Diurnal cortisol secretion and 2-year changes in older adults' physical symptoms: The moderating roles of negative affect and sleep.

Objective: This study examined whether the association between cortisol secretion and changes in physical health symptoms would depend on other factors in a person's life. The authors expected that physical health effects would emerge particularly when cortisol disturbances co-occur in the context of high levels of trait negative affect or poor sleep. Design: Physical symptoms, diurnal cortisol secretion, affective tendencies, and sleep efficiency were assessed in a 2-yr longitudinal study of 184 older adults. Main Outcome Measure: Two-year changes in physical symptoms. Results: High cortisol levels were associated with increases in physical symptoms, but only among participants who experienced high negative affect and poor sleep. Conclusion: Elevated levels of cortisol secretion contribute to older adults' physical symptoms if they co-occur in the context of other emotional and behavioral problems. By contrast, cortisol disturbances may not influence physical symptoms among people who are emotionally well or engage in efficient sleep behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and physical decline in community-dwelling older persons

CONTEXT: Significant symptoms of depression are common in the older community-dwelling population. Although depressive symptoms and disability may commonly occur in the same person, whether depressive symptoms contribute to subsequent functional decline has not been elucidated. OBJECTIVE: To determine whether depressive symptoms in older persons increase the risk of subsequent decline in physical function as measured by objective performance-based tests. DESIGN: A 4-year prospective cohort study. SETTING: The communities of Iowa and Washington counties, Iowa. PARTICIPANTS: A total of 1286 persons aged 71 years and older who completed a short battery of physical performance tests in 1988 and again 4 years later. MAIN OUTCOME MEASURES: Baseline depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance tests included an assessment of standing balance, a timed 2.4-m (8-ft) walk, and a timed test of 5 repetitions of rising from a chair and sitting down. RESULTS: After adjustment for baseline performance score, health status, and sociodemographic factors, increasing levels of depressive symptoms were predictive of greater decline in physical performance over 4 years (odds ratio for decline in those with depressed mood vs those without, 1.55; 95% confidence interval [CI], 1.02-2.34). Even among those at the high end of the functional spectrum, who reported no disability, the severity of depressive symptoms predicted subsequent decline in physical performance (odds ratio for decline, 1.03; 95% CI, 1.00-1.08). CONCLUSIONS: This study provides evidence that older persons who report depressive symptoms are at higher risk of subsequent physical decline. These results suggest that prevention or reduction of depressed mood could play a role in reducing functional decline in older persons.     

Impact of psychological and physical health, stressful events, and social support on subsequent mental health help seeking among older adults.

Factors that influence mental health help seeking among adults 55+ yrs were examined prospectively. A discriminant analysis significantly differentiated between 120 older adults needing and seeking services and a comparison group of 120 older adults not needing services. Prior to having sought help, help seekers demonstrated poorer psychological well-being, reported more physical health problems, reported a higher level of unpleasant stressful events, and perceived greater deficits in the amount of social support available to them in time of need. The vast majority of these older help seekers sought help for their mental health problems from a medical doctor rather than from a mental health center or clinic or from a minister. Significantly more help seekers than nonseekers experienced stressful events involving bereavement, social and economic loss, and new physical illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical status as a moderator of depressive symptoms among older adults with dual sensory loss.

Objective: This study evaluated the ability of three measures of physical status—physical activity, physical condition, and body mass index (BMI)—to moderate the relationship between dual sensory loss (DSL) and depressive symptoms in older adults. Method: Nationally representative longitudinal data were used to develop multilevel models predicting depressive symptoms among two groups of older adults, 1380 who developed DSL during the study and 1308 without sensory loss. Results: All three measures were associated with depressive symptoms for persons who had or would develop a DSL: participation in physical activity and being in better physical condition were associated with lower levels of depressive symptoms, while lower BMI levels were associated with higher levels of depressive symptoms. All moderator variables had a larger effect for persons with DSL as compared to persons without sensory loss. Implications: The implication of these findings is that participation in a regular program of physical activity may provide multiple benefits to older persons with DSL. Families and health care providers can offer support for being physically active by ensuring the person has the best possible correction for the sensory losses, providing encouragement, and/or providing physical assistance with exercise. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of depressive symptoms on health behavior practices among older adults with vision loss.

Objective: The authors examined the interface between visual impairment and depressive symptoms on health behaviors, self-care, and social participation among adults ages 65 and older. Method: The authors analyzed data from the 1997–2004 National Health Interview Survey on visual impairment and depressive symptoms for 49,278 adults ages 65 and older, comparing visually impaired adults (n = 8,787) with and without depressive symptoms with a reference group of adults with neither condition (n = 3,136) for outcome measures: physical health, health behaviors, and difficulties with self-care and social participation. Results: Adults with visual impairment and severe depressive symptoms were more likely than adults with neither condition to smoke (14.9%, adjusted odds ratio [AOR] = 1.6), be obese (28.2%, AOR = 1.9), be physically inactive (80.5%, AOR = 3.0), have fair–poor health (76.0%, AOR = 26.5), and have difficulties with self-care (27.9%, AOR = 11.8) and social participation (52.1%, AOR = 10.9). Discussion and Conclusions: Older visually impaired adults with depressive symptoms are vulnerable to health decline and further disablement without timely interventions that target smoking cessation, healthy eating, and increased physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood abuse and current health problems among older adults: The mediating role of self-efficacy.

Objectives: Child abuse has negative consequences on health functioning and the self-concept. Prior studies have garnered support for these relationships in younger adults; yet few studies have looked at the effects of abuse on health in older adults and the psychosocial variables, specifically self-efficacy, that may influence the abuse-health relationship. Methods: Data obtained from the Physical Health and Disability Study were used to explore the impact of child abuse on current medical problems among older adults who were screened on physical disability status (N = 1396, Mean age = 67, SD = 10.2). The study was conducted in South Florida and used a multiethnic sample that is representative of the general population in this area. Results: Child abuse was associated with the number of current medical problems and disability. Child abuse was also related to lower self-efficacy, and self-efficacy explained the relationship between abuse and the number of health problems. Conclusions: There are far-reaching effects of child abuse on older adults' health and self-concept. Health care providers and gerontologists need to be aware that child abuse is a lifelong risk factor for increased disability and specific health problems, especially among the elderly. Future research should examine treatments designed to increase self-efficacy, especially among those who experienced child abuse, and observe any positive effects on health functioning. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Control striving in older adults with serious health problems: A 9-year longitudinal study of survival, health, and well-being.

The present longitudinal study of 143 older adults (73–98 years) with serious health problems (arthritis, heart disease, heart attack, stroke) examined the effects of goal engagement, disengagement, and self-protection control strategies on self-rated physical health (condition severity, functional status) and subjective well-being (life satisfaction) at 5 years and survival at 9 years. Main effects and interactions between strategy use and the occurrence of an acute vascular event (no, yes) as well as age (young-old vs. old-old) were assessed. As hypothesized, goal engagement predicted greater survival for individuals with acute conditions but poorer physical health for those with chronic conditions and among old-old adults. In contrast, goal disengagement predicted poorer physical health for those with acute conditions but better health for individuals with chronic conditions and old-old adults. Self-protective strategies (positive reappraisal) predicted greater survival, health, and subjective well-being for those with acute conditions, as well as better physical health for old-old adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neighborhood deterioration, religious coping, and changes in health during late life

Research indicates that older adults who reside in deteriorated neighborhoods experience more physical health problems than elderly people who dwell in more favorable living environments. The purpose of this study is to see whether the deleterious effects of run-down neighborhoods are reduced for older people who use religious coping responses. Data from a nationwide longitudinal survey of elderly people suggest that the noxious impact of living in a dilapidated neighborhood on changes in self-rated health over time is offset completely for older adults who rely heavily on religious coping strategies. In contrast, significant stress-buffering effects failed to emerge when functional disability served as the outcome measure.     

Prevalence of depressive symptoms among rural elderly: Examining the need for mental health services.

Reexamined the prevalence of depressive symptoms among 1,724 rural, noninstitutionalized older adults (aged 59–99 yrs) and documented the need for mental health services as they relate to depression and potential barriers to receiving needed services. A telephone survey was conducted in North Dakota, with a random sample drawn from each of 8 human service districts. Instruments included the Geriatric Depression Scale and the CAGE. Results indicate that the prevalence of depression was relatively low. Controlling for potential alcohol abuse, cognitive impairment, and medical problems, the study found that 5% of older adults reported current depressive symptomatology. When using a cutoff score that is likely to correspond to a diagnosis of major depression, the study found a prevalence rate of 1.6%. Of those reporting significant levels of depression, only 27.6% were currently being treated for an emotional problem. The survey data suggested that cost, transportation, and concern about stigma are not major barriers to receiving needed mental health services. Rather, lack of awareness of available services and a lack of routine contact with mental health service providers are important factors that limit service utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spousal loss predicts alterations in diurnal cortisol activity through prospective changes in positive emotion.

Objective: The objective of this study was to examine the role of spousal bereavement and positive emotion in naturally occurring levels of daily cortisol. Methods: Analyses were conducted using data from the Midlife in the United States survey and the National Study of Daily Experiences. Baseline assessments of extraversion, neuroticism, trait positive emotion, and trait negative emotion were obtained, as were reports of demographic and health behavior covariates. Salivary cortisol levels were measured at wakeup, 30 min after awakening, before lunch, and at bedtime on each of 4 successive days. Results: Multilevel growth curve analyses indicated that independent of age, gender, education, extraversion, neuroticism, negative emotion, medication use, and smoking, spousal bereavement was associated with lower levels of cortisol at wakeup and a flattening of the diurnal cortisol rhythm. Mediation analyses revealed that prospective changes in positive emotion accounted for the impact of bereavement on diurnal cortisol slopes. Conclusion: The current prospective study is among the first to provide evidence for a role for positive emotion as a mechanism by which bereavement influences hypothalamic–pituitary–adrenal axis dysregulation in older adults. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Neighborhood deterioration and self-rated health in later life.

This study examined the relationship between the physical living environment and self-rated health in later life. It is hypothesized that older adults who reside in deteriorated neighborhoods will report more physical health problems than elderly people who live in better physical environments. However, it is further predicted that these effects will only emerge in the most dilapidated living conditions. Data from a nationwide survey of older adults provide support for this complex nonlinear relationship. Further analyses reveal that part of the effect can be attributed to friendship strains that arise in deteriorated neighborhood environments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping and physical health during caregiving: The roles of positive and negative affect.

The associations among coping, mood, and health variables were examined prospectively over 2 years in 86 HIV positive (HIV+) and 167 HIV negative (HIV-) gay men undergoing the stress of AIDS-related caregiving. Path models suggested that including both positive and negative mood and the men's associated coping strategies increases understanding of why some people suffer adverse health effects during times of stress. Among the HIV- caregivers, higher levels of social coping predicted increases in positive affect, which in turn resulted in lower levels of physical symptoms. In contrast, higher levels of cognitive avoidance predicted increases in negative affect, which in turn resulted in higher levels of physical symptoms. Self-injurious forms of avoidance coping predicted higher levels of physical symptoms independent of mood among the HIV+ caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebrovascular risk factors, activity limitations, and depressed mood in African American older adults.

This study investigated the association between cerebrovascular risk factors (CVRFs), physical activity limitations, and depressed mood. The 12-item Short-Form Health Survey (SF-12) was administered to 1,034 urban African American older adults. A chi-square analysis demonstrated that the prevalence of depressed mood among those with high CVRF burden (13.4%) was significantly higher than among those with low vascular burden (7.6%). Physical activity limitations also predicted depressed mood, but this relationship did not mediate the relationship between cerebrovascular burden and depression. These findings highlight the relationships among cerebrovascular burden, physical activity limitations, and depressed mood among African American older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of widowhood on physical and mental health, health behaviors, and health outcomes: The Women's Health Initiative.

This study examined whether widowhood was associated with physical and mental health, health behaviors, and health outcomes using a cross-sectional (N=72,247) and prospective (N=55,724) design in women aged 50-79 years participating in the Women's Health Initiative observational study (85.4% White). At baseline, married women reported better physical and mental health and generally better health behaviors than widowed women. Whereas women who remained married over the 3-year period showed stability in mental health, recent widows experienced marked impairments and longer term widows showed stability or slight improvements. Both groups of widows reported more unintentional weight loss over the 3-year period. Changes in physical health and health behaviors were inconsistent, with generally small effect sizes. Findings underscore the resilience of older women and their capacity to reestablish connections, but point to the need for services that strengthen social support among women who have difficulty during this transition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults.

Healthy adults (N?=?28) participated in a randomized trial of Bonny Method of Guided Imagery and Music (GIM; a depth approach to music psychotherapy) sessions on mood and cortisol. Participants in both GIM and wait-list control conditions completed the Profile of Mood States (POMS) and donated 15 cc of blood before and after the 13-week intervention period and again at a 6-week follow-up. Split-plot factorial and post hoc analyses demonstrated that after 6 biweekly sessions GIM participants reported significant decreases between pre- and postsession depression, fatigue, and total mood disturbance and had significant decreases in cortisol level by follow-up. Pretest to follow-up decrease in cortisol was significantly associated with decrease in mood disturbance. A short series of GIM sessions may positively affect mood and reduce cortisol levels in healthy adults. Such changes in hormonal regulation may have health implications for chronically stressed people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. Rodriguez's (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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic financial strain, social support, and depressive symptoms among older adults.

The purpose of this study is twofold: one, to determine whether chronic financial strain is related to depressive symptoms among a random community sample of older adults, and two, to assess whether social support counterbalances or buffers the deleterious effects of financial strain. The findings suggest that elderly people suffering from financial strain are more likely to be depressed than are older adults with fewer financial problems. In addition, the data support the stress-buffering hypothesis, that is, that older people who have more informational support and who provide support to others, more often report fewer symptoms of depression as a result of financial strain than do elderly respondents who have less informational support and who do not provide support to others. Tangible and emotional support are found to be less effective coping resources when financial strain is present. (PsycINFO Database Record (c) 2010 APA, all rights reserved)