Suzanne Meeks

Contribution of education to health and life satisfaction in older adults mediated by negative affect.

Objectives: The authors developed a model of relationships between two enduring attributes (educational attainment and negative affect) and two indicators of successful aging (health and life satisfaction). Methods: A probability sample of 1,177 participants (age 55 and older) were interviewed four times at 6-month intervals. Structural equation models were developed based on the authors’ hypothetical model proposing a mediating effect of negative affect between health and successful aging. Results: As predicted, education and negative affect both were directly related to health and life satisfaction. Also, as predicted, negative affect mediated the relationship between education and successful aging indicators. Discussion: Education appears to confer a lifelong advantage for healthy aging. Part of this advantage is accounted for by the relationship between education and trait negative affect. Higher educational attainment is related to lower levels of trait negative affect; lower negative affect results in better health and life satisfaction.

Protective functions of health and self-esteem against depression in older adults facing illness or bereavement.

Four functions were examined by which health and self-esteem could ward off depression over time in older adults. Adults (N = 1,074)--55 years and older--were interviewed 5 times at 6-month intervals. Demographic and prevent depression controls were included. Neither health nor self-esteem served as an interactive buffer. Both had direct negative effects on depression, independent of events, over 2 years. Neither illnesses nor bereavements had direct effects on depression; both had indirect effects through other events; illness also had indirect effects by weakening health. Health had stronger preventive effect on illnesses but was more vulnerable to undesirable events than was self-esteem. There was little support for the specificity hypothesis that a close match between event and resource would increase resource effects.

Longitudinal relationships between depressive symptoms and health in normal older and middle-aged adults

Comorbidity between health and depression is salient in late life, when risk for physical illness rises. Other community studies have not distinguished between the effects of brief and long-standing depressive symptoms on excess morbidity and mortality. S. Cohen and M. S. Rodriguezs (1995) differential hypothesis of pathways between depression and health was used to examine the relationships between health and depression in a prospective probability sample of 1,479 community-resident middle-aged and older adults. Findings suggest that different durations of depressive symptoms have different relationships to health. Health had an impact on short-term increases in depressive symptoms but depressive symptoms had a weaker impact on health. The reciprocal impact was indistinguishable from the health influence on depression. In contrast, longer term depressive symptoms had a clear impact on health. The results imply that physical illness can affect depressive states; depressive traits but not states can affect illness.

Mental health needs of the chronically mentally ill elderly.

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population.

Educational Attainment, Positive Psychological Mediators, and Resources for Health and Vitality in Older Adults

Objectives: To further explain the relationship of education to health by a prospective examination of positive psychological states as mediators. Furthermore, to examine the resources of desirable events, self-esteem, and social support as possible mediators between positive psychological states and subsequent health and vitality. Methods: Four in-home interviews were conducted at 6-month intervals with a probability sample of 1,277 older adults (aged 55 and older); multiple regression was used to estimate mediating effects. Results: Positive states mediated the education relationship to both symptoms and vitality, independent of negative states; the resource measures did not mediate the positive state-health relationship. Discussion: Higher education level appears to increase the likelihood of being serene and happy, and healthy and vital, in later years; positive psychological states appeared to have both a promotion function (for vitality) and protective function (against health symptoms); self-esteem showed promise as a possible mediator of the effects of psychological states on health.

Psychological, economic, and social mediators of the education-health relationship in older adults.

Objective: Mediators in the relationship of education to health were examined to further explicate education as a resource. Methods: Income, life satisfaction, services, and social support were assessed as mediators of the education-health relationship following criteria developed by Baron and Kenny and Holmbeck as applied to four aspects of health. A probability sample of 1,667 participants (age 55 and older) was interviewed in their homes. Results: Education was related to all health measures and to all mediators; all mediators were related to all health measures. Education continued to have significant relationships to all health measures after each mediator was entered, but its contribution was lower in each analysis. Life satisfaction was consistently a strong mediator. Discussion: Low-energy aspects of health may be more likely to be mediated by variables of a more psychological nature. Overall, educational attainment is a good investment for successful aging.

Bipolar disorder in the latter half of life: symptom presentation, global functioning and age of onset

BACKGROUND Little is known about bipolar disorder in late life. Recent research has been in acute, in-patient, settings, and has focused on late-onset mania, or has produced samples with surprisingly late mean ages of onset. No recent study has used a larger out-patient sample to address late-life outcomes of bipolar disorder. METHODS 86 community-residing, middle-aged and older adults who met RDC for bipolar I or II were interviewed using the Schedule for Affective Disorders and Schizophrenia, three times over 8 months. RESULTS Participants were primarily unmarried and impoverished. Most were living alone or with immediate family members. The majority were in depressive episodes. Depressive symptoms were more common and more predictive of functioning than manic symptoms. Age of onset was related to global functioning. The effect of age of onset was mediated by number of depressive episodes. CONCLUSION Most adults in this sample had supports to maintain them in the community in spite of chronic or intermittently cycling manifestations of affective disorder and limited medication. Consistent with prior research, early age of onset was related to poorer functioning, apparently by increasing the number and severity of depressive episodes. LIMITATIONS Limitations stem from possible exclusion of those people with the worst and best outcomes. It also is a relatively young sample for a gerontological study. CLINICAL RELEVANCE The study suggests that more attention needs to be paid to diagnosing and treating depressive episodes in later life.

Mental illness in late life: Socioeconomic conditions, psychiatric symptoms, and adjustment of long-term sufferers.

The relationships between social and economic conditions and psychiatric disorder among 346 older adults with severe mental illness living in the community are examined in this article. Measures included socioeconomic indexes, symptoms, diagnoses, and adjustment. As expected, socioeconomic and illness factors were interrelated in this sample. Diagnosis was related to both functioning and socioeconomic factors. As a rule, participants were financially impoverished but socially integrated into social networks consisting largely of kin. In spite of impoverishment and presence of significant symptoms, most were maintaining themselves in the community with at least marginal functioning, though they received very little support from the mental health system beyond medication. Compared with the younger cohort, the older cohort was functioning better, had fewer symptoms, and had better global adjustment. Those with coexisting psychotic and affective syndromes were most at risk. Future analyses with this data set will need to develop complex multivariate models to predict the primary influences on functioning and short-term stability.

Health-Related Stress, Affect, and Depressive Symptoms Experienced by Caregiving Mothers of Adults With a Developmental Disability

The interrelationships among health-related stress, positive and negative affect, and depressive symptoms patterned in the dynamic model of affect (J. Reich, A. Zautra, & M. Davis, 2003) were examined using data from 932 women having an adult child with a developmental disability. Results indicate that women experience a moderate inverse correlation between positive and negative affect under conditions of low levels of health-related stress, whereas at high levels of stress, positive and negative affect become more strongly inversely correlated. Under high-stress conditions, both negative affect and positive affect have a stronger relationship to depressive symptoms than they do under low-stress conditions.

Perceptions of Patronizing Speech by Older Women in Nursing Homes and in the Community: Impact of Cognitive Ability and Place of Residence

This study compared community and nursing home elders’ evaluations of patronizing and nonpatronizing speech and explored the influence of living environment and cognitive ability on these perceptions. Both samples rated the nurse more favorably and the elder target as more satisfied with the conversation when the nurse’s speech was nonpatronizing as opposed to patronizing. Respondents’ cognitive ability covaried significantly with speech ratings in both samples, such that speech-style effects disappeared after accounting for cognitive ability. Community respondents downgraded elder targets of patronizing speech as less competent than the elder targets of nonpatronizing speech, suggesting a “blaming the victim” effect. Neither the living environment of the respondents nor the elderly recipients of patronizing speech influenced evaluations of speech styles or the elderly target.