Almar Kok

Capturing the Diversity of Successful Aging: An Operational Definition Based on 16-Year Trajectories of Functioning

Purpose of the Study To determine the prevalence and extent of successful aging (SA) when various suggestions proposed in the previous literature for improving models of SA are incorporated into one holistic operational definition. These suggestions include defining and measuring SA as a developmental process, including subjective indicators alongside more objective ones, and expressing SA on a continuum. Design and Methods Data were used from 2,241 respondents in the Longitudinal Aging Study Amsterdam, a multidisciplinary study in a nationally representative sample of older adults in the Netherlands. Latent class growth analysis was used to identify successful 16-year trajectories within nine indicators of physical, cognitive, emotional, and social functioning. SA was quantified as the number of indicators in which individual respondents showed successful trajectories (range 0-9). Results Successful trajectories were characterized by stability, limited decline, or even improvement of functioning over time. Of the respondents, 39.6% of men and 29.3% of women were successful in at least seven indicators; 7% of men and 11% of women were successful in less than three indicators. Proportions of successful respondents were largest in life satisfaction (>85%) and smallest in social activity (<25%). Correlations of success between separate indicators were low to moderate (range r = .02-.37). Implications Many older adults age relatively successfully, but the character of successful functioning over time varies between indicators, and the combinations of successful indicators vary between individuals.

Socioeconomic inequalities in a 16-year longitudinal measurement of successful ageing

Background This study examines to what extent education, occupation and income are associated with the multidimensional process of successful ageing, encompassing trajectories of physical, mental and social functioning in old age. Methods We employed 16-year longitudinal data from 2095 participants aged 55–85 years at baseline in the Dutch, nationally representative Longitudinal Aging Study Amsterdam. For 9 indicators of successful ageing, separate Latent Class Growth models were used to identify subgroups of older adults with a ‘successful’ trajectory. A ‘Successful Aging Index’ expressed the number of indicators for which individual respondents had a successful trajectory (range 0–9). Using multivariate regression models, we investigated associations between socioeconomic position and the Successful Ageing Index, and with separate indicators of successful ageing. Results Higher education, occupational skill level and income were independently associated with higher numbers of successful trajectories. Education (β=0.09) was a slightly stronger correlate of successful ageing than income (β=0.08). Analyses of separate indicators of successful ageing showed that cognitive functioning, functional limitations and emotional support given were associated with all three components of socioeconomic position, while other indicators were associated with only one (eg, life satisfaction) or none (eg, social loneliness). For some indicators of successful ageing, socioeconomic inequalities were present at baseline, and also increased or decreased during follow-up. Conclusions Education, occupation and income represent distinct socioeconomic life course factors, each of which contribute in a specific way to inequalities in successful ageing. Physical and cognitive functioning were associated more strongly with socioeconomic position than social and emotional functioning.

The Effects of Life Events and Socioeconomic Position in Childhood and Adulthood on Successful Aging

Objectives Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA. Method We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA. Results Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability. Discussion SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully.

Staff’s normative attitudes towards coercion: the role of moral doubt and professional context—a cross-sectional survey study

BackgroundThe use of coercion is morally problematic and requires an ongoing critical reflection. We wondered if not knowing or being uncertain whether coercion is morally right or justified (i.e. experiencing moral doubt) is related to professionals’ normative attitudes regarding the use of coercion.MethodsThis paper describes an explorative statistical analysis based on a cross-sectional survey across seven wards in three Norwegian mental health care institutions.ResultsDescriptive analyses showed that in general the 379 respondents a) were not so sure whether coercion should be seen as offending, b) agreed with the viewpoint that coercion is needed for care and security, and c) slightly disagreed that coercion could be seen as treatment. Staff did not report high rates of moral doubt related to the use of coercion, although most of them agreed there will never be a single answer to the question ‘What is the right thing to do?’.Bivariate analyses showed that the more they experienced general moral doubt and relative doubt, the more one thought that coercion is offending. Especially psychologists were critical towards coercion. We found significant differences among ward types. Respondents with decisional responsibility for coercion and leadership responsibility saw coercion less as treatment. Frequent experience with coercion was related to seeing coercion more as care and security.ConclusionsThis study showed that experiencing moral doubt is related to some one’s normative attitude towards coercion. Future research could investigate whether moral case deliberation increases professionals’ experience of moral doubt and whether this will evoke more critical thinking and increase staff’s curiosity for alternatives to coercion.

De invloed van stressvolle levensgebeurtenissen en sociaal-economische positie op succesvol ouder worden

SamenvattingStressvolle levensgebeurtenissen zoals echtscheiding van de ouders of een vroege sterfte van de ouders kunnen op hogere leeftijd nog grote gevolgen hebben. De kansen om dergelijke gebeurtenissen mee te maken zijn echter ongelijk verdeeld en verschillen tussen sociaal-economische groepen. Dit kan leiden tot sociaal-economische ongelijkheid in succesvol oud worden. Op basis van de Longitudinal Aging Study Amsterdam (LASA) onderzoeken wij hoe levensgebeurtenissen en sociaal-economische positie (SEP) samenhangen met succesvolle veroudering. We doen hierbij een aantal verrassende constateringen.

Smoking Cessation and 16-year Trajectories of Functional Limitations Among Dutch Older Adults: Results from the Longitudinal Aging Study Amsterdam

Background This study examined whether smoking cessation in middle age and old age is associated with following a successful trajectory of functional limitations over time in Dutch older adults. Methods We used 16-year longitudinal data from 645 participants of the Longitudinal Aging Study Amsterdam. Three types of trajectories regarding functional limitations over time were defined: successful (high initial level of functioning and limited decline), late decline (high initial level of functioning and late onset of decline), and early decline (lower initial level of functioning and early onset of decline). Smoking cessation status was self-reported and categorized into: early quitters (stopped in middle age [35-40 years]), late quitters (already smoked in middle age and stopped in old age [≥55 years]), and continued smokers (smoked in middle age and still smoking in old age). Multinomial Logistic Regression Analyses were used to assess the association between smoking cessation and trajectory membership. Results The sample (55-85 years at baseline) consisted of 20.3% early quitters, 22.9% late quitters, and 56.8% continued smokers. After adjustment for confounders, the model showed that late quitters were less likely to follow an early decline trajectory instead of a successful trajectory compared to continued smokers (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.24-0.97). After adjustment for clinically relevant level of depressive symptoms, this association remained substantial but was no longer statistically significant (OR = 0.50, 95% CI = 0.24-1.02). Conclusions Although not statistically significant in the full model, the observed associations suggest that smoking cessation in old age may have an important impact on daily functioning in old age.

“Tough Times Have Become Good Times”: Resilience in Older Adults With a Low Socioeconomic Position

Background and Objectives This qualitative study applied a resilience perspective to socioeconomic inequalities in the functioning of older adults. We aimed to gain insight into how some older adults managed to age successfully despite having a low socioeconomic position (SEP) throughout their lives. Research Design and Methods Semistructured interviews were conducted with 11 resilient adults over the age of 79 years participating in the Longitudinal Aging Study Amsterdam, the Netherlands. Participants were defined as resilient on the basis of having a low lifetime SEP and favorable trajectories of physical, mental, and social functioning. Grounded Theory coding techniques were applied to identify themes reflecting distinct ways in which participants dealt with what they indicated were the most significant adversities in their lives. The analysis focused on experiences linked to socioeconomic conditions. Results Six themes reflecting psychological, behavioral, and social factors were derived from the data: drawing support from social contacts; investing in younger generations; taking actions to manage or improve socioeconomic conditions; putting the impact of a low SEP into perspective; persevering; and resigning oneself to adversity. Discussion and Implications Findings suggest that successful aging despite a low SEP throughout ones lifetime requires considerable psychological and social resources. In addition, resignation and specific manifestations of generativity are identified as new elements of resilience. These findings may help to reduce the stereotyping of older adults with a low SEP, and nuance the heroic image of resilience as something that is primarily attributable to extraordinary individual abilities or efforts.

Decentralisatie in de langdurige zorg en sociaal-economische gezondheidsverschillen onder ouderen: gemengde gevolgen

Anderhalf jaar na de decentralisatie van de langdurige zorg via de Wet maatschappelijke ondersteuning (Wmo) en de Wet langdurige zorg (Wlz) trekt de rook op en wordt het mogelijk om beter te kijken naar een beladen transitie waar veel, heel veel, van werd verwacht. Doel van de decentrale organisatie is om gemeenten en zorgaanbieders beter in staat te stellen effectiever en kostenefficiënt problemen en oplossingen te identificeren. Daarnaast zou de decentralisatie zelfredzaamheid, mantelzorg en vrijwilligerswerk bevorderen en de behoefte aan formele zorg verminderen. De beoogde kostenbesparing is daarbij door de rijksoverheid gestimuleerd door een reductie van 25% van het gemeentelijk Wmo-budget.

The impact of conscientiousness, mastery, and work circumstances on subsequent absenteeism in employees with and without affective disorders.

BackgroundHigh numbers of employees are coping with affective disorders. At the same time, ambitiousness, achievement striving and a strong sense of personal control and responsibility are personality characteristics that are nowadays regarded as key to good work functioning, whereas social work circumstances tend to be neglected. However, it is largely unkown how personality characteristics and work circumstances affect work functioning when facing an affective disorder. Given the high burden of affective disorders on occupational health, we investigate these issues in the context of affective disorders and absenteeism from work. The principal aim of this paper is to examine whether particular personality characteristics that reflect self-governance (conscientiousness and mastery) and work circumstances (demands, control, support) influence the impact of affective disorders on long-term absenteeism (>10 working days).MethodsBaseline and 1-year follow-up data from 1249 participants in the Netherlands Study of Depression and Anxiety (NESDA) in 2004–2006 was employed. Multivariate logistic regression analyses were performed, including interaction effects between depressive, anxiety, and comorbid disorders and personality and work circumstances.ResultsIn general, mastery and conscientiousness increased nor diminished odds of subsequent long-term absenteeism, whereas higher job support significantly decreased these odds. Interaction effects showed that the impact of affective disorders on absenteeism was stronger for highly conscientious employees and for employees who experienced high job demands.ConclusionsAffective disorders may particularly severely affect work functioning of employees who are highly conscientious or face high psychological job demands. Adjusting working conditions to their individual needs may prevent excessive work absence.

Diversiteit in ouder worden hanteerbaar maken voor beleid en praktijk

SamenvattingIedereen wordt anders oud. Om deze diversiteit in ouder worden inzichtelijk te maken, gebruiken we gegevens uit de Longitudinal Aging Study Amsterdam om trajecten van veroudering over een periode van 16 jaar in negen (kern) uitkomsten van ouder worden op het vlak van fysiek, cognitief, emotioneel en sociaal functioneren te beschrijven. Uit deze trajecten stellen we vier profielen samen die in principe al beleidsrelevant moeten zijn.