Depressive Symptoms in Later Life in China: Situating "Long Arm" of Child Physical Maltreatment Within a Family Context.

Objective: This article intends to reveal the long-term effects of physical maltreatment in childhood on depressive symptoms in later life in China. Methods: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). 8676 respondents aged 45 and older were included in the study. In this study, we use ordinary least squares (OLS) regression models to estimate the long-term impact on children of physical punishment from their parents. Results: We found that individuals who recalled being hit by their mother in early life reported more depressive symptoms than those who recalled being punished by their father. Difficult family contexts (e.g., comparative poverty, family violence, and parent's poor mental health) had a weak association with higher risk of reporting physical maltreatment and more depressive symptoms among respondents in later life. Conclusion: This article extended the exploration of the long-term impact of child physical maltreatment beyond adolescence and into until later adult life. Effective policies to protect children from maltreatment in the form of physical punishment require further attention to the challenges posed by tradition and culture.

Feasibility and acceptability of the community-based program: Plan Ahead.

OBJECTIVES: In this article, we assess the feasibility and acceptability and the effect of the Plan Ahead for community dwelling older adults. In addition, we investigated the effects of the program. In addition, we aimed to examine whether the completion of the specific Future Care Planning depended on the participants' competence level. METHODS: In this single group feasibility study, trained facilitators delivered the program to a sample of 234 community-residing older adults. Participants completed both pre, post assessments about the acceptability of the program and their completion of the recommended future care planning activities. RESULTS: Based on participant's report on the usefulness and satisfaction of the program after the completion of the program, we found that participants reported high levels of acceptance of the program. Participation rates also confirmed the feasibility of the program. In terms of effects of program implementation, statistically significant changes were noted for several outcomes, such as resource building and FCP activities. In particular, we found that these gains were particularly robust for participants in the low competence group. CONCLUSION: Pilot program results suggest the feasibility of a short community program enhancing proactive planning for future care needs among older adults residing in their community.

The role of goal and meaning in life for older adults facing interpersonal stress.

Interpersonal stressful events (ISE) have been shown to be potent predictors of major depressive symptoms among older adults. This study examines the relationships between recent ISE and depressive symptoms in late life and explores whether having coping cognitive resource (e.g. finding meaning and goal in life) can buffer the effects of ISE on depressive symptoms for older adults. We utilized a sample of residents in Florida retirement communities (N = 588) who participated in a long-term-panel study using yearly assessments for six years. Additionally, we modeled within-person differences in ISE and depressive symptoms simultaneously with multilevel modeling. Then, we tested the moderating effect of coping resource (i.e. meaning in life and goal in life) in the association between ISE and depressive symptoms. We found that the mean level of ISE is associated with higher depressive symptoms and lower life satisfaction. In addition, higher levels of within-person meaning and goal buffered the negative effect of ISE on depressive symptoms for older adults. Similarly, within-person meaning and goal also attenuated the negative effect of ISE on life satisfaction.

Altruistic Attitudes Among Older Adults: Examining Construct Validity and Measurement Invariance of a New Scale.

BACKGROUND AND OBJECTIVES: Scholarly research has established the role of altruism in facilitating human cooperation and prosocial behaviors and highlighted its contribution to psychological well-being. Given the health significance of altruistic attitudes and orientations, we developed a valid and reliable measure of this construct that is suitable for use with older adults. RESEARCH DESIGN AND METHODS: Based on data from a long-term panel study on adaptation to frailty among older adults (n = 366; mean age = 86 years), we used confirmatory factor analysis to perform construct validation of a five-item Elderly Care Research Center Altruism Scale among older adults (e.g., "Seeing others prosper makes me happy"). Moreover, we examined the invariance of the scale's factor structure across time and gender using nested models. RESULTS: Composite reliability (coefficient omega = 0.78), factor loadings (>0.45 with eigenvalue = 2.84) from exploratory factor analysis, and model fit indices (e.g., comparative fit index = 0.999) from confirmatory factor analysis suggest a single factor, supporting a unidimensional reliable construct of altruistic orientation at baseline. The results provided support for configural, metric, and scalar invariance across time. Findings pertaining to measurement invariance across gender confirmed full configural invariance but only offered support for partial metric, scalar, and residual invariance at baseline. Strong correlations among the altruism scale, salient personality traits, psychological well-being, religiosity, and meaning in life help establish construct validity. DISCUSSION AND IMPLICATIONS: The availability of a reliable and valid measure of altruistic attitudes enables a comprehensive evaluation of altruism's influence on later-life health and well-being.

Driving Cessation in Old Age: Gender Influences on Mortality.

Objective: This study examined health and social support as mediators of the association between driving cessation and 10-year mortality among older men and older women. Method: Data were drawn from a prospective panel survey of 1000 community-dwelling older adults with follow-ups over a 10-year period. Extended Cox proportional hazard regression models were used to estimate the relative risk of driving cessation on mortality. Results: Mortality risk was 1.36 (CI = [1.06, 1.73]) times higher for nondrivers than drivers. This relationship was significantly mediated by health status in the overall sample. Physical health and cognitive health fully mediated the association between driving cessation and mortality among older men, whereas the mediation effects were partial among older women. Discussion: Gender differences in driving patterns may account for the differential mediation effects in the association between driving cessation and mortality.

Depressive symptoms among elderly men and women who transition to widowhood: comparisons with long term married and long term widowed over a 10-year period.

This study explores gender differences in mental health sequelae of transition to widowhood among old-old retirement community dwellers. Data are based on a prospective panel survey of 748 older adults (mean age = 78) with follow-ups over a 10-year period. Mixed-effects models suggest that elderly widows and widowers experienced sharp increases of depressive symptoms subsequent to spousal loss. Men showed stable increases of depressive symptoms after widowhood whereas an inverted U-shape curve of depressive symptoms was prominent for older women. Findings indicate that women are more resilient and are better able to cope with spousal loss than are their male counterparts.

Loving Others: The Impact of Compassionate Love on Later-Life Psychological Well-being.

OBJECTIVES: Existing scholarship in social gerontology has paid relatively little attention to broader loving emotions, such as compassionate and altruistic love, as potentially meaningful mechanisms for improving later-life psychological well-being outside a family framework. METHOD: Drawing from a 3-wave longitudinal survey of community-dwelling older residents (n = 334) of Miami, Florida, we utilized generalized estimating equation models to examine the influence of changes in compassionate love (i.e., feeling love toward other persons and experiencing love from others) on depressive symptoms over time. We also explored cross-sectional relationship between compassionate love and positive and negative affects. RESULTS: An increase in the feeling of being loved (ß = -0.77, p < .001) and feeling love for others (ß = -0.78, p < .001) led to a decline in odds of reporting greater levels of depressive symptoms over time. The odds of reporting higher level of positive affect were significantly greater for older adults who reported feeling loved by others (ß = .63, p < .001) and expressed love for other people (ß = 0.43, p < .05). Older adults who felt loved and expressed love for other people, respectively, had 0.71 and 0.54-point lower ordered log odds of reporting higher negative affect than those who reported lower levels of love. The statistically significant impact of feeling loved on all well-being outcomes was maintained even after adjustment for altruistic attitudes and emotional support. Except for depressive symptoms, such adjustments explained the positive influence of love for others on well-being outcomes. DISCUSSION: Our findings underscore the powerful influence of both receiving and giving loving emotions for the maintenance of later-life psychological well-being.

Racial differences in future care planning in late life.

Objectives: Although many older adults fear frailty and loss of independence in late life, relatively few make plans for their future care. Such planning is particularly limited among racial minorities. Given the benefits of future care planning (FCP), it is important to understand factors that facilitate or hamper FCP in late life. Our study explored racial, demographic, and dispositional influences on thinking about and engagement in FCP among community-dwelling older adults.Design: This study utilized data from the Elderly Care Research Center's longitudinal study of successful aging based on interviews with 409 older adults. Along with race, education and other demographic factors, we explored dispositional influences of optimism and religiosity on FCP using logistic regression.Results: African American older adults had significantly lower odds of executing FCP (ß = 0.36, p < .05) when compared to White older adults. However, this estimate was no longer statistically significant after controlling for education, disability status, optimism, and religiosity. Older adults with higher education had significantly higher odds of thinking about and executing FCP. Higher level of optimism was associated with lower odds of FCP.Conclusions: Limited educational resources and the greater prevalence of dispositions of religiosity and optimism among African American older adults may contribute to their reluctance to engage in FCP in comparison to their white counterparts. Our findings offer practice implications indicating a need for interventions to encourage older adults, particularly racial minorities, to recognize and actively plan for their future care needs.

Meeting Challenges of Late Life Disability Proactively.

Discussions of disability in the gerontological and the disability studies literatures have seldom considered unique perspectives and needs of older adults. Disability has often been stigmatized and viewed as antithetical to successful aging. We call for expansion of prevailing paradigms of disability to address the resilience and continuing human potential of older adults living with disabilities. In addition to recognizing the environmental context of disability, we propose greater attention to adaptive potential of disabled older adults. We discuss 6 types of proactive adaptations that can contribute to empowerment, meaning, enhanced quality of life and psychological well-being among persons living with late-life onset disabilities. These include: (a) helping others, (b) planning for future care, (c) marshaling intergenerational support, (d) self-advocacy for responsive health care, (e) making environmental modifications to improve safety and comfort of the home, and (f) finding strength in spiritual pursuits. Enacting proactive adaptations can contribute to resilience in facing late life impairments and functional limitations. Such efforts can complement utilization of services and obtaining accommodations. Maintaining life satisfaction among older adults living with disabilities also involves focus on transcendent personal goals and acceptance of an altered self. We note how a more integrative view of medical and social dimensions of disability, infused with concepts of human agency, contributes to rapprochement between alternative disciplinary orientations to late life disability. Without negating society's important responsibilities for accommodating to needs of older adults living with disability, we reaffirm their potential for greater control and self-determination through proactive adaptations.

Whose advocacy counts in shaping elderly patients' satisfaction with physicians' care and communication?

PURPOSE: The purpose of this article was to examine the relative importance of patients' self-advocacy and perceived physicians' advocacy for impacting patients' satisfaction in terms of physician communication and physician-patient relationship. We also examine the influence of physicians' emotional support and patients' demographic as well as health characteristics on patients' satisfaction. SAMPLE: Our sample includes interviews with 806 community dwelling older adults (mean age =77.82 years, SD=8.41). The sample included residents of a large retirement community in Clearwater, FL, USA. Respondents were also included from representative samples of older adults living in Orlando and Miami, FL, USA, and Cleveland, OH, USA. METHODS AND RESULTS: Using multiple hierarchical regression analyses, we found that patients' age and functional limitations were negatively associated with their care satisfaction. When compared with White patients, African-American patients were less satisfied with their physicians while Latino patients expressed greater satisfaction with their medical care. We found limited evidence of patients' self-advocacy and such advocacy did not serve as a significant predictor of satisfaction with physicians. In contrast, patients' perception of physicians' readiness to act as patient advocates was a significant predictor of patients' satisfaction. Emotional support of physicians was also associated with patients' satisfaction. CONCLUSION: These findings raise questions about consumer empowerment among older adults and underscore their desire for and appreciation of physicians' advocacy. Findings are discussed in the context of power imbalance between elderly patients and their doctors.

Beyond Ageist Attitudes: Researchers Call for NIH Action to Limit Funding for Older Academics.

Purpose: This article explores manifestations of ageism in response to a proposed National Institutes of Health (NIH) Emeritus Grant initiative aimed at funding older investigators. Design and Methods: Comments were requested by NIH in 2015, through a Request for Information (RFI) as well as a public blog regarding the merits of a proposed grant mechanism that would help older researchers transfer their labs to junior scientists and transition into retirement. This article reports content analysis of comments from 134 respondents to the blog. Results: We found consistent patterns of disapproval of the proposed NIH initiative, which was viewed by most respondents as an undeserved benefit for older scientists. Negative attitudes were also expressed toward senior investigators by a large majority of commenters. In addition to broad opposition to new grant funding for senior investigators, many commenters also advocated for other punitive actions toward older investigators, including forced retirement. These opinions were generally justified by negative appraisals of senior investigators' competence, productivity, and even their character. Ageist comments were not limited to younger researchers, suggesting potential internalized ageism by older investigators. Implications: We discuss manifestations of ageism and advocacy for age discrimination in the broader social context of modernization theory, intergenerational conflict and social closure. Our findings raise important questions about the limited value of higher education in counteracting prejudice toward older people. We propose potential remedies to reduce ageism in academia.

Successful Aging from the Viewpoint of Older Adults: Development of a Brief Successful Aging Inventory (SAI).

OBJECTIVE: Researcher-defined criteria for successful aging (SA) have been criticized for their limited perspective and failure to acknowledge subjective perceptions of older individuals. We assessed the extent to which older individuals consider specific factors, which they had suggested, to be important in defining SA. The present study had 2 objectives: (a) to develop a brief multidimensional questionnaire for assessing SA and to evaluate its psychometric properties; and (b) to examine age associations with each dimension of SA. METHODS: A survey was conducted with 550 participants in a panel study of older adult residents of an elderly retirement community and with community-dwelling older adults, regarding factors that they considered to be important for SA. The psychometric evaluation involved exploratory and confirmatory factor analyses, reliability and validity analyses, and measurement invariance testing. Partial correlations were used to examine the association of age with SA. RESULTS: The 4-factor solution provided a satisfactory fit to the data: proactive engagement, wellness resources, positive spirit, and valued relationships. Metric measurement invariance for this factor structure was confirmed across 2 age groups. The findings also suggest that the Successful Aging Inventory (SAI) scale might be a useful predictor of SA. DISCUSSION: Our findings highlight the value of considering more comprehensive models of SA that include social relationships and proactive engagement.

Elderly Cancer Survivors Reflect on Coping Strategies During the Cancer Journey.

PURPOSE: This paper focuses on perspectives of elderly cancer survivors on their experiences of coping with cancer during various phases of their illness journey, ranging from diagnosis phase to treatment and finally considering post treatment survivorship. Anchored in the stress paradigm, the purpose of this study was to explore the meaning of living with cancer and older adults' orientations to coping with stressors encountered during their cancer journey as reflected in narratives of elderly cancer survivors. METHODS: A nonclinical sample of 174 older adults who reported a cancer diagnosis were selected from a panel study of successful aging. In-depth interviews with respondents focused on perceived stressors and coping strategies at different phases of their cancer experience. Themes were derived from narratives based on consensus by two raters. RESULTS: Most of the elderly patients accepted their diagnosis without dismay. Resolve and determination during the diagnosis phase was followed by assuming a more passive role during the treatment phase, relying on expert medical care. During the longer term survivorship phase older adults looked back at the adaptations they found most useful. The majority reported valuing active coping styles. These include seeking social support and instrumental orientations to dealing with the illness followed by religious or spiritual approaches. CONCLUSIONS: The "on time" interpretation of having a cancer diagnosis in old age may diminish the stressfulness of the diagnosis and may enhance the patients' ability to proactively deal with the reality of their illness.

Social support and cognitive functioning as resources for elderly persons with chronic arthritis pain.

OBJECTIVE: Arthritis pain and depression are prevalent physical and psychological disorders in late life and co-occur frequently. We explored the stability and covariation of arthritis pain and depressive symptoms. We also addressed the influence of cognitive functioning and social support on the relationship between pain and depressive symptoms among community-dwelling older individuals. METHOD: This longitudinal study utilized a sample of 299 residents of Florida retirement communities who participated in a long-term panel study using yearly assessments across 4 years. Using multilevel modeling, we modeled the individual differences as well as stability in arthritis pain and depressive symptoms simultaneously. Further, we tested the role of cognitive functioning and social support in the association between arthritis pain and depressive symptoms. RESULTS: We found substantial within-person variation in both pain and depressive symptoms (between 58% and 65%) across 4 years even after controlling for a time effect. After controlling for arthritis pain, persons with higher social support and higher cognitive functioning reported lower levels of depressive symptoms. DISCUSSION: Findings suggest that fluctuations in pain and depressive symptoms are common for older adults. Furthermore, social support and intact cognitive functioning may serve as useful resources, as they buffer the negative impact of arthritis pain on depressive symptoms.

Defining successful aging: a tangible or elusive concept?

PURPOSE OF THE STUDY: Everyone wants to age successfully; however, the definition and criteria of successful aging remain vague for laypersons, researchers, and policymakers in spite of decades of research on the topic. This paper highlights work of scholars who made significant theoretical contributions to the topic. DESIGN AND METHODS: A thorough review and evaluation of the literature on successful aging was undertaken. RESULTS: Our review includes early gerontological definitions of successful aging and related concepts. Historical perspectives reach back to philosophical and religious texts, and more recent approaches have focused on both process- and outcome-oriented models of successful aging. We elaborate on Baltes and Baltes' theory of selective optimization with compensation [Baltes, P. B., & Baltes, M. M. (1990a). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (pp. 1-34). United Kingdom: Cambridge University Press], Kahana and Kahana's preventive and corrective proactivity model [Kahana, E., & Kahana, B. (1996). Conceptual and empirical advances in understanding aging well through proactive adaptation. In V. Bengtson (Ed.), Adulthood and aging: Research on continuities and discontinuities (pp. 18-40). New York: Springer], and Rowe and Kahn's model of successful aging [Rowe, J. W., & Kahn, R. L. (1998). Successful aging. New York: Pantheon Books], outlining their commonalities and differences. Additional views on successful aging emphasize subjective versus objective perceptions of successful aging and relate successful aging to studies on healthy and exceptional longevity. IMPLICATIONS: Additional theoretical work is needed to better understand successful aging, including the way it can encompass disability and death and dying. The extent of rapid social and technological change influencing views on successful aging also deserves more consideration.

Patient Planning and Initiative Enhances Physician Recommendations for Cancer Screening and Prevention.

BACKGROUND: The growing population of older adults is at the highest risk for cancer, yet they are underserved in terms of cancer prevention and care. Discussions between patients and physicians that result in tailored recommendations are now called for by the U.S. Preventive Services Task Force. AIMS & METHOD: The current study explored the role of physician-patient relationships and of patient initiatives in health communication on primary care physicians' recommendations of cancer prevention and screening. Our data was collected from baseline questionnaires from elderly patients 60 years of age or older (N=360) who attended an adult community center where an educational intervention was administered. RESULTS: Our findings demonstrate the importance of elderly patients' advocacy, shown through planning and initiative in communication for eliciting doctor's cancer screening and cancer prevention recommendations in primary care settings.

Positive affect, depressive symptoms, and arthritis pain of elderly people over time.

BACKGROUND: Older adults frequently experience physical symptoms of arthritis pain. We examined the dynamic change of arthritis pain and depressive symptoms over time. We also addressed the influence of time varying arthritis pain on depressive symptoms and positive affect among community dwelling older individuals. METHODS: Analyses were based on data from 4 annual follow-ups in a sample of 299 elderly residents (M=83.78) of Florida retirement communities. We estimated a hierarchical growth curve model that related the effects of time varying pain and characteristics of participants such as age, gender, cognitive functioning, emotional support and health. Growth curve modeling was used to assess changes in emotional well-being as a function of arthritis pain over time. RESULTS: We found that depressive symptoms increased over 4 years whereas positive affect declined over 4 years with significant between-person differences in levels and slopes. As predicted, changes in arthritis pain co-varied with both depressive symptoms and positive affect over time. Gender, cognitive functioning, health conditions and emotional support from others were associated with between person differences in level of emotional well-being. CONCLUSIONS: Our findings suggest that conceptualization of emotional well-being of older adults as a dynamic, changing construct applies both depressive symptoms and positive affect. Findings also suggest that arthritis pain as well as emotional support contribute to depressive symptoms and to positive affect among older adults with arthritis.

Proactive approaches to successful aging: one clear path through the forest.

The importance of successful aging is increasingly acknowledged in the field of gerontology. In this paper we contribute to ongoing efforts to clarify and operationalize this concept by presenting our revised Comprehensive Preventive Corrective Proactive (PCP) model that builds on relevant research traditions, our prior formulations and accumulating research evidence based on testing this model. Recognizing biopsychosocial challenges and contextual stressors that are normative for older individuals, we emphasize the critical role of proactive behavioral adaptations in ameliorating the adverse effects of stressors. We argue that competent actions to address age-related changes and stressors are necessary to achieve positive quality-of-life outcomes. We propose that future research may benefit from employing more complex methodological approaches and data analytic tools.

Altruism, helping, and volunteering: pathways to well-being in late life.

OBJECTIVE: We examined the influence of prosocial orientations including altruism, volunteering, and informal helping on positive and negative well-being outcomes among retirement community dwelling elders. METHOD: We utilize data from 2 waves, 3 years apart, of a panel study of successful aging (N = 585). Psychosocial well-being outcomes measured include life satisfaction, positive affect, negative affect, and depressive symptomatology. RESULTS: Ordinal logistic regression results indicate that altruistic attitudes, volunteering, and informal helping behaviors make unique contributions to the maintenance of life satisfaction, positive affect and other well being outcomes considered in this research. Predictors explain variance primarily in the positive indicators of psychological well-being, but are not significantly associated with the negative outcomes. Female gender and functional limitations are also associated with diminished psychological well-being. DISCUSSION: Our findings underscore the value of altruistic attitudes as important additional predictors, along with prosocial behaviors in fostering life satisfaction and positive affect in old age.