Resilience and aging

Age-friendliness of community and sleep quality: The role of mental health

BACKGROUND

The relationship between age-friendliness of community (AFC), mental health and sleep quality is still unclear.

METHOD

Using a sample of Chinese older adults aged ≥60 years (N = 3099), this cross-sectional study aimed to investigate the serial mediating roles of resilience and depressive symptoms between AFC and sleep quality through structural equation modeling. Additionally, this study examined the association between each AFC dimension and sleep quality stratified by mental health, using the multivariable linear regression models. Mental health was categorized based on levels of resilience and depressive symptoms. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The AFC dimensions included housing, transportation, built environment, social participation, as well as social inclusion and health services.

RESULTS

Resilience and depressive symptoms completely mediated the relationship between AFC and sleep quality through three paths: (1) the independent mediating role of resilience or (2) depressive symptoms, and (3) the serial mediating roles of resilience and depressive symptoms. Furthermore, higher AFC and higher age-friendliness in transportation dimension as well as social inclusion and health services dimension were associated with better sleep quality among older adults with high levels of mental health.

CONCLUSIONS

Resilience and depressive symptoms played serial mediating roles in the relationship between AFC and sleep quality. For older adults with low or medium levels of mental health, a community-based approach may not be recommended.

LIMITATIONS

This cross-sectional study used self-reported sleep measures and could not make cause inferences.

Family Environment, Loneliness, Hope, and Subjective Well-Being of Asian Older Adults

The current study examined the interactions between family environment, hope, and loneliness, and their subsequent influence on the subjective well-being (SWB) of 345 noninstitutionalized older adults (aged 60 years and above) in Singapore. Door-to-door surveys information was collected on family environment (cohesiveness, relationship closeness, and support), hope, loneliness, and SWB (life satisfaction, happiness, and absence of negative affect). Structural equation modelling was conducted to test competing hypotheses derived from life stress and integrated resource theories. The results revealed that family environment influenced SWB both directly and indirectly. Family environment decreased loneliness and increased SWB. Additionally, family environment influenced SWB by offering increased hope. Family environment sets the context for the SWB of older adults in Singapore. Families should therefore be targeted for interventions to reduce loneliness, increase psychological resources, and raise SWB during old age.

A Randomized Controlled Trial of Tai Chi Chih or Health Education for Geriatric Depression

OBJECTIVES

Geriatric depression is difficult to treat and frequently accompanied by treatment resistance, suicidal ideations and polypharmacy. New adjunctive mind-body treatment strategies can improve clinical outcomes in geriatric depression and reduce risk for side-effects of pharmacological treatments.

METHODS

We conducted a 3-month randomized controlled trial to assess the efficacy and tolerability of combining Tai Chi Chih (TCC) or Health Education and Wellness training (HEW) with the stable standard antidepressant treatment on mood and cognitive functioning in depressed older adults (NCT02460666). Primary outcome was change in depression as assessed by the Hamilton Rating Scale for Depression (HAM-D) post-treatment. Remission was defined as HAM-D ≤ 6; naturalistic follow-up continued for 6 months. We also assessed psychological resilience, health-related quality of life and cognition.

RESULTS

Of the 178 randomized participants, 125 completed the 3-month assessment and 117 completed the 6-month assessment. Dropout and tolerability did not differ between groups. Remission rate within TCC was 35.5% and 33.3%, compared to 27.0% and 45.8% in HEW, at 3 and 6 months respectively (χ²(1) = 1.0, p = 0.3; χ²(1) = 1.9, p =0.2). Both groups improved significantly on the HAM-D at 3 and 6 months. TCC demonstrated a greater improvement in general health compared to HEW.

CONCLUSIONS

Both TCC and HEW combined with a standard antidepressant treatment improved symptoms of depression in older adults. While TCC was superior to HEW in improving general health, we did not find group differences in improvement in mood and cognition.

The Psychological Benefits of Receiving Real-Life Altruism

This study investigates the impact of receiving real-life altruism on such positive attitudinal aspects as empathy, optimism, and motivation to help others. A mixed convenience/snowball sample of 148 participants (79 men, 67 women, 2 gender unknown), responded to an online questionnaire. Most were between 21 and 40 years of age, and had at least a college degree; all but eight were born in Venezuela, and the remainder were from other Hispanic/Latino countries. Participants were asked to describe an experience in which they had received unexpected altruism and rate its impact on their subsequent view of life. They were also asked to rate its effect on their optimism about human nature, trust in social relationships, appreciation for life, sense of gratitude, self-esteem, sense of being valued by others, empathy for others, motivation to help others, energy and enthusiasm in general, and religious faith. A total of 64.2% reported an unexpected altruistic experience. Of those, almost 75% reported the experience changed their view of life at least “strongly” and only 4.2% stated that it had little or no effect. The intensity of their change in life view correlated significantly with all 10 dependent variables except for gratitude. Women were significantly more likely to report that their experience boosted their gratitude for others, and participants whose altruistic experiences were attitudinally more life-changing were significantly more likely to indicate that religion was very important to them. The implications of these findings for understanding the psychological benefits of altruistic experience are discussed and avenues for future research are suggested.

Moving on from adversity: an understanding of resilience in rural Thai older people

OBJECTIVE

This study explored the concept of resilience in rural Thai older people.

METHOD

The study was exploratory and descriptive in design. Ethnographic fieldwork was undertaken in four rural Thai communities. Non-participant observation (340 h) and 35 semi-structured interviews with older people enabled the collection of qualitative data. Nvivo 10 was used to collate and organise the qualitative data. Data analysis was conducted thematically.

RESULTS

One major core theme and five qualitative sub-themes emerged from the data related to the theoretical construct of rural Thai elders' resilience. The subthemes of the core theme 'moving on' include: (1) keep doing a job and earning a living; (2) having Jai-Yai to fight for life; (3) accepting a situation (Plong and Taam-Jai); (4) expressing difficulty; and (5) connecting with people, beliefs and customs.

CONCLUSION

The concept of 'moving on' provides a subcultural viewpoint of older rural Thai people in the face of adversity in their everyday lives. Previous conceptions of resilience and older people focus on it being bouncing back from adversity. Bouncing back implies a setback, whereas 'moving on' found in this study is the process of continuous movement forward and getting on with one's life despite difficulties.

Psychobiological factors of resilience and depression in late life

In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD.

Resilience and amygdala function in older healthy and depressed adults

BACKGROUND

Previous studies suggest that low emotional resilience may correspond with increased or over-active amygdala function. Complementary studies suggest that emotional resilience increases with age; older adults tend to have decreased attentional bias to negative stimuli compared to younger adults. Amygdala nuclei and related brain circuits have been linked to negative affect, and depressed patients have been demonstrated to have abnormal amygdala function.

METHODS

In the current study, we correlated psychological resilience measures with amygdala function measured with resting-state arterial spin-labelled (ASL) and blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) in older adults with and without depression. Specifically, we targeted the basolateral, centromedial, and superficial nuclei groups of the amygdala, which have different functions and brain connections.

RESULTS

High levels of psychological resilience correlated with lower basal levels of amygdala activity measured with ASL fMRI. High resilience also correlated with decreased connectivity between amygdala nuclei and the ventral default-mode network independent of depression status. Instead, lower depression symptoms were associated with higher connectivity between the amygdalae and dorsal frontal networks.

LIMITATIONS

Future multi-site studies with larger sample size and improved neuroimaging technologies are needed. Longitudinal studies that target resilience to naturalistic stressors will also be a powerful contribution to the field.

CONCLUSIONS

Our results suggest that resilience in older adults is more closely related to function in ventral amygdala networks, while late-life depression is related to reduced connectivity between the amygdala and dorsal frontal regions.

The relationship between trait emotional intelligence, resiliency, and mental health in older adults: the mediating role of savouring

OBJECTIVES

The present study explores savouring, defined as the process of attending to positive experiences, as a mediator in the relationships between resiliency, trait emotional intelligence (EI), and subjective mental health in older adults. Following Fredrickson's Broaden and Build Theory of positive emotions, the present study aims to extend our understanding of the underlying processes that link resiliency and trait EI with self-reported mental health in older adulthood.

METHOD

A sample of 149 adults aged 65 and over (M = 73.72) were recruited from retirement homes and community groups. Participants completed measures of resiliency, savouring, trait EI, and subjective mental health either online or in a paper format.

RESULTS

Path analysis revealed that savouring fully mediated the relationship between resiliency and mental health. However, trait EI did not significantly predict mental health in this sample.

CONCLUSION

These findings provided partial support for the Broaden and Build Theory of positive emotions. As anticipated, savouring imitated the broadening effect of positive emotions by mediating the relationship between resiliency and mental health. However, savouring failed to reflect the undoing effect of positive emotions and did not mediate the relationship between EI and mental health. These findings have implications for positive psychology exercises and may be a simple, yet effective means of improving the life quality of older adults.

Examining the Effects of Religious Attendance on Resilience for Older Adults

Growing older often brings hardship, adversity, and even trauma. Resilience is a broad term used to describe flourishing despite adversity. To date, resilience and the connections to religion have not been well studied, despite compelling evidence that religious practice can promote psychological health. This research examines the role that religion plays in promoting resilience among older adults. Research questions include: (a) What is the relationship between religion and trait resilience? and (b) Does religion promote resilient reintegration following traumatic life events? Results indicate that religious service attendance is tied to higher levels of trait resilience and that both service attendance and trait resilience directly predict lower levels of depression and higher rates of resilient reintegration following traumatic life events. Findings suggest that religious service attendance has protective properties that are worthy of consideration when investigating resilience.

Aging and the HPA axis: Stress and resilience in older adults

Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and altered diurnal or stress-induced secretion of the hormone cortisol could predispose older adults to negative health outcomes. We propose that psychological resilience may interact with diurnal cortisol to affect health outcomes later in life. Emotion regulation and social support are two constructs that contribute to resilience and exhibit age-specific patterns in older adults. Determining how the use of resilience resources interacts with age-related diurnal cortisol will improve our understanding of the pathways between stress, resilience, and well-being. In this review, we assess published studies evaluating diurnal cortisol in older adults to better understand differences in their HPA axis functioning. Evidence thus far suggests that diurnal cortisol may increase with age, although cross-sectional studies limit the conclusions that can be drawn. We also review extant evidence connecting age-specific signatures of emotion regulation and social support with diurnal cortisol. Conclusions are used to propose a preliminary model demonstrating how resilience resources may modulate the effects of cortisol on health in aging.

Keeping up with the caravan of life: Successful aging strategies for Iranian women

Background

Because of improving life expectancy in the world in recent times, the focus has shifted to the issue of the quality and nature of life and how to assist successful aging (SA) rather than increasing physical survival and lifespan. SA is a multidimensional, relative, and context-dependent concept with different paths and outcomes. The purpose of this qualitative study was to explore older women's strategies for SA in a specific context.

Methods

Following a grounded theory design approach, we conducted semi-structured individual interviews with 21 women between the ages of 28 and 96 years. We analyzed the data from interviews, written narratives, and field notes using the grounded theory approach.

Results

We identified four categories: prevention of threats, internal self-control against threats, coping with threats, and optimizing the passage of time according to opportunity. These described the strategies for SA when encountering with age-related changes. Utilizing these strategies, the women accompanied the caravan of life in the context of threats and opportunities.

Conclusions

The findings suggest that SA is a continuous process in confronting changes related to age. The identified strategies can help to promote SA by familiarizing older women with the threats and opportunities of life and training them in how to use these strategies.

Sleep and inflammation in resilient aging

Sleep quality is important to health, and increasingly viewed as critical in promoting successful, resilient aging. In this review, the interplay between sleep and mental and physical health is considered with a focus on the role of inflammation as a biological pathway that translates the effects of sleep on risk of depression, pain and chronic disease risk in aging. Given that sleep regulates inflammatory biologic mechanisms with effects on mental and physical health outcomes, the potential of interventions that target sleep to reduce inflammation and promote health in aging is also discussed.

Psychological Resilience and the Onset of Activity of Daily Living Disability Among Older Adults in China: A Nationwide Longitudinal Analysis

OBJECTIVES

This study explores the influence of psychological resilience on the onset of activities of daily living (ADL) disability among Chinese older adults and examines whether this association varies by age.

METHOD

Using a sample of 11,112 older adults from 2 waves of the Chinese Longitudinal Healthy Longevity Survey, collected in 2002 and 2005, this study examines whether higher levels of psychological resilience (measured by a 5-item scale) predict lower risk of ADL incidence during a 3-year follow-up and whether this effect varies by age.

RESULTS

Higher levels of resilience at the baseline are significantly associated with reduced risk of becoming ADL disabled during the 3-year follow-up period, independent of baseline sociodemographic characteristics, family support, and health. Moreover, resilience by age interaction is detected. Higher levels of resilience are more protective against the onset of disability for the younger old (aged 65-84) than the oldest old (aged 85 and older).

DISCUSSION

Among older adults in China, psychological resilience is a protective factor against ADL disability, and the benefits are particularly significant for older adults younger than 85 years.

Stress, inflammation, and aging

This editorial provides a summary of the state of research on stress-related changes associated with aging and discuss how factors such as inflammation and sex steroid alterations may interact with psychosocial stress to affect the risk for mood and cognitive disturbance in older individuals. The authors provide an integrated summary of four studies reported in this issue of the journal and views on future direction in stress and aging research and interventions targeting resilience to stress.

Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial

BACKGROUND

Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy. In this study, we ask whether a mind-body exercise, Tai Chi Chih (TCC), added to escitalopram will augment the treatment of geriatric depression designed to achieve symptomatic remission and improvements in health functioning and cognitive performance.

METHODS

: One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks. Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were randomly assigned to 10 weeks of adjunct use of either 1) TCC for 2 hours per week or 2) health education (HE) for 2 hours per week. All participants underwent evaluations of depression, anxiety, resilience, health-related quality of life, cognition, and inflammation at baseline and during 14-week follow-up.

RESULTS

Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE. Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker, C-reactive protein, compared with the control group.

CONCLUSION

: Complementary use of a mind-body exercise, such as TCC, may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression.

The Role of Positive Cognitions in Egyptian Elders’ Relocation Adjustment

Relocation is a major life event for elders and it has been found to adversely affect their adjustment. Resilience theory suggests that adverse effects can be minimized if elders have positive cognitions. In addition, research has shown that positive cognitions are related to independence and healthy, productive lifestyles in older adults. Yet no studies have determined whether the relationship between relocation and adjustment is mediated or moderated by positive cognitions. This study examined these relationships in a sample of 94 cognitively intact elders (aged 60+ years) who had relocated to retirement communities in Alexandria, Egypt. Results showed that relocation controllability had direct effects on positive cognitions and on relocation adjustment. Positive cognitions had a moderating and a partial mediating effect on the relationship between relocation controllability and relocation adjustment. These findings suggest that it is imperative to develop interventions to enhance positive thinking for elders facing the need to relocate.