A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.     

Understanding Within-Group Variability of Everyday Cognition in Aging Black/African American Adults: A Mimic (Multiple Indicators,Multiple Causes) Model Approach

Background/Study Context: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults.

Methods: Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators.

Results: Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics.

Conclusion: These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.     

Determinants of a sense of mastery in African American and White older adults

OBJECTIVES: This study compares determinants of a sense of mastery in African American and White older adults. METHODS: The association between predictor variables (sociodemographic variables, health conditions, social resources, and religiosity) and feelings of mastery was assessed by using representative community-dwelling samples of 250 African American (mean age = 71.6) and 452 White (mean age = 73.0) older adults. RESULTS: African American older adults had a lower sense of mastery than White older adults. Significant modification by race was found in the associations of age, self-rated health, and religiosity with feelings of mastery. The negative effects of old age and poor health on feelings of mastery were stronger in the White sample, whereas the positive effect of religiosity on feelings of mastery was observed only in the African American sample. DISCUSSION: Although African American older adults had a lower sense of mastery than Whites, their feelings of mastery were less likely to be diminished by old age and poor health and more likely to be enhanced by religiosity. Possible explanations for cross-racial differences are discussed, as are implications.     

APOE epsilon4 as a predictor of subjective quality of life in a biracial older person community sample

The epsilon4 allele of apolipoprotein E (APOE) has been associated with health-related outcomes that may adversely affect quality of life (QOL) in older adults. In the absence of published information, we sought to determine whether the epsilon4 allele was associated with subjective QOL across 5 parameters in a community sample of older adults. Design: Prospective cohort study. Setting: Community-based sample of older adults in North Carolina (Duke site of the Established Populations for Epidemiologic Studies of the Elderly [Duke EPESE]). Participants: Self-responding genotyped sample members (n = 1,880) of whom 1,254 provided longitudinal data. Measurements: APOE genotype and five newly constructed, reliable, and valid measures of subjective QOL derived from the Duke EPESE questionnaire. The 5 parameters measured were social, economic, mental and physical health, and functional status. Control variables included age, gender, race (African American or White), education and urban/rural residence. Results: Among those with good baseline QOL, there was no significant association between the epsilon4 allele and any of the parameters of subjective QOL in longitudinal analyses. In controlled longitudinal analysis, older age women predicted poorer functional status; being African American, and reporting lower education predicted poorer subjective economic well-being; and being African American predicted better self-assessed mental health. Conclusions: This study is among the first to explore the association of the epsilon4 allele with overall QOL. Considered from a public health perspective, these findings challenge the uncritical assumption that the presence of this susceptibility gene in the population implies an excess burden of poor QOL. The findings do not contradict the previous association of epsilon4 with Alzheimer's disease (AD) and other conditions. Such conditions continue to merit full attention.     

A systematic review of diabetes self-care interventions for older,African American,or Latino adults

PURPOSE: This study systematically identified and examined published self-care interventions designed to improve glycemic control or quality of life (QoL) among older, African American, or Latino adults. METHODS: Six electronic databases were searched. Eligible publications were those that described an intervention to change knowledge, beliefs, or behavior among adults with diabetes who were either older than 55 years, African American, or Latino, and that measured the outcomes of glycemic control or QoL. RESULTS: Twelve studies met the inclusion criteria, of which 8 were randomized controlled trials (RCTs). Of the 8 RCTs, improved glycemic control was reported in the intervention arm of 5 RCTs compared with the control arm. Of the 4 RCTs that examined QoL, improved QoL was reported in the intervention arm of 1 study. Characteristics of successful interventions included poor glycemic control at baseline (A1C > 11%), cultural or age-tailoring the intervention, use of group counseling or support, and involvement of spouses and adult children. CONCLUSIONS: Large-scale clinical trials designed according to cultural and age criteria specific for older Latinos and African Americans with diabetes are needed to determine how best to address this growing public health problem.     

Does Race Moderate Social Support and Psychological Distress Among Rural Older Adults?

Greater social support is associated with decreased psychological distress among older adults. Researchers have found racial differences in psychological distress. Might race moderate social support and psychological distress? The authors hypothesized African American collectivistic values could increase the importance of social support. Participants were rural adults aged 60 and older (N = 100). Multiple regression analyses controlled for health, income, education, and sex. Race moderated satisfaction with social support and psychological distress. However, greater satisfaction predicted less psychological distress among Caucasians while it was not associated with African Americans’ distress in this sample. Achieving satisfaction with social support may be particularly important for Caucasians receiving therapy. Interventions may also address strategies to improve physical health, emotional support, and quality of social support, which significantly predicted psychological distress for both groups.     

Dimensions of self-report about everyday memory in young and older adults.

This study investigated the relationship between several aspects of memory self-report, objective memory, attitude toward intellectual aging, self-rated health, and self-rated depression in young and older adults. Participants completed a self-report depression scale, and then rated their discomfort with eight categories of everyday forgetting and their attitudes toward intellectual aging. One week later, they rated how frequently they experience the same categories of forgetting, and then completed a battery of objective memory tests analogous to those categories. Ten days later, they rated their willingness to participate in both memory improvement classes and nonmemory classes. Older adults reported significantly more frequent failures but less discomfort with the failures than the young adults. Frequency, discomfort, and self-reported depression were all positively correlated in the older group, but not the young group. Young and old adults were equally positive about participating in memory classes, which both age groups preferred to nonmemory classes; the correlation between willingness to participate in memory classes and objective memory approached significance in the young, but not in the old. Attitude toward intellectual aging was correlated with frequency of and discomfort with forgetting in the older group.     

Prospective predictors of successful aging in community-residing and institutionalized Canadian elderly

This study examined the unique and combined contribution of existential variables (purpose in life, religiousness, and death acceptance) and traditional resource measures (social resources, intellectual competence, and cognitive competence) as prospective predictors of successful aging in community-residing and institutionalized older adults. Using multiple hierarchical regression, the results showed that baseline successful aging, social resources, purpose in life, and low religiousness predicted successful aging in community-residing elderly 14 months later; baseline successful aging, social resources, purpose in life, and being of male gender predicted successful aging in institutionalized elderly. Intellectual and cognitive competence and death acceptance failed to account for significant variance in successful aging, although the latter approached significance in the community-residing older adults. In both samples, the existential variable of purpose in life accounted for unique variance in successful aging over and above that accounted for by demographic, baseline successful aging, and traditional predictors. The important role of existential constructs in promoting successful aging in community-residing and institutionalized elderly is discussed. Gary T. Reker is a full professor in the Department of Psychology of Trent University. His research interests have focused on the aging process, particularly in the role of personal optimism and personal meaning in wellness promotion. This work was supported by a Population Aging Grant from the Social Sciences and Humanities Research Council of Canada. The work was begun by Paul T.P. Wong and Gary T. Reker and continued by Gary T. Reker under grants from the Trent University Research Fund.     

Falls efficacy and self-rated health in older African American adults

Fear of falling and mobility restrictions have a significant negative impact on the quality of life of older adults. Because older African American adults are at increased risk for various modifiable health problems, understanding potential constraints on their overall health and mobility is critical in this population. The current study investigated this issue by analyzing a dataset of 449 older African American adults (mean age = 72.3 years) living in Detroit. We characterized and investigated the relationships among the following falls- and health-related variables: previous falls, falls efficacy, mobility, self-rated health (SRH), and depression and well-being. As a whole, participants reported moderate health and well-being, little depression, few mobility problems (mean = 8.4/40), and very high falls efficacy (mean = 94.9/100) despite the fact that a quarter of the sample experienced a fall within the past year. Correlation results indicated that previous falls, falls efficacy, mobility, SRH and depression and well-being were all inter-related. Regression analyses revealed that higher falls efficacy was more closely associated with better SRH than was having previously fallen. Findings suggest that improving falls efficacy in older African American adults may be beneficial to their mobility and overall health and well-being. Further, by asking a single-item SRH question, clinicians may be able to quickly identify older African American adults who have low falls efficacy and are at high risk for falling.     

Do racial differences in hypertension persist in successful agers? Findings from the MacArthur Study of Successful Aging

The objective of this study was to determine whether racial differences in hypertension in a random sample of community-dwelling older adults also remained significant in a sample of successful agers. Data for the random sample of community-dwelling older adults came from the Duke University Established Populations for Epidemiologic Studies of the Elderly (4,162 community-dwelling adults age 65 and older) and showed strong racial differences in hypertension. Data for successful agers came from the Duke MacArthur (428 of EPESE respondents in the top 30% in terms of physical, cognitive, and psychosocial performance). The mean of two sitting blood pressure measurements was the dependent variable for both sets of analyses. Independent variables included demographics and health factors. Using logistic regression, odds ratios in the Duke EPESE and Duke MacArthur samples for race were similar (Duke EPESE odds ratio = 1.30; Duke MacArthur odds ratio = 1.29). Sample size differences affected statistical significance. However, race differences in hypertension in older adults appear to be unexplained by socioeconomic status or other usual explanatory variables. Even among successful agers, racial differences in hypertension persist.     

Successful aging: perceptions of adults aged between 70 and 101 years

In this research, content analysis was employed to investigate older adults' perceptions of successful aging and the relationship of these perceptions to definitions given in the literature to date. Participants were 18 males and 42 females between the ages of 70 and 101 years. Analyses revealed older adults mentioned only 1 or 2 criteria of successful aging if asked for a definition; however, when prompted, they rated almost all the criteria emerging from the literature as highly important. Participants reported adjusting to the situations they were in by compensating for losses that occurred and selecting activities that best suited their capabilities. Overall, older adults' perceptions of successful aging were similar to aspects identified in the literature. Not all aspects, however, were seen as important by all participants, and only low to moderate correlations were found between some aspects of successful aging.     

Barriers to diabetes education in urban patients: perceptions, patterns, and associated factors

PURPOSE: This study explored patients' perceptions of barriers to diabetes education among a mostly African American population of adults with diabetes. METHODS: A survey was conducted among 605 new patients attending an urban outpatient diabetes clinic. The questionnaire gathered information on issues patients believed would adversely affect their ability to learn about diabetes. The type and frequency of education barriers were evaluated, and variables associated with reporting an obstacle were analyzed. RESULTS: Average patient age was 50 years, diabetes duration was 5.6 years, body mass index was 32 kg/m2, and hemoglobin A1C was 9.1%. The majority (56%) were women, 89% were African American, and 95% had type 2 diabetes. Most respondents (96%) had received some prior instruction in diabetes care; however, 53% anticipated future difficulties learning about diabetes. The most commonly cited concerns were poor vision (74%) and reading problems (29%). Patients with a perceived barrier to diabetes education were older (P < .001) than were persons without a barrier, and they differed in both employment and educational status (both P < .001). In adjusted analyses, older age, male gender, being disabled, and having an elementary education or less were associated with a significantly increased likelihood of having a barrier to diabetes education, whereas having a college education decreased the odds. Higher hemoglobin A1C levels also tended to be associated with a greater chance of reporting an education barrier (P = .05). CONCLUSIONS: A substantial number of persons anticipated a barrier to diabetes education. Interventions at multiple levels that address the demographic and socioeconomic obstacles to diabetes education are needed to ensure successful self-management training.     

Cognitive reserve and depression predict subjective reports of successful aging

BackgroundWith graying of western societies, successful aging is a hotly debated topic. Attaining successful aging brings benefits not only at the individual level, but also to society. To better understand successful aging, we conducted a study of older adults in the Republic of Slovenia.MethodsWe recruited 213 community-dwelling adults, age 65 years and older, who responded to the Successful Aging Inventory (SAI), Purpose of Life Questionnaire (PIL), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), Cognitive Reserve Index, Functional Activities Questionnaire (FAQ), and Multiple Abilities Self-Report Questionnaire (MASQ).ResultsResponses to all scales were significantly correlated, which was taken into account when identifying covariates of latent successful aging in a structural equation model. Successful aging, as evaluated by the combination questionnaire responses, was most strongly associated with depression and marginally associated with cognitive reserve. Self-rated functional and cognitive capacities did not significantly explain individual differences in successful aging.DiscussionIn our study of community-dwelling, older Slovenes, self-rated depression emerged as a strong correlate of successful aging and, to a lesser degree, cognitive reserve. Future studies of interventions that aim to promote successful aging should consider the role of depression and cognitive reserve in the older adult’s experience of aging.     

Successful aging among the young-old,old-old,and oldest-old Chinese

In this study, successful aging was defined by four dimensions including functional status, affective status, cognitive status, and productive involvement status. This study examined successful aging among Hong Kong Chinese old people in three different age cohorts: young-old, old-old, and oldest-old. The respondents were 1106 people aged 60 years or older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong. We found modest associations between four dimensions of successful aging, indicating the relative independence of these four criteria for successful aging. Using multiple regression models, we found that age, gender, years of education, number of close relatives, frequency of contact with friends, financial strain, number of chronic illnesses, self-rated health, hearing impairment, and life satisfaction were associated with the successful aging indicator.     

A New Multidimensional Model of Successful Aging: Perceptions of Japanese American Older Adults

This study examined the concept of successful aging using an ethnographic grounded-theory approach. Seventy-seven Japanese American older adults participated in focus groups. Participants perceived successful aging as optimal functioning in the following areas: Physical health, psychological health, cognitive functioning, socialization, spirituality, and financial security. The content of each dimension represents both culture-specific and culturally-universal elements. This new multidimensional model of successful aging was compared to Rowe and Kahn’s (The Gerontologist 37:433–440, 1997) and Phelan et al.’s frameworks (Journal of the American Geriatric Society 52:211–216, 2004) of successful aging. The model of successful aging generated from this study appears to be more comprehensive than existing models and incorporates sociocultural experiences.     

Successful aging and well-being: self-rated compared with Rowe and Kahn

PURPOSE: This research evaluates the utility of two different definitions of successful aging in predicting well-being. DESIGN AND METHODS: We assessed the definitions of (a) self-rating and (b) Rowe and Kahn's criteria of absence of disease, disability, and risk factors; maintaining physical and mental functioning; and active engagement with life. We made associations with well-being for each definition using data from 867 Alameda County Study participants aged 65-99 years. RESULTS: The percentage of those rating themselves as aging successfully was 50.3% compared with 18.8% classified according to Rowe and Kahn's criteria. Although absence of chronic conditions and maintaining functioning were positively associated with successful aging for both definitions, many participants with chronic conditions and with functional difficulties still rated themselves as aging successfully; none were so classified according to Rowe and Kahn's criteria. On 14 of 15 measures, self-rated successful aging resulted in sharper contrasts for well-being. IMPLICATIONS: Understanding criteria used by older persons to assess their own successful aging should enhance the conceptualization and measurement of this elusive concept.     

Who Is Likely to Commit to a Career With Older Adults?

Gerontology, as an academic discipline, provides professionals with the conceptual knowledge and the skills necessary to address the complexities of working with a diverse aging population. We know little about what attracts professionals to the aging field and what maintains commitment to these careers. The aim of this study was to investigate the roles of career motivation, job satisfaction, anxiety about aging, and professional identity in relation to career commitment among those working with older adults. Participants (N = 756) were recruited through organizations and institutions serving older adults and responded to an online survey. Participants’ motivation for working with older adults, level of job satisfaction, and exposure to formal gerontological education significantly predicted career commitment. In addition, aging anxiety mediated the relationship between job satisfaction and career commitment. This study sheds lights on perspectives of professionals working with older adults and highlights areas for future gerontological research and training.     

Environmental press and adaptation to disability in hospitalized live-alone older adults

PURPOSE: This study examined the ability of personal competency variables at the time of hospital discharge to predict primary instrumental activities of daily living (IADLs) and secondary outcomes (living arrangements) in a sample of 194 urban, live-alone, older adults who had a new onset disability. DESIGN AND METHODS: Consecutively admitted medical rehabilitation patients, 72% women and 85% African American, participated in the study. Using path analysis, three of the four competency variables collected at the time of hospitalization (cognition, medical burden, activities of daily living) predicted IADLs at 3 and 6 months after hospitalization (e.g., cooking, telephone use, money management). IADLs, in turn, predicted living arrangements at 3 and at 6 months after hospitalization. RESULTS: The findings provided strong support for the importance of assessing a broad range of competency variables when investigating adaptation to disability. IMPLICATIONS: The increased understanding of adaptation in live-alone older adults with a new-onset disability is particularly timely given the increase in live-alone older adults and the dire consequences associated with change in living arrangement (i.e., mortality and morbidity) in this group.     

Prevalence and Correlates of Nocturia in Community‐Dwelling Older Adults

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults. DESIGN: Planned secondary analysis of cross‐sectional data from the University of Alabama at Birmingham Study of Aging population‐based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African‐American women, African‐American men, white women, and white men. MEASUREMENTS: In‐person interviews included sociodemographic information, medical history, Mini‐Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African‐American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m²). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African‐American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community‐dwelling older adults is a common symptom associated with male sex, African‐American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.