Possible selves and illness: A comparison of individuals with Parkinson's disease, early-stage Alzheimer's disease, and healthy older adults

Advance care planning: End-of-life hopes and fears among community dwelling adults

End-of-life (EOL) medical care in the United States often does not align with patients' goals and preferences. This study explored EOL hopes and fears among 86 community-dwelling adults and examined medical and psychological predictors of death anxiety. Common EOL hopes included absence of suffering, closure, and personal fulfillment. Common EOL fears included suffering, lack of competence, and specific types of death. Fear of the dying process was greater than fear of death itself. Health predicted death anxiety; age alone, did not. Advance care planning and clinical decision making should include these psychological insights and explicitly address EOL hopes and fears.

Women's Self-Relevant Goal Pursuit in the Presence of Physical Pain: An Intraindividual Variability Approach

OBJECTIVES

Pursuing personal goals that are relevant to one's sense of self is important for adjusting to age-related changes. Experiences of physical pain, however, are thought to threaten both people's sense of self and their pursuit of personal goals. Although a majority of older women experience physical pain, little is known about their day-to-day regulation of their self-relevant goals in the presence of physical pain. The objectives of this study were to explore associations between physical pain and health goal pursuit on a daily basis for women who identified health as a part of their possible selves.

METHODS

We took an intraindividual variability approach to analyze whether there were within- and between-person differences in associations between daily pain and daily health goal progress among 62 women who provided data over the course of 100 days, yielding 4,150 occasions of data.

RESULTS

At the between-person level, women with higher pain on average had lower health goal pursuit on average. At the within-person level, days of higher-than-average pain were associated with lower same-day health goal progress.

DISCUSSION

Our results suggest that pain interrupts regulation of a self-relevant goal at a within-person-not just between-person-daily level. Future work should consider how these daily, within-person, disruptions affect broader identity processes and overall well-being.

A test of a triadic conceptualization of future self-identification

People encounter intertemporal decisions every day and often engage in behaviors that are not good for their future. One factor that may explain these decisions is the perception of their distal future self. An emerging body of research suggests that individuals vary in how they perceive their future self and many perceive their future self as a different person. The present research aimed to (1) build on and extend Hershfield's et al. (2011) review of the existing literature and advance the conceptualization of the relationship between the current and future self, (2) extend and develop measures of this relationship, and (3) examine whether and how this relationship predicts intrapsychic and achievement outcomes. The results of the literature review suggested that prior research mostly focused on one or two of the following components: (a) perceived relatedness between the current and future self in terms of similarity and connectedness, (b) vividness in imagining the future self, and (c) degree of positivity felt toward the future self. Additionally, differences in how researchers have labeled the overall construct lead us to propose future self-identification as a new label for the three-component construct. Our research built on existing measures to test the validity of a three-component model of future self-identification. Across three samples of first-year undergraduates, this research established the psychometric properties of the measure, and then examined the relationships between the components and four outcome domains of interest: (1) psychological well-being (self-esteem, hope), (2) imagination of the future (visual imagery of future events, perceived temporal distance), (3) self-control, and (4) academic performance. We demonstrated that the three components of future self-identification were correlated but independent factors. Additionally, the three components differed in their unique relationships with the outcome domains, demonstrating the utility of measuring all three components of future self-identification when seeking to predict important psychological and behavioral outcomes.

An Examination of Age-Based Stereotype Threat About Cognitive Decline

"Stereotype threat" is often thought of as a singular construct, with moderators and mechanisms that are stable across groups and domains. However, this is not always true. To illustrate this, the current review focuses on the stereotype threat that older adults face about their cognitive abilities. Drawing upon the multithreat framework, I first provide evidence that this is a self-concept threat and not a group-reputation threat. Because this differs from the forms of stereotype threat experienced by other groups (e.g., the threat that minority students face about their intellectual abilities), the moderators of stereotype threat observed in other groups (i.e., group identification) do not always generalize to age-based stereotype threat about cognitive decline. Looking beyond the forms of stereotype threat elicited, this review also provides evidence that the mechanisms underlying stereotype-threat effects may vary across the adult life span. Because of age-related improvements in emotion-regulation abilities, stereotype threat does not seem to reduce older adults' executive-control resources. Overall, this review highlights the need to approach the concept of stereotype threat with more granularity, allowing researchers to design more effective stereotype-threat interventions. It will also shed light on why certain stereotype threat effects "fail to replicate" across domains or groups.

Present and future selves in Parkinson's disease

The study of the self in neuropsychological patients raises not only theoretical questions on the relationships between the self, autobiographical memory (AM), and episodic future thinking but also clinical issues for patients' daily life and care. We addressed this issue in Parkinson's disease patients for whom AM and future thinking impairments have been documented. All patients and controls generated and dated up past and future self-images and provided associated past and future events. Our findings suggest a subtle pattern of preservation/impairment of different dimensions (quantitative and qualitative) of self-images, which rely partially on the episodic quality of past and future events.

Cost of Living with Parkinson's Disease over 12 Months in Australia: A Prospective Cohort Study

Background. Parkinson disease (PD) is a costly chronic condition in terms of managing both motor and nonmotor symptoms. The burden of disease is high for individuals, caregivers, and the health system. The aim of this study is to estimate the annual cost of PD from the household, health system, and societal perspectives. Methods. A prospective cohort study of newly referred people with PD to a specialist PD clinic in Melbourne, Australia. Participants completed baseline and monthly health resource use questionnaires and Medicare data were collected over 12 months. Results. 87 patients completed the 12-month follow-up assessments. The mean annual cost per person to the health care system was $32,556 AUD. The burden to society was an additional $45,000 per annum per person with PD. The largest component of health system costs were for hospitalisation (69% of total costs). The costs for people with moderate to severe disease were almost 4 times those with mild PD ($63,569 versus $17,537 p < 0.001). Conclusion. PD is associated with significant costs to individuals and to society. Costs escalated with disease severity suggesting that the burden to society is likely to grow with the increasing disease prevalence that is associated with population ageing.

How do people in the early stage of Alzheimer’s disease see their future?

Older people fear Alzheimer’s disease. Central to the fear of the disease is the dread of the loss of identity or self. The aim of this study is to investigate the thoughts people in an early stage of Alzheimer’s disease have about their future selves, and the consequences these thoughts have for their temporary lives. The concepts of future and self are understood in terms of the concepts ‘possible selves’ and ‘selfhood’. The participants in the study are two men in their early 60 s. The data consist of four individual interviews and 11 facilitated family conversations including two of their next of kin. The data were collected over a two-year period. The data were interpreted using a hermeneutic analysis inspired by Gadamer. The main findings were the efforts made by the participants to live in the present and their worries about a future as ‘living dead’.

Possible Selves and Self-Regulatory Beliefs: Exploring the Relationship Between Health Selves, Health Efficacy, and Psychological Well-Being

The present study identified middle-aged (ages 40-64) and older individuals (ages 65-90) who reported a highly important possible self related to health. The relationship between age, physical health, health efficacy, and psychological well-being were examined among these individuals. We tested a model in which health efficacy predicted both positive and negative psychological well-being. For both age groups, self-reported health predicted health self-efficacy; however, the direct effects of health efficacy on both positive and negative psychological well-being were also significant. Higher levels of health efficacy were associated with higher levels of positive psychological well-being and lower levels of negative well-being, as predicted. Physical health indirectly predicted well-being through its impact on health self-efficacy for middle-aged and older individuals who valued their health highly. Overall, these results support the notion that health efficacy related to a most important health self is a predictor of psychological well-being in mid and late life.

Possible selves and depressive symptoms in later life

The pursuit of personal goals has been linked to general psychological well-being; however, less is known about the association with depression in later adulthood when individuals are contending with age-related changes in health and social relationships. We explored the connection between both health- and social related goals (as measured by possible selves) and depressive symptoms in a sample of 85 community-dwelling older adults who ranged in age from 60 to 92 (M = 74, standard deviation = 7.5). Participants took part in face-to-face, semistructured interviews in which they responded to measures of possible selves (future images of oneself), health, and depressive symptoms. We found that the presence of health-related, but not social-related, possible selves was significantly associated with fewer reported depressive symptoms. Additionally, the presence of health-related fears was specifically linked to fewer reported depressive symptoms. These findings suggested that the promotion of and investment in health-related personal goals may be useful in off-setting depressive symptoms in older adults, as well as indicated a potential benefit of a disease prevention focus regarding health in later life. Finally, the results may have implications for potential clinical interventions in addressing late-life depression.

The experience of Parkinson's disease: a systematic review and meta-ethnography

There has been little attempt to summarise and synthesise qualitative studies concerning the experience and perception of living with Parkinson's disease. Bringing this information together would provide a background to understand the importance of an individual's social identity on their well-being and hope. Three primary aims were identified (a) understanding the importance of social identity and meaningful activities on individuals' well-being, (b) identifying factors and strategies that influence well-being and hope, and (c) establishing a model that relates to an individual's hope and well-being. Three stages were undertaken including a traditional electronic search, a critical appraisal of articles, and a synthesis of studies. Qualitative articles were included that considered the experience of living with Parkinson's disease. Thirty seven articles were located and included in the review. Five themes were identified and the themes were used to inform development of a new model of hope enablement. The current review furthered understanding of how physical symptoms and the experience of Parkinson's disease affect the individual's well-being and hope. Social identity was established as a key factor that influenced an individual's well-being. Being able to maintain, retain, or develop social identities was essential for the well-being and hope of individuals with Parkinson's disease. Understanding the factors which prevent or can facilitate this is essential.

Social possible selves, self-regulation, and social goal progress in older adulthood

Lifespan development involves setting and pursuing self-guided goals. This study examines how in the social domain, possible selves, a future-oriented self-concept, and self-regulation, including self-regulatory beliefs and intraindividual variability in self-regulatory behavior, relate to differences in overall daily social goal progress. An online older-adult sample worked towards a self-defined meaningful social goal over 100 days. Multilevel analysis showed that participants with social possible selves made higher overall daily goal progress, especially those with both hoped-for and feared possible selves, than those with possible selves in nonsocial domains. Self-regulatory beliefs were positively whereas variability was negatively associated with overall daily goal progress. The findings suggest that possible selves, in combination with two distinct self-regulatory constructs, significantly guide social goal progress.

A lines-of-defense model for managing health threats: a review

As older individuals face challenges of progressive disease and increasing disability and approach the end of their lives, their capacity for controlling their environment and own health and functioning declines. The Lines-of-Defense Model is based on the Motivational Theory of Life-Span Development and proposes that individuals can adjust their control striving to the progressive physical decline in distinctly organized cycles of goal engagement and goal disengagement that reflect sequentially organized lines of defense. This organized process allows individuals to hold onto and defend still feasible levels of physical health and functioning in activities of daily living, while adjusting to increasing impairments. As physical constraints become more severe towards the end of life, avoiding psychological suffering becomes the focus of individuals' strivings for control. The Lines-of-Defense Model can also be applied to the inverse process of growth in functioning during recovery and rehabilitation.

Conceptualisation of self-management intervention for people with early stage dementia

Dementia is a major challenge for health and social care services. People living with dementia in the earlier stages experience a "care-gap". Although they may address this gap in care, self-management interventions have not been provided to people with dementia. It is unclear how to conceptualise self-management for this group and few published papers address intervention design. Initial focusing work used a logic mapping approach, interviews with key stakeholders, including people with dementia and their family members. An initial set of self-management targets were identified for potential intervention. Self-management for people living with dementia was conceptualised as covering five targets: (1) relationship with family, (2) maintaining an active lifestyle, (3) psychological wellbeing, (4) techniques to cope with memory changes, and (5) information about dementia. These targets were used to focus literature reviewing to explore an evidence base for the conceptualisation. We discuss the utility of the Corbin and Strauss (Unending work and care: managing chronic illness at home. Jossey-Bass, Oxford, 1988) model of self-management, specifically that self-management for people living with dementia should be conceptualised as emphasising the importance of "everyday life work" (targets 1 and 2) and "biographical work" (target 3), with inclusion of but less emphasis on specific "illness work" (targets 4, 5). We argue that self-management is possible for people with dementia, with a strengths focus and emphasis on quality of life, which can be achieved despite cognitive impairments. Further development and testing of such interventions is required to provide much needed support for people in early stages of dementia.

School Success and School Engagement of Immigrant Children and Adolescents

Academic achievement in immigrant children and adolescents is an indicator of current and future adaptive success. Since the future of immigrant youths is inextricably linked to that of the receiving society, the success of their trajectory through school becomes a high stakes issue both for the individual and society. The present article focuses on school success in immigrant children and adolescents, and the role of school engagement in accounting for individual and group differences in academic achievement from the perspective of a multilevel integrative model of immigrant youths’ adaptation ( Motti-Stefanidi, Berry, Chryssochoou, Sam, & Phinney, 2012 ). Drawing on this conceptual framework, school success is examined in developmental and acculturative context, taking into account multiple levels of analysis. Findings suggest that for both immigrant and nonimmigrant youths the relationship between school engagement and school success is bidirectional, each influencing over time the other. Evidence regarding potential moderating and mediating roles of school engagement for the academic success of immigrant youths also is evaluated.

Feasibility and acceptance of a nonpharmacological cognitive remediation intervention for patients with Parkinson disease

Many patients with idiopathic Parkinson disease (PD) experience deficits in executive skills (ES; eg, attentional control, self-monitoring), which are associated with a range of impairing symptoms such as visual hallucinations, decreased motor control, and increased apathy. Pharmacological methods for improving ES in PD have shown to be somewhat unreliable. The goal of this study was to evaluate the feasibility and patient acceptance of a nonpharmacological cognitive remediation program that aimed to improve sustained, selective, alternating, and divided attentional abilities in a sample of 16 nondemented PD patients. Based on ratings of 4 feasibility dimensions (fatigue, effort, progress, enjoyment), patients with PD demonstrated a high degree of acceptance and successfully engaged in the program. As predicted, ratings of progress differed significantly across tasks according to difficulty level and were positively related to posttraining improvement in ES. Fatigue ratings showed negative associations with other indices across task types, suggesting that monitoring fatigue during cognitive remediation is essential. Patients' ratings of enjoyment did not correspond to task difficulty, indicating that tasks could be simultaneously challenging and rewarding. Males reported exerting greater effort during the training than females. It was concluded that the intervention is appropriate for testing in a randomized controlled trial.

An interpretative phenomenological analysis of delusions in people with Parkinson's disease

PURPOSE

The aim of this qualitative study was to explore what delusional experiences mean for people with Parkinson's disease (PD) and to examine how psychosocial factors contribute to the development and maintenance of delusional beliefs.

METHOD

Eight participants were interviewed, and interpretative phenomenological analysis was used to identity themes within their accounts. Participants were either recruited from a hospital-based outpatient movement disorder clinic or from a PD support group in the north-west of England.

RESULTS

Four themes emerged from the analysis: (1) 'I got very frightened': The emotional experience associated with delusions; (2) 'Why the hell's that happening?': Sense of uncertainty and of losing control; (3) 'I feel like I'm disintegrating': Loss of identity and sense of self; (4) 'I've just tried to make the best of things': Acceptance and adjustment to experience of delusions. These interconnected themes in participants' accounts of delusional beliefs were reflected in their descriptions of living with, and adjusting to, PD.

CONCLUSIONS

The results of this study add to the evidence base indicating the urgent examination of psychological alternatives to conventional, medication-based approaches to alleviating the distress caused by delusions in people with PD.

Late-midlife and older couples' shared possible selves and psychological well-being during times of illness: the role of collaborative problem solving

We investigated associations between spouses' shared possible selves and well-being as a function of their perceptions of collaboration in 61 late-midlife (M = 60 years) and older (M = 72 years) couples dealing with prostate cancer. Spouses completed assessments of possible selves (with shared selves defined as possible selves portraying a similar goal across spouses), psychological well-being, and enjoyment and frequency of collaboration. Associations between shared selves and better well-being occurred through better enjoyment of collaboration regardless of age (after controlling for marital quality and subjective health). An interaction revealing that shared selves were associated with better well-being only with frequent collaboration was obtained with older couples but was not found in late-midlife couples.

A Novel Approach to Treating Anxiety and Enhancing Executive Skills in an Older Adult with Parkinson's Disease

Scientific interest in the nonmotoric symptoms of Parkinson's disease (PD) has increased dramatically, and psychiatric symptoms (e.g., cognitive impairment, anxiety and mood disorders) are now considered prime targets for treatment optimization. Psychiatric complications in PD are quite common, affecting as many as 60 to 80% of patients. This study describes the case of a 74 year-old male with PD who presented with complaints of anxiety and trouble with memory and attention. A combined cognitive behavior therapy and cognitive enhancement intervention was delivered in ten 90-to-120 minute sessions. The patient showed a reduction in anxiety symptoms that was of sufficient magnitude to meet criteria for 'responder' status. His cognitive skills were mostly unchanged, despite the rigorous rehabilitation practice. Implications for treatment and strategies for enhancing therapeutic benefits are discussed.

Linking Possible Selves and Behavior: Do Domain-Specific Hopes and Fears Translate Into Daily Activities in Very Old Age?

We used time-sampling information from a subsample of the Berlin Aging Study (N=83; M=81.1 years) to investigate the link between possible selves in three domains (health, everyday cognition, and social relations) and performance of daily activities. In the domains of health and social relations, hoped-for selves were associated with higher probabilities of performing daily activities in those domains. There were no associations in the cognitive domain or between feared selves and activities. Individuals who engaged in hope-related activities reported concurrent higher positive affect and subsequently had a higher probability of survival over a 10-year period. These findings speak to important associations between beliefs about possible selves and activities in advanced old age and the value of considering associations between microlevel and macrolevel indicators of successful aging.

Possible selves of individuals with Alzheimer's disease

This study is one of the first to examine self-goals and their relationship to affect among individuals with Alzheimer's disease (AD). Using the construct of possible selves, the authors collected data from 50 participants with mild to moderate AD and 50 demographically similar cognitively intact older adults. Findings suggest a resourcefulness and flexibility of the self-system in response to the presence of dementia-related concerns. Positive affect was associated with family-related self-goals of AD participants, indicating particular importance of this domain. Some of these responses may represent goal modifications that result in a more satisfactory adjustment to the illness; further inquiry may lead to a better understanding of resiliency and quality of life in persons with AD.

Personality reconsidered: a new agenda for aging research

The purpose of this article is to introduce a newly emerging model of personality that integrates structures and processes within a levels-of-analysis framework. This model, labeled the six foci of personality, includes traits, personal action constructs, and life stories as structural components, and it includes states, self-regulation, and self-narration as the parallel process constructs. Conceptual and methodological issues are discussed in relation to this model, and each of the six foci is reviewed for its relevance to personality and aging. It is argued that the model provides a framework so that the research base in each of the six focal areas can be nurtured, solidified, and organized-ultimately contributing to a more integrative, comprehensive understanding of personality and its importance over the life span.