Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem

In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one's own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one's own age group is an important key in maintaining high levels of self-esteem, but only in old age.     

Wederzijdse stereotypen van jongeren en ouderen en hun relatie met zelfbeeld en zelfwaardering

Mutual stereotypes of younger and older adults and their relation with self-concept and self-esteem In this study younger and older persons were compared with regard to their stereotypes about both age groups, their self-concept and self-esteem. We examined the relation between age and stereotypes about younger and older adults, the relation between stereotypes about one’s own age group and self-concepts, and the relation between self-concepts and self-esteem. Stereotypes and self-concepts were measured on two dimensions, warmth and competence. Twenty-eight younger adults (16-25 years) and 26 older adults (65-85 years) participated in this study. Both age groups perceived younger persons as more competent than older persons and older persons as more warm than younger persons. Older persons rate themselves higher than their in-group on competence and warmth. Younger respondents did the same, but on warmth only. A rating of the own person as more competent than the stereotype of their own age group, is related to self-esteem for older persons. Distancing oneself from negative stereotypes about one’s own age group is an important key in maintaining high levels of self-esteem, but only in old age.     

Operations upon the aged

From the point of view of the surgeon, as repeatedly emphasized in the surgical literature, the mortality rate for operations upon old persons is only slightly higher for elective surgical operations than for the same operations on younger persons when proper preoperative and postoperative precautions are taken. However, the mortality rate for emergency operations is much higher in old persons than in younger ones. Many surgeons believe, therefore, that disease for which operation is otherwise indicated should be treated surgically irrespective of the age of the patient per se. The authors' experience with operations upon old persons at the San Francisco Hospital accords with these conclusions.     

Physiological changes in successive pregnancies and birth‐order effects

Abstract

An analysis of mortality rates documents that the well‐established female advantage in mortality continues to increase. Data from the U.S. census show that the sex differential in mortality has increased from 1.69 in 1963 to 1.82 in 1976. The age groups which show the most pronounced changes are youth (15–24), young adults (25–34), and old persons (75–84). Following Enterline (1961), we assess the major causes of death within each of these age groups in terms of their relative contributions to changing sex ratios. The major factors among young persons, apart from declining maternal mortality, are found to involve violent deaths, especially traffic accidents and suicide. Among old persons, death rates in general have declined, but advances in medical technology appear to have been more beneficial for older women than for older men, supporting the hypothesis of a biological superiority among women. However, death rates for malignant neoplasms have increased for older women as well as older men, suggesting that changing life styles may eventually have an impact on female mortality. The data suggest a need for additional research concerning the increase in violent deaths among young women and the potential increase in cancer deaths among older women.     

Nutritional problems and blood dyscrasias in aging patients

Accurate solution of the problems of aging awaits better understanding and definition of senescence. However, adequate nutrition ranks high on the list of causes of increased longevity and happiness in old age. Optimum diets for aging people differ from other age groups only in some reduction in total calories. The digestive apparatus of older people is adequate except when influenced by pathological conditions. Hematologic standards are essentially unchanged in aging persons. Proper management of hematological problems in all age groups depends on accurate diagnosis. Aged patients tolerate diagnostic procedures very well under gentle management. Pure nutritional anemia is rare but poor nutrition is an important complicating factor in the management of blood dyscrasias in older people.     

OPERATIONS UPON THE AGED

From the point of view of the surgeon, as repeatedly emphasized in the surgical literature, the mortality rate for operations upon old persons is only slightly higher for elective surgical operations than for the same operations on younger persons when proper preoperative and postoperative precautions are taken. However, the mortality rate for emergency operations is much higher in old persons than in younger ones. Many surgeons believe, therefore, that disease for which operation is otherwise indicated should be treated surgically irrespective of the age of the patient per se.The authors'' experience with operations upon old persons at the San Francisco Hospital accords with these conclusions.     

IL-4-producing CD8+ T cells with a CD62L++(bright) phenotype accumulate in a subgroup of older adults and are associated with the maintenance of intact humoral immunity in old age

An increased production of proinflammatory cytokines occurs in a high percentage of elderly persons and is associated with an impaired humoral immune response. However, high IL-4 production has also been observed in old age. We now demonstrate an IL-4-producing subpopulation of CD8+ T cells in a subgroup of healthy older adults. This T cell subset is substantial in size and has a characteristic phenotype expressing CD45RO, CD28, CD62L, and CD25. IL-4-producing CD8+ T cells produce large amounts of IL-2 but not IFN-gamma or perforin, and these cells do not have a regulatory suppressive effect on other T cells. In vivo IL-4-producing CD8+ T cells can be stably detected over a year. When put into culture they also have a stable cytokine production pattern but fail to produce perforin even in the presence of IL-12. This special T cell type does not occur in persons under the age of 40, but is present in 36% of the persons >60 years of age. In this age group, IL-4-producing CD8+ T cells are more frequent in persons who are still capable of raising a humoral immune response following immunization than in others who fail to produce protective Abs after vaccination. Our results suggest that CD8+ T cells with a CD62L++(bright) phenotype accumulate in a subgroup of older adults. Due to their phenotype that enables them to migrate into lymphoid tissues and to their capacity to produce IL-4, these cells may counterbalance the overproduction of proinflammatory cytokines in old age.     

Biofeedback and behavioral treatment of persistent pain in the older adult: a review and a study

Persistent pain is a common health problem for older adults, age 60+, with a prevalence twice that in younger adults. Yet, older adults with chronic pain and headache are underrepresented in behaviorally oriented clinical programs that have proven effective for younger adults. A review of the literature indicates that older adults develop multiple pain-related problems that are similar to those of younger individuals. When offered the opportunity, older pain patients accept and benefit from multidisciplinary pain programs, cognitive–behavioral therapies and biofeedback training. A study comparing 58 older and 59 younger adults in a multidisciplinary pain program indicates that older pain patients readily acquire the physiological self-regulation skills taught in biofeedback-assisted relaxation training, and achieve comparable decreases in pain for the pain program as a whole.     

Accidental finding of an anomalous spinal nerve root during lumbar-disc surgery: a case report and a review of literature

Anomalies of lumbosacral nerve roots, even though are rare, have been well documented so far in the medical literature. The early diagnosis of these anomalies may be difficult and it is crucial to develop specific methods for depicting them. Preoperative diagnosis of anomalous lumbosacral spinal nerve roots using the magnetic resonance imaging is essential to facilitate thorough surgical planning in order to avoid unnecessary complications for the patient during surgery. The operative management of these anomalies depends on the patient's neurological problems and while asymptomatic and accidentally diagnosed cases do not require treatment, patients who suffer low back or sciatic pain need surgical intervention in order to decompress nerve roots. We report a 45-years old woman presented with severe low back pain associated with left lumboischialgia. Intraoperative finding of an aberrant L5/S1 nerve root, optimal surgical therapy and different classifications are discussed together with a review of literature.     

Gehechtheid als beïnvloedende factor van gedrags- en psychologische symptomen bij dementie

Contemporary research has increasingly acknowledged the importance of attachment on stress-related processes in ageing. Congruent with this, there has been much research on attachment in older adults over the past three decades. In this article, the main findings of this research are summarized, with a focus on attachment and dementia. Results show that, in general, the number of attachment figures decreases in old age. Moreover, their identity changes as adult children, deceased loved ones and God become more prominent. With relation to the quality of attachment, anxiety in close relations appears to diminish as people age, while attachment avoidance remains relatively stable. Individuals with high levels of attachment security also report greater well-being and a more positive attitude towards ageing compared to persons with low levels of attachment security. Furthermore, individuals characterized by insecure attachment show more behavioral and psychological problems in dementia. Also, caregiver burden, depression, as well as the quality of care giving and future caregiver commitment differ depending on the quality of attachment of the caregiver. There is preliminary evidence for the efficacy of attachment-based interventions in dementia. Finally, there is a need for greater methodological uniformity and the use of measures that are validated for an older population.     

Unequal chances for reaching 'a good old age'. Socio-economic health differences among older adults from a life course perspective

This article provides an overview of the socioeconomic inequality in physical and psychological health of older adults between 55 and 85 years of age, with a focus on the older adults whose socioeconomic status (SES) remains at a low level all their life. Data are derived from 1471 men and 1568 women, participating in the Longitudinal Aging Study Amsterdam (LASA) in 1992/1993. Based on the parental and own level of education, respondents are divided in four categories: those with a life time low level of SES, those with downward or upward mobility in SES, and those with a life time high level of SES. Logistic regression analyses showed that older adults with upward SES mobility and life time high SES, had a lower risk for functional limitations, chronic diseases (men only), 6-year mortality, depression and loneliness, compared with the older adults with life time low SES. The disadvantaged position of the low SES persons with regard to age, health and psychosocial conditions explained the SES differences in depression, but SES differences in mortality (for men) and in functional disability (for men and women) are not explained by the risk factors under study. SES differences in loneliness were attributed to differences in psychosocial conditions. Lifestyle did not add to the explanation of any of the SES differences. There were only small differences between those with a life time low SES and those with downward mobility in SES. It is concluded that a low level of education (regardless of the parental level) contributes to restricted psychosocial conditions, health problems and low well-being in old age, thereby decreasing the chances for a 'good old age' considerably.     

Rehabilitation after falls and fractures

Falls are one of the most common geriatric problems threatening the independence of older persons. Elderly patients tend to fall more often and have a greater tendency to fracture their bones. Fractures occur particularly in osteoporotic people due to increased bone fragility, resulting in considerable reduction of quality of life, morbidity, and mortality. This article provides information for the rehabilitation of osteoporotic fractures pertaining to the rehabilitation of the fractured patient, based on personal experience and literature. It also outlines a suggested effective and efficient clinical strategy approach for preventing falls in individual patients.     

Effect of exercise on muscle function decline with aging.

As people age, changes in muscle occur that are associated with a decrease in strength and endurance. These changes result in decreased functional capacity and quality of life. A substantial portion of this decrease is the result not of aging but of the sedentary life-style so frequently associated with aging. In "healthy old" persons and in older animals in experiments, an appropriate exercise program can result in increased strength and endurance. This is true both in longitudinal and short-term studies. As physical impairment increases, the exercise program must be individualized, and results are not as readily predictable. Much work remains before we may be certain how much exercise can be tolerated in these more impaired persons and what the effects may be.     

Stability Over Time in the Preferences of Older Persons for Life-Sustaining Treatment

Objective: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. Design: Longitudinal cohort study. Setting: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. Results: 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. Conclusion: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.     

Infantile stage of rat development in behavioral parameters of depression-like state and pain response

In the 7–8- and the 10–11-day old male rat pups born to dams exposed to an immobilization stress for the last week of pregnancy and to the dams exposed to no stress (control), behavioral parameters were studied: the level of depression in the test of forced swimming (the Porsolt’s test) and 24 h after a long pain response during inflammation (the formalin test—a subcutaneous injection of 2.5% formalin into the hind leg plantar pad). In control pups, significant age-related changes in the forced swimming were revealed: the immobility time was longer in animals of the older age group, whereas no age differences were found in parameters of the persistent inflammatory pain and in flexing + shaking behavior. The prenatal stress produced an increase in the immobility time and the flexing + shaking behavior in the 7–8-day old, but not in the 10–11-day old rat pups. This resulted in elimination of the age differences in the immobility time in the prenatally stressed animals. Thus, use of different methodic approaches has allowed revealing peculiarities in the parameters of the degree of depression and duration of the pain response at inflammation in the 7–8- and 10–11-day old rat pups, which indicates heterogeneity of the infantile development stage that, according to literature data, includes in rats the period from the 5th to the 10th postnatal days.     

The prevalence of root surface caries amongst Irish adults

In a national survey of adult dental health conducted in the Republic of Ireland in 1989/90 a total of 1,527 subjects aged 25 and older were examined for root surface caries. It was found that the prevalence of root surface caries was highest in older age groups and also amongst males, residents of non-fluoridated communities and those earning low incomes. Tooth loss masked the potential prevalence of root surface caries. With more persons retaining their natural teeth into middle and old age the prevalence of root surface caries is likely to increase in the future.     

Urban Neighborhoods and Depressive Symptoms in Late Middle Age

This study examines associations between multiple urban neighborhood characteristics (socioeconomic disadvantage, affluence, and racial/ethnic composition) and depressive symptoms among late middle aged persons and compares findings to those previously obtained for persons age 70 years and older. Survey data are from the Health and Retirement Study (HRS), a U.S. national probability sample of noninstitutionalized persons aged 51 to 61 years in 1992. Neighborhoods are 1990 U.S. census tracts. Hierarchical linear regression is used to estimate multilevel models. Depressive symptoms vary significantly across urban neighborhoods among late middle age persons. Neighborhood socioeconomic disadvantage is significantly associated with depressive symptoms, net of both individual-level sociodemographic and health variables. However, this association is contingent upon individual-level wealth in that persons with low wealth in the most disadvantaged neighborhoods report the most depressive symptoms. Unlike findings for older adults for whom neighborhood effects appear to be entirely compositional in nature, neighborhood context matters to subgroups of late middle age adults.     

Social Support,Socio-Economic Status,Health and Abuse among Older People in Seven European Countries

Background

Social support has a strong impact on individuals, not least on older individuals with health problems. A lack of support network and poor family or social relations may be crucial in later life, and represent risk factors for elder abuse. This study focused on the associations between social support, demographics/socio-economics, health variables and elder mistreatment.

Methods

The cross-sectional data was collected by means of interviews or interviews/self-response during January-July 2009, among a sample of 4,467 not demented individuals aged 60–84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden).

Results

Multivariate analyses showed that women and persons living in large households and with a spouse/partner or other persons were more likely to experience high levels of social support. Moreover, frequent use of health care services and low scores on depression or discomfort due to physical complaints were indicators of high social support. Low levels of social support were related to older age and abuse, particularly psychological abuse.

Conclusions

High levels of social support may represent a protective factor in reducing both the vulnerability of older people and risk of elder mistreatment. On the basis of these results, policy makers, clinicians and researchers could act by developing intervention programmes that facilitate friendships and social activities in old age.     

Comparing the Health State Preferences of Older Persons,Informal Caregivers and Healthcare Professionals: A Vignette Study

Background

The Older Persons and Informal Caregivers Survey—Minimum Dataset (TOPICS-MDS) collects uniform information from research projects funded under the Dutch National Care for the Elderly Programme. To compare the effectiveness of these projects a preference-weighted outcome measure that combined multidimensional TOPICS-MDS outcomes into a composite endpoint (TOPICS-CEP) was developed based on the health state preferences of older persons and informal caregivers.

Objectives

To derive preference weights for TOPICS-CEP’s components based on health state preferences of healthcare professionals and to investigate whether these weights differ between disciplines and differ from those of older persons and informal caregivers.

Materials and Methods

Vignette studies were conducted. Participants assessed the general wellbeing of older persons described in vignettes on a scale (0-10). Mixed linear analyses were used to obtain and compare the preference weights of the eight TOPICS-CEP components: morbidities, functional limitations, emotional wellbeing, pain experience, cognitive problems, social functioning, self-perceived health, and self-perceived quality of life (QOL).

Results

Overall, 330 healthcare professionals, 124 older persons and 76 informal caregivers participated. The preference weights were not significantly different between disciplines. However, the professionals’ preference weights differed significantly from those of older persons and informal caregivers. Morbidities and functional limitations were given more weight by older persons and informal caregivers than by healthcare professionals [difference between preference weights: 0.12 and 0.07] while the opposite was true for pain experience, social functioning, and self-perceived QOL [difference between preference weights: 0.13, 0.15 and 0.26].

Conclusion

It is important to recognize the discrepancies between the health state preferences of various stakeholders to (1) correctly interpret results when studying the effectiveness of interventions in elderly care and (2) establish appropriate healthcare policies. Furthermore, we should strive to include older persons in our decision making process through a shared decision making approach.