Psychosocial factors associated with fall-related hip fractures

BACKGROUND: fall-related injuries in older people are a major public health concern. This study examined the relationship between psychosocial determinants of healthy ageing and risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for promotion of healthy ageing strategies in population-based interventions for fall injury prevention. METHODS: a case-control study was conducted with 387 participants, with at least two controls recruited per case. Cases of fall-related hip fracture in community-dwelling people aged 65 and older were recruited from hospital admissions in Brisbane, Australia, in 2003-2004. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire assessing psychosocial factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: psychosocial factors having a significant independent protective effect on hip fracture risk included being currently married [OR: 0.44 (0.22 to 0.88)], living in present residence for 5 years or more [OR: 0.43 (0.22 to 0.84)], having private health insurance [OR: 0.49 (0.27 to 0.90)], using proactive coping strategies [OR: 0.52 (0.29 to 0.92)], having a higher level of life satisfaction [OR: 0.47 (0.27 to 0.81)], and engagement in social activities in older age [OR: 0.30 (0.17 to 0.54)]. CONCLUSION: this study suggests that psychosocial determinants of healthy ageing are protective in fall-related hip fracture injury in older people. Reduction in the public health burden caused by this injury may then be achieved by implementing healthy ageing strategies involving community-based approaches to enhance the psychosocial environments of older people.     

Volunteering and health among older people: a review

This paper presents a review of the available literature on the relationship between volunteering and health among older people. There is consistent evidence that morbidity rates, functional health indices, self reported health and life satisfaction are affected by formal and informal volunteering. Some studies suggest that the benefits of volunteering are reciprocal, in that both those who give and those who receive assistance benefit. The evidence is consistent with the proposal that social capital is generated through volunteering. It is likely that the presence of high levels of social capital supports and maintains the health of older persons, provides informal support in times of sickness and stress and thus enhances quality of life as well as reducing or delaying the onset of illness and death.     

Productive activities and psychological well-being among older adults

OBJECTIVES: The purpose of this study was to test whether paid work and formal volunteering reduce the rate of mental health decline in later life. METHODS: Using four waves of Health and Retirement Study data collected from a sample of 7,830 individuals aged 55 to 66, I estimated growth curve models to assess the effects of productive activities on mental health trajectories. The analytical strategy took into account selection processes when examining the beneficial effects of activities. The analyses also formally attended to the sample attrition problem inherent in longitudinal studies. RESULTS: The results indicated that activity participants generally had better mental health at the beginning of the study. Full-time employment and low-level volunteering had independent protective effects against decline in psychological well-being. Joint participants of both productive activities enjoyed a slower rate of mental health decline than single-activity participants. DISCUSSION: The results are consistent with activity theory and further confirm the role accumulation perspective. The finding that full-time work combined with low-level volunteering is protective of mental health reveals the complementary effect of volunteering to formal employment. Methodological and theoretical implications are discussed.     

Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study

BACKGROUND: Fall-related hip fractures are one of the most common causes of disability and mortality in older age. The study aimed to quantify the relationship between lifestyle behaviours and the risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for the promotion of healthy ageing as a population-based intervention for falls injury prevention. METHODS: A case-control study was conducted with 387 participants, with a case-control ratio of 1:2. Incident cases of fall-related hip fracture in people aged 65 and over were recruited from six hospital sites in Brisbane, Australia, in 2003-04. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire designed to assess lifestyle risk factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: Behavioural factors which had a significant independent protective effect on the risk of hip fracture included never smoking [adjusted odds ratio (AOR): 0.33 (0.12-0.88)], moderate alcohol consumption in mid- and older age [AOR: 0.49 (0.25-0.95)], not losing weight between mid- and older age [AOR: 0.36 (0.20-0.65)], playing sport in older age [AOR: 0.49 (0.29-0.83)] and practising a greater number of preventive medical care [AOR: 0.54 (0.32-0.94)] and self-health behaviours [AOR: 0.56 (0.33-0.94)]. CONCLUSION: With universal exposures, clear associations and modifiable behavioural factors, this study has contributed evidence to reduce the major public health burden of fall-related hip fractures using readily implemented population-based healthy ageing strategies.     

Review Article: Healthy ageing in rural Australia: Issues and challenges

Approximately 36% of the rural Australian population is 65 years and older. In fact, many rural and remote communities have higher proportions of older people than metropolitan centres. The rate of growth, patterns of migration, higher levels of health risk factors and of social and economic disadvantage all impact on rural healthy ageing. Older people in rural communities have become marginalised by longstanding misconceptions about rural life and urban‐centric policies, much of which goes unchallenged because of a paucity of research in key areas and a lack of intrarural research. Understanding the complexities of rural healthy ageing is challenging, and more research is required to develop a stronger empirical base. The aim of this review is to critique the literature related to rural ageing in Australia to identify the issues and challenges for rural healthy ageing and implications for policy and practice.     

Childhood adversity and healthy ageing: a study of the Chinese older population

This study examines the relationship between childhood adversities and healthy ageing in the Chinese older population. The data come from the China Health and Retirement Longitudinal Survey (CHARLS), a national survey that collected life history and ageing-related information on 9248 older people aged over 60 in 2014 and 2015. The analysis of healthy ageing focuses on seven indicators: IADL limitations, ADL limitations, cognitive functioning, depressive symptoms, life satisfaction, self-reported health, and chronic illness. Using k-means clustering, an unsupervised learning technique, we identified four qualitatively different groups according to their achievement in healthy ageing. We studied 17 types of childhood adversities and found that experiencing multiple childhood adversities is associated with a lower probability of achieving healthy ageing. This relationship is moderated by age and gender. Women are more vulnerable than men to the negative impacts of childhood adversities. The threat of childhood adversities to healthy ageing is greatly attenuated among people aged over 80. We argue that the policy response to healthy ageing should not be confined to those services and programmes that directly target older people. Instead, healthy ageing can be better addressed by concerted efforts in different areas of social policy.     

The health advantage of volunteering is larger for older and less healthy volunteers in Europe: a mega-analysis

There is a vast literature on the health benefits associated with volunteering for volunteers. Such health advantages are likely to vary across groups of volunteers with different characteristics. The current paper aims to examine the health advantages of volunteering for European volunteers and explore heterogeneity in the association between volunteering and health. We carry out a mega-analysis on microdata from six panel surveys, covering 952,026 observations from 267,212 respondents in 22 European countries. We provide open access to the code we developed for data harmonization. We use ordinary least squares, fixed effects, first difference, and fixed effect quantile regressions to estimate how volunteering activities and changes therein are related to self-rated health for different groups. Our results indicate a small but consistently positive association between changes in volunteering and changes in health within individuals. This association is stronger for older adults. For respondents 60 years and older, within-person changes in volunteering are significantly related to changes in self-rated health. Additionally, the health advantage of volunteering is larger for respondents in worse health. The advantage is largest at the lowest decile and gradually declines along the health distribution. The magnitude of the association at the first decile is about twice the magnitude of the association at the ninth decile. These results suggest that volunteering may be more beneficial for the health of specific groups in society. With small health advantages from year to year, volunteering may protect older and less healthy adults from health decline in the long run.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00691-5.     

Productive Ageing in China: Development of Concepts and Policy Practice

With a growing ageing population, productive ageing in China must evolve with the new social and historical context. This paper summarizes the development of the concept of productive ageing in Chinese history and its components. By referring to other related concepts such as social participation among older adults and active ageing, it supplements the conceptual framework of productive ageing and makes it more complete. This paper proposes that the conceptual framework of productive ageing includes not only the social and political participation of older adults but also their contributions within families. It asserts that older adults are the most important part of productive ageing, as both the agents and the beneficiaries, in achieving the ultimate goal of harmonious development of individual and social values.     

Volunteering and mortality among older adults: findings from a national sample.

OBJECTIVES: Although a number of authors have proposed that older volunteers should benefit in terms of better health and well-being, few researchers have examined the issue empirically to see whether this is true. The purpose of this article is to build on this literature by empirically examining the association between volunteering and mortality among older adults. METHODS: Using data from a nationally representative sample, we use Cox proportional hazards regression to estimate the effects of volunteering on the rate of mortality among persons aged 65 and older. RESULTS: We find that volunteering has a protective effect on mortality among those who volunteered for one organization or for forty hours or less over the past year. We further find that the protective effects of volunteering are strongest for respondents who report low levels of informal social interaction and who do not live alone. DISCUSSION: We discuss the possibility that the curvilinear relationship we observe between volunteering and mortality is due to a combination of factors, including self-identity, role strain, and meaningfulness. Other research using more precise data is needed to determine whether these ideas are supportable.     

Successful ageing: The case of Taiwan

Aim: To investigate the conditions of successful ageing in Taiwan. Methods: The respondents included two age groups, namely, 45–64 years (n = 1143), and 65 years and older (n = 1309), from a cross‐section national representative survey conducted in 2007. Results: Older people faced more problems that cause depression than their counterparts. Eleven per cent of older people were in the labour market. Neither middle‐aged people nor older people were actively involved in volunteer services. Those who lived longer had less social support. Over 50% felt their financial preparations for later life were not adequate. Educational levels and family income were the significant factors affecting the levels of successful ageing. Conclusions: Improvement in the four dimensions of successful ageing must be re‐emphasised for both age groups.     

Developing an Older Adult Volunteer Program in a New York Chinese Community: An Evidence-Based Approach

This study reports the results of a pilot volunteer project for older Chinese immigrants and documents benefits for both volunteers and caregiver recipients. Using a social marketing approach, the volunteer project was designed as a social model to promote better health among older Chinese immigrants in New York City. The packaging of this health promotion project as a volunteer program was based on a strengths perspective. In the program, 18 older Chinese immigrants were trained to provide support and referral to family caregivers of ill relatives in the Chinese community. At 6 months, outcomes were evaluated for both volunteers and caregivers. The older volunteers perceived benefits associated with volunteering, specifically, a greater sense of well-being and satisfaction with life. In addition, the majority of volunteers felt empowered by training and volunteering (100 %), felt the skills they learned improved communication with their own families (90 %), and reported physical and emotional health benefits (61 %). At the same time, caregivers reported stress reduction following volunteer support. Findings suggest that a volunteer program model may be an effective health promotion intervention for older Chinese immigrants.     

Lay perceptions of successful ageing: findings from a national survey of middle aged and older adults in Britain

The main aim of the research presented here was to identify perceptions of successful ageing among people in middle and older age groups. The method was a British population survey of 854 community-dwelling men and women aged 50 or more. Just over three-quarters of respondents rated themselves as ageing successfully (“very well” or “well”). Respondents’ definitions of successful ageing, and the reasons given for their self-ratings, based on open-ended questioning, illustrated the multidimensionality of the concept. Definitions varied with respondents’ characteristics. Self-rated health status and quality of life consistently retained significance in the multivariate models of predictors of self-rated successful ageing, while self-rated quality of life made the greatest contribution to the models. Reporting a longstanding, limiting illness was not significant. The overall models explained about a third of the variation in self-rated successful aging. Lay definitions of successful ageing were multidimensional. A biomedical perspective of successful ageing therefore needs balancing with a psycho-social perspective, and vice versa. This is particularly relevant for biomedical approaches which have largely ignored the rich tradition of social and psychological research on this topic. Self-rated successful ageing should be included in measuring instruments to enhance social relevance. This research, with the use of open-ended questioning, makes a novel methodological contribution to the literature, is unique in questioning middle aged as well as older people, and provides a British perspective on a largely US and German topic.An erratum to this article can be found at     

Aging in America: The Link Between Productivity and Resources in the Third Age

The United States, like most industrialized nations, has experienced rapid population aging in the last few decades. The social changes associated with population aging resulted in the emergence of a period in later life called the third age, a period which occurs after retirement and prior to the onset of disability. The depiction of third agers as healthy, retired, and resource-rich has led to a growing expectation that they the capacity to remain productive in society through volunteerism. This study examined the extent to which the characteristics associated with the third age shape whether and how much older adults volunteer in the United States. Results from logistic regression models indicate that third age characteristics, including having adequate economic, human, health, and temporal capital, are associated with volunteer behaviors, and that having access to a social network also increases the likeliness of volunteering. These characteristics suggest that possession of and access to these resources is important to having the ability to “choose” to engage in voluntary activities. Furthermore, if the United States seeks to increase participation of older adults in such activities, it is important to facilitate opportunities for elders to obtain access to the resources needed to volunteer and support opportunities for older adults and society to mutually benefit from such engagement.     

Differential benefits of volunteering across the life course

OBJECTIVES: Studies often fail to adequately test the causal relationship between volunteering and well-being. Yet the media and empirical research have focused attention on the impact of volunteering on the well-being of elderly persons. This study addresses two questions: First, does volunteering improve the psychological and physical well-being of elderly persons? Second, do elderly volunteers experience different benefits than younger adults? METHODS: Using nationally representative panel data, I assessed the long-term impact of volunteering on the life satisfaction and perceived health of persons aged 60 and over. I then compared ordinary least squares regression results for seniors with those for younger adults. RESULTS: I found that older volunteers experienced greater increases in life satisfaction over time as a result of their volunteer hours than did younger adult volunteers, especially at high rates of volunteering. Older adults experienced greater positive changes in their perceived health than did younger adult volunteers. DISCUSSION: The type of volunteer work in which older and younger adults engage may be part of the reason for these differential effects. But the context in which older and younger adults volunteer and the meaning of their voluntarism are more likely explanations. Researchers should take into account volunteer commitment when studying volunteering's effect on well-being, not simply volunteer role.     

The potential of older adults to enhance community quality of life: Links between positive psychology and productive aging

Enhancing quality of life in aging is an important goal of gerontologists. Quality of life research tends to view aging persons as recipients of external influences rather than active agents operating in context. Quality of life and subjective well-being can be regarded as functions of the extent of fit between the person and the environment, a fit which can be improved by enhancing personal abilities, reducing environmental press, and/or a combination of these. It follows that the expression of individual talents and competencies can be facilitated by removing barriers to their development and expression. This paper combines recent empirical work on productive ageing with concepts from the emerging science of positive psychology in order to illustrate the potential of the person-environment fit concept to enhance the ability of older people to contribute to society and improve the quality of life of the whole community. It is argued that older people have unique talents in the realms of community development and citizenship. A paradigm shift in attitudes to older people is required, towards viewing them as a resource rather than a burden. Proactive ageing can enhance an older individual’s quality of life and by extension the quality of life of the whole community. The paper concludes with implications for professionals, families and caregivers, policy-makers, and gerontological researchers. Rob Ranzijn is a Senior Lecturer in Psychology and the President of the Australian Association of Gerontology (SA/NT Division). His publications in social gerontology include papers on well-being, productive ageing, mature aged employment, fear of crime, and Indigenous ageing.     

Aging mothers and daughters: Relationship changes over time

In the midst of health care crises involving older mothers and their adult daughters, health care professionals must attend to the significance of past roles and relationships of aging women. This article explores two concepts that influence aging mothers’ and daughters’ management of a health crisis. The two concepts, Internalizing Female Lineage and Evolving Matriarchs facilitate understanding of the complexities of the mother-daughter relationship over time. These concepts emerged from a grounded theory study of six older mothers who had experienced an acute hip fracture and their adult caregiving daughters. The purpose of this article is to highlight the experiences of these elderly mothers and their adult daughters prior to a health crisis. These aging mothers and daughters reported that understanding who they were as women, their history, their relationship, and sources of strength during health crisis was essential in order to understand their situations during a health crisis. Study findings are presented in the context of the literature about healthy mother-daughter relationship, mother-daughter transition to caregiving, and future direction of research related to multiple generations negotiating a health crisis. She serves as the faculty consultant for Geriatric Nursing Education in the undergraduate and graduate programs. She has presented papers and conducted numerous seminars at the national, regional, and local level regarding women’s health and women’s aging. She is certified by the American Nurses’ Association as a Psychiatric Clinical Nurse Specialist.     

The potential role of ecological health promotion in progressing healthy ageing

The economic and social implications of population trends make it an imperative for the aged care industry to develop frameworks to facilitate healthy ageing, the compression of disease and a more productive, active older population. Ecological health promotion delivered through a settings-based approach has been found to be a useful means to promote population health across a number of settings. Such an approach could offer both a framework to organize the many worthwhile strategies and practices being implemented for healthy ageing and a suite of concrete processes to engage stakeholders in such endeavors. In this regard, residential aged care facilities exhibit many of the characteristics of other settings such as schools and workplaces and, as such, should be developed as a health promoting setting. This paper asks whether residential aged care could become a health promoting setting for the ageing population?     

Determinants of life satisfaction and self-perception of ageing among elderly people in China: An exploratory study in comparison between physical and social functioning

ObjectiveThis study attempted to figure out the difference between physical and social functioning in determining life satisfaction and self-perception of ageing among community-dwelling elderly people in China.MethodsA representative random sample of 2161 participants aged 60 years or older was surveyed by face-to-face interview. Sociodemographic factors were measured by age, educational level, and marital status. Physical functioning was identified in terms of self-perceived health, basic and instrumental activities of daily living, and number of chronic illnesses. Social functioning was characterized in terms of number of people living together, social support network, and sense of loneliness. Hierarchical multiple linear regressions were performed to identify significant determinants of life satisfaction and self-perception of ageing.ResultsOlder age and lower educational level were related to higher degree of life satisfaction; whereas younger age and higher educational level were related to higher level of self-perception of ageing. Social functioning took precedence over physical functioning in contributing to life satisfaction. In contrast, physical functioning outweighed social functioning in promoting a positive self-perception of ageing.ConclusionA sense of companionship and a supportive social network are vital in enhancing life satisfaction, whereas perceived physical health and functional independence are essential in facilitating a positive self-perception of ageing. Understanding the underlying determinants can provide a novel insight into the mechanism involved in achieving successful ageing.     

Volunteering and psychological well-being among young-old adults: how much is too much?

PURPOSE: Research concerned with the relationship between volunteer activity and psychological well-being has typically reported higher levels of well-being among older adult volunteers relative to nonvolunteers. However, few studies have examined nonlinear associations between frequency of volunteer activity and well-being. We examined nonlinear associations between hours spent volunteering and psychological well-being, controlling for employment status, partner status, physical health, and education. We also investigated associations between different domains of volunteer activity and well-being, along with the possible moderating effects of gender on these relationships. DESIGN AND METHODS: We used data from the PATH Through Life Project, a population-based study of Australian adults. Participants consisted of 2,136 older adults aged 64 to 68. RESULTS: Nonlinear associations between hours spent volunteering and psychological well-being were evident, with these associations characterized by inverted U shapes, with nonvolunteers and those volunteering at high levels producing lower well-being scores relative to those volunteering at moderate levels. Few associations between specific domains of volunteer activity and well-being were evident, and no notable gender interactions emerged. IMPLICATIONS: The results point toward optimal frequency of engagement in volunteer activity for psychological well-being as being bounded by upper and lower levels, outside of which benefits to well-being diminish.