Social frailty in older adults: a scoping review.

Social frailty is a rather unexplored concept. In this paper, the concept of social frailty among older people is explored utilizing a scoping review. In the first stage, 42 studies related to social frailty of older people were compiled from scientific databases and analyzed. In the second stage, the findings of this literature were structured using the social needs concept of Social Production Function theory. As a result, it was concluded that social frailty can be defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during the life span. Moreover, the results of this scoping review indicate that not only the (threat of) absence of social resources to fulfill basic social needs should be a component of the concept of social frailty, but also the (threat of) absence of social behaviors and social activities, as well as (threat of) the absence of self-management abilities. This conception of social frailty provides opportunities for future research, and guidelines for practice and policy.

Interventions based on self-management of well-being theory: pooling data to demonstrate mediation and ceiling effects, and to compare formats.

OBJECTIVES: Interventions based on self-management of well-being (SMW) theory have shown positive effects, but additional questions remain: (1) Are improvements in well-being, as induced by the interventions, mediated by improved self-management ability (SMA)? (2) Do the interventions show ceiling effects? (3) Is a particular format of SMW intervention (individual, group, or self-help) more effective? METHOD: Data of three randomized controlled trials were pooled. The greater part of the sample (N = 445) consisted of single older females. A bootstrap analysis was performed to test for mediation. Regression analyses with interaction effects were performed to test for ceiling effects. Controlled and transformed effect sizes (proportion of maximum change) were calculated to compare formats. RESULTS: There was a full significant mediation of well-being by SMA. A significant interaction (ceiling) effect was found on well-being, but not on SMA. The controlled effect sizes of the raw scores were small to medium (.04-.49), and were small to large after transformation (.41-.73). None of the intervention formats was more effective. CONCLUSION: Support for SMW theory was found, i.e. increasing self-management ability lead to improved well-being. Some ceiling effect was found. We conclude that various SMW interventions formats can improve self-management abilities and well-being with medium effects.

[Happy and healthy aging: well-being, resources and self-management abilities]. / Gelukkig en gezond ouder worden: welbevinden, hulpbronnen en zelfmanagementvaardigheden.

This article gives an overview of the research program directed by the author. First, the integrated theoretical framework of the program is presented, including sub-theories. The following assumptions are central to the program: (a) there are physical and social basic needs that, if not fulfilled, lead to deficits in well-being; (b) for the fulfilment of these basic needs both external resources and self-management abilities (internal resources) are needed; (c) self-management abilities and external resources mutually influence each other, which makes it possible to intervene. This theoretical basis allows the formulation of clear criteria for happy and healthy aging, and the derivation of the most important (social) conditions that influence the fulfilment of the basic needs. The article also presents the main empirical tests and intervention studies that have been executed, along with the first steps that have been taken to implement the interventions in practice. Recently, the program is focussing more on a lifespan perspective because important influences on happy and healthy aging often originate at younger ages. More insight in the life-span development of external resources and of self-management ability promises a better understanding of what happy and healthy aging is about and of what can be done to positively influence it.

[Psychologists and openness concerning the diagnosis of dementia to the patient: exploratory research]. / Psychologen en openheid over de diagnose dementie aan de patiënt: een verkennend onderzoek.

AIM: To explore the openness about the diagnosis dementia amongst psychologists the following questions were asked. What is their opinion about openness concerning the diagnosis of dementia? What do they actually tell their patients? Why do or don't they mention dementia? METHOD: A semistructured questionnaire was given to 17 psychologists working in the North of the Netherlands. They were asked to report on their intention to be open about the diagnosis dementia in general and after neuropsychological examination of 90 patients. These answers were compared to what was actually said to the 90 patients. The collected data have been analyzed mainly qualitatively. RESULTS: Essentially psychologists believe that patients need to be informed openly about the diagnosis of dementia. In practice nearly all psychologists also intended to mention the diagnosis of dementia. However, in about a third of the cases, where the results indicated dementia, this was not mentioned openly. Whether or not the diagnosis dementia is discussed openly and in which way, appears to depend on the context and the clarity of the diagnosis, the wishes and reaction of the carer and whether the patient is judged to be able to cope. CONCLUSION: Just like physicians, psychologists are not, as a matter of course, open about the diagnosis of dementia to their patients. Circumstances appear to guide them more than their own opinion about what is appropriate.

The MDS Challenging Behavior Profile for long-term care.

The objective was to construct a reliable and valid challenging behavior scale with items from the Minimum Data Set (MDS). Exploratory factor analyses of a sample of 656 nursing home residents yielded a 16-item Behavior Profile containing four internally consistent and valid subscales measuring conflict behavior, withdrawn behavior, agitation and attention seeking behavior (alpha range: 0.69-0.80). On a second dataset of 227 nursing home residents, internal consistency, inter-rater reliability and validity against the Behavior Rating Scale for Psychogeriatric Inpatients (GIP) were established. Internal consistency of the subscales ranged between 0.54 and 0.78. The overall inter-rater reliability of the items was 0.53 (kappa); of the scale it was 0.75 (ICC). The MDS Challenging Behavior Profile could potentially be an important contribution to existing clinical MDS-scales but additional studies on reliability, validity and usefulness are needed.

Improved self-management ability and well-being in older women after a short group intervention.

In the present randomized controlled trial (RCT) it was investigated whether single women, 55 years of age and older, improved with regard to self-management ability, well-being, and social and emotional loneliness after having participated in a newly designed self-management group intervention based on the Self-Management of Well-being (SMW) theory. The expected mediating effect of self-management ability on well-being was not found. Although self-management ability, well-being and loneliness improved significantly in the intervention group immediately after the intervention, and also remained at this improved level after six months, there was also improvement in the control group after six months, rendering the longer-term differences between the groups non-significant. It can, however, be concluded that, although the longer-term effectiveness could not be proven, this SMW theory-based intervention seems to be useful in supporting older women to improve their self-management ability and well-being.

Down and drowsy? Do apathetic nursing home residents experience low quality of life?

This cross-sectional study investigated the relationship between apathy and quality of life (QOL) in nursing home residents (n = 227). In all, 92 residents could be assessed with the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Philadelphia Geriatric Centre Morale Scale (PGCMS), and were able to answer a question about overall subjective QOL. Apathetic behaviour and consciousness disorders were measured with the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). Linear regression analysis was first applied to study the association of cognition, depression and consciousness with apathy. It was then used to study the relationship between apathy and QOL, controlling for the constructs that were associated with apathy. The relationship between apathy and QOL appeared to vary with the cognitive functioning of the residents: In residents with a low level of cognitive functioning, apathetic behaviour was associated with high QOL; in residents with a higher level of cognitive functioning, apathetic behaviour was associated with low QOL. The necessity and nature of interventions aimed at stimulating apathetic residents may depend on the level of cognitive functioning of the residents. Further research is needed to determine if and when apathy interventions are appropriate.

Het effect van sociale vergelijkingsinformatie op de levenssatisfactie van fragiele ouderen.

Social comparison is increasingly recognized as an important cognitive process in adaptation to old age. By comparing themselves with age peers who are doing worse, i.e., downward comparison, older persons can make an adjusted assessment that allows them to reinterpret their present lives in a positive manner. "Even though I can no longer do my own shopping, I'm still fortunate compared to those who can not leave their houses at all". In this way, older persons may preserve a certain level of life satisfaction, despite age-related loss. In a study among 455 community-dwelling older persons, the effects of social comparison on life satisfaction were examined. Older persons were confronted with a fictitious interview with either an upward or a downward target. After downward comparison, older persons felt more satisfied with their lives than after upward comparison, especially those who had higher levels of frailty. These effects were only found with lower levels of identification. With higher levels of identification, older persons felt more satisfied with their lives after upward comparison than after downward comparison. Apparently, downward comparison only serves its self-enhancing function on life satisfaction among frail elderly persons when they perceive the comparison target as different from themselves.

Finding a useful conceptual basis for enhancing the quality of life of nursing home residents.

In this article it is depicted that before nursing home staff can effectively contribute to optimising the quality of life (QOL) of nursing home residents, it has to be clear what exactly QOL is and how it can be enhanced. The aim is to identify a QOL framework that provides tools for optimising QOL and can form the basis for the development of guidelines for QOL enhancement. For that purpose, a framework should meet three basic criteria: (1) it should be based on assumptions about comprehensive QOL of human beings in general; (2) it should clearly describe the contribution of each dimension to QOL and identify relationships between the dimensions; (3) it should take individual preferences into account. After the criteria are defined, frameworks identified from a literature search are discussed and evaluated according to these criteria. The most suitable framework appears to be the QOL framework of the theory of Social Production Functions. The implications of this framework in understanding the QOL of nursing home residents are described and recommendations for further research are discussed.

The personal experience of aging, individual resources, and subjective well-being.

The personal experience of aging, the resources relevant to it, and the consequences for subjective well-being were investigated in a sample of 4034 Germans aged 40 to 85. The data revealed 3 dimensions of aging experiences as particularly relevant: (a) physical decline, (b) continuous growth, and (c) social loss. Not only being younger but also having better subjective health, higher income, less loneliness, higher education, and greater hope were negatively associated with physical decline and social loss and positively associated with continuous growth. The number of children participants had played no role. All three dimensions of the aging experience were also found to be related to both positive and negative affect and, with the exception of physical decline, to life satisfaction.

[Future time perspectives of the elderly; an empirical study rooted in theory]. / Het toekomstperspectief van ouderen: een theoretisch-empirische verkenning.

Which factors other than age play a role in the future time perspective of elderly people? In the literature no consensus exists on these factors. Besides, the usual approach of future time perspective as 'extension' seems limited and less suited for elderly people. Therefore, in this study the future time perspective is defined and measured as the expectation of the future with respect to new or enduring possibilities (a positive perspective) or increasing restrictions (a negative perspective). The role of 'a sense of control'--by some authors emphasized as an important factor in the future time perspective--is elaborated under the concept of 'competence belief'. Based on a theoretical framework, an elaboration of the antecedents of the future time perspective of elderly people is suggested. This led to specific expectations, which are empirically tested in a group of 4792 elderly of age 57 years and over. The results show that age indeed has an in-fluence on the future time perspective of elderly, but resources play a relatively larger role than age. This holds especially for vitality, social contact and affection, and to a lesser degree for income and activity. Also the expected positive relationship between competence belief was controlled for. The main conclusion is that elderly people show a more positive view towards the future, the more vitality, social contacts and affection they have, and the more they believe themselves associated to be competent.

The self-concept of the elderly: a cross-cultural comparison.

This study examines the self-concept of the elderly in a cross-cultural perspective. An open-ended sentence completion methodology was employed. A sample of elderly Spanish and elderly Dutch were compared to gain an idea of the cross-cultural generality of the content of the self-concept. Analysis focuses on responses to sentences which probed the respondents' motivations and future plans and goals. Differences could be interpreted as reflecting an individualistic (Dutch) vs. collectivistic (Spanish) distinction between the two cultures. Furthermore, the findings had implications for how to interpret dimensions of meaningful aging. For example, a dimension such as "purpose in life" was more generalizable across the two samples than a dimension such as "autonomy."

Quality of life and social production functions: a framework for understanding health effects.

Quality of life (QofL) has emerged as a new outcome paradigm. It is now the endpoint in various taxonomies of patient outcomes, in which relationships are modeled amongst biological abnormalities, symptom status, functional status, disability, health perceptions and quality of life. Although current models and taxonomies point at important determinants of QofL, they do not provide a heuristic that guides the conceptualization of QofL and the systematic development of an explanatory theory of how ill health affects QofL. General mechanisms linking ill health, behavior, and QofL are lacking. In this paper we propose social production function (SPF) theory as providing such a heuristic, relating the effects of ill health, the activities that patients engage in to maintain QofL, and QofL itself. This theory basically asserts that people produce their own well-being by trying to optimize achievement of universal human goals via six instrumental goals within the environmental and functional limitations they are facing. Three important notions of SPF theory are: (1) the linkages between goals, needs, and well-being; (2) the distinction between universal needs and instrumental goals; and (3) substitution among instrumental goals, activities and endowments according to cost-benefit considerations, whereby costs refer to scarce resources such as functional capacity, time, effort and money. We will argue that SPF theory meaningfully relates the "biomedical model"-with its focus on pathological processes and biological, physiological and clinical outcomes-to the "quality of life" model, with its focus on functioning and well-being. We describe SPF theory and how SPF theory can be used to: (1) operationally define and measure QofL; (2) clarify persistent measurement problems; and (3) develop an explanatory framework of the effects of disease on QofL. In the discussion section, we address the limitations of the SPF approach of QofL and its relationship with personality.

The assessment of ADL among frail elderly in an interview survey: self-report versus performance-based tests and determinants of discrepancies.

The impact of three sociodemographic, two cognitive, two affective, and four personality measures on the discrepancies between self-reported and performance-based ADL in a sample of 753 frail elderly is studied by means of multiple regression analyses. Underestimation (i.e., lower self-reported levels of ADL compared to performance-based levels) occurs, in particular, among subjects with low perceptions of physical competence and mastery or personal control, and high levels of depressive symptomatology. In contrast, the role of cognitive functioning and sociodemographic variables in the discrepancies is a minor one. Although self-report ADL measures are easier to administer and less sensitive to nonresponse than performance-based ADL measures, the confounding effects of perceived physical competence, mastery, and depressive symptomatology on self-reported ADL should be considered in any application of self-report measures of ADL among frail elderly.

Three conflicts as a result of causal attributions.

There is a difference between the causal attributions of cancer (Ca)-patients and those of myocardial infarction (MI)-patients. MI-patients go through and check their autobiographies looking for the possible causes suggested by the medical world. Ca-patients on the contrary search for possible explanations. This is probably due to the lack of medical knowledge on the cause and course of their disease. They search through their autobiographies and the result is idiosyncratic, very personal attributions with which they create an explanation which is often not in accordance with the physicians' view. These attributions of Ca-patients are a source of conflicts, both within themselves (doubt), with their physicians and with their partners or other close relatives. Nevertheless they stick to their own explanations, although often secretly and with ambivalence, and despite the conflicts which they produce.