Successful Aging and Subjective Aging: Toward a Framework to Research a Neglected Connection.

Research related to subjective aging, which describes how individuals perceive, interpret and evaluate their own aging, has substantially grown in the past two decades. Evidence from longitudinal studies shows that subjective aging predicts health, quality of life, and functioning in later life. However, the existing literature on successful aging has mostly neglected the role of subjective aging. This paper proposes an extended framework of successful aging linking subjective aging conceptually and empirically to Rowe and Kahn's (1997) three original key criteria of successful aging (i.e., avoiding disease and disability, maintaining high cognitive and physical function, and engagement with life). A particular focus is placed on subjective aging as an antecedent of successful aging. A review of the empirical subjective aging literature shows that subjective aging concepts consistently predict all three of Rowe and Kahn's criteria of successful aging. Mechanisms underlying these relations are discussed at three levels, namely psychological, behavioral, and physiological pathways. The proposed addition also takes into consideration the interconnections between subjective aging and successful aging throughout the lifespan and across historical time. Finally, we discuss the importance of facilitating successful aging through systematic interventions that support more positive views of aging at the individual and societal level.

Postponing old age: Evidence for historical change toward a later perceived onset of old age.

"At what age would you describe someone as old?" Perceptions of when old age begins might be prone to upward shifts because of historical increases in life expectancy and in retirement age, as well as because of better psychosocial functioning in later life. We investigated historical changes in within-person trajectories of the perceived onset of old age using data from 14,056 participants who entered the German Ageing Survey at age 40-85 years and who completed up to eight assessments across 25 years. Using longitudinal multilevel regression models, we found that at age 64, the average perceived onset of old age is at about age 75 years. Longitudinally, this perceived onset age increased by about 1 year for every 4-5 years of actual aging. We also found evidence for historical change. Compared to the earliest-born cohorts, later-born cohorts reported a later perceived onset of old age, yet with decelerating trend among more recent birth cohorts. Within-person increases of the perceived onset of old age were steeper in later-born cohorts. The described cohort trends were only slightly reduced when controlling for covariates. Being younger, male, living in East Germany, feeling older, reporting more loneliness, more chronic diseases, and poorer self-rated health were each associated with a perceived earlier onset of old age. Our results suggest that there is a nonlinear historical trend toward a later perceived onset of old age, which might have meaningful implications for individuals' perspectives on aging and old age. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Strengthening prevention and health promotion in and for old age]. / Prävention und Gesundheitsförderung im und für das Alter stärken.

BACKGROUND: Disease prevention and health promotion in and for old age have become increasingly more important. Nevertheless, more (national) research and implementation in practice is needed, as the international comparison shows. OBJECTIVE: To develop guiding principles for research and practice on prevention and health promotion in and for old age. MATERIAL AND METHODS: As part of an iterative process, members of the German Society of Gerontology and Geriatrics came together in workshops and symposia to formulate key guiding principles and fields of action for prevention and health promotion. RESULTS: The following were worked out: 1) prevention and health promotion are useful and possible up to oldest age, 2) prevention and health promotion for advanced age should start early, 3) prevention and health promotion must take into account the diversity and heterogeneity of the life situations of old people, 4) prevention and health promotion promote and demand self-determination and participation, 5) prevention of multiple illnesses must be given greater attention, 6) prevention of the need for long-term care and prevention in long-term care must be treated equally, 7) prevention and health promotion must be thought of in terms of life worlds and across sectors, paying particular attention to aspects of social inequality and a focus on resources, 8) prevention and health promotion and the related research must be interdisciplinary and transdisciplinary and be applied at different levels, from molecular to societal. DISCUSSION: The guiding principles outline the focal points of future-oriented ageing, health and healthcare research and open up fields of action but also show the limits of this approach for political decision-makers, researchers and practitioners.

Prevalence of living wills among older adults in Germany.

Background: Living wills regulate medical decisions in emergency situations. Those who create a living will can have it registered voluntarily in the Central Register of Lasting Powers of Attorney. Little is known about the general prevalence of living wills. Methods: The German Ageing Survey is an ongoing, population-representative study. 4,185 people aged 50 and older were surveyed about living wills in 2020/2021. Results: 44.8 % of people aged 50 and older have a living will, women more often than men (50.1 % vs. 39.2 %), older people more often than middle-aged people. Educational differences do not exist. Conclusions: Living wills increase the autonomy in medical emergency situations because the patient's wishes are specified in written form. People of all age groups should inform themselves about the significance of living wills and should seek advice about the contents, for example from the general practitioner or one's own health insurance.

Prevalence of loneliness among older adults in Germany.

Background: Loneliness refers to the subjective perception of a mismatch between a person's social needs and their actual personal relationships. In this paper, the prevalence of loneliness in the older population was examined based on current data. Methods: The German Ageing Survey is an ongoing, population-representative study. A total of 4,261 people 50 years of age and older were surveyed in 2020/2021 with regard to their experience of loneliness. Results: Overall, 8.3 % of the population 50 years of age and older feel lonely. The findings showed no differences between different age groups over 50 years of age, nor are there gender or educational differences. Conclusions: There was no evidence that older individuals living in private households experience loneliness more commonly than middle-aged individuals. Data from nursing home residents indicate that there may be a higher risk of loneliness.

Fear of Falling Carries Over into Overprotection in Old Age: A Cross-Lagged Panel Analysis.

Fear of falling might result in overprotection by one's social environment. In turn, feeling dependent could increase fear of falling. However, the association between fear of falling and perceived overprotection and its temporal order is unknown. This longitudinal study explores this potential mutual longitudinal association. This study presents secondary analyses from a larger trial. We tested the association between fear of falling and perceived overprotection in a cross-lagged path model controlled for falls, health-related quality of life, age, gender, and trial condition. N = 310 participants (M = 70 years, range: 64-92) completed self-reports at Time 1, 7 (Time 2), and 11 weeks (Time 3) after baseline assessment. We found a positive association from fear of falling to perceived overprotection (ß = .12, 95% CI[0.02, 0.21], p = .02; ß = .10; [0.01, 0.18], p = .03). The reversed cross-lagged paths were not significant. Findings suggest higher fear of falling translates into perceived overprotection, which may in turn increase loss of independence in old age.

Younger Than Ever? Subjective Age Is Becoming Younger and Remains More Stable in Middle-Age and Older Adults Today.

Little is known about historical shifts in subjective age (i.e., how old individuals feel). Moving beyond the very few time-lagged cross-sectional cohort comparisons, we examined historical shifts in within-person trajectories of subjective age from midlife to advanced old age. We used cohort-comparative longitudinal data from middle-age and older adults in the German Ageing Survey (N = 14,928; ~50% female) who lived in Germany and were between 40 and 85 years old when entering the study. They provided up to seven observations over 24 years. Results revealed that being born later in historical time is associated with feeling younger by 2% every birth-year decade and with less intraindividual change toward an older subjective age. Women reported feeling younger than men; this gender gap widened across cohorts. The association of higher education with younger subjective age became weaker across cohorts. Potential reasons for the subjective-rejuvenation effect across cohorts are discussed.

The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study.

BACKGROUND: Elective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap. METHODS: We used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied. RESULTS: Our analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH. CONCLUSIONS: Meaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health. TRIAL REGISTRATION: PAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311 .

Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis.

This article updates and extends an earlier meta-analysis (Westerhof et al., 2014) on the longitudinal effects of subjective aging (SA) on health outcomes. A systematic search in different databases (APA PsycInfo, PubMed, Web of Science, and Scopus) resulted in 99 articles, reporting on 107 studies. Participants: Studies had a median sample size of 1,863 adults with a median age of 66 years. A randomized effect meta-analysis showed a significant, small effect (likelihood ratio = 1.347; 95% confidence interval [1.300, 1.396]; p < .001), similar in magnitude to the previous meta-analysis of 19 studies. Although the results showed high heterogeneity in the longitudinal link between SA and health outcomes, there were no differences in effects according to chronological age of participants, welfare state status (more or less developed social security system), length of follow-up, type of health-related outcome, or quality of the study. Effects were stronger for multiitem measures of self-perceptions of aging than for the frequently used single-item measures assessing subjective age, especially for indicators of physical health. Based on this meta-analysis, building on five times more studies than the 2014 review, we consider the associations of measures of SA with health and longevity across time as robust, albeit small in size. Future research should concentrate on the clarification of pathways mediating the relation between SA and health outcomes, as well as potential bidirectional effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preliminary results of the cross-sectional associations of sedentary behavior and physical activity with serum brain-derived neurotrophic factor in adults with coronary heart disease.

This is the first study to analyze the association of accelerometer-measured patterns of habitual physical activity (PA) and sedentary behavior (SB) with serum BDNF in individuals with coronary heart disease. A total of 30 individuals (M = 69.5 years; 80% men) participated in this pre-post study that aimed to test a multi-behavioral intervention. All participants underwent standardized measurement of anthropometric variables, blood collection, self-administered survey, and accelerometer-based measurement of PA and SB over seven days. Serum BDNF concentrations were measured using enzyme-linked immunosorbent assay kit. We applied separate multiple linear regression analysis to estimate the associations of baseline SB pattern measures, light and moderate-to-vigorous PA with serum BDNF (n = 29). Participants spent 508.7 ± 76.5 min/d in SB, 258.5 ± 71.2 min/d in light PA, and 21.2 ± 15.2 min/d in moderate-to-vigorous PA. Per day, individuals had 15.5 ± 3.2 numbers of 10-to-30 min bouts of SB (average length: 22.2 ± 2.1 min) and 3.4 ± 1.2 numbers of > 30 min bouts of SB (average length: 43.8 ± 2.4 min). Regression analysis revealed no significant associations between any of the accelerometer-based measures and serum BDNF. The findings of this study did not reveal an association of accelerometer-measured PA and SB pattern variables with serum BDNF in individuals with coronary heart disease. In addition, our data revealed a considerable variation of PA and SB which should be considered in future studies.

Information assistance systems as preventive mediators between increasing customization and mental workload.

BACKGROUND: The future of work in Germany is shaped by megatrends like globalization, automatization, digitization, and the demographic change. Furthermore, mass customization and the increasing usage of AI even in manual assembly offers new opportunities as well as it creates new challenges. OBJECTIVE: The trend towards mass customization in turn leads to increased complexity in production, which results in additional mental workload. This effect will continue in the foreseeable future. METHOD: Especially for small and medium sized companies, the backbone of Germany's economy, automatization and Human-Robot-Collaboration will take time to develop. Information assistance systems are and will be a bridging technology to help organizations to manage increasing complexity and the mental workload of their employees to not only boost productivity but also keep their workforce healthy. The ongoing demographic change further underlines the need to use information assistance systems to compensate possible age-associated deficits, but also keep older employees committed to their work and avoid effects of disengagement or disenfranchisement through participatory ergonomics. RESULTS: Information assistance systems can only develop their inherent potential if they are designed to support employees of varying age, competence levels, and affinity for technology. Participatory development and early engagement are key factors for an increased acceptance and usage of the systems as well as the individualization to make it suitable for each individual employee. CONCLUSION: Expanding the functionalities to an adaptive assistance system, using physiological correlates of mental workload as an input, is conceivable in the future.

"Gain- but not loss-related self-perceptions of aging predict mortality over a period of 23 years: A multidimensional approach": Correction.

Reports an error in "Gain- but not loss-related self-perceptions of aging predict mortality over a period of 23 years: A multidimensional approach" by Susanne Wurm and Sarah K. Schäfer (Journal of Personality and Social Psychology, Advanced Online Publication, Feb 24, 2022, np). In the original article, there was an error in the third sentence in the Combined Model Comprising SPA Dimensions and SA section. The corrected sentence should read as: Again, an increase of gain-related SPA by 1 SD was related to a decrease in risk of death by 12%. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2022-31793-001). Some 2 decades have passed since Levy et al. (2002) published their seminal study on the impact of self-perceptions of aging (SPA) on mortality over a period of 23 years in this journal; we aimed at replicating and extending these findings against the background of recent discussions in the research on subjective aging. Based on a large German nationwide population-based sample of individuals aged 40 and older (N = 2,400), for whom mortality was also documented over a period of 23 years (1996-2019), the present study is the first to investigate the unique impact of gain- and loss-related SPA and subjective age (SA) as components of subjective aging on mortality. Data were analyzed with hierarchical Cox proportional hazard regressions. The study pointed to the prominent role of gain-related SPA. For individuals who perceived aging as associated with ongoing development risk of death was half that of individuals with less gain-related SPA. Viewing aging as associated with physical or social losses could not predict mortality after controlling for covariates such as age, gender, education, health-related variables, and psychological variables known to predict mortality. Neither could SA predict mortality. When SA and gain- and loss-related SPA were analyzed in a combined model, gain-related SPA remained a significant predictor of mortality. The findings support previous studies on the importance of SPA for mortality. In addition, the results suggest that mainly gain-related SPA (but not loss-related SPA and SA) explain differences in mortality and should thus be addressed in intervention studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Gain- but not loss-related self-perceptions of aging predict mortality over a period of 23 years: A multidimensional approach.

[Correction Notice: An Erratum for this article was reported online in Journal of Personality and Social Psychology on Apr 25 2022 (see record 2022-56187-001). In the original article, there was an error in the third sentence in the Combined Model Comprising SPA Dimensions and SA section. The corrected sentence should read as: Again, an increase of gain-related SPA by 1 SD was related to a decrease in risk of death by 12%. All versions of this article have been corrected.] Some 2 decades have passed since Levy et al. (2002) published their seminal study on the impact of self-perceptions of aging (SPA) on mortality over a period of 23 years in this journal; we aimed at replicating and extending these findings against the background of recent discussions in the research on subjective aging. Based on a large German nationwide population-based sample of individuals aged 40 and older (N = 2,400), for whom mortality was also documented over a period of 23 years (1996-2019), the present study is the first to investigate the unique impact of gain- and loss-related SPA and subjective age (SA) as components of subjective aging on mortality. Data were analyzed with hierarchical Cox proportional hazard regressions. The study pointed to the prominent role of gain-related SPA. For individuals who perceived aging as associated with ongoing development risk of death was half that of individuals with less gain-related SPA. Viewing aging as associated with physical or social losses could not predict mortality after controlling for covariates such as age, gender, education, health-related variables, and psychological variables known to predict mortality. Neither could SA predict mortality. When SA and gain- and loss-related SPA were analyzed in a combined model, gain-related SPA remained a significant predictor of mortality. The findings support previous studies on the importance of SPA for mortality. In addition, the results suggest that mainly gain-related SPA (but not loss-related SPA and SA) explain differences in mortality and should thus be addressed in intervention studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations of Agency and Communion With Domain-Specific Self-Perceptions of Aging: A Cross-Sectional Study In Old-Old Adults in Poor Health.

A large body of research indicates that self-perceptions of aging (SPA) play an important role for health in later life. Hence, more research on SPA and correlates is needed, especially in old age and poor health, where negative SPA tend to prevail. Recent studies identified personality as an important correlate of SPA in young-old and relatively healthy samples. Thus, we investigated cross-sectional associations of agency and communion with two SPA domains in a sample of old-old adults in poor health (n = 154; Mage = 81.55, SD = 4.56, 58.4% women). In multiple regression analyses, agency and communion were associated with SPA related to ongoing development beyond health. In contrast, only health as a covariate was significantly associated with SPA related to physical losses. Thus, personality may be a resource associated with gain-related SPA, at least for those in poor health and old age.

What makes implementation intentions (in)effective for physical activity among older adults?

OBJECTIVES: For most populations, implementation intentions (IIs) facilitate physical activity (PA). However, for older adults, previous studies found mixed evidence for the effectiveness of this behaviour change technique. To examine which characteristics of IIs predict successful enactment, the content of older participants' IIs formed within a self-regulatory intervention to prompt PA was analysed. DESIGN: A sample of N = 126 German speaking adults aged 64 and older formed up to six IIs for PA and reported their enactment 5 weeks later. METHODS: Controlling for age and sex, multilevel models tested associations between characteristics of IIs (e.g., chronological rank of II, hetero- and homogeneity, specificity, presence of certain cues) and enactment. RESULTS: Significantly related to enactment were: the chronological rank of an II (first IIs superior to last IIs), greater heterogeneity in activities, greater specificity of when-cues, and greater use of pre-existing routines. CONCLUSIONS: Participants were more likely to enact their IIs 5 weeks later if they planned different (heterogeneous) activities, created IIs with more specific when-cues (e.g., on Monday at 9 am), and in particular a routine (e.g., after breakfast). They also enacted the first three IIs (chronological rank of II) more often than the last three IIs. Future experimental studies should test whether providing instructions to create IIs based on the above significant characteristics lead to more effective health behaviour change among older adults.

Longitudinal measurement invariance of the patient health questionnaire in a German sample.

BACKGROUND: The Patient Health Questionnaire-8 (PHQ-8) is a screening questionnaire of depressive symptoms. However, it is unknown whether it is equivalent across time and between groups of individuals. The aim of our paper was to test whether the PHQ-8 has the same meaning in two groups of individuals over time. METHODS: Primary care patients were proactively recruited from three German cities. PHQ-8 data from a baseline assessment (n = 588), two assessments during the intervention (n = 246/225), and a six (n = 437) and 12 months (n = 447) follow-up assessment were first used to examine the factor structure of the PHQ-8 by confirmatory factor analysis (CFA). The best fitting factor solution was then used to test longitudinal invariance across time and between intervention and control group by Multiple Group CFA. RESULTS: A two-factor structure consistently showed the best model fit. Only configural longitudinal invariance was evidenced when the baseline assessment was included in the analysis. Without the baseline assessment, strict longitudinal invariance was shown across the intervention and the follow-up assessments. Scalar invariance was established between the intervention and control group for the baseline assessment and strict invariance between groups and across the 6- and 12-month follow-up assessments. CONCLUSIONS: The lack of longitudinal invariance might be attributed to various differences between the baseline assessments and all following assessments, e.g., assessment mode (iPad vs telephone), potential changes in symptom perception, and setting. TRIAL REGISTRATION: DRKS0001163 5, date of trial registration: 20.01.2017; DRKS00011637 , date of trial registration: 25.01.2017.

Shifting self-perceptions of ageing: differential effects of value priorities on self-perceptions of ageing beyond age stereotypes.

Self-perceptions of ageing (SPA) are important predictors of health in later life. However, research on antecedents of SPA other than age stereotypes is scarce. To address this gap, this study investigates the impact of personal value priorities beyond age stereotypes on SPA. Can values as the motivational basis of attitudes and evaluations predict gain- and loss-related SPA? To answer this question, we conducted multiple regression analyses of longitudinal data from two waves (2008, 2011) of the German Ageing Survey (DEAS; N = 6089, age range in 2008: 40-93 years). Gain- and loss-related SPA as well as age stereotypes were assessed with two AgeCog scales and personal values with the 21-item Portrait Values Questionnaire. Results indicate that value priorities relate to SPA longitudinally in domain-specific ways: People with a value priority of openness to change and self-transcendence reported more gain-related SPA at follow-up, whereas those who prioritized conservation reported less gain-related SPA. In the domain of loss-related SPA, those people with a value priority of self-enhancement reported more and those prioritizing self-transcendence reported less loss-related SPA at follow-up. These results complement and extend recent findings on the role of personality for SPA. They suggest that whether people focus on the gains or losses that occur with age, whether they perceive ageing as a threat or chance, is not only shaped by their age stereotypes, but also by what they find important-their values.

Correction to: Views on ageing: a lifespan perspective.

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

Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study.

INTRODUCTION: Stroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke. METHODS AND ANALYSIS: The study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1-5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models. ETHICS AND DISSEMINATION: The study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives. TRIAL REGISTRATION NUMBER: NCT04704635.