Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility,accomplishment of social activities and frequency of leisure activities in older adults having disabilities

BackgroundSocial participation, a determinant of health in older adults, requires innovative interventions. The personalised citizen assistance for social participation (APIC) involves weekly three-hour personalised stimulation sessions targeting significant social and leisure activities difficult to accomplish. Recently adapted for older adults, the APIC’s impact on this population is unknown.ObjectiveThis study explored the impact of APIC on older adults with disabilities.MethodsA mixed-method design including a pre-experimental component was used with 16 participants (11 women) aged 66–91 (79.4 ± 8.7) with disabilities, living at home. They completed functional autonomy, social participation, leisure and quality of life questionnaires, and semi-structured interviews.ResultsAPIC increased older adults’ functional autonomy (p = 0.02), accomplishment (p < 0.01) and satisfaction (p = 0.02) with social participation, and frequency of leisure practice (p < 0.01). Post-intervention, participants wished to modify the practice (p < 0.01) and frequency (p < 0.01) of leisure activities, and difficulties in their social environment diminished (p = 0.03). Their attitude toward leisure (p = 0.04) as well as their health (p < 0.01) and psychological (p = 0.03) quality of life improved. Older adults thought APIC helped them resume, maintain, explore and experiment with significant social activities. It also increased their psychological and physical well-being, feeling of control, connectedness, self-esteem and motivation to accomplish activities. Finally, APIC can compensate for an unavailable and crumbling social network.ConclusionAPIC is a promising intervention that leads to new opportunities for older adults to increase community integration and enhance the social component of their lives. It can also optimise how the needs of older adults are met, including utilisation of personal and environmental resources.     

Depression,functional disability and quality of life among Nigerian older adults: Prevalences and relationships

BackgroundAgeing is associated with increased morbidity, depression and decline in function. These may consequently impair the quality of life (QoL) of older adults.PurposeThis study was used to investigate the prevalence of functional disability, depression, and level of quality of life of older adults residing in Uyo metropolis and its environs, Nigeria.MethodThis cross sectional survey involved 206 (116 females and 90 males) older adults with mean age of 69.8 ± 6.7. The World Health Organization Quality of Life-OLD, Functional status Questionnaire (FSQ) and Geriatric Depression Scale (GDS) were used to measure quality of life, functional disability and depression respectively. Data was analysed using frequency counts and percentages and Spearman rank-order correlation coefficient, at 0.05 alpha level.Results45.5% of participants had depression, and at least 30% had functional disability in at least one domain, but their quality of life was fairly good (>60.0%) across all domains. Significant correlation existed between depression scores and individual quality of life and functional disability domains and between overall QoL and each functional disability domain (p < 0.001).ConclusionsDepression and functional disability were quite prevalent among sampled older adults but their QOL was not too severely affected. Since the constructs were interrelated, it seems interventions targeted at depression and functional status may invariably enhance the quality of life of the older adults.     

Dispositional hope and life satisfaction among older adults attending lifelong learning programs

BackgroundThe aim of this study is to explore the indirect effects of dispositional hope in the life satisfaction of older adults attending a lifelong learning program at the University of Valencia, Spain. We examine the mediating impact of dispositional hope regarding its ability to impact life satisfaction while considering affective and confidant social support, perceived health and leisure activities, consciousness and spirituality as predictors.MethodsAnalysis were based on survey data (response rate 77.4%) provided by 737 adults 55 years old or more (Mean age = 65.41, SD = 6.60; 69% woman). A structural model with latent variables was specified and estimated in Mplus.ResultsThe results show the ability of just a few variables to sum up a reasonable model to apply to successful aging population. All these variables are correlated and significantly predict hope with the exception of health. The model additionally includes significant positive indirect effects from spirituality, affective support and consciousness on satisfaction. The model has a good fit in terms of both the measurement and structural model. Regarding predictive power, these comprehensive four main areas of successful aging account for 42% of hope and finally for one third of the life satisfaction variance.ConclusionsResults support the mediating role of dispositional hope on the life satisfaction among older adults attending lifelong learning programs. These findings also support the MacArthur model of successful aging adapted to older adults with high levels of functional, social and cognitive ability. Dispositional hope, perceived health, and social support were the strongest predictors of satisfaction with life.     

Predictors of functional disability with focus on activities of daily living: A community based follow-up study in older adults in India

BackgroundDisability in activities of daily living is a growing concern among older populations all over the world. India has one of the rapidly ageing populations and predicted burden of functional disability is higher for Indian older adults as compared to other ageing Asian countries.MethodsTotal 1140 aged 60 years and over participated in a baseline study. 560 of them participated in the prospective cohort study conducted in the city of Pune, India. An interview and functional assessment using a questionnaire and Pune-FAAT tool was carried out in 2013–14. Binary logistic regression was used to obtain the factors that increased the odds of having ADL disability at follow-up.ResultsThe mean age of the study population was 69.73 ± 5.48 years. Squatting, walking and climbing functions were affected significantly. Total 376 participants (67.1%) reported difficulties and/or disability in performing activities of daily living (ADL) at follow-up. Hospitalization (OR = 3.6; 95% CI: 1.9–6.7), being female (OR = 2.3; 95% CI: 1.5–3.5), presence of two or more chronic diseases (OR = 1.7; 95% CI: 1.1–2.7), experience of memory loss (OR = 1.9; 95% CI: 1.2–3.0) and feeling of loneliness (OR = 2.3; 95% CI: 1.0–5.3) increased the odds of being in the “With disability” group at follow-up. Apart from this, self-rated health and self-reported depression were associated with limitations in ADL.ConclusionHospitalization and being female appeared to be the most significant risk factors for disability in urban older adults in India. Rehabilitation services after hospitalization, physical exercise, effective control on chronic illness, and social participation to reduce loneliness is recommended.     

The latent factors of depression from the short forms of the CES-D are consistent,reliable and valid in community-living older adults

BackgroundDepression is an important public health outcome in the older adult population. It is associated with declining physical and psychological well-being and increasing healthcare utilisation. The Center for Epidemiological Studies Depression Scale (CES-D) although widely accepted as a screening tool for depressive symptoms in older adults, can be long and exhaustive as part of a comprehensive geriatric assessment.AimWe investigated the consistency, reliability and validity of the original and three short formats of the CES-D.MethodsSix thousand six hundred and thirty-seven community-living adults, aged ≥ 50 years from The Irish Longitudinal Study on Ageing (TILDA), completed the 20-item CES-D. Confirmatory factor analysis determined the factor structures of the 20-, 10- and two 8-item formats of the CES-D. Latent factors from each format were validated against disability and perceived stress, particularly the Positive Affect factor. Analysis was also performed in a subset aged 65+ years.ResultsAll formats of the CES-D displayed good internally consistency (0.87–0.72) and good model fit for the expected four- and three-factor structures of the CES-D. Latent factors from all formats were representative of each other and the Positive Affect factor was negatively correlated with disability and perceived stress on all CES-D formats.ConclusionShort forms of the CES-D are consistent, reliable and valid for use in the older adult population (50+ or 65+ years), where avoiding long assessments and response fatigue is warranted. These formats may be used to measure Positive Affect, an important construct related to physical health, resilience and psychological well-being in later life.     

Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study

BackgroundOrthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore.MethodsData was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status.ResultsThe prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26–4.30; p = 0.007) compared to those aged 75–84 years (OR: 1.76; 1.08-2.85; p = 0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56–5.88, p = 0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p = 0.007).ConclusionsOlder age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult’s functional capacity and quality of life to prevent injury.     

Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression

This study investigated whether sleep duration and quality were related to life satisfaction (LS) among older Chinese adults and whether depression mediated those relationships. Cross-sectional data from the aging arm of the Rugao Longevity and Aging Study were used. Sleep duration, sleep quality, depression, LS and covariates were analyzed using logistic regressions. To assess the potential mediation of depression on the association between sleep duration and quality and LS, Aroian tests were used. Of 1756 older Chinese adults aged 70–84 years, 90.7% of the men and 83.3% of the women reported being satisfied with their lives. After adjusting for covariates, older adults who slept ≤6 h per night were more likely to suffer from life dissatisfaction compared with those who slept 7–8 h (OR = 2.67, 95% CI 1.86–3.79), and individuals who slept poorly were almost 2 times (OR = 2.91, 95% CI 2.16–3.91) more likely to have life dissatisfaction. The Aroian tests confirmed that these relationships were partially mediated by depression (p < 0.001). Between short sleep and LS, the mediating effect of depression accounted for 13.9% of the total effects. Moreover, the mediating effect of depression on the association between sleep quality and LS was 13.3%. Short sleep duration and poor sleep quality were inversely associated with LS, and the relationships were partially mediated by depression. Our study suggests that both sleep and depression status are important factors for LS among the elderly.     

Prevalence,characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey

ObjectiveThe aim of this study was to investigate the prevalence, characteristics, and acute care utilization of community dwelling disabled older adults with an absence of help for activities of daily living (ADL).MethodsWe analyzed cross-sectional data from a nationally representative sample of people aged 65 years and over (n = 2904) participating in the 2009 National Health Interview Survey in Taiwan. Disability was defined as self-reporting a lot of difficulty or complete inability to carry out one or more ADL tasks. Participants with disability were asked whether they received help in the form of personal assistance or assistive devices to complete ADL tasks, with a yes response indicating the presence of help and a no response indicating the absence of help. Hospitalization and emergency department visits was assessed as a dichotomous variable (any or none), respectively.ResultsAn absence of available help for ADL disability was reported in 16.6% of disabled older adults. Disabled older adults reporting an absence of help were more likely to be female. After adjustment for other factors, compared to older adults without disability, older adults with disability not receiving help for ADL tasks were highly related to hospitalization (OR = 4.57; 95%CI = [1.51–13.82]) and emergency department visits (OR = 3.52; 95%CI = [1.15–10.76]) during the past year, respectively.ConclusionsWe found that there is high prevalence of absence of help to perform ADL tasks in older adults with disability, and that this absence of help for ADL disability is associated with a greater burden of acute care utilization than those without disability.     

Depression and pain in patients with rheumatoid arthritis: Mediating role of illness perception

Aim of the workIllness perception is considered to be an important contributor in the relationship between physical and psychological factors in rheumatoid arthritis (RA). This study examined the mediational role of illness perceptions in the relationship between depression and pain in RA.Patients and methodsIllness perception, depression and pain were assessed in 100 adults with RA (72 females and 28 males). Patients were asked to complete 4 questionnaires including socio-demographic data form, depression subscale of Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (Brief-IPQ) and Rheumatoid Arthritis Pain Scale (RAPS). Using the Baron and Kenny approach and Sobel tests, the mediation of illness perceptions in the relationship between depression and pain symptoms was examined.ResultsSixty-six RA patients (66%) endorsed a clinically significant level of depression (HADS 12.94 ± 5.39). The mean RAPS was 41.97 ± 23.45 (range = 4–91.93). Depression symptoms were significantly associated with perceived pain (r = −0.57, p < 0.001). Three illness perceptions significantly mediated the relationship between depression and pain; consequences (z = 1.39, p < 0.05); personal control (z = 1.47, p < 0.05) and emotional response (z = 1.51, p < 0.05). Gender and education showed no significant effect on the presented results.ConclusionsGreater depression symptoms were associated with perceptions that pain negatively affected one’s life and emotions and was difficult to control. These negative illness perceptions were, in turn, related to greater pain symptoms. Illness perceptions helped explain the depression-pain link in RA patients. Results suggest that targeting illness perceptions in adults with RA and depression may help reduce pain symptoms.     

Trasplante de hígado en adultos mayores mexicanos: un estudio comparativo en un solo centro

IntroductionLiver disease is currently one of the leading causes of death in older adults and the only option deemed curative is liver transplantation. However, it is uncertain whether the successful results obtained in older adults that receive a liver transplant in developed countries can be replicated in developing countries.AimTo determine if there are differences in the survival time between older (≥ 60 years) and younger adults that underwent liver transplantation at a university-affiliated tertiary care center in Mexico City.Materials and methodsA 2-year longitudinal study was conducted. It included 244 participants that were divided into 2 groups according to age at the time of transplantation: older adults (≥ 60 years) and younger adults (18-59 years). Survival time was defined as the number of days that elapsed between transplantation and death. Survival was expressed as Kaplan-Meier curves.ResultsMedian age in the older adults (n = 52) was 63.0 (IQR = 60-69) and 23 participants were females (44.2%). In the younger adults (n = 196) median age was 47.0 (IQR = 16-59) and 104 were females (52%). The leading indication for transplant was hepatitis C virus. After the follow-up, fifteen participants died (12 younger adults and 3 older adults). No significant differences were observed between older and younger participants in postoperative complications, the number of re-admissions, or mean post-transplantation survival time.ConclusionsThere were no statistically significant differences in relation to survival times between older and younger adults that received a liver transplant. Older patients in developing countries should not be excluded from the selection process due only to age.     

Arterial pulse wave velocity in relation to carotid intima-media thickness, brachial flow-mediated dilation and carotid artery distensibility: the Cardiovascular Risk in Young Finns Study and the Health 2000 Survey

ObjectiveIncreased arterial pulse wave velocity (PWV) is a strong predictor of cardiovascular events and mortality. The data regarding the relationships between PWV and other indices of vascular damage is limited and partly controversial. We conducted the present study to examine PWV in relation to non-invasive measures of early atherosclerosis (brachial flow-mediated dilation [FMD], carotid intima-media thickness [IMT]) and local arterial stiffness (carotid artery distensibility [Cdist]).MethodsThe study population consisted of 1754 young adults (aged 30–45 years, 45.5% males) participating in the Cardiovascular Risk in Young Finns Study (YFS), and of 336 older adults (aged 46–76 years, 43.2% males) participating in the Health 2000 Survey. FMD was measured only in the YFS cohort. FMD, IMT and Cdist were assessed by ultrasound, and PWV was measured using the whole-body impedance cardiography device.ResultsIn young adults, FMD and IMT were not associated with PWV independently of cardiovascular risk factors. Moreover, FMD status was not found to modulate the association between cardiovascular risk factors and PWV. In older adults, PWV and IMT were directly and independently associated (β = 1.233, p = 0.019). In both cohorts, PWV was inversely related with Cdist, and this relation remained significant (p < 0.04) in models adjusted for cardiovascular risk factors.ConclusionsThe current findings suggest that PWV reflects a different aspect of vascular damage than FMD or IMT in young adults, whereas in older adults the information provided by PWV and IMT may be, to some extent, similar as regards subclinical vascular damage. The present observations also suggest that PWV and Cdist represent, at least in part, a similar adverse vascular wall process.     

Relationship between health status,illness perceptions,coping strategies and psychological morbidity: A preliminary study with IBD stoma patients

Background and aimsIndividuals living with IBD and a stoma are at an increased risk of anxiety and depression and it is likely that several factors mediate these relationships, including illness perceptions and coping strategies. Using the Common Sense Model (CSM), this study aimed to characterize the mediators of anxiety and depression in an IBD stoma cohort.MethodsEighty-three adults (23 males) with a stoma (25 ileostomy, 58 colostomy; 26 emergency, 57 planned, 55 permanent, 28 temporary) completed an online survey. Health status was measured with the Health Orientation Scale (HOS), coping styles assessed with the Carver Brief COPE scale, illness perceptions explored with the Brief Illness Perceptions Questionnaire (BIPQ), and anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).ResultsCombining the questionnaire data using structural equation modeling resulted in a final model with an excellent fit (χ² (11) = 12.86, p = 0.30, χ²/N = 1.17, SRMR < 0.05, RMSEA < 0.05, GFI > 0.96, CFI > 0.99). Consistent with the CSM, health status directly influenced illness perceptions, which in turn, influenced coping (emotion-focused and maladaptive coping). Interestingly, months since surgery was found to influence illness perceptions and emotion-focused coping directly, but not health status. While depression was influenced by illness perceptions, emotion-focused coping and maladaptive coping, anxiety was only influenced by illness perceptions and maladaptive coping.ConclusionsThe preliminary results provide further evidence for the complex interplay between psychological processes. In terms of directions for psychological interventions, a focus on identifying and working with illness perceptions is important.     

Association of HbA1c with emotion regulation,intolerance of uncertainty,and purpose in life in type 2 diabetes mellitus

BackgroundThe extant literature lacks breadth on psychological variables associated with health outcome for type 2 diabetes mellitus (T2DM). This investigation extends the scope of psychological information by reporting on previously unpublished factors.ObjectiveTo investigate if intolerance of uncertainty, emotion regulation, or purpose in life differentiate T2DM adults with sustained high HbA_1c (HH) vs. sustained acceptable HbA_1c (AH).Subjects and methodsCross-sectional observational study. Adult patients with diagnosed T2DM meeting inclusionary criteria for AH, HH, or a nondiabetic reference group (NDR) were randomly selected and invited to participate. Patients who consented and participated resulted in a final sample of 312 subgrouped as follows: HH (n = 108); AH (n = 98); and NDR (n = 106). Data sources included a survey, self-report questionnaires, and electronic medical record (EMR).ResultsHH individuals with T2DM reported lower purpose in life satisfaction (p = 0.005) compared to the NDR group. The effect size for this finding is in the small-to-medium range using Cohen's guidelines for estimating clinical relevance. The HH–AH comparison on purpose in life was nonsignificant. The emotion regulation and intolerance of uncertainty comparisons across the three groups were not significant.ConclusionsThe present study determined that lower purpose in life satisfaction is associated with higher HbA_1c. In a T2DM patient with sustained high HbA_1c, the primary care clinician is encouraged to consider screening for purpose in life satisfaction by asking a single question such as “Do the things you do in your life seem important and worthwhile?” The patient's response will assist the clinician in determining if meaning or purpose in life distress may be interferring with diabetes self-care. If this is the case, the clinician can shift the conversation to the value of behavioral and emotional health counseling.     

Illness perceptions in IBD influence psychological status,sexual health and satisfaction,body image and relational functioning: A preliminary exploration using Structural Equation Modeling

Background and aimsThis study aimed to characterize the relationships between illness perceptions, body image and self-consciousness, sexual health (sexual problems and sexual satisfaction), anxiety and depression, and marital and family functioning in patients with IBD.MethodsSeventy-four IBD patients (44 CD, 13 males, 61 females, mean age 38 years) completed an online questionnaire. Illness perceptions explored with the Brief Illness Perceptions Questionnaire, and anxiety and depression measured using the Hospital Anxiety and Depression Scale, Sexual Problems Scale, Sexual Satisfaction Scale, Marital Functioning Scale, Family Functioning Scale, and Body Image and Self-Consciousness During Intimacy Scale.ResultsExploratory Structural Equation Modeling (SEM) provided a final model with an excellent fit (χ² (25) = 27.84, p = .32, χ²/N = 1.11, CFI > 0.99, RMSEA < 0.04, SRMR < 0.07, GFI > 0.93). Illness perceptions had a significant direct influence on depression (β = 0.49, p < 0.001), anxiety (β = 0.55, p < 0.001), and family functioning (β = − 0.17, p < 0.001). Several mediating pathways were also found involving sexual problems, sexual satisfaction, and body image and self-consciousness during intimacy. Being female was associated with increased sexual problems but increased sexual satisfaction.ConclusionsThe findings provide further evidence for the adverse impact of patient IBD-related illness perceptions on anxiety and depression. The findings also provide the preliminary evidence for the impact of illness perceptions and psychological comorbidity in relation to sexual health and relationship and family functioning. These aspects of psychological processing provide a framework and direction for further research into the nature of IBD and its influence on the patient and their family.     

Perceived autonomy support,psychological needs satisfaction,depressive symptoms and apathy in French hospitalized older people

Based on the self-determination theory, the aim of the present study was (1) to provide a better understanding of older people’s psychological needs satisfaction in geriatric care units, then to link this information with depressive symptoms and apathy; (2) to examine whether the perceived autonomy support from health care professionals differs between needs satisfaction profiles; and (3) to investigate for all participants how each need satisfaction was related to depressive symptoms and apathy. Participants (N = 100; M_age = 83.33 years, SD = 7.78, 61% female) completed the measures of psychological needs satisfaction, perceived autonomy support, geriatric depression and apathy. Sociodemographic data were also collected. Cluster analyses showed three distinct profiles: one profile with low-moderate need satisfaction, one profile with high-moderate need satisfaction and one profile with high need satisfaction. These profiles are distinct, and did not differ in terms of participants' characteristics, except gender. Multivariate analysis of covariance (MANCOVA) revealed that participants with low-moderate need satisfaction profile have significantly higher level of depressive symptoms and apathy, and lower levels of perceived autonomy support than participants of the two other profiles. Moreover, for all participants, regression analyses revealed that both competence and relatedness needs satisfaction significantly and negatively explained 28% of the variance in depressive symptoms score and 44% of the variance in apathy score. Our results highlight the interest to examine more thoroughly the variables fostering autonomy-supportive environment in geriatric care units, and to deepen the relationship between competence and relatedness needs satisfaction and depressive symptoms and apathy.     

Late-career unemployment and all-cause mortality,functional disability and depression among the older adults in Taiwan: A 12-year population-based cohort study

ObjectiveTo evaluate whether late-career unemployment is associated with increased all-cause mortality, functional disability, and depression among older adults in Taiwan.MethodIn this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was conducted from 1996 to 2007. The complete data from 716 men and 327 women aged 50–64 years were retrieved. Participants were categorized as normally employed or unemployed depending on their employment status in 1996. The cumulative number of unemployment after age 50 was also calculated. Logistic regression analysis was used to examine the effect of the association between late-career unemployment and cumulative number of late-career unemployment on all-cause mortality, functional disability, and depression in 2007.ResultsThe average age of the participants in 1996 was 56.3 years [interquartile range (IQR) = 7.0]. A total of 871 participants were in the normally employed group, and 172 participants were in the unemployed group. After adjustment of gender, age, level of education, income, self-rated health and major comorbidities, late-career unemployment was associated with increased all-cause mortality [Odds ratio (OR) = 2.79; 95% confidence interval (CI) = 1.74–4.47] and functional disability [OR = 2.33; 95% CI = 1.54–3.55]. The cumulative number of late-career unemployment was also associated with increased all-cause mortality [OR = 1.91; 95% CI = 1.35–2.70] and functional disability [OR = 2.35; 95% CI = 1.55–3.55].ConclusionLate-career unemployment and cumulative number of late-career unemployment are associated with increased all-cause mortality and functional disability. Older adults should be encouraged to maintain normal employment during the later stage of their career before retirement. Employers should routinely examine the fitness for work of older employees to prevent future unemployment.     

What are the sociodemographic and health determinants for older adults continue to participate in work?

ObjectiveThis study aimed to determine the sociodemographic and health factors that influence older adults who continue to participate in the workforce.MethodsData were collected and evaluated for 1762 older adults aged 65 years and older who were living in the community and were enrolled in a population-based study (FIBRA Network Study). Older adults who participated in the workforce were compared with those who did not in terms of sociodemographic characteristics, physical and mental health, and physical functioning and performance in advanced and instrumental activities characteristic of daily living. A multivariate hierarchical logistic regression analysis was performed.ResultsFactors associated with not participating in the workforce were aged (OR: 1.71, [95% CI: 1.26–2.30], p < 0.001), female gender (OR: 1.70, [95% CI: 1.22–2.37], p = 0.002), poor visual perception (OR: 1.31, [95% CI: 1.00–1.72], p = 0.046), using 4 or more medications regularly (OR: 1.41, [95% CI: 1.489–2.247], p = 0.034), having 3 or more comorbidities (OR: 1.44, [95% CI: 1.01–2.04], p = 0.040), and a handgrip strength below 24.6 kg/f (18.1–24.6 kg/f (2nd tertile): OR: 1.52, [95% CI: 1.06–2.18], p = 0.022; 0–18 kg/f (1st tertile): OR: 1.60, [95% CI: 1.08–2.38], p = 0.019). The probability estimates of the final model explained 67.9% of the events related to not participating in the workforce, as observed by the area under the ROC curve.ConclusionOur results highlight that work in later life is influenced by sociodemographic characteristics, intrinsic capacity, and multimorbidity. We suggest that strategies for optimizing healthy and active aging may help older people to continue participating in the workforce and contributing toward their communities.     

Cortisol and physical performance in older populations: Findings from the international mobility in aging study (IMIAS)

ObjectiveTo compare diurnal cortisol profiles across samples of older adults from diverse populations and to examine if differences in circadian cortisol secretion are associated with poor physical performance (SPPB<9).MethodsData were collected during the baseline survey of the International Mobility in Aging Study conducted in 2012 in Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania) and Manizales (Colombia). Salivary cortisol was collected from a subsample of 309 participants instructed to collect saliva on two consecutive days, and 5 different intervals each day: upon awakening (M1), 30 min (M2) and 60 min after awakening, at 15:00 h and before bedtime (E). Cortisol was analyzed using enzyme immunoassay kits. Physical performance was measured by the Short Physical Performance Battery (SPPB). Mixed linear models were fit to assess the associations between cortisol diurnal output and physical performance, adjusting for potential confounders.ResultsKingston, Saint-Hyacinthe and Tirana residents had significantly higher cortisol values than their Manizales counterparts, with the population from Tirana showing the highest levels. Attenuated morning cortisol peak (M2) (p = 0.025), higher cortisol bed time (E) (p = 0.005), and lower M2/E ratio (p < 0.001) were found among those with SPPB<9 compared with those with good physical performance (SPPB ≥ 9). These results were not altered after adjustment by potential confounders.ConclusionCortisol profiles varied across four diverse populations of older adults. Circadian cortisol secretion is associated with physical performance as an attenuated morning response and higher bed time values were observed in older adults with SPPB < 9.     

Caring for disabled older adults with musculoskeletal conditions: A transactional model of caregiver burden,coping strategies,and depressive symptoms

ObjectivesThis study investigated the mediating role of coping strategies in the relationship between caregiver burden and depressive symptoms among family caregivers caring for disabled older adults with musculoskeletal (MSK) conditions.MethodsThe cross-sectional data were from a quota sampling of 494 pairs of disabled older adults and their primary family caregivers in Shanghai, China. The disabled older adults had MSK conditions and limitations in activities of daily living. The mean ages of the older adults and their caregivers were 83.9 and 62.6 years. Path analysis was conducted to test the proposed hypotheses.ResultsCaregivers of adults with MSK conditions were more likely to use active coping to handle time dependence (β [SD] = 0.182 [0.055]) and physical burden (β [SD] = 0.226 [0.071]) and to use avoidant coping to handle developmental burden (β [SD] = 0.414 [0.061]). Both coping strategies were used to handle social burden(active: β [SD] = 0.179 [0.078]; avoidant: β [SD] = 0.241 [0.073]). Experiencing emotional burden reduced the likelihood of using both coping strategies (active: β [SD] = −0.266 [0.066]; avoidant: β [SD] = −0.373 [0.062]). Active coping had a protective impact on depressive symptoms (β [SD] = −0.228 [0.050]), whereas avoidant coping had an adverse impact on depressive symptoms (β [SD] = 0.232 [0.053]).ConclusionsThe findings confirm the mediating effects of coping strategies in the relationship between caregiver burden and depressive symptoms.