Roman Kaspar

Natural Occurrence of Subjective Aging Experiences in Community-Dwelling Older Adults

OBJECTIVES The subjective experience of aging is a relevant correlate of developmental outcomes. However, traditional approaches fall short of capturing the inherent multidimensionality of subjective aging experiences (SAEs). Based on the concept of Awareness of Age-Related Change (AARC; Diehl, M. K., & Wahl, H.-W. (2010). Awareness of age-related change: Examination of a (mostly) unexplored concept. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 65, 340-350. doi:10.1093/geronb/gbp110), this study provides a description of SAEs that is facet rich, and based on their natural occurrence, analyzes interindividual differences and associations with well-being. METHOD Data came from 225 participants (70-88 years) of the ongoing BEWOHNT study. Open-ended diary entries about age-related experiences were collected for more than 14 days and coded according to AARC domains and subdomains. RESULTS Seventy percent of all participants had SAEs about physical functioning. About half of the sample reported experiences in the domains interpersonal relations, social-emotional and social-cognitive functioning (COGN-EMOT), and lifestyle. Thirty percent experienced aging in terms of changes in cognitive functioning. Contents of SAEs varied by gender, age group, and functional status. SAEs about COGN-EMOT were most consistently related to affective components of subjective well-being. DISCUSSION Our results demonstrate the benefits of an open-ended approach to a multidimensional understanding of SAEs. Content-related, social-cognitive and social-emotional changes more than functional age-related changes were most important for well-being.

Multimorbidity's research challenges and priorities from a clinical perspective: The case of ‘Mr Curran’

ABSTRACT Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. Effective approaches are needed to manage such complex patients in primary care. This paper describes the results of a scoping exercise, including a two-day workshop with 17 professionals from six countries, experienced in general practice and primary care research as well as epidemiology, clinical pharmacology, gerontology and methodology. This was followed by a consensus process investigating the challenges and core questions for multimorbidity research in primary care from a clinical perspective and presents examples of the best research practice. Current approaches in measuring and clustering multimorbidity inform policy-makers and researchers, but research is needed to provide support in clinical decision making. Multimorbidity presents a complexity of conditions leading to individual patients needs and demanding complex processes in clinical decision making. The identification of patterns presupposes the development of strategies on how to manage multimorbidity and polypharmacy. Interventions have to be complex and multifaceted, and their evaluation poses numerous methodological challenges in study design, outcome measurement and analysis. Overall, it can be seen that complexity is a main underlying theme. Moreover, flexible study designs, outcome parameters and evaluation strategies are needed to account for this complexity.

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.

Technisierte Umwelten als Handlungs- und Erlebensräume älterer Menschen

Zu Beginn des 21. Jahrhunderts stellen verschiedenste technische Gerate und Systeme einen der wohl wesentlichsten Aspekte der beruflichen und in zunehmendem Masse auch der privaten Lebenswelten moderner Gesellschaften dar. Ob es um Arbeit oder Freizeitaktivitaten, um die Gestaltung sozialer Kontakte und Hobbies oder die alltagliche Haushaltsfuhrung, um Mobilitat und Erreichbarkeit oder um Gesundheitsversorgung und Pflege geht — kaum ein Bereich menschlichen Lebens ist mehr ohne technische Unterstutzung oder Vermittlung denkbar. Im Hinblick auf die im Alter steigende Vulnerabilitat funktionaler Kompetenzen konnen technische Gerate einen bedeutsamen Beitrag zur selbstbestimmten Lebensfuhrung und sozialen Teilhabe alterer Menschen leisten. So hat die technische Haushaltsrevolution auch alten Menschen viel muhsame Alltagsarbeit erleichtert und ihre individuellen Handlungsraume erweitert. Immer schnellere und bequemer handhabbare Verkehrsmittel rucken entfernte Orte, Einrichtungen und Personen in erreichbare Nahe. Information und Unterhaltung, kunstlerische Tatigkeit und lebenslanges Lernen konnen uber eine wachsende Vielfalt von Medien erfolgen, Kommunikation — eine in pluralistischen Gesellschaften mit ihren vielfaltigen Lebensformen, Wertorientierungen und gesellschaftlichen Bereichen unerlassliche Voraussetzung fur soziale Integration und gesellschaftliche Teilhabe — mittels interaktiver Ubertragungssysteme ermoglicht oder zumindest erleichtert werden. Raumliche und zeitliche Beschrankungen verlieren durch neue Medien an Gewicht, und die Grenzen zwischen virtuellen und konkreten Raumen, zwischen Nahe und Distanz verschwimmen.

OUTDOOR MOBILITY IN LATE LIFE: PERSONS, ENVIRONMENTS AND SOCIETY

This chapter deals with a complex phenomenon: the out-of-home mobility of ageing and aged persons. It is a complex issue because so many different aspects come together in the interaction between persons and their environments. Mobility means the physical ability to move and the realisation of all types of trips and activities outside the home, and it can be motivated by diverse, often inseparably intertwined motives. Trips can be manifested in a goal-directed mode or for its own sake, and they can be performed on foot, by harnessing natural forces or by employing any mechanised or motorised means of transportation. Spatial and traffic conditions as well as the societal conditions for mobility are different. This holds not only for national legislations, traffic policy, level of mechanisation, etc. but also for values, lifestyles or what we call a society’s “Zeitgeist”. In that sense, mobility is a crucial characteristic of modern societies. And last but not least, all of these conditions are subject to permanent change. Over the course of the 20th century, technological advances—from individual automobiles, public transportation systems and special driving services to trains, ships and airplanes—have made it possible to traverse distances even despite physical or sensory impairments or frailty. As transport technologies improved, the shape of urban and rural settlements has changed as well. The provision of an extended road infrastructure accelerated extensive suburban development and the establishment of industrial and commercial enterprises beyond residential areas. The growing dispersal of travel origins and destinations, in turn, increased the importance of mobility for bridging the widening gap between functional areas. Altogether, these developments led to a continual increase in mobility and travel (World Business Council for Sustainable Development, 2002). Therefore, mobility has become a major condition for ensuring the ability to lead an autonomous life and participate actively in society. Individual states, resources, and needs change as people age. Ageing is accompanied by an increasing risk of physical disabilities, as well as declining sensory abilities, and hence, restriction of mobility. At the same time, social changes, such as grown children leaving home, retirement and the loss of close confidants, demand a growing measure of mobility if the elderly person is to continue being part of society (Mollenkopf, 1996). Mobility also promotes healthy ageing and delays the onset of frailty (Leventhal, Rabin, Leventhal, & Burns, 2001; Rantanen et al., 2000). Hence, the detailed analysis of outdoor mobility in old age, as well as its potentials and hindrances, is highly relevant for a “good life” (Lawton, 1983) for both today’s and tomorrow’s ageing population.

On the Quantitative Assessment of Perceived Housing in Later Life

Person-environment relationships become particularly important in later life. Our discussion of challenges in the assessment of experiential person-environment exchange processes is grounded on a four-domain model of perceived housing. We present empirical findings from an iterative process of instrument revision seeking optimization of both reliability and validity issues regarding control-related and meaning-oriented domains of perceived housing. Our initial reconstruction, however, was not confirmed to represent a consistent and reliable measure for the suggested dimensions of housing-related identity, privacy, and autonomy. Exploratory post-hoc analyses of the pilot pool of indicators suggests six holistic facets, such as “daily independence” “neighborhood belonging”, “mirror of self”, “continuity and remaining in place” and “being alone and at peace”. Plausible content-related interpretation and relations to major background characteristics encourage the continuous task of tailoring assessment instruments to meet the holistic character of housing experiences in later life.

Emotional competencies in geriatric nursing: empirical evidence from a computer based large scale assessment calibration study

The care of older people was described as involving substantial emotion-related affordances. Scholars in vocational training and nursing disagree whether emotion-related skills could be conceptualized and assessed as a professional competence. Studies on emotion work and empathy regularly neglect the multidimensionality of these phenomena and their relation to the care process, and are rarely conclusive with respect to nursing behavior in practice. To test the status of emotion-related skills as a facet of client-directed geriatric nursing competence, 402 final-year nursing students from 24 German schools responded to a 62-item computer-based test. 14 items were developed to represent emotion-related affordances. Multi-dimensional IRT modeling was employed to assess a potential subdomain structure. Emotion-related test items did not form a separate subdomain, and were found to be discriminating across the whole competence continuum. Tasks concerning emotion work and empathy are reliable indicators for various levels of client-directed nursing competence. Claims for a distinct emotion-related competence in geriatric nursing, however, appear excessive with a process-oriented perspective.

Perceived Social Capital in Self-Defined Urban Neighborhoods as a Resource for Healthy Aging

Environmental gerontology has adopted a social cohesion perspective on social capital, defining social capital as a neighborhood-level characteristic rather than a property of the individual. This chapter will discuss the macro-micro relationship between social capital and healthy aging by focusing on the relevance of the perceived socio-physical environment in terms of cognitive experiential processes (e.g., urban-related identity) and behavioral processes of engagement in the community (e.g., social participation). We study individuals’ subjective definitions of neighborhood boundaries in geographical space in our attempt to assure a valid mapping of person–environment references. Based on both a phenomenological approach and a comprehensive survey with 595 community-dwelling urban citizens (Frankfurt am Main, Germany) stratified by age (70–79 vs. 80–89 years) and household composition (living alone vs. with partner), a variety of constituents of perceived neighborhood in old age are identified that clearly challenge common notions of what defines a neighborhood as well as point to potential mechanisms of neighboring that have been neglected in most current studies of social capital. On a descriptive level, disparities with respect to aspects of healthy aging, urban-related identity and social participation are investigated across 37 shared perceived neighborhoods using a multi-level approach. Finally, we test the hypothesis that neighborhood-level social capital moderates the effects of place identity and social participation on healthy aging. The consequences of perceived social capital in the neighborhood for agency, belonging, aging in place and, ultimately, for healthy aging in urban neighborhoods are revisited.

Biographiearbeit in der stationären Langzeitpflege von Menschen mit Demenz

ZusammenfassungIn der Pflege und Betreuung von Menschen mit Demenz ist die Biographiearbeit ein weitverbreitetes Konzept. In Literatur und Praxis finden sich jedoch zahlreiche unterschiedliche Vorstellungen davon, wie diese angewendet werden soll. Auch im DEMIAN-Konzept, einem Pflegekonzept zur Förderung des subjektiven Wohlbefindens, nimmt die Biographiearbeit einen zentralen Stellenwert ein. Der vorliegende Artikel gibt einen Überblick über den Stellenwert der Biographiearbeit in der Pflege und Betreuung von Menschen mit Demenz. Insbesondere wird die Rolle und Gestaltung von Biographiearbeit im DEMIAN-Konzept thematisiert. Im Rahmen der Anamnese des DEMIAN-Pflegekonzepts werden durch Gespräche mit den verschiedenen Akteuren (Menschen mit Demenz, Angehörige bzw. Bezugspersonen sowie Mitarbeitende im Pflege- und Betreuungsteam) und durch gezielte Beobachtung Themen erfasst, die für die Person mit Demenz individuell bedeutsam sind. Diese dienen als Grundlage für die gezielte Gestaltung positiver Alltagssituationen im Pflege- und Betreuungsalltag mit dem Ziel, das emotionale Wohlbefinden zu fördern. Die Potenziale des DEMIAN-Konzepts werden diskutiert und Weiterentwicklungsmöglichkeiten aufgezeigt.AbstractIn nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.In nursing care for people with dementia, biographical work is a popular concept. In the literature and practice, many different viewpoints of the way biographical work can/should be promoted exist. In the DEMIAN concept, a nursing concept to promote emotional well-being for people with dementia, it is also of major significance. This article gives an overview of the importance of biographical work in caring for people with dementia. In particular, the role and arrangement of biographical work in the DEMIAN concept are described. Within the anamnesis of the DEMIAN concept, meaningful themes are identified in conversations with different participants (person with dementia, reference persons, and care workers) and through observations. From these findings, specific interventions, aimed at supporting emotional well-being of people with dementia, are derived and integrated into everyday nursing care to promote emotional well-being. The potential of the DEMIAN nursing concept are discussed and further possibilities are highlighted.