Individual differences in the effects of disease and disability on depressive symptoms: the role of age and subjective health

Profiles of centenarians' functioning: linking functional and cognitive capacity with depressive symptoms

BACKGROUND

Despite most centenarians facing age-related declines in functional and cognitive capacities, the severity of these declines varies among individuals, as does the maintenance of good mental health (e.g., depressive symptoms) despite these declines. This study aims to examine this heterogeneity in centenarians from the Second Heidelberg Centenarian Study, which collected data from 112 centenarians living in Germany. In our study, we focus on a subsample of 73 centenarians who provided self-reports for our measures of interest (M age = 100.4, SD age = 0.55).

METHODS

We examined correlations between functional capacity (i.e., PADL, IADL), cognitive capacity (i.e., MMSE), and depressive symptoms (i.e., GDS), and the existence of different profiles using hierarchical clustering.

RESULTS

Higher functional capacity was related to higher cognitive capacity and to fewer depressive symptoms. Yet, higher cognitive capacity was associated with more depressive symptoms. Hierarchical clustering analysis elucidated this contradiction by identifying three profiles: low-capacity individuals (i.e., 24 individuals had low functional and cognitive capacities, with low depressive symptoms), high-capacity individuals (i.e., 33 individuals with high functional and cognitive capacities, with low depressive symptoms), and low-functional-high-cognitive-capacity individuals (i.e., 16 individuals showed low functional but high cognitive capacity, with high depressive symptoms). Our post-hoc analyses highlighted arthritis and pain as risk factors for functional dependence and depression.

CONCLUSIONS

Our findings emphasize the importance of identifying centenarian subgroups with specific resource- and risk profiles to better address their needs, and of treating pain to improve functional capacity and mental health in centenarians.

The relationship between depressive mood and subjective health in centenarians and near-centenarians: a cross-sectional study from Korean centenarian cohort

BACKGROUND

With the rapid increase in population longevity, more clinical attention is being paid to the overall health of long-lived people, especially centenarians. Subjective health, which is the perception of one's health status, predicts both mortality and declining physical function in older adults. The purpose of this study was to investigate the factors related to subjective health among centenarians and near-centenarians (ages ≥95) living in a rural area of South Korea.

METHODS

A total of 101 participants were enrolled from four different regions (Gurye, Gokseong, Sunchang, and Damyang), known as the Longevity Belt in Korea. Variables assessing physical and mental health, including the results of blood tests, were examined. Factors associated with good subjective health were identified with logistic regression analysis.

RESULTS

Fifty-six participants (59.6%) were subjectively healthy among the centenarians and near-centenarians. Logistic regression analysis revealed that depressive mood was the only factor associated with subjective health and was negatively correlated. The regression model explained 39% of the variance in subjective health.

CONCLUSIONS

These findings emphasize the importance of mental health at very advanced ages. Because depressive mood negatively correlates with subjective health, more attention is needed to prevent and manage mood symptoms of people of advanced ages, including centenarians.

Walking activity increases physical abilities and subjective health in people with seven different types of disabilities

Introduction

People with disabilities have a great risk of physical inactivity, which causes several diseases, dependency, and long-term care. Walking helps to increase physical activity, which leads to better overall health and independence. However, less research attention has focused on walking for people with disabilities, and even fewer studies have been considered for different types of disabilities. The present study aimed to demonstrate how walking distance was associated with people with seven different types of disabilities- including visual, hearing, physical/mobility, intellectual, learning, autism, and emotional/behavioral disabilities-in terms of their physical abilities and subjective health.

Methods

A total of 378 participants (aged 13-65) were gathered from seven national organizations in Thailand. A survey questionnaire on aspects of physical abilities (i.e., walking distance or manually rolling wheelchair distance; body balance; weightlifting; exercise duration and frequency); and subjective health (i.e., health status and satisfaction) was completed online by all participants.

Results

The walking distance was partially positive and associated with exercise duration, weightlifting, exercise frequency, and health status (all p values < 0.001), as well as body balance and health satisfaction (p = 0.001 and 0.004, respectively), after controlling for age, sex, and types of disability. This demonstrated that increasing the amount of distance walked could well lead to a more positive body and mind.

Discussion

The present study suggests that the possibility of having a walk and/or encouraging people with disabilities to walk for greater distances can have a significant impact on both their physical and subjective health outcomes.

Social engagement and subjective health among older adults in South Korea: Evidence from the Korean Longitudinal Study of Aging (2006-2018)

Background

Social engagement serves as the foundation for social connections by providing a sense of belonging, social identity, and fulfillment. Previous studies have mainly focused on the one-way relationship between social engagement and subjective health among older individuals, and little attention has been paid to their mutual relationship. Therefore, this study aimed to examine the mutual association relationship between social engagement and their subjective health in older Koreans.

Methods

Seven waves of data samples (aged ≥60 years) from 2006 to 2018 from the Korean Longitudinal Study of Aging (KLoSA) was used in this study. Descriptive analysis, chi-squared tests, 2-year lagged Generalized estimating equation (GEE) model, and cross-lagged panel model were performed to investigate the mutual association between social engagement and subjective health among six survey periods.

Results

Results of the GEE model revealed when controlling for other variables, older Koreans who reported good subjective health only had a higher OR (1.678 vs. 1.650, p < 0.001) of participating in social engagement than those who had bad subjective health in 2006-2008 period; the occurrence rate of more social engagement was significantly higher among older adults with good subjective health than among those with bad subjective health (five out six survey periods). Cross-lagged analysis showed similar results that coefficients of social engagement on subjective were relatively larger in three survey periods; coefficients of subjective health on social engagement were relatively larger in the other three survey periods. The impact of social engagement on subjective health might be greater than that of subjective health on social engagement.

Conclusion

All-around participation and engagement of older people in society have become a consensus among the international community. In view of the single social engagement activities and less relevant participation channels in Korea, government departments should consider not only regional but also local characteristics to create more social participation opportunities for older individuals.

Health sensitivity in the daily lives of younger and older adults: correlates and longer-term change in health

OBJECTIVES

How susceptible older adults' affect is to fluctuations in health (i.e., health sensitivity) indicates how well they adapt to everyday health challenges. Theory and evidence are inconsistent as to whether older adults are more or less health sensitive than younger adults. The role of health burden as correlate and outcome of health sensitivity and age differences therein is also unclear. We thus move the study of health sensitivity ahead from longitudinal inquiry to examine age differences, the role of health burden, and long-term implications of daily life health sensitivitMethods: We use data from COGITO where 101 younger adults (M_age = 25; range = 20-31) and 103 older adults (M_age = 71; range = 65-80) gave daily reports of physical symptoms and positive and negative affect during a ∼100-day micro-longitudinal phase, as well as reports of trait-level health two years before and after.

RESULTS

Extending earlier reports, older age and higher health burden were (independently) associated with lower health sensitivity in positive but not negative affect. Health sensitivity was unrelated to long-term changes in health burden.

CONCLUSION

We take our findings to indicate successful aging (older adults are not more emotionally vulnerable to health issues) and discuss habituation as a process underlying how age and health burden may reduce health sensitivity.

A systematic review of the associations, mediators and moderators of life satisfaction, positive affect and happiness in near-centenarians and centenarians

OBJECTIVE

Results from studies investigating life satisfaction, positive affect and happiness of near-centenarians (95+) and centenarians are inconsistent. This is the first systematic review to summarise the extant literature on the subjective well-being of this unique age group.

METHOD

Seven electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and the Cochrane database for systematic reviews) were systematically searched. Subjective well-being was defined as life satisfaction, positive affect and happiness. A narrative synthesis of relevant articles was undertaken.

RESULTS

Of 28 studies eligible for inclusion in this review, 20 predominantly examined life satisfaction, 11 positive affect and 4 happiness. Sex and other demographic variables were not significant predictors of subjective well-being. In contrast, greater perceived health was significantly associated with higher levels of life satisfaction and positive affect. Fatigue and visual impairment were significantly correlated with lower levels of life satisfaction and positive affect. However, there was considerable heterogeneity in the findings on physical, cognitive and social associations, mediators and moderators.

CONCLUSION

The large discrepancy of results in the literature may be explained by methodological differences between studies. Centenarian research needs a clearer definition of life satisfaction, positive affect and happiness as their operationalisation is inconsistent. An international consortium of centenarian studies could facilitate cross-cultural comparisons on subjective well-being. Future research should be directed towards interventions that promote subjective well-being in the oldest-old.

Shorter telomeres among individuals with physical disability: The moderating role of perceived stress

OBJECTIVES

Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown.

METHODS

The participants consisted of 119 male subjects (mean age 54.36 years, range 35-70). Of them, 30 were able-bodied and 86 had a physical disability: 34 were due to Poliomyelitis (polio) and 55 were due to spinal cord injury (SCI). Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation.

RESULTS

Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression compared with able-bodied controls. Both the perceived stress and depression were correlated with a shorter TL. Nonetheless, perceived stress, rather than depression, moderated the relationship between disability and TL; among participants with higher perceived stress levels, in particular, individuals with physical disability had a shorter TL than the able-bodied controls.

DISCUSSION

The present findings suggest that individuals with physical disability and who exhibit high levels of perceived stress may be particularly vulnerable for accelerated cellular aging, suggesting that perceived stress can be used as a valuable target for intervention.

Dual trajectories of loneliness and depression and their baseline correlates over a 14-year follow-up period in older adults: Results from a nationally representative sample in Taiwan

AIMS

To explore the codevelopment between loneliness and depression in older adults, and to identify its potential baseline individual, family and extrafamilial correlates.

BACKGROUND

The number of older adults around the world has steadily increased over the last decades. Later life is a particularly vulnerable life stage due to multiple unfavourable conditions, and mental health in this stage appears to become an inescapable issue. Previous research has found the cross-sectional association between loneliness and depression, but their codevelopment has been understudied. Therefore, exploring the codevelopment and its correlates has significant implications for prevention and healthcare professionals.

DESIGN

A longitudinal follow-up study.

METHODS

The study used nationally representative data over a 14-year follow-up period from the Taiwan Longitudinal Study on Ageing focused on Taiwanese aged 60 years and above (n = 4049). Group-based trajectory modelling, group-based dual-trajectory modelling and multinomial logistic regression were the primary analytical methods.

RESULTS

We identified three distinct dual trajectories of loneliness and depression: longitudinal low-frequency lonely depressed (29.3%), longitudinal moderate-frequency lonely depressed (59.4%) and longitudinal high-frequency lonely depressed (11.3%). After considering several demographic and background characteristics, difficulty in physical functioning, number of physical symptoms and diseases, sleep quality and number of child deaths were found to be significantly associated.

CONCLUSION

Across the three identified dual-trajectory groups, they all showed a stable loneliness frequency pattern over time; however, the moderate-frequency group and high-frequency group both had a trajectory of increasing depression. It seems that depression tends to change over time in a worsening direction, especially for those with a certain frequency of loneliness. Furthermore, differences in individual and family correlates were found across the groups.

IMPLICATIONS FOR PRACTICE

Interventions focusing on the specific factors may help hinder coexisting loneliness and depression, and have implications for developing health promotion strategies and chronic disease care plans.

The prevalence and predictors of anxiety and depression in near-centenarians and centenarians: a systematic review

BACKGROUND

Current research on the psychological health of near-centenarians (95-99 years old) and centenarians remains limited. Existing studies have mainly characterized their physical, cognitive, and social health. Results on the anxiety and depression of near-centenarians and centenarians (more than 95 years old) have been mixed with some studies, finding higher rates of anxiety and depression among those older than 95 years and others reporting no difference in rates compared with younger age groups. This study aims to synthesize the existing literature on the prevalence and predictors of anxiety and depression in near-centenarians and centenarians.

METHOD

A systematic review was conducted using Ovid Medline, Embase, PsycINFO, CINAHL, SCOPUS, and the Cochrane database. Common and conflicting findings among the literature were examined.

RESULTS

Thirty-eight studies met the inclusion criteria. Six studies examined the prevalence and predictors of anxiety, and 37 studies investigated the prevalence and predictors of depression. Five studies examined both anxiety and depression in the same sample. Prevalence data on anxiety and depression varied significantly, as did comparisons with rates in younger populations. Findings on predictors of anxiety and depression were contradictory.

CONCLUSION

There is a large degree of heterogeneity among studies of centenarians' psychological status. Findings conflict on the prevalence and predictors of anxiety and depression and rates compared with younger age groups. Variation in findings may result from the different inclusion criteria, sampling methods, and measurement tools. Better harmonization of centenarian study methodologies may improve consistency of findings to aid in developing clinical interventions.

The psychological health of 207 near-centenarians (95-99) and centenarians from the Sydney Centenarian Study

OBJECTIVE

While near-centenarians (95-99) and centenarians are the fastest growing sectors of the population in many countries, few studies have investigated their psychological health. We aimed to compare levels of psychological distress and life satisfaction in individuals aged 95 or above (95+) with younger age groups and identify the factors associated with psychological distress and life satisfaction in near-centenarians and centenarians.

METHODS

We assessed the physical, cognitive, social and psychological health of 207 participants aged 95+ in the Sydney Centenarian Study. Psychological distress and life satisfaction were rated on the Kessler Psychological Distress Scale (K10) and Satisfaction with Life Scale, respectively. Cross-sectional univariate comparisons were performed with participants aged 70-90 years from the Sydney Memory and Ageing Study. Factors associated with psychological distress and life satisfaction among Sydney Centenarian Study participants were examined using multiple regression analyses.

RESULTS

In Sydney Centenarian Study and Memory and Ageing Study, mean K10 scores were 15.3 (±5.9) and 13.4 (±3.6), and clinical levels of psychological distress (K10 ⩾ 20) were 19% and 7%, respectively. Sydney Centenarian Study participants demonstrated significantly higher levels and rates of psychological distress (t = 3.869, p < 0.001; χ² = 27.331, p < 0.001). In Sydney Centenarian Study, more psychotropic medications and having fewer relatives and friends were associated with higher psychological distress. Sydney Centenarian Study participants reported significantly higher levels of life satisfaction than Memory and Ageing Study participants, mean scores 6.0 (±1.5) and 5.6 (±1.3); t = 5.835, p < 0.001. Lower Mini-Mental State Examination scores and having fewer relatives and friends were associated with lower life satisfaction in Sydney Centenarian Study.

CONCLUSION

Despite showing higher levels of psychological distress in the prior 4 weeks than younger age groups, near-centenarians and centenarians remained highly satisfied with their overall lives. The identification of risk and protective factors for psychological distress and life satisfaction provides opportunities for interventions to maintain good psychological health in this vulnerable population.

Ageism: we are our own worst enemy

In 1969, Butler (1969) first coined the term "ageism" to confront "prejudice by one age group toward other age groups" (pp. 243). As with other "isms," such as racism and sexism, ageism leads to bigotry and discrimination, though it is a very distinct beast in that, for the most part, other "isms" refer to those different from ourselves: distinct, mutually exclusive, and impervious groups. Conversely, age is a fluid social construct in which we are all intimately bound as we move through the lifespan, transitioning in and out of different age-groups. Unlike other "isms," individuals negotiate shifts from the "in-group" of youth to the "out-group" of old age. Yet we are all immersed, largely unconsciously, in this ubiquitous but too often unrecognized "ism" that needs to be named and challenged.

Health sensitivity: Age differences in the within-person coupling of individuals' physical health and well-being

Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals' well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50-109 year olds; 55% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity-on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect-and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record

Depression Moderates the Frailty-Subjective Health Link among Chinese Near Centenarians and Centenarians

OBJECTIVE

Very old adults may be physically frail, but they do not necessarily experience poor subjective health. The authors hypothesized that the relationship between frailty and subjective health is moderated by depression for very old people.

METHODS

In a cross-sectional study, a survey administered was by a face-to-face interview to 129 community-dwelling older adults aged 95-108. Measurements included the five-item FRAIL scale, the Geriatric Depression Scale Short-Form (GDS), and a subjective health rating. Hierarchical multiple regressions were conducted to test the moderation effects, adjusting for age, gender, living arrangement, perceived socioeconomic status, and cognition.

RESULTS

The interaction effect between frailty and depression was significant. Inspection of the simple slopes revealed that those who were more depressed had a more negative frailty-subjective health relationship. There was no significant moderation effect for a withdrawal-apathy-vigor dimension of the GDS.

CONCLUSION

Our findings suggest a protective psychological mechanism may enable very old adults to maintain an optimistic view of their health despite their increasing physical and functional limitations.

The Mediating Role of Health Perceptions in the Relation Between Physical and Mental Health

Objective: Responding to the increased need for research on older residents in assisted living facilities (ALFs), this study assessed the connections between physical and mental health among 150 older residents in ALF settings. Method: The major focus of the study was to explore whether individuals' subjective perceptions of their own health mediate the associations between health-related variables (chronic conditions and functional disability) and depressive symptoms. Results: The analyses showed that the adverse effects of chronic conditions and functional disability on depressive symptoms were not only direct but also indirect through negative health perceptions. Discussion: The findings that health perceptions serve as an intervening step between physical and mental health provide important implications for promotion of mental well-being among older residents in ALFs. In addition to disease/disability prevention and health promotion efforts, attention should be paid to ways to enhance older individuals' positive beliefs and attitudes toward their own health and to promote healthful behaviors.

Mediating effect of social support on the association between functional disability and psychological distress in older adults in rural China: does age make a difference?

This study aimed to determine the prevalence of psychological distress among elderly people in rural China. Moreover, the mediating effect of social support on the association between functional disability and psychological distress and whether this effect varies with age would be examined. A total of 741 elderly people aged 60–89 years from a rural area of Shandong Province, China participated in a cross-sectional survey. Their psychological distress, perceived social support, enacted social support, and functional disability were assessed through questionnaires. A total of 217 (29.3%) rural elderly people had psychological distress. The functional disability of people ≥75 years old had smaller total effects (0.18) on their psychological distress than in people <75 years old (0.30). Moreover, most of the effects of functional disability on psychological distress among the people ≥75 years old were indirect (0.12; 66.67% of total effects) through the mediating effect of social support especially perceived support, while the direct effect of functional disability was insignificant. In contrast, most of the effects of functional disability on psychological distress among the people <75 years old were direct (0.29; 96.67% of total effects), while the mediating effect of social support was insignificant. In conclusion, the total effect of functional disability, especially the direct effect, on psychological distress decreases sharply with age. The mediating effect of social support on the association between functional disability and psychological distress varies with age and is only found in people ≥75 years.

Immigration and loneliness in later life

Although the loneliness of both older adults and immigrants is frequently asserted, knowledge regarding the implications of immigration for loneliness in later life is limited. In particular, little attention has been directed to the impact of factors that might differentiate individuals within the immigrant population. Using data from the 2007 General Social Survey (GSS-21) conducted by Statistics Canada, this study examined the effects of immigrant status as well as immigrant generation, length of residence in Canada and race/ethnicity on loneliness among adults aged 60 and over (N=10,553). Regression analyses (ordinary least squares) estimating both the general and age-specific effects of immigrant experience on loneliness, indicated that immigrants report higher levels of loneliness than native-born Canadians, that race/ethnicity influenced loneliness particularly among immigrants and that generational status as well as length of residence also had an impact, but one that differed across age groups. Immigration-related variables appeared less consequential for loneliness in the oldest-old (aged 80+) than in younger elderly age groups. These findings attest to the significance of immigrant status for an understanding of loneliness in later life but suggest a need to acknowledge the diversity of immigrant experiences associated with lifecourse and other factors.

The prediction of subjective wellness among the old-old: implications for the "fourth-age" conception

OBJECTIVES

As the "fourth-age" conception suggests that the adaptability of psychosocial capabilities is disrupted at old-old age due to failures in maintaining balanced functions, this study examines the predictability of subjective wellness outcomes by factual dysfunction markers of health among old-old people across 12 years.

METHOD

Participants were self-respondents in a 3-wave survey that sampled the older (age 75-94) Jewish population in Israel. Wave 1 (N = 1,369, mean age = 83.5) preceded Wave 2 (N = 687, mean age = 85.4) by 4 years and Wave 3 (N = 164, mean age = 91.6) by 12 years.

RESULTS

The dysfunction markers (comorbidity, medication consumption, doctor's visits, and difficulties in activities of daily living [ADL]) predicted subjective wellness by relating to an increase in depressive symptoms, as well as to a decrease in life evaluation and self-rated health, beyond adjustment for sociodemographics. However, in most cases, an interaction finding indicated that dysfunction markers were weaker predictors of age-related change in subjective wellness among older participants.

DISCUSSION

At old-old age, the results point to reduced predictability of subjective wellness by factual dysfunction. This finding supports the fourth-age model. Still, researchers should consider an alternative interpretation, by which increasing independence between factual and subjective indicators is protective, rather than debilitating, among old-old people.

Older Men's Lay Definitions of Successful Aging over Time: The Manitoba Follow-up Study

The concept of “successful aging” has become widely accepted in gerontology, yet continues to have no common underlying definition. Researchers have increasingly looked to older individuals for their lay definitions of successful aging. The present analysis is based on responses to five questionnaires administered to surviving participants of the male Manitoba Follow-up Study cohort ( www.mfus.ca ) in 1996, 2000, 2002, 2004, and 2006 ( n = 2,043 men were alive at a mean age of 78 years in 1996). One question on each survey asked: “What is YOUR definition of successful aging?” Applying content analysis to the 5,898 narratives received over the 11 years, we developed a coding system encompassing 21 main themes and 86 sub-themes defining successful aging. We quantitatively analyzed trends in prevalence of themes of successful aging prospectively over time. Our findings empirically support colleagues' past suggestions to shift from defining successful aging in primarily biomedical terms, by taking lay views into account.

Exceptional Longevity: An Introduction to the IOWA Centenarian Study

The primary objective of the Iowa Centenarian Study is to further our understanding of determinants of exceptional longevity above and beyond health outcomes, particularly in rural environments. This introductory article provides a general overview of the study, its methodology and basic descriptive results. One hundred and fifty-two centenarians from a rural state participated in the study (average age was 101.6 years). Baseline data collection included questions on demographics, cognitive representation of being a centenarian, mental status, past family history, life events, activities of daily living, coping, physical health and health history, nutrition, exercise, personality, social support, mental health, economic status and perceptions, and fatigue. A subset of the baseline sample (n = 28) participated in a short-term longitudinal study that assessed stability and change in mental status, mental health, and activity. Four additional papers in this issue (Franke, Margrett, Heinz, & Martin, 2012; Garasky, Martin, Margrett, & Cho, 2012; Margrett, Hsieh, Heinz, & Martin, 2012; Martin, da Rosa, Margrett, Garasky, & Franke, 2012) will highlight substantive findings, including longitudinal analyses, in activities of daily living, economic status, mental status, and positive and negative affect.

Social Resources and Change in Functional Health: Comparing Three Age Groups

This study examined the mediating and moderating role of social resources on the association between age and change in functional health for three age groups of older adults. Data were provided by those in their 60s, 80s, and 100s who participated in the first two phases of the Georgia Centenarian study. Analyses confirmed the study's hypothesis that social resources moderated the relationship between age group and change in functional health; in particular, centenarians who experienced the greatest decline in IADLs scored the highest on social resources at time 1. No evidence was found for mediation by social resources or a directional influence by either level of social resources or functional health on change in the other resource. Evidence from this study challenges researchers and service providers to consider the heterogeneity in resources among older adults.

Self-rated health in centenarians: a nation-wide cross-sectional Greek study

Self-rated health (SRH) is an inclusive measure of public health that is correlated with quality of life and subsequent mortality. Extensive literature has identified multiple determinants of SRH in different populations. However, such studies on centenarians are scarce and parsimonious. Our objective is to identify SRH determinants in centenarians. This is a nationwide cross-sectional study on 400 Greek centenarians that was carried out between 2007 and 2010. SRH was evaluated by a simple question with a 5-point scale. Three categories of SRH were formed (very good/good/poor), which served as the dependent variable in multinomial regression models. Various sociodemographic, disease-related, lifestyle and psychosocial variables were assessed as candidate determinants of SRH. According to our results, SRH ratings among centenarians were better than that expected according to previous studies showing worse SRH ratings with increasing age in Greece. The 22.4% of the variance in SRH among centenarians was predicted by gender, habitat region and status, financial problems, disease presence and autonomy. Among lifestyle and psychosocial variables, obesity, good relationships with children, lack of feelings of loneliness, high optimism, adaptability and an internal health locus of control profile were independently associated with good SRH. These results indicate that SRH in individuals of extreme longevity were related to specific personal psychosocial factors that contribute to healthy aging and thus support the biopsychosocial model of health promotion.

Health self-perception by dementia family caregivers: sociodemographic and clinical factors

Caring for a demented family member has been associated with burden. Studies concerning health self-perception of family caregivers are still scarce.

OBJECTIVE

To investigate caregivers perceived health and to look into relationships with patients and caregivers' sociodemographic and clinical data.

METHOD

Dyads of dementia outpatients and family caregivers (n=137) were assessed with Mini Mental State Examination, Functional Activities Questionnaire, Neuropsychiatric Inventory and Clinical Dementia Rating. Caregivers answered Sociodemographic Questionnaire, Beck Depression and Anxiety Inventories, Zarit Burden Interview and Maslach Burnout Inventory.

RESULTS

Caregivers poor perceived health was associated with emotional exhaustion, burden, depression and anxiety. Logistic regression analyses revealed caregivers' age, anxiety and physical problem as the main predictors of health self-perception.

CONCLUSION

Aged family caregivers with anxiety who also report physical problem characterize a group at risk for poor self-perceived health. Evaluation of health self-perception may be useful for designing interventions to improve anxiety and physical health.

Do centenarians have higher levels of depression? Findings from the Georgia Centenarian Study

OBJECTIVES

To examine age differences on specific items and subscales of the Geriatric Depression Scale (GDS).

DESIGN

Specific items, subscales, and total score on the GDS of three age groups were compared.

SETTING

Community-dwelling older adults.

PARTICIPANTS

One hundred thirty-nine centenarians were compared with 93 octogenarians and 91 sexagenarians.

MEASUREMENTS

GDS scores.

RESULTS

Results indicated age group differences in overall depression score and in withdrawal-apathy-vigor (WAV), cognitive impairment, and hopelessness subscale scores. Significant age group differences were also obtained for 12 of the 30 items. Centenarians rated higher on all subscales, but there was no difference in dysphoric mood and worry.

CONCLUSION

It is important to distinguish different dimensions of depression when assessing very old populations because some of the questions on the GDS are associated with fatigue, mild cognitive decline, and decline in physical functioning, which increase with aging. Future research should revisit the concept of depression in very late life.

Biodemography of exceptional longevity: early-life and mid-life predictors of human longevity

This study explores the effects of early-life and middle-life conditions on exceptional longevity using two matched case-control studies. The first study compares 198 validated centenarians born in the United States between 1890 and 1893 to their shorter-lived siblings. Family histories of centenarians were reconstructed and exceptional longevity validated using early U.S. censuses, the Social Security Administration Death Master File, state death indexes, online genealogies, and other supplementary data resources. Siblings born to young mothers (aged less than 25 years) had significantly higher chances of living to 100 compared to siblings born to older mothers (odds ratio = 2.03, 95% CI = 1.33-3.11, p = .001). Paternal age and birth order were not associated with exceptional longevity. The second study explores whether people living to 100 years and beyond differ in physical characteristics at a young age from their shorter-lived peers. A random representative sample of 240 men who were born in 1887 and survived to age 100 was selected from the U.S. Social Security Administration database and linked to U.S. World War I civil draft registration cards collected in 1917 when these men were 30 years old. These validated centenarians were then compared to randomly selected controls who were matched by calendar year of birth, race, and place of draft registration in 1917. Results showed a negative association between "stout" body build (being in the heaviest 15 percent of the population) and survival to age 100. Having the occupation of "farmer" and a large number of children (4 or more) at age 30 increased the chances of exceptional longevity. The results of both studies demonstrate that matched case-control design is a useful approach in exploring effects of early-life conditions and middle-life characteristics on exceptional longevity.

Prevalence and predictors of anemia in a population-based study of octogenarians and centenarians in Georgia

BACKGROUND

Anemia has been associated with increased physical and financial costs and occurs more frequently in older individuals. Therefore, the primary objectives of this study were to examine the prevalence and possible predictors of anemia in the very old.

METHODS

Hemoglobin was used to identify those with anemia in a group of centenarians and near centenarians (98+, n = 185) and octogenarians (n = 69), who were recruited as part of the population-based multidisciplinary Georgia Centenarian Study. Blood markers, including ferritin, vitamin B12, red blood cell folate, methylmalonic acid, creatinine, and C-reactive protein, demographic variables, and medication and/or supplement usage were used to determine possible predictors of anemia.

RESULTS

The prevalence of anemia was 26.2% in octogenarians and 52.1% in centenarians. Low serum albumin (<3.6 g/dL) and decreased estimated glomerular filtration rate (<45 mL/min/m(2)) were predictors of anemia in centenarians.

CONCLUSIONS

Anemia is a major health issue, particularly as people age. Because of the high prevalence of anemia in older individuals, awareness of the predictors associated with anemia becomes increasingly important so as to reduce the negative consequences associated with it and allow for the identification of steps that can be taken to correct anemia, including managing chronic disease.

Understanding centenarians' psychosocial dynamics and their contributions to health and quality of life

While it is understood that longevity and health are influenced by complex interactions among biological, psychological, and sociological factors, there is a general lack of understanding on how psychosocial factors impact longevity, health, and quality of life among the oldest old. One of the reasons for this paradox is that the amount of funded research on aging in the US is significantly larger in the biomedical compared to psychosocial domains. The goals of this paper are to highlight recent data to demonstrate the impact of four pertinent psychosocial domains on health and quality of life of the oldest old and supplement recommendations of the 2001 NIA Panel on Longevity for future research. The four domains highlighted in this paper are (1) demographics, life events, and personal history, (2) personality, (3) cognition, and (4) socioeconomic resources and support systems.

Psychological resilience and depressive symptoms in older adults diagnosed with post-polio syndrome

Depression is a serious comorbidity in people with disabilities; however, few studies have focused on depressive symptoms in older adults with post-polio syndrome (PPS). This study used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (e.g., acceptance, self-efficacy, personal resources, interpersonal relationships, self-rated health, spiritual growth, stress management) and depressive symptoms in a large sample (N = 630) of people older than 65 years who were diagnosed with PPS. Forty percent of the sample scored > or = 10 on the Center for Epidemiologic Studies Short Depression Scale (CES-D10), which is a higher percentage than what has been previously cited in other studies; however, 53% of the sample had good or excellent self-rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms, with spiritual growth representing the main predictor (beta = -.26). The implications for rehabilitation nurses in developing a patient-strengths perspective in the assessment and counseling of older adults with PPS are discussed.

Intergenerational financial transfers and mental health: an analysis using SHARE-Israel data

OBJECTIVES

The purpose of this study was to examine the association between financial transfers from older parents to their adult children and mental health among the parents. The analysis examined the act of transfer-giving, the extent of transfers given and the purpose of the transfer in relation to depressive symptoms.

METHOD

This study was a secondary analysis of data gathered in the first wave of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analysis focused upon persons from the majority Jewish elderly cohort, aged 50 years and older, who had living children (N = 1795). Respondents' scores on the Euro-D Depression Scale were regressed on the three financial transfer measures, controlling for age, gender, marital status, household income, health and functional status.

RESULTS

The findings demonstrate a significant inverse relationship between the giving of financial transfers and the number of depressive symptoms of the giver, above and beyond the effects of gender, marital status, income, health status and functional status. The extent of giving was positively related.

CONCLUSION

The findings support a positive association between acceptable levels of financial giving in late life and mental health. This association is explained as the result of altruistic motivations for giving. Maintenance of viable levels of income security for the older population and promotion of acceptable intergenerational transfers from them to their adult children will benefit both sides of the generational divide.

Timing, social support, and the effects of physical limitations on psychological distress in late life

OBJECTIVES

Previous research shows that limitations in activities of daily living (ADLs) are related to greater psychological distress. This study uses a synthesis of life course and stress process perspectives to examine how social support resources and the timing of limitations intersect to shape the relationship between ADL limitations and changes in psychological distress.

METHODS

Data are derived from a longitudinal study of adults aged 65 and older in the Washington, DC, metropolitan area over a 2-year period (2001-2003).

RESULTS

ADL limitations are positively related to change in depressive symptoms. This relationship is weakened for older individuals, but only at higher levels of perceived social support.

DISCUSSION

The contribution of this research is to offer a more nuanced view of the mental health consequences of physical limitations in late life by demonstrating that perceived social support provides an important context for age-variegated associations between ADL limitations and changes in psychological distress.

Enhancing caregiver health: findings from the resources for enhancing Alzheimer's caregiver health II intervention

OBJECTIVES

To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother.

DESIGN

Randomized, multisite clinical trial.

SETTING

CG and care recipient (CR) homes in five U.S. cities.

PARTICIPANTS

Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls.

INTERVENTION

CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period.

MEASUREMENTS

The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention.

RESULTS

After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race.

CONCLUSION

A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.

Perceived income inadequacy as a predictor of psychological distress in Alzheimer's caregivers

The authors examined perceived income inadequacy as a predictor of self-reported depressive symptomatology and anxiety in the original sites of the Resources for Enhancing Alzheimer's Caregiver Health I project. Perceived income inadequacy, self-reported household income, and control factors (e.g., subjective health) were entered into hierarchical regression analyses predicting psychological distress. Findings suggest that perceived income inadequacy and not household income significantly predicted more self-reported depressive symptomatology and greater self-reported anxiety. This supports previous findings that objective income measures alone are not adequate indicators of socioeconomic status in older adults.

A qualitative investigation of adaptation in older individuals with multiple sclerosis

PURPOSE

This qualitative investigation was designed to identify themes that underlie adaptation in older individuals with multiple sclerosis (MS).

METHOD

Thirteen individuals (age 60 and above) with MS were recruited from an MS Comprehensive Care Centre and local chapters of the National Multiple Sclerosis Society. Participants completed The Perceptions of Aging Interview by telephone. This open-ended interview was developed to explore two lines of inquiry: MS: Perceptions of Aging, which was based on the literature on adaptation in MS, and Life Strengths, which was adapted from Kivnick's Life Strengths Inventory.

RESULTS

The majority of participants reported having adapted to MS and aging. They described several themes and subthemes that seemed to influence their levels of adaptation: Social comparisons, mobility/independence, integration of MS into self-identity, acceptance, pacing and planning, finding meaning/cognitive reframing, social support, religion/spirituality and generativity.

CONCLUSIONS

The themes identified in this investigation are generally supported by the literatures on adaptation to MS and adaptation to aging. However, this is the first study to examine these factors in an older MS sample. Moreover, many of these themes are potentially modifiable through clinical intervention, and should be examined in future research with this population.

Health-related quality of life in community-dwelling older Whites and African Americans

OBJECTIVE

This study assesses structural and functional characteristics of Short Form-36 Health Survey (SF-36) domains using community-based samples of older Whites and African Americans. Although the eight domains of the SF-36 have by convention been collapsed into two summary categories- physical health and mental health-the authors examine a three-factor model including physical health, mental health, and general well-being. They hypothesized that the general well-being factor would be a mediator between physical and mental health in both groups.

METHOD

Analyses using structural equation modeling provide support for the approach.

RESULTS

In both White and African American samples, the three-factor model demonstrated a better fit than the two-factor model. Also, in both groups, general well-being mediated the relationship between physical health and mental health.

DISCUSSION

Findings suggest that general well-being serves as an intervening step between physical and mental health in both White and African American older adults.

Serious health events and their impact on changes in subjective health and life satisfaction: the role of age and a positive view on ageing

Various studies have pointed to the great importance of subjective health as an indicator for mortality in older age, while less is known about factors that contribute to changes of subjective (self-rated) health over time. Based on a nationwide longitudinal survey (German Ageing Survey, N = 1,286; initial age 40-85), two major findings emerged: first, the incidence of a serious health event caused greater changes in subjective health and life satisfaction in middle compared to older age. This was as expected because serious health events are less common in middle age and are correspondingly experienced more often as an "off-time event". Secondly, the study extended previous findings on the impact of a positive view of ageing on health by showing that this optimistic view positively affects subjective health and life satisfaction even in the face of a serious health event. Overall, the study indicates that a positive view on ageing is an important psychological resource in the case of a serious health event, both when it occurs on-time or off-time from a developmental perspective.

Do vulnerável ser ao resiliente envelhecer: revisão de literatura

Desde o dealbar da infância até à velhice, a resiliência edifica-se por meio de um jogo complexo de processos defensivos de ordem intrapsíquica e de fatores de proteção internos e externos. O objetivo deste estudo foi investigar a produção científica em periódicos indexados nas bases de dados Medline, Lilacs e PsycINFO sobre o conceito de resiliência, no período de 1994-2004, e analisar a contribuição dessa literatura na especificidade do indivíduo idoso. Trata-se de um estudo documental e retrospectivo que evidenciou quatro núcleos temáticos: precursores da resiliência, resiliência e envelhecimento, relatividade dos fatores de proteção e resiliência e velhice bem sucedida. A análise da literatura permite constatar um incremento nas publicações, sendo ainda notória a falta de assertividade quanto à perenidade da resiliência ao longo do desenvolvimento humano, com especial enfoque no envelhecimento.

Health perception and depressive symptoms among older Korean Americans

Given the increasing recognition of racial/ethnic health disparities, the present study focused on older Korean Americans. Using data from 230 older Korean Americans in Florida (M age = 69.8, SD = 7.05), we assessed (a) how background variables (demographic information and acculturation), health constraints (chronic conditions and functional disability), and psychosocial factors (sense of mastery and filial satisfaction) were associated with health perception and depressive symptoms; and (b) whether health perception mediated the connections between health constraints and depressive symptoms. We observed positive perceptions of health and emotional states among individuals with higher levels of acculturation, fewer chronic conditions, less disability, and a greater sense of mastery. We also found that persons who were more satisfied with their relationships with adult children and who had more positive health perception were less depressed. Additionally, the findings supported a mediation model of health perception in the linkages between physical and mental health. Findings and implications are discussed here in a cultural context.

Altersunterschiede in psychosozialen Ressourcen und im Befinden von Krebspatienten am Beginn einer Chemotherapie

It has been suggested that older patients would have fewer resources than younger patients. We assessed psychosocial resources in 361 recently diagnosed cancer patients. Older patients had a stronger internal health-related locus of control but also less hope than younger patients. No age differences were found for self-esteem and perceived social support. In addition, older patients reported lower levels of negative and positive affect. Curative-intended therapy and social support were associated with a more positive affect only in younger patients, whereas hope was only related to older patients' psychological well-being. It is concluded that older cancer patients have similar levels of psychosocial resources compared to younger patients, but that lack of hope is a vulnerability factor for older patients in particular.

Sociodemographic, Disease Status, and Illness Perceptions Predictors of Global Self-ratings of Health and Quality of Life Among those with Coronary Heart Disease – One Year Follow-up Study

This one-year follow-up study (n = 130 at baseline, n =2745 at follow-up, aged 45-74 years) examined the relationship of patients' perceptions of coronary heart disease (CHD) and illness-related factors with global health status and global quality of life (QOL) ratings. The independent variables were CHD history (myocardial infarction, revascularisation), CHD severity (use of nitrates, CHD risk factors and co-morbidities) and illness perceptions. In multivariate regression analysis, CHD history and severity explained 13% of variance in global health status and 8% in global QOL ratings at the baseline. Illness perceptions increased the share of explained variance by 18% and 16% respectively. In the follow-up, illness perceptions explained a significant but modest share of variance in change in health status and QOL when baseline health status and QOL and CHD severity were adjusted for more symptoms being attributed to CHD, severe perceived consequences of CHD, as well as a weak belief in the controllability of CHD were related to poor global health status and QOL ratings. In structural path models associations of CHD severity factors were mediated by illness perceptions. The association of disease severity with dependent variables was weaker after controlling for illness perceptions. Cognitive representations of CHD contribute to both global health status and QOL ratings and they also mediate the associations between CHD severity and well-being. No gender differences were found in associations of illness perceptions with health status or QOL ratings.

Die subjektive Gesundheit älterer Menschen im Spiegel des SF-36

This paper presents data regarding the German version of the SF-36 (Short Form 36 Questionnaire; Bullinger and Kirchberger, 1998) that were obtained from a large community based sample of the German population. Results are reported for the elderly at the age of 60 and older from the German general population (N = 690; 57% female). Presented are the internal consistencies of the scales (Cronbach's Alpha), the intercorrelations of the scales, mean values of the scales separated by sex, age group (60-64 years, 65-69 years, 70-74 years, 75-79 years, 80 years and older) and residence (Eastern and Western Germany) as well as percentile ranks for the whole sample.