A decade of research using the CASP scale: key findings and future directions

Time, age, gender and cultural measurement invariance of the CASP-12, a measure of psychological quality of life in adulthood

PURPOSE

Whereas Quality of Life in older populations has long been conceptualized in regards to health or illness, the Control, Autonomy, Self-Realization and Pleasure scale (CASP-12) focuses on the positive facets of aging. Although the CASP is a widely used scale, its measurement invariance has seldom been examined. The present study aims to ascertain the measurement invariance of the CASP-12 over a period of 10 years and between age, culture and gender.

METHODS

Secondary data analyses were conducted on the longitudinal data collected in four waves between 2006 and 2016-2017 of the Survey of Health, Ageing and Retirement in Europe study (SHARE). The factorial validity of the CASP-12 was examined and its measurement invariance was tested with a sample of 3684 men and 4955 women aged 30-99 years, coming from 10 different European countries.

RESULTS

Results showed a strong theoretical and empirical dimensionality of the CASP-12, a well as invariance of time (10 years), age and culture. It was also found that the scale is gender invariant at the strict level. These results were replicated with two more waves of SHARE, measured six years apart.

CONCLUSION

This study replicates the CASP-12 dimensional structure, factorial structure and factor loadings. The scale has demonstrated to be a reliable and valid measurement of the positive aspects of quality of life to be used across time, age, gender and culture. The Autonomy dimension of the scale warrants further investigation.

Stability and Change in Mental Health Profiles from Middle Adulthood to Very Old Age

OBJECTIVES

This study investigates mental health (MH) through the dual-factor model, emphasizing both well-being and ill-being. Our objectives were to (1) identify MH profiles based on this model; (2) track these profiles over time; and (3) explore socio-demographic and physical health factors associated with these profiles.

METHODS

We employed Latent Transition Analysis on data from 5,561 individuals aged 39-92, using two waves from the Survey of Health, Ageing, and Retirement in Europe. Well-being was assessed via life satisfaction and quality of life, while ill-being was measured through depression and loneliness. The predictors were socio-demographic and physical health variables.

RESULTS

Four distinct MH profiles emerged, each with unique levels of well-being and ill-being. Stability was more common in adaptive profiles. Physical health was key in predicting transition.

CONCLUSIONS

Identifying MH profiles in old age enhances our understanding of how MH adapts with aging. This approach reveals the complexity of MH beyond traditional ill-being, underscoring the importance of well-being.

CLINICAL IMPLICATIONS

• The majority of older adults maintain good MH, suggesting a need for a paradigm shift toward enhancing well-being rather than solely treating ill-being.• Effective MH interventions should integrate both well-being and ill-being assessments to offer understanding and support.

Associations of psychological wellbeing with COVID-19 hospitalization and mortality in adults aged 50 years or older from 25 European countries and Israel

Background

Lower psychological wellbeing is associated with poor outcomes in a variety of diseases and healthy populations. However, no study has investigated whether psychological wellbeing is associated with the outcomes of COVID-19. This study aimed to determine whether individuals with lower psychological wellbeing are more at risk for poor outcomes of COVID-19.

Methods

Data were from the Survey of Health, Aging, and Retirement in Europe (SHARE) in 2017 and SHARE's two COVID-19 surveys in June-September 2020 and June-August 2021. Psychological wellbeing was measured using the CASP-12 scale in 2017. The associations of the CASP-12 score with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, body mass index, smoking, physical activity, household income, education level, and chronic conditions. Sensitivity analyses were performed by imputing missing data or excluding cases whose diagnosis of COVID-19 was solely based on symptoms. A confirmatory analysis was conducted using data from the English Longitudinal Study of Aging (ELSA). Data analysis took place in October 2022.

Results

In total, 3,886 individuals of 50 years of age or older with COVID-19 were included from 25 European countries and Israel, with 580 hospitalized (14.9%) and 100 deaths (2.6%). Compared with individuals in tertile 3 (highest) of the CASP-12 score, the adjusted odds ratios (ORs) of COVID-19 hospitalization were 1.81 (95% CI, 1.41-2.31) for those in tertile 1 (lowest) and 1.37 (95% CI, 1.07-1.75) for those in tertile 2. As for COVID-19 mortality, the adjusted ORs were 2.05 (95% CI, 1.12-3.77) for tertile 1 and 1.78 (95% CI, 0.98-3.23) for tertile 2, compared with tertile 3. The results were relatively robust to missing data or the exclusion of cases solely based on symptoms. This inverse association of the CASP-12 score with COVID-19 hospitalization risk was also observed in ELSA.

Conclusion

This study shows that lower psychological wellbeing is independently associated with increased risks of COVID-19 hospitalization and mortality in European adults aged 50 years or older. Further study is needed to validate these associations in recent and future waves of the COVID-19 pandemic and other populations.

Derivation, and establishment of the validity and reliability, of the CASP-11-SG quality of life scale among community-dwelling older adults

PURPOSE

The number and proportion of older adults, aged ≥ 60 years, in Singapore is rapidly increasing. A valid and reliable quality of life (QoL) measure will enable assessment of their situation and help evaluate social and clinical interventions, potentially improving care. This study aims to evaluate the validity and reliability of the control, autonomy, self-realization, and pleasure (CASP)-12v.3 QoL scale and establish a scale suitable for use among older adults in Singapore.

METHODS

Data from 3526 community-dwelling older adults from a national survey was used. Measurement properties of the CASP-12v.3 scale were evaluated. Confirmatory factor analysis (CFA; testing single- and two-factor models with residual covariances for negatively worded items and a bifactor model) was performed in half of the sample and exploratory factor analysis (EFA) was performed in the other half. The results led to revised CFA models and the CASP-11-SG scale. The CASP-11-SG scale's measurement properties, convergent, and known-groups validity, and measurement equivalence/invariance (ME/I) across English and Chinese languages were evaluated.

RESULTS

Item 3 'I feel free to plan for the future' of the CASP-12v.3 scale had low correlation with other items of the control/autonomy subscale, low item-total correlation and high item-scale correlation. While CFA and EFA supported the two-factor model, removing item 3 improved model fit. The resulting CASP-11-SG scale (Cronbach's alpha: 0.81) demonstrated convergent and known-groups validity and partial ME/I across English and Chinese languages.

CONCLUSION

The CASP-11-SG scale, with satisfactory psychometric properties, can be used for assessing QoL among older adults in Singapore.

Multimorbidity and its socio-economic associations in community-dwelling older adults in rural Tanzania; a cross-sectional study

Objectives

This paper aims to describe the prevalence and socio-economic associations with multimorbidity, by both self-report and clinical assessment/screening methods in community-dwelling older people living in rural Tanzania.

Methods

A randomised frailty-weighted sample of non-institutionalised adults aged ≥ 60 years underwent comprehensive geriatric assessment and in-depth assessment. The comprehensive geriatric assessment consisted of a history and focused clinical examination. The in-depth assessment included standardised questionnaires, screening tools and blood pressure measurement. The prevalence of multimorbidity was calculated for self-report and non-self-reported methods (clinician diagnosis, screening tools and direct measurement). Multimorbidity was defined as having two or more conditions. The socio-demographic associations with multimorbidity were investigated by multiple logistic regression.

Results

A sample of 235 adults participated in the study, selected from a screened sample of 1207. The median age was 74 years (range 60 to 110 inter-quartile range (IQR) 19) and 136 (57.8%) were women. Adjusting for frailty-weighting, the prevalence of self-reported multimorbidity was 26.1% (95% CI 16.7–35.4), and by clinical assessment/screening was 67.3% (95% CI 57.0–77.5). Adjusting for age, sex, education and frailty status, multimorbidity by self-report increased the odds of being financially dependent on others threefold (OR 3.3 [95% CI 1.4–7.8]), and of a household member reducing their paid employment nearly fourfold (OR 3.8. [95% CI 1.5–9.2]).

Conclusions

Multimorbidity is prevalent in this rural lower-income African setting and is associated with evidence of household financial strain. Multimorbidity prevalence is higher when not reliant on self-reported methods, revealing that many conditions are underdiagnosed and undertreated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14340-0.

Routes to retirement, working conditions and quality of life in comparative perspective

An important response to the challenges of ageing populations has been reforms to decrease the economic incentives for early retirement. For individuals with poor working conditions, however, there is a risk that each additional working year may have negative consequences on their quality of life after retirement. Using data from 12 countries and 3000 individuals from the SHARE (Survey of Health, Ageing and Retirement in Europe), this study analyses exit routes from work to retirement in a comparative perspective. Using group-based trajectory modelling, results indicated that poor late-working life working conditions was associated with exit routes with high reliance upon income from different transfer schemes. Using multilevel models, analyses then indicated that the generosity of these transfer schemes has a positive impact on post-retirement quality of life. Limitations and policy implication of the study are discussed at the end.

Associations of recognition at work with subsequent health and quality of life among older working adults

PURPOSE

Recognition for work-an act of conveying non-financial appreciation for an outstanding accomplishment or performance-is the top motivator of employee performance and important contributor to psychologically healthy work. Employee recognition programs are offered by many companies and have been shown to retain top talent, increase job satisfaction, and performance. Yet, evidence on the role of received employee recognition for health and quality of life remains limited. This study examined whether receiving recognition for work was prospectively associated with six indicators of health, quality of life, and loneliness.

METHODS

Data were retrieved from the Survey of Health, Ageing and Retirement in Europe (SHARE), a biennial cross-national panel database of people aged > 50 years. Our sample included 5,048 middle-aged and older working adults.

RESULTS

The results indicated that employees receiving recognition for work reported higher quality of life ([Formula: see text]=0.065, 95% CI = 0.047, 0.082), had lower risks of hypertension (RR = 0.932; 95% CI = 0.899, 0.966) and high blood cholesterol (RR = 0.922; 95% CI = 0.879, 0.967). These associations were independent of demographics, socioeconomic status, personality, prior history of diseases, depression, lifestyle, and work conditions. The set of sensitivity analyses provided substantial evidence for the robustness of the associations between recognition for work and quality of life as well as hypertension but not necessarily with high blood cholesterol.

CONCLUSIONS

Promotion of employee recognition might emerge as a valuable business resource and health policy tool helping middle-aged and older adults maintain health and good quality of life. It may also help willing older adults to remain on the labour market until older age.

Guidelines for performing systematic reviews in sports science

Most of the reviews carried out in sports science have used the general items suggested by Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Due to the specific requirements of each knowledge area, several modifications of the PRISMA are necessary to optimize the process of the systematic reviews and, in consequence, the quality of the conclusions provided in this type of study. Therefore, this work aimed to adapt PRISMA to provide specific guidelines to carry out systematic reviews in sports science. The methodology criteria (search strategy, databases, and eligibility) and the results section (flow diagrams and study contents) were adapted based on previous studies, and several new considerations were added to design the new guidelines. We compiled 28 items suggested by sports science researchers and included two new items: (i) population/problem (i.e., age, level, and country) and (ii) the entire training process, which is monitored and compared between groups (e.g., total training load). To maximize the benefit of this document, we encourage people to read it in conjunction with the PRISMA statement. The main differences between PRISMA and the PRISMA adapted to sports science were related to registration, search strategy, flow diagrams, and results. Application of the new guidelines could improve the information provided to readers and make it easier to generalize and compare the results in sports science.

Social vulnerability, frailty and their association with mortality in older adults living in rural Tanzania

Background

Social vulnerability correlates with frailty and is associated with mortality and disability. However, few studies have investigated this relationship outside of high-income country settings. This study aimed to produce and analyze a culturally adapted social vulnerability index (SVI) to investigate the relationship between social vulnerability, frailty, and mortality in older adults in Tanzania.

Methods

An SVI was produced using data from a cohort study investigating frailty in older adults in Tanzania. Variables were selected based on previous SVI studies using the categories established by Andrew et al. from the Canadian Study of Health and Aging, and National Population Health Survey. The SVI distribution was examined and compared with a frailty index (FI) produced from the same sample, using mutually exclusive variables. Cox regression survival analysis was used to investigate the association between social vulnerability, frailty, and mortality.

Results

A stratified cohort of 235 individuals were included in the study at baseline, with a mean age of 75.2 (SD 11.5). Twenty-six participants died within the follow-up period, with a mean of 503 days (range: 405–568) following the initial assessment. The SVI had a median score of 0.47 (interquartile range: 0.23, range: 0.14–0.86). Social vulnerability significantly predicted mortality when adjusting for age and gender, but not when also adjusting for frailty.

Conclusions

Social vulnerability can be successfully operationalized and culturally adapted in Tanzania. Social vulnerability is associated with mortality in Tanzania, but not independently of frailty.

Incontinência urinária, senso de controle e autonomia, e participação social em idosos residentes na comunidade

Resumo Objetivo Identificar a presença de sintomas de incontinência urinária (IU) e testar um modelo de associações diretas e indiretas com as variáveis psicossociais senso de controle/autonomia e participação social em idosos residentes na comunidade. Método Estudo transversal, realizado com 419 idosos de 72 anos ou mais (70,2% feminino) participantes das medidas de seguimento do Estudo Fibra-Polo Unicamp. Idade, sexo e escolaridade foram as variáveis sociodemográficas selecionadas como antecedentes das relações entre IU e participação social. Senso pessoal de controle e autonomia foi testado como mediador dessas relações em análise de caminhos via método de equações estruturais (Path Analysis). Resultados A IU foi relatada por 38% da amostra, com diferenças significativas entre os sexos (41% feminino versus 31,3% masculino). Foram propostos três níveis de participação social a partir do grau de envolvimento dos indivíduos com a sociedade. O modelo de associações explicou 15% da variância em participação social. Efeitos diretos foram encontrados entre controle e autonomia e participação social. Efeitos indiretos entre escolaridade e participação foram mediados pela presença de IU. Conclusão IU contribuiu para a restrição em participação social em todos os níveis. Controle e autonomia não se mostrou um mediador psicológico para as relações entre IU e participação, embora associada a ambas variáveis. A presença de IU potencializou as relações desvantajosas entre escolaridade e participação social. Enquanto fatores de natureza modificável, iniciativas clínicas e psicossociais sobre IU podem resultar em diminuição de efeitos psicológicos negativos e redução de desigualdades educacionais em participação social.

Urinary incontinence, sense of control/autonomy and social participation in community-dwelling older adults

Abstract Objective Identify the presence of urinary incontinence (UI) symptoms and test a model of direct and indirect associations with the psychosocial variables sense of control/autonomy and social participation in community-dwelling older adults. Method Cross-sectional study conducted with 419 adults aged 72 years or over (70.2% female) participating in the follow-up survey of the FIBRA Study - Polo Unicamp. Age, sex and educational level were the sociodemographic variables selected as antecedents of the relationship between UI and social participation. A sense of control/autonomy was tested as a mediator of these relationships in a path analysis through structural equation modelling. Results UI was reported by 38% of the sample, with significant differences according to sex (41% female versus 31.3% male). Three levels of social participation were proposed, based on the degree of interaction between the individual and society. The model of relationships explained 15% of the variance in social participation. Direct effects were observed between control/autonomy and social participation; indirect effects between education and participation, mediated by the presence of UI. Conclusion UI contributed to restrictions in social participation at all levels. Control/autonomy, although related, did not prove to be a psychological mediator for the relationship between UI and participation. The presence of UI potentialized the disadvantageous relationships between education and social participation. As modifiable factors, the treatment and management of UI through clinical and psychosocial initiatives can act to reduce negative psychological effects and reduce socioeconomic inequalities in social participation.

Reassessing the CASP-19 adapted for Brazilian Portuguese: insights from a population-based study

The study reassessed the configural and metric structures of the Brazilian version of the Control, Autonomy, Self-realization and Pleasure (CASP-19) quality-of-life scale. Data came from the EpiFloripa Ageing Study, which included 1,131 respondents from Southern Brazil. The original and two recently factorial solutions for the Brazilian CASP-19 were initially examined. Exploratory Factor Analyses and Exploratory Structural Equation Models were estimated in the first half of the sample, selected at random. In the second half, Confirmatory Factor Analyses determined the most tenable configural and metric model for the instrument. Neither the original nor the two Brazilian solutions were supported by our data. Instead, we suggest that two factors underlie CASP-19's configural structure: while the first one groups the control and autonomy dimensions, the second combines self-realization and pleasure. Except for four items, all others presented moderate to strong loadings, and only two showed a theoretically meaningful and sufficiently large residual correlation, which was worthy of inclusion in the final model. Cross-loadings were not detected. When assessed in a population-based sample of older respondents, this Brazilian version of the CASP-19 appeared to have two factors, moderate to strong loadings and a pair of redundant items. Future studies should evaluate the consistency of these findings, examine the scalar structure of the instrument, and assess configural, metric and scalar invariance across social groups.

Measuring Quality of Life in Carers of People With Dementia: Development and Psychometric Evaluation of Scales measuring the Impact of DEmentia on CARers (SIDECAR)

Background and Objectives

A 2008 European consensus on research outcome measures in dementia care concluded that measurement of carer quality of life (QoL) was limited. Three systematic reviews (2012, 2017, and 2018) of dementia carer outcome measures found existing instruments wanting. In 2017, recommendations were published for developing reliable measurement tools of carers’ needs for research and clinical application. The aim of this study was to develop a new instrument to measure the QoL of dementia carers (family/friends).

Methods

Items were generated directly from carers following an inductive needs-led approach. Carers (n = 566) from 22 English and Welsh locations then completed the items and comparator measures at three time points. Rasch, factor, and psychometric (reliability, validity, responsiveness, and minimally important differences [MIDs]) analyses were undertaken.

Results

Following factor analysis, the pool of 70 items was refined to three independent scales: primary SIDECAR-D (direct impact of caring upon carer QOL, 18 items), secondary SIDECAR-I (indirect impact, 10 items), and SIDECAR-S (support and information, 11 items). All three scales satisfy Rasch model assumptions. SIDECAR-D, I, S psychometrics: reliability (internal ≥ .70; test–retest ≥ .85); convergent validity (as hypothesized); responsiveness (effect sizes: D: moderate; I and S: small); MIDs (D = 9/100, I = 10/100, S = 11/100).

Discussion and Implications

SIDECAR scales demonstrate robust measurement properties, meeting COSMIN quality standards for study design and psychometrics. SIDECAR provides a theoretically based needs-led QoL profile specifically for dementia carers. SIDECAR is free for use in public health, social care, and voluntary sector services, and not-for-profit organizations.

One slope does not fit all: longitudinal trajectories of quality of life in older adulthood

PURPOSE

Maintaining or improving quality of life (QoL) in later life has become a major policy objective. Yet we currently know little about how QoL develops at older ages. The few studies that have modelled QoL change across time for older adults have used 'averaged' trajectories. However, this ignores the variations in the way QoL develops between groups of older adults.

METHODS

We took a theoretically informed 'capabilities approach' to measuring QoL. We used four waves of data, covering 6 years, from the New Zealand Health, Work and Retirement Study (NZHWR) (N = 3223) to explore whether distinct QoL trajectories existed. NZHWR is a nationally representative longitudinal study of community-dwelling adults aged 50 + in New Zealand. Growth mixture modelling was applied to identify trajectories over time and multinomial regressions were calculated to test baseline differences in demographic variables (including age, gender, ethnicity, education and economic living standards).

RESULTS

We found five QoL trajectories: (1) high and stable (51.94%); (2) average and declining (22.74%); (3) low and increasing (9.62%); (4) low and declining (10.61%); (5) low and stable (5.09%). Several differences across profiles in baseline demographic factors were identified, with economic living standards differentiating between all profiles.

CONCLUSIONS

The trajectory profiles demonstrate that both maintaining and even improving QoL in later life is possible. This has implications for our capacity to develop nuanced policies for diverse groups of older adults.

Association between structural social support and quality of life among urban older Malaysians

OBJECTIVE

The aim of this study was to examine the association between structural social support and quality of life (QoL) among urban older people in Malaysia.

METHODS

Cross-sectional data of 1484 participants from the first wave of the Malaysian Elders Longitudinal Research (MELoR) were analysed. QoL was measured with the Control, Autonomy, Self-realization, and Pleasure 12-item scale (CASP-12). Multivariate analyses were run using the generalised linear interactive model (GLIM) to determine the association between structural social support measures and QoL.

RESULTS

The mean age of the sample was 70.1 (SD = 7.4) years. Being married (B = 0.05, 95%CI 0.02, 0.08), larger social networks (B = 0.01, 95%CI 0.01, 0.02) and social participation (B = 0.02, 95%CI 0.02, 0.09) were associated with higher QoL, while living alone (B= -0.04, 95%CI -0.06, -0.02) was associated with lower QoL.

CONCLUSION

Structural social support plays an important role in the QoL of older people in Malaysia.

Debt matters? Mental wellbeing of older adults with household debt in England

Background

A record number of older individuals have household debt, but little is known about possible links between debts and their mental wellbeing. This study examines the extent to which different aspects of household indebtedness predict mental wellbeing among this population.

Methods

A sample of 17,091 individuals (72,700 observations) aged 50 and over in England was derived from waves 1–8 of the English Longitudinal Study of Ageing. Mental wellbeing was assessed by two outcome measures: number of depressive symptoms (CES-D 8) and quality of life (CASP-19 score). The predictors of mental wellbeing were examined using quartiles of non-zero overall debt amount, debt-to-income and debt-to-non-housing wealth ratios as alternative measures of debt burden. Linear regression models estimated the associations of mortgage and non-mortgage debt measures with mental wellbeing while adjusting for observable socioeconomic confounding factors. Individual fixed effect models were used to control for all time-constant factors among a longitudinal subsample.

Results

Individuals in the highest debt-to-wealth quartile were particularly at risk of lower mental wellbeing, that is, a higher number of depressive symptoms and lower quality of life. After covariate adjustment, non-mortgage debt predicted lower mental wellbeing on both measures but mortgage debt was only linked to lower quality of life. Among the subsample who experienced changes in high non-mortgage debt levels, a small association of these changes with mental wellbeing outcomes were observed. Asymmetric within-individual estimation showed that both getting rid of and acquiring new debts during the study period predicted symmetrically (small) increases and decreases, respectively, in mental wellbeing.

Conclusion

These findings indicate that among older individuals in England, non-mortgage debt status is linked to poor mental wellbeing. High, non-mortgage, debt-to-wealth ratios may help identify risk of mental wellbeing issues in older people with debts.

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Little is known on debt and mental wellbeing among older individuals in England.

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Debt type and debt measures matter for mental wellbeing.

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Non-mortgage debt was linked to lower mental wellbeing between observations.

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However, smaller effects of non-mortgage debts were observed within-individuals.

Life worth living: cross-sectional study on the prevalence and determinants of the wish to die in elderly patients hospitalized in an internal medicine ward

BACKGROUND

Elderly people frequently express the wish to die: this ranges from a simple wish for a natural death to a more explicit request for death. The frequency of the wish to die and its associated factors have not been assessed in acute hospitalization settings. This study aimed to investigate the prevalence and determinants of the wish to die in elderly (≥65 years) patients hospitalized in an internal medicine ward.

METHODS

This cross-sectional study was conducted between 1 May, 2018, and 30 April, 2019, in an acute care internal medicine ward in a Swiss university hospital. Participants were a consecutive sample of 232 patients (44.8% women, 79.3 ± 8.1 years) with no cognitive impairment. Wish to die was assessed using the Schedule of Attitudes toward Hastened Death-senior and the Categories of Attitudes toward Death Occurrence scales.

RESULTS

Prevalence of the wish to die was 8.6% (95% confidence interval [CI]: 5.3-13.0). Bivariate analysis showed that patients expressing the wish to die were older (P = .014), had a lower quality of life (P < .001), and showed more depressive symptoms (P = .044). Multivariable analysis showed that increased age was positively (odds ratio [OR] for a 5-year increase: 1.43, 95% CI 0.99-2.04, P = .048) and quality of life negatively (OR: 0.54, 95% CI 0.39-0.75, P < 0.001) associated with the likelihood of wishing to die. Participants did not experience stress during the interview.

CONCLUSIONS

Prevalence of the wish to die among elderly patients admitted to an acute hospital setting is low, but highly relevant for clinical practice. Older age increases and better quality of life decreases the likelihood of wishing to die. Discussion of death appears to be well tolerated by patients.

Psychometric Properties of the CASP-12 Scale in Portugal: An Analysis Using SHARE Data

The purpose of this study is to assess the psychometric properties of the Portuguese version of the Control, Autonomy, Self-realization, and Pleasure (CASP)-12 scale used in the Survey of Health, Aging and Retirement in Europe (SHARE) project. Data were obtained from a representative sample of 1666 people aged ≥50 years living in Portugal and participating in the SHARE wave 6. In addition to the CASP-12 scale, sociodemographic data and health status, activity limitation (GALI), depression (Euro-D) and satisfaction with life scores were collected. Data quality and acceptability, construct and structural validity and internal consistency of the CASP-12 scale were analyzed. A Rasch analysis was also performed. CASP-12 total score (mean: 33.3; standard deviation: 5.8, range: 12-48) correlated with Euro-D (-0.57) and with life satisfaction (0.52). Mean scores were significantly lower for women, people aged ≥75 years and those with activity limitations and worse health status (p < 0.001). The confirmatory factor analysis showed good fit to the 4-factor model (root mean squared error of approximation (RMSEA): 0.07; comparative fit index (CFI): 0.90, χ² (48) = 444.59, p < 0.001), which was confirmed by Rasch analysis (χ² (36) = 10.089, p = 0.745, person separation index (PSI) = 0.722 for the 4-factor model). For domains, person separation index ranged 0.31-0.79 and Cronbach's alpha, 0.37-0.73. In conclusion, the Portuguese version of the CASP-12 scale presents some inadequacies in acceptability, internal consistency and structural validity.

Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis

Background: Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features. Several studies have proposed therapy with music as a possible strategy to slow down cognitive decline and behavioral changes associated with aging in combination with the pharmacological therapy. Objective: We performed a systematic review and subsequent meta-analysis to check whether the application of music therapy in people living with dementia has an effect on cognitive function, quality of life, and/or depressive state. Methods: The databases used were Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. The search was made up of all the literature until present. For the search, key terms, such as "music," "brain," "dementia," or "clinical trial," were used. Results: Finally, a total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. After meta-analysis, it was shown that the intervention with music improves cognitive function in people living with dementia, as well as quality of life after the intervention and long-term depression. Nevertheless, no evidence was shown of improvement of quality of life in long-term and short-term depression. Conclusion: Based on our results, music could be a powerful treatment strategy. However, it is necessary to develop clinical trials aimed to design standardized protocols depending on the nature or stage of dementia so that they can be applied together with current cognitive-behavioral and pharmacological therapies.

Validation of the Brief Ageing Perceptions Questionnaire (B-APQ) in Malaysia

Objectives: The Brief Ageing Perceptions Questionnaire (B-APQ) has five domains that explore views about own ageing. The aim of this study was to validate the B-APQ for use among older adults in Malaysia and to explore socio-demographic variations in ageing self-perceptions.Method: Older adults aged 50 years and above were randomly selected to complete a set of questionnaires. Cronbach's α was used to measure internal consistency, while corrected item-total correlations and correlation with DASS-21 and the CASP-19 scores were employed to assess convergent and discriminant validity. Confirmatory Factor Analysis (CFA) was conducted to confirm the factorial structure of the B-APQ. Difference in self-perceptions of ageing across socio-demographic variables was assessed.Results: Internal consistency for each of the domains was good. Item-total correlations within each domain were strong (>0.6) or very strong (>0.8). Convergent and discriminant validity were supported by significant correlations with DASS-21 depression and CASP-19 scores. CFA results indicated good model fit with the original B-APQ model. Presence of chronic illness also has a significant impact on B-APQ domain scores.Conclusion: The B-APQ is a valid and reliable instrument which can be used to assess self-perceptions of ageing among older Malaysian adults.

An update of the profile of older adults with dementia in Europe: findings from SHARE

Background: The increase in longevity due to the reduction of premature deaths has led to an increase of the number of people with dementia. The objective of the present work was to analyze the profile of the European population with dementia aged more than 50.Methods: The sample of individuals aged 51 or more years was taken from a European database within the last wave of the SHARE Project (Wave 6, March 2017). Participants with and without a diagnosis of dementia were compared in terms of socio-demographic, general health, mental health, behavioural risks, education and employment, by age group. Categorical variables were compared using chi-square test, quantitative variables were compared with the independent sample t-test.Results: From 45,340 subjects (40% males) 897 (2%) had dementia. The findings corroborate recent evidence stating that individuals with dementia have a lower physical and mental health as well as a lower quality of life than people without dementia. It was also verified that people with dementia: (i) had a lower employment rate; (ii) showed lower levels of formal education; (iii) less were living a married life; (iv) exhibited a moderate pattern of behavioural risks, but had higher levels of physical inactivity; (v) had more chronic diseases and (iv) higher intake of more than 5 drugs per day. The unfavourable health and well-being status of dementia subjects was found in all age groups.Conclusions: An update of the profile of older Europeans with dementia was performed with data from 18 countries. The findings of co-morbidity, high rates of intake of more than 5 drugs daily and low levels of well-being irrespective of age should be considered in the assessment and management of dementia in the European population.

Theory and Design of the Community for successful ageing (ComSA) program in Singapore: connecting BioPsychoSocial health and quality of life experiences of older adults

BACKGROUND

Despite the emphasis on holistic health promotion in community programs for older people, few studies explicitly consider how BioPsychoSocial (BPS) health elements are interconnected and function to improve Quality of Life (QoL). The Community for Successful Ageing (ComSA) program in Singapore focuses on Community Development (CD) initiatives for older people, accounting for BPS theory in its design and content. Biological (B) health is conceived as physiological and cognitive functioning and related biological self-care; Psychological (P) health as feelings of life satisfaction, and Social health (S) as perceived social support and civic engagement. Furthermore, three overlapping sub-constructs are theorized to connect these elements. Namely Bio-Psychological (BP) health in terms of self-perceptions of ageing; the Psycho-Social (PS) aspects of interpersonal communication; and the Socio-Communal (SC) health in terms of civic engagement. BPS health is conceived as distinct from QoL, defined as composed of control, autonomy, self-realisation and pleasure (measured by CASP-19) of the older person. We examined 1) interconnections of BPS constructs and related sub-constructs and 2) their associations with QoL to inform a practical, applied program theory.

METHODS

A baseline survey (n = 321) of program participants (Mean = 70 years, SD = 8.73). All continuous variables were binarized as 'high' if the scores were above the median. Multivariate logistic regression was used to assess 1) the adjusted effect of each BPS construct on CASP-19, and 2) the odds of scoring high on one BPS construct with the odds of scoring high on a related sub-construct (e.g. B and BP health).

RESULTS

The strongest relationship with QoL was markedly with BP self-perceptions of ageing (OR = 4.07, 95%CI = 2.21-7.49), followed by P life satisfaction (OR = 3.66, 95%CI = 2.04-6.57), PS interpersonal communication (OR = 2.42, 95%CI = 1.23-4.77), SC civic engagement (OR = 1.94, 95%CI = 1.05-3.57), and S social support (OR = 1.89, 95%CI = 1.06-3.38). Core B, P and S health were closely associated with their sub-constructs.

CONCLUSION

ComSA CD is tightly coupled to its proposed program theory. It offers classes to improve B self-care and BP self-perceptions of ageing, group-based guided autobiography to improve P life-satisfaction and PS interpersonal communication, and community initiatives that encourage seniors to solve community issues. This holistic approach is likely to enhance ageing experiences and QoL.

Associations of childhood health and financial situation with quality of life after retirement - regional variation across Europe

Many studies have shown that childhood circumstances can have long term consequences that persist until old age. To better understand the transmission of early life circumstances, this paper analyses the effects of health and financial situation during childhood on quality of life after retirement as well as the mediating role of later life health, educational level, and income in this association. Moreover, this study is the first to compare these pathways across European regions. The analyses are based on data of 13,092 retirees aged ≥ 60 and ≤ 85 years from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE) with full information on childhood and later life measures of health, educational level, financial situation, and quality of life as well as relevant covariates. Five European regions are studied: Central-Western Europe (Austria, Germany), Central-Eastern Europe (Czech Republic, Estonia, Slovenia), Northern Europe (Denmark, Sweden), Southern Europe (Italy, Spain), and Western Europe (Belgium, France, The Netherlands). Path analysis is used to identify the direct and indirect effects of childhood measures on quality of life. We find retirees' quality of life to be associated with childhood finances and health in all five European regions. While both the direct and indirect effects of childhood health are rather moderate and homogeneous across regions, especially the direct effects of childhood finances on quality of life after retirement display a distinct North-South gradient being strongest in Southern Europe. Potential explanations for the regional variations are differences in the countries' welfare systems.

Quality of life associated with handgrip strength and sarcopenia: EpiFloripa Aging Study

BACKGROUND

Quality of life (QoL) is an important measure, and it can be defined as the presence of control, autonomy, self-realization and pleasure. This study aims to verify the association between handgrip strength (HGS), sarcopenia and sarcopenic obesity with quality of life (QoL) among community-dwelling older adults in southern Brazil.

METHODS

Cross-sectional analyses data of the "EpiFloripa Aging" cohort study were carried out. The participants were community-dwelling older adults (60 years and over). QoL was evaluated by CASP-16 Brazil instrument, with a score of zero, representing no QoL, to 48, total satisfaction. The TAKEI hand dynamometer verified the HGS. Sarcopenia was defined as appendicular skeletal muscle mass/body weight <2 standard deviations below gender-specific means for young adults. Sarcopenic obesity was identified as the concomitant presence of obesity and sarcopenia. Multiple linear regression was performed to estimate the associations.

RESULTS

The analytical sample consisted of 584 older adults (652% females). In the adjusted analysis, at each increase of one kgf in HGS there was a 0.24 and 0.18 increase in the QoL score, for females and males, respectively. Sarcopenia was negatively associated with QoL in males, and sarcopenic obesity wasn't associated with QoL.

CONCLUSION

QoL was positively associated with HGS for both sexes, and negatively associated with sarcopenia for males. Low HGS, as well as sarcopenia, lead to critical health losses. Interventions that minimize phenotypes related to these conditions are fundamental, but mainly, conditions as severe as these need to be early identified to reduce the impact on QoL.

Factors associated with the quality of life of elderly caregivers of other elderly persons

Abstract Objective : To evaluate the association between the double vulnerability of being elderly and a caregiver and quality of life assessed by Control, Autonomy, Self-realization and Pleasure factors (CASP-19). Method : 148 elderly caregivers participated in the present study. They were selected for convenience from Brazilian public and private health services - a sample from the study “The Psychological Well-Being of Elderly Persons Caring for Other Elderly Persons in a Family Context”. The variables: caregiver’s state of health, care demands, perception of burden, self-rated health, and quality of life were selected. Descriptive analyses, chi-squared tests, Fisher’s exact test, the Kruskal-Wallis test and analysis of multivariate hierarchical logistics were carried out, with theStepwisecriteria applied for selection of variables. Results : The hierarchical multivariate analyses found that number of symptoms and total burden were significantly associated with a poorer quality of life. Elderly persons with three or more symptoms and those with a high burden level were at a higher risk of poor quality of life. The variables number of diseases, burden, and self-rated health compared with the past, were significantly associated with a poorer quality of life. Conclusion : It can be concluded that for the elderly caregiver, physical aspects (signs and symptoms, chronic diseases and a perception of health deterioration) combined with burden are the aspects that most influence quality of life.

Obesity in Older Type 2 Diabetic Patients: Does Working Environment Add Vulnerability?

Little is known about how working adults with type 2 diabetes are managing their health. This study aims to analyze the associations between health, behavioral, and sociodemographic characteristics and obesity in older diabetic patients in Europe. Data from the Survey of Health, Ageing, and Retirement in Europe was used to compare 1447 participants that were identified as having type 2 diabetes with 28,047 participants without diabetes. Multilevel logistic models stratified by type 2 diabetes examined the relationships of health, behavioral, and sociodemographic characteristics with obesity. The proportion of physical inactivity was significantly higher among those with type 2 diabetes (15.0% vs. 6.1%). Individuals with diabetes had more chronic diseases, more limitations in activities, higher body mass index, more depression, lower quality of life and well-being, and lower employment rate. Among those with type 2 diabetes, those employed were more likely to be obese (OR = 1.377, 95% CI, 1.023 to 1.853) and women were 52% more likely to be obese than men. The surveillance of weight in working environments should be required within workers with type 2 diabetes. It is concluded that this and other adjustments could be beneficial in people with diabetes.

[New semantic-cultural validation and psychometric study of the CASP-19 scale in adult and elderly Brazilians]

The study aimed to investigate psychometric indicators of validity in the new version of CASP-19 for Brazilians 55 years and older and to study relations between scores on the scale and sex, age, schooling, and conjugal status. A total of 368 participants enrolled in educational programs for the elderly answered the CASP-19 scale (control, autonomy, self-realization, and pleasure), translated from English by five specialists and tested in 19 women (α = 0.730). The data were submitted to exploratory factors analyses (EFA) and confirmatory factor analyses (CFA) using the structural equations method for latent variables and for internal consistency and correlation with scales of similar content. The scores were compared according to sex, age, schooling, and conjugal status. CFA produced a model with 19 items and 2 factors (self-realization/pleasure and control/autonomy), with good fit indices (GFI = 0.8; AGFI = 0.7606; CFI = 0.7241; NNFI = 0.6876; SRMR = 0.0902; RMSEA = 0.0928; 90%CI: 0.0827-0.1031). Cronbach's α was 0.837 for factor 1 and 0.670 for factor 2, and 0.874 on the total scale for individuals with 9 or more years of schooling, 0.834 for 5 to 8 years, and 0.772 for 1 to 4 years. High and significant correlations were observed with the scores in scales on satisfaction and subjective happiness. Men scored higher than women on self-realization/pleasure; older individuals and those with the most schooling scored lower on control/autonomy; individuals with a spouse or partner scored higher on control/autonomy. The new version of CASP-19 was effective in assessing self-rated quality of life in individuals 55 years or older in residents of the Southeast, South, and Northeast of Brazil.

Quality of life at the retirement transition: Life course pathways in an early 'baby boom' birth cohort

Promoting quality of life (QoL) in later life is an important policy goal. However, studies using prospective data to explore the mechanisms by which earlier events influence QoL in older age are lacking. This study is the first to use prospective data to investigate pathways by which a range of measures of life-course socioeconomic status contribute to later-life QoL. The study uses data from the Newcastle Thousand Families Study cohort (N = 1142), an early 'baby-boom' birth cohort born in 1947 in Newcastle upon Tyne, an industrial city in north-east England. Using prospective survey data collected between birth and later adulthood (N = 393), a path analysis investigated the effects and relative contributions of a range of life-course socioeconomic factors to QoL at age 62-64 measured using the CASP-19 scale. Strong positive effects on later-life QoL were found for advantaged occupational status in mid-life and better self-reported health, employment and mortgage-freedom in later adulthood. Significant positive indirect effects on QoL were found from social class at birth and achieved education level, mediated through later-life socioeconomic advantage. Experiencing no adverse events by age five had a large total positive effect on QoL at age 62-64, comprising a direct effect and indirect effects, mediated through education, mid-life social class and later-life self-reported health. Results support a pathway model with the effects of factors in earlier life acting via later-life factors, and an accumulation model with earlier-life factors having large total, cumulative effects on later-life QoL. The presence of a direct effect of adverse childhood events by age five on QoL suggests a 'critical period' and indicates that policies across the life-course are needed to promote later-life QoL, with policies directed towards older adults perhaps too late to 'undo the damage' of earlier adverse events.

The scarring effect of unemployment on psychological well-being across Europe

Past unemployment may have a pervasive psychological impact that occurs across nations. We investigate the association between unemployment events across working life and subsequent psychological well-being across 14 European countries. Additionally, we consider the influence of between-country differences in labour market institutions and conditions on the cross-country well-being effects of unemployment. Data detailing life-long employment trajectories and contemporary life conditions are drawn from the Survey of Health, Ageing and Retirement in Europe. The well-being impact of unemployment is modeled using linear, multi-level specifications. Each six-month spell of past unemployment is found to predict reduced quality of life and life satisfaction after the age of 50, having adjusted for a broad range of individual and country-specific covariates. In contrast, the impact of past unemployment on depression is explained by individual demographic factors. We identify the first comparative long-term evidence that unemployment welfare scarring may be a broad, international phenomenon.

A systematic review of the clinical applications and complications of bone marrow aspirate concentrate in management of bone defects and nonunions

PURPOSE

Fracture healing encompasses a succession of dynamic multifactorial metabolic events, which ultimately re-establishes the integrity of the biomechanical properties of the bone. Up to 10% of the fractures occurring annually will need additional surgical procedures because of impaired healing. The aim of this article is to review the current literature regarding the use of bone marrow aspirate concentrate (BMAC) and its effectiveness in the management of bone defects.

METHODS

We have included all published clinical literature investigating the development, techniques and applications of BMAC. Language, design and risk of bias did not deter the initial inclusion of any study. Our search was exclusively limited to studies involving human subjects. A PRISMA compliant search was carried out as published in 2009. This included the online databases: PubMed, EMBASE, clinical trial.gov and the Cochrane library from 1960 to the end of May 2015. MeSH terms used included: "Bone" AND "Marrow" AND "Aspirate" AND "Concentrate" AND "Bone Defects" AND "NONUNION". Eligible studies were independently appraised by two authors using the Critical Appraisal Skills Program checklist. For the purpose of narrative review, relevant studies were included irrespective of methodology or level of evidence.

RESULTS

Thirty-four of the 103 (48 PubMed and 55 EMBASE) results yielded by the preliminary search were included. Exclusions included three duplicate records, six letters, 17 non-orthopaedics related studies and four records irrelevant to our search topic. The CASP appraisal confirmed a satisfactory standard of 31 studies. They all had clearly defined objectives, were well designed and conducted appropriately to meet them. The published studies reported the use of BMAC in non-union and fracture healing (15 studies), bone defects (nine studies), spine fusion (two studies), distraction osteogensis (two studies) and complications related to the use of BMAC (seven studies).

CONCLUSIONS

Stem cells found in BMAC have the potential to self-renew, undertake clonal expansion and differentiate into different musculoskeletal tissues. The commercial processing of BMAC needs to be optimized in order to achieve a consistent end product, which will provide predicable and translatable results. The future potential of cell characterization in order to determine the optimum cell for repair/regeneration of bone also needs to be explored.

LEVEL OF EVIDENCE

Systematic Review of minimum level IV studies.

The relationship between kidney function and quality of life among community-dwelling adults varies by age and filtration marker

Background

The impact of a diminished level of kidney function on the well-being of an older individual is poorly understood. We sought to determine the association between estimated glomerular filtration rate (eGFR) and overall quality of life (QoL) among older adults.

Methods

Cross-sectional analysis of 4293 participants from the Irish Longitudinal Study on Ageing, a population-based study of community-dwelling adults ≥50 years of age. We used multivariable negative binomial regression to model the relationship between categories of cystatin C eGFR (eGFR_cys) or creatinine eGFR (eGFR_cr) and the number of QoL deficits from the Control, Autonomy, Self-realization and Pleasure (CASP-19) scale, a holistic measure of QoL among older adults (range 0-57). We further explored this relationship across age strata.

Results

Median age was 61 [interquartile range (IQR) 55-68] years, 53% were female, mean (SD) CASP-19 score was 44.8 (7.4) and median eGFR_cys was 81 (IQR 68-93) mL/min/1.73 m². After multivariable adjustment, participants with eGFR_cys <45 mL/min/1.73 m² had 14% greater QoL deficits {incidence rate ratio 1.14 (95% confidence interval 1.03-1.25)] relative to the reference group (eGFR_cys ≥90 mL/min/1.73 m²). This relationship appeared linear across eGFR_cys categories and was more pronounced in younger (50-64 years) compared with older participants (65-74 or ≥75 years). There was no substantive relationship between eGFR_cr and CASP-19.

Conclusions

Cystatin C but not creatinine eGFR was associated with clinically modest declines in QoL among a large sample of community-dwelling older adults. This relationship varied by age, suggesting that a diminished eGFR contributes little to overall QoL beyond middle age in this population.

A systematic review of the concept and clinical applications of Bone Marrow Aspirate Concentrate in Orthopaedics

Introduction: Mesenchymal stem cells (MSC’s) are believed to have multipotent plasticity with the capability to differentiate along multiple cell lineages such as cartilage, bone, tendon, muscle, and nerve. Such multipotency has the potential to play an important role in the repair and reconstruction of multiple tissues across a number of orthopaedic specialties. Bone marrow and fat are the most abundant and accessible source of MSC’s with bone marrow aspirate the most commonly being reported to stimulate healing.

Methods: This review examines the current reported 20 Q2 clinical applications of bone marrow aspirate concentrate and its effectiveness.

Results: The published studies reported techniques of collection and preparation of BMAC in addition to its applications in a number of orthopaedic sub-specialities. Studies could be sub-categorised into: techniques of extraction, processing and microscopic examination of BMAC (31), reconstruction of osseous defects/non-union (20), treatment of avascular necrosis (9), repair of cartilage defects (8), treatment of sports injuries and tendon injury/repair (9), injection in regenerative therapy (4), treatment of spine conditions (4) including enhancing postoperative fusion and degenerative disc pathology and orthopaedic oncology (4). A few published studies combined the use of platelet-rich plasma (PRP) with BMAC (4) or compared them in different applications (5).

Conclusions: BMAC has been used in bone, cartilage and tendon injuries with encouraging results.

Quality of life and its association with work, the Internet, participation in groups and physical activity among the elderly from the EpiFloripa survey, Florianópolis, Santa Catarina State, Brazil

The study aimed to investigate the association between changes in social relations and physical activity on the quality of life of the elderly in the city of Florianópolis, Santa Catarina state, Brazil. Data on 1,197 elderly from two waves of the population and household survey, EpiFloripa Idoso, were analyzed. Multiple linear regression was performed to estimate association of social change variables and lifestyle on quality of life score (QoL; measured by CASP-16 Brazil, score can range from 0, which represents no QoL to 48, total satisfaction in all domains of CASP). The average QoL score in the sample was 37.6 (95%CI: 37.2; 38.1). The social relations that were associated with positive QoL score were to start to work, to continue to use the Internet, to start participating in religious or lifestyle groups, to remain and to become physically active, and for those who were physically active, but became inactive in the second wave. To remain living with family had a negative effect on QoL score for the elderly. Some changes in social relations had a positive effect on QoL, and results reaffirmed the importance of physical activity to healthy aging, since to pursue it in some of the waves was better than to remain inactive.

Who in Europe Works beyond the State Pension Age and under which Conditions? Results from SHARE

There is much research about those who exit the labour market prematurely, however, comparatively little is known about people working longer and about their employment and working conditions. In this paper, we describe the employment and working conditions of men and women working between 65 and 80 years, and compare them with previous conditions of those retired in the same age group. Analyses are based on wave 4 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with information collected between 2009 and 2011 from 17,625 older men and women across 16 European countries. Besides socio-demographic and health-related factors (physical and mental health), the focus lies on employment conditions (e.g. employment status, occupational position and working hours) and on stressful working conditions, measured in terms of low control at work and effort-reward imbalance. In case of retired people, information on working conditions refer to the last job before retirement. Following descriptive analyses, we then conduct multivariable analyses and investigate how working conditions and poor health are related to labour market participation (i.e. random intercept models accounting for country affiliation and adjusted for potential confounders). Results illustrate that people working between the ages of 65 and 80 are more likely to be self-employed (either with or without employees) and work in advantaged occupational positions. Furthermore, findings reveal that psychosocial working conditions are generally better than the conditions retired respondents had in their last job. Finally, in contrast to those who work, health tends to be worse among retired people. In conclusion, findings deliver empirical evidence that paid employment beyond age 65 is more common among self-employed workers throughout Europe, in advantaged occupations and under-favourable psychosocial circumstances, and that this group of workers are in considerably good mental and physical health. This highlights that policies aimed at increasing the state pension age beyond the age of 65 years put pressure on specific disadvantaged groups of men and women.

The relationship of tobacco and alcohol use with ageing self-perceptions in older people in Ireland

Background

Health behaviour patterns in older groups, including tobacco and alcohol use, are key factors in chronic disease prevention. We explore ageing self-perceptions as motivating factors behind smoking and drinking alcohol in older adults, and the complex reasons why individuals engage harmfully in these behaviours.

Methods

Cigarette and alcohol use was assessed in a large cross-sectional national sample aged 50 years and above from the Irish Longitudinal Study on Ageing (TILDA) (n = 6,576). The Brief Ageing Perceptions Questionnaire (BAPQ) assessed individual’s views of their own ageing across five domains. Study hypothesis that stronger beliefs on each of the BAPQ domains would be related to drinking and smoking was examined using multinomial logit models (MNLM). Regression parameter estimates for all variables were estimated relative risk ratios (RRR).

Results

More women were non-drinkers (30 % vs. 20 %) and men displayed significantly higher alcohol use patterns. One in five older Irish adults was a current smoker (16.8 % of women, 17 % of men), and smoking and harmful drinking were strongly associated (P < .001). Some domains of ageing perceptions were significantly associated with harmful drinking and smoking. While the risk of being be harmful drinker decreased with stronger beliefs about the positive consequences of ageing (RRR 0.89), it increased with higher scores on both emotional representation and control positive domains.

Greater awareness of ageing and stronger emotional reaction to ageing increased likelihood of smoking. A greater sense of control over the outcomes of ageing was associated with increased risk of both harmful drinking (RRR control positive 1.16) and smoking (RRR control and consequences negative 1.25). This suggests optimistic bias in relation to perceived health risk from smoking and harmful drinking as a potential adverse effect of perceptions of control.

Risks of concurrent smoking and harmful drinking increased with chronic awareness of ageing (RRR 1.24), and negative emotional responses to it (RRR 1.21), and decreased with stronger perceptions of the positive consequences of ageing (RRR 0.85).

Conclusions

The relationship between ageing perceptions, smoking and drinking is complex. Altering perceptions of ageing may be a useful intervention target aimed at facilitating engagement in preventative health behaviours in older people.