly individuals living alone in an urban area of Shaanxi Province, China: a cross-sectional study

Objectives

To describe health-related quality of life (HRQoL), sex differences in HRQoL, and factors affecting the HRQoL of elderly people living alone in urban areas of Shaanxi Province, China.

Methods

A cohort was obtained using multistage stratified cluster random sampling. We collected cross-sectional data using surveys. HRQoL was measured using the 36-item Short Form Health Survey. Multivariable multilevel linear regression analysis was used to examine factors associated with mental and physical health component summary scores.

Results

Overall, 442 elderly Chinese individuals who lived alone completed the survey (mean age 73 years, women: 59%). Women were more likely to report better mental health than men. Factors significantly associated with reduced mental health scores were older age, having never been married or being divorced, and having a history of cancer, urinary tract disease, fractures or gastrointestinal disorders. Factors associated with physical health were having never been married or being divorced and having hypertension.

Conclusions

To our knowledge, this is the first study to describe HRQoL in a representative sample of elderly people living alone in urban areas of Shaanxi, China. Poor physical and mental HRQoL in this elderly Chinese population was mainly associated with chronic diseases and demographic factors.

Coping Strategies among Malaysian Women with Recurrent Ovarian Cancer: A Qualitative Study

Objective:

Ovarian cancer is one of the most common cancers among Malaysian women with high recurrence. Patients with recurrence are prone to emotional distress and are forced to cope with poor prognosis. This study aimed to explore the coping strategies employed by women with recurrent ovarian cancer in Malaysia, a developing multicultural country in Asia.

Methods:

This was a qualitative study with patients diagnosed with recurrent ovarian cancer and receiving chemotherapy at a hospital gynecologic day-care unit. In-depth individual interviews were conducted with patients to explore how they coped with recurrence of ovarian cancer. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

Results:

The participants' (n = 10) age range was 52–84 years, the three most common ethnic backgrounds were represented (Malay, Chinese, and Indian), and most of the patients were well educated. All patients were on chemotherapy. Six coping strategies were identified: (1) maintaining a mindset of hopefulness, (2) avoidance of information, (3) accepting their condition, (4) seeking spiritual help, (5) relying on family for support, and (6) coping with financial costs.

Conclusions:

Coping strategies employed during ovarian cancer recurrence in this setting were rarely based on the accurate information appraisal, but rather on the individual emotion and personal beliefs.

Conceptualization, measurement and correlates of dementia worry: A scoping review

PURPOSE

The combination of a growing population of older adults and increasing prevalence and awareness of dementia diagnoses suggests that dementia worry may also intensify. As a relatively new area of investigation, the dementia worry literature is growing, but variability in definitions and measurement continue. A scoping review was conducted to gather and examine existing research, as well as assist in guiding future studies in this area. The review focused on characterizing the conceptualization, measurement, and correlates of dementia worry.

METHODS

Using PubMed, CINAHL, AgeLine, and PsycINFO, a search of literature concerning dementia worry was completed.

RESULTS

A total of 45 articles examining dementia worry fulfilled the inclusion criteria. Most studies were cross-sectional (n = 39), quantitative (n = 38), and conducted in the United States (n = 22). Inconsistencies in the conceptualization, measurement, and correlates examined make it difficult to determine the meaning and true levels of dementia worry.

CONCLUSIONS

Recent attention to dementia worry has increased awareness of the basic concept and its correlates. However, the lack of unity in the definition and measurement of dementia worry impedes advancement in this research area, as well as in establishing its clinical significance.

Factors Associated With How Long People Would Like to Live

This article examined the factors of how long people would like to live involving 462 respondents aged 40 years and older in Malaysia. Data collected through an online self-administered survey indicated that 75% of the respondents would like to live at least 80 years and on average most people would like to live 81 years. Rural respondents, those who agreed that they have a loving family, those who agreed that they want to continue working for as long as they can, respondents who believed that they will not need long-term care at 65 years and older, and those who may consider living in an assisted living facility were more likely to want to live at least 80 years compared with respondents who did not agree. Efforts should be targeted at promoting healthy lifestyle and providing more employment opportunities for older persons.

Epidemiological dimensions of the association between type 2 diabetes and cancer: A review of observational studies

Type 2 diabetes (T2D) is a major cause of complications and death in many countries. The possible causal relation between T2D and cancer has been the aim of many research investigations. In view of the importance of the topic we carried out a narrative review of observational studies to summarize the available evidence of the association between T2D and cancer. To deal with the problem of abundance of published studies, we reviewed up to December 2017, the literature of meta-analyses of observational studies first, then we reviewed cohort studies not reported in meta-analyses because of more recent publication. We found that the association of T2D with risk of colorectal cancer was robust, whereas the evidence of the associations with other cancer sites was lower. Some of the observed associations could be overestimated, due to publication bias, unmeasured confounders (such as obesity) and surveillance bias. In conclusion a probable causal association of T2D with risk of colorectal cancer was confirmed. A possible causal association with pancreatic, endometrial, hepatocellular and gallbladder carcinoma was also found. Substantial uncertainty exists for other cancer sites.