Family Environment, Loneliness, Hope, and Subjective Well-Being of Asian Older Adults.

The current study examined the interactions between family environment, hope, and loneliness, and their subsequent influence on the subjective well-being (SWB) of 345 noninstitutionalized older adults (aged 60 years and above) in Singapore. Door-to-door surveys information was collected on family environment (cohesiveness, relationship closeness, and support), hope, loneliness, and SWB (life satisfaction, happiness, and absence of negative affect). Structural equation modelling was conducted to test competing hypotheses derived from life stress and integrated resource theories. The results revealed that family environment influenced SWB both directly and indirectly. Family environment decreased loneliness and increased SWB. Additionally, family environment influenced SWB by offering increased hope. Family environment sets the context for the SWB of older adults in Singapore. Families should therefore be targeted for interventions to reduce loneliness, increase psychological resources, and raise SWB during old age.

Experiences of Elder Mistreatment: A Latent Profile Analysis.

Using a polyvictimization framework, this study seeks to identify profiles of older adults who are mistreated by their family members. Data were drawn from a survey (n = 897) on the prevalence of elder mistreatment in rural India. This study involved 187 community-dwelling older adults (aged 61 years and above) with experiences of mistreatment in the year prior to the interview. Mistreatment was assessed through an adapted version of the Conflict Tactics Scale. Latent profile analysis was conducted to classify older adults into empirically derived clusters. The best fitting model yielded three distinct profiles: multiple mistreatment all (high frequency), multiple mistreatment (predominantly psychological), and multiple mistreatment (predominantly neglect). The three clusters differed in terms of individual, familial, and perpetrator characteristics. These findings highlight the heterogeneity of elder mistreatment experiences and the need for specific interventions that address the needs of mistreated older adults.

Prevalence of and risk factors for loneliness in rural older adults.

OBJECTIVE: The study investigated the prevalence of and risk factors (socio-economic, health and kinship ties) for loneliness in older adults in rural India. METHODS: Data were collected from a random sample of 897 older adults in rural India. Loneliness was measured through a 3-item scale, and measures of kinship ties and health status were included. A hierarchical regression analysis was conducted. RESULTS: The prevalence rate of loneliness was 48%. The kinship factors contributed more to loneliness than the socio-demographic and health variables. The subjective aspects of kinship ties (relationship strain, support, family cohesion) explained more variance in loneliness than the structural aspects (living arrangements, family size). Within the functional component of kinship ties, relationship strain contributed more to loneliness. CONCLUSION: Strategies to combat loneliness should include multidynamic interventions on strengthening family ties and promoting optimal health during old age.

Activity Patterns Associated With Health Status in Later Life Among Singaporeans.

Research on activities overlooks the possibility that older adults engage in different activities contemporaneously. To address this gap, we used latent class analyses to identify activity patterns and then examined demographic and health correlates of these patterns among a nationally representative sample of older adults in Singapore. We identified four classes of activities: the family-focused instrumental activity (FIA) class, the social leisure activity (SLA) class, the multidynamic activity (MDA) class, and the passive activity (PA) class. Furthermore, the MDA members showed higher scores in their mental health. Worse physical functioning and higher depression scores also increased the likelihood of being in the FIA and PA groups. Significant demographics such as gender, ethnicity, marital status, education, employment, house type, and income were related to heterogeneity in older adults' activity patterns. Service providers might consider the impact of certain significant demographic and health-related correlates when planning programs to ensure greater reach and access.

A review on healthy ageing interventions addressing physical, mental and social health of independent community-dwelling older adults.

Healthy ageing is a multi-dimensional concept which appertains to all older adults. This study reviewed the intervention characteristics, intervention content and effectiveness of multi-dimensional healthy ageing interventions (MHAIs) addressing physical, mental and social health among independent community-dwelling older adults. A search was conducted in PubMed, CINAHL, Embase, Scopus, and PsycINFO for studies published from Jan 2007 to October 2016. 18 publications were included, accounting for 15 studies. The review reflected the complexity, variations and methodological considerations of developing a comprehensive MHAI. It demonstrated the possibility of integrating person-focused to environment-focused content topics in future MHAIs, beyond the physical, mental and social health dimensions. Among the reviewed studies, health education programs reported improvements in quality of life and life satisfaction while health assessment and education programs promoted positive health behaviors. Future MHAIs studies need to employ more robust research methods and greater contextual information reports to build stronger evidence base.

Perceived Quality of Life following Elder Mistreatment in Rural India.

Objectives: Using resilience theory, we examined multiple risks (individual, familial, and mistreatment characteristics) and promotive factors (mastery and social support) associated with perceived quality of life following mistreatment and tested two competing models, compensatory and protective models, to explain the role of promotive factors in the mistreatment-wellbeing linkage. Method: Face-to-face interviews were conducted by administering standardized instruments to 897 randomly selected older adults in rural Tamil Nadu, India. Information from 187 older adults, who, in the interview had reported mistreatment in the past 1 year formed the analysis. Quality of life following mistreatment was measured using the Satisfaction with Life Scale. Mistreatment was measured by an adapted version of the Conflict Tactics Scale. Results: Being single, hailing from a low income family, experiencing high levels of relationship strain, and experiencing more than one type of mistreatment were associated with decreased quality of life. High levels of mastery and social support were associated with high levels of quality of life following mistreatment. There was support for both compensatory and protective-reactive models of resilience. Some of the resources that counteract the negative effects of adversities and mistreatment appear to be effective only at lower levels of mistreatment. Discussion: Quality of life following mistreatment was influenced by multiple risk and promotive factors, results that are consistent with resilience theory. Concerted efforts must be undertaken to bolster protective factors and minimize risk factors to enhance quality of life following mistreatment.

Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households: A study protocol.

AIMS: To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore. BACKGROUND: In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people. DESIGN: A stratified randomized control trial with process evaluation is proposed. METHODOLOGY: The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme. DISCUSSION: The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senior-only households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life.

Health, family strains, dependency, and life satisfaction of older adults.

Using stress process theory and structural equation modelling, this study investigated the complex relationship between health status, family strain, dependency, and the life satisfaction of rural older adults with reported functional impairments in India. Data were extracted from a large-scale study of 903 randomly selected adults aged 61 years and older from 30 rural clusters of India. The sample for this study was confined to 653 older adults who reported functional impairments. Structural equation modelling showed that poor health status indirectly lowered the life satisfaction of older adults through family strains. Moreover, poor health status also indirectly influenced life satisfaction through dependency and family strain (poor health→dependency→family strains→life satisfaction). The findings indicate that for professionals who deal with the health of older adults, exploring relationship strains and dependency is vital to the assessment and intervention of subjective wellbeing. Inter-sectoral coordination and communication between healthcare and social service agencies might facilitate effective management of health problems among older adults. Moreover, taking family strains and dependency into account when caring for older adults with health problems is critical to help improve their quality of life and maintain their wellbeing.

Stressors social support and elder mistreatment.

OBJECTIVES: This study sought to examine the pathways through which interpersonal relationship strain and loneliness (stressors) influence elder mistreatment. In addition, the study tested the buffer effects of social support within the stressor-mistreatment relationship. METHOD: Face-to-face interviews were conducted with 897 randomly selected older adults in rural Tamil Nadu, India. Mediation and moderation models were tested using the process module. RESULTS: Results showed that, in addition to the direct effects, interpersonal problems also influenced mistreatment via loneliness (partially mediating model). In the moderation model, social support buffered the influence of interpersonal strain on mistreatment (unconditional direct effect) and also buffered the influence of interpersonal strain on mistreatment through loneliness (conditional indirect effects). DISCUSSION: Intervention on mistreatment should involve elimination of risk factors and strengthening of social resources.

Elder Mistreatment and Health Status of Rural Older Adults.

There is limited information on the nature of and health factors associated with elder mistreatment in rural areas. To address this gap in the literature, the current study described the nature of such mistreatment and investigated the association between different types of mistreatment and health factors among 897 randomly selected elderly persons in rural India. The results show that elder mistreatment was widely prevalent (21%). Furthermore, the higher frequency of and simultaneous occurrence of multiple types of mistreatment (83.4%) suggest that mistreatment was a continuous stressor. The presence of overall mistreatment was positively associated with depression symptoms and subjective health status. The higher levels of chronicity and multiple mistreatments further increased depression symptoms and lowered the health status of those who were mistreated. Although women, more than men, were more likely to experience mistreatment, chronic mistreatment, and multiple mistreatments, there were no significant gender differences in the mistreatment-health relationship. These findings suggest that older adults with depression symptoms and poor health should be screened for mistreatment.

Factors associated with elder mistreatment in rural Tamil Nadu, India: a cross-sectional survey.

BACKGROUND: There is limited evidence for the multifactorial aetiology of elder mistreatment. The goal of this study is to investigate the factors associated with the mistreatment of older adults living in rural Tamil Nadu, India. METHOD: A cross-sectional household survey was conducted in a sub-district of rural Tamil Nadu by using a standard questionnaire. Face to face interviews were conducted with 902 older adults aged 61 years and older. The relation between the characteristics of older adults, family members and family environments with reported mistreatment was examined by univariate and multivariate logistic regression analyses. RESULTS: The multivariate results reveal that elder mistreatment is related to several factors associated with the perpetrator and the family environment. Perpetrator factors include middle age, a tertiary education (protective), alcohol consumption and the mistreatment of other family members. Family environment factors include family stress and low cohesion. Among the factors related to older adults, only physical abuse of family members was associated with exposure to mistreatment. CONCLUSION: The characteristics of older adults, family members and family environment are potent predictors of elder mistreatment. Multi-dynamic interventions should target dysfunctional families displaying alcohol use, relationship conflicts, low cohesion and the presence of some form of family violence.

Elder abuse and barriers to help seeking in Chennai, India: a qualitative study.

This qualitative study attempts to understand why older persons abused by their family members in India do not seek help. In-depth interviews over three visits were conducted with six adults aged 65 years and above who had been physically abused by their sons/daughters-in-law. The interviews were transcribed and themes identified using a thematic analysis method. The barriers preventing a person from seeking help were service-related (accessibility, lack of trust); religious (Karma); family (deleterious effects on family, family members' responses to help seeking); and individual (socioeconomic dependency, self-blame). The unique findings that surfaced were fear of losing one's identity by losing one's family, attributing abuse to past sins, and concern over not attaining salvation if one's sons did not perform funeral rites. The authors propose a checklist to explore and assess the barriers to seeking help. Recommendations for geroprofessionals in overcoming barriers include implementing outreach programs and changing the misconceptions regarding Karma.

Religiosity and well-being of older adults in Chennai, India.

OBJECTIVES: Using the theory of religious effects (Journal for the Scientific Study of Religion, 42, 17-30 ( 2003 )), the current study examined the relationship among religiosity, psychosocial resources (social support and mastery) and psychological distress. METHOD: Through face-to-face interviewing, data were collected from 321 randomly selected older adults in Chennai, India. Structural equation modelling (SEM) was conducted to test the direct-effect and the mediation models. The direct-effect model posited a direct inverse relation between religiosity and psychological distress. The mediation model posited that psychosocial resources mediate the influence of religiosity on psychological distress. RESULTS: The fit indices supported a partial mediation model. Psychosocial resources partially mediated the influence of religiosity on psychological distress. CONCLUSION: These findings suggest the crucial role of religiosity in influencing the well-being of older adults. The need to integrate religiosity in interventions for older Indian adults is discussed.

Factor structure of the CES-D scale among older adults in Chennai, India.

To examine the psychometric properties of the 20-item Centre for Epidemiological Studies - Depression scale (CES-D). Data were collected from 400 community-dwelling older adults aged 65 years and above, residing in Chennai, India. The instruments including the CES-D scale were translated into Tamil language. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. EFA on a subsample (n = 200) yielded two factors, depressed affect and positive affect. CFA with another subsample (n = 200) indicated a good fit for the two-factor structure. In addition, the two-factor model evinced a superior fit to one-, three- and four-factor models. The internal consistency was high for the total scale and its subscales. The convergent validity of the scale was supported by significant correlations with theoretically related measures. The results indicate acceptable measurement properties of the CES-D scale. However, some items appear to be problematic for Indian older adults. Therefore, there is a need for further studies among Indian older adults.

Resources, stressors and psychological distress among older adults in Chennai, India.

Scant information exists on the complex interaction between resources and stressors and their subsequent influence on the psychological distress of older adults in India. Within the framework of resource theory, the present study examined the various pathways through which resources and stressors influence psychological distress by testing four models - the independence model, the stress-suppression model, the counteractive model and the resource-deterioration model. The independence model posits that resources and stressors have a direct relationship with psychological distress. The stress-suppression model hypothesizes that stressors mediate the influence of resources on psychological distress. The counteractive model postulates that stressors mobilize resources, which in turn influence psychological distress. The resource-deterioration model states that stressors deplete resources and subsequently exacerbate distress. In the present study, resources include social support, religiosity and mastery; stressors include life events, abuse and health problems. Psychological distress was measured using the Center for Epidemiological Studies Depression scale and Geriatric Depression Scale. Interviews were conducted among 400 adults aged 65 years and above, randomly selected from the electoral list of urban Chennai, India. The battery of instruments was translated into Tamil (local language) by back-translation. Structural Equation Modeling was conducted to test the three models. The results supported the stress-suppressor model. Resources had an indirect, negative relationship with psychological distress, and stressors had a direct, positive effect on distress. As such there is a need to identify and strengthen the resources available to older adults in India.

Factor structure of the 10-item CES-D scale among community dwelling older adults in Singapore.

OBJECTIVE: To establish the factor structure, reliability and validity of a brief CESD scale among Community dwelling older adults in Singapore. METHOD: Data were derived from interviews conducted among 1,013 randomly selected non-institutionalized older adults aged 65 years and above in Singapore. First, Confirmatory Factor Analysis (CFA) was conducted to test three factors in the entire sample: a one-factor model, a two-factor model (Depressed affect, Positive affect) and a three-factor model (Depressed affect, Somatic retardation, and Positive affect). Next, Multi-Group Analysis was conducted to test the scale invariance for male and female older adults. RESULTS: Findings supported a two-factor model--depressed affect and positive affect for the entire sample. In addition, multi-group analysis showed the two-factor structure to be invariant for male and female older adults. CONCLUSION: Brief CESD demonstrates adequate reliability and validity. The CESD scores can be used to compare symptoms of depression between male and female older adults.

Elder mistreatment in urban India: a community based study.

This study examined the extent and correlates of elder mistreatment among 400 community dwelling older adults aged 65 and above in Chennai, India. The prevalence rate of mistreatment was 14%. Chronic verbal abuse was the most common followed by financial abuse and the rate of physical abuse and neglect was similar. Among the mistreated, exactly half of them had experienced more than one type of mistreatment (multifaceted-mistreatment). With the exception of financial abuse, a significantly greater number of women experienced verbal and physical abuse as well as neglect compared to men. Adult children, daughters-in-law, spouses, and sons-in-law were the prominent perpetrators. The mistreated older adults were more depressed and less satisfied with life than those who were not mistreated. Logistic regression analysis revealed gender, social support, and subjective rating of physical health as significant factors associated with abuse.