Sharon Shiovitz-Ezra

Quality of Life and Psychological Health Indicators in the National Social Life, Health, and Aging Project

BACKGROUND The National Social Life, Health, and Aging Project (NSHAP) measures seven indicators of quality of life (QoL) and psychological health. The measures used for happiness, self-esteem, depression, and loneliness are well established in the literature. Conversely, measures of anxiety, stress, and self-reported emotional health were modified for their use in this unique project. The purpose of this paper is to provide (a) an overview of NSHAPs QoL assessment and (b) evidence for the adequacy of the modified measures. METHODS First, we examined the psychometric properties of the modified measures. Second, the established QoL measures were used to examine the concurrent validity of the modified measures. Finally, gender- and age-group differences were examined for each modified measure. RESULTS The anxiety index exhibited good internal reliability and concurrent validity. Consistent with the literature, a single-factor structure best fit the data. Stress was satisfactory in terms of concurrent validity but with only fair internal consistency. Self-reported emotional health exhibited good concurrent validity and moderate external validity. CONCLUSIONS The modified indices used in NSHAP tended to exhibit good internal reliability and concurrent validity. These measures can confidently be used in the exploration of QoL and psychological health in later life and its many correlates.

Social network type and health-related behaviors: Evidence from an American national survey

This study examined the association between social network type and engagement in physical activity, alcohol abuse and use of complementary and alternative medicine by older Americans. Data from the National Social Life, Health & Aging Project were employed. Multivariate logistic regressions conducted separately for each health behavior showed that older people embedded in less resourceful network types were at greater risk for alcohol abuse, physical inactivity and less use of complementary and alternative medicine, net of the effects of sociodemographic characteristics, health, and the quality of the social relationships. The study underscores the importance of the construct of social network type for understanding healthy lifestyle in late life.

Assessment of Smoking Behaviors and Alcohol Use in the National Social Life, Health, and Aging Project

OBJECTIVES The National Social Life, Health, and Aging Project (NSHAP) assessed smoking behaviors and alcohol use as factors directly related to physical health, well-being, and social relationships. We describe self-report measures of tobacco and alcohol use, as well as an established biological marker of tobacco exposure, cotinine, collected in Wave 1 of NSHAP. METHODS We compare smoking behaviors and alcohol use by gender and age group. We report on derived measures of alcohol consumption and tobacco exposure widely used in medical and substance use literature, compare current and past users, and describe associations between self-reported smoking status and cotinine. RESULTS Men are more likely than women to report alcohol use, potential problem drinking, and ever smoking. Alcohol use and smoking are lower among older age groups. Although current smoking is less prevalent than in the general U.S. adult population, 50% of current and 29% of past smokers have lifetime exposure of 40 pack-years or more. Cotinine is directly related to number of cigarettes per day but with considerable unexplained variation. Cotinine levels contradict self-report in fewer than 4% of nonsmokers. CONCLUSION NSHAP provides data useful for investigation of smoking and alcohol use and their association with health and social factors.

Use of Direct Versus Indirect Approaches to Measure Loneliness in Later Life

The aim of the current investigation was to compare a direct versus an indirect approach for measuring loneliness by comparing the one-item Center for Epidemiologic Studies Depression Scale, representing the direct approach, with the shortened version of the Revised UCLA Loneliness Scale, representing the indirect approach, using approximately 2,000 observations from the 2002 Health and Retirement Study. The authors artificially identified a cut point of ≥6 on the three-item Revised UCLA Loneliness Scale to potentially yield the most similar results to the single-item scale and demonstrate the best sensitivity and specificity. Nonetheless, a high rate of respondents (57%) who reported being lonely on the direct item were classified as not lonely on the indirect scale. Inconsistency between the two approaches was also evident with regard to the associations between loneliness and age, as well as with education. These findings indicate that the different measures of loneliness provide a somewhat different picture of both the prevalence of loneliness and the characteristic of the people who suffer from it.

Associations of loneliness in older married men and women

We evaluated the associations between loneliness and subjective appraisals of marital relationship as well as reciprocal associations of loneliness in married men and women. The Health and Retirement Study is a national survey of older adults over the age of 50, residing in the US. This study is based on a paper and pencil questionnaire administered in the year 2006. Overall, 2723 couples completed this questionnaire. Loneliness was evaluated using the three-item version of the Revised University of California Los Angeles Loneliness Scale. A non-recursive path analysis was conducted. The model suggested that subjective appraisals of the relationship with spouse play a major role in ones sense of loneliness. In addition, loneliness in men and women shares reciprocal associations. The model explained 24% and 29% of the variability in loneliness reported by married men and women, respectively. Results indicate that capitalizing and enhancing ones social life might also be beneficial for his or her partner. Any intervention to alleviate loneliness in married couples has to take into consideration their perceived marital relationship as well as the reciprocal associations of loneliness in married men and women.

Self- and other-oriented potential lifetime traumatic events as predictors of loneliness in the second half of life

Objectives: This study examined the relationship between self- and other-oriented potential lifetime traumatic events (PLTE) and loneliness at the second half of life. Method: The sample was comprised of 7446 respondents who completed the Health and Retirement Study (HRS) 2006 psychosocial questionnaire. PLTE were classified into self-oriented PLTE, defined as traumatic events that primarily inflict the self (e.g., being abused by parents) and other-oriented PLTE, defined as events that affect the self by primarily targeting others (e.g., death of ones child). We evaluated the role of self- and other-oriented PLTE as predictors of loneliness, as evaluated by the short R-UCLA. Analyses were stratified by age at which trauma happened categorized into four life periods (0–17, 18–30, 31–49, 50+). Results: The results showed that PLTE is positively related to loneliness. Moreover, the number of other-oriented PLTE, and even more pronouncedly self-oriented PLTE, that happened up until adulthood were the strongest predictors of loneliness at the second half of life. Conclusion: The study suggests that self- and other-oriented PLTE reported to have occurred early in life are associated with perceived loneliness in the second half of life.

The Association of Background and Network Type Among Older Americans Is “Who You Are” Related to “Who You Are With”?

This study examined the sociodemographic and health correlates of social network types among older Americans. It also considered whether greater human capital is associated with embeddedness in more socially endowed network types. Data from the first wave of the National Social Life, Health and Aging Project (NSHAP) were employed, focusing on the 65 years and older subsample. Multivariate logistic regressions were executed with core sociodemographic and health characteristics viewed in relation to five social network types: diverse, friend, congregant, family, and restricted networks. The analysis showed that religion, educational level, ethnicity, and gender were indeed associated with network type, to varying degrees. Age was unrelated to network type, but the interaction of disability and age was. Moreover, human capital was found to be partially correlated with social network type, mainly in the friend network. The findings substantiate that older Americans coalesce in varied social network types and that these interpersonal constellations are differentially associated with background characteristics.

Ageism among physicians, nurses, and social workers: findings from a qualitative study

This study investigated ageism among healthcare professionals in various therapeutic settings in Israel. Using a qualitative approach, the current study aimed to examine similarities and differences across healthcare disciplines. Three focus groups were conducted with physicians, nurses, and social workers. Data from each focus group were analyzed separately, and then commonalities and differences across the groups were evaluated. Three main themes relating to older adults emerged from the data. The first theme pertains to perceived difficulties that healthcare professionals experience in working with older adults and their family members; the second focuses on invisibility and discriminatory communication patterns; and the third theme relates to provision of inappropriate care to older adults. Similarities and differences across the three disciplines were found. The differences related mainly to the examples provided for manifestations of ageism in the healthcare system. Provision of inadequate treatment to older adults due to their age appeared to be the most complex theme, and is discussed at length in the Discussion. Briefly, the complexity stems from the fact that although some behaviors can be clearly described as inappropriate and undesirable, other behaviors such as avoidance of invasive medical procedures for older patients raise ethical dilemmas. Potentially, avoidance of invasive medical treatment can be perceived as compassionate care rather than as undertreatment due to ageist perceptions. A related dilemma, i.e., longevity versus quality-of-life, is also discussed in light of the finding that the balance of these two aspects changes as patients grow old.

No place like home? Potential pathways to loneliness in older adults under the care of a live-in foreign home care worker.

ABSTRACT The arrangement in which frail older adults from the developed world are cared for in their homes by individuals from the developing world has become increasingly prevalent worldwide. In Israel, this arrangement is termed foreign home care. In this article, the authors first describe the global phenomenon of foreign home care of frail older adults as well as the more local characteristics of this arrangement in Israel. The authors then describe the concept of loneliness. Based on empirical and theoretical knowledge in the field of loneliness, the authors argue that older adults under live-in foreign home care may be particularly prone to feelings of loneliness for several reasons: some that are general to older adults with cognitive or physical disability and others that are specific to this particular caregiving arrangement. The authors conclude by providing ideas for future practice and research on this highly vulnerable group that, to date, has received only minimal research attention.

A cross-lagged model of the reciprocal associations of loneliness and memory functioning.

The study was designed to evaluate the reciprocal associations of loneliness and memory functioning using a cross-lagged model. The study was based on the psychosocial questionnaire of the Health and Retirement Study, which is a U.S. nationally representative survey of individuals over the age of 50 and their spouses of any age. A total of 1,225 respondents had complete data on the loneliness measure in 2004 and at least in 1 of the subsequent waves (e.g., 2008, 2012) and were maintained for analysis. A cross-lagged model was estimated to examine the reciprocal associations of loneliness and memory functioning, controlling for age, gender, education, depressive symptoms, number of medical conditions, and the number of close social relationships. The model had adequate fit indices: χ2(860, N = 1,225) = 1,401.54, p < .001, Tucker-Lewis index = .957, comparative fit index = .963, and root mean square error of approximation = .023 (90% confidence interval [.021, .025]). The lagged effect of loneliness on memory functioning was nonsignificant, B(SE) = -.11(.08), p = .15, whereas the lagged effect of memory functioning on loneliness was significant, B(SE) = -.06(.02), p = .01, indicating that lower levels of memory functioning precede higher levels of loneliness 4 years afterward. Further research is required to better understand the mechanisms responsible for the temporal association between reduced memory functioning and increased loneliness. (PsycINFO Database Record