Trends in working conditions and health across three cohorts of older workers in 1993, 2003 and 2013: a cross-sequential study.

BACKGROUND: Over the past decades, the number of older workers has increased tremendously. This study examines trends from 1993 to 2013 in physical, cognitive and psychological functioning among three successive cohorts of Dutch older workers. The contribution of the changes in physical and psychosocial work demands and psychosocial work resources to change in functioning is examined. Insight in health of the older working population, and in potential explanatory variables, is relevant in order to reach sustainable employability. METHODS: Data from three cohorts (observations in 1993, 2003 and 2013) of the Longitudinal Aging Study Amsterdam (LASA) were used. Individuals aged 55-65 with a paid job were included (N = 1307). Physical functioning was measured using the Timed Chair Stand Test, cognitive functioning by a Coding Task and psychological functioning by the positive affect scale from the CES-D. Working conditions were deduced from a general population job exposure matrix. Linear and logistic regression analyses were performed. RESULTS: From 1993 to 2013, time needed to perform the Timed Chair Stand Test increased with 1.3 s (95%CI = 0.89-1.71), to a mean of 11.5 s. Coding Task scores increased with 1.7 points (95%CI = 0.81-2.59), to a mean of 31 points. The proportion of workers with low positive affect increased non-significantly from 15 to 20% (p = 0.088). Only the improvement in cognitive functioning was associated with the change in working conditions. The observed decrease of physically demanding jobs and increase of jobs with higher psychosocial resources explained 8% of the improvement. CONCLUSIONS: Changes in working conditions may not contribute to improved physical and psychological functioning, but do contribute to improved cognitive functioning to some extent. Further adjustment of physical work demands and psychosocial work resources may help to reach sustainable employability of older workers.

[Loneliness and self-management abilities in the visually impaired elderly]. / Eenzaamheid en zelfmanagementvaardigheden bij visueel beperkte ouderen.

OBJECTIVES: To describe the degree of loneliness among the visually impaired elderly and to make a comparison with a matched reference group of the normally sighted elderly. In addition, we examined self-management abilities (SMAs) as determinants of loneliness among the visually impaired elderly. METHODS: In a cross-sectional study, 173 visually impaired elderly persons completed telephone interviews. Loneliness and SMAs were assessed with the Loneliness Scale of De Jong Gierveld and the SMAS-30, respectively. RESULTS: The prevalence of loneliness among the visually impaired elderly was higher compared to the reference group (50% vs 29%; p < .001). Multivariate hierarchical regression analysis showed that the SMA self-efficacy, partner status, and self-esteem were determinants of loneliness. Severity and duration of visual impairment had no effect on loneliness. DISCUSSION: The relationship between SMAs (i.e., self-efficacy) and loneliness is promising, since SMAs can be learned through training. Consequently, self-management training may reduce feelings of loneliness. An adapted version of this paper was published in Journal of Aging and Health, doi: 10.1177/0898264311399758.

Gender differences in the relation between depression and social support in later life.

BACKGROUND: Prevalence of depression is twice as high in women as in men, also in older adults. Lack of social support is a risk factor for late-life depression. The relation between depression and social support may be different for men and women. METHODS: Data from the Longitudinal Aging Study Amsterdam were used to investigate gender differences in the relation between social support and depression in a population-based sample aged 55-85 years, with n = 2,823 at baseline and using the 13-year follow-up data on onset of depression. RESULTS: Respondents without a partner in the household, with a small network, and with low emotional support were more often depressed, with men showing higher rates of depression than women. A high need for affiliation was associated with depression in women but not in men. Lack of a partner in the household and having a small network predicted onset of depression in men but not in women. In respondents with high affiliation need and low social support, depression rates were higher, with men being more often depressed than women. CONCLUSIONS: Low social support and a high need for affiliation were related to depression in later life, with men being more vulnerable for depression than women. Considering the serious consequences of depression, especially in older people, it is important to identify the persons with low social support and a high need for affiliation, and to help them to increase their social support or to adjust their needs.

Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL).

BACKGROUND: Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors. METHOD: In our prospective cohort study of 4004 older persons aged 65-84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors. RESULTS: At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04-1.63] in men and 1.04 (95% CI 0.90-1.24) in women. No higher risk of mortality was found for social isolation. CONCLUSIONS: Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

[A shortened scale for overall, emotional and social loneliness]. / De ingekorte schaal voor algemene, emotionele en sociale eenzaamheid.

Loneliness is an indicator of social well-being and pertains to the feeling of missing an intimate relationship (emotional loneliness) or missing a wider social network (social loneliness). The 11-item De Jong Gierveld scale has proved to be a valid and reliable measuring instrument for overall, emotional and social loneliness, although its length has sometimes rendered it difficult to use the scale in large surveys. In this study, we empirically tested a shortened version of the scale on data from two surveys (N=9448). Confirmatory factor analyses confirmed the specification of two latent factors. Congruent validity and the relationship with determinants (partner status, health) proved to be optimal. The 6-item De Jong Gierveld scale is a reliable and valid measuring instrument for overall, emotional and social loneliness, which is suitable for large surveys.

[Loneliness interventions among older adults: sense or nonsense?]. / Zin en onzin van eenzaamheidsinterventies bij ouderen.

This article focuses on the most important findings of a unique evaluation study of loneliness interventions among older adults. Eighteen interventions have recently been carried out and closely monitored in various parts of the Netherlands. In ten of these interventions the number of participants was sufficiently large to quantitatively determine the effect of the intervention on loneliness. It does not appear to be easy to overcome loneliness: no more than two of the ten interventions resulted in a reduction in loneliness among participants that may be attributed to the intervention. Two other interventions may have had a preventive effect: whereas loneliness increased among members of the control group, it remained more or less constant over time among participants. The effect measurements were followed by process evaluations in an effort to gain insight into the possible reasons why feelings of loneliness were not alleviated among participants in the case of most of the interventions. This resulted in a number of lessons for the future, which may be used as a checklist when designing new interventions projects.

[Effect of changes in physical capacities upon personal social network in aging people]. / Gevolgen van veranderingen in fysiek functioneren voor het persoonlijk relatienetwerk bij het ouder worden.

The aim of the research is to assess whether there is change in the size and composition of older adults' personal network. Furthermore, change in contact frequency and received instrumental support within the relationships is studied. Five relationship types are distinguished: children, other kin, friends, neighbors and acquaintances. Older adults with a decline in physical capacity are compared with those with stable and increased capacities. Furthermore, differences according to (change in) partner status and age are investigated. Data are from the Longitudinal Aging Study Amsterdam, including the first and fourth observation of 1634 older adults living independently. The observation interval is 7 years. A decline in physical capacities is observed for 35% of the older adults, the capacities are stable for 60% and an increase is observed for 5% of the respondents. In general, network size and composition did not change. The frequency of contact within the relationships decreased. Decline was considerable for parent-child relationships, but relatively modest among older adults who faced a moderate to strong physical decline. However, among older adults who did not have a partner at the fourth observation and among the oldest (> 75 years) the frequency of contact with children increased, independently of the degree of physical decline. The decline in contact with neighbours was nearly absent for older adults who faced a moderate to strong physical decline; the contact increased when there was no partner at the fourth observation. The instrumental support received increased within all relationship types, independently of the degree of physical decline. It is concluded that research into determinants of the decline and increase in parent-child contacts is needed and that the meaning of neighbours should receive attention.

Social network, social support, and loneliness in older persons with different chronic diseases.

OBJECTIVES: This study examines whether patterns of social network size, functional social support, and loneliness are different for older persons with different types of chronic diseases. METHODS: In a community-based sample of 2,788 men and women age 55 to 85 years participating in the Longitudinal Aging Study Amsterdam, chronic diseases status, social network size, support exchanges, and loneliness were assessed. RESULTS: Social network size and emotional support exchanges were not associated with disease status. The only differences between healthy and chronically ill people were found for receipt of instrumental support and loneliness. Disease characteristics played a differential role: greater feelings of loneliness were mainly found for persons with lung disease or arthritis, and receiving more instrumental support was mainly found for persons with arthritis or stroke. DISCUSSION: The specifics of a disease appear to play a (small) role in the receipt of instrumental support and feelings of loneliness of chronically ill older persons.

[Reference standards for the loneliness scale]. / Cesuurbepaling van de eenzaamheidsschaal.

This article focuses on the cutting scores for the measurement of loneliness on the Loneliness Scale. A cutting score is used to distinguish the lonely from the not lonely. Data have been analyzed relating to interviews with 3,823 respondents (54-89 years old) who live independently. Use has been made of the individuals' self-assessed level of loneliness. More than would be the case with arbitrary cutting scores, this is in keeping with the individuals' own perception. The figures show that 68% of the elderly persons in the Netherlands are not lonely, 28% are moderately lonely, and 4% are quite lonely. Previous research used a lower cutting score and, consequently, observed that much more people are lonely.

Living arrangements of older adults in the Netherlands and Italy: coresidence values and behaviour and their consequences for loneliness.

Value studies indicate that the process of individualization in Europe started in Sweden and Norway, and continued via France and the Netherlands; the southern European countries lag behind, and are still characterized by more traditional family orientations. Starting from this point of view, this paper investigates the effects of differences between the Netherlands and Italy in the field of living arrangements of older adults with and without partners. The consequences of living alone and of coresidence with adult children have been further investigated, using loneliness as the dependent variable. The size and support functions of the network of social relationships, socio-economic resources, health, sex and age are also taken into account. Data come from face-to-face surveys among a random sample of older adults (55- to 89-year-old women and men) in the Netherlands (n=4,494) and in Italy (n=1,570), using the same research design and questionnaire. The data show country-specific differences in household types of older adults: the proportion living alone is much higher among older people without partners in the Netherlands; the proportion coresiding with their adult children is higher in Italy than in the Netherlands. Controlled for age, health, sex, size and support of the network, and for differences in socio-economic resources, household composition is still the most important determinant of loneliness. Living without a partner in the same household as one's adult children yields country-specific correlations that correspond with differences in value orientations: less loneliness in Italy, more loneliness in the Netherlands.

Effects of social support and personal coping resources on depressive symptoms: different for various chronic diseases?

Effects of psychosocial coping resources on depressive symptoms were examined and compared in older persons with no chronic disease or with recently symptomatic diabetes mellitus, lung disease, cardiac disease, arthritis, or cancer. The 719 persons without diseases reported less depressive symptoms than the chronically ill. Direct favorable effects on depressive symptoms were found for having a partner, having many close relationships, greater feelings of mastery, greater self-efficacy expectations, and high self-esteem. Buffer effects were observed for feelings of mastery, having many diffuse relationships, and receiving emotional support. Buffer effects were differential across diseases for emotional support (in cardiac disease and arthritis only) and for diffuse relationships (in lung disease). Receiving instrumental support was associated with more depressive symptoms, especially in diabetes patients.

Losing and gaining in old age: changes in personal network size and social support in a four-year longitudinal study.

OBJECTIVES: Previous studies have shown that most older people have a significant number of relationships. However, the question of whether the aging of old people produces losses in their personal networks remains open for discussion. This study models the individual variability of the changes affecting multiple personal network characteristics. METHODS: Personal interviews were conducted with 2,903 older Dutch adults (aged 55-85) in three waves of a four-year longitudinal study. RESULTS: A stable total network size was observed, with an increasing number of close relatives and a decreasing number of friends. Contact frequency decreased in relationships, and the instrumental support received and emotional support given increased. Age moderated the effect of time for some of the network characteristics, and for many of them, effects of regression towards the mean were detected. Furthermore, major variations in the direction and the speed of the changes were detected among individual respondents, and nonlinear trends were observed. DISCUSSION: The widely varying patterns of losses and gains among the respondents squares with the focus on the heterogeneity of developments among aging people. The instability of the network composition might reflect the natural circulation in the membership of networks.

[Living arrangements and social networks of elders. A selection of findings from a NESTOR-Study]. / Leefvormen en sociale netwerken van ouderen. Een selectie van bevindingen uit een NESTOR-Studie.

This article presents an overview of the design and results of the NESTOR survey 'Living Arrangements and Social Networks of Older Adults', an empirical study, started in 1992, among a representative sample of 4495 people, aged 55-89, selected from the population registers of 11 municipalities in the Netherlands. Questions were asked about living arrangements, the composition and functions of social networks, and important transitions in the marital, parental and occupational careers. The results indicated a wide diversity in living arrangements and social networks, a diversity which is particularly visible among the young old. They not only have larger networks, but are also more likely to live alone, to be divorced and to participate in shared housing arrangements. The networks vary considerably in size, from 0 to more than 40 important relationships. The decrease in network size with age appears to be directly related to specific life events such as widowhood, physical handicaps, residential moves etc. About 2/3 of the relationships are family relationships: parents, children (in law), grandchildren (in law), brothers and sisters (in law), uncles and aunts. Older people tend to be in touch at least once a month with the majority of close family members. The intensity of supportive exchanges (giving and receiving instrumental and emotional support in the twelve relationships with the highest levels of contact) is moderate, however mostly in balance. Only the very old receive somewhat more instrumental support and give considerably less than the 'young-old'. We studied the shift in balance between giving and receiving over a period of 12 months among a small proportion of the sample, checking a central hypothesis of exchange theory. In some cases a new balance evolves. In others the relationship continues to exist for a number of reasons, despite the imbalance. Early life experiences appear to be important for later life outcomes. Those who experienced the divorce of their parents before the age of 15 or those whose parents lived apart permanently (e.g. unmarried mothers) have a smaller social network and feel more lonely. Marital history has an impact on patterns of informal and formal care. E.g., those respondents without a partner who have children are less likely to use formal care than those who are childless. Among divorced elderly the use of formal care not only varies between men and women but also differs according to the marriage in which the children are born, first or second marriage. Occupational history is strongly related to the income level of older women living alone.

[Gerotranscendence as a life cycle perspective: an initial empirical approach among the elderly in The Netherlands]. / Gerotranscendentie als levensperspectief: een eerste empirische benadering bij ouderen in Nederland.

Gerotranscendence has been defined as a shift in meta-perspective, from a materialistic and rationalistic perspective to a more cosmic and transcendent one that accompanies the process of aging. The present study describes scale characteristics of the Dutch translation of Tornstam's gerotranscendence scale, using data from a sample among adults aged 56-76 years (N = 556). Two subscales evolve from scale analysis, similar to those found by Tornstam: cosmic transcendence and egotranscendence. Scores on both subscales are higher for the older old, as well as for the unmarried; divorced or widowed respondents who suffer from physical impairments. Scale scores are also higher for respondents with depressive complaints. On the subscale cosmic transcendence Roman Catholics have higher scores than Protestants and non-church members. On the subscale ego-transcendence well educated respondents and those with few social contacts have higher scores than persons with less education and those with many contacts. The strength of the associations is modest and the variance explained is small. The findings warrant further research into the question whether gerotranscendence adds to competence in later life.

Effects of social support and personal coping resources on mortality in older age: the Longitudinal Aging Study Amsterdam.

This study focuses on the role of social support and personal coping resources in relation to mortality among older persons in the Netherlands. Data are from a sample of 2,829 noninstitutionalized people aged between 55 and 85 years who took part in the Longitudinal Aging Study Amsterdam in 1992-1995. Social support was operationally defined by structural, functional, and perceived aspects, and personal coping resources included measures of mastery, self-efficacy, and self-esteem. Mortality data were obtained during a follow-up of 29 months, on average. Cox proportional hazards regression models revealed that having fewer feelings of loneliness and greater feelings of mastery are directly associated with a reduced mortality risk when age, sex, chronic diseases, use of alcohol, smoking, self-rated health, and functional limitations are controlled for. In addition, persons who received a moderate level of emotional support (odds ratio (OR) = 0.49, 95% confidence interval (CI) 0.33-0.72) and those who received a high level of support (OR = 0.68, 95% CI 0.47-0.98) had reduced mortality risks when compared with persons who received a low level of emotional support. Receipt of a high level of instrumental support was related to a higher risk of death (OR = 1.74, 95% CI 1.12-2.69). Interaction between disease status and social support or personal coping resources on mortality could not be demonstrated.

Religious involvement and depression in older Dutch citizens.

It has been suggested that religiosity helps prevent depression in older people. This study examines the association between religious involvement and depression in older Dutch citizens and focuses on models of the mechanism in which religious involvement has an impact on other factors related to depression. The subjects were 2,817 older adults aged 55-85 years living in the community who participated in the Longitudinal Aging Study Amsterdam. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Religious involvement was assessed using items on frequency of church attendance and strength of church affiliation. Further data were collected on physical health, size of social network, social support, sense of mastery and self-esteem. As in North American studies, religious involvement appeared to be inversely associated with depression, both on symptom and syndrome levels. Controlling for sociodemographics, physical impairment and network support did not substantially affect this association, particularly among subjects aged 75-85 years. The inverse association between religious involvement and depression was not selectively more pronounced among older people with physical impairments. However, the association appeared to be most specific for subjects with a small social network and those with a low sense of mastery.

Changes in the support networks of older adults in the Netherlands.

At first, the study describes the hierarchy in types of network members who provide instrumental and/or emotional support within a sample of older Dutch adults aged between 55 and 89 (n = 2,709). The hierarchy of instrumental support differs by partner status of the older adult, but the hierarchy in emotional support does not vary with the availability of partner or children. Secondly, multi-level regression analyses using longitudinal data indicate that 46 bereaved older adults received increased instrumental support from their network, while their receipt of emotional support remained unchanged. Shifts in the hierarchy of instrumental support were observed, but not in the hierarchy of emotional support. Older people who suffered a decrease in physical mobility (n = 384) received more instrumental and emotional support, but the ranking of supporter types changed little. It is concluded that despite changes in intensity of support, the hierarchies of types of supporters have generally remained stable over time.

Direct and buffer effects of social support and personal coping resources in individuals with arthritis.

The direct and buffer effects of various aspects of social support and personal coping resources on depressive symptoms were examined. The study concerned a community-based sample of 1690 older persons aged 55-85 yrs, of whom 719 had no chronic disease, 612 had mild arthritis and 359 had severe arthritis. Persons with arthritis reported more depressive symptoms than persons with no chronic diseases. Irrespective of arthritis, the presence of a partner, having many close social relationships, feelings of mastery and a high self-esteem were found to have direct, favourable effects on psychological functioning. Mastery, having many diffuse social relationships, and receiving emotional support seem to mitigate the influence of arthritis on depressive symptoms, which is in conformity with the buffer hypothesis. Favourable effects of these variables on depressive symptomatology were only, or more strongly, found in persons suffering from severe arthritis.

[Assessment of indications for admission to a nursing home: evaluation of the questionnaire indication Alkmaar]. / De indicatiestelling voor het verzorgingshuis: evaluatie van de vragenlijst indicatie Alkmaar.

This article aims at testing an assessment schedule which is generally applied in order to determine the necessity and urgency of admission into a home for the aged. The central question concerns the extent to which this schedule contributes to (1) objectivity, implying that applicants with similar 'needs' will have an equal opportunity of being admitted to the requested provision, and (2) efficiency, meaning that a clear distinction in the urgency of admission is being made according to the seriousness of 'needs'. The research therefore concentrates on two topics. First, the homogeneity and statistical reliability of the assessment schedule, i.e. the questionnaire which is used for measuring the need for (institutional) care. Second, the statistical association between the measured need and the urgency of admission into a home for the aged. The research rests upon data on 164 older adults who have requested for admission; this data were obtained by a local agency responsible for need-assessment in relation to institutional care. The findings are as follows: (1) the homogeneity of the instrument can be improved, (2) the reliability is fairly good, (3) the association between 'need' and 'urgency of admission' is not very strong, notwithstanding the fact that (4) persons with lower scores on ADL- and IADL-capacities, with more psycho-social problems and with stronger feelings of anxiety have significantly better opportunities of being admitted to a residential facility. It is concluded that the association between 'need' and 'urgency of admission' might be improved by refining the assessment schedule and standardizing its application.