Enjoyment of life and declining physical function at older ages: a longitudinal cohort study

Gratitude and Life Satisfaction among Older Adults in Saudi Arabia: Social Support and Enjoyment of Life as Mediators

This cross-sectional study aimed to investigate the relationship between gratitude and life satisfaction, and the mediation role of social support and enjoyment of life among older individuals. The measures employed include the Gratitude, Resentment, and Appreciation test; the Enjoyment of Life scale; the Satisfaction with Life scale; and the Multidimensional Scale of Perceived Social Support. These were administered to a sample of 260 older individuals aged between 60 and 80. The main findings revealed a positive association between gratitude and life satisfaction, and social support was a partial mediator in this relationship. Although enjoyment of life was not a direct mediator in the relationship between gratitude and life satisfaction, the final model indicated a significant serial pathway from gratitude to social support and then through enjoyment of life to life satisfaction. In conclusion, enhancing gratitude, promoting the enjoyment of life, and social support to older individuals might increase their life satisfaction, which in turn might contribute to their successful aging.

Sleep timing, sleep regularity, and psychological health in early late life women: Findings from the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

To examine the associations of actigraphy-assessed sleep timing and regularity with psychological health in early late life women, whose circadian rhythms may be impacted by aging.

DESIGN

Cross-sectional.

PARTICIPANTS

A racially/ethnically diverse sample of 1197 community-dwelling women (mean age 65 years) enrolled in the Study of Women's Health Across the Nation.

MEASURES

Actigraphy-assessed sleep measures included timing (mean midpoint from sleep onset to wake-up) and regularity (standard deviation of midpoint in hours). Psychological health measures included a composite well-being score, the Center for Epidemiological Studies Depression Scale, and the Generalized Anxiety Disorder-7 Scale. Linear and logistic regression models, adjusted for covariates (including sleep duration), tested associations between sleep and psychological health measures.

RESULTS

After covariate adjustment, a sleep midpoint outside of 2:00-4: 00 AM was significantly associated with depressive symptoms (β = 0.88, 95% CI = 0.06, 1.70) and scoring above the cut-point for clinically significant depressive symptoms (OR = 1.72, 95% CI = 1.15, 2.57). Sleep irregularity was significantly associated with lower psychological well-being (β = -0.18, 95% CI = -0.33, -0.03), depressive (β = 1.36, 95% CI = 0.29, 2.44) and anxiety (β = 0.93, 95% CI = 0.40, 1.46) symptoms, and scoring above the cut-point for clinically significant depressive (OR = 1.68, 95% CI = 1.01, 2.79) and anxiety (OR = 1.62, 95% CI = 1.07, 2.43) symptoms.

CONCLUSION

Above and beyond sleep duration, a sleep midpoint outside of 2:00-4:00 AM was associated with depressive symptoms while sleep irregularity was associated with multiple psychological health domains in late life women.

Multicomponent Training in Progressive Phases Improves Functional Capacity, Physical Capacity, Quality of Life, and Exercise Motivation in Community-Dwelling Older Adults: A Randomized Clinical Trial

OBJECTIVE

To evaluate the effect of a multicomponent progressive training program (MPTP) on functionality, quality of life (QoL) and motivation to exercise (EM) in a group of older adults (OA) of a community.

METHODS

A total of 55 participants of 69.42 ± 6.01 years of age were randomized into two groups; experimental (EG:35) and control (CG:20), and subjected to 27 weeks of MPTP. Functionality (pre/post-intervention) was assessed using the Short Physical Performance Battery (SPPB), Time Up and Go (TUG), Walking While Talking Test (WWT), Manual Dynamometry (MD), Forced Expiratory Volume in the first second (FEV₁), Sit and Reach (SR), Back Scratch (BS), and walk for 2 min (2 mST). QoL was assessed using the SF-36 questionnaire and EM using the BREQ-3. The Kolmogorov-Smirnov and Levene tests were applied. A two-way repeated measures ANOVA was applied. A significance level of p < 0.05 was accepted for all comparisons.

RESULTS

The EG compared to the CG improved in SPPB (ΔEG/CG: 29.67%/p < 0.001), TUG (ΔEG/CG: 35.70%/p < 0.05), WWT (ΔEG/CG: 42.93%/p < 0.001), MD (ΔEG/CG: 20.40%/p < 0.05), FEV₁ (ΔEG/CG: 21.37%/p < 0.05), BS (ΔEG/CG: 80.34%/p < 0.05), 2 mST (ΔEG/CG: 33.02%/p < 0.05), SF-36 (ΔEG/CG: 13.85%/p < 0.001), and Intrinsic Regulation (ΔEG/CG: 27.97%/p < 0.001); Identified by regulation (ΔEG/CG: 9.29%/p < 0.05).

CONCLUSION

An MPTP improves functionality, QoL and EM, and is a safe and effective method for community OAs.

Friendly Residential Environments and Subjective Well-Being in Older People with and without Help Needs

Previous studies have shown that friendly environments are associated with well-being and higher quality of life in older people. This study aimed to investigate the relationship between friendly environments and subjective well-being by segmenting the population according to the need for help in performing activities of daily living (ADLs) in a representative sample of people over 55 years of age in the Basque Country (Spain) (n = 2760). To determine the predictive power of friendliness on subjective well-being, two separate linear regression models were obtained according to the need for help in ADLs. The results obtained show a greater explanatory power of the model in the case of people who required help. However, in the case of people who do not need help, subjective health had a greater weight in the predictions. This paper's findings support the greater importance of the characteristics of the physical and social environment, as people's functional status worsens, with friendliness being an explanatory factor for people's well-being as they age and their dependency increases.

Neighborhood Environment and Mental Well-Being Among Chinese Older Adults: The Mediating Role of Social Capital

Background and Objectives

Neighborhood environments are increasingly recognized as associated with mental well-being among older adults. However, their underlying mechanisms remain unclear. This study investigated mediating effects of cognitive and structural social capital (SC) in relationships between neighborhood environments and mental well-being among older adults.

Research Design and Methods

We conducted a cross-sectional analysis of 1,277 community-dwellers aged 60 years and older in Hong Kong in 2021. The Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Perceived age-friendly environment was assessed. Objective neighborhood environment was measured by the number of neighborhood facilities (e.g., transportation, community centers, leisure facilities) within 200-m and 500-m buffer areas from respondents' residences. Structural equational modeling was used.

Results

Perceived age-friendly environment regarding community and health support had a protective role on mental well-being. More community centers were directly associated with better affective-emotional well-being, while more passive leisure facilities directly lowered psychological-functioning well-being. Cognitive SC outweighed structural SC in mediating relationships of neighborhood environment on mental well-being.

Discussion and Implications

Our findings advance the ecological model of aging by providing evidence for cognitive and structural SC as mediators to explain the relationship between neighborhood environment and mental well-being. Policy implications for optimizing mental well-being in aging societies are discussed.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey

BACKGROUND

The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults.

METHODS

A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire.

RESULTS

Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20).

CONCLUSION

COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

Enjoyment of life predicts reduced type 2 diabetes incidence over 12 years of follow-up: findings from the English Longitudinal Study of Ageing

BACKGROUND

Subjective well-being appears to be associated with reduced risk of type 2 diabetes (T2D). However, it is unknown whether this association is similar across different types of well-being. We examined the relationship between hedonic and eudaimonic well-being and incident T2D, and explored the role of sociodemographic, behavioural and clinical factors in these associations.

METHODS

We used data from 4134 diabetes-free participants from the English Longitudinal Study of Ageing (mean age =64.97). Enjoyment of life and purpose in life were assessed using items from the CASP-19 to reflect hedonic and eudaimonic well-being, respectively. Participants reported T2D diagnosis over 12 years. We used Cox proportional hazards regression analyses and also explored the percentage of association explained by different covariates.

RESULTS

Results revealed a protective role for enjoyment of life in T2D rate adjusting for sociodemographic (age, sex, wealth, ethnicity, marital status), behavioural (physical activity, smoking, alcohol consumption, body mass index) and clinical (hypertension, coronary heart disease and glycated haemoglobin) characteristics (HR =0.93, p=0.021, 95% CI (0.87, 0.99)). Sociodemographic, behavioural and clinical factors accounted for 27%, 27% and 18% of the association, respectively. The relationship between purpose in life and T2D was non-significant (adjusted HR =0.92, p=0.288, 95% CI (0.78, 1.08)).

CONCLUSION

This study illustrates how the link between subjective well-being and T2D varies between well-being components. It also demonstrates that sociodemographic, behavioural and clinical factors partially explain this association. Intervention studies examining whether changes in enjoyment of life can help delay T2D onset are warranted.

Optimism and longevity beyond age 85

BACKGROUND

Optimism is associated with health benefits and improved survival among adults aged >65. Whether or not optimism beyond age 85 continues to confer survival benefits is poorly documented. We examine the hypothesis that being optimistic at ages 85 and 90 is associated with improved survival.

METHODS

The Jerusalem Longitudinal Study (1990-2020) assessed comorbidity, depression, cognition, social and functional status, and 5-year mortality among a representative community sample, born 1920-1921, at age 85 (n=1096) and age 90 (n=533). Overall optimism (Op-Total) was measured using a validated 7-item score from the Scale of Subjective Wellbeing for Older Persons. The four questions concerning positive future expectations (Op-Future) and three questions concerning positive experiences (Op-Happy) were also analyzed separately. We determined unadjusted mortality Hazards Ratios, and also adjusted for gender, financial difficulty, marital status, educational status, ADL dependence, physical activity, diabetes mellitus, hypertension, ischemic heart disease, cognitive impairment and depression.

RESULTS

Between ages 85-90 and 90-95 years, 33.2% (364/1096) and 44.3% (236/533) people died respectively. All mean optimism scores declined from age 85 to 90, with males significantly more optimistic than females throughout. All measures of optimism (Op-Total, Op-Future, Op-Happy) at age 85 and 90 were significantly associated with improved 5-year survival from age 85-90 and 90-95 respectively, in both unadjusted and adjusted models. Findings remained unchanged after separately excluding depressed subjects, cognitively impaired subjects, and subjects dying within 6 months from baseline.

CONCLUSIONS

These finding support the hypothesis that being optimistic continues to confer a survival benefit irrespective of advancing age.

Mental component of health-related quality of life is an independent predictor of incident functional disability among community-dwelling older people: a prospective cohort study

PURPOSE

Previous studies have reported a positive association between poor health-related quality of life (HRQOL) and disability mainly in relation to the physical component of HRQOL. Given the mental component's responsivity to interventions, this study aimed to investigate whether the mental component of HRQOL independently predicted functional disability.

METHODS

We targeted all residents aged ≥ 65 years in one municipality and analyzed 3858 men and 4475 women without disability at baseline (November 2016). HRQOL was measured using the physical component summary (PCS) and mental component summary (MCS) of the SF-8 Health Survey. At 3-year follow-up (October 2019), incident functional disability was measured, defined as a new certification according to the Japanese long-term care insurance system. Multivariable Poisson regression models stratified by gender were used to estimate adjusted cumulative incidence ratio (CIR) and 95% confidence interval (CI) for functional disability.

RESULTS

Among both genders, there was a significant dose-response relationship between better MCS and lower risk of functional disability, independent of potential confounders including the PCS (P for trend = 0.026 in men and 0.003 in women). Compared with the worst MCS group, the CIRs (95% CIs) for functional disability in the second worst, the middle, the second best, and the best MCS quintile groups were 1.09 (0.80-1.48), 0.58 (0.40-0.85), 0.90 (0.59-1.37), and 0.70 (0.48-1.02) for men, and 0.76 (0.58-1.00), 0.62 (0.46-0.84), 0.73 (0.53-0.99), and 0.63 (0.48-0.85) for women, respectively.

CONCLUSION

The MCS is an independent predictor of functional disability among high-functioning older adults. This suggests that strategies focused on mental HRQOL are important for realizing a healthy, long-lived society.

Is well-being prior to receiving rehabilitation services associated with postrehabilitation mental health and functioning?

OBJECTIVES

Millions of older adults receive rehabilitation services every year, which aim to restore, maintain, or limit decline in functioning. We examine whether lower reported well-being prior to receiving rehabilitation services is associated with increased odds of worsening anxiety symptoms, depressive symptoms, and impairment in self-care and household activities following rehabilitation.

METHODS

Data come from the National Health and Aging Trends Study (NHATS), an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our sample consists of 811 NHATS participants who, in the 2015 interview, had information on well-being and, in the 2016 interview, reported receiving rehabilitation services in the prior year.

RESULTS

In multivariable logistic regression analyses, compared to the highest quartile, those in the lowest quartile of well-being at baseline have increased odds of having worsening depressive symptoms (OR = 9.25, 95% CI: 3.78-22.63) and worsening impairments in self-care activities (OR = 2.39, 95% CI: 1.12-5.11).

CONCLUSION

Our findings suggest that older adults with the lowest levels of baseline well-being may be susceptible to having worsening depressive symptoms and impairment in self-care activities following rehabilitation services. Examination on whether consideration of well-being during the rehabilitation process could lead to better mental health and functional outcomes following rehabilitation is needed.

Mitigating the Challenges and Capitalizing on Opportunities: A Qualitative Investigation of the Public Library's Response to an Aging Population

Public libraries are community hubs that can both create opportunities and address challenges often associated with later life and population aging. Using a thematic analysis of 18 in-depth interviews with public librarians, this study investigates common practices and challenges experienced while developing programs for older adults. This analysis is augmented by an environmental scan of older-adult programming offered in member libraries of the Canadian Urban Library Council (CULC). Results indicate that public librarians leverage community partnerships and staff training to develop programs that foster digital, financial, language, and health literacy and create opportunities for both intergenerational and peer social connection. At the same time, they face challenges related to limited space, budgets, and staff capacity, difficulty meeting the extensive and often conflicting interests of various groups within the library, and marketing programming to older adults. Findings indicate that public libraries may be key players in mitigating challenges often associated with having an aging population, and indeed highlight the many benefits of valuing and providing services to this population.

Midlife Factors Related to Psychological Well-Being at an Older Age: Study of Women's Health Across the Nation

Background: Psychological well-being (PWB) is predictive of future health and mortality. Midlife is a pivotal time in women's lives and may impact future PWB. This study, based on a longitudinal cohort of women, sought to identify how personal and social resources and modifiable behaviors at midlife relate to women's PWB in later life, and to determine if psychological resilience in later life moderates the impact of health problems on PWB. Materials and Methods: We assessed the association of midlife factors with PWB ∼9 years later in 1693 women from the multiracial/ethnic Study of Women's Health Across the Nation (SWAN) cohort. PWB was a composite score with cognitive and affective components. Midlife factors included sociodemographics, health, menopause-related, and psychosocial factors collected over the course of midlife. Results: In a multivariable model, greater PWB at an older age was associated with the following at midlife: less financial strain, greater physical activity, not smoking, better physical functioning, and fewer sleep problems. More positive attitudes toward menopause and aging, less cynicism, greater optimism, less trait anxiety, greater spirituality, and greater resilience were also independently associated with better PWB. Chinese women reported lower PWB compared with whites. Later life resilience moderated the impact of sleep problems on PWB. Conclusions: Several modifiable factors at midlife are associated with better PWB in older women and highlight the importance of healthy behaviors such as physical activity and good sleep hygiene at midlife. Interventions to increase optimism, spirituality, and resilience are also worth exploring.

Wearable device adoption among older adults: A mixed-methods study

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Using a mixed-methods approach, we analyzed the adoption of wearable devices among older adults.

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Perceived complexity of devices (specifically interpreting the outputs) is the most salient deterrent of adoption.

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The effect of cognitive age on adoption is moderated by subjective well-being (SWB).

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Cognitive age negatively (vs. positively) impacts the older adults’ adoption intention when their SWB is high (vs. low).

Recently, the popularity of smart wearable technologies, such as Fitbit, has significantly increased. There are numerous potential benefits in using these devices, especially among seniors. Yet, little is known about seniors’ adoption behavior. Through a mixed-methods approach, this study investigates the factors that impact seniors’ intention to use wearable devices. Results from an online survey and interviews showed that seniors’ perception of the complexity of working with these devices is a barrier to their adoption decisions. Looking more deeply into the role of complexity revealed that seniors’ concern about the complexity of reading and interpreting the output of wearable devices is the main deterring element. Furthermore, we explored the role of two important elements: seniors’ cognitive age, and the influence of their subjective well-being on their adoption behavior. Results demonstrated that cognitive age does not significantly impact use intention by itself; nonetheless, subjective well-being moderates its effect. This result revealed an interesting finding, which is that the influence of cognitive age on seniors’ use intention depends on seniors’ level of subjective well-being. When seniors’ subjective well-being is low, surprisingly, cognitive age increases seniors’ intention to use the device. These findings provide interesting implications for practice and future research.

An outcome-wide analysis of bidirectional associations between changes in meaningfulness of life and health, emotional, behavioural, and social factors

The sense that one is living a meaningful life is associated with positive health outcomes, but less is known about the role of changes in sense of meaning. This outcome-wide analysis investigated bidirectional associations between changes in ratings of doing worthwhile things in life and 32 factors in 6 domains of human function in 5,694 men and women (M = 66.65 years) from the English Longitudinal Study of Ageing. Participants rated the extent they felt that the things they did in life were worthwhile in 2012 and 2014. Analyses were adjusted for age, gender, education and social class, and were weighted for non-response. We found that health (e.g. few chronic diseases, no chronic pain), emotional wellbeing (e.g. few depressive symptoms, good sleep), greater physical activity, social factors (e.g. close relationships, friends, organizational membership, volunteering, cultural engagement), and economic factors (wealth, income), at baseline were associated with 2 year increases in worthwhile ratings. Conversely, increases in worthwhile ratings over 2 years were related to more favourable health, emotional, behavioural, and social changes between 2012 and 2016 independently of baseline levels. These bidirectional relationships highlight the importance of maintaining worthwhile activities at older ages.

Investing in Happiness: The Gerontological Perspective

Optimising happiness is a desirable societal aim in itself, but there are four more specific reasons why research on happiness is an important emerging theme in gerontology. First, happiness is not merely the mirror of depression, anxiety or distress, but has distinct relationships with a range of outcomes, so benefits from study in itself. Second, happiness appears to be a protective factor for morbidity and mortality; although studies are complex and take a long time to complete, there is accumulating evidence that greater happiness predicts survival among older people independently of covariates including health status and depression. Third, happiness has broad ramifications at older ages, being related to personal and social relationships, economic prosperity, biological risk factors, health behaviours, and time use as well as health. Fourth, happiness is malleable, and can potentially be modified in ways that will enhance the health and well-being of older people.

Association Between Subjective Well-being and Living Longer Without Disability or Illness

IMPORTANCE

Subjective well-being is associated with reduced mortality, but it is not clear whether additional time is spent in good health or with chronic disease and disability.

OBJECTIVE

To evaluate the associations between affective well-being, total life expectancy, and life expectancy free of disability and chronic disease.

DESIGN, SETTING, AND PARTICIPANTS

This survey study used data on 9761 participants from the English Longitudinal Study of Ageing who were followed up for a maximum of 10 years (mean [SD] follow-up, 6 [3.7] years). Discrete-time multistate life table models were used to estimate total life expectancy and life expectancy free of disability or chronic disease. Data were collected between March 2002 and March 2013 and analyzed from December 2018 to April 2019. Analyses were adjusted for wealth and cohabiting status.

MAIN OUTCOMES AND MEASURES

The main outcome was life expectancy free of disability and chronic disease. Affective well-being was assessed at baseline as a combination of enjoyment of life and the lack of significant depressive symptoms. Disability was measured in terms of impaired activities of daily living and instrumental activities of daily living, and chronic disease as the occurrence of 6 serious illnesses.

RESULTS

Data were analyzed from 9761 participants (5297 [54%] female; mean [SD] age at baseline, 64 [9.9] years). High affective well-being was associated with longer life expectancy and with longer disability-free and chronic disease-free life expectancies. For example, a woman aged 50 years who reported high affective well-being could expect to live 6 years longer than a woman of similar age with low well-being; 31.4 of her remaining years (95% CI, 30.5-31.9 years) would be likely to be free of disability, compared with 20.8 years (95% CI, 20.1-22.1 years) for a woman with low affective well-being. A man aged 50 years with high affective well-being could expect to live 20.8 years (95% CI, 18.7-22.4 years) without chronic disease, compared with 11.4 years (95% CI, 8.5-14.6 years) for a man reporting low well-being. Similar patterns were observed at the ages of 60, 70, and 80 years.

CONCLUSIONS AND RELEVANCE

This study suggests that people who report high levels of subjective well-being live longer and also healthier lives than those with lower well-being. These findings add weight to endeavors to promote the subjective well-being of older people.

Happiness and Health

Research into the relationship between happiness and health is developing rapidly, exploring the possibility that impaired happiness is not only a consequence of ill-health but also a potential contributor to disease risk. Happiness encompasses several constructs, including affective well-being (feelings of joy and pleasure), eudaimonic well-being (sense of meaning and purpose in life), and evaluative well-being (life satisfaction). Happiness is generally associated with reduced mortality in prospective observational studies, albeit with several discrepant results. Confounding and reverse causation are major concerns. Associations with morbidity and disease prognosis have also been identified for a limited range of health conditions. The mechanisms potentially linking happiness with health include lifestyle factors, such as physical activity and dietary choice, and biological processes, involving neuroendocrine, inflammatory, and metabolic pathways. Interventions have yet to demonstrate substantial, sustained improvements in subjective well-being or direct impact on physical health outcomes. Nevertheless, this field shows great potential, with the promise of establishing a favorable effect on population health.

Evaluation of a Community-Based Program That Integrates Joyful Movement Into Fall Prevention for Older Adults

Background: Despite the development of evidence-based fall-prevention programs, there remains a need for programming that will engage older adults in real-world settings. Objective: This study aimed to evaluate a community-based group program that integrates joyful movement into fall prevention. The curriculum emphasizes a positive experience of movement, cultivating a healthy body image, and retraining of biomechanics. Design: Program evaluation was conducted using a one-group pre–post test study design. Key outcomes were functional balance and confidence. Qualitative feedback was gathered at the final class sessions. Results: Two hundred fifteen older adults enrolled at four sites over the period from 2010 to 2014. Among 86 participants who provided feedback, most credited the program for an increased sense of optimism and/or confidence (70%), and better walking ability (50%). Among 102 participants who completed both initial and final assessments, there was evidence of significant improvements on the Functional Reach Test (d = .60, p < .001) and Modified Falls Efficacy Scale (d = .17, p < .001). Conclusion: A joyful movement curriculum is acceptable to older participants, and they show improvements in functional balance and confidence. Future research should examine whether the positive changes encouraged by joyful movement lead to lasting reductions in fall risk and additional health benefits.

Advances and Open Questions in the Science of Subjective Well-Being

Subjective well-being (SWB) is an extremely active area of research with about 170,000 articles and books published on the topic in the past 15 years. Methodological and theoretical advances have been notable in this period of time, with the increasing use of longitudinal and experimental designs allowing for a greater understanding of the predictors and outcomes that relate to SWB, along with the process that underlie these associations. In addition, theories about these processes have become more intricate, as findings reveal that many associations with SWB depend on people's culture and values and the context in which they live. This review provides an overview of many major areas of research, including the measurement of SWB, the demographic and personality-based predictors of SWB, and process-oriented accounts of individual differences in SWB. In addition, because a major new focus in recent years has been the development of national accounts of subjective well-being, we also review attempts to use SWB measures to guide policy decisions.

Laugh and grow fat: Happiness affects body mass index among Urban Chinese adults

Previous studies have extensively examined the relationship between body mass index (BMI) and subjective well-being (SWB) but have mainly focused on the effects of BMI on SWB, leaving the question of whether BMI can be influenced by SWB largely neglected. In this study, we present the first empirical evidence on the effects of SWB on BMI among adults, using data combined from four waves of the Chinese General Social Survey (CGSS) (2010-2013). We find that, among urban Chinese adults, those who have a higher level of happiness tend to have higher BMI, after extensively controlling for a constellation of individual sociodemographic and health attributes. Further analyses using the instrumental variable method and propensity score matching provided similar results.

The decision to work after state pension age and how it affects quality of life: evidence from a 6-year English panel study

Background

despite an increasing proportion of older people working beyond State Pension Age (SPA), little is known about neither the motivations for this decision nor whether, and to what extent, working beyond SPA affects quality of life (QoL).

Methods

QoL was measured using the CASP-19 scale. Respondents in paid work beyond SPA were distinguished based on whether they reported financial constraints as the main reason for continuing in work. Linear regression models were used to assess the associations between paid work beyond SPA and CASP-19 scores among men aged 65-74 and women aged 60-69 (n = 2,502) cross-sectionally and over time using Wave 4 and Wave 7 of the English Longitudinal Study of Ageing.

Results

approximately, one in five respondents were in paid work beyond SPA, one-third of whom reported financial issues as the main reason. These individuals reported significantly lower CASP-19 scores (β = -1.21) compared with those who retired at the expected/usual age. Respondents who declared being in paid work beyond SPA because they enjoyed their work or wanted to remain active, reported significantly higher QoL (β = 1.62). Longitudinal analyses suggest that those who were working post-SPA by choice, but who had stopped working at follow-up, also reported marginally (P < 0.10) higher CASP-19 scores.

Conclusions

potential QoL benefits of working beyond SPA need to be considered in light of individual motivations for extending working life. Given the trend towards working longer and the abolishment of mandatory retirement ages, it is important that older people maintain control over their decision to work in later life.

Maintaining Healthy Behavior: a Prospective Study of Psychological Well-Being and Physical Activity

BACKGROUND

Although higher psychological well-being has been linked with a range of positive biological processes and health outcomes, the prospective association between psychological well-being and physical activity among older adults has been understudied.

PURPOSE

We tested whether higher baseline psychological well-being predicted higher levels of physical activity over time.

METHODS

Prospective data were from the English Longitudinal Study of Aging, a nationally representative sample of English adults over the age of 50. Our sample included 9986 adults who were assessed up to six times across an average of 11 years.

RESULTS

After adjusting for sociodemographic factors, each standard deviation increase in baseline psychological well-being was associated with higher median physical activity in linear regression models that examined physical activity across all six waves (β = 0.20; 95% confidence interval [CI] 0.18-0.21) and in linear mixed effect models that examined repeated measures of physical activity over the entire follow-up period (β = 0.20; 95% CI 0.19-0.21). Further, higher baseline psychological well-being was associated with a slower rate of decline in physical activity among people who were active at baseline (hazard ratio [HR] = 0.79, 95% CI 0.76-0.82) and increasing physical activity among people who were inactive at baseline (HR = 1.28, 95% CI 1.22-1.35). Findings were maintained after adjusting for baseline health status and depression.

CONCLUSIONS

Psychological well-being was independently associated with attaining and maintaining higher physical activity levels over 11 years, suggesting that it may be a valuable target for interventions aimed at helping older adults acquire more physical activity.

Expanding the Happiness Paradox: Ethnoracial Disparities in Life Satisfaction Among Older Immigrants in the United States

OBJECTIVE

This study investigated nativity disparities in life satisfaction among ethnoracial groups of older adults in the United States and the factors associated with such disparities.

METHOD

Cross-sectional data from 7,348 respondents aged 60 and older from the 2012/2014 waves of the Health and Retirement Study (HRS) were used to estimate linear regression models.

RESULTS

Older immigrants experienced higher levels of life satisfaction than comparable native-born individuals. This "happiness advantage" was particularly salient for Hispanic immigrants, who reported the highest levels of life satisfaction of all groups included in the study. With increasing education, life satisfaction increased for White and "Other Race" groups, regardless of nativity. However, for both Black groups and native-born Hispanics, higher levels of education were associated with lower life satisfaction.

DISCUSSION

Findings suggest that the "happiness paradox" may not only be a matter of Hispanic ethnicity, but that it may also extend to immigrants from other ethnoracial backgrounds.

Association of experienced and evaluative well-being with health in nine countries with different income levels: a cross-sectional study

BACKGROUND

It is important to know whether the relationships between experienced and evaluative well-being and health are consistent across countries with different income levels. This would allow to confirm whether the evidence found in high income countries is the same as in low- and middle-income countries and to suggest policy recommendations that are generalisable across countries. We assessed the association of well-being with health status; analysed the differential relationship that positive affect, negative affect, and evaluative well-being have with health status; and examined whether these relationships are similar across countries.

METHODS

In this cross-sectional study, interviews were conducted amongst 53,269 adults from nine countries in Africa, Asia, Europe, and Latin America. Evaluative well-being was measured with a short version of the World Health Organization (WHO) Quality of Life instrument, and experienced well-being was measured with the Day Reconstruction Method. Decrements in health were assessed with the 12-item version of WHO Disability Assessment Schedule 2.0. Block-wise linear regression and structural equation models were employed.

RESULTS

Considering the overall sample, evaluative well-being was more strongly associated with health (β = -0.35) than experienced well-being (β = -0.14), and negative affect was more strongly associated with health (β = 0.10) than positive affect (β = -0.02). The relationship between health and well-being was similar across countries. Lower scores in evaluative well-being and a higher age were the factors more strongly related with a worse health.

CONCLUSIONS

The different patterns observed across countries may be related to differences in the countries' gross domestic product, social protection system, economic situation, health care provision, lifestyle behaviours, or living conditions. The fact that evaluative well-being is more predictive of health than experienced well-being suggests that our level of satisfaction with our lives might be more important for our health than the actual emotions than we experience in our day-to-day lives and points out the need of interventions that improve the way people evaluate their lives.

Sense of life worth living (ikigai) and incident functional disability in elderly Japanese: The Tsurugaya Project

OBJECTIVE

To test the hypothesis that elderly persons who feel ikigai (a sense of life worth living) have a lower risk of incident functional disability than those who do not. Recent studies have suggested that ikigai impacts on mortality. However, its impact upon disability is unknown. The aim of the present study was to investigate the association between ikigai and incident functional disability among elderly persons.

METHODS

We conducted a prospective cohort study of 830 Japanese elderly persons aged ≥70 years as a comprehensive geriatric assessment in 2003. Information on ikigai was collected by self-reported questionnaire. Data on functional disability were retrieved from the public Long-term Care Insurance database in which participants were followed up for 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of functional disability were calculated for three groups delineated according to the presence of ikigai (“no”, “uncertain” or “yes”) using the Cox proportional hazards regression model.

RESULTS

The 11-year incidence of functional disability was 53.3% (442 cases). As compared with the “no” group, the multiple-adjusted HR (95% CI) of incident functional disability was 0.61 (0.36–1.02) for the “uncertain” group and 0.50 (0.30–0.84) for the “yes” group.

CONCLUSION

A stronger degree of ikigai is significantly associated with a lower risk of incident functional disability.

Sustained enjoyment of life and mortality at older ages: analysis of the English Longitudinal Study of Ageing

OBJECTIVE

 To test whether the number of reports of enjoyment of life over a four year period is quantitatively associated with all cause mortality, and with death from cardiovascular disease and from other causes.

DESIGN AND SETTING

 Longitudinal observational population study using the English Longitudinal Study of Ageing (ELSA), a nationally representative sample of older men and women living in England.

PARTICIPANTS

 9365 men and women aged 50 years or older (mean 63, standard deviation 9.3) at recruitment.

MAIN OUTCOME MEASURES

 Time to death, based on mortality between the third phase of data collection (wave 3 in 2006) and March 2013 (up to seven years).

RESULTS

 Subjective wellbeing with measures of enjoyment of life were assessed in 2002 (wave 1), 2004 (wave 2), and 2006 (wave 3). 2264 (24%) respondents reported no enjoyment of life on any assessment, with 1833 (20%) reporting high enjoyment on one report of high enjoyment of life, 2063 (22%) on two reports, and 3205 (34%) on all three occasions. 1310 deaths were recorded during follow-up. Mortality was inversely associated with the number of occasions on which participants reported high enjoyment of life. Compared with the no high enjoyment group, the hazard ratio for all cause mortality was 0.83 (95% confidence interval 0.70 to 0.99) for two reports of enjoyment of life, and 0.76 (0.64 to 0.89) for three reports, after adjustment for demographic factors, baseline health, mobility impairment, and depressive symptoms. The same association was observed after deaths occurring within two years of the third enjoyment measure were excluded (0.90 (0.85 to 0.95) for every additional report of enjoyment), and in the complete case analysis (0.90 (0.83 to 0.96)).

CONCLUSIONS

 This is an observational study, so causal conclusions cannot be drawn. Nonetheless, the results add a new dimension to understanding the significance of subjective wellbeing for health outcomes by documenting the importance of sustained wellbeing over time.

Association Between Social Participation and 3-Year Change in Instrumental Activities of Daily Living in Community-Dwelling Elderly Adults

OBJECTIVES

To investigate whether social participation (SP) in older adults is associated with ability to perform instrumental activities of daily living (IADLs).

DESIGN

Prospective cohort study.

SETTING

Two local municipalities of Nara, Japan.

PARTICIPANTS

Individuals aged 65 to 96 (n = 2,774 male, n = 3,586 female) free of IADL disability at baseline.

MEASUREMENTS

SP and IADLs were assessed using self-administered questionnaires. SP was categorized into five types and assessed using the number and type of social activities. IADLs were evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression analysis stratified according to sex was used to examine change in IADLs according to SP, with nonparticipation as a reference.

RESULTS

During the 3-year follow-up, 13.6% of men and 9.0% of women reported IADL decline. After adjusting for age, family structure, body mass index, pension, occupation, medical treatment, self-rated health, drinking, smoking, depression, cognitive function, and activities of daily living, participation in various social activities was inversely associated with change in IADLs in women but not men. Participation in the following types of social activities had significant inverse associations with IADL disability: hobby clubs (odds ratio (OR) = 0.68, 95% confidence interval (CI) = 0.49-0.94) for men and local events (OR = 0.68, 95% CI = 0.48-0.95), hobby clubs (OR = 0.53, 95% CI = 0.36-0.79), senior citizen clubs (OR = 0.74, 95% CI = 0.56-0.97), and volunteer groups (OR = 0.56, 95% CI = 0.32-0.99) for women.

CONCLUSION

Participation in a variety of different types of social activities was associated with change in IADLs over the 3 years of this study in women, and participation in hobby clubs was associated with change in IADLs in men and women. Recommending that community-dwelling elderly adults participate in social activities appropriate for their sex may promote successful aging.

Purpose in Life is Associated with a Reduced Risk of Incident Physical Disability in Aging U.S. Military Veterans

OBJECTIVES

The current study evaluated the incidence and determinants of physical disability in a contemporary, nationally representative sample of U.S. military veterans.

DESIGN, SETTING, PARTICIPANTS

Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of 1,686 veterans aged 55 years and older. Waves 1 and 2 were conducted in 2011 and 2013, respectively.

MEASUREMENTS

Potential determinants of incident disability in activities of daily living (ADL; e.g., bathing, dressing) and instrumental activities of daily living (IADL; e.g., food preparation, medication adherence) were assessed at Wave 1, and included sociodemographic characteristics, and risk (e.g., medical conditions, psychiatric distress), and protective psychosocial (e.g., psychological resilience, purpose in life) factors.

RESULTS

The two-year incidence of any physical disability (ADL or IADL) among veterans aged 55 years and older was 11.5%, and the incidence of ADL and IADL disability was 3.0% and 11.4%, respectively. Older age, being married/cohabiting, and number of medical conditions-specifically, diabetes, heart attack, and chronic pain-were associated with an increased risk of any incident physical disability and incident IADL disability (adjusted odds ratio [AOR] range: 1.10-3.10). Retirement was associated with an increased risk of incident ADL disability (AOR: 7.53, 95% CI: 1.37-41.51). Purpose in life was found to be protective for incident IADL disability (AOR: 0.93, 95% CI: 0.87-0.99).

CONCLUSIONS

Although greater medical burden is associated with increased incidence of physical disability in U.S. veterans, results of this study suggest that initiatives designed to foster greater purpose in life may help protect against the development of physical disability in this rapidly growing segment of the population.

General life satisfaction predicts dementia in community living older adults: a prospective cohort study

BACKGROUND

Low life satisfaction predicts adverse outcomes, and may predict dementia. The objectives were: (1) to determine if life satisfaction predicts dementia over a five year period in those with normal cognition at baseline; and (2) to determine if different aspects of life satisfaction differentially predict dementia.

METHODS

Secondary analysis of an existing population-based cohort study with initial assessment in 1991 and follow-up five years later. Initially, 1,751 adults age 65+ living in the community were sampled from a representative sampling frame. Of these, 1,024 were alive and had complete data at time 2, of whom 96 were diagnosed with dementia. Life satisfaction was measured using the Terrible-Delightful scale, which measures overall life satisfaction on a 7-point scale, as well as various aspects of life satisfaction (e.g. friendships, finances, etc.) Dementia was diagnosed by clinical examination using DSM-IIIR criteria. Logistic regression models were constructed for the outcome of dementia at time 2, and adjusted for age, gender, education, and comorbidities.

RESULTS

Overall life satisfaction predicted dementia five years later, at time 2. The unadjusted Odds Ratio (OR; 95% confidence interval) for dementia at time 2 was 0.72 (0.55, 0.95) per point. The adjusted OR for dementia was 0.70 (0.51, 0.96). No individual item on the life satisfaction scale predicted dementia. However, the competing risk of mortality was very high for some items.

CONCLUSION

A global single-item measure of life satisfaction predicts dementia over a five year period in older adults without cognitive impairment.

Measurement of Function Post Hip Fracture: Testing a Comprehensive Measurement Model of Physical Function

BACKGROUND

Measurement of physical function post hip fracture has been conceptualized using multiple different measures.

PURPOSE

This study tested a comprehensive measurement model of physical function.

DESIGN

This was a descriptive secondary data analysis including 168 men and 171 women post hip fracture.

METHODS

Using structural equation modeling, a measurement model of physical function which included grip strength, activities of daily living, instrumental activities of daily living, and performance was tested for fit at 2 and 12 months post hip fracture, and among male and female participants. Validity of the measurement model of physical function was evaluated based on how well the model explained physical activity, exercise, and social activities post hip fracture.

FINDINGS

The measurement model of physical function fit the data. The amount of variance the model or individual factors of the model explained varied depending on the activity.

CONCLUSION

Decisions about the ideal way in which to measure physical function should be based on outcomes considered and participants.

CLINICAL RELEVANCE

The measurement model of physical function is a reliable and valid method to comprehensively measure physical function across the hip fracture recovery trajectory.

Physical Functioning among Women 80 Years of Age and Older With and Without a Cancer History

BACKGROUND

Females 80 years and older comprise 22% of the total U.S. survivor population, yet the impact of cancer on the physical well-being of women is this age group has not been well characterized.

METHODS

We compared women, 80 years of age and older in the Women's Health Initiative extension 2, who did (n = 2,270) and did not (n = 20,272) have an adjudicated history of cancer during Women's Health Initiative enrollment; analyses focused on women >2-years postcancer diagnosis. The physical functioning subscale of the RAND-36 was the primary outcome. Demographic, health-status, and psychosocial covariates were drawn from Women's Health Initiative assessments. Analysis of covariance was used to examine the effect of cancer history on physical function, with and without adjustment for covariates.

RESULTS

In adjusted models, women with a history of cancer reported significantly lower mean physical functioning (56.6, standard error [SE] 0.4) than those without a cancer history (58.0, SE 0.1), p = .002. In these models, younger current age, lower body mass index, increased physical activity, higher self-rated health, increased reported happiness, and the absence of noncancer comorbid conditions were all associated with higher physical functioning in both women with and without a history of cancer.

CONCLUSIONS

Women older than 80 years of age with a cancer history have only a moderately lower level of physical function than comparably aged women without a cancer history. Factors associated with higher levels of physical functioning were similar in both groups.

Positive affect and pain: mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia

Fibromyalgia (FM) is a chronic pain condition often resulting in functional impairments. Nonrestorative sleep is a prominent symptom of FM that is related to disability, but the day-to-day mechanisms relating the prior night's sleep quality to next-day reports of disability have not been examined. This study examined the within-day relations among early-morning reports of sleep quality last night, late-morning reports of pain and positive and negative affect, and end-of-day reports of activity interference. Specifically, we tested whether pain, positive affect, and negative affect mediated the association between sleep quality and subsequent activity interference. Data were drawn from electronic diary reports collected from 220 patients with FM for 21 consecutive days. The direct and mediated effects at the within-person level were estimated with multilevel structural equation modeling. Results showed that pain and positive affect mediated the relation between sleep quality and activity interference. Early-morning reports of poor sleep quality last night predicted elevated levels of pain and lower levels of positive affect at late-morning, which, in turn, predicted elevated end-of-day activity interference. Of note, positive affect was a stronger mediator than pain and negative affect was not a significant mediator. In summary, the findings identify 2 parallel mechanisms, pain and positive affect, through which the prior night's sleep quality predicts disability the next day in patients with FM. Furthermore, results highlight the potential utility of boosting positive affect after a poor night's sleep as one means of preserving daily function in FM.

Physical Activity and Mental Well-being in a Cohort Aged 60-64 Years

INTRODUCTION

Although evidence suggests physical activity (PA) may be associated with mental well-being at older ages, it is unclear whether some types of PA are more important than others. The purpose of this study is to investigate associations of monitored total PA under free-living conditions, self-reported leisure-time PA (LTPA), and walking for pleasure with mental well-being at age 60-64 years.

METHODS

Data on 930 (47%) men and 1,046 (53%) women from the United Kingdom Medical Research Council (MRC) National Survey of Health and Development collected in 2006-2011 at age 60-64 were used in 2013-2014 to test the associations of PA (PA energy expenditure and time spent in different intensities of activity assessed using combined heart rate and acceleration monitors worn for 5 days, self-reported LTPA, and walking for pleasure) with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS; range, 14-70).

RESULTS

In linear regression models adjusted for gender, long-term limiting illness, smoking, employment, socioeconomic position, personality, and prior PA, those who walked for >1 hour/week had mean WEMWBS scores 1.47 (95% CI=0.60, 2.34) points higher than those who reported no walking. Those who participated in LTPA at least five times/month had WEMWBS scores 1.25 (95% CI=0.34, 2.16) points higher than those who did not engage in LTPA. There were no statistically significant associations between free-living PA and WEMWBS scores.

CONCLUSIONS

In adults aged 60-64 years, participation in self-selected activities such as LTPA and walking are positively related to mental well-being, whereas total levels of free-living PA are not.

Childhood Environment and Mental Wellbeing at Age 60-64 Years: Prospective Evidence from the MRC National Survey of Health and Development

BACKGROUND

Mental wellbeing, conceptualised as positive affect, life satisfaction and realisation of needs that contribute to psychological growth, captures more than the absence of mental ill health. Several nations now aim to monitor and improve mental wellbeing. Whilst many studies document associations between adverse childhood experiences and mental disorders in adulthood, possible links between childhood experiences and adult mental wellbeing have so far received less attention.

METHODS

Using data from 1976 men and women in the MRC National Survey for Health and Development, we investigated prospective associations between childhood socioeconomic and psychosocial environments and the Warwick Edinburgh Mental Wellbeing Scale, designed to capture both hedonic and eudaimonic facets of wellbeing, at age 60-64.

RESULTS

Whilst there was no evidence that childhood socioeconomic circumstances were related to later wellbeing independently of other childhood experiences, elements of childrearing and parenting, parental health and adjustment, and childhood illness were related. More advantaged socioeconomic position was associated with greater wellbeing but this did not explain the links between these childhood exposures and adult wellbeing, suggesting alternative explanatory pathways should be considered.

CONCLUSIONS

Childhood illness and family psychosocial environment are associated with mental wellbeing in early older age, with effects sizes that are larger or comparable to socioeconomic circumstances in adulthood. Initiatives to improve the nation's mental wellbeing that include programmes targeted to supporting families and children may additionally have benefits that continue into older age.

Findings regarding the relationships between sociodemographic, psychological, comorbidity factors, and functional status, in geriatric inpatients

OBJECTIVE

To assess the impact of socio-demographic and comorbidity factors, and quantified depressive symptoms on disability in inpatients.

METHODS

Observational cross-sectional study, including a number of 80 elderly (16 men, 64 women; mean age 72.48 years; standard deviation 9.95 years) admitted in the Geriatrics Clinic of "St. Luca" Hospital, Bucharest, between May-July, 2012. We used the Functional Independence Measure, Geriatric Depression Scale and an array of socio-demographic and poly-pathology parameters. Statistical analysis included Wilcoxon and Kruskal-Wallis tests for ordinal variables, linear bivariate correlations, general linear model analysis, ANOVA.

RESULTS

FIM scores were negatively correlated with age (R=-0.301; 95%CI=-0.439 -0.163; p=0.007); GDS scores had a statistically significant negative correlation (R=-0.322; 95% CI=-0.324 -0.052; p=0.004) with FIM scores. A general linear model, including other variables (gender, age, provenance, matrimonial state, living conditions, education, respectively number of chronic illnesses) as factors, found living conditions (p=0.027) and the combination of matrimonial state and gender (p=0.004) to significantly influence FIM scores. ANOVA showed significant differences in FIM scores stratified by the number of chronic diseases (p=0.035).

DISCUSSION AND CONCLUSIONS

Our study objectified the negative impact of depression on functional status; interestingly, education had no influence on FIM scores; living conditions and a combination of matrimonial state and gender had an important impact: patients with living spouses showed better functional scores than divorced/widowers; the number of chronic diseases also affected the FIM scores: lower in patients with significant polypathology. These findings should be considered when designing geriatric rehabilitation programs, especially for home--including skilled--cares.

Quality of life attenuates age-related decline in functional status of older adults

PURPOSE

In the present study, we aimed to examine the total and moderating effects of needs-satisfaction-driven quality-of-life (QoL) measure on age-related change in functional status.

METHODS

Participants in the Survey of Health and Retirement in Europe (N = 18,781 at Wave 1) completed a measure of QoL (CASP-12) at baseline and reported their functional status across subsequent three waves using activities of daily living (ADL), instrumental activities of daily living (IADL), and functional limitation indices.

RESULTS

Growth-curve model estimates revealed that aged individuals with lower QoL scores at baseline had a steeper increase in disability deficits accumulation and functional limitation progression than their counterparts with a higher sense of QoL. The effects were more pronounced in ADL and IADL disability scales in which QoL moderated both linear and quadratic age-related changes.

CONCLUSIONS

Higher QoL attenuates processes of functional decline in late adulthood. Practitioners may seek strategies for improving and enhancing patients' QoL, as its salutary effects diffuse beyond psychological experience and include long-term effects on physical functioning.

Sports activity following total knee arthroplasty in patients older than 60 years

In a retrospective study with a population over 65 years, sports activity was conducted 6 years after cruciate retaining (CR) total condylar knee arthroplasty (TKA) with rotating platform (RP). Eighty-one Patients (71.8±5.4years) were examined at follow-up 6.4±0.9 years postoperative. Sport was practiced 5.3 hours every week in mean. Patients were active in sports 3.5times per week. Twenty-five percent performed high impact sports, 47% medium impact sports and 52% low impact sports at follow-up. In KOOS sports 60±28 was reached, in WOMAC 12.1±15.1. It can be concluded that in this population 50% of patients were active in medium and low impact sport 6 years after surgery. However, a quarter of patients were also active in high impact sports.