Markus Wettstein

Out-of-Home Behavior and Cognitive Impairment in Older Adults Findings of the SenTra Project

This study explores differences in the out-of-home behavior of community-dwelling older adults with different cognitive impairment. Three levels of complexity of out-of-home behavior were distinguished: (a) mostly automatized walking behavior (low complexity), (b) global out-of-home mobility (medium complexity), and (c) defined units of concrete out-of-home activities, particularly cognitively demanding activities (high complexity). A sample of 257 older adults aged 59 to 91 years (M = 72.9 years, SD = 6.4 years) included 35 persons with early-stage Alzheimer’s disease (AD), 76 persons with mild cognitive impairment (MCI), and 146 cognitively healthy persons (CH). Mobility data were gathered by using a GPS tracking device as well as by questionnaire. Predicting cognitive impairment status by out-of-home behavior and a range of confounders by means of multinomial logistic regression revealed that only cognitively demanding activities showed at least a marginally significant difference between MCI and CH and were highly significant between AD and CH.

Daily Mood and Out-of-Home Mobility in Older Adults Does Cognitive Impairment Matter?

This study explores the relationship between out-of-home behavior and daily mood of community-dwelling older adults with different levels of cognitive impairment across four consecutive weeks. The sample included 16 persons with early stage Alzheimer’s disease (AD), 30 persons with mild cognitive impairment (MCI), and 95 cognitively healthy persons (CH). Using a multi-method approach, GPS tracking and daily-diary data were combined on a day-to-day basis. AD and MCI adults showed lower mood than the CH group. Whereas stronger positive links between mood and out-of-home behavior were found for AD compared to the total sample on an aggregate level, predicting daily mood by person (i.e., cognition) and occasion-specific characteristics (i.e., mobility and weekday), using multilevel regression analysis revealed no corresponding effect. In conclusion, cognitive status in old age appears to impact on mobility and mood as such, rather than on the mood and out-of-home behavior connection.

Interplay of Cognitive and Motivational Resources for Out-of-Home Behavior in a Sample of Cognitively Heterogeneous Older Adults: Findings of the SenTra Project

OBJECTIVES We examined in this study the hypothesis that cognitive resources are more closely linked with out-of-home behavior than motivational resources. METHOD A cognitively heterogeneous sample of 222 older adults aged 59-91 years (M = 72.7; SD = 6.2), including 146 cognitively healthy persons and 76 persons with mild cognitive impairment-recruited in the German and Israeli arm of the SenTra project-was used for the analysis. Out-of-home behavior was assessed by means of global positioning system technology (time out of home; number of nodes visited) as well as by questionnaire (out-of-home activities). Mini-Mental State Examination and trail-making tests A and B were used to assess cognitive resources. Well-being, depression, and environmental mastery were assessed as motivational resources. RESULTS Findings at the zero-order and latent variable levels confirmed that cognitive resources were more closely linked with out-of-home behavior than motivational resources. DISCUSSION Findings support the view that well-being-related motivations to exert out-of-home behavior may become less important in old age because of the increasing cognitive resources required by such behavior.

Cognitive status moderates the relationship between out-of-home behavior (OOHB), environmental mastery and affect.

Studies on the relationship between behavioral competence, such as the competence of exerting out-of-home behavior (OOHB), and well-being in older adults have rarely addressed cognitive status as a potentially moderating factor. We included 35 persons with early-stage dementia of the Alzheimers type (DAT), 76 individuals with mild cognitive impairment (MCI) and 146 cognitively healthy (CH) study participants (grand mean age: M=72.9 years; SD=6.4 years). OOHB indicators were assessed based on a multi-method assessment strategy, using both GPS (global positioning system) tracking technology and structured self-reports. Environmental mastery and positive as well as negative affect served as well-being indicators and were assessed by established questionnaires. Three theoretically postulated OOHB dimensions of different complexity (out-of-home walking behavior, global out-of-home mobility, and out-of-home activities) were supported by confirmatory factor analysis (CFA). We also found in the DAT group that environmental mastery was substantially and positively related to less complex out-of-home walking behavior, which was not the case in MCI and CH individuals. In contrast, more complex out-of-home activities were associated with higher negative affect in the DAT as well as the MCI group, but not in CH persons. These findings point to the possibility that relationships between OOHB and well-being depend on the congruence between available cognitive resources and the complexity of the OOHB dimension considered.

Four-year stability, change, and multidirectionality of well-being in very-old age.

We examined stability, change, and dedifferentiation of well-being in 124 participants with a baseline age between 87 and 97 years (M = 90.56, SD = 2.92) across 7 measurement occasions over 4 years. Measures of hedonic (life satisfaction, positive affect and negative affect) and eudaimonic well-being (autonomy, purpose in life, self-acceptance, environmental mastery), as well as indicators of mental distress (depressive symptoms, attitudes toward death and dying, disease phobia) were included. Average levels indicated high well-being at all measurement occasions in the majority of indicators analyzed. However, mean numbers of depressive symptoms were close to the cutoff point of clinical depression. Analyses of intra-individual correlations revealed high loadings of depressive symptoms, positive affect, and environmental mastery on a common factor. However, several well-being indicators were not substantially interrelated on the intra-individual level, suggesting their trajectories were rather independent of each other. Acceptance of death and dying was surprisingly high and even increased, whereas mean levels in fear of death were very low and declined over time. Overall, our findings do not suggest late-life dedifferentiation of well-being trajectories in very-old age. Our results rather support the need to consider indicators of hedonic and eudaimonic well-being, as well as mental distress, to understand the multifaceted and multidirectional dynamics of well-being in very-old age.

Identifying Mobility Types in Cognitively Heterogeneous Older Adults Based on GPS-Tracking What Discriminates Best?

Heterogeneity in older adults’ mobility and its correlates have rarely been investigated based on objective mobility data and in samples including cognitively impaired individuals. We analyzed mobility profiles within a cognitively heterogeneous sample of N = 257 older adults from Israel and Germany based on GPS tracking technology. Participants were aged between 59 and 91 years (M = 72.9; SD = 6.4) and were either cognitively healthy (CH, n = 146), mildly cognitively impaired (MCI, n = 76), or diagnosed with an early-stage dementia of the Alzheimer’s type (DAT, n = 35). Based on cluster analysis, we identified three mobility types (“Mobility restricted,” “Outdoor oriented,” “Walkers”), which could be predicted based on socio-demographic indicators, activity, health, and cognitive impairment status using discriminant analysis. Particularly demented individuals and persons with worse health exhibited restrictions in mobility. Our findings contribute to a better understanding of heterogeneity in mobility in old age.

Cross-sectional and longitudinal relationship between neuroticism and cognitive ability in advanced old age: the moderating role of severe sensory impairment.

Objectives: Gaining a comprehensive picture of the network of constructs in which cognitive functioning is embedded is crucial across the full lifespan. With respect to personality, previous findings support a relationship between neuroticism and cognitive abilities. However, findings regarding old age are inconsistent. In particular, little is known about potentially moderating variables which might explain some of the inconsistency. Our aim was to examine the moderating effect of severe sensory impairment on cross-sectional and longitudinal associations between neuroticism and cognitive functioning. Method: The study sample consisted of 121 visually impaired (VI), 116 hearing impaired (HI), and 150 sensory unimpaired older adults (UI). Mean age was 82.50 years (SD = 4.71 years). Neuroticism was assessed by the NEO Five Factor Inventory, and multiple established tests were used for the assessment of cognitive performance (e.g., subtests of the revised Wechsler Adult Intelligence Scale). Results: Bivariate correlations and multi-group structural equation models indicated stronger relationships between cognitive abilities and neuroticism in both sensory impaired groups (VI and HI) compared to UI older individuals. This relationship was attenuated but still significant in both sensory impaired groups when controlling for age, education and health (number of chronic conditions). In cross-lagged panel models, higher baseline neuroticism was significantly associated with lower cognitive performance four years later in VI and HI individuals. Conclusion: Our results suggest that sensory impairment moderates both cross-sectional and longitudinal associations between neuroticism and cognitive function in advanced old age.

The interplay between personality and cognitive ability across 12 years in middle and late adulthood: Evidence for reciprocal associations.

Research on relationships between personality and cognitive abilities has so far resulted in inconsistent findings regarding the strength of the associations. Moreover, relationships have rarely been compared longitudinally and bidirectionally between midlife versus late-life cohorts by considering different personality traits as well as multiple cognitive domains over a long-term follow-up period. We hypothesize that the interplay between the “Big Five” personality traits (Neuroticism, Extraversion, Openness to Experience, Agreeableness and Conscientiousness) and cognitive abilities (information processing speed, crystallized intelligence, fluid intelligence) may change from midlife to old age due to age-associated changes in cognitive and personality plasticity. We used data from the German Interdisciplinary Longitudinal Study of Adult Development (ILSE study; n = 1,002). Participants were either born in 1950/52 (midlife sample, n = 502) or in 1930/32 (late-life sample, n = 500) and followed up for up to 12 years. Based on bivariate latent change score regression models (adjusted for gender, education, self-rated and physician-rated health), we observed that, apart from very few exceptions, the intervariable cross-lagged associations between personality traits and cognitive abilities were generally similar between cohorts. Moreover, in case of neuroticism, extraversion, and openness, the effects of cognitive abilities on change in personality were stronger than the reversed effects. Our findings thus suggest that the so far predominant perspective of personality in middle adulthood and late-life as a predictor, rather than as an outcome, of cognitive abilities needs more differentiation and reconsideration.

12-Year Associations of Health with Personality in the Second Half of Life

We examined longitudinal associations between personality, objective (physician-rated) and self-rated health over 12 years in two German cohorts (midlife cohort, born 1950/52, nT0 = 502; late-life cohort, born 1930/32, nT0 = 500) from the Interdisciplinary Longitudinal Study of Adult Development (ILSE). Based on cross-lagged panel design analyses controlling for sex, education, depression, and cognitive abilities, we found that after 12 years better baseline objective health predicted lower Neuroticism and higher Agreeableness, whereas baseline Extraversion and Conscientiousness were positive predictors of later self-rated health. Our findings thus illustrate that the direction of longitudinal personality-health associations is dependent on whether objective or self-rated health is considered, whereas relations do not seem to be considerably different in midlife vs. in old age.

Profiles of Subjective Well-being in Patients with Chronic Back Pain: Contrasting Subjective and Objective Correlates

Objective. The detrimental impact of nonspecific chronic low back pain (CLBP) on quality of life is well known. However, patients with CLBP represent a remarkably heterogeneous group, and not all of them report compromised well‐being. Methods. In this study, we investigated this heterogeneity by identifying profiles (or clusters) of well‐being and their correlates in 239 CLBP patients. To take the multidimensionality of subjective well‐being into account, we included multiple well‐being indicators (depression, anxiety, affective distress, perceived control over life). For an in‐depth characterization of the well‐being profiles, we assessed 1) sociodemographic indicators (age, gender, education, marital status, occupational status), 2) pain‐related measures (pain intensity, subjective and objective pain disability, number of pain locations), 3) psychosocial resources (mental health, resilience, perceived support), 4) biographical factors (trauma), and 5) somatosensory profiles based on quantitative sensory testing. Results. Based on two‐step cluster analysis, we identified three distinct well‐being profiles, characterized by either generally high well‐being (cluster 1, n = 51), moderate well‐being (cluster 2, n = 104), or consistently low well‐being (cluster 3, n = 77), respectively. Most differences between the derived well‐being profiles regarding sociodemographic, psychosocial, and biographical measures were of weak to moderate effect size. Larger effect sizes were observed for differences in pain intensity and subjective, but not objective, pain disability. Finally, the largest effects were found for differences in psychosocial resources. Conclusions. Our findings suggest that not only in nonclinical samples, but also in patients with chronic pain, well‐being is more closely associated with psychological resources and subjective evaluations than with objective parameters.