Life satisfaction, distress, and resiliency across the life span of women

Does psychological distress vary between younger and older adults in health and disease?

OBJECTIVE

The effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made.

METHODS

In 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (<65, N=1040) and older (≥65, N=428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models.

RESULTS

Among the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p=.026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p=.016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis.

CONCLUSIONS

Medical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.

Association between higher levels of sexual function, activity, and satisfaction and self-rated successful aging in older postmenopausal women

OBJECTIVES

To determine whether measures of successful aging are associated with sexual activity, satisfaction, and function in older postmenopausal women.

DESIGN

Cross-sectional study using self-report surveys; analyses included chi-square and t-tests and multiple linear regression analyses.

SETTING

Community-dwelling older postmenopausal women in the greater San Diego region.

PARTICIPANTS

One thousand two hundred thirty-five community-dwelling women aged 60 to 89 participating at the San Diego site of the Women's Health Initiative.

MEASUREMENTS

Demographic information and self-reported measures of sexual activity, function, and satisfaction and successful aging.

RESULTS

Sexual activity and functioning (desire, arousal, vaginal tightness, use of lubricants, and ability to climax) were negatively associated with age, as were physical and mental health. In contrast, sexual satisfaction and self-rated successful aging and quality of life remained unchanged across age groups. Successful aging measures were positively associated with sexual measures, especially self-rated quality of life and sexual satisfaction.

CONCLUSION

Self-rated successful aging, quality of life, and sexual satisfaction appear to be stable in the face of declines in physical health, some cognitive abilities, and sexual activity and function and positively associated with each other from age 60 to 89.

Prospective association between self-reported life satisfaction and mortality: results from the MONICA/KORA Augsburg S3 survey cohort study

Background

To identify factors which determine high life satisfaction (LS) and to analyse the prognostic influence of LS on mortality.

Methods

Data collection was conducted on 2,675 participants, age 25-74 years, as part of the MONICA Augsburg Project 1994-95. Multivariate logistic regression analyses were used to determine factors associated with high LS (measured with one item, 6-level Likert scale, where "high" = very satisfied/most of the time very satisfied with ones personal life). After 12 years mean follow-up, a total of 245 deaths occurred. We calculated age- and sex-adjusted incident mortality rates per 10,000. Hazard ratios (HRs) were estimated from Cox proportional hazards models.

Results

Independent determinants of LS were income, health-perception, and social support, as well as somatisation, anger or depressive symptoms (all p < 0.05). Participants with higher LS (n = 721, 27%) benefited the most with respect to absolute mortality risk reduction (higher LS = 67; mid = 98; low = 140 per 10,000). The sex-stratified analyses indicated an independent association of higher LS and survival for men (HR 0.55; 95% CI 0.37 - 0.81) but not for women.

Conclusions

Baseline assessment demonstrated that psychological, social and life-style factors, but not somatic co-morbidities, were relevant determinants of LS. Moreover, the analysis showed that men with higher LS have a substantial long-term survival benefit. The observed association between LS and mortality may be attributed to common underlying causes such as social network integration and/or self-rated health.

Alters- und geschlechtspezifische Neunormierung der Fragen zur Lebenszufriedenheit (FLZM) für die Altersspanne von 14 bis 64 Jahre

Zusammenfassung. Theoretischer Hintergrund: Der FLZM-Fragebogen (Fragen zur Lebenszufriedenheit) ist ein ökonomisches, reliables Verfahren zur Erfassung der allgemeinen Lebenszufriedenheit. Fragestellung: Die vorhandenen Normwerte sind über 10 Jahre alt, zudem fehlen bislang Angaben über Prozentränge. Methode: Die vorliegende Studie stellt eine alters- und geschlechtsspezifische Neunormierung anhand einer bevölkerungsrepräsentativen Stichprobe aus Deutschland für den Altersbereich 14 bis 64 Jahre vor (N = 3877). Ergebnisse: Mittelwerte, Standardabweichungen, Trennschärfeindices und Prozentränge werden für Alter und Geschlecht getrennt berichtet. Die Ergebnisse zeigen gute interne Konsistenzen für die gewichtete (Cronbachs Alpha = 0,83) wie auch für die ungewichtete Lebenszufriedenheit (Cronbachs Alpha = 0,82). Schlussfolgerungen: Für die FLZM liegen aktualisierte Normdaten vor. Für einen Einsatz des Messinstruments können nun aktuelle Vergleichsdaten der gesamtdeutschen Bevölkerung zwischen 14–64 Jahren herangezogen werden.

Retrospective agreement and consent to neurocritical care is influenced by functional outcome

INTRODUCTION

Only limited data are available on consent and satisfaction of patients receiving specialized neurocritical care. In this study we (i) analyzed the extent of retrospective consent to neurocritical care--given by patients or their relatives--depending on functional outcome one year after hospital stay, and (ii) identified predisposing factors for retrospective agreement to neurocritical care.

METHODS

We investigated 704 consecutive patients admitted to a nonsurgical neurocritical care unit over a period of 2 years (2006 through 2007). Demographic and clinical parameters were analyzed, and the patients were grouped according to their diagnosis. Functional outcome, retrospective consent to neurocritical care, and satisfaction with hospital stay was obtained by mailed standardized questionnaires. Logistic regression analyses were calculated to determine independent predictors for consent.

RESULTS

High consent and satisfaction after neurointensive care (91% and 90%, respectively) was observed by those patients who reached an independent life one year after neurointensive care unit (ICU) stay. However, only 19% of surviving patients who were functionally dependent retrospectively agreed to neurocritical care. Unfavorable functional outcome and the diagnosis of stroke were independent predictors for missing retrospective consent.

CONCLUSIONS

Retrospective agreement to neurocritical care is influenced by functional outcome. Especially in severely affected stroke patients who cannot communicate their preferences regarding life-sustaining therapy, neurocritical care physicians should balance the expected burdens and benefits of treatment to meet the patients' putative wishes. Efforts should be undertaken to identify predictors for severe disability after neurocritical care.

Assessment of self-esteem in mid-aged women

OBJECTIVE

To assess self-esteem and affecting factors in a middle-aged Ecuadorian female population using the Rosenberg Self-Esteem Scale (RSES).

STUDY DESIGN

This was a cross-sectional study in which 149 women (40-59 years) were requested to fill out the RSES and a general socio-demographic form containing personal and partner data.

RESULTS

Mean age of sample was 47.6+/-5.5 years, a 67.8% had less than 12 years of schooling and 33.6% were postmenopausal. At the moment of the survey 2.7% were on hormone therapy, and 2% were taking psychotropic drugs. Mean total RSES score was 26.6+/-3.1 (median 26, range 17-35). A 35.6% and 18.1% of women respectively presented total RSES scores below 26 (median) and 25 (25th percentile) suggesting lower self-esteem. Total scores did not differ when comparing older age, menopausal phases or time since the menopause. Logistic regression analysis determined that women with lower parity and an unhealthy partner were related to lower total RSES scores (below the 25th percentile) suggesting lower self-esteem.

CONCLUSIONS

In this mid-aged series lower self-esteem was not related to the aging process per se yet to socio-demographic female/male aspects. More research is needed in this regard that incorporates other sociological aspects.