The mediating role of health-related behavior in the relationship between wisdom and depressive symptoms in older Polish adults.

OBJECTIVES: Although studies have shown that wisdom is positively related to mental health in older adults, little is known about its possible mechanisms. The current study examines whether health-related behavior can play a mediating role in the relationships between wisdom and geriatric depressive symptoms. METHODS: The study included 334 Polish older adults aged 60-99 years (M = 71.91; SD = 7.01). The respondents completed the Geriatric Depression Scale, Three-Dimensional Wisdom Scale, Health-Related Questionnaire for Seniors, and a sociodemographic survey. RESULTS: Three-dimensional wisdom and its three dimensions correlated negatively with geriatric depressive symptoms but positively with general health-related behavior and its factors. Health-related behavior acted partially as a mediator between wisdom and geriatric depressive symptoms. CONCLUSION: Wiser seniors tend to take part in more health-promoting behavior, which may prevent depressive symptoms. The findings support the important role played by wisdom in mental health-promoting interventions for older adults.

Effects of wisdom and religiosity on subjective well-being in old age and young adulthood: exploring the pathways through mastery and purpose in life.

ABSTRACTObjectives:Prior research found that the positive association between wisdom and subjective well-being might at least partially be explained by a greater sense of mastery and purpose in life. This study tested whether religiosity provides an alternative pathway to well-being and whether the associations are moderated by age cohort and nation of residency. DESIGN AND PARTICIPANTS: A quota sample design was used, stratified by age group, sex, and nation of residency, to collect cross-sectional survey data of 111 older adults (age range 62-99 years, M = 77.20, SD = 8.98) and 100 young adults (age range 21-30 years, M = 24.05, SD = 2.69) from Canada and the United States. MEASUREMENTS: Face-to-face interviews were conducted to administer the survey. All measures consisted of validated scales and items. RESULTS: Multi-group path analysis confirmed that mastery and purpose in life partially mediated the association between wisdom and well-being. Religiosity offered an alternative pathway to well-being, also partially through a greater sense of mastery and purpose in life. Wisdom was statistically more strongly related to mastery among older adults, whereas the association between mastery and purpose in life was statistically stronger among young adults. The mediated pathways from wisdom and religiosity to well-being did not differ by nation of residency. CONCLUSIONS: These results highlight the importance of internal strengths for subjective well-being among both young and older adults and add confidence to the generalizability of the mediated path model for North America.

The impact of spiritual care delivered by nurses on patients' comfort: A propensity score matched cohort utilizing electronic health record data.

BACKGROUND: Spiritual care has been associated with better health outcomes. Despite increasing evidence of the benefits of spiritual care for older patients coping with illness and aggressive treatment, the role of spirituality is not well understood and implemented. Nurses, as frontline holistic healthcare providers, are in a position to address patients' spiritual needs and support them in finding meaning in life. This study aimed to identify spiritual care by analyzing nursing data and to compare the psychological and physical comfort between older chronically ill patients who received spiritual care versus those who did not receive spiritual care. MATERIAL AND METHODS: A propensity score matched cohort utilizing nursing care plan data was used to construct balanced groups based on patient characteristics at admission. 45 older patients (≥65 years) with chronic illnesses received spiritual care with measured psychological or physical comfort and 90 matched controls. To ensure the robustness of our results, two sensitivity analyses were performed. Group comparisons were performed to assess the average treatment effect of spiritual care on psychological and physical comfort outcomes. RESULTS: The mean psychological comfort was 4.3 (SD = 0.5) for spiritual care receivers and 3.9 (SD = 0.9) for non-receivers. Regression analysis showed that spiritual care was associated with better psychological comfort (estimate = 0.479, std. error = 0.225, p = 0.041). While its effect on physical comfort was not statistically significant (estimate = -0.265, std. error = 0.234, p = 0.261). This study provides suggestive evidence of the positive impact of nurses' spiritual care in improving psychological comfort for older patients with chronic illnesses. CONCLUSION: Using interoperable nursing data, our findings suggest that spiritual care improves psychological comfort in older patients facing illness. This finding suggests that nurses may integrate spiritual care into their usual care to support patients experiencing distress.

The measurement of wisdom: a commentary on Taylor, Bates, and Webster's comparison of the SAWS and 3D-WS.

In a commentary on Taylor, Bates, and Webster's article (2011, Experimental Aging Research, 37, pp. 129-140), the author (a) clarifies the development and assessment of the Three-Dimensional Wisdom Scale (3D-WS); (b) describes the difference between the essential components of wisdom and its predictors, correlates, and consequences; and (c) conducts additional bivariate correlation analyses between the components of the 3D-WS and Webster's Self-Administered Wisdom Scale (SAWS) and all the forgiveness and psychological well-being subscales. Results show that the cognitive, reflective, and affective dimensions of the 3D-WS were significantly and positively correlated with all the forgiveness and psychological well-being subscales. By contrast, only the emotional regulation and humor components of the SAWS were consistently positively associated with those subscales. It appears that the 3D-WS measures the essential cognitive, reflective, and affective components of wisdom, whereas the SAWS contains a reflective wisdom component, a wisdom predictor, a consequence of wisdom, and two necessary but not sufficient wisdom components.

The natural history of male mental health: health and religious involvement.

In prior studies, the effect of religious involvement upon physical health has shown generally positive results, but these studies have been marred by confounders. The 65-year-old US prospective Study of Adult Development has offered an opportunity to repeat these studies with somewhat better control over confounders. The physical and mental health of 224 Harvard University sophomores was monitored for 65 years. Their religious involvement from church attendance to private spirituality was prospectively monitored every 2-4 years from age 47 to 85. In this analysis we focus on the male respondent. We found that religious involvement, no matter how measured was uncorrelated with their late life physical, mental and social well-being. The exception was that the 44 men with major depression or with multiple negative life events were twice as likely to manifest high religious involvement as men with the least "stress." If these findings can be generalized, they suggest that religious involvement may exert the greatest mental health benefits on people with the fewest alternative social and personal resources.

Wisdom and Hard Times: The Ameliorating Effect of Wisdom on the Negative Association Between Adverse Life Events and Well-Being.

Objectives: Old age is characterized by many physical and social losses that adversely affect subjective well-being (SWB). Yet, past studies have shown that wisdom tends to be positively related to SWB in old age, particularly under adverse circumstances. We tested whether three-dimensional wisdom, measured as a combination of cognitive, reflective, and compassionate (affective) personality qualities, moderated the inverse association between adverse life events and well-being. Method: A sample of 994 adults aged 51-99 years (M = 77) from the Successful AGing Evaluation (SAGE) study and structural equation models with well-being as a latent variable were used to test the hypothesis. Results: Greater wisdom, in particular the reflective wisdom dimension, was positively associated with SWB and buffered the inverse relation between the experience of adverse life events during the previous year and current well-being. Discussion: Wisdom appears to strengthen older adults' ability to cope with aging-related losses and, therefore, is a valuable psychological resource in old age.

Early and Midlife Predictors of Wisdom and Subjective Well-Being in Old Age.

Objectives: We explored whether wisdom and well-being in old age are the result of early personality traits related to personality growth or personality adjustment, respectively, or successful human development as outlined by Erikson's stage theory and the life course paradigm. Method: Structural equation models were applied to analyze 60-year longitudinal data of 98 white male Harvard graduates born between 1915 and 1924. Different sets of judges rated the men's childhood and adolescence, early adult personality, and midlife generativity. Items measuring wisdom and well-being in old age were self-assessed. Results: Although wisdom and subjective well-being at age 80 were positively correlated, early life predictors differed. Openness to experiences in early adulthood predicted wisdom 60 years later, whereas greater emotional stability and extraversion predicted subjective well-being. Additionally, old age wisdom could be traced back to psychosocial growth throughout life, facilitated by a supportive childhood, adolescent competence, emotional stability in early adulthood, and generativity at midlife. Discussion: Personality traits indicative of personality adjustment or growth differentially predict late-life well-being and wisdom. Yet a balance between personality adjustment and growth, aided by social support and competence during the formative years, might be required to promote wisdom development throughout life.

The Relation Between Age and Three-Dimensional Wisdom: Variations by Wisdom Dimensions and Education.

Objectives: Curvilinear relations between age and wisdom have been found in prior research with its peak either in young adulthood or in midlife. This study tested whether the association between age and three-dimensional wisdom differed for the cognitive, reflective, and compassionate (affective) wisdom dimensions and whether the results varied by education. Method: OLS regression was used to analyze an online sample of 14,248 adults between the ages of 18 and 98 years (mean [M] = 36.46, standard deviation [SD] = 12.68) from four educational groups. Results: The relation between age and three-dimensional wisdom was curvilinear and varied in shape by wisdom dimensions and education. The association between age and wisdom followed an inverse U-curve with the peak at midlife and almost opposing shapes for the cognitive and compassionate dimensions and an intermediate shape for the reflective dimension. Education was positively related to wisdom and affected the shape of the relationships. Discussion: Because the association between age and wisdom appears to be curvilinear and varies by education, studies that test a linear association without separating the sample by education might arrive at the wrong conclusions. In general, education seems to promote the attainment of wisdom and also inoculate individuals against a decline in wisdom later in life.

Development of a 12-Item Abbreviated Three-Dimensional Wisdom Scale (3D-WS-12): Item Selection and Psychometric Properties.

Wisdom has been reported to be associated with better mental health and quality of life among older adults. Over the past decades, there has been considerable growth in empirical research on wisdom, including the development of standardized measures. The 39-item Three-Dimensional Wisdom Scale (3D-WS) is a useful assessment tool, given its rigorous development and good psychometric properties. However, the measure's length can prohibit use. In this article, we used a sample of 1,546 community-dwelling adults aged 21 to 100 years (M = 66 years) from the Successful AGing Evaluation (SAGE) study to develop an abbreviated 12-item version of the 3D-WS: the 3D-WS-12. Balancing concerns for measurement precision, internal structure, and content validity, factor analytic methods and expert judgment were used to identify a subset of 12-items for the 3D-WS-12. Results suggest that the 3D-WS-12 can provide efficient and valid assessments of Wisdom within the context of epidemiological surveys.

Wisdom at the End of Life: An Analysis of Mediating and Moderating Relations Between Wisdom and Subjective Well-Being.

OBJECTIVES: Several studies have shown that wisdom, measured as an integration of cognitive, reflective, and compassionate dimensions, is positively related to subjective well-being in old age. This study investigated whether wisdom might be particularly beneficial for people at the end of life, when extrinsic means to increase well-being largely disappear, and whether the association between wisdom and well-being is mediated by mastery and purpose in life. METHODS: Samples of 156 older community residents (M = 71 years) and 41 older hospice patients and nursing home residents (M = 77 years) were analyzed, using a moderated and mediated path model. RESULTS: (a) Wisdom was positively related to subjective well-being in the later years, even after controlling for physical health, socioeconomic status, financial situation, social involvement, age, gender, race, and marital status. (b) The association between wisdom and well-being was significantly stronger in the nursing home and hospice sample than the community sample. (c) The relation between wisdom and well-being was partially mediated by purpose in life, both directly and via a sense of mastery. CONCLUSION: Aging well at the end of life might depend to a larger extent on psychosocial growth across the life course than on present circumstances.

The Many Faces of Wisdom: An Investigation of Cultural-Historical Wisdom Exemplars Reveals Practical, Philosophical, and Benevolent Prototypes.

Psychological research on wisdom has flourished in the last 30 years, much of it investigating laypeople's implicit theories of wisdom. In three studies, we took an exemplar and prototype approach to implicit wisdom theories by asking participants to nominate one or more cultural-historical figures of wisdom. Study 1 revealed that individuals draw from a wide range of wisdom exemplars, with substantial agreement on the most iconic figures. In Study 2, multidimensional scaling analysis of exemplars revealed practical, philosophical, and benevolent prototypes; follow-up analyses indicated that prototypes differed in familiarity, likability, and perceived wisdom. Study 3 showed that individuals nominated exemplars from the practical prototype more frequently than from the philosophical and benevolent prototypes and that prototype nomination depended in part on nominator characteristics. These studies suggest that exemplar- and prototype-based implicit wisdom theories are consistent with explicit psychological theories of wisdom.

Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain.

Chronic pain remains a daunting clinical challenge, affecting 30% of people in the United States and 20% of the global population. People meeting this challenge by achieving wellbeing while living with pain are a virtually untapped source of wisdom about this persistent problem. Employing a concurrent mixed-methods design, we studied 80 people living with chronic pain with "positive stories to tell" using semi-structured interviews and standardized questionnaires. In-depth interviews focused on what helped, what hindered, how they changed, and advice for others in similar circumstances. Major qualitative themes included acceptance, openness, self-efficacy, hope, perseverance, self-regulation, kinesthetic awareness, holistic approaches and integrative therapies, self-care, spirituality, social support, and therapeutic lifestyle behaviors such as music, writing, art, gardening, and spending time in nature. Themes of growth and wisdom included enhanced relationships, perspective, clarity, strength, gratitude, compassion, new directions, and spiritual change. Based on narrative analysis of the interviews and Ardelt's Three-Dimensional Wisdom Model, participants were divided into 2 groups: 59 wisdom exemplars and 21 nonexemplars. Non-exemplar themes were largely negative and in direct contrast to the exemplar themes. Quantitatively, wisdom exemplars scored significantly higher in Openness and Agreeableness and lower in Neuroticism compared to non-exemplars. Wisdom exemplars also scored higher in Wisdom, Gratitude, Forgiveness, and Posttraumatic Growth than nonexemplars, and more exemplars used integrative therapies compared to the non-exemplars. As a whole, the exemplar narratives illustrate a Positive Approach Model (PAM) for living well with pain, which allows for a more expansive pain narrative, provides positive role models for patients and clinicians, and contributes to a broader theoretical perspective on persistent pain.

El dolor crónico sigue siendo un desafío clínico abrumador, que afecta al 30 % de las personas de los Estados Unidos y al 20 % de la población mundial. Las personas que se enfrentan a este reto logrando bienestar mientras conviven con el dolor son una fuente prácticamente sin explotar de sabiduría sobre este persistente problema. Empleando un diseño concurrente de métodos mixtos, hemos estudiado a 80 personas que viven con dolor crónico con "historias positivas que contar" usando entrevistas semiestructuradas y cuestionarios estándar. Las entrevistas en profundidad se centraron en qué les ayudó, qué les ocasionó dificultades, cómo han cambiado y en consejo para otras personas en circunstancias similares. Los principales temas cualitativos incluían la aceptación, la apertura, la confianza en sus capacidades, la esperanza, la perseverancia, la autorregulación, la conciencia propioceptiva, los enfoques psicosomáticos y los tratamientos integrales, el cuidado propio, la espiritualidad, el apoyo social y los comportamientos del estilo de vida terapéutico como la música, la escritura, el arte, la jardinería y pasar tiempo en la naturaleza. Los temas de crecimiento y sabiduría incluían relaciones más estrechas, perspectiva, claridad, fuerza, gratitud, compasión, nuevos rumbos y cambio espiritual. Basándonos en el análisis de los informes de las entrevistas y en el paradigma de sabiduría de tres dimensiones de Ardelt, se dividieron a los participantes en 2 grupos: 59 modelos de sabiduría y 21 no modelos de sabiduría. Los temas no modelo eran mucho más negativos y estaban en directo contraste con los temas modelo. Cuantitativamente, los modelos de sabiduría obtuvieron una puntuación significativamente más alta en apertura y amabilidad y más baja en neuroticismo en comparación con los no modelo. Los modelos de sabiduría también puntuaron más alto en sabiduría, gratitud, perdón y crecimiento postraumático que los no modelos y más modelos usaron tratamientos integrales en comparación con los no modelos. En conjunto, los informes de los modelos ilustran un modelo de enfoque positivo para vivir bien con el dolor, que permite informes de dolor más comunicativos, proporciona modelos de rol positivos para los pacientes y médicos y contribuye a una perspectiva teorética más amplia acerca del dolor persistente.

Wisdom in Medicine: What Helps Physicians After a Medical Error?

PURPOSE: Confronting medical error openly is critical to organizational learning, but less is known about what helps individual clinicians learn and adapt positively after making a harmful mistake. Understanding what factors help doctors gain wisdom can inform educational and peer support programs, and may facilitate the development of specific tools to assist doctors after harmful errors occur. METHOD: Using "posttraumatic growth" as a model, the authors conducted semistructured interviews (2009-2011) with 61 physicians who had made a serious medical error. Interviews were recorded, professionally transcribed, and coded by two study team members (kappa 0.8) using principles of grounded theory and NVivo software. Coders also scored interviewees as wisdom exemplars or nonexemplars based on Ardelt's three-dimensional wisdom model. RESULTS: Of the 61 physicians interviewed, 33 (54%) were male, and on average, eight years had elapsed since the error. Wisdom exemplars were more likely to report disclosing the error to the patient/family (69%) than nonexemplars (38%); P < .03. Fewer than 10% of all participants reported receiving disclosure training. Investigators identified eight themes reflecting what helped physician wisdom exemplars cope positively: talking about it, disclosure and apology, forgiveness, a moral context, dealing with imperfection, learning/becoming an expert, preventing recurrences/improving teamwork, and helping others/teaching. CONCLUSIONS: The path forged by doctors who coped well with medical error highlights specific ways to help clinicians move through this difficult experience so that they avoid devastating professional outcomes and have the best chance of not just recovery but positive growth.

Gender as a Moderator of the Relation Between Age Cohort and Three-Dimensional Wisdom in Iranian Culture.

This study examined whether gender moderated the association between age cohort and the cognitive, reflective, and compassionate dimensions of wisdom, using an Iranian sample of 439 adults from three age cohorts: young (18-34), middle-aged (35-54), and older (55 and above). Results indicated that the interaction effect between gender and age cohort was significant for three-dimensional wisdom and all three wisdom dimensions. Compared with younger women and older men, older women tended to have less education and to score lower on the cognitive wisdom dimension, but they had similar average scores as older men on the compassionate wisdom dimension. Overall, the association between age and wisdom was only positive for men, due mainly to the positive relation between age and the reflective and compassionate wisdom dimensions for men after adjusting for education. The results are interpreted with reference to generation gaps, socialization of men versus women, and life experiences and opportunities.

Childhood adversity, midlife generativity, and later life well-being.

OBJECTIVES: Prior studies confirm that after experiencing childhood adversity, resilient adults can recover and engage in generative growth. This study explored the long-term effects of childhood adversity (assessed as harsh parenting and/or childhood poverty) on successful aging for individuals who either achieved or failed to achieve Erikson's psychosocial developmental stage of generativity in midlife. METHOD: The study utilized a sample of 636 men from the Harvard Sample and Inner City Cohort of the 73-year longitudinal Study of Adult Development. Nested ordinary least squares regression models were used to test the mediating and moderating effects of midlife generativity on later life health and adjustment to aging. RESULTS: Men who experienced childhood adversity were less likely than men with no childhood adversity to achieve generativity in midlife. Although achievement of generativity was associated with better later life health and adjustment to aging, it neither mediated nor moderated the negative relation between childhood poverty and later life health outcomes. However, for men who experienced an adversarial childhood, achievement of generativity mediated and moderated adjustment to aging. DISCUSSION: Results suggest that psychosocial growth in adulthood can compensate for the long-term negative effects of an adversarial childhood on adjustment to aging, but not for later life health.

Expert consensus on characteristics of wisdom: a Delphi method study.

PURPOSE: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. DESIGN AND METHODS: A survey questionnaire comprised 53 Likert scale statements related to the concepts of wisdom, intelligence, and spirituality was developed to determine if and how wisdom was viewed as being distinct from the latter 2 concepts. Of the 57 international wisdom experts contacted by e-mail, 30 completed the Phase 1 survey and 27 also completed the Phase 2 survey. RESULTS: In Phase 1, there were significant group differences among the concepts of wisdom, intelligence, and spirituality on 49 of the 53 items rated by the experts. Wisdom differed from intelligence on 46 of these 49 items, whereas wisdom differed from spirituality on 31 items. In Phase 2, we sought to define wisdom further by selecting 12 items based on Phase 1 results. Most experts agreed on many of the suggested characteristics of wisdom-that is, it is uniquely human; a form of advanced cognitive and emotional development that is experience driven; and a personal quality, albeit a rare one, which can be learned, increases with age, can be measured, and is not likely to be enhanced by taking medication. IMPLICATIONS: There was considerable agreement among the expert participants on wisdom being a distinct entity and a number of its characteristic qualities. These data should help in designing additional empirical research on wisdom.