Development and validation of a paternalism and autonomist care assessment.

AIM: There is a need for a validated instrument to measure the type of care (paternalism or person-centred) provided for older adults. Since paternalism and person-centred care are the most important caregiving styles in the field of care and as they are usually opposed, the study aims to develop and establish psychometrics data of an instrument to identify paternalistic and autonomist behaviours in older adults care contexts, which can help to enhance care practice. DESIGN: Instrument development. METHODS: After observing and standardizing behaviours in formal care contexts in 2016, an instrument was developed and proceeding to a first validation using standard validation techniques among caregivers in two care settings during 2016-2017: senior citizen centres and older adult day care centres. RESULTS: The Paternalist/Autonomist Care Assessment (PACA) is a 30-item, behaviour-based instrument which measures both the appraisal of caregivers on elements of care (Care Appraisal Scale- PACA-Appraisal) and the occurrence of behaviours (Occurrence of Care in Context- PACA-Occurrence). The Paternalist/Autonomist Care Assessment (PACA) was validated in 160 professional caregivers and was able to discriminate two factors: paternalistic or overprotective behaviours and autonomist behaviours. However, these factors were not fully dichotomous and were shown to coexist to some degree. CONCLUSION: The instrument displayed good psychometric properties to measure paternalism and autonomy in older adult care. Moreover, it showed that the two types of care are not antagonistic and can coexist, with overprotective behaviours being more frequent in contexts of care for more dependent persons. IMPACT: There are no validated instruments to measure paternalism and person-centred behaviour in care contexts. The two measures yielded by the PACA show good construct and concurrent empirical validity, internal consistency, and convergent and discriminant validity. Family caregiver, professional caregivers, nurses, older adults.

Promoting aging well: evaluation of Vital-Aging-Multimedia Program in Madrid, Spain.

This article attests to the effectiveness of Vital Aging-Multimedia (VA-M, 'Vivir con Vitalidad-M'), a psycho-educational multimedia program designed to promote successful aging. The program was implemented over 3 months through 35 h of video lessons grouped into 15 thematic units addressing four domains of experience commonly associated with aging well: health and healthy habits, cognitive functioning, aging self-efficacy and well-being and social participation. In accordance with a quasi-experimental design, a total of 115 senior citizens (aged 54-82) participated: 73 subjects attended the VA-M, while 42 subjects with similar characteristics served as controls. All subjects were assessed before and after the program on target variables related to the above domains of functioning. Significant changes in most of the examined variables documented the positive effects of the program.

Positive Perception of Aging and Performance in a Memory Task: Compensating for Stereotype Threat?

UNLABELLED: BACKGROUND/STUDY CONTEXT: The aim of this research is to explore whether segments of seniors might be immune to aging stereotypes of the older adult group. Stereotype threat research indicates that older adults show low memory recall under conditions of stereotype threat. Stereotype internalization theory (Levy, 2009) predicts that a positive perception of aging has favorable effects on the behavior and health of older people. METHODS: A total of 112 older adult participants (62% women, aged 55 to 78) attending the University Programme for Older Adults were assigned to one of two conditions: stereotype threat condition and positive information condition. A control group was included from participants in the same program (n = 34; 61% women, aged 55 to 78). Individual differences in self-perception of aging were considered as continuous variable. RESULTS: Participants with better self-perception of aging showed better memory performance than those with poorer self-perception of aging in the stereotype threat condition and control condition. However, no differences were found in the positive information condition between participants with high and low self-perception of aging. These results indicate that positive self-perception of aging moderates the effects of stereotype threat, and that positive information promotes better memory performance for those older adults with a poorer self-perception of aging. CONCLUSION: As expected, individuals with a positive perception of their own aging were less vulnerable to the activation of a negative older adult stereotype in the stereotype threat condition.

Anthropometric, body composition and health determinants of active ageing: a gender approach.

This study applied a gender perspective to establish some of the anthropometric, body composition, health and socio-cultural determinants of active ageing. The variable 'active ageing' (presence/absence) was created based on cognitive and disability/illness/physical functioning, subjective health, satisfaction with life and productive activity performed, and used in predictive models to establish its relationship with anthropometric variables, physical health indicators and educational level. The sample consisted of 456 home-living individuals (169 men and 287 women; age range 54-75 years) from Madrid and Toledo in Spain. The women had a higher prevalence of obesity than the men (37.6% vs 29.0%), significantly greater fat accumulation in the abdominal area and worst perceived health (p=0.003). The frequency of active agers is higher in men than in women (38.4% vs 21.9%; p<0.001). Men and women were found to have distinctive ageing patterns. Health factors condition the presence of active ageing in women, while education factors are also relevant in men.

Health, Psycho-Social Factors, and Ageism in Older Adults in Spain during the COVID-19 Pandemic.

Older adults are a population at risk for COVID-19. This study has two independent objectives: (1) to report the impact of COVID-19, as well as psycho-social responses during lockdown, in a sample of older adults in Spain, and (2) to explore through the review of published surveys what extent ageism has increased at the population level. The first objective was to search through an online questionnaire collecting information about self-reported health, lifestyles, psycho-social conditions, and a diversity of concerns. This questionnaire was administered to a volunteer sample of 315 older Spanish men and women (301 COVID-19-free and 14 diagnosed with COVID-19). All individuals reported that they had information about the COVID-19 pandemic. Their self-perception of health was also quite good, most maintaining healthy lifestyles and few reporting unhealthy behaviors. They reported few changes in family and interpersonal relations during lockdown. Those diagnosed with COVID-19 reported higher levels of anxiety, irritation, and fear, in comparison with the COVID-19-free group. Interestingly, instead of being concerned about health, the greatest concern in both groups (COVID-free and those diagnosed with COVID) were politics and the future. Our second objective, to explore ageism during the first wave of the COVID-19 pandemic, was examined across various surveys conducted in several populations by several authors. Results showed an increase in ageism in Spain. Although some new information about health perception, psychosocial responses, and concerns during this unknown stressful situation was obtained, much more research with representative samples is required in order to arrive at more accurate conclusions.

Cognition in Healthy Aging.

The study of cognitive change across a life span, both in pathological and healthy samples, has been heavily influenced by developments in cognitive psychology as a theoretical paradigm, neuropsychology and other bio-medical fields; this alongside the increase in new longitudinal and cohort designs, complemented in the last decades by the evaluation of experimental interventions. Here, a review of aging databases was conducted, looking for the most relevant studies carried out on cognitive functioning in healthy older adults. The aim was to review not only longitudinal, cross-sectional or cohort studies, but also by intervention program evaluations. The most important studies, searching for long-term patterns of stability and change of cognitive measures across a life span and in old age, have shown a great range of inter-individual variability in cognitive functioning changes attributed to age. Furthermore, intellectual functioning in healthy individuals seems to decline rather late in life, if ever, as shown in longitudinal studies where age-related decline of cognitive functioning occurs later in life than indicated by cross-sectional studies. The longitudinal evidence and experimental trials have shown the benefits of aerobic physical exercise and an intellectually engaged lifestyle, suggesting that bio-psycho-socioenvironmental factors concurrently with age predict or determine both positive or negative change or stability in cognition in later life.

Behavioral Lifestyles and Survival: A Meta-Analysis.

The aim of the study is to determine the association between Behavioral Lifestyles (regular physical activity, healthy diet, sleeping, and weight control) and longevity in the elderly. A search strategy was conducted in the PsycInfo, Medline, PubMed, Web of Science (WoS), and Scopus databases. The primary outcome was mortality/survival. Four variables (mean of participant's age at the baseline of the study, follow-up years of the study, gender, and year of publication) were analyzed to evaluate the role of potential moderators. Ninety-three articles, totaling more than 2,800,000 people, were included in the meta-analysis. We found that the lifestyles analyzed predict greater survival. Specifically, doing regular physical activity, engaging in leisure activities, sleeping 7-8 h a day, and staying outside the BMI ranges considered as underweight or obesity are habits that each separately has a greater probability associated with survival after a period of several years.

Cultural aging stereotypes in European Countries: Are they a risk to Active Aging?

A growing body of literature acknowledges the association between negative stereotypes and individual components of active aging, but very few studies have tested this association, at both individual and population levels. The Stereotypes Content Model (SCM) states that the cultural aging stereotyping of higher warmth than competence (called paternalistic or ambivalent prejudice) is universal. Our aims in this study are to test the extent to which the universality of this stereotype is confirmed in European Countries as well as how far "positive", "negative" or "ambivalent" views towards older people, and other negative attitudes such as prejudice and behaviours such as discrimination, predict active aging assessed both at individual and population levels. We have analyzed data from the European Social Survey-2008 (ESS-2008), containing SCM stereotypical and other appraisal items (such as direct prejudice and perceived discrimination) about adults aged over-70 from 29 European countries. First, SCM cultural stereotypes about older adults ("friendly", "competent", and "ambivalent") were calculated; secondly, after developing a typology of countries based on their "negative", "ambivalent" and "positive" views about older adults, the universality of cultural stereotypes was tested; thirdly, taking into consideration ESS data of those older persons (over 70s) who self-reported indicators of active aging (health, happiness, satisfaction and social participation), multilevel analyses were performed, taking our inter-individual measure of active aging as dependent variable and our stereotypical classification (positive/negative/ambivalent), direct prejudice and perceived discrimination as predictors; finally, relationships between stereotypical and appraisal items on older adults were examined at population level with country data from Active Aging Indexes. Our results show cultural stereotypes about older people (more friendly than competent) are widespread in most European countries, and negative cultural views of older adults are negatively associated with active aging both at individual and population level, supporting that negative cultural views of older adults could be considered as a threat to active aging.

Are Psycho-Behavioral Factors Accounting for Longevity?

The general objective of this article is to critically review the state of the art regarding current factors accounting for aging, longevity and successful longevity. There are two major constructs which most authors are employing to account for longevity: genetic or intrinsic components versus environmental or extrinsic factors. This classification has important flaws: (i) From an epigenetic standpoint, such a polar classification could lead to misconceptions since both factors are interdependent through lifelong interactions. (ii) There are no specifications regarding these "environmental" factors, which include a broad heterogeneity of conditions (physical, economic, social, and cultural aspects as well as behavioral ones such as lifestyle) but do not include personal conditions, such as psychological characteristics. The review of the new paradigm called successful aging yields an important set of psycho-behavioral factors, and although population indexes such as Disability Free Life Expectancy (DFLE) or Healthy Life expectancy (HLE) have been developed, authors do not take into consideration healthy or successful longevity as a potential prolongation of the new paradigm of active or successful aging. There is a broad corpus of research literature supporting the importance of psycho-behavioral (PB) factors intervening in the ways of aging, specifically intelligence and cognitive functioning, positive emotion and control, personality traits, psychosocial, physical conditions, and lifestyles, all of which are highly associated with active aging, health, longevity, and survival. The importance of these factors accounting for longevity, and successful longevity must be taken into consideration as a pending issue in gerontology.

A training intervention to reduce paternalistic care and promote autonomy: a preliminary study.

INTRODUCTION: Paternalism, assuming control of aged care, is a widespread orientation in older adults care. Paternalistic attitudes and practices are commonly understood as a threat to the freedom and autonomy of a person, making patients more dependent. Therefore, the reduction of these attitudes and behaviors is a primary goal for any older adult health and social care situation. The aim of this preliminary study is to develop a behavioral intervention to decrease paternalistic behaviors in formal caregivers and to increase those care behaviors which promote autonomy at post-intervention (1 week) and at follow-up (14 weeks). METHODS: A sample of 118 professional caregiver volunteers working in day care centers and nursing homes were assigned to quasi-experimental (N=47) and control (N=71) conditions. The intervention consisted of 3 weekly group sessions. Individual and contextual measures were collected: 1) the primary outcome variable was the type of care (paternalistic versus autonomist) measured through the self-report Paternalist/Autonomist Care Assessment (PACA); 2) A 10-item caregiver self-register of paternalistic behaviors was carried out, 3) Finally, in order to assess the potential effects on observed behavior both in caregiver and older adult functioning at a contextual level, the five institutions were assessed through the SERA-RS. RESULTS: Compared with the control group, caregivers in the behavioral intervention group displayed significantly lower paternalistic appraisals at posttest and follow-up. Regarding the intervention group, caregivers at posttest and follow-up showed significantly greater occurrence of autonomist behaviors being promoted and lower paternalistic appraisal. The results regarding the effect on the institutions showed better personnel performance and older adult functioning. CONCLUSION: Caregivers who followed the intervention learned to better identify older adult needs; although we did not find significant differences in autonomy occurrence compared with the control group, a behavioral intervention may promote more autonomist environments and, therefore, better personnel and older adult functioning.

[Cognitive plasticity in Alzheimer's disease patients receiving cognitive stimulation programs]. / Plasticidad cognitiva en personas con la enfermedad de Alzheimer que reciben programas de estimulación cognitiva.

The main purpose of this article is to examine whether cognitive plasticity increases after cognitive training in Alzheimer's disease patients. Twenty six patients participated in this study, all of them diagnosed with mild Alzheimer's disease, 17 of them received a cognitive training program during 6 months, and the other 9 were assigned to the control group. Participants were assigned to experimental or control conditions for clinical reasons. In order to assess cognitive plasticity, all patients were assessed before and after treatment with three subtests from the "Bateria de Evaluación de Potencial de Aprendizaje en Demencias" [Assessment Battery of Learning Potential in Dementia] (BEPAD). After treatment, Alzheimer's disease patients improved their performance in all the tasks assessing cognitive plasticity: viso-spatial memory, audio-verbal memory and verbal fluency. However, the cognitive plasticity scores of the patients in the control group decreased. In conclusion, this study showed that cognitive stimulation programs can improve cognitive functioning in mildly demented patients, and patients who do not receive any cognitive interventions may reduce their cognitive functioning.

Cultural stereotypes in care contexts.

INTRODUCTION: The main goal of the present study was to examine the stereotype content model (SCM) assumption for universality and to test whether the mediating role of cultural views about older adult caregivers is maintained in other health care contexts. METHODS: One hundred and sixty professionals and volunteers who worked with older adults in day care centers (DCCs) and senior citizen centers (SCCs) and 1,151 participants from a representative sample of the Spanish population were examined using the SCM questionnaire; older adult and personnel functioning were assessed through an observation procedure with two subscales of the Evaluation Scale from the Sistema de Evaluación de Residencias de Ancianos. RESULTS: The results showed that the context does not seem to influence the cultural views about older adults held by caregivers. All results support the cultural stereotype pattern in which members of the older adult group are viewed with high warmth (HW) and low competence (LC) as posited by the SCM model. With respect to the mediation of cultural stereotypes on caregivers/older adult functioning, this has not been supported in this study. Neither cultural views of warmth (predicted by the SCM) nor views of competence (from our previous studies) influence either caregiver functional behaviors or older adult functioning. CONCLUSION: Two post hoc hypotheses can be inferred: 1) there is more variability in competence and warmth in DCCs and SCCs and 2) although we did not find significant differences in the pattern of competence and warmth in perceived cultural stereotypes about older adults, more healthy environments could reduce the influence of cognitive views on behavior.

The role of perceived discrimination on active aging.

Among older adults, perceived age discrimination is highly associated with unhealthy outcomes and dissatisfaction. Active aging is a multidimensional concept described by a set of characteristics, particularly health, positive mood and control; most importantly, active aging is currently at the core of public policies. The aim of the present study was to test to what extent perceived discrimination influences active aging. Methods A total of 2005 older adults in three representative samples from regions of Germany, Mexico and Spain participated; they were tested on active aging and perceived discrimination. First, active aging was defined as high reported health, life satisfaction and self-perception of aging. Second, authors introduced the assumption that, in the total sample, structural equation modelling would confirm the hypothesis of a direct negative link between perceived age discrimination and active aging. Finally, multiple group comparison performed through structural equation modelling also provided support for the negative association between perceived discrimination and active aging proposed. In spite of the differences found among the three countries in both active aging variables and age discrimination perception, multiple group comparison indicates that regardless of the culture, perceived discrimination is a negative predictor of active aging.

Assessing aging stereotypes: Personal stereotypes, self-stereotypes and self-perception of aging.

BACKGROUND: There is a broad semantic network of aging stereotypes; where different concepts and their measurement are confused: personal stereotypes, self-stereotypes and self-perception of aging. METHOD: First, we analyze the translated version of the Image of Aging Scale (IAS) measurement model through exploratory and confirmatory factor analysis, with two representative sub-samples of the Spanish population aged over eighteen (N = 1,105) and in a sample of gerontologists and geriatricians (N = 325). Second, in an effort to disentangle the theoretical relationships between personal stereotypes, self-stereotypes and self-perception of aging, both the IAS (with different instructions) and Lawton’s 5-item scale were administered to a representative sample of Spanish people over 50. RESULTS: Our results indicate that the Spanish version of the IAS has a similar psychometric structure to that proposed by the authors. Furthermore, the factorial structure (equal form and metric invariance) is replicated in both samples, but latent means and factor correlations were higher in the professional group. CONCLUSIONS: We discuss Levy’s theoretical assumptions about personal-stereotypes and the self-stereotype measured with IAS and their relationship to self-perception of ageing.

Effectiveness of the Vital Aging program to promote active aging in Mexican older adults.

INTRODUCTION: Aging is not only a population phenomenon but also an experience and an individual reality. Vital Aging® is a program that considers active aging as the lifelong adaptation process of maximizing health and independence, physical and cognitive functioning, positive affect regulation and control, and social engagement. Through its different versions and editions, it has demonstrated being an effective program to promote active aging. The aim of this study is to determine the effectiveness of the "face-to-face" and "combined" versions of the program to promote active aging in Mexican older adults trial. METHODS: Seventy-six older adults aged 60 years and over participated in a quasi-experimental study and were recruited in a senior center to participate in the two experimental conditions: Vital Aging face-to-face (VA-FF) (n=35) and Vital Aging combined (VA-C; multimedia/face-to-face) (n=15), and the remaining 26 adults were assigned to a control group. Pretest and posttest assessments were performed after the theoretical-practical intervention. Mean differences and size effects were calculated for estimating the effect of the program. RESULTS: At the end of the study, participants showed improvements in the active aging outcome measures. Positive effects were observed in the frequency of intellectual, cultural - artistic, and social activities, perceptions of aging, satisfaction with social relationships, and self-efficacy for aging. Additionally, those who participated in VA-FF showed better memory performance, meta-memory, and a trend to report less memory problems, while older persons in VA-C showed a trend to have better life satisfaction. No effects were observed in physical activity, frequency of social relationships, and subjective health. CONCLUSION: Findings show that the Vital Aging program in face-to-face and combined versions encourages active aging in Mexican older persons. These results are in general similar to those found in editions performed in Spain, revealing its consistency as a cross-cultural practical initiative for promoting active aging.

Is older adult care mediated by caregivers' cultural stereotypes? The role of competence and warmth attribution.

PURPOSE: The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers. METHODS: A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers' cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers' cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents' functioning) were applied. RESULTS: Caregivers' cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research. CONCLUSION: Our results underline the influence of caregivers' cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers' cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component.

[Age discrimination. Point of view of the professionals]. / ¿Se discrimina a los mayores en función de su edad? Visión del profesional.

INTRODUCTION: It is generally believed that legislation is an essential resource in the prevention of discriminatory behaviour against older people. This study first examines the Spanish legislation for potential age discrimination and then uses the C-EVE-D questionnaire to ask professionals in social work and health care settings the extent to what certain ageist behaviours described in the questionnaire are observed in practice. METHODS: The field study was carried out with professionals in geriatrics and gerontology, who are members of Spanish Society for Geriatrics and Gerontology (SEGG). The EVE discrimination questionnaire consists of 28 items which investigate the existence of age discrimination in medical and social care contexts. RESULTS: A total of 174 people (63% women; mean age: 45.6 years) took part in the study, with a mean professional experience of 17.2 years. Doctors made up 59% of the sample, psychologists 19%, with the rest coming from other professions. The first 20 discrimination items of the EVE-D questionnaire were significantly positively reported by more than 60% of the sample. CONCLUSIONS: Although Spanish legislation, from the constitution down to the rules that govern social and health care settings, clearly prohibits any kind of discrimination with regard to age, our results show that Spanish professionals most closely involved in the care of older people perceive both direct and indirect age discrimination. Furthermore, evidence was found of prejudice in the treatment of older people as a phenomenon in day-to-day health and social services care, both when analysing medical cases and, to a greater extent, cases of a more general nature and/or relating to co-existence.