The relationship of preparation for future care to depression and anxiety in older primary care patients at 2-year follow-up

Racial differences in the effect of verbal and nonverbal memory on concrete planning for future care needs among older adults: a multi-group structural equation modeling approach

Concrete planning for future care needs may positively impact older adults' subsequent mental health and quality of life. However, the cognitive factors that facilitate concrete planning among Black and White older adults are still poorly understood. We investigated whether there are significant differences between Black (n = 159) and White (n = 262) older adults in concrete planning and explored racial differences in the relationship between verbal and nonverbal episodic memory and concrete planning. Results revealed that Blacks showed lower engagement in concrete planning and lower scores than Whites on each verbal and nonverbal memory task. For Blacks, but not Whites, verbal memory and nonverbal memory performance predicted concrete planning with higher nonverbal memory relating to less concrete planning and higher verbal memory associated with more concrete planning. Our findings suggest racial differences exist in how episodic verbal and nonverbal memory affect concrete planning, a crucial factor for older adults' preparation for future care.

Personal Health Planning in Adult-Child Former Caregivers of Parents Living With Dementia

PURPOSE

To examine how former caregivers for parents living with dementia engage in personal health planning.

DESIGN

An inductive, qualitative study.

SETTING

Virtual, audio-recorded, semi-structured interviews.

PARTICIPANTS

Thirty-two midlife former primary caregivers for parents who died following advanced dementia 3 months to 3 years prior.

METHOD

Participants responded to a series of open-ended interview prompts. Interview recordings were transcribed and evaluated by a trained, diverse team to generate Consensual Qualitative Research (CQR) domains and categories.

RESULTS

Caregivers developed health planning outlooks (ie, mindsets regarding willingness and ability to engage in personal health planning) that guided health planning activities (ie, engaging in a healthy lifestyle, initiating cognitive/genetic testing, maintaining independence and aging in place, ensuring financial and legal security). An agentic outlook involved feeling capable of engaging in health planning activities and arose when caregivers witnessed the impact and feasibility of their parents' health planning. Anxiety-inducing and present-focused outlooks arose when caregivers faced barriers (eg, low self-efficacy, lack of social support, perception that parent's health planning did not enhance quality of life) and concluded that personal health planning would not be valuable or feasible.

CONCLUSION

Caregiving for a parent living with dementia (PLWD) shapes former caregivers' personal health planning. Interventions should support former caregivers who have developed low self-efficacy or pessimistic views on healthy aging to support them in addressing health planning activities.

A longitudinal study of the effects of well-being and perceived control on preparations for old age: moderation effects of contexts

Extending research on determinants of preparations for old age across adulthood, we examined the relationship between well-being, perceived control, and preparations for old age over time, along with variation in the strength of these relationships depending on domains of functioning, cultures, and age. We analyzed longitudinal data from the Ageing as Future study assessing changes in well-being, perceived control, and preparations in four different life domains (social relations, finances, work, and health) across a five-year period collected from adults aged from 30 to 85 years in Germany (N = 623), Hong Kong (N = 317), and the USA (N = 315). Positive feelings about one's current situation predicted greater perceived control five years later, and vice versa. Also, perceived control and preparations were positively associated over time, with only a few exceptions within each domain. For example, high control beliefs were related to subsequent greater preparations and well-being within the domain of social relations and finances, with weak effects of culture. These results suggest that current well-being may promote adaptive behaviors in later life, with the accumulated effects over time. Thus, focusing on how to improve our well-being may promote engagement in preparations for old age. Our results also indicate that these relations in our model vary by contexts, highlighting the importance of variability in age-related processes.

Feasibility and acceptability of the community-based program: Plan Ahead

OBJECTIVES

In this article, we assess the feasibility and acceptability and the effect of the Plan Ahead for community dwelling older adults. In addition, we investigated the effects of the program. In addition, we aimed to examine whether the completion of the specific Future Care Planning depended on the participants' competence level.

METHODS

In this single group feasibility study, trained facilitators delivered the program to a sample of 234 community-residing older adults. Participants completed both pre, post assessments about the acceptability of the program and their completion of the recommended future care planning activities.

RESULTS

Based on participant's report on the usefulness and satisfaction of the program after the completion of the program, we found that participants reported high levels of acceptance of the program. Participation rates also confirmed the feasibility of the program. In terms of effects of program implementation, statistically significant changes were noted for several outcomes, such as resource building and FCP activities. In particular, we found that these gains were particularly robust for participants in the low competence group.

CONCLUSION

Pilot program results suggest the feasibility of a short community program enhancing proactive planning for future care needs among older adults residing in their community.

How widowhood status relates to engagement in advance care planning among older adults: does race/ethnicity matter?

OBJECTIVES

This study investigated whether and to what extent widowhood status is related to engagement in advance care planning (ACP), and further whether race/ethnicity moderated the relation.

METHODS

We analyzed a total of 11,257 older Americans from the Health and Retirement Study using random-effect regression models after controlling for covariates and year-fixed effects.

RESULTS

We found that both being a widow/widower ever and having been widowed for a longer period of time were associated with a higher probability of engagement in ACP. Specifically, we found that a one-year increase in the number of years since spousal death was associated with 1.02 (p < 0.05, 95% CI = 1.00, 1.03) changes in the odds ratios of informal ACP; however, inclusion of a quadratic term indicated that this association reversed after the peak. Moreover, our findings suggested a moderating effect of race/ethnicity on the relations of the length of time since spousal loss with engagement in ACP. Specifically, the odds of widowed non-Hispanic Blacks discussing with someone the care or medical treatment (informal ACP) and having a living will (formal ACP) were 0.96 (p < 0.05, 95% CI = 0.93, 1.00) and 0.88 (p < 0.05, 95% CI = 0.79, 0.97) times that of non-widowed non-Hispanic Whites. Compared with their non-Hispanic White counterparts, widowed non-Hispanic Blacks were less likely to engage in ACP, and the negative relations were exacerbated when they became widows/widowers.

CONCLUSION

We elaborated on these findings and discussed their implications for understanding the moderating effect of race/ethnicity on the relation between late-life widowhood and engagement in ACP. In order to develop programs that enhance engagement in ACP and reduce racial/ethnic disparities, research must incorporate intersectionality theory with attention to motivations and decision-making style among diverse widows/widowers. The findings from this study could help inform policy makers when developing public health programs and health care reimbursement programs that enhance engagement in ACP among widows/widowers.

Patterns and Predictors of Preparation for Future Care Among Older Rural Chinese Adults: A Latent Profile Analysis

This study aimed to identify profiles of preparation for future care (PFC) among older rural Chinese adults. A total of 481 older adults were recruited. PFC was evaluated using Preparation for Future Care Needs and respondents' social services knowledge. Information on individual characteristics, physical health indicators, mental health, and support system was collected. Four profiles of PFC were identified: scarce-preparation (22.42%), high-avoidance/low-action (26.91%), moderate-preparation (44.17%), and high-avoidance/high-action (6.50%). The scarce-preparation and high-avoidance/low-action profiles had the lowest levels of social services knowledge. Multinomial logistic regression showed that older adults in moderate-preparation and high-avoidance/high-action profiles had fewer illnesses, exercised more frequently, and had higher loneliness levels compared with those in the scarce-preparation profile. Compared with high-avoidance/low-action persons, high-avoidance/high-action persons had fewer illnesses, exercised more frequently, and had lower self-esteem and higher loneliness levels. People who performed poorly in physical health indicators and well in mental health need to increase PFC.

COVID-19 worry, mental health indicators, and preparedness for future care needs across the adult lifespan

OBJECTIVE

The COVID-19 pandemic has been a source of worry for many, but older adults have been identified as more vulnerable to serious cases and may therefore feel more concerned about the virus. We assessed whether COVID-19 worry was related to indicators of mental health and preparedness for future care, in an adult lifespan sample.

METHOD

An online study (n = 485; age 18-82, M = 49.31, SD = 15.39) included measures of COVID-19 worry, depression, general anxiety, health anxiety, hostile and benevolent ageism, preparedness for future care, and demographic information.

RESULTS

Age and living alone were positively associated with greater COVID-19 worry, as were health anxiety, general anxiety, benevolent ageism, and preparedness for future care needs via gathering information. A significant interaction indicated that among individuals reporting lower health anxiety, greater preference for gathering information was positively associated with greater COVID-19 worry; however, for individuals having high health anxiety, gathering information about future care was not related to COVID-19 worry, as their COVID-19 worry levels were moderately high.

CONCLUSION

Older age was associated with greater COVID-19 worry, perhaps in response to the much publicized greater risk for negative outcomes in this population. In spite of this specific concern, indicators of older adults' continued mental health emerged. Preparedness for future care is also highlighted, as well as clinical implications.

Adaptation and Validation of the Preparation for Future Care Needs Scale for Chinese Older Adults in Hong Kong

Background and Objectives

Care planning can protect against or offset potential stressors in the caregiving stage and mitigate their detrimental effects. This study aimed to translate, adapt, and validate 2 short forms of the multidimensional, theory-guided scale measuring preparation for future care needs (PFCN) among Chinese older adults in Hong Kong.

Research Design and Methods

Data were derived from a cross-sectional survey of 862 community-dwelling individuals aged 60 years and older. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess the structural validity of the scales. Criterion-related validity, known-groups validity, and internal consistency were also examined.

Results

EFA yielded a 14-item 4-factor (awareness, avoidance, decision making, and concrete planning) model, which was supported by CFA and explained 68.9% of the total variance. CFA also supported the structural validity of the 5-item scale. Criterion-related validity of the 2 scales was supported by their significant and positive correlations with domain-specific planning behaviors for retirement. Known-groups validity of the 2 scales was demonstrated by significant differences in scores between male and female older adults and scores between different educational levels and socioeconomic status. Cronbach’s alphas for the internal consistency of the 14-item and 5-item scales were 0.889 and 0.774, respectively.

Discussion and Implications

PFCN scales enable researchers and service practitioners to accurately understand and assess older adults’ processes and efforts in care planning, facilitate the identification of individuals at risk from inadequate planning, and inform the development of interventions to enhance care preparation in target domains.

Perspectives on Aging-Related Preparation

When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.

Preparation for Future Care Needs in Middle-Aged and Older Adults: What Promotes Feeling of Preparedness?

OBJECTIVE

To examine whether demographic, dementia-related, and control-related variables predict preparation for future care needs (PFCN) in a sample of middle-aged and older adults. PFCN is defined in this study as a self-perceived sense of preparedness for one's own future care needs, including general awareness of future care needs, gathering relevant information, decision-making about care preferences, concrete planning, and non-avoidance of care planning.

METHODS

Participants (N = 122; age 40 to 88 years: M = 65.83, SD = 9.80) completed self-report measures in an in-person study. Hierarchical multiple regression was calculated to predict PFCN.

RESULTS

Being female, having more positive dementia attitudes, higher attribution to powerful others for health condition(s), and more completed end-of-life (EOL) planning significantly predicted greater PFCN.

CONCLUSION

Findings indicate a positive relationship between objective (completed EOL planning items) and subjective (PFCN) components of planning, thus highlighting the importance of taking concrete steps in EOL planning to yield greater feelings of preparedness, which has been associated with positive psychological outcomes.

For a better me? Or for a better us? Perceived utilities of aging preparatory activities and positive future thinking in Germany, USA and Hong Kong

Engaging in aging preparatory activities that is perceived to be utile for oneself (e.g., to retain autonomy and independence) and for others (e.g., to retain a harmonious relationship with important others) may have a functional effect on one's aging process. We examined how perceived self- and other-related utilities of aging preparatory activities were associated with positive future thinking across adulthood, and whether these associations differed by culture. Building upon cross-sectional data from a web-based study conducted in Hong Kong (n = 283, M _age = 55.12, aged 18-85 years), the USA (n = 264, M _age = 51.06, aged 20-85 years) and Germany (n = 402, M _age = 51.65, aged 19-90 years), we observed different patterns of associations across these three cultures. Perceiving self-related utilities was linked to positive future thinking in the USA and Germany, but not in Hong Kong. In contrast, perceiving other-related utilities of aging preparatory activities was positively associated with future thinking in Hong Kong, but not in the USA or Germany. Perceived risks, on the other hand, showed a negative association with positive future thinking across all cultures. Findings suggest that there might be a culture-specific tendency for individuals to appraise their future, based on their perceived self- or other-related utilities of aging preparatory activities.

Does Caregiving Influence Planning for Future Aging?: A Mixed Methods Study Among Caregivers in Canada

A mixed method design was used to examine how caregiving and transitioning a family member into long-term care (LTC) influence planning. Participants, aged 50+ from the community, completed self-report questionnaires. Quantitative data evaluated differences between three groups (non-caregivers, caregivers, caregivers with experience in assisting with a LTC transition); and predictive effects of caregiving, care expectations and social support to planning. Interviews among a subsample of caregivers examined how experiences of caregiving, including assisting in a transition to LTC, and social support influenced planning. Results indicated that: (1) caregivers with LTC transition experience planned significantly more than non-caregivers, (2) caregiving, care expectations, and social support significantly predicted of planning, and (3) future care expectation was an important mechanism in the relationship between caregiving and planning. These findings underscore the impact of caregiving experiences on expectations of future care needs and preparation for future care needs, and the importance of social support.

Late-Life Preparedness and Its Correlates: A Behavioral Perspective on Preparation

OBJECTIVES

The present study examined the extent of late-life preparedness and its correlates. In accordance with behavior theories, we postulated that those who have prior experience with caregiving and who perceive such activities as more useful and less risky are more likely to engage in late-life preparatory activities. Because the perceived distance until aging-related life challenges become prevalent may play a role in late-life preparedness, we hypothesized that the effects of the correlates would vary depending on one's subjective remaining life expectation (SRLE).

METHODS

Building upon cross-sectional data including 581 German adults from 18 to 93 years, we fitted a hurdle model that separately analyzes the presence and variety of self-reported action engagement to better handle the zero-inflated count measure of preparatory activities.

RESULTS

The results revealed that the effects of perceived utility, caregiving experience, and SRLE were significant for both the presence and variety of activities. SRLE was found to moderate the observed effects in the models: The effect of perceived utility on the presence of at least one late-life preparatory activity was larger for those with lower SRLE. In contrast, among those with higher SRLE, having provided care increased the variety of preparatory activities.

DISCUSSION

Findings suggest that some of the examined psychosocial factors are similarly associated with both the presence of at least one and the variety of late-life preparatory activities, although the extent of their effects varies depending on one's subjective life stage.

Preparation for future care moderates the relationship between loneliness and depression among Chinese rural older adults: A cross-sectional study

Loneliness has been identified as a risk factor for depression, while preparation for future care (PFC) can be a protective factor. Little is known about their complex relationships in older adults in China. This study aimed to explore whether PFC moderated the association between loneliness and depression. A total of 481 older adults aged 60 years and above were recruited in rural Shandong, China. After excluding those whose data missing rates were over 15%, data were analyzed for a total of 436 participants. Loneliness, PFC, and depression were measured. Statistical analyses included descriptive analysis, and moderating effects analyses. Our findings showed that PFC and its related dimensions can moderate the relationship between loneliness and depression. When the level of PFC and its dimensions were higher, the effect of loneliness on depression was weaker. PFC should be taken into consideration when interventions are being developed to reduce depression in older adults.

Racial differences in future care planning in late life

Objectives: Although many older adults fear frailty and loss of independence in late life, relatively few make plans for their future care. Such planning is particularly limited among racial minorities. Given the benefits of future care planning (FCP), it is important to understand factors that facilitate or hamper FCP in late life. Our study explored racial, demographic, and dispositional influences on thinking about and engagement in FCP among community-dwelling older adults.Design: This study utilized data from the Elderly Care Research Center's longitudinal study of successful aging based on interviews with 409 older adults. Along with race, education and other demographic factors, we explored dispositional influences of optimism and religiosity on FCP using logistic regression.Results: African American older adults had significantly lower odds of executing FCP (β = 0.36, p < .05) when compared to White older adults. However, this estimate was no longer statistically significant after controlling for education, disability status, optimism, and religiosity. Older adults with higher education had significantly higher odds of thinking about and executing FCP. Higher level of optimism was associated with lower odds of FCP.Conclusions: Limited educational resources and the greater prevalence of dispositions of religiosity and optimism among African American older adults may contribute to their reluctance to engage in FCP in comparison to their white counterparts. Our findings offer practice implications indicating a need for interventions to encourage older adults, particularly racial minorities, to recognize and actively plan for their future care needs.

The Impact of Perceived Control and Future-Self Views on Preparing for the Old Age: Moderating Influences of Age, Culture, and Context

OBJECTIVES

Preparation for age-related changes has been shown to be beneficial to adjustment in later life. However, an understanding of the factors that influence such preparations is rather limited. This study examines whether perceived control and future-self views (FSV) influence preparations for old age, and if this influence varies across ages, domains of functioning, and cultures.

METHODS

Assessments of perceived control, FSV, and preparations for old age in each of four different life domains (social relationships, finances, work, and health) were obtained from 1,813 adults (ages 35-85) from Germany, Hong Kong, and the United States.

RESULTS

Future-self views partially mediated the relationship between perceived control and preparation for old age across both domains of functioning and cultures. With one exception, the association between perceived control and preparations increased with advancing age across contexts. Evidence for similar age-related moderation of the indirect effect of control through FSV was more limited.

DISCUSSION

These results suggest that perceived control that is not necessarily related to aging affect FSV, which in turn influence preparing for old age. Further, our results indicate that such relationships are context- and age-specific, highlighting the importance of considering the salience and diversity of life domains and cultures.

Preparation and Planning for Future Care in the Deep South: Adapting a Validated Tool for Cultural Sensitivity

BACKGROUND AND OBJECTIVES

This study describes the adaptation and validation of Sörensen et al. (2017)'s preparation for future care (PFC) scale with diverse samples including rural dwelling African Americans and certified nursing assistants (CNAs), and subsequent psychometric development.

RESEARCH DESIGN AND METHODS

Responses to the five-subscale PFC survey from 33 rural African American men across 12 months and cognitive interviews with a subset of 12 of these men are described. Psychometric refinement included descriptive qualitative analyses of consultations with experienced lay research advisors (N = 4 and N = 7) regarding potential changes to the PFC and a confirmatory factor analysis of the resultant scale (N = 138).

RESULTS

Cognitive interviews with rural African American men revealed difficulty understanding Eurocentric questions. Emergent themes included emotional avoidance of planning, considerations of nursing homes and possible care providers, and coping strategies. In two consultation meetings, trained lay research advisors recommended language modifications to the original questions and response options. Factor analyzing the resultant scale revealed support for the original subscale constructs (acceptable fit: χ2 = 205.03, df = 124, p < .001; root mean square error of approximation = .069 [.052-.085]; comparative fit index = .93; Tucker-Lewis index = .91).

DISCUSSION AND IMPLICATIONS

PFC and engagement in advance care planning is uncommon among African Americans, possibly due to distrust of and lack of cultural competency among health care professionals. The resulting tool and response options may be used as an interview guide/survey with African Americans to gain understanding about their preparation for future health care needs.

Life Restoration and Future Care Preparation Among Older Parents in Shanghai Who Have Lost Their Only Adult Child

The combination of aging and losing their only adult child challenges an increasing number of older adults in China. Current literature primarily focuses on older parents' bereavement but seldom examines their effort to cope with subsequent life changes brought about by only-child loss. This study explores how older parents in Shanghai who lost their only adult child restore their lives and prepare for future care. Twenty-four older adults were purposively sampled and participated in face-to-face, in-depth interviews. The findings suggest that participants tried to restore their lives by rationalizing grief and expanding their social networks. Despite their losses, participants remained in favor of family caregiving and reluctantly prepared for future care. Their ambivalent attitudes toward government support call for caution in approaches to service delivery.

Family Support and Preparation for Future Care Needs Among Urban Chinese Baby Boomers

Objectives

Little is reported about the family's role in preparation for future care (PFC) before the onset of care needs. The primary aim was to examine the relationships between PFC and different types of family support exchanged with generations both above and below.

Method

Path analysis was conducted on 516 Chinese baby boomers aged 45-65 to examine the associations between PFC (care expectation, awareness, information gathering, and decision making) and 4 types of family support (instrumental support, financial assistance, information and appraisal, and emotional support) when the covariates were controlled for.

Results

The current planning status and planning paths are consistent with those of the U.S. and European populations. Providing instrumental support to a parent was positively associated with awareness of care needs. Providing emotional support to a child was negatively associated with information gathering. In general, receiving support from a child facilitated PFC. Although those receiving emotional support from an adult child had less awareness of care needs, they displayed more information gathering.

Discussion

The role of family support in PFC is more subtle than simply increasing and decreasing resource volumes. Future research is needed to better understand this complexity.

Subjective remaining lifetime and concreteness of the future as differential predictors of preparation for age-related changes

Demographic changes have been linked to the expectation of cuts in government-provided social security services, emphasizing individual responsibility to prepare for old age and concomitant challenges and changes. Accordingly, the identification of psychological variables predicting preparation is a matter of theoretical as well as practical importance. We thus consider different aspects of a person's future time as theoretically prominent psychological predictors of preparation. The subjectively perceived quantity of remaining lifetime, the concreteness of future time, and preparation for life domains indicative of an active third age as well as of a more dependent fourth age were assessed in a longitudinal study in a core sample of N = 593 participants (30-80 years old at T₁) at two measurement occasions 4 years apart. The quantity of subjective remaining lifetime predicted subsequent changes in preparation, but this effect was restricted to preparation for the fourth age. In contrast, a more open and concrete outlook on ones' personal future predicted changes in preparation for an active third age. Our findings highlight the importance of distinguishing between different aspects of future time-its quantity versus its relation to goals and action plans-when predicting specific facets of developmental self-regulation.

Assessing future care preparation in late life: Two short measures

The purpose of this article is to introduce 2 short forms of the previously published measure of preparation for future care (PFC). Community-dwelling older adults ages 65-94 who had completed the 29-item Preparation for Future Care Needs scale were randomly divided into scale development (n = 697) and scale validation (n = 690) samples. Fifteen items were selected using exploratory and confirmatory factor analyses on the scale development and scale validation samples, respectively. Consistent with PFC theory, the 5 subscales of the original long-form measure (Awareness, Gathering Information, Decision Making, Concrete Planning, Avoidance of Care Planning) were maintained. A 5-item scale with acceptable score reliability and validity was also developed. Compared to the long form, these short forms are more easily incorporated into epidemiologic studies and can be used in medical, psychology, and social work practice to initiate discussions about long-term care planning. (PsycINFO Database Record

The effects of familism on intended care arrangements in the process of preparing for future care among one-child parents in urban China

Guided by Sörensen and Pinquart's model of preparation for future care, this study investigated the relationship between familism and intended care arrangements. Ordinal logistic regression was performed on a sample of 516 urban Chinese one-child parents aged 45–65 with an equal gender ratio to examine the associations between five care expectations, familism (filial obligation and child gender) and future care planning constructs (awareness, information gathering and avoidance). Awareness and information gathering were positively associated with service-focused care arrangements. Avoidant planners were more inclined to rely on adult children. Participants with a stronger filial obligation had greater expectations for ageing at home with the aid of a spouse, siblings or helper. Child gender was not significantly associated with intended care arrangements. The model of preparation for future care was useful when predicting service-focused care arrangements. Familism was a powerful predictor of family-focused care arrangements. Females were more likely to rely on children regardless of child gender but less likely to rely on spouses and siblings. The study enriches researchers' understanding of urban Chinese older adults' intended care arrangements in the context of fading familism and single-child families.

Trait Hope and Preparation for Future Care Needs among Older Adult Primary Care Patients

We examined associations between trait hope and preparation for future care needs (PFCN) among 66 older adult primary care patients in western New York. Participants completed a questionnaire assessing PFCN (awareness, information gathering, decision-making, concrete planning, and avoidance), and the Adult Trait Hope Scale. In multivariate regressions, lower hope, particularly less agency, was associated with more awareness of needing care, whereas higher hopefulness, particularly pathways thinking, was associated with increased decision-making and concrete planning. Greater hopefulness appears to be linked to goal-directed planning behaviors, although those with lower hope may actually be more aware of the need for planning. Evidence-based programming that encourages learned hopefulness may contribute to enhanced health planning and decision-making among older adult primary care patients.

Passive Suicide Ideation: An Indicator of Risk Among Older Adults Seeking Aging Services?

OBJECTIVES

This study examines patterns of endorsements of active suicide ideation (SI), passive SI (synonymous with death ideation), and psychological distress (i.e., depressive and anxious symptomatology) in a sample of vulnerable older adults.

METHODS

Data were collected via in-home interviews with aging services care management clients aged 60 years and older (n = 377). The Paykel scale for suicide measured the most severe level of suicidality over the past year, and the ninth item of the Patient Health Questionnaire (PHQ-9) measured current passive/active SI. The remaining items from the PHQ (i.e., PHQ-8) and the Goldberg Anxiety scale measured distress.

RESULTS

Latent class analysis revealed a four-class model: a group with mild distress and no active SI, a group with high distress and no ideation, a group with mild distress and both passive and active SI, and a group with high distress and both passive and active SI.

DISCUSSION

Results indicate that passive SI rarely presents in vulnerable older adults in the absence of significant risk factors for suicide (i.e., psychological distress or active SI). Thus, the desire for death and the belief that life is not worth living do not appear to be normative in late life.

The macular degeneration and aging study: Design and research protocol of a randomized trial for a psychosocial intervention with macular degeneration patients

BACKGROUND

Age-related Macular Degeneration (AMD) is the leading cause of irreversible and predictable blindness among older adults with serious physical and mental health consequences. Visual impairment is associated with negative future outlook and depression and has serious consequences for older adults' quality of life and, by way of depression, on long-term survival. Psychosocial interventions have the potential to alleviate and prevent depression symptoms among older AMD patients.

METHODS

We describe the protocol of the Macular Degeneration and Aging Study, a randomized clinical trial of a psychosocial Preventive Problem-Solving Intervention. The intervention is aimed at enhancing well-being and future planning among older adults with macular degeneration by increasing preparation for future care.

RESULTS

Adequate randomization and therapeutic fidelity were achieved. Current retention rates were acceptable, given the vulnerability of the population. Acceptability (adherence and satisfaction) was high.

CONCLUSION

Given the high public health significance and impact on quality of life among older adults with vision loss, this protocol contributes a valid test of a promising intervention for maintaining mental and physical health in this population.

Optimism and Planning for Future Care Needs among Older Adults

Aging is associated with an increase in need for assistance. Preparation for future care (PFC) is related to improved coping ability as well as better mental and physical health outcomes among older adults. We examined the association of optimism with components of PFC among older adults. We also explored race differences in the relationship between optimism and PFC. In Study 1, multiple regression showed that optimism was positively related to concrete planning. In Study 2, optimism was related to gathering information. An exploratory analysis combining the samples yielded a race interaction: For Whites higher optimism, but for Blacks lower optimism was associated with more planning. High optimism may be a barrier to future planning in certain social and cultural contexts.

Preparation for old age in different life domains

We investigated preparation for age-related changes from a multidimensional, life span perspective and administered a newly developed questionnaire to a large sample aged 30–80 years. Preparing for age-related changes was organized by life domains, with domain-specific types of preparation addressing obstacles and opportunities in the respective domains. Preparing for a third (focusing on activities, leisure, work, fitness, appearance) and a fourth age (focusing on emergencies, dependence/independence, housing, financial arrangements) emerged as superordinate categories of preparation. Different age gradients were obtained for the factors, the former peaking around the age of 65, whereas the latter increased linearly up to the age of 80. Furthermore, preparation factors were characterized by distinct personality profiles. The findings attest to the importance of a differentiated view on preparation for age-related changes and its relevance across the life span.

Trajectories of preparation for future care among first-degree relatives of Alzheimer's disease patients: an ancillary study of ADAPT

PURPOSE

 This study examines the longitudinal patterns of Preparation for Future Care (PFC), defined as Awareness, Avoidance, Gathering Information, Decision Making, and Concrete Plans, in first-degree relatives of people with Alzheimer's disease (AD). 

DESIGN AND METHODS

 Eight time points across 6.5 years from a subsample of adults aged 70 years and older who were participating in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) were analyzed using latent growth modeling. Baseline attitudes toward planning for future care and demographic variables functioned as predictors in the conditional analyses. 

RESULTS

 Awareness, Gathering Information, Decision Making, and Concrete Planning increased across time, but Avoidance did not. Covariates were more often associated with the initial levels of planning behavior than with change across time. Women engaged in more initial Decision Making than men. Education was associated with more initial Gathering Information, Decision Making, and less Avoidance. Favorable attitudes toward planning were more predictive of baseline Awareness, Gathering Information, Avoidance, and less so for Decision Making or Concrete Planning. 

IMPLICATIONS

 Older adults with an elevated risk for AD increase in positive PFC behaviors gradually across time. Demographic characteristics and attitudes predict initial levels of planning, making it possible to identify individuals who might need help progressing to more advanced levels of planning. Future studies are needed to understand rates of change in planning behaviors.