Life Satisfaction among Older Adults in Rural and Urban Mongolia: A Cross-Sectional Survey Study.

Introduction: Life satisfaction is a strong indicator of well-being for older adults. In this study, we aimed to assess the level and correlates of life satisfaction among older adults in urban and rural Mongolia. Methods: We recruited 304 community-dwelling older adults in urban and rural regions of Mongolia. We compared levels of life satisfaction for the two groups, and then used hierarchical regression to examine the association of sociodemographic, health, psychosocial factors, and urban/rural status with life satisfaction. Results: Older adults in urban areas reported higher levels of life satisfaction than their rural counterparts. In the final step of the hierarchical regression model, more grandchildren in the household, better self-rated health, and reporting more positive than negative affect were associated with better life satisfaction at p < 0.05 as were engaging in paid work and lower levels of loneliness at p < 0.10. Net the effects of all other variables in the analysis, older adults in rural areas reported lower levels of life satisfaction. Conclusion: Our findings indicate that living in rural areas of Mongolia leads to lower levels of life satisfaction. We identify potential points to intervene through policies, programs, and practices that target the strengths and needs of older adults in rural areas by addressing inequities in socioeconomics, health, mental health, and opportunities for social integration.

Sociodemographic predictors of flourishing among older adults in rural and urban Mongolia.

Flourishing is an eudaimonic dimension of psychological well-being associated with positive social and health outcomes. Determining correlates of health and well-being is critical for the development of evidence-based best practices, policies, and action plans that target older adults, especially in low- and middle-income countries where research on ageing, health and well-being is still scarce. The study aimed to determine the level of flourishing among older adults in Mongolia and to explore demographic and social factors that contribute to their flourishing in urban and rural areas of Mongolia. We used proportional quota sampling to select a non-probability sample of 304 community-dwelling older adults that reflected the national distribution of older age groups and rural/urban residency. We adapted and administered a widely used standardized questionnaire on flourishing and used multiple regression to establish correlates of flourishing. Study participants reported "very high" levels of flourishing; differences in median scores 53 for urban and 50 for rural older adults were significant. Sex ([Formula: see text], [Formula: see text]), level of education([Formula: see text], [Formula: see text]) and receive help with ADLs ([Formula: see text], [Formula: see text]) were associated with flourishing in rural areas, as were self-rated health ([Formula: see text], [Formula: see text]), number of social activities ([Formula: see text], [Formula: see text]),and friends network ([Formula: see text], [Formula: see text]) in urban areas. Despite facing many challenges to well-being, older adults in Mongolia reported high levels of flourishing. Those in urban areas had higher scores than those in rural areas and predictors of flourishing differed for these groups.

Psychological sense of community, self-rated health and quality of life among older adults in Puerto Rico two years after Hurricane María.

Older adults who experience natural disasters are at risk for immediate and longer-term negative health outcomes and diminished quality of life (QOL), in part due to disruptions to social relationships and protections. We use a risk and resilience framework to examine the protective effects of psychological sense of community (PSOC) on self-rated health (SRH) and QOL for older adults in Puerto Rico 2 years after the devastation of Hurricane María in 2017. Between September 2019 and January 2020, we conducted face-to-face interviews with a nonprobability sample of 154 community-dwelling adults aged 60+ in Puerto Rico. Controlling for covariates, we used multivariate regression to examine the association of PSOC and key social risk factors (mental health, social isolation, and loneliness) with SRH and QOL. Higher levels of PSOC were significantly associated with better SRH and QOL. Regarding risks, worse mental health was significantly associated with lower QOL and SRH, loneliness was significantly related to worse QOL, and social isolation was significantly associated with better SRH and better QOL. PSOC was a protective factor for older adults, suggesting that prevention and intervention efforts should focus on building and sustaining older adults' sense of community in the longer-term wake of natural disasters.

Validation of the abbreviated Lubben Social Network Scale (LSNS-6) and its association with self-rated health amongst older adults in Puerto Rico.

Social isolation is a well-established determinant of late-life well-being, and it may be particularly relevant for older adults in Puerto Rico following Hurricane María. The abbreviated Lubben Social Network Scale (LSNS-6) is a widely used measure of social isolation, but it has not been validated with Spanish-speaking older adults. The objectives of this study were to (1) assess the psychometric properties of a Spanish-language LSNS-6 and (2) examine its association with self-rated health (SRH) and psychological sense of community (PSOC). Data came from face-to-face survey interviews with a nonprobability sample of 154 community-dwelling older adults in Puerto Rico 2 years after Hurricane María. We assessed the LSNS-6's internal consistency reliability and convergent validity. We then conducted structural equational modelling consisting of (1) a measurement model using confirmatory factor analysis to test the factor structure of the LSNS-6 and (2) a structural model using path analysis to examine the direct effect of social isolation on SRH and to test the role of PSOC as a mediator in this relationship. The LSNS-6 demonstrated acceptable internal consistency reliability (α = 0.74) and convergent validity, r(151) = -0.33, p < 0.001. A correlated two-factor model (Family and Friends) provided the best fit (comparative fit index = 0.986, Tucker-Lewis index = 0.975, root mean square error of approximation = 0.082, standardised root mean squared residual = 0.033). Path model results show the Friends factor was negatively associated with SRH (ß = -0.31, p = 0.045), whilst the Family factor was nonsignificant. The Friends factor had a statistically significant indirect effect on SRH through PSOC (ß = 0.08, 95% CI [0.01, 0.29]). Our findings provide insight into the effect of social isolation on health amongst older adults in Puerto Rico and highlight the potential role of PSOC for assessment and intervention with older adults in post-disaster settings.

Age-Friendly Communities and Older Adults' Health in the United States.

As age-friendly community (AFC) initiatives grow, it will be essential to determine whether older adults who live in an AFC have better health than those who live in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: an AFC group (livability score of 51+; n = 2364) and a non-AFC (score ≤ 50, n = 663). The outcome variable was self-rated health (M = 3.5; SD = 1.1; range: 1-5). We used an inverse probability weighting approach to evaluate whether older adults who live in an AFC reported better self-rated health than those who live in a non-AFC. Findings showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b = 0.08, p = 0.027). Compared to non-Hispanic Whites, Black and Hispanic older adults reported worse self-rated health. Inasmuch as living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to develop and sustain high-quality, accessible built and social environments.

Geographic proximity to neighborhood resources and depression among older adults in South Korea.

OBJECTIVES: Older adults are closely connected to their neighborhoods and they spend more time there than younger adults. Because their mobility is often impeded by diminished health and functioning, access to neighborhood health and social services is essential for their well-being. This article examines whether geographic proximity to these types of neighborhood resources is associated with depression among older adults in South Korea. METHODS: Data are from A Profile of Older Adults: 2015 which sampled 1,455 community-dwelling individuals ages 60 and older in South Korea. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the outcome. We measured geographic proximity to neighborhood destinations, which included the time it takes the respondent to go to the grocery store, hospital, government office, senior center, social service center, and bus stop. We conducted latent profile analyses (LPA) with a distal outcome using the BCH method to determine whether geographic proximity to neighborhood resources is associated with depression. RESULTS: The LPA identified three distinct subgroups of geographic proximity to neighborhood resources: High Access (10%), Moderate Access (41%), and Low Access (49%). Low Access (b = 3.71, p < .001) and Moderate Access (b = 3.00, p < .001) groups had higher levels of depression compared to those in the High Access group. DISCUSSION: Our findings suggest that access to essential services in one's neighborhood is associated with lower levels of depression, which supports existing evidence that age-friendly community initiatives are important to older adults' psychological well-being.

Measurement Indicators of Age-Friendly Communities: Findings From the AARP Age-Friendly Community Survey.

BACKGROUND AND OBJECTIVES: Cities and counties worldwide have adopted the concept of "age-friendly communities." These communities aspire to promote older adults' well-being by providing a safe, affordable built environment and a social environment that encourages their participation. A major limitation in this field is the lack of valid and reliable measures that capture the complex dimensionality and dynamic nature of the aging-environment interface. RESEARCH DESIGN AND METHODS: This study uses data from the AARP 2016 Age-Friendly Community Surveys (N = 3,652 adults aged 65 and older). The survey includes 62 indicators of age-friendliness, for example, outdoor spaces, transportation, housing, social participation, and community and health services. We randomly split the sample into 2 equal subsamples for confirmatory factor analysis (CFA) and structural equation modeling (SEM). RESULTS: CFA results indicated that both the 5-factor model and the second-order factor model adequately fit the data. In the SEM 5-factor model, outdoor space (ß = 0.134; p = .017), social participation (ß = 0.307; p < .001), and community and health services (ß = -0.149; p = .008) were associated with self-rated health, the outcome of interest. The path coefficients of housing and transportation were not significant. In the second-order factor model, people who lived in more age-friendly communities reported better self-rated health (ß = 0.295; p < .001). DISCUSSION AND IMPLICATIONS: Our findings show that the Age-Friendly Community Survey measures demonstrate reliability and concurrent validity. To promote older adults' well-being, practitioners, policymakers, and researchers should focus on improving their built and social environments. They can use these measures for short- and long-term planning, monitoring, and evaluating age-friendly community initiatives.

Psychometric testing of the Brief Sense of Community Scale with older adults in Puerto Rico.

The Brief Sense of Community Scale (BSCS) is a well-validated measure of psychological sense of community (PSOC), but it has yet to be tested with Spanish-speaking older adults. The current study uses data from face-to-face interviews with a non-probability sample of 154 community-dwelling older adults in Puerto Rico. We used confirmatory factor analysis (CFA) to test three competing factor structures. We also tested internal consistency reliability and convergent validity. CFA results show the second-order four-factor model was the best fit (χ2 (16) = 20.78, p = 0.187; CFI = 0.997, TLI = 0.995, SRMR = 0.026, RMSEA = 0.044, 90% CI [<0.001, 0.092]). The BSCS showed good reliability (α = 0.85) and was correlated in the expected direction with social network size (r = 0.34, p < 0.001) and loneliness (r = -0.27, p < 0.001). These findings indicate that the BSCS comprises the four domains (membership, needs fulfillment, emotional connection, and influence) from the original PSOC theory. These results inform theory development and can aid program planning, policy, and practice with older adults in Puerto Rico.

Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis.

OBJECTIVES: To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model. DESIGN: Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007-2010). SETTING: National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas. PARTICIPANTS: A total of 9,663 adults aged 50 years and older. MEASUREMENTS: We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses. RESULTS: Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas. CONCLUSION: This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults' community involvement, especially in urban areas, will help to enhance QoL.

Comparison of the 18-item and 6-item Lubben Social Network Scales with community-dwelling older adults in Mongolia.

This study compares the psychometric properties of two versions of the Lubben Social Network Scale (LSNS-18 and LSNS-6) with community dwelling older adults in Mongolia. We recruited 650 older adult in the capital city of Ulaanbaatar and the country's four rural regions. We used the Geriatric Depression Scale (GDS-15), the Short Form 12 (SF-12) physical and mental health functioning measures, and a multi-dimensional scale of social isolation for confirmatory factor analyses of the LSNS-18 and the LSNS-6. Both versions demonstrated excellent internal consistency and intraclass correlation and both correlated in expected directions with other study measures. Only the LSNS-6 provided a good fit to the data. The LSNS-6 is a viable instrument for assessing the social networks of older adults in Mongolia. The study adds to the sparse literature on measuring social and behavioral determinants of health in resource-constrained settings characterized by aging populations and high internal migration rates.

Varying Appraisals of Elder Mistreatment Among Victims: Findings from a Population-Based Study.

OBJECTIVES: Prior elder mistreatment (EM) research has not examined subjective assessments of problem seriousness from the perspective of victims. This study sought to describe the variation in appraisals of perceived EM seriousness among victims of emotional abuse, physical abuse, and neglect and to examine factors that influence varying appraisals using neutralization theory. METHODS: Data came from a subsample of EM victims (n = 191) drawn from a representative, population-based study (n = 4,156) of community-dwelling, cognitively intact older adults in New York State. The Conflict Tactics Scale and Duke Older Americans Resources and Services scales were adapted to assess EM. Subjective appraisal of abuse/neglect was measured according to ordinal levels of victim-perceived seriousness and predicted using ordinal regression. RESULTS: Emotional abuse was appraised less seriously among victims who were both functionally impaired and dependent upon the perpetrator, lived with the perpetrator, and of increasing age. Emotional abuse was perceived with greater seriousness among victims enduring more frequent/varied abuse and when the perpetrator was distally-related. Neglect was appraised with lower seriousness among female victims and greater seriousness if perpetrated by a paid homecare attendant or in scenarios involving more frequent/varied unmet needs. DISCUSSION: Findings carry implications for understanding victim help-seeking behavior and informing EM measurement.

Psychological distress, social support, and quality of life among cancer caregivers in Albania.

OBJECTIVE: Drawing on the Stress Process Model, this study examines cancer caregiving in Albania. We used conditional process analysis to test the relationship between psychological distress and quality of life through social support and to examine whether gender moderates pathways in this mediation model. METHODS: Face-to-face interviews were conducted with a non-probability sample of 377 caregivers from the public oncology service. Standardized measures were selected based on psychometric properties and cross-cultural adequacy; all had good internal consistency. RESULTS: Participants reported high levels of psychological distress, moderate social support, and poor quality of life. Compared with men, women had higher levels of distress, worse quality of life, and comparable levels of support. Men were more likely to be caring for a spouse and to rely on friends, while women also cared for others and relied more on family. Social support mediated a strong negative relationship between psychological distress and QoL. These pathways did not differ by gender. CONCLUSIONS: Cancer is increasing rapidly in developing countries, where family caregiving is the preferred and often only option for long-term, intensive care. This study points to high risks for psychological distress and reduced quality of life, especially for female caregivers in Albania. Findings further highlight the importance of social supports an as avenue for prevention and intervention to improve quality of life for both men and women. Copyright © 2016 John Wiley & Sons, Ltd.

Levels and correlates of knowledge about Alzheimer's disease among older Chinese Americans.

OBJECTIVE: This study examined knowledge of Alzheimer's disease (AD) and correlates of AD knowledge in a sample of Chinese American older adults living in the Phoenix metropolitan area of the United States. METHODS: Survey data were collected from 385 Chinese Americans age 55 or older (M = 72.43, SD = 8.67) recruited from various settings not limited to senior housing facilities, senior clubs, senior centers and church groups. RESULTS: Participants responded to a 24-item true/false AD knowledge scale with 73 % accuracy. Multivariate regression analyses found that participants who held more traditional Chinese cultural beliefs of AD tended to have less AD knowledge. Older women had more knowledge of AD than men when educational differences were controlled. Participants who used media to acquire AD information had more AD knowledge than those did not. CONCLUSIONS: AD educational programs should target domains (e.g., risk factors, symptoms, and caregiving) about which Chinese American elders tend to have less knowledge; AD information should be disseminated through appropriate media to outreach Chinese American elders more effectively. Addressing the biases in elders' cultural beliefs of AD should be incorporated in AD educational programs.

Broadening the etiological discourse on Alzheimer's disease to include trauma and posttraumatic stress disorder as psychosocial risk factors.

Biomedical perspectives have long dominated research on the etiology and progression of Alzheimer's disease (AD); yet these approaches do not solely explain observed variations in individual AD trajectories. More robust biopsychosocial models regard the course of AD as a dialectical interplay of neuropathological and psychosocial influences. Drawing on this broader conceptualization, we conducted an extensive review of empirical and theoretical literature on the associations of trauma, posttraumatic stress disorder (PTSD) and AD to develop a working model that conceptualizes the role of psychosocial stressors and physiological mechanisms in the onset and course of AD. The proposed model suggests two pathways. In the first, previous life trauma acts as a risk factor for later-life onset of AD, either directly or mediated by PTSD or PTSD correlates. In the second, de novo AD experiential trauma is associated with accelerated cognitive decline, either directly or mediated through PTSD or PTSD correlates. Evidence synthesized in this paper indicates that previous life trauma and PTSD are strong candidates as psychosocial risk factors for AD and warrant further empirical scrutiny. Psychosocial and neurological-based intervention implications are discussed. A biopsychosocial approach has the capacity to enhance understanding of individual AD trajectories, moving the field toward 'person-centered' models of care.

Translation and validation of the 18-item Lubben Social Network Scale with older adults in Mongolia.

BACKGROUND: In Mongolia, social, demographic, and geographic factors have heightened the need for a reliable means to assess social isolation of older adults. The purpose of this study was to identify, translate, and validate such a measure. METHODS: The study was conducted in two phases: translation and back translation of the 18-item Lubben Social Network Scale to Mongolian (LSNS-18-M) and field testing to establish reliability and validity and to explore potential cut-off points. The sample comprised 198 Mongolians aged ≥ 55 years selected from six hospitals in Ulaanbaatar, Mongolia. RESULTS: Internal consistency and intraclass correlations for the LSNS-18-M were excellent, indicating high reliability. The scale showed strong convergence with social disconnectedness and perceived isolation scales and with the Geriatric Depression Scale. It was also inversely related to self-rated health status, but not to the physical or mental health subscales of the Short Form-12 (SF-12) survey. The LSNS-18-M scores discriminated among three levels of social disconnectedness and three levels of perceived isolation. Regarding content validity, the 18 items loaded cleanly on the same three factors as the original LSNS-18, inter-factor correlations were good, all factors were correlated with the LSNS-18-M, and they accounted for two-thirds of variance in scores. CONCLUSIONS: The LSNS-18-M had excellent reliability and good validity with a sample of older Mongolians and should be useful for screening, assessment, and monitoring social isolation. Future studies should examine lack of association with the SF-12 and should assess the scale's use with non-hospitalized and non-urban older adults in Mongolia and with Mongolian speakers outside the country.

The influence of ethnicity and culture on dementia caregiving: a review of empirical studies on Chinese Americans.

The purpose of this article is to pinpoint the cultural and ethnic influences on dementia caregiving in Chinese American families through a systemic review and analysis of published research findings. Eighteen publications on Chinese American dementia family caregivers published in peer-reviewed journals between 1990 and early 2011 were identified. Based on a systematic database search and review process, we found that caregivers' beliefs concerning dementia and the concept of family harmony as evidenced through the practice of filial piety are permeating cultural values, which together affect attitudes toward research and help-seeking behaviors (ie, seeking information on diagnosis and using formal services). There is also evidence to suggest that these cultural beliefs impinge on key elements of the caregiving process, including caregivers' appraisal of stress, coping strategies, and informal and formal support. The study concludes with recommendations for future research and practice with the Chinese American population.

Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV.

In this article, we examine parent-adolescent communication about sex among rural Indian youth and their parents. We conducted in-depth interviews (N = 40) with mothers, fathers, and adolescent boys and girls aged 14 to 18 years in a rural community in Maharashtra, India. In the context of key cultural factors, including gender-related norms, we explore issues of sexual health and critically assess widely held beliefs that Indian parents are unwilling or unable to discuss sex-related topics with their children. Our findings suggest that despite communication barriers, e.g., lack of knowledge and cultural proscriptions, Indian families are interested in and willing to communicate about sex-related topics. Future research should seek to determine the viability of family-based HIV prevention interventions for Indian adolescents.

India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for rural Indian youth.

BACKGROUND: Despite the centrality of family in Indian society, relatively little is known about family-based communication concerning sexual behaviour and HIV/AIDS in rural Indian families. To date, very few family-based adolescent HIV-prevention interventions have been developed for rural Indian youth. This study conducted formative research with youth aged 14 to18 years and their parents in order to assess the feasibility of conducting a family-based HIV-prevention intervention for rural Indian adolescents. METHODS: Eight focus groups were conducted (n = 46) with mothers, fathers, adolescent females and adolescent males (two focus groups were held for each of the four groups). All focus groups consisted of same-gender participants. Adolescents aged 14 to18 years old and their parents were recruited from a tribal community in rural Maharashtra, India. Focus group transcripts were content analyzed to identify themes related to family perceptions about HIV/AIDS and participation in a family-based intervention to reduce adolescent vulnerability to HIV infection. RESULTS: Six primary thematic areas were identified: (1) family knowledge about HIV/AIDS; (2) family perceptions about adolescent vulnerability to HIV infection; (3) feasibility of a family-based programme to prevent adolescent HIV infection; (4) barriers to participation; (5) recruitment and retention strategies; and (6) preferred content for an adolescent HIV prevention intervention. CONCLUSION: Despite suggestions that family-based approaches to preventing adolescent HIV infection may be culturally inappropriate, our results suggest that a family-based intervention to prevent adolescent HIV infection is feasible if it: (1) provides families with comprehensive HIV prevention strategies and knowledge; (2) addresses barriers to participation; (3) is adolescent friendly, flexible and convenient; and (4) is developmentally and culturally appropriate for rural Indian families.

Gender, self-care and functional status among older persons with coronary heart disease: a national perspective.

The risk and burdens of cardiovascular diseases rise in late life and shift from men to women at age 65. This study uses baseline data from the National Survey of Self-Care and Aging to assess the association of self-care and functional status of older men and women with coronary heart disease (CHD). We first compare men and women with and without CHD, then base subsequent analyses on 597 persons with CHD. Three types of self-care (behavior changes, environmental adaptations, medical equipment use) were examined, and functional status was measured as difficulty with basic, mobility, and instrumental ADLs. Regardless of gender, persons with CHD had more functional impairment and used more self-care than those without the disease. Women were more impaired and engaged in more self-care than men. Equipment use was associated with higher functioning for men and women. Behavioral changes were significant only for men, as were advanced age, non-white ethnicity, more depressive symptoms, and low physical activity for women. Education, intervention, and supportive care for older adults with CHD should consider the role of specific types of self-care in disease management and prevention of decline as well as gender differences in use of various self-care strategies.