The stability of coping strategies in older adults with osteoarthritis and the ability of these strategies to predict changes in depression,disability, and pain

Objectives: Given the chronically painful, incurable nature of osteoarthritis, effective cognitive and behavioral coping strategies may be critical for older adults with the disease. Little is known about how and why coping changes over time, nor about stability of coping strategies in persons with osteoarthritis. The aims of this work were to examine the structure of coping in older adults with osteoarthritis, the association of coping strategies with well-being, the stability of coping over time, and its association with changes in well-being over the same period.

Method: In a cross-sectional study, 199 older adults with osteoarthritis of the knee were assessed at baseline and two-years’ follow-up. Items from two coping scales were factor analyzed, and Pearson's correlations and paired-samples t-tests assessed relative and absolute stability of the resultant coping strategies. CFA assessed the stability of the factor structure itself. Ordinary least-squares regression analyses examined the impact of change in coping on well-being.

Results: A five-factor coping solution emerged: stoicism, refocusing, problem-solving, wishful-thinking, and emotion-focused coping. The factor structure showed stability over the two-year period. Absolute stability of strategies varied, indicating that change in coping styles was possible.

Conclusion: Changes in coping style predicts future well-being; however, coping remains malleable with age and maladaptive strategies can be effectively targeted. Greater knowledge of the utility or maladaptive nature of a given strategy may help guide decisions about interventions for patients with osteoarthritis and encourage more adaptive coping styles.     

Worry and rumination in older adults: Differentiating the processes

Objectives: This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults.

Method: A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour.

Results: A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways.

Conclusion: The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.     

Positive reappraisal in older adults: a systematic literature review

Objectives: Positive reappraisal is a meaning-based cognitive emotion regulation strategy that is frequently used by older adults to deal with stressors. The strategy involves finding personally relevant positive meaning from an experience in the face of its negative reality. As positive reappraisal has not been previously systematically examined and appears to be particularly relevant to older adults, this paper reviews the research on positive reappraisal in older adult populations.

Method: Database searches identified 302 studies, of which 22 addressed positive reappraisal in older adult samples. The findings were categorised into four core themes: use and value for older adults, effects on mental health, benefit for physical illness, and influence of cognitive functioning and gender.

Results: The literature indicates that positive reappraisal is an adaptive coping strategy for older adults with wide-ranging benefits. Specifically, positive reappraisal appears to be related to improved mental health for older adults, and particularly in the context of physical illness.

Conclusion: Helping older adults find meaning in their negative experiences appears to be a worthwhile research area to pursue. Questions for future research on positive reappraisal in older adulthood are proposed.     

Resilience,stress, and life quality in older adults living with HIV/AIDS

Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living with HIV/AIDS (OPLWHA).

Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).

Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.

Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.     

The role of sex and autonomy-connectedness in internalizing and externalizing personality pathology,coping and axis-I pathology: among psychiatric and healthy elderly

Objectives: In the current study we investigated the relationship of sex and autonomy-connectedness with internalizing and externalizing personality disorder symptoms (PDS), coping and axis-I pathology in older age.

Method: A path model was tested which was based on neo-analytical object relation, attachment- and primary-personality theory, among 100 clinical and 106 non-clinical elderly.

Results: In line with our model, autonomy-connectedness (self-awareness and capacity of managing new situations) was strongly associated to internalizing PDS in both groups. In both groups, neither sex nor autonomy-connectedness predicted externalizing PDS. Sex, internalizing as well as externalizing PDS and reactive defensive coping were associated to axis-I psychopathology.

Conclusions: We conclude that sex and autonomy-connectedness were, similarly as in adult populations, associated to internalizing PDS and axis-I pathology. Treatment of elderly with internalizing PDS and axis-I psychopathology should therefore focus on enhancing autonomy-connectedness.     

Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Sense of coherence,depressive feelings and life satisfaction in older persons: a closer look at the role of integrity and despair

Objectives: The present study investigated the relationship between Antonovsky's sense of coherence (SOC) and well-being in a sample of Flemish elderly. In addition, the mediating role of Erikson's developmental task of integrity versus despair was examined in the relationship between SOC, depression, and life satisfaction.

Method: Data on sociodemographic variables, SOC, depressive symptoms, life satisfaction, ego-integrity, and despair were collected. In total, 100 older persons with a mean age of 76.5 years participated. Mplus was used to test the mediating role of integrity and despair in the relationship between SOC and both life satisfaction and depression.

Results: A positive relationship between SOC and well-being was found. More precisely, elderly individuals with a strong SOC experienced less depressive symptoms and higher levels of satisfaction with their life. In addition, mediation analysis indicated that the relationship between SOC and depressive symptoms was partially mediated by the positive resolution of the integrity–despair crisis, whereas the relationship between SOC and life satisfaction was fully mediated by integrity and despair.

Conclusion: Our findings indicate that SOC might be a resource for greater well-being in the elderly. Furthermore, our study offers a partial explanation for the relations found and points to the importance of finding integrity and resolving despair in this stage of life.     

Buddhism-as-a-meaning-system for coping with late-life stress: a conceptual framework

Objectives: Religion is increasingly conceptualized as a meaning system for adjustment and coping. Most of the conceptualizations are grounded in the Judeo-Christian tradition. They may thus not be applicable to Buddhism, which provides a distinct tenor of meaning for coping. This article seeks to construct a conceptual framework of Buddhism-as-a-meaning-system for coping with late-life stress.

Method: Literature review and conceptualization were employed.

Results: Under this framework, Buddhism functions as a meaning system involving existential meaning, cognitive meaning, and behavioral meaning.

Conclusion: There is reason to believe that this framework promises to offer a holistic conceptual map of Buddhist coping in late life. Thus, it could serve as a guide for further empirical and theoretical exploration in the uncharted terrains of Buddhist coping in old age. In addition, gerontological practitioners could use this framework as a frame of reference when working with elderly Buddhist clients who are in stressful circumstances.     

Coping strategies in Spanish older adults: a MIMIC model of socio-demographic characteristics and activity level

Objectives: The aim of this study was to analyze the combined effect of socio-demographic characteristics and activity level on coping strategies and to test which of these variables has a greater impact on coping.

Method: A sample of 243 men and women aged 55–99 years old was selected from different elderly activity centers in Granada, Spain, using a convenience sampling. Associations between eight coping strategies measured by Coping Strategies Inventory and the above mentioned variables were examined using a Multiple Indicator and Multiple Causes model.

Results: Age was negatively related with problem solving, express emotions and social support. Activity level was positively related with problem solving, cognitive restructuring, express emotions and social support and it was negatively associated with social withdrawal. Gender only predicted the scores in self-criticism and living alone was related with higher emotional expression. Participation in creative activities, attending University for the third age and practicing physical exercise were related with differences in the use of several coping strategies.

Conclusions: There is a complex relationship between socio-demographic characteristics, activity level and the coping strategies used by the elderly. It is important to understand this relationship in order to identify older adults who use ineffective coping, and to subsequently include them in intervention programs to improve their coping abilities.     

Quality of in-home care,long-term care placement,and the survival of persons with dementia

Purpose of the study: Caregivers of persons with dementia living at home adopt a variety of caregiving styles that vary in quality. Three styles of high-quality care and poor-quality care have been identified. The outcomes, however, of varying styles of caregiving are unknown. Our purpose was to investigate the linkage of quality of care to long-term care placement and survival.

Design and methods: We used a sample of 148 primary caregivers of a relative living at home and needing assistance due to memory or thinking problems. We used items from four existing scales and five new items to construct measures of high-quality and poor-quality care. Long-term care and survival were determined from two follow-ups. Cox proportional hazards regression was used to estimate the relationship of quality of care to long-term care placement and survival.

Results: Poor quality of care increased the risk of long-term care placement, as expected, but high-quality care was not related to placement. Surprisingly, high-quality care increased the risk of death while poor-quality care decreased the risk. Secondary results were: wishful/intrapsychic coping (a dysfunctional type of emotion-focused coping) and long-term care placement shortened the survival; and caregiver personality traits of neuroticism and agreeableness lengthened the survival.

Implications: It is premature to recommend caregiver interventions based on our unexpected findings. Further studies are vital and should include care-recipient impairments and the quality of life of the person with dementia as additional outcomes.     

A prospective study of the impact of floods on the mental and physical health of older adults

Objectives: With a longitudinal prospective design, we examined the impact of floods on the mental and physical health of older adults and explored risk and protective factors.

Method: Two hundred and seventy four older adults (age ≥60) completed surveys before and after a flood event. Both the surveys included measures of anxiety, depression, self-reported health, and satisfaction with life; the post-flood survey also included questionnaires on flood experience, symptoms of post-traumatic stress disorder (PTSD), stoicism, and psychological coping with floods.

Results: Compared to those not personally affected (78.8%), personally affected individuals (21.2%) reported significantly higher PTSD symptoms, with about one in six reporting PTSD symptoms that might require clinical attention. Personally affected individuals also reported a greater increase in anxiety post-flood, but changes in their depressive symptoms and self-reported health were not significantly different from those not personally affected. Greater flood exposure and the lack of social support were the risk factors for poorer mental and physical health. Higher stoicism was associated with higher post-flood depression and poorer self-reported mental health. The use of maladaptive coping, such as venting and distraction, was associated with greater deterioration in mental health after floods, whilst emotion-focused coping such as acceptance, positive reframing, and humour, was protective against such deterioration.

Conclusion: Floods had adverse psychological impacts on some older adults who were personally affected. Despite the evidence of resilience, a small proportion of older adults experienced significant difficulties after the floods. The findings in this study help understand older adults’ psychological responses to disasters and have practical implications for service planning and delivery.     

Possible error in the Danish version of the WHO Quality of Life (WHOQOL-BREF) Questionnaire

Background: The WHOQOL-BREF is widely used to measure quality of life.

Aims: The goal of the present study was to use the questionnaire in a doctoral study.

Methods: We studied all the instructions provided by the WHO.

Results: In the Danish version of the WHOQOL-BREF there is a discrepancy between the negatively phrased question 9 and both the syntax file and the verbal instructions for coding the data provided by the WHO.

Conclusions: This is a notification of possible error interpretations in projects that use the questionnaire. This could be corrected by manual correction in the coding process or by changing the negatively phrased question 9.     

Locus of control and coping strategies in older persons with and without depression

Objectives: To compare locus of control and coping strategies in older persons with and without depression.

Method: This cross-sectional study included 144 depressed in-patients from seven psychogeriatric hospital units, and 106 community-dwelling older persons without depression. All participants were 60 years and older. Locus of control was assessed by a 17-items self-report questionnaire with six response categories. Coping strategies were assessed by a 26-items self-report questionnaire with five response categories. For analytical purposes, age (<75 years vs. ≥75 years), level of education (<10 years vs. ≥10 years) and general medical health (poor vs. not poor) were categorized.

Results: In linear regression analysis, controlling for demographics, health, and social variables, the depressed in-patients showed a higher external locus of control orientation and a less frequent use of problem-focused coping strategies compared with the non-depressed group. No differences in use of emotion-focused strategies were found between the two groups.

Conclusion: Compared with the non-depressed old persons, the depressed hospitalized older persons were characterized by perceptions of less personal control, and less use of problem-focused strategies, what also might have brought positive alterations into their situation.     

Quality of informal care for persons with dementia: dimensions and correlates

Objectives: The majority of persons with dementia live in the community where most of their care is provided by family members. We aimed to expand our limited knowledge about the styles of high-quality care, such as person-centered care, and poor-quality care adopted by these informal caregivers and the characteristics of those who provide better care.

Method: We conducted a mail survey of 148 family caregivers. Caregiving styles were measured with items from existing scales that had not been analyzed together before. Factor analysis of these items was used to identify styles of caregiving, and structural equation modeling was used to identify their relationships with caregiver and care-recipient characteristics.

Results: Three high quality-of-care factors (personalized, respectful, and compensatory) and three poor quality-of-care factors (punitive, controlling, and withdrawing) were found. The personality traits of agreeableness, openness, conscientiousness, and neuroticism were related to higher quality of care, and the trait of extraversion was related to poorer quality of care. Wishful coping – an avoidance/escape strategy – was linked to poorer quality of care.

Conclusion: We discovered new dimensions of quality of care, some consistent with person-centered care and some antithetical to this model, and we identified for the first time caregiver personality traits and coping strategies associated with better quality of care. These results may be useful in targeting caregiver interventions to benefit both caregivers and care recipients.     

Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Objective: Analysis of three case reports of nerve root anomalies detected intra-operatively and its implications.

Design: Data collected during one year prospective non-randomised study using hospital records.

Setting: Single tertiary care centre.

Subjects: 3 patients in one year period.     

Gratitude and coping among familial caregivers of persons with dementia

Objectives: Gratitude is widely perceived as a key factor to psychological well-being by different cultures and religions. The relationship between gratitude and coping in the context of familial dementia caregiving has yet to be investigated.

Design: This study is the first to examine the associations among gratitude, coping strategies, psychological resources and psychological distress using a structural equation modelling approach.

Results: Findings with 101 Chinese familial caregivers of persons with dementia (mean age = 57.6, range = 40–76; 82% women) showed that gratitude was related to the greater use of emotion-focused coping (positive reframing, acceptance, humour, emotional social support seeking, religious coping) and psychological resources (caregiving competence and social support). Psychological resources and emotion-focused coping in turn explained the association between gratitude and lower levels of psychological distress (caregiving burden and depressive symptoms).

Conclusion: The present results indicate the beneficial role of gratitude on coping with caregiving distress and provide empirical foundation for incorporating gratitude in future psychological interventions for caregivers.     

Does social capital influence preferences for aging in place? Evidence from urban China

Objective: This study investigated the relationships between social capital and preferences for aging in place among older urban adults in eastern China.

Method: Quota sampling was used to recruit 456 respondents aged 60 and older from Gusu District, Suzhou City, in 2015. Random-effects logistic regression was used to test the proposed model.

Results: Respondents who had better quality family social capital, a higher level of social trust, and more organization memberships were more likely to choose to live in local communities, even after we controlled for individual characteristics.

Discussion: The findings highlight the important role of both family and community social capital in influencing preferences for aging in place among older adults in urban China. This is particularly important for developing long-term care systems for older adults living in naturally occurring retirement communities.     

Depression and infrequent participation in social activities among older adults: the moderating role of high-quality familial ties

Objectives: The primary objective of this study is to investigate whether depression is associated with reduced participation in social activities among older adults. Additionally, this study assesses whether high-quality familial ties diminish the negative association between depression and social activities.

Methods: Using cross-sectional telephone interview data from a sample of individuals 60 years of age and older in Arizona and Florida (N = 2000), this study estimates a series of linear regression models to assess the relationship between depression and social activities, and test whether this association is conditioned by high-quality familial ties using multiplicative interaction terms.

Results: As expected, an inverse relationship between depression and social activities is observed. Delving deeper, the regression models reveal that the depression–inactivity association is weaker among older individuals with strong, positive ties to spouses and children. Additional tests demonstrate the mere of existence of familial bonds provides no meaningful benefit – the quality of such ties matters.

Conclusion: Findings support the theoretical argument that high-quality familial ties provide supportive coping resources that buffer individuals from the undesirable consequences associated with depression. Moving forward, longitudinal research on the causal links between depression and infrequent participation in social and leisure activities among older adults is warranted.     

Emotional experience with dyslexia and self-esteem: the protective role of perceived family support in late adulthood

Objectives: Despite the growing body of evidence that suggests dyslexia persists through the life span, there is a dearth of research that explores the complicating factor of dyslexia in late adulthood. Based upon stress and coping theory, this study examined whether perceived family support protects the impact of negative emotional experience with dyslexia on self-esteem.

Methods: Adults aged 21 years and older with diagnosed or self-reported dyslexia were participants in a web-based survey. A total of 224 individuals completed the survey. These findings are from the 50 participants who reported to be 60 years or older. Completed measures include their perception of family support, emotional experience with dyslexia, self-esteem, and demographic variables.

Results: Preliminary analysis revealed that negative emotional experience with dyslexia negatively impacts self-esteem. Hierarchical moderated regression analysis demonstrated that positive perceived family support significantly buffers, mitigates, and protects the effects of negative emotional experiences with dyslexia on self-esteem in individuals with dyslexia in late adulthood.

Conclusion: In this study, family support promoted self-esteem because as a protective dynamic, it helped older adults cope with the emotional distress associated with dyslexia. Implications of these findings are discussed.     

Marital satisfaction and depressive symptoms among Chinese older couples

Background: Depression is one of the most prevalent mental disorders among older people. Consistent with the Marital Discord Model of Depression (MDMD), research in Western cultures has found that marital distress is one of the risk factors for depression among older adults. However, the effect of marital distress on depression among older adults has not been examined in a collectivistic society, such as China.

Objectives: The purpose of this study was to examine the relationship between marital satisfaction and depressive symptoms in a sample of Chinese older adults. Considering the dyadic nature of the data, the Actor–Partner Interdependence Model was used to test for the actor and partner effects.

Methods: The study investigated 139 older couples who were recruited from communities in Beijing, the capital of China. The Lock–Wallace Marital Adjustment and the CES-D scales were administered to the participants.

Results: The results indicated that neither of the actor effects was significant. One of the partner effects was significant, with the husbands’ marital satisfaction predicting their wives’ depressive symptoms.

Conclusions: The MDMD was only partially supported among older couples in China. An asymmetrical pattern of cross-spouse effects was found, suggesting that the husbands’ perception of marital dissatisfaction could significantly predict their wives’ depressive symptoms.