Autonomy and loneliness - longitudinal within- and between-person associations among Swedish older adults.

OBJECTIVES: Loneliness is an important risk factor for mental and physical health over the life span. Little is known about psychosocial predictors and consequences of loneliness apart from social network characteristics. One important factor that may both prevent from, but also be affected by loneliness, is perceived autonomy. METHOD: In the present study, we investigated the longitudinal association of loneliness and autonomy over four years among participants of the Swedish Health, Aging and Retirement Transitions in Sweden (HEARTS) study (n = 5718, age 60-66 at baseline). We used a latent curve model with structured residuals, which distinguishes within- and between-person associations and includes cross-lagged parameters. RESULTS: Higher levels of autonomy at baseline were associated with lower levels of loneliness, and increases in autonomy were associated with decreases in loneliness. When individuals felt more autonomous than usual, they also reported less loneliness. However, the cross-lagged paths were not significant, which means that autonomy did not predict loneliness over time on the within-person level, and loneliness did not predict autonomy over time. CONCLUSION: Our findings show that higher autonomy was related to lower loneliness on different analytical levels, but the direction of effects is unclear. More research is needed to understand the development of this association over the life span.

Gender differences in resources related to depressive symptoms during the early years of retirement: A Swedish population-based study.

OBJECTIVES: To examine levels of depressive symptoms during the early years of retirement in men and women and to investigate potential gender differences in associations with self-reported health, financial insecurity, social network and psychological resources. METHODS: Data was drawn from the first wave in the Health, Aging and Retirement Transitions in Sweden-study (HEARTS) including a total sample of 1148 retirees, aged 60 to 66. Level of depressive symptoms and associations with health, financial insecurity, social network and psychological resources were investigated in regression analyses in the total sample and in bivariate correlation analyses in the subgroup at risk of depression as defined by a cut-off ≥9 on the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Mean CES-D scores were similar in men and women in the entire sample. The CES-D identified 144 individuals at risk of depression (men 14%, women 11%, n.s.). Although the pattern of related resources was similar in men and women, a greater proportion of the variance was explained in the male group (51% vs 37%). Health, quality of social network, social support and competence satisfaction were all correlated with depressive symptoms in men in the high risk group, but no associations were seen in women. CONCLUSIONS: Similar levels of depressive symptoms were observed in women and men in the retirement transition. However, the relevance of the selected resources may be greater in men. Research on the management of depressive symptoms in the transition between midlife and aging needs to take gender into consideration.

The role of personality in retirement adjustment: Longitudinal evidence for the effects on life satisfaction.

OBJECTIVE: Research on retirement suggests that personality can influence the adjustment process, but the mechanisms involved remain still largely unknown. In the present study, we investigate direct and indirect associations between the Big Five personality traits and life satisfaction over the retirement transition. Indirect effects were evaluated through the role of personality for levels and changes in self-esteem, autonomy, social support, self-rated physical health, self-rated cognitive ability, and financial satisfaction. METHOD: Our sample consisted of 796 older adults (age 60-66) and four annual measurement waves from the longitudinal population-based HEalth, Ageing, and Retirement Transitions in Sweden (HEARTS) study, including individuals retiring during the study period. RESULTS: Results from multivariate latent growth curve analysis revealed multiple indirect associations between personality and life satisfaction. Extraversion, Agreeableness, and Conscientiousness were positively related to life satisfaction through higher levels of self-esteem, autonomy, and social support. Neuroticism was negatively associated with life satisfaction through lower levels of self-esteem and lower levels and negative changes in autonomy and social support. CONCLUSIONS: Our findings suggest that retirees with higher levels of Neuroticism are more vulnerable in the transition process and they are also more likely to experience adjustment problems resulting from negative changes in key resources.

Beyond health and economy: resource interactions in retirement adjustment.

Objectives: The retirement transition is a multidimensional and dynamic process of adjustment to new life circumstances. Research has shown that individual differences in resource capability accounts for a substantial amount of the previously observed heterogeneity in retirement adjustment. The aim of the present study was to investigate interaction effects of self-esteem, autonomy, social support, self-rated physical health, self-rated cognitive ability, and basic financial resources on levels and changes in life satisfaction in the retirement transition. Method: Our sample included 1924 older adults from the longitudinal population-based HEalth, Ageing, and Retirement Transitions in Sweden (HEARTS) study. The participants were assessed annually over a three-year period, covering the transition from work to retirement (n = 614). Participants continuously working (n = 1310) were included as a reference group. Results: Results from latent growth curve models showed that the relationship between a particular resource and levels and changes in life satisfaction varied depending on other available resources, but also that these effects varied between retirees and workers. Autonomy moderated the effect of physical resources, and social support and perceived cognitive ability moderated the effect of financial resources. Discussion: Our findings add to the current knowledge on retirement adjustment and suggest that negative effects of poor health and lack of basic financial resources on retirees life satisfaction may be compensated for by higher levels of autonomy, social support, and perceived cognitive ability.

High Prevalence of Stress and Low Prevalence of Alzheimer Disease CSF Biomarkers in a Clinical Sample with Subjective Cognitive Impairment.

BACKGROUND/AIMS: Subjective cognitive impairment (SCI) is a trigger for seeking health care in a possible preclinical phase of Alzheimer's disease (AD), although the characteristics of SCI need clarification. We investigated the prevalence of psychosocial stress, depressive symptoms and CSF AD biomarkers in SCI and MCI (mild cognitive impairment). METHODS: Memory clinic patients (SCI: n = 90; age: 59.8 ± 7.6 years; MCI: n = 160; age: 63.7 ± 7.0 years) included in the Gothenburg MCI study were examined at baseline. Variables were analyzed using logistic regression with SCI as dependent variable. RESULTS: Stress was more prevalent in SCI (51.1%) than MCI (23.1%); p < 0.0005. SCI patients had more previous depressive symptoms (p = 0.006), but showed no difference compared to MCI patients considering current depressive symptoms. A positive CSF AD profile was present in 14.4% of SCI patients and 35.0% of MCI patients (p = 0.001). Stress (p = 0.002), previous stress/depressive symptoms (p = 0.006) and a negative CSF AD profile (p = 0.036) predicted allocation to the SCI group. CONCLUSION: Psychosocial stress is more prevalent in SCI than previously acknowledged. The high prevalence and long-term occurrence of stress/depressive symptoms in SCI in combination with a low prevalence of altered CSF AD biomarkers strengthens the notion that AD is not the most likely etiology of SCI.

Reasons for attempted suicide in later life.

OBJECTIVE: Using the Interpersonal Theory of Suicide as a guiding framework, we investigated older adults' causal attributions for suicidal behavior. We hypothesized that older adults who attributed their suicidal behavior to thwarted belongingness or perceived burdensomeness would be more likely to use more immediately lethal means and to re-attempt suicide during the 12-month follow-up. DESIGN: Prospective cohort study in western Sweden. PARTICIPANTS: A total of 101 older adults who presented to medical emergency rooms for suicide attempts. MEASUREMENTS: Participants were asked why they attempted suicide. RESULTS: Attributions included: a desire to escape (N = 29), reduced functioning and autonomy (N = 24), psychological problems, including depression (N = 24), somatic problems and physical pain (N = 16), perceived burdensomeness (N = 13), social problems that reflected either thwarted belongingness or family conflict (N = 13), and lack of meaning in life (N = 8); 41 participants provided more than one reason. No specific reason was given by 28 participants, 15 of whom reported not understanding or remembering why they attempted suicide and 13 reported simply wanting to die (or go to sleep and not wake up). As hypothesized, patients who attributed the attempt to thwarted belongingness were more likely to use more immediately lethal means for their index attempt and were more likely to re-attempt during follow-up. This was not the case for those reporting burdensomeness. CONCLUSION: People who attribute suicide attempts to thwarted belongingness use more lethal methods and have a poorer prognosis. Replications across diverse cultural settings are needed to determine whether attributing suicide attempts to thwarted belongingness may warrant increased monitoring.

Living with stable MCI: experiences among 17 individuals evaluated at a memory clinic.

OBJECTIVES: Mild cognitive impairment (MCI) is a state of mildly impaired cognitive functioning but with an intact capability of performing basic daily activities. Few studies have targeted personal narratives from persons living with MCI, the major focus in this study is directed to methods for better predictions of the likelihood for conversion to dementia. This study directly explores experiences among individuals who have lived with MCI over seven years without converting to dementia. METHODS: Seventeen individuals, who had been diagnosed with MCI across four occasions over a seven-year period at a memory clinic, were interviewed at a single occasion about their experiences of living with MCI, life events, stress, coping, psychosocial resources, and lifestyle behaviors. RESULTS: Thematic analysis of the transcripts of the interviews resulted in themes revolving around the life situation and events related to the first visit at the memory clinic, coping with lower cognitive capacity with the aim of enhancing quality of life, and worries about dementia and further cognitive deteriorations. CONCLUSION: The participants' experiences of living with MCI indicate that issues and changes in life situations such as long-term stress, retirement, loss of relatives, perceived heritability of dementia, needs to be understood in the context of the individual's understanding and interpretation of their everyday cognitive functioning. Also, supportive long-term contacts with the specialist care unit were vital for creating a personal understanding of MCI. Addressing the intra-personal dynamics of cognitive functioning in the boundary between normal and pathological cognitive aging can also improve diagnostic accuracy.

Retirement and Sexual Satisfaction.

BACKGROUND AND OBJECTIVES: Although interest in sexuality in older age has increased over the last decades, few studies have focused on longitudinal change in sexual satisfaction around retirement age. In the present study, we studied change in sexual satisfaction across retirement in a sample of Swedish older adults with a partner. RESEARCH DESIGN AND METHODS: Our analyses were based on n = 759 participants (359 male, 400 female) from the longitudinal Health, Aging, and Retirement Transitions in Sweden study. For this study, we used 5 waves spanning over a period of 4 years. RESULTS: On average, sexual satisfaction did not change significantly before retirement, but decreased after retirement. Interestingly, women showed higher sexual satisfaction than men, as well as a more positive development of both pre- and postretirement sexual satisfaction. Individuals with higher relationship satisfaction had a higher sexual satisfaction until retirement, but their sexual satisfaction also decreased faster after retirement, whereas those with lower relationship satisfaction showed a stable but lower sexual satisfaction. DISCUSSION AND IMPLICATIONS: Sexual satisfaction can change in the retirement transition in several important ways and further studies on the impact of retirement and other late-life stage transitions are warranted.

Do neuroticism and conscientiousness interact with health conditions in predicting 4-year changes in self-rated health among Swedish older adults?

Health conditions such as higher disease burden, pain, or lower functional health are associated with poorer self-rated health (SRH) in older age. Poorer SRH, in turn, is a predictor of morbidity and mortality. Personality traits are associated with SRH as well, but little is known about the interaction of personality and health conditions. In the present preregistered analyses, we used five annual waves of the Health, Aging and Retirement Transitions in Sweden (HEARTS) study (N = 5,823, M age = 63.09, SD = 2.01) to investigate the associations of personality (neuroticism and conscientiousness) and physical health indices (disease burden, pain, and functional limitations) with levels and change in SRH. In addition, we tested Personality × Health interaction effects. We found that higher neuroticism and lower conscientiousness were related to lower levels of SRH, but not to change in SRH after controlling for the health indices. Personality did not moderate the effect of health indices on levels and change in SRH. Exploratory analyses showed that high scores of neuroticism may augment the association of increased pain and functional limitations with declines in SRH. Additional studies with other samples are needed to test if this result can be replicated. Taken together, our findings provide only weak evidence for interaction effects of personality and physical health factors on SRH. More research is needed to understand the interplay of physical and psychological factors in shaping individual SRH. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Increases in Neuroticism May Be an Early Indicator of Dementia: A Coordinated Analysis.

OBJECTIVES: Although personality change is typically considered a symptom of dementia, some studies suggest that personality change may be an early indication of dementia. One prospective study found increases in neuroticism preceding dementia diagnosis (Yoneda, T., Rush, J., Berg, A. I., Johansson, B., & Piccinin, A. M. (2017). Trajectories of personality traits preceding dementia diagnosis. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 72, 922-931. doi:10.1093/geronb/gbw006). This study extends this research by examining trajectories of personality traits in additional longitudinal studies of aging. METHODS: Three independent series of latent growth curve models were fitted to data from the Longitudinal Aging Study Amsterdam and Einstein Aging Study to estimate trajectories of personality traits in individuals with incident dementia diagnosis (total N = 210), in individuals with incident Mild Cognitive Impairment (N = 135), and in individuals who did not receive a diagnosis during follow-up periods (total N = 1740). RESULTS: Controlling for sex, age, education, depressive symptoms, and the interaction between age and education, growth curve analyses consistently revealed significant linear increases in neuroticism preceding dementia diagnosis in both datasets and in individuals with mild cognitive impairment. Analyses examining individuals without a diagnosis revealed nonsignificant change in neuroticism overtime. DISCUSSION: Replication of our previous work in 2 additional datasets provides compelling evidence that increases in neuroticism may be early indication of dementia, which can facilitate development of screening assessments.

What matters, and what matters most, for change in life satisfaction in the oldest-old? A study over 6 years among individuals 80+.

OBJECTIVES: The study investigates whether markers of life satisfaction identified in a cross-sectional study-quality of social network, self-rated health, depressive symptoms, locus of control and widowhood, in addition to financial satisfaction and the personality traits of extraversion and neuroticism-predict change in life satisfaction (LSI-Z) across four measurement occasions during a 6-year period in individuals aged 80+. METHOD: Data were drawn from the Swedish OCTO-Twin-study of individuals aged 80 and older. RESULTS: Growth curve analysis showed a relatively consistent significant linear decline in life satisfaction, but certain markers predicted change in life satisfaction. The loss of spouse, in particular in men, and higher levels of depressive symptoms were related to lower levels of life satisfaction over time. CONCLUSION: The results from the study question the notion of a life-long stability of life satisfaction.

Trajectories of Personality Traits Preceding Dementia Diagnosis.

BACKGROUND: Several retrospective studies using informant report have shown that individuals with dementia demonstrate considerable personality change. Two prospective studies, also using informant report, have shown that individuals who develop dementia show some personality changes prior to diagnosis. The current study is the first to assess personality trait change prior to dementia diagnosis using self-report measures from longitudinal data. METHOD: This study used data from the Swedish OCTO-Twin Study, a longitudinal panel of 702 twins aged 80 and older. Analysis was restricted to 86 individuals who completed the Eysenck Personality Inventory and received a dementia diagnosis during follow-up occasions. Latent growth curve analyses were used to examine trajectories of extraversion and neuroticism preceding dementia diagnosis. RESULTS: Controlling for sex, age, education, depressive symptoms, and the interaction between age and education, growth curve analyses revealed a linear increase in neuroticism and stability in extraversion. Individuals who were eventually diagnosed with dementia showed a significant increase in neuroticism preceding diagnosis of dementia. DISCUSSION: Personality change, specifically an increase in neuroticism, may be an early indicator of dementia. Identification of early indicators of dementia may facilitate development of screening assessments and aid in early care strategies and planning.

Psychological Health in the Retirement Transition: Rationale and First Findings in the HEalth, Ageing and Retirement Transitions in Sweden (HEARTS) Study.

From an aging research and life-course perspective, the transition to retirement marks a significant life-event and provides a unique opportunity to study psychological health and coping during a period of substantial change in everyday life. The aim of the present paper is to: (a) outline the rationale of the HEalth, Ageing and Retirement Transitions in Sweden (HEARTS) study, (b) describe the study sample, and (c) to present some initial results from the two first waves regarding the association between retirement status and psychological health. The HEARTS study is designed to annually study psychological health in the years before and following retirement, and to examine change and stability patterns related to the retirement event. Among a representative Swedish population-based sample of 14,990 individuals aged 60-66 years, 5,913 completed the baseline questionnaire in 2015. The majority of the participants (69%) completed a web-based survey, and the rest (31%) completed a paper version. The baseline HEARTS sample represents the general population well in terms of gender and age, but is more highly educated. Cross-sectional findings from the first wave showed that retired individuals demonstrated better psychological health compared to those who were still working. Longitudinal results from the first and second waves showed that individuals who retired between waves showed more positive changes in psychological health compared with those still working or previously retired.

Differential Impact of Neurofilament Light Subunit on Cognition and Functional Outcome in Memory Clinic Patients with and without Vascular Burden.

The neurofilament light (NF-L) subunit is mainly expressed in large-caliber myelinated axons, and elevated concentrations in the cerebrospinal fluid (CSF) are correlated with damage to white matter and subcortical regions. Because the correlation between NF-L and cognition and functional impairment is largely unknown, we investigated associations in patients (n = 622) with (n = 199) and without (n = 423) vascular burden in subjective cognitive impairment (SCI, n = 168), mild cognitive impairment (MCI, n = 261), and dementia (n = 193). Patients were staged according to disease severity and the presence/absence of cerebrovascular disease. CSF amyloid-ß(1-42) (Aß(1-42)) was included in all models due to its concomitant influence on vascular and primary etiology. Linear regression was used to assess associations between NF-L and Aß(1-42) and five cognitive domains of a comprehensive neuropsychological battery as well as with functional impairment using the Clinical Dementia Rating. Changes in these outcomes at the 2-year follow-up were also evaluated. In SCI and MCI patients with vascular burden, higher NF-L concentrations were associated with baseline cognitive performance (ß = -0.38 to -0.58) and executive decline (ß = -0.44). Lower Aß(1-42) levels were associated with worse cognitive performance in dementia (ß = 0.46 to 0.51). In MCI and dementia patients without vascular burden, higher NF-L (ß = -0.30 to -0.34) and lower Aß(1-42) concentrations (ß = 0.30) were associated with reduced cognitive performance. Higher NF-L concentrations (ß = -0.26) were associated with functional decline in patients with vascular burden. CSF NF-L is associated with cognition in patients with and without vascular etiology. These associations were greater in pre-dementia phases in those with vascular etiology and vice versa in those without vascular burden.

Personality Change in the Oldest-Old: Is It a Matter of Compromised Health and Functioning?

The present longitudinal study investigates continuity and change in the personality dimensions of extraversion and neuroticism among the oldest-old. Overall disease load, self-rated health, functional capacity, impaired vision and hearing, self-reported cognitive impairment, and measured cognitive status were tested for their role as potentially relevant late-life predictors of personality change. The sample consists of 408 individuals aged 80-98 in the Swedish OCTO-Twin Study who completed the Eysenck Personality Inventory at four measurement occasions during a 6-year period. Growth curve analyses revealed an age-related linear decrease in extraversion and stability in neuroticism. More extraverted individuals were more educated and perceived their health and cognition as better. Notably, only hearing impairment was found to be related to a steeper age-related decline in extraversion. A life span developmental model focusing on health-related changes can improve our understanding of personality change in late life.

Cerebrospinal fluid biomarkers mirror rate of cognitive decline.

The ability to predict future decline in cognitive systems using the cerebrospinal fluid (CSF) biomarkers 42 amino acid form of amyloid-ß (Aß42) and total tau (T-tau) is not fully understood. In a clinical sample ranging from cognitively healthy to dementia (n = 326), linear regression models were performed in order to investigate the ability of CSF biomarkers to predict cognitive decline in all cognitive domains from baseline to 2-year follow-up. Gender, age, and years of education were included as covariates. In patients with subjective cognitive impairment, T-tau had a small impact on executive functions (r2 = 0.07). T-tau had a small to moderate influence (r2 = 0.06-0.11) on all cognitive functions with the exception of visuospatial functions in patients with mild cognitive impairment (MCI). In patients with dementia, the impact of T-tau was large (r2 = 0.29) on semantic memory. Aß42 had a small effect (r2 = 0.07) on speed and executive functions in MCI. In patients with dementia, Aß42 had a moderate influence (r2 = 0.13-0.24) on semantic and verbal working memory/fluency. Our results speak in favor of the notion that CSF biomarkers reflect the rate of cognitive decline across the continuum of cognitive impairment from healthy to dementia. CSF predicted subsequent decline in more cognitive domains among MCI cases, but the impact was most pronounced in patients with dementia.

Factorial validity and invariance of the Life Satisfaction Index in older people across groups and time: addressing the heterogeneity of age, functional ability, and depression.

In the last decades, extensive research efforts have been directed at exploring life satisfaction in old age, and the Life Satisfaction Index A (LSIA) scale, developed by Neugarten et al. in the 1960s, is one of the most commonly used instruments. However, studies have focused on predicting and comparing changes in people's life satisfaction without testing if the LSIA instrument is equally valid for different subgroups of people. The present study investigated the underlying dimensions of the LSIA in a Swedish population (n=1402) of people 60-96 years of age. The study also examined factorial invariance across age, gender, functional ability and depression during a six-year period. The results showed that while a five-factor solution of the LSIA did not exhibit an acceptable fit to the data, a three-factor solution did show a close fit. The two three-factor models that demonstrated the best fit showed invariance across gender and across time, but noninvariance across groups with different levels of reduced functional ability, depressive symptoms and age. These findings suggest that the psychometric properties of life satisfaction instruments like the LSIA need to be taken into consideration before drawing conclusions about life satisfaction when comparing older people of different ages and with different depression and function levels.

Personality and personal control make a difference for life satisfaction in the oldest-old: findings in a longitudinal population-based study of individuals 80 and older.

This study investigates life satisfaction in relation to impending death among the oldest-old using overall disease load, self-rated health, and personality as interacting covariates of level and change. We used data from a sample of 370 healthy individuals who completed the Life Satisfaction Index-Z at four measurement occasions during a 6-year period in the Swedish OCTO-Twin study of individuals aged 80 and older. Growth curve analyses showed a linear decrease in life satisfaction as individuals approached death. The decrease was not related to level or change in self-rated health and disease load. High disease load was, however, related to lower levels of life satisfaction, but, this association was moderated by locus of control, such that those with high disease load and high locus of control did not show lower life satisfaction. Poor self-rated health was also associated with lower life satisfaction, but, this association was moderated by neuroticism, such that those with poor-rated health and low neuroticism did not show lower live satisfaction. Personality factors such as locus of control and neuroticism can influence the association between health and life satisfaction. The findings suggest further investigations of the role of personality characteristics in late life satisfaction and whether interventions aimed to increase personal control can improve life satisfaction in old age.

Amyloid-ß42 is associated with cognitive impairment in healthy elderly and subjective cognitive impairment.

The aim of this study was to predict cognitive performance on the basis of the cerebrospinal fluid (CSF) biomarkers total tau (T-tau) and amyloid-ß42 (Aß42) in controls and patients at various impairment levels. Previous studies have found an association of CSF T-tau levels with cognitive symptoms, but it has been difficult to relate Aß to cognition, and it has thus been hypothesized that Aß reaches a plateau level prior to cognitive symptoms. A comprehensive battery of neuropsychological tests was subjected to factor analysis to yield aggregated cognitive domains. Linear regression models were performed for the total sample of the Gothenburg MCI study (n = 435) and for each level of impairment. Aß42 and T-tau accounted for a significant proportion of performance in all cognitive domains in the total sample. In controls (n = 60) and patients with subjective cognitive impairment (n = 105), Aß42 predicted a significant proportion of semantic and working memory performance. For patients with mild cognitive impairment (n = 170), T-tau had the most pronounced impact across cognitive domains, and more specifically on episodic memory, visuospatial, and speed/executive performance. For patients with dementia (n = 100), the most pronounced impacts of Aß42 were found in episodic memory and visuospatial functioning, while T-tau was substantially associated with episodic memory. Our results suggest that cognition is related to CSF biomarkers regardless of impairment level. Aß42 is associated with cognitive functions from a potentially early to a later disease phase, and T-tau is more indicative of performance in a later disease phase.

"As long as I'm in good health". The relationship between medical diagnoses and life satisfaction in the oldest-old.

BACKGROUND AND AIMS: Life satisfaction in the elderly has usually been found to be closely related to self-rated health, and less to diagnoses and more objective measures of health status. However, few studies have examined the relative importance of various specific diagnoses in population-based samples. METHODS: In this study, we investigate the relationship between life satisfaction and medical diagnoses in a non-demented sample of 392 participants aged 80 and older. RESULTS: Among 25 common diagnoses, only sleeping problems, urinary incontinence and stroke were significantly related to life satisfaction. Men with angina pectoris and eczema were less satisfied with life compared with men without these diagnoses, whereas women with peptic ulcer were less satisfied with life compared with women without this diagnosis. CONCLUSIONS: Our results confirm previous findings of a weak relationship between medically based measures of health and life satisfaction. However, health care and future studies of health and quality of life need to focus on the fact that meaning and consequences of various diseases differ among individuals and that gender may partially account for variability.