Personality and demographic factors in older adults' fear of death

Study objectives were to clarify controversy regarding the factors influencing fear of death in old age, using a hypothesized path model. Participants were 123 African American and 265 White elders aged 60 to 100; they were assessed on specific fears of death, religiosity, externality, perceived social support, socioeconomic status, age, ethnicity, and gender. Externality, religiosity, and social support had direct effects on fear of the unknown, whereas remaining variables had indirect effects (p < .05). Externality, religiosity, ethnicity, age, and gender all had direct effects on fear of dying, with the background factors also having indirect effects. Conclusions underscore the need for practitioners to understand and consider older adults' fears.     

Risk and protective factors for health-related quality of life among persons aging with HIV

For persons living with HIV, health-related quality of life (HRQOL) may be threatened by physical and mental conditions but may be protected by positive psychological traits. We performed an exploratory look at the risk and protective factors for HRQOL in older adults living with HIV. Cross-sectional analyses of baseline data from the Rush Center of Excellence on Disparities in HIV and Aging (CEDHA), a community-based cohort of persons ages ≥50 living with HIV (n?=?176) were performed. Analyses examined the relationship between risk/protective factors and two outcomes (i.e., self-reported health status [SRHS] and the healthy days index [HDI]). Having good/excellent health was associated with being a non-smoker (p?=?0.002), greater purpose in life (p?=?0.006), higher education (p?=?0.007), fewer depressive symptoms (p?=?0.004), fewer disabilities (p?=?0.000), and less loneliness (p?=?0.002) in bivariate analyses. Males (p?=?0.03) and African Americans/Blacks (p?=?0.03) reported higher HDI. Fewer depressive symptoms (p?=?0.000), disabilities (p?=?0.002), adverse life events (p?=?0.0103), and loneliness (p?=?0.000) were associated with higher HDI in bivariate analyses. In a logistic regression model, greater purpose in life, fewer disabilities, and being a non-smoker were associated with better SRHS after adjusting for covariates. For African Americans/Blacks, having fewer depressive symptoms and disabilities were associated with higher HDI after adjusting for covariates. Disabilities, depression, smoking status, race/ethnicity, and purpose in life were significantly associated with HRQOL. Findings support the need for research to examine the influence of cultural interpretations of life quality and focus on promoting physical function, smoking cessation, and psychological wellness in persons aging with HIV.     

Loneliness and perceived social support in pregnancy and early postpartum of mothers living with HIV in Ontario,Canada

The HIV Mothering Study (n?=?72) was a prospective, observational, cohort study exploring psychosocial experiences and needs of WLWHIV in pregnancy and postpartum. We performed quantitative analysis of determinants of loneliness (UCLA Loneliness Scale) and lower perceived social support (SS) (Medical Outcomes Study-Social Support Survey). The hypothesized determinants included: age, years with HIV, racism (Everyday Discrimination Scale), depression (Edinburgh Postnatal Depression Scale [EPDS]), nadir CD4 (<200?cells/μL), tertiary vs. community HIV care, and marital status. The median age was 33 (IQR?=?30–37); 65.3% were African/Caribbean/Black. Multivariable analyses revealed associations between marital status and perceived social support (β?=??16.48, p?<?0.0001), and this association was also seen with change over time (p?=?0.02). Variables associated with SS that did not change over time were: income, EDS racism, EPDS score. Significant associations with loneliness were seen with the same variables associated with SS. Variables associated with loneliness that also changed over time were: EDS Racism (β?=?0.22, p?=?0.0005, and over time p?=?0.003), and EPDS score (β?=?0.74, p?<?0.0001), and over time (p?=?0.0211). Variables associated with loneliness but that did not change over time were: marital status and income. This analysis provides clinicians with prenatal risk factors which may be associated with increase loneliness and lower SS during pregnancy and postpartum: marital status, income, racism and depression.     

Physical activity affects plasma coenzyme Q10 levels differently in young and old humans

Coenzyme Q (Q) is a key lipidic compound for cell bioenergetics and membrane antioxidant activities. It has been shown that also has a central role in the prevention of oxidation of plasma lipoproteins. Q has been associated with the prevention of cholesterol oxidation and several aging-related diseases. However, to date no clear data on the levels of plasma Q during aging are available. We have measured the levels of plasmatic Q₁₀ and cholesterol in young and old individuals showing different degrees of physical activity. Our results indicate that plasma Q₁₀ levels in old people are higher that the levels found in young people. Our analysis also indicates that there is no a relationship between the degree of physical activity and Q₁₀ levels when the general population is studied. However, very interestingly, we have found a different tendency between Q₁₀ levels and physical activity depending on the age of individuals. In young people, higher activity correlates with lower Q₁₀ levels in plasma whereas in older adults this ratio changes and higher activity is related to higher plasma Q₁₀ levels and higher Q₁₀/Chol ratios. Higher Q₁₀ levels in plasma are related to lower lipoperoxidation and oxidized LDL levels in elderly people. Our results highlight the importance of life habits in the analysis of Q₁₀ in plasma and indicate that the practice of physical activity at old age can improve antioxidant capacity in plasma and help to prevent cardiovascular diseases.     

Associations between distress tolerance and asthma symptoms and quality of life

Objective: Given the robust associations between anxiety and asthma, the purpose of the current study was to explore associations between asthma outcomes and tolerance for negative affective states (i.e. distress tolerance) as well as tolerance for the specific negative emotional states of anxiety and fear. Methods: Participants were 61 nonsmoking adults with asthma (61.9% female, 54.8% African-American, M_age?=?34.72, SD?=?13.58) who underwent spirometry and completed self-report measures. Results: After controlling for the effects of age, race and the physical concerns domain of anxiety sensitivity, poorer global distress tolerance and tolerance for fear and anxiety each significantly predicted poorer lung function (8.7–13.8% variance), asthma control (4.9–8.8% variance) and asthma-related quality of life (6.7–8.9%). Conclusions: These findings suggest that targeting distress tolerance, specifically tolerance of fear and anxiety, may be helpful in improving asthma outcomes.     

Asthma outcomes are poor among older adults with low health literacy

Objective: To examine the association of health literacy (HL) with asthma outcomes among older asthmatics. Methods: The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1?s (FEV₁) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life. HL was assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Multivariate logistic regression models controlled for age, sex, race, income, general health and years with asthma. Results: Among 433 individuals, 36% had low HL, 55% were over age 65, 38% were Hispanic and 22% were black. Poor asthma control was reported by 40% and 32% had FEV₁ <70% of predicted; 9% had a hospital stay, 23% had an ED and 38% had poor quality of life. In multivariable analysis, individuals with low HL were more likely to have FEV₁ <70% predicted (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.39–3.94, p?=?0.001), hospitalizations (OR 2.53, 95% CI 1.17–5.49, p?=?0.02) and ED visits for asthma (OR 1.81, 95% CI 1.05–3.10, p?=?0.03). There were no differences in self-reported asthma control and quality of life. Conclusions: Low HL is associated with poor asthma control by objective measure, and greater likelihood of ED visits and hospitalization. HL is a modifiable target for interventions to improve asthma outcomes in the elderly.     

Is death anxiety more closely linked with optimism or pessimism among older adults?

The purpose of this study was to investigate whether death anxiety is more closely linked with optimism or pessimism among older adults. Participants consisted of community-dwelling older adults (N = 253; 73.1% female) in the southern U.S. Both optimism and pessimism demonstrated a bivariate association with death anxiety; however, when considering optimism and pessimism together—and after controlling for age, gender, physical health, and mental health—optimism was not associated with death anxiety, while pessimism was associated with higher death anxiety. Post hoc analyses found a unique relationship between pessimism and greater fear of the unknown. Perhaps, given the inevitability of death, limiting negative expectancies is more salient to death anxiety than having positive expectancies, and pessimism may be particularly associated with existential and religious concerns.     

Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective

BACKGROUND AND AIMS: The aim of this work was to study feelings of loneliness and fear among elderly people (75+) in a gender perspective, and to explore their causes. METHODS: A cross-sectional study (postal questionnaire) with a randomised and age-stratified sample (n = 4277) was used to study the variables of interest. Because the variables were compared between men and women, weighted values for means, standard deviations, and ratios were used. Multiple logistic regression analysis was used to identify the causes of loneliness and fear. RESULTS: Findings showed that loneliness and fear were both more frequently reported by women than men. Loneliness was significantly associated with gender, marital status, living in special accommodation, fear, and need of help with activities of daily living (IADL). Fear was significantly associated with gender, number of children, having someone to trust, loneliness, and being in need of help with IADL. Those who reported loneliness and/or fear had significantly lower health-related quality of life than those who did not. Many of the elderly feared violence/crime, but only a few had been exposed to violence/crime. CONCLUSIONS: Loneliness and fear are common among elderly people. Both variables seem to be related to each other and were both found to be "threats" to a good life in old age. However, to minimize these "threats" and perhaps improve these people's quality of life, action can be taken in the care for elderly people such as involving the social network and reducing the need of help with IADL.     

Anxiety sensitivity as a mediator of the association between asthma and smoking

Objective: Despite its negative effects, smoking is more common among individuals with asthma compared to those without. Anxiety sensitivity (fear of arousal-related sensations) is associated with both smoking and asthma; however, no research, to date, has examined the interplay between these three factors. Thus, the purpose of the current study was to evaluate the mediating role of anxiety sensitivity in the association between asthma diagnosis and smoking status. Methods: The current study was a secondary analysis of data from three existing datasets of non-smokers and smokers with and without asthma (n?=?433; 56.3% female, M_age?=?34.01 years, SD?=?13.9). Participants provided information on their asthma diagnosis status and smoking status and completed self-report measures. Results: As hypothesized, after controlling for gender, race and age, there was a significant indirect effect of asthma diagnosis on smoking status through anxiety sensitivity (95% CI?=?0.07–0.48). Conclusions: These results indicate that the association between asthma diagnosis and smoking status appears to be driven, in part, by anxiety sensitivity and suggest that anxiety sensitivity may serve as an important target for prevention and intervention efforts for smokers with asthma.     

Age-associated changes in circulatory fatty acids: new insights on adults and long-lived individuals

Long-lived individuals (LLIs) are considered an ideal model to study healthy human aging. Blood fatty acid (FA) profile of a cohort of LLIs (90–111 years old, n?=?49) from Sicily was compared to adults (18–64 years old, n?=?69) and older adults (65–89 years old, n?=?54) from the same area. Genetic variants in key enzymes related to FA biosynthesis and metabolism were also genotyped to investigate a potential genetic predisposition in determining the FA profile. Gas chromatography was employed to determine the FA profile, and genotyping was performed using high-resolution melt (HRM) analysis. Blood levels of total polyunsaturated FA (PUFA) and total trans-FA decreased with age, while the levels of saturated FA (SFA) remained unchanged. Interestingly, distinctively higher circulatory levels of monounsaturated FA (MUFA) in LLIs compared to adults and older adults were observed. In addition, among LLIs, rs174537 in the FA desaturase 1/2 (FADS1/2) gene was associated with linoleic acid (LA, 18:2n-6) and docosatetraenoic acid (DTA, 22:4n-6) levels, and the rs953413 in the elongase of very long FA 2 (ELOVL2) was associated with DTA levels. We further observed that rs174579 and rs174626 genotypes in FADS1/2 significantly affect delta-6 desaturase (D6D) activity. In conclusion, our results suggest that the LLIs have a different FA profile characterized by high MUFA content, which indicates reduced peroxidation while maintaining membrane fluidity.

     

Dating Relationships in College Students with Childhood-Onset Asthma

Objective. The current study investigated whether differences existed in dating anxiety and fear of intimacy between individuals with childhood-onset asthma and individuals without a chronic illness. Analyses were also conducted to determine if dating anxiety or fear of intimacy were predictors of health-related quality of life in individuals with asthma and healthy controls. Additionally, potential gender differences in dating anxiety and fear of intimacy in individuals with childhood-onset asthma were explored. Methods. College undergraduates at least 17 years of age who self-identified as having childhood asthma were randomly matched by age and gender to healthy control participants. Participants completed a demographic form, the Dating Anxiety Scale for Adolescents, the Fear of Intimacy Scale, and the SF-36 Health Survey, a measure of health-related quality of life. Results. There were no significant differences between self-identified participants with asthma and matched healthy controls on the Dating Anxiety Scale or Fear of Intimacy Scale. However, dating anxiety was a significant predictor of mental health-related quality of life in participants with asthma but not in matched health controls. Fear of intimacy was not a significant predictor of mental or physical health-related quality of life in individuals with asthma. In addition, women with asthma endorsed significantly more dating anxiety and lower physical health-related quality of life than males with asthma. Conclusion. College students with asthma appear to experience similar levels of dating anxiety and fear of intimacy than healthy college students; however, their anxiety about dating may have a larger effect on health-related quality of life than healthy individuals. Additional examination of dating and interpersonal relationships among individuals with asthma appears warranted, particularly as it concerns possible gender differences in individuals with childhood-onset asthma.     

Lower expression of PD-1 and PD-L1 in peripheral blood from patients with chronic ITP

Background: T-cell dysregulation is a major event involved in immune thrombocytopenic purpura (ITP). Increasing data have indicated that abnormal expression of T-cell immunosuppressive receptors, such as programmed death (PD) 1 and cytotoxic T lymphocyte antigen-4 (CTLA-4), may be related to autoimmune disease pathogenesis.

Methods: We analyzed the expression levels of PD-1, its ligand PD-L1, and CTLA-4 in peripheral blood mononuclear cells from 18 patients with chronic ITP by real-time polymerase chain reaction, and samples from 20 healthy individuals served as control.

Results: The results demonstrated significantly lower expression of PD-1 (median: 0.0015) and PD-L1 (median: 0.0572) in chronic ITP patients compared with healthy individuals (PD-1: median: 0.0117, P?<?0.0001; PD-L1: median: 0.5428, P?<?0.0001), while there was no significant difference in the CTLA-4 expression level between the chronic ITP patients (median: 0.0818) and healthy individuals (median: 0.1667) (P?=?0.219). Moreover, a positive correlation between the expression levels of PD-1 and PD-L1 (r_s?=?0.486, P?=?0.041) and CTLA-4 and PD-1 (r_s?=?0.643, P?=?0.004) in the chronic ITP patients was found.

Conclusion: Consistently lower expression of T-cell immunosuppressive receptors is a common characteristic of chronic ITP, which may be associated with its pathogenesis.     

Association of extraintestinal manifestations and anaemia with disease outcomes in patients with inflammatory bowel disease

Objective: The association between extraintestinal manifestations (EIMs) and disease activity suggest a common pathogenetic link with inflammatory bowel disease (IBD). We report on the association of EIMs and anaemia with long-term disease outcomes, including treatment steps, hospitalization, and surgery in the prospective population-based IBD inception cohort from Veszprem province.

Methods: Data of 678 incident IBD patients (Crohn’s disease/ulcerative colitis(CD/UC): 331/347) diagnosed from 1st January 2000 to 31st December 2012 were analyzed (CD: m/f: 176/155, median age at diagnosis: 28, IQR: 21–40 years, disease duration: 6, IQR: 2–9 years; UC: m/f: 200/147, median age at diagnosis: 36, IQR: 26–50 years, duration: 7, IQR: 4–10 years).

Results: EIMs were present in 30% of the CD and 17.3% of the UC patients. In CD, female gender (p?=?0.02) need for steroid (p ?p?=?0.02), while in UC, young age at onset (p?=?0.03), extensive disease (p?=?0.003), female gender (p?=?0.07), need for steroids (p?p?=?0.004) and need for IBD-related hospitalization (p?=?0.01) were associated with the presence of EIMs. Anaemia was present in 56.7% of the CD and 30.2% of the UC patients. In both CD and UC anaemia was associated with age at onset (p_CD?=?0.001, p_UC?=?0.04), disease location/extent (p_CD?=?0.02, p_UC?p_CD,UC?p_CD?p_UC?=?0.002) and hospitalization (p_CD?=?0.004, p_UC?p?=?0.002).

Conclusions: The presence of EIMs was associated with disease phenotype in UC and with treatment strategy in both CD and UC. Additionally, anaemia was associated with hospitalization and surgery in both CD and UC, suggesting that EIMs and anaemia may be helpful in stratifying disease severity in IBD.     

Minority women's attitudes about aging

Abstract

Many factors combine to make middle age a critical period with respect to views about aging. To examine the effects of culture, background, and familial characteristics on attitudes toward old age, 304 middle-aged women from Black, Cuban, American Indian, Chicano, and white cultures were studied. A stepwise multiple regression analysis examined the contribution of each variable in the prediction of attitudes toward old age. Attitude toward death, attitude toward family, and church affiliation were found to be important predictors of attitude toward old age. Thus, clinicians dealing with middle-aged women having negative attitudes or fears about aging and old age in general may need to examine family dynamics as well as views about death and dying for possible problems. Where religion is already an integral part of a client's life, perhaps clinicians could use this orientation for added support.     

Does religiousness buffer against the fear of death and dying in late adulthood? Findings from a longitudinal study

We used longitudinal data (N = 155) to investigate the relation between religiousness and fear of death and dying in late adulthood. We found no linear relations between religiousness and fear of death and dying. Individuals who were moderately religious feared death more than individuals who scored high or low on religiousness. Fear of death also characterized participants who lacked congruence between belief in an afterlife and religious practices. We replicated the curvilinear relation between fear of death and religiousness in late adulthood with religiousness in middle adulthood, controlling for sociodemographic variables, life satisfaction, social support, and stressors. Older participants (in their mid-70s) who experienced more bereavement and illness feared the dying process less than younger participants (in their late 60s). The findings support the hypothesis that firmness and consistency of beliefs and practices, rather than religiousness per se, buffers against death anxiety in old age.     

Living alone and cognitive function in later life

BackgroundLiving alone may be associated with greater risk for social isolation and loneliness. Living alone, social isolation, loneliness, and limited engagement in social activity have all been associated with poorer cognitive function in later life. Hence, if individuals who live alone are also at greater risk of isolation and loneliness, this may exacerbate poor cognitive function.ObjectiveTo determine whether people living alone are more at risk of social isolation, feelings of loneliness, and limited social activity, and to examine the associations between living alone and cognitive function in later life.MethodBaseline (N = 2197) and two-year follow-up (N = 1498) data from community-dwelling participants, age ≥65 years, without cognitive impairment or depression at baseline from CFAS-Wales were used. Linear regression analyses were conducted to assess the association between living arrangement and cognitive function at baseline and two-year follow-up.ResultsPeople living alone were more isolated from family and experienced more emotional loneliness than those living with others, but were not more isolated from friends, did not experience more social loneliness, and were more likely to engage in regular social activity. Living alone was not associated with poorer cognitive function at baseline or two-year follow-up.DiscussionThese findings have positive implications and suggest that people who live alone in later life are not at greater risk of poor cognitive function at baseline or two-year follow-up. Social isolation may be more associated with poor cognitive function.     

Longitudinal association of executive function and structural network controllability in the aging brain

Executive function encompasses effortful cognitive processes that are particularly susceptible to aging. Functional brain networks supporting executive function—such as the frontoparietal control network and the multiple demand system—have been extensively investigated. However, it remains unclear how structural networks facilitate and constrain the dynamics of functional networks to contribute to aging-related executive function declines. We examined whether changes in structural network modal controllability—a network’s ability to facilitate effortful brain state transitions that support cognitive functions—are associated with changes in executive function cross-sectionally and longitudinally. Diffusion-weighted imaging and neuropsychological testing were conducted at two time points (Time 1: ages 56 to 66, N?=?172; Time 2: ages 61 to 70, N?=?267) in community-dwelling men from the Vietnam Era Twin Study of Aging. An executive function factor score was computed from six neuropsychological tasks. Structural networks constructed from white matter connectivity were used to estimate modal controllability in control network and multiple demand system. We showed that higher modal controllability in control network and multiple demand system was associated with better executive function at Time 2, after controlling for age, young adult general cognitive ability, and physical health status. Moreover, changes in executive function over a period of 5 to 6 years (Time 1-Time 2, N?=?105) were associated with changes in modal controllability of the multiple demand system and weakly in the control network over the same time period. These findings suggest that changes in the ability of structural brain networks in facilitating effortful brain state transitions may be a key neural mechanism underlying aging-related executive function declines and cognitive aging.

     

Alcohol use,expectancies and HIV-related sexual risk: a cross-sectional survey of male migrant workers in South India

Male migrant workers (MMWs) in India are vulnerable to developing alcohol-related problems and engaging in unprotected sex, putting them at risk of HIV. Research has shown that alcohol-related expectancies mediate vulnerability to alcoholism. We examined which expectancies were associated with sexual risk and drinking. We surveyed 1085 heterosexual MMWs in two South Indian municipalities, assessing expectancies, sex under the influence, and unprotected sex with female sex workers (FSW) and casual female partners in the prior 30 days. Men more strongly endorsed positive than negative expectancies (t?=?53.59, p?p?p?p?p?相似文献   

Examining the health and health service utilization of heterosexual men with HIV: a community-informed scoping review

The prevalence of HIV infection among heterosexual men has increased. Consequently, the need for health and support services for this group is likely to increase. We conducted a scoping review of studies regarding the health and health service use of heterosexual men with HIV that was informed by research priorities identified by this community. We searched six databases from inception to August 2014. We included all English-language qualitative and quantitative studies examining the health and health service use of heterosexual men with HIV. Our search strategy yielded 2665 references, of which 70 were included in the scoping review. We summarized the research into the following domains identified by summit participants: treatment of HIV and its complications (n?=?9), health and social support services utilization (n?=?27), social determinants of health (n?=?20), prevention (n?=?11), family planning (n?=?4) and psychosocial research (n?=?33). Key findings from the review included poor mental health-related well-being, over-representation among “late presenters” to care and greater fear of disclosure of HIV status relative to men who have sex with men. In general, research conducted to date was not well aligned with the priorities identified by the community.     

Correlates of loneliness in older persons living with HIV

ABSTRACT

Loneliness poses a significant risk for morbidity and mortality in the context of older adulthood. Research shows that older persons living with HIV (PLWH) often face increased and complex vulnerability in terms of physical and psychosocial needs which may promote loneliness. The current study sought to identify correlates of loneliness in a sample of 146 older PLWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA. Participants completed a survey on loneliness, depression, HIV-related stigma, social network size, HIV-disclosure status, disease burden, and demographics. HIV biomarkers were abstracted from electronic medical records. Participants were predominantly male (60%) and African American (86%). Twelve percent (n?=?17) reported past homelessness/unstable housing. Multivariable modeling revealed that depression and HIV-related stigma explained 41% of the variance in loneliness, above and beyond the effects of past homelessness/unstable housing and disease burden (R ^2?=?0.41, F(7, 138)?=?13.76, p?<?.001). Findings suggest that targeting HIV-related stigma and depression may reduce loneliness in older PLWH, but more studies are needed to elucidate causal pathways. A greater understanding of the mechanisms by which loneliness affects health among older PLWH could help better inform efforts to improve health in this patient population.