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Positive Self-Perceptions of Aging and Lower Rate of Overnight Hospitalization in the US Population Over Age 50
Abstract
Objective:
The aging of the baby boomer generation has led to an unprecedented rise in the number of US adults reaching old age, prompting an urgent call for innovative and cost-effective ways to address the increasing health care needs of the aging population. Studying the role of psychosocial factors on health care use could offer insight into how to minimize hospitalizations among older adults.
Methods:
We use prospective data from a subsample of 4735 participants (mean [standard deviation] age = 69 [8.79] years, 61% women) from the Health and Retirement Study, a nationally representative study of US adults over age 50, to examine the association between self-perceptions of aging (SPA) and self-reported overnight hospitalizations after adjusting for a comprehensive list of sociodemographic, health-related, and behavioral factors.
Results:
Over the 4-year follow-up period, there were a total of 5196 overnight hospitalizations, and 44% of the sample reported being hospitalized overnight at least once. After adjusting for sociodemographic factors, each standard deviation increase in positive SPA was associated with a lower rate of overnight hospitalization (incidence rate ratio = 0.75; 95% confidence interval = 0.71-0.80, p < .001). After dividing respondents into quartiles of SPA, we observed a dose-response relationship with individuals in higher quartiles showing increasingly lower rates of overnight hospitalization.
Conclusions:
Positive self-perceptions of aging are associated with a lower rate of hospitalization among older adults over a 4-year period. Future research should examine the factors that contribute to older adults' SPA and explore the pathways through which attitudes toward aging influence the use of health care resources.
... Both subjective age and SPA are significant predictors of a wide range of health outcomes in old age (Westerhof et al., 2014;Westerhof & Wurm, 2018). Independent of chronological age, an older subjective age and more negative SPA predict a higher risk of incident hospitalization (Stephan et al., 2016;Sun et al., 2017), dementia Stephan, Sutin, Luchetti et al., 2018), and both overall and cardiovascular mortality (Levy & Bavishi, 2018;. ...
... In addition, the study extends evidence that incident CVD predicts subjective aging (i.e., negative changes in SPA and subjective age; Wurm et al., 2019), by providing new evidence that subjective aging also predicts incident CVD, which suggests a vicious cycle between subjective aging and cardiovascular health. Given that CVDs are among the leading causes of death and disability across the globe (GBD 2017 Causes of Death Collaborators, 2018), the higher incidence of CVD may be a key mechanism between feeling older or negative SPA, respectively, and the increased risk of cognitive impairment and dementia Stephan, Sutin, Luchetti et al., 2018), functional limitations (Rippon & Steptoe, 2018;Wurm & Benyamini, 2014), hospitalization (Stephan et al., 2016;Sun et al., 2017), and mortality (Levy et al., 2002;. The association between subjective aging and the incidence of CVD may be explained by several behavioral, biological, and psychological factors. ...
Objectives:
Subjective aging, including subjective age and self-perceptions of aging (SPA), predicts health-related outcomes in older adults. Despite its association with cardiovascular risk factors, little is known about the association between subjective aging and the incidence of cardiovascular disease. Therefore, the present study examined whether subjective age and SPA are related to the incidence of heart conditions and stroke.
Methods:
The sample comprises 10,695 participants aged 50-100 years from the Health and Retirement Study. Subjective age, SPA, demographic factors, and health-related behaviors, body mass index (BMI), hypertension, diabetes, and depressive symptoms were assessed at baseline. Self-reported physician diagnosis of heart conditions and stroke were assessed biennially over up to 9 years of follow-up.
Results:
Controlling for demographic factors, an older subjective age and more negative SPA were related to a higher risk of incident heart conditions and stroke. Feeling older and holding negative SPA were associated with around 40% higher risk of experiencing heart conditions over time. An older subjective age and negative SPA were related to almost twofold and 30% higher risk of incident stroke, respectively. Health risk behaviors, BMI, hypertension, diabetes, and depressive symptoms accounted for part of the associations between subjective aging and heart diseases and stroke.
Conclusions:
Consistent with the literature on subjective aging and cardiovascular risk factors, this large prospective study indicates that an older subjective age and negative SPA increase the risk of incident stroke and other cardiovascular diseases.
... SPA impact health behavior and health outcomes in later life, with more positive SPA being associated with greater well-being and more negative SPA being associated with worse well-being. SPA is associated with eating behaviors (Klusmann, Sproesser, Wolff, & Renner, 2017), physical activity (Hooker, Mejía, Phibbs, Tan, & Stevens, 2019), overnight hospitalization rates (Sun, Kim, & Smith, 2017), depressive symptoms (Gum & Ayalon, 2018), and even mortality (Levy, Slade, Kunkel, & Kasl, 2002). ...
... For example, researchers are increasingly theorizing that views on aging are both positive and negative (Davidson & Vaillant, 2016), representing both gains and losses (Diehl & Wahl, 2010). As such, any one person could simultaneously have both high positive SPA and high negative SPA, and indeed, recent analyses include SPA as an overarching construct divided into two separate but interconnected positive and negative factors (Hooker et al., 2019;Sun et al., 2017). Confirming such a two-dimensional structure can inform future studies that aim to elucidate the specific mechanisms through which SPA operates to impact health behavior and health outcomes. ...
Background and objectives:
Self-perceptions of aging (SPA)-the appraisals people place on their own aging processes-predict well-being in later life. Researchers are increasingly hypothesizing that the overarching construct of SPA is comprised of two factors-positive SPA and negative SPA-and that SPA are gendered. The purpose of this study was to empirically test the hypothesized two-factor structure of SPA and to analyze how the two-factor structure varies between men and women.
Research design and methods:
Data come from the 2012 wave of the Health and Retirement Study (N = 7,029; Mage = 68.08), which includes an 8-item SPA scale. We used confirmatory factor analysis (CFA) to assess (i) the positive SPA and negative SPA two-factor solution for the 8-item scale and (ii) whether the two-factor solution had configural, strong, or weak invariance across men and women.
Results:
CFAs indicated a two-factor latent structure of the 8-item scale, with SPA being comprised of both a positive SPA factor and a negative SPA factor. The latent structure was the same for both men and women.
Discussion and implications:
Results suggest that SPA is a broader construct made up of positive and negative latent factors. Researchers should consider separating the SPA by positive and negative factors to analyze how each factor uniquely shapes health. Moreover, the two-factor solution was equivalent across men and women, possibly because of the generalized nature of the 8-item scale. Researchers can use the 8-item scale similarly for men and women and should continue to elucidate possible gender differences in SPA.
... Converging evidence also indicates that how people experience their own aging process influences their health and longevity (e.g., Chang et al., 2020;Maier & Smith, 1999;Westerhof et al., 2014;Westerhof & Wurm, 2015;Wurm et al., 2017). The pathways discussed that operate between aging attitudes and health outcomes include motivational mechanisms (Levy, Slade, Kunkel, et al., 2002;Tovel, Carmel, & Raveis, 2019), physiological effects (Levy, Hausdorff, Hencke, & Wei, 2000;Levy, Moffat, Resnick, Slade, & Ferrucci, 2016;Levy et al., 2008;Stephan, Sutin, & Terracciano, 2015), as well as psychological-behavioral pathways (Beyer et al., 2015;Levy & Myers, 2004;Schmidt, Gabrian, Jansen, Wahl, & Sieverding, 2018;Sun, Kim, & Smith, 2017;Wurm, Tomasik, & Tesch-Römer, 2010;Zhang, Kamin, Liu, Fung, & Lang, 2018). ...
... As has been argued, societal beliefs about age and aging are internalized and reinforced throughout the life span, become increasingly self-relevant with advancing age and shape key developmental outcomes such as health (Diehl & Wahl, 2010;Kornadt, Kessler, et al., 2019;Levy, 2009). Controlling for a range of confounders, more negative attitudes were found to be longitudinally associated with poorer functional health Sargent-Cox et al., 2012;Tovel et al., 2019) and higher risk of hospitalization (Sun et al., 2017), cognitive decline and cognitive impairment (Siebert, Wahl, Degen, & Schröder, 2018;, as well as of respiratory and all-cause mortality (Kotter-Grühn et al., 2009;Levy & Myers, 2005;Levy, Slade, Kunkel, et al., 2002;Maier & Smith, 1999;Westerhof et al., 2014). ...
Personality traits affect health throughout adulthood. Recent research has demonstrated that attitudes toward own aging (ATOA) also play an important role in various health outcomes. To date, the role of personality versus ATOA for health has rarely been considered in parallel and contrasted for different periods of the second half of life, such as midlife versus early old age. We posit that with advancing age, associations of personality and ATOA with trajectories of health might change. To address this assumption, we examined trajectories of physician-rated health and its between-person and time-varying, within-person associations with personality (neuroticism and conscientiousness) and ATOA over 20 years in middle-aged (baseline age 43-46 years; n = 502) and older (61-65 years; n = 500) adults. Based on longitudinal multilevel regression models (controlling for gender and education), we found at the between-person level that lower neuroticism scores and more positive ATOA scores were independently associated with better physician-rated health at baseline. This association of ATOA with health was stronger in the old age sample than in the midlife sample. At the within-person level, time-varying associations revealed that both middle-aged and older individuals had better physician-rated health on measurement occasions when they reported more favorable ATOA. In addition, in the old age subsample alone, individuals' physician-rated health was better on occasions when they had higher conscientiousness scores. Our findings suggest that certain personality traits (conscientiousness, but not neuroticism) as well as attitudes toward own aging may gain in importance in later life as predictors of objective health changes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Looking at individuals who experienced a worsening of their SPA, this finding may reflect the fact that those with more negative SPA use preventive health care services less often, which may eventually result in an increase of GP visits because diseases are recognized later and need more intensive care. This is also in line with a study by Sun et al. (2017) based on HRS data, reporting that more positive SPA were related to fewer hospitalizations. ...
With increasing age, the experience of both chronic conditions and serious acute health events (e.g., stroke) becomes more likely. Consequently, most younger and older individuals consider aging primarily as a phase of life with increasing physical and cognitive decline. At the same time, the fact that aging is also associated with gains and growth is largely overlooked. This is of particular importance, because a number of studies have shown that views of aging play an important role for medical conditions and premature mortality in later life. This chapter reviews existing findings on the role of different views of aging for health in later life. It illustrates how self-perceptions of aging, which are shaped by societal thoughts (stereotypes) and feelings (prejudices) about aging and old age, can develop to have a substantial impact on individuals’ health. Moreover, the chapter describes physiological, behavioral, and psychological pathways by which views of aging can affect health outcomes and considers when and to what extent views of aging act as moderator and/or mediator for other factors influencing health. Finally, the chapter closes with recommendations for practice and future research, which should focus on the investigation of pathways by which different views of aging affect similar or different health outcomes.KeywordsSelf-perceptions of agingViews of agingPhysical healthMental healthPathways
... Looking at individuals who experienced a worsening of their SPA, this finding may reflect the fact that those with more negative SPA use preventive health care services less often, which may eventually result in an increase of GP visits because diseases are recognized later and need more intensive care. This is also in line with a study by Sun et al. (2017) based on HRS data, reporting that more positive SPA were related to fewer hospitalizations. ...
This closing chapter discusses the major advances in theory, research, and practice to show that the field of subjective views of aging (VoA) has indeed reached a qualitatively new developmental stage. At the theoretical level there is an increasing consensus that a lifespan developmental perspective may be most appropriate to study VoA across the adult years and into late life. This perspective can serve as a unifying framework with important implications for the integration of diverse literatures and increased methodological diversity and sophistication. Specifically, the impact of greater methodological diversity and sophistication is seen at the level of empirical research, including the greater diversity in study designs, the emerging focus on multilevel investigations (e.g., the concomitant study of biological, psychological, and social processes), and the translation into areas of intervention and prevention. All these advances bode well for the future of the field of VoA research and lay the foundation for promising future directions.
... A study with a 4-year follow-up showed the impact on cognitive functioning and found that people with negative views of ageing were more likely to develop dementia than those with positive outlooks . The study also found that the life expectancy of those in a positive ageing state increased by 7.5 years compared with those with a negative perspective Schroyen et al., 2017;Sun et al., 2017). Stewart et al. (2012) found that the mortality rate of elderly people with a negative perception of ageing was more than twice that of elderly people with a positive perception. ...
Background
To examine the effects of physical and mental health factors and family functioning on the self‐perception of ageing in elderly people.
Methods
A random cluster sampling method was used to select elderly people aged over 60 from three communities in Handan City. Subjects were evaluated via face‐to‐face interviews using the Chinese version of the Ageing Perception Questionnaire, the Family Function Scale, the SF‐36 Short‐Form Health Survey, and a self‐compiled general questionnaire. A single factor and stepwise multiple regression analysis were evaluated using SPSS 17.0 software.
Results
Among the 1815 elderly people surveyed, the total negative dimension score was 91.67 ± 16.58 with an index of 73.34%, which is higher than the positive dimension score (6.01 ± 0.52, 60.10%). Elderly people with varying degrees of family dysfunction accounted for 11.63%, and the score for self‐perceived ageing in elderly participants with good family function was 95.74 ± 12.63. The proportions with poor physical and mental health factors were 45.40% and 28.10%, respectively, and the scores for ageing self‐perception in elderly participants with good or moderate mental health were 89.11 ± 12.65 and 86.22 ± 12.58, respectively. A stepwise multiple regression analysis showed that age, presence of a spouse, and family function were positive protective factors for ageing self‐perception, while physical health factors were risk factors for the positive dimension of self‐perceived ageing. Age and family function were risk factors for the negative dimension of ageing self‐perception, while physical and mental health factors were protective factors for the negative dimension of self‐perceived ageing.
Conclusions
Younger elderly and elderly people with good family function have positive self‐perceptions of ageing, while elderly participants with poor physical and mental health have a negative perception of ageing.
... This introspective belief is called self-perceptions of aging (SPA) and appears to have effects on psychological, behavioral, and physiological pathways (Levy, 2009). Previous studies have shown that more negative SPA was associated with adverse health outcomes (frailty, falls, hospitalizations, and decrease in activities of daily living; Moser et al., 2011;Sun et al., 2017), higher risk of death and shorter longevity (Sargent-Cox et al., 2014), higher depressive symptoms (Freeman et al., 2016). and worse cognitive functioning (Siebert et al., 2020). ...
Objectives
The aims of the study were first to investigate the association between self-perceptions of aging and frailty and second to determine whether self-perceptions of aging affects frailty via depressive symptoms and cognitive status among older adults living in the community in China.Methods
Among 850 older adults who participated in this cross-sectional study, 822 older adults made valid responses to Tilburg Frailty Indicator, Brief Aging Perceptions Questionnaire, UCLA loneliness scale-8, Mini-Mental State Examination, and Patient Health Questionnaire-9 between March to December 2019. The possible pathways of self-perceptions of aging affecting frailty were analyzed based on the structural equation modeling analysis.ResultsA total of 21.53% of older adults reported frailty. Correlation analyses showed that higher degrees of frailty were related to greater loneliness, more depressive symptoms, more negative self-perceptions of aging, worse locomotive function, and cognitive status (r = 0.267, r = 0.440, r = 0.481, r = 0.451, r = −0.337; p < 0.001). Multiple regression analysis showed that loneliness, depressive symptoms, self-perceptions of aging, locomotive function, and cognitive status were the five factors to be entered the regression equation, and the variance of joint explanation was 46.60%. SPA had a direct effect on frailty (β = 0.306 and p < 0.001), and SPA indirectly affects frailty by independently affecting depressive symptoms (β = 0.391, 95% CI [0.027, 0.061], and p < 0.001) or cognitive status (β = 0.148, 95% CI [0.009, 0.024], and p < 0.001) of older adults.Conclusion
These findings help explain the potential psychological mechanisms through which SPA impacts frailty and may aid community healthcare providers in China in identifying individuals at high risk of frailty. The results suggest that health staff should help older adults improve their perspectives on aging, alleviate or prevent depressive symptoms, and improve cognitive status to delay the progress of frailty and promote healthy aging.
... Aside from this, a substantial body of longitudinal research underscores the fact that the younger a person feels, the better their health will tend to be, at least over longer periods and after controlling for confounding influences. For instance, having a younger subjective age has been found to predict better functioning of one's objective and subjective memory, better sleep quality, less overnight hospitalization, fewer occurrences of dementia, and lower mortality due to all causes (Hülür et al., 2015;Stephan et al., 2016Stephan et al., , 2018Sun et al., 2017). The meta-analyses available further substantiate this role of subjective age in predicting good health across a range of health outcomes (Alonso Debreczeni & Bailey, 2020;Westerhof et al., 2014). ...
Objectives
We addressed two questions: (1) Does advanced cancer in later life affect a person’s awareness of time and their subjective age? (2) Are awareness of time and subjective age associated with distress, perceived quality of life, and depression?
Methods
We assessed patients suffering terminal cancer (OAC, n = 91) and older adults free of any life-threatening disease (OA, n = 89), all subjects being aged 50 years or older.
Results
Older adults with advanced cancer perceived time more strongly as being a finite resource and felt significantly older than OA controls. Feeling younger was meaningfully related with better quality of life and less distress. In the OA group, feeling younger was also associated to reduced depression. Perceiving time as a finite resource was related to higher quality of life in the OA group.
Discussion
Major indicators of an older person’s awareness of time and subjective aging differ between those being confronted with advanced cancer versus controls.
... In addition, previous research found SPA ongoing development to buffer the negative effect of precariousness on health and well-being [28] and promote health behavior [29]. Positive SPA are also associated with a lower rate of overnight hospitalizations after 4 years [30], pointing to better health in older adults with positive SPA. Furthermore, the association of positive SPA and better self-reported physical function in late life is mediated by self-efficacy [8]: This means that positive SPA foster a person's ability to cope successfully with aging-related challenges, which is then later reflected in better self-reported, and, presumably, also objective physical function. ...
Background
Previous studies have pointed to the impact of self-perceptions of aging (SPA) on self-reported physical function in later life. However, less is known about associations of SPA with objectively measured physical function, especially gait. Research that examined other psychological variables and objectively measured gait has focused on single gait parameters such as gait speed, which seems to fall short for the complexity of this movement. Some approaches have proposed ways to identify gait patterns in specific patient groups, but not in community samples. Our goal was (a) to identify gait patterns based on a combination of important gait parameters in a community sample, and (b) to investigate differential associations of gain- and loss-related SPA with these gait patterns.
Methods
The study used an electronic walkway to assess gait parameters of 150 community dwelling adults aged 71–93 years (61.0% women) at their usual and maximum gait speed. SPA were assessed with a questionnaire. We used latent profile analysis (LPA) to identify groups exhibiting distinct gait patterns and binary logistic regression to investigate associations of SPA with these groups, controlling for personality traits, number of illnesses, age, gender, and education. To compare overall function between groups, a t-test for scores in the Short Physical Performance Battery was used.
Results
LPA revealed two distinct groups in both gait speed conditions. The fit group exhibited a stable, well-coordinated and faster gait pattern, while the functionally limited group’s gait pattern was less stable, less coordinated and slower. The odds of belonging to the functionally limited group were increased by loss-related SPA at usual gait speed, while the odds of belonging to the fit group were increased by gain-related SPA at individual maximum speed.
Conclusions
The findings (a) suggest LPA as a useful approach to investigate complex gait patterns considering several gait parameters simultaneously, and (b) provide first evidence for differential associations of gain- and loss-related SPA with gait patterns at usual and maximum gait speed. Intervention studies addressing gait in older adults should additionally address gain-related views on aging.
... Previous research that did not consider domain-speci c views on aging but looked at overall positive SPA showed that these views can buffer the negative effect of precariousness on health and well-being (23) and promote healthy behavior (24). Positive SPA are also associated with a lower rate of overnight hospitalizations after four years (25). Furthermore, the association of positive SPA and better self-reported physical function in late life is mediated by self-e cacy (8): This means that positive SPA subsequently foster a person's ability to cope successfully with aging-related challenges, which is then later re ected in better self-reported, and, presumably, also objective physical function. ...
Background: Previous studies have pointed to the impact of self-perceptions of aging (SPA) on self-reported physical function in later life. However, less is known about the role of SPA for objectively measured physical function, especially gait. Research that examined other psychological variables and objectively measured gait has focused on single gait parameters such as gait speed, which seems to fall short for the complexity of this movement. Some approaches have proposed ways to identify gait patterns in specific patient groups (such as patients with hemiplegia), but not in community samples. Our goal was a) to identify gait patterns based on a combination of important gait parameters in a community sample, and b) to investigate differential associations of gain- and loss-related SPA with these gait patterns.
Methods: The study used an electronic walkway to assess gait parameters of 150 community dwelling adults aged 71-93 years (61.0% women) at their usual and maximum gait speed. SPA were assessed with a questionnaire. We used latent profile analysis (LPA) to identify groups exhibiting distinct gait patterns and binary logistic regression to investigate associations of SPA with these groups, controlling for personality traits, number of illnesses, age, gender, and education. To compare overall function between groups, a t-test for scores in the Short Physical Performance Battery was used.
Results: LPA revealed two distinct groups in both gait speed conditions. The fit group exhibited a stable, well-coordinated and faster gait pattern while the functionally limited group’s gait pattern was less stable, less coordinated and slower. The odds of belonging to the functionally limited group were increased by loss-related SPA at usual gait speed, while the odds of belonging to the fit group were increased by gain-related SPA at individual maximum speed.
Conclusions: The findings a) suggest LPA as a useful approach to investigate complex gait patterns considering several gait parameters simultaneously, and b) provide first evidence for the differential role of gain- and loss-related SPA for gait patterns at usual and maximum gait speed. Intervention studies addressing gait in older adults should additionally address gain-related views on aging.
Trial registration: NA
... Obstacles for healthcare access in older adults have been consistently associated with worsened outcomes and increased all-cause mortality, particularly for those facing social inequalities [28]. Previous research has shown that negative self-perceived aging influences healthcare-seeking behavior, particularly in settings of limited healthcare access [29,30]. Our results suggest that reduced healthcare access, as measured by increases in the SLI, is associated with increased COVID-19 severity and lethality in older adults, likely reflecting the effect of structural inequalities across Mexican municipalities. ...
BACKGROUND
COVID-19 has had a disproportionate impact on older adults. Mexico's population is younger, yet COVID-19’s impact on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging.
METHODS
We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for COVID-19 mortality risk prediction.
RESULTS
We analyzed 20,804 confirmed SARS-CoV-2 cases in adults aged ≥60 years. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization and ICU admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and combination of structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age alone. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas.
CONCLUSIONS
Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach.
... Similarly, another study by Levy und Myers showed that positive self-perceptions of ageing were associated with an increased likelihood of preventive health behaviors (including, for example exercising or balanced diet) (Levy & Myers, 2004). Furthermore, based on data from the Health and Retirement Survey, Sun et al. (Sun, Kim, & Smith, 2017) showed that positive self-perceptions of ageing are associated with a reduced likelihood of overnight hospitalization among older adults over 4 years. ...
Objectives: The aim of this study was to clarify the link between self-perceptions of ageing and the number of general practitioner (GP) visits, as well as frequent GP visits, longitudinally.
Methods: In this study, longitudinal data with n = 7,062 observations from 2014 (wave 5) to 2017 (wave 6) were taken from the German Ageing Survey (representative sample of middle aged and older individuals residing in private households). The five-item Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS) was used to quantify self-perceptions of ageing. The frequency of GP visits in the past 12 months served as outcome measure (first model: measured continuously; second model: top 10% were defined as frequent attenders). To exploit the features of panel data, and to mitigate the problem of unobserved heterogeneity, fixed effects regressions were used.
Results: Adjusting for predisposing characteristics, enabling resources and need-factors, regressions showed that an increase in self-perceptions of ageing was associated with decreases in the number of GP visits (IRR= .83 (95% CI: .77-.91)), and a decreased likelihood of becoming a frequent attender (OR= .44 (95% CI: .29-.66)).
Conclusions: Using data from a longitudinal study and exploiting the longitudinal data structure, the current study adds to our current knowledge by demonstrating that self-perceptions of ageing contribute to the frequency of GP visits as well as frequent attendance. Since self-perceptions of ageing are modifiable, this may help to manage health care use.
... On multivariate analyses, compared to those who felt younger than their chronological age, those who felt the same or older than their chronological age were more likely to be impaired in physical performance [Adjusted Odds Ratio (AOR) 5 ...
Objectives:
Older self-perceived age is associated with poor health and higher healthcare utilization in the geriatric population. We evaluated the associations of self-perceived age with geriatric assessment (GA) domain impairments in older adults with cancer.
Methods:
This was a secondary analysis of baseline data from a GA cluster-randomized trial (URCC 13070; PI: Mohile). We included patients aged ≥70 with incurable stage III/IV solid tumor or lymphoma considering or receiving treatment and had ≥1 GA domain impairment other than polypharmacy. Multivariate analyses were used to evaluate the associations of age difference between chronological and self-perceived age (categorized into "feeling younger than chronological age" vs. "feeling the same or older than their chronological age") with GA domain impairments.
Results:
We included 533 patients; mean age was 76.6 (SD 5.2). On multivariate analyses, compared to those who felt younger than their chronological age, those who felt the same or older were more likely to have impairments in physical performance [Adjusted Odds Ratio (AOR) 5.42, 95% Confidence Interval (CI) 1.69-17.40)], functional status (AOR 2.31, 95% CI 1.73-3.07), comorbidity (AOR 1.62, 95% CI 1.20-2.19), psychological health (AOR 2.62, 95% CI 1.85-3.73), and nutrition (AOR 1.65, 95% CI 1.20-2.28). They were also more likely to screen positively for polypharmacy (AOR 1.86, 95% CI 1.30-2.65).
Conclusions:
Older adults with cancer who felt the same or older than their chronological age were more likely to have GA domain impairments. Further studies are needed to better understand the relationships between self-perceived age, aging-related conditions, and outcomes in this population.
... 16 The major factors determining the subjective age (meaning how young or old the person feels) are: health status, in both physical and psychological aspects, optimism, sense of effectiveness of activities, openness, personal development. [17][18][19][20][21][22][23][24][25][26][27] The factors without a significant effect on the perceived age include sex, economic status, education, level of incomes. [25][26][27] Worse perceptions of age are linked to the intensification of health problems (pain, health status) and mortality in the group of older people. ...
Background:
The aim of the study was to determine the effect of regular Nordic walking (NW) and memory training on the quality of life and subjective age perception in older adults. Relationships between changes in quality of life and subjective age and changes in physical and perceptual fitness were also examined.
Methods:
The study examined 61 women aged 64 to 93 years living in adult day care centers. Twenty people participated in a 3-month program combining Nordic walking and cognitive training (group NW+C), 20 people participated only in Nordic walking classes (group NW), and 21 people were a control group (group C). The Fullerton Functional Fitness Test, the Romberg balance test, WHOQOL-Bref Age questionnaire and the Attention and Perceptivity Test were used in the study.
Results:
After three months of exercises, a decrease in subjective age and an improvement in perceived quality of life was observed in NW+C and NW groups, with no such changes found in group C. Positive correlations were also found for the index of decline in subjective age and quality of life with indices of physical fitness improvement.
Conclusions:
Regular physical and intellectual activity has a positive effect on perceived quality of life and subjective age of the residents of adult day care centers.
... Yaşlı bireyin yaşlanma sürecinde yaşadığı deneyimler yaşlılık algısını etkilemektedir 9,10 . Bu dönemde yaşlı bireylerin kendisini olumlu ve yeterli algılaması, yaşam kalitesini olumlu yönde etkilemekte, başarılı ve üretken bir yaşlılık dönemi geçirilmesini mümkün kılmaktadır [11][12][13][14] . Yaşlılık döneminin yaşlılar tarafından olumlu bir şekilde değerlendirilmesi sağlık bakım hizmetlerinden etkin bir şekilde yararlanmayı sağlayarak sağlığın geliştirilmesi ve hastalıkların yönetimine katkıda bulunmaktadır 3,11 . ...
Amaç: Bu araştırmanın amacı, Yaşlılığı Algılama Anketi Kısa Formu (Brief Aging Perceptions Questionnaire: B-APQ)’nun Türkçe versiyonunun geçerlilik ve güvenirlik çalışmasının yapılmasıdır.Gereç ve Yöntem: Bu araştırma Sinop il merkezinde yaşayan 170 yaşlı bireyle yapılan metodolojik bir araştırmadır. Verilerin toplanmasında “Kişisel Tanıtım Formu” ve “Yaşlılığı Algılama Anketi Kısa Formu” kullanılmıştır. Araştırmada ilk aşamada dil ve kapsam geçerliliği, ikinci aşamada ise güvenirlik analizleri yapılmıştır.Bulgular: Katılımcıların yaş ortalaması 71.5±7.42 yıl olup çoğunluğu (%69.4) erkektir. Beş uzman tarafından değerlendirilen form maddelerine ilişkin kapsam geçerlik oranı ve kapsam geçerlik indeksi (CVI) 1.0 olarak hesaplanmıştır. Doğrulayıcı faktör analizi sonucunda formun 17. maddesi çıkartılmış ve nihai ölçek 16 maddeden oluşmuştur. Doğrulayıcı faktör analizinde 𝜒2/𝑠𝑑 değerinin 3’den küçük olduğu belirlenmiştir. Karşılaştırmalı Uyum İyiliği İndeksi (CFI) değeri 1.00; Uyum İyiliği İndeksi (GFI) değeri 0.96 ve Normlaştırılmış Uyum değeri (NFI) 0.94 olarak belirlenmiştir. Araştırmamızda anket Cronbach alfa değeri alt boyutlar için Zaman Süreci-Yaşlanmayla İlgili Sürekli Farkındalık 0.94; Pozitif Sonuçlar 0.80; Pozitif Kontrol 0.92; Negatif Sonuçlar ve Kontrol 0.77; Emosyonel İfadeler 0.37; olarak hesaplanmış olup tüm ölçek için Cronbach alfa değeri ise 0.63’dür.Sonuç: Araştırmamızdan elde edilen bulgular “Yaşlılığı Algılama Anketi Kısa Formu” Türkçe versiyonunun geçerli ve güvenilir bir ölçme aracı olduğunu göstermiştir. Yaşlı bireyler tarafından yaşlılığın nasıl algılandığını değerlendirilmek amacıyla yapılacak olan çalışmalarda kullanılabilir.
... Older adults are at highest risk of any other age population to experience declines in multiple life domains such as physical, cognitive, and social. These life domains are interrelated in that declines or deficits in one domain may have direct or indirect influences on one or multiple other domains (Robertson and Kenny 2016;Sun, Kim, and Smith 2017). Self-perceptions of aging and challenges that accompany this process are important for understanding how older adults perceive their life quality in various life domains as well as their overall quality of life perceptions. ...
... There is additional evidence that having lower expectations regarding aging is associated with placing less importance on seeking health care, and that beliefs about one's aging can predict their likelihood of engaging in preventive health behaviors over time (Levy & Myers, 2004;Sarkisian, Hays, & Mangione, 2002). Sun and colleagues had previously reported that negative self-perceptions on aging was associated with a higher rate of overnight hospitalization, an important driver in health care costs (Sun, Kim, & Smith, 2017). In this supplement, Sun and Smith report an association between negative self-perceptions of aging and higher likelihood of health care delay and more perceived barriers to care. ...
... The level of SWB declines later in life (25,26). Regardless of functional limitation, high life satisfaction has been associated with fewer doctor visits and higher use of preventive health care services (27), and fewer overnight hospitalizations (28). Individuals with disabilities spend less time on work and productive activities and more time on passive leisure (29), and they experience increased frustration and decreased activity-related happiness. ...
Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of physiologic systems. Measures of physical, cognitive and sensory, and psychosocial or emotional function predict important health outcomes like death and disability independently from the severity of a specific disease, cumulative co-morbidity, or disease severity measures. A growing number of clinical scientists in several subspecialties are exploring the utility of functional assessment to predict complication risk, indicate stress resistance, inform disease screening approaches and risk factor interpretation, and evaluate care. Because a substantial number of older adults in the community have some form of functional limitation, integrating functional assessment into clinical medicine could have a large impact. Although interest in functional implications for health and disease management is growing, the science underlying functional capacity, functional limitation, physical frailty, and functional metrics is often siloed among different clinicians and researchers, with fragmented concepts and methods. On August 25-26, 2016, participants at a trans-disciplinary workshop, supported by the National Institute on Aging and the John A. Hartford Foundation, explored what is known about the pathways, contributors, and correlates of physical, cognitive and sensory functional measures across conditions and disease states; considered social determinants and health disparities; identified knowledge gaps, and suggested priorities for future research. This paper summarizes those discussions.
... Interestingly, this effect was also larger than the gain in years of life known from other studies for physiological measures (e.g., low cholesterol or systolic blood pressure), or health behavior (e.g., lower body mass index, no history of smoking, tendency to exercise). In addition, two recent longitudinal studies suggest that feeling older increases the risk for overnight hospitalization of older adults while positive self-perceptions of aging are associated with a lower risk for overnight hospitalization (Stephan, Sutin, & Terracciano, 2016;Sun, Kim, & Smith, 2017). Finally, subjective age and self-perceptions of aging also have effects on cognitive abilities and psychological health. ...
Personal views on aging, such as age stereotypes and subjective aging, can affect various
health outcomes in later life. For the past 20 years or so, a large body of experimental
and longitudinal work has provided ample evidence for this connection. Thus, it seems
timely to better understand the pathways of this linkage. The majority of existing studies
has either focused on age stereotypes or subjective aging. This theoretical paper provides a
systematic comparison of major theoretical approaches that offer explanations through
which different views on aging may affect health. After a short review of findings on the
short- and long-term effects of different views on aging, we describe theoretical
approaches that provide explanations of underlying mechanisms for the effect of both
uni- and multidimensional views on aging on health outcomes. We compare the specific
characteristics of these approaches, provide a heuristic framework and outline recommendations
for future research routes. A better understanding of the impact of different views
on aging on health outcomes is not only relevant for basic research in life-span developmental
psychology, geropsychology and health psychology, it has also implications for
intervention research and public health practices.
Purpose
This study aims to examine the phenomenon of self-perceived age (SPA) identity for Generation X (GenX) women in the UK. Squeezed between the more ubiquitous “boomer” and “millennial” cohorts, and now with both gender and age stigma-related challenges, this study looks to provide insights for understanding this group for marketing.
Design/methodology/approach
This study adopts an existential phenomenological approach using a hybrid structured/hermeneutic research design. Data is collected using solicited diary research (SDR) that elicits autoethnographic insights into the lived experiences of GenX women, these in the context of SPA.
Findings
For this group, the authors find age a gendered phenomenon represented via seven “age frames”, collectively an “organisation of experience”. Age identity appears not to have unified meaning but is contingent upon individuals and their experiences. These frames then provide further insights into how diarists react to the stigma of gendered ageism.
Research limitations/implications
SDR appeals to participants who like completing diaries and are motivated by the research topic. This limits both diversity of response and sample size, but coincidentally enhances elicitation potential – outweighing, the authors believe, these constraints. The sample comprises UK women only.
Practical implications
This study acknowledges GenX women as socially real, but from an SPA perspective they are heterogeneous, and consequently distributed across many segments. Here, age is a psychographic, not demographic, variable – a subjective rather than chronological condition requiring a nuanced response from marketers.
Originality/value
To the best of the authors’ knowledge, this is the first formal study into how SPA identity is manifested for GenX women. Methodologically, this study uses e-journals/diaries, an approach not yet fully exploited in marketing research.
This article updates and extends an earlier meta-analysis (Westerhof et al., 2014) on the longitudinal effects of subjective aging (SA) on health outcomes. A systematic search in different databases (APA PsycInfo, PubMed, Web of Science, and Scopus) resulted in 99 articles, reporting on 107 studies. Participants: Studies had a median sample size of 1,863 adults with a median age of 66 years. A randomized effect meta-analysis showed a significant, small effect (likelihood ratio = 1.347; 95% confidence interval [1.300, 1.396]; p < .001), similar in magnitude to the previous meta-analysis of 19 studies. Although the results showed high heterogeneity in the longitudinal link between SA and health outcomes, there were no differences in effects according to chronological age of participants, welfare state status (more or less developed social security system), length of follow-up, type of health-related outcome, or quality of the study. Effects were stronger for multiitem measures of self-perceptions of aging than for the frequently used single-item measures assessing subjective age, especially for indicators of physical health. Based on this meta-analysis, building on five times more studies than the 2014 review, we consider the associations of measures of SA with health and longevity across time as robust, albeit small in size. Future research should concentrate on the clarification of pathways mediating the relation between SA and health outcomes, as well as potential bidirectional effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Perception of one’s own age and the aging process can influence healthy aging and encourage younger adults to be more proactive in taking care of themselves. There is a shortage of literature on college students’ self-perceptions of aging and old age. This descriptive qualitative study explored how short-term aging research training and activities influenced college students’ perceptions of aging, older adults, and their future older selves. Students were exposed to discussions about aging, the aging process, myths, a brief TED talk, and a video on positive age stereotypes in preparation for their encounter with older adults in a more extensive photovoice aging research project. Data for the study were collected using weekly guided reflections and drawing. Findings show that college students improved perceptions of aging and older adults after the short-term research training. We found cultural differences in self-perception of the onset of old age. Students perceived healthy aging in terms of biological, psychological, spiritual, and social dimensions of health. Students presented a hopeful, positive picture of their future older self as opposed to the negative stereotypic views they initially had of older adults. Reflections on one’s own aging may be crucial in encouraging younger adults to be more proactive in taking care of themselves for a healthier life in later adulthood.
The present study aims to understand young adults’ self-perceptions of aging (SPA) and the way their SPA would form throughout close contact with a grandparent, guided by the intergroup contact hypothesis. Fourteen young adults participated in a semi-structured interview for this study. They were ages 18 to 39 and had experienced at least one year of close contact with a grandparent. Thematic analysis of the interviews generated four overarching themes: (1) dichotomous prospects of the older self; (2) intangible resources considered essential for older adulthood; (3) grandparent setting an example of older adulthood; and (4) SPA formed by life events, others’ aging, and physical appearance.
Advancing worker assistive technology, such as exoskeletons, has been increasingly implemented in broad workplaces due to its potential to improve worker health and safety, as well as retain and increase productivity, especially among workers with limited physical capabilities and older workers. Exoskeletons available at physically demanding workplaces may enable older workers to have a positive outlook and motivation for their jobs, affecting their retirement attitudes. This study examined how industrial exoskeletons impact older workers’ retirement intentions. Results showed that older workers whose jobs involve physical demands are likely to have increased retirement age expectations and intentions to delay their retirements when knowing that exoskeletons are potentially available to assist them with their jobs. The findings suggest that worker assistive technology has the potential to improve older worker retention in the workforce and contribute to older adults’ health, safety, and well-being.
Objectives
We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging.
Method
We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood.
Results
Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women.
Discussion
Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.
Importance:
A poor prognostic understanding regarding curability is associated with lower odds of hospice use among patients with cancer. However, the association between poor prognostic understanding or prognostic discordance and health care use among older adults with advanced incurable cancers is not well characterized.
Objective:
To evaluate the association of poor prognostic understanding and patient-oncologist prognostic discordance with hospitalization and hospice use among older adults with advanced cancers.
Design, setting, and participants:
This was a post hoc secondary analysis of a cluster randomized clinical trial that recruited patients from October 29, 2014, to April 28, 2017. Data were collected from community oncology practices affiliated with the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program. The parent trial enrolled 541 patients who were aged 70 years or older and were receiving or considering any line of cancer treatment for incurable solid tumors or lymphomas; the patients' oncologists and caregivers (if available) were also enrolled. Patients were followed up for at least 1 year. Data were analyzed from January 3 to 16, 2021.
Main outcomes and measures:
At enrollment, patients and oncologists were asked about their beliefs regarding cancer curability (100%, >50%, 50%, <50%, and 0%; answers other than 0% reflected poor prognostic understanding) and life expectancy (≤6 months, 7-12 months, 1-2 years, 2-5 years, and >5 years; answers of >5 years reflected poor prognostic understanding). Any difference between oncologist and patient in response options was considered discordant. Outcomes were any hospitalization and hospice use at 6 months captured by the clinical research associates.
Results:
Among the 541 patients, the mean (SD) age was 76.6 (5.2) years, 264 of 540 (49%) were female, and 486 of 540 (90%) were White. Poor prognostic understanding regarding curability was reported for 59% (206 of 348) of patients, and poor prognostic understanding regarding life expectancy estimates was reported for 41% (205 of 496) of patients. Approximately 60% (202 of 336) of patient-oncologist dyads were discordant regarding curability, and 72% (356 of 492) of patient-oncologist dyads were discordant regarding life expectancy estimates. Poor prognostic understanding regarding life expectancy estimates was associated with lower odds of hospice use (adjusted odds ratio, 0.30; 95% CI, 0.16-0.59). Discordance regarding life expectancy estimates was associated with greater odds of hospitalization (adjusted odds ratio, 1.64; 95% CI, 1.01-2.66).
Conclusions and relevance:
This study highlights different constructs of prognostic understanding and the need to better understand the association between prognostic understanding and health care use among older adult patients with advanced cancer.
Trial registration:
ClinicalTrials.gov Identifier: NCT02107443.
The population is ageing, but while average life expectancy continues to increase, healthy life expectancy has not necessarily matched this and negative ageing stereotypes remain prevalent. Self-directed ageing stereotypes are hypothesised to play an important role in older adults’ health and well-being; however, a wide variety of terms and measures are used to explore this construct meaning there is a lack of clarity within the literature. A review was conducted to identify tools used to measure self-directed ageing stereotype in older adults and evaluate their quality. Searches identified 109 papers incorporating 40 different measures. Most common were the Philadelphia Geriatric Centre Morale Scale Attitude Towards Own Ageing (ATOA) subscale, Ageing Perceptions Questionnaire (APQ) and Attitudes to Ageing Questionnaire. Despite being most frequently used, the ATOA was developed to measure morale in older adults rather than self-directed ageing stereotypes. Over 25 terms were used to describe the concept, and it is suggested that for consistency the term “self-directed ageing stereotype” be adopted universally. Across measures, poor reporting of psychometric properties made it difficult to assess scale quality and more research is needed to fully assess measures before conclusions can be drawn as to the best tool; however, the Brief-APQ appears to hold most promise. Future research must address this issue before interventions to reduce negative self-directed ageing stereotypes can be developed and fully evaluated.
Objectives:
Adults' perceptions of aging are known to affect their mental and physical health. However, not much is known about how perceptions of aging within the couple-unit affect each member of the unit. Therefore, the current study explores the effects of husbands' and wives' self-perceptions of aging (SPA) on each other's physical and mental health, both directly and indirectly, through impacting each other's SPA.
Method:
The study used data from the Health and Retirement Study, focusing on couples aged 50 and above. Self-rated health and CES-D depression scale were used as indicators of physical and mental health. SPA was measured using the "Attitudes toward aging" subscale of the "Philadelphia Geriatric Center Morale Scale". An actor-partner interdependence mediation model was used to examine the effects of the 2008 SPA of couples on each other's 2012 SPA and 2016 health.
Results:
The SPA of both husbands and wives was associated with their own future mental and physical health in 2016, but not with that of their partner. However, their SPA was associated with their partner's health indirectly, by influencing the SPA of the partner. That is, the SPA of both husbands and wives in 2008 impacted their partner's SPA in 2012, which was subsequently related to that partner's mental and physical health in 2016.
Discussion:
Older couples can influence each other's health indirectly, by affecting each other's SPA. This indicates that adults' SPA are interconnected and thus, the entire couple-unit should be targeted to enhance positive SPA.
Objectives: Little is known about the specific association of vision loss and psychosocial outcome measures in contrast to other health limitations. The aim of this study was to identify whether vision problems are associated with psychosocial outcomes among middle-aged and older adults and to compare it with the association between other chronic health conditions and psychosocial factors.
Method: Cross-sectional data came from wave 5 (2014) of the German Ageing Survey which is a representative sample of non-institutionalized individuals ≥ 40 years in Germany. Psychosocial outcomes (life satisfaction, positive affect, negative affect, depressive symptoms, optimism, general self-esteem, and social isolation) were assessed using well-established and widely used scales. Self-rated trouble reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used as independent variables of interest.
Results: Regressions showed that both ‘vision problems: reading the newspaper’ and ‘vision problems: difficulties recognizing people’ are consistently associated with worse psychosocial outcomes (decreased life satisfaction, decreased positive affect, increased negative affect, increased depressive symptoms, decreased optimism, decreased self-esteem and increased social isolation). In contrast, none of the physical illnesses was consistently associated with all psychosocial outcome measures.
Conclusion: Adjusting for various potential confounders and in contrast to various chronic diseases, our findings emphasize an association between vision problems and worse psychosocial outcomes in middle-aged and older adults. Future longitudinal studies are needed to validate our findings.
Self-perceptions of aging (SPA) are an important resource for health in later life. A large body of research has demonstrated that more positive SPA are beneficial for various health-related outcomes, such as self-rated, functional, physical and mental health, as well as for health behaviors. However, there are further, ongoing issues in SPA research addressed in the present dissertation. At first, recent findings point out that SPA are domain-specific and that individuals hold both positive and negative SPA. However, international studies have shown that negative SPA predominate. Second, given the detrimental effects of having more negative SPA, the promotion of more positive SPA for better health in older age seems warranted. And third, given low activity levels among older adults, research calls for taking a lifespan perspective in the promotion of physical activity (PA) for older adults. The aim of the present thesis was to address these issues, by having a closer look at the multidimensional nature of SPA, the changeability of SPA, and a lifespan perspective in the promotion of PA among older adults. In study 1 it was investigated whether are they positive or negative SPA that dominate among the German population, and whether SPA has changed in Germany over the last two decades. Using representative data for Germany (n = 4,295), results showed that adults in Germany aged 40 years and older hold both positive, gain-related SPA and negative, loss-related SPA. In particular, older adults and those with lower education are groups vulnerable to holding less gain-related and more loss-related SPA. Furthermore, cohort comparisons between four subsequent measurement waves (n = 15,558) suggested that SPA could change over an 18-year period and become more positive over time—mainly in older age. Study 2 aimed at investigating whether it is possible to improve SPA among older adults via directly addressing them in an intervention. Study 2 tested the effectiveness of a randomized controlled trial intervention to promote more positive SPA among eighty-four community-dwelling older adults aged 65 years and older. The SPA intervention was embedded in a 12-week exercise program. Results showed an improvement of participants’ SPA in the intervention group in terms of holding more gain-related and less loss-related SPA after the program period. In the control group, participants’ SPA did not change. Furthermore, all participants profited from their participation in the exercise program in terms of better functional health at follow-up, but only participants in the intervention group showed an increase in mental health. The aim of study 3 was to investigate the domain-specific relationship between SPA and PA. Furthermore, it was investigated whether this relationship depended on a person’s perceived residual lifetime. Results using longitudinally data (n = 2,367) demonstrated that there was a domain-specific relationship between the gain-related domain and moderate kinds of PA and the loss-related domain and a more vigorous kind of PA. Furthermore, it was found that the relationship between SPA and PA depended on perceived residual lifetime. The findings of this thesis showed that SPA are complex and multidimensional. This supports a domain-specific investigation of SPA, their changes, and the relationship they have with outcomes. Furthermore, it was shown that SPA are changeable at the individual level via an intervention as well as at the societal level over decades. In addition, from a lifespan perspective, SPA have emerged as a promising approach in the promotion of PA among older adults, as well as the consideration of the perceived residual lifetime. This knowledge could now be implemented in health-promotion interventions for older adults for maintaining good health, autonomy, and quality of life in older age and may help older adults to realize their potentials and opportunities in an aging society.
Aging is often associated with inevitable biological decline. Yet research suggests that subjective aging-the views that people have about their own age and aging-contributes to how long and healthy lives they will have. Subjective age and self-perceptions of aging are the two most studied aspects of subjective aging. Both have somewhat different theoretical origins, but they can be measured reliably. A total of 41 studies have been conducted that examined the longitudinal health effects of subjective age and self-perceptions of aging. Across a wide range of health indicators, these studies provide evidence for the longitudinal relation of subjective aging with health and longevity. Three pathways might explain this relation: physiological, behavioral, and psychological pathways. The evidence for behavioral pathways, particularly for health behaviors, is strongest, whereas only a few studies have examined physiological pathways. Studies focusing on psychological pathways have included a variety of mechanisms, ranging from control and developmental regulation to mental health. Given the increase in the number of older people worldwide, even a small positive change in subjective aging might come with a considerable societal impact in terms of health gains.
Keywords: subjective aging, subjective age, self-perceptions of aging, views on aging, health, longevity, pathways
Background and objectives:
Self-perceptions of aging (SPA), or attitudes toward one's aging experience, have been linked to health through multiple pathways. Few studies, however, have investigated how older adults' views on aging influence their care-seeking behaviors.
Research design and methods:
Using two independent subsamples from the Health and Retirement Study (2011 Health Care Mail Survey: N = 2,866; 2013 Health Care and Nutrition Study: N = 2,474), logistic regression and negative binomial regression were used to examine the association between SPA and health care delay over the next 12 months. Subsequently, we used latent class analysis to identify subgroups reporting different reasons for delay. With multinomial logistic regression, we then examined if, compared with the no delay group, SPA differentiated membership in the delay subgroups.
Results:
In both samples, more negative aging self-perceptions were associated with a higher likelihood of health care delay and more perceived barriers to care, after adjusting for predisposing, enabling, and need factors. Latent class analysis revealed three subgroups characterized by different reasons for delay: (a) limited health care access, (b) too busy to go to the doctor, and (c) dislike of going to the doctor. In fully adjusted models, individuals with more negative SPA were more likely to belong to "limited-access" and "dislike" subgroups compared with the no delay group.
Discussion and implications:
SPA may affect decision-making processes regarding whether to seek care for worrisome symptoms. Efforts to promote more positive SPA may encourage older adults to be more proactive in addressing their health care needs.
Negative age stereotypes that older individuals assimilate from their culture predict detrimental outcomes, including worse physical function. We examined, for the first time, whether positive age stereotypes, presented subliminally across multiple sessions in the community, would lead to improved outcomes. Each of 100 older individuals (age = 61-99 years, M = 81) was randomly assigned to an implicit-positive-age-stereotype-intervention group, an explicit-positive-age-stereotype-intervention group, a combined implicit- and explicit-positive-age-stereotype-intervention group, or a control group. Interventions occurred at four 1-week intervals. The implicit intervention strengthened positive age stereotypes, which strengthened positive self-perceptions of aging, which, in turn, improved physical function. The improvement in these outcomes continued for 3 weeks after the last intervention session. Further, negative age stereotypes and negative self-perceptions of aging were weakened. For all outcomes, the implicit intervention's impact was greater than the explicit intervention's impact. The physical-function effect of the implicit intervention surpassed a previous study's 6-month-exercise-intervention's effect with participants of similar ages. The current study's findings demonstrate the potential of directing implicit processes toward physical-function enhancement over time.
Objective:
Preventive health service use is relatively low among older age groups. We hypothesized that aging satisfaction would be associated with increased use of preventive health services four years later.
Method:
We conducted multiple logistic regression analyses on a sample of 6177 people from the Health and Retirement Study, a nationally representative study of U.S. adults over the age of 50 (M age=70.6; women n=3648; men n=2529).
Results:
Aging satisfaction was not associated with obtaining flu shots. However, in fully-adjusted models, each standard deviation increase in aging satisfaction was associated with higher odds of reporting service use for cholesterol tests (OR=1.10, 95% CI=1.00-1.20). Further, women with higher aging satisfaction were more likely to obtain a mammogram/x-ray (OR=1.17, 95% CI=1.06-1.29) or Pap smear (OR=1.10, 95% CI=1.00-1.21). Among men, the odds of obtaining a prostate exam increased with higher aging satisfaction (OR=1.20 95% CI=1.09-1.34).
Conclusion:
These results suggest that aging satisfaction potentially influences preventive health service use after age 50.
The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over
age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide
a national resource for data on the changing health and economic circumstances associated with ageing at both individual and
population levels. Its multidisciplinary approach is focused on four broad topics—income and wealth; health, cognition and
use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level
to administrative records from Social Security and Medicare, Veteran’s Administration, the National Death Index and employer-provided
pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater
depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented
potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid
release of data while simultaneously protecting the confidentiality of respondents. Three categories of data—public, sensitive
and restricted—can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).
This study assessed the extent to which older adults attribute a recent heart attack/stroke to "old age," and examined consequences for subsequent lifestyle behavior and health-care service utilization. Community-dwelling adults (N = 57, ages 73-98 years) were interviewed about their heart attack/stroke, and an objective health registry provided data on health-care utilization over a 3-year period. Endorsement of "old age" as a cause of heart attack/stroke negatively predicted lifestyle behavior change, and positively predicted frequency of physician visits and likelihood of hospitalization over the subsequent 3 years. Findings suggest the importance of considering "old age" attributions in the context of cardiovascular health events.
Objective
Identifying positive psychological factors that reduce health care use may lead to innovative efforts that help build a more sustainable and high-quality health care system. Prospective studies indicate that life satisfaction is associated with good health behaviors, enhanced health, and longer life, but little information about the association between life satisfaction and health care use is available. We tested whether higher life satisfaction was prospectively associated with fewer doctor visits. We also examined potential interactions between life satisfaction and health behaviors.Methods
Participants were 6379 adults from the Health and Retirement Study, a prospective and nationally representative panel study of American adults older than 50 years. Participants were tracked for 4 years. We analyzed the data using a generalized linear model with a gamma distribution and log link.ResultsHigher life satisfaction was associated with fewer doctor visits. On a 6-point life satisfaction scale, each unit increase in life satisfaction was associated with an 11% decrease in doctor visits-after adjusting for sociodemographic factors (relative risk = 0.89, 95% confidence interval = 0.86-0.93). The most satisfied respondents (n = 1121; 17.58%) made 44% fewer doctor visits than did the least satisfied (n = 182; 2.85%). The association between higher life satisfaction and reduced doctor visits remained even after adjusting for baseline health and a wide range of sociodemographic, psychosocial, and health-related covariates (relative risk = 0.96, 95% confidence interval = 0.93-0.99).Conclusions
Higher life satisfaction is associated with fewer doctor visits, which may have important implications for reducing health care costs.
Objectives:
Individuals' perceptions of their own age(ing) are important correlates of well-being and health. The goals of the present study were to (a) examine indicators of self-perceptions of aging across adulthood and (b) experimentally test whether age stereotypes influence self-perceptions of aging.
Method:
Adults 18-92 years of age were presented with positive, negative, or no age stereotypes. Before and after the stereotype activation, aging satisfaction and subjective age were measured.
Results:
The activation of positive age stereotypes did not positively influence self-perceptions of aging. Quite the contrary, priming middle-aged and older adults in good health with positive age stereotypes made them feel older. After the activation of negative age stereotypes, older adults in good health felt older and those in bad health wanted to be younger than before the priming. Even younger and middle-aged adults reported younger desired ages after the negative age stereotype priming. Persons in bad health also thought they looked older after being primed with negative age stereotypes.
Discussion:
Taken together, although we find some support for contrast effects, most of our results can be interpreted in terms of assimilation effects, suggesting that individuals integrate stereotypical information into their self-evaluations of age(ing) when confronted with stereotypes.
Researchers have increasingly turned their attention from younger individuals who hold age stereotypes to older individuals who are targeted by these stereotypes. The refocused research has shown that positive and negative age stereotypes held by older individuals can have beneficial and detrimental effects, respectively, on a variety of cognitive and physical outcomes. Drawing on these experimental and longitudinal studies, a theory of stereotype embodiment is presented here. It proposes that stereotypes are embodied when their assimilation from the surrounding culture leads to self-definitions that, in turn, influence functioning and health. The theory has four components: The stereotypes (a) become internalized across the life span, (b) can operate unconsciously, (c) gain salience from self-relevance, and (d) utilize multiple pathways. The central message of the theory, and the research supporting it, is that the aging process is, in part, a social construct.
Physical activity is one of the most important health behaviours associated with the prevention and management of chronic diseases in older adults, but this potential is often insufficiently used. The present study examined for the first time whether a positive view on ageing (PVA) may contribute to a higher level of physical activity. Analyses were based on the German Ageing Survey, a longitudinal population-based survey (N = 4034) on middle-aged and older adults (40-85 years) conducted in the years 1996 and 2002. As hypothesised, middle-aged adults with a PVA not only engaged in physical activity in the form of sports more frequently; they even increased this activity provided that they were healthy enough to do so. For older adults, PVA was particularly associated with more regular walking and increases of walking over time. Because walking is often still recommended in spite of health problems, it was remarkable that even older people with worse health walked just as regularly as those with good health, provided that they had a positive view on ageing. The results shed some light on recent findings about the importance of PVA for health and longevity and point to a partial mediation between PVA and health by physical exercise.
Satisfaction with one's own aging and feeling young are indicators of positive well-being in late life. Using 16-year longitudinal data from participants of the Berlin Aging Study (P. B. Baltes & K. U. Mayer, 1999; N = 439; 70- to 100-year-olds), the authors examined whether and how these self-perceptions of aging change with age and how such changes relate to distance from death. Extending previous studies, they found that it is not only higher aging satisfaction and younger subjective age but also more favorable change patterns (e.g., less decline in aging satisfaction) that are uniquely associated with lower mortality hazards. These effects are robust after controls for objective measures such as age, gender, socioeconomic status, diagnosis of dementia, or number of illnesses. As individuals approach death, they become less satisfied with their aging and report feeling older. For aging satisfaction, mortality-related decline is much steeper than age-related decline, whereas change in subjective age is best characterized as an age-related process. The authors discuss how self-perceptions of aging are embedded in mechanisms underlying pathways of dying late in life.
To examine the association between strength, function, lean mass, muscle density, and risk of hospitalization.
Prospective cohort study.
Two U.S. clinical centers.
Adults aged 70 to 80 (N=3,011) from the Health, Aging and Body Composition Study.
Measurements were of grip strength, knee extension strength, lean mass, walking speed, and chair stand pace. Thigh computed tomography scans assessed muscle area and density (a proxy for muscle fat infiltration). Hospitalizations were confirmed by local review of medical records. Negative binomial regression models estimated incident rate ratios (IRRs) of hospitalization for race- and sex-specific quartiles of each muscle and function parameter separately. Multivariate models adjusted for age, body mass index, health status, and coexisting medical conditions.
During an average 4.7 years of follow-up, 1,678 (55.7%) participants experienced one or more hospitalizations. Participants in the lowest quartile of muscle density were more likely to be subsequently hospitalized (multivariate IRR=1.47, 95% confidence interval (CI)=1.24-1.73) than those in the highest quartile. Similarly, participants with the weakest grip strength were at greater risk of hospitalization (multivariate IRR=1.52, 95% CI=1.30-1.78, Q1 vs. Q4). Comparable results were seen for knee strength, walking pace, and chair stands pace. Lean mass and muscle area were not associated with risk of hospitalization.
Weak strength, poor function, and low muscle density, but not muscle size or lean mass, were associated with greater risk of hospitalization. Interventions to reduce the disease burden associated with sarcopenia should focus on increasing muscle strength and improving physical function rather than simply increasing lean mass.
The objective of this study was to assess disparities in health care utilization, by smoking status, among adults in the United States. We used 1999-2004 National Health and Nutrition Examination Survey (NHANES) data from 15,332 adults. Multivariate logistic regressions were used to examine the relationship between smoking status (current, former, and never smoker), with health care utilization. After controlling for demographic characteristics, current smokers and former smokers who quit either <2 years or > or =10 years prior to the survey were more likely to have had inpatient admission in the past year than never smokers. Current smokers did not differ from never smokers on whether they had an outpatient visit in the past year. They were, however, more likely than never smokers to have > or =4 outpatient visits. Smokers who quit either <2 years ago or > or =10 years ago were more likely to have had an outpatient visit than never smokers. Former smokers were more likely than never smokers to have > or =4 outpatient visits regardless of when they quit. Our results show that cigarette smoking is associated with higher health care utilization for current and former smokers than for never smokers. Frequent hospitalization and outpatient visits translate into higher medical costs. Therefore, more efforts are needed to promote interventions that discourage smoking initiation and encourage cessation.
Older individuals assimilate, and are targeted by, contradictory positive and negative age stereotypes. It was unknown whether the influence of stereotype valence is stronger when the stereotype content corresponds to the outcome domain. We randomly assigned older individuals to either positive-cognitive, negative-cognitive, positive-physical, or negative-physical subliminal-age-stereotype groups and assessed cognitive and physical outcomes. As predicted, when the age stereotypes corresponded to the outcome domains, their valence had a significantly greater impact on cognitive and physical performance. This suggests that if a match occurs, it is more likely to generate expectations that become self-fulfilling prophecies.
The present study examined time-related change in felt age, physical age, and satisfaction with aging in old age and covariates
of this change. Using 6-year-longitudinal data from the Berlin Aging Study (age range = 70–104 years), we found that individuals'
felt age remained on average about 13 years below their actual age over time, whereas they reported a decreasing discrepancy
between physical and actual age and a decrease in aging satisfaction over time. After we controlled for level differences,
a differential pattern of individual differences in change appeared for the three dimensions: Age contributed to a greater
decline in aging satisfaction but an increase in the discrepancy of felt age. A higher number of illnesses at baseline attenuated
change in felt age discrepancy. Future research on change of self-perceptions of aging will provide insight into mechanisms
of resilience of the aging self in later life.
This research examines the structure of the Philadelphia Geriatric Center (PGC) Morale Scale. A multiple indicator structural equation model including three first-order factors and one second-order factor is proposed to account for the dimensionality of the PGC Morale Scale. Based on data from the 1968 National Senior Citizens Survey, the proposed model is consistently supported and replicated across four randomly divided subsamples. Given these results, the claim that the PGC Morale Scale is multidimensional is only appropriate for the first-order factors. On the level of the second-order, a unidimensional interpretation is more accurate.
This research demonstrates that subliminally activated stereotypes can alter judgments about oneself and can change cognitive performance. In the first study, an intervention that activated positive stereotypes of aging without the participants' awareness tended to improve memory performance, memory self-efficacy, and views of aging in old individuals; in contrast, an intervention that activated negative stereotypes of aging tended to worsen memory performance, memory self-efficacy, and views of aging in old participants. A second study demonstrated that for the strong effects to emerge from the shifting stereotypes, the stereotypes must be important to one's self-image: Young individuals randomly assigned to the same conditions as the old participants in the first study did not exhibit any of the significant interactions that emerged among the old participants. This research highlights the potential for memory improvement in old individuals when the negative stereotypes of aging that dominate the American culture are shifted to more positive stereotypes.
Over 60 years ago, Selye1 recognized the paradox that the physiologic systems activated by stress can not only protect and restore but also damage the body. What links these seemingly contradictory roles? How does stress influence the pathogenesis of disease, and what accounts for the variation in vulnerability to stress-related diseases among people with similar life experiences? How can stress-induced damage be quantified? These and many other questions still challenge investigators. This article reviews the long-term effect of the physiologic response to stress, which I refer to as allostatic load.2 Allostasis — the ability to achieve stability through change3 — . . .
We examined whether aging self-stereotypes, or older individuals' beliefs about elderly people, can influence cardiovascular function. Older individuals were subliminally exposed to either positive or negative aging stereotypes. Then all participants faced mathematical and verbal challenges. Those exposed to the negative aging stereotypes demonstrated a heightened cardiovascular response to stress, measured by systolic blood pressure, diastolic blood pressure, and heart rate, compared with those exposed to positive aging stereotypes. The aging stereotypes appeared to influence the outcome variable of skin conductance in the same way. It appears that the negative aging stereotypes acted as direct stressors, whereas the positive aging stereotypes reduced cardiovascular stress. These findings indicate that negative aging stereotypes may contribute to adverse health outcomes in elderly persons without their awareness. The results also suggest that positive aging stereotypes could be used in interventions to reduce cardiovascular stress.
This research found that older individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. This advantage remained after age, gender, socioeconomic status, loneliness, and functional health were included as covariates. It was also found that this effect is partially mediated by will to live. The sample consisted of 660 individuals aged 50 and older who participated in a community-based survey, the Ohio Longitudinal Study of Aging and Retirement (OLSAR). By matching the OLSAR to mortality data recently obtained from the National Death Index, the authors were able to conduct survival analyses. The findings suggest that the self-perceptions of stigmatized groups can influence longevity.
We examined whether those with more positive self-perceptions of aging (older individuals' beliefs about their own aging)
report better functional health over an 18-year period than do those with more negative self-perceptions of aging. We found
that those with more positive self-perceptions of aging in 1975 reported better functional health from 1977 to 1995, when
we controlled for baseline measures of functional health, self-rated health, age, gender, race, and socioeconomic status.
We also demonstrated that perceived control partially mediates the relationship between self-perceptions of aging and functioning.
The sample consisted of 433 participants in the Ohio Longitudinal Study of Aging and Retirement, a community-based study of
individuals aged 50 and older, who were interviewed in 6 waves. Our study suggests that the way in which individuals view
their own aging affects their functional health.
Research has found that the elderly are the age group that is the least likely to engage in preventive health behaviors, even though these behaviors continue to benefit individuals throughout the life span. We investigated for the first time whether an age-specific factor, older individuals' beliefs about their own aging, predicts their likelihood of engaging in preventive health behaviors over time.
We conducted multivariate linear regression to test the predictive value of aging self-perceptions on the preventive health behaviors of 241 individuals, who participated in the Ohio Longitudinal Study of Aging and Retirement (OLSAR) aged 50-80 years old. The preventive health behaviors included eating a balanced diet, exercising, and following directions for taking prescribed medications.
Individuals with more positive self-perceptions of aging tended to practice more preventive health behaviors over the next two decades after controlling for age, education, functional health, gender, self-rated health, and race (P = 0.032).
Our findings suggest that addressing views about aging could help improve efforts to increase preventive health behaviors in the older population.
Although age-related hearing loss is one of the most prevalent conditions affecting older individuals, little research has
been conducted on the social-psychological factors that might contribute to it. The present study examines whether older individuals'
age stereotypes predict screened hearing over time. The sample consisted of 546 community-dwelling persons, aged 70 to 96
years old. Participants with more negative and more external (i.e., related to physical appearance) age stereotypes demonstrated
worse screened hearing at 36 months, after adjusting for baseline-screened hearing, age, and other relevant variables. These
findings suggest that age stereotypes influence older individuals' sensory perception.
To pilot test a new behavioral intervention to increase walking in sedentary older adults.
Pre-post community-based pilot study.
Three senior centers in greater Los Angeles.
Forty-six sedentary adults aged 65 and older.
At four weekly 1-hour group sessions held at the senior centers, a trained health educator applied a theoretically grounded, standardized "attribution retraining" curriculum developed by a multidisciplinary team of investigators. Participants were taught that becoming sedentary is not inevitable with aging and that older adults should attribute being sedentary to modifiable attributes rather than to old age. A 1-hour exercise class including strength, endurance, and flexibility training followed each weekly attribution retraining session.
Change from baseline in steps per week recorded using a digital pedometer was measured after 7 weeks. Age expectations (measured using the Expectations Regarding Aging-38 survey, a previously tested instrument on which higher scores indicate that the participant expects high functioning with aging and lower scores indicate that the participant expects physical and mental decline) and health-related quality of life were measured using in-person interviews.
Mean steps per week increased from 24,749 to 30,707, a 24% increase-equivalent to 2.5 miles (2-sided t-test P=.002). Age expectation scores increased 30% (P<.001), and the changes in age expectations and steps per week correlated (correlation coefficient=0.39, P=.01). Participants experienced improved mental health-related quality of life (P=.049) and reported less difficulty with activities of daily living (P=.04). More than 50% of participants reported improvements in pain, energy level, and sleep quality.
In this small pre-post community-based pilot study, a structured attribution retraining curriculum accompanied by a weekly exercise class was associated with increased walking levels and improved quality of life in sedentary older adults. Attribution retraining deserves further investigation as a potential means of increasing physical activity in sedentary older adults.
Objective:
To assess the net impact of purpose in life on all-cause mortality and cardiovascular events.
Methods:
The electronic databases PubMed, Embase, and PsycINFO were systematically searched through June 2015 to identify all studies investigating the relationship between purpose in life, mortality, and cardiovascular events. Articles were selected for inclusion if, a) they were prospective, b) evaluated the association between some measure of purpose in life and all-cause mortality and/or cardiovascular events, and c) unadjusted and/or adjusted risk estimates and confidence intervals (CIs) were reported.
Results:
Ten prospective studies with a total of 136,265 participants were included in the analysis. A significant association was observed between having a higher purpose in life and reduced all-cause mortality (adjusted pooled relative risk = 0.83 [CI = 0.75-0.91], p < .001) and cardiovascular events (adjusted pooled relative risk = 0.83 [CI = 0.75-0.92], p = .001). Subgroup analyses by study country of origin, questionnaire used to measure purpose in life, age, and whether or not participants with baseline cardiovascular disease were included in the study all yielded similar results.
Conclusions:
Possessing a high sense of purpose in life is associated with a reduced risk for all-cause mortality and cardiovascular events. Future research should focus on mechanisms linking purpose in life to health outcomes, as well as interventions to assist individuals identified as having a low sense of purpose in life.
Exaggerated cardiovascular (CV) reactivity to laboratory challenge has been shown to predict future CV morbidity and mortality. CV recovery has been less studied and has yielded inconsistent findings, possibly due to the presence of moderators. Reviews on the relationship between CV recovery and CV outcomes have been limited to cross-sectional studies and have not considered methodological factors. We performed a comprehensive meta-analytic review of the prospective literature investigating CV recovery to physical and psychological challenge and adverse CV outcomes.
We searched PsycINFO and PubMed for prospective studies investigating the relationship between CV recovery and adverse CV outcomes. Studies were coded for variables of interest and for effect sizes. We conducted a random-effects weighted meta-analysis. Moderators were examined with analysis of variance-analog and meta-regression analyses.
Thirty-seven studies met the inclusion criteria (n = 125,386). Impaired recovery from a challenge predicted adverse CV outcomes (summary effect, r = 0.17, p < .001). Physical challenge was associated with larger predictive effects than psychological challenge. Moderator analyses revealed that recovery measured at 1 minute postexercise, passive recovery, use of mortality as an outcome measure, and older sample age were associated with larger effects.
Poor recovery from laboratory challenges predicts adverse CV outcomes, with recovery from exercise serving as a particularly strong predictor of CV outcomes. The overall effect size for recovery and CV outcomes is similar to that observed for CV reactivity and suggests that the study of recovery may have incremental value for understanding adverse CV outcomes.
Objective:
To improve health care for the elderly, a consideration of biopsychosocial health care needs may be of particular importance-especially because of the prevalence of multiple conditions, mental disorders, and social challenges facing elderly people. The aim of the study was to investigate significance and costs of biopsychosocial health care needs in elderly people.
Methods:
Data were derived from the 8-year follow-up of the ESTHER study-a German epidemiological study in the elderly population. A total of 3124 participants aged 57 to 84 years were visited at home by trained medical doctors. Biopsychosocial health care needs were assessed using the INTERMED for the Elderly (IM-E) interview. Health-related quality of life (HRQOL) was measured by the 12-Item Short-Form Health Survey, and psychosomatic burden was measured by the Patient Health Questionnaire.
Results:
The IM-E correlated with decreased mental (mental component score: r = -0.38, p < .0001) and physical HRQOL (physical component score: r = -0.45, p < .0001), increased depression severity (r = 0.53, p < .0001), and costs (R = 0.41, p < .0001). The proportion of the participants who had an IM-E score of at least 21 was 8.2%; according to previous studies, they were classified as complex patients (having complex biopsychosocial health care needs). Complex patients showed a highly reduced HRQOL compared with participants without complex health care needs (mental component score: 37.0 [10.8] versus 48.7 [8.8]; physical component score: 33.0 [9.1] versus 41.6 [9.5]). Mean health care costs per 3 months of complex patients were strongly increased (1651.1 &OV0556; [3192.2] versus 764.5 &OV0556; [1868.4]).
Conclusions:
Complex biopsychosocial health care needs are strongly associated with adverse health outcomes in elderly people. It should be evaluated if interdisciplinary treatment plans would improve the health outcomes for complex patients.
Objective:
Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention.
Design:
Randomised controlled trial with three groups aged 65+: Intervention for physical activity with 'views-on-ageing'-component (n = 101; IGVoA), and without 'views-on-ageing'-component (n = 30; IG), and active control intervention for volunteering (n = 103; CG).
Main outcome measures:
Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5 months after the intervention.
Results:
Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable.
Conclusion:
A 'views-on-ageing'-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.
The Index of ADL was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding. More than 2,000 evaluations of 1,001 individuals demonstrated use of the Index as a survey instrument, as an objective guide to the course of chronic illness, as a tool for studying the aging process, and as an aid in rehabilitation teaching. Of theoretical interest is the observation that the order of recovery of Index functions in disabled patients is remarkably similar to the order of development of primary functions in children. This parallelism, and similarity to the behavior of primitive peoples, suggests that the Index is based on primary biological and psychosocial function, reflecting the adequacy of organized neurological and locomotor response.
Examined whether handwriting can act as a tool to monitor the influence of negative self-stereotypes on the elderly. Handwriting samples of 20 Ss (mean age 71 yrs) were randomly selected, with half of the sample taken from individuals who had been subliminally exposed to positive stereotypes of aging while the other half was taken from individuals who had been subliminally exposed to negative stereotypes of aging. The handwriting samples were produced both before and after the priming. 40 individuals (aged 16–36 yrs) then judged the handwriting samples according to how much they felt the samples were characterized by six attributes: accomplished, confident, deteriorating, senile, shaky, and wise. The age of each writer was also guessed. Results found that judges were able to distinguish the writers who had been exposed to the negative stereotypes from those exposed to positive stereotypes. It is concluded that self-stereotypes influence mental functioning and behavior in the elderly. The possibility of using handwriting as a diagnostic tool in evaluating the effects of negative self-stereotyping of aging is presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Negative self-perceptions of aging (SPA) have been linked to poor physical health and functioning outcomes in late life, yet the direction of this relationship remain unclear. Using data from the Australian Longitudinal Study of Aging, we investigated the directionality of the dynamic relationship between self-perceptions of aging and physical functioning in 1,212 adults 65 years and above (mean age = 76.89, SD = 6.12) over 5 waves (up to 16 years). Bivariate Dual Change Score Models (BDCSM) revealed that the best fitting model for the data was that which allowed SPA to predict change in physical functioning over time lags of 1 year. The direction of the relationship remained after controlling for age, gender, partner status, residential care, number of medical conditions, self-rated health, and psychological well-being. Findings suggest that more positive SPA may be protective of decline in physical functioning in late life. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
This study examines the relationship between self-perception of aging and vulnerability to adverse outcomes in adults aged 65-70 years using data from a cohort of 1,422 participants in Lausanne, Switzerland.
A positive or negative score of perception of aging was established using the Attitudes Toward Own Aging subscale including 5 items of the Philadelphia Geriatric Center Morale Scale. Falls, hospitalizations, and difficulties in basic and instrumental activities of daily living (ADL) collected in the first 3 years of follow-up were considered adverse outcomes. The relationship between perception and outcomes were evaluated using multiple logistic regression models adjusting for chronic medical conditions, depressive feelings, living arrangement, and socioeconomic characteristics.
The strongest associations of self-perception of aging with outcomes were observed for basic and instrumental ADL. Associations with falls and hospitalizations were not constant but could be explained by health characteristics.
A negative self-perception of aging is an indicator of risk for future disability in ADL. Factors such as a low-economic status, living alone, multiple chronic medical conditions, and depressive feelings contribute to a negative self-perception of aging but do not explain the relationship with incident activities of daily living disability.
An increasing number of studies has tested whether greater cardiovascular responses to acute mental stress predict future cardiovascular disease, but results have been variable. This review aimed quantitatively to evaluate the association between cardiovascular responses to laboratory mental stress and subsequent cardiovascular risk status in prospective cohort studies. We searched general bibliographic databases, PsycINFO, Web of Science, and PubMed, up to December 2009. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. There were 169 associations (36 articles) of stress reactivity and 30 associations (5 articles) of poststress recovery in relation to future cardiovascular risk status, including elevated blood pressure, hypertension, left ventricular mass, subclinical atherosclerosis, and clinical cardiac events. The overall meta-analyses showed that greater reactivity to and poor recovery from stress were associated longitudinally with poor cardiovascular status (r=0.091 [95% CI: 0.050 to 0.132], P<0.001, and r=0.096 [95% CI: 0.058 to 0.134], P<0.001, respectively). These findings were supported by more conservative analyses of aggregate effects and by subgroup analyses of the methodologically strong associations. Notably, incident hypertension and increased carotid intima-media thickness were more consistently predicted by greater stress reactivity and poor stress recovery, respectively, whereas both factors were associated with higher future systolic and diastolic blood pressures. In conclusion, the current meta-analysis suggests that greater responsivity to acute mental stress has an adverse effect on future cardiovascular risk status, supporting the use of methods of managing stress responsivity in the prevention and treatment of cardiovascular disease.
In recent years, general-purpose statistical software packages have incorporated new procedures that feature several useful options for design-based analysis of complex-sample survey data. A common and frequently desired technique for analysis of survey data in practice is the restriction of estimation to a subpopulation of interest. These subpopulations are often referred to interchangeably in a variety of fields as subclasses, subgroups, and domains. In this article, we consider two approaches that analysts of complex-sample survey data can follow when analyzing subpopulations; we also consider the implications of each approach for estimation and inference. We then present examples of both approaches, using selected procedures in Stata to analyze data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We conclude with important considerations for subpopulation analyses and a summary of suggestions for practice. Copyright 2008 by StataCorp LP.
The 22-item Philadelphia Geriatric Center (PGC) Morale Scale was subjected to a series of principal component analyses utilizing different item pools and rotating differing numbers of factors. Subjects were 1086 tenants of federally-assisted housing for the elderly and older people living in the community. Results were compared with analyses of the PGC Scale done by Morris and Sherwood. Consideration of factors defined by the analyses suggested three consistently reproduced factors: Agitation, Attitude Toward Own Aging, and Lonely Dissatisfaction, utilizing 17 of the original items. These results were compared with other multi-dimensional measures of morale: the Bradburn Affect Balance Scale, and morale scales reported by Pierce and Clark, and Schooler. In addition to the dimensions derived from the current study related domains of self-rated health, social accessibility, generalized attitude toward aging, and positive affect were suggested as worthy of further exploration as dimensions of morale.
The purpose of this study was to determine whether walking is associated with a reduced risk of cardiovascular disease hospitalization and death in community-dwelling older men and women.
A prospective study, with follow-up time of 4 to 5 years (average 4.2 years).
A western Washington health maintenance organization.
Men and women aged 65 years and older from a random sample of HMO enrollees invited by mail to participate in a health promotion intervention trial (36% accepted the invitation and completed questionnaires). This report is based on 1645 older adults without severe disability and without history of heart disease. Vital status ascertainment was complete (100%), and only 2.6% did not complete the follow-up.
Reported frequency and duration of walking for exercise, work, errands, pleasure, and hiking in the 2 weeks before baseline were used to classify hours of walking per week. The two main outcomes were: (1) cardiovascular disease hospitalizations with a discharge diagnosis of coronary (ICD-9-CM 410-414) or other cardiovascular diseases (ICD-9-CM 390-409, 415-448) documented by computerized hospitalization records and (2) death. Numerous potential confounding factors were considered, including age, sex, treated high blood pressure, current estrogen use and chronic disease score (ascertained by computerized medical and pharmacy records), and ethnicity, education, income, physical function, self-rated health status, smoking, alcohol intake, and body mass index (ascertained by self-report on the mailed questionnaire).
Walking more than 4 hours/week was associated significantly with a reduced risk of cardiovascular disease hospitalization in both sexes combined compared with walking less than 1 hour/week (age and sex-adjusted relative risk = 0.69; 95% confidence interval, 0.52-0.90). This association was not altered by adjustment for baseline cardiovascular risk factors and indicators of general health status. The association was present in all age groups, among those with and without physical limitations, and also among those who did and did not also participate in more vigorous physical activities. Walking more than 4 hours/week was also associated with a reduced risk of death (age and sex-adjusted relative risk = 0.73; 95% confidence interval, 0.48-1.10), however, this association was substantially diminished by adjustment for cardiovascular risk factors and measures of general health status.
Walking more than 4 hours/week may reduce the risk of hospitalization for cardiovascular disease events. The association of walking more than 4 hours/week with reduced risk of death may be mediated by effects of walking on other risk factors. These findings provide much stronger evidence than previously available for advising older men and women to embark on or maintain a sustained program of walking to prevent cardiovascular disease events.
To measure expectations regarding aging among community-residing-older adults, identify characteristics associated with having low expectations regarding aging, and examine whether expectations regarding aging are associated with healthcare-seeking beliefs for age-associated conditions.
Self-administered mail survey.
Greater Los Angeles.
Four hundred twenty-nine of 588 (73%) randomly selected community-residing adults aged 65 to 100 (mean age 76) cared for by 20 primary care physicians; 54% were women, and 76% were white.
The Expectations Regarding Aging Survey, a validated survey measuring expectations regarding aging; 13 items measuring care seeking beliefs; and validated measures of health status.
More than 50% of participants felt it was an expected part of aging to become depressed, to become more dependent, to have more aches and pains, to have less ability to have sex, and to have less energy. After adjusting for sociodemographic and health characteristics using multivariate regression, older age was independently associated with lower expectations regarding aging (P <.001), as was having lower physical and mental health-related quality of life. Having lower expectations regarding aging was independently associated with placing less importance on seeking health care (P =.049).
Most older adults in this sample did not expect to achieve the model of successful aging in which high cognitive and physical functioning is maintained. Older age was independently associated with lower expectations regarding aging. Furthermore, having low expectations regarding aging was independently associated with not believing it important to seek health care.
There is no consensus on how to define successful aging. The authors sought to determine the correlates of self-rated successful aging as well as its correspondence with major researcher-defined criteria.
Participants were 205 community-dwelling adults over age 60. A questionnaire survey asked the participants to rate their own degree of successful aging and inquired about demographic characteristics, medical history, activity levels, resilience, daily functioning, and health-related quality of life (Medical Outcomes study 36-item Short-Form [MOS-SF-36]). Participants' subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined.
Ninety-two percent of the participants rated themselves as aging successfully. A majority of them also met other research criteria for successful aging such as independent living, mastery/growth, and positive adaptation but not those requiring an absence of chronic medical illness or physical disability. Higher SF-36 scores as compared with a published sample indirectly corroborated participants' subjectively rated successful aging. Subjective ratings of successful aging were significantly correlated with higher scores on health-related quality of life as well as resilience, greater activity, and number of close friends but not with several demographic characteristics.
Most community-dwelling older adults viewed themselves as aging successfully despite having chronic physical illnesses and some disability. Longitudinal studies of the reliability and validity of subjective ratings of successful aging are warranted.
We considered whether positive and stable self-stereotypes of stigmatized group members can influence functioning (in contrast, stereotype threat theory suggests these influential self-stereotypes are limited to ones that are negative and situational). Specifically, we examined older individuals' positive age stereotypes after a life-threatening event, an acute myocardial infarction (AMI). Sixty-two persons, aged 50 to 96, participated. As expected, positive age stereotypes were found, even immediately after an AMI, and they did not significantly change over the next seven months. Also as expected, these self-stereotypes predicted physical recovery, after adjusting for potentially relevant covariates. Recovery expectations acted as a mediator. These findings suggest the importance of understanding the role that positive stereotypes may play in the health of stigmatized group members.
Medication nonadherence may reduce the effectiveness of therapies. To our knowledge, the association between medication nonadherence and mortality remains unexplored outside the context of clinical trials.
A retrospective cohort study of 11 532 patients with diabetes mellitus in a managed care organization. Medication adherence was calculated as the proportion of days covered for filled prescriptions of oral hypoglycemics, antihypertensives, and statin medications. The primary outcomes of interest were all-cause hospitalization and all-cause mortality. Multivariable regression analyses were performed to assess the independent association between medication adherence and outcomes.
Nonadherent patients (proportion of days covered, <80%; prevalence, 21.3%) were younger and had fewer comorbidities compared with adherent patients. During follow-up, nonadherent patients had higher glycosylated hemoglobin, systolic and diastolic blood pressure, and low-density lipoprotein cholesterol levels. In unadjusted analyses, nonadherent patients had higher all-cause hospitalization (23.2% vs 19.2%, P<.001) and higher all-cause mortality (5.9% vs 4.0%, P<.001). In multivariable analyses, medication nonadherence remained significantly associated with increased risks for all-cause hospitalization (odds ratio, 1.58; 95% confidence interval, 1.38-1.81; P<.001) and for all-cause mortality (odds ratio, 1.81; 95% confidence interval, 1.46-2.23; P<.001). The findings were consistent across patient subgroups and using different cutoffs for the proportion of days covered.
Medication nonadherence is prevalent among patients with diabetes mellitus and is associated with adverse outcomes. Interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.
Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.
We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.
We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims).
The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory.
Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.
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