Race differences in the association of spiritual experiences and life satisfaction in older age

Objectives: The primary objective of this study was to examine an African American ‘faith advantage’ in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites.

Method: The data came from 6864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale.

Results: In a regression model adjusting for age, sex, marital status, education, income and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race by spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans.

Conclusion: The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource – distinct from worship attendance – that enable older African Americans to overcome decrements in life satisfaction and, in fact, that lower spiritual experiences may be especially harmful for older African American's life satisfaction.     

Differences in life satisfaction among older community-dwelling Hispanics and non-Hispanic Whites

Objectives: Hispanics are the fastest growing ethnic/racial group of the older adult population in the United States, yet little is known about positive mental health in this group. We examined differences in life satisfaction between demographically matched groups of older Hispanics and non-Hispanic Whites, and sought to identify specific factors associated with these differences

Methods: Participants included 126 community-dwelling English-speaking Hispanics aged 50 and older, and 126 age-, gender-, and education-matched non-Hispanic Whites. Participants completed standardized measures of life satisfaction and postulated correlates, including physical, cognitive, emotional and social functioning, as well as positive psychological traits and religiosity/spirituality.

Results: Hispanics reported greater life satisfaction than non-Hispanic Whites (p < 0.001). Ethnic groups were comparable on most postulated correlates of life satisfaction, except that Hispanics had lower levels of cognitive performance, and higher levels of daily spiritual experiences, private religious practices and compassion (ps < 0.001). Among these factors, spiritual experiences, religious practices, and compassion were significantly associated with life satisfaction in the overall sample. Multivariable analyses testing the influence of these three factors on the association between ethnicity and life satisfaction showed that higher spirituality among Hispanics accounted for ethnic differences in life satisfaction.

Conclusion: English-speaking Hispanics aged 50 and older appeared to be more satisfied with their lives than their non-Hispanic White counterparts, and these differences were primarily driven by higher spirituality among Hispanics. Future studies should examine positive mental health among various Hispanic subgroups, including Spanish speakers, as an important step toward development of culturally sensitive prevention and intervention programs aimed at promoting positive mental health.     

Association of socio-demographic factors and parental education with depressive symptoms among older African Americans and Caribbean Blacks

Objective: The purpose of this study was to examine ethnic variation in the relationship between individual socio-demographic factors, parental educational level, and late-life depressive symptoms in older African Americans and Caribbean Blacks.

Method: This cross-sectional study used data from the National Survey of American Life. A subsample of older African Americans (N = 837) and Caribbean Blacks (N = 271) was analyzed using multiple regression analysis.

Results: Findings suggest differences in predictors of depressive symptoms for the two ethnic groups. Among older African Americans, lower educational attainment and lower income were predictive risk factors for higher depressive symptoms. Findings among older Caribbean Blacks suggest that nativity and income were significantly associated with depressive symptoms. This study did not find support for any association between parental education and late-life depressive symptoms.

Conclusion: This study adds new information by considering ethnic variation in an examination of depressive symptoms in older Black Americans. The results contribute to the growing awareness of the older Caribbean Black population in the United States.     

Anxious depression among Puerto Rican and African-American older adults

Objectives: To determine racial/ethnic differences in the prevalence and impact of anxious depression (i.e. major depressive disorder, MDD, occurring concomitant with generalized anxiety symptoms) among older adults.

Method: Interviews were conducted with 218 Puerto Rican and 206 African American older (age ≥60) urban senior housing residents. Data were collected on diagnostic status, depression severity and psychosocial functioning.

Results: Results indicated a higher prevalence of MDD and anxious depression among Puerto Rican participants. Anxious depression was associated with more severe ratings of distress and suicidality compared with MDD alone, and the impact of depression and anxiety was most pronounced for the Puerto Rican participants. Puerto Rican participants also reported poorer subjective health and more substantial disability; however, these effects were independent of depression or anxiety status.

Conclusions: Anxious depression is common among older ethnic minority adults and the impact of these symptoms differs by race/ethnicity. These results highlight the importance of conducting culturally sensitive assessments of depression and anxiety among older adults.     

Sensory loss and its consequences for couples’ psychosocial and relational wellbeing: an integrative review

Objectives: Previous research has shown that marital communication is key to couples' successful illness adjustment. However, little is known about couples' experiences of health conditions characterised by communication difficulties such as acquired hearing, vision, and dual-sensory loss. The aim of this review was to identify the effect of sensory loss, and associated communication difficulties, on couples' relational and psychosocial adjustment.

Method: A systematic search was conducted to identify studies investigating the social, psychological, and relational impact of sensory loss on couples.

Results: Twenty-four articles met the criteria for inclusion in the review. Significant heterogeneity in the measurements and design of the quantitative studies prevented statistical data synthesis. All but two studies reported some effect of sensory loss on couples' psychosocial or relational wellbeing. Higher levels of marital satisfaction were found to buffer against adverse psychological outcomes. Results of quantitative and qualitative studies were synthesised to form an integrative model illustrating the associations between sensory loss and couples' relational and psychosocial wellbeing.

Conclusions: Although this review reports an association between sensory loss and couples' relational and psychosocial wellbeing, the results should be viewed with caution given that relatively few studies on couples' experiences of acquired sensory loss exist, and many have methodological limitations.     

Psychosocial correlates of aspects of sleep quality in community-dwelling Irish older adults

Objectives: While it is known that psychosocial factors affect overall sleep quality, there is little consensus on the factors that affect different aspects of sleep. The Pittsburgh Sleep Quality Index (PSQI) provides a means of examining these separate aspects of sleep.

Method: This study investigated whether the different components of the PSQI are affected by different psychosocial factors, or whether all aspects of sleep are associated with the same factors. 505 community-dwelling older adults took part in this study. Psychosocial status, comprising of measures of depression, anxiety, perceived stress, social and emotional loneliness and personality, was assessed for each participant. Health-related factors (pain, comorbidities, polypharmacy) as well as age and gender were also measured.

Results: Neuroticism, depression, anxiety and age accounted for overall sleep quality. Further analyses revealed that different psychosocial and health-related factors such as pain, loneliness and personality accounted for scores in the different components.

Conclusion: Interventions for poor sleep quality may depend on the aspect of sleep affected in the individual, and treatment may be contingent on a number of different psychosocial variables. Future research could focus on developing personalised treatment programs for older adults with sleep complaints.     

Spirituality attenuates the association between depression symptom severity and meaning in life

Objectives: This cross-sectional study examined whether spirituality moderates the association between depression symptom severity and meaning in life among treatment-seeking adults.

Method: Participants were 55 adults (≥60 years of age) newly seeking outpatient mental health treatment for mood, anxiety, or adjustment disorders. Self-report questionnaires measured depression symptom severity (Patient Health Questionnaire-9), spirituality (Spirituality Transcendence Index), and meaning in life (Geriatric Suicide Ideation Scale-Meaning in Life subscale).

Results: Results indicated a significant interaction between spirituality and depression symptom severity on meaning in life scores (β = .26, p = .02). A significant negative association between depression symptom severity and meaning in life was observed at lower but not the highest levels of spirituality.

Conclusion: In the presence of elevated depressive symptomatology, those participants who reported high levels of spirituality reported comparable levels of meaning in life to those without elevated depressive symptomatology. Assessment of older adult patients’ spirituality can reveal ways that spiritual beliefs and practices can be can be incorporated into therapy to enhance meaning in life.     

Perceived discrimination and mental health among older African Americans: the role of psychological well-being

Objectives: Examine the effect of perceived discrimination (both racial and non-racial) on the mental health of older African Americans and explore the buffering role of psychological well-being (purpose in life and self-acceptance).

Methods: Using an older African American subsample from the National Health Measurement Study (n = 397), multiple regression model by gender was used to estimate the effects of two types of discrimination (every day and lifetime) on SF-36 mental component and mediating role of two concepts of psychological well-being.

Results: With no gender difference on the everyday discrimination, older men experienced more lifetime discrimination than older women. The older men's model found that the depressive symptomology was significantly explained by only everyday discrimination and mediated by self-acceptance. The older women's model was significant, with everyday discrimination and both self-acceptance and purpose in life emerging as mediating variables.

Discussion: The prevalence of institutional lifetime discrimination for older African American men is consistent with previous research. Inconsistency with past research indicated that only everyday discrimination is statistically associated with depressive symptoms. Considering the buffering role of psychological well-being served for mental health problems, practitioners need to emphasize these factors when providing services to older African Americans. Equally important, they must address racial discrimination in mental health care settings.     

The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults

Objectives: To evaluate the relationships between perceived exposure to major lifetime discrimination, everyday discrimination, and mental health in three racial/ethnic groups of older adults.

Design: The Health and Retirement Study is a nationally representative sample of individuals 50 years and older living in the United States. A total of 6455 Whites, 716 Latinos, and 1214 Blacks were eligible to complete a self-report psychosocial questionnaire in the year 2006.

Results: Whereas 30% of the general population reported at least one type of major lifetime discrimination, almost 45% of Black older adults reported such discrimination. Relative to the other two racial/ethnic groups (82% Whites, 82.6% Blacks), Latinos were significantly less likely to report any everyday discrimination (64.2%), whereas Blacks reported the greatest frequency of everyday discrimination. Whites reported the highest levels of life satisfaction and the lowest levels of depressive symptoms. Relative to major lifetime discrimination, everyday discrimination had a somewhat stronger correlation with mental health indicators. The relationships between discrimination and mental health outcomes were stronger for White compared to Black older adults, although everyday discrimination was still significantly associated with outcomes for Black older adults.

Conclusions: Black older adults experience the greatest number of discriminative events, but weaker associated mental health outcomes. This could be because they have become accustomed to these experiences, benefit from social or cultural resources that serve as buffers, or selective survival, with the present sample capturing only the most resilient older adults who have learned to cope with the deleterious effects of discrimination.     

‘Not of this world’: The subjective experience of late-onset psychosis

Objectives: Psychosis with first onset after the age of 60 arising in the absence of dementia or primary affective disorder is thought to affect 2–4% of older people. Up to half will not respond fully to medication.The subjective experience of living with late-onset psychosis (LOP) has not yet been considered and this study represents a preliminary attempt to explore the subjective experience and psychological features of older people living with LOP.

Method: The study was conducted in Ireland. Seven participants between the ages of 67 and 87 years who met diagnostic criteria for very late-onset schizophrenia-like psychosis were interviewed using a semi-structured interview schedule. Participants spoke about previous life experiences as well as the experience of developing and living with LOP. Interpretative phenomenological analysis was used to identify common themes within their accounts.

Results: Four themes emerged which reflected participants’ subjective experiences of earlier life stages as well as their current experiences of LOP. Three interrelated themes described participants’ experiences of social isolation, a solitary coping style and the experience of the self as ‘different’. A final theme reflected participants’ attempts to explain and find meaning in their psychotic experiences.

Conclusions: Results support the view that the experience of LOP emerges in the context of psychosocial vulnerabilities combined with adversities associated with the experience of ageing.     

Lack of motivation for treatment associated with greater care needs and psychosocial problems

Objective: To compare the care needs and severity of psychosocial problems in older patients with severe mental illness (SMI) between those who were and were not motivated for treatment.

Methods: Cross-sectional study in which we enrolled 141 outpatients with SMI aged 55 and older. Needs were measured using the Camberwell Assessment of Needs for the Elderly, and psychosocial problems with the Health of the Nation Outcome Scale 65+. Motivation for treatment was assessed using a motivation-for-change scale. Parametric and non-parametric tests were used to analyze differences between motivated and non-motivated patients. Explorative logistic regression analyses were used to establish, which unmet needs were associated with motivation.

Results: Less-motivated patients had greater unmet care needs and more psychosocial problems than those who were motivated. Logistic regression analyses showed that lack of motivation was associated with greater unmet needs regarding daytime activities, psychotic symptoms, behavioral problems, and addiction problems.

Conclusions: Lack of treatment motivation was associated with more unmet needs and more severe psychosocial problems. Further research will be needed to identify other factors associated with motivation in older people with SMI and to investigate whether this group of patient benefits from interventions such as assertive outreach, integrated care or treatment-adherence therapy.     

Moderating effect of communication difficulty on the relationship between depression and pain: a study on community-dwelling older adults in Hong Kong

Objectives: This study examined the relationship between depression and pain, and the moderating effect of communication difficulty on this relationship, among community-dwelling older adults in Hong Kong.

Method: We used logistic regression to analyze secondary data regarding 12,402 Chinese older adults applying for long-term care service in Hong Kong in 2012.

Results: Approximately 30% of participants were depressed and 37% experienced communication difficulty. Depression was associated with increased pain. Communication difficulty was found to moderate the relationship between depression and pain. Pain scores increased more when individuals who experienced communication difficulty reported being depressed, compared to those who did not experience communication difficulty.

Conclusion: The moderating effect of communication difficulty may be explained by the interaction between depression and communication difficulty. Participants who were depressed and concurrently experienced communication difficulty may be more likely to catastrophize their pain and may tend to report or experience more pain. Health care professionals need to be aware of the different effects of communication difficulty on the pain experiences of older adults. Psychosocial intervention may be provided to minimize older adults’ communication barriers to pain management.     

Regulation of affect in late adulthood: effects of mild depressive symptoms

Background: Recent research has highlighted the important role of emotion dysregulation in the occurrence and maintenance of depressive symptomatology.

Objectives: The purpose of this study was to test the effects of mild depressive symptoms (MDS) on older adults’ ability to regulate emotional experiences.

Method: A total of 70 community dwelling older adults completed self-report measures of affect and were asked to report how often they use specific emotion regulation strategies.

Results: Consistent with previous theories older adults experiencing MDS reported greater difficulties in regulating affect compared to normal controls (NCs).

Conclusion: The present results provide support for previous findings demonstrating that experiencing depressive symptoms affects the ability to regulate emotional responses. Current findings are likely to be informative in terms of understanding emotion dysregulation in older adults at risk of experiencing clinical symptoms of depression.     

Savoring,resilience, and psychological well-being in older adults

Objectives: Guided by Fredrickson's broaden and build theory of positive emotions and Zautra's dynamic model of affect, the current study examines the relation between savoring positive experiences (i.e., the ability to notice and regulate positive feelings) and psychological well-being for older adults with higher and lower levels of resilience.

Method: A sample of 164 (74% female) older adults living in a large metropolitan area participated in this study. Participants were recruited from a continuing care retirement community and community centers in the surrounding area. Participants completed a survey measuring savoring, resilience, happiness, depression, and satisfaction with life.

Results: In older adults, greater ability to savor positive experiences and higher resilience both predicted greater happiness, lower depression, and greater satisfaction with life (i.e., greater psychological well-being). Savoring is associated with positive outcomes for people with higher and lower levels of resilience. However, the relationship between savoring and psychological well-being is stronger for people with lower resilience.

Conclusion: These findings have implications for the development of positive psychological interventions to enhance resilience and well-being in older adults. From a practical standpoint, adaptable interventions to enhance savoring and boost positive emotions in older adults may improve well-being and resilience to life's stressors.     

Age differences in rumination and autobiographical retrieval

Objectives: Higher well-being in older adults compared to young adults is a well-known phenomenon. However, the variables associated with this effect are still uncertain. Negative repetitive thinking (rumination) is a transdiagnostic variable related to psychopathology. It is strongly associated with depression and a lack of specificity in autobiographical retrieval. This research explores age differences in the association of rumination with mood, autobiographical memories and working memory.

Method: Two groups of participants (older adults versus young adults), recruited through a public announcement, were compared in a cross-sectional study.

Results: Older adults ruminated less than young participants. Rumination was positively associated with depression scores but not with working memory scores in both samples. More importantly, the interaction between brooding rumination and negative autobiographical memories was the only significant variable to explain the variance of mood scores in young participants. However, in older participants, the interaction between brooding and positive autobiographical memories significantly explained the variance of mood scores. Digit span forward and the interaction of brooding by negative autobiographical memories also significantly explained mood scores in older adults.

Conclusion: These results suggest that a different interaction between brooding rumination and the valence of autobiographical memories may be a relevant variable associated with mood differences by age.     

Older adults' response to the loss of a spouse: the function of spirituality in understanding the grieving process

Objective: The objective of this study was to examine the role of spirituality in helping older adults grieve the loss of a spouse in the context of a model of group psychotherapy.

Methods: Twenty-four older adults, ranging in age from 65 to 82, whose spouses had died in the previous year, were assigned, in groups of six, to a 14-week group therapy intervention facilitated by trained, experienced co-therapist social workers. All sessions were audio recorded.

Results: Qualitative analysis of the four therapy groups at beginning, middle and ending sessions yielded salient themes that illustrate associations between spirituality and shifts in self-identity, mourning the loss and social re-engagement.

Discussion: Observed were within process acknowledgement of the role played by spiritual beliefs in mourning the loss of a spouse. Implications for group intervention for older adults grieving the loss of a spouse are discussed.     

Physical health-related quality of life among older adults with personality disorders

Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50.

Methods: Data for 16,884 adults ages 50 and older from the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants’ PHRQoL.

Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score.

Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs.     

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.