The cross-sectional relationship between pain and awareness of age-related changes

The Role of Awareness of Age-Related Change in the Longitudinal Association between Pain and Physical Activity

We examined how physical pain impacts the developmental construct of Awareness of Age-Related Change (AARC-gains and AARC-losses) and, in turn, how AARC mediates and moderates the association between pain and subsequent physical activity. We used longitudinal data from 434 participants of the UK PROTECT Study (mean age = 65.5 years; SD = 6.94 years). We found that pain in 2019 predicted higher AARC-losses (β = .07; p = .036) and less physical activity (β = -.13; p-value = .001) in 2020. Additionally, we found that AARC-losses partially mediated, but did not moderate, the association of pain in 2019 and physical activity in 2020. AARC-losses may explain physical inactivity in middle-aged and older adults experiencing pain. Incorporating developmental constructs such as AARC into theories and empirical studies on pain and pain management may be necessary to more fully capture people's responses to pain.

Rumination moderates the longitudinal associations of awareness of age-related change with depressive and anxiety symptoms

OBJECTIVE

Lower awareness of age-related gains (AARC-gains) and higher awareness of age-related losses (AARC-losses) may be risk factors for depressive and anxiety symptoms. We explored whether: (1) Baseline AARC-gains and AARC-losses predict depressive and anxiety symptoms at one-year follow-up; (2) age and rumination moderate these associations; (3) levels of AARC-gains and AARC-losses differ among individuals with different combinations of current and past depression and/or with different combinations of current and past anxiety.

METHODS

In this one-year longitudinal cohort study participants (N = 3386; mean age = 66.0; SD = 6.93) completed measures of AARC-gains, AARC-losses, rumination, depression, anxiety, and lifetime diagnosis of depression and anxiety in 2019 and 2020. Regression models with tests of interaction were used.

RESULTS

Higher AARC-losses, but not lower AARC-gains, predicted more depressive and anxiety symptoms. Age did not moderate these associations. Associations of lower AARC-gains and higher AARC-losses with more depressive symptoms and of higher AARC-losses with more anxiety symptoms were stronger in those with higher rumination. Individuals with both current and past depression reported highest AARC-losses and lowest AARC-gains. Those with current, but not past anxiety, reported highest AARC-losses.

CONCLUSION

Perceiving many age-related losses may place individuals at risk of depressive and anxiety symptoms, especially those who frequently ruminate.

Physical and mental health conditions account for variability in awareness of age-related changes

Background

The concept of Awareness of Age-Related Changes captures people's perceptions of the positive (AARC-gains) and negative (AARC-losses) age-related changes they experience in several life domains, including their health. We investigated the cross-sectional associations of number and type of physical and mental health conditions with AARC-gains and AARC-losses.

Methods

The sample comprised 3,786 middle-aged and older adults (mean age = 67.04 years; SD = 6.88) participating to the UK PROTECT study. We used hierarchical regression models to analyze whether after having included sociodemographic variables (model 1), number of physical (model 2) and of mental (model 3) health conditions explained a significant additional amount of variance in AARC-gains and AARC-losses, and whether the association between number of conditions and AARC depended on participants' age. We used multiple regression models to analyze the associations of types of physical and mental health conditions with AARC-gains and AARC-losses.

Results

A higher number of physical health conditions was associated with higher AARC-gains and higher AARC-losses, but the association did not depend on participant age. After controlling for the number of physical health conditions, a higher number of mental health conditions was associated with higher AARC-losses but not with AARC-gains, and the association was stronger among older participants. Small effects were found between greater AARC-gains and current cancer and between greater AARC-losses and diagnoses of mild cognitive impairment, Parkinson's disease, arthritic condition, cancer in full remission, osteoporosis, depression, anxiety disorders, and personality disorder. The remaining health conditions were either negligibly or non-statistically related to AARC-losses.

Conclusion

Middle-aged and older adults having more physical health conditions and more mental health conditions may be at higher risk of negative views on their own aging. However, specific physical health conditions, such as arthritis, and certain mental health conditions, such as depression, may make adults particularly vulnerable to negative age-related perceptions.

Cross-Sectional and Longitudinal Associations between Subjective Sleep Difficulties and Self-Perceptions of Aging

BACKGROUND

Only one study has explored the associations of subjective sleep difficulties with self-perceptions of aging. It focused on a global indicator of self-perceptions of aging (subjective age) despite individuals reporting different experiences of aging in relation to different life domains. The concept of awareness of negative age-related change, capturing perceived losses across five domains (e.g., physical health, cognition), may be more appropriate when relating subjective sleep difficulties to self-perceptions of aging. We examined whether nine different indicators of subjective sleep difficulties predict levels of awareness of negative age-related change and subjective age, measured concurrently and one year later, while controlling for covariates (mood and daily function).

PARTICIPANTS/METHODS

We used data from the PROTECT cohort study; 4,482 UK residents (mean age = 66.1; SD = 6.9) completed measures of awareness of age-related change, subjective age, mood, daily function, and subjective sleep difficulties.

RESULTS

Based on linear regression analyses, poorer quality of sleep, lower alertness after awakening, satisfaction with sleep, depth of sleep, more frequent early awakening, difficulty falling asleep, more times awake during a night, fewer hours of sleep during the night and more hours of sleep during the day predicted higher awareness of negative age-related change at baseline and follow-up (p< .001). Associations were small in size. Associations between subjective sleep difficulties and subjective age were either negligible or statistically non-significant.

CONCLUSIONS

Although subjective sleep difficulties are one of the many factors associated with awareness of negative age-related change, addressing sleep difficulties, alongside negative mood, and poor daily functioning, may promote a small additional increase in positive self-perceptions of aging.

Exploring awareness of age-related changes among over 50s in the UK: findings from the PROTECT study

OBJECTIVES

Older people describe positive and negative age-related changes, but we do not know much about what contributes to make them aware of these changes. We used content analysis to categorize participants' written comments and explored the extent to which the identified categories mapped onto theoretical conceptualizations of influences on awareness of age-related change (AARC).

DESIGN

Cross-sectional observational study.

PARTICIPANTS

The study sample comprised 609 UK individuals aged 50 years or over (mean (SD) age = 67.9 (7.6) years), enrolled in the PROTECT study.

MEASUREMENTS

Between January and March 2019, participants provided demographic information, completed a questionnaire assessing awareness of age-related change (AARC-10 SF), and responded to an open-ended question asking them to comment on their responses.

RESULTS

While some of the emerging categories were in line with the existing conceptual framework of AARC (e.g. experiencing negative changes and attitudes toward aging), others were novel (e.g. engagement in purposeful activities or in activities that distract from age-related thoughts). Analysis revealed some of the thought processes involved in selecting responses to the questionnaire items, demonstrating different ways in which people make sense of specific items.

CONCLUSIONS

Results support the ability of the AARC questionnaire to capture perceived age-related changes in cognitive functioning, physical and mental health, and engagement in social activities and in healthy and adaptive behaviors. However, findings also suggest ways of enriching the theoretical conceptualization of how AARC develops and offer insights into interpretation of responses to measures of AARC.

No Pain, No Gain? Personality Associations With Awareness of Aging Depend on Arthritis

Background

Awareness of aging brings to light one’s own perceived behavioral, physical, and cognitive changes associated with getting older. Personality and physical illness are each related to two components of awareness of aging: attitudes toward own aging (ATOA), and awareness of age-related changes (AARC). Here, we move beyond main effects to examine how personality and arthritis interact with respect to awareness of aging.

Materials and Methods

296 participants (M age = 64.67, SD = 4.36, Range = 60–90 years, 49.7% women) completed online self-report questionnaires of personality, arthritis, ATOA, and AARC gains and losses.

Results

We ran three hierarchical multiple regression models to test how personality traits and arthritis interacted to predict ATOA, AARC gains, and AARC losses, respectively. Higher extraversion was related to positive ATOA, and higher openness was related to positive ATOA and more AARC gains. Higher neuroticism was related to negative ATOA, more AARC losses, and less AARC gains. We found a main effect for arthritis, where those with arthritis reported more AARC losses. Lastly, we found a significant interaction between arthritis and agreeableness when predicting AARC gains. Among those with low agreeableness, people with arthritis reported significantly more AARC gains compared to those without arthritis.

Conclusion

Personality and arthritis are each important for awareness of aging. Overall, our study suggests that for those with arthritis, it is especially important to consider behavioral and cognitive factors related to agreeableness, as they may be important means of promoting positive views on aging.

Identifying predictors of self-perceptions of aging based on a range of cognitive, physical, and mental health indicators: Twenty-year longitudinal findings from the ILSE study

Research exploring whether health predicts self-perceptions of aging (SPA) has mostly focused on single predictors and has been hampered by short observational intervals. We examined whether 20-year changes in cognitive functioning, physical and mental health predict SPA. We used data of 103 German participants who remained of a sample of 500 participants born in 1930-1932 enrolled in the Interdisciplinary Longitudinal Study of Adult Development (ILSE) in 1993/1996 (mean age at fourth measurement wave = 82.5 years). Health indicators included six cognitive tests, objective and subjective physical health, and self-reported depression. We used a new and multidimensional (awareness of age-related gains and losses) and a well-established (attitudes toward own aging) measure of SPA. Linear regression analyses showed that, among the cognitive tests, decline in information processing speed (Digit Symbol) predicted less awareness of age-related gains and more awareness of age-related losses but not attitudes toward own aging. Decline in subjective but not objective physical health, predicted more awareness of age-related losses and negative attitudes toward own aging, but not awareness of age-related gains. Increase in depressive symptoms predicted more awareness of age-related losses and negative attitudes toward own aging, but not awareness of age-related gains. The size of associations suggests that objective cognitive decline has limited influence on older adults' SPA and, if so, only when the decline is related to mental slowing. Similarly, perceived physical and mental health, but not objective health, have a small-to-moderate influence on awareness of age-related losses and attitudes toward own aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Awareness of Age-Related Changes Among Middle-Aged and Older Adults: Longitudinal Trajectories, and the Role of Age Stereotypes and Personality Traits

Awareness of Age-Related Change (AARC) describes to what extent people become aware of changes which they attribute to getting older. So far little is known regarding how different AARC dimensions change over time, to what extent these changes in different domains of AARC gains and losses are interrelated, and which predictors account for inter-individual differences in within-person longitudinal trajectories. Specifically, the extent to which individuals perceive age-related gains and losses might be shaped by their chronological age, their personality as well as by their general views on aging (i.e., their age stereotypes). We investigated changes in global and domain-specific AARC gains and losses over about five years in a sample of originally N = 423 participants aged 40 to 98 years at baseline. We analyzed the role of personality traits and age stereotypes for levels and changes of AARC, taking into account participants' age at baseline and controlling for gender, education, and subjective health. Based on longitudinal multilevel regression models, we observed mean-level declines in most AARC gain domains. In contrast, perceived general AARC losses, as well as AARC losses in health and physical functioning, in cognitive functioning and in social-cognitive/socio-emotional functioning remained, on average, stable over time. Baseline scores on AARC gains (global scale) were higher among individuals with higher neuroticism, openness, conscientiousness and more positive age stereotypes. Additionally, the association of higher neuroticism with higher AARC gain scores was stronger among individuals with more positive age stereotypes. Higher neuroticism and more negative age stereotypes also predicted higher baseline scores on AARC losses (global scale). At the same time, higher neuroticism was associated with a steeper decrease in AARC loss perceptions over time. Most of the intercorrelations within the intercepts and within the intra-individual trajectories of the different AARC domains were positive, but small in size. Our findings show the importance of considering trajectories of age-related gains and losses in parallel and across multiple developmental domains when investigating the subjective perception of the aging process. They also suggest that personality traits and general age stereotypes are related with individual experiences of aging.

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.

Awareness of age-related change in the context of major life events

Although gains and losses are an integral part of human development, the experience of change and readjustment that often comes with major life events may be particularly influential for an individual's subjective aging experience and awareness of age-related change (AARC). Thus, this study focused on the role of life events in the domains of family and health for an individual's awareness of age-related gains and losses. Specifically, we differentiated between the experience of specific life events (e.g., entering a new romantic relationship; hospital stay) and the cumulative experience of multiple life events. Furthermore, we differentiated between life events experienced at an expected time in life and life events experienced relatively early or relatively late compared to established social norms. Data came from the Innovation Sample of the German Socio-Economic Panel (SOEP-IS) and consisted of 1,612 participants aged 16 to 93 years (M = 54.1; SD = 18.2). Life events were assessed annually and retrospectively for the last 2 years. Propensity score matching provided evidence for an association of specific family life events and a higher awareness of age-related gains, as well as specific health life events and a higher awareness of age-related losses. Results furthermore indicated that the cumulative experience of family life events was associated with a higher awareness of age-related gains. Conversely, the cumulative experience of health events was associated with higher awareness of both age-related losses and age-related gains. Moreover, it was not only life events happening at an expected age, but also those happening relatively early and particularly those happening late in life, which were associated with AARC. In summary, life events and the change they may bring seem to be reflected in individuals' awareness of age-related losses and awareness of age-related gains.

Experience of Time and Subjective Age When Facing a Limited Lifetime: The Case of Older Adults with Advanced Cancer

Objectives

We addressed two questions: (1) Does advanced cancer in later life affect a person’s awareness of time and their subjective age? (2) Are awareness of time and subjective age associated with distress, perceived quality of life, and depression?

Methods

We assessed patients suffering terminal cancer (OAC, n = 91) and older adults free of any life-threatening disease (OA, n = 89), all subjects being aged 50 years or older.

Results

Older adults with advanced cancer perceived time more strongly as being a finite resource and felt significantly older than OA controls. Feeling younger was meaningfully related with better quality of life and less distress. In the OA group, feeling younger was also associated to reduced depression. Perceiving time as a finite resource was related to higher quality of life in the OA group.

Discussion

Major indicators of an older person’s awareness of time and subjective aging differ between those being confronted with advanced cancer versus controls.

Cross-sectional association between objective cognitive performance and perceived age-related gains and losses in cognition

OBJECTIVES

Evidence linking subjective concerns about cognition with poorer objective cognitive performance is limited by reliance on unidimensional measures of self-perceptions of aging (SPA). We used the awareness of age-related change (AARC) construct to assess self-perception of both positive and negative age-related changes (AARC gains and losses). We tested whether AARC has greater utility in linking self-perceptions to objective cognition compared to well-established measures of self-perceptions of cognition and aging. We examined the associations of AARC with objective cognition, several psychological variables, and engagement in cognitive training.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

The sample comprised 6056 cognitively healthy participants (mean [SD] age = 66.0 [7.0] years); divided into subgroups representing middle, early old, and advanced old age.

MEASUREMENTS

We used an online cognitive battery and measures of global AARC, AARC specific to the cognitive domain, subjective cognitive change, attitudes toward own aging (ATOA), subjective age (SA), depression, anxiety, self-rated health (SRH).

RESULTS

Scores on the AARC measures showed stronger associations with objective cognition compared to other measures of self-perceptions of cognition and aging. Higher AARC gains were associated with poorer cognition in middle and early old age. Higher AARC losses and poorer cognition were associated across all subgroups. Higher AARC losses were associated with greater depression and anxiety, more negative SPA, poorer SRH, but not with engagement in cognitive training.

CONCLUSIONS

Assessing both positive and negative self-perceptions of cognition and aging is important when linking self-perceptions to cognitive functioning. Objective cognition is one of the many variables - alongside psychological variables - related to perceived cognitive losses.