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).

Differences in awareness of positive and negative age-related changes accounting for variability in health outcomes.

Higher awareness of positive age-related changes (AARC gains) is related to better mental health, whereas higher awareness of negative age-related changes (AARC losses) is related to poorer mental and physical health. So far perceived gains and losses have been explored separately, but people report gains and losses concurrently in varying degrees, and different profiles of gains and losses may be differentially associated with health. We identified profiles of gains and losses and explored whether different profiles differed in physical, mental, and cognitive health. We used cross-sectional data from the PROTECT study (N = 6192; mean (SD) age = 66.1 (7.0)). Using latent profile analysis, a four-class solution showed the best model fit. We found that 45% of people perceived many gains and few losses (Class 1); 24% perceived moderate gains and few losses (Class 2); 24% perceived many gains and moderate losses (Class 3); 7% perceived many gains and many losses (Class 4). Analysis of variance and Chi-squared tests showed that Class 1 had relatively better physical, mental, and cognitive health, followed by Classes 2, 3, and 4. Experiencing one's ageing to a high degree as gain may be related to better health only when individuals interpret ageing as involving low levels of loss across several life domains. Risk in terms of poorer health emerged in those who perceived high losses. Considering gains and losses in parallel, rather than separately, may lead to a more fine-tuned understanding of relations with health. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00673-z.

Identifying predictors of self-perceptions of aging based on a range of cognitive, physical, and mental health indicators: Twenty-year longitudinal findings from the ILSE study.

Research exploring whether health predicts self-perceptions of aging (SPA) has mostly focused on single predictors and has been hampered by short observational intervals. We examined whether 20-year changes in cognitive functioning, physical and mental health predict SPA. We used data of 103 German participants who remained of a sample of 500 participants born in 1930-1932 enrolled in the Interdisciplinary Longitudinal Study of Adult Development (ILSE) in 1993/1996 (mean age at fourth measurement wave = 82.5 years). Health indicators included six cognitive tests, objective and subjective physical health, and self-reported depression. We used a new and multidimensional (awareness of age-related gains and losses) and a well-established (attitudes toward own aging) measure of SPA. Linear regression analyses showed that, among the cognitive tests, decline in information processing speed (Digit Symbol) predicted less awareness of age-related gains and more awareness of age-related losses but not attitudes toward own aging. Decline in subjective but not objective physical health, predicted more awareness of age-related losses and negative attitudes toward own aging, but not awareness of age-related gains. Increase in depressive symptoms predicted more awareness of age-related losses and negative attitudes toward own aging, but not awareness of age-related gains. The size of associations suggests that objective cognitive decline has limited influence on older adults' SPA and, if so, only when the decline is related to mental slowing. Similarly, perceived physical and mental health, but not objective health, have a small-to-moderate influence on awareness of age-related losses and attitudes toward own aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cross-sectional association between objective cognitive performance and perceived age-related gains and losses in cognition.

OBJECTIVES: Evidence linking subjective concerns about cognition with poorer objective cognitive performance is limited by reliance on unidimensional measures of self-perceptions of aging (SPA). We used the awareness of age-related change (AARC) construct to assess self-perception of both positive and negative age-related changes (AARC gains and losses). We tested whether AARC has greater utility in linking self-perceptions to objective cognition compared to well-established measures of self-perceptions of cognition and aging. We examined the associations of AARC with objective cognition, several psychological variables, and engagement in cognitive training. DESIGN: Cross-sectional observational study. PARTICIPANTS: The sample comprised 6056 cognitively healthy participants (mean [SD] age = 66.0 [7.0] years); divided into subgroups representing middle, early old, and advanced old age. MEASUREMENTS: We used an online cognitive battery and measures of global AARC, AARC specific to the cognitive domain, subjective cognitive change, attitudes toward own aging (ATOA), subjective age (SA), depression, anxiety, self-rated health (SRH). RESULTS: Scores on the AARC measures showed stronger associations with objective cognition compared to other measures of self-perceptions of cognition and aging. Higher AARC gains were associated with poorer cognition in middle and early old age. Higher AARC losses and poorer cognition were associated across all subgroups. Higher AARC losses were associated with greater depression and anxiety, more negative SPA, poorer SRH, but not with engagement in cognitive training. CONCLUSIONS: Assessing both positive and negative self-perceptions of cognition and aging is important when linking self-perceptions to cognitive functioning. Objective cognition is one of the many variables - alongside psychological variables - related to perceived cognitive losses.

The Effects of Age Stereotypes on Physical and Mental Health Are Mediated by Self-perceptions of Aging.

OBJECTIVES: Although the evidence linking views on aging (VoA) with aging outcomes is robust, little is known about how different types of VoA may interact to influence such outcomes. Therefore, this study examined two types of VoA, age stereotypes (AS), representing general VoA, and self-perceptions of aging (SPA), representing personal VoA. We operationalized SPA in terms of awareness of age-related change (AARC), distinguishing between gain- and loss-related SPA (e.g., awareness of positive and negative age-related changes, respectively). Based on theoretical reasoning, we hypothesized that AS would be an antecedent of SPA, and that the effect of AS on physical and mental health would be mediated by SPA. METHOD: A total of 819 German and U.S. adults aged 40-98 completed a survey on VoA, physical health, and mental health at baseline and 2.5 years later. Structural equation modeling with latent variables was used to examine the effects of Time 1 AS (predictor) and Time 2 gain- and loss-related SPA (mediators) on physical and mental health outcomes. RESULTS: As hypothesized, AS predicted later SPA. Loss-related SPA mediated the effect of AS on physical health; both gain- and loss-related SPA mediated the effect of AS on mental health. DISCUSSION: Congruent with theoretical assumptions, our findings provide empirical support for a directional pathway by which AS shape later SPA. We conclude that AS and SPA may affect physical health outcomes more strongly than mental health outcomes. Studies that assess both types of VoA are needed to illuminate the pathways by which VoA influence aging outcomes.

International relevance of two measures of awareness of age-related change (AARC).

BACKGROUND: A questionnaire assessing awareness of positive and negative age-related changes (AARC gains and losses) was developed in the US and Germany. We validated the short form of the measure (AARC-10 SF) and the cognitive functioning subscale from the 50-item version of the AARC (AARC-50) questionnaire in the UK population aged 50 and over. METHODS: Data from 9410 participants (Mean (SD) age = 65.9 (7.1)) in the PROTECT cohort were used to explore and confirm the psychometric properties of the AARC measures including: validity of the factor structure; reliability; measurement invariance across men and women, individuals with and without a university degree, and in middle age, early old age, and advanced old age; and convergent validity with measures of self-perception of aging and mental, physical, and cognitive health. We explored the relationship between demographic variables (age, sex, marital status, employment, and university education) and AARC. RESULTS: We confirmed the two-factor structure (gains and losses) of the AARC-10 SF and the AARC-50 cognitive functioning subscale. Both scales showed good reliability and good convergent validity for AARC losses, but weak convergent validity for AARC gains. For both scales metric invariance was held for the two subgroups defined by education level and age. For the AARC-50 subscale, but not for the AARC-10 SF, strong invariance was also held for the two subgroups defined by sex. Age, sex, marital status, employment, and university education predicted AARC gains and losses. CONCLUSIONS: The AARC-10 SF and AARC-50 cognitive functioning subscale identify UK individuals who perceive age-related changes in their mental, physical, and cognitive health.

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.

Advance care planning for patients with amyotrophic lateral sclerosis.

PURPOSE: To determine whether an advance care planning (ACP) decision-aid could improve communication about end-of-life treatment wishes between patients with amyotrophic lateral sclerosis (ALS) and their clinicians. METHODS: Forty-four patients with ALS (>21, English-speaking, without dementia) engaged in ACP using an interactive computer based decision-aid. Before participants completed the intervention, and again three months later, their clinicians reviewed three clinical vignettes, and made treatment decisions (n = 18) for patients. After patients indicated their agreement with the team's decisions, concordance was calculated. RESULTS: The mean concordance between patient wishes and the clinical team decisions was significantly higher post-intervention (post = 91.9%, 95% CI = 87.8, 96.1, vs. pre = 52.4%, 95% CI = 41.9, 62.9; p <0.001). Clinical team members reported greater confidence that their decisions accurately represented each patient's wishes post-intervention (mean = 6.5) compared to pre-intervention (mean = 3.3, 1 = low, 10 = high, p <0.001). Patients reported high satisfaction (mean = 26.4, SD = 3.2; 6 = low, 30 = high) and low decisional conflict (mean = 28.8, SD = 8.2; 20 = low, 80 = high) with decisions about end-of-life care, and high satisfaction with the decision-aid (mean = 52.7, SD = 5.7, 20 = low, 60 = high). Patient knowledge regarding ACP increased post-intervention (pre = 47.8% correct responses vs. post = 66.3%; p <0.001) without adversely affecting patient anxiety or self-determination. CONCLUSION: A computer based ACP decision-aid can significantly improve clinicians' understanding of ALS patients' wishes with regard to end-of-life medical care.

Examination of Associations Among Three Distinct Subjective Aging Constructs and Their Relevance for Predicting Developmental Correlates.

OBJECTIVES: This study examined (a) the empirical associations among three subjective aging (SA) constructs: felt age, attitudes toward own aging (ATOA), and awareness of age-related change (AARC); (b) the moderating role of chronological age in these associations; and (c) the predictive relevance of the SA constructs with regard to two developmental correlates: functional health and satisfaction with life. METHOD: Participants were 819 adults aged 40-98 years from the United States and Germany. Parallel multiple mediation, moderated mediation, and hierarchical regression analyses were used. RESULTS: As hypothesized, AARC mediated the association between the global measures of SA (felt age and ATOA) and the developmental correlates. Specifically, more negative global subjective aging predicted more AARC losses, which predicted poorer health and well-being. Furthermore, this mediation pathway was moderated by chronological age, such that, with increasing age, greater AARC was more strongly related to poorer functional health (but not well-being). The multidimensional measure, AARC, accounted for a significant amount of the variance in the developmental correlates over and above the unidimensional SA constructs. A consistent pattern emerged supporting the role of domain specificity and valence. DISCUSSION: These findings support the need for conceptualizing SA across different behavioral domains and for distinguishing between positive and negative SA.

Feasibility and Efficacy of the AgingPlus Program: Changing Views on Aging to Increase Physical Activity.

This study evaluated the feasibility and efficacy of the AgingPlus intervention program. AgingPlus is an 8-week multi-component motivational program which promotes increased physical activity by targeting adults' negative views on aging (NVOA) and perceptions of control, two known psychological barriers to physical exercise. A total of 62 adults, ages 50-82 years, participated in this feasibility study. We assessed NVOA, perceptions of control, and physical activity level at baseline (Week 0), immediate posttest (Week 4), and delayed posttest (Week 12). High attendance rates, low attrition, and positive participant feedback indicated that the program had high acceptability. Repeated measures multivariate analyses of variance (RM-MANOVA) showed statistically significant and substantively meaningful improvements in NVOA, control beliefs, and physical activity from pretest to immediate and delayed posttest. The program effects did not differ between those younger or older than age 65. These findings provide promising support for the feasibility and efficacy of the AgingPlus program.

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

The influence of subjective aging on health and longevity: a meta-analysis of longitudinal data.

Evidence is accumulating on the effects of subjective aging-that is, how individuals perceive their own aging process-on health and survival in later life. The goal of this article is to synthesize findings of existing longitudinal studies through a meta-analysis. A systematic search in PsycInfo, Web of Science, Scopus, and Pubmed resulted in 19 longitudinal studies reporting effects of subjective aging on health, health behaviors, and longevity. The authors combine the outcomes reported in these studies using a random effects meta-analysis, assuming that there would be differences in effect sizes across studies. The meta-analysis resulted in an overall significant effect of subjective aging (likelihood ratio = 1.429; 95% confidence interval = 1.273-1.604; p < .001). The analyses revealed heterogeneity, with stronger effects for studies with a shorter period of follow-up, for studies of health versus survival, for studies with younger participants (average age of the studies varies between 57 and 85 years with a median of 63 years), and for studies in welfare systems where state provisions of welfare are minimal. However, effects did not vary either across different operationalizations of subjective aging or by study quality. Subjective aging has a small significant effect on health, health behaviors, and survival. Further theoretical conceptualizations and empirical studies are needed to determine how subjective aging contributes to health and survival.

Measuring future time perspective across adulthood: development and evaluation of a brief multidimensional questionnaire.

PURPOSE OF THE STUDY: Despite calls for the consideration of future time perspective (FTP) as a multidimensional construct, mostly unidimensional measurement instruments have been used. This study had two objectives: (a) to develop a brief multidimensional questionnaire for assessing FTP in adulthood and evaluate its psychometric properties; and (b) to examine age associations and age-group differences of the dimensions of FTP. DESIGN AND METHODS: Data were collected from 625 community-residing adults between the ages of 18 and 93, representing young, middle-aged, and older adults. The psychometric evaluation involved exploratory factor analyses (EFA) and confirmatory FA (CFA), reliability and validity analyses, and measurement invariance testing. Zero-order and partial correlations were used to examine the association of the dimensions of FTP with age, and multivariate analysis of variance was used to examine age-group differences. RESULTS: EFA and CFA supported a three-factor solution: Future as Open, Future as Limited, and Future as Ambiguous. Metric measurement invariance for this factor structure was confirmed across the three age groups. Reliability and validity analyses provided evidence of sound psychometric properties of the brief questionnaire. Age was negatively associated with Future as Open and positively associated with Future as Limited. Young adults exhibited significantly greater ambiguity toward the future than middle-aged or older adults. IMPLICATIONS: This study provides evidence in support of the psychometric properties of a new brief multidimensional FTP scale. It also provides evidence for a pattern of age associations and age-group differences consistent with life-span developmental theory.

Awareness of Aging: Theoretical Considerations on an Emerging Concept.

Humans are able to reflect on and interpret their own aging. Thus, as individuals grow older, calendar age may become increasingly a subjective variable. This theoretical paper proposes the concept of Awareness of Aging (AoA) as a superordinate construct that can serve an integrative function in developmental research on subjective aging. It is argued that the AoA construct can incorporate the theoretical components of other existing concepts by acknowledging that judgments of subjective aging tend to be made on an awareness continuum ranging from pre-conscious/implicit to conscious/explicit. We also argue that processes of AoA are inherently self-related processes and that AoA is a particular aspect of self-awareness that results in specific aging-related self-knowledge. Over time, aging individuals incorporate this self-knowledge into their self-concept and personal identity. We provide theoretical evidence showing that although all major theories of adult development and aging draw on phenomena related to AoA, the explicit incorporation of aging-related awareness processes has been missing. We also provide an overarching framework to illustrate in a heuristic way how AoA in combination and interaction with other influences affects developmental outcomes. Finally, we argue that attention to AoA-related processes has a number of societal and applied implications and thereby addresses issues of applied developmental psychology.

Frontotemporal degeneration in the patient with amyotrophic lateral sclerosis: helping the caregiver cope.

Research in the previous decade has found a link between amyotrophic lateral sclerosis (ALS) and frontotemporal degeneration (FTD). It is estimated that as many as 50% of all people with ALS will have some degree of cognitive impairment and that approximately 10%-25% of patients will meet the Neary criteria for FTD. For the caregivers of persons with both ALS and FTD, the burden of care can be quite high. Nurses are in a position to help the caregivers cope.

Declines in problem solving and anosognosia in amyotrophic lateral sclerosis: application of Guilford's structure of intellect theory.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a multisystem disorder in which frontotemporal dysfunction without overt dementia is relatively common. Accordingly, there is need for a valid, brief, motor-free cognitive examination conducive to the ALS Clinic. OBJECTIVE: To validate a brief examination against a comprehensive neuropsychological battery to determine its sensitivity in identifying deficits in judgment and problem solving. We enrolled 13 individuals with intact brief examinations, 25 individuals with 1 or more impaired brief examination measures, and 18 healthy volunteers. Cognitive brief examination measures were classified into factors based on Guilford's Structure of Intellect theory. Cognitive anosognosia ratios were calculated to examine the degree of "unawareness of cognitive deficit." RESULTS: Statistically significant correlations were evidenced for each brief examination and comprehensive examination measure categorized by the same Guilford factor. In comparison to healthy controls, insight to level of cognitive abilities was significantly compromised for cognitively impaired ALS patients, with respect to their ratings of their responses to comprehension tasks assessing convergent and divergent production. CONCLUSIONS: Brief examination measures of verbal fluency and problem solving may serve as sensitive indicators of emerging difficulties in ALS patients with frontotemporal dysfunction. The prevalence of cognitive anosognosia warrants further attention because of its impact on treatment compliance, safety and quality of life for ALS patients with frontotemporal dysfunction.

Penn State screen exam for the detection of frontal and temporal dysfunction syndromes: application to ALS.

We improved standard treatment approaches by systematically addressing cognitive and behavioral change in association with frontal and temporal dysfunction in ALS. We evaluated the profile of inchange 198 ALS patients with a 20-minute screen exam. Significant deficiencies in letter fluency and reading comprehension (N=59) were found in 22.7% and 12.8% of limb onset and 36.4% and 20% of bulbar-onset patients. Deficiencies in abstract reasoning and judgment were found in 17%, and 29.5% of limb onset and 19.2%, and 46.7% of bulbar-onset patients. Significant behavioral change (N=89) was also reported in 2.4% of limb onset and 4.3% of bulbar-onset patients. Accommodations were provided from the time of initial detection of acquired deficiencies, with the goal of optimizing the patient's role in decision making throughout the process of treatment planning and implementation. This screen is of practical clinical value for assessment and intervention of deficiencies that affect treatment and quality of life.