The relationship of tobacco and alcohol use with ageing self-perceptions in older people in Ireland

Development, feasibility, and acceptability of a process based intervention to decrease internalized ageism

A lifetime of exposure to ageism may be internalized in older adults, and these ageist beliefs that are directed inwards can have severe consequences. However, research on reducing internalized ageism is scarce. To address this, we designed and implemented a six-week online process-based intervention to reduce internalized ageism and to assess its feasibility. The intervention utilized a process-based therapy approach targeting psychological, behavioral, and physiological pathways through which internalized ageism negatively impacts health, as specified by stereotype embodiment theory. Intervention components included education, acceptance and commitment therapy techniques, and attributional retraining. A total of 81 older adult participants participated in the feasibility study. Most participants rated each session and the overall program as very useful after each session (average program usefulness rating of 4.54/5). Participants also attributed a wide range of novel behaviors to this intervention and stated that they felt it changed their perspectives on ageism and/or internalized ageism. Results from this study provide a promising foundation from which to advance research on interventions that address internalized ageism - a problem that has severe consequences on the health and well-being of growing numbers of older adults globally.

Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys

OBJECTIVES

We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.

METHODS

For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.

RESULTS

The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.

CONCLUSIONS

Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.

'Ageing with an alcohol problem is not what I envision': reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems

BACKGROUND

Eliciting and understanding older persons' descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

METHODS

Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

RESULTS

Three themes were identified: "Tipping the balance", "Staying behind a veil" and "Lifting the vail". First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

CONCLUSIONS

Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons' desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

The Relationship between Subjective Aging and Cognition in Elderly People: A Systematic Review

There is a growing body of evidence on the effects of subjective aging on health, well-being and quality of life. This review aims to synthesize findings about the link between subjective aging and cognition and cognitive decline. Furthermore, it provides an examination of variation sources such as subjective aging construct, cognitive domains, measures employed, age and moderator variables. A systematic search was performed in PubMed, PsychInfo and Web of Science, as well as grey literature searches in Google Scholar, OpenGrey, WorldCat and NDLTD, which resulted in 59 reports being included. Subjective aging is a relevant construct in the explanation and prediction of cognitive aging and cognitive decline in elderly adults. More positive views about own aging and self-perceptions of aging, as well as a younger subjective age, were consistently related to better cognition and lower risk of cognitive decline. However, there were differences due to subjective aging subdimensions and cognitive domains, as well as an effect of age. Additionally, there were concerns about the content validity of some measures employed, such as the Philadelphia Geriatric Center Morale Scale for subjective aging and the Mini Mental State Examination for global cognition. Further studies should employ longitudinal designs with a process-based approach to cognition and precise subjective aging measures.

Internalization of negative societal views on old age into self-perceptions of aging: exploring factors associated with self-directed ageism

Introduction

A growing number of research has provided evidence for the negative impact of ageism on older people's health and well-being. Among the three different manifestations of ageism, namely institutional, interpersonal and self-directed ageism, significant ageism-health associations have been proved to be strongest for self-directed ageism. This supports stereotype embodiment theory, which maintains that lifetime exposure to negative age stereotypes leads to the internalization of ageism as a form of negative attitudes towards own aging and it adversely affects health and well-being in old age. However, little is known about how people internalize negative age stereotypes held in the society into self-perceptions of aging.

Methods

This study aimed to explore how socially shared beliefs about old age are internalized into self-perceptions of aging focusing on uncovering factors related to self-directed ageism. Data were derived from the survey that had examined citizen's attitudes towards old age and aging in Finland. Multinominal logistic regression models were performed to examine the association of sociodemographic and contextual factors with different combinations of societal age stereotypes and two indicators of self-perceptions of aging: subjective views on old age and personal feelings of own old age.

Results

The analyses showed that being female, attaining tertiary education, evaluating poor quality of life and awareness of institutional old age discrimination were related to holding negative views on aging towards both society and oneself.

Discussion

The findings from univariate and multivariate models suggest that it is not age per se, but structural and cultural circumstances shaped with growing older that turns socially shared negative age stereotypes into negative self-perceptions of aging. Even though the study addressed situations in one country, the findings have an important implication for other rapidly aging societies regarding how social and cultural contexts are closely linked to the formation of self-directed ageism.

USING MACHINE LEARNING METHODS TO ASSESS THE RISK OF ALCOHOL MISUSE IN OLDER ADULTS

The population of older adults, defined in this study as those 50 years of age or older, continues to increase every year. Substance misuse, particularly alcohol misuse, is often neglected in these individuals. To better identify older adults who might not be properly assessed for alcohol misuse, we have derived a risk assessment tool using patients from the United Kingdom Biobank (UKB), which was validated on patients in the Weill Cornell Medicine (WCM) electronic health record (EHR). The model and tooling created stratifies the risk of alcohol misuse in older adults using 10 features that are commonly found in most EHR systems. We found that the area under the receiver operating curve (AUROC) to correctly predict alcohol misuse in older adults for the UKB and WCM models were 0.84 and 0.78, respectively. We further show that of those who self-identified as having ongoing alcohol misuse in the UKB cohort, only 12.5% of these patients had any alcohol-related F.10 ICD-10 code. Extending this to the WCM cohort, we forecast that 7,838 out of 12,360 older adults with no F.10 ICD-10 code (63.4%) may be missed as having alcohol misuse in the EHR. Overall, this study importantly prioritizes the health of older adults by being able to predict alcohol misuse in an understudied population.

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.

Latent profile analysis of self-perceptions of ageing among Chinese community-dwelling older adults

BACKGROUND

Self-perceptions of ageing (SPA) is an important predictor for physical and mental health of older adults in successful ageing. SPA is mainly studied from negative or positive perspectives using variable-centred methodologies. The aim of the current study was to explore distinct profiles of SPA among Chinese community-dwelling older adults using a person-centred method and validate the SPA profiles by examining associations with psychological outcomes.

METHODS

Participants aged 65 and over were randomly divided into test and validation samples (n = 451, respectively). SPA was measured by the Brief Ageing Perceptions Questionnaire using latent profile analysis.

RESULTS

Three SPA profiles were identified. One adaptive subgroup was designated as 'Low ageing awareness and high positive control' (LAPC, 84.7% and 75% in both samples, respectively). Two maladaptive SPA subgroups were designated as 'Low positive consequences and control' (LPCC, 3.9% and 8.2% in both samples, respectively), and 'High ageing awareness and negative control' (HANC, 11.4% and 16.8% in both samples, respectively). Similar to negative/positive SPA, the HANC and LAPC subgroups showed the highest and lowest levels of depressive symptoms and cognitive decline. Low cognitive function was found in the LPCC subgroup.

CONCLUSIONS

These findings highlight the heterogeneity of older adults' SPA. SPA profiles may aid community healthcare providers in China to identify individuals with high risk of maladaptive SPA and to tailor targeted interventions for psychological health in later life. Distinct SPA profiles require different interventions targeting negative or positive control or both aspects. More positive control strategies might be beneficial for cognitive functioning in older adults from the LPCC subgroup.

Dynamic associations between anxiety, depression, and tobacco use in older adults: Results from The Irish Longitudinal Study on Ageing

Evidence supports moderate-to-large reductions in anxiety, depression, and perceived stress after smoking cessation; however, much of the available evidence has focused on young adults. Therefore, this study quantified associations between smoking and smoking cessation on prevalent and incident generalised anxiety disorder (GAD) and major depression (MDD) in a nationally representative sample of Irish older adults. Participants (n = 6201) were community dwelling adults aged ≥50 years resident in Ireland. Smoking status and self-reported doctor diagnosis of anxiety or depression prior to baseline were assessed at baseline (i.e., Wave 2). At baseline and 2-, 4-, and 6-year follow-up (i.e., Waves 3-5), GAD and MDD were assessed by the Composite International Diagnostic Interview Short-Form. Logistic regression quantified cross-sectional and prospective associations (odds ratios (ORs) and 95% confidence intervals (95%CIs)) between smoking status and mental health. Prevalence and incidence of GAD was 9.1% (n = 566) and 2.8% (n = 148), respectively. Prevalence and incidence of depression was 11.1% (n = 686) and 6.4% (n = 342), respectively. Following full adjustment, current smokers had higher odds of prevalent GAD (OR = 1.729, 1.332-2.449; p < 0.001) and MDD (OR = 1.967, 1.548-2.499; p < 0.001) than non-smokers. Former smokers had higher odds of prevalent GAD than non-smokers (OR = 1.276, 1.008-1.616; p < 0.001). Current smokers did not have higher odds of incident MDD (OR = 1.399, 0.984-1.990; p = 0.065) or GAD than non-smokers (1.039, 0.624-1.730; p = 0.881). Findings may have important implications for interventions designed to curb tobacco abuse, which tend to be less successful among those with anxiety and depression.

Influence of healthy lifestyle behaviors on life satisfaction in the aging population of Thailand: a national population-based survey

BACKGROUND

Understanding the influence of healthy lifestyle behaviors on population-level life satisfaction is few known in the aging population, especially in low- and middle-income countries in Asia. The objective of our study was to analyse the association of lifestyle behaviors with life satisfaction in a nationally-representative sample of older persons in Thailand.

METHODS

The sample was obtained from a baseline phase of a nationally-representative, longitudinal survey of the Thai population. The study employed a multistage sampling technique to recruit study participants age 60 years or older from the five geographic regions of Thailand. In this study, 1460 adults age 60 years or older from 3670 households successfully completed face-to-face interviews by trained staff with a structured questionnaire. Information on self-reported life satisfaction, lifestyle behaviors, and sociodemographic characteristics were collected via survey questionnaire. Life satisfaction was assessed using the Scale with Life Satisfaction (SWLS) [1 to 7] response. Binary logistic regression analysis was used in investigating the association between lifestyle behaviors and life satisfaction.

RESULTS

The median age of the participants was 68.1 (60-93 years). The overall mean life satisfaction score was 24.2 ± 5.6. Regular physical activity (at least 30 min per day) and sufficient fruit and vegetable (FV) intake (at least 400 g per day) were significantly associated with older people's life satisfaction (p ≤ 0.001 and p ≤ 0.10, respectively) after controlling all sociodemographic variables. Participants who had regular physical activity were 1.7 times as likely to be satisfied as those with less physical activity (95% CI 1.284-2.151). Participants with sufficient daily FV intake were 1.3 times as likely to be satisfied with life as those with insufficient daily FV (95% CI 0.994-1.723). Life satisfaction score also differed significantly by sociodemographic characteristics (sex, age, marital status, educational attainment) and presence of chronic disease.

CONCLUSIONS

To improve the life satisfaction of older persons, taking into account sociodemographic characteristics of the population and absence of chronic disease, the need for promotion of healthy lifestyle behaviors, especially regular physical activity and sufficient FV intake, must be recommended.

Acceptance of Love and Remarriage Among Older Adults in the Philippines

Objectives: Later-life re-partnership has been linked to healthy aging, but little is known about Philippine older adults' perception of love and remarriage in older age. Methods: Using two nationally representative surveys on aging in the Philippines, we estimated the proportion of older adults reporting acceptance. Using weighted logistic regression, we assessed sociodemographic and health factors associated with acceptance as well as the relationship of this acceptance with social activity and health behaviors. Results: Only seventeen percent of respondents reported acceptance. Per multivariable analyses, unmarried men and married women reported acceptance, and acceptance was associated with increased social activity and smoking in men, less smoking in women, and more drinking in both genders. Discussion: Most older adults in the Philippines reported love and remarriage in old age as unacceptable. Through these results, we can understand how attitudes toward later-life relationship impact older adults' health and well-being.

Respiratory epidemics and older people

Coronavirus disease 2019 (COVID-19) has been particularly severe on older people. Past coronavirus epidemics namely Severe Acute Respiratory Syndrome and the Middle East Respiratory Syndrome have also been severe on older people. These epidemics lasted for only a limited period, however, and have proven short lived in the memories of both the public and public health systems. No lessons were learnt to mitigate the impact of future epidemics of such nature, on older people. This complacency we feel has claimed the lives of many older people during the current COVID-19 global epidemic. The nature of risks associated with acquiring infections and associated mortality among older people in respiratory epidemic situations are varied and of serious concern. Our commentary identifies demographic, biological, behavioural, social and healthcare-related determinants, which increase the vulnerability of older people to respiratory epidemics. We acknowledge that these determinants will likely vary between older people in high- and low-middle income countries. Notwithstanding these variations, we call for urgent action to mitigate the impact of epidemics on older people and preserve their health and dignity. Intersectoral programmes that recognise the special needs of older people and in unique contexts such as care homes must be developed and implemented, with the full participation and agreement of older people. COVID-19 has created upheaval, challenging humanity and threatening the lives, rights, and well-being of older people. We must ensure that we remain an age-friendly society and make the world a better place for all including older people.

Positive, but Not Negative, Self-Perceptions of Aging Predict Cognitive Function Among Older Adults

Self-perceptions of aging (SPA) refer to attitudes about one’s aging process and are linked to physical health and longevity. How SPA correlates with cognitive function in older adulthood is less well known. 136 older adults were administered a multifaceted SPA measure, The Brief Ageing Perceptions Questionnaire (B-APQ), in addition to a demographic form and a comprehensive neuropsychological battery. Positive and negative subscales of the B-APQ were correlated with aspects of cognitive function. Regression analyses revealed that only the positive B-APQ subscales predicted mental status ( β = .19, p < .05), short-delay memory ( β = .16, p < .05), processing speed ( β = −.21, p < .05), and two measures of executive function ( β = −.21, p < .01; β = .18, p < .05). This is the first study to demonstrate that positive dimensions of SPA relate to cognitive function in older adulthood.

Global reach of ageism on older persons' health: A systematic review

OBJECTIVE

Although there is anecdotal evidence of ageism occurring at both the structural level (in which societal institutions reinforce systematic bias against older persons) and individual level (in which older persons take in the negative views of aging of their culture), previous systematic reviews have not examined how both levels simultaneously influence health. Thus, the impact of ageism may be underestimated. We hypothesized that a comprehensive systematic review would reveal that these ageism levels adversely impact the health of older persons across geography, health outcomes, and time.

METHOD

A literature search was performed using 14 databases with no restrictions on region, language, and publication type. The systematic search yielded 13,691 papers for screening, 638 for full review, and 422 studies for analyses. Sensitivity analyses that adjusted for sample size and study quality were conducted using standardized tools. The study protocol is registered (PROSPERO CRD42018090857).

RESULTS

Ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The studies reported ageism effects in all 45 countries, 11 health domains, and 25 years studied, with the prevalence of significant findings increasing over time (p < .0001). A greater prevalence of significant ageism-health findings was found in less-developed countries than more-developed countries (p = .0002). Older persons who were less educated were particularly likely to experience adverse health effects of ageism. Evidence of ageism was found across the age, sex, and race/ethnicity of the targeters (i.e., persons perpetrating ageism).

CONCLUSION

The current analysis which included over 7 million participants is the most comprehensive review of health consequences of ageism to date. Considering that the analysis revealed that the detrimental impact of ageism on older persons' health has been occurring simultaneously at the structural and individual level in five continents, our systematic review demonstrates the pernicious reach of ageism.

Socio-economic and demographic characteristics associated with risk behaviour patterns for chronic non-communicable diseases in Brazil: data from the National Health Survey, 2013

OBJECTIVE

To identify risk behaviour patterns for chronic non-communicable diseases (NCD) in the Brazilian population and to investigate associated socio-economic and demographic factors.

DESIGN

Factor analysis was used to identify patterns considering the following risk behaviours: consumption of soft drinks/artificial juice, sweet foods, red meat with apparent fat, chicken skin; inadequate consumption of fruits and vegetables; alcohol abuse; smoking; absence of physical activity during leisure time; and time spent watching television. The χ 2 test was used to compare ratios. All analyses accounted for weighting factors and the study's complex sampling design effect. The socio-economic and demographic variables evaluated were gender, age, schooling level and macro region of residence.

SETTING

National Health Survey, a household survey with national representation, conducted in 2013 in Brazil.ParticipantsIndividuals (n 60202) aged 18 years or over.

RESULTS

Four risk behaviour patterns were identified: 'Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables', 'Saturated fat', 'Alcohol and Smoking' and 'Sedentary behaviour and Sugar', explaining 52·01 % of the total variance. Overall, greater adherence to 'Saturated fat' and 'Alcohol and Smoking' patterns was observed among men and those with lower education level. The 'Sedentary behaviour and Sugar' and 'Physical inactivity in leisure time and Inadequate consumption of fruits and vegetables' patterns had greater adherence among younger individuals, and the first was associated with higher education whereas the second with less education among individuals residing in the North and Northeast regions.

CONCLUSIONS

Risk behaviour patterns for NCD were heterogeneous, reflecting the socio-economic and demographic differences in Brazil.

Use of web-based screening and brief intervention for unhealthy alcohol use by older adults

BACKGROUND

While the number of older adults who engage in unhealthy drinking is increasing, few studies have examined the role of online alcohol screening and intervention tools for this population. The objective of this study was to describe characteristics of drinking behaviors among older adults who visited an alcohol screening and intervention website, and compare them to younger adults.

METHODS

We analyzed the responses of visitors to Alcoholscreening.org in 2013 (n=94,221). The prevalence of unhealthy alcohol use, behavioral change characteristics, and barriers to changing drinking were reported by age group (ages 21-49, 50-65, 66-80). Logistic regression models were used to identify characteristics associated with receiving a plan to either help cut back or quit drinking.

RESULTS

Of the entire study sample, 83% of respondents reported unhealthy drinking (exceeding daily or weekly recommended limits) with 84% among 21-49year olds, 79% among 50-65year olds, and 85% among adults over 65. Older adults reported fewer negative aspects of drinking, lower importance to change, highest confidence and fewer barriers to change, compared to younger adults. In the adjusted model, females (AOR=1.45, p<0.001) and older adults (AOR=1.55, p<0.002) were more likely to receive a plan to change drinking behaviors.

DISCUSSION

An online screening and intervention tool identified many older adults with unhealthy alcohol use behaviors and most were receptive to change. Web-based screening and interventions for alcohol use have the potential to be widely used among older adults.