Sharon Avidor

Subjective Age and Health in Later Life: The Role of Posttraumatic Symptoms

OBJECTIVES We examined: (a) long-term effects of war-related trauma and captivity on posttraumatic stress symptoms (PTSS), physical health, and subjective age; and (b) the moderation effect of PTSS and health on subjective age among ex-prisoners of war (ex-POWs) and war veterans. METHOD Israeli veterans of the 1973 Yom Kippur War (mean age 57 years), including 111 ex-POWs and 167 matched veterans were assessed for subjective age, war-related PTSS, and health-related measures (physical symptoms, somatization, health-risk behaviors, and self-rated health). RESULTS Controlling for age, ex-POWs endorsed higher subjective age than controls, and ex-POWs with posttraumatic stress disorder (PTSD) endorsed higher subjective age than ex-POWs and controls without PTSD. PTSS and health measures besides health-risk behaviors predicted subjective age. Significant interactions were found between PTSS and each health measure, suggesting that health only predicts subjective age for those reporting high PTSS. DISCUSSION PTSS appear to be implicated in the link between health measures and subjective age in later life, pointing to the long-term effect of captivity and war-induced traumatic distress on aging.

Accelerated increase and decrease in subjective age as a function of changes in loneliness and objective social indicators over a four-year period: results from the health and retirement study

Objectives: The study examined the role of changes in loneliness and objective social indicators in the formation of changes in subjective age over a four-year period. Methods: The Health and Retirement Study is a US nationally representative study of older adults over 50 and their spouse of any age. We restricted the sample to individuals, 65 years of age and older (n = 2591). An accelerated increase in subjective age was defined as an increase in subjective age over the two waves greater than five years. An accelerated decrease in subjective age was defined as a difference that was lower than three years. These were examined against a change in subjective age in the range of three to five years (i.e., change consistent with the passage of time). Results: For 23.4% of the sample, changes in subjective age were consistent with the passage of time. A total of 38.3% had an accelerated decrease in subjective age, whereas 38.3% had an accelerated increase. A decrease in loneliness over the two waves resulted in an accelerated decrease in subjective age, whereas an increase in depressive symptoms resulted in an accelerated increase in subjective age. Changes in objective social indicators, physical difficulties or medical comorbidity did not predict changes in subjective age. Conclusions: This is one of very few studies that examined changes in subjective age over time. Changes in subjective age represent an important construct that corresponding to other changes in subjective experiences.

Longitudinal associations between perceived age discrimination and subjective well-being: variations by age and subjective life expectancy

ABSTRACT Objectives: Perceived age discrimination can have negative effects on ones subjective well-being (SWB). The response to age discrimination might differ based on age, and based on perceived longevity, or subjective life expectancy (SLE). These differential effects have not yet been prospectively examined within adult life span samples. Method: We examined the association between perceived age discrimination at baseline (T1) and SWB at follow-up (T2), and the moderation effect of SLE. We compared differences in these effects between middle-aged and older adults. Analyses were based on participants who took part in the 2008 (T1) and 2011 (T2) assessments of the German Ageing Survey (DEAS; listwise N = 1534), a population-based representative sample of the German adult population. Participants were categorized as middle-aged (ages 40–64; n = 919) or older adults (ages 65–93; n = 615). Results: Regression analyses indicated that T1 perceived age discrimination significantly predicts lower T2 SWB among middle-aged, but not among older adults, after adjusting for covariates and T1 SWB. There is a significant interaction between age discrimination and SLE for predicting SWB, only among middle-aged participants, suggesting that age discrimination predicts decreases in SWB for those reporting higher, but not lower levels of SLE. Conclusion: People in the transition from midlife to old age, who hold higher SLE, appear to be more vulnerable to age discrimination. This may be due to the experience of age discrimination as an ‘off-time’, or unexpected event for those in midlife who have a higher expectation to live longer.

Changes in positive and negative affect as predictors of change in felt age: Results from the Health and Retirement Study

Abstract The present study aimed to examine how changes in positive and negative affect and their interaction predict changes in felt age in a longitudinal design of two waves drawn from the Health and Retirement Study (HRS). Participants (n = 4174) at an average age of 67.97 completed the 2008 and 2012 left behind questionnaire of the HRS. Our results showed that an increase in positive affect and a decrease in negative affect from Wave 1 to Wave 2 predicted an accelerated decrease in felt age. There was an interaction effect showing that for those with an increase in negative affect, a higher change in positive affect predicted reduced odds for accelerated increase in felt age. To conclude, improving favorable change in the combination between positive and negative affect might in turn relate to the individual’s self-perceptions of aging, in the second half of life.

Guilt Among Ex-Prisoners of War

The article explores guilt and its correlates among Israeli ex-prisoners of war (ex-POWs) of the 1973 Yom Kippur War (YKW; N = 119) and a matched group of veterans of the same war who were not held captive (N = 97). Results revealed that compared with controls, ex-POWs reported both more posttraumatic stress symptoms (PTSS) and more guilt, after adjusting for PTSS. Results also revealed a significant PTSS × Group interaction effect on guilt, wherein the association between PTSS and guilt was stronger among ex-POWs than among controls. Among ex-POWs, results showed that feelings of helplessness when falling captive, inwardly directed active coping, and a sense of loss of control during captivity contributed to the prediction of guilt. Support at homecoming made no contributions to variance, and circumstances of falling into captivity did not predict guilt. Results support the notion that guilt is a significant component of the psychological aftermath of war captivity, and highlight its correlates. Clinical and theoretical implications of the findings are discussed.

Telomere Length and Depression Among Ex-Prisoners of War: The Role of Subjective Age

Objectives Exposure to captivity increases the risk for multiple disturbances that may intensify during old age. In later phases of life, former-prisoners-of-war (ex-POWs) may suffer from depression as well as from accelerated aging, manifested in older subjective age and leukocyte telomere shortening. The current study assesses the link between these varied facets of increased vulnerability during old age and explores (a) the associations between subjective age and telomere length; (b) the mediating role of changes in subjective age over time within the associations between depression and telomere length. Methods Eighty eight ex-POWs were assessed prospectively 30 (T1), 35 (T2) and 45 (T3) years after the 1973 Israeli Yom-Kippur War. Depression was assessed at T1; subjective age was assessed at T2 and T3; and telomere length and control variables were assessed at T3. Results Older subjective age at T3 was associated with concurrent shorter telomeres, beyond the effect of chronological age. Change in subjective age between T2 and T3 mediated the relations between depression at T1 and shorter telomeres at T3 beyond the effects of control variables. Discussion Findings suggest that the detrimental ramifications of accelerated subjective age involve premature cellular senesces, and may explain the relation between depression and accelerated aging processes among trauma victims. Hence, clinical interventions may seek to address accelerated subjective age among trauma survivors who suffer from depression.

The Role of the Hostile-World Scenario in Predicting Physical and Mental Health Outcomes in Older Adults.

Objective: The hostile-world scenario (HWS) denotes a personal belief system regarding threats to one’s physical and mental integrity. We examined whether the HWS predicted health among older adults. Method: The Israeli branch of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) provided data on 1,286 participants, aged 50+, interviewed in two waves 4 years apart. A special measure assembled items pertinent to the HWS throughout the SHARE survey. Nine outcomes indicated physical health (e.g., activities of daily living, medical conditions) and mental health (e.g., depressive symptoms, satisfaction with life). Results: The HWS at Wave 1 predicted all physical and mental outcomes at Wave 2, except cognitive functioning, beyond effects of sociodemographics and the respective outcome’s baseline at Wave 1. This predictive effect was stronger among older participants. Discussion: The results support the conception of the HWS as a psychological monitor that senses approaching functional declines in later life.

On the edge: The association between extreme values of proportional felt-age and functioning

The present study examined whether endorsing a felt-age that is extremely divergent from ones actual age (whether older or younger) is related to worse functioning four years later. Data were drawn from 4938 participants, who completed the 2008 and 2012 questionnaires of the Health-and-Retirement-Study (HRS). Participants were divided into four groups according to their reported proportional-felt-age: the normative-young (N = 2229), reported a normative felt-age at the median or younger; normative-old (N = 2226), reported normative felt-age at the median and older; and the extremely young and extremely old proportional-felt-age (upper and lower 5% of felt-age; Ns = 242 and 241, respectively). These groups were compared on chronic medical conditions, depressive symptoms, activities of daily living (ADL), instrumental activities of daily living (IADL), functional limitations, and loneliness. While extremely younger proportional-felt-age participants did not reveal worse (or better) outcomes compared with the normative-young group, extremely old proportional-felt-age participants reported worse physical health, mental health, and functioning in cross-sectional, as well as longitudinal comparisons. Extreme values of older proportional-felt-age are usually not reported randomly and reflect less adaptive adjustment. The findings underscore the importance of studying participants at the extreme values of felt-age, especially extreme old proportional-felt-age, and the need for further inspection of the mechanisms underlying these evaluations.

Perception Counts: The Relationships of Inner Perceptions of Trauma and PTSD Symptoms Across Time

Objective: This study examined how inner perceptions that develop in the aftermath of exposure to trauma attenuate the association between posttraumatic symptoms across time and what the reciprocal relations between inner perceptions of trauma and posttraumatic symptoms are. Method: The present article is based on two studies. The data in Study 1 are drawn from three waves of a longitudinal study of community-dwelling midlife adults and older adults residing in the south of Israel. In Wave 1, 339 participants were interviewed (mean age = 65.44, SD = 9.77). Of these participants, 170 and 132, respectively, participated in Waves 2 (one year later) and 3 (two years later). Posttraumatic stress symptoms were self-reported in all three waves. Inner perceptions of trauma were assessed with the Subjective Traumatic Outlook scale (STO) and Centrality of Event Scale (CES), administered at Wave 3. Study 2 is drawn from two waves of research of young adults. Wave 1 included 138 participants (mean age = 32.01, SD = 10.57) from a convenience sample. At Wave 2, 128 participants were interviewed again a month later. Participants reported their level of posttraumatic stress symptoms and completed the STO and the CES in both waves. Results: In Study 1, analyses showed stronger associations between posttraumatic symptoms across waves among those who reported higher subjective traumatic outlook and higher centrality of events. In Study 2, significant reciprocal relationships between PTSD and STO were found, but whereas the W1 PTSD–W2 CES path was significant, the W1 CES–W2 PTSD path was not. Conclusions: The findings emphasize that overintegration and especially disintegration of the pretraumatic identity with traumatic experiences are associated with the deleterious effects of long-lasting exposure to traumatic events.

Subjective Age as a Moderator in the Reciprocal Effects Between Posttraumatic Stress Disorder Symptoms and Self-Rated Physical Functioning

It is now widely acknowledged that physical decline may increase among middle-aged and older adults who suffer from posttraumatic stress disorder (PTSD). Much less is known about the temporal sequencing of PTSD and physical decline relationship over time. While PTSD can lead to physical decline, physical decline may preserve or augment existing PTSD symptoms. Both problems can also mutually affect each other forming a vicious cycle. Additionally, it is important to address variables that can mitigate these longitudinal effects. Following the recovery capital framework, we consider how the existence or lack of capital in the form of young age identity may affect the recovery process. Therefore, the current study aimed to examine the reciprocal effects of PTSD symptoms and self-rated physical functioning and further test whether one’s subjective age moderates these effects. Using in-region random digit dialing, we collected a stratified sample of community dwelling older adult residing in south Israel. Of that sample (N at T1 = 339), 132 older adults (age range = 51–88, mean age = 66.90, SD = 9.14) were interviewed 4 months after the 2014 Israel–Gaza conflict (T2) and 1 year later (T3). Participants responded to PTSD symptoms scale, and reported their physical functioning and subjective age. PTSD symptoms and self-rated physical functioning were tested as both predictors and outcomes in a cross-lagged model. The moderating effect of subjective age was assessed by examining whether T2 variables interacted with subjective age in predicting T3 outcomes. Results showed that higher PTSD symptoms at T2 were associated with subsequent lower self-rated physical functioning at T3, yet self-rated physical functioning at T2 did not predict PTSD symptoms at T3, thereby highlighting the PTSD self-rated physical function direction. Moreover, subjective age moderated this latter association, so that this relationship was significant only for those who felt relatively older. In addition to clarifying the temporal sequencing of the PTSD self-rated physical functioning association, the study further suggests that an older subjective age (i.e., lack of recovery capital) could render middle-aged and older adults more susceptible to physical decline following PTSD symptoms. We therefore propose to develop interventions aimed at coping with an older age identity and facilitating a younger age identity among traumatized older individuals.