Rocío Fernández-Ballesteros

The contribution of socio-demographic and psychosocial factors to life satisfaction

Life satisfaction continues to be an important construct in the psychosocial study of ageing. It is one of the commonly-accepted subjective conditions of quality of life and seems to be one of the facets of successful ageing, both of which are key concepts in ageing. Research reports that life satisfaction is strongly related to socio-demographic and psychosocial variables. These, however, are mutually dependent interactive variables, and much more attention should be paid to the study of the relative contribution of these two types of factors to life satisfaction. The purpose of the research reported in this article was to discover which socio-demographic conditions and psychosocial factors are the most important, and to decide to what extent they contribute to life satisfaction. A sample of 507 individuals aged 65 and over and representative of the Spanish population in terms of age and gender, were interviewed at home. The results indicate that two socio-demographic characteristics (income and education) influence life satisfaction both directly and also indirectly, through psychosocial factors such as activity (physical activity level, satisfaction with leisure activities, and social contacts), perceived health and physical illness. Among psychosocial factors, activity and health both contribute to explaining life satisfaction. The results are discussed from the point of view of the activity theory of ageing.

Determinants and Structural Relation of Personal Efficacy to Collective Efficacy

Dans cette recherche, on eprouve un modele structurel concernant l’impact du statut socioeconomique sur l’efficacite individuelle percue et le rapport qu’elle entretient avec la perception de l’efficacite collective. Dans les travaux sociodemographiques, les jeunes, par comparaison aux plus âges, s’estiment moins efficaces dans la gestion de leur vie professionnelle, de leurs relations intimes et de leur situation financiere, mais plus aptes a promouvoir le changement social. Les hommes ont plus que les femmes le sentiment de pouvoir contribuer a la solution des problemes sociaux. En accord avec le modele structurel enonce, le statut socioeconomique contribue a la fois a la perception de l’efficacite personnelle dans la gestion des evenements de sa propre vie et dans la participation a l’amelioration de la societe. Ces deux aspects de l’efficacite individuelle percue contribuent a leur tour fortement a la conviction qu’une action collective peut effectivement induire le changement social. Un autre modele ou l’efficacite collective percue devient la cause premiere de l’efficacite individuelle percue se revela moins proche des donnees recueillies. This study tested a structural model regarding the impact of socioeconomic status on people’s perceived individual efficacy and its link to their perceived collective efficacy. In sociodemographic analyses younger participants, compared to their older counterparts, judged themselves less efficacious to manage their worklife, intimate partnerships, and financial condition, but of higher efficacy in promoting social change. Men had a higher sense of efficacy than women to contribute to the solution of social problems. In accord with the posited structural model, socioeconomic status contributed to both perceived personal efficacy to manage one’s life circumstances and individual efficacy to contribute to the betterment of societal conditions. Both forms of perceived individual efficacy, in turn, contributed substantially to a sense of collective efficacy to effect social change through unified action. An alternative model in which perceived collective efficacy is assigned causal primacy affecting perceived individual efficacy provided a poorer fit to the data.

Assessing Competence: The European Survey on Aging Protocol (ESAP)

Objectives: The main goal of this research project was to translate and adapt the European Survey on Ageing Protocol (ESAP) to 7 European countries/cultures. This article presents preliminary results from the ESAP, the basic assessment instrument of EXCELSA (European Longitudinal Study of Aging). Methods: 672 individuals aged 30–85, selected through quota sampling (by age, gender, education and living conditions), participated in this study, with 96 subjects from each of the 7 European countries. The basic research protocol for assessing competence and its determinants was designed to be administered in a 90-min in-home face-to-face interview. It contains a series of questions, instruments, scales and physical tests assessing social relationships and caregiving, mental abilities, well-being, personality, mastery and perceived control, self-reported health, lifestyles, anthropometry, biobehavioral measures and sociodemographic variables. Results: 84% of ESAP measures are age-dependent and 75% of them discriminate between education levels. Minor differences were found due to gender, and between people living in rural and urban areas. Exploratory factor analysis yielded 10 factors accounting for 67.85% of total variance, one of which was identified as cognitive and physical ‘competence’. This factorial structure was tested across countries through concordance coefficients. Finally, using structural equation modeling, our data were fitted into a model of competence. When the sample was split into younger groups (aged 30–49 years) and older ones (50 and more years), the same model was appropriate for our data. Discussion: The results are discussed in accordance with other findings on psychosocial, biophysical and sociodemographic components of competence, and also in accordance with theories on competence and successful aging.

Training effects on intelligence of older persons

In the present study, we tried to answer two main questions: (1) do the elderly of low educational level improve their performance in ability tests when they are trained in inductive reasoning, spatial orientation, or everyday problem solving? (2) If such training were effective, what will the level of training transfer be? Ninety elderly participated in this study (36 women, 54 men; mean age = 67.87); 93.2% of them had less than 4 years of education. The study was based on an experimental-control group design with three main parts: pre-test, cognitive training (three training conditions - Inductive Reasoning, Spatial Orientation and Everyday Problem Solving vs. placebo control) and two post-tests with 3 months of interval. The results indicate that the elderly of low educational level improve their performance both in the domain and transfer test in two of the three training conditions: inductive reasoning and spatial orientation. Results are discussed in relation to other topics related to research studies.

Evaluation of “Vital Aging-M”: A Psychosocial Program for Promoting Optimal Aging

Europe has become the most aged continent: In the Europe of the Fifteen (EU-15), one in five Europeans is now older than 65, a proportion set to increase (Eurostat, 2000). Although the aging population should be considered a positive phenomenon – the expression of sociopolitical, educational, and bio-medical development – it also undoubtedly represents a challenge to science and society: Since age is associated with illness, and illness with disability, the increased size of the older population brings with it high social and health costs. Thus, on average, in EU-15, social and health expenditures for those over-65 represents 10.5% of gross domestic product (GDP) and half of all health costs (Eurostat, 2001). The estimate is that, in accordance with future population distribution, by 2020 it will be necessary to increase the expenditure in social and health care. Thus, the aging population implies not only that people will live longer, it is also highly likely that to some extent they live longer with disability. On the basis of the prevalence of illnesses and disability and life expectancy, disability-adjusted life expectancy (DALE, also healthy life expectancy) refers to the estimation of a person’s probability, at birth (or at a certain age), of living free of disability – in other words, of their expectancy of living healthily. A comparison of life expectancy at birth with disability-adjusted life expectancy also at birth (WHO, 2000) for the EU-15 shows that, on average (men and women), while life expectancy at birth (EU, 2000) runs from 79.6 (Sweden) through 75.8 (Portugal), disabilityadjusted life expectancy (WHO, 2000) runs from 73.1 years (France) to 69.3 (Portugal). If we take into consideration men and women, the lowest expectation of disability at birth is in Greece (5.0 years per men and 5.9 per women) and highest in Luxemburg (6.5 per men and 7.2 per women) with an average of 6.3 years in EU-15. Thus, bearing in mind that life expectancy is projected to increase in the forthcoming decades, we may predict many more years of disability. Consequently, the challenge represented by the aging of the population derives not from the population rates, but from the rates of disability involved and the costs thereof. On the other hand, an increasing life expectancy free of disability would imply a reduction in social costs and would produce greater well-being and quality of life for citizens. But will this occur? Is there any empirical evidence that disability rates can in fact be reduced – or that DALE can increase? The evidence we have comes from two types of data: predictions of disability rates through longitudinal studies and studies on successful, active, or optimal aging. Longitudinal studies show a decline in disability among the elderly in the last decades compared to what has been expected (Cutler, 2001; Manton & Gu, 2001). For example, the Federal Interagency Aging Related Statistics predicted in 1982 a disability rate of 7.5 for 1984, of 8.3 for 1989 and of 8.7 for 1994, but the true data showed disability rates of 7, 7.1, and 7.3, respectively. The post-hoc explanation for this epidemiological finding may lie, according to the World Health Organization (WHO, 2002), in a situation whereby progress in the prevention of illness, the compression of morbidity, and the promotion of health have actually led to a decrease in the percentage of older people with disability. In sum, as Fries and Crapo (1981) stated, theoretical and experimental observations from physiology, medicine, psychology, sociology, and other discipline support the lengthening not only of life expectancy, but also of disability-free life expectancy, vitality or the vigor curve, always against the limit of lifespan (p. 123). Our second source of evidence comes from those studies focusing on how individuals age or, more precisely, on the changes that occur across the course of life or as part of the aging process. From these studies, it is commonly accepted that the individual process of aging can be reduced to a combination of patterns of growth, stability, and decline (e.g., Baltes, 1987; Schroots; Fernandez-Ballesteros & Rudinger, 1999, Schroots & Birren, 1993). Thus, those sciences that contribute to the

PERSONAL AND ENVIRONMENTAL RELATIONSHIPS AMONG THE ELDERLY LIVING IN RESIDENTIAL SETTINGS

There is strong empirical evidence to support the influence of environmental and social factors in health and behavior among the institutionalized elderly. In order to assess personal and environmental relationships, 32 residential centers for the elderly and 1403 of their inhabitants were assessed using the Sistema de Evaluación de Residencias de Ancianos (SERA). Our principal findings were as follows: (1) relationships between individual variables (e.g. objective and subjective health, depression) and subjective variables (e.g. satisfaction); (2) the predictive power of the environment characteristics (e.g. policy choice) on the subjects functioning (e.g. level of activity); (3) residential satisfaction is the product of several personal variables (e.g. objective and perceived health), as well as of social environmental factors (e.g. physical comfort); and (4) very weak relationships were found between social climate dimensions and other environmental factors.

Positive Perception of Aging and Performance in a Memory Task: Compensating for Stereotype Threat?

Background/Study Context: The aim of this research is to explore whether segments of seniors might be immune to aging stereotypes of the older adult group. Stereotype threat research indicates that older adults show low memory recall under conditions of stereotype threat. Stereotype internalization theory (Levy, 2009) predicts that a positive perception of aging has favorable effects on the behavior and health of older people. Methods: A total of 112 older adult participants (62% women, aged 55 to 78) attending the University Programme for Older Adults were assigned to one of two conditions: stereotype threat condition and positive information condition. A control group was included from participants in the same program (n = 34; 61% women, aged 55 to 78). Individual differences in self-perception of aging were considered as continuous variable. Results: Participants with better self-perception of aging showed better memory performance than those with poorer self-perception of aging in the stereotype threat condition and control condition. However, no differences were found in the positive information condition between participants with high and low self-perception of aging. These results indicate that positive self-perception of aging moderates the effects of stereotype threat, and that positive information promotes better memory performance for those older adults with a poorer self-perception of aging. Conclusion: As expected, individuals with a positive perception of their own aging were less vulnerable to the activation of a negative older adult stereotype in the stereotype threat condition.

Age Discrimination, Eppur Si Muove (Yet It Moves)†

nine other medications. The promethazine led to multiple side effects, followed by medications to treat those side effects. She was ultimately hospitalized in a catatonic state and bed-bound for 4 months, and it took a year’s worth of recovery before she could interact with her family again. Mrs. Smith’s age is important because the American Geriatrics Society (AGS) recommends against using promethazine in the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Despite promethazine’s effectiveness in its study populations, it should have been avoided in her case. As a medical student, hearing this story terrified me because I would have chosen the same treatment for Mrs. Smith What her doctor and I failed to consider are the effects that the prescribed medication would have on an 83-year-old vs the younger individuals in which its efficacy and safety were tested. After completing my preclinical curriculum, I realized I was not taught how to care for older adults. Our education exposes us to a wide breadth of subjects and fields, but our lectures and rotations lack a dedicated exposure to geriatrics. According to the Census Bureau, the United States had more than 40 million elderly persons in 2010 and will have 70 million by 2029. Despite this increase in the size of this population and its healthcare needs, the number of geriatricians in the country is inadequate and dwindling. According to the AGS, there was a 33% decline in medical school graduates pursuing advanced training in geriatric medicine between 2005 and 2010. Although we cannot reverse this trend and build a sufficient geriatric physician workforce overnight, we can better prepare current medical students for the practice of geriatric medicine that they will assume, regardless of their field. To see firsthand the approach to care in elderly adults and what we as medical students must do to practice it competently, I requested to work 1 month on a geriatrics unit during my internal medicine subspecialty rotation. The approach to care I witnessed was different from what I had seen on other services, even when I had been caring for older adults, and it changed how I will care for elderly adults in the future. One practice I observed is deprescribing, or stopping a current medication. Deprescribing is necessary to combat polypharmacy, which is prevalent, and sometimes dangerous, in elderly adults. More than 36% of people aged 75 to 85 are taking five or more prescribed medications, and almost 100,000 adults aged 65 and older are hospitalized for adverse drug events each year. Although polypharmacy is risky, deprescribing can be dangerous. Appropriate medications extend and improve the quality of life as well. Choosing which ones to discontinue can amount to playing Russian roulette. To address this, Dr. Joshua Uy, a geriatrician on my rotation, taught a tactic he called “the partnership with patients.” The partnership uses close follow-up to obtain feedback on the effects of deprescribing, as opposed to adherence to an evidence-based algorithm that I have learned on other rotations. This collaborative relationship allows the doctor and the patient to balance risks and benefits and make shared decisions to treat or not in time-limited trials. Combining their knowledge of geriatric-specific guidelines such as the Beers criteria with the partnership strategy allowed Dr. Uy and his colleagues to personalize medical care to each person. Despite the importance of deprescribing and other skills that geriatricians need and interactions that they have with greater frequency, such as palliative care and the dying experience, only approximately 10% of my classmates will complete a geriatrics rotation during medical school. Although most medical students will not become geriatricians, the majority will care for older adults, and it is essential that we learn to do so responsibly. The task falls on medical schools and us as students. Our curriculums should better emphasize geriatric medicine in our preclinical years and should provide more opportunities on a geriatric service in our clinical years. As students, we must take the initiative to pursue clerkships, subinternships, and electives in geriatric medicine. As Dr. William Osler once said, “The good physician treats the disease; the great physician treats the patient who has the disease.” If those words ring true today, then the future of American medicine must learn to treat the 83-year-old Mrs. Smith and not just her nausea.

Berlin declaration on the quality of life for older adults: Closing the gap between scientific knowledge and intervention

This declaration on Quality of Life for Older Adults highlights some central topics that were discussed at the New Horizons Expert Workshop on Quality of life in Old Age held as part of the XXIXth International Congress of Psychology in Berlin, 2008. In many countries life expectancy has dramatically increased over the past 100 years – with an average gain of 30 years. The shift in life expectancy has consequences for current aging cohorts, and for future cohorts, for the aging individual, for the relevant institutions of the welfare state, and for the science of psychology at large. Quality of life encompasses many individual aspects of functioning, such as physical and mental health, cognitive processing, and social participation. In addition, quality of life also refers to adequate contexts and environments, such as family support, access to social and health services, environmental stimulation and safety, and a satisfying economic standing. All this concerns populations that become more and more heterogeneous in terms of their physical and mental conditions, lifestyles, ethnicities and religions. Discussions of the quality of life in old age thus need to focus on how to activate and promote resources and unused potentials, how to prevent or delay age-associated declines, and how to introduce therapeutic interventions that compensate age-related losses and thus maintain competence and mental health. • Activate resources and potentials of older adults. There are many possibilities for increasing the quality of life by social participation, be it through volunteering or through new formats of age-fair work that avoid marginalization of the elderly without putting undue pressures on those who cannot live-up to standards of activity but allowing those who are able and want to continue working after the mandatory retirement age. For future cohorts we need to make sure that education, work, and leisure occur at varying levels of intensity and quality over the entire life span, rather than in a fixed linear sequence as is still common. • Promotion of competence. Solid evidence from decades of cognitive training research has shown This Declaration was signed by the International Experts of the Forum on Aging that took place on July 22, 2008, on the occasion of the 29th International Congress of Psychology in Berlin, Germany.