Tenacious goal pursuit and flexible goal adjustment in older people over 5 years: a latent profile transition analysis

Coping Patterns in Advanced Old Age: Findings from the Fordham Centenarian Study

INTRODUCTION

Research on coping in advanced old age is scarce. In the present study, we explored coping patterns in near-centenarians and centenarians, and characteristics associated to using a specific coping pattern.

METHODS

We analyzed the frequency with which participants (N = 87, MAge = 99.05; SDage = 2.6; age range 95-107) reported using specific coping strategies (i.e., coping strategy use) and the relative preference for specific strategies (i.e., relative coping preferences) in data from the Fordham Centenarian Study. Moreover, we applied cluster analysis to detect coping patterns, and we compared cluster characteristics.

RESULTS

Very old individuals reported using emotion control and acceptance the most. Cluster analysis further revealed two distinct groups: The high coping group reported significantly higher coping strategy use than the low coping group (p < 0.001). The two groups also favored different strategies (p < 0.001), with the high coping group showing significantly higher relative preferences than the low coping group for active problem-solving, proactive prevention, and strategic planning (all ps < 0.05). The groups furthermore differed significantly in psychological strengths (i.e., personality, self-efficacy, ps < 0.001) and well-being outcomes (i.e., life satisfaction, p = 0.05).

DISCUSSION

This study provides evidence for a general preference for acceptance and emotion control in very old individuals, supporting theories of a developmental coping shift in old age, yet our findings also document the existence of groups with different coping patterns. More frequent coping use, and particularly continued use of active problem-solving and proactive prevention, may enable well-being in very old age.

Adaptive Goal Processes and Underlying Motives That Sustain Mental Wellbeing and New Year Exercise Resolutions

Exercise resolutions are the most common goals people set each New Year. However, research has rarely examined adaptive goal processes and motives that may maintain wellbeing and resolution pursuit. We therefore investigated if (1) personal goal flexibility and tenacity maintain mental wellbeing and adherence to New Year exercise resolutions and if (2) underlying intrinsic and extrinsic motives maintain wellbeing and sustained exercise resolution adherence. A community sample (N = 297) completed an online longitudinal study. At baseline, participants listed their most important exercise-related New Year resolution. Participants then completed measures to assess goal flexibility and tenacity, resolution motives, and mental wellbeing at baseline. At three follow-up surveys over a two-month period, participants completed self-report measures of wellbeing and adherence to their exercise resolution. As predicted, goal flexibility and tenacity each independently predicted wellbeing across time. Counter to prediction, neither goal flexibility nor tenacity predicted sustained exercise adherence. Notably, underlying intrinsic motives (but not extrinsic motives) maintained mental wellbeing and exercise adherence across time. Our findings indicate that goal flexibility and tenacity are beneficial in maintaining mental wellbeing and that pursuing resolutions for internalised motives is beneficial for one's mental wellbeing and exercise adherence.

Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018

Long-term health conditions can limit achievement of personal goals. We aimed to map and synthesize definitions of goal adjustment, theoretical underpinnings, associations with recovery and supportive interventions for adults with long-term conditions. We searched multiple databases (January 2007-June 2018) and identified peer-reviewed research relating to goal adjustment. Data were charted, mapped and synthesized using content analysis and descriptive summaries. Two stakeholder consultations informed the review. Ninety-one articles were included. A range of long-term conditions were represented including cancer (22%), stroke (12%) and mixed neurological conditions (8%). Goal adjustment was one available option when faced with unattainable goals; other options were goal disengagement and goal re-engagement. Most studies were quantitative (58%), reporting mainly positive associations between goal adjustment, disengagement, reengagement and recovery. The Dual Process Model, Goal Adjustment Model and Self-Regulation Theory were most cited underpinning models/theory. Five interventions were identified; only one (self-system therapy) was evaluated in a randomized controlled trial. Our review provides original and significant insights into goal adjustment definitions, theoretical underpinnings and association with recovery. Effective interventions to support goal adjustment, disengagement and reengagement are lacking. This research-practice gap warrants attention to ensure people with long-term conditions are optimally supported when facing unattainable goals.

Self-Regulatory Goal Motivational Processes in Sustained New Year Resolution Pursuit and Mental Wellbeing

Recent research suggests people typically “give up” pursuing their New Year resolutions within the first month. The present study investigated goal features proposed to be implicated in promoting both mental wellbeing and sustained New Year resolution pursuit. Australian and UK participants (n = 182) took part in an online longitudinal study, including four timepoints over a two-month period. At baseline, participants listed the New Year resolution to which they were most committed, and completed self-report measures to assess mental wellbeing, goal flexibility and tenacity. At the follow-up surveys, participants completed the wellbeing measure and their New Year resolution commitment, effort and stickability. As predicted, flexibility predicted wellbeing across time, however, tenacity did not. Counter to prediction, neither flexibility nor tenacity reported at baseline predicted “sticking” with one’s New Year resolution. The predicted interaction between flexibility and tenacity was not significant. New Year resolutions focused predominantly on “diet” and “exercise” were predominantly the same resolutions previously pursued and tended to be relatively abstract. Although goal flexibility predicted greater wellbeing, the findings overall tend to support the view that people are not particularly good at sticking with their New Year resolutions. Implications of the findings are discussed.

Associations of Age and Pain With 9-Year Functional Health Trajectories

Abstract. We investigated whether information-processing speed and accommodative coping moderate associations of age and pain with 9-year functional health trajectories. Our sample consisted of 5,254 participants of the German Ageing Survey aged 40 years and older ( M = 62.33 years) who participated in up to four measurement occasions. After controlling for sex, chronic diseases, and education, our longitudinal multilevel regression models revealed that the association of older age and higher pain severity with lower functional health was weaker in individuals with higher processing speed. The relationship between pain and functional health was weaker in individuals with higher scores on accommodative coping. Our findings suggest that processing speed and accommodative coping may be important compensatory resources buffering negative associations of age and pain with functional health.

An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness

Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (vs. passive) and approach-oriented (vs. avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles, and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.

Goal Pursuit, Goal Adjustment, and Pain in Middle-Aged Adults Aging With Physical Disability

Objective: Aging with physical disability disrupts one's ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies-tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)-were associated with reduced pain interference and depressive symptoms and greater well-being, and protected against pain intensity, and FGA was more protective with increasing age and worse physical function. Method: Middle-aged adults with muscular dystrophy, multiple sclerosis, post-polio syndrome, or spinal cord injury (N = 874; M_AGE = 58.3 years, range = 46-68; M_{DISEASEDURATION} = 26.2 years, range = 2-67) completed two questionnaires, a year apart. Results: TGP and FGA use was associated with greater well-being. FGA use predicted decreased depressive symptoms. Concurrent use of both predicted decreased pain interference. Discussion: Adults with disability employ a variety of goal management strategies. Findings support TGP and FGA as potential intervention targets for healthy aging with disabilities.

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people

BACKGROUND

As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility.

AIMS

We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one's goals) and flexible goal adjustment (FGA; adjusting one's goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people.

METHODS

Participants (n = 186) were aged 79-93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA.

RESULTS

General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations.

CONCLUSIONS

Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life.

Assimilative and accommodative coping in older adults with and without sensory impairment: four-year change and prospective relations with affective well-being

Objectives: Sensory impaired older adults may be particularly dependent on coping strategies such as assimilation (or tenacious goal pursuit [TGP]) and accommodation (or flexible goal adjustment [FGA]) to secure high levels of well-being. We investigated if late-life changes in these coping strategies and prospective associations of TGP and FGA with affective well-being vary according to sensory impairment status. Method: Our study sample consisted of 387 adults aged 72-95 years (M = 82.50 years, SD =4.71 years) who were either visually impaired (VI; n = 121), hearing impaired (HI; n = 116), or sensory unimpaired (UI; n = 150). One hundred sixty-eight individuals were reassessed after approximately 4 years. Results: Both VI and HI revealed a decrease in TGP, whereas TGP remained stable in UI. For FGA, a significant increase in HI was observed, whereas a significant decline emerged in UI. Controlling for age, gender, and cognitive abilities, higher TGP at baseline was significantly associated with higher negative affect 4 years later in VI. Moreover, the positive association between baseline FGA and subsequent positive affect was stronger in HI than in UI older adults. Conclusion: Our findings suggest that older adults with sensory impairments reveal trajectories of assimilative and accommodative coping and associations of TGP and FGA with affective well-being that are different from sensory unimpaired individuals.

Assimilative and Accommodative Coping and Older People's Leisure Activities

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite low physical performance, people with high TGP had close to mean level of leisure activity participation, whereas low TGP was associated with very little activity. Most notably, people without high TGP had fewer outdoor activities and group activities outside home. Similar effects were not found for FGA. Discussion: Persistency, rather than flexibility, in goal pursuit appears to help older people be active in their leisure time.

Understanding how coping strategies and quality of life maintain hope in patients deliberating phase I trial participation

OBJECTIVE

This study aimed to understand how hope and motivation of patients considering phase I trial participation are affected by psychological factors such as coping strategies and locus of control (LoC) and general well-being as measured by the quality of life (QoL).

METHODS

An exploratory cross-sectional study was performed in patients with incurable cancer (N = 135) referred to our phase I unit for the first time. Patients were potentially eligible for phase I trial participation and participated in our study while deliberating phase I trial participation. We used questionnaires on hope, motivation to participate, coping, LoC, and QoL. To investigate the nature and magnitude of the relationships between the scales, a structural equation modeling (SEM) was fitted to the data.

RESULTS

Hope significantly predicted the motivation to participate in phase I trials. Predictors of hope were a combination of flexible and tenacious goal pursuit (both P < .01), internal LoC (P < .01), and QoL (P < .01). The SEM showed an exact fit to the data, using a null hypothesis significance test: chi-square (8) = 9.30, P = .32.

CONCLUSIONS

Patients considering phase I trial participation seem to use a pact of tenacious and flexible coping and control to stay hopeful. Furthermore, hope and QoL positively affected each other. The psychological pact may promote an adaptation enabling them to adjust to difficult circumstances by unconsciously ignoring information, called dissonance reduction. This mechanism may impair their ability to provide a valid informed consent. We suggest including a systematic exploration of patients' social context and values before proposing a phase I trial.

Longitudinal Patterns of Stability and Change in Tenacious Goal Pursuit and Flexible Goal Adjustment among Older People over a 9-Year Period

Using the dual-process model of assimilative-tenacity (TGP) and accommodative-flexibility (FGA), the study aims to identify trajectories of TGP and FGA over five time points within a 9-year period, explore the relationships between the trajectories of TGP and FGA, and explore if participants from distinct TGP and FGA trajectories differed in indicators of well-being and depression. Latent class growth analysis was used in a five-wave longitudinal design among an older population of 747 participants over 65 years. Results highlight (1) emergence of four trajectories for flexibility (low and increasing, moderate and increasing, moderately high and stable, and high and stable trajectories) and three trajectories for tenacity (low and stable, moderate and stable, and high and decreasing trajectories), (2) that older people belonging to particular trajectories of FGA are not more likely to belong to particular trajectories of TGP, and (3) that participants from the high and decreasing TGP and high or moderately high and stable FGA trajectories were characterized by high score of perceived health, satisfaction with life, and self-esteem and low score of depression moods. These results highlight that the heterogeneity in longitudinal TGP and FGA scores throughout the life span needs to be accounted for in future research.