Francine Cartwright

Successful Aging: Early Influences and Contemporary Characteristics

PURPOSE positing that successful aging has independent, yet related, dimensions that are both objective and subjective, we examine how early influences and contemporary characteristics define 4 groups of people. DESIGN AND METHODS data were gathered from 5,688 persons aged 50-74 years living in New Jersey who participated in telephone interviews. Latent profile analysis defined people who age successfully according to both objective and subjective criteria, neither criteria, and one, but not the other, criteria. Multinomial logistic regression was used to examine the extent to which early influences and contemporary characteristics predict group membership. RESULTS although characteristics observable early in life predict group membership, their influence is modified by current health behaviors and social support. The roles of education and incarceration feature prominently. Marital, work, and volunteer statuses, as well as moderate alcohol consumption, distinguish those aging successfully according to both criteria from the other 3 groups. IMPLICATIONS results help to define successful aging as a multidimensional construct having both objective and subjective dimensions, provide greater clarity regarding its correlates, and increase understanding of its modifiable aspects.

A Two-Factor Model of Successful Aging

OBJECTIVES To propose and test a conceptual two-factor model of successful aging that includes objective and subjective components. METHODS Data were derived from 5,688 persons aged 50-74 years living in New Jersey who participated in the ORANJ BOWL panel. Participants were recruited using random digit dial procedures and interviewed by telephone. A measurement model was developed and tested using data from two independent samples (each n = 1,000); a structural model examining the effects of age and gender was tested using data from another 3,688 people. RESULTS Confirmatory factor analyses provided support for a multidimensional model incorporating objective criteria and subjective perceptions. Age and gender were associated with objective but not subjective success. DISCUSSION Results add rigor to the measurement of a construct that has intrigued philosophers and scientists for hundreds of years, providing the empirical foundation on which to build research about successful aging.

Depressive Symptoms and Marital Satisfaction in the Context of Chronic Disease: A Longitudinal Dyadic Analysis

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples.

Self-Rated Health and Depressive Symptoms in Patients With End-Stage Renal Disease and Their Spouses: A Longitudinal Dyadic Analysis of Late-Life Marriages

Limited research has examined the ways in which changes in self-rated health experienced by aging spouses affect depressive symptoms of both members of the dyad. Longitudinal data from 315 older couples in which one partner had end-stage renal disease were analyzed using multilevel modeling. Results indicate that for both patients and spouses, own mean self-rated health was associated with own depressive symptoms, and change in self-rated health had a significant negative association with change in own depressive symptoms. Both mean self-rated health of the patient and change in patients self-rated health had negative relationships with spouse depressive symptoms, with changes in patients self-rated health having a stronger impact on spouse depressive symptoms than changes in spouses own self-rated health. Results suggest the importance of understanding physical and mental health in the context of the marital dyad.

The Texture of Neighborhoods and Disability Among Older Adults

OBJECTIVES To present and test an ecological multidimensional model of neighborhood characteristics and examine its relationship to older disability among older adults. METHOD Indicators of social vulnerability, wealth, violence, storefronts, residential stability, and the presence of physicians, supermarkets, and fast-food establishments for 1,644 of New Jerseys census tracts were derived from sources that include the U.S. Census 2000, Uniform Crime Report for New Jersey, New Jersey Department of Agriculture, Division of Marketing and Development, New Jersey Department of Law and Public Safety Division of Alcohol Beverage Control, and Health Resources and Services Administration Geospatial Data Warehouse. Confirmatory factor analyses were used to develop and test a measurement model of neighborhood texture. Structural equation modeling examined the relationships between neighborhood characteristics and disability of persons aged 65-69 years. RESULTS Analyses revealed that distinct dimensions of neighborhoods could be modeled with administrative data and that neighborhood contextual (supermarkets, physicians, storefronts, violence) and compositional (social vulnerability, wealth, residential stability) characteristics were related to the prevalence of disability. DISCUSSION The use of multiple indicators of neighborhood with good psychometric qualities is critical for advancing knowledge about the mechanisms by which neighborhood characteristics are associated with the health of older people.

Effects of marital closeness on the transition from caregiving to widowhood

Objective: To examine the effects of marital closeness on indicators of well-being (depressive symptoms, grief, and relief) as spouses transition from the role of caregiver to that of widowed person. Methods: 118 spouses of persons with end stage renal disease were interviewed prior to and after the death of the patient. Spouses reported on marital closeness, multiple indicators of pre-death strain as reflected by subjective health, depressive symptoms, caregiving burden, and caregiving satisfaction, as well as post-loss feelings of grief, depression, and relief. Results: Hierarchical regressions indicated that post-loss grief was predicted by gender (b = 0.32, p < 0.001), self-reported health (b = −0.28, p < 0.01), marital closeness (0.22, p < 0.05), and pre-loss depressive symptoms (b = 0.19, p < 0.10). Caregiver burden (b = 0.28, p < 0.05) and marital closeness (b = −0.41, p < 0.001) before the death, predicted relief from the caregiver role post-loss. Subjective health (b = −0.21, p < 0.05) and pre-loss depressive symptoms (b = 0.47, p < 0.001) predicted change in depressive symptoms over time. Conclusion: These data highlight differences in the experiences of grief, relief, and depressive symptoms and suggest that marital closeness plays a central role. Results are interpreted in terms of theory regarding marital quality. Implications for interventions to improve the lives of caregivers and newly widowed spouses are discussed.

The Effects of Race on Patient Preferences and Spouse Substituted Judgments.

Knowledge about the ways in which race affects decision-making at the end of life is minimal, yet this information is critical for providing culturally sensitive care at the end of life. Data matching socio-demographic characteristics of 34 black and 34 white patients with end-stage renal disease and their spouses reveal that there are no significant differences in the preferences to continue dialysis on the part of black and white patients. However, the substituted judgments of black and white spouses differ from one another, with black spouses being more likely to indicate that they believe that the patient would be more inclined to continue dialysis under a host of hypothetical conditions than white spouses. Structural equation modeling analyses revealed that differences in spouse substituted judgments between black and white spouses are explained as a direct function of race differences in perception of patients health, and caregiver burden, and that indirect effects are associated with spouses fear of death and participation in religious services. We conclude that these variables rather than race per se explain differences in end of life decision making.