Age Patterns in Mental Representations of Time: Underlying Constructs and Relevant Covariates

Background/Study Context: Research suggests that mental representations of time encompass multiple distinct aspects that vary with age, but prior studies rarely assessed more than one aspect of time perception and did not systematically consider relevant covariates. This lack of integration across studies hampers theory building and limits a deeper understanding of underlying constructs.

Methods: Five widely used and conceptually distinct measures of time perception (i.e., perceived life position, global future horizons, future orientation and planning, self-continuity, and the temporal extension of episodic future thought) were administered to a demographically stratified adult life-span sample. Theoretically implicated covariates, including cognition, current affect, personality, and subjective health, were also assessed.

Results: Principle component analyses suggested a four-component solution. Perceived life position and global future horizons formed a single component reflecting subjective life span; the remaining measures each constituted separate components. The life span component and episodic future thought were negatively associated with age, self-continuity was positively associated with age, and future orientation did not vary by age. Among the covariates, mental and physical health showed the most pronounced associations with time perceptions, but the direction of effects varied across components.

Conclusion: Findings suggest that mental representations of time encompass multiple components that show distinct age patterns and associations with covariates. Implications for theory building and practical applications are discussed.     

Self-rated health trajectories and mortality among older adults

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates. METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources. RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked. DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.     

Ten dimensions of health and their relationships with overall self-reported health and survival in a predominately religiously active elderly population: the cache county memory study

OBJECTIVES: To document the extent of healthy aging along 10 different dimensions in a population known for its longevity. DESIGN: A cohort study with baseline measures of overall self-reported health and health along 10 specific dimensions; analyses investigated the 10 dimensions as predictors of self-reported health and 10-year mortality. SETTING: Cache County, Utah, which is among the areas with the highest conditional life expectancy at age 65 in the United States. PARTICIPANTS: Inhabitants of Cache County aged 65 and older (January 1, 1995). MEASUREMENTS: Self-reported overall health and 10 specific dimensions of healthy aging: independent living, vision, hearing, activities of daily living, instrumental activities of daily living, absence of physical illness, cognition, healthy mood, social support and participation, and religious participation and spirituality. RESULTS: This elderly population was healthy overall. With few exceptions, 80% to 90% of persons aged 65 to 75 were healthy according to each measure used. Prevalence of excellent and good self-reported health decreased with age, to approximately 60% in those aged 85 and older. Even in the oldest old, the majority of respondents were independent in activities of daily living. Although vision, hearing, and mood were significant predictors of overall self-reported health in the final models, age, sex, and cognition were significant only in the final survival models. CONCLUSION: This population has a high prevalence of most factors representing healthy aging. The predictors of overall self-reported health are distinct from the predictors of survival in this age group and, being potentially modifiable, are amenable to clinical and public health efforts.     

Latitude of choice and well-being in institutionalized and noninstitutionalized elderly

While important positive effects on the psychological and physical well-being of the elderly often result from increased perceived and actual personal control, the literature also reflects many inconsistent findings. The lack of consensus on aging and the psychology of control has been variously attributed to differences in methodology, measurement devices, theoretical assumptions and the impact of moderator variables. To help bring order to this area the present study evaluated the Latitude of Choice model to determine whether Latitude of Choice scores differ across living arrangements, gender or age. Analysis of covariance tests, controlling for measures of education, perceived health and economic satisfaction, yielded significant main effects but no significant interactions. Partial correlations between Latitude of Choice and measures of psychological well-being, for the total sample and each of the main effect samples, were all significant. These findings provide substantive support for the theoretical approach that underlies Latitude of Choice as a measure of personal control of everyday activities and the potential value of personal control as a moderator of well-being in different environments.     

Stability in perceived control: implications for health among very old community-dwelling adults

Objective: Our purpose was to examine how stability/variability in perceptions of control (PC) relate to a variety of health-related variables. Design: PC stability/variability across multiple domains was assessed in a longitudinal design including 318 adults, 72 to 99 years of age. Method: PC and health-related measures were obtained during in-person interviews conducted approximately 3 months apart. PC variability was assessed in relation to self-reported health outcomes (perceived health, chronic health conditions, functional status) and objective measures of physician visits and hospitalizations recorded over a 4-year period in a highly reliable and comprehensive database. Results: PC variability was associated with poorer health, poorer functional status, and more physician visits and hospital admissions, even after statistically controlling for mean PC level and direction-of-change in PC. Implications: Our findings suggest that health and well-being among very old individuals may be compromised by fluctuating levels of PC, or conversely, that stability in PC enhances health.     

The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture

BACKGROUND: Polysomnography is used to assess sleep quality and to gauge the functional effect of sleep disorders. Few population-based data are available to estimate the variation in sleep architecture across the population and the extent to which sleep-disordered breathing (SDB), a common health condition, contributes to poor sleep independent of other factors. The objective of this study was to describe the population variability in sleep quality and to quantify the independent associations with SDB. METHODS: Cross-sectional analyses were performed on data from 2685 participants, aged 37 to 92 years, in a community-based multicenter cohort study. Dependent measures included the percentage time in each sleep stage, the arousal index, and sleep efficiency. Independent measures were age, sex, ethnicity, comorbidity status, and the respiratory disturbance index. RESULTS: Lighter sleep was found in men relative to women and in American Indians and blacks relative to other ethnic groups. Increasing age was associated with impaired sleep in men, with less consistent associations in women. Notably, women had, on average, 106% more slow wave sleep. Sleep-disordered breathing was associated with poorer sleep; however, these associations were generally smaller than associations with sex, ethnicity, and age. Current smokers had lighter sleep than ex-smokers or never smokers. Obesity had little effect on sleep. CONCLUSIONS: Sleep architecture varies with sex, age, ethnicity, and SDB. Individual assessment of the effect of SDB on sleep quality needs to account for other host characteristics. Men, but not women, show evidence of poorer sleep with aging, suggesting important sex differences in sleep physiology.     

Relationship between subjective social status and measures of health in older Taiwanese persons

OBJECTIVES: To compare the association between subjective ladder ranking and health measures with the association between objective indices and health measures in older Taiwanese men and women. DESIGN: Cross-sectional study. SETTING: A population-representative sample of elderly and nearly elderly men and women in Taiwan. PARTICIPANTS: The study included 991 participants from the Social Environment and Biomarkers of Aging Study in Taiwan. MEASUREMENTS: The information collected included demographic characteristics; subjective ladder score of SES; objective measures of SES, including education, income, and occupation; health behaviors; health-related variables such as self-rated health, basic activity of daily living difficulties, instrumental activity of daily living (IADL) difficulties, and physical activity difficulties; and depression score. RESULTS: Low ladder score was associated with poorer self-rated health and more reported IADL and physical activity difficulties, even after adjustment for objective measures of SES and other covariates. The multiply adjusted odds ratio for a one-quartile difference in ladder score and worse self-rated health was 1.19 (95% confidence interval=1.06-1.33). The associations between subjective ladder ranking and health status were generally stronger in those who had 6 years or less of education than in those who received more education. CONCLUSION: A simple subjective assessment of one's ranking on the social hierarchy was associated with self-rated health and physical functional status in an older ethnic Chinese population. The associations were independent of the effects of traditional objective measures of SES, such as education, income, and occupation.     

Socioeconomic inequalities in health in older women

Socioeconomic status differentials in health are well documented. Less is known about the socioeconomic variation in health in older people, and in older women in particular. The aim of the study was to examine the association between socioeconomic status and health in older women in relation to two indicators of socioeconomic status and three measures of health, and further, to investigate whether socioeconomic differences in health increase or decrease with advancing age. Data from a cross-sectional population based health survey inviting all women ≥70 years were analysed; 6,380 women aged 70–103 years participated. Logistic regression was applied to analyse variation in health by socioeconomic status. Disadvantaged socioeconomic status (i.e. lower educational levels and previous manual or never been in paid work) was significantly associated with poorer health outcomes, whether measured as self-assessed health or depression. Limiting long-standing illness was significantly associated with never been in paid work. The associations were not attenuated by simultaneous adjustments for health behavioural factors, social support, and marital status. Additional adjustments for medical conditions did only alter the significant association between employment status and limiting long-standing illness. The analyses revealed that educational inequalities did not decrease with advancing age, whereas the results for employment varied across age groups. Our findings suggest an enduring relation between socioeconomic status and health in later life. The study adds to the understanding of the consistent associations between poorer health and social disadvantages at older age. We are not aware of any previous study showing the persistence of social inequalities in health upon adjustments for medical conditions.     

Survival in advanced age--a comparison of short- and long-lived probands of the Bonn gerontologic longitudinal study

A comparison between rather short-lived (n = 60) and rather long-lived (n = 88) participants of the initial sample of the Bonn longitudinal study on aging (BOLSA) yielded evidence - with regard to differences in the central tendencies of these two groups - for a variety of determinants of longevity in old age. The statistical analyses included eight constructs or clusters of variables, respectively, that were either empirically or theoretically based and were supposed to have predictive power (intelligence, health status, satisfaction, personality, family involvement, socioeconomic/ecological aspects, coping techniques/dominant themes of life, general social participation). Within each "cluster", it could be referred to several different aspects. Besides defining general characteristics of longevious people, the purpose of the study was to look for differentiating aspects. Thus, a host of evidence was yielded for gender- and cohort-linked differences in the structure and relevance of the included central clusters with regard to "prediction" of advanced longevity in old age.     

Personality and perceived health in older adults: the five factor model in primary care

Responses to specific questions tapping perceived health are associated with morbidity, mortality, and the use of health services, yet there has been little research on their personality correlates. We examined the associations between Five Factor Model personality traits and responses to four items extracted from the Medical Outcomes Study Short Form-36 in 266 primary care patients who were 65 years of age or older. Multivariate analyses controlling for age, gender, depressive symptoms, and physical disease burden showed that having a higher Neuroticism score was associated with worse perceived health in response to all items except "I am as healthy as anybody I know." Having a lower Extraversion score was associated with worse perceived health in response to the item "I expect my health to get worse." We discuss implications for understanding personality influences on morbidity, mortality, and health services utilization.     

Mental health of the Canadian population: a comprehensive analysis

This study examines eight measures of mental health and looks for associations with nine potential demographic and psychosocial determinants. Data from the National Population Health Survey (NPHS), analyzed by logistic regression, reveal consistently strong, graded, independent associations of current stress, social support, life events, education and childhood traumas with both positive and negative indicators of mental health status. Sex differences exist for four of eight measures. For most indicators, mental health is relatively poor among youth and improves with age. Physical and mental health problems are associated. There is no independent relation between mental health and income adequacy or province of residence. Two measures used in several previous Canadian surveys are recommended for inclusion in the NPHS to better monitor population mental health.     

Psychosocial factors,gender and late-life mortality

Psychosocial factors have rarely been examined to determine their influence on longevity in very old adults. The present study evaluated the effect of psychosocial factors, self-rated health and self-rated life expectancy on mortality risk over a nine-year period. A stratified random sample of 2087 males and females aged 65 and older recruited for the Australian Longitudinal Study of Ageing were assessed on measures of perceived control, morale, self-rated health (SRH), social participation, life satisfaction, self-rated life expectancy and self reported physical function. Cox hierarchical regression analyses revealed that for men, perceived control was associated with longevity after controlling for age, SRH and physical function. For women, social participation, morale and perceived control were associated with longevity after controlling for age, SRH and physical function. The effects were of moderate size. Results suggest that social participation and well-being, may account for gender differences in longevity. The impact of positive aspects of psychological functioning, particularly feeling in control, have been under-recognised in gerontological research, which is unfortunate, given their amenability to change or intervention that could result in not only a longer life, but also a more satisfying one. Kaarin Anstey is a Fellow at the Centre for Mental Health at the Australian National University and works on longitudinal epidemiological studies of aging and mental health. She has published extensively in the field of gerontology, focussing on predictors of cognitive decline, psychological predictors of mortality and biomarkers of aging. Centre for Mental Health Research, Australian National University, School of Psychology, Flinders University, Centre for Ageing Studies, Flinders University. Mary Luszcz is Professor of Psychology at Flinders University, Editor of the Behavorial Sciences Section of Gerontology and former Secretary General and Vice President of the International Association of Gerontology (IAG). She has published widely in the field of cognitive aging and has specific interests in memory aging, gender, and wellbeing. Gary Andrews is the immediate Past-President of the IAG, Honorary Professor and Director of the Centre for Ageing Studies, Flinders University of South Australia. He is a principal investigator of the ALSA, and has also been responsible for a series of studies of health and social aspects of aging in more than 16 countries in Asia, the Pacific and in the Middle East under WHO auspices.     

Assessing the influence of adult day care on client satisfaction

Using data collected from 74 adult day care centers, this study measured various program characteristics from four different categories of respondents--clients, caregivers, staff members, and administrators. The perceptions of these respondents were examined for their associations with each other and with client satisfaction. Three program characteristics, as perceived by clients, were significantly associated with client satisfaction (staff caring, general morale, and interior environment). The caregivers', staff members' and administrators' perceptions were not significantly associated with client satisfaction. In addition, most of these program component ratings were not significantly associated among clients, caregivers, staff members, and administrators.     

Predicting perceived health in Angolan elderly: The moderator effect of being oldest old

The objective of this study was to test the predicting effects of variables measuring social support, dependence/active perceptions, and generativity, on this facet of well-being when controlled for socio-demographic variables (age, gender, marital status, and institutionalization). The research tries to extend previous literature by assessing them in a multivariate context, studying differential effects of these variables in young old and oldest old, and offering evidence of the scarcely studied population of Angola. The sample was formed by 737 young old and 266 oldest old. It was built a hierarchical regression, in which, among the different predictors, interactions effects between age and the psychosocial factors were included. Results provide evidence of the qualitative different perceived health and well-being of the young old and oldest old. When predicting perceived health of the Angolan oldest old, psychosocial factors lose much of its importance, and age itself and the limitations that accompanied it seem to be the key point.     

The relationship between age, gender, historical change, and adults' perceptions of mental health and mental health services

The purpose of this study was to explore the impact of age, historical change, and gender on perceptions of mental health and mental health services. Using multidimensional measures to assess such perceptions among older adults (1977, 1991, 2000), and younger adults (1991, 2000), we expected that older adults would have less positive mental health perceptions than would younger adults, that more recently born cohorts of older persons would evidence more positive perceptions, and that women, especially those more recently assessed, would also evidence more positive perceptions. To an extent, we found positive historical shifts in mental health perceptions, though data also indicated that such views may have stabilized over the last decade for older persons, and interacted with age and gender in this respect. Age differences favoring younger persons were, in part, replicated across historical time, and women held more positive mental health perceptions than did men. Over historical time, older persons' mental health perceptions are, for the most part, increasingly positive, significant in light of the increasing proportion of older persons and changes in the mental health system itself. Our data suggest that efforts to reach older men should be given high priority.     

Psychosocial distress and perceived health status among elderly users of a health maintenance organization

A variety of measures was used to assess the relationship of psychosocial distress and perceived health status among 1,034 older (65+) members of an HMO. Distress was measured by recent life events, four types of social strain, and the CES-D, a measure of depression/demoralization. The distributions of these measures and perceived health status indicate that this sample was relatively healthy and undistressed. The strength of the associations within each group of variables is significant but generally modest. Using hierarchical multiple regression analysis with demographic variables, social support, and religiosity as controls, the strongest associations are between health status and the CES-D, life events, financial strain, and the strain of being single (unmarried respondents only).     

Effect of chronic disease-related symptoms and impairments on universal health outcomes in older adults

OBJECTIVES: To determine the extent to which disease‐related symptoms and impairments, which constitute measures of disease severity or targets of therapy, account for the associations between chronic diseases and universal health outcomes. DESIGN: Cross‐sectional. SETTING: The Cardiovascular Health Study (CHS) and the Health, Aging and Body Composition Study (Health ABC). PARTICIPANTS: Five thousand six hundred fifty‐four CHS members and 2,706 Health ABC members. MEASUREMENTS: Diseases included heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, and cognitive impairment. The universal health outcomes included self‐rated health, basic and instrumental activities of daily living (ADLs and IADLs), and death. Disease‐related symptoms and impairments included HF symptoms and ejection fraction (EF) for HF, Dyspnea Scale and forced expiratory volume in 1 second for COPD, joint pain for osteoarthritis, and executive function for cognitive impairment. RESULTS: The diseases were associated with the universal health outcomes (P<.001) except osteoarthritis with death (both cohorts) and cognitive impairment with self‐rated health (Health ABC). Symptoms and impairments accounted for 30% or more of each disease's effect on the universal health outcomes. In CHS, for example, HF was associated with one fewer (0.918) ADL and IADL performed without difficulty than no HF; HF symptoms accounted for 27% of this effect and EF for only 5%. The hazard ratio for death with HF was 6.5 (95% confidence interval=4.7–8.9) with EF accounting for 40% and HF symptoms for only 14%. CONCLUSION: Disease‐related symptoms and impairments accounted for much of the significant associations between the four chronic diseases and the universal health outcomes. Results support considering universal health outcomes as common metrics across diseases in clinical decision‐making, perhaps by targeting the disease‐related symptoms and impairments that contribute most strongly to the effect of the disease on the universal health outcomes.     

Self-perceptions of health: a prospective analysis of mortality, control, and health

A growing number of studies show that self-perceptions of health are an important predictor of mortality. The present study was designed to extend this research by examining the relation between health perceptions and a range of other outcome measures besides mortality, including control beliefs and morbidity. The results show that older adults who rated their health as "bad/poor" and "fair" were more than twice as likely to die within three to three-and-a-half years following the initial survey than those who perceived their health as "excellent." However, although health perceptions assessed in 1991/92 were related to health perceptions four years later, they did not predict morbidity. Health perceptions also predicted perceived control and use of control-enhancing strategies in dealing with age-related challenges, as assessed in 1995. These findings contribute to our understanding of the benefits of positive health perceptions by showing that they are connected to an adaptive psychological profile including perceptions of control and use of control-enhancing strategies that are linked to health and well-being.     

Association between aspects of oral health-related quality of life and body mass index in community-dwelling older adults

OBJECTIVES: To investigate whether underweight, normal-weight, overweight, and obese older adults differ in aspects of their oral health–related quality of life (OHRQoL).
DESIGN: Cross-sectional study using a 54-item OHRQoL questionnaire.
SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Hale, Bibb, and Pickens (rural).
PARTICIPANTS: The 291 subjects were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility. Participants ranged in age from 65 to 90 (60.5% women, 50.5% non-Hispanic white, and 50.5% rural).
MEASUREMENTS: Participants completed an in-home interview about their OHRQoL using a 54-item questionnaire and were classified into four categories of body mass index (BMI) (<20.0 (underweight), 20.0–24.9 (normal), 25.0–29.9 (overweight), and ≥30.0 (obese)). Multivariate analyses were used to examine associations between BMI and OHRQoL, adjusting for age, race, sex, depression, education, perceived income, comorbidity score, life-space mobility, and physical activity level.
RESULTS: The results suggested that a parabolic effect existed, with strongest associations occurring in the underweight and obese categories. With the normal BMI group as the reference group, obese participants were more likely to avoid eating foods they would like to eat, overweight participants were less likely to cook foods differently and reported better chewing ability, and underweight persons were more likely to limit foods they eat because of mouth dryness.
CONCLUSION: Objective measures may not accurately reflect peoples' perceptions; therefore, OHRQoL determined according to response to subjective questions is important to properly assess a patient's overall health status. Older adults who are under- or overweight should be evaluated for oral health conditions that may affect their nutritional status.