Older adults' coping with negative life events: common processes of managing health, interpersonal, and financial/work stressors

Internalized stigma: Social support, coping, psychological distress, and mental well-being among older adults in Ghana

BACKGROUND

Older adults have been found to internalize stigma from society and this has been linked to several variables including social support, coping, psychological distress, and mental well-being. However, there is a dearth of research on how these variables interact with each other to impact the life of older adults.

AIMS

This study employed path analysis to explore social support and coping as boundary conditions and underlying mechanisms in the link between internalized stigma, psychological distress, and mental well-being, among older adults in Ghana.

METHOD

Using a cross-sectional design, the study recruited 167 older adults who responded to standardized questionnaires including The Internalized Stigma of Mental Illness scale, Multidimensional Perceived Social Support Scale, The Brief Coping Inventory, Kessler Distress Scale, and the Warwick-Edinburgh Mental Well-being Scale, to determine levels of internalized stigma, social support, coping strategies, psychological distress, and mental well-being, respectively.

RESULTS

The findings revealed that at low levels of social support, there is a significant and positive correlation between internalized stigma and mental well-being (β = -.36, SE = 0.17, p < .001). Path analysis showed that the relationship between internalized stigma and mental well-being was fully mediated by problem-focused coping (β = .11, p = . 001, 95% CI [0.04, 0.21]), but not psychological distress. Problem-focused coping was also found to have a significant positive correlation with mental well-being but no significant correlation with psychological distress. Conversely, avoidant-focused coping was found to have a significant positive correlation with psychological distress and a significant negative correlation with mental well-being.

CONCLUSIONS

This study revealed the importance of social support and coping to attaining mental well-being among older adults. This study provides insights into the development of tailored interventions aimed at improving social support and problem-focused coping among older Ghanaian adults facing internalized stigma, and it also establishes a base for future research.

Dyadic Associations Between Burden and Depressive Symptoms Among Patients With Heart Failure and Their Caregivers: The Mediating Role of Perceived Stress

BACKGROUND

Depressive symptoms are prevalent in patients with heart failure and their family caregivers. Given the interpersonal interactions between dyadic individuals with intimate relationship, it is essential to consider the dyads as a unit when exploring the factors associated with depressive symptoms in heart failure patient-caregiver dyads.

OBJECTIVE

The aims of this study were to explore the dyadic effects of burden on depressive symptoms in heart failure patient-caregiver dyads and investigate whether perceived stress acts as a mediator in these relationships.

METHODS

In this cross-sectional study, 237 heart failure patient-caregiver dyads were recruited from 3 hospitals in China between November 2018 and June 2019. Symptom burden, caregiving burden, perceived stress, and depressive symptoms were assessed using self-report questionnaires. The actor-partner interdependence model and actor-partner interdependence mediation model were used to analyze the data.

RESULTS

Patients' symptom burden had an actor effect on their own depressive symptoms and a partner effect on their caregivers' depressive symptoms. Similarly, caregivers' caregiving burden had an actor effect on their own depressive symptoms and a partner effect on patients' depressive symptoms. The actor effects between burden and depressive symptoms were partially mediated by their own perceived stress in heart failure patient-caregiver dyads. Furthermore, the partner effect between caregivers' caregiving burden and patients' depressive symptoms was completely mediated by patients' perceived stress.

CONCLUSIONS

Patients' symptom burden and caregivers' caregiving burden aggravated their depressive symptoms by increasing their own perceived stress. Moreover, patients' symptom burden led to caregivers' depressive symptoms, and caregivers' caregiving burden contributed to patients' depressive symptoms through patients' perceived stress. These interdependent relationships suggest that dyadic interventions focused on reducing burden and perceived stress may be beneficial for relieving depressive symptoms in heart failure patient-caregiver dyads.

Gender differences in the association between physical frailty and life satisfaction among older adults in India

BACKGROUND

One of the sustainable development goals' (SDGs) primary goals (Goal 3) is to ensure healthy lives and promote well-being for persons of all ages. While extensive literature documents the link between physical frailty and low life satisfaction (LLS) among older adults, research of this nature is limited within low and middle-income countries including India. The purpose of this study was to examine the association between physical frailty and life satisfaction among community-dwelling older men and women in India.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study in India (LASI), with a sample of 30 390 individuals aged 60 and above (14 559 men and 15 831 women). Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. Ordered logistic regression models are employed to examine the association between physical frailty and life satisfaction.

RESULTS

The prevalence of frailty was higher in older women than men (32.2% vs. 27.5%). Nearly 30.4% of men and 33.8% of women reported having LLS. However, after adjusting for the selected confounders, women were less likely (adjusted odds ratio [aOR]: 0.92; CI: 0.87-0.97) to report LLS compared to men. The physically frail older adults were more likely (aOR: 1.40; CI: 1.27-1.55) to report LLS relative to their physically stronger counterparts. Moreover, we found that frail older men had higher odds of reporting LLS than non-frail older men (aOR: 1.25; CI: 1.09-1.43). Also, non-frail older women had lower odds of reporting LLS than non-frail older men (aOR: 0.80; CI: 0.67-0.95).

CONCLUSIONS

Findings of our study suggest that policies and programs to address later life well-being need to consider gender differences. Doing so would not only help identify older adults most at risk of LLS, but gender differentiated policies would help streamline health expenditures and costs typically relegated to assist all older adults without proper focus on the uniqueness of their social location.

Stress and suicidal ideation in Korean baby boomers: the mediating effect of mindfulness and meaning in life

Stress has been shown to enhance elderly suicidal ideation. However, the effect of mindfulness and meaning in life on the relationship between stress and suicidal ideation in Korean baby boomers are still unknown. This study investigated (a) a significant correlation between the stress, suicidal ideation, mindfulness, and meaning in life, (b) the mediating effect of mindfulness in the association between stress and suicidal ideation, and (c) the serial mediating effect of mindfulness and then meaning in life on the relationship between stress and suicidal ideation. Data were collected from 200 baby boomers (born between 1955-1963) concerning their stress, mindfulness, meaning in life, and suicidal ideation. These findings suggest that if interventions directed at baby boomers can successfully improve their mindfulness and by extension raise their meaning in life, suicidal ideation will decrease within their population.

Characteristics of people who have received treatment for late-onset problem drinking and alcohol use disorder: A systematic review and narrative synthesis

Aims: The current review investigated the psychosocial characteristics of late-onset problem drinkers, an under-researched area of alcohol harm that accounts for one-third of older problem drinkers. Method: Following the PRISMA model, the protocol and search strategy included a scoping search and main search of nine databases. A total of 1,595 papers were identified; after screening, 26 papers were considered eligible and were included in the review. The review used an investigative framework comprising three categories: standardising age of onset; gender differences; and psychosocial and mental health characteristics. The review also investigated how meaning and purpose in life, and treatment have been reported in relation to this cohort. Findings/Conclusions: The combined onset ages of the reviews’ 26 papers (mean age = 52.69 years) and the participants’ self-reported age at onset (mean age = 56.79 years), suggest that late-onset alcohol use disorder (AUD)/problem drinking is likely to emerge at the age of 55 years and older. Moreover, there is a high prevalence of co-morbid mental health disorders among elderly, late-onset drinkers. Retirement was reported as the most prevalent psychosocial risk factor for late-onset problematic drinking; other late-life events included bereavement, loneliness and social isolation, and boredom. In the context of gender, women are at greater risk of developing late-onset problem drinking than men. Furthermore, late-onset problem drinkers, particularly women, are more treatment compliant than their early-onset counterparts, highlighting the case for bespoke treatments/interventions for late-onset problem drinkers. Finally, the role that meaning and purpose in life plays in late-onset problem drinking has been under-reported and requires further investigation.

Coping in Mid- to Late Life and Risk of Mild Cognitive Impairment Subtypes and Dementia: A JPHC Saku Mental Health Study

BACKGROUND

The relationship between coping in mid- to late life and cognitive functions remains unclear.

OBJECTIVE

To investigate the relationship between habitual coping behaviors of a large Japanese population in their mid- to late-lives and their risk of cognitive decline 15 years later.

METHODS

Overall 1,299 participants were assessed for coping behaviors (in 2000) and cognition (2014-2015). We used the Stress and Coping Inventory to assess the frequency of six coping behaviors (i.e., consulting, planning, positive reappraisal, avoidance, fantasizing, and self-blame). Logistic regression analyses were conducted to examine odds ratios (ORs) for the diagnosis of mild cognitive impairment (MCI), MCI subtypes (single- and multiple-domain MCI), and dementia for coping behaviors.

RESULTS

Among the eligible 1,015 participants (72.6 [SD = 5.5] years old in 2014-2015), the numbers for cognitively normal, single-domain MCI, multiple-domain MCI, and dementia were 650 (64.0%), 116 (11.4%), 213 (21.0%), and 36 (3.5%), respectively. Among the six coping behaviors, avoidant coping was significantly associated with noticeable cognitive decline (multiple-domain MCI and dementia). This association remained significant after adjusting for sex, age, education, diagnosis of current major depressive disorder, past history of ischemic heart disease, diabetes, regular alcohol consumption, and smoking (OR = 2.52, 95% CI = 1.23 to 5.15). No significant association with other coping behaviors was found.

CONCLUSION

Avoidant coping in mid- and late life is associated with cognitive decline among older people.

Iranian older adults women: The Impact of COVID-19 and Coping Strategies

In the field of epidemics, some vulnerable groups, such as older adults, are at greater risk. Many psychological, social, economic and physical hazards have threatened older adults during the COVID-19 pandemic. Some threats can be managed with medical system interventions. However, social and psychological challenges cannot be controlled quickly. People will have a better quality of life if they can take appropriate action in critical situations. There is a strong theoretical and empirical background that a sense of control and self-efficacy can promote psychological well-being. The main questions of this study included the following: What were the main problems experienced by older Iranian women during the outbreak of COVID-19? What coping methods did they use to control the situation? What were their views on the future? This research was conducted in Kerman city, the capital of Kerman Province. A phenomenological method was used. We interviewed 15 women over 65 years old. We extracted five main themes from the interviews. These themes were health issues, persistent anxiety, economic and social pressures, identifying unique solutions to the current situation, and optimism versus pessimism: what is the future? From the participants' point of view, psychological, social and physical problems have disturbed them during the pandemic, especially at the beginning. However, they controlled their problems by using selective coping strategies. In Iran, planners can use the potential of the two institutions of family and religion to reduce the problems of older adults.

Coping strategies moderate the effect of perceived stress on sleep and health in older adults during the COVID-19 pandemic

Stress in the context of the COVID-19 pandemic may have a significant impact on health, including sleep health. Older adults may be particularly vulnerable. This study examined associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether specific coping strategies moderate these associations. Older adults (n = 115; M_age  = 68.62) reported perceived stress, coping strategies, global sleep quality, depressive symptoms, and perceived mental, physical, and overall health before and during the COVID-19 pandemic. Stress-health relationships were modelled with hierarchical linear regression. Higher perceived stress was associated with greater depressive symptoms and poorer mental health concurrently and longitudinally. Coping strategies moderated the association of perceived stress with physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health among those with lower problem-focussed coping, but not among those with higher problem-focussed coping. Older adults may benefit from prevention and intervention strategies targeting stress management. Furthermore, identifying people with low problem-focussed coping might be a useful strategy to prevent worsening health in future public health crises.

Negative Life Events, Social Ties, and Depressive Symptoms for Older Adults in China

Although it is widely acknowledged that older adults who have gone through negative life events are more likely to develop depression, there is limited evidence on whether and which type of social ties moderate this perceived relationship. Based on 2016 and 2018 waves of Chinese Longitudinal Aging Social Survey (4,466 individuals, 8,932 observations), we apply linear fixed effects models and confirm that negative life events are associated with depressive symptoms for older adults (Coef. = 0.35; 95% CIs 0.11–0.61), and social ties are negatively associated with depression (Coef. = −0.08; 95% CIs −0.10 to −0.07). Our study further suggests that the association between negative life events and depressive symptoms is significantly moderated by friendship ties (Coef. = −0.18, 95% CIs −0.30 to −0.07), rather than family ties (Coef. = −0.03, 95% CIs −0.09 to 0.15). Moreover, the buffering effects of friendship ties are more prominent for the less resilient and less privileged groups, namely male, rural, and less educated older adults. Our findings point to the importance of expanding and strengthening social networks for Chinese older adults in promoting their psychological health.

Travesty of Life Elders Abuse an Inquiry of Physical and Psychological Abuse

Elder abuse is evil in human society. The present paper unveils this social issue from two major factors psychological and physical abuse. The study sensitizes the subject matter of study by examining the effects of demographic variables like gender and age on elders. For achieving the purpose of the study the research is a design by exploring and validating the factors of measuring elder abuse through the mix method approach, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). To test the established hypotheses of the effects of the demographic variable on elders the two-way ANOVA was applied. The present study verdicts the development of a sound measurement scale with two influence factors. The separate and composite effect of aging and gender type on elder abuse was evidenced. These findings are crucial especially when the prevalence of elder abuse is higher during COVID-19. The limited novel understudied variable opens an avenue for further research in behavioral and demographic variables like marital status. The present study has practical insinuation for caring the elders in any human society like physical and psychological treatment of elders to avoid abusive situations. In addition, the study attempts to validate the novel issues like psychological and physical abuse of elders in the dimensions of demographic variables. Some rare studies in the Indian continent established the motivation of conducting the research on this dimension.

Change in prevalence of post-traumatic stress disorder in the two years following trauma: a meta-analytic study

BACKGROUND

Understanding the course of post-traumatic stress disorder (PTSD) and the factors that impact this is essential to inform decisions about when and for whom screening and intervention are likely to be beneficial.

OBJECTIVE

To provide meta-analytic evidence of the course of recovery from PTSD in the first year following trauma, and the factors that influence that recovery.

METHOD

We conducted a meta-analysis of observational studies of adult PTSD prevalence which included at least two assessments within the first 12 months following trauma exposure, examining prevalence statistics through to 2 years post-trauma. We examined trauma intentionality (intentional or non-intentional), PTSD assessment method (clinician or self-report), sample sex distribution, and age as moderators of PTSD prevalence over time.

RESULTS

We identified 78 eligible studies including 16,484 participants. Pooled prevalence statistics indicated that over a quarter of individuals presented with PTSD at 1 month post-trauma, with this proportion reducing by a third between 1 and 3 months. Beyond 3 months, any prevalence changes were detected over longer intervals and were small in magnitude. Intentional trauma, younger age, and female sex were associated with higher PTSD prevalence at 1 month. In addition, higher proportions of females, intentional trauma exposure, and higher baseline PTSD prevalence were each associated with larger reductions in prevalence over time.

CONCLUSIONS

Recovery from PTSD following acute trauma exposure primarily occurs in the first 3 months post-trauma. Screening measures and intervention approaches offered at 3 months may better target persistent symptoms than those conducted prior to this point.

HIGHLIGHTS

PTSD rates in the immediate aftermath of trauma exposure decline from 27% at 1 month to 18% at 3 months post-trauma, showing significant spontaneous recovery.Problems appear to stabilize after 3 months.Screening/intervention for PTSD at 3 months post-trauma is indicated.

Exploring the Dilemma of Ethical Issues Using the Lens of Seedhouse Can Help Oncology Nurses to Gain a Different Perspective on Caring for Older Adults with Cancer

OBJECTIVE

To explore ethical issues associated with older adults with cancer and the people who matter to them.

DATA SOURCES

A scoping review of the literature was conducted to inform the article using CINAHL, Medline, and Google Scholar databases using broad terms, older adults, geriatrics, cancer, and ethics.

CONCLUSION

Older adults with cancer experience ageism, which stems from a range of uncertainties on best practice in care and treatment. By employing an ethical lens, decision-making by oncology nurses can be aided by creating and promoting autonomy through impeccable communication. Best interests for individual older adults with cancer can also be served by oncology nurses working in a way that serves needs first and acts in the best interests of the person and their family.

IMPLICATIONS FOR NURSING PRACTICE

The article is of relevance to practicing oncology globally nurses because the framework can be easily used in clinical practice.

Parental Monitoring, Individual Dispositions, and Alcohol Use Disorder: A Longitudinal Study with Young Swiss Men

This paper evaluates the interaction between level of parental monitoring in adolescence and individual dispositions present in early adulthood in the prediction of alcohol use disorder (AUD) in the mid-20s. Data were drawn from the Cohort Study on Substance Use Risk Factors (C-SURF), encompassing 4844 young Swiss men who were surveyed three times within a 5-year period. The outcome variable was alcohol use disorder (AUD) as defined in the DSM-5. Independent variables were sensation seeking (Brief Sensation Seeking Scale) and the coping strategies active coping and denial (Brief COPE). Low parental monitoring, high sensation seeking, and high denial were found risk factors of AUD (odds ratio (OR) = 1.21 (1.05–1.40); OR = 1.56 (1.37–1.78); OR = 1.15 (1.01–1.31)). A significant interaction effect was identified between active coping and parental monitoring; high active coping in early adulthood was found protective of AUD, only among individuals who had low parental monitoring in adolescence (OR = 0.70 (0.52–0.96)). In addition to interventions to upskill parents for improving monitoring, other interventions directed to young adults who had disadvantaged family contexts could be implemented, with the aim of enhancing the use of adaptive coping strategies such as active coping. Prevention targeting avoidant coping strategies and sensation seeking should be privileged too.

"Getting Used to It, but Still Unwelcome": A Grounded Theory Study of Physical Identity Development in Later Life

Given the global trends toward an aging society and the increased desire for healthy aging in late life, this study examines older adults' perceptions of aging and their physical identity through their engagement in physical activities. Adopting a grounded theory, we interviewed 15 individuals aged 65 years and older, who were involved in physical activities on a regular basis. This study provided a final model depicting (a) divergent and convergent modes of strategies and socioemotional aspects of physical identity development in later life and (b) different strategies employed between younger-old versus older-old age groups and between participants who have underlying health conditions and those who do not. These findings add a contextual explanation of identity development in later life and stress the recurring process of physical identity development.

Directed coping: A key to coping effectively?

Directed coping, or the use of fewer coping strategies, represents attempts of the individual to effectively cope with stressors. As individuals engage in this process, health and wellness (e.g., physical and mental) generally improve, suggesting directed coping may be an effective technique. However, little specific information is known about the directed coping construct beyond the results of the single study by Wright et al. among nurses dealing with work stressors. Therefore, the current study seeks to examine the directed coping construct in more depth. Following a pre/post study design, 611 undergraduate students participated in a health behaviour change program, completing an online questionnaire regarding their health, wellness and general life stressors as well as an in-person physical health assessment before and after the 6-week program. Consistent with hypotheses, directed coping was associated with and predictive of improved health and wellness subjectively (e.g., affect and stress) and objectively (e.g., heart rate, blood pressure and grip strength) relative to coping with general life stressors. Moreover, directed coping demonstrated stability over time and was related to personality characteristics. Thus, the results suggest directed coping is an effective method of coping and may be stable across situations.

Negative life events and self-harm among the elderly: Result from a survey of 7070 people aged≥60 in China

PURPOSES

Negative life events have been reported as a risk factor for elderly self-harm. The aim of this study was to examine the relationship between negative life events and self-harm in a large sample of people aged 60 and older, and explore the role of some previously identified influential factors in this relationship.

METHODS

Multi-stage stratified sampling method was used to select the elderly people over 60 years old in Shandong, China. Information were collected through face-to-face interviews. Univariate and multivariable logistic regression were used for initial analysis. Karlson-Holm-Breen (KHB) method was used for mediating effect analysis.

RESULTS

A total of 7070 participants were included in the study, 160 reported they had a history of self-harm (2.3%), 756 reported they had negative life event experience (10.7%). After model adjustment, the association between negative life events, loneliness, economic status and self-harm was still statistically significant. Mediation analysis showed that the association is explained by loneliness (proportion of mediation 48.86%), self-rated economic status (16.13%).

CONCLUSIONS

Negative life events, loneliness and economic status were associated with self-harm among the older adults. Loneliness and economic status may play an intermediary role in the relationship between negative life events and self-harm, especially loneliness. More psychological and social functions intervention strategies and prevention measures on the self-harm of the elderly should be provided for the elderly who have experienced negative life events.

About me but without me? Older adult's perspectives on interpersonal communication during care transitions from hospital to seniors' residence

BACKGROUND

Transitions in care can be stressful for an older adult. While communication protocols between health care professionals during transitions have been thoroughly studied, there is a need to better understand how older adults transitioning perceive interpersonal communication. Relying on Communication Accommodation Theory, the goal of this study is to explore Canadian older adults' perspectives of interpersonal communication during care transition from acute care in a hospital to a residence and assess if and how communication could improve health and well-being. Using a longitudinal exploratory design, 13 older adults (M_Age = 84 years) transitioning from acute hospital care to a residence were interviewed at three time points: (1) in the hospital, (2) upon arriving at the residence and (3) in the residence, 2-3 months later. A total of 30 interviews were analyzed using thematic content analysis. Five main themes emerged from participants' descriptions of their transition and communication with health care professionals: (1) Interpersonal Communication or Information, (2) Gratefulness & Burden, (3) Acceptance & Resilience, (4) Maintaining Autonomy and (5), Level of satisfaction. Most participants described being informed rather than being an active participant during the transition process. Most also accepted the transition and tried to reduce the burden on family notably by finding ways to maintain autonomy. A major finding of this study is the lack of interpersonal communication taking place during the transition process, which increased older adults' feeling of uncertainty about the future. Many were unclear on why this move was taking place and where they were going. Providing a space for older adults to communicate their perspectives could attenuate the negative outcomes stemming from stressful care transitions.

Not Just Doing Time: Distinct Typologies of Attitudes and Emotions among Juvenile Justice-Involved Youth

Adolescents' views of the legal system, just world beliefs, and moral emotions are interrelated and form an important frame of reference, particularly for young people involved in the juvenile justice system. Yet past scholarship has generally treated these as independent indices of youths' experience. This study took a person-centered, latent profile approach to attitudes and beliefs among 136 male youth incarcerated within secure US juvenile facilities. Three heterogeneous profiles were found (negative attitudes/low emotion, moderate attitudes/mixed emotions, and positive attitudes/positive emotion) which were differentially associated with antisocial behavior. Youth who belonged to historically marginalized populations had significantly lower odds of belonging to a protective profile characterized by positive legal attitudes, just world beliefs, and emotions (positive attitudes/positive emotion). Findings highlight our gaps in understanding young people's experiences with legal and judicial entities and illustrate significant heterogeneity in youth's frame of reference within the juvenile justice system.

Association of positive and negative life events with cognitive performance and psychological status in late life: A cross-sectional study in Northern Portugal

Objectives

Life events have important effects on psychological well-being. Yet, studies have mainly focused on exploring the impact of traumatic and negative experiences on health and well-being, with positive events receiving marginal attention. In this study, we investigated the association between negative and positive life events, cognitive performance and psychological status in older individuals.

Method

A cross-sectional approach with a sample of 97 community-dwelling adults, recruited from a network of 23 centres/institutions in Northern Portugal, and aged between 56 and 85 years, was conducted. All participants were evaluated through a battery of tests assessing for depressive mood, perceived stress, and cognitive functioning. Life events were measured using the Lifetime Experiences Scale (LIFES) which covers 75 life experiences organized in eight domains.

Results

A total of 95.9% of the participants reported more positive life events than negative throughout life. Participants reporting more positive experiences had lower scores in the depressive mood and perceived stress measures. At the domain-level of LIFES scale, more negative experiences in the Work and Health domains were associated with a depressed mood and more perceived stress. Significant positive associations were found between positive life experiences and most cognitive measures, after controlling for sex, education, age and depressive symptoms. Namely, more positive experiences at School, Leisure, and Living conditions were positively associated with better performance across cognitive tests.

Discussion

This study adds important evidence on the association between of life events, both negative and positive experiences, on cognition and psychological well-being, providing a more balanced view of the field.

The Role of Self-Esteem in the Relationship Between Loneliness and Life Satisfaction in Late Adulthood: Evidence from Poland

Background

The life satisfaction of elderly persons has been extensively investigated and discussed. However, a literature review shows that relatively few studies have focused on the effect of loneliness on the life satisfaction of older adults. Some researchers have acknowledged that the character of the relationship between loneliness and life satisfaction is still unclear, and this association is much more complex that it appears to be. Therefore, the main purpose of the current study was to understand how loneliness is associated with satisfaction, and whether self-esteem and educational involvement in the University of the Third Age (U3A) courses can affect this relationship among elderly people.

Methods

The research was conducted on a group of 179 elderly adults (65% women). We measured loneliness, satisfaction, and self-esteem. The data were collected via the paper-and-pencil format through convenience sampling, just before the COVID-19 pandemic began.

Results

The results obtained show that loneliness correlated negatively with self-esteem and life satisfaction. Self-esteem was associated positively with life satisfaction. Self-esteem acted as a suppressor between loneliness and life satisfaction. The participation of older adults in U3A moderated the strength of the relationship between loneliness and life satisfaction (direct effect) and between loneliness and life satisfaction mediated by self-esteem (indirect effect).

Conclusion

The mediatory role of self-esteem and the moderating role of educational activities in the relationship between loneliness and life satisfaction in late adulthood have important developmental and social implications. It appears that although feelings of loneliness and social isolation have a negative association on the life satisfaction of older adults, this relationship may be altered by empowering seniors’ self-esteem through their involvement in lifelong learning. Such a solution supports the functioning of older people also at the social level.

An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness

Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (vs. passive) and approach-oriented (vs. avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles, and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.

Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0-18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0-15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = -0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = -0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults' social networks, and these moderating effects vary between rural and urban China.

Related risk factors associated with post-stroke fatigue: a systematic review and meta-analysis

BACKGROUND

Post-stroke fatigue (PSF) is one of the most common complications of stroke and has a negative impact on quality of life over time. Although several therapeutic approaches have been explored in the last decade, the risk factors responsible for the occurrence of PSF are still largely unknown.

OBJECTIVE

The aim of this meta-analysis was to identify the risk factors contributing to PSF, especially clinical and social risk factors, which may help to prevent PSF.

METHODS

A systematic literature search was performed with PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception until April 2019. Only original studies measuring the association between potential risk factors and PSF were included. All relevant data the included studies were extracted by two independent reviewers using predefined data fields.

RESULTS

Fourteen studies (n = 3933) were included in this meta-analysis. Female (OR = 1.39; p < 0.01), thalamus (OR = 1.76; p = 0.02), leucoaraiosis (OR = 1.73; p < 0.01), NIHSS score (OR = 1.16; p < 0.01), modified Rankin Scale (OR = 1.63; p < 0.01), depression (OR = 1.75; p < 0.01), and sleeping disturbances (OR = 2.01; p < 0.01) were all significantly associated with PSF. In the subgroup analysis, depression (OR = 2.75; p < 0.01) tended to be associated with Asian patients with PSF. For patients who had a stroke survive for more than half a year, PSF was more likely to occur in stroke survivors with depression (OR = 1.46; p < 0.01), anxiety (OR = 1.13; p < 0.01), or sleeping disturbances (OR = 1.98; p < 0.01).

CONCLUSION

Despite some limitations, this study first identified that female and depression conferred an increased susceptibility to PSF, regardless of whether in European or Asian populations. Risk factors associated with PSF included female, thalamic, leucoaraiosis, depression, sleeping disturbances, diabetes mellitus, and anxiety. This meta-analysis shows that chronic PSF appears to be largely attributable to patients with multiple comorbidities. It is necessary to strengthen the treatment for stroke-related complications and improve stroke patient care, which could help to reduce the incidence of PSF.

TRIAL REGISTRATION

CRD42019128751.

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.

Threats to Belonging-Stressful Life Events and Mental Health Symptoms in Aging Men-A Longitudinal Cohort Study

Objectives: Stressful life events, especially relationship events, are frequent in adult life. We investigated the impact of a variety of stressful life events on symptoms of depression, anxiety, and hostility. Methods: We analyzed data from a large prospective cohort study of men (n = 1,437) in the Boston area (assessed in 1985, 1988, and 1991). Main outcomes were measures of depression, anxiety and hostility symptoms. We used the Elders Life Stress Inventory (ELSI) to measure stressful life events in the past 12 months and examine their association with symptoms of depression, anxiety and hostility. First, we analyzed the association of stressful life events with symptom changes; second, we categorized stressful life events into finance/work, health, relationships, loss, living situations events; and third, we estimated the specific association between relationship events and depression, anxiety and hostility symptoms using multilevel models. Results: The most frequent stressful life events were health, relationship, and financial events. Depression, anxiety, and hostility symptoms were relatively stable among men who did not experience these life events. However, those who reported life events in the past 12 months had a greater increase in symptoms of depression (+0.05; 95% CI: 0.01 to 0.10) and of hostility (+0.05; 95% CI: 0.01 to 0.09) than those who did not. Additionally, we found a significant decrease in hostility (-0.05; 95% CI: -0.08 to -0.01) in those experiencing no life events. Conclusion: Relationship events were more important than any other type of events, and were significantly associated with increased depression and hostility in aging men. Although the effects were small, the results point to a need to understand better the impact of relationships on psychopathology in the aging population.

The caregiving dyad: Do caregivers' appraisals of caregiving matter for care recipients' health?

Caregiving experiences matter for caregivers' own wellbeing, but few studies link caregivers' burden and benefit perceptions with recipient outcomes. Following the stress process model, I prospectively explore how caregivers' experiences shape recipients' mental health. I match US National Health and Aging Trends Study and National Study of Caregivers, employing logistic regression on 781 older adult-informal caregiver dyads. I examine how caregivers' appraisals shape recipients' subsequent depression and anxiety, with caregiver mental health and recipient unmet care need as key covariates. Recipients receiving care from caregivers reporting predominantly benefits are less likely to become depressed than counterparts receiving care from persons reporting predominantly burden. Recipients receiving care from persons reporting benefits even alongside low or moderate burden are also less likely to become anxious. Recipient unmet care need, but not caregiver mental health, is associated with recipient mental health. Improving caregiver conditions may have benefits for both dyad members.

The influence of mastery on mother's health in middle years: Moderating role of stressful life context

Using data from 416 middle-aged mothers gathered over the course of a decade, this study examined the influence of mastery trajectories (the initial level and change), on change in physical health. Mastery is defined as one's ability to control and influence his/her life and environment to reach a desired outcome or goal. Both the initial level and change in mastery from 1991 to 1994 were associated with decreased physical health problems over the middle years (1991-2001). Contextual moderation of this association by stressful life contexts including negative life events and work-family conflict was investigated. Moderation analysis showed that under conditions of low contextual life stressors, the level and increase in mastery significantly contributed to decreases in physical health problems in middle-aged mothers. Alternatively, conditions of high contextual life stressors inhibited the ability of mastery to influence physical health of mothers, suggesting that the positive health impact of mastery on physical health is mitigated by stressful life experiences. Implications for the need to maintain important personal resources, such as mastery, during times of stress are discussed.

How did older adults respond to challenges after an earthquake? Results from a qualitative study in Iran

OBJECTIVES

In many areas, natural disasters are a major challenge for life and property of people. Earthquake is one of the most devastating natural disasters. This study aimed to explore how older adults responded to challenges after the earthquake in Iran.

METHODS

This study was based on qualitative analysis. Data were collected through in-depth and semi-structured interviews. 29 participants including 18 older adult survivors of the earthquake-stricken areas, four lay caregivers, and three health professionals in disasters, one social worker, two relief worker and one disaster psychologist were interviewed. The interviews were recorded and transcribed. The transcribed texts were analyzed using inductive qualitative content analysis recommended by Graneheim and Lundman (2004).

RESULTS

The study explored two main categories regarding older adults' responses to challenges after the earthquake: adaptive and maladaptive responses. Adaptive response has been developed by four factors including; religious coping, sharing feelings and information, coping with new activities, roles and place. Also, maladaptive response was included; the lack of motivation to search for relief supplies, undue dependency, and decrease of social activities.

CONCLUSION

Service providers are recommended to identify the patterns of vulnerability and cultural sensitivities in older adults' responses to manage the negative consequences of disasters on older adults. Furthermore, older adults can make a substantial contribution in recovery programs based on the adaptive responses, such as helping in the rescue efforts and psychological support from family and community after disasters.

Antecedents and Outcomes of Uncertainty in Older Adults With Cancer: A Scoping Review of the Literature

PROBLEM IDENTIFICATION

Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential. 
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LITERATURE SEARCH

MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging. 
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DATA EVALUATION

Extracted data included research aims; research design or analysis approach; sample size; mean age; type, stage, and duration of cancer; type and duration of treatment; uncertainty scale; and major results. 
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SYNTHESIS

Of 2,584 articles initially identified, 44 studies (30 qualitative, 12 quantitative, and 2 mixed-methods) were included. Evidence tables were developed to organize quantitative and qualitative data. Descriptive numeric and thematic analyses were used to analyze quantitative results and qualitative findings, respectively. Outcomes were reported under four main categories.

CONCLUSIONS

Uncertainty is an enduring and common experience in cancer survivorship. Uncertainty is affected by a number of demographic and clinical factors and affects quality of life (QOL) and psychological well-being. 
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IMPLICATIONS FOR PRACTICE

Uncertainty should be considered a contributing factor to psychological well-being and QOL in older adults with cancer. Nurses are in a unique position to assess negative effects of uncertainty and manage these consequences by providing patients with information and emotional support.

Coping strategies in Spanish older adults: a MIMIC model of socio-demographic characteristics and activity level

OBJECTIVES

The aim of this study was to analyze the combined effect of socio-demographic characteristics and activity level on coping strategies and to test which of these variables has a greater impact on coping.

METHOD

A sample of 243 men and women aged 55-99 years old was selected from different elderly activity centers in Granada, Spain, using a convenience sampling. Associations between eight coping strategies measured by Coping Strategies Inventory and the above mentioned variables were examined using a Multiple Indicator and Multiple Causes model.

RESULTS

Age was negatively related with problem solving, express emotions and social support. Activity level was positively related with problem solving, cognitive restructuring, express emotions and social support and it was negatively associated with social withdrawal. Gender only predicted the scores in self-criticism and living alone was related with higher emotional expression. Participation in creative activities, attending University for the third age and practicing physical exercise were related with differences in the use of several coping strategies.

CONCLUSIONS

There is a complex relationship between socio-demographic characteristics, activity level and the coping strategies used by the elderly. It is important to understand this relationship in order to identify older adults who use ineffective coping, and to subsequently include them in intervention programs to improve their coping abilities.

Dispositional and situational coping among individuals with alcohol use disorder

Previous research has documented that patients referred for problems related to alcohol use rely primary on maladaptive coping and are deficient in adaptive coping skills. However, the relation between dispositional and situational coping in these patients is not yet fully understood. Therefore, the first aim of the present study was to assess dispositional and situational coping among individuals with alcohol use disorder compared to matched healthy controls. Furthermore, we aimed at assessing gender differences in dispositional and situational coping among individuals with alcohol use disorder. Fifty-five patients with alcohol use disorder were compared to 55 age, years of education, and gender-matched healthy volunteers. Participants filled out the Coping Orientation to Problem Experiences-New Italian version assessing dispositional coping and the Coping Responses Inventory - Adult Form assessing situational coping. Regarding dispositional coping, patients with alcohol use disorder employed more avoidant coping styles compared to matched healthy controls. No differences between groups emerged on situational coping. With respect to gender differences in dispositional coping, women, regardless of group membership, employed more coping styles aimed at construing a stressful transaction in positive terms and turned to religion more relative to men. With respect to situational coping, women, again regardless of group membership, employed more strategies aimed at construing a stressful transaction in positive terms and more problem-solving strategies compared to men. Results of the present study may assist with treatment planning for alcohol use disorder and lead to the development of treatment programs targeting patients' specific coping difficulties.

Depression and infrequent participation in social activities among older adults: the moderating role of high-quality familial ties

OBJECTIVES

The primary objective of this study is to investigate whether depression is associated with reduced participation in social activities among older adults. Additionally, this study assesses whether high-quality familial ties diminish the negative association between depression and social activities.

METHODS

Using cross-sectional telephone interview data from a sample of individuals 60 years of age and older in Arizona and Florida (N = 2000), this study estimates a series of linear regression models to assess the relationship between depression and social activities, and test whether this association is conditioned by high-quality familial ties using multiplicative interaction terms.

RESULTS

As expected, an inverse relationship between depression and social activities is observed. Delving deeper, the regression models reveal that the depression-inactivity association is weaker among older individuals with strong, positive ties to spouses and children. Additional tests demonstrate the mere of existence of familial bonds provides no meaningful benefit - the quality of such ties matters.

CONCLUSION

Findings support the theoretical argument that high-quality familial ties provide supportive coping resources that buffer individuals from the undesirable consequences associated with depression. Moving forward, longitudinal research on the causal links between depression and infrequent participation in social and leisure activities among older adults is warranted.

Coping: Impact of Gender and Stressful Life Events in Middle and in Old Age

OBJECTIVES

This study seeks to identify different life events that participants considered stressful and to study the joint effect of gender, age group, and main stressful life events on the use of different coping strategies.

METHODS

The sample comprised 243 men and women, 55 to 99 years old, who attended senior activity centers. Analyses were conducted using multivariate analysis of variance (MANOVA).

RESULTS

Three main categories of stressful life events were identified: health problems, family problems, and other problems. Significant main effects of gender and stressful life events, and marginal effects of age group on coping strategies were found. Furthermore, an interaction between gender and age group, and also between gender and stressful life events emerged in some of the coping strategies analyzed.

CONCLUSIONS

Age, gender or type of stressful situation impact on the coping strategies used by older people. Older men and women were found to use different strategies depending upon the situation they are facing and upon their age group. The results may prove useful to practitioners and clinicians who directly work with older people and may help clinicians provide effective coping strategies to address the specific life events that older adults find stressful.

The Stressors and Coping Strategies of Older Adults With Persistent Atrial Fibrillation Prior to and Following Direct Current Cardioversion

Objective:The purpose of this study was to explore the stressors and coping strategies of older adults with persistent atrial fibrillation (AF) before and after direct current cardioversion. Method: The study used a qualitative descriptive design. Sixteen patients were recruited through an AF clinic to participate in individual interviews prior to the cardioversion and at 6 and 12 weeks post procedure. Results: Pre-cardioversion, older adults experienced symptom and health care–related stressors superimposed on existing non-AF stressors. They used a range of emotion and problem-focused coping. Non-AF stressors increased post procedure at the same time that participants perceived less need for coping strategies with a return to regular rhythm. Discussion: There was a shift from AF to non-AF related stressors following the cardioversion but a decrease in coping strategies. Older adults with AF should be encouraged to maintain use of coping strategies to manage ongoing stress and reduce the risk of AF recurrence.

Have I Ever Done Anything Like This Before? Older Adults Solving Ill-Defined Problems in Intensive Volunteering

This study examined the ways in which individuals over 50 years old solved problems while volunteering in intensive humanitarian and disaster relief service. Thirty-seven men and women in the sample were sponsored by three religious organizations well known for providing humanitarian and disaster relief service. Semistructured interviews yielded data that were analyzed qualitatively, using McCracken's five-step process for analysis. We found that volunteers used three different abilities to solve problems: drawing upon experience to create strategies, maintaining emotional stability in the midst of trying circumstances, and applying strategies in a context-sensitive manner. These findings illustrate that these factors, which are comparable to those used in solving everyday problems, are unique in the way they are applied to intensive volunteering. The volunteers' sharing of knowledge, experience, and support with each other were also noticeable in their accounts of their service. This sharing contributed strongly to their sense of emotional stability and effectiveness in solving problems.

Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke

Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

Changes and events over life course: a comparative study between groups of older adults

OBJECTIVE

to identify the changes which had occurred over the last year in the life of older adults, as well as the values attributed to these changes.

METHOD

this is a multicentric, cross-sectional study, of the inquiry type, undertaken in three cities of the Brazilian Northeast, investigating two distinct groups of older adults.

RESULTS

among the 236 older adults interviewed, it was observed that 30.0% reported health as the main change in their life course in the last year, this category being the most significant response among the older adults aged between 80 and 84 years old (37.7%). Changes in the family were mentioned by 11.5% of the older adults; death (9.6%) and alterations in routine activities (9.6%). In relation to the value attributed to these changes, it was ascertained that for 64.7% of the older adults aged between 65 and 69 years old, these changes were positive. In the older group, 49.4% of the older adults believe that their changes were related to losses.

CONCLUSION

the knowledge of the changes mentioned, the value attributed to these changes, and the self-evaluation of health provide information which assists in formulating actions which are more specific to the real needs of these age groups. They also provide the health professionals with a better understanding of how some experiences are experienced in the life trajectories of these older adults.

Subcortical white matter infarcts predict 1-year outcome of fatigue in stroke

Background

Fatigue is common in stroke survivors. Lesion location may influence the risk of poststroke fatigue (PSF) but it is uncertain whether location has an impact on the prognosis of PSF. This study examined the association between PSF outcome and infarct location.

Methods

The study sample comprised 435 Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university affiliated regional hospital in Hong Kong. Three and fifteen months after the onset of the index stroke a research assistant administered the Fatigue Severity Scale (FSS). PSF was defined as a FSS score of 4.0 or above. Of the 139 patients with PSF three months poststroke, 97 (69.8%) attended the 15-month follow-up, when 50 (51.5%) patients still had PSF (‘non-remitters’) and 47 (48.5%) did not report fatigue (‘remitters’). The presence and location of infarcts were evaluated with magnetic resonance imaging.

Results

In comparison with the remitters, the non-remitters were more likely to have subcortical white matter infarcts (40.0% vs 21.3%, p = 0.046). These infarcts remained an independent predictor of non-remission of PSF in the multivariate analysis, with an odds ratio of 4.208 (p = 0.011).

Conclusions

The results suggest that subcortical white matter infarcts may influence the outcome of PSF. Further investigations are needed to explore whether infarcts have any impact on the response of PSF to pharmacological or psychological interventions.

Worry and Depression in the Old and Young: Differences and Mediating Factors

Objective: This study examined whether differences in habitual negative self-thinking and coping strategies might contribute to the age differences in worry and depression. Method: 60 undergraduate students (age range: 18–24 years, M = 19.10, SD = 1.3) and 45 community-dwelling older adults (age range: 60–89 years, M = 73.5, SD = 7.5) participated. Participants completed self-report measures of worry, depression, negative self-thinking, and coping styles. Results: We replicated previous findings that older adults were less worried and less depressed than younger adults. Older adults also reported engaging in less habitual negative thinking and using more problem solving as a coping strategy than younger adults. Furthermore, negative self-thinking and problem-solving skills were found to partially mediate age differences in worry and fully mediate depression scores. Conclusions: These results suggest that habitual negative thinking and problem-solving skills play a role in explaining the lower rates of worry and depression in older populations.

Increases in alcohol consumption in women and elderly groups: evidence from an epidemiological study

BACKGROUND

In most Western countries, alcohol consumption continues to increase, specifically among women and older adults. Insight into these trends may aid intervention strategies. Here we present data on alcohol consumption by age and sex as well as associations between alcohol use and demographic lifestyle/traits. The data are from a large (N>16,000) population-based Dutch sample, ascertained based on the presence of twins in the family.

METHODS

A set of 16 indicators of normative and problematic alcohol use was assessed in participants of the Netherlands Twin Register between 2009-2012 (ages 18-97; 6,052 men; 10,535 women). Alcohol consumption and demographic/lifestyle traits, including educational attainment, work-related/financial stress, urbanization, religiousness, smoking/cannabis initiation, and BMI were described by age and sex. Associations were examined by regressing aspects of alcohol use on age, sex, their interaction, and demographic/lifestyle variables.

RESULTS

Age, sex, and initiation of cigarette and cannabis use were the most important predictors of alcohol use. Frequency of alcohol use was lowest between 18-25 years, with 3.2% of men and .6% of women drinking 6-7 times/week, and highest above age 65 years, with 30.6-32.7% of men and 20.2-22.0% of women drinking 6-7 times/week. Women consumed the lowest quantities of alcohol between 25-45 years, with a 5.7-5.9% prevalence of excessive drinking (>14 glasses/week), and the largest quantities between 55-65 years (15.5% excessive drinkers). Age at alcohol initiation, onset of regular drinking, and first alcohol intoxication were lowest between ages 18-25 years and highest above age 65 years. Among older participants, men initiated alcohol use and regular drinking earlier, and had lower age at first intoxication than women, but among young adults, no sex differences were observed.

CONCLUSIONS

Alcohol consumption was high in the elderly Dutch population, especially among women. Alcohol initiation, onset of regular drinking, and first alcohol intoxication occur at increasingly younger ages, and the previous gap between men and women in age at alcohol initiation, onset of regular drinking, and first alcohol intoxication has closed almost entirely. Heavy alcohol use was most strongly predicted by older age, sex (male), and initiation of smoking and cannabis use.

Patient perspectives on the benefits of psychotherapy for late-life depression

OBJECTIVES

The future of psychotherapy research lies in the development of easy-to-use, efficient treatments that target specific characteristics and needs of patients with a given disorder. Meeting this aim will involve understanding why people seek psychotherapy and the therapeutic features that they feel are most helpful in their recovery. Identifying key features of treatment that patients feel lead to improvement may help identify the active ingredients of psychotherapy and further refine treatment.

DESIGN

We selected 22 older adults who participated in a larger randomized trial of psychotherapy for late-life depression to participate in individual, semistructured qualitative interviews.

SETTING

Interviews took place at the University of California, San Francisco or in the participant's home.

PARTICIPANTS

All participants were age 60 years or older with major depression and co-occurring executive dysfunction.

MEASUREMENTS

Participants were asked about their depression experience, their expectations for treatment, most and least helpful aspects of treatment, effects of treatment, and recommended improvements to treatment. Data were transcribed, coded, and analyzed using NVivo (QSR International, Cambridge, MA).

RESULTS

The most commonly noted causes for seeking treatment were depression related to interpersonal relationships, health conditions, grief/loss, finances, housing, and challenges due to executive dysfunction. Participants had few expectations about treatment and they found support, the problem-solving therapy process, and focus on interpersonal relationships to be the most helpful processes in treatment.

CONCLUSION

Suggestions for psychotherapy include increasing the number of sessions, discussing problems in a more proactive way, and considering participant choice in treatment. This research demonstrates the value of mixed-methods approaches, in that qualitative approaches assist in contextualizing and interpreting quantitative data.

The moderating effect of the negative impact of recent life events on the relation between intrinsic religiosity and death ideation in older adults

Researchers tested the hypothesis that the negative impact of recent life events would moderate the relationship between intrinsic religiosity and death ideation in older adults. Participants (n = 272) completed assessments of death ideation, intrinsic religiosity, and negative impact of recent life events. We confirmed the presence of concurrent moderation and found that older adults with greater negative impact of recent life events and high intrinsic religiosity reported greater death ideation. These relatively surprising findings may be due to reduced fear of death in intrinsically religious older adults, an explanation consistent with previous research.

Ecosystem focused therapy in poststroke depression: a preliminary study

OBJECTIVE

Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the ecosystem focused therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the "psychosocial storm" of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy.

DESIGN

A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks.

RESULTS

Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability.

CONCLUSION

These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.

Coping with negative life events in old age: the role of tenacious goal pursuit and flexible goal adjustment

OBJECTIVE

This study examines the relationships between negative life events and tenacious goal pursuit (TGP) and flexible goal adjustment (FGA), two fundamental modes of self-regulation suggested by Brandtstädter, and their effects on mental health.

METHODS

TGP/FGA, negative life events and depression were assessed in 670 elderly people living in the community. Hierarchical regressions were carried out to examine the effects of the two self-regulation modes and negative life events on depression.

RESULTS

Findings demonstrate the role of TGP and FGA in coping with negative life events. While both FGA and TGP were related to depression, FGA was found to have beneficial effects for the participants who had encountered negative life events. With age, people become less tenacious, but no conclusive relationship was found between flexibility and age.

DISCUSSION

Our findings support the importance of both modes of coping for the mental health of older adults. In particular, the ability to adjust goals was shown to be critical as a way of preventing the development of depressive symptoms following negative life events.

Coping trajectories in later life: a 20-year predictive study

OBJECTIVES AND METHOD

Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults' (n = 719; baseline M = 61 years) 20-year, intraindividual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories.

RESULTS

Over the 20-year study interval, participants declined in the use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms, and fewer financial resources were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant.

CONCLUSION

Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults' stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle-age.

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.

Aging and disability: biopsychosocial perspectives

Understanding the complex trajectories of disability and aging requires a biopsychosocial approach that considers disability in the broader context of later adulthood. Although disability service researchers and gerontologists have many shared interests and a similar mission, the fields are relatively new to one another and have had little historical interaction. The purpose of this article is to increase and improve collaboration among investigators in these fields by providing some background in social gerontology to the disability researcher, and by applying key theories in aging to the issue of growing older with physical disability. The article discusses particular problem areas for older adults, including social support, and also discusses the parallel paradoxes of aging and disability.