Older adults' subjective aging perceptions, mentalization, and social relationships: a micro-longitudinal study.

OBJECTIVES: Social relationships are associated with various positive physical, psychological, and emotional outcomes in older adults. In line with the growing understanding of the role of subjective views of aging (VoA) for older adults' quality of life, the current work examines how daily fluctuations in VoA affect social relationships. Moreover, as the ability to mentalize others' states of mind (i.e. Theory of Mind) considerably enhances such relationships, this study assesses whether mentalization abilities mediate the VoA-social relationships link. METHOD: Eighty-two Israeli older adults (mean age = 73.44, SD = 8.64, range = 60-95) completed a baseline online questionnaire containing background information, and subsequently filled out daily online questionnaires assessing ageist attitudes, subjective age, mentalization abilities, and positive social relationships for 14 consecutive days. RESULTS: Positive VoA (reduced ageist attitudes and/or a young subjective age) were associated with enhanced mentalization and positive relationships on a given day and in time-lagged analyses. Moreover, mentalization mediated the effect of previous-day VoA on next-day positive social relationships. VoA also mediated the effect of previous-day mentalization on next-day positive social relationships. CONCLUSION: The study highlights the importance of mentalization capabilities for maintaining positive VoA/social relationships and expands the understanding of underlying factors associated with meaningful and close relationships in older adults.

Feeling Younger, Rehabilitating Better: Reciprocal and Mediating Effects between Subjective Age and Functional Independence in Osteoporotic Fracture and Stroke Patients.

INTRODUCTION: The current study aimed to find reciprocal effects between subjective age and functional independence during rehabilitation from osteoporotic fractures and stroke and whether these effects can be mediated by indicators of well-being. METHODS: Participants were 194 older adults (mean age = 78.32 years, SD = 7.37; 64.8% women) who were hospitalized following an osteoporotic fracture or stroke. Participants completed measures of subjective age and well-being (i.e., optimism, self-esteem, and life satisfaction) several times during rehabilitation. Functional Independence Measure (FIM) was completed by nursing personnel at admission and at discharge. RESULTS: Younger subjective age at admission predicted higher FIM scores at discharge. The reverse effect, that is, of FIM scores at admission on subjective age at discharge, was nonsignificant. Optimism during hospitalization mediated the effect of subjective age on subsequent FIM scores while self-esteem and life satisfaction did not. Sensitivity analyses further showed that the effect of subjective age on FIM was significant for both fracture and stroke patients. DISCUSSION: The findings highlight the effect of subjective age on rehabilitation outcomes among osteoporotic fractures and stroke patients and suggest several potential mechanisms behind this effect. Rehabilitation outcomes following osteoporotic fractures or strokes could improve if subjective age and an optimistic outlook are taken into consideration.

Financial exploitation and mental health among Holocaust survivors: the moderating role of posttraumatic symptoms.

OBJECTIVES: We examined whether anxiety and depressive symptoms associated with self-reported history of financial exploitation (FE) are more pronounced among Holocaust survivors (HS), especially those with high-level posttraumatic stress disorder (PTSD) symptoms. DESIGN: Self-report questionnaires completed online via Qualtrics. SETTING: An online-based survey conducted in Israel. PARTICIPANTS: A community-based cohort of 137 Israeli older adults born prior to 1945 were included in the study sample. HS (n = 61) were participants who reported living in a European country occupied or dominated by Nazi or pro-Nazi regimes between 1939 and 1945. Groups were further subdivided into survivors with low or high levels of PTSD symptoms (≥31 on the PTSD Checklist; PCL-5). MEASUREMENTS: Questionnaires assessed FE history, posttraumatic symptoms (PCL-5), depressive symptoms (PHQ-9), and anxiety (GAD-7). Age, education, self-rated health, and non-Holocaust lifetime adversity were also measured and included as covariates. RESULTS: Hierarchical linear regression models revealed that relationships between FE and depressive and anxiety symptoms were significant only among survivors (p = 0.005 and p = 0.008, respectively). The interaction between PTSD symptom level group and FE was also significant for both depressive (p = 0.007) and anxiety (p = 0.012) symptoms, such that survivors with PTSD who reported FE had significantly greater symptoms of depression and anxiety compared to all other groups. CONCLUSIONS: Findings suggest that the experience of FE may be particularly impactful among survivors who continue to struggle with posttraumatic symptoms related to the Holocaust. Future studies may consider examining whether findings are relevant to other groups with PTSD.

Caregiver burden among adults caring for their Holocaust-survivor parents during the COVID-19 pandemic.

This study aimed to examine the caregiver burden among offspring of Holocaust survivors (OHS) caring for their parents during the COVID-19 pandemic, hypothesizing that caregivers whose parents suffer from posttraumatic stress disorder (PTSD) would report an increased burden. The sample consisted of 109 caregivers with older adult care recipient parents (average caregivers' age = 57.67, SD = 8.49). Caregivers were divided into three groups: 20 OHS who reported that at least one care recipient had PTSD, 60 OHS who reported that their care recipients did not have PTSD, and 29 comparison caregivers (whose care recipients did not undergo the Holocaust). Caregivers completed questionnaires about SARS-CoV-2 exposure, COVID-19 concerns, helping their care recipients, their experiences of caregiver burden, and perceived changes to their caregiver burden during the pandemic. The caregivers also reported PTSD symptoms-in themselves as well as in their care recipients. Relative to comparisons, OHS with parental PTSD reported higher caregiver burden in four aspects: time-dependent burden, developmental burden, physical burden, and social burden. Furthermore, OHS reported a greater perceived increase in caregiver burden during the pandemic than the comparisons. The study findings illuminate the difficulties OHS caregivers, especially those whose care recipients have PTSD, face during the COVID-19 pandemic. This group of caregivers is at risk of experiencing more distress and may need help and support. Further research is needed to determine whether people taking care of their posttraumatic parents following other massive traumatic events also feel a heavier caregiver burden-both in general and specifically during the current pandemic.

Activity engagement and psychological distress among Holocaust survivors during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic may pose a specific threat for Holocaust survivors, as such threats may be linked with increased psychological distress. Moreover, research has demonstrated that engaging in planful problem-solving activities is associated with reduced distress. Accordingly, we aimed to examine the link between engaging in activities during COVID-19 and psychological distress among Holocaust survivors with varying levels of post-traumatic symptoms (PTS) and comparisons (not directly exposed to the Holocaust). DESIGN: A cross-sectional design composed of Holocaust survivors and a comparison group. SETTING: Participants were interviewed face-to-face, over the telephone, or filled the scales online at their leisure. PARTICIPANTS: Data were collected from 131 older Jewish Israelis (age range 76-94, M = 82.73, SD = 4.09), who were divided into three groups (comparisons; low-PTS survivors; high-PTS survivors). MEASUREMENTS: Participants completed scales assessing PTS, activity engagement, and psychological distress and provided additional sociodemographic, medical, and COVID-19-related information. RESULTS: When activity engagement was low, high-PTS survivors reported extremely high levels of psychological distress relative to low-PTS survivors and comparisons. However, when activity engagement was high, these group differences were considerably reduced, as the psychological distress of high-PTS survivors was significantly lower. CONCLUSIONS: The study highlights the importance of daily planning and activity engagement for Holocaust survivors with high PTS levels in reducing psychological distress. Clinicians are urged to take this factor into account when dealing with the psychological effects of COVID-19 on survivors and on traumatized older adults in general.

Qualities of social relationships as mediators of the relationship between future perceptions and health.

OBJECTIVES: Foreshortened future perceptions relate to higher mental and physical morbidity. However, socioemotional selectivity theory (SST) maintains that psychological well-being improves as future perceptions narrow due to growing tendency to prioritize meaningful goals and close relationships. The objective of this study was to reconcile this contradiction by examining a model in which the focus on close relationships suppresses the direct relationship between narrow future perceptions and physical/mental morbidity. METHOD: Community-dwelling older adults (N = 249, mean age = 75.60, SD = 7.54) recruited through social clubs and day centers were interviewed at home. They filled self-report questionnaires measuring future time perspective, subjective nearness to death, positivity of relationships with others and inclusion of others in the self, while rating several physical/mental health indices. A structural equation modeling analysis tested direct and indirect effects. RESULTS: Narrow future perceptions related to higher mental (|ß| ranged .28 to .47, p < .001) and physical morbidity (|ß| ranged .37 to .45, p < .001) and, surprisingly, also to lower positivity of close relationships (|ß| ranged .24 to .31, p < .01) and less inclusion of others (|ß| ranged .17 to .21, p < .01). Both social indices mediated the relationship with lower physical health, while positivity of close relationships also mediated the relationship with psychological distress. CONCLUSION: The findings challenge SST assumptions by underscoring the negative effects of narrow future perceptions on social relationship, making the latter a mediator rather than suppressor in the link between future perceptions and physical/mental morbidity. The findings should be viewed in light of the study's limitations, including convenience sampling and cross-sectional design.

COVID-19 related loneliness and sleep problems in older adults: Worries and resilience as potential moderators.

OBJECTIVES: Older adults may experience loneliness due to social distancing and isolation during the Coronavirus disease 2019 (COVID-19) pandemic. Loneliness may further catalyze numerous poor health outcomes including impaired sleep. This study aimed to assess COVID-19 related worries and resilience as potential moderators of the loneliness-sleep problems link. METHOD: In the midst of the lock-down period of COVID-19, we collected data using a web-based public platform from 243 Israeli older adults (mean age = 69.76, SD = 6.69, age range = 60-92). Participants completed measures of COVID-19 related loneliness, sleep problems, COVID-related worries, and resilience. RESULTS: COVID-19 related loneliness was related to more sleep problems. The loneliness-sleep association was especially strong among those with more COVID-19 related worries or among those with lower resilience. CONCLUSION: The relationship between COVID-19 related loneliness and sleep problems is not uniform across older adults. The subjective sleep quality of those with more COVID-19 related worries or less resilience (i.e., feeling less being able to adapt to the challenging circumstances) is more susceptible to feeling lonely. Considering these variables may facilitate detection of and intervention for older adults vulnerable to aversive results in the context of COVID-19.

COVID-19-Related Loneliness and Psychiatric Symptoms Among Older Adults: The Buffering Role of Subjective Age.

OBJECTIVE: The study examined whether subjective age moderated the relationship between loneliness due to the COVID-19 pandemic and psychiatric symptoms. METHODS: A convenience sample of older adult Israelis (N = 277, mean age = 69.58 ± 6.72) completed web-based questionnaires comprising loneliness, anxiety, depressive, and peritraumatic distress symptoms. They also reported how old they felt. RESULTS: The positive relationship between loneliness due to the COVID-19 pandemic and psychiatric symptoms was weak among those who felt younger than their age while this very same relationship was robust among those feeling older. CONCLUSIONS: Young subjective age may weaken the loneliness-symptom association among older adults during the COVID-19 pandemic. Older adults holding an older age identity are more susceptible to the adverse effects of loneliness. Although preliminary, the findings may inform screening and interventions. Subjective age may help identify those at high risk in suffering from loneliness, and suggest interventions aimed at ameliorating both loneliness and older subjective ages.

COVID-19 health worries and anxiety symptoms among older adults: the moderating role of ageism.

A prominent feature of anxiety in late life is concerns regarding physical health. Anxiety symptoms among older adults have been connected with various psychological outcomes, including social isolation and loneliness. During the coronavirus disease 2019 (COVID-19) pandemic, many societies have demonstrated increased ageist attitudes, encouraging older adults to distance themselves from society. Accordingly, the current study examined the moderating role of COVID-19-related ageism in the connection between COVID-19 health worries and anxiety symptoms among older adults. Data were collected from 243 older adults (age range 60-92; M = 69.75, SD = 6.69), who completed scales assessing COVID-19-related health worries and ageism, as well as anxiety symptoms. The results demonstrated that both health worries and ageism were positively associated with anxiety symptoms. Moreover, the connection between health worries and anxiety symptoms was more pronounced among older adults with high ageism levels. The study highlights the vulnerability of older adults in general, and ageist older adults in particular, to the negative consequences of COVID-19-related health worries, and emphasizes the role of the increased ageist stance of society during the pandemic in this regard.

Subjective nearness-to-death and negative attitudes toward persons with disability: Attachment patterns moderate.

We examined whether subjective nearness-to-death is associated with negative attitudes toward people with disabilities, and whether attachment patterns moderate this connection. A total of 462 Israeli adults, average age 57 years, completed scales measuring subjective nearness-to-death, negative attitudes toward people with disability, and attachment patterns. High levels of subjective nearness-to-death were associated with negative attitudes toward people with disability, and attachment patterns were significant moderators. Findings point to the theoretical importance of both perceptions of death and personal resources for coping with subjective nearness-to-death in relation to attitudes toward individuals with disabilities.

[AGING IN THE SHADOW OF INTERGENERATIONAL TRANSMISSION OF TRAUMA: THE CASE OF OFFSPRING OF HOLOCAUST SURVIVORS].

INTRODUCTION: Can trauma experienced by previous generations shape the aging process of subsequent generations? This fascinating question is relevant to hundreds of thousands of second generation Holocaust survivors, many of whom are middle-aged or older. Therefore, we need to understand in which cases we can find signs of intergenerational transmission, via which mechanisms, under which conditions, and which aspects of functioning and wellbeing are affected. This paper reviews relevant findings from national studies and studies with parent-offspring dyads. From this review, one can conclude that parental exposure to the Holocaust per se is not associated with less favorable aging among offspring, as most Holocaust survivor families are characterized by an impressive resilience extending across generations. Nevertheless, in some cases, second generation Holocaust survivors report increased physical morbidity, perceive aging less favorably, and experience increased filial anxiety. Accumulated evidence points to a series of moderating and mediating variables for these effects. Thus, increased morbidity and difficulties vis-à-vis age-related challenges in offspring are associated with increased parental posttraumatic distress and an intrusive Holocaust-related communication pattern. Several mechanisms link between parental behaviors and offspring aging, amongst them are secondary traumatization symptoms, unhealthy behaviors and avoidance of health-promoting behaviors, and epigenetic modification regulating genes related to the physiological stress response and to other bodily systems. Future studies are needed in order to better understand intergenerational effects among middle-aged and older adult offspring. Additional work will help guide future, interdisciplinary theoretical models and therapeutic interventions aimed at advancing successful aging among adult offspring of Holocaust survivors.

Filial anxiety and sense of obligation among offspring of Holocaust survivors.

OBJECTIVES: Much is known about adult children caring for their aging parents, yet the potentially unique experience of offspring caring for traumatized parents is underexplored. Therefore, the current studies assessed filial anxiety and sense of obligation among offspring of Holocaust survivors (OHS) in caring for their parents. METHOD: In Study 1, we interviewed 10 OHS (mean age = 61.0) in order to extract themes of filial anxiety. Based on Study 1's data, a newly constructed scale of filial anxiety was administered in Study 2 to 59 adult offspring (mean age = 56.4): 28 OHS and 31 comparisons. Study 3 included 143 dyads of parents and offspring (mean age = 55.4 and 81.7, respectively): 86 Holocaust dyads and 57 comparison dyads. Parents reported posttraumatic stress disorder (PTSD) symptoms and offspring reported filial anxiety and sense of obligation. RESULTS: In Study 1, interviewees referred to concerns about parent experiencing decline alongside caregiving difficulties. In Study 2, OHS reported higher filial anxiety and sense of obligation relative to comparisons. This group difference was mediated by sense of obligation. In Study 3, OHS with parental PTSD reported higher filial anxiety and sense of obligation relative to comparisons. Once more, filial sense of obligation served as a mediator. In Studies 2-3, results remained significant after adjusting for offspring symptoms. CONCLUSION: Parental exposure to the Holocaust, and especially parental PTSD, related to higher filial obligation, which in turn was related to higher filial anxiety. These findings bear important implications for practitioners working with survivors' families.

Reciprocal relationships between the will-to-live and successful aging.

Objectives: The search for concomitants and predictors of successful aging is of theoretical and practical importance. In this study, we assessed the reciprocal relationships between the will-to-live (WTL) and both objective and subjective successful aging (SA) among older adults. Methods: Interviews were conducted with 1,216 randomly selected persons aged 75+ years (T1) and repeated with 1,019 of these participants one year later (T2). At each session, we collected data on WTL, subjective SA, and objective SA (medical conditions, disability, pain symptoms), and demographics. Using SEM techniques, we examined cross-lagged autoregressive relationships between WTL and both objective and subjective SA. Results: Significant reciprocal relationships were found among WTL, objective SA, and subjective SA. Higher WTL at T1 predicted higher objective and subjective SA at T2 (i.e., fewer medical conditions, less disability, less pain symptoms and higher ratings of subjective SA). Higher objective and subjective SA at T1 predicted higher WTL at T2. Comparison of the bidirectional temporal relationship between WTL and SA showed that the effect of WTL on objective SA was as strong as the reverse effect, but the influence of WTL on subjective SA was stronger than the reverse effect. Finally, objective SA at T1 predicted subjective SA at T2, but the reverse effect was not significant. Conclusion: WTL is an important precursor for both objective and subjective SA. It may also be maintained and further strengthened by successful aging. Policy makers and practitioners should consider WTL in their efforts to help older adults enhance and preserve SA.

Subjective nearness to death and end-of-life anxieties: the moderating role of ageism.

OBJECTIVES: Subjective nearness to death (SNtD), or individuals' subjective evaluation of how close they are to death, has been demonstrated to be an important predictor for different aspects of the individual's aging process across the life cycle. However, the relationship between SNtD and anxieties linked with the aging process has not been examined among individuals who may be in the initial stages of experiencing the first physical and cognitive signs of aging. Thus, this study examined the association between SNtD and aging, dying, and death anxieties. Moreover, the role of ageism, or negative attitudes toward older adults, as a moderator for these perceptions regarding the end of life has not been addressed. Moreover, we examined whether ageism serves as a moderator for the aforementioned association. METHOD: A convenience sample of 1146 Israeli participants, ranging in age from 45 to 65, filled out scales assessing SNtD, aging anxiety, dying anxiety, death anxiety, and ageism. RESULTS: High levels of SNtD were positively associated with aging, dying, and death anxieties. Moreover, there was a positive association between ageism and the three end-of-life anxieties. Significant interactions demonstrated the moderating effect of ageism for the relationship between SNtD and both aging and dying anxieties, but not for death anxiety. CONCLUSION: SNtD is an important construct, which is connected to various perceptions and anxieties concerning the aging and dying processes. Moreover, while high ageism mitigates the positive association between SNtD and certain anxieties, the role of ageism is more complicated, and its negative aspects are discussed.

A light in a sea of darkness: the moderating role of emotional complexity in the PTSD symptoms-successful aging association.

OBJECTIVES: This study aimed to assess the underexplored effects of posttraumatic stress disorder (PTSD) symptoms on objective and subjective successful aging and to inquire whether emotional complexity moderates these effects. METHODS: Community-dwelling older adults (N = 127, mean age = 67.86, SD = 11.07) rated their PTSD symptoms and completed measures of objective and subjective successful aging. They further reported their emotions on a daily basis over 14 days. RESULTS: After controlling for background characteristics, self-rated health and cumulative lifetime adversity, results showed that higher PTSD symptoms were related to less successful aging, both objective and subjective. However, this relationship existed only amongst older adults with low emotional complexity, but not amongst those with high emotional complexity. CONCLUSION: The findings suggest that high emotional complexity buffers against the negative effects of PTSD symptoms on successful aging. Interventions that empower emotional complexity amongst traumatized older adults may attenuate these negative effects.

The reciprocal relationship between participation in leisure activities and cognitive functioning: the moderating effect of self-rated literacy level.

OBJECTIVE: Participation in leisure activities is beneficial for cognitive functioning of older adults, but it is less known whether it is also beneficial for those with low basic cognitive level. This study examined the reciprocal relationship between participating in leisure activities and cognitive functioning among low and higher literacy level older adults. METHOD: Respondents aged 60 years and older who participated in both first waves (2005-2006 and 2009-2010) of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) were divided into low (n = 139) and higher literacy level respondents (n = 714). They reported participation in leisure activities and completed measures of cognitive functioning at both waves. RESULTS: Cross-lagged models showed that participation in leisure activities predicted higher cognitive functioning four years later only among older adults with low literacy level. On the other hand, cognitive functioning predicted more participation in leisure activities four years later only among higher literacy level older adults. CONCLUSIONS: Participating in leisure activities may be especially beneficial to cognitive functioning among older adults with low literacy level, as their initial low cognitive level allows more room for cognitive improvement than among higher literacy level older adults. Public efforts aimed at increasing participation in leisure activities may therefore target particularly older adults with low basic cognitive level.

The emotional impact of national music on young and older adults differing in posttraumatic stress disorder symptoms.

In spite of previous evidence regarding the function of national songs as a contextual stimulus, their effect on the emotional state of older adults living with different levels of posttraumatic stress disorder (PTSD) symptoms has not be been examined. Following the 2014 Israel-Gaza conflict, we examined the emotional effects of listening to happy national songs (songs of Independence Day) and sad national songs (Memorial Day songs) on young (N = 144, mean age = 29.4) and older adults (N = 132, mean age = 68.5). Respondents were exposed to happy or sad national songs, and completed measures of exposure to missile attacks, related PTSD symptoms, and positive and negative emotions. Sad national songs were related to higher negative affect among young adults who were lower on PTSD symptoms, but not among their older counterparts. In contrast, sad national songs were related to higher negative affect among older adults who were higher on PTSD symptoms, but not among their young counterparts. These findings support the strength and vulnerability model, as they demonstrate that relative to young adults, older adults are generally more capable to withstand negative stimuli, yet are more sensitive to negative stimuli when they suffer from chronic vulnerability, as in the case of higher level of PTSD symptoms.

Perceptions of aging among middle-aged offspring of traumatized parents: the effects of parental Holocaust-related communication and secondary traumatization.

OBJECTIVES: Traumatized parents may transmit anxieties of physical deterioration and demise to their offspring. These anxieties can amplify negative perceptions of the aging process when the offspring enter old age. The current study examined how middle-aged offspring of Holocaust survivors (OHS) recount trauma-related communication by their parents, and how these reports are related to offspring's perceptions of their aging process. METHOD: The study included 450 respondents at the age range of 50-67 (mean age = 57.5, SD = 4.6): 300 OHS and 150 comparisons. Participants reported parental communication of the Holocaust, completed measures of subjective successful aging, aging and death anxieties, and reported secondary traumatization assessing symptoms, developed as a result of a close and continuous relationship with a traumatized parent. RESULTS: Latent profile analysis identified two profiles of parental Holocaust-related communication: intrusive and informative. Offspring who reported intrusive parental communication about the Holocaust perceived themselves as aging less successfully and were more anxious of aging and death than comparisons. Offspring who reported informative parental communication and comparisons did not differ in perceptions of aging. Secondary traumatization mediated these group differences, meaning, intrusive parental communication was related to higher secondary traumatization, which in turn was related to less favorable perceptions of aging. CONCLUSION: These findings allude to the possibility that secondary traumatization mold negative perceptions of the aging process among middle-aged offspring of traumatized parents. Mental health practitioners may help OHS process fragmented and intrusive remnants of parental trauma, thereby diminishing secondary traumatization, and promoting more adaptive perceptions of aging.