Individual and societal wisdom: explaining the paradox of human aging and high well-being

Quality of Life among LGBTQ Older Adults in the United States: A Systematic Review

BACKGROUND

Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples.

AIM

To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020.

METHOD

Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations.

RESULTS

The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

CONCLUSIONS

Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.

Parental Self-Efficacy Among Israeli Older Adults

Parental self-efficacy (PSE) is a central aspect of parenting research. Although parenting continues in older ages, few studies have focused on PSE among older adults. In line with the parenting determinant model, the study examined the associations between psychological distress, social support, loneliness, and PSE in older age.The study used a quantitative cross-sectional survey, including 362 Israeli parents age 65 years and above. Participants were asked to complete questionnaires of psychological distress, social support, loneliness, PSE, and background information.Results revealed that higher PSE was associated with lower psychological distress, higher social support, and a lower sense of loneliness in older adults. The research model explained 36.9 per cent of the variance in PSE among older adults.Mental state and social conditions are important for PSE of older adults; therefore, professionals should ensure the availability of diverse solutions to enable, maintain, and promote well-being through social and familial engagement in this population.

Paradoxical age-related improvement in mental health in U.S. military veterans: Results from the national health and resilience in veterans study

OBJECTIVE

To determine whether a seemingly "paradoxical" trend whereby mental health improves as a function of age despite declining physical and cognitive health occurs in U.S. military veterans, who are older, and have higher rates of trauma exposure and psychiatric morbidities relative to non-veterans.

METHODS

Using data from a nationally representative, cross-sectional sample of 4069 U.S. veterans, polynomial regression analyses were conducted to examine changes in self-reported physical, cognitive, and mental health of veterans representing the full age spectrum.

RESULTS

Physical health scores were consistently average and stable until around age 80 when they declined. In contrast, cognitive and mental health scores were markedly lower in young veterans and then increased linearly and positively well into late-life.

CONCLUSIONS

While greater age is associated with relative stability and late-life decline in physical health in U.S. veterans, mental and cognitive health steadily improve until much later in life. Results may help inform age-specific prevention and treatment efforts to promote healthy aging in this population.

Understanding the Value of Tourism to Seniors' Health and Positive Aging

The value of tourism has been included in studies of active aging, and the existing public health implications of the physical and mental health effects of tourism among seniors are recognized as important issues. This study uses a mixed methods research approach to explore the effects of tourism value on the health and mortality risk of older adults, referred to in this paper as seniors. Survival analysis and cohort analysis are combined with the narrative analysis of in-depth interviews with eight convenience-sampled seniors to construct a narrative framework of seniors' active aging tourism and its intrinsic drivers. The study found that the intrinsic framework of active aging tourism values for seniors has a three-stage continuum, an interaction, and orientation characteristics. There are six intrinsic key value drivers of tourism value and public health for seniors. In addition, this study identifies the personal characteristics and strengths of seniors as important influences on tourism value practices for active aging and public health. This study provides a positive psychological and behavioral research direction for existing research on the value of tourism in active aging. It provides an empirical basis for exploring the intrinsic mechanisms of tourism and public health.

Aging Parents' and Middle-Aged Children's Evaluations of Parents' Disability and Life Problems

This study examined discrepancies in aging parents' and middle-aged children's evaluations of aging parents' problems and how these discrepancies were associated with relationship characteristics. Using data from the Family Exchanges Study (dyad N = 331 ), discrepancies in the parents' disabilities and life problems reported by parents and their offspring were examined. Children reported a greater number of disabilities and life problems in their parents' lives than parents did. The discrepancy in the number of disabilities was associated with the frequency of phone contact, but not the frequency of in-person contact between generations. Findings confirm the gap in the evaluations of parents' problems between generations, indicating that children may overestimate their parents' problems, whereas parents may underreport their own problems. Frequent phone calls between aging parents and middle-aged children seem to play a positive role in conveying aging parents' problems. The gap in knowledge of parents' problems may lead to unmet needs and/or undesirable support exchanges between parents and offspring. Future research needs to consider both generations' reports and to develop reliable methods to assess parents' problems.

Exploring the Relationships between Posttraumatic Growth, Wisdom, and Quality of Life in Older Cancer Survivors

Objective:

The number of older cancer survivors is steadily rising with a growing aging population, and a great interest in evaluating the quality of life is emerged. Although understanding how to improve the quality of life in older cancer survivors is critical as the number of older survivors continues to grow in communities, little is known about empirical evidence regarding predictors of the quality of life in older cancer survivors. This study aimed to examine relationships between posttraumatic growth, wisdom, and quality of life in older cancer survivors.

Methods:

A convenience sample of older cancer survivors after completing cancer treatments (n=121) participated from one public health center, and they filled out self-report questionnaires on measures of posttraumatic growth, wisdom, and quality of life.

Results:

As results of multiple regression analysis, the most significant factor on each domain of the quality of life has shown that higher levels of subjective economic status were associated with significant improvement of four domains of quality of life, and wisdom and posttraumatic growth were associated with significant improvement in social/family well-being.

Conclusion:

This study highlights predictors of each domain of quality of life that subjective economic status, posttraumatic growth and wisdom significantly affected the quality of life in older cancer survivors. Findings indicate that psychological interventions need to be developed and implemented for older cancer survivors to prevent long-term effects of cancer and to increase their quality of life. For improving their quality of life, primary care providers or community health professionals need to develop tailored interventions, such as home-based cancer survivorship programs.

Exploring the Wisdom Structure: Validation of the Spanish New Short Three-Dimensional Wisdom Scale (3D-WS) and Its Explanatory Power on Psychological Health-Related Variables

Introduction: Personal wisdom has demonstrated important implications for the health of individuals. The aim of the present study was to validate a Spanish version of the Three-Dimensional Wisdom Scale (3D-WS), exploring the structure of a possible general factor, and assessing its explanatory power on psychological health-related variables. Methods: A cross-sectional study design was used, with a total sample of 624 Spanish participants recruited on the Internet and randomly split into two halves. The following instruments were applied: 3D-WS, Purpose in Life (PIL), Multidimensional State Boredom Scale (MSBS), Positive and Negative Affect Scale (PANAS), and Difficulties in Emotion Regulation Scale (DERS). Factorial structures were analyzed through exploratory and confirmatory factor analysis (EFA and CFA), and the general factor was characterized by using bifactor models. The explanatory power of the 3D-WS was established by multiple regression. Results: The original long and short versions of the 3D-WS were not replicated in the first subsample using EFA, and there was a high rate of cross-loadings. Thus, a new short 3D-WS was proposed by ordering the original items according to factorial weights. This three-correlated-factor (reflective, cognitive, and affective) proposal was tested by means of CFA in the second subsample, with adequate psychometrics and invariance, and a good fit (χ2/df = 1.98; CFI = 0.946; RMSEA = 0.056; 90% CI = 0.040-0.072). A bifactor structure, in which the reflective trait of wisdom was integrated into a general factor (G-Reflective) improved the model fit (χ2/df = 1.85; CFI = 0.959; RMSEA = 0.052; 90% CI = 0.035-0.070). The explained common variance of G-Reflective was 0.53; therefore, the new short 3D-WS should not be considered essentially unidimensional. The new short 3D-WS showed positive relationships with the PIL and PANAS-positive, and negative associations with the MSBS, PANAS-negative and DERS, contributing to explain all the referred variables. These results were consistent across subsamples. Conclusion: The new short 3D-WS appears to be a reliable instrument for measuring wisdom in the Spanish general population. The reflective facet might influence the cognitive and affective wisdom components through the G-Reflective general factor. There seems to be a high explanatory power of the 3D-WS on psychological health-related variables. This study will facilitate the development of future research and psychological knowledge regarding wisdom.

Mixed-methods quantitative-qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: focus on positive psychological traits

OBJECTIVE

This was a study of positive psychological traits in a group of rural Italians aged 90 to 101 years, and their children or other family members.

DESIGN

Mixed-methods quantitative (standardized rating scales) and qualitative (semi-structured interviews) study.

SETTING

Study participants' homes in nine villages in the Cilento region of southern Italy.

PARTICIPANTS

Twenty-nine nonagenarians and centenarians and 51 family members aged 51-75 years, selected by their general practitioners as a part of a larger study called CIAO (Cilento Initiative on Aging Outcomes).

METHODS

We used published rating scales of mental and physical well-being, resilience, optimism, anxiety, depression, and perceived stress. Qualitative interviews gathered personal narratives of the oldest-old individuals, including migrations, traumatic events, and beliefs. Family members described their impressions about the personality traits of their older relative.

RESULTS

Participants age ≥90 years had worse physical health but better mental well-being than their younger family members. Mental well-being correlated negatively with levels of depression and anxiety in both the groups. The main themes that emerged from qualitative interviews included positivity (resilience and optimism), working hard, and bond with family and religion, as described in previously published studies of the oldest old, but also a need for control and love of the land, which appeared to be unique features of this rural population.

CONCLUSIONS

Exceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life.

Age-Friendliness and Life Satisfaction of Young-Old and Old-Old in Hong Kong

Age-friendliness, promoted by the World Health Organization (WHO), aims to enable and support individuals in different aspects of life for fostering life satisfaction and personal well-being as they age. We identified specific aspect(s) of age-friendliness associated with life satisfaction and examined similarities and differences in age-friendliness and life satisfaction in young-old and old-old adults. Six hundred and eighty-two ageing adults were asked to complete a survey questionnaire consisting of the Age-friendly City Scale, Satisfaction with Life Scale, and sociodemographic variables. Multiple linear regression analysis was used to examine the effects of various domains of age-friendliness on life satisfaction among the young-old adults (aged 65 to 74, n = 351) and the old-old adults (aged 75 to 97, n = 331). Common domains associated with life satisfaction in both young-old and old-old groups were transportation and social participation. Community and health services were associated with life satisfaction for the young-old group only. On the other hand, civic participation and employment was significantly associated with the old-old group only. Social participation is important for the young-old and the old-old. Ageing older adults can be a resource to the society. Implications for promoting and implementing age-friendliness were discussed in the context of successful and productive ageing and the need for a more refined taxonomy of social activities.

Older Adults' Perspectives on Clinical Research: A Focus Group and Survey Study

OBJECTIVES

Clinical trials can benefit from patient perspectives to inform trial design, such as choice of outcome measures. We engaged older adults in focus groups and surveys to get their perspective regarding needs in clinical research. The goal was to inform the development of a new clinical trial of medication strategies for treatment-resistant depression in older adults.

METHODS

Older adults with depression participated in focus groups and a subsequent survey in St. Louis and New York. They were queried regarding research design features including outcomes, clinical management, mobile technology and iPad-administered assessments, the collection of DNA, and the receipt of their personal results.

RESULTS

Patients told us: (1) psychological well-being and symptomatic remission are outcomes that matter to them; (2) it is important to measure not only benefits but risks (such as risk of falling) of medications; (3) for pragmatic trials in clinical settings, the research team should provide support to clinicians to ensure that medications are properly prescribed; (4) technology-based assessments are acceptable but there were concerns about data security and burden; (5) DNA testing is very important if it could improve precision care; (6) participants want to receive aggregate findings and their own personal results at the end of the study.

CONCLUSIONS

Patients gave useful and wide-ranging guidance regarding clinical and comparative effectiveness research in older adults. We discuss these findings with the goal of making the next generation of geriatric studies more impactful and patient-centered.

Paradoxical Trend for Improvement in Mental Health With Aging: A Community-Based Study of 1,546 Adults Aged 21-100 Years

OBJECTIVE

Studies of aging usually focus on trajectories of physical and cognitive function, with far less emphasis on overall mental health, despite its impact on general health and mortality. This study examined linear and nonlinear trends of physical, cognitive, and mental health over the entire adult lifespan.

METHODS

Cross-sectional data were obtained from 1,546 individuals aged 21-100 years, selected using random digit dialing for the Successful AGing Evaluation (SAGE) study, a structured multicohort investigation that included telephone interviews and in-home surveys of community-based adults without dementia. Data were collected from 1/26/2010 to 10/07/2011 targeting participants aged 50-100 years and from 6/25/2012 to 7/15/2013 targeting participants aged 21-100 years with an emphasis on adding younger individuals. Data included self-report measures of physical health, measures of both positive and negative attributes of mental health, and a phone interview-based measure of cognition.

RESULTS

Comparison of age cohorts using polynomial regression suggested a possible accelerated deterioration in physical and cognitive functioning, averaging 1.5 to 2 standard deviations over the adult lifespan. In contrast, there appeared to be a linear improvement of about 1 standard deviation in various attributes of mental health over the same life period.

CONCLUSIONS

These cross-sectional findings suggest the possibility of a linear improvement in mental health beginning in young adulthood rather than a U-shaped curve reported in some prior studies. Lifespan research combining psychosocial and biological markers may improve our understanding of resilience to mental disability in older age and lead to broad-based interventions promoting mental health in all age groups.

Development of a 12-Item Abbreviated Three-Dimensional Wisdom Scale (3D-WS-12)

Wisdom has been reported to be associated with better mental health and quality of life among older adults. Over the past decades, there has been considerable growth in empirical research on wisdom, including the development of standardized measures. The 39-item Three-Dimensional Wisdom Scale (3D-WS) is a useful assessment tool, given its rigorous development and good psychometric properties. However, the measure’s length can prohibit use. In this article, we used a sample of 1,546 community-dwelling adults aged 21 to 100 years ( M = 66 years) from the Successful AGing Evaluation (SAGE) study to develop an abbreviated 12-item version of the 3D-WS: the 3D-WS-12. Balancing concerns for measurement precision, internal structure, and content validity, factor analytic methods and expert judgment were used to identify a subset of 12-items for the 3D-WS-12. Results suggest that the 3D-WS-12 can provide efficient and valid assessments of Wisdom within the context of epidemiological surveys.