Control strategies for managing health threats in older adults.

This article addresses the motivational processes that enable older adults to manage health-related threats and to protect their psychological and physical functioning. Based on the Motivational Theory of Life-Span Development (MTD) [1], we describe how an age- and opportunity-adjusted use of control strategies can support the regulation of important developmental goals across the lifespan. In addition, we apply the premises of the MTD to the management of health threats in later adulthood and review the pertinent empirical literature. Finally, we use the Lines-of-Defense model [2] to show how an orchestrated and strategic use of control strategies can help older adults to manage the experience of progressive health declines and remain engaged in the pursuit of important health goals.

Downward adjustment of rehabilitation goals may facilitate post-stroke arm motor recovery.

Objective: Patients starting with physical rehabilitation often hold unrealistically high expectations for their recovery. Because of a lower-than-expected rate of recovery, such unrealistic goals have been linked to adverse effects on mental health. Additionally, overtraining due to overly ambitious goals can lead to suboptimal recovery. We investigated the effectiveness of adjusting rehabilitation goals to a more realistic level as a strategy to select appropriate exercise intensity and achieve better recovery outcomes. Design: Patients with arm paralysis from recent stroke were recruited and went through 6-8 weeks of telerehabilitation and in-clinic rehabilitation programme conducted at 11 US sites (N = 124). Main Outcome Measures: Adjustment of recovery goal was assessed in two timepoints during the rehabilitation programme and arm motor function was assessed before and after the clinical trial. Results: Greater use of goal adjustment strategies predicted better recovery of arm motor function, independent from therapy compliance. This pattern was observed only when the choice of exercises is patient-regulated rather than directed by a physical therapist. Conclusion: Benefits from goal adjustment were more pronounced among patients who entered the programme with poorer motor functions, suggesting that goal adjustment is the most beneficial when goals of complete recovery are most unrealistic.

Shared and nonshared agency for occupational goals with mothers, fathers, VIPs, and romantic partners during young adulthood.

This study applied a framework of shared and nonshared agency to investigate how social partners can help and hinder young adults' career development. We also considered the extent to which motivational control could be promoted or burdened when young people seek help and encouragement from others in their careers. Based on the importance of shared agency in life goal pursuit, it was hypothesized that shared agency (i.e., perceived support and collaboration) with mothers, fathers, important adults, and romantic partners would have direct and positive associations with young adults' career satisfaction and exploration and positive indirect associations on career development via motivational control. We further hypothesized that nonshared agency (i.e., directing and uninvolvement) would have direct and negative effects on career satisfaction and exploration and negative indirect effects on career development via motivational strategies. Results indicated that relationships can facilitate career development but differently depending upon relationship type. We found that support and directing from mothers and VIPs had positive associations with outcomes via individual motivational control whereas a total effect of collaboration with fathers and romantic partners were associated with outcomes without an indirect effect via motivational control. These findings are discussed within the context of previous socialization research and theory.

The Development of Life Goals Across the Adult Life Span.

OBJECTIVES: Life goals are important organizing units for individual agency in development. On a societal level, they align with age-normative developmental tasks; on the individual level, they guide people's attempts at shaping their own development. This study investigates the development of life goals across the adult life span with a focus on differences regarding gender, parental status, education, and region. METHOD: Using longitudinal data from the German Socio-Economic Panel study (N = 52,052, age range: 18-84 years), we estimated the developmental trajectories of importance ratings for 9 life goals across the adult life span using multiple-group latent growth curve modeling. RESULTS: Having a happy relationship or marriage, having children, and being there for others are the life goals rated as most important across almost the entire adult life span. Having a happy relationship or marriage differed strongly by gender. Up to middle adulthood it was more important for women, but more important for men in late adulthood. Parental status amplified gender differences in the work and family domain. Low education was associated with a higher perceived importance of being there for others. The largest regional differences (East vs. West) were found for home ownership. DISCUSSION: Although the importance of some life goal trajectories reflects typical age-grading in developmental tasks, other life goals (e.g., having children) remain important even after goal attainment or after developmental deadlines have passed.

The role of goal adjustment during rehabilitation from stroke.

We investigated motivational regulation involving adjustment of recovery goals in post-stroke rehabilitation via standard in-clinic physiotherapy and in-home telerehabilitation (TR). We used a secondary dataset collected at 11 US sites as part of a clinical trial using video games and game control pads designed to induce certain arm movements required for recovery (n = 124; Mage  = 61.44, SD = 13.30). Participants were randomly assigned to either the TR or in-clinic condition and underwent 36 therapy sessions, reporting on their activity-inherent enjoyment for 6-8 weeks. Compared with the in-clinic patients and TR patients with high game performance, TR patients with lower game performance reported lower activity-inherent enjoyment, which is an important motivational resource for successful recovery. The results suggest that these differences occur because TR patients become discouraged by low game score feedback, which may have signaled a poor prospect for recovery. However, the results also suggest that low game performers who successfully adjusted their recovery goals were resilient to the impact of low game score feedback on their motivational resources and satisfaction with therapy. The findings suggest that goal adjustment may be particularly beneficial when patients are discouraged by feedback indicating suboptimal recovery prospects.

Goal Changes and Healthy Aging.

This article discusses ways in which aging individuals respond to physical, social, and environmental changes and constraints by modifying their goals. We review aging-related trends, which we derive from several theoretical approaches, including goal systems theory, the motivational theory of life-span development and its action-phase model, and the Selection, Optimization, and Compensation model. These theories explain how biological and social role changes in later adulthood prompt individuals to make changes to the content, orientation, and composition of their goals, including disengaging from and adjusting previously central goals. They also help identify individual differences in the capacity to do so effectively. We review several motivation-related interventions that address the challenges in goal adjustment and call for more research on identifying processes of goal changes conducive to healthy aging, more interventions, and modifications of societal and institutional (e.g., workplace, nursing home) operations that support adaptive goal change in older adults.

Motivation and Healthy Aging at Work.

The aims of this paper were to review theoretical and empirical research on motivation and healthy aging at work and to outline directions for future research and practical applications in this area. To achieve these goals, we first consider the World Health Organization's (WHO) definition of healthy aging in the context of paid employment and life-span development in the work domain. Second, we describe contemporary theoretical models and cumulative empirical findings on age, motivation, and health and well-being at work, and we critically discuss to what extent they are consistent with the WHO's definition of healthy aging. Finally, we propose several directions for future research in the work context that are aligned with the WHO's definition of healthy aging, and we describe a number of interventions related to the design of work environments and individual strategies to promote the motivation for healthy aging at work.

Prosociality across adulthood: A developmental and motivational perspective.

Why do people contribute to the well-being of others? What promotes or hinders their contribution? Framed by expectancy-value theory and the motivational theory of life span development, we use data from the Midlife in the United States National longitudinal study (MIDUS I, II, and III) to examine how individuals' perceived contributions to the well-being of others develop across adulthood, in the related but distinct forms of overall prosociality (more other-focused) and generativity (more self-focused). Our findings show that prosociality and generativity display similar, yet distinct trajectories, peaking in midlife a decade apart from each other, when expectancy and value for prosocial behavior are highest. Moreover, expectancy as reflected in perceived control and control strivings, and value as indicated by agreeableness, predict individuals' prosociality and generativity. Trajectories of prosocial contributions further differ according to individual differences in perceived control, control striving, education, income, and number of children, whereas trajectories of generativity only differ across levels of perceived control and income. By applying motivational and life span developmental perspectives, our study offers insight into how prosociality and generativity develop throughout adulthood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intense Arm Rehabilitation Therapy Improves the Modified Rankin Scale Score: Association Between Gains in Impairment and Function.

OBJECTIVE: To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains. METHODS: Patients were enrolled >90 days poststroke. Each was evaluated before and 30 days after a 6-week course of daily rehabilitation targeting the arm. Activity gains, measured using the mRS, were examined and compared to body structure/function gains, measured using the Fugl-Meyer (FM) motor scale. Additional analyses examined whether activity gains were more strongly related to specific body structure/function gains. RESULTS: At baseline (160 ± 48 days poststroke), patients (n = 77) had median mRS score of 3 (interquartile range, 2-3), decreasing to 2 [2-3] 30 days posttherapy (p < 0.0001). Similarly, the proportion of patients with mRS score ≤2 increased from 46.8% at baseline to 66.2% at 30 days posttherapy (p = 0.015). These findings were accounted for by the mRS score decreasing in 24 (31.2%) patients. Patients with a treatment-related mRS score improvement, compared to those without, had similar overall motor gains (change in total FM score, p = 0.63). In exploratory analysis, improvement in several specific motor impairments, such as finger flexion and wrist circumduction, was significantly associated with higher likelihood of mRS decrease. CONCLUSIONS: Intensive arm motor therapy is associated with improved mRS in a substantial fraction (31.2%) of patients. Exploratory analysis suggests specific motor impairments that might underlie this finding and may be optimal targets for rehabilitation therapies that aim to reduce activities limitations. CLINICAL TRIAL: Clinicaltrials.gov identifier: NCT02360488. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients >90 days poststroke with persistent arm motor deficits, intensive arm motor therapy improved mRS in a substantial fraction (31.2%) of patients.

Social Network Structure Is Related to Functional Improvement From Home-Based Telerehabilitation After Stroke.

Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based TR program for stroke patients and evaluated which social factors might be related to motor gains and reduced depressive symptoms. Methods: Stroke patients (n = 13) with arm motor deficits underwent supervised home-based TR for 12 weeks with routine assessments of motor function and mood. At the 6-week midpoint, we mapped each patient's personal social network and evaluated relationships between social network metrics and functional improvements from TR. Finally, we compared social networks of TR patients with a historical cohort of 176 stroke patients who did not receive any TR to identify social network differences. Results: Both network size and network density were related to walk time improvement (p = 0.025; p = 0.003). Social network density was related to arm motor gains (p = 0.003). Social network size was related to reduced depressive symptoms (p = 0.015). TR patient networks were larger (p = 0.012) and less dense (p = 0.046) than historical stroke control networks. Conclusions: Social network structure is positively related to improvement in motor status and mood from TR. TR patients had larger and more open social networks than stroke patients who did not receive TR. Understanding how social networks intersect with TR outcomes is crucial to maximize effects of virtual rehabilitation.

Invited Commentary: Societal Constraints and Individual Agency: Navigating Educational Transitions for Upward Mobility.

This article discusses three empirical studies of the role of individual agency in educational transitions in the conceptual framework of the motivational theory of lifespan development that integrates life-course sociological and life-span psychological perspectives. The educational systems in the U.K., the US, and Switzerland set up specific opportunities and constraints in their primary to secondary and secondary to tertiary educational tracks. Individual agency plays out in different ways in these country- and transition-specific fields of action and accordingly enables or hinders individual youths' upward mobility. Early transitions into segregated secondary school systems are dominated by the influence of teachers and parents and tend to maintain social inequality. Later transitions into tertiary education are more open to individual agency that can substantially contribute to overcoming social inequalities in college admission. Finally, once enrolled in university, students have comparatively better opportunities to overcome disadvantages of their parents' socio-economic status and educational background.

Risk of cognitive declines with retirement: Who declines and why?

Retiring is associated with increased risk of cognitive decline (e.g., Bonsang, Adam, & Perelman, 2012; Wickrama, O'Neal, Kwag, & Lee, 2013). However, little is known about the moderating role of motivational and demographic factors that are implicated in adaptive development and the retirement transition process. We used data from the Midlife in the United States Study (n = 732, Mage = 57, SD = 5.76, 50% female) to examine whether the association between retirement and cognitive decline depended on a key motivation factor (goal disengagement) in propensity score matched samples of older retirees and employees. We explored whether these effects were further moderated by gender. Results showed that those who retired (vs. remained employed) experienced steeper 9-year declines in episodic memory (b = -.41, p = .001) only if they were high in goal disengagement and female. Findings are consistent with theories of lifespan development and cognitive aging and provide initial evidence that retirement may be associated with increased cognitive declines for only certain individuals prone to disengage from highly challenging activities and goal pursuits. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke.

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.

Understanding the effects of Covid-19 through a life course lens.

The Covid-19 pandemic is shaking fundamental assumptions about the human life course in societies around the world. In this essay, we draw on our collective expertise to illustrate how a life course perspective can make critical contributions to understanding the pandemic's effects on individuals, families, and populations. We explore the pandemic's implications for the organization and experience of life transitions and trajectories within and across central domains: health, personal control and planning, social relationships and family, education, work and careers, and migration and mobility. We consider both the life course implications of being infected by the Covid-19 virus or attached to someone who has; and being affected by the pandemic's social, economic, cultural, and psychological consequences. It is our goal to offer some programmatic observations on which life course research and policies can build as the pandemic's short- and long-term consequences unfold.

Cohort differences in adult-life trajectories of internal and external control beliefs: A tale of more and better maintained internal control and fewer external constraints.

Life Span theory posits that sociohistorical contexts shape individual development. In line with this proposition, cohort differences favoring later-born cohorts have been widely documented for cognition and health. However, little is known about historical change in how key resources of psychosocial functioning such as control beliefs develop in old age. We pooled data from 3 independent samples: Berlin Aging Study (6 waves, N = 414); Interdisciplinary Longitudinal Study of Adult Development (4 waves, N = 925); and Berlin Aging Study II (4 waves, N = 1,111) to construct overlapping multiyear longitudinal data from ages 61 through 85 years for cohorts born 1905 to 1953 and examine historical changes in within-person trajectories of internal and external control beliefs. Results revealed that earlier-born cohorts exhibit age-related declines in internal control beliefs regarding both desirable and undesirable outcomes, whereas later-born cohorts perceive higher internal control and maintain this advantage into old age. Earlier-born cohorts also experience steep age-related increases in external control beliefs regarding both powerful others and chance, whereas later-born cohorts perceive lower external control and were stable across old age. Education and gender disparities in control beliefs narrowed over historical time. Sociodemographic, physical health, cognitive, and social factors explained some of the differences in control beliefs, and accounted for sizable portions of cohort effects. Our results indicate that current generations of older adults perceive more and better maintained internal control and fewer external constraints. We discuss potential underlying mechanisms and consider conceptual and societal implications of our findings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial.

IMPORTANCE: Many patients receive suboptimal rehabilitation therapy doses after stroke owing to limited access to therapists and difficulty with transportation, and their knowledge about stroke is often limited. Telehealth can potentially address these issues. OBJECTIVES: To determine whether treatment targeting arm movement delivered via a home-based telerehabilitation (TR) system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic (IC) setting, and to examine whether this system has comparable efficacy for providing stroke education. DESIGN, SETTING, AND PARTICIPANTS: In this randomized, assessor-blinded, noninferiority trial across 11 US sites, 124 patients who had experienced stroke 4 to 36 weeks prior and had arm motor deficits (Fugl-Meyer [FM] score, 22-56 of 66) were enrolled between September 18, 2015, and December 28, 2017, to receive telerehabilitation therapy in the home (TR group) or therapy at an outpatient rehabilitation therapy clinic (IC group). Primary efficacy analysis used the intent-to-treat population. INTERVENTIONS: Participants received 36 sessions (70 minutes each) of arm motor therapy plus stroke education, with therapy intensity, duration, and frequency matched across groups. MAIN OUTCOMES AND MEASURES: Change in FM score from baseline to 4 weeks after end of therapy and change in stroke knowledge from baseline to end of therapy. RESULTS: A total of 124 participants (34 women and 90 men) had a mean (SD) age of 61 (14) years, a mean (SD) baseline FM score of 43 (8) points, and were enrolled a mean (SD) of 18.7 (8.9) weeks after experiencing a stroke. Among those treated, patients in the IC group were adherent to 33.6 of the 36 therapy sessions (93.3%) and patients in the TR group were adherent to 35.4 of the 36 assigned therapy sessions (98.3%). Patients in the IC group had a mean (SD) FM score change of 8.36 (7.04) points from baseline to 30 days after therapy (P < .001), while those in the TR group had a mean (SD) change of 7.86 (6.68) points (P < .001). The covariate-adjusted mean FM score change was 0.06 (95% CI, -2.14 to 2.26) points higher in the TR group (P = .96). The noninferiority margin was 2.47 and fell outside the 95% CI, indicating that TR is not inferior to IC therapy. Motor gains remained significant when patients enrolled early (<90 days) or late (≥90 days) after stroke were examined separately. CONCLUSIONS AND RELEVANCE: Activity-based training produced substantial gains in arm motor function regardless of whether it was provided via home-based telerehabilitation or traditional in-clinic rehabilitation. The findings of this study suggest that telerehabilitation has the potential to substantially increase access to rehabilitation therapy on a large scale. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02360488.

Engagement with six major life domains during the transition to retirement: Stability and change for better or worse.

Active engagement with multiple life domains (cross-domain engagement) is associated with adaptation throughout the adult life span. However, less is known about the role of cross-domain engagement during significant life course transitions that can challenge motivational resources, such as the shift to retirement. Based on the motivational theory of life span development (Heckhausen, Wrosch, & Schulz, 2010, 2019), the present study used 9-year data from the national Midlife in the United States Study (MIDUS; n = 1,301, M age = 57, SD = 6.96, 56% female) to identify profiles of cross-domain engagement and to assess stability and change in these profiles during the transition to retirement. We also examined whether stability and change in the engagement profiles had implications for psychological adjustment. Results of latent profile analyses showed that three profiles of cross-domain engagement emerged both before and after retirement (high engagement, low work engagement, moderate engagement). Latent transition analyses indicated that most participants remained in their preretirement profiles at postretirement, with the majority classified in a profile defined by stable high engagement with multiple life domains. Results of ANCOVAs showed this stable high engagement profile was associated with the most adaptive 9-year changes in cross-domain perceived control, cross-domain situation quality, and cross-dimension eudaimonic well-being. Findings advance the literature by showing that cross-domain profiles of engagement can be identified and that stability and change in these profiles have consequences for longitudinal psychological adjustment in retirement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Agency and Motivation in Adulthood and Old Age.

This review addresses conceptual and empirical research about how individual agency and motivation influences development during adulthood and old age. The major life-span approaches to individual agency and developmental regulation are discussed, with a focus on the motivational theory of life-span development. Developmental agency unfolds through action cycles of pursuing long-term goals for optimal development. Individuals differ in their capacity to regulate their goal engagements effectively within the age-graded structure of opportunities and constraints in their life courses. We discuss a set of research examples about specific developmental challenges, such as transition to adulthood, biological aging, illness, and societal transformation, and show how individuals, as agents in their own development, navigate change for better or worse. We conclude with suggestions for future research.