Regional Impact of Population Aging on Changes in Individual Self-perceptions of Aging: Findings From the German Ageing Survey

Neighborhood Social Environment and Self-Perceptions of Aging

Background and Objectives

Self-perceptions of aging (SPA) are associated with health and well-being later in life. Although prior studies have identified individual-level predictors of SPA, the role of neighborhood social context in SPA remains largely unexplored. A neighborhood social environment may act as a critical avenue for older adults to remain healthy and socially active, contributing to their evaluations of how they grow old. The present study aims to fill the previous research gap by examining the relationship between neighborhood social environment and SPA, and how age may moderate this relationship. This study is guided by Bronfenbrenner's Ecology of Human Development theory and Lawton's Ecological Model of Aging, positing that an individual's aging experience is deeply rooted in their residential environment.

Research Design and Methods

Our sample includes 11,145 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study. We included 4 social and economic aspects of neighborhoods: (1) neighborhood poverty; (2) percentage of older adults; (3) perceived social cohesion; and (4) perceived disorder.

Results

Multilevel linear regression models showed that respondents in neighborhoods with higher percentages of the older population and with perceptions of high neighborhood disorder reported more negative SPA. Those who perceived their neighborhoods as more socially cohesive reported more positive SPA. Controlling for individual socioeconomic and health status, only neighborhood social cohesion remained significant. We also found significant interaction effects between neighborhood social cohesion and age: The effects of neighborhood cohesion on SPA were stronger in middle age than in old age.

Discussion and Implications

Our findings provide insights into how neighborhood social context is associated with SPA, suggesting that a socially cohesive neighborhood may be important to promote more favorable perceptions of aging, particularly for middle-aged residents.

Resuscitation room management of patients with non-traumatic critical illness in the emergency department (OBSERvE-DUS-study)

BACKGROUND

Few studies address the care of critically ill non-traumatic patients in the emergency department (ED). The aim of this study was to assess the epidemiology, management, and outcome of these patients.

METHODS

In this retrospective study, we identified and analyzed data from all consecutive adult critically ill non-traumatic ED patients treated from March 2018 to February 2019. Patient characteristics, major complaint leading to admission, out-of-hospital, and in-hospital interventions and 30-day mortality were extracted from medical records of the electronic patient data management system.

RESULTS

During the study period, we analyzed 40,764 patients admitted to the ED. Of these, 621 (1.5%) critically ill non-traumatic patients were admitted for life-threatening emergencies to the resuscitation room (age: 70 ± 16 years, 52% male). Leading problem on admission was disability/unconsciousness (D), shock (C), respiratory failure (B), airway obstruction (A), and environment problems (E) in 41%, 31%, 25%, 2%, and 1%, respectively. Out-of-hospital and in-hospital measures included: intravenous access (61% vs. 99%), 12-lead ECG (55% vs. 87%), invasive airway management (21% vs. 34%) invasive ventilation (21% vs. 34%), catecholamines (9% vs. 30%), arterial access (0% vs. 52%), and cardiopulmonary resuscitation (11% vs. 6%). The underlying diagnoses were mainly neurological (29%), followed by cardiological (28%), and pulmonological (20%) emergencies. The mean length of stay (LOS) in the resuscitation room and ED was 123 ± 122 and 415 ± 479 min, respectively. The 30-day mortality was 18.5%.

CONCLUSION

The data describe the care of critically ill non-traumatic patients in the resuscitation room. Based on these data, algorithms for the structured care of critically ill non-traumatic patients need to be developed.

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain

INTRODUCTION

Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers.

AIMS

To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA).

METHODS

We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes.

RESULTS

Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals.

CONCLUSION

Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Age integration in later life social networks and self-perceptions of aging: examining their reciprocal associations

Relying on the age segregation theory (limited contact between age groups), this study examined the temporal reciprocal associations between age integration-the inclusion of older and younger people in one's personal network-and one's self-perceptions of aging (SPA). Data came from the 2014 and 2017 waves of the German Ageing Survey and focused on adults aged 60 and above (N = 5239). Age composition of the network was assessed as the number of kin and non-kin in the social network who are either more than 10 years older or more than 10 years younger than the respondent. A latent change score model assessed the bidirectional associations. The results showed that adults who had younger social network members, both kin and non-kin, had better SPA 3 years later. A positive SPA at baseline also predicted a higher number of younger non-kin and older non-kin relationships over time. These results stress the role of SPA in adults' social network as well as the role of age integration in shaping adults' SPA. Practitioners and policy makers should encourage connections between people of different ages and should strive to decrease the age segregation in society.

Differences in awareness of positive and negative age-related changes accounting for variability in health outcomes

Higher awareness of positive age-related changes (AARC gains) is related to better mental health, whereas higher awareness of negative age-related changes (AARC losses) is related to poorer mental and physical health. So far perceived gains and losses have been explored separately, but people report gains and losses concurrently in varying degrees, and different profiles of gains and losses may be differentially associated with health. We identified profiles of gains and losses and explored whether different profiles differed in physical, mental, and cognitive health. We used cross-sectional data from the PROTECT study (N = 6192; mean (SD) age = 66.1 (7.0)). Using latent profile analysis, a four-class solution showed the best model fit. We found that 45% of people perceived many gains and few losses (Class 1); 24% perceived moderate gains and few losses (Class 2); 24% perceived many gains and moderate losses (Class 3); 7% perceived many gains and many losses (Class 4). Analysis of variance and Chi-squared tests showed that Class 1 had relatively better physical, mental, and cognitive health, followed by Classes 2, 3, and 4. Experiencing one's ageing to a high degree as gain may be related to better health only when individuals interpret ageing as involving low levels of loss across several life domains. Risk in terms of poorer health emerged in those who perceived high losses. Considering gains and losses in parallel, rather than separately, may lead to a more fine-tuned understanding of relations with health.

Positive Self-Perceptions of Aging Play a Significant Role in Predicting Physical Performance among Community-Dwelling Older Adults

Self-perceptions of aging (SPA) is associated with various health-related outcomes, including physical performance. No previous study has investigated the potential predictive influence of SPA on physical performance among Swedish community-dwelling older adults. This was a cross-sectional study using a random sample of 153 Swedish community-dwelling individuals aged 70 and older. Multiple logistic regression analysis was performed, using the subscale “Attitude Towards Own Aging” of the Philadelphia Geriatric Center Morale Scale, as a measure of SPA. The Short Physical Performance Battery (SPPB) was dichotomized and used as the outcome variable. SPA was a significant predictor (OR = 1.546, CI = 1.066–2.243) of physical performance, adjusted for age, cognitive function, and life-space mobility. Further analyses revealed significant sex differences, with SPA not being included in the model for the men whilst it was still a significant predictor (OR = 1.689, CI = 1.031–2.765) of physical performance in the group of women. SPA plays a significant role in predicting physical performance among Swedish community-dwelling older adults. To further clarify this relationship and its consequences, future longitudinal research should focus on the relationship between SPA, physical performance, and fall risk.

Age Discrimination in the Context of Motivation and Healthy Aging

Age discrimination can undermine older people's motivation to stay engaged with their lives and poses a major challenge to healthy aging. In this article, we review research on age discrimination in different life domains, including health and work. Motivation and health constitute potential antecedents as well as outcomes of age discrimination, with reduced motivation and impaired health increasing the likelihood of becoming a victim of age discrimination, but also resulting from age discrimination. Furthermore, high levels of motivation and health can also serve as buffers against the negative effects of age discrimination. Based on our literature review, we discuss possible strategies aimed at reducing age discrimination. Understanding and combating age discrimination can foster older people's motivation to participate in meaningful activities and promote healthy aging.

Age-related change in self-perceptions of aging: Longitudinal trajectories and predictors of change

Using data from the German Ageing Survey (Deutscher Alterssurvey, DEAS; N = 4,712), this study examined age-related change in three dimensions of self-perceptions of aging (SPA): perceptions of physical losses, social losses, and ongoing development. Participants ranged in age from 40 to 85 years at study entry (1996, 2002, or 2008) and were followed for up to 21 years. Time-invariant, context-specific and time-varying, person-specific predictors of the observed age-related changes were examined. Findings from longitudinal multilevel regression analyses showed significant nonlinear age-related change for all three dimensions. Specifically, starting at about age 65, participants showed age-related increases in perceptions of physical and social losses, with increases getting steeper in old age. Starting at about age 55, participants reported increasingly fewer perceptions related to ongoing development. The decline in perceptions of ongoing development also became increasingly steeper after age 70. Region of residence was a significant context-specific predictor of the intercepts of the three SPA dimensions. Health-related variables (i.e., number of chronic diseases, self-rated health), affective well-being (i.e., positive and negative affect), and measures of social integration (i.e., loneliness) were significant person-specific predictors. Health-related variables had their strongest association with perceptions of physical losses, whereas negative affect and loneliness had their strongest association with perceptions of social losses. Positive affect had its strongest association with perceptions of ongoing development. This study is the first one to describe age-related change trajectories in multiple dimensions of SPA and significant predictors of these change trajectories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Views on ageing: a lifespan perspective

Views on ageing (VoA) have special relevance for the ageing process by influencing health, well-being, and longevity. Although VoA form early in life, so far, most research has concentrated on how VoA affect later middle-aged and older adults. In this theoretical article, we argue that a lifespan approach is needed in order to more fully understand the origins of VoA, how they change over ontogenetic time, and how they shape development across the full breadth of the lifespan. We begin by explicitly linking VoA to fundamental principles of lifespan development. We review existing theories of VoA and discuss their respective contributions and limitations. We then outline a lifespan approach to VoA that integrates existing theories and addresses some of their limitations. We elaborate on three core propositions of a lifespan approach to VoA: (1) VoA develop as the result of a dynamic, ongoing, and complex interaction between biological-evolutionary, psychological, and social-contextual factors; however, the relative importance of different sources changes across the lifespan; (2) VoA impact development across the whole lifespan; however, different outcomes, mechanisms, and time frames need to be considered in order to describe and understand their effects; and (3) VoA are multidimensional, multidirectional, and multifunctional throughout life, but their complexity, meaning, and adaptivity change across the lifespan. We conclude with recommendations for future lifespan research on VoA.

Measuring Self-Perceptions of Aging: Differences Between Measures When Predicting Health Outcomes

Objectives

The majority of self-perceptions of aging (SPA) research uses either a combination of the Aging-related Cognitions (AgeCog) scales of Ongoing Development and Physical Loss, or the Attitudes Towards Own Aging (ATOA) subscale to assess views on aging. Although these scales are used interchangeably, the valence (positive/negative) and the specificity of the view on aging (domain-based/general) being assessed are not consistent. This study investigates how different measures of SPA relate to one another and whether they differentially predict various types of health outcomes (psychological/physiological; well-being/ill-being).

Method

Data from the 2008 and 2014 waves of the German Aging Survey (DEAS; N = 3,745), a population-based representative survey of adults aged 40–95, was used to examine the relationship between the AgeCog scales and the ATOA subscale, as well as the differences in the types of health outcomes each predicts.

Results

The correlations between the AgeCog scales and the ATOA were higher than the correlation between the AgeCog scales (p < .001). The AgeCog scale of Ongoing Development significantly predicted psychological health outcomes across a 6-year period, while the AgeCog scale of Physical Loss and the ATOA subscale predicted both physiological and psychological health outcomes.

Discussion

Evidence supports using the AgeCog scale of Ongoing Development to predict domain-relevant, psychological health outcomes. However, the multidimensionality of SPA is best measured by the ATOA subscale or a combination of the two AgeCog scales. Both forms of measurement were found to maximize the amount of explained variance for psychological and physiological indicators of well-being and ill-being.

Antibiotic use, knowledge and health literacy among the general population in Berlin, Germany and its surrounding rural areas

Objectives

Knowledge concerning antibiotic use in the general population is insufficient. The way health literacy is related to antibiotic use aside from knowledge needs further investigation. Our aim was to compare the levels of knowledge of antibiotics and health literacy in individuals who had taken antibiotics in recent years compared with those who not had taken antibiotics.

Methods

A population-based cross-sectional survey of 2,000 individuals aged 35 and older from Berlin, Germany and its surrounding rural and suburban areas (response rate 59%) with strata urban/rural, sex, age, and education. Computer-assisted personal interviews were conducted by external, trained interviewers during home visits. Knowledge, health literacy, and antibiotic use were assessed using standardized questionnaires.

Results

In all, 33.3% (666/2,000) of the participants indicated having had an antimicrobial therapy during the previous 12 months. Adjusting for sex, age, educational level and health literacy, individuals with four correct answers regarding antibiotics were 1.70 times and those with three correct answers 1.94 more likely to have had a history of recent antibiotic use than those who did not have any correct answers. Individuals with sufficient health literacy were 0.57 times less likely to have had a recent history of antibiotic use than individuals with insufficient health literacy.

Conclusion

Patients who have used antibiotics might have more knowledge as a result of their recent involvement with the topic of antibiotic use; health literacy may be a preventive mechanism to use antibiotics more critically. Besides improving the health knowledge of the general population and of vulnerable groups such as patients with low levels of health literacy, intervention strategies should focus on providers as well.