Psychological approach to successful ageing predicts future quality of life in older adults

Resilience and successful aging: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis investigates the relationship between successful aging (SA) and resilience in older adults, focusing on individuals aged 60 and above, to address a significant gap in understanding how resilience contributes to SA.

METHODS

Following the Cochrane review guidelines, we conducted searches in databases such as Web of Science, PsycNet, and PubMed up to December 2021 and used PRISMA as a tool for reporting the results. Our inclusion criteria were studies on psychological resilience and SA in older adults aged 60 and above. Exclusion criteria included studies on physical resilience, medical outcomes of SA, other indicators not used in screened studies (e.g., prevalence, means), populations with suicidal ideation or chronic/palliative illnesses, studies considering resilience as an indicator of SA, and qualitative studies on the association between resilience and SA.

RESULTS

A total of 21 studies were included and assessed for risk of bias using funnel plot and trim-and-fill methods. The meta-analysis revealed a medium effect size indicating a positive relationship between resilience and SA. However, high heterogeneity warrants a cautious interpretation of these results. No significant differences were found between older adults in the general population and those in retirement communities, nor were geographical variations (Asia, Europe, America) found to moderate this relationship.

DISCUSSION

The findings highlight the intrinsic link between older adults' attitudes towards aging, their subjective evaluations, and their level of psychological resilience. Resilience acts as a protective factor against psychological and physical adversities, underscoring the importance of resilience-enhancing strategies in interventions aimed at promoting SA. The conclusions drawn from this analysis should be approached with caution due to the heterogeneity of the included studies.

Perceptions of Adulthood and Mental Health

BACKGROUND

In contrast to conventional definitions, the contemporary conceptualization of adulthood emphasizes psychological characteristics over sociodemographic milestones. At the same time, an increasing number of theorists propose that the way individuals view adulthood may have a significant impact on the mental health of both adolescents and adults. However, empirical examination of this hypothesis has been notably limited to date. The aim of this study is to explore the association between individuals' perceptions of adulthood and multiple dimensions of mental health.

METHOD

This study applied some adulthood markers and multiple mental health indexes (including well-being, optimism, Alexithymia, satisfaction with life, Goldberg's index of mental health, the dark triad, and dimensional personality disorders) to a community sample comprising 1772 individuals in Spain, spanning ages from 16 to 93 years.

RESULTS

The findings support the overarching hypothesis, as perceptions of adulthood display strong correlations with nearly every assessed index of mental health, particularly those that comprise a dimension of negative emotions. These associations persist even after accounting for age and socio-economic status, and in alignment with the psychological paradigm of adulthood, they show a notable consistency across various age groups.

CONCLUSIONS

This study establishes that such perceptions of adulthood represent a modifiable factor contributing to positive mental health. The implications of these findings for the formulation of public policies aimed at promoting mental health in the context of adulthood, as well as a number of future studies, are deliberated.

Life-course socio-economic status and its impact on functional health of Portuguese older adults

Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

Mediating effect of successful aging on the relationship between psychological resilience and death anxiety among middle-aged and older adults with hypertension

Objective

The aging trend of China's population is severe and successful aging (SA) is imminent. Aging can lead to various chronic diseases, with hypertension being the most common. Due to this lifelong disease, patients suffer from many anxieties, as death anxiety (DA) can be the most prevalent. Studies have exhibited that middle-aged adults approaching the transition to an older state show more pronounced DA than the more senior. It has been suggested that psychological resilience (PR) can reduce DA. Therefore, this study aimed to analyze the mediating effect of SA between PR and DA in middle-aged and older adults with hypertension.

Methods

A cross-sectional survey was designed. From August to December 2021, 298 middle-aged and older adults with hypertension were selected by multistage cluster random sampling in three districts (Ling he District, Gu ta District, and Tai He District) of Jinzhou City, Liaoning Province. They were surveyed using the demographic questionnaires, the Conner-Davidson Resilience Scale, the Successful Aging Inventory, and the Chinese version of a Likert-type Templer-Death Anxiety Scale. Descriptive analyses, independent sample T-test, and one-way analysis of variance (ANOVA) were used to describe demographic characteristics among hypertensive patients with different characteristics, respectively. Statistics were considered significant when P < 0.05. Pearson correlation coefficients describe the relationship between PR, SA, and DA. The research model was shaped through Structural Equation Modeling (SEM). SPSS PROCESS macro was used to verify the mediation model. A binary logistic regression model was used with DA as the dependent variable.

Results

The scores for PR, SA, and DA in hypertensive patients are (49.52 ± 14.38) points, (51.22 ± 7.63) points, and (46.67 ± 9.03) points. PR was negatively correlated with DA (r = -0.307, P < 0.01). Moreover, incorporating SA as a mediating variable in PR and DA, SA was positively correlated with PR (r = 0.335, P < 0.01) and DA (r = 0.085, P > 0.05). The direct effect is opposite to the sign of the indirect effect. There is a suppression between PR and DA with a percentage of 20.7%. Good self-assessed health status [0.057 (0.018, 0.183)] may be a protective factor for DA.

Conclusion

Healthcare providers should improve the PR of middle-aged and older adults with hypertension through interventions that reduce DA and increase the likelihood of SA.

Subjective Wellbeing of Community Dwelling Older Adults in Nigeria

Previous comparative international studies on wellbeing of older adults in Africa have presented figures based on indicators which tend to obscure the variations in terms of wellbeing among the older adults in a particular country. This paper examined the subjective dimension of quality of life of community dwelling elders in Nigeria. It identified factors related to different levels of subjective wellbeing in different parts of the country and among different socio-economic groups.Data for the paper were drawn from a national study on vulnerability of older adults in Nigeria. A sample of 3,696 older adults (55.6% males; 44.4% females; mean age = 69.2, SD = 8.60) was selected through multi-stage systematic random sampling, using the national census enumeration area framework. Data were collected using structured interviews via Open Data Kit (ODK). Subjective Wellbeing was measured using the Flourishing Scale.Multiple linear regression analysis revealed resilience as the main predictor for older adults' subjective wellbeing. Other significant predictors included perceived attitudes towards old age in the respondents' community, ability to meet daily financial needs, independence in Activities of Daily Living (ADL), membership in social and religious groups and location, whether rural, peri-urban or urban.The findings of the study make significant contributions to the existing literature on older adults' wellbeing in Nigeria and provide material for future regional and international comparisons on the subject. The findings also provide data that can be utilized for policies and programme interventions that will be in alignment with the older adults' perceived needs.

Latent subgroups with distinct patterns of factors associated with self-rated successful aging among 1,510 community-dwelling Americans: potential role of wisdom as an implicit promoter

OBJECTIVES

To investigate whether latent subgroups with distinct patterns of factors associated with self-rated successful aging can be identified in community-dwelling adults, and how such patterns obtained from analysis of quantitative data are associated with lay perspectives on successful aging obtained from qualitative responses.

METHODS

Cross-sectional data were collected from 1,510 community-dwelling Americans aged 21-99 years. Latent class regression was used to identify subgroups that explained the associations of self-rated successful aging with measures of physical, cognitive, and mental health as well as psychological measures related to resilience and wisdom. Natural language processing was used to extract important themes from qualitative responses to open-ended questions, including the participants' definitions of successful aging.

RESULTS

Two latent subgroups were identified, and their main difference was that the wisdom scale was positively associated with self-rated successful aging in only one subgroup. This subgroup had significantly lower self-rated successful aging and worse scores for all health and psychological measures. In the subgroup's qualitative responses, the theme of wisdom was only mentioned by 10.6%; this proportion was not statistically different from the other subgroup, for which the wisdom scale was not statistically associated with the self-rated successful aging.

CONCLUSION

Our results showed heterogeneous patterns in the factors underpinning successful aging even in community-dwelling adults. We found the existence of a latent subgroup with lower self-rated successful aging as well as worse health and psychological scores, and we suggest a potential role of wisdom in promoting successful aging for this subgroup, even though individuals may not explicitly recognize wisdom as important for successful aging.

Maintaining psychological well-being amidst the COVID-19 pandemic: The beneficial effects of health-promoting behaviors and sense of control

The present research reports the findings of three studies, with objectives to demonstrate the impacts of health-promoting behaviors on psychological well-being as well as the mediating roles of sense of control (SOC) and perceived severity of COVID-19 in these relationships. Study 1 was a cross-sectional survey conducted in 473 middle-aged and older Chinese adults before the COVID-19 pandemic to assess their health-promoting behaviors, personal mastery and perceived constraints, life satisfaction, and depressive symptoms. Study 2 was conducted during the second wave of the COVID-19 outbreak in Hong Kong (between March to April 2020), in which 292 participants from Study 1 were successfully contacted to report their emotional responses to the pandemic. Using a different sample, Study 3 was a longitudinal study that measured 495 participants' health-promoting behaviors, personal mastery and perceived constraints at baseline, and their perceived severity and mental health outcomes during the outbreak of omicron cases in Hong Kong (i.e., the fifth wave of the COVID-19 outbreak) in March 2022. All three studies demonstrate that the beneficial effects of health behaviors can be extended to psychological well-being and reveal possible underlying mechanisms through enhancing one's SOC and lowering perceived severity of the COVID-19 outbreak. These results provide important insights to future health promotion programs for improving psychological resources and psychological well-being of middle-aged and older adults in face of disease-related threats.

[Cross-cultural adaptation and clinical application of Meniere's disease outcomes questionnaire]

Objective:To cross-culturally adapt the Meniere's Disease Outcomes Questionnaire（MDOQ） into Chinese language, to evaluate its reliability and validity, and to apply in clinical. Methods:The MDOQ was translated according to the Brislin model. Cross-cultural adaption was done by expert discussion and pilot study. The MDOQ was applied to 101 patients to test its reliability and validity. The quality of life（QOL） of 272 patients was measured by MDOQ-C, analyzing the influence factors of QOL of patients with Meniere's disease. Results:The CR value of each item of MDOQ-C exceeded 3.00, the Cronbach's α coefficient was 0.88, and the Spearman Brown coefficient was 0.90. The Pearson correlation coefficient of MDOQ-C and the DHI was 0.803（P<0.01）. Three factors were extracted by factor analysis, which could explain 60.503% of the total variance. The dimension composition was different from the original scale. The average QOL score of Meniere's disease patients was 52.94±13.87. The main influence factors were age, marital status, work status, with tinnitus and the number of vertigo attacks. Conclusion:The MDOQ-C is reliable and valid. After dimension reconstruction, MDOQ-C can be used to evaluate the QOL of patients with Meniere's disease. Through the preliminary clinical application, the influence factors of quality of life of patients with Meniere's disease were identified, thus providing reference for optimizing clinical management strategies.

Insights Into Sibling Relationships and Longevity From Genetics of Healthy Ageing Nonagenarians: The Importance of Optimisation, Resilience and Social Networks

Understanding how to “Age Longer and Age Well” is a priority for people personally, for populations and for government policy. Approximately ten percent of nonagenarians reach 90 years and beyond in good condition and seem to have a combination of both age-span and health-span. However, the factors which contribute to human longevity remain challenging. Culture is a shared system of learning ideas, feelings, and survival strategies. It has a strong influence on each person’s psychological development, behavior, values and beliefs. Nonagenarians have rich life experiences that can teach us much about aging well; they are rich reservoirs of genetic, lifestyle and psychological information which can help understanding about how to live longer and better. Sibling or trio nonagenarians are important sources of family beliefs and behaviors upon which individual personalities may have been built. Their personal family histories and narratives are powerful tools that help to determine familial traits, beliefs and social behaviors which may help establish factors important in the siblings’ longevity. Using purposefully selected subjects, recruited to the Genetics of Healthy Ageing (GeHA) project in four European countries, this research used the simple life story and qualitative research methods to analyze contrasting and distinctive questions about the interface between the psychological and social worlds as presented in the nonagenarian siblings’ insights about their longevity. Their stories aimed to give better understanding about which psychological aspects of their common life journey and the degree of emotional support in their sibling relationships may have supported their paths to longevity. The most universal finding in each of the four European countries was that nonagenarians demonstrated high positivity, resilience and coping skills and were supported in social networks. Around this theme, nonagenarians reported “being happy,” “always cheerful,” “never melancholy” and having a contentment with a “rich life” and family relationships which fits with accumulating evidence that life satisfaction comes from a perceived self-efficacy and optimism. Most sibling relationships in this study, when analyzed according to the Gold classification, fit the “congenial” or “loyal” relationship type – demonstrating a healthy respect for the others’ opinion without overt dependence, which may help individual coping and survival mechanisms.

The Association of Neighborhood Changes with Health-Related Quality of Life in the Women's Health Initiative

Longitudinal studies can help us understand the effects of long-term neighborhood changes, as these can capture individual self-appraisal of current and future circumstances. We analyzed the association between neighborhood changes and health-related quality of life (HRQoL) outcomes among older women from the Women's Health Initiative (WHI) study. We used a subset (n = 49,254) of the longitudinal WHI dataset of female participants, aged 50-79 at baseline, recruited from 40 clinical centers across the U.S. beginning in 1993. Two HRQoL outcomes were explored: self-rated quality of life (SRQoL), and physical functioning-related quality of life (PFQoL). We used U.S. census tract-level changes in median household income between the 2000 census and 2007-2011 American Community Survey to classify neighborhoods as "upgrading," "declining," or "stable." Multi-level models were used to identify significant associations between neighborhood change and HRQoL outcomes over time. Compared to participants residing in upgrading neighborhoods, participants in stable and declining neighborhoods reported significantly lower PFQoL. A significant interaction was observed with income such that the effect of neighborhood change was greater at lower levels of income.

Convivir (to Coexist) and Other Insights: Results From the Positive Aging for Latinos Study

Many Latinos in the United States do not have access to culturally sensitive services to help them age well. We combined community-based participatory research with concept mapping methods to understand how a sample of community-dwelling Latino older adults view positive aging. Nine focus groups (N = 101) generated 85 non-repeating statements, which were used to produce a final map with 11 clusters, organized into four overarching regions: Convivir (To Coexist), Self-Sufficiency, Perspectives on Life, and Healthy Behaviors. Further analyses revealed three themes: (1) the importance of varied social connections, as conveyed by the region labeled Convivir; (2) a multifaceted understanding of "stability" that includes finances, relationships, and spirituality; and (3) the need for a mature mindset reflected in the thematic cluster Tomalo Suave (Take It Easy). Findings can inform the development of interventions for Latino older adults and the cultural adaptation of programs initially designed for non-Latinos.

The ideal neighbourhoods of successful ageing: A machine learning approach

Ageing outcomes are shaped by not only health conditions, but also their interactions with the external environment. While the effects of some specific neighbourhood characteristics such as rurality on ageing have been evaluated in various studies, we still know little about the relative importance of particular natural and urban environments and how the impact varies at different stages of the ageing process. This article addresses these knowledge gaps by analysing survey data from 33 European countries using a machine learning method called multivariate regression trees (MRT). Multiple wellbeing indicators are combined to form an ageing profile for each individual in the survey. After studying these profiles using MRT, we find that generally the affordability of health facilities is a major determinant of life satisfaction, self-rated health condition and mental wellbeing for individuals in most age groups. Other important but age-specific determinants are neighbourhood safety and accessibility to cultural facilities and to green areas. In contrast, characteristics such as urbanity, transportation and air quality do not significantly influence ageing outcomes. Our findings lend support to the resources theory in explaining ageing outcomes and suggest that more resources may have to be directed to improve the affordability and quality of health care services, the policing services and the accessibility to cultural and green areas in order to achieve more favourable ageing outcomes.

Association between resilience and cortical thickness in the posterior cingulate cortex and the temporal pole in Japanese older people: A population-based cross-sectional study

BACKGROUND

Resilience is a crucial factor preventing the onset of mental illness and contributing to the well-being and healthy longevity, whose neural bases are not fully elucidated in older people. The present study aimed to identify the cortical thickness associating with resilience in older adults.

METHODS

This is a part of the cross-sectional Arakawa geriatric cohort study for people aged 65 years or older, consisting of 1001 individuals. A Self-Reported Resilience Scale (RS), neuropsychological batteries, face-to-face interviews for diagnosis, and a three-dimensional T1-weighted magnetic resonance imaging were conducted. Cortical thickness was computed by the FreeSurfer. The relationships among cortical thickness, total RS score, and clinico-demographic data were investigated using univariate and multivariable regression analyses.

RESULTS

The total RS score was correlated with age, education, and scores of the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) in univariate analyses. The total RS score was associated with cortical thicknesses in the left posterior cingulate (β [95 % CI of B] = 0.07 [0.16-14.84]) and the left temporal pole (β [95 % CI of B] = 0.08 [0.63-9.93]) after adjusting sex, age, imaging acquisition site, education, MMSE and GDS scores, hypertension, hyperlipidemia, diabetes mellitus, Barthel index, BMI, and living situation in multivariable regression analyses.

CONCLUSION

The present analyses suggest that the resilience capacity may be related to the cortical thickness in the posterior cingulate and temporal cortices in older adults. Our findings warrant further longitudinal studies to confirm the causal relationship between stress events, resilience, and brain structures.

Associations between Disability in Activities of Daily Living and Social Capital aspects among older adults: a scoping review

Social capital aspects are playing an important role in activities of daily living (ADL) performance, thus on independent living. This paper was aimed to present an overview of the associations and adverse effects between social capital aspects and disability in ADL and health-related quality of life (HRQoL) in an older population aged 65 years old and over. Α scoping review was designed following the guidelines of PRISMA Extension for Scoping Reviews (PRISMA-ScR) and the review was conducted by 3 authors. A total of 185 primary studies were extracted and, finally, 40 studies did meet the inclusion criteria and critically appraised in two main categories; Category 1(29 studies) ‘social capital and disability in ADL’ deducing that as greater a social capital as better ADL performance and Category 2 (11 studies) ‘Social capital and HRQoL’ concluding that people 65 years old and over with lower social capital were presented with a poor HRQoL. Study synthesis highlights the impact of social capital suggesting that nurses caring for older people must focus on their engagement in terms of social diversity and trust in the community.

Associations between migration experience and perceived mental health in optimal ageing: Evidence from the Sardinian Blue Zone

The effect of migration on perceived mental health has not been examined in older migrants after their return to their places of origin. This study was mainly aimed at evaluating the perceived mental health of older people who experienced migration and permanent resident peers living in the Sardinian Blue Zone (i.e. one of the four areas of exceptional longevity in the world). Forty‐eight community‐based older participants (32 males and 16 females) with and without a migration experience were recruited in two villages of the Sardinian Blue Zone and completed a battery of self‐report inventories assessing psychological well‐being, negative mood, and ego resilience. Older individuals who experienced migration reported higher ego resilience and exhibited greater resources used to manage positive emotionality (i.e. openness to life experiences). Moreover, compared to the normative data, both the groups reported higher psychological well‐being and fewer depressive symptoms. Finally, no significant associations were found between the length of migration and each mental health index. In conclusion, resilience seems to represent a psychological trait that helps to manage stressful events and contributes to the preservation of perceived mental health in late adulthood.

Rural-Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural–urban differences. This study investigates rural–urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural–urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural–urban differences. This study may serve as a basis for interventions to address rural–urban differences in health and social services and reduce health inequalities among Chinese older adults.

Effects of restraining measures due to COVID-19: Pre- and post-lockdown cognitive status and mental health

The COVID-19 pandemic has prompted all countries to adopt restraining measures to mitigate the spread of the disease. Usually, large-scale disasters tend to be accompanied by significant increases of psychological distress, depression and anxiety. Confinement measures imposed during the COVID-19 pandemic are likely to have similar consequences. In the present study we aim to evaluate how COVID-19 affected the overall psychological functioning of Portuguese individuals by providing a comparison of current data with status prior to the COVID-19 pandemic. The study sample was composed of 150 cognitively healthy participants. Results show an overall maintenance of cognitive capacities, although subjective cognitive decline complaints significantly increased during the pandemic. Regarding mental health, restraining measures culminated in an aggravation of depressive and decrease of the perceived quality of life, associated with feelings of loneliness and perceived social isolation. Finally, higher levels of pre-COVID-19 quality of life seem to play a protective role against depression and anxiety and predict less difficulties in emotion regulation, feelings of solitude and cognitive complaints. In sum, confinement due to COVID-19 implied an aggravation of the mental health of the Portuguese population, which appears to have been attenuated in those with higher pre-pandemic levels of perceived quality of life.

Health congruence paradox in older adults: Contribution of cognition and relational visits

The health congruence paradox can have important implications for those working with older adults as older adults' health understanding may be vague or directed toward health concerns other than those medically identified. Objective health was measured as diagnosed conditions from medical records. Two measures of subjective health were obtained through relational visits of university students, 1) health concerns older adults reported on a visit survey, 2) health concerns students reported during casual conversation. The results showed that community dwelling older adults with lower cognitive functioning ability were more susceptible to the health congruence paradox on the subjective measure of the survey report. Qualitative analysis of health concerns from subjective measures found older adults most concerned about health conditions impacting daily functioning, such as mobility and cognition, but not diagnosed hypertension. This mixed methods study confirmed the importance of understanding older adults' subjective health with measures easily obtained through relational visits with university students.

Psychometric properties and factor structure of the Medical Outcomes Study Social Support Survey Instrument in a sample of Spanish older adults

The aim of this study was to explore the factor structure of the MOS-SSS in a sample of community-dwelling Spanish older adults. The sample comprised 406 community-dwelling older adults aged between 65 to 99 years old (M _age = 74.88, SD = 6.75). Confirmatory factor analysis (CFA) was performed, and four possible models were compared: the one-factor, the three-factor, the four-factor and the five-factor model, using an additional analysis with a second-order factor. The internal consistency reliability and convergent validity of the scale were also assessed. For the 19-item MOS-SSS scale, the five-factor model had the best fit to the data. All five subscales of the MOS-SSS showed adequate internal consistency, good convergent and discriminant validity. These findings contribute to the literature on the factor structure of the MOS-SSS in Spanish older adults. The MOS-SSS is a reliable and valid scale that can be used to assess Spanish older adults' social support perception for social services, health and in research contexts.

Factors associated with successful aging in Brazilian community-dwelling older adults: When physical health is not enough

OBJECTIVES

To determine the main factors (physical, psychological, social and spiritual) associated with successful aging in community-dwelling older adults.

METHODS

A cross-sectional study of older adults was conducted evaluating successful aging (Successful Aging Scale-SAS) and its associated factors (sociodemographics, resilience, religiosity/spirituality, meaning in life, quality of life, social support, self-reported diseases, mental health, medications used, among others) using regression models.

RESULTS

A total of 534 older adults were assessed. Linear regression models showed an association of higher SAS score with greater resilience (Beta = 0.371, p < 0.001), spiritual well-being - meaning (Beta = 0.174, p < 0.001) and quality of life - physical (Beta=0.203, p < 0.001), fewer diseases (Beta=-0.128, p < 0.001), greater meaning in life (Beta=0.116, p = 0.001), less loneliness (Beta=-0.133, p = 0.001), lower tobacco use (Beta=0.080, p = 0.013), greater quality of life - environment (Beta=-0.092, p = 0.013) and more frequent religious attendance (Beta=0.068, p = 0.035).

CONCLUSION

The study results suggested that physical factors, although relevant, were not the main factors associated with successful aging.

The Role of Psychological and Social Well-being on Physical Function Trajectories in Older Adults

BACKGROUND

Psychological and social well-being are emerging as major determinants in preserving health in old age. We aimed to explore the association between these factors and the rate of decline in physical function over time in older adults.

METHODS

Data were gathered from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). The study population consisted of 1,153 non-demented, community-dwelling men and women free from multimorbidity or impairments in basic or instrumental activities of daily living at baseline. They were followed over 12 years to capture the rate of decline in physical function, which was measured by combining data on walking speed, balance, and chair stands. The association between baseline psychological and social well-being and decline in physical function was estimated through linear mixed models, after multiple adjustments including personality and depressive symptoms.

RESULTS

Higher levels of psychological (β = .007; p = .037) and social (β = .008; p = .043) well-being were significantly associated with a decreased rate of decline in physical function over the follow-up. There was a significant three-way interaction between psychological well-being*time*sex (female vs male) (β = .015; p = .047), showing that a slower decline in physical function was observed only among women and not in men. The association was strongest for individuals with high levels of both psychological and social well-being (β = .012; p = .019).

CONCLUSION

High levels of psychological and social well-being may slow down the age-related decline in physical function, which confirms the complexity of older adults' health, but also points towards new preventative strategies.

Leisure and Social Supports in Relation to Positive Affect Among Older Adults

The current study examined the extent to which leisure activities were related to different forms of social support and its association with positive affect. A secondary data analysis was employed using data drawn from the Health and Retirement Study (HRS) in 2014. The study sample was composed of 4,303 individuals whose ages ranged from 65 to 105 (M = 75.78, SD = 7.42; 57.8% females). Employing bootstrapping technique, the hypothesized relationship between leisure, social support, and positive affect was examined. Mediating effect of social support was also determined. Results indicated that leisure activity, social support, and positive affect were significantly associated, but the relationship varied. The study findings expanded our understanding of the divergent leisure paths to positive social support and emotional well-being of the older adults. Promoting diverse recreational settings is necessary in leisure interventions that can facilitate frequent and positive social exchanges in both in-home and out-of-home environments.

The Relationship of Race, Psychosocial Stress and Resiliency Indicators to Neurocognitive Impairment among Older Americans Enrolled in the Health and Retirement Survey: A Cross-Sectional Study

Background: Race/ethnicity, toxic stress (TS), resilience-promoting factors (RPFs), and their interactions were investigated in relationship to neurocognitive impairment (NI) in a nationally representative sample of adult Americans ≥50 years enrolled in the Health and Retirement Study (HRS) between 2012 and 2014. Methods: NI was defined as physician diagnosis of Alzheimer’s disease/dementia or HRS total cognition score ≤ 10. Race/ethnicity (i.e., African American, White, or Other), TS (i.e., everyday discrimination and chronic stressors), and mastery (as indicator of RPF) were self-reported. Multivariable logistic regression models estimated race-, TS-, RPF-associated odds ratios (ORs), and 95% confidence intervals (CI) for NI adjusting for socio-demographic confounders. Results: 6317 respondents interviewed between the years 2012 and 2014, age range 55–104 years old, 83% White, 13% Black and 4% Other race were included in the study. Chronic stress (OR = 1.88, 95% CI: 1.42–2.48), discrimination (OR = 3.31, 95% CI: 2.12–5.19) and low mastery (OR = 1.85, 95% CI: 1.38–2.48) were each associated with higher NI risk while low mastery was associated with higher NI risk in discrimination and race/ethnicity dependent manner. Specifically, low mastery-associated risk for NI was evident among adults that denied experiencing discrimination (OR = 2.01, 95% CI: 1.51–2.68), but absent among those that experienced discrimination (OR = 0.72, 95% CI: 0.32–1.62). Further, AA race was associated with NI risk but only among adults with high mastery (OR = 2.00, 95% CI: 1.20–3.35). Conclusions: Discrimination, chronic stress, and low mastery were associated with worse cognition. Persisting cognitive disadvantage for AA vs. White/Other race only among high mastery adults suggests that adverse social experiences may counteract mastery-associated cognitive benefits among AA population. TS reduction through policies that promote equal treatment by race/ethnicity in social life, health, justice, and economic systems may promote successful cognitive aging.

Psychometric Evaluation of the Persian Version of the Successful Aging Inventory

BACKGROUND

The first step to successful aging planning is to assess the current status using valid instruments. This study aimed to evaluate the psychometric properties of the Persian version of the Successful Aging Inventory (SAI).

MATERIALS AND METHODS

In the first step, SAI. was translated through forward-backward translation, and its face and content validity were qualitatively and quantitatively assessed. For construct validity assessment, 300 elderly were recruited through multi-stage random sampling. Exploratory factor analysis and known-group comparison were used. SAI reliability through internal consistency and stability was assessed using the Cronbach's alpha values of the inventory and intraclass correlation coefficient (ICC), respectively. The standard error of measurement, smallest detectable change, and floor and ceiling effects were calculated.

RESULTS

The impact scores, content validity ratios, and content validity indices of all items were more than 1.5, 0.62, and 0.8, respectively. The scale-level content validity index was 0.94. Factor analysis identified four factors for the inventory, which explained 58.17% of the total variance of the SAI score. SAI mean score among mentally healthy participants was significantly higher (P<0.001). The relative frequencies with the lowest and highest possible scores of SAI were 0 and 3.7%, respectively. The Cronbach's alpha, ICC, standard error of measurement, and the smallest detectable change of SAI were 0.835, 0.999, ±0.47, and 1.9, respectively.

CONCLUSION

As a valid and reliable instrument, the Persian version of SAI could be used for a successful aging assessment.

Anxiety, Depression and Quality of Life in Older Adults: Trajectories of Influence across Age

This study focuses on the influence of anxiety and depression on individual trajectories of quality of life in old age through a longitudinal approach. A representative sample of adults aged 50+ living in Portugal and participating in wave 4 (W4) and wave 6 (W6) of the Survey of Health, Ageing and Retirement in Europe (SHARE) project was considered. Participants, 1765 at baseline (W4) and 1201 at follow up (W6), were asked about their quality of life (CASP-12) and emotional status (Euro-D scale; five items from the Beck Anxiety Inventory). Linear Mixed Effects models were performed to identify factors associated with changes in quality of life across age. Increasing age was found to have a significant negative effect on quality of life. Lower education and higher levels of depression and anxiety at baseline were also associated with worse quality of life; 42.1% of the variation of CASP-12 across age was explained by fixed and random effects, being depression followed by anxiety as the factors that presented with the highest relative importance. Both depression and anxiety play an important role in quality of life in older adults and must be acknowledged as important intervention domains to foster healthy and active aging.

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

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

Health-Related Quality of Life in Older Adults: Its Association with Health Literacy, Self-Efficacy, Social Support, and Health-Promoting Behavior

This cross-sectional study aimed to explore the relationships among sociodemographics, health literacy, self-efficacy, social support, health-promoting behavior, and health-related quality of life (HRQOL) in older adults. A total of 240 older adults aged >65 years were recruited from three community senior welfare centers in South Korea. Standardized self-administered questionnaires measuring sociodemographic characteristics, health literacy, social support, self-efficacy, health-promoting behavior, and health-related quality of life were distributed to older adults. Multiple regression analyses with stepwise selection was used to determine the factors affecting health-related quality of life. Factors affecting a higher physical component score of HRQOL were a higher comprehension level of and numeracy in health literacy, physical health-promoting behavior, perceived emotional-informational support, and a lesser number of comorbidities. Factors affecting a higher mental component score of HRQOL were a higher comprehension level of and numeracy in health literacy, self-efficacy, physical health-promoting behavior, perceived emotional-informational support, and a lesser number of comorbidities. To improve HRQOL among older adults, nursing interventions are required to measure health literacy, empower physical health-promoting behavior and self-efficacy, and enhance emotional-informational support from family or other resources.

The additive impact of multiple psychosocial protective factors on selected health outcomes among older adults

Our objective was to investigate the additive properties of five psychosocial protective factors: purpose-in-life, resilience, optimism, internal locus of control and social connections. Self-reported psychological (depression, stress) and physical (health status, functionality) health outcomes and measured healthcare utilization and expenditures were included. The study sample was identified from adults age ≥65 who completed a health survey during May-June 2019 (N = 3,577). Each of the five protective factors was dichotomized as high/low (1/0) and counted with equal weighting. The protective factors were additive such that significant improvements in psychological and physical health outcomes were evident across factor subgroups: as the number of factors increased, health outcomes improved. The magnitude of the improvements was greatest between 0 and 1 factor. In addition, a significant linear trend for reduced healthcare expenditures ($1,356 reduction per factor added) was evident. Interventions promoting at least one protective factor would be beneficial for older adult populations.

Frailty Status Typologies in Spanish Older Population: Associations with Successful Aging

Background: Defining frailty typologies would contribute to guiding specific care interventions. These typologies could additionally be related to different health outcomes. This study aims at identifying subgroups of frail older adults based on the physical frailty phenotype and examining the relationships of these frailty profiles with quality of life and perceived health. Methods: This study relies on data from the SHARE project, namely a representative sample of 1765 Spanish-dwelling older adults identified as frail or pre-frail. Analysis included general descriptive statistics, exploratory latent class analysis (LCA) to determine the number of frailty subgroups, and LCA with covariates to examine differential relationships with markers of successful aging. Results: Statistical criteria and interpretability of the classes suggested that the LCA model with four classes should be retained. Class 1 was identified as the “frail people” group, Class 2 “activity problems” group, Class 3 “fatigued” group, and those belonging to Class 4 “lack of strength” group. Final LCA with covariates showed lower levels of quality of life and perceived health of the “frail” as compared to other frailty subgroups. Conclusion: This study revealed four different patterns of frailty attributes and further offered evidence on individuals’ differential status of health regarding distinct frailty conditions.

Population Priorities for Successful Aging: A Randomized Vignette Experiment

Objectives

Aging populations have led to increasing interest in “successful aging” but there is no consensus as to what this entails. We aimed to understand the relative importance to the general population of six commonly-used successful aging dimensions (disease, disability, physical functioning, cognitive functioning, interpersonal engagement, and productive engagement).

Method

Two thousand and ten British men and women were shown vignettes describing an older person with randomly determined favorable/unfavorable outcomes for each dimension and asked to score (0–10) how successfully the person was aging.

Results

Vignettes with favorable successful aging dimensions were given higher mean scores than those with unfavorable dimensions. The dimensions given greatest importance were cognitive function (difference [95% confidence interval {CI}] in mean scores: 1.20 [1.11, 1.30]) and disability (1.18 [1.08, 1.27]), while disease (0.73 [0.64, 0.82]) and productive engagement (0.58 [0.49, 0.66]) were given the least importance. Older respondents gave increasingly greater relative importance to physical function, cognitive function, and productive engagement.

Discussion

Successful aging definitions that focus on disease do not reflect the views of the population in general and older people in particular. Practitioners and policy makers should be aware of older people’s priorities for aging and understand how these differ from their own.

Does the selective attrition of a panel survey of older people affect the multivariate estimations of subjective well-being?

PURPOSE

The increased population aging has resulted in a growing need for longitudinal studies about the quality of life among older people. Nevertheless, the results of these investigations could be biased because more disadvantaged people leave the original sample. The purpose of this study is to examine how the selective attrition observed in a panel survey affect multivariate models of subjective well-being (SWB). The question is if we could do reliable longitudinal investigations concerning the predictors of SWB in old age.

METHODS

This paper examines attrition in a panel of older people in Chile. Attrition was evaluated in the variables that affect elderly SWB. Probit models were fitted to compare dropouts with nondropouts. Then, multivariate probit models were estimated on satisfaction and depressive symptoms, comparing dropouts and nondropouts. Finally, we compared weighted and unweighted multivariate probit models on SWB.

RESULTS

The attrition rate in 2 years was 38.8%, including deaths and 32.9%, excluding them. Survey dropouts had lower satisfaction but not higher depressive symptoms. Among SWB predictors, people without a partner and with lower self-efficacy abandoned more the study. When applying the Becketti, Gould, Lillard, and Welch test, the probit coefficients of the predictor variables on SWB outcome variables were similar for dropouts and nondropouts. Finally, the comparison of multivariate models on SWB with weighting methods did not find substantial differences in the explanatory coefficients.

CONCLUSION

Although some predictors of attrition were associated with SWB, attrition did not produce biased estimates in multivariate models of life satisfaction life or depressive symptoms in old age.

Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic imposed a psychological burden on people worldwide, including fear and anxiety. Older adults are considered more vulnerable during public health emergency crises. Therefore, the aim of the present study was to investigate the psychological response of older adults during the acute phase of the pandemic in Greece.

METHOD

This cross-sectional study was part of a larger three-day online survey. A total of 103 participants over the age of 60 fulfilled inclusion criteria. The survey included sociodemographic questions and six psychometric scales: the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), the Athens Insomnia Scale (AIS), the Intolerance of Uncertainty Scale (IUS-12), and the De Jong Gierveld Loneliness Scale (JGLS).

RESULTS

A significant proportion of the participants reported moderate to severe depressive symptoms (81.6%), moderate to severe anxiety symptoms (84.5%), as well as disrupted sleep (37.9%). Women reported significantly higher levels of COVID-19-related fear, more severe depressive symptoms and sleep disturbances, as well as higher levels of intolerance of uncertainty. Participants living alone showed higher levels of loneliness. Intolerance of uncertainty was shown to modulate levels of loneliness.

CONCLUSIONS

During the quarantine, attention was promptly drawn upon the risks related with older people's loneliness. Studies identifying factors that may contribute to loneliness during a public health emergency facilitate the implementation of supportive interventions. Preparedness to address and manage older people's loneliness may limit this deleterious emotional response during the pandemic, as well as at the post-COVID-19 phase.

The relationship between quality of life in a nursing home and personal, organizational, activity-related factors and social satisfaction: a cross-sectional study with multiple linear regression analyses

Objectives: This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction.Methods: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [±5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range -5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents' quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data.Results: Nursing home residents reported a quality of life score of 2.12 (±2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life.Conclusions: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents' subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated.

The Dunedin dementia risk awareness project: pilot study in older adults

AIMS

The USA and UK governmental and academic agencies suggest that up to 35% of dementia cases are preventable. We canvassed dementia risk and protective factor awareness among New Zealand older adults to inform the design of a larger survey.

METHOD

The modified Lifestyle for Brain Health scale quantifying dementia risk was introduced to a sample of 304 eligible self-selected participants.

RESULTS

Two hundred and sixteen older adults (≥50 years), with mean ± standard deviation age 65.5 ± 11.4 years (50-93 years), completed the survey (71% response rate). Respondents were mostly women (n = 172, 80%), European (n = 207, 96%), and well educated (n = 100, 46%, with a tertiary qualification; including n = 17, 8%, with a postgraduate qualification). Around half of the participants felt that they were at a future risk of living with dementia (n = 101, 47%), and the majority felt that this would change their lives significantly (n = 205, 95%), that lifestyle changes would reduce their risk (n = 197, 91%), and that they could make the necessary changes (n = 189, 88%) and wished to start changes soon (n = 160, 74%). Only 4 of 14 modifiable risk or protective factors for dementia were adequately identified by the participants: physical exercise (81%), depression (76%), brain exercises (75%), and social isolation (83%). Social isolation was the commonly cited risk factor for dementia, while physical exercise was the commonly cited protective factor. Three clusters of brain health literacy were identified: psychosocial, medical, and modifiable.

CONCLUSION

The older adults in our study are not adequately knowledgeable about dementia risk and protective factors. However, they report optimism about modifying risks through lifestyle interventions.

Psychobiological indicators of the subjectively experienced health status - findings from the Women 40+ Healthy Aging Study

BACKGROUND

Healthy aging is particularly important in women, as their life-span is generally longer than men's, leaving women at higher risk for age-related diseases. Understanding determinants of women's healthy aging is therefore a major public health interest. Clinical utility of previous research is limited, through its focus on either single psychosocial or biological predictors. The present study investigated psychobiological predictors of women's healthy aging, for the first time including positive psychological traits and biomarkers of healthy aging.

METHODS

Totally, 121 generally healthy women aged 40 to 75 were investigated cross-sectionally. Healthy aging was operationalized via self-rated health (SRH). To gain a nuanced view of the particularities at the upper end of the illness-wellness continuum, women with excellent SRH and those with good SRH were analyzed as distinct groups. Socioeconomic and sociodemographic variables, health behavior, resilience, optimism, and self-worth as well as menopausal symptoms, and levels of steroid hormones and gonadotropins were considered as predictors of SRH. Binary logistic regression analyses using the forward conditional method were performed with the two health status groups as dependent variable.

RESULTS

Women with a lower body mass index (BMI; OR = .59, 95% CI = .33-1.03), higher intensive physical activity (OR = 2.27, 95% CI = 1.06-4.86), and higher resilience (OR = 2.37, 95% CI = 1.34-4.18) were more likely to rate their health as excellent compared to good. No clinically significant differences could be found regarding endocrine levels.

CONCLUSION

Psychobiological indicators (lower BMI, intensive physical activity, higher resilience) discriminated SRH at the top level of the health spectrum. In healthy women, the predictive value of endocrine markers seems to be secondary. Interventions targeting these indicators could promote women's healthy aging.

Anxiety about aging, resilience and health Status among Chinese older adults: Findings from Honolulu and Wuhan

A growing body of literature found that anxiety about aging is related to health and well-being of older adults. However, very few studies have been conducted on Chinese older adults residing in different countries and examined the role of resilience. Using the Pearlin's Stress Process Model, this study aims to fill in this gap by examining the relationship between anxiety about aging as the stressor and health status among Chinese older adults living in Honolulu, the United States (N = 292) and Wuhan, China (N = 532). The survey data were collected through June 2017 to September 2018, using snowball and convenience sampling strategy. The moderating role of resilience on the focal relationship is also explored. Results showed that for both samples, the negative relationship between anxiety about aging and self-rated health was significantly moderated by resilience (18 % and 13 %, respectively), implying the stress-buffering role of resilience. Although both mean levels of resilience and anxiety about aging were lower for the Honolulu sample, the moderating effect appeared to be stronger, implying that older adults in the Honolulu sample might rely more on psychological resources such as resilience in coping with stressors, compared with their counterparts in Wuhan. However, the moderating effect of resilience did not work for the association between anxiety about aging and number of chronic conditions for both samples. Our findings suggest that future research needs to take into account both social and psychological resources when examining anxiety about aging and health status among Chinese older adults residing in different cultural contexts.

A Systematic Literature Review of Efficiency Measurement in Nursing Homes

Background: As our population ages at an increasing rate, the demand for nursing homes is rising. The challenge will be for nursing homes to maintain efficiency with limited resources while not compromising quality. This study aimed to review the nursing home efficiency literature to survey the application of efficiency methods and the measurements of inputs, outputs, facility characteristics and operational environment, with a special focus on quality measurement. Methods: We systematically searched three databases for eligible studies published in English between January 1995 and December 2018, supplemented by an exhaustive search of reference lists of included studies. The studies included were available in full text, their units of analysis were nursing homes, and the analytical methods and efficiency scores were clearly reported. Results: We identified 39 studies meeting the inclusion criteria, of which 31 accounted for quality measures. Standard efficiency measurement techniques, data envelopment analysis and stochastic frontier method, and their specifications (orientation, returns to scale, functional forms and error term assumptions) were adequately applied. Measurements of inputs, outputs and control variables were relatively homogenous while quality measures varied. Notably, most studies did not include all three quality dimensions (structure, process and outcome). One study claimed to include quality of life; however, it was not a well-validated and widely used measure. The impacts of quality on efficiency estimates were mixed. The effect of quality on the ranking of nursing home efficiency was rarely reported. Conclusions: When measuring nursing home efficiency, it is crucial to adjust for quality of care and resident’s quality of life because the ultimate output of nursing homes is quality-adjusted days living in the facility. Quality measures should reflect their multidimensionality and not be limited to quality of throughput (health-related events). More reliable estimation of nursing home efficiencies will require better routine data collection within the facility, where well-validated quality measures become an essential part of the minimum data requirement. It is also recommended that different efficiency methods and assumptions, and alternative measures of inputs, outputs and quality, are used for sensitivity analyses to ensure the robustness and validity of findings.

Aging in high functioning elderly persons: study design and analyses of behavioral and psychological factors

This article aims to (a) describe the study design of a 6‐year follow‐up multidisciplinary research project on aging, (b) report the psychosocial characteristics of the sample in detail, and (c) evaluate aging‐related changes of health, physical activity, and psychosocial characteristics in 10 young‐old (age at pre‐test: M ± SD = 63.2 ± 1.5) and 12 old‐old (age at pre‐test: M ± SD = 69 ± 2) individuals. Both age groups consist of individuals displaying a high health status, a high extent of physical activity, high levels of psychosocial properties in the dimensions of well‐being, life satisfaction, self‐concept, body image, self‐esteem, and self‐efficacy, as well as a low general depression index. Psychosocial characteristics demonstrated a stable pattern over a period of nearly 6 years in both age groups with the exceptions of physical activity, satisfaction with children, general depression, and self‐efficacy. Furthermore, physical self‐concept decreased in old‐old adults, whereas the young‐olds showed no change. We assume that a high psychosocial status and a physically active lifestyle play an important role for mastering aging successfully in two life phases, each of which has its own challenges for older individuals. The decline in the physical self‐concept of old‐olds is interpreted as a first sign of subjective aging. Its association with losses in physical performance should be addressed in future studies. Finally, aging‐related changes should be monitored on an individual level in order to capture the complex dynamic of aging that is not considered in analyses of between‐person differences or averages.

Psychological outcomes of life story work for community-dwelling seniors: A randomised controlled trial

BACKGROUND AND OBJECTIVE

Life story work has a long tradition in the caring sciences and has been found to serve a number of psychological functions. The effects of life story work on the psychological well-being of community-dwelling older people were examined in this study.

DESIGN AND METHODS

For this randomised controlled trial, 244 community-dwelling participants in 17 social centres run by a non-governmental organisation were recruited. The participants were randomly allocated to intervention (n = 124) and control (n = 120) groups. Each member of the intervention group worked with a volunteer to prepare his/her life storybook, while those in the control group participated in a social program. Data were collected at baseline, immediately postintervention, and at three and six months postintervention. The outcomes included measures of life satisfaction, self-esteem, general mental well-being and depressive symptoms.

RESULTS

No significant interaction effect was observed between the groups over time, except for an improvement in the general mental well-being of the control group at three months postintervention.

CONCLUSIONS

A comparison of the findings in the literature showed that some positive results were reported for LSW studies conducted in nursing homes, whereas in community studies, the results were not always positive. Life story work for seniors in the community did not have the same positive outcomes as previously observed among nursing home residents. It is possible that the intervention had a greater effect on more deprived individuals. Community-dwelling seniors can be encouraged to participate in social activities, which apparently can lead to similar outcomes.

IMPLICATIONS FOR PRACTICE

Clinicians should not assume that similar interventions can have similar effects when delivered in a different setting. Community-dwelling seniors can be encouraged to participate in social activities, which can also promote psychological wellbeing similar to to the effects of activities related to life story work.

Does abuse in late life worsen sleep quality? A two-year prospective cohort study among rural older adults

BACKGROUND

Elder abuse and neglect (EAN) is a growing public health problem, and numerous adverse health effects of abuse in late life have been documented. Little is known, however, about the impact of elder abuse on sleep quality. This study examines the longitudinal relationship between EAN and sleep quality.

METHODS

This was a 2-year prospective cohort study involving 1927 older adults in a rural Malaysian district, Kuala Pilah. A multi-stage cluster sampling strategy was employed. After 2 years, 1189 respondents were re-assessed. EAN was determined using the modified Conflict Tactic Scale, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The prevalence of elder abuse was 8.1% (95% CI:6.9,9.3). Longitudinal analysis using generalized estimating equations showed that elder abuse contributed to higher PSQI scores (B:0.49, 95% CI:0.17,0.58). Sub-analyses demonstrated that psychological abuse and neglect had significant longitudinal relationships with increase of PSQI scores, while other subtypes did not.

CONCLUSION

Abuse in late life, particularly psychological abuse and neglect, result in greater PSQI scores. Even though this may imply decline in sleep quality, our findings were not considered clinically significant as they did not exceed the clinical cut-off score of five. Nevertheless, sleep quality is an important determinant of health and a predictor of mortality among older adults; thus, understanding its relationship with abuse is useful to health care providers and policy-makers in improving health services and upgrading preventive measures.

Benefit of Gender-Affirming Medical Treatment for Transgender Elders: Later-Life Alignment of Mind and Body

PURPOSE

This study examined whether older age moderates the association between gender-affirming medical treatment and quality of life (QOL) among transgender individuals.

METHODS

Transgender men and women from the National Transgender Discrimination Survey who had either recently or never undergone medical treatment were included (n = 2420). A moderation analysis was utilized.

RESULTS

As predicted, participants who initiated medical treatment had higher QOL than those who did not. Age moderated this association. The QOL difference was greater for older than for younger transgender individuals.

CONCLUSION

Among all transgender men and women, gender-affirming medical treatment can be especially beneficial for elders.

Brain Networks Reorganization During Maturation and Healthy Aging-Emphases for Resilience

Maturation and aging are important life periods that are linked to drastic brain reorganization processes which are essential for mental health. However, the development of generalized theories for delimiting physiological and pathological brain remodeling through life periods linked to healthy states and resilience on one side or mental dysfunction on the other remains a challenge. Furthermore, important processes of preservation and compensation of brain function occur continuously in the cerebral brain networks and drive physiological responses to life events. Here, we review research on brain reorganization processes across the lifespan, demonstrating brain circuits remodeling at the structural and functional level that support mental health and are parallelized by physiological trajectories during maturation and healthy aging. We show evidence that aberrations leading to mental disorders result from the specific alterations of cerebral networks and their pathological dynamics leading to distinct excitability patterns. We discuss how these series of large-scale responses of brain circuits can be viewed as protective or malfunctioning mechanisms for the maintenance of mental health and resilience.

Positive perception of aging is a key predictor of quality-of-life in aging people

OBJECTIVE

We conducted a cross-sectional survey in France in a cohort over 55 years of age to characterize the impact of psychological dimensions on quality-of-life (QoL).

METHODS

The predictors of QoL in relation with aging were studied using an adapted quality-of-life model, based on emotional, cognitive and physical symptoms, functional status, and general health perception. Adding psychological dimensions such as self-esteem, psychological distress, perceptions of ageing and coping, was hypothesized to improve the QoL model. Responses were analyzed using structural equation modeling and path analysis.

RESULTS

The study involved 258 participants, mean age 66.9±7.9 years. Psychological distress and positive perception of aging exhibited the strongest direct impact on QoL (p<0.0001). Psychological distress also appeared to be mediator on QoL for perceived health status, self-esteem and negative perception of aging. Coping centred on emotion exhibited direct impact on self-esteem and so, indirect impact on QoL (p = 0.0002). Perception of personal financial situation (p = 0.0007) and coping centred on social support (p = 0.02) appeared as direct mediators influencing QoL.

CONCLUSIONS

Psychological dimensions are predictors of QOL and have to be taken into account to maximize the resources with a view to successful aging. Further interventions targeting successful aging should focus on positive perception aging.

Psychometric properties the Iranian version of Older People's Quality Of Life questionnaire (OPQOL)

BACKGROUND

Assessing quality of life (QOL) in elderly needs specific instruments. The Older People's Quality of Life Questionnaire (OPQOL-35) is one of the common tools that used for measuring quality of life in elderly populations. The questionnaires contains 35 items tapping into eight domains including life overall, health, social relationships and participation, independence, control over life and freedom, home and neighborhood, psychological and emotional well-being, financial circumstances, culture and religion. This study aimed to translate and validate the OPQOL-35 in Iran.

METHODS

Forward-backward procedure was applied to translate the original questionnaire from English into Persian. Then following qualitative face and content validity, a sample of elderly people completed the questionnaire. In order to evaluate the construct validity, exploratory and confirmatory factor analyses was performed. Subsequently, convergent and divergent validity of the factors were evaluated. Reliability was evaluated by performing internal consistency analysis and Intraclass Correlation Coefficients (ICC).

RESULTS

In all 500 older people completed the questionnaire. The mean age of participant was 68.92 (SD = 6.97) years, and mostly were males (66.6%). The result of exploratory factor analysis showed 8 factors with Eigen values of greater than one, which explained 67.4% of the variance observed. Confirmatory factor analysis showed acceptable fit indexes for the data [Comparative Fit Index (CFI) = 0.92, Minimum Discrepancy Function by Degrees of Freedom divided (CMIN/DF) = 2.832, Root Mean Square Error of Approximation (RMSEA) = 0.067]. The convergent and divergent validity did not support three latent factors (Life overall, Independence, control over life, freedom and Psychological and emotional well-being). Convergent and divergent validity shown that construct fulfilled for the health, social relationships and participation, home and neighborhood, financial circumstances, culture and religion latent factors, however the results did not support the convergent and divergent validity for three latent factors (Life overall, Independence, control over life, freedom and Psychological and emotional well-being). Cronbach's alpha coefficient for the subscales ranged from 0.65-0.95. Test-retest reliability (ICC) of the questionnaire with two weeks interval were ranged from 0.88-0.95 indicating a good range of reliability.

CONCLUSION

The findings suggest that the Iranian version of OPQOL-35 is a valid measure for assessing quality of life in elderly populations in different settings.

What Is Successful Aging? A Psychometric Validation Study of Different Construct Definitions

Background and Objectives

We examined the validity of 5 successful aging (SA) operationalizations that assessed different facets of the SA construct (cognitive and physical health and disability; well-being; social engagement).

Research Design and Methods

A total of 2,478 participants (mean age = 82.5 years, standard deviation [SD] = 3.47) were studied. We used confirmatory factor analysis to investigate the relationships between facets and to determine the convergent validity as well as short-term (1.5 years) and long-term (4.5 years) predictive validity of the 5 SA operationalizations for measures of quality of life (QoL) and objective health outcomes.

Results

A general SA operationalization that included all SA facets but also allowed differences between them showed the best model fit and construct validity. A biomedical operationalization of SA that excluded either the well-being or the social engagement facet showed lower convergent and predictive validity for subjective measures (e.g., QoL) but higher associations with objective measures (e.g., health). A purely psychosocial SA operationalization that excluded the physiological facet did not allow good prediction of objective health outcomes.

Discussion and Implications

Our results suggest that a well-balanced SA operationalization should include measures assessing health, disability, well-being, and social engagement.