Associations between cognitive abilities and life satisfaction in the oldest-old. Results from the longitudinal population study Good Aging in Skåne

Cardiac arrest survivors' self-reported cognitive function, and its association with self-reported health status, psychological distress, and life satisfaction-a Swedish nationwide registry study

AIM

Self-reported cognitive function has been described as an important complement to performance-based measurements but has seldom been investigated in cardiac arrest (CA) survivors. Therefore, the aim was to describe self-reported cognitive function and its association with health status, psychological distress, and life satisfaction.

METHODS

This study utilised data from the Swedish Register of Cardiopulmonary Resuscitation (2018-2021), registered 3-6 months post-CA. Cognitive function was assessed by a single question: "How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?". Health status was measured using the EQ VAS, psychological distress with the Hospital Anxiety and Depression Scale, and overall life satisfaction with the Life Satisfaction checklist. Data were analysed using binary logistic regression.

RESULTS

Among 4026 identified survivors, 1254 fulfilled the inclusion criteria. The mean age was 65.9 years (SD = 13.4) and 31.7% were female. Self-reported cognitive function among survivors was reported as: 'Much worse' by 3.1%, 'Worse' by 23.8%, 'Unchanged' by 68.3%, 'Better' by 3.3%, and 'Much better' by 1.5%. Declined cognitive function was associated with lower health status (OR = 2.76, 95% CI = 2.09-3.64), symptoms of anxiety (OR = 3.84, 95% CI = 2.80-5.24) and depression (OR = 4.52, 95% CI = 3.22-6.32), and being dissatisfied with overall life (OR = 2.74, 95% CI = 2.11-3.54). These associations remained significant after age, sex, place of CA, aetiology, initial rhythm, initial witnessed status, and cerebral performance were controlled.

CONCLUSIONS

Survivors experiencing declined cognitive function post-CA are at a higher risk of poorer health status, increased psychological distress, and reduced life satisfaction, and these risks should be acknowledged by healthcare professionals.

The Association between Physical Frailty and Cognitive Performance in Older Adults Aged 60 to 96 Years: Data from the "Good Aging in Skåne" (GÅS) Swedish Population Study

BACKGROUND

The association between physical frailty and performance in different cognitive domains in the absence of cognitive disorders is poorly understood. Hence, we aimed to explore the associations between frailty levels based on the Fried Physical Frailty Phenotype and performance of different cognitive domains. We also aimed to examine the associations between cognitive function and each criterion in the Fried Frailty Scale using the same cognitive domains in a non-dementia population aged 60-96 years.

METHODS

This cross-sectional study included 4,329 participants aged 60-96 years, drawn from the "Good Aging in Skåne" population study. Frailty indices included handgrip strength, physical endurance, body mass index (BMI), physical activity, and walking speed. Cognitive function was assessed across eight domains: episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, executive function, and visual perception. We constructed adjusted multiple linear regression models for each cognitive domain, with the frailty levels as the independent variable. Likewise, we constructed linear regression models with each cognitive domain as the dependent variable and frailty criteria as independent variables.

RESULTS

Physical frailty was associated with poor performance in episodic memory, processing speed, semantic memory, verbal fluency, working memory, attention, and executive functions (p<0.001 for all associations). Weaker hand grip strength was independently associated with poorer performance in all cognitive domains (p < 0.015).

CONCLUSION

Higher levels of frailty were associated with poorer performance in all cognitive domains except visual perception. Describing frailty by considering cognitive functioning may provide a better understanding of frailty.

The Association between Untreated and Treated Hearing Loss and Cognitive Performance in Men and Women Aged 60-96 Years: Data from the Swedish "Good Aging in Skåne" Population Study

Background/Objectives: Recent decades have witnessed a sharp increase in research investigating the association between hearing loss and cognitive impairment. Few previous studies have stratified for sex when investigating this issue, where results were inconsistent and require further clarification. Thus, the objective was to investigate the association between self-reported hearing loss and levels of cognitive impairment, stratified for sex. Methods: In this cross-sectional study, data were collected from 2001 to 2016. The study sample consisted of 5075 individuals, 2325 (45.8%) men, mean age 68.3 years, and 2750 (54.2%) women, mean age 70.0 years. Multiple variate ordinal regression models were constructed and adjusted for age, marital status, education, physical activity, depressive mood, hypertension, stroke, diabetes, and use of sedatives to investigate associations between groups of self-reported untreated and treated hearing loss and those reporting no hearing loss in relation to levels of cognitive impairment assessed by the Mini-Mental State Examination scale. Results: In men, treated hearing loss was associated with levels of cognitive impairment, odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.14-2.36. In women, both untreated hearing loss, (OR = 1.45, CI 1.07-1.98) and treated hearing loss (OR= 1.46, CI 1.06-2.04) were associated with levels of cognitive impairment. Conclusions: Hearing loss was found to be associated with cognitive impairment despite hearing aid use as well as awareness amongst physicians. The introduction of screening programs for hearing loss in older adults could be a crucial step for earlier identification of individuals at higher risk of developing cognitive impairment and dementia.

The relationship between depressive mood and subjective health in centenarians and near-centenarians: a cross-sectional study from Korean centenarian cohort

BACKGROUND

With the rapid increase in population longevity, more clinical attention is being paid to the overall health of long-lived people, especially centenarians. Subjective health, which is the perception of one's health status, predicts both mortality and declining physical function in older adults. The purpose of this study was to investigate the factors related to subjective health among centenarians and near-centenarians (ages ≥95) living in a rural area of South Korea.

METHODS

A total of 101 participants were enrolled from four different regions (Gurye, Gokseong, Sunchang, and Damyang), known as the Longevity Belt in Korea. Variables assessing physical and mental health, including the results of blood tests, were examined. Factors associated with good subjective health were identified with logistic regression analysis.

RESULTS

Fifty-six participants (59.6%) were subjectively healthy among the centenarians and near-centenarians. Logistic regression analysis revealed that depressive mood was the only factor associated with subjective health and was negatively correlated. The regression model explained 39% of the variance in subjective health.

CONCLUSIONS

These findings emphasize the importance of mental health at very advanced ages. Because depressive mood negatively correlates with subjective health, more attention is needed to prevent and manage mood symptoms of people of advanced ages, including centenarians.

Psychological resilience and competence: key promoters of successful aging and flourishing in late life

Many individuals, both in the public and within the field of psychology, often perceive aging as a burden that negatively impacts intellectual and mental health. Our present study aims to challenge this notion by identifying the crucial components of positive mental health in later life. These components not only promote positive mental health but also actively contribute to it, even under difficult circumstances. To accomplish this, we first offer a concise review of well-being and mental health models that highlight the psychological aspects of flourishing in late life. We then introduce a psychological competence-based model for positive mental health, which aligns with the concept of positive aging. Subsequently, we present a measurement tool suitable for practical applications. Finally, we provide a comprehensive overview of positive aging, drawing on methodological guidelines and existing research findings concerning sustainable positive mental health in later life. We examine the evidence indicating that psychological resilience (the capacity to adapt and recover from adversity or stress) and competence (skills and abilities to effectively cope with challenges across various life domains) significantly contribute to slowing down biological aging processes. Furthermore, we discuss insights into the relationship between psychological factors and aging derived from research on Blue Zones (regions characterized by a higher proportion of individuals experiencing longer, healthier lives).

Do executive functions explain older adults' health-related quality of life beyond event-based prospective memory?

Previous work has shown that event-based prospective memory (EBPM) predicted health-related quality of life (HrQoL). In the present study, we aimed to examine whether the relationship between EBPM and HrQoL extended to life satisfaction, and whether it persisted after controlling for other cognitive functions related to EBPM, namely executive functions and retrospective memory. We tested two models using structural equation modeling with latent variables in a sample of older adults. In the first model, we assessed whether EBPM predicted life satisfaction and HrQoL; in the second model, we controlled for retrospective memory and executive functions. The first model indicated that EBPM was related to HrQoL. However, in the second model, this relationship was eliminated by executive functions; life satisfaction was not related to any of the cognitive variables. Findings corroborated the link between HrQoL and EBPM, suggesting that such relationship stems from executive functions rather than retrospective memory.

Erectile Function, Sexual Satisfaction, and Cognitive Decline in Men From Midlife to Older Adulthood

BACKGROUND AND OBJECTIVES

Vascular theories of cognitive aging have focused on macrovascular changes and cognitive decline. However, according to the artery-size hypothesis, microvascular changes, such as those that underlie changes in erectile function, may also play an important role in contributing to cognitive decline. Thus, we examined associations between erectile function, sexual satisfaction, and cognition starting in middle age because this represents a transition period where declines in these areas emerge.

RESEARCH DESIGN AND METHODS

We examined 818 men from the Vietnam Era Twin Study of Aging across three waves at mean ages 56, 61, and 68. Erectile function and sexual satisfaction were measured using the International Index of Erectile Function. Cognitive performance was measured using factor scores for episodic memory, executive function, and processing speed. We tested multilevel models hierarchically, adjusting for demographics, frequency of sexual activity, and physical and mental health confounders to examine how changes in erectile function and sexual satisfaction related to changes in cognitive performance.

RESULTS

Lower erectile function at baseline was related to poorer performance in all cognitive domains at baseline and faster declines in processing speed over time. However, baseline sexual satisfaction was unrelated to cognitive performance. Decreases in erectile function and sexual satisfaction were both associated with memory decline.

DISCUSSION AND IMPLICATIONS

Decreasing sexual health may signal an increased risk for cognitive decline. We discuss potential mechanisms, including microvascular changes and psychological distress. Discussing and tracking sexual health in middle-aged men may help to identify those likely to face memory decline.

Inferring Cognitive Abilities from Response Times to Web-Administered Survey Items in a Population-Representative Sample

Monitoring of cognitive abilities in large-scale survey research is receiving increasing attention. Conventional cognitive testing, however, is often impractical on a population level highlighting the need for alternative means of cognitive assessment. We evaluated whether response times (RTs) to online survey items could be useful to infer cognitive abilities. We analyzed >5 million survey item RTs from >6000 individuals administered over 6.5 years in an internet panel together with cognitive tests (numerical reasoning, verbal reasoning, task switching/inhibitory control). We derived measures of mean RT and intraindividual RT variability from a multilevel location-scale model as well as an expanded version that separated intraindividual RT variability into systematic RT adjustments (variation of RTs with item time intensities) and residual intraindividual RT variability (residual error in RTs). RT measures from the location-scale model showed weak associations with cognitive test scores. However, RT measures from the expanded model explained 22−26% of the variance in cognitive scores and had prospective associations with cognitive assessments over lag-periods of at least 6.5 years (mean RTs), 4.5 years (systematic RT adjustments) and 1 year (residual RT variability). Our findings suggest that RTs in online surveys may be useful for gaining information about cognitive abilities in large-scale survey research.

Does Neurocognition Predict Subjective Well-Being?

Greater subjective well-being (SWB) is associated with a myriad of positive outcomes across adulthood. While several studies have demonstrated a relationship between cognition and SWB, the current study extends previous work by examining the relationship between neurocognition and SWB across age and time. Data were drawn from 3,856 individuals between the ages of 18-99 years who participated in the Virginia Cognitive Aging Project, a prospective study of cognition in community dwelling adults. Participants completed a battery of neurocognitive tasks (assessing spatial visualization, episodic memory, reasoning, processing speed, and vocabulary) and measures assessing SWB (life satisfaction, positive affect, and negative affect). Results indicated that spatial visualization, episodic memory, and processing speed predicted life satisfaction only in specific age groups, but the magnitude of the coefficients were not significantly different between the groups, providing limited evidence of age moderation. Vocabulary was negatively associated with positive affect for all age groups. The temporal relationships between neurocognition and SWB were generally non-significant, and age did not moderate this relationship. Within the broader context of neurocognition, this study provides evidence that the relationship between neurocognition and SWB cross-sectionally may be partially age dependent for one facet of SWB, and the temporal relationship may be minimal.

Cognitive Functioning Mediates the Association of Cognitive Reserve with Health-Related Quality of Life

We investigated whether the relations of the cognitive reserve markers education and cognitive level of work to the physical and the mental component of health-related quality of life (HRQoL) were mediated via cognitive functioning in a large sample of 701 older adults (mean age = 70.36 years, SD = 6.87). HRQoL was measured with the 12-item Short-Form Health Survey. To measure cognitive functioning, we used the COGTEL, which is a cognitive test battery assessing prospective memory, verbal short-term memory, verbal long-term memory, working memory, verbal fluency, and inductive reasoning, combined into a composite score. Individuals reported information on their education and their main profession during their working life. Mediation analyses showed that better cognitive functioning mediated the association of higher values in the cognitive reserve markers (longer education and a high cognitive level of work) with higher HRQoL. In conclusion, the present study suggests that the sustainability of cognitive functioning in old age with the help of cognitive reserve is fundamental for the sustainability of quality of life, presumably particularly for the mental HRQoL component.

Relationship between psychological capital and quality of life among seniors working after retirement: The mediating role of hope of success

INTRODUCTION

As a result of the increasing average human life expectancy and the related population growth in many countries, research on factors increasing seniors' quality of life is becoming particularly important. An event critical for seniors' functioning is retirement. A concept reflecting the dynamics of seniors' personality associated with the changes taking place in their life situation is psychological capital. This concept was identified as a factor that is constituted by four personality variables changing because of experiences: self-efficacy, optimism, psychological resilience, and hope of success. An interesting issue is the relationship between psychological capital and quality of life in seniors working after retirement.

AIM

The aim of this paper was to analyze the relationship between psychological capital (self-efficacy, dispositional optimism, psychological resilience) and quality of life in seniors working after retirement, as well as the mediating role of hope of success in this relationship.

METHODS

A total of 304 seniors-103 women and 201 men-participated in the study. The mean age was 65.24. The Quality-of-Life Scale (CASP-19), the Polish adaptation of Life Orientation Test (LOT-R), the Generalized Self-Efficacy Scale (GSES), the Hope of Success Questionnaire (KNS), and polish adaptation of the Resilience Assessment Scale (SPP-25) were employed in the research. A mediation model was applied to explore the pathway from psychological capital via hope of success to quality of life.

RESULTS

The tested components of psychological capital correlate positively with working senior citizens' quality of life. The mediating role of hope of success between psychological capital and quality of life was confirmed. The study presented three mechanisms in which hope of success strengthens the relationships between the components of psychological capital and working senior citizens' quality of life.

CONCLUSIONS

The mediating role of hope of success between the remaining components of psychological capital and quality of life confirms pattern posited in the COR theory, namely, that increasing one resource leads to the activation of others, which results in a spiral of personal resources being generated. One the one hand, people who have greater resources have a greater capacity for generating spirals of gains. One the other hand, individuals who lack personal resources are both more exposed to losing them and less capable of starting a spiral of gains in resources.

Gendered racial differences and similarities in subjective cognitive decline and life satisfaction: results from a population-based sample

OBJECTIVE

The objectives of this study were to: 1) Determine the association between subjective cognitive decline (SCD) and life satisfaction; and 2) Assess the gendered racial/ethnic disparities in the association between SCD and life satisfaction.

METHOD

Data were obtained from 3,795 participants from the Behavioral Risk Factor Surveillance System survey. SCD was operationalized by "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?" Life satisfaction was operationalized by the question "In general how satisfied are you with your life?" Interaction terms of SCD*sex, SCD*race/ethnicity, and SCD*sex*race/ethnicity were used to determine potential effect measure modification. Crude and adjusted linear regression models, controlling for age, education, income and employment, were used to assess the association between SCD and life satisfaction by sex, race, and by gendered racial/ethnic groups: Black women, White women, Hispanic women, Other women; and Black men, White men, Hispanic men and Other men.

RESULTS

SCD was negatively associated with life satisfaction in the overall sample (β: -0.55; 95% CI: -0.66, -0.43). However, the negative associations seen across gender, race/ethnicity, and gendered racial/ethnic groups were statistically similar (p for interaction terms > 0.05). The highest effect estimate was seen for Other men (β: -1.22; 95% CI: -1.37, -1.09).

CONCLUSION

Interventions geared towards improving cognition may improve life satisfaction for all groups, irrespective of gender and/or race/ethnicity. Future research may include longitudinal studies to determine the temporal sequence between SCD and life satisfaction.

Larger increase in trait negative affect is associated with greater future cognitive decline and vice versa across 23 years

BACKGROUND

Trait negative affect (NA) is a central feature of anxiety and depression disorders. Neurocognitive and scar models propose that within-person increase in NA across one period of time relates to a decline in cognitive functioning at a future period of time and vice versa. Yet, there has been little research on whether a within-person change in trait NA across one time-lag precedes and is associated with a change in cognition across a future time lag and vice versa. Due to a growing aging population, such knowledge can inform evidence-based prevention.

METHODS

Participants were 520 dementia-free community-dwelling adults (mean age = 59.76 years [standard deviation = 8.96], 58.08% females). Trait-level NA (negative emotionality scale), spatial cognition (block design and card rotations), verbal working memory (WM; digit span backward), and processing speed (symbol digit modalities) were assessed at five time points (waves) across 23 years. Bivariate dual latent change score (LCS) approaches were used to adjust for regression to the mean, lagged outcomes, and between-person variability.

RESULTS

Unique bivariate LCS models showed that within-person increase in trait NA across two sequential waves was related to declines in spatial cognition, verbal WM, and processing speed across the subsequent two waves. Moreover, within-person reductions in spatial cognition, verbal WM, and processing speed across two sequential waves were associated with future increases in trait NA across the subsequent two waves.

CONCLUSIONS

Findings concur with neurobiological and scar theories of psychopathology. Furthermore, results support process-based emotion regulation models that highlight the importance of verbal WM, spatial cognition, and processing speed capacities for downregulating NA.

The Life Satisfaction Index-A (LSI-A): Normative Data for a General Swedish Population Aged 60 to 93 Years

PURPOSE OF STUDY

To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60-93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment.

MATERIALS AND METHODS

The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies' "Good Aging in Skåne" (GÅS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires.

RESULTS

Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS.

CONCLUSION

Norm values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS.

The Role of Cognitive Control in Age-Related Changes in Well-Being

Maintaining emotional well-being in late life is crucial for achieving successful and healthy aging. While previous research from Western cultures has documented that emotional well-being improves as individuals get older, previous research provided mixed evidence on the effects of age on well-being in Eastern Asian cultures. However, previous studies in East Asia do not always take into account the effects of cognitive control—an ability which has been considered as a key to enable older adults to regulate their emotions. In the current study, we tested whether cognitive control abilities interact with age in determining individuals’ well-being in 59 Japanese females (age range: 26–79; M_age = 64.95). Participants’ mental health and mental fatigue were tracked for 5 years together with their cognitive control abilities. We found that as individuals became older, they showed improved mental health and decreased mental fatigue. In addition, we found a quadratic effect of age on mental fatigue, which was further qualified by baseline cognitive control abilities. Specifically, in those who had a lower level of cognitive control abilities, mental fatigue declined until the mid-60s, at which point it started increasing (a U-shape effect). In contrast, in those who had a higher level of cognitive control ability, mental fatigue showed a steady decrease with age even after their mid-60s. These results suggest that whether advancing age is associated with positive vs. negative changes in well-being depends on cognitive control abilities, and that preserved cognitive control is a key to maintain well-being in late life.

The psychological health of 207 near-centenarians (95-99) and centenarians from the Sydney Centenarian Study

OBJECTIVE

While near-centenarians (95-99) and centenarians are the fastest growing sectors of the population in many countries, few studies have investigated their psychological health. We aimed to compare levels of psychological distress and life satisfaction in individuals aged 95 or above (95+) with younger age groups and identify the factors associated with psychological distress and life satisfaction in near-centenarians and centenarians.

METHODS

We assessed the physical, cognitive, social and psychological health of 207 participants aged 95+ in the Sydney Centenarian Study. Psychological distress and life satisfaction were rated on the Kessler Psychological Distress Scale (K10) and Satisfaction with Life Scale, respectively. Cross-sectional univariate comparisons were performed with participants aged 70-90 years from the Sydney Memory and Ageing Study. Factors associated with psychological distress and life satisfaction among Sydney Centenarian Study participants were examined using multiple regression analyses.

RESULTS

In Sydney Centenarian Study and Memory and Ageing Study, mean K10 scores were 15.3 (±5.9) and 13.4 (±3.6), and clinical levels of psychological distress (K10 ⩾ 20) were 19% and 7%, respectively. Sydney Centenarian Study participants demonstrated significantly higher levels and rates of psychological distress (t = 3.869, p < 0.001; χ² = 27.331, p < 0.001). In Sydney Centenarian Study, more psychotropic medications and having fewer relatives and friends were associated with higher psychological distress. Sydney Centenarian Study participants reported significantly higher levels of life satisfaction than Memory and Ageing Study participants, mean scores 6.0 (±1.5) and 5.6 (±1.3); t = 5.835, p < 0.001. Lower Mini-Mental State Examination scores and having fewer relatives and friends were associated with lower life satisfaction in Sydney Centenarian Study.

CONCLUSION

Despite showing higher levels of psychological distress in the prior 4 weeks than younger age groups, near-centenarians and centenarians remained highly satisfied with their overall lives. The identification of risk and protective factors for psychological distress and life satisfaction provides opportunities for interventions to maintain good psychological health in this vulnerable population.

Examining processing speed as a predictor of subjective well-being across age and time in the German Aging Survey

The purpose of the current study was to examine the associations between cognition, measured via the Digit Symbol Substitution Task, and subjective well-being (measured using the Satisfaction with Life Scale and the Positive and Negative Affect scale) in a community-based sample of middle-aged and older adults. Specifically, we examined both the cross-sectional and the longitudinal relationships between processing speed and subjective well-being. Data are from participants between 40-85 years-old (at baseline) who participated in the German Aging Survey across four waves. Results showed that processing speed was a weak but consistent predictor of positive affect, while age was associated with decreases in negative affect and positive affect, and increases in life satisfaction cross-sectionally. Conversely, cross-lagged panel analyses showed that the temporal relationship between processing speed and positive affect was close to zero, and non-significant. The results of this study shed additional light on the relationship between subjective well-being and cognition.

The dynamic relationship between cognitive function and positive well-being in older people: a prospective study using the English Longitudinal Study of Aging

There is evidence that having a stronger sense of positive well-being may be a potential resource for healthier aging as represented by slower physical decline, reduced risk of frailty and longer survival. However, it is unclear whether positive well-being is protective of another crucial component of healthy aging, cognitive function, or whether it has a bidirectional relationship with cognitive function. We use multilevel models with within-person centering to estimate the within- and between-person association between cognitive function and positive well-being in 4 waves of data from the English Longitudinal Study of Ageing (ELSA), (N = 10985, aged 50–90 years at wave 1). Our findings show that, although most variation in cognitive function was explained by age, and most variation in well-being was explained by depression, small but significant associations between cognition and well-being remained after variation in age and depression were controlled. In models where cognition was the outcome, the association was mainly because of variation in mean levels of well-being between persons. In models where well-being was the outcome, the association was mainly because of within-person fluctuation in cognitive test performance. Exercise and depression were the most important moderating influences on the association between cognition and positive well-being. Depression had greater effect upon this association for those with higher well-being, but exercise protected cognitive performance against the adverse effects of lower well-being.