Perceived social control as a mediator of the relationships among social support, psychological well-being, and perceived health

Social support in maintaining mental health and quality of life among community-dwelling older people with functional limitations in Malaysia: a population-based cross-sectional study

OBJECTIVE

This study aimed to examine the mediation role of perceived social support in the relationship between functional limitations, depressive symptoms and quality of life among older people in Malaysia.

SETTING

The Malaysian National Health Morbidity Survey 2018: Elderly Health was a cross-sectional health community survey among adults aged 50 and above.

PARTICIPANTS

3977 community-dwelling older Malaysians aged 60 and above.

OUTCOME MEASURES

Functional limitations were defined as personal activities of daily living (PADL) and instrumental activities of daily living (IADL), tested in separate paths in all analyses. PADL was measured using the Barthel Index, while IADL was measured using the Lawton and Brody scale. Perceived social support, depressive symptoms and quality of life were measured using the Duke Social Support Index, Geriatric Depression Scale-14 and Control, Autonomy, Self-Realisation and Pleasure-19 tools. We used mediation analysis through structural equation modelling to explore the role of perceived social support.

RESULTS

Perceived social support mediated the relationship between PADL and IADL with depressive symptoms, with the indirect effects at -0.079 and -0.103, respectively (p<0.001). Similarly, perceived social support mediated the relationship between PADL and IADL with quality of life, with the indirect effects at 0.238 and 0.301, respectively (p<0.001). We performed serial multiple mediation analysis and found that perceived social support and depressive symptoms mediated the path between PADL and IADL with quality of life, with the indirect effects at 0.598 and 0.747, respectively (p<0.001). The relationship between functional limitations and all outcomes remained significant in all mediation analyses.

CONCLUSION

The present study provides evidence that perceived social support relieves the influence of functional limitations on depressive symptoms and declining quality of life among older people. Therefore, it is imperative to establish a social support system to improve the overall well-being of older people.

The Mediating Role of Sense of Control in the Associations Between Remote Contacts and Loneliness Among Older Adults

This study explored whether a sense of control over social life mediated the associations between using remote contact (phone calls, letters/emails, social media) and loneliness for socially isolated older adults. We used path analysis with the 2014 and 2016 Health and Retirement Study datasets (N = 3767). Results showed that more frequent phone calls and letters/emails were associated with lower levels of loneliness through sense of control. However, sense of control did not mediate the association between social media and loneliness. Findings suggest that promoting sense of control over social life by remote contact, particularly phone calls and letters/emails, may be effective in alleviating loneliness for isolated older adults.

Communication Modalities, Personality Traits, and Change in Perceived Control Over Social Life Following Onset of the COVID-19 Pandemic Among Older Americans

We examined associations between change in social contact communication modalities and change in perceived control over social life (PCOSL) following onset of the COVID-19 pandemic among older Americans and evaluated the extent to which associations were moderated by personality. Data were from the 2016 and 2020 waves of the Health and Retirement Study. Multivariate ordinary least squares regression analyses were computed adjusting for baseline PCOSL, sociodemographic, health, and psychosocial factors. Multiple moderation analyses revealed that extraversion moderated the association between change in social media communication and change in PCOSL before to during COVID-19. As levels of engagement in social media communication increased, those with high extraversion experienced increases in PCOSL, whereas those with low extraversion experienced decreases in PCOSL. Findings suggest that social interventions targeting perceived control and communication modality may be useful for older adults during global health events and that personality characteristics can help to inform intervention choices.

The relationship of social isolation and sleep in older adults: evidence from cross-sectional and longitudinal studies

OBJECTIVES

This study aimed to explore the relationship between social isolation and sleep in later life and the role of loneliness in this relationship.

METHODS

In Study 1, we conducted a cross-sectional analysis of the correlation between social isolation and sleep in community-dwelling older adults (N = 108). This relationship was assessed using subjective and objective measures. Moreover, we examined the mediating role of loneliness cross-sectionally (Study 1) and longitudinally (Study 2). Longitudinal study was based on three waves of data from the National Scale Life, Health, and Aging Project (N = 1, 554).

RESULTS

The results showed that social isolation was robustly associated with sleep in the general population of older adults. Specifically, subjective social isolation was associated with subjective sleep, and objective social isolation was associated with objective sleep. The results of the longitudinal study showed that loneliness mediated the reciprocal link between social isolation and sleep across time after controlling for autoregressive effects and basic demographics.

CONCLUSIONS

These findings address the gap in the literature on the link between social isolation and sleep in older adults, extending the understanding of improvement in older adults' social networks, sleep quality, and psychological well-being.

Association between positive control in self-perceptions of aging and motoric cognitive risk syndrome among Chinese community-dwelling older adults: a cross-sectional study

BACKGROUND

Self-perceptions of aging (SPA) are important psychosocial factors that lead to a wide range of outcomes including dementia. However, the relationships between positive SPA and motoric cognitive risk syndrome (MCR) which is a predementia syndrome are still unknown. This study aimed to reveal the associations of positive control and aging awareness of SPA with the risk of MCR and its components.

METHODS

A cross-sectional design was conducted among 1137 Chinese community-dwelling older adults. Positive control and aging awareness were defined by two dimensions of SPA (Positive control and Timeline chronic). MCR was determined according to definition. Multivariable logistic regression was used to examine the associations.

RESULTS

The overall prevalence of MCR was 11.5% (mean age = 71.62 ± 5.22). After adjusting for depression, anxiety, and cognitive function, positive control was associated with reduced risk of MCR (OR = 0.624, 95% CI 0.402-0.969, P = 0.036), subjective cognitive complaints (SCC) (OR = 0.687, 95% CI 0.492-0.959, P = 0.027), and gait speed (GS) (OR = 0.377, 95% CI 0.197-0.720, P = 0.003), respectively. Aging awareness was merely related to increased risk of MCR (OR = 1.386, 95% CI 1.062-1.810, P = 0.016).

CONCLUSIONS

This study highlights the crucial associations of positive control and aging awareness with MCR and its components. Our results emphasize that positive belief in control and adaptive aging awareness might be promising targets for preventing MCR.

Fire spreading across boundaries: The positive spillover of entrepreneurial passion to family and community domains

Passion plays a crucial role in entrepreneurial activity, while its positive spillover to the family and community domains is scant. We proposed an integrated enrichment framework of “work-family-community” based on the literature in the field. Drawing upon the matching samples of entrepreneurs' individuals, families, and communities in the China Labor-force Dynamics Survey (CLDS) database, we identified a significant positive spillover effect into the family and community domains and explored the moderating role of the entrepreneur's perceived personal control. The empirical results indicate that entrepreneurs with higher passion experience higher subjective wellbeing related to family members and have a higher likelihood of engagement in prosocial behaviors. Perceived personal control positively moderates the spillover of passion to life and economic satisfaction. The spread of an entrepreneurial role model's peer effect and the contagion of entrepreneurial passion have a significant positive impact on entrepreneurial behavior in a cluster. Synthesizing our findings, we contribute to the literature concerning work-family enrichment, entrepreneurial passion, and the spillover-crossover model and offer important implications for entrepreneurs' role transition tension.

Relationship Between Frailty and Depression Among Community-Dwelling Older Adults: The Mediating and Moderating Role of Social Support

BACKGROUND AND OBJECTIVES

Frailty is associated with depression in older adults and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression.

RESEARCH DESIGN AND METHODS

This cross-sectional study was conducted among 1,779 community-dwelling older adults aged 60 and older. Frailty, social support, and depressive symptoms were measured by the Physical Frailty Phenotype, Social Support Rating Scale, and five-item Geriatric Depression Scale, respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain.

RESULTS

Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson-Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset.

DISCUSSION AND IMPLICATIONS

Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.

The impact of social interactions and pain on daily positive and negative affect in adults with osteoarthritis of the knee

This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (β = 0.49, p < .001) and momentary, especially positive (β = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (β = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.

Associations of objective versus subjective social isolation with sleep disturbance, depression, and fatigue in community-dwelling older adults

Objective: Older adults are at higher risk of experiencing social isolation, which has been linked to impaired physical and mental health. The link between social isolation and health might be due to objective deprivation of social network and/or subjective experience of loneliness. This community-based cross-sectional study examined whether the associations between social isolation and behavioral symptoms including sleep disturbance, depression, and fatigue are mostly explained by its subjective component. Methods: Randomly selected 2541 community-dwelling individuals in Los Angeles aged ≥60 years were telephone-interviewed regarding their objective and subjective social isolation (respectively social network size and loneliness), sleep disturbance, depression, and fatigue. Results: When objective and subjective social isolation were separately included in multivariate regression models, both were significantly associated with behavioral symptoms. However, once they were simultaneously included in the same multivariate models, while subjective social isolation remained strongly associated (adjusted beta 0.24 for sleep disturbance [P < 0.001], 0.44 for depression [P < 0.001], 0.17 for fatigue [P < 0.001]), objective social isolation was weakly or non-significantly associated (-0.04 for sleep disturbance [P = 0.03], -0.01 for depression [P = 0.48], -0.003 for fatigue [P = 0.89]). Additionally, those with objective social isolation were found to have worse symptoms mostly when they also experienced subjective social isolation. Conclusions: Older adults with objective social isolation may experience sleep disturbance, depression, and fatigue because they feel socially isolated, not just because they are deprived of social networks. Interventions that target social isolation might serve as potential treatments for improving behavioral health of older adults, especially by targeting its subjective component.

The Impact of Communication Impairments on the Social Relationships of Older Adults: Pathways to Psychological Well-Being

Purpose Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment was associated with a range of social measures and to examine the association between these characteristics and psychological well-being. Method Community-dwelling older adults ranging in age from 65 to 94 were recruited for the study of Communication, Health, Aging, Relationship Types and Support. The sample included 240 participants with communication disorders arising from a variety of etiologies including hearing impairment, voice disorders, head and neck cancer, and neurologic disease, as well as older adults without a communication disorder. Results Communication impairment was a significant independent predictor for key characteristics of social relationships, including the number of friends in the social network, two types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was also a significant predictor for higher levels of loneliness and depression. In addition, two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Conclusions Even after controlling for age, gender, health, and disability, communication impairment is a significant independent predictor for key aspects of the social function of older adults and demonstrates two distinct pathways to loneliness and depression. Supplemental Material https://doi.org/10.23641/asha.7250282.

Suicide in older adults: current perspectives

Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.

Social network and cognitive functioning in old age : Self-efficacy as a mediator?

This study investigated self-efficacy (self-perceived and rated by an informant) as a mediator of the relationship between social network variables (including network size, frequency of social contacts, satisfaction with social contacts and social support) and cognitive impairment. Participants were 189 adults with a mean age of 75 years, 32 of whom suffered from mild cognitive impairment (MCI), 39 from early stage Alzheimer's disease (AD) and 118 who had no cognitive impairment. Binary logistic regression and linear regression models were used to assess the association between the predictor variables and cognitive impairment, controlling for several confounders. Network size was significantly associated with the cognitive status (mini mental status examination; β = 0.15, p < 0.05) and with odds of cognitive impairment (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93-0.99). General self-efficacy rated by the informant mediated this relationship in both analyses. Possible underlying mechanisms, including neuroendocrine reactivity and health behavior are discussed.

The Longitudinal Effects of Network Characteristics on the Mental Health of Mothers of Children with ASD: The Mediating Role of Parent Cognitions

Employing a cohort sequential design, the effects of network characteristics on maternal cognitions (perceived social support and parenting self-efficacy) and mental health (depression and well-being) were assessed over 7 years when children with ASD of mothers in the study were age 7-14. Findings indicated that network size, network emotional support, and network instrumental support were positively related to perceived support, while network availability and emotional support were positively linked to self-efficacy. In addition, network support exerted direct and indirect effects on maternal depression and well-being, with cognitive resources mediating the social network-mental health relationship. Finally, consistent with the support-efficacy model, parenting efficacy partially mediated the effects of perceived support on maternal mental health outcomes. Study findings and implications are discussed.

Social support and protection from depression: systematic review of current findings in Western countries

BACKGROUND

Numerous studies report an association between social support and protection from depression, but no systematic review or meta-analysis exists on this topic.

AIMS

To review systematically the characteristics of social support (types and source) associated with protection from depression across life periods (childhood and adolescence; adulthood; older age) and by study design (cross-sectional v cohort studies).

METHOD

A systematic literature search conducted in February 2015 yielded 100 eligible studies. Study quality was assessed using a critical appraisal checklist, followed by meta-analyses.

RESULTS

Sources of support varied across life periods, with parental support being most important among children and adolescents, whereas adults and older adults relied more on spouses, followed by family and then friends. Significant heterogeneity in social support measurement was noted. Effects were weaker in both magnitude and significance in cohort studies.

CONCLUSIONS

Knowledge gaps remain due to social support measurement heterogeneity and to evidence of reverse causality bias.

Consumers attitudes and beliefs towards the receipt of antenatal corticosteroids and use of clinical practice guidelines

BACKGROUND

Active participation of consumers in health care decision making, policy and clinical research is increasingly encouraged by governments, influential bodies and funders. Identifying the best way to achieve this is difficult due to the paucity of evidence. Consumers have mixed feelings towards clinical practice guidelines (CPG) demonstrating scepticism towards their purpose and applicability to their needs. There is no information pertaining to consumers' views and attitudes on the receipt of antenatal corticosteroids (ACS). The aim of this study was to examine the barriers and enablers to receiving ACS and use of CPG amongst consumers.

METHODS

Consumers were recruited from neonatal units across three district health boards (DHBs) in Auckland, New Zealand. Participants completed a semi-structured interview or questionnaire. The questions posed and analyses were informed by the Theoretical Domains Framework (TDF). Barriers and enablers were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on use of CPG and receipt of ACS.

RESULTS

Twenty four consumers participated in the study. Six domains were identified as barriers to receipt of ACS and use of CPG. Key barriers to receipt of ACS included: difficulty retaining information conveyed, requiring further information in a variety of formats, and time constraints faced by consumers and health professionals in the provision and understanding of information to facilitate decision making. Barriers to use of CPG included: uncertainty about applicability of guideline use among consumers and scepticism about health professionals adhering too rigidly to guidelines. Enablers to receipt of ACS included: optimism toward ACS use, a strong knowledge of why ACS were administered, improved resilience in their pregnancy and confidence in their decision making following receipt of information about ACS. Enablers to use of CPG included: validation and standardisation of decision making among health professionals providing care and facilitating the best care for women and their babies.

CONCLUSIONS

Key barriers and enablers exist among consumers regarding receipt of ACS and use of CPG. These need to be addressed or modified in any intervention strategy to facilitate implementation of the ACS CPG.

Well-Being and Institutional Care in Older Adults: Cross-Sectional and Time Effects of Provided and Received Support

BACKGROUND

The aim of the study was to examine the cross-sectional and longitudinal effects of provided and received support on older adults' subjective well-being (positive affect and depression) and to examine whether being a recipient of institutional care moderates these effects.

METHODS

Social support (provided and received), positive affect, and depressive symptoms were assessed twice (at baseline and 1 month later) for 277 older adults (age 77.39 ± 9.20 years, 67.50% women, 65% residents of an institutional care facility).

FINDINGS

Two structural equation models were analyzed: cross-sectional (at baseline) and longitudinal (after 1 month). The first model revealed a significant positive relationship between providing and receiving support and positive affect, and a negative relationship between receiving support and depression. However, being a recipient of institutional care appeared to be a significant moderator in the longitudinal model. Specifically, the findings indicated effects of both providing and receiving support on positive affect but only for noninstitutionalized older adults.

DISCUSSION

Although both types of support may be beneficial for older adults, their effects depend on the nature of social exchange and the dimensions of well-being. This suggests that such factors should be systematically investigated in future research.

A Phenomenological Perspective on Older Widows’Satisfactions With Their Lives

The study of life satisfaction (LS) has been a preeminent focus in gerontological research, but the validity of the construct has been questioned. The main aim of this descriptive phenomenological study was to describe the structures of experience (phenomena) that older widows associated with perceptions of gratification, pleasure, or contentment. A secondary analysis was done of 44 interviews conducted with 16 older widows. The phenomenon of interest was savoring satisfactions. Six component phenomena, including “doing what I can for them” and “bringing variety to life,” were common across the sample. The women’s specific intentions reflected personal nuances of the phenomenon. The personal-social context of the experience was described, and sources of satisfaction were highlighted as opportunities afforded by the environment. Findings were compared to domains typically measured in LS instruments and predominant research traditions. Ideas were cited for preventive interventions and further research about satisfying experiences and sources of satisfaction.

Financial Strain, Negative Interactions, and Mastery: Pathways to Mental Health Among Older African Americans

This study examines the impact of financial strain, social support, and negative interactions on depressive symptoms among African Americans and the role of mastery as a mediator in these relationships. Structural equation modeling and baseline data from the Americans' Changing Lives Study were used to test these relationships among a sample of African Americans aged 50 to 96 years (N = 583). Findings illustrate the mechanistic pathways whereby financial strain is associated with depressive symptoms. Moreover, the study findings give further credence to the notion that positive and negative aspects of social relationships are distinctive with respect to social status factors, financial strain, and their relationship to depressive symptoms. This research suggests that mastery is an important mechanism linking negative interaction to mental health. The collection of findings provide a number of provocative departures from research conducted primarily using White samples and identifies important areas of intervention with older African Americans.

Aspirations for Older Age in the 21st Century: What is Successful Aging?

The literature on successful aging reveals a wide range of definitions, generally reflecting the academic discipline of the investigator. Biomedical models primarily emphasise physical and mental functioning as successful aging; socio-psychological models emphasise social functioning, life satisfaction and psychological resources as successful aging. Several studies also identify these factors as the precursors of successful aging. Moreover, research shows that older people consider themselves to have aged successfully, but classifications based on traditional medical models do not. Fewer studies have explored lay views, and most of these have been exploratory or restricted to specific groups of areas. A model of successful aging needs to be multi-dimensional, incorporate a lay perspective for social significance, use a continuum rather than dichotomous cut-offs for “success” and lack of, and distinguish clearly between predictor and constituent variables.

Understanding Associations of Control Beliefs, Social Relations, and Well-Being in Older Adults with Osteoarthritis

Control beliefs and social relationships have been individually assessed in relation to adaptation to chronic illness, although only rarely together. Further, some control scales show psychometric limitations in older adult samples. To address these concerns, a scale assessing external control was created by factor analyzing the items from Levenson's (1974) control subscales. We tested the association of external control beliefs, measured with the new formulation of items, and two social relations variables (support and strain) to well-being measures in a sample of older adults reporting osteoarthritis (OA; N = 95, 72% female). We also compared the new formulation of items to the original subscales. The Levenson measures were significantly related to life satisfaction after controlling for social relations. However, the new externality scale was a stronger correlate than the chance subscale (though not different from powerful others). Only the new scale was related to depressive symptoms once social relations were controlled. In addition, social support was significantly associated with both outcomes.

Relationships among social support, self-concept, and wellbeing of older adults: A study of process using dynamic factor models

Intra-individual patterns of time-lagged relationships among self-reports of social support, self-concept, and physical and psychological wellbeing were investigated. Participants were older adults (mean age = 77 years) who were measured weekly on some scales and biweekly on others, covering a total of 25 weeks. Dynamic factor models were fitted to multivariate repeated measures data pooled over subsets of participants. The results indicate significant time-lagged, cross-factor relationships showing that negative social support has both a direct effect and an indirect effect, through less positive self-concept, on physical health measures. For the measures of negative social support, self-concept, subjective health, and physical performance (gait), there are substantial autoregressive effects indicating persisting factor scores over 1 or 2 weeks. How intra-individual perspectives and methods can facilitate the study of complex developmental processes is discussed.

Perceived Social Support, Hassles, and Coping Among the Elderly

An essential aspect of aging is successful coping. This entails learning how to deal effectively with change, losses, disappointments, and decline. The present study examined the relationship between coping, social support, daily hassles, functional disability, and physical and psychological health status in a sample of 224 community-residing older adults. Data were collected using a confidential and anonymous questionnaire. Results of structural equation analyses showed that social support was associated with fewer daily hassles. Social support was also indirectly related to daily hassles—that is, by increasing proactive coping. Further results indicated that proactive coping was inversely related to health hassles and functional disability. Proactive coping also was indirectly related to somatization and functional disability through health hassles. Results also showed that greater functional disability was associated with greater somatization. Implications of the results for healthy psychological functioning in the elderly are discussed.

Social support and cognitive functioning as resources for elderly persons with chronic arthritis pain

OBJECTIVE

Arthritis pain and depression are prevalent physical and psychological disorders in late life and co-occur frequently. We explored the stability and covariation of arthritis pain and depressive symptoms. We also addressed the influence of cognitive functioning and social support on the relationship between pain and depressive symptoms among community-dwelling older individuals.

METHOD

This longitudinal study utilized a sample of 299 residents of Florida retirement communities who participated in a long-term panel study using yearly assessments across 4 years. Using multilevel modeling, we modeled the individual differences as well as stability in arthritis pain and depressive symptoms simultaneously. Further, we tested the role of cognitive functioning and social support in the association between arthritis pain and depressive symptoms.

RESULTS

We found substantial within-person variation in both pain and depressive symptoms (between 58% and 65%) across 4 years even after controlling for a time effect. After controlling for arthritis pain, persons with higher social support and higher cognitive functioning reported lower levels of depressive symptoms.

DISCUSSION

Findings suggest that fluctuations in pain and depressive symptoms are common for older adults. Furthermore, social support and intact cognitive functioning may serve as useful resources, as they buffer the negative impact of arthritis pain on depressive symptoms.

Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients

Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers.

Perceived Social Cohesion, Frequency of Going Out, and Depressive Symptoms in Older Adults: Examination of Longitudinal Relationships

Objective: To examine both cross-sectional and longitudinal relationships between older adults’ perceptions of social cohesion in their community and depressive symptoms and the potential mediating effect of the frequency of going outside one’s home/building. Method: Using two waves (T1 and T2) of the National Health and Aging Trend Study (n = 5,326), gender-stratified structural equation models were estimated to determine direct and indirect effects of perceived social cohesion on depressive symptoms. Results: At T1, both perceived cohesion and frequency of going out were directly associated with depressive symptoms; however, perceived cohesion predicted frequency of going out only for women. At T2, only frequency of going out was directly associated with depressive symptoms, although perceived cohesion predicted frequency of going out for both genders. T1 perceived cohesion did not predict T2 depressive symptoms. T1 depressive symptoms were the strongest predictor of T2 depressive symptoms. Conclusion: The findings underscore the importance of enhancing the social environment in promoting mental health in late life through active aging.

Risk of dementia in older adults with low versus high occupation-based motivational processes: differential impact of frequency and proximity of social network

OBJECTIVES

This study investigates the impact of occupation-based motivational processes and social network variables on the incidence of dementia over 8 years.

METHOD

Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged 75 years and older (n=1692 at baseline). Motivational processes were estimated based on the main occupation using the Occupational Information Network database.

RESULTS

In a Cox proportional hazard model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals with low indices of motivational processes, the frequency of social contacts was associated with a lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR: 1.09, 95% CI: 1.01-1.19).

DISCUSSION

Results indicate that the frequency and proximity of social contacts have a differential impact on the risk of dementia according to lower or higher indices of motivational processes, while the impact of motivational processes on risk of dementia could not be confirmed. Future studies should carefully disentangle different aspects of social interactions and their association with motivational processes.

Effects of participation in swimming lessons on health perception and belief

This study was conducted to investigate the effects of the degree of participation in swimming lessons and the participation styles on health perception and belief. To do this, several analyses were conducted-statistical analysis, frequency analysis, factorial analysis, reliability analysis, correlation analysis, and regression analysis-using SPSS 18.0. A total of 300 copies of the questionnaire were distributed and after excluding those that are considered invalid, only 278 copies were used for the study. As a result, first, for the participants for "30 min-1 h," "1 h-2 h," and "more than 2 h" in time and "2-3 times a week" and "4-5 times a week" in frequency, swimming lessons in types had a significant effect on health interest and health concern. Second, participants for "30 min-1 h" and "1 h-2 h" in time and "hard' in intensity had a significant effect on resistance and sensitivity. Third, all frequencies and intensities excluding the participants for "15 min-30 min." and "swimming lessons" in types had a significant effect on perceived benefit. Fourth, all participants for a time period did not have a significant effect on the perceived disability, but they all had a significant effect on the former in terms of frequency and intensity. This being said, however, the participating types did not have any a significant effect.

An examination of the effects of intra and inter-individual changes in wellbeing and mental health on self-rated health in a population study of middle and older-aged adults

PURPOSE

Self-rated health is frequently used as an indicator of health and quality of life in epidemiological studies. While the association between self-rated health and negative mental health is well established, associations with indictors of positive wellbeing are less clear. Data from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project were used to compare the effects of vitality and mental health on self-rated health.

METHODS

Participants (n = 40,712) provided information on vitality, mental health and self-rated health, were aged 45-95 years at baseline, and were followed between 1 and 10 years (M = 5.6; SD = 2.9).

RESULTS

In comparison with mental health, multi-level modelling indicated between- and within-person change in vitality was more strongly associated with self-rated health. Bivariate dual change score modelling of the cross-lagged associations between vitality and self-rated health indicated vitality to be a stronger predictor of change in self-rated health. Self-rated health was unrelated to change in vitality.

CONCLUSION

Vitality accounted for most of the mental health effect on self-rated health and was identified as a significant predictor of change in self-rated health over a 10-year period. Promoting wellbeing and psychological functioning may have significant protective effects on negative health outcomes throughout the adult lifespan and into late life.

Trajectories of social support and well-being across the first two years of widowhood

The death of a spouse can be one of the most challenging events an older adult can face, yet many exhibit resilience. The present study examined the trajectories of structural and functional social support components, depression, and life satisfaction across the first two years of widowhood. The majority of structural and functional support trajectories exhibited stability across the first two years postloss. However, emotional support and support provided by family members did display a slight decline across time. Depression showed a linear pattern across time (e.g., decline in depressive symptomology) and life satisfaction demonstrated evidence of a one-year anniversary effect.

Intergenerational Exchange and Expected Support Among the Young-Old

The authors used data from the Wisconsin Longitudinal Study (N = 5,023) to determine how 3 attributes of intergenerational exchange (content, direction, and recency) are associated with older adults' expected sick care and comfort from their adult children. They found more like-kind associations (expecting same types of support that had been exchanged before) than spillover associations (expecting different types of support than that had been exchanged before). Same patterns of like-kind associations were found for expected sick care and comfort, regardless of the direction and recency of exchange, but expected sick care and comfort had different patterns of spillover associations. Specifically, recent emotional transfer, upward or downward, was related to expected sick care, but only recent upward instrumental transfer was related to expected comfort. This study advances the gerontological literature by elucidating the complex relations between each of the 3 attributes of intergenerational exchange and expected support among older adults.

Depressive symptoms in later life: differential impact of social support and motivational processes on depression in individuals with and without cognitive impairment

This study investigates the role of a motivational process based on a composite of four subcomponents (self-efficacy, decision regulation, activation regulation and motivation regulation), as a mediator of the relationship between social support and depression assessed with the Geriatric Depression Scale in cognitively impaired and unimpaired individuals. Participants were 229 adults with a mean age of 74 years (range: 52-94 years). The sample comprised 64 participants diagnosed with mild cognitive impairment (MCI), 47 participants diagnosed with early-stage Alzheimer's disease (AD), and a group of 118 participants without any cognitive impairment. In this cross-sectional study, bivariate correlations and linear regression models were used to assess the association between the predictor variables and depression. Linear regression models were controlled for age, gender, education, cognitive status, cognitive impairment and activities. In the total sample, social support (β = -0.15, p < 0.05) and motivational processes (β = -0.41, p < 0.001) were significantly associated with depression; the impact of social support was mediated by motivational processes. While motivational processes were associated with depression in all three groups (no impairment: β = -0.61, p < 0.001; MCI: β = -0.28, p < 0.05; early AD: β = -0.30, p < 0.06), social support lost significance (no impairment: β = -0.36, p < 0.001; MCI: β = 0.07, p = 0.59; early AD: β = -0.08, p = 0.62). Based on these findings, it can be argued that the impact of social support on depressive symptoms is attenuated by cerebral deterioration in cognitively impaired individuals, while motivational processes remain relevant.

Interrelations of stress, optimism and control in older people's psychological adjustment

AIM

To investigate the influence of perceived stress, optimism and perceived control of internal states on the psychological adjustment of older adults.

METHOD

The sample consisted of 212 older adults, aged between 58 and 103 (M = 80.42 years, SD = 7.31 years), living primarily in retirement villages in Melbourne, Victoria. Participants completed the Perceived Stress Scale, Life Orientation Test-Revised, Perceived Control of Internal States Scale and the World Health Organisation Quality of Life-Bref.

RESULTS

Optimism significantly mediated the relationship between older people's perceived stress and psychological health, and perceived control of internal states mediated the relationships among stress, optimism and psychological health. The variables explained 49% of the variance in older people's psychological adjustment.

CONCLUSION

It is suggested that strategies to improve optimism and perceived control may improve the psychological adjustment of older people struggling to adapt to life's stressors.

Information needs, seeking behaviors, and support among low-income expectant women

Previous studies have consistently found associations between low income and infant health outcomes. Moreover, although health information-seeking is a maternal behavior related to improved health outcomes, little is known about the health information-seeking behaviors and information needs of low-income pregnant women. The purpose of the current investigation was to examine the information needs, information-seeking behaviors, and perceived informational support of low-income pregnant women. Accordingly, the study recruited 63 expectant women enrolled in a subsidized prenatal care program in Milwaukee, Wisconsin, during two time periods: March-May 2011 and October-December 2011. Results indicated that participants relied heavily upon interpersonal sources of information, especially family and the father of the baby; rarely used the Internet for health-related information; and desired information beyond infant and maternal health, such as finding jobs and accessing community/government resources. Participants who used family members as primary sources of information also had significantly increased levels of perceived informational support and reduced uncertainty about pregnancy. Our findings have implications for the dissemination of pregnancy-related health information among low-income expectant women.

Gender differences in the association of perceived social support and social network with self-rated health status among older adults: a population-based study in Brazil

Background

Older adults are more likely to live alone, because they may have been predeceased by their spouse and friends. Social interaction could also be reduced in this age group due by limited mobility caused by chronic conditions. Therefore, aging is frequently accompanied by reduced social support, which might affect health status. Little is known about the role of gender in the relationship between social support and health in older adults. Hence, the present study tests the hypothesis that gender differences exist in the relationship between perceived social support, social network, and self-rated health (SRH) among older adults.

Methods

A cross-sectional study using two-stage probabilistic sampling recruited 3,649 individuals aged 60 years and above. Data were collected during the national influenza vaccination campaign in Rio de Janeiro, Brazil, in 2006. Individual interviews collected information on SRH, perceived social support, social network, and other covariates. Multivariate logistic regression analyses using nested models were conducted separately for males and females. Independent variables were organised into six blocks: (1) perceived social support and social network, (2) age group, (3) socioeconomic characteristics, (4) health-related behaviours, (5) use of health care services, (6) functional status measures and somatic health problems.

Results

Older men who did not participate in group activities were more likely to report poor SRH compared to those who did, (OR = 1.63; 95% CI = 1.16–2.30). Low perceived social support predicted the probability of poor SRH in women (OR = 1.64; 95% CI = 1.16–2.34). Poor SRH was associated with low age, low income, not working, poor functional capacity, and depression in both men and women. More somatic health problems were associated with poor SRH in women.

Conclusions

The association between social interactions and SRH varies between genders. Low social network involvement is associated with poor SRH in older men, whereas low perceived social support is associated with poor SRH in older women. The hypothesis that the relationship of perceived social support and social networks to SRH differs according to gender has been confirmed.

A narrative exploration of older people's transitions into residential care

OBJECTIVES

Moving into residential care has been argued to be a significant life transition for older people, often resulting in stress and anxiety. This research aimed to explore qualitatively older people's experiences of this transition, including how relocation is reflected upon and incorporated into their personal narratives.

METHOD

Eight older adults (65-97 years) living in a residential facility for between three and 12 months participated in interviews focussed on their experiences of relocating to a residential care home.

RESULTS

Narrative analysis revealed that rather than depicting time bound stages of transition, participants' experiences reflected key plots of 'control', 'power', 'identity' and 'uncertainty' interwoven throughout their narratives. Participants experienced some difficulties in incorporating this transition into their life stories. Furthermore, participants discussed not feeling confident in their decision to move, living in constant fear of losing their memory, and limited expectations for their future.

CONCLUSION

Professionals should move away from considering transition as a stage-based process ending in acceptance, instead focussing on how residents perceive relocation in relation to previous life experiences, unspoken fears evoked by moving and how the environment and relationships with staff may be altered to assist residents in maintaining their identity and sense of control.

Perceived control in the lives of older adults: the influence of Langer and Rodin's work on gerontological theory, policy, and practice

A key concept driving the field of both clinical and applied gerontology is that of personal control. Seminal work conducted in the late 1970s to early 1980s by Ellen Langer and Judith Rodin, who examined the effect of choice and enhanced responsibility on older adults, not only contributed to the discussion of the relevance of control in contemporary theories and practices of aging but also aided in the development of today's philosophy of how to serve and care for older adults in ways that are passionate, humanistic, and empowering. In their early research, residents at a nursing home were randomly assigned to 2 groups: 1 group was told they could arrange their furniture as they wanted, go where they wanted, spend time with whom they wanted, and so forth and were given a plant to care for; the other group was told that the staff was there to take care of and help them, including watering a plant given to each of them. During this study, and 18 months later, residents who were given control and personal responsibility had improved health; among those for whom control had not changed, a greater proportion had died. Since these original studies, research has continued to support the need for personal control as we age. This paper presents a brief overview of literature informed by Langer and Rodin's seminal findings, as well as the role of control to theory, policy, and practice.

Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone

OBJECTIVES

To investigate the association between multimorbidity-a construct comprising several health domains (medical comorbidity, musculoskeletal, physical and social functional status, mental health, and geriatric problems)-and overall self-rated health (SRH), an important chronic disease health outcome. We investigate whether medical comorbidity effects are mediated through other health domains and whether these domains have independent effects on SRH.

STUDY DESIGN AND SETTING

Medicare recipients (n=958) completed a questionnaire 3 years post primary total hip replacement surgery. Self-reported sociodemographic characteristics, SRH, and health domain statuses were ascertained. Probit regressions and path analyses were used to evaluate the independent effects of the health domains on SRH and the interrelationships between domains and to quantify direct and mediated effects.

RESULTS

All domains were independently associated with SRH. Medical comorbidity explained 11.7% of the variance in SRH, and all other health domains explained 27.3%. The impact of medical comorbidity was largely direct (only 21.5% mediated through other domains). Medical comorbidity minimally explained the variance in other domain scores.

CONCLUSION

SRH has multiple determinants. This finding suggests that an exclusive focus on any one domain in health research may limit the researchers' ability to understand health outcomes for which SRH is predictive.

Comparing the Support-Efficacy Model among Centenarians Living in Private Homes, Assisted Living Facilities, and Nursing Homes

We investigated the influence of social relations on health outcomes in very late life by examining the support-efficacy convoy model among older adults who resided in three different residential environments (centenarians in private homes, n = 126; centenarians in assisted living facilities, n = 55; centenarians in nursing homes, n = 105). For each group, path analytic models were employed to test our hypotheses; analyses controlled for sex, mental status, education, perceived economic sufficiency, and activities of daily living. The hypothesized relationships among the models' variables were unique to each of the three groups; three different models fit the data depending upon residential environment. The direct and indirect effects of social relations assessments were positive for the mental and physical health of very old adults, suggesting that participants welcomed the support. However, residential status moderated the associations between the assessments of social relations, self-efficacy, and both outcomes, physical and mental health.

Functional health status among rural and urban older adults in Taiwan: the effect of personal control and social control

AIM

To assess the relationship between perceived social control/personal control and functional health status among older adults in rural and urban Taiwan.

BACKGROUND

The ageing of the population is poised to emerge as a preeminent worldwide phenomenon. It is assumed that even though older adults experience many decades of autonomy and independence, the potential for illness or bodily decline will induce a serious reduction in the level of perceived control in older adult populations.

METHOD

This is a descriptive correlational study using a secondary data base, Social Environment and Biomarkers of Aging Study. Social Environment and Biomarkers of Aging Study is a nationally representative study of health outcomes in the Taiwanese population.

RESULTS

Both perceived levels of social control and personal control had a statistically significant relationship with functional health status. Functional health status was significantly higher for urban older adults than their rural counterparts.

CONCLUSIONS

Personal control and social control were both found to be predictors of functional health status. Major findings are supported by previous studies.

RELEVANCE TO CLINICAL PRACTICE

Nurses should create programs and plan activities to assist older adults to enhance their perceptions of social control or personal control in order to improve the health status of older adults and minimize associated health care costs.

The Impact of Social and Interpersonal Resources on Adjustment Disorder Symptoms in Older Age

This study investigates self-efficacy and motivation regulation as possible mediators of the relationship between social and interpersonal resources (i.e., social network, social support, social acknowledgment as a victim, and disclosure) and adjustment disorder (AJD) symptoms in a sample of 121 adults aged 65–97 years. AJD was conceptualized as a form of stress-response syndrome, core symptoms of which are intrusions, avoidance, and failure to adapt after having experienced a critical event. Motivational variables mediated the relationship between social acknowledgment and AJD symptoms. Contrary to expectations, motivational variables were not found to mediate the link between reluctance to disclose and AJD symptoms. This study casts new light on the psychological processes that enable older adults to adjust to critical life events and to exhibit resilience, which is important for successful aging.

Antecedent-consequent relations of perceived control to health and social support: longitudinal evidence for between-domain associations across adulthood

OBJECTIVES

To examine antecedent-consequent relations of perceived control to health and social support across adulthood and old age.

METHODS

We applied (multigroup) change score models to two waves of data collected 9 years apart from 6,210 participants of the Midlife in the United States survey (MIDUS, 24-75 years at baseline). We used composite measures of perceived control (personal mastery and constraints), health (chronic conditions, acute conditions, and functional limitations), and social support (support and strain associated with spouse/partner, family, and friends).

RESULTS

Analyses revealed evidence for direct and independent multidirectional accounts. Greater initial control predicted weaker declines in health and stronger increases in support. In turn, increases in control were predicted by better initial health and more support. Changes in control were also accompanied by concurrent changes in the other two domains, and relations involving control were larger in size than those between health and support. We found only small sociodemographic differences across age, gender, and education group.

DISCUSSION

We conclude that perceiving control may serve as both a precursor and an outcome of health and social support across the adult age range and suggest routes for further inquiry.

Giving and Taking —Differential Effects of Providing, Receiving and Anticipating Emotional Support on Quality of Life in Adults with Multiple Illnesses

Multimorbidity challenges quality of life (QoL) in old age. Anticipating and providing social support have been shown to promote QoL whereas receiving support often had detrimental effects. Little is known about which psychological processes explain these effects. This study examines the effects of receiving, anticipating and providing emotional support on QoL, with control beliefs and self-esteem as simultaneous mediators in an elderly multimorbid sample ( N = 1415). Anticipating and providing support positively predicted QoL, mediated through self-esteem and control beliefs. Received support negatively predicted QoL, without mediation. Self-esteem and control beliefs can help to explain the relation between QoL and support.

Contextual Effects on Life Satisfaction of Older Men and Women

Des différences existent entre les sexes dans les variables liées à la démographie, à la santé et aux réseaux sociaux, variables qui sont associés à un vieillissement réussi, mais on n'en trouve généralement pas en ce qui concerne la satisfaction face à la vie. La présente étude avait pour but premier de déterminer s'il y a des différences entre les hommes et les femmes par rapport à leur satisfaction dans des domaines particuliers et en général à l'égard de la vie. Ont également été examinées les différences dans la satisfaction face au parcours de la vie entre les hommes et les femmes. Dans un deuxième temps, nous avons procédé à une analyse de l'ensemble de données recueillies dans l'étudeVieillir dans la communauté(Béland et al., 1989) afin d'évaluer le bien-être des adultes francophones plus âgés (N=958). Des analyses acheminatoires ont révélé une bonne concordance des modèles utilisés pour les échantillons masculins et féminins. Chez les hommes, la satisfaction face à la vie s'explique positivement selon l'âge, le revenu et le contrôle et négativement selon les erreurs de mémoire, la maladie et les limitations fonctionnelles. Chez les femmes, la satisfaction face à la vie s'explique selon l'âge, la scolarité, le revenu, la maladie, les limitations fonctionnelles, le soutien social, le contrô le et le mode de vie. Les résultats ont fait ressortir les aspects positifs et négatifs du soutien social pour les femmes. Tel que nous nous y attendions, les modèles de parcours ont indiqué que, même s'il existe des similitudes dans la satisfaction face au parcours de la vie chez les hommes et chez les femmes plus âgés, on retrouve également des différences importantes.

Still happy after all these years: research frontiers on subjective well-being in later life

OBJECTIVES. Understanding the factors that promote quality of life in old age has been a staple of social gerontology since its inception and remains a significant theme in aging research. The purpose of this article was to review the state of the science with regard to subjective well-being (SWB) in later life and to identify promising directions for future research.

METHODS

This article is based on a review of literature on SWB in aging, sociological, and psychological journals. Although the materials reviewed date back to the early 1960s, the emphasis is on publications in the past decade.

RESULTS

Research to date paints an effective portrait of the epidemiology of SWB in late life and the factors associated with it. Although the research base is large, causal inferences about the determinants of SWB remain problematic. Two recent contributions to the research base are highlighted as emerging issues: studies of secular trends in SWB and cross-national studies. Discussion. The review ends with discussion of priority issues for future research.