Assessment of factors influencing morale in the elderly

Bem-estar psicológico, sintomas de depressão e forças do caráter em idosos da comunidade

Em um mundo com um número crescente de idosos, envelhecer bem se torna cada vez mais importante, e as forças do caráter podem contribuir para que isso seja alcançado. A fim de analisar forças na velhice, associando-as com sintomas depressivos e bem-estar psicológico, 188 idosos responderam às versões reduzidas e em português dos instrumentos Values-in-Action Inventory of Strengths, Escala de Depressão Geriátrica e Philadelphia Geriatric Center Morale Scale. As forças Amor, Esperança, Curiosidade, Perdão e Vitalidade se associaram tanto a níveis mais elevados de bem-estar psicológico quanto a mais baixos de sintomas depressivos. Foram obtidas correlações significativas entre seis forças e sintomas depressivos – negativas fracas – e entre 11 delas e bem-estar psicológico – positivas fracas. Os resultados deste estudo ampliam, ainda que limitadamente, o conhecimento sobre forças de idosos, especialmente como elas se relacionam com dois construtos que influenciam a velhice. Ademais, fornecem uma base para o desenvolvimento de intervenções futuras.

Relationship between morality, happiness, and social support among elderly people

Background

Various factors influence the lives of elders, such as social support, which is critical in preventing physical, psychological, and social difficulties. This study aimed to investigate the relationship between morality, happiness, and social support among elderly people. A descriptive correlational design was used in carrying out this study. This study was conducted at the Geriatric Social Club in El-Qawmia; Zagzig City, Alsharkia Governorate. A purposeful sample of 235 elders was recruited for this study. Four tools were used to collect data: A structured interview questionnaire, Philadelphia Geriatric Center Morale Scale (interview version), Multidimensional Scale of Perceived Social Support, and Oxford Happiness Questionnaire.

Results

Results denoted that less than half of studied elders had moderate score as regards morale scale and perceived social support. As well, less than three-fifths of them had moderate score regards total happiness. There were statistically significant relations between morality and both of age, income, chronic diseases, and taking medication. Perceived social support was positively statistically significantly related with elders’ gender, marital status, chronic diseases, medication, and income. There were statistical significant relations between elderly happiness level and working condition, income, and with whom they live. Elders’ perceived social support was highly positively statistically correlated with happiness and morality.

Conclusions

It was concluded that these variables were positively correlated with each one, where increasing perceived social support and feeling of happiness associated with enhancing feeling of morality among elders. The perceived social support and happiness were the key co-existences of elders’ morality. Therefore, it is recommended to implement caring and training programs focusing on enhancing social support in order to develop morale among elders. The country should provide various kinds of assistance to the elderly, such as counseling services.

Does personality shape the personal social networks of older Europeans?

The aim of the study was to clarify whether personality traits predict the structure, function and quality of egocentric confidant networks in later life. Data were drawn from Waves 7 and 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (N = 39,172). We regressed network size, contact frequency and network satisfaction on the Big-5 personality traits, using a single path analysis structure, controlling for country, sociodemographic background and health status. The findings showed that the personality traits were related to the social network outcomes, but their effect was modest and less predictive than the contextual factors. The country predictors explained the most variance, generally, with some surprising results. For example, confidant networks were the largest in Scandinavia and Central Europe, and smallest in the Mediterranean region and Eastern Europe. Among the personality traits, extraversion was the most consistent positive predictor, but conscientiousness was also predictive. Neuroticism was a negative predictor, but not of network size. The sociodemographic variables, particularly partner status, explained more variance than the personality traits did. In sum, the SHARE database offers a comprehensive and differentiated view of the complex interpersonal milieus in which older Europeans are embedded.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-021-00678-8.

Scaling Down the PGCM Scale to Assess Views on Ageing More Efficiently: Finding a New Alternative

The aim of the study is to present a new and efficient way of measuring the quality of life among older populations, with special attention to morale, positive outlook on life and ageing. The measure is based on the Philadelphia Geriatric Center Morale Scale (PGCM), originally consisting of 22 items. The growing numbers and proportions of older people among European populations has increased the need to obtain more reliable data on their needs, values, life experiences and overall quality of life. Using data from six surveys conducted in the Czech Republic, we have formulated a three-item positive outlook on life and ageing (POLA) scale. Our analyses are divided into three steps: (1) constructing the scale and testing its internal consistency; (2) testing the scale's external validity using mean comparisons and correlation coefficients; and (3) determining the factors affecting a positive outlook on later life, such as gender and education. We have confirmed that the three-item approach to measuring positive outlook on ageing as a part of morale is highly applicable to surveys, producing compelling results in assessing important quality-of-life sub-concepts, such as subjective health, subjective age, and loneliness.

Morale in Old Age and Its Association with Sociodemographic, Social, and Health-Related Factors in Different Age Groups

Morale can be viewed as a future-oriented optimism or pessimism regarding challenges associated with aging and is closely related to subjective well-being. Promoting morale in old age could be considered to have important implications for aging well, and increased knowledge about morale in different stages of old age is needed. Hence, the aim of this study was to investigate factors associated with morale in different age groups among old people. Data were derived from a survey conducted in 2016, as a part of the Gerontological Regional Database (GERDA). The sample consisted of 9,047 individuals aged between 65 and 86 years from Ostrobothnia and Southern Ostrobothnia in Finland, and Västerbotten in Sweden. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS) and regressed upon a number of sociodemographic, social, and health-related factors using linear regression analyses. The results showed that older age was an independent factor explaining lower level of morale. Additionally, the sociodemographic, social, and health-related variables could explain a large proportion of the variance in morale. Perceived loneliness, having gone through a crisis in life, poor self-rated health, and depression were associated with lower morale, and sleeping well with higher morale, in all age groups. Furthermore, the oldest age groups seem to be more exposed to several risk factors of lower morale identified in this study. Multidimensional interventions targeting especially social and mental health and the oldest-old could therefore be recommended.

Risk factors for a decrease in high morale in very old people over a 5-year period: data from two Nordic countries

High morale could be considered to be an essential part of aging well and increased knowledge of how to prevent a decrease in high morale in very old age could have important implications for policy, and social and health care development. The objective was to identify social and health-related risk factors for a decrease in morale over 5 years in very old people among those with high morale at baseline. The study is based on data derived from the Umeå85+/GERDA study conducted in Northern Sweden and Western Finland. The final sample consisted of 174 individuals who were 85 years and older at baseline and who had completed the follow-up 5 years later. Morale was measured with The Philadelphia Geriatric Center Morale Scale (PGCMS). A set of social and health-related variables were used to test which factors were associated with a decrease in morale over 5 years. Linear regression was used for the multivariable analyses. The sample had a mean change of − 1.3 (SD = 2.5) in PGCMS scores from T1 to T2. The results from the regression analyses showed that development of depressive disorders, increased feelings of loneliness and the death of a child during the follow-up period were associated with a decrease in morale. The results from our study indicate that preventing the development of depressive disorders and increasing loneliness are key factors in preventing a decrease in high morale. Additionally, very old people who have recently lost an adult child should receive adequate psychosocial support.

A new method of mark detection for software-based optical mark recognition

Software optical mark recognition (SOMR) is the process whereby information entered on a survey form or questionnaire is converted using specialized software into a machine-readable format. SOMR normally requires input fields to be completely darkened, have no internal labels, or be filled with a soft pencil, otherwise mark detection will be inaccurate. Forms can also have print and scan artefacts that further increase the error rate. This article presents a new method of mark detection that improves over existing techniques based on pixel counting and simple thresholding. Its main advantage is that it can be used under a variety of conditions and yet maintain a high level of accuracy that is sufficient for scientific applications. Field testing shows no software misclassification in 5695 samples filled by trained personnel, and only two misclassifications in 6000 samples filled by untrained respondents. Sensitivity, specificity, and accuracy were 99.73%, 99.98%, and 99.94% respectively, even in the presence of print and scan artefacts, which was superior to other methods tested. A separate direct comparison for mark detection showed a sensitivity, specificity, and accuracy respectively of 99.7%, 100.0%, 100.0% (new method), 96.3%, 96.0%, 96.1% (pixel counting), and 99.9%, 99.8%, 99.8% (simple thresholding) on clean forms, and 100.0%, 99.1%, 99.3% (new method), 98.4%, 95.6%, 96.2% (pixel counting), 100.0%, 38.3%, 51.4% (simple thresholding) on forms with print artefacts. This method is designed for bubble and box fields, while other types such as handwriting fields require separate error control measures.

Factors Associated With Worsened or Improved Mental Health in the Great East Japan Earthquake Survivors

OBJECTIVE

The aim of this study was to identify factors contributing to the worsening or improved mental health of long-term evacuees over three years following the Great East Japan Earthquake.

METHOD

The Japanese version of the K6 questionnaire was used as a measure of mental health. The first- and third-year survey results were compared and differences in mental health status calculated. Respondents were then divided into two groups according to worsening or improved mental health status. Differences in stress factors, stress relief methods, and demographics were compared between the two groups.

RESULTS

Factors associated with exacerbation of poor mental health were the stress factors "Uncertainty about future" (p=0.048) and "Loss of purpose in life" (p=0.023). Multivariable analysis identified two factors associated with improved mental health, the stress relief methods "Accepting myself" (odds ratio (OR): 2.15, 95% confidence interval (CI): 1.02-4.51) and "Interactions with others" (OR: 3.34, 95% CI: 1.43-7.79).

CONCLUSION

While motivation and hope of livelihood reconstruction have gradually risen in the three years since the disaster, anxieties about an uncertain future, loss of purpose in life, and disruption of social networks continue adversely to affect the mental health of survivors.

Childhood trauma and resilience in old age: applying a context model of resilience to a sample of former indentured child laborers

OBJECTIVES

Psychological resilience has been rarely investigated in elderly populations. We applied a more comprehensive model of trauma-specific coping and resilience, which included Ungar's context model and included decentral factors of resilience (i.e., environments that provide resources to build resilience).

METHOD

We assessed resilience in a cohort of former Swiss indentured child laborers (N = 74; 59% males) at two time points; first at the mean age of 80 years and then again 20 months later. At each time point, the following measures of resilience were assessed: resilience indicators of life satisfaction and lack of depression. In addition, resilience predictors of trauma exposure, perceived social support, dysfunctional disclosure of traumatic experiences, social acknowledgment as a victim, and self-efficacy; and decentral resilience factors of education, income, number of children, and physical health were measured.

RESULTS

Using path-analysis, we found that life satisfaction and lack of depression were predicted by dysfunctional disclosure, social support, and self-efficacy at various significance levels. Change scores of resilience were predicted by higher trauma exposure, social acknowledgment as a victim, and an interaction between the two. The model for decentral factors also fitted, with physical health and income predicting the resilience indicators.

CONCLUSION

Applying this comprehensive resilience model in a sample of older adults revealed meaningful findings in predicting resilience at a single time point and over time. Atypical coping strategies, such as perceived social acknowledgment as a victim and disclosure, may be particularly important for former victims who have suffered institutional abuse.

Higher morale is associated with lower risk of depressive disorders five years later among very old people

OBJECTIVE

The aim of this study was to investigate whether higher morale, i.e. future-oriented optimism, at baseline was associated with lower risk of depressive disorders five years later among very old people.Methods The Umeå85+/GErontological Regional Database, a population-based study with a longitudinal design, recruited participants in Sweden and Finland aged 85, 90 and ≥95 years. The sample in the present study included 647 individuals (89.1±4.4 years (Mean±SD), range 85-103). After five years, 216 were alive and agreed to a follow-up (92.6±3.4 years, range 90-104). The Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale. The depressive disorder diagnosis was determined according to DSM-IV based on medical records and interview data including assessment scales for depressive disorders. A number of sociodemographic, functional and health-related variables were analysed as possible confounders.Results For those with no depressive disorders at baseline, the only baseline variable significantly associated with depressive disorders five years later was the PGCMS score. A logistic regression model showed lower risk of depressive disorders five years later with higher baseline PGCMS scores (odds ratio 0.779 for one point increase in PGCMS, p<0.001). The association remained after adjusting for social isolation (p<0.1 association with depressive disorders five years later).Conclusion Our results indicate that the higher the morale, the lower the risk of depressive disorders five years later among very old people. The PGCMS seems to identify those very old individuals at increased risk of depressive disorders five years later. Preventive measures could befocused on this group.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Functional connectivity associated with social networks in older adults: A resting-state fMRI study

Poor social networks and decreased levels of social support are associated with worse mood, health, and cognition in younger and older adults. Yet, we know very little about the brain substrates associated with social networks and social support, particularly in older adults. This study examined functional brain substrates associated with social networks using the Social Network Index (SNI) and resting-state functional magnetic resonance imaging (fMRI). Resting-state fMRI data from 28 non-demented older adults were analyzed with independent components analyses. As expected, four established resting-state networks-previously linked to motor, vision, speech, and other language functions-correlated with the quality (SNI-1: total number of high-contact roles of a respondent) and quantity (SNI-2: total number of individuals in a respondent's social network) of social networks: a sensorimotor, a visual, a vestibular/insular, and a left frontoparietal network. Moreover, SNI-1 was associated with greater functional connectivity in the lateral prefrontal regions of the left frontoparietal network, while SNI-2 was associated with greater functional connectivity in the medial prefrontal regions of this network. Thus, lateral prefrontal regions may be particularly linked to the quality of social networks while medial prefrontal regions may be particularly linked to the quantity of social networks.

The impact of social networks on the relationship between functional impairment and depressive symptoms in older adults

BACKGROUND

To examine the role of meaningful relationship characteristics, defined here as social network type, in relation to the association between functional impairment and depressive symptoms.

METHODS

The sample included respondents aged 65 years and older (n = 26,401) from the fourth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Respondents were classified into one of seven relationship network types (Distal Children (living at a distance), Proximal Family (living nearby), Spouse, Other Family, Friend, Other, and No Network) according to the predominant characteristics of their most meaningful relationships. A two-stage regression analysis was performed in which the number of depressive symptoms was first regressed on the extent of functional impairment and network type, controlling for sociodemographic characteristics, cognition, health, and country. In the second stage, variables representing the interactions between functional impairment and network type were considered.

RESULTS

The compositional characteristics of respondents' relationships in later life, as defined by social network type, were associated with depressive symptoms. In particular, when experiencing functional impairment, those without any meaningful relationships were found to have more depressive symptoms when compared to all other network types. The findings underscore the importance of meaningful relationships for the mental health of older adults experiencing functional impairment as well as the risk of experiencing depression among those who maintain no personal social network.

CONCLUSIONS

The study shows that differing constellations of meaningful relationships in later life yield different associations with mental health, especially when taking functional limitations into account.

Examining the Disability Model From the International Classification of Functioning, Disability, and Health Using a Large Data Set of Community-Dwelling Malaysian Older Adults

Objective: This study examines the International Classification of Functioning, Disability, and Health model (ICF) using a data set of 2,563 community-dwelling elderly with disease-independent measures of mobility, physical activity, and social networking, to represent ICF constructs. Method: The relationship between chronic disease and disability (independent and dependent variables) was examined using logistic regression. To demonstrate variability in activity performance with functional impairment, graphing was used. The relationship between functional impairment, activity performance, and social participation was examined graphically and using ANOVA. The impact of cognitive deficits was quantified through stratifying by dementia. Results: Disability is strongly related to chronic disease (Wald 25.5, p < .001), functional impairment with activity performance (F = 34.2, p < .001), and social participation (F= 43.6, p < .001). With good function, there is considerable variability in activity performance (inter-quartile range [IQR] = 2.00), but diminishes with high impairment (IQR = 0.00) especially with cognitive deficits. Discussion: Environment modification benefits those with moderate functional impairment, but not with higher grades of functional loss.

High morale is associated with increased survival in the very old

BACKGROUND

high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.

OBJECTIVE

to investigate whether high morale is associated with increased survival among very old people.

SUBJECTS

the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.

METHODS

demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.

RESULTS

the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).

CONCLUSION

high morale is independently associated with increased survival among very old people.

Social isolation in older Malaysians: prevalence and risk factors

BACKGROUND

Social isolation is one of the most important emerging issues among ageing populations, as it reduces well-being, health and quality of life. The purpose of this study was to identify prevalence and risk factors of social isolation in older Malaysians.

METHODS

The sample for this study was drawn from a national survey entitled 'Patterns of Social Relationships and Psychological Well-Being among Older Persons in Peninsular Malaysia'. Social isolation was measured with the Lubben Social Network Scale.

RESULTS

The findings from the present study showed that 49.8% of older Malaysians are at risk for social isolation. The results of logistic regression analysis revealed that the number of sons, number of brothers, number of sisters, household size, self-rated health, place of residence, home ownership, sex and ethnicity were significantly associated with social isolation.

CONCLUSION

These findings may have some implications for social and health-care policymakers in planning and developing new and effective interventions such as educational programmes to reduce social isolation among this vulnerable population.

Living arrangement and life satisfaction in older Malaysians: the mediating role of social support function

BACKGROUND

This cross-sectional and correlational survey examines the association between different types of living arrangements and life satisfaction in older Malaysians, while taking into account the mediating effects of social support function.

METHODOLOGY AND FINDINGS

A total of 1880 of older adults were selected by multistage stratified sampling. Life satisfaction and social support were measured with the Philadelphia Geriatric Center Morale Scale and Medical Outcomes Study Social Support Survey. The result shows living with children as the commonest type of living arrangement for older adults in peninsular Malaysia. Compared to living alone, living only with a spouse especially and then co-residency with children were both associated with better life satisfaction (p<.01) and social support function (p<.01). The mediating effect of social support function enhanced the relation between living arrangements and life satisfaction.

CONCLUSION

This study revealed that types of living arrangement directly, and indirectly through social support function, play an important role in predicting life satisfaction for older adults in Malaysia. This study makes remarkable contributions to the Convoy model in older Malaysians.

Comparisons of the prevalence of and risk factors for elderly depression between urban and rural populations in Japan

BACKGROUND

The aim of the present study was to investigate the differences in the prevalence of and risk factors for elderly depression between urban and rural areas in Japan and to further understanding of the features of elderly depression.

METHODS

A multistage, random sampling procedure and mailing method were used in urban and rural areas in Kumamoto Prefecture. A total of 2,152 participants aged 65 years and older were evaluated for depression using the Geriatric Depression Scale (GDS). Factors associated with depression were also examined. In order to assess the relationship between risk factors and subjective happiness, the Philadelphia Geriatric Center Morale Scale (PGC-MS) was used.

RESULTS

Depressive symptoms were associated with living alone, being unemployed, chronic illness, sleep disturbance, suicidal ideation, financial strain, and poor social support; the risk factors for elderly depression were almost the same in the two areas. Although three factors (financial strain, work status, and PGC-MS) were significantly associated with depression in both areas on logistic regression analysis, sleep disturbance was significant only for the urban area, and poor social support was significant only for the rural area.

CONCLUSIONS

Although factors related to depression did not differ markedly between urban and rural elderly people, some risk factors differed between the two areas. Effective intervention programs for elderly depression should pay more attention to regional differences.

Loneliness as a risk factor for hypertension in later life

OBJECTIVE

The present study aims to determine the impact of loneliness on hypertension in later life.

METHOD

Data for this study are derived from a sample of 1,880 older Malaysians via a cross-sectional survey entitled "Patterns of Social Relationships and Psychological Well-Being Among Older Persons in Peninsular Malaysia." Loneliness is assessed by the PGCMS item, "How much do you feel lonely?" Data analysis is carried out using the Statistical Package for Social Sciences (SPSS) version 19.0.

RESULTS

Nearly one third of respondents report high level of loneliness. The overall prevalence of hypertension is 39% (95% CI=36.9-41.3). Logistic regression, controlling for sociodemographic factors and several chronic medical conditions, shows that loneliness significantly increases likelihood of hypertension in later life (OR=1.31, p≤.05, 95% CI=1.04-1.66).

DISCUSSION

The results show loneliness as a major risk factor for hypertension and call for health care professionals to be aware of the negative physiological effects of loneliness in old age.