Physical health problems, depressive mood, and cortisol secretion in old age: buffer effects of health engagement control strategies.

OBJECTIVE: This study examined the protective role played by control behaviors aimed at overcoming physical health problems (health engagement control strategies; HECS) in the associations between older adults' physical health problems, depressive mood, and diurnal cortisol secretion. It was expected that adaptive levels of HECS would buffer the adverse effects of physical health problems on depressive mood and diurnal cortisol secretion. DESIGN AND MEASURES: Physical health problems and HECS were measured in a cross-sectional sample of 215 community-dwelling older adults. In addition, participants' depressive mood and patterns of diurnal cortisol secretion were assessed across 3 days. RESULTS: The findings demonstrate that physical health problems predicted high levels of depressive mood and diurnal cortisol secretion, but only among older adults who reported low levels of HECS (and not among older adults who reported high levels of HECS). Moreover, depressive mood completely mediated the buffering effect of HECS on the association between physical health problems and cortisol secretion. CONCLUSION: The results suggest that adaptive levels of HECS represent a psychological mechanism that can protect older adults from experiencing the adverse emotional and biological consequences of physical health problems.     

Health stresses and depressive symptomatology in the elderly: the importance of health engagement control strategies.

The study presents cross-sectional (N = 127) and longitudinal (n = 111) analyses examining relations between health engagement control strategies (HECSs), depressive symptoms, and health stresses in elderly individuals. HECS was measured as people's behavioral and cognitive investments toward attaining health goals. HECS was related to low levels of depressive symptoms, particularly among people experiencing acute physical symptoms. Moreover, HECS predicted reduction of depressive symptoms over time, and depressive symptomatology predicted negative change in HECS. The findings show that active investments of HECSs significantly moderate the negative affective consequences of health threats. Individuals who are characterized by low levels of HECS and high levels of depressive symptoms may be at increased risk of accelerated decline in their physical and mental health.     

The associative memory deficit of older adults: the role of strategy utilization

Past research has established an associative deficit hypothesis (e.g., M. Naveh-Benjamin, 2000) that attributes part of older adults' poor episodic memory performance to their difficulty in creating and retrieving cohesive episodes. Here, the authors evaluate the degree to which this deficit can be reduced by older adults' use of associative strategies. Young and older adults learned word pairs under either intentional-learning instructions or instructions eliciting associative strategies either at encoding or both at encoding and at retrieval, and they then took tests on their memory for both the components and the associations. Results replicated the associative deficit of older adults under intentional-learning instructions. In addition, they showed that instructions to use appropriate associative strategies during either encoding or, even more so, during encoding and retrieval resulted in a significant decrease in the associative deficit. The theoretical and applied implications of these results are discussed.     

Interactive Effects of Chronic Health Conditions And Financial Hardship On Episodic Memory Among Older Blacks: Findings From The Health And Retirement Study

Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the 2006 Health and Retirement Study . Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p = .010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.     

The Content of Behavior Therapy for Depression Demonstrates Few Associations With Treatment Outcome Among Low-Income, Medically Ill Older Adults

We reported previously the results of a randomized controlled trial of a home-based behavioral treatment for dysthymia or minor depression that emphasized problem solving and activity scheduling among low-income, medically ill older adults. This report focuses on the content of treatment sessions as predictors of depressive symptoms, social activity, and physical activity outcomes among 64 participants who completed 2 or more sessions and evaluations at 6 and 12 months after the baseline evaluation. Worksheets from the treatment sessions were coded for focus on 4 types of problems (functional, social, health/physical, emotional); the number of activities planned was counted. More activity scheduling was associated with increased physical activity at the 12-month evaluation relative to baseline. The limited findings suggest either that the study methodology did not reveal extant associations between treatment variables and outcomes or that the session content variables tested in this study are not the active ingredients of treatment.     

Attributing illness to 'old age:' consequences of a self-directed stereotype for health and mortality

Stereotypic beliefs about older adults and the aging process have led to endorsement of the myth that 'to be old is to be ill.' This study examined community-dwelling older adults' (N?=?105, age 80+) beliefs about the causes of their chronic illness (ie, heart disease, cancer, diabetes, etc.), and tested the hypothesis that attributing the onset of illness to 'old age' is associated with negative health outcomes. A series of multiple regressions (controlling for chronological age, gender, income, severity of chronic conditions, functional status and health locus of control) demonstrated that 'old age' attributions were associated with more frequent perceived health symptoms, poorer health maintenance behaviours and a greater likelihood of mortality at 2-year follow-up. The probability of death was more than double among participants who strongly endorsed the 'old age' attribution as compared to those who did not (36% vs. 14%). Findings are framed in the context of self-directed stereotypes and implications for potential interventions are considered.     

Day-to-day Consistency in Positive Parent–Child Interactions and Youth Well-Being

The frequency of positive parent–child interactions is associated with youth adjustment. Yet, little is known about daily parent–child interactions and how day-to-day consistency in positive parent–child interactions may be linked to youth well-being. Using a daily diary approach, this study added to this literature to investigate whether and how day-to-day consistency in positive parent–child interactions was linked to youth depressive symptoms, risky behavior, and physical health. Participants were youth whose parents were employed in the IT division of a Fortune 500 company (N?=?129, youth’s mean age?=?13.39, 55?% female), who participated in an 8?day daily diary study. Analyses revealed that, controlling for cross-day mean levels of positive parent–child interactions, older (but not younger) adolescents who experienced more consistency in positive interactions with parents had fewer depressive and physical health symptoms (e.g., colds, flu). The discussion focuses on the utility of daily diary methods for assessing the correlates of consistency in parenting, possible processes underlying these associations, and intervention implications.     

Giving up on unattainable goals: benefits for health?

Three studies examined associations between goal disengagement and goal reengagement tendencies and indicators of physical health (e.g., health problems, cortisol rhythms, sleep efficiency). Based on research showing that goal adjustment tendencies are associated with subjective well-being, the authors predicted that people who are better able to disengage from unattainable goals and reengage with alternative goals also may experience better physical health. Across the three studies, the findings demonstrate that the ability to disengage from unattainable goals is associated with better self-reported health and more normative patterns of diurnal cortisol secretion. Goal reengagement, by contrast, was unrelated to indicators of physical health but buffered some of the adverse effects of difficulty with goal disengagement. The results also indicate that subjective well-being can mediate the associations between goal disengagement tendencies and physical health.     

Adults' age-related differences in adaptivity of strategy choices: evidence from computational estimation

Four experiments document adults' age-related changes in computational estimation performance and in adaptivity of strategy choices (i.e., the ability to choose the most precise strategy on each trial). Young and older adults were asked to provide estimates of 2-by-2-digit multiplication problems (e.g., 43 x 78) under varying conditions of speed and accuracy emphasis. The main findings showed that (a) older adults provided less accurate estimates and took more time to estimate, especially on the most difficult problems or when using harder strategies; (b) young and older adults had similar strategy preferences; and (c) older adults chose estimation strategies less adaptively than young adults. Implications of these findings for understanding strategic changes during adulthood in a wide variety of cognitive domains are discussed.     

The role of religious resources for older adults coping with illness

The present study investigated the role of religious/spiritual appraisal and coping among a community sample of older adults with illness. In particular this study explored the relationship between these religious resources and nonreligious cognitive appraisals (e.g., threat) and coping behavior in response to illness. These religious resources were related to more adaptive forms of general appraisal and coping. For example, meaning-making related to God (e.g., God's will) was linked to more positive appraisals of the illness and its potential to lead to growth. As well, various forms of religious coping behavior were associated with older adults' use of positive reframing and active forms of general coping. Such findings have implications for counselors and health care providers in their work with older adults adjusting to illness.     

Gambling, health and age: data from the National Epidemiologic Survey on Alcohol and Related Conditions.

The health effects of recreational gambling are presently unclear, particularly across age groups. Theories of healthy aging suggest that social activities, including gambling, may be beneficial to the health of older adults. Using cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093), the authors examined associations between gambling (categorized as nongambling, recreational gambling, or problem/pathological gambling) and health and functioning measures stratified by age (40-64 years and >/=65). Problem/pathological gambling was uniformly associated with poorer health measures among both younger and older adults. Among younger respondents, poorer health measures were also found among recreational gamblers. However, among older respondents, recreational gambling was associated not only with some negative measures (e.g., obesity) but also with some positive measures (e.g., better physical and mental functioning). Longitudinal studies are needed to clarify the relationship between gambling and health in older adults in the context of healthy aging.     

老年人医疗语篇理解的影响因素和补偿模型

医疗语篇理解是老年人实现自我照护的关键因素,改善老年人医疗语篇理解有助于提高其生存质量并节约医疗成本。本文整理了老年人医疗语篇理解的影响因素,包括加工能力等老年人个体因素和可读性等语篇设计因素,并在此基础上提出了老年人医疗语篇理解补偿模型。该模型尝试阐述上述各影响因素中,那些随龄衰退的因素(如加工能力),如何从别的因素中得到补偿(如医疗知识),从而支撑老年人的医疗语篇理解。补偿模型有利于干预研究的设计,但也还有待更多的实证研究。     

Sexual-Assault History and Long-Term Physical Health Problems: Evidence From Clinical and Population Epidemiology

Having a history of sexual assault is associated with both poor general health and limitations in physical functioning, as well as with specific health problems such as chronic pelvic pain, premenstrual disturbance, other gynecologic symptoms, fibromyalgia, headache, other pain syndromes, and gastrointestinal disorders. In studies evaluating the possible role of depression in these associations, depression among sexually assaulted persons did not account for their poorer health. Although there are unanswered questions in the literature on the associations between sexual assault and health, existing findings are consistent with standard criteria for inferring causal relationships from observational data. For example, many assault-health associations are supported by multiple, independent studies, and many demonstrate dose-response relationships (i.e., more incidents of sexual assault, or more severe assaults, are associated with more adverse health outcomes).     

Betrayal Trauma,Health Care Relationships,and Health in Patients with a Chronic Neurovascular Condition

Individuals who have been exposed to trauma are at a greater risk of developing a chronic physical health condition and use health services more frequently than individuals who have not experienced trauma. The mechanism by which trauma affects health is not fully understood, but relationships with health care providers could be important in understanding this association. The purpose of this study was to explore the relationships among betrayal trauma, health care relationships, and physical and mental health in a chronic medical population. Participants (N = 272) diagnosed with a chronic neurovascular condition (cavernous malformation) completed an online survey. Questionnaires assessed self-rated health, instances of betrayal trauma, posttraumatic stress disorder (PTSD) and depression symptoms, income, and other demographic factors, and health care relationships. Level of income and the experience of betrayal trauma predicted mental health symptoms (depression, PTSD, or both) and also predicted health care relationships. After controlling for income and previous trauma, mental health symptoms significantly predicted health care relationships. Finally, mental health symptoms, health care relationships, and income predicted self-rated health, although the associations were not straightforward. These results suggest complex interrelations among trauma, mental health, income, health care relationships, and physical health, and a model is proposed for explaining these associations.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Symptoms of Attention-Deficit/Hyperactivity Disorder and Social and School Adjustment: The Moderating Roles of Age and Parenting

This study examined the associations between symptoms of attention-deficit/hyperactivity disorder (ADHD) and social and school adjustment (academic performance, peer relationships, school social problems) and the moderating roles of children’s age and maternal parenting (affection and overprotection) in these associations. The sample consisted of 2,463 students who were in the first to ninth grade in northern Taiwan. Results from the linear mixed models demonstrated that ADHD symptoms were inversely associated with academic performance and positively associated with social adjustment problems. Further, children’s age and maternal parenting moderated the associations between ADHD symptoms and school and social adjustment. For example, maternal overprotection moderated the relation between hyperactivity and negative peer relationships (i.e., difficulty forming and maintaining friendships), such that this relation was stronger for children who experienced higher levels of overprotection than children who did not. Moreover, children’s age moderated the association between attention problems and decreased academic performance, such that this association was stronger for older children and adolescents than for younger children. Furthermore, children’s age and maternal affection interacted to influence the association between attention problems and school social problems (i.e., bullying, aggression, and peer rejection) with maternal affection acting as a buffer for older children (grades 4–6) only. These findings are discussed from a developmental psychopathology perspective.     

Longitudinal associations among quality of life and its predictors in patients treated for prostate cancer: the moderating role of age

This study examined moderating effects of age on longitudinal associations among quality of life (QOL) and its demographic (e.g., age), clinical [e.g., prostate-specific antigen (PSA) level], and affective and cognitive predictors (i.e., distress, worries about recurrence, decisional regret, subjective life expectancy) in prostate cancer patients treated with external beam radiation (N = 391). Demographic and clinical characteristics were assessed at diagnosis, affective and cognitive variables at 6 months after diagnosis, and QOL at 12 months after diagnosis. Multiple-group analyses showed that among younger patients (< or =68 years old, n = 199), lower levels of decisional regret were associated with better functional QOL, and lower Gleason scores and PSA levels were associated with lower levels of distress and longer expected survival time, respectively. Being employed was related to higher levels of functional QOL and frequent worries about recurrence. Among older patients (>68 years old, n = 192), lower levels of distress were associated with higher levels of functional QOL, and longer expected survival time was associated with better functional and physical QOL.     

Regret intensity, diurnal cortisol secretion, and physical health in older individuals: evidence for directional effects and protective factors

Two studies were conducted to examine the associations between life regrets and health-relevant variables among older adults. Study 1 explored whether intense experiences of regret would be associated with a health-relevant biological process (i.e., diurnal cortisol secretion) and acute physical problems (N = 183). In Study 2, a group of 103 older adults was followed over a period of 3 months, and changes in cold symptoms and sleep problems were examined. Study 2 incorporated an experimental manipulation, targeted at engaging participants in adaptive social- cognitive processes through writing. The results of Study 1 showed intense life regrets to be associated with a larger volume and a steeper morning rise of cortisol secretion and with higher levels of acute physical symptoms. Study 2 demonstrated that levels of regret intensity generally declined only in the experimental group, whereas certain aspects of regret intensity remained stable in the control group. In addition, the intervention evidenced a beneficial effect on the association between initial regret intensity and increased sleep problems over time.     

Self-Discrepancy and Mental Health in Older Women with Chronic Illnesses

Self-discrepancy was investigated as a self-enhancing mechanism by which older women maintain their mental health and psychological well-being while coping with declines in physical health. In this 6-year longitudinal study, the mediating and moderating effects of self-discrepancy on mental health outcomes in older women with chronic health problems were tested. Participants were 103 community-dwelling older women who completed multiple, self-report measures of physical and mental health and self-discrepancy. There was a decline in physical health over time but an improvement in self-discrepancies. Low self-discrepancy (i.e., little discrepancy between the actual and ideal self) mediated and moderated the effects of physical health decline on mental health and psychological well-being. Thus, self-discrepancy appears to play a significant role in maintaining mental health in the face of declining physical health in older women.     

The Coping Self-Efficacy Scale: Psychometric properties in an outpatient sample of active duty military personnel

ABSTRACT

Active duty military service members endure a unique constellation of stressors while deployed or at home. Yet, assessment of protective factors against these stressors among active duty service members represents an under studied area. The present study advances the assessment of protective factors through the psychometric evaluation of the Coping Self-Efficacy Scale (CSES) in a clinical sample of military service members in mental health or substance abuse treatment (n = 200). Cross-sectional data were drawn from military medical records and a supplemental self-report questionnaire. Data extracted included demographic (e.g., sex, age), military characteristics (e.g., rank, years in service), physical health and mental health (e.g., anxiety, depression), and coping self-efficacy. Findings suggest a 3-factor (i.e., problem-focused coping, thought-stopping, and getting social support) CSES structure with acceptable internal consistency. Further, there were small-to-moderate associations with physical and mental health outcomes, providing evidence of construct validity. There were few significant associations with military-related characteristics. Finally, controlling for covariates, thought-stopping beliefs explained unique variance in suicide-related behaviors. Together, findings support the use of the CSES to measure coping-related beliefs in military service members. Recommendations are offered for future research and practice with active duty service members.