Clemens Tesch-Römer

On the importance of a positive view on ageing for physical exercise among middle-aged and older adults: Cross-sectional and longitudinal findings

Physical activity is one of the most important health behaviours associated with the prevention and management of chronic diseases in older adults, but this potential is often insufficiently used. The present study examined for the first time whether a positive view on ageing (PVA) may contribute to a higher level of physical activity. Analyses were based on the German Ageing Survey, a longitudinal population-based survey (N = 4034) on middle-aged and older adults (40–85 years) conducted in the years 1996 and 2002. As hypothesised, middle-aged adults with a PVA not only engaged in physical activity in the form of sports more frequently; they even increased this activity provided that they were healthy enough to do so. For older adults, PVA was particularly associated with more regular walking and increases of walking over time. Because walking is often still recommended in spite of health problems, it was remarkable that even older people with worse health walked just as regularly as those with good health, provided that they had a positive view on ageing. The results shed some light on recent findings about the importance of PVA for health and longevity and point to a partial mediation between PVA and health by physical exercise.

Gesundheit und Krankheit im Alter

ISBN 978-3-89606-193-5 Deutschland ist eine Gesellschaft des langen Lebens. Bereits heute leben in Deutschland mehr 65-jahrige und altere Menschen als 15-jahrige und jungere. Und die Altersstruktur wird sich weiter zugunsten der alteren Menschen verschieben. Gesundheit im Alter ist heute und zukunftig ein Thema von hoher individueller und gesellschaftlicher Bedeutung. Mit fortschreitendem Alter ist ein deutlicher Anstieg von Gesundheitsproblemen zu beobachten. Auch die Komplexitat der vorliegenden Beeintrachtigungen wachst mit dem Alter. Ein groser Teil der Gesundheitsprobleme alterer Menschen kann durch primar-, sekundaroder tertiarpraventive Masnahmen gunstig beeinflusst werden. Zudem gibt es mit Blick auf den Wandel der Gesundheit in den letzten Jahrzehnten positive Nachrichten. Im vorliegenden Buch geht es um die Gesundheit und Krankheit von Menschen, die 65 Jahre und alter sind. Es werden somatische und psychische Gesundheit, funktionale Gesundheit und Pflegebedurftigkeit sowie subjektive Gesundheit behandelt. Die Einflusse von Lebenslagen und Lebensstilen auf die Gesundheit von alter werdenden und alten Menschen wird analysiert. Anhand der Angebote, die professionelle, familiare und ehrenamtliche Seite bereitstellen, wird die gesundheitliche und pflegerische Versorgung alter Menschen untersucht. Vor dem Hintergrund des demografischen Wandels werden schlieslich die okonomischen Chancen und Herausforderungen des Alterns fur das Gesundheitswesen analysiert. Hier werden wichtige Erklarungsansatze fur das Kostengeschehen geliefert, und es wird die Bedeutung des Gesundheitswesen als Wirtschaftszweig dargestellt Beitrage zur Gesundheitsberichterstattung des Bundes

Medication beliefs predict medication adherence in older adults with multiple illnesses

OBJECTIVE To examine factors preventing medication nonadherence in community-dwelling older adults with multiple illnesses (multimorbidity). Nonadherence threatens successful treatment of multimorbidity. Adherence problems can be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage) or unintentional (e.g., forgetting to take medication) and might depend on a range of factors. This study focused in particular on the role of changes in beliefs about medication to explain changes in adherence. METHODS Longitudinal study with N = 309 individuals aged 65-85 years with two or more diseases at three measurement points over six months. Medication adherence and beliefs about medicines were assessed by questionnaire. Hierarchical weighted least squares regression analyses were used to predict individual intentional and unintentional nonadherence. RESULTS Changes in intentional nonadherence were predicted by changes in specific necessity beliefs (B = -.19, P<.01), after controlling for sociodemographic factors, health status and number of prescribed medicines. Changes in unintentional nonadherence were predicted by changes in general overuse beliefs (B = .26, P<.01), controlling for the same covariates. CONCLUSION Beliefs about medication affect both intentional and unintentional adherence to medication in multimorbid older adults. This points to the importance of addressing medication beliefs in patient education to improve adherence.

Resources for health: differential effects of optimistic self-beliefs and social support according to socioeconomic status.

OBJECTIVE This study examined whether socioeconomic status (SES) determines the degree to which psychological and social resources such as optimistic self-beliefs and social support affect health. DESIGN We used data from the representative German Ageing Survey (N = 2,454, aged 40-85 years). Structural equation modeling was employed to examine whether relationships between psychological (self-esteem, control beliefs, optimism) and social resources (perceived emotional and informational support, network size) and health differ between education and income groups. MAIN OUTCOME MEASURES Self-reported physical health, functional health, and subjective health. RESULTS Psychological resources positively affected health in all groups but were stronger predictors of functional and subjective health in low compared to higher educated participants. A higher level of social resources was associated with better functional and subjective health mainly in the low-income group. Social resources were particularly important for financially disadvantaged older people. CONCLUSION Our results provide evidence for differential effects of optimistic self-beliefs and social support on health depending on whether individuals are challenged by low incomes or low education. Future research, especially aimed at intervention, should consider that different aspects of SES have differential meanings and that the impact of health-protective factors may vary according to SES facet.

Giving and Taking —Differential Effects of Providing, Receiving and Anticipating Emotional Support on Quality of Life in Adults with Multiple Illnesses

Multimorbidity challenges quality of life (QoL) in old age. Anticipating and providing social support have been shown to promote QoL whereas receiving support often had detrimental effects. Little is known about which psychological processes explain these effects. This study examines the effects of receiving, anticipating and providing emotional support on QoL, with control beliefs and self-esteem as simultaneous mediators in an elderly multimorbid sample (N = 1415). Anticipating and providing support positively predicted QoL, mediated through self-esteem and control beliefs. Received support negatively predicted QoL, without mediation. Self-esteem and control beliefs can help to explain the relation between QoL and support.

Comparative ageing research: a flourishing field in need of theoretical cultivation

Comparative ageing research is a flourishing field, partly because of European funding in this area. Comparing different societies and cultures seems especially fruitful for the analysis of societal and cultural factors in development over the life course. From a nomothetic perspective, the aim of comparisons is the search for similarities and communalities in different societies and cultures; from an idiographic perspective, researchers are looking for societal and cultural specificity and distinctiveness. However, the potentials of comparative ageing research are not fully realized for the time being. In many cases, there is little theorizing as to whether there should be differences (or similarities) in ageing processes across countries, societies, or cultures. This paper discusses theoretical aims and ambitions of comparative ageing research in general. Comparative theories are sketched which could serve as a basis for comparative ageing research, and ageing theories are discussed which could be modified to be used in comparative research. The rationale of comparative ageing research is described and illustrated through empirical examples. Epistemological and methodological pitfalls (problems of conceptual, operational, functional, and measurement equivalence) are a substantial obstacle to comparative ageing research. Hence, merits and limitations of comparative designs and sampling procedures are considered.

Gesundheit, Hilfebedarf und Versorgung

Der sich derzeit vollziehende demografische Wandel fuhrt auf individueller Ebene zu einer hoheren Lebenserwartung und auf gesellschaftlicher Ebene zu einem Zuwachs des Anteils alter und sehr alter Menschen. Aktuelle Modellrechnungen gehen von einer Entwicklung der durchschnittlichen Lebenserwartung bis zum Jahr 2050 fur Manner von 79 bis 83 Jahren aus, fur Frauen von einem Anstieg auf 86 bis 88 Jahre (Statistisches Bundesamt, 2003). Derzeit liegt die Lebenserwartung bei Geburt fur Manner bei 75,6, fur Frauen bei 81,3 Jahren1. Zugleich wird der Anteil alter und sehr alter Menschen an der Gesamtbevolkerung in Zukunft deutlich zunehmen: Im Jahr 2002 waren 17,5 Prozent der Bevolkerung in Deutschland im Alter von 65 Jahren und alter. Der Anteil dieser Altersgruppe wird sich, Bevolkerungsvorausberechnungen zufolge, innerhalb der ersten Halfte dieses Jahrhunderts fast verdoppeln—fur das Jahr 2050 ist ein Anteil von 29,6 Prozent prognostiziert. Ein besonders hoher Anstieg wird fur den Anteil der Hochbetagten erwartet, d.h. der 80-Jahrigen und Alteren. Dieser betrug im Jahr 2002 4,0 Prozent der Bevolkerung und wird Vorausberechnungen zufolge bis zum Jahr 2050 mit 12,1 Prozent dreimal so hoch liegen2. Der prognostizierte demografische Wandel ist von hoher individueller Bedeutung, denn er impliziert fur viele Menschen eine lange Lebensphase des Altseins. Gesundheit und Alltagskompetenz entscheiden dabei masgeblich uber die individuelle Lebensqualitat (vgl. den Beitrag von Tesch-Romer, Wurm in diesem Band) sowie uber die Moglichkeit, eine selbststandige Lebensfuhrung aufrechterhalten zu konnen.

Loneliness in old age in Eastern and Western European societies: theoretical perspectives

Data from European countries participating in the Generations and Gender Surveys showed that mean loneliness scores of older adults are higher in Eastern than in Western European countries. Although co-residence is considered as one of the fundamental types of social integration, and although co-residence is more common in Eastern Europe, the mean loneliness scores of older co-resident adults in Eastern Europe are still very high. This article investigates mechanisms behind the puzzling between-country differences in social integration and loneliness. Firstly, the theoretical framework of loneliness is discussed starting from the individual’s perspective using the deficit and the cognitive discrepancy approach and taking into account older adults’ deprived living conditions. Secondly, mechanisms at the societal level are investigated: cultural norms, the demographical composition and differences in societal wealth and welfare. It is argued that an integrated theoretical model, as developed in this article, combining individual and societal level elements, is most relevant for understanding the puzzling reality around social integration and loneliness in country-comparative research. An illustration of the interplay of individual and societal factors in the emergence of loneliness is presented.

Social inequality in the later life: Cross-national comparison of quality of life

This paper analyses quality of life and inequality in old age in an international comparative and a life course perspective. Quality of life is seen as an outcome of unequal chances in life. We distinguish between overall and domain specific expressions of quality of life which allows us to analyse the determinants of overall quality of life and their development over the life course. The data presented come from the research project “OASIS - Old Age and Autonomy: The Role of Service Systems and Intergenerational Family Solidarity”. This data set is based on an age stratified random sample of the urban population (25–102 years) in Norway, England, Germany, Spain, and Israel (n=6,106). With advancing age, there are decreasing mean levels and increasing variation of quality of life. With age, the impact of physical health on overall quality of life increases, while the predictive power of other domains decreases. The results support the hypothesis of differentiation as well as the age-dependency hypothesis. For both these both aspects, international comparisons show similar results in different societies. These uniform age tendencies in modern European societies point to a limited importance of societal embeddedness and support the interpretation of age group differences as being life course effects.

Cohort Profile: The German Ageing Survey (DEAS)

Population ageing and longevity as observed in Germany is not simply a phenomenon of an increasing number of old people: it also involves a range of qualitative and structural changes affecting older people. For this reason the German Federal Government, aiming to improve the quality of its monitoring efforts on older people in Germany, launched the German Ageing Survey (DEAS) in the mid 1990s, under the auspices of the Federal Ministry for Family Affairs and Senior Citizens (BMFuS, now German Federal Ministry for Family Affairs, Senior Citizens, Women, and Youth, BMFSFJ). In 1996, the first wave of the survey was conducted by two collaborating research groups: the Research Group on Ageing and the Life Course at the Freie Universit€at in Berlin; and the Research Group on Psycho-Gerontology at the University of Nijmegen in The Netherlands. From the year 2002 onwards, the German Centre of Gerontology in Berlin (DZA) has been responsible for the conduct and ongoing development of the study. The DEAS is funded by the BMFSFJ. Fieldwork for all waves (1996–2014) is carried out by the Bonn-based Institute for Applied Social Sciences (infas). The primary goal of the project is to provide a representative national database containing information describing the living conditions of the country’s middle-aged and older population and to study diversity within the older section of the population, the process of ageing as it affects individuals and processes of social change as they relate to old age and ageing. For this purpose, a cohort-sequential design has been set up combining large cross-sectional samples with longitudinal samples. The design of the DEAS permits three different perspectives for analyses: (i) analysis of social change; (ii) analysis of intra-individual change; and (iii) analysis of historical changes affecting individual ageing trajectories.