Financial strain measures and associations with adult health: A systematic literature review

Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.

The prevalence and predictors of anxiety and depression in near-centenarians and centenarians: a systematic review

BACKGROUND

Current research on the psychological health of near-centenarians (95-99 years old) and centenarians remains limited. Existing studies have mainly characterized their physical, cognitive, and social health. Results on the anxiety and depression of near-centenarians and centenarians (more than 95 years old) have been mixed with some studies, finding higher rates of anxiety and depression among those older than 95 years and others reporting no difference in rates compared with younger age groups. This study aims to synthesize the existing literature on the prevalence and predictors of anxiety and depression in near-centenarians and centenarians.

METHOD

A systematic review was conducted using Ovid Medline, Embase, PsycINFO, CINAHL, SCOPUS, and the Cochrane database. Common and conflicting findings among the literature were examined.

RESULTS

Thirty-eight studies met the inclusion criteria. Six studies examined the prevalence and predictors of anxiety, and 37 studies investigated the prevalence and predictors of depression. Five studies examined both anxiety and depression in the same sample. Prevalence data on anxiety and depression varied significantly, as did comparisons with rates in younger populations. Findings on predictors of anxiety and depression were contradictory.

CONCLUSION

There is a large degree of heterogeneity among studies of centenarians' psychological status. Findings conflict on the prevalence and predictors of anxiety and depression and rates compared with younger age groups. Variation in findings may result from the different inclusion criteria, sampling methods, and measurement tools. Better harmonization of centenarian study methodologies may improve consistency of findings to aid in developing clinical interventions.

Self-Perception of Economic Means Is Associated with Dietary Choices, Diet Quality and Physical Health in the Oldest Old Men from the Highest Socioeconomic Group

INTRODUCTION

Self-perception of economic means may affect dietary choices, diet quality, and health behavior. We examined these associations in the oldest-old men from the highest socioeconomic class.

METHODS

The participants in this cross-sectional analysis were the oldest- old home-dwelling men (n = 314, mean age 87 years, range 82-97 years) from the longitudinal Helsinki Businessmen Study cohort. They responded to a postal health and nutrition questionnaire, whereupon dietary intakes were assessed using 3-day food diaries and two diet quality indices. The questionnaire also included items about health, exercise, falls, and economic means.

RESULTS

Higher self-perception of economic means was linearly associated with higher fish intake (p = 0.021), fruit and vegetable intakes (p = 0.027), use of alcohol (p = 0.003), overall diet quality according to IDQ (p = 0.008), self-perceived physical condition (p = 0.002) and inversely associated with body weight (p = 0.011), weight loss (p = 0.008), blood glucose levels (p = 0.020), and falls (p = 0.029).

CONCLUSION

Self-perception of economic means was associated with dietary choices and physical health even among affluent older men. This information is important, because self-perception of economic means, however real, may affect health and nutrition behavior of older people.

Changes in depressive symptoms during widowhood among older Mexican Americans: the role of financial strain, social support, and church attendance

OBJECTIVES

This study examines how depressive symptoms change during the widowhood process among older adults of Mexican descent. This research also investigates whether financial strain, social support, and church attendance moderate changes in depressive symptoms in the context of widowhood.

METHOD

This study uses seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly collected at approximately two-year intervals. This research applies multiphase growth models to examine changes in depressive symptomatology before, during, and after the transition to widowhood (the measurement wave at which spousal bereavement was first reported) among 385 older adults of Mexican descent who experienced the death of a spouse during the survey.

RESULTS

This study demonstrates that older adults of Mexican descent experienced a significant increase in depressive symptoms pre-widowhood and in particular, during the transition to widowhood. The levels and rates of changes in depressive symptoms post-widowhood did not differ from the pre-widowhood ones. Greater social support was related to more depressive symptoms during the transition to widowhood. More frequent church attendance was a protective factor against increases in depressive symptoms pre-widowhood.

CONCLUSION

This study highlights the multiphase pattern in the effects of the widowhood process on depressive symptomatology among older adults of Mexican descent. The findings also suggest that social support and church attendance can have implications for the interplay between widowhood and depressive symptoms.

Older Men's Lay Definitions of Successful Aging over Time: The Manitoba Follow-up Study

The concept of “successful aging” has become widely accepted in gerontology, yet continues to have no common underlying definition. Researchers have increasingly looked to older individuals for their lay definitions of successful aging. The present analysis is based on responses to five questionnaires administered to surviving participants of the male Manitoba Follow-up Study cohort ( www.mfus.ca ) in 1996, 2000, 2002, 2004, and 2006 ( n = 2,043 men were alive at a mean age of 78 years in 1996). One question on each survey asked: “What is YOUR definition of successful aging?” Applying content analysis to the 5,898 narratives received over the 11 years, we developed a coding system encompassing 21 main themes and 86 sub-themes defining successful aging. We quantitatively analyzed trends in prevalence of themes of successful aging prospectively over time. Our findings empirically support colleagues' past suggestions to shift from defining successful aging in primarily biomedical terms, by taking lay views into account.

Exceptional Longevity: An Introduction to the IOWA Centenarian Study

The primary objective of the Iowa Centenarian Study is to further our understanding of determinants of exceptional longevity above and beyond health outcomes, particularly in rural environments. This introductory article provides a general overview of the study, its methodology and basic descriptive results. One hundred and fifty-two centenarians from a rural state participated in the study (average age was 101.6 years). Baseline data collection included questions on demographics, cognitive representation of being a centenarian, mental status, past family history, life events, activities of daily living, coping, physical health and health history, nutrition, exercise, personality, social support, mental health, economic status and perceptions, and fatigue. A subset of the baseline sample (n = 28) participated in a short-term longitudinal study that assessed stability and change in mental status, mental health, and activity. Four additional papers in this issue (Franke, Margrett, Heinz, & Martin, 2012; Garasky, Martin, Margrett, & Cho, 2012; Margrett, Hsieh, Heinz, & Martin, 2012; Martin, da Rosa, Margrett, Garasky, & Franke, 2012) will highlight substantive findings, including longitudinal analyses, in activities of daily living, economic status, mental status, and positive and negative affect.