Resilient Aging: Psychological Well-Being and Social Well-Being as Targets for the Promotion of Healthy Aging

The role of quality of life data as an endpoint for collecting real-world evidence within geroscience clinical trials

With geroscience research evolving at a fast pace, the need arises for human randomized controlled trials to assess the efficacy of geroprotective interventions to prevent age-related adverse outcomes, disease, and mortality in normative aging cohorts. However, to confirm efficacy requires a long-term and costly approach as time to the event of morbidity and mortality can be decades. While this could be circumvented using sensitive biomarkers of aging, current molecular, physiological, and digital endpoints require further validation. In this review, we discuss how collecting real-world evidence (RWE) by obtaining health data that is amenable for collection from large heterogeneous populations in a real-world setting can help speed up validation of geroprotective interventions. Further, we propose inclusion of quality of life (QoL) data as a biomarker of aging and candidate endpoint for geroscience clinical trials to aid in distinguishing healthy from unhealthy aging. We highlight how QoL assays can aid in accelerating data collection in studies gathering RWE on the geroprotective effects of repurposed drugs to support utilization within healthy longevity medicine. Finally, we summarize key metrics to consider when implementing QoL assays in studies, and present the short-form 36 (SF-36) as the most well-suited candidate endpoint.

Health locus of control, resilience and self-efficacy among elderly patients with psychiatric disorders

This study aimed to assess the relationship between health locus control, resilience and self-efficacy in older adults with psychiatric disorders. This study was conducted using a cross-sectional design. Sample: A purposive sample of 291 older adults receiving psychiatric outpatient care at Alabbasya Hospital for Mental Health in Cairo was recruited for this study. The data were collected by the following tools: sociodemographic data sheet, the multidimensional health locus of control scale, the general self-efficacy scale, the brief resilience scale and the general health questionnaire. The study participants reported low levels of health locus of control, low levels of self-efficacy and normal levels of resilience. Furthermore, we found a strong positive correlation between resilience and general self-efficacy. The study concluded that older people with psychiatric disorders reported low levels of health locus of control and self-efficacy, while they experienced normal resilience levels. There was a strong positive correlation between resilience and general self-efficacy among the study participants. The results of this study can guide healthcare professionals in developing tailored interventions and support programs to improve this population's quality of life and overall mental health outcomes.

The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach

BACKGROUND

A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

METHODS

We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).

RESULTS

Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

CONCLUSIONS

Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

Harnessing Resilience in the Healthy Ageing Discourse: Insights from Attappadi Indigenous Older Adults, Kerala, India

In this "Decade of Healthy Ageing," the integration of resilience into the healthy aging discourse becomes paramount, particularly in the context of indigenous communities grappling with the enduring effects of historical oppression, persistent poverty, and health disparities in their aging journey. Employing a phenomenological lens, this study seeks to derive the resilient characteristics exhibited by the Attappadi indigenous older adults of Kerala, aiming to explore the role of resilience in their pursuit of healthy aging. In-depth phenomenological interviews (n = 34), observation, and document analysis have revealed four key themes: A life course marked by adversities, Embracing the unyielding strength within, Personal resilience catalysts, and Extrinsic resilience catalysts. The participants exhibited a reasonably well-functioning collective, given their persistent adversities in their life course. Narratives illuminated a notable connection between the presence of resilience characteristics and the overall functioning of older adults. From a social work standpoint on resilience, this article underscores the vital interplay between individual agency and environmental factors in addressing adversity. The article advocates culturally sensitive, asset-based strategies to strengthen indigenous older adults' intrinsic and extrinsic resilience to ensure that they are not left behind in the global pursuit of healthy aging.

The Role of Place Attachment in the Relationship between Attitudes toward Aging and Subjective Well-Being among Community-Dwelling Older Adults in Taiwan

Subjective well-being presents a societal challenge for vulnerable older adults. This study aims to investigate the mediating role of place attachment in the relationship between attitudes toward aging and subjective well-being among community-dwelling older adults in Taiwan. Two waves of investigations were conducted to examine the interplay between attitudes toward aging, subjective well-being, and place attachment among older adults. In Wave I, 1190 participants were enrolled, revealing predominantly younger cohorts with substantial educational levels. The subsequent Wave II involved 483 participants, maintaining continuity in characteristics. Subjective well-being remained moderate across waves, with prevalent positive attitudes toward aging. Place attachment scores indicated moderate to high associations. After controlling for demographics, structural equation modeling (SEM) in both waves revealed significant positive associations: attitudes toward aging influenced well-being, attitudes toward aging were positively associated with place attachment, and place attachment was positively related to well-being. Mediation testing confirmed the mediating role of place attachment in the relationship between attitudes toward aging and well-being. These findings underscore the important role of place attachment. It is evident that improving attitudes toward aging is an effective intervention which can lead to a better sense of well-being by enhancing place attachment to empower civil society.

The severity of andropause symptoms and its relationship with social well-being among retired male nurses: a preliminary cross-sectional study

BACKGROUND

Andropause is a syndrome that occurs due to decreased androgen levels in men. Various aspects of health, such as social well-being, can affect andropause status during men's retirement. This study aimed to determine the severity of andropause symptoms and its relationship with social well-being among retired male nurses.

METHODS

This preliminary cross-sectional study was conducted on 284 retired male nurses in Ardabil (northwest of Iran). The participants were selected through the census sampling method. Data were collected using a demographic information form, the Male Andropause Symptoms Self-Assessment Questionnaire (MASSQ), and the Social Well-Being Scale (SWBS). Data were analyzed using SPSS software (version 22.0).

RESULTS

The study found that the overall mean scores of the severity of andropause symptoms and social well-being among retired male nurses were 57.24 ± 12.62 (range = 35-91) and 94.54 ± 12.77 (range = 75-123), respectively. The highest and lowest mean scores between dimensions of social well-being were related to social contribution (20.26 ± 2.47) and social acceptance (15.26 ± 2.77), respectively. Multiple linear regression analysis revealed that subscales of social well-being, age, marital status, and spouse's menopause were predictors of the severity of andropause symptoms among retired male nurses. The selected predictors accounted for 53.1% of the total variance in severity of andropause symptoms (F = 36.613, p < 0.001).

CONCLUSION

The results showed a moderate to severe prevalence of andropause among retired male nurses and a significant association between andropause and social well-being. The study suggests further research to examine sexual orientation and other factors that may affect andropause in retired male nurses.

Can Creativity and Cognitive Reserve Predict Psychological Well-Being in Older Adults? The Role of Divergent Thinking in Healthy Aging

The maintenance of psychological well-being (PWB) in the older adult population is a pivotal goal for our rapidly aging society. PWB is a multicomponent construct that can be influenced by several factors in the lifespan. The beneficial role of divergent thinking (DT) and cognitive reserve (CR) in sustaining older subjects' PWB has been scarcely investigated so far. The present study aims to investigate the relationships between DT, CR, and PWB in a sample of 121 healthy older adults (61 females; M age: 73.39 ± 6.66 years; M education: 11.33 ± 4.81 years). The results highlight that better DT performance predicts higher CR, which mediates an indirect positive effect of DT on emotional competence, one of the PWB factors. It follows that DT and CR can be considered protective factors in aging, and their effects go beyond cognitive functioning, revealing a positive effect even on some PWB components. The practical implications regarding targeted health interventions for prevention in the older adult population to support well-being and promote healthy aging are discussed.

Factors Associated With Food Insecurity Among a Community-Based Sample of Older Adults in a North Florida County

Food insecurity impacts the lives of 7.6 million U.S. adults aged 60 and older and is linked to numerous life challenges. This study examined the nature of food insecurity among community-based participants ≥65 years in a north Florida county and conceptualized food insecurity as encompassing the lack of food and individual adaptability. Thus, food insecurity was measured using three dependent variables: (1) worrying that food would run out, (2) cutting meal size or skipping meals, and (3) food not lasting. Logistic regression revealed that older participants, those with better-perceived health status, and those who were confident that they could find solutions to their problems had lower odds of reporting food insecurity. However, respondents who lived in low-income, low-access zip codes and those who received food assistance were more likely to report food insecurity. To improve outcomes and reduce healthcare disparities, solutions to food insecurity must vary in focus and approach.

Impact of Optimism on Cognitive Performance of People Living in Rural Area: Findings From a 20-Year Study in US Adults

Objectives: Mid- or early-late-life cognitive function is an indicator for developing late-life dementia. However, it is still unclear whether rural/urban living contexts provide cognitive benefits across adulthood. Further, higher optimism serves as a general protective factor for many health outcomes. The present study examines associations between rurality/urbanicity, optimism, and change in mid/late-life cognitive functions over time. Methods: Data were from waves 1 to 3 (1995-2015) of the Midlife in the United States (MIDUS) study (N = 2,507). Structural equation models examine whether long-term rural living across both waves (1-2) or intermittent rural living at one wave is associated with better cognitive function over 20 years, compared to no rural living, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if optimism mediates the above associations. Results: After controlling for covariates, long-term rural living (waves 1-2) was indirectly (through less optimism) associated with significantly lower levels of cognitive executive function and episodic memory in wave 3. Conclusions: While long-term rural living and cognitive outcomes have no direct association for MIDUS middle-aged and older adults, mediating roles of optimism in these associations were evident. Future investigations could examine mechanisms that underlie these risk/protective factors on late-life cognition.

Resilience in caregivers of people with mild-to-moderate dementia: findings from the IDEAL cohort

OBJECTIVES

A novel model of resilience was tested in caregivers of people with mild-to-moderate dementia and was extended to explore whether including self-efficacy, optimism, and self-esteem improved its predictive value.

DESIGN

Cross-sectional.

SETTING

Data from the IDEAL cohort were used.

PARTICIPANTS

The study comprised 1222 caregivers of people with dementia.

MEASUREMENTS

A composite resilience score was calculated from five measures. Multivariable regressions were used to investigate factors associated with resilience.

RESULTS

Greater resilience was associated with being older, being male, and caregiving for older people with dementia. Greater resilience was also observed when people with dementia had fewer functional difficulties and/or fewer neuropsychiatric symptoms, there was a stronger dyadic relationship, and the caregiver had fewer social restrictions, less neuroticism, and greater perceived competence. Surprisingly, caregiver self-efficacy, optimism, and self-esteem were unrelated to resilience.

CONCLUSION

Caregivers of people with mild-to-moderate dementia generally scored well for resilience. Resilience was associated with both the personal characteristics of caregivers and level of care need among people with dementia. Future work is needed to determine whether the caregivers in this cohort appeared resilient because the care recipients had relatively low care needs and consequently placed fewer demands on caregiver well-being than would be the case where dementia is more advanced.

Economic Resources and Health: A Bi-Directional Cycle for Resilience in Old Age

Objectives: The paper offers an expanded framework for conducting empirical research on resilient aging. Methods: We review the conceptual frameworks for resilient aging and incorporate the role of economic factors as resources that contribute to resilience, in addition to social and psychological factors emphasized in the existing literature. Moreover, the idea of reinforcing cycles of resilience is incorporated in the framework. Existing empirical evidence that supports the conceptual arguments is presented. Results: Examples from Mexico and other low-middle-income countries are included, as well as from high-income countries. Data requirements for applying the conceptual framework in empirical analysis and the state of data availability are examined. We illustrate the measures that are available for this purpose using the Mexican Health and Aging Study. Discussion: We discuss and conclude that the state of the field is rich in data to conduct empirical work on resilience in old age.

Social Participation: A Strategy to Manage Depression in Disabled Populations

This study aimed to investigate whether social participation (SP) can decrease depressive symptom severity in disabled older adults. A total of 5,937 disabled participants (4877, 1970, 219, and 8 participants responding 1, 2, 3, 4 times, respectively), obtained from the China Health and Retirement Longitudinal Study, were enrolled in our analysis. Based on pooled Ordinary Least Square regressions, SP was associated with decreased depressive symptom severity, and this association was significant in recreational activities and interacting with friends. For brain-disabled respondents, the association was not significant. SP is effective in decreasing depressive symptom severity in disabled older populations. Diversified activities and targeted interventions should be applied to specified older disabled populations to prevent depression.

The Impact of Dance Movement Interventions on Psychological Health in Older Adults without Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Lifestyle-based multimodal interventions that integrate physical, sensory, cognitive and social enrichment are suggested to promote healthy mental aging and resilience against aging and Alzheimer's disease (AD).

OBJECTIVES

This meta-analysis examined the efficacy of dance movement interventions (DMI) as an integrated mind-body activity on outcomes of psychological health in older adults.

METHODS

Pre-registration was carried out with PROSPERO (CRD42021265112). PubMed, Web of Science and PsycINFO were searched for randomized controlled trials (RCT) evaluating the effects of DMI (>4 weeks' duration) compared to comparators on measures of psychological health (primary outcome) and cognitive function (additional outcome) among older adults without dementia (aged ≥55). Data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) were synthesized using a random effects meta-analysis with robust variance estimation.

RESULTS

DMI had a small positive effect on overall psychological health (g = 0.30; 95% confidence interval [CI]: 0.06, 0.53; p = 0.02, I²= 65.04) compared to control conditions. Small effects of DMI on positive and negative psychological domains as well as quality of life were not statistically significant. DMI had a medium positive effect on general cognitive function (g = 0.50; 95% CI: 0.12, 0.89, p = 0.02, I²= 79.61) over comparators. None of the primary intervention studies evaluated measures of neuroplasticity.

CONCLUSIONS

We found that DMI was effective in promoting mental health amongst older adults without dementia, suggesting that the multimodal enrichment tool is a potential strategy for health promotion and prevention of AD. High-quality intervention studies are needed to expand evidence on DMI-induced changes in specific psychological domains and identify underlying neurophysiological correlates.

Trajectories of Physical Function and Behavioral, Psychological, and Social Well-Being in a Cohort of Swedish Older Adults

Background and Objectives

Successful aging has been described as a multifactorial and dynamic process. The aims of the study were to detect aging trajectories of physical function and behavioral, psychological, and social well-being; and to explore the correlations between functional versus well-being trajectories by age group.

Research Design and Methods

Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (N = 1,375). Subjects' physical function was assessed through walking speed and chair-stand tests, behavioral well-being through participation in mental and physical activities, psychological well-being through life satisfaction and positive affect, and social well-being through social connections and support. All exposures were standardized (z-scores). Linear mixed models were used to estimate trajectories of physical function and well-being over a 12-year follow-up.

Results

The steepest declines were seen for physical function (relative change [RC] in z-scores across ages; RC = 3.01), followed by behavioral well-being (RC = 2.15), psychological well-being (RC = 2.01), and social well-being (RC = 0.76). Correlations between physical function and the different well-being domains were weak, especially for slopes. Stronger intercept correlations were observed among the oldest-compared to the youngest-old, especially with behavioral (r = 0.39 vs r = 0.24) and psychological (r = 0.33 vs r = 0.22) well-being.

Discussion and Implications

Physical function declines the fastest throughout aging. The different well-being domains decline at a slower rate, which may be a possible sign of compensation against age-related functional decline, especially among the youngest-old, for whom discordances between physical function and the different well-being domains were more common.

The effect of positive thinking on resilience and life satisfaction of older adults: a randomized controlled trial

The cumulative effects of adversity and unhappiness affect life satisfaction and quality of life in the growing older adult population. Most of the interventions aimed at improving the health and quality of life of older adults have adopted a problem-oriented or weakness-focused approach. However, a positive or strengths-focused approach can also have a virtuous but more effective capacity to contribute to the well-being and life satisfaction of older adults. Therefore, the present study was conducted to investigate the effect of positive thinking training on improving resilience and life satisfaction among older adults. A randomized controlled trial was conducted on 100 older adults with simple random sampling. The intervention group received 90-min weekly sessions for eight weeks on positive thinking training through written homework for reflection, group discussion, and media. The data were collected using Ingram and Wisnicki Positive Thinking Questionnaire, Connor-Davidson Resilience Scale, and Tobin Life Satisfaction Questionnaire at baseline and one week and two months after the training. The collected data were analyzed using descriptive and inferential statistics in SPSS software 26. P values below 0.05 were considered statistically significant. Positive thinking training led to better thinking (p < 0.001), higher resilience (p < 0.001), and greater life satisfaction (p < 0.001). The study's findings showed the effectiveness of the positive thinking training approach in improving resilience and life satisfaction in older adults. It is recommended to evaluate the long-term outcome in populations with different social, economic, and cultural statuses in future studies.

Predictors of loneliness during the Covid-19 pandemic in people with dementia and their carers in England: findings from the DETERMIND-C19 study

OBJECTIVES

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic.

METHODS

People with dementia and their carers completed assessments before (July 2019-March 2020; 206 dyads) and after (July-October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline.

RESULTS

In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness.

CONCLUSION

Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed.

Socioeconomic, Behavioural, and Social Health Correlates of Optimism and Pessimism in Older Men and Women: A Cross-Sectional Study

BACKGROUND

Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessimism in older adults.

METHODS

Participants included 10,146 community-dwelling, apparently healthy Australian adults aged 70 years and over from the ASPREE Longitudinal Study of Older Persons (ALSOP). Optimism and pessimism were measured using the revised Life Orientation Test. Cross-sectional ordinal logistic regression was used to determine the socioeconomic, behavioural, and social health factors associated with optimism and pessimism.

RESULTS

Higher education, greater physical activity, lower loneliness, and volunteering were associated with higher optimism and lower pessimism. Low social support was associated with higher pessimism. Higher socioeconomic advantage, greater income, and living alone were associated with lower pessimism. Women were more optimistic and less pessimistic than men. The association of age, smoking status, and alcohol consumption with optimism and pessimism differed for men and women.

CONCLUSIONS

Factors associated with higher optimism and lower pessimism were also those demonstrated to support healthy ageing. Health-promotion action at the individual level (e.g., smoking cessation or regular physical activity), health professional level (e.g., social prescribing or improving access and quality of care for all older adults), and community level (e.g., opportunities for volunteer work or low-cost social activities for older adults) may improve optimism and reduce pessimism, possibly also promoting healthy ageing.

Active aging awareness and well-being among older adults in Portugal

Objective

This study aims to assess the active aging awareness of older adults in mainland Portugal and their levels of overall well-being and to identify social and health-related factors.

Methods

A cross-sectional study was conducted with a representative sample of 613 older adults, aged 65 or older, who participated in the PROKnos - Knowing Social Prescribing needs of the elderly study in Portugal. The questionnaire consisted of the Active Ageing Awareness Questionnaire and the World Health Organization - Five Well-Being Index, as well as sociodemographic, economic, and health status questions. Correlation coefficients, t-tests for independent samples, and one-way ANOVA were used to explore potential associations between variables.

Results

The active aging awareness levels were significantly higher for women (p = 0.031), and those who were younger (p = 0.011), more educated (p < 0.001), had a better financial situation (p < 0.001), and had better health (p < 0.001). The same pattern was found for well-being, except in relation to gender, as men had higher levels (p = 0.016). These variables were found to be correlated.

Discussion

Even though active aging is an important strategy to implement, it is indispensable to consider the perceptions and conditions that need to be in place before that. This study reveals that several social and health-related factors are associated with well-being and active aging awareness, as well as the differences between groups that exist in mainland Portugal in relation to that. This emphasizes how vital it is to address social inequalities in active aging efforts, which are not necessarily uncovered when only considering actual active aging measures.

The COVID-19 Pandemic, Social Ties, and Psychosocial Well-Being of Middle-Aged Women in Rural Africa

The study contributes to the understanding of the societal impact of the coronavirus disease 2019 pandemic in the Global South by examining longer term implications of pandemic-induced disruptions and deprivations for social ties and psychosocial well-being. Using data from a survey of middle-aged women in rural Mozambique, the author finds a negative association between the pandemic-triggered household economic decline and perceived changes in the quality of relations with marital partners, non-coresident children, and relatives, but not with generally more distant actors, such as coreligionists and neighbors. In turn, multivariable analyses detect a positive association of changes in the quality of family and kin ties with participants' life satisfaction, regardless of other factors. Yet women's expectations for changes in their household living conditions in the near future show a significant association only with changes in the quality of relations with marital partners. The author situates these findings within the context of women's enduring vulnerabilities in low-income patriarchal settings.

Advanced brain age correlates with greater rumination and less mindfulness in schizophrenia

BACKGROUND

Individual variation in brain aging trajectories is linked with several physical and mental health outcomes. Greater stress levels, worry, and rumination correspond with advanced brain age, while other individual characteristics, like mindfulness, may be protective of brain health. Multiple lines of evidence point to advanced brain aging in schizophrenia (i.e., neural age estimate > chronological age). Whether psychological dimensions such as mindfulness, rumination, and perceived stress contribute to brain aging in schizophrenia is unknown.

METHODS

We estimated brain age from high-resolution anatomical scans in 54 healthy controls (HC) and 52 individuals with schizophrenia (SZ) and computed the brain predicted age difference (BrainAGE-diff), i.e., the delta between estimated brain age and chronological age. Emotional well-being summary scores were empirically derived to reflect individual differences in trait mindfulness, rumination, and perceived stress. Core analyses evaluated relationships between BrainAGE-diff and emotional well-being, testing for slopes differences across groups.

RESULTS

HC showed higher emotional well-being (greater mindfulness and less rumination/stress), relative to SZ. We observed a significant group difference in the relationship between BrainAge-diff and emotional well-being, explained by BrainAGE-diff negatively correlating with emotional well-being scores in SZ, and not in HC. That is, SZ with younger appearing brains (predicted age < chronological age) had emotional summary scores that were more like HC, a relationship that endured after accounting for several demographic and clinical variables.

CONCLUSIONS

These data reveal clinically relevant aspects of brain age heterogeneity among SZ and point to case-control differences in the relationship between advanced brain aging and emotional well-being.

Spatiotemporal Characteristics of Coupling and Coordination of Cultural Tourism and Objective Well-Being in Western China

A supply of high-quality cultural tourism products effectively promotes people's happiness. This study takes the coupling and coordination relationship between cultural tourism (CT) and objective well-being (OWB) in western China as the research object and constructs an index evaluation system for the development levels of cultural tourism and objective welfare, which are divided into three development stages of dysfunctional, transitional, and coordinated development and 10 coordination levels, including high-quality coordination. The entropy weight method, coupled coordination model, Thiel index, standard deviation, and coefficient of variation were used to calculate the comprehensive development index and coupling coordination degree of the CT and OWB systems in western China from 2007 to 2020, and then their evolution characteristics were analyzed from the perspectives of time and space. The results show the following: (1) The comprehensive development capacity of the CT and OWB systems in the western region shows a relatively consistent growth trend except for 2020, the overall development capacity of objective welfare was relatively high, and the development capacity of cultural tourism was relatively low. (2) The CT and OWB systems were in a state of transition from high coupling and low coordination to high coupling and high coordination, which were divided into three development stages: imbalanced stage (2007-2008), transitional stage (2009-2011), and coordinated development (2012-2020). The coordination degree has developed steadily from moderate misalignment to good coordination over time, and the diversified characteristics of coupling coordination levels are obvious. (3) The spatial equilibrium of the CT and OWB systems is obvious, and the spatial difference in the western region is getting smaller, but the relative gap is widening significantly. (4) The comprehensive development capacity of the cultural tourism system should be enhanced, the spiritual needs of residents based on objective well-being should be met, and the sustainable development of the CT and OWB systems.

Trait Mindfulness and Physical Health among Chinese Middle-Older Adults: The Mediating Role of Mental Health

Few studies have focused on the specific effects of trait mindfulness on physical health status, especially from a resilient aging perspective. This study examined the mediating role of mental health in the association between trait mindfulness and physical health status among middle-older adults in urban China. The participants included 188 individuals who were recruited from a community senior university and five community senior care centers. The findings reveal: (1) trait mindfulness has a strong effect on two physical health indicators (self-rated physical health and subjective sleep quality); (2) mental health is a significant mediator in the relationship between trait mindfulness and physical health status; and (3) the mediation role of mental health is more evident in the self-rated physical health model (24.15%) than subjective sleep quality (18.10%). This study improves our knowledge of how trait mindfulness can lead to a better physical health in middle-older adults and can lead to the development of social value communication and effective prevention.

An examination of cyberchondria's relationship with trait anxiety and psychological well-being in women of reproductive age: A cross-sectional study

Online environments have become the main sources of health-related information. However, if used incorrectly, this can decrease the level of well-being. Cyberchondria corresponds to the hypochondria in the digital age. We aimed to investigate the relationship between cyberchondria and trait anxiety, psychological well-being, and other factors in women of reproductive age. This study used a descriptive cross-sectional design. Face-to-face questionnaires were administered to women aged 18 to 49. The sample size was formed and stratified according to the population of the 47 family health centers to reflect the entire population. The questionnaire included a sociodemographic information form, the Cyberchondria Severity Scale (CSS), the State-Trait Anxiety Inventory, and the Psychological Well-Being Scale (PWBS). This study included 422 participants. The average daily use of the Internet was 2.14 ± 1.837 hours, while that of social media was 2.69 ± 2.027 hours. The mean CSS score was 89.42 ± 21.688; the mean trait anxiety score was 44.34 ± 8.791, and the mean PWBS score was 324.26 ± 35.944. Factors that interacted with the level of cyberchondria were the trait anxiety score, PWBS score, alcohol consumption, and average daily use of the internet and social media. Increased online time, alcohol consumption, trait anxiety levels, and psychological well-being increase cyberchondria levels. Improvements must be made in the accuracy of online information, which is unsupervised and easily accessible to society as a source of information. Future studies should focus on the prevention, detection, and treatment of cyberchondriasis. Identifying and improving the factors affecting women's and mothers' cyberchondria will also increase the chances of providing primary protection against certain diseases.

Patterns of the physical, cognitive, and mental health status of older individuals in a real-life primary care setting and differences in coping styles

Background

Physical frailty and cognitive decline are two major consequences of aging and are often in older individuals, especially in those with multimorbidity. These two disorders are known to usually coexist with each other, increasing the risk of each disorder for poor health outcomes. Mental health disorders, anxiety and depression, are common in older people with multimorbidity, in particular those with functional or sensory deficits, and frailty.

Purpose

The aim of this study was to show how physical frailty, cognitive impairments and mental disorders, cluster in the real life setting of older primary care (PC) patients, and how these clusters relate to age, comorbidities, stressful events, and coping strategies. Knowing that, could improve risk stratification of older individuals and guide the action plans.

Methods

Participants were older individuals (≥60, N = 263), attenders of PC, independent of care of others, and not suffering from dementia. For screening participants on physical frailty, cognitive impairment, and mental disorders, we used Fried‘s phenotype model, the Mini-Mental State Examination (MMSE), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS). For testing participants on coping styles, we used the 14-scale Brief-Coping with Problems Experienced (Brief-COPE) questionnaire. To identify clusters, we used the algorithm fuzzy k-means. To further describe the clusters, we examined differences in age, gender, number of chronic diseases and medications prescribed, some diagnoses of chronic diseases, the number of life events, body mass index, renal function, expressed as the glomerular filtration rate, and coping styles.

Results

The most appropriate cluster solution was the one with three clusters, that were termed as: functional (FUN; N = 139), with predominant frailty or dysfunctional (DFUN; N = 81), and with predominant cognitive impairments or cognitively impaired (COG-IMP; N = 43). Participants in two pathologic clusters, DFUN and COG-IMP, were in average older and had more somatic diseases, compared to participants in cluster FUN. Significant differences between the clusters were found in diagnoses of osteoporosis, osteoarthritis, anxiety/depression, cerebrovascular disease, and periphery artery disease. Participants in cluster FUN expressed mostly positive reframing coping style. Participants in two pathological clusters were represented with negative coping strategies. Religion and self-blame were coping mechanisms specific only for cluster DFUN; self-distraction only for cluster COG-IMP; and these two latter clusters shared the mechanisms of behavioral disengagement and denial.

Conclusion

The research approach presented in this study may help PC providers in risk stratification of older individuals and in getting insights into behavioral and coping strategies of patients with similar comorbidity patterns and functional disorders, which may guide them in preparing prevention and care plans. By providing some insights into the common mechanisms and pathways of clustering frailty, cognitive impairments and mental disorders, this research approach is useful for creating new hypotheses and in accelerating geriatric research.

Social Frailty in Late Adulthood: Social Cognitive and Psychological Well-Being Correlates

OBJECTIVES

Social frailty poses a major threat to successful aging, but its social cognitive and psychological well-being correlates remain poorly understood. This cross-sectional study provides initial insights into whether social cognitive difficulties in older age are associated with social frailty, as well as how social frailty is linked to psychological characteristics known to be important for health and well-being.

METHOD

Ninety community-dwelling older adults completed measures of social frailty and social cognition (social perception, theory of mind, affective empathy, and informant-rated social behavior) as well as measures of psychological function known to be important for health and well-being, both positively (resilience and life satisfaction) and negatively (demoralization, social anxiety, and apathy). Measures of cognitive frailty, physical frailty, and depression were also administered to test the specificity of any observed relationships with social frailty.

RESULTS

Both affective empathy and social behavior were predictive of increased social frailty, but social behavior emerged as the only unique predictor after controlling for covariates. Social frailty also predicted unique variance in all five measures of psychological well-being, and for three of these measures (demoralization, resilience, and life satisfaction), the effects remained significant even after adjusting for covariates.

DISCUSSION

Findings are discussed in relation to models of socioemotional aging and frailty. Potential mechanisms linking social behavior to social capital in older age are identified, as well as how loss of social resources might both directly and indirectly impact well-being.

What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach

Aims

Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults.

Methods

We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t₀;2006/2008 and t₁;2010/2012) were associated with purpose four years later (t₂;2014/2016) after adjustment for a rich set of baseline covariates.

Results

Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose.

Conclusions

Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life.

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Factors that lead to increased purpose in life in older adults remain unclear.

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We leveraged a large and prospective cohort of US adults aged >50.

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We evaluated associations between 61 predictors and subsequent purpose in life.

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Some health/well-being factors were associated with purpose in life 4 years later, but not others.

Older People's Usage Pattern, Satisfaction with Community Facility and Well-Being in Urban Old Districts

Community facilities are an important element that supports older people's daily life and promotes their well-being. However, there is a dearth of comprehensive studies on the effect of planning and design of different types of community facilities on older people's usage patterns and satisfaction. This study aims to provide a framework to explore the relationship among the planning of community facilities, older people's usage and satisfaction level and well-being for different types of community facilities. Both spatial analysis and questionnaire survey (n = 497) methods are employed in this study. This study finds that commercial (89.34%), municipal (83.10%) and leisure (88.13%) facilities are most commonly used by older people. This study suggests that older people's frequency of visiting community facilities is mainly affected by the purpose of visiting a community facility. Planning and design quality of the community facility are found to be significantly associated with older people's satisfaction level with using a community facility. In addition, older people's higher satisfaction level and usage level of community facilities could increase their physical and psychological well-being. The findings of this study not only contribute to the knowledge gap of older people's usage and satisfaction with using community facilities but also suggest that planners should aim toward a better distribution of community facilities to improve older adults' well-being.

Older adults recall memories of life challenges: the role of sense of purpose in the life story

Late life is still often characterized as a time of loss and decline. The current study moved beyond this view, using both the resilience framework and the life story approach to highlight the rich life experiences of older adults. Doing so created an opportunity to explore perspectives on sense of purpose in life, from the vantage point of old age. The study had two central questions. That is, how have older adults drawn on their sense of purpose across their lives, and what factors led to the development of a sense of purpose? Following guidelines for the consensual qualitative research method (CQR; Hill et al., The Counseling Psychologist, 25(4), 517-572, 1997; Hill & Knox, 2021), in-depth, semi-structured interviews were conducted with 18 older women and men (aged 60 - 100 years) and transcribed for analysis. The CQR method revealed seven domains in the interviews. Three domains were relevant to the first research question, including: overcoming life challenges to pursue purpose, perspective-taking to maintain purpose, and purpose as part of one's religion. Four domains provided insights on the second research question: life background influencing purpose, shifts in purpose across life, fulfilling purpose across life, and obstacles to pursuing purpose in life. Findings highlighted how older people use sense of purpose as a guide in the face of life's inevitable challenges. They also revealed the unique life story paths that lead to the development of purpose across individuals' lifetimes. The implications of maintaining a sense of purpose in life, across the later years, are discussed.

Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults

IMPORTANCE

Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.

OBJECTIVES

To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.

EXPOSURE

Aging satisfaction.

MAIN OUTCOMES AND MEASURES

A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.

RESULTS

During the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.

CONCLUSIONS AND RELEVANCE

This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.

The Impact of COVID-19 on Older Adults: Results from an Annual Survey

Objectives

Assess well-being among older adults through secondary analysis measured during an annual survey in 2018, 2019, and 2020, to determine trends from before and during the COVID-19 pandemic.

Methods

Mailed surveys sent annually included measures related to various psychosocial factors.

Main findings

Response rates were 29% in 2018, 25% in 2019, and 24% in 2020. Most respondents reported average or high resilience (89% 2018-2020), high purpose (64% in 2018 and 2019, 63% in 2020), moderate optimism (46% in 2019, 44% in 2020) and low stress (88% in 2019 and 2020). Reported loneliness increased 13% from 2018 to 2020. In 2020, only 45% reported high comfort with technology, decreasing with age (>75).

Principal conclusion

Psychosocial well-being of respondents were doing well despite changes related to COVID-19. However, increased loneliness may negatively impact long-term health outcomes; thus, a focus on technology options to stay socially connected and access healthcare are needed.

Social Well-Being, Psychological Factors, and Chronic Conditions Among Older Adults

Background

Aging is characterized by the decline in physical health, functional status, and loss of social roles and relationships that can challenge the quality of life. Social well-being may help explain how aging individuals experience declining physical health and social relationships. Despite the high prevalence of chronic conditions among older adults, research exploring the relationship between social well-being and chronic disease is sparse.

Objectives

The study aims were to investigate the relationship between social well-being and psychological factors (e.g., perceived control, life satisfaction, self-esteem, active coping, optimism, and religious coping) by chronic condition in older adults.

Design

Cross-sectional study.

Participants

The current study comprises older adults (N = 1,251, aged ≥ 65 y) who participated in the third wave of the National Survey of Midlife in the United States (i.e., MIDUS).

Setting

MIDUS was conducted on a random-digit-dial sample of community-dwelling, English-speaking adults.

Measurements

Six instruments representing psychological resources (life satisfaction, perceived control, self-esteem, optimism, active coping, and religious coping) and five dimensions of social well-being (social actualization, social coherence, social acceptance, social contribution, social integration) were measured. An index of chronic disease comprised of self-reported data whether they had received a physician's diagnosis for any chronic conditions over the past year.

Results

The findings indicated that the individuals without chronic conditions had significantly higher social integration, social acceptance, and social contribution scores than the individuals with chronic conditions (t = 2.26, p < 0.05, t = 2.85, p < 0.01, and t = 2.23, p < 0.05, respectively). For individuals diagnosed with more than one chronic condition, perceived control, self-esteem, and optimism were positively related to their social well-being (β = .33, p < .001, β = .17, p < .001, and β = .33, p < .001, respectively).

Conclusion

Findings suggested that older adults with multiple chronic conditions have a decrease in social well-being. Chronic disease management programs may help increase social well-being among individuals with multiple chronic conditions.

Low Psychological Resilience in Older Individuals: An Association with Increased Inflammation, Oxidative Stress and the Presence of Chronic Medical Conditions

The term resilience, which has been present in science for almost half a century, stands for the capacity of some system needed to overcome an amount of disturbance from the environment in order to avoid a change to another stable state. In medicine, the concept of resilience means the ability to deal with daily stress and disturbance to our homeostasis with the intention of protecting it from disturbance. With aging, the organism becomes more sensitive to environmental impacts and more susceptible to changes. Mental disturbances and a decline in psychological resilience in older people are potentiated with many social and environmental factors along with a subjective perception of decreasing health. Distinct from findings in younger age groups, mental and physical medical conditions in older people are closely associated with each other, sharing common mechanisms and potentiating each other’s development. Increased inflammation and oxidative stress have been recognized as the main driving mechanisms in the development of aging diseases. This paper aims to reveal, through a translational approach, physiological and molecular mechanisms of emotional distress and low psychological resilience in older individuals as driving mechanisms for the accelerated development of chronic aging diseases, and to systematize the available information sources on strategies for mitigation of low resilience in order to prevent chronic diseases.

Sense of Purpose in Life and Subsequent Physical, Behavioral, and Psychosocial Health: An Outcome-Wide Approach

PURPOSE

Growing evidence indicates that a higher sense of purpose in life (purpose) is associated with reduced risk of chronic diseases and mortality. However, epidemiological studies have not evaluated if change in purpose is associated with subsequent health and well-being outcomes.

DESIGN

We evaluated if positive change in purpose (between t₀; 2006/2008 and t₁;2010/2012) was associated with better outcomes on 35 indicators of physical health, health behaviors, and psychosocial well-being (at t₂;2014/2016).

SAMPLE

We used data from 12,998 participants in the Health and Retirement study-a prospective and nationally representative cohort of U.S. adults aged >50.

ANALYSIS

We conducted multiple linear-, logistic-, and generalized linear regressions.

RESULTS

Over the 4-year follow-up period, people with the highest (versus lowest) purpose had better subsequent physical health outcomes (e.g., 46% reduced risk of mortality (95% CI [0.44, 0.66])), health behaviors (e.g., 13% reduced risk of sleep problems (95% CI [0.77, 0.99])), and psychosocial outcomes (e.g., higher optimism (β = 0.41, 95% CI [0.35, 0.47]), 43% reduced risk of depression (95% CI [0.46, 0.69]), lower loneliness (β = -0.35, 95% CI [-0.41, -0.29])). Importantly, however, purpose was not associated with other physical health outcomes, health behaviors, and social factors.

CONCLUSION

With further research, these results suggest that sense of purpose might be a valuable target for innovative policy and intervention work aimed at improving health and well-being.