Scott D. Landes

The Long-Term Effects of World War II Combat Exposure on Later Life Well-Being Moderated by Generativity

According to theories of stress-related growth, coping with traumatic events can lead to greater psychosocial maturity in resilient individuals or psychosocial maladjustment in less resilient individuals. Using a sample of 160 World War II veterans of the 60-year longitudinal Study of Adult Development, this research examined the long-term effects of high and no combat exposure among Harvard-educated white men who either achieved or failed to achieve Eriksons psychosocial developmental stage of generativity in midlife. Although combat exposure by itself was unrelated to the outcome variables, only among veterans with high combat exposure was generativity consistently positively related to physical and psychological health, wisdom characteristics, and well-being. The results indicate a resilience effect for men with high combat exposure who experienced subsequent psychosocial growth.

Attention Deficit Hyperactivity Disorder and adult mortality.

This study examines the relationship between self-reported ADHD and adult mortality over a four-year period, and whether ADHD is associated with underlying cause of death (accidents versus all others). If ADHD increases mortality risk through accidents, then interventions may be designed and implemented to reduce risk and prevent premature death. We estimate descriptive statistics and multivariate logistic regression models using data from the 2007 U.S. National Health Interview Survey (NHIS) Sample Adult File linked to National Death Index (NDI) data through 2011 (N=23,352). Analyses are weighted and standard errors are adjusted for the complex sampling design. We find that the odds of dying are significantly higher among those with ADHD than among those without ADHD net of exogenous sociodemographic controls (adjusted odds ratio=1.78, 95% confidence interval=1.01, 3.12). Although marginally non-significant, accidental death is more common among those with ADHD than among those without ADHD (13.2% versus 4.3%, p=0.052). Few population-representative studies examine the relationship between ADHD and adult mortality due to data limitations. Using NHIS data linked to the NDI, we are only able to observe a few deaths among adults with ADHD. However, ADHD is associated with significantly higher odds of dying for adults and results suggest that accidents may be an underlying cause of death more often for decedents with ADHD. Future research should further examine the mechanisms linking ADHD to adult mortality and the extent to which mortality among persons with ADHD is preventable. Regular measurement of ADHD among adults in the NHIS is warranted.

Childhood Adversity, Midlife Generativity, and Later Life Well-Being

OBJECTIVES Prior studies confirm that after experiencing childhood adversity, resilient adults can recover and engage in generative growth. This study explored the long-term effects of childhood adversity (assessed as harsh parenting and/or childhood poverty) on successful aging for individuals who either achieved or failed to achieve Eriksons psychosocial developmental stage of generativity in midlife. METHOD The study utilized a sample of 636 men from the Harvard Sample and Inner City Cohort of the 73-year longitudinal Study of Adult Development. Nested ordinary least squares regression models were used to test the mediating and moderating effects of midlife generativity on later life health and adjustment to aging. RESULTS Men who experienced childhood adversity were less likely than men with no childhood adversity to achieve generativity in midlife. Although achievement of generativity was associated with better later life health and adjustment to aging, it neither mediated nor moderated the negative relation between childhood poverty and later life health outcomes. However, for men who experienced an adversarial childhood, achievement of generativity mediated and moderated adjustment to aging. DISCUSSION Results suggest that psychosocial growth in adulthood can compensate for the long-term negative effects of an adversarial childhood on adjustment to aging, but not for later life health.

Rediscovering Internal Strengths of the Aged: The Beneficial Impact of Wisdom, Mastery, Purpose in Life, and Spirituality on Aging Well

What explains aging and dying well? Previous research primarily examined the effects of objective life conditions (e.g., physical health, finances, socioeconomic status, age, social relationships) on older adults’ subjective well-being, whereas their internal strengths have often been ignored. Applying theories of life-long psychosocial growth and the life course principles of life span development and human agency, and using a sample of 144 older community residents, nursing home residents, and hospice patients (aged 56+) living in North Central Florida, this study investigated the effects of older people’s psychosocial strengths (their wisdom, mastery, purpose in life) and spirituality on subjective well-being and death attitudes. Wisdom was defined and operationalized as a combination of cognitive, reflective, and compassionate personality characteristics. Results of hierarchical regression analyses showed that, contrary to situational theory, internal strengths of the aged had a stronger effect on greater subjective well-being and less death fear than on objective circumstances.

The effect of race and birth cohort on the veteran mortality differential

Research on veteran versus nonveteran mortality outcomes provides contrary results, with some studies reporting a veteran mortality advantage while others report a veteran mortality disadvantage. Life course scholars suggest these conflicting results may be explained by a crossover in the veteran-nonveteran mortality differential, with veterans having a mortality advantage during early and midlife and a mortality disadvantage during older age. We conducted discrete time hazard analysis of a veteran-nonveteran mortality crossover among black and white men in the United States by birth cohort using data from the 1986-2009(2011) National Health Interview Survey-Linked Mortality Files. Among men who turned age 18 during non-war eras, veterans had an early to midlife mortality advantage and later life mortality disadvantage, with differences more pronounced among black men. However, differences between veteran and nonveteran mortality risk were not significant among the majority of men who turned age 18 during war eras. Findings clarify that the mortality related benefits of military service may only apply to veterans who came of age during non-war eras. Furthermore, results suggest that military service may provide a greater mortality benefit to black veterans than white veterans.

The Association between Education and Mortality for Adults with Intellectual Disability

Although the relationship between education and mortality is well documented in the general population, it has not been examined for adults with intellectual disability. Informed by fundamental cause theory, I explore the association between education and mortality in a sample of 4,241 adults with intellectual disability from the 1986–2009 National Health Interview Survey with Linked Mortality Files through 2011. Cox regression models were utilized to analyze the predictive effect of education on mortality risk while taking into account birth cohort differences. Increased education was associated with lower mortality risk for adults with intellectual disability, and this relationship strengthened in later birth cohorts who had greater access to the public education system. Comparison with a sample of 21,205 adults without intellectual disability demonstrates that the association between education and mortality risk was not as robust for adults with intellectual disability and highlights the ongoing socioeconomic challenges faced by this population.

Culture and Language Discordance in the Workplace: Evidence From the National Home Health Aide Survey

Purpose of the study Home health aides (HHAs) provide valuable resources to address existing and predicted needs for taking care of the aging population. Both the older adult and healthcare provider populations in the United States are becoming increasingly diverse. The study examined the effect of culture and language discordance between HHAs and their patients or coworkers on worker outcomes. Design and methods Data from this study were from the 2007 National Home Health Aide Survey. T Tests and ordinary least squares regression were used to analyze the relationships between cultural discordance and worker outcomes. Results Cultural discordance with patients was associated with lower levels of job satisfaction among HHAs. Cultural discordance with coworkers was associated with lower levels of job satisfaction and, increased intent to leave ones job. Implications The current study suggests that cultural discordance does affect worker outcomes. However, home healthcare workers appear to differentiate between cultural discordance with patients and with coworkers. This article concludes with strategies for all involved in the care of older adults to improve the experience of HHAs and to ensure patients receive the best possible care.

Practicing Discernment: Pastoral Care in Crisis Situations

This article correlates a particular experience of providing pastoral care for a person in a crisis situation with a particular understanding of the practice of pastoral care. Through engaging in correlative practical theology, it highlights the need for practicing discernment when providing pastoral care for persons utilizing narratives to work through crisis situations.

Self-Reported ADHD and Adult Health in the United States

Objective: Informed by a social determinants of health framework, we investigate the relationship between self-reported ADHD diagnosis status and adult health, and whether observed associations are attenuated by biomedical and socioeconomic factors. Method: Using 2007 National Health Interview Survey data (N = 19,104), we present multivariate logistic regression analyses of associations between self-reported ADHD diagnosis status and five adult health outcomes. Results: ADHD diagnosis was significantly associated with higher odds of injury, physical health conditions, functional limitations, fair/poor health, and psychological distress in fully specified models (adjusted odds ratios [AORs] = 1.62-2.36). Inclusion of controls for exogenous demographic characteristics, psychiatric comorbidities and health behaviors, and adult social and economic statuses attenuated but did not eliminate observed associations between ADHD and poorer adult health. Conclusion: Research on adult health outcomes for those with ADHD should include consideration of the mechanisms by which a diagnosis of ADHD leads to cumulative social disadvantages that independently contribute to poorer health outcomes.

The Intellectual Disability Mortality Disadvantage: Diminishing With Age?

On average, adults with intellectual disability (ID) have higher mortality risk than their peers in the general population. However, the effect of age on this mortality disadvantage has received minimal attention. Using data from the 1986-2011 National Health Interview Survey-Linked Mortality Files (NHIS-LMF), discrete time hazard models were used to compare mortality risk for adults with and without ID by age and gender. Increased mortality risk was present for all adults with ID, but was most pronounced among younger age females. The mortality differential between those with and without ID diminished with increased age for both females and males. Findings support the argument that heterogeneity of frailty may explain differences in mortality risk between those with and without ID.