Christoph Rott

Adaptation in very old age : Exploring the role of resources, beliefs, and attitudes for centenarians' happiness

When individuals reach very old age, accumulating negative conditions represent a serious challenge to their capacity to adapt and are likely to reduce the quality of life. By examining happiness and its determinants in centenarians, this study investigated the proposal that psychological resilience may come to an end in extremely old age. Data from the population-based Heidelberg Centenarian Study indicated high levels of happiness. Basic resources (i.e., job training, cognition, health, social network, extraversion) explained a substantial proportion of variance in happiness, but some resource effects were mediated through self-referent beliefs (e.g., self-efficacy) and attitudes toward life (e.g., optimistic outlook). Results challenge the view that psychological resilience reaches a critical limit or that the self-regulatory adaptation system loses its efficiency in very advanced age.

Is Aging in Place a Resource for or Risk to Life Satisfaction

PURPOSE Given age-related health restrictions, the importance of the environment for life satisfaction may increase in later life. This study investigated whether objective and perceived physical and social environmental aspects of the home and of the surrounding neighborhood represent resources for or risks to life satisfaction among young-old and old-old individuals. DESIGN AND METHODS A population-based sample of 381 community-dwelling individuals aged 65-94 years reported on their sociophysical environment and life satisfaction using questionnaires. RESULTS On average, young-old differ from old-old in indoor physical environmental indicators but not in neighborhood characteristics or social aspects of housing. Regression analyses revealed that apartment size, perceived neighborhood quality, and outdoor place attachment explained life satisfaction independently, whereas social housing aspects played only a minor role. Separate analyses for both age groups revealed age differential explanation patterns. Apartment size was positively related to life satisfaction in the young-old but was negatively related in the old-old. For the old-old, perceived neighborhood quality and outdoor place attachment were more important than for the young-old. Living with others was positively related to life satisfaction only for the young-old.  IMPLICATIONS Environmental characteristics at home and in the neighborhood need to be considered to better understand differential processes of aging in place with respect to well-being.

The many faces of health, competence and well-being in old age: Integrating epidemiological, psychological and social perspectives

Preface. Part 1: Focusing on Social-Ecological Research - Contributions to Health, Competence, and Well-Being in Old Age. Introduction: The Person-Environment Perspective in Ageing Research. The Role of the Home Environment in Middle and Late Adulthood. Commentary: A House is Not a Home: But Can it Become One?. Outdoor Mobility in Late Life: Persons, Environments and Society. Commentary: Mobility - A Key to Understanding and Improving Transportation Services for Seniors and Others. Age-Related Loss in Vision: A Case to Learn About Ageing in Context. Commentary: Age-Related Loss in Vision: A Case to Learn About Ageing in Context. Part 2: Focusing on Psychological Research - Contributions to Health, Competence, and Well-Being in Old Age. Introduction: Developmental Perspectives in the Second Half of Life. The Influence of Social Support on Marital Support: Age and Gender Differences?. Commentary: Changed Gender Roles and Their Impact on Marital Support and Satisfaction. Stressful Life Events, Protective Factors, and Depressive Disorders in Middle Adulthood. Commentary: Stressful Life Events, and Depressive Disorders: The Paradigm Shift. Predictors of Well-Being in Very Old Age. Commentary: Well-Being in Very Old Age - Old and New Issues. Part 3: Focusing on Epidemiological Research - Contribution to Health, Competence, and Well-Being. Introduction: Epidemiological Perspectives in Ageing Research. Cancer Among Older Adults. Incidence, Prognosis and New Avenues of Prevention. Commentary: Cancer in the elderly: prevention and better care needed. Cardiovascular Disease among Older Adults. Incidence, Prognosis and New Avenues for Prevention. Commentary: Cardiovascular Disease among Older Adults. Incidence, Prognosis and New Avenues for Prevention. Medical Care for Nursing Home Residents. National Perspectives in International Context. Commentary: Medical Care for Nursing Home Residents. National and International Perspectives. Part 4: Synergies betweenSocial-Ecological, Psychological and Epidemiological Research. The Impact of Internal and External Resources on Health, Competence, and Well-Being: Longitudinal Findings from the ILSE. Determinants and Prognostic Relevance of Depression and Anxiety in Patients with Coronary Heart Disease: An Interdisciplinary Approach within the KAROLA Study. Commentary: Interdisciplinary Longitudinal Studies of Ageing. Part 5: Applications and Social Policy Implications. Ageing Europe: Challenges for Policy and Research. On the Relevance of Ageing Research for Policy and Practise. Appendix. Abstracts of Poster session.

Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study

The purpose of this study was to examine the hypothesis of whether early education and/or maintaining intellectual activities over the life-course have the power to protect against cognitive impairment even in extremely old adults. Ninety centenarians from the population-based Heidelberg Centenarian Study were assessed with a modified version of the Mini Mental State Exam (MMSE). Data about education, occupational status, and life-long intellectual activities in four selected domains were obtained. Results demonstrated that 52% of the sample showed mild-to-severe cognitive impairment. Analyzing the influence of early education, occupational status, and intellectual activities on cognitive status we applied several (logistic) regression analyses. Results revealed independent, significant and strong influence of both formal school education and intellectual activities on the cognitive status in very late life, even after controlling for occupational status. However, about one fourth of the effect of early education on cognitive status was exerted indirectly via the assessed intellectual activities. In summary, the present study provides first evidence for the conclusion that even with regard to cognitive performance in very old age, both early education and life-long intellectual activities seem to be of importance.

A Molecular View of Coping Behavior in Older Adults

Objectives: The purpose of this studywas to assess age, gender, ethnicity, and education differences in specific (“molecular”) coping behaviors for three older adult age groups. Methods: Thirty-five specific coping reactions were assessed on the item level for 74 sexagenarians, 70 octogenarians, and 116 centenarians of the Georgia Centenarian Study. Results: A multivariate analysis of covariance revealed significant age group, gender, and education differences for 14 coping reactions. Four items were affected exclusively by age; five were affected only by gender; and three were affected only by education. One item showed age group and education differences; another showed gender and education differences. No ethnicity differences were obtained. The largest effect for an age group difference was found for accepting health problems. Discussion: The findings suggest that a molecular viewof specific coping behaviors in reaction to health problems, in addition to global measures of coping, is essential.

Age differences and changes of coping behavior in three age groups: findings from the Georgia Centenarian Study.

With increasing age, older adults are more likely to be challenged by an increasing number of physical, functional and social losses. As a result, coping with losses becomes a central theme in very late life. This study investigated age differences and age changes in active behavioral, active cognitive and avoidance coping and related coping to adaptational outcomes, such as physical and mental health. Sixty-one sexagenarians, 46 octogenarians, and 47 centenarians from the Georgia Centenarian Study participated in this longitudinal study to assess coping with health and family events. The results indicated age group differences in active behavioral coping, suggesting that centenarians were less likely to use this mode of coping. Centenarians and octogenarians were also more likely to experience decreases in active behavioral coping over time, while sexagenarians were more likely to experience increases in this coping mode. No significant differences in coping with health versus family events were obtained suggesting that coping is consistent across life domains. Moderate levels of stability were obtained for coping in all age groups. Active behavioral and active cognitive coping predicted functional health, active behavioral coping predicted social relations, and avoidance coping predicted negative affect.

Die Heidelberger Hundertjährigen-Studie: Theoretische und methodische Grundlagen zur sozialwissenschaftlichen Hochaltrigkeitsforschung

Zusammenfassung Dieser Beitrag thematisiert zwei wichtige Aspekte der Hochaltrigkeitsforschung. Zunächst wird der Frage nachgegangen, ob die Unterschiede zwischen sehr alten Personen als Folge besonders lang andauernder Alternsprozesse in körperlichen, sozialen und psychologischen Funktionen zu betrachten sind, oder ob sie allein auf dem selektiven Überleben besonders robuster Individuen beruhen. Beide Entwicklungsresultate beinhalten geringe Variabilität, aber auf unterschiedlichem Niveau. Zweitens wird untersucht, inwieweit extrem alte Personen im Hinblick auf die Variabilität mit den herkömmlichen psychosozialen Instrumenten überhaupt untersucht werden können. 156 Hundertjährige wurden kontaktiert, von denen 91 sowie 86 Proxies an der Untersuchung teilnahmen. In Bezug auf den kognitiven Status zeigt sich eine hohe Variabilität. Hinsichtlich der funktionalen Kapazität sind die Unterschiede gering, da 83% der Studienteilnehmer Leistungen der gesetzlichen oder privaten Pflegeversicherung beziehen. Die höhere Variabilität in der psychologischen Variable wird als Hinweis auf adaptives Potenzial interpretiert, wobei im extrem hohen Alter möglicherweise unterschiedliche Ressourcen zur Aufrechterhaltung der körperlichen Funktionsfähigkeit oberhalb eines kritischen Grenzwertes eingesetzt werden.Summary This paper addresses two important issues of oldest old research. First, we try to answer the question whether differences between extremely old persons are based on enduring aging processes of physical, social and psychological functions, or whether they are the result of selective survival weeding out the frail. Both trajectories predict low variability, but on different levels. Second, we investigate to which extent the variability of extremely old persons can be assessed by traditional psychosocial instruments. One hundred and fifty six centenarians were contacted, of whom 91 centenarians and 86 proxies participated in this study. The distribution of the cognitive status reveals a high amount of variability. In contrast, with respect to functional capacity 83% receive support from the German Statutory Insurance System for Long-Term Care. The higher variability in the psychological variable points to adaptive potential. We assume that in extreme old age various resources are used to maintain physical functioning above a critical threshold.

Life events and personality predicting loneliness among centenarians: findings from the Georgia Centenarian Study.

ABSTRACT Regarding the purpose of this study, the researchers analyzed the roles that both life events (life-time positive events and life-time negative events) and personality (Neuroticism, Extraversion, Trust, Competence, and Ideas) played in participants of the Georgia Centenarian Study. The researchers analyzed these variables to determine whether they predicted loneliness. Analyses indicated that life-time negative events significantly predicted loneliness. In essence, the higher was the number of life-time negative life events, the higher was the loneliness score. Moreover, Neuroticism, Competence, and Ideas were all significant predictors of loneliness. The higher was the level of Neuroticism and intellectual curiosity, the higher was the level of loneliness, whereas the lower was the level of Competence, the higher was the level of loneliness. In addition, both life-time positive and life-time negative life events were significant predictors of Neuroticism. The higher was the number of life-time positive events, the lower was the level of Neuroticism, and the higher was the number of life-time negative events, the greater was the level of Neuroticism. These results indicated that life-time negative events indirectly affect loneliness via Neuroticism. Last, our results indicated that the Competence facet mediated the relationship between life-time negative life events and loneliness. Life-time negative life events significantly affected centenarians’ perceived competence, and Competence in turn significantly affected the centenarians’ loneliness. These results as a whole not only add to our understanding of the link between personality and loneliness, but also provide new insight into how life events predict loneliness.

Health and Disease at Age 100.

BACKGROUND Centenarian studies from around the world have shown that reaching age 100 typically involves substantial health issues. The present study adds to the existing knowledge from other countries by describing health conditions in German centenarians. METHODS A total of 112 centenarians or their primary contacts provided information on acute and chronic health conditions and pain in the context of the Second Heidelberg Centenarian Study (mean age = 100.45 years, standard deviation [SD] = 0.47, 89% females). RESULTS Participants showed high comorbidity, with an average of five illnesses (mean = 5.3; SD = 2.20). Health conditions with highest prevalence were sensory (vision, hearing; 94%), mobility (72%) and musculoskeletal conditions (60%). Cardiovascular conditions (57%) and urinary system ailments (55%) were also common. Pain was experienced often by 30% of the participants. Of those reporting any pain, 36% indicated pain exceeding bearable levels. CONCLUSION German centenarians experienced a substantial number of ill nesses, dominated by sensory and mobility conditions. Cardiovascular diseases were the only potentially lethal illnesses with high prevalence. Evidence of unaddressed pain seems alarming, requiring future research. Emerging health profiles indicate that even in very advanced age, quality of life may be improved by enhanced diagnostics and optimal disease management. Mobility limitations may be addressed with preventive efforts.

Funktionale Kompetenz und Pflegebedürftigkeit nach SGB XI bei Hundertjährigen

Zusammenfassung.Im sehr hohen Alter ist die selbstständige Lebensführung durch den Verlust funktionaler, aber auch kognitiver Fähigkeiten besonders gefährdet. In dieser Studie wird zunächst der Frage nachgegangen, welches Ausmaß dieser Selbstständigkeitsverlust bei Hundertjährigen hat. Mit einem Klassifikationssystem, das funktionale und kognitive Einschränkungen gleichermaßen berücksichtigt, wird dann die funktionale Kompetenz extrem Hochaltriger bestimmt. Daran anschließend wird geprüft, inwieweit dem damit verbundenem Versorgungsbedarf durch Leistungen der Pflegeversicherung entsprochen wird und in welchem Umfang kognitive Einbußen bei der Einstufung Berücksichtigung finden. Dazu wurden 85 Hundertjährige mit standardisierten Verfahren untersucht und zusätzlich oder ergänzend die Fremdeinschätzungen von Angehörigen und Interviewern herangezogen. Die Ergebnisse zeigen einen hohen Verlust an Selbstständigkeit. Bei 91% der Hundertjährigen liegt aufgrund funktionaler Kompetenzeinbußen ein mindestens einmal täglicher Versorgungsbedarf vor. In 44% der Fälle wird nach den Maßgaben der Pflegeversicherung ein geringerer Pflegebedarf zugrundegelegt als nach wissenschaftlichen Kriterien für erforderlich gehalten. Die adäquate Berücksichtigung von kognitiven Einschränkungen begründet bei 20% der Hundertjährigen einen höheren Versorgungsbedarf als er durch die Pflegeversicherung gewährt wird. Die großen Unterschiede beim Vergleich mit der Einstufung durch die Pflegeversicherung weisen auf die erhebliche Beteiligung der Angehörigen bei der Versorgung extrem Hochaltriger hin.Summary.The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.