Life satisfaction of Korean Vietnam War Veterans in later life: A lifespan approach.

The current study examined correlates of life satisfaction among Korean Vietnam War Veterans. The sample included 450 male Veterans from the Korean Vietnam War Veterans Study, surveyed by mail in 2013 (Mean age = 67.4 years old, SD = 3.0). A hierarchical analysis was conducted by entering four blocks of variables: first demographic factors, and then pre-military service, military service, and post-military service variables. Each successive regression analysis showed a significant additional contribution to the variance in life satisfaction. In the final model, Korean Veterans had higher life satisfaction when they were married, had higher monthly income and poorer childhood family environment, appraised their military service in a positive light, and had less stressors after homecoming and better perceived physical health. However, combat exposure and social support after homecoming were not independently associated with life satisfaction in the final model. These results imply that both pre- and post-military service factors, as well as cognitive appraisals of military service, should be considered in understanding the subjective well-being of Korean Vietnam War Veterans in later life.

Cross-cultural comparison of self-transcendent wisdom between the United States and Korea.

Whether wisdom is a culturally-specific or universal construct is a matter of some debate (see Curnow 1999; Grossman et al. Psychological Science, 2012). This study compared similarities and differences in the factor structure of a measure of wisdom focused on self-transcendence in U.S. (n = 305, M(age) = 33.99) and Korean samples (n = 838, M(age) = 30.28), with ages ranging from 20 to 73). The Adult Self-Transcendence Inventory (ASTI; Levenson et al. International Journal of Aging and Human Development, 60, 127-143, 2005) has two factors, self-transcendence and alienation, the latter of which was included to differentiate between social withdrawals due to contemplative practices versus that due to depression. Confirmatory factor analyses found a partial scalar factorial invariance model fit the data best, indicating that the factor structure of the ASTI is largely equivalent and that the construct is comparable across the two cultures. Regression analyses showed that age and religiousness were related to self-transcendence and alienation. Education was related to self-transcendence only. The interaction between age and culture was significant on alienation; alienation was higher in mid-life Koreans but not in Americans, which may reflect either age or cohort effects. Thus, self-transcendence may be a more universal measure of wisdom than those based on pragmatics or cognitive functioning.

Cohort Differences in PTSD Symptoms and Military Experiences: A Life Course Perspective.

BACKGROUND AND OBJECTIVES: There have been major changes in military service over the past 50 years. Most research on posttraumatic stress disorder (PTSD) among combat Veterans comes from help-seeking Vietnam and WWII cohorts; results from more recent cohort comparisons are mixed. The present study addressed these gaps by exploring cohort differences among Vietnam, Persian Gulf, and Post-9/11 combat Veterans from a life course perspective. RESEARCH DESIGN AND METHODS: We recruited community-dwelling combat and war zone Veterans (N = 167), primarily from Veterans' associations in Oregon from three cohorts: Vietnam, Persian Gulf, and Post-911. Online surveys assessed current PTSD symptoms, life course (demographics and cohort membership), and experiential variables (combat severity, appraisals of military service, homecoming, and social support). RESULTS: Cohorts were comparable in demographics and war experiences. Step one of a hierarchical regression found that PTSD symptoms were higher among Veterans of color and those with lower incomes, R2 = 0.37, p < .001. When cohort was added, Vietnam Veterans had higher symptoms than Post-9/11; income and race/ethnicity remained significant, ΔR2 = 0.01, p = .13. The final model added experiential variables, ΔR2 = 0.38, p < .001; cohort and income were no longer significant, although Veterans of color still reported higher symptoms. Those with more undesirable service appraisals and who sought social support had higher symptoms, while desirable appraisals were protective. DISCUSSION AND IMPLICATIONS: From a life course perspective, the particular war zone that Veterans served in was less important than demographics and both service and postservice experiences, suggesting generalizability of risk and protective factors, as well as treatment modalities, across cohorts.

An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods.

BACKGROUND: The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water. DESIGN AND SETTING: This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels. INTERVENTION: The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES. MEASURABLE OUTCOMES: Pre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys. IMPLICATIONS: The results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations. TRIAL REGISTRATION NUMBER: NCT05395663.

Adaptation to changes in COVID-19 pandemic severity: Across older adulthood and time scales.

The COVID-19 pandemic has been observed to negatively affect older adults' psychological health compared with prepandemic levels. However, older adults' coping efficacy may differ depending on their age, and little is known about effects of fluctuations in pandemic severity. Two longitudinal studies tested the hypothesis that pandemic severity would affect psychological health and be moderated by age. In Study 1 (N = 111), older adults (aged 62-96) were assessed semiannually before and after the first United States COVID-19 case over up to 10 years. Depressive symptoms and stress, but not cognitive difficulties, were higher during COVID-19; pandemic severity had little effect. Estimated increases were smaller for a 65-year-old than for an 85-year-old. In Study 2 (N = 221), older adults (aged 51-95) were assessed weekly over up to 8 weeks during the COVID-19 pandemic. Higher national pandemic severity was associated with more cognitive difficulties, more depressive symptoms, and more stress. In an opposite pattern from Study 1, estimated increases were larger for a 65-year-old than for an 85-year-old. Old-old adults might be most susceptible to long-term psychological effects of the pandemic era, as in Study 1, but more resilient to short-term effects, as in Study 2. Coping strategies associated with increasing age may be less efficacious for more chronic and severe problems. Conversely, the same coping strategies may be more efficacious for shorter, less severe problems. Differentiating between reactivity to longer term and shorter term pandemic stressors can identify the most resilient or vulnerable ages within older adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Resilience in Older Adults During the COVID-19 Pandemic: A Socioecological Approach.

OBJECTIVES: We examined sources of vulnerability and resilience among older adults early in the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We surveyed 235 respondents, 51-95 years old (M = 71.35; SD = 7.39; 74% female), including 2 open-ended questions concerning COVID-19-related difficulties and positive experiences during the past week. Using inductive coding, we found 9 final codes for difficulties and 12 for positives and grouped them into socioecological levels: personal, interpersonal, and societal. RESULTS: Difficulties were reported by 94% of the sample, while 63% described positives. Difficulties and positive responses were made at all socioecological levels and illustrated a dialectic between personal-level constraints and opportunities, interpersonal-level social isolation and integration, and societal-level outrage, sorrow, and social optimism. DISCUSSION: Respondents described sources of vulnerabilities and resilience that supported a socioecological approach to understand resilience during this pandemic. A notable example was resilience derived from witnessing and contributing to the community and social solidarity, highlighting the potential of older adults as resources to their communities during the global pandemic.

Impact of combat exposure on mental health trajectories in later life: Longitudinal findings from the VA Normative Aging Study.

Cross-sectional studies have shown contradictory results concerning the impact of combat exposure on mental health in later life. We examined whether combat exposure influences trajectories of mental health symptoms in older male veterans using longitudinal data collected from 1985 to 1991 in the Veterans Affairs Normative Aging Study (N = 1,105, age range = 40-86 years in 1985). Noncombat veterans showed little systematic change in depressive and anxiety symptoms with age, whereas combat veterans showed U-shaped nonlinear changes, with higher levels in midlife decreasing until the mid-60s and then increasing again in the 70s and 80s. These findings support the notion that military service, and especially combat exposure, is a hidden variable in aging research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity.

BACKGROUND AND OBJECTIVES: As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups. RESEARCH DESIGN AND METHODS: Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations. RESULTS: Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites. DISCUSSION AND IMPLICATIONS: Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.

Does combat exposure affect well-being in later life? The VA Normative Aging Study.

OBJECTIVE: Combat exposure can have long-term negative effects in later life; although aspects of service may be appraised positively, the long-term positive effects of combat on well-being in later life is largely unknown. METHOD: The sample included 1,006 male veterans from the VA Normative Aging Study, surveyed by mail in 1986, 1990, and 1991 (Mage = 65.5 years, SD = 7.3). They reported on their combat exposure, desirable appraisals of military service, unit cohesion, dispositional optimism, self-rated health, and psychological well-being (PWB), as well as age, military rank, and education. Perceived positive aspects (PPA) of military service was postulated to mediate the effects of combat exposure on PWB. Structural equation modeling was used to examine both mediating and moderating effects. RESULTS: Age, combat exposure, and optimism had independent effects on PPA, but optimism did not moderate the effect of combat exposure on PPA. Combat exposure had only indirect effects on PWB through PPA, controlling for the direct effects of optimism. Education had no direct effects on the positive outcomes but did have indirect effects through optimism. CONCLUSION: Combat exposure contributes to positive well-being in later life, indirectly through positive appraisals, and this effect was independent of optimism. Thus, these results support the idea that combat veterans should be encouraged to focus on positive aspects of military service, which may serve as resilience resources to facilitate optimal aging. (PsycINFO Database Record

A Life-span Perspective on Combat Exposure and PTSD Symptoms in Later Life: Findings From the VA Normative Aging Study.

PURPOSE OF THE STUDY: We tested a life-span model of combat exposure on posttraumatic stress disorder (PTSD) symptoms in later life, examining the direct and indirect effects of prewar, warzone, and postwar factors. DESIGN AND METHODS: The sample included 947 male World War II and Korean War veterans from the VA Normative Aging Study (Mage = 65, SD = 7). They completed mail surveys on childhood family environment, military service and postwar experience, stressful life events, and PTSD symptoms (response rates > 80%). RESULTS: We constructed an initial path model testing cumulative advantage and disadvantage pathways. Although all hypothesized relationships were significant, the model was not a good fit to the data. Subsequent models showed that all three life-span periods had both direct and indirect effects on PTSD symptoms and that there were interesting cross-links between the two sets of pathways. IMPLICATIONS: The life-span perspective provides a useful heuristic to model various developmental effects on later-life outcomes. A supportive childhood family environment can have lifelong protective effects, whereas a conflictual one can set up lifelong patterns of pessimistic appraisals.

Spiritual peace predicts 5-year mortality in congestive heart failure patients.

OBJECTIVE: Spirituality is favorably related to depression, quality of life, hospitalizations, and other important outcomes in congestive heart failure (CHF) patients but has not been examined as a predictor of mortality risk in this population. Given the well-known difficulties in managing CHF, we hypothesized that spirituality would be associated with lower mortality risk, controlling for baseline demographics, functional status, health behaviors, and religiousness. METHOD: Participants were 191 CHF patients (64% male; M age = 68.6 years, SD = 10.1) who completed a baseline survey and were then followed for 5 years. RESULTS: Nearly 1/3 of the sample (32%) died during the study period. Controlling for demographics and health status, smoking more than doubled the risk of mortality, whereas alcohol consumption was associated with slightly lower risk of mortality. Importantly, adherence to healthy lifestyle recommendations was associated with halved mortality risk. Although both religion and spirituality were associated with better health behaviors at baseline in bivariate analyses, a proportional hazard model showed that only spirituality was significantly associated with reduced mortality risk (by 20%), controlling for demographics, health status, and health behaviors. CONCLUSIONS: Experiencing spiritual peace, along with adherence to a healthy lifestyle, were better predictors of mortality risk in this sample of CHF patients than were physical health indicators such as functional status and comorbidity. Future research might profitably examine the efficacy of attending to spiritual issues along with standard lifestyle interventions.

Do hassles mediate between life events and mortality in older men? Longitudinal findings from the VA Normative Aging Study.

We investigated whether hassles mediated the effect of life events on mortality in a sample of 1293 men (Mage=65.58, SD=7.01), participants in the VA Normative Aging Study. We utilized measures of stressful life events (SLE) and hassles from 1989 to 2004, and men were followed for mortality until 2010. For life events and hassles, previous research identified three and four patterns of change over time, respectively, generally indicating low, moderate, and high trajectories, with one moderate, non-linear pattern for hassles (shallow U curve). Controlling for demographics and health behaviors, we found that those with moderate SLE trajectories (38%) more likely to die than those with low SLE trajectories, HR=1.42, 95% CI [1.16, 3.45]. Including the hassles classes showed that those with the moderate non-linear hassles trajectory were 63% more likely to die than those with low hassles trajectory, HR=1.63, 95% CI [1.19, 2.23], while those with consistently high hassles trajectory were over 3 times more likely to die, HR=3.30, 95% CI [1.58, 6.89]. However, the HR for moderate SLE trajectory decreased only slightly to 1.38, 95% CI [1.13, 1.68], suggesting that the two types of stress have largely independent effects on mortality. Research is needed to determine the physiological and behavioral pathways through which SLE and hassles differentially affect mortality.