Successful ageing from old to very old: a longitudinal study of 12,432 women from Australia

Association of optimism and social support with health-related quality of life among Australian women cancer survivors - A cohort study

AIM

Large-scale studies investigating health-related quality of life (HRQL) in cancer survivors are limited. This study aims to investigate HRQL and its relation to optimism and social support among Australian women following a cancer diagnosis.

METHODS

Data were from the Australian Longitudinal Study on Women's Health, a large cohort study (n = 14,715; born 1946-51), with 1428 incident cancer cases ascertained 1996-2017 via linkage to the Australian Cancer Database. HRQL was measured using the Short Form-36 (median 1.7 years post-cancer-diagnosis). Multivariable linear regression was performed on each HRQL domain, separately for all cancers combined, major cancer sites, and cancer-free peers.

RESULTS

Higher optimism and social support were significantly associated with better HRQL across various domains in women with and without a cancer diagnosis (p < 0.05). Mean HRQL scores across all domains for all cancer sites were significantly higher among optimistic versus not optimistic women with cancer (p < 0.05). Adjusting for sociodemographic and other health conditions, lower optimism was associated with reduced scores across all domains, with greater reductions in mental health (adjusted mean difference (AMD) = -11.54, p < 0.01) followed by general health (AMD = -11.08, p < 0.01). Social support was less consistently related to HRQL scores, and following adjustment was only significantly associated with social functioning (AMD = -7.22, p < 0.01) and mental health (AMD = -6.34, p < 0.01).

CONCLUSIONS

Our findings highlight a strong connection between optimism, social support, and HRQL among cancer survivors. Providing psychosocial support and addressing behavioral and socioeconomic factors and other health conditions associated with optimism and social support may improve HRQL.

Trajectories of Successful Aging Among Older Adults in Aotearoa New Zealand

Successful aging was defined as having no multimorbidity, high functional capacity, active life engagement, and good health-related quality of life. This study analyzed data from 1433 older adults who were followed up for 12 years across seven waves from the New Zealand Health, Work and Retirement study by examining the trajectories of successful aging. Latent growth curve modeling was used to assess the growth factors of successful aging trajectories of older adults. The mean successful aging score was 3.53 (range: 0-6) in 2006 and linearly declined by 0.064 units every year. Those with higher successful aging scores at baseline had a slower decline. Successful aging scores were lower among females, Māori, and those aged 65 years and above at baseline. The findings from this study suggest that gender and ethnic inequalities play significant roles in successful aging among older adults in New Zealand.

Accepting the Aging Body: Protective Factors of Body Acceptance in Persons of Advanced Age

Introduction: Physical attractiveness, productivity, religiosity, meaningfulness, and relationships are important characteristics of successful aging. To maintain psychological flexibility, acceptance and values-directed interventions have been effective in managing difficulties with aging. Objectives: The present paper aimed to investigate body acceptance and individual values in healthy individuals over the age of 50 living in Austria. Methods: In addition to sociodemographic variables, subjective age, attractiveness, and desire for body changes were assessed in our survey. The Austrian Value Questionnaire was used to record values, and the German Version of the Quality of Marriage scale assessed partnership quality. Data from 187 older adults were recruited via snowball sampling. Analyses were performed in SPSS and R, using a structural equation modeling approach. Results: The results indicate that as age increases and subjective attractiveness decreases, body acceptance declines. Materialism seems to support the desire for cosmetic surgery (β = .230, p = .016). A negative association between conservatism and changes in desires for body change (β = -.221, p = .044) suggests that greater value commitment and conservative attitudes are related to fewer change desires. Conclusion: These findings underpin the necessity for encouraging individuals early on to be in touch with their values to promote psychological flexibility.

Loneliness and resilience are associated with nutrition risk after the first wave of COVID-19 in community-dwelling older Canadians

Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the coronavirus disease 2019 (COVID-19) pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and whether loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19 in association analyses and when adjusting for meaningful covariates. Data were collected from 12 May 2020 to 19 August 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78 ± 7.3 years old, 70% female), the median Seniors in the Community: Risk evaluation for Eating and Nutrition (SCREEN-8) score (nutrition risk) was 35 [1st quartile, 3rd quartile: 29, 40], and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses adjusting for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% confidence interval [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness, but not mental health and meal assistance, was associated with nutrition risk in older adults after the first wave of COVID-19. Future research should consider longitudinal associations among loneliness, resilience, and nutrition.

Health and study dropout: health aspects differentially predict attrition

Background

Participant dropout poses significant problems in longitudinal survey studies. Although it is often assumed that a participant’s health predicts future study dropout, only a few studies have examined this topic, with conflicting findings. This study aims to contribute to the literature by clarifying the relationship between different aspects of health and study dropout.

Methods

The 2008 baseline sample of the German Aging Survey was used to predict study dropout (N = 4442). Indicators of health included physical health using the number of chronic conditions, physical functioning using the SF-36 Physical Functioning subscale, cognitive functioning using the digit symbol substitution test, and depression using the CESD-15.

Results

It was found that different aspects of health had differential associations with survey dropout: Worse physical functioning and in part worse cognitive functioning predicted increased dropout rates; contrarily, worse physical health predicted decreased dropout when controlling for other health aspects and covariates. Depression was not significantly related to study dropout.

Conclusions

Therefore, participants with chronic conditions, but minimal physical and cognitive disability were most likely to participate in the future. These findings suggest that health has a complex relationship with survey dropout and must be accounted for in longitudinal studies. Neglecting this systematic attrition due to health problems bears the risk of severely under- or overestimating health-related effects and trends.

Housing and Care for Older Women in Australia

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs.

Methods: Data from 12,432 women in the 1921–26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life.

Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services.

Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.

Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage

BACKGROUND

The aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends.

METHODS

Data were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models.

RESULTS

Persons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile.

CONCLUSION

Overall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.

Estimating the effect of health assessments on mortality, physical functioning and health care utilisation for women aged 75 years and older

Health assessments have potential to improve health of older people. This study compares long-term health care utilisation, physical functioning, and mortality for women aged 75 years or over who have had a health assessment and those who have not. Prospective data on health service use, physical functioning, and deaths among a large cohort of women born 1921–26 were analysed. Propensity score matching was used to produce comparable groups of women according to whether they had a health assessment or not. The study population included 6128 (67.3%) women who had an assessment, and 2971 (32.7%) women who had no assessment. Propensity matching produced 2101 pairs. Women who had an assessment had more use of other health services, longer survival, and were more likely to survive with high physical functioning compared to women with no assessment. Among women who had good baseline physcial functioning scores, women who had an assessment had significantly lower odds of poor outcomes at 1000 days follow-up compared to women who had no assessment (OR: 0.67, 95%CI: 0.52, 0.85). This large observational study shows the real-world potential for assessments to improve health outcomes for older women. However, they also increased health service use. This increased healthcare is likely to be an important mechanism in improving the women’s health outcomes.