App-Based Addiction Prevention at German Vocational Schools: Implementation and Reach for a Cluster-Randomized Controlled Trial.

This article examines the implementation, participation rates, and potential determinants of participation in the digital addiction prevention program "ready4life." A two-arm cluster-randomized trial recruited German vocational students via class-based strategies. Intervention group received 16 weeks of in-app coaching; the control group received health behavior information, with coaching offered after 12 months. Potential determinants of participation were analyzed based on class and individual characteristics. Out of 525 contacted schools, 35 participated, enrolling 376 classes. Implementation during the pandemic required flexible adjustments, with 49.7% of introductions conducted in person, 43.1% digitally via online streaming, and 7.2% received a video link via email. Despite challenges, 72.3% of the vocational students downloaded the app, and 46.7% gave informed consent. Participation rates were highest among (associate) professionals, vocational grammar school classes, classes introduced by females, younger individuals, members of the project team, and classes introduced face-to-face. Female gender, lower social competencies, lifetime cannabis use, higher problematic internet use, and higher perceived stress were associated with higher individual participation. The study highlights the importance of proactive outreach and personalized interventions for addiction prevention programs in vocational schools. While reached students aligned with the aims of the app, tailored recruitment strategies could enhance engagement among under-represented groups. The trial was registered in the German Clinical Trials Register (DRKS): DRKS00022328; registration date 09.10.2020.

Younger Than Ever? Subjective Age Is Becoming Younger and Remains More Stable in Middle-Age and Older Adults Today.

Little is known about historical shifts in subjective age (i.e., how old individuals feel). Moving beyond the very few time-lagged cross-sectional cohort comparisons, we examined historical shifts in within-person trajectories of subjective age from midlife to advanced old age. We used cohort-comparative longitudinal data from middle-age and older adults in the German Ageing Survey (N = 14,928; ~50% female) who lived in Germany and were between 40 and 85 years old when entering the study. They provided up to seven observations over 24 years. Results revealed that being born later in historical time is associated with feeling younger by 2% every birth-year decade and with less intraindividual change toward an older subjective age. Women reported feeling younger than men; this gender gap widened across cohorts. The association of higher education with younger subjective age became weaker across cohorts. Potential reasons for the subjective-rejuvenation effect across cohorts are discussed.

The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study.

BACKGROUND: Elective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap. METHODS: We used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied. RESULTS: Our analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH. CONCLUSIONS: Meaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health. TRIAL REGISTRATION: PAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311 .

Fear of Falling Carries Over into Overprotection in Old Age: A Cross-Lagged Panel Analysis.

Fear of falling might result in overprotection by one's social environment. In turn, feeling dependent could increase fear of falling. However, the association between fear of falling and perceived overprotection and its temporal order is unknown. This longitudinal study explores this potential mutual longitudinal association. This study presents secondary analyses from a larger trial. We tested the association between fear of falling and perceived overprotection in a cross-lagged path model controlled for falls, health-related quality of life, age, gender, and trial condition. N = 310 participants (M = 70 years, range: 64-92) completed self-reports at Time 1, 7 (Time 2), and 11 weeks (Time 3) after baseline assessment. We found a positive association from fear of falling to perceived overprotection (ß = .12, 95% CI[0.02, 0.21], p = .02; ß = .10; [0.01, 0.18], p = .03). The reversed cross-lagged paths were not significant. Findings suggest higher fear of falling translates into perceived overprotection, which may in turn increase loss of independence in old age.

[Strengthening prevention and health promotion in and for old age]. / Prävention und Gesundheitsförderung im und für das Alter stärken.

BACKGROUND: Disease prevention and health promotion in and for old age have become increasingly more important. Nevertheless, more (national) research and implementation in practice is needed, as the international comparison shows. OBJECTIVE: To develop guiding principles for research and practice on prevention and health promotion in and for old age. MATERIAL AND METHODS: As part of an iterative process, members of the German Society of Gerontology and Geriatrics came together in workshops and symposia to formulate key guiding principles and fields of action for prevention and health promotion. RESULTS: The following were worked out: 1) prevention and health promotion are useful and possible up to oldest age, 2) prevention and health promotion for advanced age should start early, 3) prevention and health promotion must take into account the diversity and heterogeneity of the life situations of old people, 4) prevention and health promotion promote and demand self-determination and participation, 5) prevention of multiple illnesses must be given greater attention, 6) prevention of the need for long-term care and prevention in long-term care must be treated equally, 7) prevention and health promotion must be thought of in terms of life worlds and across sectors, paying particular attention to aspects of social inequality and a focus on resources, 8) prevention and health promotion and the related research must be interdisciplinary and transdisciplinary and be applied at different levels, from molecular to societal. DISCUSSION: The guiding principles outline the focal points of future-oriented ageing, health and healthcare research and open up fields of action but also show the limits of this approach for political decision-makers, researchers and practitioners.

Associations of Agency and Communion With Domain-Specific Self-Perceptions of Aging: A Cross-Sectional Study In Old-Old Adults in Poor Health.

A large body of research indicates that self-perceptions of aging (SPA) play an important role for health in later life. Hence, more research on SPA and correlates is needed, especially in old age and poor health, where negative SPA tend to prevail. Recent studies identified personality as an important correlate of SPA in young-old and relatively healthy samples. Thus, we investigated cross-sectional associations of agency and communion with two SPA domains in a sample of old-old adults in poor health (n = 154; Mage = 81.55, SD = 4.56, 58.4% women). In multiple regression analyses, agency and communion were associated with SPA related to ongoing development beyond health. In contrast, only health as a covariate was significantly associated with SPA related to physical losses. Thus, personality may be a resource associated with gain-related SPA, at least for those in poor health and old age.

Longitudinal measurement invariance of the patient health questionnaire in a German sample.

BACKGROUND: The Patient Health Questionnaire-8 (PHQ-8) is a screening questionnaire of depressive symptoms. However, it is unknown whether it is equivalent across time and between groups of individuals. The aim of our paper was to test whether the PHQ-8 has the same meaning in two groups of individuals over time. METHODS: Primary care patients were proactively recruited from three German cities. PHQ-8 data from a baseline assessment (n = 588), two assessments during the intervention (n = 246/225), and a six (n = 437) and 12 months (n = 447) follow-up assessment were first used to examine the factor structure of the PHQ-8 by confirmatory factor analysis (CFA). The best fitting factor solution was then used to test longitudinal invariance across time and between intervention and control group by Multiple Group CFA. RESULTS: A two-factor structure consistently showed the best model fit. Only configural longitudinal invariance was evidenced when the baseline assessment was included in the analysis. Without the baseline assessment, strict longitudinal invariance was shown across the intervention and the follow-up assessments. Scalar invariance was established between the intervention and control group for the baseline assessment and strict invariance between groups and across the 6- and 12-month follow-up assessments. CONCLUSIONS: The lack of longitudinal invariance might be attributed to various differences between the baseline assessments and all following assessments, e.g., assessment mode (iPad vs telephone), potential changes in symptom perception, and setting. TRIAL REGISTRATION: DRKS0001163 5, date of trial registration: 20.01.2017; DRKS00011637 , date of trial registration: 25.01.2017.

Domain-specific self-perceptions of aging are associated with different gait patterns in older adults: a cross-sectional latent profile analysis.

BACKGROUND: Previous studies have pointed to the impact of self-perceptions of aging (SPA) on self-reported physical function in later life. However, less is known about associations of SPA with objectively measured physical function, especially gait. Research that examined other psychological variables and objectively measured gait has focused on single gait parameters such as gait speed, which seems to fall short for the complexity of this movement. Some approaches have proposed ways to identify gait patterns in specific patient groups, but not in community samples. Our goal was (a) to identify gait patterns based on a combination of important gait parameters in a community sample, and (b) to investigate differential associations of gain- and loss-related SPA with these gait patterns. METHODS: The study used an electronic walkway to assess gait parameters of 150 community dwelling adults aged 71-93 years (61.0% women) at their usual and maximum gait speed. SPA were assessed with a questionnaire. We used latent profile analysis (LPA) to identify groups exhibiting distinct gait patterns and binary logistic regression to investigate associations of SPA with these groups, controlling for personality traits, number of illnesses, age, gender, and education. To compare overall function between groups, a t-test for scores in the Short Physical Performance Battery was used. RESULTS: LPA revealed two distinct groups in both gait speed conditions. The fit group exhibited a stable, well-coordinated and faster gait pattern, while the functionally limited group's gait pattern was less stable, less coordinated and slower. The odds of belonging to the functionally limited group were increased by loss-related SPA at usual gait speed, while the odds of belonging to the fit group were increased by gain-related SPA at individual maximum speed. CONCLUSIONS: The findings (a) suggest LPA as a useful approach to investigate complex gait patterns considering several gait parameters simultaneously, and (b) provide first evidence for differential associations of gain- and loss-related SPA with gait patterns at usual and maximum gait speed. Intervention studies addressing gait in older adults should additionally address gain-related views on aging.

There Is Still Time to Be Active: Self-Perceptions of Aging, Physical Activity, and the Role of Perceived Residual Lifetime Among Older Adults.

Self-perceptions of aging (SPA) are a resource in later life. As aging is accompanied with perceptions of the finitude of life, it is assumed that perceived residual lifetime may play a role in the relationship between SPA and health behavior. Among older adults aged 65 years and older, the present study tested whether the relationships between gain- and loss-related SPA and two kinds of physical activity are moderated by perceived residual lifetime. Data were based on 2.367 participants over a 3-year period. Participants with less gain-related SPA were less likely to walk on a regular basis; however, a longer residual lifetime compensated for this negative effect. In addition, participants did sports more often if they not only held less loss-related SPA but also perceived a longer residual lifetime. These results emphasize the importance of perceived residual lifetime in health promotion interventions targeting physical activity in older adults.

[Demographic and Social Transitions - Results of the Working Group 2 of the Forum Future Public Health, Berlin 2016]. / Demografischer und sozialer Wandel.

Demographic and social transformation occur due to changes in the structure of the population and employment especially of women, increasing cultural diversity, unequal educational opportunities for children and adolescents, and regional variation in the provision of services. Meeting the challenges requires flexible, responsive and integrated social and health care systems that allow participation of individuals and groups concerned and recognition of their views and perspectives. Health monitoring and knowledge management is adjusted to the needs of the population and transfers high quality, evidence-based knowledge into all policy areas (health in all policies strategy).

Translating good intentions into physical activity: older adults with low prospective memory ability profit from planning.

Prospective memory (PM) is the ability to remember to perform an intended action in the future and is necessary for regular physical activity (PA). For older adults with declining PM, planning strategies may help them to act upon their intentions. This study investigates PM as a moderator in a mediation process: intention predicting PA via planning. A mediated moderation was estimated with longitudinal data of older adults (M = 70 years). Intentions (T1) predicted PA (T3) via action and coping planning (T2). PM was included as moderator on the planning-PA association. Both planning strategies were significant partial mediators (action planning: b = 0.17, 95 % CI [0.10, 0.29]; coping planning: b = 0.08, 95 % CI [0.02, 0.18]). For individuals with lower PM, the indirect effect via coping planning was stronger than with higher PM (b = 0.06, 95 % CI [0.01, 0.16]). Action planning is important for PA in old age regardless of PM performance, whereas older adults with lower PM benefitted most from coping planning. Intervention studies for older adults should consider training PM and promote planning skills.

District-level primary care supply buffers the negative impact of functional limitations on illness perceptions in older adults with multiple illnesses.

BACKGROUND: Illness perceptions predict important outcomes, e.g. coping, adherence and well-being. Less is known about the sources of illness perceptions, in particular the role of environmental factors such as primary care supply. PURPOSE: This study examines whether and how primary care supply (on district level) affects individual illness perceptions. METHODS: We conducted a longitudinal study in 271 adults 65 years and older with multiple illnesses. Functional limitations (SF-36 physical functioning subscale) at time 1 were tested as predictors of illness perceptions 6 months later. Primary care supply on district level was matched to individual data. RESULTS: In multilevel models, functional limitations predicted illness perceptions. Primary care supply on district level moderated the impact of functional limitations on individual identity and emotional response perceptions, with better supply buffering detrimental effects of functional limitations. CONCLUSIONS: Illness perceptions do not only depend on individual factors, but socio-structural factors also substantially contribute to individual illness perceptions.

Health motives and health behaviour self-regulation in older adults.

Health motives are motivational dispositions towards health. They are implicitly inherent in most health behaviour theories, yet rarely studied. We examined the role of health motives in health behaviour self-regulation (physical activity), particularly in the mediation of intention effects on behaviour via planning in an at-risk population with high need for behaviour change, older adults with multiple illnesses. A longitudinal study with two measurement points over 6 months was conducted, assessing 309 community-dwelling adults with multiple illnesses aged 65 and older. Health motives were assessed by contrasting health ratings with all other domains on the Personal Life Investment Schedule. Data were analysed in a moderated mediation framework using path analyses. Health Motives moderated the degree to which intentions predicted behaviour via planning (intention*health motives ß = .18, p < .05). Intentions are better translated into planning and behaviour if furnished with health motives. For older adults, this suggests that "health" in health behaviour change motivation merits more investigation, for example by stressing functional implications.

The role of social network diversity in self-perceptions of aging in later life.

While the link between self-perceptions of aging (SPA) and healthy aging is well established, less is known about the association between social factors and SPA. The present study investigated whether higher social network diversity is associated with more positive and less negative SPA and whether this association is moderated by age. We examined cross-sectional data from the German Ageing Survey of 2008 (DEAS; N = 6205, 40-85 years, 49.5% female). Network diversity was assessed as the number of social roles in an individual's network (such as spouse, friend and colleague). Three domains of SPA were measured using the Aging-Related Cognitions Scale (AgeCog): ongoing development (positive SPA), social losses (negative SPA) and physical losses (negative SPA). We conducted multiple linear regression models and tested for a moderator effect of age using an interaction term of age and network diversity. Results showed that at higher ages older adults with higher network diversity reported more positive SPA related to ongoing development and more negative SPA related to social losses than those with less diverse networks, indicating that age has a moderating effect. We found no association between network diversity and negative SPA related to physical losses and no indication that age was relevant to this relationship. The present study adds to evidence on the role of social networks in SPA. Our findings suggest that in certain SPA domains and depending on age, network diversity is related to both more positive and more negative SPA, which emphasizes the importance of considering domain-specific SPA.

Postponing old age: Evidence for historical change toward a later perceived onset of old age.

"At what age would you describe someone as old?" Perceptions of when old age begins might be prone to upward shifts because of historical increases in life expectancy and in retirement age, as well as because of better psychosocial functioning in later life. We investigated historical changes in within-person trajectories of the perceived onset of old age using data from 14,056 participants who entered the German Ageing Survey at age 40-85 years and who completed up to eight assessments across 25 years. Using longitudinal multilevel regression models, we found that at age 64, the average perceived onset of old age is at about age 75 years. Longitudinally, this perceived onset age increased by about 1 year for every 4-5 years of actual aging. We also found evidence for historical change. Compared to the earliest-born cohorts, later-born cohorts reported a later perceived onset of old age, yet with decelerating trend among more recent birth cohorts. Within-person increases of the perceived onset of old age were steeper in later-born cohorts. The described cohort trends were only slightly reduced when controlling for covariates. Being younger, male, living in East Germany, feeling older, reporting more loneliness, more chronic diseases, and poorer self-rated health were each associated with a perceived earlier onset of old age. Our results suggest that there is a nonlinear historical trend toward a later perceived onset of old age, which might have meaningful implications for individuals' perspectives on aging and old age. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Successful Aging and Subjective Aging: Toward a Framework to Research a Neglected Connection.

Research related to subjective aging, which describes how individuals perceive, interpret and evaluate their own aging, has substantially grown in the past two decades. Evidence from longitudinal studies shows that subjective aging predicts health, quality of life, and functioning in later life. However, the existing literature on successful aging has mostly neglected the role of subjective aging. This paper proposes an extended framework of successful aging linking subjective aging conceptually and empirically to Rowe and Kahn's (1997) three original key criteria of successful aging (i.e., avoiding disease and disability, maintaining high cognitive and physical function, and engagement with life). A particular focus is placed on subjective aging as an antecedent of successful aging. A review of the empirical subjective aging literature shows that subjective aging concepts consistently predict all three of Rowe and Kahn's criteria of successful aging. Mechanisms underlying these relations are discussed at three levels, namely psychological, behavioral, and physiological pathways. The proposed addition also takes into consideration the interconnections between subjective aging and successful aging throughout the lifespan and across historical time. Finally, we discuss the importance of facilitating successful aging through systematic interventions that support more positive views of aging at the individual and societal level.

Prevalence of living wills among older adults in Germany.

Background: Living wills regulate medical decisions in emergency situations. Those who create a living will can have it registered voluntarily in the Central Register of Lasting Powers of Attorney. Little is known about the general prevalence of living wills. Methods: The German Ageing Survey is an ongoing, population-representative study. 4,185 people aged 50 and older were surveyed about living wills in 2020/2021. Results: 44.8 % of people aged 50 and older have a living will, women more often than men (50.1 % vs. 39.2 %), older people more often than middle-aged people. Educational differences do not exist. Conclusions: Living wills increase the autonomy in medical emergency situations because the patient's wishes are specified in written form. People of all age groups should inform themselves about the significance of living wills and should seek advice about the contents, for example from the general practitioner or one's own health insurance.

Prevalence of loneliness among older adults in Germany.

Background: Loneliness refers to the subjective perception of a mismatch between a person's social needs and their actual personal relationships. In this paper, the prevalence of loneliness in the older population was examined based on current data. Methods: The German Ageing Survey is an ongoing, population-representative study. A total of 4,261 people 50 years of age and older were surveyed in 2020/2021 with regard to their experience of loneliness. Results: Overall, 8.3 % of the population 50 years of age and older feel lonely. The findings showed no differences between different age groups over 50 years of age, nor are there gender or educational differences. Conclusions: There was no evidence that older individuals living in private households experience loneliness more commonly than middle-aged individuals. Data from nursing home residents indicate that there may be a higher risk of loneliness.

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).

Health-specific optimism mediates between objective and perceived physical functioning in older adults.

Particularly in older adults, self-reports of physical health need not necessarily reflect their objective health status as they can be biased by optimism. In this study, we examine whether the effect of objective physical functioning on subjective physical functioning is modified by health-specific optimism and self-efficacy. A longitudinal study with three measurement points over 6 months and 309 older adults (aged 65-85) with multimorbidity was conducted. Subjective physical functioning was regressed on objective physical functioning, health-specific optimism and self-efficacy. Subjective physical functioning was predicted by both objective physical functioning and optimism as a mediator. Moreover, an interaction between optimism and self-efficacy was found: Optimism predicted subjective physical functioning only for individuals with low self-efficacy. Subjective physical functioning is as much based on objective physical functioning as it is on health-specific optimism. Older adults base their subjective physical functioning on objective indicators but also on optimism, when they are less self-efficacious.