Conscientiousness, Activity Engagement, and Momentary Affect in Oldest-Old Adulthood.

OBJECTIVES: Remaining engaged with life is a hallmark of aging well and pursuing personally meaningful activities is presumably important for late-life affect. We examined how moment-to-moment variability in meaning and degree of challenge ascribed to daily activities relate to positive and negative affect in very old adults. Possible moderating effects of between-person differences in conscientiousness on meaning-affect associations were also examined. METHODS: Participants were 73 adults aged 89 years on average from the Australian Daily Life Time-Sampling module of the Australian Longitudinal Study of Aging. Participants provided self-report data on activity engagement (meaning and challenge associated with activities) and affect, on 5 occasions per day for a period of 7 consecutive days. RESULTS: Within-person associations of activity meaning with affect varied as a function of within-person challenge ratings. Specifically, gains in positive affect associated with meaningful activity were more strongly evident when activities were regarded as more challenging. In contrast, meaningful activity was associated with higher negative affect when activities were regarded as more challenging and lower negative affect when activities were regarded as less challenging. Conscientiousness did not moderate associations of activity meaning with affect. DISCUSSION: Our findings shed light on the intricate interplay between maintaining meaningful engagement and daily emotional experiences in very old age. We discuss theoretical and practical implications and consider the role of late-life conscientiousness for self- and emotion regulation.

Perceived Control Moderates the Effects of Functional Limitation on Older Adults' Social Activity: Findings From the Australian Longitudinal Study of Ageing.

OBJECTIVES: Research has shown that functional limitation is related to reduced social activity in older adults; however, individuals with high perceived control have greater confidence in their ability to achieve outcomes and are more likely to show persistence and employ strategies to overcome challenges. The aim of this study was to examine whether perceived control protects against the negative effects of functional limitation on older adults' social activity. METHOD: Participants were 835 older adults aged 69 to 103 years at baseline from the Australian Longitudinal Study of Ageing. Multilevel modeling was used to examine baseline and within-person change in functional limitation and perceived control as predictors of 18-year trajectories of social activity. RESULTS: An interaction between baseline functional limitation and perceived control indicated that having greater functional limitation was associated with less social activity and greater decline over time for those with lower perceived control, but not for those with higher control. Within-person change in functional limitation was not reliably associated with social activity. DISCUSSION: This study highlights the importance of perceived control as a protective psychological resource and may have implications for developing interventions aimed at enabling older adults to maintain their social activity as they experience functional decline.

Estimating the Years Lived With and Without Age-Related Sensory Impairment.

BACKGROUND: The aim of this study was to estimate the expected years lived with hearing impairment, vision impairment, and dual sensory impairment among older adults. METHODS: A total of 4,160 adults (45.1% men) from two Australian community based studies were followed for up to 16 years (average 8.9 years). Hearing impairment was defined by a pure-tone average (500-4000 Hz) greater than 25 dB in the better ear. Vision impairment was defined by presenting distance visual acuity worse than 6/12 (20/40). Postliminary analyses were also conducted for moderate levels of sensory impairment. Dual sensory impairment was defined by concurrent hearing and vision impairment. Multistate Markov models were used to calculate sensory life expectancies based on transition probabilities between health states (no sensory impairment, sensory impairment, and death). RESULTS: Based on thresholds for mild impairment, men aged 65 had a total life expectancy of 19.4 years, and were estimated to live for 10.4 years (95% confidence interval [CI]: 9.1, 11.7) with hearing impairment, 2.8 years (95% CI: 2.4, 3.2) with vision impairment, and 2.2 years (95% CI: 1.8, 2.6) with dual sensory impairment. Women aged 65 had a total life expectancy of 23.2 years, and were estimated to live for 12.9 years (95% CI: 11.9, 13.9) with hearing impairment, 3.9 years (95% CI: 3.4, 4.4) with vision impairment, and 3.2 years (95% CI: 2.7, 3.7) with dual sensory impairment. CONCLUSIONS: In addition to being highly prevalent, hearing and vision impairment affect older adults for substantial periods of their remaining life. Given their broad ranging impacts on health and well-being, sensory impairments are ideal targets for strategies to compress morbidity in late life.

How important is health status in defining quality of life for older people? An exploratory study of the views of older South Australians.

BACKGROUND: Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health. OBJECTIVE: To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians. METHODS: Older adults (n=21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People's Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT. RESULTS: Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman's Rho: 0.730; p<0.01), but not ASCOT. Approximately half (52.4%) of the participants ranked either 'health' or 'psychological and emotional well-being' as the domain most important to their quality of life. However, one-third (33.3%) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life. CONCLUSIONS: Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life.

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents.

BACKGROUND: Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea. METHODS: Cross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH. RESULTS: SRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations. CONCLUSIONS: We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

Antidepressant use and depressive symptomatology among older people from the Australian Longitudinal Study of Ageing.

BACKGROUND: Depression is one of the leading contributors to the burden of non-fatal diseases in Australia. Although there is an overall increasing trend in antidepressant use, the relationship between use of antidepressants and depressive symptomatology is not clear, particularly in the older population. METHODS: Data for this study were obtained from the Australian Longitudinal Study of Ageing (ALSA), a cohort of 2087 people aged over 65 years at baseline. Four waves of home interviews were conducted between 1992 and 2004 to collect information on sociodemographic and health status. Depressive symptoms were measured by the Center for Epidemiologic Studies - Depression Scale. Use of antidepressants was based on self-report, with the interviewer able to check packaging details if available. Longitudinal analysis was performed using logistic generalized estimating equations to detect if there was any trend in the use of antidepressants, adjusting for potential confounding factors. RESULTS: The prevalence of depressive symptoms was 15.2% in 1992 and 15.8% in 2004 (p > 0.05). The prevalence of antidepressant users increased from 6.5% to 10.9% (p < 0.01) over this period. Among people with depressive symptoms, less than 20% were taking antidepressants at any wave. Among people without depressive symptoms, the prevalence of antidepressant use was 5.2% in 1992 and 12.0% in 2004 (p < 0.01). Being female (OR = 1.67, 95%CI: 1.25-2.24), having poor self-perceived health status (OR = 1.17, 95%CI: 1.04-1.32), having physical impairment (OR = 1.48, 95%CI: 1.14-1.91) and having depressive symptoms (OR = 1.62, 95%CI: 1.24-2.13) significantly increased the use of antidepressants, while living in community (OR = 0.51, 95%CI: 0.37-0.71) reduced the risk of antidepressant use. CONCLUSIONS: Use of antidepressants increased, while depressive symptoms remained stable, in the ALSA over a 12-year period. Use of antidepressants was low for people with depressive symptoms.

Determinants of self-rated health items with different points of reference: implications for health measurement of older adults.

OBJECTIVE: This study assessed whether three commonly used self-rated health (SRH) items (global, age-comparative, and self-comparative) are equivalent measures of health perception for older adults. METHOD: Regression analyses were used to simultaneously contrast the associations between physical, psychological, and social factors relating to health for three SRH items, in a large ( N = 2,034) population-based sample of older adults (65 years and older) from the Australian Longitudinal Study of Aging. RESULTS: Health perceptions were more positive for the age-comparative SRH measure, compared to the pessimistic ratings of the self-comparative measure, particularly for the oldest-old adults. Different patterns of associations between the health factors and SRH measures were found. DISCUSSION: These results show the three SRH items are not equivalent measures of health and cannot be used interchangeably. The reference point of the SRH item has a considerable influence on health perceptions of older adults as it encapsulates unique health information.

Specialized palliative care services are associated with improved short- and long-term caregiver outcomes.

GOALS OF WORK: The goal of this study was to evaluate, at a population level, the association between specialized palliative care services (SPCS) and short- and long-term caregiver outcomes. PATIENTS AND METHODS: The Health Omnibus Survey, a face-to-face survey conducted annually in South Australia since 1991, collects health-related data from a rigorously derived, representative sample of 4,400 households. This study included piloted questions in the 2001, 2002, and 2003 Health Omnibus Survey on the impact of SPCS. Sample size was 9,088 individuals. "Unmet needs," a short-term outcome relevant to the caregiving period during a life-limiting illness, were tallied. "Moving on," a long-term caregiver-defined outcome reflecting the caregiver's adaptation and return to a new equilibrium after the death, was assessed with and without SPCS. RESULTS: Thirty-seven percent (3,341) indicated that someone close to them had died of a terminal illness in the preceding 5 years, of whom 949 (29%) reported that they provided care. SPCS were involved in caring for 60% of deceased patients. Day-to-day caregivers indicated fewer unmet needs when SPCS were involved (p = 0.0028). More caregivers were able to "move on" with their lives when SPCS were involved than when SPCS were not involved (86 vs 77%, p = 0.0016); this effect was greatest in the first 2 years after the loved one's death. CONCLUSION: At a population level, SPCS were associated with meaningful improvements in short-term ("unmet needs") and long-term ("moving on") caregiver-defined outcomes.

Effect of social networks on 10 year survival in very old Australians: the Australian longitudinal study of aging.

STUDY OBJECTIVES: To examine if social networks with children, relatives, friends, and confidants predict survival in older Australians over 10 years after controlling for a range of demographic, health, and lifestyle variables. DESIGN: Prospective longitudinal cohort study (the Australian longitudinal study of aging) SETTING: Adelaide, South Australia. PARTICIPANTS: 1477 persons aged 70 years or more living in the community and residential care facilities. MAIN RESULTS: After controlling for a range of demographic, health, and lifestyle variables, greater networks with friends were protective against mortality in the 10 year follow up period. The hazard ratio for participants in the highest tertile of friends networks compared with participants in the lowest group was 0.78 (95%CI 0.65 to 0.92). A smaller effect of greater networks with confidants (hazard ratio = 0.84; 95%CI = 0.71 to 0.98) was seen. The effects of social networks with children and relatives were not significant with respect to survival over the following decade. CONCLUSIONS: Survival time may be enhanced by strong social networks. Among older Australians, these may be important in lengthening survival.

Selective non-response to clinical assessment in the longitudinal study of aging: implications for estimating population levels of cognitive function and dementia.

OBJECTIVE: to identify the cognitive outcome of interviewed participants who did not progress to partake in clinical assessments in a longitudinal aging study. DESIGN: a retrospective study was conducted on participants who were interviewed but who did not complete the clinical assessment (including an extended cognitive assessment) at either Wave 1 or both Wave 1 and Wave 3 of the Australian Longitudinal Study of Ageing. A total of 1947 participants aged 70 and older commenced the study, 246 participants without clinical data at either or both Waves 1 and 3 were identified for the sub-sample followed-up retrospectively. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was administered to informants and medical records were reviewed. RESULTS: participants who did not complete the clinical assessment at Wave 3 reported poorer health and had poorer cognitive function at Wave 1 independent of age and gender. Rates of possible dementia or cognitive decline were higher in the group who did not undertake the clinical assessment compared with both those who did the clinical assessment and with population data. CONCLUSION: selective non-response to clinical assessment in a longitudinal aging study is associated with higher risk of cognitive decline and probable dementia. Longitudinal aging studies may underestimate rates of dementia and population levels of cognitive decline.