Community Wise-effects and participant perceptions of a community- based -positive health intervention for older inhabitants of low SES neighbourhoods: a mixed-methods approach.

BACKGROUND: The Community Wise (CW) intervention applies a community-based approach to improve the physical fitness, self-management ability, loneliness, social cohesion, and well-being of older adults living in neighbourhoods characterized by lower socioeconomic status (SES). METHODS: Participants (N = 108) were recruited using several strategies, including door-to-door visits and community key peers. The study was based on a pre-test/post-test design. Outcomes were assessed through mixed methods using questionnaires, performance tests, semi-structured interviews, and focus-group sessions. RESULTS: Results showed significant improvements on aerobic endurance and shoulder flexibility, but no significant improvements on self-management ability, social cohesion, loneliness, or well-being. Qualitative data analysis did indicate that participants experienced improvements on social connectedness with members of the group, as well as on self-management ability. CONCLUSION: The results of the intervention seem to depend on programme fidelity and method of assessment. Adapting the intervention and including more older adults with poor health status could lead to better outcomes in the future. This results of this study should be interpreted in light of the complexity and methodological challenges of conducting a community-based health-promotion intervention for this target group. TRAIL REGISTRATION: Retrospective registration.

Gendered work-family life courses and late-life physical functioning: A comparative analysis from 28 European countries.

Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.

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.

Geographical life-space and subjective wellbeing in later life.

Geographical life-space is an important factor to consider when studying subjective wellbeing of older adults. The purpose of this article is twofold: to provide an in-depth understanding of 1) the geographical life-spaces in which the lives of older adults take place and 2) the relation between life-space and experienced levels of subjective wellbeing. Seventy-six older adults (aged 65 and older) participated in our qualitative study. We applied a qualitative research approach, through combining indepth-interviews with visual life-space diagrams. Our findings show that most older adults continue to experience a high level of subjective wellbeing, regardless of the extent of their life-space. We conclude that the possibility to fulfill one's needs, even in a restricted life-space, is more conducive to maintaining subjective wellbeing than the extent of life-space itself.

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.

The Dutch Comparative Scale for Assessing Volunteer Motivations among Volunteers and Non-Volunteers: An Adaptation of the Volunteer Functions Inventory.

Currently, no valid scales exist to compare volunteer motivations between volunteers and non-volunteers. We aimed to adapt the Dutch version of the Volunteer Functions Inventory (VFI) in order to make it applicable for the comparison of volunteer motivations between Dutch older volunteers and non-volunteers. The Dutch version of the VFI was included in the Lifelines 'Daily Activities and Leisure Activities add on Study', which was distributed among participants aged 60 to 80. Confirmatory factor analysis (CFA) models were estimated for volunteers and non-volunteers separately, and subsequently a CFA model was created based on all observations irrespective of volunteer status. Finally, group-based CFA models were estimated to assess measurement invariance. The resulting measurement instrument (6 factors, 18 items), containing both a volunteer version and a non-volunteer version, indicated an acceptable model fit for the separate and the combined CFA models (root mean square error of approximation (RMSEA) = 0.06, comparative fit index (CFI) = 0.95). Group-based models demonstrated strong invariance between the samples. The current study provides support for the validity of the Dutch Comparative Scale for Assessing Volunteer Motivations among Volunteers and Non-Volunteers, among Dutch older adults.

The pains and reliefs of the transitions into and out of spousal caregiving. A cross-national comparison of the health consequences of caregiving by gender.

Spousal caregiving offers a unique opportunity to investigate how gender shapes the influence of care responsibilities on health at older ages. However, empirical evidence supporting a causal link between the transitions into and out of caregiving and health is mixed. This study investigates the influence of spousal care transitions on the health of older men and women living in 17 European countries. We use five waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) between the years 2004 and 2015 for a total of 43,435 individuals and 117,831 observations. Health is defined as a Frailty Index calculated from 40 items. Caregiving is defined as intensive help with personal care provided to spouses. Results from asymmetric fixed-effects linear regression models show that the transitions into caregiving have a detrimental effect on health. On the contrary, the transitions out of caregiving have in most cases no beneficial consequences on health. Most importantly, we found evidence supporting differential effects of caregiving transitions by gender and welfare arrangement: the transitions out of caregiving are associated with better health conditions only for Southern and Eastern European women. Our study highlights the asymmetric and gendered nature of care transitions and suggests that the impact of caregiving is somewhat permanent and has long lasting effects for the caregiver. Policies should account for this asymmetry when assessing the impact and consequences of caregiving.

Translation and Validation of the Volunteer Functions Inventory (VFI) among the General Dutch Older Population.

Improvement of volunteering rates in the Netherlands is important because increased productivity among older adults would contribute to societal sustainability in the light of population aging. Therefore, a better understanding of volunteer motivations of Dutch older adults is needed. The Volunteer Functions Inventory (VFI) for assessing volunteer motivations has good psychometric properties and is adapted to several languages, but no validated Dutch translation yet exists. The aim of the current study is to validate the VFI for use in the Dutch older population (60 years and over). The Dutch-translated VFI (6 scales, 30 items) is included in the Lifelines 'Daily Activities and Leisure Activities add-on Study', which was distributed among participants aged 60 to 80. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are performed to assess the validity of the translated VFI. Internal consistency is assessed by computing Cronbach's α's. Results of the EFA (N = 4208) point towards a six-factor solution with a nearly perfectly clean structure. Deletion of three problematic items results in a clean factor structure. CFA results indicate moderate model fit (RMSEA = 0.06, CFI = 0.90, TLI = 0.89). Cronbach's α's (0.78 to 0.85) indicate good internal consistency. Goodness-of-fit indices are sufficient and comparable to those obtained in the validation of the original VFI. The current study provides support for use of the Dutch-translation of the VFI (6 scales, 27 items) to assess volunteer motivations among Dutch volunteers aged 60 years and over.

Gender and Socioeconomic Inequalities in Health at Older Ages Across Different European Welfare Clusters: Evidence from SHARE Data, 2004-2015.

This study takes a comparative approach to assess whether the association between socioeconomic status (SES) and health in later life differs by gender in a sample of individuals aged 50 and above living in nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, Spain, Sweden, and Switzerland). We apply linear hybrid (between-within) regression models using panel data (50,459 observations from 13,955 respondents) from five waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) between the years 2004-2015. SES measures included education, income, and wealth. A 40- item Frailty Index (FI) of accumulated deficits, an important indicator of health in older populations, was used as dependent variable. Considering between-effects estimates, our results show that the positive impact of education and wealth on health is stronger for women living in countries where the welfare arrangements are less decommodifying and defamilializing. No such interaction is found for income and for fixed-effects estimates. This study could advance the understanding of gender inequalities in health. Also, such findings can guide future policies devoted at reducing gender and socioeconomic inequalities in health in later life.

Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study.

BACKGROUND: When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account. METHODS: Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher's exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level. RESULTS: Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were 'ownership', 'relative advantage', 'support from colleagues' and 'compatibility'. Determinants on the organizational level were 'organizational size' and 'innovation-task orientation fit'. Multilevel analysis showed that 'compatibility', a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model. CONCLUSIONS: This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals' perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers' perception of 'innovation-task orientation fit' were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.

Determinants of participation in voluntary work: a systematic review and meta-analysis of longitudinal cohort studies.

BACKGROUND: Participation in voluntary work may be associated with individual and societal benefits. Because of these benefits and as a result of challenges faced by governments related to population ageing, voluntary work becomes more important for society, and policy measures are aimed at increasing participation rates. In order to effectively identify potential volunteers, insight in the determinants of volunteering is needed. Therefore, we conducted a systematic review including meta-analyses. METHODS: A systematic search in MEDLINE, PsycINFO, SocINDEX, Business Source Premier, and EconLit was performed on August 12th 2015. We included longitudinal cohort studies conducted in developed countries that quantified factors associated with volunteering among samples from the general adult population. Two reviewers independently selected eligible studies, extracted the data and assessed the risk of bias of the included studies using the QUIPS tool. Estimates reported in the papers were transformed into Odds Ratios and 95% Confidence Intervals. For each determinant, random-effects meta-analyses were used to generate summary estimates. RESULTS: We found that socioeconomic status, being married, social network size, church attendance and previous volunteer experiences are positively associated with volunteering. Age, functional limitations and transitions into parenthood were found to be inversely related to volunteering. CONCLUSIONS: Important key factors have been identified as well as gaps in the current literature. Future research should be directed towards deepening the knowledge on the associations between the factors age, education, income, employment and participation in voluntary work. Moreover, major life course transitions should be studied in relation to volunteering.

Cross-Cultural Adaptation of the Social Vulnerability Index for Use in the Dutch Context.

Being able to identify socially frail older adults is essential for designing interventions and policy and for the prediction of health outcomes, both on the level of individual older adults and of the population. The aim of the present study was to adapt the Social Vulnerability Index (SVI) to the Dutch language and culture for those purposes. A systematic cross-cultural adaptation of the initial Social Vulnerability Index was performed following five steps: initial translation, synthesis of translations, back translation, a Delphi procedure, and a test for face validity and feasibility. The main result of this study is a face-valid 32 item Dutch version of the Social Vulnerability Index (SVI-D) that is feasible in health care and social care settings. The SVI-D is a useful index to measure social frailty in Dutch-language countries and offers a broad, holistic quantification of older people's social circumstances related to the risk of adverse health outcomes.

Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults.

OBJECTIVE: The Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity. METHODS: In the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants' baseline characteristics. Professionals completed questions regarding program fidelity. RESULTS: No significant differences were found on effect outcomes and adherence between IMP and RCT (all p≥0.135). Intervention effect sizes were equal (0.47-0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations. CONCLUSION: The effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity. PRACTICE IMPLICATIONS: The SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.

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

Purpose of the study: Previous research has overlooked the heterogeneity in older adults' personal conceptions of subjective well-being (SWB), by not taking into account intradomain differences in the conceptions of SWB for different groups of older adults. The aim of this article is therefore to explore (a) older adults' own views on which aspects, categorized under domains, are important to their SWB and (b) which domains and aspects are important to older adults in different contexts and with different characteristics: to men and women, of different ages, and in different housing arrangements. Design and methods: Sixty-six older adults (aged 65 and older) participated in our study. We asked the participants to freely nominate aspects of SWB that are important to them, using participant-generated word clouds as our exploratory, qualitative data collection method. The data were analyzed using qualitative inductive content analysis. Results: We found 15 domains based on our participants' conceptions of SWB. The multidimensional domains of social life, activities, health, and space and place were most important to our participants. The domains and aspects were defined and prioritized differently by different groups of participants. Implications: SWB should be studied as a multidimensional, individualized, and contextualized process to generate meaningful empirical information for researchers and policymakers.

Keeping up appearances: the role of identity concealment in the workplace among adults with degenerative eye conditions and its relationship with wellbeing and career outcomes.

PURPOSE: This study aims to describe the interplay between the work trajectories and the passing patterns of individuals with degenerative eye conditions in different phases of their career, as well as the disease progression and the career and well-being outcomes associated with different works and passing trajectories. METHODS: Qualitative interviews on the topic of work trajectories were conducted with 36 working or retired individuals with degenerative eye conditions. The "bigger picture" method was used to explore passing and concealment behavioral patterns, and their associations with various work trajectories. RESULTS: Five patterns of passing and concealment behavior in the workplace were identified and were linked with various work trajectories among visually impaired study participants: (1) no career adjustments, concealed condition throughout career; (2) revealed condition after adjusting career plans; (3) increasingly open about their condition over the course of their career; (4) engaged in career planning, always open about their condition; and (5) engaged in limited career planning, always open about their condition. CONCLUSIONS: Patterns characterized by less planning and more identity concealment were associated with more stress and lower levels of self-acceptance, while patterns characterized by more planning for vision deterioration and less passing behavior were associated with higher levels self-acceptance and fewer obstacles over the course of an individual's career. The study's findings can serve as a guide for health professionals. IMPLICATIONS FOR REHABILITATION: Many individuals with degenerative eye conditions try to conceal their identity as visually impaired in the professional setting. Different aspects of career outcomes (e.g. age of retirement) and wellbeing outcomes (e.g. self-acceptance and stress) associate with identity concealment patterns of individuals throughout their careers. Identifying concealment patterns will allow health professionals to tackle particular adverse outcomes and challenges associated with these patterns.

Identifying the determinants of use of the G&G interventions for older adults in health and social care: protocol of a multilevel approach.

BACKGROUND: Despite aging-related losses, many older adults are able to maintain high levels of subjective well-being. However, not all older adults are able to self-manage and adapt. The GRIP&GLEAM [Dutch: GRIP&GLANS] (G&G) interventions have shown to significantly improve self-management ability, well-being and loneliness in older adults. Actual use of the evidence-based G&G interventions, however, remains limited as long as the interplay between implementation factors at different hierarchical stakeholder levels is poorly understood. The aim of the study is to identify the determinants of successful implementation of the G&G interventions. METHODS/DESIGN: The study is performed in health and social care organizations in the northern part of the Netherlands. The degree of implementation success is operationalized by four parameters: use (yes/no), pace (time to initial use), performance (extent of use) and prolongation (intention to continue use). Based on the Fleuren model, factors at four hierarchical stakeholder levels (i.e. target group, professionals, organizations and financial-political context) are assessed at three measurement points in 2 years. The nested data are analyzed applying multilevel modeling techniques. DISCUSSION: In this study, health and social care organizations are considered to be part of multilevel functional systems, in which factors at different hierarchical stakeholder levels impede or facilitate use of the G&G interventions. Strengths of the study are the multifaceted measurement of use, and the multilevel approach in identifying the determinants. The study will contribute to the development of ecologically valid implementation strategies of the G&G interventions and comparable evidence-based practices.

Personal networks and mortality risk in older adults: a twenty-year longitudinal study.

BACKGROUND: Research on aging has consistently demonstrated an increased chance of survival for older adults who are integrated into rich networks of social relationships. Theoretical explanations state that personal networks offer indirect psychosocial and direct physiological pathways. We investigate whether effects on and pathways to mortality risk differ between functional and structural characteristics of the personal network. The objective is to inquire which personal network characteristics are the best predictors of mortality risk after adjustment for mental, cognitive and physical health. METHODS AND FINDINGS: Empirical tests were carried out by combining official register information on mortality with data from the Longitudinal Aging Study Amsterdam (LASA). The sample included 2,911 Dutch respondents aged 54 to 85 at baseline in 1992 and six follow-ups covering a time span of twenty years. Four functional characteristics (emotional and social loneliness, emotional and instrumental support) and four structural characteristics (living arrangement, contact frequency, number of contacts, number of social roles) of the personal network as well as mental, cognitive and physical health were assessed at all LASA follow-ups. Statistical analyses comprised of Cox proportional hazard regression models. Findings suggest differential effects of personal network characteristics on survival, with only small gender differences. Mortality risk was initially reduced by functional characteristics, but disappeared after full adjustment for the various health variables. Mortality risk was lowest for older adults embedded in large (HR = 0.986, 95% CI 0.979-0.994) and diverse networks (HR = 0.948, 95% CI 0.917-0.981), and this effect continued to show in the fully adjusted models. CONCLUSIONS: Functional characteristics (i.e. emotional and social loneliness) are indirectly associated with a reduction in mortality risk, while structural characteristics (i.e. number of contacts and number of social roles) have direct protective effects. More research is needed to understand the causal mechanisms underlying these relations.

Geographic proximity of adult children and the well-being of older persons.

This article aims to contribute to the discussion of how adult children affect the well-being of their older parents by investigating the importance of living in close geographic proximity. We investigate whether having children at all, and/or having them geographically proximate, contributes differently to the well-being of older persons living with and without a partner. We enriched survey data for the Netherlands (N = 8,379) with municipal register data and regressed life satisfaction of persons aged 65+ on having children and three different measures of geographic proximity. Having children contributes to the well-being of older men with a partner. There is evidence for a positive association between proximity of children and parental well-being, in particular for widowed and separated mothers and for separated fathers. Our findings suggest that close proximity may be a condition under which adult children can significantly add to the well-being of widowed and separated mothers and separated fathers.

Receiving Instrumental Support in Late Parent-Child Relationships and Parental Depression.

OBJECTIVES: This study investigates the role of gender, functional limitations, and social interaction in the association between instrumental support from adult children and parental depression. We apply self-determination theory to hypothesize about the role of physical needs and social resources on parental depression in a European context. METHOD: A sample of 6,268 parents older than 65 who have nonresident children from the first wave of Survey of Health, Ageing and Retirement in Europe (2004) is analyzed. We estimate logistic regression models to test for the association between instrumental support and depression. Physical needs, gender, and social interaction are used as moderators. RESULTS: Net of core factors that contribute to depression, including previous history of depression, there is a U-shaped pattern between receiving instrumental support and depression that persists across country regimes. For respondents with medium physical limitations, too little or too frequent support from children is associated with higher depression. For respondents with severe limitations, receiving at least some support is better than receiving none at all. The receipt of too frequent support from children increases the level of depression more for women than men. All interaction effects are comparable across country regimes. DISCUSSION: Heterogeneity in physical needs and resources of older individuals must be taken into account when assessing the effects of instrumental support on mental health.

Does loneliness mediate the relation between social support and cognitive functioning in later life?

Research in gerontology has demonstrated mixed effects of social support on cognitive decline and dementia: Social support has been shown to be protective in some studies, but not in others. Moreover, little is known about the underlying mechanisms between social support and cognitive functioning. We investigate one of the possible mechanisms, and argue that subjective appraisals rather than received amounts of social support affect cognitive functioning. Loneliness is seen as an unpleasant experience that occurs when a person's network of relationships is felt to be deficient in some important way. As such, loneliness describes the extent to which someone's needs are not being met and thus provides a subjective assessment of support quality. We expect that receiving instrumental and emotional support reduces loneliness, which in turn preserves cognitive functioning. Data are from the Longitudinal Aging Study Amsterdam (LASA) and include 2255 Dutch participants aged 55-85 over a period of six years. Respondents were measured every three years. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), the Coding Task, and the Raven's Coloured Progressive Matrices. The analytical approach comprised latent growth mediation models. Frequent emotional support related to reduced feelings of loneliness and better cognitive functioning. Increases in emotional support also directly enhanced cognitive performance. The protective effect of emotional support was strongest amongst adults aged 65 years and older. Increase in instrumental support did not buffer cognitive decline, instead there were indications for faster decline. After ruling out the possibility of reversed causation, we conclude that emotional support relationships are a more powerful protector of cognitive decline than instrumental support relationships.