An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods

BACKGROUND

The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water.

DESIGN AND SETTING

This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels.

INTERVENTION

The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES.

MEASURABLE OUTCOMES

Pre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys.

IMPLICATIONS

The results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations.

TRIAL REGISTRATION NUMBER

NCT05395663.

Cohort Differences in PTSD Symptoms and Military Experiences: A Life Course Perspective

BACKGROUND AND OBJECTIVES

There have been major changes in military service over the past 50 years. Most research on posttraumatic stress disorder (PTSD) among combat Veterans comes from help-seeking Vietnam and WWII cohorts; results from more recent cohort comparisons are mixed. The present study addressed these gaps by exploring cohort differences among Vietnam, Persian Gulf, and Post-9/11 combat Veterans from a life course perspective.

RESEARCH DESIGN AND METHODS

We recruited community-dwelling combat and war zone Veterans (N = 167), primarily from Veterans' associations in Oregon from three cohorts: Vietnam, Persian Gulf, and Post-911. Online surveys assessed current PTSD symptoms, life course (demographics and cohort membership), and experiential variables (combat severity, appraisals of military service, homecoming, and social support).

RESULTS

Cohorts were comparable in demographics and war experiences. Step one of a hierarchical regression found that PTSD symptoms were higher among Veterans of color and those with lower incomes, R2 = 0.37, p < .001. When cohort was added, Vietnam Veterans had higher symptoms than Post-9/11; income and race/ethnicity remained significant, ΔR2 = 0.01, p = .13. The final model added experiential variables, ΔR2 = 0.38, p < .001; cohort and income were no longer significant, although Veterans of color still reported higher symptoms. Those with more undesirable service appraisals and who sought social support had higher symptoms, while desirable appraisals were protective.

DISCUSSION AND IMPLICATIONS

From a life course perspective, the particular war zone that Veterans served in was less important than demographics and both service and postservice experiences, suggesting generalizability of risk and protective factors, as well as treatment modalities, across cohorts.

Adaptation to changes in COVID-19 pandemic severity: Across older adulthood and time scales

The COVID-19 pandemic has been observed to negatively affect older adults' psychological health compared with prepandemic levels. However, older adults' coping efficacy may differ depending on their age, and little is known about effects of fluctuations in pandemic severity. Two longitudinal studies tested the hypothesis that pandemic severity would affect psychological health and be moderated by age. In Study 1 (N = 111), older adults (aged 62-96) were assessed semiannually before and after the first United States COVID-19 case over up to 10 years. Depressive symptoms and stress, but not cognitive difficulties, were higher during COVID-19; pandemic severity had little effect. Estimated increases were smaller for a 65-year-old than for an 85-year-old. In Study 2 (N = 221), older adults (aged 51-95) were assessed weekly over up to 8 weeks during the COVID-19 pandemic. Higher national pandemic severity was associated with more cognitive difficulties, more depressive symptoms, and more stress. In an opposite pattern from Study 1, estimated increases were larger for a 65-year-old than for an 85-year-old. Old-old adults might be most susceptible to long-term psychological effects of the pandemic era, as in Study 1, but more resilient to short-term effects, as in Study 2. Coping strategies associated with increasing age may be less efficacious for more chronic and severe problems. Conversely, the same coping strategies may be more efficacious for shorter, less severe problems. Differentiating between reactivity to longer term and shorter term pandemic stressors can identify the most resilient or vulnerable ages within older adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PHYSICAL SYMPTOM TRAJECTORIES OF OLDER ADULTS DURING THE COVID-19 PANDEMIC

Older adults experience increased risk for morbidity and mortality during the COVID-19 pandemic (CDC, 2021). Social distancing and lockdown to prevent contagion may affected physical and mental health. We examined the fifteen physical symptom trajectories of older adults during the early months of the COVID-19 pandemic. We also examined age, gender, and marital status differences in each physical symptom trajectory. The sample consisted of 247 older adults (Mage = 71.1, SD = 7.3, 88.7% White, 73% women, 73.4% married), who participated in eight weekly longitudinal online surveys from April 28 to June 23, 2020. Random-effects logistic regression analysis controlling for age, gender, marital status, and depressive symptoms showed that the nine physical symptoms (headache, constipation/diarrhea, muscle soreness, shortness of breath, tightness of chest, backache, heart pounding, congestion, and sore throat) significantly decreased in the first few weeks, but then six symptoms (constipation/diarrhea, shortness of breath, tightness of chest, heart pounding, congestion, and sore throat) increased in later weeks of the study period. Middle-aged participants reported higher number of headache, tightness of chest, heart pounding, and nausea/upset stomach than older participants. Women experienced more constipation/diarrhea, trembling/shaking, and sore throat than men. Those who were not married responded with higher number of shortness of breath, backache and poor appetite compared to married participants. Higher depressive symptoms were significantly related to each physical symptom. The results suggest that healthcare providers should evaluate physical symptoms focusing on the patients who are at greater risk of poor health during the pandemic.

ARE OLDER ADULTS ABLE TO DRAW UPON PRIOR EXPERIENCES WHEN COPING WITH THE NOVEL COVID-19 STRESSOR?

Despite higher physiological vulnerability to stress, older adults may accumulate resources through prior experiences that can promote resilience (Aldwin & Igarashi, 2016). During the COVID-19 pandemic, older adults drew on prior experiences and resources to cope (McKinlay et al., 2021; Herron et al., 2021), although these events were typically not specified. Some found vulnerability due to prior trauma (Galica et al., 2021). We examined whether older adults drew upon specific experiences or more general resilience resources in coping with this novel stressor. Data were collected using an online survey from April 28-May 4, 2020 from 235 older adults in Oregon (Mage = 71.35, SD = 7.39; 74% female; 92% White). We examined open-ended responses from a question that asked whether prior experiences influenced how they were dealing with the COVID-19 situation. Nearly 2/3 provided valid responses (n=144). After inductive open coding, preliminary consolidation resulted in three broad categories: past experiences (74%), resources (19%), and both (8%). The most common prior experiences were illness (n = 20) and work (n = 19). Some (n=10) reported specific coping strategies learned during prior stressful experiences. Resources include personal characteristics (e.g., being “introverted” or “resilient”), financial (“financially secure”) and social resources (“loving spouse”). Five reported experiences that made COVID-19 more difficult (“PTSD/anxiety prior to COVID-19 makes this even worse”). Although 1/3 of the sample could not draw upon a prior experience in coping with this novel stressor, many older participants could utilize their lived experience when coping with problems during the COVID-19 pandemic.

OPTIMAL AGING AND SATISFACTION WITH SOCIAL SUPPORT DURING THE COVID-19 PANDEMIC

Social support is important for optimal aging, especially during the COVID-19 pandemic when older adults are at risk of social isolation and its attendant health problems. Providing support may be especially protective of health outcomes. We examined whether actual received, provided, and satisfaction with support were related to optimal aging early in the pandemic (April-May, 2020). Survey participants (N=238) were on average 71.2 years old (SD=7.3), 73% female, 92.6% White, and highly educated (48% with post-graduate degrees). Optimal aging (Aldwin & Igarashi, 2016) was indicated by a latent variable of health outcomes, including depressive symptoms, cognitive lapses, and physical symptoms. Nearly all older adults (90+%) reported receiving or providing actual support from or to at least one family member or friend. We investigated the associations between age, summed social support, satisfaction with support, and health outcomes, controlling for chronic illnesses. Two SEM models were estimated for received support and provided support, respectively. After trimming non-significant paths, both models had acceptable fits (CFI > .90, RMSEA < .08, SRMR < .08). Age and chronic illnesses had negative associations with health outcomes, but neither received nor provided social support was significant. However, satisfaction with both received and provided support were significant and independently associated with optimal aging in both models. Thus, isolation levels in this sample were surprisingly low, as indicated by high levels of social support received and provided. However, only the quality of (or satisfaction with) support was important for optimal aging during this unique and shared stressful experience.

COVID-19 ERA EFFECTS ON OLDER ADULTS’ COGNITIVE COMPLAINTS, DEPRESSIVE SYMPTOMS, AND STRESSFUL EVENTS

Older adults have adjusted better to the COVID-19 pandemic in terms of their psychological well-being than younger adults. We investigated individual differences in vulnerability within older adulthood as pandemic severity changed, providing a more refined prediction of older adults’ adjustment to COVID-19. Participants from this longitudinal study were included if they had at least one semiannual assessment before and one during the COVID-19 era (N = 111, 65% women, age range = 62-96 at onset of COVID-19 era in the US). There were 1,098 pre-COVID-19 assessments (M=9.9, 1/5/2018-1/22/2020) and 265 post-COVID-19 (M=2.4, 1/23/2020-10/31/2021). At each assessment, participants reported on six cognitive complaints (MOS), five depressive symptoms (Geriatric Depression Scale), and six domains of undesirability-weighted stressful life events (Louisville Older Persons Event Scale). Daily national, state, and regional COVID-19 case and death rates were obtained from the Centers for Disease Control and summed for the week preceding each assessment. In multilevel ZIP models, the COVID-19 era significantly increased depressive symptoms (0.68 to 1.18, p < .0001) and stressful events (30.9 to 48.5, p < .0001), but did not significantly affect severity of cognitive complaints. Older age was associated with greater impact of COVID-19 on depressive symptoms and stressful events; women reported more stressful events when pandemic severity was high, but men reported more stressful events when pandemic severity was low. Although older adults in general have adjusted better to the pandemic than younger adults, the old-old had greater vulnerability to this unavoidable event than the young-old.

TRAJECTORIES OF ANXIETY SYMPTOMS DURING THE COVID-19 PANDEMIC AMONG OLDER ADULTS

Older adults face particular challenges during the COVID-19 pandemic, including increased risk for morbidity and mortality (CDC, 2021). Social distancing and lockdown to prevent contagion may create social isolation and loneliness, adversely affecting mental and physical health. We examined anxiety symptom trajectories of older adults and identified risk and protective factors during the early months of the COVID-19 pandemic. We also examined how anxiety symptoms were associated with both between- and within-person variations in loneliness, social contacts, and physical problems. We sampled 247 older adults (Mage = 71.1, SD = 7.3, range = 51 - 95), who participated in eight weekly longitudinal online surveys from April 28 to June 23, 2020. Multilevel modeling analysis controlling for age, gender, marital status, and education showed that anxiety symptoms significantly decreased in the first few weeks, but then increased around week 6 of the study period. At the between-person level, individuals with higher levels of both loneliness and physical problems were at risk for experiencing higher levels of anxiety, but social contacts were not significant. Middle-aged participants reported higher anxiety symptoms than older participants. Women experienced higher anxiety symptoms than men. As a protective factor, individuals who were high in resilience had significantly lower anxiety symptoms over time, compared to those with low in resilience. In the within-person level, anxiety symptoms were positively coupled with both loneliness and physical symptoms over time. We conclude that lonely individuals and those in poor health were at greater risk of poor mental health during the pandemic.

LONG-TERM POSITIVE AND NEGATIVE CONSEQUENCES OF THE COVID-19 PANDEMIC AMONG OLDER ADULTS

Despite their greater physiological vulnerability, community-residing older adults have shown surprising psychological resilience, at least at the beginning of the COVID-19 pandemic. However, a handful of reports suggest that older adults’ well-being has decreased after a few months, although others have suggested a recovery after a year (Schlomann et al., 2021). The purpose of this study was to examine change in change from baseline (April-May, 2020) to a 13- month follow-up (June, 2021). We analyzed data from 162 older adults with complete data at both time points. Mean age at baseline was 72, SD = 7.6, range = 51-96; 71% were female, 13% were minorities; 74% were married, 71% retired, and most (85%) had at least a BA. Linear modelling showed that there were only marginal increases in the number of problems across time (B = .25, p = .08), but their severity did not increase. There were no significant changes in depression, anxiety, loneliness or physical symptoms over this time period. The modest increase in problems may have been offset by an end to being in lockdown and an increase in social contacts which doubled over this time period, B = 1.65, p <.001). More troubling was that self-reported resilience decreased, B = -.92, p < .01), as did the ability to perceive positives in this situation, B = -2.46, p < .01), and self-reported cognitive problems increased, B=.67, p < .01). Thus, the results showed decidedly mixed effects, suggesting individual differences in long-term adaptation to COVID.

Loneliness, Social Contact, and Health Among Older Adults During the COVID-19 Pandemic

The COVID-19 pandemic is a challenging situation for many older adults at elevated risk for mortality. Social distancing and lockdown to prevent contagion may result in social isolation and feelings of loneliness, which can have adverse effects on health. We examined how depressive symptoms were associated with between-person differences and within-person variations in loneliness, social contacts, and daily physical problems during 8 weeks. We sampled 247 older adults (Mage = 71.1, SD = 7.3, range = 51 - 95), who participated at micro-longitudinal online surveys (baseline and 7 weekly follow-ups) from April 28 to June 23. Multilevel modeling analysis controlling age, gender, marital status, and education showed that depressive symptoms were significantly decreased during 8 weeks. Further, depressive symptoms were positively coupled with both loneliness and physical problems for both the within-and between-person levels. Increase in social contact was related to decreases in depressive symptoms only at the between-person level.

Correlates of Psychological Well-being Among Korean Vietnam War Veterans

Prior research on Veterans’ mental health has largely focused on identifying risk and protective factors for negative psychological symptoms such as PTSD. However, mental health indicates not merely absence of psychopathology, but also the existence of positive psychological well-being (Keyes, 2005). Thus, the current study aimed to examine the correlates of psychological well-being, which is less studied, in an Asian sample, Korean veterans. Data for this 2017 study were from Korean Vietnam War Veterans Study. Participants were 348 male veterans, and their mean age was about 72 years old (SD = 2.7, range = 65-84). Using Keyes’ (2002) classification criteria, psychological well-being was divided into three types: flourishing (9.5%), moderately health (59.95%), and languishing (25.3%). Own-way analyses of variance showed that the groups did not differ in demographic variables (age, marital status, education, and income). Further, there were no differences in combat exposure, negative appraisals of military service, smoking, and alcohol consumption. However, significant group differences were found for resources; Scheffé's post-hoc analyses indicated that optimism, positive appraisals of military service, four types of social support (family, significant others, friend, and military peer), and self-rated health were significantly different among the groups, and highest in the flourishing group. The moderately health group showed higher levels of positive appraisals of military service and four types of social support than the languishing group. Thus, the majority (about 60%) of Korean Vietnam veterans were moderately psychologically healthy in this sample, but those with positive psychosocial resources were more likely to be healthiest.

A Social Ecological Model of Vulnerability and Resilience in Older Adults During the Covid-19 Pandemic

Objectives: We used a social ecological model to examine vulnerability and resilience among older adults during the COVID-19 pandemic. Methods: We analyzed two open-ended questions included in a survey of 235 respondents, 51–95 years old (M = 71.35; SD = 7.39; 74% female), which asked about COVID-19-related difficulties and positive experiences during the past week. We identified three different levels for difficulties and positives at the personal, interpersonal, and/or societal levels. Results: Fewer than half of the respondents reported on difficulties (41%) and positives (40%) just at the personal level. In terms of crossing levels, people were most likely to report events spanning the personal and interpersonal levels (14% and 18%, respectively). A few individuals reported difficulties and positives at the societal level. Discussion: Older individuals were acutely aware of challenges and positives existing at all three levels, and contributed to resources at the interpersonal and community levels.

Change in Stress and Positive Experiences among Older Oregonians during the COVID-19 Pandemic

Several cross-sectional studies have examined stressors and positive events among older adults during COVID-19. We extend these studies by examining changes across time in perceptions of stress and positive experiences. Older adults in Oregon (Mage = 71.1, SD = 7.3, range = 51-95) completed weekly surveys from April 28 to June 23, responding to an adaptation of the Daily Stress Inventory (DISE; Almeida et al., 2002). DISE examines stressors and positive experiences across six domains (health, spouse/partner, other relationships, work/volunteer, finances, and retirement) on a 7-point scale (1 = not at all to 7 = extremely). At baseline, those who felt more stressed were younger, female, and reported more chronic health conditions, while younger adults, especially males, reported more positive events. Positive and stress intensity scores were not correlated. Multilevel models found that for both positive, Blinear = -2.54, SE = 0.52, p < .001; Bquadratic = 0.21, p < .05, and stress, Blinear = -0.79, p < .001; Bquadratic = 0.07, p <.01, intensity showed decelerated decreases across time; residuals for both models were significant. Older adults had lower stress levels, while women and those with chronic health conditions had higher stress levels. Women also reported lower levels of positive events. In both models, neither age, gender, nor chronic health conditions predicted change. These results highlight the evolving experiences during COVID-19, as perceptions of stress and positive events decreased. Future studies should examine how the changing circumstances during COVID-19 affect adaptation, including perceived stress and positive events.

Resilience in Older Adults during the COVID-19 Pandemic: A Socioecological Approach

Objectives

We examined sources of vulnerability and resilience among older adults early in the COVID-19 pandemic.

Methods

We surveyed 235 respondents, 51–95 years old (M = 71.35; SD = 7.39; 74% female), including two open-ended questions concerning COVID-19-related difficulties and positive experiences during the past week. Using inductive coding, we found nine final codes for difficulties and 12 for positives and grouped them into socioecological levels: personal, interpersonal, and societal.

Results

Difficulties were reported by 94% of the sample, while 63% described positives. Difficulties and positive responses were made at all socioecological levels and illustrated a dialectic between personal level constraints and opportunities, interpersonal level social isolation and integration, and societal level outrage, sorrow, and social optimism.

Discussion

Respondents described sources of vulnerabilities and resilience that supported a socioecological approach to understanding resilience during this pandemic. A notable example was resilience derived from witnessing and contributing to community and social solidarity, highlighting the potential of older adults as resources to their communities during the global pandemic.

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity

BACKGROUND AND OBJECTIVES

As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups.

RESEARCH DESIGN AND METHODS

Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations.

RESULTS

Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites.

DISCUSSION AND IMPLICATIONS

Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.

PTSD SYMPTOMS AMONG VIETNAM, PERSIAN GULF, AND OEF/OIF/OND VETERANS: A RURAL/URBAN COMPARISON

There are mixed results in studies examining rural/urban differences in PTSD symptoms among veterans; however, many of these studies failed to consider possible confounds with geographic location. This study examined rural/urban differences in PTSD symptoms by combat exposure, war cohort, and gender. The VALOR (Veterans Aging: Longitudinal studies in Oregon) pilot study sampled Vietnam, Persian Gulf, and OEF/OIF/OND war cohorts using an online survey. The sample (N=237, Mage=57.84, SD=12.68) was mainly male (65%), White (85%), and urban (75.95%); most reported combat exposure (71%). Participants completed measures of PTSD, combat exposure, and demographics. Results indicate no effect of cohort or rural/urban status on PTSD symptoms. There was a significant effect of combat exposure, F(1,224)=4.58, p=.03, and gender, F(1,224)=4.13, p =.04, with males reporting higher levels of PTSD symptoms and combat exposure. Contrary to our expectations, there were no effects of cohort or geographic location on PTSD symptoms.

DOES PERSONALITY PREDICT PATTERNS OF AGING? LONGITUDINAL FINDINGS FROM THE VA NORMATIVE AGING STUDY

Previous research using the Veterans Affairs Normative Aging Study identified four patterns of aging using group-based multi-trajectory modelling to identify joint changes in life satisfaction (LS) and functional health (FH) (Nath et al., 2018a,b). The purpose of the present study was to examine whether personality traits predicted these four patterns: impaired (stable low LS and FH), normal (decreasing LS and FH), optimal (high LS, decreasing FH), and successful aging (high LS and FH). The sample consisted of 992 NAS men who provided 3,853 observations (M=2.81, SD=1.54, range 1–8) between 1987 and 2010 (Mage=62.31, SDage=7.50, range 44-86 in 1987). Multinomial logit regression analysis with robust estimation controlled for marital, employment, and self-rated health status, using optimal aging as the reference group. Compared to the optimal aging group, neuroticism predicted membership to the normal aging (RR=1.61, CI=1.16–2.22) and the successful aging groups (RR=.55, CI=.38–.79). Optimism predicted membership to all groups, with lower risk ratios to the impaired aging group (RR=.11, CI=.04–.33) and normal aging group (RR=.57, CI=.42–.79), and higher risk ratio to the optimal aging group (RR=1.96, CI=1.35–2.85). Extraversion only predicted membership in the impaired aging group (RR=.27, CI=.12–.63) indicating high levels of social isolation. Thus, personality may play an important role in determining the patterns of aging.

DISCRIMINATION, STRESS, AND MORTALITY AMONG BLACKS AND WHITES

Mortality rates have declined significantly in the past decades. However, Case and Deaton (2015) showed that middle-aged white Americans with lower education levels have increasing mortality rates. Although some have suggested that stress is an important factor in both this and in racial/ethnic disparities in mortality, relatively few studies have examined vulnerability to stress and mortality, and typically have examined only one type of stress. We examined racial/ethnic and gender differences in different types of stressors, from everyday discrimination, to lifetime trauma, as well as differential mortality risk due to stress vulnerability. Using data from the Health and Retirement Study (HRS), the sample consisted of 6,810 (Mage=68.9 years, SD=10.1) who completed the Psychosocial Questionnaire (PQ) in 2006; mortality was assessed to 2014. Blacks were higher on most stressors except for lifetime trauma. Women reported higher level of financial strain but lower levels of everyday discrimination and lifetime trauma than men. Controlling for demographics and self-rated health, Cox proportional hazard models revealed that everyday discrimination, financial strain, SLEs, lifetime trauma were significantly associated with the risk of mortality. There were no significant racial/ethnic differences in mortality risk. However, interaction effects showed that whites had higher mortality risk with lifetime trauma than Blacks, while those with lower education had higher mortality risk for SLEs. This supports the idea that lower education whites may be more susceptible to some types of stressors, providing a possible mechanism for Case and Deaton’s finding (2015) of increasing mortality risk in this group.

PREDICTORS OF MORTALITY RISK AMONG MEDICARE ADVANTAGE ENROLLEES

Overall all-cause mortality rates have declined significantly in past decades among individuals aged 65 and above in every racial and ethnic group. We explored demographic, overall health, and disability development as predictors of mortality in Medicare beneficiaries enrolled in Medicare Advantage plans. We used data from the 2014-2018 Medicare Health Outcomes Survey, a nationally representative panel survey with a two-year follow-up, administered by the Centers for Medicare and Medicaid Services. Our sample consisted of 1,273,494 community-dwelling adults aged 65 and older (Mage = 74.5 years, age range: 65-109 years) enrolled in Medicare Advantage plans. Mortality was assessed over a 2-year follow-up period. We used Cox proportional hazards regression analysis to predict risk of all-cause mortality by demographics, self-rated health, chronic health conditions, smoking status, and activities of daily living (ADLs). Among all participants, the mortality rate was 7.0% (n = 88,058) at 2-year follow-up. Advanced age and being male were significantly associated with greater risk of mortality, while higher levels of education and income were inversely associated with mortality. Controlling for other factors, white adults had higher mortality risk than black or African American, Hispanic, and Asian older adults. Individuals who were unmarried, had lower self-rated health, had more chronic health conditions, smoked, and had more ADL limitations had higher mortality risk. Our findings suggest that sustained health and better functional capacity are important elements in decreasing the risk of mortality in older adults.

WAR COHORT DIFFERENCES IN MILITARY SERVICE APPRAISALS AND HOMECOMING EXPERIENCES

Nearly all the research on appraisals of military service and homecoming experiences have been done on World War II veterans. However, Spiro et al. (2016) hypothesized that there were war cohort differences in military experiences that could affect life-long adaptation. For example, Boscarino et al. (2018) found that Vietnam veterans reported less welcoming homecoming experiences than OEF/OIF/OND veterans. We examined war cohort differences among OEF/OIF/OND, Persian Gulf, and Vietnam combat veterans in military service appraisals and homecoming experiences. We used pilot data from Veterans Aging: Longitudinal studies in Oregon (VALOR) from an online survey. The sample included male and female combat veterans (Mage = 58.1, SD = 12.0, range = 35-83, 30.5% female): 39 from the OEF/OIF/OND, 68 from the Persian Gulf War, and 60 from the Vietnam War cohorts. Comparable to earlier studies (e.g., Aldwin et al., 1994), combat veterans were surprisingly much more likely to endorse desirable appraisals than the undesirable ones, with each of the 14 desirable appraisals endorsed by over 90% of the veterans. Fewer endorsed the undesirable experience items; the most common was separation from loved ones and loss of friends. Most also reported positive homecoming experiences. Contrary to expectations, ANOVAs revealed that there were no significant differences in appraisals of desirable and undesirable military service experiences, nor in homecoming experiences among the war cohorts. In this small sample, military experiences were perceived similarly among combat veterans despite differences in wartime experiences. Most felt that positive experiences resulted from their desirable military service.

Does combat exposure affect well-being in later life? The VA Normative Aging Study

OBJECTIVE

Combat exposure can have long-term negative effects in later life; although aspects of service may be appraised positively, the long-term positive effects of combat on well-being in later life is largely unknown.

METHOD

The sample included 1,006 male veterans from the VA Normative Aging Study, surveyed by mail in 1986, 1990, and 1991 (Mage = 65.5 years, SD = 7.3). They reported on their combat exposure, desirable appraisals of military service, unit cohesion, dispositional optimism, self-rated health, and psychological well-being (PWB), as well as age, military rank, and education. Perceived positive aspects (PPA) of military service was postulated to mediate the effects of combat exposure on PWB. Structural equation modeling was used to examine both mediating and moderating effects.

RESULTS

Age, combat exposure, and optimism had independent effects on PPA, but optimism did not moderate the effect of combat exposure on PPA. Combat exposure had only indirect effects on PWB through PPA, controlling for the direct effects of optimism. Education had no direct effects on the positive outcomes but did have indirect effects through optimism.

CONCLUSION

Combat exposure contributes to positive well-being in later life, indirectly through positive appraisals, and this effect was independent of optimism. Thus, these results support the idea that combat veterans should be encouraged to focus on positive aspects of military service, which may serve as resilience resources to facilitate optimal aging. (PsycINFO Database Record

Spiritual peace predicts 5-year mortality in congestive heart failure patients

OBJECTIVE

Spirituality is favorably related to depression, quality of life, hospitalizations, and other important outcomes in congestive heart failure (CHF) patients but has not been examined as a predictor of mortality risk in this population. Given the well-known difficulties in managing CHF, we hypothesized that spirituality would be associated with lower mortality risk, controlling for baseline demographics, functional status, health behaviors, and religiousness.

METHOD

Participants were 191 CHF patients (64% male; M age = 68.6 years, SD = 10.1) who completed a baseline survey and were then followed for 5 years.

RESULTS

Nearly 1/3 of the sample (32%) died during the study period. Controlling for demographics and health status, smoking more than doubled the risk of mortality, whereas alcohol consumption was associated with slightly lower risk of mortality. Importantly, adherence to healthy lifestyle recommendations was associated with halved mortality risk. Although both religion and spirituality were associated with better health behaviors at baseline in bivariate analyses, a proportional hazard model showed that only spirituality was significantly associated with reduced mortality risk (by 20%), controlling for demographics, health status, and health behaviors.

CONCLUSIONS

Experiencing spiritual peace, along with adherence to a healthy lifestyle, were better predictors of mortality risk in this sample of CHF patients than were physical health indicators such as functional status and comorbidity. Future research might profitably examine the efficacy of attending to spiritual issues along with standard lifestyle interventions.

A Life-span Perspective on Combat Exposure and PTSD Symptoms in Later Life: Findings From the VA Normative Aging Study

PURPOSE OF THE STUDY

We tested a life-span model of combat exposure on posttraumatic stress disorder (PTSD) symptoms in later life, examining the direct and indirect effects of prewar, warzone, and postwar factors.

DESIGN AND METHODS

The sample included 947 male World War II and Korean War veterans from the VA Normative Aging Study (Mage = 65, SD = 7). They completed mail surveys on childhood family environment, military service and postwar experience, stressful life events, and PTSD symptoms (response rates > 80%).

RESULTS

We constructed an initial path model testing cumulative advantage and disadvantage pathways. Although all hypothesized relationships were significant, the model was not a good fit to the data. Subsequent models showed that all three life-span periods had both direct and indirect effects on PTSD symptoms and that there were interesting cross-links between the two sets of pathways.

IMPLICATIONS

The life-span perspective provides a useful heuristic to model various developmental effects on later-life outcomes. A supportive childhood family environment can have lifelong protective effects, whereas a conflictual one can set up lifelong patterns of pessimistic appraisals.

Do hassles mediate between life events and mortality in older men? Longitudinal findings from the VA Normative Aging Study

We investigated whether hassles mediated the effect of life events on mortality in a sample of 1293 men (Mage=65.58, SD=7.01), participants in the VA Normative Aging Study. We utilized measures of stressful life events (SLE) and hassles from 1989 to 2004, and men were followed for mortality until 2010. For life events and hassles, previous research identified three and four patterns of change over time, respectively, generally indicating low, moderate, and high trajectories, with one moderate, non-linear pattern for hassles (shallow U curve). Controlling for demographics and health behaviors, we found that those with moderate SLE trajectories (38%) more likely to die than those with low SLE trajectories, HR=1.42, 95% CI [1.16, 3.45]. Including the hassles classes showed that those with the moderate non-linear hassles trajectory were 63% more likely to die than those with low hassles trajectory, HR=1.63, 95% CI [1.19, 2.23], while those with consistently high hassles trajectory were over 3 times more likely to die, HR=3.30, 95% CI [1.58, 6.89]. However, the HR for moderate SLE trajectory decreased only slightly to 1.38, 95% CI [1.13, 1.68], suggesting that the two types of stress have largely independent effects on mortality. Research is needed to determine the physiological and behavioral pathways through which SLE and hassles differentially affect mortality.