Adverse childhood experiences, adult trauma, and depressive symptom trajectories.

OBJECTIVES: Associations among adverse childhood experiences prior to age 18 (ACEs), subjective reports of trauma during Hurricane Sandy, and trajectories of depressive symptoms reported by community-dwelling older people were examined. METHODS: We analyzed 6 waves of data from 5,688 people aged 50-74 recruited in 2006 and followed for 12-years using multilevel mixed effects models. RESULTS: We found that: (1) people who experienced ACEs had trajectories of depressive symptoms in late life that were higher than people not having these experiences, (2) people experiencing two or more ACEs were more likely to report fear and distress when Hurricane Sandy hit than people experiencing either one or no adverse childhood experiences, and (3) while both ACE exposure and peri-traumatic stress were associated with trajectories having higher levels of depressive symptoms, the risk associated with ACEs (especially multiple ACEs) was greater. CONCLUSION: Findings support life course stress theories including the cumulative inequality theory and stress proliferation theory, suggesting that inequalities are manifested over the life course and that people experiencing adversity during childhood are at increased risk of experiencing adversity in late life. By studying the relationship between adverse childhood experiences and response to Hurricane Sandy our findings demonstrate that adverse childhood experiences can alter the way traumatic events in adulthood are experienced. This finding in turn, has important implications for clinical practice, as it identifies a group of people likely to be at risk for adult trauma.

The Prospective Association of Personality Traits and Successful Aging.

We used data (N = 928) from ORANJ BOWL, a six-wave panel of adults (aged 50-74 at baseline) to address the association between personality and successful aging at two points in time, 8 years apart. Regressions examined the associations between Wave 2 neuroticism, extraversion, openness, agreeableness, and conscientiousness and Wave 3 subjective success, functional ability, pain, and chronic conditions. Models tested personality traits independently and then simultaneously, with interactions. Confirmatory analyses used Waves 5/6 data. All traits but openness were individually associated with successful aging at both time points. When testing traits simultaneously, only neuroticism and extraversion were consistently associated with subjective success, with an interaction at Waves 2/3. Neuroticism (Waves 2/3) and conscientiousness (Waves 5/6) were associated with functional ability. Neuroticism was associated with pain (Waves 2/3). Personality was not associated with chronic conditions. These analyses set up future work examining relationships between change in personality and change in successful aging.

Exposure to Hurricane Sandy, neighborhood collective efficacy, and post-traumatic stress symptoms in older adults.

OBJECTIVES: Older adults exposed to natural disasters are at risk for negative psychological outcomes such as post-traumatic stress disorder (PTSD). Neighborhood social capital can act as a resource that supports individual-level coping with stressors. This study explores the ability of perceived neighborhood collective efficacy, a form of social capital, to moderate the association between exposure to Hurricane Sandy and PTSD symptoms in older adults. METHOD: Data from 2205 older individuals aged 54-80 residing in New Jersey who self-reported exposure to Hurricane Sandy in October of 2012 were identified and extracted from the ORANJ BOWL™ research panel. Participants completed baseline assessments of demographic and individual-level characteristics in 2006-2008 and follow-up assessments about storm exposure, perceived neighborhood collective efficacy (social cohesion and social control), and PTSD symptoms 8-33 months following the storm. Zero-inflated Poisson regression models were tested to examine the association between exposure, neighborhood collective efficacy, and PTSD symptoms. RESULTS: After accounting for known demographic and individual-level covariates, greater storm exposure was linked to higher levels of PTSD symptoms. Social cohesion, but not social control, was linked to lower reports of PTSD symptoms and moderated the association between exposure and PTSD. The impact of storm exposure on PTSD symptoms was less for individuals reporting higher levels of social cohesion. CONCLUSION: Mental health service providers and disaster preparedness and response teams should consider the larger social network of individuals served. Building social connections in older adults' neighborhoods that promote cohesion can reduce the negative psychological impact of a disaster.

Subjective Successful Aging Predicts Probability of Mortality Over 9 Years Among Adults Aged 50-74.

BACKGROUND AND OBJECTIVES: Although the relationship between mortality and objective successful aging (health, functional ability, social engagement) is clear, the relationship between subjective successful aging (SSA) and mortality is inconclusive. Building on the broader literature regarding psychological well-being, these analyses examine the relationship between SSA and mortality, adjusting for demographic, health, and lifestyle characteristics with known mortality risks. RESEARCH DESIGN AND METHODS: We analyzed self-report data collected between 2006 and 2008 from 5,483 people. In addition to demographic, health, and lifestyle variables, we measured SSA using a valid, reliable measure. Over the course of 3,285 days, 695 people died. We computed four sequential Cox proportional-hazard models to examine the association between SSA and time to death. The first model included only SSA; Model 2 added demographic characteristics; Model 3 added health characteristics; Model 4 added lifestyle characteristics. RESULTS: We found that SSA had a significant association with mortality, accounting for known mortality risk factors. Each one-point rise in SSA decreased the risk of mortality by three percent (0.97; 95% CI= 0.95-0.99; p<0.05). The probability of death within 9 years for persons with SSA scores from 0-5 was 45%; for persons with SSA scores from 25-30, risk of mortality was less than 10%. DISCUSSION AND IMPLICATIONS: Findings provide evidence that lower SSA scores reveal greater risk for mortality beyond demographic, health, and lifestyle variables. A brief assessment of SSA can provide unique clinical information and be used to identify people who might benefit from interventions to reduce mortality risk.

Subjective Successful Aging: Measurement Invariance Across 12 Years.

BACKGROUND AND OBJECTIVES: Debates about how to define successful aging have dominated gerontology for over 60 years. Regardless of how successful aging is conceptualized, in order to accurately understand how the construct changes over time and how it differs between people of varying ages, successful aging must be measured with instruments that are valid, reliable, and have measurement invariance. These analyses focus on subjective successful aging and examine the extent to which a reliable, valid, 3-item scale has measurement invariance across 12 years for individuals aged 50-86. RESEARCH DESIGN AND METHODS: We analyzed 5 waves of data collected from a panel of 5,688 community-dwelling people aged 50-74 when recruited in 2006. We tested measurement invariance using the standard 4 nested steps,, introducing increasing parameter constraints at each step. Analyses were conducted using Mplus 7. RESULTS: Analyses revealed that the 3-item scale measuring subjective successful aging has adequate measurement invariance across time. We demonstrated that the scale has configural, metric, and scalar invariance by most standard metrics. Only residual invariance was not supported. However, because residuals are not part of the latent factor, invariance of the item residuals is inconsequential to interpretation of latent mean differences. DISCUSSION AND IMPLICATIONS: Findings provide the foundation needed for researchers to examine change in subjective successful aging over time, differences in subjective successful aging between people of varying ages, and predictors of subjective successful aging, confident that the scale has adequate measurement invariance.

Long-Term Impact of Hurricane Sandy Exposure on Positive and Negative Affect: The Role of Perceived Social Support.

OBJECTIVES: Natural disasters can have devastating, long-lasting effects on the mental health of older adults. However, few studies have examined associations among disaster exposure and positive and negative affect, and no longitudinal studies have investigated the extent to which predisaster perceived social support affects these associations. These analyses examine the associations among predisaster perceived social support, disaster exposure, and positive and negative affect experienced by community-dwelling older adults 4 years after Hurricane Sandy, controlling for predisaster affect. METHODS: Self-reported data collected before and after Hurricane Sandy from participants (aged 50-74 years) in the ORANJ BOWL panel (N = 2,442) were analyzed using linear regression models. RESULTS: Higher levels of peritraumatic stress experienced during Hurricane Sandy and greater hardship experienced after the storm were associated with more negative affect 4 years following the disaster. Higher perceived social support at baseline was related to more positive affect and less negative affect both before and after the hurricane. Social support did not moderate the effect of hurricane exposure on either positive or negative affect. DISCUSSION: Findings suggest that psychological effects may persist years after natural disasters and that more effective interventions may be needed during and after a disaster. While social support is critical to positive and negative affect in general, its buffering effects when disaster strikes may be limited.

Change in Loneliness Experienced by Older Men and Women Living Alone and With Others at the Onset of the COVID-19 Pandemic.

Building on theory suggesting that loneliness is distinct from living arrangements, social isolation, and perceived social support, we examined change in loneliness for older people at the onset of the COVID-19 pandemic. Analyzing 14-years of data with multilevel mixed-effects models, we found higher levels of loneliness among people living alone, people more socially isolated, and people with less perceived support. Gender affected changes in loneliness, controlling for social isolation, perceived support, living arrangements, age, education, income, health, and marital status. Women, whether living alone or with others, experienced increases in loneliness; women living alone reported the greatest increase in loneliness. Men living alone reported high levels of loneliness prior to the pandemic, but only a slight increase over time. These analyses, which demonstrate that loneliness changed at the onset of the pandemic as a function of gender and living arrangement identify older people most likely to benefit from intervention.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women.

BACKGROUND AND METHODS: Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019). RESULTS: We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves. CONCLUSION: Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

Understanding Attrition and Bolstering Retention in a Longitudinal Panel of Older Adults: ORANJ BOWL.

BACKGROUND AND OBJECTIVES: Attrition from longitudinal studies can affect the generalizability of findings especially when studying developmental constructs such as successful aging. RESEARCH DESIGN AND METHODS: Using data from a 12-year (6-wave) panel of 5,688 older people (aged 50-74 at baseline), we compared people retained in the panel with people lost to follow-up on demographic characteristics and measures of successful aging. After instituting expanded retention strategies at Wave 6 (i.e., a team-based approach, social media, and paid web search engines), we compared different groups of people lost to follow-up (i.e., deceased and withdrawn due to lack of interest) and different types of completers (i.e., full completers vs. lost and reengaged completers). RESULTS: At baseline, Wave 6 completers were significantly younger, less likely to be African American, more likely to be married, reported higher levels of income and education, were more likely to be working full-time, had less pain and fewer chronic illnesses, and reported higher levels of subjective successful aging and functional ability than those lost to follow-up. Analyses demonstrated differences across groups based on the reason for loss (i.e., deceased, impaired, and not interested). Participants who missed an interview but returned to the panel were significantly different from those who participated in all waves of data collection. Expanded retention efforts improved generalizability, as people returning to the panel reported lower levels of education, lower levels of income, and were more likely to be African American. DISCUSSION AND IMPLICATIONS: Biased attrition within longitudinal research affects the interpretation of study findings, especially when studying developmental outcomes. However, expanded retention strategies can reduce bias and loss and should be used to enhance retention efforts in longitudinal work.

Impact of Upper and Lower Body Functional Ability on Affect in Older Couples.

Objective: We explore how upper and lower body functional ability of older adults and their partners relate to affect in later life. Methods: Data regarding own and partner's upper and lower body functional abilities were reported by 1767 married/partnered persons aged 57-83. Using multilevel modeling to account for nesting within couples, we examined the impact of a respondent's own functional abilities, their perception of their partner's abilities, and the interaction of respondent's and perceived partner's abilities on respondent's positive and negative affect. Results: Higher upper and lower body ability of both respondents and partners were associated with higher positive and lower negative affect. Moderating effects demonstrated a protective role of respondents' ability on affect when their partners experienced lower ability. Discussion: There is a potential compensatory relationship between older couples adapting to functional changes; it is important to support the functional abilities of both partners in couples to maximize psychological well-being.

Challenges Experienced by Older People During the Initial Months of the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has created unique stressors for older people to manage. Informed by the Stress Process Model and the Transactional Model of Stress and Coping, we examined the extent to which older people are adhering to physical distancing mandates and the pandemic-related experiences that older people find most challenging. RESEARCH DESIGN AND METHODS: From May 4 to May 17, 2020, a web-based questionnaire focused on the COVID-19 pandemic was completed by 1,272 people (aged 64 and older) who were part of an ongoing research panel in New Jersey recruited in 2006. Frequencies for endorsement of physical distancing behaviors were tabulated, and open-ended responses to the biggest challenge of the pandemic were systematically coded and classified using content analysis. RESULTS: More than 70% of participants reported adhering to physical distancing behaviors. Experiences appraised as most difficult by participants fell into 8 domains: Social Relationships, Activity Restrictions, Psychological, Health, Financial, Global Environment, Death, and Home Care. The most frequently appraised challenges were constraints on social interactions (42.4%) and restrictions on activity (30.9%). DISCUSSION AND IMPLICATIONS: In the initial weeks of the pandemic, the majority of older adults reported adhering to COVID-19 physical distancing mandates and identified a range of challenging experiences. Results highlight the factors having the greatest impact on older adults, informing quantitative modeling for testing the impact of the pandemic on health and well-being outcomes, and identifying how intervention efforts may be targeted to maximize the quality of life of older adults.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession.

OBJECTIVES: To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession. METHODS: We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression. RESULTS: We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy. DISCUSSION: Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

Type of Disaster Exposure Affects Functional Limitations of Older People 6 Years Later.

BACKGROUND: Natural disasters, including earthquakes, tsunamis, tornadoes, and hurricanes, are traumatic events that simultaneously affect the lives of many people. Although much is known about the effects that natural disasters have on mental health, little is known about how natural disasters affect physical health. These analyses add to the literature by examining the ways in which four types of disaster exposure (geographic, peri-traumatic stress, personal and property loss, and poststorm hardship) experienced by older people during and after Hurricane Sandy affected functional limitations. METHODS: We analyzed five waves of data from the ORANJ BOWL panel ("Ongoing Research on Aging in New Jersey: Bettering Opportunities for Wellness in Life") using multilevel mixed-effects models. RESULTS: We found that although peri-traumatic stress and poststorm hardship each had independent effects on functional limitations, the effects of peri-traumatic stress dominated and were evident 6 years after the hurricane. Geographic exposure and personal/property loss were not associated with functional limitations. CONCLUSIONS: These findings add important information to what is known about older people who experience a natural disaster and suggest opportunities for intervention. Finding that an individual's emotional response during the disaster plays an important role in the development of functional limitations suggests that reduction of exposure to traumatic stress during a storm (ie, evacuation from a storm area) may be important for older people. Likewise, interventions immediately after a disaster that target older people who experience high levels of peri-traumatic distress may be needed in order to alleviate functional limitations before they develop.

Effects of marital closeness on the transition from caregiving to widowhood.

OBJECTIVE: To examine the effects of marital closeness on indicators of well-being (depressive symptoms, grief, and relief) as spouses transition from the role of caregiver to that of widowed person. METHODS: 118 spouses of persons with end stage renal disease were interviewed prior to and after the death of the patient. Spouses reported on marital closeness, multiple indicators of pre-death strain as reflected by subjective health, depressive symptoms, caregiving burden, and caregiving satisfaction, as well as post-loss feelings of grief, depression, and relief. RESULTS: Hierarchical regressions indicated that post-loss grief was predicted by gender (b = 0.32, p < 0.001), self-reported health (b = -0.28, p < 0.01), marital closeness (0.22, p < 0.05), and pre-loss depressive symptoms (b = 0.19, p < 0.10). Caregiver burden (b = 0.28, p < 0.05) and marital closeness (b = -0.41, p < 0.001) before the death, predicted relief from the caregiver role post-loss. Subjective health (b = -0.21, p < 0.05) and pre-loss depressive symptoms (b = 0.47, p < 0.001) predicted change in depressive symptoms over time. CONCLUSION: These data highlight differences in the experiences of grief, relief, and depressive symptoms and suggest that marital closeness plays a central role. Results are interpreted in terms of theory regarding marital quality. Implications for interventions to improve the lives of caregivers and newly widowed spouses are discussed.

Depressive symptoms and marital satisfaction in the context of chronic disease: a longitudinal dyadic analysis.

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples.

Stability and change in patient preferences and spouse substituted judgments regarding dialysis continuation.

OBJECTIVES: The objective of this study was to examine whether some treatment preferences are more stable than others, how patient preferences and substituted judgments change over time, and whether some people's decisions are more stable than others'. METHODS: Hypothetical scenarios elicited preferences for dialysis continuation under various health conditions at two points in time. Predictors included initial treatment preference, age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health. RESULTS: Some treatment preferences were more stable than others, and the cause of this stability varied across treatment preferences. Similarity between patient preferences and spouse substituted judgments within couples was low and varied as a function of hypothetical condition. The strongest predictor of treatment preferences at follow-up was initial preference. Age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health had limited effects on changes to treatment preferences. DISCUSSION: There is a great deal more stability than change in patient preferences and substituted judgments regarding continuation of dialysis over the course of 1 year. This suggests that if patients have previously expressed preferences it is possible for this to maintain their voice in end-of-life decisions when the patients themselves are unable to express their wishes.

Challenges Faced and Support Received: Older Adults' Perceptions of Hurricane Sandy.

OBJECTIVE: Individuals exposed to natural disasters are at risk for negative physical and psychological outcomes. Older adults may be particularly vulnerable; however, social support can act as a resource to help individuals respond to severe stressors. This study explored the challenges older people faced before, during, and after Hurricane Sandy in October 2012 and the people they turned to for support. METHODS: Semi-structured interviews were conducted with 20 older adults in New Jersey drawn from the ORANJ BOWL (Ongoing Research on Aging in New Jersey - Bettering Opportunities for Wellness in Life) research panel, who experienced high levels of primary home damage during Hurricane Sandy. Content analysis of interview transcripts classified older adults' perceptions on how they "made it" through-the challenges they faced and the support they received. RESULTS: The findings suggested that older adults experienced emotional, instrumental, social, and financial challenges before, during, and after the storm. However, by relying on family and friends, as well as neighbors and community networks, older people were able to respond to stressors. CONCLUSIONS: Our findings carry implications for ensuring that older adults are connected to social networks before, during, and after disasters. The role of neighbors is particularly important when disasters strike. (Disaster Med Public Health Preparedness. 2017;11:39-47).

Vulnerable, But Why? Post-Traumatic Stress Symptoms in Older Adults Exposed to Hurricane Sandy.

OBJECTIVE: Drawing on pre-disaster, peri-disaster, and post-disaster data, this study examined factors associated with the development of post-traumatic stress disorder (PTSD) symptoms in older adults exposed to Hurricane Sandy. METHODS: We used a sample of older participants matched by gender, exposure, and geographic region (N=88, mean age=59.83 years) in which one group reported clinically significant levels of PTSD symptoms and the other did not. We conducted t-tests, chi-square tests, and exact logistic regressions to examine differences in pre-disaster characteristics and peri-disaster experiences. RESULTS: Older adults who experienced PTSD symptoms reported lower levels of income, positive affect, subjective health, and social support and were less likely to be working 4 to 6 years before Hurricane Sandy than were people not experiencing PTSD symptoms. Those developing PTSD symptoms reported more depressive symptoms, negative affect, functional disability, chronic health conditions, and pain before Sandy and greater distress and feelings of danger during Hurricane Sandy. Exact logistic regression revealed independent effects of preexisting chronic health conditions and feelings of distress during Hurricane Sandy in predicting PTSD group status. CONCLUSIONS: Our findings indicated that because vulnerable adults can be identified before disaster strikes, the opportunity to mitigate disaster-related PTSD exists through identification and resource programs that target population subgroups. (Disaster Med Public Health Preparedness. 2016;10:362-370).

The texture of neighborhoods and disability among older adults.

OBJECTIVES: To present and test an ecological multidimensional model of neighborhood characteristics and examine its relationship to older disability among older adults. METHOD: Indicators of social vulnerability, wealth, violence, storefronts, residential stability, and the presence of physicians, supermarkets, and fast-food establishments for 1,644 of New Jersey's census tracts were derived from sources that include the U.S. Census 2000, Uniform Crime Report for New Jersey, New Jersey Department of Agriculture, Division of Marketing and Development, New Jersey Department of Law and Public Safety Division of Alcohol Beverage Control, and Health Resources and Services Administration Geospatial Data Warehouse. Confirmatory factor analyses were used to develop and test a measurement model of neighborhood texture. Structural equation modeling examined the relationships between neighborhood characteristics and disability of persons aged 65-69 years. RESULTS: Analyses revealed that distinct dimensions of neighborhoods could be modeled with administrative data and that neighborhood contextual (supermarkets, physicians, storefronts, violence) and compositional (social vulnerability, wealth, residential stability) characteristics were related to the prevalence of disability. DISCUSSION: The use of multiple indicators of neighborhood with good psychometric qualities is critical for advancing knowledge about the mechanisms by which neighborhood characteristics are associated with the health of older people.

A two-factor model of successful aging.

OBJECTIVES: To propose and test a conceptual two-factor model of successful aging that includes objective and subjective components. METHODS: Data were derived from 5,688 persons aged 50-74 years living in New Jersey who participated in the ORANJ BOWL panel. Participants were recruited using random digit dial procedures and interviewed by telephone. A measurement model was developed and tested using data from two independent samples (each n = 1,000); a structural model examining the effects of age and gender was tested using data from another 3,688 people. RESULTS: Confirmatory factor analyses provided support for a multidimensional model incorporating objective criteria and subjective perceptions. Age and gender were associated with objective but not subjective success. DISCUSSION: Results add rigor to the measurement of a construct that has intrigued philosophers and scientists for hundreds of years, providing the empirical foundation on which to build research about successful aging.