Exploring Subjective Well-being in Older Age by Using Participant-generated Word Clouds

Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease

The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.

What makes older adults feel good?

BACKGROUND AND AIM

To inform health promotion interventions, there is a need for large studies focusing specifically on what makes older adults feel good, from their own perspective. The aim was to explore older adults' views of what makes them feel good in relation to their different characteristics.

METHODS

A qualitative and quantitative study design was used. Independently living people (n = 1212, mean age 78.85) answered the open-ended question, 'What makes you feel good?' during preventive home visits. Following inductive and summative content analysis, data was deductively sorted, based on The Canadian model of occupational performance and engagement, into the categories leisure, productivity, and self-care. Group comparisons were made between: men/women; having a partner/being single; and those with bad/good subjective health.

RESULTS

In total, 3117 notes were reported about what makes older adults feel good. Leisure activities were the most frequently reported (2501 times), for example social participation, physical activities, and cultural activities. Thereafter, productivity activities (565 times) such as gardening activities and activities in relation to one's home were most frequently reported. Activities relating to self-care (51 times) were seldom reported. There were significant differences between men and women, having a partner and being single, and those in bad and good health, as regards the activities they reported as making them feel good.

DISCUSSION AND CONCLUSIONS

To enable older adults to feel good, health promotion interventions can create opportunities for social participation and physical activities which suit older adults' needs. Such interventions should be adapted to different groups.

The hidden stigma of aging and COVID-19: aggravating factors and strategies to mitigate the impact of the pandemic in older adults, a text mining analysis

OBJECTIVE

To identify factors associated with mental health of older adults during the pandemic and to provide strategies to mitigate their psychosocial impact in the elderly.

METHOD

An integrative text mining analysis in Medline was performed to identify studies on the mental health of older adults during the pandemic. Subsequently, statistical topic modeling was performed to identify the most prevalent terms and topics discussed in included studies.

RESULTS

A total of 29 studies were retrieved until July 1st 2020, including a majority of letters (12 studies) and commentaries (8 studies). The most frequent terms overall were: loneliness (n = 137), support (n = 132), home (n = 102), suicide (n = 96) and help (n = 94). The most prevalent terms were then divided in five topics: home (33%), suicide (32%), apps (15%), loneliness (12%) and physical activity (9%). Additionally, a section focused on low- and middle-income countries was included. A summary of strategies to mitigate the effects of pandemic in mental health of older adults was also provided.

CONCLUSION

These factors demonstrate the importance of developing strategies for psychosocial support that take into consideration the particularities of the elderly. Different levels of care are immediately necessary to diminish the devastating impact of the pandemic in the mental health of older adults.

Predictors of resilience in older adults with lower limb osteoarthritis and persistent severe pain

BACKGROUND

Resilience refers to the process in which people function well despite adversity. Persistent severe pain may be considered an adversity in people with lower limb osteoarthritis (LLOA). The objectives of this study are: (1) to identify what proportion of older adults with LLOA and persistent severe pain show good functioning; and (2) to explore predictors of resilience.

METHODS

Data from the European Project on OSteoArthritis (EPOSA) were used involving standardized data from six European population-based cohort studies. LLOA is defined as clinical knee and/or hip osteoarthritis. Persistent severe pain is defined as the highest tertile of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index both at baseline and follow-up. Resilience is defined as good physical, mental or social functioning at follow-up despite having LLOA with persistent severe pain.

RESULTS

In total, 95 (14.9%) out of 638 individuals with LLOA had persistent severe pain. Among these, 10 (11.0%), 54 (57.4%) and 49 (53.8%) had good physical, mental and social functioning, respectively. Only 4 individuals (4.5%) were resilient in all three domains of functioning. Younger age, male sex, higher education, higher mastery, smoking and alcohol use, higher physical activity levels, absence of chronic diseases, and more contacts with friends predicted resilience in one or more domains of functioning.

CONCLUSIONS

Few people with LLOA and persistent severe pain showed good physical functioning and about half showed good mental or social functioning. Predictors of resilience differed between domains, and might provide new insights for treatment.

How is your life? understanding the relative importance of life domains amongst older adults, and their associations with self-perceived COVID-19 impacts

Purpose

This study aims to provide new knowledge on the relative importance of key life domains amongst older adults, and how the Coronavirus pandemic has influenced their life (domain) satisfaction.

Methods

A cross-sectional survey was administrated to an online panel of the general public aged 65 years and older in Australia from 28 April to 26 May 2020. Life satisfaction was measured by the Personal Wellbeing Index (PWI, including both global life satisfaction and life domain satisfaction). A discrete choice experiment technique was used to elicit how respondents perceive the relative importance of six key life domains drawn from the PWI: standard of living, health, relationships, safety, community connectedness, and future security.

Results

A total of 1,056 respondents (53% female) with a mean (range) age of 73 (65–91) years old completed the survey. After controlling for a rich set of confounding factors, regardless of the choice of overall life satisfaction indicators, there were consistent findings that the strongest negative influence of COVID-19 on life domains and decrements on life satisfaction was for Personal Health, Personal Relationships and Standard of Living. The DCE data revealed that all six life domains were statistically significant in contributing to a better life, and there exists some preference heterogeneity between those who perceived no impact versus negative impacts from COVID-19.

Conclusions

From both revealed and stated preference data there was robust evidence that health, relationships, and standard of living represent the three most important life domains for older adults in Australia.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-03043-5.

"Post-lockdown Depression": Adaptation Difficulties, Depressive Symptoms, and the Role of Positive Solitude When Returning to Routine After the Lifting of Nation-Wide COVID-19 Social Restrictions

OBJECTIVES

The aim of the current study was to identify difficulties in adapting to normal life once COVID-19 lockdown has been lifted. Israel was used as a case study, as COVID-19 social restrictions, including a nation-wide lockdown, were lifted almost completely by mid-April 2021, following a large-scale vaccination operation.

METHODS

A sample of 293 mid-age and older Israeli adults (M age = 61.6 ± 12.8, range 40-85 years old) reported on return-to-routine adaptation difficulties (on a novel index), depression, positive solitude, and several demographic factors.

RESULTS

Of the participants, 40.4% met the criteria of (at least) mild depressive symptoms. Higher levels of adaptation difficulties were related to higher ratios of clinical depressive symptoms. This link was moderated by positive solitude. Namely, the association between return-to-routine adaptation difficulties and depression was mainly indicated for individuals with low positive solitude.

CONCLUSIONS

The current findings are of special interest to public welfare, as adaptation difficulties were associated with higher chance for clinical depressive symptoms, while positive solitude was found to be as an efficient moderator during this period. The large proportion of depressive symptoms that persist despite lifting of social restrictions should be taken into consideration by policy makers when designing return-to-routine plans.

A healthy view? exploring the positive health perceptions of older adults with a lower socioeconomic status using photo-elicitation interviews

Purpose: The health perceptions of older adults with a lower socioeconomic status still seems to be unsettled. To gain more insight in these perceptions, 19 older adults were interviewed with the use of a photo-elicitation method.Methods: Participants reflected on ten photographs covering aspects of physical, social and mental health, and were also asked if and how they experience to have control over their health.Results: The results showed that the perception of health depended on the background of the participant, was experience-oriented and was mostly focused on the negative aspects of physical and mental health. Social contacts were an important contributor to well-being, especially when physical health declined. Although most participants seem hardly aware of having influence on their own health, several participants showed automatic self-management abilities.Conclusion: For participants who need more support to improve, or become more aware of their self-management abilities, interventions with an experience-oriented approach are needed.

Content validation of the Well-being of Older People measure (WOOP)

BACKGROUND

Valid measures of the well-being of older people are important for the evaluation of health and social care services. The nine-item Well-being of Older People measure (WOOP) was based on a novel framework derived from a recent Q-methodology study, and was developed to capture a comprehensive set of well-being domains relevant to older people, as identified by themselves. This study introduces the WOOP and describes the qualitative assessment of its feasibility and content validity.

METHODS

Between December 2017 and January 2018, a sampling agency retrieved data from 269 adults aged 65 years and older in the Netherlands. Using an online survey, participants were asked to complete the WOOP and to indicate the importance of each item to their well-being. Open-ended questions were used to collect information about participants' own definition of well-being, their interpretation of the items of the WOOP, and their assessment of the descriptions and response options provided with each item. Data were analysed using inductive content analysis with the software package ATLAS.ti.

RESULTS

The WOOP closely resembled respondents' own description of what well-being means to them. The majority of the respondents reported no important well-being aspects to be missing from the WOOP, and indicated all WOOP items to be at least 'reasonably important' to their well-being. Many linked the WOOP items to well-being aspects as intended, and only a few had suggestions for improving the items' descriptions and response options.

CONCLUSIONS

Given these results, all nine items were retained, and no items were added to the measure. Based on respondents' feedback, minor changes were made to the wording of some descriptions and response options of items. Concluding, the feasibility and content validity of the WOOP seem satisfactory. Further validation of this new measure is required, in different health and social care settings and among subgroups of older people with potentially different views on what constitutes well-being.

A Closer Look at Loneliness: Why Do First-Generation Migrants Feel More Lonely Than Their Native Dutch Counterparts?

Background and Objectives

Along with the current aging demographics in the Netherlands, the number of older first-generation migrants is also increasing. Despite studies suggesting a higher quantity of social contacts of migrants, loneliness is more common among migrants as compared to native Dutch. We theorize that migrants experience more emotional and social loneliness due to a lower satisfaction with social relationships and lower participation in social activities, respectively, compared to their native counterparts.

Research Design and Methods

We use data from Statistics Netherlands (N = 7,920) with first-generation migrants aged 40 years and older and their Dutch counterparts. Contact frequency, household composition, satisfaction with social relationships, relationship quality with the partner, and social activities, are used as main predictors and separate regression models for social and emotional loneliness are analyzed.

Results

Compared to the native Dutch, first-generation migrants are both socially and emotionally more lonely. Migrants have a similar contact frequency as the native Dutch, but are less satisfied with their social relationships, which contributes to their higher emotional, social, and overall loneliness. Migrants engage less in social activities but this does not put them at additional risk of loneliness.

Discussion and Implications

Migrants experience more social and emotional loneliness and are less satisfied with their social relationships compared to their native counterparts. Interventions should focus on reducing both social and emotional loneliness among older migrants. Specific attention should be paid to fostering satisfying social interactions. Additionally, encouraging migrants to broaden their social network may reduce social loneliness.

Community singing, wellbeing and older people: implementing and evaluating an English singing for health intervention in Rome

Aim:

The aim of this research was to explore the transferability and effectiveness of the English Silver Song Clubs model for older people in a different social and cultural context, that is, in the capital city of Italy, Rome.

Methods:

A single condition, pretest, post-test design was implemented. Participants completed the following two questionnaires: EuroQoL-5 Dimension (EQ-5D) and York Short Form (SF)-12.

Results:

After the singing experience, participants showed a decrease in their levels of anxiety and depression. An improvement was also found from baseline to follow-up in reported performance of usual activities. The English study showed a difference between the singing and non-singing groups at 3 and 6 months on mental health, and after 3 months on specific anxiety and depression measures. This study (Rome) shows similar findings with an improvement on specific anxiety and depression items.

Conclusion:

Policy makers in different national contexts should consider social singing activities to promote the health and wellbeing of older adults as they are inexpensive to run and have been shown to be enjoyable and effective.

Successful Aging and Personal Well-Being Among the Chilean Indigenous and Non-Indigenous Elderly

Objective: The aim of this research was to analyse the association between successful aging (SA) and subjective well-being (SWB) in different domains. Method: The study is quantitative and cross-sectional, with a sample consisting of 800 older people, including 569 indigenous (Aymara and Mapuche) participants living in northern and southern Chile. Results: Domains associated with SA are satisfaction with health, satisfaction with social relationships, satisfaction with future security, and satisfaction with spiritual and religious experiences. SA is also positively associated with being a woman, being young, and not being indigenous. Conclusion: The research has two main practical implications. First, SWB domains may be incorporated into socio-health interventions as they relate to elements that can be changed or improved (health, social inclusion, security, and beliefs). Second, this study suggests a situation of risk among older indigenous Chileans, confirming the premise that the life paths of indigenous Chileans at social risk give rise to a more socially unequal old age with; therefore, it is important to analyse positive aspects that promote better old age.

Goals of older hospitalised patients: a qualitative descriptive study

OBJECTIVES

Since the population continues ageing and the number of patients with multiple chronic diseases is rising in Western countries, a shift is recommended from disease oriented towards goal-oriented healthcare. As little is known about individual goals and preferences of older hospitalised patients, the aim of this study is to elucidate the goals of a diverse group of older hospitalised patients.

DESIGN

Qualitative descriptive method with open interviews analysed with inductive content analysis.

SETTING

A university teaching hospital and a regional teaching hospital.

PARTICIPANTS

Twenty-eight hospitalised patients aged 70 years and older.

RESULTS

Some older hospitalised patients initially had difficulties describing concrete goals, but after probing all were able to state more concrete goals. A great diversity of goals were categorised into wanting to know what the matter is, controlling disease, staying alive, improving condition, alleviating complaints, improving daily functioning, improving/maintaining social functioning, resuming work/hobbies and regaining/maintaining autonomy.

CONCLUSIONS

Older hospitalised patients have a diversity of goals in different domains. Discussing goals with older patients is not a common practice yet. Timely discussions about goals should be encouraged because individual goals are not self-evident and this discussion can guide decision making, especially in patients with multimorbidity and frailty. Aids can be helpful to facilitate the discussion about goals and evaluate the outcomes of hospitalisation.

What does quality of life mean to older adults? A thematic synthesis

BACKGROUND

Consideration of older adults' quality of life (QoL) is becoming increasingly important in the evaluation, quality improvement and allocation of health and social care services. While numerous definitions and theories of QoL have been proposed, an overall synthesis of the perspective of older adults themselves is lacking.

METHODS

Qualitative studies were identified in PubMed, Ebsco/Psycinfo and Ebsco/CINAHL, through a search on 28 November 2018. Articles needed to meet all of the following criteria: (i) focus on perceptions of QoL, (ii) older adults living at home as main participants, (iii) use of qualitative methodology, (iv) conducted in a Western country and (v) published in English (vi) not focused on specific patient groups. A thematic synthesis was conducted of the selected studies, using the complete 'findings/results' sections from the papers.

RESULTS

We included 48 qualitative studies representing the views of more than 3,400 older adults living at home in 11 Western countries. The QoL aspects identified in the synthesis were categorized into nine QoL domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighbourhood, and financial security. The results showed that although different domains can be distinguished, these are also strongly connected.

CONCLUSION

QoL can be expressed in a number of domains and related subthemes that are important for older adults living at home. The findings further support that the concept of QoL should be seen as a dynamic web of intertwined domains.

A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment

Purpose of the study

We consider the points at which cognitive impairment may impact on the pathway to loneliness for older people, through impeding social interaction with family and friends, or by interfering with judgments concerning satisfaction with relationships.

Design and methods

We conceptualize a mediation model anticipating that social resources (LSNS-6) will mediate the pathway between disability (Townsend Disability Scale) and loneliness (De Jong Gierveld 6-item scale) and a moderated-mediation model in which we hypothesize that cognitive impairment (MMSE) will moderate the association between disability and social resources and between social resources and loneliness. To validate the hypothesized pathways, we draw on the CFAS Wales data set (N = 3,593) which is a nationally representative study of community-dwelling people aged 65 and older in Wales.

Results

Disability had a significant indirect effect on loneliness through the mediating variable social resources. Cognitive impairment was significantly associated with social resources, but did not moderate the relationship between disability and social resources. Cognitive impairment had a significant impact on loneliness, and moderated the effect of social resources on loneliness.

Implications

Social structures can (dis)empower people with cognitive impairment and lead to exclusion from social resources or impact on the social construction of aging, cognitive impairment, and dementia. The sense of self for an older person with cognitive impairment may be influenced by social norms and stereotypes, or through a temporal social comparison with an "earlier" sense of self. We conclude that loneliness interventions should be theoretically informed to identify key areas for modification.