Age Identification in the Framework of Successful Aging. A Study of Older Finnish People

A person-oriented approach was used in a study of age identification among community-dwelling older people. The study was based on 8-year follow-up data; 843 persons aged 65–84 were involved in the first phase of the study, and 426 persons aged 73–92, in the second phase. Loosely, on the basis of the distinction between successful, usual, and pathological aging (Rowe & Kahn, 1987, 1997), participants were grouped according to their self-ratings of cognitive and physical functioning as “Positive,” “Negative,” and “Others.” Participants possessing at least 4 out of the 5 criteria used as indicators of successful aging in the study (no illness or injury presenting problems in daily life, no health problems imposing limitations on hobbies, self-rated cognitive functioning better than satisfactory, age-comparative functional capacity as good, and no signs of depression) were assigned to the “Positive” group. The results showed these individuals typically to have a more youthful age identity, indicated by a lower feel age and thus a lower subjective age-perception score, lower mental, physical, and look ages, and a less frequently reported sense of age weighing on them. Moreover, this group reported a higher ideal age and had a chronological age satisfaction score closer to 0, suggesting higher satisfaction with chronological age. Also a tendency to set the onset of old age later and a willingness to live to 100 years of age were features that were more characteristic of the “Positive” than the other groups. The findings, supported by multivariate analyses, were in line with those of previous variable-oriented studies on age identification, suggesting that an association exists between perceptions of personal aging and physical and psychological well-being.

Revising the negative meaning of chronic pain - A phenomenological study

OBJECTIVES

Chronic pain may disable the body, depress the mind and ruin the quality of life. The aim of this study was to use the participants' personal experiences to explore the meaning of the experience of chronic pain and to find successful ways to manage chronic pain.

METHODS

Thirty-four participants with chronic pain were interviewed. The transcribed interviews were analysed using Giorgi's phenomenological method consisting of four phases: (1) reading the transcriptions several times, (2) discriminating meaning units, (3) collecting meaning units into groups and (4) the synthesis.

RESULTS

The participants stated that the key to managing chronic pain was to reconsider the individual meaning of the experience of pain. As a result of the interviews, seven subthemes were found based on the 'Negativity of chronic pain', namely, 'State of reflection', 'Reconsidering values', 'Acceptance of pain', 'Support network', 'Altered self', 'Joys in life' and 'Pain dissociation'.

CONCLUSIONS

Pain is an aversive sensation, which leads to the conclusion that the meaning of the experience is also negative, but it can be reversed. In clinical practice, the focus should be on revising the subjective meaning of pain in order to manage pain and to restore positivity in personal life.

The dominance of chronic pain: a phenomenological study

BACKGROUND

Chronic pain is not only a physical disorder, but also a complex combination of biopsychosocial symptoms affecting each other. When in chronic pain, the patient's entire body becomes a source of pain, and eventually the pain occupies the patient's mind and entire life. The aim of the present study was to examine the life experience and management of chronic pain from the patient's perspective.

METHODS

Thirty-four participants with chronic pain were interviewed. For 21 of the participants, the duration of pain was more than five years. Most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi's four-phase phenomenological method.

RESULTS

The results indicated that chronic pain impaired the participant's psychosocial well-being by controlling thoughts and making life itself painful. When life is filled with pain, the entire life is seen through pain. Continuity, unpredictability and the fear of the pain decreased quality of life. As a result of the interviews, the following subthemes were identified, based on the essential theme of 'the dominance of chronic pain': namely: 'pain is the master', 'life is not worth living', 'contextual pain' and 'waiting and hoping'.

CONCLUSIONS

Chronic pain may decrease the quality of the patient's life to such an extent that it may be regarded as not worth living. Multidisciplinary management of chronic pain may lead to a better health status and diminish the adverse consequences of chronic pain.

Psychomotor slowness is associated with self-reported sleep duration among the general population

Short and long self-reported sleep durations have been found to be associated with several seemingly disparate health risks and impaired functional abilities, including cognitive functioning. The role of long sleep is especially poorly understood in this context. Psychomotor slowness, shown to have analogous associations with cognitive performance and health risks as self-reported long sleep duration, has not been studied together with sleep duration in epidemiological settings. We hypothesized that self-reported habitual sleep duration, especially long sleep, is associated with slow psychomotor reaction time, and that this association is independent of vigilance-related factors. The hypothesis was tested in a sample of 5352 individuals, representing the general adult population. We found a U-shaped association between self-reported sleep duration and psychomotor speed, which prevailed even after controlling for several pertinent confounders. This novel finding can be interpreted to mean that self-reported sleep duration, at least in the case of long sleep, is an indicator of bodily/brain integrity and, taken together with the results of cognitive epidemiology, may provide some new insights into the mechanisms underlying the associations between habitual self-reported sleep duration, health risks and impaired functional abilities.

Cohort differences in health, functioning and physical activity in the young-old Finnish population

BACKGROUND AND AIMS

A mixed picture emerges from the international literature about secular and cohort changes in the health and functioning of older adults. We conducted a repeated population based cross-sectional study to determine trends in health, functioning and physical activity in the young old Finnish population.

METHODS

Representative samples of community-dwelling people aged 65-69 years in 1988 (n=362), 1996 (n=320) and 2004 (n=292) were compared in socio-economic status, self-rated health, chronic diseases, memory problems, ability to carry out instrumental activities of daily living, physical activity, and five-year mortality.

RESULTS

Significant improvement in all the investigated modalities, except that of chronic diseases, was observed in the newer cohorts. In logistic regression analysis, after controlling for socioeconomic status and gender, cohort effects remained significant for memory problems, IADL difficulties and physical activity. Cox regression analyses showed significant improvement in survival when later cohorts were compared with the earlier ones.

CONCLUSIONS

This study provides evidence of improving levels of socio-economic status, self-rated health, functioning, physical activity, and lower risk of mortality in the newer cohorts of the Finnish young-old, but this was not accompanied by a parallel diminution in chronic diseases.

Change in Subjective Age among Older People over an Eight-Year Follow-Up: ‘Getting Older and Feeling Younger?’

The purpose of this prospective study was to describe changes in subjective age over an 8-year period among community-dwelling people aged 65 to 84 years in Finland. At the baseline 1155 respondents met study criteria and 451 of these participated in the follow-up study. Participants described in years the age they felt themselves to be (feel age) and their preferred age (ideal age). Discrepancy scores relative to chronological age were calculated for feel age and ideal age. No significant mean-level changes were observed in the age discrepancy scores over the 8-year time frame. The baseline discrepancy between chronological and feel age remained constant among 48% of the participants, with 26% reporting a younger and 26% an older feel age. Similar patterns were observed in the discrepancy between chronological age and ideal age. The findings point both to stability and to individual variability in feel and preferred age identification over time in older adults.

Mobility limitations and cognitive deficits as predictors of institutionalization among community-dwelling older people

PURPOSE

Mobility limitations and cognitive disorders have often been observed as risks for institutionalization. However, their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported.

DESIGN

A prospective cohort study with 10-year surveillance on institutionalization.

SUBJECTS

Study population (n = 476) consisted of 75- and 80-year-old people who were community-dwelling, had not been diagnosed with dementia, and participated in tests on walking speed and cognitive capacity at a research centre.

MEASURES

Cognitive capacity was measured with three validated psychometric tests that were from the Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Schaie-Thurstone Adult Mental Abilities Test. Mobility was measured with walking speed over a 10-m distance. Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows: no limitation, solely mobility limitation, solely cognitive deficits, and combined mobility limitation and cognitive deficits. Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups.

RESULTS

Eleven percent of the participants were institutionalized during the 10-year surveillance. The risk for institutionalization was 4.9 times greater (95% confidence interval: 2.1-11.2) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations.

CONCLUSIONS

The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home. This might be due to a decreased reserve capacity and ineffective compensatory strategies. Therefore, interventions targeted to improve even one limitation, or prevent accumulation of these risk factors, could significantly reduce the risk of institutionalization.

Perceived age as a predictor of old age mortality: a 13-year prospective study

OBJECTIVES

To examine whether in older people perceived age is associated with risk of total mortality independent of chronological age.

DESIGN

Prospective population-based study (Evergreen project) with mortality surveillance for 13 years after the baseline.

SETTING

Face-to-face interview among community-dwelling residents of the city of Jyväskylä, Finland.

SUBJECTS

395 men and 770 women aged 65-84 years at baseline.

MEASURES

Perceived physical age and perceived mental age were rated either as younger, the same or older in comparison with subject's chronological age. Death dates were received from the official register of the province of Central Finland. Confounders used were chronological age, education in years, number of long-term illnesses, self-rated health, depression score (Beck's 13-item depression scale), and cognitive status.

RESULTS

Mortality rates per 1,000 person-years from the older to younger perceived physical age category were 99, 65 and 59 in men, and 81, 54 and 36 in women. In the perceived mental age categories, correspondingly, mortality rates were 139, 63 and 64 in men, and 82, 55 and 44 in women. The fully adjusted relative risk (RR) of death over 13 years with the perceived younger physical age category as referent was 1.42 (95% CI 1.00-2.02) in the older category and 1.28 (1.03-1.60) in the same age category (P=0.049). The crude RR of mortality for perceived mental age categories was 1.56 (1.09-2.23) in the older and 1.10 (0.92-1.31) in the same age as compared with the younger category (P=0.046). Adding cognitive status into the model diminished the predictive value of the model (P=0.545).

CONCLUSIONS

Perceived age predicted worsening of health as described as mortality. Perceived age may indicate general well-being and faith in the future, potentially reflecting changes in health.

Life-lines of Finnish people aged 83-87

This article presents the characteristics of the life-lines drawn by older Finnish men and women. The study was part of the Evergreen Project, Finland. Seventy-eight persons aged 83-87 participated in an interview, in which they were asked to draw a life-line. The life-line was drawn on a standardized sheet as a continuous line which showed the intensity of positive and negative affects during the course of life. An interview concerning the major life events on the life-line and the most positive and negative life periods was administered after the life-line was drawn. The shape of the life-line was analyzed by calculating the level, trend, and variance, as well as the maximum and minimum points. The content analysis of the life-lines was based on self-reports concerning the major life events and the most positive and negative periods in life. The drawings mostly showed an upward trend. On average, women drew the line on a slightly higher level than men. Interindividual variance was greatest in early childhood and old age and smallest in middle age, whereas intra-individual variance was greatest in early adulthood and smallest in old age. Most of the lowest points were located in childhood and the highest points in the present (old age). The densest period in terms of the location of major life events and their affective meaning was youth and young adulthood (15-30 years). The most frequently expressed contents of the life-line dealt with human relationships and school in women, and work-related issues and war in men.

Changes in cognitive functioning from 75 to 80 years of age: a 5-year follow-up in two Nordic localities

The purpose of the study was to analyze changes and stability in cognitive functions among older persons aged from 75 to 80 years, as well as differences in this development between two Nordic localities. The number of subjects taking part in the follow-up phase was 188 in Jyväskylä, Finland, and 184 in Göteborg, Sweden. Cognitive functions were assessed using conventional memory tests (Digit Span Forward and Backward for assessing primary working memory; Visual Reproduction for visual memory) and intelligence tests (Digit Symbol for assessing psychomotor speed; Word Fluency for verbal ability; Raven's Matrices for non-verbal reasoning). With few exceptions, the mean test scores declined significantly among the retested men and women in both localities. Analyses showed that generally over half of the subjects maintained their level of performance over the 5-year period, while a part of the deteriorating minority had a steep decline. There were significant differences in the test performance between the localities both at the baseline and follow-up assessments, but few differences between women and men. On the whole, however, the groups of older women and men from the two Nordic localities had a similar pattern of cognitive development from 75 to 80 years of age.

Cognitive functioning of 75- and 80-year-old people and changes during a 5-year follow-up

The aim of the study was to analyze cognitive functioning among two cohorts of elderly people, aged 75 and 80 years at baseline, and changes in the functioning during a five-year period. Cognitive functioning was assessed using psychometric tests, neuropsychological tasks, metacognitive self-evaluations, cognitive screening tests and reaction time tasks. The objective methods correlated significantly with each other, and only one general factor was clearly produced by the factor analyses. However, the speed of cognitive processing was concluded to have a central meaning in the kind of assessments used in this study. Selective attrition affected the results of psychometric and neuropsychological methods; subjects with better cognitive functioning participating in the follow-up assessments. Among those retested, the cognitive level decreased significantly, but the magnitude of the decline was usually low. Differences between the men and the women were mostly nonsignificant. The retest correlations were high in the psychometric tests but lower in many of the neuropsychological and metacognitive methods. Connections between the metamemory scores and the objective test scores were variable.

Factors related to carrying out everyday activities among elderly people aged 80

The study was based on an epidemiological model in which performing activities of daily living (ADL) was the dependent variable. Variation in performing was explained by physical and mental health, and by physical performance. The population consisted of all 80-year-old residents (N = 291) of the city of Jyväskylä in central Finland; 90% of them agreed to take part in the interviews at home, while 72% took part in the laboratory examinations to determine health status and functional capacity. Difficulties in at least some PADL (Physical Activities of Daily Living) tasks were reported by 86.5% of the men, and 87.2% of the women; none said they could perform all IADL (Instrumental Activities of Daily Living) tasks without difficulty. Physical performance (grip strength and stair mounting test in men, and stair mounting test, balance, and upper extremity function test in women) and visual acuity showed a significant association with ADL performance both in men and in women. In addition, depressive symptoms in women, and cognitive capacity in men were associated with both PADL and IADL, and ADL performance, respectively. In the search for pathways to reduced ADL performance, it is important to look not only at chronic diseases but also at the aging processes as well as the disabilities caused by inactivity. Tests of cognitive capacity, psychological well-being and physical performance provide valuable information on the factors that underlie the aged individual's reduced functional capacity.