Changes in older people's quality of life in the COVID-19 era: a population-based study in Finland.

PURPOSE: We investigated how quality of life (QoL) changed between 2018 and 2020, and how its related factors, i.e., communication with friends and family, loneliness, and sleeping difficulties changed amid the early-phase COVID-19 pandemic among Finnish older people. METHODS: This study utilizes data from a repeated cross-sectional, population-based FinSote survey in 2018 and 2020. Participants were community-dwelling people aged 75 years or older (N = 9781 in 2018 and N = 9919 in 2020). QoL was assessed with the EUROHIS-QoL-8 scale. Changes in QoL-related factors were self-evaluated in 2020. Statistical methods included t test, Cohen's D, and chi-square test. To identify potential risk groups, all analyses were stratified by socio-demographic features including sex, age, economic deprivation, living alone, and difficulties in Instrumental Activities of Daily Living (IADL). RESULTS: QoL improved slightly from 2018 to 2020 (means 3.68 and 3.81, respectively). Only those reporting economic deprivation demonstrated a slight decrease in QoL (3.24 vs. 3.14). Of respondents, 63% reported having less communication with friends and family, 42% having felt lonelier, and 20% having more sleeping difficulties amid the pandemic. Negative changes were more often reported by women, the oldest old, those living alone, reporting economic deprivation, or manifesting IADL difficulties. CONCLUSION: Finnish older people's QoL was not affected as much as expected amid the pandemic, although some population groups were, however, more susceptible to the negative effects of the pandemic on QoL-related factors. Results imply that various socio-demographic features may shape the effects of a global pandemic and its control measures on wellbeing.

Use of walking modifications, perceived walking difficulty and changes in outdoor mobility among community-dwelling older people during COVID-19 restrictions.

BACKGROUND: Outdoor mobility enables participation in essential out-of-home activities in old age. AIM: To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. METHODS: Community-dwelling participants of AGNES study (2017-2018, initial age 75-85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. RESULTS: Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p < 0.001), and a smaller decline in autonomy in participation outdoors (p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p < 0.001 for both). DISCUSSION: Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. CONCLUSION: Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.

Psychometric properties of the 10-item Connor-Davidson resilience scale among Finnish older adults.

OBJECTIVES: Resilience, the ability to bounce back after adverse events may be an important factor in active aging. The 10-item version of the Connor-Davidson Resilience Scale (CD-RISC10) seems suitable for aging research owing to its low participant burden; however, its psychometric properties have not been comprehensively reported for older people. For example, no estimate exists of the test-retest reliability of the scale when used with older adults. Hence, this study evaluated the psychometric properties of the CD-RISC10 in a large population-based sample of community-dwelling older people. METHOD: The scale's internal consistency, factor structure, construct validity, test-retest reliability, and user experience were analyzed among 1018 Finnish older adults (57% women) aged 75 (45%), 80 (33%) and 85 years (22%). RESULTS: The internal consistency of the CD-RISC10 was good (Cronbach's α = 0.85), test-retest reliability moderate (ICC = 0.61), and the scale was unidimensional. However, a two-factor solution was found among the 75-year-olds, where the ability to deal positively with change (e.g. using humor) explained an additional part of resilience. While no differences by gender, age, or education were observed in total scores, very good perceived financial situation was associated with higher resilience. The scale showed good construct validity, and user feedback indicated that administering the scale in research is quick and easy. CONCLUSION: In general, the CD-RISC10 is a valid method to study older adults' psychological resilience. However, the present test-retest reliability values suggest caution in using the scale as an outcome measure in intervention studies.

The effect of individualized, theory-based counselling intervention on active aging and quality of life among older people (the AGNES intervention study).

BACKGROUND: We define active aging as a striving for activities as per one's goals, capacities and opportunities. AIM: To test the 1-year counselling intervention effects on active aging. METHODS: In this two-arm single-blinded randomized controlled trial, the intervention group received individually tailored counselling supporting autonomous motivation for active life (one face-to-face session, four phone calls and supportive written material, n = 101) and the control group written health information (n = 103). Participants were community-dwelling men and women aged 75 or 80 years with intermediate mobility function and without cognitive impairment. The primary outcome was active aging total score measured with the University of Jyväskylä Active Aging Scale (UJACAS, range 0-272, higher values indicate more activity) and secondary outcomes were its subscores for goals, ability, opportunity and activity (range 0-68) and a quality of life (QoL) score. Measures took place at pre-trial, mid-trial (6 months) and post-trial (12 months), except for QoL only pre and post-trial. Data were analyzed with intention-to-treat principles using GEE-models. RESULTS: The UJACAS total score increased in the intervention group slightly more than in the control group (group by time p-value = 0.050, effect size 0.011, net benefit 2%), but the group effect was not statistically significant. A small effect was observed for the activity subscore (p = 0.007). DISCUSSION: The individualized counselling supporting autonomous motivation for active life increased the UJACAS score slightly. CONCLUSIONS: It may be possible to promote active aging with individualized counselling, but the effect is small and it is unclear whether the change is meaningful.

Individualized counselling for active aging: protocol of a single-blinded, randomized controlled trial among older people (the AGNES intervention study).

BACKGROUND: Active aging has been established as a policy goal for aging societies. We define active aging at the individual level as striving for elements of well-being through activities in relation to a person's goals, functional capacities and opportunities. Increasing evidence suggests that any meaningful activity is beneficial for different aspects of well-being in older people. The aim of the present randomized controlled trial is to test the feasibility and effectiveness of a one-year community-based intervention on active aging. The AGNES intervention aims at increasing older peoples' participation in self-selected valued activities. METHODS: The proposed study is a two-arm single-blinded randomized controlled trial. The intervention group receives individually tailored counselling for an active life (one face-to-face session, four phone calls and supportive written material) and the control group written general health information only. Two hundred older adults aged 75- and 80- year old, with intermediate mobility function and without cognitive impairment, living independently in the municipality of Jyväskylä, Finland, are recruited and randomized with a 1:1 allocation to the intervention and control group. Randomization is computer-generated stratified by sex and age. The primary outcome is active aging and secondary outcomes are well-being, depressive symptoms, quality of life, personal goals, mobility and physical activity. Measures are administered at pre-trial, mid-trial (at 6 months) and post-trial (12 months after baseline). DISCUSSION: The AGNES intervention study will provide new knowledge on the effects of individualized counselling on active aging and the potential of older people to promote their own well-being. TRIAL REGISTRATION: The trial is registered at ISRCTN - ISRCTN16172390 : Promoting well-being through active aging.

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people.

BACKGROUND: As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility. AIMS: We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one's goals) and flexible goal adjustment (FGA; adjusting one's goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people. METHODS: Participants (n = 186) were aged 79-93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA. RESULTS: General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations. CONCLUSIONS: Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life.

Active aging - resilience and external support as modifiers of the disablement outcome: AGNES cohort study protocol.

BACKGROUND: Population aging increases the need for knowledge on positive aspects of aging, and contributions of older people to their own wellbeing and that of others. We defined active aging as an individual's striving for elements of wellbeing with activities as per their goals, abilities and opportunities. This study examines associations of health, health behaviors, health literacy and functional abilities, environmental and social support with active aging and wellbeing. We will develop and validate assessment methods for physical activity and physical resilience suitable for research on older people, and examine their associations with active aging and wellbeing. We will examine cohort effects on functional phenotypes underlying active aging and disability. METHODS: For this population-based study, we plan to recruit 1000 participants aged 75, 80 or 85 years living in central Finland, by drawing personal details from the population register. Participants are interviewed on active aging, wellbeing, disability, environmental and social support, mobility, health behavior and health literacy. Physical activity and heart rate are monitored for 7 days with wearable sensors. Functional tests include hearing, vision, muscle strength, reaction time, exercise tolerance, mobility, and cognitive performance. Clinical examination by a nurse and physician includes an electrocardiogram, tests of blood pressure, orthostatic regulation, arterial stiffness, and lung function, as well as a review of chronic and acute conditions and prescribed medications. C-reactive protein, small blood count, cholesterol and vitamin D are analyzed from blood samples. Associations of factors potentially underlying active aging and wellbeing will be studied using multivariate methods. Cohort effects will be studied by comparing test results of physical and cognitive functioning with results of a cohort examined in 1989-90. CONCLUSIONS: The current study will renew research on positive gerontology through the novel approach to active aging and by suggesting new biomarkers of resilience and active aging. Therefore, high interdisciplinary impact is expected. This cross-sectional study will not provide knowledge on temporal order of events or causality, but an innovative cross-sectional dataset provides opportunities for emergence of novel creative hypotheses and theories.

Active Aging in Senior Housing Residents and Community-Dwelling Older Adults: A Comparative Study in Finland.

OBJECTIVES: Leading an active life in old age underpins positive life experience. This study aimed to compare the levels of active aging in senior housing residents and community-dwelling older people. METHODS: We combined data from the BoAktiv senior house survey (N = 336, 69% women, mean age 83 years) and AGNES cohort study among community-dwelling older adults (N = 1021, 57% women, mean age 79 years). Active aging was assessed with the University of Jyvaskyla Active Aging scale. Data were analyzed with general linear models, and the analyses were stratified by sex. RESULTS: Men in senior houses demonstrated lower active aging scores in general than community-dwelling men. Women in senior houses showed greater will to be active, but poorer ability and possibilities for activity than community-dwelling women. DISCUSSION: Despite the social and supporting environment, senior housing residents' possibilities for leading an active life seem to be compromised, potentially leading to an unmet activity need.

Social Mobility and Health-Related Quality of Life Trajectory Classes Among Older Women and Men.

OBJECTIVES: Changes in socioeconomic status (SES) during life may impact health in old age. We investigated whether social mobility and childhood and adulthood SES are associated with trajectories of health-related quality of life (HrQoL) over a 17-year period. METHODS: We used data from the Helsinki Birth Cohort Study (n = 2003, 46% men, mean age 61.5 years). Social mobility was derived from childhood SES, obtained from healthcare records, and register-based adulthood SES. RESULTS: Logistic regression models showed that lower adulthood SES was associated with lower physical HrQoL trajectories. Among men low (OR 3.95, p < .001), middle (OR 2.20, p = .006), and declining lifetime SES (OR 2.41, p = .001) were associated with lower physical HrQoL trajectories compared to men with high SES. Socioeconomic status was not associated with mental HrQoL trajectories. DISCUSSION: Declining SES during life course may have negative health consequences, while improving SES is potentially as beneficial as high SES to later-life health among men.

Do the integrated theories of self-determination and planned behavior explain the change in active life engagement following a motivational counseling intervention among older people?

BACKGROUND: An integrated model based on self-determination and planned behavior theories has been used to explain physical activity and other health-related behaviors mainly among younger populations, not older adults. The present study aimed to conduct a secondary analysis to explore whether changes in theory-based constructs explain a change in activity level (including 17 activities in essential life areas) among 75- and 80-year-old individuals. METHODS: Data came from the Promoting well-being through active aging (AGNES) study, a two-arm single-blinded randomized control trial, where participants in the intervention group (n = 101) received year-long individualized counseling between 2017-19 in Jyväskylä, Finland. Activity frequency was assessed using the University of Jyväskylä Active Aging Scale (UJACAS) activity sub-score, perceived autonomy support with the Health Climate Questionnaire, autonomous motivation with a sub-scale from the Self-Regulation Questionnaire, and attitude with three items. Subjective norm, perceived behavioral control, and intention were each assessed with one item. Change in variables between baseline and the 12-month follow-up was specified via latent factors. Various structural equation models were tested to assess whether the basic or modified model, including additional paths from baseline variables to change factors, provided a better data fit. RESULTS: In the modified integrated model, baseline attitude and change in attitude directly explained the change in activity frequency. Moreover, statistically significant indirect paths were observed from baseline autonomous motivation through baseline attitude, and from activity frequency through change in attitude to change in activity frequency. CONCLUSIONS: The theoretical integrated model did not account for the change in active life engagement. The modified integrated model revealed significant change paths, highlighting autonomous motivation and attitudes as influential change constructs. For future intervention design, the modified integrated model appears useful in identifying behavior change pathways for older adults.

Self-rated resilience and mobility limitations as predictors of change in active aging during COVID-19 restrictions in Finland: a longitudinal study.

Social distancing during the COVID-19 pandemic decreased older people's opportunities to lead an active life. The purpose of this study was to investigate whether walking difficulties predict changes in leading an active life during the COVID-19 social distancing recommendation compared to 2 years before, and whether self-rated resilience moderates this association among older people. Data were collected during social distancing recommendation in May and June 2020 and 2 years before (2017-18) among community-living AGNES study participants initially aged 75, 80, or 85 years (n = 809). Leading an active life was assessed with the University of Jyväskylä Active Aging Scale (UJACAS; total score range 0-272) and resilience with the 10-item Connor-Davidson Resilience Scale (0-40). Self-reported walking difficulties over a 2 km distance were categorized into no difficulty, difficulty, and unable to walk. The total UJACAS score declined 24.9 points (SD 23.5) among those without walking difficulty, 27.0 (SD 25.0) among those reporting walking difficulty and 19.5 (SD 31.2) among those unable to walk 2 km. When adjusted for baseline UJACAS score, those unable to walk 2 km demonstrated the greatest decline. Baseline resilience moderated this association: Higher resilience was associated with less declines in UJACAS scores among persons with or without walking difficulty, and with more declines among persons unable to walk 2 km. When opportunities for leading an active life are compromised, those with less physical and psychological resources become particularly vulnerable to further declines in activity.

Psychological resilience and active aging among older people with mobility limitations.

Active aging refers to striving for well-being through preferred activity and may be restricted with declining mobility. We investigated whether psychological resilience, i.e., the ability to tolerate hardship, can aid older people in being active despite mobility limitations. Participants were 961 community-dwelling persons aged 75, 80, or 85 years living in Jyväskylä, Central Finland. Mobility limitations were indicated as self-reported difficulty in walking 2 km. Categories were no difficulty (reference), difficulty, and unable to walk. Resilience was assessed with the 10-item Connor-Davidson Resilience Scale and active aging with the University of Jyvaskyla Active Aging scale. Data were analyzed with OLS regression analyses, which were stratified by age. In all age-groups, having difficulties walking or being unable to walk 2 km was associated with lower active aging scores. Resilience moderated this association especially among the 75-year-olds, but not among the 85-year-olds: The higher the resilience score, the higher the active aging score among those reporting no or some walking difficulties. Those unable to walk 2 km had lower active aging scores irrespective of resilience level. Psychological resilience may alleviate the negative effects of early phase walking difficulties on active aging but may be insufficient to compensate for more severe walking limitations that restrict not only function but also autonomy.

Assimilative and Accommodative Coping and Older People's Leisure Activities.

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite low physical performance, people with high TGP had close to mean level of leisure activity participation, whereas low TGP was associated with very little activity. Most notably, people without high TGP had fewer outdoor activities and group activities outside home. Similar effects were not found for FGA. Discussion: Persistency, rather than flexibility, in goal pursuit appears to help older people be active in their leisure time.

Effects of an Individualized Active Aging Counseling Intervention on Mobility and Physical Activity: Secondary Analyses of a Randomized Controlled Trial.

Objectives: The aim of this study was to report preplanned secondary analyses of the effects of a 12-month individualized active aging counseling intervention on six mobility and physical activity outcomes. Methods: A two-arm, single-blinded randomized controlled trial was conducted among 75- and 80-year-old community-dwelling people. The intervention group (IG, n = 101) received counseling aimed at increasing self-selected, primarily out-of-home activity. The control group (CG, n = 103) received general health information. Data were analyzed with generalized estimating equations. Results: Physical performance improved in the IG more than that in the CG (group by time p = .022), self-reported physical activity increased in both groups (time p = .012), and autonomy in outdoor mobility declined in the IG and was enhanced in the CG (group by time p = .011). No change was observed for life-space mobility, proportion of persons perceiving difficulty walking 2 km, or monitored physical activity. Discussion: Individualized counseling aiming at increasing self-selected out-of-home activity had nonsystematic effects on mobility and positively affected physical performance only.

The Associations of Activity Fragmentation With Physical and Mental Fatigability Among Community-Dwelling 75-, 80-, and 85-Year-Old People.

BACKGROUND: Fatigue related to task standardized by duration and intensity, termed fatigability, could manifest as shortening of activity bouts throughout the day causing daily activity to accumulate in a more fragmented pattern. Our purpose was to study the association of activity fragmentation with physical and mental dimensions of fatigability. METHODS: A cross-sectional study of 485 community-dwelling 75-, 80-, and 85-year-old people using a thigh-worn accelerometer for 3-7 days. Activity fragmentation was studied as Active-to-Sedentary Transition Probability for 2 operational definitions of physical activity: accelerations equivalent to at least light physical activity and for upright posture. Physical fatigability was assessed as perceived exertion fatigability, performance fatigability severity, and with the Physical Fatigue Subscale of the Situational Fatigue Scale. Mental fatigability was assessed with the Mental Fatigue Subscale of the Situational Fatigue Scale and as a decrease in perceived mental alertness after a 6-minute walk test. RESULTS: Higher activity fragmentation was associated with higher self-reported physical fatigability, perceived exertion fatigability, and performance fatigability severity, independent of total activity minutes (ß = 0.13-0.33, p < .05 for all). Higher activity fragmentation was not associated with mental fatigability in the fully adjusted models. The associations with fatigability indices were similar for both activity fragmentation indicators. Associations of activity fragmentation and performance fatigability severity were similar also among those with the highest intensity-based physical activity volume. CONCLUSIONS: The findings provide support that studying fragmented activity patterns can be useful in identifying those at risk for high fatigability, even among those with relatively high physical activity level.

The Combined Effect of Lower Extremity Function and Cognitive Performance on Perceived Walking Ability Among Older People: A 2-Year Follow-up Study.

Background: We studied the combined effects of cognitive performance and lower extremity function on self-reported walking modifications and walking difficulty and on self-reported walking difficulty incidence over a 2-year follow-up. Methods: A total of 848 community-dwelling older people aged 75-90 years participated at baseline, 816 at the 1-year follow-up, and 761 at the 2-year follow-up. Baseline lower extremity function was measured with the Short Physical Performance Battery (<10 vs. ≥10) and cognitive performance with the Mini-Mental State Examination (<24 vs. ≥24). Difficulty in walking 2 km was self-reported and categorized into no difficulties, no difficulties but walking modifications, and prevalent difficulties. Data were analyzed with multinomial and Cox regressions and a mediation analysis. Results: At baseline, 33% reported no walking difficulties, 25% walking modifications, and 42% walking difficulty. Poorer lower extremity function and lower cognition increased the odds for walking difficulty. For those with both, the odds were almost eightfold higher for walking difficulty and threefold higher for walking modifications compared with having neither. Poorer lower extremity function mediated the association between low cognition and poorer perceived walking ability. Of those with no walking difficulty at baseline, 31% developed walking difficulty during the follow-up, the risk being almost twofold higher among those with poorer lower extremity function at baseline (hazard ratio = 1.82, 95% confidence interval = 1.28-2.59). Conclusion: Older people with poorer lower extremity function and cognitive performance are likely to have walking difficulties, rendering them especially vulnerable to further disability. Cognitive performance should be considered in interventions aimed at preventing mobility disability.