Kyle Kercher

Assessing Subjective Well-Being in the Old-Old The PANAS as a Measure of Orthogonal Dimensions of Positive and Negative Affect

A review of past research reveals apparent gaps in many current measures of positive affect (PA) and negative affect (NA) including the Bradburn (1969) Affect Balance subscales popular among gerontologists and other social scientists. In many cases, the measures produce PA/NA correlations so high that some researchers claim subjective well-being is unidimensional. A viable alternative measure of positive and negative affect is the PANAS (Watson, Clark, and Tellegen 1988), which appears to distinguish clearly between these two emotional dimensions of subjective well-being. Unfortunately, however, only younger samples have served as subjects in research on the PANAS. Accordingly, the current study assessed the psychometric qualities of the PANAS applied to a sample of the old-old. Consistent with prior studies of younger samples, the results here clearly support the viability of the measure among the elderly. Of particular significance, the PA and NA dimensions appear completely independent of each other. More broadly, the results also support using the circumplex model of emotions when selecting mood adjectives to represent the affective dimensions of subjective well-being.

Long-term impact of preventive proactivity on quality of life of the old-old.

Objective This research explored the long-term benefits of engaging in proactive health promotion efforts among old-old residents of Sunbelt retirement communities to empirically test components of the Preventive and Corrective Proactivity (PCP) Model of Successful Aging. Specifically, we examined the contributions of exercise, tobacco use, moderate alcohol use, and annual medical checkups to multidimensional quality of life indicators of physical health, psychological well-being, and mortality. Method Data were obtained from a longitudinal study of adaptation to aging. Annual in-home interviews were conducted with 1000 older adults over a 9-year period. Whether health promotion behaviors at baseline predicted quality of life outcomes 8 years later was examined, controlling for the baseline outcome, sociodemographic variables, and, as an additional test, baseline health conditions. Results Exercise was predictive of fewer IADL limitations and greater longevity, positive affect, and meaning in life 8 years later. Avoiding tobacco was predictive of longevity. Before controlling for health conditions, exercise predicted decreased risk of basic activities of daily living limitations and having more goals; moderate alcohol use predicted longevity; annual health checkup predicted more IADL limitations; and having once smoked predicted having more IADL limitations and negative affect. Conclusions Among the old-old, exercise had long-term and multifaceted benefits over an 8-year period. Tobacco avoidance also contributed to long-term positive outcomes. These results lend support to the long-term preventive value of health-promoting proactivity spontaneously engaged in by old-old persons proposed in the framework of the PCP model.

The Personal and Social Context of Planning for End-of-Life Care

Objectives: To examine the potential facilitators of or deterrents to end‐of‐life planning for community‐dwelling older adults, including personal (health‐related and sociodemographic) and social (physician and family) influences.

The Effects of Stress, Vulnerability, and Appraisals on the Psychological Well-Being of the Elderly

A conceptual model was developed and tested that examined the relationships between respondent characteristics, stressors, psychological well-being measures, and intervening life domain appraisals. The model was tested using data from elderly members of a Detroit area HMO. An innovative focus of the study was comprehensive consideration of the array of stressors impinging on the elderly. Stressors examined included recent negative life events, cumulative life crises, living with an ill family member, and social isolation. Domain appraisals in the model concerned satisfaction with activities, relationships, health, and income. Support was found for the hypothesis that stressors affect well-being indirectly through domain satisfactions.

The Role of Pain in the Cascade from Chronic Illness to Social Disability and Psychological Distress in Late Life

Pain has been viewed as an important concomitant of late-life illness that can threaten the quality of life of older adults. In considering linkages between chronic physical illness and psychological distress in late life, the associations between reporting of pain and indices of depression have been extensively studied (Parmelee, 1994; Romano & Turner, 1985). Nevertheless, the role of pain in mediating the effects of ill health on functioning and psychological well-being has seldom been considered in a more comprehensive framework. Such a framework could organize our understanding of the biopsychosocial and ecological context of pain and consider its sequelae for both social and psychological well-being (Kahana & Kahana, 1996).

CHANGING HEALTH CARE EXPERIENCES AND PERSPECTIVES OF OLDER ADULTS: COMPARISON OF HMO AND FEE-FOR-SERVICE ENROLLEES

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care. Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.

Health and illness behavior of type a persons

The complex and controversial relationship of type A behavior to myocardial infarction and other illnesses may be mediated through health habits and illness behavior. We hypothesized that type A persons tend to reject the sick role, delay in seeking medical care, seek convenient medical care facilities, are impatient for recovery, return to work before they have fully recovered, and are less likely to engage in positive health habits. A cross-sectional survey was conducted at a large corporation in Cleveland, Ohio. A detailed questionnaire that examined health-promoting and illness behaviors was sent to 385 managers, 54% of whom responded. Models tested using path analysis supported the hypotheses that type A persons are more likely than are type B employees to reject the sick role, delay in seeking medical care, be impatient for recovery, and return to work before a full recovery. The study findings imply that type A employees may be less likely to miss work for minor illnesses, but they may be prone to adverse outcomes from illnesses that require early care or assumption of the sick role. The hypothesis that type A persons are less likely to engage in positive health-habits behavior was not supported.