Health incongruence in later life: implications for subsequent well-being and health care.

OBJECTIVE: The premise that pessimistic health appraisals compromise well-being whereas optimistic appraisals are compensatory was examined in a longitudinal study of 232 community-dwelling older adults (ages 79-98 years). DESIGN: Subjective health (SH) appraisals were contrasted with objective health (OH) to identify realists, whose ratings were congruent (SH = OH), distinguishing them from health pessimists (SH < OH) and health optimists (SH > OH), whose ratings were incongruent. Analyses of covariance were used to examine group differences 2 years later on well-being and health care. MAIN OUTCOME MEASURES: Outcome measures were psychological well-being (life satisfaction, positive and negative emotions), functional well-being (objective and perceived physical activity, activity restriction), and health care (health care management, hospital admissions, length of hospital stays). RESULTS: Compared with realists, pessimists had significantly poorer outcomes and optimists had better outcomes. Because perceived control (PC) was weaker among pessimists and stronger among optimists, supplemental analysis determined whether PC differences explained these findings. When accounting for PC, many pessimism and optimism effects became nonsignificant, yet effects on functional well-being remained unchanged. CONCLUSION: Findings have implications for older adults at risk of functional decline.     

Contribution of Leisure-Time Physical Activity on Psychological Benefits Among Elderly Immigrants

Research provides evidence that leisure-time physical activity engagement promotes health and well-being among older adults. In this study, using data released from the Health and Retirement Study (HRS) in 2008, we focused on the exploration of the relationship between leisure-time physical activity and psychological benefits such as positive affect, optimism, psychological well-being, and life satisfaction among elderly immigrants. The results of this study demonstrated that leisure-time physical activities play an important role in gaining psychological benefits. This finding provided further evidence that leisure-time physical activities provides rich opportunities for elderly immigrants to experience psychological benefits, which may contribute to quality of life and successful aging.     

Uses of music and psychological well-being among the elderly

A questionnaire was sent to a random sample of 500 community living older adults in Sweden (aged 65–75 years). The questionnaire assessed uses of music in everyday life: frequency of listening, situations where music is encountered, emotional responses to music, and motives for listening (i.e., listening strategies). Also, different facets of psychological well-being (e.g., affective well-being, life satisfaction, and eudaimonic well-being) and selected background variables (e.g., education level, health status, activity level, and Big-5 personality characteristics) were assessed. Results showed that listening to music is a common leisure activity encountered in many everyday situations, and that listening to music is a frequent source of positive emotions for older adults. Also, the participants reported using a variety of listening strategies related to emotional functions (e.g., pleasure, mood regulation, and relaxation) and issues of identity, belonging, and agency. The associations between listening strategies and well-being were explored through correlation and multiple regression analyses where the influence of background variables was controlled for. Health status and personality were the most important predictors of well-being, but some listening strategies were also significantly associated with psychological well-being. The results give important insights into older adults’ uses of music in everyday life and give clues regarding possible relationships between musical activities and well-being.     

A Secondary Analysis of Perceptions of Quality of Life of Older Adults Residing in a Nursing Home and Assisted Living Setting Using an Integrated Conceptual Model of Measurement

Quality of life is difficult to measure but is fast becoming the standard for long-term care. A secondary analysis was conducted of quality-of-life perceptions of older adults residing in a nursing home and then an assisted living facility from the perspectives of older adults and their family members/friends. This study shows that using a comprehensive integrated model that incorporates six major life domains of physical well-being, social well-being, psychological well-being, cognitive well-being, spiritual well-being, and environmental well-being into the assessment process appears to be a promising approach to determining quality-of-life perceptions of older adults. Findings also suggest that healthcare and human services professionals should place more reliance on indicators of social and environmental well-being, including opportunities for choice, when striving to maximize quality of life of older adults. As the demographic composition of the United States changes, policies and services will need to be modified to accommodate the changing needs of older adults in a way that optimizes perspectives of quality of life.     

When time is running out: changes in positive future perception and their relationships to changes in well-being in old age

How optimistically individuals view their future and what they expect from it has often been studied in younger adults. Less attention has been paid to future perceptions in older adults whose future is temporally limited. Using longitudinal data from the Berlin Aging Study, the authors examined whether future orientation and optimism change in older adults (70-104 years) and whether changes in future perception precede changes in well-being. With advancing age participants reported fewer future plans and less optimism. Those changes were related to changes in well-being with partial support for a lead-lag relationship.     

Anger and sadness in response to an emotionally neutral film: evidence for age-specific associations with well-being

When the association between emotion and well-being is being considered, positive emotions usually come to mind. However, negative emotions serve important adaptive functions and particular negative emotions may be especially adaptive at different stages of adult development. We examined the associations between self-reported negative emotions in response to an emotionally neutral, thematically ambiguous film and subjective well-being among 76 young (age 20-29), 73 middle-aged (age 40-49), and 73 older (age 60-69) adults. Results indicated that higher self-reported anger in response to the film was associated with higher well-being for middle-aged adults, but not for young and older adults. Higher self-reported sadness in response to the film was associated with higher well-being for older adults, but not for young and middle-aged adults. These findings were stronger for cognitive well-being (i.e., satisfaction with life) than for affective well-being (i.e., ratio of dispositional positive to negative affect) and were specific to these emotions (not found for self-reported disgust or fear) and to the emotionally neutral film (not found for sad or disgusting films). Results are discussed in terms of the functions that anger and sadness are thought to serve and the control opportunities afforded in midlife and late life that render these functions differentially adaptive.     

Optimism and Mental Health in Adolescence: a Prospective Validation Study of the Dutch Life-Orientation Test-Revised (LOT-R-A) for Adolescents

The study aimed to examine the psychometric properties of the Dutch Life Orientation Test-Revised for Adolescents (LOT-R-A), a self-report questionnaire assessing dispositional optimism, and to evaluate the two-factor structure (optimism, pessimism). The LOT-R-A and the questionnaires measuring well-being (MHC-SF-A) and psychological problems (SDQ) were completed by 459 Dutch adolescents (178 boys and 281 girls) between the ages of 11 and 18 years at baseline and 281 adolescents at a four-week follow-up. The results confirmed the two-factor structure (optimism, pessimism) of the LOT-R-A. The findings provided evidence of internal consistency of scores ranging from low to good, and evidence of good test-retest reliability of scores. Further, scores of optimism were cross-sectionally positively associated with scores of positive emotions and well-being and negatively with scores of psychological problems and negative emotions, providing evidence of convergent and divergent validity of optimism scores with emotions, well-being, and psychological problems. Lastly, scores of optimism were prospectively positively associated with scores of well-being and negatively with scores of psychological problems, providing evidence of criterion validity of optimism scores with well-being and psychological problems. Based on these findings it can be concluded that the LOT-R-A is a valid instrument to examine optimism among adolescents. Future research can help to elucidate the role of optimism in mental health interventions and can gather knowledge on how these interventions can be refined to optimally cultivate optimism during the developmental period of adolescence.     

Altruism and health outcomes in multiple sclerosis: The effect of cognitive reserve

Despite age-associated decreases in cognitive and physical abilities, age is not associated with a decrease in ratings of well-being; this phenomenon is termed the ‘paradox of well-being.’ One potential explanation for this paradox may be that older adults place less value on cognitive abilities that have been shown to decrease with age (e.g., memory) and more value on cognitive abilities shown to increase with age (e.g., knowledge). Using online methods, 358 individuals between the ages of 18 and 88 completed a survey assessing the values placed on everyday cognitive abilities, self-ratings for those same abilities, and life satisfaction. Results indicated that there were minimal age-related differences in values placed on everyday cognitive abilities and that values generally did not moderate the relationship between perceptions of cognitive functioning and life satisfaction. Of note, values placed on cognition significantly predicted life satisfaction in younger adults, but not in middle-aged and older adults.     

Subjective well-being evaluations among older black Americans

The causal relations among social status and resource, health, and stress factors, and a single-item measure of subjective well-being (i.e., happiness) were examined among a national sample of 581 Black adults aged 55 years and over. Results indicated that although social status and resource factors had a limited impact on happiness ratings, these measures were important in predicting intermediate factors related to health status and satisfaction and stress. Happiness was directly influenced by stress and reported satisfaction with health, whereas the effect of health disability was mediated by stress and health satisfaction. The findings suggest that certain groups of older Blacks (i.e., relatively younger, widowed, and separated) may be at specific risk for diminished well-being. However, adverse health and life conditions, which are determined by status and resources, represent circumstances that further jeopardize the well-being of older Black adults.     

Lifespan Differences in a Self Determination Theory Model of Eudaimonia: A Cross-Sectional Survey of Younger,Middle-Aged,and Older Adults

Despite the myriad physical, cognitive, and social losses that are increasingly common as we age, a growing body of evidence suggests that aging is positively associated with mental health and well-being. The majority of this evidence is in the form of mental health, personality, and subjective/hedonic well-being outcomes; far less is known about lifespan differences in eudaimonic well-being. The objective of this study was to examine differences across three age groups in a relatively recent model of eudaimonia informed by self-determination theory that focuses on the process of living well, but also acknowledges outcomes of that process. In comparison to young (n = 66) and middle-aged adults (n = 66), older adults (n = 66) were especially likely to be living eudaimonically (i.e., to have intrinsic aspirations, goal autonomy, mindfulness, and basic psychological need fulfillment). The effect of age on well-being outcomes was mixed; the oldest group reported the highest levels of life satisfaction (hedonic well-being) but the lowest levels of purpose and growth (eudaimonic well-being) in comparison to their younger counterparts. As predicted by the model, basic psychological need fulfillment mediated the relationship between motivational constructs and well-being outcomes. Furthermore, the model applied equally well to younger, middle-aged, and older adults. Our results are consistent with recent theoretical models emphasizing the socioemotional benefits of aging, as well as potential challenges to well-being that exist in later life.     

Comparative optimism and well-being during the COVID-19 pandemic

Past research suggests that being comparatively optimistic about one's risk for disease is associated with benefits to mental health, such as lowered stress and anxiety. However, few studies have longitudinally examined whether comparative optimism has the same protective benefits during the COVID-19 pandemic. The current study examined levels of comparative optimism, changes in comparative optimism over time, and the association between comparative optimism and COVID-related mental and physical health outcomes among a US adult sample during the COVID-19 pandemic. Participants completed online surveys at four timepoints, over the course of four weeks in May and June of 2020. Results from paired-samples t-tests revealed that comparative optimism was present, such that participants estimated their risk for COVID-19 as being significantly lower than that of others their age and sex. Results from linear mixed models suggested that people who were more comparatively optimistic reported lower anxiety, depression, and stress. However, at times when people were more comparatively optimistic, they also reported greater depression and poorer sleep quality. Together, the findings suggest that the relationship between comparative optimism and health may be more complex than previously anticipated and further research is needed to examine the potential pathways through which comparative optimism affects health.     

Mental Illness and Mental Health: The Two Continua Model Across the Lifespan

Mental health has long been defined as the absence of psychopathologies, such as depression and anxiety. The absence of mental illness, however, is a minimal outcome from a psychological perspective on lifespan development. This article therefore focuses on mental illness as well as on three core components of positive mental health: feelings of happiness and satisfaction with life (emotional well-being), positive individual functioning in terms of self-realization (psychological well-being), and positive societal functioning in terms of being of social value (social well-being). The two continua model holds that mental illness and mental health are related but distinct dimensions. This model was studied on the basis of a cross-sectional representative internet survey of Dutch adults (N = 1,340; 18–87 years). Mental illness was measured with the Brief Symptom Inventory and mental health with the Mental Health Continuum Short Form. It was found that older adults, except for the oldest-old, scored lower on psychopathological symptoms and were less likely to be mentally ill than younger adults. Although there were fewer age differences for mental health, older adults experienced more emotional, similar social and slightly lower psychological well-being. In sum, today’s older adults have fewer mental illness problems, but they are not in a better positive mental health than today’s younger adults. These findings support the validity of the two continua model in adult development.     

Comparative optimism for severity of negative health outcomes

People tend to be comparatively optimistic (i.e., believe that negative outcomes are less likely for themselves than for typical others) regarding their susceptibility to negative health outcomes. The present study investigates the extent to which perceptions of the severity of these health outcomes show similar comparative optimism. A student sample (study 1; N = 200) and a healthy non-student adult sample (study 2; N = 257) completed self-report measures of susceptibility, severity, worry, control and experience in relation to negative health outcomes. Participants in both studies demonstrated significant levels of comparative optimism for both perceived likelihood and severity of health outcomes. Comparative optimism concerning severity was very strongly associated (r = 0.85 to 0.89) with comparative optimism concerning susceptibility. In addition to being comparatively optimistic over their chances of experiencing negative health outcomes, people are also comparatively optimistic regarding how severe the health outcomes will be.     

A five-year study of older adults' health incongruence: consistency, functional changes and subsequent survival

In later life, optimistic health appraisals promote well-being and survival, whereas pessimistic appraisals can be harmful. This study contrasted subjective health (SH) appraisals with objective health (OH) to identify realists, whose ratings were congruent (SH?=?OH), distinguishing them from health pessimists (SH??OH) with incongruent ratings. Health congruence and functional well-being of 757 older adults were assessed via two interviews conducted 5 years apart. We examined consistency in health congruence, and among those with persistent OH, we examined 5-year functional well-being changes that corresponded with SH shifts and determined whether SH shifts predicted 30-month survival. Most realists remained realists; health optimists and pessimists tended to become realists. Increased health optimism corresponded with enhanced functioning; increased pessimism corresponded with decreased functioning. Among realists, increasingly positive SH predicted survival. Findings have implications for quality and length of life among older adults with chronic health conditions.     

Optimism, pessimism, and positive and negative affectivity in middle-aged adults: a test of a cognitive-affective model of psychological adjustment

This study attempted to address limitations in the understanding of optimism and pessimism among middle-aged adults. Specifically, a model of affectivity as a mediator of the link between outcome expectancies and psychological adjustment (life satisfaction and depressive symptoms) was presented and examined in a sample of 237 middle-aged adults. Consistent with a mediation model, results of path analyses indicated that optimism and pessimism (particularly the former) had significant direct and indirect links (by means of positive and negative affectivity) with depressive symptoms and life satisfaction. These results add to the small but growing literature identifying optimism and pessimism as important concomitants of psychological adjustment in more mature adults.     

An Integrated Conceptual Model of Quality of Life for Older Adults Based on a Synthesis of the Literature

Quality of life is fast becoming a standard of measure of long-term care and gerontological service outcomes. Although the issue of quality of life has been of increasing interest in the field of aging, there has been little agreement as to the clarity and definition of the concept and how to measure it, especially as it relates to older adults. Presented here is a comprehensive, integrated model of quality of life that was developed by synthesizing existing constructs within the literature into six major life domains—(1) social well-being, (2) physical well-being, (3) psychological well-being, (4) cognitive well-being, (5) spiritual well-being, and (6) environmental well-being. Consistent with a general systems framework, this holistic model expands the predominant Health-Related Quality of Life constructs to incorporate non-physical aspects of well-being. Each of these domains was broken down into several dimensions in an effort to operationalize the concept of quality of life so that it can have some common standard of useful measurement. These major life domains and indicators are important factors in determining the perceptions of quality of life of older adults. Understanding what constitutes quality of life and how to measure it comprehensively has significant implications for social policy and practice in the field of aging.     

Emotional states and physical health

Positive emotional states may promote healthy perceptions, beliefs, and physical well-being itself. To explore potential mechanisms linking pleasant feelings and good health, the authors consider several lines of research, including (a) direct effects of positive affect on physiology, especially the immune system, (b) the information value of emotional experiences, (c) the psychological resources engendered by positive feeling states, (d) the ways in which mood can motivate health-relevant behaviors, and (e) the elicitation of social support. As anticipated by the Greek physician Hippocrates, positive emotions and healthy outcomes may be linked through multiple pathways.     

Attitudes, perceptions, and risk-taking behaviors of smokers, ex-smokers, and nonsmokers.

A sample of American adults completed questionnaires relevant to cigarette smoking. The questions were related to three areas: risk, perceptions of their or others' smoking, and satisfaction with life and health. The results revealed that smokers were greater risk-takers, that they perceived their smoking to be due to both physical and psychological addictions, and that they expressed less satisfaction and control. Results also indicated that smokers who saw their smoking as being addictive tended to be less satisfied with their health and felt less control over their lives. On the other hand, those smokers who were more likely to deny the health risks did not differ from either non- or ex-smokers on any of the satisfaction or control questions.     

The role of community context and psychological well-being for physical health: A dyadic study of military couples

Drawing from the social organizational theory of community action and change (SOAC) within a systemic biopsychosocial perspective, associations between community context (military community connections and satisfaction with military life), psychological well-being (depressive symptoms, anxiety, and self-efficacy), and physical health were examined for a sample of active duty service members and their civilian spouses (N = 236 couples) using an actor partner interdependence framework. Service members with higher levels of military community connections reported better psychological well-being. When civilian spouses were more satisfied with military life, both partners reported better psychological well-being. In turn, both spouses’ psychological well-being was related to their own reports of physical health. Statistically significant indirect effects were found between community contexts and spouses’ physical health. Enhancing community connections may be an important leverage point for supporting health and family readiness.     

The heart's content: the association between positive psychological well-being and cardiovascular health

This review investigates the association between positive psychological well-being (PPWB) and cardiovascular disease (CVD). We also consider the mechanisms by which PPWB may be linked with CVD, focusing on the health behaviors (e.g., smoking, alcohol consumption, physical activity, sleep quality and quantity, and food consumption) and biological functions (e.g., cardiovascular, inflammatory, and metabolic processes) that are most relevant for cardiovascular health. Because PPWB is a broad concept, not all aspects of PPWB may be associated with cardiovascular health. Thus, we distinguish between eudaimonic well-being, hedonic well-being, optimism, and other measures of well-being when reviewing the literature. Findings suggest that PPWB protects consistently against CVD, independently of traditional risk factors and ill-being. Specifically, optimism is most robustly associated with a reduced risk of cardiovascular events. In general, PPWB is also positively associated with restorative health behaviors and biological function and inversely associated with deteriorative health behaviors and biological function. Cardiovascular health is more consistently associated with optimism and hedonic well-being than with eudaimonic well-being, although this could be due in part to more limited evidence being available concerning eudaimonic well-being. Some similarities were also evident across different measures of PPWB, which is likely due to measurement overlap. A theoretical context for this research is provided, and suggestions for future research are given, including the need for additional prospective investigations and research that includes multiple constructs of psychological well-being and ill-being.