Using wearables to promote physical activity in old age : Feasibility, benefits, and user friendliness.

BACKGROUND: Wearables provide new opportunities to promote physical activity also among older adults but data on effectiveness and user friendliness are rare. OBJECTIVE: The effects of a comprehensive self-regulative intervention on moderate to vigorous physical activity (MVPA) and number of steps were examined using commercially available activity trackers. Acceptance regarding the devices was analysed in various domains. METHODS: In this study 80 older adults (mean = 67.03 years, standard deviation = 3.97 years; 59% women) wore a Fitbit Charge HR for 21 days including a baseline, a postintervention and a follow-up week. The intervention comprised feedback, goal setting and planning and 50% of the participants were additionally randomized to a role model component. Social cognitive predictors based on the health action process approach (HAPA) and user experience were assessed via questionnaires. RESULTS: The MVPA increased by an average of 19 min per week and steps by 1317 per day. An additional benefit of the role model component could be observed for MVPA. In the follow-up, the intervention effect was still significant for the number of steps, while MVPA dropped back to baseline. Multilevel models including HAPA variables explained small but significant amounts of variance in MVPA (8% within-person, 26% between-person) and steps (11% within-person, 12% between-person). User experience was rated as very high. CONCLUSION: Providing an intervention based on established behavior change techniques and self-monitoring via wearables seems to be effective for increasing physical activity among older adults. The HAPA variables seem to play a limited role to explain activity levels. Acceptance of wearables can be expected to be high.

Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase.

This vignette based study aimed to examine recommendations of health care professionals (HCPs) in promoting self-management strategies to cancer patients. Nine-hundred-forty-two physicians and nurses were asked to (1) indicate if they would recommend self-management strategies to a vignette cancer patient, and (2) to specify those in an open format. Vignettes included a manipulation of patient age (60 vs. 75 years) and treatment phase (currently treated versus treatment completed). Six categories emerged through coding a total of 2303 recommendations: physical activity (71.8%), nutrition (64.3%), psychological support (36.7%), medical support (29.2%), conscious living (17.2%) and naturopathy (12.3%). While psychological support was particularly recommended during treatment, physical activity was more frequently recommended after completion of treatment. Results suggest that HCPs recommend a variety of self-management strategies besides standard medical treatment. Patient's treatment phase and age seem to partly influence recommendation behavior, potentially indicating insecurities regarding acute treatment situations and age-related stereotypes.

Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients.

PURPOSE: Although many cancer patients benefit from physical activity (PA), healthcare professionals (HCP) still do not promote it routinely. Including different groups of HCP, this study aimed to examine how structural barriers are perceived as impeding by HCP for promoting PA to cancer patients, how the perceptions of structural barriers are associated with promoting PA, and how HCP react to information resources. METHODS: A total of 287 physicians in outpatient care, 242 physicians in inpatient care, and 388 oncology nurses completed our questionnaire (paper-pencil or online). Participants assessed nine different structural barriers (on a 4-point Likert Scale) and reported their PA promotion frequency. Further, they could request three different kinds of information resources about PA in oncological settings. RESULTS: Across professional groups, more than 70% of HCP indicated that they promoted PA to their cancer patients often or routinely. Oncology nurses indicated that they were more impeded in promoting PA by six structural barriers than physicians (all p < .01). "Not enough time per patient" and "lack of an expert contact person" were associated with a reduced PA promotion in two professional groups (all p < .05). Information resources were requested by 69.5% of the participants: mostly physicians working in outpatient care and especially by those perceiving structural barriers. CONCLUSIONS: Although a big proportion of HCP reported that they frequently promoted PA, our findings suggest that HCP still perceive structural barriers. The perception and influence of structural barriers differed between professional groups, pointing to the importance of profession specific guidance.

What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals' concerns, perceived patient characteristics and perceived structural factors.

Despite a large body of evidence showing that physical activity (PA) is beneficial to patients with cancer, healthcare professionals (HCPs) are promoting it too scarcely. Factors that hinder HCPs from promoting PA have remained understudied so far. Using a qualitative approach, this study aimed at a comprehensive description of influencing factors for HCPs' PA promotion behaviour and at identifying the reasons and mechanisms behind them. Semi-structured interviews with 30 HCPs were undertaken with a focus on concerns, patient characteristics and structural factors. Answers were analysed using thematic analysis. Results revealed that HCPs had concerns regarding a physical overexertion and psychological stress for patients with cancer. A patient's physical condition and the assumed interest in PA, often derived from former PA, turned out to be the most crucial patient characteristics influencing if PA is addressed. Structural factors relevant for PA promotion pertained to in-house structures, HCPs' workload, timing and coordination, information material for HCPs and patients and availability of exercise programs. In conclusion, this study revealed undetected concerns of HCPs and underlined the relevance of patient characteristics and structural conditions for HCPs' PA promotion towards patients with cancer. A broader perspective is needed to assess these factors in their influence on HCPs' PA promotion.

Subjective Time Perceptions and Aging Well: A Review of Concepts and Empirical Research - A Mini-Review.

Human beings impose subjective, time-related interpretations on their existence, and the experience of time is a major aspect of lifespan development. In this mini-review, we understand subjective time as the way individuals subjectively perceive and evaluate the passing of their personal "objective" lifetime. A broad range of constructs and operationalizations has been developed in (gero-) psychology to capture subjective time, including future time perspective, personal goals, or autobiographical memories. In order to theoretically integrate this yet loosely connected body of literature, we propose a conceptual model of subjective time concepts according to 2 dimensions: temporal direction (past, present, future) and thematic field (duration/expansion, time-ordered life content, and time-related evaluations, attitudes, and mindsets). This conceptual model of subjective time perceptions builds the foundation for a review of the empirical literature regarding associations of subjective time with developmental outcomes (i.e., subjective well-being and physical health) in middle and late adulthood. Empirical findings establish subjective time concepts as a consistent predictor of well-being and health. Positive subjective time perceptions (i.e., an expanded view of the future, a focus on positive past and future life content, and favorable time-related evaluations) were associated with higher well-being and better physical health, while negative subjective time perceptions in general were linked to lower levels of health and well-being. Contrasting past- and future-oriented subjective time perceptions, it appears that past-oriented subjective time perceptions have been studied primarily in relation to subjective well-being, while future-oriented time perceptions play a key role both with regard to physical health and well-being. In conclusion, we argue that a stronger integration of subjective time constructs into developmental regulation models may deepen our understanding of human development across the lifespan. To this end, we call for theoretical and empirical interlinkages between yet loosely connected conceptual developments related to subjective time. These endeavors should be paralleled by an extension of methodological procedures (e.g., implementation of longitudinal research designs as well as a focus on the oldest-old) in order to inform a "lifespan theory of subjective time."

Correction to: Views on ageing: a lifespan perspective.

[This corrects the article DOI: 10.1007/s10433-019-00535-9.].

What is the Image of the "Typical Cancer Patient"? The View of Physicians.

Former research has identified stigmatizing attitudes toward cancer patients in the general population. Little is known about (implicit) attitudes of physicians toward cancer patients. By using the prototype approach, the study investigated German physicians' prototypical perceptions of cancer patients. Five hundred nineteen physicians (mean age: 46 years, 47% female) who regularly treat cancer patients participated in the questionnaire study. Participants were asked to state three prototype attributes that describe the "typical cancer patient." Open format answers were coded on the dimensions favorability (coded with unfavorable, favorable, or neutral) and gender-stereotypicality (coded with masculine stereotypical, feminine stereotypical, or gender-neutral). Of all prototype attributes (N = 1,589), 69.9% were coded as unfavorable and 14.3% as favorable, the remaining attributes were neutral (15.9%). Analysis of gender-stereotypicality revealed that nearly half of the attributes (49.5%) were compatible with the feminine, whereas only 6.5% were compatible with the masculine stereotype. The remaining attributes (44.0%) were gender-neutral. There were no significant associations between prototype favorability or gender-stereotypicality and demographic/professional characteristics of physicians. The prototype approach was successful to identify (implicit) attitudes toward cancer patients and might be more sensitive than social distance scales when investigating stigmatizing attitudes. Physicians described the "typical cancer patient" with predominantly unfavorable and feminine attributes, while favorable attributes were underrepresented and positive masculine attributes were barely mentioned. The finding that the "typical cancer patient" lacks (positive) masculine attributes should be followed up in further research.

The assessment of views on ageing: a review of self-report measures and innovative extensions.

This is a review of existing self-report measures for assessing views on ageing. It provides an overview of instruments, for which basic psychometric properties are available and describes them according to the purposes for which they are suitable. Literature search resulted in the inclusion of 89 instruments which were categorised along eight dimensions. The majority of measures focus on explicit cognitions about people's own age and ageing or other (older) people. A substantial amount of tools account for the multidimensionality and multidirectionality of views on ageing, i.e. the idea that ageing is accompanied by both gains and losses in several different domains. To some extent, measures reflect that ageing is a long-term process and that views on ageing are malleable, rather than just stable traits. Cluster analysis revealed heterogeneity in instruments regarding the dimensions of Ecosystem, Balance, Stability, Dynamics, and Complexity. It becomes apparent, however, that approaches to measure views on ageing should be extended to more specifically target the implicit level as well as affective, physiological, and behavioural manifestations. Additionally, means for capturing views on ageing on the societal level and tools with a distinct time reference are needed. This is particularly important when one wants to account for the lifelong dynamics of views on ageing.

Views on ageing: a lifespan perspective.

Views on ageing (VoA) have special relevance for the ageing process by influencing health, well-being, and longevity. Although VoA form early in life, so far, most research has concentrated on how VoA affect later middle-aged and older adults. In this theoretical article, we argue that a lifespan approach is needed in order to more fully understand the origins of VoA, how they change over ontogenetic time, and how they shape development across the full breadth of the lifespan. We begin by explicitly linking VoA to fundamental principles of lifespan development. We review existing theories of VoA and discuss their respective contributions and limitations. We then outline a lifespan approach to VoA that integrates existing theories and addresses some of their limitations. We elaborate on three core propositions of a lifespan approach to VoA: (1) VoA develop as the result of a dynamic, ongoing, and complex interaction between biological-evolutionary, psychological, and social-contextual factors; however, the relative importance of different sources changes across the lifespan; (2) VoA impact development across the whole lifespan; however, different outcomes, mechanisms, and time frames need to be considered in order to describe and understand their effects; and (3) VoA are multidimensional, multidirectional, and multifunctional throughout life, but their complexity, meaning, and adaptivity change across the lifespan. We conclude with recommendations for future lifespan research on VoA.

A New Multidimensional Questionnaire to Assess Awareness of Age-Related Change (AARC).

BACKGROUND AND OBJECTIVES: This two-study article describes the development and evaluation of a multidimensional questionnaire based on the subjective aging construct Awareness of Age-Related Change (AARC). AARC captures the inherent multidimensionality and complexity of aging attitudes, which are strongly linked to indicators of successful aging, including health and well-being. RESEARCH DESIGN AND METHODS: In Study 1, we generated a large item pool related to subjective aging experiences and then evaluated the psychometric properties of a 189-item version of the AARC questionnaire in a sample of 396 adults aged 40-95 years. Based on findings from Study 1, we retained the best-performing items and arrived at a more parsimonious 50-item version (AARC-50). In Study 2, the psychometric properties of the 50-item version were examined in an expanded sample of 424 adults ages 40-98. RESULTS: Factor analyses in Study 1 indicated a two-factor structure of the questionnaire, representing the awareness of positive (AARC-Gains) and negative (AARC-Losses) age-related changes across five behavioral domains. Confirmatory factor analysis in Study 2 further supported this two-factor structure. In both studies, the AARC questionnaire demonstrated strong psychometric properties, including scale and item reliability, convergent and divergent validity, and predictive validity. DISCUSSION AND IMPLICATIONS: The availability of a reliable and valid assessment tool for measuring AARC-Gains and AARC-Losses allows researchers to capture detailed information about adults' positive and negative self-perceptions of aging across multiple behavioral domains, which are instrumental for promoting successful aging.

Measuring Awareness of Age-Related Change: Development of a 10-Item Short Form for Use in Large-Scale Surveys.

BACKGROUND AND OBJECTIVES: Existing measures of subjective aging have been useful in predicting developmental outcomes. Unlike other constructs of subjective aging, Awareness of Age-Related Change (AARC) focuses on how adults' self-perceptions of aging result in an awareness of age-related gains and losses. We developed a 10-item short form (SF) of the existing 50-item AARC questionnaire as a reliable, valid, and parsimonious solution for use primarily in large-scale surveys but also in applied contexts. RESEARCH DESIGN AND METHODS: AARC was assessed in a German and North American sample of 819 individuals. Item selection for the suggested AARC-10 SF was based on multidimensional item response theory (MIRT). Multi-group confirmatory factor analysis (CFA) was used to test for measurement invariance (MI) across groups of participants in middle age (40-69 years), early old age (70-79 years), and advanced age (80+ years). Concurrent and discriminant validity in old age was assessed with regard to established measures of subjective aging, well-being, and health. RESULTS: The AARC-10 SF showed adequate fit to the data and reliability for the perceived gains and losses composites. Valid comparison of latent means was confirmed for early old and advanced age respondents and with some reservation also for middle-aged individuals due to partial MI. Concurrent and discriminant validity were confirmed. DISCUSSION AND IMPLICATIONS: The proposed AARC-10 SF offers an economic device to measure AARC and use the construct as an antecedent or outcome in the context of substantive model testing in large-scale survey data.

Developmental Regulation and Awareness of Age-Related Change: A (Mostly) Unexplored Connection.

Objectives: Linkages between developmental regulation and awareness of aging-although suggested by theoretical considerations-have not found much empirical consideration. To address this gap, we examined associations between two established modes of developmental regulation, that is, assimilation and accommodation, and awareness of age-related change (AARC) in midlife and old age, while considering the role of chronological age as a moderator. Method: Data are based on a cross-sectional sample of 356 adults (aged 42-100 years). A newly developed measure of AARC was used to assess perceived gain- and loss-related aging experiences. Results: AARC was associated with assimilation and accommodation over and above a range of control variables. Individuals who perceived many loss-related aging experiences were less likely to use assimilation and accommodation. Individuals perceiving many gain-related aging experiences were more likely to make use of these strategies. The effects remained stable when controlling for subjective age and self-efficacy, except for the association between gain-related aging experiences and assimilation. No moderation effect of calendar age was found. Discussion: Results suggest that multidimensional subjective aging constructs may enrich our understanding of how developmental regulation modalities are used by aging individuals.

Awareness of Age-Related Change and Depressive Symptoms in Middle and Late Adulthood: Longitudinal Associations and the Role of Self-Regulation and Calendar Age.

Objectives: Studies that examine bidirectional relations between subjective aging and depressive symptoms have remained rare. We addressed this issue by investigating longitudinal linkages between awareness of age-related change (AARC) and depressive symptomatology in midlife and old age. Assimilative and accommodative self-regulation strategies and calendar age were studied as moderators. Method: Analyses were based on two measurements (Time 1: 2012, N = 423 (40-98 years); Time 2: 2015, N = 356). AARC was operationalized as perceived age-related gains and losses. Data were analyzed by means of a cross-lagged panel model and multiple regression. Results: Perceived losses but not gains had an effect on change in depressive symptoms over time. The reverse effect with depressive symptoms predicting change in AARC was not significant. The association between perceived gains but not losses and change in depressive symptoms was moderated by self-regulation; when perceived gains were low, less increase in depressive symptoms was reported when accommodation was high. The association between AARC and change in depressive symptoms was stable across the entire second half of the life span. Discussion: Results suggest that a better integration of research on subjective aging with clinically relevant developmental outcomes is a promising future pathway.

Being slower, feeling older? Experimentally induced cognitive aging experiences have limited impact on subjective age.

Initial experimental research has shown that subjective age may change in response to induced aging experiences, but replication and extension are needed. The present study investigates if age-related cognitive gain or loss experiences evoke decreases/increases in subjective age. A multidimensional subjective age measure was used to explore domain-specific internalization effects. 78 individuals aged 59-70 years were randomly assigned to two experimental conditions and a control group. Participants took a cognitive attention test and received gain-oriented feedback on their accuracy or loss-oriented feedback on their processing speed. A mixed factors analysis of covariance was used to examine changes in feel age, look age, do age, and interest age. After being primed with age-related losses, participants reported older do ages as compared to before the experimental priming. Priming age-related gains had only a marginally significant effect on do age. All other subjective age dimensions remained unaffected by the experimental priming. Although previous research has shown that subjective age can be manipulated experimentally, findings from the present study underscore that a comprehensive and cross-domain improvement of subjective age may require personally relevant and repeated experiences of age-related gains.

Future time perspective and awareness of age-related change: Examining their role in predicting psychological well-being.

This study examined how 2 distinct facets of perceived personal lifetime-future time perspective (FTP) and awareness of age-related change (AARC)-are associated with another, and how they may interact to predict psychological well-being. To better understand associations among subjective perceptions of lifetime, aging, and well-being, we tested a series of models to investigate questions of directionality, indirect effects, and conditional processes among FTP, AARC-Gains, AARC-Losses, and psychological well-being. In all models, we tested for differences between middle-aged and older adults, and between adults from the United States and Germany. Analyses were conducted within a structural equation modeling framework on a cross-national, 2.5-year longitudinal sample of 537 community-residing adults (age 40-98 years). Awareness of age-related losses (AARC-Losses) at Time 1 predicted FTP at Time 2, but FTP did not predict AARC-Gains or AARC-Losses. Furthermore, future time perspective mediated the association between AARC-Losses and well-being. Moderation analyses revealed a buffering effect of awareness of age-related gains (AARC-Gains) in which perceptions of more age-related gains diminished the negative effect of a limited future time perspective on well-being. Effects were robust across age groups and countries. Taken together, these findings suggest that perceived age-related loss experiences may sensitize individuals to perceive a more limited future lifetime which may then lead to lower psychological well-being. In contrast, perceived age-related gains may function as a resource to preserve psychological well-being, in particular when time is perceived as running out. (PsycINFO Database Record