Maintenance of quality of life improvements in diverse rural older adults

The maintenance of effects from home-delivered cognitive-behavioral therapy (CBT) was examined. One hundred thirty-four participants, predominantly African American and primarily rural, low-resource, and physically frail, were randomly assigned to either immediate or delayed CBT. The six-month follow-up assessments indicated that among those who remained in the study, participants evidenced significantly improved quality of life and reductions in psychological symptoms at follow-up, relative to pretreatment levels. Posttreatment gains were maintained at follow-up. These data suggest that treatment effects can be achieved and perhaps maintained with a disadvantaged sample of older adults and suggest that evidence-based treatments delivered through nontraditional means can have effects beyond posttreatment.     

Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life.

This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.     

Using video life reviews with older adults

Reminiscence by elderly people, known as life review (Butler, 1963), has been widely used as a therapeutic technique. This paper discusses a study with fifteen ageing families in which a therapist assisted the ageing member in producing a videotaped vignette from the life review. The resulting video life reviews were found to be an effective tool in helping the ageing family in 're-storying' the past events with new narrative and meaning. Three predominant themes were identified: (1) historical and evaluative reviews, (2) transition reviews, and (3) reviews dealing with emotional pain. Also discussed are the reactions of the ageing families to the video life reviews, the therapeutic uses of the technique, and format suggestions for therapists.     

Perceived life quality of older and younger tibetans

Tibetans have enjoyed a reputation for contentment and a jovial disposition. This study examines the extent to which this positive outlook on life persists despite their 25-year stay as refugees in India, and the transferability of this positive outlook to first-generation, Indian-born Tibetans. With this in mind, older Tibetan refugees (N = 45) and younger Tibetan refugees (N = 45) residing in Himachal Pradesh in India were administered the Life Quality Scale (Q.O.L.). As expected, younger Tibetan refugees shared significant characteristics on the Q.O.L. scale with older Tibetans. Similarities and differences in the outlook of the two age groups are examined.Portions of this paper were presented at the annual meeting of the International Society for Intercultural Education, Training, and Research in Montreal in May 1987.The author wishes to thank Sherab Gyatso of Tibetans' Childrens Village, a school in Dharamsala, for his help in collecting the data.     

Improving quality of life in diverse rural older adults: a randomized trial of a psychological treatment

The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care.     

Loneliness, depression, social support, and quality of life in older chronically ill Appalachians

This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.     

Some everyday life consequences of disability and bereavement for older adults

The study analyzed daily event differences between groups experiencing the major stressors of conjugal bereavement and physical disability, and analyzed the association of everyday events with self-reports of mental health for different groups across a 3-month time span. Monthly interviews were conducted with 61 recently conjugally bereaved, 62 recently physically disabled, and 123 matched-comparison older adults between the ages of 60 and 80. The purpose of these interviews was to obtain a comprehensive assessment of the monthly frequencies of everyday life events. Self-reports of mental health were obtained from paper-and-pencil measures filled out after each interview. Causal models were used to analyze the best-fitting structure of event/mental health relationships for the first 3 monthly interviews. Undesirable events showed uniformly adverse effects on mental health. Desirable events benefited the psychological well-being of the disabled the most and had no positive effects on the mental health of the bereaved. The bereaved also evidenced less stability over time than other groups in the frequency of small undesirable events.     

Effect of integrative reminiscence therapy on depression,well-being,integrity, self-esteem,and life satisfaction in older adults

Reminiscence therapy is a psychological intervention for older adults to remembering and interpreting life events that were experienced at some time in the past. The purpose of the present study was to investigate the extent of integrative reminiscence intervention effects, with the aim to produce statistically significant reduction in depression symptoms, and significant improvement in psychological well-being, life satisfaction, self esteem, and integrity were examined. Thirty-four healthy elderly participated in the intervention that was implemented in eight sessions. To evaluate the effects of the program, a quasi-experimental design was applied with pretest and posttest evaluations comparing the intervention group with a control group on a waiting list. In comparison to control group, individuals in treatment sample of older adults in an integrative reminiscence group demonstrated statistically significant reduction in depression symptoms and a significant improvement in self-esteem, integrity, life satisfaction, and psychological well-being.     

Social support, life events, and stress as modifiers of adjustment to bereavement by older adults

As part of a larger panel study, interviews were obtained from 3 samples of older adults: 45 persons who had recently lost a spouse, 40 who had lost a parent or child, and 45 who were not bereaved. Assessments were conducted before and after the deaths. In the widowed sample, health remained quite stable, but depression increased sharply, then remained elevated. Changes were minimal in the sample who had lost a parent or child and in the nonbereaved sample. Multiple regression procedures were used to identify factors that contribute to depression and health 9 months after the spouse's death. Postbereavement depression was associated with higher prebereavement depression, higher financial pressures, higher global stress, fewer new interests, and lower social support. Health was a function of prebereavement health, new interests, financial pressures, and global stress. In general, life events and resources had stronger effects in the widowed sample than in the comparison samples.     

Memory failures appraisal in younger and older adults: role of individual difference and event outcome variables

The authors examined the role of individual difference and event outcome variables in younger and older adults' memory failures appraisal. Participants read vignettes that described fictitious younger characters (in their 20s-30s) or older characters (in their 60s-70s) who had experienced a minor or severe consequence of their forgetfulness. The authors solicited attribution ratings on the potential causes of the forgetfulness and memory opinion ratings. Younger and older adults' ratings were largely similar, although age differences occurred on the effort and luck attribution scales. The consequences of the forgetting had a sizable impact on both the attribution and memory opinion ratings. Individual differences in self-reported memory had a relatively small impact on causal attribution and memory opinion ratings. These results suggested that people weigh their judgments of fictitious forgetful characters against event outcomes more so than ageist beliefs that portray a negative image of cognitive competence in later life.     

Preferences and life evaluations of older adults with and without dementia: reliability, stability, and proxy knowledge

This study assessed the reliability and stability of care preferences and life evaluations among older adults with and without dementia. The study also examined spouse proxy predictions of partner responses. Test-retest reliability over 1 week, stability over 1 year, and proxy knowledge were all moderate to good, but lower for people with dementia. In all 3 areas, however, there was broad interindividual variability. People with dementia may become less reliable and stable in their self-reports, and some spouse proxies may have flawed knowledge about their partner, but dementia status alone is not sufficient to presume poor reliability or knowledge.     

Personal investment predictors of life satisfaction among physically active middle-aged and older adults

The purpose of this study was to determine the relationship between the social psychological components of personal investment and life satisfaction among 85 middle-aged and older men and women participating in a structured exercise program. Specifically, we examined the degree to which personal incentives for exercise, perceptions of a sense of self, and the congruency between the exercise program and the participants' goals, predicted life satisfaction. Multiple regression analyses revealed that the social psychological variables reflecting personal investment accounted for 52% of the variance for life satisfaction in physically active middle-aged and older adults. The personal investment theory is supported as a framework for investigating psycho-social predictors of situational outcomes such as life satisfaction.     

Forgiveness in adolescents, young, middle-aged, and older adults

The evolution of the propensity to forgive an offense was studied in a sample of 236 people from various age groups. The effect of a number of circumstances connected with the offense was considered: intent to harm, severity of consequences, cancellation of consequences, social proximity to the offender, apologies from the offender, and the attitude of others. The method was an application of information integration theory. A global increase in the propensity to forgive from adolescence to old age was observed. Several interactions between age and circumstances were found: (a) The effect of the cancellation factor was higher in young adolescents and in the very old than in the middle-aged, (b) the attitude of others and the restoration of harmony factors were important only in adolescents. Finally, the structure of the Forgiveness schema was shown to be an additive one, regardless of the age of the participants.     

Neural activity,neural connectivity,and the processing of emotionally valenced information in older adults: links with life satisfaction

This study examines whether differences in late-life well-being are linked to how older adults encode emotionally valenced information. Using fMRI with 39 older adults varying in life satisfaction, we examined how viewing positive and negative images would affect activation and connectivity of an emotion-processing network. Participants engaged most regions within this network more robustly for positive than for negative images, but within the PFC this effect was moderated by life satisfaction, with individuals higher in satisfaction showing lower levels of activity during the processing of positive images. Participants high in satisfaction showed stronger correlations among network regions—particularly between the amygdala and other emotion processing regions—when viewing positive, as compared with negative, images. Participants low in satisfaction showed no valence effect. Findings suggest that late-life satisfaction is linked with how emotion-processing regions are engaged and connected during processing of valenced information. This first demonstration of a link between neural recruitment and late-life well-being suggests that differences in neural network activation and connectivity may account for the preferential encoding of positive information seen in some older adults.     

Relational integration, inhibition, and analogical reasoning in older adults

The difficulty of reasoning tasks depends on their relational complexity, which increases with the number of relations that must be considered simultaneously to make an inference, and on the number of irrelevant items that must be inhibited. The authors examined the ability of younger and older adults to integrate multiple relations and inhibit irrelevant stimuli. Young adults performed well at all but the highest level of relational complexity, whereas older adults performed poorly even at a medium level of relational complexity, especially when irrelevant information was presented. Simulations based on a neurocomputational model of analogical reasoning, Learning and Inference with Schemas and Analogies (LISA), suggest that the observed decline in reasoning performance may be explained by a decline in attention and inhibitory functions in older adults.     

Using religious paradox to facilitate life review groups with shame-driven older adults

This article explains how pastoral counselors who lead life review groups with shame-driven older members can use religious paradox as a model for change. The article first elaborates upon the challenge to self-acceptance that poor self-esteem poses for older adults engaged in life review. It then shows how paradoxes enhance self-acceptance by drawing reviewers to a more holistic understanding of their past and evoking insights about the meaning of their personal history. It presents a model of group process in which members individually select religious paradoxes and relate such paradoxes to their life review. It concludes with examples of how three participants used religious paradoxes to own the life review instead of feeling threatened by it.     

Chronic strain, locus of control, and distress in older adults

In this study, I examined whether locus of control beliefs buffer or mediate the impact of chronic financial strain on psychological well-being. Data are from a longitudinal survey of a random community sample of older adults. Findings suggest that elderly people with internal locus of control beliefs are less likely to suffer from the deleterious effects of chronic financial strain than are older adults with external locus of control orientations.